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INTRODUCTION: The aim was to investigate psychiatric health care utilization two years before death by suicide among individuals with previous suicide attempts (PSA) compared with those without (NSA).METHOD: A retrospective population-based cohort study was conducted including 484 individuals who died by suicide in Sweden in 2015 and were in contact with psychiatric services within the two years preceding death, identified through the Cause of Death register. Data on psychiatric health care two years before death, including suicide attempts according to notes in the medical record was used. Associations between having at least one PSA vs. NSA and health care utilization were estimated as odds ratios (OR) with 95% confidence intervals (CI) by logistic regression analyses.RESULTS: Of the 484 individuals included, 51% had PSA. Those with PSA were more likely than NSA to have received a psychiatric diagnosis [OR 1.96 (CI 95% 1.17-3.30)], to have ongoing psychotropic medication [OR 1.96 (CI 95% 1.15-3.36)] and to have been absent from appointments during the last three months [1.97 (1.25-3.13)]. In addition, elevated suicide risk was more often noted in the psychiatric case records of those with a PSA than those without [OR 2.17 (CI 95% 1.24-3.79)].CONCLUSION: The results underline the importance of improved suicide risk assessment as well as thorough diagnostic assessment and when indicated, psychiatric treatment as suicide preventive interventions regardless of PSA. Furthermore, the larger proportion of absence from appointments in individuals with PSA may indicate a need of improved alliance between psychiatric care providers and individuals with PSA.HIGHLIGHTSBeing assessed with elevated suicide risk was more common among those with previous attempt/s (PSA).One-fifth of all with no previous attempt (NSA) had no psychiatric diagnosis, compared to one in ten in those with PSA.Receiving psychotropic medication was more common among those with PSA.

Introduction Subjective well-being (SWB) is a contributing factor for building resilience and a resource for positive outcomes, e.g. study achievement and work performance. Earlier studies have examined associations between and prospective effects of personality traits on SWB, but few addressed the role that SWB plays in formation of personality over time. The purpose of our study was to examine associations and prospective effects of SWB on personality traits and vice versa in a cohort sample of secondary school students in Sweden who completed self-reported measures of SWB and personality traits at baseline (N = 446, 76% females) and at 15–18 month follow-up (N = 283, 71% females). Methods SWB was defined and measured by the WHO-5 Well-being Index and the Satisfaction with Life Scale. The Big Five Inventory was used to measure personality traits. Autoregressive models were used to analyse associations and potential prospective effects of SWB on personality traits and vice versa. Results Low levels of neuroticism and high levels of extraversion, conscientiousness and agreeableness were associated with high levels of SWB at baseline and follow-up. The association between SWB and neuroticism was notably strong. We found high statistically significant rank order stability across the two time points for all measures of personality traits with stability effects, derived from the autoregressive models, ranging from .199 for extraversion to .440 for neuroticism. Stability for SWB was statistically significant across the two time points and ranged from .182 for well-being to .353 for life satisfaction. SWB had a prospective effect on agreeableness only. None of the personality traits had any significant prospective effects on SWB. Conclusions The present findings indicate that although correlated, bidirectional prospective effects between personality traits and SWB could not be confirmed. Neuroticism displayed the strongest negative association with adolescents’ SWB. Schools are an appropriate setting to improve well-being, and allocating resources that reduce neuroticism is crucial, including structural interventions, policies for healthy school settings and teaching emotional regulation techniques.

Purpose To examine health-related quality of life (HRQoL) in refugee minors resettled in Sweden and compare results to a European reference population, while exploring associations between sociodemographic factors and HRQoL dimensions. Methods A cross-sectional, nation-wide study was conducted with a stratified sample of refugee minors ages 12–15 and 16–18 from Afghanistan, Iraq and Syria, resettled in Sweden between 2014 and 2018. HRQoL was measured using KIDSCREEN-27. HRQoL dimension scores of the sample were compared to mean scores of European age and gender-matched reference population. Associations between sociodemographic factors and HRQoL dimensions were investigated with independent t tests and ANOVA. A multivariable regression analysis was performed to identify the sociodemographic factors associated with HRQoL. Results The questionnaire was sent to 10,000 potential respondents. The response rate was 26%, yielding n = 2559 refugee minors (boys 55%, girls 45%) in the study sample. Compared to European references, minors in the present study had significantly lower scores of HRQoL within psychological wellbeing and peers and social support, whereas levels for autonomy and parent/guardian relations and school environment were higher. Several sociodemographic factors were significantly associated with all HRQoL dimensions, with those 16–18 years old, having average or poor family economy, and living with an unrelated adult or family reporting lower levels of HRQoL. Minors from Afghanistan had significantly lower scores of HRQoL for all dimensions compared to those from Iraq and Syria. Conclusion Refugee minors had significantly lower levels of HRQoL for psychological wellbeing and peers and social support compared to European references. Future research should further investigate this potential HRQoL gap further.

Introduction Common mental disorders (CMD) are leading causes of decreased workability in Sweden and worldwide. Effective interventions to prevent or treat such disorders are important for public health. Objective To synthesize the research literature regarding occupational health service (OHS) interventions targeting prevention or reduction of CMD among employees. The effect on workability (sickness absence, return-to-work and self-reported workability) and on CMD symptoms was evaluated in a narrative analysis. Data sources The literature search was performed in four electronic databases in two searches, in 2014 and in 2017. Eligibility criteria (using PICO) Population: studies investigating employees at risk or diagnosed with CMD, as well as preventive workplace intervention targeting mental health. Intervention: studies where the recruitment or the intervention was delivered by the OHS or OHS personnel were included. Control: individuals or groups who did not receive the target intervention. Outcome: all types of outcomes concerning sickness absence and psychological health were included. Study quality was assessed using a Swedish AMSTAR-based checklist, and results from studies with low or medium risk of bias were narratively synthesized based on effect or absence thereof. Results Thirty-three studies were included and assessed for risk of bias. Twenty-one studies had low or medium risk of bias. In 18 studies, rehabilitation interventions were evaluated, 11 studies concerned interventions targeting employees at risk for developing CMD and four studies investigated preventive interventions. Work-focused cognitive behavioral therapy and problem-solving skill interventions decreased time to first return-to-work among employees on sick leave for CMD in comparison with treatment-as-usual. However, effect on return to full-time work was not consistent, and these interventions did not consistently improve CMD symptoms. Selective interventions targeting employees at risk of CMD and preventive interventions for employees were heterogeneous, so replication of these studies is necessary to evaluate effect. Limitations Other workplace interventions outside the OHS may have been missed by our search. There was considerable heterogeneity in the included studies, and most studies were investigating measures targeting the individual worker. Interventions at the workplace/organizational level were less common. Conclusions and implication of key findings Return-to-work and improvement of CMD symptoms are poorly correlated and should be addressed simultaneously in future interventions. Further, interventions for CMD administered through the occupational health service require further study. Rehabilitative and preventive strategies should be evaluated with scientifically robust methods, to examine the effectiveness of such interventions.

The purpose of this study was to use a longitudinal approach to investigate the association between work-related psychosocial factors and workplace bullying in an academic setting. A questionnaire ...

Background Scientific knowledge on risk factors for work disability in terms of long-term sickness absence (SA) and disability pension (DP) following acute myocardial infarction (AMI) is limited. The study aimed to investigate socio-demographic, work-related and medical characteristics as risk factors for long-term SA (>90 days) and DP in patients with a first AMI. Methods This is a population-based cohort study of 8199 individuals aged 19-60 years who had a first AMI during 2008-10 and were alive 30 days after AMI. Univariate and multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) with regard to long-term SA and DP with a 3-year follow-up were estimated by Cox regression. Results We found a higher risk of long-term SA and DP after AMI in women, those with lower education and previous SA (range of HRs: 1.29-7.34). Older age and being born in non-European countries were associated with a 2- to 3-fold higher risk of DP. Moreover, ST-elevation myocardial infarction (STEMI), musculoskeletal and common mental disorders (CMDs) were risk factors for long-term SA and DP, while diabetes mellitus and stroke were associated with a higher risk of DP (range of HRs: 1.12-2.98). Coronary artery bypass grafting (CABG) compared with percutaneous coronary intervention was associated with a 2-fold higher risk of work disability. Conclusions Older women, those with lower education and non-European immigrants had a higher risk of work disability after AMI, particularly permanent work disability. STEMI, CABG, diabetes mellitus, stroke, musculoskeletal disorders and CMDs provide important clinical information for work disability after AMI.

In 2008, Sweden introduced a policy change to limit the number of days for sickness benefits (SB). This study aimed to elucidate the characteristics of those who reached the maximum entitlement period for receiving sickness benefits (MEPSB) and their future main source of income. Methods: All 5,309,759 individuals, aged 20–63 and residents of Sweden in 2009 were followed from July 2008 to July 2010 regarding SB-days and date of MEPSB and then categorised into three groups: I) no SB-days, II) ongoing SB-days, and III) MEPSB. Mean numbers of SB-days 2.5 years before and 2 years after the policy change and main source of income in 2011 were assessed. Associations between sociodemographic factors, occupation and paid work as main source of income were estimated by odds ratio (OR). Results: A total of 0.7% reached MEPSB in 2010. The mean numbers of SB-days before and after the policy change were higher in the MEPSB group than in the other two groups. In the MEPSB group, 14% had their main source of income from paid work in 2011; this was more common among women born in Sweden (OR = 1.29), people living with a partner and children (women OR = 1.29; men OR = 1.48), and those with occupations representing high educational levels. Conclusions: One out of seven individuals with MEPSB in 2010 had their main source of income from paid work in 2011, although they had a long-term SB before and after the policy change. Further research is warranted to address the long-term effects of this policy change.

Background The objective of the present study was to assess nation-wide, representative prevalence estimates for symptom-defined posttraumatic stress disorder (PTSD) within populations of refugee minors from Afghanistan, Syria and Iraq resettled in Sweden. Methods A nation-wide, cross-sectional, questionnaire study with a stratified sample of refugee minors, aged 16–18 years, from Afghanistan, Iraq and Syria, resettled in Sweden between 2014 and 2018 (N = 5071) was conducted. The response rate was 22.3%, leaving n = 1129 refugee minors (boys 53.1% / girls 46.9%) in the final sample. Symptom-defined prevalences of PTSD were measured using CRIES-8 with ≥17 as cut-off. Data were analyzed using frequency distributions, and strata-specific PTSD prevalences with 95% confidence intervals (95% CIs), were estimated. The association between migratory status on arrival (unaccompanied vs. accompanied) and PTSD was estimated using crude and adjusted odds ratios (OR) utilizing logistic regression analyses with 95% CIs. Results Overall, the weighted PTSD prevalence was 42% (95% CI 38.9–45.1), with minors from Afghanistan presenting the highest prevalence (56.9, 95% CI 51.5–62.2), compared to minors from Iraq (36.8, 95% CI 28.9–45.4) and Syria (33.4, 95% CI 29.4–37.6). Unaccompanied minors from Afghanistan had higher odds of PTSD compared to accompanied minors from Afghanistan (OR = 1.92, 95% CI 1.08–3.40). Gender differences were non-significant. Conclusions High prevalences of symptom-defined PTSD among refugee minors in general and in unaccompanied minors from Afghanistan in particular, were revealed. Findings calls for continued efforts to support this especially vulnerable group.

Aim: To assess the association between physical intimate partner violence (physical IPV) in the past 5 years, perceived need for help and primary health care utilization due to mental health problems in a general population-based sample of women in Sweden. Methods: We performed structured follow-up interviews with 616 women between 1995 and 2015. Associations between physical IPV in the past 5 years and (i) perceived need for help and (ii) primary health care utilization due to mental health problems, were estimated by logistic regression analyses with crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results: Of the women who had experienced physical IPV in the past 5 years, 45.1% perceived a need for help but refrained from seeking care. After adjusting for sociodemographic factors, exposure to physical IPV in the past 5 years remained associated with perceived need for help (OR 3.54; CI 1.77–7.11). After adjusting for sociodemographic factors, the association between exposure to physical IPV and primary health care utilization did not remain statistically significant. Conclusions: Women exposed to physical IPV were more likely to perceive the need for help compared with unexposed women. A large proportion of IPV-exposed women in the general population may refrain from seeking care although they perceive a need for help. Future studies need to investigate potential barriers to mental health care seeking among women exposed to IPV. Routine questioning about IPV should be implemented in primary health care with improved referral to available support services.

This study investigated the extent to which work disability patterns including sickness absence and disability pension (SA/DP) before and after acute myocardial infarction (AMI) were associated with subsequent common mental disorders (CMDs) such as depression and anxiety in AMI patients without previous CMD. Total 11,493 patients 26–64 years with incident AMI during 2008–10 were followed up for CMD (measured as antidepressant prescription) through 2013. Four SA/DP trajectory groups during the 3-years pre-AMI and 1-year post-AMI were identified. Hazard ratios (HRs) with 95% confidence intervals for subsequent CMD were estimated in Cox models. Higher pre-AMI SA/DP annual levels (>1–12 months/year) were associated with 40–60% increased CMD rate than the majority (78%) with low increasing levels (increasing up to 1 month/year). Regarding post-AMI findings, constant high (~25–30 days/month) SA/DP levels within the first 3 months was associated with a 76% higher CMD rate, compared to constant low (0 days/month). A gradually decreasing post-AMI SA/DP pattern over a 12-month period suggested protective influences for CMD (HR = 0.80). This is the first study to demonstrate that pre- and post-AMI work disability patterns are associated with subsequent CMD risk in AMI patients. Work disability patterns should be considered as an indicator of AMI prognosis in terms of CMD risk.

Background This study investigated the extent to which work-disability patterns including sickness absence and disability pension (SA/DP) before and after acute myocardial infarction (AMI) were associated with subsequent common mental disorders (CMDs) such as depression and anxiety in AMI patients without previous CMD. Methods A cohort of 11,493 patients aged 26-64 years without previous CMD with incident AMI during 2008-2010 were followed up for CMD measured as antidepressant prescription through 2013. Four SA/DP trajectory groups during the 3 years pre-AMI and 1 year post-AMI were identified. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated in Cox models. Results Higher pre-AMI SA/DP levels (>1-12 months/year), compared to the majority of patients (78%) following low increasing annual levels (increasing up to 1 month/year) of pre-AMI SA/DP, were associated with a 40-60% increased CMD rate. Regarding post-AMI findings, constant high (∼25-30 days/month) and steeply decreasing SA/DP levels within the first 3 months were associated with a 76% and 35% higher CMD rate, respectively, compared to constant low ( Conclusions This is the first study to demonstrate that pre- and post-AMI work disability patterns are associated with subsequent CMD risk in AMI patients. Work disability patterns should be considered in clinical practice as an indicator of AMI prognosis in terms of CMD risk. Key messages Increasing and high persistent levels of pre-AMI work disability are associated with higher risk of subsequent CMD, while gradually decreasing post-AMI work disability has a favourable CMD prognosis. Pre- and post-AMI patterns of work disability (sickness absence and disability pension) can be a useful marker in terms of CMD prognosis.

Most women of working ages with limited breast cancer (BC) have returned to work within the first year after diagnosis. However, little is known about what is happening during this year regarding sickness absence and return to work. Also, the knowledge is very limited about the occurrence of part-time sickness absence after BC diagnosis. Therefore, the aim of this study was to describe occurrence, extent and length of SA during a two-year follow-up after BC surgery and to analyse the association between being SA and type of cancer treatment.In this prospective cohort study, 497 women responded to questionnaires about different aspects of sickness absence at six occasions during two years after primary BC surgery (at baseline and after 4, 8, 12, 18 and 24 months). Treatment information was obtained from the National breast cancer register. Multinomial logistic regression was used to calculate odds ratios (OR) for likelihood of being sickness absent more than once.Two-thirds of the women were sickness absent at baseline; this proportion decreased, especially during the first eight months. At 24 months, 13% were sickness absent. Of all women, 27% never reported sickness absence and 14% were sickness absent at most of the six survey times. At eight months, many had shifted from full- to part-time sickness absence. Women with chemotherapy and/or advanced BC surgery had higher ORs for being sickness absent at most of the follow-ups.Most women returned to work within the first eight months after BC surgery and of those sickness absent after that, most had been part-time sickness absent. Thus, it is important to differentiate between part- and full-time sickness absence in future studies. Special attention should be paid to the impact of chemotherapy and type of surgery on the likelihood of being sickness absent.

Aim: This study assesses the predictive ability of the full Work Ability Index (WAI) as well as its individual items in the general population. Methods: The Work, Health and Retirement Study (WHRS) is a stratified random national sample of 25–75-year-olds living in Sweden in 2000 that received a postal questionnaire ( n = 6637, response rate = 53%). Current and subsequent sickness absence was obtained from registers. The ability of the WAI to predict long-term sickness absence (LTSA; ⩾ 90 consecutive days) during a period of four years was analysed by logistic regression, from which the Area Under the Receiver Operating Characteristic curve (AUC) was computed. Results: There were 313 incident LTSA cases among 1786 employed individuals. The full WAI had acceptable ability to predict LTSA during the 4-year follow-up (AUC = 0.79; 95% CI 0.76 to 0.82). Individual items were less stable in their predictive ability. However, three of the individual items: current work ability compared with lifetime best, estimated work impairment due to diseases, and number of diagnosed current diseases, exceeded AUC > 0.70. Excluding the WAI item on number of days on sickness absence did not result in an inferior predictive ability of the WAI. Conclusions: The full WAI has acceptable predictive validity, and is superior to its individual items. For public health surveys, three items may be suitable proxies of the full WAI; current work ability compared with lifetime best, estimated work impairment due to diseases, and number of current diseases diagnosed by a physician.

Many refugees have been subjected to pre-migratory trauma. Evidence is needed to address the heterogeneity within refugee populations in regard to patterns of multiple trauma exposures. This study identified subgroups within a refugee population displaying different profiles of multiple trauma exposures and assessed sociodemographic predictors and differences in mental health symptom severity across these classes.Study population consisted of 1215 refugees from Syria resettled in Sweden. Latent class analysis 3-step method for modelling predictors and outcomes and a class-specific weighted multigroup approach were used to identify classes of refugees using self-reported data on violent and non-violent trauma exposures, sociodemographic variables and symptom severity scores for depression, anxiety and PTSD.Three classes were identified: class 1 'multiple violent and non-violent trauma' (39.3%, n = 546); class 2 'witnessing violence and multiple non-violent trauma' (40.8%, n = 569); and class 3 'low multiple non-violent trauma' (20.1%, n = 281). Trauma exposure and gender significantly predicted class membership. Male gender and highest severity of mental ill health defined class 1. Female gender predicted higher mental ill health within classes 1 and 2. Across all three classes living with a partner was associated with lower severity of mental ill health regardless of trauma exposure classes.There are distinct patterns within refugee populations concerning exposure to multiple trauma. Violence is a primary marker for higher likelihood of multiple trauma exposures and severity of mental health. Gender predisposes individuals to trauma exposure and its outcomes differentially.

Aim: The aim of this study was to analyze possible changes in the gender composition of occupations in Sweden, using register data covering the whole working population. Methods: Cross tabulations on gender by occupation were computed and comparisons made of numbers and proportions of women and men aged 20–64 years to illustrate occupational gender-segregation categories in 2003 and 2011, respectively. All of those in working ages, employed in 2003 and 2011 (4.2 resp 4.7 millions individuals), were included. Differences in the distribution of women and men in all occupations were summarized using two gender-segregation indexes from 2003 and 2011, separately. Results: The proportion of women increased in the gender-integrated (⩾40–

Background Little is known about temporal changes in the prevalence of self-reported suicidal ideation and attempts within general populations of women. The aim of this study was to assess the prevalence of self-reported suicidal ideation and attempts over a 26 year period (1989–2015) among women from the general population aged 20–49 years. A further aim was to investigate associations between sociodemographic factors and lifetime suicidal ideation over this study period. Methods A total of 2072 structured personal interviews were performed with a stratified population-based sample of women between 1989 and 2015. Questions about lifetime suicidal ideation and attempts as well as sociodemographic factors were assessed at four data collection waves. Lifetime prevalence of suicidal ideation and attempts were compared through analysis of differences between two independent proportions and their 95% Confidence Intervals (CI). Associations between sociodemographic factors and lifetime suicidal ideation were estimated by weighted odds ratios (OR). Results Women aged 20–30 years reported higher lifetime prevalence of suicidal ideation in 2013–2015 compared to 1989–1991 (45 and 33% respectively). Rates of lifetime suicide attempts remained similar between these time points (3.5 and 3.1% respectively). Women aged 31–49 years reported higher lifetime prevalence of suicidal ideation in 2013–2015 compared to 2000–2002 (35.4 and 23.1% respectively). In this age group, lifetime suicide attempts increased from 0.0% in 2000–2002 to 3.6% in 2013–2015. Women aged 20–30 years who were single, unemployed or had low educational attainment had higher OR of lifetime suicidal ideation compared to the reference categories in most of the study waves. In 2013–2015, young students had lower OR of lifetime suicidal ideation (OR 0.34; 95% CI 0.17–0.69) compared to those with employment. Women aged 31–49 years, who were single, had higher OR of lifetime suicidal ideation (OR 2.61; 95% CI 1.06–6.44) than married, cohabiting women and this was observed in 2013–2015. Conclusion The results raise a general concern about an increasing trend in suicidal ideation among young and middle-aged women. The current study expands on previous research by demonstrating that sociodemographic factors may show changing patterns in the associations with lifetime suicidal ideation over time.

BACKGROUND: The aim of this study is threefold: (i) to establish the psychometric properties and gender invariance of ENRICHD Social Support Inventory (ESSI), which was used for the first time in the present study in the population of Syrian refugees resettled in Sweden; (ii) to assess whether gender moderates the associations between social support, exposure to torture and PTSD; (iii) to assess whether social support mediates the association between exposure to torture and PTSD, and whether this mediation is in turn moderated by gender. METHODS: Data from a cross-sectional and population-based study of a random sample of Syrian refugees (n = 1215) resettled in Sweden 2011-2013 was analyzed within a Structural Equation Modeling (SEM) framework. RESULTS: Our results indicate adequate fit and gender invariance for a unidimensional model of ESSI. Exposure to torture was associated with lower social support (B = -0.22, p

Background Toinvestigate the effects of psychosocial work factors (PWF) and psychological distress (PD) on self-assessed work ability. Methods This follow-up study included 7,810 individuals (55%women) with good work ability at baseline. PWFandPD (measured by GHQ-12) were assessed at baseline and work ability at 7-year follow-up. Effects of PWF and PD on work ability were analyzed by logistic regression, odds ratios (OR) with 95% CI, and by mediation analysisusing 4-way decomposition. Results Low support was associated with poor work ability for both women and men (OR 1.78 and 1.89). For men, also low skill discretion was associated with poor work ability (OR 2.07). For both women and men, PD was associated with poor work ability (OR 3.41 and 1.84). PD did not act as an intermediate variablein the association between PWF and work ability. Conclusion Strategies for sustainable work ability should focus on both working conditions and health factors. Am. J. Ind. Med. © 2016 Wiley Periodicals, Inc.

While flight experiences of refugees and asylum-seekers might differ profoundly, previous research has, to a large degree, not differentiated between these forcibly displaced groups. Furthermore, research has mainly focused on post-migratory stress measured after resettlement. The aim of this study was therefore to chart mental health disorders and the associations between mental health and early post-migratory stress among asylum-seekers.Using a cross sectional survey design, data collection was conducted from 2016 to 2018, in three large asylum-seekers' housing facilities located in Sweden.In total 455 asylum-seekers from Afghanistan, Eritrea, Iraq, Somalia and Syria responded to the questionnaire. The most prevalent type of mental health disorder was depression (67.9%) followed by posttraumatic stress disorder (PTSD) (60.7%), and anxiety (59.3%). More men than women reported mental health disorders particularly with regard to anxiety and PTSD, and respondents with the lowest level of education (≤9 years) reported the highest levels of mental health problems. Associations between mental health disorders and post-migratory stress revealed that three post-migratory stressors were consistently the strongest indicators of mental health disorders.Compared to previous research within populations of refugees who have received formal refugee status or resident permits, the prevalences of mental health disorders reported in the present study were substantially larger and the associations between post-migratory stressors and mental health disorders appears to be substantially stronger for asylum-seekers. This might suggest that the asylum-seekers' psychosocial situation becomes a diathesis or predisposition that interacts with early post-migratory stressors, in turn having detrimental effects on mental health.

Background: Although the labour market is characterized by a strong numerical gender segregation of occupations, there is little knowledge about the associations of this with the future labour market situation for an individual person. Objectives: This study aimed to elucidate whether working in a gender-segregated or gender-integrated occupation is associated with future labour market attachment and sickness absence or disability pensions among women and men. Methods: We used a population-based prospective cohort study with univariate and multiple logistic regression analyses stratified by gender, including all people living in Sweden aged 20–56 years and in paid work in 2003 ( n=3,239,989). They were followed up eight years later with regard to employment status, sickness absence and disability pension. Results: Women and men employed in extremely female-dominated occupations in 2003 had the highest employment levels and the lowest unemployment levels at follow up in 2011. When adjusting for age, level of education and sector of employment, the highest odds ratios (ORs) for not being employed in 2011 were found for women working in extremely male-dominated occupations in 2003 (OR 1.27; 95% CI 1.21–1.33) and for men in female-dominated occupations (OR 1.42; 95% CI 1.39–1.45) relative to those in gender-integrated occupations. Women in extremely male-dominated occupations had the highest ORs for sickness absence or the receipt of a disability pension at follow up (OR 1.26; 95% CI 1.17–1.36) and men in female-dominated occupations had the highest OR 1.15 (95% CI 1.11–1.20). Conclusions: For both women and men, the gender composition of the occupation they work in seems to be of importance for their future labour market attachment and sickness absence or receipt of a disability pension.

Anxiety is one of the main components of distress among women with breast cancer (BC), particularly in the early stages of the disease. Changes in anxiety over time may reflect the process of adjustment or lack thereof. The process of adjustment in the traverse of acute to transitional stages of survivorship warrants further examination. To examine the trajectory of anxiety and the specific patterns that may indicate a lack of adjustment within 2 years following BC surgery, survey data from a 2-year prospective cohort study of 725 women with BC were analyzed by Mixture Growth Modelling and logistic regression and Analysis of Variance. A piece-wise growth curve displayed the best fit to the data, indicating a significant decrease in anxiety in the first year, followed by a slower rate of change during the second year. Four classes of trajectories were identified: High Stable, High Decrease, Mild Decrease, and Low Decrease. Of these, High Stable anxiety showed the most substantive indications of lack of adjustment. This subgroup was predominantly characterized by sociodemographic variables such as financial difficulties. Our results support an emphasis on the transitional nature of the stage that follows the end of primary active treatment and imply a need for supportive follow up care for those who display lack of adjustment at this stage.

Background.Possible age-related differences in risk of completed suicide following non-fatal self-harm remain unexplored. We examined associations between self-harm and completed suicide across age groups of self-harming patients, and whether these associations varied by violent index method, presence of mental disorder, and repeated self-harm.Method.The design was a cohort study with linked national registers in Sweden. The study population comprised individuals aged ⩾10 years hospitalized during 1990–1999 due to non-fatal self-harm (n = 53 843; 58% females) who were followed for 9–19 years. We computed hazard ratios (HRs) across age groups (age at index self-harm episode), with time to completed suicide as outcome.Results.The 1-year HR for suicide among younger males (10–19 years) was 14.6 [95% confidence interval (CI) 4.1–51.9] for violent method and 8.4 (95% CI 1.8–40.0) for mental disorder. By contrast, none of the three potential risk factors increased the 1-year risks in the youngest females. Among patients aged ⩾20 years, the 1-year HR for violent method was 4.6 (95% CI 3.8–5.4) for males and 10.4 (95% CI 8.3–13.0) for females. HRs for repeated self-harm during years 2–9 of follow-up were higher in 10- to 19-year-olds (males: HR 4.0, 95% CI 2.0–7.8; females: HR 3.7, 95% CI 2.1–6.5). The ⩾20 years age groups had higher HRs than the youngest, particularly for females and especially within 1 year.Conclusions.Violent method and mental disorder increase the 1-year suicide risk in young male self-harm patients. Further, violent method increases suicide risk within 1 year in all age and gender groups except the youngest females. Repeated self-harm may increase the long-term risk more in young patients. These aspects should be accounted for in clinical suicide risk assessment.

ObjectiveScientific knowledge on work disability in terms of sickness absence and disability pension (SA/DP) among patients with acute myocardial infarction (AMI) is scarce. The study aimed to investigate trajectories of SA/DP among individuals with or without AMI and examined the associations between sociodemographic, morbidity and coronary revascularisation characteristics with such trajectories among patients with AMI.MethodsThis is a population-based cohort study of 10 255 individuals aged 30–60 years who had a first AMI during 2008–2010 and were alive 30 days after AMI. Each case was matched by sociodemographics to one control without AMI. Trajectories of annual SA/DP months over a 6-year period for cases and controls were analysed by group-based trajectory modelling. Associations of characteristics with trajectory groups were estimated by Χ2 test and multinomial logistic regression.ResultsThe majority of patients (59%) had slightly increased annual levels of SA/DP (1 month) at the time of AMI, which returned to no SA/DP 2 years after the event. One group (4%) had increasing SA/DP months preceding and after AMI. Three groups showed constant SA/DP months on low (14%), medium (9%) and high (15%) levels. Sex, unemployment, education, musculoskeletal disorders and prescription of antidepressants were the strongest factors discriminating the SA/DP trajectories (R2difference=0.02–0.03, pConclusionsThe majority of patients with AMI have a good outcome in terms of low levels of work disability within 2 years after AMI. Patterns of SA/DP before AMI, sex, socioeconomic status as well as comorbid musculoskeletal and mental disorders provide crucial clinical information on work disability after AMI.

Aims The study investigated whether regional differences in choice of coronary revascularization affected outcomes in Sweden. Methods and results We conducted a prospective nationwide study of outcome in patients undergoing coronary artery bypass grafting (CABG, n = 47 065) or percutaneous coronary intervention (PCI, n = 140 945) from 2001 through 2011, tracked for a median of 5 years. During this period, the proportion of CABG in revascularization procedures decreased nationwide from an average of 38% to 18%e. Three-vessel disease and left main stem coronary artery stenosis were more common among CABG patients than in PCI patients. In both males and females, all-cause mortality was higher in CABG patients than in PCI patients, while repeat PCI was performed more frequently in the PCI group. CABG proportions in 21 counties ranged from 13% to 42% in females and males. The combined outcomes of repeat revascularization, non-fatal acute myocardial infarction, and death during the tracking period was recorded in 151 936 patients without ST-elevation myocardial infarction after PCI (n = 37 820, 36%) and CABG (n = 18 903, 40%). The multivariable adjusted risk of combined outcomes was higher after both PCI and CABG in both females and males in the three quartiles of counties with a smaller proportion of CABG than in the quartile of counties with the highest proportion of CABG. Similar patterns persisted after including only mortality in the analyses. Conclusion There are subgroups of patients who have prognostic benefits of CABG in addition to symptomatic improvement that is well documented with both PCI and CABG.

A high proportion of refugees have been subjected to potentially traumatic experiences (PTEs), including torture. PTEs, and torture in particular, are powerful predictors of mental ill health. This paper reports the development and preliminary validation of a brief refugee trauma checklist applicable for survey studies. Methods: A pool of 232 items was generated based on pre-existing instruments. Conceptualization, item selection and item refinement was conducted based on existing literature and in collaboration with experts. Ten cognitive interviews using a Think Aloud Protocol (TAP) were performed in a clinical setting, and field testing of the proposed checklist was performed in a total sample of n = 137 asylum seekers from Syria. Results: The proposed refugee trauma history checklist (RTHC) consists of 2 × 8 items, concerning PTEs that occurred before and during the respondents’ flight, respectively. Results show low item non-response and adequate psychometric properties Conclusions: RTHC is a usable tool for providing self-report data on refugee trauma history surveys of community samples. The core set of included events can be augmented and slight modifications can be applied to RTHC for use also in other refugee populations and settings.

Purpose The aim of the present study was to estimate whether self-assessed mental well-being and work capacity determines future sickness absence (SA). Methods A questionnaire was sent to employed individuals (n = 6,140), aged 19–64 years, who were registered as sick-listed with a new sick-leave spell in 2008. The response rate was 54 %. In this study we included individuals with a single sick-leave spell in 2008 (n = 2,502). The WHO (Ten) Well-Being Index and four dimensions of self-assessed work capacity (knowledge, mental, collaborative, physical) were used as determinants. Future sickness absence was identified through national register in 2009. Outcome was defined as no sickness benefit compensated days (no SBCD) and at least one sickness benefit compensated day (SBCD). Logistic regression analyses were used to estimate odds ratios (OR) with 95 % confidence intervals (CI) for the likelihood of SBCD. Results In 2009, 28 % of the women and 22 % of the men had SBCD; the median was 59 and 66 benefit days, respectively. Individuals with low mental well-being had higher odds for SBCD with OR 1.29 (95 % CI 1.01–1.65) in the fully adjusted model. Participants reporting low work capacity in relation to knowledge (OR 1.55, 95 % CI 1.13–2.13), collaborative (OR 1.36, 95 % CI 1.03–1.79) and physical (OR 1.50, 95 % CI 1.22–1.86) demands at work had higher odds for SBCD after adjustments for all covariates; no relation was demonstrated with mental work capacity (OR 0.99, 95 % CI 0.76–1.27). Conclusion Mental well-being and work capacity emerged as determinants of future SA. Screening in health care could facilitate early identification of persons in need of interventions to prevent future SA.

Work-related violence is one of the most serious threats to employee safety and health.To ascertain the extent of self-reported violence or threats of violence at work in relation to the general health of public sector employees.The study population comprised 9,611 female (83%) and male public employees in Sweden. A questionnaire based on items derived mainly from validated instruments was constructed to cover aspects such as health, lifestyle, and physical and psychosocial work conditions.One in three employees reported work-related violence, with the highest proportions among psychiatric nurses (79%) and psychiatric attendants (75%). Work-related violence more often affected those who were45 years old, worked40 hours/week, worked nights, or reported poor health. Regardless of gender, age, hours of work, night work, and type of occupation, exposure to work-related violence was associated with less than good general health, and this relationship was strongest for psychiatric nurses (OR=3.19; 95% CI=1.28-7.98), medical doctors/dentists (OR=2.46; 95% CI=1.35-4.49), compulsory school teachers (OR=2.14; 95% CI=1.33-3.45), and other nurses (OR=1.87; 95% CI=1.23-2.84).Work-related violence was frequently reported by employees in the most common public sector occupations, and it was associated with poor health in both genders.

To describe and appraise the research literature reporting prevalence of torture and/or war-related potentially traumatic experiences (PTEs) in adult forced migrants living in high-income countries.A search for peer-reviewed articles in English was conducted in PubMed, Web of Science, PILOTS, key journals, and reference lists. Studies based on clinical samples and samples where less than half of participants were forced migrants were excluded. Data was extracted and a methodological quality appraisal was performed.A total of 3,470 titles and abstracts were retrieved and screened. Of these, 198 were retrieved in full-text. Forty-one articles fulfilled inclusion criteria and the total number of study participants was 12,020 (median 170). A majority focused on specific ethnic groups or nationalities, Southeast Asian, Middle Eastern and Balkan being the most frequent. Reported prevalence rates of torture ranged between one and 76 % (median 27 %). Almost all participants across all studies had experienced some kind of war-related PTE.Reported prevalence rates of torture and war-related PTEs vary between groups of forced migrants. Trauma history was often studied as a background variable in relation to mental health. The heterogeneity of data, as well as the methodological challenges in reaching forced migrants and defining and measuring traumatic experiences, prevent generalisation concerning trauma history across groups.

INTRODUCTION: As half of the women with breast cancer are of working ages and usually survive, knowledge is needed on how to support them early regarding work-related problems caused by treatments. ...

Aims Common mental disorders i.e. depressive and anxiety disorders (CMD) are frequent comorbid conditions in individuals with ischaemic heart disease (IHD). Still, their effect on preterm exit from the labour market [i.e. disability pension (DP)] in individuals with IHD has to date not been scrutinized. The aim of this study was to investigate the separate and joint effect of IHD and CMD on the risk of DP for women and men of working age. Material and methods This population-based cohort study included all non-pensioned 4 823 069 individuals, registered as living in Sweden 31 December 2004 and then 16-64 years of age. Individuals with IHD or CMD were identified through using data on sickness absence, prescribed medication or in- or specialized outpatient care in 2005. Crude and adjusted hazard ratios (HR) and 95% confidence intervals (CI) for being granted DP in 2006-10 were estimated by means of Cox proportional hazard regression. Results In the fully adjusted models, HRs for DP were 2.84 (95% CI; 2.57-3.13) and 2.83 (2.66-3.01) in women and men with IHD, respectively. Hazard ratios for DP in women and men with CMD were 5.13 (5.03-5.24) and 6.08 (5.93-6.24). In women and men with both conditions, crude HRs for DP were 18.38 (15.01-22.50) and 25.58 (22.27-29.37). There was a significant synergistic effect between IHD and CMD in both sexes in the crude models, which disappeared in women after adjusting for socio-demographic variables, and in men after additionally adjusting for comorbid somatic disorders. Conclusion A comorbid CMD worsens the prognosis of IHD in terms of early exit from the labour market. Processes leading to DP in individuals with IHD are multifactorial and may involve the presence of CMD as well as comorbidity with other somatic diseases.

Several methodological challenges arise when attempting to analyse individual data on changes of sick-leave diagnoses over several years. Sick-leave spells for a person can recur, have different sick-leave diagnoses, and both these aspects are dependent of previous episodes, the numbers of repeated periods vary across subjects, and standard statistical methods are not valid for variables on nominal scales, e. g. sick-leave diagnoses. Objective: Our aim was to ascertain whether the number and pattern of changes in sick-leave diagnoses are associated with future disability pension (DP) and to test methods for analysis of repeated measurements on nominal data. Participants: Data from a 12-year prospective cohort study of the 8000 sick-leave periods of the 213 persons aged 25-34 who, in 1985, had a new sick-leave spell andgt;= 28 days with back diagnoses were used. Methods: We used entropies, uncertainty coefficients adjusted for repeated measurements, and transition matrices to examine the changes in sick-leave diagnoses that occurred during follow up. Results: In the 12 years 22% were granted DP and they had changed sick-leave diagnosis less frequently and more often had new sick-leave periods with musculoskeletal diagnoses than the others. The variation in diagnoses and the degree of dependence between consecutive diagnoses were associated with DP. Conclusions: Many tools in statistics are based on linear methods that require numerical variables, but such methods are not valid for repeated measurements on discrete variables on nominal scales, as for sick-leave diagnosis. In such cases, it can be beneficial to use tools that are applied in statistical information theory.

The most common female cancer in Western countries is breast cancer and women diagnosed with this disease are often under 65 years old. With increasing prevalence of survivors it is important to shed light on problems facing these women after diagnosis and treatment. The aim of this study was to assess factors predicting return to work (RTW) in women with early-stage breast cancer.A cohort of 102 women aged 18-64 with early-stage breast cancer who had undergone curative primary surgery with or without systemic adjuvant therapy were followed for 10 months using data from questionnaires and medical files.Ten months after primary surgery, 59% of the women had returned to work while 41% were sick-listed part-time or full-time. After adjusting for age, health status, life satisfaction, vocational situation, and irradiation to the breast/chest wall and regional nodes, a multivariate logistic regression revealed the following factors as being negatively associated with RTW: a high-demand job (OR=0.1, 95% CI 0.0-0.8), axillary node dissection (OR=0.1, 95% CI 0.0-0.6), and treatment with chemotherapy (OR=0.1, 95% CI 0.0-0.7).Treatment factors and high demands at work play an important role in RTW for women with early-stage breast cancer.

Centre of Public Health, StockholmCounty Council, Stockholm, SwedenAbstractAim: To investigate whether family obligations influence the risk of sickness absence among female municipal employees inSweden. Methods: A 1-year prospective cohort study of 1464 female municipal employees v50 years of age in Sweden in2000 was conducted using questionnaire responses and absence data from the employers’ personnel records. The relativerisk of having children v16 years of age in the home, marital status, household work, financial situation, working hours andwork–family conflicts for repeated sick-leave spells (>4 spells) and long-term sickness absence (>28 days) were calculatedby applying Poisson regression models. Results: Women reporting financial strain or work–family conflicts were at elevatedrisk for long-term sickness absence. Having children was not a risk factor for repeated sick-leave spells or long-term sicknessabsence among married/cohabiting women. Single women with children had a two-fold greater risk of repeated sick-leavespells than single women without children. Conclusions: The findings suggest that the combination of gainfulemployment and children does not influence the risk of repeated sick-leave spells or long-term sickness absenceamong married/cohabiting publicly employed women. However, this was not true for single women withchildren, which indicates that their circumstances are particularly strained.Key Words: Children, female municipal employees, financial situation, household work, marital status, sick-leave, work–family conflict, working hours

In this study we investigated whether or not problems experienced during years at university affect academic achievement. Students enrolled full-time at a Swedish university were followed up from their year of entry in 1998/1999 through to 2000/2001 (N = 1,127) by self-administered questionnaires. Students' sociodemographic characteristics, their experience of stressors, psychological symptoms, and mental and general health ratings were linked to their academic achievement (degree completed). The extent to which various factors or groups of factors affect academic achievement was measured by a series of multiple logistic regression analyses. Older students, females, and those enrolled on comparatively shorter programs (3 years) tended to have higher odds of being awarded a degree. Experienced stress brought on by not coping academically and due to study support demands was a substantial barrier to students' academic achievement.

Over the last decade sickness absence and disability pension (DP) due to psychiatric disorders have increased considerably in Western countries. The scientific knowledge base about prognoses for such absences is very limited, but employers and clinicians often predict them to be very long. The aim of this study was to investigate sickness absence and disability pension in a cohort of employees who initially were on long-term sick leave due to psychiatric disorders, with regard to gender, age, socioeconomic status, and previous sickness absence. The cohort included 4,891 employees in Sweden, who, in 1999 were aged 20–61 and had a new sick-leave spell >90 days with a psychiatric disorder. Retrospective and prospective registry data on sickness absence and DP for 1996–2002 were obtained. Logistic regressions were performed to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for having a low, intermediate, or high level of sickness absence (