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Heinonen N, Katainen A, Lallukka T, Nordquist H, Kouvonen A. Explanations for sickness absence due to common mental disorders: A narrative study of young health and social care workers. SOCIOLOGY OF HEALTH & ILLNESS 2024. [PMID: 38289869 DOI: 10.1111/1467-9566.13754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/09/2024] [Indexed: 02/01/2024]
Abstract
Over recent decades, sickness absence due to common mental disorders has increased among young workers. The phenomenon is mostly understood on the basis of epidemiological research, and knowledge regarding the viewpoints of young workers themselves is lacking. Our study explored the explanations for mental health-related sickness absence in the narrative accounts of young workers in high-risk health and social care occupations. Semi-structured narrative interviews were conducted with 23 Finnish young workers (aged 21-34), with self-reported sickness absence related to common mental disorders over the previous year. Our analysis identified three narrative explanations for the onset of mental health problems leading to sick leave: work as the sole cause, work as an additional cause and work as a trigger. These findings indicate that mental health-related sickness absences form a complex phenomenon related to various life and work-related circumstances. More comprehensive preventive measures are needed in the health and social care sector to help tackle mental health problems among young workers.
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Affiliation(s)
- Noora Heinonen
- The Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anu Katainen
- The Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Hilla Nordquist
- The Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- South-Eastern Finland University of Applied Sciences, Kotka, Finland
| | - Anne Kouvonen
- The Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Perhoniemi R, Blomgren J, Laaksonen M. Unemployed and disabled for work: identifying 3-year labour market pathways from the beginning of a sickness absence using sequence and cluster analyses in a register-based longitudinal study in Finland. BMJ Open 2023; 13:e076435. [PMID: 38151282 PMCID: PMC10753752 DOI: 10.1136/bmjopen-2023-076435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVES This study followed the labour market pathways of unemployed persons who started a sickness absence (SA) spell. We aimed to unravel subgroups based on altering labour market states and to identify covariates of these subgroups. DESIGN Register-based longitudinal study, with nine labour market states and 36-month units. SETTING AND PARTICIPANTS All Finnish persons aged 18-59 years with an SA in 2016 who were unemployed at the start of the SA spell (N=12 639). OUTCOME MEASURES Sequence analysis was used to study transitions between nine labour market states based on monthly register data on permanent and temporary (full and partial) disability pensions (DP), rehabilitation, all-cause SA, unemployment and employment. Individuals were grouped into clusters based on cluster analysis and intersequence distances. Multinomial regression analysis was used to examine covariates of cluster memberships. RESULTS Six clusters with the following pathway identities were found: (1) recurring unemployment (44%); (2) employment after a short SA (18%); (3) rehabilitation, recurring SA and unemployment (12%); (4) unknown sources of income (11%); (5) permanent DP after a prolonged SA (9%) and (6) temporary DP after a prolonged SA (7%).Compared with the reference cluster 2, all other clusters were associated with less employment days and having a chronic illness before the SA spell, SA based on a mental disorder and a rejected DP application during the follow-up. In addition, the clusters had some unique covariates. CONCLUSIONS Unemployed persons starting an SA are a heterogeneous group, with different labour market pathways. For many, the combination of unemployment and work disability means low chances for employment or regained work ability during the following years. Unemployed persons with poorer health, long history outside employment, older age, low educational level, a rejected DP application and a mental disorder could benefit from targeted support.
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Affiliation(s)
| | - Jenni Blomgren
- Social Insurance Institution of Finland, Helsinki, Finland
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Alaie I, Svedberg P, Ropponen A, Narusyte J. Longitudinal trajectories of sickness absence among young adults with a history of depression and anxiety symptoms in Sweden. J Affect Disord 2023; 339:271-279. [PMID: 37437735 DOI: 10.1016/j.jad.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/05/2023] [Accepted: 07/08/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Depression and anxiety are associated with increased risk of sickness absence (SA), yet the developmental patterns of SA remain unclear. We aimed to identify trajectories of SA in young adults with depression and/or anxiety, accounting for sociodemographic and occupational factors. METHODS Longitudinal study of 1445 twin individuals with elevated depressive/anxiety symptoms in late adolescence or young adulthood (age range: 19-30), assessed in Swedish surveys completed in 2005. Through linkage to nationwide registries, individuals were prospectively followed from 2006 to 2018. The outcome included consecutive annual days of SA, which were analyzed using group-based trajectory modeling. Multinomial logistic regression estimating odds ratios (OR) with 95 % confidence intervals (CI) was used to examine associations of age, sex, and educational level with the resulting SA trajectories. RESULTS Four distinct SA trajectories were identified in the total sample: 'high-increasing' (6 %), 'low-increasing' (12 %), 'high-decreasing' (13 %), and 'low-constant' (69 %). Increasing age was associated with higher odds of belonging to the low-increasing trajectory (OR = 1.07, 95 % CI = 1.02-1.12). Women had higher odds of belonging to the low-increasing trajectory (OR = 1.67, 95 % CI = 1.10-2.53), compared with men. Higher education was associated with lower odds of belonging to high-increasing (OR = 0.34, 95 % CI = 0.22-0.54) and high-decreasing (OR = 0.59, 95 % CI = 0.43-0.81) trajectories, compared with lower education. Few differences were observed in analyses stratified by occupational sector. LIMITATIONS Information on potential confounders (e.g., psychiatric comorbidity, work-environment factors) was not available. CONCLUSIONS Among young adults with prior depression/anxiety, close to every fifth showed rising SA trajectories over time. This calls for targeted strategies to improve public mental health already at young ages.
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Affiliation(s)
- Iman Alaie
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Division of Child and Adolescent Psychiatry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Pia Svedberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Annina Ropponen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jurgita Narusyte
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Olsson C, Tinnerholm Ljungberg H, Björk Brämberg E, Nybergh L, Jensen I. A gender perspective on perceived causes of sick leave due to common mental disorders among young Swedish employees: A qualitative interview study. PLoS One 2023; 18:e0291551. [PMID: 37721945 PMCID: PMC10506715 DOI: 10.1371/journal.pone.0291551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 08/31/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVE Common mental disorder (CMD) is the most common reason for sick leave among young employees in Sweden, with young women having a higher prevalence. There is a lack of studies focusing on young employees' own perceptions of sick leave. The aim was twofold: to investigate 1) perceived causes of sick leave due to CMD among young employees, and 2) differences and similarities among women and men. METHODS Using a qualitative design with an applied gender perspective enabled us to capture young employees' gendered experiences and consider cultural and social aspects of their situations. We interviewed 13 women and 12 men (aged 20-29) with experience of being on sick leave and applied a conventional inductive content analysis. RESULTS Six categories were identified: a) Being new to the labour market and the workplace; b) Want to prove themselves; c) To be exposed to poor working conditions; d) Relations at work; e) Being vulnerable; and f) Additional private life burdens. CONCLUSION This study adds to the understanding of young employees' perceived causes of sick leave due to CMD, by letting them share their experiences of events prior to sick leave connected to work and private life. Similarities and differences in women's and men's experiences were revealed. Overall, both young men and women describe a more pressured work situation for young women compared to their male counterparts, that young women take more social responsibility in private life and at work whereas men on the other hand find it harder to disclose mental health problems.
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Affiliation(s)
- Caroline Olsson
- Institute of Environmental Medicine, Karolinska Institutet, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden
| | - Helena Tinnerholm Ljungberg
- Institute of Environmental Medicine, Karolinska Institutet, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden
| | - Elisabeth Björk Brämberg
- Institute of Environmental Medicine, Karolinska Institutet, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden
| | - Lotta Nybergh
- Institute of Environmental Medicine, Karolinska Institutet, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden
| | - Irene Jensen
- Institute of Environmental Medicine, Karolinska Institutet, Unit of Intervention and Implementation Research for Worker Health, Stockholm, Sweden
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Hensing G, Rajagopalan V, Staland-Nyman C. Domestic Factors as Determinant of Sickness Absence with Psychiatric Disorders: A Scoping Review of Nordic Research Published between 2010-2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6292. [PMID: 37444138 PMCID: PMC10341713 DOI: 10.3390/ijerph20136292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/30/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023]
Abstract
Uneven division of domestic factors may contribute to sex differences in sickness absence with psychiatric disorders. The aim of this scoping review was to compile current Nordic research on domestic factors and sickness absence with psychiatric disorders. A systematic search was performed to identify studies from the Nordic countries published between 1 January 2010 and 31 December 2019. Twelve studies were included. Marital status, family situation, work-home interference (in both directions), social affiliation, and loss of child/young adult (suicide, accident, or natural death) were identified as measures of domestic factors. In 8 of the 12 studies, domestic factors were used as co-variates, while four used them as the main exposure. Social affiliation, home-to-work conflict, and total workload were not associated with the outcome. One study found that parents with children older than two years, widows/widowers, and those divorced or unmarried had an increased risk of sickness absence with psychiatric disorders. One study found that work-to-home conflict was associated with sickness absence with stress-related diagnoses in men, and with other mental disorders in women. Finally, one study found that losing a son or daughter aged 16-24 years increased the risk of future sickness absence with a psychiatric disorder regardless of the cause of death. Future studies need to develop concepts, study designs, and measurements to move this research area further. In particular, the concept of "unpaid domestic work" needs theoretical and empirical development.
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Affiliation(s)
- Gunnel Hensing
- School of Public Health and Community Medicine, Sahlgrenska Academy at University of Gothenburg, 405 30 Gothenburg, Sweden; (V.R.); (C.S.-N.)
| | - Varsha Rajagopalan
- School of Public Health and Community Medicine, Sahlgrenska Academy at University of Gothenburg, 405 30 Gothenburg, Sweden; (V.R.); (C.S.-N.)
| | - Carin Staland-Nyman
- School of Public Health and Community Medicine, Sahlgrenska Academy at University of Gothenburg, 405 30 Gothenburg, Sweden; (V.R.); (C.S.-N.)
- School of Health and Welfare, Halmstad University, 301 18 Halmstad, Sweden
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Lindberg A, Svedberg P, Ropponen A, Narusyte J, Wang M. Work incapacity and psychiatric patient care following attempted suicide - a cohort study of 65 097 Swedish twins. Psychol Med 2023; 53:3728-3734. [PMID: 35260212 PMCID: PMC10277756 DOI: 10.1017/s0033291722000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/29/2021] [Accepted: 02/04/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Research is scarce on the role of familial factors and previous psychiatric care on the association between suicide attempt and future work incapacity as well as deterioration in mental health. We aimed to investigate the associations between suicide attempt and sickness absence, disability pension and psychiatric patient care and to study the influence of previous psychiatric care and familial factors (genetics and shared environment) on the associations. METHODS The study included 65 097 twins living in Sweden on 31st of December 2006, aged 19-60 years. The twins were followed 2007-2013 regarding sickness absence, disability pension, inpatient care or specialized outpatient care for a mental diagnosis. Cox regression models were performed for the whole sample, and conditional models for discordant twin pairs. The analyses were also stratified by psychiatric care before 2007. RESULTS We found that suicide attempt predicted sickness absence, disability pension, and future mental diagnosis among the whole sample. The discordant twin pair analyses showed that the association between suicide attempt and sickness absence or disability pension was influenced by familial factors. Stratified analyses of individuals with or without psychiatric care before 2007 showed that previous psychiatric care had some impact on the associations. CONCLUSIONS A suicide attempt is a risk factor for work incapacity and psychiatric patient care. Familial factors and previous psychiatric care play a role in the associations between attempting suicide and work incapacity as well as psychiatric patient care. These factors are important when developing measures preventing work incapacity among those with a suicide attempt.
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Affiliation(s)
- Anton Lindberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Pia Svedberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Annina Ropponen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jurgita Narusyte
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center of Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Mo Wang
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Ropponen A, Josefsson P, Böckerman P, Silventoinen K, Narusyte J, Wang M, Svedberg P. Sustainable Working Life Patterns in a Swedish Twin Cohort: Age-Related Sequences of Sickness Absence, Disability Pension, Unemployment, and Premature Death during Working Life. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10549. [PMID: 36078264 PMCID: PMC9517844 DOI: 10.3390/ijerph191710549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
We aimed to investigate sustainable working life via age-related sequences of sickness absence (SA), disability pension (DP), unemployment (UE), premature death, and the influence of individual characteristics, accounting for familial confounding. The sample included monozygotic (MZ) and dizygotic (DZ) same-sexed twin pairs with register data (n = 47,450) that were followed for 10 years in four age cohorts: 26-35 (n = 9892), 36-45 (n = 10,620), 46-55 (n = 12,964) and 56-65 (n = 13,974). A sequence analysis was done in a 7-element state space: 1. "Sustainable working life": SA/DP 0-30 days and UE 0-90 days; 2. "Unemployment >90 days": SA/DP 0-30 days and UE > 90 days; 3. "Moderate SA/DP": SA/DP 30-180 days; 4. "Almost full year of SA/DP": SA/DP 180-365 days; 5. "Full year of SA/DP": SA/DP ≥ 365 days; 6. Death; 7. Old-age pension. The largest cluster had a sustainable working life and never experienced states 2-6 (34-59%). Higher education and being married predicted a lower likelihood of experiencing states 2-6. The MZ twin pairs (vs. DZ) were more often in the same cluster suggesting the role of genetic factors. To conclude, the sustainable working life was the largest cluster group. Few individuals had prolonged periods of interruptions of sustainable working life meriting actions, especially in early adulthood for interventions to support workability.
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Affiliation(s)
- Annina Ropponen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
- Finnish Institute of Occupational Health, 00032 Työterveyslaitos, Finland
| | - Pontus Josefsson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Petri Böckerman
- IZA Institute of Labor Economics, 53113 Bonn, Germany
- School of Business and Economics, University of Jyväskylä, 40014 Jyväskylä, Finland
- Labour Institute for Economic Research LABORE, 00100 Helsinki, Finland
| | - Karri Silventoinen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, 00014 Helsinki, Finland
| | - Jurgita Narusyte
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
- Center of Epidemiology and Community Medicine, Stockholm County Council, 104 31 Stockholm, Sweden
| | - Mo Wang
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Pia Svedberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden
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Heinonen N, Lallukka T, Lahti J, Pietiläinen O, Nordquist H, Mänty M, Katainen A, Kouvonen A. Working Conditions and Long-Term Sickness Absence Due to Mental Disorders: A Prospective Record Linkage Cohort Study Among 19- to 39-Year-Old Female Municipal Employees. J Occup Environ Med 2022; 64:105-114. [PMID: 34723911 PMCID: PMC8812422 DOI: 10.1097/jom.0000000000002421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE We examined associations between working conditions and long-term sickness absence due to mental disorders (LTSA-MD) among younger female public sector employees from different employment sectors. METHODS Survey data collected in 2017 (n = 3048) among 19- to 39-year-old female employees of the City of Helsinki, Finland, were used to examine job demands, job control, physical workload, computer work, and covariates. Register data on LTSA-MD were used over 1-year follow-up. Negative binomial regression models were applied. RESULTS Adverse psychosocial and physical working conditions were associated with higher LTSA-MD during the follow-up. Health and social care workers had the highest number of days of LTSA-MD. CONCLUSION Working conditions are important factors when aiming to prevent LTSA-MD among younger employees, in the health and social care sector in particular.
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Affiliation(s)
- Noora Heinonen
- Faculty of Social Sciences, University of Helsinki, Finland (Heinonen, Dr Nordquist, Dr Katainen, and Dr Kouvonen); Department of Public Health, Faculty of Medicine, University of Helsinki, Finland (Dr Olli, Dr Nordquist, and Dr Mänty); South-Eastern Finland University of Applied Sciences, Kotka, Finland (Dr Nordquist); Department of Public Health, Faculty of Medicine, University of Helsinki, Finland; and Unit of strategy and research, City of Vantaa, Vantaa, Finland (Dr Mänty); Centre for Public Health, Queen's University Belfast, UK (Dr Kouvonen)
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Kuklek NM, Cséplő M, Pozsonyi E, Pusztafalvi H. Raising employment and quality of life among people with disadvantages - results of a Hungarian project. BMC Public Health 2021; 21:1729. [PMID: 34556054 PMCID: PMC8461927 DOI: 10.1186/s12889-021-11763-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with disadvantages are a high-risk group of unemployment or underemployment. Disadvantages include disability, under-education, or being a member of a minority, etc. Effective labor market programs could be a key in raising employment and quality of life among this high-risk group of society. The TOP 6.8.2.-15-NA1 project is one of the main Hungarian labor market programs. The project's primary aims are increasing the employability of disadvantaged unemployed and supporting the efficiency of job-seeking. METHODS Our goal was to analyze the effects and methodology of the TOP 6.8.2.-15-NA1 project in Hungary. The sample of our study contains participants of the project (n = 300), based in Zala County, Hungary. RESULTS After 28 days, 53.3% of participants had a job. At the 180th day status, the rate of employed people was 47.3%. We could identify low-educated participants and older participants as higher-risk groups of long-term unemployment. CONCLUSIONS We emphasize the role of these services (job-seeking clubs, organization of job fairs, and mentorship) in the long-term individual success of participants. Improving the employment rate for people with disadvantages is a critical factor for enhancing the quality of life for individuals with disadvantages.
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Affiliation(s)
- Noémi Meisznerné Kuklek
- Faculty of Health Sciences, Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary.
| | - Máté Cséplő
- Faculty of Health Sciences, Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary
| | - Eszter Pozsonyi
- Faculty of Health Sciences, Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary
| | - Henriette Pusztafalvi
- Department of Health Promotion and Public Health, Faculty of Health Sciences, Institute of Health Insurance, University of Pécs, Pécs, Hungary
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10
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Damari B, Sharifi V, Asgardoon MH, Hajebi A. Community Action Package in Iran's Comprehensive Mental and Social Health Services (the SERAJ Program). IRANIAN JOURNAL OF PSYCHIATRY 2021; 16:76-86. [PMID: 34054986 PMCID: PMC8140293 DOI: 10.18502/ijps.v16i1.5382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 07/15/2020] [Accepted: 07/24/2020] [Indexed: 11/24/2022]
Abstract
Objective: The social component of health plays a significant role in improving the mental health of the people of a district. A national program on providing comprehensive social and mental health services, entitled "SERAJ", was developed and piloted in three districts of Iran. The present study aims to determine its model for improving the indicators of the social component of mental health. Method : This study is a system design for which a literature review, interviews with experts, and focused group discussions with stakeholders were used. Results: Community action in promoting the mental health of the districts has three main components: strengthening intersectoral collaboration through the memorandum of understandings (MoU), increasing people's participation by establishing People's Participation House (PPH) with the presence of the representative of current People's network, and social protection of people suffering from mental disorders by establishing the Social Support Unit (SSU) for self-reliance activity. All three components are controlled by the governor and with supervision and technical consult of the health network of the district and stakeholder participation. Conclusion: The model uses the inner capacities of the city instead of creating new structures. The prerequisites for the effective function of the main three components are educating departments, educating members of the PPH, and hiring a social worker at the SSU. The effective measures taken by the departments to reduce the risk factors for mental disorders are dependent on the technical and financial support of relevant organizations at the provincial and national levels.
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Affiliation(s)
- Behzad Damari
- Department of Governance and Health, Neuroscience Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Vandad Sharifi
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Asgardoon
- Department of Governance and Health, Neuroscience Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Iranian Student Society for Immunodeficiencies, Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Hajebi
- Research Center for Addiction and Risky Behaviors (ReCARB), Psychiatric Department, Iran University of Medical Sciences, Tehran, Iran
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11
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Di Thiene D, Mittendorfer-Rutz E, Rahman S, Wang M, Alexanderson K, Tiihonen J, La Torre G, Helgesson M. Trajectories of sickness absence, disability pension and unemployment in young immigrants with common mental disorders. Eur J Public Health 2020; 29:1055-1062. [PMID: 30929006 DOI: 10.1093/eurpub/ckz046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The aims were to elucidate if trajectories of labour market marginalization (LMM), measured as sickness absence (SA)/disability pension (DP) or unemployment, differed between young immigrants and natives before and after an incident diagnosis of a common mental disorder (CMD), and to investigate if educational level, psychiatric comorbidity and duration of residence in Sweden (in immigrants) had different associations with subsequent LMM in natives compared with immigrants. METHODS A total of 28 971 young adults (19-30 years), with an incident CMD (inpatient or specialized outpatient healthcare due to CMDs or dispensed prescribed antidepressants during 2007) were included. Group-based trajectory models were utilized to identify trajectories of annual months of LMM 3 years before and 6 years after the diagnosis. The associations of risk factors with different trajectories were investigated by multinomial logistic regression, χ2-test and Nagelkerke R2 to measure the associations' strength. Immigrants were categorized into Western and non-Western immigrants. RESULTS Young natives and immigrants showed similar trajectories of SA/DP. A higher proportion of non-Western immigrants (20.5%) followed trajectories of high levels of unemployment (>2 annual months) compared with Western immigrants (15%) and natives (16.5%). Educational level and duration of residence in Sweden (in immigrants) discriminated trajectories of both SA/DP and unemployment, whereas psychiatric comorbidity only discriminated trajectories of SA/DP. CONCLUSIONS Differences in trajectories of unemployment between young natives and immigrants with an incident CMD were found. Educational level and psychiatric comorbidity provided information on differences between natives and immigrants and duration of residence gave information for subgroups of immigrants.
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Affiliation(s)
- D Di Thiene
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - E Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - S Rahman
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - M Wang
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - K Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - J Tiihonen
- Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.,Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - G La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - M Helgesson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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12
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Lallukka T, Shiri R, Pietiläinen O, Kausto J, Sumanen H, Halonen JI, Lahelma E, Rahkonen O, Mänty M, Kouvonen A. Timing of Entry into Paid Employment, Adverse Physical Work Exposures and Health: The Young Helsinki Health Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217854. [PMID: 33120885 PMCID: PMC7662500 DOI: 10.3390/ijerph17217854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/12/2020] [Accepted: 10/23/2020] [Indexed: 01/07/2023]
Abstract
It is not well known how the timing of entry into paid employment and physical work exposures contribute to different health outcomes in young employees. Thus, we determined the associations of age at entry into paid employment and physical work exposures with general and mental health in young employees and determined whether associations differ by behavior-related risk factors. Data were collected via online and mailed surveys in autumn 2017 from employees of the City of Helsinki aged 18–39 years (n = 5897; 4630 women and 1267 men, response rate 51.5%). Surveys comprised measures of age at entry into paid employment, seven working conditions, behavior-related risk factors and health outcomes (self-rated health [SRH] and common mental disorders [CMD] as generic indicators of physical and mental health). Logistic regression analysis was used. After full adjustment, age at entry was not associated with the health outcomes; however, in additional analyses, younger age at first employment was associated with smoking and obesity (OR 3.00, 95% CI 2.34–3.85 and 1.67, 95% CI 1.32–2.11 for those started working at age of ≤18 years, respectively). Of the working conditions, sitting and standing were positively associated with poor SRH and CMD and uncomfortable working postures with CMD. Working conditions were broadly similarly associated with health outcomes among those with and without behavior-related risk factors. Although we found little support for modification by behavior-related risk factors, overweight, obesity and smoking were associated with poor SRH and binge drinking and smoking with CMD. Additionally, moderate and high levels of leisure-time physical activity were inversely associated with poor SRH. In conclusion, early entry into paid employment appears not to associate to immediate poorer health in young employees, although it was associated with smoking and obesity even after full adjustment. Exposure to physically heavy work and uncomfortable working postures may increase the risk of adverse health outcomes.
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Affiliation(s)
- Tea Lallukka
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (O.P.); (H.S.); (E.L.); (O.R.); (M.M.)
- Finnish Institute of Occupational Health, P.O. Box 18, 00032 Helsinki, Finland; (R.S.); (J.K.)
- Correspondence: ; Tel.: +358-505-704-399
| | - Rahman Shiri
- Finnish Institute of Occupational Health, P.O. Box 18, 00032 Helsinki, Finland; (R.S.); (J.K.)
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (O.P.); (H.S.); (E.L.); (O.R.); (M.M.)
| | - Johanna Kausto
- Finnish Institute of Occupational Health, P.O. Box 18, 00032 Helsinki, Finland; (R.S.); (J.K.)
| | - Hilla Sumanen
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (O.P.); (H.S.); (E.L.); (O.R.); (M.M.)
- Department of Health Care and Emergency Care, South Eastern Finland University of Applied Sciences, 48220 Kotka, Finland
| | - Jaana I. Halonen
- Department of Health Security, Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland;
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (O.P.); (H.S.); (E.L.); (O.R.); (M.M.)
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (O.P.); (H.S.); (E.L.); (O.R.); (M.M.)
| | - Minna Mänty
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (O.P.); (H.S.); (E.L.); (O.R.); (M.M.)
- Department of Strategy and Research, City of Vantaa, 01030 Vantaa, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, 00014 Helsinki, Finland;
- Research Institute of Psychology, SWPS University of Social Sciences and Humanities, 53-238 Wroclaw, Poland
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Hakulinen C, Böckerman P, Pulkki-Råback L, Virtanen M, Elovainio M. Employment and earnings trajectories before and after sickness absence due to major depressive disorder: a nationwide case-control study. Occup Environ Med 2020; 78:oemed-2020-106660. [PMID: 33051385 DOI: 10.1136/oemed-2020-106660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine employment and earnings trajectories before and after the first sickness absence period due to major depressive disorder (MDD). METHODS All individuals (n=158 813) in Finland who had a first sickness absence period (lasting longer than 9 days) due to MDD between 2005 and 2015 were matched with one randomly selected individual of the same age and gender with no history of MDD. Employment status and earnings were measured using register-based data annually from 2005 to 2015. Generalised estimating equations were used to examine the trajectories of employment and earnings before and after MDD diagnosis in men and women separately. RESULTS Sickness absence due to MDD was associated with increased probability of non-employment during and after the year of the first sickness absence period. In men, but not in women, the probability of being employed was lower 5 years before the sickness absence period due to MDD. When compared with the individuals in the control group, men had around 34% and women 15% lower earnings 1 year, and 40% and 23%, respectively, 5 years, after the first sickness absence period due to MDD. More severe MDD and longer duration of sickness absence period were associated with lower probability of being employed. CONCLUSIONS Sickness absence due to MDD was associated with considerable reduction in employment and earnings losses. For men and individuals with more severe MDD, this reduction was before the first sickness period. This supports a reciprocal association between employment and earnings with MDD.
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Affiliation(s)
- Christian Hakulinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Service System Research Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Petri Böckerman
- Labour Institute for Economic Research, Helsinki, Finland
- School of Business and Economics, University of Jyväskylä, Jyväskylä, Finland
- IZA (Institute for the Study of Labor), Bonn, Germany
| | - Laura Pulkki-Råback
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Department of Child Psychiatry, University of Turku, Turku, Finland
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
- Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marko Elovainio
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Service System Research Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Lallukka T, Mittendorfer-Rutz E, Ervasti J, Alexanderson K, Virtanen M. Unemployment Trajectories and the Early Risk of Disability Pension among Young People with and without Autism Spectrum Disorder: A Nationwide Study in Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072486. [PMID: 32260520 PMCID: PMC7177271 DOI: 10.3390/ijerph17072486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/02/2020] [Indexed: 12/20/2022]
Abstract
Depression and anxiety are associated with unemployment and disability pension, while autism spectrum disorder (ASD) is less studied. We aimed to first identify unemployment trajectories among young adults with and without ASD, and then to examine their social determinants. Finally, we used the trajectories as determinants for subsequent disability pension. We used a population-based cohort, including 814 people who were 19–35 years old, not on disability pension, and who had their ASD diagnosis between 2001 and 2009. A matched reference population included 22,013 people with no record of mental disorders. Unemployment follow-up was the inclusion year and four years after. Disability pension follow-up started after the unemployment follow-up and continued through 2013. We identified three distinctive trajectories of unemployment during the follow-up: (1) low, then sharply increasing (9%,) (2) low (reference, 67%), and (3) high then slowly decreasing (24%). People with ASD had higher odds of belonging belong to the trajectory groups 1 (OR 2.53, 95% CI 2.02–3.18) and 3 (OR 3.60, 95% CI 3.08–4.19). However, the mean number of unemployment days was relatively low in all groups. A disability pension was a rare event in the cohort, although memberships to groups 1 and 3 were associated with the risk of a future disability pension. More knowledge is needed about factors facilitating participation in paid employment among people with ASD.
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Affiliation(s)
- Tea Lallukka
- Department of Public Health, University of Helsinki, P.O.B. 20, 00014 Helsinki, Finland
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden; (E.M.-R.); (K.A.); (M.V.)
- Finnish Institute of Occupational Health, Work Ability and Working Careers, P.O.B. 18, 00032 Helsinki, Finland;
- Correspondence:
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden; (E.M.-R.); (K.A.); (M.V.)
| | - Jenni Ervasti
- Finnish Institute of Occupational Health, Work Ability and Working Careers, P.O.B. 18, 00032 Helsinki, Finland;
| | - Kristina Alexanderson
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden; (E.M.-R.); (K.A.); (M.V.)
| | - Marianna Virtanen
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden; (E.M.-R.); (K.A.); (M.V.)
- School of Educational Sciences and Psychology, University of Eastern Finland, P.O.B. 111, 80101 Joensuu, Finland
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Acevedo P, Mora-Urda AI, Montero P. Social inequalities in health: duration of unemployment unevenly effects on the health of men and women. Eur J Public Health 2019; 30:305-310. [DOI: 10.1093/eurpub/ckz180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AbstractBackgroundEmployment status is an important determinant of health inequalities. The aim of this article is to analyze the association between duration of unemployment and the presence of cardiovascular risk factors, self-perception of health and presence of depression and anxiety, assessing differences in the effects of unemployment by sex and age.MethodsThe sample was composed of 12 123 people (52.4% men), 18 to 74 years old (mean age= 43.5 years, SD = 10.4). Logistic regression analyses were used to study the influence of duration of unemployment on health (‘0 days’, ‘≤11 months’ and ‘≥12 months’). Sex, age, level of education, employment status and time spent unemployed, as well as tobacco and alcohol use and physical activity, were considered. Morbidity variables were hypertension, hypercholesterolemia, diabetes, obesity, depression and anxiety, and a subjective health assessment.ResultsThe results showed both unemployed men and women had worse outcome in health compared with their active counterparts. The risk of hypertension was presented in long-term unemployed men, which had 1.3 times more likely to suffer from hypertension. The risk of obesity was presented only in unemployed women, which had 1.5 times more risk of obesity, doubling the risk (OR= 2.2) among women under age 40. The unemployment had a protective effect against anxiety among younger women (OR = 0.53)ConclusionIt has been observed a different influence of unemployment time on men and women’s health. The employment status should be considered in public health policy agendas with the purpose of reducing inequalities in health.
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Affiliation(s)
- Paula Acevedo
- Physical Anthropology, Biology Department, Autonomous University of Madrid, Madrid, Spain
| | - Ana I Mora-Urda
- Physical Anthropology, Biology Department, Autonomous University of Madrid, Madrid, Spain
| | - Pilar Montero
- Physical Anthropology, Biology Department, Autonomous University of Madrid, Madrid, Spain
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Lallukka T, Kerkelä M, Ristikari T, Merikukka M, Hiilamo H, Virtanen M, Øverland S, Gissler M, Halonen JI. Determinants of long-term unemployment in early adulthood: A Finnish birth cohort study. SSM Popul Health 2019; 8:100410. [PMID: 31193554 PMCID: PMC6535628 DOI: 10.1016/j.ssmph.2019.100410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/09/2019] [Accepted: 05/12/2019] [Indexed: 11/30/2022] Open
Abstract
Cumulative contributions of social and health-related determinants to long-term unemployment during early working life among young adults are poorly understood. Therefore, we used four cumulative indices of both parental and own social and health-related determinants of such unemployment among a cohort which comprised a complete census of children born in Finland in 1987. The cohort participants were registered in the Medical Birth Register, and they were followed-up through 2015 (N = 46 521). We calculated predicted probabilities for long-term unemployment (> 12 months) when participants were 25–28 years. Moreover, we examined whether the associations differed by unemployment at the municipal level. During the follow-up, 4.5% of women and 7.1% of men experienced long-term unemployment. All cumulative indices of parental and own social and health-related determinants predicted the probability of long-term unemployment. The greatest probabilities were observed for own social determinants, both in municipalities with high and low unemployment although the probabilities were higher in the high-unemployment municipalities. Of the individual determinants, poor school performance showed the strongest association with long-term unemployment among women (OR 6.65, 95% CI 5.21–8.55) and men (OR 3.70, 95% CI 2.96–4.67), after adjusting for other own social determinants. The results highlight the importance of life course social equality in the prevention of long-term unemployment in early adulthood. Parental and own social and health-related factors predict long-term unemployment. Particularly poor school performance increases the odds for long-term unemployment. With high municipal unemployment rates, effects of social disadvantage are emphasized. Those better off have a lower risk of unemployment even in high unemployment areas.
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Affiliation(s)
- Tea Lallukka
- Department of Public Health, University of Helsinki, Finland.,Finnish Institute of Occupational Health, Helsinki, Finland
| | - Martta Kerkelä
- National Institute for Health and Welfare, Department of Welfare, Children, Adolescents and Families Unit, Oulu, Finland.,Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Finland
| | - Tiina Ristikari
- National Institute for Health and Welfare, Department of Welfare, Children, Adolescents and Families Unit, Oulu, Finland.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland
| | - Marko Merikukka
- National Institute for Health and Welfare, Department of Welfare, Children, Adolescents and Families Unit, Oulu, Finland
| | - Heikki Hiilamo
- Department of Social Research, Social and Public Policy, University of Helsinki, Helsinki, Finland
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Simon Øverland
- Division of Physical and Mental Health, Norwegian Institute of Public Health, Norway.,Department of Psychosocial Science, University of Bergen, Norway
| | - Mika Gissler
- National Institute for Health and Welfare, Department of Information Services, Statistics and Registers Unit, Helsinki, Finland.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Stockholm, Sweden
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