Jan F. Nygård

Prevalence, incidence and age at onset of psychiatric disorders in Norway

Abstract  Background: Increased demands for psychiatric services and increased rates of sickness absence for depression have raised the question of the occurrence of psychiatric disorders in Norway, and whether there is in fact a rising incidence rate. Methods: Between 1989–1991, 2015 and 617 persons participated in a two-phase population study. Phase I comprised screening by the Hopkins Symptom Check List 25 items (HSCL-25), and phase II a diagnostic interview by the Composite International Diagnostic Interview (CIDI), including report of date (year) of the first occurrence of any symptoms, and any consequent diagnosis: Results: A symptom score of 1.75 or more was found in 19.8% of the women and 9.3% of the men by the HSCL-25. Depression, anxiety or somatoform disorder by CIDI was found in 21.5% of the women and 11.5% of the men. The incidence rate increased significantly from 3.3 to 12.8 per 1000 person years from 1930 to 1991. The incidence rate in the year before the interview was 42.6 per 1000 person years. Age of onset became lower. More women became ill, but the illness seemed to last longer in men. A major problem in comparing results between studies is the different concepts and operationalisations of psychiatric illness, and the varying time periods given for estimates. Conclusion: The findings provide evidence of psychiatric illness being a rising and major health problem, but the role of recall bias must be further investigated.

Sickness absence with psychiatric disorders--an increased risk for marginalisation among men?

Abstract  Background: Sickness absence with psychiatric disorders is a major public health problem with serious consequences for the individual, the employer and society. The aim was to assess the occurrence of psychiatric sickness absence with special focus on sex differences. Methods: A nationwide sickness insurance register was used. Population at risk was defined as all individuals entitled to sickness benefits in 1994 (N = 1,978,030). Those who were sick-listed for more than 14 consecutive days with a psychiatric diagnosis (n = 28,799) were selected as cases. Results: Of the population under study, 1.46% had at least one psychiatric sickness absence episode. Women had twice the male cumulative incidence of sickness absence for a psychiatric diagnosis. Cumulative incidence was highest among those aged 45–59 years. Men had more sickness absence days. Depression was the most common diagnosis among both women and men. Conclusion: Increased efforts are needed to recognise, treat and rehabilitate individuals with a lowered work capacity due to sickness absence. The increased risk of long sick-leave spells among men needs further attention.

Back to work: predictors of return to work among patients with back disorders certified as sick: a two-year follow-up study.

Study Design. A 2-year follow-up study of patients with back disorders certified as sick. Objectives. To identify predictors of return to work. Summary of Background Data. Back disorders are common health problems and the most important disorders associated with absence from work in the welfare states. Predictors of future absence may be of help in allocating rehabilitation efforts to such patients. Possible predictors include demographic and medical factors, the patients’ functional status, and former absence. Methods. For this study, 190 patients certified as sick who attended a back disorder outpatient clinic from September 1997 to December 1998 answered a questionnaire. Demographic data, medical factors, self-assessed function, and absence data were recorded. Return to work, defined as returning to work for at least 60 consecutive calendar days, was used in Cox regression analyses. Results. According to multiple Cox regression analyses, age of 40 to 49 years (HR, 0.52; 95% confidence interval [95%CI], 0.29–0.94), high pain intensity (HR, 0.30; 95%CI, 0.17–0.55), low self-assessed work ability (HR, 0.43; 95%CI, 0.25–0.73), and a self-predicted absence status of not returning to work (HR, 0.31; 95%CI, 0.17–0.54) predicted longer time until return to work. Back disorders with radiation predicted shorter time until return to work (HR, 2.08; 95%CI, 1.37–3.16). The COOP/WONCA chart’s physical fitness, daily activities, overall health, and change in health were associated with time until return to work in univariate analyses only, as was the duration of the sickness certification episodes from start to inclusion and the degree of sickness certification at inclusion. Conclusions. Information about the age of the patients, diagnoses, pain intensity, self-assessed work ability, and self-predicted absence status may be used as predictors of time until return to work in patients with back disorders certified as sick who attend a back disorder outpatient clinic.

Changes in body mass index by age, gender, and socio-economic status among a cohort of Norwegian men and women (1990–2001)

BackgroundConsistent with global trends, the prevalence of obesity is increasing among Norwegian adults. This study aimed to investigate individual trends in BMI (kg/m2) by age, gender, and socio-economic status over an 11-year period.MethodsA cohort of 1169 adults (n = 581 men; n = 588 women) self-reported BMI during a general health interview twice administered in two regions in Norway.ResultsAverage BMI increased significantly from 23.7 (SD = 3.4) to 25.4 (SD = 3.8), with equivalent increases for both genders. Proportion of obesity (BMI ≥ 30) increased from 4% to 11% for women and 5% to 13% for men. Of those already classified as overweight or obese in 1990, 68% had gained additional weight 10 years later, by an average increase of 2.6 BMI units. The greatest amount of weight gain occurred for the youngest adults (aged 20–29 years). Age-adjusted general linear models revealed that in 1990, women with a lower level of education had a significantly greater BMI than more educated women. In both 1990 and 2001, rural men with the highest level of household income had a greater BMI than rural men earning less income. Weight gain occurred across all education and income brackets, with no differential associations between SES strata and changes in BMI for either gender or region.ConclusionResults demonstrated significant yet gender-equivalent increases in BMI over an 11-year period within this cohort of Norwegian adults. Whereas socio-economic status exerted minimal influence on changes in BMI over time, young adulthood appeared to be a critical time period at which accelerated weight gain occurred.

Emotional distress as a predictor for low back disability: a prospective 12-year population-based study.

Study Design. A population-based, prospective cohort. Objective. To study associations between emotional distress and long-term low back disability in a general population. Summary of Background Data. In primary and hospital care studies, emotional, cognitive, and personality factors have been associated with low back disability, while the association between distress and novel back pain episodes has been uncertain. Methods. A randomly drawn cohort of 1152 occupationally active persons aged 20–55 years was interviewed with a comprehensive psychosocial questionnaire in 1990, and was followed for 12 years in national registers over sickness, rehabilitation, and disability benefits. Data on emotional distress, earlier low back pain (LBP), education, life style, psychosocial, and work-related factors were collected at baseline. Results. Long-term benefits due to low back disability were granted to 131 persons (11.4%) in the follow-up period. In multivariate analysis, earlier LBP, emotional distress, low grade of education, and high physical job stress were associated with low back disability. Persons with both emotional distress and earlier back pain were most at risk for disability (hazard ratio 2.91, 95% confidence interval 1.60–5.29). Persons with emotional distress but no earlier episodes of LBP had no increased risk for low back disability (hazard ratio 0.71, 95% confidence interval 0.34–1.45). Conclusions. Emotional distress is a predictor for low back disability in persons with earlier LBP, but not in persons without. To prevent low back disability, emotional distress should be considered and treated in persons with LBP.

Is women's mental health more susceptible than men's to the influence of surrounding stress?

Abstract.Background:Most epidemiological population studies have demonstrated that women suffer more anxiety and depression than men. A higher level of stress, greater vulnerability to stress, and a non-additive effect of private/domestic and occupational obligations on women have been suggested as an explanation.Objective:The objective of this study was to examine if women’s mental health is more susceptible than men’s to the influence of surrounding stress.Material and method:A cross-sectional, random sample of the population resulted in 651 men and 626 women, all of whom were employed, participating in the study. Participants were interviewed using face-to-face standardized questionnaires.Results:Younger women experienced more stressful relationship events, illness events and network events than men of the same age. Relationship events were more important for men as they grew older, and interacted with other stress to increase anxiety and depression symptoms. Stressful illness events were more strongly related to anxiety/depression symptoms in women over 40 than in men of the same age, and interacted with work stress to increase symptom scores.Conclusion:Stress was more strongly related to symptoms in women, suggesting that they may have a greater susceptibility to surrounding stress, and to somatic illness stress. This might contribute to the sex difference in psychiatric illness.

Relation between health problems and sickness absence: gender and age differences A comparison of low-back pain, psychiatric disorders, and injuries

Women have higher long-term sickness absence rates than men, and higher rates of most health problems. The rates vary with type of problem and diagnosis. The objectives were to examine whether equal proportions of women and men had sickness absence when they had a given health problem, and if disparities were diagnosis specific. Prevalence of low-back pain, psychiatric disorders, and injuries was assessed in random samples of two populations in Norway. Prevalence of long-term sickness absence for the same diagnostic categories was estimated for the same time period (1990). For injuries, the prevalence ratios between a health problem and a sickness absence were equal for women and men. For psychiatric health problems, there were 1.7 more women than men behind each sickness absence. Low-back pain showed an intermediate gender ratio of 1.3, indicating that also for this condition women tended to have less sickness absence. Musculoskeletal and psychiatric health problems (fluctuating, chronic) may result in more gender-biased, subjective, and random assessment of work ability than injuries (acute health problem).

Self-reported work ability of Norwegian women in relation to physical and mental health, and to the work environment

ObjectivesTo examine the self-reported level of work ability among female employees and the relationship between work ability and demographic characteristics, physical health, mental health, and various psychosocial and organizational work environment factors.MethodsParticipants were 597 female employees with an average age of 43 years from urban and rural areas in Norway. Trained personnel performed a structured interview to measure demographic variables, physical health, and characteristics of the working environment. Mental health was assessed using the 25-item version of the Hopkins Symptoms Checklist (HSCL-25). Work ability was assessed using a question from the Graded Reduced Work Ability Scale.ResultsOf the 597 female employees, 8.9% reported an extremely or very reduced ability to work. Twenty-four percent reported poor physical health and 21.9% reported mental distress (≥ 1.55 HSCL-25 cut-off). Women, who reported moderately and severely reduced work ability, did not differ a lot. Moderately reduced work ability increased with age and was associated with physical and mental health. Severely reduced work ability was strongly associated only with physical health and with unskilled occupation. Of eight work environment variables, only three yielded significant associations with work ability, and these associations disappeared after adjustment in the multivariate analysis.ConclusionResults indicate that ageing, in addition to poor self-reported physical health and unskilled work, were the strongest factors associated with reduced work ability among female employees. Impact of work environment in general was visible only in univariate analysis.

The impact of psychosocial and organizational working conditions on the mental health of female cleaning personnel in Norway

BackgroundThis study examined the association between psychosocial and organizational work conditions and mental health among women employed in the cleaning profession in Norway.MethodsSelf-report questionnaires were mailed to 661 cleaning staff personnel from seven cleaning organizations in seven different cities across Norway. The response rate was 64%, of which 374 (88%) respondents were women. The questionnaires assessed socio-demographic information and employment history, work organization, and psychosocial working conditions. The Hopkins Symptoms Checklist (HSCL-25) was included to assess mental health.ResultsOn average, respondents were 43 years old and reported 10.8 years of experience working in the cleaning industry. The proportion of women scoring a HSCL-25 equal to or above 1.75 was 17.5%, which was higher than the average prevalence of mental health problems among working Norwegian women (8.4%). A factor analysis of the questions specific to the psychosocial work environment identified the following four underlying dimensions: leadership, co-workers, time pressure/control, and information/knowledge. Two of these, poor satisfaction with leadership (OR = 3.6) and poor satisfaction with co-workers (OR = 2.3), were significantly related to mental health. In addition, having contact with colleagues less than once a day (OR = 2.4) and not being ethnically Norwegian (OR = 3.0) increased the risk for mental health problems.ConclusionMental health problems are frequent among female cleaning professionals in Norway. Our results indicate that quality of leadership, collaboration with co-workers, and ethnicity were significantly associated with mental health.

Job demands, job control, and mental health in an 11-year follow-up study: Normal and reversed relationships

Abstract Despite numerous studies of the demand-control model, there is a need for more longitudinal studies to test not only the normal, but also the reversed and reciprocal relationships between work characteristics and mental health. There is also a need for more studies of the multiplicative interaction between demands and control with respect to mental health, which is different from the simple additive effect of the two variables. This is a longitudinal study with an exceptionally long period of follow-up (11 years), with the focus on normal as well as reciprocal and reversed causality between work characteristics and mental health, as measured by reliable instruments close to the original definitions of Karasek. The study was based on a sample of 439 Norwegian employees of different occupations who had stayed in the same profession during the follow-up period. The results were in agreement with the hypothesis that low job control, and in particular low control in combination with high demands (“high strain jobs”), has a negative effect on mental health. There was a significant multiplicative interaction between demands and control, indicating a “buffering” effect of job control. Job demands alone were not significantly associated with mental health. The reversed relationship hypothesis was supported for job demands, but not for job control.