Jesper Löve

Pushing Oneself Too Hard : Performance-Based Self-Esteem as a Predictor of Sickness Presenteeism Among Young Adult Women and Men-A Cohort Study

Objective: To examine whether young adults with highly performance-based self-esteem (PBSE) were present at work/studies when ill more frequently than were others. Methods: By using data from a Swedish cohort of young adults aged 20 to 25 years (n = 5582 at baseline), we examined the association between PBSE and sickness presenteeism (SP) >5 times/yr (retrospectively at 1-year follow-up). Results: PBSE was a predictor of SP even when adjusting for general health, psychological demands, physical demands, economic problems, and main occupation. A synergy effect was also observed between PBSE and environmental and personal factors in relation to SP. The effect of PBSE on SP was four times higher among individuals with poor health, compared to individuals with good health. Conclusions: These results provide support for the role of personality characteristics as a predictor of frequent SP.

Can work ability explain the social gradient in sickness absence: a study of a general population in Sweden

BackgroundUnderstanding the reasons for the social gradient in sickness absence might provide an opportunity to reduce the general rates of sickness absence. The complete explanation for this social gradient still remains unclear and there is a need for studies using randomized working population samples. The main aim of the present study was to investigate if self-reported work ability could explain the association between low socioeconomic position and belonging to a sample of new cases of sick-listed employees.MethodsThe two study samples consisted of a randomized working population (n = 2,763) and a sample of new cases of sick-listed employees (n = 3,044), 19-64 years old. Both samples were drawn from the same randomized general population. Socioeconomic status was measured with occupational position and physical and mental work ability was measured with two items extracted from the work ability index.ResultsThere was an association between lower socioeconomic status and belonging to the sick-listed sample among both women and men. In men the crude Odds ratios increased for each downwards step in socioeconomic status, OR 1.32 (95% CI 0.98-1.78), OR 1.53 (1.05-2.24), OR 2.80 (2.11-3.72), and OR 2.98 (2.27-3.90). Among women this gradient was not as pronounced. Physical work ability constituted the strongest explanatory factor explaining the total association between socioeconomic status and being sick-listed in women. However, among men, the association between skilled non-manual, OR 2.07 (1.54-2.78), and non-skilled manual, OR 2.03 (1.53-2.71) positions in relation to being sick-listed remained. The explanatory effect of mental work ability was small. Surprisingly, even in the sick-listed sample most respondents had high mental and physical work ability.ConclusionsThese results suggest that physical work ability may be an important key in explaining the social gradient in sickness absence, particularly in women. Hence, it is possible that the factors associated with the social gradient in sickness absence may differ, to some extent, between women and men.

Balancing extensive ambition and a context overflowing with opportunities and demands: A grounded theory on stress and recovery among highly educated working young women entering male-dominated occupational areas

Several factors underline the issue of stress-related health among young highly educated women. Major societal changes might provide more new challenges with considerably changed and expanded roles than were expected by earlier generations, especially among women. The quantity of young women with higher education has also increased threefold in Sweden in less than two decades and there are a growing number of young women that hereby break with traditional gender positions and enter new occupational areas traditionally dominated by men. The research questions in the present study were: “What is the main concern, regarding stress and recovery, among young highly educated working women breaking with traditional gender positions and entering male-dominated occupational areas?” and “How do they handle this concern?” We conducted open-ended interviews with 20 informants, aged 23–29 years. The results showed that the synergy between highly ambitious individuals and a context overflowing with opportunities and demands ended up in the informants’ constantly striving to find a balance in daily life (main concern). This concern refers to the respondents experiencing a constant overload of ambiguity and that they easily became entangled in a loop of stress and dysfunctional coping behavior, threatening the balance between stress and sufficient recovery. In order to handle this concern, the respondents used different strategies in balancing extensive ambition and a context overflowing with opportunities and demands (core category). This preliminary theoretical model deepens our understanding of how the increasing numbers of highly educated young women face complex living conditions endangering their possibility of maintaining health and work ability.

Health care professionals' experience-based understanding of individuals' capacity to work while depressed and anxious

Abstract Aim: The meaning of capacity to work while depressed and anxious is not well comprehended. The aim of this study was to explore and describe health care professionals’ experience-based understanding of capacity to work in individuals with depression and/or anxiety disorders. Method: An exploratory qualitative design was used. Four focus groups were conducted with 21 professionals from psychiatric, occupational, and primary health care. Data were analysed using inductive content analysis. Results: Capacity to work while depressed and anxious was understood as a change from the familiar to a no longer recognizable performance at work. Managing time, daily work demands, and emotions was described as difficult for the patients, and capacity to work could be fragmented by anxiety attacks. Patients were perceived as continuing to work while life outside work crumbled. Capacity to work was described as part of a greater whole, the work community, and the patient’s participation in the work community was considered problematic. Conclusions. The findings provide a deeper understanding of the reduced capacity to work compared with theoretical or medico-administrative descriptions. Applied to patient encounters it could promote fitness-for-work dialogues, rehabilitation, and tailor-made work interventions.

Mental disorders and stress resilience in adolescence and long-term risk of early heart failure among Swedish men

BACKGROUND Recent research suggests that the prevalence of early heart failure may be on the rise. Compromised mental health in adolescence may help to explain this phenomenon. We aimed to investigate whether nonpsychotic mental disorder and low stress resilience in late adolescence were associated with increased risk of early heart failure. METHODS A prospective cohort study of 18-year-old men (n=1,784,450) who enlisted 1968-2005. At the conscription examination, 74,522 individuals were diagnosed with nonpsychotic mental disorders. Stress resilience was rated by psychologists; values were trichotomized. The risk of heart failure during the 46-year follow-up was calculated with Cox proportional hazards models. Baseline comorbidities, BMI, blood pressure, fitness, IQ, and parental education were included in the models. RESULTS Incident cases of heart failure (n=9962) were identified in the National Hospital Register. In fully adjusted models, increased risk of early heart failure was observed in males diagnosed with nonpsychotic mental disorders at conscription (hazard ratio (HR), 1.36; 95% confidence interval (CI), 1.25-1.47). The highest risk was seen among men with the risk factor alcohol/substance use (HR 1.90; 95% CI 1.59-2.28). Conscripts with the risk factor low stress resilience showed increased risk of heart failure compared to those with high scores (HR 1.41; 95% CI 1.30-1.53). CONCLUSION Nonpsychotic mental disorder, as well as low stress resilience in late adolescence may be associated with increased risk of early heart failure. Adolescence is potentially an important time for mental health interventions that may reduce both short and long-term consequences.

Future marginalisation and mortality in young Swedish men with non-psychotic psychiatric disorders and the resilience effect of cognitive ability: a prospective, population-based study

Objective Large-scale studies examining future trajectories of marginalisation and health in adolescents with mental illness are scarce. The aim of this study was to examine if non-psychotic psychiatric disorders (NPDs) were associated with future indicators of marginalisation and mortality. We also aimed to determine whether these associations might be mediated by education level and attenuated by high cognitive ability. Design This is a prospective cohort study with baseline data from the Swedish Conscription register. Setting The study was carried out in Sweden from 1969 to 2005. Participants All of the participants were 18-year-old men at mandatory conscription in Sweden between 1969 and 2005 (n=1 609 690). Measures NPDs were clinically diagnosed at conscription. Cognitive ability was measured by a standardised IQ test at conscription. National register data covered information on welfare support, long-term unemployment, disability pension (DP) and mortality over a period of 1–36 years. Results NPD at the age of 18 years was a predictor of future welfare support, OR 3.73 (95% CI 3.65 to 3.80); long-term unemployment, OR 1.97 (95% CI 1.94 to 2.01); DP, HR 2.95 (95% CI 2.89 to 3.02); and mortality, HR 2.45 (2.33–2.52). The adjusted models suggested that these associations were not confounded by fathers’ educational level, cognitive ability had only a minor attenuating effect on most associations and the mediating effect of own educational level was small. Conclusions The present study underlines a higher prevalence of future adversities in young men experiencing NPDs at the age of 18 years. It also indicates that higher cognitive ability may work as a potential resilience factor against future marginalisation and mortality.

Remain in work--what work-related factors are associated with sustainable work attendance: a general population-based study of women and men.

Objective: To analyze if organizational climate and work commitment, demand and control, job strain, social support, and physical demands at work are associated with remain in work (RIW), that is, work attendance without sick leave over 15 days per year. Methods: This Swedish cross-sectional study was based on 4013 workers (aged 19 to 64 years), randomly selected from a general population. Data were collected (2008) through postal questionnaire and registers. Results: Fair organizational climate, the combination of fair organizational climate and fair work commitment, high control, and low physical demands were associated with RIW for women and men. Conclusions: This study adds to the rather scarce research findings on factors that promote RIW by identifying work organizational factors and physical prerequisites as being important. Preventive work to create a healthy work environment could be directed at improving organizational climate and reducing physical demands.

Frequent headache and work ability: a population-based study in Sweden.

Objective: The aim of this study was to analyze the association between frequent headache and self-reported mental and physical work ability in a general population sample in Sweden. Methods: The study was conducted in western Sweden in 2008. Frequent headache was analyzed in relation to mental and physical work ability. Covariates included demographics and socioeconomic variables, work-related variables, and a symptom index. Self-reported and register-based sickness absence data were also analyzed. Results: Sixteen per cent of those who answered the question about headache (n = 2590) had frequent headache (at least once a week). Regression analyses showed that frequent headache sufferers were twice more likely to have poor mental and physical work ability than those having infrequent headache. Conclusions: Frequent headache was associated with poor mental and physical work ability but not with sickness absence.

Soil-transmitted Helminth infection in the Tiko Health District, South West Region of Cameroon: a post-intervention survey on prevalence and intensity of infection among primary school children

Introduction Soil-transmitted helminths (STH) infection remains a public health problem in sub-Saharan Africa with children being most vulnerable. STH infection may result in impairment, permanent disability or death. Annual mass deworming has been implemented in the Tiko Health District (THD), however, no study has assessed the current prevalence of STH infection. This study aimed to determine the prevalence, intensity of STH infections and associated risk factors among school children. Methods Two months after the school deworming exercise, 400 children were sampled from 10 schools in THD. Stool samples were collected and analyzed using the Kato-katz technique. Data on socio-demographic and behavioral factors were collected using questionnaires. Data were analyzed using SPSS and intensity of infection categorized following WHO recommendations. Descriptive data were calculated with frequencies (n) and proportions (%), prevalence and 95% confidence interval calculated for gender and age respectively. Differences in prevalence for socio-demographic characteristics and behavioral variables were calculated with Chi square (χ2). Independent sample t-test was used to compare the means in the number of eggs in feces between male and female school children. Results The prevalence of STH was 1% (95% CI: 0.02-1.98). Ascaris lumbricoides was the only STH species detected and all cases were of low intensities. The arithmetic mean egg intensity was 3.1egg per gram of faeces. Rates of infection were similar between gender and age. Site of defecation showed an association with STH infection (χ2 = 13.63, p=0.03). Conclusion These findings suggested a low prevalence of STH infection which could be explained by the prior deworming of children, modification in environmental and behavioral factors. Questions on effectiveness of annual mass deworming in achieving STH elimination targets need to be investigated further.

Cause-specific mortality in Swedish males diagnosed with non-psychotic mental disorders in late adolescence: a prospective population-based study

Background While risk of premature death is most pronounced among persons with severe mental illness, also milder conditions are associated with increased all-cause mortality. We examined non-psychotic mental (NPM) disorders and specific causes of natural death in a cohort of late adolescent men followed for up to 46 years. Methods Prospective cohort study of Swedish males (n=1 784 626) who took part in structured conscription interviews 1968–2005. 74 525 men were diagnosed with NPM disorders at or prior to conscription. Median follow-up time was 26 years. HRs for cause-specific mortality were calculated using Cox proportional hazards models. Results Risks in fully adjusted models were particularly elevated for death by infectious diseases (depressive and neurotic/adjustment disorders (HR 2.07; 95% CI 1.60 to 2.67), personality disorders (HR 2.90; 95% CI 1.96 to 4.28) and alcohol-related and other substance use disorders (HR 9.02; 95% CI 6.63 to 12.27)) as well as by gastrointestinal causes (depressive and neurotic/adjustment disorders (HR 1.64; 95% CI 1.42 to 1.89), personality disorders (HR 2.77; 95% CI 2.27 to 3.38) and alcohol-related/substance use disorders (HR 4.41; 95% CI 3.59 to 5.42)). Conclusion Young men diagnosed with NPM disorders had a long-term increased mortality risk, in particular due to infectious and gastrointestinal conditions. These findings highlight the importance of early preventive actions for adolescents with mental illness.