Karsten Thielen
University of Copenhagen
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Featured researches published by Karsten Thielen.
Journal of Epidemiology and Community Health | 2009
Ingelise Andersen; Karsten Thielen; Else Nygaard; Finn Diderichsen
Background: Uncertainties exist about the strength of the relation between socioeconomic position and depressive disorders. The aim of this study was to investigate the association between education, occupation, employment and income and depressive disorders measured as minor and major depression, as well as antidepressant prescriptions. Methods: Data were collected from a Danish cross-sectional study collected year 2000, comprising 9254 subjects, 55% women, and aged 36–56 years. Register-based information on education, income and prescription were used. Results: The prevalence of major depression DSM-IV algorithm was 3.3% among men and women, whereas minor depression and prescriptions revealed statistically significant higher prevalence among females. A social gradient was found for all depressive end-points with the strongest estimates related to major depressive disorder (MDD). The associations were as follows: MDD and low education odds ratio (OR) 2.38 (CI 95% 1.68 to 3.37), MDD and non-employment OR 11.67 (CI 95% 8.06 to 16.89), MDD and low income OR 9.78 (CI 95% 6.49 to 14.74). Education only explained a minor part of the association between non-employment and depressive disorders and no associations were found between education and prescription. This indicates a strong two-way association between depression and non-employment, low-income respectively. Conclusion: A social gradient in depressive disorders was found regardless of socioeconomic position being measured by education, occupation, employment or income. Severe socioeconomic consequences of depression are indicated by the fact that the associations with non-employment and low income were much stronger than the association with low education.
Scandinavian Journal of Public Health | 2011
Ingelise Andersen; Karsten Thielen; Per Bech; Else Nygaard; Finn Diderichsen
Aim: Depression is the leading cause of disability and is projected to become the second highest burden of disease (measured in disability-adjusted life years) by 2020, but only a few studies have examined changes over time in the occurrence of depression. The aim of this study is to provide evidence to the hypothesis that the prevalence of depression is rising in the Danish population. We will do that in a longitudinal design among adult Danes by studying the trends from 2000 to 2006 of major depressive disorder (MDD) as well as the distribution across the whole Major Depression Inventory (MDI) scale. In addition, we will investigate whether the trend in MDD is similar across socioeconomic groups. Methods: A random sample of 4759 Danes in their forties and fifties were followed in a longitudinal study based on postal questionnaires answered in 2000 and 2006. Results: The prevalence of MDD increased from 2.0% to 4.9% during 2000–06. Also the distribution of the MDI score in its entirety moves higher up the scale, with the 90th percentile changing from 12 in year 2000 to 20 in 2006. The increasing prevalence is in absolute terms more pronounced among women in their forties and in lower socioeconomic positions. Conclusions: The rising MDI score indicates that MDD as well as mental health generally is of public health concern.
Journal of Aging and Health | 2014
Ulla Christensen; Rikke Krølner; Charlotte Juul Nilsson; Pernille W Lyngbye; Charlotte Ørsted Hougaard; Else Nygaard; Karsten Thielen; Bjørn Evald Holstein; Kirsten Avlund; Rikke Lund
Objective: To present the Danish Occupational Social Class (DOSC) measurement as a measure of socioeconomic position (SEP) applicable in a late midlife population, and to analyze associations of this measure with three aging-related outcomes in midlife, adjusting for education. Method: Systematic coding procedures of the DOSC measurement were applied to 7,084 participants from the Copenhagen Aging and Midlife Biobank (CAMB) survey. We examined the association of this measure of SEP with chronic conditions, self-rated health, and mobility in logistic regression analyses, adjusting for school education in the final analysis. Results: The measure of SEP showed a strong social gradient along the social classes in terms of prevalence of chronic conditions, poor self-rated health, and mobility limitations. Adjusting for school education attenuated the association only to a minor degree. Discussion: The DOSC measure was associated with aging-related outcomes in a midlife Danish population, and is, thus, well suited for future epidemiological research on social inequalities in health and aging.
Journal of Epidemiology and Community Health | 2010
Reiner Rugulies; Karsten Thielen; Else Nygaard; Finn Diderichsen
Background: A study was undertaken to investigate whether job insecurity predicts incident use of antidepressant medication and whether the association is modified by a history of prolonged unemployment. Methods: A prospective follow-up study was performed in 5142 Danish employees, including 632 employees with and 4510 without a history of prolonged unemployment. Participants were drawn from a random 10% sample of the Danish population. Survey data on job insecurity were linked with register data on history of unemployment and dispensing of antidepressant medication between June 2000 and December 2003 retrieved from the Danish Medicinal Product Statistics. Respondents with major depression at baseline or antidepressant use in the 5 years preceding baseline were excluded. Results: Job insecurity predicted use of antidepressants after adjustment for sex, age, cohabitation, socioeconomic position and alcohol consumption (OR 1.43, 95% CI 1.09 to 1.88). The effect was attenuated after further adjustment for baseline depressive symptoms (OR 1.15, 95% CI 0.87 to 1.52). A history of prolonged unemployment predicted use of antidepressants in both models (OR 1.62, 95% CI 1.14 to 2.30 and OR 1.49, 95% CI 1.04 to 2.13, respectively) Compared with participants with neither job insecurity nor unemployment history, the OR for the joint effect of job insecurity and history of prolonged unemployment was substantially higher (OR 1.79, 95% CI 1.15 to 2.79) than the OR for job insecurity (OR 1.02) and unemployment history (OR 1.10) alone in the fully adjusted model. Conclusion: Job insecurity predicts incident use of antidepressants among Danish employees with a history of prolonged unemployment.
Acta Psychiatrica Scandinavica | 2009
Karsten Thielen; Else Nygaard; Irene Andersen; Reiner Rugulies; Eskil Heinesen; Per Bech; Ute Bültmann; Finn Diderichsen
Objective: To study the degree to which depression indicators based on register data on hospital and antidepressant treatment suffer from differential misclassification with respect to gender, age and social group.
International Journal of Health Services | 2011
Paula Holland; Lotta Nylén; Karsten Thielen; Kjetil A. van der Wel; Wen-Hao Chen; Ben Barr; Bo Burström; Finn Diderichsen; Espen Dahl; Sharanjit Uppal; Stephen Clayton; Margaret Whitehead
The authors investigate three hypotheses on the influence of labor market deregulation, decommodification, and investment in active labor market policies on the employment of chronically ill and disabled people. The study explores the interaction between employment, chronic illness, and educational level for men and women in Canada, Denmark, Norway, Sweden, and the United Kingdom, countries with advanced social welfare systems and universal health care but with varying types of active and passive labor market policies. People with chronic illness were found to fare better in employment terms in the Nordic countries than in Canada or the United Kingdom. Their employment chances also varied by educational level and country. The employment impact of having both chronic illness and low education was not just additive but synergistic. This amplification was strongest for British men and women, Norwegian men, and Danish women. Hypotheses on the disincentive effects of tighter employment regulation or more generous welfare benefits were not supported. The hypothesis that greater investments in active labor market policies may improve the employment of chronically ill people was partially supported. Attention must be paid to the differential impact of macro-level policies on the labor market participation of chronically ill and disabled people with low education, a group facing multiple barriers to gaining employment.
Occupational and Environmental Medicine | 2011
Karsten Thielen; Else Nygaard; Reiner Rugulies; Finn Diderichsen
Objectives To investigate if exposure to adverse psychological job characteristics predicts incident use of antidepressants, taking into account differential misclassification and residual confounding. Methods A prospective cohort study with a 3.5-year follow-up of 4661 Danish employees, aged 40 and 50 years, drawn from a 10% random sample of the Danish population was carried out. Job characteristics were the predictor variables and use of antidepressants was the outcome variable. Survey data on psychosocial work environment were linked with register data on dispensing of antidepressant medicine between June 2000 and December 2003. Respondents with major depression at baseline, with antidepressant use in the 5 years preceding baseline, or not employed at baseline were excluded. Results Among men, the OR for antidepressant use was significantly increased for high quantitative demands (OR 2.12, 95% CI 1.29 to 3.48) and low social support from colleagues (OR 2.28, 95% 1.36 to 3.82) after adjustment for lifestyle factors, socio-demographic factors, co-morbidity, other work factors and depressive symptoms at baseline. Both effects were dose dependent. An interaction effect with high demands was found for high anticipated private social support and living with children. Among women, no effect of job characteristics on antidepressant use was found. Conclusion Among men, but not among women, high quantitative demands and low social support from colleagues were predictive of incident use of antidepressants, indicating incident depressive episodes, even after taking into account differential misclassification and residual confounding. The effects were buffered for those with high anticipated private social support and for those having children.
European Journal of Public Health | 2014
Karsten Thielen; Else Nygaard; Ingelise Andersen; Finn Diderichsen
BACKGROUND Denmark, like other Western countries, is recently burdened by increasingly high social spending on employment consequences caused by ill mental health. This might be the result of high work demands affecting persons with ill mental health. Therefore, this study assesses to what extent depressive symptoms and high work demands, individually and combined, have an effect on employment consequences. METHODS We conducted a population-based 7-year longitudinal follow-up study with baseline information from the year 2000 on socio-demographics, lifestyle, depressive symptoms and work demands. In total, 5785 employed persons, aged 40 and 50 years, were included. Information about employment status, sick leave and work disability was obtained from registers. Logistic regression models were used to measure separate and combined effects of depressive symptoms and work demands on job change, unemployment and sick leave during 2001-02 and work disability during 2003-07. RESULTS After adjustment for covariates, high physical work demands and depressive symptoms had a graded effect on subsequent unemployment, sick leave and permanent work disability. Persons with both depressive symptoms and high physical demands had the highest risks, especially for sick leave, but the combined effect did not exceed the product of single effects. Persons who perceived high amount of work changed job significantly more frequently. CONCLUSION Persons with depressive symptoms might have an increased risk of negative employment consequences irrespective of the kind and amount of work demands. This might be an effect on the level of work ability in general as well as partly the result of health selection and co-morbidity.
International Journal of Health Services | 2012
Kjetil A. van der Wel; Espen Dahl; Karsten Thielen
In comparative studies of health inequalities, public health researchers have usually studied only disease and illness. Recent studies have also examined the sickness dimension of health, that is, the extent to which ill health is accompanied by joblessness, and how this association varies by education within different welfare contexts. This research has used either a limited number of countries or quantitative welfare state measures in studies of many countries. In this study, the authors expand on this knowledge by investigating whether a regime approach to the welfare state produces consistent results. They analyze data from the European Union Statistics on Income and Living Conditions (EU-SILC); health was measured by limiting longstanding illness (LLSI). Results show that for both men and women reporting LLSI in combination with low educational level, the probabilities of non-employment were particularly high in the Anglo-Saxon and Eastern welfare regimes, and lowest in the Scandinavian regime. For men, absolute and relative social inequalities in sickness were lowest in the Southern regime; for women, inequalities were lowest in the Scandinavian regime. The authors conclude that the Scandinavian welfare regime is more able than other regimes to protect against non-employment in the face of illness, especially for individuals with low educational level.
Journal of Epidemiology and Community Health | 2010
Ben Barr; Stephen Clayton; Margaret Whitehead; Karsten Thielen; Bo Burström; Lotta Nylén; Espen Dahl
Background Reductions in the eligibility requirements and generosity of disability benefits have been introduced in several Organisation for Economic Cooperation and Development (OECD) countries in recent years, on the assumption that this will increase work incentives for people with chronic illness and disabilities. This paper systematically reviews the evidence for this assumption in the context of well-developed welfare systems. Method Systematic review of all empirical studies from five OECD countries from 1970 to December 2009 investigating the effect of changes in eligibility requirements or level of disability benefits on employment of disabled people. Results Sixteen studies were identified. Only one of five studies found that relaxed eligibility was significantly associated with a decline in employment. The most robust study found no significant effect. On generosity, eight out of 11 studies reported that benefit levels had a significant negative association with employment. The most robust study demonstrated a small but significant negative association. Conclusion There was no firm evidence that changes in benefit eligibility requirements affected employment. While there was some evidence indicating that benefit level was negatively associated with employment, there was insufficient evidence of a high enough quality to determine the extent of that effect. Policy makers and researchers need to address the lack of a robust empirical basis for assessing the employment impact of these welfare reforms as well as potentially wider poverty impacts.