Lennart Hallsten

Unemployment and mortality—a longitudinal prospective study on selection and causation in 49321 Swedish middle-aged men

Background: Unemployment is associated with increased risk of mortality. It is, however, not clear to what extent this is causal, or whether other risk factors remain uncontrolled for. The aim of this study was to investigate the association between unemployment and all-cause and cause-specific mortality, adjusting for indicators of mental disorder, behavioural risk factors and social factors over the life course. Methods: This study was based on a cohort of 49321 Swedish males, born 1949/51, tested for compulsory military conscription in 1969/70. Data on employment/unemployment 1990–4 was based on information from the Longitudinal Register of Education and Labour Market Statistics. Information on childhood circumstances was drawn from National Population and Housing Census 1960. Information on psychiatric diagnosis and behavioral risk factors was collected at conscription testing in 1969/70. Data on mortality and hospitalisation 1973–2004 were collected in national registers. Results: An increased risk of mortality 1995–2003 was found among individuals who experienced 90 days or more of unemployment during 1992–4 compared with those still employed (all-cause mortality HR 1.91, 95% CI 1.58 to 2.31. Adjustment for risk factors measured along the life course considerably lowered the relative risk (all cause mortality HR 1.30, 95% CI 1.06 to 1.58). Statistically significant increased relative risk was found during the first 4 years of follow up (all-cause mortality, adjusted HR 1.57, 95% CI 1.13 to 2.18, but not the following 4 years (all cause mortality, adjusted HR 1.17, 95% CI 0.91 to 1.50). Conclusion: The results suggest that a substantial part of the increased relative risk of mortality associated with unemployment may be attributable to confounding by individual risk factors.

Problematic Interpersonal Relationships at Work and Depression : A Swedish Prospective Cohort Study

Problematic Interpersonal Relationships at Work and Depression: A Swedish Prospective Cohort Study: Ulrich Stoetzer, et al. Department of Public Health Sciences, Occupational and Environmental Medicine, Karolinska Institutet, Sweden

Genetic susceptibility to burnout in a Swedish twin cohort

Most previous studies of burnout have focused on work environmental stressors, while familial factors so far mainly have been overlooked. The aim of the study was to estimate the relative importance of genetic influences on burnout (measured with Pines Burnout Measure) in a sample of monozygotic (MZ) and dizygotic (DZ) Swedish twins. The study sample consisted of 20,286 individuals, born 1959–1986 from the Swedish twin registry who participated in the cross-sectional study of twin adults: genes and environment. Probandwise concordance rates (the risk for one twin to be affected given that his/her twin partner is affected by burnout) and within pair correlations were calculated for MZ and DZ same—and opposite sexed twin pairs. Heritability coefficients i.e. the proportion of the total variance attributable to genetic factors were calculated using standard biometrical model fitting procedures. The results showed that genetic factors explained 33% of the individual differences in burnout symptoms in women and men. Environmental factors explained a substantial part of the variation as well and are thus important to address in rehabilitation and prevention efforts to combat burnout.

Do job demands and job control affect problem-solving?

OBJECTIVE The Job Demand Control model presents combinations of working conditions that may facilitate learning, the active learning hypothesis, or have detrimental effects on health, the strain hypothesis. To test the active learning hypothesis, this study analysed the effects of job demands and job control on general problem-solving strategies. PARTICIPANTS A population-based sample of 4,636 individuals (55% women, 45% men) with the same job characteristics measured at two times with a three year time lag was used. METHODS Main effects of demands, skill discretion, task authority and control, and the combined effects of demands and control were analysed in logistic regressions, on four outcomes representing general problem-solving strategies. RESULTS Those reporting high on skill discretion, task authority and control, as well as those reporting high demand/high control and low demand/high control job characteristics were more likely to state using problem solving strategies. CONCLUSIONS Results suggest that working conditions including high levels of control may affect how individuals cope with problems and that workplace characteristics may affect behaviour in the non-work domain.

Working conditions predicting interpersonal relationship problems at work

Interpersonal relationships have been shown to be an important component of the psychosocial work environment that may affect health, job satisfaction, and productivity. The question whether interpersonal relationships at work are influenced by other psychosocial working conditions such as demands and control has not been studied. The aim of the present study is to investigate if high work demands and aspects of low work control could predict three indicators of detrimental interpersonal relationships at work. In a representative Swedish cohort study, data were obtained in two waves three years apart from 4049 participants, who did not change their jobs between the waves. These data were analysed by multiple logistic regression analyses. Odds ratios adjusted for possible confounders and negative interpersonal relationships at base-line showed that high demands predicted serious conflict and exclusion by co-workers. Low skill discretion predicted exclusion by co-workers. It is argued that these prospective findings are of relevance to interventions targeting troublesome and detrimental interpersonal relationships at work and that the findings can be important in understanding the development of work-related mental ill-health.

The Importance of Genetic and Shared Environmental Factors for the Associations between Job Demands, Control, Support and Burnout

Within occupational health research, one of the most influential models is the Job Demands-Control-Support model. Numerous studies have applied the model to different domains, with both physical and psychological health outcomes, such as burnout. The twin design provides a unique and powerful research methodology for examining the effects of environmental risk factors on burnout while taking familial factors (genetic and shared environment) into account. The aim of the present study was to investigate the impact of familial factors on the associations of burnout with job demands, control and support. A total of 14 516 individuals from the Swedish Twin Registry, who were born between 1959 and 1986, and who participated in the Study of Twin Adults: Genes and Environment (STAGE) by responding to a web-based questionnaire in 2005, were included in the analyses. Of these, there were 5108 individuals in complete same-sex twin pairs. Co-twin control analyses were performed using linear mixed modeling, comparing between-pairs effects and within-pair effects, stratified also by zygosity and sex. The results indicate that familial factors are of importance in the association between support and burnout in both women and men, but not between job demands and burnout. There are also tendencies towards familial factors being involved in the association between control and burnout in men. These results offer increased understanding of the mechanisms involved in the associations between work stress and burnout.

Does Contingent Self-esteem Increase During Higher Education?

Contingent self-esteem has been identified as a marker of psychological vulnerability. The assumption that contingent self-esteem is influenced by socialization processes was examined in a prospective national cohort study of 1,220 Swedish nursing students during their three-year education. Contingent self-esteem was annually assessed by a measure of performance-based self-esteem. Mean levels of performance-based self-esteem increased from the first to the later years of education, and the increase over one year was greater for the nursing students than for a matched group of work employees. These data suggest that participation in higher education could be associated with increased contingent self-esteem. The findings also introduce questions about whether investment in a professional role may foster vulnerability, thereby raising issues for the social investment principle.

Genetic and Environmental Influences on Performance-based Self-esteem in a Population-based Cohort of Swedish Twins

Contingent self-esteem has regularly been associated with socialization experiences. In the present study, genetic and environmental influences on a contingent self-esteem construct were investigated among women and men in different age groups. The study sample consisted of 21,703 same and opposite sex Swedish twins, aged 20 to 46 years. Contingent self-esteem was measured on a scale for performance-based self-esteem. Sex and age-group effects were assessed using biometrical model fitting procedures. Individual differences in performance-based self-esteem were best explained by additive genetic and non-shared environmental factors for both female and male twins, with similar heritability estimates. No age-group effects were found. However, partially different genes seem to influence performance-based self-esteem among women and men.