Lennart Levi

Health and environment—Psychosocial stimuli: A review

Abstract A model of psychosocial factors and disease in terms of six defined subsystems—Psychosocial Stimuli, Psychobiological Programme, Mechanisms, Precursors of Disease, Disease and Interacting Variables, is described in section 2. Current knowledge on the inter-relationships of these subsystems is reviewed in sections 4–7. Monitoring for the early appraisal of risk of disease from psychosocial factors and the importance of evaluation of the effects of health action is discussed in section 8. The authors conclude (section 9) that causation of disease by psychosocial stimuli is unproven but at a high level of suspicion. The action of such stimuli on mechanisms and precursors of disease is better understood. There is also a high level of suspicion that interacting psychosocial factors and physical factors could prevent some mechanisms, precursors and diseases. Though some health planners, in the particular circumstances of their community, may feel that action should be taken on the basis of existing levels of suspicion, the authors believe that in the present state of knowledge such procedures carry a risk to health as well as a high cost to the community. They therefore conclude that evaluation of such health actions in terms of efficiency, safety and cost should be mandatory so as to establish scientific principles, protect individuals from danger, and the community (and other communities) from unnecessary expense, to avoid false sense of security, to prevent delay in applying useful procedures, and to provide rational support for innovative measures based on perceived cost and effect.

Neuroendocrine and immunologic effects of unemployment and job insecurity.

We prospectively followed a cohort of 354 blue-collar men and women, some of whom lost their jobs. Results show marked effects during the anticipatory and early unemployment phase on mental well-being, serum cortisol, prolactin, total cholesterol, HDL cholesterol, and phytohemagglutinin reactivity of lymphocytes. Most of these changes appear to be of short-term duration. However, changes in cardiovascular risk factors are observed at least 2 years following the loss of ones job. Coping style appears to be a major determinant whether or not and how people will react to unemployment.

An experimental study of social isolation of elderly people: psychoendocrine and metabolic effects.

&NA; Psychoendocrine and metabolic effects of social isolation and understimulation in real life were examined in a controlled study of 60 elderly people representative of their age group. Together with the staff and the elderly, a social activation program was formed at a senior citizen apartment building. Half of the elderly were part of this activation program (experimental group). The other half constituted the control group. Blood sampling and psychosocial testing were performed immediately before and after 3 and 6 months of social activation. Social activation increased threefold in the experimental group. Height decreased in the control group compared to the experimental subjects. Plasma levels of testosterone, dehydroepiandrosterone, and estradiol increased significantly in the experimental group over the 6‐month period compared to the control group. The most pronounced increase took place during the initial 3 months. Hemoglobin A1c decreased significantly in the experimental group over the 6‐month period compared to the control group. In this preliminary study it is concluded that social isolation and understimulation may be associated with a wide range of psychophysiologic effects in elderly people.

Long-term unemployment among women in Sweden

Vulnerability at long-term unemployment is discussed and the results of a study of the effects of job loss and long-term unemployment among Swedish women are presented. Psychological and physiological data for the unemployed were sampled repeatedly over a two year period. Some of the unemployed were subject to an intervention programme aiming at buffering for the possibly negative effects of unemployment. Health data from matched control groups of employed were gathered over the same period. The results indicate a strong negative stress reaction at the job loss period, followed by a gradual adaptation to the conditions of unemployment as measured by biochemical and physiological health indicators. However, a substantial proportion of the unemployed compared to the employed showed a lower degree of psychological well-being and more severe depressive reactions. Recommendations are given concerning further research approaches on long-term unemployment. Policy implications to reduce vulnerability at long-term unemployment are discussed.

Structural changes, ill health, and mortality in Sweden, 1963-1983: a macroaggregated study.

An exploratory time series analysis was performed on selected indicators of structural change, health behavior, and ill health in Sweden in the years 1963–1983. Both synchronic (nonlagged) and asynchronic (lagged) analyses were made. The synchronic analysis of variations in the suicide rate reveals two main contributory factors: level of employment and overtime work. For cardiovascular mortality in men, the synchronic and the two-year time lagged analyses reveal that the sale of alcohol and, to a certain extent, the length of the period of unemployment play a major role. In an analysis with a three-year time lag, only one significant factor for both men and women is revealed, namely the level of employment. In the synchronic analysis of cirrhosis mortality in men, the sale of alcohol plays a dominant role. The results of the synchronic analysis of the variations in sick leave show a similar pattern for both men and women. In both cases, the sale of alcohol is positively associated and the proportion of unemployed industrial workers negatively associated with sick leave. The results give rise to a number of questions. For example, how should these findings be interpreted and how should they be related to existing knowledge about the links between business cycles and changes in the health of the population? The answers to such questions are of importance both from a scientific viewpoint and with regard to health policy. We argue that the answers require further studies of the characteristics of the periods in the business cycle and of how these periods affect peoples lives, living conditions, and behavioral patterns in general.

The Psychological, Social, and Biochemical Impacts of Unemployment in Sweden: Description of a Research Project

In order to understand the meaning of unemployment in Sweden, it is important to consider the cultural attitudes toward work. The following discussion is not intended to explain every individual response to job loss, but rather to provide a sense of the general orientation common to many Swedes.1 Until the late 19th century, 80% of the population of Sweden was agrarian, the vast majority of Swedes working as farmers and living either in villages or on solitary farmsteads. Life was stable, but materially difficult. Under this primarily agrarian social system, if someone was unable to work because of crop failure, loss of land tenure, etc.he was regarded by the state, the church, and the community as a vagrant. Most unemployed people were impressed

Work, worker and wellbeing: An overview

Work-related psychosocial stressors originate in social structures and processes, affect humans through psychological processes and influence health through four types of interrelated mechanisms - cognitive, emotional, behavioral and physiological. The health outcome is modified by situational (e.g. social support) and individual factors (e.g. personality, coping repertoire). The work environment-stress-health system is dynamic, with many feedback loops.

Society, Brain and Gut—A Psychosocial Approach to Dyspepsia

Common denominators in the etiology of psychosocially induced ill health--in the gastrointestinal tract and elsewhere--flow from discrepancies between human ability, needs, and expectations on the one hand, and environmental demands, opportunities, and individual perception of these on the other. Pathogenic mechanisms include emotional reactions (anxiety, depression, hypochondria), behavioural reactions (abuse of alcohol, drugs, and tobacco, destructive and self-destructive behaviour, and resistance to prevention, therapy and rehabilitation), and physiological reactions (neuroendocrine and immunological). Through these mechanisms, psychosocial stressors can precipitate ill health, influence well-being, and modify the outcome of health action. Interacting variables (coping, social support) can buffer these effects. One of the targets of such influences is the gastrointestinal tract. Present knowledge concerning socio-psycho-gastrointestinal interrelationships is far from conclusive. Some of its implications for therapeutic approaches to gastrointestinal patients are discussed.

Empowerment, Learning and Social Action during Unemployment

A good job helps to give life purpose and meaning. It provides the day, week, year and lifetime with structure and content. The worker gains identity and self-respect and is able to give, and receive, social support in social networks. In addition, a job provides material advantages and a reasonable living. A person excluded from the labour market risks losing or perhaps never accessing, all of these benefits and also runs an increased risk of physical and mental ill health. To prevent this, the European Council’s Summit on Employment advocated developing entrepreneurship, improving employability, encouraging the adaptability of business and their employees, and strengthening the policies for equal opportunities as a co-ordinated EU strategy. This approach is based on a necessary but probably insufficient topdown strategy. A necessary complement to this is a bottom-up approach, an attempt to empower, train, and mobilise the 16 millions of European unemployed for mutual help and self-help (social economy), and to remove obstacles to their initiatives to do so. Both approaches need to be applied across societal sectors and academic disciplines, and at all societal levels, in a systems approach.