Line Nielsen

What characterizes persons with high levels of perceived stress in Denmark? A national representative study

Aims: Stress is a growing public health problem, but there are only a few studies with national representative samples on the occurrence of stress. The aim of this study was to assess the level of stress, measured by the Perceived Stress Scale, in Denmark, and to identify and characterize the group with high levels of stress by factors measured at both the individual and neighbourhood levels in a national representative sample of the Danish population. Methods: The 10,022 participants in the National Health Interview Survey 2005 were asked about perceived stress and individual factors in a cross-sectional design. Information on neighbourhood factors was derived from a national registry. Data were analysed by means of logistic regression models. Results: Low education, heavy smoking, physical inactivity, lack of social network and poor working conditions were associated with perceived stress. For women, living in a neighbourhood with low average education, and for men, living in a neighbourhood with a high rate of crime and a low degree of ethnic diversity, were associated with higher perceived stress. Perceived stress was also related to indicators of morbidity. Conclusions: The group with high perceived stress is characterized by individual and neighbourhood factors with negative impacts on quality of life and risk of illness. This knowledge can guide future stress prevention efforts. Additionally, the results suggest a negative social component where perceived stress, unhealthy lifestyle and low social status are accumulated, and perceived stress might be used as a measure to identify groups characterized by accumulation of risk factors.

Perceived problems with computer gaming and internet use among adolescents: measurement tool for non-clinical survey studies.

BackgroundExisting instruments for measuring problematic computer and console gaming and internet use are often lengthy and often based on a pathological perspective. The objective was to develop and present a new and short non-clinical measurement tool for perceived problems related to computer use and gaming among adolescents and to study the association between screen time and perceived problems.MethodsCross-sectional school-survey of 11-, 13-, and 15-year old students in thirteen schools in the City of Aarhus, Denmark, participation rate 89%, n = 2100. The main exposure was time spend on weekdays on computer- and console-gaming and internet use for communication and surfing. The outcome measures were three indexes on perceived problems related to computer and console gaming and internet use.ResultsThe three new indexes showed high face validity and acceptable internal consistency. Most schoolchildren with high screen time did not experience problems related to computer use. Still, there was a strong and graded association between time use and perceived problems related to computer gaming, console gaming (only boys) and internet use, odds ratios ranging from 6.90 to 10.23.ConclusionThe three new measures of perceived problems related to computer and console gaming and internet use among adolescents are appropriate, reliable and valid for use in non-clinical surveys about young people’s everyday life and behaviour. These new measures do not assess Internet Gaming Disorder as it is listed in the DSM and therefore has no parity with DSM criteria. We found an increasing risk of perceived problems with increasing time spent with gaming and internet use. Nevertheless, most schoolchildren who spent much time with gaming and internet use did not experience problems.

Promotion of Social and Emotional Competence: Experiences from a Mental Health Intervention Applying a Whole School Approach.

Purpose – Within the framework of Health Promoting Schools Up is an intervention using a whole school approach aimed at promoting mental health by strengthening social and emotional competence among schoolchildren. Social and emotional competence is an integral part of many school-based mental health interventions but only a minority of interventions measure changes in competences. The purpose of this paper is to present the intervention Up and document changes in social and emotional competence among schoolchildren before and after the intervention. Design/methodology/approach –Up consists of four components: education and activities for schoolchildren; development of staff skills; involvement of parents; and initiatives in everyday life at school. Up was implemented in two Danish schools in 2010-2011. Social and emotional competence was measured among 11-15-year old schoolchildren before (response rate 96.2 per cent, n=589) and after (response rate 83.9 per cent, n=532) the intervention. Findings – Chan...

From rhetoric to action: Adapting the Act-Belong-Commit Mental Health Promotion Programme to a Danish context

In response to recent calls for implementing mental health promotion (MHP) in Denmark, the Danish National Institute of Public Health undertook a perusal of existing MHP frameworks. While a small number of such frameworks exist, the Act-Belong-Commit campaign that originated in Western Australia, was the only comprehensive, population-wide program identified that had a strong evidence base, demonstrated success in implementation and universal principles of well-being. Following a successful funding application to the Ministry of Health, the National Institute for Public Health, is leading a partnership to implement the Act-Belong-Commit campaign in Denmark in 2015–2017. This article describes the Act-Belong-Commit campaign and its implementation in Australia and how the National Institute of Public Health plans to introduce the campaign into Denmark. It is hoped that our planning for Denmark will be helpful to other countries planning to adopt the Act-Belong-Commit campaign.

Socioeconomic differences in emotional symptoms among adolescents in the Nordic countries: Recommendations on how to present inequality

Aims: This comparative study examines absolute and relative socioeconomic differences in emotional symptoms among adolescents using standardised data from five Nordic countries and gives recommendations on how to present socioeconomic inequality. Methods: The Health Behaviour in School-aged Children (HBSC) international cross-sectional study from 2005/2006 provided data on 29,642 11–15-year-old adolescents from nationally random samples in Denmark, Finland, Iceland, Norway and Sweden. The outcome was daily emotional symptoms. Family Affluence Scale (FAS) was used as indicator of socioeconomic position. We applied four summary measures of inequality: Prevalence Difference, Odds Ratio, Slope Index of Inequality and Relative Index of Inequality, and presented the socioeconomic inequality by a graphical illustration of the prevalence of emotional symptoms, the size of the FAS groups and the summary indices of inequality in each country. Results: The prevalence of emotional symptoms ranged from 8.1% in Denmark to 13.2% in Iceland. There were large country variations in the size of the low FAS-group ranging from 2% in Iceland to 12% in Finland. The largest absolute and relative socioeconomic inequalities were found in Iceland and the smallest in Finland for girls and in Denmark for boys. Conclusions: Emotional symptoms were more common among Nordic adolescents from low affluence families. This association appeared in the study of both absolute and relative inequality. A comprehensive presentation of socioeconomic inequality should include the prevalence of the health outcome, the size of the socioeconomic groups, and the regression line representing the summary indices of inequality.

Emotional symptoms among adolescents: epidemiological analysis of individual-, classroom- and school-level factors

BACKGROUND Large proportions of schoolchildren suffer from emotional symptoms and there are large variations across schools. It is unknown to what degree this variation is due to composition of schoolchildren in each school or to contextual factors. Objectives are to identify factors at individual, classroom and school levels associated with emotional symptoms. METHOD Data stem from the Danish contribution to the international Health Behaviour in School-aged Children study 2010 including 4922 schoolchildren aged 11-15-years from a random sample of schools and including data from school leaders. Emotional symptoms are defined as daily presence of at least one of four symptoms: feeling low, irritable or bad tempered, nervous and having difficulties falling asleep. Multilevel multivariable logistic regression analyses are applied to identify and quantify factors at individual, classroom and school level. RESULTS Schoolchildren from low (odds ratio (OR) 1.70, 95% CI: 1.33-2.17) and medium (OR 1.50, 95% CI: 1.22-1.85) occupational social class (OSC), girls (OR 1.32, 95% CI: 1.13-1.56) and schoolchildren exposed to bullying (OR 3.82, 95% CI: 2.71-5.40), had increased odds for emotional symptoms. A negative classroom climate was associated with emotional symptoms (OR 1.29, 95% CI: 0.99-1.69) and so was being part of classrooms with a high prevalence of bullying (OR 1.28, 95% CI: 1.0-1.60). CONCLUSION Female sex, low OSC, single parent family, exposure to bullying and a high prevalence of bullying within a class are all associated with emotional symptoms. Most variation across schools is explained by individual-level factors but psychosocial aspects of the classroom environment also play a role.

Loneliness, immigration background and self-identified ethnicity: a nationally representative study of adolescents in Denmark

ABSTRACT Migration is an increasing worldwide phenomenon that creates multicultural societies with a growing number of adolescents who have experienced a process of migration or who have an ethnic background other than that of the majority. Migration may lead to loss of social relations and create challenges related to acculturation in the new country. These experiences may induce feelings of loneliness. Research on ethnic and migrant disparities in loneliness among adolescents is limited and inconsistent. The purpose of this study was to examine how adolescents’ immigration background and self-identified ethnicity are associated, independently and combined, with loneliness. We used data from the Danish 2010 Health Behaviour in School-aged Children survey which included a representative sample of 3083 13- and 15-year-olds. The results suggest that immigrants but not descendants of immigrants have an increased risk of loneliness compared to adolescents with a Danish origin. The results also suggest that adolescents’ self-identified ethnicity plays an essential role but differently for immigrants and descendants: identifying with the Danish majority was protective against loneliness among immigrants, whereas identifying with an ethnic minority group was protective against loneliness among descendants.

The protective properties of Act-Belong-Commit indicators against incident depression, anxiety, and cognitive impairment among older Irish adults: Findings from a prospective community-based study

ABSTRACT The Act‐Belong‐Commit campaign is the worlds first comprehensive, population‐wide, community‐based program designed to promote mental health. The campaign targets individuals to engage in mentally healthy activities, while at the same time, encouraging community organizations that offer such activities, to increase participation in their activities. Using nationally‐representative data from Ireland, the aim of this study was to prospectively assess the association between indicators of the Act‐Belong‐Commit behavioral domains and incident depression, anxiety, and cognitive impairment. Data from two consecutive waves of the Irish Longitudinal Study on Ageing (TILDA) were analyzed. The analytical sample consisted of 6098 adults aged ≥ 50 years. Validated scales for depression, anxiety, and cognitive impairment were used. The number of social/recreational activities engaged in was used as an indicator of Act, social network integration as an indicator of Belong, and frequency of participation in these social/recreational activities as an indicator of Commit. Multivariable logistic regression analyses were conducted to assess associations between baseline indicators of Act‐Belong‐Commit and incident depression, anxiety, and cognitive impairment at two‐year follow‐up. The adjusted model showed that each increase in the number of social/recreational activities (Act) inversely predicted the onset of depression, anxiety, and cognitive impairment. The same was the case for social network integration (Belong); that is, being well integrated into social networks was a significant protective factor against all mental health outcomes. Finally, frequency of participation in social/recreational activities (Commit) significantly and inversely predicted the onset of depression and anxiety, while the protective effect against cognitive impairment was only marginally significant. Act‐Belong‐Commit indicators are shown to be protective against mental disorders and cognitive impairment among older Irish adults. This provides further evidence for the campaigns potential efficacy and has potentially wide‐ranging implications for preventing the deterioration of mental health and cognitive decline in the aging community. HighlightsThe predictive validity of Act‐belong‐Commit indicators was assessed.Outcomes were incident depression, anxiety and cognitive impairment at 2‐year follow‐up.A large nationally‐representative sample of older Irish adults was used.More activities and better social network integration protected against all outcomesThe Act‐Belong‐Commit campaign holds potential for promoting public mental health.

Social inequalities in self-rated health: A comparative cross-national study among 32,560 Nordic adolescents

Aims: We aimed to estimate the magnitude of socioeconomic inequality in self-rated health among Nordic adolescents (aged 11, 13 and 15 years) using the Family Affluence Scale (a composite measure of material assets) and perceived family wealth as indicators of socioeconomic status. Methods: Data were collected from the Health Behaviour in School-aged Children (HBSC) survey in 2013–2014. A sample of 32,560 adolescents from Denmark, Norway, Finland, Iceland, Greenland and Sweden was included in the study. Age-adjusted regression analyses were used to estimate associations between fair or poor self-rated health and the ridit scores for family affluence and perceived wealth. Results: The pooled relative index of inequality of 2.10 indicates that the risk of fair or poor health was about twice as high for young people with the lowest family affluence relative to those with the highest family affluence. The relative index of inequality for observed family affluence was highest in Denmark and lowest in Norway. For perceived family wealth, the pooled relative index of inequality of 3.99 indicates that the risk of fair or poor health was about four times as high for young people with the lowest perceived family wealth relative to those with the highest perceived family wealth. The relative index of inequality for perceived family wealth was highest in Iceland and lowest in Greenland. Conclusions: Social inequality in self-rated health among adolescents was found to be robust across subjective and objective indicators of family affluence in the Nordic welfare states.

Associations between perceived stress, socioeconomic status, and health-risk behaviour in deprived neighbourhoods in Denmark: a cross-sectional study

BackgroundPrevious studies have found that residents of deprived neighbourhoods have an increased risk of perceived stress compared to residents with similar sociodemographic and socioeconomic characteristics in non-deprived neighbourhoods. While stress may provide an explanatory pathway linking neighbourhood deprivation to health-risk behaviour, only limited research has been undertaken on whether perceived stress influences health-risk behaviour in deprived neighbourhoods. Moreover, it is uncertain whether perceived stress has a negative effect on the associations between socioeconomic status and health-risk behaviours in deprived neighbourhoods. The overall aim of this study was to compare perceived stress in deprived neighbourhood with that in the general population, and to examine whether perceived stress was associated with health-risk behaviours (including their co-occurrence) in deprived neighbourhoods. A further aim was to examine whether perceived stress modified the associations between socioeconomic status and health-risk behaviours.MethodsFour questions from the Perceived Stress Scale were used as indicators of perceived stress. Multiple logistic regression analyses were applied to cross-sectional data from 5113 adults living in 12 deprived neighbourhoods in Denmark. Data from 14,868 individuals from the nationally representative Danish Health and Morbidity Survey 2010 were used as a comparison group with regard to perceived stress.ResultsResidents of deprived neighbourhoods had higher odds of perceived stress than the general population. Associations between disposable income, economic deprivation, strain, and perceived stress were found in deprived neighbourhoods. Perceived stress was significantly associated with higher odds of health-risk behaviour, including a low intake of fruit or vegetables, daily smoking, physical inactivity, and the co-occurrence of health-risk behaviours, even after adjustment for demographic and socioeconomic characteristics. Perceived stress was more strongly associated with physical inactivity and having two or more health-risk behaviours among residents with medium/high socioeconomic status compared to residents with low socioeconomic status.ConclusionsOverall, the study showed a clear association between perceived stress and health-risk behaviour in deprived neighbourhoods. Future health promotion interventions targeting deprived neighbourhoods may benefit from incorporating stress reduction strategies to reduce health-risk behaviour. Further research is needed to fully understand the mechanism underlying the association between perceived stress and health-risk behaviour in deprived neighbourhoods.