Margareta Lindén-Boström

Mental health symptoms in relation to socio-economic conditions and lifestyle factors – a population-based study in Sweden

BackgroundPoor mental health has large social and economic consequences both for the individual and society. In Sweden, the prevalence of mental health symptoms has increased since the beginning of the 1990s. There is a need for a better understanding of the area for planning preventive activities and health care.MethodsThe study is based on a postal survey questionnaire sent to a random sample of men and women aged 18–84 years in 2004. The overall response rate was 64%. The area investigated covers 55 municipalities with about one million inhabitants in central part of Sweden. The study population includes 42,448 respondents. Mental health was measured with self-reported symptoms of anxiety/depression (EQ-5D, 5th question). The association between socio-economic conditions, lifestyle factors and mental health symptoms was investigated using multivariate multinomial logistic regression models.ResultsAbout 40% of women and 30% of men reported that they were moderately or extremely anxious or depressed. Younger subjects reported poorer mental health than older subjects, the best mental health was found at ages 65–74 years.Factors that were strongly and independently related to mental health symptoms were poor social support, experiences of being belittled, employment status (receiving a disability pension and unemployment), economic hardship, critical life events, and functional disability. A strong association was also found between how burdensome domestic work was experienced and anxiety/depression. This was true for both men and women. Educational level was not associated with mental health symptoms.Of lifestyle factors, physical inactivity, underweight and risk consumption of alcohol were independently associated with mental health symptoms.ConclusionOur results support the notion that a ground for good mental health includes balance in social relations, in domestic work and in employment as well as in personal economy both among men and women. In addition, physical inactivity, underweight and risk consumption of alcohol are associated with mental health symptoms independent of socio-economic factors.

A selective follow-up study on a public health survey

Background: The non-response rates in surveys are increasing which is problematic as it means that a progressively smaller proportion of the population represents the majority, and it is uncertain how health survey results are affected. This follow-up was performed on the non-responders to the postal questionnaire in the public health survey Life and Health, conducted in Örebro County Council, Sweden, where large differences in response rates had been found between different socio-demographic groups and geographical areas. The main objective was to analyse non-response bias regarding self-rated health. Methods: This follow-up study was conducted as a census to all non-responders in the area that had the lowest response rate and, in one other geographical area used as a control. It was carried out by telephone interviews, 49.3% (580 individuals) answered the follow-up. The outcome variable was self-rated health, a main variable in public health surveys. Differences in response patterns between responders and initial non-responders were approximated by prevalences with confidence intervals and adjusted odds ratios. Results: Poor health was more common in the initial non-response group than among the responders, even with consideration given to sex, age, country of birth and education. However, good health was equally common among responders and initial non-responders. Conclusions: Public health surveys can be biased due to certain groups being under-represented or not represented at all. For this reason, in repeated public health surveys, we recommend selective follow-ups of such groups at regular intervals.

Reasons for non-participation in a parental program concerning underage drinking: a mixed-method study

BackgroundAlcohol consumption among adolescents is a serious public health concern. Research has shown that prevention programs targeting parents can help prevent underage drinking. The problem is that parental participation in these kinds of interventions is generally low. Therefore, the aim of the present study is to examine non-participation in a parental support program aiming to prevent underage alcohol drinking. The Health Belief Model has been used as a tool for the analysis.MethodsTo understand non-participation in a parental program a quasi-experimental mixed-method design was used. The participants in the study were invited to participate in a parental program targeting parents with children in school years 7-9. A questionnaire was sent home to the parents before the program started. Two follow-up surveys were also carried out. The inclusion criteria for the study were that the parents had answered the questionnaire in school year 7 and either of the questionnaires in the two subsequent school years (n = 455). Multinomial logistic regression analysis was used to examine reasons for non-participation. The final follow-up questionnaire included an opened-ended question about reasons for non-participation. A qualitative content analysis was carried out and the two largest categories were included in the third model of the multinomial logistic regression analysis.ResultsEducational level was the most important socio-demographic factor for predicting non-participation. Parents with a lower level of education were less likely to participate than those who were more educated. Factors associated with adolescents and alcohol did not seem to be of significant importance. Instead, program-related factors predicted non-participation, e.g. parents who did not perceive any need for the intervention and who did not attend the information meeting were more likely to be non-participants. Practical issues, like time demands, also seemed to be important.ConclusionTo design a parental program that attracts parents independently of educational level seems to be an important challenge for the future as well as program marketing. This is something that must be considered when implementing prevention programs.

Social inequalities in self-reported refraining from health care due to financial reasons in Sweden: health care on equal terms?

BackgroundThe main goal of the health care system in Sweden is good health and health care on equal terms for the entire population. This study investigated the existence of social inequalities in refraining from health care due to financial reasons in Sweden.MethodsThe study is based on 38,536 persons who responded to a survey questionnaire sent to a random sample of men and women aged 18-84 years in 2008 (response rate 59%). The proportion of persons who during the past three months due to financial reasons limited or refrained from seeking health care, purchasing medicine or seeking dental care is reported. The groups were defined by gender, age, country of origin, educational level and employment status. The prevalence of longstanding illness was used to describe morbidity in these groups. Differences between groups were tested with chi-squared statistics and multivariate logistic regression models.ResultsIn total, 3% reported that they had limited or refrained from seeking health care, 4% from purchasing medicine and 10% from seeking dental care. To refrain from seeking health care was much more common among the unemployed (12%) and those on disability pension (10%) than among employees (2%). It was also more common among young adults and persons born outside the Nordic countries. Similar differences also apply to purchasing medicine and dental care. The odds for refraining from seeking health care, purchasing medicine or seeking dental care due to financial reasons were 2-3 times higher among persons with longstanding illness than among persons with no longstanding illness.ConclusionsThere are social inequalities in self-reported refraining from health care due to financial reasons in Sweden even though the absolute levels vary between different types of care. Often those in most need refrain from seeking health care which contradicts the national goal of the health care system. The results suggest that the fare systems of health care and dental care should be revised because they contribute to inequalities in health care.

Domestic work and self-rated health among women and men aged 25–64 years: Results from a population-based survey in Sweden

Aims: This study investigated the association between domestic work and self-rated health among women and men in the general population. Methods: The study is based on women (N = 12,910) and men (N = 9784) aged 25–64 years, who responded to a survey questionnaire in 2008 (response rate 56%). Logistic regression models were used to assess the association adjusting for age, educational level, employment status, family status and longstanding illness. Population attributable risks (PAR) were calculated to assess the contribution of domestic work to the prevalence of suboptimal self-rated health. Results: More women (29%) than men (12%) spent more than 20 hours per week in domestic work. Women also experienced domestic work more often as burdensome. Disability pensioners and single mothers reported highest levels of burdensome domestic work. There was a strong independent association between burdensome domestic work and suboptimal self-rated health both in women and men. The PAR for burdensome domestic work was 21% in women and 12% in men and comparable to other major risk factors. Conclusions: The results suggest that domestic work should not be omitted when considering factors that affect self-rated health in the general population.

Disparities in mental health among adolescents with and without impairments

Aim: To analyse whether there are differences in mental health among adolescents with and without various kinds of impairments, taking into account the number of impairments and gender. Methods: Data from the study Life & Health – Young People conducted in a Swedish county in 2011 was used. The survey included all students in grades 7 (13–14 years) and 9 (15–16 years) in compulsory school and grade 2 (17–18 years) in upper secondary school; there were 7793 respondents (81.0%). The students answered a questionnaire anonymously during school hours. Various measures of mental health were assessed in the groups: hard of hearing, visual impairment, motor impairment, difficulties in reading/writing/dyslexia, attention deficit hyperactive disorder/attention deficit disorder, other impairment, no impairment. Results: Of the studied impairments, difficulties in reading/writing/dyslexia are the most common (6.3%), followed by hard of hearing (5.4%). To have at least one impairment is more common among boys (18.2%) than girls (15.4%). In the impairment group, 21.5% have multiple impairments. Adolescents with impairments have worse mental health than those without, and those with multiple impairments have particularly higher odds ratio to have worse mental health. There are also differences in mental health between number and various kinds of impairments and between girls and boys. Conclusion: Adolescents with impairments, particularly girls and those with multiple impairments, have considerably worse mental health than others. These inequalities in health are an immense challenge, not only for those directly involved with the impaired: they affect everyone involved with the goal health equity for the whole population.

Alkohol och äldre

M. Lindén-Boström & C. Persson & M. Berglund: Risk consumption of alcohol among older people – results from a Swedish population study Aim The aim of this study was to describe risk consumption of alcohol among older people and relate it to living conditions, health behaviour, social support and health. Method We used data from Life & Health 2008, a postal questionnaire to inhabitants aged 18–84 in 55 municipalities in central Sweden. The study population included 40 267 respondents aged 18–84 and 21 326 respondents aged 55–84. The overall response rate was almost 60 per cent, a figure that differed between age groups with the highest rate, >70 per cent, among respondents aged 65–79. The first three questions in the AUDIT questionnaire were used to estimate risk consumption. They were also analysed separately to describe different patterns of alcohol consumption. Results In the 65–75 age group, 2.7 per cent of men and 1.9 per cent of women could be defined as risk consumers of alcohol. In the 76–84 age group, the corresponding figure is less than 1 per cent for both sexes. Risk consumption is related to high education, smoking, use of snuff, physical inactivity, psychological distress and use of tranquilisers. Conclusion Targeted preventive strategies need to be developed to tackle risk consumption among older people.