Marie Berlin

Young people’s health : Health in Sweden: The National Public Health Report 2012. Chapter 3

Summary Over 18 per cent of Sweden’s population – approximately 1.8 million people – are 65 years of age or older. The proportion of elderly people in the population has been growing for more than a century and is expected to continue to rise given the gains in average life expec tancy and the fact that large age cohorts are reaching retirement age. The average remaining life expectancy among those who had reached the age of 65 in 2011 was 21 years for women and 18 years for men. The most common causes of death among elderly people are cardiovascular diseases and cancer. The risk of suffering a stroke or heart attack has declined and morbidity has shifted to the upper age groups. On the other hand, the cancer incidence has increased, while cancer mortality has declined, owing to earlier detection and more effective treatment. The most common forms of cancer among elderly people are prostate cancer, breast cancer, colorectal cancer, and lung cancer. There has been a rise in the proportion of elderly people who perceive their general state of health as good. In the case of women, however, the increase is mainly noticeable among younger pensioners, while in men, it is spread across all age groups, according to the Statistics Sweden’s Survey of Living Conditions (ULF). The percentage of elderly people reporting long-term illness has risen, while the proportion with illnesses or complaints that interfere with daily life activities has declined. The percentage of people suffering from impaired mobility has fallen since the 1980s, while pain issues have remained at about the same level. Reports of nervousness, anxiety and sleeping

Living in two homes-a Swedish national survey of wellbeing in 12 and 15 year olds with joint physical custody

BackgroundThe practice of joint physical custody, where children spend equal time in each parent’s home after they separate, is increasing in many countries. It is particularly common in Sweden, where this custody arrangement applies to 30 per cent of children with separated parents. The aim of this study was to examine children’s health-related quality of life after parental separation, by comparing children living with both parents in nuclear families to those living in joint physical custody and other forms of domestic arrangements.MethodsData from a national Swedish classroom study of 164,580 children aged 12 and 15-years-old were analysed by two-level linear regression modelling. Z-scores were used to equalise scales for ten dimensions of wellbeing from the KIDSCREEN-52 and the KIDSCREEN-10 Index and analysed for children in joint physical custody in comparison with children living in nuclear families and mostly or only with one parent.ResultsLiving in a nuclear family was positively associated with almost all aspects of wellbeing in comparison to children with separated parents. Children in joint physical custody experienced more positive outcomes, in terms of subjective wellbeing, family life and peer relations, than children living mostly or only with one parent. For the 12-year-olds, beta coefficients for moods and emotions ranged from −0.20 to −0.33 and peer relations from −0.11 to −0.20 for children in joint physical custody and living mostly or only with one parent. The corresponding estimates for the 15-year-olds varied from −0.08 to −0.28 and from −0.03 to −0.13 on these subscales. The 15-year-olds in joint physical custody were more likely than the 12-year-olds to report similar wellbeing levels on most outcomes to the children in nuclear families.ConclusionsChildren who spent equal time living with both parents after a separation reported better wellbeing than children in predominantly single parent care. This was particularly true for the 15-year-olds, while the reported wellbeing of 12-years-olds was less satisfactory. There is a need for further studies that can account for the pre and post separation context of individual families and the wellbeing of younger age groups in joint physical custody.

Fifty moves a year: is there an association between joint physical custody and psychosomatic problems in children?

Background In many Western countries, an increasing number of children with separated parents have joint physical custody, that is, live equally much in their parents respective homes. In Sweden, joint physical custody is particularly common and concerns between 30% and 40% of the children with separated parents. It has been hypothesised that the frequent moves and lack of stability in parenting may be stressful for these children. Methods We used data from a national classroom survey of all sixth and ninth grade students in Sweden (N=147839) to investigate the association between childrens psychosomatic problems and living arrangements. Children in joint physical custody were compared with those living only or mostly with one parent and in nuclear families. We conducted sex-specific linear regression analyses for z-transformed sum scores of psychosomatic problems and adjusted for age, country of origin as well as childrens satisfaction with material resources and relationships to parents. Clustering by school was accounted for by using a two-level random intercept model. Results Children in joint physical custody suffered from less psychosomatic problems than those living mostly or only with one parent but reported more symptoms than those in nuclear families. Satisfaction with their material resources and parent–child relationships was associated with childrens psychosomatic health but could not explain the differences between children in the different living arrangements. Conclusions Children with non-cohabitant parents experience more psychosomatic problems than those in nuclear families. Those in joint physical custody do however report better psychosomatic health than children living mostly or only with one parent. Longitudinal studies with information on family factors before and after the separation are needed to inform policy of childrens postseparation living arrangements.

Migrant density and well-being—A national school survey of 15-year-olds in Sweden

BACKGROUND The aim of this study was to investigate the impact of migrant density in school on the well-being of pupils with a migrant origin in first as well as second generation. METHODS Cross-sectional analysis of data from a national classroom survey of 15-year-old Swedish schoolchildren. The study population included 76 229 pupils (86.5% participation) with complete data set from 1352 schools. Six dimensions of well-being from the KIDSCREEN were analysed in two-level linear regression models to assess the influence of migrant origin at individual level and percentage of students with a migrant origin at school level, as well as interaction terms between them. Z-scores were used to equalize scales. RESULTS A high density (>50%) of pupils with a migrant origin in first or second generation was associated with positive well-being on all six scales for foreign-born pupils originating in Africa or Asia compared with schools with low (<10%) migrant density. The effect sizes were 0.56 for boys and 0.29 for girls on the comprehensive KIDSCREEN 10-index (P<0.001) and 0.61 and 0.34, respectively, for psychological well-being (P<0.001). Of the boys and girls born in Africa or Asia, 31.6% and 34.6%, respectively, reported being bullied during the past week in schools with low (<10%) migrant density. CONCLUSIONS Pupils born in Africa or Asia are at high risk for being bullied and having impaired well-being in schools with few other migrant children. School interventions to improve peer relations and prevent bullying are needed to promote well-being in non-European migrant children.

Violence: Health in Sweden: The National Public Health Report 2012. Chapter 12.

In Sweden and in other countries, it has become increasingly common to view violence from a public health perspective. This chapter presents a description of interpersonal violence with an emphasis on violence in close relations, particularly in partner relationships. According to the Swedish Crime Survey 2010, approximately one in ten inhabitants was exposed to violence, threats or harassment of some kind in 2009. Young people and single mothers with small children are particularly vulnerable to violence. According to Statistics Swedens ULF surveys (Survey on Living Conditions) for 2004-2005, 17 per cent of men and 12 per cent of women aged 16-24 years reported having been subjected to violence or serious threats at some time in the previous 12 months. Boys and men are more frequently subjected to lethal violence and to violence resulting in hospitalisation than girls and women. Similarly, men also make up a majority of the victims of assaults reported to the police. On the other hand, domestic violence and work-related violence more often involve women than men, and sexual violence is chiefly directed at girls and women. Most women and children who are subjected to assault are acquainted with the perpetrator, while this only applies to a minority of male victims. Women are four to five times as likely to be killed by a partner as men. Partner assaults against women, rapes, and gross violations of a womans integrity account for a fifth of all reported crimes of violence (against women and men combined). Violence in partner relationships has significant consequences for physical and mental health; between 12,000 and 14,000 women seek outpatient care each year as a result of violence committed by a partner. Violence can also have serious social repercussions: isolation, financial difficulties, sick leave from work, unemployment, etc., and women subjected to this form of violence can be prevented from seeking medical or other assistance. Children are often involved. Approximately 10 per cent of all children have experienced violence in the home and 5 per cent have experienced it frequently. Many children who witness violence are also beaten themselves. In 2006, the Swedish National Board of Health and Welfare estimated the annual socioeconomic cost of violence against women to be between SEK 2.7 and 3.3 billion, SEK 38 million of which were direct medical costs. Factors affecting the risk of violence in partner relationships are related both to the social structure and individual character of the perpetrator. Trends in violence have moved in different directions. Today, more people in all age groups, with the exception of the most elderly (aged 65-84), report that they have been exposed to threats or violence than in the 1980s. In recent years, however, the increase has halted; there has even been a decline among young people aged 16-24. Crimes of violence reported to the police are growing in number, and the number of reports of work-related violence, for example, has more than doubled since the mid 1970s. The number of rapes reported to the police has also risen significantly in recent year, and the victims are on average becoming younger. Furthermore, rape and gross violation of a womans integrity (combined) are now almost as common as robbery. This increase is probably due to a combination of greater willingness to report crimes, a lower tolerance threshold for violence, legislative changes and an increase in the number of violent acts committed. The rise in violence represented by crime statistics is not reflected in the proportion of people who have suffered serious physical injuries as a result of violence. Over the past ten years, the number of deaths resulting from violence has declined among women and men. Hospital statistics also show that although the percentage of people receiving treatment has remained relatively stable, more people are now seeking hospital treatment following a sexual assault.

Placement breakdowns in long-term foster care – a regional Swedish study

ABSTRACT We used a regional sample of children in long‐term foster care to investigate the prevalence of placement breakdown in adolescence, and to assess risk factors/risk markers for placement disruption. The sample consisted of all 136 foster children in the region, born 1980–1992, who on their 12th birthday had been in the same foster family for at least 4 years. They were followed in case files until date of disruption or their 18th birthday. Data on conditions before and during placement were retrieved from case files, and analysed in bi‐ and multivariate models. Results showed that one in four placements broke down in adolescence. The median child who experienced a breakdown was 14 years old, and had been in the same foster home for more than 10 years. Prominent risk factors were (i) being placed after age 2 and (ii) having a birth sibling in the same foster home. We also uncovered strong risk markers that can be viewed as precursors of placement disruption. When the child or the foster parents repeatedly over time expressed dissatisfaction with the placement, this ended with a placement breakdown in 60% of cases. Implications for practice are discussed.

Health in the working-age population: Health in Sweden: The National Public Health Report 2012. Chapter 4.

Summary The present chapter deals with health in the working-age population (aged 25–64). The working age span covers a substantial portion of people’s lives, and morbidity rates vary considerably at the beginning and end of the age range. In this age group, for example, 10–20 times more people die at the age of 64 than at the age of 25. Since the beginning of the 1950s accidents, followed by suicide, have been the leading cause of death among men in the 25–44 age group, while cancer has been the most common cause of death among women in the same age group. For a long time, cardiovascular diseases were the most common cause of death among men aged 45– 64. However cardiovascular mortality has declined significantly and cancer is now an equally common cause of death. Since 1952, cancer has been the leading cause of death among women aged 45–64, as it has been among younger women. More working-age women than men die of cancer. This is because breast, uterine, and ovarian cancer often occur in women before retirement age. Breast cancer is the most common form of cancer among women. However; although breast cancer morbidity is rising, mortality has shown a slight decline. Overall, significantly more working-age men than women die, due to the higher risk among men of death from cardiovascular diseases, in accidents, from suicide and from alcohol-related causes. Mortality from these causes has declined significantly over the past 25 years, along with a corresponding decline in gender disparities in mortality. Impaired mental wellbeing became increasingly prevalent in the 1990s. The deterioration in mental wellbeing was more pronounced among younger people than older people. The percentage of women aged 25–44 who suffer from anxiousness, nervousness, and anxiety (angst) has doubled since the end of the 1980s, and these problems are now more common than in the 45–64 age group, which was not the case in the 1980s. In recent years, however, the trend has reversed, and mental wellbeing appears to be improving among women and men in both age groups. Mental ill-health and pain are the most common causes of reduced work capacity. Reduced work capacity due to illness has also become more prevalent among women in all age groups since the 1980s. The same adverse trend has also been observed in men in the younger age groups, although work capacity has improved among men aged 55–64. Since the end of the 1990s, it has become more common for mental strain to cause work-related health issues.

Mortality and Cause of Death—A 30-Year Follow-Up of Substance Misusers in Sweden

ABSTRACT Background: This article presents a 30-year follow-up study of a cohort of 1163 substance misusers who were in inpatient treatment in the early 1980s. Data was originally collected in the Swedish Drug Addict Treatment Evaluation (SWEDATE). Objectives: The aim is to examine the overall mortality and identify causes of death in different groups based on self-reported most dominant substance misuse among those who have died during January 1984–December 2013. Methods: SWEDATE-data was linked to the National Cause of Death Register. Five mutually exclusive study groups were created based on self-reported most dominant substance misuse for the last 12 months before intake to treatment: Alcohol, Cannabis, Stimulants, Opiates, and Other. The Standardized Mortality Ratio (SMR) was calculated. Results: During the follow-up, 40% died. SMR is 10.3 for women and 11.7 for men. The study groups differed regarding SMR; 13.1 in the Alcohol group, 9.2 in the Cannabis group, 9.6 in the Stimulants group, 16.7 in the Opiates group and 10.8 in the Other group. Drug related death was the most common cause of death (28% only underlying, 19% both underlying and contributing) followed by alcohol related reasons (17% vs. 9%). Conclusions: Alcohol misuse among substance abusers might have a negative impact on mortality rates. Methodological changes in how drug related deaths is registered affects the interpretation of the statistics of cause of death. Further analysis on the relation between drug related cause of death and drug misuse related death is needed.

Dental healthcare utilisation among young adults who were in societal out-of-home care as children: A Swedish National Cohort Study: Dental care utilisation among young adults from out-of-home care

We used Swedish national registers to analyse dental health care among young adults with childhood experience of out-of-home care (OHC), in Cox regression analyses. All 1.7 million Swedish resident ...

School Contextual Features of Social Disorder and Mental Health Complaints—A Multilevel Analysis of Swedish Sixth-Grade Students

This study addressed school-contextual features of social disorder in relation to sixth-grade students’ experiences of bullying victimization and mental health complaints. It investigated, firstly, whether the school’s concentrations of behavioural problems were associated with individual students’ likelihood of being bullied, and secondly, whether the school’s concentrations of behavioural problems and bullying victimization predicted students’ emotional and psychosomatic health complaints. The data were derived from the Swedish National Survey of Mental Health among Children and Young People, carried out among sixth-grade students (approximately 12–13 years old) in Sweden in 2009. The analyses were based on information from 59,510 students distributed across 1999 schools. The statistical method used was multilevel modelling. While students’ own behavioural problems were associated with an elevated risk of being bullied, attending a school with a higher concentration of students with behavioural problems also increased the likelihood of being bullied. Attending a school with higher levels of bullying victimization and behavioural problems predicted more emotional and psychosomatic complaints, even when adjusting for their individual level analogues. The findings indicate that school-level features of social disorder influence bullying victimization and mental health complaints among students.