Marit Knapstad

Shame among long-term sickness absentees: Correlates and impact on subsequent sickness absence

Aims: The contribution of general psychological aspects, such as emotions, has received little focus in research on sickness absence. We wanted to study the relationship between shame and sickness absence, which factors that explained differences in levels of shame, and if shame predicted subsequent sickness absence. Methods: We employed a Swedish population-based cohort of current sickness absentees (19–64 years old), responding to a mailed questionnaire in 2008. Data was linked to national registries on sickness absence.Results: The young, those born outside the Nordic countries, those on lower incomes and those with higher level of education reported being more ashamed of their sickness absence. Those with more sickness absence in the past were also more likely to report higher levels of shame. Level of shame was not associated with gender or occupational class. Compared to those absent for a somatic cause, mental or co-morbid illness was associated with higher levels of shame. Those reporting high level of shame were more likely to have prolonged sickness absence the following year. Symptoms of depression at baseline only partly explained these associations. Conclusions: Our results suggest that shame might prolong sickness absence. Increased understanding of the impact of social and emotional aspects around sickness absence could be an important source for improved quality of rehabilitation.

Polarity Correspondence in Comparative Number Magnitude Judgments

When asked which of two digits is greater, participants respond more quickly if physical size corresponds to number magnitude, such as in 3 7, than when the two attributes contradict each other, such as in 3 7. This size congruence effect in comparative number judgments is a well-documented phenomenon. We extended existing findings by showing that this effect does not depend on physical size of the number alone but can be observed with number symmetry. In addition, we observed that symmetric numbers are judged as being smaller than asymmetric numbers, which renders an interpretation of the number symmetry congruence effect in terms of physical size implausible. We refer to the polarity correspondence principle (Proctor & Cho, 2006) to explain the present findings.

Previous sickness absence and current low perceived social support at work among employees in the general population: a historical cohort study

Objective Although sickness absence often is a process over time, most studies have treated the phenomenon as a discrete event and focused more on its causes than its consequences. We aimed to examine whether various patterns of previous long-term sickness absence were associated with current low perceived social support at work. Method This is a historical cohort study based on data from a population-based survey among Swedish employees (n=2581). The survey data were linked to official registries yielding data on sickness absence 1–7 years prior to the survey. Results The main finding was that previous sickness absence was associated with current low perceived social support at work. The highest odds for low social support were found among those who had a stable high level of sickness absence. The two indicators of perceived social support employed were somewhat differently associated with previous sickness absence: Recency of absence showed to be of importance for general support at the workplace and the relationship with colleagues and superiors. Experiencing that ones immediate superior rarely or never regards ones view was, on the other hand, mainly related to having had a high level of sickness absence, irrespective of recency. Conclusions Our results indicate that recency and extent of previous sickness absence are related to perceived social support at work. Future research on the relationship between social support and sickness absence should use repeated measurements and acknowledge the possible bidirectional relationship.

An investigation of factors identified at birth in relation to anxiety and depression in old age: the Hordaland Health Study (HUSK)

BackgroundAlthough life course influences have long been recognised in affective disorder, little is known about the influence of early life factors on late life anxiety and depression. The aim was to investigate the extent to which birth measures, maternal health and family circumstances were associated with symptoms of anxiety and depression in late life.MethodsA retrospective cohort study was constructed from a cross-sectional survey sample of community residents aged 72–74 years, 406 of whom had traceable birth records. Cases and controls for late life anxiety and depression were defined applying standard cut-offs to the Hospital Anxiety and Depression Scale. A range of measures and circumstances were extracted from birth records blind to survey data and compared in age- and gender-adjusted models.ResultsThere were no differences in any anthropometric measure in either case control comparison. Case-level anxiety and depression were both associated with significantly lower maternal age. Late-life anxiety was additionally associated with smaller maternal pelvic size and the mother’s condition being rated as poor at birth/discharge. Late-life depression was associated with a lower status paternal occupation.ConclusionsThere was no evidence for a substantial influence of early life size on late life affective disorder. However, there was some evidence in secondary analyses for an enduring influence of the family’s socioeconomic environment and maternal health.

Do gastrointestinal complaints increase the risk for subsequent medically certified long-term sickness absence? The HUSK study

BackgroundGastrointestinal complaints are very common in the general population and very often co-occur with common mental disorders. We aimed to study the prospective impact of gastrointestinal complaints on long term sickness absence, and address the contribution from co-occurring common mental disorders and other somatic symptoms.MethodHealth data on 13 880 40-45 year olds from the Hordaland Health Study (1997-99) were linked to national registries on sickness absence. As part of a wider health screening, gastrointestinal complaints were ascertained. Participants anxiety and depression, and the presence of other somatic symptoms were evaluated. In Cox regression models, we predicted sickness absences over an average 5.4 years follow-up, with adjustment for confounders, anxiety and depression and other somatic symptoms.ResultsAfter adjusting for gender, level of education and smoking, those reporting GI complaints had higher risk for later sickness absence (HR = 1.42, 95% CI 1.34-1.51). GI complaints were associated with both anxiety (OR = 3.66, 95% CI 3.31-4.04) and depression (OR = 3.28, 95% CI 2.89-3.72), and a high level of other somatic symptoms (OR = 8.50, 95% CI 7.69-9.40). The association of GI complaints was still independently associated with future sickness absence (HR = 1.17, 95% CI 1.10-1.16) adjusting for mental illness and other somatic symptoms.DiscussionSickness absence is a complex behavioural outcome, but our results suggest GI complaints contribute by increasing the risk of long term sickness absence independently of comorbid mental illness and presence of other somatic symptoms. Occupational consequences of illness are important, and should also be addressed clinically with patients presenting with GI complaints.

The Norwegian student introductory week: who takes part, and is participation associated with better social integration and satisfaction among students?

ABSTRACT Norwegian universities and university colleges yearly arrange an introductory week to welcome new students. This study provides new insight about who takes part in the event, to what degree students are satisfied with the event, and whether participation is associated with social integration. Data from the Norwegian study of students’ health and well-being was used. Satisfaction with the introductory week and other variables of interest were described for individuals taking part, partly taking part and not taking part in the event. The associations between participation, satisfaction and social integration were investigated (linear regression). More than 70% of students were satisfied with the introductory week and the opportunity it provided for getting to know other students. Participation in the event was associated with higher satisfaction with the student community and student city, and better social integration. Individuals who were younger, single and had moved to the student city were more likely to participate in the event, alcohol abstainers were less likely to participate. Though the introductory week is associated with beneficial outcomes with regards to satisfaction and social integration, the event might be in danger of excluding individuals who cannot or do not want to consume alcohol.

Registry-based analysis of participator representativeness: a source of concern for sickness absence research?

Objectives Selective participation can bias results in epidemiological surveys. The importance of health status is often suggested as a possible explanation for non-participation but few empirical studies exist. In a population-based study, explicitly focused on sickness absence, health and work, we examined whether a history of high levels of sickness absence was associated with non-participation. Design The study is based on data from official sickness absence registers from participants, non-participants and the total target population of the baseline survey of the Health Assets Project (HAP). Setting HAP is a population-based cohort study in the Västra Götaland region in South Western Sweden. Participants HAP included a random population cohort (n=7984) and 2 cohorts with recent sickness absence (employees (n=6140) and non-employees (n=990)), extracted from the same overall general working-age population. Primary outcome measures We examined differences in participation rates between cohorts (2008), and differences in previous sickness absence (2001–2008) between participants (individual-level data) and non-participants or the target population (group-level data) within cohorts. Results Participants had statistically significant less registered sickness absence in the past than non-participants and the target population for some, but not all, of the years analysed. Yet these differences were not of substantial size. Other factors than sickness absence were more important in explaining differences in participation, whereby participants were more likely to be women, older, born in Nordic countries, married and have higher incomes than non-participants. Conclusions Although specifically addressing sickness absence, having such experience did not add any substantial layer to selective participation in the present survey. Detailed measures are needed to gain a better understanding for health selection in health-related surveys such as those addressing sickness absence, for instance in order to discriminate between selection due to ability or motivation for participation.

Early life factors in relation to cardiovascular risk and cardiovascular disease in old age in Bergen: a Norwegian retrospective cohort study based on the Hordaland Health Study (HUSK).

Summary Objectives The fetal origins of adult disease hypothesis describes associations found for fetal or early-life exposures with cardiovascular risk and disease in adulthood. The extension or not of these associations into old age has received less attention. We investigated if maternal health and family circumstances were associated with cardiovascular risk factors and cardiovascular disease (CVD) in late life and discuss results in light of possible selection effects and measurement error. Design A retrospective cohort study based on community survey. We examined 224 possible associations between anthropometric measures, maternal health information and family socioeconomic status at birth versus CVD and CVD-related risk factors 72–74 years later. Participants Of 3341 participants in a community survey of people aged 72–74 years, we were able to trace birth records from a historical archive in a broadly representative subsample of 480. Setting Bergen, Norway Main outcome measures Established cardiovascular risk factors and indicators of CVD. Results Only 11 (4.9%) of these associations were found to be statistically significant, and no strong or consistent patterns in the associations between exposures and outcomes were found. Conclusions There was little evidence in this relatively elderly sample for an association between early life factors and CVD outcomes of clinical or public health relevance. Further research is required to confirm the extent to which a diminution of early life influences into old age, if genuine, can be accounted for by selective mortality, systematic bias or by dilution of effects due to competing risk factors.