Rikke Lund

Social relations: network, support and relational strain

We introduce a conceptual framework with social relations as the main concept and the structure and the function of social relations as subconcepts. The structure of social relations covers aspects of formal relations and social network. The function of social relations covers social support, social anchorage and relational strain. We use this conceptual framework to describe social relations in the Danish population, with questionnaire data from the Danish Longitudinal Health Behaviour Study including a random sample of each of the age groups 25-, 50-, 60-and 70-year olds, N = 2,011. The postal questionnaires were answered by a random sample in each of the age groups. The results show marked age and gender differences in both the structure and the function of social relations. The social network, measured as weekly contacts, weakens with age and so does instrumental support. Emotional support is unrelated to this decline in contact frequency and appears to be at the same level for younger and older individuals. Relational strain, measured as conflicts, declines with age for all kinds of social relations. The weakening of the social network with age does not seem to affect the level of emotional support and in turn seems to be partly compensated for by a simultaneous decline in relational strain.

Socioeconomic position in early life, birth weight, childhood cognitive function, and adult mortality. A longitudinal study of Danish men born in 1953

Objective: To examine the relation between socioeconomic position in early life and mortality in young adulthood, taking birth weight and childhood cognitive function into account. Design: A longitudinal study with record linkage to the Civil Registration System and Cause of Death Registry. The data were analysed using Cox regression. Setting: The metropolitan area of Copenhagen, Denmark. Subjects: 7493 male singletons born in 1953, who completed a questionnaire with various cognitive measures, in school at age 12 years, and for whom birth certificates with data on birth and parental characteristics had been traced manually in 1965. This population was followed up from April 1968 to January 2002 for information on mortality. Main outcome measures: Mortality from all causes, cardiovascular diseases, and violent deaths. Results: Men whose fathers were working class or of unknown social class at time of birth had higher mortality rates compared with those whose fathers were high/middle class: hazard ratio 1.39 (95% CI 1.15 to 1.67) and 2.04 (95% CI 1.48 to 2.83) respectively. Birth weight and childhood cognitive function were both related to father’s social class and inversely associated with all cause mortality. The association between father’s social class and mortality attenuated (HRworking class1.30 (1.08 to 1.56); HRunkown class1.81 (1.30 to 2.52)) after control for birth weight and cognitive function. Mortality from cardiovascular diseases and violent deaths was also significantly higher among men with fathers from the lower social classes. Conclusion: The inverse association between father’s social class at time of birth and early adult mortality remains, however somewhat attenuated, after adjustment for birth weight and cognitive function.

Cohabitation and marital status as predictors of mortality: an eight year follow-up study

In a follow-up study of 1265 women and men aged 50, 60 and 70 years, we analysed how mortality was associated with cohabitation status (living alone/not living alone), living with/without a partner, and marital status respectively. Data originate from a longitudinal questionnaire study of a random sample of people born in 1920, 1930 and 1940 with baseline in 1990. Survival time for all individuals were established during the next 8 years until May 1998. Multivariate Cox analysis stratified by age and gender showed that individuals living alone experienced a significantly increased mortality compared to individuals living with somebody HR = 1.42(1.04-1.95) adjusted for functional ability, self-rated health, having children, smoking, diet and physical activity. Similar analyses were performed for the variable living with/without a partner HR = 1.38(1.01-1.88) and marital status HR = 1.25(0.93-1.69), adjusted for the same covariates. Inclusion of the health behaviour variables--smoking, diet and physical activity--one by one to a model with functional ability, self-rated health and one of the three determinants (cohabitation status, living with/without partner, marital status) showed no effect on the association with mortality. Hereby, we found no evidence of an indirect effect of health behaviours on the association between living arrangements and mortality. In contrast to many previous studies, we found no significant gender and age differences in the association between living arrangement and mortality. We suggest that in future studies of social relations and mortality, cohabitation status is considered to replace marital status as this variable may account for more of the variation in mortality.

Can the higher risk of disability onset among older people who live alone be alleviated by strong social relations? A longitudinal study of non-disabled men and women

PURPOSE to investigate if the increased risk of disability onset among older people who live alone could possibly be moderated by either high social participation or by being satisfied with the social relations. DESIGN AND METHODS logistic regression models were tested using two waves in a study population of 2,697 non-disabled older men and women from The Danish Longitudinal Study on Preventive Home Visits. RESULTS living alone and low social participation were significant risk factors for later male disability onset. Not being satisfied with the social relations was significantly associated with onset of disability for both genders. Among men who lived alone low social participation was a significant predictor of disability onset [odds ratio, OR = 2.30 (1.00-5.29)]; for cohabiting men social participation was not associated with disability onset, [adjusted OR = 0.91 (0.49-1.71)]. Similar results were present concerning satisfaction with the social relations among men. There was no significant interaction for women. CONCLUSIONS the study suggests that men who live alone can possibly alleviate their risk of disability onset by being socially active and by having access to satisfactory social relations. Women do not seem to benefit as much from cohabitation as men, although women who live alone and who are not satisfied with their social relations also constitute a significant risk category.

Cynical hostility, socioeconomic position, health behaviors, and symptom load: a cross-sectional analysis in a Danish population-based study.

Objective: To analyze the cross-sectional association between cynical hostility and high symptom load in a Danish population-based study. Furthermore, the aim was to investigate to what extent health risk behaviors mediated this association. Methods: Data were based on a postal questionnaire in a Danish random sample of 3426 men and 3699 women aged 40 or 50 years. Cynical hostility was measured by the 8-item Cynical Distrust Scale. High symptom load was assessed by physiological and mental symptoms experienced within the last 4 weeks. Confounders were age and socioeconomic position, while potential mediators were alcohol consumption, smoking, physical activity, and BMI. Results: Higher cynical hostility was associated with self-reported symptom load. Health behaviors did not seem to mediate this effect. Socioeconomic position was a strong confounder for the effect on both health and health behaviors. After adjustment the effects of hostility on health remained with odds ratios of 2.1 (1.7–2.6) for women and 2.3 (1.8–2.8) for men. Conclusion: After adjustment for socioeconomic position, cynical hostility has an effect on self-reported high symptom load, and this effect is not mediated by health behaviors.

Is bullying equally harmful for rich and poor children?: a study of bullying and depression from age 15 to 27.

BACKGROUND Exposure to bullying in childhood and adolescence is harmful to health, well-being and social competence of the victim. However, little is known about the long-term consequences of bullying victimization. In this paper, we use a longitudinal study from age 15 to 27 to examine whether childhood socioeconomic position (CSP) modifies the association between exposure to bullying in childhood and symptoms of depression in young adulthood. METHODS Nationally representative baseline sample in 1990 (n = 847), followed up 2002 (n = 614). We used multivariate analyses of variance to examine the influence of bullying on symptoms of depression at age 27. RESULTS Analyses showed that exposure to bullying, low CSP and female gender significantly increased the risk of depression in young adulthood. There was a statistically significant interaction between bullying and CSP, so that bullying increased the risk of depression for people from low CSP, while there was only a weak association between bullying victimization and depressive symptoms for people from more affluent childhood socioeconomic backgrounds. The same pattern was found for analyses stratified by sex. CONCLUSION Our study suggests that the effects of bullying may have more serious long-term implications on health for children from less affluent backgrounds. Our study points at bullying exposure as another pathway through which social adversity in childhood influences social inequalities in adult health. Political efforts are needed to improve norms and legislations about how to treat children and more specific interventions should take place in schools to reduce the exposure to bullying.

Copenhagen Aging and Midlife Biobank (CAMB): an introduction

Since the early 1980s, a number of large-scale, population-based, epidemiologic studies have focused on the development of disability, cognitive impairment, dementia, long-term care, and other health issues with particular relevance to older adults. With few exceptions, these health issues have been investigated in older populations, usually defined on the basis of chronological age (e.g., older than 65). Examples are the Established Populations for Epidemiologic Studies of the Elderly (EPESE), Women’s Health and Aging Studies (WHAS), and several other American, Australian, Canadian, and

Stability and change in structural social relations as predictor of mortality among elderly women and men

In a follow-up study of 70–95years old women and men (n = 911) we studied the association between change and stability in three structural aspects of social relations (contact frequency, contact diversity, cohabitation status) from 1986–1990 and mortality after the next four years in 1994. Women aged 70–74years who developed low contact frequency or developed small contact diversity showed significantly higher mortality, adjusted ORfreq: 3.78 (1.08–13.20), adjusted ORdiv: 3.79 (1.24–11.58). Women aged 70–74years with continuously low contact frequency showed an increased mortality compared to women constantly experiencing high contact frequency, adjusted OR: 2.75 (1.04–7.26). A tendency in the same direction for sustained small contact diversity was found, adjusted OR: 1.98 (0.70–5.61). Among women aged 75+ years no impact of frequency and diversity was demonstrated, whereas continuously living alone was a significant predictor of mortality, when compared to women continuously living with somebody, adjusted OR: 2.57 (1.29–5.09). In men, we found a significantly increased mortality among those who developed high contact frequency and developed large contact diversity ORfreq: 3.91 (1.02–14.94) and ORdiv: 6.04 (1.30–28.03). In summary, we found rather larger age differences in the strength of the association between change in structural social relations and mortality. Furthermore, the associations seemed stronger among women than men, which may however mainly be explained by the small number of men in our cohort.

Marital status and twins' health and behavior: an analysis of middle-aged Danish twins.

Objective: To disentangle the influences on health of selection processes related to genetic and rearing environmental factors from factors related to marriage benefits. We compared health status among same-sex male and female twin pairs who lived together during childhood and were discordant or concordant on adult marital status. Methods: A cross-sectional survey of a random sample of middle-aged Danish twins was conducted in 1998 to 1999. This study included 1175 same-sex twin pairs (52.5% monozygotic (MZ) and 47.5% dizygotic (DZ)). Data were obtained on adult marital status and on height, body mass index (BMI), depression symptoms, self-rated health, cognitive function, physical activity, smoking, and alcohol intake. Results: Among all 2350 individual twins, men who were divorced/widowed or never married had higher depression scores, lower cognitive test scores, lower physical activity scores, and were also less often moderate drinkers and nonsmokers compared with married men. Divorced/widowed women had higher depression scores and those divorced/widowed or never married were more often smokers than married women. Within twin pairs discordant on marital status, the divorced/widowed twin had higher average depression scores and was more likely to be a smoker. Never married twins had lower physical activity scores and never married male twins had higher BMI and higher depression scores than their married co-twin. Conclusion: This study suggests that the relationships of adult divorce with depression and smoking in Danish twins are due to the stressful effects of marital dissolution, but that marital differences in other health and behavioral outcomes are most consistent with selection effects related to genetic or rearing environmental factors. BMI = body mass index; MZ = monozygotic; DZ = dizygotic; MADT = middle-aged Danish twins.

Addressing Social Inequality in Aging by the Danish Occupational Social Class Measurement

Objective: To present the Danish Occupational Social Class (DOSC) measurement as a measure of socioeconomic position (SEP) applicable in a late midlife population, and to analyze associations of this measure with three aging-related outcomes in midlife, adjusting for education. Method: Systematic coding procedures of the DOSC measurement were applied to 7,084 participants from the Copenhagen Aging and Midlife Biobank (CAMB) survey. We examined the association of this measure of SEP with chronic conditions, self-rated health, and mobility in logistic regression analyses, adjusting for school education in the final analysis. Results: The measure of SEP showed a strong social gradient along the social classes in terms of prevalence of chronic conditions, poor self-rated health, and mobility limitations. Adjusting for school education attenuated the association only to a minor degree. Discussion: The DOSC measure was associated with aging-related outcomes in a midlife Danish population, and is, thus, well suited for future epidemiological research on social inequalities in health and aging.