Socioeconomic status, lifestyle factors and asthma prevalence: results from a population-based study in Sweden.

AIM: To examine differences in the prevalence of self-reported diagnosed asthma by socioeconomic status and the contribution of lifestyle factors to these differences. METHODS: The study was based on 28,531 persons aged 18 years or older who answered a survey questionnaire sent to a random population sample in mid-Sweden in 2017. The overall response rate was 44%. Socioeconomic status was measured with educational level and economic difficulties, and lifestyle factors with physical activity, smoking, snuff use, risk-drinking of alcohol and obesity. The associations between socioeconomic status and asthma were analysed using multivariate logistic regression. RESULTS: The overall asthma prevalence was 9% among women and 7% in men and decreased with increasing age. Educational level was not independently associated with asthma, but a statistically significant odds ratio (with 95% confidence intervals) for the prevalence of asthma was observed for economic difficulties 1.5 (1.3-1.7). Also, physical inactivity 1.2 (1.1-1.3) and obesity 1.6 (1.4-1.8) were associated with increased asthma prevalence. Smoking and risk-drinking were not statistically significantly associated with asthma whereas snuff users had a higher prevalence of asthma among women. Adjusting for lifestyle factors did not affect the association between socioeconomic status and asthma. CONCLUSIONS: In this population-based study, self-reported diagnosed asthma was independently associated with economic difficulties but not with educational level. Lifestyle factors did not explain the association between economic difficulties and asthma prevalence. This applies to both men and women as well as younger and older age groups.

At-risk drinking, loneliness and self-reported diagnosed depression among older people, 70-84 years of age.

OBJECTIVES: At-risk drinking of alcohol is increasing in the older population and both at-risk drinking and loneliness have been shown to be risk factors for depression. The aim of this study was therefore to investigate the associations between at-risk drinking, loneliness, and self-reported diagnosed depression in the older population. METHODS: The study was based on 10,096 persons aged 70-84 years who answered a survey questionnaire sent to a random population sample in Mid-Sweden in 2017. The overall response rate was 77%. The associations between at-risk drinking, loneliness and depression were analysed using multivariate logistic regression, adjusting for age, educational level, country of birth, economic stress, social support, living alone, physical activity, smoking, BMI, and medication use. RESULTS: The prevalence of at-risk drinking during the last 12 months was 8% among men and 4% among women. In total, 8% of the men and 14% of the women suffered from loneliness at least weekly. Having a current diagnosed depression was more commonly reported among women (9%) than among men (5%). At-risk drinking was associated with a higher prevalence of diagnosed depression in both men (OR:1.76; 95% CI:1.03-3.01) and women (OR:1.83; 95% CI:1.06-3.18), compared to moderate drinking when adjusting for loneliness and potential confounders. Furthermore, persons who suffered from loneliness every week had a higher prevalence of diagnosed depression (OR:5.95; 95% CI:3.72-9.53 in men and OR:4.80; 95% CI:3.44-6.69 in women) than those who did not suffer from loneliness. CONCLUSION: In this population-based study, both at-risk drinking and loneliness were independently associated with self-reported diagnosed depression among men and women aged 70-84 years. These findings are important for prevention of depression among older people.

Living conditions, lifestyle habits and health among adults before and after the COVID-19 pandemic outbreak in Sweden - results from a cross-sectional population-based study.

BACKGROUND: Studies on the public health consequences of COVID-19 pandemic showing data based on robust methods are scarce. The aim of this study was to investigate mental and physical health as well as living conditions and lifestyle habits in the general population before and after the COVID-19 outbreak in Sweden. METHODS: The study is based on 2273 persons 16-84 years who responded to the national public health survey in February-May 2020 in Värmland county (overall response rate 45%). The differences between early respondents (before the outbreak, n = 1711) and late respondents (after the outbreak, n = 562) were studied using multivariate logistic regression, adjusting for background characteristics: age, gender, educational level, and country of birth. The same analyses were also completed in the corresponding survey carried out in February-June 2018. RESULTS: Statistically significant differences between the groups were obtained for economic difficulties and worry about losing one's job, which were more common among late respondents, and for sleeping difficulties, which were more common among early respondents after adjusting for background characteristics. There were no differences in other living conditions nor in lifestyle factors. Prevalence of good self-rated health, high blood pressure, aches in shoulders or neck, anxiety or worry and stress did not differ between the groups. In 2018, the only statistically significant difference between early and late respondents concerned economic difficulties. CONCLUSIONS: Very few differences in living conditions, lifestyle factors and health were observed in the study population before and after the COVID-19 outbreak. The results suggest that, in addition to a possible decrease in sleeping difficulties, the prevalence of being worried about losing one's job increased among the employed after the outbreak.

Alcohol consumption and self-rated health among older people: population-based study in Sweden.

OBJECTIVE: To analyse alcohol consumption and its association with self-rated health among a representative sample of older people in mid-Sweden. BACKGROUND: Over the past decades, alcohol consumption has increased in the older population in Sweden, but few studies have investigated the association between alcohol consumption and self-rated health in this group. The aim was therefore to investigate alcohol consumption and self-rated health among older Swedes. METHODS: The study is based on a cross-sectional study of 11,716 men and women, 65 years and over, answering a survey questionnaire sent to a random population sample in mid-Sweden in 2012. We assessed alcohol consumption with AUDIT-C and its association with self-rated health using logistic regression analysis, adjusting for age, economic situation, educational level, BMI, physical activity, social support and medication use. RESULTS: Men (83%) were more prone to drink alcohol compared to women (71%). The prevalence of risk drinking was about 2% for both genders. Alcohol consumption declined with age. Moderate consumption of alcohol was associated with lower probability of poor self-rated health compared to non-drinking with an adjusted odds ratio 0.64 (95% confidence interval: 0.54-0.76) for men and 0.68 (0.59-0.79) for women. CONCLUSION: Since the study was cross-sectional the direction of the association could not be determined, and the results should not be interpreted as an argument for promoting alcohol consumption among older people.

Economic stress and condescending treatment in childhood and adult self-rated health: results from a population study in Sweden.

BACKGROUND: Even today, 12% of the children in Sweden live in poverty and many children are exposed to adverse experiences, such as being bullied, which may have long-term consequences on public health. This study examined the associations between economic stress and condescending treatment in childhood and self-rated health (SRH) in adulthood. METHODS: The study is based on 26,706 persons who responded to a postal survey questionnaire sent to a random sample of men and women aged 25-84 years in 2012 (response rate 53%). The associations between childhood circumstances and adult SRH were analysed by logistic regression, adjusting for sex, age, economic stress in adulthood, condescending treatment in adulthood, socioeconomic status and several other known material, behavioural and psychosocial risk factors. RESULTS: In total, 39% of both men and women reported economic stress in their family during childhood. 36% of the men and 41% of the women indicated that they had been treated in a condescending manner, e.g. in school or at home, during childhood. Both economic stress in childhood and condescending treatment in childhood were strongly associated with adult SRH. The associations attenuated, but were still statistically significant after adjustment for adulthood circumstances and other risk factors. CONCLUSION: Economic stress in childhood and condescending treatment in childhood were associated with SRH in adulthood, both independently and through adulthood circumstances. The results underline the importance of taking into account both material and psychosocial circumstances over the whole life course when developing public health measures.

A health dialogue intervention reduces cardiovascular risk factor levels: a population based randomised controlled trial in Swedish primary care setting with 1-year follow-up.

BACKGROUND: The total number of cardiovascular (CVD) deaths accounted for almost a third of all deaths globally in 2013. Population based randomised controlled trials, managed within primary care, on CVD risk factor interventions are scarce. The aim of the study was to evaluate the effects of a health dialogue intervention in a primary care setting offered to a population at the age of 55 years, focusing on CVD risk factors. METHODS: The study was performed in five primary health care centres in the county of Västmanland, Sweden between April 2011 and December 2012. Men and women were randomly assigned to intervention (n = 440) and control groups (n = 440). At baseline, both groups filled in a health questionnaire and serum cholesterol, fasting plasma glucose, glycated haemoglobin (HbA1c), weight, height, waist (WC) and hip circumference, waist hip ratio (WHR) and systolic/diastolic blood pressure were measured. Intervention group attended a health dialogue, supported by a visualised health profile, with a possibility for further activities. Participation rates at baseline were 53% and 52% respectively. A 1-year follow-up was carried out. RESULTS: The intervention group (n = 165) showed reductions compared to the control group (n = 177) concerning body mass index (BMI) (0.3 kg/m2, p = .031), WC (2.1 cm, p ≤ .001) and WHR (.002, p ≤ .001) at the 1-year follow-up. No differences between the intervention and control groups were found in other variables. Intervention group, compared to baseline, had reduced weight, BMI, WC, WHR, HbA1c, and diet, while the men in the control group had reduced their alcohol consumption. CONCLUSIONS: A health dialogue intervention at the age of 55 years, conducted in ordinary primary care, showed a moderate effect on CVD risk factor levels, in terms of BMI, WC and WHR. TRIAL REGISTRATION NUMBER: BioMed Central, ISRCTN22586871 , date assigned; 10/12/2015.

Obesity continues to increase in the majority of the population in mid-Sweden-a 12-year follow-up.

BACKGROUND: The aim was to investigate trends in the prevalence of obesity by age and level of education in the general population in mid-Sweden from year 2000 to 2012. METHODS: A postal questionnaire was sent to a random population sample aged 25-74 years in years 2000, 2004, 2008 and 2012. The overall response rates were 67%, 65%, 60% and 53%, respectively, and the study included 29 017, 27 385, 25 910 and 24 152 respondents, respectively. Obesity (BMI ≥ 30 kg/m(2)) was based on self-reported weight and height. RESULTS: The age-standardized prevalence of obesity increased from 13% to 17% in women and from 12% to 17% in men between 2000 and 2012. Obesity increased in all age groups from 2000 to 2008 and continued to increase among the middle aged (45-64 years) between 2008 and 2012. The socioeconomic gradient in obesity changed during the study period since the absolute increase in obesity was steepest at the middle educational level. In 2012, the prevalence of obesity was almost twice as high at both middle and low educational levels compared with high educational level. The 'true' prevalence of adult obesity, corrected for self-reported weight and height, was around 20% in 2012 for both men and women. CONCLUSION: In the majority, among the middle-aged and those with secondary education, the prevalence of obesity continued to increase even between 2008 and 2012.

Exploring trends in and determinants of educational inequalities in self-rated health.

AIMS: Educational inequalities in self-rated health (SRH) in European welfare countries are documented, but recent trends in these inequalities are less well understood. We examined educational inequalities in SRH in different age groups, and the contribution of selected material, behavioural and psychosocial determinants from 2000 to 2008. METHODS: Data were derived from cross-sectional surveys conducted in 2000, 2004 and 2008 including 37,478, 34,876 and 32,982 respondents, respectively, aged 25-75 in mid-Sweden. Inequalities were analysed by age-standardized and age-stratified rate ratios of poor SRH and age-standardized prevalence of determinants, and contribution of determinants by age-adjusted logistic regression. RESULTS: Relative educational inequalities in SRH increased among women from 2000 (rate ratio (RR) 1.70, 95% CI 1.55-1.85) to 2008 (RR 2.07, 95% CI 1.90-2.26), but were unchanged among men (RR 1.91-2.01). The increase among women was mainly due to growing inequalities in the age group 25-34 years. In 2008, significant age differences emerged with larger inequalities in the youngest compared with the oldest age group in both genders. All determinants were more prevalent in low educational groups; the most prominent were lack of a financial buffer, smoking and low optimism. Educational differences were unchanged over the years for most determinants. In all three surveys, examined determinants together explained a substantial part of the educational inequalities in SRH. CONCLUSIONS: Increased relative educational health inequalities among women, and persisting inequalities among men, were paralleled by unchanged, large differences in material/structural, behavioural and psychosocial factors. Interventions to reduce these inequalities need to focus on early mid-life.

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.

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

BACKGROUND: The 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. METHODS: The 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. RESULTS: In 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. CONCLUSIONS: There 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.

Socioeconomic differences in self-rated oral health and dental care utilisation after the dental care reform in 2008 in Sweden.

BACKGROUND: The aims of this study were to determine self-rated oral health and dental attendance habits among Swedish adults, with special reference to the role of social inequalities, after the Swedish dental care reform in 2008. METHODS: The study is based on a survey questionnaire, sent to 12,235 residents of a Swedish county, in 2012. The age group was 16-84 years: 5,999 (49%) responded. Using chi-square statistics, differences in prevalence of self-rated oral health and regular dental attendance were analysed with respect to gender, age, educational level, family status, employment status and country of birth. Self-rated poor oral health was analysed by multivarite logistic regression adjusting for the different socio-demographic factors, financial security and having refrained from dental treatment for financial reasons. RESULTS: Three out of four respondents (75%) reported fairly good or very good oral health. Almost 90% claimed to be regular dental attenders. Those who were financially secure reported better oral health. The differences in oral health between those with a cash margin and those without were large whereas the differences between age groups were rather small. About 8% reported that they had refrained from dental treatment for financial reasons during the last three months. Self-rated poor oral health was most common among the unemployed, those on disability pension or on long-term sick leave, those born outside the Nordic countries and those with no cash margin (odds ratios ranging from 2.4 to 4.4). The most important factor contributing to these differences was having refrained from dental treatment for financial reasons. CONCLUSION: The results are relevant to strategies intended to reduce social inequalities in oral health, affirming the importance of the provision of equitable access to dental care.

Living conditions, lifestyle habits and health in the general population in spring 2020 and one year into the COVID-19 pandemic in Sweden - Results from two cross-sectional studies carried out in 2020 and 2021.

The aim of the study was to investigate mental and physical health as well as living conditions and lifestyle habits in the adult general population in spring 2020 and one year into the COVID-19 pandemic in Sweden comparing results from two cross-sectional studies carried out in February-May 2020 and 2021. The study population comprises 2,273 persons in 2020 and 2,216 persons in 2021 who responded to the national public health survey sent to random population samples in one county in Sweden. The age group was 16-84 years, and the response rates were 45% and 44%, respectively. Differences in living conditions (economic difficulties, social support and worrying about losing one's job), lifestyle habits (physical activity, daily smoking, sitting duration and alcohol use), and health (self-rated health, pain in shoulders or neck, sleeping difficulties, anxiety or worry, and obesity) between years 2020 and 2021 were analysed using multiple binary logistic regression in men and women, adjusting for age group and educational level. Very few statistically significant differences were observed between 2020 and 2021 regarding living conditions, lifestyle factors and health. The main finding was that the prevalence of anxiety and worry increased among women. Surveillance of the long-term public health consequences of the pandemic in the general population using robust data and methods, is important for planning and targeting preventive activities.

The Association between Time Spent in Domestic Work and Mental Health among Women and Men.

BACKGROUND: Unpaid domestic work has been found to be negatively associated with mental health, especially among women, in previous studies but the measures of domestic work vary. The aim of this study was to elucidate the association between time spent in domestic work and mental health in the general population. METHOD: The study is based on 14,184 women and men aged 30-69 years who responded to a survey questionnaire in Central Sweden in 2017 (overall response rate: 43%). Multivariate logistic regression models, adjusting for age group, educational level, family status, employment status, economic difficulties, and social support, were used to study the association between hours spent in domestic work and depressive symptoms and self-reported diagnosed depression, respectively. RESULTS: In total, 26.7% of the respondents reported depressive symptoms and 8.8% reported diagnosed depression. No independent associations between hours spent in domestic work and depressive symptoms were found. Among women, the lowest prevalence of depression was found among those who spend 11-30 h per week in domestic work. Among men, the prevalence of self-reported diagnosed depression was highest among those who spend 0-2 h per week in domestic work, but no other statistically significant associations between time spent in domestic work and depression were found. In addition, a strong dose-response relationship was found between experiencing domestic work as burdensome and both depressive symptoms and self-reported diagnosed depression among women and men. CONCLUSION: Investigating time spent in unpaid domestic work may not be sufficient to assess the association between exposure to domestic work and mental health. Conversely, strain in domestic work may be a more important factor contributing to the prevalence of poor mental health in the general population.

Can financial insecurity and condescending treatment explain the higher prevalence of poor self-rated health in women than in men? A population-based cross-sectional study in Sweden.

INTRODUCTION: Women have in general poorer self-rated health than men. Both material and psychosocial conditions have been found to be associated with self-rated health. We investigated whether two such factors, financial insecurity and condescending treatment, could explain the difference in self-rated health between women and men. METHODS: The association between the two factors and self-rated health was investigated in a population-based sample of 35,018 respondents. The data were obtained using a postal survey questionnaire sent to a random sample of men and women aged 18-75 years in 2008. The area covers 55 municipalities in central Sweden and the overall response rate was 59%. Multinomial odds ratios for poor self-rated health were calculated adjusting for age, educational level and longstanding illness and in the final model also for financial insecurity and condescending treatment. RESULTS: The prevalence of poor self-rated health was 7.4% among women and 6.0% among men. Women reported more often financial insecurity and condescending treatment than men did. The odds ratio for poor self-rated health in relation to good self-rated health was 1.29 (95% CI: 1.17-1.42) for women compared to men when adjusted for age, educational level and longstanding illness. The association became, however, statistically non-significant when adjusted for financial insecurity and condescending treatment. CONCLUSION: The present findings suggest that women would have as good self-rated health as men if they had similar financial security as men and were not treated in a condescending manner to a larger extent than men. Longitudinal studies are, however, required to confirm this conclusion.

Domestic Work, Self-Reported Diagnosed Depression and Related Costs among Women and Men-Results from a Population-Based Study in Sweden.

BACKGROUND: In contrast to paid work, few studies have investigated the association between unpaid domestic work and mental health. The aim of this study was to investigate the association between domestic work and self-reported diagnosed depression and to estimate related costs in a general population. METHOD: The study is based on women (N = 7981) and men (N = 6203) aged 30-69 years who responded to a survey questionnaire in Mid-Sweden in 2017 (overall response rate 43%). Multivariate logistic regression models, adjusting for age group, educational level, family status, employment status, economic difficulties, and social support, were used to study the association between domestic work and depression. The estimation of direct and indirect costs was based on the calculation of population attributable risks, the literature, and administrative data. RESULTS: In total, 25% of the women and 14% of the men spent more than 20 h a week on domestic work, and 57% of the women and 39% of the men experienced domestic work sometimes or more often as burdensome. A strong independent association between experiencing domestic work as burdensome and depression was observed both in women and men. The total cost of depression possibly related to burdensome domestic work was estimated up to EUR 135.1 million (min EUR 20.7 million-max EUR 21.4 billion) of the total EUR 286.4 million per year in Mid-Sweden. CONCLUSIONS: The association between experiencing domestic work as burdensome and depression was strong among both women and men and was not restricted to employed persons or to parents with children. Even though the cross-sectional design does not allow one to assess the direction of the association between domestic work and depression, and longitudinal studies are needed, the results imply that strain in domestic work should be taken into account when considering factors that contribute to the prevalence of depression in the general population and its high societal costs.

Self-rated health and associated factors among the oldest-old: results from a cross-sectional study in Sweden.

BACKGROUND: Very few population-based studies have investigated self-rated health and related factors in the increasing age group 85 years or older. The aim of this study was to examine self-rated health and its association with living conditions, lifestyle factors, physical and mental health problems and functional ability among the oldest-old in the general population in Sweden. METHODS: The study is cross-sectional and based on 1360 persons, 85 years of age or older, who answered a survey questionnaire sent to a random population sample in 2012 (participation rate 47%). Multivariate logistic regression was used as the statistical method. RESULTS: The prevalence of good self-rated health was 39% in men and 30% in women. Physical inactivity, impaired physical mobility, pain, anxiety/depression and longstanding illness were independently associated with poorer than good self-rated health, while factors such as gender, age, educational level, cash margin, living alone, social support, smoking, alcohol use, obesity, accidents and impaired vision/hearing were not. CONCLUSIONS: While a considerable part of the oldest-old assess their health as good, not being physically active and having common health problems such as pain and depression as well as impaired physical mobility are associated with poorer than good self-rated health. This should be considered when planning how to improve and maintain health in the growing population of persons 85 years and older.

Desire to lose weight and need of weight loss support in the adult population-Results from a cross-sectional study in Sweden.

OBJECTIVE: Evidence-based methods to lose weight are important in tackling increasing obesity trends in adult populations. More knowledge about persons who want to lose weight and do not/do need weight loss support is necessary to design effective preventive practices. Thus, the aim of the study was to investigate the prevalence of desire to lose weight in the general population and the prevalence of health problems and health-related factors in persons with overweight or obesity who want to lose weight and believe that they do not/do need weight loss support. METHODS: The study included 14 126 persons aged 30 to 69 years who responded to a questionnaire sent to a random sample. Persons with overweight or obesity (BMI ≥ 25 kg/m2) were divided into three groups: those who do not want to lose weight (n = 1236), those who want to lose weight but do not believe they need support (n = 5484), and those who want to lose weight and believe they need weight loss support (n = 1462). RESULTS: In total, 69% of the women and 59% of the men reported that they wanted to lose weight. The prevalence of hypertension, musculoskeletal pain, poor self-rated health, anxiety/worry, and depression was highest among persons with overweight or obesity who wanted to lose weight and believed they need weight loss support. They were also more physically inactive and reported less social support. CONCLUSIONS: To want to lose weight is very common among adults. People with overweight or obesity who want to lose weight and believe they need weight loss support have higher frequency of various health problems, including mental health problems, and less social support.

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

BACKGROUND: Poor 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 1990 s. There is a need for a better understanding of the area for planning preventive activities and health care. METHODS: The 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. RESULTS: About 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. CONCLUSION: Our 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.

Socio-economic factors, lifestyle, and headache disorders - a population-based study in Sweden.

OBJECTIVE: To study the association between socio-economic factors, lifestyle habits, and self-reported recurrent headache/migraine (RH/M) in a general population. METHODS: The study population comprised a random sample of men and women aged 18-79 years. The data were obtained using a postal survey questionnaire during March-May 2000. The overall response rate was 65%. The area investigated covers 58 municipalities with about one million inhabitants in central part of Sweden. The study is based on 43,770 respondents. Odds ratios for RH/M were calculated for a set of variables using multiple logistic regression models. RESULTS: The overall prevalence of self-reported RH/M during the last 3 months was 10% among men and 23% among women and decreased with increasing age. Physically inactive subjects were more likely to suffer from headache disorders than physically active subjects. Smoking was only moderately associated with RH/M. There was an inverse relationship between heavy alcohol use and RH/M. Underweight and obesity were not associated with headache disorders when adjusted for socio-economic factors. Subjects with frequent economic problems had almost twice the risk of RH/M compared with subjects with no economic problems. Poor social support was associated with headache disorders and subjects who had been belittled during the last 3 months were more than twice as likely to suffer from RH/M as subjects who had not been belittled. The effect of educational level was modest. Marital status and country of origin were not associated with headache disorders after adjustment for other socio-economic factors. Dissatisfaction with work, worry about losing one's job, and absenteeism due to illness were strongly associated with headache disorders. Physical working conditions and working hours were not associated with RH/M. CONCLUSION: Headache disorders mainly affect young and middle-aged adults. There are, however, socio-economic disparities in self-reported recurrent headache and migraine. The relationship was particularly evident for economic hardship and psychosocial factors. Of lifestyle factors, physical inactivity was strongly associated with headache disorders independent of economic and psychosocial factors.