Psychosocial factors and patient and healthcare delays in large (class T3-T4) oral, oropharyngeal, and laryngeal carcinomas.

BACKGROUND: Psychosocial factors and socioeconomic status have been associated with incidence, survival, and quality of life among patients with head and neck cancer. We investigated the association between different psychosocial factors, socioeconomic status, and patient delays in T3-T4 oral, oropharyngeal, and laryngeal cancer. PATIENTS AND METHODS: We conducted a nationwide prospective questionnaire-based study (n = 203) over a 3-year period. RESULTS: We found no association between psychosocial factors (depression, social isolation, loneliness, and cynical hostility) and patient delay. Depression was three times more common among head and neck cancer patients compared with the general Finnish population. Head and neck cancer patients had lower educational levels and employment status, and were more often current smokers and heavy drinkers. CONCLUSIONS: Although we found no association between patient delay and psychosocial factors, patients diagnosed with a large head and neck cancer appeared to have a lower socioeconomic status and higher risk for developing depression, which should be considered in clinical practice.

Predicting work disability among people with chronic conditions: a prospective cohort study.

Few risk prediction scores are available to identify people at increased risk of work disability, particularly for those with an existing morbidity. We examined the predictive performance of disability risk scores for employees with chronic disease. We used prospective data from 88,521 employed participants (mean age 43.1) in the Finnish Public Sector Study including people with chronic disorders: musculoskeletal disorder, depression, migraine, respiratory disease, hypertension, cancer, coronary heart disease, diabetes, comorbid depression and cardiometabolic disease. A total of 105 predictors were assessed at baseline. During a mean follow-up of 8.6 years, 6836 (7.7%) participants were granted a disability pension. C-statistics for the 8-item Finnish Institute of Occupational Health (FIOH) risk score, comprising age, self-rated health, number of sickness absences, socioeconomic position, number of chronic illnesses, sleep problems, BMI, and smoking at baseline, exceeded 0.72 for all disease groups and was 0.80 (95% CI 0.80-0.81) for participants with musculoskeletal disorders, 0.83 (0.82-0.84) for those with migraine, and 0.82 (0.81-0.83) for individuals with respiratory disease. Predictive performance was not significantly improved in models with re-estimated coefficients or a new set of predictors. These findings suggest that the 8-item FIOH work disability risk score may serve as a scalable screening tool in identifying individuals with increased risk for work disability.

Living alone as a risk factor for cancer incidence, case-fatality and all-cause mortality: A nationwide registry study.

Lack of social contacts has been associated with an increased risk of cancer mortality, but it is not known whether living alone increases the risk of cancer incidence or case fatality. We examined the association between living alone with cancer incidence, case-fatality and all-cause mortality in eight most common cancers. All patients with their first cancer diagnosis in 2000-2017 were identified from the nationwide Finnish Cancer Registry. Information on living arrangements was derived from Statistics Finland. The incidence analyses were conducted using Poisson regression. The total Finnish population served as the population at risk. Fine-Gray model was used to estimate case-fatality and Cox proportional regression model all-cause mortality. In men, we found an association between history of living alone and excess lung cancer incidence but living alone seemed to be associated with lower incidence of prostate cancer and skin melanoma. In women, living alone was more consistently associated with higher incidence of all studied cancers. Cancer patients living alone had an 11%-80% statistically significantly increased case-fatality and all-cause mortality in all studied cancers in men and in breast, colorectal and lung cancer in women. Living alone is consistently associated with increased cancer incidence risk in women but only in some cancers in men. Both men and women living alone had an increased risk of all-cause mortality after cancer diagnosis.

Are a lack of social relationships and cigarette smoking really equally powerful predictors of mortality? Analyses of data from two cohort studies.

OBJECTIVE: The suggestion from cross-review comparison that lower levels of social integration (social isolation, loneliness) and cigarette smoking are equally powerful predictors of premature mortality has been promulgated by policy organisations and widely reported in the media. For the first time, we examined this assertion by simultaneously comparing these associations using data from two large cohort studies. STUDY DESIGN: Individual-participant analyses of two large prospective cohort studies. METHODS: Participants in UK Biobank and the English Longitudinal Study of Ageing reported loneliness, social-isolation and smoking behaviours using standard scales at baseline. Cause-specific mortality was ascertained via linkage to national registries. We used Cox regression analyses to compute a relative index of inequality to summarise the relation between these baseline characteristics and mortality experience. RESULTS: Mean age at baseline was 56.5 years in the 466,876 (273,452 women) Biobank participants and 66.1 years in the 7505 (4123 women) English Longitudinal Study of Ageing members. In Biobank, a mean duration of mortality surveillance of 6.6 years gave rise to a total of 13,072 deaths, while in the English Longitudinal Study of Ageing, 1183 deaths occurred after a mean of 7.7 years. In ascending magnitude, loneliness, social isolation then cigarette smoking were associated with an increased risk of mortality from all-causes and all cancers combined. When cardiovascular disease mortality was the endpoint of interest, both smoking and social isolation, though not loneliness, revealed similar relationships. CONCLUSIONS: Contrary to cross-review comparisons, in the present datasets it appears that poor social integration is in fact less strongly linked to total mortality than cigarette smoking.

Childhood Psychosocial Environment and Adult Cardiac Health: A Causal Mediation Approach.

INTRODUCTION: This study used causal mediation analysis to assess the life-course associations of a favorable childhood psychosocial environment with left ventricular mass and diastolic function in adulthood and the extent to which adult health behaviors mediate these associations. METHODS: The sample included 880 participants (56% women) from the Young Finns Study with data on the childhood environment from 1980, adult health behaviors (smoking, physical activity, diet, and BMI) from 2001 and an echocardiographic assessment of the left ventricular mass (g/m2.7) and diastolic function (E/e' ratio; higher values indicating a lower diastolic function) from 2011. The associations of the childhood environment with the left ventricular mass and E/e' ratio and mediation pathways through health behaviors were assessed using marginal structural models that were controlled for age, sex, and time-dependent confounding by adult socioeconomic position (measured as educational attainment) via inverse probability weighting. The data were analyzed in 2018-2019. RESULTS: The mean age in 2011 was 41 (range 34-49) years. Those above versus below the median childhood score had a 1.28 g/m2.7 lower left ventricular mass (95% CI= -2.63, 0.07) and a 0.18 lower E/e' ratio (95% CI= -0.39, 0.03). There was no evidence for indirect effects from childhood environments to left ventricular outcomes through adult health behaviors after controlling for time-dependent confounding by the adult socioeconomic position (indirect effect ß= -0.30, 95% CI= -1.22, 0.63 for left ventricular mass; ß= -0.04, 95% CI= -0.18, 0.11 for E/e' ratio). The results after multiple imputation were similar. CONCLUSIONS: A favorable childhood environment is associated with more optimal cardiac structure and function in adulthood. After accounting for socioeconomic positions, adult health behaviors explain little of the associations.

The role of oxytocinergic genes in the intergenerational transmission of parent-child relationship qualities.

Parenting qualities are known to transmit across generations, but less is known about genetic processes that may modify how strongly parenting quality carries across generations. We examined in prospective data whether oxytocinergic genes of offspring moderate the intergenerational transmission of warm and accepting parent-child relationship qualities. The sample comprised 1167 Finnish parents (G2, 62% female) and their mothers (G1). At the study baseline, G1 mothers (Mage = 38) reported parent-child relationship qualities towards G2 children (age range 3-18). After 28-34 years, G2 offspring reported parent-child relationship qualities towards their own children using the same questionnaire. A cumulative genetic score was computed for G2 by summing up previously identified four alleles associated with non-optimal parenting or social impairments across OXTR (rs1042778, rs2254298, rs53576) and CD38 (rs3796863) genes. Results indicated no interaction effects of G2 cumulative genetic score on the transmission of parent-child relationship qualities. Among single polymorphisms in OXTR, the interaction effects of rs53576 and rs1042778 were found. G1 maternal emotional warmth was associated with higher G2 emotional warmth among G2 participants with the OXTR rs53576 AA/AG genotype, but not among those with the GG genotype. G1 maternal acceptance was associated with higher G2 acceptance among those G2 participants with the OXTR rs1042778 GG/GT genotype, but not among those with the TT genotype. Oxytocinergic genes may influence sensitivity to quality of parent-child relationship, although this needs replication in future studies.

Socioeconomic position and intergenerational associations of ideal health behaviors.

BACKGROUND: Promoting ideal cardiovascular health behaviors is an objective of the American Heart Association 2020 goals. We hypothesized that ideal health behaviors of parents are associated with health behaviors of their adult offspring, and that higher socioeconomic position in either generation enhances intergenerational associations of ideal health behaviors. DESIGN: Prospective cohort study. METHODS: We included 1856 Young Finns Study participants who had repeated measurements of socioeconomic position (education, income, occupation), smoking status, body mass index, physical activity and diet from 2001, 2007 and 2011, and data on parental socioeconomic position and health behaviors from 1980. We calculated the total number of ideal behaviors in both generations using American Heart Association definitions. Intergenerational associations were examined using ordinal and linear multilevel regression with random intercepts, in which each participant contributed one, two or three measurements of adult health behaviors (2001, 2007, 2011). All analyses were adjusted for offspring sex, birth year, age, parental education and single parenthood. RESULTS: Overall, parental ideal health behaviors were associated with ideal behaviors among offspring (odds ratio (OR) 1.28, 95% confidence interval 1.17, 1.39). Furthermore, ORs for these intergenerational associations were greater among offspring whose parents or who themselves had higher educational attainment (OR 1.56 for high vs. OR 1.19 for low parental education; P = 0.01 for interaction, OR 1.32 for high vs. OR 1.04 for low offspring education; P = 0.02 for interaction). Similar trends were seen with parental income and offspring occupation. Results from linear regression analyses were similar. CONCLUSIONS: These prospective data suggest higher socioeconomic position in parents or in their adult offspring strengthens the intergenerational continuum of ideal cardiovascular health behaviors.

Is It Good To Be Good? Dispositional Compassion and Health Behaviors.

BACKGROUND: Despite the documented importance of dispositional compassions for a range of health-related outcomes, its role in predicting health behaviors remains unclear. PURPOSE: This study examined the associations between dispositional compassion and three domains of health behavior, including physical activity, alcohol use, and smoking. METHODS: The participants (N = 1,279-1,913) were from the Finnish population-based Young Finns study. We collected self-reports of compassion in 1997 and 2011 and health behaviors in 2001, 2007, and 2011. In addition, an objective pedometer measure of physical activity was collected in 2011. Linear and logistic regression models were fitted to estimate the cross-sectional and longitudinal associations between compassion and the health behavior outcomes. RESULTS: In a cross-sectional analysis, compassion was associated with having never smoked and a reduced likelihood of at-risk alcohol use and binge drinking. There was no robust association between compassion and physical activity. In longitudinal analyses over a 14-year period, the associations remained for at-risk alcohol use and binge drinking. CONCLUSIONS: Dispositional compassion may have a protective effect against unhealthy behaviors, especially excessive alcohol consumption.

Lifestyle factors and risk of sickness absence from work: a multicohort study.

BACKGROUND: Lifestyle factors influence the risk of morbidity and mortality, but the extent to which they are associated with employees' absence from work due to illness is unclear. We examined the relative contributions of smoking, alcohol consumption, high body-mass index, and low physical activity to diagnosis-specific sickness absence. METHODS: We did a multicohort study with individual-level data of participants of four cohorts from the UK, France, and Finland. Participants' responses to a lifestyle survey were linked to records of sickness absence episodes, typically lasting longer than 9 days; for each diagnostic category, the outcome was the total number of sickness absence days per year. We estimated the associations between lifestyle factors and sickness absence by calculating rate ratios for the number of sickness absence days per year and combining cohort-specific estimates with meta-analysis. The criteria for assessing the evidence included the strength of association, consistency across cohorts, robustness to adjustments and multiple testing, and impact assessment by use of population attributable fractions (PAF), with both internal lifestyle factor prevalence estimates and those obtained from European populations (PAFexternal). FINDINGS: For 74 296 participants, during 446 478 person-years at risk, the most common diagnoses for sickness absence were musculoskeletal diseases (70·9 days per 10 person-years), depressive disorders (26·5 days per 10 person-years), and external causes (such as injuries and poisonings; 12·8 days per 10 person-years). Being overweight (rate ratio [adjusted for age, sex, socioeconomic status, and chronic disease at baseline] 1·30, 95% CI 1·21-1·40; PAFexternal 8·9%) and low physical activity (1·23, 1·14-1·34; 7·8%) were associated with absences due to musculoskeletal diseases; heavy episodic drinking (1·90, 1·41-2·56; 15·2%), smoking (1·70, 1·42-2·03; 11·8%), low physical activity (1·67, 1·42-1·96; 19·8%), and obesity (1·38, 1·11-1·71; 5·6%) were associated with absences due to depressive disorders; heavy episodic drinking (1·64, 1·33-2·03; 11·3%), obesity (1·48, 1·27-1·72; 6·6%), smoking (1·35, 1·20-1·53; 6·3%), and being overweight (1·20, 1·08-1·33; 6·2%) were associated with absences due to external causes; obesity (1·82, 1·40-2·36; 11·0%) and smoking (1·60, 1·30-1·98; 10·3%) were associated with absences due to circulatory diseases; low physical activity (1·37, 1·25-1·49; 12·0%) and smoking (1·27, 1·16-1·40; 4·9%) were associated with absences due to respiratory diseases; and obesity (1·67, 1·34-2·07; 9·7%) was associated with absences due to digestive diseases. INTERPRETATION: Lifestyle factors are associated with sickness absence due to several diseases, but observational data cannot determine the nature of these associations. Future studies should investigate the cost-effectiveness of lifestyle interventions aimed at reducing sickness absence and the use of information on lifestyle for identifying groups at risk. FUNDING: NordForsk, British Medical Research Council, Academy of Finland, Helsinki Institute of Life Sciences, and Economic and Social Research Council.

Unfavorable and favorable changes in modifiable risk factors and incidence of coronary heart disease: The Whitehall II cohort study.

BACKGROUND: Few studies have examined long-term associations of unfavorable and favorable changes in vascular risk factors with incident coronary heart disease (CHD). We examined this issue in a middle-aged disease-free population. METHODS: We used repeat data from the Whitehall II cohort study. Five biomedical, behavioral and psychosocial examinations of 8335 participants without CHD produced up to 20,357 person-observations to mimic a non-randomized pseudo-trial. After measurement of potential change in 6 risk factors twice (total cholesterol, blood pressure, smoking, overweight, psychological distress, problems in social relationships), a 5-year follow-up of CHD was undertaken. RESULTS: Incidence of CHD was 7.4/1000 person-years. Increases from normal to high cholesterol (hazard ratio, HR = 1.59, 95% CI 1.26-2.00) and from normal to high blood pressure (HR = 1.64, 95% CI 1.33-2.03), as compared to remaining at the normal level, were associated with increased risk of CHD. In contrast, decreases from high to low levels of cholesterol (HR = 0.73, 95% CI 0.58-0.91), psychological distress (HR = 0.68, 95% CI 0.51-0.90), and problems in social relationships (HR = 0.65, 95% CI 0.50-0.85), and quitting smoking (HR = 0.49, 95% CI 0.29-0.82) were associated with a reduced CHD risk compared to remaining at high risk factor levels. The highest absolute risk was associated with persistent exposure to both high cholesterol and hypertension (incidence 18.1/1000 person-years) and smoking and overweight (incidence 17.7/1000 person-years). CONCLUSIONS: While persistent exposures and changes in biological and behavioral risk factors relate to the greatest increases and reductions in 5-year risk of CHD, also favorable changes in psychosocial risk factors appear to reduce CHD risk.

Is the association between depressive symptoms and glucose bidirectional? A population-based study.

OBJECTIVE: Depressive symptoms have been associated with Type 2 diabetes, but the temporal direction of this association and the underlying mechanisms remain unclear. The present study examined a potential bidirectional association between depressive symptoms and glucose levels in women and men, and the factors mediating this association. METHOD: The participants were from the Cardiovascular Risk in Young Finns Study, a prospective, population-based, cohort study (N = 2,534). Depressive symptoms were assessed using a modified Beck Depression Inventory. Fasting glucose was measured concurrently with depressive symptoms. To analyze the data, a multiple-group cross-lagged analysis and parallel multiple mediation in structural equation modeling were used. RESULTS: Depressive symptoms in 2001 were positively associated with glucose levels in 2012 in women (ß = .07, p = .023) but not in men (ß = -.03, p = .45). This sex difference was statistically significant (p = .042). Glucose levels in 2001 did not predict depressive symptoms in 2012 in either women or men (ps = .96). Changes in body mass index, high-sensitivity C-reactive protein, alcohol consumption, or tobacco or cigarette smoking did not mediate the observed association (ps > .05). CONCLUSIONS: The results showed a positive association between depressive symptoms and glucose levels in women but not in men. The direction of this relationship seems to be from depressive symptoms to glucose levels rather than the reverse. Changes in body fat, inflammation, alcohol consumption, or tobacco or cigarette smoking may not play a mediating role in this observed association. (PsycINFO Database Record

Relationship transitions and change in health behavior: A four-phase, twelve-year longitudinal study.

RATIONALE: Extensive scientific evidence shows an association between involvement in social relationships and healthy lifestyle. Prospective studies with many participants and long follow-ups are needed to study the dynamics and change in social factors within individuals over time. OBJECTIVE: Our aim was to determine whether a change in relationship status (single, married, divorced, widow, cohabiting) is followed by a change in health behavior (smoking, alcohol consumption, physical activity, and body mass index). METHODS: We used data from 81,925 healthy adults participating in the prospective longitudinal Finnish Public Sector Study in the period 2000-2013. We analyzed 327,700 person-observations from four data collection phases. Missing data were multiply imputed. A within-individual methodology was used to minimize the possibility of selection effects affecting the interpretation. RESULTS: All four health behaviors showed associations with relationship status. The effects were very similar and in the same direction in women and men, although there were gender differences in the magnitudes of the effects. The end of a relationship was followed by a decrease in body mass index, increased odds of being a smoker, increase in physical activity, and increase in alcohol consumption (widowed men). The effects were reverse when forming a new relationship. CONCLUSION: A change in relationship status is associated with a change in health behavior. The association is not explained by socioeconomic status, subjective health status, or anxiety level. People leaving or losing a relationship are at increased risk of unhealthy behavior (smoking and alcohol consumption), but at the same time they have a lower BMI and show higher physical activity compared to the time they were in a relationship. It is not clear if the cumulative health effect of these health behavior changes is positive or negative.

Personality traits and career choices among physicians in Finland: employment sector, clinical patient contact, specialty and change of specialty.

BACKGROUND: Personality influences an individual's adaptation to a specific job or organization. Little is known about personality trait differences between medical career and specialty choices after graduating from medical school when actually practicing different medical specialties. Moreover, whether personality traits contribute to important career choices such as choosing to work in the private or public sector or with clinical patient contact, as well as change of specialty, have remained largely unexplored. In a nationally representative sample of Finnish physicians (N = 2837) we examined how personality traits are associated with medical career choices after graduating from medical school, in terms of employment sector, patient contact, medical specialty and change of specialty. METHODS: Personality was assessed using the shortened version of the Big Five Inventory (S-BFI). An analysis of covariance with posthoc tests for pairwise comparisons was conducted, adjusted for gender and age with confounders (employment sector, clinical patient contact and medical specialty). RESULTS: Higher openness was associated with working in the private sector, specializing in psychiatry, changing specialty and not practicing with patients. Lower openness was associated with a high amount of patient contact and specializing in general practice as well as ophthalmology and otorhinolaryngology. Higher conscientiousness was associated with a high amount of patient contact and specializing in surgery and other internal medicine specialties. Lower conscientiousness was associated with specializing in psychiatry and hospital service specialties. Higher agreeableness was associated with working in the private sector and specializing in general practice and occupational health. Lower agreeableness and neuroticism were associated with specializing in surgery. Higher extraversion was associated with specializing in pediatrics and change of specialty. Lower extraversion was associated with not practicing with patients. CONCLUSIONS: The results showed distinctive personality traits to be associated with physicians' career and specialty choices after medical school independent of known confounding factors. Openness was the most consistent personality trait associated with physicians' career choices in terms of employment sector, amount of clinical patient contact, specialty choice and change of specialty. Personality-conscious medical career counseling and career guidance during and after medical education might enhance the person-job fit among physicians.

Childhood socioeconomic status and lifetime health behaviors: The Young Finns Study.

BACKGROUND: Differences in health behaviors partly explain the socioeconomic gap in cardiovascular health. We prospectively examined the association between childhood socioeconomic status (SES) and lifestyle factors in adulthood, and the difference of lifestyle factors according to childhood SES in multiple time points from childhood to adulthood. METHODS AND RESULTS: The sample comprised 3453 participants aged 3-18 years at baseline (1980) from the longitudinal Young Finns Study. The participants were followed up for 31 years (N = 1675-1930). SES in childhood was characterized as reported annual family income and classified on an 8-point scale. Diet, smoking, alcohol intake and physical activity were used as adult and life course lifestyle factors. Higher childhood SES predicted a healthier diet in adulthood in terms of lower consumption of meat (ß ±â€¯SE -3.6 ±â€¯0.99,p < 0.001), higher consumption of fish (1.1 ±â€¯0.5, p = 0.04) and higher diet score (0.14 ±â€¯0.044, p = 0.01). Childhood SES was also directly associated with physical activity index (0.059 ±â€¯0.023, p = 0.009) and inversely with the risk of being a smoker (RR 0.90 95%CI 0.85-0.95, p < 0.001) and the amount of pack years (-0.47 ±â€¯0.18, p = 0.01). Life course level of smoking was significantly higher and physical activity index lower among those below the median childhood SES when compared with those above the median SES. CONCLUSIONS: These results show that childhood SES associates with several lifestyle factors 31 years later in adulthood. Therefore, attention could be paid to lifestyle behaviors of children of low SES families to promote cardiovascular health.

Social networks and patterns of health risk behaviours over two decades: A multi-cohort study.

OBJECTIVE: To determine the associations between social network size and subsequent long-term health behaviour patterns, as indicated by alcohol use, smoking, and physical activity. METHODS: Repeat data from up to six surveys over a 15- or 20-year follow-up were drawn from the Finnish Public Sector study (Raisio-Turku cohort, n=986; Hospital cohort, n=7307), and the Health and Social Support study (n=20,115). Social network size was determined at baseline, and health risk behaviours were assessed using repeated data from baseline and follow-up. We pooled cohort-specific results from repeated-measures log-binomial regression with the generalized estimating equations (GEE) method using fixed-effects meta-analysis. RESULTS: Participants with up to 10 members in their social network at baseline had an unhealthy risk factor profile throughout the follow-up. The pooled relative risks adjusted for age, gender, survey year, chronic conditions and education were 1.15 for heavy alcohol use (95% CI: 1.06-1.24), 1.19 for smoking (95% CI: 1.12-1.27), and 1.25 for low physical activity (95% CI: 1.21-1.29), as compared with those with >20 members in their social network. These associations appeared to be similar in subgroups stratified according to gender, age and education. CONCLUSIONS: Social network size predicted persistent behaviour-related health risk patterns up to at least two decades.

Contribution of risk factors to excess mortality in isolated and lonely individuals: an analysis of data from the UK Biobank cohort study.

BACKGROUND: The associations of social isolation and loneliness with premature mortality are well known, but the risk factors linking them remain unclear. We sought to identify risk factors that might explain the increased mortality in socially isolated and lonely individuals. METHODS: We used prospective follow-up data from the UK Biobank cohort study to assess self-reported isolation (a three-item scale) and loneliness (two questions). The main outcomes were all-cause and cause-specific mortality. We calculated the percentage of excess risk mediated by risk factors to assess the extent to which the associations of social isolation and loneliness with mortality were attributable to differences between isolated and lonely individuals and others in biological (body-mass index, systolic and diastolic blood pressure, and handgrip strength), behavioural (smoking, alcohol consumption, and physical activity), socioeconomic (education, neighbourhood deprivation, and household income), and psychological (depressive symptoms and cognitive capacity) risk factors. FINDINGS: 466 901 men and women (mean age at baseline 56·5 years [SD 8·1]) were included in the analyses, with a mean follow-up of 6·5 years (SD 0·8). The hazard ratio for all-cause mortality for social isolation compared with no social isolation was 1·73 (95% CI 1·65-1·82) after adjustment for age, sex, ethnic origin, and chronic disease (ie, minimally adjusted), and was 1·26 (95% CI 1·20-1·33) after further adjustment for socioeconomic factors, health-related behaviours, depressive symptoms, biological factors, cognitive performance, and self-rated health (ie, fully adjusted). The minimally adjusted hazard ratio for mortality risk related to loneliness was 1·38 (95% CI 1·30-1·47), which reduced to 0·99 (95% CI 0·93-1·06) after full adjustment for baseline risks. INTERPRETATION: Isolated and lonely people are at increased risk of death. Health policies addressing risk factors such as adverse socioeconomic conditions, unhealthy lifestyle, and lower mental wellbeing might reduce excess mortality among the isolated and the lonely. FUNDING: Academy of Finland, NordForsk, and the UK Medical Research Council.

Accumulation of Depressive Symptoms and Carotid Intima-Media Thickness: the Cardiovascular Risk in Young Finns Study.

BACKGROUND: The association between depressive symptoms and subclinical atherosclerosis has been inconsistent. PURPOSE: We sought to replicate our previous study, which demonstrated a positive relation between depressive symptoms and subclinical atherosclerosis assessed with carotid intima-media thickness (IMT) in men, using a newer measurement of carotid IMT and a cumulative loading of depressive symptoms over three follow-ups. METHODS: The sample comprised 996 adults (352 men) aged 30 to 45 years in 2007 from a prospective population-based Finnish sample. The participants completed a modified version of Beck Depression Inventory in 1992, 1997, and 2001. Carotid IMT was assessed with ultrasound in 2001 and 2007. Cardiovascular risk factors (i.e., body mass index, systolic blood pressure, low-density lipoprotein cholesterol, and smoking) were measured in childhood (1980) and in adulthood (2007). RESULTS: We found no association between the accumulative depression index and carotid IMT before or after controlling for the traditional risk factors (all p values ≥0.67). Depressive symptoms did not predict IMT progression over two time points and the highest level of carotid wall thickening. Imputed and non-imputed data sets provided similar results. Results remained the same when men and women were analyzed separately. Additional analyses revealed no significant interactions between depressive symptoms and cardiovascular risk factors (i.e., body mass index and systolic blood pressure) on carotid IMT (all p values >0.15). CONCLUSIONS: The findings of this population-based study did not indicate any direct association between depressive symptoms and carotid IMT in asymptomatic, young adults.

Coronary heart disease and risk factors as predictors of trajectories of psychological distress from midlife to old age.

OBJECTIVE: To examine coronary heart disease (CHD) and its risk factors as predictors of long-term trajectories of psychological distress from midlife to old age. METHODS: In the Whitehall II cohort study, 6890 participants (4814 men, 2076 women; mean age 49.5 years) had up to seven repeat assessments of psychological distress over 21 years (mean follow-up 19 years). CHD and its risk factors (lifestyle-related risk factors, diabetes, hypertension and cholesterol) were assessed at baseline. Group-based trajectory modelling was used to identify clusters of individuals with a similar pattern of psychological distress over time. RESULTS: We identified four trajectories of psychological distress over the follow-up: 'persistently low' (69% of the participants), 'persistently intermediate' (13%), 'intermediate to low' (12%) and 'persistently high' (7%). The corresponding proportions were 60%, 16%, 13% and 11% among participants with CHD; 63%, 15%, 12% and 10% among smokers and 63%, 16%, 12% and 10% among obese participants. In multivariable adjusted multinomial regression analyses comparing other trajectories to persistently low trajectory, prevalent CHD was associated with intermediate to low (OR 1.70, 95% CI 1.08 to 2.68) and persistently high (OR 1.92, 95% CI 1.16 to 3.19) trajectories. Smoking (OR 1.33, 95% CI 1.07 to 1.64; OR 1.55, 95% CI 1.19 to 2.04) and obesity (OR 1.33, 95% CI 1.04 to 1.70; OR 1.47, 95% CI 1.07 to 2.01) were associated with persistently intermediate and persistently high trajectories, respectively. CONCLUSION: CHD, smoking and obesity may have a role in the development of long-lasting psychological distress from midlife to old age.

Job insecurity and risk of diabetes: a meta-analysis of individual participant data.

BACKGROUND: Job insecurity has been associated with certain health outcomes. We examined the role of job insecurity as a risk factor for incident diabetes. METHODS: We used individual participant data from 8 cohort studies identified in 2 open-access data archives and 11 cohort studies participating in the Individual-Participant-Data Meta-analysis in Working Populations Consortium. We calculated study-specific estimates of the association between job insecurity reported at baseline and incident diabetes over the follow-up period. We pooled the estimates in a meta-analysis to produce a summary risk estimate. RESULTS: The 19 studies involved 140 825 participants from Australia, Europe and the United States, with a mean follow-up of 9.4 years and 3954 incident cases of diabetes. In the preliminary analysis adjusted for age and sex, high job insecurity was associated with an increased risk of incident diabetes compared with low job insecurity (adjusted odds ratio [OR] 1.19, 95% confidence interval [CI] 1.09-1.30). In the multivariable-adjusted analysis restricted to 15 studies with baseline data for all covariates (age, sex, socioeconomic status, obesity, physical activity, alcohol and smoking), the association was slightly attenuated (adjusted OR 1.12, 95% CI 1.01-1.24). Heterogeneity between the studies was low to moderate (age- and sex-adjusted model: I2 = 24%, p = 0.2; multivariable-adjusted model: I2 = 27%, p = 0.2). In the multivariable-adjusted analysis restricted to high-quality studies, in which the diabetes diagnosis was ascertained from electronic medical records or clinical examination, the association was similar to that in the main analysis (adjusted OR 1.19, 95% CI 1.04-1.35). INTERPRETATION: Our findings suggest that self-reported job insecurity is associated with a modest increased risk of incident diabetes. Health care personnel should be aware of this association among workers reporting job insecurity.

Psychological wellbeing in 20-year-old adults receiving repeated lifestyle counselling since infancy.

AIM: This study examined whether there was an association between a repeated dietary and lifestyle intervention that began in infancy and participants' psychological wellbeing at the age of 20. METHODS: We examined the psychological wellbeing of 457 young adults participating in the Special Turku Coronary Risk Factor Intervention Project (STRIP), a randomised controlled trial conducted in Finland between 1989 and 2011. We assessed potential differences in psychological wellbeing between the intervention and control groups by examining participants' satisfaction with life, how they rated their health, their experiences of stress and the consequences of experiencing stress and symptoms of depression at the age of 20. We also assessed socio-economic status during childhood as a potential confounding factor. RESULTS: We found no association between the long-term dietary and lifestyle intervention and participants' psychological wellbeing in adulthood. Adjusting for sex and childhood socio-economic status did not affect the results and socio-economic status did not moderate the association between the intervention and psychological wellbeing. CONCLUSION: Our findings showed no association between intensive dietary and lifestyle counselling that was initiated in infancy with psychological wellbeing in adulthood and the initiative did not appear to pose any psychological risks.