Psychosocial work environment as a dynamic network: a multi-wave cohort study.

While characteristics of psychosocial work environment have traditionally been studied separately, we propose an alternative approach that treats psychosocial factors as interacting elements in networks where they all potentially affect each other. In this network analysis, we used data from a prospective occupational cohort including 10,892 participants (85% women; mean age 47 years) and repeated measurements of seven psychosocial work characteristics (job demands, job control, job uncertainty, team climate, effort-reward imbalance, procedural justice and interactional justice) assessed in 2000, 2004, 2008 and 2012. Results from multilevel longitudinal vector autoregressive models indicated that job demands as well as interactional and procedural justice were most broadly associated with the subsequent perceptions of the work-related psychosocial factors (high out-Strength), suggesting these factors might be potentially efficient targets of workplace interventions. The results also suggest that modifying almost any of the studied psychosocial factors might be relevant to subsequent perceptions of effort-reward imbalance and interactional justice at the workplace.

Risk of Early-Onset Depression Associated With Polygenic Liability, Parental Psychiatric History, and Socioeconomic Status.

Importance: Combining information on polygenic risk scores (PRSs) with other known risk factors could potentially improve the identification of risk of depression in the general population. However, to our knowledge, no study has estimated the association of PRS with the absolute risk of depression, and few have examined combinations of the PRS and other important risk factors, including parental history of psychiatric disorders and socioeconomic status (SES), in the identification of depression risk. Objective: To assess the individual and joint associations of PRS, parental history, and SES with relative and absolute risk of early-onset depression. Design, Setting, and Participants: This case-cohort study included participants from the iPSYCH2012 sample, a case-cohort sample of all singletons born in Denmark between May 1, 1981, and December 31, 2005. Hazard ratios (HRs) and absolute risks were estimated using Cox proportional hazards regression for case-cohort designs. Exposures: The PRS for depression; SES measured using maternal educational level, maternal marital status, and paternal employment; and parental history of psychiatric disorders (major depression, bipolar disorder, other mood or psychotic disorders, and other psychiatric diagnoses). Main Outcomes and Measures: Hospital-based diagnosis of depression from inpatient, outpatient, or emergency settings. Results: Participants included 17 098 patients with depression (11 748 [68.7%] female) and 18 582 (9429 [50.7%] male) individuals randomly selected from the base population. The PRS, parental history, and lower SES were all significantly associated with increased risk of depression, with HRs ranging from 1.32 (95% CI, 1.29-1.35) per 1-SD increase in PRS to 2.23 (95% CI, 1.81-2.64) for maternal history of mood or psychotic disorders. Fully adjusted models had similar effect sizes, suggesting that these risk factors do not confound one another. Absolute risk of depression by the age of 30 years differed substantially, depending on an individual's combination of risk factors, ranging from 1.0% (95% CI, 0.1%-2.0%) among men with high SES in the bottom 2% of the PRS distribution to 23.7% (95% CI, 16.6%-30.2%) among women in the top 2% of PRS distribution with a parental history of psychiatric disorders. Conclusions and Relevance: This study suggests that current PRSs for depression are not more likely to be associated with major depressive disorder than are other known risk factors; however, they may be useful for the identification of risk in conjunction with other risk factors.

Determinants of prescription opioid use: population-based evidence from Finland.

BACKGROUND AND AIMS: Previous studies have shown that prescription opioid use is more common in socio-economically disadvantaged communities in the United States. This study examined the area and individual-level determinants of prescription opioid use in Finland during the period 1995-2016. DESIGN: Logistic regression analysis using nation-wide data on filled opioid-related prescriptions dispensed at Finnish pharmacies and covered by National Health Insurance. Opioid consumption was linked, using personal identification codes, to population-based data maintained by Statistics Finland, which records individual background and area-level characteristics. SETTING AND PARTICIPANTS: Working-age population aged between 15 and 64 years in Finland during the periods 1995-2007 (n = 4 315 409) and 2009-16 (n = 4 116 992). MEASUREMENTS: Annual prescription opioid use was measured using defined daily doses (DDD) and whether people used opioids during a year. FINDINGS: Prescription opioid use increased in Finland from 1995 to 2016 (from less than 1 to 7%), but the increase was explained by the change in the treatment of codeine-based opioids in National Health Insurance. The area-level unemployment rate was positively correlated with the share of opioid users at the municipal level (r = 0.36; P < 0.001). In comparison with being employed, being outside the labour force was associated with increased opioid use in 1995-2007 [odds ratio (OR) = 2.22, 95% confidence interval (CI) = 2.10-2.36] and non-codeine opioid use in 2009-16 (OR = 2.16, 95% CI = 2.06-2.27), but not with codeine opioid use in 2009-16. CONCLUSIONS: Prescription opioid use in Finland appears to be more common among low socio-economic status people, similar to the United States and the United Kingdom.

The Contribution of Neighborhood Socioeconomic Disadvantage to Depressive Symptoms Over the Course of Adult Life: A 32-Year Prospective Cohort Study.

The association between socioeconomic disadvantage and increased risk of depressive symptoms in adulthood is well established. We tested 1) the contribution of early exposure to neighborhood socioeconomic disadvantage to later depressive symptoms throughout life, 2) the persistence of the potential association between early exposure and depressive symptoms, and 3) the contributions of other known risk factors to the association. Data were collected from the Young Finns Study, a prospective, population-based 32-year follow-up study that included participants aged 3-18 years at baseline in 1980. Participants were followed up with repeated measurements of depressive symptoms between 1992 and 2012 (n = 2,788) and linked to national grid data on neighborhood disadvantage via residential addresses. We examined the associations in mixed models separately for the 5-, 10-, 15-, and 20-year follow-ups. Living in a disadvantaged neighborhood during childhood and adolescence was associated with a higher level of depressive symptoms in adulthood during all follow-up periods (ß = 0.07, P = 0.001) than living in a nondisadvantaged area. Individual adulthood socioeconomic status mediated the associations. These findings suggest that living in a socioeconomically disadvantaged area during childhood and adolescence has a long-lasting negative association with mental health irrespective of family-related risks, partially due to socioeconomic adversity later in life.

Association Between Parental Income During Childhood and Risk of Schizophrenia Later in Life.

Importance: Evidence linking parental socioeconomic position and offspring's schizophrenia risk has been inconsistent, and how risk is associated with parental socioeconomic mobility has not been investigated. Objective: To elucidate the association between parental income level and income mobility during childhood and subsequent schizophrenia risk. Design, Setting, and Participants: National cohort study of all persons born in Denmark from January 1, 1980, to December 31, 2000, who were followed up from their 15th birthday until schizophrenia diagnosis, emigration, death, or December 31, 2016, whichever came first. Data analyses were from March 2018 to June 2019. Exposure: Parental income, measured at birth year and at child ages 5, 10, and 15 years. Main Outcomes and Measures: Hazard ratios (HRs) for schizophrenia were estimated using Cox proportional hazard regression. Cumulative incidence values (absolute risks) were also calculated. Results: The cohort included 1 051 033 participants, of whom 51.3% were male. Of the cohort members, 7544 (4124 [54.7%] male) were diagnosed with schizophrenia during 11.6 million person-years of follow-up. There was an inverse association between parental income level and subsequent schizophrenia risk, with children from lower income families having especially elevated risk. Estimates were attenuated, but risk gradients remained after adjustment for urbanization, parental mental disorders, parental educational levels, and number of changes in child-parent separation status. A dose-response association was observed with increasing amount of time spent in low-income conditions being linked with higher schizophrenia risk. Regardless of parental income level at birth, upward income mobility was associated with lower schizophrenia risk compared with downward mobility. For example, children who were born and remained in the lowest income quintile at age 15 years had a 4.12 (95% CI, 3.71-4.58) elevated risk compared with the reference group, those who were born in and remained in the most affluent quintile, but even a rise from the lowest income quintile at birth to second lowest at age 15 years appeared to lessen the risk elevation (HR, 2.80; 95% CI, 2.46-3.17). On the contrary, for those born in the most affluent quintile, downward income mobility between birth and age 15 years was associated with increased risks of developing schizophrenia. Conclusions and Relevance: This study's findings suggest that parental income level and income mobility during childhood may be linked with schizophrenia risk. Although both causation and selection mechanisms could be involved, enabling upward income mobility could influence schizophrenia incidence at the population level.

Employment Status and Personal Income Before and After Onset of a Severe Mental Disorder: A Case-Control Study.

OBJECTIVE: Individuals with severe mental disorders have an impaired ability to work and are likely to receive income transfer payments as their main source of income. However, the magnitude of this phenomenon remains unclear. Using longitudinal population cohort register data, the authors conducted a case-control study to examine the levels of employment and personal income before and after a first hospitalization for a serious mental disorder. METHODS: All individuals (N=50,551) who had been hospitalized for schizophrenia, other nonaffective psychosis, or bipolar disorder in Finland between 1988 and 2015 were identified and matched with five randomly selected participants who were the same sex and who had the same birth year and month. Employment status and earnings, income transfer payments, and total income in euros were measured annually from 1988 to 2015. RESULTS: Individuals with serious mental disorders had notably low levels of employment before, and especially after, the diagnosis of a severe mental disorder. Their total income was mostly constituted of transfer payments, and this was especially true for those diagnosed as having schizophrenia. More than half of all individuals with a serious mental disorder did not have any employment earnings after they received the diagnosis. CONCLUSIONS: The current study shows how most individuals in Finland depend solely on income transfer payments after an onset of a severe mental disorder.

Association of Income With the Incidence Rates of First Psychiatric Hospital Admissions in Finland, 1996-2014.

Importance: The association between income and mental health has long been a question of interest. Nationwide register data provide means to examine trends and patterns of these associations. Objectives: To compare income-specific trends in the incidence rates of first psychiatric hospital admissions and to evaluate whether an income gradient exists in the incidence rates at all levels of household income. Design, Setting, and Participants: This population-based open cohort study used linked registry data from nationwide Finnish Hospital Discharge and Statistics Finland population registers to determine annual incidence rates of first psychiatric hospital admissions. All Finnish citizens (N = 6 258 033) living in the country at any time from January 1, 1996, through December 31, 2014, contributed to 96 184 614 person-years at risk of first inpatient treatment for mental disorders. The analyses were conducted from August 1, 2018, through September 30, 2019. Exposures: Equivalized disposable income, sex, age group, reduction in income decile in the previous 3 years, urbanicity, educational level, and living alone status. Main Outcomes and Measures: Annual percentage changes in the age-standardized incidence rates and incidence rate ratios (IRRs). Results: Altogether, 186 082 first psychiatric inpatient treatment episodes occurred (93 431 [50.2%] men), with overall age-standardized incidence rates per 1000 person-years varying from 1.59 (95% CI, 1.56-1.63) in 2014 to 2.11 (95% CI, 2.07-2.15) in 2008. In the highest income deciles, a continuous mean decrease per year of 3.71% (95% CI, 2.82%-4.59%) in men and 0.91% (95% CI, 0.01%-1.80%) in women occurred throughout the study period, in contrast to the lowest deciles, where the trends first increased (1.31% [95% CI, 0.62%-2.01%] increase in men from 1996 to 2007 and 5.61% [95% CI, 2.36%-8.96%] increase in women from 1996 to 2001). In the adult population, an income gradient was observed at all levels of household income: the lower the income decile, the higher the adjusted IRRs compared with the highest decile. The IRRs in the lowest decile varied from 2.94 (95% CI, 2.78-3.11) to 4.46 (95% CI, 4.17-4.76). In other age groups, the gradient did not persist at the highest income deciles. Diagnosis-specific income gradient was steepest in schizophrenia and related psychotic disorders, with estimated IRRs of the lowest income decile of 5.89 (95% CI, 5.77-6.02). Conclusions and Relevance: In this cohort study, clear negative income gradient in the incidence rates of first hospital-treated mental disorders was observed in the adult population of Finland. These findings suggest that reduction in the use of inpatient care has not taken place equally between different income groups.

A network approach to the analysis of psychosocial risk factors and their association with health.

We modeled early psychosocial risks as a network of interconnected variables to study their associations with later depressive symptoms and cardiometabolic outcomes. The participants were a nationally representative sample of 2580 men and women aged 3-18 years in 1980. Their parents reported the psychosocial risks in 1980, including the following: (1) child-specific life events, (2) parental health behavior, (3) parental socioeconomic status, and (4) parental psychological problems. Adulthood depressive symptoms and cardiometabolic outcomes were measured in 2007-2012. The most central risks (most number of connections to other risks) were socioeconomic risks that also predicted health outcomes more consistently than others.

Longitudinal Associations of Explosive and Adventurous Temperament Profiles With Character Development: The Modifying Effects of Social Support and Attachment.

OBJECTIVE: The aim of this study was to examine (a) whether adventurous and explosive temperament profiles (presumed precursors of antisocial and borderline personality) are associated with character traits over a 15-year follow-up and (b) whether social support and attachment security modify the relationship between temperament profiles and character development. METHODS: 2,028 subjects of the Young Finns study completed the Temperament and Character Inventory, the Multidimensional Scale of Perceived Social Support, and the Relationship Questionnaire at 3 assessment points between 1997 and 2012. RESULTS: Both explosive and adventurous temperament profiles seemed to predispose individuals to have less mature personalities; that is, these profiles were consistently associated with lower cooperativeness (P < .001), and explosive temperament also with lower self-directedness (P < .001), over the entire follow-up period. These relationships did not vary significantly at the individual level and were sustained after controlling for age, gender, and socioeconomic status. However, the presence of high social support and secure attachment was found to decrease the likelihood that explosive temperament would lead to an immature adulthood character (P < .001). In contrast, persons with the adventurous temperament were likely to have a more mature character under low social support and an immature one under high experienced social support (P < .05). CONCLUSIONS: Individuals with the explosive temperament benefit from high social support and secure attachment. From the point of view of the therapy process, this knowledge might be of importance. In contrast, individuals with the adventurous temperament were able to direct their behavior better in social environments that were not likely to support their basic temperaments.

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.

Trajectories of Physical Activity Predict the Onset of Depressive Symptoms but Not Their Progression: A Prospective Cohort Study.

This prospective, community-based study examined trajectories of physical activity from childhood to adulthood and whether these trajectories contributed to depressive symptoms in adulthood to a greater degree than adulthood physical activity. Participants (n = 3596) were from the ongoing Cardiovascular Risk in Young Finns Study which started in 1980. Depressive symptoms were measured with Beck Depression Inventory (BDI-II) in 2012, and physical activity was assessed from 1980 to 2011 with self-reports. Analyses were adjusted for age, sex, childhood negative emotionality, socioeconomic factors, previous depressive symptoms, social support, body mass index, and smoking status (1980-2007). Highly, moderately, and lightly physically active trajectory groups were identified. Highly active participants reported lower levels of depressive symptoms compared to lightly active ones (p < 0.001) and compared to moderately active ones (p = 0.001). Moderately active participants had less symptoms than lightly active ones (p < 0.001). High levels of adulthood physical activity associated with lower levels of depressive symptoms (p < 0.001). The findings did not withstand adjustment for previous depressive symptoms (p > 0.05). Lifelong physical activity trajectories or adulthood physical activity was not associated with the progression of depressive symptoms in adulthood. Thus, physical activity history does not contribute to the progression of the depressive symptoms to a greater degree than adulthood physical activity.

Neighbourhood effects in health behaviours: a test of social causation with repeat-measurement longitudinal data.

BACKGROUND: Neighbourhood characteristics have been associated with health behaviours of residents. We used longitudinal data to examine whether neighbourhood characteristics (level of urbanization and socioeconomic status) are related to within-individual variations in health behaviours (alcohol consumption, smoking, exercise and self-interest in health) as people live in different neighbourhoods over time. METHODS: Participants were from the Young Finns prospective cohort study (N = 3145) with four repeated measurement times (1992, 2001, 2007 and 2011/2012). Neighbourhood socioeconomic status and level of urbanization were measured on the level of municipality and zip code area. Within-individual (i.e. fixed-effect) regression was used to examine whether these associations were observed within individuals who lived in different neighbourhood in different measurement times. RESULTS: People living in more urban zip code areas were more likely to smoke (b = 0.06; CI = 0.03-0.09) and drink alcohol (b = 0.11; CI = 0.08-0.14), and these associations were replicated in within-individual analysis-supporting social causation. Neighbourhood socioeconomic status and urbanization were associated with higher interest in maintaining personal health (b = 0.05; CI = 0.03-0.08 and b = 0.05; CI = 0.02-0.07, respectively), and these associations were also similar in within-individual analysis. Physical exercise was not associated with neighbourhood characteristics. CONCLUSIONS: These data lend partial support for the hypothesis that neighbourhood differences influence people's health behaviours.

Moving on: How depressive symptoms, social support, and health behaviors predict residential mobility.

BACKGROUND: There are major health inequalities between residential areas. However, it remains unclear whether these inequalities are due to social causation or selective residential mobility, because little is known about the associations between health-related factors and selective residential mobility. This study examined how depressive symptoms, social support, and health behaviors are associated with subsequent residential mobility, as measured by frequency, distance, and direction of moves. METHODS: Participants were selected from the Young Finns prospective cohort study (N = 3017) with four study waves in 1992, 1997, 2001, and 2007. Complete residential mobility history was gathered for each participant from registry data. Residential mobility was assessed over three-year periods following each study wave. The direction of mobility was measured as changes in residential location's population density, health index, mortality index, and unemployment. Area characteristics were used as covariates together with the participants' age, sex, and education. RESULTS: Individuals reporting higher social support from friends were more likely to move (b = 0.20; 95% confidence interval (CI): 0.08, 0.37) and move more frequently (b = 0.08; 95% CI: 0.01, 0.14), whereas individuals reporting higher social support from their family members were less likely to move (b = -0.08; 95% CI: -0.14, -0.02). Better health behaviors were associated with longer moving distances (b = 0.14; 95% CI: 0.06, -0.23). None of the individual characteristics were associated with the direction of moves as measured by changes in municipality characteristics. CONCLUSIONS SOME OF THE HEALTH-RELATED CHARACTERISTICS ARE ASSOCIATED WITH RESIDENTIAL MOBILITY IN FINLAND HOWEVER, THESE INDIVIDUAL CHARACTERISTICS DO NOT SEEM TO PREDICT SYSTEMATIC SELECTIVE RESIDENTIAL MOBILITY ACROSS MUNICIPALITIES WITH DIFFERENT REGIONAL HEALTH PROFILES.

Childhood and adolescence risk factors and development of depressive symptoms: the 32-year prospective Young Finns follow-up study.

BACKGROUND: Environmental risks in childhood have been shown to predict later depressive symptoms. In this study, we examined whether various environmental risk domains in childhood and adolescence, socioeconomic, psychoemotional, parental lifestyle and life-events, predict depressive symptom trajectories in adulthood individually by domain and as a cumulative risk score across domains. METHODS: Participants were a nationally representative sample of 1289 men and 1585 women from the Young Finns study, aged 3-18 years at study entry in 1980. They responded to questions on depressive symptoms (modified version of the Beck Depression Inventory) at four study phases from 1997 to 2012. RESULTS: Findings from longitudinal repeated multilevel modelling showed that all clusters of risk within domain and the cumulative risk score were associated with later depressive symptoms (regression coefficient range from 0.07 to 0.34). Socioeconomic risk, psychoemotional risk and the cumulative risk score predicted later depressive symptoms after adjustment for the effects of adulthood risk. No interaction with time was observed. CONCLUSIONS: Our findings suggest that environment risks in childhood and adolescence, particularly in the socioeconomic and psychoemotional domains, are associated with a higher risk, but not an increased progression, of depressive symptoms in adulthood.

Neighborhood effects in depressive symptoms, social support, and mistrust: Longitudinal analysis with repeated measurements.

While many associations between neighborhood characteristics and individual well-being have been reported, there is a lack of longitudinal studies that could provide evidence for or against causal interpretations of neighborhood effects. This study examined whether neighborhood urbanicity and socioeconomic status were associated with within-individual variation in depression, mistrust and social support when individuals were living in different neighborhoods with different levels of urbanicity and socioeconomic status. Participants were from the Young Finns prospective cohort study (N = 3074) with five repeated measurement times in 1992, 1997, 2001, 2007, and 2011. Neighborhood urbanicity and socioeconomic status were measured at the level of municipalities and zip-code areas. Within-individual variation over time was examined with multilevel regression, which adjusted the models for all stable individual differences that might confound associations between neighborhood characteristics and individual well-being. Social support from friends was higher in urban areas and in areas with higher socioeconomic status, whereas social support from the family was higher in rural areas. These associations were observed also in the within-individual analyses, and they were partly accounted for by employment and socioeconomic status of the participants. There were no associations between neighborhood characteristics and depression or mistrust. These findings suggest that people receive less support from their families and more support from their friends when living in urban compared to rural regions of Finland. These differences are partly explained by people's changing socioeconomic and employment statuses.

Cumulative effect of psychosocial factors in youth on ideal cardiovascular health in adulthood: the Cardiovascular Risk in Young Finns Study.

BACKGROUND: The American Heart Association has defined a new metric of ideal cardiovascular health as part of its 2020 Impact Goals. We examined whether psychosocial factors in youth predict ideal cardiovascular health in adulthood. METHODS AND RESULTS: Participants were 477 men and 612 women from the nationwide Cardiovascular Risk in Young Finns Study. Psychosocial factors were measured from cohorts 3 to 18 years of age at the baseline of the study, and ideal cardiovascular health was examined 27 years later in adulthood. The summary measure of psychosocial factors in youth comprised socioeconomic factors, emotional factors, parental health behaviors, stressful events, self-regulation of the child, and social adjustment of the child. There was a positive association between a higher number of favorable psychosocial factors in youth and greater ideal cardiovascular health index in adulthood (ß=0.16; P<0.001) that persisted after adjustment for age, sex, medication use, and cardiovascular risk factors in childhood (ß=0.15; P<0.001). The association was monotonic, suggesting that each increment in favorable psychosocial factors was associated with improvement in cardiovascular health. Of the specific psychosocial factors, a favorable socioeconomic environment (ß=0.12; P<0.001) and participants' self-regulatory behavior (ß=0.07; P=0.004) were the strongest predictors of ideal cardiovascular health in adulthood. CONCLUSIONS: The findings suggest a dose-response association between favorable psychosocial factors in youth and cardiovascular health in adulthood, as defined by the American Heart Association metrics. The effect seems to persist throughout the range of cardiovascular health, potentially shifting the population distribution of cardiovascular health rather than simply having effects in a high-risk population.