A measure for assessment of beneficial and harmful fortitude: development and initial validation of the Sisu Scale.

Sisu is a Finnish cultural concept that denotes determination and resoluteness in the face of adversity. We propose that sisu will supplement the English-language based research on mental fortitude traits. Sisu has not been the focus of systematic research until very recently. We created a new questionnaire measuring sisu (the Sisu Scale), sought to validate the sisu construct and its sub-factor structure as postulated in a recent qualitative study. We investigated associations of sisu with other measures of mental fortitude and well-being. More generally we aimed to enrichen the cross-cultural understanding of human experience of overcoming adversity across life's challenges. We describe and validate a questionnaire that effectively measures both beneficial and harmful sisu, each comprising three sub-factors. Beneficial sisu was associated with other measures of fortitude, but less with personality dimensions. We also confirmed the existence of an independent harmful sisu factor. Beneficial sisu was associated with higher well-being and lower depressive symptoms, and harmful sisu with lower well-being and higher levels of general stress, work stress and depressive symptoms. Together the two factors were superior compared to pre-existing measures when predicting well-being-related variables. Results suggest that the new Sisu Scale we developed may provide a valuable addition to research on mental fortitude, resilience and their consequences for well-being.

Changing associations between socioeconomic status and self-reported discrimination from the 1990s to the 2010s in the United States.

We examined whether prevalence of social class discrimination-and its association with psychological distress-has changed between 1990s and 2010s in the United States. Data were from the original Midlife in the United States (MIDUS) study with data collections in 1995-1996 (n = 2931) and 2004-2005 (n = 1708), and the new MIDUS Refresher sample from 2011 to 2014 (n = 2543). Socioeconomic status (SES) became more strongly associated with self-rated discrimination over time, with individuals with the lowest SES experiencing more discrimination (B = 0.75, p < .001) and those with the highest SES less discrimination (B = 0.36, p < .001) over time: at baseline, the difference in self-rated discrimination between the highest and lowest SES groups was 15.3% versus 10.8% (4.7% point difference). This difference increased to 20.0% versus 7.4% in the last study wave (12.6% point difference). Association between self-reported discrimination and psychological distress strengthened over time, but the associations between socioeconomic indicators and distress did not change. The results suggest that people with low SES had higher risk of encountering unfair and disrespectful treatment in the 2010s compared to the 1990s.

Socioeconomic inequalities in impairment associated with depressive symptoms: Evidence from the National Survey on Drug Use and Health.

OBJECTIVE: Individuals with low socioeconomic status have higher rates of depression, but it is unknown whether the socioeconomically disadvantaged also have more disabling depressive symptoms. We examined (1) the associations of three indicators of socioeconomic status with depression-related severe role impairment, and (2) whether socioeconomic factors moderate the association between individual depression symptoms and depression-related severe role impairment. METHODS: We used data from the National Survey on Drug Use and Health (NSDUH). Depressive symptoms, role impairment and socioeconomic indicators (poverty, participation in workforce, educational attainment) were self-reported by participants. The analytic sample consisted of participants who screened positive for a depressive episode during past 12 months (n = 32 661). We used survey-weighted logistic models to examine the associations of depressive symptoms with severe role impairment and the modifying effects of socioeconomic indicators. RESULTS: The association between depression symptom count and severe role impairment was stronger among those not in workforce (OR = 1.12[1.02-1.23]). The association between specific depression symptoms and severe role impairment was stronger for conditions of poverty (fatigue, OR = 2.97 [1.54-5.73]; and anhedonia, OR = 1.93[1.13-3.30]), workforce non-participation (inability to concentrate/indecisiveness, OR = 1.54[1.12-2.12]), and lower educational attainment (anhedonia, OR = 0.77 [0.59-0.99]). Feelings of worthlessness was the only symptom with independent associations for all socioeconomic groups (adjusted OR = 1.91[1.35-2.70]). CONCLUSION: Depression was more frequent and also more disabling for socioeconomically disadvantaged groups, especially when assessed with workforce participation. Additionally, some specific symptoms showed socioeconomic differences. Our findings highlight the need to prioritize population groups with more severe impairment associated with depressive symptoms.

A Changing Landscape of Health Opportunity in the United States: Increases in the Strength of Association Between Childhood Socioeconomic Disadvantage and Adult Health Between the 1990s and the 2010s.

Understanding the changing health consequences of childhood socioeconomic disadvantage (SED) is highly relevant to policy debates on inequality and national and state goals to improve population health. However, changes in the strength of association between childhood SED and adult health over historic time are largely unexamined in the United States. The present study begins to address this knowledge gap. Data were from 2 national samples of adults collected in 1995 (n = 7,108) and 2012 (n = 3,577) as part of the Midlife in the United States study. Three measures of childhood SED (parents' occupational prestige, childhood poverty exposure, and parents' education) were combined into an aggregate index and examined separately. The association between childhood SED (aggregate index) and 5 health outcomes (body mass index, waist circumference, chronic conditions, functional limitations, and self-rated health) was stronger in the 2012 sample than the 1995 sample, with the magnitude of associations being approximately twice as large in the more recent sample. Results persisted after adjusting for age, sex, race, marital status, and number of children, and were similar across all 3 measures of childhood SED. The findings suggest that the socioeconomic circumstances of childhood might have become a stronger predictor of adult health in recent decades.

Immigrants' mental health service use compared to that of native Finns: a register study.

PURPOSE: Many aspects related to migration might predispose immigrants to mental health problems. Yet immigrants have been shown to underuse mental health services. The aim of this study was to compare the intensity of psychiatric care, as an indicator of treatment adequacy, between natives and immigrants living in Finland. METHODS: We used nationwide register data that included all the immigrants living in Finland at the end of 2010 (n = 185,605) and their matched controls. Only those who had used mental health services were included in the analyses (n = 14,285). We used multinomial logistic regression to predict the categorized treatment intensity by immigrant status, region and country of origin, length of residence, and other background variables. RESULTS: Immigrants used mental health services less than Finnish controls and with lower intensity. The length of residence in Finland increased the probability of higher treatment intensity. Immigrants from Eastern Europe, sub-Saharan Africa, the Middle East, and Northern Africa were at the highest risk of receiving low-intensity treatment. CONCLUSIONS: Some immigrant groups seem to persistently receive less psychiatric treatment than Finnish-born controls. Identification of these groups is important and future research is needed to determine the mechanisms behind these patterns.

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.

Personality traits and perceptions of organisational justice.

This study examined the association between five-factor model personality traits and perceptions of organisational justice. The sample for the study comprised 903 participants (35-50 years old; 523 women) studied in 2007 and 2012. Measures used were the Neuroticism, Extraversion, Openness, Five-Factor Inventory questionnaire and the short organisational justice measure. The results showed that high neuroticism was associated with low distributive, procedural and interactional justice. Furthermore, high agreeableness was associated with high procedural and interactional justice and high openness with high distributive justice. This study suggests that neuroticism, agreeableness and openness are involved in perceptions of organisational justice and that personality should be considered in research and in practices at the workplace.

Socioeconomic status, non-communicable disease risk factors, and walking speed in older adults: multi-cohort population based study.

OBJECTIVE: To assess the association of low socioeconomic status and risk factors for non-communicable diseases (diabetes, high alcohol intake, high blood pressure, obesity, physical inactivity, smoking) with loss of physical functioning at older ages. DESIGN: Multi-cohort population based study. SETTING: 37 cohort studies from 24 countries in Europe, the United States, Latin America, Africa, and Asia, 1990-2017. PARTICIPANTS: 109 107 men and women aged 45-90 years. MAIN OUTCOME MEASURE: Physical functioning assessed using the walking speed test, a valid index of overall functional capacity. Years of functioning lost was computed as a metric to quantify the difference in walking speed between those exposed and unexposed to low socioeconomic status and risk factors. RESULTS: According to mixed model estimations, men aged 60 and of low socioeconomic status had the same walking speed as men aged 66.6 of high socioeconomic status (years of functioning lost 6.6 years, 95% confidence interval 5.0 to 9.4). The years of functioning lost for women were 4.6 (3.6 to 6.2). In men and women, respectively, 5.7 (4.4 to 8.1) and 5.4 (4.3 to 7.3) years of functioning were lost by age 60 due to insufficient physical activity, 5.1 (3.9 to 7.0) and 7.5 (6.1 to 9.5) due to obesity, 2.3 (1.6 to 3.4) and 3.0 (2.3 to 4.0) due to hypertension, 5.6 (4.2 to 8.0) and 6.3 (4.9 to 8.4) due to diabetes, and 3.0 (2.2 to 4.3) and 0.7 (0.1 to 1.5) due to tobacco use. In analyses restricted to high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was 8.0 (5.7 to 13.1) for men and 5.4 (4.0 to 8.0) for women, whereas in low and middle income countries it was 2.6 (0.2 to 6.8) for men and 2.7 (1.0 to 5.5) for women. Within high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was greater in the United States than in Europe. Physical functioning continued to decline as a function of unfavourable risk factors between ages 60 and 85. Years of functioning lost were greater than years of life lost due to low socioeconomic status and non-communicable disease risk factors. CONCLUSIONS: The independent association between socioeconomic status and physical functioning in old age is comparable in strength and consistency with those for established non-communicable disease risk factors. The results of this study suggest that tackling all these risk factors might substantially increase life years spent in good physical functioning.

Money for microbes-Pathogen avoidance and out-group helping behaviour.

Humans have evolved various adaptations against pathogens, including the physiological immune system. However, not all of these adaptations are physiological: the cognitive mechanisms whereby we avoid potential sources of pathogens-for example, disgust elicited by uncleanliness-can be considered as parts of a behavioural immune system (BIS). The mechanisms of BIS extend also to inter-group relations: Pathogen cues have been shown to increase xenophobia/ethnocentrism, as people prefer to keep their societal in-group norms unaltered and "clean." Nonetheless, little is known how pathogen cues influence people's willingness to provide humanitarian aid to out-group members. We examined how pathogen cues affected decisions of providing humanitarian aid in either instrumental (sending money) or non-instrumental form (sending personnel to help, or accepting refugees), and whether these effects were moderated by individual differences in BIS sensitivity. Data were collected in two online studies (Ns: 188 and 210). When the hypothetical humanitarian crisis involved a clear risk of infection, participants with high BIS sensitivity preferred to send money rather than personnel or to accept refugees. The results suggest that pathogen cues influence BIS-sensitive individuals' willingness to provide humanitarian aid when there is a risk of contamination to in-group members.

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.

Secular rise in economically valuable personality traits.

Although trends in many physical characteristics and cognitive capabilities of modern humans are well-documented, less is known about how personality traits have evolved over time. We analyze data from a standardized personality test administered to 79% of Finnish men born between 1962 and 1976 (n = 419,523) and find steady increases in personality traits that predict higher income in later life. The magnitudes of these trends are similar to the simultaneous increase in cognitive abilities, at 0.2-0.6 SD during the 15-y window. When anchored to earnings, the change in personality traits amounts to a 12% increase. Both personality and cognitive ability have consistent associations with family background, but the trends are similar across groups defined by parental income, parental education, number of siblings, and rural/urban status. Nevertheless, much of the trends in test scores can be attributed to changes in the family background composition, namely 33% for personality and 64% for cognitive ability. These composition effects are mostly due to improvements in parents' education. We conclude that there is a "Flynn effect" for personality that mirrors the original Flynn effect for cognitive ability in magnitude and practical significance but is less driven by compositional changes in family background.

Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women.

BACKGROUND: In 2011, WHO member states signed up to the 25 × 25 initiative, a plan to cut mortality due to non-communicable diseases by 25% by 2025. However, socioeconomic factors influencing non-communicable diseases have not been included in the plan. In this study, we aimed to compare the contribution of socioeconomic status to mortality and years-of-life-lost with that of the 25 × 25 conventional risk factors. METHODS: We did a multicohort study and meta-analysis with individual-level data from 48 independent prospective cohort studies with information about socioeconomic status, indexed by occupational position, 25 × 25 risk factors (high alcohol intake, physical inactivity, current smoking, hypertension, diabetes, and obesity), and mortality, for a total population of 1 751 479 (54% women) from seven high-income WHO member countries. We estimated the association of socioeconomic status and the 25 × 25 risk factors with all-cause mortality and cause-specific mortality by calculating minimally adjusted and mutually adjusted hazard ratios [HR] and 95% CIs. We also estimated the population attributable fraction and the years of life lost due to suboptimal risk factors. FINDINGS: During 26·6 million person-years at risk (mean follow-up 13·3 years [SD 6·4 years]), 310 277 participants died. HR for the 25 × 25 risk factors and mortality varied between 1·04 (95% CI 0·98-1·11) for obesity in men and 2 ·17 (2·06-2·29) for current smoking in men. Participants with low socioeconomic status had greater mortality compared with those with high socioeconomic status (HR 1·42, 95% CI 1·38-1·45 for men; 1·34, 1·28-1·39 for women); this association remained significant in mutually adjusted models that included the 25 × 25 factors (HR 1·26, 1·21-1·32, men and women combined). The population attributable fraction was highest for smoking, followed by physical inactivity then socioeconomic status. Low socioeconomic status was associated with a 2·1-year reduction in life expectancy between ages 40 and 85 years, the corresponding years-of-life-lost were 0·5 years for high alcohol intake, 0·7 years for obesity, 3·9 years for diabetes, 1·6 years for hypertension, 2·4 years for physical inactivity, and 4·8 years for current smoking. INTERPRETATION: Socioeconomic circumstances, in addition to the 25 × 25 factors, should be targeted by local and global health strategies and health risk surveillance to reduce mortality. FUNDING: European Commission, Swiss State Secretariat for Education, Swiss National Science Foundation, the Medical Research Council, NordForsk, Portuguese Foundation for Science and Technology.

Interventions following a high violence risk assessment score: a naturalistic study on a Finnish psychiatric admission ward.

BACKGROUND: Patient aggression and violence against staff members and other patients are common concerns in psychiatric units. Many structured clinical risk assessment tools have recently been developed. Despite their superiority to unaided clinical judgments, staff has shown ambivalent views towards them. A constant worry of staff is that the results of risk assessments would not be used. The aims of the present study were to investigate what were the interventions applied by the staff of a psychiatric admission ward after a high risk patient had been identified, how frequently these interventions were used and how effective they were. METHODS: The data were collected in a naturalistic setting during a 6-month period in a Finnish psychiatric admission ward with a total of 331 patients with a mean age of 42.9 years (SD 17.39) suffering mostly from mood, schizophrenia-related and substance use disorders. The total number of treatment days was 2399. The staff assessed the patients daily with the Dynamic Appraisal of Situational Aggression (DASA), which is a structured violence risk assessment considering the upcoming 24 h. The interventions in order to reduce the risk of violence following a high DASA total score (≥4) were collected from the patients' medical files. Inductive content analysis was used. RESULTS: There were a total of 64 patients with 217 observations of high DASA total score. In 91.2% of cases, at least one intervention aiming to reduce the violence risk was used. Pro re nata (PRN)-medication, seclusion and focused discussions with a nurse were the most frequently used interventions. Non-coercive and non-pharmacological interventions like daily activities associated significantly with the decrease of perceived risk of violence. CONCLUSION: In most cases, a high score in violence risk assessment led to interventions aiming to reduce the risk. Unfortunately, the most frequently used methods were psychopharmacological or coercive. It is hoped that the findings will encourage the staff to use their imagination when choosing violence risk reducing intervention techniques.

Intergenerational transmission of socioeconomic position and ideal cardiovascular health: 32-year follow-up study.

OBJECTIVES: Socioeconomic position (SEP) in childhood predicts cardiovascular health in adulthood but the underlying mechanisms remain unclear. Using a longitudinal study design, we examined the extent to which adult SEP acts as a pathway (mediator) connecting childhood SEP with adult cardiovascular health, and if upward social mobility mitigates the health-effects of early low SEP. METHOD: The sample comprised 697 participants from a prospective Finnish cohort followed during 32 years. Childhood SEP was assessed from the parents in 1980 (participant mean age 10.9) and adulthood SEP was examined in 2007 and 2012 (participant mean age 43.2 in 2012). Both childhood and adulthood SEP scores comprised education, income, occupational status, and occupational stability. Ideal cardiovascular health was assessed in 2007 and 2012 according to the American Heart Association's guidelines. RESULTS: Higher childhood SEP was associated with higher ideal cardiovascular health index in adulthood (ß = 0.13, p < .001) independently of sex, age, childhood cardiovascular risk factors, and chronic conditions. Mediation analysis showed that adult SEP accounted for 33% of the association between childhood SEP and ideal cardiovascular health index. Upwardly mobile participants scored higher on ideal cardiovascular health in adulthood compared with participants staying in lower SEP (M = 4.05 vs. 3.56, p < .001). CONCLUSIONS: Transmission of SEP over generations is a predictor of health inequalities, which should be considered in cardiovascular prevention. Although upward social mobility mitigates some of the effect of early SEP disadvantage on later cardiovascular health, childhood SEP remains an important predictor of future health. (PsycINFO Database Record

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.

Socioeconomic gradient in work disability in diabetes: evidence from three occupational cohorts.

BACKGROUND: The role of socioeconomic status in work disability among employees with diabetes is not well known. We examined the association between socioeconomic status and work disability among employees with and without diabetes taking into account comorbid conditions. METHODS: We used individual participant data from three occupational cohorts from Finland, France and the UK (employees with diabetes, n=2170, age-matched and sex-matched controls without diabetes, n=4340). In all cohorts, survey data were linked with register data and the employees were followed up on average for 4.4 years. Socioeconomic status was based on occupational titles. Work disability (sickness absence and disability pension) was indexed as the numbers of disability days and episodes. The study-specific estimates were pooled using meta-analysis and effect modifications were studied with meta-regression. RESULTS: The average numbers of disability days and episodes per year were 1.5-3.5 times higher for persons with diabetes compared to those without. Among persons with diabetes, the risk of work disability was almost four times higher in the lowest compared to the highest occupational position (relative index of inequality (RII) for days 3.82; 95% CI 2.77 to 5.56; RII for episodes 3.80; 95% CI 3.13 to 4.61). This association was consistent in both sexes and regardless of comorbid conditions. In relative terms, the association of socioeconomic status and work disability was similar among those free of diabetes. CONCLUSIONS: A strong socioeconomic gradient in work disability was observed among people with and without diabetes.

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.

Does neighbourhood deprivation cause poor health? Within-individual analysis of movers in a prospective cohort study.

BACKGROUND: Neighbourhood deprivation has been associated with poor health. The evidence for social causation, however, remains scarce because selective residential mobility may also create neighbourhood differences. The present study examined whether individuals had poorer health when they were living in a deprived neighbourhood compared to another time when the same individuals were living in a less deprived neighbourhood. METHODS: Participants were from the British Household Panel Survey prospective cohort study with 18 annual measurements of residential location and self-reported health outcomes between 1991 and 2009 (n=137 884 person-observations of 17 001 persons in England). Neighbourhood deprivation was assessed concurrently with health outcomes using the Index of Multiple Deprivation at the geographically detailed level of Lower Layer Super Output Areas. The main analyses were replicated in subsamples from Scotland (n=4897) and Wales (n=4442). Multilevel regression was used to separate within-individual and between-individuals associations. RESULTS: Neighbourhood deprivation was associated with poorer self-rated health, and with higher psychological distress, functional health limitations and number of health problems. These associations were almost exclusively due to differences between different individuals rather than within-individual variations related to different neighbourhoods. By contrast, poorer health was associated with lower odds of moving to less deprived neighbourhoods among movers. The analysis was limited by the restricted within-individual variation and measurement imprecision of neighbourhood deprivation. CONCLUSIONS: Individuals living in deprived neighbourhoods have poorer health, but it appears that neighbourhood deprivation is not causing poorer health of adults. Instead, neighbourhood health differentials may reflect the more fundamental social inequalities that determine health and ability to move between deprived and non-deprived neighbourhoods.