School environment and mental health in early adolescence - a longitudinal study in Sweden (KUPOL).

BACKGROUND: Longitudinal studies indicate strong associations between school proficiency and indicators of mental health throughout adulthood, but the mechanisms of such associations are not fully elucidated. The Kupol study is a prospective cohort study in Sweden set up in order to: (i) describe the association of school pedagogic and social environment and its specific dimensions with the risk of mental ill-health and psychiatric disorders in adolescence; (ii) evaluate the direct effects of school pedagogic and social environment on mental health and the effects mediated by the individual's academic achievements; and (iii) assess if school pedagogic and social environment are associated with mental ill-health through epigenetic mechanisms, in particular those involving genes regulating the response to stress. METHODS: The Kupol cohort at baseline consists of 3959 children attending the 7th grade of compulsory school (13-14 years old) in 8 regions of central Sweden in the school years 2013-2014 or 2014-2015. Three follow-up surveys in subsequent years are planned. Teachers' and students' perceptions of the culture, climate and ethos of their schools, and students' mental ill-health are assessed at the whole school level by annual questionnaire surveys. In order to conduct epigenetic analyses saliva specimens are collected from a nested sample of students at inception and two years later. Further, class-, family- and child-level information is collected at baseline and during each year of follow-up. Self-reported information is being complemented with register data via record-linkages to national and regional health and administrative registers. DISCUSSION: The topic being investigated is new, and the sample constitutes the largest adolescent cohort in Sweden involved in an ad hoc study. Epigenetic analyses centered on environmental cues to stress response are a thoroughly new approach. Finally a notable feature is the multi-informant and multi-method data collection, with surveys at the school, class, family, and student level. Collaboration and data access: interested investigators should contact the coordinating centre. Additional information is available on the study's website, http://kupolstudien.se/ .

Do overeducated individuals have increased risks of ill health?: a Swedish population-based cohort study.

Previous studies indicate that the increasing educational level in many post-industrial nations may imply that subgroups of the population work in occupations for which they are overeducated. We aimed to investigate whether overeducation is associated with future self-rated health and psychological distress. The analytical sample consisted of 21,159 participants from the Stockholm Public Health Cohort. Individuals with upper secondary or university education, who in 2006 or 2007 had occupations requiring less education, were considered overeducated. The outcomes were self-rated health (SRH) and psychological distress in 2010. Overeducated women had an increased risk of less than good SRH, compared to university-educated women in matching occupations (adjusted odds ratios (OR): 2.44 confidence intervals (CI): 1.32-4.51 for overeducated women with secondary school education), but not compared to less educated women in the same occupational class (adjusted OR: 0.87 CI:0.32-2.38 for overeducated women with secondary school education). We found no increased risk of less than good SRH for overeducated men, and no association between overeducation and psychological distress for either sex. The results indicate that overeducation is not per se associated with onset of less than good SRH or psychological distress in a short-term perspective, and the findings support education expansion as a means of improving public health.

Short-term sick leave and future risk of sickness absence and unemployment - the impact of health status.

BACKGROUND: In previous studies the authors have found sick leave to be a predictor of future sick leave, unemployment and disability pension. Although sick leave reflects underlying health problems, some studies have suggested that sick leave may have consequences beyond the consequences of the underlying illness. However, few studies have aimed at studying consequences of sick leave while adjusting for ill health. This study aims to explore whether short-term sick leave increases the risk of future long-term sick leave, disability pension, and unemployment. Furthermore, we aim to control for the potentially confounding effects of physical and mental health status. METHODS: Data were gathered from the Stockholm Public Health Cohort (SPHC), restricted to 11,156 employed individuals (48.6% men) aged 18-59, without long-term sick leave, disability pension or in-patient care the year before inclusion (2002). These were followed-up with regard to unemployment, long-term sick leave, and disability pension in 2006 and 2007.Odds ratios (OR) with corresponding 95% confidence intervals (CI) were estimated by logistic regression, controlling for six different measures of health status (limiting long-standing illness, self-rated health, mental health, somatic disease, musculoskeletal pain and in-patient care) and socio-demographic factors. RESULTS: Results from the unadjusted analyses indicated increased risks of long-term sick leave (OR 2.00; CI 1.62-2.46) and short-term unemployment (OR 1.76; CI 1.35-2.29) for individuals exposed to more than one short-term sick-leave spell. There were no increased odds of long-term unemployment (OR 0.54; CI 0.28-1.04) or disability pension (OR 0.72; CI 0.42-1.24). After adjusting for the different measures of health status the odds ratio for short-term unemployment was not statistically significant (OR 1.29; CI 0.97-1.74). The odds ratios for the other outcomes slightly increased after adjustment for the used measures of health status. CONCLUSIONS: The results support the assumption that short-term sick leave may have consequences for future sick leave beyond the effect of ill health. The results point to the importance of paying attention to short-term sick leave in order to prevent subsequent sickness absence.

Work-related psychosocial events as triggers of sick leave--results from a Swedish case-crossover study.

BACKGROUND: Although illness is an important cause of sick leave, it has also been suggested that non-medical risk factors may influence this association. If such factors impact on the period of decision making, they should be considered as triggers. Yet, there is no empirical support available.The aim was to investigate whether recent exposure to work-related psychosocial events can trigger the decision to report sick when ill. METHODS: A case-crossover design was applied to 546 sick-leave spells, extracted from a Swedish cohort of 1430 employees with a 3-12 month follow-up of new sick-leave spells. Exposure in a case period corresponding to an induction period of one or two days was compared with exposure during control periods sampled from workdays during a two-week period prior to sick leave for the same individual. This was done according to the matched-pair interval and the usual frequency approaches. Results are presented as odds ratios (OR) with 95% confidence intervals (CI). RESULTS: Most sick-leave spells happened in relation to acute, minor illnesses that substantially reduced work ability. The risk of taking sick leave was increased when individuals had recently been exposed to problems in their relationship with a superior (OR 3.63; CI 1.44-9.14) or colleagues (OR 4.68; CI 1.43-15.29). Individuals were also more inclined to report sick on days when they expected a very stressful work situation than on a day when they were not under such stress (OR 2.27; CI 1.40-3.70). CONCLUSIONS: Exposure to problems in workplace relationships or a stressful work situation seems to be able to trigger reporting sick. Psychosocial work-environmental factors appear to have a short-term effect on individuals when deciding to report sick.

The Importance of Pedagogical and Social School Climate to Bullying: A Cross-Sectional Multilevel Study of 94 Swedish Schools.

BACKGROUND: Bullying is a public health issue with long-term effects for victims. This study investigated if there was an association between pedagogical and social school climate and student-reported bullying victimization, which dimensions of pedagogical and social school climate were associated with bullying, and if these associations were modified by individual-level social factors. METHODS: The study had a cross-sectional multilevel design with individual-level data on bullying from 3311 students nested in 94 schools over 3 consecutive school years. School climate was measured with student and teacher questionnaires, aggregated at the school level. The association between school climate and bullying victimization was estimated with multilevel mixed-model logistic regression. RESULTS: In schools with the most favorable school climate, fewer students reported being bullied. This was especially evident when school climate was measured with the student instrument. Students in schools with favorable climate had an adjusted odds ratio of bullying of 0.74 (95% CI: 0.55-1.00) compared to students in schools with the worst climate. Results from the teacher instrument were in the same direction, but less consistent. CONCLUSIONS: Improvement in school climate has the potential to affect students both academically, and socially, as well as decrease the prevalence of bullying.

Low level of adjustment latitude--a risk factor for sickness absence.

BACKGROUND: The prerequisite for obtaining sickness benefit is reduced work ability for medical reasons in combination with work demands which cannot be adjusted accordingly. The aim of this study was to investigate if low levels of adjustment latitude, defined as the possibility to temporarily adjust work demands in case of ill health, influence sickness absence. METHODS: A prospective cohort study of 1420 employees (47% participation, aged 19-68; 56% women) was conducted at six Swedish workplaces. Exposure to two general and nine specific types of adjustment latitude was ascertained at baseline. Outcome was defined as the first new employer-reported sick-leave spell during a follow-up of 3-12 months. Hazard ratios (HR) of sick leave, with 95% confidence intervals (CI), were estimated by Cox proportional hazards regression. RESULTS: The incidence of sickness absence was 2.85/1000 person-days. The self-reported reasons for sick leave were mainly minor complaints such as colds, influenzas and headaches. Employees lacking adjustment latitude had an adjusted HR of sickness absence of 1.51 (95% CI 1.08-2.11). Among specific adjustment latitude types, those not having the possibility to work from home generated an HR of 1.86 (95% CI 1.31-2.64). The effects of lack of adjustment latitude were similar for men and women but seemed to vary between different occupations. CONCLUSION: A low level of adjustment latitude at work is a risk factor for sickness absence.

Death of a Close Relative and the Risk of Suicide in Sweden-A Large Scale Register-Based Case-Crossover Study.

BACKGROUND: Bereavement is thought to be a risk factor for suicide but the association has not been thoroughly investigated according to specific sensitive time periods and risk groups using a self-matched design. We aimed to 1) determine the risk of suicide within the first year after death of a close relative, 2) investigate if and how the risk changes within this time window and 3) determine if sex, age, and type of relationship, affect this association. METHODS: A self-matched, case-crossover study was performed by linking Swedish registers. In total, 31 059 individuals with suicide between 1990 and 2011 were included. Different periods within the year prior to the suicide were compared with corresponding periods one year earlier in the same individual's life. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for suicide after death of a close relative. RESULTS: Increased ORs of suicide were seen during the first month, OR 1·77 (95% CI 1·35-2·34), and the first half-year, 1·27 (1·13-1·43). An even higher OR was found within the first week, 3·43 (1·89-6·22). Patterns were similar for women and men and across age groups. Death of a partner or child but not death of a sibling or parent was associated with a significantly increased suicide risk. The strongest association was seen after death of a partner in individuals aged 45 and older. DISCUSSION: These findings provide knowledge of sensitive time periods and at-risk groups in the early period of bereavement. Due to the use of a self-matched study design, methodological challenges of unmeasured residual confounding could be overcome.

Lack of adjustment latitude at work as a trigger of taking sick leave-a Swedish case-crossover study.

OBJECTIVES: Research has shown that individuals reporting a low level of adjustment latitude, defined as having few possibilities to temporarily adjust work demands to illness, have a higher risk of sick leave. To what extent lack of adjustment latitude influences the individual when making the decision to take sick leave is unknown. We hypothesize that ill individuals are more likely to take sick leave on days when they experience a lack of adjustment latitude at work than on days with access to adjustment latitude. METHODS: A case-crossover design was applied to 546 sick-leave spells, extracted from a cohort of 1 430 employees at six Swedish workplaces, with a 3-12 month follow-up of all new sick-leave spells. Exposure to lack of adjustment latitude on the first sick-leave day was compared with exposure during several types of control periods sampled from the previous two months for the same individual. RESULTS: Only 35% of the respondents reported variations in access to adjustment latitude, and 19% reported a constant lack of adjustment latitude during the two weeks prior to the sick-leave spell. Among those that did report variation, the risk of sick leave was lower on days with lack of adjustment latitude, than on days with access (Odds Ratio 0.36, 95% Confidence Interval 0.25-0.52). CONCLUSIONS: This is the first study to show the influence of adjustment latitude on the decision to take sick leave. Among those with variations in exposure, lack of adjustment latitude was a deterrent of sick leave, which is contrary to the à priori hypothesis. These results indicate that adjustment latitude may not only capture long-lasting effects of a flexible working environment, but also temporary possibilities to adjust work to being absent. Further studies are needed to disentangle the causal mechanisms of adjustment latitude on sick-leave.

Is there an association between long-term sick leave and disability pension and unemployment beyond the effect of health status?--a cohort study.

BACKGROUND: Studies have shown that long-term sick leave is a strong predictor of disability pension. However, few have aimed to disentangle the effect of sick leave and of health status. The objective of this study was to investigate whether there is an association between long-term sick leave and disability pension and unemployment, when taking health status into account. METHODS/PRINCIPAL FINDINGS: The study was based on the Stockholm Public Health Cohort, restricted to 13,027 employed individuals (45.9% men) aged 18-59 in 2002 and followed until 2007. Hazard ratios (HR) with 95% Confidence Interval (CI) were estimated by Cox regression models adjusting for socio-demographic factors and five measures of health status. Having been on long-term sick leave increased the risk of disability pension (HR 4.01; 95% CI 3.19-5.05) and long-term unemployment (HR 1.45; 95% CI 1.05-2.00), after adjustment for health status. The analyses of long-term sick leave due to specific illness showed that the increased risk for long-term unemployment was confined to the group on sick leave due to musculoskeletal (HR 1.70 95% CI 1.00-2.89) and mental illness (HR 1.80 95% CI 1.13-2.88) and further that there was an increased risk for short-term unemployment in the group on sick leave due to mental illness (HR1.57 95%CI 1.09-2.26). CONCLUSIONS/SIGNIFICANCE: Long-term sick leave increases the risks of both disability pension and unemployment even when taking health status into account. The results support the hypothesis that long-term sick leave may start a process of marginalization from the labor market.

The impact of adjustment latitude on self-assessed work ability in regard to gender and occupational type.

OBJECTIVE: Adjustment latitude describes opportunities to change demands at work when ill and may affect work ability. The aim here is to study the association between adjustment latitude and self-assessed work ability among men and women and employees from different occupational sectors. METHODS: This cross-sectional study used data from a questionnaire sent to 3020 employees in three occupational sectors in Sweden; 1430 responded. Subjects were divided into: full, moderately reduced, and greatly reduced work ability. Presence of nine adjustment opportunities was requested and subjects were divided into three groups. Each specific opportunity was also analyzed in relation to work ability. Multinomial logistic regression was used for analyses. RESULTS: Number of opportunities to adjust was associated with work ability among men and employees in health care. "Shortening the working day" was associated with work ability in most groups. For men and industrial employees, "postponing work", "going home and working later", and "working without disturbance" were associated with work ability. "To work from home" was associated with work ability among women and employees in insurance. CONCLUSIONS: The assumption that adjustment latitude affects work ability is supported. Associations differ with regard to gender and occupational sectors. Further studies with longitudinal design and alternative samples are needed.

Low workload as a trigger of sick leave: results from a Swedish case-crossover study.

OBJECTIVES: To investigate if exposure to an unusually low workload when ill can trigger taking sick leave. METHODS: A case-crossover design was applied to 546 sick-leave spells obtained from a cohort of 1430 employees within six Swedish workplaces. New sick-leave spells were reported from the workplaces during 3 to 12 months follow-up. Exposure was assessed in structured participant interviews at sick leave. Case and control periods from the same individual were sampled according to the matched-pair and usual-frequency approaches. Results are presented as odds ratios with surrounding 95% confidence intervals. RESULTS: The odds ratio of sick leave on a day with an unusually low workload was 2.57 (confidence interval, 1.07-6.16). CONCLUSIONS: Becoming ill on a day with a lower workload than usual can trigger the decision to take sick leave.