Marital status and cause-specific mortality: A population-based prospective cohort study in southern Sweden.

The aim was to investigate associations between marital status and mortality with a prospective cohort study design. A public health survey including adults aged 18-80 was conducted with a postal questionnaire in southern Sweden in 2008 (54.1% participation). The survey formed a baseline that was linked to 8.3-year follow-up all-cause, cardiovascular (CVD), cancer and other cause mortality. The present investigation entails 14,750 participants aged 45-80. Associations between marital status and mortality were investigated with multiple Cox-regression analyses. A 72.8% prevalence of respondents were married/cohabitating, 9.1% never married, 12.2% divorced and 5.9% widows/widowers. Marital status was associated with age, sex, socioeconomic status (SES) by occupation, country of birth, chronic disease, Body Mass Index (BMI), health-related behaviors and generalized trust covariates. Never married/single, divorced, and widowed men had significantly higher hazard rate ratios (HRRs) of all-cause mortality than the reference category married/cohabitating men throughout the multiple analyses. For men, CVD and other cause mortality showed similar significant results, but not cancer. No significant associations were displayed for women in the multiple analyses. Associations between marital status and mortality are stronger among men than women. Associations between marital status and cancer mortality are not statistically significant with low effect measures throughout the multiple analyses among both men and women.

Mental distress in relation to police reporting among adolescent victims of robbery. A population-based study in southern Sweden.

•Robberies as well as mental distress have increased among adolescents in Sweden.•This study on school students in southern Sweden was population-based with a high response rate.•Half of the robbed adolescents abstained from police reporting.•Non-reporters had poorer mental health than victims who reported the robbery.•Non-reporters were also an overall more disadvantaged group.

Poor psychological health and 8-year mortality: a population-based prospective cohort study stratified by gender in Scania, Sweden.

OBJECTIVES: We investigated gender differences in the association between mortality and general psychological distress (measured by 12-item General Health Questionnaire, GHQ-12), as an increased mortality risk has been shown in community studies, but gender differences are largely unknown. SETTING: We used data from a cross-sectional population-based public health survey conducted in 2008 in the Swedish region of Skåne (Scania) of people 18-80 years old (response rate 54.1 %). The relationship between psychological distress and subsequent all-cause and cause-specific mortality was examined by logistic regression models for the total study population and stratified by gender, adjusting for age, socioeconomic status, lifestyle (physical activity, smoking, alcohol consumption), and chronic disease. PARTICIPANTS: Of 28 198 respondents, 25 503 were included in analysis by restrictive criteria. OUTCOME MEASURES: Overall and cause-specific mortality by 31 December 2016. RESULTS: More women (20.2 %) than men (15.7 %) reported psychological distress at baseline (GHQ ≥3). During a mean follow-up of 8.1 years, 1389 participants died: 425 (30.6%) from cardiovascular diseases, 539 (38.8%) from cancer, and 425 (30.6%) from other causes. The overall association between psychological distress and mortality risk held for all mortality end-points except cancer after multiple adjustments (eg, all-cause mortality OR 1.8 (95 % CI 1.4 to 2.2) for men and women combined. However, stratification revealed a clear gender difference as the association between GHQ-12 and mortality was consistently stronger and more robust among men than women. CONCLUSION: More women than men reported psychological distress while mortality was higher among men (ie, the morbidity-mortality gender paradox). GHQ-12 could potentially be used as one of several predictors of mortality, especially for men. In the future, screening tools for psychological distress should be validated for both men and women. Further research regarding the underlying mechanisms of the gender paradox is warranted.

Health locus of control and all-cause, cardiovascular, cancer and other cause mortality: A population-based prospective cohort study in southern Sweden.

The aim was to investigate associations between health locus of control (HLC) and all-cause, cardiovascular (CVD), cancer and other cause mortality. A public health postal questionnaire was distributed in the autumn of 2008 to a stratified random sample of the 18-80 year old adult population in Scania in southernmost Sweden. The participation rate was 54.1%, and 25,517 participants were included in the present study. Baseline 2008 survey data was linked to cause of death register data to create a prospective cohort with 8.3-year follow-up. Associations between health locus of control and mortality were investigated in survival (Cox) regression models. Prevalence of internal HLC was 69.0% and external HLC 31.0% among women. Internal HLC was 67.6% and external HLC 32.4% among men. In the models with women and men combined, external HLC had significantly higher all-cause, CVD, cancer and other cause mortality even after adjustments for sociodemographic factors and chronic disease at baseline, but after the introduction of health-related behaviors, external HLC only displayed higher cancer mortality compared to internal HLC. External HLC displayed higher all-cause, cancer and other cause mortality for men in the final model adjusted for health-related behaviors, but not for women. Other pathways than health-related behaviors may exist for the association between external HLC and cancer mortality, particularly among men.

Gender Differences and Associated Factors Influencing Problem Gambling in Adolescents in Sweden: Cross-sectional Investigation.

BACKGROUND: Although gambling disorder is traditionally considered an adult phenomenon, the behavior usually begins in childhood or adolescence. OBJECTIVE: The aim of this study was to explore the frequency of problem gambling among Swedish adolescents and the suspected associated factors. METHODS: This study was based on data collected through a public health survey distributed in 2016 to pupils in ninth grade of primary school and in second grade of secondary school in Sweden. Bayesian binomial regression models, with weakly informative priors, were used to examine whether the frequency of the associated factors differed between those with and without problem gambling. RESULTS: Approximately 11.7% (469/4002) of the boys in ninth grade of primary school and 13.9% (472/3407) of the boys in second grade of secondary school were classified as problem gamblers. For girls, the corresponding frequencies were 1.2% (48/4167) and 0.7% (27/3634), respectively. The overall response rate was 77% (9143/11,868) among ninth grade pupils and 73.4% (7949/10,832) among second grade pupils, resulting in a total of 17,092 responses. Problem gambling was associated with poor sleep and having tried smoking, alcohol, and other substances among both boys and girls in ninth grade of primary school and boys in second grade of secondary school. Problem gambling among girls in second grade of secondary school was associated with an increased prevalence of having tried smoking and other substances and an increased prevalence of poor sleep. CONCLUSIONS: Using a large representative sample of Swedish adolescents, we found that problem gambling was robustly associated with a substantially increased prevalence of poor sleep and having tried smoking, alcohol, and other substances among both boys and girls in ninth grade of primary school as well as among boys in second grade of secondary school. Our study adds important information for policy makers pointing at vulnerable groups to be considered in their work to prevent problem gambling.

Gender-Based Differences and Associated Factors Surrounding Excessive Smartphone Use Among Adolescents: Cross-sectional Study.

BACKGROUND: Excessive smartphone use is a new and debated phenomenon frequently mentioned in the context of behavioral addiction, showing both shared and distinct traits when compared to pathological gaming and gambling. OBJECTIVE: The aim of this study is to describe excessive smartphone use and associated factors among adolescents, focusing on comparisons between boys and girls. METHODS: This study was based on data collected through a large-scale public health survey distributed in 2016 to pupils in the 9th grade of primary school and those in the 2nd grade of secondary school. Bayesian binomial regression models, with weakly informative priors, were used to examine whether the frequency of associated factors differed between those who reported excessive smartphone use and those who did not. RESULTS: The overall response rate was 77% (9143/11,868) among 9th grade pupils and 73.4% (7949/10,832) among 2nd grade pupils, resulting in a total of 17,092 responses. Based on the estimated median absolute percentage differences, along with associated odds ratios, we found that excessive smartphone use was associated with the use of cigarettes, alcohol, and other substances. The reporting of anxiety and worry along with feeling low more than once a week consistently increased the odds of excessive smartphone use among girls, whereas anxiety and worry elevated the odds of excessive smartphone use among boys. The reporting of less than 7 hours of sleep per night was associated with excessive smartphone use in all 4 study groups. CONCLUSIONS: The results varied across gender and grade in terms of robustness and the size of estimated difference. However, excessive smartphone use was associated with a higher frequency of multiple suspected associated factors, including ever having tried smoking, alcohol, or other substances; poor sleep; and often feeling low and feeling anxious. This study sheds light on some features and distinctions of a potentially problematic behavior among adolescents.

A cross-sectional study on extensive gaming in adolescents.

BACKGROUND: Extensive gaming and the consequences thereof is frequently reported from child and adolescent psychiatry and school health care. The behavior is associated with compulsion, psychiatric and physical symptoms, impaired cognitive development and poorer school performance. This phenomenon has been described as an emergent health issue for men and little is known about its potential gender-specific characteristics. The aim of this study was to explore extensive gaming among male and female adolescents and to investigate whether the frequency of often feeling low, often feeling anxious, self-reported ADHD, self-reported ASD, being satisfied with one's own general health, poor sleep, loneliness, and having tried smoking, alcohol, and/or other substances differed among those with and without extensive gaming. DESIGN AND METHODS: This study was based on data collected through a public health survey distributed in 2016 to pupils in 9th grade of primary school and in second grade of secondary school, including a total of 13498 participants. The association between extensive gaming and different factors was estimated among male and female respondents separately. RESULTS: Roughly 30% of the male and 5% of the female respondents were categorized as extensive gamers. Extensive gaming was associated with a higher prevalence of poor sleep and a lower prevalence of being satisfied with one's own health among boys and (to a higher degree) among girls. CONCLUSIONS: Altogether, our results contribute to the impression that extensive gaming is more heavily related to subjective health complaints among female than male adolescents.

Poor psychological health and 5-year suicide mortality: A population-based prospective cohort study.

OBJECTIVE: The objective was to investigate associations between the General Health Questionnaire with twelve sub-items (GHQ-12) and prospective five-year suicide mortality. The two commonly used GHQ-12 cut-offs (2/3 and 3/4) were analyzed. METHOD: The 2008 public health survey, which was conducted in the autumn of 2008 in Scania, southern Sweden, is based on a postal questionnaire answered by 28,198 participants, aged 18 to 80. GHQ-12 was assessed from the baseline questionnaire, and five-year prospective register data on causes of death were connected to the baseline survey. In total, 21 persons died from intentional self-inflicted injuries, and twenty of them had complete answers regarding GHQ-12. Hazard rate ratios (HRR) were analyzed in survival (Cox-) regression analyses, adjusted for age, sex, marital status and socioeconomic status (SES). RESULTS: The prevalence of poor psychological health according to GHQ-12 with the 2/3 cut-off was 14% among men and 18% among women, and with the 3/4 cut-off it was 11% among men and 15% among women. The 2/3 cut-off yielded a HRR of 3.02 (1.14-7.98, 95% CI) which decreased to 2.44 (0.92-6.49) when adjusted for marital status and SES, and a 3/4 cut-off HRR of 3.97 (1.51-10.47) which decreased to 3.23 (1.22-1.22-8.56) when adjusted for marital status and SES. CONCLUSION: The results indicate high effect measures (HRRs) between GHQ12 with both cut offs and five-year suicide mortality.

Associations between self-injury and involvement in cyberbullying among mentally distressed adolescents in Scania, Sweden.

AIMS: To investigate associations between self-injury and involvement in cyberbullying as a bully, victim or bully-victim among mentally distressed adolescents. METHODS: Data from the public health survey of children and adolescents in Scania, Sweden 2016 were used. A questionnaire was answered anonymously in school by 9143 students in 9th grade compulsory school (response rate 77%) and 7949 students in 2nd grade of upper secondary school (response rate 73%). Students with past year (broadly defined) mental distress at least 2 weeks in a row (33% of boys and 63% of girls) were asked if they had performed self-injury (i.e. cut, superficially cut or otherwise injured themselves) past year, and those with data on self-injury and cyberbullying were included in the present study ( n=6841). Associations between self-injury and cyberbullying were investigated by multiadjusted logistic regression analysis. RESULTS: Among mentally distressed students, self-injury was reported by 11.7% of boys and 25.9% of girls. Age-adjusted analysis showed increasingly higher odds of self-injury among cyberbullies, cybervictims and cyberbully-victims, using non-involved as reference group (OR boys: 1.8, 2.3, 3.0; girls: 2.1, 3.2, 4.8). Associations weakened after adjustment for several potential confounders but remained significant for all cyberbullying groups except male cyberbullies, among whom significance was lost after adjustment for smoking, alcohol and narcotics. CONCLUSIONS: Peer victimization in cyber space is associated with self-injury, especially among victims and bully-victims. Decreasing peer victimization is a priority, and school and health professionals need to be aware of the associations between cyberbullying and self-injury among mentally distressed adolescents.

Subjective health complaints and exposure to peer victimization among disabled and non-disabled adolescents: A population-based study in Sweden.

AIMS: To investigate subjective health complaints (SHCs) (psychological and somatic, respectively) among disabled and non-disabled adolescents, focusing on the impact of traditional bullying and cyber harassment, and furthermore to report psychological and somatic SHCs across different types of disability. METHODS: Data from the public health survey of children and adolescents in Scania, Sweden, 2012 was used. A questionnaire was answered anonymously in school by 9791 students in the 9th grade (response rate 83%), and 7533 of these with valid answers on key questions were included in this study. Associations with daily SHCs were investigated by multi-adjusted logistic regression analyses. RESULTS: Any disability was reported by 24.1% of boys and 22.0% of girls. Disabled students were more exposed to cyber harassment (boys: 20.0%; girls: 28.2%) than non-disabled peers (boys: 11.8%; girls: 18.1%). Exposure to traditional bullying showed the same pattern but with a lower prevalence. Disabled students had around doubled odds of both daily psychological SHCs and daily somatic SHCs in the fully adjusted models. In general, the odds increased with exposure to cyber harassment or traditional bullying and the highest odds were seen among disabled students exposed to both cyber harassment and traditional bullying. Students with ADHD/ADD had the highest odds of daily psychological SHCs as well as exposure to traditional bullying across six disability types. CONCLUSIONS: Disabled adolescents report poorer health and are more exposed to both traditional bullying and cyber harassment. This public health issue needs more attention in schools and in society in general.

Subjective health complaints in adolescent victims of cyber harassment: moderation through support from parents/friends - a Swedish population-based study.

BACKGROUND: Victimization in cyberspace has emerged as a new public health issue among the young. The main purpose of this study was to analyze associations between cyber victimization defined as cyber harassment (CH) (a somewhat broader concept than cyberbullying) and subjective health complaints (SHC), to study whether these associations were modified by parental/friend support (measured as communication), and to explore the influence of traditional bullying victimization (TBV) on the association between CH and SHC. METHODS: The study population consisted of 8544 students in 9th grade (around 15 years old) who participated in the 2012 Scania public health survey of children and adolescents. The survey was a cross-sectional total-population study conducted in school, with a response rate of 83 %. Main and interaction (stress-buffering) effects of social support on the relationship between CH and SCH were investigated by hierarchical multiple linear regression analyses, adjusted for potential confounders, including TBV. RESULTS: The past-year prevalence of CH (once or several times) was 14 % among boys and 20 % among girls. Having been cyber harassed once or several times during the past year was associated with higher levels of SHC, controlling for age, parental occupation, parental origin, daily smoking, intense alcohol consumption, and disability. Among both boys and girls, the associations were stronger for CH occurring several times than for CH occurring only once. Main effects of parental/friend support were seen for both boys and girls, while stress-buffering effects were indicated for boys only. Additional analysis further adjusting for TBV did not change the associations substantially, indicating that CH has an effect of its own on SHC. CONCLUSION: Intervention programs aimed at improving the quality of peer and family relationships among children and adolescents might reduce the incidence of both cyber harassment and traditional bullying and lower the prevalence of psychosomatic complaints.

Experience of physical violence and mental health among young men and women: a population-based study in Sweden.

BACKGROUND: In Sweden mental ill-health has increased among the young, especially among young women. Our aim was to investigate the association between experience of physical violence during the past year and self rated psychological health among young men and women. METHODS: The study population consisted of men (n = 2,624) and women (n = 3,569) aged 18-34 years who participated in the 2008 public health survey study in Skåne. The survey was a cross-sectional stratified random sample postal questionnaire study with a 54.1% participation rate. Associations were investigated by logistic regression models. RESULTS: The prevalence of poor psychological health was 18.9% among men and 27.7% among women. One in ten men and one in twenty women had experienced physical violence during the past year. Most men were violated in public places, while women were most often violated at home. Women who had experienced violence during the past year showed more than doubled odds of poor psychological health, odds ratio (OR): 2.66 (95% confidence interval (CI): 2.00, 3.53). Such an association could not be seen in men OR: 1.12 (95% CI: 0.85, 1.47). Adjustment for covariates (i.e. age, country of birth, socioeconomic status, economic stress, alcohol risk consumption, emotional support, instrumental support and generalized trust in other people) did not change the association found among women. CONCLUSION: Violated women, but not men, showed nearly doubled odds of poor psychological health after multiple adjustments. There was also a gender difference regarding location of violence. Awareness of gender differences regarding context and mental impact of violence may assist public health workers in reducing the consequences of violence and to design preventive strategies.

Economic stress in childhood and adulthood, and poor psychological health: three life course hypotheses.

Investigations of mental health in a life course perspective are scarce. The aim is to investigate associations between economic stress in childhood and adulthood, and poor psychological health in adulthood with reference to the accumulation, critical period and social mobility hypotheses in life course epidemiology. The 2008 public health survey in Skåne is a cross-sectional postal questionnaire study. A random sample was invited which yielded 28,198 respondents aged 18-80 (55% participation). Psychological health was assessed with the GHQ12 instrument. Logistic regression models were used to investigate the associations adjusting for age, country of birth, socioeconomic status, emotional support, instrumental support and trust, and stratifying by sex. The accumulation hypothesis was confirmed because combined childhood and adulthood exposures to economic stress were associated with poor psychological health in a graded manner. The social mobility hypothesis was also confirmed. The critical period hypothesis was not confirmed because both childhood and adulthood economic stress remained significantly associated with poor psychological health in adulthood. Economic stress in childhood is associated with mental health in adulthood.