Validation of Lund University Sexual Harassment Inventory (LUSHI)-A Proposed Instrument for Assessing Sexual Harassment among University Employees and Students.

The objective was to investigate the validity and reliability of a new instrument assessing sexual harassment at a public university in Sweden. In-depth interviews and focus group discussions resulted in a 10-item instrument, the 'Lund University Sexual Harassment Inventory' (LUSHI). A survey was sent to all staff, including PhD students, and students, with a response rate of 33% (n = 2736) and 32% (n = 9667), respectively. Exploratory factor analysis and Cronbach's alpha statistics were applied. Having experienced one or more of 10 specific behaviors was defined as sexual harassment exposure and was reported by 17.1% of staff/PhD students and 21.1% of students. Exploratory factor analysis yielded two factors with Eigenvalues above 1, labeled 'unwanted sexual attention of soliciting type' and 'unwanted sexual attention of non-soliciting type'. Rape/attempted rape fell outside of the two factors. The Cronbach's alpha values of the original 10-item scale and of the two newly formed scales were 0.80, 0.80, and 0.66, respectively. The mentioned statistics were markedly similar among men, women, and non-binary individuals and between staff/PhD students and students. We conclude that the 10-item instrument could be used for assessing sexual harassment in university settings or any type of workplace.

Selling one's future: over-indebtedness and the risk of poor mental health and the role of precarious employment - results from the Scania Public Health Cohort, Sweden.

OBJECTIVES: The credit market has expanded rapidly, increasing the risk of over-indebtedness among those who lack secure employment or adequate income, an issue of concern in the COVID-19 aftermath. We investigated the role of over-indebtedness for developing poor mental health, and whether this impact is modified by age, gender, educational level or being in precarious employment. METHODS: This is a cohort study using data from the Swedish Scania Public Health Cohort, based on individuals randomly selected from the general adult population in Scania, southern Sweden, initiated in 1999/2000 (response rate 58%) with follow-ups in 2005 and 2010. Over-indebtedness was assessed by combining information on cash margin and difficulty in paying household bills. Mental health was assessed by General Health Questionnaire-12. Those with poor mental health at baseline were excluded, and the analyses were further restricted to vocationally active individuals with complete data on main variables, resulting in 1256 men and 1539 women. RESULTS: Over-indebtedness was more common among women, among persons with a low educational level, born abroad and with a precarious employment at baseline. The age-adjusted incidence rate ratio (IRR) for poor mental health in 2010 among individuals exposed to over-indebtedness in 1999/2000 or 2005 was 2.2 (95% CI 1.7 to 2.8). Adjusting for educational level, country of origin and precarious employment in 1999/2000 or 2005, yielded an IRR of 2.0 (95% CI 1.6 to 2.6). An interaction analysis indicated that a high level of education may act synergistically with over-indebtedness, regarding poor mental health among men. CONCLUSIONS: Over-indebtedness was related to unfavourable societal power relations, regarding social class, gender and foreign birth. Precarious employment was independently linked to poor mental health and may also mediate the effect by over-indebtedness. The COVID-19 pandemic might entail increased over-indebtedness, which should be acknowledged in policies aiming at buffering social effects of the pandemic.

One-year incidence of sexual harassment and the contribution to poor mental health in the adult general population.

BACKGROUND: Sexual harassment (SH) has been highlighted as an important determinant for mental health. The aims of this study were to describe SH in terms of cumulative 1-year incidence, exposed groups, types of perpetrators and settings, and to measure the association between SH and poor mental well-being. METHODS: Data from two waves of the Scania Public Health Cohort Study, comprising 7759 randomly recruited individuals above 18 years. Exposure to SH was measured by an instrument that also recorded place of exposure and type of perpetrator. Poor mental well-being was assessed by General Health Questionnaire (GHQ)-12, 36-Item Short Form Health Survey questionnaire (SF-36) (mental health module) and self-reported use of prescribed psychotropic medication. Logistic regression was used for multivariate analyses. RESULTS: The cumulative 1-year incidence of SH was six times greater among women, the highest figure (17.5%) was noted for women 18-34 years of age. No difference was noted regarding educational level or country of origin. Public places, including public transportation, and unknown offenders were the most frequently reported setting of SH for both genders. Exposure to SH was associated with a doubled risk for low mental well-being, according to all three outcome definitions, and after adjustment for mental health 6 years earlier. Female gender was related to greater vulnerability to SH exposure concerning GHQ-12 and SF-36. The Population Attributable Fraction for poor mental health was calculated to 13% for women 34 years and younger. CONCLUSION: The results of this study make SH an important issue for gender policy as well as for public health policy and intervention.

Psychosocial Working Conditions and Social Participation. A 10-Year Follow-Up of Senior Workers.

Social participation is important for health, and it is well known that high strain jobs impact negatively on mental and physical health. However, knowledge about the impact of psychosocial working conditions on social participation from a long-term perspective is lacking. The purpose of this study was to investigate the associations between different job types and social participation from a long-term perspective. A comprehensive public health questionnaire "The Scania Public Health Survey", was used, and psychosocial working conditions were measured with a Swedish translation of the Job Content Questionnaire. Based on data from 1098 working respondents aged 55 at baseline and a 10-year follow-up when the respondents were not working, the analyses revealed that social participation varied by job type. Jobs with high decision latitude, as in active and relaxed jobs, seem to predict high social participation, even after cessation of employment. Besides that, the result suggests that high social participation during working life is a predictor of high social participation from a long-term perspective which promotes healthy aging. Incentives for working longer are strongly related to good working conditions. A supportive work environment with possibilities for employees to participate in decision making, i.e., high control, is vital for a sustainable working life. This may contribute to an extended working life and may also support social participation prior to retirement as well as after retirement and thus to healthy aging.

Reweighting a Swedish health questionnaire survey using extensive population register and self-reported data for assessing and improving the validity of longitudinal associations.

BACKGROUND: In cohorts with voluntary participation, participants may not be representative of the underlying population, leading to distorted estimates. If the relevant sources of selective participation are observed, it is however possible to restore the representativeness by reweighting the sample to resemble the target population. So far, few studies in epidemiology have applied reweighting based on extensive register data on socio-demographics and disease history, or with self-reported data on health and health-related behaviors. METHODS: We examined selective participation at baseline and the first two follow-ups of the Scania Public Health Cohort (SPHC), a survey conducted in Southern Sweden in 1999/2000 (baseline survey; n = 13,581 participants, 58% participation rate), 2005 (first follow-up, n = 10,471), and 2010 (second follow-up; n = 9,026). Survey participants were reweighted to resemble the underlying population with respect to a broad range of socio-demographic, disease, and health-related characteristics, and we assessed how selective participation impacted the validity of associations between self-reported overall health and dimensions of socio-demographics and health. RESULTS: Participants in the baseline and follow-up surveys were healthier and more likely to be female, born in Sweden, middle-aged, and have higher socioeconomic status. However, the differences were not very large. In turn, reweighting the samples to match the target population had generally small or moderate impacts on associations. Most examined regression coefficients changed by less than 20%, with virtually no changes in the directions of the effects. CONCLUSION: Overall, selective participation with respect to the observed factors was not strong enough to substantially alter the associations with self-assessed health. These results are consistent with an interpretation that SPHC has high validity, perhaps reflective of a relatively high participation rate. Since validity must be determined on a case-by-case basis, however, researchers should apply the same method to other health cohorts to assess and potentially improve the validity.

Assessment of selection bias due to dropouts in the follow-up of the Scania Public Health Cohort.

Aims: To investigate potential differences between participants and dropouts in the 2005 follow-up of the Scania Public Health Cohort Study regarding the prevalence of commonly studied health determinants and whether these factors had differential associations with three health outcomes: all-cause mortality and purchase of prescribed cardiovascular or psychotropic drugs during a 10-year follow-up period. Methods: The Scania Public Health Cohort was initiated in 1999/2000, with randomly invited participants aged 18-80 years from the general population (58% participation). Questionnaire data from 10,462 participants and 2576 dropouts in the 2005 follow-up (80% participation) were linked to public registers on mortality and purchase of prescribed drugs. Results: Age, male gender, being born abroad, low educational level, low self-rated mental and general health and daily smoking were all related to dropping out. The 10-year mortality was higher among dropouts (13.4% versus 11.9%; age-adjusted hazard ratio 1.6, 95% confidence interval: 1.4-1.8). In 13 out of 18 analyses, similar associations between health determinants and outcomes were found across participants and dropouts. However, being born outside of Sweden was associated with higher risks for all three poor health outcomes among participants, but not so among dropouts. Conclusions: Despite selective participation at follow-up, there was little evidence of selection bias, insofar as estimated associations were generally similar across participants, dropouts and the whole cohort. This finding is important for the assessment of the validity of prospective findings from this cohort and similar ones, where the loss of individuals at consecutive follow-ups of exposure is non-negligible.

Investigating the effect of social networking site use on mental health in an 18-34 year-old general population; a cross-sectional study using the 2016 Scania Public Health Survey.

BACKGROUND: Social Networking Sites (SNS) are commonly used, especially by young adults. Their impact on mental health is unclear. Moreover, little is known about how social factors, e.g. Perceived Emotional Support (PES), may affect this association. Mental health issues are increasingly burdening the young generation and society as a whole. This study aims to investigate the association between frequency of SNS use and number of SNS contacts with the mental health of a young, Swedish population. Additionally, the potential effect modification of PES will be analysed in regard to these relationships. METHOD: This cross-sectional study applied logistic regression analyses to data on 1341 participants (aged 18-34), retrieved from the Scania Public Health Survey (2016). Analyses were stratified by gender and the GHQ-12 scale assessed poor mental health. A 2-way interaction model was used to test for effect modification by PES regarding the association between SNS use and mental health. RESULTS: Increased risk for poor mental health was found in women only. Using SNS almost hourly vs. less often resulted in an odds ratio (OR) of 1.66 (95% confidence interval (CI) = 1.16-2.38). The corresponding figures for having ≥600 contacts vs. ≤599 were (1.89; 1.21-2.97). Having low PES and using SNS almost hourly was associated with an OR of 3.12 (CI = 1.69-5.76; synergy index (SI) = 1.25). Low PES and ≥ 600 contacts resulted in an OR of 6.07 (CI = 1.73-21.33), whereby interaction was detected (SI = 2.88). CONCLUSION: Women, but not men, with frequent SNS use and a high number of SNS contacts were more likely to have poor mental health, which was exacerbated in women with low PES. Facilitating PES could be an approach for improving mental health among young adults. Future studies on the use of SNS should focus more on gender analyses.

The role of social embeddedness for remaining in non-desired workplaces and mental health consequences: Results from Scania Public Health Cohort.

AIMS: The aim of the study was to investigate the role of social embeddedness on and off the job in relation to remaining in non-desired workplaces (NDWs) and the development of mental health. METHOD: The study used questionnaire data from the Scania Public Health cohort ( N=2410) that were collected in 2000 (T1), 2005 (T2) and 2010 (T3). Logistic regression models were calculated to probe how NDWs and social embeddedness factors measured at baseline (T1) related to NDWs five years later (T2), and to investigate how NDWs and social embeddedness factors at T2 related to poor mental health at T3. Synergy indices were calculated in both analyses to test for additive v. interactive effects between NDWs and social embeddedness factors on the outcomes. RESULTS: NDWs at baseline and low social embeddedness on and off the job was associated with NDWs at T2. For those in a desired workplace, low support from co-workers as well as low workplace affinity increased the risk to be in an NDW at T2. NDWs and low social embeddedness also associated with impaired mental health (T3). For those in an NDW, low support from co-workers as well as low workplace affinity increased the risk of poor mental health at T3. CONCLUSIONS: This study underlines the importance of social embeddedness for NDWs and the development of poor mental health over time. Particularly low social support from co-workers and low workplace affinity seem to be risk factors for future experience of an NDW and impaired mental health.

The negative effects on mental health of being in a non-desired occupation in an increasingly precarious labour market.

Precarious employment has been associated with poor mental health. Moreover, increasing labour market precariousness may cause individuals to feel 'locked-in', in non-desired workplaces or occupations, out of fear of not finding a new employment. This could be experienced as a 'loss of control', with similar negative health consequences. It is plausible that the extent to which being in a non-desired occupation (NDO) or being in precarious employment (PE) has a negative impact on mental health differs according to age group. We tested this hypothesis using data from 2331 persons, 18-34, 35-44, and 45-54 years old, who answered questionnaires in 1999/2000, 2005, and 2010. Incidence rate ratios (IRR) were calculated for poor mental health (GHQ-12) in 2010, after exposure to NDO and PE in 1999/2000 or 2005. NDO and PE were more common in the youngest age group, and they were both associated with poor mental health. In the middle age group the impact of NDO was null, while in contrast the IRR for PE was 1.7 (95% CI: 1.3-2.3) after full adjustment. The pattern was completely the opposite in the oldest age group (adjusted IRR for NDO 1.6 (1.1-2.4) and for PE 0.9 (0.6-1.4)). The population attributable fraction of poor mental health was 14.2% and 11.6%, respectively, for NDO in the youngest and oldest age group, and 17.2% for PE in the middle age group. While the consequences of PE have been widely discussed, those of NDO have not received attention. Interventions aimed at adapting work situations for older individuals and facilitating conditions of job change in such a way as to avoid risking unemployment or precarious employment situations may lead to improved mental health in this age group.

Precarious employment is a risk factor for poor mental health in young individuals in Sweden: a cohort study with multiple follow-ups.

BACKGROUND: The globalisation of the economy and the labour markets has resulted in a growing proportion of individuals who find themselves in a precarious labour market situation, especially among the young. This pertains also to the Nordic countries, despite their characterisation as well developed welfare states with active labour market policies. This should be viewed against the background of a number of studies, which have shown that several aspects of precarious employment are detrimental to mental health. However, longitudinal studies from the Nordic region that examine the impact of precarious labour market conditions on mental health in young individuals are currently lacking. The present study aims to examine this impact in a general cohort of Swedish young people. METHODS: Postal questionnaires were sent out in 1999/2000 to a stratified random sample of the Scania population, Sweden; the response rate was 58 %. All of those who responded at baseline were invited to follow-ups after 5 and 10 years. Employment precariousness was determined based on detailed questions about present employment, previous unemployment, and self-rated risk of future unemployment. Mental health was assessed by GHQ-12. For this study individuals in the age range of 18-34 years at baseline, who were active in the labour market (employed or seeking job) and had submitted complete data from 1999/2000, 2005, and 2010 on employment precariousness and mental health status, were selected (N = 1135). RESULTS: Forty-two percent of the participants had a precarious employment situation at baseline. Labour market trajectories that included precarious employment in 1999/2000 or 2005 predicted poor mental health in 2010: the incidence ratio ratio was 1.4 (95 % CI: 1.1-2.0) when excluding all individuals with mental health problems at baseline and adjusting for age, gender, social support, social capital, and economic difficulties in childhood. The population attributable fraction regarding poor mental health in the studied age group was 18 %. CONCLUSIONS: This study supported the hypothesis that precarious employment should be regarded as an important social determinant for subsequent development of mental health problems in previously mentally healthy young people.

Insomnia increases risk for cardiovascular events in women and in men with low socioeconomic status: a longitudinal, register-based study.

OBJECTIVES: Insomnia and short and long sleep durations have all been linked to cardiovascular disease. Male gender and low socioeconomic status are also related to cardiovascular disease, but it is unclear whether these two factors modify the impact of poor sleep on cardiovascular disease incidence. METHODS: Participants (5875 men and 7742 women ages 45 to 64 with no history of cardiovascular disease from the general population of Malmö, Sweden; participation rate 41%) were enrolled from 1992 to 1994 and followed until 2005 or until the first cardiovascular event (defined as myocardial infarction, stroke, or death due to ischemic heart disease), as recorded by official registers. Baseline blood pressure, BMI, and inquiry data concerning psychosocial circumstances and self-reported sleep habits were compared with hazard ratios (HRs) of cardiovascular events. RESULTS: Affirming 'moderate' or 'considerable' problems with at least one out of the four insomnia symptoms was associated with cardiovascular event in women (fully-adjusted HR 1.4 [95% CI 1.2-1.6] and population attributable fraction 17.3%). The same was true of men with past or present manual occupation (HR 1.3 [95% CI 1.1-1.6] and population attributable fraction 11.8%). The HRs increased further in women where insomnia symptoms were combined with short or long sleep duration. CONCLUSIONS: Insomnia is a significant public health problem with implications for cardiovascular disease incidence. Taking gender and socioeconomic status into account is a worthwhile approach in research on sleep and cardiovascular disease outcomes.

Insomnia symptoms, sleep duration, and disability pensions: a prospective study of Swedish workers.

BACKGROUND: Previous studies have found insomnia and long sleep duration to be independently associated with subsequent disability pension (DP). However, the issue of a possible gender-based pattern in this context has received little attention. PURPOSE: This study aims to assess the impact of insomnia symptoms and sleep duration on the DP rates among Swedish women and men during a 12-year follow-up period. METHOD: The participants, from the general population of Malmö, Sweden, were enrolled from 1992 to 1994 (n = 4,319; participation rate 41 %), aged 45-64, healthy, and employed ≥30 h per week. Baseline inquiry data concerning psychosocial circumstances and self-reported sleep habits were compared with official register-based DP rates. RESULTS: Five hundred and nine persons were granted a DP. Insomnia symptoms, affirmed by 33 % of the men and 41 % of the women, were associated with receiving a DP; the hazard ratios in the fully adjusted model were 1.4 for both men [95 % confidence interval (CI) 1.1, 1.9] and women (95 % CI 1.1, 1.7). The fully adjusted hazard ratio for women sleeping ≥9 h was 7.8 (95 % CI 3.7, 16.6) for DP due to a mental disorder. In the age-adjusted analyses, the sub-domain "difficulties falling asleep" was related to DP due to mental disorders in men and DP due to cardiovascular diseases in women. CONCLUSION: The findings suggest that preventing and treating insomnia symptoms could reduce DP and that disease mechanisms linking sleep disturbances to DP may differ by gender.

Can high psychological job demands, low decision latitude, and high job strain predict disability pensions? A 12-year follow-up of middle-aged Swedish workers.

OBJECTIVES: The aim of this study was to investigate whether job strain, psychological demands, and decision latitude are independent determinants of disability pension rates over a 12-year follow-up period. METHODS: We studied 3,181 men and 3,359 women, all middle-aged and working at least 30 h per week, recruited from the general population of Malmö, Sweden, in 1992. The participation rate was 41 %. Baseline data include sociodemographics, the Job Content Questionnaire, lifestyle, and health-related variables. Disability pension information was obtained through record linkage from the National Health Insurance Register. RESULTS: Nearly 20 % of the women and 15 % of the men were granted a disability pension during the follow-up period. The highest quartile of psychological job demands and the lowest quartile of decision latitude were associated with disability pensions when controlling for age, socioeconomic position, and health risk behaviours. In the final model, with adjustment also for health indicators and stress from outside the workplace, the hazard ratios for high strain jobs (i.e. high psychological demands in combination with low decision latitude) were 1.5 in men (95 % CI, 1.04-2.0) and 1.7 in women (95 % CI, 1.3-2.2). Stratifying for health at baseline showed that high strain tended to affect healthy but not unhealthy men, while this pattern was reversed in women. CONCLUSIONS: High psychological demands, low decision latitude, and job strain were all confirmed as independent risk factors for subsequent disability pensions. In order to increase chances of individuals remaining in the work force, interventions against these adverse psychosocial factors appear worthwhile.

Synergistic interaction effect between job control and social support at work on general psychological distress.

PURPOSE: Little is known about the interaction between job control and social support at work on common mental disorders. To examine whether there is a synergistic interaction effect between job control and social support at work on general psychological distress and whether it differs by the level of job demands. METHODS: About 1,940 male and female workers from the Malmö Shoulder and Neck Study were chosen for this cross-sectional study. Job control, social support at work, and job demands were measured by the Swedish version of the Job Content Questionnaire, and general psychological distress was assessed by the General Health Questionnaire. RESULTS: A significant excessive risk increase for general psychological distress was observed when workers had both low job control and low social support at work in both men and women. The synergistic effect was stronger in women, when job demands were low (Rothman's synergy index was 2.16 vs. 1.51 when job demands were high). However, in male workers, while a strong synergistic effect between job control and social support at work was found when job demands were low (synergy index was 9.25), there was an antagonistic effect when job demands were high (synergy index was 0.52). CONCLUSIONS: There was a synergistic interaction effect between job control and social support at work on general psychological distress, but the synergistic effect or its effect size differed by the level of job demands and gender. An atomic, additive approach to the risk assessment of the psychosocial work characteristics on common mental disorders could be misleading or lead to a risk underestimation.

Psychosocial working conditions and exhaustion in a working population sample of Swedish middle-aged men and women.

BACKGROUND: Exhaustion is a concept of interest for both occupational health research and stress-disease theory research. The aim of the present study was to explore associations between chronic stressors, in terms of psychosocial working conditions, and exhaustion in a Swedish middle-aged population sample. METHODS: A vocationally active population sample of the Malmö Shoulder and Neck Study cohort, comprising 2555 men and 2466 women between 45 and 64 years of age, was used. Psychosocial working conditions, assessed by means of the demand-control-support model, were measured longitudinally with a 1-year interval. Exhaustion was assessed by the SF-36 vitality scale and measured at follow-up, yielding a cross-sectional study design. RESULTS: Exhaustion was twice as common in women as in men. High psychological job demands, low job control and low job support were independently associated with exhaustion in both men and women. These associations remained after controlling for a variety of potential confounders and mediators, including socio-demographic factors, lifestyle factors, musculoskeletal pain, disease, other work-related factors (including physical workload) and non-work-related factors. High demands in combination with low control (job strain), and job strain combined with low job support (iso-strain), increased the risk for exhaustion. CONCLUSION: Psychosocial working conditions seem to contribute to exhaustion in middle-aged men and women. Future research should include exploration of exhaustion as a possible mediator between work stress and disease, as well as exploration of other chronic stressors, including non-work-related stressors, regarding their effects on exhaustion in men and women.

Conflict between the work and family domains and exhaustion among vocationally active men and women.

Exhaustion is consistently found to be more prevalent in women than in men. Women suffer from job strain more often, which may constitute a partial explanation for this phenomenon, but experienced shortcomings in combining work and family demands may also contribute to ill health. The aim of this study was to investigate, and analyse by gender, how work-related and family-related factors, as well as the interface between them, i.e. work-to-family conflict (WFC) and family-to-work conflict (FWC), are related to exhaustion. The study was cross-sectional with self-administered questionnaires assessing exposures and outcome with previously well-validated instruments. The participants were 2726 men and 2735 women, aged 45-64, vocationally active, and residing in Malmö, Sweden. Sixteen percent of the women and 8% of the men considered themselves exhausted. WFC, FWC, job strain, and low job support were all strongly correlated to exhaustion in both genders. In the multivariate analyses, adjusting for other work and family risk factors, WFC and FWC remained statistically significant risk factors for exhaustion in both men and women. Job strain, low job support, and having a somatic disorder were also independently associated with exhaustion. While WFC was more prevalent among men, it was more strongly associated with exhaustion in women than in men. In women, WFC and FWC contributed to a larger part of the explanatory power of the model, which amounted to 22% of the variance in women and 14% in men. The results imply that the concept of 'work stress' should be regarded in a wider context in order to understand gender related issues of exhaustion among vocationally active individuals.

Sleeping problems as a risk factor for subsequent musculoskeletal pain and the role of job strain: results from a one-year follow-up of the Malmö Shoulder Neck Study Cohort.

BACKGROUND: The role of sleeping problems in the causal pathway between job strain and musculoskeletal pain is not clear. PURPOSE: To investigate the impact of sleeping problems and job strain on the one-year risk for neck, shoulder, and lumbar pain. METHOD: A prospective study, using self-administered questionnaires, of a healthy cohort of 4,140 vocationally active persons ages 45-64, residing in the city of Malmo. RESULTS: At follow-up, 11.8% of the men and 14.8% of the women had developed pain. The odds ratios (OR) for pain at follow-up and sleeping problems at baseline were 1.72 (95% CI: 1.13-2.61) in men and 1.91 (1.35-2.70) in women. Regarding exposure to job strain, ORs were 1.39 (0.94-2.05) for men and 1.63 (1.18-2.23) for women. These statistically significant risks remained so when controlled for possible confounding. A modest synergistic effect was noted in women with concurrent sleeping problems and job strain, but not in men. CONCLUSION: One in 15-20 of all new cases of chronic pain in the population could be attributed to sleeping problems. No evidence was found for a causal chain with job strain leading to musculoskeletal pain by the pathway of sleeping problems.