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Background: The aim of this study is to examine the relevance of macroeconomic conditions (boom vs. recession) and own labor market status on alcohol use in youth and midlife. Method: Two Northern Swedish cohorts, born in either 1965 (boom at age 21 years) or 1973 (recession at age 21 years), included all pupils attending the last grade of compulsory school in Luleå, in 1981 (n = 990) or 1989 (n = 686), respectively. Questionnaires were completed at ages 21 and 43/39 years. Alcohol use was measured as volume of consumption (cl/year) and heavy episodic drinking (HED). Results: Women aged 21 years during the boom (Cohort65) consumed less alcohol and were less likely to be heavy episodic drinkers at age 21 years compared to those who were exposed to recession at the same age (Cohort73). In men there were no such cohort differences. Women, and to some extent men, in Cohort65 increased their consumption at midlife, whereas this decreased for those in Cohort73. HED decreased in both cohorts, but the decrease was steeper in the recession cohort. Analyses stratified by labor market status revealed between-cohort differences in consumption among women who were either employed or students at baseline; but not for men. Alcohol use for those unemployed did not differ between the cohorts. Conclusions: In our study, comparing two cohorts that experienced either macroeconomic boom (1986) or recession (1994) at age 21 years in Sweden, the association between individual alcohol use and concurrent unemployment in youth was not affected by macroeconomic conditions. [ABSTRACT FROM AUTHOR]

Background Previous studies suggest an overall increase of adolescent mental health symptoms globally since the 1980s until today, especially an increase of internalizing symptoms in girls. Due to methodological limitations of these studies, further studies are warranted to obtain a more solid knowledgebase. Methods This study was cross-sectional and compared two separate but geographically identical groups of adolescents in a middle-sized industrial municipality in Northern Sweden at two time-points [(i) 1981, n = 1083, (505 girls, 577 boys), response rate 99.7%; (ii) 2014, n = 682, (338 girls, 344 boys), response rate 98.3%]. All students in their last year of compulsory school were included. The same self-report questionnaire, consisting of four sub-scales (functional somatic-, anxiety-, depressive symptoms and conduct problems), was used at both occasions. Data were analyzed with descriptive statistics, two-way ANOVA and general linear model. Results Symptoms of anxiety and depression and functional somatic symptoms, increased among both boys and girls from 1981 until 2014 (P < 0.001 for all subscales), and the increase of these symptoms was higher in girls. Conduct problems were significantly higher in boys in 1981 and decreased over time so that in 2014 there was no longer a significant difference between boys and girls regarding conduct problems (P = 0.286). Conclusion In this population-based study spanning over 30 years, both girls and boys showed increasing internalizing problems, while conduct problems decreased. To halt this trend, we need a deeper understanding of the impact of the major societal changes that have occurred during the last three decades. [ABSTRACT FROM AUTHOR]

Background Organized group activities (e.g. sports or arts clubs) have long been noted as important developmental settings for youth, yet previous studies on the relationships between participation and mental health outcomes have focused on short-term effects among school-aged adolescents. The subsequent period of life, emerging adulthood, has been largely overlooked despite being another important life stage where individuals face new existential challenges and may benefit from group activity participation. The potential for macroeconomic conditions to modify these relationships has also not been considered. Methods Participants (n = 1654) comprise two cohorts, born in either 1965 (n = 968) or 1973 (n = 686), from the same middle-sized industrial town in Northern Sweden. Both cohorts completed detailed questionnaires at age 21 (macroeconomic boom for Cohort 65, recession for Cohort 73) and approximately 20 years follow-up (age 43 for Cohort 65, age 39 for Cohort 73). General linear models were used to assess concurrent and prospective associations between regular group activity participation and depressive symptoms, as well as the potential interaction with boom/recession. Results After controlling for sociodemographic factors, regular group activity participation at age 21 was associated with lower depressive symptoms, both concurrently and at follow-up. Those exposed to recession at age 21 reported higher depressive symptoms at the time but there was no interaction between cohort (boom/recession) and group activity participation. Conclusions Regular group activity participation during emerging adulthood is associated with lower depressive symptoms uniformly in times of boom and recession. Beneficial effects of such participation may contribute to better mental health over 20 years. [ABSTRACT FROM AUTHOR]

Background: Numerous studies have demonstrated an association between social support and health, almost regardless of how social support and health have been conceptualised or measured. Even so, the issue of causality has not yet been sufficiently addressed. This issue is particularly challenging for mental health problems such as depressive symptoms. The aim of the present study is to longitudinally assess structural and functional aspects of social support in relation to depressive symptoms in men and women, through a series of competing causal models that, in contrast to many other statistical methods, allow for bi-directional effects. Methods: Questionnaire data from the Northern Swedish Cohort (n = 1001) were utilised for the years 1995 (age 30) and 2007 (age 42). Associations were analysed by means of gender-specific structural equation modelling, with structural and functional support modelled separately. Results: Both structural and functional support were associated with depressive symptoms at ages 30 and 42, for men and women alike. A higher level of support, particularly functional support, was associated with a decrease in depressive symptoms over time among men. Among women, there were bi-directional effects of social support and depressive symptoms over time. Conclusion: Concerning social support and health, the social causation hypothesis seems relevant for men whereas, for women, the associations appear to be more complex. We conclude that preventive and health promoting work may need to consider that the presence of depressive symptoms in itself impedes on women's capability to increase their levels of social support. [ABSTRACT FROM AUTHOR]

Background: Experiencing adversities during upbringing has short-term and long-term effects on mental health. This study aims to explore how social adversities in adolescence predict trajectories of internalized mental health symptoms (IMHS), from adolescence and onward until middle age. Methods: Based on 1040 individuals from the Northern Swedish Cohort Study, a community-based cohort with 27 years of follow-up. We applied latent class growth analysis to extract trajectories of IMHS between ages 16 and 43. Multinomial logistic regression was used to study the association of social adversities (residential mobility, residential crowding, parental loss, unemployment of a parent, physical illness of a parent, mental illness or alcohol problems of a parent) in adolescence with IMHS trajectories. Results: Five trajectory classes were identified: 'very low stable' (26% of the sample), 'low stable' (58%), 'moderate stable' (5%), 'increasing' (8%) and 'high decreasing' (3%). Both in men and women, reporting social adversities at the age of 16 increased the risk of belonging to the classes with less favourable development of IMHS. Reporting adversities was positively associated with the initial level of the IMHS trajectories. Thus it seems that the influence of adversities is more pronounced during the early years of follow-up and is attenuated over time. Conclusion: Experiencing social adversities in adolescence increases the risk of entering unfavourable developmental trajectories of mental health until middle age. [ABSTRACT FROM AUTHOR]

Background: Earlier research shows that there is an association between unemployment and poor mental health, and that recovery from the damages to mental health obtained during unemployment remains incomplete over a long period of time. The present study relates this 'mental health scarring' to the trade cycle, exploring if those exposed to youth unemployment during boom differ from those exposed during recession with respect to mental health in the middle age. Methods: The sample consists of two cohorts from the same industrial town in Northern Sweden: the cohort born in 1965 and the cohort born in 1973 included all pupils attending the last grade of compulsory school, respectively, in 1981 and in 1989. Their depressiveness and anxiousness were assessed by questionnaires at age 21 and again at age 43/39. Mental health at follow-up was related to exposure to unemployment during age years 21-25. Statistical significance of the cohort*exposure interactions from binary logistic regression analyses were used to assess the cohort differences in the mental health between Cohort65 and Cohort73, entering the labour market, respectively, during a boom and a recession. Results: Compared to the unexposed, high exposure to unemployment at the age from 21 to 25 was associated to increased probability of poor mental health in the middle age in both in Cohort65 (odds ratio 2.19 [1.46-3.30] for anxiousness and 1.85 [1.25-2.74]for depressiveness) and in Cohort73 (odds ratio 2.13 [1.33-3.39] for anxiousness and 1.38 [0.89-2.14] for depressiveness). The differences between the cohorts also turned out as statistically non-significant. Conclusions: The scars of unemployment exposure onto future health seem to be rather insensitive to economic trades. Thus, at the population level this would mean that the long-term health costs that can be attributed to youth unemployment are more widespread in the generation that suffers of recession around the entry to the work life. [ABSTRACT FROM AUTHOR]

Background: There are inherent methodological challenges in the measurement of mental health problems in longitudinal research. There is constant development in definitions, taxonomies and demands concerning the properties of mental health measurements. The aim of this paper was to construct composite measures of mental health problems (according to today's standard) from single questionnaire items devised in the early 1980s, and to evaluate their internal consistency and factorial invariance across the life course using the Northern Swedish Cohort.Methods: All pupils in the last year of compulsory school in Luleå in 1981 (n = 1083) form a prospective cohort study where the participants have been followed with questionnaires from the age of 16 (in 1981) until the age of 43 (in 2008). We created and tested the following composite measures from self-reports at each follow-up: depressive symptoms, anxiety symptoms, functional somatic symptoms, modified GHQ and positive health. Validity and internal consistency were tested by confirmatory factor analysis, including tests of factorial invariance over time.Results: As an overall assessment, the results showed that the composite measures (based on more than 30-year-old single item questions) are likely to have acceptable factorial invariance as well as internal consistency over time.Conclusions: Testing the properties of the mental health measures used in older studies according to the standards of today is of great importance in longitudinal research. Our study demonstrates that composite measures of mental health problems can be constructed from single items which are more than 30 years old and that these measures seem to have the same factorial structure and internal consistency across a significant part of the life course. Thus, it can be possible to overcome some specific inherent methodological challenges in using historical data in longitudinal research. [ABSTRACT FROM AUTHOR]

According to previous studies, the relationship between parenthood and mental health is not straightforward. One reason could be that selection effects on parenthood are seldom accounted for. Using the unique Northern Swedish Cohort dataset, following individuals from age 16 to 43 (n = 1001), this study examines whether there is a selection effect of self-reported mental health in adolescence into parenthood; and whether entry into parenthood is related to subsequent mental health after controlling for prior mental health. Our results show no evidence of a selection effect for women, but men with poor mental health at age 16 were less likely to become fathers. Having children improved women's subsequent mental health after controlling for adolescent mental health, something that was not true for men. Our result reinforces the need for future research of the complex relationship between mental health and parenthood through focusing on, for example, timing of parenthood as well as through using different mental health measures. [ABSTRACT FROM AUTHOR]

Background: Most previous studies on the effects of length of unemployment on health have focused on the duration of continuous spells of unemployment rather than on the cumulative length of intermittent spells. This study analysed the relationship between the cumulative length of intermittent spells of unemployment and different health-related outcomes using data from a longitudinal study of school leavers. Methods: All pupils who completed compulsory schooling in 1981 in a medium-sized town in northern Sweden (N= 1083) were followed for 14 years with repeated questionnaires including questions about unemployment, health and health behaviour. Results: Men tended to react with a steady state or a levelling off of health symptoms with increased unemployment, whereas women showed deteriorating health symptoms. For health behaviour the reverse occurred. Women's health behaviour was less connected with increased unemployment while men's health behaviour tended to deteriorate. Conclusion: Cumulative length of unemployment is correlated with deteriorated health and health behaviour. Long-term unemployment, even as a result of cumulated shorter employment spells over a number of years should be an urgent target for policy makers. [ABSTRACT FROM AUTHOR]

Aim: Although health effects of social relationships are well-researched, long-term health consequences of adolescent family as well as peer relationships are poorly understood. The aim of the study was to explore the prospective importance of parental and peer social relationships in adolescence on internalising and functional somatic symptoms in adulthood. Methods: Data were drawn from four waves of the Northern Swedish Cohort Study, response rate 94.3%, N=1001. Outcome variables were internalising and functional somatic symptoms at the ages of 21, 30 and 42. Relationship variables at age 16 were poor parental contact and three indicators of poor peer relationships. Associations were assessed in multivariate ordinal logistic regressions with adjustment for confounders and baseline health. Results: Results show that the main relationships-related predictors of adult internalising symptoms were self-rated poor peer relationships in terms of spending time alone during after-school hours and poor parental relationship. Functional somatic symptoms on the other hand were most strongly associated with poor parental contact and not being happy with classmates at age 16. Conclusions: The quality of parental and peer relationships in adolescence predicts adult mental and functional somatic health as much as 26 years later, even when accounting for confounders and adolescent symptomatology. This study extends past research by exploring how both adolescent parental and peer relationships (self-reported as well as teacher reported) predict adult self-reported health. [ABSTRACT FROM AUTHOR]

Background: There are contradictory results regarding whether there is a social gradient in common mental disorders or not, or if this relation differs for different indicators or by gender. We analysed the relation between various measures of socio-economic position and later psychological distress among men and women in a Swedish context. Methods: The study is based on data from the Northern Swedish Cohort (N= 1001, 93.5% response rate), a 27-year prospective study. Logistic regression was used to explore the relation between various indicators of socio-economic position at age 30 (occupation, education, financial strain, cash margin, unemployment and living primarily on social welfare or unemployment insurance) and psychological distress (age 42), controlling for earlier psychological distress (age 21) and parental occupational class. Register data were used to measure unemployment. All other variables were self-reported, and measured by a questionnaire. Results: Financial strain and living on social welfare or unemployment insurance at age 30 were associated with psychological distress at age 42 for men and women. Poor cash margin and unemployment were only associated with psychological distress in women, after controlling for potential confounders. Low occupational class and low education were not significantly related to later psychological distress. Conclusion: The two most commonly used measures of socio-economic position, occupation and education, were not significantly associated with psychological distress while other, less studied measures were. This study highlights the importance of measuring socio-economic position in several ways when studying common mental disorders, as well as to take gender into account. [ABSTRACT FROM AUTHOR]

ObjectiveTo analyse whether poor breakfast habits in adolescence predict the metabolic syndrome and its components in adulthood. Previous studies suggest that regular breakfast consumption improves metabolic parameters.DesignProspective. Breakfast habits and other lifestyle variables at age 16 years were assessed from questionnaires. Poor breakfast habits were defined as skipping breakfast or only drinking or eating something sweet. At age 43 years, the effective sample consisted of 889 participants defined as having the metabolic syndrome or not, using the International Diabetes Federation criteria. Logistic regression was used to calculate odds ratios and confidence intervals.SettingThe Northern Swedish Cohort, a longitudinal population-based cohort with 27-year follow-up.SubjectsAdolescents (age 16 years).ResultsPrevalence of the metabolic syndrome at age 43 years was 27·0 %. Of the participants, 9·9 % were classified with poor breakfast habits at age 16 years. Adjusted odds for the metabolic syndrome at age 43 years was OR = 1·68 (95 % CI 1·01, 2·78) for those with poor breakfast habits at age 16 years compared with breakfast eaters. Looking at the metabolic syndrome components, poor breakfast habits at age 16 years were associated with central obesity (OR = 1·71; 95 % CI 1·00, 2·92) and high fasting glucose (OR = 1·75; 95 % CI 1·01, 3·02) at age 43 years, even after multivariate adjustments.ConclusionsPoor breakfast habits in adolescence predicted the metabolic syndrome in adulthood. Of the metabolic syndrome components, poor breakfast habits in adolescence predicted central obesity and high fasting glucose in adulthood. Further research is needed to fully understand the relationship between early breakfast habits and adult metabolic syndrome. [ABSTRACT FROM PUBLISHER]

Aim: To examine social capital across life and functional somatic symptoms in middle-age, according to life-course models of cumulative risk and sensitive periods. Methods: Data from the 26-year prospective study the Northern Swedish Cohort enabled complete case analyses on 940 individuals (451 women and 489 men) participating in questionnaire surveys at ages 16, 21, 30 and 42. Social capital was operationalized at the individual level, comprising items on social participation, social influence and social support. Functional somatic symptoms were a summary measure of self-reported physical symptoms, palpitation and sleeping difficulties occuring during the 12 months prior to the data collection. Linear regression was used as the main statistical method, examining the relationship between functional somatic symptoms at age 42 and social capital across life. Results: Lower levels of social capital accumulated over the life course were associated with higher levels of functional somatic symptoms at age 42, for both women and men. Social capital was, especially among adolescent men, related to functional somatic symptoms at age 42, independently of social capital later in life and baseline material circumstances. Conclusions: The health impact of poor social capital may be due to accumulation across the life course and to adolescence being a particularly sensitive period. It is relevant for preventive work to acknowledge effects of social capital throughout life. [ABSTRACT FROM PUBLISHER]

Background: There has been little research on the long-term relationship between unemployment experiences and mental health over the life course. This article investigates the relationship between youth unemployment as well as that of unemployment experiences during later periods and mental health at ages 16, 21, 30 and 42 years. Methods: The study makes use of the ‘Northern Swedish Cohort’ (NSC), a 27-year prospective cohort study. The cohort, investigated at ages 16, 18, 21, 30 and 42 years, consisted of all graduates from compulsory school in an industrial town in Sweden. Of the original 1083 participants, 94.3% of those still alive were still participating at the 27-year follow up. Mental health, measured through a three-item index of nervous symptoms, depressive symptoms and sleeping problems, was analysed using a repeated measures linear mixed models approach using ages 16, 21, 30 and 43 years. Unemployment exposure was measured as exposure to at least a 6-month spell during three periods; 18–21, 21–30 and 30–42 years. Results: Youth unemployment was shown to be significantly connected with poorer mental health at all three target ages, 21, 30 and 42 years. Later singular unemployment experiences did not appear to have the same long-term negative effects. There was however an accumulation in poorer mental health among respondents with unemployment experiences during two, and even more so three, of the periods. Conclusion: There are long-term mental health scarring effects of exposure to youth unemployment and multiple exposure to unemployment during the life course. [ABSTRACT FROM AUTHOR]

Background: Previous research has found a positive association between health-behaviour and health. Only a few longitudinal studies have been performed, and as far as we found, none have followed a cohort for 27 years. Methods: This study used a cohort study, the “Northern Swedish Cohort”, which consisted of all graduates, n = 1080, from a compulsory school in a Swedish town. Data were collected with a comprehensive questionnaire; response rate 96.4%. Health-behaviour was analysed with binary logistic regression, with health-behaviour at age 21, 30 and 43 years as dependent variable. Besides baseline health-behaviour, gender, somatic and psychological health and socioeconomic background, the analyses were adjusted for work situation and social network. Results: The main findings were that education reduces the probability of unhealthy behaviour over the life course, which held after controlling for early life health-behaviour and possible confounders. The general education effect on health-behaviour was stronger among men than among women. Conclusions: Higher education reduces the probability of unhealthy behavior. Thus, investments in higher education should be an important public goal. [ABSTRACT FROM PUBLISHER]

Background: The importance of social and avoidable determinants of depressive symptoms has been increasingly recognized in public health research. However, when it comes to determinant of gender differences in depressive symptoms the focus is predominantly on biological unavoidable determinants. Thus, there is a need for more focus on gendered social determinants of health. The aim of this study was to analyse the importance of gender relations for depressive symptoms after taking socioeconomic factors and earlier depressive symptoms into account in the Northern Swedish cohort. Methods: A 26-year follow-up study of a cohort of all school leavers in a middle-sized industrial town in Northern Sweden was performed from age 16 until age 42. Of those still alive of the original cohort, 94% participated during the whole period and answered extensive questionnaires. Exposure was measured as socioeconomic status, financial strain, perceived gender inequity in the couple relationship and division of responsibility for domestic work. The outcome was depressive symptoms at age 42, while depressive symptoms were controlled at age 30. Results: In multivariate logistic regression analyses significant relations between financial strain and, among women only, also perceived gender equity in the couple relationship and depressive symptoms after adjustment for earlier health status, as well as for all other exposure measures. Conclusions: Financial strain, and among women, also gender inequity in the couple relationship was related to depressive mood. There is a need to pay more attention to gender relations in future research on social determinants of depressive mood. [ABSTRACT FROM PUBLISHER]

Background: Despite the inconsistent findings of the growing amount of research analysing the possible health consequences of temporary employment, there is a lack of heterogeneous perspectives. The aim of the study was to analyse whether the health consequences of temporary employment are worse among low educated compared with high educated, after control for health-related selection. Methods: A 26-year follow-up study of a cohort of all school leavers in a middle-sized industrial town in northern Sweden was performed between 1981 and 2007. Of those still alive of the original cohort, 94% participated during the whole period. For this study, a sample of participants with temporary and permanent employment contracts between the age of 30 and 42 years was selected (n = 660). Results: In multivariate logistic regression analyses, an additive synergistic interaction effect was found for low education and high exposure to temporary employment in relation to suboptimal self-rated health, after controlling for health-related selection and sex. An additive antagonistic interaction was found between low education in combination with high exposure to temporary employment in relation to psychological distress, whereas no interaction was found for depressive symptoms. Conclusion: Our hypothesis regarding worse health effects of temporary employment among low educated was partly confirmed. Our results indicate the need to analyse temporary employment from a more heterogeneous perspective as well as in relation to different health outcomes. [ABSTRACT FROM AUTHOR]

Background: Previous research has shown that unemployment experiences increase the risk of poor mental health and that this effect differs depending on individual characteristics. Relatively little is known, however, about how the unemployment rate and labour market conditions impact the relationship. This study investigates how municipal unemployment rates and vacancy rates affect mental health in a nationally representative longitudinal survey of initially unemployed Swedish respondents. Methods: The study uses a nationally representative longitudinal survey of currently and recently unemployed people in Sweden, in which respondents were re-interviewed one year after the initial interview. Mental health was measured using the GHQ-12. The present article uses multilevel models (hierarchical linear models) to combine municipal-level information on unemployment levels and vacancy rates with individual-level control variables. Results: Higher municipal vacancy rates improved mental health among the unemployed. However, no coherent effect of municipal unemployment rate on the relationship between unemployment and mental health was found. Conclusions: The effect of municipal vacancy rates can be understood in terms of the impact of perceived opportunity on the sense of life-course predictability. That there was no effect of municipal unemployment rate indicates that high local unemployment levels do not reduce the sense of shame and perceived stigma among the unemployed. Taken together, our findings would seem to present a rather bleak picture of the current dramatic labour market situation. The unemployed will be negatively affected by the extremely low demand for labour, while they will not be able to take comfort from their growing numbers. [ABSTRACT FROM AUTHOR]

Background: Even though population health is strongly influenced by employment and working conditions, public health research has to a lesser extent explored the social determinants of health inequalities between people in different positions on the labour market, and whether these social determinants vary across the life course. This study analyses mental health inequalities between unemployed and employed in three age groups (youth, adulthood and mid-life), and identifies the extent to which social determinants explain the mental health gap between employed and unemployed in northern Sweden. Methods: The Health on Equal Terms survey of 2014 was used, with self-reported employment (unemployed or employed) as exposure and the General Health Questionnaire (GHQ-12) as mental health outcome. The social determinants of health inequalities were grouped into four dimensions: socioeconomic status, economic resources, social network and trust in institutional systems. The non-linear Oaxaca decomposition analysis was applied, stratified by gender and age groups. Results: Mental health inequality was found in all age groups among women and men (difference in GHQ varying between 0.12 and 0.20). The decomposition analysis showed that the social determinants included in the model accounted for 43–51% of the inequalities among youths, 42–98% of the inequalities among adults and 60–65% among middle-aged. The main contributing factors were shown to vary between age groups: cash margin (among youths and middle-aged men), financial strain (among adults and middle-aged women), income (among men in adulthood), along with trust in others (all age groups), practical support (young women) and social support (middle-aged men); stressing how the social determinants of health inequalities vary across the life course. Conclusions: The health gap between employed and unemployed was explained by the difference in access to economic and social resources, and to a smaller extent in the trust in the institutional systems. Findings from this study corroborate that much of the mental health inequality in the Swedish labour market is socially and politically produced and potentially avoidable. Greater attention from researchers, policy makers on unemployment and public health should be devoted to the social and economic deprivation of unemployment from a life course perspective to prevent mental health inequality. [ABSTRACT FROM AUTHOR]