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  • 1.
    Airaksinen, Jaakko
    et al.
    Univ Helsinki, Dept Psychol & Logoped, Med, Haartmaninkatu 3,PL 21, FIN-00014 Helsinki, Finland; Finnish Inst Occupat Hlth, Dept Occupat Hlth, Helsinki, Finland.
    Ervasti, Jenni
    Department of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland.
    Pentti, Jaana
    Clinicum, University of Helsinki, Helsinki, Finland; Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.
    Oksanen, Tuula
    Department of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland.
    Suominen, Sakari
    Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.
    Vahtera, Jussi
    Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Department of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland.
    Kivimäki, Mika
    Department of Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland; Clinicum, University of Helsinki, Helsinki, Finland; Department of Epidemiology and Public Health, University College London, London, UK.
    The effect of smoking cessation on work disability risk: a longitudinal study analysing observational data as non-randomized nested pseudo-trials2019In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 48, no 2, p. 415-422Article in journal (Refereed)
    Abstract [en]

    Background

    Smoking increases disability risk, but the extent to which smoking cessation reduces the risk of work disability is unclear. We used non-randomized nested pseudo-trials to estimate the benefits of smoking cessation for preventing work disability.

    Methods

    We analysed longitudinal data on smoking status and work disability [long-term sickness absence (≥90 days) or disability pension] from two independent prospective cohort studies—the Finnish Public Sector study (FPS) (n = 7393) and the Health and Social Support study (HeSSup) (n = 2701)—as ‘nested pseudo-trials’. All the 10 094 participants were smokers at Time 1 and free of long-term work disability at Time 2. We compared the work disability risk after Time 2 of the participants who smoked at Time 1 and Time 2 with that of those who quit smoking between these times.

    Results

    Of the participants in pseudo-trials, 2964 quit smoking between Times 1 and 2. During the mean follow-up of 4.8 to 8.6 years after Time 2, there were 2197 incident cases of work disability across the trials. Quitting smoking was associated with a reduced risk of any work disability [summary hazard ratio = 0.89, 95% confidence interval (CI) 0.81–0.98]. The hazard ratio for the association between quitting smoking and permanent disability pension (928 cases) was of similar magnitude, but less precisely estimated (0.91, 95% CI 0.81–1.02). Among the participants with high scores on the work disability risk score (top third), smoking cessation reduced the risk of disability pension by three percentage points. Among those with a low risk score (bottom third), smoking cessation reduced the risk by half a percentage point.

    Conclusions

    Our results suggest an approximately 10% hazard reduction of work disability as a result of quitting smoking.

  • 2.
    Akbaraly, Tasmine
    et al.
    PSL Res Univ, Univ Montpellier, MMDN, EPHE, INSERM, U1198, Montpellier, France; UCL, Dept Epidemiol & Publ Hlth, London, England; Hosp & Univ Res Ctr Montpellier, Dept Psychiat, Montpellier, France; Hosp & Univ Res Ctr Montpellier, Autism Resources Ctr, Montpellier, France.
    Sexton, Claire
    Univ Oxford, FMRIB Ctr, Nuffield Dept Clin Neurosci, Oxford, England.
    Zsoldos, Eniko
    Univ Oxford, Dept Psychiat, Neurobiol Ageing Grp, Oxford, England.
    Mahmood, Abda
    Univ Oxford, Dept Psychiat, Neurobiol Ageing Grp, Oxford, England.
    Filippini, Nicola
    Univ Oxford, Dept Psychiat, Neurobiol Ageing Grp, Oxford, England.
    Kerleau, Clarisse
    PSL Res Univ, Univ Montpellier, MMDN, EPHE, INSERM, U1198, Montpellier, France.
    Verdier, Jean-Michel
    PSL Res Univ, Univ Montpellier, MMDN, EPHE, INSERM, U1198, Montpellier, France.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Gabelle, Audrey
    Univ Montpellier, Memory Resources & Res Ctr Alzheimers Dis & Relat, Dept Neurol, Gui de Chauliac Hosp, INSERM, U1183, Montpellier, France.
    Ebmeier, Klaus
    Univ Oxford, Dept Psychiat, Neurobiol Ageing Grp, Oxford, England.
    Kivimäki, Mika
    UCL, Dept Epidemiol & Publ Hlth, London, England.
    Association of Long-Term Diet Quality with Hippocampal Volume: Longitudinal Cohort Study2018In: American Journal of Medicine, ISSN 0002-9343, E-ISSN 1555-7162, Vol. 131, no 11, p. 1372-1381.e4Article in journal (Refereed)
    Abstract [en]

    Background: Diet quality is associated with brain aging outcomes. However, few studies have explored in humans the brain structures potentially affected by long-term diet quality. We examined whether cumulative average of the Alternative Healthy Eating Index 2010 (AHEI-2010) score during adult life (an 11-year exposure period) is associated with hippocampal volume.

    Methods: Analyses were based on data from 459 participants of the Whitehall II imaging sub-study (mean age [standard deviation] (SD) = 59.6 [5.3] years in 2002-2004, 19.2% women). Multimodal magnetic resonance imaging examination was performed at the end of follow-up (2015-2016). Structural images were acquired using a high-resolution 3-dimensional T1-weighted sequence and processed with Functional Magnetic Resonance Imaging of the Brain Software Library (FSL) tools. An automated model-based segmentation and registration tool was applied to extract hippocampal volumes.

    Results: Higher AHEI-2010 cumulative average score (reflecting long-term healthy diet quality) was associated with a larger total hippocampal volume. For each 1 SD (SD = 8.7 points) increment in AHEI-2010 score, an increase of 92.5 mm3 (standard error = 42.0 mm3) in total hippocampal volume was observed. This association was independent of sociodemographic factors, smoking habits, physical activity, cardiometabolic health factors, cognitive impairment, and depressive symptoms, and was more pronounced in the left hippocampus than in the right hippocampus. Of the AHEI-2010 components, no or light alcohol consumption was independently associated with larger hippocampal volume.

    Conclusions: Higher long-term AHEI-2010 scores were associated with larger hippocampal volume. Accounting for the importance of hippocampal structures in several neuropsychiatric diseases, our findings reaffirm the need to consider adherence to healthy dietary recommendation in multi-interventional programs to promote healthy brain aging.

  • 3.
    Bean, Christopher G.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Westerlund, Hugo
    Stress Research Institute, Stockholm University.
    Berg, Noora
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Group activity participation at age 21 and depressive symptoms during boom and recession in Sweden: a 20-year follow-up2019In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, no 3, p. 475-481Article in journal (Refereed)
    Abstract [en]

    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.

  • 4.
    Bean, Christopher
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Virtanen, Pekka
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Berg, Noora
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Hammarström, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Youth participation in Active Labour Market Programs (ALMPs) during boom/recession and mental health: a 20-year follow-up2019Conference paper (Refereed)
  • 5. Ervasti, Jenni
    et al.
    Airaksinen, Jaakko
    Pentti, Jaana
    Vahtera, Jussi
    Suominen, Sakari
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Finnish Institute of Occupational Health, Helsinki, Finland.
    Kivimäki, Mika
    Does increasing physical activity reduce the excess risk of work disability among overweight individuals?2019In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 45, no 4, p. 376-385Article in journal (Refereed)
    Abstract [en]

    Objectives We examined the extent to which an increase in physical activity would reduce the excess risk of work disability among overweight and obese people (body mass index ≥ 25kg/m2).

    Methods We used counterfactual modelling approaches to analyze longitudinal data from two Finnish prospective cohort studies (total N=38 744). Weight, height and physical activity were obtained from surveys and assessed twice and linked to electronic records of two indicators of long-term work disability (≥90-day sickness absence and disability pension) for a 7-year follow-up after the latter survey. The models were adjusted for age, sex, socioeconomic status, smoking, and alcohol consumption.

    Results The confounder-adjusted hazard ratio (HR) of long-term sickness absence for overweight compared to normal-weight participants was 1.43 [95% confidence interval (CI) 1.35–1.53]. An increase in physical activity among overweight compared to normal-weight individuals was estimated to reduce this HR to 1.40 (95% CI 1.31–1.48). In pseudo-trial analysis including only the persistently overweight, initially physically inactive participants, the HR for long-term sickness absence was 0.82 (95% CI 0.70–0.94) for individuals with increased physical activity compared to those who remained physically inactive. The results for disability pension as an outcome were similar.

    Conclusions These findings suggest that the excess risk of work disability among overweight individuals would drop by 3–4% if they increased their average physical activity to the average level of normal-weight people. However, overweight individuals who are physically inactive would reduce their risk of work disability by about 20% by becoming physically active.

  • 6. Ervasti, Jenni
    et al.
    Kivimäki, Mika
    Head, Jenny
    Goldberg, Marcel
    Airagnes, Guillaume
    Pentti, Jaana
    Oksanen, Tuula
    Salo, Paula
    Suominen, Sakari
    Jokela, Markus
    Vahtera, Jussi
    Zins, Marie
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Sickness absence diagnoses among abstainers, low-risk drinkers and at-risk drinkers: consideration of the U-shaped association between alcohol use and sickness absence in four cohort studies2018In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 113, no 9, p. 1633-1642Article in journal (Refereed)
    Abstract [en]

    Aims To estimate differences in the strength and shape of associations between alcohol use and diagnosis-specific sickness absence. Design A multi-cohort study. Participants (n = 47 520) responded to a survey on alcohol use at two time-points, and were linked to records of sickness absence. Diagnosis-specific sickness absence was followed for 4-7 years from the latter survey. Setting and participants From Finland, we had population cohort survey data from 1998 and 2003 and employee cohort survey data from 2000-02 and 2004. From France and the United Kingdom, we had employee cohort survey data from 1993 and 1997, and 1985-88 and 1991-94, respectively. Measurements We used standard questionnaires to assess alcohol intake categorized into 0, 1-11 and > 11 units per week in women and 0, 1-34 and > 34 units per week in men. We identified groups with stable and changing alcohol use over time. We linked participants to records from sickness absence registers. Diagnoses of sickness absence were coded according to the International Classification of Diseases. Estimates were adjusted for sex, age, socio-economic status, smoking and body mass index. Findings Women who reported drinking 1-11 units and men who reported drinking 1-34 units of alcohol per week in both surveys were the reference group. Compared with them, women and men who reported no alcohol use in either survey had a higher risk of sickness absence due to mental disorders [rate ratio = 1.51, 95% confidence interval (CI) = 1.22-1.88], musculoskeletal disorders (1.22, 95% CI = 1.06-1.41), diseases of the digestive system (1.35, 95% CI = 1.02-1.77) and diseases of the respiratory system (1.49, 95% CI = 1.29-1.72). Women who reported alcohol consumption of > 11 weekly units and men who reported alcohol consumption of > 34 units per week in both surveys were at increased risk of absence due to injury or poisoning (1.44, 95% CI = 1.13-1.83). Conclusions In Finland, France and the United Kingdom, people who report not drinking any alcohol on two occasions several years apart appear to have a higher prevalence of sickness absence from work with chronic somatic and mental illness diagnoses than those drinking below a risk threshold of 11 units per week for women and 34 units per week for men. Persistent at-risk drinking in Finland, France and the United Kingdom appears to be related to increased absence due to injury or poisoning.

  • 7.
    Ervasti, Jenni
    et al.
    Finnish Institute of Occupational Health, Helsinki, Finland .
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Finnish Institute of Occupational Health, Helsinki, Finland .
    Lallukka, Tea
    Finnish Institute of Occupational Health, Helsinki, Finland ; Faculty of Medicine, University of Helsinki, Helsinki, Finland .
    Friberg, Emilie
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden .
    Mittendorfer-Rutz, Ellenor
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden .
    Lundström, Erik
    Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Alexanderson, Kristina
    Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden .
    Trends in diagnosis-specific work disability before and after ischaemic heart disease: a nationwide population-based cohort study in Sweden2018In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 8, no 4, article id e019749Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We examined trends of diagnosis-specific work disability before and after ischaemic heart disease (IHD).

    DESIGN: Participants were followed 4 years before and 4 years after an IHD event for diagnosis-specific work disability (sickness absence and disability pension).

    SETTING AND PARTICIPANTS: A Swedish population-based cohort study using register data on all individuals aged 25-60 years, living in Sweden, and who suffered their first IHD event in 2006-2008 (n=23 971) was conducted.

    RESULTS: Before the event, the most common diagnoses of work disability were musculoskeletal disorders (21 annual days for men and 44 for women) and mental disorders (19 men and 31 for women). After multivariable adjustments, we observed a fivefold increase (from 12 to 60 days) in work disability due to diseases of the circulatory system in the first postevent year compared with the last pre-event year among men. Among women, the corresponding increase was fourfold (from 14 to 62 days). By the second postevent year, the number of work disability days decreased significantly compared with the first postevent year among both sexes (to 19 days among men and 23 days among women). Among women, mean days of work disability due to diseases of the circulatory system remained at a higher level than among men during the postevent years. Work disability risk after versus before an IHD event was slightly higher among men (rate ratio (RR) 2.49; 95% CI 2.36 to 2.62) than among women (RR 2.29, 95% CI 2.12 to 2.49). When pre-event long-term work disability was excluded, diseases of the circulatory system were the most prevalent diagnosis for work disability after an IHD event among both men and women.

    CONCLUSIONS: An IHD event was strongly associated with an increase in work disability due to diseases of the circulatory system, especially among men and particularly in the first postevent year.

  • 8.
    Hakulinen, Christian
    et al.
    Univ Helsinki, Fac Med, Dept Psychol & Logoped, Helsinki, Finland; Natl Inst Hlth & Welf, Helsinki, Finland.
    Pulkki-Råback, Laura
    Univ Helsinki, Fac Med, Dept Psychol & Logoped, Helsinki, Finland.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Finnish Inst Occupat Hlth, Helsinki, Finland.
    Jokela, Markus
    Univ Helsinki, Fac Med, Dept Psychol & Logoped, Helsinki, Finland.
    Kivimäki, Mika
    UCL, Dept Epidemiol & Publ Hlth, London, England; Univ Helsinki, Fac Med, Clinicum, Helsinki, Finland.
    Elovainio, Marko
    Univ Helsinki, Fac Med, Dept Psychol & Logoped, Helsinki, Finland; Natl Inst Hlth & Welf, Helsinki, Finland.
    Social isolation and loneliness as risk factors for myocardial infarction, stroke and mortality: UK Biobank cohort study of 479 054 men and women2018In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 104, no 18, p. 1536-1542Article in journal (Refereed)
    Abstract [en]

    Objective: To examine whether social isolation and loneliness (1) predict acute myocardial infarction (AMI) and stroke among those with no history of AMI or stroke, (2) are related to mortality risk among those with a history of AMI or stroke, and (3) the extent to which these associations are explained by known risk factors or pre-existing chronic conditions.

    Methods: Participants were 479 054 individuals from the UK Biobank. The exposures were self-reported social isolation and loneliness. AMI, stroke and mortality were the outcomes.

    Results: Over 7.1 years, 5731 had first AMI, and 3471 had first stroke. In model adjusted for demographics, social isolation was associated with higher risk of AMI (HR 1.43, 95% CI 1.3 to –1.55) and stroke (HR 1.39, 95% CI 1.25 to 1.54). When adjusted for all the other risk factors, the HR for AMI was attenuated by 84% to 1.07 (95% CI 0.99 to 1.16) and the HR for stroke was attenuated by 83% to 1.06 (95% CI 0.96 to 1.19). Loneliness was associated with higher risk of AMI before (HR 1.49, 95% CI 1.36 to 1.64) but attenuated considerably with adjustments (HR 1.06, 95% CI 0.96 to 1.17). This was also the case for stroke (HR 1.36, 95% CI 1.20 to 1.55 before and HR 1.04, 95% CI 0.91 to 1.19 after adjustments). Social isolation, but not loneliness, was associated with increased mortality in participants with a history of AMI (HR 1.25, 95% CI 1.03 to 1.51) or stroke (HR 1.32, 95% CI 1.08 to 1.61) in the fully adjusted model.

    Conclusions: Isolated and lonely persons are at increased risk of AMI and stroke, and, among those with a history of AMI or stroke, increased risk of death. Most of this risk was explained by conventional risk factors.

  • 9.
    Halonen, Jaana I
    et al.
    Finnish Inst Occupat Hlth, Helsinki 70032, Finland; Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Lallukka, Tea
    Finnish Inst Occupat Hlth, Helsinki 70032, Finland;Univ Helsinki, Dept Publ Hlth, Helsinki, Finland .
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Rod, Naja
    Univ Copenhagen, Sect Epidemiol, Dept Publ Hlth, Copenhagen, Denmark ; Univ Copenhagen, Copenhagen Stress Res Ctr, Copenhagen, Denmark.
    Magnusson Hanson, Linda
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Bi-directional relation between effort‒reward imbalance and risk of neck-shoulder pain: assessment of mediation through depressive symptoms using occupational longitudinal data2019In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 45, no 2, p. 126-133Article in journal (Refereed)
    Abstract [en]

    Objectives Bi-directional associations between perceived effort‒reward imbalance (ERI) at work and neck-shoulder pain have been reported. There is also evidence of associations between ERI and depressive symptoms, and between depressive symptoms and pain while the links between ERI, depressive symptoms and pain have not been tested. We aimed to assess whether depressive symptoms mediate the association between ERI and neck-shoulder pain, as well as the association between neck-shoulder pain and ERI.

    Methods We used prospective data from three consecutive surveys of the Swedish Longitudinal Occupational Survey of Health (SLOSH) study. ERI was assessed with a short version of the ERI questionnaire, and pain was defined as having had neck-shoulder pain that affected daily life during the past three months. Depressive symptoms were assessed with a continuous scale based on six-items of the (Hopkins) Symptom Checklist. Counterfactual mediation analyses were applied using exposure measures from 2010/2012 (T1), depressive symptoms from 2012/2014 (T2), and outcomes from 2014/2016 (T3), and including only those free of outcome at T1 and T2 (N=2876‒3239).

    Results ERI was associated with a higher risk of neck-shoulder pain [risk ratio (RR) for total effect 1.24, 95% confidence interval (CI) 1.02–1.50] and 40% of this total effect was mediated through depressive symptoms. Corresponding RR for association between neck-shoulder pain and ERI was 1.36 (95% CI 1.13–1.65), but the mediating role of depressive symptoms was less consistent.

    Conclusions Depressive symptoms appear to be an intermediate factor in the relationship between ERI and neck-shoulder pain.

  • 10. Halonen, Jaana I
    et al.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Ala-Mursula, Leena
    Miettunen, Jouko
    Vaaramo, Eeva
    Karppinen, Jaro
    Kouvonen, Anne
    Lallukka, Tea
    Socioeconomic and health-related childhood and adolescence predictors of entry into paid employment2019In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, no 3, p. 555-561Article in journal (Refereed)
    Abstract [en]

    Background

    Most studies on prolonging working careers have explored later career, while less is known about social and particularly health-related determinants of entry into labour market. We examined social and health-related factors from childhood and adolescence as predictors of age at entry into paid employment and early occupational class, and whether own education moderates these associations.

    Methods

    The Northern Finland Birth Cohort 1986 was followed from birth until the end of 2015. We included 8542 participants (52% male) who had had a minimum of 6-month employment that was defined by registered earning periods. As socioeconomic predictors, we examined low parental education at age 7 and low household income at age 16. Behaviour- and health-related factors at age 16 included smoking, alcohol use, physical inactivity, overweight, length of sleep and not having breakfast, while mental health problems included symptoms of anxiety and depression, attention problems and social problems. The analyses for significant predictors were further stratified by register-based level of completed own education by age 28–29 (low/high).

    Results

    After adjustments, low parental education, smoking and having been drunk were significant predictors of early entry into paid employment (≤18 vs. ≥24 years), especially among those who later obtained high education. Low parental education and smoking were predictors of low or non-specified (vs. high) occupational class in the first job. Mental health problems were not associated with either outcome.

    Conclusions

    Socioeconomic background and unhealthy lifestyle contribute to early entry into the labour market and low occupational status in the first job.

  • 11.
    Halonen, Jaana
    et al.
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Merikukka, Marko
    Natl Inst Hlth & Welf THL, Dept Welf, Oulu, Finland; Univ Oulu, PEDEGO Res Uni, Oulu, Finland.
    Gissler, Mika
    Natl Inst Hlth & Welf THL, Informat Serv Dept, Helsinki, Finland; Univ Turku, Res Ctr Child Psychiat, Turku, Finland; Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med, Stockholm, Sweden.
    Kerkelä, Martta
    Natl Inst Hlth & Welf THL, Dept Welf, Oulu, Finland.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Ristikari, Tiina
    Natl Inst Hlth & Welf THL, Dept Welf, Oulu, Finland.
    Hiilamo, Heikki
    Univ Helsinki, Social & Publ Policy, Dept Social Res, Helsinki, Finland.
    Lallukka, Tea
    Finnish Inst Occupat Hlth, Helsinki, Finland; Univ Helsinki, Dept Publ Hlth, Helsinki, Finland.
    Pathways from parental mental disorders to offspring's work disability due to depressive or anxiety disorders in early adulthood—The 1987 Finnish Birth Cohort2019In: Depression and anxiety (Print), ISSN 1091-4269, E-ISSN 1520-6394, Vol. 36, no 4, p. 305-312Article in journal (Refereed)
    Abstract [en]

    Background: Parental mental disorders have been shown to predict offspring's mental health problems. We examined whether pathways from parental mental disorders to offspring's psychiatric work disability in early adulthood are mediated through offspring's mental disorders and social disadvantage in adolescence.

    Methods: Study population consisted of the 1987 Finnish Birth Cohort. Data on parents’ psychiatric care or work disability due to mental diagnosis between 1987 and 2000 and the cohort participants’ health and social factors between 2001 and 2005 were derived from administrative national registers. From 2006 through 2015, 52,182 cohort participants were followed for admittance of psychiatric work disability due to depressive or anxiety disorders. First, we applied a pathway analysis to examine the occurrence of each path. We then used mediation analysis to assess the proportion of association between parental mental disorders and work disability mediated by offspring's health and social disadvantage.

    Results: The pathway model indicated that the association from parental mental disorders to offspring's work disability due to depressive or anxiety disorder is through mental disorders and social disadvantage in adolescence. Odds Ratio for the total effect of parental mental disorders on offspring's psychiatric work disability was 1.85 (95% confidence interval [CI] 1.46–2.34) in the model including offspring's mental disorders that mediated this association by 35%. Corresponding results were 1.86 (95% CI 1.47–2.35) and 28% for social disadvantage in adolescence.

    Conclusions: These findings suggest that intergenerational determination of work disability due to mental disorders could be addressed by actions supporting mental health and social circumstances in adolescence.

  • 12.
    Hanson, Linda L. Magnusson
    et al.
    Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden.
    Rod, Naja H.
    Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden;Univ Copenhagen, Dept Publ Hlth, Sect Epidemiol, Copenhagen, Denmark.
    Steptoe, Andrew
    UCL, Res Dept Behav Sci & Hlth, London, England.
    Head, Jenny
    UCL, Dept Epidemiol & Publ Hlth, London, England.
    Batty, G. D.
    UCL, Dept Epidemiol & Publ Hlth, London, England.
    Kivimäki, Mika
    UCL, Dept Epidemiol & Publ Hlth, London, England;Univ Helsinki, Fac Med, Clinicum, Helsinki, Finland.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, S-10691 Stockholm, Sweden.
    Does inflammation provide a link between psychosocial work characteristics and diabetes?: Analysis of the role of interleukin-6 and C-reactive protein in the Whitehall II cohort study2019In: Brain, behavior, and immunity, ISSN 0889-1591, E-ISSN 1090-2139, Vol. 78, p. 153-160Article in journal (Refereed)
    Abstract [en]

    Objective: Inflammation may underlie the association between psychological stress and cardiometabolic diseases, but this proposition has not been tested longitudinally. We investigated whether the circulating inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP) mediate the relationship between psychosocial work characteristics and diabetes.

    Methods: We used three phases of data at 5 years intervals from the Whitehall II cohort study, originally recruiting 10,308 civil service employees aged 35-55 years. The data included repeat self-reports of job demands, control and social support, IL-6 from plasma samples, CRP from serum samples, and diabetes, ascertained through oral glucose tolerance test, medications, and self-reports of doctor-diagnosed diabetes.

    Results: Structural equation models with age, sex and occupational position considering men and women combined, showed that low social support at work, but not high job demands or low job control, was prospectively associated with diabetes (standardized beta = 0.05, 95% confidence interval (CI) 0.01-0.09) and higher levels of IL-6 (beta = 0.03, CI 0.00-0.06). The inflammatory markers and diabetes were bidirectionally associated over time. A mediation model including workplace social support, IL-6 and diabetes further showed that 10% of the association between social support and diabetes over the three repeat examinations (total effect beta = 0.08, CI 0.01-0.15) was attributable to a weak indirect effect through IL-6 (beta = 0.01, CI 0.00-0.02). A similar indirect effect was observed for CRP in men only, while job control was prospectively associated with IL-6 among women.

    Conclusions: This study indicates an association between poor workplace support and diabetes that is partially ascribed to an inflammatory response.

  • 13. Harkko, Jaakko
    et al.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Finnish Inst Occupat Hlth, Helsinki, Finland.
    Kouvonen, Anne
    Unemployment and work disability due to common mental disorders among young adults: selection or causation?2018In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 28, no 5, p. 791-797Article in journal (Refereed)
  • 14. Juvani, Anne
    et al.
    Oksanen, Tuula
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Finnish Inst Occupat Hlth, Helsinki, Finland.
    Salo, Paula
    Pentti, Jaana
    Kivimäki, Mika
    Vahtera, Jussi
    Clustering of job strain, effort-reward imbalance, and organizational injustice and the risk of work disability: a cohort study2018In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 44, no 5, p. 485-495Article in journal (Refereed)
    Abstract [en]

    Objectives The aim of this study was to examine the association between co-occurring work stressors and risk of disability pension.

    Methods The work stressors job strain, effort−reward imbalance (ERI), and organizational injustice were measured by a survey in 2008 of 41 862 employees linked to national records of all-cause and cause-specific disability pensions until 2011. Co-occurring work stressors were examined as risk factors of work disability using Cox regression marginal models.

    Results Work stressors were clustered: 50.8% had no work stressors [observed-to-expected ratio (O/E)=1.2], 27.4% were exposed to one stressor (O/E=0.61–0.81), 17.7% to two stressors (O/E=0.91–1.73) and 6.4% to all three stressors (O/E=2.59). During a mean follow-up of 3.1 years, 976 disability pensions were granted. Compared to employees with no work stressors, those with (i) co-occurring strain and ERI or (ii) strain, ERI and injustice had a 1.9–2.1-fold [95% confidence interval (CI) 1.7–2.6] increased risk of disability retirement. The corresponding hazard ratios were 1.2 and 1.5 (95% CI 1.0–1.8) for strain and ERI alone. Risk of disability pension from depressive disorders was 4.4–4.7-fold (95% CI 2.4–8.0) for combinations of strain+ERI and strain+ERI+injustice, and 1.9–2.5-fold (95% CI 1.1–4.0) for strain and ERI alone. For musculoskeletal disorders, disability risk was 1.6–1.9-fold (95% CI 1.3–2.3) for strain+ERI and ERI+injustice combinations, and 1.3-fold (95% CI 1.0–1.7) for strain alone. Supplementary analyses with work stressors determined using work-unit aggregates supported these findings.

    Conclusions Work stressors tend to cluster in the same individuals. The highest risk of disability pension was observed among those with work stressor combinations strain+ERI or strain+ERI+injustice, rather than for those with single stressors.

  • 15.
    Kivimäki, Mika
    et al.
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England;Univ Helsinki, Clinicum, Fac Med, Helsinki, Finland;Univ Helsinki, Helsinki Inst Life Sci, Helsinki, Finland.
    Pentti, Jaana
    Univ Helsinki, Clinicum, Fac Med, Helsinki, Finland;Univ Helsinki, Helsinki Inst Life Sci, Helsinki, Finland;Univ Turku, Dept Publ Hlth, Turku, Finland.
    Ferrie, Jane E.
    Univ Bristol, Sch Social & Community Med, Bristol, Avon, England;UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Nyberg, Solja T.
    Univ Helsinki, Clinicum, Fac Med, Helsinki, Finland;Univ Helsinki, Helsinki Inst Life Sci, Helsinki, Finland.
    Jokela, Markus
    Univ Helsinki, Inst Behav Sci, Helsinki, Finland.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Alfredsson, Lars
    Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden;Karolinska Inst, Inst Environm Med, Stockholm, Sweden.
    Dragano, Nico
    Univ Dusseldorf, Med Fac, Inst Med Sociol, Dusseldorf, Germany.
    Fransson, Eleonor I.
    Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden;Jonkoping Univ, Sch Hlth & Welf, Jonkoping, Sweden;Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Goldberg, Marcel
    INSERM, Populat Based Epidemiol Cohorts Unit, UMS 011, Villejuif, France;Versailles St Quentin Univ, UMS 011, Villejuif, France.
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden.
    Koskenvuo, Markku
    Univ Helsinki, Dept Publ Hlth, Helsinki, Finland.
    Koskinen, Aki
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Kouvonen, Anne
    Univ Helsinki, Fac Social Sci, Helsinki, Finland;Queens Univ Belfast, Ctr Publ Hlth, Adm Data Res Ctr Northern Ireland, Belfast, Antrim, North Ireland;SWPS Univ Social Sci & Humanities Wroclaw, Div Hlth Psychol, Wroclaw, Poland.
    Luukkonen, Ritva
    Univ Helsinki, Clinicum, Fac Med, Helsinki, Finland;Univ Helsinki, Helsinki Inst Life Sci, Helsinki, Finland.
    Oksanen, Tuula
    Rugulies, Reiner
    Natl Res Ctr Working Environm, Copenhagen, Denmark;Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark;Univ Copenhagen, Dept Psychol, Copenhagen, Denmark.
    Siegrist, Johannes
    Univ Dusseldorf, Med Fac, Inst Med Sociol, Dusseldorf, Germany.
    Singh-Manoux, Archana
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England;Ctr Res Epidemiol & Populat Hlth, INSERM, UMR 1018, Villejuif, France.
    Suominen, Sakari
    Folkhalsan Res Ctr, Helsinki, Finland;Univ Skovde, Sch Hlth & Educ, Skovde, Sweden;Univ Kent, Sch Social Policy Sociol & Social Res, Canterbury, Kent, England;Univ Turku, Dept Publ Hlth, Turku, Finland.
    Theorell, Töres
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden;Finnish Inst Occupat Hlth, Helsinki, Finland.
    Väänänen, Ari
    Finnish Inst Occupat Hlth, Helsinki, Finland.
    Vahtera, Jussi
    Turku Univ Hosp, Turku, Finland;Univ Turku, Dept Publ Hlth, Turku, Finland.
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden.
    Zins, Marie
    INSERM, Populat Based Epidemiol Cohorts Unit, UMS 011, Villejuif, France;Versailles St Quentin Univ, UMS 011, Villejuif, France.
    Strandberg, Timo
    Helsinki Univ Hosp, Dept Internal Med, Helsinki, Finland;Univ Helsinki, Clinicum, Fac Med, Helsinki, Finland;Univ Helsinki, Helsinki Inst Life Sci, Helsinki, Finland;Univ Oulu, Ctr Life Course Hlth Res, Oulu, Finland.
    Steptoe, Andrew
    UCL, Dept Epidemiol & Publ Hlth, London WC1E 6BT, England.
    Deanfield, John
    UCL, Natl Ctr Cardiovasc Prevent & Outcomes, London, England.
    Work stress and risk of death in men and women with and without cardiometabolic disease: a multicohort study2018In: The Lancet Diabetes and Endocrinology, ISSN 2213-8587, E-ISSN 2213-8595, Vol. 6, no 9, p. 705-713Article in journal (Refereed)
    Abstract [en]

    Background: Although some cardiovascular disease prevention guidelines suggest a need to manage work stress in patients with established cardiometabolic disease, the evidence base for this recommendation is weak. We sought to clarify the status of stress as a risk factor in cardiometabolic disease by investigating the associations between work stress and mortality in men and women with and without pre-existing cardiometabolic disease.

    Methods: In this multicohort study, we used data from seven cohort studies in the IPD-Work consortium, initiated between 1985 and 2002 in Finland, France, Sweden, and the UK, to examine the association between work stress and mortality. Work stress was denoted as job strain or effort-reward imbalance at work. We extracted individual-level data on prevalent cardiometabolic diseases (coronary heart disease, stroke, or diabetes [without differentiation by diabetes type]) at baseline. Work stressors, socioeconomic status, and conventional and lifestyle risk factors (systolic and diastolic blood pressure, total cholesterol, smoking status, BMI, physical activity, and alcohol consumption) were also assessed at baseline. Mortality data, including date and cause of death, were obtained from national death registries. We used Cox proportional hazards regression to study the associations of work stressors with mortality in men and women with and without cardiometabolic disease.

    Results: We identified 102 633 individuals with 1 423 753 person-years at risk (mean follow-up 13.9 years [SD 3.9]), of whom 3441 had prevalent cardiometabolic disease at baseline and 3841 died during follow-up. In men with cardiometabolic disease, age-standardised mortality rates were substantially higher in people with job strain (149.8 per 10 000 person-years) than in those without (97.7 per 10 000 person-years; mortality difference 52.1 per 10 000 person-years; multivariable-adjusted hazard ratio [HR] 1.68, 95% CI 1.19-2.35). This mortality difference for job strain was almost as great as that for current smoking versus former smoking (78.1 per 10 000 person-years) and greater than those due to hypertension, high total cholesterol concentration, obesity, physical inactivity, and high alcohol consumption relative to the corresponding lower risk groups (mortality difference 5.9-44.0 per 10 000 person-years). Excess mortality associated with job strain was also noted in men with cardiometabolic disease who had achieved treatment targets, including groups with a healthy lifestyle (HR 2.01, 95% CI 1.18-3.43) and those with normal blood pressure and no dyslipidaemia (6.17, 1.74-21.9). In all women and in men without cardiometabolic disease, relative risk estimates for the work stress-mortality association were not significant, apart from effort-reward imbalance in men without cardiometabolic disease (mortality difference 6.6 per 10 000 person-years; multivariable-adjusted HR 1.22, 1.06-1.41).

    Interpretation: In men with cardiometabolic disease, the contribution of job strain to risk of death was clinically significant and independent of conventional risk factors and their treatment, and measured lifestyle factors. Standard care targeting conventional risk factors is therefore unlikely to mitigate the mortality risk associated with job strain in this population.

  • 16. Nyberg, Solja
    et al.
    Batty, David
    Pentti, Jaana
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Alfredsson, Lars
    Fransson, Eleonor
    Goldberg, Marcel
    Heikkilä, Katriina
    Jokela, Markus
    Knutsson, Andreas
    Koskenvuo, Markku
    Lallukka, Tea
    Leineweber, Constanze
    Lindbohm, Joni
    Madsen, Ida
    Magnusson Hanson, Linda
    Nordin, Maria
    Oksanen, Tuula
    Pietiläinen, Olli
    Rahkonen, Ossi
    Rugulies, Reiner
    Shipley, Martin
    Stenholm, Sari
    Suominen, Sakari
    Theorell, Töres
    Vahtera, Jussi
    Westerholm, Peter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Westerlund, Hugo
    Zins, Marie
    Hamer, Mark
    Singh-Manoux, Archana
    Bell, Joshua
    Ferrie, Jane
    Kivimäki, Mika
    Obesity and loss of disease-free years owing to major non-communicable diseases: a multicohort study2018In: Lancet Public Health, E-ISSN 2468-2667, Vol. 3, no 10, p. e490-e497Article in journal (Refereed)
    Abstract [en]

    Background

    Obesity increases the risk of several chronic diseases, but the extent to which the obesity-related loss of disease-free years varies by lifestyle category and across socioeconomic groups is unclear. We estimated the number of years free from major non-communicable diseases in adults who are overweight and obese, compared with those who are normal weight.

    Methods

    We pooled individual-level data on body-mass index (BMI) and non-communicable diseases from men and women with no initial evidence of these diseases in European cohort studies from the Individual-Participant-Data Meta-Analysis in Working Populations consortium. BMI was assessed at baseline (1991–2008) and non-communicable diseases (incident type 2 diabetes, coronary heart disease, stroke, cancer, asthma, and chronic obstructive pulmonary disease) were ascertained via linkage to records from national health registries, repeated medical examinations, or self-report. Disease-free years from age 40 years to 75 years associated with underweight (BMI <18·5 kg/m2), overweight (≥25 kg/m2 to <30 kg/m2), and obesity (class I [mild] ≥30 kg/m2 to <35 kg/m2; class II–III [severe] ≥35 kg/m2) compared with normal weight (≥18·5 kg/m2 to <25 kg/m2) were estimated.

    Findings

    Of 137 503 participants from ten studies, we excluded 6973 owing to missing data and 10 349 with prevalent disease at baseline, resulting in an analytic sample of 120 181 participants. Of 47 127 men, 211 (0·4%) were underweight, 21 468 (45·6%) normal weight, 20 738 (44·0%) overweight, 3982 (8·4%) class I obese, and 728 (1·5%) class II–III obese. The corresponding numbers among the 73 054 women were 1493 (2·0%), 44 760 (61·3%), 19 553 (26·8%), 5670 (7·8%), and 1578 (2·2%), respectively. During 1 328 873 person-years at risk (mean follow-up 11·5 years [range 6·3–18·6]), 8159 men and 8100 women developed at least one non-communicable disease. Between 40 years and 75 years, the estimated number of disease-free years was 29·3 (95% CI 28·8–29·8) in normal-weight men and 29·4 (28·7–30·0) in normal-weight women. Compared with normal weight, the loss of disease-free years in men was 1·8 (95% CI −1·3 to 4·9) for underweight, 1·1 (0·7 to 1·5) for overweight, 3·9 (2·9 to 4·9) for class I obese, and 8·5 (7·1 to 9·8) for class II–III obese. The corresponding estimates for women were 0·0 (−1·4 to 1·4) for underweight, 1·1 (0·6 to 1·5) for overweight, 2·7 (1·5 to 3·9) for class I obese, and 7·3 (6·1 to 8·6) for class II–III obese. The loss of disease-free years associated with class II–III obesity varied between 7·1 and 10·0 years in subgroups of participants of different socioeconomic level, physical activity level, and smoking habit.

    Interpretation

    Mild obesity was associated with the loss of one in ten, and severe obesity the loss of one in four potential disease-free years during middle and later adulthood. This increasing loss of disease-free years as obesity becomes more severe occurred in both sexes, among smokers and non-smokers, the physically active and inactive, and across the socioeconomic hierarchy.

  • 17.
    Pekurinen, Virve
    et al.
    Univ Turku, Dept Nursing Sci, Turku 20014, Finland.
    Välimäki, Maritta
    Univ Turku, Dept Nursing Sci, Turku 20014, Finland;Hong Kong Polytech Univ, Sch Nursing, Hong Kong, Peoples R China.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Kivimäki, Mika
    Univ Helsinki, Fac Med, Helsinki, Finland;Finnish Inst Occupat Hlth, Helsinki, Finland.
    Vahtera, Jussi
    Univ Turku, Dept Publ Hlth, Turku, Finland;Turku Univ Hosp, Turku, Finland.
    Work Stress and Satisfaction with Leadership Among Nurses Encountering Patient Aggression in Psychiatric Care: A Cross-Sectional Survey Study2019In: Administration and Policy in Mental Health, ISSN 0894-587X, E-ISSN 1573-3289, Vol. 46, no 3, p. 368-379Article in journal (Refereed)
    Abstract [en]

    We examined the associations between work stress (job strain, effort-reward imbalance), perceived job insecurity, workplace social capital, satisfaction with leadership and working hours in relation to the likelihood of encountering patient aggression (overall exposure, assaults on ward property, mental abuse, physical assaults). We conducted a cross-sectional survey for nurses (N = 923) in 84 psychiatric units. Both work stress indicators were associated higher odds for different types of patient aggression. Poorer satisfaction with leadership was associated with higher odds for overall exposure to patient aggression. These findings were robust to adjustment for several nurse and work characteristics, and unit size.

  • 18.
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Towards sustainable work and longer working lives2018In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 46, no 3, p. 287-289Article in journal (Other academic)
  • 19.
    Virtanen, Marianna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Ervasti, Jenni
    Head, Jenny
    Oksanen, Tuula
    Salo, Paula
    Pentti, Jaana
    Kouvonen, Anne
    Väänänen, Ari
    Suominen, Sakari
    Koskenvuo, Markku
    Vahtera, Jussi
    Elovainio, Marko
    Zins, Marie
    Goldberg, Marcel
    Kivimäki, Mika
    Lifestyle factors and risk of sickness absence from work: a multicohort study2018In: Lancet Public Health, ISSN 2468-2667, Vol. 3, no 11, p. e545-e554Article in journal (Refereed)
    Abstract [en]

    Background: Lifestyle factors influence the risk of morbidity and mortality, but the extent to which they are associated with employees' absence from work due to illness is unclear. We examined the relative contributions of smoking, alcohol consumption, high body-mass index, and low physical activity to diagnosis-specific sickness absence.

    Methods: We did a multicohort study with individual-level data of participants of four cohorts from the UK, France, and Finland. Participants' responses to a lifestyle survey were linked to records of sickness absence episodes, typically lasting longer than 9 days; for each diagnostic category, the outcome was the total number of sickness absence days per year. We estimated the associations between lifestyle factors and sickness absence by calculating rate ratios for the number of sickness absence days per year and combining cohort-specific estimates with meta-analysis. The criteria for assessing the evidence included the strength of association, consistency across cohorts, robustness to adjustments and multiple testing, and impact assessment by use of population attributable fractions (PAF), with both internal lifestyle factor prevalence estimates and those obtained from European populations (PAF external).

    Findings: For 74 296 participants, during 446 478 person-years at risk, the most common diagnoses for sickness absence were musculoskeletal diseases (70.9 days per 10 person-years), depressive disorders (26.5 days per 10 person-years), and external causes (such as injuries and poisonings; 12.8 days per 10 person-years). Being overweight (rate ratio [adjusted for age, sex, socioeconomic status, and chronic disease at baseline] 1.30, 95% CI 1.21-1.40; PAF external 8.9%) and low physical activity (1.23, 1.14-1.34; 7.8%) were associated with absences due to musculoskeletal diseases; heavy episodic drinking (1.90, 1.41-2.56; 15.2%), smoking (1.70, 1.42-2.03; 11.8%), low physical activity (1.67, 1.42-1.96; 19.8%), and obesity (1.38, 1.11-1.71; 5.6%) were associated with absences due to depressive disorders; heavy episodic drinking (1.64, 1.33-2.03; 11.3%), obesity (1.48, 1.27-1.72; 6.6%), smoking (1.35, 1.20-1.53; 6.3%), and being overweight (1.20, 1.08-1.33; 6.2%) were associated with absences due to external causes; obesity (1.82, 1.40-2.36; 11.0%) and smoking (1.60, 1.30-1.98; 10.3%) were associated with absences due to circulatory diseases; low physical activity (1.37, 1.25-1.49; 12.0%) and smoking (1.27, 1.16-1.40; 4.9%) were associated with absences due to respiratory diseases; and obesity (1.67, 1.34-2.07; 9.7%) was associated with absences due to digestive diseases.

    Interpretation: Lifestyle factors are associated with sickness absence due to several diseases, but observational data cannot determine the nature of these associations. Future studies should investigate the cost-effectiveness of lifestyle interventions aimed at reducing sickness absence and the use of information on lifestyle for identifying groups at risk.

  • 20.
    Virtanen, Marianna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Finnish Inst Occupat Hlth, Helsinki, Finland..
    Jokela, Markus
    Univ Helsinki, Inst Behav Sci, Helsinki, Finland..
    Madsen, Ida E. H.
    Natl Res Ctr Working Environm, Copenhagen, Denmark..
    Hanson, Linda L. Magnusson
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden..
    Lallukka, Tea
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Univ Helsinki, Dept Publ Hlth, Helsinki, Finland..
    Nyberg, Solja T.
    Univ Helsinki, Dept Publ Hlth, Helsinki, Finland..
    Alfredsson, Lars
    Karolinska Inst, Inst Environm Med, Stockholm, Sweden.;Stockholm Cty Council, Ctr Occupat & Environm Med, Stockholm, Sweden..
    Batty, G. David
    UCL, Dept Epidemiol & Publ Hlth, London, England..
    Bjorner, Jakob B.
    Natl Res Ctr Working Environm, Copenhagen, Denmark..
    Borritz, Marianne
    Koge Hosp, Dept Occupat Med, Koge, Denmark..
    Burr, Hermann
    Fed Inst Occupat Safety & Hlth BAuA, Berlin, Germany..
    Dragano, Nico
    Univ Dusseldorf, Med Fac, Inst Med Sociol, Dusseldorf, Germany..
    Erbel, Raimund
    Univ Duisburg Essen, Dept Cardiol, West German Heart Ctr Essen, Essen, Germany..
    Ferrie, Jane E.
    UCL, Dept Epidemiol & Publ Hlth, London, England.;Univ Bristol, Sch Social & Community Med, Bristol, Avon, England..
    Heikkila, Katriina
    London Sch Hyg & Trop Med, Dept Hlth Serv & Policy, London, England..
    Knutsson, Anders
    Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden..
    Koskenvuo, Markku
    Univ Helsinki, Dept Publ Hlth, Helsinki, Finland..
    Lahelma, Eero
    Univ Helsinki, Dept Publ Hlth, Helsinki, Finland..
    Nielsen, Martin L.
    Frederiksberg Univ Hosp, Unit Social Med, Copenhagen, Denmark..
    Oksanen, Tuula
    Finnish Inst Occupat Hlth, Helsinki, Finland..
    Pejtersen, Jan H.
    Danish Natl Ctr Social Res, Copenhagen, Denmark..
    Pentti, Jaana
    Univ Helsinki, Dept Publ Hlth, Helsinki, Finland..
    Rahkonen, Ossi
    Univ Helsinki, Dept Publ Hlth, Helsinki, Finland..
    Rugulies, Reiner
    Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark.;Univ Copenhagen, Dept Psychol, Copenhagen, Denmark..
    Salo, Paula
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Univ Turku, Dept Psychol, Turku, Finland..
    Schupp, Jurgen
    German Inst Econ Res, Berlin, Germany.;Free Univ Berlin, Berlin, Germany..
    Shipley, Martin J.
    UCL, Dept Epidemiol & Publ Hlth, London, England..
    Siegrist, Johannes
    Singh-Manoux, Archana
    UCL, Dept Epidemiol & Publ Hlth, London, England.;INSERM, Ctr Res Epidemiol & Populat Hlth, U1018, Villejuif, France..
    Suominen, Sakari B.
    Univ Turku, Dept Publ Hlth, Turku, Finland.;Univ Skovde, Skovde, Sweden.;Folkhalsan Res Ctr, Helsinki, Finland..
    Theorell, Tores
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden..
    Vahtera, Jussi
    Univ Turku, Dept Publ Hlth, Turku, Finland.;Turku Univ Hosp, Turku, Finland..
    Wagner, Gert G.
    German Inst Econ Res, Berlin, Germany.;Max Planck Inst Human Dev, Berlin, Germany.;Berlin Univ Technol, Berlin, Germany..
    Wang, Jian Li
    Univ Ottawa, Sch Epidemiol Publ Hlth & Prevent Med, Inst Mental Hlth Res, Ottawa, ON, Canada..
    Yiengprugsawan, Vasoontara
    Australian Natl Univ, Ctr Res Ageing Hlth & Wellbeing, Canberra, ACT, Australia.;Australian Natl Univ, ARC Ctr Excellence Populat Ageing Res, Canberra, ACT, Australia..
    Westerlund, Hugo
    Stockholm Univ, Stress Res Inst, Stockholm, Sweden..
    Kivimaki, Mika
    Finnish Inst Occupat Hlth, Helsinki, Finland.;Univ Helsinki, Dept Publ Hlth, Helsinki, Finland.;UCL, Dept Epidemiol & Publ Hlth, London, England..
    Long working hours and depressive symptoms: systematic review and meta-analysis of published studies and unpublished individual participant data2018In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 44, no 3, p. 239-250Article, review/survey (Refereed)
    Abstract [en]

    Objectives This systematic review and meta-analysis combined published study-level data and unpublished individual-participant data with the aim of quantifying the relation between long working hours and the onset of depressive symptoms. Methods We searched PubMed and Embase for published prospective cohort studies and included available cohorts with unpublished individual-participant data. We used a random-effects meta-analysis to calculate summary estimates across studies. Results We identified ten published cohort studies and included unpublished individual-participant data from 18 studies. In the majority of cohorts, long working hours was defined as working >= 55 hours per week. In multivariable-adjusted meta-analyses of 189 729 participants from 35 countries [96 275 men, 93 454 women, follow-up ranging from 1-5 years, 21 747 new-onset cases), there was an overall association of 1.14 (95% confidence interval (CI) 1.03-1.25] between long working hours and the onset of depressive symptoms, with significant evidence of heterogeneity (I-2 = 45.1%, P=0.004). A strong association between working hours and depressive symptoms was found in Asian countries (1.50, 95% CI 1.13-2.01), a weaker association in Europe (1.11, 95% CI 1.00-1.22), and no association in North America (0.97, 95% CI 0.70-1.34) or Australia (0.95, 95% CI 0.70-1.29). Differences by other characteristics were small. Conclusions This observational evidence suggests a moderate association between long working hours and onset of depressive symptoms in Asia and a small association in Europe.

  • 21.
    Virtanen, Marianna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Kivimäki, Mika
    Is an unhealthy lifestyle more harmful for poor people?2018In: Lancet Public Health, Vol. 3, no 12, p. E558-E559Article in journal (Other academic)
  • 22.
    Virtanen, Marianna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Kivimäki, Mika
    Long Working Hours and Risk of Cardiovascular Disease2018In: Current Cardiology Reports, ISSN 1523-3782, E-ISSN 1534-3170, Vol. 20, no 11, article id 123Article in journal (Refereed)
    Abstract [en]

    To summarize the evidence on the relationship between long working hours and cardiovascular disease, such as coronary heart disease and stroke. Large-scale meta-analyses with published and individual participant observational data on more than 740,000 men and women free of cardiovascular disease report a link between long working hours (>= 55 h a week) and the onset of cardiovascular events. Our meta-analytic update of summary evidence suggests a 1.12-fold (95% CI 1.03-1.21) increased risk associated with coronary heart disease and a 1.21-fold (95% CI 1.01-1.45) increased risk of stroke, although the evidence is somewhat inconsistent and the possibility of residual confounding and bias cannot be ruled out. Few studies have examined the mechanisms which may be stress-related, behavioral, or biological. The recent pooled analyses suggest that increased cardiac electric instability and hypercoagulability might play a role. The evidence that long working hours are a risk factor for cardiovascular disease is accumulating and suggests a small risk. Studies on the effects of long working hours in high-risk populations and those with pre-existing cardiovascular disease, mechanistic research, and intervention studies are needed to advance this research field.

  • 23.
    Virtanen, Marianna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health. Stress Research Institute, Stockholm University, Stockholm, Sweden .
    Magnusson Hanson, Linda
    Stress Research Institute, Stockholm University, Stockholm, Sweden .
    Goldberg, Marcel
    Population-Based Epidemiologic Cohorts Unit, Inserm UMS 011, Villejuif, France; Faculty of Medicine, Paris Descartes University, Paris, France .
    Zins, Marie
    Population-Based Epidemiologic Cohorts Unit, Inserm UMS 011, Villejuif, France; Faculty of Medicine, Paris Descartes University, Paris, France .
    Stenholm, Sari
    Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland .
    Vahtera, Jussi
    Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland .
    Westerlund, Hugo
    Stress Research Institute, Stockholm University, Stockholm, Sweden ; Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden .
    Kivimäki, Mika
    Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Epidemiology and Public Health, University College London, London, UK .
    Long working hours, anthropometry, lung function, blood pressure and blood-based biomarkers:: cross-sectional findings from the CONSTANCES study2019In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 73, no 2, p. 130-135Article in journal (Refereed)
    Abstract [en]

    Background Although long working hours have been shown to be associated with the onset of cardiometabolic diseases, the clinical risk factor profile associated with long working hours remains unclear. We compared the clinical risk profile between people who worked long hours and those who reported being never exposed to long hours.

    Methods A cross-sectional study in 22 health screening centres in France was based on a random population-based sample of 75 709 participants aged 18–69 at study inception in 2012–2016 (the CONSTANCES study). The data included survey responses on working hours (never, former or current exposure to long working hours), covariates and standardised biomedical examinations including anthropometry, lung function, blood pressure and standard blood-based biomarkers.

    Results Among men, long working hours were associated with higher anthropometric markers (Body Mass Index, waist circumference and waist:hip ratio), adverse lipid levels, higher glucose, creatinine, white blood cells and higher alanine transaminase (adjusted mean differences in the standardised scale between the exposed and unexposed 0.02–0.12). The largest differences were found for Body Mass Index and waist circumference. A dose–response pattern with increasing years of working long hours was found for anthropometric markers, total cholesterol, glucose and gamma-glutamyltransferase. Among women, long working hours were associated with Body Mass Index and white blood cells.

    Conclusion In this study, men who worked long hours had slightly worse cardiometabolic and inflammatory profile than those who did not work long hours, especially with regard to anthropometric markers. In women, the corresponding associations were weak or absent.

  • 24.
    Virtanen, Marianna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Vahtera, Jussi
    Department of Public Health, University of Turku, Turku University Hospital, Turku, Finland.
    Singh-Manoux, Archana
    French National Institute for Health & Medical Research, Inserm, U1018, Villejuif, France.
    Elovainio, Marko
    Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.
    Ferrie, Jane
    Department of Epidemiology and Public Health, University College London, London, UK.
    Kivimäki, Mika
    Department of Epidemiology and Public Health, University College London, London, UK.
    Unfavorable and favorable changes in modifiable risk factors and incidence of coronary heart disease: The Whitehall II cohort study2018In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 269, p. 7-12Article in journal (Refereed)
    Abstract [en]

    Background

    Few studies have examined long-term associations of unfavorable and favorable changes in vascular risk factors with incident coronary heart disease (CHD). We examined this issue in a middle-aged disease-free population.

    Methods

    We used repeat data from the Whitehall II cohort study. Five biomedical, behavioral and psychosocial examinations of 8335 participants without CHD produced up to 20,357 person-observations to mimic a non-randomized pseudo-trial. After measurement of potential change in 6 risk factors twice (total cholesterol, blood pressure, smoking, overweight, psychological distress, problems in social relationships), a 5-year follow-up of CHD was undertaken.

    Results

    Incidence of CHD was 7.4/1000 person-years. Increases from normal to high cholesterol (hazard ratio, HR = 1.59, 95% CI 1.26–2.00) and from normal to high blood pressure (HR = 1.64, 95% CI 1.33–2.03), as compared to remaining at the normal level, were associated with increased risk of CHD. In contrast, decreases from high to low levels of cholesterol (HR = 0.73, 95% CI 0.58–0.91), psychological distress (HR = 0.68, 95% CI 0.51–0.90), and problems in social relationships (HR = 0.65, 95% CI 0.50–0.85), and quitting smoking (HR = 0.49, 95% CI 0.29–0.82) were associated with a reduced CHD risk compared to remaining at high risk factor levels. The highest absolute risk was associated with persistent exposure to both high cholesterol and hypertension (incidence 18.1/1000 person-years) and smoking and overweight (incidence 17.7/1000 person-years).

    Conclusions

    While persistent exposures and changes in biological and behavioral risk factors relate to the greatest increases and reductions in 5-year risk of CHD, also favorable changes in psychosocial risk factors appear to reduce CHD risk.

  • 25. Xu, Tianwei
    et al.
    Magnusson Hanson, Linda
    Lange, Theis
    Starkopf, Liis
    Westerlund, Hugo
    Madsen, Ida
    Rugulies, Reiner
    Pentti, Jaana
    Stenholm, Sari
    Vahtera, Jussi
    Hansen, Åse M
    Virtanen, Marianna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Kivimäki, Mika
    Rod, Naja
    Workplace bullying and workplace violence as risk factors for cardiovascular disease: a multi-cohort study2019In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 40, no 14, p. 1124-1134Article in journal (Refereed)
    Abstract [en]

    Aims:

    To assess the associations between bullying and violence at work and cardiovascular disease (CVD).

    Methods and results:

    Participants were 79 201 working men and women, aged 18–65 years and free of CVD and were sourced from three cohort studies from Sweden and Denmark. Exposure to workplace bullying and violence was measured at baseline using self-reports. Participants were linked to nationwide health and death registers to ascertain incident CVD, including coronary heart disease and cerebrovascular disease. Study-specific results were estimated by marginal structural Cox regression and were combined using fixed-effect meta-analysis. Nine percent reported being bullied at work and 13% recorded exposure to workplace violence during the past year. We recorded 3229 incident CVD cases with a mean follow-up of 12.4 years (765 in the first 4 years). After adjustment for age, sex, country of birth, marital status, and educational level, being bullied at work vs. not was associated with a hazard ratio (HR) of 1.59 [95% confidence interval (CI) 1.28–1.98] for CVD. Experiencing workplace violence vs. not was associated with a HR of 1.25 (95% CI 1.12–1.40) for CVD. The population attributable risk was 5.0% for workplace bullying and 3.1% for workplace violence. The excess risk remained similar in analyses with different follow-up lengths, cardiovascular risk stratifications, and after additional adjustments. Dose–response relations were observed for both workplace bullying and violence (Ptrend < 0.001). There was only negligible heterogeneity in study-specific estimates.

    Conclusion:

    Bullying and violence are common at workplaces and those exposed to these stressors are at higher risk of CVD.

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