I have nine years of teaching experience in Statistics at the Master's and Post-Graduate Diploma level.

I address empirical causal questions of work-stressors (e.g. psychological work demand-control, effort- reward imbalance) on health (e.g. depression), and application of advanced statistical techniques to clustered and longitudinal data (such as, multilevel modeling, GEE, structural equation modeling, marginal structural, mediation, moderation etc.). At present I am working on the estimation of working life expectancy in relation to psychosocial work stressors and health using data from some European countries. Another area of interest is in modeling of missing data for longitudinal design.

I urval från Stockholms universitets publikationsdatabas

• Estimating Working Life Expectancy: A Comparison of Multistate Models

  2023. Holendro Singh Chungkham (et al.). SAGE Open 13 (2)

  Artikel

  Increases in retirement ages make it particularly pressing to better understand how long people will work. Working life expectancy (WLE) is a useful measure for this and the current paper assesses the tools, that is, software packages, available to assess it. We do this using data from the English Longitudinal Survey on Ageing (ELSA, 2003-2018) and multistate models to estimate WLE stratified by sex and socioeconomic status. Men's versus women's WLEs were slightly higher at all ages. Estimates were similar in ELECT and SPACE by both sex and socioeconomic status. WLEs were comparatively higher from IMaCh, ranging from approximately 0.28 to 1.49 years. Life expectancy estimates from IMaCh were also higher compared to SPACE and ELECT. Using multistate models to estimate WLE provides a useful indication of the actual expected length of working life. More research is needed to better understand why estimates from IMaCh differed from ELECT and SPACE.

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• A structured additive modeling of diabetes and hypertension in Northeast India

  2022. Strong P. Marbaniang, Holendro Singh Chungkham, Hemkhothang Lhungdim. PLOS ONE 17 (1)

  Artikel

  Background

  Multiple factors are associated with the risk of diabetes and hypertension. In India, they vary widely even from one district to another. Therefore, strategies for controlling diabetes and hypertension should appropriately address local risk factors and take into account the specific causes of the prevalence of diabetes and hypertension at sub-population levels and in specific settings. This paper examines the demographic and socioeconomic risk factors as well as the spatial disparity of diabetes and hypertension among adults aged 15–49 years in Northeast India.

  Methods

  The study used data from the Indian Demographic Health Survey, which was conducted across the country between 2015 and 2016. All men and women between the ages of 15 and 49 years were tested for diabetes and hypertension as part of the survey. A Bayesian geo-additive model was used to determine the risk factors of diabetes and hypertension.

  Results

  The prevalence rates of diabetes and hypertension in Northeast India were, respectively, 6.38% and 16.21%. The prevalence was higher among males, urban residents, and those who were widowed/divorced/separated. The functional relationship between household wealth index and diabetes and hypertension was found to be an inverted U-shape. As the household wealth status increased, its effect on diabetes also increased. However, interestingly, the inverse was observed in the case of hypertension, that is, as the household wealth status increased, its effect on hypertension decreased. The unstructured spatial variation in diabetes was mainly due to the unobserved risk factors present within a district that were not related to the nearby districts, while for hypertension, the structured spatial variation was due to the unobserved factors that were related to the nearby districts.

  Conclusion

  Diabetes and hypertension control measures should consider both local and non-local factors that contribute to the spatial heterogeneity. More importance should be given to efforts aimed at evaluating district-specific factors in the prevalence of diabetes within a region.

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• Socioeconomic Status and Working Life Expectancy in Sweden

  2022. Holendro Singh Chungkham, Robin S. Högnäs, Hugo Westerlund. 33rd REVES – Advances in International Research on Health and Life Expectancy in the Covid-19 era, 6-6

  Konferens

  Longer life expectancy and fertility decline have increased concerns about the security of old-age pensions. Raising retirement ages is one strategy to offset rising costs, though the option to retire varies considerably by socioeconomic status (SES) and sex. In terms of SES, the level of variation may depend on the measure used. Also, many workers now transition into retirement slowly, e.g., move from full- to part-time work. Thus, retirement age may not sufficiently capture how long people work. Working life expectancy (WLE)—the expected average number of years worked—better measures total working life. We use data from the Swedish Longitudinal Occupational Survey of Health (SLOSH) from 2008 to 2020 (n=4,940 people age 50+ and n=74,093 person-observations) to examine WLE by education and occupation. We estimate a three-state multistate model (i.e., working, not working, dead) and a four-state model (working part-time, working full-time, not working, and dead); both assume a continuous-time first-order Markov process. We estimate two sex-stratified models, cross-classified by: 1) occupation; and 2) education. We find that professionals work full-time 1 year more than routine workers, regardless of sex. The low educated work full-time 1 year less than the highly educated. In our weighted three-state model, where part-time work contributed ½ of full-time work, the difference increased to 1.14 and 1.05 years, respectively. Our unweighted three-state model showed slightly larger education differences. Findings suggest that WLE differs by SES, regardless of sex, and the differences are greater by education than occupation. This has implications for extending working life policies.

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• Childhood Anemia in India

  2021. Holendro Singh Chungkham, Strong P. Marbaniang, Pralip Kumar Narzary. BMC Pediatrics 21 (1)

  Artikel

  Background The geographical differences that cause anaemia can be partially explained by the variability in environmental factors, particularly nutrition and infections. The studies failed to explain the non-linear effect of the continuous covariates on childhood anaemia. The present paper aims to investigate the risk factors of childhood anaemia in India with focus on geographical spatial effect.

  Methods Geo-additive logistic regression models were fitted to the data to understand fixed as well as spatial effects of childhood anaemia. Logistic regression was fitted for the categorical variable with outcomes (anaemia (Hb < 11) and no anaemia (Hb >= 11)). Continuous covariates were modelled by the penalized spline and spatial effects were smoothed by the two-dimensional spline.

  Results At 95% posterior credible interval, the influence of unobserved factors on childhood anaemia is very strong in the Northern and Central part of India. However, most of the states in North Eastern part of India showed negative spatial effects. A U-shape non-linear relationship was observed between childhood anaemia and mother's age. This indicates that mothers of young and old ages are more likely to have anaemic children; in particular mothers aged 15 years to about 25 years. Then the risk of childhood anaemia starts declining after the age of 25 years and it continues till the age of around 37 years, thereafter again starts increasing. Further, the non-linear effects of duration of breastfeeding on childhood anaemia show that the risk of childhood anaemia decreases till 29 months thereafter increases.

  Conclusion Strong evidence of residual spatial effect to childhood anaemia in India is observed. Government child health programme should gear up in treating childhood anaemia by focusing on known measurable factors such as mother's education, mother's anaemia status, family wealth status, child health (fever), stunting, underweight, and wasting which have been found to be significant in this study. Attention should also be given to effects of unknown or unmeasured factors to childhood anaemia at the community level. Special attention to unmeasurable factors should be focused in the states of central and northern India which have shown significant positive spatial effects.

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• Job strain and loss of healthy life years between ages 50 and 75 by sex and occupational position

  2018. Linda L. Magnusson Hanson (et al.). Occupational and Environmental Medicine 75 (7), 486-493

  Artikel

  Objectives Poor psychosocial working conditions increase the likelihood of various types of morbidity and may substantially limit quality of life and possibilities to remain in paid work. To date, however, no studies to our knowledge have quantified the extent to which poor psychosocial working conditions reduce healthy or chronic disease-free life expectancy, which was the focus of this study.

  Methods Data were derived from four cohorts with repeat data: the Finnish Public Sector Study (Finland), GAZEL (France), the Swedish Longitudinal Occupational Survey of Health (Sweden) and Whitehall II (UK). Healthy (in good self-rated health) life expectancy (HLE) and chronic disease-free (free from cardiovascular disease, cancer, respiratory disease and diabetes) life expectancy (CDFLE) was calculated from age 50 to 75 based on 64394 individuals with data on job strain (high demands in combination with low control) at baseline and health at baseline and follow-up.

  Results Multistate life table models showed that job strain was consistently related to shorter HLE (overall 1.7 years difference). The difference in HLE was more pronounced among men (2.0 years compared with 1.5 years for women) and participants in lower occupational positions (2.5 years among low-grade men compared with 1.7 years among high-grade men). Similar differences in HLE, although smaller, were observed among those in intermediate or high occupational positions. Job strain was additionally associated with shorter CDFLE, although this association was weaker and somewhat inconsistent.

  Conclusions These findings suggest that individuals with job strain have a shorter health expectancy compared with those without job strain.

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• Physical occupational exposures and health expectancies in a French occupational cohort

  2017. Loretta G. Platts (et al.). Occupational and Environmental Medicine 74 (3), 176-183

  Artikel

  Objectives To examine the relationships of strenuous and hazardous working conditions and rotating shifts that involve night working with life expectancy in good perceived health and life expectancy without chronic disease.

  Methods The sample contained male gas and electricity workers from the French GAZEL cohort (n=13 393). Six measures of physical working conditions were examined: Self-reports from 1989 and 1990 of ergonomic strain, physical danger, rotating shifts that involve night working and perceived physical strain; company records of workplace injuries and a job-exposure matrix of chemical exposures. Partial healthy life expectancies (age 50-75) relating to (1) self-rated health and (2) chronic health conditions, obtained from annual questionnaires (1989-2014) and company records, were estimated using multistate life tables. The analyses were adjusted for social class and occupational grade.

  Results Participants with physically strenuous jobs and who had experienced industrial injuries had shorter partial life expectancy. More physically demanding and dangerous work was associated with fewer years of life spent in good self-rated health and without chronic conditions, with the exception of shift work including nights, where the gradient was reversed.

  Conclusions Strenuous and hazardous work may contribute to lost years of good health in later life, which has implications for individuals' quality of life as well as healthcare use and labour market participation.

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• Psychosocial work characteristics, sleep disturbances and risk of subsequent depressive symptoms

  2017. Linda L. Magnusson Hanson (et al.). Journal of Sleep Research 26 (3), 266-276

  Artikel

  Job strain and low social support at work are recognized risk factors for depression. However, people with poor sleep may represent a high-risk group more likely to benefit from interventions against work stress. The present study examined whether the associations between these work stressors and depressive symptoms differed by strata of sleep disturbances (effect modification/effect moderation) considering repeat measures of work characteristics and sleep. The study was based on five biennial measurements of the Swedish Longitudinal Occupational Survey of Health, including 1537 respondents recurrently in paid work, from an originally representative sample of the Swedish working population. High work demands, low decision authority and low social support were measured waves 2 and 4, sleep disturbances (putative moderator/modifier) waves 1 and 3, and depressive symptoms (outcome) wave 5. Causal effect modification, whether the effect of working conditions differed by strata of sleep disturbances, was analysed by structural nested mean modelling estimated using a regression-with-residuals with inverse-probability-of-treatment weighting approach. High demands and low social support, but not low decision authority, influenced subsequent depressive symptoms. The relationship between social support and depressive symptoms was not apparently modified by sleep disturbances. However, disturbed sleep wave 3 modified the effect of high demands wave 4 (coefficient 1.77, P<0.05) on depressive symptoms wave 5. The results indicate that high job demands is a stronger risk factor for depressive symptoms in people with pre-existing sleep disturbances, suggesting that targeted workplace interventions may be more effective when it comes to preventing negative effects of job demands.

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• Longitudinal Mediation Modeling of Unhealthy Behaviors as Mediators between Workplace Demands/Support and Depressive Symptoms

  2016. Linda L. Magnusson Hanson (et al.). PLOS ONE 11 (12)

  Artikel

  Lifestyle has been regarded as a key pathway through which adverse psychosocial working characteristics can give rise to long-term health problems. The purpose of this study was to estimate the indirect/mediated effect of health behaviors in the longitudinal work characteristics-depression relationship. The analyses were based on the Swedish Longitudinal Occupational Survey of Health, including 3706 working participants with repeat survey measures on four occasions (2008, 2010, 2012 and 2014). Psychosocial work characteristics including demands and social support were analyzed in relation to depressive symptoms. Autoregressive longitudinal mediation models using structural equation modeling were used to estimate the intermediate effects of unhealthy behaviors including current smoking, excessive alcohol consumption, unhealthy diet and physical inactivity. Both workplace demands and social support were related to later depressive symptoms. In bivariate models we found no significant paths from workplace demands to health behaviors, but two out of three significant time-specific paths from workplace support to excessive drinking and from excessive drinking to depressive symptoms. Social support was also associated with subsequent unhealthy diet, and one path from unhealthy diet to depressive symptoms was found. However, despite indications of certain longitudinal relationships between psychosocial working conditions and health behaviors as well as between health behaviors and depressive symptoms, no significant intermediate effects were found (p>0.05). We conclude that changes in unhealthy behaviors over a period of two years are unlikely to act as strong intermediaries in the longitudinal relationship between job demands and depressive symptoms and between social support and depressive symptoms.

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• Loss of healthy life years between ages 50-75 years attributed to job strain

  2016. Linda L. Magnusson Hanson (et al.). International Journal of Behavioral Medicine 23, S64-S64

  Artikel

  Introduction: Poor working conditions potentially limit quality of life and the possibilities for individuals to remain in paid employment because of poor health. However, no studies so far have investigated how psychosocial working conditions might impact on how long older workers can expect to stay healthy. This study examines whether job strain in older workers is associated with healthy life expectancy (HLE).

  Methods: We used repeated measures data for 64,533 individuals from four cohort studies: Whitehall II (UK), Finnish Public Sector Study (Finland), GAZEL (France), and Swedish Longitudinal Occupational Survey of Health (Sweden). Job strain at baseline and two different measures of HLE were computed based on self-rated health and chronic health conditions. Multistate life table models were used to estimate partial life expectancy (LE) and HLE from ages 50 to 75 by job strain, cohort, occupational position and sex.

  Results: Job strain was consistently related to shorter HLE, but not total LE. Particularly men in lower occupational positions with job strain had shorter HLE. The HLE in good self-rated health was 2–3 years shorter in this group. The corresponding HLE based on chronic disease was almost 2 years shorter although the relation was less pronounced for GAZEL. Women with job strain in lower occupational positions also lived 1–2 fewer years in good health.

  Conclusions: The results indicate that job strain affects how long people remain healthy, and that interventions to prevent high job strain in older workers might enable people to work for longer in good health.

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• Nurses’ practice environment and satisfaction with schedule flexibility is related to intention to leave due to dissatisfaction

  2016. Constanze Leineweber (et al.). International Journal of Nursing Studies 58, 47-58

  Artikel

  Background

  Nursing turnover is a major issue for health care managers, notably during the global nursing workforce shortage. Despite the often hierarchical structure of the data used in nursing studies, few studies have investigated the impact of the work environment on intention to leave using multilevel techniques. Also, differences between intentions to leave the current workplace or to leave the profession entirely have rarely been studied.

  Objective

  The aim of the current study was to investigate how aspects of the nurse practice environment and satisfaction with work schedule flexibility measured at different organisational levels influenced the intention to leave the profession or the workplace due to dissatisfaction.

  Design

  Multilevel models were fitted using survey data from the RN4CAST project, which has a multi-country, multilevel, cross-sectional design. The data analysed here are based on a sample of 23,076 registered nurses from 2020 units in 384 hospitals in 10 European countries (overall response rate: 59.4%). Four levels were available for analyses: country, hospital, unit, and individual registered nurse. Practice environment and satisfaction with schedule flexibility were aggregated and studied at the unit level. Gender, experience as registered nurse, full vs. part-time work, as well as individual deviance from unit mean in practice environment and satisfaction with work schedule flexibility, were included at the individual level. Both intention to leave the profession and the hospital due to dissatisfaction were studied.

  Results

  Regarding intention to leave current workplace, there is variability at both country (6.9%) and unit (6.9%) level. However, for intention to leave the profession we found less variability at the country (4.6%) and unit level (3.9%). Intention to leave the workplace was strongly related to unit level variables. Additionally, individual characteristics and deviance from unit mean regarding practice environment and satisfaction with schedule flexibility were related to both outcomes. Major limitations of the study are its cross-sectional design and the fact that only turnover intention due to dissatisfaction was studied.

  Conclusions

  We conclude that measures aiming to improve the practice environment and schedule flexibility would be a promising approach towards increased retention of registered nurses in both their current workplaces and the nursing profession as a whole and thus a way to counteract the nursing shortage across European countries.

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• Purchases of prescription antidepressants in the Swedish population in relation to major workplace downsizing

  2016. Linda L. Magnusson Hanson (et al.). Epidemiology 27 (2), 257-264

  Artikel

  Organizational downsizing may be a risk factor for morbidity among both the displaced and those who remain in work. However, the knowledge is limited regarding its impact on clinically relevant mental health problems. Our objective was to investigate purchases of prescription antidepressants across 5 years in relation to workplace downsizing. We studied all Swedish residents 2004 throughout 2010, 22–54 years old in 2006, gainfully employed, and with a stable labor market position up to 2006. People primarily employed at a workplace with ≥18% staff reduction were considered exposed to major downsizing (in 2006–2007, 2007–2008, or 2008–2009). We applied repeated measures regression analyses through generalized estimating equations, calculating odds of any purchase of prescription antidepressants (inferred from the prescribed drug register) within five 12-month periods from 2 years before to 2 years after the period of major downsizing and compared the trends for newly exposed (n = 632,500) and unexposed (n = 1,021,759) to major downsizing. The odds of purchasing prescription antidepressants for exposed increased more than for nonexposed, mainly peridownsizing (1 year before to 1 year after), and postdownsizing (1 year after to 2 years after) for survivors (odds ratio 1.24 vs. 1.14 peridownsizing and 1.12 vs. 1.00 postdownsizing) and those changing workplace (odds ratio 1.22 vs. 1.14 peridownsizing and 1.10 vs. 1.00 postdownsizing) with no previous sickness absence or disability pension (≥7% more than unexposed peri- and postdownsizing). This large-scale study indicates that downsizing is associated with a slight increase in the odds of purchasing prescription antidepressants among people without previous sickness absence or disability pension.

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• The impact of involuntary exit from employment in later life on the risk of major depression and being prescribed anti-depressant medication

  2015. Martin Hyde (et al.). Aging & Mental Health 19 (5), 381-389

  Artikel

  Objectives: Involuntary employment exit in later life has been shown to be a risk factor for poor physical and mental health. This study aims to examine the relationship between involuntary employment exit in later life and subsequent risk of reporting major depression or being prescribed anti-depressant medication (ADM). Method: Data were drawn from four waves of the Swedish Longitudinal Occupational Survey of Health (SLOSH). This is a nationally representative longitudinal cohort survey of persons employed in Sweden in 2003 and 2005. The sample was restricted to respondents who had exited the labour market aged 50+ years between 2006 and 2012 (N = 1433). Major depression was measured using the Symptom Checklist Core Depression Scale (SCL-CD6). Prescription ADM redeemed from a pharmacy was based on the National Prescribed Drug Register. Results: After controlling for socio-demographic variables, health, health behaviours, and baseline depression, involuntary employment exit was associated with an increased risk of reporting major depression (OR 3.16; CI 1.32-7.61) and becoming newly prescribed ADM (HR 2.08; CI 1.03-4.21) compared to voluntary employment exit. Conclusion: Involuntary employment exit represents a risk for subsequent depression in later life. Mental health and social services ought to consider identifying these individuals for possible intervention programs to reduce the burden of depression in later life.

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• Threats of dismissal and symptoms of major depression

  2015. Linda. L. Magnusson Hanson (et al.). Journal of Epidemiology and Community Health 69 (10), 963-969

  Artikel

  Background Job insecurity is considered a profound work stressor. While previous research has indicated that job insecurity represents a substantial mental health burden, few studies have examined its relationship with symptoms of major depression. The aim of this study was to assess whether episodic and repeated self-reported threats of dismissal increase the risk of subsequent symptoms of major depression and whether symptoms of major depression are related to subsequent experience of threats of dismissal. Methods The study is based on the Swedish Longitudinal Occupational Survey of Health (SLOSH) study, a cohort study with multiple repeated measurements. The sample consisted of 6275 participants who were in regular paid employment and who provided data in 2008, 2010 and 2012. Severity of depression was assessed with a brief Symptom Checklist scale and categorised according to symptoms of major depression or not. Results Results based on generalised estimating equations logit models showed that prior threats of dismissal predicted symptoms of major depression OR 1.37; 95% CI 1.04 to 1.81) after adjustment for prior depression and major confounders. Especially related threats increased the risk of major depression symptoms (OR 1.74 CI 1.09 to 2.78). Major depression symptoms also increased the odds of subsequent threats of dismissal (OR 1.52, CI 1.17 to 1.98). Conclusions These findings support a prospective association between threats of dismissal and symptoms of major depression, in particular repeated exposure to threats of dismissal. The results also indicate that threats of dismissal are more likely to be reported by workers with symptoms of major depression.

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• Hospital organizational factors influence work-family conflict in registered nurses

  2014. Constanze Leineweber (et al.). International Journal of Nursing Studies 51 (5), 744-751

  Artikel

  Background: The present shortage of registered nurses (RNs) in many European countries is expected to continue and worsen, which poses a substantial threat to the maintenance of healthcare in this region. Work-family conflict is a known risk factor for turnover and sickness absence. Objective: This paper empirically examines whether the nurse practice environment is associated with experienced work-family conflict. Design: A multilevel model was fit with the individual RN at the 1st, and the hospital department at the 2nd level using cross-sectional RN survey data from the Swedish part of RN4CAST, an EU 7th framework project. The data analyzed here is based on a national sample of 8356 female and 592 male RNs from 369 hospital departments. Results: We found that 6% of the variability in work-family conflict experienced by RNs was at the department level. Organizational level factors significantly accounted for most of the variability at this level with two of the work practice environment factors examined, staffing adequacy and nurse involvement in hospital affairs, significantly related to work-family conflict. Due to the design of the study, factors on ward and work group levels could not be analyzed, but are likely to account for additional variance which in the present analysis appears to be on the individual level, with private life factors likely explaining another major part. Conclusion: These results suggest that higher level organizational factors in health care have a significant impact on the risk of work-family conflict among RNs through their impact on the nurse practice environment. Lower level organizational factors should be investigated in future studies using hierarchical multilevel sampling.

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• Nurses' Practice Environment and Work-Family Conflict in Relation to Burn Out

  2014. Constanze Leineweber (et al.). PLOS ONE 9 (5), e96991

  Artikel

  Objectives: To investigate associations between nurse work practice environment measured at department level and individual level work-family conflict on burnout, measured as emotional exhaustion, depersonalization and personal accomplishment among Swedish RNs. Methods: A multilevel model was fit with the individual RN at the 1st, and the hospital department at the 2nd level using cross-sectional RN survey data from the Swedish part of RN4CAST, an EU 7th framework project. The data analysed here is based on a national sample of 8,620 RNs from 369 departments in 53 hospitals. Results: Generally, RNs reported high values of personal accomplishment and lower values of emotional exhaustion and depersonalization. High work-family conflict increased the risk for emotional exhaustion, but for neither depersonalization nor personal accomplishment. On department level adequate staffing and good leadership and support for nurses reduced the risk for emotional exhaustion and depersonalization. Personal accomplishment was statistically significantly related to staff adequacy. Conclusions: The findings suggest that adequate staffing, good leadership, and support for nurses are crucial for RNs' mental health. Our findings also highlight the importance of hospital managers developing policies and practices to facilitate the successful combination of work with private life for employees.

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• Office design's impact on sick leave rates

  2014. Christina Bodin Danielsson (et al.). Ergonomics 57 (2), 139-147

  Artikel

  The effect of office type on sickness absence among office employees was studied prospectively in 1852 employees working in (1) cell-offices; (2) shared-room offices; (3) small, (4) medium-sized and (5) large open-plan offices; (6) flex-offices and (7) combi-offices. Sick leaves were self-reported two years later as number of (a) short and (b) long (medically certified) sick leave spells as well as (c) total number of sick leave days. Multivariate logistic regression analysis was used, with adjustment for background factors. A significant excess risk for sickness absence was found only in terms of short sick leave spells in the three open-plan offices. In the gender separate analysis, this remained for women, whereas men had a significantly increased risk in flex-offices. For long sick leave spells, a significantly higher risk was found among women in large open-plan offices and for total number of sick days among men in flex-offices. Practitioner Summary: A prospective study of the office environment's effect on employees is motivated by the high rates of sick leaves in the workforce. The results indicate differences between office types, depending on the number of people sharing workspace and the opportunity to exert personal control as influenced by the features that define the office types.

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• Quality of Life amongst Older Brazilians

  2014. Fabia M. Lima (et al.). PLOS ONE 9 (4), e94289

  Artikel

  Introduction: As population ageing becomes a global phenomenon the need to understand the quality of life of older people around the world has become increasingly salient. The CASP-19 is a well established measure of quality of later life. The scale is composed of 19 items which map onto the four domains of control (C), Autonomy (A), Self-Realisation (S) and Pleasure (P). It has already been translated to 12 languages and has been used in a number of national and international studies. However use of the scale outside of Europe has been very limited. The objective of this study was to translate and evaluate the use of the CASP-19 amongst older Brazilians. Methods: The CASP-19 was translated from English to Portuguese, back-translated and submitted to an analysis of equivalence by a committee of judges. The scale was then administered to a sample of community dwelling older people in Recife, Brazil (n = 87), and tested for psychometric properties. The Control and Pleasure domains exhibited good internal consistency. By removing one item from each of the Autonomy and Self Realisation domains their internal consistency was improved. Results: The mean age of the sample was 75.6 +/- 0.7 years, subjects were mainly female (52.9%), white (52.9%), who lived without a partner (54%), and had a monthly income varying from USD 340.00 to USD 850.00. Translation and cross-cultural adaptation permitted good understanding and applicability of final version. Psychometric analyses revealed that the removal of two items improved the internal consistency of the Autonomy and Pleasure domains. Confirmatory factor analyses suggest that a 16 item, four factor, model best fits the data. Conclusion: In this small exploratory study the CASP-19 Brazil demonstrated good psychometric properties. It was easy to use for both participants and researchers. Hopefully future studies in Brazil will employ the scale so that more direct cross national comparisons can be made with older people in Europe and the US.

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• Religion, spirituality, social support and quality of life

  2014. Kidist Hamren, Holendro Singh Chungkham, Martin Hyde. Aging & Mental Health 19 (7), 610-621

  Artikel

  Objectives: As African populations begin to age developing accurate measures of quality of life (QoL) in later life for use on the continent is becoming imperative. This study evaluates the measurement and predictors of QoL amongst older Ethiopians. Method: The data come from a multi-stage cluster sample of 214 people aged 55 and over living in Addis Ababa, Ethiopia. QoL was measured using the CASP-12(v2). Confirmatory factor analysis (CFA) was used to test the properties of the scale. The relationships between social support, religiosity/spirituality and socio-demographic factors on QoL were tested with linear regression analyses. Results: The CASP subscales exhibited good internal reliability and the CFA provides reasonable support for an 11-item 4-factor model (CFI, 0.954; RMSEA 0.075). Multivariate regression analyses suggest that both religiousness/spirituality and social support have positive relationships with QoL. Conclusion: Older people in Africa can often be socially isolated, marginalised and in extreme poverty. Yet few studies have looked at QoL more generally and there is no accepted gold standard measurement of QoL. Yet such a development would allow researchers to directly compare QoL and the determinants of QoL amongst older Africans and those elsewhere. The results show that a modified 11-item CASP is a meaningful measure of QoL for use with older Ethiopians. Both religiousness/spirituality and social support are positively associated with QoL and might be important buffers against deprivation.

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• The Role of Sleep Disturbances in the Longitudinal Relationship Between Psychosocial Working Conditions, Measured by Work Demands and Support, and Depression.

  2014. Linda Magnusson Hanson (et al.). Sleep 37 (12), 1977-1985

  Artikel

  Study Objectives: Because work demands and lack of social support seem to be prospectively linked to sleep problems, and sleep problems are linked to depression, sleep problems may play a role in the relationship between these work characteristics and depressive symptoms. In order to shed more light on this relationship, the current study investigated whether disturbed sleep is a mediator in the longitudinal relationships between work demands, social support, and depression.

  Design: Longitudinal cohort study with repeated survey measures on four occasions.

  Setting: Swedish workforce.

  Participants: 2,017 working participants from the Swedish Longitudinal Occupational Survey of Health in 2006, 2008, 2010, and 2012.

  Measurements and results: Work demands (four items) and social support (six items) were assessed with the Demand Control Questionnaire, disturbed sleep (four items) with the Karolinska Sleep Questionnaire, and depressive symptoms with a brief subscale (six items) from the Symptom Checklist. Autoregressive longitudinal mediation models using structural equation modeling were tested. The work characteristics, and disturbed sleep, were found to be separately associated with depressive symptoms in subsequent waves. However, only demands were found to be longitudinally related to subsequent disturbed sleep. The longitudinal autoregressive models supported a weak mediating role of disturbed sleep in the relationship between demands and depressive symptoms (standardized beta 0.008, P < 0.001), but not between support and depressive symptoms.

  Conclusions: These results indicate that higher demands at work might cause an increase in depressive symptoms, in part, by increasing disturbed sleep, although the mediated effect was relatively small compared to the total effect.

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• Treatment with antidepressants in the Swedish population in relation to major workplace downsizing

  2014. Linda Magnusson Hanson (et al.). 17th EPA Section Meeting 2014, 75-75

  Konferens

  Background/Objectives: Previous research has indicated that downsizing may be a risk factor for morbidity and mortality both among those who are made redundant and those remaining in the workplace. However, there are contradictory results and little evidence on clinically relevant mental health effects. Our objective was to investigate change in antidepressants treatment across 5 years in relation to workplace downsizing.

  Methods: This study is based on all individuals in Sweden 22-54 years of age in 2006, registered as living in Sweden Dec 31 2004 to Dec 31 2010, gainfully employed and with a stable labour market position in 2004-2006. Organisational changes were assessed from national statistics on workplaces and purchases of prescribed psychotropic drugs from the Prescribed Drug Register. People with their primary employment at an establishment with ≥ 18 % personnel reduction were considered exposed to major downsizing between the end of 2006 to the end of 2007, 2007-2008 or 2008- 2009. We applied a repeated-measures regression analysis by the generalised estimating equations (GEE) method, calculating yearly prevalence of any antidepressant treatment two years before, during the year of major downsizing and two years after workplace downsizing and tested for trends.

  Results: There was a significant increase in prevalence of antidepressant treatment during the years preceding a major downsizing, although small, for all exposed (632500 persons). In separate analyses, however, only those who remained at the same establishment at the end of the downsizing period (stayers) had a significant upward trend before and a downward trend in the years after, and this was most obvious among survivors with no long period of sickness absence or disability pension the past two year before downsizing. The prevalence ratio (PR) comparing year -1 to -2 was 1.11 with 95 % confidence interval (CI) of 1.10-1.13 and the PR comparing year 2 to 1 after was 0.98 (CI 0.96-1.00, P<0.05). Among those becoming unemployed, the prevalence of antidepressant treatment tended to increase before but then stayed virtually the same during and after downsizing. The patterns were slightly different for people with longer periods of sickness absence or disability pension before, especially for those changing jobs, but a significant decrease in prevalence was only found when analysing stayers, job changers and unemployed collectively (PR 0.83, CI 0.77-0.88).

  Discussion/Conclusions: This large scale study indicates that downsizing is associated with increased risk of treatment with antidepressants among those seemingly healthy before and remaining in work after major personnel reduction. Moreover, the increased prevalence for those remaining at the same workplace seems to be explained by workplace characteristics or anticipation some time before downsizing was carried out.

  Funding: The study was supported by the Swedish Research Council for Health, Working Life and Welfare (FORTE) [grant numbers 2009-1758, 2008-1103], partly through the Stockholm Stress Centre of excellence. 

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• Work-home interference and its prospective relation to major depression and treatment with antidepressants

  2014. Linda L. Magnusson Hanson (et al.). Scandinavian Journal of Work, Environment and Health 40 (1), 66-73

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  OBJECTIVES: Few longitudinal studies have investigated if "work-home interference" (WHI), conflicts between work and home demands, predicts depressive disorders. We examined if WHI was prospectively associated with indicators of major depression in a nationally representative sample.

  METHODS: We used multiple logistic and Cox regression models to examine if self-reported WHI was related to probable major depression [scoring high on a brief self-report scale based on the (Hopkins) Symptom Checklist] and/or any new antidepressant treatment using the prescribed drug register during a 2-year follow-up. The analytic sample comprised 1576 men and 1678 women, working respondents to the Swedish Longitudinal Occupational Survey of Health (SLOSH), free of major depression and prior purchases of antidepressants at baseline.

  RESULTS: Altogether, 7% experienced high (very often/the whole time) and 32% moderate (sometimes) WHI. Overall, the analyses indicated prospective associations between especially high WHI and major depression and/or antidepressant treatment also when adjusting for work characteristics (demands, control, support, overtime). However, the estimates for major depression differed by sex. Separate analyses indicated that only women with high WHI were significantly more likely to have subsequent major depression. Analyses further indicated an elevated rate of antidepressant treatment for men in particular, partly explained by work characteristics and that major depression was related to subsequent high WHI.

  CONCLUSIONS: Based on a two-year follow-up, this study indicated that high WHI prospectively predicted major depression and/or antidepressant treatment, though effects appeared to differ to some extent by sex.

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• A Longitudinal Analysis of Confirmatory Factor Structure and Measurement Invariance of the Demand Control Support Model

  2013. Holendro Singh Chungkham, Hugo Westerlund, Töres Theorell.

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• Does disturbed sleep mediate the longitudinal relationshipbetween work stress and depression?

  2013. Linda Magnusson Hanson (et al.). European Journal of Epidemiology 28, S57-S58

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• Factor Structure and Longitudinal Measurement Invariance of the Demand Control Support Model

  2013. Holendro Singh Chungkham (et al.). PLOS ONE 8 (8)

  Artikel

  OBJECTIVES: To examine the factor structure and to evaluate the longitudinal measurement invariance of the demand-control-support questionnaire (DCSQ), using the Swedish Longitudinal Occupational Survey of Health (SLOSH).

  METHODS: A confirmatory factor analysis (CFA) and multi-group confirmatory factor analysis (MGCFA) models within the framework of structural equation modeling (SEM) have been used to examine the factor structure and invariance across time.

  RESULTS: FOUR FACTORS: psychological demand, skill discretion, decision authority and social support, were confirmed by CFA at baseline, with the best fit obtained by removing the item repetitive work of skill discretion. A measurement error correlation (0.42) between work fast and work intensively for psychological demands was also detected. Acceptable composite reliability measures were obtained except for skill discretion (0.68). The invariance of the same factor structure was established, but caution in comparing mean levels of factors over time is warranted as lack of intercept invariance was evident. However, partial intercept invariance was established for work intensively.

  CONCLUSION: Our findings indicate that skill discretion and decision authority represent two distinct constructs in the retained model. However removing the item repetitive work along with either work fast or work intensively would improve model fit. Care should also be taken while making comparisons in the constructs across time. Further research should investigate invariance across occupations or socio-economic classes.

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• Prospective effects of work-to-home interference and its prospective relation to major depression and treatment with antidepressants using the Swedish Longitudinal Occupational Survey of Health

  2013. Linda. L. Magnusson Hanson (et al.).

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• The impact of psychosocial working conditions on expected and desired retirement ages in a reprentative sample of Swedish workers

  2013. Martin Hyde, Holendro Singh Chungkham, Hugo Westerlund.

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