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Hugo WesterlundProfessor, stf föreståndare SFI

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Hugo Westerlund är professor i epidemiologi och föreståndare för Stressforskningsinstitutet, vid Stockholms universitet.



I urval från Stockholms universitets publikationsdatabas

  • How consistently does sleep quality improve at retirement? Prospective analyses with group-based trajectory models

    2022. Paraskevi Peristera (et al.). Journal of Sleep Research 31 (2)


    Growing evidence indicates that retiring from paid work is associated, at least in the short-term, with dramatic reductions in sleep difficulties and more restorative sleep. However, much is still not known, in particular how universal these improvements are, how long they last, and whether they relate to the work environment. A methodological challenge concerns how to model time when studying abrupt changes such as retirement. Using data from Swedish Longitudinal Occupational Survey of Health (n = 2,148), we studied difficulties falling asleep, difficulties maintaining sleep, premature awakening, restless sleep, a composite scale of these items, and non-restorative sleep. We compared polynomial and B-spline functions to model time in group-based trajectory modelling. We estimated variations in the individual development of sleep difficulties around retirement, relating these to the pre-retirement work environment. Reductions in sleep difficulties at retirement were sudden for all outcomes and were sustained for up to 11 years for non-restorative sleep, premature awakening, and restless sleep. Average patterns masked distinct patterns of change: groups of retirees experiencing greatest pre-retirement sleep difficulties benefitted most from retiring. Higher job demands, lower work time control, lower job control, and working full-time were work factors that accounted membership in these groups. Compared to polynomials, B-spline models more appropriately estimated time around retirement, providing trajectories that were closer to the observed shapes. The study highlights the need to exercise care in modelling time over a sudden transition because using polynomials can generate artefactual uplifts or omit abrupt changes entirely, findings that would have fallacious implications.

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  • Work changes and employee age, maladaptive coping expectations, and well-being

    2022. Annelies E. M. Van Vianen (et al.). International Archives of Occupational and Environmental Health


    Purpose Older workers are expected to suffer more from work changes than younger ones, but empirical evidence is lacking. Negative responses to work changes may result rather from maladaptive coping expectations. This study examined possible age differences in job and life satisfaction, and sleep disturbances, after work changes (voluntary and involuntary job changes, reorganizations) and the moderating role of maladaptive coping expectations.

    Methods Four biennial waves from the Swedish Longitudinal Occupational Survey of Health (SLOSH) including respondents who participated in all four waves (n = 3084). We used multilevel path analyses to estimate direct and moderated relationships between work changes and outcomes.

    Results Involuntary job changes were associated with lower job and life satisfaction and more sleep disturbances. Reorganizations were only associated with lower job satisfaction. Older employees were more satisfied with their jobs and lives than younger employees and experienced more sleep disturbances. After involuntary job changes, older employees had similar (lower) levels of well-being as younger ones, but they reported more sleep disturbances when having experienced reorganizations. Maladaptive coping expectations were related to lower job and life satisfaction and more sleep disturbances. Employees with maladaptive coping expectations reported more sleep disturbances after involuntary job changes and reorganizations.

    Conclusion Our results suggest that there are few age differences in well-being after work changes. Employee well-being seems to mostly depend on maladaptive coping expectations. Organizations aiming to prepare employees for job changes and reorganizations could focus their efforts on employees with maladaptive expectations rather than on older ones.

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  • Changes in Job Quality as People Work Beyond Pensionable Age in Sweden

    2021. Lawrence B. Sacco (et al.). Work, Aging and Retirement


    Large numbers of people remain in paid work after pensionable age, often in bridge jobs or with reduced working hours. Remarkably, knowledge about the quality of these jobs relative to those taken prior to pension eligibility is very limited. In this paper, we examined changes in job quality among workers in their sixties in the context of contemporaneous changes in work intensity and employment characteristics. This study is based on data from the biennial Swedish Longitudinal Occupational Survey of Health (SLOSH, 2006–2018, n = 1890–3013). Job quality outcomes were physical (dangerous, strenuous or unpleasant work) and psychosocial (job strain, effort-reward imbalance, work time control) working conditions and job satisfaction. First difference estimation was used to observe within-individual wave-to-wave changes in job quality over ages 61/62–69/70. Changes in working hours, employment characteristics (shifting to a non-permanent contract, the private sector and self-employment) and health were included as covariates. The typical individual who worked beyond pensionable age experienced statistically significant improvements in job quality. Improvements in psychosocial working conditions and job satisfaction were larger for those who reduced working hours and shifted from permanent to non-permanent contracts, from the public into the private sector and from wage-and-salary to self-employment. Work beyond pensionable age is a distinctive period, characterized by employment that becomes more flexible and rewarding and less stressful. These improvements are a function of older individuals’ preferences and ability to work fewer hours and transition to new lines of work.

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  • Commuting distance and behavior-related health

    2021. Auriba Raza (et al.). Preventive Medicine 150


    Health benefits of active commuting and short commuting time are well-documented; however, limited evidence exists on the effects of commuting distance. We examined longitudinal associations between commuting distance and behavior-related health. Participants were from four survey waves of the Swedish Longitudinal Occupational Survey of Health (2012, 2014, 2016, and 2018). Analytical sample included 11,023 individuals and 21,769 observations. Random effects method used binomial logistic regression with generalized estimating equations. The outcomes were self-reported physical inactivity, overweight, smoking, problem drinking, and disturbed sleep. Models were adjusted for age, sex, occupational position, civil status, chronic disease, work strain, number of children under 12, and home/workplace neighborhood socioeconomic status. Using continuous measure, long commuting distance was associated with a higher odds of physical inactivity (OR 1.06; 95% CI, 1.04–1.09 per doubling of distance), overweight (OR 1.02; 95% CI, 1.00–1.04), and disturbed sleep (OR 1.03; 95% CI, 1.00–1.05) in fully adjusted models. Using categorized measure, individuals who commuted longer distance had a higher odds of physical inactivity compared to those with the shortest commute (3.1 km - <7.9 km vs. <3.1 km: OR 1.15; 95% CI, 1.04–1.28 and 7.9 km - <20 km vs. <3.1 km: OR 1.18; 95% CI, 1.06–1.32, fully adjusted model). Such dose-response associations were not observed for overweight or disturbed sleep. Our results suggest short commuting distance may be beneficial for behavior-related health.

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  • Do good psychosocial working conditions prolong working lives?

    2021. Johanna Stengård (et al.). European Journal of Ageing


    Due to an ageing population, governments in European countries are striving to keep older workers longer in the workforce. Remarkably few studies have paid attention to the influence of psychosocial working conditions on timing of retirement for older workers in and beyond normative retirement age. The aim of the present study was to examine whether good psychosocial working conditions contribute to prolonged working lives among older workers (59 years and above). A particular question was whether such conditions increase in importance with age. Seven waves (2006-2018) of the Swedish Longitudinal Occupational Survey of Health (SLOSH) were used (N = 6000, observations = 10,632). Discrete-time event history analyses showed that higher levels of job resources (decision authority [OR 1.13, 95% CI 1.06-1.22], skill use [OR 1.17, 95% CI 1.07-1.29], learning opportunities [OR 1.22, 95% CI 1.13-1.31], social support [OR 1.29 (95% CI 1.16-1.42], work-time control [OR 1.07, 95% CI 1.01-1.13], and reward [OR 1.40, 95% CI 1.24-1.57])-but not lower levels of job demands (quantitative and emotional demands or effort)-were associated with working longer (continued work two years later). Also, low effort-reward imbalance (OR 0.84 [95% CI 0.73-0.96]) was associated with working longer. In addition, skill use, work-time control, reward, and low effort-reward imbalance increased in importance with age for continued work. These results suggest that providing older workers with control over their work tasks, giving opportunities for learning and using their skills, as well as rewarding and acknowledging their achievements, may keep them in the workforce longer. Especially, job resources may grow in importance with age.

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  • Does workplace social capital predict care quality through job satisfaction and stress at the clinic? A prospective study

    2021. Hanne Berthelsen, Mikaela Owen, Hugo Westerlund. BMC Public Health 21 (1)


    Background: Welfare societies like Sweden face challenges in balancing the budget while meeting the demand for good quality healthcare. The aim of this study was to analyse whether care quality, operationalized as survival of dental fillings, is predicted by workplace social capital and if this effect is direct or indirect (through stress and/or job satisfaction among staff at the clinic), controlling for patient demographics.

    Methods: The prospective design includes A) work environment data from surveys of 75 general public dental clinics (aggregated data based on 872 individual ratings), and B) register-based survival of 9381dental fillings performed during a 3-month period around the time of the survey, and C) patient demographics (age, gender, income level and birth place). Using a multi-level discrete-time proportional hazard model, we tested whether clinic-level social capital, stress, and job satisfaction could predict tooth-level filling failure, controlling for patient demographics. One direct and two indirect pathways, moderated by filling tooth, location, and filling type, were tested.

    Results: High workplace social capital reduced the risk of early failure of fillings in molar teeth, mediated by group-perceived job satisfaction (indirect path: OR=0.93, p<.05, direct path from job satisfaction: OR=0.89, p<.05). Contrary to expectations, we found no support for a direct effect from social capital on care quality or for the indirect pathway via stress at the clinic level.

    Conclusions: Workplace social capital boosted the quality of dental fillings through increased levels of job satisfaction. In addition, staff at clinics with higher social capital reported less stress and higher levels of job satisfaction. These results indicate that promotion of social capital may improve both occupational health and care quality.

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  • Health- and Age-Related Workplace Factors as Predictors of Preferred, Expected, and Actual Retirement Timing

    2021. Marta Sousa-Ribeiro (et al.). International Journal of Environmental Research and Public Health 18 (5)


    To address the challenges of demographic aging, governments and organizations encourage extended working lives. This study investigates how individual health- and age-related workplace factors contribute to preferred, expected and actual retirement timing, as well as to the congruency between preferences vs. expectations, and preferences vs. actual retirement. We used data from a representative Swedish longitudinal sample comprising 4058 workers aged 50–64, with follow-up data regarding actual retirement timing available for 1164 respondents. Multinomial logistic regression analyses suggest that later preferred, expected, and actual retirement timing were, to different extent, influenced by better health, an age-friendly workplace and feeling positive regarding the future at work. Emotional exhaustion, age-related inequalities at work and experiencing aging as an obstacle increased the likelihood of preferring to retire earlier than one expected to, over retiring at the time one expected to. Those with better health and positive work prospects were less likely to prefer retiring earlier than they expected to, and more likely to being “pulled toward working until 65 and beyond”, compared to being “pulled toward early retirement”. Experiencing aging as an obstacle decreased the chances of being “pulled toward working until 65 and beyond”. The results provide insights on how to facilitate extended working lives.

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  • Home and Workplace Neighborhood Socioeconomic Status and Behavior-related Health

    2021. Auriba Raza (et al.). Annals of Behavioral Medicine 55 (8), 779-790


    Background: The influence of individual and home neighborhood socioeconomic status (SES) on health-related behaviors have been widely studied, but the majority of these studies have neglected the possible impact of the workplace neighborhood SES.

    Objective: To examine within-individual associations between home and work place neighborhood SES and health-related behaviors in employed individuals.

    Methods: We used participants from the Swedish Longitudinal Occupational Survey of Health who responded to a minimum of two surveys between 2012 and 2018. Data included 12,932 individuals with a total of 35,332 observations. We used fixed-effects analysis with conditional logistic regression to examine within-individual associations of home, workplace, as well as time-weighted home and workplace neighborhood SES index, with self-reported obesity, physical activity, smoking, excessive alcohol consumption, sedentary lifestyle, and disturbed sleep.

    Results: After adjustment for covariates, participants were more likely to engage in risky alcohol consumption when they worked in a workplace that was located in the highest SES area compared to time when they worked in a workplace that was located in the lowest SES area (adjusted odds ratios 1.98; 95% confidence interval: 1.12 to 3.49). There was an indication of an increased risk of obesity when individuals worked in the highest compared to the time when they worked in the lowest neighborhood SES area (1.71; 1.02–2.87). No associations were observed for the other outcomes.

    Conclusion: These within-individual comparisons suggest that workplace neighborhood SES might have a role in health-related behaviors, particularly alcohol consumption.

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  • How does cessation of work affect sleep? Prospective analyses of sleep duration, timing and efficiency from the Swedish Retirement Study

    2021. Johnna Garefelt (et al.). Journal of Sleep Research 30 (3)


    Several strands of research indicate that work competes for time with sleep, but to what extent the timing and duration of sleep is affected by work is not known. Retirement offers a quasi-experimental life transition to study this in a within-individual study design. The few existing studies report that people sleep longer and later after retirement but mainly rely on self-reported data or between-individual analyses. We recruited 100 participants aged 61–72 years who were in paid work but would soon retire and measured them in a baseline week with accelerometers, diaries and questionnaires. After 1 and 2 years, the measurements were repeated for the now retired participants. Changes in sleep duration, timing, efficiency, chronotype and social jetlag were analysed using multilevel modelling. Gender, chronotype at baseline and partner's working status were analysed as potential effect modifiers. Sleep duration increased by 21 min, whereas sleep efficiency remained similar. Time of sleep onset and final awakening were postponed by 26 and 52 min, respectively, pushing midsleep forward from 03:17 to 03:37 hours. Changes in duration and timing of sleep were driven by weekday sleep, whereas weekend sleep stayed about the same. Social jetlag decreased but still occurred after retirement. Changes at retirement in sleep duration and timing were smaller for participants with a later chronotype and who had full-time working partners. These findings indicate that paid work generates sleep loss and hinders people from sleeping in line with their biological time.

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  • How does work impact daily sleep quality? A within-individual study using actigraphy and self-reports over the retirement transition

    2021. Johanna Garefelt (et al.). Journal of Sleep Research


    This study examined how the cessation of work at retirement affects daily measures of actigraphy-measured and self-rated sleep quality. Time in bed or asleep and stress at bedtime were examined as potential mechanisms. In total 117 employed participants who were aged 60-72 years and planned to retire soon were recruited to the Swedish Retirement Study. Sleep quality was measured in a baseline week using accelerometers, diaries, and questionnaires. Subjective sleep measures were sleep quality, restless sleep, restorative sleep, getting enough sleep, estimated wake after sleep onset, difficulties falling asleep, too early final awakening, and difficulties waking up. Actigraphy measures were sleep efficiency, wake after sleep onset, and average awakening length. After 1 and 2 years, the measurements were repeated for the now retired participants. Daily variations in sleep quality before and after retirement were analysed using multilevel modelling, with time in bed or asleep and stress at bedtime as potential mediators. We found that several self-reports of sleep improved (e.g., +0.2 standard deviations for sleep quality and +0.5 standard deviations for restorative sleep) while objective sleep quality remained unchanged or decreased slightly with retirement (e.g., -0.8% for sleep efficiency). Increased time in bed or asleep and stress at bedtime accounted partially for the improvements in self-rated sleep quality at retirement. In conclusion, actigraph-measured and self-reported sleep quality do not change in concert at retirement, highlighting the interest of studying both outcomes. The main effects of retirement from work concern subjective experiences of recovery more than sleep quality per se.

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  • Long working hours and risk of 50 health conditions and mortality outcomes

    2021. Jenni Ervasti (et al.). The Lancet Regional Health 11


    Background: Studies on the association between long working hours and health have captured only a narrow range of outcomes (mainly cardiometabolic diseases and depression) and no outcome-wide studies on this topic are available. To achieve wider scope of potential harm, we examined long working hours as a risk factor for a wide range of disease and mortality endpoints.

    Methods: The data of this multicohort study were from two population cohorts from Finland (primary analysis, n=59 599) and nine cohorts (replication analysis, n=44 262) from Sweden, Denmark, and the UK, all part of the Individual-participant Meta-analysis in Working Populations (IPD-Work) consortium. Baseline-assessed long working hours (≥55 hours per week) were compared to standard working hours (35-40 h). Outcome measures with follow-up until age 65 years were 46 diseases that required hospital treatment or continuous pharmacotherapy, all-cause, and three cause-specific mortality endpoints, ascertained via linkage to national health and mortality registers.

    Findings: 2747 (4·6%) participants in the primary cohorts and 3027 (6·8%) in the replication cohorts worked long hours. After adjustment for age, sex, and socioeconomic status, working long hours was associated with increased risk of cardiovascular death (hazard ratio 1·68; 95% confidence interval 1·08-2·61 in primary analysis and 1·52; 0·90-2·58 in replication analysis), infections (1·37; 1·13-1·67 and 1·45; 1·13-1·87), diabetes (1·18; 1·01-1·38 and 1·41; 0·98-2·02), injuries (1·22; 1·00-1·50 and 1·18; 0·98-1·18) and musculoskeletal disorders (1·15; 1·06-1·26 and 1·13; 1·00-1·27). Working long hours was not associated with all-cause mortality.

    Interpretation: Follow-up of 50 health outcomes in four European countries suggests that working long hours is associated with an elevated risk of early cardiovascular death and hospital-treated infections before age 65. Associations, albeit weak, were also observed with diabetes, musculoskeletal disorders and injuries. In these data working long hours was not related to elevated overall mortality.

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  • Sexual and gender harassment in Swedish workplaces

    2021. Katrina Blindow (et al.). Scandinavian Journal of Work, Environment and Health 47 (6), 466-474


    Objectives This prospective cohort study aimed to investigate gender harassment and sexual harassment as risk factors for prospective long-term sickness absence (LTSA, >= 21 days). Furthermore, support from colleagues was investigated as a moderating factor of this association.

    Methods Information on gender harassment, sexual harassment and support by colleagues were derived from the biannual Swedish Work Environment Survey 1999-2013, a representative sample of the Swedish working population (N=64 297). Information on LTSA as well as demographic and workplace variables were added from register data. Relative rates of LTSA the year following the exposure were determined using modified Poisson regression.

    Results Monthly to daily exposure to gender harassment was a risk factor for prospective LTSA among women [rate ratio (RR) 1.04, 95% confidence interval (CI) 1.02-1.05] and men (RR 1.07, 95% CI 1.04-1.10). Monthly to daily exposure to sexual harassment was also a risk factor for LTSA among women (RR 1.05, 95% CI 1.01-1.10) and men (RR 1.07, 95% CI 1.02-1.13). Exposure to sexual or gender harassment once in the last 12 months was not associated with LTSA. There was no support for an interaction between either of the exposures and support from colleagues in relation to LTSA.

    Conclusions Sexual harassment and gender harassment appear to contribute to a small excess risk for LTSA among women and men. For both kinds of offensive behaviors, the pervasiveness appears to be important for the outcome. The role of support by colleagues was inconclusive and needs further investigation.

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  • Technostress operationalised as information and communication technology (ICT) demands among managers and other occupational groups

    2021. Magdalena Stadin (et al.). Computers in human behavior 114


    Exposure to technostress operationalised as ICT demands is more prevalent in higher socioeconomic groups, but little is known about the exposure in different occupational groups considering industry and position. The aim of the present study was to explore the exposure to ICT demands in managers and other occupational groups. Cross-sectional self-reported data from the Swedish Longitudinal Occupational Survey of Health (SLOSH), collected in 2016 was used, including 13 572 respondents (1 241 'managers', 12 331 'non-managers'). ICT demands based on a six-item Likert scale were analysed as the main measure. 'Managers' (varying industries and positions) in comparison with 'non-managers', including nine occupational groups separated by industry and education level, showed the highest prevalence (74.7%) of ICT demands. 'Managers in health care, other community services and education' showed the highest odds ratio (OR) with 95% Confidence Intervals (CI) of ICT demands, in comparison with 'non-managers' (OR 4.64 [CI 3.26-6.61], and with 'all other managers' (OR 1.55 [CI 1.01-2.38]), after adjustment for sex, age, job strain, and social support. In conclusion, managers have increased odds of exposure to ICT demands, especially managers in health care, other community services and education. Targeted actions to improve the digitalised work environment among managers are warranted.

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  • The nature of paid work in the retirement years

    2021. Loretta G. Platts (et al.). Ageing & Society


    Ever more people are in paid work following the age of state pension availability, and yet the experience of working in this phase of the late career has been little studied. We interviewed a purposive sample of 25 Swedish people in their mid- to late sixties and early seventies, many of whom were or had recently been working while claiming an old-age pension. The data were analysed with constant comparative analysis in which we described and refined categories through the writing of analytic memos and diagramming. We observed that paid work took place within a particular material, normative and emotional landscape: a stable and secure pension income decommodifying these workers from the labour market, a social norm of a retired lifestyle and a looming sense of contraction of the future. This landscape made paid work in these years distinctive: characterised by immediate intrinsic rewards and processes of containing and reaffirming commitments to jobs. The oldest workers were able to craft assertively the temporal flexibility of their jobs in order to protect the autonomy and freedom that retirement represented and retain favoured job characteristics. Employed on short-term (hourly) contracts or self-employed, participants continually reassessed their decision to work. Participation in paid work in the retirement years is a distinctive second stage in the late career which blends the second and third ages.

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  • Cohort Profile

    2018. Linda L. Magnusson Hanson (et al.). International Journal of Epidemiology 47 (3), 691-692


    Cohort Profile in a nutshell

    • The Swedish Longitudinal Occupational Survey of Health (SLOSH) is a longitudinal cohort study with repeated follow-ups aiming to investigate longitudinal associations between work organization, work environment, labour force participation, health and well-being, taking social conditions, individual differences, health behaviours, coping strategies, work-private life interaction, sleep and ageing into account.

    • In SLOSH, several nationally representative subsamples of working individuals, 16-64 years of age at inclusion, responding to baseline questionnaires, have been followed up biennially with more comprehensive self-report questionnaires.

    • Since the start in 2006, six waves of follow-up data have been collected with successively increasing numbers of men and women invited. In total 40 877 individuals have been invited, and 28 672 (70%) have responded to follow-up questionnaires at least once.

    • Further waves of follow-up are planned in 2018 and every second year in the foreseeable future.

    • The follow-up questionnaires include a wide range of measures on work or non-work situation/leaving the labour force temporarily or permanently, social situation, health and well-being. The questionnaire data are also linked to register data on demographics, employment, enterprises and establishments and health.

    • A strategy for data access has been developed, striving to satisfy legal requirements and ethical principles. Requests for data for specific research questions or collaboration are welcome via email: For more information, visit

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