Linda Magnusson Hanson

Linda Magnusson Hanson


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Arbetar vid Psykologiska institutionen
Telefon 08-553 789 42
Besöksadress Albanovägen 12
Rum 304
Postadress Psykologiska institutionen 106 91 Stockholm

Om mig

Linda Magnusson Hanson, med.dr, är forskare och docent vid Epidemiologiska enheten , Stressforskningsinstitutet, vid Psykolgiska Institutionen och SLOSH Study Manager. Lindas forskning fokuserar främst på samband mellan olika organisatoriska eller psykosociala arbetsmiljöfaktorer och hälsoutfall såsom psykisk ohälsa, smärta och kardiometabola sjukdomar, mortalitet, och vad som kan förklara den typen av samband. De organisatoriska eller psykosocial arbetsmiljöfaktorerna innefattar bland annat krav, kontroll, stöd i arbetet, långa arbetstider, organisatoriska förändringar, anställningsotrygghet, liksom sociala stressorer såsom arbetsrelaterad exponering för våld/hot om våld, mobbning och sexuella trakasserier som kommer vara i speciellt fokus i kommande studier. Studierna bygger främst på longitudinella data från den Svenska Longitudinella studien Om Sociala förhållanden, arbetsliv och Hälsa/Swedish Longitudinal Occupational Survey of Health (SLOSH) som drivs av Epidemiologienheten vid Stressforskningsinstitutet, men även på liknande data från andra länder såsom Danmark, Finland, England och Australien genom internationella samarbeten.


I urval från Stockholms universitets publikationsdatabas
  • 2019. Julia Åhlin, Anthony LaMontagne, Linda Magnusson Hanson. Occupational and Environmental Medicine 76 (7), 455-461

    Objectives Psychosocial work characteristics have been prospectively associated with depressive symptoms. However, methodological limitations have raised questions regarding causality. It is also unclear to what extent depressive symptoms affect the experience of the psychosocial work environment. We examined contemporaneous (measured simultaneously) and lagged bidirectional relationships between psychosocial work characteristics and depressive symptoms, simultaneously controlling for time-stable individual characteristics.

    Methods We included 3947 subjects in the Swedish Longitudinal Occupational Survey of Health (SLOSH), with self-reported job demands, control, social support, work efforts, rewards, procedural justice and depressive symptoms in four waves 2010–2016. We applied dynamic panel models with fixed effects, using structural equation modelling, adjusting for all time-stable individual characteristics such as personality and pre-employment factors.

    Results Higher levels of job demands, job demands in relation to control, work efforts and efforts in relation to rewards were contemporaneously associated with more depressive symptoms (standardised β: 0.18–0.25, p<0.001), while higher levels of workplace social support, rewards at work and procedural justice were associated with less depressive symptoms (β: −0.18, p<0.001, β: –0.16, p<0.001 and β: −0.09, p<0.01, respectively). In contrast, only work efforts predicted higher levels of depressive symptoms 2 years later (β:0.05, p<0.05). No other lagged associations were foundin any direction.

    Conclusions After controlling for all time-invariant confounding, our results suggest that psychosocial work characteristics predominantly affect depressive symptoms immediately or with only a short time lag. Furthermore, we found no evidence of reverse causation. This indicates short-term causal associations, although the temporal precedence of psychosocial work characteristics remains uncertain.

  • 2019. Jaana Halonen (et al.). Scandinavian Journal of Work, Environment and Health 45 (2), 126-133

    Objectives Bi-directional associations between perceived effort-reward imbalance (FRI) 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 1.22, 95% confidence interval (CI) 1.00-1.48] and 41% of this total effect was mediated through depressive symptoms. Corresponding RR for association between neck-shoulder pain and ERI was 1.34 (95% CI 1.09-1.64), 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.

  • 2019. Linda L. Magnusson Hanson (et al.). Brain, behavior, and immunity 78, 153-160

    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.

  • 2019. Marianna Virtanen (et al.).

    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.

  • 2019. Linda L. Magnusson Hanson (et al.). Occupational and Environmental Medicine 76 (11), 785-792

    Objectives Several recent large-scale studies have indicated a prospective association between job strain and coronary heart disease, stroke and diabetes. Job strain is also associated with poorer mental health, a risk factor for cardiometabolic disease. This study investigates the prospective relationships between change in job strain, poor mental health and cardiometabolic disease, and whether poor mental health is a potential mediator of the relationship between job strain and cardiometabolic disease.

    Methods We used data from five cohort studies from Australia, Finland, Sweden and UK, including 47 757 men and women. Data on job strain across two measurements 1-5 years apart (time 1 (T1)-time 2 (T2)) were used to define increase or decrease in job strain. Poor mental health (symptoms in the top 25% of the distribution of the scales) at T2 was considered a potential mediator in relation to incident cardiometabolic disease, including cardiovascular disease and diabetes, following T2 for a mean of 5-18 years.

    Results An increase in job strain was associated with poor mental health (HR 1.56, 95% CI 1.38 to 1.76), and a decrease in job strain was associated with lower risk in women (HR 0.70, 95% CI 0.60-0.84). However, no clear association was observed between poor mental health and incident cardiometabolic disease (HR 1.08, 95% CI 0.96-1.23), nor between increase (HR 1.01, 95% CI 0.90-1.14) and decrease (HR 1.08, 95% CI 0.96-1.22) in job strain and cardiometabolic disease.

    Conclusions The results did not support that change in job strain is a risk factor for cardiometabolic disease and yielded no support for poor mental health as a mediator.

  • 2019. Jaana I. Halonen (et al.). Spine 44 (17), 1248-1255

    Study Design. Prospective longitudinal cohort study.

    Objective. To determine the associations for workload and health-related factors with incident and recurrent low back pain (LBP), and to determine the mediating role of health-related factors in associations between physical workload factors and incident LBP.

    Summary of Background Data. It is not known whether the risk factors for the development of LBP are also prognostic factors for recurrence of LBP and whether the associations between physical workload and incident LBP are mediated by health-related factors. We used data from the Swedish Longitudinal Occupational Survey of Health study. Those responding to any two subsequent surveys in 2010 to 2016 were included for the main analyses (N = 17,962). Information on occupational lifting, working in twisted positions, weight/height, smoking, physical activity, depressive symptoms, and sleep problems were self-reported. Incident LBP was defined as pain limiting daily activities in the preceding three months in participants free from LBP at baseline. Recurrent LBP was defined as having LBP both at baseline and follow-up. For the mediation analyses, those responding to three subsequent surveys were included (N = 3516).

    Methods. Main associations were determined using generalized estimating equation models for repeated measures data. Mediation was examined with counterfactual mediation analysis.

    Results. All risk factors at baseline but smoking and physical activity were associated with incident LBP after adjustment for confounders. The strongest associations were observed for working in twisted positions (risk ratio = 1.52, 95% CI 1.37, 1.70) and occupational lifting (risk ratio = 1.52, 95% CI 1.32, 1.74). These associations were not mediated by health-related factors. The studied factors did not have meaningful effects on recurrent LBP.

    Conclusion. The findings suggest that workload and health-related factors have stronger effects on the development than on the recurrence or progression of LBP, and that health-related factors do not mediate associations between workload factors and incident LBP.

  • 2019. Tianwei Xu (et al.). European Heart Journal 40 (14), 1124-1134


    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.


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

  • Cecilia U.D. Stenfors (et al.). PLoS ONE
  • Cecilia U.D. Stenfors (et al.). BMC Psychology
  • 2018. Jaana I. Halonen (et al.). Pain 159 (8), 1477-1483

    Existing evidence of an association between effort-reward imbalance (ERI) at work and musculoskeletal pain is limited, preventing reliable conclusions about the magnitude and direction of the relation. In a large longitudinal study, we examined whether the onset of ERI is associated with subsequent onset of musculoskeletal pain among those free of pain at baseline, and vice versa, whether onset of pain leads to onset of ERI. Data were from the Swedish Longitudinal Occupational Survey of Health (SLOSH) study. We used responses from 3 consecutive study phases to examine whether exposure onset between the first and second phases predicts onset of the outcome in the third phase (N = 4079). Effort-reward imbalance was assessed with a short form of the ERI model. Having neck-shoulder and low back pain affecting life to some degree in the past 3 months was also assessed in all study phases. As covariates, we included age, sex, marital status, occupational status, and physically strenuous work. In the adjusted models, onset of ERI was associated with onset of neck-shoulder pain (relative risk [RR] 1.51, 95% confidence interval [CI] 1.21-1.89) and low back pain (RR 1.21, 95% CI 0.97-1.50). The opposite was also observed, as onset of neck-shoulder pain increased the risk of subsequent onset of ERI (RR 1.36, 95% CI 1.05-1.74). Our findings suggest that when accounting for the temporal order, the associations between ERI and musculoskeletal pain that affects life are bidirectional, implying that interventions to both ERI and pain may be worthwhile to prevent a vicious cycle.

  • 2020. Sandra Blomqvist (et al.). Journal of Affective Disorders 266, 215-222

    Background: Previous research suggests that job insecurity is associated with poor mental health, but research examining how different aspects of job insecurity relate to clinical measures of poor mental health are lacking. We aimed to investigate the association between cognitive and affective job insecurity and incident purchases of psychotropic drugs.

    Methods: We included 14,586 employees participating in the Swedish Longitudinal Occupational Survey of Health (SLOSH), who answered questions on cognitive and/or affective job insecurity in 2010, 2012 or 2014. Respondents were followed in the Swedish Prescribed Drug Register (2.5 years on average). We investigated the association between job insecurity and incident psychotropic drugs with marginal structural Cox models.

    Results: Affective job insecurity was associated with an increased risk of purchasing any psychotropic drugs (Hazard Ratio (HR) 1.40 (95% Confidence Interval (CI) 1.04–1.89)) while cognitive job insecurity was not (HR 1.15 (95% CI 0.92–1.43)). Cognitive and affective job insecurity were both associated with antidepressants, affective job insecurity with anxiolytics, but no association was found with sedatives. Women and younger workers seemed to have higher risk compared to men and older workers, but differences were not statistically significant.

    Limitations: Although job insecurity and psychotropic drugs were assessed through independent sources and several covariates were considered, unmeasured confounding cannot be ruled out.

    Conclusions: The findings support that affective job insecurity is a risk factor for psychotropic drug treatment, that it may be relevant to distinguish between different types of job insecurity, and to consider sex and age as moderating factors.

  • 2020. Elisabeth Framke (et al.). European Heart Journal 41 (11), 1164-1178

    Aims: We examined the extent to which associations between education and cardiovascular disease (CVD) morbidity and mortality are attributable to income and work stress.

    Methods and results: We included all employed Danish residents aged 30–59 years in 2000. Cardiovascular disease morbidity analyses included 1 638 270 individuals, free of cardiometabolic disease (CVD or diabetes). Mortality analyses included 41 944 individuals with cardiometabolic disease. We assessed education and income annually from population registers and work stress, defined as job strain, with a job-exposure matrix. Outcomes were ascertained until 2014 from health registers and risk was estimated using Cox regression. During 10 957 399 (men) and 10 776 516 person-years (women), we identified 51 585 and 24 075 incident CVD cases, respectively. For men with low education, risk of CVD was 1.62 [95% confidence interval (CI) 1.58–1.66] before and 1.46 (95% CI 1.42–1.50) after adjustment for income and job strain (25% reduction). In women, estimates were 1.66 (95% CI 1.61–1.72) and 1.53 (95% CI 1.47–1.58) (21% reduction). Of individuals with cardiometabolic disease, 1736 men (362 234 person-years) and 341 women (179 402 person-years) died from CVD. Education predicted CVD mortality in both sexes. Estimates were reduced with 54% (men) and 33% (women) after adjustment for income and job strain.

    Conclusion: Low education predicted incident CVD in initially healthy individuals and CVD mortality in individuals with prevalent cardiometabolic disease. In men with cardiometabolic disease, income and job strain explained half of the higher CVD mortality in the low education group. In healthy men and in women regardless of cardiometabolic disease, these factors explained 21–33% of the higher CVD morbidity and mortality.

  • 2019. Mika Kivimäki (et al.). Epidemiology 30 (4), e27-e29
  • Julia Åhlin (et al.).


    Retirement is a major life transition. However, previous evidence on how it influences mental health is inconclusive. Whether retirement is desirable or not may depend on work characteristics. We aimed to investigate trajectories of depressive symptoms across retirement, and how a number of psychosocial working characteristics influence these trajectories.


    We included 1735 subjects in the Swedish Longitudinal Occupational Survey of Health (SLOSH), retiring in 2008-2016 (mean age 66 years). They had completed biennial questionnaires and reported job demands, job control, workplace social support, effort, reward, procedural justice as well as depressive symptoms. We applied group-based trajectory modeling to model trajectories of depressive symptoms across retirement. Multinomial logistic regression analyses estimated the associations between the psychosocial working characteristics and the depressive symptom trajectories.


    We identified five depression trajectories, of which in four groups, depressive symptoms decreased slightly around retirement. For a small group, the symptom level was initially high, but then decreased markedly in relation to retirement. Perceptions of job demands, job strain, workplace social support, rewards, effort-reward imbalance and procedural justice were associated with the trajectories, while perceptions of job control and work effort were only related to some of the trajectories.


    We observed positive effects of retirement on depressive symptoms in a sample of Swedish retirees, with a small group showing a clear improvement. A relief from poor psychosocial working conditions seemed to be associated with a more significant improvement. However, poor working conditions were also associated with persistent symptoms suggesting a long-term effect.

  • Artikel 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

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

    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.

  • 2018. Marianna Virtanen (et al.). Scandinavian Journal of Work, Environment and Health 44 (3), 239-250

    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.

  • 2018. Paraskevi Peristera, Hugo Westerlund, Linda L. Magnusson Hanson. BMJ Open 8 (6)

    Background Long working hours and unpaid work are possible risk factors for depressive symptoms. However, little is known about how working hours influence the course of depressive symptoms. This study examined the influence of paid, unpaid working hours and total working hours on depressive symptoms trajectories.

    Methods The study was based on data from four waves of the Swedish Longitudinal Occupational Survey of Health (SLOSH 2008–2014). We applied group-based trajectory modelling in order to identify trajectories of depressive symptoms and studied paid and unpaid working hours and total working hours as risk factors.

    Results Six trajectory groups were identified with symptoms: ‘very low stable’, ‘low stable’, ‘doubtful increasing’, ‘high decreasing’, ‘mild decreasing’ and ‘high stable’. More time spent on unpaid work was associated with the ‘low stable’ (OR 1.16, 95% CI 1.04 to 1.30) and the ‘high stable (OR 1.40, 95% CI 1.18 to 1.65) symptom trajectories compared with being in the ‘very low stable’ symptom group. In addition, more total working hours was associated with a higher probability of having ‘high decreasing’ (OR 1.30, 95% CI 1.14 to 1.48) and ‘high stable’ (OR 1.22, 95% CI 1.01 to 1.47) symptoms, when adjusting for sex, age, civil status and socioeconomic status. The results, however, differed somewhat for men and women. More unpaid working hours was more clearly associated with higher symptom trajectories among women. More total working hours was associated with ‘high stable’ symptoms among women only.

    Conclusions This study supported heterogeneous individual patterns of depressive symptoms over time among the Swedish working population. The results also indicate that a higher burden of unpaid work and longer total working hours, which indicate a double burden from paid and unpaid work, may be associated with higher depressive symptom trajectories, especially among women.

  • 2018. Tianwei Xu (et al.). Diabetologia 61 (1), 75-83

    AIMS/HYPOTHESIS: The aim of this multicohort study was to examine whether employees exposed to social stressors at work, such as workplace bullying and violence, have an increased risk of type 2 diabetes.

    METHODS: The study included 45,905 men and women (40-65 years of age and free of diabetes at baseline) from four studies in Sweden, Denmark and Finland. Workplace bullying and violence were self-reported at baseline. Incident diabetes was ascertained through national health and medication records and death registers. Marginal structural Cox models adjusted for age, sex, country of birth, marital status and educational level were used for the analyses.

    RESULTS: Nine per cent of the population reported being bullied at work and 12% were exposed to workplace violence or threats of violence. Bullied participants had a 1.46 (95% CI 1.23, 1.74) times higher risk of developing diabetes compared with non-bullied participants. Exposure to violence or threats of violence was also associated with a higher risk of diabetes (HR 1.26 [95% CI 1.02, 1.56]). The risk estimates attenuated slightly when taking BMI into account, especially for bullying. The results were similar for men and women, and were consistent across cohorts.

    CONCLUSIONS/INTERPRETATION: We found a higher risk of incident type 2 diabetes among employees exposed to bullying or violence in the workplace. Further research is needed to determine whether policies to reduce bullying and violence at work may reduce the incidence of type 2 diabetes in working populations. Research on the mechanisms is also highly warranted.

  • 2017. Anna Nyberg (et al.). International Journal of Epidemiology 46 (4), 1137-1146

    Background: Higher occupational status has consistently been shown to be associated with better health, but few studies have to date examined if an upward change in occupational status is associated with a positive change in health. Furthermore, very little is known about whether this association differs by sex. Methods: Data were derived from four waves (2008-14) of the Swedish Longitudinal Occupational Survey of Health (SLOSH), a follow-up study of a nationally representative sample of the Swedish working population. The present study comprises 1410 men and 1926 women. A dynamic panel model with fixed effects was used to analyse the lagged association between job promotion on the one hand and self-rated health (SRH) and symptoms of depression on the other. This method allowed controlling for unobserved time-invariant confounders and determining the direction of causality between the variables. Multigroup comparisons were performed to investigate differences between the sexes. Results: The results showed that job promotion was associated with decreased subsequent SRH and increased symptoms of depression among both men and women. Women reported a larger relative worsening of self-rated health following a job promotion than men and men reported a larger relative worsening of depression symptoms. There was limited evidence that SRH and symptoms of depression were associated with subsequent job promotion. Conclusions: The present study indicates that a job promotion could lead to decreased SRH and increased symptoms of depression in a 2-4-year perspective. Associations appear to differ for women and men.

  • 2017. Linda L. Magnusson Hanson (et al.). Scandinavian Journal of Work, Environment and Health 43 (5), 396-404

    Objectives Psychosocial working conditions are suggested risk factors for low-back pain, but it is unclear whether these associations are causal. The present study examined whether there are lagged and bidirectional associations between job strain and low-back pain and further controlled for unmeasured time-invariant confounding.

    Methods The study was based on four biennial waves of data from the Swedish Longitudinal Occupational Survey of Health (SLOSH), including 3084 men and women. Cross-lagged analyses using structural equation modeling (SEM) were conducted on job strain, a combination of high job demands and low control, and any as well as low-back pain severity (how much any problems affected the respondents life). Analogous SEM (dynamic panel) models with fixed effects were also fitted to remove confounding from time-invariant factors (such as non-observed individual and environmental factors, eg, genetics, childhood conditions, personality).

    Results The SEM models indicated bidirectional associations between job strain and any back pain over a 2-year time lag (β=0.21 and 0.19, P<0.05), when adjusting for a range of covariates. Job strain was also associated with an increase in low-back pain severity and vice versa. However, the SEM models with fixed-effects showed no statistically significant lagged relationships between job strain and any or low-back pain severity (β=-0.05 and β=0.00, respectively).

    Conclusions This study suggests that associations between job strain and low-back pain with a lag of years may be due to residual confounding by time invariant characteristics. Further studies are, however, needed to elucidate short-term relationships.

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

    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.

  • 2017. Magnus Sverke (et al.).

    This report includes a research overview commissioned by the Swedish Work Environment Authority with the aim of detailing relationships between organizational and psychosocial factors at work, and various work-related and health-related outcomes among working women and men. A second aim involved reporting on the prevalence of the different work environment factors among women and men. To fulfil the first aim, systematic research reviews, including meta-analyses and literature reviews, were retrieved from combined searches in different international and national databases. Search terms were chosen to target the broad array of organizational and psychosocial factors, and to retrieve published journal articles and systematic reports of Swedish government agencies linking such factors to various outcomes. The time period was restricted to the past ten years.

  • 2017. I. E. H. Madsen (et al.). Psychological Medicine 47 (8), 1342-1356

    Background. Adverse psychosocial working environments characterized by job strain (the combination of high demands and low control at work) are associated with an increased risk of depressive symptoms among employees, but evidence on clinically diagnosed depression is scarce. We examined job strain as a risk factor for clinical depression. Method. We identified published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpublished individual-level data from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium. Summary estimates of the association were obtained using random-effects models. Individual-level data analyses were based on a pre-published study protocol. Results. We included six published studies with a total of 27 461 individuals and 914 incident cases of clinical depression. From unpublished datasets we included 120 221 individuals and 982 first episodes of hospital-treated clinical depression. Job strain was associated with an increased risk of clinical depression in both published [relative risk (RR) = 1.77, 95% confidence interval (CI) 1.47-2.13] and unpublished datasets (RR = 1.27, 95% CI 1.04-1.55). Further individual participant analyses showed a similar association across sociodemographic subgroups and after excluding individuals with baseline somatic disease. The association was unchanged when excluding individuals with baseline depressive symptoms (RR = 1.25, 95% CI 0.94-1.65), but attenuated on adjustment for a continuous depressive symptoms score (RR = 1.03, 95% CI 0.81-1.32). Conclusions. Job strain may precipitate clinical depression among employees. Future intervention studies should test whether job strain is a modifiable risk factor for depression.

  • 2017. Linda L. Magnusson Hanson (et al.). Scientific Reports 7

    Work stress is a risk factor for cardio-metabolic diseases, but few large-scale studies have examined the clinical profile of individuals with work stress. To address this limitation, we conducted a cross-sectional study including 43,593 working adults from a French population-based sample aged 18-72 years (the CONSTANCES cohort). According to the Effort-Reward Imbalance model, work stress was defined as an imbalance between perceived high efforts and low rewards at work. A standardized health examination included measures of anthropometry, lung function, blood pressure and standard blood-based biomarkers. Linear regression analyses before and after multivariable adjustment for age, socioeconomic status, depressive symptoms, health-related behaviours, and chronic conditions showed that work stress was associated with higher BMI, waist circumference, waist-hip ratio, alanine transaminase, white blood cell count and lower high-density lipoprotein cholesterol in men, and with higher BMI and white blood cell count in women (differences 0.03-0.06 standard deviations, P < 0.05 between individuals with and without work stress). No robust associations were observed with lung function, haemoglobin, creatinine, glucose levels or resting blood pressure measures. This indicates that work stress is associated altered metabolic profile, increased systemic inflammation, and, in men, poorer liver function, which is a marker of high alcohol consumption.

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

    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.

  • 2014. Linda L. Magnusson Hanson (et al.). Scandinavian Journal of Public Health 42 (1), 82-88

    Aims: Major depressive disorders are common, with substantial impact on individuals/society. Brief scales for depression severity, based on a small number of characteristics all of which are necessary for diagnosis, have been recommended in self-reported versions for clinical work or research when aiming to quickly and accurately measure depression. We have examined psychometric properties of a brief 6-item version of the Symptom Checklist (SCL), the Symptom Checklist core depression scale (SCL-CD6) and aimed to identify a cut-point for epidemiological research. Methods: The psychometric evaluation of the SCL-CD6 was mainly performed by a Mokken analysis of unidimensionality in a random sample of 1476 residents in the Stockholm County, aged 18-64 years. The standardization of SCL-CD6 was based on ROC analysis, using the Major Depression Inventory as index of validity. Predictive validity was subsequently assessed using register data on hospital admissions and purchases of prescribed medications linked to a sample of 5985 participants in the Swedish Longitudinal Occupational Survey of Health (SLOSH). Results: The SCL-CD6 obtained a coefficient of homogeneity of 0.70 by Mokken analysis, which indicates high unidimensionality and a meaningful dimensional measure of depression severity. By ROC we identified a score of 17 or higher (total range 0-24) as the best cut-point for major depression (sensitivity 0.68, specificity 0.98) which predicted subsequent purchases of antidepressants as well as hospitalisations with a depressive episode. Conclusions: The SCL-CD6 was found a valid depression scale with higher unidimensionality than longer epidemiological instruments and thus particularly suitable for assessment in larger population surveys.

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

    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.

  • 2013. Katriina Heikkilä (et al.). BMJ. British Medical Journal 346

    Objective To investigate whether work related stress, measured and defined as job strain, is associated with the overall risk of cancer and the risk of colorectal, lung, breast, or prostate cancers. Design Meta-analysis of pooled prospective individual participant data from 12 European cohort studies including 116 056 men and women aged 17-70 who were free from cancer at study baseline and were followed-up for a median of 12 years. Work stress was measured and defined as job strain, which was self reported at baseline. Incident cancers (all n=5765, colorectal cancer n=522, lung cancer n=374, breast cancer n=1010, prostate cancer n=865) were ascertained from cancer, hospital admission, and death registers. Data were analysed in each study with Cox regression and the study specific estimates pooled in meta-analyses. Models were adjusted for age, sex, socioeconomic position, body mass index (BMI), smoking, and alcohol intake Results A harmonised measure of work stress, high job strain, was not associated with overall risk of cancer (hazard ratio 0.97, 95% confidence interval 0.90 to 1.04) in the multivariable adjusted analyses. Similarly, no association was observed between job strain and the risk of colorectal (1.16, 0.90 to 1.48), lung (1.17, 0.88 to 1.54), breast (0.97, 0.82 to 1.14), or prostate (0.86, 0.68 to 1.09) cancers. There was no clear evidence for an association between the categories of job strain and the risk of cancer. Conclusions These findings suggest that work related stress, measured and defined as job strain, at baseline is unlikely to be an important risk factor for colorectal, lung, breast, or prostate cancers.

  • 2015. Eleonor I. Fransson (et al.). Stroke 46 (2), 557-559

    BACKGROUND AND PURPOSE: Psychosocial stress at work has been proposed to be a risk factor for cardiovascular disease. However, its role as a risk factor for stroke is uncertain.

    METHODS: We conducted an individual-participant-data meta-analysis of 196 380 males and females from 14 European cohort studies to investigate the association between job strain, a measure of work-related stress, and incident stroke.

    RESULTS: In 1.8 million person-years at risk (mean follow-up 9.2 years), 2023 first-time stroke events were recorded. The age- and sex-adjusted hazard ratio for job strain relative to no job strain was 1.24 (95% confidence interval, 1.05;1.47) for ischemic stroke, 1.01 (95% confidence interval, 0.75;1.36) for hemorrhagic stroke, and 1.09 (95% confidence interval, 0.94;1.26) for overall stroke. The association with ischemic stroke was robust to further adjustment for socioeconomic status.

    CONCLUSION: Job strain may be associated with an increased risk of ischemic stroke, but further research is needed to determine whether interventions targeting job strain would reduce stroke risk beyond existing preventive strategies.

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

    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.

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

    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.

  • 2013. Linda Magnusson Hanson (et al.). European Journal of Epidemiology 28, S57-S58
Visa alla publikationer av Linda Magnusson Hanson vid Stockholms universitet

Senast uppdaterad: 9 september 2021

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