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  • 51.
    Koyanagi, A.
    et al.
    Universitat de Barcelona, Barcelona, Spain / CIBERSAM, Madrid, Spain.
    Oh, H.
    University of California Berkeley School of Public Health, USA / Pacific Institute for Research and Evaluation, Oakland, USA.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change).
    Haro, J. M.
    Universitat de Barcelona, Barcelona, Spain / CIBERSAM, Madrid, Spain.
    DeVylder, J.
    University of Maryland, Baltimore, USA.
    Risk and functional significance of psychotic experiences among individuals with depression in 44 low- and middle-income countries2016In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 43, no 12, p. 2655-2665Article in journal (Refereed)
    Abstract [en]

    Background: Studies on whether the co-occurrence of psychotic experiences (PEs) and depression confers a more pronounced decrement in health status and function compared with depression alone are scarce in the general adult population. Method: Data on 195 479 adults aged ⩾18 years from the World Health Survey were analysed. Using the World Mental Health Survey version of the Composite International Diagnostic Interview (CIDI), depression in the past 12 months was categorized into four groups: depressive episode, brief depressive episode, subsyndromal depression, and no depression. Past 12-month psychotic symptoms were assessed using four questions on positive symptoms from the CIDI. Health status across seven domains (cognition, interpersonal activities, sleep/energy, self-care, mobility, pain/discomfort, vision) and interviewer-rated presence of a mental health problem were assessed. Multivariable logistic and linear regression analyses were performed to assess the associations. Results: When compared with those with no depression, individuals with depression had higher odds of reporting at least one PE, and this was seen across all levels of depression severity: subsyndromal depression [odds ratio (OR) 2.38, 95% confidence interval (CI) 2.02–2.81], brief depressive episode (OR 3.84, 95% CI 3.31–4.46) and depressive episode (OR 3.75, 95% CI 3.24–4.33). Having coexisting PEs and depression was associated with a higher risk for observable illness behavior and a significant decline in health status in the cognition, interpersonal activities and sleep/energy domains, compared with those with depression alone. Conclusions: This coexistence of depression and PEs is associated with more severe social, cognitive and sleep disturbances, and more outwardly apparent illness behavior. Detecting this co-occurrence may be important for treatment planning.

  • 52.
    Koyanagi, A.
    et al.
    Parc Sanitari Sant Joan de Déu, Barcelona, Spain / Centro de Investigación Biomédica en Red de Salud Mental, Cibersam, Spain .
    Stickley, Andrew
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). The University of Tokyo, Tokyo, Japan .
    Garin, N.
    Parc Sanitari Sant Joan de Déu, Barcelona, Spain / Centro de Investigación Biomédica en Red de Salud Mental, Cibersam, Spain.
    Miret, M.
    Universidad Autónoma de Madrid, Madrid, Spain / Centro de Investigación Biomédica en Red de Salud Mental, Cibersam, Spain / Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain .
    Ayuso-Mateos, J. L.
    Universidad Autónoma de Madrid, Madrid, Spain / Centro de Investigación Biomédica en Red de Salud Mental, Cibersam, Spain / Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, Spain .
    Leonardi, M.
    Neurological Institute Carlo Besta IRCCS Foundation, Milan, Italy.
    Koskinen, S.
    National Institute for Health and Welfare, Helsinki, Finland .
    Galas, A.
    Jagiellonian University Medical College, Krakow, Poland .
    Haro, J. M.
    Parc Sanitari Sant Joan de Déu, Barcelona, Spain / Centro de Investigación Biomédica en Red de Salud Mental, Cibersam, Spain .
    The association between obesity and back pain in nine countries: A cross-sectional study2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, no 1, article id 123Article in journal (Refereed)
    Abstract [en]

    Background: The association between obesity and back pain has mainly been studied in high-income settings with inconclusive results, and data from older populations and developing countries are scarce. The aim of this study was to assess this association in nine countries in Asia, Africa, Europe, and Latin America among older adults using nationally-representative data. Methods: Data on 42116 individuals ≥50 years who participated in the Collaborative Research on Ageing in Europe (COURAGE) study conducted in Finland, Poland, and Spain in 2011-2012, and the World Health Organization's Study on Global Ageing and Adult Health (SAGE) conducted in China, Ghana, India, Mexico, Russia, and South Africa in 2007-2010 were analysed. Information on measured height and weight available in the two datasets was used to calculate Body Mass Index (BMI). Self-reported back pain occurring in the past 30 days was the outcome. Multivariable logistic regression analysis was used to assess the association between BMI and back pain. Results: The prevalence of back pain ranged from 21.5% (China) to 57.5% (Poland). In the multivariable analysis, compared to BMI 18.5-24.9 kg/m2, significantly higher odds for back pain were observed for BMI ≥35 kg/m2 in Finland (OR 3.33), Russia (OR 2.20), Poland (OR 2.03), Spain (OR 1.56), and South Africa (OR 1.48); BMI 30.0-34.0 kg/m2 in Russia (OR 2.76), South Africa (OR 1.51), and Poland (OR 1.47); and BMI 25.0-29.9 kg/m2 in Russia (OR 1.51) and Poland (OR 1.40). No significant associations were found in the other countries. Conclusions: The strength of the association between obesity and back pain may vary by country. Future studies are needed to determine the factors contributing to differences in the associations observed. © 2015 Koyanagi et al.

  • 53.
    Koyanagi, A
    et al.
    Universitat de Barcelona, Barcelona, Spain / CIBERSAM, Madrid, Spain.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change).
    Haro, J M
    Universitat de Barcelona, Barcelona, Spain / CIBERSAM, Madrid, Spain.
    Psychotic symptoms and smoking in 44 countries.2016In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 133, no 6, p. 497-505Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess the association between psychotic symptoms and smoking among community-dwelling adults in 44 countries.

    METHOD: Data from the World Health Survey (WHS) for 192 474 adults aged ≥18 years collected in 2002-2004 were analyzed. The Composite International Diagnostic Interview was used to identify four types of past 12-month psychotic symptoms. Smoking referred to current daily and non-daily smoking. Heavy smoking was defined as smoking ≥30 tobacco products/day.

    RESULTS: The pooled age-sex-adjusted OR (95% CI) of psychotic symptoms (i.e., at least one psychotic symptom) for smoking was 1.35 (1.27-1.43). After adjustment for potential confounders, compared to those with no psychotic symptoms, the ORs (95% CIs) for smoking for 1, 2, and ≥3 psychotic symptoms were 1.20 (1.08-1.32), 1.25 (1.08-1.45), and 1.36 (1.13-1.64) respectively. Among daily smokers, psychotic symptoms were associated with heavy smoking (OR = 1.45, 95% CI = 1.10-1.92), and individuals who initiated daily smoking at ≤15 years of age were 1.22 (95% CI = 1.05-1.42) times more likely to have psychotic symptoms.

    CONCLUSIONS: An increased awareness that psychotic symptoms are associated with smoking is important from a public health and clinical point of view. Future studies that investigate the underlying link between psychotic symptoms and smoking prospectively are warranted.

  • 54.
    Koyanagi, A.
    et al.
    Universitat de Barcelona, Barcelona, Spain / CIBERSAM, Madrid, Spain.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change).
    Haro, J. M.
    Universitat de Barcelona, Barcelona, Spain / CIBERSAM, Madrid, Spain.
    Psychotic-like experiences and disordered eating in the English general population2016In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 241, p. 26-34Article in journal (Refereed)
    Abstract [en]

    There are no studies on psychotic-like experiences (PLEs) and disordered eating in the general population. We aimed to assess this association in the English adult population. Data from the 2007 Adult Psychiatric Morbidity Survey (APMS) were analyzed. This was a nationally representative survey comprising 7403 English adults aged ≥16 years. The Psychosis Screening Questionnaire was used to identify the past 12-month occurrence of five forms of psychotic symptoms. Questions from the five-item SCOFF screening instrument were used to identify those with eating disorder (ED) symptoms and possible ED in the past year. The prevalence of any PLE was 5.1% (female) and 5.4% (male), while that of possible ED was 9.0% (female) and 3.5% (male). After adjustment for potential confounders, possible ED was associated with hypomania/mania in females (OR=3.23 95%CI=1.002-10.39), strange experiences [females (OR=1.85 95%CI=1.07-3.20) and males (OR=3.54 95%CI=1.65-7.57)], and any PLE in males (OR=3.44 95%CI=1.85-6.39). An interaction analysis revealed that the association was stronger among males for: auditory hallucinations and uncontrolled eating; and any PLE with uncontrolled eating, food dominance, and possible ED. Clinical practitioners should be aware that PLEs and disordered eating behavior often coexist. When one condition is detected, screening for the other may be advisable, especially among males.

  • 55.
    Koyanagi, A.
    et al.
    Universitat de Barcelona, Barcelona, Spain / CIBERSAM, Madrid, Spain.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change).
    Haro, J. M.
    Universitat de Barcelona, Barcelona, Spain / CIBERSAM, Madrid, Spain.
    Subclinical psychosis and pain in an English national sample: The role of common mental disorders2016In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 175, no 1-3, p. 209-215Article in journal (Refereed)
    Abstract [en]

    Background: Information on the association between subclinical psychosis and pain is scarce, and the role of common mental disorders (CMDs) in this association is largely unknown. The aim of the current study was to therefore assess this association in the general population using nationally representative data from England. Methods: Data for 7403 adults aged. ≥. 16. years were used from the 2007 Adult Psychiatric Morbidity Survey. Five forms of psychotic symptoms were assessed by the Psychosis Screening Questionnaire, while pain was assessed in terms of the level of its interference with work activity in the past four weeks. The Clinical Interview Schedule Revised (CIS-R) was used to assess anxiety disorders, depressive episode, and mixed anxiety-depressive disorder (MADD). Participants with probable or definite psychosis were excluded. The association between psychotic symptoms and pain was assessed by ordinal and binary logistic regression analysis. Results: When adjusted for confounders other than CMDs, psychotic symptoms were significantly associated with pain [e.g., the OR (95%CI) for the severest form of pain (binary outcome) was 1.78 (1.11-2.85)]. However, this association was no longer significant when CMDs were controlled for in most analyses. Anxiety disorders and depressive episode explained 34.8%-47.1% of the association between psychotic symptoms and pain, while this percentage increased to 62.7%-78.0% when the sub-threshold condition of MADD was also taken into account. Conclusions: When coexisting psychotic symptoms and pain are detected, assessing for anxiety and depression (even at sub-threshold levels) may be important for determining treatment options.

  • 56.
    Koyanagi, A.
    et al.
    Universitat de Barcelona, Spain / SIBERSAM, Madrid, Spain.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). The University of Tokyo, Japan / National Center of Neurology and Psychiatry, Ogawa-Higashi, Japan.
    Haro, J. M.
    Universitat de Barcelona, Spain / SIBERSAM, Madrid, Spain.
    Subclinical psychosis and suicidal behavior in England: Findings from the 2007 Adult Psychiatric Morbidity Survey2015In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 168, no 1-2, p. 62-67Article in journal (Refereed)
    Abstract [en]

    Background: Psychotic disorders have been associated with suicidality but information on the association between subclinical psychosis and suicidality in the general adult population is scarce. Methods: Data from the 2007 Adult Psychiatric Morbidity Survey (n = 7403) were analyzed. This was a nationally representative survey of the English adult household population (aged ≥. 16. years). Five types of psychotic symptoms (hypomania, thought control, paranoia, strange experience, auditory hallucination) occurring in the past 12. months were assessed with the Psychosis Screening Questionnaire. Participants with probable or definite psychosis were excluded. Logistic regression analysis was used to assess the association between psychotic symptoms and suicidal ideation and suicide attempt in the past 12. months. Results: The prevalence of at least one psychotic symptom was 5.4%. After adjusting for potential confounders including mental disorders, each individual psychotic symptom was significantly associated with suicidal ideation with odds ratios (ORs) ranging from 3.22 to 4.20. With the exception of thought control, all symptoms were also associated with significantly higher odds for suicide attempt (ORs 3.95 to 10.23). Having at least one psychotic symptom was associated with ORs of 3.13 (95%CI 2.09-4.68) and 3.84 (95%CI 1.67-8.83) for suicidal ideation and suicide attempt respectively. In addition, a greater number of psychotic symptoms was associated with higher odds for suicidal ideation and suicide attempt. Conclusions: Psychotic symptoms, regardless of the type, were independently associated with higher odds for suicidal ideation and suicide attempt. Assessment and management of suicide risk in individuals with psychotic symptoms may be important for suicide prevention.

  • 57.
    Koyanagi, Ai
    et al.
    Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain / Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.
    Lara, Elvira
    entro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain / Universidad Autónoma de Madrid, Madrid, Spain.
    Stubbs, Brendon
    South London and Maudsley National Health Service Foundation Trust, London, UK / King's College London, London, UK / Anglia Ruskin University, Chelmsford, UK.
    Carvalho, Andre F
    Federal University of Ceará, Fortaleza, Brazil.
    Oh, Hans
    University of Southern California, Los Angeles, California, USA.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change).
    Veronese, Nicola
    National Relevance and High Specialization Hospital, Genova, Italy / National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy.
    Vancampfort, Davy
    Katholieke Universiteit Leuven, Leuven, Belgium.
    Chronic Physical Conditions, Multimorbidity, and Mild Cognitive Impairment in Low- and Middle-Income Countries2018In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 66, no 4, p. 721-727Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To assess the association between chronic physical conditions and multimorbidity and mild cognitive impairment (MCI) in low- and middle-income countries (LMICs).

    DESIGN: Nationally representative, cross-sectional, community-based study.

    SETTING: Six countries that participated in the World Health Organization Study on Global Ageing and Adult Health.

    PARTICIPANTS: Individuals aged 50 and older (N=32,715; mean age 62.1 ± 15.6; 51.7% female).

    MEASUREMENTS: The definition of MCI was based on the recommendations of the National Institute on Ageing and Alzheimer's Association. Ten chronic conditions were assessed (angina pectoris, arthritis, asthma, cataract, chronic lung disease, diabetes mellitus, edentulism, hearing problems, hypertension, stroke). Multivariable logistic regression analysis was conducted to assess the association between chronic physical conditions, multimorbidity (≥2 chronic conditions), and MCI.

    RESULTS: The prevalence of multimorbidity was 49.8% (95% confidence interval (CI)=48.1-51.5%) and of MCI was 15.3% (95% CI=14.4-16.3%). After adjustment for potential confounders, edentulism (odds ratio (OR)=1.24), arthritis (OR=1.24), chronic lung disease (OR=1.29), cataract (OR=1.33), stroke (OR=1.94), hearing problems (OR=2.27), and multimorbidity (OR=1.40) were significantly associated with MCI. There was a gradual increase in the likelihood of MCI (1 condition: OR=1.21, 95% CI=1.03-1.42; ≥4 conditions: OR=2.07, 95% CI=1.70-2.52).

    CONCLUSION: These results highlight the need to investigate the underlying mechanisms linking chronic conditions and MCI and whether prevention or treatment of chronic conditions or multimorbidity can reduce the onset of cognitive decline and subsequent dementia, especially in LMICs.

  • 58.
    Koyanagi, Ai
    et al.
    Universitat de Barcelona, Barcelona, Spain / Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
    Oh, Hans
    University of Southern California, CA, USA.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change).
    Stubbs, Brendon
    South London and Maudsley NHS Foundation Trust, London, United Kingdom / King's College London, London, United Kingdom / Anglia Ruskin University, Chelmsford, United Kingdom.
    Veronese, Nicola
    National Research Council, Padova, Italy / E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genova, Italy.
    Vancampfort, Davy
    KU Leuven, Leuven, Belgium.
    Haro, Josep Maria
    Universitat de Barcelona, Barcelona, Spain / Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
    DeVylder, Jordan E.
    Fordham University, NY, USA.
    Sibship size, birth order and psychotic experiences: Evidence from 43 low- and middle-income countries2018In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 201, p. 406-412Article in journal (Refereed)
    Abstract [en]

    Background Sibship size and birth order may be contributing factors to the multifactorial etiology of psychosis. Specifically, several studies have shown that sibship size and birth order are associated with schizophrenia. However, there are no studies on their association with psychotic experiences (PE). Methods Cross-sectional, community-based data from 43 low- and middle-income countries which participated in the World Health Survey were analyzed. The Composite International Diagnostic Interview was used to identify four types of past 12-month PE. The association of sibship size and birth order with PE was assessed with multivariable logistic regression. Results The final sample consisted of 212,920 adults [mean (SD) age 38.1 (16.0) years; 50.7% females]. In the multivariable analysis, compared to individuals with no siblings, the OR increased linearly from 1.26 (95%CI = 1.01–1.56) to 1.72 (95%CI = 1.41–2.09) among those with 1 and ≥ 9 siblings, respectively. Compared to the first-born, middle-born individuals were more likely to have PE when having a very high number of siblings (i.e. ≥9). Conclusions Future studies should examine the environmental and biological factors underlying the association between sibship size/birth order and PE. Specifically, it may be important to examine the unmeasured factors, such as childhood infections and adversities that may be related to both family structure and PE.

  • 59.
    Koyanagi, Ai
    et al.
    Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). Universitat de Barcelona, Spain / SIBERSAM, Madrid, Spain.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). niversity of Tokyo, Tokyo, Japan / National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.
    The association between psychosis and severe pain in community-dwelling adults: Findings from 44 low- and middle-income countries2015In: Journal of Psychiatric Research, ISSN 0022-3956, E-ISSN 1879-1379, Vol. 69, p. 19-26Article in journal (Refereed)
    Abstract [en]

    Previous studies examining the association between schizophrenia and pain have produced mixed results and data on sub-threshold psychosis or psychotic symptoms and pain are scarce. This study assessed the association between psychosis and severe pain among community-dwelling adults in 44 low- and middle-income countries (LMICs) where no data exists.Data on 235,370 adults aged ≥18 years from the World Health Survey (WHS) 2002-2004 were analyzed. The presence of past 12-month psychotic symptoms was established using four questions from the Composite International Diagnostic Interview. Participants were categorized into four mutually exclusive groups based on whether they had at least one psychotic symptom and/or a lifetime psychosis or schizophrenia diagnosis. Multivariable logistic regression was used to estimate the association between psychosis and past 30-day severe pain. The prevalence of severe pain among those with 0, 1, 2, ≥3 psychotic symptoms was 8.7%, 16.7%, 21.8%, 30.5% respectively. Compared to those with no psychotic symptoms or diagnosis, the ORs (95%CIs) were: at least one symptom without diagnosis [2.17 (1.99-2.38)]; no symptom with diagnosis [2.33 (1.71-3.17)]; at least one symptom and diagnosis [4.27 (3.20-5.71)]. Associations were partly mediated by chronic physical conditions, anxiety, and depression. Despite some limitations such as the use of a single-item question to assess pain, the results of this study suggest that individuals with psychotic symptoms or a psychosis diagnosis should be systematically assessed for pain, and if necessary, receive treatment for pain and its underlying conditions. Future research on the effect of pain management on psychosis outcome is warranted.

  • 60.
    Koyanagi, Ai
    et al.
    Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). Fundacio St Joan de Deu, Parc Sanitari St Joan de Deu, Barcelona, Spain / Inst Salud Carlos III, CIBERSAM, Madrid, Spain.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). University of Tokyo, Tokyo, Japan / Natl Ctr Neurol & Psychiat, Natl Inst Mental Hlth, Tokyo, Japan.
    The Association between Sleep Problems and Psychotic Symptoms in the General Population: A Global Perspective2015In: Sleep, ISSN 0161-8105, E-ISSN 1550-9109, Vol. 38, no 12, p. 1875-1885Article in journal (Refereed)
    Abstract [en]

    Study Objectives: To assess the prevalence of sleep problems and their association with psychotic symptoms using a global database. Design: Community-based cross-sectional study. Setting: Data were analyzed from the World Health Organization's World Health Survey (WHS), a population-based survey conducted in 70 countries between 2002 and 2004. Patients or Participants: 261,547 individuals aged >= 18 years from 56 countries. Interventions: N/A. Measurements and Results: The presence of psychotic symptoms in the past 12 months was established using 4 questions pertaining to positive symptoms from the psychosis screening module of the Composite International Diagnostic Interview. Sleep problems referred to severe or extreme sleep problems in the past 30 days. Multivariable logistic regression was used to estimate the associations. The overall prevalence of sleep problems was 7.6% and ranged from 1.6% (China) to 18.6% (Morocco). Sleep problems were associated with significantly higher odds for at least one psychotic symptom in the vast majority of countries. In the pooled sample, after adjusting for demographic factors, alcohol consumption, smoking, and chronic medical conditions, having sleep problems resulted in an odds ratio (OR) for at least one psychotic symptom of 2.41 (95% confidence interval [CI] 2.18-2.65). This OR was 1.59 (1.40-1.81) when further adjusted for anxiety and depression. Conclusions: A strong association between sleep problems and psychotic symptoms was observed globally. These results have clinical implications and serve as a basis for future studies to elucidate the causal association between psychotic symptoms and sleep problems.

  • 61.
    Koyanagi, Ai
    et al.
    Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain / Instituto de Salud Carlos III, CIBERSAM, Madrid, Spain.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). University of Tokyo, Tokyo, Japan.
    Haro, Josep Maria
    Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain / Instituto de Salud Carlos III, CIBERSAM, Madrid, Spain.
    Psychotic-Like Experiences and Nonsuidical Self-Injury in England: Results from a National Survey2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 12, article id e0145533Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Little is known about the association between psychotic-like experiences (PLEs) and nonsuicidal self-injury (NSSI) in the general adult population. Thus, the aim of this study was to examine the association using nationally-representative data from England.

    METHODS: Data from the 2007 Adult Psychiatric Morbidity Survey was analyzed. The sample consisted of 7403 adults aged ≥16 years. Five forms of PLEs (mania/hypomania, thought control, paranoia, strange experience, auditory hallucination) were assessed with the Psychosis Screening Questionnaire. The association between PLEs and NSSI was assessed by multivariable logistic regression. Hierarchical models were constructed to evaluate the influence of alcohol and drug dependence, common mental disorders, and borderline personality disorder symptoms on this association.

    RESULTS: The prevalence of NSSI was 4.7% (female 5.2% and male 4.2%), while the figures among those with and without any PLEs were 19.2% and 3.9% respectively. In a regression model adjusted for sociodemographic factors and stressful life events, most types of PLE were significantly associated with NSSI: paranoia (OR 3.57; 95%CI 1.96-6.52), thought control (OR 2.45; 95%CI 1.05-5.74), strange experience (OR 3.13; 95%CI 1.99-4.93), auditory hallucination (OR 4.03; 95%CI 1.56-10.42), and any PLE (OR 2.78; 95%CI 1.88-4.11). The inclusion of borderline personality disorder symptoms in the models had a strong influence on the association between PLEs and NSSI as evidenced by a large attenuation in the ORs for PLEs, with only paranoia continuing to be significantly associated with NSSI. Substance dependence and common mental disorders had little influence on the association between PLEs and NSSI.

    CONCLUSIONS: Borderline personality disorder symptoms may be an important factor in the link between PLEs and NSSI. Future studies on PLEs and NSSI should take these symptoms into account.

  • 62.
    Koyanagi, Ai
    et al.
    Universitat de Barcelona, Barcelona, Spain / CIBERSAM, Madrid, Spain / ICREA, Barcelona, Spain.
    Veronese, Nicola
    National Research Council, Padova, Italy / National Institute of Gastroenterology, Bari, Italy.
    Stubbs, Brendon
    South London and Maudsley NHS Foundation Trust, London, UK / King’s College London, London, UK / Anglia Ruskin University, Chelmsford, UK.
    Vancampfort, Davy
    KU Leuven, Leuven, Belgium.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.
    Oh, Hans
    University of Southern California, CA, USA.
    Shin, Jae Il
    Yonsei University College of Medicine, Seul, Korea / Severance Children’s Hospital, Seuo, Korea.
    Jackson, Sarah
    University College London, London, UK.
    Smith, Lee
    Anglia Ruskin University, Cambridge, UK.
    Lara, Elvira
    CIBERSAM, Madrid, Spain / Hospital Universitario de La Princesa, Madrid, Spain.
    Food Insecurity Is Associated with Mild Cognitive Impairment among Middle-Aged and Older Adults in South Africa: Findings from a Nationally Representative Survey.2019In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 11, no 4, article id E749Article in journal (Refereed)
    Abstract [en]

    There are no studies on the association between food insecurity and mild cognitive impairment (MCI). Thus, cross-sectional, community-based data on individuals aged ≥50 years from the World Health Organization's Study on Global AGEing and Adult Health (SAGE) conducted in South Africa (2007⁻2008) were analyzed to assess this association. The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria. Past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable logistic regression analysis was conducted. The sample consisted of 3,672 individuals aged ≥50 years [mean (SD) age 61.4 (18.3); 56% females]. The prevalence of MCI was 8.5%, while 11.0% and 20.8% experienced moderate and severe food insecurity, respectively. After adjustment for potential confounders, moderate and severe food insecurity were associated with 2.82 (95%CI = 1.65⁻4.84) and 2.51 (95%CI = 1.63⁻3.87) times higher odds for MCI compared with no food insecurity, respectively. The OR for those aged ≥65 years with severe food insecurity was particularly high (OR = 3.87; 95%CI = 2.20⁻6.81). In conclusion, food insecurity was strongly associated with MCI among South African older adults. Future longitudinal research is required to assess whether addressing food insecurity may reduce risk of MCI and subsequent dementia.

  • 63.
    Koyanagi, Ai
    et al.
    Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, Barcelona, Spain / ICREA, Barcelona, Spain.
    Veronese, Nicola
    National Research Council, Padova, Italy / National Institute of Gastroenterology “S. De Bellis” Research Hospital, Castellana Grotte, Italy.
    Vancampfort, Davy
    KU Leuven, Leuven, Belgium.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Center of Neurology and Psychiatry, Kodaira, Japan.
    Jackson, Sarah E
    University College London, London, UK.
    Oh, Hans
    University of Southern California, Los Angeles, California, USA.
    Shin, Jae Il
    Yonsei University College of Medicine, Seoul, Republic of Korea.
    Haro, Josep Maria
    Universitat de Barcelona, Fundació Sant Joan de Déu, CIBERSAM, Barcelona, Spain.
    Stubbs, Brendon
    South London and Maudsley NHS Foundation Trust, London, UK / King's College London, London, UK / Anglia Ruskin University, Chelmsford, UK.
    Smith, Lee
    Anglia Ruskin University, Cambridge, UK.
    Association of bullying victimization with overweight and obesity among adolescents from 41 low- and middle-income countries2020In: Pediatric Obesity, ISSN 2047-6302, E-ISSN 2047-6310, Vol. 15, no 1, article id e12571Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Data on the association between overweight/obesity and bullying victimization among adolescents are scarce from low- and middle-income countries.

    OBJECTIVES: We assessed the associations between overweight/obesity and bullying victimization in 41 low- and middle-income countries.

    METHODS: Cross-sectional data from the Global School-based Student Health Survey were analysed. Data on past 30-day bullying victimization (including type) and body mass index based on measured weight and height were collected. The 2007 WHO Child Growth reference was used to define overweight and obesity. Multivariable logistic regression (multinomial and binary) and meta-analyses based on country-wise estimates were conducted. Data on 114 240 adolescents aged 12 to 15 years were analysed (mean age [SD], 13.8 [1.0] y; 48.8% girls).

    RESULTS: Among girls, compared with normal weight, overweight (OR = 1.08; 95% CI, 1.02-1.16; between-country heterogeneity I2  = 0.0%) and obesity (OR = 1.20; 95% CI, 1.07-1.34; I2  = 0.0%) were associated with significantly higher odds for any bullying victimization, but no significant association was observed among boys. However, overweight and obesity were both associated with significantly increased odds for bullying by being made fun of because of physical appearance among both sexes-obesity (vs normal weight): girls OR = 3.42 (95% CI, 2.49-4.71); boys OR = 2.38 (95% CI, 1.67-3.37).

    CONCLUSIONS: Effective strategies to reduce bullying of children with overweight/obesity are needed in low- and middle-income countries.

  • 64.
    Kravchenko, Zhanna
    et al.
    Södertörn University, School of Social Sciences, Sociology.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). University of Tokyo, Japan.
    Koyanagi, Ai
    Univeristy of Barcelona, Spain / Inst Salud Carlos III, CIBERSAM, Madrid, Spain.
    Close Relationships Matter: Family Well-being and its Effects on Health in Russia2015In: Europe-Asia Studies, ISSN 0966-8136, E-ISSN 1465-3427, Vol. 67, no 10, p. 1635-1655Article in journal (Refereed)
    Abstract [en]

    Dramatic fluctuations have occurred in population health in Russia since the collapse of the Soviet Union. Although many factors have been examined in connection with this, there has been little focus on the role of the family, despite evidence from Western studies linking family functioning to individual health. Using data from 1,190 respondents collected during the Moscow Health Survey 2004 we examined the association between family relations and health outcomes. Poorer family functioning was strongly associated with worse self-rated physical health and mental health. Our results suggest that the proximal social environment of the family is important for understanding health outcomes in contemporary Russia.

  • 65. Kulhánová, Ivana
    et al.
    Hoffmann, Rasmus
    Judge, Ken
    Looman, Caspar W N
    Eikemo, Terje A
    Bopp, Matthias
    Deboosere, Patrick
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre on Health of Societies in Transition). National Institute for Health Development, Tallinn, Estonia.
    Martikainen, Pekka
    Rychtaříková, Jitka
    Wojtyniak, Bogdan
    Menvielle, Gwenn
    Mackenbach, Johan P
    Assessing the potential impact of increased participation in higher education on mortality: Evidence from 21 European populations2014In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 117, p. 142-149Article in journal (Refereed)
    Abstract [en]

    Although higher education has been associated with lower mortality rates in many studies, the effect of potential improvements in educational distribution on future mortality levels is unknown. We therefore estimated the impact of projected increases in higher education on mortality in European populations. We used mortality and population data according to educational level from 21 European populations and developed counterfactual scenarios. The first scenario represented the improvement in the future distribution of educational attainment as expected on the basis of an assumption of cohort replacement. We estimated the effect of this counterfactual scenario on mortality with a 10-15-year time horizon among men and women aged 30-79 years using a specially developed tool based on population attributable fractions (PAF). We compared this with a second, upward levelling scenario in which everyone has obtained tertiary education. The reduction of mortality in the cohort replacement scenario ranged from 1.9 to 10.1% for men and from 1.7 to 9.0% for women. The reduction of mortality in the upward levelling scenario ranged from 22.0 to 57.0% for men and from 9.6 to 50.0% for women. The cohort replacement scenario was estimated to achieve only part (4-25% (men) and 10-31% (women)) of the potential mortality decrease seen in the upward levelling scenario. We concluded that the effect of on-going improvements in educational attainment on average mortality in the population differs across Europe, and can be substantial. Further investments in education may have important positive side-effects on population health.

  • 66.
    Kulhánová, Ivana
    et al.
    Erasmus Medical Center, Rotterdam, Netherlands .
    Menvielle, Gwenn
    Pierre Louis Institute of Epidemiology and Public Health, Paris, France .
    Bopp, Matthias
    University of Zürich, Zürich, Switzerland .
    Borrell, Carme
    Agència de Salut Pública de Barcelona, Barcelona, Spain .
    Deboosere, Patrick
    Universiteit Brussel, Brussels, Belgium .
    Eikemo, Terje A
    Erasmus Medical Center, Rotterdam, Netherlands / Norwegian University of Science and Technology, Trondheim, Norway.
    Hoffmann, Rasmus
    Erasmus Medical Center, Rotterdam, Netherlands .
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute for Health Development, Tallinn, Estonia .
    Martikainen, Pekka
    University of Helsinki, Helsinki, Finland .
    Regidor, Enrique
    Universidad Complutense de Madrid, Madrid, Spain .
    Rodríguez-Sanz, Maica
    Agència de Salut Pública de Barcelona, Barcelona, Spain .
    Rychtaříková, Jitka
    Charles University in Prague, Prague, Czech Republic .
    Wojtyniak, Bogdan
    National Institute of Public Health, National Institute of Hygiene, Warsaw, Poland .
    Mackenbach, Johan P
    Erasmus Medical Center, Rotterdam, Netherlands .
    Socioeconomic differences in the use of ill-defined causes of death in 16 European countries2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, article id 1295Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cause-of-death data linked to information on socioeconomic position form one of the most important sources of information about health inequalities in many countries. The proportion of deaths from ill-defined conditions is one of the indicators of the quality of cause-of-death data. We investigated educational differences in the use of ill-defined causes of death in official mortality statistics.

    METHODS: Using age-standardized mortality rates from 16 European countries, we calculated the proportion of all deaths in each educational group that were classified as due to "Symptoms, signs and ill-defined conditions". We tested if this proportion differed across educational groups using Chi-square tests.

    RESULTS: The proportion of ill-defined causes of death was lower than 6.5% among men and 4.5% among women in all European countries, without any clear geographical pattern. This proportion statistically significantly differed by educational groups in several countries with in most cases a higher proportion among less than secondary educated people compared with tertiary educated people.

    CONCLUSIONS: We found evidence for educational differences in the distribution of ill-defined causes of death. However, the differences between educational groups were small suggesting that socioeconomic inequalities in cause-specific mortality in Europe are not likely to be biased.

  • 67.
    Kulhánová, Ivana
    et al.
    Erasmus Medical Center, Rotterdam, The Netherlands.
    Menvielle, Gwenn
    Sorbonne Universités, UPMC University Paris 06, Paris, France.
    Hoffmann, Rasmus
    Erasmus Medical Center, Rotterdam, The Netherlands.
    Eikemo, Terje A
    Erasmus Medical Center, Rotterdam, The Netherlands / Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
    Kulik, Margarete C
    Erasmus Medical Center, Rotterdam, The Netherlands.
    Toch-Marquardt, Marlen
    Erasmus Medical Center, Rotterdam, The Netherlands / Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
    Deboosere, Patrick
    Vrije Universiteit Brussel, Brussels, Belgium.
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute for Health Development, Tallin, Estonia.
    Lundberg, Olle
    Stockholm University.
    Regidor, Enrique
    Universidad Complutense de Madrid, Madrid, Spain.
    Looman, Caspar W N
    Erasmus Medical Center, Rotterdam, The Netherlands.
    Mackenbach, Johan P
    Erasmus Medical Center, Rotterdam, The Netherlands.
    The role of three lifestyle risk factors in reducing educational differences in ischaemic heart disease mortality in Europe2017In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 27, no 2, p. 203-210Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Ischaemic heart disease (IHD) is one of the leading causes of death worldwide with a higher risk of dying among people with a lower socioeconomic status. We investigated the potential for reducing educational differences in IHD mortality in 21 European populations based on two counterfactual scenarios-the upward levelling scenario and the more realistic best practice country scenario.

    METHODS: We used a method based on the population attributable fraction to estimate the impact of a modified educational distribution of smoking, overweight/obesity, and physical inactivity on educational inequalities in IHD mortality among people aged 30-79. Risk factor prevalence was collected around the year 2000 and mortality data covered the early 2000s.

    RESULTS: The potential reduction of educational inequalities in IHD mortality differed by country, sex, risk factor and scenario. Smoking was the most important risk factor among men in Nordic and eastern European populations, whereas overweight and obesity was the most important risk factor among women in the South of Europe. The effect of physical inactivity on the reduction of inequalities in IHD mortality was smaller compared with smoking and overweight/obesity. Although the reduction in inequalities in IHD mortality may seem modest, substantial reduction in IHD mortality among the least educated can be achieved under the scenarios investigated.

    CONCLUSION: Population wide strategies to reduce the prevalence of risk factors such as smoking, and overweight/obesity targeted at the lower socioeconomic groups are likely to substantially contribute to the reduction of IHD mortality and inequalities in IHD mortality in Europe.

  • 68. Kulik, MC
    et al.
    Hoffmann, R
    Judge, K
    Looman, C
    Menvielle, G
    Kulhánová, I
    Toch, M
    Östergren, O
    Martikainen, P
    Borrell, C
    Rodríguez-Sanz, M
    Bopp, M
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre on Health of Societies in Transition). National Institute for Health Development, Tallinn.
    Jasilionis, D
    Eikemo, TA
    Mackenbach, JP
    Smoking and the potential for reduction of inequalities in mortality in Europe2013In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 28, p. 959-971Article in journal (Refereed)
  • 69.
    Kulik, MC
    et al.
    Erasmus Medical Center, Rotterdam, The Netherlands.
    Menvielle, G
    Epidemiology of Occupational and Social Determinants of Health, Villejuif, France / University of Versailles Saint Quentin, Versailles, France.
    Eikemo, TA
    Erasmus Medical Center, Rotterdam, The Netherlands.
    Bopp, M
    University of Zurich, Zurich, Switzerland.
    Jasilionis, D
    Max Planck Institute for Demographic Research, Rostock, Germany.
    Kulhánová, I
    Erasmus Medical Center, Rotterdam, The Netherlands.
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre on Health of Societies in Transition). National Institute for Health Development, Tallinn, Estonia.
    Martikainen, P
    University of Helsinki, Helsinki, Finland.
    Östergren, O
    CHESS, Stockholm University/Karolinska Institutet.
    Mackenbach, JP
    Erasmus Medical Center, Rotterdam, The Netherlands.
    Educational inequalities in three smoking-related causes of death in 18 European populations2014In: Nicotine & tobacco research, ISSN 1462-2203, E-ISSN 1469-994X, Vol. 16, no 5, p. 507-518Article in journal (Refereed)
    Abstract [en]

    Introduction: Smoking is an important determinant of socioeconomic inequalities in mortality in many countries. As the smoking epidemic progresses, updates on the development of mortality inequalities attributable to smoking are needed. We provide estimates of relative and absolute educational inequalities in mortality from lung cancer, aerodigestive cancers, and chronic obstructive pulmonary disease (COPD)/asthma in Europe and assess the contribution of these smoking-related diseases to inequalities in all-cause mortality.

    Methods: We use data from 18 European populations covering the time period 1998–2007. We present age-adjusted mortality rates, relative indices of inequality, and slope indices of inequality. We also calculate the contribution of inequalities in smoking-related mortality to inequalities in overall mortality.

    Results: Among men, relative inequalities in mortality from the 3 smoking-related causes of death combined are largest in the Czech Republic and Hungary and smallest in Spain, Sweden, and Denmark. Among women, these inequalities are largest in Scotland and Norway and smallest in Italy and Spain. They are often larger among men and tend to be larger for COPD/asthma than for lung and aerodigestive cancers. Relative inequalities in mortality from these conditions are often larger in younger age groups, particularly among women, suggesting a possible further widening of inequalities in mortality in the coming decades. The combined contribution of these diseases to inequality in all-cause mortality varies between 13% and 32% among men and between −5% and 30% among women.

    Conclusion: Our results underline the continuing need for tobacco control policies, which take into account socioeconomic position.              

  • 70.
    Lai, Taavi
    et al.
    Fourth View Consulting, Tallinn, Estonia.
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute for Health Development in Tallinn, Estonia.
    Trends and inequalities in mortality of noncommunicable diseases. Case study for Estonia2015Report (Other academic)
    Abstract [en]

    This case study aims to provide a comprehensive overview of trends and inequalities in mortality of noncommunicable diseases in Estonia over the first decade of the 2000s. Decomposition of life expectancy by causes and age groups, and calculation of age-standardized rates for total and cause-specific mortality were used to assess differences over time and across social groups. The findings of the analysis showed significant overall reduction in mortality and increasing life expectancy in Estonia during the 2000s. The considerable improvement in mortality was observed in all groups distinguished by gender, ethnicity, educational level or by place of residence resulting in narrowing absolute inequalities, although the relative inequalities by educational level and by place of residence slightly increased. Despite progress, mortality rates remained higher among non-Estonians, the lower educated and residents of Ida-Viru county. Circulatory diseases and external causes of death contributed the most to the overall life expectancy at birth improvement and to the larger mortality decline among non-Estonians, the lower educated and in Ida-Viru county, with the opposite effect seen for infectious diseases.

  • 71.
    Laidra, K.
    et al.
    National Institute for Health Development, Tallinn, Estonia.
    Rahu, K.
    National Institute for Health Development, Tallinn, Estonia.
    Tekkel, M.
    National Institute for Health Development, Tallinn, Estonia.
    Aluoja, A.
    University of Tartu, Tartu, Estonia.
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute for Health Development, Tallinn, Estonia.
    Mental health and alcohol problems among Estonian cleanup workers 24 years after the Chernobyl accident2015In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 50, no 11, p. 1753-1760Article in journal (Refereed)
  • 72.
    Laidra, Kaia
    et al.
    National Institute for Health Development, Tallinn, Estonia.
    Rahu, Kaja
    National Institute for Health Development, Tallinn, Estonia.
    Kalaus, Katri-Evelin
    Center of Psychiatry and Psychotherapy SENSUS, Tallinn, Estonia.
    Tekkel, Mare
    National Institute for Health Development, Tallinn, Estonia.
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute for Health Development, Tallinn, Estonia.
    Mental disorders among Chernobyl cleanup workers from Estonia: A clinical assessment.2017In: Psychological Trauma, ISSN 1942-9681, E-ISSN 1942-969X, Vol. 9, no Suppl 1, p. 93-97Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess, at a clinical level, the mental health of former Chernobyl cleanup workers from Estonia by comparing them with same-age controls.

    METHOD: The Mini International Neuropsychiatric Interview (MINI) was administered during 2011-2012 to 99 cleanup workers and 100 population-based controls previously screened for mental health symptoms.

    RESULTS: Logistic regression analysis showed that cleanup workers had higher odds of current depressive disorder (odds ratio [OR] = 3.07, 95% confidence interval [CI: 1.34, 7.01]), alcohol dependence (OR = 3.47, 95% CI [1.29, 9.34]), and suicide ideation (OR = 3.44, 95% CI [1.28, 9.21]) than did controls. Except for suicide ideation, associations with Chernobyl exposure became statistically nonsignificant when adjusted for education and ethnicity.

    CONCLUSION: A quarter of a century after the Chernobyl accident, Estonian cleanup workers were still at increased risk of mental disorders, which was partly attributable to sociodemographic factors. (PsycINFO Database Record

  • 73.
    Larsen, Anna
    et al.
    Karolinska Institutet.
    Lilja, Marie
    Karolinska Institutet.
    Sturidsson, Knut
    Karolinska Institutet / Säter Forensic Psychiatric Clinic.
    Blatny, Marek
    Institute of Psychology of the Czech Academy of Sciences, Brno, Czech Republic..
    Hrdlicka, Michal
    University Hospital Motol, Prague, Czech Republic..
    Stickley, Andrew
    Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change).
    Ruchkin, Vladislav
    Uppsala Univeristy / Yale University Medical School, New Haven, USA / Säter Forensic Psychiatric Clinic.
    Bulimia symptoms in Czech youth: prevalence and association with internalizing problems2019In: Eating and Weight Disorders, ISSN 1124-4909, E-ISSN 1590-1262Article in journal (Refereed)
    Abstract [en]

    Objective Although clinical studies suggest that bulimia symptoms are common in youth, research on the prevalence of such symptoms and of their association with comorbid internalizing problems in the general population has been limited. This study aimed to evaluate the gender-specific prevalence of bulimia symptoms in Czech youth and explored the association between a clinical level of self-reported bulimia symptoms (CLBS) and internalizing problems by gender, controlling for age, socio-economic status and puberty status. Method The study was conducted on a representative national sample of Czech youth (N = 4430, 57.0% female) using self-report scales. Multivariate analysis of covariance (MANCOVA) was used to examine the associations. Results The 3-month CLBS prevalence was higher in girls (11.4%) than in boys (3.8%) and in both genders a CLBS was associated with higher levels of comorbid internalizing problems. Discussion Timely recognition of bulimia symptoms and associated risk factors is important for early prevention and intervention strategies.

  • 74.
    Leinsalu, Mall
    et al.
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute for Health Development, Tallinn, Estonia.
    Reile, Rainer
    National Institute for Health Development, Tallinn, Estonia.
    Stickley, Andrew
    Södertörn University, School of Culture and Education. National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
    Economic fluctuations and long-term trends in depression: a repeated cross-sectional study in Estonia 2004-20162019In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 73, no 11, p. 1026-1032Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In the 2000s, the Baltic countries experienced unprecedented credit-driven economic growth that was followed by a deep recession. This study examined the impact of profound macroeconomic changes on population mental health in Estonia in 2004-2016.

    METHODS: Data on 17 794 individuals in the 20-64 age group were obtained from seven nationally representative cross-sectional surveys. The prevalence of past 30-day depression was calculated for men and women further stratified by sociodemographic characteristics. Multivariable regression analysis was used to assess whether these characteristics were associated with the yearly variation in depression.

    RESULTS: In 2006, the adjusted prevalence ratio for depression was 0.77 (95% CI 0.64 to 0.93) for men and 0.85 (95% CI 0.74 to 0.97) for women as compared with 2004; in 2010, the prevalence ratio as compared with 2008 for both men and women was 1.22 (95% CIs 1.04 to 1.43 and 1.09 to 1.37, respectively). Among men, the increase in the prevalence of depression in 2008-2010 was statistically significant for 35-64 year olds, ethnic Estonians, those who were married, mid-educated or were employed, whereas among women, a significant increase was observed in 50-64 year olds, Estonians and non-Estonians, those who were not-married, were highly educated or mid-educated, in the mid-income group or were employed.

    CONCLUSIONS: Population mental health is responsive to macroeconomic changes. In less wealthy high-income countries, the greater impact of recession on depression among advantaged groups may relate to a higher debt burden coupled with job insecurity.

  • 75.
    Leinsalu, Mall
    et al.
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute for Health Development, Tallinn, Estonia.
    Reile, Rainer
    National Institute for Health Development, Tallinn, Estonia.
    Vals, Kaire
    National Institute for Health Development, Tallinn, Estonia.
    Petkeviciene, Janina
    Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Tekkel, Mare
    National Institute for Health Development, Tallinn, Estonia.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change).
    Macroeconomic changes and trends in dental care utilization in Estonia and Lithuania in 2004-2012: a repeated cross-sectional study2018In: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 18, no 1, article id 199Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The aim of this study was to assess trends and inequalities in dental care utilization in Estonia and Lithuania in relation to large-scale macroeconomic changes in 2004-2012.

    METHODS: Data on 22,784 individuals in the 20-64 age group were retrieved from nationally representative cross-sectional surveys in 2004, 2006, 2008, 2010 and 2012. Age- and sex-standardized prevalence estimates of past 12-month dental visits were calculated for each study year, stratified by gender, age group, ethnicity, educational level and economic activity. Multivariable logistic regression analysis was used to assess the independent effect of study year and socioeconomic status on dental visits.

    RESULTS: The age- and sex-standardized prevalence of dental visits in the past 12 months was 46-52% in Estonia and 61-67% in Lithuania. In 2004-2008, the prevalence of dental visits increased by 5.9 percentage points in both countries and fell in 2008-2010 by 3.8 percentage points in Estonia and 4.6 percentage points in Lithuania. In both countries the prevalence of dental care utilization had increased slightly by 2012, although the increase was statistically insignificant. Results from a logistic regression analysis showed that these differences between study years were not explained by differences in socioeconomic status or oral health conditions. Women, the main ethnic group (only in Estonia), and higher educated and employed persons had significantly higher odds of dental visits in both countries, but the odds were lower for 50-64 year olds in Lithuania.

    CONCLUSIONS: In European Union countries with lower national wealth, the use of dental services is sensitive to macroeconomic changes regardless of the extent of public coverage, at the same time, higher public coverage may not relate to lower inequalities in dental care use.

  • 76.
    Leinsalu, Mall
    et al.
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute for Health Development, Tallinn, Estonia.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). University of Tokyo, Japan.
    Kunst, Anton E
    University of Amsterdam, the Netherlands.
    Reduced affordability of cigarettes and socio-economic inequalities in smoking continuation in Stakhanov, Ukraine, 20092015In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 25, no 2, p. 216-218Article in journal (Refereed)
    Abstract [en]

    The recent tobacco excise tax increase and economic crisis reduced cigarette affordability in Ukraine dramatically. Using survey data from Stakhanov (n = 1691), eastern Ukraine, we employed logistic regression analysis to examine whether socio-economic status was associated with the continuation of smoking in this environment in 2009. Low education (in women) and ownership of household assets (in men) were negatively associated with smoking continuation, whereas a positive association was found for personal monthly income. Our findings suggest that in a low-income setting where efficient cessation services are absent, reduced cigarette affordability may have only a limited effect in cutting down smoking.

  • 77. Lim, Stephen S
    et al.
    Allen, Kate
    Bhutta, Zulfiqar A
    Dandona, Lalit
    Forouzanfar, Mohammad H
    Fullman, Nancy
    Gething, Peter W
    Goldberg, Ellen M
    Hay, Simon I
    Holmberg, Mollie
    Kinfu, Yohannes
    Kutz, Michael J
    Larson, Heidi J
    Liang, Xiaofeng
    Lopez, Alan D
    Lozano, Rafael
    McNellan, Claire R
    Mokdad, Ali H
    Mooney, Meghan D
    Naghavi, Mohsen
    Olsen, Helen E
    Pigott, David M
    Salomon, Joshua A
    Vos, Theo
    Wang, Haidong
    Abajobir, Amanuel Alemu
    Abate, Kalkidan Hassen
    Abbafati, Cristiana
    Abbas, Kaja M
    Abd-Allah, Foad
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    Latif, Asma Abdul
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    Leigh, James
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute for Health Development, Tallinn, Estonia.
    Leung, Janni
    Leung, Ricky
    Levi, Miriam
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    Mirarefin, Mojde
    Misganaw, Awoke
    Mitchell, Philip B
    Mock, Charles N
    Mohammadi, Alireza
    Mohammed, Shafiu
    Monasta, Lorenzo
    de la Cruz Monis, Jonathan
    Hernandez, Julio Cesar Montañez
    Montico, Marcella
    Moradi-Lakeh, Maziar
    Morawska, Lidia
    Mori, Rintaro
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    Murimira, Brighton
    Murray, Joseph
    Murthy, Gudlavalleti Venkata Satyanarayana
    Murthy, Srinivas
    Musa, Kamarul Imran
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    Xu, Gelin
    Yadav, Ajit Kumar
    Yakob, Bereket
    Yalew, Ayalnesh Zemene
    Yan, Lijing L
    Yano, Yuichiro
    Yaseri, Mehdi
    Ye, Pengpeng
    Yip, Paul
    Yonemoto, Naohiro
    Yoon, Seok-Jun
    Younis, Mustafa Z
    Yu, Chuanhua
    Zaidi, Zoubida
    El Sayed Zaki, Maysaa
    Zambrana-Torrelio, Carlos
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    Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 20152016In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 388, no 10053, p. 1813-1850Article in journal (Refereed)
    Abstract [en]

    BackgroundIn September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015).

  • 78.
    Lipsicas, C. B.
    et al.
    Karolinska Institute.
    Mäkinen, Ilkka Henrik
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). Uppsala University.
    Wasserman, D.
    Karolinska Institute / Collaborating Centre of Mental Health Problems and Suicide Across Europe, Stockholm.
    Apter, A.
    Schneider Children Medical Center, Petah-Tikva, Israel .
    Kerkhof, A.
    Vrije Universiteit, Amsterdam, Netherlands .
    Michel, K.
    University Psychiatric Services, Bern, Switzerland .
    Renberg, E. S.
    Umeå University.
    Van Heeringen, K.
    University Hospital, Gent, Belgium .
    Värnik, A.
    Estonian-Swedish Mental Health and Suicidology Institute,Tallinn, Estonia / Tallinn University,Tallinn, Estonia .
    Schmidtke, A.
    University of Würzburg, Würzburg, Germany .
    Repetition of attempted suicide among immigrants in Europe2014In: Canadian journal of psychiatry, ISSN 0706-7437, Vol. 59, no 10, p. 539-547Article in journal (Refereed)
    Abstract [en]

    Objectives: To compare frequencies of suicide attempt repetition in immigrants and local European populations, and the timing of repetition in these groups. Method: Data from 7 European countries, comprising 10 574 local and 3032 immigrant subjects, were taken from the World Health Organization European Multicentre Study on Suicidal Behaviour and the ensuing Monitoring Suicidal Behaviour in Europe (commonly referred to as MONSUE) project. The relation between immigrant status and repetition of suicide attempt within 12-months following first registered attempt was analyzed with binary logistic regression, controlling for sex, age, and method of attempt. Timing of repetition was controlled for sex, age, and the recommended type of aftercare. Results: Lower odds of repeating a suicide attempt were found in Eastern European (OR 0.50; 95% CI 0.41 to 0.61, P < 0.001) and non-European immigrants (OR 0.68; 95% CI 0.51 to 0.90, P < 0.05), compared with the locals. Similar patterns were identified in the sex-specific analysis. Eastern European immigrants tended to repeat their attempt much later than locals (OR 0.58; 95% CI 0.35 to 0.93, P < 0.05). In general, 32% of all repetition occurred within 30 days. Repetition tended to decrease with age and was more likely in females using harder methods in their index attempt (OR 1.29; 95% CI 1.08 to 1.54, P < 0.01). Large variations in the general repetition frequency were identified between the collecting centres, thus influencing the results. Conclusions: The lower repetition frequencies in non-Western immigrants, compared with locals, in Europe stands in contrast to their markedly higher tendency to attempt suicide in general, possibly pointing to situational stress factors related to their suicidal crisis that are less persistent over time. Our findings also raise the possibility that suicide attempters and repeaters constitute only partially overlapping populations.

  • 79. Lipsicas, Cendrine Bursztein
    et al.
    Mäkinen, Ilkka Henrik
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre on Health of Societies in Transition).
    Wasserman, Danuta
    Apter, Alan
    Bobes, Julio
    Kerkhof, Ad
    Michel, Konrad
    Renberg, Ellinor Salander
    van Heeringen, Kees
    Vaernik, Airi
    Schmidtke, Armin
    Immigration and recommended care after a suicide attempt in Europe: equity or bias?2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no 1, p. 63-65Article in journal (Refereed)
    Abstract [en]

    This report describes the investigation of care recommendations in the medical system across European countries to immigrants who attempted suicide. Data from seven European countries with 8865 local and 2921 immigrant person-cases were derived from the WHO/EURO Multicentre Study on Suicidal Behaviour and ensuing MONSUE (Monitoring Suicidal Behaviour in Europe) project. The relationship between immigrant status and type of aftercare recommended was analysed with binary logistic regression, adjusting for gender, age, method of attempt and the Centre collecting the data. Clear disparities were identified in the care recommendation practices toward immigrants, compared with hosts, over and above differing policies by the European Centres.

  • 80. Lipsicas, Cendrine Bursztein
    et al.
    Mäkinen, Ilkka Henrik
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre on Health of Societies in Transition).
    Wasserman, Danuta
    Apter, Alan
    Kerkhof, Ad
    Michel, Konrad
    Renberg, Ellinor Salander
    van Heeringen, Kees
    Varnik, Airi
    Schmidtke, Armin
    Gender distribution of suicide attempts among immigrant groups in European countries-an international perspective2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no 2, p. 279-284Article in journal (Refereed)
    Abstract [en]

    Background: Studies report high rates of suicide attempts for female immigrants. This study assesses variations in the distribution of suicide attempts across gender in immigrant and non-immigrant groups in Europe. Method: Data on 64 native and immigrant groups, including 17 662 local and 3755 immigrant person-cases collected, between 1989 and 2003, in 24 million person-years were derived from the WHO/EURO Multicentre Study on Suicidal Behaviour. Female-to-male ratios of suicide attempt rates (SARs) were calculated for all groups. Results: The cases were combined into four major categories: hosts; European and other Western immigrants; non-European immigrants; and Russian immigrants. The non-European immigrants included higher female SARs than the Europeans, both hosts and immigrants. Unlike the other groups, the majority of suicide attempters among the Russian immigrants in Estonia and Estonian hosts were male. This was also true for immigrants from Curacao, Iran, Libya and Sri Lanka. When the single groups with a male majority were excluded, the correlation between female and male SARs was relatively high among the European immigrants (r = 0.74, P < 0.0005) and lower among the non-European immigrants (r = 0.55, P < 0.03). Generalized estimating equation analysis yielded a highly significant difference (P < 0.0005) in gender ratios of suicide attempts between hosts (ratio 1.52) and both non-European immigrants (ratio 2.32) and Russian immigrants (0.68), but not the European immigrants. Conclusions: The higher suicide attempt rates in non-European immigrant females compared with males may be indicative of difficulties in the acculturation processes in Europe. Further understanding of factors underlying suicidal behaviour in immigrant and minority groups is necessary for planning effective prevention strategies.

  • 81.
    Lorant, Vincent
    et al.
    Université Catholique de Louvain, Brussels, Belgium.
    de Gelder, Rianne
    Erasmus MC, Rotterdam, the Netherlands.
    Kapadia, Dharmi
    University of Manchester, Manchester, UK.
    Borrell, Carme
    Agència de Salut Pública de Barcelona, Barcelona, Spain.
    Kalediene, Ramune
    Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Kovács, Katalin
    Demographic Research Institute of the Central Statistical Office, Budapest, Hungary.
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute for Health Development, Tallinn, Estonia.
    Martikainen, Pekka
    Department of Sociology, University of Helsinki, Finland.
    Menvielle, Gwenn
    Sorbonne Universités, Paris, France.
    Regidor, Enrique
    Universidad Complutense de Madrid, Spain.
    Rodríguez-Sanz, Maica
    Agència de Salut Pública de Barcelona, Barcelona, Spain.
    Wojtyniak, Bogdan
    National Institute of Public Health, National Institute of Hygiene, Warsaw, Poland.
    Strand, Bjørn Heine
    Norwegian Institute of Public Health, Oslo, Norway.
    Bopp, Matthias
    University of Zürich, Switzerland.
    Mackenbach, Johan P
    Erasmus MC, Rotterdam, the Netherlands.
    Socioeconomic inequalities in suicide in Europe: the widening gap2018In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 212, no 6, p. 356-361Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Suicide has been decreasing over the past decade. However, we do not know whether socioeconomic inequality in suicide has been decreasing as well.AimsWe assessed recent trends in socioeconomic inequalities in suicide in 15 European populations.

    METHOD: The DEMETRIQ study collected and harmonised register-based data on suicide mortality follow-up of population censuses, from 1991 and 2001, in European populations aged 35-79. Absolute and relative inequalities of suicide according to education were computed on more than 300 million person-years.

    RESULTS: In the 1990s, people in the lowest educational group had 1.82 times more suicides than those in the highest group. In the 2000s, this ratio increased to 2.12. Among men, absolute and relative inequalities were substantial in both periods and generally did not decrease over time, whereas among women inequalities were absent in the first period and emerged in the second.

    CONCLUSIONS: The World Health Organization (WHO) plan for 'Fair opportunity of mental wellbeing' is not likely to be met.Declaration of interestNone.

  • 82.
    Lozano, Rafael
    et al.
    University of Washington, US.
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute for Health Development, Tallin, Estonia.
    Murray, Christopher J. L.
    University of Washington, US / Christian Medical College & Hospital (CMCH) Vellore, India.
    Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 20172018In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 392, no 10159, p. 2091-2138Article in journal (Refereed)
    Abstract [en]

    Background Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of "leaving no one behind", it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health -related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990-2017, projected indicators to 2030, and analysed global attainment. 

    Methods We measured progress on 41 health-related S DG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health related SDG index, we transformed the value for each indicator on a scale of 0-100, with 0 as the 2.5th percentile and 100 as the 97.5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. 

    Findings The global median health-related SDG index in 2017 was 59.4 (IQR 35.4-67.3), ranging from a low of 11.6 (95% uncertainty interval 9.6-14.0) to a high of 84.9 (83.1-86.7). SDG index values in countries assessed at the subnational level varied substantially particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attaimnent by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030.

    Interpretation The GBD study offers a unique, robust platform for monitoring the health -related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health -related SDG indicators, NCDs, NCD-related risks, and violence -related indicators will require a concerted shift away from what might have driven past gains curative interventions in the case of NCDs towards multisectoral, prevention -oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the S DGs. What is clear is that our actions or inaction today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030. 

  • 83.
    Löfving–Gupta, S.
    et al.
    Uppsala University.
    Lindblad, F.
    Uppsala University.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change).
    Schwab-Stone, M.
    Yale University Medical SchoolNew Haven, CT, United States .
    Ruchkin, V.
    Uppsala University / Yale University Medical SchoolNew Haven, CT, United States / Säter Forensic Psychiatric Clinic, Säter, Sweden .
    Community violence exposure and severe posttraumatic stress in suburban American youth: risk and protective factors2015In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 50, no 4, p. 539-547Article in journal (Refereed)
    Abstract [en]

    Purpose: The psychological effects of community violence exposure among inner-city youth are severe, yet little is known about its prevalence and moderators among suburban middle-class youth. This study aimed to assess the prevalence of community violence exposure among suburban American youth, to examine associated posttraumatic stress and to evaluate factors related to severe vs. less severe posttraumatic stress, such as co-existing internalizing and externalizing problems, as well as the effects of teacher support, parental warmth and support, perceived neighborhood safety and conventional involvement in this context. Method: Data were collected from 780 suburban, predominantly Caucasian middle-class high-school adolescents in the Northeastern US during the Social and Health Assessment (SAHA) study. Results: A substantial number of suburban youth were exposed to community violence and 24 % of those victimized by community violence developed severe posttraumatic stress. Depressive symptoms were strongly associated with higher levels and perceived teacher support with lower levels of posttraumatic stress. Conclusion: Similar to urban youth, youth living in suburban areas in North American settings may be affected by community violence. A substantial proportion of these youth reports severe posttraumatic stress and high levels of comorbid depressive symptoms. Teacher support may have a protective effect against severe posttraumatic stress and thus needs to be further assessed as a potential factor that can be used to mitigate the detrimental effects of violence exposure.

  • 84. Mackenbach, J. P.
    et al.
    Kulhánová, I.
    Bopp, M.
    Deboosere, P.
    Eikemo, T. A.
    Hoffmann, R.
    Kulik, M. C.
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute for Health Development, Tallinn, Estonia .
    Martikainen, P.
    Menvielle, G.
    Regidor, E.
    Wojtyniak, B.
    Östergren, O.
    Lundberg, O.
    Variations in the relation between education and cause-specific mortality in 19 European populations: A test of the "fundamental causes" theory of social inequalities in health2015In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, no 127, p. 51-62Article in journal (Refereed)
    Abstract [en]

    Link and Phelan have proposed to explain the persistence of health inequalities from the fact that socioeconomic status is a "fundamental cause" which embodies an array of resources that can be used to avoid disease risks no matter what mechanisms are relevant at any given time. To test this theory we compared the magnitude of inequalities in mortality between more and less preventable causes of death in 19 European populations, and assessed whether inequalities in mortality from preventable causes are larger in countries with larger resource inequalities. We collected and harmonized mortality data by educational level on 19 national and regional populations from 16 European countries in the first decade of the 21st century. We calculated age-adjusted Relative Risks of mortality among men and women aged 30-79 for 24 causes of death, which were classified into four groups: amenable to behavior change, amenable to medical intervention, amenable to injury prevention, and non-preventable. Although an overwhelming majority of Relative Risks indicate higher mortality risks among the lower educated, the strength of the education-mortality relation is highly variable between causes of death and populations. Inequalities in mortality are generally larger for causes amenable to behavior change, medical intervention and injury prevention than for non-preventable causes. The contrast between preventable and non-preventable causes is large for causes amenable to behavior change, but absent for causes amenable to injury prevention among women. The contrast between preventable and non-preventable causes is larger in Central & Eastern Europe, where resource inequalities are substantial, than in the Nordic countries and continental Europe, where resource inequalities are relatively small, but they are absent or small in Southern Europe, where resource inequalities are also large. In conclusion, our results provide some further support for the theory of "fundamental causes". However, the absence of larger inequalities for preventable causes in Southern Europe and for injury mortality among women indicate that further empirical and theoretical analysis is necessary to understand when and why the additional resources that a higher socioeconomic status provides, do and do not protect against prevailing health risks.

  • 85.
    Mackenbach, J. P.
    et al.
    Erasmus MC, Rotterdam, The Netherlands.
    Rubio Valverde, J.
    Erasmus MC, Rotterdam, The Netherlands.
    Bopp, M.
    University of Zürich, Zurich, Switzerland.
    Brønnum-Hansen, H.
    Copenhagen University, Copenhagen, Denmark.
    Costa, G.
    University of Turin, Turin, Italy.
    Deboosere, P.
    Vrije Universiteit Brussel, Brussels, Belgium.
    Kalediene, R.
    Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Kovács, K.
    Demographic Research Institute, Budapest, Hungary.
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute for Health Development, Tallinn, Estonia.
    Martikainen, P.
    University of Helsinki, Helsinki, Finland.
    Menvielle, G.
    Sorbonne Universités, Paris, France.
    Rodriguez-Sanz, M.
    Agència de Salut Pública de Barcelona, Barcelona, Spain / CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
    Nusselder, W. J.
    Erasmus MC, Rotterdam, The Netherlands.
    Progress against inequalities in mortality: register-based study of 15 European countries between 1990 and 20152020In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 34, no 12, p. 1131-1142Article in journal (Refereed)
    Abstract [en]

    Socioeconomic inequalities in mortality are a challenge for public health around the world, but appear to be resistant to policy-making. We aimed to identify European countries which have been more successful than others in narrowing inequalities in mortality, and the factors associated with narrowing inequalities. We collected and harmonised mortality data by educational level in 15 European countries over the last 25 years, and quantified changes in inequalities in mortality using a range of measures capturing different perspectives on inequality (e.g., ‘relative’ and ‘absolute’ inequalities, inequalities in ‘attainment’ and ‘shortfall’). We determined which causes of death contributed to narrowing of inequalities, and conducted country- and period-fixed effects analyses to assess which country-level factors were associated with narrowing of inequalities in mortality. Mortality among the low educated has declined rapidly in all European countries, and a narrowing of absolute, but not relative inequalities was seen in many countries. Best performers were Austria, Italy (Turin) and Switzerland among men, and Spain (Barcelona), England and Wales, and Austria among women. Ischemic heart disease, smoking-related causes (men) and amenable causes often contributed to narrowing inequalities. Trends in income inequality, level of democracy and smoking were associated with widening inequalities, but rising health care expenditure was associated with narrowing inequalities. Trends in inequalities in mortality have not been as unfavourable as often claimed. Our results suggest that health care expansion has counteracted the inequalities widening effect of other influences. © 2019, The Author(s).

  • 86.
    Mackenbach, Johan P.
    et al.
    University Medical Center Rotterdam, Rotterdam, Netherlands.
    Bopp, Matthias
    University of Zürich, Zürich, Switzerland.
    Deboosere, Patrick
    Vrije Universiteit Brussel, Brussels, Belgium.
    Kovacs, Katalin
    Demographic Research Institute of the Central Statistical Office, Budapest, Hungary.
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute for Health Development, Tallinn, Estonia.
    Martikainen, Pekka
    University of Helsinki, Helsinki, Finland.
    Menvielle, Gwenn
    Sorbonne Universités, UPMC Univ Paris 06, INSERM, Paris, France.
    Regidor, Enrique
    Universidad Complutense de Madrid, Madrid, Spain.
    de Gelder, Rianne
    University Medical Center Rotterdam, Rotterdam, Netherlands.
    Determinants of the magnitude of socioeconomic inequalities in mortality: A study of 17 European countries2017In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 47, p. 44-53Article in journal (Refereed)
    Abstract [en]

    The magnitude of socioeconomic inequalities in mortality differs importantly between countries, but these variations have not been satisfactorily explained. We explored the role of behavioral and structural determinants of these variations, by using a dataset covering 17 European countries in the period 1970–2010, and by conducting multilevel multivariate regression analyses. Our results suggest that between-country variations in inequalities in current mortality can partly be understood from variations in inequalities in smoking, excessive alcohol consumption, and poverty. Also, countries with higher national income, higher quality of government, higher social transfers, higher health care expenditure and more self-expression values have smaller inequalities in mortality. Finally, trends in behavioral risk factors, particularly smoking and excessive alcohol consumption, appear to partly explain variations in inequalities in mortality trends. This study shows that analyses of variations in health inequalities between countries can help to identify entry-points for policy.

  • 87.
    Mackenbach, Johan P
    et al.
    Erasmus University Medical Center, Rotterdam, The Netherlands.
    Kulhánová, Ivana
    Erasmus University Medical Center, Rotterdam, The Netherlands.
    Bopp, Matthias
    University of Zurich, Zurich, Switzerland.
    Borrell, Carme
    Agència de Salut Pública de Barcelona, Barcelona, Spain.
    Deboosere, Patrick
    Vrije Universiteit Brussel, Brussels, Belgium.
    Kovács, Katalin
    Hungarian Central Statistical Office, Budapest, Hungary.
    Looman, Caspar W N
    Erasmus University Medical Center, Rotterdam, The Netherlands.
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute for Health Development, Tallinn, Estonia.
    Mäkelä, Pia
    National Institute for Health and Welfare, Helsinki, Finland.
    Martikainen, Pekka
    University of Helsinki, Helsinki, Finland.
    Menvielle, Gwenn
    Sorbonne Universités, Paris, France.
    Rodríguez-Sanz, Maica
    Agència de Salut Pública de Barcelona, Barcelona, Spain.
    Rychtaříková, Jitka
    Charles University, Prague, Czech Republic.
    de Gelder, Rianne
    Erasmus University Medical Center, Rotterdam, The Netherlands.
    Inequalities in Alcohol-Related Mortality in 17 European Countries: A Retrospective Analysis of Mortality Registers.2015In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 12, no 12, article id e1001909Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Socioeconomic inequalities in alcohol-related mortality have been documented in several European countries, but it is unknown whether the magnitude of these inequalities differs between countries and whether these inequalities increase or decrease over time.

    METHODS AND FINDINGS: We collected and harmonized data on mortality from four alcohol-related causes (alcoholic psychosis, dependence, and abuse; alcoholic cardiomyopathy; alcoholic liver cirrhosis; and accidental poisoning by alcohol) by age, sex, education level, and occupational class in 20 European populations from 17 different countries, both for a recent period and for previous points in time, using data from mortality registers. Mortality was age-standardized using the European Standard Population, and measures for both relative and absolute inequality between low and high socioeconomic groups (as measured by educational level and occupational class) were calculated. Rates of alcohol-related mortality are higher in lower educational and occupational groups in all countries. Both relative and absolute inequalities are largest in Eastern Europe, and Finland and Denmark also have very large absolute inequalities in alcohol-related mortality. For example, for educational inequality among Finnish men, the relative index of inequality is 3.6 (95% CI 3.3-4.0) and the slope index of inequality is 112.5 (95% CI 106.2-118.8) deaths per 100,000 person-years. Over time, the relative inequality in alcohol-related mortality has increased in many countries, but the main change is a strong rise of absolute inequality in several countries in Eastern Europe (Hungary, Lithuania, Estonia) and Northern Europe (Finland, Denmark) because of a rapid rise in alcohol-related mortality in lower socioeconomic groups. In some of these countries, alcohol-related causes now account for 10% or more of the socioeconomic inequality in total mortality. Because our study relies on routinely collected underlying causes of death, it is likely that our results underestimate the true extent of the problem.

    CONCLUSIONS: Alcohol-related conditions play an important role in generating inequalities in total mortality in many European countries. Countering increases in alcohol-related mortality in lower socioeconomic groups is essential for reducing inequalities in mortality. Studies of why such increases have not occurred in countries like France, Switzerland, Spain, and Italy can help in developing evidence-based policies in other European countries.

  • 88. Mackenbach, Johan P
    et al.
    Kulhánová, Ivana
    Menvielle, Gwenn
    Bopp, Matthias
    Borrell, Carme
    Costa, Giuseppe
    Deboosere, Patrick
    Esnaola, Santiago
    Kalediene, Ramune
    Kovacs, Katalin
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute for Health Development, Tallinn, Estonia .
    Martikainen, Pekka
    Regidor, Enrique
    Rodriguez-Sanz, Maica
    Strand, Bjørn Heine
    Hoffmann, Rasmus
    Eikemo, Terje A
    Ostergren, Olof
    Lundberg, Olle
    Trends in inequalities in premature mortality: a study of 3.2 million deaths in 13 European countries.2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, p. 207-217Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Over the last decades of the 20th century, a widening of the gap in death rates between upper and lower socioeconomic groups has been reported for many European countries. For most countries, it is unknown whether this widening has continued into the first decade of the 21st century.

    METHODS: We collected and harmonised data on mortality by educational level among men and women aged 30-74 years in all countries with available data: Finland, Sweden, Norway, Denmark, England and Wales, Belgium, France, Switzerland, Spain, Italy, Hungary, Lithuania and Estonia.

    RESULTS: Relative inequalities in premature mortality increased in most populations in the North, West and East of Europe, but not in the South. This was mostly due to smaller proportional reductions in mortality among the lower than the higher educated, but in the case of Lithuania and Estonia, mortality rose among the lower and declined among the higher educated. Mortality among the lower educated rose in many countries for conditions linked to smoking (lung cancer, women only) and excessive alcohol consumption (liver cirrhosis and external causes). In absolute terms, however, reductions in premature mortality were larger among the lower educated in many countries, mainly due to larger absolute reductions in mortality from cardiovascular disease and cancer (men only). Despite rising levels of education, population-attributable fractions of lower education for mortality rose in many countries.

    CONCLUSIONS: Relative inequalities in premature mortality have continued to rise in most European countries, and since the 1990s, the contrast between the South (with smaller inequalities) and the East (with larger inequalities) has become stronger. While the population impact of these inequalities has further increased, there are also some encouraging signs of larger absolute reductions in mortality among the lower educated in many countries. Reducing inequalities in mortality critically depends upon speeding up mortality declines among the lower educated, and countering mortality increases from conditions linked to smoking and excessive alcohol consumption such as lung cancer, liver cirrhosis and external causes.

  • 89.
    Mackenbach, Johan P.
    et al.
    University Medical Center Rotterdam, Rotterdam, Netherlands.
    Valverde, Jose Rubio
    University Medical Center Rotterdam, Rotterdam, Netherlands.
    Bopp, Matthias
    University of Zürich, Zürich, Switzerland.
    Bronnum-Hansen, Henrik
    University of Copenhagen, Copenhagen, Denmark.
    Deboosere, Patrick
    rije Universiteit Brussel, Brussels, Belgium.
    Kalediene, Ramune
    Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Kovacs, Katalin
    Hungarian Demographic Research Institute, Budapest, Hungary.
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). ational Institute for Health Development, Tallinn, Estonia.
    Martikainen, Pekka
    University of Helsinki, Helsnki, Finland.
    Menvielle, Gwenn
    INSERM, Sorbonne Universités, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France.
    Regidor, Enrique
    niversidad Complutense de Madrid, Madrid, Spain / CIBER Epidemiologí y Salud Püblica, Madrid, Spain.
    Nusselder, Wilma J.
    University Medical Center Rotterdam, Rotterdam, Netherlands.
    Determinants of inequalities in life expectancy: an international comparative study of eight risk factors2019In: The Lancet Public Health, ISSN 2468-2667, Vol. 4, no 10, p. E529-E537Article in journal (Refereed)
    Abstract [en]

    Background Socioeconomic inequalities in longevity have been found in all European countries. We aimed to assess which determinants make the largest contribution to these inequalities. Methods We did an international comparative study of inequalities in risk factors for shorter life expectancy in Europe. We collected register-based mortality data and survey-based risk factor data from 15 European countries. We calculated partial life expectancies between the ages of 35 years and 80 years by education and gender and determined the effect on mortality of changing the prevalence of eight risk factors-father with a manual occupation, low income, few social contacts, smoking, high alcohol consumption, high bodyweight, low physical exercise, and low fruit and vegetable consumption-among people with a low level of education to that among people with a high level of education (upward levelling scenario), using population attributable fractions. Findings In all countries, a substantial gap existed in partial life expectancy between people with low and high levels of education, of 2.3-8.2 years among men and 0.6-4.5 years among women. The risk factors contributing most to the gap in life expectancy were smoking (19.8% among men and 18.9% among women), low income (9.7% and 13.4%), and high bodyweight (7.7% and 11.7%), but large differences existed between countries in the contribution of risk factors. Sensitivity analyses using the prevalence of risk factors in the most favourable country (best practice scenario) showed that the potential for reducing the gap might be considerably smaller. The results were also sensitive to varying assumptions about the mortality risks associated with each risk factor. Interpretation Smoking, low income, and high bodyweight are quantitatively important entry points for policies to reduce educational inequalities in life expectancy in most European countries, but priorities differ between countries. A substantial reduction of inequalities in life expectancy requires policy actions on a broad range of health determinants.

  • 90.
    Mackenbach, Johan P
    et al.
    Erasmus University Medical Center, Rotterdam, The Netherlands.
    Valverde, José Rubio
    Erasmus University Medical Center, Rotterdam, The Netherlands.
    Artnik, Barbara
    Faculty of Medicine, Ljubljana, Slovenia.
    Bopp, Matthias
    University of Zürich, Zurich, Switzerland.
    Brønnum-Hansen, Henrik
    Copenhagen University, Copenhagen, Denmark.
    Deboosere, Patrick
    Vrije Universiteit Brussel, Ixelles, Belgium.
    Kalediene, Ramune
    Lithuanian University of Health Sciences, Kaunas, Lithuania;.
    Kovács, Katalin
    Demographic Research Institute, Budapest, Hungary.
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute for Health Development, Tallinn, Estonia.
    Martikainen, Pekka
    University of Helsinki, Helsinki, Finland.
    Menvielle, Gwenn
    Sorbonne Universités, Paris, France.
    Regidor, Enrique
    Universidad Complutense de Madrid, Madrid, Spain.
    Rychtaříková, Jitka
    Charles University, Prague, Czech Republic.
    Rodriguez-Sanz, Maica
    Agència de Salut Pública de Barcelona, Barcelona, Spain.
    Vineis, Paolo
    Imperial College, London, United Kingdom.
    White, Chris
    Office of National Statistics, Newport, United Kingdom.
    Wojtyniak, Bogdan
    National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland.
    Hu, Yannan
    Erasmus University Medical Center, Rotterdam, The Netherlands.
    Nusselder, Wilma J
    Erasmus University Medical Center, Rotterdam, The Netherlands.
    Trends in health inequalities in 27 European countries2018In: Proceedings of the National Academy of Sciences of the United States of America, ISSN 0027-8424, E-ISSN 1091-6490, Vol. 115, no 25, p. 6440-6445Article in journal (Refereed)
    Abstract [en]

    Unfavorable health trends among the lowly educated have recently been reported from the United States. We analyzed health trends by education in European countries, paying particular attention to the possibility of recent trend interruptions, including interruptions related to the impact of the 2008 financial crisis. We collected and harmonized data on mortality from <i>ca</i> 1980 to <i>ca</i> 2014 for 17 countries covering 9.8 million deaths and data on self-reported morbidity from <i>ca</i> 2002 to <i>ca</i> 2014 for 27 countries covering 350,000 survey respondents. We used interrupted time-series analyses to study changes over time and country-fixed effects analyses to study the impact of crisis-related economic conditions on health outcomes. Recent trends were more favorable than in previous decades, particularly in Eastern Europe, where mortality started to decline among lowly educated men and where the decline in less-than-good self-assessed health accelerated, resulting in some narrowing of health inequalities. In Western Europe, mortality has continued to decline among the lowly and highly educated, and although the decline of less-than-good self-assessed health slowed in countries severely hit by the financial crisis, this affected lowly and highly educated equally. Crisis-related economic conditions were not associated with widening health inequalities. Our results show that the unfavorable trends observed in the United States are not found in Europe. There has also been no discernible short-term impact of the crisis on health inequalities at the population level. Both findings suggest that European countries have been successful in avoiding an aggravation of health inequalities.

  • 91. Marcinczak, Szymon
    et al.
    Gentile, Michael
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre on Health of Societies in Transition). Umeå University.
    Stepniak, Marcin
    Paradoxes of (Post)Socialist Segregation: Metropolitan Sociospatial Divisions Under Socialism and After In Poland2013In: Urban geography, ISSN 0272-3638, E-ISSN 1938-2847, Vol. 34, no 3, p. 327-352Article in journal (Refereed)
    Abstract [en]

    The state of the art in research on residential segregation and concentr= ion in Central and Eastern Europe (CEE) largely focuses on process descri= ion (e.g., the multitude of works on gentrification and suburbanization).= ven though major advances in the conceptualization and measurement of seg= gation have been made, works that scrutinize the patterns of segregation = d/or concentration in CEE are rare, while studies that simultaneously exp= re and link segregation patterns under socialism and after are virtually = nexistent. Relying on Polish census-tract level data on the educational s= ucture of population in 1978, 1988, and 2002, this study explores the pat= rns of social segregation and concentration in the three major Polish cit= s (Warsaw, Cracow, and od), representing different paths of development u= er socialism and after. The results show that the population of the three= ajor Polish cities was still socially heterogeneous at the census tract l= el in 2002. ! he results also reveal that the level of social residential segregation i= the three cities has been decreasing steadily since 1978, irrespective of= he prevailing economic system.

  • 92.
    Murphy, A.
    et al.
    London School of Hygiene and Tropical Medicine, London, UK.
    Roberts, B.
    London School of Hygiene and Tropical Medicine, London, UK.
    Kenward, M. G.
    London School of Hygiene and Tropical Medicine, London, UK.
    De Stavola, B. L.
    London School of Hygiene and Tropical Medicine, London, UK.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre on Health of Societies in Transition).
    McKee, M.
    London School of Hygiene and Tropical Medicine, London, UK.
    Using multi-level data to estimate the effect of social capital on hazardous alcohol consumption in the former Soviet Union2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no 4, p. 572-577Article in journal (Refereed)
    Abstract [en]

    Background: Hazardous alcohol consumption is a leading cause of mortality in the former Soviet Union (fSU), but little is known about the social factors associated with this behaviour. We set out to estimate the association between individual- and community-level social capital and hazardous alcohol consumption in the fSU. Methods: Data were obtained from Health in Times of Transition 2010, a household survey of nine fSU countries (n = 18 000 within 2027 communities). Individual-level indicators of social isolation, civic participation, help in a crisis and interpersonal trust were aggregated to the community level. Adjusting for demographic factors, the association of individual- and community-level indicators with problem drinking (CAGE) and episodic heavy drinking was estimated using a population average model for the analysis of multi-level data. Results: Among men, individual social isolation [odds ratio (OR) = 1.20], community social isolation (OR = 1.18) and community civic participation (OR = 4.08) were associated with increased odds of CAGE. Community civic participation (OR = 2.91) increased the odds of episodic heavy drinking, while community interpersonal trust (OR = 0.89) decreased these odds. Among women, individual social isolation (OR = 1.30) and community civic participation (OR = 2.94) increased odds of CAGE. Conclusion: Our results provide evidence of the role of some elements of social capital in problem drinking in the fSU, and highlight the importance of community effects. The nature of civic organizations in the fSU, and the communities in which civic participation is high, should be further investigated to inform alcohol policy in the region.

  • 93. Murphy, Adrianna
    et al.
    Levchuk, Nataliia
    Stickley, Andrew
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre on Health of Societies in Transition).
    Roberts, Bayard
    McKee, Martin
    A country divided?: Regional variation in mortality in Ukraine2013In: International Journal of Public Health, ISSN 1661-8556, E-ISSN 1661-8564, Vol. 58, no 6, p. 837-844Article in journal (Refereed)
    Abstract [en]

    We set out to identify the contribution of various causes of death to regional differences in life expectancy in Ukraine. Mortality data by oblast (province) were obtained from the State Statistical Committee of Ukraine. The contribution of various causes of death to differences in life expectancy between East, West and South Ukraine was estimated using decomposition. In 2008, life expectancy for men in South (61.8 years) and East Ukraine (61.2 years) was lower than for men in West Ukraine (64.0 years). A similar pattern was observed among women. This was mostly due to deaths from infectious disease and external causes among young adults, and cardio- and cerebro-vascular deaths among older adults. Deaths from TB among young adults contribute most to differences in life expectancy. Deaths due to infectious disease, especially TB, play an important role in the gap in life expectancy between regions in Ukraine. These deaths are entirely preventable-further research is needed to identify what has 'protected' individuals in Western Ukraine from the burden of deaths experienced by their Southern and Eastern counterparts.

  • 94. Murphy, Adrianna
    et al.
    Roberts, Bayard
    Ploubidis, George B
    Stickley, Andrew
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). London School of Hygiene and Tropical Medicine, London, UK.
    McKee, Martin
    Using multi-level data to estimate the effect of an 'alcogenic' environment on hazardous alcohol consumption in the former Soviet Union.2014In: Health and Place, ISSN 1353-8292, E-ISSN 1873-2054, Vol. 27, p. 205-211Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The purpose of this study was to assess whether alcohol-related community characteristics act collectively to influence individual-level alcohol consumption in the former Soviet Union (fSU).

    METHODS AND RESULTS: Using multi-level data from nine countries in the fSU we conducted a factor analysis of seven alcohol-related community characteristics. The association between any latent factors underlying these characteristics and two measures of hazardous alcohol consumption was then analysed using a population average regression modelling approach. Our factor analysis produced one factor with an eigenvalue >1 (EV=1.28), which explained 94% of the variance. This factor was statistically significantly associated with increased odds of CAGE problem drinking (OR=1.40 (1.08-1.82)). The estimated association with EHD was not statistically significant (OR=1.10 (0.85-1.44)).

    CONCLUSIONS: Our findings suggest that a high number of beer, wine and spirit advertisements and high alcohol outlet density may work together to create an 'alcogenic' environment that encourages hazardous alcohol consumption in the fSU.

  • 95.
    Mäkinen, Ilkka Henrik
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre on Health of Societies in Transition).
    The East is – Empty2013In: Baltic Rim Economies : Quarterly Review, ISSN 1459-9759, no 1, p. 41-42Article in journal (Other academic)
  • 96.
    Nagavci, B L
    et al.
    Erasmus Medical Centre, Rotterdam, The Netherlands.
    de Gelder, R
    Erasmus Medical Centre, Rotterdam, The Netherlands.
    Martikainen, P
    University of Helsinki, Helsinki, Finland.
    Deboosere, P
    Vrije Universiteit Brussel, Brussels, Belgium.
    Bopp, M
    University of Zürich, Zurich, Switzerland .
    Rychtaříková, J
    Charles University, Prague, Czech Republic.
    Kalediene, R
    Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Leinsalu, Mall
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute for Health Development, Tallinn, Estonia.
    Mackenbach, J P
    Erasmus Medical Centre, Rotterdam, The Netherlands.
    Inequalities in tuberculosis mortality: long-term trends in 11 European countries.2016In: The International Journal of Tuberculosis and Lung Disease, ISSN 1027-3719, E-ISSN 1815-7920, Vol. 20, no 5, p. 574-581Article in journal (Refereed)
    Abstract [en]

    SETTING: Previous studies in many countries have shown that mortality due to tuberculosis (TB) is higher among people of lower socio-economic status.

    OBJECTIVE: To assess the magnitude and direction of trends in educational inequalities in TB mortality in 11 European countries.

    DESIGN: Data on TB mortality between 1980 and 2011 were collected among persons aged 35-79 years. Age-standardised mortality rates by educational level were calculated. Inequalities were estimated using the relative and slope indices of inequality.

    RESULTS: In the first decade of the twenty-first century, educational inequalities in TB mortality occurred in all countries in this study. The largest absolute inequalities were observed in Lithuania, and the smallest in Denmark. In most countries, relative inequalities have remained stable since the 1980s or 1990s, while absolute inequalities remained stable or went down. In Lithuania and Estonia, however, absolute inequalities increased substantially.

    CONCLUSION: The reduction in absolute inequalities in TB mortality, as seen in many European countries, is a major achievement; however, inequalities persist and are still a major cause for concern in the twenty-first century. Interventions aimed at preventing TB disease and reducing TB case fatality in lower socio-economic groups should be intensified, especially in the Baltic countries.

  • 97.
    Ng, Chris Fook Sheng
    et al.
    Nagasaki Univiversity,Nagasaki , Japan / University of Tokyo, Tokyo, Japan.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). University of Tokyo, Tokyo, Japan.
    Konishi, Shoko
    University of Tokyo, Tokyo, Japan / University of Washington, Seattle, USA.
    Watanabe, Chiho
    University of Tokyo, Tokyo, Japan.
    Ambient air pollution and suicide in Tokyo, 2001-20112016In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 201, p. 194-202Article in journal (Refereed)
    Abstract [en]

    Background: Some evidence suggests an association may exist between the level of air pollution and suicide mortality. However, this relation has been little studied to date. The current study examined the association in Tokyo, Japan. Methods: Suicide mortality data for Tokyo for the 11-year period 2001-2011 were obtained together with data on four air pollutants: fine particulate matter (PM2.5), suspended particulate matter (SPM), sulphur dioxide (SO2) and nitrogen dioxide (NO2). A time-stratified case-crossover study design was used to examine the daily association between the level of air pollution and suicide mortality. Results: During the study period there were 29,939 suicide deaths. In stratified analyses an interquartile range (IQR) increase in the same-day concentration of NO2 was linked to increased suicide mortality among those aged under 30 (percentage change: 6.73%, 95% Cl: 0.69-13.12%). An IQR increase in PM25 and SO2 was associated with a 10.55% (95% Cl: 2.05-19.75%) and 11.47% (95% Cl: 3.60-19.93%) increase, respectively, in suicide mortality among widowed individuals for mean exposure on the first four days (average lags 0-3). Positive associations were observed for the air pollutants in the summer although associations were reversed in autumn. Limitations: We relied on monitoring data to approximate individual exposure to air pollutants. Conclusions: Higher levels of air pollution are associated with increased suicide mortality in some population subgroups in Tokyo. Further research is needed to elucidate the mechanisms linking air pollutants and suicide in this setting.

  • 98. Norström, Thor
    et al.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, Sociology. Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre on Health of Societies in Transition). University of Tokyo.
    Alcohol tax, consumption and mortality in tsarist Russia: is a public health perspective applicable?2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no 2, p. 340-344Article in journal (Refereed)
    Abstract [en]

    Background: The public health perspective on alcohol comprises two main tenets: (i) population drinking impacts on alcohol-related harm and (ii) population drinking is affected by the physical and economic availability of alcohol, where alcohol taxes are the most efficient measure for regulating consumption. This perspective has received considerable empirical support from analyses of contemporary data mainly from Europe and North America. However, as yet, it has been little examined in a historical context. The aims of the present article are to use data from tsarist Russia to explore (i) the relation between changes in the tax on alcohol and per capita alcohol consumption and (ii) the relation between per capita alcohol consumption and alcohol mortality. Methods: The material comprised annual data on alcohol taxes, alcohol consumption and alcohol mortality. The tax and alcohol consumption series spanned the period 1864-1907 and the mortality data covered the period 1870-94. The data were analysed by estimating autoregressive integrated moving average models on differenced data. Results: Changes in alcohol taxes were significantly associated with alcohol consumption in the expected direction. Increases in alcohol consumption, in turn, were significantly related to increases in alcohol mortality. Conclusion: This study provides support for the utility of the public health perspective on alcohol in explaining changes in consumption and alcohol-related harm in a historical context. We discuss our findings from tsarist Russia in the light of experiences from more recent alcohol policy changes in Russia.

  • 99.
    Ogino, K.
    et al.
    National Institute of Mental Health, Tokyo, Japan.
    Takahashi, H.
    National Institute of Mental Health, Tokyo, Japan.
    Nakamura, T.
    University of Tokyo, Tokyo, Japan.
    Kim, J.
    University of Tokyo, Tokyo, Japan.
    Kikuchi, H.
    Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan.
    Nakahachi, T.
    National Institute of Mental Health, Tokyo, Japan.
    Ebishima, K.
    National Institute of Mental Health, Tokyo, Japan.
    Yoshiuchi, K.
    University of Tokyo, Tokyo, Japan.
    Ando, T.
    National Institute of Mental Health, Tokyo, Japan.
    Sumiyoshi, T.
    National Institute of Mental Health, Tokyo, Japan.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute of Mental Health, Tokyo, Japan.
    Yamamoto, Y.
    University of Tokyo, Tokyo, Japan.
    Kamio, Y.
    National Institute of Mental Health, Tokyo, Japan.
    Negatively skewed locomotor activity is related to autistic traits and behavioral problems in typically developing children and those with autism spectrum disorders2018In: Frontiers in Human Neuroscience, ISSN 1662-5161, E-ISSN 1662-5161, Vol. 12, article id 518Article in journal (Refereed)
    Abstract [en]

    An important objective for researchers and clinicians is to gain a better understanding of the factors that underlie autism spectrum disorders (ASDs). It is possible that investigating objective and quantitative behavioral phenotypes and their relationship to clinical characteristics, such as autistic traits and other emotional/behavioral problems, might facilitate this process. Given this, in the current study we examined the link between locomotor dynamics and clinical characteristics, including autistic traits and emotional/behavioral problems, in children with ASD (n = 14) and typically developing (TD) children (n = 13). A watch-type actigraph was used to continuously measure locomotor activity which was assessed in terms of mean activity levels and the skewness of activity. Parents assessed quantitative autistic traits using the Japanese version of the Social Responsiveness Scale (SRS) and emotional and behavioral problems using the Japanese version of the Strengths and Difficulties Questionnaire (SDQ). Results showed that among all children, all-day activity was more negatively skewed, suggesting sporadic large all-day “troughs” in activity and was significantly correlated with the SRS social awareness subscale score (ρ = −0.446, p = 0.038). In addition, the more negatively skewed daytime locomotor activity was associated with the SDQ Hyperactivity Inattention subscale score (ρ = −0.493, p = 0.020). The results of this study indicate that investigating locomotor dynamics may provide one way to increase understanding of the neurophysiological mechanisms underlying the clinical characteristics of ASD.

  • 100.
    Oh, H.
    et al.
    University of Southern California, Los Angeles, USA.
    Stickley, Andrew
    Södertörn University, School of Social Sciences, SCOHOST (Stockholm Centre for Health and Social Change). National Institute of Mental Health, Tokyo, Japan.
    Koyanagi, Ai
    Universitat de Barcelona, Barcelona, Spain / Instituto de Salud Carlos III, Madrid, Spain.
    Yau, Rebecca
    Pacific Institute for Research and Evaluation, Berkeley, USA.
    DeVylder, Jordan E.
    Fordham University, New York, USA.
    Discrimination and Suicidality amongst racial and ethnic minorities in the United States2018In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 245, p. 517-523Article in journal (Refereed)
    Abstract [en]

    Background: Over the past decade, suicide rates have increased among certain racial/ethnic minority groups in the United States. To better understand suicide vulnerability among people of color, studies have examined the relations between social risk factors –such as discrimination –and suicidal thoughts and behaviors. However, the literature has been inconsistent, calling for more population studies.

    Methods: This study analyzed data from two surveys: (1) The National Survey of American Life; and (2) The National Latino and Asian American Survey, which taken together are representative of Black, Latino, and Asians in the United States. Multivariable logistic regression models were used to examine the association between levels of discrimination on the Everyday Discrimination Scale and suicidal thoughts and behaviors. Additional models tested for effect modification by race and by psychiatric diagnosis.

    Results: We found that individuals who reported the highest levels of discrimination had greater odds of reporting lifetime suicidal thoughts, plans, and attempts, when compared with people who did not report discrimination, after adjusting for socio-demographic characteristics. Notably, discrimination increased odds of reporting an unplanned suicide attempt and a suicide attempt without the intent to die. Adjusting for psychiatric diagnoses attenuated these effects. We found no evidence of effect modification by race or by psychiatric diagnosis.

    Limitations: Data were cross-sectional, which did not allow for causal inferences.

    Conclusions: Future translational research can explore how screening for discrimination may help identify individuals and groups of racial/ethnic minorities at risk for suicidal thoughts and behaviors.

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