Operational leadership : Relationship with swift trust, moral stress, and adaptability

Forutsetningene for krigføring og militær ledelse har endret seg dramatisk de siste tiårene. Raske teknologiske fremskritt og et nytt geopolitisk landskap innebærer en rekke nye krav og utfordringer for militære ledere. Denne avhandlingenfokuserer på den enkelte militære leder fra et psykologisk perspektiv. Det overordnede målet med dette doktorgradsprosjektet var å gi en større forståelse av hvordan rask tillit til midlertidige grupper, moralsk stress og tilpasningsevne er relatert til operativ ledelse blant hærledere på lavere nivå. Studie 1 hadde som mål å belyse faktorer som gagner, eller ikke gagner, utviklingen av rask tillit til ledere i midlertidige militærgrupper. Totalt deltok 581 norske og svenske kadetter og offiserer og en kombinasjon av kvalitativ metode og ikke-parametrisk statistikk ble brukt. En hierarkisk modell av faktorer som bidrar til rask tillit til ledere av midlertidige grupper dukket opp. Modellen består av to kategorier på høyt nivå – individuelle kjennetegn og relasjonsrelaterte kjennetegn, som begge omfatter flere underordnede kategorier. Studie 2 hadde som mål å identifisere og få en dypere forståelse av miljø-, organisasjons- og gruppeforhold, og ledelsesrelaterte spørsmål spesielt, rapportert som viktige i alvorlig stressende situasjoner som involverer en moralsk stressor som militær- og politifolk står overfor. Studiegruppen besto av 16 militærkadetter og offiserer og 10 politifolk (alle svenske). Det ble gjennomført dybdeintervjuer og analysert ved hjelp av en fundert teoritilnærming. Den nye modellen består av et hierarkisk system av innbyrdes beslektede koder og kategorier av aspekter rapportert som viktige i alvorlig stressende situasjoner som involverer en moralsk stressor. Kategoriene var følgende (hver er underbygget av flere koder): Miljø, Organisasjon, Ledelse og Gruppe. Studie 3, til slutt, besto av en innledende kvalitativ studie (studie 3A), etterfulgt av en kvantitativ studie (studie 3B). Målet med studie 3A var å oppnå en dypere forståelse av følgende spørsmål: hva kjennetegner vellykket og mislykket militær ledelse på et lavere hierarkisk nivå, når tilpasningsevne er nødvendig for å håndtere en uventet truende hendelse under et fredsbevarende eller fredshåndhevelsesoppdrag i et miljø preget ved irregulær krigføring? Siden kvalitative studier har lav generaliserbarhet, ble de oppnådde resultatene operasjonalisert til et spørreskjema (studie 3B) for å fastslå om en kvantitativ studie ville validere resultatene eller ikke. Intervjuer ble gjennomført med 16 svenske soldater og offiserer i studie 3A, og svar innhentet fra 193 svenske soldater og offiserer i studie 3B. En prosessmodell som beskriver forhold som påvirker tilpasningsevnen når man møter en uventet hendelse ble utviklet i studie 3A. Modellen ble testet i studie 3B. Regresjonsanalyser viste høye til moderat høye justerte R²-koeffisienter. Imidlertid ga en moderasjonsanalyse et ikke-signifikant resultat og en baneanalyse resulterte i en dårlig modelltilpasning. Hovedbidragene til avhandlingen er de tre utviklede teoretiske modellene, og ved tilpasningsevne, den kvantitative testen av modellen. Person-for-situasjon-paradigmet ble brukt som rammeverk i den generelle diskusjonen av alle tre studiene. Til sammen utvider funnene den nåværende forståelsen av operativ ledelse blant militære ledere på lavere nivå.The conditions for warfare and military leadership have changed dramatically in the last few decades. Rapid technological advancements and a new geopolitical landscape imply an array of new demands and challenges for military leaders. This thesis focuses on the individual military leader from a psychological perspective. The overall aim of this thesis was to provide a greater understanding how swift trust in temporary groups, moral stress and adaptability are related to operational leadership among lower-level army leaders. Study 1 aimed to illuminate factors that benefit, or do not benefit, the development of swift trust towards leaders in temporary military groups. A total of 581 Norwegian and Swedish cadets and officers participated and a combination of qualitative clustering and non-parametric statistics was used. A hierarchical model of factors contributing to swift trust in leaders of temporary groups emerged. The model consists of two high-level categories—Individual-related characteristics and Relationship-related characteristics, both of which comprise several subordinate categories. Study 2 aimed to identify and gain a deeper understanding of environmental, organizational, and group conditions, and leadership-related issues in particular, reported as being important in severely stressful situations involving a moral stressor faced by military and police officers. The study group consisted of 16 military cadets and officers and 10 police officers (all Swedish). In-depth interviews were conducted and analyzed using a grounded theory-approach. The emerging model consists of a hierarchical system of interrelated codes and categories of aspects reported as being important in severely stressful situations involving a moral stressor. The categories were the following (each being underpinned by several codes): Environment, Organization, Leadership, and Group. Study 3, finally, consisted of an initial qualitative study (study 3A), followed by a quantitative study (study 3B). The aim of study 3A was to obtain a deeper understanding regarding the following question: what characterizes successful and unsuccessful military leadership at a lower hierarchical level, when adaptability is needed to handle an unexpected threatening event during a peacekeeping or peace enforcement mission in an environment characterized by irregular warfare? Since qualitative studies have low generalizability, the obtained results were operationalized into a questionnaire (study 3B) in order to ascertain whether a quantitative study would validate the results or not. Interviews were conducted with 16 Swedish soldiers and officers in study 3A, and responses obtained from 193 Swedish soldiers and officers in study 3B. A process model describing conditions that affect adaptability when encountering an unexpected event was developed in study 3A. The model was tested in study 3B. Regression analyses showed high to moderately high adjusted R² coefficients. However, a moderation analysis yielded a non-significant result and a path-analysis resulted in a poor model fit. The main contributions of the thesis are the three developed theoretical models, and in the case of adaptability, the quantitative test of the model. The person-by-situation paradigm was used as a framework in the general discussion of all three studies. Taken together, the findings broaden the current understanding of operational leadership among lower-level military leaders.Doktorgradsavhandlin

Tervise enesehinnang: hindamine, sotsiaalne variatiivsus ja seos suremusega

Väitekirja elektrooniline versioon ei sisalda publikatsioone„Milline on Teie tervis üldiselt?” on küsitlusuuringutes sagedasti kõlav küsimus. See lihtne enesehinnangule tuginev terviseseisundi mõõdik on laialdaselt kasutusel ning tõendus varasematest uuringutest kinnitab instrumendi valiidsust rahvastiku terviseseisundi hindamisel ning edasiste tervisetulemite prognoosimisel. Rainer Reile doktoritöö analüüsis subjektiivse tervise hindamismehhanisme, tervise enesehinnangu aluseks olevaid tegureid ja nende sotsiaalset variatiivsust, ning seost edasise suremusega. Töös leiti, et tervise enesehinnangu mõjurid varieeruvad sõltuvalt tervise enesehinnangu tasemest: kui negatiivne hinnang seondus põhiliselt füüsilise ja vaimse tervise aspektidega, siis positiivne hinnang seondus ka demograafiliste, sotsiaalmajanduslike ja heaolu teguritega. Negatiivse tervise enesehinnangu korral prognoosisid edasist suremust haigustega seotud piirangud, positiivse tervise enesehinnangu korral sõltus suremusrisk demograafilistest, sotsiaalmajanduslikest ja tervisekäitumisega seotud teguritest. Halva tervise enesehinnanguga vastajatel oli ligi 40% suurem suremusrisk ligi 18-aastase jälgimisaja jooksul. Leid, et erinevalt eestlastest ei prognoosi tervise enesehinnang prognoosib edasise suremusriski mitte-eestlastel, viitab võimalikule sotsiaalsele variatiivsusele tervise hindamisel. Töö näitas, et tervise enesehinnang on tundlik mõõdik tervise hindamiseks makromajanduslike muutuste taustal – 2008. aastal alanud majanduskriis peatas eelneva tervise enesehinnangu olulise paranemise trendi kriisist tugevalt mõjutatud Eestis ja Leedus. Makromajanduslikud muutused avaldasid mõju ka tervise enesehinnangu sotsiaalsele varieeruvusele – kui majanduskasvuga seoses ebavõrdsus kasvas, siis majanduskriisi tingimustes ebavõrdsus pigem kahanes. Doktoritöö näitab, et tervise enesehinnang varieerub lisaks tervisega otseselt seotud teguritele ka demograafiliste, sotsiaalmajanduslike ning psühholoogiliste tegurite lõikes. Need tegurid mõjutavad nii terviseseisundit kui ka selle tõlgendamist ja hindamist tervise enesehinnangu kontekstis. Seega saab tervist subjektiivsete tervisemõõdikute kontekstis käsitleda eelkõige ettevaatlikku tõlgendust vajava sotsiaalse nähtusenaThe single question on individual’s self-rated health (SRH) –“How would you rate your health in general?”– has become a popular tool in survey research as its validity for assessing population health status and predicting mortality and morbidity outcomes has been consistently demonstrated. Rainer Reile’s dissertation analyzed the mechanisms underlying the subjective health evaluations, their social variations and associations between SRH and mortality. The findings support the existing evidence that SRH is a valid and responsive indicator of individual health that rests on a wide range of determinants that differ for negative and positive health assessments. The former is characterized mostly by the physical and psychological aspects whereas a wide range of demographic, socioeconomic and wellbeing-related factors contribute to the latter. Moreover, similar patterning of predictors of positive and negative health was also found for factors underpinning the mortality risk in an analysis stratified by SRH. Those with poor SRH had approximately 40% higher mortality during the 18-year follow-up period. SRH was found to predict subsequent mortality only among Estonians with social variations in health assessments being one of the plausible explanations. The dissertation studied SRH in the context of macroeconomic changes demonstrating the health effects of late-2000s economic recession that halted the previous trend of health improvement in Estonia and Lithuania. The reduction in existing health disparities during the recession indicates that rapid economic fluctuations may affect different socioeconomic groups disproportionately. SRH is influenced by a wide range of factors, not necessarily limited to those directly related to physical aspects of health. The social determinants affect health outcomes but are also the source of social variation in health assessments as they influence how health is conceptualized and evaluated. In this, health can be interpreted essentially as a social phenomenon that in the context of subjective health measures requires careful interpretatio

Long-term sick leave and work rehabilitation - prognostic factors for return to work

The main objective of this thesis is to examine individual prognostic factors for return to work (RTW) after work rehabilitation, for workers on long-term sick leave with common musculoskeletal and mental health complaints. The process of returning to work after long-term sick leave may be complex, and is often influenced by other factors than health complaints and diagnoses alone. The primary hypothesis in this thesis was that individual’s cognitions about health and illness would be central for returning to work or not, after work rehabilitation. A second hypothesis was that socioeconomic status (SES) through education or occupation would predict RTW after work rehabilitation. A third hypothesis was that the process of returning to work would be complex and differ between subgroups of work rehabilitation participants. Cognitions, such as illness perceptions and fear avoidance beliefs may be a matter of beliefs about cure, control, and expectancies, thus of coping. Coping, as defined in the Cognitive activation theory of stress (CATS), was applied in this thesis. In the CATS, coping is defined as positive response outcome expectancies, in contrast to negative response outcome expectancies (hopelessness) or no response outcome expectancies (helplessness). In Norway, comprehensive inpatient work rehabilitation may be offered to individuals on long-term sick leave. Participants in inpatient work rehabilitation programs typically have sick leave diagnoses related to musculoskeletal and mental health complaints, often characterized by non-specific conditions, mostly subjective health complaints, with few objective medical findings. Individuals with subjective health complaints may believe that their complaints are harmful and may therefore try to avoid activities they believe will harm them, such as work. Experiencing distress and poor functional ability may lead to vicious circles of hopelessness and helplessness, i.e. poor coping. Maladaptive illness perceptions and fear avoidance beliefs about work may contribute to prolonged disability and time out of work. The aim of work rehabilitation is to alter such vicious circles through positive experiences and cognitive processes, and facilitate RTW. This is done by interdisciplinary assessments, education, physical activities, and cognitive behavior modifications offered in a combination of individual and group-based sessions. In addition, collaboration with external stakeholders, such as health care providers, the employer, or the local social insurance office (NAV-office) are important elements during work rehabilitation. In this thesis, individual prognostic factors for RTW after work rehabilitation were investigated in three different samples of work rehabilitation participants. Predictive information was extracted from questionnaires and patient journals while information of work and sick leave were measured by self-reports and official register data of The Norwegian labor and welfare administration (NAV). The primary and secondary hypotheses were investigated in the first paper, where the aim was to examine whether health complaints, illness perceptions, fear avoidance beliefs, coping, and education predicted non-working 3 and 12 months after participating in work rehabilitation, and to assess the relative importance and interrelationship of these factors. Logistic regression analysis was conducted. The results showed that fear avoidance beliefs for work were the most important predictor for non-working both at 3 months, and at 12 months follow-up after participating in work rehabilitation. A multiple regression analysis displayed that almost half of the variance in fear avoidance beliefs for work were explained by the amount of musculoskeletal and pseudoneurological health complaints, i.e. tiredness, sadness/depression, and anxiety, and by illness perceptions and education. For illness perceptions, the components concerning perceived duration, consequences, and personal control of the illness were the most important. Coping did not contribute to explain any variance in fear avoidance beliefs for work. In conclusion, high levels of fear avoidance beliefs for work were a strong predictor for non-working after work rehabilitation. However, the intervening mechanisms between fear avoidance beliefs and subsequent avoidance behavior, in terms of avoiding the workplace when sick, are still poorly understood. The primary and secondary hypotheses were investigated in the second paper, where the aim was to test if fear avoidance beliefs for work would mediate the relationships between musculoskeletal and pseudoneurological complaints, functional ability, level of education, and number of days on sickness benefits during 3-year follow-up after work rehabilitation. Structural equation modeling (SEM) was used to test a predefined mediation model for direct and indirect effects between the hypothesized predictors and days on sickness benefits during follow-up. As hypothesized, fear avoidance beliefs for work mediated the effect of musculoskeletal complaints and education on sick leave during follow-up. There was however, no direct effect of musculoskeletal complaints on fear avoidance beliefs, as this relationship was fully mediated by poor physical function, in terms of moving ability and lifting/carrying ability. Fear avoidance beliefs for work did not mediate the relationship between pseudoneurological complaints or mental function, in terms of coping/interaction ability and sick leave during follow-up. Pseudoneurological complaints had a small direct effect, and length of previous sick leave had a strong independent effect on days on sickness benefits after work rehabilitation. In conclusion, the mechanisms involved in the process of returning to work are complex and involve several intervening factors including health and functional ability, education, previous sick leave, and fear avoidance beliefs for work. The second and third hypotheses were investigated in the third paper. Here the aim was to examine if gender, age, diagnosis, occupation, and length of previous sick leave predicted differences in the process of returning to work, in terms of being at work or registered with sickness benefits, and transitions in and out of work and sickness benefits, during a 4-year follow-up after work rehabilitation. Proportional hazard regression analysis was used to explore the probabilities of being at work, or of receiving sickness benefits, or disability pension, and differences in the transitions between any of these states during follow-up. Regression models based on transition intensities detected differences in the risk factors of entering and leaving a given state. For example among women, the lower probability of being at work than men, could be explained by a lower probability of transitions to work, and not by a higher probability of leaving work. In addition, the probabilities of being at work, and of receiving sickness benefits, and disability pension differed between men and women, age groups, diagnostic category, type of work, and previous history of sick leave. Being a female, having diagnoses other that mental and musculoskeletal, having bluecollar work, and receiving long-term sick leave before entering work rehabilitation, increased the risk of not returning to work and of receiving disability pension during follow-up. The use of novel statistical methods made it possible to understand more of the different patterns in or out of work or of receiving sickness benefits, and how the prognosis differed between groups. The results from this thesis show that the process of returning to work after long-term sick leave and work rehabilitation depends on the interplay between multifaceted prognostic factors related to the history of previous sick leave, age, gender, SES, health, function, and cognitions in terms of illness perceptions and fear avoidance beliefs for work. These findings may have implications for selection criteria into work rehabilitation, for tailoring actions during a work rehabilitation program, and may guide follow-up actions aiming at RTW in collaboration with stakeholders outside the work rehabilitation clinic

Sleep and insomnia symptoms in adolescence

Insufficient sleep, sleep problems and insomnia are common in adolescents, and insomnia and insufficient sleep are public health concerns that can impact adolescents’ mental and physical health. There are several different treatments for sleep problems and insomnia, and there is a great focus on the problem when it has already arisen. However, since this is a public health problem, it is important to shed light on it at an early stage, and to inform about adolescents’ sleep problems and insomnia symptoms. This, in hope to help the adolescents’, adults in their environment and professionals in school health care. Aim and methods: The overall aim of this doctoral thesis was to contribute with knowledge about possible factors influencing sleep and insomnia symptoms among adolescents. Paper I investigated adolescents’ experiences regarding what they perceived as facilitators and barriers for a good night´s sleep. This study has a qualitative design, focus groups interviews were performed and analysed with qualitative content analysis. Paper II investigated the associations between insomnia symptoms, academic performance, self-reported health, physical activity, school start time, and substance use in adolescents. This paper was a cross-sectional survey and analysed with descriptive and analytic statistics. Paper III aimed to test the measurement properties of the Minimal Insomnia Symptom Scale (MISS) together with an additional item focusing on daytime functioning, Minimal Insomnia Symptom Scale-Revised (MISS-R) among adolescents. This study has cross-sectional design and data was analysed with Rash measurement model. Paper IV aimed to investigate whether sleep duration, difficulties waking up, tiredness in school, and family financial situation among school-aged girls and boys (aged 6-10 years) can predict insomnia symptoms among female and male adolescents (aged 14-16 years). This was a longitudinal design and was analysed with descriptive and analytic statistics.Results: From paper I emerge that the adolescents were aware of the importance of sleep for managing during the day. However, there were both facilitators and barriers for achieving a good night sleep. Three categories were identified: striving for a sense of well-being, tiring yourself out and regulating electronic media. Paper II highlights that insomnia was associated with poor self-reported health, failed school courses, and use of alcohol and/or cigarettes. When the combined effect of self-reported health and physical activity were investigated, a combination of low physical activity and poor self-reported health was strongly associated with insomnia. Paper III showed that both MISS and MISS-R had good measurement properties, regarding targeting, items tended to represent more severe levels of insomnia symptoms than reported by the adolescents. Older adolescents were more likely to score higher than younger adolescents in the items concerning “problems with not being rested by sleep”, and “problems with daytime disturbance”. Paper IV showed different factors in childhood that predicted insomnia symptoms in adolescence. These factors differed between sex. Perceived quite bad/very bad family financial situation, and short sleep duration at baseline was associated with insomnia symptoms among female adolescents. However, problems waking up at baseline was associated with insomnia symptoms among male adolescents.Conclusions: This thesis shows that the adolescents want to talk about sleep problems and insomnia symptoms with adults in their environment. One instrument that professionals in school health care can have benefit of in the conversation with the adolescents, are MISS-R. MISS-R seem to be a reliable screening instrument for insomnia symptoms among adolescents. The adolescents need support from adults to facilitate a good night sleep

Oral health & olfactory function : what can they tell us about cognitive ageing?

The objective of this thesis was to advance our understanding of whether oral health and olfactory function may predict accelerated cognitive ageing. Data from two Swedish study populations and one from the United States were applied to investigate the relationship of oral health and olfactory function with cognitive decline and brain ageing in late life. Study I examined the association of self-reported tooth loss with cognitive decline, and brain volume differences in older adults (n= 2715) from the Swedish National study of Aging and Care-Kungsholmen (SNAC-K). A subsample (n= 394) underwent magnetic resonance imaging (MRI). Tooth loss was associated with a steeper global cognitive decline (β: -0.18, 95% confidence interval [CI]: -0.24 to -0.11). Participants with complete or partial tooth loss had significantly lower total brain volume (β: -28.89, 95% CI: -49.33 to -8.45) and grey matter volume (β: -22.60, 95% CI: -38.26 to -6.94). Thus, tooth loss may be a risk factor for accelerated cognitive ageing. Study II Investigated the effect of poor masticatory ability on cognitive trajectories and dementia risk in 544 cognitively intact adults aged ≥50 from the Swedish Adoption/Twin Study of Aging (SATSA) with 22 years of follow-up. Masticatory ability was assessed using the Eichner Index and categorised according to the number of posterior occlusal zones: A (all four), B (3-1), and C (none). After the age of 65, participants in Eichner category B and C showed an accelerated decline in spatial/fluid abilities compared to those in category A (β: -0.16, 95% CI: -0.30 to -0.03 and β: -0.15, 95% CI: -0.28 to -0.02, respectively). Hence, poor masticatory ability is associated with an accelerated cognitive decline in fluid/spatial abilities. Study III examined whether impaired olfaction is associated with cognitive decline and indicators of neurodegeneration in 380 participants (mean age = 78 years) from the Memory and Aging Project (MAP). Participants with hyposmia (β = −0.03, 95% CI: −0.05 to −0.02) or anosmia (β = −0.13, 95% CI −0.16 to −0.09) had a faster global cognitive decline than those with normal olfaction. Impaired olfaction was related to smaller volumes of primarily the medial temporal cortex (β = −0.38, 95% CI −0.72 to −0.01). Olfactory deficits predict faster cognitive decline and indicate neurodegeneration in older adults. Study IV identified age-related trajectories in episodic memory and odour identification, as well as determinants of the trajectories. 1023 MAP participants were followed for up to 8 years with annual assessments. Three joint trajectories were identified; Class 1- stable performance in both functions; Class 2- stable episodic memory and declining odour identification; and Class 3- decline in both functions. Predictors of class membership were age, sex, APOE ε4 carrier status, cognitive activity, and BMI. Episodic memory and olfactory function often show similar trajectories in ageing, reflecting their shared vulnerability to changes in the medial-temporal lobes. Conclusions: Both poor oral health and olfactory deficits may predict cognitive decline and indicate neurodegeneration in the brain. Poor oral health is associated with accelerated cognitive decline and brain ageing, whereas, olfactory deficits may reflect loss of brain integrity in old age

Depression and chronic diseases in old age : understanding their interplay for better health

Late-life depression is intricately linked with somatic diseases. This thesis aimed to systematically explore this complex interplay. Specifically, we investigated: 1) the symptom-level interconnectedness between depression and somatic diseases, 2) the association of depression with somatic multimorbidity accumulation, 3) the role of somatic disease burden in depression development, and 4) the association of somatic burden with transitions across depressive states in older adults. Data were gathered from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), a populationbased study comprising 3,363 individuals aged 60+ years who underwent clinical assessments over a 15-year follow-up. Study I. Using a network approach, we aimed to describe the interconnectedness between depressive symptoms and somatic disease burden in older people. We found that sadness, pessimism, anxiety, and suicidal thoughts were central to the network, whereas somatic symptoms of depression appeared peripherally with fewer interconnections. When examining the association between depressive symptoms and measures of somatic disease burden, we found that suicidal thoughts, reduced appetite, and cognitive difficulties were bridge symptoms, linking late-life depression with somatic health. Study II. We investigated the impact of depression severity and phenotypes (i.e., affective, anxiety, cognitive, and psychomotor) on the progression of somatic multimorbidity over 15 years. Compared to those without depression, individuals with major (β*year: 0.33, 95%CI: 0.06-0.61) and subsyndromal depression (β*year: 0.21, 95%CI: 0.12-0.30) presented an accelerated accumulation of somatic multimorbidity. An increase in the cognitive phenotype burden (and not in the other three) was associated with faster accumulation of somatic diseases in old age (β*year: 0.07, 95%CI: 0.03-0.10). Study III. We aimed to examine the association between quantitative and qualitative measures of somatic disease burden and the incidence of depression in older adults. Each additional somatic disease was associated with an increased hazard of depression over a 15-year follow-up (HR 1.16, 95%CI: 1.08-1.24). Individuals presenting with disease patterns of sensory/anemia (HR 1.91, 95%CI: 1.03-3.53), thyroid/musculoskeletal (HR 1.90, 95%CI: 1.06-3.39), and cardiometabolic patterns (HR 2.77, 95%CI: 1.40-5.46) had higher depression hazards compared to those without multimorbidity. In the subsample of multimorbid participants, the cardiometabolic pattern remained associated with a higher depression risk (HR 1.71, 95%CI: 1.02-2.84) compared to the unspecific pattern. Study IV. We examined the course of old-age depression by investigating 15-year transitions along the depressive continuum and exploring time-varying factors associated with specific transition patterns. Over the follow-up, 19.1% had ≥1 transitions across depressive states (no depression, subsyndromal depression [SSD], depression), while 6.5% had ≥2 transitions. A higher number of somatic diseases was associated with progression from no depression to both SSD (HR 1.09, 95%CI: 1.07-1.10) and depression (HR 1.06, 95%CI: 1.04-1.08), and with lower recovery rates from SSD (HR 0.95, 95%CI: 0.93- 0.97) and depression (HR 0.96, 95%CI: 0.93-0.99). A richer social network was linked to lower transition rates to depressive states (HRNoDep-SSD 0.81, 95%CI: 0.70-0.94; HRNoDep-Dep 0.58, 95%CI: 0.46-0.73; HRSSD-Dep 0.66, 95%CI: 0.44-0.98), and higher recovery rates (HRSSD-NoDep 1.44, 95%CI: 1.26-1.66; HRDep-NoDep 1.51, 95%CI: 1.34-1.71). Being physically active was associated with higher recovery rates (HRSSD-NoDep 1.49, 95%CI: 1.28-1.73; HRDep-NoDep 1.20, 95%CI: 1.00-1.44). Conclusions. Our findings suggest that several dimensions of complexity characterize the interconnection of depression and somatic disease burden in old age. A symptomlevel characterisation of depression, along with a consideration of subsyndromal severity, may help clarify the comorbidity of depression and somatic diseases, as well as predict health decline in people with depressive symptoms. Similarly, recognizing disease patterns may help improve risk stratification for depression development in clinically complex older adults. Last, the natural course of depression in late life is dynamic and involves complex patterns of transitions through symptom severities, which can be influenced by the time-varying burden of somatic diseases. Developing person-centered care that integrates these complexities could enhance resilience and contribute to better health in old age

Meta-analysis of gender and science research. Synthesis report

Sección Deptal. de Economía Aplicada, Pública y Política (Políticas)Fac. de Ciencias Políticas y SociologíaTRUEpu

Ageing Online : Promoting older persons' subjective wellbeing in a digital everyday life

Background: Digital technology and online services are often seen as one response to many of the challenges that the modern welfare state is expected to face. Evidently, digital technology is an essential part of the society as well as in our daily lives alike. Therefore, the digital context should be taken into consideration when studying subjective wellbeing— also among older persons. Digitalization further entails new ways of working among the multiprofessional personnel groups within the health and social care sector. The importance of meaningful engagement of older persons as part of the development of services is being recognized both within the international policies of active and healthy ageing as well as within the field of innovation studies. In general, more applied research is necessary when moving from evidence to practice in research regarding the promotion of wellbeing among older persons and related working methods and initiatives. Aim: To explore the multidimensionality of older persons’ subjective wellbeing and to deepen the understanding of health promotion practice and participatory approaches together with older persons in an increasingly digital everyday life. Methods: A multi-method design was applied and the thesis consist of four separate studies. Two studies were based on data from a cross-sectional, population-based survey study (the GERDA-project) conducted in 2016 in the Bothnia region (Finland and Sweden, n= ). Study III was a focus-group study with practitioners working with community-level health promotion targeting older persons in two regions in Finland and Sweden in 2019–2020. The last study is based on semi-structured interviews with older persons participating in the @geing online project in 2018–2020. Results: According to the study findings, there is a statistically significant association between subjective well-being and internet use in the studied older population. However, nuanced and multidimensional approaches—simultaneously taking into account the kind of online activities that the older persons engage in, as well as the particular dimensions of subjective wellbeing under study—are needed in order to develop the knowledge field. When it comes to health promotion practice, the findings highlight the importance of seeing the persons among the older people. Digital technology as well as an increased user involvement can support tailored work approaches and initiatives in future health promotion practice by breaking the current perceived barriers related to inflexible organizational routines and the own prejudices. The findings further highlight that being part of the development of an application can be an uplifting experience and increase the interest and confidence in digital technology use among older participants and combat stereotypical beliefs. However, participatory approaches are not linear, rather they are perceived as messy processes— which also can evoke experiences of disappointment among the participants. Conclusion: Digitalization is not only about the technology. Future research endeavours applying various, and preferably mixed methods, simultaneously examining the everyday life both online and offline in later life are warranted. This in order to deepen the understanding regarding the underlying mechanisms between subjective wellbeing and internet use and further answering the remaining question if internet per se actually is the driving component— affecting experienced well-being in later life— or if it is merely a key component of an already rich everyday life. In both design and implementation of technology, the process could entail more value and be facilitated if the user groups (which can be both older persons and practitioners) are actively participating and contributing with their expertise and contextual knowledge. However, advances are needed also regarding the methods for participatory technology design among older persons and especially regarding participatory approaches with diverse groups of older persons (especially more vulnerable groups). The findings highlights the importance of not generalizing the perquisites nor the health promotion actions for experiencing wellbeing an increasingly digital everyday later life.Bakgrund: Digitaliseringen av tjänster är en snabbt växande samhällstrend och ses som en av de viktigaste lösningarna för att göra de omställningar som krävs för att möta många av framtidens utmaningar. I och med att digitala verktyg och tjänster är en stor del av vardagen för en klar majoritet av befolkningen är det följaktligen viktigt att undersöka välbefinnandet i en digital vardagskontext – också bland äldre. Digitaliseringen innebär också ett förändrat arbetssätt inom social-och hälsovårdssektorn. Att på ett meningsfullt sätt inkludera äldre i utvecklingen av tjänster som berör dem är viktig och rekommenderas i såväl riktlinjer för att främja ett aktivt och hälsosamt åldrande som inom innovationsforskning. Överlag behövs mera tillämpad forskning för att kunna göra framsteg inom det gerontekonogiska forskningsfältet och för att kunna utveckla det hälsofrämjande arbetet. Syfte: Att undersöka det mångdimensionella subjektiva välbefinnandet bland äldre och att fördjupa kunskapen om hälsofrämjande arbete och samskapandearbetssätt med äldre personer i en alltmer digital vardag. Metod: Avhandlingen har en multi-metod design och innehåller fyra enskilda studier. De två första baserar sig på material som insamlats genom en enkät inom ramarna för GERDA-projektet år 2016 och är befolkningsbaserade tvärsnittsstudier. Den tredje studien består av fokusgruppintervjuer som gjorts med personal som arbetar med hälsofrämjande arbete i två regioner i Finland och Sverige under 2019–2020. I den fjärde studien analyserades semistrukturerade intervjuer som gjordes med äldre personer som deltog i projektet @geing online under åren 2018–2020. Resultat: Avhandlingen visar på att det finns ett samband mellan subjektivt välbefinnande och internetanvändning och digitala tjänster bland äldre personer i Botnia regionen. För att inte gå miste om viktig information om kopplingen mellan subjektivt välbefinnande och internetanvändning behöver man beakta både vilka digitala tjänster som äldre använder samt hur välbefinnande egentligen mäts. Vad gäller hälsofrämjande arbete riktat till äldre visar avhandlingens resultat på vikten att se de äldre personerna inom den äldre befolkningen. Vidare förslås också att digitala tjänster och samskapande tillvägagångssätt kan möjliggöra personcentrering och skräddarsydda tjänster genom att förändra styva riktlinjer och arbetssätt samt motarbeta de egna fördomarna. Resultaten visar också att det kan vara upplyftande att delta i utvecklingen av en ny applikation och att intresset för digitala verktyg och tilltron till sig själv som teknikanvändare ökade bland äldre deltagare. Samtidigt är samskapande innovationsprocesser inte linjära, utan det rör sig snarare om omständliga processer som också kan väcka olika känslor förknippade med besvikelse bland deltagarna. Slutsatser: Digitaliseringen handlar om mycket mer än bara teknik. För att kunna få svar på frågan om internetanvändning verkligen påverkar välbefinnande bland äldre eller om olika digitala tjänster bara är en del av ett sedan tidigare rikt liv behövs mera forskning. Framtida studier behöver inkludera och kombinera olika metoder samt undersöka båda ”offline” och ”online” aktiviteter samtidigt i en vardagskontext för att kunna titta närmare på för vem och under vilka omständigheter internet potentiellt kan främja välbefinnande. Både utvecklingen och implementeringen av nya digitala verktyg kan underlättas och ge mervärde ifall användare (både äldre och personal i detta fall) aktivt deltar och involveras. Forskning om samskapande innovationsprocesser behöver utökas och metoder för sådana tillvägagångssätt utvecklas – speciellt då det kommer till äldre och de olika grupperna inom den äldre befolkningen. Slutligen är det viktigt att inte generalisera då det kommer till äldres subjektiva välbefinnande, internetanvändning och hälsofrämjande arbete