Neighborhood effects in mental health and health behavior : Longitudinal analysis of social causation versus selective residential mobility

Differences in well-being between neighborhoods have long been recognized. These inequalities have been explained by neighborhood effects, in other words characteristics of the neighborhoods that affect well-being. However, the direction of causality in neighborhood effects is still unknown. This dissertation examines whether inequalities in well-being between neighborhoods are caused by neighborhood characteristics social causation, or by selective residential mobility social selection. The participants in these studies were from the ongoing prospective longitudinal population-based Young Finns study. The aims of this study were: 1) to examine whether neighborhood urbanicity and socioeconomic status affected health behaviors, depressive symptoms and source of social support, and 2) to examine how those variables affect residential mobility behavior. The results suggest that people in more urban and affluent neighborhoods are more interested in their health. However, simultaneously those people drink more alcohol, and also people in more urban areas smoke more. People in more rural areas received more social support from their family, whereas people in more urban areas received more social support from their friends. While part of the results were explained by social causation, most of the effects were attributed to social selection. People who received more social support from their friends were more likely to move and to move more frequently. Also, people with better health behaviors moved longer distances. None of the individual level variables were associated with selective residential mobility between municipalities. This dissertation addressed the problem of causality in neighborhood effects. The findings do give some support for social causation in neighborhood effects, but most of the effects are explained by social selection. However, the results also imply that health behaviors or social support do not affect selective residential mobility. Therefore, it is likely that some other individual level variables govern selective residential mobility and the forming of differences in well-being between neighborhoods.Asuinalueiden väliset hyvinvointierot on tunnistettu jo kauan sitten. Näitä epäsuhtia on selitetty naapurustovaikutuksilla, toisin sanoen asuinalueen ominaisuuksilla, jotka vaikuttavat hyvinvointiin. Naapurustovaikutuksien kausaalisuuden suunta on kuitenkin edelleen epäselvä. Tässä väitöskirjassa tarkastellaan sitä, johtuvatko asuinalueiden väliset hyvinvointierot asuinalueen ominaisuuksista vai siitä, että tietynlaiset ihmiset valikoituvat asumaan tietynlaisille asuinalueille. Tutkimuksen osallistujat valittiin Lasten ja nuorten sepelvaltimotaudin riskitekijät -tutkimuksesta. Tämän väitöstutkimuksen tarkoitus on 1) selvittää, vaikuttavatko asuinalueen kaupunkimaisuus ja sosioekonominen asema asukkaiden terveyskäyttäytymiseen, masennusoireisiin ja sosiaalisen tuen lähteeseen ja 2) tarkastella, vaikuttavatko edellä mainitut yksilötason muuttujat siihen, miten ihmiset muuttavat. Tulosten perusteella kaupunkimaisilla ja varakkailla alueilla asuvat ihmiset ovat enemmän kiinnostuneita terveydestään kuin muualla asuvat. Toisaalta he kuitenkin juovat enemmän alkoholia. Kaupunkimaisilla alueilla asuvat myös polttavat enemmän tupakkaa. Vaikka osa tuloksista selittyy naapurustovaikutuksilla niin paremmin tuloksia kuitenkin selittää ihmisten valikoituminen asumaan tietynlaisille alueille. Ihmiset, jotka saivat enemmän sosiaalista tukea ystäviltään, muuttivat muita todennäköisemmin ja useammin. Lisäksi he, joiden terveyskäyttäytyminen oli parempaa, tekivät pidempiä muuttoja. Mikään yksilötason tekijä ei ollut yhteydessä valikoivaan muuttoliikkeeseen kuntien välillä. Tämä väitöskirja keskittyi naapurustovaikutusten kausaalisuhteiden selvittämiseen. Tulokset viittaavat siihen, että osa alueiden välisistä hyvinvointieroista selittyy naapurustovaikutuksilla, mutta selvästi suurempi osa valikoivalla muuttoliikkeellä. Terveyskäyttäytyminen tai sosiaalisen tuen lähde eivät kuitenkaan vaikuta muuttoliikkeeseen, joka todennäköisesti selittyy muilla yksilötason tekijöillä

Associations Between Cohabitation, Marriage, and Suspected Crime : a Longitudinal Within-Individual Study

The effects of marriage on criminal behavior have been studied extensively. As marriages today are typically preceded by cohabiting relationships, there is a growing need to clarify how different relationship types are associated with criminality, and how these effects may be modified by relationship duration, partner's criminality, and crime type. We used Finnish longitudinal register data and between- and within-individual analyses to examine how cohabitation and marriage were associated with suspected crime. The data included 638,118 residents of Finland aged 0-14 in 2000 and followed for 17 years for a suspected crime: having been suspected of violent, drug, or any crime. Between-individual analyses suggested that those who were cohabiting or married had a 40-65% lower risk of being suspected of a crime compared to those who were single, depending on the type of crime. The within-individual analysis showed a 25-50% lower risk for suspected crime when people were cohabiting or married compared to time periods when they were single. Those in a relationship with a criminal partner had 11 times higher risk for suspected crime than those in a relationship with a non-criminal partner. Forming a cohabiting relationship with a non-criminal partner was associated with reduced criminality. The risk reduction was not fully explained by selection effects due to between-individual differences. Marriage did not introduce further reduction to criminality. Our findings demonstrate that selection effects partly explain the association between relationship status and criminality but are also compatible with a causal effect of cohabitation on reduced risk of being suspected of a crime.Peer reviewe

Health behaviors and psychological distress : changing associations between 1997 and 2016 in the United States

Objectives Smoking rates have declined with a slower pace among those with psychological distress compared to those without. We examined whether other health behaviors (heavy alcohol consumption, physical inactivity, short sleep duration) showed similar trends associated with sychological distress. We also examined differences by age and birth cohort. Methods Data were from the annually repeated cross-sectional U.S. National Health Interview Surveys (NHIS) of 1997-2016 (total n = 603,518). Psychological distress was assessed with the 6-item Kessler Psychological Distress Scale (K6). Results Psychological distress became more strongly associated with smoking (OR 1.09 per 10 years; 95% CI 1.07, 1.12), physical inactivity (OR 1.08; 1.05, 1.11), and short sleep (OR 1.12; 1.06, 1.18), but less strongly associated with heavy alcohol consumption (OR 0.93; 0.89, 0.98). The associations of smoking and alcohol consumption attenuated with age, whereas the association with physical inactivity strengthened with age. Compared to older birth cohorts, smoking became more strongly associated with psychological distress among younger birth cohorts up to those born in the 1980s. Conclusions The strength of associations between psychological distress and health behaviors may vary by time period, age, and birth cohort.Peer reviewe

Personality, disability-free life years, and life expectancy : Individual participant meta-analysis of 131,195 individuals from 10 cohort studies

Objective We examined how personality traits of the Five Factor Model were related to years of healthy life years lost (mortality and disability) for individuals and the population. Method Participants were 131,195 individuals from 10 cohort studies from Australia, Germany, the United Kingdom, and the United States (n = 43,935 from seven cohort studies for the longitudinal analysis of disability, assessed using scales of Activities of Daily Living). Results Lower Conscientiousness was associated with higher mortality and disability risk, but only when Conscientiousness was below its median level. If the excess risk associated with low Conscientiousness had been absent, population life expectancy would have been 1.3 years longer and disability-free life 1.0 years longer. Lower emotional stability was related to shorter life expectancy, but only among those in the lowest 15% of the distribution, and disability throughout the distribution: if the excess risk associated with low emotional stability had been absent, population life expectancy would have been 0.4 years longer and disability-free life 2.4 years longer. Conclusions Personality traits of low Conscientiousness and low emotional stability are associated with reduced healthy life expectancy of individuals and population.Peer reviewe

Does antidepressant treatment response depend on specific symptoms of depression? : A multi-trial study

Peer reviewe

Chronic diseases and social risk factors in relation to specific symptoms of depression : Evidence from the U.S. national health and nutrition examination surveys

Background: Depression is a heterogeneous mental disorder with multiple symptoms, but only few studies have examined whether associations of risk factors with depression are symptom-specific. We examined whether chronic diseases and social risk factors (poverty, divorce, and perceived lack of emotional support) are differently associated with somatic and cognitive/affective symptoms of depression. Methods: Cross-sectional analyses were based on individual-level data from the 31,191 participants of six cross-sectional U.S. National Health and Nutrition Examination Surveys (NHANES) carried out between 2005 and 2016. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire. Information on chronic diseases and social risk factors was self-reported by participants. Results: After adjustment for sex, age, race/ethnicity, and all the of other symptoms besides the outcome symptom, higher number of chronic diseases was independently related to fatigue, psychomotor retardation/agitation, and sleep problems in a dose-response pattern (range of odds ratios: 1.21 to 2.59). Except for concentration problems, social risk factors were associated with almost all of the cognitive/affective symptoms (range of odds ratios: 1.02 to 2.09) but only sporadically with somatic symptoms. Limitations: All measures were self-reported by the participants, which may have introduced bias to the associations. Cross-sectional data did not allow us to study temporal dynamics. Conclusions: Specific symptoms of depression may be useful in characterizing the heterogeneous etiology of depression with respect to somatic versus social risk factors.Peer reviewe

Association of depressive symptoms with health care utilization in older adults : Longitudinal evidence from the Survey of Health, Aging and Retirement in Europe

Objectives Many older adults with depression do not receive adequate treatment. Differences in treatment utilization may reflect the heterogeneous nature of depression, encompassing multiple distinct symptoms. We assessed whether depressive symptoms are differentially associated with subsequent health care utilization with respect to three outcomes as follows: (1) contact with a medical doctor (MD), (2) depression-specific treatment, and (3) inpatient psychiatric admission. Methods/Design Longitudinal analyses were based on data from three follow-up cycles conducted between 2004 and 2013 among 53,139 participants from the Survey of Health, Aging, and Retirement in Europe. Depressive symptoms were self-reported at baseline of each follow-up cycle using the 12-item EURO-D scale. Health care utilization was self-reported at the end of each follow-up cycle. Results After adjustment for sex, age, country of interview, follow-up time, educational attainment, presence of a partner in household, body-mass index, the number of chronic diseases, disability, average/prior frequency of contact with an MD, and all other depressive symptoms, people with more frequent contact with an MD had most often reported sleep problems (IRR = 1.10) and fatigue (IRR = 1.10), followed by sad/depressed mood, tearfulness, concentration problems, guilt, irritability, and changes in appetite. Those treated for depression had most often reported sad/depressed mood (OR = 2.18) and suicidal ideation (OR = 1.72), but also sleep problems, changes in appetite, fatigue, concentration problems, hopelessness, and irritability. Sad/depressed mood (OR = 2.87) was also associated with psychiatric inpatient admission. Similarly to other outcomes, appetite change, fatigue, and sleep problems were associated with inpatient admission. Conclusions Specific symptoms of depression may determine utilization of different types of health care among elderly.Peer reviewe

Prediction of violence or threat of violence among employees in social work, healthcare and education: the Finnish Public Sector cohort study

Objectives: To develop a risk prediction algorithm for identifying work units with increased risk of violence in the workplace. // Design: Prospective cohort study. // Setting: Public sector employees in Finland. // Participants: 18 540 nurses, social and youth workers, and teachers from 4276 work units who completed a survey on work characteristics, including prevalence and frequency of workplace violence/threat of violence at baseline in 2018–2019 and at follow-up in 2020–2021. Those who reported daily or weekly exposure to violence or threat of violence daily at baseline were excluded. // Exposures: Mean scores of responses to 87 survey items at baseline were calculated for each work unit, and those scores were then assigned to each employee within that work unit. The scores measured sociodemographic characteristics and work characteristics of the work unit. // Primary outcome measure: Increase in workplace violence between baseline and follow-up (0=no increase, 1=increase). // Results: A total of 7% (323/4487) of the registered nurses, 15% (457/3109) of the practical nurses, 5% of the social and youth workers (162/3442) and 5% of the teachers (360/7502) reported more frequent violence/threat of violence at follow-up than at baseline. The area under the curve values estimating the prediction accuracy of the prediction models were 0.72 for social and youth workers, 0.67 for nurses, and 0.63 for teachers. The risk prediction model for registered nurses included five work unit characteristics associated with more frequent violence at follow-up. The model for practical nurses included six characteristics, the model for social and youth workers seven characteristics and the model for teachers included four characteristics statistically significantly associated with higher likelihood of increased violence. // Conclusions: The generated risk prediction models identified employees working in work units with high likelihood of future workplace violence with reasonable accuracy. These survey-based algorithms can be used to target interventions to prevent workplace violence

Prediction of long-term absence due to sickness in employees : development and validation of a multifactorial risk score in two cohort studies

Objectives This study aimed to develop and validate a risk prediction model for long-term sickness absence. Methods Survey responses on work-and lifestyle-related questions from 65 775 public-sector employees were linked to sickness absence records to develop a prediction score for medically-certified sickness absence lasting > 9 days and >= 90 days. The score was externally validated using data from an independent population-based cohort of 13 527 employees. For both sickness absence outcomes, a full model including 46 candidate predictors was reduced to a parsimonious model using least-absolute-shrinkage-and-selection-operator (LASSO) regression. Predictive performance of the model was evaluated using C-index and calibration plots. Results Variance explained in >= 90-day sickness absence by the full model was 12.5%. In the parsimonious model, the predictors included self-rated health (linear and quadratic term), depression, sex, age (linear and quadratic), socioeconomic position, previous sickness absences, number of chronic diseases, smoking, shift work, working night shift, and quadratic terms for body mass index and Jenkins sleep scale. The discriminative ability of the score was good (C-index 0.74 in internal and 0.73 in external validation). Calibration plots confirmed high correspondence between the predicted and observed risk. In > 9-day sickness absence, the full model explained 15.2% of the variance explained, but the C-index of the parsimonious model was poor ( Conclusions Individuals' risk of a long-term sickness absence that lasts >= 90 days can be estimated using a brief risk score. The predictive performance of this score is comparable to those for established multifactorial risk algorithms for cardiovascular disease, such as the Framingham risk score.Peer reviewe

Socioeconomic inequalities in impairment associated with depressive symptoms : Evidence from the National Survey on Drug Use and Health

Objective: Individuals with low socioeconomic status have higher rates of depression, but it is unknown whether the socioeconomically disadvantaged also have more disabling depressive symptoms. We examined (1) the associations of three indicators of socioeconomic status with depression-related severe role impairment, and (2) whether socioeconomic factors moderate the association between individual depression symptoms and depression-related severe role impairment. Methods: We used data from the National Survey on Drug Use and Health (NSDUH). Depressive symptoms, role impairment and socioeconomic indicators (poverty, participation in workforce, educational attainment) were self-reported by participants. The analytic sample consisted of participants who screened positive for a depressive episode during past 12 months (n = 32 661). We used survey-weighted logistic models to examine the associations of depressive symptoms with severe role impairment and the modifying effects of socioeconomic indicators. Results: The association between depression symptom count and severe role impairment was stronger among those not in workforce (OR = 1.12[1.02-1.23]). The association between specific depression symptoms and severe role impairment was stronger for conditions of poverty (fatigue, OR = 2.97 [1.54-5.73]; and anhedonia, OR = 1.93[1.13-3.30]), workforce non-participation (inability to concentrate/indecisiveness, OR = 1.54 [1.12-2.12]), and lower educational attainment (anhedonia, OR = 0.77 [0.59-0.99]). Feelings of worthlessness was the only symptom with independent associations for all socioeconomic groups (adjusted OR = 1.91 [1.35-2.70]). Conclusion: Depression was more frequent and also more disabling for socioeconomically disadvantaged groups, especially when assessed with workforce participation. Additionally, some specific symptoms showed socioeconomic differences. Our findings highlight the need to prioritize population groups with more severe impairment associated with depressive symptoms.Peer reviewe