The Association between Time Spent in Domestic Work and Mental Health among Women and Men

BACKGROUND: Unpaid domestic work has been found to be negatively associated with mental health, especially among women, in previous studies but the measures of domestic work vary. The aim of this study was to elucidate the association between time spent in domestic work and mental health in the general population. METHOD: The study is based on 14,184 women and men aged 30-69 years who responded to a survey questionnaire in Central Sweden in 2017 (overall response rate: 43%). Multivariate logistic regression models, adjusting for age group, educational level, family status, employment status, economic difficulties, and social support, were used to study the association between hours spent in domestic work and depressive symptoms and self-reported diagnosed depression, respectively. RESULTS: In total, 26.7% of the respondents reported depressive symptoms and 8.8% reported diagnosed depression. No independent associations between hours spent in domestic work and depressive symptoms were found. Among women, the lowest prevalence of depression was found among those who spend 11-30 h per week in domestic work. Among men, the prevalence of self-reported diagnosed depression was highest among those who spend 0-2 h per week in domestic work, but no other statistically significant associations between time spent in domestic work and depression were found. In addition, a strong dose-response relationship was found between experiencing domestic work as burdensome and both depressive symptoms and self-reported diagnosed depression among women and men. CONCLUSION: Investigating time spent in unpaid domestic work may not be sufficient to assess the association between exposure to domestic work and mental health. Conversely, strain in domestic work may be a more important factor contributing to the prevalence of poor mental health in the general population

Domestic Work, Self-Reported Diagnosed Depression and Related Costs among Women and Men-Results from a Population-Based Study in Sweden

Background: In contrast to paid work, few studies have investigated the association between unpaid domestic work and mental health. The aim of this study was to investigate the association between domestic work and self-reported diagnosed depression and to estimate related costs in a general population. Method: The study is based on women (N = 7981) and men (N = 6203) aged 30-69 years who responded to a survey questionnaire in Mid-Sweden in 2017 (overall response rate 43%). Multivariate logistic regression models, adjusting for age group, educational level, family status, employment status, economic difficulties, and social support, were used to study the association between domestic work and depression. The estimation of direct and indirect costs was based on the calculation of population attributable risks, the literature, and administrative data. Results: In total, 25% of the women and 14% of the men spent more than 20 h a week on domestic work, and 57% of the women and 39% of the men experienced domestic work sometimes or more often as burdensome. A strong independent association between experiencing domestic work as burdensome and depression was observed both in women and men. The total cost of depression possibly related to burdensome domestic work was estimated up to EUR 135.1 million (min EUR 20.7 million-max EUR 21.4 billion) of the total EUR 286.4 million per year in Mid-Sweden. Conclusions: The association between experiencing domestic work as burdensome and depression was strong among both women and men and was not restricted to employed persons or to parents with children. Even though the cross-sectional design does not allow one to assess the direction of the association between domestic work and depression, and longitudinal studies are needed, the results imply that strain in domestic work should be taken into account when considering factors that contribute to the prevalence of depression in the general population and its high societal costs

Diagnostic accuracy for colorectal cancer of a quantitative faecal immunochemical test in symptomatic primary care patients : a study protocol

BACKGROUND: There is increasing evidence supporting the use of faecal immunochemical tests (FIT) in patients reporting symptoms associated with colorectal cancer (CRC), but most studies until now have focused on selected subjects already referred for investigation. We therefore set out to determine the accuracy and predictive values of FIT in a primary care population. METHOD: A prospective, multicentre, single-gated comparative diagnostic study on quantitative FIT in patients aged 40 years and above presenting in primary care with symptoms associated with CRC will be conducted. Patients representing the whole spectrum of severity of such symptoms met with in primary care will be eligible and identified by GPs. Participants will answer a short form on symptoms during the last month. They will provide two faecal samples from two separate days. Analyses will be performed within 5 days (QuikRead go®, Aidian Oy). The analytical working range is 10-200 μg Hb/g faeces. Reference test will be linked to the Swedish Colorectal Cancer Registry up to 2 years after inclusion. Accuracy, area under ROC curves, and predictive values will be calculated for one FIT compared to the highest value of two FIT and at cutoff < 10, 10-14.9, 15-19.9 and ≥ 20 μg Hb/g faeces. Subgroup analyses will be conducted for patients with anaemia and those reporting rectal bleeding. A model-based cost-effectiveness analysis based on the clinical accuracy study will be performed. Based on previous literature, we hypothesized that the sensitivity of the highest value of two FIT at cutoff 10 μg Hb/g faeces will be 95% (95% CI + / - 15%). The prevalence of CRC in the study population was estimated to be 2%, and the rate of non-responders to be 1/6. In all, 3000 patients will be invited at 30 primary care centres. DISCUSSION: This study will generate important clinical real-life structured data on accuracy and predictive values of FIT in the most critical population for work-up of CRC, i.e. patients presenting with at times ambiguous symptoms in primary care. It will help establish the role of FIT in this large group

Burden of Atopic Dermatitis in Swedish Adults : A Population-based Study

The burden of atopic dermatitis (AD) was assessed. A population-based, cross-sectional questionnaire study was performed among 34,313 Swedish adults in 2017. The prevalence of AD was 14%. Adults with mild AD had an increased relative risk ratio (RRR) of severe depression (aRRR 1.78, 95% confidence interval (95% CI) 1.50–2.12) and anxiety (aRRR 1.97, 95% CI 1.69–2.30), which was higher for severe AD (aRRR 6.22 95% CI 4.60– 8.42, aRRR 5.62 95% CI 4.10–7.71, respectively). Persons with severe AD were less likely to have a university degree (aRRR 0.55, 95% CI 0.34–0.90) and more likely to have a lower annual income (238,000–324,000 SEK: aRRR 0.51, 95% CI 0.39–0.77; 325,000 SEK or more 0.36; 0.25–0.58) compared with individuals without AD. These results suggest that AD implies an increased prevalence of comorbid mental conditions and an adverse impact on academic achievement and work. These adverse associations increase substantially for patients with severe AD and comorbid asthma

Societal economic burden and determinants of costs for atopic dermatitis

Background: Atopic dermatitis (AD) is a common inflammatory skin disease while the economic burden of AD by severity is not adequately understood. Objective: To estimate the societal economic burden and to identify cost determinants of AD. Methods: In this population-based, controlled cohort study in Sweden, patients with AD were identified through diagnosis codes in primary or secondary care or by dispensed medications using administrative healthcare registers. A reference cohort without AD was randomly selected from the general population. Healthcare costs (primary/secondary care visits and dispensed medication) and indirect costs (care for sick children and long-term sick leave for adults) were calculated annually. AD patients were stratified by age (paediatric [age < 12], adolescent [12 ≤ age < 18] or adult [age ≥ 18]), and severity (mild-to-moderate [M2M] or severe AD) and matched to the reference cohort. Results: Compared with controls, the annual mean per-patient direct healthcare costs in the first year following diagnosis were €941 and €1259 higher in paediatric patients with M2M and severe AD, respectively. In the first year following diagnosis, the mean indirect cost for care of sick children was €69 and €78 higher per patient in M2M and severe AD, respectively. In adolescents with M2M and severe AD, direct healthcare costs were €816 and €1260 higher, respectively. In adults, healthcare costs were €1583 and €2963 higher in patients with M2M and severe AD, respectively and indirect costs were €148 and €263 higher compared with controls. Management of comorbid medical conditions was an important driver of incremental healthcare costs. Total incremental societal economic burden for AD was €351 and €96 million higher in patients with M2M and severe AD, respectively, compared to controls. Conclusion: AD is associated with a significant societal economic burden primarily driven by the cost burden of M2M AD due to the high prevalence of this population. Regardless of severity level, management of non-AD comorbidities is a major driver of total costs