hig.sePublications
Change search
Link to record
Permanent link

Direct link
BETA
Hiswåls, Anne-Sofie
Publications (10 of 10) Show all publications
Macassa, G., Hiswåls, A.-S., Ahmadi, N. & McGrath, C. (2017). Educating Public Health Professionals for an Unknown Future: Insight from a New Bachelor Programme Linking Health Promotion and Sustainable Development. Research in Health Science, 2(2), 70-78
Open this publication in new window or tab >>Educating Public Health Professionals for an Unknown Future: Insight from a New Bachelor Programme Linking Health Promotion and Sustainable Development
2017 (English)In: Research in Health Science, ISSN 2470-6205, Vol. 2, no 2, p. 70-78Article in journal (Refereed) Published
Abstract [en]

This paper aims to provide a description of the new bachelor programme “Health Promotion through Sustainable Development”, which started in autumn 2016 at the University of Gävle, Faculty of Health and Working Life. The programme was built integrating public health and biology through a thread of health promotion and sustainable development across the three years of study. In the era of sustainable development and more complex health threats, future public health professionals need to be equipped with the right knowledge and skills that will enable them to promote a sustainable population health.

Keywords
Public health, health promotion, biology, sustainable development, University of Gävle
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:hig:diva-24113 (URN)10.22158/rhs.v2n2p70 (DOI)
Available from: 2017-06-09 Created: 2017-06-09 Last updated: 2018-03-13Bibliographically approved
Hiswåls, A.-S. (2017). Employment Status and Inequalities in Health Outcomes: Population-based Studies from Gävleborg County. (Doctoral dissertation). Sundsvall: Mid Sweden University
Open this publication in new window or tab >>Employment Status and Inequalities in Health Outcomes: Population-based Studies from Gävleborg County
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and objectives: From a public health perspective, it is important not only to improve and maintain health, but also to promote equality in health. Epidemiological research has showed the importance of work and unemployment in the development of socio-economic health inequalities, and peoples life chances are suggested to be conditioned by participation or exclusion from the labour market. The most recent economic recession has brought further changes to the labour market that might have aggravated the already multifaceted image of inequalities in health. Gävleborg County was one of the hardest hit counties in Sweden, which experienced a myriad of changes in the labour market that went beyond those of the Swedish national average, in terms of increase in flexible forms of employment, factory closures, and lay-offs. The overall objective of this thesis was to investigate the relationship between employment status and health-related inequalities in Gävleborg County, Sweden. In addition, the Specific objectives for the thesis were to: assess the relationship between employment status and self-reported health in Gävleborg (Study I); to estimate the relationship between employment status and suicidal ideation during the economic recession in Gävleborg (Study II); to estimate the prevalence of anxiety and depression among economically active people living in the Municipality of Gävle (Study III) and to assess experiences and perceptions of well-being after involuntary job loss in Gävle (Study IV).

Methods: Study I and II in this thesis used data from the 2010 Health in Equal Terms survey, a cross-sectional survey carried out in Gävleborg County in Sweden. A total of 4,245 individuals, aged 16–65 years were included in the analyses. Study III was performed in Wave 1 (baseline survey) of the Gävle Household, Labour Market Dynamics and Health Outcomes survey (GHOLDH), a panel survey with household as the follow-up unit. A total of 241 persons completed a self-administered postal questionnaire which collected information on the employment status and psychological health (anxiety and depression) among persons aged 18–65 years. The thesis used descriptive analyses and logistic regression models to describe and explore the relationship between employment status, self-reported health and suicidal ideation in Gävleborg County (Studies I and II). Descriptive analysis of means and a multiple regression analysis for adjusted means of HADS, were used in order to estimate the prevalence of anxiety and depression among economically active persons residing in the Gävle Municipality (Study III). Study IV used a qualitative approach to gain a deeper understanding of how involuntarily unemployed persons in Gävlexperceive their well-being. Sixteen unemployed men and women aged 28–62 were interviewed face-to-face. A purposeful sampling strategy was used in order to suit the research question and to increase the variation among informants. The interview texts in Study IV were analysed using thematic analysis.

Results: In Study I, the prevalence of poor self-reported health (SRH) was twice as high in the group of people who were not employed (42%) compared to the employed group (21.6%). Individuals outside the labour market had odds of poor health of 2.64 (Cl 2.28–3.05) compared to their employed counterparts. Controlling for other covariates reduced the risk slightly to 2.10 (1.69–2.60), but remained statistically significant. Moreover, other variables such as long-standing illness, age, income and lack of social support were associated with self-reported poor health. In Study II, among those not employed, 11.2% had been in a situation where they had seriously considered taking their life (at some time during the past 12 months). The corresponding figure for those employed was 2.9%. Unadjusted results of the logistic regression analysis revealed that people who were not employed had about a four times higher risk of suicidal ideation, with an OR of 4.21 (CI: 3.14–5.64) compared to their employed counterparts. Controlling for other covariates, reduced the risk from 4.21(CI 3.14–5.64) in model I, to 1.73 (CI 1.16–2.57) in model IV, but remained statistically significant. In addition, other variables were associated with suicidal ideation. In Study III, the prevalence and risk of anxiety and depression were high among people who were out of work. In the multiple regression analysis, compared to employed people, those who were not employed had a risk of anxiety of 7.76 (5.97–9.75) and 4.67 (3.60–5.74) for depression. Study IV revealed six different themes from the interviews: Work was perceived as the basis for belonging; loss of work affected people’s social life and consumption patterns due to changes in their financial situation. Feelings of isolation, loss of self-esteem, and feelings of hopelessness were reported, affecting the respondents’ physical well-being. Longer duration of unemployment increased the respondents’ negative emotions. Activities, structure, and affiliation in other contexts were reported as part of their strategy for coping with poor mental health.

Conclusion: This thesis found a statistically significant relationship between being outside the labour market and poor SRH, a high risk of suicidal ideation, anxiety, and depression during the recent economic recession. The relationship between employment status and SRH was partially explained by socioeconomic, demographic and lifestyle variables. In addition, the relationship between employment status and suicidal ideation was, for the most part, explained by demographic, socio-economic and self-reported psychological variables. Atxithe municipal level, the prevalence of anxiety and depression was higher among those who were out of the labour market as compared to those who were employed and the odds of anxiety and depression were higher among people out of the labour market, but this was less prominent for depression than for anxiety. Job loss created feelings of loss of dignity and belonging as a human being. The participants experienced feelings of worry, insecurity, and stress due to their changed financial situation, which in turn led to isolation and loss of self-esteem. Social support and having activities other than work gave structure and meaning to everyday life. The results of this thesis indicate a need for early detection and potential treatment of people out of the labour force and for being aware of the increased risk of poor health symptoms and disorders among unemployed individuals. The findings also indicate a need for primary prevention strategies, implying that policy-makers must pay attention to the health status of those who are out of work, especially during times of combined economic hardship and labour market fluctuations. However, longitudinal studies are warranted to shed further light on the mechanisms through which employment status and conditions impact physical and psychological health outcomes.

Abstract [sv]

Bakgrund och Syfte: I ett folkhälsoperspektiv är det viktigt att inte bara förbättra och bibehålla hälsan utan också främja jämlikhet i hälsa. Epidemiologisk forskning har visat vilken betydelse arbete och arbetslöshet har i utvecklingen av socioekonomiska hälsorisker, där människors möjligheter i livet föreslås vara beroende av deltagande i eller uteslutning från arbetsmarknaden. Den senaste ekonomiska lågkonjunkturen har medfört ytterligare förändringar på arbetsmarknaden som kan ha förvärrat den redan mångfacetterade bilden av ojämlikheter i hälsa. Gävleborgs län var ett av de hårdast drabbade länen i Sverige, som upplevde en myriad av förändringar på arbetsmarknaden som gick utöver det svenska nationella genomsnittet när det gäller ökning av flexibla anställningsformer, fabriksnedläggningar och uppsägningar. Det övergripande syftet för denna avhandling var att undersöka förhållandet mellan anställningsstatus och hälsorelaterade ojämlikheter i Gävleborgs län. Dessutom var de specifika syftena för avhandlingen, att bedöma sambandet mellan anställningsstatus och självrapporterad hälsa i Gävleborgs län (studie I); att bedöma relationen mellan anställningsstatus och självmordstankar under ekonomisk recession i Gävleborgs län (Studie II); att uppskatta förekomsten av ångest och depression bland ekonomiskt aktiva personer bosatta i Gävle kommun (Studie III) och att bedöma erfarenheter och uppfattningar om välbefinnande efter ofrivillig arbetsförlust i Gävle kommun (Studie IV).

Metoder: Studie I och II i den här avhandlingen använde data från hälsa på lika villkor-undersökningen 2010, en tvärsnittsundersökning utförd i Gävleborgs län i Sverige. Totalt 4 445 individer, i åldrarna 16-65 år, ingick i analyserna. Studie III utfördes inom baslinjeundersökningen av Gävle Household, Labour Market Dynamics and Health Outcomes survey (GHOLDH), en panelundersökning med hushåll som uppföljningsenhet. Totalt 241 personer besvarade ett frågeformulär som samlade information om anställningsstatus och psykisk hälsa (ångest och depression) bland personer i åldrarna 18-65 år. Avhandlingen använde beskrivande analyser och logistiska regressionsmodeller för att beskriva och undersöka förhållandet mellan anställningsstatus, självrapporterad hälsa (SRH) och självmordstankar i Gävleborgs län (studie I och II). Beskrivande analys av medelvärden för HADS och en multipel regressionsanalys för justerade medelvärden för HADS användes för att uppskatta förekomsten av ångest och depression bland ekonomiskt aktiva personer bosatta i Gävle kommun (studie III). Studie IV använde ett kvalitativt tillvägagångssätt för att få en djupare förståelse förxivhur ofrivilligt arbetslösa personer i Gävle uppfattar sitt välbefinnande, här definierat som övergripande fysiskt och psykiskt välbefinnande inklusive livskvalitet. Sexton arbetslösa män och kvinnor i åldrarna 28-62 år intervjuades ansikte mot ansikte. En målstyrd urvalsstrategi användes för att passa forskningsfrågan och för att öka variationen mellan informanter. Intervjutexterna i studie IV analyserades med hjälp av tematisk analys.

Resultat: I studie I var förekomsten av dålig SRH dubbelt så hög i gruppen av personer som inte var anställda (42%) jämfört med den anställda gruppen (21,6%). Personer utanför arbetsmarknaden hade odds för dålig självrapporterad hälsa på 2,64 (Cl 2,28-3,05) jämfört med deras anställda motsvarigheter. Efter kontroll för andra möjliga påverkande faktorer minskade risken något till 2,10 (1,69-2,60), men förblev statistiskt signifikant. Vidare visade sig andra faktorer såsom långvarig sjukdom, ålder, inkomst och brist på socialt stöd vara förknippade med dålig självrapporterad hälsa. I studie II, hade 11,2% bland de som inte var anställda, varit i en situation där de allvarligt hade övervägt att ta sitt liv (någon gång under de senaste tolv månaderna). Motsvarande siffra för de anställda var 2,9%. Ojusterade resultat av den logistiska regressionsanalysen visade att personer som inte var anställda hade fyra gånger högre risk för självmordstankar, med odds på 4,11 (CI: 3,14-5,64) jämfört med deras anställda motsvarigheter. När andra kontrollvariabler adderades till analysen, reducerades risken från 4.21 (CI 3.14-5.64) i modell I till 1,73 (CI 1,16-2,57) i modell IV, men förblev statistiskt signifikant. Andra variabler visade sig också vara associerade med självmordstankar. I studie III var prevalensen och risken för ångest och depression hög bland personer som var utanför arbetsmarknaden. I regressionsanalysen, hade de som inte var anställda en risk för ångest på 7,76 (5,97-9,75) och för depression på 4,67 (3,60-5,74), jämfört med sina anställda motsvarigheter. Studie IV avslöjade sex olika teman från intervjuerna: Arbetet uppfattades som grunden för tillhörighet, arbetsförlust påverkade respondenternas sociala liv och konsumtionsmönster på grund av förändringar i deras ekonomiska situation. Känslor av isolering, förlust av självkänsla och känslor av hopplöshet rapporterades, vilket påverkade respondenternas fysiska välbefinnande. Längre tid i arbetslöshet ökade respondenternas negativa känslor. Aktiviteter, struktur och tillhörighet i andra sammanhang rapporterades som en del av deras strategier för att motverka dåligt psykiskt välbefinnande.

Konklusion: Denna avhandling hittade ett statistiskt signifikant förhållande mellan att vara utanför arbetsmarknaden och dålig SRH, hög risk för självmordstankar samt ångest och depression under den senaste ekonomiska lågkonjunkturen. Förhållandetxvmellan anställningsstatus och SRH förklarades delvis av socioekonomiska, demografiska och livsstilsfaktorer. Vidare, så förklarades förhållandet mellan anställningsstatus och självmordstankar till största delen av demografiska, socioekonomiska och självrapporterade psykologiska variabler. På kommunal nivå var prevalensen av ångest och depression högre bland de som var utanför arbetsmarknaden jämfört med de med anställning, och oddsen för ångest och depression var högre bland människor utanför arbetsmarknaden, men detta var mindre framträdande för depression än för ångest. Att förlora jobbet skapade känslor av förlust av värdighet och tillhörighet som en människa. Deltagarna upplevde känslor av oro, osäkerhet och stress på grund av deras förändrade ekonomiska situation, vilket i sin tur ledde till isolering och förlust av självkänsla. Socialt stöd och andra aktiviteter än arbete gav struktur och betydelse för vardagen. Resultaten av denna avhandling tyder på ett behov av tidig upptäckt och potentiell behandling av människor som befinner sig utanför arbetsmarknaden och att vara medveten om den ökade risken för dåliga hälsosymtom och störningar bland arbetslösa individer. Resultaten visar också på behovet av primära förebyggande strategier och innebär att de politiska beslutsfattarna måste uppmärksamma dem som inte är i arbetet, särskilt i tider med kombinerade ekonomiska svårigheter och arbetsmarknadsfluktuationer. Långtidsstudier är dock nödvändiga för att ytterligare belysa de mekanismer genom vilka anställningsstatus och anställningsvillkor påverkar fysiska och psykologiska hälsoproblem.

Place, publisher, year, edition, pages
Sundsvall: Mid Sweden University, 2017. p. 52
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 272
Keywords
Employment status, self-reported health, health inequalities, suicidal ideation, anxiety, depression, out of work, perceived well-being, qualitative approach, recession time, Gävle, Anställningsstatus, självrapporterad hälsa, ojämlikhet i hälsa, självmordstankar, ångest, utanför arbetsmarknaden, upplevt välbefinnande, kvalitativt tillvägagångssätt, lågkonjunktur, Medical and Health Sciences, Medicin och hälsovetenskap
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hig:diva-26054 (URN)978-91-88527-31-8 (ISBN)
Public defence
2017-12-08, C326, Sundsvall, 10:00 (Swedish)
Opponent
Supervisors
Note

Vid tidpunkten för disputationen var följande delarbeten opublicerade: delarbete 4 accepterat. At the time of the doctoral defence the following papers were unpublished: paper 4 accepted.

Available from: 2018-01-23 Created: 2018-01-23 Last updated: 2018-03-13Bibliographically approved
Hiswåls, A.-S., Walander, A., Soares, J. F. & Macassa, G. (2017). Employment Status, Anxiety and Depression in a Municipal Context. Research in Health Science, 2(1), 12-23
Open this publication in new window or tab >>Employment Status, Anxiety and Depression in a Municipal Context
2017 (English)In: Research in Health Science, ISSN 2470-6213, Vol. 2, no 1, p. 12-23Article in journal (Refereed) Published
Abstract [en]

Objectives:This study aimed to investigate the prevalence of anxiety and depression by employment status among a sample of the working age population residing in Gävle Municipality in Sweden.

Methods: A total of 241 persons completed a self-administered postal questionnaire in the baseline survey of the Gävle Household, Labour Market and Health Outcomes (GHOLDH) survey, which collected information on the employment status and psychological health (anxiety and depression) among persons aged 18-65 years. Descriptive and multivariate analyses were performed.

Results: The prevalence and risk of anxiety and depression were high among people who were out of work. In the multiple regression analysis, compared to employed people, those who were not employed had a risk of anxiety of 7.76 (5.97-9.75) and 4.67 (3.60-5.74) for depression.

Conclusion: The prevalence of anxiety and depression was higher among those who were out of labour marketas compared to those employed. Furthermore, people who were out of work had a higher risk of anxiety and depression. The odds were slightly higher for anxiety than for depression.

Keywords
Gävle, employment status, anxiety, depression
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:hig:diva-23714 (URN)10.22158/rhs.v2n1p12 (DOI)
Available from: 2017-03-06 Created: 2017-03-06 Last updated: 2018-03-13Bibliographically approved
Hiswåls, A.-S., Marttila, A., Mälstam, E. & Macassa, G. (2017). Experiences of Unemployment  and Well-Being  After Job Loss During Economic Recession: Results of a Qualitative Study in East Central Sweden. Journal of Public Health Research, 6(3), 135-141, Article ID 995.
Open this publication in new window or tab >>Experiences of Unemployment  and Well-Being  After Job Loss During Economic Recession: Results of a Qualitative Study in East Central Sweden
2017 (English)In: Journal of Public Health Research, ISSN 2279-9028, E-ISSN 2279-9036, Vol. 6, no 3, p. 135-141, article id 995Article in journal (Refereed) Published
Abstract [en]

Introduction: Several studies have revealed an association between unemployment and ill health, and shown that unemployment can affect people differently. This study aimed to provide an understanding of the experiences of unemployment and perceptions of wellbeing among persons who involuntary lost their work during the recent economic recession in Gävle Municipality. Methods: Sixteen unemployed men and women aged 28-62 were interviewed face-to-face. A purposeful sampling strategy was used in order to suit the research question and to increase the variation among informants. The interview texts were analysed using thematic analysis. Results: Six different themes emerged from the accounts: The respondents perceived work as the basis for belonging, and loss of work affected their social life and consumption patterns due to changes in their financial situation. They also expressed feelings of isolation, loss of self-esteem, and feelings of hopelessness, which affected their physical well-being. Longer duration of unemployment increased the respondents’ negative emotions. The respondents reported activities, structure, and affiliation in other contexts as part of their coping strategy against poor mental health. Conclusions: After job loss, the respondents experienced feelings of loss of dignity and belonging as a human being. They also felt worry, insecurity, and stress due to their changed financial situation, which in turn led to isolation and loss of self-esteem. Social support and having other activities gave the respondents structure and meaning.

Keywords
Out of work; perceived wellbeing; qualitative approach; recession time
National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-25315 (URN)10.4081/jphr.2017.995 (DOI)000440723600002 ()29291191 (PubMedID)2-s2.0-85038114572 (Scopus ID)
Available from: 2017-09-21 Created: 2017-09-21 Last updated: 2018-12-06Bibliographically approved
Hiswåls, A.-S., Ghilagaber, G., Wijk, K., Öberg, P., Soares, J. & Macassa, G. (2015). Employment status and suicidal ideation during economic recession. Health Science Journal, 9(1), Article ID 13.
Open this publication in new window or tab >>Employment status and suicidal ideation during economic recession
Show others...
2015 (English)In: Health Science Journal, ISSN 1791-809X, Vol. 9, no 1, article id 13Article in journal (Refereed) Published
Abstract [en]

Objective: Suicide is a public health problem and an important indicator of severe mental ill-health. Thus, identifying risk factors for suicidal ideation is a public health priority. The aim of this study was to examine the relationship between employment status and suicidal ideation in Gävleborg County. Method: The study used data from the 2010 Health in Equal Terms survey, a cross-sectional survey carried out in Gävleborg County in Sweden. A total of 4,245 individuals, aged 16–65 years were included in the analyses. Descriptive and logistic regression analyses were carried out to assess the relationship between employment status and suicidal ideation Results: Individuals outside the labour market had odds of suicidal ideation of 4.21 (CI 3.14-5.64) compared to their employed counterparts. Controlling for other covariates, reduced the risk from 4.21(CI 3.14-5.64) in model I, to 1.73 (CI 1.16- 2.57) in model IV, but remained statistically significant. In addition, other variables were associated with suicidal ideation. Conclusion: There was a statistically significant association between being out of work and suicidal ideation. The association was explained partly by demographic, socio-economic and self-reported psychological variables. Results of the study suggest the need for primary prevention strategies among those out of the labour market, especially during times of economic hardship.

Keywords
Employment status; Health inequalities; Suicidal ideation
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:hig:diva-18964 (URN)2-s2.0-84926348708 (Scopus ID)
Available from: 2015-02-03 Created: 2015-02-10 Last updated: 2018-12-03Bibliographically approved
Macassa, G., Ahmadi, N., Hiswåls, A.-S., Alfredsson, J., Soares, J. & Stankunas, M. (2014). Differences in health care-seeking behavior during economic recession. Paper presented at The European Public Health Conference (EUPHA), Glasgow 2014. European Journal of Public Health, 24(Suppl. 2)
Open this publication in new window or tab >>Differences in health care-seeking behavior during economic recession
Show others...
2014 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no Suppl. 2Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background

In Europe, equitable access to high-quality healthcare constitutes a key challenge for health systems across the continent. However, the recent economic recession left many outside the labour market, causing many to fall in poverty and social exclusion. Unemployment is probably the main factor leading to social exclusion. Studies which analysed health seeking behaviour among unemployed people have reported a variety of results, from low to high utilization of health services. However, some researchers argue that during stressful economic and social circumstances can cause high utilization of the health care system due to increased psychological disorders masked by physical complaints. This study examined differences in health seeking behaviour in Gävleborg County, which at the pick of the economic recession had high levels of unemployment as compared to the national average.

Methods

The data for the study come from the 2010 Survey of Health in Equal terms carried out in Gävleborg County, Sweden. The sample included 4245 persons aged 16-65 years. Descriptive and binary logistic analysis was used to assess differences in health seeking behavior by employment status.

Results

There was a statistical significant relationship between employment status and health-seeking behavior. Compared to employed persons, people who were out of the labor market had odds ratio of 1.42 (1.12-1.62) for contact with health care services; of 1.30 (1.12-1.50) for contact with a doctor in a health care facility and 1.67 (1.42-1.97) for contact with a doctor in a hospital. Controlling for age, sex, marital status, education, income, smoking habits, physical activity, self-rated health, and long standing illness removed the statistical significance of the observed relationships. Thus, the odds for contact with health care services went from.

Conclusions

At the pic of the recent economic recession, people who were outside the labor market had more contact with health care services, with doctor in hospitals as well as primary health care services as compared to employed counterparts. The differences in health seeking behavior were explained by demographic, socioeconomic and health variables.

Key Words: Employment status, Health care, Gävleborg, economic recession.

Key messages

  • People who were out of labor market in Gävleborg County in 2010 had more contact with health care services, with a doctor in hospital and primary health care respectively.

  • Future studies are warranted that can assess trends in health-seeking behavior among people outside Gävleborgs labor market.

National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-17926 (URN)10.1093/eurpub/cku161.085 (DOI)
Conference
The European Public Health Conference (EUPHA), Glasgow 2014
Available from: 2014-09-11 Created: 2014-11-10 Last updated: 2018-12-03Bibliographically approved
Macassa, G., Hiswåls, A.-S., Ahmadi, N., Alfredsson, J., Soares, J. F. J. & Stankunas, M. (2014). Employment status and health care utilization in a context of economic recession: Results of a population based survey in East Central Sweden. Science Journal of Public Health, 2(6), 610-616
Open this publication in new window or tab >>Employment status and health care utilization in a context of economic recession: Results of a population based survey in East Central Sweden
Show others...
2014 (English)In: Science Journal of Public Health, ISSN ISSN 2328-7942, EISSN 2328-7950, Vol. 2, no 6, p. 610-616Article in journal (Refereed) Published
Abstract [en]

Introduction: The most recent economic recession left many people outside the labour market world-wide, causing widespread poverty and social exclusion. Gävleborg County in East Central Sweden experienced massive layoffs caused by closure of various industries. Objective: The objective of this study was to investigate differences in health-care use according to employment status at the pick of the recent economic recession. Methods: The study used data from a cross-sectional survey “Health in Equal Terms” carried out in Gävleborg County in 2010. The sample included 4245 persons aged 16-65 years. Descriptive and logistic regression analyses were used to assess differences in health-care seeking behaviour by employment status. Results: Employment status was statistically significantly associated with health-care use in Gävleborg County. In the bivariate analysis people who were not employed had odds ratio of 1.62 (CI 1.18-1.72) for health care use as compared to their employed counterparts. Controlling for other variables in Model II to IV removed the statistical significance and reduced the odds to 0.44(CI 0.20-1.00). Conclusions: This study found that at the pick of the most recent economic recession, people who were out of work used more often health services as compared with their employed counterparts. The observed differences in health-care use were explained by demographic, socio-economic and health-related variables. Further studies are needed to analyze trends of healthcare utilization according to employment nationally, particularly at the county level.

Keywords
Health-Care Use, Employment Status, Economic Recession
National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-18664 (URN)10.11648/j.sjph.20140206.28 (DOI)
Available from: 2015-01-05 Created: 2015-01-05 Last updated: 2018-12-03Bibliographically approved
Hiswåls, A.-S., Ghilagaber, G., Walander, A., Wijk, K., Öberg, P., Soares, J. & Macassa, G. (2014). Employment Status and Inequalities in Self-Reported Health. Epidemiology, Biostatistics and Public Health, 11(4), 1-11
Open this publication in new window or tab >>Employment Status and Inequalities in Self-Reported Health
Show others...
2014 (English)In: Epidemiology, Biostatistics and Public Health, ISSN 2282-2305, E-ISSN 2282-0930, Vol. 11, no 4, p. 1-11Article in journal (Refereed) Published
Abstract [en]

Background: The aim of this study was to investigate the impact of employment status on self-reported health in gävleborg county.

Methods: The study used data from the 2010 health in equal terms survey, a cross-sectional survey carried out in gävleborg county in sweden. a total of 4,245 individuals, aged 16–65 years were included in the analyses. descriptive and logistic regression analyses were used to assess the relationship between employment status and self-reported health

Results: Individuals outside the labour market had odds of poor health of 2.64 (cl 2.28–3.05) compared to their employed counterparts. controlling for other covariates reduced the risk slightly to 2.10 (1.69-2.60), but remained statistically significant. In addition, other variables were associated with self-reported poor health.

Conclusions: This study found a statistically significant association between being outside the labour market and poor self-reported health. The relation was explained partially by socio-economic and demographic variables. More studies, in particular longitudinal, are needed to further investigate the observed relationships. Policy-makers within the gävleborg county need to pay attention to the health status of those out of work, especially during times of combined economic and labour market fluctuations.

Results of the study suggest the need to pay attention to the health status of those outside the labour market, especially during times of economic hardship.

National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-17472 (URN)10.2427/10006 (DOI)2-s2.0-84919763977 (Scopus ID)
Available from: 2014-09-07 Created: 2014-09-08 Last updated: 2018-12-03Bibliographically approved
Hiswåls, A.-S., Ghilagaber, G., Wijk, K., Öberg, P., Soares, J. & Macassa, G. (2014). Inequalities and Suicide Ideation during Recession Times. Paper presented at The 7th European Public Health Conference (EUPHA), Glasgow November 19-22 2014. European Journal of Public Health, 24(Suppl. 2), 361
Open this publication in new window or tab >>Inequalities and Suicide Ideation during Recession Times
Show others...
2014 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no Suppl. 2, p. 361-Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background

Suicide behaviour is a serious public health problem as it imposes economic and human costs to individuals, families and communities. Available evidence from some European countries indicates a significant rise in suicides related to economic recession. However, the debate continues regarding the role of unemployment in the reported suicide rates. In Sweden, very few studies have investigated the relationship between suicide behaviours and employment status in the context of the recent economic crisis although unemployment increased nationally and across different counties.

The aim of this study was to examine the relationship between employment status and suicide ideation in Gävleborg, Sweden.

Methods

The study used data from a cross-sectional survey, Health in Equal terms, carried out in Gävleborg County in Sweden, 2010. A total of 4245 individuals, aged 16–65 years were included in the analysis. The relationship between employment status and suicide ideation was assessed using descriptive and logistic regression analyses.

Results

People who were not working had odds of suicide ideation of 4.21 (95% Cl 3.14–5.64) as compared to those employed. Controlling for other covariates reduced the risk to 1.73 (95% CI 1.16-2.57) but remained statistically significant. In addition variables like anxiety, self-reported stress and young age were also associated with suicide ideation. However among the covariates, people who reported anxiety had the highest odds of suicide ideation.

Conclusions

This study found a statistically significant association between being out of work and suicide ideation. The association was largely explained by self-reported stress, anxiety, socioeconomic and demographic variables.

Policy-makers within the County need to pay attention to the health status of those out of work, especially during times of combined economic and labour market fluctuations.

Key messages

  • Suicide ideation was more common among people out of labor force in Gävleborg County, Sweden.

  • Further studies are needed to investigate suicide ideation among unemployed persons during times of economic and labor market insecurity.

National Category
Health Sciences
Identifiers
urn:nbn:se:hig:diva-17925 (URN)10.1093/eurpub/cku166.155 (DOI)
Conference
The 7th European Public Health Conference (EUPHA), Glasgow November 19-22 2014
Available from: 2014-11-10 Created: 2014-11-10 Last updated: 2018-12-03Bibliographically approved
Macassa, G., Walander, A. & Hiswåls, A.-S. (2013). Living in the Municipality of Gävle: Report on the Gävle Household, Labour Market Dynamics and Health Outcomes Survey - Wave 1. Gävle: Gävle University Press
Open this publication in new window or tab >>Living in the Municipality of Gävle: Report on the Gävle Household, Labour Market Dynamics and Health Outcomes Survey - Wave 1
2013 (English)Report (Other academic)
Abstract [en]

In many industrialized countries including those in Europe, there is an established relationship between work conditions and health. For instance employment status and conditions have been reported to influence physical health (self-assessed health, pain and various somatic conditions), as well as mental health outcomes such as anxiety and depression, even if debate is still ongoing. Employment conditions have been suggested to be a key determinant of health inequalities, although this factor has been less researched than have education and income. Therefore, a study of the role played by employment status/conditions in a small geographical area such as Gävle Municipality (with its pattern of industries, plant and services closures, and high levels of unemployment) could contribute to knowledge on ways to reduce ill health related to labour market. 

 The overall aim of this study was to examine the relationship between employment status, household income and physical and psychological health outcomes among economically active people residing in Gävle Municipality, using data from Wave 1 of the Gävle Household, Labour Market Dynamics and Health Outcomes (GHOLDH) survey, a household panel survey carried out between April and June 2012. Data analysis was conducted using descriptive statistics and mixed multivariate models.

There were differences in physical and psychological health by employment status. Individuals who were outside the labour market were more likely to report poor health, body pain and exhaustion than were individuals who were employed. In addition, those individuals who were outside work had a higher prevalence and risk of anxiety and depression. Data on household income also showed associations with physical and psychological health, with a concentration of poor self-reported health, somatic complaints, anxiety and depression in lower income households.

Interestingly, the study findings revealed that anxiety was also prevalent among employed people, suggesting that people with insecure jobs might also be at risk of poor mental health. This finding requires further research to discern the role of precarious employment conditions on inequalities in physical and mental health outcomes. In addition, studies on the impact of gender on the relationship between employment status/conditions and physical and psychological health outcomes are warranted. To this end, the follow-up survey to be carried out in 2014 might provide additional knowledge pertaining to ways to reduce employment-related health inequalities within the municipality.

Place, publisher, year, edition, pages
Gävle: Gävle University Press, 2013. p. 78
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:hig:diva-16635 (URN)978-91-977592-6-7 (ISBN)
Available from: 2014-05-09 Created: 2014-05-09 Last updated: 2018-03-13Bibliographically approved
Organisations

Search in DiVA

Show all publications