Bibliotek

Three models of the relations of coping efficacy, coping, and psychological problems of children of divorce were investigated. A structural equation model using cross-sectional data of 356 nine- to twelve-year-old children of divorce yielded results that supported coping efficacy as a mediator of the relations between both active coping and avoiding coping and psychological problems. In a prospective longitudinal model with a subsample of 162 of these children, support was found for Time 2 coping efficacy as a mediator of the relations between Time 1 active coping and Time 2 internalizing of problems. Individual growth curve models over four waves also found support for coping efficacy as a mediator of the relations between active coping and psychological problems. No support was found for alternative models of coping as a mediator of the relations between efficacy and symptoms or for coping efficacy as a moderator of the relations between coping and symptoms.

This brief self-report inventory identifies cognitive and behavioural responses the individual used to cope with a recent problem or stressful situation. The 8 scales include Approach Coping Styles (Logical Analysis, Positive Reappraisal, Seeking Guidance and Support, and Problem Solving) and Avoidant Coping Styles (Cognitive Avoidance, Acceptance or Resignation, Seeking Alternative Rewards, and Emotional Discharge). Information about reliability and validity is presented in the professional manual for each version.

The CRI can be used in in counselling, stress management education, and other settings to identify and monitor coping strategies in adults and adolescents, to develop better clinical case descriptions, and to plan and evaluate the outcome of treatment.

Two separate versions of the CRI have been developed, the CRI-Adult (older than 18 years of age) and the CRI-Youth (ages 12-18 years). Each version has its own manual and an Ideal and an Actual Form. The Ideal Form may be used to compare actual and preferred coping styles, to set treatment goals, and to monitor progress. The Actual Form surveys the individual's actual coping behaviour, whereas the Ideal Form surveys preferred coping styles. Both forms are written at a 6th-grade reading level.

Individuals complete the self-report inventory, marking answers on the answer sheet. The carbonless bottom sheet contains a scoring grid for quick and easy calculation of raw scores. The back page of the answer sheet contains a profile for determining and plotting T-scores and examining patterns of coping. Scoring and profiling take about 5 minutes.

This study examines whether and how couples share the provision of informal care for their parents. Four waves of the British General Household Survey contain cross-sectional information about caring for parents and parents-in-law. Descriptive and multivariate analyses were conducted on 2214 couples that provided parent care. The findings emphasise married men's contribution to informal caring for the parental generation and at the same time demonstrate the limits of their involvement. Spouses share many parts of their care-giving but this arrangement is less common with respect to personal and physical care. The more care is required the more likely are people to participate in care for their parents-in-law. More sons-in-law than daughters-in-law provide care but, once involved, daughters-in-law provide on average more hours of care than sons-inlaw. Own full-time employment reduces both men's and women's caring for their parents-in-law, and men's caring drops further if their wife is not in the labour market. The findings suggest that daughters-in-law often take direct responsibility whereas sons-in-laws' care-giving depends more on their wives' involvement. Children-in-laws' informal care-giving might decrease in the future because of women's increasing involvement in the labour market and rising levels of nonmarital cohabitation in mid-life.

The study compared the effect of couples-based vs individual-based therapy for men who entered outpatient substance abuse treatment on the psychosocial functioning of children in their homes. Men were randomly assigned to (1) behavioral couples therapy (BCT), (2) individual-based treatment (IBT) or (3) couples-based psychoeducational attention control treatment (PACT). For both children of alcohol (N=71) and drug-abusing men (N=64), parents' ratings of children's psychosocial functioning was higher for children whose fathers participated in BCT at posttreatment and at 6- and 12-mo follow-up than for children whose fathers participated in IBT or PACT. BCT resulted in greater improvements in parents' dyadic adjustment and fathers' substance use. Thus, couples-based intervention that addresses both issues may have greater benefits for children in these homes. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

The aim of this thesis was to describe how early triadic interaction between the newborn child and its mother and father begins, develops, and matures over the child's first 4 years of life. Systemic family theory and developmental theory are combined to go beyond the "mother-child" dyad to the "mother-father-child" triad. Lausanne Trilogue Play (LTP, originally Lausanne Triadic Play) was developed by Elisabeth Fivaz and her learn in Lausanne, Switzerland, and used to carry out standardised studies of child-mother-father interaction. The family is placed in a triangle that allows all three partners optimal access to each other. The focus of this thesis was to describe triadic interaction when all members of the triad interact with each other. It is based on a pioneering longitudinal and prospective study. It was begun with interviews when the parents were expecting their first child. The development of triadic interaction was then monitored by repeated, videotaped LTP observations when the child was 3, 9, 18, and 48 months of age. The study is part of an international collaboration to describe the development of triadic interaction in four groups: 20 Swiss German-speaking families, 20 Swiss French-speaking families, 20 American families (Seattle, Washington, USA), and 20 Swedish families. In Sweden, consecutive Swedish-speaking couples were recruited by midwives at a maternity health care clinic in Stockholm. Twelve boys and 8 girls were born. To analyse the children's communicative skills in relation to their behaviour at age 4 years, the preschool teachers were asked to fill in the Preschool Behaviour Questionnaire (PBQ). The author developed the Child-Parents-Interaction Coding System (CPICS) to analyse quantitative and qualitative variables in triadic interaction. The CPICS was used to analyse LTP observations of the Swedish families over time and to compare the Swedish and American groups of families. One child, a girl, exhibited a typical development. At the age of 5 she was referred to a child and adolescent neuropsychiatric department where, at the age of 7 years, she was diagnosed with an autism spectrum disorder. She was excluded from the group analysis and instead presented as a case report. When the children were 3 months of age, parents held back concerning contribiltion (the starting point for a sequence of interactions) and allowed the "child's just being- to launch conversation. This pattern persisted up to 48 months, with the parents giving the child space. Types or child contributions varied over time. When the child was 3 months old, its parents treated all its behaviours as contributions for starting points of conversation, while child contributions at 48 months generally had a communicative character. Coparenting seems to set the structure for early communication by using various nonverbal, vocal, and verbal methods to support the child in turn-taking sequences. A cultural difference in the tempo of play between American and Swedish families was found. Although both groups of families interacted in a synchronized and reciprocal way, the pace of play in triadic interaction was taster in American families. Positive correlations between complex triadic interaction (number of turn-taking sequences) at 3, 9, and 18 months (significant at 9 months) and preschool teachers' assessments of children's social competence at 48 months suggest some predictive power of this variable in the assessment system. The autistic girl and her parents exhibited deviations in early triadic communication - most clearly when she was 9 months old. Findings are discussed regarding their importance concerning early interventions in the family system.

This article looks at how the children of disabled parents are being defined as 'young carers', arguing that the way in which this is hap pening undermines both the rights of children and the rights of disabled people, Analysis of the social construction of 'children as carers' illustrates that researchers and pressure groups are colluding with the government's insistence that 'care in the community' must mean 'care by the community'.

Dementia is a chronic illness involving increasing levels of care, often provided by family members, particularly in culturally and linguistically diverse (CALD) communities. Multicultural community link workers are often the primary service providers assisting families to access health and welfare services and as such have extensive experience of, and possess in-depth knowledge about, CALD family care-giving for dementia. While research has been undertaken on dementia in CALD communities, this research has not focused on the experiences and perceptions of these multicultural workers with regards to CALD family care-giving. In response to this gap in the research, this paper presents the results of an empirical investigation of multicultural workers' perspectives with regard to the cultural traditions informing CALD family care-giving, CALD families' understandings of the term 'carer' and family arrangements regarding care. Due to their close relationship and knowledge of families, multicultural workers can offer an important perspective that is invaluable in informing the provision of carer education and support within CALD communities.

Background. Few population studies have investigated the functional disabilities that accompany specific psychiatric diagnoses. This study assesses the nature and strength of current and residual impairments in various functional domains of life.
Methods. Data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a prospective study in the Dutch general population aged 18 to 64 (N = 7147). Psychiatric diagnoses were based on the Composite International Diagnostic Interview; functional disability was assessed on the basis of the Short-Form-36 and the number of disability days.
Results. Psychopathology was associated with increased disability in social, emotional and physical domains of life. Disability levels varied by psychiatric diagnosis, with mood disorders showing the poorest levels of functioning, especially for vitality and social functioning; alcohol-related disorders were associated with few disabilities. Co-morbidity strongly aggravated the disability. The effect of contextual factors on disability was limited, although somatic ill health, unemployment and adverse youth history increased the likelihood of functional disability. The findings indicate that psychopathology can also have residual debilitating effects.
Conclusions. Mental health care providers should be aware that the extent and the type of disability may vary with the different types of disorders and among different groups within the population. Since recovery from functional limitations may not be complete or may take more time than the remission of the psychiatric symptomatology, non-psychiatric follow-up care is needed. The high number of lost work days is relevant from an economic perspective. There is a need for illness-specific disability assessment instruments.

This review summarizes a growing number of methodological concerns emerging from research on child witnesses of intimate partner violence (IPV). A brief summary of various psychological, biological, and cognitive impairments associated with witnessing IPV is presented. Directions for future research in this area are explored with particular attention paid to experimental design. Advantages and disadvantages of retrospective, cross-sectional, and longitudinal designs are evaluated. Suggested improvements include the use of multiple informants, behavioral observations, and prospective, longitudinal assessment.

I en alltmer globaliserad värld får
fler möjlighet att bosätta sig i ett annat land
än det de föddes i. Som ett resultat av detta ökar andelen utlandsfödda i de flesta höginkomstländer, så även i Sverige. Den 31 december år 2006 hade 17
procent av den svenska befolkningen utländsk bakgrund, dvs. var antingen
född i något annat land än Sverige (13 procent) eller hade två utlandsfödda
föräldrar (4 procent). Av dessa var 52 000 utlandsadopterade. Därtill kommer
asylsökande och andra migranter som saknar uppehållstillstånd, som inte finns med i befolkningsstatistiken.
Många utlandsfödda har
flyttat från länder där risken att smittas av vissa
svåra och långvariga infektioner är betydligt större än i Sverige. De viktigaste
av dessa smittämnen är hepatit B och C, tuberkulos och hiv.
Migranterna tar med sig sin livsstil till det nya landet, t ex kost- , tobaksoch
alkoholvanor. Mötet med det nya landets kultur leder till att livsstilen
förändras, men lång tid efter invandringen kan in
flytande av ursprungslandets
livsstil ofta spåras i invandrares sjukdomsmönster. Så har t.ex. män med
ursprung i Medelhavsområdet en högre risk att drabbas av tobaksrelaterad
sjuklighet, som lungcancer jämfört med genomsnittsbefolkningen i Sverige,
men samtidigt har de en lägre risk att drabbas av alkoholrelaterad sjuklighet,
som levercirrhos.
Många betydande folkhälsoproblem orsakas av miljöfaktorer i samspel med
en medfödd sårbarhet, t.ex. allergiska sjukdomar och diabetes. Förekomsten
av de genetiska faktorer som orsakar denna sårbarhet skiljer sig mellan olika
befolkningar i världen och fortsätter att påverka risken för dessa sjukdomar
hos migranter även i det nya landet .
Flyktingen har ett annat utgångsläge än den som
flyttar till ett annat land
för att arbeta eller för att bilda familj. Personer som
flyr från sitt hemland har
nästan alltid levt en tid under stor stress innan de
flyr. Själva
flykten är ofta
omgärdad av umbäranden och hot, och många familjer splittras under långa
perioder. Efter ankomsten till det nya landet väntar en tid av ovisshet under
asylprocessen innan det nya livet kan ta sin början. Detta leder sammantaget
till att psykisk ohälsa är ett större problem hos nyanlända
flyktingar än hos
andra grupper av migranter,

"Jag vill ha en annan mamma, en som kan springa ..."

Kerstins fotbollslag ska spela match mot föräldrarna. Kerstins pappa, som brukar vara bäst på plan, kan inte vara med så mamma ska med i stället. Men mamma sitter ju i rullstol, hon kan ju inte spela.

Mamma kommer till matchen och rycker dessutom in som värsta hjälten.

Det här är en berättelse om att ha en förälder som inte är som alla andra, men som kan vara världsbäst ändå!

Denna danska bilderbok bygger på vikten av att prata med barn när deras förälder eller annan vuxen som barnet bor tillsammans med drabbas av psykisk ohälsa.I slutet av boken diskuterar författaren effekterna för barnen och familjen i sin helhet då någon vuxen drabbas av ångest och/eller depression och vad det gör med familjen. Vilka situationer och frågeställningar som kan uppkomma och som behöver förklaras och besvaras för att barnen ska förstå vad som sker. Boken riktar sig till barn mellan 3-10 år.
Boken går att laddda ner på www.issuu.com

På morgonen den 10 december 1996 förändrades Jill Bolte Taylors liv totalt. Den 37-åriga hjärnforskaren drabbades av en kraftig stroke då ett blodkärl brast i vänstra halvan av hjärnan. Inom loppet av några timmar försvann förmågan att tala, läsa, skriva, gå och hennes minne var i det närmaste helt utraderat.

Tiden som följde blev en berg- och dalbana mellan två verkligheter: den euforiska känslan från höger hjärnhalva som styr känslor och kreativitet, och de logiska rationella tankarna från vänstra halvan som talade om för Jill att hon var sjuk och fick henne att söka hjälp i tid.

Det tog åtta år för Jill Bolte Taylor att tillfriskna helt och hållet. Tack vare en otrolig envishet, sin kunskap om hur den mänskliga hjärnan fungerar och inte minst med stor hjälp av sin fantastiska mamma lyckades hon få tillbaka det liv hon en gång hade. Idag anser Jill att stroken var det bästa som kunde hända henne. Genom att tvingas använda sin högra hjärnhalva insåg hon att vi människor kan tillgodogöra oss de känslor av frid och välbehag som den vänstra halvan gör sitt bästa för att trycka ner.

Min stroke tar läsaren med på en fascinerande resa in i den mänskliga hjärnan. Det är både en värdefull hjälp för alla som drabbats av någon form av hjärnskada och ett känslosamt vittnesmål om att djup inre frid är möjligt att uppnå för alla människor, vid alla tillfällen. Boken har i flera veckor legat på topp 10 på New York Times bästsäljarlista för faktaböcker.

Flera tusen barn befinner sig varje år
på ett skyddat boende med sin mamma,
på flykt undan det livsfarliga våldet
hemma. Hur påverkas barnets liv av
våldet och av att tvingas bryta upp från
sin vardag? I den här rapporten lyfts
barns egna röster och erfarenheter,
tillsammans med aktuell kunskap.
Rapporten visar hur barns behov och
rättigheter många gånger blir sekundära
när barnet i praktiken blir medföljande
till sin mamma. Det blir tydligt att
rättssäkerheten måste stärkas för barn
som utsätts för våld i hemmet.

The YABCL has 107 items that describe specific behavioral and emotional problems. Parents and others rate the young adult for how true each item is now or was within the past six months using the following scale: 0 = not true (as far as you know); 1 = somewhat or sometimes true; 2 = very true or often true. In addition, 13 socially desirable items are rated, and space is also provided for responses to two open-ended items covering physical and other problems, plus anything else the respondent wants to report about the young adult. These questionnaires are designed to provide standardized descriptions of behavior, feelings, thoughts, and competencies rather than diagnoses per se. The YABCL has 109 problem items and 11 competence items that are scored on 3-step scales. Eight syndromes are derived from the items on the YABCL, including 2 designated as Internalizing (Anxious/Depressed, Withdrawn) and 3 designated as Externalizing (Aggressive, Delinquent, and Intrusive Behavior). Reliability on the YABCL averages 0.85 across syndromes and Internalizing, Externalizing, and Total Problems scales (P .001). Validity has been demonstrated by showing significantly higher scores for subjects referred for mental health services than for matched nonreferred subjects.36-38 For the 8 syndrome scales, the 95th percentile is considered the borderline clinical cutoff and the 98th percentile the clinical cutoff on the basis of a nonreferred population. For the problem scales (Internalizing, Externalizing, and Total Problems), the 83rd percentile is considered the borderline clinical cutoff and the 90th percentile the clinical cutoff.33.

Managing the assets of older people is a common and potentially complex task of informal care with legal, financial, cultural, political and family dimensions. Older people are increasingly recognised -as having significant assets, but the family, the state, service providers and the market have competing interests in their use. Increased policy interest in self-provision and user-charges for services underline the importance of asset management in protecting the current and future health, care and accommodation choices of older people. Although 'minding the money' has generally been included as an informal care-giving task, there is limited recognition of either its growing importance and complexity or of care-givers' involvement. The focus of both policy and practice have been primarily on substitute decision-making and abuse. This paper reports an Australian national survey and semi-structured interviews that have explored the prevalence of non-professional involvement in asset management. The findings reveal the nature and extent of involvement, the tasks that informal carers take on, the management processes that they use, and that 'minding the money' is a common informal care task and mostly undertaken in the private sphere using some risky practices. Assisting informal care-givers with asset management and protecting older people from financial risks and abuse require various strategic policy and practice responses that extend beyond substitute decision-making legislation. Policies and programmes are required: to increase the awareness of the tasks, tensions and practices surrounding asset management; to improve the financial literacy of older people, their informal care-givers and service providers; to ensure access to information, advice and support services; and to develop better accountability practices.

Although the whole family is affected by a parent's palliative disease, palliative care research does not yet routinely consider patients' minor children. Children's and adolescents' psychosocial functioning may be impaired during prolonged parental disease with poor prognosis. Therefore, more and more health care providers are establishing clinical initiatives for families of palliative patients with minor children. However, the number of these family interventions, as well as their theoretical and empirical backgrounds and evidence base, has yet to be determined. The purpose of this study was to systematically review structured and published interventions for this target group, as well as empirical studies on these interventions. The evidence base and impact of interventions on families were considered. Literature published between 1980 and present focusing on psychosocial family-, child- or parent-centered interventions during palliative care was retrieved from PsycINFO®, Embase, MEDLINE®, CINAHL®, and PSYNDEX databases. Five interventions met the inclusion criteria. Programs focused on different populations, had diverse empirical and theoretical backgrounds and features, and were evaluated by studies of varying methodological quality. This systematic review illustrates the lack of well designed and elaborated intervention concepts and evaluation studies in this field, highlighting the necessity of conceptual and methodological rigor to inform clinical practice on a sustainable basis in the future.

Starting university is associated with major academic, personal and social opportunities. For many people, university entrance is also associated with increased stress and alcohol consumption. At the start of the autumn term 2002, all students entering educational programmes at two comparable middle-sized Swedish universities were invited to participate in a comparative intervention study. This included both primary and secondary interventions targeting hazardous drinking and stress. The overall aim was to improve alcohol habits and stress patterns in university freshmen at an intervention university in comparison with a control university.

A total of 2,032 (72%) freshmen responded to the baseline assessment. Half of them scored above traditional AUDIT cut-off levels for hazardous alcohol use. Factors associated with hazardous use were age below 26, male gender, family history of alcohol problems, and not being in a serious relationship. The Arnetz and Hasson Stress Questionnaire was evaluated and used to study a selection of freshmen at high riskof stress. It was easy to use and offered sufficient internal consistency and construct validity. In the freshman year, 517 students (25%) dropped out from university education. A multivariate analysis established that high stress and university setting was associated with dropout from university studies, while symptoms of depression and anxiety as well as hazardous drinking were not.

Outcome was analysed in students remaining at university at one-year follow-up. The primary interventions offered to freshmen at the intervention university reduced alcohol expectancies and mental symptoms compared with freshmen at the control university. Secondary stress interventions were effective in reducing mental symptoms and alcohol expectancies. Secondary alcohol interventions were effective in reducing AUDIT scores, alcohol expectancies, estimated blood alcohol concentrations, as well as stress and mental symptoms.

In conclusion, both primary and secondary alcohol and stress interventions have one-year effects in university freshmen and could be used in university settings.

Ann Gomér berättar sin historia om hur livet förändrades för henne och hennes familj när andra dottern Frida föddes. Frida föddes med omfattande funktionsnedsättningar och läkarna kunde inte riktigt ge henne en diagnos. Många tankar och många svårigheter, men också glädjeämnen mitt i det svåra. Hur livet blir för andra dottern Fanny beskriver Ann, men Fanny själv berättar mer i ett efterord

Den 1 januari 2010 infördes en ny bestämmelse i hälso- och sjukvårdslagen som ger hälso- och sjukvårdens verksamheter och dess personal skyldighet att särskilt beakta barnets behov av information, råd och stöd när en förälder har en psykisk sjukdom, är allvarligt somatiskt sjuk eller missbrukar. Detsamma gäller när en förälder oväntat avlider. Den nya lagstiftningen stärker barns rätt och ställer krav på att ett familjeorienterat synsätt utvecklas inom verksamheter som möter vuxna patienter inom de ovan nämnda grupperna.

Stiftelsen Allmänna Barnhuset och Socialstyrelsen har 2008 -2010 drivit ett gemensamt projekt i syfte att skaffa kunskap om vilka åtgärder som behöver vidtas för att lagen ska få avsedd effekt. Denna bok är en rapport från det arbete och vi hoppas att den kan inspirera, stimulera och visa på möjliga vägar för lokalt och regionalt utvecklingsarbete i syfte att bättre uppmärksamma barn som anhöriga.

I boken framkommer också vilka svårigheter som finns och vikten av ett gemensamt ansvarstagande av de huvudmän som möter barn i dessa situationer.

Several issues impinge on scholars and practitioners interested in adolescent bereavement. First and foremost, adolescent bereavement over the death of a family member or a friend is more prevalent than many persons recognize. Second, scholars and practitioners need models that link adolescent development with adolescent coping during bereavement. Third, models are needed (a) to assist in rethinking what "recovery from bereavement" denotes and (b) to afford criteria for assessing recovery from bereavement. The author reviews findings on bereavement during adolescent development and gives particular attention to three models that enhance our understanding of coping with the life crises bereavement presents to adolescents. One model links grief during adolescence to developmental tasks; another model presents adaptive tasks and coping skills; and the third model identifies sentiments essential for human wholeness. Findings from a variety of studies with bereaved adolescents provide data to test the usefulness of the models. The closing discussion centers on implications for working with bereaved adolescents.

Early life stress (ELS) is expected to increase reactivity of the hypothalamic-pituitary-adrenocortical (HPA) axis; however, several recent studies have shown diminished cortisol reactivity among adults and children with ELS exposure. The goal of this study was to examine cortisol activity in 10-12-year-old internationally adopted children to determine if moderate and severe ELS have different impacts on the HPA axis. Salivary cortisol and two measures of autonomic activity were collected in response to the Trier Social Stress Test for Children (TSST-C). Three groups reflecting moderate, severe, and little ELS were studied: early adopted children who came predominantly from foster care overseas (early adopted/foster care (EA/FC), n=44), later adopted children cared for predominantly in orphanages overseas (late adopted/post-institutionalized (LA/PI), n=42) and non-adopted (NA) children reared continuously by their middle- to upper-income parents in the United States (n=38). Diminished cortisol activity was noted for the EA/FC group (moderate ELS), while the LA/PI group (severe ELS) did not differ from the NA group. Overall, few children showed cortisol elevations to the TSST-C in any group. The presence/absence of severe growth delay at adoption proved to be a critical predictive factor in cortisol activity. Regardless of growth delay, however, LA/PI children exhibited higher sympathetic tone than did NA children. These results suggest that moderate ELS is associated with diminished cortisol activity; however, marked individual differences in cortisol activity among the LA/PI children suggest that child factors modify the impact of severe ELS. Lack of effects of severe ELS even for growth delayed children may reflect the restorative effects of adoption or the generally low responsiveness of this age group to the TSST-C.

Det svenska samhället har under senare delen av 1900-talet påverkats och förändrats på grund av en ökad internationell migration. År 1950 var 2,8 % av den svenska befolkningen utrikesfödd; idag utgör de utrikesfödda 12,0 % av totalbefolkningen. Om även andragenerationens migranter (de som har en eller båda föräldrar utrikesfödda) räknas med utgör första och andragenerationens migranter tillsammans 20 % av Sveriges befolkning. Tidigare studier har visat att migration kan påverka hälsa och hälsoutveckling på både positiva och negativa sätt. Ett accepterat sätt att mäta hälsa och hälsoutveckling är att studera morbiditet och mortalitet i en befolkning. Ett fåtal studier har återfunnits som har undersökt morbiditet och mortalitet bland migranter. Ingen av dessa har haft en longitudinell design och undersökt en total population av migranter i ett land. Det övergripande syftet var att beskriva och jämföra hälsa och hälsoutveckling över tid mellan svenskfödda och utrikesfödda och genom detta att studera migrationens påverkan på hälsa. De fyra i avhandlingen ingående delarbetena bygger på analys av data från Statistiska Centralbyrån och Socialstyrelsens Centrum för Epidemiologi. I databasen har ingått samtliga utrikesfödda, 16 eller äldre som fanns i Sverige 1970. Till varje utrikesfödd person finns en svensk kontroll matchad vad gäller kön, ålder, sysselsättning, yrke och bosättningslän. För 20 518 utrikesfödda personer kunde inte en kontroll skapas på grund av matchningskriterierna; dessutom exkluderades de personer som under den studerade tiden (1970?1999) hade emigrerat från Sverige. Totalt kom databasen som användes för analys att omfatta 723 948 personer, 50 % utrikesfödda och 50 % svenska kontroller. Den första delstudiens syfte var att beskriva och jämföra mortalitet mellan utrikesfödda och svenskfödda under perioden 1970?1999. Resultaten visade en generellt högre dödlighet bland utrikesfödda (OR 1,08) och en lägre medelålder vid tidpunkten för dödsfallet. Speciellt hög mortalitetsrisk återfanns bland män från Finland (OR 1,21), Danmark (OR 1,11) och Norge/Island (OR 1,07). Två ålderskohorter jämfördes, personer födda 1901?1920 respektive personer födda 1921?1944, och analysen visade en högre mortalitet för personer i den äldsta ålderskohorten. Personer som hade invandrat ?sent? till Sverige visade större skillnader i medelålder vid död än de som hade invandrat ?tidigt?; personer som kommit till Sverige under perioden 1941?1970 hade en 2,5 år lägre medelålder vid tiden för dödsfallet. Syftet för den andra delstudien var beskriva, jämföra och analysera dödsorsaksmönster bland utrikesfödda och svenskfödda under perioden 1970?1999. Studiens resultat visade ett större antal avlidna i sex olika ICD-huvuddiagnosgrupper och en lägre medelålder vid tiden för dödsfallet bland utrikesfödda. Födelselandet hade betydelse för dödsorsaksmönstret. Vid jämförelse med de svenska kontrollerna återfanns bland migranter från Danmark ett större antal avlidna i diagnosgruppen ?Neoplasm?, bland migranter från Finland och Polen var skillnaden stor i gruppen ?Diseases of the circulatory system? och personer från tidigare Jugoslavien särskilde sig mot kontrollerna framför allt med ett större antal avlidna i gruppen ?Symptoms, signs and ill-defined conditions?. Över tid fanns en tendens till en utjämning av skillnaderna i diagnosmönstret mellan utrikesfödda och svenskfödda. Då de två tidigare studierna hade visat på skillnader i mortalitet och morbiditet mellan utrikesfödda och svenskfödda kom den tredje studien att som syfte ha att beskriva, jämföra och analysera konsumtion av hälso- och sjukvård i fyra olika ICD-diagnosgrupper. Som mått på sjukvårdskonsumtion användes antal inläggningar på sjukhus, totalt antal vårddagar och vårddagar under de två sista inläggningstillfällena på sjukhus bland avlidna utrikesfödda och svenskfödda 1987?1999. Resultatet visade en tendens till mindre sjukvårdskonsumtion bland utrikesfödda, särskild vad gäller utrikesfödda män. Mindre sjukvårdskonsumtion för utrikesfödda återfanns i två av de fyra använda diagnosgrupperna (?Symptoms, signs and ill-defined conditions? och ?Injury and poisoning ?). Att vara utrikesfödd, justerat för ålder, var en oberoende bestämmande faktor för inläggning på sjukhus. Den nollhypotes som formulerats vid studiens start, att skillnader mellan utrikesfödda och svenskfödda beträffande sjukvårdkonsumtion inte fanns, kunde tillbakavisas. Det sista delarbetets syfte var att beskriva och jämföra skillnader i mortalitet i olika landsting mellan utrikesfödda och svenskfödda med en formulerad nollhypotes att inga mortalitetsskillnader fanns mellan olika landsting. Studiens resultat kunde tillbakavisa nollhypotesen, det fanns skillnader i mortalitet mellan utrikesfödda och svenskfödda framför allt i de län som kunde karaktäriseras som mera ?landsbygds?-dominerade. Landsbygdsdominerade län hade också gemensamt att deras populationer av migranter var förhållandevis små. Medelåldern vid tiden för avlidande var för män mellan 1,0?4,3 år lägre för utrikesfödda personer. Resultaten av de i avhandlingen ingående fyra olika studierna visar högre dödlighet, annorlunda sjukdomsmönster och tendens till lägre konsumtion av vård bland utrikesfödda än bland svenskfödda personer under perioden 1970?1999. Flera faktorer, såsom ekonomisk situation, arbete, arbetsmiljö, arbetslöshet, sociala nätverk och situationen före migrationen kan ha påverkat de utrikesföddas sämre hälsoläge. Den fysiska och sociala miljön och eventuella ojämlikheter i sjukvårdsresurser och tillgång till vård spelar också en viktig roll. Migrationen har haft en negativ inverkan på de utrikesföddas hälsa och är en viktig faktor att ta hänsyn till vid studier av hälsa och hälsoutveckling bland befolkningen i ett land

This study examined the relationship of caregiving roles to labor force participation using the nationally representative data from the Health and Retirement Study. The sample was composed of men and women aged 50 to 61 years (N = 5,119). Caregiving roles included caregiving for spouse, parents, and grandchildren; a summary of three caregiving roles was used to indicate multiple caregiving roles. Bivariate analysis using chi-square and t tests and binary logistic regression models were applied. Results show that women caregivers for parents and/or grandchildren were less likely to be in the labor force than non-caregivers and that caregiving responsibility was not related to labor force participation for the sample of men. Findings have implication for supporting family caregivers, especially women, to balance work and caregiving commitments.

Abstract

Background

Bereavement by spousal death and child death in adulthood has been shown to lead to an increased risk of mortality. Maternal death in infancy or parental death in early childhood may have an impact on mortality but evidence has been limited to short-term or selected causes of death. Little is known about long-term or cause-specific mortality after parental death in childhood.

Methods and Findings

This cohort study included all persons born in Denmark from 1968 to 2008 (n = 2,789,807) and in Sweden from 1973 to 2006 (n = 3,380,301), and a random sample of 89.3% of all born in Finland from 1987 to 2007 (n = 1,131,905). A total of 189,094 persons were included in the exposed cohort when they lost a parent before 18 years old. Log-linear Poisson regression was used to estimate mortality rate ratio (MRR). Parental death was associated with a 50% increased all-cause mortality (MRR = 1.50, 95% CI 1.43–1.58). The risks were increased for most specific cause groups and the highest MRRs were observed when the cause of child death and the cause of parental death were in the same category. Parental unnatural death was associated with a higher mortality risk (MRR = 1.84, 95% CI 1.71–2.00) than parental natural death (MRR = 1.33, 95% CI 1.24–1.41). The magnitude of the associations varied according to type of death and age at bereavement over different follow-up periods. The main limitation of the study is the lack of data on post-bereavement information on the quality of the parent-child relationship, lifestyles, and common physical environment.

Conclusions

Parental death in childhood or adolescence is associated with increased all-cause mortality into early adulthood. Since an increased mortality reflects both genetic susceptibility and long-term impacts of parental death on health and social well-being, our findings have implications in clinical responses and public health strategies.

Abstract:
Background Most research on parental bereavement and health have analysed health consequences of parental loss in childhood, while collateral health in adulthood has been less studied. Methods Using register-based population data from Finland, we analyse adult offspring aged 18–50 years with discrete-time hazard models that adjust for offspring and parental socioeconomic and demographic characteristics. In focus are adult children whose parents were alive and lived together at the beginning of the observation period. We compare two culturally distinct but otherwise similar ethno-linguistic groups, Finnish speakers and Swedish speakers. Results The results suggest that bereaved men have an approximately 30% higher death risk than non-bereaved men, while there is practically no difference in women. Associations between parental and child deaths are, as expected, stronger for concordant causes of death than for discordant causes of death. However, some associations for discordant causes of death remain, which may indicate causality. Among Swedish speakers, who have notably higher family stability than Finnish speakers, the death of one or both parents shows a stronger association with own mortality. Conclusions The estimated associations found are generally larger than in the neighbouring country Sweden, which may be due to a stronger obedience to traditional family values and patriarchal family roles in Finland. These findings suggest that the association between parental death and mortality in adult offspring may depend on the societal context as well as on cultural practices. These factors should be increasingly acknowledged in future studies on collateral health.

Abstract
BACKGROUND:
Little is known about the effect of parental bereavement on physical health. We investigated whether the death of a child increased mortality in parents.
METHODS:
We undertook a follow-up study based on national registers. From 1980 to 1996, we enrolled 21062 parents in Denmark who had a child who had died (exposed cohort), and 293745 controls--ie, parents whose children were alive, and whose family structure matched that of the exposed cohort. Natural deaths were defined with ICD8 codes 0000-7969 and ICD10 codes A00-R99, and unnatural deaths with codes 8000-9999 and V01-Y98. We used Cox's proportional-hazards regression models to assess the mortality rate of parents up to 18 years after bereavement.
FINDINGS:
We observed an increased overall mortality rate in mothers whose child had died (hazards ratio 1.43, 95% CI 1.24-1.64; p<0.0001). An excess mortality from natural causes (1.44, 1.15-1.78; p<0.0001) was noted in mothers only during the 10th-18th year of follow-up. Mothers had increased mortality rates from unnatural causes throughout follow-up, with the highest rate recorded during the first 3 years (3.84, 2.48-5.88; p<0.0001). Bereaved fathers had only an early excess mortality from unnatural causes (1.57, 1.06-2.32; p=0.04). Mothers who lost a child due to an unnatural death or an unexpected death had a hazard ratio of 1.72 (1.38-2.15; p=0.0040) and 1.67 (1.37-2.03; p=0.0037), respectively.
INTERPRETATION:
The death of a child is associated with an overall increased mortality from both natural and unnatural causes in mothers, and an early increased mortality from unnatural causes in fathers.