Viveca Östberg

Importance: Workplace bullying poses significant risks to mental and occupational health, highlighting the need for efficient measurement in surveys and large-scale observational studies. Objective: The aim of this mixed-methods study was to evaluate the validity of the PP-item, a brief measure of personal persecution at work, used to assess workplace bullying, included in the Swedish Longitudinal Occupational Survey of Health (SLOSH). Methods: Using two samples based on SLOSH 2008 and SLOSH 2023 (N=445 and N=1148, respectively), the theoretical properties of the PP-item were assessed through qualitative content analysis of self-reported experiences of personal persecution, while psychometric properties were evaluated by examining convergence with established measures, as well as examining its discriminant and predictive performance. Results: We found that the PP-item captures experiences that reflect meaningful categories of bullying behaviours and that it showed moderate agreement with established measures of workplace bullying (self-labelling, κ=0.6; Negative Acts Questionnaire-Revised, κ=0.5). The PP-item was able to distinguish bullying from workplace violence and predicted subsequent symptoms of depression (odds ratio: 4.6, 95% confidence interval 2.5-8.7) and anxiety (odds ratio 3.1, 95% confidence interval 1.9-4.9) in an expected manner. However, the PP-item appeared more sensitive to person-related than work-related negative acts and potentially included also lower-threshold negative interactions, showing moderate correlations with workplace conflicts. Conclusions: The findings from both quantitative and qualitative analyses support the PP-item as a valid tool for capturing exposure to negative workplace interactions, that are largely aligned with the theoretical construct of workplace bullying. Implications for practice: While the overall findings support the validity of the PP-item, it may be useful to consider distinct features, such as exposure frequency and duration, when using the PP-item.

Herd immunity levels of vaccine uptake are still not reached in some high-income countries, usually in countries with persisting social inequities in uptake. Previous studies have focused on factors within one health care system. This study takes a broader health care systems approach by reviewing the socioeconomic distribution of vaccination coverage on the national level in light of structural and organizational differences of primary care for children. A systematic literature review of socio-economic patterns of uptake of Measles-Mumps-Rubella (MMR) and/or Diphteria-Tetanus-Pertusis (DTP) in population based studies of children 0–5 years of age living in the 30 European Economic Area (EEA) or European Free Trade Association (EFTA) countries and Australia, was carried out using the PRISMA guidelines. The health care system in the countries in the study were categorized by degree of freedom of the primary care provider (hierarchical or non-hierarchical) and whether preventive services were provided in a separate organization (well-baby clinics). The review identified 15 studies from 10 European countries and Australia that fulfilled the criteria. Although the heterogeneity of the socio-economic indicators did not allow for a conclusive meta-analysis, the study pointed towards lower levels of inequities in primary care models with well-baby clinics. In non-hierarchical primary care organizations that also lacked well-baby clinics, socioeconomic gaps in uptake were often found to be large. This review indicates that structural and organizational aspects of health care systems for young children are important for equity in vaccine uptake.

Stress, and stress-related health complaints, are common among young people, especially girls. Since studies have shown that school demands are an important driver of stress in adolescents, identifying if school-based resources can protect against stress is highly relevant. The aim of this study was to analyse task-related demands and task-related coping resources as aspects of the school work environment of potential relevance for stress in mid-adolescent girls and boys. The data came from “The School Stress and Support study” (TriSSS) conducted among students in grades 8 and 9 (aged 14–16 years). Self-reports of demands, coping resources, stress, as well as recurrent pain, were collected through questionnaires (n = 411). A subsample of students (n = 191–198) also provided salivary samples, which were analysed for the stress marker cortisol. Linear (OLS) and binary logistic regression analyses showed that higher demands were associated with more perceived stress, a higher likelihood of recurrent pain, and a lower cortisol awakening response. Greater coping resources were associated with less perceived stress and a lower likelihood of recurrent pain, but there was no association with cortisol. The strength of the associations differed by gender. The findings suggest that schools can promote student wellbeing by providing clear and timely information and teacher support to the students, especially for boys. Identifying specific features of the schoolwork that give rise to stress and to modify these accordingly is also of importance, especially for girls.

Bullying involves repeated exposure to negative actions while also invoking a power asymmetry between the involved parties. From a stress perspective, being bullied can be seen as a severe and chronic stressor, and an everyday social-evaluative threat, coupled with a shortage of effective social resources for dealing with this particular stressor. The aim of this study was to investigate whether exposure to bullying among mid-adolescent girls and boys is associated with subjective and objective stress-related outcomes in terms of perceived stress, recurrent pain, and salivary cortisol. The data came from the School Stress and Support Study (TriSSS) including students in grades 8–9 in two schools in Stockholm, Sweden, in 2010 (study sample n = 392; cortisol subsample n = 198). Bullying was self-reported and measured by multiple items. The statistical analyses included binary logistic and linear (OLS) regression. Being bullied was associated with greater perceived stress and an increased risk of recurrent pain, among both boys and girls. Also, bullied students had lower cortisol output (AUC_G) and lower cortisol awakening response (CAR_G) as compared to those who were not bullied. Gender-stratified analyses demonstrated that these associations were statistically significant for boys but not for girls. In conclusion, this study demonstrated that being bullied was related to both subjective and objective stress markers among mid-adolescent girls and boys, pointing to the necessity of continuously working against bullying.