Anu Molarius

Aim: To investigate the association between loneliness, living alone and mental well-being among Swedish adults. Methods: The study is based on 6315 men and women aged 18 years or older responding to a population survey in 2022 (overall response rate 45%). A short version of the Warwick Edinburgh Mental Well Being Scale was used to measure mental well-being. The associations between loneliness, living alone and mental well-being were analysed using multiple logistic regression, adjusting for gender, age group, educational level, economic difficulties, social support, risk consumption of alcohol and longstanding illness. Results: Overall, the majority of the study population did not feel lonely, with 63.5% living with someone and 16.1% living alone. The proportion reporting loneliness, in total 20.4%, was about the same irrespective of whether the respondent lived with someone (10.7%) or was living alone (9.7%). More women than men reported loneliness, living alone and poor mental well-being. The youngest age group, 18–29 years, reported the highest levels of loneliness and poor mental well-being. Loneliness was independently associated with poor mental well-being, and the association was as strong among those who lived alone as among those who lived with someone. Conclusions: Loneliness was associated with poor mental well-being irrespective of living alone or not. Public health actions aiming to reduce loneliness and strengthen mental well-being in the general population need to address all age groups, in particular young adults and those who live with someone but still feel lonely.

Background: Unpaid labour has been recognised as an important yet neglected social determinant of health. We investigated gendered trends in unpaid labour/domestic work by educational level in prime working-age Swedish adults (30–49 years) from 2004–2022. Methods: The study is based on a postal survey sent to a random general population sample of adults from central Sweden in 2004, 2008, 2012, 2017 and 2022. The 30–49-year age group included between 5,500 and 12,200 respondents depending on the survey year. Trends in hours spent in domestic work and in experiencing domestic work as burdensome by gender and educational level were estimated by age-standardised proportions with corresponding 95% confidence intervals. Results: Women reported spending more time in domestic work than men throughout every survey period from 2004 to 2022. Over time, hours spent in domestic work decreased in women whereas no trend was observed in men. In 2022, 31% of women spent more than 20 h per week in domestic work compared to 20% of men. Among women, educational level appeared to make no difference to prevalence of high domestic work time whereas, among men, it was consistently greater among those with higher educational levels. In general, women experienced domestic work as burdensome to a higher degree than men did. Conclusion: As gender differences in unpaid labour persist in Sweden, more effort is needed to implement social policies to increase men’s participation in domestic work, especially among men with low and middle educational levels, which has the potential to reduce gendered health inequities.

Atopic dermatitis (AD) is associated with impaired health-related quality of life (HRQoL), especially in moderate-to-severe disease. The Dermatology Life Quality Index (DLQI) is the most widely used dermatology-specific measure, whereas the EuroQol Five-Dimension, Five-Level questionnaire (EQ-5D-5L), a generic preference-based instrument, assesses health status across diseases. This study examined the relationship between DLQI and EQ-5D-5L in Swedish adults with ADatopic dermatitis and developed a mapping model to estimate EQ-5D-5L utilities from DLQI scores. In this cross-sectional study, 112 Swedish adults with self-reported physician-diagnosed ADatopic dermatitis, recruited through the Swedish Asthma and Allergy Patient Association, completed both questionnaires. DLQI scores correlated strongly and negatively with EQ-5D-5L index values (r=−-0.64, p<0.001). Each 5-point increase in DLQI corresponded on average to a 0.07 decrease in EQ-5D-5L utility. A fractional logit regression model including covariates age, sex, and disease severity, showed good calibration and explained 27 % of the variance in EQ-5D-5L values. These findings demonstrate that DLQI scores meaningfully reflect generic HRQoL among adults with ADatopic dermatitis and can be used to estimate EQ-5D-5L utilities when preference-based data are unavailable. The results enhance understanding of how DLQI relaterelates to overall health status and support the application of DLQI-derived utilities in cost-effectiveness analyses and health technology assessments.

Atopic dermatitis (AD) is a chronic skin disease associated with impaired quality of life. Evidence from Sweden on out-of-pocket expenses and productivity losses remains limited. This study assessed the burden of AD among adults in relation to health-related quality of life (HRQoL), work productivity, activity impairment, willingness to pay for symptom relief, economic outcomes, considering comorbid asthma, allergies, depression and anxiety. A cross-sectional survey was conducted between 2024 and 2025 among 220 members of the Swedish Asthma and Allergy Patient Association. Validated instruments included the Dermatology Life Quality Index (DLQI), EuroQol five-dimensions, five-levels instrument (EQ-5D-5L), Patient Benefit Index, and Work Productivity and Activity Impairment questionnaire. Descriptive and regression analyses were performed. Respondents (89.8% female; mean age 43 years) reported moderate HRQoL impairment (mean DLQI 10.1). DLQI and EQ-5D-5L were worse among those with allergic or non-atopic comorbidities but did not differ by asthma status. Mean annual out-of-pocket costs and productivity losses were €900 (95% CI: 401.1–1,758.4) and €1,972 (95% CI: 1,198.7–2,828.0), respectively. Itch intensity and activity impairment were associated with lower HRQoL and higher costs. AD is related to worsened work and activity functioning and high economic burden, suggesting the need for improved support and management strategies for affected adults.

Background: Physical inactivity, impaired physical mobility and poor mental health are common in the older population and increasing as the population ages. We examined the relationships between physical activity, physical mobility, and mental health in the general population of older adults. Methods: The study is based on 12 959 men and women aged 70 years or older answering a survey questionnaire sent to a random population sample in Mid-Sweden in 2022 (response rate 66%). The associations between physical activity (at least 150 min/week), physical mobility (no difficulties e.g. in walking short distances or climbing stairs) and mental health were investigated with multiple logistic regression analyses, adjusting for gender, age group and educational level. Mental health was measured with symptoms of anxiety or worry, and self-reported diagnosed depression. Results: In total, 51% were physically inactive and 31% had impaired physical mobility. Symptoms of anxiety or worry (33%) were more common among older people who were physically inactive than among those who were physically active (24%). The prevalence of symptoms of anxiety or worry was also higher among those with impaired physical mobility (40%) than among those with physical mobility (23%). Physical inactivity and impaired physical mobility were also associated with self-reported depression. When stratified by physical mobility, physical inactivity was significantly associated with symptoms of anxiety or worry (OR: 1.20, 95% CI: 1.08–1.34) and self-reported depression (OR: 1.66, 95% CI: 1.27–2.17) among those with physical mobility, whereas no association was found among those with impaired physical mobility. Conclusion: The results suggest that physical activity is positively associated with mental health among older people with physical mobility. However, about one in three in the older population has impaired physical mobility with poorer mental health irrespective of physical activity. These results are important for promoting mental health in an aging population.

Aims: The primary aim of the present study was to explore the prevalence of psychological distress among single fathers and single mothers in comparison to parents living together, and the factors contributing to the differences between single and partnered parents. A secondary aim was to investigate the perceived need for parental support in relation to severe psychological distress in these groups. Methods: A survey questionnaire was sent to a random population sample in Sweden in 2022 and 5750 parents aged 18–69 years participated. The outcome was severe psychological distress, measured by the Kessler-6 (scores ⩾13). Associations between single parenthood and severe psychological distress were analysed with multiple logistic regression, adjusting for age group, economic difficulties, social support, risk consumption of alcohol and need for parental support. Results: Severe psychological distress was more common among single fathers (age-adjusted odds ratio (OR): 2.2; 95% confidence interval (CI): 1.4–3.5) and mothers (age-adjusted OR: 2.4; 95% CI: 1.8–3.3) than among partnered fathers and mothers. The main explanatory factors for the difference were economic difficulties and lack of social support, accounting together for 75% of the excess of severe psychological distress in single fathers and 64% in single mothers. Risk consumption of alcohol among both single and partnered fathers was also associated with severe psychological distress. Being in need of more parental support, for example, from maternity/child health care or family centres was associated with severe psychological distress among all parents, regardless of partnership status and gender. Conclusions: Single parents had a higher prevalence of severe psychological distress than partnered parents, mainly explained by economic difficulties and the lack of social support. Both among single and partnered parents, the need for more parental support was associated with severe psychological distress.

Objective: The aim of this study was to investigate factors associated with reported need of weight loss support among adults with overweight or obesity in the general population. Design: A cross-sectional population study based on a survey questionnaire sent to a random population sample. Multivariate odds ratios for reported need of weight loss support were calculated for socio-economic, lifestyle and health indicators, in total and by gender and age group. Setting: Five counties in Sweden in 2022. Participants: The study includes 10 069 persons with overweight or obesity (BMI ≥ 25 kg/m²) aged 30–69 years. BMI was based on self-reported weight and height. Results: In total, about 20 % reported needing weight loss support. The factors most strongly associated with reported need of weight loss support were obesity and female gender. Lack of social support, economic difficulties, physical inactivity, poor self-rated health, musculoskeletal pain and depression were also associated with reported need of weight loss support, whereas diabetes and hypertension were not. Some differences in these associations were observed between age groups. Conclusion: Reported need of weight loss support is more common among women than among men and associated with obesity, lack of social support, economic difficulties, physical inactivity, poor self-rated health, musculoskeletal pain and depression in both genders. These factors are important for planning preventive and weight-control measures among adults with overweight or obesity.

Background: Unpaid labour has recently been recognised as an important yet neglected social determinant of health. Our aim was to investigate the gendered trends in unpaid labour/domestic work by educational level in prime working-age Swedish adults (30-49 years) from 2004-2022. Methods: The study is based on a postal survey sent to a random general population sample of adults from central Sweden in 2004, 2008, 2012, 2017 and 2022. The 30-49-year age group included between 5,500 and 12,200 respondents depending on the survey year. Trends in hours spent in domestic work and in experiencing domestic work as burdensome by gender and educational level were estimated by age-standardised proportions with corresponding 95% confidence intervals. Results: Women reported spending more time in domestic work than men throughout every survey period from 2004 to 2022. For example, in 2022, 31% of women spent more than 20 hours per week in domestic work compared to 20% of men. Over time, hours spent in domestic work decreased in women whereas no trend was observed in men. Among women, educational level appeared to make no difference to prevalence of high domestic work time whereas, among men, it was consistently greater among those with higher educational levels. In general, women experienced domestic work as burdensome to a higher degree than men did. Conclusions: As gender differences in unpaid labour/domestic work persist in Sweden, more effort is needed to implement social policies to increase men’s participation in domestic work, especially among men with low and middle educational levels, which has the potential to reduce gendered health inequities. Key messages: • Amongst Swedish adults aged 30-49 years, the gender gap in unpaid labour has declined during the last two decades, but this is only due to women reducing their domestic work time. • For men, prevalence of high domestic work time was consistently greater among those with higher educational levels, whereas no difference was observed among women.

Background: The aim was to investigate trends in obesity prevalence by gender and educational level in the general population aged 30–69 years, based on large surveys conducted in Mid-Sweden in 2012, 2017 and 2022. Methods: The study included 22 082, 15 264 and 17 055 respondents, respectively. Obesity (body mass index ≥30 kg/m²) was based on self-reported weight and height. Trends in obesity prevalence, including comparisons across educational levels, were estimated by age-standardised proportions with corresponding 95% CIs. Differences between genders, educational levels and survey years were tested using multiple logistic regression. Results: The overall age-standardised prevalence of obesity increased from 17.6% in 2012 to 20.1% in 2017 and to 23.3% in 2022. There was no statistically significant difference in obesity prevalence between men and women. Large and persisting inequalities between educational levels were however observed. In 2022, the prevalence of obesity was about 30% among persons with low/middle education and 18% among persons with high education. Conclusion: Efforts to tackle the obesity epidemic are urgently required in Sweden, taking into consideration the circumstances of groups with low and middle levels of education.