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Johansson, F., Rozental, A., Edlund, K., Côté, P., Sundberg, T., Onell, C., . . . Skillgate, E. (2023). Associations between procrastination and subsequent health outcomes among university students in Sweden. JAMA Network Open, 6(1), e2249346, Article ID e2249346.
Open this publication in new window or tab >>Associations between procrastination and subsequent health outcomes among university students in Sweden
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2023 (English)In: JAMA Network Open, E-ISSN 2574-3805, Vol. 6, no 1, p. e2249346-, article id e2249346Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE: Procrastination is prevalent among university students and is hypothesized to lead to adverse health outcomes. Previous cross-sectional research suggests that procrastination is associated with mental and physical health outcomes, but longitudinal evidence is currently scarce.

OBJECTIVE: To evaluate the association between procrastination and subsequent health outcomes among university students in Sweden.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study was based on the Sustainable University Life study, conducted between August 19, 2019, and December 15, 2021, in which university students recruited from 8 universities in the greater Stockholm area and Örebro were followed up at 5 time points over 1 year. The present study used data on 3525 students from 3 time points to assess whether procrastination was associated with worse health outcomes 9 months later.

EXPOSURE: Self-reported procrastination, measured using 5 items from the Swedish version of the Pure Procrastination Scale rated on a Likert scale from 1 ("very rarely or does not represent me") to 5 ("very often or always represents me") and summed to give a total procrastination score ranging from 5 to 25.

MAIN OUTCOMES AND MEASURES: Sixteen self-reported health outcomes were assessed at the 9-month follow-up. These included mental health problems (symptoms of depression, anxiety, and stress), disabling pain (neck and/or upper back, lower back, upper extremities, and lower extremities), unhealthy lifestyle behaviors (poor sleep quality, physical inactivity, tobacco use, cannabis use, alcohol use, and breakfast skipping), psychosocial health factors (loneliness and economic difficulties), and general health.

RESULTS: The study included 3525 participants (2229 women [63%]; mean [SD] age, 24.8 [6.2] years), with a follow-up rate of 73% (n = 2587) 9 months later. The mean (SD) procrastination score at baseline was 12.9 (5.4). An increase of 1 SD in procrastination was associated with higher mean symptom levels of depression (β, 0.13; 95% CI, 0.09-0.17), anxiety (β, 0.08; 95% CI, 0.04-0.12), and stress (β, 0.11; 95% CI, 0.08-0.15), and having disabling pain in the upper extremities (risk ratio [RR], 1.27; 95% CI, 1.14-1.42), poor sleep quality (RR, 1.09, 95% CI, 1.05-1.14), physical inactivity (RR, 1.07; 95% CI, 1.04-1.11), loneliness (RR, 1.07; 95% CI, 1.02-1.12), and economic difficulties (RR, 1.15, 95% CI, 1.02-1.30) at the 9-month follow-up, after controlling for a large set of potential confounders.

CONCLUSIONS AND RELEVANCE: This cohort study of Swedish university students suggests that procrastination is associated with subsequent mental health problems, disabling pain, unhealthy lifestyle behaviors, and worse psychosocial health factors. Considering that procrastination is prevalent among university students, these findings may be of importance to enhance the understanding of students' health.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:shh:diva-4752 (URN)10.1001/jamanetworkopen.2022.49346 (DOI)36598789 (PubMedID)
Available from: 2023-03-10 Created: 2023-03-10 Last updated: 2024-01-16Bibliographically approved
Onell, C., Skillgate, E., Melin, A., Källberg, H., Waldén, M., Edlund, K., . . . Asker, M. (2023). Dietary habits in adolescent male and female handball players: The Swedish Handball Cohort. In: : . Paper presented at Scandinavian Sports Medicine Congress, Köpenhamn, Danmark, 2-4 februari 2023.
Open this publication in new window or tab >>Dietary habits in adolescent male and female handball players: The Swedish Handball Cohort
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2023 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Physiotherapy
Identifiers
urn:nbn:se:shh:diva-5094 (URN)
Conference
Scandinavian Sports Medicine Congress, Köpenhamn, Danmark, 2-4 februari 2023
Available from: 2023-12-20 Created: 2023-12-20 Last updated: 2023-12-20Bibliographically approved
Onell, C., Skillgate, E., Melin, A., Källberg, H., Waldén, M., Edlund, K., . . . Asker, M. (2023). Dietary habits in adolescent male and female handball players: The Swedish Handball Cohort. BMJ open sport & exercise medicine, 9(4), Article ID e001679.
Open this publication in new window or tab >>Dietary habits in adolescent male and female handball players: The Swedish Handball Cohort
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2023 (English)In: BMJ open sport & exercise medicine, ISSN 2055-7647, Vol. 9, no 4, article id e001679Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: This cross-sectional study aimed to describe dietary habits in Swedish adolescent handball players and differences with respect to sex and school grade.

METHODS: Participants in the Swedish Handball Cohort answered a web-survey assessing adherence to sports nutrition recommendations for meal frequency and meal timing, and the Nordic Nutrition Recommendations (NNR) for fruits/vegetables and fish/seafood, food exclusions and use of dietary supplements. Differences with respect to sex and school grade were estimated with generalised linear models, generating prevalence ratios (PR) with 95% CIs.

RESULTS: A total of 1040 participants (16.6±0.9 years, 51% males) were included. Overall, 70% and 90%, respectively, met recommendations for meal frequency and meal timing, whereas adherence to recommended carbohydrate intake during training/game was met by 17%. Adherence to the NNR for fruits/vegetables and fish/seafood was met by 16% and 37%, respectively. Twenty-eight per cent reported using dietary supplements. Females reported lower frequency of meals, especially morning snacks (-0.6 days/week (95% CI -0.3 to -0.9)) and evening snacks (-0.8 days/week (95% CI -0.5 to -1.1)), higher prevalence of exclusions due to intolerances (PR 1.66 (95% CI 1.31 to 2.01)) and other reasons (PR 1.36 (95% CI 1.08 to 1.64)), higher adherence to the NNR for fruits/vegetables (PR 2.30 (95% CI 1.98 to 2.62)) and use of micronutrient supplements (PR 1.72 (95% CI 1.43 to 2.00)) compared with males. Only small differences were observed between school grades.

CONCLUSIONS: Swedish adolescent handball players' dietary habits are fairly in accordance with sports nutrition recommendations but not the NNR. Females appear to display more restrictive habits than males.

Keywords
Adolescent, Athlete, Epidemiology, Handball, Sports and nutrition
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:shh:diva-5107 (URN)10.1136/bmjsem-2023-001679 (DOI)38143719 (PubMedID)
Available from: 2024-01-12 Created: 2024-01-12 Last updated: 2024-01-12Bibliographically approved
Onell, C., Skillgate, E., Melin, A., Källberg, H., Waldén, M., Edlund, K., . . . Asker, M. (2023). Matvanor inom svensk ungdomshandboll. In: : . Paper presented at Idrottsmedicinskt vårmöte, Norrköping, 20-21 april 2023.
Open this publication in new window or tab >>Matvanor inom svensk ungdomshandboll
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2023 (Swedish)Conference paper, Oral presentation only (Other academic)
National Category
Physiotherapy
Identifiers
urn:nbn:se:shh:diva-5095 (URN)
Conference
Idrottsmedicinskt vårmöte, Norrköping, 20-21 april 2023
Available from: 2023-12-20 Created: 2023-12-20 Last updated: 2023-12-20Bibliographically approved
Edlund, K., Nigicser, I., Sansone, M., Identeg, F., Hedelin, H., Forsberg, N. & Tranaeus, U. (2023). Protocol for a 2-year longitudinal study of eating disturbances, mental health problems and overuse injuries in rock climbers (CLIMB). BMJ Open, 13(9), Article ID e074631.
Open this publication in new window or tab >>Protocol for a 2-year longitudinal study of eating disturbances, mental health problems and overuse injuries in rock climbers (CLIMB)
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2023 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 9, article id e074631Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Rock climbing is a rapidly growing sport in which performance may be affected by participant's weight and leanness, and there may be pressure on athletes with respect to their eating behaviour and body weight. However, there is sparse research performed on climbers, constituting a knowledge gap which the present study aims to fill. The primary outcomes of the study are to examine disordered eating and overuse injuries in rock climbers. Secondary variables are body image, indicators of relative energy deficiency, mental health problems, compulsive training, perfectionism, sleep quality and bone density.

METHOD AND ANALYSIS: This prospective longitudinal study aims to recruit Swedish competitive rock climbers (>13 years) via the Swedish Climbing Federation. A non-athlete control group will be recruited via social media (n=equal of the climbing group). Data will be collected using streamlined validated web-based questionnaires with three follow-ups over 2 years. Inclusion criteria for rock climbers will be a minimum advanced level according to International Rock-Climbing Research Association. The non-athlete control group is matched for age and gender. Exclusion criteria are having competed at an elite level in any sport as well as training more often than twice per week. Statistical analyses will include multinominal logistic regression, multivariate analysis of variance (MANOVA) and structural equation modelling (SEM). We will assess effect measure modification when relevant and conduct sensitivity analyses to assess the impact of lost to follow-up.

ETHICS AND DISSEMINATION: The Rock-Climbers' Longitudinal attitudes towards Injuries, Mental health and Body image study, CLIMB, was approved by the Swedish ethics authority (2021-05557-01). Results will be disseminated through peer-reviewed research papers, reports, research conferences, student theses and stakeholder communications.

TRIAL REGISTRATION NUMBER: NCT05587270.

Keywords
Eating disorders, Mental health, Sports medicine
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:shh:diva-5104 (URN)10.1136/bmjopen-2023-074631 (DOI)37709336 (PubMedID)
Available from: 2024-01-08 Created: 2024-01-08 Last updated: 2024-01-08Bibliographically approved
Johansson, F., Côté, P., Onell, C., Källberg, H., Sundberg, T., Edlund, K. & Skillgate, E. (2023). Strengths of associations between depressive symptoms and loneliness, perfectionistic concerns, risky alcohol use and physical activity across levels of sleep quality in Swedish university students: A cross-sectional study. Journal of Sleep Research, 32(2), Article ID e13745.
Open this publication in new window or tab >>Strengths of associations between depressive symptoms and loneliness, perfectionistic concerns, risky alcohol use and physical activity across levels of sleep quality in Swedish university students: A cross-sectional study
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2023 (English)In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 32, no 2, article id e13745Article in journal (Refereed) Published
Abstract [en]

Previous research shows that sleep quality may interact with some other predictors of depression, such that poor sleep could strengthen the association between these factors and depression. We aimed to determine the presence of statistical interactions between sleep quality and loneliness, risky alcohol use, perfectionistic concerns and/or physical inactivity in relation to depressive symptoms. Further, we aimed to describe the functional form of the statistical interactions and associations. We used a cross-sectional design and included 4262 Swedish university students. All measures were self-reported, sleep quality was measured with the Pittsburgh Sleep Quality Index, and depressive symptoms with the short-form Depression, Anxiety and Stress Scale. Regression models of increasing complexity (linear and non-linear, with and without interactions) were compared to determine the presence of associations and statistical interactions, and to explore the best functional form for these associations and interactions. Out-of-sample R2 from repeated cross-validation was used to select the final models. We found that sleep quality was associated with depressive symptoms in all final models. Sleep quality showed a linear interaction with perfectionistic concerns in relation to depressive symptoms, such that perfectionistic concerns were more strongly associated with depressive symptoms when sleep quality was poor. Loneliness, risky alcohol use and physical inactivity were non-linearly associated with depressive symptoms but did not interact with sleep quality. We concluded that out of the four examined variables, only perfectionistic concerns interacted with sleep quality in relation to depressive symptoms. This interaction was weak and explained little of the overall variance in depressive symptoms.

Keywords
Alcohol use, Depression, Interaction, Loneliness, Perfectionism, Sleep quality
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:shh:diva-4667 (URN)10.1111/jsr.13745 (DOI)36217878 (PubMedID)
Available from: 2022-12-08 Created: 2022-12-08 Last updated: 2024-01-16Bibliographically approved
Edlund, K., Johansson, F., Lindroth, R., Bergman, L., Sundberg, T. & Skillgate, E. (2022). Body image and compulsive exercise: Are there associations with depression among university students?. Eating and Weight Disorders, 27(7), 2397-2405
Open this publication in new window or tab >>Body image and compulsive exercise: Are there associations with depression among university students?
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2022 (English)In: Eating and Weight Disorders, ISSN 1124-4909, E-ISSN 1590-1262, Vol. 27, no 7, p. 2397-2405Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Mental health problems among university students have been reported to be significantly increasing and suggested to be associated with college drop-out. Body dissatisfaction and compulsive exercise are both constructs relevant for mental health problems in general and eating disorders in particular. This study examined associations between body dissatisfaction, compulsive exercise and self-reported symptoms of depression among Swedish university students.

METHODS: Participants (n = 4262) are students in an ongoing cohort study, and data from the baseline assessment were used. Four linear regression models were built to explore the associations between body dissatisfaction, compulsive weight control exercise and depressive symptoms.

RESULTS: Our findings showed that females reported higher levels of body dissatisfaction than males. Body dissatisfaction and compulsive exercise were associated with self-reported symptoms of depression in this non-clinical population. Results showed that compulsive exercise was negatively associated with reported symptoms of depression, while body dissatisfaction was positively associated with symptoms of depression.

CONCLUSION: In line with previous research, there was a gender difference in body dissatisfaction where females displayed higher levels of dissatisfaction than males.  Body dissatisfaction was  positively associated with reported symptoms of depression, suggesting support of previous research indicating body dissatisfaction to increase mental health problems. Compulsive exercise was negatively associated with symptoms of depression suggesting a behavior negatively reinforced, supporting both constructs to be of interest for reported symptoms of depression in a non-clinical population of Swedish university students.

LEVEL OF EVIDENCE: III, cohort study.

TRIAL REGISTRATION: http://clinicaltrials.gov/ID : NCT04465435.

Keywords
Body dissatisfaction, Compulsive exercise, Depression, University students
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:shh:diva-4350 (URN)10.1007/s40519-022-01374-x (DOI)35179726 (PubMedID)
Available from: 2022-03-09 Created: 2022-03-09 Last updated: 2023-01-03Bibliographically approved
Larsson, K., Onell, C., Edlund, K., Källberg, H., Holm, L. W., Sundberg, T. & Skillgate, E. (2022). Lifestyle behaviors in Swedish university students before and during the first six months of the COVID-19 pandemic: A cohort study. BMC Public Health, 22(1), Article ID 1207.
Open this publication in new window or tab >>Lifestyle behaviors in Swedish university students before and during the first six months of the COVID-19 pandemic: A cohort study
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2022 (English)In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, no 1, article id 1207Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Changes in Swedish university students' lifestyle behaviors during the COVID-19 pandemic are unknown. This study aimed to assess physical activity, sitting time, meal frequency and risk substance use (alcohol, tobacco, and illicit use of drugs) in Swedish university students before and during the first six months of the COVID-19 pandemic, for all and stratified by age and sex.

METHODS: Data were obtained from the Sustainable University Life cohort study in which web-based surveys were sent to university students repeatedly for one year. Baseline assessment (before the pandemic) was between August 2019-March 2020, follow-up 1 (FU1) between March-June 2020, and follow-up 2 (FU2) between June-September 2020. Participants reported weekly minutes of physical activity, daily sitting hours, meal frequency by weekly intake of different meals, and motivation for eating irregularly, if so. Also, harmful use of alcohol, tobacco and illicit drugs was assessed. Population means and differences with 95% confidence intervals (95% CI) in lifestyle behaviors between time points were calculated with Generalized Estimating Equations.

RESULTS: 1877 students (73% women, mean age 26.5 years) answered the baseline survey. Weekly exercise decreased by -5.7 min (95% CI: -10.0, -1.5) and -7.7 min (95% CI: -12.6, -2.8) between baseline and FU1 and FU2, respectively. Weekly daily activities increased by 5.6 min (95% CI: 0.3, 11.7) and 14.2 min (95% CI: 7.9, 20.5) between baseline and FU1 and FU2. Daily sitting time decreased by -1.4 h (95% CI: -1.7, -1.2) between baseline and FU2. Breakfast intake increased by 0.2 days per week (95% CI: 0.1, 0.3) between baseline and FU2. Lunch intake decreased by -0.2 days per week (95% CI: -0.2, -0.1) between baseline and FU1 and by -0.2 days per week (95% CI: -0.3, -0.0) between baseline and FU2. Dinner intake decreased by -0.1 days per week (95% CI: -0.2, -0.0) between baseline and both FU1 and FU2. Only minor differences in risk substance use were observed. Similar changes were observed in analyses stratified by age and sex.

CONCLUSIONS: Lifestyle behaviors in Swedish university students slightly improved during the first six months of the COVID-19 pandemic compared to before.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT04465435 . 10/07/2020.

Keywords
Alcohol, COVID-19, Lifestyle behaviors, Longitudinal, Meal habits, Physical activity, Students, Substance use, Tobacco
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:shh:diva-4535 (URN)10.1186/s12889-022-13553-7 (DOI)35710368 (PubMedID)
Available from: 2022-06-29 Created: 2022-06-29 Last updated: 2023-08-28Bibliographically approved
Edlund, K., Sundberg, T., Johansson, F., Onell, C., Rudman, A., Holm, L. W., . . . Skillgate, E. (2022). Sustainable UNiversity Life (SUN) study: Protocol for a prospective cohort study of modifiable risk and prognostic factors for mental health problems and musculoskeletal pain among university students. BMJ Open, 12(4), Article ID e056489.
Open this publication in new window or tab >>Sustainable UNiversity Life (SUN) study: Protocol for a prospective cohort study of modifiable risk and prognostic factors for mental health problems and musculoskeletal pain among university students
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2022 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 4, article id e056489Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Mental health problems and musculoskeletal pain are common health problems among young adults including students. Little is known about the aetiology and prognosis of these problems in university students. We aim to determine the role of personal, sociodemographic, academic and environmental factors for risk and prognosis of symptoms of depression, anxiety and stress as well as musculoskeletal pain in university students. The constructs that will be studied are based on the biopsychosocial model and psychopathology associated with disabling pain. This model acknowledges illness to consist of interrelated mechanisms categorised into biological, psychological, environmental and social cues.

METHODS AND ANALYSIS: This cohort study aims to recruit around 5000 Swedish full-time students. Data will be collected using five online surveys during one academic year. A subgroup (n=1851) of the cohort, recruited before the COVID-19 pandemic, receive weekly text messages with three short questions assessing mood, worry and pain, sent through the web-based platform SMS-track . Statistical analyses will include Kaplan-Meier estimates, Cox regression analyses, multinomial logistic regression analyses and generalised estimating equations. We will assess effect measure modification when relevant and conduct sensitivity analyses to assess the impact of lost to follow-up.

PROTOCOL AMENDMENTS: Due to opportunity and timing of the study, with relevance to the outbreak of the COVID-19 pandemic, this study further aims to address mental health problems, musculoskeletal pain and lifestyle in university students before and during the pandemic.

ETHICS AND DISSEMINATION: The Sustainable UNiversity Life study was approved by the Swedish ethics authority (2019-03276; 2020-01449). Results will be disseminated through peer-reviewed research papers, reports, research conferences, student theses and stakeholder communications.

TRIAL REGISTRATION NUMBER: NCT04465435.

Keywords
Epidemiology, Mental health, Public health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:shh:diva-4459 (URN)10.1136/bmjopen-2021-056489 (DOI)35379630 (PubMedID)
Available from: 2022-05-03 Created: 2022-05-03 Last updated: 2023-08-28Bibliographically approved
Haukeli, K. & Edlund, K. (2022). Two-year longitudinal case study of intensive exposure treatment in an adolescent girl with social anxiety disorder. Clinical Case Reports, 10(3), e05588, Article ID e05588.
Open this publication in new window or tab >>Two-year longitudinal case study of intensive exposure treatment in an adolescent girl with social anxiety disorder
2022 (English)In: Clinical Case Reports, ISSN 2050-0904, Vol. 10, no 3, p. e05588-, article id e05588Article in journal (Refereed) Published
Abstract [en]

The purpose was to adapt the "Bergen 4-Day Treatment" for severe social anxiety disorder and to study the 28 months follow-up effects for a 16-year-old girl. It was delivered over three full days. At post-treatment, 48% reduction in symptoms, she no longer met the diagnostic criteria for SAD.

Keywords
Adolescent, Cognitive‐behavioral therapy, Intensive exposure, Social anxiety, The Bergen four day treatment
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:shh:diva-4698 (URN)10.1002/ccr3.5588 (DOI)35340635 (PubMedID)
Available from: 2023-01-04 Created: 2023-01-04 Last updated: 2023-01-04Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-2614-5174

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