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Background Taking a broad approach, the aim of this study was to better understand severity and prevalence of various types of mental ill-health across age and sex groups in the general adult population. A first objective was to determine symptom severity of anxiety, depression, insomnia, burnout and somatization in combinations of different age groups and sex. A second objective was to determine prevalence of caseness of these types of mental ill-health in both absolute and relative terms in the combinations of age groups and sex. Methods Cross-sectional data based on validated questionnaire instruments were used from the Västerbotten Environmental Health Study in Sweden. In total, 3406 participants, aged 18 to 79 years, constituted a random sample stratified for age and sex. Results Severity and prevalence of anxiety, insomnia and burnout were high in women, in particular young women, and lower in older age groups. The prevalence rates for insomnia, burnout and somatization were particularly high based on the used cut-off scores. Men aged 30–49 years had the highest prevalence of mental ill-health compared to other age groups among men. Men and women aged 60–69 years had generally the lowest symptom severity and caseness. The prevalence of depression was similar in men and women in all age groups, whereas sex-related differences in extent in general were largest in the youngest age group, and gradually decreased with age. Conclusion The results suggest that focus in primary healthcare regarding mental ill-health should to be directed more towards insomnia, burnout and somatization, in particular in young women.

The aim of this study was to investigate how self-rated health (SRH) reflects ongoing ill-health and how SRH is associated with previous ill-health and/or predicts future ill-health such as burnout, disturbed sleep, and somatic symptoms. The study used two waves from the population-based Västerbotten Environmental and Health Study in which 2 336 adult persons participated by answering a questionnaire at two time points three years apart. Hierarchical and logistic regression analyses were conducted, thus treating all variables both continuously (degree) and categorically (case). The analyses were performed both cross-sectionally and longitudinally. The results showed bidirectionality between suboptimal SRH and burnout, disturbed sleep and somatic severity caseness. Moreover, degree of poor SRH was more likely to occur simultaneously to high degrees of burnout and somatic severity than to degree of poor sleep quality. Also, caseness of burnout, disturbed sleep and somatic severity increased the risk of simultaneous suboptimal SRH. Finally, the results showed that degree of burnout three years earlier, predicted degree of poor SRH, and that degree of poor SRH predicted degree of sleep three years later. In conclusion, in a population-based, normal adult sample there is a bidirectional relationship between suboptimal SRH and caseness of burnout, disturbed sleep quality and somatic symptoms, but not between degree of these symptoms. The results can have implications for health care meeting patients complaining about poor general health.

There is a need for better understanding of various characteristics in hyperacusis in the general population. The objectives of the present study were to investigate individuals in the general population with hyperacusis regarding demographics, lifestyle, perceived general health and hearing ability, hyperacusis-specific characteristics and behavior, and comorbidity. Using data from a large-scale population-based questionnaire study, we investigated individuals with physician-diagnosed (n = 66) and self-reported (n = 313) hyperacusis in comparison to individuals without hyperacusis (n = 2995). High age, female sex, and high education were associated with hyperacusis, and that trying to avoid sound sources, being able to affect the sound environment, and having sough medical attention were common reactions and behaviors. Posttraumatic stress disorder, chronic fatigue syndrome, generalized anxiety disorder, depression, exhaustion, fibromyalgia, irritable bowel syndrome, migraine, hearing impairment, tinnitus, and back/joint/muscle disorders were comorbid with hyperacusis. The results provide ground for future study of these characteristic features being risk factors for development of hyperacusis and/or consequences of hyperacusis.

Background Anxiety and depression are amongst the most prevalent mental health problems. Their pattern of comorbidity may inform about their etiology and effective treatment, but such research is sparse. Here, we document long-term prognosis of affective caseness (high probability of being a clinical case) of anxiety and depression, their comorbidity, and a no-caseness condition at three time-points across six years, and identify the most common prognoses of these four conditions. Methods Longitudinal population-based data were collected from 1,837 participants in 2010, 2013 and 2016. Based on the Hospital Anxiety and Depression Scale they formed the four groups of anxiety, depression and comorbidity caseness, and no caseness at baseline. Results The three-year associations show that it was most common to recover when being an anxiety, depression or comorbidity caseness (36.8 − 59.4%), and when not being a caseness to remain so (89.2%). It was also rather common to remain in the same caseness condition after three years (18.7 − 39.1%). In comorbidity it was more likely to recover from depression (21.1%) than from anxiety (5.4%), and being no caseness it was more likely to develop anxiety (5.9%) than depression (1.7%). The most common six-year prognoses were recovering from the affective caseness conditions at 3-year follow-up (YFU), and remain recovered at 6-YFU, and as no caseness to remain so across the six years. The second most common prognoses in the affective conditions were to remain as caseness at both 3-YFU and 6-YFU, and in no caseness to remain so at 3-YFU, but develop anxiety at 6-YFU. Conclusions The results suggest that only 37 − 60% of individuals in the general population with high probability of being a clinical case with anxiety, depression, and their comorbidity will recover within a three-year period, and that it is rather common to remain with these affective conditions after 6 years. These poor prognoses, for comorbidity in particular, highlight the need for intensified alertness of their prevalence and enabling treatment in the general population.

Parosmia, distorted smell sensations, is a common consequence of respiratory virus infections. The phenomenon is not well understood in terms of its impact and long-term outcomes. We examined self-reported experiences of parosmia in a population-based sample from the Betula study that was conducted in Umeå in northern Sweden (baseline data collected in 1998–2000). We used a baseline sample of 2168 individuals aged 35–90 years and with no cognitive impairment at baseline. We investigated the prevalence of parosmia experiences and, using regression analyses, its relationship to other olfactory and cognitive variables and quality of life. Benefitting from the longitudinal study design, we also assessed the persistence of parosmia over 5 and 10 years prospectively. Parosmia experiences were prevalent in 4.8% of the population and it often co-occurred with phantosmia (“olfactory hallucinations”), but was not associated with lower self-rated overall quality of life or poor performance on olfactory or cognitive tests. For some individuals, parosmia was retained 5 years (17.0%) or even 10 years later (10.3%). Thus, parosmia experiences are commonly reported in the population, and can be persistent for some individuals, but might be mostly benign in nature. Our work complements research on clinical-level parosmia, which is typically more severe, and recent parosmia reports during the COVID-19 pandemic, where long-term outcomes are still unknown.

Objectives Health effects associated with air pollution at exposure levels below toxicity may not be directly related to level of exposure, but rather mediated by perception of the air pollution and by top-down processing (e.g., beliefs that the exposure is hazardous). The aim of the study was to test a model that describes interrelations between odorous air pollution at non-toxic exposure levels, perceived pollution, health risk perception, annoyance and health symptoms. Methods A population-based questionnaire study was conducted in a Swedish community of residents living near a biofuel facility that emitted odorous substances. Individuals aged 18–75 years were selected at random for participation ( n  = 1,118); 722 (65 %) agreed to participate. Path analyses were performed to test the validity of the model. Results The data support a model proposing that exposure level does not directly influence annoyance and symptoms, and that these relations instead are mediated by perceived pollution and health risk perception. Conclusions Perceived pollution and health risk perception play important roles in understanding and predicting environmentally induced annoyance and health symptoms in odorous environments at non-toxic levels of exposure.

Coping strategies, perceived environmental exposure control and mental distress appear to be important concepts in persons with symptoms associated with environmental factors (SAEF), but their interplay is not well documented. The objective was to investigate (i) use of coping strategies, (ii) prevalence of perceived exposure control, (iii) whether the control is associated with mental distress and SAEF type, and (iv) whether coping strategies are associated with mental distress in SAEF regarding chemicals (SAEF-C), buildings (SAEF-B), electromagnetic fields (SAEF-EMF) and sounds (SAEF-S) in a general population. Cross-sectional population-based data (n = 391) and validated questionnaire instruments were used to assess symptoms of anxiety, depression, burnout and sleep disturbance, applying analysis of covariance and hierarchical regression analysis. The most used problem- and emotion-focused coping strategies were avoiding environments and accepting the situation, respectively. A majority of those with SAEF-C (71.7%), SAEFF-EMF (75.9%) and SAEF-S (64.1%), but not SAEF-B (36.4%) were able to control the adverse exposure, and low level of control was associated with anxiety, depression, burnout and sleep disturbance in all four SAEF types. Use of the strategies avoidance and eating/drinking/smoking were associated with depression, and reprioritizing with burnout. An implication of the results is that suitable coping strategies and perceived control may be considered as part of treatment of SAEF.

Olfaction, the sense of smell, is characterized by a notable age-dependency such that aging individuals are more likely to have poor olfactory abilities. These impairments are considered to be mostly irreversible and as having potentially profound effects on quality of life and food behavior, as well as constituting warning signs of mortality, cognitive dysfunction, and dementia. Here, we review the current state of research on aging and olfaction, focusing on five topics which we regard to be of particular relevance for the field: nutrition and health, cognition and dementia, mortality, environment and genetics, and training-based enhancement. Under each of these headlines, we provide a state-of-the-art overview and discuss gaps in our knowledge which might be filled by further research. Understanding how olfactory abilities are diminished in aging, and how they may be alleviated or recovered, involves a set of challenging tasks for researchers in the years to come.

Multiple chemical sensitivity (MCS) is characterized by widespread symptoms attributed to exposure to airborne chemicals. MCS is categorized as a functional somatic syndrome (FSS), and MCS cases often meet the criteria for other types of FSS, e.g. fibromyalgia. The primary aim was to characterize MCS regarding symptom triggers, symptoms, lifestyle and describe demographics, socioeconomics and lifestyle factors associated with MCS. A secondary aim was to examine the implication of FSS comorbidity. Data were derived from a random sample of the Danish adult population enrolled in the Danish Study of Functional Disorders (DanFunD; n = 9,656). Questionnaire data comprised information used to delimit MCS and four additional types of FSS, as well as data on demographics, socioeconomics and lifestyle. MCS cases (n = 188) was stratified into subgroups; MCS only (n = 109) and MCS with comorbid FSS (n = 73). Information regarding FSS comorbidities were missing for six MCS cases. MCS subgroups and controls without FSS comorbidities (n = 7,791) were compared by means of logistic regression analyses, adjusted for age and sex. MCS was associated with female sex, not being in occupation and low social status, but not with age or education. MCS cases reported normal dietary intake and smoking habits and lower alcohol consumption. Additional associations were found between MCS and low rate of cohabitation, sedentarism, daily physically limitations, and poor quality of sleep. However, subgroup analysis revealed that these findings were primarily associated with MCS with comorbid FSS. MCS was associated with lower socioeconomic status, physically inactivity and poor quality of sleep. Subgroup analysis revealed that several associations was explained by FSS comorbidity, i.e. MCS cases with no comorbid FSS showed normal rate of cohabitation and did not report physical limitations or difficulties sleeping. Overall, our findings emphasise the importance of screening MCS cases for FSS comorbidity both in epidemiological and clinical settings.

We examined whether conversion to dementia can be predicted by self-reported olfactory impairment and/or by an inability to identify odors. Common forms of dementia involve an impaired sense of smell, and poor olfactory performance predicts cognitive decline among the elderly. We followed a sample of 1529 participants, who were within a normal range of overall cognitive function at baseline, over a 10-year period during which 159 were classified as having a dementia disorder. Dementia conversion was predicted from demographic variables, Mini-Mental State Examination score, and olfactory assessments. Self-reported olfactory impairment emerged as an independent predictor of dementia. After adjusting for effects of other predictors, individuals who rated their olfactory sensitivity as “worse than normal” were more likely to convert to dementia than those who reported normal olfactory sensitivity (odds ratio [OR] = 2.17; 95% confidence interval [CI] [1.40, 3.37]). Additionally, low scores on an odor identification test also predicted conversion to dementia (OR per 1 point increase = 0.89; 95% CI [0.81, 0.98]), but these two effects were additive. We suggest that assessing subjective olfactory complaints might supplement other assessments when evaluating the risk of conversion to dementia. Future studies should investigate which combination of olfactory assessments is most useful in predicting dementia conversion. (JINS, 2014, 20, 1–9)