Life Course Pathways of Adversities Linking Adolescent Socioeconomic Circumstances and Functional Somatic Symptoms in Mid-Adulthood: A Path Analysis Study.

Frida Jonsson,Miguel San Sebastian,Lotta M J Strömsten,Per E Gustafsson,Anne Hammarström,Hajo Zeeb

doi:10.1371/journal.pone.0155963

Abstract

While research examining the health impact of early socioeconomic conditions suggests that effects may exist independently of or jointly with adult socioeconomic position, studies exploring other potential pathways are few. Following a chain of risk life course model, this prospective study seeks to examine whether pathways of occupational class as well as material and social adversities across the life course link socioeconomic disadvantage in adolescent to functional somatic symptoms in mid-adulthood. Applying path analysis, a multiple mediator model was assessed using prospective data collected during 26 years through the Northern Swedish Cohort. The sample contained 987 individuals residing in the municipality of Luleå, Sweden, who participated in questionnaire surveys at age 16, 21, 30 and 42. Socioeconomic conditions (high/low) in adolescence (age 16) were operationalized using the occupation of the parents, while occupational class in adulthood (manual/non-manual) was measured using the participant’s own occupation at age 21 and 30. The adversity measurements were constructed as separate age specific parcels at age 21 and 30. Social adversity included items pertaining to stressful life events that could potentially harm salient relationships, while material adversity was operationalized using items concerning unfavorable financial and material circumstances. Functional somatic symptoms at age 42 was a summary measure of self-reported physical symptoms, palpitation and sleeping difficulties that had occurred during the last 12 months. An association between socioeconomic conditions at age 16 and functional somatic symptoms at age 42 (r = 0.068) which was partially explained by people’s own occupational class at age 21 and then material as well as social adversity at age 30 was revealed. Rather than proposing a direct and independent health effect of the socioeconomic conditions of the family, the present study suggests that growing up in an unfavorable socioeconomic environment might be a source for a chain of adverse material and social living situations, which in turn affects adult health.

Highlights

A person’s current occupational class, education or income, and the socioeconomic circumstances they encountered prior in life have been found to be important for selfrated health in adulthood [1,2,3]
In accordance with a social chain of risk life course model, hypothesizing that adulthood health might be affected by a continuity of unfavorable life circumstances [4], this prospective study seeks examine if pathways of occupational class as well as material and social adversities across the life course linked socioeconomic disadvantage in adolescence to functional somatic symptoms in mid-adulthood
In light of studies suggesting that people who are exposed to such adverse life events tend to experience more stress-related health problems [40], we propose that these circumstances might be what connects class with functional somatic symptoms

Summary

Introduction

A person’s current occupational class, education or income, and the socioeconomic circumstances they encountered prior in life have been found to be important for selfrated health in adulthood [1,2,3]. In accordance with a social chain of risk life course model, hypothesizing that adulthood health might be affected by a continuity of unfavorable life circumstances [4], this prospective study seeks examine if pathways of occupational class as well as material and social adversities across the life course linked socioeconomic disadvantage in adolescence to functional somatic symptoms in mid-adulthood. By examining the independent effects of various determinants across life in relation to poorer selfrated health [21] and with regard the risk of heart attack in later life [22], additional pathways have been proposed Studies of this kind do not consider the temporal relation among the exposures, and they provide limited insight to whether such pathways may constitute a potential chain of risk

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