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From the Department of Psychology, Division of Applied Psychology, University of Helsinki, Helsinki, Finland (M.K.); Finnish Institute of Occupational Health, Helsinki (M.K.) and Turku, Finland (J.V.); Department of Social Research, National Research and Development Center for Welfare and Health, Helsinki, Finland (M.E.); and Department of Public Health, University of Turku, and Turku University Central Hospital, Turku (B.L., M.V.K.), Finland.
Address reprint requests to: Mika Kivimäki, Department of Psychology, Division of Applied Psychology, P.O. Box 13, 00014 University of Helsinki, Finland. Email: mika.kivimaki{at}occuphealth.fi
OBJECTIVE: Although an association between stressful life events and health problems has been demonstrated, the underlying mechanisms have remained unclear. We examined whether psychological problems and health-risk behaviors underpin the health effects of different event categories.
METHOD: The initially healthy participants were 2991 (796 men, 2195 women) municipal employees who had taken no sick leave in 1995. In 1997, they completed a questionnaire requesting information on recent life events and psychological and behavioral factors. The outcome was recorded sickness absences in 1998.
RESULTS: In men, the death or serious illness of a family member, violence, and financial difficulties increased the risk of later sickness absence. According to structural equation modeling, violence and financial difficulties also induced psychological problems such as anxiety, mental distress, and lowered sense of coherence. Psychological problems were associated with heightened cigarette and alcohol consumption, which in turn increased sickness absence. A corresponding structural model did not fit the data in relation to death or serious illness of a family member. In women, life events were associated with psychological problems and smoking but not sickness absence.
CONCLUSIONS: Longitudinal evidence suggests that increased psychological problems and behaviors involving risk to health partially mediate the effect of stressful life events on health, as indicated by sickness absence. This model received support among men and for the event categories of violence and financial difficulties. Women were less affected by stressful life events than men.
Key Words: life event, • health, • health-risk behaviors, • anxiety, • mental distress, • sense of coherence.
Abbreviations: GFI = goodness-of-fit index;; SRMR = standardized root mean squared residual.
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