title: The impact of economic recession on the association between youth unemployment and functional somatic symptoms in adulthood: a difference-in-difference analysis from Sweden.
abstract: BACKGROUND
  The impact of macroeconomic conditions on health has been extensively explored, as well as the relationship between individual unemployment and health. There are, however, few studies taking both aspects into account and even fewer studies looking at the relationship in a life course perspective. In this study the aim was to assess the role of macroeconomic conditions, such as national unemployment level, for the long-term relationship between individual unemployment and functional somatic symptoms (FSS), by analysing data from two longitudinal cohorts representing different periods of unemployment level in Sweden.
  
  
  METHODS
  A difference-in-difference (DiD) analysis was applied, looking at the difference over time between recession and pre-recession periods for unemployed youths (age 21 to 25) on FSS in adulthood. FSS was constructed as an index of ten self-reported items of somatic ill-health. Covariates for socioeconomics, previous health status and social environment were included.
  
  
  RESULTS
  An association was found in the difference of adult FSS between unemployed and employed youths in the pre-recession and recession periods, remaining in the adjusted model for the pre-recession period. The DiD analysis between unemployed youths showed that men had significantly lower adult FSS during the recession compared to men in the pre-recession time.
  
  
  CONCLUSIONS
  Adulthood FSS showed to be significantly lower among unemployed youths, in particular among men, during recession compared to pre-recession times. Since this is a fairly unexplored research field, more research is needed to explore the role of macroeconomic conditions for various health outcomes, long-term implications and gender differences.
authors.affiliation: Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden. anna.brydsten@umu.se.
authors.forename: Anna
authors.initials: A
authors.lastname: Brydsten
authors.affiliation: Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden. anne.hammarstrom@umu.se.
authors.forename: Anne
authors.initials: A
authors.lastname: Hammarström
authors.affiliation: Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden. miguel.san.sebastian@umu.se.
authors.forename: Miguel
authors.initials: M
authors.lastname: San Sebastian
mesh_terms: D000328:Adult; D015331:Cohort Studies; D057172:Economic Recession; D005260:Female; D006801:Humans; D008297:Male; D013001:Somatoform Disorders / Q000453:epidemiology*; D013548:Sweden / Q000453:epidemiology; D014478:Unemployment / Q000706:statistics & numerical data*; D055815:Young Adult