BACKGROUND:Little is known about whether and how the timing and duration of work-family experiences are associated with subsequent mental health outcomes in the current generation of young adults. Such information may inform the development of timely interventions to promote better mental health. In this study, we use two complementary approaches to examine the complex relationship between work, family and mental health in young Dutch adults born around 1990. First, we examine the association between work-family trajectories and mental health. Second, we examine which timing and duration features of work-family trajectories are related to subsequent mental health. METHODS:Sequences of monthly work-family states from ages 18 to 28 years were constructed in a sample of Dutch young adults participating in the TRAILS cohort study (N = 992). Mental health was operationalised as experiencing internalising or externalising problems at age 29. We created a typology of work-family trajectories by clustering individual sequences and used regression analysis to examine the association between work-family trajectories and mental health. Next, we used the Boruta feature selection algorithm to identify timing and duration features of work-family trajectories related to mental health at age 29 and conducted a regression analysis to examine the associations between the identified features and mental health. All regression analyses were controlled for mental health problems between ages 11 and 16. RESULTS:Women in the work-family trajectories long education and inactive were most likely to experience internalising problems at age 29. Women in the work-family trajectory inactive were also most likely to experience externalising problems. In line, the feature selection analysis showed that both being inactive and being in education in the first stage of young adulthood, being a parent and in work in the last stage of young adulthood and the total duration of inactivity were associated with internalising problems. Being inactive in the first and the last stages of young adulthood and being inactive and a parent in the third stage of young adulthood were associated with externalising problems. Men in the work-family trajectory inactive were most likely to experience both internalising and externalising problems. Additionally, men in the work-family trajectory continuous education and work were most likely to report externalising problems. The feature selection analysis showed that being in education in the last stage of young adulthood was associated with internalising problems. Similar to women, inactivity in the first stage of young adulthood was associated with internalising and externalising problems at age 29. CONCLUSION:Work-family trajectories in young adulthood are associated with mental health problems at age 29, even when controlling for early-life mental health problems. In particular, the timing and duration of inactivity and education were found to be associated with subsequent mental health problems. Combining sequence analysis and feature selection provides a more nuanced understanding of the dynamics between work-family experiences and mental health.

Purpose Work-family life courses have been associated with mental health at various time points in life but little is known about how mental health develops during these work-family life courses. The aim of this study was to examine mental health trajectories from adolescence to young adulthood in women and men with different work-family life courses. Methods Data from 992 young adults participating in the 18-year follow-up TRacking Adolescents' Individual Lives Survey (TRAILS) were used. Work-family life courses from ages 18 to 28 years were previously constructed using sequence analysis. For each work-family life course, trajectories of internalising and externalising problems from ages 11 to 29 years were estimated using a multi-group random intercept growth model. Differences in mental health trajectories were examined across work-family life courses. Results For women, trajectories of internalising and externalising problems in young adulthood differed significantly between work-family life courses (p = 0.037 and p < 0.001, respectively). Women in the inactive work-family life course reported the highest scores of internalising and externalising problems during the entire young adulthood but the differences in mental health scores became most pronounced at age 29. Trajectories of internalising and externalising problems of men did not significantly differ between the work-family life courses. Conclusion Mental health trajectories differed between women depending on their work-family life course. In men, differences between work-family life courses were less pronounced. Future studies should examine which work-family events and transitions captured in work-family life courses are associated with subsequent mental health problems during longer follow-up.

Background: Work and family lives interact in complex ways across individuals' life courses. In the past decade, many studies constructed work-family trajectories, some also examined the relation with health. The aims of this systematic review were to summarise the evidence from studies constructing work-family trajectories, and to synthesise the evidence on the association between work-family trajectories and health. Methods: We searched MEDLINE, EMBASE, PsycINFO, SocINDEX and Web of Science databases. Key search terms related to work, family and trajectories. Studies that built combined work-family trajectories or examined the relationship between work and family trajectories were included. Risk of bias was assessed independently by two authors. The identified work-family trajectories were summarised and presented for men and women, age cohorts and contexts. The evidence on the association with health as antecedent or consequence was synthesised. Results: Forty-eight studies, based on 29 unique data sources, were included. Thirty-two studies (67%) were published in 2015 or later, and sequence analysis was the primary analytic technique used to construct the trajectories (n = 43, 90%). Trajectories of women were found to be more diverse and complex in comparison with men. Work-family trajectories differed by age cohorts and contexts. Twenty-three studies (48%) examined the association between work-family trajectories and health and most of these studies found significant associations. The results indicate that work-family trajectories characterised by an early transition to parenthood, single parenthood, and weak ties to employment are associated with worse health outcomes. Conclusions: Work-family trajectories differed greatly between men and women, but differences seemed to decrease in the youngest cohorts. Given the current changes in labour markets and family formation processes, it is important to investigate the work and family lives of younger cohorts. Work-family trajectories were associated with health at different life stages. Future research should examine longitudinal associations of work-family trajectories with health and focus on elucidating why and under which circumstances some trajectories are associated with better or worse health compared with other trajectories.

During young adulthood, several transitions in work and family lives occur, but knowledge of the work-family trajectories of the current generation of young adults, i.e. people born in the 1990s, is lacking. Moreover, lit-tle is known about whether the mental health status before the start of the working life may shape work-family trajectories. We used 18-year follow-up data from the TRAILS cohort study of individuals born between 1989 and 1991 (n = 992; 63.2% women). Internalising and externalising problems were measured with the Youth Self -Report at ages 11, 13 and 16 years. Monthly employment, education and parenthood states were recorded be-tween 18 and 28 years. Applying sequence analysis, we identified six work-family trajectories in women and men. The first five trajectories were labelled: long education, continuous education and work, education and work to work, early work, and inactive. The main difference between trajectories of women and men was in the timing of parenthood, thus the remaining trajectory of women was labelled active with children, and the remaining tra-jectory of men active. Women who experienced externalising problems in adolescence were more likely to belong to the trajectory characterised by parenthood. Men who experienced internalising problems in adolescence were more likely to belong to the trajectory characterised by a long time spent in education. The TRAILS data allowed us to consider timing, duration and ordering of the work and family states in young adulthood, and to use multiple assessments of mental health in adolescence. Further research needs to examine the mechanisms through which early mental health affects later work and family outcomes.

Background We aimed to determine the prevalence and gap in use of mental health services for late-life depression in four European regions (Western Europe, Scandinavia, Southern Europe and Central and Eastern Europe) and explore socio-demographic, social and health-related factors associated with it. Methods We conducted a cross-sectional study based on data from the Survey on Health, Ageing and Retirement in Europe. Participants were a population-based sample of 28 796 persons (53% women, mean age 74 years old) residing in Europe. Mental health service use was estimated using information about the diagnosis or treatment for depression. Results The prevalence of late-life depression was 29% in the whole sample and was highest in Southern Europe (35%), followed by Central and Eastern Europe (32%), Western Europe (26%) and lowest in Scandinavia (17%). Factors that had the strongest association with depression were total number of chronic diseases, pain, limitations in instrumental activities of daily living, grip strength and cognitive impairment. The gap in mental health service use was 79%. Conclusions We suggest that interventions to decrease the burden of late-life depression should be targeted at individuals that are affected by chronic somatic comorbidities and are limited in mental and physical functioning. Promotion of help-seeking of older adults, de-stigmatization of mental illness and education of general practitioners could help decrease the gap in mental health service utilization.

Abstract Studies from North America and Western Europe suggest stable or declining trends in impaired cognition. Nevertheless, data on changes in cognitive health from Central and Eastern Europe are largely lacking. Therefore, we aimed to examine changes in the age-specific prevalence of cognitive impairment in the Czech Republic, a country in Central Europe. To this aim we used two samples from the population-based Czech Survey on Health, Ageing and Retirement in Europe (SHARE). Age-specific prevalence of cognitive impairment (defined based on scores in verbal fluency, immediate recall, delayed recall and temporal orientation) was compared between participants in wave 2 (2006/2007; n=1,107) and wave 6 (2015; n=3,104). Logistic regression was used to estimate the association between wave and cognitive impairment, step-wise adjusting for sociodemographic and clinical characteristics. Multiple sensitivity analyses, focusing on alternative operationalisations of relative cognitive impairment, impact of missing cognitive data and survival bias, were carried out. The most conservative estimate suggested that the age-specific prevalence of cognitive impairment declined by one fifth, from 11% in 2006/2007 to 9% in 2015. Decline was observed in all sensitivity analyses. Multivariate decomposition for nonlinear models was used to examine which predictors explain the change in prevalence. Reduction in physical inactivity, control of high blood cholesterol and increases in length of education were the main predictors contributing to decline in cognitive impairment. In conclusion, our findings are in line with those found in North America and Western Europe even though countries in Central and Eastern Europe, including Czech Republic, have poorer risk profiles.

Background:Studies from North America and Western Europe suggest stable or declining trends in impaired cognition across birth cohorts. Objective:We aimed to examine changes in the age-specific prevalence of cognitive impairment in the Czech Republic. Methods:The study used two samples from the pop ulation-based Czech Survey on Health, Ageing and Retirement in Europe. Age-specific prevalence of cognitive impairment (defined based on scores in verbal fluency, immediate recall, delayed recall, and temporal orientation) was compared between participants in wave 2 (2006/2007; n = 1,107) and wave 6 (2015; n = 3,104). Logistic regression was used to estimate the association between the wave and cognitive impairment, step-wise adjusting for sociodemographic and clinical characteristics. Multiple sensitivity analyses, focusing on alternative operationalizations of relative cognitive impairment, impact of missing cognitive data, and survival bias, were carried out. Results:The most conservative estimate suggested that the age-specific prevalence of cognitive impairment declined by one fifth, from 11% in 2006/2007 to 9% in 2015. Decline was observed in all sensitivity analyses. The change was associated with differences in physical inactivity, management of high blood cholesterol, and increases in length education. Conclusion:Older adults in the Czech Republic, a country situated in the Central and Eastern European region, have achieved positive developments in cognitive aging. Longer education, better management of cardiovascular factors, and reduced physical inactivity seem to be of key importance.

Just over 25 years have passed since the major sociopolitical changes in central and eastern Europe; our aim was to map and analyse the development of mental health-care practice for people with severe mental illnesses in this region since then. A scoping review was complemented by an expert survey in 24 countries. Mental health-care practice in the region differs greatly across as well as within individual countries. National policies often exist but reforms remain mostly in the realm of aspiration. Services are predominantly based in psychiatric hospitals. Decision making on resource allocation is not transparent, and full economic evaluations of complex interventions and rigorous epidemiological studies are lacking. Stigma seems to be higher than in other European countries, but consideration of human rights and user involvement are increasing. The region has seen respectable development, which happened because of grassroots initiatives supported by international organisations, rather than by systematic implementation of government policies.