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Preface When I First Started Working on This Thesis I Was Based in Norway

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Preface When I First Started Working on This Thesis I Was Based in Norway Preface When I first started working on this thesis I was based in Norway. But after a while I recognised that this kind of work sometimes requires the skill of hanging on in quiet desperation1, so therefore it was more natural to continue the work overseas – it is after all the English way2. After a lot of rewriting, recoding and redoing I have finally reached my goal. However sometimes the journey towards the goal is more important and I feel I have learned a lot about geography, health research, statistics, GIS and most of all myself during this last year. And for that I need to thank my supervisors Stig Jørgensen and Andy Jones for professional support and feedback. I also need to thank Caroline Mevik and Andreea Cetateanu for controlled procrastinating between the sessions of perspiration. “Every now and then go away, have a little relaxation, for when you come back to your work your judgment will be surer. Go some distance away because then the work appears smaller and more of it can be taken in at a glance and a lack of harmony and proportion is more readily seen” - Leonardo Da Vinci. And thanks to my brother for statistical aid and my father for re-drawing a bad scan of Meade and Earicksons “Trinangle of Ecology”. Trondheim 27. April 2012 Anja Fleten Nielsen Acknowledgements The data used in this study is kindly made available by “Helseundersøkelsen i Nord- Trøndelag” (HUNT). HUNT is not responsible for the analysis and interpretations made in this research. REK (Regional Etisk Komité) have approved the data for research purposes. All data was received anonymously. 1 “Time” - Pink Floyd 2 “Time” - Pink Floyd i Table of contents Preface ...................................................................................................................................................... i Abstract .................................................................................................................................................... v 1.0 Introduction ....................................................................................................................................... 1 1.1 Choice of topic and importance of the study ................................................................................ 1 1.2 About the data material ................................................................................................................ 3 1.3 Research questions........................................................................................................................ 3 1.4 Organization of the thesis ............................................................................................................. 4 2.0. Theory ............................................................................................................................................... 5 2.1 Health and disease ........................................................................................................................ 5 2.1.2 Health as wellbeing .............................................................................................................. 10 2.1.3 Health as ability .................................................................................................................... 10 2.2 Mental health and depression .................................................................................................... 11 2.3 Triangle of Human Ecology .......................................................................................................... 13 2.3.1 Population Factors ................................................................................................................ 14 2.3.2 Environmental Factors ......................................................................................................... 15 2.3.3 Behavioural Factors .............................................................................................................. 22 2.4. Health and the importance of location ...................................................................................... 25 2.4.1. Place .................................................................................................................................... 25 2.4.2. Context or Composition? ..................................................................................................... 26 3.0 Method ............................................................................................................................................ 30 3.1 About the study ........................................................................................................................... 30 3.1.1 Individual data from HUNT 3 ................................................................................................ 30 3.1.2 Area based data from Statistics Norway (SSB) ..................................................................... 33 3.1.3 Climatic data from Metorologisk Institutt ............................................................................ 33 3.1.4 Using Secondary Data ........................................................................................................... 34 3.2 Validity, reliability and representativeness ................................................................................. 34 3.2.1 Validity .................................................................................................................................. 34 3.2.2 Reliability .............................................................................................................................. 35 3.2.3 Representativeness .............................................................................................................. 35 ii 3.3 Operationalization of variables ................................................................................................... 36 3.3.1 Outcome variable ................................................................................................................. 36 3.3.2 Demographic classifications ................................................................................................. 40 3.3.3 Area factors .......................................................................................................................... 42 3.3.4 Risk and protective factors ................................................................................................... 43 3.3.5 Risk and protective factors related to work environment ................................................... 48 3.4 Statistical methods ...................................................................................................................... 50 3.4.1 Significance ........................................................................................................................... 50 3.4.2 Cross tabulation and chi square ........................................................................................... 50 3.4.3 T-test ..................................................................................................................................... 50 3.4.4 Logistic Regression ............................................................................................................... 51 3.5 Mapping using GIS ....................................................................................................................... 53 3.6 Methodological problems ........................................................................................................... 54 3.6.1 Ecological, atomistic and psychologistic fallacy ................................................................... 54 3.6.2 Latency period ...................................................................................................................... 55 3.6.3 Migration as a confounding variable .................................................................................... 55 3.6.4 Ethical considerations........................................................................................................... 56 4.0 Study area and geographical distribution of area factors ............................................................... 57 4.1 Population and settlement .......................................................................................................... 59 4.2 Climate ......................................................................................................................................... 63 4.3 Education ..................................................................................................................................... 65 4.4 Depression and participation percentages ................................................................................. 66 5.0 Results ............................................................................................................................................. 69 5.1 Descriptives stratified by gender ................................................................................................. 69 5.2 Descriptives stratified by urbanity .............................................................................................. 71 5.3 Unadjusted associations .............................................................................................................. 73 5.3.1 Population factors ................................................................................................................ 73 5.3.2 Behavioural factors ..............................................................................................................
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