The emergence and preservation of sick building syndrome : research challenges of a modern age disease

Since the 1970ies, the sick building syndrome (SBS) has become a common health problem. It is usually defined as a state of ill health consisting of subjective symptoms from mucous membranes and skin, as well as of' general symptoms such as e.g. fatigue and headache. At the same time, demonstrable pathological alterations should be absent. Its occurrence is associated to a wide variety of factors related to the building, its indoor environment, work and work organisation, as well as to personal, individual characteristics of its inhabitants. The accumulated scientific knowledge on SBS is, however, vague and general, and the aim of this thesis is to contribute to the understanding of the development and maintenance of the syndrome.

Applying a multi-case study design, the thesis consists of six cases. Four focus on the buildings inclusive of their populations, while the remaining two put their centre on individuals. Information was retrieved from a wide range of historical documents. Data were also collected by questionnaire -based surveys as well as by semi-structured, openended interviews. The case buildings had varying histories of proven or hypothesised water damage, ventilation defects and chemical emissions. Such conditions might, have initiated the building-related health problems, which in turn seemed to generate protracted and complicated processes. These involved conflicting agendas between different, parties within the buildings, and between the buildings and the surrounding society. This, together with structural conditions, such as e.g. economic and gender perspectives, seemed to influence the long-term outcome of SBS. Therefore, it was suggested that evolving sick building syndromes should be approached and analysed using integrated bio-psycho-social models. This seemed particularly important from an intervention aspect as there were indications that symptoms might persist in spite of' rational corrective measures, taken from strictly bio-medical perspectives.

The thesis examined the concept of SBS and compared it with other building-related diagnoses. As a diagnostic concept, the construction of the SBS definition was shown to be inadequate. In spite of that, it was found to be used in legal contexts. This conveyed the ambiguous notion of a formal, individual diagnosis, which could have a normative and prescriptive force, which was one reason, why it was suggested that, the term SBS should be abandoned. Finally, methodological research aspects were examined. It was concluded that qualitative methods are well suited in the study of environmentally related, non-specific syndromes such as SBS.

List of scientific papers

I. Thörn Å. (1994). Case report on a sick building: analysis and interpretation in the context of its disease history. Scand J Soc Med. 22(3):228-34.
https://pubmed.ncbi.nlm.nih.gov/7846483

II. Thörn Å. Case study of a sick building: could an integrated bio-psycho-social perspective prevent chronicity? Eur J Public Health. [Accepted]

III. Thörn Å. The emergence and preservation of a chronically sick building. [Submitted]

IV. Thörn Å. (1998). Building-related health problems: reflections on different symptom prevalence among pupils and teachers. Int J Circumpolar Health. 57(4):249-56.
https://pubmed.ncbi.nlm.nih.gov/9857581

V. Thörn Å. (1998). The sick building syndrome: a diagnostic dilemma. Soc Sci Med. 47(9):1307-12.
https://pubmed.ncbi.nlm.nih.gov/9783873

VI. Thörn Å, Lewné M, Belin L. (1996). Allergic alveolitis in a school environment. Scand J Work Environ Health. 22(4): 311-4
https://pubmed.ncbi.nlm.nih.gov/8881020