Material standard of living, social class, and the prevalence of the common mental disorders in Great Britain

Prevalence of depressive symptoms and associated factors in Brazilian older adults: 2019 Brazilian National Health Survey

This study aimed to describe the prevalence of depressive symptoms and associated factors among older adults. A cross-sectional population-based study using data from the 2019 Brazilian National Health Survey was carried out. The prevalence of depressive symptoms was determined using the 9-item Patient Health Questionnaire (PHQ-9), and associations were tested according to sociodemographic, health and behavioral variables. Crude and adjusted prevalence ratios (PR) with 95% confidence intervals (95%CI) were calculated using Poisson's regression. The overall prevalence of depressive symptoms was 10.7% (95%CI: 9.9; 11.5). Higher PHQ-9 scores were associated with female gender (PR = 2.11, 95%CI: 1.82; 2.44), lack of participation in religious activities (PR = 1.20, 95%CI: 1.07; 1.35), nonsmoking status (PR = 1.55, 95%CI: 1.32; 1.83), poor or very poor self-perceived health (PR = 7.55, 95%CI: 5.82; 9.80), and multimorbidity (PR = 2.26, 95%CI: 1.85; 2.75). Higher education (PR = 0.55, 95%CI: 0.42; 0.73), income (PR = 0.68, 95%CI: 0.54; 0.85), and physical activity (PR = 0.72, 95%CI: 0.57; 0.90) were found to be negatively associated with the outcome. The most prevalent depressive symptoms were: sleeping problems (24.8%, 95%CI: 23.8; 25.8), not feeling rested or willing/feeling without energy (14.5%, 95%CI: 13.7; 15.4), and being depressed/down/without perspective (10.5%, 95%CI: 9.7; 11.2). These findings highlight the importance of prioritizing the identification and treatment of depressive symptoms in older Brazilian populations, particularly given that one in ten older Brazilians experience depressive symptoms.

Extending intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to study individual longitudinal trajectories, with application to mental health in the UK

The intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) approach is gaining prominence in health sciences and beyond, as a robust quantitative method for identifying intersectional inequalities in a range of individual outcomes. However, it has so far not been applied to longitudinal data, despite the availability of such data, and growing recognition that intersectional social processes and determinants are not static, unchanging phenomena. Drawing on intersectionality and life course theories, we develop a longitudinal version of the intersectional MAIHDA approach, allowing the analysis not just of intersectional inequalities in static individual differences, but also of life course trajectories. We discuss the conceptualization of intersectional groups in this context: how they are changeable over the life course, appropriate treatment of generational differences, and relevance of the age-period-cohort identification problem. We illustrate the approach with a study of mental health using United Kingdom Household Longitudinal Study data (2009-2021). The results reveal important differences in trajectories between generations and intersectional strata, and show that trajectories are partly multiplicative but mostly additive in their intersectional inequalities. This article provides an important and much needed methodological contribution, enabling rigorous quantitative, longitudinal, intersectional analyses in social epidemiology and beyond.

Risk factors and digital interventions for anxiety disorders in college students: Stakeholder perspectives

The worldwide prevalence of anxiety disorders among college students is high, which negatively affects countries, schools, families, and individual students to varying degrees. This paper reviews the relevant literature regarding risk factors and digital interventions for anxiety disorders among college students from the perspectives of different stakeholders. Risk factors at the national and societal levels include class differences and the coronavirus disease 2019 pandemic. College-level risk factors include the indoor environment design of the college environment, peer relationships, student satisfaction with college culture, and school functional levels. Family-level risk factors include parenting style, family relationship, and parental level of education. Individual-level risk factors include biological factors, lifestyle, and personality. Among the intervention options for college students' anxiety disorders, in addition to traditional cognitive behavioral therapy, mindfulness-based interventions, psychological counseling, and group counseling, digital mental health interventions are increasingly popular due to their low cost, positive effect, and convenient diagnostics and treatment. To better apply digital intervention to the prevention and treatment of college students' anxiety, this paper suggests that the different stakeholders form a synergy among themselves. The nation and society should provide necessary policy guarantees, financial support, and moral and ethical supervision for the prevention and treatment of college students' anxiety disorders. Colleges should actively participate in the screening and intervention of college students' anxiety disorders. Families should increase their awareness of college students' anxiety disorders and take the initiative to study and understand various digital intervention methods. College students with anxiety disorders should actively seek psychological assistance and actively accept and participate in digital intervention projects and services. We believe that in the future, the application of methods such as big data and artificial intelligence to improve digital interventions and provide individualized treatment plans will become the primary means of preventing and treating anxiety disorders among college students.

Surviving in Crisis Mode: The Effect of Material Hardship and Social Support on Emotional Wellbeing Among People in Poverty During COVID-19

The COVID-19 pandemic triggered a sudden economic crisis that led to increases in hardship and poverty. Motivated by the concern that people living in long-term poverty have few reserves to draw upon in times of crisis and may experience severe consequences, this study focuses on the association between material hardship and emotional wellbeing among people in poverty. The data were collected in two waves of telephone surveys during the pandemic (n = 88). Participants for the study were recruited through social service departments in six cities in Northern Israel. The findings show that COVID-19 increased material hardship, and that material hardship has detrimental effects on the four measures of emotional wellbeing selected (stress, anxiety, depression, and physical symptoms). Informal social support has positive effects on emotional wellbeing but it does not counter the negative effects of material hardship. Policy implications are discussed.

Illusory Essences: A Bias Holding Back Theorizing in Psychological Science

The reliance in psychology on verbal definitions means that psychological research is unusually moored to how humans think and communicate about categories. Psychological concepts (e.g., intelligence, attention) are easily assumed to represent objective, definable categories with an underlying essence. Like the “vital forces” previously thought to animate life, these assumed essences can create an illusion of understanding. By synthesizing a wide range of research lines from cognitive, clinical, and biological psychology and neuroscience, we describe a pervasive tendency across psychological science to assume that essences explain phenomena. Labeling a complex phenomenon can appear as theoretical progress before there is sufficient evidence that the described category has a definable essence or known boundary conditions. Category labels can further undermine progress by masking contingent and contextual relationships and obscuring the need to specify mechanisms. Finally, we highlight examples of promising methods that circumvent the lure of essences and suggest four concrete strategies for identifying and avoiding essentialist intuitions in theory development.

Stress and its Social Determinants - A Qualitative Study Reflecting the Perceptions of a Select Small Group of the Public in Sri Lanka

BACKGROUND

Exposure to stress, especially for prolonged periods, can result in physical and mental disorders. To attribute causality to its associated disease profile, social determinants need to be identified at the population level. The objective of this study was to explore perceptions regarding stress and its probable social determinants, among a purposeful cohort of the public from Colombo district, Sri Lanka.

METHODS

A qualitative study using focus group discussions (FGDs) was conducted among adults. Purposive sampling was used to recruit 8--10 participants into homogenous groups. Data were collected until information saturation. A semistructured FGD guide was used to facilitate the discussions. Content analysis methods were used to analyze data.

RESULTS

Six FGDs consisting of 59 participants were conducted. Participants included primary healthcare workers, community members, village leaders, private and public sector employees, unemployed individuals, homemakers, self-employed persons, slum dwellers, and persons from affluent communities. Three main themes emerged: social, economic, and cultural factors. Social factors consisted of four sub-themes: social role or status, generation gap, disability, and unsafe environment. Economic factors included three related subthemes: poverty, unemployment, and job insecurity. Cultural factors included three subthemes: superstitious beliefs, religion and caste, marriage and dowry.

CONCLUSION

Elements regarding stress and its social determinants among the public in Sri Lanka seem to be an amalgam of interconnected sociocultural and economic factors. However, addressing these social determinants in isolation (at an individual level) may not be feasible, as most causes appear to be outside the scope of the individual.

Does living in remote Australia lessen the impact of hardship on psychological distress?

AIMS

Rural and remote regions tend to be characterised by poorer socioeconomic conditions than urban areas, yet findings regarding differences in mental health between rural and urban areas have been inconsistent. This suggests that other features of these areas may reduce the impact of hardship on mental health. Little research has explored the relationship of financial hardship or deprivation with mental health across geographical areas.

METHODS

Data were analysed from a large longitudinal Australian study of the mental health of individuals living in regional and remote communities. Financial hardship was measured using items from previous Australian national population research, along with measures of psychological distress (Kessler-10), social networks/support and community characteristics/locality, including rurality/remoteness (inner regional; outer regional; remote/very remote). Multilevel logistic regression modelling was used to examine the relationship between hardship, locality and distress. Supplementary analysis was undertaken using Australian Household, Income and Labour Dynamics in Australia (HILDA) Survey data.

RESULTS

2161 respondents from the Australian Rural Mental Health Study (1879 households) completed a baseline survey with 26% from remote or very remote regions. A significant association was detected between the number of hardship items and psychological distress in regional areas. Living in a remote location was associated with a lower number of hardships, lower risk of any hardship and lower risk of reporting three of the seven individual hardship items. Increasing hardship was associated with no change in distress for those living in remote areas. Respondents from remote areas were more likely to report seeking help from welfare organisations than regional residents. Findings were confirmed with sensitivity tests, including replication with HILDA data, the use of alternative measures of socioeconomic circumstances and the application of different analytic methods.

CONCLUSIONS

Using a conventional and nationally used measure of financial hardship, people residing in the most remote regions reported fewer hardships than other rural residents. In contrast to other rural residents, and national population data, there was no association between such hardship and mental health among residents in remote areas. The findings suggest the need to reconsider the experience of financial hardship across localities and possible protective factors within remote regions that may mitigate the psychological impact of such hardship.

Place and preference effects on the association between mental health and internal migration within Great Britain

Individuals with mental health needs are more likely to migrate than the general population, but the effects of migration preference and place of residence are often overlooked. These issues are addressed through the application of a novel origin and destination multilevel model to survey data. In comparison to those with good mental health, individuals with poor mental health are more likely to make undesired moves and this is moderated, but not explained by place of residence. Implications for understanding the mental health and migration relationship, and its impact on service provision are then proposed.

Does the psychosocial quality of unpaid family work contribute to educational disparities in mental health among employed partnered mothers?

PURPOSE

The contribution of unpaid family work quality to understanding social inequalities in women's mental health has been understudied and further limited by a scarcity of psychometrically sound instruments available to measure family work. Therefore, using a multi-item scale of family work quality with evidence of validity and reliability, the overall aim of the present study was to determine whether psychosocial qualities of unpaid family work contribute to educational inequities in women's mental health.

METHODS

Study participants in this cross-sectional study were 512 employed partnered mothers living in a Canadian province and recruited from an online research panel. The dependent variable was psychological distress. In addition to a 28-item measure assessing five dimensions of unpaid family work quality, independent variables included material deprivation, job decision latitude, job demands and several measures of the work-family interface. Multiple linear regression was the primary analysis.

RESULTS

Compared to women with high school or less, university educated women reported lower psychological distress [b = - 2.23 (SE = 0.50) p = 0.001]. The introduction of material deprivation into the model resulted in the largest reduction to the education disparity (51%), followed by equity in responsibility for unpaid family work (25%), family-to-work facilitation (22%), and decision latitude in paid work (21%). When entered simultaneously into the final model, the association between education and psychological distress was reduced by 70% and became statistically non-significant [b = - 0.68 (SE = 0.47) p = 0.10].

CONCLUSIONS

In addition to the more established mechanisms of material conditions and decision latitude to explain mental health disparities, inequity in responsibility for unpaid family work may also play a role.

Out-of-pocket health expenditures in patients with bipolar disorder, anxiety, schizophrenia and other psychotic disorders: findings from a study in a psychiatry outpatient clinic in Turkey

PURPOSE

The aim of this study is to explore the amount of OOP health expenditures and their determinants in patients with bipolar disorder, anxiety, schizophrenia and other psychotic disorders in a psychiatry outpatient clinic of Turkey.

METHODS

The study group was 191 patients who attended to the Psychiatry Outpatient Clinic in June 2014. All patients were previously diagnosed with either 'bipolar disorder', 'anxiety disorder' or 'schizophrenia and other psychotic disorders'. The dependent variable was OOP expenditures for prescription, medical tests and examinations. Independent variables were age, gender, education, occupation, existence of social and/or private health insurance, equivalent household income and the financial resources. Student's t test, Mann-Whitney U test, ANOVA and logistic regression methods were applied with SPSS 15.0 for analysis.

RESULTS

OOP expenditures per admission were higher in patients with schizophrenia and other psychotic disorders ($8.4) than those with anxiety disorders ($4.8) (p = 0.02). OOP expenditures were higher in patients paying with debit ($9.8) than paying with monthly income ($6.2) (p = 0.04). OOP expenditures were higher in patients without social health insurance ($45.8) than others ($4.8) (p = 0.003). There was not a difference in OOP expenditures with respect to equivalent household income level, occupational class or education level of the patients (respectively p: 0.90, p: 0.09, p: 0.52).

CONCLUSIONS

Patients who were diagnosed with 'schizophrenia and other psychotic disorders' were disadvantaged in paying significantly higher amounts for their treatment. A substantial group of these patients compulsorily payed with debit. Considering this financial burden, diagnosis of the patient should be prioritized in health insurance coverage.

Income inequality widens the existing income-related disparity in depression risk in post-apartheid South Africa: Evidence from a nationally representative panel study

AIM

Income inequality (II) and poverty are major challenges in South Africa (SA) yet little is known about their interaction on population mental health. We explored relationships between district II, household income (HHI) and depressive symptoms in national panel data.

METHOD

We used 3 waves (2008, 2010, 2012) of the SA National Income Dynamics Study (n=25936) in adjusted mixed effects logistic regression to assess if the relationship between HHI and depressive symptoms is dependent on level of II. Depressive symptoms were assessed with Centre for Epidemiologic Studies Depression scale, and District inequality ratios (P10P90) derived from HHI distributions in 53 districts.

RESULTS

Lower HHI and increasing II were associated with depressive symptoms. The interaction term between HHI and II on depressive symptoms was significant (β=0.01, 95% CI: <0.01-0.01); with increasing II and decreasing HHI, depression risk increased.

CONCLUSION

II widens income-related disparities in depression risk in SA, with policy implications for understanding socioeconomic determinants of mental health and informing global efforts to reduce disparities in high poverty and inequality contexts.

Long-term adolescent multi-site musculoskeletal pain is associated with psychological distress and anxiety

OBJECTIVE

Although several studies have shown that adolescent musculoskeletal pain is associated with psychological problems in a cross-sectional setting, the associations of long-term musculoskeletal pain with psychological distress and anxiety are not known.

METHODS

The study included 1773 adolescents belonging to the Northern Finland Birth Cohort 1986. They received a postal questionnaire at the age of 16years and a follow-up questionnaire two years later. The first inquiry contained questions about the sites of musculoskeletal pain; the second had the same pain questions, along with measures of distress and anxiety. Risk ratios (RR) were assessed by log-linear regression analysis.

RESULTS

Multi-site musculoskeletal pain (in ≥2 body locations) at both 16 and 18years was common, reported by 53% of girls and 30% of boys. Multi-site pain at both ages, compared to those with multi-site pain neither at 16 nor 18years, was associated with psychological distress at the age of 18 among both girls (RR 1.8 95% CI 1.2-2.7) and boys (RR 3.5 95% CI 2.1-5.9). For anxiety, the corresponding relative risks were 1.5 (95% CI 1.0-2.2) and 1.8 (95% CI 1.4-2.3), respectively. For short-term multi-site pain (prevalent only at the age of 16 or 18), these relative risks were between 0.8 and 2.3.

CONCLUSIONS

Adolescents with long-term multi-site pain have higher levels of distress and anxiety than those without or with only short-term multi-site pain. Associations were found in both genders, but the relationship between pain and distress was more pronounced among boys. The associations had modest effect strength.

Association between depression and fruit and vegetable consumption among adults in South Asia

BACKGROUND

In recent years there has been a growing research interest regarding the impact of dietary behaviour on mental health outcomes. The present study aimed to investigate the association between fruit and vegetable (F&V) consumption and depression in three south Asian countries- Bangladesh, India and Nepal.

METHODS

Cross-sectional data were obtained from World Health Survey of WHO conducted during 2002-04. In total 14,133 adult subjects (Bangladesh 3262, India 7594, Nepal 3277) aged 18 years and above were included in the study. Outcome variables were Self-Reported Depression (SRD) during last 30 days and 12 months. Multivariable regression methods were used to explore the association between F&V consumption and depression.

RESULTS

Prevalence of Self-Reported Depression during past 12 months were respectively 39%, 17.7%, and 49.9% for Bangladesh, India and Nepal. In India, those who consumed less than five servings of vegetables were respectively 41% [AOR = 1.41; 95%CI = 0.60-3.33] and 57% [AOR = 1.57; 95%CI = 0.93-2.64] more likely to report severe-extreme and mild-moderate depression during past 30 days compared to those who consumed five servings a day. Regarding fruit consumption, compared to those who consumed five servings a day, the odds of severe-extreme and mild-moderate SRD were respectively 3.5 times [AOR = 3.48; 95%CI = 1.216-10.01] and 45% [AOR = 1.44; 95%CI = 0.89-2.32] higher in Bangladesh, and 2.9 times [AOR = 2.92; 95%CI = 1.12-7.64] and 42% higher [AOR = 1.41; 95%CI = 0.89-2.24] in Nepal compared to those who consumed less than five servings a day during last 30 days.

CONCLUSION

Daily intake of less than five servings of F&V was associated with higher odds of depression. Nutrition programs aimed at promoting F&V consumption might prove beneficial to reduce the prevalence of depression in south Asian population. Further studies are required to understand the factors limiting the adequate consumption of F&V.

Family socioeconomic position in early life and onset of depressive symptoms and depression: a prospective cohort study

PURPOSE

To investigate whether low parental socioeconomic position (SEP) at birth is associated only with early-onset depressive symptoms in offspring.

METHODS

This prospective cohort study used data on 9193 individuals (4768 females, 4425 males) from the Avon Longitudinal Study of Parents and Children. Depressive symptoms during three age periods (10-12, 12-16, 16-20 years) were assessed using the Short Mood and Feelings Questionnaire, and ICD-10 depression at age 18 was assessed using the Clinical Interview Schedule-Revised.

RESULTS

Low SEP was associated with increased incidence rates of depressive symptoms in all age periods, with indicators of low standard of living showing the strongest associations. For instance, incidence rate ratios for material hardship were 1.75 (95% CI [1.42-2.15]) at 10-12 years, 1.36 (1.16-1.61) at 12-16 years and 1.39 (1.21-1.59) at 16-20 years. Low SEP was also associated with increased odds of ICD-10 depression at 18 years, ranging from OR = 1.20 (95% CI [0.94-1.52]) for manual social class to 1.74 (1.35-2.24) for material hardship.

CONCLUSIONS

There was no evidence that depressive symptoms can be "subtyped" by the age of onset, because the association with low SEP was evident for early- and later-onset symptoms. If socioeconomic inequalities in early life have long-term adverse impacts on mental health, policies addressing these inequalities could benefit the mental health of the population.

Mental symptoms and cause-specific mortality among midlife employees

BACKGROUND

Mental symptoms are prevalent among populations, but their associations with premature mortality are inadequately understood. We examined whether mental symptoms contribute to cause-specific mortality among midlife employees, while considering key covariates.

METHODS

Baseline mail survey data from 2000-02 included employees, aged 40-60, of the City of Helsinki, Finland (n = 8960, 80 % women, response rate 67 %). Mental symptoms were measured by the General Health Questionnaire 12-item version (GHQ-12) and the Short Form 36 mental component summary (MCS). Covariates included sex, marital status, social support, health behaviours, occupational social class and limiting long-standing illness. Causes of death by the end of 2013 were obtained from Statistics Finland (n = 242) and linked individually to survey data pending consent (n = 6605). Hazard ratios (HR) and 95 % confidence intervals (95 % CI) were calculated using Cox regression analysis.

RESULTS

For all-cause mortality, only MCS showed a weak association before adjustments. For natural mortality, no associations were found. For unnatural mortality (n = 21), there was a sex adjusted association with GHQ (HR = 1.96, 95 % CI = 1.45-2.64) and MCS (2.30, 95 % CI = 1.72-3.08). Among unnatural causes of death suicidal mortality (n = 11) was associated with both GHQ (2.20, 95 % CI = 1.47-3.29) and MCS (2.68, 95 % CI = 1.80-3.99). Of the covariates limiting long-standing illness modestly attenuated the associations.

CONCLUSIONS

Two established measures of mental symptoms, i.e. GHQ-12 and SF-36 MCS, were both associated with subsequent unnatural, i.e. accidental and violent, as well as suicidal mortality. No associations were found for natural mortality due to diseases. These findings need to be corroborated in further populations. Supporting mental health through workplace measures may help counteract subsequent suicidal and other unnatural mortality among midlife employees.

Health, work and working conditions: a review of the European economic literature

Economists have traditionally been very cautious when studying the interaction between employment and health because of the two-way causal relationship between these two variables: health status influences the probability of being employed and, at the same time, working affects the health status. Because these two variables are determined simultaneously, researchers control endogeneity skews (e.g., reverse causality, omitted variables) when conducting empirical analysis. With these caveats in mind, the literature finds that a favourable work environment and high job security lead to better health conditions. Being employed with appropriate working conditions plays a protective role on physical health and psychiatric disorders. By contrast, non-employment and retirement are generally worse for mental health than employment, and overemployment has a negative effect on health. These findings stress the importance of employment and of adequate working conditions for the health of workers. In this context, it is a concern that a significant proportion of European workers (29 %) would like to work fewer hours because unwanted long hours are likely to signal a poor level of job satisfaction and inadequate working conditions, with detrimental effects on health. Thus, in Europe, labour-market policy has increasingly paid attention to job sustainability and job satisfaction. The literature clearly invites employers to take better account of the worker preferences when setting the number of hours worked. Overall, a specific "flexicurity" (combination of high employment protection, job satisfaction and active labour-market policies) is likely to have a positive effect on health.

The role of financial hardship, mastery and social support in the association between employment status and depression: results from an Australian longitudinal cohort study

OBJECTIVE

There is robust epidemiological and clinical evidence of the harmful effects of unemployment on psychological well-being, but the mechanisms through which this occurs is still strongly debated. In addition, there is even less evidence on the impact of underemployment on mental health. Using longitudinal data collected from a cohort of 20-24 years old, the present study examines a range of employed states and investigates the role of mastery, financial hardship and social support in the relationship between labour status and depression.

METHOD

Responses were from the Personality and Total Health (PATH) Through Life Project: A representative, community-based survey conducted in Canberra and Queanbeyan (NSW) in Australia, where respondents (n=2404) in their early twenties were followed for 8 years. Depression was measured using the self-report Goldberg Depression Scale, with the likely presence of depression being indicated by scores 7 or greater.

RESULTS

The analyses identified unemployment and underemployment as significant predictors of depression, compared to their employed counterparts. Both unemployment and underemployment remained significantly correlated with depression even after accounting for sociodemographic, economic and psychological variables. Social support, financial hardship and a sense of personal control (mastery) all emerged as important mediators between unemployment and depression.

CONCLUSIONS

Both unemployment and underemployment were associated with increased risk of depression. The strength of this relationship was attenuated but remained significant after accounting for key variables (mastery, financial hardship and social support), and extensive sociodemographic and health covariates, indicating that no or inade-quate employment contributes to poorer mental health over and above these factors.

The Potential for Poverty to Lower the Self-Efficacy of Adults With Asthma: An Australian Longitudinal Study

PURPOSE

It is known that strong feelings of self-efficacy are linked with better management of asthma. However, it is not known whether the experience of poverty can detrimentally impact the self-efficacy feelings of asthma patients. This paper aims to determine whether falling into income or multidimensional poverty lowers self-efficacy among people diagnosed with asthma.

METHODS

Longitudinal analysis of Waves 7 to 11 (2007 to 2011) of the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey using generalized linear models. The analysis was limited to those who had been diagnosed with asthma. The Freedom Poverty Measure was used to identify those in multidimensional poverty.

RESULTS

People with asthma who fell into income poverty had significantly lower self-efficacy scores-23% lower (95% CI: -35.1 to -9.1), after falling into income poverty for 3 or 4 years between 2007 and 2011 compared to those who were never in income poverty. Those who fell into multidimensional poverty also had significantly lower self-efficacy scores-25% lower (95% CI: -42.8 to -2.0), after being in multidimensional poverty for 3 or 4 years between 2007 and 2011 compared to those who were never in poverty.

CONCLUSIONS

Asthmatics who fall into poverty are likely to experience a decline in their feelings of self-efficacy. The findings of this study show that experiencing poverty should be a flag to identify those who may need extra assistance in managing their condition.

Life course models of economic stress and poor mental health in mid-adulthood: Results from the prospective Northern Swedish Cohort

AIM

The aim was to analyse the association between economic stress during youth and adulthood, and poor mental health through life course models of (1) accumulation of risk and (2) sensitive period.

METHODS

The study was based on the Northern Sweden Cohort, a 26-year prospective cohort (N = 1010 in 2007; 94% of those participating in 1981 still alive) ranging from adolescence to middle age. Economic stress was measured at age 16, 21, 30 and 42 years. Two life course models of accumulation of risk and sensitive period were analysed using ordinal regression with internalized symptoms of mental health as outcome.

RESULTS

Exposure of economic stress at several life course periods was associated with higher odds of internalized mental health symptoms for both women and men, which supports the accumulated risk model. No support for a sensitive period was found for the whole sample. For men, however, adolescence appears to be a sensitive period during which the exposure to economic stress has negative mental health consequences later in life independently of economic stress at other ages.

CONCLUSION

This study confirms that the duration of economic stress between adolescence and middle age is important for mental health. In addition, the results give some indication of a sensitive period of exposure to economic stress during adolescence for men, although more research is needed to confirm possible gender differences.

Assisting Australians with mental health problems and financial difficulties: a Delphi study to develop guidelines for financial counsellors, financial institution staff, mental health professionals and carers

Background

There is a strong association between mental health problems and financial difficulties. Therefore, people who work with those who have financial difficulties (financial counsellors and financial institution staff) need to have knowledge and helping skills relevant to mental health problems. Conversely, people who support those with mental health problems (mental health professionals and carers) may need to have knowledge and helping skills relevant to financial difficulties. The Delphi expert consensus method was used to develop guidelines for people who work with or support those with mental health problems and financial difficulties.

Methods

A systematic review of websites, books and journal articles was conducted to develop a questionnaire containing items about the knowledge, skills and actions relevant to working with or supporting someone with mental health problems and financial difficulties. These items were rated over three rounds by five Australian expert panels comprising of financial counsellors (n = 33), financial institution staff (n = 54), mental health professionals (n = 31), consumers (n = 20) and carers (n = 24).

Results

A total of 897 items were rated, with 462 items endorsed by at least 80 % of members of each of the expert panels. These endorsed statements were used to develop a set of guidelines for financial counsellors, financial institution staff, mental health professionals and carers about how to assist someone with mental health problems and financial difficulties.

Conclusions

A diverse group of expert panel members were able to reach substantial consensus on the knowledge, skills and actions needed to work with and support people with mental health problems and financial difficulties. These guidelines can be used to inform policy and practice in the financial and mental health sectors.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-015-0868-2) contains supplementary material, which is available to authorized users.

How financial hardship is associated with the onset of mental health problems over time

PURPOSE

Poor mental health has been consistently linked with the experience of financial hardship and poverty. However, the temporal association between these factors must be clarified before hardship alleviation can be considered as an effective mental health promotion and prevention strategy. We examined whether the longitudinal associations between financial hardship and mental health problems are best explained by an individual's current or prior experience of hardship, or their underlying vulnerability.

METHODS

We analysed nine waves (years: 2001-2010) of nationally representative panel data from the Household, Income, and Labour Dynamics in Australia survey (n = 11,134). Two components of financial hardship (deprivation and cash-flow problems) and income poverty were coded into time-varying and time-invariant variables reflecting the contemporaneous experience of hardship (i.e., current), the prior experience of hardship (lagged/12 months), and any experience of hardship during the study period (vulnerability). Multilevel, mixed-effect logistic regression models tested the associations between these measures and mental health.

RESULTS

Respondents who reported deprivation and cash-flow problems had greater risk of mental health problems than those who did not. Individuals vulnerable to hardship had greater risk of mental health problems, even at the times they did not report hardship. However, their risk of mental health problems was greater on occasions when they did experience hardship.

CONCLUSIONS

The results are consistent with the argument that economic and social programmes that address and prevent hardship may promote community mental health.

Associations of financial strain and income with depressive and anxiety disorders

BACKGROUND

Previous research has shown socioeconomic inequality in prevalence and onset of depressive disorders. It is not yet clear whether perceived financial strain is associated with depressive and/or anxiety disorders in addition to an objective indicator, such as income. This study examines whether financial strain is associated with the prevalence and onset/recurrence of depressive and/or anxiety disorders, above income.

METHODS

Data are from the Netherlands Study of Depression and Anxiety. Associations between financial strain, income and presence of depressive and/or anxiety disorder at baseline were assessed among 2937 participants (18-65 years). Impact of financial strain and income on 4-year onset/recurrence of depressive and/or anxiety disorders were examined among 1250 participants without a depressive or anxiety disorder at baseline. Depressive and anxiety disorders were determined with the Composite-International-Diagnostic-Interview. Financial strain and income were assessed in an interview.

RESULTS

Participants with mild or severe financial strain had higher odds of being depressed (OR=1.68, 95% CI 1.35 to 2.09; OR=3.88, 95% CI 2.58 to 5.81) or remitted (OR=1.56, 95% CI 1.24 to 1.96; OR=1.99, 95% CI 1.27 to 3.11) at baseline compared with healthy controls, after adjusting for income. Mild or severe financial strain was not associated with onset/recurrence of depressive and/or anxiety disorders during follow-up (OR=1.08, 95% CI 0.83 to 1.42; OR=1.05, 95% CI 0.64 to 1.73).

CONCLUSIONS

Financial strain was associated with having a depressive and/or anxiety disorder, above the effect of income. Healthcare and social services should be alert to this association, even for higher income households. However, financial strain and income were not related with 4-year onset/recurrence of depressive and/or anxiety disorders.

Exploring evidence for a prospective relationship between common mental disorder and meeting residential mobility preferences

This study investigates evidence of a selective influence of mental health in meeting residential mobility preferences. Data from two waves of Understanding Society (the UK Household Longitudinal Study) were used to identify four preference-mobility groups ('desired stayers', 'entrapped', 'desired movers', 'displaced'). Associations between mental health (symptoms of common mental disorder, CMD) and preference-mobility groups were measured both before and after residential moves. Those identified with CMD at baseline were at greater risk of being both in the 'entrapped' and the 'desired mover' groups, relative to the 'desired stayer' group in the following year. The association between preference-mobility group and subsequent poorer mental health was found among both groups that failed to meet their mobility preferences ('entrapped' and 'displaced'). This study finds evidence for a selective influence of mental health - such that those with poorer mental health are less likely to achieve a desired residential move, and highlights the importance of considering a bidirectional relationship between residential mobility and mental health.

The association between material living standard and psychological distress: results from a New Zealand population survey

BACKGROUND

People with a low material living standard experience more psychological distress than those with a high living standard, but previous studies suggest the size of this difference is modest.

AIM

To measure the association between living standard and psychological distress using a multidimensional measure of living standard, the Economic Living Standard Index (ELSI).

METHODS

Adults aged 25-64 years (n = 8,465) were selected from a New Zealand community survey. Logistic regression models were used to compare household income and ELSI scores as risk factors for high psychological distress, defined as a K10 score of 12 or over.

RESULTS

In the population, the prevalence of high psychological distress was 5.8%. The prevalence of high distress increased steeply with decreasing living standard. In the most deprived decile according to ELSI score, 24.3% had high distress, compared to 0.8% in the least deprived decile. For household income, high distress was present in 15.9% of people in the lowest decile and 2.2% of the highest decile. In fully adjusted models, ELSI score remained significantly associated with high distress but household income was not.

CONCLUSION

The mental health disparity between those at opposite ends of the social spectrum is very large. Comprehensive measures such as the ELSI give a more accurate estimate of this disparity than household income.

Inequalities in the incidence of infectious disease in the North East of England: a population-based study

The objective of this study was to measure the association between deprivation and incidence of 21 infectious diseases in the North East of England (2007–2011). We used count regression models with the Index of Multiple Deprivation and population/landscape data for small areas (~1500 persons). Deprivation significantly predicted incidence (P < 0·05) for 17 infectious diseases. The direction of association was broadly consistent within groups: increased incidence with increased deprivation for all three bloodborne viruses, 2/3 invasive bacterial diseases, 4/5 sexually transmitted infections (STI) and tuberculosis (TB); decreased incidence with increased deprivation for 5/6 infectious intestinal diseases (IID) and 2/3 vaccine-preventable diseases. Associations were removed for all but one IID (E. coliO157 infection) after accounting for recent foreign travel. Hepatitis C virus, TB and STI are priority infections for reduction of inequalities associated with deprivation in the North East of England.

A prediction algorithm for first onset of major depression in the general population: development and validation

OBJECTIVE

Prediction algorithms are useful for making clinical decisions and for population health planning. However, such prediction algorithms for first onset of major depression do not exist. The objective of this study was to develop and validate a prediction algorithm for first onset of major depression in the general population.

METHODS

Longitudinal study design with approximate 3-year follow-up. The study was based on data from a nationally representative sample of the US general population. A total of 28 059 individuals who participated in Waves 1 and 2 of the US National Epidemiologic Survey on Alcohol and Related Conditions and who had not had major depression at Wave 1 were included. The prediction algorithm was developed using logistic regression modelling in 21 813 participants from three census regions. The algorithm was validated in participants from the 4th census region (n=6246). Major depression occurred since Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions, assessed by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-diagnostic and statistical manual for mental disorders IV.

RESULTS

A prediction algorithm containing 17 unique risk factors was developed. The algorithm had good discriminative power (C statistics=0.7538, 95% CI 0.7378 to 0.7699) and excellent calibration (F-adjusted test=1.00, p=0.448) with the weighted data. In the validation sample, the algorithm had a C statistic of 0.7259 and excellent calibration (Hosmer-Lemeshow χ(2)=3.41, p=0.906).

CONCLUSIONS

The developed prediction algorithm has good discrimination and calibration capacity. It can be used by clinicians, mental health policy-makers and service planners and the general public to predict future risk of having major depression. The application of the algorithm may lead to increased personalisation of treatment, better clinical decisions and more optimal mental health service planning.

Demographic factors, social problems and material amenities as predictors of psychological distress: a cross-sectional study in Karachi, Pakistan

PURPOSE

Previous research has shown high prevalence rates for stress and psychiatric morbidity in rural areas of Pakistan, but prevalence findings from urban areas vary widely (between 18 and 70%). Many of these studies have focused on special populations and may not be representative of the general population in urban settings. The purpose of the present study was to ascertain prevalence and predictors of psychological distress in a representative sample of community dwelling adults from mid-low to low-income urban areas of Karachi, Pakistan.

METHOD

A cross-sectional survey was undertaken utilizing probability-based sampling from five mid-low to low-income communities of Karachi. Measures included the twelve-item Urdu version of general health questionnaire (GHQ-12), a demographic questionnaire, and questions about financial, health-related and family problems and about access to services and material amenities owned.

RESULTS

Seventeen per cent of respondents (N = 1,188) were positive for psychological distress. More females were distressed than males and migrant groups had higher prevalence of distress as compared with natives of the city. Although other studies have shown low education or income to be associated with emotional distress and non-psychotic psychiatric morbidity, our study suggested that having limited income or education may make one more vulnerable to social problems that in turn may be associated with greater distress. An access to services and material amenities had a small but significant association with decreased distress.

CONCLUSION

The overall national prevalence rates may not reveal the influence of gender, region (rural v. urban) and migration on psychological distress. Further research is needed to address mental health of migrant groups in urban centers of Pakistan.

A clinical predictive score for mood disorder risk in low-income primary care settings

BACKGROUND

Despite availability of validated screening tests for mood disorders, busy general practitioners (GPs) often lack the time to use them routinely. This study aimed to develop a simplified clinical predictive score to help screen for presence of current mood disorder in low-income primary care settings.

METHODS

In a cross-sectional study, 197 patients seen at 10 primary care centers in Santiago, Chile completed self-administered screening tools for mood disorders: the Patient Health questionnaire (PHQ-9) and the Mood Disorder Questionnaire (MDQ). To determine participants' current-point mood disorder status, trained clinicians applied a gold-standard diagnostic interview (SCID-I). A simplified clinical predictive model (CM) was developed based on clinical features and selected questions from the screening tools. Using CM, a clinical predictive score (PS) was developed. Full PHQ-9 and GP assessment were compared with PS.

RESULTS

Using multivariate logistic regression, clinical and demographic variables predictive of current mood disorder were identified for a simplified 8-point predictive score (PS). PS had better discrimination than GP assessment (auROC-statistic=0.80 [95% CI 0.72, 0.85] vs. 0.58 [95% CI 0.52, 0.62] p-value <0.0001), but not as good as the full PHQ-9 (0.89 [95% CI 0.85, 0.93], p-value=0.03). Compared with GP assessment, PS increased sensitivity by 50% at a fixed specificity of 90%. Administered in a typical primary care clinical population, it correctly predicted almost 80% of cases.

LIMITATIONS

Further research must verify external validity of the PS.

CONCLUSION

An easily administered clinical predictive score determined, with reasonable accuracy, the current risk of mood disorders in low-income primary care settings.

Development and validation of prediction algorithms for major depressive episode in the general population

BACKGROUND

To develop and validate sex specific prediction algorithms for 4-year risk of major depressive episode (MDE) using data from a population-based longitudinal cohort.

METHODS

Household residents from 10 provinces were randomly recruited and interviewed by Statistics Canada. 10,601 participants who were aged 18 years and older and who did not meet the criteria for MDE in the 12 months prior to a baseline interview in 2000/01 were included in algorithm development; data from 7902 participants who were aged 18 and older and who were free of MDE in 2004/05 were used for validation. Validation was also conducted in sub-populations that are of practice and policy importance. MDE was assessed using the World Health Organization's Composite International Diagnostic Interview(CIDI)-Short Form for Major Depression (CIDI-SFMD).

RESULTS

In the training data, the C statistics for algorithms in men was 0.7953 and was 0.7667 for algorithm in women. The algorithms had good predictive power and calibrated well in the development and validation data.

LIMITATIONS

The data relied on self-report. MDE was assessed with CIDI-SFMD. It was not feasible to validate the algorithms in different populations from different countries.

CONCLUSIONS

More studies are needed to further validate and refine these algorithms. However, the ability of a small number of easily assessed variables to predict MDE risk indicates that algorithms are a promising strategy for identifying individuals in need of enhanced monitoring and preventive interventions. Ultimately, application of algorithms may lead to increased personalization of treatment, and better clinical outcomes.

Frequent mental distress (FMD) in Irish Travellers: discrimination and bereavement negatively influence mental health in the All Ireland Traveller Health Study

Travellers are an indigenous minority group in Ireland, with poorer life expectancy and health status than the general population. Recent data have shown that Travellers are at increased risk of poor mental health and sequelae from same. We aimed to examine the associations between sociodemographic and lifestyle factors with poor mental health in Irish Travellers. A census survey of all Travellers was undertaken, with 8,492 enumerated families (80% response rate). A random subset of 1,796 adults completed an adult health survey. Traveller peer researchers employed a novel oral-visual computer-aided data collection tool. Frequent mental distress (FMD) was defined as 14 or more days of poor mental health in the preceding 1 month. Prevalence ratios for typical associates of FMD were estimated using a Poisson regression model, adjusted for age and sex. FMD was present in 11.9% of Traveller respondents, and prevalence increased with age. After age and sex adjustment, FMD was more prevalent in those whose quality of life was impaired by physical health, by those who were recently bereaved of a friend or family member, and by those who had greater experiences of discrimination. This study shows that Travellers experience discrimination and bereavement, which negatively influence their mental health. The findings have implications for the mental healthcare needs of indigenous ethnic minorities worldwide.

Mental disorders and cigarette use among adults in the United States

BACKGROUND

The goal of this study was to determine the association between mental disorders and cigarette consumption and nicotine dependence.

METHODS

Data were drawn from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), a nationally representative survey of adults (N = 43,093) aged 18 and older. Relationships between specific anxiety disorders, mood disorders, nondependent cigarette use, nicotine dependence among the whole sample, and nicotine dependence among cigarette users were examined.

RESULTS

After adjusting for demographics and comorbid mental disorders, generalized anxiety disorder (OR = 1.16 (1.29-1.51)), specific phobia (OR = 1.35 (1.21-1.51)), panic disorder (PD) (OR = 1.90 (1.62-2.23)), major depression (MDD) (OR = 1.31 (1.16-1.48)), and bipolar disorder (OR = 1.30 (1.09-1.54)) were associated with increased likelihood of nondependent cigarette use. Specific phobia (OR = 1.69 (1.49-1.91)), PD (OR = 1.82 (1.50-2.21)), MDD (OR = 1.59 (1.38-1.84)), and bipolar disorder (OR = 1.71 (1.39-2.09)) were associated with increased odds of nicotine dependence among the whole sample; social phobia (OR = 1.69 (1.19-2.40)), specific phobia (OR = 1.69 (1.43-2.01)), MDD (OR = 1.65 (1.34-2.02)), and bipolar disorder (OR = 2.38 (1.74-3.24)) were associated with increased risk of nicotine dependence among cigarette users.

CONCLUSIONS

Specific anxiety disorders and mood disorders were uniquely associated with nondependent cigarette use, nicotine dependence among the whole sample, and the risk of nicotine dependence among cigarette users in the United States. Findings suggest that demographic differences, comorbid mood, anxiety, substance, and personality disorders all contributed to previously observed associations between mental disorders and nicotine dependence, explaining these links in some but not all cases.

Psychotic experience subtypes, poor mental health status and help-seeking behaviour in a community sample of young adults

BACKGROUND

Different subtypes of psychotic experiences (PEs) have been identified in clinical and non-clinical samples. Researchers have considered these PEs to either be variations of personality or expressions of vulnerability to psychotic disorder. This study aimed to determine which particular subtypes of PEs were more likely to be associated with poor mental health status and help-seeking behaviour in a non-clinical sample of young adults.

METHODS

The study was conducted on a community sample of 997 young adults. The prevalence of PEs and distress was measured using the community assessment of psychic experiences (CAPE), depressive and anxiety symptoms were measured using Beck depression inventory-II and Beck anxiety inventory, and general functioning was measured using the general health questionnaire-12. Factorial analysis of the CAPE positive dimension was conducted and correlations between factors and clinical variables were analysed.

RESULTS

Four PE subtypes were identified: perceptual abnormalities, persecutory ideas (PI), bizarre experiences, and magical thinking. At least one high frequency PI was endorsed by 60.8% (n = 606) of the sample and proved to be significantly associated both with poor mental health status and help-seeking behaviour.

CONCLUSION

PEs subtypes are differentially associated with various markers of poor mental health status. PI seem to have stronger psychopathological significance than other subtypes of PEs. Further longitudinal studies are required to extend these findings.

The role of hardship in the association between socio-economic position and depression

OBJECTIVE

It is well established that socio-economic position is associated with depression. The experience of financial hardship, having to go without the essentials of daily living due to limited financial resources, may explain the effect. However, there are few studies examining the link between financial hardship and diagnosable depression at a population level. The current paper addresses this gap and also evaluates the moderating effect of age.

METHOD

Data were from 8841 participants aged 16-85 years in Australia's 2007 National Survey of Mental Health and Wellbeing. The 12-month prevalence of depressive episode was assessed using the Composite International Diagnostic Interview. Measures of socio-economic position included: financial hardship, education, labour-force status, occupational skill, household income, main source of income, and area-level disadvantage.

RESULTS

Financial hardship was more strongly associated with depression than other socio-economic variables. Hardship was more strongly associated with current depression than with prior history of depression. The relative effect of hardship was strongest in late adulthood but the absolute effect of hardship was greatest in middle age.

CONCLUSIONS

The results demonstrate the critical role of financial hardship in the association between socio-economic disadvantage and 12-month depressive episode, and suggest that social and economic policies that address inequalities in living standards may be an appropriate way to reduce the burden attributable to depression.

Are the national preventive health initiatives likely to reduce health inequities?

This paper examines commitments to address health inequities within current (2008-11) Australian government initiatives on health promotion and chronic disease prevention. Specifically, the paper considers: the Council of Australian Governments' 'National partnership agreement on preventive health'; the National Preventative Health Taskforce report, 'Australia: the healthiest country by 2020'; and the Australian Government's response to the taskforce report, 'Taking preventative action'. Arising from these is the recent establishment of the Australian National Preventive Health Agency. Together, these measures represent a substantial public investment in health promotion and disease prevention. The present paper finds that these initiatives clearly acknowledge significantly worse health outcomes for those subject to social or economic disadvantage, and contain measures aimed to improve health outcomes among Indigenous people and those in low socioeconomic status communities. However, we argue that, as a whole, these initiatives have (thus far) largely missed an opportunity to develop a whole of government approach to health promotion able to address upstream social determinants of health and health inequities in Australia. In particular, they are limited by a primary focus on individual health behaviours as risk factors for chronic disease, with too little attention on the wider socioeconomic and cultural factors that drive behaviours, and so disease outcomes, in populations.

Psychosocial stressors and depression at a Swedish primary health care centre. A gender perspective study

Background

Psychosocial stress may account for the higher prevalence of depression in women and in individuals with a low educational background. The aim of this study was to analyse the association between depression and socio-demographic data, psychosocial stressors and lifestyle circumstances from a gender perspective in a relatively affluent primary care setting.

Methods

Patients, aged 18- 75 years, visiting a drop-in clinic at a primary care health centre were screened with Beck's Depression Inventory (BDI). The physicians used also targeted screening with BDI. A questionnaire on socio-demographic data, psychosocial stressors and use of alcohol and tobacco was distributed. Among patients, who scored BDI ≥10, DSM-IV-criteria were used to diagnose depression. Of the 404 participants, 48 men and 76 women were diagnosed with depression. The reference group consisted of patients with BDI score <10, 187 men and 93 women. Age-adjusted odds ratios (ORs) with 95% confidence intervals (CI) as being depressed were calculated for the psychosocial stressors and lifestyle circumstances, separately for men and women. Multiple logistic regression analyses were used to determine the age-adjusted main effect models for men and women.

Results

The same three psychosocial stressors: feeling very stressed, perceived poor physical health and being dissatisfied with one's family situation were associated with depression equally in men and women. The negative predictive values of the main effect models in men and women were 90.7% and 76.5%, respectively. Being dissatisfied with one's work situation had high ORs in both men and women. Unemployment and smoking were associated with depression in men only.

Conclusions

Three questions, frequently asked by physicians, which involve patient's family and working situation as well as perceived stress and physical health, could be used as depression indicators in early detection of depression in men and women in primary health care.

Explanations of educational differences in major depression and generalised anxiety disorder in the Irish population

BACKGROUND

Social inequalities in mental disorders have been described, but studies that explain these inequalities are lacking, especially those using diagnostic interviews. This study investigates the contribution of various explanatory factors to the association between educational level and major depression and generalised anxiety disorder in Irish men and women.

METHODS

The study population comprised a national random sample of 5771 women and 4207 men aged 18 or more in Ireland (SLÁN 2007 survey). Major depression and generalised anxiety disorder were measured using a standardised diagnostic interview (CIDI-SF). Four groups of explanatory factors were explored: material, psychosocial, and behavioural factors, and chronic disease.

RESULTS

For both genders, low educational level increased the risk of both mental disorders. Material factors, especially no private health insurance, but also no car, housing tenure, insufficient food budget, and unemployment (for men), made the highest contribution (stronger for men than for women) in explaining the association between education and both mental disorders. Psychosocial (especially formal social participation, social support and marital status) and behavioural factors (smoking and physical activity for both genders, and alcohol and drug use for men) and chronic disease made low independent contributions in explaining the association between education and both mental disorders.

LIMITATIONS

Given the cross-sectional study design, no causal conclusion could be drawn.

CONCLUSIONS

Targeting various material, psychosocial, and behavioural factors, as well as chronic diseases may help to reduce educational differences in depression and anxiety in the general population.

Economic hardships in adulthood and mental health in Sweden. The Swedish National Public Health Survey 2009

Background

Possible accumulative effects of a combined economic hardship's measure, including both income and non-income related economic hardships measures, on mental health has not been well investigated. The aim of this paper was to investigate; (i) independent associations between multiple measures of economic hardships and mental health problems, and (ii) associations between a combined economic hardships measure and mental health problems.

Methods

We analysed data from the 2009 Swedish National Survey of Public Health comprising a randomly selected representative national sample combined with a randomly selected supplementary sample from four county councils and three municipalities consisting of 23,153 men and 28,261 women aged 16-84 years. Mental health problems included; psychological distress (GHQ-12), severe anxiety and use of antidepressant medication. Economic hardship was measured by a combined economic hardships measure including low household income, inability to meet expenses and lacking cash reserves.

Results

The results from multivariate adjusted (age, country of birth, educational level, occupational status, employment status, family status and long term illness) logistic regression analysis indicate that self-reported current economic difficulties (inability to pay for ordinary bills and lack of cash reserves), were significantly associated with both women's and men's mental health problems (all indicators), while low income was not. In addition, we found a statistically significant graded association between mental health problems and levels of economic hardships.

Conclusions

The findings indicate that indicators of self-reported current economic difficulties seem to be more strongly associated with poor mental health outcomes than the more conventional measure low income. Furthermore, the likelihood of mental health problems differed significantly in a graded fashion in relation to levels of economic hardships.

Social economic inequalities and mental health II. Methodological aspects and literature review

Summary

Objective - This study provides a framework for mental health inequalities beginners. It describes the methods used to measure socio economic inequalities and the inter-relations with different aspects of mental health: residence, mental health services organisation and main diagnostic categories. Method - Literature electronic-search on Medline, Psyclit, Econlit, Social Science Index and SocioSearch usingand relating the key-words inequalities, deprivation, poverty, socio-economic status, social class, occupational class, mental health for the period 1965-2002 (June). The articles selected were integrated with manual search (publications of the same authors, cross-references, working documents and reports of international andregional organisations). Results - Inequality is not an absolute concept and, mainly, it has been changing during the last years. For example, the integration and re-definition of variables that capture, in simple indices, a complex reality; the accent on social more than on economic aspects; the geo-validity and time-reference of the inequality's indices. Moreover, the inequalities could be the result of individual preferences, in this case, the social selectionand social causation issues will raise the suitability for a public intervention. Conclusions - Up to now, research has been mainly concentrated in describing and measuring health inequalities. For designing effective interventions, policy makers need to ground decisions on health-socioeconomic inequalities explanatory models.

Declaration of Interest

this work was partly funded by the Department of the Public Health Sciences “G. Sanarelli” of the University of Rome “La Sapienza” and the Department of Medicine and Public Health of the University of Verona.

The pattern of physical comorbidity and the psychosocial determinants of depression: a prospective cohort study on a representative sample of family practice attendees in Slovenia

Objectives This study aims to present the patterns of physical comorbidity in depressed patients and factors strongly associated with depression in a representative sample of Slovenian family practice attendees.Methods Medical data was obtained for 911 general practice attendees. Of them, 221 (24.3%) were diagnosed as depressed. The depressive states of the subjects were evaluated using the Composite International Diagnostic Interview (CIDI). Physical comorbidity was assessed with a questionnaire covering the most common health problems in the Slovenian adult population. Several psycho-social factors were also analysed.Results Those variables significantly related to ICD depression were included in multivariate binary logistic regression analysis, adjusted by age, gender and education. The calculation included the chi-square, odds ratio (OR) with confidence interval (95% CI) and P-value. A P-value < 0.05 was marked as statistically significant.Conclusions There was no significant difference in the number of concurrent chronic diseases in depressed and non-depressed subjects. The risk of depression was increased by the presence of several concomitant factors. The burden of somatic co-morbidity was shown to be smaller than the impact of psychosocial determinants, which also acted as protective factors: the feeling of safety at home and the absence of problems in intimate relationships. The abuse of alcohol and drugs by a family member and current poor financial situation were strongly associated with depression. The impact of concurrent incontinence and chronic bowel disease was also important, though somewhat weaker.

Design for health: the relationship between design and noncommunicable diseases

The authors explore the relationship between design and noncommunicable diseases, first by highlighting how design knowledge and practice can have a direct and indirect effect on these diseases. They then review the literature on the link between the physical environment (e.g., dwellings, the neighborhood, cities) and noncommunicable diseases. Last, they illustrate the links between design and noncommunicable diseases by exploring in greater detail how designers and the design of the urban environment can play a positive role in the reduction of noncommunicable diseases.

Disentangling associations between poverty at various levels of aggregation and mental health

The present editorial discusses whether socioeconomic status of the individual and of the neighbourhood could be important in prevalence, treatment and prevention of psychiatric morbidity. Previous research showed that patients diagnosed with mental disorders are concentrated in socioeconomically disadvantaged areas. This could be the result of (1) an association between individual socioeconomic status and mental health, (2) an association between neighbourhood socioeconomic status and mental health, or (3) social selection. Research disentangling associations between individual and neighbourhood socioeconomic status on the one hand and mental health outcomes on the other, reported that neighbourhood socioeconomic disadvantage was associated with individual mental health over and above individual-level socioeconomic status, indicating deleterious effects for all inhabitants both poor and affluent. In conclusion, subjective mental health outcomes showed stronger evidence for an effect of neighbourhood socioeconomic status than research focussing on treated incidence. Within the group of patients, however, service use was higher in patients living in disadvantaged neighbourhoods. Social capital was identified as one of the mechanisms whereby neighbourhood socioeconomic disadvantage may become associated with observed reductions in mental health. After controlling for individual socioeconomic status, there is evidence for an association between neighbourhood socioeconomic status and objective as well as subjective mental health in adults. Evidence for such an association in young children is even stronger.

Equity in mental health

Aim– The aim of this paper is to discuss the study of equity in mental health contexts.Methods– We review major principles and theories of distributive justice, covering various disciplines such as ethics, philosophy, economics, medicine and sociology. Recent literature on empirical analysis of inequalities in the mental health field is also reviewed.Results– The review of literature reveals a general lack of debate on equity principles in relation to mental health. Robust empirical evidence on inequalities in the field is also scarce.Conclusions– There is need for better exposition of the relevance of different equity principles for mental health policy and practice. There is also a need for developing standardised methods for the empirical analysis of equity, to examine the distribution of psychiatric morbidity and use of services by income, socioeconomic group, ethnicity, gender and place of residence, and, of course, to examine how equity can be promoted.

Declaration of Interest: This work was funded by the Department of Health programme grant to the PSSRU.

Prevalência e fatores associados a sintomas depressivos em adultos do sul do Brasil: estudo transversal de base populacional

Com o objetivo de identificar a prevalência de sintomas depressivos e examinar fatores associados em uma população adulta do sul do Brasil, foi realizado um estudo transversal de base populacional, incluindo 972 indivíduos, de ambos os sexos, idade entre 20 e 69 anos, moradores na zona urbana da cidade de Pelotas, Rio Grande do Sul. A seleção amostral teve os setores censitários do município como unidades amostrais primárias e os domicílios como unidades secundárias. O questionário incluiu variáveis socioeconômicas, comportamentais e nutricionais. As prevalências dos sintomas depressivos tristeza, ansiedade, falta de energia, falta de disposição, pensar no passado e preferir ficar em casa, na população de Pelotas, foram, respectivamente, de 29,4%, 57,6%, 37,4%, 40,4%, 33,8% e 54,3%. Concluiu-se que as prevalências de sintomas depressivos foram elevadas e os indivíduos do sexo feminino, idade avançada, fumantes e obesos mostraram-se associadas à maioria dos desfechos. A depressão é um importante problema de saúde publica e o conhecimento de como a sintomatologia depressiva se distribui na população e os fatores associados à sua presença podem ajudar no melhor entendimento da fenomenologia dos transtornos depressivos e a traçar estratégias de prevenção e intervenção.

The social determinants of mental health: implications for research and health promotion

Social determinants of health have come to greater prominence through the recent work of the WHO Commission on the Social Determinants of Health, and the Marmot Review of Health Inequalities in England. These reports also have significant implications for promotion of mental health in developed countries. In particular they reflect a growing research interest in the view that certain adverse social conditions may detrimentally affect mental or physical health by acting as chronic stressors. However, although the case for chronic arousal of stress systems as a risk factor for mental health is empirically well-founded, questions remain about how and why psychological exposure to certain kinds of proximal social conditions might contribute to such arousal. In this paper we argue that combining evidence and ideas from a number of disciplines, including public health research and psychiatry, presents an opportunity to understand the relationship better, and so inform complementary strategies in treatment, prevention and health promotion.

Correlates of perceived need for and use of mental health services by older adults in the collaborative psychiatric epidemiology surveys

OBJECTIVES

Older adults are especially unlikely to seek mental health services, but little is known about whether their perceptions of need for help contribute to this problem. The objectives of this study were to compare perceived need across the lifespan and to examine sociodemographic and mental health correlates of whether older adults sought professional help, perceived the need for help without seeking it, and sought help from specialty mental health professionals.

METHODS

The authors examined help-seeking and perceived need with the Collaborative Psychiatric Epidemiology Surveys, focusing on 3,017 adults aged 55 years and older. Logistic regressions predicted help-seeking and perceived need from sociodemographic factors, past-year psychiatric disorders, and past-year suicidal behaviors. Individuals who perceived the need for help without receiving it also reported barriers to help-seeking.

RESULTS

Levels of perceived need were highest among 25-44 year olds and lowest among adults aged 65 years and older. Among older adults with psychiatric disorders, 47.1% did not perceive a need for professional help. Diagnoses and suicidal behaviors were strong predictors of whether individuals perceived need, whereas among those who perceived the need for help, only older age was positively associated with help-seeking. Few factors clearly distinguished those who did and did not seek help from specialty mental health professionals with the exception of having three or more psychiatric diagnoses. Finally, the most common barrier to help-seeking was a desire to handle problems on one's own.

CONCLUSIONS

A lack of perceived need for mental health services and self-sufficiency beliefs are significant barriers to older adults' use of mental health services.