An intersectional approach to understandings of mental health inequalities among men with disability

Similarities and Differences in the Longitudinal Trajectories of Depressive Symptoms from Mid-Adolescence to Young Adulthood: the Intersectionality of Gender, Race/Ethnicity, and Levels of Depressive Symptoms

BACKGROUND

Understanding similarities and differences between groups with intersecting social identities provides key information in research and practice to promote well-being. Building on the intersectionality literature indicating significant gender and racial/ethnic differences in depressive symptoms, the present study used quantile regression to systematically present the diversity in the development of depressive symptoms for individuals with intersecting gender, race/ethnicity, and levels of symptoms.

METHODS

Information from the National Longitudinal Survey of Youth 79: Child and Young Adult study was employed. A detailed picture of depressive symptom trajectories from low to high quantiles was illustrated by depicting 13 quantile-specific trajectories using follow-up data from ages 15 to 40 in six gender-race/ethnicity groups: both genders of Black, Hispanic, and non-Black, non-Hispanic individuals.

RESULTS

From low to high quantiles, Black and non-Black, non-Hispanic individuals showed mostly curved, and Hispanic individuals showed mostly flat trajectories. Across the six gender-race/ethnicity groups, the trajectories below 0.50 quantiles were similar in levels and shapes from mid-adolescence to young adulthood. The differences between the six gender-race/ethnicity groups widened, indicated by outspreading trajectories, especially at quantiles above 0.50. Furthermore, non-Black, non-Hispanic males and females showed especially fast-increasing patterns at quantiles above 0.75. Among those without or with only a high school degree, Black females and non-Black, non-Hispanic females tended to report similar levels of depressive symptoms higher than other groups at high quantiles. These unique longitudinal trajectory profiles cannot be captured by the mean trajectories.

CONCLUSIONS

The intersectionality of gender, race/ethnicity, and quantile of symptoms on the development of depressive symptoms was identified. Further studying the mechanism explaining this diversity can help reduce mental health disparities.

Sex and Gender Differences in Psychosocial Risk Profiles Among Patients with Coronary Heart Disease - the THORESCI-Gender Study

BACKGROUND

Psychosocial factors tend to cluster and exhibit differences associated with sex assigned at birth. Gender disparities, though, remain uncharted so far. The current study aimed to first explore the clustering of eight established psychosocial risk factors among patients with coronary heart disease (CHD), followed by examining how sex and gender differences characterize these psychosocial risk profiles, while adjusting for the effect of age.

METHOD

In total, 532 patients with CHD (Mage = 68.2 ± 8.9; 84% male) completed the comprehensive psychosocial screener and questionnaires to gauge gender identity, traits, and sociocultural norm scores. A three-step latent profile analysis (LPA) was performed to identify latent profiles and their correlates.

RESULTS

LPA revealed six psychosocial risk profiles: (1) somewhat distressed overall (32%); (2) low distress (27%); (3) anger, hostility, and Type D (15%); (4) emotional distress and trauma (11%); (5) anxiety (9%); and (6) high overall distress (7%). Masculine traits and older age increased the odds to belong to the low distress profile (#2), while feminine traits and a feminine gender norm score increased the chance to belong to profiles with moderate to high distress. The effects of gender identity and feminine traits were sex dependent.

CONCLUSION

The current study's findings explain heterogeneity among patients with CHD by considering the joint occurrence of psychosocial risk factors, and the role of sex, age, and gender within those profiles. Being more sensitive to the roles that sex, gender, and an integrated set of risk factors play may ultimately improve treatment and adherence.

Measuring equity of access to eye health outreach camps in rural Malawi

Introduction

Equity in the access and use of health services is critical if countries are to make progress towards universal health coverage and address the systematic exclusion of the most vulnerable groups. The purpose of this study was to assess if the Co-ordinated Approach To Community Health programme implemented by Sightsavers was successful in reaching the poorest population, women, and people living with disabilities in Kasungu district, Malawi.

Methods

Between April and September 2017, data on socio-economic status, household characteristics and functional disability were collected from patients attending at eye camps in Kasungu district, Malawi. Using asset-based tools to measure household wealth (EquityTool© and Simple Poverty Scorecard©) and the Washington Group Short Set of Questions, individuals were categorised by wealth quintiles, poverty status, and functional disability status and then compared to relevant representative national household surveys. In addition, a follow-up household survey was conducted to check the validity of self-reported household characteristics at eye camps.

Results

A total of 1,358 individuals participated in the study. The study shows that self-reported data on household characteristics and assets are reliable and can be collected in clinical settings (instead of relying on direct observations of assets). Individuals attending outreach camps were poorer in terms of relative wealth and absolute poverty rates compared to the rest of the population in Kasungu. It was estimated that 9% of the participants belonged to the poorest quintile compared to 4% for the population in Kasungu (DHS 2015–2016). The ultra-poverty rate was also lower among respondents (13%) compared to 15% for Kasungu district (IHS 2017). The functional disability rate was 27.5% for study participants, and statistically higher than the general population (5.6%, SENTIF 2017). Even though women are more at risks than men, 54% of the participants were men.

Conclusions

Our study shows that existing tools can be reliably used, and combined, if based on recent population data, to assess equity of access to health services for vulnerable groups of the population. The findings suggest that the programme was successful in reaching the poorest people of the Kasungu district population as well as those with disabilities through outreach camps but that more men than women were reach through the programme. Subsequently, our study showed that self-reported household characteristics are a reliable method to measure asset-based wealth of camps’ attendee. However, it is essential to use sub-national data (district or regional level) from recent surveys for the purpose of benchmarking in order to produce accurate results.

Placing intersectional inequalities in health

Research into geographical inequalities in health has focused almost exclusively on examining the effects of area-level deprivation and has been largely framed through a compositional-contextual lens, their inter-relationship and the influence of vertical macro-economic and political/policy drivers. However, in the broader health inequalities field, intersectionality has recently emerged as a critical theoretical and methodical approach which examines the concurrent and interacting influences on health of multiple axes of inequality (such as socio-economic status, gender, race/ethnicity and sexuality or gender-identity). Simultaneously, social geography has been explicitly using intersectionality to analyse how mutually constitutive forms of social oppression interact and interrelate with place. This paper exploits the analytical space opened up by this 'intersectional turn' by outlining the benefits for research into geographical inequalities in health that can be achieved by taking a more explicit approach to intersectional inequalities. It argues that: (1) geographical research into health inequalities should more explicitly and widely apply an intersectional lens; and relatedly that, in turn, (2) place needs to be considered as an aspect of intersectionality and integrated into the wider intersectional inequalities in health literature. The paper summarises the evolution of theories of place and health inequalities and outlines intersectional theory and the work to date that has been undertaken to integrate this perspective into our understanding of health inequalities. Drawing on the social geography literature into place and intersectionality, the paper explores how this perspective is being used to enhance our understanding of place effects more generally - and how place itself can be considered as an element of intersectional inequalities. Drawing these different bodies of work together, the paper concludes by considering the implications for theories of geographical inequalities in health.

The effects of the COVID-19 pandemic on the psychosocial well-being of people with disabilities

Background

Before the COVID-19 pandemic, people with mobility, vision, hearing, and cognitive disabilities were at a higher risk of lower psychosocial well-being than people without disabilities. It is, therefore, of great importance to investigate whether the pandemic has exacerbated this difference.

Objective

This study examines whether people with disabilities (categorized as mobility, vision, hearing, cognitive, and any disabilities) report more COVID-19-related negative effects on psychosocial well-being (loneliness, decreased social contact, decreased hope for the future, concerns about being infected) than people without disabilities.

Methods

We analyzed population-based data from the Finnish Health, Welfare, and Services (FinSote) survey carried out in 2020–2021 (N = 22 165, age 20+). Logistic regression models were applied, controlling for the effects of age, sex, partnership, living alone, and education.

Results

All disability groups, except those with vision disabilities, reported significantly more often that the pandemic increased loneliness than people without disabilities. There were no significant differences between the disability groups and people without disabilities in decreased social contacts. People with only mobility and cognitive disabilities reported significantly more often that the pandemic decreased their hope for the future than those without disabilities. All disability groups were more often concerned about being infected than people without disabilities, but this effect was not significant among people 75 or older.

Conclusion

The psychosocial well-being of people with specific types of disabilities should receive special attention during crises like the COVID-19 pandemic.

Raising employment and quality of life among people with disadvantages - results of a Hungarian project

BACKGROUND

People with disadvantages are a high-risk group of unemployment or underemployment. Disadvantages include disability, under-education, or being a member of a minority, etc. Effective labor market programs could be a key in raising employment and quality of life among this high-risk group of society. The TOP 6.8.2.-15-NA1 project is one of the main Hungarian labor market programs. The project's primary aims are increasing the employability of disadvantaged unemployed and supporting the efficiency of job-seeking.

METHODS

Our goal was to analyze the effects and methodology of the TOP 6.8.2.-15-NA1 project in Hungary. The sample of our study contains participants of the project (n = 300), based in Zala County, Hungary.

RESULTS

After 28 days, 53.3% of participants had a job. At the 180th day status, the rate of employed people was 47.3%. We could identify low-educated participants and older participants as higher-risk groups of long-term unemployment.

CONCLUSIONS

We emphasize the role of these services (job-seeking clubs, organization of job fairs, and mentorship) in the long-term individual success of participants. Improving the employment rate for people with disadvantages is a critical factor for enhancing the quality of life for individuals with disadvantages.

Masculinity and men's health service use across four social generations: Findings from Australia's Ten to Men study

There is a perception that traditional masculine ideals, usually thought deleterious for men's health outcomes, are no longer as relevant for younger social generations such as Millennials as they are for older social generations such as Baby Boomers. Yet, in Australia, there remains a disparity between younger men's and women's health outcomes and use of health services. Conformity to traditional masculinity is often cited as a barrier to men's positive health behaviours but conceptualisation of the construct is contested. We analysed a selected secondary dataset (n = 14,917) of Australian males aged between 15 and 55 years from Ten to Men: The Australian Longitudinal Study on Male Health. We examined the role of conformity to traditional masculine norms in predicting likelihood of regular primary and preventative health services use for different social generations. Analyses included mediated regression and adjusted logistic regression. Conformity to ten of the eleven specific traditional masculine norms predicted likelihood of increased or decreased regular health service use depending on the generation and health service type. Specific traditional masculine norms play a complex role in men's use of distinct health service types for different generations of Australian males. Practitioners wishing to increase men's engagement with health services should consider gender-sensitive approaches that leverage specific masculine norms relevant to the age cohort to drive positive outcomes in men's health.

Can intersectionality help with understanding and tackling health inequalities? Perspectives of professional stakeholders

Background

The concept of “intersectionality” is increasingly employed within public health arenas, particularly in North America, and is often heralded as offering great potential to advance health inequalities research and action. Given persistently poor progress towards tackling health inequalities, and recent calls to reframe this agenda in the United Kingdom and Europe, the possible contribution of intersectionality deserves attention. Yet, no existing research has examined professional stakeholder understandings and perspectives on applying intersectionality to this field.

Methods

In this paper we seek to address that gap, drawing upon a consultation survey and face-to-face workshop (n = 23) undertaken in the United Kingdom. The survey included both researchers (n = 53) and policy and practice professionals (n = 20) with varied roles and levels of engagement in research and evaluation. Topics included familiarity with the term and concept “intersectionality”, relevance to health inequalities work, and issues shaping its uptake. Respondents were also asked to comment on two specific policy suggestions: intersectionally targeting and tailoring interventions, and evaluating the intersectional effects of policies. The workshop aims were to share examples of applying intersectionality within health inequalities research and practice; understand the views of research and practice colleagues on potential contributions and challenges; and identify potential ways to promote intersectional approaches.

Results

Findings indicated a generally positive response to the concept and a cautiously optimistic assessment that intersectional approaches could be valuable. However, opinions were mixed and various challenges were raised, especially around whether intersectionality research is necessarily critical and transformative and, accordingly, how it should be operationalized methodologically. Nonetheless, there was general agreement that intersectionality is concerned with diverse inequalities and the systems of power that shape them.

Conclusions

We position intersectionality within the wider context of health inequalities policy and practice, suggesting potential ways forward for the approach in the context of the United Kingdom. The views of policy and practice professionals suggest that intersectionality has far to travel to help counter individualistic narratives and to encourage an approach that is sensitive to subgroup inequalities and the processes that generate them. Examples of promising practice, albeit mostly in North America, suggest that it is possible for intersectionality to gain traction.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-021-00742-w.

Intersectionality in quantitative health disparities research: A systematic review of challenges and limitations in empirical studies

RATIONALE

Quantitative health disparities research has increasingly employed intersectionality as a theoretical tool to investigate how social characteristics intersect to generate health inequality. Yet, intersectionality was not designed to quantify, predict, or identify health disparities, and, as a result, multiple criticisms against its misapplication in health disparities research have been made. As such, there is an emerging need to evaluate the growing body of quantitative research that aims to investigate health disparities through an intersectional lens.

METHODS

We conducted a systematic review from earliest records to January 2020 to (i) describe the scope of limitations when applying intersectionality to quantitative health disparities research, and (ii) identify recommendations to improve the future integration of intersectionality with this scholarship. We identified relevant publications with electronic searches in PubMed and CA Web of Science. Studies eligible for inclusion were English-language publications that used quantitative methodologies to investigate health disparities among adults in the U.S. while explicitly claiming to adopt an intersectional perspective. Out of 1279 articles reviewed, 65 were eligible for inclusion.

RESULTS

Our review found that, while the value of intersectionality to the study of health disparities is evident, the existing research struggles with meeting intersectionality's fundamental assumptions. In particular, four limitations were found to be widespread: narrowing the measurements of intersectionality, intersectional groups, and health outcomes; placing primacy on the study of certain intersectional groups to the neglect of others; overlooking underlying explanatory mechanisms that contribute to the health disparities experienced by intersectional groups; and, lacking in the use of life-course perspectives to show how health disparities vary across different life stages.

CONCLUSION

If the goal of health equality is to be achieved among diverse intersectional groups, future research must be assisted by the collection and examination of data that overcomes these limitations.

The effect of gender on mental health service use: an examination of mediation through material, social and health-related pathways

PURPOSE

We aimed to understand how much of the gender difference in mental health service use could be due to the joint mediation of employment, behavioural and material factors, social support and mental health need.

METHODS

We used data from employed individuals aged 18-65 years who participated in the 2015-2017 waves of the Household, Income and Labour Dynamics in Australia survey. The exposure (male, female) and confounders were measured in 2015, mediators in 2016 and the outcome-whether a person had seen a mental health professional in the previous year-was measured in 2017. We estimated natural mediation effects using weighted counterfactual predictions from a logistic regression model.

RESULTS

Men were less likely to see a mental health care provider than women. The total causal effect on the risk difference scale was  - 0.045 (95% CI  - 0.056,  - 0,034). The counterfactual of men taking the mediator values of women explained 28% (95% CI 1.7%, 54%) of the total effect, with the natural direct effect estimated to represent an absolute risk difference of  - 0.033 (95% CI  - 0.048,  - 0.018) and the natural indirect effect  - 0.012 (95% CI  - 0.022,  - 0.0027).

CONCLUSION

Gendered differences in the use of mental health services could be reduced by addressing inequalities in health, employment, material and behavioural factors, and social support.