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Berardi C, Antonini M, Jordan Z, Wechtler H, Paolucci F, Hinwood M. Barriers and facilitators to the implementation of digital technologies in mental health systems: a qualitative systematic review to inform a policy framework. BMC Health Serv Res 2024; 24:243. [PMID: 38408938 PMCID: PMC10898174 DOI: 10.1186/s12913-023-10536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 12/28/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Despite the potential for improved population mental health and wellbeing, the integration of mental health digital interventions has been difficult to achieve. In this qualitative systematic review, we aimed to identify barriers and facilitators to the implementation of digital technologies in mental healthcare systems, and map these to an implementation framework to inform policy development. METHODS We searched Medline, Embase, Scopus, PsycInfo, Web of Science, and Google Scholar for primary research articles published between January 2010 and 2022. Studies were considered eligible if they reported barriers and/or facilitators to the integration of any digital mental healthcare technologies. Data were extracted using EPPI-Reviewer Web and analysed thematically via inductive and deductive cycles. RESULTS Of 12,525 references identified initially, 81 studies were included in the final analysis. Barriers and facilitators were grouped within an implementation (evidence-practice gap) framework across six domains, organised by four levels of mental healthcare systems. Broadly, implementation was hindered by the perception of digital technologies as impersonal tools that add additional burden of care onto both providers and patients, and change relational power asymmetries; an absence of resources; and regulatory complexities that impede access to universal coverage. Facilitators included person-cantered approaches that consider patients' intersectional features e.g., gender, class, disability, illness severity; evidence-based training for providers; collaboration among colleagues; appropriate investment in human and financial resources; and policy reforms that tackle universal access to digital health. CONCLUSION It is important to consider the complex and interrelated nature of barriers across different domains and levels of the mental health system. To facilitate the equitable, sustainable, and long-term digital transition of mental health systems, policymakers should consider a systemic approach to collaboration between public and private sectors to inform evidence-based planning and strengthen mental health systems. PROTOCOL REGISTRATION The protocol is registered on PROSPERO, CRD42021276838.
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Affiliation(s)
- Chiara Berardi
- Newcastle Business School, The University of Newcastle, Hunter St & Auckland St, 2300, Newcastle, NSW, Australia.
| | - Marcello Antonini
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Department of Health Policy, London School of Economics and Political Science, London, WC2A 2AE, UK
| | - Zephanie Jordan
- Newcastle Business School, The University of Newcastle, Hunter St & Auckland St, 2300, Newcastle, NSW, Australia
| | - Heidi Wechtler
- Newcastle Business School, The University of Newcastle, Hunter St & Auckland St, 2300, Newcastle, NSW, Australia
| | - Francesco Paolucci
- Newcastle Business School, The University of Newcastle, Hunter St & Auckland St, 2300, Newcastle, NSW, Australia
| | - Madeleine Hinwood
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Talamonti D, Schneider J, Gibson B, Forshaw M. The impact of national and international financial crises on mental health and well-being: a systematic review. J Ment Health 2023:1-38. [PMID: 37934869 DOI: 10.1080/09638237.2023.2278104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/03/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Evidence suggests that financial crises and poor mental health are reciprocally related, but no systematic review has been conducted to synthesise the existing literature on the impact of national and international financial crises on population-level mental health and well-being. AIMS The aim of this study was to systematically review the available literature on the global impact of financial crises on mental health and well-being outcomes. METHODS After registration on PROSPERO, a systematic search was conducted in PsycINFO, MEDLINE, Wiley, and Web of Science for papers published until 21 November 2022. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement, 98 papers were identified as meeting eligibility criteria. Included studies were assessed using the Mixed Methods Appraisal Tool (MMAT) and results were presented in a formal narrative synthesis. RESULTS Our findings show that financial crises are significantly associated with well-being and occurrence of psychological conditions. Several socio-demographic, cultural, and country-specific characteristics played a crucial role in the prevention of population mental health decline in periods of financial crises. CONCLUSIONS Based on the findings of this review, evidence-based recommendations were developed to guide the design of policy actions that protect population mental health during and after financial crises.
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Affiliation(s)
- Deborah Talamonti
- AXDEV Group Inc, Québec, Canada
- Université de Montréal, Montreal, Canada
| | - Jekaterina Schneider
- Centre for Appearance Research, School of Social Sciences, College of Health, Science and Society, University of the West of England, Bristol, UK
| | - Benjamin Gibson
- Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Mark Forshaw
- Department of Psychology, Edge Hill University, Ormskirk, UK
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3
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Andrade CAS, Mahrouseh N, Gabrani J, Charalampous P, Cuschieri S, Grad DA, Unim B, Mechili EA, Chen-Xu J, Devleesschauwer B, Isola G, von der Lippe E, Baravelli CM, Fischer F, Weye N, Balaj M, Haneef R, Economou M, Haagsma JA, Varga O. Inequalities in the burden of non-communicable diseases across European countries: a systematic analysis of the Global Burden of Disease 2019 study. Int J Equity Health 2023; 22:140. [PMID: 37507733 PMCID: PMC10375608 DOI: 10.1186/s12939-023-01958-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Although overall health status in the last decades improved, health inequalities due to non-communicable diseases (NCDs) persist between and within European countries. There is a lack of studies giving insights into health inequalities related to NCDs in the European Economic Area (EEA) countries. Therefore, the aim of the present study was to quantify health inequalities in age-standardized disability adjusted life years (DALY) rates for NCDs overall and 12 specific NCDs across 30 EEA countries between 1990 and 2019. Also, this study aimed to determine trends in health inequalities and to identify those NCDs where the inequalities were the highest. METHODS DALY rate ratios were calculated to determine and compare inequalities between the 30 EEA countries, by sex, and across time. Annual rate of change was used to determine the differences in DALY rate between 1990 and 2019 for males and females. The Gini Coefficient (GC) was used to measure the DALY rate inequalities across countries, and the Slope Index of Inequality (SII) to estimate the average absolute difference in DALY rate across countries. RESULTS Between 1990 and 2019, there was an overall declining trend in DALY rate, with larger declines among females compared to males. Among EEA countries, in 2019 the highest NCD DALY rate for both sexes were observed for Bulgaria. For the whole period, the highest DALY rate ratios were identified for digestive diseases, diabetes and kidney diseases, substance use disorders, cardiovascular diseases (CVD), and chronic respiratory diseases - representing the highest inequality between countries. In 2019, the highest DALY rate ratio was found between Bulgaria and Iceland for males. GC and SII indicated that the highest inequalities were due to CVD for most of the study period - however, overall levels of inequality were low. CONCLUSIONS The inequality in level 1 NCDs DALYs rate is relatively low among all the countries. CVDs, digestive diseases, diabetes and kidney diseases, substance use disorders, and chronic respiratory diseases are the NCDs that exhibit higher levels of inequality across countries in the EEA. This might be mitigated by applying tailored preventive measures and enabling healthcare access.
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Affiliation(s)
- Carlos Alexandre Soares Andrade
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028, Debrecen, Hungary
| | - Nour Mahrouseh
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028, Debrecen, Hungary
| | - Jonila Gabrani
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Periklis Charalampous
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sarah Cuschieri
- Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Diana Alecsandra Grad
- Department of Public Health, Babes-Bolyai University, Cluj-Napoca-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca-Napoca, Romania
| | - Brigid Unim
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore Di Sanità, Rome, Italy
| | - Enkeleint A Mechili
- Department of Healthcare, Faculty of Health, University of Vlora, Vlora, Albania
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Crete, Greece
| | - José Chen-Xu
- Public Health Unit, Primary Healthcare Cluster Baixo Mondego, Coimbra, Portugal
- National School of Public Health, NOVA University of Lisbon, Lisbon, Portugal
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Gaetano Isola
- Department of General Surgery and Surgical Medical Specialties, University of Catania, Catania, Italy
| | - Elena von der Lippe
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | | | - Florian Fischer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nanna Weye
- Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Mirza Balaj
- Department of Sociology and Political Science, Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Romana Haneef
- Department of Non-Communicable Diseases and Injuries, Santé Publique France, Saint-Maurice, France
| | - Mary Economou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Juanita A Haagsma
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Orsolya Varga
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028, Debrecen, Hungary.
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Natsiou K, Karaoulanis SE, Dafopoulos K, Garas A, Bonotis K. The Effect of Socioeconomic Factors on Maternal Perinatal Depressive Symptoms and the Contribution of Group Prenatal Support as a Preventive Measure. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:31-38. [PMID: 36727096 PMCID: PMC9883668 DOI: 10.1089/whr.2022.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/26/2023]
Abstract
Background The European and Greek financial turmoil that began in 2007 has had adverse health consequences. Stillbirth, low birth weight, infant mortality, and maternal suicide have all increased. The purpose of this study was to evaluate whether socioeconomic factors contribute to postpartum blues, and whether psychoprophylaxis with group prenatal education and support may have a beneficial effect. Materials and Methods The sample study comprised 414 pregnant women equally divided into psychoprophylaxis or standard care. There were six psychoprophylaxis sessions, with two each week lasting 2 hours each in groups of five people at the urban health center of Larissa, Greece. A questionnaire was used for data collection, including (1) closed-type questions about sociodemographic characteristics, and medical and obstetric history; (2) the Hamilton Depression Scale; (3) a Blues Questionnaire; (4) the Holmes and Rahe stressful life events scale; and (5) a scale of effects of the economic crisis. Differences between the two groups and within the groups at different time points were assessed by two-way repeated measures ANOVA tests. Results Maternity blues scores, depression scores at all time points, life stress event score, and financial difficulty score were all significantly related to each other in both groups at all time points (p < 0.01). The correlation between financial difficulties and depression/maternity blues disappeared after delivery in the intervention group. Financial difficulties, depression, and psychoprophylaxis sessions emerged as independent prognostic factors of maternity blues score, the group variable being most significantly associated with maternal blues. Conclusion Although financial status as well as depression continued to play a role, the deterrent contribution of psychoprophylaxis was the most important parameter in the final maternity blues prognostic model. The results of our study show a potential for prevention and suggest interesting hypotheses for future interventions.
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Affiliation(s)
- Konstantina Natsiou
- Midwife, Psychoprophylaxis Department, Health Center of Larissa, Larissa, Greece.,Address correspondence to: Konstantina Natsiou, MSc, Midwife, Psychoprophylaxis Department, Health Center of Larissa, Larissa, Greece, Platykampos Larissa, PC 40009, Larissa, Greece,
| | - Sokratis E. Karaoulanis
- Department of Psychiatry, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Konstantinos Dafopoulos
- Department of Obstetrics & Gynecology, Faculty of Medicine, School of Health Science, University of Thessaly, Larissa, Greece
| | - Antonis Garas
- Department of Obstetrics & Gynecology, Faculty of Medicine, School of Health Science, University of Thessaly, Larissa, Greece
| | - Konstantinos Bonotis
- Department of Psychiatry, University Hospital of Larissa, University of Thessaly, Larissa, Greece
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5
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The Effect of the Great Recession on Italian Life Expectancy. POPULATION RESEARCH AND POLICY REVIEW 2023; 42:3. [PMID: 36742059 PMCID: PMC9884069 DOI: 10.1007/s11113-023-09755-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 11/21/2022] [Indexed: 01/30/2023]
Abstract
The 2008 economic crisis, also called the Great Recession, produced only a moderate rise in unemployment in Italy, but the consequences for public debt management were far more serious. Italy makes for a good case study for evaluating the effect on life expectancy at birth of the cost containment program in the health care system, implemented after the crisis began. To this end we employed the Artificial Control method using the data from the Human Mortality Database to assess the causal effect of the 2008 economic crisis on the subsequent evolution of life expectancy at birth (until 2019, before the onset of the COVID-19 pandemic). Our analysis identifies a significant deceleration in the progression of Italian life expectancy. Ten years after the onset of the crisis, Italy appears to have lost almost 1 year of life expectancy with respect to what would have been expected had the crisis never happened.
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Dorn F, Lange B, Braml M, Gstrein D, Nyirenda JLZ, Vanella P, Winter J, Fuest C, Krause G. The challenge of estimating the direct and indirect effects of COVID-19 interventions - Toward an integrated economic and epidemiological approach. ECONOMICS AND HUMAN BIOLOGY 2022; 49:101198. [PMID: 36630757 PMCID: PMC9642024 DOI: 10.1016/j.ehb.2022.101198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 10/26/2022] [Accepted: 11/06/2022] [Indexed: 05/06/2023]
Abstract
Decisions on public health measures to contain a pandemic are often based on parameters such as expected disease burden and additional mortality due to the pandemic. Both pandemics and non-pharmaceutical interventions to fight pandemics, however, produce economic, social, and medical costs. The costs are, for example, caused by changes in access to healthcare, social distancing, and restrictions on economic activity. These factors indirectly influence health outcomes in the short- and long-term perspective. In a narrative review based on targeted literature searches, we develop a comprehensive perspective on the concepts available as well as the challenges of estimating the overall disease burden and the direct and indirect effects of COVID-19 interventions from both epidemiological and economic perspectives, particularly during the early part of a pandemic. We review the literature and discuss relevant components that need to be included when estimating the direct and indirect effects of the COVID-19 pandemic. The review presents data sources and different forms of death counts, and discusses empirical findings on direct and indirect effects of the pandemic and interventions on disease burden as well as the distribution of health risks.
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Affiliation(s)
- Florian Dorn
- ifo Institute - Leibniz Institute for Economic Research, Munich, Germany; Department of Economics, University of Munich (LMU), Germany; CESifo Munich, Germany.
| | - Berit Lange
- Epidemiology Department, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany; Hannover Medical School (MHH), Germany; German Center for Infection Research (DZIF), Braunschweig, Germany
| | - Martin Braml
- ifo Institute - Leibniz Institute for Economic Research, Munich, Germany; World Trade Organization, Economic Research and Statistics Division, Geneva, Switzerland
| | - David Gstrein
- ifo Institute - Leibniz Institute for Economic Research, Munich, Germany; Department of Economics, University of Munich (LMU), Germany
| | - John L Z Nyirenda
- Epidemiology Department, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany; University Hospital Freiburg, University of Freiburg, Germany
| | - Patrizio Vanella
- Epidemiology Department, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany; Hannover Medical School (MHH), Germany; Department of Health Reporting & Biometrics, aQua-Institut, Göttingen, Germany
| | - Joachim Winter
- Department of Economics, University of Munich (LMU), Germany; CESifo Munich, Germany
| | - Clemens Fuest
- ifo Institute - Leibniz Institute for Economic Research, Munich, Germany; Department of Economics, University of Munich (LMU), Germany; CESifo Munich, Germany
| | - Gérard Krause
- Epidemiology Department, Helmholtz Centre for Infection Research (HZI), Braunschweig, Germany; Hannover Medical School (MHH), Germany; German Center for Infection Research (DZIF), Braunschweig, Germany
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7
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Salinari G, Benassi F. The long-term effect of the Great Recession on European mortality. JOURNAL OF POPULATION RESEARCH 2022; 39:417-439. [PMID: 35966415 PMCID: PMC9358630 DOI: 10.1007/s12546-022-09290-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 12/03/2022]
Abstract
Some European countries, such as Greece and Spain, were severely hit by the 2008 economic crisis whereas others, such as Germany, were practically spared by it. This divergence allowed us to implement a difference in differences research design which offered the possibility to observe the long-lasting effects produced by the crisis on European life expectancy. Our analysis—based on Eurostat data from 2001 to 2019—shows that life expectancy increased faster, after the onset of the crisis, in those countries where the rise in unemployment was more intense. Furthermore, our results show that this gain in life expectancy persisted, and sometimes further increased, until 2019 when most macro-economic variables had returned to their pre-crisis values. Previous research has identified that mortality behaves procyclically in developed countries: when the economy slows down mortality decreases and vice versa. Our findings show, by contrast, that life expectancy behaves asymmetrically: it responded to an increase but not to a decrease in unemployment. This calls for a reconsideration of the causal mechanisms linking together the economic cycle and mortality in developed countries.
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8
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Xu Y, Tao R, Mahmood CK, Altuntaş M. Re-Examining the Financial Structure and Health Nexus in Asian Economies. Front Public Health 2022; 10:860325. [PMID: 35309196 PMCID: PMC8931330 DOI: 10.3389/fpubh.2022.860325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/02/2022] [Indexed: 11/21/2022] Open
Abstract
The study's main purpose is to estimate the impact of the financial structure of Asian economies on the healthcare sector from 2000 to 2019. For empirical estimation, we relied on two-stage least square (2SLS) and generalized method of moment (GMM) estimation techniques. Two different proxies, infant mortality and life expectancy, were used in the analysis to represent the health status of the people. The findings of both 2SLS and GMM models confirm that improved financial structure causes life expectancy to rise and infant mortality to fall. Moreover, the increased usage of the internet also exerts a positive impact on the health status of Asians. Further, the rise in gross domestic product (GDP) and health expenditures also improve the health status of Asians by increasing their life expectancy and reducing their infant mortality rate. Improvement in financial structure causes the health status of the people to rise. Therefore, to achieve superior health status, the development of financial structure should be part and parcel of health policies and strategies in Asian economies.
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Affiliation(s)
- Yanling Xu
- School of Business, Wuchang University of Technology, Wuhan, China
| | - Ran Tao
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
- *Correspondence: Ran Tao
| | - Chaudhry Kashif Mahmood
- College of Business Administration, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mehmet Altuntaş
- Department of Economics, Faculty of Economics, Administrative and Social Sciences, Nisantasi University, Istanbul, Turkey
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9
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Saad G. Suicide rates and institutional quality in an emerging country. JOURNAL OF GLOBAL RESPONSIBILITY 2022. [DOI: 10.1108/jgr-07-2021-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study is to investigate the relationship between suicide rates and institutional quality.
Design/methodology/approach
This study used autoregressive distributed lag model and error correction model to examine short-run and long-run relationships during 1996–2017 in Lebanon.
Findings
The study shows that in the long-run, suicide rates are significantly associated to the control of corruption, voice and accountability and rule of law, but not to regulatory quality, political stability and government efficiency. In the short-run, nearly all variables of institutional quality have a negative and significant relationship to suicide rates. Results are discussed in detail.
Originality/value
This research is the first to inspect the relation between the quality of institutions and suicide rates. Empirical results of this study add new evidence to the literature and provide support to policymakers.
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Maleitzke T, Zocholl D, Topp T, Dimitrov-Discher A, Daus E, Reaux G, Zocholl M, Conze RN, Kolster M, Weber P, Fleckenstein FN, Scheutz Henriksen L, Stöckle U, Fuchs T, Gümbel D, Spranger N, Ringk A, Märdian S. Quality and quantity of serious violent suicide attempts during the COVID-19 pandemic. Front Psychiatry 2022; 13:927696. [PMID: 35928775 PMCID: PMC9343723 DOI: 10.3389/fpsyt.2022.927696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND While repeated shutdown and lockdown measures helped contain the spread of SARS-CoV-2 during the COVID-19 pandemic, social distancing and self-isolation negatively impacted global mental health in 2020 and 2021. Although suicide rates did reportedly not increase during the first months of the pandemic, long-term data, and data on the quality of serious violent suicide attempts (SVSAs) are not available to date. MATERIALS AND METHODS Orthopaedic trauma patient visits to the emergency department (ED), ED trauma team activations, and SVSAs were retrospectively evaluated from January 2019 until May 2021 in four Level-I Trauma Centers in Berlin, Germany. SVSAs were assessed for suicide method, injury pattern and severity, type of treatment, and length of hospital stay. RESULTS Significantly fewer orthopaedic trauma patients presented to EDs during the pandemic (n = 70,271) compared to the control (n = 84,864) period (p = 0.0017). ED trauma team activation numbers remained unchanged. SVSAs (corrected for seasonality) also remained unchanged during control (n = 138) and pandemic (n = 129) periods, and no differences were observed for suicide methods, injury patterns, or length of hospital stay. CONCLUSION Our data emphasize that a previously reported rise in psychological stress during the COVID-19 pandemic does not coincide with increased SVSA rates or changes in quality of SVSAs.
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Affiliation(s)
- Tazio Maleitzke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany
| | - Dario Zocholl
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany
| | - Tobias Topp
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Orthopaedic, Trauma, Hand and Reconstructive Surgery, Berlin, Germany
| | - Annika Dimitrov-Discher
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
| | - Elly Daus
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
| | - Gabriel Reaux
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
| | - Malin Zocholl
- Department of Orthopaedic, Trauma, Hand and Reconstructive Surgery, Vivantes Hospital Friedrichshain, Berlin, Germany
| | - Rolf Nicolas Conze
- Department of Orthopaedic, Trauma, Hand and Reconstructive Surgery, Vivantes Hospital Friedrichshain, Berlin, Germany
| | - Moritz Kolster
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Philipp Weber
- Center for Orthopaedics and Trauma Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Florian Nima Fleckenstein
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany.,Department of Growth and Reproduction, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Louise Scheutz Henriksen
- International Centre for Research and Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ulrich Stöckle
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
| | - Thomas Fuchs
- Department of Orthopaedic, Trauma, Hand and Reconstructive Surgery, Vivantes Hospital Friedrichshain, Berlin, Germany
| | - Denis Gümbel
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Nikolai Spranger
- Department of Trauma and Orthopaedic Surgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Alexander Ringk
- Center for Orthopaedics and Trauma Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Sven Märdian
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Musculoskeletal Surgery, Berlin, Germany
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Relationships between Expenditure of Regional Governments and Suicide Mortalities Caused by Six Major Motives in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010084. [PMID: 35010343 PMCID: PMC8751063 DOI: 10.3390/ijerph19010084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 01/02/2023]
Abstract
Suicide mortality in Japan reduced in the period of 2009-2018. A number of studies identified the impact of financial governmental support for social welfare systems on suicide mortality; however, the detailed effects of specific regional policies, designed according to regional cultural, economic, education and welfare situations, on suicide mortality remain to be clarified. Therefore, the present study analyses the associations between the regional governmental expenditure of six major divisions, "public health", "public works", "police", "ambulance/fire services", "welfare" and "education", and suicide mortalities caused by six major suicidal motives, related to "family", "health", "economy", "employment", "romance" and "school", across the 47 prefectures in Japan during the period of 2009-2018, using fixed-effect analysis of hierarchal linear regression with robust standard error. The expenditure of "public works" displayed a positive relationship with suicide mortality of females caused by family-related motives but was not related to other suicide mortalities, whereas the expenditures in "public health", "police", "ambulance/fire services", "welfare" and "education" contributed to a reduction in suicide mortality, at least in some statistical indicators. The expenditures of both "ambulance/fire" and "education" were predominantly effective among the six major divisions of regional governmental expenditure in reducing suicide mortalities. In the education subdivisions, the expenditure of "kindergarten" was related to a reduction in suicide mortalities caused by a wide spectrum of motives. The amount of expenditure of welfare indicated the limited possibility of facilitating a reduction in suicide mortalities caused by only motives associated with economy or employment. However, in the welfare subdivisions, the expenditure of "child welfare" and "social welfare" was effective in reducing suicide mortalities, but the expenditure of "elderly welfare" was unexpectedly related to an increase in suicide mortalities. These results suggest that most Japanese people are struggling to bring up children even in the situation of an increasing elderly population with a decreasing birth rate. Therefore, it is important to enhance the investment welfare policy for the future to improve the childcare environment. Although the issue of an increasing elderly population and a decreasing birth rate in Japan has not yet improved, the obtained results suggest that evidence-based welfare expenditure redistributions of prefectures and municipalities could improve Japanese society and welfare systems.
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Njagi P, Groot W, Arsenijevic J. Impact of household shocks on access to healthcare services in Kenya: a propensity score matching analysis. BMJ Open 2021; 11:e048189. [PMID: 34561259 PMCID: PMC8475159 DOI: 10.1136/bmjopen-2020-048189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 09/13/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study examines the effects of household shocks on access to healthcare services in Kenya. Shocks are adverse events that lead to loss of household income and/or assets. DESIGN AND SETTING The study used data from the Kenya Integrated Household Budget Survey 2015/2016, a nationally representative cross-sectional survey. A propensity score matching approach was applied for the analysis. PARTICIPANTS The study sample included 16 297 individuals from households that had experienced shocks (intervention) and those that had not experienced shocks (control) within the last 12 months preceding the survey. OUTCOME MEASURES The outcome of interest was access to healthcare services based on an individual's perceived need for health intervention. RESULTS The results indicate that shocks reduce access to healthcare services when household members are confronted with an illness. We observed that multiple shocks in a household exacerbate the risk of not accessing healthcare services. Asset shocks had a significant negative effect on access to healthcare services, whereas the effect of income shocks was not statistically significant. This is presumably due to the smoothing out of income shocks through the sale of assets or borrowing. However, considering the time when the shock occurred, we observed mixed results that varied according to the type of shock. CONCLUSIONS The findings suggest that shocks can limit the capacity of households to invest in healthcare services, emphasising their vulnerability to risks and inability to cope with the consequences. These results provoke a debate on the causal pathway of household economic shocks and health-seeking behaviour. The results suggest a need for social protection programmes to integrate mechanisms that enable households to build resilience to shocks. A more viable approach would be to expedite universal health insurance to cushion households from forgoing needed healthcare when confronted with unanticipated risks.
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Affiliation(s)
- Purity Njagi
- Maastricht Graduate School of Governance, UNU-MERIT, Maastricht, The Netherlands
| | - Wim Groot
- Maastricht Graduate School of Governance, UNU-MERIT, Maastricht, The Netherlands
- Department of Health Services Research, Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
| | - Jelena Arsenijevic
- School of Governance, Utrecht University Faculty of Law, Economics and Governance, Utrecht, The Netherlands
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Watts MJ, Sarto i Monteys V, Mortyn PG, Kotsila P. The rise of West Nile Virus in Southern and Southeastern Europe: A spatial-temporal analysis investigating the combined effects of climate, land use and economic changes. One Health 2021; 13:100315. [PMID: 34485672 PMCID: PMC8408625 DOI: 10.1016/j.onehlt.2021.100315] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/18/2021] [Accepted: 08/18/2021] [Indexed: 12/03/2022] Open
Abstract
West Nile Virus (WNV) has recently emerged as a major public health concern in Europe; its recent expansion also coincided with some remarkable socio-economic and environmental changes, including an economic crisis and some of the warmest temperatures on record. Here we empirically investigate the drivers of this phenomenon at a European wide scale by constructing and analyzing a unique spatial–temporal data-set, that includes data on climate, land-use, the economy, and government spending on environmental related sectors. Drivers and risk factors of WNV were identified by building a conceptual framework, and relationships were tested using a Generalized Additive Model (GAM), which could capture complex non-linear relationships and also account for spatial and temporal auto-correlation. Some of the key risk factors identified in our conceptual framework, such as a higher percentage of wetlands and arable land, climate factors (higher summer rainfall and higher summer temperatures) were positive predictors of WNV infections. Interestingly, winter temperatures of between 2 °C and 6 °C were among some of the strongest predictors of annual WNV infections; one possible explanation for this result is that successful overwintering of infected adult mosquitoes (likely Culex pipiens) is key to the intensity of outbreaks for a given year. Furthermore, lower surface water extent over the summer is also associated with more intense outbreaks, suggesting that drought, which is known to induce positive changes in WNV prevalence in mosquitoes, is also contributing to the upward trend in WNV cases in affected regions. Our indicators representing the economic crisis were also strong predictors of WNV infections, suggesting there is an association between austerity and cuts to key sectors, which could have benefited vector species and the virus during this crucial period. These results, taken in the context of recent winter warming due to climate change, and more frequent droughts, may offer an explanation of why the virus has become so prevalent in Europe.
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Affiliation(s)
- Matthew J. Watts
- Institute of Environmental Science and Technology (ICTA), Autonomous University of Barcelona (UAB), Bellaterra, Spain
- Corresponding author.
| | - Victor Sarto i Monteys
- Institute of Environmental Science and Technology (ICTA), Autonomous University of Barcelona (UAB), Bellaterra, Spain
- Departament d’Agricultura, Ramaderia, Pesca, Alimentació i Medi Natural, Generalitat de Catalunya, Avinguda Meridiana, Barcelona, Spain
| | - P. Graham Mortyn
- Institute of Environmental Science and Technology (ICTA), Autonomous University of Barcelona (UAB), Bellaterra, Spain
- Department of Geography, Autonomous University of Barcelona (UAB), Bellaterra, Spain
| | - Panagiota Kotsila
- Institute of Environmental Science and Technology (ICTA), Autonomous University of Barcelona (UAB), Bellaterra, Spain
- Barcelona Laboratory for Urban Environmental Justice and Sustainability (BCNEJ), Institute of Environmental Science and Technology (ICTA), Autonomous University of Barcelona (UAB), Bellaterra, Spain
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Karnecki K, Steiner J, Guest PC, Krzyżanowska M, Mańkowski D, Gos T, Kaliszan M. Epidemiology of suicide in the Tricity metropolitan area in northern Poland 1980–2009: Evidence of influence by political and socioeconomic changes. FORENSIC SCIENCE INTERNATIONAL: REPORTS 2021. [DOI: 10.1016/j.fsir.2021.100219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Ismail N. Rolling back the prison estate: the pervasive impact of macroeconomic austerity on prisoner health in England. J Public Health (Oxf) 2021; 42:625-632. [PMID: 31125072 PMCID: PMC7435213 DOI: 10.1093/pubmed/fdz058] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 04/27/2019] [Accepted: 05/07/2019] [Indexed: 11/25/2022] Open
Abstract
Prisons offer policymakers an opportunity to address the pre-existing high prevalence of physical and mental health issues among prisoners. This notion has been widely integrated into international and national prison health policies, including the Healthy Prisons Agenda, which calls for governments to address the health needs of prisoners and safeguard their health entitlement during imprisonment, and the Sustainable Development Goals 2030 concerning reducing inequality among disadvantaged populations. However, the implementation of the austerity policy in the United Kingdom since the re-emergence of the global financial crisis in 2008 has impeded this aspiration. This interdisciplinary paper critically evaluates the impact of austerity on prison health. The aforementioned policy has obstructed prisoners’ access to healthcare, exacerbated the degradation of their living conditions, impeded their purposeful activities and subjected them to an increasing level of violence. This paper calls for alternatives to imprisonment, initiating a more informed economic recovery policy, and relying on transnational and national organizations to scrutinize prisoners’ entitlement to health. These systemic solutions could act as a springboard for political and policy discussions at national and international forums with regard to improving prisoners’ health and simultaneously meeting the aspirations of the Healthy Prisons Agenda and the Sustainable Development Goals.
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Affiliation(s)
- Nasrul Ismail
- ESRC PhD Researcher in Public Health, Centre for Public Health & Wellbeing, University of the West of England (UWE Bristol), Frenchay Campus, Coldharbour Lane, Bristol, UK
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Ortega-Loubon C, Ruiz López Del Prado G, Muñoz-Moreno MF, Gómez-Sánchez E, López-Herrero R, Sánchez-Quirós B, Lorenzo-Lopez M, Gómez-Pesquera E, Jorge-Monjas P, Bustamante-Munguira J, Álvarez FJ, Resino S, Tamayo E, Heredia-Rodríguez M. Impact of the Economic Crisis on Endocarditis Mortality in Spain: A Nationwide Study. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2021; 52:383-391. [PMID: 33913368 DOI: 10.1177/00207314211012357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Economic recession has dire consequences on overall health. None have explored the impact of economic crisis (EC) on infective endocarditis (IE) mortality. We conducted a retrospective, nationwide, temporal trend study analyzing mortality trends by age, sex, and adverse outcomes in patients diagnosed with IE in Spain from 1997 to 2014. Data were divided into two subperiods: pre-EC (January 1997-August 2008) and post-EC (September 2008-December 2014). A total of 25 952 patients presented with IE. The incidence increased from 301.4 to 365.1 per 10 000 000 habitants, and the mortality rate rose from 24.3% to 28.4%. Those aged >75 years experienced more adverse outcomes. Complications due to sepsis, shock, acute kidney injury requiring dialysis, and heart failure increased after the EC onset, and expenditures soared to €16 216. Expenditure per community was related to mortality (P < .001). The EC resulted as an independent predictor for mortality (hazard ratio 1.06; 95% confidence interval 1.01-1.11). Incidence and mortality rate in patients with IE after the onset of the EC have increased as a result of rising adverse outcomes despite an overall increased investment.
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Affiliation(s)
- Christian Ortega-Loubon
- Clinic University Hospital of Valladolid, Valladolid, Spain.,Group for Biomedical Research in Critical Care Medicine (BioCritic), Valladolid, Spain
| | | | | | - Esther Gómez-Sánchez
- Clinic University Hospital of Valladolid, Valladolid, Spain.,Group for Biomedical Research in Critical Care Medicine (BioCritic), Valladolid, Spain
| | - Rocío López-Herrero
- Clinic University Hospital of Valladolid, Valladolid, Spain.,Group for Biomedical Research in Critical Care Medicine (BioCritic), Valladolid, Spain
| | - Belén Sánchez-Quirós
- Clinic University Hospital of Valladolid, Valladolid, Spain.,Group for Biomedical Research in Critical Care Medicine (BioCritic), Valladolid, Spain
| | - Mario Lorenzo-Lopez
- Clinic University Hospital of Valladolid, Valladolid, Spain.,Group for Biomedical Research in Critical Care Medicine (BioCritic), Valladolid, Spain
| | - Estefanía Gómez-Pesquera
- Clinic University Hospital of Valladolid, Valladolid, Spain.,Group for Biomedical Research in Critical Care Medicine (BioCritic), Valladolid, Spain
| | - Pablo Jorge-Monjas
- Clinic University Hospital of Valladolid, Valladolid, Spain.,Group for Biomedical Research in Critical Care Medicine (BioCritic), Valladolid, Spain
| | | | - F Javier Álvarez
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Valladolid, Spain.,16782University of Valladolid, Valladolid, Spain
| | - Salvador Resino
- Group for Biomedical Research in Critical Care Medicine (BioCritic), Valladolid, Spain.,38176Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Eduardo Tamayo
- Clinic University Hospital of Valladolid, Valladolid, Spain.,Group for Biomedical Research in Critical Care Medicine (BioCritic), Valladolid, Spain
| | - María Heredia-Rodríguez
- Clinic University Hospital of Valladolid, Valladolid, Spain.,Group for Biomedical Research in Critical Care Medicine (BioCritic), Valladolid, Spain
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Experiences of involuntary job loss and health during the economic crisis in Portugal. Porto Biomed J 2021; 6:e121. [PMID: 33884317 PMCID: PMC8055490 DOI: 10.1097/j.pbj.0000000000000121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 11/27/2020] [Indexed: 11/26/2022] Open
Abstract
Background: The economic recession that started in 2008 left many unemployed across several European countries. Many studies have analyzed the relationship between job loss, health, and well-being in other contexts. This study aimed to explore experiences of involuntary unemployment during the economic recession and their relationship with health, conceptualized as a state of physical, mental, and social well-being among unemployed individuals. Methods: Semistructured qualitative interviews were carried out among a convenience sample of participants who became unemployed during the economic recession. The analysis was conducted to identify patterns and themes. Results: Participants (n = 22; 8 men and 14 women; 23–51 years) experienced feelings of loss of identity, stress, and a sense of powerlessness due to unemployment, as well as a lack of purpose and structure in their daily lives. Six themes were identified: work as the basis for life structure and personal fulfillment; response to unemployment and the importance of its duration; unemployment leading to isolation and loss of a role in society; impact of a change in financial situation on social life and consumption patterns; the physical and psychological health consequences of unemployment; and searching for ways to cope with unemployment and to feel well. Conclusions: Losing a job is an adverse experience that impairs an individual's perception of overall health and well-being. From a public health perspective, the results of this study highlight the need for policymakers’ awareness to help mitigate the potential consequences of involuntary job loss in the short- and long-term.
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Abstract
The worldwide economic crisis of the last decade, and still unresolved, led to a great recession involving all major economies. Since economic factors may influence mental wellbeing, not surprisingly a rise in poor mental health was observed in different countries, while representing a great challenge to psychiatric interventions. This paper aims at reviewing the available English literature focusing on the impact of the current economic crisis on mental health, with a special focus on depression and suicide. Available studies indicate that consequences of economic crisis, such as unemployment, increased workload or work reorganization, and reduced staff and wages, may constitute important stressing factors with a negative impact on mental health. Although data are not easily comparable in different countries, depression seems to be the most common psychiatric disorders especially in middle-aged men. Even suicide rates seem to be increased in men, mainly in countries with no public welfare or poor family relationships. All these findings require a careful attention from both governments that cut resources on public health instead of investing in it, and psychiatric associations that should implement appropriate strategies to face and to manage this sort of depression epidemic driven by economic crisis. Again, as available data suggest that the impact of the crisis might have been attenuated in countries with higher spending in social protection, they clearly urge policy makers to take into account possible health externalities associated to inadequate social protection systems.
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Costa C, Freitas A, Almendra R, Santana P. The Association between Material Deprivation and Avoidable Mortality in Lisbon, Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228517. [PMID: 33212953 PMCID: PMC7698341 DOI: 10.3390/ijerph17228517] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/04/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022]
Abstract
There is considerable evidence pointing to the existence of a socioeconomic gradient in mortality, which tends to be steeper in urban areas. Similar to other European cities, Lisbon is far from homogeneous since considerable geographical inequalities exist between the more advantaged and the more deprived neighborhoods. The main goals of this study are to describe the geographical pattern of premature deaths (before 65 years old), avoidable deaths (preventable and amenable to healthcare) and cause-specific mortality (HIV/AIDS and suicide) in Lisbon, at the lower administrative level (civil parish, in Portuguese: Freguesia), and analyze the statistical association between mortality risk and deprivation, before (1999–2003) and during the economic crisis (2008–2012). Smoothed Standardized Mortality Ratios (sSMR) and Relative Risk (RR) with 95% credible intervals were calculated to identify the association between mortality and deprivation. The analysis of the geographical distribution of cause-specific mortality reveals that civil parishes with high sSMR in the first period continued to present higher mortality rates in the second. Moreover, a significant statistical association was found between all the causes of death and deprivation, except suicide. These findings contribute to understanding how social conditions influence health outcomes and can offer insights about potential policy directions for local government.
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Affiliation(s)
- Claudia Costa
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal; (A.F.); (R.A.); (P.S.)
- Correspondence:
| | - Angela Freitas
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal; (A.F.); (R.A.); (P.S.)
| | - Ricardo Almendra
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal; (A.F.); (R.A.); (P.S.)
- Department of Geography and Tourism, University of Coimbra, 3004-530 Coimbra, Portugal
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal; (A.F.); (R.A.); (P.S.)
- Department of Geography and Tourism, University of Coimbra, 3004-530 Coimbra, Portugal
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Palència L, Ferrando J, Marí-Dell'Olmo M, Gotsens M, Morrison J, Dzurova D, Lustigova M, Costa C, Rodríguez-Sanz M, Bosakova L, Santana P, Borrell C. Socio-economic inequalities on cancer mortality in nine European areas: The effect of the last economic recession. Cancer Epidemiol 2020; 69:101827. [PMID: 33038640 DOI: 10.1016/j.canep.2020.101827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND The effect of inequalities aggravated by economic recessions in the mortality rates of certain diseases has been previously described. In this study, we analyzed the relationship between socio-economic deprivation and cancer mortality. We focused on lung, colon, prostate, and breast cancers in nine European urban areas over three periods: two before (2000-2003 and 2004-2008) and one after (2009-2014) the onset of the 2008 financial crisis. METHODS This is an ecological study of trends. The units of analysis were small areas within nine European urban areas. We used a composite deprivation index as a socio-economic indicator. As a mortality indicator, we used the smoothed standardized mortality ratio, calculated using the hierarchical Bayesian model proposed by Besag, York and Mollié. To analyze the evolution of socio-economic inequalities, we fitted an ecological regression model that included the socio-economic indicator, the period of time, and the interaction between these terms. RESULTS In men, socio-economic inequalities in all-cancer and lung cancer mortality were observed in most of the cities studied, but did not increase after the onset of the economic crisis. In women, only two cities (Stockholm and London) showed socio-economic inequalities in all-cancer and lung cancer mortality; there was also no increase in inequalities. CONCLUSIONS Our results did not validate our hypothesis that inequalities increase in times of crisis. However, they emphasize the importance of socio-economic measurements for understanding mortality inequalities, and can be used to inform prevention strategies and help plan local health programs aimed at reducing health inequalities.
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Affiliation(s)
- Laia Palència
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | | | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Joana Morrison
- Institute of Health Equity at the Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Dagmar Dzurova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czechia
| | - Michala Lustigova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czechia
| | - Claudia Costa
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal
| | - Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | - Lucia Bosakova
- Department of Health Psychology and Research Methodology, Medical Faculty, P. J. Safarik University in Kosice, Kosice, Slovak Republic; Olomouc University Social Health Institute (OUSHI), Palacky University in Olomouc, Olomouc, Czech Republic
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain
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Varbanova V, Beutels P. Recent quantitative research on determinants of health in high income countries: A scoping review. PLoS One 2020; 15:e0239031. [PMID: 32941493 PMCID: PMC7498048 DOI: 10.1371/journal.pone.0239031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 08/28/2020] [Indexed: 01/21/2023] Open
Abstract
Background Identifying determinants of health and understanding their role in health production constitutes an important research theme. We aimed to document the state of recent multi-country research on this theme in the literature. Methods We followed the PRISMA-ScR guidelines to systematically identify, triage and review literature (January 2013—July 2019). We searched for studies that performed cross-national statistical analyses aiming to evaluate the impact of one or more aggregate level determinants on one or more general population health outcomes in high-income countries. To assess in which combinations and to what extent individual (or thematically linked) determinants had been studied together, we performed multidimensional scaling and cluster analysis. Results Sixty studies were selected, out of an original yield of 3686. Life-expectancy and overall mortality were the most widely used population health indicators, while determinants came from the areas of healthcare, culture, politics, socio-economics, environment, labor, fertility, demographics, life-style, and psychology. The family of regression models was the predominant statistical approach. Results from our multidimensional scaling showed that a relatively tight core of determinants have received much attention, as main covariates of interest or controls, whereas the majority of other determinants were studied in very limited contexts. We consider findings from these studies regarding the importance of any given health determinant inconclusive at present. Across a multitude of model specifications, different country samples, and varying time periods, effects fluctuated between statistically significant and not significant, and between beneficial and detrimental to health. Conclusions We conclude that efforts to understand the underlying mechanisms of population health are far from settled, and the present state of research on the topic leaves much to be desired. It is essential that future research considers multiple factors simultaneously and takes advantage of more sophisticated methodology with regards to quantifying health as well as analyzing determinants’ influence.
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Affiliation(s)
- Vladimira Varbanova
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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Matsubayashi T, Sekijima K, Ueda M. Government spending, recession, and suicide: evidence from Japan. BMC Public Health 2020; 20:243. [PMID: 32079525 PMCID: PMC7033906 DOI: 10.1186/s12889-020-8264-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 01/22/2020] [Indexed: 01/26/2023] Open
Abstract
Backgrounds Austerity has been shown to have an adverse influence on people’s mental health and suicide rates. Most existing studies have focused on the governments’ reactions to a single event, for example, the Great Recession of 2008. Methods This study focused on significant changes in fiscal policy between 2001 and 2014 in Japan. The size of expenditures by national and local governments decreased dramatically between 2001 and 2006 under the neoliberal reform and then increased after the global economic crisis and the Great East Japan Earthquake. Using the data from 47 prefectures between 2001 and 2014, we tested whether more spending by the local governments was associated with a lower suicide rate in their jurisdiction. We also investigated whether this relationship was particularly salient during a more severe recession. Results Our analysis revealed that an increase of 1% in the per capita local government expenditures was associated with a decrease of 0.2% in the suicide rates among males and females aged between 40 and 64 and that this correlation was strengthened as the unemployment rate increased, particularly among males. Conclusions Government’s reaction to economic crises can either exacerbate or mitigate the negative impact of the economic recession on people’s mental health and suicide rates.
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Affiliation(s)
- Tetsuya Matsubayashi
- Osaka School of International Public Policy, Osaka University, 1-31 Machikaneyama, Toyonaka, Osaka, 560-0043, Japan.
| | - Kozue Sekijima
- Nippon Institute for Research Advancement, Yebisu Garden Place Tower, 34th Floor 4-20-3 Ebisu Shibuya-ku, Tokyo, Japan
| | - Michiko Ueda
- Faculty of Political Science and Economics, Waseda University, 1-6-1 Nishi-waseda Shinjuku, Tokyo, 169-8050, Japan
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Gotsens M, Ferrando J, Marí-Dell’Olmo M, Palència L, Bartoll X, Gandarillas A, Sanchez-Villegas P, Esnaola S, Daponte A, Borrell C. Effect of the Financial Crisis on Socioeconomic Inequalities in Mortality in Small Areas in Seven Spanish Cities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030958. [PMID: 32033162 PMCID: PMC7037194 DOI: 10.3390/ijerph17030958] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/23/2020] [Accepted: 01/30/2020] [Indexed: 01/08/2023]
Abstract
Background: The aim of this study was to analyze the trend in socioeconomic inequalities in mortality in small areas due to several specific causes before (2001–2004, 2005–2008) and during (2009–2012) the economic crisis in seven Spanish cities. Methods: This ecological study of trends, with census tracts as the areas of analysis, was based on three periods. Several causes of death were studied. A socioeconomic deprivation index was calculated for each census tract. For each small area, we estimated standardized mortality ratios, and controlled for their variability using Bayesian models (sSMR). We also estimated the relative risk of mortality according to deprivation in the different cities, periods, and sexes. Results: In general, a similar geographical pattern was found for the socioeconomic deprivation index and sSMR. For men, there was an association in all cities between the deprivation index and all-cause mortality that remained stable over the three periods. For women, there was an association in Barcelona, Granada, and Sevilla between the deprivation index and all-cause mortality in the third period. Patterns by causes of death were more heterogeneous. Conclusions: After the start of the financial crisis, socioeconomic inequalities in total mortality in small areas of Spanish cities remained stable in most cities, although several causes of death showed a different pattern.
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Affiliation(s)
- Mercè Gotsens
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain
| | - Josep Ferrando
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
| | - Marc Marí-Dell’Olmo
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Laia Palència
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Xavier Bartoll
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain
| | - Ana Gandarillas
- Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, 28035 Madrid, Spain
| | - Pablo Sanchez-Villegas
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Observatorio de Salud y Medio Ambiente de Andalucía, Escuela Andaluza de Salud Pública, 18080 Granada, Spain
| | - Santi Esnaola
- Department of Health of the Basque Country, 01006 Vitoria-Gasteiz, Spain
| | - Antonio Daponte
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Observatorio de Salud y Medio Ambiente de Andalucía, Escuela Andaluza de Salud Pública, 18080 Granada, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
- Institut d’Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, 08002 Barcelona, Spain
- Correspondence:
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Demirci Ş, Konca M, Yetim B, İlgün G. Effect of economic crisis on suicide cases: An ARDL bounds testing approach. Int J Soc Psychiatry 2020; 66:34-40. [PMID: 31564187 DOI: 10.1177/0020764019879946] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Suicide events observed in various groups, community or countries, especially in the periods of economic recession. It is thought that suicide cases increase when people's income decreases dramatically and they lose their jobs. AIM/OBJECTIVE In this study, it was aimed to investigate whether the 2008 economic crisis had any effect on suicides in the United States. METHODS Autoregressive distributed lag method was used. For the purpose of the study, the number of suicide-related deaths was taken as the dependent variable, while unemployment rates and 2008 economic crisis were taken as independent variables. FINDINGS The short-term and long-term relationships obtained within the scope of the study indicated that the 2008 economic crisis had a statistically significant effect on suicide cases in the United States. RESULTS AND CONCLUSION It can be said that the results of this study are consistent with the information which emphasizes that economic crises increase suicide cases in the literature.
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Affiliation(s)
- Şenol Demirci
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara, Turkey
| | - Murat Konca
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara, Turkey
| | - Birol Yetim
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara, Turkey
| | - Gülnur İlgün
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara, Turkey
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Palència L, Gotsens M, Marí-Dell'Olmo M, Bosakova L, Burström B, Costa C, Deboosere P, Dzurova D, Lustigova M, Morrison J, Santana P, Borrell C. Effect of the recent economic crisis on socioeconomic inequalities in mortality in nine urban areas in Europe. GACETA SANITARIA 2020; 34:253-260. [PMID: 31983478 DOI: 10.1016/j.gaceta.2019.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/31/2019] [Accepted: 11/05/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To analyse socioeconomic inequalities in all-cause mortality among men and women in nine European urban areas during the recent economic crisis, and to compare the results to those from two periods before the crisis. METHOD This is an ecological study of trends based on three time periods (2000-2003, 2004-2008 and 2009-2014). The units of analysis were the small areas of nine European urban areas. We used a composite deprivation index as a socioeconomic indicator, along with other single indicators. As a mortality indicator, we used the smoothed standardized mortality ratio, calculated using the hierarchical Bayesian model proposed by Besag, York and Mollié. To analyse the evolution of socioeconomic inequalities, we fitted an ecological regression model that included the socioeconomic indicator, the period of time, and the interaction between these terms. RESULTS We observed significant inequalities in mortality among men for almost all the socioeconomic indicators, periods, and urban areas studied. However, no significant changes occurred during the period of the economic crisis. While inequalities among women were less common, there was a statistically significant increase in inequality during the crisis period in terms of unemployment and the deprivation index in Prague and Stockholm, respectively. CONCLUSIONS Future analyses should also consider time-lag in the effect of crises on mortality and specific causes of death, and differential effects between genders.
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Affiliation(s)
- Laia Palència
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Lucia Bosakova
- Department of Health Psychology, Medical Faculty, P.J. Safarik University in Kosice, Kosice, Slovak Republic; Olomouc University Social Health Institute, Palacky University in Olomouc, Olomouc, Czech Republic
| | - Bo Burström
- Department of Public Health Sciences, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden
| | - Cláudia Costa
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal
| | - Patrick Deboosere
- Interface Demography, Section Social Research, Vrije Universiteit Brussels, Brussels, Belgium
| | - Dagmar Dzurova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czech Republic
| | - Michala Lustigova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czech Republic
| | - Joana Morrison
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal; Department of Geography and Tourism, Humanities Faculty, University of Coimbra, Coimbra, Portugal
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
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Thompson K, Ophem JV, Wagemakers A. Studying the impact of the Eurozone's Great Recession on health: Methodological choices and challenges. ECONOMICS AND HUMAN BIOLOGY 2019; 35:162-184. [PMID: 31376735 DOI: 10.1016/j.ehb.2019.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/13/2019] [Accepted: 06/17/2019] [Indexed: 06/10/2023]
Abstract
Europe's Great Recession provides an opportunity to study the impact of increased financial insecurity on health. A number of studies explored the impact of the Recession on health, but they often reached different conclusions. To understand the root of this debate, we undertook a systematic literature review. Articles were analysed thematically based on: geography, data type, operationalisations of wealth and health, and study design. A critical appraisal was also undertaken. Forty-two studies, published from January 2010 to October 2018, were included in our review. Twenty-six of the forty-two studies found that the Great Recession worsened physical health indicators in the Eurozone. In terms of geography, a large concentration of studies focussed on Spain and Greece, indicating that there may be a gap in understanding the health consequences for EU countries with less severe experiences of the Recession. Regarding data type, nearly all studies used secondary datasets, possibly meaning that studies were constrained by the data available. In terms of operationalisations of wealth and health, a majority of studies used single/simple measures of both, so that these multi-faceted concepts were not fully reflected. Further, fewer than half included studies used panel data, with the remaining studies unable to undertake more causal analyses. The results of the critical appraisal showed that lower-quality studies tended to not find a negative impact of the Recession on health, whereas higher quality studies generally did. In future, we recommend conducting cross-country comparisons, using (inter)nationally-representative panel data conducted over a minimum of a ten-year time horizon, and employing multi-faceted operationalisations of wealth and health. This could provide more common ground across studies, and a clearer indication of whether the Recession impacted health.
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Affiliation(s)
- Kristina Thompson
- Department of Health Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands.
| | - Johan van Ophem
- Chair Group Urban Economics, Department of Social Sciences, Wageningen University and Research, Hollandseweg 1, 6706KN Wageningen, the Netherlands
| | - Annemarie Wagemakers
- Chair Group Health and Society, Department of Social Sciences, Wageningen University and Research, Hollandseweg 1, 6706KN Wageningen, the Netherlands
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Health-related quality of life in adult population before and after the onset of financial crisis: the case of Athens, Greece. Qual Life Res 2019; 28:3237-3247. [PMID: 31463726 DOI: 10.1007/s11136-019-02281-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Trends of person-oriented indices with respect to the general population have not been adequately investigated. In Athens, two Health Surveys in 2003 and 2016 provide the opportunity to analyze HRQL in the general adult population. The objectives of this study were to investigate changes in HRQL of adults in the broader area of Athens between 2003 and 2016 and their association with certain socio-demographic determinants. METHODS We compared participants from pre- and during-crisis cross-sectional surveys. We used data from 982 and 1060 adult residents of Athens from 2003 and 2016 surveys, respectively. Income-related missing data were treated using three alternative methods. Subscale and summary component SF-36 scores were compared with Mann-Whitney tests and linear regression analyses were used to estimate the effect of demographic and socio-economic variables on HRQL before and after the onset of crisis. RESULTS The analysis was based on the results of the procedure of handling missing income data as a separate income group and showed that physical component summary score (PCS) has improved and Mental Component Summary score has deteriorated. The most important predictors of HRQL were being widowed and during the crisis not being employed. Additionally, socio-demographic characteristics explained a higher proportion of variance of HRQL after the onset of crisis, especially for PCS. CONCLUSION Decline in mental and improvement in physical HRQL were observed between 2003 and 2016. HRQL has been certainly affected by the recession, but it is difficult to estimate the exact impact of the financial crisis on HRQL.
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López-Contreras N, Rodríguez-Sanz M, Novoa A, Borrell C, Medallo Muñiz J, Gotsens M. Socioeconomic inequalities in suicide mortality in Barcelona during the economic crisis (2006-2016): a time trend study. BMJ Open 2019; 9:e028267. [PMID: 31455702 PMCID: PMC6719772 DOI: 10.1136/bmjopen-2018-028267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES This study aimed to analyse trends in socioeconomic inequalities in suicide mortality in Barcelona before and after the start of the economic crisis that started at the end of 2008, including both individual factors and contextual factors of the deceased's neighbourhood of residence. DESIGN This is a trend study of three time periods: pre-economic crisis (2006-2008), early crisis (2009-2012) and late crisis (2013-2016). SETTING Total Barcelona residents between 2006 and 2016 (≥25 years of age) and death data derived from the Judicial Mortality Registry of Barcelona. PARTICIPANTS 996 deaths by suicide between 2006 and 2016 were analysed. PRIMARY AND SECONDARY OUTCOME MEASURES The outcomes were age-standardised suicide mortality rates and the associations (relative and absolute risk) between suicide mortality and individual and contextual characteristics for the three time periods. RESULTS From 2006 to 2008, men with a lower educational level were more likely to commit suicide than better educated men (relative risk (RR)=1.46; 95% CI 1.11 to 1.91). This difference disappeared after the onset of the crisis. We found no differences among women. From 2013 to 2016, suicide risk increased among men living in neighbourhoods with higher unemployment levels (RR=1.57; 95% CI 1.09 to 2.25) and among women living in neighbourhoods with a higher proportion of elderly people living alone (RR=2.13; 95% CI 1.15 to 3.93). CONCLUSIONS We observed risks for suicide among men living in neighbourhoods of Barcelona with higher unemployment levels and among women living in neighbourhoods with a higher proportion of elderly people living alone. Inequalities in suicide mortality according to educational level tended to disappear during the crisis among men. Thus, it is important to continue to monitor suicide determinants especially in times of economic crisis.
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Affiliation(s)
- Natalia López-Contreras
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Maica Rodríguez-Sanz
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Àrea de Recerca, Docència i Comunicació, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Institut d'Investigació Biomèdica (IIB) de Sant Pau, Barcelona, Spain
| | - Ana Novoa
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Institut d'Investigació Biomèdica (IIB) de Sant Pau, Barcelona, Spain
| | - Carme Borrell
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica (IIB) de Sant Pau, Barcelona, Spain
- Gerència, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Jordi Medallo Muñiz
- Clinical Service, Catalonian Institute of Legal Medicine and Forensic Science, Barcelona, Spain
| | - Mercè Gotsens
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Saez M, Barceló MA, Saurina C, Cabrera A, Daponte A. Evaluation of the Biases in the Studies that Assess the Effects of the Great Recession on Health. A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2479. [PMID: 31336776 PMCID: PMC6678595 DOI: 10.3390/ijerph16142479] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Our main objective was to evaluate the fundamental biases detected in studies assessing the effects the Great Recession had on health for the case of Spain. As secondary objectives we presented methods to control these biases and to discuss the results of the studies in question if they had controlled for them. METHODS We carried out a systematic review of the literature published up to June 2018. We evaluated the biases that could have happened in all the eligible studies. RESULTS From the review, we finally selected 53 studies. Of the studies we reviewed, 60.38% or 32 out of 53, were evaluated as having a high risk of bias. The main biases our review revealed were problems with evaluation, time bias, lack of control of unobserved confounding, and non-exogeneity when defining the onset of the Great Recession. CONCLUSIONS The results from the studies that controlled the biases were quite consistent. Summing up, the studies reviewed found that the Great Recession increased the risk of declaring poor self-rated health and the deterioration of mental health. Both the mortality rate and the suicide rate may well have increased after the Great Recession, probably after a three- to four-year delay.
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Affiliation(s)
- Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, 17003 Girona, Spain.
- Network Biomedical Research Center of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain.
| | - Maria Antònia Barceló
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, 17003 Girona, Spain
- Network Biomedical Research Center of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Carme Saurina
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, 17003 Girona, Spain
- Network Biomedical Research Center of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Andrés Cabrera
- Network Biomedical Research Center of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Andalusian School of Public Health, 18080 Granada, Spain
- Instituto de Investigación Biosanitaria (IBS), Hospital Universitario de Granada, Universidad de Granada, 18014 Granada, Spain
| | - Antonio Daponte
- Network Biomedical Research Center of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Andalusian School of Public Health, 18080 Granada, Spain
- Instituto de Investigación Biosanitaria (IBS), Hospital Universitario de Granada, Universidad de Granada, 18014 Granada, Spain
- Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), 18080 Granada, Spain
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Hunter PR, Colón-González FJ, Brainard J, Majuru B, Pedrazzoli D, Abubakar I, Dinsa G, Suhrcke M, Stuckler D, Lim TA, Semenza JC. Can economic indicators predict infectious disease spread? A cross-country panel analysis of 13 European countries. Scand J Public Health 2019; 48:351-361. [PMID: 31291826 DOI: 10.1177/1403494819852830] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: It is unclear how economic factors impact on the epidemiology of infectious disease. We evaluated the relationship between incidence of selected infectious diseases and economic factors, including economic downturn, in 13 European countries between 1970 and 2010. Methods: Data were obtained from national communicable disease surveillance centres. Negative binomial forms of the generalised additive model (GAM) and the generalised linear model were tested to see which best reflected transmission dynamics of: diphtheria, pertussis, measles, meningococcal disease, hepatitis B, gonorrhoea, syphilis, hepatitis A and salmonella. Economic indicators were gross domestic product per capita (GDPpc), unemployment rates and (economic) downturn. Results: GAM models produced the best goodness-of-fit results. The relationship between GDPpc and disease incidence was often non-linear. Strength and directions of association between population age, tertiary education levels, GDPpc and unemployment were disease dependent. Overdispersion for almost all diseases validated the assumption of a negative binomial relationship. Downturns were not independently linked to disease incidence. Conclusions: Social and economic factors can be correlated with many infections. However, the trend is not always in the same direction, and these associations are often non-linear. Economic downturn or recessions as indicators of increased disease risk may be better replaced by GDPpc or unemployment measures.
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Affiliation(s)
| | | | | | | | - Debora Pedrazzoli
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
| | | | - Girmaye Dinsa
- T.H. Chan School of Public Health, Harvard University, USA
| | - Marc Suhrcke
- Centre for Health Economics, University of York, UK
| | | | - Tek-Ang Lim
- Science and International Office, French Public Health Agency, France
| | - Jan C Semenza
- European Centre for Disease Prevention and Control (ECDC), Sweden
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Moreno-Lostao A, Barrio G, Sordo L, Cea-Soriano L, Martínez D, Regidor E. Mortality in working-age population during the Great Recession and austerity in Spain. PLoS One 2019; 14:e0218410. [PMID: 31247019 PMCID: PMC6597056 DOI: 10.1371/journal.pone.0218410] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/31/2019] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To analyze the mortality trend in Spain before, during and after the economic crisis and austerity policies in the working-age population. METHODS From 2005 to 2016 we calculated the annual all-cause mortality rate and the annual mortality rate from the main causes of death in the population aged 15 to 64. We also estimated the linear trends in mortality rates during four time intervals-2005-2007 (before crisis), 2008-2010 (first part of the crisis), 2011-2013 (second part of the crisis and implementation of austerity policies) and 2014-2016 (after the crisis)- by the annual percentage change (APC). RESULTS The all-cause mortality rate in men and women showed the greatest decline in 2008-2010 and the smallest decline in 2014-2016. The decline in 2011-2013 was higher than in 2014-2016. The APCs in 2005-2007, 2008-2010, 2011-2013 and 2014-2016 were -2.8, -4.1, -3.0 and -1.5 in men and -1.0. -2.1, -1.1 and -0.6 in women, respectively, although the APC in 2014-2016 in women was not significant. In 2014-2016, cancer mortality showed the largest decrease, mortality from cardiovascular diseases (men), respiratory diseases and traffic accidents reversed and showed an upward trend, and the downward trend in mortality from infectious diseases and digestive diseases was equal to or greater than that observed before the crisis. CONCLUSION The decline in all-cause mortality in the working-age population during the economic crisis and the introduction of austerity measures was greater than that observed before and after the economic crisis. The slowing of the decline after the crisis was due to the reversal of the trend in mortality from cardiovascular and respiratory diseases.
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Affiliation(s)
| | - Gregorio Barrio
- Health National School, Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Sordo
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Lucía Cea-Soriano
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - David Martínez
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Enrique Regidor
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Regidor E, Mateo A, Barrio G, Fuente LDL. Mortality in Spain in the Context of the Economic Crisis and Austerity Policies. Am J Public Health 2019; 109:1043-1049. [PMID: 31095411 DOI: 10.2105/ajph.2019.305075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To analyze the mortality trend in Spain before, during, and after the economic crisis and austerity policies. Methods. We calculated age-standardized annual mortality rates in 2001 through 2016 and estimated linear trends in mortality rates during 4 periods (2001-2007, 2008-2010, 2011-2013, and 2014-2016) using the annual percentage change (APC). Results. All-cause mortality rate decreased during the period 2001 to 2016, although we found increases over the previous year. After adjusting for increased influenza activity (P = .743) and heat waves (P = .473), we found the greatest declines during the economic crisis (2008-2010) and the smallest in the period 2014 to 2016, in which the APC in mortality rates was -2.9 and -0.6, respectively. The APC before the crisis (2001-2007) and during austerity (2011-2013) was -2.0 and -2.2, respectively. We observed similar results in mortality from cardiovascular, respiratory, and digestive diseases and motor vehicle accidents. Mortality from cancer showed the smallest decline during the crisis and the austerity period, whereas suicide increased in the period 2011 to 2013. Conclusions. Lifestyle changes could explain the decline in mortality during the economic crisis. Increased influenza activity and the 2015 heat wave may prevent identifying a possible delayed effect of austerity policies in the slowing down of mortality decline in the period 2014 to 2016.
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Affiliation(s)
- Enrique Regidor
- Enrique Regidor is with the Department of Public Health and Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain, CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid. Alberto Mateo is with the National Epidemiology Center, Instituto de Salud Carlos III, Madrid, and the School of Public Health, Health Education North West, Manchester, UK. Gregorio Barrio is with the National School of Public Health, Instituto de Salud Carlos III, Madrid. Luis de la Fuente is with the National Epidemiology Center, Instituto de Salud Carlos III, Madrid, and CIBERESP, Madrid
| | - Alberto Mateo
- Enrique Regidor is with the Department of Public Health and Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain, CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid. Alberto Mateo is with the National Epidemiology Center, Instituto de Salud Carlos III, Madrid, and the School of Public Health, Health Education North West, Manchester, UK. Gregorio Barrio is with the National School of Public Health, Instituto de Salud Carlos III, Madrid. Luis de la Fuente is with the National Epidemiology Center, Instituto de Salud Carlos III, Madrid, and CIBERESP, Madrid
| | - Gregorio Barrio
- Enrique Regidor is with the Department of Public Health and Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain, CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid. Alberto Mateo is with the National Epidemiology Center, Instituto de Salud Carlos III, Madrid, and the School of Public Health, Health Education North West, Manchester, UK. Gregorio Barrio is with the National School of Public Health, Instituto de Salud Carlos III, Madrid. Luis de la Fuente is with the National Epidemiology Center, Instituto de Salud Carlos III, Madrid, and CIBERESP, Madrid
| | - Luis de la Fuente
- Enrique Regidor is with the Department of Public Health and Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain, CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, and Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid. Alberto Mateo is with the National Epidemiology Center, Instituto de Salud Carlos III, Madrid, and the School of Public Health, Health Education North West, Manchester, UK. Gregorio Barrio is with the National School of Public Health, Instituto de Salud Carlos III, Madrid. Luis de la Fuente is with the National Epidemiology Center, Instituto de Salud Carlos III, Madrid, and CIBERESP, Madrid
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Ballester J, Robine JM, Herrmann FR, Rodó X. Effect of the Great Recession on regional mortality trends in Europe. Nat Commun 2019; 10:679. [PMID: 30737401 PMCID: PMC6368579 DOI: 10.1038/s41467-019-08539-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/16/2019] [Accepted: 01/17/2019] [Indexed: 11/08/2022] Open
Abstract
Previous studies have consistently shown the recurrent relationship between macroeconomic cycles and changes in mortality trends, so that recessions are generally associated with periods of faster life expectancy rise, and periods of economic growth with slower reductions or even increases in mortality trends. Here we analyze the link between annual per capita estimates of gross domestic product and daily atmospheric temperatures and standardized death rates for a large ensemble of European regions to describe the effect of the Great Recession on annual and seasonal changes in all-cause human mortality trends. Results show that the countries and regions with the largest (smallest) economic slowdown were also those with the largest (smallest) strengthening of the declining mortality trend. This procyclical evolution of mortality rates is found to be stronger during the cold part of the year, showing that it also depends on the seasonal timing of the underlying causes of death.
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Affiliation(s)
- Joan Ballester
- Climate and Health Program, Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain.
| | - Jean-Marie Robine
- Institut National de la Santé et de la Recherche Médicale (INSERM), Montpellier, France
- École Pratique des Hautes Études, Paris, France
| | - François R Herrmann
- Division of Geriatrics, Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Thonex, Switzerland
| | - Xavier Rodó
- Climate and Health Program, Barcelona Institute for Global Health (ISGlobal), Barcelona, Catalonia, Spain
- ICREA, Barcelona, Catalonia, Spain
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Brzezinski M. What accounts for the rise of low self-rated health during the recent economic crisis in Europe? Int J Equity Health 2019; 18:21. [PMID: 30691481 PMCID: PMC6350338 DOI: 10.1186/s12939-019-0926-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 01/21/2019] [Indexed: 11/11/2022] Open
Abstract
Background A growing literature investigates health effects of the recent economic crisis. This study examines how different economic mechanisms affected low self-rated health (SRH) in Europe over the crisis period (2008–2011). We measure changes in low SRH over 2008–2011 and analyze how they are accounted for by changes in household income levels and income distribution (income poverty, income inequality), labour market developments (increasing unemployment, falling employment, changes in labour market inactivity), and non-income poverty (material deprivation). Methods We use balanced panel data for 2008–2011 covering 26 European countries and 43,456 participants. The data come from longitudinal 2011 European Union Statistics on Income and Living Conditions (EU-SILC) database. Increases in low SRH incidence over time are decomposed into the contributions of changes in the distribution of covariates and changes in returns to the covariates. Main covariates include household income and its distribution, labour market developments, and non-income poverty (material deprivation). The decompositions are performed using a detailed non-linear multivariate regression-based decomposition methodology. Results Low SRH incidence increased in Europe during the crisis by almost 2 percentage points, and by 3.7 percentage points in case of the Baltic countries. Decomposition analysis shows that: 1) decreasing household incomes and changing income distribution had no impact on low SRH incidence, 2) rise of material deprivation accounts for a significant portion (12%) of the overall growth in low SRH rates (27% for the Baltic countries), 3) decreasing levels of full-time and part-time employment as well as transitions to unemployment, economic inactivity, disability, or retirement account jointly for about 21% of the rise in low SRH in Europe (73% for Baltic countries). Conclusion Together, the recession-related economic factors account for about 33% of the increase in low SRH incidence in Europe during the crisis, and for about 100% of the increase in the Baltic countries. Public health policy during recessions should focus also on reducing material deprivation through free or subsidized access to public services, public housing, and other means. Electronic supplementary material The online version of this article (10.1186/s12939-019-0926-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michal Brzezinski
- Faculty of Economic Sciences, University of Warsaw, Dluga 44/50, 00-241, Warsaw, Poland.
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Thomson RM, Niedzwiedz CL, Katikireddi SV. Trends in gender and socioeconomic inequalities in mental health following the Great Recession and subsequent austerity policies: a repeat cross-sectional analysis of the Health Surveys for England. BMJ Open 2018; 8:e022924. [PMID: 30166307 PMCID: PMC6119415 DOI: 10.1136/bmjopen-2018-022924] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE It is known that mental health deteriorated following the 2008 global financial crisis, and that subsequent UK austerity policies post-2010 disproportionately impacted women and those in deprived areas. We aimed to assess whether gender and socioeconomic inequalities in poor mental health have changed since the onset of austerity policies. DESIGN Repeat cross-sectional analysis of survey data. SETTING England. PARTICIPANTS Nationally and regionally representative samples of the working-age population (25-64 years) from the Health Survey for England (1991-2014). OUTCOME MEASURES Population-level poor mental health was measured by General Health Questionnaire-12 (GHQ) caseness, stratified by gender and socioeconomic position (area-level deprivation and highest educational attainment). RESULTS The prevalence of age-adjusted male GHQ caseness increased by 5.9% (95% CI 3.2% to 8.5%, p<0.001) from 2008 to 2009 in the immediate postrecession period, but recovered to prerecession levels after 2010. In women, there was little change in 2009 or 2010, but an increase of 3.0% (95% CI 1.0% to 5.1%, p=0.004) in 2012 compared with 2008 following the onset of austerity. Estimates were largely unchanged after further adjustment for socioeconomic position, employment status and household income as potential mediators. Relative socioeconomic inequalities in GHQ caseness narrowed from 2008 to 2010 immediately following the recession, with Relative Index of Inequality falling from 2.28 (95% CI 1.89 to 2.76, p<0.001) to 1.85 (95% CI 1.43 to 2.38, p<0.001), but returned to prerecession levels during austerity. CONCLUSIONS Gender inequalities in poor mental health narrowed following the Great Recession but widened during austerity, creating the widest gender gap since 1994. Socioeconomic inequalities in poor mental health narrowed immediately postrecession, but this trend may now be reversing. Austerity policies could contribute to widening mental health inequalities.
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Affiliation(s)
- Rachel M Thomson
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Public Health Department, NHS Ayrshire & Arran, Ayr, UK
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Alves L, Stringhini S, Barros H, Azevedo A, Marques-Vidal P. Inequalities in obesity in Portugal: regional and gender differences. Eur J Public Health 2018; 27:775-780. [PMID: 28407055 DOI: 10.1093/eurpub/ckx041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Obesity levels vary considerably according to geographical region and socio-economic status. We evaluated the prevalence of obesity by education and occupational position across seven Portuguese regions. Relative and absolute inequalities in obesity were also assessed. Methods Data was drawn from the Portuguese Health Survey 2005/6 (26 674 adults, 46.6% women). Education was categorized as ≤4, 5-11 and ≥12 complete years of education. Occupational position was grouped as upper white collar, lower white collar and blue collar. The Relative Index of Inequality (RII) and the Slope Index of Inequality (SII) were used to quantify relative and absolute inequalities in obesity, respectively. Results In women, prevalence of obesity ranged between 10.0% (Algarve) and 20.3% (Azores); in men, it ranged between 13.3% (Algarve) and 16.4% (Lisbon). In women, the educational RII (95% confidence interval) ranged between 2.4 (1.1 to 5.1) in the Centre and 6.6 (3.0 to 14.2) in Alentejo, and the SII (95% CI) between 9.7 (-1.3 to 20.7) and 33.0 (26.0 to 40.0), respectively. In men, the RII ranged between 0.8 (0.4 to 1.5) in Madeira and 1.9 (1.0 to 4.5) in the Centre, and the SII between -8.3 (-19.0 to 2.5) and 9.5 (-0.1 to 19.1), respectively. Occupational RIIs were similar to those for education, although somewhat lower. Conclusion In Portugal, large educational and occupational inequalities in obesity are observed, but they vary considerably by region and are larger among women than men.
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Affiliation(s)
- Luís Alves
- EPIUnit - Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal.,Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
| | - Silvia Stringhini
- Institute of Social and Preventive Medicine (IUMSP), University Hospital Centre, Biopole 2, Lausanne, Switzerland
| | - Henrique Barros
- EPIUnit - Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal.,Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Ana Azevedo
- EPIUnit - Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal.,Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Kim C. The Impacts of Social Protection Policies and Programs on Suicide: A Literature Review. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2018; 48:512-534. [PMID: 29614903 DOI: 10.1177/0020731418767548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite vigorous interest in showing the association between economic determinants and suicide, not many studies have focused on the social protection that can moderate the detrimental impact of the economic environment on suicide. This article is the first to review the relationship between suicide and social protection. In this article, I summarize the empirical findings and theoretical approaches in published papers on the relationship between suicide and social protection, and I identify knowledge gaps for future studies. The review included all quantitative and qualitative articles published in peer-reviewed journals, regardless of study setting, language, and time period. Among 19 papers meeting the inclusion criteria, 16 studies reported at least one negative association, 2 studies failed to prove a statistical association, and 1 study showed ambiguous results. However, due to the heterogeneity of contexts, the diversity of indicators of social protection, and the paucity of theoretical mechanisms for interpreting the results, further research is required in this area.
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Affiliation(s)
- Chungah Kim
- 1 Department of Health Policy, McMaster University, Hamilton, Ontario, Canada
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Abstract
RESUMO Objetivo Identificar padrões de tendências do suicídio registrado em Portugal, tendo em conta um conjunto de variáveis socioeconômicas e demográficas entre os anos 2007 e 2014, de modo a obter uma visão geral desse flagelo em Portugal. Métodos Recorrendo a dados do Instituto Nacional de Estatística (INE) e do Sistema de Informação dos Certificados de Óbito (SICO), foi analisado o suicídio segundo a categoria do CID-10 (Classificação Internacional de Doenças), examinando-se as incidências por gênero, faixa etária e região. Resultados Os mais acometidos pelo suicídio são homens (54,8%), com idade superior a 75 anos (30,9%), e ele ocorre nas zonas economicamente mais desfavorecidas. A mortalidade por suicídio mais elevada encontra-se na região do Alentejo (12,8%). Conclusão A mortalidade por suicídio continua a crescer em Portugal e varia em função do gênero e idade, sendo mais elevada nas regiões do Centro e Sul. É necessária uma estratégia de acompanhamento e de prevenção no âmbito da ação social e dos cuidados de saúde, com importantes variações regionais, e maior vigilância sobre a comercialização ilegal de armas de fogo e de pesticidas.
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Ferrando J, Palència L, Gotsens M, Puig-Barrachina V, Marí-Dell'Olmo M, Rodríguez-Sanz M, Bartoll X, Borrell C. Trends in cancer mortality in Spain: the influence of the financial crisis. GACETA SANITARIA 2018; 33:229-234. [PMID: 29452751 DOI: 10.1016/j.gaceta.2017.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine if the onset of the economic crisis in Spain affected cancer mortality and mortality trends. METHOD We conducted a longitudinal ecological study based on all cancer-related deaths and on specific types of cancer (lung, colon, breast and prostate) in Spain between 2000 and 2013. We computed age-standardised mortality rates in men and women, and fit mixed Poisson models to analyse the effect of the crisis on cancer mortality and trends therein. RESULTS After the onset of the economic crisis, cancer mortality continued to decline, but with a significant slowing of the yearly rate of decline (men: RR = 0.987, 95%CI = 0.985-0.990, before the crisis, and RR = 0.993, 95%CI = 0.991-0.996, afterwards; women: RR = 0.990, 95%CI = 0.988-0.993, before, and RR = 1.002, 95%CI = 0.998-1.006, afterwards). In men, lung cancer mortality was reduced, continuing the trend observed in the pre-crisis period; the trend in colon cancer mortality did not change significantly and continued to increase; and the yearly decline in prostate cancer mortality slowed significantly. In women, lung cancer mortality continued to increase each year, as before the crisis; colon cancer continued to decease; and the previous yearly downward trend in breast cancer mortality slowed down following the onset of the crisis. CONCLUSIONS Since the onset of the economic crisis in Spain the rate of decline in cancer mortality has slowed significantly, and this situation could be exacerbated by the current austerity measures in healthcare.
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Affiliation(s)
| | - Laia Palència
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain.
| | | | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain
| | - Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain; Departamento de Ciencias Experimentales y de la Salud, Facultad de Ciencias de la Salud y de la Vida, Universitat Pompeu Fabra, Barcelona, Spain
| | - Xavier Bartoll
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica IIB Sant Pau, Barcelona, Spain; Departamento de Ciencias Experimentales y de la Salud, Facultad de Ciencias de la Salud y de la Vida, Universitat Pompeu Fabra, Barcelona, Spain
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Abstract
Health care is one of the key essential services to be traditionally impacted by financial turbulences. The Government of India announced the demonetization of INR 500 and INR 1000 currency notes in November 2016 to curb corruption and introduce economic transparency. The present commentary analyzes the impact of this economic reform on the availability/delivery of health-care services and also its transient effect on the general population availing such services during the first 2 weeks post demonetization. While print and electronic media indicated initial setback and displeasure with reference to delivery and access of health-care services, personal interaction with caregivers or patients suggested that there was no lasting adverse effect on health-care delivery. In fact, the enthusiasm for a cleaner economy meant for the greater good of the country prevailed among the general public and allowed them to bear these hardships. Our assessment suggests that demonetization and its consequential transition were viewed favorably. Financial and economic reforms initiated in the national interest can therefore be managed well with public support.
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Affiliation(s)
- Sanghamitra Pati
- Department of Health Research, ICMR- Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Economou M, Souliotis K, Peppou LE, Agapidaki I, Tzavara C, Stefanis CN. Major depression in Cyprus amid financial crisis: prevalence and correlates. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/17542863.2017.1364283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Marina Economou
- Community Mental Health Centre, University Mental Health Research Institute (UMHRI), Athens, Greece
- First Department of Psychiatry, Medical School, National & Kapodistrian University, Athens, Greece
| | - Kyriakos Souliotis
- Faculty of Social and Political Sciences, University of Peloponnese, Corinth, Greece
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National & Kapodistrian University, Athens, Greece
| | - Lily Evangelia Peppou
- Community Mental Health Centre, University Mental Health Research Institute (UMHRI), Athens, Greece
| | - Irene Agapidaki
- Centre for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National & Kapodistrian University, Athens, Greece
| | - Chara Tzavara
- Community Mental Health Centre, University Mental Health Research Institute (UMHRI), Athens, Greece
| | - Costas N. Stefanis
- Community Mental Health Centre, University Mental Health Research Institute (UMHRI), Athens, Greece
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Nelson K, Tøge AG. Health trends in the wake of the financial crisis—increasing inequalities? Scand J Public Health 2017; 45:22-29. [DOI: 10.1177/1403494817707088] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: The financial crisis that hit Europe in 2007–2008 and the corresponding austerity policies have generated concern about increasing health inequalities, although impacts have been less salient than initially expected. One explanation could be that health inequalities emerged first a few years into the crisis. This study investigates health trends in the wake of the financial crisis and analyses health inequalities across a number of relevant population subgroups, including those defined by employment status, age, family type, gender, and educational attainment. Methods: This study uses individual-level panel data (EU-SILC, 2010–2013) to investigate trends in self-rated health. By applying individual fixed effects regression models, the study estimates the average yearly change in self-rated health for persons aged 15–64 years in 28 European countries. Health inequalities are investigated using stratified analyses. Results: Unemployed respondents, particularly those who were unemployed in all years of observation, had a steeper decline in self-rated health than the employed. Respondents of prime working age (25–54 years) had a steeper decline than their younger (15–24) and older (55–64) counterparts, while single parents had a more favorable trend in self-rated health than dual parents. We did not observe any increasing health inequalities based on gender or educational attainment. Conclusions: Health inequalities increased in the wake of the financial crisis, especially those associated with employment status, age, and family type. We did not observe increasing health inequalities in terms of levels of educational attainment and gender.
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Affiliation(s)
- Kenneth Nelson
- The Swedish Institute for Social Research, Stockholm University, Stockholm
| | - Anne Grete Tøge
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Malard L, Chastang JF, Niedhammer I. Évolution des comportements et indicateurs de santé mentale entre 2006 et 2010 dans la population au travail en France. Rev Epidemiol Sante Publique 2017. [DOI: '10.1016/j.respe.2017.04.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Malard L, Chastang JF, Niedhammer I. [Changes in behaviors and indicators of mental health between 2006 and 2010 in the French working population]. Rev Epidemiol Sante Publique 2017; 65:309-320. [PMID: 28601504 DOI: 10.1016/j.respe.2017.04.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 12/02/2016] [Accepted: 04/03/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The 2008 economic crisis may have had an impact on mental health but the studies on this topic are sparse, in particular among the working population. However, mental health at work is a crucial issue involving substantial costs and consequences. The aim of the study was to assess changes in behaviors and indicators of mental health in the French working population between 2006 and 2010, and to explore the differential changes according to age, origin, occupation, activity sector, public/private sector, self-employed/employee status and work contract. METHODS The data came from the prospective national representative Santé et itinéraire professionnel (SIP) survey, including a sample of 5600 French workers interviewed in 2006 and 2010. The behaviors and indicators of mental health studied were excessive alcohol consumption, smoking, sleep problems (sleep disorders and/or insufficient sleep duration), psychotropic drug use (antidepressants, anxiolytics and/or hypnotics), and poor self-reported health. Generalized estimating equations were used to analyze changes in behaviors and indicators of mental health, and the analyses were adjusted for age. Covariates (age, origin, occupation, activity sector, public/private sector, self-employed/employee status and type of contract) were added separately to assess differential changes. RESULTS Increases in excessive alcohol consumption among women, sleep problems among men, and smoking, insufficient sleep duration and poor self-reported health for both genders were observed in the French working population between 2006 and 2010. Some differential changes were observed, negative changes being more likely to affect young workers and workers with a permanent contract. CONCLUSION Prevention policies should consider that behavior and indicators of mental health may deteriorate in times of economic crisis, especially among some sub-groups of the working population, such as young workers and workers with a permanent contract. These changes might foreshadow a forthcoming increase in mental disorders.
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Affiliation(s)
- L Malard
- Inserm, UMR_S 1136, Institut Pierre-Louis d'épidémiologie et de santé publique, Équipe de recherche en épidémiologie sociale, 75013 Paris, France; Institut Pierre-Louis d'épidémiologie et de santé publique, Équipe de recherche en épidémiologie sociale, Sorbonne universités, UPMC université Paris 06, UMR S 1136, 75013 Paris, France; Université de Versailles-Saint-Quentin, 78000 Versailles, France
| | - J-F Chastang
- Inserm, UMR_S 1136, Institut Pierre-Louis d'épidémiologie et de santé publique, Équipe de recherche en épidémiologie sociale, 75013 Paris, France; Institut Pierre-Louis d'épidémiologie et de santé publique, Équipe de recherche en épidémiologie sociale, Sorbonne universités, UPMC université Paris 06, UMR S 1136, 75013 Paris, France
| | - I Niedhammer
- Inserm, UMR_S 1136, Institut Pierre-Louis d'épidémiologie et de santé publique, Équipe de recherche en épidémiologie sociale, 75013 Paris, France; Institut Pierre-Louis d'épidémiologie et de santé publique, Équipe de recherche en épidémiologie sociale, Sorbonne universités, UPMC université Paris 06, UMR S 1136, 75013 Paris, France.
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The relationship of the perceived impact of the current Greek recession with increased suicide risk is moderated by mental illness in patients with long-term conditions. J Psychosom Res 2017; 96:98-105. [PMID: 28545799 DOI: 10.1016/j.jpsychores.2017.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 03/20/2017] [Accepted: 03/21/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Adverse life events may contribute to the emergence of suicidality. We aimed to test the relationship between the impact of the Greek recession and suicidal risk in people with long-term conditions (LTCs) and to determine whether this relationship is moderated by the presence of a mental disorder. METHODS Suicidal risk (RASS) and crisis parameters were assessed in a cross-sectional survey including 376 patients with LTCs (type-II diabetes mellitus, rheumatological disorders and chronic obstructive pulmonary disease) attending the Emergency Department or specialty clinics. A diagnosis of mental disorder was confirmed by the Mini International Neuropsychiatric Interview (MINI) interview. Hierarchical regression models were used to quantify moderator effects. RESULTS Suicidal risk was significantly associated with the perceived impact of the recession (p=0.028). However, moderation analysis showed that this relationship was significant only in those diagnosed with either major depressive disorder or generalized anxiety disorder. CONCLUSIONS These findings suggest that the perceived impact of the current Greek recession is not correlated with suicidal risk per se, but the recession may act as precipitator in combination with other risk factors, such as the presence of a mental illness, thus supporting the importance of early diagnosis and treatment of mental disorders in vulnerable groups.
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Tziatzios G, Gkolfakis P, Dimitriadis GD, Triantafyllou K. Long-term effects of video capsule endoscopy in the management of obscure gastrointestinal bleeding. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:196. [PMID: 28567376 DOI: 10.21037/atm.2017.03.80] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Obscure gastrointestinal bleeding (OGIB) accounts for approximately 5% of all gastrointestinal (GI) hemorrhages. It usually arises from a small bowel lesion beyond the reach of conventional endoscopy including esophagogastroduodenoscopy and colonoscopy. Video capsule endoscopy (VCE) revolutionized the evaluation of OGIB patients since it allows reliable and noninvasive visualization of the small bowel mucosal surface. Since 2001, VCE has evolved into an efficient technology integrated in clinical practice. It is the cornerstone in the algorithm of OGIB investigation given its high diagnostic yield, which compares favorably to that of double-balloon enteroscopy (DBE). In terms of outcomes, a positive index VCE examination usually correlates to a high re-bleeding rate, while a negative one provides adequate evidence of low re-bleeding risk, suggesting a wait and watch approach in this subset of patients. Additionally, a variety of factors has been acknowledged as significant predictors of re-bleeding episodes. While research data regarding immediate endoscopic findings have matured, data concerning the clinical utility of VCE in patients with OGIB on the long-term remain sparse. This manuscript reviews the current literature, aiming to highlight the role of VCE in the long-term management of OGIB.
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Affiliation(s)
- Georgios Tziatzios
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, ''Attikon" University General Hospital, Athens, Greece
| | - Paraskevas Gkolfakis
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, ''Attikon" University General Hospital, Athens, Greece
| | - George D Dimitriadis
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, ''Attikon" University General Hospital, Athens, Greece
| | - Konstantinos Triantafyllou
- Hepatogastroenterology Unit, Second Department of Internal Medicine - Propaedeutic, Research Institute and Diabetes Center, Medical School, National and Kapodistrian University of Athens, ''Attikon" University General Hospital, Athens, Greece
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Brazinova A, Moravansky N, Gulis G, Skodacek I. Suicide rate trends in the Slovak Republic in 1993-2015. Int J Soc Psychiatry 2017; 63:161-168. [PMID: 28114844 DOI: 10.1177/0020764016688715] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Suicide is a significant public health issue worldwide, resulting in loss of lives, and burdening societies. AIMS To describe and analyze the time trends of suicide rates (SRs) in the Slovak Republic in 1993-2015 for targeted suicide prevention strategies. METHODS Data for this study were obtained from the mortality database of the Statistical Office of the Slovak Republic. Crude and standardized annual SRs were calculated. Trends and relative risks of suicide according to age and sex were analyzed by joinpoint regression and negative binomial regression. RESULTS In total, there were 14,575 suicides in the Slovak Republic in the period 1993-2015 (85.3% were men). The overall average age-standardized SR for the study period was 11.45 per 100,000 person years. The rate increases with age, the highest is in men aged 75+ (42.74 per 100,000 person years). Risk of suicide is six times higher in men than in women and nine times higher in men than in women in the age group 25-34. The time trend of SRs is stable or decreasing from 1993 to 2007, but increasing after 2007, corresponding with increased unemployment rate in the country. CONCLUSION The SR in the Slovak Republic is slightly below the average of Organisation for Economic Co-operation and Development (OECD) nations. Highest SR is observed in men of working age and in retirement. Society might benefit from a strategy of education for improving the recognition of suicide risks.
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Affiliation(s)
- Alexandra Brazinova
- 1 Department of Public Health, Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovak Republic
| | - Norbert Moravansky
- 2 Institute of Forensic Medicine, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovak Republic.,3 forensic.sk Institute of Forensic Medical Analyses, Bratislava, Slovak Republic
| | - Gabriel Gulis
- 4 Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark
| | - Igor Skodacek
- 5 Department of Psychiatry, Faculty of Medicine, Comenius University in Bratislava and Children Teaching Hospital, Bratislava, Slovak Republic
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A 13-year time trend analysis of 3724 small bowel video capsule endoscopies and a forecast model during the financial crisis in Greece. Eur J Gastroenterol Hepatol 2017; 29:185-191. [PMID: 27775952 DOI: 10.1097/meg.0000000000000771] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Since its introduction, small bowel video capsule endoscopy (VCE) use has evolved considerably. AIM Evaluation of the temporal changes of small bowel VCE utilization in three tertiary centers in Greece in Era 1 (2002-2009) and Era 2 (2010-2014) and the development a forecast model for future VCE use during 2015-2017. MATERIALS AND METHODS Data from all small bowel VCE examinations were retrieved and analyzed in terms of the annual number of the performed examinations, their indications and the significance of their findings. RESULTS Overall, we evaluated 3724 VCE examinations. The number of studies peaked in 2009 (n=595) and then decreased to reach 225 in 2014. Overall, more (53.8 vs. 51.4%) patients with iron-deficiency anemia and obscure gastrointestinal bleeding (IDA/OGIB) and fewer (10.7 vs. 14%) patients with chronic diarrhea were evaluated in Era 2 compared with Era 1 (P=0.046). In Era 2, there were more nondiagnostic examinations (39.5 vs. 29.3%, P<0.001), whereas the rate of cases with relevant findings decreased from 47.8 to 40.9%. According to the time trend analysis, we developed a forecast model with two scenarios: the pessimistic and the optimistic. Validation of the model with 2015 data showed that reality was close to the pessimistic scenario: the number of exams further decreased to 190, studies carried out for IDA/OGIB increased to 67%, and there were more negative than positive exams (40.7 vs. 39.2%). CONCLUSION The number of VCE studies carried out after the emergence of the financial crisis decreased significantly and VCE indications were optimized. Our forecast model predicts lower numbers of VCE studies, with IDA/OGIB being the dominant indication. However, the predicted increase of negative exams requires further evaluation.
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Regidor E, Vallejo F, Granados JAT, Viciana-Fernández FJ, de la Fuente L, Barrio G. Mortality decrease according to socioeconomic groups during the economic crisis in Spain: a cohort study of 36 million people. Lancet 2016; 388:2642-2652. [PMID: 27745879 DOI: 10.1016/s0140-6736(16)30446-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Studies of the effect of macroeconomic fluctuations on mortality in different socioeconomic groups are scarce and have yielded mixed findings. We analyse mortality trends in Spain before and during the Great Recession in different socioeconomic groups, quantifying the change within each group. METHODS We did a nationwide prospective study, in which we took data from the 2001 Census. All people living in Spain on Nov 1, 2001, were followed up until Dec 31, 2011. We included 35 951 354 people alive in 2001 who were aged between 10 and 74 years in each one of the four calendar years before the economic crisis (from 2004 to 2007) and in each one of the first four calendar years of the crisis (from 2008 to 2011), and analysed all-cause and cause-specific mortality in those people. We classified individuals by socioeconomic status (low, medium, or high) using two indicators of household wealth: household floor space (<72 m2, 72-104 m2, and >104 m2) and number of cars owned by the residents of the household (none, one, and two or more). We used Poisson regression to calculate the annual percentage reduction (APR) in mortality rates during 2004-07 (pre-crisis) and 2008-11 (crisis) in each socioeconomic group, as well as the effect size, measured by the APR difference between the pre-crisis and crisis period. FINDINGS The annual decline in all-cause mortality in the three socioeconomic groups was 1·7% (95% CI 1·2 to 2·1) for the low group, 1·7% (1·3 to 2·1) for the medium group, and 2·0% (1·4 to 2·5) for the high group in 2004-07, and 3·0% (2·5 to 3·5) for the low group, 2·8% (2·5 to 3·2) for the medium group, and 2·1% (1·6 to 2·7) for the high group in 2008-11 when individuals were classified by household floor space. The annual decline in all-cause mortality when people were classified by number of cars owned by the household was 0·3% (-0·1 to 0·8) for the low group, 1·6% (1·2 to 2·0) for the medium group, and 2·2% (1·6 to 2·8) for the high group in 2004-07, and 2·3% (1·8 to 2·8) for the low group, 2·4% (2·0 to 2·7) for the medium group and 2·5% (1·9 to 3·0) for the high group in 2008-11. The low socioeconomic group showed the largest effect size for both wealth indicators. INTERPRETATION In Spain, probably due to the decrease in exposure to risk factors, all-cause mortality decreased more during the economic crisis than before the economic crisis, especially in low socioeconomic groups. FUNDING None.
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Affiliation(s)
- Enrique Regidor
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - Fernando Vallejo
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; National Epidemiology Centre, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Luis de la Fuente
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; National Epidemiology Centre, Instituto de Salud Carlos III, Madrid, Spain
| | - Gregorio Barrio
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
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Pérez G, Gotsens M, Palència L, Marí-Dell'Olmo M, Domínguez-Berjón MF, Rodríguez-Sanz M, Puig V, Bartoll X, Gandarillas A, Martín U, Bacigalupe A, Díez E, Ruiz M, Esnaola S, Calvo M, Sánchez P, Luque Fernández MÁ, Borrell C. Protocolo del estudio sobre el efecto de la crisis económica en la mortalidad, la salud reproductiva y las desigualdades en salud en España. GACETA SANITARIA 2016; 30:472-476. [PMID: 27474486 DOI: 10.1016/j.gaceta.2016.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/27/2016] [Accepted: 05/02/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Glòria Pérez
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, España; Departamento de Ciencias Experimentales y de la Salud, Universitat Pompeu Fabra, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Investigación Biomédica Sant Pau, Barcelona, España.
| | - Mercè Gotsens
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Investigación Biomédica Sant Pau, Barcelona, España
| | - Laia Palència
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, España; Instituto de Investigación Biomédica Sant Pau, Barcelona, España
| | - Marc Marí-Dell'Olmo
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Investigación Biomédica Sant Pau, Barcelona, España; Universitat Rovira i Virgili, Tarragona, España
| | - M Felicitas Domínguez-Berjón
- Servicio de Informes de Salud y Estudios, Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, España
| | - Maica Rodríguez-Sanz
- Area de Recerca i Docencia, Agència de Salut Pública de Barcelona, Barcelona, España
| | - Vanessa Puig
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, España
| | - Xavier Bartoll
- Servei de Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, España
| | - Ana Gandarillas
- Servicio de Epidemiología, Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, España
| | - Unai Martín
- Departamento de Sociología 2, Universidad del País Vasco UPV/EHU, Leioa, Bizkaia, España; Grupo de Investigación en Determinantes Sociales de la Salud y Cambio Demográfico-OPIK, Leoia, Bizkaia, España
| | - Amaia Bacigalupe
- Departamento de Sociología 2, Universidad del País Vasco UPV/EHU, Leioa, Bizkaia, España; Grupo de Investigación en Determinantes Sociales de la Salud y Cambio Demográfico-OPIK, Leoia, Bizkaia, España
| | - Elia Díez
- Servei de Programes d'Intervencions Preventives, Agència de Salut Pública de Barcelona, Barcelona, España
| | - Miguel Ruiz
- Consejería de Salud, Junta de Andalucía, Sevilla, España
| | | | | | - Pablo Sánchez
- Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), Escuela Andaluza de Salud Pública, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
| | - Miguel Ángel Luque Fernández
- Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Carme Borrell
- Gerencia, Agència de Salut Pública de Barcelona, Barcelona, España
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