Do stressful events account for the link between socioeconomic status and mental health?

Socioeconomic inequalities in pandemic-induced psychosocial stress in different life domains among the working-age population

BACKGROUND

Psychosocial stress is considered a risk factor for physical and mental ill-health. Evidence on socioeconomic inequalities with regard to the psychosocial consequences of the COVID-19 pandemic in Germany is still limited. We aimed to investigate how pandemic-induced psychosocial stress (PIPS) in different life domains differed between socioeconomic groups.

METHODS

Data came from the German Corona-Monitoring nationwide study - wave 2 (RKI-SOEP-2, November 2021-February 2022). PIPS was assessed using 4-point Likert scales with reference to the following life domains: family, partnership, own financial situation, psychological well-being, leisure activity, social life and work/school situation. Responses were dichotomised into "not stressed/slightly stressed/rather stressed" (0) versus "highly stressed" (1). The sample was restricted to the working-age population in Germany (age = 18-67 years, n = 8,402). Prevalence estimates of high PIPS were calculated by sex, age, education and income. Adjusted prevalence ratios (PRs) were estimated using Poisson regression to investigate the association between education/income and PIPS; high education and income were the reference groups.

RESULTS

The highest stress levels were reported in the domains social life and leisure activity. Women and younger participants reported high stress levels more frequently. The highest inequalities were found regarding people's own financial situation, and PIPS was higher in low vs. high income groups (PR 5.54, 95% CI 3.61-8.52). Inequalities were also found regarding partnerships with higher PIPS in low vs. high education groups (PR 1.68, 95% CI 1.13-2.49) - and psychological well-being with higher PIPS in low vs. high income groups (PR 1.52, 95% CI 1.14-2.04).

CONCLUSION

Socioeconomic inequalities in PIPS were found for different life domains. Generally, psychosocial support and preventive interventions to help people cope with stress in a pandemic context should be target-group-specific, addressing the particular needs and circumstances of certain socioeconomic groups.

The Effect of Social Determinants of Health on Psychological Health Among Older Adults in Ghana

This study examines the effects of various factors, including socioeconomic status, built environment, access to healthcare, educational level, social participation, and economic stability, on older adults' psychological health. The current study analyzed a nationally representative sub-sample of 2,577 respondents aged 50 and above from the World Health Organization's Study on Global AGEing and Adult Health (WHO SAGE) Wave 2. WHO SAGE Wave 2 is cross-sectional data collected via in-person structured interviews. Ordinal least square (OLS) was used to measure the average effect of social determinants of health (SDoH), and quantile regression analysis was used to determine the effects of SDoH on older adults' psychological health at different quantiles, specifically 10th, 50th, and 90th percentiles. Significant determinants of psychological health across all quantiles included age, healthcare access, marital status, economic stability, and neighborhood and built environment. However, the degrees of significance for residence, gender, educational level, chronic diseases, and social participation varied between quantiles, showing differing effects on older adults with high or low psychological health. Religion was insignificant across all quantiles. This study highlights the need for governments and public health agencies to develop targeted interventions and strategies that support the psychological well-being of older adults in the country.

Association of pre-migration socioeconomic status and post-migration mental health in Syrian refugees in Lebanon: a descriptive sex-stratified cross-sectional analysis

BACKGROUND

Refugee populations present with high levels of psychological distress, which may vary among sociodemographic characteristics. Understanding the distribution across these characteristics is crucial to subsequently provide more tailored support to the most affected according to their specific healthcare needs. This study therefore seeks to investigate the association between pre-migration socioeconomic status (SES) and post-migration mental health separately for male and female Syrian refugees in Lebanon.

METHODS

In a cross-sectional study, a cluster randomized sample of 599 refugees from Syria were recruited between 2016 and 2019 within 12 months after they fled to Lebanon. Logistic regression was used to determine the association between self-reported pre-migration SES and levels of anxiety and depressive symptoms assessed on the Hopkins Symptoms Checklist-25 (HSCL-25) scale, both for the entire sample and stratified by sex. To assess the informative value of self-reported SES, its correlation with education variables was tested. All analyses were conducted in R version 4.3.

RESULTS

Using complete cases, 457 participants (322 female, 135 male) were included in the analyses. Females showed on average more symptoms of anxiety (Median: 2.5) and depression (Median: 2.4) than males (Median: 2.10 and 2.07, respectively). Below average SES was associated with significantly higher odds for mental illness compared to average SES (anxiety: OR 4.28, 95% CI [2.16, 9.49]; depression: OR 1.85, 95% CI [1.06, 3.36]). For anxiety, differences between SES strata were larger for males than females. The self-reported SES measure showed only a weak positive correlation with education.

CONCLUSIONS

This study adds additional descriptive data highlighting mental health differences in Syrian refugees in Lebanon, whereby below average SES is associated with worse mental health outcomes compared to average SES. These findings demand further research into the underlying mechanisms. Improving our understanding of the observed differences will provide valuable insights that can contribute to the future development of targeted measures.

Genetic influences on depression and selection into adverse life experiences

Genome-wide association studies find that a large number of genetic variants jointly influence the risk of depression, which is summarized by polygenic indices (PGIs) of depressive symptoms and major depression. But PGIs by design remain agnostic about the causal mechanisms linking genes to depression. Meanwhile, the role of adverse life experiences in shaping depression risk is well-documented, including via gene-environment correlation. Building on theoretical work on dynamic and contingent genetic selection, we suggest that genetic influences may lead to differential selection into negative life experiences, forging gene-environment correlations that manifest in various permutations of depressive behaviors and environmental adversities. We also examine the extent to which apparent genetic influences may reflect spurious associations due to factors such as indirect genetic effects. Using data from two large surveys of middle-aged and older US adults, we investigate to what extent a PGI of depression predicts the risk of 27 different adversities. Further, to glean insights about the kinds of processes that might lead to gene-environment correlation, we augment these analyses with data from an original preregistered survey to measure cultural understandings of the behavioral dependence of various adversities. We find that the PGI predicts the risk of majority of adversities, net of class background and prior depression, and that the selection risk is greater for adversities typically perceived as being dependent on peoples' own behaviors. Taken together, our findings suggest that the PGI of depression largely picks up the risk of behaviorally-influenced adversities, but to a lesser degree also captures other environmental influences. The results invite further exploration into the behavioral and interactional processes that lie along the pathways intervening between genetic differences and wellbeing.

Structural enrichment attenuates colitis-associated colon cancer

Colorectal cancer (CRC) is a major public health concern and disproportionately impacts racial/ethnic minority populations in the US. Animal models are helpful in examining human health disparities because many stress-induced human health conditions can be recapitulated using mouse models. Azoxymethane (AOM)/ dextran sodium sulfate (DSS) treatment can be used to model colitis-associated cancers. While colitis-associated cancers account for only 2% of colon cancers, the AOM/DSS model is useful for examining links between inflammation, immunity, and colon cancer. Mice were housed in enriched and impoverished environments for 1-month prior to behavioral testing. Following behavioral testing the mice were subjected to the AOM/DSS model. While our analysis revealed no significant behavioral variances between the impoverished and enriched housing conditions, we found significant effects in tumorigenesis. Enriched mice had fewer tumors and smaller tumor volumes compared to impoverished mice. African Americans are at higher risk for early onset colorectal cancers in part due to social economic status. Furthermore, housing conditions and environment may reflect social economic status. Research aimed at understanding links between social economic status and colorectal cancer progression is important for eliminating disparities in health outcomes.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

Influence of the COVID-19 pandemic on prenatal and postpartum patient experiences and well-being

BACKGROUND

It has yet to be fully elucidated how differing populations of obstetric patients adapted to the disruptions in perinatal care and postpartum support from the COVID-19 pandemic. We surveyed an enriched sample of socioeconomically advantaged patients to understand the influence of COVID-19 on their perinatal care experience, well-being, and coping.

METHODS

We surveyed pregnant and postpartum patients (n = 6140) at a large academic medical center in the Midwest of the United States using the Coronavirus and Perinatal Experiences instrument in Spring 2021.

RESULTS

The survey was sent to 6141 pregnant and postpartum patients; 1180 (17.8%) respondents completed the survey, including 256 who were pregnant and 834 postpartum. Most pregnant patients experienced no changes in their prenatal care with 16.5% indicating somewhat worsened care. In the postpartum cohort, 37.5% stated their care had somewhat worsened. In describing influences on stress and mental health, 58.1% of postpartum respondents stated it was moderately, and 17.4% significantly, worse. The pandemic had a somewhat or moderately negative influence for 72.7% of respondents, with 11.0% stating these effects were extremely negative. Both cohorts characterized a range of coping strategies, most commonly, talking with friends and family (76.3%).

CONCLUSION(S)

Even among this sample of socioeconomically advantaged patients, respondents indicated that the pandemic disrupted many facets of their medical care and daily life, especially social activities and postpartum support. Our findings suggest that counseling on coping and adaptation strategies for stressors and increased health systems support be part of perinatal care during public health emergencies for all demographic groups.

The role of inflammation in the effects of peer victimisation and stressful life events on mental health in childhood

Background

Peer victimisation represents a salient stressor during childhood. However, studies investigating the mechanism of its impact on children's mental health typically examine socio-cognitive factors as mediators. The current study sought to provide novel insight through testing a potential biological mechanism, inflammation. It also tested for pathway-specific effects by comparing how inflammation may mediate the effect of peer victimisation and that of another important stressor in childhood: adverse life events.

Method

Data from 4,583 participants of the Avon Longitudinal Study of Parents and Children (ALSPAC) were used. Path analysis was carried out to investigate whether inflammation (IL-6 and CRP) at age 9 years mediates the effect of peer victimisation and stressful life events at age 8 years on internalising (peer and emotional) or externalising (hyperactivity and conduct) problems (measured at age 11 years), both before and after adjustment for potential confounders.

Results

IL-6 partially mediated the effect of peer victimisation on peer problems, even after adjustment for potential confounders. Inflammation did not mediate the effect of stressful life events on either type of internalising problems. Neither stressor predicted externalising problems via inflammation.

Conclusion

We did not find evidence that inflammation mediates the effect of stressful life events on mental health in childhood when they are considered alongside experiences of peer victimisation. Inflammation may already represent a form of biological embedding of peer victimisation in the early years.

Mind-Wandering and Its Relationship With Psychological Wellbeing and Obsessive-Compulsive Symptomatology in the Context of Covid-19

Mind-wandering (MW) as a research topic has received considerable attention over the last several decades. The recent differentiation between spontaneous and deliberate MW has suggested a particular effect of the former on psychopathology; in that increased spontaneous MW may precede mental illness. The present study sought to explore MW as a potential contributing factor to poor mental health in the context of the Covid-19 pandemic. More specifically, we sought to determine firstly, whether the effects of MW frequency, type and content on subjective psychological wellbeing was consistent with previous findings after controlling for the impacts of Covid-related stress. Secondly, previous research has demonstrated an effect of both Covid-stress and spontaneous MW on the experience of obsessive-compulsive symptomatology (OCS), and so the present study explored this relationship further by assessing whether Covid-stress mediated the relationship between spontaneous MW and OCS. Participants completed measures of MW, OCS and psychological wellbeing through an online questionnaire. The results indicated that increased spontaneous MW was indicative of both poorer subjective psychological wellbeing and OCS, with Covid-stress partially mediating the relationship between spontaneous MW and OCS. Our findings provide further support for the adverse effect of unintentional MW on psychological wellbeing, as well as for the differentiation between both forms of the cognitive phenomenon. Additionally, they provide an important insight into one of the factors that may have preceded poor mental health among the Irish population during Covid-19. Future research may build upon the present study by exploring similar relationships among clinical populations.

Differential sensitivity to adversity by income: Evidence from a study of Bereavement

Adverse life events are often understood as having negative consequences for mental health via objective hardships, which are worse for persons with less income. But adversity can also affect mental health via more subjective mechanisms, and here, it is possible that persons with higher income will exhibit greater psychological sensitivity to negative events, for various reasons. Drawing on multiple sociological literatures, this article theorizes potential mechanisms of increasing sensitivity with income. The proposition of differential sensitivity is tested using the strategic case of spousal and parental bereavement among older US adults. The analyses find consistent evidence of increasing sensitivity of depressive symptoms with income. A series of robustness checks indicate that findings are not due to endogenous or antecedent selection. Further, exploratory analyses of mechanisms suggest that higher sensitivity among the affluent was driven by greater expectations and better relationship quality with the deceased. These findings problematize the conceptualization and assessment of human suffering in economically stratified societies.

COVID-19-related mental health difficulties among marginalised populations: A literature review

The COVID-19 pandemic has had negative consequences on the mental health of the population, which has been documented. Marginalised groups that are at risk of poor mental health overall have been particularly impacted. The purpose of this review is to describe the mental health impact of the COVID-19 pandemic on marginalised group (i.e. persons who are socio-economically disadvantaged, migrants and members of ethno-racial minorities, experience homelessness) and identified interventions which could be well-suited to prevent and address mental health difficulties. We conducted a literature review of systematic reviews on mental health difficulties since the beginning of the COVID-19 epidemic and appropriate interventions among marginalised groups published from January 1, 2020 to May 2, 2022, using Google Scholar and PubMed (MEDLINE). Among 792 studies on mental health difficulties among members of marginalised groups identified by keywords, 17 studies met our eligibility criteria. Twelve systematic reviews examining mental health difficulties in one or several marginalised groups during the COVID-19 pandemic and five systematic reviews on interventions that can mitigate the mental health impact of the COVID-19 pandemic were retained in our literature review. The mental health of marginalised groups was severely affected during the COVID-19 pandemic. Most frequently reported mental health difficulties included symptoms of anxiety and depression. Additionally, there are interventions that appear effective and well-suited for marginalised populations, which should be disseminated on a large scale to mitigate the psychiatric burden in these groups and at the population level.

Socioeconomic status associates with worse asthma morbidity among Black and Latinx adults

BACKGROUND

Asthma disproportionately affects African American/Black (AA/B) and Hispanic/Latinx (H/L) patients and individuals with low socioeconomic status (SES), but the relationship between SES and asthma morbidity within these racial/ethnic groups is inadequately understood.

OBJECTIVE

To determine the relationship between SES and asthma morbidity among AA/B and H/L adults with moderate to severe asthma using multidomain SES frameworks and mediation analyses.

METHODS

We analyzed enrollment data from the PeRson EmPowered Asthma RElief randomized trial, evaluating inhaled corticosteroid supplementation to rescue therapy. We tested for direct and indirect relationships between SES and asthma morbidity using structural equation models. For SES, we used a latent variable defined by poverty, education, and unemployment. For asthma morbidity, we used self-reported asthma exacerbations in the year before enrollment (corticosteroid bursts, emergency room/urgent care visits, or hospitalizations), and Asthma Control Test scores. We tested for mediation via health literacy, perceived stress, and self-reported discrimination. All models adjusted for age, sex, body mass index, ethnicity, and comorbidities.

RESULTS

Among 990 AA/B and H/L adults, low SES (latent variable) was directly associated with hospitalizations (β = 0.24) and worse Asthma Control Test scores (β = 0.20). Stress partially mediated the relationship between SES and increased emergency room/urgent care visits and worse asthma control (β = 0.03 and = 0.05, respectively). Individual SES domains were directly associated with asthma morbidity. Stress mediated indirect associations between low educational attainment and unemployment with worse asthma control (β = 0.05 and = 0.06, respectively).

CONCLUSIONS

Lower SES is directly, and indirectly through stress, associated with asthma morbidity among AA/B and H/L adults. Identification of stressors and relevant management strategies may lessen asthma-related morbidity among these populations.

Links Between Socioeconomic Status, Daily Depressive Affect, Diurnal Cortisol Patterns, and All-Cause Mortality

OBJECTIVE

Socioeconomic status (SES) remains a robust risk factor for mortality. Various theoretical models postulate that lower SES is associated with higher negative affect, which then initiates a cascade of physiological disturbances that contribute to illness and early mortality. However, few studies have explicitly investigated the interplay between psychological and biological factors in determining SES disparities in mortality. This study examined the role of daily negative affect and cortisol secretion in explaining the SES-mortality link in a large sample of US adults.

METHODS

Using data from the Midlife in the United States study (n = 1735, mean [standard deviation] age = 56.40 [12.10] years, 56.4% female), we tested longitudinal associations between SES, daily negative affect, daily cortisol levels, and all-cause mortality 13 years later. Daily negative affect was classified into three clusters reflecting depressive affect, anxiety, and anger.

RESULTS

Higher SES was linked to a lower risk of all-cause mortality (hazard ratio = 0.94, 95% confidence interval = 0.90 to 0.97). Furthermore, there was a sequential link between higher SES and lower mortality through lower daily depressive affect and a steeper ("healthier") diurnal cortisol slope (indirect effect = -0.0007, 95% confidence interval = -0.0014 to -0.0002). Daily anxiety and anger were not associated with cortisol levels or mortality (p values > .05).

CONCLUSIONS

These findings suggest that daily negative emotional experiences and the hypothalamic-pituitary-adrenal axis functioning may constitute important psychological and physiological pathways underlying the link between SES and all-cause mortality.

Slovak parents' mental health and socioeconomic changes during the COVID-19 pandemic

The changes in people's mental health have become one of the hot topics during the COVID-19 pandemic. Parents have been said to be among the most vulnerable groups in terms of the imposed anti-pandemic measures. The present paper analyzes the trends in mental health indicators in a sample of Slovak parents (N = 363) who participated in four waves of data collection over a year and a half of the COVID-19 pandemic. The mental health indicators were represented by general levels of depression and anxiety as well as COVID-related stress and anxiety. While there were only minor changes in depression and anxiety, the dynamic in COVID-related stress and especially anxiety was more noteworthy. Besides some exceptions, the results hold even after controlling for the socioeconomic situation. The gender differences in the mental health trends were found to be negligible. Overall, we observed no substantial deterioration in the mental health indicators across the four waves of the study.

Is the Association Between Education and Sympathovagal Balance Mediated by Chronic Stressors?

Background

This study investigated whether raised chronic stress in low education groups contributes to education differences in cardiovascular disease by altering sympathovagal balance.

Methods

This study included cross-sectional data of 10,202 participants from the multi-ethnic, population-based HELIUS-study. Sympathovagal balance was measured by baroreflex sensitivity (BRS), the standard deviation of the inter-beat interval (SDNN) and the root mean square of successive differences between normal heartbeats (RMSSD). The associations between chronic stressors (work, home, psychiatric, financial, negative life events, lack of job control and perceived discrimination) in a variety of domains and BRS, SDNN and RMSSD were assessed using linear regression, adjusted for age, ethnicity, waist-to-hip ratio and pack-years smoked. Mediation analysis was used to assess the contribution of chronic stress to the association between education and sympathovagal balance.

Results

Modest but significant associations were observed between financial stress and BRS and SDNN in women, but not in RMSSD nor for any outcome measure in men. Women with the highest category of financial stress had 0.55% lower BRS (ms/mmHg; β = -0.055; CI = -0.098, -0.011) and 0.61% lower SDNN (ms; β = -0.061; CI = -0.099, -0.024) than those in the lowest category. Financial stress in women contributed 7.1% to the association between education and BRS, and 13.8% to the association between education and SDNN.

Conclusion

No evidence was found for the hypothesized pathway in which sympathovagal balance is altered by chronic stress, except for a small contribution of financial stress in women.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12529-021-10027-9.

Socioeconomic status and fertility treatment outcomes in high-income countries: a review of the current literature

The association between socioeconomic status and fertility is a subject that has received much attention. Yet, little is known as to whether the socioeconomic status has an impact on the outcomes of fertility treatment. This systematic review aims to assess any possible relationship between socioeconomic deprivation and treatment outcomes. A database search was conducted of all publications in this field up to March 2021. Eleven studies were identified and six of these specifically investigated the impact of socioeconomic status on fertility treatment outcomes. Children conceived following assisted conception are more likely to be born to mothers of a higher socioeconomic status than those conceived naturally. Of the few studies investigating the impact of socioeconomic status on fertility treatment outcomes and the results are conflicting, making it difficult to draw robust conclusions as to its effect. It is unknown which, if any, marker of socioeconomic status is the most significant for fertility patients: whether it is the characteristics of the individual or that of their surroundings. Further research is urgently needed.

Development and validation of a socioeconomic status short-form questionnaire (SES-SQ)

BACKGROUND

Evaluation of socioeconomic status (SES) is an important aspect in community-based health studies and it is a major predictor of health and nutritional status as well as mortality and morbidity from many diseases. This study aimed to construct and validate socioeconomic status short-from questionnaire (SES-SQ) in Iranian population.

METHODS

This cross-sectional methodological study was conducted among 1437 Iranian general population. Face and content validity of the developed questionnaire was evaluated qualitatively. Internal consistency, construct validity using exploratory factor analysis (EFA) and latent class analysis (LCA), and convergent and known-group validity were also evaluated.

RESULTS

The SES-SQ consisted of 6 items. The overall Cronbach's alpha was 0.64, showing acceptable internal consistency. EFA resulted in two factors explaining 47.78% of total variance. Three SES classes (low/middle/high) were extracted by LCA. The score of SES-SQ ranged from 0 to 17; two cutoff scores of 4.5 and 8.5 were determined by receiver operating characteristic (ROC) analysis for differentiating low from middle and middle from high SES classes, respectively.

CONCLUSION

An efficient, reliable, and valid short-form questionnaire was developed for evaluating SES in Iranian general population. The relevancy of questionnaire items is not lost over time.

Coping styles as predictors of negative affective conditions in Asian Indians: does being optimistic still make a difference?

The present study examined the role of optimism, as measured by the Life Orientation Test-Revised, and coping styles, as measured by the COPE scale, in predicting negative affective conditions (viz., depressive symptoms, stress, and negative affect) among 386 Asian Indian young adults (197 females and 189 males). Results from our hierarchical regression analyses indicated that coping styles accounted for a medium-large amount of variance in negative affective conditions, after controlling for demographic factors (i.e. age, gender, parent's education, and monthly income). Five coping styles were significant in predicting negative affective conditions across all three indices; mental disengagement, denial, and venting emotions were found to be maladaptive, while positive reinterpretation and humor were found to be adaptive among Asian Indian young adults. Furthermore, when optimism was included in the prediction model, optimism consistently accounted for additional variance in negative affective conditions, beyond coping styles. Due to the additional variance among negative affective conditions accounted for by optimism when compared to coping, we advise that mental health professionals consider prioritizing the reinforcement of positive expectancy in addition to enhancing adaptive coping styles and reducing the use of maladaptive coping among Asian Indians.

Socioeconomic status and sleep disturbances among pediatric population: a continental systematic review of empirical research

To this day, no consensus has been established on the definition and the conceptualization of the socioeconomic status (SES), since all the available studies on the relation between SES and health did not use the same conceptual framework and operationalization to assess SES. While literature reported that SES markers (such as income, social support networks, education, employment or occupation) influence the health of populations by shaping living conditions; empirical research does not tell us which SES markers affect more strongly the sleep components of the individuals, as well as which sleep disorders (SD) are affected and how. Even though several original studies have tried to assess how changes in socioeconomic status of parents may affect the psychosocial environment and mental health of an individual directly or through his community, no systematic reviews on the influence of SES on children's sleep are available. This systematic review make an update on the different measures of SES and sleep disturbances used for pediatric population across the different regions of the world. Recommendations for a future standardization of SES measures is proposed, for a better understanding of its influence on sleep disturbances.

Stressful life events and transitions in problematic alcohol use involvement among US adults

OBJECTIVE

We investigated the impact of stressful life events (SLEs) for males and females on transitions in problematic alcohol involvement, both progression and recovery, over a 3-year interval.

METHOD

Participants of both Wave 1 (2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were stratified by sex (14,233 males and 19,550 females). Latent transition analysis estimated the impact of experiencing ≥3 SLE in the year preceding the Wave 1 interview on the probability of transitioning between three empirically-derived stages of alcohol involvement (patterns of alcohol use disorder [AUD] symptoms), across waves. Propensity score methods adjusted for confounding.

RESULTS

For males, three or more SLEs were associated with progression from the moderate to the severe problem stage (odds ratio [OR] = 2.23, 95% confidence interval [CI] = 1.17, 4.26). Among those in the severe problem stage, SLEs negatively impacted recovery regardless of sex. Employment/Financial SLEs were associated with a higher odds of transition from the moderate to the no problem stage (OR = 1.60, 95% CI = 1.03, 2.46) and lower odds of transitions from the severe to the moderate problem stage (OR = 0.40, 95% CI = 0.16, 0.99) among males, and from the severe to the no problem stage (OR = 0.26, 95% CI = 0.07, 0.88) among females.

CONCLUSION

Stressful life events appear to affect transitions in alcohol involvement over time among those who already have alcohol problems, rather than impacting a transition among those without AUD problems.

Effects of housing value and medical subsidy on treatment and outcomes of breast cancer patients in Singapore: A retrospective cohort study

Background

Socioeconomic status (SES) is likely to affect survival in breast cancer patients. Housing value is a reasonable surrogate for SES in Singapore where most residents own their own homes, which could be public (subsidised) or private housing. We evaluated effects of housing value and enhanced medical subsidies on patients’ presentation, treatment choices, compliance and survival in a setting of good access to healthcare.

Methods

A retrospective analysis of breast cancer patients treated in a tertiary hospital cluster from 2000 to 2016 was performed. Individual-level Housing value Index (HI) was derived from each patient's address and then grouped into 3 tiers: HI(high)(minimal subsidy), HI(med)(medium subsidy) and HI(low)(high subsidy). Cox regression was performed to evaluate the associations between overall survival (OS) and cancer-specific survival (CSS) with HI and various factors.

Findings

We studied a multiracial cohort of 15,532 Stage 0–IV breast cancer patients. Median age was 53.7 years and median follow-up was 7.7 years. Patients with lower HI presented with more advanced disease and had lower treatment compliance. On multivariable analysis, compared to HI(high) patients, HI(med) patients had decreased OS (HR=1.14, 95% CI 1.05–1.23) and CSS (HR=1.15, 95% CI 1.03–1.27), and HI(low) patients demonstrated reduced OS (HR=1.16, 95% CI 1.01–1.33). Ten-year non-cancer mortality was higher in lower HI-strata. Enhanced medical subsidy approximately halved treatment noncompliance rates but its receipt was not an independent prognostic factor for survival.

Interpretation

Despite good healthcare access, lower-HI patients have poorer survival from both cancer and non-cancer causes, possibly due to delayed health-seeking and poorer treatment compliance. Enhanced subsidies may mitigate socioeconomic disadvantages.

Funding

None.

Socioeconomic status and differential psychological and immune responses to a human-caused disaster

OBJECTIVE

Individuals from different socioeconomic status (SES) backgrounds may respond variably to stressful events, and such differences are likely to contribute to health disparities. The current study leveraged data collected before and after a petrochemical explosion and aimed to investigate how individuals from different SES backgrounds responded to this unexpected stressor in terms of perceived social support, perceived stress, and systemic inflammation.

METHODS

Data were drawn from 124 participants (M_age = 55.9 ± 16.1 years, 69.4% female, 29.0% White) living close to a petrochemical complex where the explosion occurred in 2005. SES was assessed at baseline, and perceived stress and inflammatory markers (i.e., C-reactive protein [CRP], interleukin-6 [IL-6]) were assessed at both pre- and post-explosion. Perceived social support was assessed at post-explosion.

RESULTS

Lower SES was associated with less perceived social support. Lower SES was also associated with a larger increase in perceived stress and higher levels of IL-6, but not CRP. Perceived social support did not moderate or mediate the effects of SES on changes in perceived stress, IL-6, or CRP. The associations between SES and inflammatory markers were also not explained by changes in perceived stress.

CONCLUSION

Findings from this study support the idea that individuals from different SES backgrounds respond differently to stressors at both the psychosocial (perceived social support and perceived stress) and biological (inflammation) levels. Our findings also suggest that these two processes appear to act independently from each other.

Predictors of Outcome of Acute Partial Hospitalization: An Exploratory Study

To identify predictors of outcome of acute partial hospital (PH) treatment, patients admitted during a 15-month period were studied. Outcomes were change in the Behavior and Symptom Identification Scale and readmission within 30 days. Predictors were clinical and demographic variables obtained on all patients. Most patients (92%) improved during acute PH treatment, only 5% were readmitted, and average changes were moderate to large. However, many patients still had significant symptoms and behavioral problems at discharge, 56.5% missed at least 1 day, and 16.5% dropped out. Less acute improvement was associated with greater long-term impairment, worse treatment attendance, more previous treatment episodes, and fewer medication changes. Readmission was associated with less acute improvement and its predictors, and with nonattendance. In summary, acute outcome in PH was predicted by functioning more generally. Factors that affect patients' acute PH responses may also affect functioning in other areas. These findings suggest possible modifications of PH practices and programs.

How Do Health and Social Networks Compare between Low-Income Multiproblem Households and the General Population?

Multiproblem households that receive social care for multiple problems, such as debts, psychiatric disorders, and domestic violence, may also be disadvantaged in terms of health and social networks. This study examines whether low-income multiproblem households and the general population differ in self-perceived health, mental health, health behaviors, and social networks. We performed a cross-sectional survey among respondents from low-income multiproblem households (n = 105) and the general population (n = 99) in the municipality of Apeldoorn in the Netherlands. Comparisons with national statistics data indicated that our sample of multiproblem households is more disadvantaged in terms of self-perceived health and mental health than low socioeconomic groups in general in the Netherlands. A multiple logistic regression analysis showed that being part of the multiproblem household group versus the general population group was associated with a lower educational level, a lower likelihood of being in paid employment, a lower score with respect to mental health, less alcohol consumption, and less fruit consumption. There were also differences between the groups on other variables, but these were not significant in adjusted analyses. In conclusion, multiproblem households in Apeldoorn had lower scores on mental health, drank fewer alcoholic drinks per week, and ate less fruit than the general population.

Association of Fear and Mistrust with Stress Among Sheltered Homeless Adults and the Moderating Effects of Race and Sex

In shelter settings, homeless individuals often congregate and sleep in proximity to one another, with limited secure places for belongings: a living environment that may engender perceived vulnerability to victimization. Fear of victimization and mistrust of others in the shelter environment may result in greater stress, and racial minority residents and women may be particularly affected. Here, we aimed to examine the associations between fear, mistrust, and fear and mistrust, and stress among sheltered homeless adults, and explore moderation by race and sex. Data were from a convenience sample of adults from a homeless shelter in Dallas, TX (N = 225; 67% black; 27% women). Participants completed the fear and mistrust scale and the urban life stressors scale. Linear regressions were used to measure associations of fear, mistrust, and fear and mistrust with stress, adjusted for age, education, sex, race, history of schizophrenia/schizoaffective disorder, and discrimination. Moderation was assessed with interaction terms. Adjusted results indicated that fear, mistrust, fear and mistrust was positively associated with stress (p < 0.001). Race, but not sex, was a significant moderator of associations between fear and stress, whereby black adults with high levels of fear were more likely than white adults to experience high stress levels. Thus, although more research is needed, results suggest that interventions aimed at reducing fear of victimization may reduce stress for black adults. Given the association of stress with myriad undesirable health outcomes that can further exacerbate known health disparities, further work in this area is critical. Future research should investigate environmental sources of fear to provide further direction for interventions.

Influences of environmental stressors on autonomic function in 12-month-old infants: understanding early common pathways to atypical emotion regulation and cognitive performance

BACKGROUND

Previous research has suggested that children exposed to more early-life stress show worse mental health outcomes and impaired cognitive performance in later life, but the mechanisms subserving these relationships remain poorly understood.

METHOD

Using miniaturised microphones and physiological arousal monitors (electrocardiography, heart rate variability and actigraphy), we examined for the first time infants' autonomic reactions to environmental stressors (noise) in the home environment, in a sample of 82 12-month-old infants from mixed demographic backgrounds. The same infants also attended a laboratory testing battery where attention- and emotion-eliciting stimuli were presented. We examined how children's environmental noise exposure levels at home related to their autonomic reactivity and to their behavioural performance in the laboratory.

RESULTS

Individual differences in total noise exposure were independent of other socioeconomic and parenting variables. Children exposed to higher and more rapidly fluctuating environmental noise showed more unstable autonomic arousal patterns overall in home settings. In the laboratory testing battery, this group showed more labile and short-lived autonomic changes in response to novel attention-eliciting stimuli, along with reduced visual sustained attention. They also showed increased arousal lability in response to an emotional stressor.

CONCLUSIONS

Our results offer new insights into the mechanisms by which environmental noise exposure may confer increased risk of adverse mental health and impaired cognitive performance during later life.

Scientific imperatives vis-à-vis growing inequality in America

A landmark article published in the American Psychologist (Adler et al., 1994) encouraged psychologists to engage in research on socioeconomic inequality and health. Numerous contributions followed to fill in psychosocial and behavioral pathways. Specifically, we review advances on health inequalities research from a large public-use study (Midlife in the United States [MIDUS]). The Great Recession of 2007 to 2009 and its lingering effects are then reviewed to underscore widening inequality in access to education, employment, and income. Two MIDUS national samples of same-aged adults recruited 2 decades apart are then compared to assess historical changes in socioeconomic, physical health, and well-being profiles from the 1990s to postrecession. Despite historical gains in educational attainment over time, we show that indicators of socioeconomic status, health, and well-being are more compromised in the postrecession sample relative to the 1990s sample. Building on these preliminary findings, we elaborate opportunities for further inquiry by the scientific community to examine whether widening socioeconomic inequalities exacerbated by the Great Recession translate to widening health inequalities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Socioeconomic status, stressful life situations and mental health problems in children and adolescents: Results of the German BELLA cohort-study

Aim

Children and adolescents with low socioeconomic status (SES) suffer from mental health problems more often than their peers with high SES. The aim of the current study was to investigate the direct and interactive association between commonly used indicators of SES and the exposure to stressful life situations in relation to children’s mental health problems.

Methods

The prospective BELLA cohort study is the mental health module of the representative, population-based German National Health Interview and Examination Survey for children and adolescents (KiGGS). Sample data include 2,111 participants (aged 7–17 years at baseline) from the first three measurement points (2003–2006, 2004–2007 and 2005–2008). Hierarchical multiple linear regression models were conducted to analyze associations among the SES indicators household income, parental education and parental unemployment (assessed at baseline), number of stressful life situations (e.g., parental accident, mental illness or severe financial crises; 1- and 2-year follow-ups) and parent-reported mental health problems (Strength and Difficulties Questionnaire; 2-year follow-up).

Results

All indicators of SES separately predicted mental health problems in children and adolescents at the 2-year follow-up. Stressful life situations (between baseline and 2-year follow-up) and the interaction of parental education and the number of stressful life situations remained significant in predicting children’s mental health problems after adjustment for control variables. Thereby, children with higher educated parents showed fewer mental health problems in a stressful life situation. No moderating effect was found for household income and parental employment. Overall, the detected effect sizes were small. Mental health problems at baseline were the best predictor for mental health problems two years later.

Conclusions

Children and adolescents with a low SES suffer from multiple stressful life situations and are exposed to a higher risk of developing mental health problems. The findings suggest that the reduction of socioeconomic inequalities and interventions for families with low parental education might help to reduce children’s mental health problems.

Mental health differences between German gay and bisexual men and population-based controls

BACKGROUND

International studies have revealed that gay and bisexual men present more mental health problems than the general male population. Furthermore, there is evidence that minority stress predicts mental health problems in gay and bisexual men. The aim of the present study is to provide initial data on mental health differences in Germany and to analyze the effect of minority stress.

METHODS

Mental health data on n = 1903 German gay and bisexual men and n = 958 men from a population-based sample were assessed using a shortened version of the SCL-90-S. The mental health of the two samples was compared. Furthermore, a linear regression was conducted for the gay and bisexual sample: mental health was used as the criterion and minority stressors as predictors.

RESULTS

As compared to our population sample, gay and bisexual men demonstrated more mental health problems with a moderate effect size. In the regression, minority stress predicted mental health problems in the gay and bisexual sample.

CONCLUSIONS

We observed pronounced mental health differences between gay and bisexual men versus the population sample. These differences could be at least partly due to the minority stress gay and bisexual men face. Research should focus on how to reduce and cope with minority stress.

Racial discrimination, socioeconomic position, and illicit drug use among US Blacks

PURPOSE

We assessed the relationship of self-reported racial discrimination with illicit drug use among US Blacks, and whether this differed by socioeconomic position (SEP).

METHODS

Among 6587 Black participants in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005), we used multiple logistic regression models to test the association between racial discrimination (measured on the 6-item Experiences of Discrimination scale) and past-year illicit drug use, and whether this differed by SEP.

RESULTS

Racial discrimination was associated with past-year drug use [adjusted odds ratio (aOR) 2.32; 95 % confidence interval (CI) 1.70, 3.16] and with frequent drug use (aOR 1.91; 95 % CI 1.22, 2.99). For frequent illicit drug use, this relationship was stronger among higher SEP participants (aOR 3.55; 95 % CI 2.09, 6.02; p interaction < 0.01).

CONCLUSIONS

The stronger association between racial discrimination and frequent illicit drug use among higher SEP Blacks suggests a complex interplay between disadvantaged and privileged statuses that merits further investigation. The finding of a significant difference by SEP highlights the importance of considering differences within heterogeneous race/ethnic groups when investigating health disparities.

Stressful Life Events and Child Anxiety: Examining Parent and Child Mediators

While a number of factors have been linked with excessive anxiety (e.g., parenting, child temperament), the impact of stressful life events remains under-studied. Moreover, much of this literature has examined bivariate associations rather than testing more complex theoretical models. The current study extends the literature on life events and child anxiety by testing a theory-driven meditational model. Specifically, one child factor (child cognitions/locus of control), two parent factors (parent psychopathology and parenting stress), and two parent-child relationship factors (parent-child dysfunctional interaction and parenting style) were examined as mediators in the relationship between stressful life events and severity of child anxiety. One hundred and thirty anxious parents and their nonanxious, high-risk children (ages ranged from 7 to 13 years) participated in this study. Results indicated that levels of parenting stress, parental anxious rearing, and dysfunctional parent-child interaction mediated the association between stressful life events and severity of anxiety symptoms. Child cognition and parent psychopathology factors failed to emerge as mediators. Findings provide support for more complex theoretical models linking life events and child anxiety and suggest potential targets of intervention.

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings

PURPOSE

The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking.

METHOD

NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized.

RESULT

The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers.

CONCLUSIONS

Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options.

Difficult Life Events, Selective Migration and Spatial Inequalities in Mental Health in the UK

Objective

Research has indicated that people moving towards neighbourhoods with disadvantaged socio-economic status have poor health, in particular mental health, but the reasons for this are unclear. This study aims to assess why people moving towards more socio-economically deprived areas have poor mental health. It focuses upon the role of difficult life events that may both trigger moves and damage mental health. This study investigates how mental health and socio-spatial patterns of mobility vary between people moving following difficult life events and for other reasons.

Methods

Longitudinal analysis of British Household Panel Survey data describing adults’ moves between annual survey waves, pooled over ten years, 1996-2006 (N=122,892 observations). Respondents were defined as ‘difficult life event movers’ if they had experienced relationship breakdown, housing eviction/repossession, or job loss between waves. Respondents were categorised as moving to more or less deprived quintiles using their Census Area Statistic residential ward Carstairs score. Mental health was indicated by self-reported mental health problems. Binary logistic regression models of weighted data were adjusted for age, sex, education and social class.

Results

The migration rate over one year was 8.5%; 14.1% of movers had experienced a difficult life event during this time period. Adjusted regression model odds of mental health problems among difficult life event movers were 1.67 (95% CI 1.35-2.07) relative to other movers. Odds of difficult life events movers, compared to other movers, moving to a less deprived area, relative to an area with a similar level of deprivation, were 0.70 (95% CI 0.58-0.84). Odds of mental health problems among difficult life event movers relocating to more deprived areas were highly elevated at 2.40 (95% CI 1.63-3.53), relative to stayers.

Conclusion

Difficult life events may influence health selective patterns of migration and socio-spatial trajectories, reducing moves to less deprived neighbourhoods among people with mental illness.

Financial strain and cancer risk behaviors among African Americans

BACKGROUND

African Americans suffer disproportionately from the adverse consequences of behavioral risk factors for cancer relative to other ethnic groups. Recent studies have assessed how financial strain might uniquely contribute to engagement in modifiable behavioral risk factors for cancer, but not among African Americans. The current study examined associations between financial strain and modifiable cancer risk factors (smoking, at-risk alcohol use, overweight/obesity, insufficient physical activity, inadequate fruit and vegetable intake, and multiple risk factors) among 1,278 African American adults (age, 46.5 ± 12.6 years; 77% female) and explored potential mediators (stress and depressive symptoms) of those associations.

METHODS

Logistic regression models were used to examine associations between financial strain and cancer risk factors. Analyses were adjusted for age, sex, partner status, income, educational level, and employment status. Analyses involving overweight/obesity status additionally controlled for fruit and vegetable intake and physical activity. Nonparametric bootstrapping procedures were used to assess mediation.

RESULTS

Greater financial strain was associated with greater odds of insufficient physical activity (P < 0.003) and smoking (P = 0.005) and was positively associated with the total number of cancer risk factors (P < 0.0001). There was a significant indirect effect of both stress and depressive symptoms on the relations of financial strain with physical inactivity and multiple risk factors, respectively.

CONCLUSIONS

Future interventions aimed at reducing cancer disparities should focus on African Americans experiencing higher financial strain while addressing their stress and depressive symptoms.

IMPACT

Longitudinal studies are needed to assess the temporal and causal relations between financial strain and modifiable behavioral cancer risk factors among African Americans.

Financial strain and self-rated health among Black adults

OBJECTIVES

To explore associations between financial strain and self-rated health among 1341 black adults.

METHODS

Associations were investigated using a covariate-adjusted linear regression model. Mediation (via stress and/or depressive symptoms) was explored in additional models using a nonparametric bootstrapping procedure.

RESULTS

Higher financial strain was associated with poorer self-rated health (p < .001). Stress and depressive symptoms were each significant mediators of this relation in both single and multiple mediator models (p values < .05).

CONCLUSIONS

Financial strain may contribute to poorer health among black adults, partially via greater stress and depressive symptoms. Potential theoretical, intervention, and policy implications are discussed. Future studies with longitudinal designs are needed to confirm these results.