Social position and minor psychiatric morbidity over time in the British Household Panel Survey 1991-1998

Contactable Non-responders Show Different Characteristics Compared to Lost to Follow-Up Participants: Insights from an Australian Longitudinal Birth Cohort Study

Objective This research aims to identify predictors of attrition in a longitudinal birth cohort study in Australia and assess differences in baseline characteristics and responses in subsequent follow-up phases between contactable non-responders and uncontactable non-responders deemed "lost to follow-up (LTF)". Methods 3368 women recruited from three public hospitals in Southeast Queensland and Northern New South Wales during antenatal visits in 2006-2011 completed a baseline questionnaire to elicit information on multiple domains of exposures. A follow-up questionnaire was posted to each participant at 1 year after birth to obtain mother's and child's health and development information. Multivariate logistic regression was used to model the association between exposures and respondents' status at 1 year. The effect of an inverse-probability-weighting method to adjust for non-response was studied. Results Overall attrition at 1-year was 35.4 %; major types of attrition were "contactable non-response" (27.6 %) and "LTF" (6.7 %). These two attrition types showed different responses at the 3-year follow-up and involved different predictors. Besides shared predictors (first language not English, higher risk of psychological distress, had smoked during pregnancy, higher levels of family conflict), distinguishable predictors of contactable non-responders were younger age, having moved home in the past year and having children under 16 in the household. Attrition rates increased substantially from 20 % in 2006 to 54 % in 2011. Conclusions This observed trend of increased attrition rates raises concern about the use of traditional techniques, such as "paper-based" questionnaires, in longitudinal cohort studies. The supplementary use of electronic communications, such as online survey tools and smart-device applications, could provide a better alternative.

The role of socio-economic status in depression: results from the COURAGE (aging survey in Europe)

BACKGROUND

Low socio-economic status (SES) has been found to be associated with a higher prevalence of depression. However, studies that have investigated this association have been limited in their national scope, have analyzed different components of SES separately, and have not used standardized definitions or measurements across populations. The aim of the current study was to evaluate the association between SES and depression across three European countries that represent different regions across Europe, using standardized procedures and measurements and a composite score for SES.

METHOD

Nationally-representative data on 10,800 individuals aged ≥18 from the Collaborative Research on Ageing in Europe (COURAGE) survey conducted in Finland, Poland and Spain were analyzed in this cross-sectional study. An adapted version of the Composite International Diagnostic Interview was used to identify the presence of depression, and SES was computed by using the combined scores of the total number of years educated (0-22) and the quintiles of the country-specific income level of the household (1-5). Multivariable logistic regression was used to assess the association between SES and depression.

RESULTS

Findings reveal a significant association between depression and SES across all countries (p ≤ 0.001). After adjusting for confounders, the odds of depression were significantly decreased for every unit increase in the SES index for Finland, Poland and Spain. Additionally, higher education significantly decreased the odds for depression in each country, but income did not.

CONCLUSION

The SES index seems to predict depression symptomatology across European countries. Taking SES into account may be an important factor in the development of depression prevention strategies across Europe.

Coping with unemployment: Does educational attainment make any difference?

Aims: The aim of this study was to examine the cross-sectional association between educational attainment and coping strategies with unemployment in a random sample of 37- to 56-year-old Danish men and women in long-term unemployment. Methods: Data were based on a survey among 575 men and 1,064 women who had been unemployed at least 70% of the time during a three-year period (October 1996 to October 1999). The outcome measures were two scales for coping with unemployment, one for problem-solving coping, and one for avoidant coping. Educational attainment was measured by years of vocational training. Results: A significant association was found between low educational attainment and low use of problem-solving coping among both men, OR=1.81 (95% CI 1.19—2.75), and women, OR=1.57 (1.13— 2.18). Adjustment for cohabitation status, self rated health, economic strain, and unemployment status did not change this association substantially. High use of avoidant coping was associated with low educational attainment among men, OR=1.57 (0.98—2.51). For women, medium educational attainment was significantly associated with low use of avoidant coping, OR=0.60 (0.42—0.85). This result was not affected by adjustment for the covariates. Conclusions: Coping strategies are considered a potential modifier of the impact of unemployment on health and well-being. In this study, differences in coping strategies with unemployment were associated with educational attainment.

Moving to Serene Nature May Prevent Poor Mental Health--Results from a Swedish Longitudinal Cohort Study

Green spaces are recognized for improving mental health, but what particular kind of nature is required is yet not elucidated. This study explores the effect of specific types of recreational nature qualities on mental health. Longitudinal data (1999/2000 and 2005) from a public health survey was distributed to a stratified sample (n = 24,945) of a Swedish population. People from rural or suburban areas (n = 9230) who had moved between baseline and follow-up (n = 1419) were studied. Individual geographic residence codes were linked to five predefined nature qualities, classified in geographic information systems (GIS). Any change in the amount of or type of qualities within 300 m distance between baseline and follow-up was correlated to any change in mental health (as measured by the General Health Questionnaire) by logistic regression models. On average, the population had limited access to nature qualities both pre- and post-move. There was no significant correlation between change in the amount of qualities and change in mental health. However, the specific quality “serene” was a significant determinant with a significantly decreased risk for women of change to mental ill-health at follow-up. The objective definition of the potentially health-promoting quality may facilitate implication in landscape practice and healthy planning.

Self-reported health and socio-economic inequalities in England, 1996-2009: Repeated national cross-sectional study

Tackling social inequalities in health has been a priority for recent UK governments. We used repeated national cross-sectional data for 155,311 participants (aged ≥16 years) in the Health Survey of England to examine trends in socio-economic inequalities in self-reported health over a recent period of sustained policy focus by successive UK governments aimed at tackling social inequalities in health. Socio-economic related inequalities in self-reported health were estimated using the Registrar General's occupational classification (1996-2009), and for sensitivity analyses, the National Statistics Socio-Economic Classification (NS-SEC; 2001-2011). Multi-level regression was used to evaluate time trends in General Health Questionnaire (GHQ-12) scores and bad or very bad self-assessed health (SAH), as well as EQ-5D utility scores. The study found that the probability of reporting GHQ-12 scores ≥4 and ≥ 1 was higher in those from lower social classes, and decreased for all social classes between 1997 and 2009. For SAH, the probability of reporting bad or very bad health remained relatively constant for social class I (professional) [0.028 (95%CI: 0.026, 0.029) in 1996 compared to 0.028 (95%CI: 0.024, 0.032) in 2009], but increased in lower social classes, with the greatest increase observed amongst those in social class V (unskilled manual) [0.089 (95%CI: 0.085, 0.093) in 1996 compared to 0.155 (95%CI: 0.141, 0.168) in 2009]. EQ-5D utility scores were lower for those in lower social classes, but remained comparable across survey years. In sensitivity analyses using the NS-SEC, health outcomes improved from 2001 to 2011, with no evidence of widening socio-economic inequalities. Our findings suggest that socio-economic inequalities have persisted, with evidence of widening for some adverse self-reported health outcomes.

Mental health trajectories and their embeddedness in work and family circumstances: a latent state-trait approach to life-course trajectories

Mental health trajectories are known to be influenced by work and family circumstances. However, few studies have examined both of these influences simultaneously in a longitudinal manner. The life-course perspective stresses the importance of examining trajectories in terms of both stable and dynamic components. In this article we use structural equation models (latent state-trait, LST) to distinguish the stable and situational components of mental health trajectories and hypothesise that situational mental health is influenced by satisfaction with work and family, and this effect differs by gender. An analysis of data from a nationally representative sample of 1616 working Swiss residents (2000-2006) shows that mental health trajectories are mostly stable and only slightly sensitive to situational influences. However, situational influences in a given wave do predict situational influences in the next wave. Satisfaction with work and family influences situational mental health in both genders, but the impact is greater for men. In conclusion, the LST approach allows for the examination of mental health trajectories from a life-course perspective by distinguishing stable and situational components. Mental health trajectories are more stable and constant than they are dependent on work and family circumstances, and men are more sensitive to family circumstances than women.

Adjusting for selection bias in longitudinal analyses using simultaneous equations modeling: the relationship between employment transitions and mental health

BACKGROUND

Effects of labor force participation on mental health can be difficult to discern due to the possibility of selection bias. Previous research typically adjusts for direct selection (reverse causality) but ignores indirect selection (unmeasured confounders).

METHODS

We investigate the relationship between men's employment transitions and mental health using a dynamic simultaneous equations model applied to data from the British Household Panel Survey (1991-2009). Outcome is self-reported distress and anxiety as summed on a 12-point scale. We allow for direct selection by allowing prior mental health to affect both subsequent mental health and employment transitions in the joint model. We adjust for indirect selection by allowing for residual correlation between mental health and employment.

RESULTS

Moving from unemployment to employment was strongly associated with an improvement in mental health, whereas becoming unemployed was detrimental. However, these associations were attenuated by unmeasured confounders. After adjustment for indirect selection, the increased distress and anxiety associated with becoming unemployed decreased from 2.5 (95% confidence interval = 2.2 to 2.7) to 2.2 (2.0 to 2.5). (A change of 2.5 equates to half a standard deviation on the 12-point scale.) The improvement with moving from unemployment to employment was also weakened slightly (from -2.1 [-2.4 to -1.7] to -1.8 [-2.1 to -1.5]).

CONCLUSIONS

There was strong evidence of indirect selection, but less support for direct selection. Nevertheless, the effects on psychological health of transitions between employment and unemployment, and between employment and economic inactivity, remained substantial after adjusting for selection.

The transition to living alone and psychological distress in later life

Background: living alone in later life has been linked to psychological distress but less is known about the role of the transition into living alone and the role of social and material resources.

Methods: a total of 21,535 person-years of data from 4,587 participants of the British Household Panel Survey aged 65+ are analysed. Participants provide a maximum 6 years' data (t₀−t₅), with trajectories of living arrangements classified as: consistently partnered/ with children/alone; transition from partnered to alone/with children to alone. General Health Questionnaire (GHQ)-12 caseness (score >3) is investigated using multi-level logistic regression, controlling for sex, age, activities of daily living, social and material resources.

Results: after a transition from partnered at t₀ to alone at t₁, the odds for GHQ-12 caseness increased substantially, but by t₃ returned to baseline levels. The odds for caseness at t₀ were highest for those changing from living with a child at t₀ to living alone at t₁ but declined following the transition to living alone. None of the covariates explained these associations. Living consistently alone did confer increased odds for caseness.

Conclusions: living alone in later life is not in itself a strong risk factor for psychological distress. The effects of transitions to living alone are dependent on the preceding living arrangement and are independent of social and material resources. This advocates a longitudinal approach, allowing identification of respondents' location along trajectories of living arrangements.

Disparities in the geography of serious mental illness in Israel

OBJECTIVE

The aim of this research is to test and apply a model of the disparities and variations in serious mental illness (SMI) to estimating prevalence in local areas throughout Israel.

METHODS

This study employs a secondary analysis of data from the 2003/2004 Israel National Health Survey of 4859 adults aged 21 and over from the household population of legal residents and citizens. It uses small area estimation methods (SAE), specifically to: (i) estimate and test a multivariate logistic model of disparities in the risk of serious mental illness; (ii) use the foregoing model for computing estimates, using census data, for local areas; (iii) validate these estimates against the rate of psychiatric hospitalizations.

RESULTS

The model uses standard demographic and socioeconomic variables to successfully predict 92.5% of respondents' statuses as SMI, with a sensitivity of 26.9%, specificity of 95.9%, and an AUC index of .797. The resulting estimates of the percentage of adults with an SMI in the 16 subdistricts ranged between 3.7% and 7.7%, with a national mean of 5.0%. The estimates have a partial correlation of .63 with rates of psychiatric hospitalization in Jewish localities, but elevated rates have not been validated in Arab localities.

CONCLUSION

The use of small area estimation methods demonstrated the capacity for deriving local prevalence rates of serious mental illness, ones that can be validated against psychiatric hospitalization for the majority population group in Israel.

Socioeconomic pathways to depressive symptoms in adulthood: evidence from the National Longitudinal Survey of Youth 1979

The existence of a direct effect of early socioeconomic position (SEP) on adult mental health outcomes net of adult SEP is still debated. This question demands the explicit modeling of pathways linking early SEP to adult SEP and mental health. In light of this background, we pursue two objectives in this study. First, we examine whether depressive symptoms in adulthood can be fit in a trajectory featuring both an intercept, or baseline range of depressive symptoms that varied between individuals, and a slope describing the average evolution of depressive symptoms over the years. Second, we estimate the direct and indirect pathways linking early SEP, respondents' education and adult household income, with a particular focus on whether early SEP retains a significant direct effect on the trajectory of depressive symptoms once adult SEP is entered into the pathway model. Drawing from 29 years of cohort data from the National Longitudinal Survey of Youth 1979, a survey that has been following a national probability sample of American civilian and military youth (Zagorsky and White, 1999), we used structural equation models to estimate the pathways between parents' education, respondent's education, and latent growth curves of household income and depressive symptoms. We found that the effect of parents' education was entirely mediated by respondent's education. In turn, the effect of respondent's education was largely mediated by household income. In conclusion, our findings showed that the socioeconomic attainment process that is rooted in parents' education and leads to respondent's education and then to household income is a crucial pathway for adult mental health. These results suggest that increasing educational opportunities may be an effective policy to break the intergenerational transmission of low socioeconomic status and poor mental health.

Class Relations and All-Cause Mortality: A Test of Wright's Social Class Scheme Using the Barcelona 2000 Health Interview Survey

The aim of this study is to test the effects of neo-Marxian social class and potential mediators such as labor market position, work organization, material deprivation, and health behaviors on all-cause mortality. The authors use longitudinal data from the Barcelona 2000 Health Interview Survey (N = 7,526), with follow-up interviews through the municipal census in 2008 (95.97% response rate). Using data on relations of property, organizational power, and education, the study groups social classes according to Wright's scheme: capitalists, petit bourgeoisie, managers, supervisors, and skilled, semi-skilled, and unskilled workers. Findings indicate that social class, measured as relations of control over productive assets, is an important predictor of mortality among working-class men but not women. Workers (hazard ratio = 1.60; 95% confidence interval, 1.10–2.35) but also managers and small employers had a higher risk of death compared with capitalists. The extensive use of conventional gradient measures of social stratification has neglected sociological measures of social class conceptualized as relations of control over productive assets. This concept is capable of explaining how social inequalities are generated. To confirm the protective effect of the capitalist class position and the “contradictory class location hypothesis,” additional efforts are needed to properly measure class among low-level supervisors, capitalists, managers, and small employers.

Epidemiological survey of mental disorders in urban regions of Ardabil province (Iran)

For any informed decision making about community-oriented nursing, it is necessary to map out the community regarding the psychological factors. This study is an attempt to estimate the mental disorders' rate among the age group of 15-65 in the urban areas of Ardabil province. A sample of 1430 individuals was selected through random multistage cluster sampling. The instruments employed in this study included Personal Data Questionnaire and the 28-item General Health Questionnaire (GHQ). The findings revealed that, on the whole, 27.83% of the subjects suffer from different mental disorders. The prevalence rate of mental disorders appeared to vary from 13.3% to 44.4% based on the place of residence, and the highest prevalence rate was found to be social dysfunction and anxiety disorders. According to GHQ test, the prevalence rate of social dysfunction, anxiety, somatization and depression disorders were 32%, 22.30%, 20% and 14%, respectively. The study also showed that the prevalence rate of mental disorders was higher among women as compared with men (34.2% vs. 21.1%). The findings of this study is hoped to contribute to community-oriented nursing practice and education.

Ageing, social class and common mental disorders: longitudinal evidence from three cohorts in the West of Scotland

BACKGROUND

Understanding how common mental disorders such as anxiety and depression vary with socio-economic circumstances as people age can help to identify key intervention points. However, much research treats these conditions as a single disorder when they differ significantly in terms of their disease burden. This paper examines the socio-economic pattern of anxiety and depression separately and longitudinally to develop a better understanding of their disease burden for key social groups at different ages.

METHOD

The Twenty-07 Study has followed 4510 respondents from three cohorts in the West of Scotland for 20 years and 3846 respondents had valid data for these analyses. Hierarchical repeated-measures models were used to investigate the relationship between age, social class and the prevalence of anxiety and depression over time measured as scores of 8 or more out of 21 on the relevant subscale of the Hospital Anxiety and Depression Scale (HADS).

RESULTS

Social class differences in anxiety and depression widened with age. For anxiety there was a nonlinear decrease in prevalence with age, decreasing more slowly for those from manual classes compared to non-manual, whereas for depression there was a non-linear increase in prevalence with age, increasing more quickly for those from manual classes compared to non-manual. This relationship is robust to cohort, period and attrition effects.

CONCLUSIONS

The more burdensome disorder of depression occurs more frequently at ages where socio-economic inequalities in mental health are greatest, representing a 'double jeopardy' for older people from a manual class.

Capitalists, managers, professionals and mortality: Findings from the Barcelona Social Class and All Cause Mortality Longitudinal Study

Aims: To examine the effects of Neo-Marxian social class (i.e. measured as relations of control over productive assets) and potential mediators such as labour-market position, work organization, material deprivation and health behaviours upon mortality in Barcelona, Spain. Methods: Longitudinal data from the Barcelona 2000 Health Interview Survey (n = 7526) with follow-up interviews through the municipal census in 2008 (95.97% response rate) were used. Using data on relations of property, organizational power, and education, social classes were grouped according to Wright’s scheme: capitalists, petit bourgeoisie, managers, supervisors, and skilled, semi-skilled and unskilled workers. Results: Social class, measured as relations of control over productive assets, is an important predictor of mortality among working-class positions for men but not for women. Workers (hazard ratio 1.60, 95% confidence interval 1.10—2.35), managers and small employers had a higher risk of death than capitalists. Conclusions: The extensive use of conventional gradient measures of social stratification has neglected sociological measurements of social class conceptualized as relations of control over productive assets. This concept is capable of explaining how social inequalities are generated. To confirm the protective effect of the capitalist class position and the ‘‘contradictory class location hypothesis’’, additional efforts are needed to properly measure class among low-level supervisors, capitalists, managers, and small employers.

Trends in socio-economic differences in self-reported depression during the years 1979-2002 in Finland

BACKGROUND

Socio-economic differences in depressive symptoms are well reported, but there are only few studies concerning changes in these differences over time. The aim of this study was to assess trends in socio-economic differences in self-reported depression over the time period 1979-2002 in Finland.

METHODS

The data source was a representative repeated cross sectional survey "Health Behaviour and Health among the Finnish Adult Population" (AVTK) linked with socio-economic register data from Statistics Finland, for the period 1979-2002. The age group of 25-64 years was included in this study (N = 71,290; average annual response rate 75%). Outcome measure was a single question of self-reported depression. Socio-economic factors included education, employment status and household income. The main analyses were conducted by multiple logistic regression.

RESULTS

The prevalence of self-reported depression fluctuated in both men and women but remained higher in women compared to men over the past 24 years. After adjusting for age, socio-economic differences in self-reported depression were clear in regard to education, employment status and household income over the time period 1979-2002. When all socio-economic factors were mutually adjusted for, the association with self-reported depression remained significant in the unemployed, the retired and in those in the lowest household income categories in both genders. The effect of education on self-reported depression was mediated by the other socio-economic factors. Based on a time trend analysis, the socio-economic differences in self-reported depression remained stable over the time period 1979-2002.

CONCLUSIONS

Socio-economic inequalities in self-reported depression were confirmed, and they have persisted with approximately the same magnitude over the past 24 years.

Prevalence of common mental disorders and their work consequences in France, according to occupational category

BACKGROUND

The aims of the study are to estimate the prevalence of the common mental disorders according to occupational category and to describe the consequences of these disorders on their work, in the French population.

METHODS

It took place in France from 1999 to 2003. The sample consisted of about 36,000 people aged 18 years and older. Data were collected face-to-face using the Mini International Neuropsychiatric Interview (MINI).

RESULTS

Anxiety disorders were most common (17% in men and 26% in women), while prevalence estimates for mood disorders were 10% in men and 14% in women. Prevalence of troubles were consistently higher among those in the lowest occupational categories. Among those reporting mental disorders, about 50% said that their work was affected. The repercussions on job varied by occupational category and differently for men and women.

CONCLUSION

This study shows the social and occupational inequalities in the prevalence of mental disorders and their important work consequences in the French working population. Am. J. Ind. Med. 52:141-152, 2009. (c) 2008 Wiley-Liss, Inc.

Social inequality and common mental disorders

OBJECTIVE

To analyze the association between the socioeconomic characteristics of individuals and common mental disorders.

METHOD

A cross-sectional survey of a representative sample of the urban population, 14 years and older, in Campinas (Brazil) (n=515) was conducted using a multipurpose instrument that included the Self-Reporting Questionnaire (SRQ-20) to assess common mental disorders in the previous 3 months. Weighted prevalence of common mental disorders was calculated for each independent variable. Crude and adjusted prevalence ratios were estimated using Poisson regression.

RESULTS

The overall prevalence was 17% (95% CI 12.8-22.3), 8.9% in males and 24.4% in females. An inverse association was found between common mental disorders and the socioeconomic characteristics (schooling and employment) even after controlling for all the other variables. Higher common mental disorders prevalence was observed in those with less than 5 years of schooling (PR=5.5) and unemployed or underemployed (PR=2.0).

CONCLUSIONS

As in other studies, common mental disorders were unevenly distributed; it was significantly more frequent in socially disadvantaged individuals. Specific actions to reduce inequalities in the general and mental health system should be studied.

Health, income and relative deprivation: evidence from the BHPS

It is believed that income affects health directly but it is argued that indirect income effects due to relative deprivation may be equally important. This paper investigates these relationships using parametric and semiparametric panel data models which ameliorate problems of mis-specification and unobservable heterogeneity. By allowing for a flexible functional form of income we ensure that coefficients on relative deprivation variables are not an artefact of a highly non-linear relationship between health and income. The results provide strong evidence for the impact of income on self-reported measures of health for men and women. These results are robust across a range of techniques and are resilient to the inclusion of measures of relative deprivation. The parametric results for relative deprivation largely reject its influence on health, although there is some evidence of an effect in the semiparametric models.

Parental detection of youth's self-harm behavior

The rate and predictors of parental detection of youth self-harm behavior and relationship with help-seeking were examined in 7,036 parent-child dyads from the 1999 and 2004 surveys of Mental Health of Children and Young People in Great Britain. Youth self-harm behavior was reported by 463 (6.6%) children and adolescents but only 190 (2.7%) of the parents (kappa=0.30). Reports were more accurate if parents were from majority White ethnicity, were mothers of girls, experienced psychological distress themselves, or if children were older or had emotional/behavioral problems. Parental detection of youth self-harm was associated with increased likelihood of professional help-seeking.

Transtornos mentais comuns e o uso de práticas de medicina complementar e alternativa: estudo de base populacional

OBJETIVO: Verificar a prevalência do transtorno mental comum (TMC) na população da cidade de Montes Claros, MG, e a existência de associação entre os fatores socioeconômicos e a utilização de práticas integrativas e complementares/medicina complementar e alternativa (PIC/MCA) com o TMC. MÉTODOS: Estudo transversal. População alvo: moradores de Montes Claros. A amostragem foi probabilística, com 3.090 pessoas. Utilizou-se formulário semi-estruturado e o self reporting questionnaire (SRQ-20) para identificação do TMC. Realizou-se regressão robusta de Poisson na análise com significância estatística considerada de p < 0,05. RESULTADOS: A prevalência de TMC foi de 23,2%, sendo 75% usuários de PIC/MCA. Após controle para fatores de confusão, a prevalência de TMC foi maior naqueles com menor escolaridade (RP = 2,12; IC = 1,80-2,49); com menor nível econômico (RP = 1,92; IC = 1,07 - 3,44); com mais de 40 anos (RP = 1,30; IC = 1,15-1,48); do gênero feminino (RP = 2,99; IC = 1,50-3,58) e mais freqüente entre os que recorreram à homeopatia (RP = 1,52; IC = 1,12-2,08) e às benzedeiras (RP = 1,25; IC = 1,08-1,46). CONCLUSÕES: O TMC é muito freqüente na população de Montes Claros. As variáveis: escolaridade, nível econômico, idade e sexo, bem como a procura por homeopatia e benzedeiras estiveram associados ao TMC.

Socioeconomic circumstances and common mental disorders among Finnish and British public sector employees: evidence from the Helsinki Health Study and the Whitehall II Study

BACKGROUND

Common mental disorders do not always show as consistent socioeconomic gradients as severe mental disorders and physical health. This inconsistency may be due to the multitude of socioeconomic measures used and the populations and national contexts studied. We examine the associations between various socioeconomic circumstances and common mental disorders among middle-aged Finnish and British public sector employees.

METHODS

We used survey data from the Finnish Helsinki Health Study (n = 6028) and the British Whitehall II Study (n = 3116). Common mental disorders were measured by GHQ-12. The socioeconomic indicators were parental education, childhood economic difficulties, own education, occupational class, household income, housing tenure and current economic difficulties. Logistic regression analysis was the main statistical method used.

RESULTS

Childhood and current economic difficulties were strongly associated with common mental disorders among men and women in both the Helsinki and the London cohort. The more conventional indicators of socioeconomic circumstances showed weak or inconsistent associations. Differences between the two cohorts and two genders were small.

CONCLUSIONS

Our findings emphasize the importance of past and present economic circumstances to common mental disorders across different countries and genders. Overall, our results suggest that among employee populations, the socioeconomic patterning of common mental disorders may differ from that of other domains of health.

The Effects of Childhood Circumstances, Adult Socioeconomic Status, and Material Circumstances on Physical and Mental Functioning: A Structural Equation Modelling Approach

PURPOSE

We sought to examine the importance of childhood circumstances, adult socioeconomic status, and material circumstances to physical and mental functioning among middle-aged women and men.

METHODS

The data were collected among the employees of the City of Helsinki by mailed questionnaires from 2000 to 2002 (7148 women and 1799 men, response rate 67%). Three latent variables covering childhood circumstances, adult socioeconomic status, and material circumstances were constructed from 10 observed socioeconomic indicators. Direct and indirect effects of the latent variables on physical and mental functioning, measured by the SF-36 component summaries, were examined using structural equation modelling.

RESULTS

Childhood circumstances were not directly associated with either physical or mental functioning but had some effect through socioeconomic status. Low socioeconomic status was associated with poor physical functioning, but mental functioning was poorer among those in higher positions. Material circumstances were associated with physical and especially with mental functioning.

CONCLUSIONS

Low socioeconomic status and material circumstances are both important for physical functioning. However, mental functioning does not necessarily follow a similar socioeconomic pattern and the results are heavily influenced by how socioeconomic position is measured.

Self-rated life expectancy and lifetime socio-economic position: cross-sectional analysis of the British household panel survey

BACKGROUND

The association between mortality risk and socio-economic position (SEP) across the lifecourse is established. This study investigates whether people's own ratings of their life expectancy are also associated with lifetime SEP. Health behaviour messages, which often emphasize the long-term benefits of behavioural change, may be received differently depending on people's perceptions of their life chances.

METHODS

Cross-sectional analysis of 4780 adults aged 25-64 interviewed in the British Household Panel Survey in 2001.

RESULTS

Just under a quarter of respondents did not think it likely they would live to 75 or older. People in lower SEPs were more likely to be pessimistic about their life expectancy. This applied across a number of socio-economic measures (father's social class, educational achievement, own social class, and household income). Eight socio-economic lifecourse pathways were compared. In comparison to those following the most advantaged pathway, those experiencing sustained socio-economic disadvantage were most likely to be pessimistic about their longevity, but those experiencing sustained upward mobility did not differ. Comparisons with measures of self-rated general health and limiting illness suggest that self-rated life expectancy is at least partially independent of current health status.

CONCLUSIONS

This study shows that people's own perceptions of their life expectancy are associated with lifetime SEP. Self-rated life expectancy, in part, appears to reflect something over and above current health status and smoking behaviour. Given its ease of collection, it would be informative to include self-rated life expectancy in future studies.

Multiple measures of socioeconomic circumstances and common mental disorders

While serious mental disorders typically show socioeconomic differences similar to physical illness-that is, that lower positions imply poorer health-differences for common mental disorders have been inconsistent. We aim to clarify the associations and pathways between measures of socioeconomic circumstances and common mental disorders by simultaneously analysing several past and present socioeconomic measures. The data were derived from middle-aged women and men employed by the City of Helsinki. Cross-sectional surveys were conducted in 2000-2002 among employees who, during each year, reached 40, 45, 50, 55 or 60 years of age. The pooled data include 8970 respondents (80% women; response rate 67%). Common mental disorders were measured by GHQ-12 and the SF-36 mental component summary. Seven socioeconomic measures were included: parental education, childhood economic difficulties, own education, occupational class, household income, home ownership, and current economic difficulties. Logistic regression analysis was used to examine associations between the socioeconomic circumstances and common mental disorders. Past and present economic difficulties were strongly associated with common mental disorders, whereas conventional past and present socioeconomic status measures showed weak or slightly reverse associations. Adjusting for age and gradually for each socioeconomic measure did not affect the main findings, which were very similar for women and men, as well as for both measures of common mental disorders. While the associations of conventional socioeconomic status measures with common mental disorders were weak and inconsistent, our results highlight the importance of past and present economic difficulties to these disorders.

Does the 12-item General Health Questionnaire contain multiple factors and do we need them?

Background

The 12-item General Health Questionnaire (GHQ-12) is widely used as a unidimensional instrument, but factor analyses tended to suggest that it contains two or three factors. Not much is known about the usefulness of the GHQ-12 factors, if they exist, in revealing between-patient differences in clinical states and health-related quality of life.

Methods

We addressed this issue in a cross-sectional survey of out-patients with psychological disorders in Singapore. The participants (n = 120) completed the GHQ-12, the Beck Anxiety Inventory, and the Short-Form 36 Health Survey. Confirmatory factor analysis was used to compare six previously proposed factor structures for the GHQ-12. Factor scores of the best-fitting model, as well as the overall GHQ-12 score, were assessed in relation to clinical and health-related quality of life variables.

Results

The 3-factor model proposed by Graetz fitted the data better than a unidimensional model, two 2-factor models, and two other 3-factor models. However, the three factors were strongly correlated. Their values varied in a similar fashion in relation to clinical and health-related quality of life variables.

Conclusions

The 12-item General Health Questionnaire contains three factors, namely Anxiety and Depression, Social Dysfunction, and Loss of Confidence. Nevertheless, using them separately does not offer many practical advantages in differentiating clinical groups or identifying association with clinical or health-related quality of life variables.