Social Inequalities and Depressive Symptoms in Adults: The Role of Objective and Subjective Socioeconomic Status

Factors associated with anxiety and depression in perimenopausal women with abnormal uterine bleeding: A retrospective cohort study

OBJECTIVE

To investigate factors associated with anxiety and depression in perimenopausal women experiencing abnormal uterine bleeding (AUB), with a focus on endocrine markers and lifestyle factors.

METHODS

This retrospective cohort study analyzed 1,234 perimenopausal women with AUB treated at a tertiary hospital from January 2023 to January 2024. Participants were classified based on DSM-5 diagnoses of anxiety and depression. Data collected included demographics, lifestyle habits, comorbidities, psychiatric history, and endocrine levels (estradiol, follicle-stimulating hormone [FSH], luteinizing hormone [LH], cortisol, prolactin, testosterone, and thyroid-stimulating hormone [TSH]). Logistic regression models identified independent predictors, with interaction and stratified analyses conducted by age group (< 50 and ≥ 50 years).

RESULTS

Factors associated with anxiety and depression included higher BMI (OR 1.08, P = 0.008), longer AUB duration (OR 1.12, P = 0.001), single/divorced/widowed marital status (OR 1.54, P = 0.015), and lower education levels (OR 1.62, P < 0.001). Smoking history (OR 2.84, P < 0.001) and psychiatric history (OR 3.11, P < 0.001) emerged as strong predictors, while regular exercise was protective (OR 0.64, P = 0.001). Hormonal factors, including lower estradiol and elevated levels of FSH, LH, and cortisol, were significantly linked to increased odds of psychological distress (P < 0.01). Interaction analyses revealed that smoking and elevated cortisol exacerbated risks, whereas regular exercise mitigated the adverse effects of elevated FSH and LH. These associations were consistent across age groups.

CONCLUSIONS

Anxiety and depression in perimenopausal women with AUB are influenced by a combination of demographic, lifestyle, clinical, and endocrine factors. Addressing modifiable risk factors, such as smoking cessation and increased physical activity, may alleviate psychological distress. Further research is needed to elucidate the hormonal pathways connecting endocrine changes to mental health.

Care Needs of Community-Dwelling Older Adults Living in Poverty and Their Relationship With Other Biopsychosocial Variables: A Cross-Sectional Study

AIM

To assess the care needs of older adults living in poverty in a high-income country and to analyse their relationship with other outcome variables.

DESIGN

A cross-sectional study.

METHOD

Data were collected between September 2022 and February 2024 from 384 older adults in southeastern Spain. Descriptive statistics were calculated to assess older adults' care needs. A multiple linear regression analysis was carried out to determine the percentage by which the socio-demographic or outcome variables could explain the number of met care needs among older adults in poverty.

RESULTS

Around 20% of the care needs amongst older adults living in poverty were unmet. The most frequently unmet care need was related to money (53.6%). Almost 30% of participants were at risk of malnutrition, 18% felt lonely, and 80% perceived a low level of social support. Age, history of falls, emergency room visits, functionality, perceived social support, quality of life and nutritional status significantly predicted the number of needs met.

CONCLUSION

The health conditions of older adults living in poverty are suboptimal and may negatively influence their care needs. Nurses should consider these factors when designing, implementing and evaluating interventions to promote the biopsychosocial health of this population.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nursing interventions to promote health amongst older adults living in poverty should focus on identifying unmet care needs, particularly those related to financial and social support. Interventions should prioritise improving nutritional status, enhancing social support networks and addressing loneliness.

IMPACT

Living in poverty increases older adults' vulnerability due to unmet financial, nutritional and social support needs. These unmet needs can negatively affect older adults' physical and mental health.

REPORTING METHOD

The study has been reported following the STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

The study's participants only participated in the data collection process.

Socioeconomic and Demographic Modifiers of Depression's Impact on Emergency Department Utilization: A Stratified Analysis

BACKGROUND

The emergency department (ED) is often considered the last line of defense for urgent health crises, and people with depression may rely more heavily on ED services to address unexpected issues related to mental health or physical health due to the acute onset of symptoms or a lack of routine medical care.

OBJECTIVE

This study aims to investigate the association between depressive symptoms and ED utilization and to systematically evaluate the moderating effects of socioeconomic status (SES), gender, and age on this relationship.

METHODS

The study utilized data from the National Health and Nutrition Examination Survey (NHANES) covering the period from 2005 to 2018, with a final sample of 26,299 adult participants. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), and ED utilization was categorized based on participants' self-reported medical service use.

RESULTS

Logistic regression analysis indicated that each 1-point increase in PHQ-9 score was associated with a 6% increase in the likelihood of ED utilization (p < 0.001). The association between depressive symptoms and ED utilization was significantly stronger in women, particularly for those with severe depression (p = 0.021).

CONCLUSION

This study demonstrates that depressive symptoms are significantly associated with a higher likelihood of ED utilization, with this association strongly moderated by SES, gender, and age. The varying impact of specific depressive symptoms, such as delayed movement or speech and sleep problems, on ED utilization highlights the importance of early intervention and targeted mental health support for high-risk groups to help reduce ED visit frequency.

Explaining subjective social status and health: Beyond education, occupation and income

Subjective measures of social status often explain variations in health better than the typical objective measures of education, occupation, and income. This raises the question: if status affects health, then what affects status? To answer this, we ran a survey using representative samples of adult populations in the UK, US and Canada (n = 3,431) to gather data on respondents' subjective social status (SSS) and health-related quality of life (HRQoL), alongside an extensive, rarely gathered set of socioeconomic variables: education, occupation, income, comparative income, wealth, childhood circumstances, parents' education, partner's education, and social and cultural capital. We conduct Shapley-Owen decompositions to identify the relative contributions of these variables in explaining variation in SSS and HRQoL and use RIF (recentered influence function) -regressions to go beyond the mean and identify how these contributions change across the quantiles of SSS and HRQoL. Results show that education, occupation, and income explain relatively little of the explained variation in SSS (26%), while comparative income, wealth and childhood circumstances together explain more than 60%. We find that at higher quantiles of SSS and HRQoL the more subjective and relativistic measures of socioeconomic status contribute more to the explained variation, whilst at lower quantiles, variation is better explained by the more objective socioeconomic variables (i.e. education, occupation, income and wealth). These findings shed light on how policy makers could consider intervening to reduce health inequalities.

Use and acceptance of video consultation among adults insured by statutory health insurance providers in Germany: A nationwide online survey

INTRODUCTION

The increasing digitalization of the healthcare system makes it possible to provide medical services using digital technologies without direct patient-provider contact. This study aimed to investigate 1) the use and acceptance of video consultation and 2) factors associated with the use of video consultation.

METHODS

A cross-sectional online survey was conducted in February 2023. Overall, 20,000 adults insured at a statutory health insurance company in Germany (10,000 users and 10,000 non-users of video consultation) were invited by email to an online survey with 31 items. The items addressed use and acceptance of digital health services with a focus on video consultation, digital health literacy, and sociodemographic characteristics. Data were analyzed using descriptive statistics and factors associated with video consultation use were assessed using binary logistic regression.

RESULTS

Among the 1,657 participants, 686 were users and 971 were non-users of video consultation. The participants were aged between 18 and 80 years (M ± SD: 44 ± 13 years), 55% were female, 59% reported a medium subjective socioeconomic status and 69% a good to very good health status. Video consultation was predominantly used following physician recommendations (71%) as part of general medical care (50%). The main reasons for using video consultation were time saving (93%) and flexibility in terms of location (87%). Most video consultation users felt well cared-for during video consulting (93%), would use it again (95%), and would recommend it to others (93%). Factors associated with video consultation use were age from 30 to 49 years, high subjective socioeconomic status, high digital health litercay, and very poor to moderate health status.

CONCLUSION

The acceptance of video consultations in this study was high. Advantages and barriers to offering video consultations from a physician perspective should be investigated to incorporate video consultations in everyday medical practice.

Agreement between CES-D and CIDI-SF scales of depression among older adults: a cross-sectional comparative study based on the longitudinal aging study in India, 2017-19

BACKGROUND

Understanding the differences between various instruments for assessing depression will help researchers and health practitioners to choose a more appropriate tool and develop a framework to enhance resilience to mental health problems in the older population. The current study aimed to compare the 10-item Center for Epidemiological Studies-Depression (CES-D) scale with the Composite International Diagnostic Interview-Short Form (CIDI-SF) for measuring depressive symptoms in older Indians.

METHODS

Data came from the first wave of the Longitudinal Aging Study in India (LASI) which was conducted during 2017-19. The final sample included 30,368 older individuals aged 60 years and above (15,824 women and 14,544 men). The level of agreement between the CES-D and CIIDI-SF instruments for depression classification was assessed using Kappa coefficients at various cut-off values. Multivariable logistic regression models were used to examine the associations between background characteristics and depressive symptoms assessed by both instruments.

RESULTS

The prevalence of depressive symptoms based on the CES-D instrument was higher than that of CIDI-SF (30.2% vs. 8.3%). The level of agreement between the CES-D and CIDI-SF for depression classification was 'none' to 'minimal' (κ = 0.04-0.24). Assuming the CIDI-SF scale as the "gold standard", with rising threshold values, sensitivity of the CES-D scale decreased while specificity increased. The CES-D scale yielded a sensitivity of 29-82% and specificity of 39-92% across cut-off values of 3 to 6. The Pearson correlation between the CIDI-SF and CES-D total scores was significant but weak (r =.20). Multivariable analysis showed that depressive symptoms were more prevalent among women, those with higher education, individuals living alone, those with diagnosed psychiatric disorders, and individuals with two or more chronic conditions, compared to men, those who were uneducated, those not living alone and healthier peers, when assessed using both CES-D and CIDI-SF scales. The associations of marital status, religion and wealth quintiles were significant only for depressive symptoms assessed using the CES-D scale.

CONCLUSIONS

Depression cases identified by the CES-D showed poor agreement with those identified by the CIDI-SF. Therefore, the prevalence of depressive symptoms measured by the CESD is not interchangeable with that measured by the CIDI-SF. These findings suggest the importance of using both the CES-D and CIDI-SF in large population-based cohorts and surveillance surveys to obtain more accurate and nuanced understanding of depressive disorders across various subgroups of the older population.

Objective socioeconomic status, subjective social status, and mental disorders in Iranian mental health survey (IranMHS): A mediation analysis

BACKGROUND

There is ample evidence that socioeconomic status, objectively quantified by tangible resources, impacts mental health outcomes. However, the psychosocial mechanism linking objective socioeconomic status (OSS) with mental health is not clear. This study examined to what extent associations between OSS and the twelve-month prevalence of mental disorders, are mediated by the individual perception of social conditions-the subjective social status (SSS).

METHODS

We employed data from the Iranian Mental Health Survey (IranMHS), collected through interviews with 7886 Iranian adults. We used the Composite International Diagnostic Interview (CIDI 2.1) to assess any mental disorder, any anxiety disorder, and any major depressive disorder (MDD). We measured OSS based on education, occupation, wealth, and a composite OSS index, while SSS was evaluated using the MacArthur scale. We investigated the indirect associations and stratified the analyses by gender.

RESULTS

In this national sample, 4499 (57.0 %) were women, 4380 (55.5 %) were urban, and the mean (SE) age was 31.7 (0.2) years. SSS had a partial to full mediating effect. Specifically, there were significant indirect effects for the impact of wealth (mediation percentage: 78.9 %), education (73.3 %), OSS index (56.0 %), and occupation (33.3 %) on any mental disorder through SSS.

LIMITATIONS

The cross-sectional nature of the data presents constraints in establishing causal relationships.

CONCLUSIONS

Our findings highlight the role of SSS as the psychosocial mechanism linking OSS with mental disorders. A better understanding of the social factors that influence the association between OSS and SSS may enhance our insight into the mental health effects of socioeconomic status.

Socioeconomic and spatial distribution of depressive symptoms and access to treatment in Peru: A repeated nationwide cross-sectional study from 2014 to 2021

Background

Globally, evidence indicates that poverty and geographical setting influence the prevalence of depressive symptoms and access to treatment. Therefore, this study aimed to evaluate the socioeconomic and spatial distribution of depressive symptoms and treatment in Peru.

Methods

We conducted an observational study based on the analysis of secondary data derived from the Peruvian Demographic and Health Surveys for 2014-2021. Using the Patient Health Questionnaire-9 on depressive symptoms, we estimated the Erreygers concentration index (ECI) to identify socioeconomic inequality in depressive symptoms and access to treatment. Spatial analyses were conducted using Global Moran's I, Kriging interpolation, hotspot analysis (Getis-Ord-Gi∗), and the Bernoulli-based Kulldorff spatial analysis.

Results

The surveys included a total of 113,392 participants. Depressive symptoms exhibited only negative ECI values throughout the 2014-2021 period (pro-poor distribution), whereas access to treatment only displayed positive ECI values (pro-rich distribution). We identified two and four significant clusters in the southeastern areas of Peru in 2014 and 2021, respectively.

Conclusions

Depressive symptoms were concentrated among the poorest, whereas access to treatment was remarkably concentrated among the wealthiest groups. A clustered spatial pattern was observed, and similar high-risk areas were identified. Social policies that address unequal socioeconomic and spatial distribution in depressive symptoms and treatment are required.

The mediating role of job fairness and job burnout between subjective social status and depressive symptoms in Chinese migrant workers: a generational difference analysis

BACKGROUND

In China, migrant workers (MWs) constitute a significant vulnerable group that may be highly susceptible to depression. However, there is a lack of empirical research exploring the correlation between subjective social status (SSS) and depressive symptoms among MWs. The objective of this study is to examine the mediating roles of job fairness and job burnout, as well as to investigate potential generational differences in this association.

METHODS

A cross-sectional study was conducted in China among two groups of 1,158 MWs (response rate, 89.08%): first generation migrant workers (FGMWs) and new generation migrant workers (NGMWs). The survey assessed SSS, depressive symptoms, job fairness, and job burnout using a questionnaire. Structural equation model was used to primarily analyze mediating roles of job fairness and job burnout in the relationship between SSS and depressive symptoms, as well as to explore potential generational differences in this association.

RESULTS

The study findings indicate that SSS significantly predicted higher depressive symptoms among MWs. However, the relationship between SSS and depressive symptoms was mediated by job fairness or job burnout. Notably, the indirect effect of SSS on depressive symptoms through job burnout was significant for FGMWs, but not for NGMWs.

CONCLUSION

This study fills a critical gap in understanding the connections between SSS, depressive symptoms, job fairness, and job burnout among MWs in China. It emphasizes the role of job fairness and job burnout as significant mediators that either worsen or alleviate the impact of SSS on depressive symptoms among MWs. Moreover, the findings suggest that the mediation differs significantly between FGMWs and NGMWs. These findings imply the need for different intervention methods to address the depressive symptoms of the two generations of MWs.

Family structure and women's mental well-being: how family stressors explain mental health inequalities between lone and partnered mothers

Lone mothers have been found to report lower average mental health than partnered mothers. Following the 'stress process model', disparities in women's mental health by family structure could be explained by lone mothers' higher exposure to multiple forms of stressors, compared to partnered mothers. Yet, this hypothesis has not been tested in previous studies. This study analysed four waves of longitudinal data from the Growing Up in Ireland study, spanning between the year when women gave birth (2008) to 9 years later (2017) (N = 5,654 women), to examine how family stressors (i.e., financial strain, caregiving strain, work-related strain, and parental conflict) influence mothers' depressive symptoms by family structure. Analyses applied random-effects models and Karlson-Holm-Breen (KHB) decomposition techniques, combined with different model specifications as robustness checks (i.e., fixed-effects). Results indicate that: (1) net of sociodemographic factors, lone mothers experience higher levels of depressive symptoms than partnered mothers, with additional analyses confirming that transitioning from partnered to lone mother is associated with higher depressive symptoms, and from lone to partnered mother with reduced depressive symptoms; (2) although 41% of the observed statistical association between family structure and mothers' depressive symptoms is direct, a larger 59% of this mental health gap is mediated by inequalities between lone and partnered mothers in their exposure to family stressors; and (3) the largest share of the observed mediation by family stressors is explained by lone mothers' higher risks of current and past caregiving strain and parental conflict, but also by their current higher financial strain. Overall, this study suggests that lone mothers' lower mental health, compared to partnered mothers, is largely explained by disparities in exposure to family stressors, pointing to how accumulated caregiving and parental stressors, as well as poverty risks, are key explanatory factors behind the mental well-being disadvantage that lone mothers face.

Mediation effects of subjective social status and personality traits between childhood nurturing experiences and depressive symptoms in adult volunteers

Aim

Various risk factors, such as childhood nurturing experiences and subjective social status, have been identified to be involved in the onset of depression. However, the mechanism of depression is not yet fully understood. In this study, we hypothesized that nurturing experienced in childhood affects subjective social status and current personality traits, which in turn influence depressive symptoms in adulthood, and verified this hypothesis through structural equation modeling.

Methods

A questionnaire survey was conducted on 404 adults. Multiple regression analysis and structural equation modeling were conducted using demographic information and scores for the Patient Health Questionnaire-9, Parental Bonding Instrument, and NEO Five-Factor Inventory.

Results

Subjective social status was found to mediate the association between nurturing experiences and neuroticism (0.029 for Overprotection and -0.034 for Care). On the other hand, neuroticism was found to mediate the association between subjective social status and depressive symptoms (-0.097 in Care model and -0.103 in Overprotection model), as well as the association between nurturing experiences and depressive symptoms (0.144 for Overprotection and -0.134 for Care). Furthermore, it was also shown that complex paths, in which the association of nurturing experiences with depressive symptoms was mediated by two factors, namely, subjective social status and neuroticism, were statistically significant as indirect effects (0.016 for Overprotection and -0.018 for Care).

Conclusion

In this study, we clarified that nurturing experienced in childhood affects neuroticism in adulthood, which is mediated by subjective social status, and furthermore, the effects of nurturing on neuroticism lead to varying levels of depressive symptoms in adulthood. The mediation effects demonstrated in the present study may contribute towards unraveling the causes of depression and developing effective treatments for depressive symptoms.

The Relationship Between Work Engagement, Depression, Anxiety, and COVID-19 Anxiety in Physician Assistant Students

Introduction: Physician assistants (PAs) are subject to high levels of burnout, depressive symptoms, and anxiety, which can negatively impact quality of care and patient outcomes. Learning how to handle stress in the classroom may increase success and engagement in PA programs. The goal of this study was to characterize burnout, depressive symptoms, and anxiety in current PA students and examine the relationship between these factors and work engagement.Methods: This cross-sectional study surveyed PA students (n = 42) via convenience sampling from eighteen different PA programs across North and South Carolina in October, 2021. Questionnaires included the Utrecht Work Engagement Scale (UWES-17), the Patient Health Questionnaire (PHQ-2), the General Anxiety Disorder scale (GAD-7), and the COVID-19 Anxiety Scale (CIAS). Adjusted linear regression was used to assess associations between the GAD-7, PHQ-2, and CIAS and the three subscales of the UWES-17 (vigor, dedication, and absorption).Results: Students were primarily female (79%), white (79%), second-year students (62%), and had an average body mass index of 21.0 ± 3.9 kg/m2. A one-unit increase in the GAD-7 was associated with a decrease in the vigor (β = -0.94, SE = 0.19, p < .01) and dedication (β = -0.42, SE = 0.15, p = .01) subscales. A one-unit increase in the PHQ-2 was associated with a decrease in the vigor subscale (β = -2.94, SE = 0.60, p < .01).Conclusions: Recognizing warning signs of declining mental health early among PA school students may be key to increasing resilience, enthusiasm, and concentration, which may enhance school/work engagement. More work is needed to elucidate potential intervention targets to increase school/work engagement in PA students.

Household income is associated with attack frequency, but not with the prevalence of headache: an analysis of self-reported headache in the general population in Germany

BACKGROUND

Headache disorders are among the most prevalent neurological disorders worldwide. However, whether groups differing in socioeconomic position (SEP) are disproportionately affected by headache disorders has not yet been adequately clarified. Our aim was to analyse (1) the headache prevalence by socioeconomic position (SEP) and (2) the attack frequency by SEP in a German population-based adult sample.

METHODS

Cross-sectional data from a random general population were used. The sample included N = 2,189 participants aged ≥ 18 years. SEP was measured using net equivalised income (NEI) and education. A binary logistic regression model tested the effect of SEP in predicting the prevalence of headache in general. Ordinal logistic regressions were modeled to predict the effect of SEP on the likelihood of attack frequency. Attack frequency was categorized in low frequency episodic headache (LFEH: 0-3 days per month), moderate frequency episodic headache (MFEH: 4-14 days per month) and chronic headache (CH: ≥ 15 days per month).

RESULTS

Of the 2,189 participants, 891 reported headache in the last six months. Neither income nor education was associated with headache prevalence. However, significant differences between income groups were found for attack frequency. Compared to participants with NEI > 150%, those with NEI < 60% were 5.21 times more likely (95%CI 2.03, 13.36) to experience higher headache frequency, and those with NEI between 60 and 150% were 2.29 times more likely (95%CI 1.02, 5.11), with adjustments made for a set of potential confounders, including depressive symptoms.

CONCLUSIONS

To reduce headache attacks, it is essential to address both low- and middle-income groups affected by headaches. Universal public health prevention campaigns are particularly appropriate.

The differential role of socioeconomic status dimensions in depressive symptoms of aging adults: data from the Hamburg City Health cohort Study

Background

Socioeconomic status (SES) has consistently been associated with depressive symptoms, however, it remains unclear which subset of SES variables is most relevant to the development of depressive symptoms. This study determined a standardized SES-Index to test the relationship of its sub-dimensions with depressive symptoms.

Methods

HCHS data (N = 10,000; analysis sample n = 8,400), comprising participants 45+ years of age, was used. A standardized approach to quantify SES was employed. Depressive symptoms were quantified using the Patient Health Questionnaire-9 (PHQ-9). Using multiple linear regression models, PHQ-9-scores were modeled as a function of age and sex, and (1a) total SES-Index score versus (1b) its three sub-dimension scores (education, occupational status, income). Models were compared on explained variance and goodness of fit. We determined risk ratios (RR, concerning a PHQ-9 sum score ≥ 10) based on (low, middle, high; 2a) SES-Index scores and (2b) the sub-dimension scores, with groups further differentiated by sex and age (45-64 versus 65+). We distinguished between the total SES-Index score and its three sub-dimension scores to identify relevant SES sub-dimensions in explaining PHQ-9-variability or risk of depression.

Results

Among all regression models (total explained variance 4-6%), income explained most variance, but performance of the SES-Index was comparable. Low versus high income groups showed the strongest differences in depressive trends in middle-aged females and males (RRs 3.57 and 4.91). In older age, this result was restricted to females (RR ≈ 2). Middle-aged males (versus females) showed stronger discrepancies in depressive trends pertaining to low versus high SES groups. In older age, the effect of SES was absent. Education was related to depressive trends only in middle-aged females and males. In an exploratory analysis, marital status and housing slightly increased model fit and explained variance while including somatic symptoms lead to substantial increases (R2 adj = 0.485).

Conclusion

In line with previous research, the study provides evidence for SES playing a significant role in depressive symptoms in mid to old age, with income being robustly linked to depressive trends. Overall, the relationship between SES and depressive trends appears to be stronger in males than females and stronger in mid compared to old age.

Subjective social status and socio-demographic correlates of perceived discrimination among older adults in India

BACKGROUND

Considering India's diversity, marked by differences in caste, class, ethnicity, religion, region, and language, discrimination can take on varying forms across social-structural locations. We examined the association between subjective social status (SSS) and perceived discrimination, and assessed the sociodemographic correlates of perceived discrimination among older persons in India.

METHODS

Data come from the 2017-18 wave 1 of the Longitudinal Aging Study in India (LASI) with a sample of 30,253 adults 60 years or older. SSS was examined using the Macarthur scale with a ladder technique. Perceived discrimination was evaluated with the Everyday Discrimination Scale. Multivariable logistic regression models examined the odds of reporting discrimination by its types and attributions.

RESULTS

39% of older adults reported low SSS, whereas 7.3% reported high SSS. Older adults with low SSS had significantly higher odds of experiencing some discrimination than those with high SSS. Compared to high-SSS peers, low-SSS individuals attributed age, gender, caste, financial, and health status as reasons for discrimination. Older women attributed gender as a reason for discrimination. Caste was reported as a reason for discrimination by rural but not urban dwellers. Relative to northerners, those from southern India reported age, financial, and health statuses as reasons for discrimination.

CONCLUSIONS

That low-SSS older adults reported age, gender, caste, financial status, and health status as reasons for discrimination and that this association persisted after considering objective indicators of socioeconomic status (SES) is suggestive of SSS as independently consequential for perceived discrimination. These findings are useful for care providers and practitioners as they encourage older patients -- especially those with low SSS who may feel stigmatized -- to seek care, comply with care regimen, and engage in behaviors that protect and promote health.

Neurexan Prescription Is Associated with Lower Risk of Sleep Disorder Recurrence and Depression Prevalence as Compared to Z-Drugs and Benzodiazepines: A Retrospective Database Analysis in Germany

Real-world evidence on the association between natural medicinal products and the recurrence of sleep disorders is currently limited, particularly when compared to the evidence reported for prescription hypnotics. In a retrospective cohort analysis, we investigated patients with sleep disorders prescribed either the natural medicinal product Neurexan (Nx4), benzodiazepines, or nonbenzodiazepines (Z-drugs) using the IQVIA Disease Analyzer database, which encompasses electronic medical records nationwide in Germany. A 1:1 matching procedure based on age, sex, prevalent depression, anxiety or adjustment disorder, and the number of medical consultations in the past 12 months resulted in four cohorts: patients prescribed Nx4 were matched with those prescribed Z-drugs (two cohorts with 8594 matched patients each), and another cohort of patients prescribed Nx4 were matched with those prescribed benzodiazepines (7779 matched pairs). Results from multivariable-adjusted Cox regression models demonstrated that Nx4 was associated with a significantly lower risk of recurrent sleep disorder diagnosis within 30-365 days after prescription compared to both Z-drugs (HR = 0.65, 95%CI = 0.60-0.70, p < 0.001) and benzodiazepines (HR = 0.85, 95%CI = 0.79-0.93, p < 0.001). Additionally, Nx4 was associated with a lower prevalence of depression compared to Z-drugs (HR = 0.90, 95%CI = 0.83-0.98, p = 0.020) and benzodiazepines (HR = 0.89, 95%CI = 0.82-0.97, p = 0.009). These findings suggest an association between Nx4 and improved sleep and mental health outcomes. However, due to inherent limitations in the study design, the causality of this relationship cannot be stated.

Income rank and depressive symptoms among employees in Germany - A 5-year cross-lagged panel analysis

Background/Objective

Socioeconomic disparities in mental health are well-established. Previous research suggests that relative income rank is associated with depressive symptoms above and beyond absolute income. This study aimed to investigate the predictive value of income rank for future depressive symptoms while accounting for absolute income. Exploring potential reverse pathways from depressive symptoms to income rank was a secondary objective.

Method

A two-wave cross-lagged panel design with a 5-year follow-up was used to analyze data for income rank, absolute income, and two dimensions of depressive symptoms (i.e., cognitive-affective and somatic symptoms) from initially 4,201 employees. Income rank was calculated for reference groups, based on the same gender, the same 5-year age band, and the same occupational skill level.

Results

Lower income rank at baseline predicted a higher severity of cognitive-affective depressive symptoms at five-year follow-up, even after adjusting for absolute income. In contrast, income rank did not demonstrate a significant unique longitudinal association with somatic depressive symptoms when simultaneously taking absolute income into account. There was no evidence for the assumption that depressive symptoms are predictive for future income rank (i.e., reverse pathway).

Conclusions

Cognitive-affective symptoms of depression might be particularly responsive to social comparisons and a relatively low social rank.

Lower Childhood Socioeconomic Status Is Associated with Greater Neural Responses to Ambient Auditory Changes in Adulthood

Humans' early life experience varies by socioeconomic status (SES), raising the question of how this difference is reflected in the adult brain. An important aspect of brain function is the ability to detect salient ambient changes while focusing on a task. Here, we ask whether subjective social status during childhood is reflected by the way young adults' brain detecting changes in irrelevant information. In two studies (total n = 58), we examine electrical brain responses in the frontocentral region to a series of auditory tones, consisting of standard stimuli (80%) and deviant stimuli (20%) interspersed randomly, while participants were engaged in various visual tasks. Both studies showed stronger automatic change detection indexed by MMN in lower SES individuals, regardless of the unattended sound's feature, attended emotional content, or study type. Moreover, we observed a larger MMN in lower-SES participants, although they did not show differences in brain and behavior responses to the attended task. Lower-SES people also did not involuntarily orient more attention to sound changes (i.e., deviant stimuli), as indexed by the P3a. The study indicates that individuals with lower subjective social status may have an increased ability to automatically detect changes in their environment, which may suggest their adaptation to their childhood environments.

Trends in Suicides and Homicides in 21st Century America

BACKGROUND

Violent deaths, including suicides and homicides, pose a significant public health challenge in the United States. Understanding the trends and identifying associated risk factors is crucial for targeted intervention strategies.

AIM

To examine the trends in suicides and homicides over the past two decades and identify demographic and contextual predictors using the Center for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System online database.

METHODS

A retrospective analysis of mortality records from 2000 to 2020 was conducted, utilizing multivariate regression analyses. Covariates included age, race, sex, education, mental health conditions, and time period. Age-adjusted rates were employed to assess trends.

RESULTS

Over the 20 years, there was an upward trajectory in suicide rates, increasing from approximately 10/100,000 to over 14/100,000 individuals, which is a notable increase among American Indians (100.8% increase) and individuals aged 25 years and younger (45.3% increase). Homicide rates, while relatively stable, exhibited a significant increase in 2019-2020, with African Americans consistently having the highest rates and a significant increase among American Indians (73.2% increase). In the multivariate regression analysis, Individuals with advanced education (OR= 1.74, 95% CI= 1.70 - 1.78), depression (OR = 13.47, 95% CI = 13.04 - 13.91), and bipolar disorder (OR = 2.65, 95% CI = 2.44 - 2.88) had higher odds of suicide. Risk factors for homicide include African Americans (OR = 4.15, 95% CI = 4.08 - 4.23), Latinx (OR = 2.31, 95% CI = 2.26 - 2.37), people aged 25 years and younger, and those with lower educational attainment.

CONCLUSION

This study highlights the changing demographic pattern in suicides and homicides in the United States and the need for targeted public health responses. Means restriction, universal suicide screening, addressing mental health stigma, and implementing broad interventions that modify societal attitudes toward suicide and homicides are essential components of a comprehensive strategy.

A systematic review on the relationship between socioeconomic conditions and emotional disorder symptoms during Covid-19: unearthing the potential role of economic concerns and financial strain

BACKGROUND

Covid-19 has disrupted the lives of many and resulted in high prevalence rates of mental disorders. Despite a vast amount of research into the social determinants of mental health during Covid-19, little is known about whether the results are consistent with the social gradient in mental health. Here we report a systematic review of studies that investigated how socioeconomic condition (SEC)-a multifaceted construct that measures a person's socioeconomic standing in society, using indicators such as education and income, predicts emotional health (depression and anxiety) risk during the pandemic. Furthermore, we examined which classes of SEC indicators would best predict symptoms of emotional disorders.

METHODS

Following PRISMA guidelines, we conducted search over six databases, including Scopus, PubMed, etc., between November 4, 2021 and November 11, 2021 for studies that investigated how SEC indicators predict emotional health risks during Covid-19, after obtaining approval from PROSPERO (ID: CRD42021288508). Using Covidence as the platform, 362 articles (324 cross-sectional/repeated cross-sectional and 38 longitudinal) were included in this review according to the eligibility criteria. We categorized SEC indicators into 'actual versus perceived' and 'static versus fluid' classes to explore their differential effects on emotional health.

RESULTS

Out of the 1479 SEC indicators used in these 362 studies, our results showed that 43.68% of the SEC indicators showed 'expected' results (i.e., higher SEC predicting better emotional health outcomes); 51.86% reported non-significant results and 4.46% reported the reverse. Economic concerns (67.16% expected results) and financial strains (64.16%) emerged as the best predictors while education (26.85%) and living conditions (30.14%) were the worst.

CONCLUSIONS

This review summarizes how different SEC indicators influenced emotional health risks across 98 countries, with a total of 5,677,007 participants, ranging from high to low-income countries. Our findings showed that not all SEC indicators were strongly predictive of emotional health risks. In fact, over half of the SEC indicators studied showed a null effect. We found that perceived and fluid SEC indicators, particularly economic concerns and financial strain could best predict depressive and anxiety symptoms. These findings have implications for policymakers to further understand how different SEC classes affect mental health during a pandemic in order to tackle associated social issues effectively.

Socioeconomic status, loneliness, and depression among older adults: a cross-sectional study in Spain

BACKGROUND

The association between socioeconomic status and depression is weaker in older adults than in younger populations. Loneliness may play a significant role in this relationship, explaining (at least partially) the attenuation of the social gradient in depression. The current study examined the relationship between socioeconomic status and depression and whether the association was affected by loneliness.

METHODS

A cross-sectional design involving dwelling and nursing homes residents was used. A total of 887 Spanish residents aged over 64 years took part in the study. Measures of Depression (GDS-5 Scale), Loneliness (De Jong-Gierveld Loneliness Scale), Socioeconomic Status (Education and Economic Hardship), and sociodemographic parameters were used. The study employed bivariate association tests (chi-square and Pearson's r) and logistic regression analyses.

RESULTS

The percentage of participants at risk of suffering depression was significantly higher among those who had not completed primary education (45.5%) and significantly lower among those with university qualifications (16.4%) (X2 = 40.25;p <.001), and respondents who could not make ends meet in financial terms faced a higher risk of depression (X2 = 23.62;p <.001). In terms of the respondents who experienced loneliness, 57.5% were at risk of depression, compared to 19% of those who did not report loneliness (X2 = 120.04;p <.001). The logistic regression analyses showed that having university qualifications meant a 47% reduction in the risk of depression. This risk was 86% higher among respondents experiencing financial difficulties. However, when scores for the loneliness measure were incorporated, the coefficients relating to education and economic hardships ceased to be significant or were significantly reduced.

CONCLUSION

Loneliness can contribute to explaining the role played by socioeconomic inequalities in depression among older adults.

Moderated moderation modelling of subjective social status, pocket money and depressive symptoms of university students in Ghana

Introduction

Although the relationship between subjective social status and depression in university students has been well-established, this association could be seen as a spurious one. Previous studies have shown that key variables like financial resources and age could play key roles in explaining the variances in social status and mental health outcomes. In this research, we assessed the complex interrelationships between subjective social status, financial resources at their disposal and depressive symptoms among university students within their young and middle adulthood stages.

Methods

A cross-sectional survey was conducted in a university in Ghana to sample 1134 university students through accidental sampling. The McArthur Scale and WHO-5 Well-being measure were used for the data collection.

Results

The results revealed that higher levels of subjective social status were associated with lower levels of depression. It was further found that the interaction between students' pocket money and age played unique roles in the relationship between subjective social status and depression.

Conclusion

The study findings call on stakeholders in education to explore funding opportunities and to examine ways of empowering parents (financially) to adequately support the students. Health educationists and promoters, including psychologists, school counsellors and parents could compliment these efforts by helping to train and empower students through self-regulation or management skills to help improve their well-being. Continuous efforts are required to improve the financial status and mental health of students.

Does subjective social status affect pain thresholds? - an experimental examination

Past research regarding the relationship between different constructs of social status and different aspects of pain has yielded divergent results. So far, there are few experimental studies to investigate the causal relationship between social status and pain. Therefore, the present study aimed to examine the effect of perceived social status on pain thresholds by experimentally manipulating participants' subjective social status (SSS). 51 female undergraduates were randomly assigned to a low- or high-status condition. Participants' perceived social standing was temporarily elevated (high SSS condition) or reduced (low SSS condition). Before and after experimental manipulation participants' pressure pain thresholds were assessed. The manipulation check confirmed that participants in the low-status condition reported significantly lower SSS than participants in the high-status condition. A linear mixed model revealed a significant group x time interaction for pain thresholds: Whereas participants' pain thresholds in the low SSS condition increased post manipulation, pain thresholds of participants in the high SSS condition decreased post manipulation (β = 0.22; 95% CI, 0.002 to 0.432; p < .05). Findings suggest that SSS may have a causal effect on pain thresholds. This effect could either be due to a change in pain perception or a change in pain expression. Future research is needed to determine the mediating factors.

The progressive place paradox: Status-based health inequalities are magnified in more economically progressive Swiss localities

Low socioeconomic status (measured both objectively and subjectively) is systematically associated with worse health. Amid renewed interest in contextual influences on health inequalities, we ask whether variation in the prevailing ideological climate moderates the size of the health gap between low and high status individuals. Based on the minority stress hypothesis, we expect that living in an economically progressive place within Switzerland - places where more residents endorse the need for change to the economic status quo - will reduce the magnitude of the health gap. Multilevel modelling of MOSAiCH 2015-2020 data shows the opposite: low status individuals in progressive places report markedly lower subjective health and life satisfaction than similarly low status individuals in conservative places, such that status-based health inequalities are maximised in progressive places. We interpret this apparent progressive place paradox in terms of collective inefficacy and system frustration, which we argue is the corollary of system justification.

The socioeconomic consequences of loneliness: Evidence from a nationally representative longitudinal study of young adults

The negative health consequences of loneliness have led to increasing concern about the economic cost of loneliness in recent years. Loneliness may also incur an economic burden more directly, by impacting socioeconomic position. Much of the research to date has focused on employment status which may not fully capture socioeconomic position and has relied on cross-sectional data, leaving questions around the robustness of the association and reverse causation. The present study used longitudinal data to test prospective associations between loneliness and multiple indicators of social position in young adulthood, specifically, whether participants who were lonelier at age 12 were more likely to be out of employment, education and training (NEET) and lower on employability and subjective social status as young adults. The data were drawn from the Environmental Risk (E-Risk) Longitudinal Twin Study, a birth cohort of 2,232 individuals born in England and Wales during 1994-1995. Loneliness and subjective social status were measured at ages 12, 18 and 26. Employability and NEET status were assessed at age 18. Findings indicate that greater loneliness at age 12 was prospectively associated with reduced employability and lower social status in young adulthood. The association between loneliness and lower social status in young adulthood was robust when controlling for a range of confounders using a sibling-control design. Results also indicate that loneliness is unidirectionally associated with reduced subjective social status across adolescence and young adulthood. Overall, our findings suggest that loneliness may have direct costs to the economy resulting from reduced employability and social position, underlining the importance of addressing loneliness early in life.

Economic disadvantage and depressive symptoms among Arab and Jewish women in Israel: the role of social support and formal services

OBJECTIVES

Depression is a major public health concern due to its high prevalence and association with functioning. Ethnic minorities in Western countries are more likely to experience economic disadvantage and exposure to stressors that may put them at higher risk of developing depression. One major protective factor associated with reduced depressive symptoms is an existing support network. This study examined the associations between economic disadvantage, formal and informal social support, and depressive symptoms among two ethnicity groups in Israel: Arab and Jewish mothers of young children, as well as the potential mediating role of formal and informal social support in the associations between economic disadvantage and depressive symptoms.

DESIGN

We recruited a representative sample of 837 Jewish and Arab mothers of children aged 2-6 years. We collected data via structured face-to-face interviews following approval of the university ethic committee. We used the Center for Epidemiologic Studies Depression Scale (CES-D), the Medical Outcomes Study (MOS) scale to measure maternal perceived social support, and a measure designed for this study to quantify formal social support.

RESULTS

Compared to the Jewish mothers, Arab mothers reported more depressive symptoms, greater economic disadvantage, and fewer informal and formal support networks. Economic disadvantage was negatively associated with informal support but positively associated with formal support among both Jewish and Arab mothers. Results further revealed that informal and formal social support mediated the associations between economic disadvantage and symptoms of depression.

CONCLUSIONS

More attention should be paid to the associations between social determinants and mothers' mental health, with a possible shift of focus to macro-level factors, such as economic inequality and minority status.

Stress, Anxiety and Depressive Symptoms are Predictors of Worse Outcomes in Outpatients With Arterial Hypertension and Coronary Heart Disease: Results of 1.5 Years Follow-up From the COMETA Multicenter Study

Aim      To study associations between the risk of severe adverse cardiovascular outcomes (SACVO) and all-cause death with psychosocial risk factors (PS RFs), such as stress, anxiety and depressive symptoms, low level of education, low income, social isolation, and type D personality, in patients with arterial hypertension (AH) and ischemic heart disease (IHD) managed in primary health care institutions in a multi-year prospective study.Material and methods  PS RFs were assessed in patients with AH or IHD, who participated in a multi-year prospective COMETA study, using the Hospital Anxiety and Depression Scale (HADS), DS-14 questionnaire, and a visual analogue scale (VAS) for assessment of stress level. Associations of PS FRs with SACVO and all-cause death after a 1.5-year follow-up were analyzed using multivariate Cox regression models.Results At 1.5 years after patients were included in the study, it was possible to obtain data for 2,538 patients (age at baseline, 66.6 ± 7.8 years, 28.1% men), 106 of whom died during that period. The incidence of SACVO was 40.0 per 1000 person-years. According to the results of multivariate regression analysis, a very high level of anxiety symptoms (HADS-A≥14) was significantly associated with SACVO (odds ratio (OR), 1.81; 95% confidence interval (CI), 1.04-3.15; p=0. 02). The composite endpoint that included all-cause death and/or SACVO was significantly associated with a high (VAS score ≥8) stress level (OR, 1.53; 95% CI, 1.00-2.33; p=0.04) and a very high (HADS-D≥14) level of depressive symptoms (OR, 2.11; 95% CI, 1.22-3.62; p=0.02). A low level of education adjusted for gender and age increased the likelihood of SACVO by 1.7 (95% CI, 1.19-2.43) times. No significant associations were found between the analyzed outcomes and type D personality or with social isolation.Conclusion      In patients with AH or IHD, the presence of high-grade stress and severe depressive symptoms increased the likelihoods of all-cause death and SACVO while a low level of education and severe anxiety symptoms were associated with SACVO. The study results showed that PS RFs for cardiovascular diseases keep the PS RF prognostic significance in the conditions of modern treatment of AH and IHD. Due to the negative impact on the prognosis, PS RFs should be taken into account when taking measures for secondary prevention of AH and IHD.

Childhood abuse as a mediator of the relationship between early family socio-economic status and geriatric depression: A population-based study in China

Previous studies have suggested that childhood socioeconomic status (SES) is linked to geriatric depressive symptoms in many developed countries. However, the potential pathways of the relationship between childhood SES and geriatric depressive symptoms need to be further explored. This study aimed to assess the mediating effect of being abused during childhood on the association between childhood SES and geriatric depressive symptoms, using evidence from a longitudinal study in China. The study cohort included 8137 individuals. Childhood abuse was defined as experiences related to parental violence, sibling abuse, school violence, community violence, and parental quarrel. Results indicated poor childhood SES was associated significantly with geriatric depressive symptoms. The indirect effect of poor childhood SES to high geriatric depressive risk through community violence, sibling abuse, school violence, and parental quarrel were 0.02, 0.01, 0.02, and 0.01, respectively. Our findings shed new light on the literature regarding the impact of childhood SES on elderly depressive symptoms. Furthermore, childhood SES demonstrated a significant correlation with geriatric depressive symptoms through bullying behaviors. The findings highlight the need to promote both childhood social welfare and psychological well-being within the elderly population.

Association between subjective social status and physical frailty in older adults in India: perceived discrimination and III-treatment as mediators and moderators

BACKGROUND

While extensive research exists on physical frailty, including in low- and middle-income countries like India, studies have yet to appraise whether perceived social standing is associated with physical frailty. As such, this study examines (1) the association between subjective social status (SSS) and physical frailty among older adults in India; and (2) whether this association is mediated and moderated by perceived discrimination and experiences of III-treatment.

METHODS

Data came from the Longitudinal Aging Study in India with a sample of 31,464 older adults aged 60 and above. Physical frailty was assessed using an adapted version of the frailty phenotype developed by Fried and colleagues. SSS was assessed using the Macarthur scale. Multivariable logistic regression models along with Karlson-Holm-Breen (KHB) methodology were employed to examine the direct association, mediational pathways, and the interactions.

RESULTS

The prevalence of frailty was 30.65% and those with lowest SSS reported higher prevalence of frailty (42.06%). After adjusting for several confounders, odds of frailty were lower among persons with high SSS relative to those with low SSS, and the variance explained by the SSS was higher than that explained by household consumption quintiles. Moreover, the association between SSS and frailty was mediated and moderated by perceived discrimination and III-treatment.

CONCLUSIONS

Our findings underscore that when examining the association between socioeconomic status (SES) and physical frailty, it is important to consider SSS given that perceived social status likely reflects the less apparent psychosocial components associated with SES, and that perceived discrimination and III-treatment both mediate and moderate the association between SSS and physical frailty is critical to identifying those older Indians most susceptible to the functional health implications of lower SSS.

What Does the MacArthur Scale of Subjective Social Status Measure? Separating Economic Circumstances and Social Status to Predict Health

BACKGROUND

Subjective socioeconomic status is robustly associated with many measures of health and well-being. The MacArthur Scale of Subjective Social Status (i.e., the MacArthur ladder) is the most widely used measure of this construct, but it remains unclear what exactly the MacArthur ladder measures.

PURPOSE

The present research sought to explore the social and economic factors that underlie responses to the MacArthur ladder and its relationship to health.

METHODS

We investigated this issue by examining the relationship between scores on the MacArthur ladder and measures of economic circumstances and noneconomic social status, as well as health and well-being measures, in healthy adults in the USA.

RESULTS

In three studies (total N = 1,310) we found evidence that economic circumstances and social status are distinct constructs that have distinct associations with scores on the MacArthur ladder. We found that both factors exhibit distinct associations with measures of health and well-being and accounted for the association between the MacArthur ladder and each measure of health and well-being.

CONCLUSIONS

Our findings suggest that the MacArthur ladder's robust predictive validity may result from the fact that it measures two factors-economic circumstances and social status-that are each independently associated with health outcomes. These findings provide a novel perspective on the large body of literature that uses the MacArthur ladder and suggests health researchers should do more to disentangle the social and economic aspects of subjective socioeconomic status.

Monitoring the Relationship between Social Network Status and Influenza Based on Social Media Data

BACKGROUND

This article aims to analyze the relationship between user characteristics on social networks and influenza.

METHODS

Three specific research questions are investigated: (1) we classify Weibo updates to recognize influenza-related information based on machine learning algorithms and propose a quantitative model for influenza susceptibility in social networks; (2) we adopt in-degree indicator from complex networks theory as social media status to verify its coefficient correlation with influenza susceptibility; (3) we also apply the LDA topic model to explore users' physical condition from Weibo to further calculate its coefficient correlation with influenza susceptibility. From the perspective of social networking status, we analyze and extract influenza-related information from social media, with many advantages including efficiency, low cost, and real time.

RESULTS

We find a moderate negative correlation between the susceptibility of users to influenza and social network status, while there is a significant positive correlation between physical condition and susceptibility to influenza.

CONCLUSIONS

Our findings reveal the laws behind the phenomenon of online disease transmission, and providing important evidence for analyzing, predicting, and preventing disease transmission. Also, this study provides theoretical and methodological underpinnings for further exploration and measurement of more factors associated with infection control and public health from social networks.

Identifying the mediating role of socioeconomic status on the relationship between schizophrenia and major depressive disorder: a Mendelian randomisation analysis

Depressive disorder prevalence in patients with schizophrenia has been reported to be 40%. People with low socioeconomic status (SES) are more likely to suffer from schizophrenia and major depressive disorder (MDD). However, the causal relationship between schizophrenia and depression and the potential mediating role of SES remains unclear. Two-sample Mendelian randomization (MR) analyses were conducted to explore the bidirectional causal relationship between schizophrenia and MDD with the largest sample size of European ancestry from public genome-wide association studies (sample size ranged from 130,644 to 480,359). Inverse variance weighted (IVW) method was used as the primary analysis, and several canonical MR methods were used as validation analyses. The mediating role of SES (educational years, household income, employment status, and Townsend deprivation index) was estimated by the two-step MR method. MR analyses showed that genetically predicted schizophrenia was associated with an increased risk of MDD (IVW odds ratio [OR] = 1.137 [95% CI 1.095, 1.181]). Reversely, MDD was also associated with an increased risk of schizophrenia (IVW OR = 1.323 [95% CI 1.118, 1.565]). The mediation analysis via the two-step MR method revealed that the causal effect of schizophrenia on MDD was partly mediated by the Townsend deprivation index with a proportion of 10.27%, but no significant mediation effect was found of SES on the causal effect of MDD on schizophrenia. These results suggest a robust bidirectional causal effect between schizophrenia and MDD. Patients with schizophrenia could benefit from the early and effective intervention of the Townsend deprivation index.

Depressive and anxiety symptoms in first generation college students

Objectives: Depression and anxiety contribute to the burden of disease among college students. The current study determined if depressive and anxiety symptoms were more prevalent in first generation students and if social and emotional support moderated this relationship. Methods: Depressive and anxiety symptoms were measured in 432 U.S. college students via an online survey. Single items determined student generation status and available social support. The CES-D10 and GAD-7 measured depression and anxiety, respectively. Structural equation modeling was used to identify significant effects. Results: First generation status was associated with increased cognitive-emotional (p = 0.036) and somatic (p = 0.013) anxiety symptoms, but not depression. High social and emotional support appeared to suppress somatic anxiety symptoms experienced by first generation students (p = 0.004). Conclusions: Greater anxiety symptoms in first generation students may be due to increased general and acculturative stress, although more research is needed. Large national surveys of college students should consider adding a question about first generation status.

Exploring access to community care and emergency department use among people with dementia: A qualitative interview study with people with dementia, and current and bereaved caregivers

OBJECTIVES

Emergency department (ED) attendance is common among people with dementia and associated with poor health outcomes. Literature suggests a link between access to community care and the ED, but we know little about the mechanisms behind this link. This study aimed to explore experiences of accessing community and emergency care among people affected by dementia.

METHODS

Informed by critical realism, semi-structured online and telephone interviews were conducted with people with dementia and family caregivers, with and without experience of using the ED. Participants were recruited from across the United Kingdom using purposive sampling with maximum variation. A mostly experiential reflexive thematic analysis approach was used, applying the candidacy model of access to deepen interpretation.

RESULTS

Two dyad and 33 individual interviews were conducted with 10 people with dementia, 11 current caregivers and 16 bereaved caregivers (men = 11, 70-89 years = 18, white ethnicity = 32). Three themes are reported: (1) Navigating a 'push system', (2) ED as the 'last resort', and (3) Taking dementia 'seriously'. Themes describe a discrepancy between the configuration of services and the needs of people affected by dementia, who resort to the ED in the absence of accessible alternatives. Underlying this discrepancy is a lack of systemic prioritisation of dementia and wider societal stigma.

CONCLUSION

Although a last resort, ED attendance is frequently the path of least resistance for people with dementia who encounter multiple barriers for timely, responsive access to community health and social care. Greater systemic prioritisation of dementia as a life-limiting condition may help to reduce reliance on the ED through essential development of post-diagnostic care, from diagnosis to the end of life.

Importance of caregivers' subjective social status and neighbourhood disadvantage for adolescents with type 1 diabetes

AIMS

Adolescents with type 1 diabetes from low-income populations are more likely to have difficulty in managing their diabetes and ultimately have poorer glycaemic outcomes, but less is known about neighbourhood-level factors or subjective social status (SSS) as risk/protective factors. We examined associations between multiple indicators of socio-economic status with diabetes outcomes.

METHODS

One hundred and ninety-eight adolescents ages 13-17 (58% female, 58% White, non-Hispanic) experiencing moderate diabetes distress completed measures of diabetes management and diabetes distress, and their caregivers reported on SSS. Glycaemic indicators were extracted from medical records, and participants' addresses were used to determine area deprivation index (ADI).

RESULTS

Higher levels of neighbourhood disadvantage were significantly associated with higher haemoglobin A1c levels and average glucose levels, but caregivers' SSS was more strongly associated with all glycaemic indicators, diabetes management and diabetes distress.

CONCLUSIONS

Given strong associations between caregivers' SSS and glycaemic control, diabetes management, and diabetes distress, screening for caregivers' SSS may identify adolescents who would benefit from additional support.

Subjective poverty, mental health, and mortality among Chinese older people: a prospective cohort study from 2008 to 2018

PURPOSE

The associations of duration of subjective poverty and poverty status with mortality among older people remains inconclusive, and the underlying mechanisms of mental health on them are rarely discussed in population-based epidemiological studies.

METHODS

We used the data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) (2008-2018). The Cox regression model was used to estimate hazard ratio (HR) and 95% confidence intervals (CIs) for mortality. Mediation analysis was applied to assess the effect of mental health.

RESULTS

When compared with participants without subjective poverty, those who reported subjective poverty at one time point (2008 or 2011) or two time points (2008 and 2011) had a higher risk of death, with multivariable-adjusted HR (95% CIs) of 1.08 (1.00-1.16) and 1.22 (1.06-1.39), respectively. For poverty status, the multivariable-adjusted HR (95% CIs) of mortality were 0.81 (0.66-0.98) for "just objective poverty" and 0.78 (0.62-0.98) for "neither subjective nor objective poverty" compared with participants who reported "just subjective poverty", while there was no statistically significant association between "poverty subjectively and objectively" and mortality (HR = 0.88, 95% CI 0.72-1.07). Besides, we found that the proportion mediated by mental health was 26.6%, and age was a significant effect modifier.

CONCLUSIONS

Subjective poverty may be associated with a higher risk of death among Chinese older people. This study showed that promoting mental health alone may not substantially reduce socioeconomic inequality in health. Further explorations of measures to tackle the social determinants of health are still needed.

Long-term trajectories of suicide ideation and its socioeconomic predictors: A longitudinal 8-year follow-up study

OBJECTIVE

Suicide ideation is the first stage of suicide behavior, and the long-term course of suicide ideation is highly variable. The aim of this study is to identify trajectories of suicide ideation over an 8-year period and explore the association of socioeconomic status (SES) with suicide ideation trajectories.

METHODS

We included 10,017 participants from Waves 7-15 of the Korea Welfare Panel Study; these have data on suicidal ideation (2012-2020). Trajectories analysis was conducted to identify distinct trajectories of suicidal ideation. Multinomial logistic regression was used to examine associations of SES with suicidal ideation trajectories. The interaction effects between current SES and prospective economic condition on trajectories were examined using a synergy index (SI).

RESULTS

We identified three suicide ideation trajectory groups: low-stable, moderate-decreasing, and high-persistent. Individuals in both moderate-decreasing and high-persistent trajectories had poorer current SES and prospective economic conditions than low-stable trajectories. Interestingly, those reporting poorer prospective economic conditions had a greater risk of being in a high-persistent trajectory than being in a moderate-decreasing trajectory. Further, individuals with poorer current SES and prospective economic conditions were more likely to be in the high-persistent trajectory.

CONCLUSIONS

Our findings demonstrated three distinct trajectories of suicide ideation which provide useful information for specific preventive interventions that could be developed. Moreover, poor prospective economic condition is a significant predictor of the high-persistent suicide ideation trajectory. Supporting economic difficulties and helping make goals and plans to strengthen positive thinking would help attenuate suicidal ideation and prevent suicidal behavior.

Socioeconomic status and depressive symptoms and suicidality: The role of subjective social status

BACKGROUND

Low socioeconomic status (SES) confers access to material resources and social standing and is an established risk factor of both depressive symptoms and suicidality. Subjective social status (SSS) assesses how people perceive their position within the social hierarchy and has been proposed to impact mental health. This study examined the relationship between SES and depressive symptoms and suicidality and tested whether SSS mediated these associations.

METHODS

This study drew on publicly available survey data from the US National Longitudinal Study of Adolescent to Adult Health (Add Health). Participants were surveyed at baseline in 2008 (N = 4948; aged 28.8 years) and at followed up in 2016-2018 (N = 3509; aged 37.8 years). SES was gauged using personal and household income, assets, education, and job prestige. SSS was assessed using the MacArthur Scale. Depressive symptoms were assessed using four-items from the Centre for Epidemiological Studies Scale of Depression (CESD) and participants reported suicidal ideation and suicide attempts in the past year.

RESULTS

Both low SES and SSS were associated with elevated levels of depressive symptoms, suicidal ideation, and suicide attempts in cross-sectional and prospective analyses. SSS explained 27 % of the association between SES and depressive symptoms, 51 % of the relationship between SES and suicidal ideation, and 37 % of the link between SES and suicide attempts on average.

CONCLUSIONS

These findings contribute to understanding the long-term effects of SSS and suggest that perceptions of status may be a key mechanism through which low SES forecasts the development of depressive symptoms and suicidality.

Subjective socioeconomic status: an alternative to objective socioeconomic status

BACKGROUND

Subjective "ladder" measurements of socio-economic status (SES) are easy-to-administer tools that ask respondents to rate their own SES, allowing them to evaluate their own material resources and determine where it places them relative to their community. Here, we sought to compare the MacArthur Scale of Subjective Social status to the WAMI, an objective measure of SES that includes data on water and sanitation, asset ownership, education, and income.

METHODS

Leveraging a study of 595 tuberculosis patients in Lima, Peru, we compared the MacArthur ladder score to the WAMI score using weighted Kappa scores and Spearman's rank correlation coefficient. We identified outliers that fell outside the 95^th percentile and assessed the durability of the inconsistencies between scores by re-testing a subset of participants. We then used Akaike information criterion (AIC) to compare the predictability of logistic regression models evaluating the association between the two SES scoring systems and history of asthma.

RESULTS

The correlation coefficient between the MacArthur ladder and WAMI scores was 0.37 and the weighted Kappa was 0.26. The correlation coefficients differed by less than 0.04 and the Kappa ranged from 0.26 to 0.34, indicating fair agreement. When we replaced the initial MacArthur ladder scores with retest scores, the number of individuals with disagreements between the two scores decreased from 21 to 10 and the correlation coefficient and weighted Kappa both increased by at least 0.03. Lastly, we found that when we categorized WAMI and MacArthur ladder scores into three groups, both had a linear trend association with history of asthma with effect sizes and AICs that differed by less than 15% and 2 points, respectively.

CONCLUSION

Our findings demonstrated fair agreement between the MacArthur ladder and WAMI scores. The agreement between the two SES measurements increased when they were further categorized into 3-5 categories, the form in which SES is often used in epidemiologic studies. The MacArthur score also performed similarly to WAMI in predicting a socio-economically sensitive health outcome. Researchers should consider subjective SES tools as an alternative method for measuring SES, particularly in large health studies where data collection is a burden.

Early life climate and adulthood mental health: how birth seasonality influences depressive symptoms in adults

BACKGROUND

Early life in-utero can have long-term influence on the mental health status of individuals in adulthood, such as depression. Age, gender, socio-economic status, education, and geography are demographic factors shown to be particularly vulnerable towards the development of depressive symptoms. In addition, climate risks on depression include sunlight, rain, and temperature. However, whether climate factors in early life have a long-term influence on depression related to demographic vulnerability remains unknown. Here, the present study explored the association between birth seasonality and adulthood depressive symptoms.

METHODS

We employed data from the project of Chinese Labour-forces Dynamic Survey (CLDS) 2016, containing the epidemiological data of depressive symptoms with a probability proportional to size cluster and random cluster sampling method in 29 provinces of China. A final sample size of 16,185 participants was included. Birth seasonality included spring (March, April, and May), summer (June, July, and August), autumn (September, October, and November), and winter (December, January, and February).

RESULTS

We found that born in Autumn peaked lowest rate of having depressive symptoms (16.8%) and born in Summer (vs. Autumn) had a significant higher ratio (OR = 1.14, 95%CI = 1.02, 1.29) when controlling for demographic variables. In addition, demographic odds ratio of having depressive symptoms differed between people born in different seasons, particular for age and geography.

CONCLUSION

Our findings suggest that birth seasonality influences the sensitive link of depressive symptoms with age and geography. It implicates early life climate environment may play a role in the development of adulthood depressive symptoms.

Differences in Preoperative Health-Related Quality of Life between Women Receiving Mastectomy or Breast Conserving Surgery in a Prospectively Recruited Cohort of Breast Cancer Patients

As rates of total mastectomy rise, the relationships between surgery modality with domains of health-related quality of life is not well understood. This study reports differences in depression, anxiety, pain, and health status among a cohort of women scheduled to receive total mastectomy or breast-conserving surgery. Patient-reported outcomes measured preoperative differences between patients receiving total mastectomy or breast-conserving surgery in a cross-sectional design. Regression analyses was used to model health outcomes and adjust for patient demographics on patient measures. Participants scheduled for total mastectomy were more likely to report more severe symptoms of depression and anxiety. This association was non-significant after adjusting for demographic differences. Younger participants were more likely to be scheduled for total mastectomy. Age was negatively associated with symptoms of depression and anxiety. Screening patients for mental health symptoms may be particularly important among younger patients who were more likely to report depression and anxiety before their surgery and were more likely to receive total mastectomy.

The independent and joint contribution of objective and subjective socioeconomic status on oral health indicators

OBJECTIVES

The understanding of how subjective socioeconomic status (SSS) relates to objective socioeconomic status (OSS), and how both conditions act together in oral health outcomes is still unclear. This study aims to test the independent and joint association between OSS and SSS with oral health, to assess the role of socioeconomic status discrepancies, and to evaluate the role of SSS in the association between OSS and oral health.

METHODS

Data from 1140 adults from a population-based study in Southern Brazil were used. We applied diagonal reference models DRM to disentangle the effects of OSS (education) and SSS (MacArthur Scale) to oral health outcomes. The outcomes were functional dentition clinically evaluated (FD ≥20 teeth) and self-reported oral health SROH. We also examined the discrepancy between OSS and SSS to oral health indicators and the effect measure modification (EMM) of SSS on the association between OSS and oral health.

RESULTS

Subjective socioeconomic status and OSS contributed equally to SROH, while OSS explained a substantially higher amount of FD than SSS (0.85 vs 0.15). An EMM of SSS was found on the association between OSS and fair/poor SROH, with a relative excess risk due to interaction (RERI) of 1.08. Less evidence of EMM was found for FD (RERI = 0.14). Individuals with lower SSS and OSS had four times the risk of the outcomes than the reference group.

CONCLUSIONS

Adults with concordant lower SSS and OSS have a worse oral health than those with concordant higher status. There was evidence that the association between OSS and SROH is modified by SSS.

Comparison of the Associations between Self-Reported Sleep Quality and Sleep Duration Concerning the Risk of Depression: A Nationwide Population-Based Study in Indonesia

There is substantial evidence that a lack of sleep quality and duration can increase the risk of depression in adults. Still, few studies have compared sleep quality and duration to the risk of depression in Indonesia. Therefore, this study aimed to compare the prevalence and risk of depression associated with both sleep quality and duration and identified those factors associated with sleep quality with sleep duration. This study was a cross-sectional study, and the data were obtained from the 2014 Indonesian Family Life Survey, with a total sample comprised of 19,675 respondents aged older than 15 years old. A self-reported questionnaire was used to assess sleep quality and duration. Depression was assessed using the Center for Epidemiologic Studies Depression (CESD-10) questionnaire. Logistic regression was used to examine the risk of depression, and multinomial logistic regression was used to examine the risk of poor sleep quality with consideration to sleep duration. The prevalence of depression was the highest in the poor sleep quality and long sleep duration groups (48.5%). After all variables associated with depression were adjusted, poor sleep quality was identified as a factor leading to a higher risk of depression (OR = 4.2; 95% CI: 3.7-4.6; p < 0.001) than long sleep duration (OR = 1.4; 95% CI: 1.2-1.6; p < 0.001). Furthermore, the interaction between poor sleep quality and long sleep duration gave the highest risk of depression (OR = 4.4; 95% CI: 3.6-5.3); p < 0.001). Multinomial logistic regression revealed that the factors leading to a significant increase in the risk of poor sleep quality, with consideration to sleep duration, in the population were age, gender, marital status, education, wealth index, physical activity, chronic illness, season, and urban area (p < 0.05). Sleep quality was found to be associated with a higher risk of depression than sleep duration. The findings of this study may be beneficial to healthcare professionals who develop health promotion strategies for reducing the incidence of depression in communities.

Prevalence and predictors of depressive symptoms among married Egyptian women: a multicenter primary healthcare study

BACKGROUND

Depression affects about 3.8% of the world's population. Although marriage may contribute to subjective well-being, some marital variables could increase women's risk for depression. This study aimed to determine the prevalence of depressive symptoms and their correlates among married females attending primary healthcare facilities.

METHODS

A cross-sectional study was conducted on a purposive sample of 371 married women at the primary healthcare centers, Assiut Governorate, Upper Egypt. In this study, an interviewer-administered questionnaire was used for data collection. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and marital satisfaction using the ENRICH Marital Satisfaction Scale (EMS). Standardized measurements of weight and height were performed.

RESULTS

According to the PHQ-9 diagnostic criteria, the prevalence of depressive symptoms among the studied married females was 30.2%. The significant predictors of depressive symptoms were advanced husbands' ages, living with an extended family, exposure to spousal verbal violence, high body weight, and low marital satisfaction levels.

CONCLUSIONS

Approximately one-third of married Egyptian women experienced depressive symptoms. In addition to high body weight, some social and marital factors contributed to the increase in women's vulnerability to depressive symptoms. Egyptian primary healthcare physicians should be trained to identify females with depressive symptoms and refer them to specialists if need be. To combat depression in women, it may be helpful to construct qualified marital counseling centers. This may improve marital satisfaction, decrease the negative consequences of spousal violence, and ensure the value of independence for new families.

The Area Deprivation Index Corresponds Effectively With Other Measures of Objective Socioeconomic Status in Adults With Chronic Low Back Pain

Background and Purpose: How the Area Deprivation Index (ADI) performs compared to other measures of socioeconomic status (SES) is unknown. The study purpose is to compare the ADI and other measures of SES in their ability to predict pain severity/interference. Methods: Four measures of SES were compared-ADI, income, education, and subjective social status (SSS). Results: Pain severity/interference correlated positively with ADI (r = .396/r = .33), and negatively with income (r = -.507/r = -.428) and education (r = -.271/r = -.102). Criterion scores of the pain severity model suggest income performs best (AIC = 428.29/BIC = 436.22), followed by ADI (AIC = 437.24/BIC = 445.17), with education performing least well (AIC = 446.35/BIC = 454.29). Similar results were seen for the pain interference model. Conclusions: Neighborhood-level factors warrant consideration along with individual-level factors when attempting to understand the impact of SES on chronic low back pain.

Growing up unequal: Objective and subjective economic disparities and authoritarian parenting

BACKGROUND

Although there is evidence of economic disparities in parents' financial and time investments in children, little existing empirical work has considered the disparities in authoritarian parenting, a risk for child maltreatment. Similarly, existing research has largely focused on the role of objective markers of socioeconomic status (SES), although perceived subjective social status (SSS) may be equally powerful in shaping disparities in parenting behaviors.

DATA

This article draws on 30 years of General Social Survey data to examine the association between objective socioeconomic status and subjective social status and parents' endorsement of authoritarian parenting practices.

METHODS

We model the association between parents' SES and SSS and approval of authoritarian parenting practices estimated with odds ratios from logistic regressions and examine parental race as a potential moderator.

RESULTS

We find that SES and SSS are both associated with increased odds of endorsing authoritarian parenting, that SSS-based disparities are independent of SES, and that white parents' parenting may be more influenced by both SES and SSS than Black parents' parenting.

CONCLUSIONS

This work provides evidence that SES not only drives gaps in parental investments in children, but also gaps in their endorsement of authoritarian parenting. This is important because authoritarian parenting is not only directly associated with adverse outcomes for children, but is also associated with an increased risk for child maltreatment. It also expands the existing literature by showing that subjective measures of social status are important and distinct from objective measures of SES, and that these associations vary by race.

An analytical pathway of consumption expenditure with neighborhood deprivation and depression on cognitive health among elderly in India: A moderated mediation approach

BACKGROUND

This study aims to find the linkage between neighborhood deprivation and cognition with depression as a mediating factor while economic condition as a moderator.

METHODS

We have used the recent baseline wave-1 data of Longitudinal Aging Study in India (LASI), 2017-2018. The study was restricted to 60 and above population, consisting of males (14,931) and females (16,533). We have used moderated mediating model to understand the relationship between deprivation (X), cognition (Y) mediated through depression (M), moderated by economic condition (W), while controlling all possible confounders.

RESULTS

Neighborhood deprivation was positively associated with depression (β: 0.12; SE: 0.01) and inversely linked to cognition (β: -0.4; SE: 0.02). Deprivation had a strong indirect effect on cognition that was mediated by depression. Further, interaction of depression (M) and economic condition (W) was negatively associated (β = -0.03; SE: 0.01) with cognition (Y), indicating that lower economic section being more depressed with lower cognitive function.

LIMITATIONS

The study failed to capture other mental health aspects like stress and anxiety using the Depression, Anxiety and Stress Scale-21 items (DASS-21).

CONCLUSIONS

This study has found a link between higher economic condition with low deprivation and depression. Older individuals with better financial situation have improved cognitive level than their counterparts, who are also depressed. This study provides an opportunity to conduct future research on cognitive health in the face of population aging in India.

Depression: why drugs and electricity are not the answer

The dominant view within mental health services and research suggests that feeling depressed is a kind of medical illness, partially caused by various biological deficits which are somehow corrected by physical interventions. This article critically appraises evidence for the effectiveness and value of antidepressant drugs and electroconvulsive therapy (ECT), the two principle physical treatments recommended for depression. It also describes the negative effects of these interventions and raises concerns about how they impact the brain. We propose an alternative understanding that recognises depression as an emotional and meaningful response to unwanted life events and circumstances. This perspective demands that we address the social conditions that make depression likely and suggests that a combination of politics and common sense needs to guide us in providing help for one another when we are suffering in this way. This alternative view is increasingly endorsed around the world, including by the United Nations, the World Health Organization and service users who have suffered negative consequences of physical treatments that modify brain functions in ways that are not well-understood.