Psychosocial determinants of mental health and risk behaviours in adolescents

Healthcare Equity and Commissioning: A Four-Year National Analysis of Portuguese Primary Healthcare Units

Equal and adequate access to healthcare is one of the pillars of Portuguese health policy. Despite the controversy over commissioning processes' contribution to equity in health, this article aims to clarify the relationship between socio-economic factors and the results of primary healthcare (PHC) commissioning indicators through an analysis of four years of data from all PHC units in Portugal. The factor that presents a statistically significant relationship with a greater number of indicators is the organizational model. Since the reform of PHC services in 2005, a new type of unit was introduced: the family health unit (USF). At the time of the study, these units covered 58.1% of the population and achieved better indicator results. In most cases, the evolution of the results achieved by commissioning seems to be similar in different analyzed contexts. Nevertheless, the percentage of patients of a non-Portuguese nationality and the population density were analyzed, and a widening of discrepancies was observed in 23.3% of the cases. The commissioning indicators were statistically related to the studied context factors, and some of these, such as the nurse home visits indicator, are more sensitive to context than others. There is no evidence that the best results were achieved at the expense of worse healthcare being offered to vulnerable populations, and there was no association with a reduction in inequalities in healthcare. It would be valuable if the Portuguese Government could stimulate the increase in the number of working USFs, especially in low-density areas, considering that they can achieve better results with lower costs for medicines and diagnostic tests.

Compositional characteristics of neighbourhoods and of schools as correlates of youths' mental health: A cross-sectional study among Swedish adolescents

AIMS

The study aimed to analyse the association between neighbourhood- and school-level socio-demographic factors and self-reported mental health among adolescents.

METHODS

The study population consisted of 3959 adolescents in southern and central Sweden (the KUPOL study), surveyed in the seventh grade (13 years old) and again in the ninth grade (15 years old). Cross-sectional associations were studied between socio-demographic indicators at neighbourhood level (proportion of adults with high education, without employment, of foreign-born residents) and at school level (proportion of students with at least one parent with high education, of students with a foreign background, mean qualification points in ninth grade) and mental health problems. These were assessed through the Strengths and Difficulties Questionnaire (SDQ). We derived odds ratios (OR) and corresponding 95% confidence intervals (CI) of scale scores above the threshold using multilevel logistic regression models.

RESULTS

After adjustment for individual- and family-level socio-demographic factors, there was an indication of higher OR of mental health problems with increasing proportions of foreign-born and residents without employment, especially among girls and in public schools. Stronger associations in the expected direction were found with the internalising subscale. Socio-demographic factors at the school level were not associated with adolescents' mental health, except in private schools, where increasing proportions of students with highly educated parents were significantly associated with SDQ scores under the threshold (OR=0.91; 95% CI 0.85-0.97).

CONCLUSIONS

The results indicate that equal living conditions may represent important cues to improve the mental health of adolescents. Longitudinal studies are needed to determine any causality.

Sex differences in adolescent mental health profiles in South Korea

Accumulating evidence indicates that sex of adolescents is a major factor affecting mental health. This study aimed to compare mental health profiles and longitudinal effects of various factors on mental health between male and female adolescents using the Korean Children and Youth Panel Survey. Results showed that females were more depressed, aggressive, and likely to develop somatic symptoms than males, while males exhibited more attention deficits than females. Moreover, abusive parenting behavior was associated with a lower level of mental health in both male and female adolescents. In addition, we found significant differences in the effects of individual factors (subjective health status and smartphone addiction), family-related factors (living with both parents, working mother, and neglectful parenting behavior), and school-related factors (school adjustment and satisfaction with grades) on mental health between male and female adolescents. These findings indicate sex differences in adolescent mental health profiles in South Korea. Further studies are needed to develop comprehensive mental health strategies that consider personal, family, and school-related factors and sex differences.

Emotional Symptoms and Risk Behaviors in Adolescents: Relationships With Cyberbullying and Implications on Well-Being

Context: Cyberbullying is considered a public health problem with serious consequences on adolescents' health and well-being. Objective: To analyze the relationships between emotional symptoms and risk behaviors with cyberbullying and understand the role of these factors as predictors of well-being. Design: This is a cross-sectional study based on the 2014 Health Behaviour in School-Aged Children of the World Health Organization (HBSC/WHO) study. Results: More girls reported being involved in cyberbullying as cybervictims, whereas more boys reported being involved in cyberbullying as cyberbullies and cyberbully victims. Girls reported more emotional symptoms, especially fear and sadness; boys reported more risk behaviors, specifically drug use and involvement in fights, but a higher well-being when compared to girls. Cyberbullies and cyberbully victims reported higher alcohol consumption than cybervictims; cyberbullies also reported higher drugs consumption compared to cybervictims and cyberbully victims. Well-being was predicted by emotional symptoms and age, independently of gender; for girls, involvement in fights also predicted well-being. Conclusions: If boys and girls, as well as cybervictims, cyberbullies, and cyberbully victims, present different levels of well-being, emotional symptoms, and risk behaviors vary in function of cyberbullying, it is crucial to develop individual interventions focused on the specific needs of each group.

Association between School Membership and Substance Use among Adolescents

BACKGROUND

Substance use among adolescents is a major problem worldwide, producing many health and economic consequences. Even though there are well-known personal, familial, and social factors associated with drug use, less is known about the effect of school-related factors. School membership is a recognized variable affecting academic performance among students; however, its effect on substance use is less understood.

AIMS

The primary aim of this study was to explore the association between school membership and cigarette, alcohol, and cannabis use among a representative sample of secondary students from municipal state-funded schools in Santiago of Chile, and secondly, to test the hypothesis that depressive or anxiety symptoms mediate this association.

METHODS

A total of 2,508 students from 22 state-funded schools in Santiago, Chile, answered a questionnaire. This instrument included an abbreviated version of the psychological sense of school membership (PSSM), questions regarding the use of alcohol, tobacco, and cannabis and scales of psychological functioning (depression, anxiety, self-concept, and problem-solving). The association analyses were performed using adjusted regression models for each outcome using all independent variables while controlling for gender and age. For the mediation effect, a combination of ordinary least square and logistic regression analyses was conducted.

RESULTS

There was an association between a strong PSSM and low risk for smoking (OR 0.57; 95% CI 0.46-0.72), drinking (0.65; 95% CI: 0.51-0.83), and cannabis use (0.52; 95% CI 0.37-0.74). We also found that depressive and anxiety symptoms do not fully mediate the association between school membership and any substance use, and 73% of this effect in the case of smoking, 80% in the case of drinking, and 78.5% in the case of cannabis use, was direct.

CONCLUSION

This is the first study in Latin America exploring the association between school membership and substance use among secondary students. School membership seems to be an important and independent factor to be included in preventive interventions. Therefore, these results support future research aiming to test interventions at increasing the sense of school membership to prevent substance use among adolescents.

CLINICAL TRIAL REGISTRATION

ISRCTN19466209. Retrospectively registered.

Effects of acute and chronic caffeine on risk-taking behavior in children and adolescents

Consumption of caffeinated beverages is associated with increased risk-taking behavior. The purpose of this study was to determine if acute caffeine administration influences risk-taking behavior in a dose-dependent manner. Participants were pre- (ages 8-9) and post-pubertal (ages 15-17) children who visited the laboratory three times and consumed a beverage containing 0, 1, or 2 mg/kg of caffeine. Thirty minutes later, participants completed the balloon analogue risk task (BART), the Iowa gambling task (IGT), and a delay discounting task. The number of balloons exploded on the BART task was significantly increased after 2 mg/kg of caffeine in moderate caffeine consumers, but was decreased after 2 mg/kg of caffeine in high caffeine consumers. There were no main effects of caffeine dose on the delay discounting task or on the IGT. Post-pubertal participants showed reduced delay discounting compared with pre-pubertal participants. Finally, average daily caffeine use was significantly, positively correlated with scores on a risk-taking questionnaire. These data suggest that caffeine dose-dependently influences decision making and risk taking. More research is needed to determine the mechanism of this difference as well as the extent to which sex and pubertal phase influence these relationships.

Connecting the dots on health inequalities--a systematic review on the social determinants of health in Portugal

INTRODUCTION

Health inequalities are recognised as a public health issue worldwide, but only a few countries have developed national strategies to monitor and reduce them. Despite its considerable health inequalities, Portugal seems to lack a systematic strategy to tackle them, possibly due to the absence of organised evidence on the issue. We performed a systematic review that aimed to describe the available evidence on social inequalities in health in Portugal, in order to contribute towards a comprehensive and focused strategy to tackle them.

METHODS

We followed the PRISMA guidelines and searched Scopus, Web of Science and PubMed for studies that looked at the association between a measure of socioeconomic status and a health outcome in the Portuguese resident population since the year 2000. We excluded health behaviours and healthcare use from our search. We performed a qualitative description of the results.

RESULTS

Seventy-one publications were selected, all reporting observational analyses, most of them using cross-sectional data. These publications showed strong evidence for health inequalities related to education and gender, chiefly for obesity, self-rated health and mental health.

CONCLUSIONS

Analysis of the eligible publications showed that current research does not seem to have consistently covered the link between health and key Portuguese social problems. A strategy focusing on the monitoring of most prevalent diseases, most determining socioeconomic factors and vulnerable populations would be crucial to guide academic research in a country in which health inequalities are so ubiquitous and deeply rooted.

REGISTRATION

This systematic review is not registered.