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Rhead R, Wels J, Moltrecht B, Shaw RJ, Silverwood R, Zhu J, Hughes A, Chaturvedi N, Demou E, Katikireddi SV, Ploubidis G. Long COVID and financial outcomes: evidence from four longitudinal population surveys. J Epidemiol Community Health 2024:jech-2023-221059. [PMID: 38508701 DOI: 10.1136/jech-2023-221059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/22/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Long-term sequelae of COVID-19 (long COVID) include muscle weakness, fatigue, breathing difficulties and sleep disturbance over weeks or months. Using UK longitudinal data, we assessed the relationship between long COVID and financial disruption. METHODS We estimated associations between long COVID (derived using self-reported length of COVID-19 symptoms) and measures of financial disruption (subjective financial well-being, new benefit claims, changes in household income) by analysing data from four longitudinal population studies, gathered during the first year of the pandemic. We employed modified Poisson regression in a pooled analysis of the four cohorts adjusting for a range of potential confounders, including pre-pandemic (pre-long COVID) factors. RESULTS Among the 20 112 observations across four population surveys, 13% reported having COVID-19 with symptoms that impeded their ability to function normally-10.7% had such symptoms for <4 weeks (acute COVID-19), 1.2% had such symptoms for 4-12 weeks (ongoing symptomatic COVID-19) and 0.6% had such symptoms for >12 weeks (post-COVID-19 syndrome). We found that post-COVID-19 syndrome was associated with worse subjective financial well-being (adjusted relative risk ratios (aRRRs)=1.57, 95% CI=1.25, 1.96) and new benefit claims (aRRR=1.79, CI=1.27, 2.53). Associations were broadly similar across sexes and education levels. These results were not meaningfully altered when scaled to represent the population by age. CONCLUSIONS Long COVID was associated with financial disruption in the UK. If our findings reflect causal effects, extending employment protection and financial support to people with long COVID may be warranted.
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Affiliation(s)
- Rebecca Rhead
- Department of Psychological Medicine, King's College London, London, UK
- University College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Jacques Wels
- University College London, London, UK
- BE, Washington, District of Columbia, USA
| | | | - Richard John Shaw
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Jingmin Zhu
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Alun Hughes
- MRC Unit for Lifelong Health and Ageing at UCL, UCL, London, UK
| | | | - Evangelia Demou
- MRC/CSO Social and Public Health Sciences Unit, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - George Ploubidis
- Centre of Longitudinal Studies, University College London, London, UK
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Rhead R, Harber-Aschan L, Onwumere J, Polling C, Dorrington S, Ehsan A, Stevelink SAM, Khunti K, Mir G, Morriss R, Wessely S, Woodhead C, Hatch S. Ethnic inequalities among NHS staff in England: workplace experiences during the COVID-19 pandemic. Occup Environ Med 2024; 81:113-121. [PMID: 38378264 PMCID: PMC10958323 DOI: 10.1136/oemed-2023-108976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 11/23/2023] [Indexed: 02/22/2024]
Abstract
OBJECTIVES This study aims to determine how workplace experiences of National Health Service (NHS) staff varied by ethnicity during the COVID-19 pandemic and how these experiences are associated with mental and physical health at the time of the study. METHODS An online Inequalities Survey was conducted by the Tackling Inequalities and Discrimination Experiences in Health Services study in collaboration with NHS CHECK. This Inequalities Survey collected measures relating to workplace experiences (such as personal protective equipment (PPE), risk assessments, redeployments and discrimination) as well as mental health (Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder 7 (GAD-7)), and physical health (PHQ-15) from NHS staff working in the 18 trusts participating with the NHS CHECK study between February and October 2021 (N=4622). RESULTS Regression analysis of this cross-sectional data revealed that staff from black and mixed/other ethnic groups had greater odds of experiencing workplace harassment (adjusted OR (AOR) 2.43 (95% CI 1.56 to 3.78) and 2.38 (95% CI 1.12 to 5.07), respectively) and discrimination (AOR 4.36 (95% CI 2.73 to 6.96) and 3.94 (95% CI 1.67 to 9.33), respectively) compared with white British staff. Staff from black ethnic groups also had greater odds than white British staff of reporting PPE unavailability (AOR 2.16 (95% CI 1.16 to 4.00)). Such workplace experiences were associated with negative physical and mental health outcomes, though this association varied by ethnicity. Conversely, understanding employment rights around redeployment, being informed about and having the ability to inform redeployment decisions were associated with lower odds of poor physical and mental health. CONCLUSIONS Structural changes to the way staff from ethnically minoritised groups are supported, and how their complaints are addressed by leaders within the NHS are urgently required.
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Affiliation(s)
- Rebecca Rhead
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Centre for Society and Mental Health, King's College London - Strand Campus, London, UK
| | - Lisa Harber-Aschan
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Demography Unit, Stockholm University, Stockholm, Sweden
| | - Juliana Onwumere
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Catherine Polling
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Sarah Dorrington
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Annahita Ehsan
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Sharon A M Stevelink
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- King's Centre for Military Health Research, King's College London, London, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, Leicester, UK
- Real World Evidence Unit, University of Leicester, Leicester, UK
| | - Ghazala Mir
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Richard Morriss
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- NIHR ARC East Midlands, University of Nottingham, Nottingham, UK
| | - Simon Wessely
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- King's Centre for Military Health Research, King's College London, London, UK
| | - Charlotte Woodhead
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Centre for Society and Mental Health, King's College London - Strand Campus, London, UK
| | - Stephani Hatch
- Psychological Medicine, King's College London - Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Centre for Society and Mental Health, King's College London - Strand Campus, London, UK
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3
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Gnan G, Asif Z, Campbell S, Dyer J, Ehsan A, Hoffmann K, Kienzler H, Mellick S, Martin N, Osei C, Rebello A, Remouche I, Rhead R, Richards D, Sabra I, Sabra S, Sterk P, Woodhead C, Hatch S. A mixed methods PAR study investigating social capital as a resource for Black and other racially minoritised communities in the UK: A study protocol. PLoS One 2023; 18:e0296125. [PMID: 38128005 PMCID: PMC10734924 DOI: 10.1371/journal.pone.0296125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023] Open
Abstract
Understanding how different Black and other racially minoritised communities thrive is an emerging priority area in mental health promotion. Literature demonstrates health benefits of social capital (social resources embedded within social networks). However, its effects are not always positive, particularly for certain subpopulations who are already disadvantaged.The CONtributions of social NEtworks to Community Thriving (CONNECT) study will use Participatory Action Research (PAR) to investigate social capital as a resource that benefits (or hinders) racially minoritised communities and their mental health. The CONNECT study was designed within a partnership with community organisations and responds to local policy in two South-East London Boroughs, thereby providing potential channels for the action component of PAR. Taking an anti-racism lens, we acknowledge the underpinning role of racism in creating health inequities. We apply an intersectional framework to be considerate of overlapping forms of oppression such as age, gender, socioeconomic status, and sexual orientation as an essential part of developing effective strategies to tackle health inequities. Key components of this mixed methods PAR study include (1) involving racialised minority community members as peer researchers in the team (2) collecting and analysing primary qualitative data via interviews, photovoice, and community mapping workshops, (3) developing relevant research questions guided by peer researchers and collaborating organisations and analysing secondary quantitative data accordingly, (4) integrating qualitative and quantitative phases, and (5) working closely with community and policy partners to act on our findings and use our research for social change.The PAR approach will allow us to engage community (voluntary sector and government) and academic partners in decision making and help address imbalances in power and resource allocation. Knowledge generated through this collaborative approach will contribute to existing community initiatives, policies, and council strategies. This will ensure the views and experiences of racially minoritised communities drive the changes we are collaboratively committed to achieving.
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Affiliation(s)
- Georgina Gnan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- ESRC Centre for Society and Mental Health, King’s College London, London, United Kingdom
| | - Zara Asif
- ESRC Centre for Society and Mental Health, King’s College London, London, United Kingdom
- Faculty of Social Science and Public Policy, Department of Global Health and Social Medicine, School of Global Affairs, King’s College London, London, United Kingdom
| | - Sanchika Campbell
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | | | - Anna Ehsan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Katrin Hoffmann
- Centre for Global Mental Health and Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Hanna Kienzler
- ESRC Centre for Society and Mental Health, King’s College London, London, United Kingdom
- Faculty of Social Science and Public Policy, Department of Global Health and Social Medicine, School of Global Affairs, King’s College London, London, United Kingdom
| | - Shabbir Mellick
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- ESRC Centre for Society and Mental Health, King’s College London, London, United Kingdom
| | - Nathaniel Martin
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Cheryl Osei
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- ESRC Centre for Society and Mental Health, King’s College London, London, United Kingdom
| | - Abreen Rebello
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- ESRC Centre for Society and Mental Health, King’s College London, London, United Kingdom
| | - Imade Remouche
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- ESRC Centre for Society and Mental Health, King’s College London, London, United Kingdom
| | - Rebecca Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Denise Richards
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- ESRC Centre for Society and Mental Health, King’s College London, London, United Kingdom
| | - Ibrahim Sabra
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- ESRC Centre for Society and Mental Health, King’s College London, London, United Kingdom
| | - Sara Sabra
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- ESRC Centre for Society and Mental Health, King’s College London, London, United Kingdom
| | - Pippa Sterk
- Faculty of Social Science and Public Policy, School of Education, Communication and Society, King’s College London, London, United Kingdom
| | - Charlotte Woodhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- ESRC Centre for Society and Mental Health, King’s College London, London, United Kingdom
| | - Stephani Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- ESRC Centre for Society and Mental Health, King’s College London, London, United Kingdom
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Shaw RJ, Rhead R, Silverwood RJ, Wels J, Zhu J, Hamilton OK, Gessa GD, Bowyer RC, Moltrecht B, Green MJ, Demou E, Pattaro S, Zaninotto P, Boyd A, Greaves F, Chaturvedi N, Ploubidis GB, Katikireddi SV. Associations between SARS-CoV-2 infection and subsequent economic inactivity and employment status: pooled analyses of five linked longitudinal surveys. medRxiv 2023:2023.07.31.23293422. [PMID: 37662323 PMCID: PMC10473774 DOI: 10.1101/2023.07.31.23293422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Introduction Following the acute phase of the COVID-19 pandemic, record numbers of people became economically inactive (i.e., neither working nor looking for work), or non-employed (including unemployed job seekers and economically inactive people). A possible explanation is people leaving the workforce after contracting COVID-19. We investigated whether testing positive for SARS-CoV-2 is related to subsequent economic inactivity and non-employment, among people employed pre-pandemic. Methods The data came from five UK longitudinal population studies held by both the UK Longitudinal Linkage Collaboration (UK LLC; primary analyses) and the UK Data Service (UKDS; secondary analyses). We pooled data from five long established studies (1970 British Cohort Study, English Longitudinal Study of Ageing, 1958 National Child Development Study, Next Steps, and Understanding Society). The study population were aged 25-65 years between March 2020 to March 2021 and employed pre-pandemic. Outcomes were economic inactivity and non-employment measured at the time of the last follow-up survey (November 2020 to March 2021, depending on study). For the UK LLC sample (n=8,174), COVID-19 infection was indicated by a positive SARS-CoV-2 test in NHS England records. For the UKDS sample we used self-reported measures of COVID-19 infection (n=13,881). Logistic regression models estimated odds ratios (ORs) with 95% confidence intervals (95%CIs) adjusting for potential confounders including sociodemographic variables, pre-pandemic health and occupational class. Results Testing positive for SARS-CoV-2 was very weakly associated with economic inactivity (OR 1.08 95%CI 0.68-1.73) and non-employment status (OR 1.09. 95%CI 0.77-1.55) in the primary analyses. In secondary analyses, self-reported test-confirmed COVID-19 was not associated with either economic inactivity (OR 1.01 95%CI 0.70-1.44) or non-employment status (OR 1.03 95%CI 0.79-1.35). Conclusions Among people employed pre-pandemic, testing positive for SARS-CoV-2 was either weakly or not associated with increased economic inactivity or non-employment. Research on the recent increases in economic inactivity should focus on other potential causes.
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Affiliation(s)
- Richard J Shaw
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rebecca Rhead
- Centre for Longitudinal Studies (CLS), UCL Social Research Institute, University College London, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | - Richard J Silverwood
- Centre for Longitudinal Studies (CLS), UCL Social Research Institute, University College London, London, UK
| | - Jacques Wels
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
- Centre Metices, Université libre de Bruxelles, Brussels, BE
| | - Jingmin Zhu
- Department of Epidemiology & Public Health, University College London, London, UK
| | - Olivia Kl Hamilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Giorgio Di Gessa
- Department of Epidemiology & Public Health, University College London, London, UK
| | - Ruth Ce Bowyer
- Department of Twin Research and Genetic Epidemiology, School of Life Course & Population Sciences, King's College London, London, UK
- AI For Science & Government, Alan Turing Institute, London, UK
| | - Bettina Moltrecht
- Centre for Longitudinal Studies (CLS), UCL Social Research Institute, University College London, London, UK
| | - Michael J Green
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Division of Women's Community and Population Health, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Evangelia Demou
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Serena Pattaro
- Scottish Centre for Administrative Data Research (SCADR), University of Glasgow, Glasgow, UK
| | - Paola Zaninotto
- Department of Epidemiology & Public Health, University College London, London, UK
| | - Andy Boyd
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Felix Greaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - George B Ploubidis
- Centre for Longitudinal Studies (CLS), UCL Social Research Institute, University College London, London, UK
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Adji A, Rhead R, McManus S, Shoham N. Associations between common mental disorders and menopause: cross-sectional analysis of the 2014 Adult Psychiatric Morbidity Survey. BJPsych Open 2023; 9:e103. [PMID: 37288736 DOI: 10.1192/bjo.2023.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
We investigated whether women who participated in a household survey in England were more likely to screen positive for possible generalised anxiety disorder and depression during and after menopause. We used logistic regression in secondary cross-sectional analyses of 1413 participants from the 2014 Adult Psychiatric Morbidity Survey data, adjusting for potential confounders (including age, deprivation score and chronic disease).We found that participants who were post-menopausal were more likely to screen positive for possible depression compared with participants who were pre-menopausal (3.9% v. 1.7%; adjusted odds ratio 3.91, 95% CI 1.23-12.46), but there was no association with perimenopause. We found no evidence of an association between menopausal stage and possible generalised anxiety disorder or symptom score. Clinicians should be aware of the association between menopause and depression, to best support women. Future research could focus on to what extent associations are driven by somatic features, and how this might be modified.
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Affiliation(s)
- Amira Adji
- Division of Psychiatry, University College London, UK
| | - Rebecca Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Sally McManus
- Violence and Society Centre, City, University of London, UK; National Centre for Social Research, UK
| | - Natalie Shoham
- Division of Psychiatry, University College London, UK; and Camden and Islington NHS Foundation Trust, St Pancras Hospital, UK
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6
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Wels J, Wielgoszewska B, Moltrecht B, Booth C, Green MJ, Hamilton OKL, Demou E, Di Gessa G, Huggins C, Zhu J, Santorelli G, Silverwood RJ, Kopasker D, Shaw RJ, Hughes A, Patalay P, Steves C, Chaturvedi N, Porteous DJ, Rhead R, Katikireddi SV, Ploubidis GB. Home working and social and mental wellbeing at different stages of the COVID-19 pandemic in the UK: Evidence from 7 longitudinal population surveys. PLoS Med 2023; 20:e1004214. [PMID: 37104282 PMCID: PMC10138202 DOI: 10.1371/journal.pmed.1004214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/07/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Home working has increased since the Coronavirus Disease 2019 (COVID-19) pandemic's onset with concerns that it may have adverse health implications. We assessed the association between home working and social and mental wellbeing among the employed population aged 16 to 66 through harmonised analyses of 7 UK longitudinal studies. METHODS AND FINDINGS We estimated associations between home working and measures of psychological distress, low life satisfaction, poor self-rated health, low social contact, and loneliness across 3 different stages of the pandemic (T1 = April to June 2020 -first lockdown, T2 = July to October 2020 -eased restrictions, T3 = November 2020 to March 2021 -second lockdown) using modified Poisson regression and meta-analyses to pool results across studies. We successively adjusted the model for sociodemographic characteristics (e.g., age, sex), job characteristics (e.g., sector of activity, pre-pandemic home working propensities), and pre-pandemic health. Among respectively 10,367, 11,585, and 12,179 participants at T1, T2, and T3, we found higher rates of home working at T1 and T3 compared with T2, reflecting lockdown periods. Home working was not associated with psychological distress at T1 (RR = 0.92, 95% CI = 0.79 to 1.08) or T2 (RR = 0.99, 95% CI = 0.88 to 1.11), but a detrimental association was found with psychological distress at T3 (RR = 1.17, 95% CI = 1.05 to 1.30). Study limitations include the fact that pre-pandemic home working propensities were derived from external sources, no information was collected on home working dosage and possible reverse association between change in wellbeing and home working likelihood. CONCLUSIONS No clear evidence of an association between home working and mental wellbeing was found, apart from greater risk of psychological distress during the second lockdown, but differences across subgroups (e.g., by sex or level of education) may exist. Longer term shifts to home working might not have adverse impacts on population wellbeing in the absence of pandemic restrictions but further monitoring of health inequalities is required.
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Affiliation(s)
- Jacques Wels
- MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
- Centre Metices, Université libre de Bruxelles, Brussels, Belgium
| | - Bożena Wielgoszewska
- Centre for Longitudinal Studies (CLS), Social Research Institute, University College London, London, United Kingdom
| | - Bettina Moltrecht
- Centre for Longitudinal Studies (CLS), Social Research Institute, University College London, London, United Kingdom
| | - Charlotte Booth
- Centre for Longitudinal Studies (CLS), Social Research Institute, University College London, London, United Kingdom
| | - Michael J. Green
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, Glasgow, United Kingdom
| | - Olivia KL Hamilton
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, Glasgow, United Kingdom
| | - Evangelia Demou
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, Glasgow, United Kingdom
| | - Giorgio Di Gessa
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Charlotte Huggins
- Centre for Genomic and Experimental Medicine, The University of Edinburgh Western General Hospital, Edinburgh, United Kingdom
| | - Jingmin Zhu
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Gillian Santorelli
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Richard J. Silverwood
- Centre for Longitudinal Studies (CLS), Social Research Institute, University College London, London, United Kingdom
| | - Daniel Kopasker
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, Glasgow, United Kingdom
| | - Richard J. Shaw
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, Glasgow, United Kingdom
| | - Alun Hughes
- MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
- Centre for Longitudinal Studies (CLS), Social Research Institute, University College London, London, United Kingdom
| | - Claire Steves
- Twin Research & Genetic Epidemiology, King’s College London, St Thomas’ Hospital London, United Kingdom
| | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - David J. Porteous
- Centre for Genomic and Experimental Medicine, The University of Edinburgh Western General Hospital, Edinburgh, United Kingdom
| | - Rebecca Rhead
- Centre for Longitudinal Studies (CLS), Social Research Institute, University College London, London, United Kingdom
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, Glasgow, United Kingdom
| | - George B. Ploubidis
- Centre for Longitudinal Studies (CLS), Social Research Institute, University College London, London, United Kingdom
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Harwood H, Rhead R, Chui Z, Bakolis I, Connor L, Gazard B, Hall J, MacCrimmon S, Rimes KA, Woodhead C, Hatch SL. Variations by ethnicity in referral and treatment pathways for IAPT service users in South London. Psychol Med 2023; 53:1084-1095. [PMID: 34334151 PMCID: PMC9976018 DOI: 10.1017/s0033291721002518] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 05/27/2021] [Accepted: 06/04/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Improving Access to Psychological Therapies (IAPT) programme aims to provide equitable access to therapy for common mental disorders. In the UK, inequalities by ethnicity exist in accessing and receiving mental health treatment. However, limited research examines IAPT pathways to understand whether and at which points such inequalities may arise. METHODS This study examined variation by ethnicity in (i) source of referral to IAPT services, (ii) receipt of assessment session, (iii) receipt of at least one treatment session. Routine data were collected on service user characteristics, referral source, assessment and treatment receipt from 85 800 individuals referred to South London and Maudsley NHS Foundation Trust IAPT services between 1st January 2013 and 31st December 2016. Multinomial and logistic regression analysis was used to assess associations between ethnicity and referral source, assessment and treatment receipt. Missing ethnicity data (18.5%) were imputed using census data and reported alongside a complete case analysis. RESULTS Compared to the White British group, Black African, Asian and Mixed ethnic groups were less likely to self-refer to IAPT services. Black Caribbean, Black Other and White Other groups are more likely to be referred through community services. Almost all racial and minority ethnic groups were less likely to receive an assessment compared to the White British group, and of those who were assessed, all racial and ethnic minority groups were less likely to be treated. CONCLUSIONS Racial and ethnic minority service users appear to experience barriers to IAPT care at different pathway stages. Services should address potential cultural, practical and structural barriers.
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Affiliation(s)
- Hannah Harwood
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rebecca Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Zoe Chui
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ioannis Bakolis
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Health Service & Population Research Department, Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Luke Connor
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Billy Gazard
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jheanell Hall
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Shirlee MacCrimmon
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katharine A. Rimes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Charlotte Woodhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
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8
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Ronaldson A, Arias de la Torre J, Bendayan R, Yadegarfar ME, Rhead R, Douiri A, Armstrong D, Hatch S, Hotopf M, Dregan A. Physical multimorbidity, depressive symptoms, and social participation in adults over 50 years of age: findings from the English Longitudinal Study of Ageing. Aging Ment Health 2023; 27:43-53. [PMID: 35037790 DOI: 10.1080/13607863.2021.2017847] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The aim of the current study was to identify specific patterns of physical multimorbidity and examine how these patterns associated with changes in social participation over time. METHODS We used latent class analysis to identify clusters of physical multimorbidity in 11,391 older adults. Mixed effects regression models were used to assess associations between physical multimorbidity clusters and changes in social participation over 15 years. RESULTS Four clusters of physical multimorbidity were identified. All physical multimorbidity clusters were associated with a reduction in cultural engagement (e.g. visits to theatre, cinema, museums) over time, with the strongest association seen in the complex/multisystem cluster (β = -0.26, 95% CI = -0.38 to -0.15). Similar results emerged for leisure activities. Adjusting for depressive symptoms fully attenuated some associations. All physical multimorbidity clusters were associated with an increase in civic participation over time. CONCLUSIONS Physical multimorbidity reduced some aspects of social participation over time, with specific combinations of conditions having increased risk of reductions. UNLABELLED Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2021.2017847.
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Affiliation(s)
- Amy Ronaldson
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Jorge Arias de la Torre
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.,CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Institute of Biomedicine (IBIOMED), University of Leon, Leon, Spain
| | - Rebecca Bendayan
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,NIHR Biomedical Research Centre at South London and Maudsley, NHS Foundation Trust and King's College London, UK
| | | | - Rebecca Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Abdel Douiri
- School of Life Course & Population Sciences, King's College London, London, UK.,National Institute for Health Research Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.,National Institute for Health Research Applied Research Collaboration South London, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - David Armstrong
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
| | - Stephani Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.,ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Alex Dregan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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9
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Woodhead C, Onwumere J, Rhead R, Bora-White M, Chui Z, Clifford N, Connor L, Gunasinghe C, Harwood H, Meriez P, Mir G, Jones Nielsen J, Rafferty AM, Stanley N, Peprah D, Hatch SL. Race, ethnicity and COVID-19 vaccination: a qualitative study of UK healthcare staff. Ethn Health 2022; 27:1555-1574. [PMID: 34092149 PMCID: PMC7614854 DOI: 10.1080/13557858.2021.1936464] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE COVID-19-related inequities experienced by racial and ethnic minority groups including healthcare professionals mirror wider health inequities, which risk being perpetuated by lower uptake of vaccination. We aim to better understand lower uptake among racial and ethnic minority staff groups to inform initiatives to enhance uptake. DESIGN Twenty-five semi-structured interviews were conducted (October 2020-January 2021) with UK-based healthcare staff. Data were inductively and thematically analysed. RESULTS Vaccine decision-making processes were underpinned by an overarching theme, 'weighing up risks of harm against potential benefits to self and others'. Sub-themes included 'fear of harm', 'moral/ethical objections', 'potential benefits to self and others', 'information and misinformation', and 'institutional or workplace pressure'. We identified ways in which these were weighted more heavily towards vaccine hesitancy for racial and ethnic minority staff groups influenced by perceptions about institutional and structural discrimination. This included suspicions and fear around institutional pressure to be vaccinated, racial injustices in vaccine development and testing, religious or ethical concerns, and legitimacy and accessibility of vaccine messaging and communication. CONCLUSIONS Drawing on a critical race perspective, we conclude that acknowledging historical and contemporary abuses of power is essential to avoid perpetuating and aggravating mistrust by de-contextualising hesitancy from the social processes affecting hesitancy, undermining efforts to increase vaccine uptake.
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Affiliation(s)
- Charlotte Woodhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Juliana Onwumere
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Rebecca Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Zoe Chui
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Naomi Clifford
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Luke Connor
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Cerisse Gunasinghe
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hannah Harwood
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paula Meriez
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Ghazala Mir
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Anne Marie Rafferty
- Department of Adult Nursing, Florence Nightingale Faculty for Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Nathan Stanley
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dorothy Peprah
- London School of Hygiene and Tropical Medicine, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
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10
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Rhead R, MacManus D, Jones M, Greenberg N, Fear NT, Goodwin L. Mental health disorders and alcohol misuse among UK military veterans and the general population: a comparison study. Psychol Med 2022; 52:292-302. [PMID: 32777197 DOI: 10.1017/s0033291720001944] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND For a small minority of personnel, military service can have a negative impact on their mental health. Yet no studies have assessed how the mental health of UK veterans (who served during the recent operations in Afghanistan or Iraq) compares to non-veterans, to determine if they are at a disadvantage. We examine the prevalence of mental disorders and alcohol misuse in UK veterans compared to non-veterans. METHODS Veteran data were taken from the third phase of the King's Centre for Military Health Research cohort study (n = 2917). These data were compared with data on non-veterans taken from two large general population surveys: 2014 Adult Psychiatric Morbidity Survey (n = 5871) and wave 6 of the UK Household Longitudinal Study (UKHLS, n = 22 760). RESULTS We found that, overall, UK veterans who served at the time of recent military operations were more likely to report a significantly higher prevalence of common mental disorders (CMD) (23% v. 16%), post-traumatic stress disorder (PTSD) (8% v. 5%) and alcohol misuse (11% v. 6%) than non-veterans. Stratifying by gender showed that the negative impact of being a veteran on mental health and alcohol misuse was restricted to male veterans. Being ill or disabled was associated with a higher prevalence of CMD and PTSD for both veterans and non-veterans. CONCLUSION Whilst the same sociodemographic groups within the veteran and non-veteran populations seemed to have an increased risk of mental health problems (e.g. those who were unemployed), male veterans, in particular, appear to be at a distinct disadvantage compared to those who have never served.
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Affiliation(s)
- Rebecca Rhead
- Department of Forensic and Neurodevelopmental Science, King's College London, London, UK
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Deirdre MacManus
- Department of Forensic and Neurodevelopmental Science, King's College London, London, UK
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Margaret Jones
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Neil Greenberg
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
- Academic Department of Military Mental Health, Department of Psychological Medicine, King's College London, London, UK
| | - Laura Goodwin
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, London, UK
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
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11
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Lamb D, Greenberg N, Hotopf M, Raine R, Razavi R, Bhundia R, Scott H, Carr E, Gafoor R, Bakolis I, Hegarty S, Souliou E, Rafferty AM, Rhead R, Weston D, Gnangapragasam S, Marlow S, Wessely S, Stevelink S. NHS CHECK: protocol for a cohort study investigating the psychosocial impact of the COVID-19 pandemic on healthcare workers. BMJ Open 2021; 11:e051687. [PMID: 34193505 PMCID: PMC8249177 DOI: 10.1136/bmjopen-2021-051687] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/18/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has had profound effects on the working lives of healthcare workers (HCWs), but the extent to which their well-being and mental health have been affected remains unclear. This longitudinal cohort study aims to recruit a cohort of National Health Service (NHS) HCWs, conducting surveys at regular intervals to provide evidence about the prevalence of symptoms of mental disorders, and investigate associated factors such as occupational contexts and support interventions available. METHODS AND ANALYSIS All staff, students and volunteers working in the 18 participating NHS Trusts in England will be sent emails inviting them to complete a survey at baseline, with email invitations for the follow-up surveys sent 6 months and 12 months later. Opening in late April 2020, the baseline survey collects data on demographics, occupational/organisational factors, experiences of COVID-19, validated measures of symptoms of poor mental health (eg, depression, anxiety, post-traumatic stress disorder), and constructs such as resilience and moral injury. These surveys will be complemented by in-depth psychiatric interviews with a sample of HCWs. Qualitative interviews will also be conducted, to gain deeper understanding of the support programmes used or desired by staff, and facilitators and barriers to accessing such programmes. ETHICS AND DISSEMINATION Ethical approval for the study was granted by the Health Research Authority (reference: 20/HRA/210, IRAS: 282686) and local Trust Research and Development approval. Cohort data are collected via Qualtrics online survey software, pseudonymised and held on secure university servers. Participants are aware that they can withdraw from the study at any time, and there is signposting to support services if participants feel they need it. Only those consenting to be contacted about further research will be invited to participate in further components. Findings will be rapidly shared with NHS Trusts, and via academic publications in due course.
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Affiliation(s)
- Danielle Lamb
- Department of Applied Health Research, University College London, London, UK
| | - Neil Greenberg
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Reza Razavi
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rupa Bhundia
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Hannah Scott
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ewan Carr
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rafael Gafoor
- Department of Applied Health Research, University College London, London, UK
| | - Ioannis Bakolis
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Siobhan Hegarty
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Emilia Souliou
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Anne Marie Rafferty
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rebecca Rhead
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Danny Weston
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sam Gnangapragasam
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sally Marlow
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Simon Wessely
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sharon Stevelink
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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12
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Chui Z, Gazard B, MacCrimmon S, Harwood H, Downs J, Bakolis I, Polling C, Rhead R, Hatch SL. Inequalities in referral pathways for young people accessing secondary mental health services in south east London. Eur Child Adolesc Psychiatry 2021; 30:1113-1128. [PMID: 32683491 PMCID: PMC8295086 DOI: 10.1007/s00787-020-01603-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/08/2020] [Indexed: 12/25/2022]
Abstract
Differences in health service use between ethnic groups have been well documented, but little research has been conducted on inequalities in access to mental health services among young people. This study examines inequalities in pathways into care by ethnicity and migration status in 12-29 years old accessing health services in south east London. This study analyses anonymized electronic patient record data for patients aged 12-29 referred to a south east London mental health trust between 2008 and 2016 for an anxiety or non-psychotic depressive disorder (n = 18,931). Multinomial regression was used to examine associations between ethnicity, migration status, and both referral source and destination, stratified by age group. Young people in the Black African ethnic group were more likely to be referred from secondary health or social/criminal justice services compared to those in the White British ethnic group; the effect was most pronounced for those aged 16-17 years. Young people in the Black African ethnic group were also significantly more likely to be referred to inpatient and emergency services compared to those in the White British ethnic group. Black individuals living in south east London, particularly those who identify as Black African, are referred to mental health services via more adverse pathways than White individuals. Our findings suggest that inequalities in referral destination may be perpetuated by inequalities generated at the point of access.
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Affiliation(s)
- Zoe Chui
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Billy Gazard
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Shirlee MacCrimmon
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Hannah Harwood
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Johnny Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ioannis Bakolis
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Catherine Polling
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Rebecca Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
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13
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Mark KM, McNamara KA, Gribble R, Rhead R, Sharp ML, Stevelink SAM, Schwartz A, Castro C, Fear NT. The health and well-being of LGBTQ serving and ex-serving personnel: a narrative review. Int Rev Psychiatry 2019; 31:75-94. [PMID: 30997848 DOI: 10.1080/09540261.2019.1575190] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The relaxation of discriminatory policies against lesbian, gay, bisexual, transgender, and queer (LGBTQ) service personnel has led to increased diversity among military populations. Given this increase, it is important to assess sexual and gender minority groups' health and well-being in the context of military service. This narrative review assessed these outcomes in LGBTQ military personnel. The electronic databases OVID Medline, PsycInfo, and Embase were searched for papers published between January 2000 and July 2018. Thirty papers were included. In line with life course model, studies aligned with four themes: (1) mental health and well-being; (2) stigma and healthcare utilization; (3) sexual trauma; and (4) physical health. These themes highlighted that LGBTQ military personnel and veterans have poorer mental health and well-being; report more stigma and barriers to mental healthcare, which reduces uptake of accessed healthcare services; experience more sexual trauma; and have poorer physical health than heterosexual military personnel and veterans. However, there are substantial gaps in the current evidence for this population. Future research should aim to address limitations of the literature, and to ensure that data on LGBTQ personnel and veterans is collected as standard.
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Affiliation(s)
- Katharine M Mark
- a King's Centre for Military Health Research , King's College London , London , UK
| | - Kathleen A McNamara
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
| | - Rachael Gribble
- a King's Centre for Military Health Research , King's College London , London , UK
| | - Rebecca Rhead
- a King's Centre for Military Health Research , King's College London , London , UK
| | - Marie-Louise Sharp
- a King's Centre for Military Health Research , King's College London , London , UK
| | - Sharon A M Stevelink
- a King's Centre for Military Health Research , King's College London , London , UK.,c Department of Psychological Medicine , King's College London , London , UK
| | - Alix Schwartz
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
| | - Carl Castro
- b Suzanne Dworak-Peck School of Social Work , University of Southern California , Los Angeles , CA , USA
| | - Nicola T Fear
- a King's Centre for Military Health Research , King's College London , London , UK.,d Academic Department of Military Mental Health , King's College London , London , UK
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14
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Rhead R. Corrigendum to 'Using latent class analysis to produce a typology of environmental concern in the UK' [Soc. Sci. Res. Vol. 74 (Aug 2018) pp. 210-222]. Soc Sci Res 2018; 76:202. [PMID: 30268280 DOI: 10.1016/j.ssresearch.2018.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Rebecca Rhead
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom; The Cathie Marsh Institute Research, School of Social Sciences, University of Manchester, United Kingdom.
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15
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Tlhajoane M, Masoka T, Mpandaguta E, Rhead R, Church K, Wringe A, Kadzura N, Arinaminpathy N, Nyamukapa C, Schur N, Mugurungi O, Skovdal M, Eaton JW, Gregson S. A longitudinal review of national HIV policy and progress made in health facility implementation in Eastern Zimbabwe. Health Res Policy Syst 2018; 16:92. [PMID: 30241489 PMCID: PMC6150955 DOI: 10.1186/s12961-018-0358-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 08/02/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In recent years, WHO has made major changes to its guidance on the provision of HIV care and treatment services. We conducted a longitudinal study from 2013 to 2015 to establish how these changes have been translated into national policy in Zimbabwe and to measure progress in implementation within local health facilities. METHODS National HIV programme policy guidelines published between 2003 and 2013 (n = 9) and 2014 and 2015 (n = 5) were reviewed to assess adoption of WHO recommendations on HIV testing services, prevention of mother-to-child transmission (PMTCT) of HIV, and provision of antiretroviral therapy (ART). Changes in local implementation of these policies over time were measured in two rounds of a survey conducted at 36 health facilities in Eastern Zimbabwe in 2013 and 2015. RESULTS High levels of adoption of WHO guidance into national policy were recorded, including adoption of new recommendations made in 2013-2015 to introduce PMTCT Option B+ and to increase the threshold for ART initiation from CD4 ≤ 350 cells/mm3 to ≤ 500 cells/mm3. New strategies to implement national HIV policies were introduced such as the decentralisation of ART services from hospitals to clinics and task-shifting of care from doctors to nurses. The proportions of health facilities offering free HIV testing and counselling, PMTCT (including Option B+) and ART services increased substantially from 2013 to 2015, despite reductions in numbers of health workers. Provision of provider-initiated HIV testing remained consistently high. At least one test-kit stock-out in the prior year was reported in most facilities (2013: 69%; 2015: 61%; p = 0.44). Stock-outs of first-line ART and prophylactic drugs for opportunistic infections remained low. Repeat testing for HIV-negative individuals within 3 months decreased (2013: 97%; 2015: 72%; p = 0.01). Laboratory testing remained low across both survey rounds, despite policy and operational guidelines to expand coverage of diagnostic services. CONCLUSIONS Good progress has been made in implementing international guidance on HIV service delivery in Zimbabwe. Further novel implementation strategies may be needed to achieve the latest targets for universal ART eligibility.
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Affiliation(s)
- Malebogo Tlhajoane
- Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG United Kingdom
| | - Tidings Masoka
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Rebecca Rhead
- Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG United Kingdom
| | - Kathryn Church
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alison Wringe
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Noah Kadzura
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Nimalan Arinaminpathy
- Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG United Kingdom
| | - Constance Nyamukapa
- Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Nadine Schur
- Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG United Kingdom
| | | | - Morten Skovdal
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jeffrey W. Eaton
- Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG United Kingdom
| | - Simon Gregson
- Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe
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16
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Rhead R, Elliot M, Upham P. Using latent class analysis to produce a typology of environmental concern in the UK. Soc Sci Res 2018; 74:210-222. [PMID: 29961487 DOI: 10.1016/j.ssresearch.2018.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/05/2018] [Accepted: 06/11/2018] [Indexed: 06/08/2023]
Abstract
Factor analysis is often used to study environmental concern. This choice of methodology is driven by predominant theories that tie environmental attitudes to the multidimensional construct of environmental concern. This paper demonstrates that using a clustering method such as latent class analysis can be a valuable tool for studying environmental attitudes as they exist within a given population. In making the case for the value of latent class analysis in this context, we examine UK public concern for the environment and how this concern is associated with pro-environmental behaviours. To do this we use responses to DEFRA's 2009 Survey of Public Attitudes and Behaviours towards the Environment, which is still the most nationally representative survey of its type in the UK. Grouping respondents according to homogenous response patterns, we identify four classes of people, defined by their concern for the environment: Pro-environment, Neutral Majority, Disengaged and Paradoxical. To understand how these attitude classes are associated with behaviour and socio-economic status, class membership probability is regressed onto education, income and social grade, as well as 16 measures of environmental behaviour related to transport, food, recycling and home energy conservation. The results contradict most previous research with the environmental attitude classes by being highly predictive of environmental behaviour.
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Affiliation(s)
- Rebecca Rhead
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom; The Cathie Marsh Institute Research, School of Social Sciences, University of Manchester, United Kingdom.
| | - Mark Elliot
- The Cathie Marsh Institute Research, School of Social Sciences, University of Manchester, United Kingdom
| | - Paul Upham
- Institute of Environment and Sustainability Communication, The Leuphana University of Lüneburg, Lower Saxon, Germany
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Skovdal M, Maswera R, Kadzura N, Nyamukapa C, Rhead R, Wringe A, Gregson S. Parental obligations, care and HIV treatment: How care for others motivates self-care in Zimbabwe. J Health Psychol 2018; 25:2178-2187. [PMID: 30027764 PMCID: PMC7583436 DOI: 10.1177/1359105318788692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This article examines how parental obligations of care intersect with HIV treatment-seeking behaviours and retention. It draws on qualitative data from eastern Zimbabwe, produced from 65 interviews. Drawing on theories of practice and care ethics, our analysis revealed that norms of parental obligation and care acted as key motivators for ongoing engagement with HIV services and treatment. Parents' attentiveness to the future needs of their children (caring about), and sense of obligation (taking care of) and improved ability to care (caregiving) following treatment initiation, emerged as central to understanding their drive for self-care and engagement with HIV services.
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Affiliation(s)
| | | | - Noah Kadzura
- Biomedical Research and Training Institute, Zimbabwe
| | - Constance Nyamukapa
- Biomedical Research and Training Institute, Zimbabwe.,Imperial College London, UK
| | | | | | - Simon Gregson
- Biomedical Research and Training Institute, Zimbabwe.,Imperial College London, UK
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18
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Tlhajoane M, Eaton JW, Takaruza A, Rhead R, Maswera R, Schur N, Sherr L, Nyamukapa C, Gregson S. Prevalence and Associations of Psychological Distress, HIV Infection and HIV Care Service Utilization in East Zimbabwe. AIDS Behav 2018; 22:1485-1495. [PMID: 28194585 PMCID: PMC5902521 DOI: 10.1007/s10461-017-1705-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The correlation between mental health and sexual risk behaviours for HIV infection remains largely unknown in low and middle income settings. The present study determined the prevalence of psychological distress (PD) in a sub-Saharan African population with a generalized HIV epidemic, and investigated associations with HIV acquisition risk and uptake of HIV services using data from a cross-sectional survey of 13,252 adults. PD was measured using the Shona Symptom Questionnaire. Logistic regression was used to measure associations between PD and hypothesized covariates. The prevalence of PD was 4.5% (95% CI 3.9-5.1%) among men, and 12.9% (95% CI 12.2-13.6%) among women. PD was associated with sexual risk behaviours for HIV infection and HIV-infected individuals were more likely to suffer from PD. Amongst those initiated on anti-retroviral therapy, individuals with PD were less likely to adhere to treatment (91 vs. 96%; age- and site-type-adjusted odds ratio = 0.38; 95% CI 0.15, 0.99). Integrated HIV and mental health services may enhance HIV care and treatment outcomes in high HIV-prevalence populations in sub-Saharan Africa.
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Affiliation(s)
- Malebogo Tlhajoane
- Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK.
| | - Jeffrey W Eaton
- Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Albert Takaruza
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Rebecca Rhead
- Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | | | - Nadine Schur
- Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
| | - Lorraine Sherr
- Institute of Epidemiology and Health, University College London, London, UK
| | - Constance Nyamukapa
- Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Simon Gregson
- Department for Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London, W2 1PG, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
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Rhead R, Elmes J, Otobo E, Nhongo K, Takaruza A, White PJ, Nyamukapa CA, Gregson S. Do female sex workers have lower uptake of HIV treatment services than non-sex workers? A cross-sectional study from east Zimbabwe. BMJ Open 2018; 8:e018751. [PMID: 29490957 PMCID: PMC5855339 DOI: 10.1136/bmjopen-2017-018751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/01/2017] [Accepted: 11/29/2017] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Globally, HIV disproportionately affects female sex workers (FSWs) yet HIV treatment coverage is suboptimal. To improve uptake of HIV services by FSWs, it is important to identify potential inequalities in access and use of care and their determinants. Our aim is to investigate HIV treatment cascades for FSWs and non-sex workers (NSWs) in Manicaland province, Zimbabwe, and to examine the socio-demographic characteristics and intermediate determinants that might explain differences in service uptake. METHODS Data from a household survey conducted in 2009-2011 and a parallel snowball sample survey of FSWs were matched using probability methods to reduce under-reporting of FSWs. HIV treatment cascades were constructed and compared for FSWs (n=174) and NSWs (n=2555). Determinants of service uptake were identified a priori in a theoretical framework and tested using logistic regression. RESULTS HIV prevalence was higher in FSWs than in NSWs (52.6% vs 19.8%; age-adjusted OR (AOR) 4.0; 95% CI 2.9 to 5.5). In HIV-positive women, FSWs were more likely to have been diagnosed (58.2% vs 42.6%; AOR 1.62; 1.02-2.59) and HIV-diagnosed FSWs were more likely to initiate ART (84.9% vs 64.0%; AOR 2.33; 1.03-5.28). No difference was found for antiretroviral treatment (ART) adherence (91.1% vs 90.5%; P=0.9). FSWs' greater uptake of HIV treatment services became non-significant after adjusting for intermediate factors including HIV knowledge and risk perception, travel time to services, physical and mental health, and recent pregnancy. CONCLUSION FSWs are more likely to take up testing and treatment services and were closer to achieving optimal outcomes along the cascade compared with NSWs. However, ART coverage was low in all women at the time of the survey. FSWs' need for, knowledge of and proximity to HIV testing and treatment facilities appear to increase uptake.
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Affiliation(s)
- Rebecca Rhead
- Department of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK
| | - Jocelyn Elmes
- Department of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK
| | - Eloghene Otobo
- Department of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK
| | - Kundai Nhongo
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Albert Takaruza
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Peter J White
- Department of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK
- MRC Centre for Outbreak Analysis and Modelling and NIHR Health Protection Research Unit in Modelling Methodology, Imperial College London School of Public Health, London, UK
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
| | - Constance Anesu Nyamukapa
- Department of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Simon Gregson
- Department of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK
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Slaymaker E, McLean E, Wringe A, Calvert C, Marston M, Reniers G, Kabudula CW, Crampin A, Price A, Michael D, Urassa M, Kwaro D, Sewe M, Eaton JW, Rhead R, Nakiyingi-Miiro J, Lutalo T, Nabukalu D, Herbst K, Hosegood V, Zaba B. The Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA): Data on mortality, by HIV status and stage on the HIV care continuum, among the general population in seven longitudinal studies between 1989 and 2014. Gates Open Res 2017. [PMID: 29528045 PMCID: PMC5841576 DOI: 10.12688/gatesopenres.12753.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Timely progression of people living with HIV (PLHIV) from the point of infection through the pathway from diagnosis to treatment is important in ensuring effective care and treatment of HIV and preventing HIV-related deaths and onwards transmission of infection. Reliable, population-based estimates of new infections are difficult to obtain for the generalised epidemics in sub-Saharan Africa. Mortality data indicate disease burden and, if disaggregated along the continuum from diagnosis to treatment, can also reflect the coverage and quality of different HIV services. Neither routine statistics nor observational clinical studies can estimate mortality prior to linkage to care nor following disengagement from care. For this, population-based data are required. The Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa brings together studies in Kenya, Malawi, South Africa, Tanzania, Uganda, and Zimbabwe. Eight studies have the necessary data to estimate mortality by HIV status, and seven can estimate mortality at different stages of the HIV care continuum. This data note describes a harmonised dataset containing anonymised individual-level information on survival by HIV status for adults aged 15 and above. Among PLHIV, the dataset provides information on survival during different periods: prior to diagnosis of infection; following diagnosis but before linkage to care; in pre-antiretroviral treatment (ART) care; in the first six months after ART initiation; among people continuously on ART for 6+ months; and among people who have ever interrupted ART.
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Affiliation(s)
- Emma Slaymaker
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Estelle McLean
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.,Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Alison Wringe
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Clara Calvert
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Milly Marston
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Georges Reniers
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.,School of Public Health, University of the Witwatersrand, Johannesburg, 2000, South Africa
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2000, South Africa
| | - Amelia Crampin
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.,Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Alison Price
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.,Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Denna Michael
- National Institute for Medical Research, Mwanza, Tanzania
| | - Mark Urassa
- National Institute for Medical Research, Mwanza, Tanzania
| | | | | | - Jeffrey W Eaton
- Department of Infectious Disease Epidemiology, Imperial College London, London, W2 1PG, UK
| | - Rebecca Rhead
- Department of Infectious Disease Epidemiology, Imperial College London, London, W2 1PG, UK
| | | | - Tom Lutalo
- Rakai Health Sciences Program, Entebbe, Uganda
| | | | - Kobus Herbst
- Africa Health Research Institute, Durban, 4001, South Africa
| | - Victoria Hosegood
- Africa Health Research Institute, Durban, 4001, South Africa.,Department of Social Statistics & Demography, University of Southampton, Southhampton, SO17 1BJ, UK
| | - Basia Zaba
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
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21
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Gregson S, Mugurungi O, Eaton J, Takaruza A, Rhead R, Maswera R, Mutsvangwa J, Mayini J, Skovdal M, Schaefer R, Hallett T, Sherr L, Munyati S, Mason P, Campbell C, Garnett GP, Nyamukapa CA. Documenting and explaining the HIV decline in east Zimbabwe: the Manicaland General Population Cohort. BMJ Open 2017; 7:e015898. [PMID: 28988165 PMCID: PMC5639985 DOI: 10.1136/bmjopen-2017-015898] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 04/10/2017] [Accepted: 04/27/2017] [Indexed: 01/20/2023] Open
Abstract
PURPOSE The Manicaland cohort was established to provide robust scientific data on HIV prevalence and incidence, patterns of sexual risk behaviour and the demographic impact of HIV in a sub-Saharan African population subject to a generalised HIV epidemic. The aims were later broadened to include provision of data on the coverage and effectiveness of national HIV control programmes including antiretroviral therapy (ART). PARTICIPANTS General population open cohort located in 12 sites in Manicaland, east Zimbabwe, representing 4 major socioeconomic strata (small towns, agricultural estates, roadside settlements and subsistence farming areas). 9,109 of 11,453 (79.5%) eligible adults (men 17-54 years; women 15-44 years) were recruited in a phased household census between July 1998 and January 2000. Five rounds of follow-up of the prospective household census and the open cohort were conducted at 2-year or 3-year intervals between July 2001 and November 2013. Follow-up rates among surviving residents ranged between 77.0% (over 3 years) and 96.4% (2 years). FINDINGS TO DATE HIV prevalence was 25.1% at baseline and had a substantial demographic impact with 10-fold higher mortality in HIV-infected adults than in uninfected adults and a reduction in the growth rate in the worst affected areas (towns) from 2.9% to 1.0%pa. HIV infection rates have been highest in young adults with earlier commencement of sexual activity and in those with older sexual partners and larger numbers of lifetime partners. HIV prevalence has since fallen to 15.8% and HIV incidence has also declined from 2.1% (1998-2003) to 0.63% (2009-2013) largely due to reduced sexual risk behaviour. HIV-associated mortality fell substantially after 2009 with increased availability of ART. FUTURE PLANS We plan to extend the cohort to measure the effects on the epidemic of current and future HIV prevention and treatment programmes. Proposals for access to these data and for collaboration are welcome.
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Affiliation(s)
- Simon Gregson
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Owen Mugurungi
- Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe
| | - Jeffrey Eaton
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Albert Takaruza
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Rebecca Rhead
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | | | | | - Justin Mayini
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Robin Schaefer
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Timothy Hallett
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | | | - Shungu Munyati
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Peter Mason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Geoffrey P Garnett
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Constance Anesu Nyamukapa
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
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22
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Garnett GP, Hallett TB, Takaruza A, Hargreaves J, Rhead R, Warren M, Nyamukapa C, Gregson S. Providing a conceptual framework for HIV prevention cascades and assessing feasibility of empirical measurement with data from east Zimbabwe: a case study. Lancet HIV 2017; 3:e297-306. [PMID: 27365204 PMCID: PMC4935672 DOI: 10.1016/s2352-3018(16)30039-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/25/2016] [Accepted: 05/06/2016] [Indexed: 12/27/2022]
Abstract
Background The HIV treatment cascade illustrates the steps required for successful treatment and is a powerful advocacy and monitoring tool. Similar cascades for people susceptible to infection could improve HIV prevention programming. We aim to show the feasibility of using cascade models to monitor prevention programmes. Methods Conceptual prevention cascades are described taking intervention-centric and client-centric perspectives to look at supply, demand, and efficacy of interventions. Data from two rounds of a population-based study in east Zimbabwe are used to derive the values of steps for cascades for voluntary medical male circumcision (VMMC) and for partner reduction or condom use driven by HIV testing and counselling (HTC). Findings In 2009 to 2011 the availability of circumcision services was negligible, but by 2012 to 2013 about a third of the population had access. However, where it was available only 12% of eligible men sought to be circumcised leading to an increase in circumcision prevalence from 3·1% to 6·9%. Of uninfected men, 85·3% did not perceive themselves to be at risk of acquiring HIV. The proportions of men and women tested for HIV increased from 27·5% to 56·6% and from 61·1% to 79·6%, respectively, with 30·4% of men tested self-reporting reduced sexual partner numbers and 12·8% reporting increased condom use. Interpretation Prevention cascades can be populated to inform HIV prevention programmes. In eastern Zimbabwe programmes need to provide greater access to circumcision services and the design and implementation of associated demand creation activities. Whereas, HTC services need to consider how to increase reductions in partner numbers or increased condom use or should not be considered as contributing to prevention services for the HIV-negative adults. Funding Wellcome Trust and Bill & Melinda Gates Foundation.
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Affiliation(s)
| | - Timothy B Hallett
- Department of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK
| | - Albert Takaruza
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Rebecca Rhead
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Constance Nyamukapa
- Department of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK; Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Simon Gregson
- Department of Infectious Disease Epidemiology, Imperial College London School of Public Health, London, UK; Biomedical Research and Training Institute, Harare, Zimbabwe
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