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Hashmi R, Keating BW, Ali MA, Keramat SA. An investigation of the longitudinal trajectory patterns of health-related quality of life among Australians with disabilities: explaining disability types and properties. Qual Life Res 2024; 33:2207-2217. [PMID: 38856945 PMCID: PMC11286656 DOI: 10.1007/s11136-024-03683-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Research on health-related quality of life (HRQoL) trajectory patterns for people with disabilities (PwD) is scant. Understanding the HRQoL trajectory patterns for PwDs and investigating their relationship with disability types and socioeconomic factors can have important implications for Australia's welfare policy. METHODS We analysed data from waves 11 to 21 of the Household, Income and Labour Dynamics in Australia (HILDA) survey of respondents aged 15 + years of the PwDs. The analytic sample consists of 3724 self-reported disabled individuals and 34,539 observations in total. The SF-6D utility score is our HRQoL measure. Group-based trajectory modelling was utilised to identify trajectory groups, and multinomial logistic regression was employed to determine the baseline factors associated with trajectory group membership. RESULTS The study identified four distinct types of HRQoL trajectories (high, moderate improving, moderate deteriorating and low HRQoL trajectories). Psychosocial disability types followed by physical disability types had a high Relative Risk Ratio (RRR) in the low group compared with high trajectory group membership of PwDs (psychosocial: 6.090, physical: 3.524). Similar, results followed for the moderate improving group albeit with lower RRR (psychosocial: 2.868, Physical: 1.820). In the moderate deteriorating group, the disability types were not significant as this group has a similar profile to high group at the baseline. Compared with males, females had a higher RRR in low and moderate versus high improving HRQoL trajectories (low: 1.532, moderate improving: 1.237). Comparing the richest class to the poorest class, socioeconomic factors (income and education) predicted significantly lower exposure for the richer class to the low and medium HRQoL trajectories groups (RRR < 1). CONCLUSION Different forms of disability, demographic and socioeconomic factors have distinct effects on the HRQoL trajectories of disabled individuals. Healthcare and economic resource efficiency might be improved with targeted government policy interventions based on disability trajectories.
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Affiliation(s)
- Rubayyat Hashmi
- The Australian Centre for Housing Research, The University of Adelaide, Adelaide, SA, 5005, Australia.
- The ALIVE National Centre for Mental Health Research Translation, The University of Melbourne, Melbourne, Australia.
| | - Byron W Keating
- QUT Business School, Queensland University of Technology, Brisbane, QLD, 4001, Australia
| | - Mohammad Afshar Ali
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
- Sydney Pharmacy School, The University of Sydney, Sydney, Australia
| | - Syed Afroz Keramat
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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2
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Hu M, Wu X, Qiu S. Examining the impact of self-stigma on workplace well-being: an empirical investigation of medical students with physical disabilities in China and the moderating role of trait mindfulness. BMC MEDICAL EDUCATION 2024; 24:741. [PMID: 38982417 PMCID: PMC11234788 DOI: 10.1186/s12909-024-05554-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 05/13/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND As societal evolution unfolds in China, individuals with physical disabilities are increasingly provided opportunities in higher education, particularly in the field of medicine. However, these medical students often encounter bias in their work environments, including during internships, which fosters self-stigma and impedes their experience for workplace well-being (WWB). Such a decrease in WWB detrimentally affects not only their mental health in the workplace but also hinders their sense of personal worth and assimilation into broader society. This study aims to examine the challenges faced by medical students with physical disabilities in China as they aspire to achieve WWB, and to explore potential intervention strategies. METHODS Leveraging cognitive consistency theory (CCT), we introduces a conceptual framework to examine the relationships among self-stigma, perceived discrimination, and WWB. It also investigates the role of trait mindfulness as a potential mitigating factor in this dynamic. We employed the Internalized Stigma of Mental Illness Scale (ISMIS), Discrimination Perception Questionnaire (DPQ), Workplace Well-being Subscale (WWBS), and Mindful Attention Awareness Scale (MAAS) to survey 316 medical students with physical disabilities. Statistical analyses, including correlation, regression, and moderated mediation effect assessments, were conducted using SPSS 22.0 and AMOS 24.0. RESULTS A notable negative correlation exists between self-stigma and WWB (r = -0.56, p < 0.01). Perceived discrimination partially mediates the relationship between self-stigma and WWB. The direct effect of self-stigma and its mediating effect through perceived discrimination account for 60.71% and 21.43% of the total effect, respectively. Trait mindfulness moderates the latter part of this mediating pathway. Moderation models indicate that trait mindfulness has a significant negative moderating effect on the impact of perceived discrimination on WWB (β = -0.10, p < 0.001). CONCLUSIONS Self-stigma adversely affects the positive work experiences of medical students with physical disabilities by eliciting a heightened sensitivity to discriminatory cues, thereby undermining their WWB. Trait mindfulness can effectively counter the detrimental effects of perceived discrimination on WWB. Consequently, this study advocates for the systematic incorporation of mindfulness training into educational services and workplace enhancement programs for medical students with disabilities, aiming to foster an inclusive and supportive external environment.
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Affiliation(s)
- Minqiao Hu
- Business School, Sichuan University, Chengdu, China
| | - Xiongfu Wu
- Business School, Sichuan University, Chengdu, China
| | - Shuang Qiu
- School of Foreign Languages, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
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3
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Wooden M, Watson N, Butterworth P. Data Resource Profile: Household, Income and Labour Dynamics in Australia (HILDA) Survey. Int J Epidemiol 2024; 53:dyae043. [PMID: 38553031 DOI: 10.1093/ije/dyae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/05/2024] [Indexed: 04/02/2024] Open
Affiliation(s)
- Mark Wooden
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Australia
| | - Nicole Watson
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Australia
| | - Peter Butterworth
- SEED Lifespan, School of Psychology, Deakin University, Melbourne, Australia
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4
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Ye L, Kavanagh A, Petrie D, Dickinson H, Aitken Z. Part-time versus full-time employment and mental health for people with and without disability. SSM Popul Health 2023; 23:101446. [PMID: 37334329 PMCID: PMC10275711 DOI: 10.1016/j.ssmph.2023.101446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/22/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023] Open
Abstract
Objectives This paper investigates the relationship between part-time and full-time employment and mental health for people with and without disability, as well as differences in the relationship by age and sex. Methods Using data from 13,219 working-aged people (15-64 years) in the labour force who participated in five annual waves of a longitudinal cohort study in Australia, the analysis used fixed effect regression models to examine within-person changes in mental health associated with changes in employment status (full-time; part-time; unemployed). Differences in the relationship between employment status and mental health by disability, sex, and age were assessed. Results Among people with disability, there was evidence that working part-time and full-time were associated with a 4.2-point (95% CI 2.6, 5.7) and 6.0-point (95% CI 4.4, 7.6) increase in mental health scores compared with when they were unemployed. For people without disability, there were much smaller differences in mental health associated with working part-time (β = 1.0, 95% CI 0.2, 1.9) and full-time (β = 1.4, 95% CI 0.5, 2.2) compared with when they were unemployed. The positive effects of both part-time and full-time employment were of greater magnitude for people with disability aged younger than 45 years compared to those aged 45 years and older. Conclusions The results of this study suggest that both part-time and full-time employment may have beneficial effects on the mental health of people with disability, particularly for younger people. The findings underscore the value of employment for people with disability, given we found much larger beneficial mental health effects in comparison to people without disability.
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Affiliation(s)
- Lu Ye
- Disability and Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Anne Kavanagh
- Disability and Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Dennis Petrie
- Centre for Health Economics, Monash Business School, Monash University, Caulfield East, Victoria, Australia
| | - Helen Dickinson
- Public Service Research Group, School of Business, UNSW Canberra, Canberra, ACT, Australia
| | - Zoe Aitken
- Disability and Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
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5
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Aitken Z, Simpson JA, Bentley R, Kavanagh AM. How much of the effect of disability acquisition on mental health is mediated through employment and income? A causal mediation analysis quantifying interventional indirect effects using data from four waves of an Australian cohort study. BMJ Open 2021; 11:e055176. [PMID: 34810192 PMCID: PMC8609928 DOI: 10.1136/bmjopen-2021-055176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES There is evidence that disability acquisition causes a decline in mental health, but few studies have examined the causal mechanisms through which the effect operates. This study used a novel approach to mediation analysis to quantify interventional indirect effects (IIEs) through employment and income. DESIGN AND SETTING We used four waves of longitudinal data (2011-2014) from the Household, Income and Labour Dynamics in Australia Survey, a nationally representative survey of Australian households. PARTICIPANTS Working aged individuals who acquired a disability (n=233) were compared with those who remained disability-free in all four waves (n=5419). PRIMARY OUTCOME MEASURE Self-reported mental health was measured using the Mental Health Inventory subscale of the Short Form 36 general health questionnaire, which measures symptoms of depression, anxiety and psychological well-being. STATISTICAL ANALYSIS We conducted a causal mediation analysis quantifying IIEs of disability acquisition on mental health operating through two distinct mediators: employment status and income. We used multiple imputation with 50 imputed datasets to account for missing data. RESULTS The total causal effect of disability acquisition on mental health was estimated to be a 4.8-point decline in mental health score (estimated mean difference: -4.8, 95% CI -7.0 to -2.7). The IIE through employment was estimated to be a 0.5-point difference (-0.5, 95% CI -1.0 to 0.0), accounting for 10.6% of the total effect, whereas there was no evidence that income explained any of the effects. CONCLUSIONS This study estimated that disability-related mental health inequalities could be reduced by 10.6% if employment rates were the same for people with disability as those without disability. The results suggest that employment is implicated in the relationship between disability acquisition and mental health and that more research is needed to understand the influence of other aspects of employment and other socioeconomic characteristics.
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Affiliation(s)
- Zoe Aitken
- Disability and Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Julie Anne Simpson
- Biostatistics Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Rebecca Bentley
- Healthy Housing Unit, Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Anne Marie Kavanagh
- Disability and Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
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6
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Lahav Y, Avidor S, Levy D, Ohry A, Zeilig G, Lahav M, Golander H, Chacham-Guber A, Uziel O, Defrin R. Shorter telomeres among individuals with physical disability: The moderating role of perceived stress. J Gerontol B Psychol Sci Soc Sci 2021; 77:1384-1393. [PMID: 34687310 DOI: 10.1093/geronb/gbab200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Evidence suggests that individuals with physical disability may suffer from psychological distress and accelerated cellular aging, manifested by shortened telomere length (TL), compared with healthy individuals. Studies indicate that high levels of perceived stress and depression may increase the physiological susceptibility and thus, may contribute to a short TL. However, the moderating role of perceived stress and depression within the relationship between physical disability and TL remains unknown. METHODS The participants consisted of 119 male subjects (mean age 54.36 years, range 35-70). Of them, 30 were able-bodied and 86 had a physical disability: 34 were due to Poliomyelitis (polio) and 55 were due to spinal cord injury (SCI). Blood samples for TL analysis were collected; the participants completed questionnaires and underwent disability evaluation. RESULTS Participants with disability had a shorter TL as well as elevated levels of perceived stress and depression compared with able-bodied controls. Both the perceived stress and depression were correlated with a shorter TL. Nonetheless, perceived stress, rather than depression, moderated the relationship between disability and TL; among participants with higher perceived stress levels, in particular, individuals with physical disability had a shorter TL than the able-bodied controls. DISCUSSION The present findings suggest that individuals with physical disability and who exhibit high levels of perceived stress may be particularly vulnerable for accelerated cellular aging, suggesting that perceived stress can be used as a valuable target for intervention.
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Affiliation(s)
- Yael Lahav
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University
| | - Sharon Avidor
- Faculty of Social and Community Sciences, Ruppin Academic Center
| | - David Levy
- Department of nursing, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University
| | - Avi Ohry
- Section of Rehabilitation Medicine, Reuth Medical and Rehabilitation Center, Tel Aviv.,Department of Rehabilitation, Sackler Faculty of Medicine, Tel Aviv University
| | - Gabi Zeilig
- Department of Neurological Rehabilitation, Chaim Sheba Medical Center, Tel Hashomer.,Department of Rehabilitation, Sackler Faculty of Medicine, Tel Aviv University
| | - Meir Lahav
- The Felsenstein Medical Research Center, Rabin Medical Center and Tel Aviv University, Petah-Tikva
| | - Hava Golander
- Department of nursing, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University
| | | | - Orit Uziel
- The Felsenstein Medical Research Center, Rabin Medical Center and Tel Aviv University, Petah-Tikva
| | - Ruth Defrin
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Israel
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7
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Emerson E, Stancliffe R, Fortune N, Llewellyn G. Disability, Loneliness and Health in the UK: cross-sectional survey. Eur J Public Health 2021; 31:533-538. [PMID: 33956951 DOI: 10.1093/eurpub/ckab018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Research has suggested that exposure to loneliness can have a powerful detrimental impact on health, including mental health. Addressing socially determined health inequity requires understanding of the situation of marginalized or vulnerable groups. People with disability are increasingly being recognized as one such group. Little population-based research has addressed the association between loneliness and health among working age adults with and without disability. METHODS Secondary analysis of data collected in waves 8 and 9 of Understanding Society, the UK's main annual household panel study. RESULTS Rates of exposure to substantial loneliness were 25.4% (95%CI 23.5-27.3%) among adults with persistent disability (disability at W8 and W9), 15.4% (13.3-17.5%) among adults with disability onset (disability at W9 only), 12.3% (10.1-14.5%) among adults with disability offset (disability at W8 only), and 6.9% (6.5-7.3%) among adults with no disability. Exposure to loneliness was positively associated with the incidence (GHQ-12) and prevalence (SF-12 Mental) of mental health problems, but not the prevalence of physical health problems (SF-12 Physical). Disability status appeared to moderate the association between loneliness and health, with the difference between the persistent disability and no disability group increasing with exposure to greater levels of loneliness. CONCLUSION Loneliness may be an important determinant of the poorer mental health of working age adults with disability in the UK. Exposure rates are significantly higher than among the non-disabled population. The strength of association between exposure to loneliness and poorer mental health is greater for people with persistent disability than people with no disability.
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Affiliation(s)
- Eric Emerson
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia.,Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, Australia.,Centre for Disability Research, Faculty of Health & Medicine, Lancaster University, Lancaster, UK
| | - Roger Stancliffe
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia.,Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, Australia
| | - Nicola Fortune
- Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, Australia
| | - Gwynnyth Llewellyn
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia.,Centre of Research Excellence in Disability and Health, University of Sydney, Sydney, NSW, Australia
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8
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Zhou Q, Li N, Du W. Does health service utilisation mediate the effect of disability on psychological distress: Evidence from a national representative survey in Australia. Glob Public Health 2020; 16:448-459. [DOI: 10.1080/17441692.2020.1814378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Qin Zhou
- School of Public Administration, University of International Business and Economics, Beijing, People’s Republic of China
| | - Ning Li
- Institute of Population Research, Peking University, Beijing, People’s Republic of China
| | - Wei Du
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education; School of Public Health, Southeast University, Nanjing, People’s Republic of China
- Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australia
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9
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Karahalios A, Pega F, Aitken Z, Milner A, Simpson JA, Kavanagh AM. The cumulative effect of living with disability on mental health in working-age adults: an analysis using marginal structural models. Soc Psychiatry Psychiatr Epidemiol 2020; 55:309-318. [PMID: 30903240 DOI: 10.1007/s00127-019-01688-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 03/09/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Previous studies have shown that acquiring a disability is associated with a reduction in mental health, but they have not considered the cumulative impact of having a disability on mental health. We used acquisition of a non-psychological disability to estimate the association of each additional year lived with disability on mental health (measured using the Mental Component Summary score of the Short Form Health Survey). METHODS We used the first 13 waves of data (years 2001-2013) from the Household, Income and Labour Dynamics in Australia Survey. The sample included 4113 working-age (18-65 years) adults who were disability-free at waves 1 and 2. We fitted marginal structural models with inverse probability weights to estimate the association of each additional year of living with disability on mental health, employing multiple imputation to handle the missing data. RESULTS Of the 4113 participants, 7.7 percent acquired a disability. On average, each additional year lived with disability was associated with a decrease in the mean Mental Component Summary score (β = - 0.42; 95% CI - 0.71, - 0.14). CONCLUSIONS This study provides evidence that each additional year lived with non-psychological disability is associated with a decline in mental health among working-age Australians.
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Affiliation(s)
- Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie Street, Parkville, Melbourne, VIC, 3010, Australia.
| | - Frank Pega
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Melbourne, VIC, Australia.,Burden of Disease Epidemiology, Equity and Cost-Effectiveness Programme (BODE3), Department of Public Health, University of Otago, Wellington, New Zealand
| | - Zoe Aitken
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Melbourne, VIC, Australia
| | - Allison Milner
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Melbourne, VIC, Australia.,Population Health Strategic Research Centre, School of Health & Social Development, Deakin University, Burwood, VIC, Australia
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie Street, Parkville, Melbourne, VIC, 3010, Australia
| | - Anne M Kavanagh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Melbourne, VIC, Australia
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10
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Mehbub Anwar AHM, Astell-Burt T, Feng X. Does social capital and a healthier lifestyle increase mental health resilience to disability acquisition? Group-based discrete trajectory mixture models of pre-post longitudinal data. Soc Sci Med 2019; 235:112143. [PMID: 31276969 DOI: 10.1016/j.socscimed.2019.01.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 01/22/2019] [Accepted: 01/25/2019] [Indexed: 01/17/2023]
Abstract
Poor mental health is strongly associated with disability acquisition. Social capital and healthier lifestyles pre-disability onset may help promote mental health resilience (i.e. a state of seemingly being unaffected by the event), or the capacity to 'bounce back', post-acquisition. This paper used a novel methodology (discrete trajectory mixture models) to examine discrete trajectories in mental health before and after disability acquisition in the Household Income Labour Dynamics in Australia (HILDA) survey. Group membership in association with pre-onset social capital and healthy lifestyles were then examined using multinomial logistic regressions. Four discrete trajectory groups were identified in 2904 Australians reporting onset of ongoing disability, with about 28.4% demonstrating mental health resilience. Three other groups were identified, each demonstrating increasingly severe reductions in mental health. No clear 'bounce back' group was observed. Group membership was associated with participants who felt they had 'no-help from others' prior to disability acquisition. Pre-disability acquisition measures of social capital and unhealthy behaviours moderated the association between disability acquisition and mental health trajectories. Social capital was protective only for the respondents who had poorer mental health before disability onset and had less resilience after onset, and long working hours and less resilience were positively associated. Public policies that help to enhance levels of social capital and reduce unhealthy behaviours at a population level may help to promote mental health resilience to adversities such as the acquisition of disability.
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Affiliation(s)
- A H M Mehbub Anwar
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia.
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia; Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia; School of Public Health, Peking Union Medical College and the Chinese Academy of Medical Sciences, Beijing, China.
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab (PowerLab), School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia; Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia; Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia.
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11
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Aitken Z, Simpson JA, Gurrin L, Bentley R, Kavanagh AM. Do material, psychosocial and behavioural factors mediate the relationship between disability acquisition and mental health? A sequential causal mediation analysis. Int J Epidemiol 2018; 47:829-840. [DOI: 10.1093/ije/dyx277] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/03/2017] [Accepted: 12/15/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zoe Aitken
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton VIC 3010, Australia
| | - Julie Anne Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton VIC 3010, Australia
| | - Lyle Gurrin
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton VIC 3010, Australia
| | - Rebecca Bentley
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton VIC 3010, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton VIC 3010, Australia
| | - Anne Marie Kavanagh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton VIC 3010, Australia
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12
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Aitken Z, Simpson JA, Bentley R, Kavanagh AM. Disability acquisition and mental health: effect modification by demographic and socioeconomic characteristics using data from an Australian longitudinal study. BMJ Open 2017; 7:e016953. [PMID: 28928189 PMCID: PMC5623536 DOI: 10.1136/bmjopen-2017-016953] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES There is evidence of a causal relationship between disability acquisition and poor mental health, but the substantial heterogeneity in the magnitude of the effect is poorly understood and may be aetiologically informative. This study aimed to identify demographic and socioeconomic factors that modify the effect of disability acquisition on mental health. DESIGN AND SETTING The Household, Income and Labour Dynamics in Australia Survey is a nationally representative longitudinal survey of Australian households that has been conducted annually since 2001. Four waves of data were included in this analysis, from 2011 to 2014. PARTICIPANTS Individuals who acquired a disability (n=387) were compared with those who remained disability-free in all four waves (n=7936). PRIMARY OUTCOME MEASURE Mental health was measured using the mental health subscale of the Short Form 36 (SF-36) general health questionnaire, which measures symptoms of depression, anxiety and psychological well-being. METHODS Linear regression models were fitted to estimate the effect of disability acquisition on mental health, testing for effect modification by key demographic and socioeconomic characteristics. To maximise causal inference, we used a propensity score approach with inverse probability of treatment weighting to control for confounding and multiple imputation using chained equations to assess the impact of missing data. RESULTS On average, disability acquisition was associated with a 5-point decline in mental health score (estimated mean difference: -5.1, 95% CI -7.2 to -3.0). There was strong evidence that income and relationship status modified the effect, with more detrimental effects in the lowest (-12.5, 95% CI -18.5 to -6.5) compared with highest income quintile (-1.1, 95% CI -4.9 to 2.7) and for people not in a relationship (-8.8, 95% CI -12.9 to -4.8) compared with those who were (-3.7, 95% CI -6.1 to -1.4). CONCLUSIONS Our results suggest that the detrimental effect of disability acquisition on mental health is substantially greater for socioeconomic disadvantaged individuals.
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Affiliation(s)
- Zoe Aitken
- Gender and Women’s Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Julie Anne Simpson
- Biostatistics Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Rebecca Bentley
- Gender and Women’s Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
| | - Anne Marie Kavanagh
- Gender and Women’s Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Australia
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13
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Helseth S, Abebe DS, Andenæs R. Mental health problems among individuals with persistent health challenges from adolescence to young adulthood: a population-based longitudinal study in Norway. BMC Public Health 2016; 16:983. [PMID: 27633884 PMCID: PMC5025537 DOI: 10.1186/s12889-016-3655-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 09/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persistent health challenges are increasing throughout the world. It has been shown that adolescents with persistent health challenges are at greater risk of having mental health problems than their healthy peers. However, these studies are mainly cross-sectional, and little is known about the transition to adulthood. Thus, the aim of this study was to examine how mental health problems in adolescents and young adults with persistent health challenges vary during adolescence and in the transition to young adulthood. METHODS The study used longitudinal and time-series data from the "Young in Norway" study. A sample of adolescents was prospectively followed from adolescence to young adulthood with measures at four different time points (n = 3,087; T1-T4): 2921 adolescents (12-19 years) participated at T1 and T2, while 2448 young adults participated at T3 and T4. Persistent health challenges, age, gender, mental health problems and parental socio-economic status were measured in the longitudinal survey. Regression models were applied to estimate associations between persistent health challenges (understood as having a chronic health condition or disability) and mental health problems during adolescence and young adulthood. Different models were tested for chronic health conditions and disability. RESULTS Adolescents with disability had higher scores for depressive and anxiety symptoms, loneliness and self-concept instability, and lower scores for self-worth, appearance satisfaction, scholastic competence and social acceptance compared with adolescents without disability. In young adulthood, there were also significant associations between disability and most mental health problems. The longitudinal associations between chronic health conditions and mental health problems during adolescence and young adulthood showed that significant associations between chronic health conditions and mental health problems were only found during adolescence. CONCLUSIONS This longitudinal survey revealed that on average, adolescents with disability had more mental health problems than those with a chronic health condition. In addition, the problems followed into adulthood for adolescents with disability. Thus, disability seems to be a much higher risk factor for developing and maintaining mental health problems than having a chronic health condition. These findings need to be followed up in further studies.
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Affiliation(s)
- Sølvi Helseth
- Department of Nursing and Health Promotion, Faculty of Health, Oslo and Akershus University College, Oslo, Norway.
| | - Dawit Shawel Abebe
- Centre for Welfare and Labour Research, NOVA, Oslo and Akershus University College, Oslo, Norway
| | - Randi Andenæs
- Department of Nursing and Health Promotion, Faculty of Health, Oslo and Akershus University College, Oslo, Norway
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14
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Emerson E, Kariuki M, Honey A, Llewellyn G. Becoming disabled: The association between disability onset in younger adults and subsequent changes in productive engagement, social support, financial hardship and subjective wellbeing. Disabil Health J 2014; 7:448-56. [DOI: 10.1016/j.dhjo.2014.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 03/09/2014] [Accepted: 03/23/2014] [Indexed: 10/25/2022]
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15
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Milner A, LaMontagne AD, Aitken Z, Bentley R, Kavanagh AM. Employment status and mental health among persons with and without a disability: evidence from an Australian cohort study. J Epidemiol Community Health 2014; 68:1064-71. [PMID: 25053615 DOI: 10.1136/jech-2014-204147] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Unemployment and economic inactivity are associated with worse mental health in the general population, but there is limited understanding of whether these relationships are different for those persons with mental or physical disabilities. The aim of this study was to assess whether there were differences in mental health by labour force status among persons with and without disabilities. METHOD Over eight annual waves of the Household, Income and Labour Dynamics in Australia (HILDA) survey, a total of 2379 people with disabilities and 11 417 people without disabilities were identified. Mental health using the Mental Component Summary (MCS) from the Short Form 36 was modelled as a function of labour force status using fixed-effects regression models to control for time invariant confounding. Differences between those with and without disabilities were assessed by including an interaction term in regression models. RESULTS After finding evidence of effect modification, regression models were stratified by disability status. After adjustment, unemployment and economic inactivity were associated with a -1.85 (95% CI -2.96 to -0.73, p=0.001) and -2.66 (95% CI -3.46 to -1.86, p<0.001) reduction in scores of the MCS among those with a disability. For those without a disability, there were smaller declines associated with unemployment (-0.57, 95% CI -1.02 to -0.12, p=0.013) and economic inactivity (-0.34, 95% CI -0.64 to 0.05, p=0.022). CONCLUSIONS These results suggest a greater reduction in mental health for those persons with disabilities who were unemployed or economically inactive than those who were employed. This highlights the value of employment for people with disabilities.
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Affiliation(s)
- A Milner
- The McCaughey Vichealth Centre for Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - A D LaMontagne
- The McCaughey Vichealth Centre for Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia Population Health Strategic Research Centre, School of Health & Social Development, Deakin University, Melbourne, Victoria, Australia
| | - Z Aitken
- Gender and Women's Health, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - R Bentley
- Gender and Women's Health, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - A M Kavanagh
- Gender and Women's Health, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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16
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Zhang L, Li W, Liu B, Xie W. Self-esteem as mediator and moderator of the relationship between stigma perception and social alienation of Chinese adults with disability. Disabil Health J 2013; 7:119-23. [PMID: 24411516 DOI: 10.1016/j.dhjo.2013.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 06/19/2013] [Accepted: 07/31/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Several studies show the relationship between self-esteem and stigma perception and also between self-esteem and social alienation, but none sufficiently analyze the relationship between stigma perception and social alienation of people with disability. OBJECTIVE/HYPOTHESIS The primary aim of this paper is to investigate the mediator and moderator effects of self-esteem on the relationship between stigma perception and social alienation of people with disability. METHODS The participants were 129 adults with disability (80 males and 49 females) from eight communities in China. Data was collected by using the stigma perception scale, self-esteem scale, social avoidance scale, social anxiety subscale of the self-consciousness scale, and loneliness scale. Each item is rated on a 5-point scale (1 = "strongly disagree" to 5 = "strongly agree"). RESULTS Stigma perception was positively correlated with social avoidance (p < 0.001), social anxiety (p < 0.001), and loneliness (p < 0.001). Self-esteem was inversely correlated with social avoidance (p < 0.001), social anxiety (p < 0.001), loneliness (p < 0.001), and stigma perception (p < 0.001). CONCLUSIONS Self-esteem partially mediated the relationship between stigma perception and social avoidance, social anxiety and loneliness. Moreover, self-esteem moderated the relationship between stigma perception and social avoidance, but not on social anxiety and loneliness.
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Affiliation(s)
- Lin Zhang
- School of Psychology, Ningbo University, Jiangbei District, Ningbo, China.
| | - Wentao Li
- Faculty of Liberal Arts and Communication, Ningbo University, Ningbo, China
| | - Binbin Liu
- Graduate School, Ningbo University, Ningbo, China
| | - Wenlan Xie
- School of Psychology, Ningbo University, Jiangbei District, Ningbo, China
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17
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Developing Research and Surveillance for Positive Mental Health: A Canadian Process for Conceptualization and Measurement. Int J Ment Health Addict 2013. [DOI: 10.1007/s11469-013-9443-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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18
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Jensen MP, Molton IR, Gertz KJ, Bombardier CH, Rosenberg DE. Physical activity and depression in middle and older-aged adults with multiple sclerosis. Disabil Health J 2012; 5:269-76. [PMID: 23021738 DOI: 10.1016/j.dhjo.2012.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 05/07/2012] [Accepted: 05/29/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Depression is common among people with multiple sclerosis (MS), and research shows that individuals, including individuals with MS, who are more physically active report lower rates of depression. However, little is known about the relative importance of level of physical activity (e.g., moderate versus vigorous) in relationship to depression, or the role that age might play in this relationship among people with MS. The current study sought to (1) clarify the associations between moderate and vigorous physical activity and depression in a sample of individuals with MS, (2) determine the associations between age and physical activity, and (3) test for the potential moderating influence of age on the associations between physical activity and depression. OBJECTIVE/HYPOTHESIS Cross-sectional survey. METHODS 112 individuals with MS completed a survey assessing demographic variables, amount of moderate and vigorous physical activity, and depression. RESULTS There was a gradual decrease in the amount of moderate and vigorous physical activity as age increased, but this decrease was not statistically significant. Moderate physical activity was significantly (negatively) associated with depression across all age cohorts. Time spent in vigorous physical activity was significantly (negatively) associated with depression among the middle-aged but not younger or older participants who are physically active. CONCLUSIONS The findings support a link between moderate physical activity and depression and, for middle-aged individuals, vigorous physical activity and depression in persons with MS. The findings indicate that research examining the impact of activity enhancing treatments on depression in individuals with MS is warranted.
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Affiliation(s)
- Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA.
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