Stigma of persons with disabilities in South Africa: Uncovering pathways from discrimination to depression and low self-esteem

Document review of the paper-based implementation of the Framework and strategy for disability and rehabilitation in Gauteng, South Africa

BACKGROUND

The prevalence of disability is on the rise globally and in South Africa, with a high number of unmet needs and poor actualisation of the health rights of persons with disabilities. A tool to realise these rights is health policy, such as the framework and strategy for disability and rehabilitation (2015-2022)(FSDR). There are limited data on the implementation outcomes of the FSDR.

OBJECTIVE

To review the implementation of the FSDR according to the paper-based provincial reports.

METHODS

The study conducted a document review and utilised a concurrent mixed-method design, combining qualitative and quantitative data extracted from paper-based evaluation templates developed by the South African National Department of Health (NDoH). The qualitative analysis involved thematic coding using the RE-AIM framework to examine the FSDR's implementation across eight provinces, while quantitative data, such as frequencies and percentages, provided supplementary insights.

RESULTS

The quantitative results revealed that 87% of the reports from provinces reported physical accessibility to the FSDR, and 62% of provinces received training on the implementation of the FSDR. Only two out of eight provinces have conducted monitoring and evaluation since implementing the FSDR in 2015. Qualitative findings revealed poor reach and adoption of the FSDR owing to a lack of implementation training for end users. The lack of indicators resulted in poor maintenance of the FSDR, as well as the lack of human resources and equipment which resulted in the reduced efficacy of the FSDR.

CONCLUSION

The FSDR has not achieved its full level of implementation due to numerous barriers, such as lack of resources, human capacity, and training on implementation.

The prevalence of postpartum depression among women with physical disabilities: a systematic review and meta-analysis

PURPOSE

Pregnant and postpartum mothers with physical disabilities face discrimination in healthcare settings and high rates of maternal and obstetric complications, as well as having higher rates of lifetime depression prior to pregnancy, potentially increasing their likelihood of experiencing postpartum depression (PPD). Some studies have found higher rates of PPD in mothers with physical disabilities than in mothers without physical disabilities, with more disabling symptoms associated with worse PPD systems; however, the literature is sparse and heterogenous. This systematic review and meta-analysis advanced this area of study by evaluating the strength of the association between PPD and physical disability.

METHODS

We searched PubMed and PsycInfo, with the primary inclusion criteria being that the studies had an established measure of depression in women during the postpartum period and either a cohort identified as having physical disability or an established measure of physical disability in a general population sample. We aggregated the prevalence of PPD in women with physical disabilities and tested the robustness of our findings to moderators, including region, sample population, and measure type.

RESULTS

Findings from our quantitative meta-analysis (n=14) demonstrated a strong (d=.76, p<.0001) association between PPD and physical disabilities, such that individuals with physical disabilities reported more depression symptoms than individuals without physical disabilities. Moderator analyses were null, revealing that the association between PPD and physical disabilities was robust to several variables. Qualitative results support our conclusion that individuals with physical disabilities are at increased risk of PPD symptoms.

CONCLUSION

Our findings of a strong association between physical disability and PPD support the need for more research. Additional studies would 1) augment a nuanced understanding of how best to conceptualize PPD in women with physical disabilities and 2) facilitate testing the robustness of the association between PPD and physical disabilities to additional important moderators.

The Case for Parent-Implemented Programs to Mitigate Musculoskeletal Complications in Children With Severe Cerebral Palsy in Resource-Limited Settings

Children with severe cerebral palsy are vulnerable to orthopedic complications, particularly in resource-limited settings, which can compound disability. A focus on home-based programs may help to improve their quality of life and participation.

It's not just a job: Meaningful work, self-stigma, and life satisfaction in people with visual impairment

BACKGROUND

Although employment has been positively linked to quality of life, recent theorising suggests the need for a broadened conceptualisation of paid work incorporating dimensions of subjective work experience as a key social determinant of life satisfaction in people with disabilities. There is also a need for further examination on the underlying mechanism between work and wellbeing outcomes amongst people with disabilities.

OBJECTIVE

In this study, we put forth the concept of meaningful work, and examined its associations with self-stigma, and life satisfaction in people with visual impairment.

METHODS

A total of 302 people with visual impairment completed a survey in Hong Kong. We analysed the data using linear regression and mediation analyses.

RESULTS

We found that meaningful work was positively associated with life satisfaction and negatively associated with self-stigma. Self-stigma was negatively associated with life satisfaction and mediated the association between meaningful work and life satisfaction.

CONCLUSIONS

The findings showed that meaningful work is a positive and important social determinant of life satisfaction among people with visual impairment, while self-stigma serves as an underlying mechanism.

Expectations regarding school decreases emotional distress among college students in Western China: the buffering role of physical exercises

Background

College students in Western China face unique economic, cultural, and educational environments, yet limited studies have specifically investigated the factors or interventions concerning emotional distress within this population.

Aim

This study aimed to explore whether school belongingness mediates the relationship between expectations regarding school and emotional distress among college students in Western China, and whether physical exercise moderates this mediation.

Methods

Employing a cross-sectional design, 1,063 college students in Xinjiang, China were recruited for this study. A self-administered electronic questionnaire assessed expectations regarding school, school belongingness, physical exercise, anxiety, and depression. Structural equation modeling was utilized to analyze mediating and moderating effects.

Results

Expectations regarding school was negatively associated with emotional distress. School exclusion and school acceptance fully mediated the effect of expectations regarding school on emotional distress. Physical exercise moderated the mediating effect of school exclusion, but not that of school acceptance.

Conclusion

Expectations regarding school and school belongingness, particularly the exclusion component, emerge as pivotal factors influencing emotional distress among college students in Western China. Furthermore, physical exercise presents itself as a promising targeted intervention for alleviating emotional distress within this demographic.

Socio-demographic, psychosocial, and suicidal behavior correlates of stigma among people with physical disabilities in Northwest Ethiopia

BACKGROUND

People with physical disability may experience stigma in various ways, including social avoidance, negative attitudes and discrimination. Stigma among people with physical disability can vary based on study participants' socio-demographic, behavioral and psychosocial factors. Therefore, identifying the socio-demographic, behavioral and psychosocial correlates of stigma is important because the findings of the study can help inform future interventions aimed at reducing stigma among individuals with a physical disability.

OBJECTIVE

This study aimed to assess the psychosocial, suicidal behavior, and socio-demographic correlates of stigma among people with physical disabilities in the University of Gondar communities, northwest Ethiopia.

METHOD

Data collection was conducted among 269 participants who had a physical disability within University of Gondar communities in Northwest Ethiopia. The participants, who included students and employees at the University completed the stigma scale for chronic illness (SSCI-8), which was used to measure stigma. The participants also completed four other questionnaires, including the perceived social support, the Kessler - 10, and the WHODAS. We used independent sample t-tests and ANOVA to examine group differences in stigma, while Pearson correlation analysis identified the correlates of stigma with other continuous variables.

RESULT

The overall mean stigma score among people with a physical disability was 14.68 with 95% CI (13.98, 15.38). About 90.71% of people with physical disability had stigma. Stigma varied along socio-demographic variables, including marital status (single) with a mean (SD) score of 15.17 ± 5.64, educational level (diploma and above) with a mean (SD) score of 14.99 ± 5.89, and occupational status with a mean (SD) score of 15.54 ± 5.79 (p < 0.001). In addition, stigma varied among participants with suicidal ideation with a mean (SD) score of 16.93 ± 7.43 and attempt (18.74 ± 8.41), levels of psychological distress (severe) with a mean (SD) score of 20.88 ± 6.94 (p < 0.001), low perceived social support with a mean (SD) score of 18.60 ± 7.54 (p < 0.001), and moderate/severe level of functional impairment with a mean (SD) score of 21.76 ± 7.34 (p < 0.001). Moreover, stigma was positively correlated with psychological distress (r = 0.42, p < 0.001) and WHO Disability Assessment Schedule (r = 0.5, p < 0.001). Conversely, it was negatively correlated with perceived social support (r=-0.31, p < 0.001).

CONCLUSION

Our findings indicate that stigma is prevalent among people with physical disabilities, with variations observed based on marital status, occupation, and education level. Additionally, stigma showed significant correlations with functional impairment, psychological distress, perceived social support, and health related quality of life. Therefore, addressing stigma, promoting social support and providing appropriate interventions can help improve the psychological well-being and quality of life of individuals with physical disabilities.

Longitudinal association between disability and suicide mortality in Republic of Korea

BACKGROUND

The Republic of Korea has reported the highest suicide rate globally since 2018. Previous studies have highlighted disability as a significant risk factor for suicide. However, comprehensive examination on the association between suicide mortality and severities and types of disabilities, and on how these associations vary according to sociodemographic characteristics, health behaviours and comorbidity profiles has never been performed.

METHODS

We performed a retrospective cohort study of a nationally representative sample of 3 591 398 individuals subject to the health check-up provided by the Korean National Health Insurance in 2009, including individuals with (n = 126 508) and without (n = 3 734 890) disabilities, and followed-up until December 2021.

RESULTS

Overall, the presence of disability was associated with an increased risk of suicide mortality [hazard ratio (HR), 1.38; 95% confidence interval (CI), 1.30-1.47] compared to the absence of disability. This risk was more pronounced in individuals with Grade 1-3 disabilities (HR, 1.68; 95% CI, 1.52-1.85) than those with Grade 4-6 disabilities (HR, 1.28; 95% CI, 1.20-1.47). Among various types of disabilities, individuals with a disability associated with a mental disorder had the highest HR (HR, 4.49; 95% CI, 3.38-5.97), followed by those with visual impairment (HR, 1.47; 95% CI, 1.26-1.73), brain damage (HR, 1.45; 95% CI, 1.18-1.79), hearing impairment (HR, 1.35; 95% CI, 1.15-1.58) and extremity disability (HR, 1.30; 95% CI, 1.21-1.40). Stratified analyses revealed that the suicide risk associated with disabilities was more pronounced in individuals with specific sociodemographic characteristics and health behaviours.

CONCLUSION

Our findings highlight the need to prioritize policy efforts to address suicide mortality among people with disabilities, considering the distinct risks associated with disability types and severity.

Addressing unique challenges and crafting inclusive policies for Queer living with disabilities

Background

This article addresses the intersectional challenges faced by Queer people living with disabilities (QPwD).

Objectives

The article aims to highlight the nature and extent of their struggles while proposing inclusive policies for societal integration and equality. Amid global efforts to promote Queer rights, discrimination and violence persist, particularly affecting those with disabilities.

Method

Drawing upon a comprehensive review of literature and empirical research, this study investigated the experiences of QPwD, identifying key challenges such as limited access to inclusive services, heightened vulnerability to abuse and systemic unemployment. The methodological approach used in this study involves synthesising existing scholarship and empirical evidence to inform the proposed inclusive policies.

Results

The findings reveal pervasive barriers encountered by QPwD, including societal stigma, attitudinal biases and physical obstacles. Discrimination in employment, education and healthcare further exacerbates their marginalisation, necessitating proactive measures to address systemic inequalities and promote social inclusion.

Conclusion

In conclusion, this article underscores the urgent need for policy reforms and societal interventions to uphold the rights and dignity of QPwD. By advocating for Queer-inclusive workplace policies, enhancing accessibility in public infrastructure and fostering governmental support for equality initiatives, this study contributes to advancing social justice and inclusivity.

Contribution

The article calls for concerted efforts to create a more equitable and inclusive society where all individuals, regardless of their sexual orientation or disability status, can thrive and fulfil their potential.

"Motherhood forced me to cope with my disability": identity intersection among mothers with physical disabilities

Background

Although motherhood plays a meaningful role in the formation of a woman's identity, most studies have focused on the process of identity transformation in the transition to motherhood among non-disabled women; less is known about this process among women with physical disabilities who become mothers.

Objective

The present study aimed to understand and describe the subjective experiences of Israeli women with lifelong physical disabilities in their motherhood journey from the perspective of the intersection of their motherhood and disability identities, and from the disability studies approach.

Methods

Semi-structured interviews were conducted with 20 Israeli mothers with visible lifelong physical disabilities who live in the community and raise their children.

Results

Three themes emerged from the interviews: (1) the decision to become a mother: Coping with the disability identity for the first time; (2) The FIRST 3 years: Depending on others as limiting their motherhood identity; (3) after age three: Balancing the motherhood and disability identities.

Conclusion

The transition to motherhood led to identity transformation among women with physical disabilities. Becoming a mother increased the tension between dependence and independence in the context of disability, which also influenced the intersection of their motherhood and disability identities and their wellbeing. Practitioners should provide emotional support to mothers with disabilities and help them embrace the positive aspects of each identity and strike a balance between them.

"We need a world we can operate in": Exploring the relationship between societal stigma and depression among wheelchair users

BACKGROUND

Stigma looms over the disability community.

OBJECTIVE OR HYPOTHESIS

The aim of this paper is to gain a deeper understanding of how societal stigma impacts depression among wheelchair users.

METHODS

Mixed research methods were used on a sample of sixty full-time wheelchair users (M age = 43.78, SD = 15.50) whose disability was either acquired (n = 32) or congenital (n = 28). Data was collected via an anonymous Qualtrics survey. Qualitative and quantitative content analyses were performed.

RESULTS

Three major themes were identified from the qualitative analysis, including pity, discomfort, and invisibility which demonstrated that our participants felt frequently stigmatized in public. Several participants noted how assumptions were made about their competence, intellect, ability, and the entire disability experience based on the physical representation of their wheelchair. The quantitative results demonstrated a positive correlation between The Major Depression Index and the Able Privilege Scale-Revised, a scale constructed to examine personal power and privilege in relation to society depending on disability type.

CONCLUSIONS

Wheelchair users feel stigmatized by members of society, which is associated with increased levels of depression and perceived pity, discomfort, and invisibility.

Access to online business opportunities: Enhancing digital technology capacity for women with disabilities in the Red River Delta of Vietnam

This study investigates the digital technology capacity of women with disabilities and the impact of access to digital business opportunities on their entrepreneurial satisfaction. A sample of 50 women with disabilities in the Red River Delta region of Vietnam provided 35 valid responses, which were analyzed using Exploratory Factor Analysis and Structural Equation Modeling. The results showed that five key factors, including course relevance, course expectancy, instructor quality, learning outcomes, and course satisfaction, accounted for 78.39 % of the variance in the data. The proposed model explained 61.3 % of the amount of variation and the study's findings supported the predicted relationships among the factors, except for two hypotheses. H1, which postulated a positive relationship between course relevance and instructor quality, and H5, which predicted a positive relationship between learning outcomes and course satisfaction. Possible reasons for these non-significant relationships were discussed, highlighting the need for further research in these areas. The findings contribute to our understanding of the factors that affect the digital technology capacity of women with disabilities and their satisfaction with digital business opportunities.

Examining the association between perceived stigma, its correlates, and restrictions in participation among persons with disabilities in Nepal: a cross-sectional study

BACKGROUND

Disability stigma in low- and middle-income countries is one of the most persistent and complex barriers limiting persons with disabilities (PwDs) from enjoying their rights and opportunities. Perceived stigma among PwDs and its impact on participation restriction is rarely assessed in Nepal.

OBJECTIVE

This study aimed to measure the extent of perceived stigma by PwDs, identify its relationships with specific demographic factors, and assess the impact on social participation.

METHODS

A cross-sectional survey was conducted between May and July 2022 among PwDs in Nepal, with a sample of 371. The Explanatory Model Interview Catalog (EMIC) stigma scale and P-scale suitable for people affected by stigmatized conditions were used, and the generated scores were analyzed. One-way ANOVA was performed to determine group differences for sociodemographic variables, and linear regression and correlational analysis were used to identify their association and measure the strength and direction of the relationship.

RESULTS

The mean stigma score was 16.9 (SD 13.8). 42% of respondents scored higher than the mean. The scores differed significantly by disability type, caste and ethnicity, education, occupation, and household wealth. Over 56% reported participation restriction, and 38% had severe/extreme restriction. Approximately 65% of participants with intellectual disabilities, 53% with multiple disabilities, and 48.5% of persons with severe or profound disabilities experienced severe or extreme restrictions. Perceived stigma had a positive correlation with Disability type (r = 0.17, P < 0.01) and negative correlations with Severity of disability (r= -0.15, P < 0.05), and Household wealth (r= -0.15, P < 0.01). Education was inversely associated with both stigma (r= -0.24, P < 0.01), and participation restriction (β= -9.34, P < 0.01). However, there was no association between stigma and participation restriction (β= -0.10, P > 0.05).

CONCLUSION

All participants exhibited stigma in general; however, the severity varied based on disability type, level of education, and sociocultural circumstances. A large proportion of participants reported facing a high degree of restrictions in participation; however, no association was detected between perceived stigma and participation restriction. A significant negative linear correlation was observed between education and participation restriction. Stigma reduction programs focusing on education and empowerment would be especially important for overcoming internalized stigma and increasing the participation of PwDs.

Social Participation: A Strategy to Manage Depression in Disabled Populations

This study aimed to investigate whether social participation (SP) can decrease depressive symptom severity in disabled older adults. A total of 5,937 disabled participants (4877, 1970, 219, and 8 participants responding 1, 2, 3, 4 times, respectively), obtained from the China Health and Retirement Longitudinal Study, were enrolled in our analysis. Based on pooled Ordinary Least Square regressions, SP was associated with decreased depressive symptom severity, and this association was significant in recreational activities and interacting with friends. For brain-disabled respondents, the association was not significant. SP is effective in decreasing depressive symptom severity in disabled older populations. Diversified activities and targeted interventions should be applied to specified older disabled populations to prevent depression.

Developing and implementing a model of care for athletes living with disabilities: A protocol

Background

Athletes living with disabilities (ALWDs) face various challenges including stigma, discrimination, poor access to quality services and lack of funding. Their needs are also numerous. Despite the transformative promise of 'Leave No One Behind' of the United Nations' 2030 agenda, people living with disabilities are still left behind.

Objectives

To investigate the challenges and needs of ALWDs and to develop and implement a model of care (MoC), using South Africa as an example.

Method

Our study will use a mixed-method design. The conceptual framework to manage this project is guided by a 'process redesign framework'. Phase 1 will analyse the problems and needs of ALWDs. Phase 2 will include a review study to map the range of care strategies for athletes. Phase 3 will include a Delphi study to develop a suitable MoC. Phase 4 will involve the implementation of the MoC. Participants for phase 1 will include ALWDs. Phases 3 and 4 will include disability sports experts.

Results

Our study will present the challenges and needs of ALWDs and propose a MoC.

Conclusion

There is a need to think beyond disability and have robust discussions to challenge the way services are provided for ALWDs. Everyone has a role to play to help bring about changes that will improve the quality of life of these athletes.

Clinical implications

A new MoC will assist in improving the quality of service for ALWDs.

Protective Role of Social Networks for the Well-Being of Persons with Disabilities: Results from a State-Wide Cross-Sectional Survey in Kerala, India

The current study presents the findings from a cross-sectional survey on social factors associated with the well-being of persons with disabilities (PWDs) in Kerala, India. We conducted a community-based survey across three geographical zones, North, Central, and South of Kerala state, between April and September 2021. We randomly selected two districts from each zone using a stratified sample method, followed by one local self-government from each of these six districts. Community health professionals identified individuals with disabilities, and researchers collected information on their social networks, service accessibility, well-being, and mental health. Overall, 244 (54.2%) participants had a physical disability, while 107 (23.78%) had an intellectual disability. The mean well-being score was 12.9 (S.D = 4.9, range = 5-20). Overall, 216 (48%) had poor social networks, 247 (55%) had issues regarding service accessibility, and 147 (33%) had depressive symptoms. Among the PWDs with issues with service access, 55% had limited social networks. A regression analysis revealed that social networks (b = 2.30, p = 0.000) and service accessibility (b = -2.09, p = 0.000) were associated with well-being. Social networks are more important than financial assistance because they facilitate better access to psycho-socioeconomic resources, a prerequisite for well-being.

Real-life experience of accepting assistive device services for Tibetans with dysfunction: A qualitative study

Objective

This study aimed to understand the real-life experiences of Tibetans in China with dysfunction in the process of accepting assistive device services and to provide a reference for service quality improvement and policy formulation.

Methods

Semi-structured personal interviews were used to collect data. Ten Tibetans with dysfunction representing three categories of different economic level areas in Lhasa, Tibet were selected to participate in the study by purposive sampling method from September to December 2021. The data were analyzed using Colaizzi's seven-step method.

Results

The results present three themes and seven sub-themes: identification of tangible benefits from assistive devices (enhancing self-care ability for persons with dysfunction, assisting family members with caregiving and promoting harmonious family relationships), problems and burdens (difficulty in accessing professional services and cumbersome processes, not knowing how to use it correctly, psychological burden: fear of falling and stigmatization), and needs and expectations (providing social support to reduce the cost of use, enhancing the accessibility of barrier-free facilities at the grassroots level and improving the environment for the use of assistive devices).

Conclusion

A proper understanding of the problems and challenges faced by Tibetans with dysfunction in the process of accepting assistive device services, focusing on the real-life experiences of people with functional impairment, and proposing targeted suggestions for improving and optimizing the user experience can provide reference and basis for future intervention studies and related policy formulation.

The research output of rod-cone dystrophy genetics

Non-syndromic rod-cone dystrophy (RCD) is the most common condition in inherited retinal diseases. The aim of this study was to evaluate the research output and productivity related to RCD genetics per countries as classified by the human development index (HDI), by analyzing publication frequency and citations, the choice of journals and publishers, since 2000 to date. We have also analyzed the use of next-generation sequencing (NGS) in publications originating from countries with different HDIs. One thousand four hundred articles focusing on non-syndromic RCD were downloaded and analyzed. Citations and published articles were adjusted per one million individuals. The research output is significantly higher in very high HDI countries (86% of the total publications and 95% of the citations) than countries with lower HDIs in all aspects. High and medium HDI countries published together 13.6% of the total articles worldwide and received 4.6% of the citations. On the publication level, the USA (26%), United Kingdom (10%), and Japan (7%) were the top 3 among very high HDI countries, while China (6%) and India (2%) ranked first in high and medium HDI countries respectively. On the citation level, similar profiles were found. Following adjustment for population size, Switzerland (~14%), Jordan (~ 1%) and Morocco (<0.2%) showed the highest rates of publications in very high, high and medium HDI countries respectively. Very high HDI countries published 71% of their papers in first quartile journals (first quartile in Scimago journal rank; Q1), and 23% in Q2 journals. High and medium HDI countries showed a similar profile in quartiles with ~ 40% of their papers published in Q1 journals and ~ 30% in Q2 journals. The first publication using NGS was issued in 2009 in very high HDI countries, while it appeared in 2012 in high HDI countries, and in 2017 in medium HDI countries, with a respective lag of 3 to 8 years compared to very high HDI countries. A profound gap exists between very high HDI countries and the rest of the world. To fill it in, we propose implementing NGS, supporting international collaborations, building capacities and infrastructures, improving accessibility of patients to services, and increasing national and international funding.

Association of Multidimensional Poverty With Dementia in Adults Aged 50 Years or Older in South Africa

Importance

Limited research exists investigating the association between multidimensional poverty and dementia in low-and middle-income countries (LMICs).

Objective

To investigate the association between multidimensional poverty and dementia among adults aged 50 years or older living in South Africa.

Design, Setting, and Participants

This cross-sectional study was conducted in Soweto, Johannesburg, South Africa, between November 11, 2019, and February 28, 2020. Participants included 227 adults aged 50 years or older. Data analysis was concluded from August 1 to 30, 2021.

Exposures

Multidimensional poverty included 7 dimensions that are central to well-being (education, health, economic activity, living standards, social participation, fair treatment, and psychological well-being) and 11 indicators of deprivation within those dimensions (limited access to education; severe limitation of activity; difficulty functioning; unemployment; deprivation of access to running water, electricity, and a flush toilet; lack of involvement in community groups; discrimination; depression; and decreased self-esteem).

Main Outcomes and Measures

The 8-item Interview to Differentiate Aging and Dementia (Assessing Dementia 8 [AD8]) and the Rowland Universal Dementia Assessment Scale (RUDAS) were used to assess dementia. Level and depth of poverty were compared between adults with no dementia and those with a score above the threshold for either the AD8 or the RUDAS, or for both the AD8 and the RUDAS, adjusting for gender, age group, and marital status. Correlation analyses assessed the overlap of dimensions of deprivation. Associations between dementia and multidimensional poverty were investigated using a multivariable logistic regression model.

Results

A total of 227 adults (146 women [64.3%]; mean [SD] age, 63.7 [0.5] years) were included in the study; 101 (44.5%) had dementia identified by the AD8, 14 (6.2%) had dementia identified by the RUDAS, and 50 (22.0%) had dementia identified by both the AD8 and the RUDAS. More men than women did not have dementia (26 of 81 [32.1%] vs 36 of 146 [24.7%]), and 33 of 165 adults with dementia (20.0%) compared with 6 of 62 adults (9.7%) without dementia were found to be deprived in 4 dimensions or more. The difference between adults with and adults without dementia in the Multidimensional Poverty Index for deprivation in 4 dimensions was 145.8% for dementia identified by both the AD8 and the RUDAS and 118.2% for dementia identified by either the AD8 or the RUDAS. Education, health, and employment were the main contributors to the adjusted poverty head count ratio. Multidimensional poverty was strongly associated with dementia as measured by the AD8 and the RUDAS (adjusted odds ratio [OR], 2.31; 95% CI, 1.08-4.95), with higher odds for older women (OR, 2.03; 95% CI, 1.00-4.12) or those living in large households (for each additional household member: OR, 1.27; 95% CI, 1.05-1.53).

Conclusions and Relevance

This study suggests that the prevalence and depth of poverty were higher among adults with dementia. A lack of education, poor health, and unemployment were major dimensions of poverty that were associated with a higher prevalence of dementia. Long-term interventions beginning early in life may affect social determinants of health through targeted structural policies (eg, access to quality education and health care) and prevent dementia later in life.

Disability and psychological distress in nine countries of the former Soviet Union

BACKGROUND

People with disabilities (PWD) are at increased risk of poor mental health. However, this association and the pathways involved remain under-researched in many parts of the world. This study examined the association between disability and psychological distress in nine countries of the former Soviet Union (FSU).

METHODS

Data were analysed from 18,000 adults aged ≥18 years collected during the Health in Times of Transition (HITT) survey undertaken in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine in 2010 and 2011. Information was obtained on disability status, the severity of the disability and psychological distress. Logistic regression analysis was used to estimate associations.

RESULTS

In a fully adjusted combined country analysis, disability was associated with over two times higher odds for psychological distress (odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.86-2.58). The strength of the association varied across the individual countries. Among PWD more severe disability was associated with significantly higher odds for psychological distress (OR: 2.12, 95%CI: 1.26-3.55).

LIMITATIONS

The data were cross-sectional and disability status was self-reported, possibly resulting in underreporting.

CONCLUSIONS

Disability is associated with worse psychological health in FSU countries, especially among those with more severe disabilities. As poor mental health may also increase the risk of negative outcomes in PWD, this finding highlights the importance of the early detection and treatment of mental disorders in PWD in these countries.