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Wickersham A, Das-Munshi J, Ford T, Jewell A, Stewart R, Downs J. Impact of inconsistent ethnicity recordings on estimates of inequality in child health and education data: a data linkage study of Child and Adolescent Mental Health Services in South London. BMJ Open 2024; 14:e078788. [PMID: 38443076 PMCID: PMC10916132 DOI: 10.1136/bmjopen-2023-078788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/12/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVES Ethnicity data are critical for identifying inequalities, but previous studies suggest that ethnicity is not consistently recorded between different administrative datasets. With researchers increasingly leveraging cross-domain data linkages, we investigated the completeness and consistency of ethnicity data in two linked health and education datasets. DESIGN Cohort study. SETTING South London and Maudsley NHS Foundation Trust deidentified electronic health records, accessed via Clinical Record Interactive Search (CRIS) and the National Pupil Database (NPD) (2007-2013). PARTICIPANTS N=30 426 children and adolescents referred to local Child and Adolescent Mental Health Services. PRIMARY AND SECONDARY OUTCOME MEASURES Ethnicity data were compared between CRIS and the NPD. Associations between ethnicity as recorded from each source and key educational and clinical outcomes were explored with risk ratios. RESULTS Ethnicity data were available for 79.3% from the NPD, 87.0% from CRIS, 97.3% from either source and 69.0% from both sources. Among those who had ethnicity data from both, the two data sources agreed on 87.0% of aggregate ethnicity categorisations overall, but with high levels of disagreement in Mixed and Other ethnic groups. Strengths of associations between ethnicity, educational attainment and neurodevelopmental disorder varied according to which data source was used to code ethnicity. For example, as compared with White pupils, a significantly higher proportion of Asian pupils achieved expected educational attainment thresholds only if ethnicity was coded from the NPD (RR=1.46, 95% CI 1.29 to 1.64), not if ethnicity was coded from CRIS (RR=1.11, 0.98 to 1.26). CONCLUSIONS Data linkage has the potential to minimise missing ethnicity data, and overlap in ethnicity categorisations between CRIS and the NPD was generally high. However, choosing which data source to primarily code ethnicity from can have implications for analyses of ethnicity, mental health and educational outcomes. Users of linked data should exercise caution in combining and comparing ethnicity between different data sources.
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Affiliation(s)
- Alice Wickersham
- CAMHS Digital Lab, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Amelia Jewell
- Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Johnny Downs
- CAMHS Digital Lab, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Ekezie W, Martin CA, Baggaley RF, Teece L, Nazareth J, Pan D, Sze S, Bryant L, Woolf K, Gray LJ, Khunti K, Pareek M. Association between ethnicity and migration status with the prevalence of single and multiple long-term conditions in UK healthcare workers. BMC Med 2023; 21:433. [PMID: 38031115 PMCID: PMC10688453 DOI: 10.1186/s12916-023-03109-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Healthcare workers' (HCW) well-being has a direct effect on patient care. However, little is known about the prevalence and patterns of long-term medical conditions in HCWs, especially those from ethnic minorities. This study evaluated the burden of multiple long-term conditions (MLTCs), i.e. the presence of two or more single long-term conditions (LTCs), among HCWs in the United Kingdom (UK) and variation by ethnicity and migration status. METHODS We used baseline data from the UK-REACH cohort study collected December 2020-March 2021. We used multivariable logistic regression, adjusting for demographic, occupational and lifestyle factors to examine the relationship between self-reported LTCs/MLTCs and ethnicity, migration status and time since migration to the UK. RESULTS Of 12,100 included HCWs, with a median age of 45 years (IQR: 34-54), 27% were overseas-born, and 30% were from non-White ethnic groups (19% Asian, 4% Black, 4% Mixed, 2% Other). The most common self-reported LTCs were anxiety (14.9%), asthma (12.2%), depression (10.7%), hypertension (8.7%) and diabetes (4.0%). Mental health conditions were more prevalent among UK-born than overseas-born HCWs for all ethnic groups (adjusted odds ratio (aOR) using White UK-born as the reference group each time: White overseas-born 0.77, 95%CI 0.66-0.95 for anxiety). Diabetes and hypertension were more common among Asian (e.g. Asian overseas, diabetes aOR 2.97, 95%CI 2.30-3.83) and Black (e.g. Black UK-born, hypertension aOR 1.77, 95%CI 1.05-2.99) groups than White UK-born. After adjustment for age, sex and deprivation, the odds of reporting MLTCs were lower in most ethnic minority groups and lowest for those born overseas, compared to White UK-born (e.g. White overseas-born, aOR 0.68, 95%CI 0.55-0.83; Asian overseas-born aOR 0.75, 95%CI 0.62-0.90; Black overseas-born aOR 0.52, 95%CI 0.36-0.74). The odds of MLTCs in overseas-born HCWs were equivalent to the UK-born population in those who had settled in the UK for ≥ 20 years (aOR 1.14, 95%CI 0.94-1.37). CONCLUSIONS Among UK HCWs, the prevalence of common LTCs and odds of reporting MLTCs varied by ethnicity and migrant status. The lower odds of MLTCs in migrant HCWs reverted to the odds of MLTCs in UK-born HCWs over time. Further research on this population should include longitudinal studies with linkage to healthcare records. Interventions should be co-developed with HCWs from different ethnic and migrant groups focussed upon patterns of conditions prevalent in specific HCW subgroups to reduce the overall burden of LTCs/MLTCs.
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Affiliation(s)
- Winifred Ekezie
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Centre for Ethnic Health Research, University of Leicester, Leicester, UK
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration East Midlands (ARC EM), Leicester, UK
- School of Social Sciences and Humanities, Aston University, Birmingham, UK
| | - Christopher A Martin
- Department of Infection and HIV Medicine, University Hospitals of Leicester, NHS Trust, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
| | - Rebecca F Baggaley
- NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Lucy Teece
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Joshua Nazareth
- Department of Infection and HIV Medicine, University Hospitals of Leicester, NHS Trust, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
| | - Daniel Pan
- Department of Infection and HIV Medicine, University Hospitals of Leicester, NHS Trust, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK
- Development Centre for Population Health, University of Leicester, Leicester, UK
- Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, Oxford, UK
| | - Shirley Sze
- Development Centre for Population Health, University of Leicester, Leicester, UK
- Cardiovascular Research Centre, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Luke Bryant
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK
| | | | - Laura J Gray
- NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Centre for Ethnic Health Research, University of Leicester, Leicester, UK
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration East Midlands (ARC EM), Leicester, UK
| | - Manish Pareek
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration East Midlands (ARC EM), Leicester, UK.
- Department of Infection and HIV Medicine, University Hospitals of Leicester, NHS Trust, Leicester, UK.
- Department of Respiratory Sciences, University of Leicester, Leicester, UK.
- NIHR Leicester Biomedical Research Centre (BRC), University of Leicester, Leicester, UK.
- Development Centre for Population Health, University of Leicester, Leicester, UK.
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3
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Stagg AL, Harber-Aschan L, Hatch SL, Fear NT, Dorrington S, Madan I, Stevelink SAM. Risk factors for the progression to multimorbidity among UK urban working-age adults. A community cohort study. PLoS One 2023; 18:e0291295. [PMID: 37682940 PMCID: PMC10490989 DOI: 10.1371/journal.pone.0291295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVES The progression of long-term conditions (LTCs) from zero-to-one (initiation), and from one-to-many (progression)are common trajectories that impact a person's quality of life including their ability to work. This study aimed to explore the demographic, socioeconomic, psychosocial, and health-related determinants of LTC initiation and progression, with a focus on work participation. METHODS Data from 622 working-age adults who had completed two waves (baseline and follow-up) of the South-East London Community Health survey were analysed. Chi square tests and multinomial logistic regression were used to describe the associations between self-reported demographic, socioeconomic, psychosocial, and health-related variables, and the progression of LTCs. RESULTS Small social networks, an increased number of stressful life events, low self-rated health, functional impairment, and increased somatic symptom severity were all associated with both the progression from zero-to-one LTC and from one LTC to multimorbidity (two or more LTCs). Renting accommodation (RRR 1.73 [95% CI 1.03-2.90]), smoking (RRR 1.91 [95% CI 1.16-3.14]) and being overweight (RRR 1.88 [95% CL 1.12-3.16]) were unique risk factors of developing initial LTCs, whereas low income (RRR 2.53 [95% CI 1.11-5.80]), working part-time (RRR 2.82 ([95% CL 1.12-7.10]), being unemployed (RRR 4.83 [95% CI 1.69-13.84]), and making an early work exit (RRR 16.86 [95% CI 3.99-71.30]) all increased the risk of progressing from one LTC to multimorbidity compared to being employed full-time. At follow-up, depression was the most prevalent LTC in the unemployed group whereas musculoskeletal conditions were the most prevalent in those working. CONCLUSIONS The journey to multimorbidity is complex, with both common and unique risk factors. Non-full-time employment was associated with an increased risk of progression to multimorbidity. Future research should explore the risk and benefit pathways between employment and progression of LTCs. Interventions to prevent progression of LTCs should include mitigation of modifiable risk factors such as social isolation.
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Affiliation(s)
- Anne L. Stagg
- Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, United Kingdom
- Department of Occupational Health, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom
| | - Lisa Harber-Aschan
- Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, United Kingdom
- Stockholm University Demography Unit, Stockholm University, Stockholm, Sweden
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Nicola T. Fear
- Academic Department of Military Mental Health, King’s College London, London, United Kingdom
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
| | - Sarah Dorrington
- Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, United Kingdom
- Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Ira Madan
- Department of Occupational Health, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sharon A. M. Stevelink
- Department of Psychological Medicine, Institute of Psychiatry Psychology & Neuroscience, King’s College London, London, United Kingdom
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
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Lee JY, Lee W, Cho SI. Characteristics of fatal occupational injuries in migrant workers in South Korea: A machine learning study. Heliyon 2023; 9:e20138. [PMID: 37810039 PMCID: PMC10559917 DOI: 10.1016/j.heliyon.2023.e20138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023] Open
Abstract
Objective Analysis of occupational injuries is essential for developing preventive strategies. However, few studies have evaluated severe occupational injuries in migrant workers from the perspective of gender. Therefore, using a new analytical method, this study was performed to identify gender-specific characteristics associated with fatal occupational injuries among migrant workers; the interactions between these factors, were also analyzed. In addition, we compared the utility of explainable artificial intelligence (XAI) using SHapley Additive exPlanations (SHAP) with logistic regression (LR) and discuss caveats regarding its use. Materials and methods We analyzed national statistics for occupational injuries among migrant workers (n = 67,576) in South Korea between January 1, 2007, and September 30, 2018. We applied an extreme gradient boosting model and developed SHAP and LR models for comparison. Results We found clear gender differences in fatal occupational injuries among migrant workers, with males in the same occupation having a higher risk of death than females. These gender differences suggest the need for gender-specific occupational injury prevention interventions for migrant workers to reduce the mortality rate. Occupation was a significant predictor of death among female migrant workers only, with care jobs having the highest fatality risk. The occupational fatality risk of female workers would not have been identified without the performance of detailed job-specific analyses stratified by gender. The major advantages of SHAP identified in the present study were the automatic identification and analysis of interactions, ability to determine the relative contributions of each feature, and high overall performance. The major caveat when using SHAP is that causality cannot be established. Conclusion Detailed job-specific analyses stratified by gender, and interventions considering the gender of migrant workers, are necessary to reduce occupational fatality rates. The XAI approach should be considered as a complementary analytical method for epidemiological studies, as it overcomes the limitations of traditional statistical analyses.
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Affiliation(s)
- Ju-Yeun Lee
- The Department of Public Health, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Woojoo Lee
- The Department of Public Health, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Sung-il Cho
- The Department of Public Health, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
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Tsai PL, Ghahari S. Immigrants' Experience of Health Care Access in Canada: A Recent Scoping Review. J Immigr Minor Health 2023; 25:712-727. [PMID: 36870008 DOI: 10.1007/s10903-023-01461-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 03/05/2023]
Abstract
Existing literature has reported inequities in access to Canadian health care services among immigrants. The aim of this scoping review was (a) to explore research regarding Canadian immigrants' unique experiences in accessing healthcare, and (b) to provide suggestions for future research and programming considering the identified immigrant-specific service gaps in health care. We searched MEDLINE, CINAHL, EMBASE, and Google Scholar, following the Arksey and O'Malley (2005) framework. The review's findings suggest unmet health care access needs specific to immigrants in Canada, with the most common access barriers including communication, socioeconomic, and cultural barriers. The scoping review expands on the immigrant health care experiences and accessibility factors through a thematic analysis. Findings suggest that developing community-based programming, improving training for health care providers in culturally competent care, and policies that address the social determinants of health can improve health care accessibility among immigrants.
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Affiliation(s)
- Pei-Ling Tsai
- Faculty of Arts and Sciences, Queen's University, 94 University Ave, Kingston, ON, Canada
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen's University, 31 George St, Kingston, ON, K7L 3N6, Canada.
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Tham SG, Hunt IM, Turnbull P, Appleby L, Kapur N, Knipe D. Suicide among psychiatric patients who migrated to the UK: a national clinical survey. EClinicalMedicine 2023; 57:101859. [PMID: 36895802 PMCID: PMC9989630 DOI: 10.1016/j.eclinm.2023.101859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Within the UK, limited research has examined migration and suicide risk. To assist with tailoring mental health care to the needs of different migrant groups, it is important to identify the clinical profile and antecedents to suicide. METHODS We focussed on two groups of migrants: those resident in the UK for less than 5 years (recent migrants) and those seeking permission to stay in the UK. Data on mental health patients who died by suicide in the UK between 2011 and 2019 were obtained as part of the National Confidential Inquiry into Suicide and Safety in Mental Health. FINDINGS 13,948 patients died by suicide between 2011 and 2019: 593 were recent migrants with 48 seeking permission to stay in the UK. The overall suicide rate between 2011 and 2017 for patients seeking to stay was 23.8/100,000 (95% CI 17.3-32.1). There was some uncertainty around this estimate but it appeared higher than the general population suicide rate of 10.6/100,000 population (95% CI 10.5-10.7; p = .0001) for the same period. A higher proportion of migrants were from an ethnic minority group (15% recent migrants vs. 70% seeking to remain vs. 7% non-migrants) and more were viewed as at low long-term risk of suicide (63% recent migrants vs. 76% seeking to remain vs. 57% non-migrants). A higher proportion of recent migrants died within three months of discharge from psychiatric in-patient care (19% vs. 14%) compared to non-migrants. Proportionally more patients seeking to remain had a diagnosis of schizophrenia and other delusional disorders (31% vs. 15%) and more had experienced recent life events compared to non-migrants (71% vs. 51%). INTERPRETATION A higher proportion of migrants had severe or acute illness at the time of their suicide. This may be linked to a range of serious stressors and/or lack of connection with services that could have identified signs of illness early. However, clinicians often viewed these patients as low risk. Mental health services should consider the breadth of stressors migrants may face and adopt a multi-agency approach to suicide prevention. FUNDING The Healthcare Quality Improvement Partnership.
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Affiliation(s)
- Su-Gwan Tham
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
- Corresponding author. National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, The University of Manchester, 2nd Floor Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK.
| | - Isabelle M. Hunt
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Pauline Turnbull
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Louis Appleby
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Nav Kapur
- National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), Centre for Mental Health and Safety, School of Health Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Duleeka Knipe
- Population Health Sciences, University of Bristol, Bristol, UK
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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] [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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Stagg AL, Hatch S, Fear NT, Dorrington S, Madan I, Stevelink SAM. Long-term health conditions in UK working-age adults: a cross-sectional analysis of associations with demographic, socioeconomic, psychosocial and health-related factors in an inner-city population. BMJ Open 2022; 12:e062115. [PMID: 36385039 PMCID: PMC9670944 DOI: 10.1136/bmjopen-2022-062115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To study the overall disease prevalence, and associations between demographic, socioeconomic, psychosocial, and health-related factors, and self-reporting one or more long-term health conditions (LTCs) in a working-age inner-city population. DESIGN Cross-sectional household-based survey with a follow-up timepoint. SETTING South-East London Community Health survey data. PARTICIPANTS 893 adults aged 16-64 years living in Lambeth and Southwark, London. OUTCOME MEASURES Prevalence estimates of individual and multiple LTCs. Multinomial logistic regression was used to analyse the association of demographic, socioeconomic, psychosocial and health-related indicators with having one and multiple LTCs at two timepoints. RESULTS More than one third of participants reported at least one LTC, with the most prevalent being musculoskeletal conditions and asthma. The prevalence of one LTC at both timepoints was 20.6% and 21.4%, and of multimorbidity was 14.0% and 16.4%. At both timepoints, the 35-44 age group showed the largest increase in prevalence of one LTC compared with the preceding age group (16-34). After adjusting for age and gender, small social networks and a larger number of stressful life events were associated with increased risk of having both one and multiple LTCs. The risk of multimorbidity was greater than for initial LTCs for small social networks (3.8 (95% CI: 1.8 to 7.8) compared with 2.0 (95% CI: 1.0 to 3.9)), and three to five stressful life events (3.0 (95% CI: 1.7 to 5.3) compared with 1.5 (95% CI 1.0 to 2.2)). CONCLUSIONS In this study, the prevalence of multimorbidity increased more than the prevalence of one LTC between the two timepoints, indicating a progression of the overall disease prevalence over time. The 35-44 age group showed the greatest increase in the number of initial LTCs which support health-promotion interventions targeting younger age groups. Focusing on increasing social support networks and treating the psychological impact of stressful life events may also be of benefit.
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Affiliation(s)
- Anne L Stagg
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- Department of Occupational Health, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Stephani Hatch
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Nicola T Fear
- Academic Department of Military Mental Health, King's College London, London, UK
- King's Centre for Military Health Research, King's College, London, UK
| | - Sarah Dorrington
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ira Madan
- Department of Occupational Health, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Sharon A M Stevelink
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- King's Centre for Military Health Research, King's College, London, UK
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Juárez SP, Honkaniemi H, Gustafsson NK, Rostila M, Berg L. Health Risk Behaviours by Immigrants’ Duration of Residence: A Systematic Review and Meta-Analysis. Int J Public Health 2022; 67:1604437. [PMID: 35990194 PMCID: PMC9388735 DOI: 10.3389/ijph.2022.1604437] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 06/28/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives: The aim was to systematically review and synthesise international evidence on changes in health risk behaviours by immigrants’ duration of residence. Methods: We searched literature databases for peer-reviewed quantitative studies published from 2000 to 2019, examining alcohol, drug and tobacco use; physical inactivity; and dietary habits by duration of residence. Results: Narrative synthesis indicated that immigrants tend to adopt health risk behaviours with longer residence in North America, with larger variation in effect sizes and directionality in other contexts. Random-effects meta-analyses examining the pooled effect across all receiving countries and immigrant groups showed lower odds of smoking (OR 0.54, 0.46–0.63, I2 = 68.7%) and alcohol use (OR 0.61, 0.47–0.75, I2 = 93.5%) and higher odds of physical inactivity (OR 1.71, 1.40–2.02, I2 = 99.1%) among immigrants than natives, but did not provide support for a universal trend by duration of residence. Conclusion: Findings suggest that duration of residence could serve as an effective instrument to monitor immigrants’ health changes. However, differences in receiving country contexts and immigrant populations’ composition seem to be important to predict the level and direction of behavioural change. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, PROSPERO CRD42018108881.
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Affiliation(s)
- Sol P. Juárez
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Faculty of Social Sciences, Stockholm University, Stockholm, Sweden
- *Correspondence: Sol P. Juárez,
| | - Helena Honkaniemi
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Faculty of Social Sciences, Stockholm University, Stockholm, Sweden
| | - Nina-Katri Gustafsson
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Faculty of Social Sciences, Stockholm University, Stockholm, Sweden
| | - Mikael Rostila
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Faculty of Social Sciences, Stockholm University, Stockholm, Sweden
| | - Lisa Berg
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Faculty of Social Sciences, Stockholm University, Stockholm, Sweden
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A Systematic Review of Inequalities in the Mental Health Experiences of Black African, Black Caribbean and Black-mixed UK Populations: Implications for Action. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01352-0. [PMID: 35767218 DOI: 10.1007/s40615-022-01352-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Measurable differences in the experience and treatment of mental health conditions have been found to exist between different racial categories of community groups. The objective of this research was to review the reported mental health of Black African-Caribbean communities in the UK, determinants of mental health, and interventions to enhance their experiences of mental health services. METHOD The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was applied. To be included, papers must be published in a peer reviewed journal; report on adult populations (over 18) from any of Black African, Black Caribbean or Black mixed people in the UK; and assess (quantitative), or discuss (qualitative) mental health experiences, determinants of mental health, or interventions intended to enhance experiences of mental health services among the target population. The aims, inclusion criteria, data extraction, and data quality evaluation were specified in advance. Searches were conducted using EBSCO (PsychInfo; MEDLINE; CINAHL Plus; psychology and behavioural sciences collection). The search strategy included search terms relating to the aim. Risk of bias was assessed using a standard tool, records were organised using Endnote, and data were extracted and synthesised using Microsoft Excel. RESULTS Thirty-six studies were included, of which 26 were quantitative and six reported exclusively on Black participants. Black populations were less likely to access mental health support via traditional pathways due to stigma and mistrust of mental health services. Black Africans especially, sought alternative help from community leaders, which increased the likelihood of accessing treatment at the point of crisis or breakdown, which in turn increased risk of being detained under the Mental Health Act and via the criminal justice system. DISCUSSION Findings suggest a cycle of poor mental health, coercive treatment, stigma, and mistrust of services as experienced by Black communities. Evidence was limited by poorly defined ethnic categories, especially where Black populations were subsumed into one category. It is recommended that mental health services work collaboratively with cultural and faith communities in supporting Black people to cope with mental illness, navigate mental health pathways, and provide culturally appropriate advice. Protocol Registration Number PROSPERO CRD42021261510.
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11
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Pan L, Wang C, Cao X, Zhu H, Luo L. Unmet Healthcare Needs and Their Determining Factors among Unwell Migrants: A Comparative Study in Shanghai. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095499. [PMID: 35564894 PMCID: PMC9103782 DOI: 10.3390/ijerph19095499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to analyze the health status and unmet healthcare needs, and the impact of related factors, of unwell migrants in Shanghai. A total of 10,938 respondents, including 934 migrants and 10,004 non-migrants, were interviewed in Shanghai’s Sixth Health Service Survey. Descriptive statistics were utilized to present the prevalence of health status and unmet healthcare needs. Binary logistic regression analysis was performed to explore the relationships between predisposing factors, enabling factors, need factors, and health-related behavior and unmet healthcare needs in the Anderson health service utilization model. This study indicated the percentages of migrants having a fair or poor self-evaluated health status (21.09%) and suffering from chronic diseases (72.91%) were lower than those of non-migrants (28.34% and 88.64%, respectively). Migrants had higher percentages of unmet hospitalization needs (88.87%), unmet outpatient care needs (44.43%), and self-medication (23.98%) than those of non-migrants (86.24%, 37.95%, 17.97%, respectively). Migrants enrolled in Urban Employee Basic Medical Insurance were more likely to utilize hospitalization services (OR = 1.457) than those enrolled in other health insurances or uninsured. Need factors had impacts on unwell migrants’ unmet healthcare needs. Other factors, including age and health behavior, were also found to significantly affect unwell migrants’ unmet health service needs. Specific gaps continue to exist between unwell migrants and non-migrants regarding the accessibility of local health services. Flexible policies, such as enhancing the health awareness of migrants and eliminating obstacles for migrants to access medical services, should be implemented to provide convenient and affordable healthcare services to unwell migrants.
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Affiliation(s)
- Lin Pan
- School of Public Health, Fudan University, Shanghai 200032, China; (L.P.); (C.W.); (H.Z.)
| | - Cong Wang
- School of Public Health, Fudan University, Shanghai 200032, China; (L.P.); (C.W.); (H.Z.)
| | - Xiaolin Cao
- Institute of Medical Information, Chinese Academy of Medical Sciences, Beijing 100020, China
- Correspondence: (X.C.); (L.L.)
| | - Huanhuan Zhu
- School of Public Health, Fudan University, Shanghai 200032, China; (L.P.); (C.W.); (H.Z.)
| | - Li Luo
- School of Public Health, Fudan University, Shanghai 200032, China; (L.P.); (C.W.); (H.Z.)
- Correspondence: (X.C.); (L.L.)
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12
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Villarroel N, MacFarlane A, Roura M, Basogomba A, Bradley C, LeMaster JW, Hannigan A. The impact of economic recession on the health of migrant fathers over time: results from the Growing up in Ireland longitudinal study. BMC Public Health 2022; 22:166. [PMID: 35073892 PMCID: PMC8788144 DOI: 10.1186/s12889-022-12596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The relationship between economic conditions and health can depend on both the health outcome measured and the composition of the population. Analysis of outcomes by both ethnicity and country of birth has been recommended. The aim of our study is to explore the impact of recession on self-rated health and depression of migrant fathers in Ireland over time, considering both ethnicity and country of birth.
Methods
Longitudinal data from waves of a population-representative cohort study (Growing up in Ireland, 2008–2013) was used with Wave 1 collected before the recession and Wave 2 collecting information on how the recession affected families. Socio-demographic variables, self-rated health and depression were compared across three groups of fathers classified by self-identified ethnicity and country of birth: White Irish (n = 5628), Other White European (EU-10) (n = 431), and Black African (n = 192) using chi-square tests and logistic regression models. Rates of follow-up were compared across groups at Wave 3.
Results
Prior to the recession, the rate of employment was lowest for African fathers (51% vs 81% for EU-10 fathers and 92% for Irish fathers, p < 0.001). At Wave 2, African families were more likely to have experienced a very significant effect of the recession (40.1% compared to 22.4% for families from EU-10 and 21.3% for Irish families, p < 0.001). However, the impact of the recession on depression and self-rated health was only found in Irish fathers. By Wave 3, rates of follow-up were lower for migrant fathers, particularly for EU-10 fathers.
Conclusions
Understanding the relationship between economic conditions and health is complex and may be related to multiple dimensions of socio-economic advantage and disadvantage. African families were already more likely to be disadvantaged prior to the recession and that pattern persisted during the recession. Further research on attrition rates of migrants in population cohort studies is needed and the development of effective strategies for recruitment, follow-up and analysis.
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Poppleton A, Howells K, Adeyemi I, Chew‐Graham C, Dikomitis L, Sanders C. The perceptions of general practice among Central and Eastern Europeans in the United Kingdom: A systematic scoping review. Health Expect 2022; 25:2107-2123. [DOI: 10.1111/hex.13433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 12/17/2021] [Accepted: 12/29/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Aaron Poppleton
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
- School of Medicine Keele University Keele UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (GM‐PSTRC) Manchester UK
| | - Kelly Howells
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
| | - Isabel Adeyemi
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
| | | | - Lisa Dikomitis
- Kent and Medway Medical School University of Kent and Canterbury Christ Church University Canterbury UK
| | - Caroline Sanders
- Centre for Primary Care and Health Services Research University of Manchester Manchester UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (GM‐PSTRC) Manchester UK
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Rhead RD, Woodhead C, Ahmad G, Das-Munshi J, McManus S, Hatch SL. A comparison of single and intersectional social identities associated with discrimination and mental health service use: data from the 2014 Adult Psychiatric Morbidity Survey in England. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2049-2063. [PMID: 35254450 PMCID: PMC9477952 DOI: 10.1007/s00127-022-02259-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/18/2022] [Indexed: 02/05/2023]
Abstract
Inequities in mental health service use (MHSU) and treatment are influenced by social stratification processes linked to socially contextualised interactions between individuals, organisations and institutions. These complex relations underpin observed inequities and their experience by people at the intersections of social statuses. Discrimination is one important mechanism influencing such differences. We compared inequities in MHSU/treatment through single and intersectional status analyses, accounting for need. We assessed whether past-year discrimination differentially influences MHSU/treatment across single and intersecting statuses. Data came from a population survey (collected 2014-2015) nationally representative of English households (N = 7546). We used a theory and datadriven approach (latent class analysis) which identified five intersectional groups in the population comprising common combinations of social statuses. Single status analyses identified characteristics associated with MHSU/treatment (being a sexual minority (adjusted odds ratio (AOR) 1.65 95% CI:1.09-2.50), female (AOR 1.71, 95% CI:1.45-2.02), economically inactive (AOR 2.02, 95% CI:1.05-3.90), in the most deprived quintile (AOR 1.33, 95% CI:1.02-1.74), and Black (AOR 0.36 95% CI:0.20-0.66)). Intersectional analyses detected patterns not apparent from single status analyses. Compared to the most privileged group ("White British, highly educated, employed, high social class"), "Retired White British" had greater odds of MHSU/treatment (AOR 1.88, 95% CI:1.53-2.32) while "Employed migrants" had lower odds (AOR 0.39, 95% CI:0.27-0.55). Past-year discrimination was associated with certain disadvantaged social statuses and greater MHSU/treatment but-except for sexual minorities-adjusting for discrimination had little influence using either analytic approach. Observing patterns only by single social statuses masks potentially unanticipated and contextually varying inequities. The latent class approach offers policy-relevant insights into patterns and mechanisms of inequity but may mask other key intersectional patterns by statuses less common or under represented in surveys (e.g. UK-born ethnic minority groups). We propose multiple, context-relevant, theory-driven approaches to intersectional understanding of mental health inequalities.
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Affiliation(s)
- Rebecca D. Rhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 3rdfloor E3.14, London, SE5 8AB UK
| | - Charlotte Woodhead
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 3rdfloor E3.14, London, SE5 8AB UK ,ESRC Centre for Society and Mental Health, King’s College London, London, UK
| | - Gargie Ahmad
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 3rdfloor E3.14, London, SE5 8AB UK
| | - Jayati Das-Munshi
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 3rdfloor E3.14, London, SE5 8AB UK ,South London and Maudsley (SLaM) NHS Trust, London, UK
| | - Sally McManus
- National Centre for Social Research, London, UK ,Violence and Society Centre, City, University of London, London, UK
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 3rdfloor E3.14, London, SE5 8AB UK ,ESRC Centre for Society and Mental Health, King’s College London, London, UK
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Krist L, Dornquast C, Reinhold T, Becher H, Jöckel KH, Schmidt B, Schramm S, Icke K, Danquah I, Willich SN, Keil T, Brand T. Association of Acculturation Status with Longitudinal Changes in Health-Related Quality of Life-Results from a Cohort Study of Adults with Turkish Origin in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062827. [PMID: 33802126 PMCID: PMC7999343 DOI: 10.3390/ijerph18062827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/27/2021] [Accepted: 03/05/2021] [Indexed: 11/18/2022]
Abstract
Health-related quality of life (HRQL) among migrant populations can be associated with acculturation (i.e., the process of adopting, acquiring and adjusting to a new cultural environment). Since there is a lack of longitudinal studies, we aimed to describe HRQL changes among adults of Turkish descent living in Berlin and Essen, Germany, and their association with acculturation. Participants of a population-based study were recruited in 2012–2013 and reinvited six years later to complete a questionnaire. Acculturation was assessed at baseline using the Frankfurt acculturation scale (integration, assimilation, separation and marginalization). HRQL was assessed at baseline (SF-8) and at follow-up (SF-12) resulting in a physical (PCS) and mental (MCS) sum score. Associations with acculturation and HRQL were analyzed with linear regression models using a time-by-acculturation status interaction term. In the study 330 persons were included (65% women, mean age ± standard deviation 43.3 ± 11.8 years). Over the 6 years, MCS decreased, while PCS remained stable. While cross-sectional analyses showed associations of acculturation status with both MCS and PCS, temporal changes including the time interaction term did not reveal associations of baseline acculturation status with HRQL. When investigating HRQL in acculturation, more longitudinal studies are needed to take changes in both HRQL and acculturation status into account.
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Affiliation(s)
- Lilian Krist
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (C.D.); (T.R.); (K.I.); (I.D.); (S.N.W.); (T.K.)
- Correspondence:
| | - Christina Dornquast
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (C.D.); (T.R.); (K.I.); (I.D.); (S.N.W.); (T.K.)
- German Center for Neurodegenerative Diseases (DZNE), 17489 Greifswald, Germany
| | - Thomas Reinhold
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (C.D.); (T.R.); (K.I.); (I.D.); (S.N.W.); (T.K.)
| | - Heiko Becher
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry und Epidemiology, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany; (K.-H.J.); (B.S.); (S.S.)
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry und Epidemiology, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany; (K.-H.J.); (B.S.); (S.S.)
| | - Sara Schramm
- Institute for Medical Informatics, Biometry und Epidemiology, University Hospital Essen, University Duisburg-Essen, 45122 Essen, Germany; (K.-H.J.); (B.S.); (S.S.)
| | - Katja Icke
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (C.D.); (T.R.); (K.I.); (I.D.); (S.N.W.); (T.K.)
| | - Ina Danquah
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (C.D.); (T.R.); (K.I.); (I.D.); (S.N.W.); (T.K.)
- Institute of Global Health (HIGH), Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Stefan N. Willich
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (C.D.); (T.R.); (K.I.); (I.D.); (S.N.W.); (T.K.)
| | - Thomas Keil
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (C.D.); (T.R.); (K.I.); (I.D.); (S.N.W.); (T.K.)
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, 97070 Würzburg, Germany
- State Institute of Health, Bavarian Health and Food Safety Authority, 97688 Bad Kissingen, Germany
| | - Tilman Brand
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology—BIPS, 28359 Bremen, Germany;
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The association of migration and ethnicity with use of the Improving Access to Psychological Treatment (IAPT) programme: a general population cohort study. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1943-1956. [PMID: 33591376 PMCID: PMC8519879 DOI: 10.1007/s00127-021-02035-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/29/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Common mental disorders (CMD), such as depression and anxiety, are an important cause of morbidity, economic burden and public mental health need. The UK Improving Access to Psychological Therapies (IAPT) programme is a national effort to reduce the burden and impact of CMD, available since 2008. AIMS To examine ethnic and migration-related differences in use of IAPT-based psychological treatment using a novel epidemiological dataset with linkage to de-identified IAPT records. METHOD Data from a psychiatric morbidity survey of two South East London boroughs (2008-2010) were individually-linked to data on IAPT services serving those boroughs. We used Poisson regression to estimate association between ethnicity and migration status (including years of UK residence), with rate of subsequent use of psychological treatment. RESULTS The rate of psychological treatment use was 14.4 cases per thousand person years [cases/1000 pyrs, 95% confidence intervals (95% CI) 12.4, 16.7]. There was strong statistical evidence that compared to non-migrants, migrants residing in the UK for less than 10 years were less likely to use psychological treatment after adjustment for probable sociodemographic predictors of need, life adversity, and physical/psychiatric morbidity at baseline [rate ratio (RR) 0.4 (95% CI 0.20, 0.75]. This difference was not explained by migration for asylum/political reasons, or English language proficiency, and was evident for both self- and GP referrals. CONCLUSIONS Lower use of IAPT among recent migrants is unexplained by sociodemographics, adversity, and baseline morbidity. Further research should focus on other individual-level and societal barriers to psychological treatment use among recent migrants to the UK, including in categories of intersecting migration and ethnicity.
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Burns R, Zhang CX, Patel P, Eley I, Campos-Matos I, Aldridge RW. Migration health research in the United Kingdom: A scoping review. J Migr Health 2021; 4:100061. [PMID: 34405201 PMCID: PMC8352015 DOI: 10.1016/j.jmh.2021.100061] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND One in seven people living in the United Kingdom (UK) is an international migrant, rendering migrants an important population group with diverse and dynamic health and healthcare needs. However, there has been no attempt to map contemporary trends within migration health research conducted in the UK. The aim of this scoping review was to describe trends within migration health research and identify gaps for future research agendas. METHODS PubMed and Embase were systematically searched for empirical research with a primary focus on the concepts "health" and "migrants" published between 2001 and 2019. Findings were analysed using the UCL-Lancet Commission on Migration and Health Conceptual Framework for Migration and Health. RESULTS In total, 399 studies were included, with almost half (41.1%; 164/399) published in the last five years of the study period between 2015 and 2019 and a third (34.1%; 136/399) conducted in London. Studies included asylum seekers (14.8%; 59/399), refugees (12.3%; 49/399), and undocumented migrants or migrants with insecure status (3.5%; 14/399), but most articles (74.9%; 299/399) did not specify a migrant sub-group. The most studied health topics were specific disease outcomes such as infectious diseases (24.1% of studies) and mental health (19.1%) compared to examining systems or structures that impact health (27.8%), access to healthcare (26.3%), or specific exposures or behaviours (35.3%). CONCLUSIONS There has been a growing interest in migration health. Ensuring a diverse geographic distribution of research conducted in the UK and disaggregation by migrant sub-group is required for a nuanced and region-specific understanding of specific health needs, interventions and appropriate service delivery for different migrant populations. More research is needed to understand how migration policy and legislation intersect with both the social determinants of health and access to healthcare to shape the health of migrants in the UK.
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Affiliation(s)
- Rachel Burns
- Centre of Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, United Kingdom
- Corresponding author at: Centre of Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, United Kingdom.
| | - Claire X. Zhang
- Centre of Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, United Kingdom
- Public Health England, Wellington House, 133-155 Waterloo Rd, South Bank, London SE1 8UG, United Kingdom
| | - Parth Patel
- Centre of Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, United Kingdom
| | - Ida Eley
- Centre of Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, United Kingdom
| | - Ines Campos-Matos
- Public Health England, Wellington House, 133-155 Waterloo Rd, South Bank, London SE1 8UG, United Kingdom
- Collaborative Centre for Inclusion Health, Institute of Epidemiology and Healthcare, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom
| | - Robert W. Aldridge
- Centre of Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London NW1 2DA, United Kingdom
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'Differences between the earth and the sky': migrant parents' experiences of child health services for pre-school children in the UK. Prim Health Care Res Dev 2020; 21:e29. [PMID: 32799953 PMCID: PMC7443772 DOI: 10.1017/s1463423620000213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aim: To explore parents’ experiences of using child health services for their pre-school children post-migration. Background: Migrating between countries necessitates movement and adjustment between systems of healthcare. Children of migrants are known to have poorer health than local children on some measures and are less likely to access primary care. In the United Kingdom (UK), children are offered a preventive Healthy Child programme in addition to reactive services; this programme consists of health reviews and immunisations with some contacts delivered in the home by public health nurses. Methods: Five focus groups were held in a city in South West England. Participants were parents of pre-school children (n = 28) who had migrated to the UK from Romania, Poland, Pakistan or Somalia within the last 10 years. Groups selected included both ‘new migrants’ (from countries which acceded to the European Union in the 2000s) and those from communities long-established in the UK (Somali and Pakistani). One focus group consisted of parents of Roma ethnicity. Interpreters co-facilitated focus groups. Findings: Participants described profound differences between child health services in the UK and in their country of origin, with the extent of difference varying according to nationality and ethnic group. All appreciated services free at the point of delivery and an equitable service offered to all children. Primary care services such as treatment of minor illness and immunisation were familiar, but most parents expected doctors rather than nurses to deliver these. Proactive child health promotion was unfamiliar, and some perceived this service as intruding on parental autonomy. Migrants are not a homogenous group, but there are commonalities in migrant parents’ experiences of UK child health services. When adjusting to a new healthcare system, migrants negotiate differences in service provision and also a changing relationship between family and state.
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Gkiouleka A, Huijts T. Intersectional migration-related health inequalities in Europe: Exploring the role of migrant generation, occupational status & gender. Soc Sci Med 2020; 267:113218. [PMID: 32732096 DOI: 10.1016/j.socscimed.2020.113218] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/13/2019] [Accepted: 07/12/2020] [Indexed: 11/18/2022]
Abstract
Integrating intersectionality theory and employing a quantitative design, the current study explores how migration-related health inequalities in Europe interact with migrant generation, occupational status and gender. Multilevel logistic regression analyses are conducted using pooled data from six waves of the European Social Survey (2004-2014), from 27 countries for two subjective health measures (general self-reported health and hampering conditions). The results reveal multiple relationships of health inequality that operate simultaneously and the complexity through which the combination of social privilege and disadvantage can have a particularly negative impact on individual health. The 'healthy migrant effect' seems to apply particularly for first-generation immigrants working as manual employees, and within occupational categories, in certain cases non-migrant women are more susceptible to poor health than migrant men. This evidence highlights how the health impact of migration is subject to additional dimensions of social positioning as well as the importance of an intersectional perspective for the monitoring of health inequalities in Europe.
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Affiliation(s)
- Anna Gkiouleka
- Department of Sociology, University of York, Wentworth College, Heslington, YO10 5DD, York, UK.
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Aung TNN, Shirayama Y, Moolphate S, Lorga T, Yuasa M, Nyein Aung M. Acculturation and Its Effects on Health Risk Behaviors among Myanmar Migrant Workers: A Cross-Sectional Survey in Chiang Mai, Northern Thailand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5108. [PMID: 32679842 PMCID: PMC7399838 DOI: 10.3390/ijerph17145108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/09/2020] [Accepted: 07/12/2020] [Indexed: 01/31/2023]
Abstract
Thailand hosts many workers who have migrated from neighboring countries and is facing a large burden of non-communicable diseases (NCDs). Health screening for migrant workers routinely emphasizes infectious diseases but overlooks NCDs. We surveyed prevalent health behaviors for NCDs and their influencing factors, particularly cultural adaptation patterns among Myanmar migrant workers in Chiang Mai, Northern Thailand. A total of 414 migrant workers consented to participate in the study. Lack of exercise (75.8%), current alcohol consumption (40.8%), current smoking (26.9%), and central obesity (24.3%) were major lifestyle problems. Being female and uneducated was associated with a lack of exercise. Current alcohol consumption was significantly associated with being male and being of Myanmar ethnicity, with an integrative strategy for acculturation, and with a higher income. Male participants and participants with a lower mean score of marginalization were more likely to smoke. Central obesity was associated with being older than 40 years, being female, engaging in an assimilation strategy, and being uneducated. These findings highlight the need for gender inclusive health promotion, the screening of NCD risk behaviors, and timely health education for migrant workers. It may assist authorities to devise strategies to extend health promotion and universal health coverage to the migrant population.
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Affiliation(s)
- Thin Nyein Nyein Aung
- Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan; (T.N.N.A.); (M.Y.)
| | - Yoshihisa Shirayama
- Faculty of International Liberal Arts, Juntendo University, Tokyo 113-8421, Japan;
| | - Saiyud Moolphate
- Department of Public Health, Faculty of Science and Technology, Chiang Mai Rajabhat University, Chiang Mai 50300, Thailand;
| | - Thaworn Lorga
- School of Nursing, Mae Fah Luang University, Chiang Rai 57000, Thailand;
| | - Motoyuki Yuasa
- Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo 113-8421, Japan; (T.N.N.A.); (M.Y.)
- Faculty of International Liberal Arts, Juntendo University, Tokyo 113-8421, Japan;
| | - Myo Nyein Aung
- Faculty of International Liberal Arts, Juntendo University, Tokyo 113-8421, Japan;
- Advanced Research Institute for Health Sciences, Juntendo University, 2 Chome-1-1 Hongo, Bunkyo City, Tokyo 113-8421, Japan
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Paediatric emergency department utilisation rates and maternal migration status in the Born in Bradford cohort: A cross-sectional study. PLoS Med 2020; 17:e1003043. [PMID: 32126079 PMCID: PMC7053707 DOI: 10.1371/journal.pmed.1003043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/29/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Globally, international migration is increasing. Population growth, along with other demographic changes, may be expected to put new pressures on healthcare systems. Some studies across Europe suggest that emergency departments (EDs) are used more, and differently, by migrants compared to non-migrant populations, which may be a result of unfamiliarity with the healthcare systems and difficulties accessing primary healthcare. However, little evidence exists to understand how migrant parents, who are typically young and of childbearing age, utilise EDs for their children. This study aimed to examine the association between paediatric ED utilisation in the first 5 years of life and maternal migration status in the Born in Bradford (BiB) cohort study. METHODS AND FINDINGS We analysed linked data from the BiB study-an ongoing, multi-ethnic prospective birth cohort study in Bradford. Bradford is a large, ethnically diverse city in the north of England. In 2017, more than a third of births in Bradford were to mothers who were born outside the UK. Between March 2007 and December 2010, pregnant women were recruited to BiB during routine antenatal care, and the children born to these mothers have been, and continue to be, followed over time to assess how social, genetic, environmental, and behavioural factors impact on health from childhood to adulthood. Data analysed in this study included baseline questionnaire data from BiB mothers, and Bradford Royal Infirmary ED episode data for their children. Main outcomes were likelihood of paediatric ED use (no visits versus at least 1 ED visit in the first 5 years of life) and ED utilisation rates (number and frequency of ED visits) for children who have accessed the ED. The main explanatory variable was mother's migrant status (foreign-born versus UK/Irish-born). Multivariable analyses (logistic and zero-truncated negative binomial regression) were conducted adjusting for socio-demographic and socio-economic factors. The final dataset included 10,168 children born between April 2007 and June 2011, of whom 35.6% were born to migrant mothers. Foreign-born mothers originated from South Asia (28.6%), Europe/Central Asia (3.2%), Africa (2.1%), East Asia/Pacific (1.1%), and the Middle East (0.6%). At recruitment the mothers ranged in age from 15 to 49 years old. Overall, 3,104 (30.5%) children had at least 1 ED visit in the first 5 years of life, with the highest proportion of visits being in the first year of life (36.7%). The proportion of children who visited the ED at least once was lower for children of migrant mothers as compared to children of non-migrant mothers (29.4% versus 31.2%). Children of migrant mothers were found to be less likely to visit the ED (odds ratio 0.88 [95% CI 0.80 to 0.97], p = 0.012). However, among children who visited the ED, the utilisation rate was significantly higher for children of migrant mothers (incidence rate ratio [IRR] 1.19 [95% CI 1.01 to 1.40], p = 0.040). Utilisation rates were higher for children born to mothers from Europe (IRR 1.71 [95% CI 1.07 to 2.71], p = 0.024) and established migrants (≥5 years living in UK) (IRR 1.24 [95% CI 1.02 to 1.51], p = 0.032) compared to UK/Irish-born mothers. Important limitations include being unable to measure children's underlying health status and the urgency of ED attendance, as well as the analysis being limited by missing data. CONCLUSIONS In this study we observed that there is no higher likelihood of first paediatric ED attendance in the first 5 years of life for children in the BiB cohort for migrant mothers. However, among ED users, children of migrant mothers attend the service more frequently than children of UK/Irish-born mothers. Our findings show that patterns of ED utilisation differ by mother's region of origin and time since arrival in the UK.
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Delgado-Angulo EK, Zúñiga Abad F, Scambler S, Bernabé E. Is there a healthy migrant effect in relation to oral health among adults in England? Public Health 2020; 181:53-58. [PMID: 31945646 DOI: 10.1016/j.puhe.2019.11.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/04/2019] [Accepted: 11/23/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of the study was to assess the healthy migrant effect in relation to oral health among adults in England. STUDY DESIGN This is a secondary data analysis of a nationally representative survey. METHODS Data from 13,373 adults of Irish, black Caribbean, Indian, Pakistani, Bangladeshi and Chinese ethnicity, who participated in the Health Survey for England, were analysed. The proportions of edentate and dentate adults with toothache in the last 6 months in first- and second-generation migrants within each ethnic group were compared with those in the white British (reference group) ethnic group in logistic regression models after adjusting for demographic factors and socio-economic position. Among first-generation migrants, the associations of age at arrival and length of residence with each oral health outcome were assessed in logistic regression models after adjusting for sociodemographic factors. RESULTS Compared with white British migrants, first-generation black Caribbean (odds ratio [OR]: 1.42) and second-generation Pakistani (OR: 3.16) migrants had higher odds of being edentulous, whereas first-generation Indian (OR: 0.62), Pakistani (OR: 0.62), Bangladeshi (OR: 0.41) and Chinese (OR: 0.49) migrants had lower odds. Among dentate adults, second-generation Irish (OR: 1.51) migrants, first- and second-generation black Caribbean (OR: 1.61 and 1.54, respectively) migrants, first-generation Indian (OR: 1.24) migrants and second-generation Pakistani (OR: 1.34) migrants had higher odds of having toothache in the past 6 months, whereas second-generation Bangladeshi (OR: 0.51) migrants had lower odds than white British. Age at arrival and length of residence were positively associated with being edentulous among first-generation black Caribbean, Pakistani and Bangladeshi migrants. CONCLUSION Evidence on the healthy migrant effect was mixed, with more consistent findings seen for edentulousness among Asian groups. Black Caribbean migrants were generally the ethnic group with the worst oral health when compared with white British.
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Affiliation(s)
- E K Delgado-Angulo
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK; Facultad de Estomatología, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - F Zúñiga Abad
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - S Scambler
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - E Bernabé
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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Bosqui TJ, Kouvonen A, Kawabata Y. Ethnic Inequalities in Psychological Distress: A Population Data Linkage Study on the Pacific Island of Guåhån/Guam. J Immigr Minor Health 2019; 21:1026-1034. [PMID: 30178241 PMCID: PMC6726839 DOI: 10.1007/s10903-018-0815-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Psychological distress and mental illness has been found to be elevated in migrant groups living in sovereign countries, as well as for indigenous people living under colonial or administrative rule. The north Pacific island of Guam is unusual in its ethnic composition as it has no majority ethnic group, has a large indigenous population and remains a territory of the U.S. This study aimed to identify ethnic differences in self-reported psychological distress between the main ethnic groups on Guam. The study uses a cross sectional design with data linkage methodology, drawing on the Guam Census and the Behavioral Risk Factor Surveillance System health survey for Guam. The results showed that the native Chamorro population had worse self-reported psychological distress (defined as a 'mental health condition or emotional problem') than White/Caucasians (OR 2.09, 95% CI 1.52-2.87), particularly for severe distress (OR 3.61, 95% CI 1.33-2.77). This relationship persisted even after adjusting for a wide range of socio-demographic and economic factors (OR 2.58, 95% CI 1.15-5.76). Other Pacific Islanders also had higher psychological distress compared to White/Caucasians, but this association was largely explained by the adjusted factors. The findings are discussed in terms of social and economic disadvantage for Pacific Island peoples on Guam, as well as the impact of colonial administration, disaffection, and lack of autonomy for the Chamorro of Guam. Recommendations are made to improve psychiatric treatment for these groups by considering wider socio-political factors in assessment and treatment, as well as broader implications for the national dialogue on self-determination.
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Affiliation(s)
- Tania J Bosqui
- Division of Social and Behavioural Sciences, UOG Station, University of Guam, Mangilao, Guam.
- Department of Psychology, American University of Beirut, P.O.Box 11-0236, Riad El-Solh, Beirut, 1107 2020, Lebanon.
- Administrative Data Research Centre Northern Ireland (ADRC-NI), Centre for Public Health, Queen's University Belfast, Belfast, UK.
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- SWPS University of Social Sciences and Humanities in Wroclaw, Wroclaw, Poland
- UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
- Administrative Data Research Centre Northern Ireland (ADRC-NI), Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Yoshito Kawabata
- Division of Social and Behavioural Sciences, UOG Station, University of Guam, Mangilao, Guam
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Alloh F, Hemingway A, Turner-Wilson A. Exploring the Experiences of West African Immigrants Living with Type 2 Diabetes in the UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3516. [PMID: 31547169 PMCID: PMC6801552 DOI: 10.3390/ijerph16193516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/09/2019] [Accepted: 09/10/2019] [Indexed: 11/16/2022]
Abstract
The increasing prevalence and poorer management of Type 2 diabetes among West African immigrants in the UK is a public health concern. This research explored the experiences of West African immigrants in the management of Type 2 diabetes in the UK using a constructivist grounded theory approach. In-depth individual interviews were conducted with thirty-four West African immigrants living with Type 2 diabetes in the London area. Fifteen male and nineteen female adult West African immigrants with age range from 33-82 years participated in the study. Participants were recruited from five diabetes support groups and community settings. Initial, focused and theoretical coding, constant comparison and memos were used to analyse collected data. Three concepts emerged: Changing dietary habits composed of participants' experiences in meeting dietary recommendations, improving physical activity concerned with the experience of reduced physical activity since moving to the UK and striving to adapt which focus on the impact of migration changes in living with Type 2 diabetes in the UK. These address challenges that West African immigrants experience in the management of Type 2 diabetes in the UK. The findings of this research provide a better understanding of the influencing factors and can be used to improve the support provided for West Africans living with Type 2 diabetes in the UK, presenting a deeper understanding of socio-cultural factors that contribute to supporting individuals from this population.
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Affiliation(s)
- Folashade Alloh
- Department of Public Health and Human Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH1 3LH, UK.
| | - Ann Hemingway
- Department of Public Health and Human Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH1 3LH, UK.
| | - Angela Turner-Wilson
- Department of Public Health and Human Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth BH1 3LH, UK.
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Condon L, Bedford H, Ireland L, Kerr S, Mytton J, Richardson Z, Jackson C. Engaging Gypsy, Roma, and Traveller Communities in Research: Maximizing Opportunities and Overcoming Challenges. QUALITATIVE HEALTH RESEARCH 2019; 29:1324-1333. [PMID: 30600758 PMCID: PMC7322935 DOI: 10.1177/1049732318813558] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Gypsy, Roma, and Traveller people are marginalized worldwide and experience severe health inequalities, even in comparison to other ethnic minority groups. While diverse and hard to categorize, these communities are highly cohesive and members have a strong sense of identity as a group apart from the majority population. Researchers commonly experience challenges in accessing, recruiting, and retaining research participants from these communities, linked to their outsider status, insular nature, and history of discrimination. In this article, the challenges and the opportunities of engaging Gypsies, Roma, and Travellers in a multicenter qualitative research project are discussed. The management of public involvement and community engagement in this U.K.-based project provides insights into conducting research effectively with ethnically and linguistically diverse communities, often considered to be "hard to reach."
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Affiliation(s)
| | - Helen Bedford
- UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Lana Ireland
- Glasgow Caledonian University, Glasgow, Scotland
| | - Susan Kerr
- Glasgow Caledonian University, Glasgow, Scotland
| | - Julie Mytton
- University of the West of England, Bristol, United Kingdom
| | - Zoe Richardson
- NHS Wakefield Clinical Commissioning Group, Wakefield, United Kingdom
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Moore L, Jayaweera H, Redshaw M, Quigley M. Migration, ethnicity and mental health: evidence from mothers participating in the Millennium Cohort Study. Public Health 2019; 171:66-75. [PMID: 31103615 DOI: 10.1016/j.puhe.2019.03.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 03/21/2019] [Accepted: 03/29/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Over a quarter of UK births are to women who were born outside of the UK. Black and Minority Ethnic (BME) women are disproportionately affected by poor mental health and inequitable access to mental health care in the perinatal period, yet the influence of the migrant status (mothers' UK vs. non-UK birth) is poorly understood. This study aimed to explore the relationship between ethnicity, migration and mental health indicators among mothers participating in a large nationally representative cohort study. STUDY DESIGN This is a secondary analysis of data from the Millennium Cohort Study. METHODS Logistic regression quantified the crude and adjusted effects of self-reported ethnicity and migrant status on prevalence of psychological distress and treatment for anxiety/depression at 9-month and 5-year postpartum. RESULTS We found substantial variation in the prevalence of distress according to ethnicity and migrant status, with Indian and Pakistani women at greatest risk. Despite equal or greater risk, BME and migrant women were less likely to report treatment for anxiety/depression. Mutually adjusted analyses showed ethnicity to be a stronger predictor of both outcomes than migrant status; however, at 5 years, being a migrant independently predicted lower odds of treatment, for a statistically similar level of distress. CONCLUSIONS Migrant women are likely to be at high risk of poor mental health in the perinatal period and beyond, yet may face significant barriers to accessing mental health care. A better understanding of ethnicity and migration as interrelated risk factors for perinatal mental ill-health is needed to help National Health Service organisations develop policy and practice that is flexible and responsive to diversity.
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Affiliation(s)
- L Moore
- Oxford School of Public Health, Old Road Campus, Headington, Oxford OX3 7LF, UK.
| | - H Jayaweera
- School of Anthropology, University of Oxford, 53 Banbury Rd, Oxford OX2 6PF, UK.
| | - M Redshaw
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK.
| | - M Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK.
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Villarroel N, Hannigan A, Severoni S, Puthoopparambil S, MacFarlane A. Migrant health research in the Republic of Ireland: a scoping review. BMC Public Health 2019; 19:324. [PMID: 30894147 PMCID: PMC6425684 DOI: 10.1186/s12889-019-6651-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/12/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Migration to European countries has increased in number and diversity in recent years. Factors such as access to healthcare, language barriers and legal status can impact the health outcomes of migrant groups. However, little is known about the evidence base on the health status of migrants in the Republic of Ireland. Our aim was to scope existing peer-reviewed research on the health of migrants in Ireland and identify any gaps in the evidence. METHODS We conducted a scoping review of peer-reviewed research on the health of migrants in the Republic of Ireland. Eleven electronic databases were searched for peer-reviewed, empirical articles published between 2001 and 2017. Search terms were adapted from a World Health Organisation review. Findings were analysed using the 2016 World Health Organisation Strategy and Action Plan for Refugee and Migrant Health in the World Health Organisation European region, which outlines nine strategic areas that require collaborative action. RESULTS Of 9396 articles retrieved, 80 met inclusion criteria, with the majority (81%) published since 2009. More than half of the studies had a quantitative design (65%). Migrants studied came from Eastern Europe, Asia and Africa and included labour migrants, refugees and asylum seekers. Most studies related to two World Health Organisation strategic areas; 4: "achieving public health preparedness and ensuring an effective response", and 5: "strengthening health systems and their resilience". CONCLUSION There is growing attention to migrant health in Ireland with a balance of qualitative and quantitative research. While much of the identified research is relevant to three of the World Health Organisation strategic areas, there are significant gaps in the other six areas. The study design could be replicated in other countries to examine and inform migrant health research.
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Affiliation(s)
- Nazmy Villarroel
- The Graduate Entry Medical School, University Of Limerick Campus, Plassey Park Road, Castletroy Co., Limerick, V94T9PX Ireland
| | - Ailish Hannigan
- The Graduate Entry Medical School, University Of Limerick Campus, Plassey Park Road, Castletroy Co., Limerick, V94T9PX Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Santino Severoni
- Migration and Health programme, Division of Policy and Governance for Health and Well-being, WHO Regional Office for Europe, København, Denmark
| | - Soorej Puthoopparambil
- The Graduate Entry Medical School, University Of Limerick Campus, Plassey Park Road, Castletroy Co., Limerick, V94T9PX Ireland
- Migration and Health programme, Division of Policy and Governance for Health and Well-being, WHO Regional Office for Europe, København, Denmark
- International Maternal and Child Health (IMCH), Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Anne MacFarlane
- The Graduate Entry Medical School, University Of Limerick Campus, Plassey Park Road, Castletroy Co., Limerick, V94T9PX Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Gazard B, Chui Z, Harber-Aschan L, MacCrimmon S, Bakolis I, Rimes K, Hotopf M, Hatch SL. Barrier or stressor? The role of discrimination experiences in health service use. BMC Public Health 2018; 18:1354. [PMID: 30526564 PMCID: PMC6286602 DOI: 10.1186/s12889-018-6267-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 11/26/2018] [Indexed: 01/01/2023] Open
Abstract
Background Discrimination is a well-established stressor that is substantially associated with poor health and a known contributor to health inequalities. However, the role of discrimination in health service use is less explored. This study will take an intersectional approach to investigate differences in health service use and examine the role of discrimination experiences. Methods Data on health service use were assessed in a diverse inner London sample of 1052 participants in the South East London Community Health (SELCoH) Study. Latent class analysis (LCA) was used to define classes of intersectional social status using multiple indicators of socioeconomic status (SES), ethnicity and migration status. Adjusted associations between intersectional social status and discrimination experiences with health service use indicators are presented. Results Using latent class analysis allowed us to identify an intersectional social status characterized by multiple disadvantage that was associated with decreased secondary physical health service use and a class characterized by both privilege and disadvantage that was associated with increased health service use for mental disorder after controlling for age, gender and health status. Anticipated discrimination was also associated with increased service use for mental disorder in adjusted models. There was no evidence to suggest that discrimination experiences were acting as a barrier to health service use. Conclusions This study highlights the complex ways in which discrimination experiences may increase the need for health services whilst also highlighting differences in health service use at the intersection of ethnicity, migration status and SES. Findings from this study illustrate the importance of measuring multiple levels of discrimination and taking an intersectional approach for health service use research.
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Affiliation(s)
- Billy Gazard
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK.
| | - Zoe Chui
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK
| | - Lisa Harber-Aschan
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Shirlee MacCrimmon
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK
| | - Ioannis Bakolis
- Centre for Implementation Science, Health Services and Population Research Department, Psychology and Neuroscience, Institute of Psychiatry, King's College London, London, UK.,Department of Biostatistics and Health Informatics, Psychology and Neuroscience, Institute of Psychiatry, King's College London, London, UK
| | - Katharine Rimes
- Psychology and Neuroscience, King's College London, Psychology, Institute of Psychiatry, London, UK
| | - Matthew Hotopf
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephani L Hatch
- Psychological Medicine, Psychology and Neuroscience, King's College London, Institute of Psychiatry, London, UK
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Taking an intersectional approach to define latent classes of socioeconomic status, ethnicity and migration status for psychiatric epidemiological research. Epidemiol Psychiatr Sci 2018; 27:589-600. [PMID: 28390448 PMCID: PMC6998994 DOI: 10.1017/s2045796017000142] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
AIMS Inequalities in mental health are well documented using individual social statuses such as socioeconomic status (SES), ethnicity and migration status. However, few studies have taken an intersectional approach to investigate inequalities in mental health using latent class analysis (LCA). This study will examine the association between multiple indicator classes of social identity with common mental disorder (CMD). METHODS Data on CMD symptoms were assessed in a diverse inner London sample of 1052 participants in the second wave of the South East London Community Health study. LCA was used to define classes of social identity using multiple indicators of SES, ethnicity and migration status. Adjusted associations between CMD and both individual indicators and multiple indicators of social identity are presented. RESULTS LCA identified six groups that were differentiated by varying levels of privilege and disadvantage based on multiple SES indicators. This intersectional approach highlighted nuanced differences in odds of CMD, with the economically inactive group with multiple levels of disadvantage most likely to have a CMD. Adding ethnicity and migration status further differentiated between groups. The migrant, economically inactive and White British, economically inactive classes both had increased odds of CMD. CONCLUSIONS This is the first study to examine the intersections of SES, ethnicity and migration status with CMD using LCA. Results showed that both the migrant, economically inactive and the White British, economically inactive classes had a similarly high prevalence of CMD. Findings suggest that LCA is a useful methodology for investigating health inequalities by intersectional identities.
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Ma S, Zhou X, Jiang M, Li Q, Gao C, Cao W, Li L. Comparison of access to health services among urban-to-urban and rural-to-urban older migrants, and urban and rural older permanent residents in Zhejiang Province, China: a cross-sectional survey. BMC Geriatr 2018; 18:174. [PMID: 30081826 PMCID: PMC6091183 DOI: 10.1186/s12877-018-0866-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 07/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While much literature reported the access of Chinese older migrants to health services, little was known about the differences among sub-groups of older adults, including urban-to-urban and rural-to-urban migrants, and urban and rural permanent residents. This study aimed to examine the access of these four groups to health services in Zhejiang Province, China and provide an evidence for the development of health services policies. METHODS A cross-sectional survey was conducted in community-dwelling older adults (aged 60 years or above) in 2013. Participants were recruited by random sampling. Demographic information and access to health services for the elderly populations were obtained via interviews using a self-designed structured questionnaire. Pearson's chi-square tests and Cochran-Mantel-Haenszel (CMH) tests were performed to examine the differences in access to health services among the four groups. Binary logistic regression was conducted to explore the associations of participants' visits to doctors with their group status after controlling confounding factors. RESULTS The two-week hospital visiting rates were significantly lower in migrants (55.56% in rural-to-urban and 62.50% in urban-to-urban) than that in urban and rural permanent residents (67.40 and 82.25%, respectively; p < 0.01). The majority of older adults who received a diagnosis indicating need for hospital treatment accepted the treatment, with no significant difference among the four groups after controlling for health service need (χ2 = 7.08, p = 0.07). On the other hand, 30.05% of the older adults did not visit a doctor when they got ailments in the past 2 weeks prior to the survey, and 16.42% (33/201) did not receive hospital treatment after receiving a diagnosis indicating need for hospital treatment. Factors including age, marital status, educational attainment, major financial source, and living with family members did not influence health services use. CONCLUSIONS Targeted social and health policies integrating the strengths of government, society and families should be implemented to further improve health services use for different groups of older adults.
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Affiliation(s)
- Sha Ma
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou, Zhejiang Province 310058 People’s Republic of China
| | - Xudong Zhou
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou, Zhejiang Province 310058 People’s Republic of China
| | - Minmin Jiang
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou, Zhejiang Province 310058 People’s Republic of China
| | - Qiuju Li
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou, Zhejiang Province 310058 People’s Republic of China
| | - Chao Gao
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou, Zhejiang Province 310058 People’s Republic of China
| | - Weiming Cao
- School of Humanities and Social Sciences, Zhejiang Chinese Medical University, Gaoke Road, Fuyang District, Zhejiang Province 311402 People’s Republic of China
| | - Lu Li
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Road, Xihu District, Hangzhou, Zhejiang Province 310058 People’s Republic of China
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Mollah TN, Antoniades J, Lafeer FI, Brijnath B. How do mental health practitioners operationalise cultural competency in everyday practice? A qualitative analysis. BMC Health Serv Res 2018; 18:480. [PMID: 29925366 PMCID: PMC6011345 DOI: 10.1186/s12913-018-3296-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 06/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite continued policy and research emphasis to deliver culturally competent mental healthcare, there is: (1) limited evidence about what frontline practitioners consider to be culturally competent care and; (2) what helps or hinders them in delivering such care in their everyday practice. The aims of this article are to address these gaps. METHODS Qualitative in-depth interviews were conducted with 20 mental health practitioners working with immigrant patients to explore their understandings and experiences of culturally competent care. Interviews were conducted between September 2015 and February 2016 in the state of Victoria, Australia. Data were thematically analysed. RESULTS There were common understandings of cultural competence but its operationalisation differed by profession, health setting, locality, and years of experience; urban psychiatrists were more functional in their approach and authoritarian in their communication with patients compared to allied health staff in non-specialist mental health settings, in rural areas, with less years of experience. Different methods of operationalising cultural competence translated into complex ways of building cultural concordance with patients, also influenced by health practitioners' own cultural background and cultural exposures. Limited access to interpreters and organisational apathy remain barriers to promoting cultural competency whereas organisational support, personal motivation, and professional resilience remain critical facilitators to sustaining cultural competency in everyday practice. CONCLUSION While there is need for widespread cultural competence teaching to all mental health professionals, this training must be specific to different professional needs, health settings, and localities of practice (rural or urban). Experiential teaching at tertiary level or professional development programs may provide an avenue to improve the status quo but a 'one-size-fits-all' model is unlikely to work.
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Affiliation(s)
- Tooba Noor Mollah
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Josefine Antoniades
- Division of Social Gerontology, National Ageing Research Institute Ltd, PO Box 2127, Royal Melbourne Hospital, Melbourne, 3050, Australia
| | - Fathima Ijaza Lafeer
- Division of Social Gerontology, National Ageing Research Institute Ltd, PO Box 2127, Royal Melbourne Hospital, Melbourne, 3050, Australia
| | - Bianca Brijnath
- Department of General Practice, School of Primary Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Australia. .,Division of Social Gerontology, National Ageing Research Institute Ltd, PO Box 2127, Royal Melbourne Hospital, Melbourne, 3050, Australia.
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Social Hazards as Manifested Workplace Discrimination and Health (Vietnamese and Ukrainian Female and Male Migrants in Czechia). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14101207. [PMID: 28994700 PMCID: PMC5664708 DOI: 10.3390/ijerph14101207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/14/2017] [Accepted: 10/02/2017] [Indexed: 01/18/2023]
Abstract
Social hazards as one of the dimensions of workplace discrimination are a potential social determinant of health inequalities. The aim of this study was to investigate relations between self-reported health and social hazard characteristics (defined as—discrimination as such, violence or threat of violence, time pressure or work overload and risk of accident) among Vietnamese and Ukrainian migrants (males and females) in Czechia by age, education level and marital status. This study is based on data from a survey of 669 immigrants in Czechia in 2013. Logistic regression analysis indicates that the given independent variables (given social hazards and socio-demographic characteristics), as predictors of a quality of self-reported health are more important for immigrant females than for males, irrespective of citizenship, albeit only for some of them and to differing extents. We found out that being exposed to the selected social hazards in the workplace leads to worsening self-rated health, especially for females. On the other hand, there was no statistically significant relationship found between poor self-rated health and discrimination as such. Reality calls for more research and, consequently, better policies and practices in the field of health inequalities.
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Sarría-Santamera A, Hijas-Gómez AI, Carmona R, Gimeno-Feliú LA. A systematic review of the use of health services by immigrants and native populations. Public Health Rev 2016; 37:28. [PMID: 29450069 PMCID: PMC5810113 DOI: 10.1186/s40985-016-0042-3] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 11/09/2016] [Indexed: 12/02/2022] Open
Abstract
Background Changes in migration patterns that have occurred in recent decades, both quantitative, with an increase in the number of immigrants, and qualitative, due to different causes of migration (work, family reunification, asylum seekers and refugees) require constant u pdating of the analysis of how immigrants access health services. Understanding of the existence of changes in use patterns is necessary to adapt health services to the new socio-demographic reality. The aim of this study is to describe the scientific evidence that assess the differences in the use of health services between immigrant and native populations. Methods A systematic review of the electronic database MEDLINE (PubMed) was conducted with a search of studies published between June 2013 and February 2016 that addressed the use of health services and compared immigrants with native populations. MeSH terms and key words comprised Health Services Needs and Demands/Accessibility/Disparities/Emigrants and Immigrants/Native/Ethnic Groups. The electronic search was supplemented by a manual search of grey literature. The following information was extracted from each publication: context of the study (place and year), characteristics of the included population (definition of immigrants and their sub-groups), methodological domains (design of the study, source of information, statistical analysis, variables of health care use assessed, measures of need, socio-economic indicators) and main results. Results Thirty-six publications were included, 28 from Europe and 8 from other countries. Twenty-four papers analysed the use of primary care, 17 the use of specialist services (including hospitalizations or emergency care), 18 considered several levels of care and 11 assessed mental health services. The characteristics of immigrants included country of origin, legal status, reasons for migration, length of stay, different generations and socio-demographic variables and need. In general, use of health services by the immigrants was less than or equal to the native population, although some differences between immigrants were also identified. Conclusions This review has identified that immigrants show a general tendency towards a lower use of health services than native populations and that there are significant differences within immigrant sub-groups in terms of their patterns of utilization. Further studies should include information categorizing and evaluating the diversity within the immigrant population.
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Affiliation(s)
- Antonio Sarría-Santamera
- Red de Investigación en Servicios de Salud y Enfermedades Crónicas, Madrid, Spain.,2National School of Public Health, Institute of Health Carlos III, Madrid, Spain.,IMIENS, UNED, Madrid, Spain.,4Faculty of Medicine, University of Alcalá, Alcalá, Spain
| | - Ana Isabel Hijas-Gómez
- University Hospital Fundación Alcorcón, Alcorcón, Spain.,6Agency for Health Technology Assessment, Institute of Health Carlos III, Madrid, Spain
| | - Rocío Carmona
- 2National School of Public Health, Institute of Health Carlos III, Madrid, Spain.,IMIENS, UNED, Madrid, Spain
| | - Luís Andrés Gimeno-Feliú
- Red de Investigación en Servicios de Salud y Enfermedades Crónicas, Madrid, Spain.,7EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), IIS Aragón, Zaragoza, Spain.,San Pablo Health Centre, Aragonese Health Service, Zaragoza, Spain.,9Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
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Veenstra G, Patterson AC. South Asian-White health inequalities in Canada: intersections with gender and immigrant status. ETHNICITY & HEALTH 2016; 21:639-648. [PMID: 27133779 DOI: 10.1080/13557858.2016.1179725] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES We apply intersectionality theory to health inequalities in Canada by investigating whether South Asian-White health inequalities are conditioned by gender and immigrant status in a synergistic way. DESIGN Our dataset comprised 10 cycles (2001-2013) of the Canadian Community Health Survey. Using binary logistic regression modeling, we examined South Asian-White inequalities in self-rated health, diabetes, hypertension and asthma before and after controlling for potentially explanatory factors. Models were calculated separately in subsamples of native-born women, native-born men, immigrant women and immigrant men. RESULTS South Asian immigrants had higher odds of fair/poor self-rated health, diabetes and hypertension than White immigrants. Native-born South Asian men had higher odds of fair/poor self-rated health than native-born White men and native-born South Asian women had lower odds of hypertension than native-born White women. Education, household income, smoking, physical activity and body mass index did little to explain these associations. The three-way interaction between racial identity, gender and immigrant status approached statistical significance for hypertension but not for self-rated health and asthma. CONCLUSION Our findings provide modest support for the intersectionally inspired principle that combinations of identities derived from race, gender and nationality constitute sui generis categories in the manifestation of health outcomes.
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Affiliation(s)
- Gerry Veenstra
- a Department of Sociology , University of British Columbia , Vancouver , Canada
| | - Andrew C Patterson
- b Prentice Institute for Global Population and Economy, University of Lethbridge , Lethbridge , Canada
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Patterson AC, Veenstra G. Black-White health inequalities in Canada at the intersection of gender and immigration. Canadian Journal of Public Health 2016; 107:e278-e284. [PMID: 27763843 DOI: 10.17269/cjph.107.5336] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 04/27/2016] [Accepted: 02/14/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Intersectionality theory proposes that each combination of social categories derived from gender, race and nationality, such as immigrant White man or native-born Black woman, is associated with unique social experiences. We tested the potential of intersectionality theory for explicating racial inequalities in Canada by investigating whether Black-White health inequalities are conditioned by gender and immigrant status in a synergistic way. METHODS Our dataset comprised 10 cycles (2001-2013) of the Canadian Community Health Survey. We used binary logistic regression to model Black- White inequalities in hypertension, diabetes, self-rated health, self-rated mental health and asthma separately for native-born women, native-born men, immigrant women and immigrant men. RESULTS After controlling for potentially confounding factors we found that immigrant Black women had significantly higher odds of hypertension, diabetes and fair/poor self-rated health than immigrant White women. Native-born Black women and immigrant Black men had higher odds of hypertension and diabetes than native-born White women and immigrant White men respectively, and native-born White women were more likely than native-born Black women to report asthma. There were no statistically significant health differences between native-born Black and White men. Socio-economic status, smoking, physical activity and body mass index were implicated in some but not all of these racial health inequalities. None of the three-way interactions between racial identity, gender and immigration status was statistically significant. CONCLUSION We found relatively high risks of ill health for Black Canadians in three of the four samples. Overall, however, we found little support for the intersectional hypothesis that Black-White health inequalities in Canada are conditioned by gender and immigrant status in a synergistic way.
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Affiliation(s)
- Andrew C Patterson
- Prentice Institute for Global Population and Economy, University of Lethbridge, Lethbridge, AB.
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Hatch SL, Gazard B, Williams DR, Frissa S, Goodwin L, Hotopf M. Discrimination and common mental disorder among migrant and ethnic groups: findings from a South East London Community sample. Soc Psychiatry Psychiatr Epidemiol 2016; 51:689-701. [PMID: 26875153 PMCID: PMC4846681 DOI: 10.1007/s00127-016-1191-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 02/01/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Few studies have examined discrimination and mental health in the UK, particularly by migrant status and in urban contexts with greater demographic diversity. This study aims to (1) describe the prevalence of discrimination experiences across multiple life domains; (2) to describe associations between discrimination experiences and common mental disorder (CMD); (3) to determine whether or not the relationship between discrimination and CMD varies by migrant status and ethnicity. METHODS Data on major, anticipated and everyday discrimination and CMD symptoms were collected from an ethnically diverse prospective sample of 1052 participants followed up from 2008 to 2013 in the South East London Community Health study, a population-based household survey. RESULTS With few exceptions, discrimination was most prevalent among those in the Black Caribbean group. However, those in the White Other ethnic group had similar or greater reporting major and anticipated discrimination to Black or mixed ethnic minority groups. The effects of discrimination on CMD were most pronounced for individuals who had recently migrated to the UK, an ethnically heterogeneous group, and for Black and Mixed ethnic minority groups in partially adjusted models. Prior CMD accounted for differences between the Mixed and White British ethnic groups, but the strength of the association for the most recent migrant group and the Black ethnic groups remained two or more times greater than the reference groups. CONCLUSIONS The strength of the relationship suggests a need for more consideration of migration status along with ethnicity in examining the impact of discrimination on mental disorder in community and clinical samples.
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Affiliation(s)
- S. L. Hatch
- />Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, 10 Cutcombe Road, London, SE5 9RJ UK
| | - B. Gazard
- />Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, 10 Cutcombe Road, London, SE5 9RJ UK
| | - D. R. Williams
- />Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA
| | - S. Frissa
- />Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, 10 Cutcombe Road, London, SE5 9RJ UK
| | - L. Goodwin
- />Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, 10 Cutcombe Road, London, SE5 9RJ UK
| | - SELCoH Study Team
- />Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, 10 Cutcombe Road, London, SE5 9RJ UK
| | - M. Hotopf
- />Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, 10 Cutcombe Road, London, SE5 9RJ UK
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Mousaid S, De Moortel D, Malmusi D, Vanroelen C. New perspectives on occupational health and safety in immigrant populations: studying the intersection between immigrant background and gender. ETHNICITY & HEALTH 2015; 21:251-267. [PMID: 26166550 DOI: 10.1080/13557858.2015.1061103] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Few studies investigating health inequalities pay attention to the intersection between several social determinants of health. The purpose of this article is to examine the relation between perceptions of work-related health and safety risk (WHSR) and (1) immigrant background and (2) gender in the EU-15. The effects are controlled for educational attainment, the quality of work (QOW) and occupation. DESIGN Pooled data from the European Social Survey 2004 and 2010 are used in this study. The sample is restricted to respondents of working age (16-65 years) (N = 17,468). The immigrants are divided into two groups according to their country of origin: (semi-)periphery and core countries. Both groups of immigrants are compared to natives. Additionally, the research population is stratified by gender. Descriptive statistics and logistic regression analyses are used. RESULTS Core immigrants (both men and women) do not differ from natives in terms of QOW. (Semi-)periphery immigrants (both men and women) are employed in jobs with lower QOW. While no differences in WHSR are found among men, female immigrants (both (semi-)periphery and core) have significantly more WHSR compared to native women. Although WHSR is generally lower in women, (semi-)periphery women have a similar prevalence of WHSR as men. CONCLUSION (Semi-)periphery immigrants are employed in lower quality jobs, while core immigrants do not differ from natives in that regard. Female immigrant workers--especially those from (semi-)periphery countries--have higher WHSR compared to native women. Our findings highlight the importance of an intersectional approach in the study of work-related health inequalities.
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Affiliation(s)
- Sarah Mousaid
- a Interface Demography , Vrije Universiteit Brussel , Brussels , Belgium
| | - Deborah De Moortel
- a Interface Demography , Vrije Universiteit Brussel , Brussels , Belgium
| | - Davide Malmusi
- b Agència de Salut Pública de Barcelona - IIB Sant Pau , Barcelona , Spain
- c Biomedical Research Network in Epidemiology and Public Health (CIBERESP) , Madrid , Spain
| | - Christophe Vanroelen
- a Interface Demography , Vrije Universiteit Brussel , Brussels , Belgium
- d Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS\Emconet) , Universitat Pompeu Fabra , Barcelona , Spain
- e Research Foundation Flanders , Brussels , Belgium
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