Social inequality in physical and mental health comorbidity dynamics

Early-life socioeconomic circumstances and the comorbidity of depression and overweight in adolescence and young adulthood: A prospective study

Depression and overweight both often emerge early in life and have been found to be associated, but few studies examine depression-overweight comorbidity and its social patterning early in the life course. Drawing on data from 4,948 participants of the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort from the UK (2,798 female, 2,150 male), we investigated how different aspects of early-life socioeconomic circumstances are associated with depression-overweight comorbidity from adolescence to young adulthood exploring any differences by age and sex. We estimated how parental education, social class and financial difficulties reported in pregnancy were associated with depression and overweight, and their comorbidity at approximately the ages 17 and 24 in males and females. The results from multinomial logistic regression models showed that all three socioeconomic markers were associated with depression-overweight comorbidity and results were similar across age. Lower parental education (relative risk ratio (RRR) and 95% confidence interval (CI) of low education v high education: 3.61 (2.30-5.67) in females and 1.54 (1.14-2.07) in males) and social class (class IV/V v class I: 5.67 (2.48-12.94) in females and 3.11 (0.70-13.91) in males) had strong associations with comorbidity at age 17 relative to having neither depression or overweight. Financial difficulties were also a risk factor in females, with less clear results in males. These findings highlight how early socioeconomic circumstances are linked with the accumulation of mental and physical health problems already in adolescence, which has implications for life-long health inequalities.

Comorbid depression and obesity among adults in Germany: Effects of age, sex, and socioeconomic status

BACKGROUND

Depression and obesity are common health problems with major public health implications. These conditions frequently co-occur, adversely affecting the course of the other. The sociodemographic and socioeconomic risk factors for comorbid depression and obesity in the German adult population have not yet been reported.

METHODS

We analyzed the prevalence and sociodemographic and socioeconomic correlates of comorbid depression and obesity using cross-sectional data from the national German health interview and examination survey for adults (DEGS1; n = 7987) and its mental health module (DEGS1-MH; n = 4493). The Composite International Diagnostic Interview was used to diagnose major depressive disorder (CIDI-MDD). Sensitivity was analyzed using the self-reported depression measure and current depressive symptoms measured by Patient Health Questionnaire-9 (PHQ-9). Obesity was defined by body mass index calculated from measured data.

RESULTS

Prevalence of comorbid depression and obesity was 1.3% (95% CI 0.8-2.0) in men and 2.0% (95% CI 1.3-3.0) in women. We found significant sex differences in results from the self-reported depression measure and the PHQ-9, but not from the CIDI-MDD. Low socioeconomic status and poor social support were linked to a higher prevalence of comorbid depression and obesity among women.

LIMITATIONS

Severe depression may have been underreported.

CONCLUSIONS

Depression is statistically more prevalent in women than in men, which accounts for many of the sex differences in the prevalence of comorbid depression and obesity in our models. Targeted public health strategies need to be developed to prevent and treat comorbid depression and obesity in women with a low socioeconomic position.

Theory driven analysis of social class and health outcomes using UK nationally representative longitudinal data

BACKGROUND

Social class is frequently used as a means of ranking the population to expose inequalities in health, but less often as a means of understanding the social processes of causation. We explored how effectively different social class mechanisms could be measured by longitudinal cohort data and whether those measures were able to explain health outcomes.

METHODS

Using a theoretically informed approach, we sought to map variables within the National Child Development Study (NCDS) to five different social class mechanisms: social background and early life circumstances; habitus and distinction; exploitation and domination; location within market relations; and power relations. Associations between the SF-36 physical, emotional and general health outcomes at age 50 years and the social class measures within NCDS were then assessed through separate multiple linear regression models. R2 values were used to quantify the proportion of variance in outcomes explained by the independent variables.

RESULTS

We were able to map the NCDS variables to the each of the social class mechanisms except 'Power relations'. However, the success of the mapping varied across mechanisms. Furthermore, although relevant associations between exposures and outcomes were observed, the mapped NCDS variables explained little of the variation in health outcomes: for example, for physical functioning, the R2 values ranged from 0.04 to 0.10 across the four mechanisms we could map.

CONCLUSIONS

This study has demonstrated both the potential and the limitations of available cohort studies in measuring aspects of social class theory. The relatively small amount of variation explained in the outcome variables in this study suggests that these are imperfect measures of the different social class mechanisms. However, the study lays an important foundation for further research to understand the complex interactions, at various life stages, between different aspects of social class and subsequent health outcomes.

Social inequalities in the burden of care: a dyadic analysis in the caregiving partners of persons with a physical disability

BACKGROUND

Socioeconomic position (SEP) is an important contextual factor in the Stress Process Model of caregiving. However, the basic assumption that low SEP is associated with greater caregiver burden has so far lacked empirical support. The objective of this study was to investigate social inequalities in the caregiver burden among caregiving partners of persons with a physical disability, i.e., spinal cord injury (SCI), applying a dyadic approach. More specifically, we investigated 1) the association of the caregivers' SEP with caregiver burden ('actor effect'); 2) the association of the care-receivers' SEP with caregiver burden ('partner effect'), and 3) potential mediators of the association between SEP and caregiver burden.

METHODS

Cross-sectional survey data from 118 couples of persons with SCI and their partners living in Switzerland was used. We firstly employed logistic regression to investigate the actor and partner effects of SEP on objective (hours of caregiving) and subjective caregiver burden (Zarit Burden Interview). We additionally used structural equation modelling to explore whether unfulfilled support needs, psychosocial resources and the care-receivers health status mediated the association between SEP and caregiver burden. SEP was operationalized by household income, education, subjective social position, financial strain and home ownership.

RESULTS

We observed a consistent trend towards higher objective and subjective burden in lower SEP groups. Caregivers with higher subjective social positon and home ownership indicated lower subjective burden, and caregivers with higher education and absence of financial strain reported lower objective burden. Further evidence suggested a partner effect of SEP on caregiver burden, whereby objective caregiver burden was reduced in couples where the care-receiver had a higher educational level. The negative association between SEP and subjective burden was partially mediated by the unfulfilled support needs and deprived psychological resources of the caregiver, and the poor health status of the care-receiver. Similar mediation effects were not supported for objective burden.

CONCLUSIONS

Our study, in the context of SCI, provides support for the contextual role of SEP in the Stress Process Model of caregiving. To reduce subjective caregiver burden, policy programs may target the strengthening of psychosocial resources, or the improvement of access to support services for caregivers with low SEP.

Early-life socioeconomic circumstances explain health differences in old age, but not their evolution over time

BACKGROUND

Early-life socioeconomic circumstances (SEC) are associated with health in old age. However, epidemiological evidences on the influence of these early-life risk factors on trajectories of healthy ageing are inconsistent, preventing drawing solid conclusion about their potential influence. Here, to fill this knowledge gap, we used a statistical approach adapted to estimating change over time and an outcome-wide epidemiology approach to investigate whether early-life SEC were associated with the level of and rate of decline of physical, cognitive and emotional functioning over time.

METHODS

We used data on more than 23 000 adults in older age from the Survey of Health, Ageing and Retirement in Europe, a 12-year large-scale longitudinal study with repeated measurements of multiple health indicators of the same participants over time (2004 -2015, assessments every 2 years). Confounder-adjusted linear growth curve models were used to examine the associations of early-life SEC with the evolution of muscle strength, lung function, cognitive function, depressive symptoms and well-being over time.

RESULTS

We consistently found an association between early-life SEC and the mean levels of all health indicators at age 63.5, with a critical role played by the cultural aspect of disadvantage. These associations were only partly explained by adult-life SEC factors. By contrast, evidences supporting an association between early-life SEC and the rate of change in health indicators were weak and inconsistent.

CONCLUSIONS

Early-life SEC are associated with health in old age, but not with trajectories of healthy ageing. Conceptual models in life course research should consider the possibility of a limited influence of early-life SEC on healthy ageing trajectories.

Physical, psychosocial, and social health of men who identify as bears: a systematic review

AIMS AND OBJECTIVES

This article examines the existing qualitative and quantitative research on physical, psychosocial and social health of men who identify as Bears, a subcultural group in the gay community.

BACKGROUND

During the 1980s, one of the first Bear communities emerged in San Francisco. Using the United States as an example, other Bear communities were created throughout the world. Today, Bear-related organizations and events are found globally.

METHODS

A systematic review was conducted exploring the health of men who identify as Bears.

DESIGN

To identify articles addressing the health outcomes of men who identify as Bears, the researcher systematically reviewed articles indexed through CINAHL, PsycINFO, Humanities International Index, Cochrane Library, Medline, and LGBT Life.

RESULTS

The major findings across the 11 articles were systematically grouped into physical, psychosocial, and social health categories. Men identifying as Bears were more likely to have a higher body mass index, engage in risky sexual behaviours and have a lower self-esteem.

CONCLUSIONS

Future implications for research and practice regarding the health of men who identify as Bears are addressed.

RELEVANCE TO CLINICAL PRACTICE

Men who identify as Bears have unique health care needs and respond to health care providers who are sensitive towards their needs. Health care providers should understand and acknowledge the unique health needs of men who identify as Bears to better care for these men.

Country specific associations between social contact and mental health: evidence from civil servant studies across Great Britain, Japan and Finland

OBJECTIVES

Little is known about which component, such as social contact of social networks is associated with mental health or whether such an association can be observed across countries. This study examined whether the association between frequent social contact and mental health differs by composition (relatives or friends) and whether the associations are similar across three occupational cohorts from Great Britain, Japan, and Finland.

STUDY DESIGN

Cross-sectional analysis of data from three prospective cohort studies.

METHODS

Participants were civil servants of a prospective cohort study based in London (Men: n = 4519; Women: n = 1756), in the West Coast of Japan (Men: n = 2571; Women: n = 1102), and in Helsinki, Finland (Men: n = 1181; Women: n = 5633); we included the information on study variables which is complete. Mental health function was the study outcome, indicated by the total score from the Mental Health Component on the Short Form Health Survey36. Participants reported frequencies of contacts with their relatives or friends via a questionnaire. Age, marital status, and occupational position were treated as confounders in this study.

RESULTS

Findings from multiple regression showed that the associations between social contact and mental health function were different depending on country of origin and gender. Among British or Japanese men, frequent contact with both friends and relatives was positively associated with their mental health function, while only social contact with friends was significantly associated with mental health of Finnish men. In women, the patterns of the associations between social contact and mental health were more distinctive: friends for Great Britain, relatives for Japan, and friends and relatives for Finland. These significant associations were independent of the confounders.

CONCLUSIONS

Social contact was related to mental health of working people; however, culture and gender are likely to be tapped into.

Absolute and Relative Socioeconomic Health Inequalities across Age Groups

Background

The magnitude of socioeconomic health inequalities differs across age groups. It is less clear whether socioeconomic health inequalities differ across age groups by other factors that are known to affect the relation between socioeconomic position and health, like the indicator of socioeconomic position, the health outcome, gender, and as to whether socioeconomic health inequalities are measured in absolute or in relative terms. The aim is to investigate whether absolute and relative socioeconomic health inequalities differ across age groups by indicator of socioeconomic position, health outcome and gender.

Methods

The study sample was derived from the baseline measurement of the LifeLines Cohort Study and consisted of 95,432 participants. Socioeconomic position was measured as educational level and household income. Physical and mental health were measured with the RAND-36. Age concerned eleven 5-years age groups. Absolute inequalities were examined by comparing means. Relative inequalities were examined by comparing Gini-coefficients. Analyses were performed for both health outcomes by both educational level and household income. Analyses were performed for all age groups, and stratified by gender.

Results

Absolute and relative socioeconomic health inequalities differed across age groups by indicator of socioeconomic position, health outcome, and gender. Absolute inequalities were most pronounced for mental health by household income. They were larger in younger than older age groups. Relative inequalities were most pronounced for physical health by educational level. Gini-coefficients were largest in young age groups and smallest in older age groups.

Conclusions

Absolute and relative socioeconomic health inequalities differed cross-sectionally across age groups by indicator of socioeconomic position, health outcome and gender. Researchers should critically consider the implications of choosing a specific age group, in addition to the indicator of socioeconomic position and health outcome, as findings on socioeconomic health inequalities may differ between them.

Bifurcating effects of hope and support in short- and long-term health outcomes among primary care patients without mental illness

RATIONALE

Adverse life events and stressors can lead to symptoms, increased alcohol intake, and impaired functional status, while hope and social support can mitigate such adverse effects. Yet, there is reason to question such simple, linear relationships among healthy adults. The purpose of this study was to assess whether short-term or long-term changes in alcohol intake, psychological symptoms or functional status were better modelled as cusp catastrophic or linear processes among primary care patients without mental illness.

METHODS

This secondary analysis of a study on the stability of psychological symptoms among primary care patients without mental disorders included 38 subjects who completed baseline, and 2-month and/or 6-month assessments of psychological symptoms, functional status and stressors as well as hope and social support. The analyses modelled short-term and long-term changes in alcohol intake, psychological symptoms and functional status using cusp catastrophe (CCM) and linear modelling.

RESULTS

Overall, four of the nine 2-month analyses found CCM superior to linear models; however, only one 6-month analysis (alcohol intake) found that CCM was superior. The 2-month cusp phenomena included both symptomatology and functional status. The asymmetry variables were often not significant in the CCM models; in fact, only distress was significant at all. While hope was a significant bifurcation variable at both the 2-month and 6-month levels, social support was a significant bifurcation variable for three of the four 2-month CCMs.

CONCLUSION

In conclusion, while 6-month outcomes were rarely explained through CCM, half of 2-month outcomes were. Hope and support demonstrated bifurcation effects.

An exploration of the dynamic longitudinal relationship between mental health and alcohol consumption: a prospective cohort study

BACKGROUND

Despite intense investigation, the temporal sequence between alcohol consumption and mental health remains unclear. This study explored the relationship between alcohol consumption and mental health over multiple occasions, and compared a series of competing theoretical models to determine which best reflected the association between the two.

METHODS

Data from phases 5 (1997 to 1999), 7 (2002 to 2004), and 9 (2007 to 2009) of the Whitehall II prospective cohort study were used, providing approximately 10 years of follow-up for 6,330 participants (73% men; mean ± SD age 55.8 ± 6.0 years). Mental health was assessed using the Short Form (SF)-36 mental health component score. Alcohol consumption was defined as the number of UK units of alcohol drunk per week. Four dynamic latent change score models were compared: 1) a baseline model in which alcohol consumption and mental health trajectories did not influence each other, 2) and model in which alcohol consumption influenced changes in mental health but mental health exerted no effect on changes in drinking and 3) vice versa, and (4) a reciprocal model in which both variables influenced changes in each other.

RESULTS

The third model, in which mental health influenced changes in alcohol consumption but not vice versa, was the best fit. In this model, the effect of previous mental health on upcoming change in alcohol consumption was negative (γ = -0.31, 95% CI -0.52 to -0.10), meaning that those with better mental health tended to make greater reductions (or shallower increases) in their drinking between occasions.

CONCLUSIONS

Mental health appears to be the leading indicator of change in the dynamic longitudinal relationship between mental health and weekly alcohol consumption in this sample of middle-aged adults. In addition to fuelling increases in alcohol consumption among low-level consumers, poor mental health may also be a maintaining factor for heavy alcohol consumption. Future work should seek to examine whether there are critical levels of alcohol intake at which different dynamic relationships begin to emerge between alcohol-related measures and mental health.

Trajectories and personality correlates of change in perceptions of physical and mental health across adulthood and old age

Subjective health is known to predict later outcomes, including survival. However, less is known about subjective health changes across adulthood, how personality moderates those changes, and whether such associations differ with age. We applied growth models to 10 waves of data from the Household, Income and Labour Dynamics in Australia Survey (HILDA, N = 7,172; median ages 20–93) to examine age-related differences in trajectories of subjective physical and mental health. On average, perceptions of physical health declined with increasing steepness in old age, whereas self-rated mental health remained relatively stable across all ages. Higher neuroticism and lower extraversion and conscientiousness were each related to less successful aging. The health implications of personality did not differ by age for physical health, but were weaker for mental health in old age. We discuss implications of our results for accelerated longitudinal designs and consider avenues for future more mechanism-oriented research.

Perceptions and attitudes towards exercise among Chinese elders - the implications of culturally based self-management strategies for effective health-related help seeking and person-centred care

BACKGROUND

Encouraging the uptake of physical activity among a culturally diverse elderly population presents a challenge for health-care providers across the world. Little is known about the health-care needs of these populations, for example the increasingly ageing group of Chinese elders in many parts of the world who are now facing later life and increasing challenges to their health.

OBJECTIVE

This study aimed to explore behaviours and attitudes towards exercise among older Chinese immigrants in the UK to provide insights into the health of Chinese populations in the UK and elsewhere.

DESIGN

A Grounded Theory approach using purposive and theoretical sampling with in-depth semi-structured interviews.

SETTING AND PARTICIPANTS

Chinese elders were recruited from Chinese communities in the North West of England. Thirty-three participants were interviewed face-to-face and audio-recorded.

RESULTS

Participants self-managed exercise based on cultural perceptions of health and ingrained Chinese values. Professional support and information was lacking and relied on folk norms rather than person-centred recommendations for healthy living. Inappropriate exercise regimes could act as a substitute for seeking health-related advice when exercise was often used as a self-monitored barometer to assess their perceived health status.

DISCUSSION AND CONCLUSION

Chinese elders may undertake inappropriate exercise, leading to high-risk situations, if appropriate professional information is not provided. Health-care practitioners should devote attention to understanding Chinese elders' attitudes towards exercise, as this may ultimately lead to successful health promotion activities. A person-centred approach that acknowledges and works with self-management practices is advocated.

The effects of a psychosocial dimension of socioeconomic position on survival: occupational prestige and mortality among US working adults

The association between education or income and mortality has been explored in great detail. These measures capture both the effects of material disadvantage on health and the psychosocial impacts of a low socioeconomic position on health. When explored independently of educational attainment and income, occupational prestige - a purely perceptual measure - serves as a measure of the impact of a psychosocial phenomenon on health. For instance, a fire-fighter, academician or schoolteacher may carry the social benefits of a higher social status without actually having the income (in all cases) or the educational credentials (in the case of the fire-fighter) to match. We explored the independent influence of occupational prestige on mortality. We applied Cox proportional hazards models to a nationally representative sample of over 380,000 US workers who had worked at any time between 1986 and 1994 with mortality follow up through 2002. We found that occupational prestige is associated with a decrease in the risk of all-cause, cancer, cardiovascular and respiratory-related mortality after controlling for household income and educational attainment. We further investigated the question of whether the effects of prestige are moderated by sex and broader occupational groupings. Prestige effects operate in white-collar occupations for men only and within service occupations for all workers.

Factors associated with differences in perceived health among German long-term unemployed

BACKGROUND

Unemployment is associated with reduced physical and psychological well-being. Perceived health is an important factor influencing health outcomes as well as successful returns to work. This study aims to determine the extent to which perceived health correlates with mental health, various health risk characteristics and socio-demographic characteristics in a setting-selected sample of long-term unemployed persons.

METHODS

Using SF-12, 365 long-term unemployed persons were assessed for self-perceived health and various socio-demographic and health characteristics. Perceived health data of the sample was compared to the German SF-12 reference population. Bivariate analyses and multiple linear regression models were applied to identify those variables significantly associated with perceived health.

RESULTS

The study population reported poorer perceived health compared with the general population. Analyses showed that perceived mental health was significantly worse in women, among persons with heightened depression and anxiety scores, and in participants reporting reduced levels of physical activity. Perceived physical health was significantly lower among older persons, participants with a higher BMI, and participants with heightened depression and anxiety scores. Both mental and physical health were worse among the unemployed assigned to an employment center as compared to those engaged in the secondary labor market. In total, 36% of the variance in the SF-12 mental score and 20% of the variance in the SF-12 physical score were explained by the factors included in the final multiple linear regression models.

CONCLUSIONS

Perceived health among a select group of long-term unemployed is reduced to a clinically relevant extent compared to the general population. The preliminary findings underline an association between mental health and perceived health. Negative self-perceptions of health were also associated with the labor market setting and some of the socio-demographic and health behavior variables. Further research is needed to determine risk factors leading to reduced perceived health in the unemployed. The strong association between mental health and perceived health suggests interventions targeting mental health are urgently needed to positively influence perceived health, a key determinant of individuals' chances to successfully return to work.

Social determinants of health and depression: a preliminary investigation from rural China

Background

In the last several years, research related to social determinants of health (SDH) has begun to resonate in the medical, behavioral, social and political sciences arena. The aim of the present study was to explore the relationship between SDH and depression, and to provide new evidences and clues for depression control and prevention.

Methodology/Principal Findings

This research was a cross-sectional survey executed door to door from October 2006 to April 2008, with a sample of 3,738 individuals aged 18 and older in rural China. The three variables of SDH were socioeconomic status (years of schooling and self-reported economic status of family), social cohesion and negative life events. Demographic variables and self-perceived physical health were taken as potential confounders. The cross-table analysis showed that variations in levels of depression were associated with variations in SDH, and logistic regression analysis confirmed the association even after adjusting for potential confounding variables.

Conclusions

Although there were some limitations, the current study provides initial evidence of the importance of SDH in depression. Findings indicate that social inequity and the role of policy action emphasized by SDH should be considered high priorities when addressing the issue of depression. In addition, cell-to-society and pill-to-policy approaches should be encouraged in the future.

A growth curve model with fractional polynomials for analysing incomplete time-course data in microarray gene expression studies

Identifying the various gene expression response patterns is a challenging issue in expression microarray time-course experiments. Due to heterogeneity in the regulatory reaction among thousands of genes tested, it is impossible to manually characterize a parametric form for each of the time-course pattern in a gene by gene manner. We introduce a growth curve model with fractional polynomials to automatically capture the various time-dependent expression patterns and meanwhile efficiently handle missing values due to incomplete observations. For each gene, our procedure compares the performances among fractional polynomial models with power terms from a set of fixed values that offer a wide range of curve shapes and suggests a best fitting model. After a limited simulation study, the model has been applied to our human in vivo irritated epidermis data with missing observations to investigate time-dependent transcriptional responses to a chemical irritant. Our method was able to identify the various nonlinear time-course expression trajectories. The integration of growth curves with fractional polynomials provides a flexible way to model different time-course patterns together with model selection and significant gene identification strategies that can be applied in microarray-based time-course gene expression experiments with missing observations.