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Beenackers MA, Kruize H, Barsties L, Acda A, Bakker I, Droomers M, Kamphuis CBM, Koomen E, Nijkamp JE, Vaandrager L, Völker B, Luijben G, Ruijsbroek A. Urban densification in the Netherlands and its impact on mental health: An expert-based causal loop diagram. Health Place 2024; 87:103218. [PMID: 38564990 DOI: 10.1016/j.healthplace.2024.103218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/30/2024] [Accepted: 02/21/2024] [Indexed: 04/04/2024]
Abstract
Urban densification is a key strategy to accommodate rapid urban population growth, but emerging evidence suggests serious risks of urban densification for individuals' mental health. To better understand the complex pathways from urban densification to mental health, we integrated interdisciplinary expert knowledge in a causal loop diagram via group model building techniques. Six subsystems were identified: five subsystems describing mechanisms on how changes in the urban system caused by urban densification may impact mental health, and one showing how changes in mental health may alter urban densification. The new insights can help to develop resilient, healthier cities for all.
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Affiliation(s)
- Mariëlle A Beenackers
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Hanneke Kruize
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; HU University of Applied Sciences Utrecht, Utrecht, the Netherlands.
| | - Lisa Barsties
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
| | - Annelies Acda
- Annelies Acda Advies - public health, policy and the built environment, Bussum, the Netherlands.
| | - Ingrid Bakker
- Department of Urban Innovation, Research Centre of Social Innovations Flevoland, Windesheim University of Applied Sciences, Almere, the Netherlands.
| | - Mariël Droomers
- Department of Public Health, City of Utrecht, Utrecht, the Netherlands.
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands.
| | - Eric Koomen
- Department of Spatial Economics, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Jeannette E Nijkamp
- Department of Healthy Cities, Research Centre for Built Environment NoorderRuimte, Hanze University of Applied Sciences Groningen, Groningen, the Netherlands.
| | - Lenneke Vaandrager
- Health and Society, Wageningen University and Research, Wageningen, the Netherlands.
| | - Beate Völker
- Department Human Geography and Spatial Planning, Utrecht University, Utrecht, the Netherlands; Netherlands Centre for the Study of Crime and Law Enforcement (NSCR), Amsterdam, the Netherlands.
| | - Guus Luijben
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
| | - Annemarie Ruijsbroek
- National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
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Stewart K, Kendler KS, Westholm A, Ohlsson H, Sundquist J, Sundquist K. Spatiotemporal patterns of drug use disorder in Sweden assessed using population-based registries. BMC Public Health 2023; 23:266. [PMID: 36750781 PMCID: PMC9906828 DOI: 10.1186/s12889-023-15149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 01/27/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Drug Use Disorder (DUD) is a major contributor to world-wide morbidity and mortality. The extensive national registers in Sweden provide the basis for a study of spatial and temporal patterns of DUD onset and recurrence in Sweden from 2001-2015. METHODS To identify patterns of DUD over space, time and gender for Swedish individuals aged 15-35, space-time clustering using SaTScan was applied. We used yearly information on residential locations in Demographic Statistical Areas (DeSO) for all of Sweden. The clustering analysis used a Poisson probability model and a null hypothesis that the expected number of cases in each DeSO was proportional to the population size of DeSOs. As SaTScan results can be unstable, steps were taken to determine stable clusters and to refine and optimize cluster size. Results for each gender-register combination were compared to the results of spatial clustering using Gi* statistics. The space-time scanning model was also run with an adjustment for neighborhood socioeconomic status to determine DUD prevalence as it relates to education, income, unemployment and receipt of social welfare. RESULTS DUD prevalence increased over time. Males yielded more significant clusters than females for both criminal and medical registers. Female DUD prevalence rates increased over time, especially after 2012. Higher correlations in DUD rates existed across the two registers than across gender. Male clusters were present from 2004 onwards while female-criminal clusters appeared after 2007, and female-medical clusters not until 2010. By 2013, clusters existed for all gender-register combinations. Male-criminal clusters were concentrated in Stockholm, Göteborg and Malmö as were male and female-medical clusters. Neighborhood SES was more highly related to the distribution of criminal than medical DUD clusters. A persistent gap in core clusters was identified in Stockholm in an area with notably high SES. CONCLUSIONS Persistent hotspots of DUD in Sweden were confirmed as well as new and emerging hotspots, especially in Stockholm, Göteborg and Malmö. Higher correlations existed in DUD rates across registers than across gender. The findings are useful for monitoring the current drug problem and for identifying drivers underlying patterns of spread and important causal pathways to DUD.
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Affiliation(s)
- Kathleen Stewart
- Center for Geospatial Information Science, Department of Geographical Sciences, University of Maryland, College Park, MD, 20742, USA
| | - Kenneth S Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
| | - Anton Westholm
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Welford P, Danielsson A, Manhica H. Parental substance use disorder and offspring not in education, employment or training: a national cohort study of young adults in Sweden. Addiction 2022; 117:2047-2056. [PMID: 35037336 PMCID: PMC9303702 DOI: 10.1111/add.15807] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/18/2021] [Indexed: 01/19/2023]
Abstract
AIMS To test the hypothesis that exposure to parental substance use disorder is associated with an increased risk of being not in education, employment or training (NEET) in male and female offspring during young adulthood. DESIGN, SETTING AND PARTICIPANTS A register-based, national cohort study of 797 376 individuals born between 1984 and 1990, residing in Sweden at age 17 years. Participants were followed from age 17 years to maximum age 32 years and assessed annually for being NEET. MEASUREMENTS The exposure variable was binary, defined as any diagnosis of substance use disorder (alcohol and/or drug use disorder) in one or both parents, measured between offspring's birth and age 17 years. Cox regression analysis was used to obtain hazard ratios (HRs) for being NEET, assessed annually as a binary variable using income and employment data. FINDINGS We found that 4.4% of individuals were exposed to parental substance use disorder. When adjusted for birth year, domicile, origin, psychiatric diagnosis, household income and parental psychiatric diagnosis, HRs for being NEET were HR = 1.13 (95% CI 1.09-1.16) for males, and HR = 1.15 (95% CI 1.12-1.19) for females. When stratified by age, adjusted HRs for experiencing the first episode of NEET peaked at age 17-19 years, HR = 1.37 (95% CI 1.25-1.50) for males, and HR = 1.31 (95% CI 1.18-1.44) for females. CONCLUSIONS In Sweden, exposure to parental substance use disorder before age 17 years is associated with increased risk of being not in education, employment or training during early adulthood. The risks were highest at age 17-19 years for both males and females, decreasing with greater age.
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Affiliation(s)
- Paul Welford
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
| | | | - Hélio Manhica
- Department of Global Public HealthKarolinska InstitutetStockholmSweden
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Saing CH, Chhoun P, Chann N, Uk P, Mun P, Tuot S, Yi S. Sex Under the Influence of Drugs Among People Who Use Drugs in Cambodia: Findings From a National Survey. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:1461-1470. [PMID: 35194721 PMCID: PMC8917026 DOI: 10.1007/s10508-021-02243-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 08/01/2021] [Accepted: 11/20/2021] [Indexed: 05/20/2023]
Abstract
Studies in drug use settings rarely use sex under the influence of drugs as an indicator of sexual risk behaviors. This study explored the prevalence of sex under the influence of drugs and its correlates among people who use drugs (PWUD) in Cambodia. We included 1147 PWUD from 12 provinces in this study. A multiple logistic regression analysis was conducted to identify factors associated with sex under the influence of drugs. Of the total, 39.7% reported having had sex under the influence of drugs in the past three months. After adjustment, sex under the influence of drugs was significantly associated with living in urban areas (AOR 2.97, 95% CI 1.68-5.27), having two to three (AOR 2.48, 95% CI 1.76-3.49) and four or more sexual partners (AOR 6.46, 95% CI 4.24-9.85), engaging in transactional sex (AOR 1.69, 95% CI 1.19-2.39), using methamphetamine (AOR 2.97, 95% CI 2.06-4.31), using drugs for three years or longer (AOR 1.67, 95% CI 1.15-2.41), having been to a drug rehabilitation center (AOR 1.77, 95% CI 1.18-2.41), having a network of ten or more PWUD (AOR 1.82, 95% CI 1.25-2.66), and having high psychological distress (AOR 1.66, 95% CI 1.25-2.22). This study documents the high prevalence of sex under the influence of drugs and its risk factors among male and female PWUD in Cambodia. These findings point to the need for integrating HIV and harm-reduction programs using innovative approaches to address the overlapping risks in this key population.
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Affiliation(s)
- Chan Hang Saing
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Navy Chann
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Ponha Uk
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Phalkun Mun
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.
- Center for Global Health Research, Touro University California, Vallejo, CA, USA.
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van der Wal JM, van Borkulo CD, Deserno MK, Breedvelt JJF, Lees M, Lokman JC, Borsboom D, Denys D, van Holst RJ, Smidt MP, Stronks K, Lucassen PJ, van Weert JCM, Sloot PMA, Bockting CL, Wiers RW. Advancing urban mental health research: from complexity science to actionable targets for intervention. Lancet Psychiatry 2021; 8:991-1000. [PMID: 34627532 DOI: 10.1016/s2215-0366(21)00047-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/30/2022]
Abstract
Urbanisation and common mental disorders (CMDs; ie, depressive, anxiety, and substance use disorders) are increasing worldwide. In this Review, we discuss how urbanicity and risk of CMDs relate to each other and call for a complexity science approach to advance understanding of this interrelationship. We did an ecological analysis using data on urbanicity and CMD burden in 191 countries. We found a positive, non-linear relationship with a higher CMD prevalence in more urbanised countries, particularly for anxiety disorders. We also did a review of meta-analytic studies on the association between urban factors and CMD risk. We identified factors relating to the ambient, physical, and social urban environment and showed differences per diagnosis of CMDs. We argue that factors in the urban environment are likely to operate as a complex system and interact with each other and with individual city inhabitants (including their psychological and neurobiological characteristics) to shape mental health in an urban context. These interactions operate on various timescales and show feedback loop mechanisms, rendering system behaviour characterised by non-linearity that is hard to predict over time. We present a conceptual framework for future urban mental health research that uses a complexity science approach. We conclude by discussing how complexity science methodology (eg, network analyses, system-dynamic modelling, and agent-based modelling) could enable identification of actionable targets for treatment and policy, aimed at decreasing CMD burdens in an urban context.
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Affiliation(s)
- Junus M van der Wal
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands; Department of Public Health, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Claudia D van Borkulo
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychological Methods, University of Amsterdam, Amsterdam, Netherlands
| | - Marie K Deserno
- Department of Psychological Methods, University of Amsterdam, Amsterdam, Netherlands; Centre for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Josefien J F Breedvelt
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; National Centre for Social Research, London, UK; Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mike Lees
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Informatics Institute, University of Amsterdam, Amsterdam, Netherlands
| | - John C Lokman
- Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Denny Borsboom
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychological Methods, University of Amsterdam, Amsterdam, Netherlands
| | - Damiaan Denys
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ruth J van Holst
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Marten P Smidt
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Karien Stronks
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Public Health, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - Paul J Lucassen
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Julia C M van Weert
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, Netherlands
| | - Peter M A Sloot
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Institute for Advanced Study, University of Amsterdam, Amsterdam, Netherlands; National Centre for Cognitive Science, ITMO University, St Petersburg, Russia
| | - Claudi L Bockting
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, Netherlands.
| | - Reinout W Wiers
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, Netherlands; Department of Developmental Psychology, University of Amsterdam, Amsterdam, Netherlands
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Abbas Z, Eiden C, Salameh P, Peyriere H. Substance use among refugees in three Lebanese camps: A cross-sectional study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 94:103204. [PMID: 33839597 DOI: 10.1016/j.drugpo.2021.103204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is a strong link between conflict exposure and ill health, including substance use. However, this widely acknowledged problem has not been studied yet in refugee camps in Lebanon. AIM To investigate substance use among civilians following war or displacement, and to assess its association with socio-demographic characteristics. METHOD Cross-sectional observational study carried out in three Palestinian camps in Lebanon using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Participants were Palestinian adults born in Lebanon and Palestinian and Syrian adults recently displaced from Syria due to war. The percentage of people reporting substance use and the associations between lifetime and last three months substance use and demographic features were assessed using a multivariate logistic regression. RESULTS In general, lifetime substance use was higher among Palestinians born in Lebanon compared to Syrians and Palestinians displaced from Syria (OR 7.241, 95% CI [3.781-13.869], P <0.0001). Results from ASSIST score during last three months showed that moderate and high-risk use of cannabis and cocaine were higher among Palestinians born in Lebanon than Palestinians and Syrians displaced from Syria. The multivariate analysis showed that women had lower lifetime (OR 0.188, 95%CI [0.080-0.442], P <0.0001) and lower last three months substance use than men, whereas single people were more likely to use substances than married people (OR: 2.78, 95%CI [1.588-4.866], P <0.0001). Tobacco was significantly associated with higher risk of substance use. CONCLUSION These findings suggest a higher rate of lifetime substance use among Palestinians born in Lebanon than in Palestinians and Syrians recently displaced from Syria. Substance use is influenced by different socio-demographic factors in the two groups of refugees. However, many factors other than socio-demographic characteristics and refugee status may influence substance use, particularly quality of life and health status that should be assessed in future studies.
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Affiliation(s)
- Zeinab Abbas
- Montpellier University, INSERM U 1058, Pathogenesis and Control of Chronic Infections (PCCI), Montpellier-France.
| | - Celine Eiden
- Medical Pharmacology, and toxicology Department, Montpellier University, Montpellier-France
| | - Pascale Salameh
- Lebanese University Faculty of Pharmacy, Hadath, Lebanon; Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie - Liban (INSPECT-LB), Beirut-Lebanon; University of Nicosia Medical School, Nicosia, Cyprus
| | - Hélène Peyriere
- Montpellier University, INSERM U 1058, Pathogenesis and Control of Chronic Infections (PCCI), Montpellier-France; Medical Pharmacology, and toxicology department Montpellier University, School of Pharmacy Montpellier- France
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Nong S, Chen Z. Whither the roads lead to? Estimating association between urbanization and primary healthcare service use with chinese prefecture-level data in 2014. PLoS One 2020; 15:e0234081. [PMID: 32492048 PMCID: PMC7269333 DOI: 10.1371/journal.pone.0234081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 05/18/2020] [Indexed: 11/23/2022] Open
Abstract
With the rapid economic development across China over recent decades, examining how urbanization may affect healthcare service use and its implications is more than urgent. This study estimates the association between urbanization and primary healthcare services use in China. We construct a prefecture-level dataset on healthcare services utilization and urbanization. We regress the proportion of residents using healthcare services in primary healthcare centers versus secondary or tertiary hospitals on a set of prefecture-level control variables. Results suggest that use of primary healthcare centers outpatient service is positively associated with being in the proximity of a provincial capital, but negatively correlated with the percentage of the urban population and the availability of public transportation. Higher likelihood of seeking care in major hospitals instead of primary healthcare centers is associated with urbanization, justifying a need for primary care physicians as gatekeepers in China's healthcare delivery system.
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Affiliation(s)
- Sheng Nong
- Youjiang Medical University for Nationalities, Baise, China
- Peking University, Beijing, China
| | - Zhuo Chen
- University of Georgia, Athens, GA, United States of America
- University of Nottingham Ningbo China, Ningbo, China
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Breuer F, Pommerenke C, Wollenhaupt L, Brettschneider P, Poloczek S. Vorkommen von Frequent Usern und Frequent Callern in einem großstädtischen Rettungsdienst: Indikatoren eines unzureichenden Gesundheits- und Sozialsystems? Notf Rett Med 2020. [DOI: 10.1007/s10049-019-0600-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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White RG. Mental wellbeing in the Anthropocene: Socio-ecological approaches to capability enhancement. Transcult Psychiatry 2020; 57:44-56. [PMID: 30074470 DOI: 10.1177/1363461518786559] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is growing recognition that "human development" frameworks, such as the Capabilities Approach (CA) with its emphasis on the promotion of justice, offer promise for guiding efforts aimed at enhancing mental wellbeing. This article explores challenges that might arise when there is a need to arbitrate among the competing demands of different parties in their efforts to enhance capabilities. Particular tensions can arise when the efforts of particular individuals to enhance their capabilities exert pressure on scarce resources, or threaten the safety and security of people living in precarious environmental contexts. Consideration is given to the need for "an ethos of restraint" to balance the consumption of resources aimed at facilitating human development on the one hand, with the need to promote environmental justice on the other. The paper highlights research that has investigated how environmental factors can impact on mental wellbeing, including rapid urbanization, climate change related issues (such as weather systems, drought, food insecurity and rising sea-levels), and access to "green/blue spaces". As such, the paper explores the important links that can exist between people and the ecosystems in which they live (including the way in which particular cultural beliefs and practices of indigenous groups can be tethered to the land). Elinor Ostrom's "design principles", derived from her work investigating the sustainable use of pooled resources, are presented as a helpful means of assisting members of communities to negotiate and apply "functioning constraints", which can promote environmental justice whilst not compromising efforts aimed at promoting mental wellbeing.
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Harris S, Dykxhoorn J, Hollander AC, Dalman C, Kirkbride JB. Substance use disorders in refugee and migrant groups in Sweden: A nationwide cohort study of 1.2 million people. PLoS Med 2019; 16:e1002944. [PMID: 31689291 PMCID: PMC6830745 DOI: 10.1371/journal.pmed.1002944] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/27/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Refugees are at higher risk of some psychiatric disorders, including post-traumatic stress disorder (PTSD) and psychosis, compared with other non-refugee migrants and the majority population. However, it is unclear whether this also applies to substance use disorders, which we investigated in a national register cohort study in Sweden. We also investigated whether risk varied by region of origin, age at migration, time in Sweden, and diagnosis of PTSD. METHODS AND FINDINGS Using linked Swedish register data, we followed a cohort born between 1984 and 1997 from their 14th birthday or arrival in Sweden, if later, until an International Classification of Diseases, 10th revision (ICD-10), diagnosis of substance use disorder (codes F10.X-19.X), emigration, death, or end of follow-up (31 December 2016). Refugee and non-refugee migrants were restricted to those from regions with at least 1,000 refugees in the Swedish registers. We used Cox proportional hazards regression to estimate unadjusted and adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) in refugee and non-refugee migrants, compared with Swedish-born individuals, for all substance use disorders (F10.X-19.X), alcohol use disorders (F10.X), cannabis use disorders (F12.X), and polydrug use disorders (F19.X). In adjusted analyses, we controlled for age, sex, birth year, family income, family employment status, population density, and PTSD diagnosis. Our sample of 1,241,901 participants included 17,783 (1.4%) refugee and 104,250 (8.4%) non-refugee migrants. Refugees' regions of origin were represented in proportions ranging from 6.0% (Eastern Europe and Russia) to 41.4% (Middle East and North Africa); proportions of non-refugee migrants' regions of origin ranged from 11.8% (sub-Saharan Africa) to 33.7% (Middle East and North Africa). These groups were more economically disadvantaged at cohort entry (p < 0.001) than the Swedish-born population. Refugee (aHR: 0.52; 95% CI 0.46-0.60) and non-refugee (aHR: 0.46; 95% CI 0.43-0.49) migrants had similarly lower rates of all substance use disorders compared with Swedish-born individuals (crude incidence: 290.2 cases per 100,000 person-years; 95% CI 287.3-293.1). Rates of substance use disorders in migrants converged to the Swedish-born rate over time, indicated by both earlier age at migration and longer time in Sweden. We observed similar patterns for alcohol and polydrug use disorders, separately, although differences in cannabis use were less marked; findings did not differ substantially by migrants' region of origin. Finally, while a PTSD diagnosis was over 5 times more common in refugees than the Swedish-born population, it was more strongly associated with increased rates of substance use disorders in the Swedish-born population (aHR: 7.36; 95% CI 6.79-7.96) than non-refugee migrants (HR: 4.88; 95% CI 3.71-6.41; likelihood ratio test [LRT]: p = 0.01). The main limitations of our study were possible non-differential or differential under-ascertainment (by migrant status) of those only seen via primary care and that our findings may not generalize to undocumented migrants, who were not part of this study. CONCLUSIONS Our findings suggest that lower rates of substance use disorders in migrants and refugees may reflect prevalent behaviors with respect to substance use in migrants' countries of origin, although this effect appeared to diminish over time in Sweden, with rates converging towards the substantial burden of substance use morbidity we observed in the Swedish-born population.
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Affiliation(s)
- Samantha Harris
- Psylife Group, Division of Psychiatry, University College London, London, United Kingdom
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Jennifer Dykxhoorn
- Psylife Group, Division of Psychiatry, University College London, London, United Kingdom
| | | | - Christina Dalman
- Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden
| | - James B. Kirkbride
- Psylife Group, Division of Psychiatry, University College London, London, United Kingdom
- * E-mail:
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Pjrek E, Silberbauer L, Kasper S, Winkler D. Alcohol consumption in Austrian physicians. Ann Gen Psychiatry 2019; 18:22. [PMID: 31572485 PMCID: PMC6760098 DOI: 10.1186/s12991-019-0246-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 09/02/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Alcohol is one of the leading exogenous causes for adverse health consequences in Europe. The aim of the present study was to examine the pattern of alcohol consumption in Austrian physicians. METHODS A telephone survey was conducted in 400 office-based physicians in Austria. Our questionnaire included the four questions of the CAGE questionnaire and questions to assess alcohol consumption on the previous day. RESULTS 131 participants (32.8%) completed the interview. 3.8% of the subjects had a CAGE score of 2 or higher indicating a problem with alcohol, but this rate was not statistically different from numbers reported for the general population (4.1%). 46.6% of our subjects had drunken alcohol on the previous day. Compared to the general population, the rate of having drunk alcohol yesterday was higher in both gender of our sample, but the amount of alcohol drunk was significantly lower. Doctors in rural areas had drunken alcohol more frequently and in greater quantities on the previous day than those in urban areas. There was a positive correlation between age and the amount of drinking on the previous day, and between age and CAGE scores. Furthermore, subjects who had consumed alcohol yesterday obtained higher scores on the CAGE. CONCLUSIONS Our findings indicate that the rate of Austrian physicians with problematic alcohol consumption is similar to the general population. Physicians in rural areas and older doctors might be of higher risk for alcohol abuse.
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Affiliation(s)
- Edda Pjrek
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Leo Silberbauer
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Dietmar Winkler
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Oshi DC, Ricketts-Roomes T, Oshi SN, Mitchell C, Agu CF, Belinfante A, Mitchell G, Whitehorne-Smith P, Harrison J, Atkinson U, Abel WD. Gender differences in the factors associated with early age of initiation of cannabis use in Jamaica. JOURNAL OF SUBSTANCE USE 2018. [DOI: 10.1080/14659891.2018.1531946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- D. C. Oshi
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
| | - T. Ricketts-Roomes
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
| | - S. N. Oshi
- Department of General Studies and Behavioural Sciences, University of the Commonwealth Caribbean, Kingston, Jamaica
| | - C. Mitchell
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
| | - C. F. Agu
- School of Nursing, The University of the West Indies, Kingston, Jamaica
| | - A. Belinfante
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
| | - G. Mitchell
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
| | - P. Whitehorne-Smith
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
| | - Joy Harrison
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
| | - U. Atkinson
- National Council on Drug Abuse, Kingston, Jamaica
| | - W. D. Abel
- Department of Community Health and Psychiatry, The University of the West Indies, Kingston, Jamaica
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Huang WK, Juang YY, Chung CC, Chang SH, Chang JWC, Lin YC, Wang HM, Chang HK, Chen JS, Tsai CS, Yu KH, Kuo CF, See LC. Timing and risk of mood disorders requiring psychotropics in long-term survivors of adult cancers: A nationwide cohort study. J Affect Disord 2018; 236:80-87. [PMID: 29723766 DOI: 10.1016/j.jad.2018.04.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 03/08/2018] [Accepted: 04/08/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND The increasing number of long-term cancer survivors over the past few decades poses the challenge of mental health care needs. However, little is known about risks of mood disorders in long-term cancer survivors. METHODS Long-term survivors (≥5 years) of adult cancers (LSAC) (n = 190,748) newly diagnosed between January 1, 2000 and December 31, 2007 were matched with one control. The primary outcome was diagnosis of mood disorders requiring psychotropics. Cumulative incidences and sub-hazard ratios (SHR) were calculated and multivariate analyses were conducted after accounting for mortality. RESULTS The mood disorder risk was significantly higher in the LSAC cohort than in the control cohort (adjusted SHR = 1.16, 95% confidence interval [CI] = 1.13-1.18, P < 0.001). Patients with certain cancer types were at increased risk, particularly in the first 2 years after diagnosis. However, patients with head and neck cancers or esophageal cancers had a higher risk after the 5-year follow-up period. Multivariate analysis indicated that being female, aged 40-59 years, with more than two primary cancers, receiving two or more treatment modalities, having CCI scores higher than 3, a higher urbanization level, and lower monthly income were independently associated with an increased risk of mood disorders. LIMITATIONS Some potential confounders such as lifestyle factors were not available in the study. CONCLUSION These findings call for increased mental health awareness not only in the early years after the cancer diagnosis, but also during long-term follow-up for certain cancer subtypes.
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Affiliation(s)
- Wen-Kuan Huang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan; Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Yeong-Yuh Juang
- Department of Psychiatry, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Chia-Chi Chung
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Hao Chang
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - John Wen-Cheng Chang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yung-Chang Lin
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hung-Ming Wang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsien-Kun Chang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chieh-Sheng Tsai
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan; Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan.
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Selin KH. Predicting Alcohol-Related Harm by Sociodemographic Background: High Prevalence versus High Risk. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/009145090503200404] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The main purpose of this study is to examine the relationship between sociodemographic background (gender, age, household situation, socioeconomic status, and region of residence) and the level of alcohol-related harm, when controlling for actual drinking habits in terms of average volume and binge drinking frequency. The dependent variables, modelled in logistic regressions, were summary measures of four areas of harm from alcohol–-impaired self-control, chronic health problems, public disorder, and interpersonal problems. The data was drawn from a 2002 Swedish national survey, consisting of 5,469 completed telephone interviews with adults 17 years old and above. Across all the problem areas, sociodemographic background variables seem to be rather weak overall predictors of experienced harm from drinking. The strongest effects found, besides drinking itself, were for being young–-especially for public disorder and impaired self-control. Socioeconomic indicators (income and education) and marital status also showed some significant effects, but these pointed in different directions for men and women, as well as for the different problem areas. Almost no regional differences could be observed. The results are, at least in part, in line with the so-called two-step model–-particularly for people above 30. According to this model, sociodemographic variables are good predictors of variation in drinking habits, while other factors may have a higher explanatory value for the harm from a given level of drinking. Based on the findings, interventions aimed to affect everybody's drinking might be preferred rather than harm reduction strategies targeted at particular risk groups.
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Boettiger DC, Law MG, Dore GJ, Guy R, Callander D, Donovan B, O’Connor CC, Fairley CK, Hellard M, Matthews G. Hepatitis C testing and re-testing among people attending sexual health services in Australia, and hepatitis C incidence among people with human immunodeficiency virus: analysis of national sentinel surveillance data. BMC Infect Dis 2017; 17:740. [PMID: 29191154 PMCID: PMC5709850 DOI: 10.1186/s12879-017-2848-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 11/22/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Direct acting antivirals are expected to drastically reduce the burden of hepatitis C virus (HCV) in people living with Human Immunodeficiency Virus (HIV). However, rates of HCV testing, re-testing and incident infection in this group remain uncertain in Australia. We assessed trends in HCV testing, re-testing and incident infection among HIV-positive individuals, and evaluated factors associated with HCV re-testing and incident infection. METHODS The study population consisted of HIV-positive individuals who visited a sexual health service involved in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance (ACCESS) between 2007 and 2015. Poisson regression was used to assess trends and to evaluate factors associated with HCV re-testing and incident HCV infection. RESULTS There were 9227 HIV-positive individuals included in our testing rate analysis. Of 3799 HIV-positive/HCV-negative people that attended an ACCESS sexual health service more than once, 2079 (54.7%) were re-tested for HCV and were therefore eligible for our incidence analysis. The rate of HCV testing increased from 17.1 to 51.4 tests per 100 patient years between 2007 and 2015 (p for trend <0.01). Over the same period, HCV re-testing rates increased from 23.9 to 79.7 tests per 100 person years (p for trend <0.01). A clear increase in testing and re-testing began after 2011. Patients who identified as men who have sex with men and those with a history of injecting drug use experienced high rates of HCV re-testing over the course of the study period. Among those who re-tested, 157 incident HCV infections occurred at a rate of 2.5 events per 100 person years. Between 2007 and 2009, 2010-2011, 2012-2013 and 2014-2015, rates of incident HCV were 0.8, 1.5, 3.9 and 2.7 events per 100 person years, respectively (p for trend <0.01). Incident HCV was strongly associated with a history of injecting drug use. CONCLUSIONS High rates of HCV testing and re-testing among HIV-positive individuals in Australia will assist strategies to achieve HCV elimination through rapid treatment scale up. Continued monitoring of HCV incidence in this population is essential for guiding both HCV prevention and treatment strategies.
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Affiliation(s)
| | | | | | - Rebecca Guy
- The Kirby Institute, UNSW Sydney, Sydney, NSW Australia
| | | | - Basil Donovan
- The Kirby Institute, UNSW Sydney, Sydney, NSW Australia
- Sydney Sexual Health Centre, Sydney, NSW Australia
| | - Catherine C. O’Connor
- The Kirby Institute, UNSW Sydney and Sexual Health Service, Sydney Local Health District, Sydney, NSW Australia
- Central Clinical School, Sydney University, Sydney, NSW Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Alfred Health and Monash University, Melbourne, Victoria Australia
| | - Margaret Hellard
- Viral Hepatitis Elimination Program, Burnet Institute, Melbourne, Victoria Australia
| | - Gail Matthews
- The Kirby Institute, UNSW Sydney, Sydney, NSW Australia
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A developmental etiological model for drug abuse in men. Drug Alcohol Depend 2017; 179:220-228. [PMID: 28806639 PMCID: PMC5623952 DOI: 10.1016/j.drugalcdep.2017.06.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/07/2017] [Accepted: 06/09/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND We attempt to develop a relatively comprehensive structural model of risk factors for drug abuse (DA) in Swedish men that illustrates developmental and mediational processes. METHODS We examined 20 risk factors for DA in 48,369 men undergoing conscription examinations in 1969-70 followed until 2011 when 2.34% (n=1134) of them had DA ascertained in medical, criminal and pharmacy registries. Risk factors were organized into four developmental tiers reflecting i) birth, ii) childhood/early adolescence, iii) late adolescence, and iv) young adulthood. Structural equational model fitting was performed using Mplus. RESULTS The best fitting model explained 47.8% of the variance in DA. The most prominent predictors, in order, were: early adolescent externalizing behavior, early adult criminal behavior, early adolescent internalizing behavior, early adult unemployment, early adult alcohol use disorder, and late adolescent drug use. Two major inter-connecting pathways emerged reflecting i) genetic/familial risk and ii) family dysfunction and psychosocial adversity. Generated on a first and tested on a second random half of the sample, a model from these variables predicted DA with an ROC area under the curve of 83.6%. Fifty-nine percent of DA cases arose from subjects in the top decile of risk. CONCLUSIONS DA in men is a highly multifactorial syndrome with risk arising from familial-genetic, psychosocial, behavioral and psychological factors acting and interacting over development. Among the multiple predisposing factors for DA, a range of psychosocial adversities, externalizing psychopathology and lack of social constraints in early adulthood are predominant.
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Horyniak D, Melo JS, Farrell RM, Ojeda VD, Strathdee SA. Epidemiology of Substance Use among Forced Migrants: A Global Systematic Review. PLoS One 2016; 11:e0159134. [PMID: 27411086 PMCID: PMC4943736 DOI: 10.1371/journal.pone.0159134] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 06/28/2016] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Forced migration is occurring at unprecedented levels. Forced migrants may be at risk for substance use for reasons including coping with traumatic experiences, co-morbid mental health disorders, acculturation challenges and social and economic inequality. This paper aimed to systematically review the literature examining substance use among forced migrants, and identify priority areas for intervention and future research. METHODS Seven medical, allied health and social science databases were searched from inception to September 2015 in accordance with PRISMA guidelines to identify original peer-reviewed articles describing any findings relating to alcohol and/or illicit drug use among refugees, internally displaced people (IDPs), asylum seekers, people displaced by disasters and deportees. A descriptive synthesis of evidence from quantitative studies was conducted, focusing primarily on studies which used validated measures of substance use. Synthesis of evidence from qualitative studies focused on identifying prominent themes relating to the contexts and consequences of substance use. Critical Appraisal Skills Programme (CASP) checklists were used to assess methodological quality of included studies. RESULTS Forty-four quantitative (82% cross-sectional), 16 qualitative and three mixed-methods studies were included. Ten studies were rated as high methodological quality (16%), 39 as moderate quality (62%) and 14 as low quality (22%). The majority of research was conducted among refugees, IDPs and asylum seekers (n = 55, 87%), predominantly in high-income settings. The highest-quality prevalence estimates of hazardous/harmful alcohol use ranged from 17%-36% in camp settings and 4%-7% in community settings. Few studies collected validated measures of illicit drug use. Seven studies compared substance use among forced migrants to other migrant or native-born samples. Among eight studies which conducted multivariable analysis, male sex, trauma exposure and symptoms of mental illness were commonly identified correlates of substance use. CONCLUSION Our understanding of substance use among forced migrants remains limited, particularly regarding persons displaced due to disasters, development and deportation. Despite a growing body of work among refugee-background populations, few studies include refugees in low and middle-income countries, where over 80% of the global refugee population resides. Findings suggest a need to integrate substance use prevention and treatment into services offered to forced migrants, particularly in camp settings. Efforts to develop and evaluate interventions to reduce substance use and related harms are needed.
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Affiliation(s)
- Danielle Horyniak
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States of America
- Centre for Population Health, Burnet Institute, Melbourne, VIC, 3004, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Jason S. Melo
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States of America
| | - Risa M. Farrell
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States of America
| | - Victoria D. Ojeda
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States of America
| | - Steffanie A. Strathdee
- Division of Global Public Health, University of California San Diego, La Jolla, CA, 92093, United States of America
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Grahn R, Chassler D, Lundgren L. Repeated addiction treatment use in Sweden: a National Register Database study. Subst Use Misuse 2014; 49:1764-73. [PMID: 24963556 DOI: 10.3109/10826084.2014.926932] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Sweden has a free, universal addiction treatment system, yet few studies exist examining utilization of treatment in this country. This study identified predisposing, enabling, and need factors associated with history of number of voluntary addiction treatment episodes for a national sample of 12,009 individuals assessed for an alcohol and/or drug use disorder in Sweden. On average, people reported 4.3 prior treatment episodes. Linear regression methods identified that predisposing factors such as older age and being male were associated with more voluntary addiction treatment episodes compared to younger and female clients; a higher Addiction Severity Index (ASI) employment score (an enabling factor) was associated with more voluntary addiction treatment episodes; and need factors including a history of inpatient mental health treatment, a higher ASI psychiatric score, a higher ASI alcohol score, higher levels of illicit drug use, more compulsory addiction treatment episodes, a lower ASI legal score, and a history of criminal justice involvement were all associated with more voluntary addiction treatment episodes compared to their counterparts.. There were no differences in the number of treatment episodes by education or immigrant status. IMPLICATIONS (1) Need is a key factor associated with more treatment use. (2) Further studies are needed to identify gender differences in access/use of treatment. (3) Given multiple treatment histories, Swedish addiction treatment policy should reflect a chronic care model rather than an acute care model.
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Giordano GN, Ohlsson H, Kendler KS, Winkleby MA, Sundquist K, Sundquist J. Age, period and cohort trends in drug abuse hospitalizations within the total Swedish population (1975-2010). Drug Alcohol Depend 2014; 134:355-361. [PMID: 24300899 PMCID: PMC3909834 DOI: 10.1016/j.drugalcdep.2013.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 11/04/2013] [Accepted: 11/05/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND The societal consequences of drug abuse (DA) are severe and well documented, the World Health Organization recommending tracking of population trends for effective policy responses in treatment of DA and delivery of health care services. However, to correctly identify possible sources of DA change, one must first disentangle three different time-related influences on the need for treatment due to DA: age effects, period effects and cohort effects. METHODS We constructed our main Swedish national DA database (spanning four decades) by linking healthcare data from the Swedish Hospital Discharge Register to individuals, which included hospitalisations in Sweden for 1975-2010. All hospitalized DA cases were identified by ICD codes. Our Swedish national sample consisted of 3078,129 men and 2921,816 women. We employed a cross-classified multilevel logistic regression model to disentangle any net age, period and cohort effects on DA hospitalization rates. RESULTS We found distinct net age, period and cohort effects, each influencing the predicted probability of hospitalisation for DA in men and women. Peak age for DA in both sexes was 33-35 years; net period effects showed an increase in hospitalisation for DA from 1996 to 2001; and in birth cohorts 1968-1974, we saw a considerable reduction (around 75%) in predicted probability of hospitalisation for DA. CONCLUSIONS The use of hospital admissions could be regarded as a proxy of the population's health service use for DA. Our results may thus constitute a basis for effective prevention planning, treatment and other appropriate policy responses.
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Affiliation(s)
- Giuseppe N Giordano
- Center for Primary Health Care Research, Lund University, Jan Waldenströmsgata 35, CRC, building 28, floor 11, entrance 72, Malmö University Hospital, Malmö, S-205 02, Sweden.
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Lund University, Jan Waldenströmsgata 35, CRC, building 28, floor 11, entrance 72, Malmö University Hospital, Malmö, S-205 02, Sweden
| | - Kenneth S Kendler
- Virginia Commonwealth University School of Medicine, PO Box 980126 Richmond, VA 23298, USA
| | | | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Jan Waldenströmsgata 35, CRC, building 28, floor 11, entrance 72, Malmö University Hospital, Malmö, S-205 02, Sweden; Stanford Prevention Research Center, MSOB, Stanford, CA 94305, USA
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Jan Waldenströmsgata 35, CRC, building 28, floor 11, entrance 72, Malmö University Hospital, Malmö, S-205 02, Sweden; Stanford Prevention Research Center, MSOB, Stanford, CA 94305, USA
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Whitfield JB, Zhu G, Heath AC, Martin NG. Choice of Residential Location: Chance, Family Influences, or Genes? Twin Res Hum Genet 2012. [DOI: 10.1375/twin.8.1.22] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe choice of where to live would appear to be determined by a combination of economic constraints and personal preferences. We have tested how far this choice is affected by the continuing effects of the environment shared within families, and genetic variation between people, using data from twin studies conducted in Australia. The addresses provided by study participants were categorized as urban, suburban and nonurban, and data were analyzed in three adult age groups. There were significant effects of both shared environment and genes, and the balance between them was affected by both sex and age. Shared environment accounted for some 50% of variation in the youngest group, but only about 10% in the oldest. As shared environmental effects decreased, additive genetic effects increased. These results have implications for internal migration of people within countries and, over the long term, for gene flow within and between populations. They may also be pertinent to the different prevalences of certain psychiatric diseases between city and country locations. Comparisons between countries with different demography are needed to confirm and further characterize these effects.
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Pitel L, Geckova AM, vanDijk JP, Reijneveld SA. Degree of urbanization and gender differences in substance use among Slovak adolescents. Int J Public Health 2011; 56:645-51. [PMID: 21120576 PMCID: PMC3220823 DOI: 10.1007/s00038-010-0219-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 10/21/2010] [Accepted: 11/06/2010] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Substance use among adolescents varies with gender and between countries. Urbanization may contribute to this. The aim of our study is to explore the association between the degree of urbanization and gender differences in adolescent smoking, binge drinking, and cannabis use. METHODS A cross-sectional questionnaire survey of Slovak adolescents was used (N = 3,493; mean age = 14.33), stratified by degree of urbanization. The effects of gender and urbanization of the area and their interaction on substance use (smoking, binge drinking, and cannabis) were analyzed using a logistic regression model adjusted for age. RESULTS Gender and area and their interaction had statistically significant (p < 0.01) associations with substance use. The lower the urbanization of the area, the less riskily females behaved. An exception was found in the case of binge drinking where the results of the interaction of gender and degree of urbanization were not significant for the second least urbanized area. CONCLUSIONS Prevalence rate of substance use among girls increased along with an increasing degree of urbanization, while the prevalence rate of substance use among boys remained constant.
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Affiliation(s)
- Lukas Pitel
- Medical Faculty, Kosice Institute for Society and Health, Graduate School and Health Psychology Unit, Public Health Institute, PJ Safarik University Kosice, Trieda SNP 1, 040 11 Kosice, Slovakia
| | - Andrea Madarasova Geckova
- Medical Faculty, Kosice Institute for Society and Health, Graduate School and Health Psychology Unit, Public Health Institute, PJ Safarik University Kosice, Trieda SNP 1, 040 11 Kosice, Slovakia
| | - Jitse P. vanDijk
- Medical Faculty, Kosice Institute for Society and Health, Graduate School and Health Psychology Unit, Public Health Institute, PJ Safarik University Kosice, Trieda SNP 1, 040 11 Kosice, Slovakia
- Department of Social Medicine, University Medical Center Groningen, Groningen University, Groningen, The Netherlands
| | - Sijmen A. Reijneveld
- Department of Social Medicine, University Medical Center Groningen, Groningen University, Groningen, The Netherlands
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Abstract
PURPOSE OF REVIEW More than half of the world's population is living in urban areas, but the evidence about urban-rural differences in drug use is not clearly defined. The present paper aims to review the international literature addressing the role of urbanization and related parameters in association with substance misuse. In particular, the evidence of urbanization being a risk factor for substance misuse is examined. RECENT FINDINGS Although it has been suggested that substance misuse is typically a characteristic of large urban areas, this did not appear to be a consistent observation from the literature review. Furthermore, the urban context may offer a relative proximity of health services and prompter emergency intervention in case of overdose. SUMMARY Although more efforts have to be put into explaining substance misuse in general, identifying which characteristics of the urban context are modifiable, and under what circumstances, is an important theoretical, empirical, and public health question.
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Tiainen A, Edman G, Flyckt L, Tomson G, Rehnberg C. Regional variations and determinants of direct psychiatric costs in Sweden. Scand J Public Health 2008; 36:483-92. [DOI: 10.1177/1403494808089065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: The aim of the present study was to investigate socioeconomic and demographic determinants of direct costs for psychiatric disorders in Sweden. The cost categories were inpatient and outpatient costs, and costs for psychopharmacological drugs. Two consecutive years, 2001 and 2002, were chosen as the study period. Methods: The study included all costs for admissions, visits and prescribed drugs for adults aged ≥18 years in 2001 and 2002 in Sweden. These costs were aggregated and analysed at the county level. A multiple linear regression analysis was fitted to the data, and independent variables (i.e. predictors) were chosen on the basis of previous studies. All cost types (e.g. total, inpatient, outpatient and drug costs) were analysed separately in different models. Results: Large variations in total direct psychiatric costs were found between county councils (for example, the total costs varied between euro112 and euro195 per capita in 2001). The results indicate that psychiatric outpatient care is less utilized in rural than in urban areas, and drugs are more often prescribed in rural areas than in urban areas. Areas with a high proportion of women and people aged 65 years and over are strong predictors of mental healthcare costs, i.e. variables showing that the higher the proportion, the lower the direct costs. Conclusions: Factors such as urbanization, gender, age and number of immigrants are reasons for differences in psychiatric direct costs. On the basis of these findings, it seems plausible to conclude that women, older patients and immigrants may benefit from specialized psychiatry, but that such healthcare does not seem to be provided in all regions.
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Affiliation(s)
- Anne Tiainen
- Danderyd Hospital, Psychiatric Clinic, R&D Section, Stockholm, Sweden, , Medical Management Centre (MMC), Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Edman
- Danderyd Hospital, Psychiatric Clinic, R&D Section, Stockholm, Sweden
| | - Lena Flyckt
- Danderyd Hospital, Psychiatric Clinic, R&D Section, Stockholm, Sweden
| | - Göran Tomson
- Medical Management Centre (MMC), Karolinska Institutet, Stockholm, Sweden
| | - Clas Rehnberg
- Medical Management Centre (MMC), Karolinska Institutet, Stockholm, Sweden
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Gene-environment interaction in adults' IQ scores: measures of past and present environment. Behav Genet 2008; 38:348-60. [PMID: 18535898 PMCID: PMC2480605 DOI: 10.1007/s10519-008-9212-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 05/22/2008] [Indexed: 11/30/2022]
Abstract
Gene-environment interaction was studied in a sample of young (mean age 26 years, N = 385) and older (mean age 49 years, N = 370) adult males and females. Full scale IQ scores (FSIQ) were analyzed using biometric models in which additive genetic (A), common environmental (C), and unique environmental (E) effects were allowed to depend on environmental measures. Moderators under study were parental and partner educational level, as well as urbanization level and mean real estate price of the participants’ residential area. Mean effects were observed for parental education, partner education and urbanization level. On average, FSIQ scores were roughly 5 points higher in participants with highly educated parents, compared to participants whose parents were less well educated. In older participants, IQ scores were about 2 points higher when their partners were highly educated. In younger males, higher urbanization levels were associated with slightly higher FSIQ scores. Our analyses also showed increased common environmental variation in older males whose parents were more highly educated, and increased unique environmental effects in older males living in more affluent areas. Contrary to studies in children, however, the variance attributable to additive genetic effects was stable across all levels of the moderators under study. Most results were replicated for VIQ and PIQ.
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Kestilä L, Martelin T, Rahkonen O, Joutsenniemi K, Pirkola S, Poikolainen K, Koskinen S. Childhood and current determinants of heavy drinking in early adulthood. Alcohol Alcohol 2008; 43:460-9. [PMID: 18364362 DOI: 10.1093/alcalc/agn018] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To explore the association of parental education, childhood living conditions and several adversities with heavy drinking in early adulthood, and to analyze the effect of the respondent's current circumstances on these associations. METHOD The analyses were conducted in a sample of 1234 adults aged 18-29 years participating in the Finnish Health 2000 Survey (65% of the original representative two-stage cluster sample, N = 1894). The outcome measure was heavy drinking measured by g/week for pure alcohol (for men >or=280 g/week and for women >or=140 g/week). RESULTS 8% of young adult men and 5% of women were heavy drinkers. In both genders, parental alcohol problems and other childhood adversities, poor own education, and unemployment status increased the risk of heavy drinking. The impact of childhood on heavy drinking was partly independent and partly mediated by adult characteristics, in particular, for both genders, low level of education. CONCLUSIONS Childhood adversities are associated with heavy drinking in early adulthood among both genders. Childhood social circumstances as well as low educational level and unemployment should be taken into account in planning preventive policies to tackle the harms caused by excessive alcohol use at the individual and population level.
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Affiliation(s)
- Laura Kestilä
- Department of Health and Functional Capacity, National Public Health Institute (KTL), Mannerheimintie 166, FI-00300 Helsinki, Finland.
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Selten JP, Wierdsma A, Mulder N, Burger H. Treatment seeking for alcohol and drug use disorders by immigrants to the Netherlands: retrospective, population-based, cohort study. Soc Psychiatry Psychiatr Epidemiol 2007; 42:301-6. [PMID: 17334900 PMCID: PMC1913176 DOI: 10.1007/s00127-007-0162-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2007] [Indexed: 10/25/2022]
Abstract
BACKGROUND We compared risks of first contact with services for an alcohol use disorder (AUD) or drug use disorder (DUD) between the largest immigrant groups to the Netherlands and Dutch nationals. We tested the hypothesis that the ethnic pattern for DUD is similar to the previously demonstrated pattern for schizophrenia. METHODS Retrospective, population-based cohort study of First Admissions to Dutch psychiatric hospitals during the period 1990-1996 (national data) and First Contacts with inpatient or outpatient centres in Rotterdam for treatment of AUD or DUD during the period 1992-2001 (Rotterdam data). RESULTS In both datasets the risk of service contact for AUD was significantly lower in immigrants from Surinam, Turkey and Morocco than in Dutch nationals. The risk was lower or moderately higher in immigrants from western countries. Analysis of the national data showed that, compared with Dutch males, the risk of first hospital admission for DUD was higher for male immigrants from the Dutch Antilles (RR = 4.6; 95% CI: 4.0-5.3), Surinam (RR = 4.3; 3.9-4.7) and Morocco (RR = 2.3; 2.0-2.6), but not for male immigrants from Turkey (RR = 0.9; 0.7-1.1). A similar pattern was found with the Rotterdam data. Female immigrants from Surinam and the Dutch Antilles had a higher risk for DUD according to the national data, but a lower risk according to the Rotterdam data. Female immigrants from Turkey and Morocco had a lower risk (both datasets). Immigrants from western countries had a higher risk for DUD, but many had developed the disorder before emigrating. CONCLUSION Those immigrant groups in the Netherlands that are at increased risk of schizophrenia appear also at increased risk of developing DUD, but not AUD.
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Affiliation(s)
- Jean-Paul Selten
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Centre Utrecht, P.O.Box 85500, Reference Nr A00.241, 3508, GA, Utrecht, The Netherlands.
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Hensing G, Andersson L, Brage S. Increase in sickness absence with psychiatric diagnosis in Norway: a general population-based epidemiologic study of age, gender and regional distribution. BMC Med 2006; 4:19. [PMID: 16923198 PMCID: PMC1601961 DOI: 10.1186/1741-7015-4-19] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Accepted: 08/22/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the incidence of sickness absence with psychiatric diagnoses from 1994-2000, and the distribution across gender, age groups, diagnostic groups and regions in a general population. METHODS The population at risk was defined as all individuals aged 16-66 years who were entitled to sickness benefits in 1994, 1996, 1998 and 2000 (n = 2,282,761 in 2000). All individuals with a full-time disability pension were excluded. The study included approximately 77% of the Norwegian population aged 16-66 years. For each year, the study base started on 1 January and ended on 31 December. Individuals that were sick-listed for more than 14/16 consecutive days with a psychiatric diagnosis on their medical certificate were selected as cases. Included in this study were data for Norway, the capital city Oslo and five regions in the southeast of the country. RESULTS Sickness absence with psychiatric diagnoses increased in all age groups, in women and men, and in all regions. At the national level, the cumulative incidence increased in women from 1.7% in 1994 to 4.6% in 2000, and in men from 0.8% in 1994 to 2.2% in 2000. The highest cumulative incidence was found in middle-aged women and men (30-59 years). Women had a higher incidence than men in all stratification groups. The cumulative incidences in 2000 varied between 4.6% to 5.6% in women in the different regions, and for men the corresponding figures were 2.1% to 3.2%. Throughout the four years studied, women in Oslo had more than twice as high incidence levels of sickness absence with alcohol and drug diagnoses as the country as a whole. There were some differences between regions in sickness absence with specific psychiatric diagnoses, but they were small and most comparisons were non-significant. CONCLUSION Sickness absence with psychiatric diagnoses increased between 1994 and 2000 in Norway. The increase was highest in the middle-aged, and in women. Few regional differences were found. That the increase pervaded all stratification groups supports general explanations of the increase, such as changes in attitudes to psychiatric disorders in both patients and doctors, and increased mental distress probably associated with societal changes at a more structural level.
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Affiliation(s)
- Gunnel Hensing
- Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
| | - Lena Andersson
- Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
| | - Sören Brage
- Department of General Practice and Community Medicine, University of Oslo, Oslo, Norway
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