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Vasiliadis HM, Spagnolo J, Bartram M, Fleury MJ, Gouin JP, Grenier S, Roberge P, Shen-Tu G, Vena JE, Lamoureux-Lamarche C, Wang J. Factors associated with change in moderate or severe symptoms of anxiety and depression in community-living adults and older adults during the COVID-19 pandemic. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024; 115:230-243. [PMID: 38117417 PMCID: PMC11006639 DOI: 10.17269/s41997-023-00832-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 10/24/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Few are the longitudinal studies on the changes in moderate or severe symptoms of anxiety or depression (MSS-ANXDEP) from before to during the COVID-19 pandemic in Canada. The aim was to study the change in MSS-ANXDEP and associated sociodemographic, economic, psychosocial, health behaviour and lifestyle, and clinical factors. METHODS The current sample includes 59,997 adults aged ≥ 35 years participating in the 2018 and 2020 health surveys of the 5 established cohorts of the Canadian Partnership for Tomorrow's Health (CanPath). MSS-ANXDEP was based on a cutoff score ≥ 10 on the 7-item Generalized Anxiety Disorder Scale and Patient Health Questionnaire (PHQ-8). Change in MSS-ANXDEP was categorized as follows: no MSS-ANXDEP, remitted, incident, and persistent. Multinomial regressions were used to study MSS-ANXDEP as a function of sociodemographic, economic, psychosocial, health behaviours and lifestyle, and clinical factors. RESULTS Sociodemographic and economic (i.e. age, gender, cohort, race/ethnicity, lower income, decreased in income, work status, being an essential worker), lifestyle and health behaviours (i.e. smoking, cannabis and alcohol use, drinking more alcohol), psychosocial (i.e. provide help to others, information and instrumental support, and change in relationships with friends, family, and partner) and clinical factors (i.e. lifetime mental disorder and multimorbidity) were associated with remitted, incident, and persistent MSS-ANXDEP. CONCLUSION Health and socio-economic factors were associated with changes in symptoms of anxiety and depression during the pandemic, further increasing inequities in mental health needs. Public health campaigns on the importance of healthy behaviours should continue and health policies should reduce economic and social barriers to integrated substance use and mental health care.
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Affiliation(s)
- Helen-Maria Vasiliadis
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Québec, Canada.
- Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada.
| | - Jessica Spagnolo
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - Mary Bartram
- Mental Health Commission of Canada, Ottawa, Ontario, Canada
- School of Public Policy & Administration, Carleton University, Ottawa, Ontario, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, Verdun, Québec, Canada
- McGill University, Montreal, Québec, Canada
| | - Jean-Philippe Gouin
- Department of Psychology, Concordia University, Montreal, Québec, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, Québec, Canada
| | - Sébastien Grenier
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, Québec, Canada
- Département de psychologie, Université de Montréal, Montréal, Québec, Canada
| | - Pasquale Roberge
- Département de médecine familiale et d'urgence, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre de recherche du Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Grace Shen-Tu
- Alberta's Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Jennifer E Vena
- Alberta's Tomorrow Project, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Catherine Lamoureux-Lamarche
- Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Québec, Canada
| | - JianLi Wang
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Veenstra M, Aartsen M. Life-course income trajectories of men and women in Norway: implications for self-rated health in later life. Eur J Public Health 2022; 32:542-547. [PMID: 35708604 PMCID: PMC9341848 DOI: 10.1093/eurpub/ckac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Socioeconomic inequalities in health are well-established, but studies addressing lagged effects of income or of fluctuations in income over the life course are relatively rare. The current study aims to (i) identify and describe life-course income trajectories for men and women who are currently in later life; and (ii) assess the association of income trajectories with self-rated health in older adults. METHODS The study sample consisted of 1625 men and 1634 women born between 1937 and 1955 who participated in the third wave of the Norwegian Life course, Ageing and Generation Study. Latent class growth analyses were used to estimate dominant income trajectories from ages 30 through 62 in men and women. Stepwise logistic regression analyses were specified to analyze the association of income trajectories with self-rated health in later life. RESULTS Four trajectories in women and three trajectories in men were estimated as dominant patterns of income over the life course. Differences in the level of income were considerable at age 30 and accumulated over time. Continued exposure to low income showed statistically significant higher odds for poor self-rated health in older men and women. This association remained significant after taking differences in educational attainment, working life, family formation and accumulated wealth into account. CONCLUSION The findings suggested remarkable rigidity in income groups that had formed by age 30. A significant share of men and women remain mired in relatively low-income status across the life course with negative implications for health in later life.
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Affiliation(s)
- Marijke Veenstra
- NOVA–Norwegian Social Research, OsloMet—Oslo Metropolitan University, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Marja Aartsen
- NOVA–Norwegian Social Research, OsloMet—Oslo Metropolitan University, Norway
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Barrett AE, Michael C. Spotlight on Age: An Overlooked Construct in Medical Sociology. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2022; 63:177-190. [PMID: 35227106 DOI: 10.1177/00221465221077221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Medical sociology gives limited attention to age-a surprising observation given the aging of the population and the fact that age is among the strongest determinants of health. We examine this issue through an analysis of articles published in Journal of Health and Social Behavior (JHSB) and Sociology of Health & Illness (SHI) between 2000 and 2019. One in 10 articles focused on age or aging, with attention increasing over the period. However, the journals differed. More JHSB than SHI articles addressed it, but fewer focused on the latest life stages when frailty often appears. We discuss three dimensions of age that would enrich medical sociology: as a dimension of inequality akin to race and gender with similar health effects, as an institution interacting with the medical one, and as an identity-again, akin to race and gender-through which people process their experiences in ways that affect health.
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Martins TA, Nunes JA, Dias I, Menezes I. Engagement in civic organisations in old age: Motivations for participation and retention. J Aging Stud 2021; 59:100977. [PMID: 34794722 DOI: 10.1016/j.jaging.2021.100977] [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: 01/23/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 11/15/2022]
Abstract
Although the importance of older citizens' civic engagement has been highlighted in research and policy, the topic remains underexplored. In this study, we discuss older Portuguese citizens' motivations for civic engagement. The research is based on interviews with eighteen participants aged over 60, who are retired but active in civic organisations, in which they hold or have held leadership positions. We employed thematic analysis to examine the qualitative data. The findings suggest a range of motivations for participation, with personal and ideological/political motives emerging as relevant for involvement, retention and leaving, and interpersonal relationships motivating involvement and retention. However, the specific motivations differ as a function of not only the stages of involvement/retention/leaving, but also the type of organisation and the participants' life experiences. There are notable differences between the motivations for involvement in cultural and recreational organisations, neighbourhood organisations and volunteer programmes, where the emphasis is on fostering interpersonal relationships, and the more ideological/political motivations that appear as determinant within political and activist organisations. As such, this study brings a more complex understanding of the range of motivations for civic engagement in later life, with significant implications for fostering older citizens' mobilisation and sustained engagement.
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Affiliation(s)
- Teresa Alves Martins
- CINTESIS - Center for Health Technology and Services Research (Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Portugal.
| | | | - Isabel Dias
- Institute of Sociology of the University of Porto - Faculty of Arts and Humanities University of Porto, Portugal.
| | - Isabel Menezes
- CIIE-Centre for Research and Intervention in Education - Faculty of Psychology and Education Sciences, University of Porto - Rua Alfredo Allen, 4200-135 Porto, Portugal.
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Veenstra M, Løset GK, Daatland SO. Socioeconomic Inequalities in Mortality After Age 67: The Contribution of Psychological Factors. Front Psychol 2021; 12:717959. [PMID: 34690874 PMCID: PMC8526927 DOI: 10.3389/fpsyg.2021.717959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Diverging trends of longer lives and increased inequalities in age-at-death invite to updated research on late-life mortality. Earlier studies have identified health behavior, childhood, psychosocial, and material conditions as key determinants of life expectancy, but the role of psychological factors remains a topic of debate. The current study is framed in a life course developmental perspective and assesses the mediating role of secondary control strategies (subjective age) and primary control capacity (perceived control) to socioeconomic (wealth and education) inequality in mortality after age 67. Data are derived from the second wave of the Norwegian Life Course, Ageing and Generation study (N=1,432 and age 67–85). All in all, 366 deaths were observed over a mean follow-up of 9.6years. Perceived control was measured by the Pearlin and Schooler Mastery Scale. SA was measured with proportional discrepancy scores in felt age and ideal age. Stepwise Cox proportional hazards regression analyses were conducted to analyze the relative contribution of SES (education and accumulated wealth), felt age, and ideal age discrepancies and perceived control on 11-year mortality. Findings show that lower levels of wealth and perceived control independently predict increased elderly mortality over an 11-year period. Feeling younger and smaller ideal age discrepancies are positively associated with perceived control, but do not account for additional variability in longevity among older adults. Findings add to the interdisciplinary field of socioeconomic inequalities in elderly mortality and underline the specific importance of structural conditions (wealth) and the continued importance of (perceived) primary control capacity for longevity also after age 67. Future research may assess in more detail how wealth and perceived control complement each other in contributing to healthy aging and longevity, for example, by longitudinal research including the role of significant life events in the second half of life in different welfare state contexts.
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Kim MH, Clarke PJ, Dunkle RE. Urban Neighborhood Characteristics and the Spatial Distribution of Home and Community-Based Service Organizations in Michigan Metropolitan Statistical Areas. Res Aging 2021; 44:156-163. [PMID: 33853449 DOI: 10.1177/01640275211005079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Living in a neighborhood with dense HCBS organizations can promote older adults' health and well-being and may mitigate health disparities generated by living in materially deprived urban neighborhoods. Using 2016 US County Business Patterns and the American Community Survey (2013-2017), focused on 516 ZIP Codes in Michigan Metropolitan Statistical Areas, this study examines the association between neighborhood characteristics and the relative density of businesses offering services for older adults and persons with disabilities (e.g., senior centers, adult day service centers, personal care) and businesses offering home health care. Results from a series of spatial econometric models show that social care organization density tends to be high in neighborhoods with a greater number of residents who have a bachelor's degree, who are older, and who are in poverty. Home health care density was not explained by neighborhood factors. Multiple neighborhood socio-demographic indicators explain the spatial distribution of social care organizations.
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Affiliation(s)
- Min Hee Kim
- Philip R. Lee Institute for Health Policy Studies, 8785University of California San Francisco, CA, USA
| | - Philippa J Clarke
- Institute of Social Research, 1259University of Michigan, Ann Arbor, MI, USA
| | - Ruth E Dunkle
- School of Social Work, 1259University of Michigan, Ann Arbor, MI, USA
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Salhi BA, Tsai JW, Druck J, Ward‐Gaines J, White MH, Lopez BL. Toward Structural Competency in Emergency Medical Education. AEM EDUCATION AND TRAINING 2020; 4:S88-S97. [PMID: 32072112 PMCID: PMC7011420 DOI: 10.1002/aet2.10416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/22/2019] [Accepted: 11/04/2019] [Indexed: 06/10/2023]
Abstract
As the emergency department (ED) is the "front door" of the hospital and the primary site by which most patients access the health care system, issues of inequity are especially salient for emergency medicine (EM) practice. Improving the health of ED patients, especially those who are stigmatized and disenfranchised, depends on having emergency physicians that are cognizant and attentive to their needs in and out of the medical encounter. EM resident education has traditionally incorporated a "cultural competency" model to equip residents with tools to combat individual bias and stigma. Although this framework has been influential in drawing attention to health inequities, it has also been criticized for its potential to efface differences within groups (such as socioeconomic differences), overstate cultural or racial differences, and unintentionally reinforce stereotypes or blaming of patients for their ill health or difficult circumstances. In contrast, emerging frameworks of structural competency call for physicians to recognize the ways in which health outcomes are influenced by complex, interrelated structural forces (e.g., poverty, racism, gender discrimination, immigration policy) and to attend to these causes of poor health. We present here the framework of structural competency, extending it to the unique ED setting. We provide tangible illustrations of the ways in which this framework is relevant to the ED setting and can be incorporated in EM education.
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Affiliation(s)
- Bisan A. Salhi
- Department of Emergency MedicineEmory UniversityAtlantaGA
- Department of AnthropologyEmory UniversityAtlantaGA
| | - Jennifer W. Tsai
- Department of Emergency MedicineYale School of MedicineNew HavenCT
| | - Jeffrey Druck
- Department of Emergency MedicineUniversity of Colorado at DenverDenverCO
| | | | | | - Bernard L. Lopez
- Department of Emergency MedicineThomas Jefferson UniversityPhiladelphiaPA
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