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Stevelink SAM, Bakolis I, Dorrington S, Downs J, Leal R, Madan I, Phillips A, Geiger B, Hotopf M, Fear NT. Personal independence payments among people who access mental health services: results from a novel data linkage. BJPsych Open 2024; 10:e150. [PMID: 39314049 DOI: 10.1192/bjo.2024.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Personal independence payment (PIP) is a benefit that covers additional daily living costs people may incur from a long-term health condition or disability. Little is known about PIP receipt and associated factors among people who access mental health services, and trends over time. Individual-level data linking healthcare records with administrative records on benefits receipt have been non-existent in the UK. AIMS To explore how PIP receipt varies over time, including PIP type, and its association with sociodemographic and diagnostic patient characteristics among people who access mental health services. METHOD A data-set was established by linking electronic mental health records from the South London and Maudsley NHS Foundation Trust with administrative records from the Department for Work and Pensions. RESULTS Of 143 714 working-age patients, 37 120 (25.8%) had received PIP between 2013 and 2019, with PIP receipt steadily increasing over time. Two in three patients (63.2%) had received both the daily living and mobility component. PIP receipt increased with age. Those in more deprived areas were more likely to receive PIP. The likelihood of PIP receipt varied by ethnicity. Patients diagnosed with a severe mental illness had 1.48 odds (95% CI 1.42-1.53) of having received PIP, compared with those with a different psychiatric diagnosis. CONCLUSIONS One in four people who accessed mental health services had received PIP, with higher levels seen among those most likely in need, as indicated by a severe mental illness diagnosis. Future research using this data-set could explore the average duration of PIP receipt in people who access mental health services, and re-assessment patterns by psychiatric diagnosis.
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Affiliation(s)
- Sharon A M Stevelink
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and King's Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Ioannis Bakolis
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK; Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Sarah Dorrington
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Johnny Downs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ray Leal
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and King's Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Ira Madan
- Department of Occupational Health, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Ava Phillips
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Ben Geiger
- Centre for Society and Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; and Academic Department of Military Mental Health, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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Tisdale C, de Andrade D, Leung J, Campbell G, Hides L. The risk of repeated suicidal presentations following residential treatment for substance use disorders: A recurrent event analysis using linked administrative data. J Affect Disord 2024; 360:364-375. [PMID: 38810779 DOI: 10.1016/j.jad.2024.05.129] [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: 01/07/2024] [Revised: 05/10/2024] [Accepted: 05/25/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Individuals seeking alcohol and other drug (AOD) treatment consistently experience higher rates of suicidal behaviours and death by suicide when compared to the general population. By linking residential AOD treatment data to administrative healthcare and death datasets, we aimed to examine suicide-related behaviours and identify risk and protective factors for these events following discharge from residential treatment. METHODS Participants included 1056 individuals aged 18-69 (M = 32.06, SD = 9.55, male = 696,65.9 %) admitted to three residential treatment facilities in Queensland, Australia from January 1, 2014 to December 31, 2016. Treatment data was linked to administrative hospital, emergency department (ED), mental health service, and Registry of Deaths data 2-years post-discharge. ICD-10 codes were used to identify and analyse suicide-related events. RESULTS Within 2-years post-discharge, 175 (16.6 %) individuals had a suicide-related event (n = 298 episodes). The highest proportion of episodes (11.1 %) occurred within 1-month of discharge. Higher risk of a recurrent suicide-related event was associated with receiving a Disability Support Pension (aHR = 1.69 (95%CI:1.10,2.59), two or more previous episodes of residential AOD treatment (aHR = 1.49 (95%CI:1.30,2.15). Completing residential treatment was associated with a lower risk of suicide-related events (aHR = 0.54 (95%CI:0.35,0.83). LIMITATIONS The amalgamation of suicidal ideation, attempts, and death into a single outcome oversimplifies their complex nature and interplay. The exclusive focus on one service provider limits generalisability, and data constraints and missingness preclude many analyses. CONCLUSIONS Understanding suicidal behaviours and critical risk periods following discharge from residential treatment is crucial for improving continuing care, developing effective suicide prevention, and implementing targeted interventions among this high-risk population.
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Affiliation(s)
- Calvert Tisdale
- National Drug and Alcohol Research Centre (NDARC), UNSW Medicine & Health, University of New South Wales, Sydney, Australia; National Centre for Youth Substance Use Research (NCYSUR), School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia.
| | - Dominique de Andrade
- School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia; Griffith Criminology Institute, Griffith University, Brisbane, Australia; Griffith Centre for Mental Health, Griffith University, Brisbane, Australia; Centre for Drug Use, Addictive, and Anti-social Behaviour Research, Deakin University, Geelong, Australia
| | - Janni Leung
- National Centre for Youth Substance Use Research (NCYSUR), School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Gabrielle Campbell
- National Centre for Youth Substance Use Research (NCYSUR), School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Leanne Hides
- National Centre for Youth Substance Use Research (NCYSUR), School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
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Wadhwa S, Taouk Y, Spittal MJ, King T. Workplace Injury Compensation and Mental Health and Self-Harm Outcomes: A Systematic Review. New Solut 2024; 34:71-82. [PMID: 38767147 PMCID: PMC11331669 DOI: 10.1177/10482911241254836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Workers' compensation systems aim to financially support injured workers. However, seeking compensation often leads to poorer physical and mental health outcomes. This review examines previous studies to investigate the relationship between workers' compensation and mental health and self-harm outcomes. A three-tiered search strategy across five databases identified studies that examined workers' compensation claims as an exposure or risk factor, with outcomes related to mental health, self-harm and suicidality. Nine full-text studies were included; however, heterogeneity limited generalizability. Most studies supported an association between pursuing compensation and poorer mental health and self-harm outcomes. Some studies attributed this to specific aspects of the system such as justice perception and navigation of the claims system. Findings suggest an association between workers' compensation and mental health or self-harm outcomes. Inconclusive findings highlight the need for further research. Understanding the psychiatric impacts of pursuing compensation is crucial to help formulate a more accessible compensation system.
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Affiliation(s)
- Sanya Wadhwa
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Yamna Taouk
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Matthew J. Spittal
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Tania King
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Tsimpida D, Tsakiridi A, Daras K, Corcoran R, Gabbay M. Unravelling the dynamics of mental health inequalities in England: A 12-year nationwide longitudinal spatial analysis of recorded depression prevalence. SSM Popul Health 2024; 26:101669. [PMID: 38708408 PMCID: PMC11066558 DOI: 10.1016/j.ssmph.2024.101669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
Background Depression is one of the most significant public health issues, but evidence of geographic patterns and trends of depression is limited. We aimed to examine the spatio-temporal patterns and trends of depression prevalence among adults in a nationwide longitudinal spatial study in England and evaluate the influence of neighbourhood socioeconomic deprivation in explaining patterns. Methods Information on recorded depression prevalence was obtained from the indicator Quality and Outcomes Framework: Depression prevalence that measured the annual percentage of adults diagnosed with depression for Lower Super Output Areas (LSOA) from 2011 to 2022. We applied Cluster and Outlier Analysis using the Local Moran's I algorithm. Local effects of deprivation on depression in 2020 examined with Geographically Weighted Regression (GWR). Inequalities in recorded prevalence were presented using Prevalence Rate Ratios (PRR). Results The North West Region of England had the highest concentration of High-High clusters of depression, with 17.4% of the area having high values surrounded by high values in both space and time and the greatest percentage of areas with a high rate of increase (43.1%). Inequalities widened among areas with a high rate of increase in prevalence compared to those with a lower rate of increase, with the PRR increasing from 1.66 (99% CI 1.61-1.70) in 2011 to 1.81 (99% CI 1.76-1.85) by 2022. Deprivation explained 3%-39% of the variance in depression in 2020 across the country. Conclusions It is crucial to monitor depression's spatial patterns and trends and investigate mechanisms of mental health inequalities. Our findings can help identify priority areas and target prevention and intervention strategies in England. Evaluating mental health interventions in different geographic contexts can provide valuable insights to policymakers on the most effective and context-sensitive strategies, enabling them to allocate resources towards preventing the worsening of mental health inequalities.
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Affiliation(s)
- Dialechti Tsimpida
- Department of Public Health, Policy and Systems, University of Liverpool, UK
- Centre for Research on Ageing, University of Southampton, UK
- Department of Gerontology, University of Southampton, UK
| | | | - Konstantinos Daras
- Department of Public Health, Policy and Systems, University of Liverpool, UK
- National Institute for Health Research Applied Research Collaboration North West Coast (NIHR ARC NWC), UK
| | - Rhiannon Corcoran
- National Institute for Health Research Applied Research Collaboration North West Coast (NIHR ARC NWC), UK
- Department of Primary Care and Mental Health, University of Liverpool, UK
| | - Mark Gabbay
- National Institute for Health Research Applied Research Collaboration North West Coast (NIHR ARC NWC), UK
- Department of Primary Care and Mental Health, University of Liverpool, UK
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Irvine A, Haggar T. Conceptualising the social in mental health and work capability: implications of medicalised framing in the UK welfare system. Soc Psychiatry Psychiatr Epidemiol 2024; 59:455-465. [PMID: 36912993 PMCID: PMC10944406 DOI: 10.1007/s00127-023-02449-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/27/2023] [Indexed: 03/14/2023]
Abstract
PURPOSE This paper asks whether the separation of mental health from its wider social context during the UK benefits assessment processes is a contributing factor to widely recognised systemic difficulties, including intrinsically damaging effects and relatively ineffective welfare-to-work outcomes. METHODS Drawing on multiple sources of evidence, we ask whether placing mental health-specifically a biomedical conceptualisation of mental illness or condition as a discrete agent-at the core of the benefits eligibility assessment process presents obstacles to (i) accurately understanding a claimant's lived experience of distress (ii) meaningfully establishing the specific ways it affects their capacity for work, and (iii) identifying the multifaceted range of barriers (and related support needs) that a person may have in relation to moving into employment. RESULTS We suggest that a more holistic assessment of work capacity, a different kind of conversation that considers not only the (fluctuating) effects of psychological distress but also the range of personal, social and economic circumstances that affect a person's capacity to gain and sustain employment, would offer a less distressing and ultimately more productive approach to understanding work capability. CONCLUSION Such a shift would reduce the need to focus on a state of medicalised incapacity and open up space in encounters for more a more empowering focus on capacity, capabilities, aspirations, and what types of work are (or might be) possible, given the right kinds of contextualised and personalised support.
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Affiliation(s)
- Annie Irvine
- ESRC Centre for Society and Mental Health, King's College London, London, UK.
| | - Tianne Haggar
- The Policy Institute, King's College London, London, UK
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Lee SC, DelPozo-Banos M, Lloyd K, Jones I, Walters JTR, John A. Trends in socioeconomic inequalities in incidence of severe mental illness - A population-based linkage study using primary and secondary care routinely collected data between 2000 and 2017. Schizophr Res 2023; 260:113-122. [PMID: 37634386 DOI: 10.1016/j.schres.2023.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/30/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE In 2008, the UK entered a period of economic recession followed by sustained austerity measures. We investigate changes in inequalities by area deprivation and urbanicity in incidence of severe mental illness (SMI, including schizophrenia-related disorders and bipolar disorder) between 2000 and 2017. METHODS We analysed 4.4 million individuals from primary and secondary care routinely collected datasets (2000-2017) in Wales and estimated the incidence of SMI by deprivation and urbanicity measured by the Welsh Index of Multiple Deprivation (WIMD) and urban/rural indicator respectively. Using linear modelling and joinpoint regression approaches, we examined time trends of the incidence and incidence rate ratios (IRR) of SMI by the WIMD and urban/rural indicator adjusted for available confounders. RESULTS We observed a turning point of time trends of incidence of SMI at 2008/2009 where slope changes of time trends were significantly increasing. IRRs by deprivation/urbanicity remained stable or significantly decreased over the study period except for those with bipolar disorder sourced from secondary care settings, with increasing trend of IRRs (increase in IRR by deprivation after 2010: 1.6 % per year, 95 % CI: 1.0 %-2.2 %; increase in IRR by urbanicity 1.0 % per year, 95 % CI: 0.6 %-1.3 %). CONCLUSIONS There was an association between recession/austerity and an increase in the incidence of SMI over time. There were variations in the effects of deprivation/urbanicity on incidence of SMI associated with short- and long-term socioeconomic change. These findings may support targeted interventions and social protection systems to reduce incidence of SMI.
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Affiliation(s)
- Sze Chim Lee
- DATAMIND at HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK,; National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Marcos DelPozo-Banos
- DATAMIND at HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK,; National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Keith Lloyd
- DATAMIND at HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK,; National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Ian Jones
- National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK; MRC Centre for Neuropsychiatric Genetics and Genomics. School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, UK
| | - James T R Walters
- DATAMIND at HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK,; National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK; MRC Centre for Neuropsychiatric Genetics and Genomics. School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, UK
| | - Ann John
- DATAMIND at HDRUK, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK,; National Centre for Mental Health. Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK.
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Fahy K, Alexiou A, Daras K, Mason K, Bennett D, Taylor-Robinson D, Barr B. Mental health impact of cuts to local government spending on cultural, environmental and planning services in England: a longitudinal ecological study. BMC Public Health 2023; 23:1441. [PMID: 37501117 PMCID: PMC10375661 DOI: 10.1186/s12889-023-16340-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Over the past decade, there have been significant and unequal cuts to local authority (LA) budgets, across England. Cultural, environmental and planning (CEP) budgets have been cut by 17% between 2011 and 2019. This funding supports services such as parks, leisure centres, community development and libraries, all of which have potential to influence population mental health. We therefore investigated whether cuts to CEP services have affected mental health outcomes and the extent to which they have contributed to mental health inequalities between areas. METHODS Using fixed effects regression applied to longitudinal LA-level panel data in England, we assessed whether trends in CEP spend were associated with trends in mental health outcomes, between 2011 and 2019. The exposure was CEP spend and the primary outcome was the LA-average Small Area Mental Health Index (SAMHI). Additionally, we considered subcategories of CEP spend as secondary exposures, and antidepressant prescription rate and self-reported anxiety levels as secondary outcomes, both aggregated to LA-level. We adjusted all models for confounders and conducted subgroup analysis to examine differential mental health effects of spending cuts based on the level of area deprivation. RESULTS The average decrease in CEP spend of 15% over the period was associated with a 0.036 (95% CI: 0.005, 0.067) increase in SAMHI score, indicating worsening mental health. Amongst subcategories of CEP spending, cuts to planning and development services impacted mental health trends the most, with a 15% reduction in spend associated with a 0.018 (95% CI: 0.005, 0.031) increase in the SAMHI score. The association between cuts in CEP and deteriorating mental health was greater in more affluent areas. CONCLUSION Cuts to spending on cultural, environmental, planning and development services were associated with worsening population mental health in England. Impacts were driven by cuts to planning and development services in particular. Reinvesting in these services may contribute to improved public mental health.
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Affiliation(s)
- Katie Fahy
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, L69 3GB, UK.
| | - Alexandros Alexiou
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, L69 3GB, UK
| | - Konstantinos Daras
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, L69 3GB, UK
| | - Kate Mason
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, L69 3GB, UK
- Melbourne School of Population and Global Health, Centre for Health Policy, The University of Melbourne, Melbourne, Australia
| | - Davara Bennett
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, L69 3GB, UK
| | - David Taylor-Robinson
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, L69 3GB, UK
| | - Ben Barr
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, L69 3GB, UK
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Favre S, Richard-Lepouriel H. Self-stigma and bipolar disorder: A systematic review and best-evidence synthesis. J Affect Disord 2023; 335:273-288. [PMID: 37207946 DOI: 10.1016/j.jad.2023.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Bipolar disorder is a severe and chronic mental illness characterized by recurrent major depressive episodes and mania or hypomania. In addition to the burden of the disease and its consequences, self-stigma can impact people with bipolar disorder. This review investigates the current state of research in self-stigma in bipolar disorder. METHODS An electronic search was carried out until February 2022. Three academic databases were systematically searched, and best-evidence synthesis was made. RESULTS Sixty-six articles were related to self-stigma in bipolar disorder. Seven key themes were extracted from these studies: 1/ Comparison of self-stigma in bipolar disorder and other mental illnesses, 2/ Sociocultural context and self-stigma, 3/ Correlates and predictors of self-stigma, 4/ Consequences of self-stigma, 5/ Treatments and self-stigma, 6/ Management of self-stigma, and 7/ Self-stigma and recovery in bipolar disorder. LIMITATIONS Firstly, a meta-analysis could not be performed due to the heterogeneity of the studies. Secondly, limiting the search to self-stigma has excluded other forms of stigma that also have an impact. Thirdly, the under-reporting of negative or nonsignificant results due to publication bias and unpublished studies might have limited the accuracy of this reviews' synthesis. CONCLUSION Research on self-stigma in persons with bipolar disorder has been the focused on different aspects, and interventions to reduce self-stigmatization have been developed, but evidence of their effectiveness is still sparse. Clinicians need to be attentive to self-stigma, its assessment, and its empowerment in their daily clinical practice. Future work is required to establish valid strategies to fight self-stigma.
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Affiliation(s)
- Sophie Favre
- Mood disorder unit, Psychiatric Specialties Service, Geneva University Hospital, Geneva, Switzerland
| | - Hélène Richard-Lepouriel
- Mood disorder unit, Psychiatric Specialties Service, Geneva University Hospital, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland.
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Brown H, Xiang H, Cheetham M, Morris S, Gibson M, Katikireddi SV, Munford LA, Taylor-Robinson D, Finney H, Bartle V, Baxter AJ, Wickham S, Craig P, Bambra C. Exploring the health and sociodemographic characteristics of people seeking advice with claiming universal credit: a cross-sectional analysis of UK citizens advice data, 2017-2021. BMC Public Health 2023; 23:595. [PMID: 36997889 PMCID: PMC10060933 DOI: 10.1186/s12889-023-15483-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND The UK Department for Work and Pensions (DWP) administers Universal Credit (UC) - the main UK benefit for people in- and out-of-work. UC is being rolled out nationally from 2013 to 2024. Citizens Advice (CA) is an independent charity that provides advice and support to people making a claim for UC. The aim of this study is to understand who is seeking advice from CA when making a UC claim and how the types of people seeking advice are changing as the rollout of UC continues. METHODS Co-developed with Citizens Advice Newcastle and Citizens Advice Northumberland we performed longitudinal analysis of national data from Citizens Advice for England and Wales on the health (mental health and limiting long term conditions) and socio-demographic of 1,003,411 observations for people seeking advice with claiming UC over four financial years (2017/18 to 2020/21). We summarised population characteristics and estimated the differences between the four financial years using population-weighted t-tests. Findings were discussed with three people with lived experience of seeking advice to claim UC to help frame our interpretation and policy recommendations. RESULTS When comparing 2017/18 to 2018/19, there was a significantly higher proportion of people with limiting long term conditions seeking advice with claiming UC than those without (+ 2.40%, 95%CI: 1.31-3.50%). However, as the rollout continued between 2018/29 and 2019/20 (-6.75%, 95%CI: -9.62%--3.88%) and between 2019/20 and 2020/21 (-2.09%, 95%CI: -2.54%--1.64%), there were significantly higher proportions of those without a limiting long term condition seeking advice than with. When comparing 2018/19 to 2019/20 and 2019/20 to 2020/21, there was a significant increase in the proportion of self-employed compared to unemployed people seeking advice with claiming UC (5.64%, 95%CI: 3.79-7.49%) and (2.26%, 95%CI: 1.29-3.23%) respectively. CONCLUSION As the rollout for UC continues, it is important to understand how changes in eligibility for UC may impact on those who need help with applying for UC. Ensuring that the advice process and application process is responsive to a range of people with different needs can help to reduce the likelihood that the process of claiming UC will exacerbate health inequalities.
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Affiliation(s)
- Heather Brown
- Division of Health Research, Lancaster University, Lancaster, UK.
| | - Huasheng Xiang
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Mandy Cheetham
- Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Steph Morris
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Marcia Gibson
- MRC/CO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - Luke Aaron Munford
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, Manchester, UK
| | - David Taylor-Robinson
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, Merseyside, UK
| | | | - Victoria Bartle
- Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Andrew J Baxter
- MRC/CO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Sophie Wickham
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, Merseyside, UK
| | - Peter Craig
- MRC/CO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
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Stevelink SAM, Phillips A, Broadbent M, Boyd A, Dorrington S, Jewell A, Leal R, Bakolis I, Madan I, Hotopf M, Fear NT, Downs J. Linking electronic mental healthcare and benefits records in South London: design, procedure and descriptive outcomes. BMJ Open 2023; 13:e067136. [PMID: 36792321 PMCID: PMC9950921 DOI: 10.1136/bmjopen-2022-067136] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVES To describe the process and outcomes of a data linkage between electronic secondary mental healthcare records from the South London and Maudsley (SLaM) NHS Foundation Trust with benefits records from the Department for Work and Pensions (DWP). We also describe the mental health and benefit profile of patients who were successfully linked. DESIGN A deterministic linkage of routine records from health and welfare government service providers within a secure environment. SETTING AND PARTICIPANTS Adults aged≥18 years who were referred to or accessed treatment at SLaM services between January 2007 and June 2019, including those who were treated as part of Improving Access to Psychological Therapies (IAPT) services between January 2008 and June 2019 (n=448 404). Benefits data from the DWP from January 2005 to June 2020. OUTCOME MEASURES The linkage rate and associated sociodemographic, diagnostic and treatment factors. Recorded primary psychiatric diagnosis based on International Classification of Diseases (ICD)-10 codes and type of benefit receipt. RESULTS A linkage rate of 92.3% was achieved. Women, younger patients and those from ethnic minority groups were less likely to be successfully linked. Patients who had subsequently died, had a recorded primary psychiatric diagnosis, had also engaged with IAPT and had a higher number of historical postcodes available were more likely to be linked. Overall, 83% of patients received benefits at some point between 2005 and 2020. Benefit receipt across the psychiatric diagnosis spectrum was high, over 80% across most ICD-10 codes. CONCLUSIONS This data linkage is the first of its kind in the UK demonstrating the use of routinely collected mental health and benefits data. Benefit receipt was high among patients accessing SLaM services and varied by psychiatric diagnosis. Future areas of research are discussed, including exploring the effectiveness of interventions for helping people into work and the impact of benefit reforms.
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Affiliation(s)
- Sharon A M Stevelink
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Ava Phillips
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Matthew Broadbent
- South London and Maudsley Mental Health NHS Trust, NIHR Maudsley Biomedical Research Centre, London, UK
| | - Andy Boyd
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dorrington
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley Mental Health NHS Trust, NIHR Maudsley Biomedical Research Centre, London, UK
| | - Amelia Jewell
- South London and Maudsley Mental Health NHS Trust, NIHR Maudsley Biomedical Research Centre, London, UK
| | - Ray Leal
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Ioannis Bakolis
- Centre for Implementation Science, Health Services and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Ira Madan
- Department of Occupational Health, Guy's and St Thomas' Hospitals NHS Trust, London, UK
- King's College London, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley Mental Health NHS Trust, NIHR Maudsley Biomedical Research Centre, London, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Academic Department of Military Mental Health, Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Johnny Downs
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley Mental Health NHS Trust, NIHR Maudsley Biomedical Research Centre, London, UK
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11
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Taylor JA, Salkever DS, Frey WD, Riley J, Marrow J. Enrollment in the Supported Employment Demonstration: An Employment Intervention for Denied Disability Benefits Applicants with a Mental Impairment. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:909-926. [PMID: 34405312 DOI: 10.1007/s10488-021-01159-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 06/01/2023]
Abstract
The Supported Employment Demonstration enrolled denied Social Security Disability Benefits applicants with alleged or documented mental impairment into an employment and health intervention. Recruiters attempted to contact 21,003 applicants located near participating community mental health agencies, and enrolled 2960 eligible applicants from November 2017 through March 2019. Among potentially eligible enrollees, 26.2% enrolled. We use regression analysis incorporating disability application data, local area economic characteristics, and benefits receipt information to assess probability of enrollment. Complementary qualitative data were drawn from ethnographic interviews with enrollees and non-enrollees. Quantitative results suggest males, people with limited work experience, and people with higher educational attainment were more likely to enroll. SSA denial based on assessment that the applicant could find alternative work in the national economy also strongly predicted enrollment. Denied applicants were also more likely to enroll if their local unemployment rate was high and if average wages in their county were rising rapidly. Qualitative interviews suggest that enrollees joined because they felt the study would improve their lives, although some enrollees reported they enrolled for the financial incentives of interview participation. Key reasons for non-enrollment include (1) lack of interest in work and (2) the perception that subjects' health prevented them from working. Comparisons between the sample selected for contact and the sample not selected for contact showed the two groups were largely identical. The SED achieved considerably higher recruitment rates than comparable studies. Applicant and local economic characteristics relate to the likelihood of enrollment. Clinical Trials Registration: This study is registered with ClinicalTrials.gov: registration number NCT03682263. This study follows the Mixed Methods guidelines.
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Affiliation(s)
| | | | | | | | - Jocelyn Marrow
- Westat, Rockville, USA.,University of Maryland Baltimore County, Baltimore, USA
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12
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Boonstra MD, Abma FI, Wilming L, Ståhl C, Karlsson E, Brouwer S. Social Insurance Literacy of Dutch Workers Receiving Disability Benefits and its Associations with Socio-Economic Characteristics. JOURNAL OF OCCUPATIONAL REHABILITATION 2022; 32:494-504. [PMID: 34985681 PMCID: PMC9576638 DOI: 10.1007/s10926-021-10018-3] [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] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
Purpose This study explores the concept social insurance literacy (SIL) and corresponding questionnaire (SILQ) among workers receiving disability benefits and the comprehensibility of the social security institute (SSI), and examines associations with socio-economic characteristics. Methods 1753 panel members of the Dutch SSI were approached to complete the SILQ-NL37. This measure was based on the original SILQ. The SILQ-NL37 contains domains for obtaining, understanding and acting upon information for both individual SIL and system comprehensibility. A higher score means better SIL or comprehensibility. Data on age, gender, education, living situation, Dutch skills and time receiving disability benefits were also collected. With k-means clustering, groups with adequate and limited SIL were created. Associations with socio-economic characteristics were examined with independent t-tests and linear regression analyses for both the total scores and within domain scores. Cronbach α and Spearman rho's indicated measurement properties were good to acceptable for the SILQ-NL37. Results Thirty-five percent of the 567 participants were in the group with limited SIL. Higher individual SILQ-NL37 scores were associated with having a partner (p = 0.018) and northeastern living region (p = 0.031). Higher scores for obtaining (p = 0.041) and understanding (p = 0.049) information were associated with female sex, and for acting on information with younger age (p = 0.020). People with limited Dutch skills (p = 0.063) and a partner (p = 0.085) rated system comprehensibility higher. Conclusions According to the SILQ-NL37 scores, about 35% of the panel members have limited ability to obtain, understand and act upon social insurance systems information. Limited SIL is associated with several socio-economic factors. Future researches should study the concept in a more representative sample, and in different countries and social insurance contexts.
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Affiliation(s)
- M D Boonstra
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, Groningen, The Netherlands.
| | - F I Abma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, Groningen, The Netherlands
- Research Center for Insurance Medicine, Amsterdam, The Netherlands
| | - L Wilming
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, Groningen, The Netherlands
- Research Center for Insurance Medicine, Amsterdam, The Netherlands
| | - C Ståhl
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- HELIX Competence Center, Linköping University, Linköping, Sweden
| | - E Karlsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - S Brouwer
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, Groningen, The Netherlands
- Research Center for Insurance Medicine, Amsterdam, The Netherlands
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13
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Cheetham M, Atkinson PJ, Gibson M, Katikireddi SV, Moffatt S, Morris S, Munford L, Shenton F, Wickham S, Craig P. Exploring the mental health effects of Universal Credit: a journey of co-production. Perspect Public Health 2022; 142:209-212. [PMID: 35833554 PMCID: PMC9284081 DOI: 10.1177/17579139221103178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- M Cheetham
- Research Fellow, National Institute for Health and Care Research (NIHR), Applied Research Collaboration North East and North Cumbria (NIHR200173), based at Department of Nursing, Midwifery and Health, Northumbria University, Coach Lane Campus East, Room H213, Newcastle-u-Tyne, NE7 7XA, UK
| | | | - M Gibson
- Investigator Scientist, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S V Katikireddi
- Professor of Public Health & Health Inequalities, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S Moffatt
- Professor of Social Gerontology, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - S Morris
- Post Doctoral Research Associate, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - L Munford
- Senior Lecturer in Health Economics, Division of Population Health, Health Services Research & Primary Care, School of Social Sciences, University of Manchester, Manchester, UK
| | - F Shenton
- Public Involvement and Community Engagement Manager, National Institute for Health and Care Research (NIHR), Applied Research Collaboration North East and North Cumbria (NIHR200173), based at CNTW NHS Foundation Trust, St Nicholas' Hospital, Newcastle Upon Tyne, NE3 3XT, UK
| | - S Wickham
- Wellcome Trust Research Fellow, Department of Public Health, Policy & Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - P Craig
- Professor of Public Health Evaluation, Inequalities and Health, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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14
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United Kingdom’s Income Support Program for People With Disabilities: Redesign, Reform, and Policy Lessons for the United States. JOURNAL OF DISABILITY POLICY STUDIES 2022. [DOI: 10.1177/10442073221094804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We reviewed the operational aspects of Employment and Support Allowance (ESA)—the income support program for people with disabilities in the United Kingdom—and its potential policy lessons for the United States’ Social Security Disability Insurance (SSDI) program. ESA has a five-step eligibility determination process, and eligible beneficiaries receive either an unconditional cash benefit or payments conditional on participating in return-to-work activities. The United Kingdom has reformed ESA to better meet policy objectives. Both ESA and SSDI collect medical documentation, but ESA also requires face-to-face eligibility assessments for almost all claimants. ESA eligibility is based on functional limitations exclusively, whereas SSDI assesses the ability to perform substantial work. With its focus on helping some beneficiaries return to work, ESA differs from SSDI, which requires no return-to-work efforts to receive benefits. ESA might offer policy lessons for SSDI with regard to pilot testing, program reform, and accurate decision making.
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15
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Craig P, Barr B, Baxter AJ, Brown H, Cheetham M, Gibson M, Katikireddi SV, Moffatt S, Morris S, Munford LA, Richiardi M, Sutton M, Taylor-Robinson D, Wickham S, Xiang H, Bambra C. Evaluation of the mental health impacts of Universal Credit: protocol for a mixed methods study. BMJ Open 2022; 12:e061340. [PMID: 35396318 PMCID: PMC8996017 DOI: 10.1136/bmjopen-2022-061340] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The UK social security system is being transformed by the implementation of Universal Credit (UC), which combines six existing benefits and tax credits into a single payment for low-income households. Despite extensive reports of hardship associated with the introduction of UC, no previous studies have comprehensively evaluated its impact on mental health. Because payments are targeted at low-income households, impacts on mental health will have important consequences for health inequalities. METHODS AND ANALYSIS We will conduct a mixed methods study. Work package (WP) 1 will compare health outcomes for new recipients of UC with outcomes for legacy benefit recipients in two large population surveys, using the phased rollout of UC as a natural experiment. We will also analyse the relationship between the proportion of UC claimants in small areas and a composite measure of mental health. WP2 will use data collected by Citizen's Advice to explore the sociodemographic and health characteristics of people who seek advice when claiming UC and identify features of the claim process that prompt advice-seeking. WP3 will conduct longitudinal in-depth interviews with up to 80 UC claimants in England and Scotland to explore reasons for claiming and experiences of the claim process. Up to 30 staff supporting claimants will also be interviewed. WP4 will use a dynamic microsimulation model to simulate the long-term health impacts of different implementation scenarios. WP5 will undertake cost-consequence analysis of the potential costs and outcomes of introducing UC and cost-benefit analyses of mitigating actions. ETHICS AND DISSEMINATION We obtained ethical approval for the primary data gathering from the University of Glasgow, College of Social Sciences Research Ethics Committee, application number 400200244. We will use our networks to actively disseminate findings to UC claimants, the public, practitioners and policy-makers, using a range of methods and formats. TRIAL REGISTRATION NUMBER The study is registered with the Research Registry: researchregistry6697.
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Affiliation(s)
- Peter Craig
- MRC/CO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Benjamin Barr
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, Merseyside, UK
| | - Andrew J Baxter
- MRC/CO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Heather Brown
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mandy Cheetham
- Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
- North East and North Cumbria Applied Research Collaboration, Newcastle-upon-Tyne, UK
| | - Marcia Gibson
- MRC/CO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - Suzanne Moffatt
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Steph Morris
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Aaron Munford
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Matteo Richiardi
- Centre for Microsimulation and Policy Analysis, University of Essex, Colchester, Essex, UK
| | - Matt Sutton
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, Manchester, UK
| | - David Taylor-Robinson
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, Merseyside, UK
| | - Sophie Wickham
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, Merseyside, UK
| | - Huasheng Xiang
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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16
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Collie A, Gray SE. The relationship between work disability and subsequent suicide or self-harm: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000922. [PMID: 36962884 PMCID: PMC10021753 DOI: 10.1371/journal.pgph.0000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 11/12/2022] [Indexed: 12/12/2022]
Abstract
Work disability occurs when an injury or illness limits the ability of a worker to participate in employment. While evidence suggests that people with work disability are at increased risk of suicide and intentional self-harm, this relationship has not been the subject of systematic review. This scoping review aims to assess and summarise the research literature regarding the relationship between work disability and subsequent suicide or intentional self-harm. Review protocol was published on the Open Science Foundation and is reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Peer-reviewed studies published in English from 1st January 2000 were included if they reported suicide or self-harm outcomes in people aged 15 years or older with work disability. Studies were identified via systematic search of Medline, Scopus and Pubmed databases, via recommendation from topic experts, and citation searching of included articles. A narrative synthesis was undertaken. Literature search yielded 859 records of which 47 eligible studies were included, nine set in workers' compensation, 20 in sickness absence, 13 in disability pension systems, and five from mixed cohorts. Of 44 quantitative studies, 41 reported a positive relationship between work disability and suicidal behaviour. The relationship is observed consistently across nations, work disability income support systems and health conditions. Several factors elevate risk of suicidal behaviour, including presence of mental health conditions and longer work disability duration. There were few studies in some nations and no suicide prevention interventions. The risk of suicide and self-harm is elevated in people experiencing work disability. Further observational research is required to fill evidence gaps. This review suggests the need for governments, employers and those involved in the care of people with work disability to focus on identification and monitoring of those at greatest risk of suicidal behaviour, and suicide prevention.
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Affiliation(s)
- Alex Collie
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Shannon Elise Gray
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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17
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Wickham S, Fancourt D. Perspective Commentary: The Implementation of Welfare Policies Are Not Held to the Same Ethical Standards as Research: Raising Intergenerational Health Inequality Concerns. Front Public Health 2021; 9:764559. [PMID: 34888286 PMCID: PMC8650605 DOI: 10.3389/fpubh.2021.764559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
Over the last 12 years the United Kingdom (UK) has seen the introduction of an austerity programme-a fiscal policy-with the primary goal to reduce the government's budget deficit and the role of the welfare system. Between 2010 and 2015 there was an estimated reduction of £14.5 billion in spending, attributable to decreasing the value of benefits and restricting entitlement to benefit claimants. By 2020, there had been an estimated unprecedented £27 billion less spent on welfare compared with spending in 2010. Whilst fiscally-successful at reducing spending, some implemented welfare policies have had direct consequences for people's health, increasing inequalities which have been heavily criticized. Moreover, there is growing concern that this has an intergenerational effect. In this paper, we describe the ethical principles in human research, how these have been considered in public health policy, and the existing evidence of the direct and intergenerational health and welfare consequences of some recent, nationally-implemented welfare policies. We argue that ethical principles, specifically the ethical principle of safety that is applied in all research, should be applied to all public welfare policies to stop the rising inequalities in health we are seeing across generations. We highlight that initial changes implemented to welfare policies as a response to COVID-19 demonstrate that there can be a political and societal perceived value in going further to support individuals and their families during times of adversity, and consider the ethical implications of this.
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Affiliation(s)
- Sophie Wickham
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Daisy Fancourt
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom
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18
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Akhter N, Fairbairn RS, Pearce M, Warren J, Kasim A, Bambra C. Local Inequalities in Health Behaviours: Longitudinal Findings from the Stockton-On-Tees Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111018. [PMID: 34769536 PMCID: PMC8582866 DOI: 10.3390/ijerph182111018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/15/2021] [Accepted: 10/15/2021] [Indexed: 12/02/2022]
Abstract
This paper provides a longitudinal examination of local inequalities in health behaviours during a period of austerity, exploring the role of ‘place’ in explaining these inequalities. Data from the Stockton-on-Tees prospective cohort study of 836 individuals were analysed and followed over 18 months (37% follow-up). Generalised estimating equation models estimated the deprivation gap in health behaviours (smoking status, alcohol use, fruit and vegetable consumption and physical activity practices) between the 20% most- and least-deprived neighborhoods (LSOAs), explored any temporal changes during austerity, and examined the underpinning role of compositional and contextual determinants. All health behaviours, except for frequent physical activity, varied significantly by deprivation (p ≤ 0.001). Smoking was lower in the least-deprived areas (OR 0.21, CI 0.14 to 0.30), while alcohol use (OR 2.75, CI 1.98 to 3.82) and fruit and vegetable consumption (OR 2.55, CI 1.80 to 3.62) were higher in the least-deprived areas. The inequalities were relatively stable throughout the study period. Material factors (such as employment, education and housing tenure) were the most-important and environmental factors the least-important explanatory factors. This study suggests that material factors are the most important ‘place’ determinants of health behaviours. Health promotion activities should better reflect these drivers.
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Affiliation(s)
- Nasima Akhter
- Department of Anthropology, Durham University, Dawson Building, Stockton Road, Durham DH1 3LE, UK;
- Correspondence: ; Tel.: +44-(0)1913340716
| | - Ross Stewart Fairbairn
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; (R.S.F.); (M.P.); (C.B.)
| | - Mark Pearce
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; (R.S.F.); (M.P.); (C.B.)
| | - Jon Warren
- St. Cuthberts Society, Durham University, Durham DH1 3LE, UK;
- Department of Sociology, Durham University, 32 Old Elvet, Durham DH1 3HN, UK
| | - Adetayo Kasim
- Department of Anthropology, Durham University, Dawson Building, Stockton Road, Durham DH1 3LE, UK;
- Durham Research Methods Center, Durham University, Durham DH1 3LE, UK
| | - Clare Bambra
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE1 7RU, UK; (R.S.F.); (M.P.); (C.B.)
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Popay J, Whitehead M, Ponsford R, Egan M, Mead R. Power, control, communities and health inequalities I: theories, concepts and analytical frameworks. Health Promot Int 2021; 36:1253-1263. [PMID: 33382890 PMCID: PMC8515177 DOI: 10.1093/heapro/daaa133] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This is Part I of a three-part series on community empowerment as a route to greater health equity. We argue that community 'empowerment' approaches in the health field are increasingly restricted to an inward gaze on community psycho-social capacities and proximal neighbourhood conditions, neglecting the outward gaze on political and social transformation for greater equity embedded in foundational statements on health promotion. We suggest there are three imperatives if these approaches are to contribute to increased equity. First, to understand pathways from empowerment to health equity and drivers of the depoliticisation of contemporary empowerment practices. Second, to return to the original concept of empowerment processes that support communities of place/interest to develop capabilities needed to exercise collective control over decisions and actions in the pursuit of social justice. Third, to understand, and engage with, power dynamics in community settings. Based on our longitudinal evaluation of a major English community empowerment initiative and research on neighbourhood resilience, we propose two complementary frameworks to support these shifts. The Emancipatory Power Framework presents collective control capabilities as forms of positive power. The Limiting Power Framework elaborates negative forms of power that restrict the development and exercise of a community's capabilities for collective control. Parts II and III of this series present empirical findings on the operationalization of these frameworks. Part II focuses on qualitative markers of shifts in emancipatory power in BL communities and Part III explores how power dynamics unfolded in these neighbourhoods.
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Affiliation(s)
- Jennie Popay
- Division of Health Research, Lancaster University, Health Innovation One, Lancaster, LA1 4AT, UK
| | - Margaret Whitehead
- Department of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool, L69 3GB, UK
| | - Ruth Ponsford
- Health Services Research & Policy, London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK
| | - Matt Egan
- Health Services Research & Policy, London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK
| | - Rebecca Mead
- Division of Health Research, Lancaster University, Health Innovation One, Lancaster, LA1 4AT, UK
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Loh S, Knight A, Loopstra R. Working-age adults using food banks in England have significantly poorer health and higher rates of mental health conditions than adults in the general population: A cross-sectional quantitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1594-1605. [PMID: 33211358 DOI: 10.1111/hsc.13226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/07/2020] [Indexed: 06/11/2023]
Abstract
Food bank use has risen rapidly in the UK since 2010. The negative health impacts of food insecurity are well-documented, but there is a lack of quantitative research exploring the health of people using food banks, who are most often severely food insecure. To address this gap, this study compares health outcomes between working-age adults using food banks and those in the general population in England, investigating whether adults using food banks are disproportionately affected by poor health, even after accounting for socioeconomic differences. Data from a survey of 598 adults using Trussell Trust food banks in 2016-2017 were merged with data from the Health Survey for England (HSE) from 2016. Outcome variables of interest were: self-rated health, life-limiting health conditions (disability) and self-reported metabolic, cardiovascular, musculoskeletal and mental health conditions. Logistic regression models were used to examine the odds of adults using food banks having health conditions, disability and poor self-rated health compared to the general population. The prevalence rates of poor self-rated health, disability, mental health disorders and musculoskeletal conditions were significantly higher among adults using food banks than the general population (p < .05 for all outcomes). These associations remained after accounting for gender, age, marital status, employment and education. This comparative study highlights the many health disadvantages among adults using food bank compared to the general population. The higher risk of poor self-rated health, disability and mental health conditions was not fully explained by measures of low socioeconomic status. Possible explanations for these findings include: first, that poor health may increase vulnerability to food insecurity, and, in turn, use of food banks; second, that experiences of food insecurity and food bank use may cause declines in health; and third, that food bank use and poor health may be joint outcomes arising from the last decade of austerity in the UK.
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Affiliation(s)
- Sin Loh
- Department of Nutritional Sciences, King's College London, London, UK
| | - Annemarie Knight
- Department of Nutritional Sciences, King's College London, London, UK
| | - Rachel Loopstra
- Department of Nutritional Sciences, King's College London, London, UK
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21
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Koltai J, McKee M, Stuckler D. Association between disability-related budget reductions and increasing drug-related mortality across local authorities in Great Britain. Soc Sci Med 2021; 284:114225. [PMID: 34311390 DOI: 10.1016/j.socscimed.2021.114225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 06/10/2021] [Accepted: 07/10/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Drug-related mortality in the UK rose markedly after 2012. Here we test the hypothesis that cuts to disability-related spending were associated with increased drug-related mortality across local governments in Great Britain. METHODS We regressed changes in drug-related death rates (years 2010-12 versus 2015-17) on local government disability-related budget reductions, adjusting for a range of regional, demographic, and economic factors. Budget reductions are captured with a combined measure of financial losses due to Incapacity Benefit and Disability Living Allowance reforms, expressed in pounds sterling per capita, per year. 364 local authorities across England, Scotland, and Wales were included in the study. FINDINGS Greater budget reductions were associated with greater increases in drug-related death rates. In the unadjusted model, each £100 per capita budget reduction was associated with an increase in drug-related death rates of 3.30 per 100 000 population (95% CI: 2.43 to 4.17). The magnitude of the association increased after adjusting for region and demographic factors (b = 4.84; 95% CI: 3.26 to 6.43). The association remained statistically significant after adjusting for a full set of controls, including baseline and trends in unemployment rates, median hourly pay, and gross disposable household income per capita (b = 4.41; 95% CI: 2.57 to 6.24). CONCLUSION Deeper cuts to local government spending in Great Britain in the 2010s were associated with larger increases in drug-related deaths.
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Affiliation(s)
- Jonathan Koltai
- Department of Sociology, University of New Hampshire, Durham, USA.
| | - Martin McKee
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
| | - David Stuckler
- Dondena Centre for Research on Social Dynamics and Public Policy, Bocconi University, Milan, Italy
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22
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Alexiou A, Fahy K, Mason K, Bennett D, Brown H, Bambra C, Taylor-Robinson D, Barr B. Local government funding and life expectancy in England: a longitudinal ecological study. LANCET PUBLIC HEALTH 2021; 6:e641-e647. [PMID: 34265265 PMCID: PMC8390384 DOI: 10.1016/s2468-2667(21)00110-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/24/2021] [Accepted: 05/04/2021] [Indexed: 12/13/2022]
Abstract
Background Since 2010, large reductions in funding for local government services have been introduced in England. These reductions in funding have potentially led to reduced provision of health-promoting public services. We aimed to investigate whether areas that showed a greater decline in funding also had more adverse trends in life expectancy and premature mortality. Methods In this longitudinal ecological study, we linked annual data from the Ministry of Housing, Communities, and Local Government on local government revenue expenditure and financing to 147 upper-tier local authorities in England between 2013 and 2017 with data from Public Health England, on male and female life expectancy at birth, male and female life expectancy at age 65 years, and premature (younger than 75 years) all-cause mortality rate for male and female individuals. Local authorities were excluded if their populations were too small or if changes in boundaries meant consistent data were not available. Using multivariable fixed-effects panel regression models, and controlling for local socioeconomic conditions, we estimated whether changes in local funding from 2013 were associated with changes in life expectancy and premature mortality. We included a set of alternative model specifications to test the robustness of our findings. Findings Between 2013 and 2017, mean per-capita central funding to local governments decreased by 33% or £168 per person (range –£385 to £1). Each £100 reduction in annual per person funding was associated over the study period 2013–17 with an average decrease in life expectancy at birth of 1·3 months (95% CI 0·7–1·9) for male individuals and 1·2 months (0·7–1·7) for female individuals; for life expectancy at age 65 years, the results show a decrease of 0·8 months (0·3–1·3) for male individuals and 1·1 months (0·7–1·5) for female individuals. Funding reductions were greater in more deprived areas and these areas had the worst changes in life expectancy. We estimated that cuts in funding were associated with an increase in the gap in life expectancy between the most and least deprived quintiles by 3% for men and 4% for women. Overall reductions in funding during this period were associated with an additional 9600 deaths in people younger than 75 years in England (3800–15 400), an increase of 1·25%. Interpretation Our findings indicate that cuts in funding for local government might in part explain adverse trends in life expectancy. Given that more deprived areas showed greater reductions in funding, our analysis suggests that inequalities have widened. Since the pandemic, strategies to address these adverse trends in life expectancy and reduce health inequalities could prioritise reinvestment in funding for local government services, particularly within the most deprived areas of England. Funding National Institute for Health Research (NIHR) School for Public Health Research, NIHR Applied Research Collaboration North East and North Cumbria, NIHR Applied Research Collaboration North West Coast and Medical Research Council.
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Affiliation(s)
- Alexandros Alexiou
- Department of Public Health, Policy, and Systems, University of Liverpool, Liverpool, UK.
| | - Katie Fahy
- Department of Public Health, Policy, and Systems, University of Liverpool, Liverpool, UK
| | - Kate Mason
- Department of Public Health, Policy, and Systems, University of Liverpool, Liverpool, UK
| | - Davara Bennett
- Department of Public Health, Policy, and Systems, University of Liverpool, Liverpool, UK
| | - Heather Brown
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - David Taylor-Robinson
- Department of Public Health, Policy, and Systems, University of Liverpool, Liverpool, UK
| | - Benjamin Barr
- Department of Public Health, Policy, and Systems, University of Liverpool, Liverpool, UK
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23
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Cherrie M, Curtis S, Baranyi G, Cunningham N, Dibben C, Bambra C, Pearce J. A data linkage study of the effects of the Great Recession and austerity on antidepressant prescription usage. Eur J Public Health 2021; 31:297-303. [PMID: 33550373 DOI: 10.1093/eurpub/ckaa253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND International literature shows unemployment and income loss during the Great Recession worsened population mental health. This individual-level longitudinal study examines how regional economic trends and austerity related to depression using administrative prescription data for a large and representative population sample. METHODS Records from a sample of the Scottish Longitudinal Study (N=86 500) were linked to monthly primary care antidepressant prescriptions (2009-15). Regional economic trends were characterized by annual full-time employment data (2004-14). Economic impact of austerity was measured via annual income lost per working age adult due to welfare reforms (2010-15). Sequence analysis identified new cases of antidepressant use, and group-based trajectory modelling classified regions into similar economic trajectories. Multi-level logistic regression examined relationships between regional economic trends and new antidepressant prescriptions. Structural equation mediation analysis assessed the contributory role of welfare reforms. RESULTS Employed individuals living in regions not recovering post-recession had the highest risk of beginning a new course of antidepressants (AOR 1.23; 95% CI 1.08-1.38). Individuals living in areas with better recovery trajectories had the lowest risk. Mediation analyses showed that 50% (95% CI 7-61%) of this association was explained by the impact of welfare benefit reforms on average incomes. CONCLUSIONS Following the Great Recession, local labour market decline and austerity measures were associated with growing antidepressant usage, increasing regional inequalities in mental health. The study evidences the impact of austerity on health inequalities and suggests that economic conditions and welfare policies impact on population health. Reducing the burden of mental ill-health primarily requires action on the social determinants.
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Affiliation(s)
- Mark Cherrie
- Centre for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - Sarah Curtis
- Centre for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK.,School of Geography, Durham University, Durham, UK
| | - Gergő Baranyi
- Centre for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - Niall Cunningham
- School of Geography Politics and Sociology, Newcastle University, Newcastle, UK
| | - Chris Dibben
- Centre for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK.,ESRC Administrative Data Research Centre, University of Edinburgh, Newcastle, UK
| | - Clare Bambra
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Jamie Pearce
- Centre for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
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24
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Neary J, Katikireddi SV, McQuaid RW, Macdonald EB, Thomson H. Using candidacy theory to explore unemployed over-50s perceptions of suitability of a welfare to work programme: A longitudinal qualitative study. SOCIAL POLICY & ADMINISTRATION 2021; 55:589-605. [PMID: 34789953 PMCID: PMC7611994 DOI: 10.1111/spol.12644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/10/2020] [Indexed: 06/13/2023]
Abstract
Welfare to work interventions seek to move out-of-work individuals from claiming unemployment benefits towards paid work. However, previous research has highlighted that for over-50s, particularly those with chronic health conditions, participation in such activities are less likely to result in a return to work. Using longitudinal semi-structured interviews, we followed 26 over-50s during their experience of a mandated welfare to work intervention (the Work Programme) in the United Kingdom. Focusing on their perception of suitability, we utilise and adapt Candidacy Theory to explore how previous experiences of work, health, and interaction with staff (both in the intervention, and with healthcare practitioners) influence these perceptions. Despite many participants acknowledging the benefit of work, many described a pessimism regarding their own ability to return to work in the future, and therefore their lack of suitability for this intervention. This was particularly felt by those with chronic health conditions, who reflected on difficulties with managing their conditions (e.g., attending appointments, adhering to treatment regimens). By adapting Candidacy Theory, we highlighted the ways that mandatory intervention was navigated by all the participants, and how some discussed attempts to remove themselves from this intervention. We also discuss the role played by decision makers such as employment-support staff and healthcare practitioners in supporting or contesting these feelings. Findings suggest that greater effort is required by policy makers to understand the lived experience of chronic illness in terms of ability to RTW, and the importance of inter-agency work in shaping perceptions of those involved.
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Affiliation(s)
- Joanne Neary
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Srinivasa V. Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ronald W. McQuaid
- Management, Work and Organisation, University of Stirling, Stirling, UK
| | - Ewan B. Macdonald
- Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Hilary Thomson
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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25
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Patrick R, Reeves A. The legacy of an ideology: a decade on from benefits as lifestyle choice. Eur J Public Health 2021; 31:242-243. [PMID: 33249451 DOI: 10.1093/eurpub/ckaa215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ruth Patrick
- Department of Social Policy and Social Work, University of York, York, UK
| | - Aaron Reeves
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
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26
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Lane TJ, Berecki-Gisolf J, Iles R, Smith PM, Collie A. The impact of long-term workers' compensation benefit cessation on welfare and health service use: protocol for a longitudinal controlled data linkage study. Int J Popul Data Sci 2021; 6:1419. [PMID: 34036182 PMCID: PMC8130798 DOI: 10.23889/ijpds.v6i1.1419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background In 2012, the Australian state of New South Wales passed legislation that reformed its workers’ compensation system. Section 39 introduced a five-year limit on income replacement, with the first affected group having their benefits cease in December 2017. There is limited evidence on how this will affect their healthcare service use and where they will go for financial support. Methods Multiple data sources will be linked: administrate workers’ compensation claims data from the State Insurance Regulatory Authority (SIRA), universal health insurance data from the Medical Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS), state hospital and emergency department data, and social welfare data from the Department of Social Services’ Data Over Multiple Individual Occurrences (DOMINO). An estimated 4,125 injured workers had their benefits cease due to Section 39. These will form the exposure group who will be compared to 1) a similar group of workers’ compensation claimants who have had at least two years of compensated time off work but whose benefits did not cease due to Section 39; and 2) a community comparison group drawn from state hospital and emergency department records. An accredited third party will link the data, which will be accessible only via secure virtual machine. Initial analyses will compare the prevalence and incidence of service use across groups in both the year before and year after benefit cessation; the community control will be assigned the median benefit cessation date in lieu of an actual date. To estimate the impact of benefit cessation due to Section 39, we will conduct time series analysis of the prevalence and incidence of service use. Discussion This study will provide much-needed evidence on the consequences of long-term benefit cessation, particularly on subsequent healthcare and welfare service use.
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Affiliation(s)
- Tyler J Lane
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Janneke Berecki-Gisolf
- Monash University Accident Research Centre (MUARC), Monash University, Clayton, Victoria, Australia
| | - Ross Iles
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Peter M Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Institute for Work and Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alex Collie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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27
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Collie A, Sheehan L, McAllister A. Health service use of Australian unemployment and disability benefit recipients: a national, cross-sectional study. BMC Health Serv Res 2021; 21:249. [PMID: 33740960 PMCID: PMC7977490 DOI: 10.1186/s12913-021-06255-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 03/08/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Healthcare is funded and delivered separately from income support programs such as unemployment and disability benefits. Greater understanding of the health service use (HSU) of benefit recipients would support more effective design and delivery of health and income support programs. This study aimed to characterise the HSU of disability and unemployment benefit recipients relative to people earning wages, while controlling for personal, household and health-related factors associated with HSU in benefit recipients. METHODS A cross-sectional national survey of 9110 working age Australian adults in three groups: (1) 566 receiving the disability support pension (DSP); (2) 410 receiving unemployment benefits; and (3) 8134 earning wages. Outcomes included prevalence and frequency of health professional consultations, hospital attendance and admission in the past 12 months, as well as medication and supplement use in the past 2 weeks. Analyses compared DSP and unemployment benefit recipients to wage earners using prevalence ratios and incident rate ratios, adjusted for predisposing, enabling and need factors that may affect HSU. RESULTS In adjusted regression models, both DSP and unemployment benefit recipients were significantly more likely than wage earners to have consulted psychologists and social workers. DSP recipients also reported a significantly higher prevalence of consultations with General Practitioners (GPs), specialist physicians and podiatrists.. Both groups reported significantly more frequent consultations with GPs and DSP recipients with specialists. No differences were observed between groups for hospital attendance or admission, or supplement use in fully adjusted models, though the DSP group reported more prevalent medication use than wage earners. Inclusion of confounders including self-assessed health, disability severity, health insurance status, and financial resources attenuated the relationship between benefit receipt and HSU, however significant associations were still observed. CONCLUSIONS People receiving unemployment and disability insurance benefits use significantly more health services than wage earners. A range of personal and clinical characteristics explained much, but not all, of the association between greater HSU and benefit receipt. Greater coordination between health and income support systems may improve health, reduce HSU and improve work ability in unemployed and working age people.
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Affiliation(s)
- Alex Collie
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Luke Sheehan
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Ashley McAllister
- School of Population and Global Health, University of Melbourne, 207 Bouverie Street, Carlton, VIC, 3053, Australia
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28
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Yu YH, Luo W, Liu B, Kuang WH, Davidson L, Wan Chan CL, Lu L, Xiang MZ, Ran MS. Poverty transitions in severe mental illness: longitudinal analysis of social drift in China, 1994-2015. Psychol Med 2021; 52:1-9. [PMID: 33618792 DOI: 10.1017/s0033291721000350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although poverty associated with severe mental illness (SMI) has been documented in many studies, little long-term evidence of social drift exists. This study aimed to unravel the poverty transitions among persons with SMI in a fast change community in China. METHODS Two mental health surveys, using the International Classification of Disease (ICD-10), were conducted in the same six townships of Xinjin county, Chengdu, China in 1994 and 2015. A total of 308 persons with SMI identified in 1994 were followed up in 2015. The profiles of poverty transitions were identified and regression modelling methods were applied to determine the predictive factors of poverty transitions. RESULTS The poverty rate of persons with SMI increased from 39.9% to 49.4% in 1994 and 2015. A larger proportion of them had fallen into poverty (27.3%) rather than moved out of it (17.8%). Those persons with SMI who had lost work ability, had physical illness and more severe mental disabilities in 1994, as well as those who had experienced negative changes on these factors were more likely to live in persistent poverty or fall into poverty. Higher education level and medical treatment were major protective factors of falling into poverty. CONCLUSIONS This study shows long-term evidence on the social drift of persons with SMI during the period of rapid social development in China. Further targeted poverty alleviation interventions should be crucial for improving treatment and mental recovery and alleviating poverty related to SMI.
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Affiliation(s)
- Yue-Hui Yu
- School of Public Administration and Policy, Renmin University of China, Beijing100872, China
| | - Wei Luo
- Chengdu Xinjin Second People's Hospital, Xinjin, Chengdu611432, China
| | - Bo Liu
- Jingzhou Mental Health Center, Jingzhou, Hubei434000, China
| | - Wei-Hong Kuang
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu610041, China
| | | | - Cecilia Lai Wan Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Lin Lu
- Peking University Sixth Hospital, Institute of Mental Health, Peking University, Beijing100191, China
| | - Meng-Ze Xiang
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu610041, China
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
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29
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Simpson J, Albani V, Bell Z, Bambra C, Brown H. Effects of social security policy reforms on mental health and inequalities: A systematic review of observational studies in high-income countries. Soc Sci Med 2021; 272:113717. [PMID: 33545493 DOI: 10.1016/j.socscimed.2021.113717] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/18/2021] [Accepted: 01/22/2021] [Indexed: 11/17/2022]
Abstract
Evidence increasingly shows that changes to social security policies can affect population mental health. Thus, in the context of rising burden of mental illness, it is of major importance to better understand how expansions and contractions to the social security system may impact on mental health of both adults and children. The aim of this systematic review is to provide a synthesis of observational literature on the effects on mental health and inequalities in mental health of social security reforms. We conducted a systematic review of quantitative observational studies of specific national and regional social security policy changes in high-income countries and summarised the mental health effects of these policies. We searched seven electronic databases, including Medline, PsychInfo, Embase, CINAHL, ASSIA (Proquest), Scopus and Research Papers in Economics from January 1979 to June 2020. We included both objective and subjective mental health and wellbeing measures. The study quality was assessed using the Validity Assessment tool for econometric studies. We identified 13,403 original records, thirty-eight of which were included in the final review. Twenty-one studies evaluated expansionary social security policies and seventeen studies evaluated contractionary policies. Overall, we found that policies that improve social security benefit eligibility/generosity are associated with improvements in mental health, as reported by fourteen of the included studies. Social security policies that reduce eligibility/generosity were related to worse mental health, as reported by eleven studies. Ten studies found no effect for either policies contracting or expanding welfare support. Fourteen studies also evaluated the impact on mental health inequalities and found that contractionary policies tend to increase inequalities whereas expansionary policies have the opposite effect. Changes in social security policies can have significant effects on mental health and health inequalities across different recipient groups. Such health effects should be taken into account when designing future social policy reforms.
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Affiliation(s)
- Julija Simpson
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 4LP, UK.
| | - Viviana Albani
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 4LP, UK
| | - Zoe Bell
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 4LP, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 4LP, UK
| | - Heather Brown
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 4LP, UK
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30
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McHale P, Pennington A, Mustard C, Mahood Q, Andersen I, Jensen NK, Burström B, Thielen K, Harber-Aschan L, McAllister A, Whitehead M, Barr B. What is the effect of changing eligibility criteria for disability benefits on employment? A systematic review and meta-analysis of evidence from OECD countries. PLoS One 2020; 15:e0242976. [PMID: 33259544 PMCID: PMC7707516 DOI: 10.1371/journal.pone.0242976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Restrictions in the eligibility requirements for disability benefits have been introduced in many countries, on the assumption that this will increase work incentives for people with chronic illness and disabilities. Evidence to support this assumption is unclear, but there is a danger that removal of social protection without increased employment would increase the risk of poverty among disabled people. This paper presents a systematic review of the evidence on the employment effects of changes to eligibility criteria across OECD countries. METHODS Systematic review of all empirical studies from OECD countries from 1990 to June 2018 investigating the effect of changes in eligibility requirements and income replacement level of disability benefits on the employment of disabled people. Studies were narratively synthesised, and meta-analysis was performed using meta-regression on all separate results. The systematic review protocol was registered with the Prospective Register for Systematic Reviews (Registration code: PROSPERO 2018 CRD42018103930). RESULTS Seventeen studies met inclusion criteria from seven countries. Eight investigated an expansion of eligibility criteria and nine a restriction. There were 36 separate results included from the 17 studies. Fourteen examined an expansion of eligibility; six found significantly reduced employment, eight no significant effect and one increased employment. Twenty-two results examined a restriction in eligibility for benefits; three found significantly increased employment, 18 no significant effect and one reduced employment. Meta-regression of all studies produced a relative risk of employment of 1.06 (95% CI 0.999 to 1.014; I2 77%). CONCLUSIONS There was no firm evidence that changes in eligibility affected employment of disabled people. Restricting eligibility therefore has the potential to lead to a growing number of people out of employment with health problems who are not eligible for adequate social protection, increasing their risk of poverty. Policymakers and researchers need to address the lack of robust evidence for assessing the employment impact of these types of welfare reforms as well as the potential wider poverty impacts.
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Affiliation(s)
- Philip McHale
- Department of Public Health, Policy and Systems, Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Andy Pennington
- Department of Public Health, Policy and Systems, Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Cameron Mustard
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Institute for Work & Health, Toronto, Ontario, Canada
| | - Quenby Mahood
- Institute for Work & Health, Toronto, Ontario, Canada
| | - Ingelise Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karsten Thielen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lisa Harber-Aschan
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ashley McAllister
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Margaret Whitehead
- Department of Public Health, Policy and Systems, Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Ben Barr
- Department of Public Health, Policy and Systems, Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom
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31
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Cherrie M, Curtis S, Baranyi G, McTaggart S, Cunningham N, Licence K, Dibben C, Bambra C, Pearce J. Use of sequence analysis for classifying individual antidepressant trajectories to monitor population mental health. BMC Psychiatry 2020; 20:551. [PMID: 33228576 PMCID: PMC7684902 DOI: 10.1186/s12888-020-02952-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 11/15/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Over the past decade, antidepressant prescriptions have increased in European countries and the United States, partly due to an increase in the number of new cases of mental illness. This paper demonstrates an innovative approach to the classification of population level change in mental health status, using administrative data for a large sample of the Scottish population. We aimed to identify groups of individuals with similar patterns of change in pattern of prescribing, validate these groups by comparison with other indicators of mental illness, and characterise the population most at risk of increasing mental ill health. METHODS National Health Service (NHS) prescription data were linked to the Scottish Longitudinal Study (SLS), a 5.3% sample of the Scottish population (N = 151,418). Antidepressant prescription status over the previous 6 months was recorded for every month for which data were available (January 2009-December 2014), and sequence dissimilarity was computed by optimal matching. Hierarchical clustering was used to create groups of participants who had similar patterns of change, with multi-level logistic regression used to understand group membership. RESULTS Five distinct prescription pattern groups were observed, indicating: no prescriptions (76%), occasional prescriptions (10%), continuation of prior use of prescriptions (8%), a new course of prescriptions started (4%) or ceased taking prescriptions (3%). Young, white, female participants, of low social grade, residing in socially deprived neighbourhoods, living alone, being separated/divorced or out of the labour force, were more likely to be in the group that started a new course of antidepressant prescriptions. CONCLUSIONS The use of sequence analysis for classifying individual antidepressant trajectories offers a novel approach for capturing population-level changes in mental health risk. By classifying individuals into groups based on their anti-depressant medication use we can better identify how over time, mental health is associated with individual risk factors and contextual factors at the local level and the macro political and economic scale.
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Affiliation(s)
- Mark Cherrie
- School of GeoSciences, The University of Edinburgh, Edinburgh, Scotland, UK. .,Institute of Occupational Medicine, Edinburgh, Scotland, UK.
| | - Sarah Curtis
- grid.4305.20000 0004 1936 7988School of GeoSciences, The University of Edinburgh, Edinburgh, Scotland, UK ,grid.8250.f0000 0000 8700 0572Department of Geography, Durham University, Durham, UK
| | - Gergő Baranyi
- grid.4305.20000 0004 1936 7988School of GeoSciences, The University of Edinburgh, Edinburgh, Scotland, UK
| | | | - Niall Cunningham
- grid.1006.70000 0001 0462 7212School of Geography, Politics & Sociology, Newcastle University, Newcastle upon Tyne, UK
| | - Kirsty Licence
- grid.508718.3Public Health Scotland, Edinburgh, UK ,grid.413893.40000 0001 2232 4338Health Protection Scotland, Glasgow, UK
| | - Chris Dibben
- grid.4305.20000 0004 1936 7988School of GeoSciences, The University of Edinburgh, Edinburgh, Scotland, UK ,grid.4305.20000 0004 1936 7988Scottish Centre for Administrative Data Research, University of Edinburgh, Edinburgh, UK
| | - Clare Bambra
- grid.1006.70000 0001 0462 7212Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jamie Pearce
- grid.4305.20000 0004 1936 7988School of GeoSciences, The University of Edinburgh, Edinburgh, Scotland, UK
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Integrating CBT and CFT within a case formulation approach to reduce depression and anxiety in an older adult with a complex mental and physical health history: a single case study. COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Depression and anxiety are major contributors to growing healthcare costs in the UK, particularly with an increasingly ageing population. However, identification of mental health needs in older adults has been overshadowed by a tendency to focus on physical health issues, despite the established co-morbidity of depression, anxiety and physical health conditions. When older adults seek psychological support, treatment options may vary and may be time limited, either because of protocol guidance or due to the resource constraints of psychology services. Time-limited treatment, common in many adult services, may not best meet the needs of older adults, whose physical, cognitive and emotional needs alter with age. It is, therefore, important to identify treatments that best meet the needs of older adults who seek psychological support, but who may arrive with complex mental and physical health histories. This paper aims to explore how a case formulation-driven approach that draws on the theoretical underpinnings of cognitive behavioural therapy (CBT) and compassion-focused therapy (CFT) can be used to reduce anxiety and depression in an older adult with a complex multi-morbid mental and physical health history. This study employs a single-case (A–B) experimental design [assessment (A), CBT and CFT intervention (B)] over 28 sessions. Results suggest the greatest reductions in depression and anxiety (as measured using PHQ-9 and GAD-7) occurred during the CFT phase of the intervention, although scores failed to drop below subclinical levels in any phase of the intervention. This case highlights the value of incorporating CFT with CBT in case formulation-driven interventions.
Key learning aims
(1)
To consider the value of using case formulation approaches in older adult populations.
(2)
To demonstrate flexibility in balancing evidence-based interventions with service user needs by incorporating CBT and CFT to treat anxiety and depression in an older adult.
(3)
To present a clinical case to identify how assessment, formulation and treatment of anxiety and depression are adapted to best meet the needs of older adults with complex co-morbid mental and physical health conditions.
(4)
To appreciate the impact of contextual factors, such as austerity measures, on therapeutic work with individuals with long-standing mental and physical health difficulties.
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Boardman J. Dismantling the social safety net: social security reforms, disability and mental health conditions. BJPsych Bull 2020; 44:208-212. [PMID: 32674748 PMCID: PMC7525580 DOI: 10.1192/bjb.2020.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This article examines the effects of UK welfare reform since 2008 on people with mental health conditions and disabilities. The results have been profound, particularly during a time of economic austerity, damaging the social safety net and pushing many vulnerable people into poverty and hardship. It has perpetuated inequalities and increased the social exclusion of disabled groups. The holes in the safety net require repair, alongside extensive social policy reform to both protect and empower people with disabilities and long-term conditions.
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Affiliation(s)
- Jed Boardman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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Foster H, Elntib S. Stress and well-being of unpaid carers supporting claimants through disability benefit assessments. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1525-1534. [PMID: 32154626 DOI: 10.1111/hsc.12975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 12/22/2019] [Accepted: 02/23/2020] [Indexed: 06/10/2023]
Abstract
This study assessed the subjective well-being and perceived stress of unpaid carers of disability benefit claimants. A total of 129 carers from the UK were surveyed between July and September 2017, using a cross-sectional design. Carers, who provided unpaid support to sick or disabled friends, family or neighbours in a non-professional capacity, reported here as unpaid carers, were asked to complete a web-based questionnaire comprising of the Perceived Stress-10-item Scale (PSS-10), the Personal Wellbeing Index-Adult (PWI-A), sociodemographic characteristics, the time they spent caring per day and the number of Personal Independence Payment and Work Capability Assessment interviews prepared for and attended by the person they cared for. Hierarchical regression analyses were performed to assess the effects of the number of benefit assessments on stress and well-being scores, controlling for carers' sociodemographic characteristics and the time they spent caring. Analyses revealed that the number of times that claimants were exposed to benefit assessments significantly and negatively predicted unpaid carers' well-being and was positively related to their stress levels. After controlling for sociodemographic characteristics and hours supporting per day, benefit assessments predicted 8.1% of perceived stress and 4.3% of well-being variance. Being a female unpaid carer of a disability benefit claimant negatively predicted 7.5% of well-being variance. The results offered unique evidence of the negative psychological effects of disability benefit assessments upon unpaid carers, while adding to the evidence of female carers facing increased risks of psychological distress.
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Affiliation(s)
- Helen Foster
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Stamatis Elntib
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
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35
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Day W, Shaw R. When benefit eligibility and patient-led care intersect. Living in the UK with chronic illness: Experiences of the work capability assessment. J Health Psychol 2020; 27:456-469. [PMID: 32859136 PMCID: PMC8793312 DOI: 10.1177/1359105320953476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Individuals living with chronic physical health conditions are more likely to be out-of-work than other groups. Often framed as a 'response' to these statistics, many countries have introduced policy instruments for promoting the employment of individuals with chronic conditions. This qualitative study sought to explore the impact of welfare reforms on UK individuals. Employing a phenomenological approach, semi-structured interviews were conducted with five participants living with chronic conditions. Three themes were generated using Interpretative Phenomenological Analysis: 'intersubjective sense making of the condition'; 'battles for control' and 'the fluidity and strengthening of identity'. Implications for further, holistic, policy reform are explored.
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Affiliation(s)
- William Day
- Aston University, Birmingham, West Midlands, UK
| | - Rachel Shaw
- Aston University, Birmingham, West Midlands, UK
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Sheridan Rains L, Weich S, Maddock C, Smith S, Keown P, Crepaz-Keay D, Singh SP, Jones R, Kirkbride J, Millett L, Lyons N, Branthonne-Foster S, Johnson S, Lloyd-Evans B. Understanding increasing rates of psychiatric hospital detentions in England: development and preliminary testing of an explanatory model. BJPsych Open 2020; 6:e88. [PMID: 32792034 PMCID: PMC7453796 DOI: 10.1192/bjo.2020.64] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The steep rise in the rate of psychiatric hospital detentions in England is poorly understood. AIMS To identify explanations for the rise in detentions in England since 1983; to test their plausibility and support from evidence; to develop an explanatory model for the rise in detentions. METHOD Hypotheses to explain the rise in detentions were identified from previous literature and stakeholder consultation. We explored associations between national indicators for potential explanatory variables and detention rates in an ecological study. Relevant research was scoped and the plausibility of each hypothesis was rated. Finally, a logic model was developed to illustrate likely contributory factors and pathways to the increase in detentions. RESULTS Seventeen hypotheses related to social, service, legal and data-quality factors. Hypotheses supported by available evidence were: changes in legal approaches to patients without decision-making capacity but not actively objecting to admission; demographic changes; increasing psychiatric morbidity. Reductions in the availability or quality of community mental health services and changes in police practice may have contributed to the rise in detentions. Hypothesised factors not supported by evidence were: changes in community crisis care, compulsory community treatment and prescribing practice. Evidence was ambiguous or lacking for other explanations, including the impact of austerity measures and reductions in National Health Service in-patient bed numbers. CONCLUSIONS Better data are needed about the characteristics and service contexts of those detained. Our logic model highlights likely contributory factors to the rise in detentions in England, priorities for future research and potential policy targets for reducing detentions.
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Affiliation(s)
| | - Scott Weich
- Professor, School of Health and Related Research, University of Sheffield, UK
| | | | - Shubulade Smith
- Behavioural and Developmental Disorders Directorate, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London; and Department of Forensic and Neurodevelopmental Disorders, Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, UK
| | - Patrick Keown
- Northumberland Tyne and Wear NHS Foundation Trust, UK
| | | | - Swaran P Singh
- Professor, Department of Mental Health and Wellbeing, University of Warwick, UK
| | - Rebecca Jones
- Division of Psychiatry, University College London, UK
| | | | | | - Natasha Lyons
- Division of Psychiatry, University College London, UK
| | | | - Sonia Johnson
- Professor, Division of Psychiatry, University College London; and Camden and Islington NHS Foundation Trust, London, UK
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Frank J, Abel T, Campostrini S, Cook S, Lin VK, McQueen DV. The Social Determinants of Health: Time to Re-Think? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5856. [PMID: 32806743 PMCID: PMC7459980 DOI: 10.3390/ijerph17165856] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 11/16/2022]
Abstract
Twelve years have now passed since the influential WHO Report on the Social Determinants of Health (SDoH) in 2008. A group of senior international public health scholars and decision-makers met in Italy in mid-2019 to review the legacy of the SDoH conceptual framework and its adequacy for the many challenges facing our field as we enter the 2020s. Four major categories of challenges were identified: emerging "exogenous" challenges to global health equity, challenges related to weak policy and practice implementation, more fundamental challenges related to SDoH theory and research, and broader issues around modern research in general. Each of these categories is discussed, and potential solutions offered. We conclude that although the SDoH framework is still a worthy core platform for public health research, policy, and practice, the time is ripe for significant evolution.
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Affiliation(s)
- John Frank
- Director of Knowledge Exchange and Research Impact, Usher Institute, University of Edinburgh, Room 1-308, Doorway #1, Teviot Hall, Teviot Place, Edinburgh EH8 9AG, UK
| | - Thomas Abel
- ISPM, University of Bern, 3012 Bern, Switzerland; (T.A.); (D.V.M.)
| | - Stefano Campostrini
- Department of Economics, University Ca’ Foscari Venice, 30121 Venice, Italy;
| | - Sarah Cook
- Director, Institute for Global Development, University of New South Wales, John Goodsell Building, Sydney, NSW 2052, Australia;
| | - Vivian K. Lin
- Executive Associate Dean, Faculty of Medicine, University of Hong Kong, Hong Kong, China;
| | - David V. McQueen
- ISPM, University of Bern, 3012 Bern, Switzerland; (T.A.); (D.V.M.)
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38
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Milner A, Kavanagh A, McAllister A, Aitken Z. The impact of the disability support pension on mental health: evidence from 14 years of an Australian cohort. Aust N Z J Public Health 2020; 44:307-312. [PMID: 32697414 DOI: 10.1111/1753-6405.13011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To assess the effect of the Australian Disability Support Pension (DSP) on the symptomology of depression and anxiety over and above the effects of reporting a disability itself. METHODS We used the Household Income Labour Dynamics in Australia (HILDA) survey from 2004 to 2017. We used fixed effects regression to understand mental health differences (using the Mental Health Inventory-5 [MHI-5]) when a person reported: i) a disability; or ii) a disability and receiving the DSP) compared to when they reported no disability. The models controlled for time-varying changes in the severity of the disability and other time-related confounders. RESULTS There was a 2.97-point decline (95%CI -3.26 to -2.68) in the MHI-5 when a person reported a disability compared to waves in which they reported no disability and 4.48-point decline (95%CI -5.75 to -3.22) when a person reported both a disability and being on the DSP compared to waves in which they reported neither. CONCLUSIONS Results suggest that accessing and being in receipt of the DSP can impact the mental health of people with disabilities. Implications for public health: Government income support policies should address the unintended adverse consequences in already vulnerable populations.
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Affiliation(s)
- Allison Milner
- Disability and Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Victoria
| | - Anne Kavanagh
- Disability and Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Victoria.,Melbourne Disability Institute, The University of Melbourne, Victoria
| | - Ashley McAllister
- Disability and Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Victoria.,Equity and Health Policy Unit, Department of Public Health Sciences, Karolinska Institutet, Sweden
| | - Zoe Aitken
- Disability and Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Victoria
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Simpson J, Brown H, Bell Z, Albani V, Bambra C. Investigating the relationship between changes in social security benefits and mental health: a protocol for a systematic review. BMJ Open 2020; 10:e035993. [PMID: 32595158 PMCID: PMC7322275 DOI: 10.1136/bmjopen-2019-035993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Poor mental health is one of the greatest causes of disability in the world. Evidence increasingly shows that population mental health may be influenced by national social security policies. This systematic review aims to establish the relationship between social security and mental health in order to help inform recommendations for policy-makers, practitioners and future research. METHODS AND ANALYSIS A systematic review of quantitative observational studies investigating mental health outcomes related to changes in social security policies will be conducted. Six major databases, including Medline, PsychInfo, Embase, Cumulative Index to Nursing and Allied Health Literature, Applied Social Sciences Index Abstracts and Scopus, as well as Research Papers in Economics will be searched from January 1979 to April 2020. The electronic database searches will be supplemented by reference and citation searches as well as hand-searching of key journals. The outcomes of interest are objective or subjective mental health outcomes, including stress, anxiety, depression, self-reported mental health scores, subjective well-being and suicide. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the quality of the studies will be assessed by the validity assessment framework designed for appraising econometric studies. A narrative synthesis will be conducted for all included studies. If data permit, study findings will be synthesised by conducting a meta-analysis. ETHICS AND DISSEMINATION As it will be a systematic review, without primary data collection, there will be no requirement for ethical approval. Findings will be disseminated through peer-reviewed publications and in various media, for example, conferences or symposia. PROSPERO REGISTRATION NUMBER CRD42019154733.
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Affiliation(s)
- Julija Simpson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Heather Brown
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Zoe Bell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Viviana Albani
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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40
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Ploetner C, Telford M, Braekkan K, Mullen K, Turnbull S, Gumley A, Allan S. Understanding and improving the experience of claiming social security for mental health problems in the west of Scotland: A participatory social welfare study. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:675-692. [PMID: 31730711 DOI: 10.1002/jcop.22278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 06/10/2023]
Abstract
A growing body of literature links claimant interactions with the UK social security system and negative psychological consequences. Psychologists for social change developed a framework to outline proposed mechanisms of psychological impact from austerity. This codesigned study aimed to make an informed comment on areas of dis(agreement) between the Austerity Ailments framework and how people claiming for mental health problems describe their own experiences. In line with the participatory social welfare design of the study, qualitative analysis was performed by both claimants and academics. The overall findings indicate that existing framework mostly captured claimant experiences. However, some aspects of the claimant experience (particularly social aspects) were not well captured. Claimants were keen to utilise this study as an opportunity to gather claimant ideas on how to improve the system. Therefore, we report their suggestions that may be useful for those designing and improving social welfare systems.
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Affiliation(s)
- Caroline Ploetner
- Glasgow Mental Health Research Facility, Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Morgan Telford
- Glasgow Mental Health Research Facility, Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Karina Braekkan
- Glasgow Mental Health Research Facility, Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Kenneth Mullen
- Glasgow Mental Health Research Facility, Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Sue Turnbull
- Glasgow Mental Health Research Facility, Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Andrew Gumley
- Glasgow Mental Health Research Facility, Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Stephanie Allan
- Glasgow Mental Health Research Facility, Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
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Wickham S, Bentley L, Rose T, Whitehead M, Taylor-Robinson D, Barr B. Effects on mental health of a UK welfare reform, Universal Credit: a longitudinal controlled study. Lancet Public Health 2020; 5:e157-e164. [PMID: 32113519 PMCID: PMC7208537 DOI: 10.1016/s2468-2667(20)30026-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Universal Credit, a welfare benefit reform in the UK, began to replace six existing benefit schemes in April, 2013, starting with the income-based Job Seekers Allowance. We aimed to determine the effects on mental health of the introduction of Universal Credit. METHODS In this longitudinal controlled study, we linked 197 111 observations from 52 187 individuals of working age (16-64 years) in England, Wales, and Scotland who participated in the Understanding Society UK Longitudinal Household Panel Study between 2009 and 2018 with administrative data on the month when Universal Credit was introduced into the area in which each respondent lived. We included participants who had data on employment status, local authority area of residence, psychological distress, and confounding variables. We excluded individuals from Northern Ireland and people out of work with a disability. We used difference-in-differences analysis of this nationally representative, longitudinal, household survey and separated respondents into two groups: unemployed people who were eligible for Universal Credit (intervention group) and people who were not unemployed and therefore would not have generally been eligible for Universal Credit (comparison group). Using the phased roll-out of Universal Credit, we compared the change in psychological distress (self-reported via General Health Questionnaire-12) between the intervention group and the comparison group over time as the reform was introduced in the area in which each respondent lived. We defined clinically significant psychological distress as a score of greater than 3 on the General Health Questionnaire-12. We tested whether there were differential effects across subgroups (age, sex, and education). FINDINGS The prevalence of psychological distress increased in the intervention group by 6·57 percentage points (95% CI 1·69-11·42) after the introduction of Universal Credit relative to the comparison group, after accounting for potential confounders. We estimate that between April 29, 2013, and Dec 31, 2018, an additional 63 674 (95% CI 10 042-117 307) unemployed people will have experienced levels of psychological distress that are clinically significant due to the introduction of Universal Credit; 21 760 of these individuals might reach the diagnostic threshold for depression. INTERPRETATION Our findings suggest that the introduction of Universal Credit led to an increase in psychological distress, a measure of mental health difficulties, among those affected by the policy. Future changes to government welfare systems should be evaluated not only on a fiscal basis but on their potential to affect health and wellbeing. FUNDING Wellcome Trust, UK National Institute for Health Research, and Medical Research Council.
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Affiliation(s)
- Sophie Wickham
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
| | - Lee Bentley
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Tanith Rose
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Margaret Whitehead
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - David Taylor-Robinson
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ben Barr
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Harber-Aschan L, Chen WH, McAllister A, Koitzsch Jensen N, Thielen K, Andersen I, Diderichsen F, Barr B, Burström B. The impact of longstanding illness and common mental disorder on competing employment exits routes in older working age: A longitudinal data-linkage study in Sweden. PLoS One 2020; 15:e0229221. [PMID: 32097437 PMCID: PMC7041791 DOI: 10.1371/journal.pone.0229221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/31/2020] [Indexed: 11/19/2022] Open
Abstract
Objectives Comorbidity is prevalent in older working ages and might affect employment exits. This study aimed to 1) assess the associations between comorbidity and different employment exit routes, and 2) examine such associations by gender. Methods We used data from employed adults aged 50–62 in the Stockholm Public Health Survey 2002 and 2006, linked to longitudinal administrative income records (N = 10,416). The morbidity measure combined Limiting Longstanding Illness and Common Mental Disorder—captured by the General Health Questionnaire-12 (≥4)—into a categorical variable: 1) No Limiting Longstanding Illness, no Common Mental Disorder, 2) Limiting Longstanding Illness only, 3) Common Mental Disorder only, and 4) comorbid Limiting Longstanding Illness+Common Mental Disorder. Employment status was followed up until 2010, treating early retirement, disability pension and unemployment as employment exits. Competing risk regression analysed the associations between morbidity and employment exit routes, stratifying by gender. Results Compared to No Limiting Longstanding Illness, no Common Mental Disorder, comorbid Limiting Longstanding Illness+Common Mental Disorder was associated with early retirement in men (subdistribution hazard ratio = 1.73, 95% confidence intervals: 1.08–2.76), but not in women. For men and women, strong associations for disability pension were observed with Limiting Longstanding Illness only (subdistribution hazard ratio = 11.43, 95% confidence intervals: 9.40–13.89) and Limiting Longstanding Illness+Common Mental Disorder (subdistribution hazard ratio = 14.25, 95% confidence intervals: 10.91–18.61), and to a lesser extent Common Mental Disorder only (subdistribution hazard ratio = 2.00, 95% confidence intervals: 1.31–3.05). Women were more likely to exit through disability pension than men (subdistribution hazard ratio = 1.96, 95% confidence intervals: 1.60–2.39). Common Mental Disorder only was the only morbidity category associated with unemployment (subdistribution hazard ratio = 1.70, 95% confidence intervals: 1.36–2.15). Conclusions Strong associations were observed between specific morbidity categories with different employment exit routes, which differed by gender. Initiatives to extend working lives should consider older workers’ varied health needs to prevent inequalities in older age.
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Affiliation(s)
- Lisa Harber-Aschan
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Wen-Hao Chen
- Social Analysis and Modelling Division, Statistics Canada, Ottawa, Canada
| | - Ashley McAllister
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden
- Melbourne School of Global and Population Health, Disability and Health Unit, The University of Melbourne, Melbourne, Australia
| | | | - Karsten Thielen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ingelise Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Finn Diderichsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ben Barr
- Department of Public Health and Policy, University of Liverpool, Liverpool, England, United Kingdom
| | - Bo Burström
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden
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43
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Ståhl C. The Judas kiss: On the work and retrenchment cures and the troubles they bring. Work 2020; 65:181-186. [DOI: 10.3233/wor-193053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Christian Ståhl
- Department of Behavioural Sciences and Learning, Linköping University, Division of Education and Sociology, 581 83 Linköping, Sweden. Tel: +46 (0) 13 282690; E-mail:
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Grigoroglou C, Munford L, Webb RT, Kapur N, Ashcroft DM, Kontopantelis E. Prevalence of mental illness in primary care and its association with deprivation and social fragmentation at the small-area level in England. Psychol Med 2020; 50:293-302. [PMID: 30744718 PMCID: PMC7083582 DOI: 10.1017/s0033291719000023] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 12/21/2018] [Accepted: 01/03/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND We aimed to spatially describe mental illness prevalence in England at small-area geographical level, as measured by prevalence of depression, severe mental illness (SMI) and antidepressant prescription volume in primary care records, and how much of their variation was explained by deprivation, social fragmentation and sociodemographic characteristics. METHODS Information on prevalence of depression and SMI was obtained from the Quality and Outcomes Framework (QOF) administrative dataset for 2015/16 and the national dispensing dataset for 2015/16. Linear regression models were fitted to examine ecological associations between deprivation, social fragmentation, other sociodemographic characteristics and mental illness prevalence. RESULTS Mental illness prevalence varied within and between regions, with clusters of high prevalence identified across England. Our models explained 33.4-68.2% of variability in prevalence, but substantial variability between regions remained after adjusting for covariates. People in socially cohesive and socially deprived areas were more likely to be diagnosed with depression, while people in more socially fragmented and more socially deprived areas were more likely to be diagnosed with SMI. CONCLUSIONS Our findings suggest that to tackle mental health inequalities, attention needs to be targeted at more socially deprived localities. The role of social fragmentation warrants further investigation, and it is possible that depression remains undiagnosed in more socially fragmented areas. The wealth of routinely collected data can provide robust evidence to aid optimal resource allocation. If comparable data are available in other countries, similar methods could be deployed to identify high prevalence clusters and target funding to areas of greater need.
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Affiliation(s)
- Christos Grigoroglou
- Division of Population Health, Health Services Research and Primary Care, NIHR School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
| | - Luke Munford
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- Division of Population Health, Health Services Research and Primary Care, Centre for Health Economics, University of Manchester, Manchester, UK
| | - Roger T. Webb
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- Division of Psychology and Mental Health, Centre for Mental Health and Safety, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| | - Nav Kapur
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
- Division of Psychology and Mental Health, Centre for Suicide Prevention, University of Manchester, Manchester, UK
- Greater Manchester Mental Health Trust
| | - Darren M. Ashcroft
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
- Faculty of Biology, Medicine and Health, Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- Division of Population Health, Health Services Research and Primary Care, NIHR School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
- Manchester Academic Health Sciences Centre (MAHSC), Manchester, UK
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Abstract
By protecting vulnerable people from poverty and debt, welfare systems can be powerful tools for promoting mental health. However, the details of how welfare systems are implemented determine whether they also cause harm. Here, we review evidence and principles that might guide the development of mental health-promoting welfare systems.
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Affiliation(s)
- Steven L Senior
- Specialty Registrar in Public Health and Honorary Lecturer, Division of Population Health, Health Services Research and Primary Care, University of Manchester, UK
| | - Woody Caan
- Professorial Fellow, Royal Society for Public Health, London, UK
| | - Mark Gamsu
- Professor, School of Health & Community Studies, Leeds Beckett University; and Chair, Citizens Advice Sheffield, UK
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Collie A, Beck D, Gray SE, Lane TJ. Impact of legislative reform on benefit access and disability duration in workers' compensation: an interrupted time series study. Occup Environ Med 2019; 77:32-39. [PMID: 31792081 DOI: 10.1136/oemed-2019-106063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the impact of legislative changes to the New South Wales (NSW) workers' compensation scheme on injured workers access to benefits, insurer claim processing and work disability duration. METHODS Population-based interrupted time series study of workers' compensation claims made in NSW 2 years before and after legislative amendment in June 2012. Outcomes included incidence of accepted claims per 100 000 workers, the median and 75th percentile insurer decision time in days, and the median and 75th percentile of work disability duration in weeks. Effects were assessed relative to a comparator of seven other Australian workers' compensation jurisdictions. RESULTS n=1 069 231 accepted workers' compensation claims were analysed. Claiming in NSW fell 15.3% following legislative reform, equivalent to 46.6 fewer claims per 100 000 covered workers per month. This effect was greater in time loss claims (17.3%) than medical-only claims (10.3%). Across models, there were consistent trend increases in insurer decision time. Median work disability duration increased following the legislative reform. CONCLUSIONS The observed reduction in access to benefits was consistent with the policy objective of improving the financial sustainability of the compensation scheme. However, this was accompanied by changes in other markers of performance that were unintended, and are suggestive of adverse health consequences of the reform. This study demonstrates the need for care in reform of workers' compensation scheme policy.
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Affiliation(s)
- Alex Collie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dianne Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shannon Elise Gray
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tyler Jeremiah Lane
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Ståhl C, Karlsson EA, Sandqvist J, Hensing G, Brouwer S, Friberg E, MacEachen E. Social insurance literacy: a scoping review on how to define and measure it. Disabil Rehabil 2019; 43:1776-1785. [PMID: 31589073 DOI: 10.1080/09638288.2019.1672111] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Sickness insurance and workers' compensation systems decide on peoples' eligibility for benefits, and are commonly based on medical certificates and assessments of work ability. Systems differ in the extent to which they preserve clients' dignity and right to fair assessments. In this article, we define a new concept for studying interactions between individuals and systems: social insurance literacy, which concerns how well people understand the different procedures and regulations in social insurance systems, and how well systems communicate with clients in order to help them understand the system. METHODS The concept was defined through a scoping literature review of related concepts, a conceptual re-analysis in relation to the social insurance field, and a following workshop. RESULTS Five related concepts were reviewed for definitions and operationalizations: health literacy, financial/economic literacy, legal capability/ability, social security literacy, and insurance literacy. CONCLUSIONS Social insurance literacy is defined as the extent to which individuals can obtain, understand and act on information in a social insurance system, related to the comprehensibility of the information provided by the system. This definition is rooted in theories from sociology, social medicine and public health. In the next step, a measure for the concept will be developed based on this review.Implications for rehabilitationSocial insurance literacy is a new concept that is based on theories in sociology, social medicine and public health.It provides conceptual orientation for analyzing factors that may influence different outcomes of peoples' contacts with social insurance systems.The concept is of relevance for rehabilitation professionals since it focuses on how interactions between individuals and systems can influence the rehabilitation process.The study will in the next step develop a measure of social insurance literacy which will have practical applications for rehabilitation professionals.
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Affiliation(s)
- Christian Ståhl
- Department of Behaviour Sciences and Learning, Linköping University, Linköping, Sweden.,HELIX Competence Centre, Linköping University, Linköping, Sweden
| | - Elin A Karlsson
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jan Sandqvist
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Gunnel Hensing
- Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Emilie Friberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Ellen MacEachen
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
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Taylor-Robinson D, Lai ETC, Wickham S, Rose T, Norman P, Bambra C, Whitehead M, Barr B. Assessing the impact of rising child poverty on the unprecedented rise in infant mortality in England, 2000-2017: time trend analysis. BMJ Open 2019; 9:e029424. [PMID: 31578197 PMCID: PMC6954495 DOI: 10.1136/bmjopen-2019-029424] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To determine whether there were inequalities in the sustained rise in infant mortality in England in recent years and the contribution of rising child poverty to these trends. DESIGN This is an analysis of trends in infant mortality in local authorities grouped into five categories (quintiles) based on their level of income deprivation. Fixed-effects regression models were used to quantify the association between regional changes in child poverty and regional changes in infant mortality. SETTING 324 English local authorities in 9 English government office regions. PARTICIPANTS Live-born children under 1 year of age. MAIN OUTCOME MEASURE Infant mortality rate, defined as the number of deaths in children under 1 year of age per 100 000 live births in the same year. RESULTS The sustained and unprecedented rise in infant mortality in England from 2014 to 2017 was not experienced evenly across the population. In the most deprived local authorities, the previously declining trend in infant mortality reversed and mortality rose, leading to an additional 24 infant deaths per 100 000 live births per year (95% CI 6 to 42), relative to the previous trend. There was no significant change from the pre-existing trend in the most affluent local authorities. As a result, inequalities in infant mortality increased, with the gap between the most and the least deprived local authority areas widening by 52 deaths per 100 000 births (95% CI 36 to 68). Overall from 2014 to 2017, there were a total of 572 excess infant deaths (95% CI 200 to 944) compared with what would have been expected based on historical trends. We estimated that each 1% increase in child poverty was significantly associated with an extra 5.8 infant deaths per 100 000 live births (95% CI 2.4 to 9.2). The findings suggest that about a third of the increases in infant mortality between 2014 and 2017 can be attributed to rising child poverty (172 deaths, 95% CI 74 to 266). CONCLUSION This study provides evidence that the unprecedented rise in infant mortality disproportionately affected the poorest areas of the country, leaving the more affluent areas unaffected. Our analysis also linked the recent increase in infant mortality in England with rising child poverty, suggesting that about a third of the increase in infant mortality from 2014 to 2017 may be attributed to rising child poverty.
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Affiliation(s)
- David Taylor-Robinson
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Eric T C Lai
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Sophie Wickham
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Tanith Rose
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Paul Norman
- School of Geography, University of Leeds, Leeds, UK
| | - Clare Bambra
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Margaret Whitehead
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Ben Barr
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Salisbury H. Helen Salisbury: Doctors' duties in a fractured welfare state. BMJ 2019; 365:l4209. [PMID: 31213432 DOI: 10.1136/bmj.l4209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Katikireddi SV, Molaodi OR, Gibson M, Dundas R, Craig P. Effects of restrictions to Income Support on health of lone mothers in the UK: a natural experiment study. LANCET PUBLIC HEALTH 2019; 3:e333-e340. [PMID: 29976327 PMCID: PMC6038023 DOI: 10.1016/s2468-2667(18)30109-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 05/27/2018] [Accepted: 05/28/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND In the UK, lone parents must seek work as a condition of receiving welfare benefits once their youngest child reaches a certain age. Since 2008, the lower age limit at which these Lone Parent Obligations (LPO) apply has been reduced in steps. We used data from a nationally representative, longitudinal, household panel study to analyse the health effects of increased welfare conditionality under LPO. METHODS From the Understanding Society survey, we used data for lone mothers who were newly exposed to LPO when the age cutoff was reduced from 7 to 5 years in 2012 (intervention group 1) and from 10 to 7 years in 2010 (intervention group 2), as well as lone mothers who remained unexposed (control group 1) or continuously exposed (control group 2) at those times. We did difference-in-difference analyses that controlled for differences in the fixed characteristics of participants in the intervention and control groups to estimate the effect of exposure to conditionality on the health of lone mothers. Our primary outcome was the difference in change over time between the intervention and control groups in scores on the Mental Component Summary (MCS) of the 12-item Short-Form Health Survey (SF-12). FINDINGS The mental health of lone mothers declined in the intervention groups compared with the control groups. For intervention group 1, scores on the MCS decreased by 1·39 (95% CI -1·29 to 4·08) compared with control group 1 and by 2·29 (0·00 to 4·57) compared with control group 2. For intervention group 2, MCS scores decreased by 2·45 (-0·57 to 5·48) compared with control group 1 and by 1·28 (-1·45 to 4·00) compared with control group 2. When pooling the two intervention groups, scores on the MCS decreased by 2·13 (0·10 to 4·17) compared with control group 1 and 2·21 (0·30 to 4·13) compared with control group 2. INTERPRETATION Stringent conditions for receiving welfare benefits are increasingly common in high-income countries. Our results suggest that requiring lone parents with school-age children toseek work as a condition of receiving welfare benefits adversely affects their mental health. FUNDING UK Medical Research Council, Scottish Government Chief Scientist Office, and National Health Service Research Scotland.
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Affiliation(s)
- Srinivasa Vittal Katikireddi
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
| | - Oarabile R Molaodi
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Marcia Gibson
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Ruth Dundas
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Peter Craig
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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