Professional health care use and subjective unmet need for social or emotional problems: a cross-sectional survey of the married and divorced population of Flanders

Gender differences in cost-related unmet healthcare needs: a national study in Turkiye

BACKGROUND

Unmet healthcare needs are a complex and multifaceted issue, influenced by individual, socioeconomic, and healthcare system factors. This study aimed to investigate the determinants influencing cost-related unmet healthcare needs within the Turkish population, emphasizing a comprehensive analysis of gender disparities in accessing healthcare services.

METHODS

This secondary analysis scrutinizes the 2019 Turkiye Health Survey data of 16,976 individuals aged 15 and older. The dependent variables included cost-related unmet medical, dental, and prescribed medication, and mental services. The independent variables were considered under a three-domain approach for the determination of health service utilization, developed by Andersen. Logistic regression models with predisposing, enabling, and need factors were run for any self-perceived cost-related unmet need for each sex and overall population. Another six regression models for both sexes were run for each subgroup of indivuals with unmet healthcare needs.

RESULTS

The study revealed that 15.4% of individuals cannot access healthcare due to financial constraints, with 16.8% for women and 13.5% for men. The highest level of unmet needs is associated with accessing dental care services for both sexes. According to multivariate analyses, the unmet need for both sexes decreases with older age and higher education level, and it is greater for those who have difficulties communicating in Turkish. By adding enabling and needs factors, the odds ratios of education decreased for men, while education became nonsignificant for women. Having chronic disease impacts unmet needs for both sexes. However, the inability to perform daily activities due to health problems was not a significant factor for men. Poorer household income increases overall unmet needs. Education is a determinant of both medical and mental care needs.

CONCLUSIONS

This pioneering study illuminates the multifaceted gender disparities in cost-related unmet healthcare needs across Turkiye, reflecting the intertwined issues of access influenced by a complex interplay of factors. Our findings underscore the significance of adopting an intersectional approach to address health inequalities.

Women’s experience of divorce. Acta biomedica scientifica

The article is devoted to the problem of studying the experience of women going through the situation of divorce at different stages of the divorce and post-divorce period.Methods. The study was carried out at the intersection of idiographic and nomothetic approaches. At the first stage, the specifics of the experience of experiencing divorce in the online space are described, revealed through an interpretive-phenomenological analysis of the content of a closed Internet forum (n = 297). On the second – the specifics of emotional perception, cognitive assessment and coping with the situation of divorce, depending on the post-divorce experience (n = 50).Results. The experience of divorce by women is accompanied by ambivalent emotions, activates the understanding of the situation and coping with it. Online communication is an effective strategy focused on getting support, self-change, designing the future, allowing you to experience a sense of community in a life situation while maintaining psychological safety. The assessment of the divorce situation and coping strategies are specific: women who have gone through a divorce less than 3 years ago are more likely to seek social support; from 3 to 10 years – prefer the strategy of “flight-avoidance”; more than 10 years ago – “positive revaluation”. Conclusion. The experience of women experiencing the situation of divorce, including emotional, cognitive and conative components, is specific depending on the stage of the divorce and post-divorce period. An effective mechanism for shaping the experience of experiencing a divorce is network communication in a closed group of people who have similar problems.

Professional Support After Partner Loss: Likelihood and Correlates of Help-Seeking Behavior

Intimate partner loss in later life can be one of the most stressful events in adulthood. Individuals who struggle to adapt to the new life conditions may need support from a mental health professional. However, less is known about the likelihood to seek professional help after separation, divorce, or bereavement in later life and associated factors. This study investigated professional help-seeking (PHS) for partner loss after a long-term marriage in separated, divorced, and bereaved individuals and examined the extent to which specific person and event-related variables, as well as depressive symptoms, increase its likelihood. The data were derived from the LIVES "Intimate Partner Loss Study." The self-administered questionnaires were completed by 388 adults. PHS was higher after separation (57%) and divorce (49%), compared to widowhood (18%). Higher likelihood of PHS was associated with separation and divorce, female gender, having someone to count on, loss unexpectedness, needing more time to overcome the loss, and more depressive symptoms. Informing individuals unlikely to seek help (e.g., males, bereaved, and individuals with no confidant) about PHS benefits may facilitate adaptation to partner loss.

Help-Seeking Patterns Among the General Population in Singapore: Results from the Singapore Mental Health Study 2016

This study aimed to establish lifetime mental health service utilisation among the general population of Singapore. The sociodemographic correlates of those seeking help from different service provider groups and changes in lifetime mental health service utilisation between 2010 and 2016 among those with mental disorders were also explored. A population-based cross-sectional epidemiological household survey of the Singapore resident population aged 18 years and above was conducted from 2016 to 2018, using the World Mental Health Composite International Diagnostic Interview (CIDI) version 3.0. Data from two cross-sectional population-based studies were used for comparison of lifetime mental health service utilisation in 2010 (n = 6616) and 2016 (n = 6126). Chi square test and multiple logistic regression were used to analyse the data. A total of 6126 respondents completed the study in 2016. Overall 9.3% of the total sample, 32.0% of those with mental disorders, and 5.7% of those not meeting criteria for mental disorders, ever sought help for their mental health issues in their lifetime, from any treatment service sectors. Several sociodemographic characteristics were found to be correlated with different service provider groups. There was no change in mental health service utilisation between 2010 and 2016 for all mental disorders included in this study, with the exception of a significant increase in help sought from professionals in social services, among those with alcohol abuse. Even though the overall help-seeking rates are low, it is encouraging that those seeking help did so from mental health professionals and professionals working in the social services.

When Love Hurts - Mental and Physical Health Among Recently Divorced Danes

The last decades of research have consistently found strong associations between divorce and adverse health outcomes among adults. However, limitations of a majority of this research include (a) lack of “real-time” research, i.e., research employing data collected very shortly after juridical divorce where little or no separation periods have been effectuated, (b) research employing thoroughly validated and population-normed measures against which study results can be compared, and (c) research including a comprehensive array of previously researched sociodemographic- and divorce-related variables. The current cross-sectional study, including 1,856 recently divorced Danes, was designed to bridge these important gaps in the literature. Mental and physical health were measured using the Short Form 36 (SF-36)-2. Analyses included correlational analyses, t-test comparisons, and hierarchical multiple regression analyses. The study found that the health-related quality of life of Danish divorcees was significantly worse than the comparative background population immediately following divorce. Across gender, higher levels of divorce conflict were found to predict worse mental health, and worse physical health for women, even when controlling for other socio-demographic variables and divorce characteristics. Among men, lower age and higher income predicted better physical health, while more children, more previous divorces, participant divorce initiation, new partner status, and lower levels of divorce conflict predicted better mental health. Among women, higher income, fewer previous divorces, new partner status, and lower levels of divorce conflict predicted better physical health while higher income, participant divorce initiation, new partner status, and lower levels of divorce conflict predicted better mental health. The findings underscore the relevance of providing assistance to divorcees who experience higher levels of divorce conflict immediately following divorce, in seeking to reduce potential long-term negative health effects of divorce.

Marital separation and contact with primary healthcare services for mental health problems: a register-based study

BACKGROUND

Marital separation is associated with mental health problems, but little is known about how this translates into healthcare use. In this study, we examine the relationship between marital separation and primary healthcare use for mental health problems.

METHODS

We used data covering the period from 2005 to 2015 from the Norwegian Population Register, Statistics Norway's Educational Registration System and the Norwegian Health Economics Database. Data were analyzed using logistic regression analysis. To control for time invariant characteristics, we estimated fixed-effect models.

RESULTS

Marital separation was associated with increased contact with primary healthcare services for mental health problems (MH-consultations). The prevalence of MH-consultations peaked during the year of marital separation. MH-consultations were more common following marital separation than prior to the separation. This pattern remained significant in the fixed-effect models.

CONCLUSIONS

Men and women who experienced marital separation were more likely to consult primary healthcare services for mental health problems than those who remained married. Our study suggests that several mechanisms are in play. The prevalence of MH-consultations of those who eventually separated were higher several years prior to the separation. This lends support to selection mechanisms, whereas the sharp rise in the prevalence of MH-consultations around the time of marital separation coupled to higher levels several years after separation, indicate that marital separation induces both transient stress and leads to more lasting strain.

A Randomised Controlled Trial Study of the Effects of a Digital Divorce Platform on Mental and Physical Health

BACKGROUND

Two decades of divorce research has consistently documented adverse mental and physical health effects of divorce. Responding to calls for evidence-based online divorce interventions, this study tests effects of the "Cooperation after Divorce" (CAD) digital intervention platform on divorcees' mental and physical health.

METHODS

Randomised control trial 12-month longitudinal study using a sample of 1,856 newly divorced Danes. Mental and physical health were measured using the SF-36 at baseline and 3, 6, and 12 months from baseline. Intervention effects were investigated using linear mixed effect models and Cohen's (d) for effect sizes.

RESULTS

The study found significant treatment effects of the CAD intervention on mental and physical health. These effects were evident across all eight health domains constituting the mental and physical health components. The study also found that the intervention group had significantly better mental health than the control group at subsequent 6- and 12-month assessments from baseline while for physical health, the intervention group had significantly better physical health at the 6-month assessment from baseline only.

CONCLUSION

The results indicate that digital solutions allowing for individually tailored user experiences may hold great potential in reducing well-known adverse health effects of divorce.

PRACTITIONER'S POINTS

The study finds highly significant treatment effects of the "CAD" digital divorce intervention on mental and physical health indicating that online interventions may be successfully integrated into help offered to divorcees post-divorce.

Récits de ruptures conjugales : « créer du sens » en négociant les frontières du réseau

Cadre de la recherche : Dans un contexte caractérisé à la fois par une augmentation du nombre de séparations et par la pérennité d’un idéal conjugal, une rupture conjugale est un événement qui est vécu comme une épreuve personnelle et douloureuse par les individus concernés, notamment parce qu’elle signifie non seulement la fin d’un couple, mais va aussi de pair avec une transformation du réseau personnel.

Objectifs : Nous étudierons ici comment les individus reforment les frontières de leur réseau personnel autour des personnes qui leur ont apporté du soutien et de la reconnaissance au cours du processus de rupture conjugale, et examinerons les négociations visant un juste partage, entre les ex-conjoints, de ces relations auparavant communes, ainsi que les sentiments – notamment, d’injustice – engendrés par ce partage.

Méthodologie : Cet article se fonde sur une analyse fine d’entretiens qualitatifs réalisés en Suisse et en Angleterre auprès de jeunes adultes qui se sont séparés d’un(e) conjoint(e) avec qui ils(elles) habitaient et avaient formé un projet de vie commune.

Résultats : Nous montrerons qu’il y a à la fois des gains et des pertes à l’issue de ce processus, et distinguerons cinq types de reconfiguration du réseau personnel : expansion amicale, recul amical, en négociation, refuge parental et nouvelle union. Nous verrons que cette reconfiguration s’accompagne également d’un récit qui est centré sur un concept de justice se déclinant en trois principes : la propriété, le partage à parts égales et le degré de culpabilité.

Conclusions : Nous mettrons en lumière en quoi ce travail sur les frontières est à la fois concret (perte et ajout de relations ainsi que réévaluation du degré d’investissement) et sémantique (par le récit élaboré). Nous y constaterons à la fois un processus de fermeture des frontières autour des personnes qui ont su être soutenantes et un processus d’ouverture pour aller au-delà de la relation conjugale.

Contribution : Cet article invite à une réflexion sur la reconfiguration des frontières de l’intimité et sur un nouveau rapport à la conjugalité ; en effet, une rupture conjugale entre jeunes adultes s’accompagne souvent d’espoirs pour la formation d’un nouveau couple.

Anxiety, depression and associated factors among recently divorced individuals

Background: In divorce research, studies using large samples, very recently divorced individuals and validated measures of depression and anxiety with available background populations for comparison are missing.Aims: This study aimed to investigate symptoms of depression and anxiety among recently divorced Danes and assess the explanatory power of relevant sociodemographic- and divorce-related variables on these symptoms.Methods: The study utilized an online cross-sectional design and a total of 1856 Danish citizens recruited through the Danish State Administration. Average scores for depression and anxiety were compared to the Danish background population and regression analyses were conducted to assess the explanatory power of sociodemographic- and divorce characteristics on symptoms of depression and anxiety.Results: Divorcees reported significantly higher levels of both depressive and anxiety symptoms than the background population with a large proportion of the sample scoring equal to or higher than generally recommended cut-off values for risk of suffering from a psychiatric diagnosable case of depression or anxiety. Both sociodemographic- and divorce characteristics were predictive of symptoms of depression and anxiety.Conclusion: The findings underline the relevance of public health intervention targeting symptoms of depression and anxiety among recently divorced individuals.

Predictors of unmet health care needs in Serbia; Analysis based on EU-SILC data

Unmet health care needs have been designated as an indicator of equality in access to health care, which provides insight into specific barriers faced by respondents when they need medical services. The purpose of this research was to analyze demographic, socioeconomic, regional characteristics and perception of the health status; and identify predictors of unmet health care needs and consequently determine the size of inequalities in the availability, accessibility and acceptability of health care. The cross-sectional study obtained data from the Survey on Income and Living Conditions in the Republic of Serbia in 2014, based on a sample of 20,069 respondents over 16 years. Data was collected by using a household questionnaire and a questionnaire for individuals. Multivariate logistic regressions were applied. Almost every seventh citizen (14.9%) reported unmet health care needs. Predictors of unmet needs, for overall reasons, which increase the likelihood of their emergence included: self-perceived health status as very bad (OR = 6.37), divorced or widower/widow (OR = 1.31), living in the Sumadija region or Western Serbia (OR = 1.54) and belonging to the age group of 27 to 44 (OR = 1.55) or 45 to 64 years (OR = 1.52). The probability for those least reporting unmet health care needs included female patients (OR = 0.81), those with higher education (OR = 0.77), those who belong to the richest quintile (OR = 0.46) and who are unemployed (OR = 0.64). Reasons for unmet needs that indicate the responsibility of the health system amounted to 58.2% and reasons which represent preferences of the respondents amounted to 41.7%. The most frequent reason for unmet needs was financial (36.6%), and the wish to wait and see if the problem got better on its own (18.3%). Health policy should adopt a multidimensional approach and develop incentives for the appropriate use of health services and should eliminate barriers which restrict the accessibility and availability.

Are health care inequalities unfair? A study on public attitudes in 23 countries

Background

In this article we focus on the following aims: (1) to analyze national and welfare state variations in the public perception of income-related health care inequalities, (2) to analyze associations of sociodemographic, socioeconomic, health-related, and health care factors with the perception of health care inequalities.

Methods

Data were taken from the International Social Survey Programme (ISSP), an annually repeated cross-sectional survey based on nationally representative samples. 23 countries (N = 37,228) were included and assigned to six welfare states. Attitude towards income-related health care inequalities was assessed by asking: “Is it fair or unfair that people with higher incomes can afford better health care than people with lower incomes?” with response categories ranging from “very fair” (1) to “very unfair” (5). On the individual level, sociodemographic (gender, age), socioeconomic (income, education) health-related (self-rated health), and health care factors (health insurance coverage, financial barriers to health care) were introduced.

Results

About two-thirds of the respondents in all countries think that it is unfair when people with higher incomes can afford better health care than people with lower incomes. Percentages vary between 42.8 in Taiwan and 84 in Slovenia. In terms of welfare states, this proportion is higher in Conservative, South European, and East European regimes than in East Asian, Liberal, and Social-Democratic regimes. Multilevel logistic regression analyses show that women, people affected by a low socioeconomic status, poor health, insufficient insurance coverage, and foregone care are more likely to perceive income-related health care inequalities as unfair.

Conclusions

In most countries a majority of the population perceives income-related health care inequalities as unfair. Large differences between countries were observed. Welfare regime classification is important for explaining the variation across countries.

Professional care seeking for mental health problems among women and men in Europe: the role of socioeconomic, family-related and mental health status factors in explaining gender differences

PURPOSE

This comparative study examines cross-national variation in gender differences in primary and specialized mental health care use in Europe. We investigate to what extent socioeconomic, family-related, and mental health factors explain the gender difference, and how the impact of these groups of determinants on gender differences in mental health care use varies between countries.

METHODS

Data from the Eurobarometer 248 (2005-2006) for 29 European countries is used and country-specific logistic regression analyses are performed.

RESULTS

Gender differences in professional care seeking are largely need based. In almost one-third of the countries examined, the gender difference is mainly attributable to women's poorer mental health status. However, in some countries, family and socioeconomic characteristics also have an independent contribution to the gender difference in mental health care use. Women's higher likelihood of a lower socioeconomic position, might partly explain their higher primary care use, while in some countries, it restricts their specialized care use. In addition, some social conditions, as having children and being widowed, seem to function in a few countries as suppressors of women's care use.

CONCLUSIONS

Our study has shown that the gender difference in mental health care use, with women having a higher care use, is not a consistent European phenomenon and is dependent on the type of care provider, with greater gender inequity in the use of primary health care. The social roles adopted by men and women have in some countries on top of the mental health status a relevant influence on the greater tendency among women to contact a care provider. How the socioeconomic and family characteristics moderate the relation between gender and mental health care use is not straightforward and country dependent.

Health conditions in regions of Eastern and Western Europe

OBJECTIVES

We report health conditions in the regions of the European Union (EU) from both objective and subjective perspectives and verify whether drawing conclusions regarding the health conditions in different countries without considering the countries' sub-national variability may lead to inaccurate results.

METHODS

To depict health conditions in the EU regions, two classification methods are used: (1) hierarchical clustering with Ward's method and squared Euclidean distance and (2) k-mean clustering. To illustrate the intra-country variability of health conditions, the coefficients of variation are computed.

RESULTS

Health conditions are considerably better in the western regions of the EU. Objective and subjective health measures do not always coincide. Extensive within-country differences in health conditions exist.

CONCLUSIONS

The EU is clearly split into the EU-15 and Central and Eastern European countries; however, this division is observed with respect to objective health conditions only. Inclusion of self-perceived health status in the analysis measures considerably changes this picture.

Undermet needs for assistance in personal activities of daily living among community-dwelling oldest old in China from 2005 to 2008

Based on the 2005 and 2008 Chinese Longitudinal Healthy Longevity Survey, this study examined the prevalence of undermet needs for assistance in personal activities of daily living (ADL) and its associated risk factors among the oldest old aged 80+. Multilevel multinomial logistic modeling was used to analyze the risk factors and changes of undermet needs over time. The results show that the prevalence of slightly undermet needs decreased in urban China from 2005 to 2008. However, the prevalence of undermet needs remained high; 50% or more for both rural and urban residents. Compared to 2005, the likelihood of having slightly undermet needs in 2008 significantly decreased by 28% among rural residents and 22% among urban residents. The common risk factors of undermet needs among rural and urban residents included financial dependence, living alone, having unwilling caregivers, more ADL disabilities, and having poor self-rated health.