1
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Muwonge JJ, Dalman C, Burström B, de Leon AP, Galanti MR, Jablonska B, Hollander AC. Are the estimated needs for mental health care among adolescents from different socioeconomic backgrounds met equally in Sweden? A longitudinal survey-registry linkage study. Eur Child Adolesc Psychiatry 2024; 33:2581-2591. [PMID: 38157010 PMCID: PMC11272712 DOI: 10.1007/s00787-023-02341-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024]
Abstract
Evidence of inequality in the utilisation of mental health care (MHC) by adolescents in Nordic countries is mixed. This study aims to investigate if there are socioeconomic differences in the utilisation of MHC, while accounting for adolescents' mental health status. We analysed a cohort of 3517 adolescents, followed from 7 to 9th grade (ages 13-16), to examine the association between parental socioeconomic position (SEP: education and disposable income), adolescents' estimated needs, and the utilisation of MHC (defined as visits to secondary psychiatric care or receipt of psychotropic medication). Logistic and negative binomial regression models, with mental health status as moderator, were used to predict utilisation during each grade. Lower SEP predicted higher odds of utilising MHC in adolescents with no/mild symptoms (e.g., odds ratio, OR = 1.33, 95% CI 1.04-1.72, lower vs highest education), but not in those with moderate-to-severe symptoms (estimates close to one and non-significant). This pattern was largely explained by treatment of attention deficit hyperactivity disorder/autism spectrum disorders (ADHD/ASD) in boys. For girls with severe symptoms, lower SEP predicted reduced odds of utilising MHC for other mental disorders (OR = 0.48, 95% CI 0.25-0.92, lower education), and fewer outpatient visits when in contact with such care, although non-significant (incidence rate ratio, IRR = 0.51, 95% CI 0.25-1.05, lowest vs highest income). Our findings suggest a more equitable use of MHC for treating ADHD/ASD, but not other mental disorders such as depression and anxiety, particularly among girls.
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Affiliation(s)
- Joseph Jr Muwonge
- Centre for Epidemiology and Community Medicine, Stockholm, Sweden.
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.
| | - Christina Dalman
- Centre for Epidemiology and Community Medicine, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Bo Burström
- Centre for Epidemiology and Community Medicine, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Antonio Ponce de Leon
- Centre for Epidemiology and Community Medicine, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | | | - Beata Jablonska
- Centre for Epidemiology and Community Medicine, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
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2
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Verhoog S, Eijgermans DGM, Fang Y, Bramer WM, Raat H, Jansen W. Contextual determinants associated with children's and adolescents' mental health care utilization: a systematic review. Eur Child Adolesc Psychiatry 2024; 33:2051-2065. [PMID: 36129544 PMCID: PMC9490713 DOI: 10.1007/s00787-022-02077-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/31/2022] [Indexed: 11/19/2022]
Abstract
Determinants at the contextual level are important for children's and adolescents' mental health care utilization, as this is the level where policy makers and care providers can intervene to improve access to and provision of care. The objective of this review was to summarize the evidence on contextual determinants associated with mental health care utilization in children and adolescents. A systematic literature search in five electronic databases was conducted in August 2021 and retrieved 6439 unique records. Based on eight inclusion criteria, 74 studies were included. Most studies were rated as high quality (79.7%) and adjusted for mental health problems (66.2%). The determinants that were identified were categorized into four levels: organizational, community, public policy or macro-environmental. There was evidence of a positive association between mental health care utilization and having access to a school-based health center, region of residence, living in an urban area, living in an area with high accessibility of mental health care, living in an area with high socio-economic status, having a mental health parity law, a mental health screening program, fee-for-service plan (compared to managed care plan), extension of health insurance coverage and collaboration between organizations providing care. For the other 35 determinants, only limited evidence was available. To conclude, this systematic review identifies ten contextual determinants of children's and adolescents' mental health care utilization, which can be influenced by policymakers and care providers. Implications and future directions for research are discussedPROSPERO ID: CRD42021276033.
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Affiliation(s)
- S Verhoog
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands
| | - D G M Eijgermans
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands
- The Generation R Study Group, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Y Fang
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - H Raat
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands
| | - W Jansen
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Social Development, City of Rotterdam, Rotterdam, the Netherlands.
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3
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Lindstrand S, Andersson F, Galanti MR. Compositional characteristics of neighbourhoods and of schools as correlates of youths' mental health: A cross-sectional study among Swedish adolescents. Scand J Public Health 2022; 50:1081-1088. [PMID: 36076348 DOI: 10.1177/14034948221113142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS The study aimed to analyse the association between neighbourhood- and school-level socio-demographic factors and self-reported mental health among adolescents. METHODS The study population consisted of 3959 adolescents in southern and central Sweden (the KUPOL study), surveyed in the seventh grade (13 years old) and again in the ninth grade (15 years old). Cross-sectional associations were studied between socio-demographic indicators at neighbourhood level (proportion of adults with high education, without employment, of foreign-born residents) and at school level (proportion of students with at least one parent with high education, of students with a foreign background, mean qualification points in ninth grade) and mental health problems. These were assessed through the Strengths and Difficulties Questionnaire (SDQ). We derived odds ratios (OR) and corresponding 95% confidence intervals (CI) of scale scores above the threshold using multilevel logistic regression models. RESULTS After adjustment for individual- and family-level socio-demographic factors, there was an indication of higher OR of mental health problems with increasing proportions of foreign-born and residents without employment, especially among girls and in public schools. Stronger associations in the expected direction were found with the internalising subscale. Socio-demographic factors at the school level were not associated with adolescents' mental health, except in private schools, where increasing proportions of students with highly educated parents were significantly associated with SDQ scores under the threshold (OR=0.91; 95% CI 0.85-0.97). CONCLUSIONS The results indicate that equal living conditions may represent important cues to improve the mental health of adolescents. Longitudinal studies are needed to determine any causality.
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Affiliation(s)
- Sofia Lindstrand
- Unit for Public Health and Statistics (FSE), University Hospital of Linköping, Sweden
| | - Filip Andersson
- Department of Global Public Health, Karolinska Institutet, Sweden.,Centre for Epidemiology and Community Medicine (CES), Stockholm County's Health Care District (SLSO), Sweden
| | - Maria Rosaria Galanti
- Department of Global Public Health, Karolinska Institutet, Sweden.,Centre for Epidemiology and Community Medicine (CES), Stockholm County's Health Care District (SLSO), Sweden
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Choi S, Kiriya J, Shibanuma A, Jimba M. Mediating role of social capital in the association between socioeconomic status and childcare practices in rural Malawi: a cross-sectional study. BMJ Open 2022; 12:e054134. [PMID: 35534073 PMCID: PMC9086639 DOI: 10.1136/bmjopen-2021-054134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Childcare practices determine the child nutritional outcomes, but resources for good practices are unequally distributed across socioeconomic status (SES). This study first examined the associations between social capital and childcare practices separately across SES groups. It then investigated the mediation effect of social capital between SES and childcare practices. DESIGN This cross-sectional study used the Short Version of the Adapted Social Capital Assessment Tool to measure structural social capital (group membership, social support and citizenship activities) and cognitive social capital of mothers. Data were analysed using multilevel logistic regressions with random intercepts and mediation modellings. SETTING Rural Lilongwe, Malawi. PARTICIPANTS A total of 320 mothers with a child aged between 12 months and 23 months. PRIMARY OUTCOME MEASURES Childcare practice outcomes included were minimum dietary diversity, handwashing and complete vaccination. RESULTS Among structural social capital dimensions, social support was found to be positively associated with minimum dietary diversity (adjusted OR (AOR)=1.44, 95% CI 1.22 to 1.71; p<0.001) and handwashing for all mothers (AOR=1.42, 95% CI 1.23 to 1.64; p<0.001). In the subgroup analysis, the higher SES group had higher odds of meeting the minimum dietary diversity (AOR=1.63, 95% CI 1.18 to 2.26; p=0.01) and handwashing with increased social support (AOR=1.53, 95% CI 1.13 to 2.08; p=0.01) than the lower SES. The mediation effect of social support accounted for 27.3% of the total effect between SES and minimum dietary diversity. Cognitive social capital was negatively associated with vaccination for the lower SES group (AOR=0.07, 95% CI 0.01 to 0.68; p=0.03). CONCLUSIONS To improve feeding and handwashing practices and to reduce health inequalities in rural Malawi, governments and organisations should consider promoting the value of social support and health. Future research is needed to explain the negative association between cognitive social capital and vaccination among the lower SES group.
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Affiliation(s)
- Suhyoon Choi
- Department of Community and Global Health, The University of Tokyo, Bunkyo-ku, Japan
| | - Junko Kiriya
- Department of Community and Global Health, The University of Tokyo, Bunkyo-ku, Japan
| | - Akira Shibanuma
- Department of Community and Global Health, The University of Tokyo, Bunkyo-ku, Japan
| | - Masamine Jimba
- Department of Community and Global Health, The University of Tokyo, Bunkyo-ku, Japan
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5
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Eijgermans DGM, Boelens M, Oude Groeniger J, van der Zanden WHM, Jansen PW, Raat H, Jansen W. Role of neighbourhood social characteristics in children's use of mental health services between ages 9 and 13 years: a population-based cohort study in the Netherlands. BMJ Open 2022; 12:e057376. [PMID: 35487739 PMCID: PMC9058809 DOI: 10.1136/bmjopen-2021-057376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This study aims to investigate the association of neighbourhood socioeconomic status (SES) and social cohesion (SC) within the neighbourhood with mental health service use in children, independent of individual-level characteristics and mental health problems. DESIGN, SETTING AND PARTICIPANTS A longitudinal analysis was done using data from the Generation R Study, a prospective, population-based cohort of children born in Rotterdam, the Netherlands. These data were linked to the Neighbourhood Profile, containing registry and survey data on residents of Rotterdam. Data of 3403 children (mean age: 13.6 years, SD: 0.4) were used to study the associations between neighbourhood SES, SC (SC belonging and SC relations) and mental health service use, adjusted for mental health problems and sociodemographic characteristics. OUTCOME MEASURES Mental health service use was reported by the accompanying parent at the research centre using the question: 'Did your child visit a psychologist or psychiatrist between 9 and 13 years old?'. RESULTS Mental health services were used by 524 (15.4%) children between ages 9 and 13 years. No significant differences in mental health service use between neighbourhoods were identified (median OR: 1.07 (p=0.50)). The neighbourhood social characteristics were associated with mental health service use, but only when adjusted for each other. Children living in neighbourhoods with a low SES (OR 0.57 (95% CI 0.32 to 1.00)) or high SC belonging (OR 0.79 (95% CI 0.64 to 0.96)) were less likely to use services compared with children in a high SES or low SC belonging neighbourhood. SC relations was not associated with mental health service use. CONCLUSIONS Our findings indicate that children living in high SES neighbourhoods or in neighbourhoods where people feel less sense of belonging are more likely to use mental health services. As these associations were only present when studied jointly, more research is warranted on the complex associations of neighbourhood factors with children's mental health service use.
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Affiliation(s)
- Diana G M Eijgermans
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mirte Boelens
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Pauline W Jansen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Psychology, Education and Child Studies, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Wilma Jansen
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Social Development, City of Rotterdam, Rotterdam, The Netherlands
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6
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Jakobsen AL. Neighborhood socioeconomic deprivation and psychiatric medication purchases. Different neighborhood delineations, different results? A nationwide register-based multilevel study. Health Place 2021; 72:102675. [PMID: 34583189 DOI: 10.1016/j.healthplace.2021.102675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 12/22/2022]
Abstract
Previous studies of neighborhood socioeconomic deprivation and mental health treatment have shown mixed results. Multiple reviews have highlighted that the definition and measurement of neighborhoods can lead to different results, providing one explanation for these mixed findings. This study compares the use of micro-areas created using an automated redistricting algorithm and divided by physical barriers with the use of two administrative units, Danish parishes and postal codes. The geographical data are linked to Danish register data of the Danish population from age 16 in 2017, N = 4,347,001, to measure the association between the purchase of psychiatric medication and neighborhood socioeconomic deprivation using logistic multilevel models. Neighborhood socioeconomic deprivation is associated with a slightly increased probability of redeeming prescriptions for psychiatric medication after controlling for individual sociodemographic composition. However, this association was present only for micro-areas and not for parishes or postal codes. The results indicate that neighborhood effects on psychiatric medication purchases are affected by the neighborhood delineations used and that future studies should carefully consider how neighborhoods are defined and measured.
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7
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Vaalavuo M, Kailaheimo-Lönnqvist S, Kauppinen TM, Sirniö O. Neighbourhood effects on psychiatric disorders among Finnish adolescents: The moderating impact of family background. Health Place 2021; 71:102671. [PMID: 34555783 DOI: 10.1016/j.healthplace.2021.102671] [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: 03/12/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
We study whether childhood neighbourhood context affects mental health in adolescence in Finland. We also examine heterogeneous effects by family background. By exploiting register data for 1999-2018, we use sibling fixed effects models to gain more robust evidence on the existence of neighbourhood effects. We do not find evidence of an association between neighbourhood characteristics and psychiatric disorders within families. Differences in the effects by family background were not consistent, and variation was mainly found in random effects models. In general, observed family characteristics were strongly associated with psychiatric disorders. This means that interventions should be targeted to children at risk rather than certain neighbourhoods.
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Affiliation(s)
- Maria Vaalavuo
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00271 Helsinki, Finland.
| | - Sanna Kailaheimo-Lönnqvist
- Institute of Criminology and Legal Policy, University of Helsinki, P.O. Box 24 (Unioninkatu 40), FI-00014, Finland; Faculty of Social Sciences, Sociology, University of Turku, Assistentinkatu 7, Publicum, FI-20014, Finland.
| | - Timo M Kauppinen
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00271 Helsinki, Finland.
| | - Outi Sirniö
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00271 Helsinki, Finland.
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8
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Berg L, Ljunggren G, Hjern A. Underutilisation of psychiatric care among refugee adolescents in Stockholm. Acta Paediatr 2021; 110:563-570. [PMID: 32762094 PMCID: PMC7891333 DOI: 10.1111/apa.15520] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/11/2020] [Accepted: 07/31/2020] [Indexed: 11/30/2022]
Abstract
AIM Refugee children have been shown to underutilise psychiatric services in Scandinavia. The aim of this study was to investigate determinants of psychiatric care utilisation in adolescents in refugee families. METHODS The study used regional data on healthcare use linked to sociodemographic data from national registers in a total population of 93 537 adolescents in the Stockholm County born in 1995-2000, including 18 831 with a refugee background. Cox regression analyses were fitted to estimate Hazard ratios (HRs) of psychiatric care utilisation in the age-span 11-18 years. RESULTS Psychiatric care use was lower in the large majority of adolescents in refugee families that originated in low- and middle-income countries, with adjusted HRs 0.34 (95% CI 0.28-0.42) and 0.51 (95% CI 0.46-0.56), respectively, compared with the Swedish majority population. Among the foreign-born refugee adolescents, psychiatric care use increased with duration of residence in Sweden and was higher in children who obtained residency as asylum seekers compared with those who settled in family reunification. CONCLUSION Adolescents in newly settled refugee families with a background in low- and middle-income countries should be a priority in mental health assessment of refugee children and referral to psychiatric care facilitated for children in need.
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Affiliation(s)
- Lisa Berg
- Department of Public Health SciencesStockholm UniversityStockholmSweden
- Centre for Health Equity StudiesStockholm University/Karolinska InstitutetStockholmSweden
| | - Gunnar Ljunggren
- Division for Family MedicineDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
- Academic Primary Health Care CentreRegion StockholmStockholmSweden
| | - Anders Hjern
- Centre for Health Equity StudiesStockholm University/Karolinska InstitutetStockholmSweden
- Clinical EpidemiologyDepartment of MedicineKarolinska InstitutetStockholmSweden
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9
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Zhou M, Zhang J, Li F, Chen C. Work-Family Conflict and Depressive Symptoms Among Chinese Employees: Cross-Level Interaction of Organizational Justice Climate and Family Flexibility. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17196954. [PMID: 32977542 PMCID: PMC7579200 DOI: 10.3390/ijerph17196954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 11/20/2022]
Abstract
This study aims to examine how organizational and family factors protect employees from depressive symptoms induced by work-family conflict. With a cross-sectional design, a total of 2184 Chinese employees from 76 departments completed measures of work-family conflict, organizational justice, family flexibility, and depressive symptoms. The results showed that work-family conflict including work-to-family conflict and family-to-work conflict was positively associated with depressive symptoms. In cross-level analysis, organizational justice climate weakened the adverse effect of work-family conflict on depressive symptoms and the buffering effects of procedural and distributive justice climate in the association between work-family conflict and depressive symptoms depended on family flexibility. Specifically, compared with employees with high family flexibility, procedural and distributive justice climate had a stronger buffering effect for employees with low family flexibility. These results indicate that organization and family could compensate each other to mitigate the effect of work-family conflict on employees’ depressive symptoms. Cultivating justice climate in organization and enhancing family flexibility might be an effective way to reduce employees’ depressive symptoms.
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Affiliation(s)
- Mingjie Zhou
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; (M.Z.); (F.L.)
- Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jinfeng Zhang
- School of Public Affairs, Chongqing University, Chongqing 400044, China
- Correspondence:
| | - Fugui Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; (M.Z.); (F.L.)
- Department of Psychology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Chen Chen
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong 999077, China;
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10
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Jablonska B, Kosidou K, Ponce de Leon A, Wettermark B, Magnusson C, Dal H, Dalman C. Neighborhood Socioeconomic Characteristics and Utilization of ADHD Medication in Schoolchildren: A Population Multilevel Study in Stockholm County. J Atten Disord 2020; 24:265-276. [PMID: 27095559 DOI: 10.1177/1087054716643257] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective: To examine the effects of neighborhood socioeconomic disadvantage and ethnic composition on the utilization of ADHD medication in schoolchildren after accounting for individual- and family-level characteristics. Method: A cohort of all schoolchildren living in Stockholm County was prospectively followed for new prescriptions of ADHD medication (N = 276,955). Three-level logistic regression models were used with individual/family characteristics (e.g., immigrant background) at the first level and small area market statistics (SAMS) and municipality characteristics (i.e., socioeconomic disadvantage and ethnic composition) at the second and third level. Results: SAMS socioeconomic disadvantage was associated with increased utilization of ADHD medication. The utilization of ADHD medication was lower among immigrant children as compared with natives, and their odds of not utilizing medication increased as the degree of concentration of foreign-born increased. Conclusion: These results suggest that interventions at the neighborhood level may offer an additional route for the prevention of the disorder and/or alleviation of its consequences.
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Affiliation(s)
- Beata Jablonska
- Stockholm County Council, Sweden.,Karolinska Institutet, Stockholm, Sweden
| | - Kyriaki Kosidou
- Stockholm County Council, Sweden.,Karolinska Institutet, Stockholm, Sweden
| | | | | | - Cecilia Magnusson
- Stockholm County Council, Sweden.,Karolinska Institutet, Stockholm, Sweden
| | - Henrik Dal
- Stockholm County Council, Sweden.,Karolinska Institutet, Stockholm, Sweden
| | - Christina Dalman
- Stockholm County Council, Sweden.,Karolinska Institutet, Stockholm, Sweden
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11
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Can environment or allergy explain international variation in prevalence of wheeze in childhood? Eur J Epidemiol 2018; 34:509-520. [PMID: 30415436 DOI: 10.1007/s10654-018-0463-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 11/02/2018] [Indexed: 12/30/2022]
Abstract
Asthma prevalence in children varies substantially around the world, but the contribution of known risk factors to this international variation is uncertain. The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Two studied 8-12 year old children in 30 centres worldwide with parent-completed symptom and risk factor questionnaires and aeroallergen skin prick testing. We used multilevel logistic regression modelling to investigate the effect of adjustment for individual and ecological risk factors on the between-centre variation in prevalence of recent wheeze. Adjustment for single individual-level risk factors changed the centre-level variation from a reduction of up to 8.4% (and 8.5% for atopy) to an increase of up to 6.8%. Modelling the 11 most influential environmental factors among all children simultaneously, the centre-level variation changed little overall (2.4% increase). Modelling only factors that decreased the variance, the 6 most influential factors (synthetic and feather quilt, mother's smoking, heating stoves, dampness and foam pillows) in combination resulted in a 21% reduction in variance. Ecological (centre-level) risk factors generally explained higher proportions of the variation than did individual risk factors. Single environmental factors and aeroallergen sensitisation measured at the individual (child) level did not explain much of the between-centre variation in wheeze prevalence.
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12
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Weinmayr G, Dreyhaupt J, Jaensch A, Forastiere F, Strachan DP. Multilevel regression modelling to investigate variation in disease prevalence across locations. Int J Epidemiol 2018; 46:336-347. [PMID: 27864412 DOI: 10.1093/ije/dyw274] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2016] [Indexed: 01/05/2023] Open
Abstract
In this article, we show how to investigate the role of individual (personal) risk factors in outcome prevalence in multicentre studies with multilevel modelling. The variation in outcome prevalence is modelled by introducing a random intercept. In the next step, the empty model is compared with the model containing the risk factor(s). Because the outcome is dichotomous, this comparison can only be carried out after having rescaled the models' parameter values to the variance of an underlying continuous variable. We illustrate this approach with data from Phase Two of the International Study of Asthma and Allergies in Childhood (ISAAC) and provide a corresponding Stata do-file.
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Affiliation(s)
- Gudrun Weinmayr
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Andrea Jaensch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - David P Strachan
- Population Health Research Institute, St George's, University of London, London, UK
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13
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Gandré C, Gervaix J, Thillard J, Macé JM, Roelandt JL, Chevreul K. The Development of Psychiatric Services Providing an Alternative to Full-Time Hospitalization Is Associated with Shorter Length of Stay in French Public Psychiatry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E325. [PMID: 28335580 PMCID: PMC5369161 DOI: 10.3390/ijerph14030325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 03/03/2017] [Accepted: 03/17/2017] [Indexed: 01/14/2023]
Abstract
International recommendations for mental health care have advocated for a reduction in the length of stay (LOS) in full-time hospitalization and the development of alternatives to full-time hospitalizations (AFTH) could facilitate alignment with those recommendations. Our objective was therefore to assess whether the development of AFTH in French psychiatric sectors was associated with a reduction in the LOS in full-time hospitalization. Using data from the French national discharge database of psychiatric care, we computed the LOS of patients admitted for full-time hospitalization. The level of development of AFTH was estimated by the share of human resources allocated to those alternatives in the hospital enrolling the staff of each sector. Multi-level modelling was carried out to adjust the analysis on other factors potentially associated with the LOS (patients', psychiatric sectors' and environmental characteristics). We observed considerable variations in the LOS between sectors. Although the majority of these variations resulted from patients' characteristics, a significant negative association was found between the LOS and the development of AFTH, after adjusting for other factors. Our results provide first evidence of the impact of the development of AFTH on mental health care and will provide a lever for policy makers to further develop these alternatives.
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Affiliation(s)
- Coralie Gandré
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, 75010 Paris, France.
- AP-HP, URC Eco, DHU PePSY, 75004 Paris, France.
| | - Jeanne Gervaix
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, 75010 Paris, France.
- AP-HP, URC Eco, DHU PePSY, 75004 Paris, France.
| | - Julien Thillard
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, 75010 Paris, France.
- AP-HP, URC Eco, DHU PePSY, 75004 Paris, France.
| | - Jean-Marc Macé
- National Conservatory of Arts and Crafts, LIRSA, EA 4603, 75003 Paris, France.
| | - Jean-Luc Roelandt
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, 75010 Paris, France.
- World Health Organization Collaborating Centre for Research and Training in Mental Health, 59000 Lille, France.
| | - Karine Chevreul
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, 75010 Paris, France.
- AP-HP, URC Eco, DHU PePSY, 75004 Paris, France.
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Lagerlund M, Merlo J, Vicente RP, Zackrisson S. Does the Neighborhood Area of Residence Influence Non-Attendance in an Urban Mammography Screening Program? A Multilevel Study in a Swedish City. PLoS One 2015; 10:e0140244. [PMID: 26460609 PMCID: PMC4604149 DOI: 10.1371/journal.pone.0140244] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/23/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND AIM The public health impact of population-based mammography screening programs depends on high participation rates. Thus, monitoring participation rates, as well as understanding and considering the factors influencing attendance, is important. With the goal to acquire information on the appropriate level of intervention for increasing screening participation our study aimed to (1) examine whether, over and above individual factors, the neighborhood of residence influences a woman's mammography non-attendance, and (2) evaluate, whether knowing a woman's neighborhood of residence would be sufficient to predict non-attendance. METHODS We analyze all women invited to mammography screening in 2005-09, residing in the city of Malmö, Sweden. Information regarding mammography screening attendance was linked to data on area of residence, demographic and socioeconomic characteristics available from Statistics Sweden. The influence of individual and neighborhood factors was assessed by multilevel logistic regression analysis with 29,901 women nested within 212 neighborhoods. RESULTS The prevalence of non-attendance among women was 18.3%. After adjusting for individual characteristics, the prevalence in the 212 neighborhoods was 3.6%. Neighborhood of residence had little influence on non-attendance. The multilevel analysis indicates that 8.4% of the total individual differences in the propensity of non-attendance were at the neighborhood level. However, when adjusting for specific individual characteristics this general contextual effect decreased to 1.8%. This minor effect was explained by the sociodemographic characteristic of the neighborhoods. The discriminatory accuracy of classifying women according to their non-attendance was 0.747 when considering only individual level variables, and 0.760 after including neighborhood level as a random effect. CONCLUSION Our results suggest that neighborhoods of residence in Malmö, Sweden (as defined by small-area market statistics (SAMS) areas) do not condition women's participation in population based mammography screening. Thus, interventions should be directed to the whole city and target women with a higher risk of non-attendance.
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Affiliation(s)
- Magdalena Lagerlund
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Skåne University Hospital, Malmö, Sweden
- * E-mail:
| | - Juan Merlo
- Unit for Social Epidemiology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Raquel Pérez Vicente
- Unit for Social Epidemiology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Sophia Zackrisson
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Skåne University Hospital, Malmö, Sweden
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15
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Vafaei A, Pickett W, Alvarado BE. Relationships between community social capital and injury in Canadian adolescents: a multilevel analysis. Inj Prev 2015; 21:389-96. [PMID: 26294708 PMCID: PMC4717402 DOI: 10.1136/injuryprev-2015-041552] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 07/30/2015] [Indexed: 12/04/2022]
Abstract
Background Characteristics of social environments are potential risk factors for adolescent injury. Impacts of social capital on the occurrence of such injuries have rarely been explored. Methods General health questionnaires were completed by 8910 youth aged 14 years and older as part of the 2010 Canadian Health Behaviour in School-Aged Children study. These were supplemented with community-level data from the 2006 Canada Census of Population. Multilevel logistic regression models with random intercepts were fit to examine associations of interest. The reliability and validity of variables used in this analysis had been established in past studies, or in new analyses that employed factor analysis. Results Between school differences explained 2% of the variance in the occurrence of injuries. After adjustment for all confounders, community social capital did not have any impact on the occurrence of injuries in boys: OR: 1.01, 95% CI 0.80 to 1.29. However, living in areas with low social capital was associated with lower occurrence of injuries in girls (OR 0.78, 95% CI 0.63 to 0.96). Other factors that were significantly related to injuries in both genders were younger age, engagement in more risky behaviours, and negative behavioural influences from peers. Conclusions After simultaneously taking into account the influence of community-level and individual-level factors, community levels of social capital remained a relatively strong predictor of injury among girls but not boys. Such gender effects provide important clues into the social aetiology of youth injury.
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Affiliation(s)
- Afshin Vafaei
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - William Pickett
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Beatriz E Alvarado
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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16
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Li X, Sjöstedt C, Sundquist K, Zöller B, Sundquist J. Neighborhood deprivation and childhood autism: a nationwide study from Sweden. J Psychiatr Res 2014; 53:187-92. [PMID: 24613033 DOI: 10.1016/j.jpsychires.2014.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 02/11/2014] [Accepted: 02/13/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine whether there is an association between neighborhood deprivation and childhood autism, after accounting for family- and individual-level sociodemographic characteristics. METHODS An open cohort of all children aged 2-11 years was followed between January 1, 2000 and December 31, 2010. Childhood residential locations were geocoded and classified according to neighborhood deprivation (an index of low education, low income, unemployment, and receipt of welfare assistance). Data were analyzed by multilevel logistic regression, with family- and individual-level characteristics at the first level and level of neighborhood deprivation at the second level. RESULTS During the study period, among a total of 643,456 children, 1699 (0.3%) were diagnosed with childhood autism. Age-standardized cumulative incidence, defined as first registration for childhood autism during the study period, increased with increasing level of neighborhood deprivation. In the study population, 2.2 per 1000 and 3.6 per 1000 children in the least and most deprived neighborhoods, respectively, were diagnosed with childhood autism. Incidence of childhood autism increased with increasing neighborhood-level deprivation across all family and individual-level sociodemographic categories. The odds ratio (OR) for childhood autism for those living in high-deprivation neighborhoods versus those living in low-deprivation neighborhoods was 1.59 (95% confidence interval = 1.35-1.88). High neighborhood deprivation remained significantly associated with odds of childhood autism after adjustment for family- and individual-level sociodemographic characteristics (OR = 1.28, 95% confidence interval = 1.07-1.53, P = 0.007). CONCLUSIONS This study is the largest so far on potential neighborhood influences on childhood autism. Our results show that neighborhood deprivation is associated with childhood autism, independently of family- and individual-level sociodemographic characteristics.
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Affiliation(s)
- Xinjun Li
- Center for Primary Health Care Research, Lund University/Region Skåne, Sweden.
| | - Cecilia Sjöstedt
- Center for Primary Health Care Research, Lund University/Region Skåne, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Sweden; Stanford Prevention Research Center, Stanford University School of Medicine, California, USA
| | - Bengt Zöller
- Center for Primary Health Care Research, Lund University/Region Skåne, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Sweden; Stanford Prevention Research Center, Stanford University School of Medicine, California, USA
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