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Mojica MG, Sjoberg-Varney TL, Rodriguez-Fernandez R, Renshaw A, Ebringer A, Kalia N. It Is Time for Employers to Recognize and Address Political Anxiety in the Workplace. J Occup Environ Med 2024; 66:e379-e381. [PMID: 38834936 DOI: 10.1097/jom.0000000000003156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
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2
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Lowenstein C. "Deaths of despair" over the business cycle: New estimates from a shift-share instrumental variables approach. ECONOMICS AND HUMAN BIOLOGY 2024; 53:101374. [PMID: 38518546 PMCID: PMC11060774 DOI: 10.1016/j.ehb.2024.101374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/31/2024] [Accepted: 03/10/2024] [Indexed: 03/24/2024]
Abstract
This study presents new evidence of the effects of short-term economic fluctuations on suicide, fatal drug overdose, and alcohol-related mortality among working-age adults in the United States from 2003-2017. Using a shift-share instrumental variables approach, I find that a one percentage point increase in the aggregate employment rate decreases current-year non-drug suicides by 1.7 percent. These protective effects are concentrated among working-age men and likely reflect a combination of individual labor market experiences as well as the indirect effects of local economic growth. I find no consistent evidence that short-term business cycle changes affect drug or alcohol-related mortality. While the estimated protective effects are small relative to secular increases in suicide in recent decades, these findings are suggestive of important, short-term economic factors affecting specific causes of death and should be considered alongside the longer-term and multifaceted social, economic, and cultural determinants of America's "despair" epidemic.
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Affiliation(s)
- Christopher Lowenstein
- University of California, Berkeley School of Public Health, Division of Health Policy and Management, 2121 Berkeley Way, Room 5302, Berkeley, CA 94720, United States.
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3
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Cohen GH, Wang R, Rosenberg SB, Sampson L, Lowe SR, Cabral H, Ruggiero K, Galea S. Neighborhood-level economic characteristics and depression and PTSD symptoms among Houstonians who have experienced Hurricane Harvey and COVID-19. Psychiatry Res 2024; 333:115766. [PMID: 38335779 PMCID: PMC10964477 DOI: 10.1016/j.psychres.2024.115766] [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: 08/28/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
Little is known about how neighborhood economic characteristics relate to risk of depression and Posttraumatic Stress Disorder (PTSD) in the context of multiple disasters. We sampled 88 super neighborhoods in Houston, Texas and surveyed 872 residents who were living in Houston during Hurricane Harvey and COVID-19 and lived in the same residence since Hurricane Harvey, about their demographics and symptoms of depression and PTSD. Using data from the American Community Survey, we estimated neighborhood-level unemployment, median income, and income inequality (i.e., Gini coefficient). We investigated whether these underlying neighborhood socioeconomic factors were associated with the mental health consequences of mass traumatic events. We examined associations between neighborhood-level constructs and individual-level depression and PTSD, using multilevel linear models. Partially adjusted multilevel models showed that lower neighborhood median income was associated with higher symptom scores of PTSD, while greater neighborhood income inequality was associated with higher symptom scores of depression and PTSD. However, fully adjusted models showed that these associations are better accounted for by event-specific stressors and traumas. These findings suggest that in the context of multiple large scale traumatic events, neighborhood socioeconomic context may structure individual-level exposure to stressful and traumatic events.
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Affiliation(s)
- Gregory H Cohen
- Boston University School of Public Health, Department of Epidemiology 715 Albany St., Boston, MA 02118, United States.
| | - Ruochen Wang
- Boston University School of Public Health, Department of Epidemiology 715 Albany St., Boston, MA 02118, United States
| | - Samuel B Rosenberg
- Boston University School of Public Health, Department of Epidemiology 715 Albany St., Boston, MA 02118, United States
| | - Laura Sampson
- Renaissance School of Medicine, Stony Brook University, Program in Public Health, Department of Family, Population, and Preventive Medicine, Stony Brook, New York, United States
| | - Sarah R Lowe
- Yale School of Public Health, Department of Social and Behavioral Sciences, New Haven, Connecticut, United States
| | - Howard Cabral
- Boston University School of Public Health, Department of Biostatistics, Boston, Massachusetts, United States
| | - Kenneth Ruggiero
- Medical University of South Carolina, College of Nursing, Charleston, South Carolina, United States
| | - Sandro Galea
- Boston University School of Public Health, Dean's Office, Boston, Massachusetts, United States
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4
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Syed O, Jancic P, Fink AB, Knezevic NN. Drug Safety and Suicidality Risk of Chronic Pain Medications. Pharmaceuticals (Basel) 2023; 16:1497. [PMID: 37895968 PMCID: PMC10609967 DOI: 10.3390/ph16101497] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
Chronic pain is one of the main leading causes of disability in the world at present. A variety in the symptomatology, intensity and duration of this phenomenon has led to an ever-increasing demand of pharmacological treatment and relief. This demand for medication, ranging from well-known groups, such as antidepressants and benzodiazepines, to more novel drugs, was followed by a rise in safety concerns of such treatment options. The validity, frequency, and diversity of such concerns are discussed in this paper, as well as their possible effect on future prescription practices. A specific caution is provided towards the psychological safety and toll of these medications, regarding suicidality and suicidal ideation. Most significantly, this paper highlights the importance of pharmacovigilance and underscores the necessity of surveillance programs when considering chronic pain medication.
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Affiliation(s)
- Osman Syed
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL 60657, USA; (O.S.); (P.J.); (A.B.F.)
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL 60515, USA
| | - Predrag Jancic
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL 60657, USA; (O.S.); (P.J.); (A.B.F.)
| | - Adam B. Fink
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL 60657, USA; (O.S.); (P.J.); (A.B.F.)
- Harborview Medical Center, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA 98104, USA
| | - Nebojsa Nick Knezevic
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL 60657, USA; (O.S.); (P.J.); (A.B.F.)
- Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA
- Department of Surgery, University of Illinois, Chicago, IL 60612, USA
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5
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Jafari M, De Roche M, Eshaghi MR. COVID-19, stress and mental health: What students expect from academic institutions during a pandemic. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1976-1983. [PMID: 34398699 DOI: 10.1080/07448481.2021.1951740] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 04/06/2021] [Accepted: 06/25/2021] [Indexed: 06/13/2023]
Abstract
Objectives: To learn about the mental health of students, the tools they use to cope with stress, and their perceptions toward the assistance they receive from their academic institutions during the COVID-19 pandemic. Participants: 593 students from two University of California campuses. Methods: The link to an anonymous survey was included in a mass email that was sent to students. Results: 87% of students expressed that their mental health has been negatively impacted by the pandemic, especially in students who already had diminished levels of self-reported mental health. Students articulated the need for increased financial, academic, and mental health support and that they want to have a voice in discussions that will lead to decisions that would impact them. Conclusion: Students reported that the pandemic has negatively impacted their mental health and that they wanted academic institutions to include them in the decision-making processes that would contribute to their health.
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Affiliation(s)
- Mahtab Jafari
- Department of Pharmaceutical Sciences, University of California, Irvine, California, USA
| | - Monica De Roche
- Department of Political Science, School of Social Sciences, University of California, Irvine, California, USA
| | - Matin Ryan Eshaghi
- Department of Economics, School of Social Sciences, University of California, Irvine, California, USA
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6
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Dackehag M, Ellegård LM, Gerdtham UG, Nilsson T. Macroeconomic fluctuations and individual use of psychotropic medications: evidence from Swedish administrative data. Eur J Public Health 2023; 33:93-98. [PMID: 36622208 PMCID: PMC9898001 DOI: 10.1093/eurpub/ckac182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND A growing literature finds that adult mental health worsens during economic downturns. Current insights on the relationship between macroeconomic fluctuations and psychotropic medication are based on self-reported information or aggregate measures on prescriptions. This study assesses the relationship between local macroeconomic conditions and individual use of psychotropic medication as reported in administrative registers. METHODS We use local information on unemployment linked to individual-level longitudinal data on detailed psychotropic drug consumption from administrative registers, for individuals in working age (20-65) in Sweden 2006-13. Any psychotropic medication uptake and the related number of redeemed prescriptions are the primary outcomes. Mortality is considered a secondary outcome. RESULTS Among young men (aged 20-44) and older women (aged 45-65), we find reduced use of psychotropic medication (2-4% compared to the mean) when the local labor market conditions deteriorate. The relationship is driven by reduced use of antidepressants. The same age-gender groups experience a significantly higher risk of mortality in bad times. CONCLUSIONS This study shows that economic downturns may not only put strain on individuals' mental health but also on their access to psychopharmaceutic treatments.
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Affiliation(s)
| | - Lina Maria Ellegård
- Department of Economics, Lund University, Lund, Sweden.,Faculty of Business, Kristianstad University, Kristianstad, Sweden
| | - Ulf-G Gerdtham
- Department of Economics, Lund University, Lund, Sweden.,Department of Clinical Sciences (Malmö), Lund University, Malmö, Sweden
| | - Therese Nilsson
- Department of Economics, Lund University, Lund, Sweden.,Research Institute of Industrial Economics, Stockholm, Sweden
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Hagen D, Lai AY, Goldmann E. State-level unemployment and negative emotions throughout the Covid-19 pandemic in the United States. Prev Med 2022; 164:107239. [PMID: 36058381 PMCID: PMC9434949 DOI: 10.1016/j.ypmed.2022.107239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/07/2022] [Accepted: 08/28/2022] [Indexed: 12/02/2022]
Abstract
Although prior research has assessed public mental health in the U.S. throughout the COVID-19 pandemic, it is unclear how area-level unemployment impacted psychological well-being; moreover, studies that examine potential effect heterogeneity of the impact of area-level unemployment on well-being by employment status are lacking. To address these shortcomings, this study utilized data from Gallup's repeated cross-sectional, nationally representative COVID-19 web survey collected between April 2020 and July 2021 (n = 132,971). Survey modified Poisson regression models were estimated to determine the association between current unemployment rate in respondents' state of residence and experience of each of the following negative emotions during a lot of the prior day: sadness, worry, stress, anger, loneliness, depression, and anxiety. These models were stratified by employment status and sequentially adjusted for individual-level covariates, state fixed effects, and current state-level COVID-19 mortality. State-level unemployment was most strongly associated with sadness, followed by worry, anger, loneliness, stress, and anxiety; no associations were observed for depression. For sadness, worry, and stress, associations were strongest among full-time employed and retired individuals, and weakest among unemployed respondents and homemakers. Moreover, there was some evidence that state-level unemployment was negatively associated with the experience of anger in the early stages of the pandemic, and positively in its later stages. In sum, these findings suggest that Americans' emotional experience during the COVID-19 pandemic was considerably impacted by the state of the economy, highlighting the need for risk-buffering social policies.
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Affiliation(s)
- Daniel Hagen
- Department of Epidemiology, New York University School of Global Public Health, NY, New York, USA
| | - Alden Yuanhong Lai
- Department of Public Health Policy and Management, New York University School of Global Public Health, NY, New York, USA
| | - Emily Goldmann
- Department of Epidemiology, New York University School of Global Public Health, NY, New York, USA.
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8
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Abstract
Over the past two decades, opioid overdose deaths contributed to the dramatic rise in all-cause mortality among non-Hispanic Whites. To date, efforts among scholars to understand the role of local area labor market conditions on opioid overdose mortality have led to mixed results. We argue the reason for these disparate findings is scholars have not considered the moderating effects of income support policies such as unemployment insurance. The present study leverages two sources of variation-county mass layoffs and changes in the generosity of state unemployment insurance benefits-to investigate if unemployment benefits moderate the relationship between job loss and county opioid overdose death rates. Our difference-in-differences estimation strategy reveals that the harmful effects of job loss on opioid overdose mortality decline with increasing state unemployment insurance benefit levels. These findings suggest that social policy in the form of income transfers played a crucial role in disrupting the link between job loss and opioid overdose mortality.
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Affiliation(s)
- Pinghui Wu
- The Federal Reserve Bank of Boston, Boston, MA, USA
| | - Michael Evangelist
- Department of Sociology, School of Social Work, and Poverty Solutions, University of Michigan, Ann Arbor, MI, USA
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9
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Hamad R, Ruffini K, Bitler M, Currie J. Leveraging the Urgency of Economic Disparities Driven by the COVID-19 Pandemic to Strengthen the U.S. Safety Net. NAM Perspect 2022; 2022:202202a. [PMID: 35402855 PMCID: PMC8970225 DOI: 10.31478/202202a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2023]
Affiliation(s)
| | | | - Marianne Bitler
- University of California, Davis and Federal Reserve Bank of Minneapolis
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10
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Aretz B. The short- and long-term effects of the Great Recession on late-life depression in Europe: The role of area deprivation. Soc Sci Med 2022; 294:114697. [PMID: 35030399 DOI: 10.1016/j.socscimed.2021.114697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/01/2021] [Accepted: 12/28/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The prevalence of depression increases in times of economic crises. Less is known about whether people living in advantaged or disadvantaged areas suffer equally from negative effects of crisis. OBJECTIVE To explore the role of area deprivation on the short- and long-term effects of the Great Recession in Europe on late-life depression. METHODS Individual panel data from Austria, Belgium, Denmark, France, Germany, Italy, Spain, Sweden, Switzerland of the SHARE (age 50+, n = 6866) between 2004 and 2017 were used. Late-life depression (LLD) was measured by the EURO-D scale (4+ symptoms). Area deprivation was assessed by a country-specific z-standardized scale measuring perceived access to various services and quality of the social and built environment. Quarterly country-level GDP and yearly unemployment data were explored to define country-specific durations of the Great Recession. Individual fixed effects panel regressions were estimated controlling for time-varying socioeconomic and health-related confounders. RESULTS Prevalence and incidence of late-life depression was generally higher in deprived than in non-deprived areas, and these differences in prevalence and incidence increased during the Great Recession. Regressions showed that the Great Recession was related to a 23% higher long-term risk of late-life depression (OR: 1.23, CI: 1.05-1.44) for all study participants. In the short-term of the Great Recession, people from deprived areas had a 22% higher risk of late-life depression (OR: 1.22, CI: 1.02-1.46) than people from non-deprived areas. CONCLUSION The findings suggest that older adults exposed to adverse area determinants suffer more from the negative short-term effects of a severe economic crisis on depression and mental health inequalities may have increased between people living in deprived versus non-deprived areas. This potential increase in mental health inequalities warrants particular attention for those people living in deprived areas.
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Affiliation(s)
- Benjamin Aretz
- Department of Demography, Faculty of Spatial Sciences, University of Groningen, Groningen, the Netherlands; Institute of Sociology and Demography, University of Rostock, Rostock, Germany.
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11
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Mutambudzi M, Flowers P, Demou E. Association of perceived job security and chronic health conditions with retirement in older UK and US workers. Eur J Public Health 2021; 32:52-58. [PMID: 34561693 PMCID: PMC8807079 DOI: 10.1093/eurpub/ckab170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The relationship between job insecurity, chronic health conditions (CHCs) and retirement among older workers are likely to differ between countries that have different labor markets and health and social safety nets. To date, there are no epidemiological studies that have prospectively assessed the role of job insecurity in retirement incidence, while accounting for CHC trajectories in two countries with different welfare systems. We investigated the strength of the association between baseline job insecurity and retirement incidence over an 11-year period while accounting for CHC trajectories, among workers 50–55 years of age at baseline in the UK and USA. Methods We performed Cox proportional hazards regression analysis, using 2006–2016 data from the Health and Retirement Study (US cohort, n = 570) and English Longitudinal Study on Aging (UK cohort n = 1052). Results Job insecurity was associated with retirement after adjusting for CHC trajectories (HR = 0.69, 95% CI = 0.50–0.95) in the UK cohort only. CHC trajectories were associated with retirement in both cohorts; however, this association was attenuated in the US cohort, but remained significant for the medium-increasing trajectory in the UK cohort (HR = 1.41, 95% CI = 1.01–1.97) after adjustment for all covariates. Full adjustment for relevant covariates attenuated the association between job insecurity and retirement indicating that CHCs, social and health factors are contributing mechanistic factors underpinning retirement incidence. Conclusions The observed differences in the two cohorts may be driven by macro-level factors operating latently, which may affect the work environment, health outcomes and retirement decisions uniquely in different settings.
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Affiliation(s)
- Miriam Mutambudzi
- Department of Public Health, Falk College, Syracuse University, Syracuse, NY, USA.,MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Paul Flowers
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Evangelia Demou
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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12
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Gunadi C, Ryu H. Does the rise of robotic technology make people healthier? HEALTH ECONOMICS 2021; 30:2047-2062. [PMID: 34046963 DOI: 10.1002/hec.4361] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/10/2021] [Accepted: 05/10/2021] [Indexed: 06/12/2023]
Abstract
Technological advancements bring changes to our life, altering our behaviors as well as our role in the economy. In this paper, we examine the potential effect of the rise of robotic technology on health. Using the variation in the initial distribution of industrial employment in US cities and the difference in robot adoption across industries over time to predict robot exposure at the local labor market, we find evidence that higher penetration of industrial robots in the local economy is positively related to the health of the low-skilled population. A 10% increase in robots per 1000 workers is associated with an approximately 10% reduction in the share of low-skilled individuals reporting poor health. Further analysis suggests that the reallocation of tasks partly explains this finding. A 10% increase in robots per 1000 workers is associated with an approximately 1.5% reduction in physical tasks supplied by low-skilled workers.
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Affiliation(s)
- Christian Gunadi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, California, USA
| | - Hanbyul Ryu
- Hanyang University (ERICA Campus), College of Business and Economics, Ansan-si, South Korea
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13
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Guerra O, Eboreime E. The Impact of Economic Recessions on Depression, Anxiety, and Trauma-Related Disorders and Illness Outcomes-A Scoping Review. Behav Sci (Basel) 2021; 11:119. [PMID: 34562956 PMCID: PMC8464685 DOI: 10.3390/bs11090119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022] Open
Abstract
In the wake of a global economic recession secondary to the COVID-19 pandemic, this scoping review seeks to summarize the current quantitative research on the impact of economic recessions on depression, anxiety, traumatic disorders, self-harm, and suicide. Seven research databases (PsycINFO, MEDLINE, Embase, Web of Science: Core Collection, National Library of Medicine PubMed, PubMed Central, and Google Scholar) were searched for keywords returning 3412 preliminary results published since 2008 in Organisation for Economic Coordination and Development (OECD)nations. These were screened by both authors for inclusion/exclusion criteria resulting in 127 included articles. Articles included were quantitative studies in OECD countries assessing select mental disorders (depression, anxiety, and trauma-/stress-related disorders) and illness outcomes (self-harm and suicide) during periods of economic recession. Articles were limited to publication from 2008 to 2020, available online in English, and utilizing outcome measures specific to the disorders and outcomes specified above. A significant relationship was found between periods of economic recession and increased depressive symptoms, self-harming behaviour, and suicide during and following periods of recession. Results suggest that existing models for mental health support and strategies for suicide prevention may be less effective than they are in non-recession times. It may be prudent to focus public education and medical treatments on raising awareness and access to supports for populations at higher risk, including those vulnerable to the impacts of job or income loss due to low socioeconomic status preceding the recession or high levels of financial strain, those supporting others financially, approaching retirement, and those in countries with limited social safety nets. Policy makers should be aware of the potential protective nature of unemployment safeguards and labour program investment in mitigating these negative impacts. Limited or inconclusive data were found on the relationship with traumatic disorders and symptoms of anxiety. In addition, research has focused primarily on the working-age adult population with limited data available on children, adolescents, and older adults, leaving room for further research in these areas.
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Affiliation(s)
- Olivia Guerra
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada;
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14
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Zilidis C, Angelopoulos NV. The impact of economic crisis on mortality due to mental health illnesses. J Public Health (Oxf) 2021; 44:92-99. [PMID: 33912955 DOI: 10.1093/pubmed/fdab129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 02/15/2021] [Accepted: 04/10/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The financial crisis affected several aspects of health. The aim of this study is to explore the impact of the crisis on mortality of mental illnesses in Greece and the socioeconomic determinants of mortality trends. METHODS Mortality data of 2000-16 were analyzed and sex-and-age-standardized death rates (SDRs) were calculated. The Average Annual Percent Change (AAPC) before and after the time point of slope change was computed. The crisis impact on SDRs was explored with interrupted time series analyses and standardized rate ratios (SRRs). The correlation of mortality with socioeconomic and healthcare-related variables was investigated with correlation and regression analyses. RESULTS A significant change in SDR trend was observed after 2012. The AAPC reversed from -2.9% to 94.5%, while the SRR was calculated at 6.1 (5.5-6.7). Income reduction, unemployment rise and health budget cuts were found to be significantly correlated with mortality rise. CONCLUSIONS Financial crisis had a significant impact on mortality due to mental illnesses, especially in females and elderly. The findings indicate that mortality increase is more driven by socioeconomic and healthcare-related factors that affect access to appropriate healthcare than by morbidity trends. The findings have implications in planning interventions to provide appropriate healthcare to patients living with mental illness.
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Affiliation(s)
- C Zilidis
- General Department, University of Thessaly, Larissa, Greece
| | - N V Angelopoulos
- Department of Psychiatry, Faculty of Medicine, University of Thessaly, Larissa, Greece
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15
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Walter E, Avgush S, Daly C, Crump C. The Impact of the Great Recession on Diabetes Management in a High-Risk Population. J Health Care Poor Underserved 2021; 31:1007-1017. [PMID: 33410821 DOI: 10.1353/hpu.2020.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study examined the effects of the Great Recession (GR) on type 2 diabetes management using individual-level data in a historically underserved, high-risk patient population at a federally qualified health center (FQHC). Comparing three time periods (pre-recession [2004-2006], recession [2007-2009], and recession recovery [2010-2012]), we found that patients had significant increases in blood pressure and body mass index as they entered the GR. Conversely, we found a significant decrease in HbA1c across the study period likely influenced by interventions to improve HbA1c during this time at this FQHC. While previous studies on the impact of the GR have focused primarily on the middle class, our findings suggest that high-risk patients who are already struggling to maintain their health may be further hurt by economic downturns. Intensive programs to serve these patients can act as a safety net to buffer the potential health impacts of these downturns.
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16
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Abstract
Social distancing policies have been widely adopted in response to the COVID-19 pandemic. High levels of social connection are positively associated with beneficial health outcomes, while social isolation is associated with poor long-term health outcomes including reduced life expectancy. The present study evaluates the impact of social distancing measures during the early period of COVID-19 on substance use behaviors among those in the United States. Methods: We used an internet-based survey with participants (n = 157; 86 male) reporting a history of problems related to drug use. We relied on ANOVA and logistic regression techniques to assess the associations between social connection and substance use. Results: People with more severe drug use problems reported feeling more socially isolated during social distancing. Those who primarily use alcohol reported higher global feelings of social connection than those who primarily use opioids. During social distancing, participants reported an increase in alcohol and cigarette consumption, and a decrease in cocaine use. Lastly, those who reported using drugs for social reasons were less likely to have decreased substance use during social distancing. Conclusions: The current study provides evidence that social distancing guidelines have impacted both substance use behaviors and feelings of social and physical connection. Further, there are differential impacts based on drug of choice. These results advance delineation of the connection between sociality and drug use.
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Affiliation(s)
- Nina C Christie
- Department of Psychology, University of Southern, Los Angeles, California, USA
| | - Vanya Vojvodic
- Department of Psychology, University of Southern, Los Angeles, California, USA.,Department of Neuroscience, University of Southern California, Los Angeles, California, USA
| | - John R Monterosso
- Department of Psychology, University of Southern, Los Angeles, California, USA.,Department of Neuroscience, University of Southern California, Los Angeles, California, USA
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17
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Brown TT, Ahn C, Huang H, Ibrahim Z. Reducing the prevalence of low-back pain by reducing the prevalence of psychological distress: Evidence from a natural experiment and implications for health care providers. Health Serv Res 2020; 55:631-641. [PMID: 33185925 DOI: 10.1111/1475-6773.13557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To determine whether exogenously reduced psychological distress reduces reported low-back pain (LBP) and is associated with reduced medical visits for LBP. DATA SOURCES National Health Interview Survey, National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey, 1998-2004. STUDY DESIGN We estimate a fuzzy regression discontinuity model in which a discontinuity in the prevalence of psychological distress is identified by exogenous national events. We examine whether this discontinuity induced a corresponding discontinuity in the prevalence of LBP. We additionally estimate a regression discontinuity model to determine associated changes in medical visits with LBP as the primary complaint. PRINCIPAL FINDINGS The prevalence of LBP was discontinuously reduced by one-fifth due to the exogenous national discontinuous reduction in psychological distress. This discontinuity in LBP cannot be explained by discontinuities in employment, insurance, injuries/poisoning, general health status, or other factors. We find an associated three-fifth discontinuous reduction in medical visits with LBP as the primary complaint. CONCLUSIONS On a monthly basis, 2.1 million (P < .01) adults ceased to suffer LBP due to the national reduction in psychological distress, and associated medical visits with LBP as the primary complaint declined by 685 000 (P < .01).
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Affiliation(s)
- Timothy T Brown
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Christie Ahn
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Haoyue Huang
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Zaidat Ibrahim
- School of Public Health, University of California, Berkeley, Berkeley, California
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18
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Wang Y, Fattore G. The impact of the great economic crisis on mental health care in Italy. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:1259-1272. [PMID: 32535852 PMCID: PMC7293427 DOI: 10.1007/s10198-020-01204-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 05/27/2020] [Indexed: 05/17/2023]
Abstract
The great economic crisis in 2008 has affected the welfare of the population in countries such as Italy. Although there is abundant literature on the impact of the crisis on physical health, very few studies have focused on the causal implications for mental health and health care. This paper, therefore, investigates the impact of the recent economic crisis on hospital admissions for severe mental disorder at small geographic levels in Italy and assesses whether there are heterogeneous effects across areas with distinct levels of income. We exploit 9-year (2007-2015) panel data on hospital discharges, which is merged with employment and income composition at the geographic units that share similar labour market structures. Linear and dynamic panel analysis are used to identify the causal effect of rising unemployment rate on severe mental illness admissions per 100,000 residents to account for time-invariant heterogeneity. We further create discrete income levels to identify the potential socioeconomic gradients behind this effect across areas with different economic characteristics. The results show a significant impact of higher unemployment rates on admissions for severe mental disorders after controlling for relevant economic factors, and the effects are concentrated on the most economically disadvantaged areas. The results contribute to the literature of spatio-temporal variation in the broader determinants of mental health and health care utilisation and shed light on the populations that are most susceptible to the effects of the economic crisis.
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Affiliation(s)
- Yuxi Wang
- Centre for Research on Health and Social Care Management Department of Social and Political Science, Bocconi University, 3-C1-01 Via Guglielmo Röntgen, 1, 20136, Milano, MI, Italy.
| | - Giovanni Fattore
- Centre for Research on Health and Social Care Management Department of Social and Political Science, Bocconi University, 3-C1-01 Via Guglielmo Röntgen, 1, 20136, Milano, MI, Italy
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19
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Du Toit EF, Tai WS, Cox A, O’Connor D, Griffith TA, Helman T, Wendt L, Peart JN, Stapelberg NJC, Headrick JP. Synergistic effects of low-level stress and a Western diet on metabolic homeostasis, mood, and myocardial ischemic tolerance. Am J Physiol Regul Integr Comp Physiol 2020; 319:R347-R357. [DOI: 10.1152/ajpregu.00322.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
How low-level psychological stress and overnutrition interact in influencing cardiometabolic disease is unclear. Mechanistic overlaps suggest potential synergies; however, findings are contradictory. We test whether low-level stress and Western diet (WD) feeding synergistically influence homeostasis, mood, and myocardial ischemic tolerance. Male C57BL6/J mice were fed a control diet or WD (32%/57%/11% calories from fat/carbohydrates/protein) for 12 wk, with subgroups restrained for 30 min/day over the final 3 wk. Metabolism, behavior, tolerance of perfused hearts to ischemia-reperfusion (I/R), and cardiac “death proteins” were assessed. The WD resulted in insignificant trends toward increased body weight (+5%), glucose (+40%), insulin (+40%), triglycerides (+15%), and cholesterol (+20%) and reduced leptin (−20%) while significantly reducing insulin sensitivity [100% rise in homeostasis model assessment of insulin resistance (HOMA-IR), P < 0.05]. Restraint did not independently influence metabolism while increasing HOMA-IR a further 50% (and resulting in significant elevations in insulin and glucose to 60–90% above control) in WD mice ( P < 0.05), despite blunting weight gain in control and WD mice. Anxiogenesis with restraint or WD was nonadditive, whereas anhedonia (reduced sucrose consumption) only arose with their combination. Neuroinflammation markers (hippocampal TNF-α, Il-1b) were unchanged. Myocardial I/R tolerance was unaltered with stress or WD alone, whereas the combination worsened dysfunction and oncosis [lactate dehydrogenase (LDH) efflux]. Apoptosis (nucleosome accumulation) and death protein expression (BAK, BAX, BCL-2, RIP-1, TNF-α, cleaved caspase-3, and PARP) were unchanged. We conclude that mild, anxiogenic yet cardio-metabolically “benign” stress interacts synergistically with a WD to disrupt homeostasis, promote anhedonia (independently of neuroinflammation), and impair myocardial ischemic tolerance (independently of apoptosis and death protein levels).
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Affiliation(s)
- Eugene F. Du Toit
- School of Medical Science, Griffith University, Southport, Queensland, Australia
| | - Wei Shan Tai
- School of Medical Science, Griffith University, Southport, Queensland, Australia
| | - Amanda Cox
- School of Medical Science, Griffith University, Southport, Queensland, Australia
| | - Dylan O’Connor
- School of Medical Science, Griffith University, Southport, Queensland, Australia
| | - Tia A. Griffith
- School of Medical Science, Griffith University, Southport, Queensland, Australia
| | - Tessa Helman
- School of Medical Science, Griffith University, Southport, Queensland, Australia
| | - Lauren Wendt
- School of Medical Science, Griffith University, Southport, Queensland, Australia
| | - Jason N. Peart
- School of Medical Science, Griffith University, Southport, Queensland, Australia
| | - Nicolas J. C. Stapelberg
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
- Mental Health and Specialist Services, Gold Coast Health, Southport, Queensland, Australia
| | - John P. Headrick
- School of Medical Science, Griffith University, Southport, Queensland, Australia
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20
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Guo LP, Li ZH, Chen TL, Liu GH, Fan HY, Yang KH. The prevalence of mental distress and association with social changes among postgraduate students in China: a cross-temporal meta-analysis. Public Health 2020; 186:178-184. [PMID: 32853995 DOI: 10.1016/j.puhe.2020.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/21/2020] [Accepted: 06/07/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study aims to estimate the mental distress prevalence of Chinese postgraduate students and the association with the social changes based on the data between 2000 and 2019. STUDY DESIGN This is a cross-temporal meta-analysis study. METHODS The literature was retrieved with both English and Chinese electronic databases, including articles published from 2002 to 2019. Statistical analyses were performed with R 3.6.1 and SPSS 22. RESULTS Eighty-nine primary studies with 99 reports were included in our meta-analysis, totaling 54,722 Chinese postgraduate students. The result showed that: (a) the prevalence of mental distress was 28% (95% confidence interval [CI]: 25%-31%), and the prevalence of moderately positive symptoms was 9% (95% CI: 7%-11%); (b) the prevalence of positive symptoms was negatively correlated with the years of data collection and the prevalence of mental distress decreased by at least 16% from 2000 to 2019; and (c) social changes, particularly the policies of mental health and the educational environment had a significant contribution to these changes. CONCLUSIONS More than a quarter of postgraduate students have mental illness in China, whereas the prevalence of their mental distress has been decreasing. Social changes are shown to play an important role in contributing to this change.
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Affiliation(s)
- Liping P Guo
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China; Evidence-Based Social Sciences Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Zhihong H Li
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China; Evidence-Based Social Sciences Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Taolin L Chen
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Guanghua H Liu
- Evidence-Based Social Sciences Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China; School of Law, Lanzhou University, Lanzhou, Gansu, China
| | - Huiyong Y Fan
- School of Education, Bohai University, Jinzhou, Liaoning, China.
| | - Kehu H Yang
- Evidence-Based Social Sciences Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China; Evidence-Based Medicine Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China.
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21
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Silva M, Antunes A, Azeredo-Lopes S, Cardoso G, Xavier M, Saraceno B, Caldas-de-Almeida JM. How did the use of psychotropic drugs change during the Great Recession in Portugal? A follow-up to the National Mental Health Survey. BMC Psychiatry 2020; 20:215. [PMID: 32393219 PMCID: PMC7216710 DOI: 10.1186/s12888-020-02620-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/26/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Research suggests that economic recessions might be associated with a higher use of psychotropic drugs, but literature is scarce and contradictory in identifying the most vulnerable groups. This study aims to assess possible changes in the use of psychotropic drugs due to the economic recession in Portugal, by comparing self-reported consumption in 2008/09 and 2015/16. METHODS Data from the World Mental Health Survey Initiative Portugal (2008/09) and the National Mental Health Survey Follow-Up (2015/16) were used (n = 911). McNemar's tests were performed to estimate changes in consumption of any psychotropic drug and of antidepressants, anxiolytics, and hypnotics/sedatives. Multiple Generalised Estimating Equations models with interaction effects were used to estimate the population odds of consuming psychotropic drugs according to year, gender and age. RESULTS An increase of 6.74% was estimated in the consumption of psychotropic drugs from 2008/09 to 2015/16. Population odds of consuming any psychotropic drugs in 2015/16 were estimated to be 1.5 times higher than in 2008/09 (OR = 1.50;95%CI:1.13-2.01), particularly for hypnotics/sedatives (OR = 1.60;95%CI:1.14-2.25). Women and older individuals presented higher odds of consuming any psychotropic drugs (OR = 2.79;95%CI:2.03-3.84, and OR = 1.80;95%CI:1.28-2.54), after adjusting for year of assessment and education. However, when evaluating the interaction effect of the year with gender and age, men and younger individuals reported higher odds of consuming any psychotropic drugs in 2015/16, when compared to 2008/09 (OR = 1.85;95%CI:1.08-3.17, and OR = 1.95;95%CI:1.32-2.90, respectively). CONCLUSIONS The findings indicate that the period of economic recession was associated with an increased risk of psychotropic drugs use in Portugal. Consumption of psychotropic drugs remained higher among women and older individuals, but the results suggest that the economic crisis had a disproportionate impact on men and younger individuals. This identification of the most vulnerable population groups is useful to design effective and targeted public health interventions aimed at alleviating the effects of economic recessions.
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Affiliation(s)
- Manuela Silva
- Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health. Nova Medical School, Nova University of Lisbon. Rua do Instituto Bacteriológico, n°5, 1150-190, Lisbon, Portugal.
| | - Ana Antunes
- grid.9983.b0000 0001 2181 4263Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health. Nova Medical School, Nova University of Lisbon. Rua do Instituto Bacteriológico, n°5, 1150-190, Lisbon, Portugal
| | - Sofia Azeredo-Lopes
- grid.10772.330000000121511713Nova Medical School, Nova University of Lisbon. Campo Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - Graça Cardoso
- grid.9983.b0000 0001 2181 4263Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health. Nova Medical School, Nova University of Lisbon. Rua do Instituto Bacteriológico, n°5, 1150-190, Lisbon, Portugal
| | - Miguel Xavier
- grid.10772.330000000121511713Chronic Diseases Research Centre (CEDOC). Nova Medical School, Nova University of Lisbon. Rua do Instituto Bacteriológico, n°5, 1150-190, Lisbon, Portugal
| | - Benedetto Saraceno
- grid.9983.b0000 0001 2181 4263Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health. Nova Medical School, Nova University of Lisbon. Rua do Instituto Bacteriológico, n°5, 1150-190, Lisbon, Portugal
| | - José Miguel Caldas-de-Almeida
- grid.9983.b0000 0001 2181 4263Comprehensive Health Research Centre (CHRC), Lisbon Institute of Global Mental Health. Nova Medical School, Nova University of Lisbon. Rua do Instituto Bacteriológico, n°5, 1150-190, Lisbon, Portugal
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22
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Elser H, Neophytou AM, Tribett E, Galusha D, Modrek S, Noth EM, Meausoone V, Eisen EA, Cantley LF, Cullen MR. Cohort Profile: The American Manufacturing Cohort (AMC) study. Int J Epidemiol 2020; 48:1412-1422j. [PMID: 31220278 DOI: 10.1093/ije/dyz059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Holly Elser
- Division of Epidemiology, UC Berkeley School of Public Health, Berkeley, CA, USA.,Center for Population Health Sciences, Stanford University, Stanford, CA, USA
| | - Andreas M Neophytou
- Division of Environmental Health Sciences, UC Berkeley School of Public Health, Berkeley, CA, USA.,Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, USA
| | - Erika Tribett
- Center for Population Health Sciences, Stanford University, Stanford, CA, USA
| | - Deron Galusha
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Sepideh Modrek
- Department of Economics, San Francisco State University, College of Business, San Francisco, CA, USA
| | - Elizabeth M Noth
- Center for Population Health Sciences, Stanford University, Stanford, CA, USA
| | - Valerie Meausoone
- Center for Population Health Sciences, Stanford University, Stanford, CA, USA
| | - Ellen A Eisen
- Division of Environmental Health Sciences, UC Berkeley School of Public Health, Berkeley, CA, USA
| | - Linda F Cantley
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Mark R Cullen
- Center for Population Health Sciences, Stanford University, Stanford, CA, USA
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23
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Grafova IB, Monheit AC, Kumar R. HOW DO CHANGES IN INCOME, EMPLOYMENT AND HEALTH INSURANCE AFFECT FAMILY MENTAL HEALTH SPENDING? REVIEW OF ECONOMICS OF THE HOUSEHOLD 2020; 18:239-263. [PMID: 32051683 PMCID: PMC7014816 DOI: 10.1007/s11150-018-9436-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Using eight two-year panels from the Medical Expenditure Panel Survey data for the period 2004 to 2012, we examine the effect of economic shocks on mental health spending by families with children. Estimating two-part expenditure models within the correlated random effects framework, we find that employment shocks have a greater impact on mental health spending than do income or health insurance shocks. Our estimates reveal that employment gains are associated with a lower likelihood of family mental health services utilization. By contrast employment losses are positively related to an increase in total family mental health. We do not detect a link between economic shocks and mental health spending on behalf of fathers.
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Affiliation(s)
- Irina B Grafova
- Department of Health Systems and Policy, Rutgers University School of Public Health
| | - Alan C Monheit
- Department of Health Systems and Policy, Rutgers University School of Public Health and National Bureau of Economic Research
| | - Rizie Kumar
- Department of Health Systems and Policy, Rutgers University School of Public Health
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24
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Elser H, Ben-Michael E, Rehkopf D, Modrek S, Eisen EA, Cullen MR. Layoffs and the mental health and safety of remaining workers: a difference-in-differences analysis of the US aluminium industry. J Epidemiol Community Health 2019; 73:1094-1100. [PMID: 31533963 PMCID: PMC10443429 DOI: 10.1136/jech-2018-211774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 05/31/2019] [Accepted: 08/31/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Relatively few studies have examined the effects of layoffs on remaining workers, although the effects of layoffs and downsizing events may extend beyond those employees who lose their jobs. METHODS We examined the effects of layoffs on mental healthcare utilisation and injury risk among workers at 30 US plants between 2003 and 2013. We defined layoffs as reductions in the hourly workforce of 20% or more at each plant. Using a difference-in-differences approach, we compared the change in outcomes during layoffs versus the same 3-month period 1 year previously, accounting for secular trends with control plants. RESULTS Our study population included 15 502 workers and 7 layoff events between 2003 and 2013. Layoffs were associated with only minor decreases in injuries (-0.006, 95% CI -0.013 to 0.001). The probability of outpatient visits related to mental health increased by 1% during layoffs (0.010, 95% CI 0.003 to 0.017), and the probability of mental health-related prescriptions increased by 1.4% (0.014, 95% CI -0.0006 to 0.027). Among women, the increase in outpatient visits was more pronounced (0.017, 95% CI 0.003 to 0.031). Increased prescription utilisation appeared attributable primarily to opioid use (0.016, 95% CI 0.005 to 0.027). CONCLUSION Our results indicate an association between layoffs and remaining workers' mental health and safety, although changes mental healthcare utilisation may reflect both changes in underlying mental health and changes in care-seeking. Future research on concordance of service utilisation and underlying health may yield valuable insight into the experiences employed workers in the wake of layoffs.
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Affiliation(s)
- Holly Elser
- School of Public Health, Division of Epidemiology, University of California Berkeley, Berkeley, California, USA
| | - Eli Ben-Michael
- Department of Statistics, University of California Berkeley, Berkeley, California, USA
| | - David Rehkopf
- Department of Medicine, Stanford University, Stanford, California, USA
| | - Sepideh Modrek
- Department of Economics, San Francisco State University, Health Equity Institute, San Francisco, California, USA
| | - Ellen A Eisen
- Department of Environmental Health Sciences, UC Berkeley School of Public Health, Berkeley, California, USA
| | - Mark R Cullen
- Department of Population Health Sciences, Stanford University School of Medicine, Stanford, California, USA
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25
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Gender, Depression, and Blue-collar Work: A Retrospective Cohort Study of US Aluminum Manufacturers. Epidemiology 2019; 30:435-444. [PMID: 30964814 DOI: 10.1097/ede.0000000000000993] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Industrial blue-collar workers face multiple work-related stressors, but evidence regarding the burden of mental illness among today's blue-collar men and women remains limited. METHODS In this retrospective cohort study, we examined health and employment records for 37,183 blue- and white-collar workers employed by a single US aluminum manufacturer from 2003 to 2013. Using Cox proportional hazards regression, we modeled time to first episode of treated depression by gender and occupational class. Among cases, we modeled rates of depression-related service utilization with generalized gamma regression. RESULTS Compared with their white-collar counterparts, blue-collar men were more likely to be treated for depression (hazard ratio [HR] = 1.3; 95% confidence interval [CI] = 1.1, 1.4) as were blue-collar women (HR = 1.4; 1.2, 1.6). Blue-collar women were most likely to be treated for depression as compared with white-collar men (HR = 3.2; 95% CI = 2.1, 5.0). However, blue-collar workers used depression-related services less frequently than their white-collar counterparts among both men (rate ratio = 0.91; 95% CI = 0.84, 0.98) and women (rate ratio = 0.82; 95% CI = 0.77, 0.88). CONCLUSIONS Blue-collar women were more likely to be treated for depression than white-collar workers, and blue-collar women were most likely to be treated for depression compared with white-collar men. However, blue-collar men and women used depression-related healthcare services less frequently than white-collar workers. These findings underscore that blue-collar women may be uniquely susceptible to depression, and suggest that blue-collar workers may encounter barriers to care-seeking related mental illness other than their insurance status.
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Hamad R, Niedzwiecki MJ. The short-term effects of the earned income tax credit on health care expenditures among US adults. Health Serv Res 2019; 54:1295-1304. [PMID: 31566732 DOI: 10.1111/1475-6773.13204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To test the hypothesis that the earned income tax credit (EITC)-the largest US poverty alleviation program-affects short-term health care expenditures among US adults. DATA SOURCES Adult participants in the 1997-2012 waves of the US Medical Expenditure Panel Survey (MEPS) (N = 1 282 080). STUDY DESIGN We conducted difference-in-differences analyses, comparing health care expenditures among EITC-eligible adults in February (immediately following EITC refund receipt) with expenditures during other months, using non-EITC-eligible individuals to difference out seasonal variation in health care expenditures. Outcomes included total out-of-pocket expenditures as well as spending on specific categories such as outpatient visits and inpatient hospitalizations. We conducted subgroup analyses to examine heterogeneity by insurance status. PRINCIPAL FINDINGS EITC refund receipt was not associated with short-term changes in total expenditures, nor any expenditure subcategories. Results were similar by insurance status and robust to numerous alternative specifications. CONCLUSIONS EITC refunds are not associated with short-term changes in health care expenditures among US adults. This may be because the refund is spent on other expenses, because of income smoothing, or because of similar refund-related variation in health care expenditures among noneligible adults. Future studies should examine whether other types of income supplementation affect health care expenditures, particularly among individuals in poverty.
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Affiliation(s)
- Rita Hamad
- Department of Family & Community Medicine, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
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27
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Abstract
The full scope of the impact of The Great Recession on individuals' mental health has not been quantified to date. This study aimed to determine whether financial, job-related, and housing impacts experienced by individuals during the recession predicted changes in the occurrence of symptoms of depression, generalized anxiety, panic attacks, and problematic alcohol or other substance use. Longitudinal survey data (n = 2,530 to n = 3,293) were analyzed from the national Midlife in the United States (MIDUS) study collected before (2003-2004) and after (2012-2013) The Great Recession. The population-level trend was towards improvements in mental health over time. However, for individuals each recession impact experienced was associated with long-lasting and transdiagnostic declines in mental health. These relationships were stronger for some sociodemographic groups, suggesting the need for additional support for people who suffer marked losses during recessions and for those without a strong safety net.
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Affiliation(s)
- Miriam K Forbes
- Departments of Psychiatry and Psychology, University of Minnesota, USA, 55454 Centre for Emotional Health, Department of Psychology, Macquarie University, Australia, 2109
| | - Robert F Krueger
- Department of Psychology, University of Minnesota-Twin Cities, USA, 55455
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Abstract
BACKGROUND Economic conditions affect surgical volumes, particularly for elective procedures. In this study, the authors aimed to identify the effects of the 2008 U.S. economic downturn on hand surgery volumes to guide surgeons and managers when facing future economic crises. METHODS The authors used the California State Ambulatory Surgery and Services Database from January of 2005 to December of 2011, which includes the entire period of the Great Recession (December of 2007 to June of 2009). The authors abstracted the monthly volume of five common hand procedures using International Classification of Diseases, Ninth Revision, and Current Procedural Terminology codes. Pearson statistics were used to identify the correlation between unemployment rate and surgical volume for each procedure. RESULTS The total number of operative cases was 345,583 during the 7-year study period. Most common elective hand procedures, such as carpal tunnel release and trigger finger release, had a negative correlation with unemployment rate, but the volume of distal radius fracture surgery did not show any correlation. Compared with carpal tunnel release (r = -0.88) or trigger finger release volumes (r = -0.85), thumb arthroplasty/arthrodesis volumes (r = -0.45) showed only a moderate correlation. CONCLUSIONS The economic downturn decreased elective hand procedure surgical volumes. This may be detrimental to small surgical practices that rely on revenue from elective procedures. Taking advantage of the principle that increased volume reduces unit cost may mitigate the lost revenue from these elective procedures. In addition, consolidating hand surgery services at larger, regional centers may reduce the effect of the economic environment on individual hand surgeons.
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Masson T, Barth M. The identification-guilt paradox revisited – Evidence for a curvilinear relationship between group-level self-investment and group-based guilt. SELF AND IDENTITY 2019. [DOI: 10.1080/15298868.2019.1591496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Torsten Masson
- Department of Social Psychology, University of Leipzig, Leipzig, Germany
- Department of Social Work, University of Applied Sciences Bielefeld, Bielefeld, Germany
| | - Markus Barth
- Department of Social Psychology, University of Leipzig, Leipzig, Germany
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30
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Masson T, Barth M. Solving the paradox - (further) evidence for a quadratic relationship between in-group centrality and group-based guilt. BRITISH JOURNAL OF SOCIAL PSYCHOLOGY 2019; 58:917-937. [PMID: 30687930 DOI: 10.1111/bjso.12310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 12/12/2018] [Indexed: 11/28/2022]
Abstract
Previous research on the relationship between strength of in-group identification and collective guilt about an in-group's wrongdoing is mixed, providing evidence for both a negative and a positive relationship. One possible way to reconcile these findings is to explore non-linear (quadratic) functions. Correlational data (Study 1) and experimental data (Study 2) from two questionnaire studies (Ntotal = 311) were in line with a quadratic relationship between self-centrality of the in-group and collective guilt (inverted U-shaped function). Collective guilt about a group's transgression was highest at medium levels of in-group centrality and lower for low and high levels of centrality, respectively. Additionally, defensive in-group beliefs (i.e., beliefs restoring a positive in-group image) were also associated non-linearly with in-group centrality (cubic relation relationship). Our findings call for a more detailed look on possible non-linear relationships between in-group identification and collective guilt or in-group defensiveness.
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Affiliation(s)
- Torsten Masson
- Department of Social Psychology, University of Leipzig, Germany.,Department of Social Work, University of Applied Sciences Bielefeld, Germany
| | - Markus Barth
- Department of Social Psychology, University of Leipzig, Germany
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Vandoros S, Avendano M, Kawachi I. The EU referendum and mental health in the short term: a natural experiment using antidepressant prescriptions in England. J Epidemiol Community Health 2018; 73:168-175. [DOI: 10.1136/jech-2018-210637] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 11/03/2022]
Abstract
BackgroundPrevious research has highlighted the impact of economic conditions and uncertainty on physical and mental health. The unexpected result of the Brexit referendum in 2016 triggered high levels of economic uncertainty.ObjectiveTo examine whether prescriptions for antidepressants increased after the referendum result, benchmarking them against other drug classes.MethodsWe used GP practice prescribing data to compile the number of defined daily doses per capita every month in each of the 326 voting areas in England over the period 2011–2016. We used a difference-in-differences (DID) approach to identify the effects of Brexit on antidepressant prescriptions, compared with trends in a control group (antigout and iron preparations) that were unlikely to be associated with uncertainty and depression.ResultsAntidepressant prescribing continued to increase after the referendum but at a slower pace. Therapeutic classes used as controls showed a decrease. The DID approach shows that there was a relative increase of 13.4% in antidepressants compared with other therapeutic classes (DID coeff: 0.134; 95% CI 0.093 to 0.174).ConclusionOur results are open to different interpretations and should be treated with caution. This relative increase in antidepressant prescribing after the referendum may be attributed to increased uncertainty for certain parts of the population, but does not rule out an improvement in mood for others. Alternatively, some other factor—for example, distraction, might have contributed to a decrease in the control therapeutic classes. A possible policy implication is that programmes for the promotion of mental health may need to be intensified during periods of uncertainty.
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Abstract
AIMS Unmet needs for mental health treatment are large and widespread, and periods of economic crisis may increase the need for care and the treatment gap, with serious consequences for individuals and society. The aim of this systematic review was to summarise the empirical evidence on the association between periods of economic crisis and the use of mental health care. METHODS Following the PRISMA statement, MEDLINE, Embase, Scopus, Open Grey and Cochrane Database were searched for relevant publications, published between 1990 and 2018, from inception to June 2018. Search terms included (1) economic crisis, (2) use of mental health services and (3) mental health problems. Study selection, data extraction and the assessment of study quality were performed in duplicate. RESULTS Seventeen studies from different countries met the inclusion criteria. The results from the included articles suggest that periods of economic crisis might be linked to an increase of general help sought for mental health problems, with conflicting results regarding the changes in the use of specialised psychiatric care. The evidence on the use of mental health care specifically due to suicide behaviour is mixed. The results also suggest that economic crises might be associated with a higher use of prescription drugs and an increase in hospital admissions for mental disorders. CONCLUSIONS Research on the impact of economic crises on the use of mental health care is scarce, and methodologies of the included papers are prone to substantial bias. More empirical and long-term studies on this topic are needed, in order to adapt mental health care systems to the specific needs of the population in times of economic crisis.
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Williams JA, Buxton O, Hinde J, Bray J, Berkman L. Psychosocial Workplace Factors and Healthcare Utilization: A Study of Two Employers. Int J Health Policy Manag 2018; 7:614-622. [PMID: 29996581 PMCID: PMC6037501 DOI: 10.15171/ijhpm.2017.132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 11/05/2017] [Indexed: 01/12/2023] Open
Abstract
Background: While a large literature links psychosocial workplace factors with health and health behaviors, there is very little work connecting psychosocial workplace factors to healthcare utilization.
Methods: Survey data were collected from two different employers using computer-assisted telephone interviewing as a part of the Work-Family Health Network (2008-2013): one in the information technology (IT) service industry and one that is responsible for a network of long-term care (LTC) facilities. Participants were surveyed four times at six month intervals. Responses in each wave were used to predict utilization in the following wave. Four utilization measures were outcomes: having at least one emergency room (ER)/Urgent care, having at least one other healthcare visit, number of ER/urgent care visits, and number of other healthcare visits. Population-averaged models using all four waves controlled for health and other factors associated with utilization.
Results: Having above median job demands was positively related to the odds of at least one healthcare visit, odds ratio [OR] 1.37 (P<.01), and the number of healthcare visits, incidence rate ratio (IRR) 1.36 (P<.05), in the LTC sample. Work-to-family conflict was positively associated with the odds of at least one ER/urgent care visit in the LTC sample, OR 1.15 (P<.05), at least one healthcare visit in the IT sample, OR 1.35 (P<.01), and with more visits in the IT sample, IRR 1.35 (P<.01). Greater schedule control was associated with reductions in the number of ER/urgent care visits, IRR 0.71 (P<.05), in the IT sample.
Conclusion: Controlling for other factors, some psychosocial workplace factors were associated with future healthcare utilization. Additional research is needed.
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Affiliation(s)
- Jessica Allia Williams
- Harvard Center for Population & Development Studies, Cambridge, MA, USA.,The University of Kansas Medical Center, Department of Health Policy and Management, Kansas City, KS, USA
| | - Orfeu Buxton
- Department of Biobehavioral Health, Pennsylvania State University, State College, PA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jesse Hinde
- Department of Public Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,RTI International, Research Triangle Park, NC, USA
| | - Jeremy Bray
- Department of Economics, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Lisa Berkman
- Harvard Center for Population and Development Studies, T.H. Chan Harvard School of Public Health, Cambridge, MA, USA
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Drewelies J, Agrigoroaei S, Lachman ME, Gerstorf D. Age variations in cohort differences in the United States: Older adults report fewer constraints nowadays than those 18 years ago, but mastery beliefs are diminished among younger adults. Dev Psychol 2018; 54:1408-1425. [PMID: 29952599 DOI: 10.1037/dev0000527] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Life Span psychological and life course sociological perspectives have long acknowledged that individual functioning is shaped by historical and sociocultural contexts. Secular increases favoring later-born cohorts are widely documented for fluid cognitive performance and well-being (among older adults). However, little is known about secular trends in other key resources of psychosocial function such as perceptions of control and whether historical changes have occurred in young, middle-aged, and older adults alike. To examine these questions, we compared data from two independent national samples of the Midlife in the United States survey obtained 18 years apart (1995/96 vs. 2013/14) and identified case-matched cohorts (per cohort, n = 2,223, aged = 23-75 years) based on age and gender. We additionally examined the role of economic resources for cohort differences in perceived mastery and constraints. Results revealed that older adults in later-born cohorts reported perceiving fewer constraints than did matched controls 18 years ago, with such positive secular trends being particularly pronounced among women. In contrast, younger adults reported perceiving more constraints in later-born cohorts than those 18 years ago and also reported perceiving lower mastery. We conclude from our national U.S. sample that secular trends generalize to central psychosocial resources across adulthood, such as perceptions of control, but are not unanimously positive. We discuss possible underlying mechanisms and practical implications. (PsycINFO Database Record
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Affiliation(s)
| | - Stefan Agrigoroaei
- Psychological Sciences Research Institute, Université catholique de Louvain
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Severino AL, Shadfar A, Hakimian JK, Crane O, Singh G, Heinzerling K, Walwyn WM. Pain Therapy Guided by Purpose and Perspective in Light of the Opioid Epidemic. Front Psychiatry 2018; 9:119. [PMID: 29740351 PMCID: PMC5925443 DOI: 10.3389/fpsyt.2018.00119] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/21/2018] [Indexed: 12/12/2022] Open
Abstract
Prescription opioid misuse is an ongoing and escalating epidemic. Although these pharmacological agents are highly effective analgesics prescribed for different types of pain, opioids also induce euphoria, leading to increasing diversion and misuse. Opioid use and related mortalities have developed in spite of initial claims that OxyContin, one of the first opioids prescribed in the USA, was not addictive in the presence of pain. These claims allayed the fears of clinicians and contributed to an increase in the number of prescriptions, quantity of drugs manufactured, and the unforeseen diversion of these drugs for non-medical uses. Understanding the history of opioid drug development, the widespread marketing campaign for opioids, the immense financial incentive behind the treatment of pain, and vulnerable socioeconomic and physical demographics for opioid misuse give perspective on the current epidemic as an American-born problem that has expanded to global significance. In light of the current worldwide opioid epidemic, it is imperative that novel opioids are developed to treat pain without inducing the euphoria that fosters physical dependence and addiction. We describe insights from preclinical findings on the properties of opioid drugs that offer insights into improving abuse-deterrent formulations. One finding is that the ability of some agonists to activate one pathway over another, or agonist bias, can predict whether several novel opioid compounds bear promise in treating pain without causing reward among other off-target effects. In addition, we outline how the pharmacokinetic profile of each opioid contributes to their potential for misuse and discuss the emergence of mixed agonists as a promising pipeline of opioid-based analgesics. These insights from preclinical findings can be used to more effectively identify opioids that treat pain without causing physical dependence and subsequent opioid abuse.
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Affiliation(s)
- Amie L. Severino
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
- Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- UCLA Brain Research Institute, Los Angeles, Los Angeles, CA, United States
| | - Arash Shadfar
- Department of Psychiatry, Western University of Health Sciences, Pomona, CA, United States
| | - Joshua K. Hakimian
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
- UCLA Brain Research Institute, Los Angeles, Los Angeles, CA, United States
| | - Oliver Crane
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
- UCLA Brain Research Institute, Los Angeles, Los Angeles, CA, United States
| | - Ganeev Singh
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
- UCLA Brain Research Institute, Los Angeles, Los Angeles, CA, United States
| | - Keith Heinzerling
- Department of Family Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, United States
| | - Wendy M. Walwyn
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
- UCLA Brain Research Institute, Los Angeles, Los Angeles, CA, United States
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Jofre-Bonet M, Serra-Sastre V, Vandoros S. The impact of the Great Recession on health-related risk factors, behaviour and outcomes in England. Soc Sci Med 2018; 197:213-225. [DOI: 10.1016/j.socscimed.2017.12.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 11/29/2017] [Accepted: 12/11/2017] [Indexed: 12/26/2022]
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Hollingsworth A, Ruhm CJ, Simon K. Macroeconomic conditions and opioid abuse. JOURNAL OF HEALTH ECONOMICS 2017; 56:222-233. [PMID: 29128677 DOI: 10.1016/j.jhealeco.2017.07.009] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/31/2017] [Indexed: 05/25/2023]
Abstract
We examine how deaths and emergency department (ED) visits related to use of opioid analgesics (opioids) and other drugs vary with macroeconomic conditions. As the county unemployment rate increases by one percentage point, the opioid death rate per 100,000 rises by 0.19 (3.6%) and the opioid overdose ED visit rate per 100,000 increases by 0.95 (7.0%). Macroeconomic shocks also increase the overall drug death rate, but this increase is driven by rising opioid deaths. Our findings hold when performing a state-level analysis, rather than county-level; are primarily driven by adverse events among whites; and are stable across time periods.
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Affiliation(s)
- Alex Hollingsworth
- School of Public and Environmental Affairs, Indiana University, United States
| | - Christopher J Ruhm
- Public Policy and Economics, Frank Batten School of Leadership and Public Policy, University of Virginia, United States; NBER, United States
| | - Kosali Simon
- School of Public and Environmental Affairs, Indiana University, United States; NBER, United States.
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Fujihara N, Lark ME, Fujihara Y, Chung KC. The effect of economic downturn on the volume of surgical procedures: A systematic review. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.06.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Malard L, Chastang JF, Niedhammer I. Évolution des comportements et indicateurs de santé mentale entre 2006 et 2010 dans la population au travail en France. Rev Epidemiol Sante Publique 2017. [DOI: '10.1016/j.respe.2017.04.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
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Malard L, Chastang JF, Niedhammer I. [Changes in behaviors and indicators of mental health between 2006 and 2010 in the French working population]. Rev Epidemiol Sante Publique 2017; 65:309-320. [PMID: 28601504 DOI: 10.1016/j.respe.2017.04.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 12/02/2016] [Accepted: 04/03/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The 2008 economic crisis may have had an impact on mental health but the studies on this topic are sparse, in particular among the working population. However, mental health at work is a crucial issue involving substantial costs and consequences. The aim of the study was to assess changes in behaviors and indicators of mental health in the French working population between 2006 and 2010, and to explore the differential changes according to age, origin, occupation, activity sector, public/private sector, self-employed/employee status and work contract. METHODS The data came from the prospective national representative Santé et itinéraire professionnel (SIP) survey, including a sample of 5600 French workers interviewed in 2006 and 2010. The behaviors and indicators of mental health studied were excessive alcohol consumption, smoking, sleep problems (sleep disorders and/or insufficient sleep duration), psychotropic drug use (antidepressants, anxiolytics and/or hypnotics), and poor self-reported health. Generalized estimating equations were used to analyze changes in behaviors and indicators of mental health, and the analyses were adjusted for age. Covariates (age, origin, occupation, activity sector, public/private sector, self-employed/employee status and type of contract) were added separately to assess differential changes. RESULTS Increases in excessive alcohol consumption among women, sleep problems among men, and smoking, insufficient sleep duration and poor self-reported health for both genders were observed in the French working population between 2006 and 2010. Some differential changes were observed, negative changes being more likely to affect young workers and workers with a permanent contract. CONCLUSION Prevention policies should consider that behavior and indicators of mental health may deteriorate in times of economic crisis, especially among some sub-groups of the working population, such as young workers and workers with a permanent contract. These changes might foreshadow a forthcoming increase in mental disorders.
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Affiliation(s)
- L Malard
- Inserm, UMR_S 1136, Institut Pierre-Louis d'épidémiologie et de santé publique, Équipe de recherche en épidémiologie sociale, 75013 Paris, France; Institut Pierre-Louis d'épidémiologie et de santé publique, Équipe de recherche en épidémiologie sociale, Sorbonne universités, UPMC université Paris 06, UMR S 1136, 75013 Paris, France; Université de Versailles-Saint-Quentin, 78000 Versailles, France
| | - J-F Chastang
- Inserm, UMR_S 1136, Institut Pierre-Louis d'épidémiologie et de santé publique, Équipe de recherche en épidémiologie sociale, 75013 Paris, France; Institut Pierre-Louis d'épidémiologie et de santé publique, Équipe de recherche en épidémiologie sociale, Sorbonne universités, UPMC université Paris 06, UMR S 1136, 75013 Paris, France
| | - I Niedhammer
- Inserm, UMR_S 1136, Institut Pierre-Louis d'épidémiologie et de santé publique, Équipe de recherche en épidémiologie sociale, 75013 Paris, France; Institut Pierre-Louis d'épidémiologie et de santé publique, Équipe de recherche en épidémiologie sociale, Sorbonne universités, UPMC université Paris 06, UMR S 1136, 75013 Paris, France.
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Burgard SA, Seelye S. Histories of Perceived Job Insecurity and Psychological Distress Among Older U.S. Adults. SOCIETY AND MENTAL HEALTH 2017; 7:21-35. [PMID: 28824825 PMCID: PMC5558894 DOI: 10.1177/2156869316679466] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Changes in the labor market and employment contracts over the past several decades and a recent global recession have increased the salience of perceived job insecurity as a risk factor for poor mental health. We use 25 years of prospective data from the Americans' Changing Lives study to examine long-term histories of perceived job insecurity and their link to psychological distress. We build on the prior literature by using a much longer window of exposure and accounting for involuntary job losses over the lengthy observation period. We find that persistent perceived job insecurity is strongly and significantly associated with greater psychological distress among U.S. workers in the latter part of their careers. Moreover, considering histories of exposure reveals more nuance in the sociodemographic characteristics and employment interruptions that predict persistent or intermittent insecurity and that identify contemporary older workers at particular risk.
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Hamad R, Rehkopf DH, Kuan KY, Cullen MR. Predicting later life health status and mortality using state-level socioeconomic characteristics in early life. SSM Popul Health 2016; 2:269-276. [PMID: 27713921 PMCID: PMC5047283 DOI: 10.1016/j.ssmph.2016.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 04/13/2016] [Accepted: 04/14/2016] [Indexed: 12/26/2022] Open
Abstract
Studies extending across multiple life stages promote an understanding of factors influencing health across the life span. Existing work has largely focused on individual-level rather than area-level early life determinants of health. In this study, we linked multiple data sets to examine whether early life state-level characteristics were predictive of health and mortality decades later. The sample included 143,755 U.S. employees, for whom work life claims and administrative data were linked with early life state-of-residence and mortality. We first created a "state health risk score" (SHRS) and "state mortality risk score" (SMRS) by modeling state-level contextual characteristics with health status and mortality in a randomly selected 30% of the sample (the "training set"). We then examined the association of these scores with objective health status and mortality in later life in the remaining 70% of the sample (the "test set") using multivariate linear and Cox regressions, respectively. The association between the SHRS and adult health status was β=0.14 (95%CI: 0.084, 0.20), while the hazard ratio for the SMRS was 0.96 (95%CI: 0.93, 1.00). The association between the SHRS and health was not statistically significant in older age groups at a p-level of 0.05, and there was a statistically significantly different association for health status among movers compared to stayers. This study uses a life course perspective and supports the idea of "sensitive periods" in early life that have enduring impacts on health. It adds to the literature examining populations in the U.S. where large linked data sets are infrequently available.
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Affiliation(s)
- Rita Hamad
- Stanford University, Department of Medicine, 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - David H. Rehkopf
- Stanford University, Department of Medicine, 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - Kai Y. Kuan
- Stanford University, Department of Statistics, 390 Serra Mall, Stanford, CA 94305, USA
| | - Mark R. Cullen
- Stanford University, Department of Medicine, 1070 Arastradero Road, Palo Alto, CA 94304, USA
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Hamad R, Modrek S, Cullen MR. The Effects of Job Insecurity on Health Care Utilization: Findings from a Panel of U.S. Workers. Health Serv Res 2016; 51:1052-73. [PMID: 26416343 PMCID: PMC4874827 DOI: 10.1111/1475-6773.12393] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the impacts of job insecurity during the recession of 2007-2009 on health care utilization among a panel of U.S. employees. DATA SOURCES/STUDY SETTING Linked administrative and claims datasets on a panel of continuously employed, continuously insured individuals at a large multisite manufacturing firm that experienced widespread layoffs (N = 9,486). STUDY DESIGN We employed segmented regressions to examine temporal discontinuities in utilization during 2006-2012. To assess the effects of job insecurity, we compared individuals at high- and low-layoff plants. Because the dataset includes multiple observations for each individual, we included individual-level fixed effects. PRINCIPAL FINDINGS We found discontinuous increases in outpatient (3.5 visits/month/10,000 individuals, p = .002) and emergency (0.4 visits/month/10,000 individuals, p = .05) utilization in the panel of all employees. Compared with individuals at low-layoff plants, individuals at high-layoff plants decreased outpatient utilization (-4.0 visits/month/10,000 individuals, p = .008), suggesting foregone preventive care, with a marginally significant increase in emergency utilization (0.4 visits/month/10,000 individuals, p = .08). CONCLUSIONS These results suggest changes in health care utilization and potentially adverse impacts on employee health in response to job insecurity during the latest recession. This study contributes to our understanding of the impacts of economic crises on the health of the U.S. working population.
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Affiliation(s)
- Rita Hamad
- Division of General Medical DisciplinesDepartment of MedicineStanford UniversityPalo AltoCA
| | - Sepideh Modrek
- Division of General Medical DisciplinesDepartment of MedicineStanford UniversityPalo AltoCA
| | - Mark R. Cullen
- Division of General Medical DisciplinesDepartment of MedicineStanford UniversityStanfordCA
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Karanikolos M, Heino P, McKee M, Stuckler D, Legido-Quigley H. Effects of the Global Financial Crisis on Health in High-Income Oecd Countries. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2016; 46:208-40. [DOI: 10.1177/0020731416637160] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A growing body of evidence documents how economic crises impact aspects of health across countries and over time. We performed a systematic narrative review of the health effects of the latest economic crisis based on studies of high-income countries. Papers published between January 2009 and July 2015 were selected based on review of titles and abstracts, followed by a full text review conducted by two independent reviewers. Ultimately, 122 studies were selected and their findings summarized. The review finds that the 2008 financial crisis had negative effects on mental health, including suicide, and to a varying extent on some non-communicable and communicable diseases and access to care. Although unhealthy behaviors such as hazardous drinking and tobacco use appeared to decline during the crisis, there have been increases in some groups, typically those already at greatest risk. The health impact was greatest in countries that suffered the largest economic impact of the crisis or prolonged austerity. The Great Recessions in high-income countries have had mixed impacts on health. They tend to be worse when economic impacts are more severe, prolonged austerity measures are implemented, and there are pre-existing problems of substance use among vulnerable groups.
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Affiliation(s)
- Marina Karanikolos
- Europe an Observatory on Health Systems and Policies, London, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pia Heino
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- University of Helsinki, Helsinki, Finland
| | - Martin McKee
- Europe an Observatory on Health Systems and Policies, London, United Kingdom
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Stuckler
- Department of Sociology, University of Oxford, Oxford, United Kingdom
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- London School of Hygiene and Tropical Medicine, London, UK
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Margerison-Zilko C, Goldman-Mellor S, Falconi A, Downing J. Health Impacts of the Great Recession: A Critical Review. CURR EPIDEMIOL REP 2016; 3:81-91. [PMID: 27239427 DOI: 10.1007/s40471-016-0068-6] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The severity, sudden onset, and multipronged nature of the Great Recession (2007-2009) provided a unique opportunity to examine the health impacts of macroeconomic downturn. We comprehensively review empirical literature examining the relationship between the Recession and mental and physical health outcomes in developed nations. Overall, studies reported detrimental impacts of the Recession on health, particularly mental health. Macro- and individual-level employment- and housing-related sequelae of the Recession were associated with declining fertility and self-rated health, and increasing morbidity, psychological distress, and suicide, although traffic fatalities and population-level alcohol consumption declined. Health impacts were stronger among men and racial/ethnic minorities. Importantly, strong social safety nets in some European countries appear to have buffered those populations from negative health effects. This literature, however, still faces multiple methodological challenges, and more time may be needed to observe the Recession's full health impact. We conclude with suggestions for future work in this field.
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Affiliation(s)
- Claire Margerison-Zilko
- Department of Epidemiology and Biostatistics, Michigan State University, 909 Fee Rd., Rm 601, East Lansing, MI 48824, Ph: 517-353-8623
| | - Sidra Goldman-Mellor
- Department of Public Health, University of California, Merced, 5200 N. Lake Rd., Merced, CA 95342, Ph: (209) 228-2498
| | - April Falconi
- General Internal Medicine, Stanford University, Palo Alto, CA 94305, Ph: (703) 328-4851
| | - Janelle Downing
- School of Public Health, University of California, Berkeley, 545 University Hall, University of California, Berkeley, CA 94720-7360, Ph: (510) 643-8571
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Navarro-Mateu F, Tormo MJ, Salmerón D, Vilagut G, Navarro C, Ruíz-Merino G, Escámez T, Júdez J, Martínez S, Kessler RC, Alonso J. Prevalence of Mental Disorders in the South-East of Spain, One of the European Regions Most Affected by the Economic Crisis: The Cross-Sectional PEGASUS-Murcia Project. PLoS One 2015; 10:e0137293. [PMID: 26394150 PMCID: PMC4578930 DOI: 10.1371/journal.pone.0137293] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/16/2015] [Indexed: 11/19/2022] Open
Abstract
Background To describe the lifetime and 12-month prevalence, severity and age of onset distribution of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) disorders and to explore the association between socio-demographic variables and economic stressors with mental disorders during the economic crisis in the general population of Murcia (Spain). Methods and Findings The PEGASUS-Murcia Project is a cross-sectional face-to-face interview survey of a representative sample of non-institutionalized adults in Murcia administered between June 2010 and May 2012. DSM-IV disorders were assessed by the Composite International Diagnostic Interview (CIDI 3.0). Main outcome measures were lifetime and 12-month prevalence of Anxiety, Mood, Impulse and Substance Disorders, Severity and Age of Onset. Sociodemographic variables and stressful economic life events during the preceding 12 months were entered as independent variables in a logistic regression analysis. A total of 2,621 participants (67.4% response rate) were interviewed, 54.5% female, mean age 48.6 years. Twelve-month prevalence (95%CI) of disorders: anxiety 9.7% (7.6–12.2), mood 6.6% (5.5–8.1), impulse 0.3% (0.1–1.2) and substance use 1.0% (0.4–2.4) disorders. Lifetime prevalence: anxiety 15.0% (12.3–18.1), mood 15.6% (13.5–18.1), impulse 2.4% (1.4–4.0) and substance use 8.3% (6.2–11.0) disorders. Severity among 12-month cases: serious 29.2% (20.8–39.4), moderate 35.6% (24.0–49.1) and mild severity 35.2% (29.5–41.5). Women were 3.7 and 2.5 times more likely than men to suffer 12-month anxiety and mood disorders, respectively. Substance use was more frequent among men. Younger age and lower income were associated with higher prevalence. Respondents exposed to multiple and recent economic stressors had the highest risk of anxiety disorders. Conclusions Mental disorders in the adult population of Murcia during the economic crisis were more prevalent and serious than those in previous estimates for Spain. Prevalence was strongly associated with exposure to stressors related to the economic crisis.
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Affiliation(s)
- Fernando Navarro-Mateu
- Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM), Servicio Murciano de Salud. Departamento de Psicología Básica y Metodología, Universidad de Murcia, Murcia, Spain
- IMIB-Arrixaca, Murcia, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Murcia, Spain
- * E-mail:
| | - Mª José Tormo
- IMIB-Arrixaca, Murcia, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Murcia, Spain
- Departamento de Ciencias Sociosanitarias, Universidad de Murcia, Murcia, Spain
| | - Diego Salmerón
- IMIB-Arrixaca, Murcia, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Murcia, Spain
- Servicio de Epidemiología, Consejería de Sanidad y Política Social, Murcia, Spain
- Departamento de Ciencias Sociosanitarias, Universidad de Murcia, Murcia, Spain
| | - Gemma Vilagut
- CIBER de Epidemiología y Salud Pública (CIBERESP), Murcia, Spain
- IMIM-Institut Hospital del Mar d´Investigacions Médiques, Barcelona, Spain
| | - Carmen Navarro
- IMIB-Arrixaca, Murcia, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Murcia, Spain
- Servicio de Epidemiología, Consejería de Sanidad y Política Social, Murcia, Spain
- Departamento de Ciencias Sociosanitarias, Universidad de Murcia, Murcia, Spain
| | - Guadalupe Ruíz-Merino
- IMIB-Arrixaca, Murcia, Spain
- Fundación para la Formación e Investigación Sanitarias (FFIS) de la Región de Murcia, Murcia, Spain
| | - Teresa Escámez
- IMIB-Arrixaca, Murcia, Spain
- Fundación para la Formación e Investigación Sanitarias (FFIS) de la Región de Murcia, Murcia, Spain
- IMIB BIOBANC-MUR, Biobanco-HUVA-AECC-FFIS, Murcia, Spain
| | - Javier Júdez
- Sociedad Española de Patología Digestiva, Fundación Española del Aparato Digestivo, Madrid, Spain
| | | | - Ron C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jordi Alonso
- CIBER de Epidemiología y Salud Pública (CIBERESP), Murcia, Spain
- IMIM-Institut Hospital del Mar d´Investigacions Médiques, Barcelona, Spain
- Departamento de Salud y Ciencias Experimentales, Universidad Pompeu Fabra, Barcelona, Spain
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Malard L, Chastang JF, Niedhammer I. Changes in major depressive and generalized anxiety disorders in the national French working population between 2006 and 2010. J Affect Disord 2015; 178:52-9. [PMID: 25795536 DOI: 10.1016/j.jad.2015.02.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/18/2015] [Accepted: 02/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND This study aimed at assessing the changes in mental disorders in the French working population between 2006 and 2010, using nationally representative prospective data and a structured diagnostic interview for major depressive episode (MDE) and generalized anxiety disorder (GAD), and also at exploring the differential changes in mental disorders according to age, origin, occupation, public/private sector, self-employed/employee status and work contract. METHODS The data came from the prospective national representative Santé et Itinéraire Professionnel (SIP) survey, including a sample of 5600 French workers interviewed in 2006 and 2010. The Mini International Neuropsychiatric Interview (MINI) was used to measure MDE and GAD. Analyses were performed using weighted generalized estimation equations, and were stratified by gender. RESULTS No changes in MDE and GAD were observed for both genders among the working population. No differential changes were observed, except one: the prevalence of GAD increased among women working in the public sector while there was no change among women in the private sector. LIMITATIONS Two data collections over a 4-year period may not capture the effects of the crisis on mental disorders properly. CONCLUSION No changes in mental disorders between 2006 and 2010 were found but the increase in the prevalence of anxiety among women in the public sector may be of particular interest for prevention policies. High levels of social protection in France might contribute to explain these non-significant results.
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Affiliation(s)
- Lucile Malard
- INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, F-75013, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, F-75013, Paris, France; Université de Versailles St-Quentin, France
| | - Jean-François Chastang
- INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, F-75013, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, F-75013, Paris, France
| | - Isabelle Niedhammer
- INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, F-75013, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, F-75013, Paris, France.
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Hamad R, Modrek S, Kubo J, Goldstein BA, Cullen MR. Using "big data" to capture overall health status: properties and predictive value of a claims-based health risk score. PLoS One 2015; 10:e0126054. [PMID: 25951622 PMCID: PMC4423900 DOI: 10.1371/journal.pone.0126054] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 03/28/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Investigators across many fields often struggle with how best to capture an individual's overall health status, with options including both subjective and objective measures. With the increasing availability of "big data," researchers can now take advantage of novel metrics of health status. These predictive algorithms were initially developed to forecast and manage expenditures, yet they represent an underutilized tool that could contribute significantly to health research. In this paper, we describe the properties and possible applications of one such "health risk score," the DxCG Intelligence tool. METHODS We link claims and administrative datasets on a cohort of U.S. workers during the period 1996-2011 (N = 14,161). We examine the risk score's association with incident diagnoses of five disease conditions, and we link employee data with the National Death Index to characterize its relationship with mortality. We review prior studies documenting the risk score's association with other health and non-health outcomes, including healthcare utilization, early retirement, and occupational injury. RESULTS AND CONCLUSIONS We find that the risk score is associated with outcomes across a variety of health and non-health domains. These examples demonstrate the broad applicability of this tool in multiple fields of research and illustrate its utility as a measure of overall health status for epidemiologists and other health researchers.
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Affiliation(s)
- Rita Hamad
- General Medical Disciplines, Stanford University, Palo Alto, California, United States of America
| | - Sepideh Modrek
- General Medical Disciplines, Stanford University, Palo Alto, California, United States of America
| | - Jessica Kubo
- Quantitative Sciences Unit, Stanford University, Palo Alto, California, United States of America
| | - Benjamin A. Goldstein
- Quantitative Sciences Unit, Stanford University, Palo Alto, California, United States of America
| | - Mark R. Cullen
- General Medical Disciplines, Stanford University, Palo Alto, California, United States of America
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