People living in disadvantaged areas faced greater challenges in staying active and using recreational facilities during the COVID-19 pandemic

This study aimed to understand the perceived effects of the COVID-19 pandemic on physical activity, recreation walking, and use of recreational facilities; and if the COVID-19 pandemic amplified disparities in physical activity, recreational walking, and use of recreational facilities related to the levels of neighborhood disadvantage. Recreational walking and the use of neighborhood streets and green spaces significantly decreased in high deprivation areas but not in low deprivation areas during the pandemic. While COVID-19 has negatively affected overall recreational activities, the inequitable impact on recreational walking and use of outdoor recreational facilities has been more evident in disadvantaged neighborhoods with greater deprivation.     

Childhood socio‐economic disadvantage predicts reduced myelin growth across adolescence and young adulthood

Socio‐economic disadvantage increases exposure to life stressors. Animal research suggests early life stressors impact later neurodevelopment, including myelin developmental growth. To determine how early life disadvantage may affect myelin growth in adolescence and young adulthood, we analysed data from an accelerated longitudinal neuroimaging study measuring magnetisation transfer (MT), a myelin‐sensitive marker, in 288 participants (149 female) between 14 and 25 years of age at baseline. We found that early life economic disadvantage before age 12, measured by a neighbourhood poverty index, was associated with slower myelin growth. This association was observed for magnetization transfer in cortical, subcortical and core white matter regions, and also in key subcortical nuclei. Participant IQ at baseline, alcohol use, body mass index, parental occupation and self‐reported parenting quality did not account for these effects, but parental education did so partially. Specifically, positive parenting moderated the effect of socio‐economic disadvantage in a protective manner. Thus, early socioeconomic disadvantage appears to alter myelin growth across adolescence. This finding has potential translational implications, including clarifying whether reducing socio‐economic disadvantage during childhood, and increasing parental education and positive parenting, promote normal trajectories of brain development in economically disadvantaged contexts.     

Neighborhood Disadvantage and Self-Esteem—Do Socioeconomic and Relational Resources Matter?

Extensive research suggests that living in a socioeconomically disadvantaged neighborhood is associated with poor mental health. Few studies, however, have examined (1) whether neighborhood disadvantage is associated with residents’ self-esteem; and (2) the extent to which individual-level socioeconomic resources such as income and education, and relational resources such as marriage and social support moderate the association between neighborhood disadvantage and self-esteem. This study employs data from the Americans’ Changing Lives panel survey (hereafter ACL), a 15-year panel study of the U.S. adult population ages 25 and older in original sample. Because hierarchical linear model was employed to analyze data, findings provide fixed effect coefficients for independent variables at both the individual and census tract levels while controlling for random intercepts between census tracts. Findings based on data from the 4th wave of ACL reveal that neighborhood disadvantage is not associated with self-esteem. We do, however, find that living in a disadvantaged neighborhood worsens self-esteem for those who have lower levels of informal social support and are currently unmarried. These findings imply that while neighborhood disadvantage does not necessarily impact self-esteem, neighborhood disadvantage is detrimental to the self-esteem of those who report lower level of relational resources.     

Sleep trajectories and mediators of poor sleep: findings from the longitudinal analysis of 41,094 participants of the UK Biobank cohort

Study objectivesTo explore sleep trajectories and identify the risk factors and mediators of poor sleep in middle-aged adults.MethodsGroup-based multi-trajectory modelling was applied to the three waves of sleep data the from UK Biobank cohort to identify latent trajectories of sleep and group characteristics. Self-reported sleep duration, sleep problems (based on insomnia symptoms, snoring and trouble waking up) and daytime sleepiness (based on daytime tiredness and sleepiness) were included in the trajectory analyses. Multinomial logistic regression and mediation analysis were used to identify the main factors associated with poor sleep.ResultsAnalysis of sleep data from 41,094 participants (51.9% females) with a median age of 57 years (interquartile range 50–62 years) identified three distinct trajectories of sleep: healthy sleepers (40.8%); borderline poor sleepers (31.6%); and poor sleepers (27.6%). Socio-economic disadvantage, ethnic minority background, shift work, unhealthy lifestyle, poor health, depressive symptoms and obesity were the main risk factors associated with poor sleep. Around a third of the total effect of socio-economic deprivation on poor sleep was mediated through depressive symptoms.ConclusionsThe distinct groups with differential risk for developing sleep issues and stable sleep trajectories highlight the non-transient nature of sleep issues. Early management of depressive symptoms can help in reducing the future burden of poor sleep. Due to the increased risk of poor sleep, people from socio-economically deprived groups, particularly females from ethnic minorities, should be the highest priority for interventions aiming to improve population sleep health.     

The indelible weight of place: Childhood neighborhood disadvantage,timing of exposure,and obesity across adulthood

I use 28 (1986–2014) years of restricted geocoded NLSY tract-level data and find positive associations between exposure to childhood neighborhood disadvantage and adult obesity and BMI among individuals growing up and entering adulthood during the rise of obesity in the United States. Sibling fixed effects and cousin fixed effects models partially address unobserved confounding nested in the nuclear as well as extended family. Furthermore, exposure to neighborhood disadvantage in adolescence is most salient, providing insight into when policy intervention may be most effective. Results are robust to alternative specifications for neighborhood disadvantage, ages of exposure, and to alternative sampling strategies.     

Le concept d’injustice épistémique en psychiatrie : quels apports,de la clinique à la classification des troubles mentaux ?

ObjectivesThe concept of epistemic injustice was developed in 2007 by Miranda Fricker. It designates a specific category of prejudices, where the subject's capacity to produce knowledge is denied or undermined. Several authors have applied this concept to the field of health and argue that people with a medical condition are more vulnerable to epistemic injustices than healthy people. In psychiatry, some authors believe that patients are even more vulnerable to such injustices in clinical practice than patients of other specialties. Some others identify certain forms of epistemic injustice in the classifications of mental disorders, and postulate that it could lead to epistemic losses in classifications, diagnoses and care. In France, this concept is relatively unexplored in psychiatry. The aim of this paper is to identify and summarize the potential contributions of the concept in psychiatry, from the clinical practices to the definition of mental disorders.Materials and methodsFirst, we will define the main types of epistemic injustice described by Fricker. We will then see how these injustices can occur in the field of health. Finally, we will study why patients with a mental disorder are particularly affected by these injustices, the potential impact on psychiatric nosography and the ways to address these epistemic injustices.ResultsThere are two types of epistemic injustice. In testimonial injustices, a person's speech is unwittingly considered to be of little or no credibility by his interlocutor, because of negative prejudices against him or his community. Hermeneutic injustice occurs when a person fails to convey their experience, due to a lack of hermeneutical resources to interpret and communicate it. In healthcare, the credibility of the patient's testimony can be diminished by several factors and general prejudices. Additionally, there is a lack of interpretive resources to understand and share many aspects of the experience of illness. In addition to this, the epistemic privilege accorded to healthcare professionals, particularly physicians, leads to accentuating the epistemic imbalance. The type of doctor-patient relationship, and its evolution, also impact the respective epistemic positions. In psychiatry, patients are seen as more vulnerable to epistemic injustices. Crichton thus identifies three common factors to all mental disorders, including a general prejudice of irrationality and unreliability. In addition, each pathology has specific factors exposing patients to a weakening of their epistemic capacity. To correct these injustices, several tools have been proposed, such as including the study of epistemic injustice in physician's training or using a phenomenological toolbox. Anke Bueter also suggested the existence of a specific form of testimonial injustice in psychiatric classifications, known as “pre-emptive”, which excludes the possibility for ill people and their relatives to testify. However, taking these testimonies into account could act as a corrective mean in the construction of nosography. This nosography is indeed based, in psychiatry, on value judgments, due to the lack of objective data. Several authors, including Bueter, therefore call for a better integration of users in the revisions of classifications, to improve their validity. This could have implications for the clinic, research and its funding, and other issues such as stigmatization. However, how exactly the users’ point of view could be integrated still needs to be defined. Several proposals have been found in the literature.ConclusionWe consider that the concept of epistemic injustice is a useful tool towards a better articulation between experiential and medical knowledges. In clinical practice, if the clinician is trained in this concept, he will be able to identify situations at risk of epistemic injustice, attempt to neutralize this imbalance and thus carry out a more exhaustive clinical examination and more appropriate care for the patient. Regarding nosography, strengthening the epistemic position of users and integrating their knowledge could improve the validity of classifications. The question of the validity of psychiatric nosography is a problem that the scientific community has faced for a long time, and it therefore seems interesting to continue this reflection through the concept of Fricker. In both cases, it is necessary to continue developing tools to better define, analyze and integrate this experiential knowledge.     

An analysis of the first implementation and impact of the World Health Organisation’s health promoting school model within disadvantaged city schools in Ireland

While knowledge about the World Health Organisation’s (WHO) healthy schools model has been developed in recent years, process implementation and outcomes for school children have not improved in line with these advances. This deficit has become known as the ‘implementation gap’ and refers to the difference between the evidence of what works in theory and what is delivered in practice. The aim of this research was to evaluate the first implementation and impact of the WHO model among urban disadvantaged school children in Ireland from 2008 to 2012. A concurrent mixed methods study design was used. A process evaluation-mapped implementation and a three-year cohort study measured the impact. Data comprised of semi-structured interviews, focus groups and documentary analysis. Instruments included the Kidscreen-27 and the Child Depression Inventory (CDI). Over 600 children in five intervention and two comparison schools were recruited. The process evaluation revealed that top-down decision making based on the communities rather than each individual school’s needs and a lack of understanding of the concept of the whole school approach inhibited implementation. No significant differences were found between intervention and comparison of schools over three years post implementation. The successful implementation within an urban disadvantaged region requires not an analysis of the regional needs but a development of the individual school needs and sufficient lead-in time to ensure that each school is ready in terms of its understanding. Furthermore, healthy schools coordinators roles need to be clarified as facilitators of development and change rather than as unsustainable providers of health activities.