A multilevel analysis of the effects of neighbourhood income inequality on individual self-rated health in Hong Kong

We examined the effect on self-rated health of neighbourhood-level income inequality in Hong Kong, which has a high and growing Gini coefficient. Data were derived from two population household surveys in 2002 and 2005 of 25,623 and 24,610 non-institutional residents aged 15 or over. We estimated neighbourhood-level Gini coefficients in each of 287 Government Planning Department Tertiary Planning Units. We used multilevel regression analysis to assess the association of neighbourhood income inequality with individual self-perceived health status. After adjustment for both individual- and household-level predictors, there was no association between neighbourhood income inequality, median household income or household-level income and self-rated health. We tested for but did not find any statistical interaction between these three income-related exposures. These findings suggest that neighbourhood income inequality is not an important predictor of individual health status in Hong Kong.     

Income inequality and mortality in Italy

BACKGROUND: The relationship between income inequality and health remains controversial in terms of whether or not it exists and, if so, its extent and the mechanisms involved. This study examines the relationship between income inequality, as indicated by the Gini coefficient, and mortality in Italy. METHODS: Cross-sectional ecological study on the 57,138,489 inhabitants living in the 95 provinces existing in Italy in 1994. Multivariate weighted regression analysis of total and age-specific mortality, income inequality, gender, and interaction between income inequality and median income or geographical area. RESULTS: A positive association between income inequality and total mortality was observed for both genders in provinces with a low per capita income and in Southern and Central Italy. The effect was present for infants and for persons over 24 years of age; it was marked for the elderly, particularly women. A negative association with mortality was observed for males living in the North-west. Interactions between income inequality and median income, and between income inequality and geographical area were found. CONCLUSION: In Italy, the relationship between income inequality and health is mixed and not universal, in so far as a positive association was observed only in provinces with lower absolute income. Elderly persons living in Southern Italy represent the population subgroup most vulnerable to unequal income distribution. Income inequality can, in part, explain the historically higher mortality among women in Southern Italy compared to women in the North. These results indicate that income inequality affects the health of population subgroups differentially.     

Income, inequality and mortality in 14 developed countries

The tendency for more egalitarian societies to have lower mortality rates has been identified in international data and subsequently confirmed in analyses of areas within countries, particularly within the USA. However, recent reports using data on OECD countries from the Luxembourg Income Study (LIS) suggest this relation no longer exists. We investigated whether the shift in relative poverty from elderly people (with high death rates) to young families (low death rates) may have affected the associations. Using age- and sex-specific mortality among 14 OECD countries in relation to income inequality, median income and absolute and relative poverty, we found that wider income distribution is related to higher premature mortality, and higher age-specific mortality rates below, but not above, age 65 years. Absolute income levels showed no consistent relation to mortality. The changing age distribution of relative poverty may have affected the way income inequality impacts on mortality measured across all ages.     

Influences of income and employment on psychological distress and depression treatment in Japanese adults

Objectives  

Psychological distress is a health issue of critical importance, especially in people of working age in developed countries, including Japan. This study examined the relationships of income and employment arrangement with psychological distress and treatment of depression in a national sample of Japanese adults.     

Income inequality and self-rated health in Stockholm, Sweden: a test of the 'income inequality hypothesis' on two levels of aggregation

The number of studies analysing income inequality and health are voluminous. However, when empirically testing the income inequality hypothesis, the level of aggregation could be crucial for whether we find an association or not and for the mechanisms we believe are active. This study hence investigates: (1) the two-year lagged effect by income inequality on health at two levels of aggregation; municipalities and neighbourhoods in Sweden; (2) whether spending on social goods accounts for the association between income inequality and health; (3) the effect by income inequality among the affluent and the disadvantaged in municipalities and neighbourhoods, respectively. The empirical data is based on a Swedish public health survey in 2002 and includes residents of Stockholm aged 18-84 years. The sample consists of 28,092 individuals nested within 22 municipalities and 709 neighbourhoods in the county of Stockholm with a non-response rate of 37 percent. A total population register (HSIA) is further used for the construction of contextual-level indicators. Primary method used is multi-level logistic regression. The findings indicate a moderate effect by high and very high income inequality on self-rated poor health at the municipality-level. The association, however, ceases after adjustment for spending on social goods. No detrimental effect by income inequality on self-rated health at the neighbourhood-level is found. The results further suggest that poor individuals residing in high inequality neighbourhoods do not have poorer health than those residing in low inequality contexts while high inequality is most deleterious for poor individuals at the municipality-level. In sum, the findings suggest that reduced spending on social goods could account for the association between income inequality and health at the municipality-level. The contrasting findings at the neighbourhood- and municipality-level indicate that it is important to consider the level of aggregation when studying health effects by income inequality.     

Relationship between neighbourhood socioeconomic position and neighbourhood public green space availability: An environmental inequality analysis in a large German city applying generalized linear models

Background

The environmental justice framework states that besides environmental burdens also resources may be social unequally distributed both on the individual and on the neighbourhood level. This ecological study investigated whether neighbourhood socioeconomic position (SEP) was associated with neighbourhood public green space availability in a large German city with more than 1 million inhabitants.

Psychological distress and post-abortion contraceptive method effectiveness level chosen at an urban clinic

Objective

We investigated whether more psychological distress before an abortion is associated with the effectiveness of contraception selected (low, moderate, or high effectiveness) at an abortion clinic visit.

Method

Using data from 253 women attending an urban abortion clinic that primarily serves low-income women, we tested the association between pre-abortion psychological distress and the effectiveness level of post-abortion contraceptive choice. Based on typical use failure rates, we classified effectiveness of contraceptive choice into three levels—low, moderate, and high effectiveness. We measured psychological distress with four validated measures of depressive, anxious, and stress symptoms, and negative affect, as well as with a global measure comprising these four measures. We used multivariable ordinal logistic regression to measure the association of each psychological distress measure with post-abortion contraceptive method effectiveness level, adjusting for sociodemographic factors, pregnancy history, trimester of abortion, and importance of avoiding pregnancy in the next year.

Results

We found that compared to women experiencing less stress symptoms, negative affect and global psychological distress, women experiencing more stress symptoms [AOR=1.028, 95% CI: 1.001–1.050], negative affect [AOR=1.05, 95% CI: 1.01–1.09] and global psychological distress [AOR=1.46, 95% CI: 1.09–1.95] were more likely to choose more effective versus less effective methods, p<.05, in adjusted models. Using dichotomous psychological measures we found similar results.

Conclusions

Women experiencing more psychological distress before an abortion selected more effective contraceptive methods after their abortion. Future research should examine whether this distress is associated with subsequent contraceptive use or continuation.

Implications

The current study suggests that contraceptive providers should not assume that women experiencing more psychological distress prefer to use less effective contraceptive methods.     

The psychological effect of orphanhood in a matured HIV epidemic: An analysis of young people in Mukono,Uganda

As the HIV pandemic progresses, the number of orphans is expected to rise. Uganda is one of the countries that has been most impacted by the pandemic. A few studies have explored the effects of orphanhood on psychological well-being; however, most of these studies have not explored potential pathways through which orphanhood could affect psychological well-being. Using a school-based sample, this study sought to examine the differences in depressive symptoms and hopelessness between orphans and non-orphans in Mukono District, Uganda. The study also explored the potential mediating role of the family environment. The study included 1500 young people from 10 randomly selected schools in Mukono Town Council. Data on school characteristics also were collected from the head teachers or their designees. Linear regression methods were used for multivariate models. We found that orphanhood was associated with psychological ill health among the males. Male double and male maternal orphans had a significantly higher level of hopelessness than their non-orphaned counterparts. Male double orphans also had more depressive symptoms, but this association was mediated by the family environment. No differences were noted between orphaned and non-orphaned females. The cause and timing of parental death was important only among the males, and loss of a parent to HIV was associated with worse psychological outcomes among the males and not the females. Lower parent/guardian connectedness, having a chronically ill adult in the household and ill treatment in residence were associated with a higher level of depression, especially among the males. The data show that the effect of orphanhood on psychological outcomes may vary by gender and type of outcome. This study also suggests an attenuated effect of orphanhood on psychological well-being among school-going youth. Programs seeking to improve psychological well-being among youth must pay attention to the family situations of these youth.     

结核病患者心理困扰现状及其影响因素分析

目的了解西安市结核病患者心理困扰的发生状况及其影响因素,为临床开展患者心理干预研究提供科学依据。方法方便抽取陕西省西安市胸科医院420例结核病患者进行横断面调查;采用单因素分析和多元线性回归法筛选可能影响结核患者心理困扰的因素。结果结核病患者心理困扰得分为(20.33±7.01)分,发生率为72.14%;自尊与心理困扰呈负相关(r=-0.356,P<0.001),消极应对方式和心理困扰程度呈正相关(r=0.338,P<0.001);治疗时间、消极应对和自尊是结核病患者心理困扰的影响因素。结论结核病患者心理困扰发生率较高,应对其加强心理支持和健康指导,对危险因素采取针对性的干预措施。     

Income inequality and physical and mental health: testing associations consistent with proposed causal pathways

OBJECTIVES: To test associations between individual health outcomes and ecological variables proposed in causal models of relations between income inequality and health. DESIGN: Regression analysis of a large, nationally representative dataset, linked to US census and other county and state level sources of data on ecological covariates. The regressions control for individual economic and demographic covariates as well as relevant potential ecological confounders. SETTING: The US population in the year 2000. PARTICIPANTS: 4817 US adults about age 40, representative of the US population. MAIN OUTCOME MEASURES: Two outcomes were studied: self reported general health status, dichotomised as "fair" or "poor" compared with "excellent", "very good", or "good", and depression as measured by a score on the Center for Epidemiologic Studies depression instrument >16. RESULTS: State generosity was significantly associated with a reduced odds of reporting poor general health (OR 0.84, 95%CI: 0.71 to 0.99), and the county unemployment rate with reduced odds of reporting depression (OR 0.91, 95%CI: 0.84 to 0.97). The measure of income inequality is a significant risk factor for reporting poor general health (OR 1.98, CI: 1.08 to 3.62), controlling for all ecological and individual covariates. In stratified models, the index of social capital is associated with reduced odds of reporting poor general health among black people and Hispanics (OR 0.40, CI: 0.18 to 0.90), but not significant among white people. The inequality measure is significantly associated with reporting poor general health among white people (OR 2.60, CI: 1.22 to 5.56) but not black people and Hispanics. CONCLUSIONS: The effect of income inequality on health may work through the influence of invidious social comparisons (particularly among white subjects) and (among black subjects and Latinos) through a reduction in social capital. Researchers may find it fruitful to recognise the cultural specificity of any such effects.     

Green space and serious psychological distress among adults and teens: A population-based study in California

There has been mounting evidence for the beneficial effect of green space on mental health among adults, but studies on the same topics are lacking for teens in the US. This study aimed to fill in this research gap by utilizing data from California Health Interview Survey (CHIS) 2011–2014. A total of 81,102 households (composed of 4538 teens and 81,102 adults) were retained for main analyses. Surrounding greenness was assessed by the Normalized Difference Vegetation Index (NDVI) within varying buffers of home residence. Survey logistic regressions accounted for sampling weights and design were conducted to examine the effects of greenness on serious psychological distress (SPD), adjusted for major socio-demographic factors, neighborhood socioeconomic status (SES) and co-respondent's psychological distress level within the same household. An inter-quartile increment of NDVI in 350 m buffer predicted decreased odds of SPDs by 36% in teens (OR = 0.64, 95% CI = [0.46, 0.91]). Mediation analyses revealed that this association remained almost unchanged even after adjusting for social cohesion. The NDVI-SPD association of adults was found to be significant only in the older group (OR = 0.81, 95% CI = [0.68, 0.95]). This study is one of the first population-based US studies extending the epidemiological evidence for benefits of green space on mental health from adults to teens.     

Resources,stressors and psychological distress among older adults in Chennai,India

Scant information exists on the complex interaction between resources and stressors and their subsequent influence on the psychological distress of older adults in India. Within the framework of resource theory, the present study examined the various pathways through which resources and stressors influence psychological distress by testing four models – the independence model, the stress-suppression model, the counteractive model and the resource-deterioration model. The independence model posits that resources and stressors have a direct relationship with psychological distress. The stress-suppression model hypothesizes that stressors mediate the influence of resources on psychological distress. The counteractive model postulates that stressors mobilize resources, which in turn influence psychological distress. The resource-deterioration model states that stressors deplete resources and subsequently exacerbate distress. In the present study, resources include social support, religiosity and mastery; stressors include life events, abuse and health problems. Psychological distress was measured using the Center for Epidemiological Studies Depression scale and Geriatric Depression Scale. Interviews were conducted among 400 adults aged 65 years and above, randomly selected from the electoral list of urban Chennai, India. The battery of instruments was translated into Tamil (local language) by back-translation. Structural Equation Modeling was conducted to test the three models. The results supported the stress-suppressor model. Resources had an indirect, negative relationship with psychological distress, and stressors had a direct, positive effect on distress. As such there is a need to identify and strengthen the resources available to older adults in India.     

Rural and urban variation in psychological distress among adults: results of the 2014–2015 Eastern Townships Population Health Survey (ETPHS)

ObjectiveA growing number of people live in urban areas. Urbanization has been associated with an increased prevalence of mental disorders, but which mechanisms cause this increase is unknown. Psychological distress is a good indicator of mental health. This study sought to examine the relationship between urbanization and distress among adults in the Eastern Townships (southern region of Quebec, Canada).MethodIn the 2014–2015 Eastern Townships Population Health Survey (N = 10,687 adults living in one of the 96 Eastern Townships communities), distress was measured with the K6 distress scale (≥ 7). Urbanization was estimated by the residential density of the community treated in quintiles. Logistic regression analyses were carried out with adjustments for individual and environmental characteristics.ResultsWomen, young people aged 18–24, single parents, those without diplomas, those without a job, those with < $20,000 in income, adults with two or more chronic physical illnesses, adults with bad perceived health, or those living in disadvantaged neighbourhoods exhibited more distress. The unadjusted estimate between density and distress is only significant for the fifth quintile when compared with the first quintile (OR 1.23; 95% CI: 1.06–1.42). The relationship is practically the same after controlling for individual characteristics but decreases considerably after controlling for environmental characteristics (lack of trees, social deprivation, intersection density, vegetation index, and land use mix).ConclusionThis study was the first to examine an association between urbanization and distress by considering individual and environmental characteristics. The latter seem to explain the relationship between these concepts.     

Neighborhood disorder, sleep quality, and psychological distress: Testing a model of structural amplification

Using data from the 2004 Survey of Texas Adults (n=1504), we examine the association between perceived neighborhood disorder and psychological distress. Building on previous research, we test whether the effect of neighborhood disorder is mediated and moderated by sleep quality. Our specific analytic strategy follows a two-stage theoretical model of structural amplification. In the first stage, perceptions of neighborhood disorder increase psychological distress indirectly by reducing sleep quality. In the second stage, the effect of neighborhood disorder on psychological distress is amplified by poor sleep quality. The results of our analyses are generally consistent with our theoretical model. We find that neighborhood disorder is associated with poorer sleep quality and greater psychological distress. We also observe that the positive association between neighborhood disorder and psychological distress is mediated (partially) and moderated (amplified) by poor sleep quality.     

Determinants, correlates and mediators of psychological distress: A longitudinal study

This study examined determinants and correlates of psychological distress focusing on the roles of psychosocial resources, such as sense of mastery and social support in mediating and/or moderating the effects of life stressors, such as unfavourable socioeconomic conditions (SES), poor physical health and chronic daily stress on individuals' level of distress. Additionally, the above examination was conducted for men and women separately and the results were compared. The study was based on secondary analyses of data collected by Statistics Canada in two cycles of the National Population Health Survey: 2002/2003 and 2004/2005. The sample used included 2535 men and 3200 women between the ages of 25 and 64 years. Further, this research used structural equation techniques to examine pathways among life stressors, psychosocial resources and distress and block regression analysis to examine the moderating roles of mastery and social support. Chronic daily stress was measured in 2004/2005 and two years earlier, in 2002/2003. Main findings included: (1) higher levels of mastery and social support were found to be associated with less depressive symptoms for both men and women, (2) in addition to its significant main effect on distress, mastery moderated the detrimental effects of poor physical health and chronic daily stress on depressive symptoms for both genders, (3) the effects of daily stress, poor physical health and unfavourable SES on level of distress were partially mediated through mastery, (4) next to daily stress, poor physical health had the most impact on level of distress for both genders, albeit a stronger impact for women, (5) mastery played a more important role in the distress process of women compared with men, and (6) while perceived social support decreased the likelihood of distress for men directly, it decreased women's likelihood of distress by increasing their mastery. Symptoms of distress indicate present and/or future need for health care services. Thus, prevention of distress may lead to a reduction in health care costs in addition to the reduction of subjective suffering. Findings emphasize the importance of allocating resources to groups at high risk of developing distress, such as the poor and the physically unhealthy.     

Gender and health care utilization: the role of mental distress and help-seeking propensity

Many studies report higher levels of health care utilization among women. Understanding how gender influences health care utilization is still unresolved. We developed a model that could explain these gender-related differences. The possible pathways assumed by this model that relate gender to utilization, can be summarized as follows: (1) utilization may be influenced by somatic morbidity, mental distress, perceived symptoms, poor subjective health and propensity to use services; (2) women have higher levels of these variables than men (mediating effect); and (3) the direct effects of some of these variables on utililization are moderated by gender, i.e. they are stronger for women than for men (moderating effect). Data were drawn from a community-based sample of adult enrollees of a sickness fund in the Netherlands, who had responded to a mailed health survey (N = 8698). This survey contained questions on somatic morbidity, mental distress and other mediating variables. Health care utilization was measured prospectively, using data extracted from a claims database held by the sickness fund that covers all types of general health services except general practitioner consultations. The model was tested using structural equation modelling. Women reported more somatic morbidity and mental distress than men did, as well as elevated levels of other mediating variables, which might explain-at least partly-gender related differences in utilization. Differences in propensity to use services were not found. The expected moderating effect of gender could not be demonstrated. That is, we did not find gender related differences in the strength of the relations between mental distress, other mediating variables and utilization. Mental distress is related to utilization in a way that is not gender specific, however, because women report higher levels of mental distress (as well as somatic morbidity), this results in a greater utilization of somatic health care services.     

High psychological distress among school-going adolescents in Afghanistan: prevalence and correlates from a national survey

ABSTRACT

The aim of this investigation was to assess the prevalence and correlates of psychological distress among adolescents Afghanistan. Cross-sectional 2014 ‘Global School-based Health Survey (GSHS)’ data included 2579 students that were representative of all students in Grades 7 to 11 in Afghanistan. The prevalence of single psychological distress was 28.4% and multiple psychological distress 27.7%. In adjusted multinomial logistic regression analysis, being female, ever cannabis and/or amphetamine use, bullying victimization and injury were associated with both single and multiple psychological distress. In addition, in unadjusted analysis, the experience of hunger, current tobacco use, secondary smoke, having been attacked, and truancy were positively and attending physical education classes was negatively associated with single and/or multiple psychological distress. High prevalence of psychological distress was observed and several risk factors identified that can facilitate intervention strategies.     

Evaluation of psychological distress using the K6 in patients on chronic hemodialysis

Objective

The aim of this study was to evaluate psychological distress in patients on chronic hemodialysis.

Subjects and methods

A total of 72 patients on chronic hemodialysis were enrolled in this study. We evaluated psychological distress by using the K6 questionnaire, health-related quality of life (HRQOL) by using the EQ-5D questionnaire, and clinical parameters. Among the 72 patients, we also evaluated changes in K6 scores in 58 patients at 1-year follow-up.

Results

The mean K6 score was 3.7 ± 3.7 and 2 subjects (2.8 %) were defined as having psychological distress. K6 scores were significantly correlated with body fat percentage, albumin level, and EQ-5D scores in total subjects. K6 scores were also significantly and negatively correlated with EQ-5D scores in men and women. In the 1-year follow-up group, changes in K6 scores were weakly and negatively correlated with changes in EQ-5D scores.

Conclusion

Psychological distress was closely associated with HRQOL in patients on chronic hemodialysis. Coping strategies for psychological distress might be useful in improving HRQOL in patients on hemodialysis.