How much does self-reported health status, measured by the SF-36, vary between electoral wards with different Jarman and Townsend scores?

BACKGROUND: The best way for practices to determine the health status of patients living in areas with different socioeconomic characteristics is unclear. AIMS: To see how much SF-36 health status varies between electoral wards, how much of this variation can be explained by census-derived Jarman and Townsend scores, and compare the performance of census scores with direct socioeconomic information. METHOD: A postal questionnaire survey of 3000 randomly selected 18 to 75-year-olds residing in 15 electoral wards and registered with two urban practices. RESULTS: The response rate was 73%. Only two of the eight SF-36 domains were significantly associated with Jarman scores, whereas seven domains were associated with the Townsend score. Of the four socioeconomic variables derived directly from the survey, unemployment showed the weakest association, housing tenure was associated with seven domains, and car ownership and low income were associated with all eight. Income explained between 47% to 71% of the variation across the eight domains. CONCLUSION: The most accurate predictions about health status were made from direct socioeconomic information. Nonetheless, the association between Townsend score and health status was strong enough to be of practical importance. This study cautions against assuming the Jarman score of a population has a clear relationship with its health status.     

Neurotic symptoms,stress, or deprivation: which is most closely associated with incidence of suicide? An ecological study of English Health Authorities

BACKGROUND: Suicide rates, anxiety/depression scores and stress scores are routinely used as mental health indicators in populations, but their inter-relationships have not been explored. Our aim was to explore the association of suicide rates with anxiety/depression and stress scores, while also referring to deprivation scores, which are known to be linked to suicide rates. METHODS: We undertook an ecological analysis of English Health Authorities, regressing suicide rates (1993-1994), on General Health Questionnaire and stress scores (1994), and also on Jarman deprivation scores (1991). RESULTS: Overall, Jarman deprivation score was a better predictor of suicide rate than the psychological distress measures. There were no statistically significant associations between suicide rates and GHQ scores, although there was a weak association between suicide rate and mean stress level in women. CONCLUSIONS: Suicide rates, though important in themselves, are not reliable indicators of the levels of neurotic symptoms or stress in populations. Suicide rates are more strongly associated with area-based measures of social disadvantage, though a possible stress-suicide relationship in women could be investigated further.     

Ethnicity moderates the influence of perceived social status on subjective sleep quality

It has long been recognized that socioeconomic status (SES) influences health and health-related behaviors, and it has been suggested that the adverse impact of low SES on health may be partly mediated by poor sleep quality. The relation between sleep and objective and subjective measures of SES has only been explored in a preliminary manner, providing indirect evidence that associations between SES and health might be explained, in part, by disrupted sleep. However, it remains unclear whether low SES directly affects sleep quality or whether the SES-sleep quality relation varies as a function of ethnicity given robust ethnic disparities across SES-related factors. This study examined the relation between perceived social status (i.e., individuals' perception of their socioeconomic standing) and subjective sleep quality among 149 college students, and examined the moderating effect of ethnicity to determine whether the magnitude or direction of association differed among Caucasian, Asian, and African Americans. Using hierarchical regressions and a dummy-coded ethnicity variable, results demonstrated significant moderation (ΔR? = 0.04, p = .02), such that both Asian (p = .04) and African Americans (p = .02) were significantly different from Caucasian Americans. Lower perceived social status was related to greater impairment in sleep quality for Asian Americans (β = -.37, p < .01) and African Americans (β = -.51, p < .01), but not Caucasian Americans (β = -.02, p = .87). These findings provide initial support for the negative impact of low perceived social status on sleep quality for specific subgroups of ethnic minorities.     

The impact of health insurance on an African-American population with colorectal cancer.

This study evaluates the impact of health insurance as a substitute for social class on tumor location, presentation, stage, grade, and age-adjusted survival in an African-American population. Patients were stratified by insurance into two groups: group 1 (private insurance and Medicare parts A & B) and group 2 (Medicaid, Medical Charity, self-pay, uninsured, or unemployed). A total of 212 patients were evaluated. Of these, 210 patients were insured or had Medical Charity, and two were uninsured. The type of health insurance did not significantly affect age-adjusted survival. However, age and stage at presentation were positive predictors of age-adjusted survival. Higher socioeconomic status was associated with group 1 health insurance.     

Childhood family relationships,marital and work conflict,and mental health distress in Mexican immigrants

The present study examined the associations among childhood family relationships, adult conflict in marriage and work relationships, and mental health distress in Mexican immigrants. The sample consisted of 135 married Mexican immigrants recruited from an ESL program in Southern California. Structural equation modeling was used to test theoretical hypotheses. The model revealed that dysfunctional childhood family relationships predicted dissatisfaction and conflict in marital and work relationships. Conflict in marital relationships directly contributed to mental health distress, whereas conflict in work relationships had an indirect effect on mental health by impacting negatively on immigrants' marital relationships. The model also indicated that immigrants' socioeconomic status in Mexico was linked to work relationships conflict in the United States, which, in turn, had a detrimental effect on marital relationships and mental health distress. Furthermore, a significant pathway was found linking recency of migration and immigrants' resident status (legal vs. illegal) to conflict in marital relationships and mental health distress. Finally, social status risk factors significantly predicted mental health distress. Mexican immigrants who were older, of lower status, and female experienced a high level of psychological distress. The findings were discussed in terms of attachment and migration stress theory, and Latino cultural patterns. © 1998 John Wiley & Sons, Inc.     

Effective group training techniques in job-search training

The aim was to examine the effects of group training techniques in job-search training on later reemployment and mental health. The participants were 278 unemployed workers in Finland in 71 job-search training groups. Five group-level dimensions of training were identified. The results of hierarchical linear modeling demonstrated that preparation for setbacks at the group level significantly predicted decreased psychological distress and decreased symptoms of depression at the half-year follow-up. Trainer skills at the group level significantly predicted decreased symptoms of depression and reemployment to stable jobs. Interaction analyses showed that preparation for setbacks at the group level predicted fewer symptoms of psychological distress and depression, and shared perceptions of skilled trainers at the group level predicted fewer symptoms of depression among those who had been at risk for depression.     

Longitudinal Association of Sleep Problems and Distress Tolerance During Adolescence

Abstract

The mechanism by which sleep problems adversely impacts adolescent health is poorly understood. Distress tolerance—a multifactorial trait indicative of one’s ability to withstand negative emotions and persist toward long-term goals—is implicated in numerous emotional psychopathologies and an important target for research and practice. We hypothesized that the adverse psychobiological effects of sleep problems could disrupt the development of distress tolerance during adolescence. This longitudinal study examined whether sleep problems predicted changes in four facets of distress tolerance during adolescence: (1) absorption—feeling attention is captured by negative emotions, (2) appraisal—experiencing distress as unacceptable, (3) regulation—engaging in behaviors to terminate distress, and (4) tolerance—low perceived ability to tolerate distress. High school students (M baseline age?=?15.5?years, N?=?2,309, 56.1% female), completed self-report measures of sleep problems and distress tolerance at baseline and 1-year follow-up. In linear regression models adjusting for baseline distress tolerance, sleep problems predicted poorer distress tolerance at 1-year follow-up for each distress tolerance facet (βs?=?–0.10 to –0.24, ps?≤?0.02). After additionally controlling for sociodemographics and emotional psychopathology, sleep problems were associated with poorer distress tolerance for absorption (β?=?-0.13, p?=?0.004) and appraisal (β?=?–0.09, p?=?0.049) facets, but not regulation or tolerance (ps?≥?0.35) facets. Interventions targeting healthy sleep habits warrant consideration for improving adolescent development of certain facets of distress tolerance, and in turn various positive health outcomes improved by distress tolerance.     

Social support, social pressures and psychological distress during unemployment

A sample of 1150 unemployed 17 year-olds, containing blacks and whites, males and females, was obtained from 11 urban regions in England. Social support was measured in respect of five different forms of help from others. Measures were also obtained of psychological distress, perceived pressure from others to obtain a job, employment commitment, contact with other young people, and contact with other unemployed young people. Two forms of social support (having someone to turn to for help with money, and having someone to suggest interesting things to do) were significantly associated with measures of distress, as were perceived pressure to obtain a job and employment commitment, but not contact with other unemployed young people. The association between distress and having someone to turn to for help with money was greater for those perceiving pressure from others to obtain a job than those not perceiving pressure. Also, the association between distress and having someone to turn to when feeling low was greater for those with a high employment commitment than for those with a low one. Other associations between support and distress were found to be affected by sex and ethnic differences in the sample. The results are discussed in the light of a stress-buffering model of social support; and the need to disaggregate social support into its component parts is emphasized.     

Managing uncertainty and responding to difficult emotions: Cancer patients’ perspectives on clinician response during the COVID-19 pandemic

ObjectivePatients undergoing cancer treatment during the COVID-19 pandemic have experienced stress and uncertainty with respect to disruptions in cancer care and COVID-19 related risks. We examined whether clinicians’ responsiveness to patients’ uncertainty and difficult emotions were associated with better health and well-being.MethodsPatients were recruited from cancer support communities and a market research firm. Respondents assessed clinicians communication that addressed uncertainty and difficult emotions. Health status measures included mental and physical health, coping during the pandemic, and psychological distress.Results317 respondents participated in the study. Patients’ perceptions of their clinicians responsiveness to patient uncertainty and negative emotions were associated with better mental health, physical health, coping, and less psychological distress (all p-values <0.001). Respondents with greater self-efficacy and social support also reported better health.ConclusionEven when controlling for patients’ personal and health-related characteristics, clinicians’ communication addressing patients’ uncertainty and difficult emotions predicted better health, better coping, and less psychological distress. Access to social support and self-efficacy also were associated with better health status.Practice implicationsClinicians’ communication focused on helping with uncertainty and difficult emotions is important to cancer patients, especially during the pandemic. Clinicians should also direct patients to resources for social support and patient empowerment.     

Symptoms of depression in the Estonian population: prevalence, sociodemographic correlates and social adjustment

OBJECTIVE: The current study presents data on the prevalence of depressive symptoms in the Estonian population and examines associated sociodemographic factors and subjective aspects of social adjustment. METHOD: The data came from the Estonian Health Interview Survey where 4711 persons aged 15-79 were interviewed. This study included 4677 respondents who answered the Emotional State Questionnaire (EST-Q), a self-rating scale of depression and anxiety. Data on the sociodemographic factors and domains of social adjustment were derived from structured interviews. RESULTS: Depressive symptoms were observed in 11.1% of the respondents. Depressiveness was more common among women, in older age groups, among those not married, in ethnic groups other than Estonians, in lower income groups, and among the unemployed and economically inactive respondents. Depressive subjects were less satisfied, had a more pessimistic prognosis about the future and lower self-rated health. A low level of perceived control was a significant correlate of depression. The association of depressiveness with poor subjective social adjustment remained significant even after controlling for objective circumstances. LIMITATIONS: Depression was identified by a self-rate questionnaire, therefore results can not be generalized to clinical depression without caution. CONCLUSION: Depressive symptoms in the Estonian population were strongly related to socioeconomic functioning. Results emphasize that subjective social adjustment and perceived control are important characteristics of depression and should be considered in assessment and treatment.     

影响女性失业者心理健康的因素和作用机制

目的考察影响女性失业者心理健康的因素和作用机制。方法采用问卷法对416名唐山市50岁以下的失业女职工进行测量。结果1失业时间长短对不同的应对方式均无显著预测作用,但对心理健康有直接影响;2目前是否已再就业对心理健康无显著预测作用,也不能通过不同的应对方式间接影响心理健康;3社会支持、成熟型应对方式可以显著预测心理健康,而不成熟型和合理化的应对方式对心理健康无显著预测;4不同应对方式在社会支持和心理健康之间起部分中介作用。结论失业时间越长,心理健康状况越好;社会支持越高,成熟型应对方式使用越多,心理健康水平越高;不同应对方式在社会支持和心理健康之间起着重要的中介作用,社会支持越高,越有利于增加成熟型应对方式的使用,减少不成熟型和合理化应对方式的使用,从而更好地保护心理健康,免受应急伤害。     

A path model of chronic stress,the metabolic syndrome,and coronary heart disease

OBJECTIVE: We tested a theoretical stress model cross-sectionally and prospectively that examined whether relationships of chronic stress, psychophysiology, and coronary heart disease (CHD) varied in older adult men (N = 47), older adult women not using hormone replacement therapy (HRT) (N = 64), and older adult women using HRT (N = 41). METHOD: Structural equations examined relationships of CHD with 1) chronic stress (caring for a spouse with Alzheimer's disease and patient functioning), 2) vulnerability (anger and hostility), 3) social resources (supports), 4) psychological distress (burden, sleep problems, and low uplifts), 5) poor health habits (high-caloric, high-fat diet and limited exercise), and 6) the metabolic syndrome (MS) (blood pressure, obesity, insulin, glucose, and lipids). RESULTS: Caregiver men had a greater prevalence of CHD (13/24) than did noncaregiver men (6/23) (p <.05) 27 to 30 months after study entry. This was influenced by pathways from caregiving to distress, distress to the MS, and the MS to CHD. In men, poor health habits predicted the MS 15 to 18 months later, and the MS predicted new CHD cases over 27 to 30 months. In women, no "caregiving-CHD" relationship occurred; however, 15 to 18 months after study entry women not using HRT showed "distress-MS" and "MS-CHD" relationships. In women using HRT, associations did not occur among distress, the MS, and CHD, but poor health habits and the MS were related. CONCLUSIONS: In older men, pathways occurred from chronic stress to distress to the metabolic syndrome, which in turn predicted CHD. Older women not using HRT showed fewer pathways than men; however, over time, distress, the MS, and CHD were related. No psychophysiological pathways occurred in older women using HRT.     

某医学院校学生睡眠质量与压力感知、社会支持及自尊水平

目的对某医学院校学生的睡眠质量与压力感知、社会支持及自尊水平进行调查,并进行相关性分析。方法采用整群抽样方法从某医学院校不同学制的学生中随机抽取278人作为调查对象,采用匹兹堡睡眠质量指数量表(PSQI)、压力感知量表(CPSS)、领悟社会支持量表(PSSS)及自尊量表(SES)进行调查分析。结果 PSQI均分为(4.94±2.46),睡眠障碍发生率为11.2%;43.5%的学生存在健康危险压力;16.5%的学生领悟社会支持较低;低自尊水平者占15.1%。PSQI总分及各成分与CPSS总分存在正相关性;PSQI总分及绝大多数成分与PSSS总分、SES总分之间存在负相关性。结论目前医学生的睡眠质量差、压力大,相当部分学生支持水平和自尊水平不高,压力感知、社会支持及自尊水平影响睡眠,应综合地采取有效措施来改善不良的心身状态。     

Measuring social capital in a known disadvantaged urban community – health policy implications

Background

To assess the social capital profile of a known disadvantaged area a large cross-sectional survey was undertaken. The social capital profile of this area was compared to data from the whole of the state. The overall health status of the disadvantaged area was assessed in relation to a wide variety of social capital related variables. Univariate and multivariate analysis were undertaken.

Results

In the univariate analysis many statistically significant differences were found between the respondents in the disadvantaged area and the state estimates including overall health status, perceived attributes of the neighbourhood, levels of trust, community involvement and social activities. In the multivariate analysis very few variables were found to be statistically significantly associated with poorer health status. The variables that jointly predicted poorer health status in the disadvantaged area were older age, lower income, low sport participation, non-seeking help from neighbours and non-attendance at public meetings.

Conclusion

Measuring social capital on a population level is complex and the use of epidemiologically-based population surveys does not produce overly valuable results. The inter-relational/dependence dichotomy of social capital is not yet fully understood making meaningful measurement in the broader population extremely difficult and hence is of questionable value for policy decision making.

     

Self-criticism and social phobia in the US national comorbidity survey

BACKGROUND: This study sought to extend findings from a preliminary clinical investigation [J. Affect. Disord. 57 (2000) 223] by examining relations between the personality dimension of self-criticism and diagnostic prevalence of social phobia in a large nationally representative sample. METHODS: Participants were from the national comorbidity survey Part II [n=5877; Arch. Gen. Psychiatry 51 (1994) 8]. Psychiatric diagnoses were made using a modified version of the composite international psychiatric interview. Personality dimensions and distress were assessed using brief self-report measures with strong psychometric properties. RESULTS: Self-criticism was elevated in NCS respondents with a diagnosis of social phobia, even in cases of only past history of social phobia (i.e. >1 year ago), compared to individuals with no psychiatric disorder. The highest levels of self-criticism were reported by people with the complex subtype of social phobia, both with and without comorbid major depression. These levels were significantly greater compared to those observed in another anxiety disorder (panic disorder), the pure speaking subtype of social phobia, and cases of major depression alone. In a regression analysis that controlled for current emotional distress, the broad personality trait of neuroticism, and lifetime histories of mood, anxiety, and substance use disorders, self-criticism remained significantly associated with lifetime prevalence of social phobia. LIMITATIONS: The cross-sectional design of the study does not permit causal inferences. CONCLUSIONS: Findings from this general population mental health survey demonstrated that self-criticism is robustly associated with social phobia. It may represent an important core psychological process in the complex subtype of this anxiety disorder.     

Difficulties falling asleep among adolescents: Social inequality and time trends 1991–2018

Sleep problems in adolescence are increasingly common, and associated with adverse health and psychological outcomes. Adolescents’ sleep problems may be related to the family’s socioeconomic status, but studies are few and no study has examined whether social inequality in sleep problems changes as sleep problems become increasingly common. This study examined trends in difficulties falling asleep among adolescents in Denmark, whether this sleep problem was associated with socioeconomic status, and whether this association changed from 1991 to 2018. The study applied data from eight comparable surveys among 11–15 year olds in Denmark 1991–2018, the Danish arm of the international Health Behaviour in School‐aged Children study, N = 30,002. The prevalence of daily difficulties falling asleep increased from 7.0% to 13.4% in 1991–2018 with higher frequencies among girls and younger adolescents. The odds ratio (95% confidence interval) for daily difficulties was 1.14 (1.05–1.24) in middle and 1.52 (1.37–1.69) in low compared with high socioeconomic status. The absolute social inequality in difficulties falling asleep was persistent in 1991–2018 whereas the relative social inequality may have decreased. The increasing prevalence and the social inequality in difficulties falling asleep among adolescents is a serious public health concern that calls for more attention and efforts.     

Subjective Social Status: Construct Validity and Associations with Psychosocial Vulnerability and Self-Rated Health

Background

Subjective social status (SSS) predicts health outcomes independently of traditional, objective indicators of socioeconomic status (SES). However, the potential confounding and mediating effects of negative affect and similar psychosocial risk and resilience factors have not been adequately addressed through formal studies of convergent and discriminant validity of SSS measures.

Purpose

The current study provides such a test of construct validity and subsequently examines whether psychosocial factors mediate the relationship between SSS and self-rated health.

Methods

We examined the convergent and discriminant validity of the MacArthur scales of SSS relative to measures of psychosocial risk and resilience (i.e., neuroticism, depressive symptoms, optimism, and marital quality) as well as SES (i.e., income) in 300 middle-aged and older married US couples. We also tested a factor of psychosocial vulnerability as a mediator of the relationship between SSS and self-rated health.

Results

Findings indicated clear convergent and discriminant validity of the MacArthur scales. Further, controlling age and income, both the US and community measures of SSS predicted psychosocial factors for men, however, only the community measure was independently predictive for women. Psychosocial vulnerability significantly mediated the pathway between SSS and self-rated health for men and women after controlling age and income.

Conclusions

These results provide strong support for the construct validity of the MacArthur scales and provide additional evidence of the role of psychosocial risk and resilience factors as mediators of the effects of SSS on health.     

The COVID-19 anxiety syndrome and selective attentional bias towards COVID-19-related stimuli in UK residents during the 2020–2021 pandemic

The psychological and social effects of the COVID-19 pandemic are pervasive, and there is potential for a long-lasting impact on mental health. In the current study, we sought to provide, in a representative sample of UK residents during the third COVID-19 lockdown in February 2021, further evidence for the validation of the COVID-19 anxiety syndrome construct. We did this by evaluating the COVID-19 anxiety syndrome against measures of personality, health anxiety and COVID-19 anxiety in predicting levels of generalized anxiety and depression and by examining whether increased health anxiety and COVID-19 psychological distress (COVID-19 anxiety and COVID-19 anxiety syndrome) scores were associated with increased attentional bias to COVID-19-related stimuli. A series of correlation analyses revealed that neuroticism, health anxiety, COVID-19 anxiety and COVID-19 anxiety syndrome scores were positively and significantly correlated with generalized anxiety and depression scores and that the perseveration component of the COVID-19 anxiety syndrome predicted generalized anxiety and depression scores independently of age, gender, conscientiousness, openness, health anxiety and COVID-19 anxiety. Furthermore, results indicated that only the total COVID-19 anxiety syndrome score and the scores on the avoidance and perseveration components were positively and significantly correlated with attentional bias indices. More specifically, the general attentional bias index was only shown to be positively and significantly correlated with the total COVID-19 anxiety syndrome score and its perseveration component, while slowed disengagement was only shown to be negatively and significantly correlated with the total COVID-19 anxiety syndrome score and its avoidance component. The implications of these findings are discussed.     

Association between polysomnographic sleep measures and health-related quality of life in obstructive sleep apnea

Many facets of health-related quality of life are diminished in obstructive sleep apnea (OSA) as they are in other chronic medical conditions. We speculated that impairment in health-related quality of life (HRQoL) might result from the fatigue and daytime somnolence associated with the sleep disorder, as an indirect result from the fragmentation of night-time sleep in OSA. Our hypothesis was that sleep fragmentation measures would correlate with poorer HRQoL measured by medical outcomes study (MOS) subscales. Thirty-nine patients with polysomnographically-confirmed OSA participated in this study. Pearson's correlations were performed with the following sleep architecture variables: wake after sleep onset, the total number of brief arousals, the number of respiratory-related arousals, the rate of respiratory events per hour, and total sleep time. To our surprise, although the total number of arousals was associated with health distress (r=-0.481, P < 0.005), it did not correlate with any other subscales indicating poorer physical and mental health. The relatively insensitive measure of total sleep time (TST) correlated in the expected direction with most subscales. However, after controlling for age and gender, respiratory disturbance indices (RDI) and/or number of arousals emerged as significantly associated with mobility, cognitive functioning, social functioning, energy and fatigue, and health distress. Our findings suggest that polysomnographic indicators of sleep quality and sleep continuity may be an important influence determining many aspects of HRQoL in OSA patients.     

Incidence and Predictors of Acute Psychological Distress and Dissociation After Motor Vehicle Collision: A Cross-Sectional Study

Objective: We examined the incidence and predictors of peritraumatic distress and dissociation after one of the most common forms of civilian trauma exposure: motor vehicle collision (MVC). Method: In this study, patients presenting to the emergency department after MVCs who were without serious injury and discharged to home after evaluation (n = 935) completed an emergency department interview evaluating sociodemographic, collision-related, and psychological characteristics. Results: The incidence and predictors of distress (Peritraumatic Distress Inventory score ≥23) and dissociation (Michigan Critical Events Perception Scale score >3) were assessed. Distress was present in 355 of 935 patients (38%), and dissociation was present in 260 of 942 patients (28%). These outcomes showed only moderate correlation (r = .45) and had both shared and distinct predictors. Female gender, anxiety symptoms prior to the MVC, and vehicle damage severity predicted both distress and dissociation. Higher socioeconomic status (higher education, higher income, full-time employment) had a protective effect against distress but not dissociative symptoms. Better physical health and worse overall mental health were associated with increased risk of dissociation but not distress. Distress but not dissociation was associated with lower patient confidence in recovery and a longer expected duration of recovery. Conclusion: There are unique predictors of peritraumatic distress and dissociation. Further work is needed to better understand the neurobiology of peritraumatic distress and dissociation and the influence of these peritraumatic outcomes on persistent psychological sequelae.