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.     

The impact of subjective and objective social status on psychological distress among men and women in Japan

From around 1990s, social disparity issues and their effects on mental health have been gaining increasing attention in Japanese society. Findings from previous studies on socioeconomic status (SES) and mental health in Japan are inconsistent. Subjective Social Status (SSS) has been proposed and tested as a stronger predictor of mental health than measures such as education, income and occupation in the UK and US, but this has not been tested enough in countries with a different social and cultural background such as Japan. In the present study, a cross-sectional questionnaire survey was conducted in 2006 among a nationally representative community-based random sample of residents in Japan aged 20–74 years. A total of 1237 participants completed the questionnaire, with the overall response rate of 61.9%. After excluding 42 respondents, data from 1195 respondents (574 men and 621 women) were analyzed. SSS, household income, and education level of respondents were measured using single-item questions. Those with a K6 score of 5 or greater were defined as having psychological distress. A multiple logistic regression model was used to examine the effects of SSS, household income, and education on psychological distress. Among men, the prevalence of psychological distress, after adjusting for age and marital status, differed significantly across groups classified based on SSS, household income, and education. Among women, only SSS was significantly associated with psychological distress after adjusting for age and marital status. However, when all three variables were simultaneously entered into the model, SSS and household income were significantly associated with psychological distress, with the low SSS group having a higher odds ratio of psychological distress. In summary, SSS seems to be a stronger predictor of psychological distress among both men and women in the Japanese community than traditional measures of SES.     

The social epidemiology of tuberculosis in South Africa: a multilevel analysis

Increased risk of tuberculosis is widely recognized to be associated with increased poverty, yet there have been few analyses of the social determinants of tuberculosis, particularly in high-burden settings. We conducted a multilevel analysis of self-reported tuberculosis disease in a nationally representative sample of South Africans based on the 1998 Demographic and Health Survey (DHS). Individual and household-level demographic, behavioral and socioeconomic risk factors were taken from the DHS; data on community-level socioeconomic status (including measures of absolute wealth and income inequality) were derived from the 1996 national census. Of the 13,043 DHS respondents, 0.5% reported having been diagnosed with tuberculosis disease in the past 12 months and 2.8% reported having been diagnosed with tuberculosis disease in their lifetime. In a multivariate model adjusting for demographic and behavioral risk factors, tuberculosis diagnosis was associated with cigarette smoking, alcohol consumption and low body mass index, as well as a lower level of personal education, unemployment and lower household wealth. In a model including individual- and household-level risk factors, high levels of community income inequality were independently associated with increased prevalence of tuberculosis (adjusted odds ratio for lifetime tuberculosis comparing the most unequal quintile to the middle quintile of inequality: 2.37, 95% confidence interval: 1.59-3.53). These results provide novel insights into the socioeconomic determinants of tuberculosis in developing country settings, although the mechanisms through which income inequality may affect tuberculosis disease require further investigation.     

Social ties and mental health

It is generally agreed that social ties play a beneficial role in the maintenance of psychological well-being. In this targeted review, we highlight four sets of insights that emerge from the literature on social ties and mental health outcomes (defined as stress reactions, psychological well-being, and psychological distress, including depressive symptoms and anxiety). First, the pathways by which social networks and social supports influence mental health can be described by two alternative (although not mutually exclusive) causal models—the main effect model and the stress-buffering model. Second, the protective effects of social ties on mental health are not uniform across groups in society. Gender differences in support derived from social network participation may partly account for the higher prevalence of psychological distress among women compared to men. Social connections may paradoxically increase levels of mental illness symptoms among women with low resources, especially if such connections entail role strain associated with obligations to provide social support to others. Third, egocentric networks are nested within a broader structure of social relationships. The notion of social capital embraces the embeddedness of individual social ties within the broader social structure. Fourth, despite some successes reported in social support interventions to enhance mental health, further work is needed to deepen our understanding of the design, timing, and dose of interventions that work, as well as the characteristics of individuals who benefit the most.     

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.     

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.     

Health-related quality of life among adults with serious psychological distress and chronic medical conditions

Objective Determine the prevalence of serious psychological distress (SPD) among adults with and without chronic medical conditions and examine the association between SPD and health-related quality of life (HRQOL). Methods Cross-sectional data from the 2005 Los Angeles County Health Survey were used to estimate prevalence of SPD. The association between SPD and HRQOL was evaluated using logistic regression and analysis of covariance, adjusting for sociodemographic variables and number of chronic conditions. Results SPD was significantly associated with younger age, lower income, being unemployed or disabled, being unmarried, fair or poor health, and having one or more chronic conditions. Adults with three or more chronic conditions were six times as likely to have SPD as those with no conditions. Adults with SPD reported significantly more unhealthy days (mental and physical) and activity limitation days than adults without SPD. The adjusted mean number of unhealthy days was highest among adults with SPD (23.3), followed by adults with depression (14.1), and diabetes (10.6). Conclusions SPD is associated with decreased HRQOL and presence of chronic medical conditions. Mental health should be routinely assessed when addressing health needs of individuals and communities. Persons with chronic diseases may benefit from targeted mental health screening and programs that employ treatment approaches that jointly manage physical and mental health and provide improved links and access to services.     

Social capital and change in psychological health over time

The positive association between social capital and general health outcomes has been extensively researched over the past decade; however, studies investigating social capital and psychological health show less consistent results. Despite this, policy-makers worldwide still employ elements of social capital to promote and improve psychological health. This United Kingdom study investigates the association between changes in psychological health over time and three different individual-level proxies of social capital, measures of socio-economic status, social support and the confounders age and gender. All data are derived from the British Household Panel Survey data, with the same individuals (N = 7994) providing responses from 2000–2007.     

Labor market integration,immigration experience,and psychological distress in a multi-ethnic sample of immigrants residing in Portugal

Objectives: This study aims at examining how factors relating to immigrants’ experience in the host country affect psychological distress (PD). Specifically, we analyzed the association among socio-economic status (SES), integration in the labor market, specific immigration experience characteristics, and PD in a multi-ethnic sample of immigrant individuals residing in Lisbon, Portugal.

Design: Using a sample (n?=?1375) consisting of all main immigrant groups residing in Portugal’s metropolitan area of Lisbon, we estimated multivariable linear regression models of PD regressed on selected sets of socio-economic independent variables. A psychological distress scale was constructed based on five items (feeling physically tired, feeling psychologically tired, feeling happy, feeling full of energy, and feeling lonely).

Results: Variables associated with a decrease in PD are being a male (demographic), being satisfied with their income level (SES), living with the core family and having higher number of children (social isolation), planning to remain for longer periods of time in Portugal (migration project), and whether respondents considered themselves to be in good health condition (subjective health status). Study variables negatively associated with immigrants’ PD were job insecurity (labor market), and the perception that health professionals were not willing to understand immigrants during a clinical interaction.

Conclusion: The study findings emphasized the importance of labor market integration and access to good quality jobs for immigrants’ psychological well-being, as well as the existence of family ties in the host country, intention to reside long term in the host country, and high subjective (physical) health. Our research suggests the need to foster cross-national studies of immigrant populations in order to understand the social mechanisms that transverse all migrant groups and contribute to lower psychological well-being.     

中国9～18岁儿童青少年心理困扰流行现状

目的描述2019年中国9～18岁儿童青少年心理困扰流行情况, 并分析其影响因素。方法使用2019年全国学生体质与健康调研数据, 纳入148 892名9～18岁汉族儿童青少年。使用凯斯勒心理困扰量表(K10)评分对心理困扰进行测量:≤19、20～、25～、≥30分别表示无、轻度、中度、重度心理困扰(中度和重度心理困扰合称高心理困扰)。使用方差分析、t检验和χ2检验比较不同特征儿童青少年K10评分和高心理困扰率的差异, 使用方差分析和趋势χ2检验分析趋势, 使用修正泊松回归模型分析高心理困扰的影响因素。结果 2019年中国9～18岁儿童青少年K10评分为21.5±9.2, 高心理困扰率为31.6%。9～、13～、16～18岁儿童青少年的高心理困扰率分别为22.3%、35.9%和38.8%, 随着年龄升高其K10评分和高心理困扰率均呈上升趋势(趋势检验均P<0.001)。年龄较高、女生、乡村、中低人均GDP水平地区、父/母亲文化程度较低儿童青少年高心理困扰率更高(均P<0.001)。多因素修正泊松回归模型分析显示, 13～15岁、16～18岁、女生、乡村和中低人均GDP水平地区的...     

The association of food security with psychological distress in New Zealand and any gender differences

Food security (access to safe, nutritious, affordable food) is intrinsically linked to feelings of stress or distress and it is strongly associated with socioeconomic factors. However, the impact of food insecurity on mental health, independent of confounding socioeconomic factors, is not clear. We investigated the association of food insecurity with psychological distress in New Zealand, controlling for socioeconomic factors. Secondarily, we examined the association in males and females. We used data from the Survey of Families, Income and Employment (SoFIE) (N = 18,955). Respondents were classified as food insecure if, in the last 12 months, they: used special food grants/banks, had to buy cheaper food to pay for other things, or went without fresh fruit and vegetables often. Psychological distress was measured using the Kessler-10 scale dichotomised at low (10-15) and moderate to high (16+). Logistic regression analyses were used to investigate the association of food insecurity with psychological distress using a staged modelling approach. Interaction models included an interaction between food security and gender, as well as interactions between gender and all other covariates (significant at p-value < 0.1). Models were repeated, stratified by gender. A strong relationship between food insecurity and psychological distress was found (crude odds ratio OR 3.4). Whilst substantially reduced, the association remained after adjusting for confounding demographic and socioeconomic variables (adjusted OR 1.8). In stratified models, food insecure females had slightly higher odds for psychological distress (fully adjusted OR 2.0) than males (fully adjusted OR 1.5). As such, an independent association of food insecurity with psychological distress was found in both males and females--slightly more so in females. However, we cannot rule out residual confounding as an explanation for the independent association and any apparent gender interaction.     

The role of social capital in reducing non-specific psychological distress: the importance of controlling for omitted variable bias

This paper examines the relationship between area-level social capital and non-specific psychological distress. It demonstrates that not controlling for non-time-varying omitted variables can seriously bias research findings. We use data from three cross-sections of the US National Health Interview Survey (1999, 2000, and 2001): 37,172 observations nested within 58 Metropolitan Statistical Areas. We also add data from the Area Resource File and County Business Patterns. We use a validated measure of social capital, the Petris Social Capital Index (PSCI), which measures structural social capital. We estimate a two-level multilevel linear model with a random intercept. Non-specific psychological distress is measured using a valid and reliable indicator, the K6. Individual-level variables include sex, age, race/ethnicity, marital status, education, family income, smoking status, exercise status, and number of visits to a health professional. Area-level covariates include the PSCI, the unemployment rate, psychiatrists per 1000 population, non-psychiatric physicians per 1000 population, and area-level indicators to account for non-time-varying area-level omitted variable bias. Time dummies are also included. We find that lagged area-level social capital is negatively related to non-specific psychological distress among individuals whose family income is less than the median. These associations are much larger when we control for non-time-varying area-level omitted variables.     

Ethnicity and nativity status as determinants of perceived social support: Testing the concept of familism

Research has demonstrated a protective effect of social support on health. Social support is most often treated as an independent variable. However, as with disease risk factors, which are not randomly distributed, health-promoting resources such as social support are also systematically patterned. For example, in the USA, family support is thought to be high among Latinos, Mexican Americans in particular. Using data from the Project on Human Development in Chicago Neighborhoods, we explored the relationships between ethnicity/nativity status, socioeconomic status (SES) and perceived social support from family and friends. We also assessed the role of retention of culture—measured as primary language spoken at home—on social support. Finally, we tested whether SES moderated the relationship between ethnicity/nativity status and social support. Foreign and US-born Latinos, most notably, foreign-born Mexicans, reported higher family support compared to non-Latino whites. Primary language spoken at home seems to account for the relationship between ethnicity/nativity and familial social support. Mexican-born and US-born Latino immigrants reported lower social support from family at higher levels of SES. Each ethnic minority group reported lower perception of friend support compared to non-Latino whites. There was a strong SES gradient in subjective support from friends with higher support reported among those with higher SES. This study provides evidence for the notion that Latinos in the USA, specifically foreign-born Mexicans, may rely on family ties for support more than do non-Latino whites. Findings also help identify ethnicity/nativity status, primary language spoken and SES as determinants of social support. Specifically, the higher familial social support found among Latino immigrants may be due to retention of culture. Effect modification by SES suggests that Latinos of lower and higher SES may differ with regard to the traditionally-held value of familism.     

Silence: a strategy used to deal with psychological distress by young people in the Eastern Cape,South Africa

Reported high levels of distress in South African youth are worrying. This article presents an analysis of expression of distress from narratives of young people in Butterworth, Eastern Cape Province, in South Africa. Twenty-four females and 16 males aged 16–22 volunteered. Self-reported data were obtained through one-on-one audio-recorded in-depth interviews conducted in IsiXhosa, transcribed verbatim and translated into English. Constant comparison analysis discovered underlying meanings for non-expression of distress related to fulfilling distinct but related purposes. First, silence was a strategy for containing a potentially explosive or hurtful situation. Second, silence showed gratitude for accrued benefits often constructed as parents’ or guardians’ generosity. Third, silence was maintained as a sign of deference; it was not a choice that participants made but rather they were conforming to standards of respect as set by their society. Lastly, silence was used to protect, in particular, the mother from distress. This study suggests that young people need to be empowered with appropriate and effective ways of handling distress not based on avoidance because silence as a strategy can only delay dealing with distressing issues.     

Individual,familial and community determinants of child physical abuse among high-school students in China

While many risk factors for child physical abuse are known, little research exists examining these in multilevel contexts including both individual and environmental influences. The authors examined the roles of individual-, family- and community-level factors such as socioeconomic status (SES) in determining the likelihood of child physical abuse in Guangzhou, China. Twenty-four schools were recruited by stratified random sampling, with 6628 junior high-school students aged 13–16 years participating. Parental child physical abuse experience, together with family and community levels of SES among students were measured and their relationships were investigated by applying univariable, multivariable and multilevel logistic regression models. Univariable, multivariable and multilevel logistic regression models were applied. Six-month prevalence of minor, severe and very severe assaults were 23.2%, 15.1% and 2.8%, respectively. A U-shaped association between family SES and likelihood of severe assaults was identified. In the multilevel model, indicators of low family SES, mother's higher occupational and educational status remained significantly independent predictors of physical abuse. Internal migration status was associated with higher risk as was younger age. The authors suggest that previous categories of risk factors for physical abuse may be too simplistic, and that further research on social and environmental influences may usefully inform intervention programs.     

Social capital, anticipated ethnic discrimination and self-reported psychological health: a population-based study

This study investigates the association between anticipated ethnic discrimination and self-reported psychological health, taking generalized trust in other people into consideration. The 2004 Public Health Survey in Skåne, Sweden, is a cross-sectional postal questionnaire study including a total of 27,757 respondents aged 18–80 with a 59% response rate. Multivariate analyses of anticipated discrimination and self-reported psychological health were performed using logistic regressions in order to investigate the importance of possible confounders (age, country of origin, education and horizontal trust). Poor psychological health was reported by 13.0% of men and 18.9% of women, and 44.8% and 44.7%, respectively, reported that 50% or more of employers would discriminate according to race, colour of skin, religion, or cultural background. Respondents in younger age groups, born abroad, with high education, low trust and high levels of self-reported anticipated discrimination, had significantly higher levels of poor self-reported psychological health. There was a significant association between anticipated discrimination and low horizontal trust. After multiple adjustments for age, country of origin and education, the addition of trust in the model reduced the odds ratio of poor self-reported psychological health in the “most employers” category from 1.8 (1.4–2.1) to 1.5 (1.3–1.9) among men and from 2.2 (1.8–2.6) to 1.8 (1.5–2.2) among women. Generalized trust in other people may be a confounder of the association between anticipated discrimination and poor psychological health. Anticipated discrimination may have effects on the mental health of not only the affected minorities, but also on the mental health of the general population.     

Residence in urban and rural areas over the life course and depression among Ghanaian and South African older adults

This study assessed associations between depression and urban/rural residence from a life-course perspective within African settings. Data on Ghanaian and South African adults aged 50 years and older were taken from wave 1 of the World Health Organization Study on Global Ageing and Adult Health (SAGE). Neither urbanicity of childhood nor adulthood residence was associated with later-life depression in either country. Significant differences were also not observed for residence changes over the life course, but there were trends in the data suggestive of higher depression prevalence in Ghanaian recent rural-urban migrants and lower prevalence among South African recent urban-rural migrants.     

The effect of pre-employment factors on job control, job strain and psychological distress: a 31-year longitudinal study

This study examined the role of pre-employment factors, such as maternal antenatal depression, low birth weight, childhood socioeconomic position, early adolescence health risk behaviours and academic performance, in the relationship between work characteristics (low job control and high job demands, or job strain) and psychological distress at age 31. The data of 2062 women and 2231 men was derived from the prospective unselected population-based Northern Finland 1966 Birth Cohort study. Results of linear regression models showed that being female, father's low socioeconomic position, and poor academic achievement in adolescence were linked to low control and high job strain jobs at age 31, and that low control and high job strain were associated with psychological distress at age 31. Although having lower school grades, high absence rate from school, and moderate alcohol consumption at age 14 were significant predictors of psychological distress at age 31, the associations between job control, job strain and psychological distress remained after controlling for these and other pre-employment effects. As such, pre-employment factors do seem to link people to risky work environments, which in turn seem to relate strongly to psychological distress. However, the relationship between pre-employment factors and later psychological distress in adulthood is not completely explained by job environment.     

Relation of female gender and low socioeconomic status to internalizing symptoms among adolescents: A case of double jeopardy?

Characteristics associated with disadvantaged social position, such as low socioeconomic status (SES) and female gender, may play a significant role in the development of internalizing symptoms among adolescents. Indeed, theories of "double jeopardy" suggest that these disadvantaged status characteristics interact to produce particularly harmful mental health outcomes. We tested the hypothesis that lower SES places adolescent females at greater risk for internalizing symptoms than males. We used data from the Project on Human Development in Chicago Neighborhoods collected from a 15-year-old adolescent cohort (n=640) at baseline and at two-year follow-up. Female gender predicted internalizing symptoms cross-sectionally and prospectively, whereas household income and caretaker education generally were not associated with internalizing symptoms. Findings overall did not indicate interactive effects between gender and SES indicators. However, subgroups of females at the lowest levels of caretaker education and household income displayed increased risk for specific outcomes, including higher internalizing symptom levels at follow-up and maintenance of severe symptom levels from baseline to follow-up.     

无锡市HIV感染者/AIDS患者心理健康状况和社会支持分析

目的 了解无锡市人类免疫缺陷病毒（human immunodeficiency virus,HIV）感染者/获得性免疫缺陷综合症（acquired immunodeficiency syndrome,AIDS）患者的心理健康和社会支持状况,探究其心理和社会支持的影响因素和两者之间的关系。方法 采用现况调查的方法,用90项症状自评量表（90 symptom checklist,SCL-90）和社会支持量表（social support rating scale,SSRS）对110名已确诊为HIV阳性的感染者进行心理健康调查。结果 该人群的SCL-90的筛查阳性有66人（60.00%）,总分及各因子均分均高于中国常模,差异均有统计学意义（均有P<0.001）。社会支持的总分和三个维度得分均小于中国常模（均有P<0.05）,其中主观支持得分在不同年龄段和婚姻状况下差异均具有统计学意义（均有P<0.05）。相关分析发现,除躯体化、强迫和其他三个因子外,社会支持总分与其他七个因子均分和总分均存在负相关（均有P<0.05）;客观支持与总分、人际关系、抑郁、焦虑和恐怖均存在负相关（均有P<0.05）;主观支持与总分、人际关系、抑郁、焦虑、敌对、偏执和精神病性均存在负相关（均有P<0.05）;利用度与心理健康状况均不存在相关性（均有P>0.05）。结论 无锡市HIV感染者存在较多心理健康问题,社会支持普遍较低,应该加强该人群的心理健康辅导,增加对该人群的社会支持,尤其是客观支持和主观支持。