Neighbourhood income inequalities in mental health in Barcelona 2001-2016: a Bayesian smoothed estimate

ObjectiveObtaining reliable health estimates at the small area level (such as neighbourhoods) using survey data usually poses the problem of small sample sizes. To overcome this limitation, we explored smoothing techniques in order to estimate poor mental health prevalence at the neighbourhood level and analyse its profile by income in Barcelona city (Spain).MethodA Bayesian smoothing model with a logit-normal transformation was applied to four repeated cross-sectional waves of the Barcelona health survey for 2001, 2006, 2011 and 2016. Mental health status was identified from the 12-item General Health Questionnaire. Income inequalities were analysed with neighbourhood income in quantiles for each year and trends in the pooled analysis.ResultsThe prevalence of poor mental health ranged from 14.6% in 2001 to 18.9% in 2016. The yearly difference between neighbourhoods was 12.4% in 2001, 16.7% in 2006, 14.2% in 2011, and 20.0% in 2016. The odds ratio and 95% credible interval (95%CI) of experiencing poor mental health was 1.40 times higher (95%CI: 1.02-1.91) in less advantaged neighbourhoods than in more advantaged neighbourhoods in 2001, 1.61 times higher (95%CI: 1.01-2.59) in 2006 and 2.31 times higher (95%CI: 1.57-3.40) in 2016.ConclusionsThis study shows that the Bayesian smoothed techniques allows detection of inequalities in health in neighbourhoods and monitoring of interventions against them. In Barcelona, mental health problems are more prevalent in low-income neighbourhoods and raised in 2016.     

Improving maternal postpartum mental health screening guidelines requires assessment of post-traumatic stress disorder

Post-traumatic stress disorder (PTSD) has a prevalence of 4–17% in the postpartum period and, like better known postpartum depression (PPD), is linked to reduced quality maternal-child interactions, decreased maternal sense of life satisfaction and functioning, and negative impacts on child development. Currently, provincial and public health organizations throughout Canada screen new mothers for PPD with the Edinburgh Postpartum Depression Scale, which while laudable does not capture PTSD. PTSD is highly associated with PPD, 65% of women with PTSD also present with PPD, presenting a significant gap in postpartum maternal mental health screening. Numerous self-report PTSD screening questionnaires are available that could be incorporated into routine maternal postpartum mental health care. Furthermore, across Canada, regional differences in availability of maternal mental health screening, services, and programs suggest a gap in one of the tenets of Canadian health care—lack of universality. Not only does Canada require national maternal mental health screening, service and program guidelines, but PTSD screening must be incorporated, in order to identify and treat new mothers experiencing mental health problems.     

Community action for health in socioeconomically deprived neighbourhoods in Barcelona: Evaluating its effects on health and social class health inequalities

BackgroundThe aim of this study was to analyse trends in several health-related indicators in socioeconomically deprived neighbourhoods in Barcelona with strong community action for health (CA), and compare them to neighbourhoods without such community action. A secondary goal was to analyse trends in socioeconomic inequalities in health in both types of neighbourhood.MethodsWe performed a quasi-experimental pre-post study using data from the Barcelona Health Surveys of 2001 and 2011. Our dependent variables were self-perceived health, mental health, previous drug use, and smoking cessation. We used Poisson regression with robust variance to calculate prevalence ratios (PR) and 95% Confidence Intervals (95% CI).ResultsThe percentage of men who had ever used drugs decreased over time in neighbourhoods with strong CA (PR = 0.48; 95% CI:0.25–0.92, from 2001 to 2011), but not in neighbourhoods without CA (PR = 1.02; 95% CI:0.74–1.40). However, the prevalence of poor mental health among men increased more in neighbourhoods with strong CA than in neighbourhoods without CA (p-value = 0.025). Among women, social class inequalities in poor mental health and smoking cessation decreased over time in neighbourhoods with strong CA but not in neighbourhoods without CA.ConclusionsOur study shows promising results regarding the effect of community action on health, particularly in terms of inequalities. Our results highlight the importance of allocating resources to implement and continuously evaluate CA initiatives.     

Widening Socioeconomic Inequalities in Smoking in Japan, 2001–2016

BackgroundJapan is one of the world’s largest tobacco epidemic countries but few studies have focused on socioeconomic inequalities. We aimed to examine whether socioeconomic inequalities in smoking have reduced in Japan in recent times.MethodsWe analyzed data from the Comprehensive Survey of Living Conditions, a large nationally representative survey conducted every 3 years (n ≈ 700,000 per year) in Japan, during 2001–2016. Age-standardized smoking prevalence was computed based on occupational class and educational level. We calculated smoking prevalence difference (PD) and ratio (PR) of (a) manual workers versus upper non-manual workers and (b) low versus high educational level. The slope index of inequality (SII) and relative index inequality (RII) by educational level were used as inequality measures.ResultsOverall smoking prevalence (25–64 years) decreased from 56.0% to 38.4% among men and from 17.0% to 13.0% among women during 2001–2016. The PD between manual and upper non-manual workers (25–64 years) increased from 11.9% (95% confidence interval [CI], 11.0–12.9%) to 14.6% (95% CI, 13.5–15.6%) during 2001–2016. In 2016, smoking prevalence (25–64 years) for low, middle, and highly educated individuals were 57.8%, 43.9%, and 27.8% for men, and 34.7%, 15.9%, and 5.6% for women, respectively. SII and RII by educational level increased among both sexes. Larger socioeconomic differences in smoking prevalence were observed in younger generations, which suggests that socioeconomic inequalities in smoking evolve in a cohort pattern.ConclusionsSocioeconomic inequalities in smoking widened between 2001 and 2016 in Japan, which indicates that health inequalities will continue to exist in near future.Key words: epidemiology, smoking, socioeconomic factors, Japan, trends     

Examining the associations between food worry and mental health during the early months of the COVID-19 pandemic in Canada

ObjectiveLittle is known about the association between mental health and diminished food worry during the COVID-19 pandemic. This paper examines worry about having enough food to meet household needs and its association with mental health during the early months of the pandemic in Canada.MethodsData are drawn from the first round of a multi-round mental health monitoring survey. Online surveys were administered between May 14 and 29, 2020, to a nationally representative sample of Canadian adults (n = 3000). Logistic regression models were used to examine associations between food worry and mental health indicators (anxious/worried, depressed, worse mental health compared with pre-pandemic, and suicidal thoughts/feelings), after adjusting for socio-demographic characteristics and pre-existing mental health conditions. Fully adjusted models explored the impact of controlling for financial worry due to the pandemic in the previous 2 weeks.ResultsOverall, 17.3% of the sample reported food worry due to the pandemic in the previous 2 weeks, with the highest prevalence found among those with a reported disability (29.3%), Indigenous identity (27.1%), or pre-existing mental health condition (25.3%). Compared with participants who did not report food worry, those who did had higher odds of reporting feeling anxious/worried (OR=1.36, 95% CI: 1.08–1.71) and suicidal thoughts/feelings (OR=1.87, 95% CI: 1.24–2.80) when controlling for socio-demographics, pre-existing mental health conditions, and financial worry.ConclusionThis paper provides insights about the associations between food worry and mental health in Canada during the COVID-19 pandemic and indicates the need for improved policies and social supports to mitigate food worry and associated mental health outcomes.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-021-00557-w.     

Vitamin D and Chronic Diseases among First-Generation Immigrants: A Large-Scale Study Using Canadian Health Measures Survey (CHMS) Data

Background: Nearly 22% of the Canadian population are first-generation immigrants. We investigated immigrants’ health status and health deterioration over time in terms of the prevalence of chronic diseases (CDs) and their relationship to vitD status. Methods: We used cycles three (2012–2013) and four (2014–2015) of the Canadian Health Measures Survey. These data contained unique health information and direct physical/blood measures, including serum 25-hydroxyvitamin D (S-25(OH)D). Indicators of health status and deterioration were the prevalence of CDs diagnosed by healthcare professionals, self-reported general and mental health, and CD-related biomarkers. Results: The data (n = 11,579) included immigrants from more than 153 countries. Immigrants were healthier than non-immigrants for most health status measures. The prevalence of CDs was higher among those who migrated to Canada aged ≥ 18 years. A longer time in Canada after immigration was associated with a higher risk for CDs. The mean S-25(OH)D was lower among immigrants, higher among patients with CDs, and inversely associated with glycated hemoglobin, total cholesterol/high-density lipoprotein ratio, immunoglobulin E, serum ferritin, and blood hemoglobin. After adjusting for covariates, no association was found between S-25(OH)D and the prevalence of CDs. Conclusions: Lower levels of accumulated S-25(OH)D among immigrants may impact their health profile in terms of CD-related biomarkers, which partially explains immigrants’ health deterioration over time. We recommend further longitudinal research to investigate immigrants’ vitD and health deterioration.     

Neighbourhood deprivation and regional inequalities in self-reported health among Canadians: Are we equally at risk?

Individual-level data from the Canadian Community Health Survey was combined with area-level data from the 2001 Canada Census to explore the relationship between neighbourhood deprivation and regional inequalities in self-reported health (n=120,290). While neighbourhood deprivation was a significant predictor of fair/poor health in all geographic regions (OR=1.11; 95% CI: 1.08, 1.14), living on the Atlantic and Pacific coasts exacerbated the detrimental effects of neighbourhood deprivation on the perceived health of respondents (OR=1.21; 1.28). By failing to explore regional variations in risk, we could fail to identify areas where provincial policies may interact with neighbourhood factors to reinforce health inequalities amongst deprived communities.     

Black,White, Black and White: mixed race and health in Canada

Objectives: To document inequalities in hypertension, self-rated health, and self-rated mental health between Canadian adults who identify as Black, White, or Black and White and determine whether differences in educational attainment and household income explain them.

Design: The dataset was comprised of ten cycles (2001–2013) of the Canadian Community Health Survey. The health inequalities were examined by way of binary logistic regression modeling of hypertension and multinomial logistic regression modeling of self-rated health and self-rated mental health. Educational attainment and household income were investigated as potentially mediating factors using nested models and the Karlson-Holm-Breen decomposition technique.

Results: Black respondents were significantly more likely than White respondents to report hypertension, a disparity that was partly attributable to differences in income. White respondents reported the best and Black respondents reported the worst overall self-rated health, a disparity that was entirely attributable to income differences. Respondents who identified as both Black and White were significantly more likely than White respondents to report fair or poor mental health, a disparity that was partly attributable to income differences. After controlling for income, Black respondents were significantly less likely than White respondents to report fair or poor mental health. Educational attainment did not contribute to explaining any of these associations.

Conclusion: Canadians who identify as both Black and White fall between Black Canadians and White Canadians in regards to self-rated overall health, report the worst self-rated mental health of the three populations, and, with White Canadians, are the least likely to report hypertension. These heterogeneous findings are indicative of a range of diverse processes operative in the production of Black-White health inequalities in Canada.     

Racial/ethnic differences in perceived need for mental health care and disparities in use of care among those with perceived need in 1990–1992 and 2001–2003

Objectives: This study examines whether there are racial/ethnic differences in perceived need for mental health care among those with a mood and/or anxiety disorder in 1990–1992 and 2001–2003 in the US. Then among those with perceived need, we examine whether racial/ethnic disparities in use of mental health care existed in both time periods.

Design: Using data from the 1990–1992 National Comorbidity Survey (NCS) and 2001–2003 National Comorbidity Survey – Replication (NCS-R), the study analyzes whether whites differed from blacks and Latinos in rates of perceived need among those with a mood and/or anxiety disorder in 1990–1992 and 2001–2003. Then among those with a disorder and perceived need, rates of mental health care use for whites are compared to black rates and Latino rates in within the 1990–1992 cohort and then within the 2001–2003 cohort.

Results: There were no statistical racial/ethnic differences in perceived need in both time periods. Among those with perceived need in 1990–1992, there were no statistical racial/ethnic disparities in the use of mental health care. However, in 2001–2003, disparities in mental health care use existed among those with perceived need.

Conclusions: The emergence of racial/ethnic disparities in use of mental health care among those with a perceived need for care in 2001–2003 suggests that personal/cultural belief along with issues concerning access and quality of mental health care may create barriers to receiving perceived needed care. More research is needed to understand why these disparities emerged among those with perceived need in the latter time period and whether these disparities continue to exist in more recent years.     

Changes in the prevalence of mood and anxiety disorders among male and female current smokers in the United States: 1990–2001

PurposeThe present study investigated whether the prevalence of mood and anxiety disorders has increased over time among current smokers and whether these trends differ by gender and in comparison with nonsmokers.MethodsData were drawn from the National Comorbidity Survey (1990) and the National Comorbidity Survey-Replication (2001), representative samples of the US adult population. Binomial regression analyses were used to determine differences between mood and anxiety disorders among current smokers in 1990 and 2001 and whether these differed by gender and in comparison with those who were former or never current smokers.ResultsAny anxiety disorder, panic attacks, panic disorder, social anxiety disorder and dysthymia were all significantly more common among current smokers in 2001 compared with 1990 and except for social anxiety disorder these increases were significantly greater than any trend found in non-smokers. Increases in panic attacks, social anxiety disorder, and dysthymia were more pronounced in female than in male smokers. Major depressive disorder and generalized anxiety disorder were not found to increase over time among smokers.ConclusionsThe prevalence of several anxiety disorders and dysthymia among current smokers appears to have increased from 1990 to 2001. Future studies are needed to determine whether these trends have continued. If so, interventions aimed at moving the prevalence lower may have limited success if treatment of mental health problems such as anxiety disorders and certain mood disorders are not considered in the development and dissemination of tobacco control programs.     

The prevalence of over-qualification and its association with health status among occupationally active new immigrants to Canada

Objectives. Occupational over-qualification refers to a situation where an individual's occupational status is lower than would be expected by their training, skills, or experience. The objective of this study is to examine the prevalence of three dimensions of over-qualification among a cohort of new immigrants to Canada, and the associations between each dimension of over-qualification with changes in general and mental health status over a four-year period.

Design. This study utilized data from the Longitudinal Survey of Immigrants to Canada. For the purpose of this study, we restricted our sample to those employed respondents who worked before coming to Canada, were planning on working after immigration, were in good health at baseline and were interviewed at 4 years post-arrival (N=2685). We defined three measures of over-qualification based on occupational attainment at 4 years relative to: level of education, previous work experience, and occupational expectation upon arrival in Canada. Regression models explored the associations between each dimension of over-qualification and change in self-reported general and mental health adjusting for a variety of immigrants' personal and immigration-related characteristics.

Results. Four years after arriving in Canada, 51.6% of immigrants were overqualified for their jobs based on their education levels, with a lesser extent overqualified based on experience (44.4%) or expectations (42.8%). Respondents experiencing any dimension of over-qualification were more likely to report a decline in mental, but not general, health. These relationships were only mildly attenuated after adjustment for other possible confounding variables. Inclusion of job satisfaction and perceptions of employment situation mediated these relationships to a large extent suggesting they are primary pathways through which over-qualification influences mental health.

Conclusions. On average, occupationally active immigrants who were overqualified for their attained occupations in Canada had poorer mental health status than other immigrants 4 years after arrival in Canada. Effective policies and services that support opportunities for immigrants to use their skills appropriately in the Canadian labor market have important labor, social- and health-related consequences.     

Suicide reduction in Canada during the COVID-19 pandemic: lessons informing national prevention strategies for suicide reduction

Objective The objective of this research was to evaluate the impact of federal, public health and social support programs on national suicide rates in Canada.DesignCross-sectional study.SettingCanadian National Database (i.e., Statistics Canada) and Statista.ParticipantsPopulation-level data, and economic and consumer market data.Main Outcome MeasuresSuicide mortality data, population data and unemployment data were obtained from available statistical databases (e.g. Statistics Canada). We quantified suicide rate by dividing the total number of suicide deaths by the national population expressed as a rate per 100,000 population.ResultsOverall suicide mortality rate decreased in Canada from 10.82 deaths per 100,000 in the March 2019 - February 2020 period to 7.34 per 100,000 (i.e. absolute difference of 1300 deaths) in the March 2020 - February 2021 period. The overall Canadian unemployment rate changed from an average monthly rate of 5.7% in 2019 to 9.5% in 2020.Conclusion Our results indicate that for the first post-pandemic interval evaluated (i.e., March 2020 - February 2021), suicide rates in Canada decreased against a background of extraordinary public health measures intended to mitigate community spread of COVID-19. An externality of public health measures was a significant rise in national unemployment rates in population measures of distress. Our results suggest that government interventions that broadly aim to reduce measures of insecurity (i.e., economic, housing, health), and timely psychiatric services, should be prioritised as part of a national suicide reduction strategy, not only during but after termination of the COVID-19 pandemic.     

Women's Sexual Orientation and Health: Results from a Canadian Population-Based Survey

The current study sought to determine whether health status and health risk behaviors of Canadian women varied based on sexual identity. This was a cross-sectional analysis of data from the Canadian Community Health Survey: cycle 2.1, a national population-based survey designed to gather health data on a representative sample of over 135,000 Canadians including 354 lesbian respondents, 424 bisexual women respondents, and 60,937 heterosexual women respondents. Sexual orientation was associated with disparities in health status and health risk behaviors for lesbian and bisexual women in Canada. Bisexual women were more likely than lesbians or heterosexual women to report poor or fair mental and physical health, mood or anxiety disorders, lifetime STD diagnosis, and, most markedly, life-time suicidality. Lesbians and bisexual women were also more likely to report daily smoking and risky drinking than heterosexual women. In sum, sexual orientation was associated with health status in Canada. Bisexual women, in particular, reported poorer health outcomes than lesbian or heterosexual women, indicating this group may be an appropriate target for specific health promotion interventions.     

Évaluation de la pertinence de deux questions relatives aux diagnostics reçus de trouble de l’humeur et d’anxiété au sein de la population québécoise

BackgroundThe objective of this study is to assess the relevance of two questions relating to received diagnoses of mood and anxiety disorders in the Quebec population.MethodsThe data analysed originate from three cycles of the Canadian Community Health Survey (CCHS 2005, 2007–2008 and 2009–2010). Four respondent groups were created from two questions on mood and anxiety disorders: those reporting no disorders, a mood disorder, an anxiety disorder, or and both disorders. Four indicators measuring mental and general health are compared across groups.ResultsResults show a significant association between group membership and some indicators of mental and general health. The percentages of people having experienced a major depressive episode, significant psychological distress and perceived poor mental and general health increased with the number of diagnoses reported. Logistic regression analyses also confirm these results.ConclusionThe results of this study show that the four groups created from the two questions render it possible to distinguish persons in terms of indicators measuring the mental and general health of the Quebec population. Convergence of results in all three cycles lends additional credence to the use of questions on received diagnoses of mood and anxiety disorders.     

Socioeconomic inequalities in self-assessed health and mental health in Barcelona, 2001-2016

ObjectivePrevious research has found persistent socioeconomic inequalities in health outcomes at the national level, with different patterns after the economic crisis. However, inequalities in urban areas are also important. This study analyses socioeconomic inequalities in self-assessed health and mental health in the city of Barcelona.MethodRepeated cross-sectional design using quinquennial data from the Barcelona Health Surveys carried out in 2001, 2006, 2011 and 2016 for the population older than 22 years. Robust Poisson regressions models were used to compute socioeconomic gradients and relative (RII) and slope indexes of inequality (SII) by occupational social class, with stratification by sex. RII and SII were also obtained with further adjustment by employment situation.ResultsA consistent socioeconomic gradient was found for all years except for 2011. Relative and absolute inequalities followed a V-shape, showing a drop during the economic crisis but widening thereafter to recover pre-crisis figures for self-assessed health and widening for mental health, in both relative and absolute terms in 2016. Adjustment for employment situation reduces inequalities but a large part of these inequalities remains, with variability across years.ConclusionsThe lasting effects of the 2008 economic crisis and the austerity programmes imposed since then may have contributed to the persistence of socioeconomic inequalities in self-assessed health and the widening of those for mental health.     

Ciprofloxacin-Resistant Campylobacter spp. in Retail Chicken,Western Canada

During 2005–2010, the Canadian Integrated Program for Antimicrobial Resistance Surveillance identified increased prevalence of ciprofloxacin (a fluororquinolone) resistance among Campylobacter isolates from retail chicken in British Columbia (4%–17%) and Saskatchewan (6%–11%), Canada. Fluoroquinolones are critically important to human medicine and are not labeled for use in poultry in Canada.     

Associations of Small Business Closure and Reduced Urban Mobility with Mental Health Problems in COVID-19 Pandemic: a National Representative Sample Study

It is suggested that the nationwide social distancing due to coronavirus disease 2019 (COVID-19) has adverse mental health consequences despite its necessity. We investigated the associations of social distancing measures with mental health problems. Using national representative sample of 509,062 adults in the USA, we examined the associations of small business closure and reduced urban mobility with generalized anxiety disorder (GAD) and major depression disorder (MDD). Multilevel regression models were fitted with individual, household, and state-level covariates, in addition to state and census-region-level random effects. Living in state with the highest quartile of small business closures was associated with increased prevalence of GAD (OR: 1.06; CI: 1.03–1.11) compared to lowest quartile, but had no association with MDD. Living in the highest quartile of urban mobility was associated with lower prevalence of both GAD (OR: 0.88; CI: 0.85–0.93) and MDD (OR: 0.90; CI: 0.86–0.95) relative to the lowest quartile. Our findings suggest that small business closures and reduced mobility during COVID-19 pandemic were negatively associated with the two mental health outcomes in the USA, despite their important roles in preventing the infection.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-020-00511-0.     

A multi-level study of the determinants of mental health service utilization

BackgroundUntil now, research has focused on neighbourhood variations in mental health services and their relationships with local attributes, such as healthcare supply and socio-economic deprivation, without controlling for individual characteristics (age, sex, income, or education, for instance). Hence, this study is a major attempt to clarify the role played by individual and local attributes in the utilization of mental health services. The aim of this study was to disentangle individual and neighbourhood effects on mental health service use.MethodsIn this cross-sectional study, individual-level data on 423 participants with a frequent mental health disorder was recruited from the general population and linked to neighbourhood-level data at the census tract level from the 2006 Canadian Census. Neighbourhood variables included socio-economic deprivation, mean income, residential stability and the proportion of recent immigrants. Individual characteristics included gender, age, marital status, self-rated mental health and the number of diagnoses. Multi-level logistic regression was used to assess the effects of individual and neighbourhood characteristics simultaneously on mental health service use.ResultsThe intraclass correlation coefficient indicated that 12.26% of the variance of mental health service utilization is at the neighbourhood level. Final analysis showed that at the individual level, being female, married, or self-rating mental health less than excellent increased healthcare use. At the neighbourhood level, deprived socio-economic neighbourhood decreased health service use (OR = 0.71, P < 0.05), while residential stability increased use (OR = 1.24, P < 0.05).ConclusionsIndividual and neighbourhood characteristics determine mental health service utilization. Taking both into consideration allows better targeting of health service policy and planning and enables more accurate needs-based resource allocation. However, future research should continue to investigate the pathway through which neighbourhood affects health service utilization.     

The association between community stressors and asthma prevalence of school children in Winnipeg, Canada

It is generally surmised that community stressors have an incubating effect for a variety of diagnoses on maternal and child health. This is of public health significance, as children of mothers facing long-term distress were found to have a 60% higher risk for asthma diagnosis at age 7 in Manitoba, Canada. Our objective was to determine the association of community stressors with childhood asthma prevalence in Winnipeg, Canada from participants who completed the Study of Asthma, Genes and the Environment (SAGE) survey administered in 2002-2003 to a birth cohort from 1995. Measures of community socioeconomic makeup and community disorder with rank ordinalized by quintile at the census tract level were obtained from the 1996 Canada Census. Crime data (annual incidence per 10,000 persons) by neighbourhood profile for 2001 was provided by the Winnipeg Police Service. Dichotomous caregiver report of child asthma along with other indicators from the geocoded SAGE survey allowed linkage to 23 neighbourhood profiles. Multilevel logistic regression analyses were performed to estimate the effect of community stressors on childhood asthma prevalence for birth and non-birth home children (N = 1472) and children resident of birth homes at age 7 or 8 (N = 698). After adjusting for individual risk factors, children resident of birth homes in a high thefts over $5,000 neighbourhood profile were twice as likely (Adjusted OR, 2.05; 95% CI, 1.11-3.81) to have report of asthma compared to children in a lower thefts over $5,000 profile, with community thefts over $5,000 explaining over half of the observed neighbourhood variation in asthma.