Men’s work,women’s work and suicide: a retrospective mortality study in Australia

Objectives: This research sought to investigate the influence of being a in male‐dominated occupation on suicide. Methods: A population‐level retrospective mortality study was conducted over the period 2001 to 2015. Data from the Australian Census and the National Coronial Information System were combined. Negative binomial regression was used to assess the relationship between occupational gender ratio and suicide rates, controlling for age, socioeconomic status and year of death. Probabilistic sensitivity analysis accounted for unmeasured confounding due to common mental disorders. Results: Males in male‐dominated occupations had a rate ratio (RR) of 7.50 (95%CI 6.07 to 9.25) compared to males in female‐dominated occupations. Females in male‐dominated occupations had a RR of 0.13 (95%CI 0.07 to 0.26) compared to females in female‐dominated occupations. Results for males were maintained after adjusting for common mental disorders. There was evidence of interaction on both additive and multiplicative scales. Conclusions: The gendered context of an occupation influences suicide, with varying risks for women and men. More research is needed to understand the mechanisms of this relationship. Implications for public health: These results suggest the need for targeted suicide prevention activities in male‐dominated occupational groups.     

Women's perspectives on resilience and research on resilience in motherhood: A qualitative study

Purpose

Definitional perspectives and operational approaches to the concept of resilience vary within the literature; however, little is known of women's opinions on current resilience research, or the philosophical and methodological directions women believe such research should take. This research explored women's perspectives on resilience research in the perinatal period and early motherhood and sought their opinions on the ways in which they believe research should be advanced.

Methods

Following ethical approval, online interviews were conducted with 14 ethnically and socioeconomically diverse women who were mothers. Findings from a concept analysis on resilience in pregnancy and early motherhood, conducted by the authors, were shared with women before and during the interview. Interviews were organised in sections corresponding to the findings within the concept analysis' four philosophical (Epistemology, Linguistic, Logic, Pragmatic) principles and thematically analysed.

Results

Epistemology—Women endorsed a dynamic process definition, and viewed resilience as influenced by multilevel, multisystemic processes. Linguistic—Women viewed words such as ‘adaptation’ and ‘adjustment’ as being more active and empowering than the term ‘coping’ in relation to motherhood. Logic—Women were resistant to the predominant operational conceptualisation of resilience as illness absence. Pragmatic—Women were wary of resilience research being used to reduce mental health support for other mothers and families.

Conclusions

Women provided constructive criticisms on the current state of resilience literature. Women suggested actionable ways in which research may be developed to better align with the epistemological and ethical approaches women want to see in resilience and maternal mental health research.

Patient or Public Contribution

Women who are mothers and participants in health research were consulted on their views of trends in mental health and resilience research in motherhood.     

A qualitative analysis of black and white British women’s attitudes to weight and weight control

Background: Rates of obesity among black African and black Caribbean women in the UK are consistently higher than among white women. Cultural, attitudinal and behavioural differences may contribute to ethnic variation in weight, and the present study aimed to explore attitudes towards weight and weight control among black and white British women using a qualitative approach. Methods: Ethnically homogeneous focus groups were carried out with 25 white women [mean (SD) body mass index (BMI, kg m^–2) = 26 (7.2) kg m^–2] and 24 black women [mean (SD) BMI = 29 (6.6) kg m^–2]. Women were recruited from London boroughs (Lambeth, Southwark and Croydon) and Guildford, Surrey, and focus groups were conducted in London. Focus groups were recorded and transcribed verbatim, and were analysed using thematic analysis. Results: All participants had fairly good knowledge of the causes, consequences and treatment of being overweight. However, black women primarily emphasised the health consequences of being overweight, whereas white women were more likely to focus on the perceived social and emotional consequences. White women associated being overweight with negative character traits, whereas black women had a broadly positive attitude towards larger body sizes. Conclusions: Black women were as well‐informed about the causes and health risks of obesity as white women in this sample of mainly educated, working women, although they were more accepting of larger body sizes and experienced less social pressure to be slim.     

Partner violence and medical encounters: African-American women’s perspectives

Objective: To examine the relationship between intimate partner violence (IPV) victimization and patient satisfaction with medical encounters among an African-American population.Design: Cross-sectional, self-administered, anonymous survey.Setting: Community-based, primary care center.Patients: Consecutive African-American women recruited from an urban health center. A total of 102 women provided sufficient information to reveal whether they were currently experiencing IPV and to allow us to assess their experiences in their most recent primary care encounter.Measurements: Patients’ perceptions of their most recent encounter using questions adopted from the Medical Interview Satisfaction Scale and Consultation Satisfaction Questionnaire. We used the Conflicts Tactics Scale, supplemented with questions measuring sexual violence and emotional abuse, to assess IPV “in the past year.”Results: Women who reported current IPV rated several aspects of the encounter more negatively than did women who did not report current abuse. The IPV victims were less likely to report that they felt respected and accepted during the encounter, and they provided lower ratings of the quality of communication with their providers.Conclusions: It is unclear why victims of partner violence experience medical encounters as less satisfactory. Researchers need to expand studies of medical encounters as experienced by abused women to determine whether IPV status adversely affects general medical care.     

Ideology and resistance in young people's experiences of health under the ‘imperative of enjoyment’

This article explores upper secondary school students’ understandings and experiences of health in Denmark, where public health promotions appeal to pleasure. Health promotion thereby taps into capitalist society's ‘imperative of enjoyment’, which reproduces ideological fantasies about the fulfilment of desires through the consumption of health. Based on qualitative empirical material produced through participatory and visual methods during fieldwork conducted in 2012, the analysis shows that relations between healthiness and pleasure are conflated and paradoxical: the students try to fit into society not only by being healthy, but also by enjoying healthiness; but if they fail pleasure, they fail healthiness and experience a loss of individual social value. Although the ‘enjoyment society’ has the potential to produce individualisation and marginalisation, the students in this study actively attempt to subvert its double bind by insisting that collective experiences with peers constitutes the foundation of enjoyable healthiness. Nevertheless, public health promotions that reproduce enjoyment as an imperative, even in the pursuit of health, risk reinforcing young people's resistance towards health.     

The place of abortion in the pregnancy decision‐making process in young adult women in Catalonia,Spain

Induced abortion is one option to control fertility in Spain. Young adult women (25–34 years old) show a different abortion pattern compared to women in other age groups, being less likely to seek abortions than younger women and having one of the lowest proportions of unintended pregnancies. We aimed to analyse the factors involved in the pregnancy decision‐making process to better understand why young adult women seek abortions in Catalonia, Spain. In‐depth semi‐structured interviews with 25 nulliparous pregnant young adult women and one focus group discussion with healthcare providers were conducted in 2008/2010. We found that inconsistent contraceptive use prior to an unintended pregnancy was due to ambivalence and weighing of priorities during sex. The quality of the relationship was paramount to the abortion decision whereas other reasons (financial/employment status, fulfilling aspirations, support networks) were less important. We conclude that the motivations for the abortion decision are interrelated and based on the current life stage of women and that there is pressure on young adult women in Spain to become mothers. Induced abortion is perceived as the last resort to postpone motherhood. Our findings reinforce the unequal societal burden placed on women to take responsibility for prevention of unintended pregnancy.     

Attending to physical health in mental health services in Australia: a qualitative study of service users’ experiences and expectations

Evidence is unequivocal: the premature death of people with severe mental health problems is attributable primarily to cardiovascular disease, and healthcare provided is often suboptimal. With the overarching aim of improving outcomes, policies and guidelines oblige mental health services and psychiatrists to monitor cardio‐metabolic health of patients and intervene as appropriate. Practice is highly variable; however, with ongoing debate about resourcing and responsibilities dominated by clinicians who have identified disinterest among patients as influencing practice. Seeking to balance discussion, we posed the question ‘what do patients experience and expect of mental health services in relation to their physical health?’ To answer it, we interviewed a convenience sample of 40 service users recruited from a mental health service in Australia, early in 2015. Data were analysed using the framework approach. With few regarding themselves as healthy, participants were commonly concerned about side effects of medication, weight and fitness but rarely mentioned tobacco smoking. Participants’ accounts reinforce extensive research demonstrating variability in attention to physical health in mental health services. Reports by some participants of comprehensive care are encouraging, but widespread uncertainty about reasons for various assessments and denial of requests for management of medication side effects, including weight gain, gives cause for concern. Although participants in this study wanted to improve their health and health‐related quality of life, they acknowledged that their motivation and ability to do so fluctuated with mental health. They expected clinicians to work proactively, especially when symptoms compromised capacity for self‐care, and mental health services to provide or enable access to health‐promoting interventions. Attention should be given, as a matter of priority, to creating conditions (culture and infrastructure) needed to support sustained attention to physical health within services and, importantly, to full engagement of service users in management of their physical health.