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Psychosocial risk factors, inequality and self-rated morbidity in a changing society
Abstract
The aim of this study was to analyse the interaction of social, economic, psychological and self-rated health characteristics of the Hungarian population in representative, stratified nation-wide samples during the period of sudden political-economic changes. In 1988 20,902 and in 1995 12,640 persons, representing the Hungarian population over the age of 16 by age, sex and place of residence were interviewed. Self-rated morbidity characteristics, shortened Beck Depression Inventory, hopelessness, hostility, ways of coping, social support, control over working situation and socioeconomic characteristics were examined. Age dependent changes could be observed between 1988 and 1995 with increasing depressive symptomatology, hopelessness, lack of control over working situation in the population above 40 years, while in the younger population improvements in depressive symptomatology could be seen. According to hierarchical loglinear analysis, depressive symptom severity mediates between relative socioeconomic deprivation and higher self-rated morbidity rates, especially among men. Depressive symptomatology is closely connected with hostility, low control in working situation, low perceived social support and emotional ways of coping. A vicious circle might be hypothesised between socially deprived situation and depressive symptomatology, which together has a major role in higher self-rated morbidity rates.
... This gender difference might be explained by the different coping strategies across genders with men more likely to engage in hazardous behaviour to alleviate stress. Comparing data from the 1988 and 1995 Hungarostudy survey using self-rated health as a dependent variable Kopp, Skrabski, and Szedmák (2000) point out that during the transition years there was a significant decrease in perceived control in work and in perceived social support from co-workers and friends, especially in the lowest socio-economic groups, which also underpins the unified chronic stress theory approach to explaining the mortality increase during the transition. Kopp, Skrabski, and Szedmák (2000) found that depressive symptom severity mediates between relative socio-economic deprivation and higher self-rated morbidity rates, especially among men. ...
... Comparing data from the 1988 and 1995 Hungarostudy survey using self-rated health as a dependent variable Kopp, Skrabski, and Szedmák (2000) point out that during the transition years there was a significant decrease in perceived control in work and in perceived social support from co-workers and friends, especially in the lowest socio-economic groups, which also underpins the unified chronic stress theory approach to explaining the mortality increase during the transition. Kopp, Skrabski, and Szedmák (2000) found that depressive symptom severity mediates between relative socio-economic deprivation and higher self-rated morbidity rates, especially among men. Low control at work, low perceived social support and emotional coping strategies are also strongly correlated with depressive symptoms, thus the researchers conclude that social deprivation, increased work or unemployment related stress, lack of active and positive coping strategies among the lower social classes and depressive symptomatology represent the vicious circle that explains the decreasing health of Hungarians during the transition years. ...
... These ecological and individual level measures of social integration have a strong correlation with social capital, stress and mental health problems. As Kopp, Skrabski, and Szedmák (2000) and Skrabski, Kopp, and Kawachi (2004) pointed out positive coping strategies, individual signs of social integration and social capital, friends' support, civil society organizations and colleagues can be important mediating and protective factors between social change and health outcomes. ...
Eastern Europe underwent one of the most dramatic economic and demographic changes in recent history with skyrocketing mortality rates in some countries during the 1990s. The case of Hungary among the post-socialist transition countries is puzzling for several reasons. Although the Hungarian transition has been often characterised as smooth and successful, a look at the human dimension of the transformation reveals large costs and a slow improvement. Based on the analysis of 29 articles we provide a systematic review of the empirical evidence about the social determinants of mortality in post-socialist Hungary establishing a hierarchy of causes. Socioeconomic position, mental health, social capital, alcohol consumption, stress, and social integration are the most important explanatory variables that received attention by the researchers. Although economic policies might have played a central role in the rise of mortality there is no empirical research on the political economy of health in Hungary. No critical analysis of post-socialism can be complete without assessing the human costs of economic transformation. Social scientists have much to learn from social epidemiologists who have designed robust methodologies and complex theoretical frameworks to analyse the political economic determinants of health.
... Comparing data from the 1988 and 1995 Hungarostudy survey using self-rated health as a dependent variable Kopp, Skrabski, and Szedmák (2000) point out that during the transition years there was a significant decrease in perceived control in work and in perceived social support from co-workers and friends, especially in the lowest socioeconomic groups, which also underpins the unified chronic stress theory approach to explaining the mortality increase during the transition. Kopp, Skrabski, and Szedmák (2000) found that depressive symptom severity mediates between relative socioeconomic deprivation and higher self-rated morbidity rates, especially among men. ...
... Comparing data from the 1988 and 1995 Hungarostudy survey using self-rated health as a dependent variable Kopp, Skrabski, and Szedmák (2000) point out that during the transition years there was a significant decrease in perceived control in work and in perceived social support from co-workers and friends, especially in the lowest socioeconomic groups, which also underpins the unified chronic stress theory approach to explaining the mortality increase during the transition. Kopp, Skrabski, and Szedmák (2000) found that depressive symptom severity mediates between relative socioeconomic deprivation and higher self-rated morbidity rates, especially among men. Low control at work, low perceived social support and emotional coping strategies are also strongly correlated with depressive symptoms, thus the researchers conclude that social deprivation, increased work or unemployment related stress, lack of active and positive coping strategies among the lower social classes and depressive symptomatology represent the vicious circle that explains the decreasing health of Hungarians during the transition years. ...
... These ecological and individual level measures of social integration are in strong correlation with social capital, stress and mental health problems. As Kopp, Skrabski, and Szedmák (2000) and Skrabski, Kopp, and Kawachi (2004) pointed out positive coping strategies, individual signs of social integration and social capital, friends' support, civil society organisations and colleagues can be important mediating and protective factors between social change and health outcomes. ...
Eastern Europe underwent one of the most dramatic economic and demographic changes in recent history with skyrocketing mortality rates in some countries during the 1990s. The case of Hungary among the post-socialist transition countries is puzzling for several reasons. Although the Hungarian transition has often been characterized as smooth and successful, a look at the human dimension of the transformation reveals large costs and a slow improvement. Based on the analysis of 29 articles we provide a systematic review of the empirical evidence about the social determinants of mortality in post-socialist Hungary establishing a hierarchy of causes. Socio-economic position, mental health, social capital, alcohol consumption, stress and social integration are the most important explanatory variables that received attention by the researchers. Although economic policies might have played a central role in the rise of mortality there is no empirical research on the political economy of health in Hungary. No critical analysis of post-socialism can be complete without assessing the human costs of economic transformation. Social scientists have much to learn from social epidemiologists who have designed robust methodologies and complex theoretical frameworks to analyse the political economic determinants of health.
... Hopelessness represents an important risk factor of some mental health disorders, such as depression, suicide, low-subjective well-being, and psychiatric disorders in the general population as well as in clinical populations [3][4][5][6][7][8]. In addition, it is linked with physical illnesses such as hypertension and cardiovascular diseases [1,2,4,9,10]. Therefore, hopelessness is not only a diagnosis category in medicine but also a variable in medical research [4,6]. ...
... According to the studies, hopelessness prevalence varies from 7.5% to 41% among adults [3,6,7,9,13], and scores of hopelessness range between 3.4 and 13.9 from a maximum score of 20 for the Beck Hopelessness Scale [8,[12][13][14][15][16][17]. It may increase in countries with unstable economies [10,18]. Studies also have shown an association with socio-demographic variables such as age, gender, education, income, and social class [6,8,13,16,17,[19][20][21]. ...
... More than half of those whose perceived health was bad felt hopeless. Parallel to the results of our study, other studies have shown that hopelessness is more commonly seen among those in bad health and those who perceive their health as bad [1,4,6,8,10,13,36]. Similarly, among those who had had an illness diagnosed by a physician, those who had had a complaint about their health in the previous 15 days, and the disabled, hopelessness was seen more frequently (p < 0.05). ...
Hopelessness has become an important issue in the fields of health and social care.
This study aims to determine the prevalence of hopelessness and its association with the current health condition, disability, and other socio-demographic characteristics.
The cross-sectional study sampled a population of 501 adults in Bolu, Turkey. Questionnaires included the Household Questionnaire, the Health Condition Questionnaire, Beck Hopelessness Scale, and Brief Disability Questionnaire. Data were collected through face-to-face home interviews between September 29 and October 11, 2003.
The prevalence of hopelessness was 30.9%. It was higher among the literate (60.0%) (p < 0.05), males (35.0%) (p > 0.05), and agricultural workers and peasants (50.0%, 41.9%) (p < 0.05). Almost half of the participants were disabled, and 44.6% of the subjects with disabilities were hopeless (p < 0.05). Being without hope was statistically significant with gender, social class, perceived health, and disability (p < 0.05). The risk of hopelessness increased in subjects with perceived bad health, lowered social class, and disability, compared with the reference groups.
In this study, hopelessness prevalence was high and it was also associated with the current state of health, perceived health, disability, and some socio-demographic variables. It will be important to increase the number of studies related to hopelessness and associated factors for improved mental health services planning at population level.
... Beck Depression Inventory (BDI). The Beck Depression Inventory (BDI, Beck, Ward, Mendelson, Mock, & Erbaugh, 1961;Kopp & Fóris, 1993) contains 21 items measuring the severity of emotional, motivational, cognitive and somatic symptoms of depression. Each item consists of four statements with varying severity of one particular symptom. ...
... It is in line with the negative view of the world in Beck's negative cognitive triad of depression (e.g. Genuchi & Valdez, 2015;Kopp, Skrabski, & Szedmák, 2000;Rude, Chrisman, Burton Denmark, & Maestas, 2012). ...
Theoretical background: The Dysfunctional Attitude Scale (DAS) is a measurement tool that is commonly used to detect dysfunctional beliefs contributing to the emergence and onset of depressive symptoms. Although it has been primarily used for testing clinical populations, and various forms of the scale have been created, only a small body of literature has proved its psychometric adequacy on a clinical sample. Goals: Therefore, the current study aims to construct an updated, reliable and brief version of the DAS. Methods: For this purpose, besides the normal samples of adolescents ( n = 195) and adults ( n = 270), a heterogeneous clinical sample ( n = 1077) was involved in cross-sectional research. Results: The overall results of parallel analysis and exploratory factor analysis suggested a bifactor structure with a general factor and three extracted subfactors (Dependence, Perfectionism and Entitlement), comprising 14 items altogether ( χ ² = 157.26, DF = 63, p < 0.001, CFI = 0.970, TLI = 0.957, RMSEA = 0.036, RMSEA CI 90 = 0.029–0.044). Convergent validity was tested by correlations with Beck Depression Inventory ( r = 0.36, p < 0.001). Conclusion: Our study was based on the largest clinical sample in the field of psychometric analysis of the DAS so far. The findings suggest that DAS14 as a brief version of the original DAS has good psychometric properties, and it can be widely used as a measurement tool in the assessment of mood disorders.
Elméleti háttér: A Diszfunkcionális Attitűd Skála (DAS) egy olyan pszichológiai kérdőíves eljárás, amely azon diszfunkcionális hiedelmek mérésére alkalmas, amelyek hozzájárulnak a depresszív tünetek kialakulásához és fennmaradásához. Annak ellenére, hogy már számos változata létezik és elsődleges használati területét a klinikai populáció jelenti, pszichometriai mutatóit klinikai mintán a kutatások szűk köre vizsgálta. Cél: Jelen tanulmány célja a DAS aktualizálása, rövidítése, megbízhatóságának és validitásának vizsgálata. Módszer: Keresztmetszeti kérdőíves vizsgálatunk keretében egészséges serdülő ( n = 195) és felnőtt ( n = 270) minta mellett heterogén klinikai mintát ( n = 1077) alkalmaztunk. Eredmények: A parallelelemzés és a feltáró faktoranalízis eredményei a bifaktoros struktúrát igazolják. A 14 itemre egy általános és három alfaktor (Dependencia, Perfekcionizmus és Elvárások) illeszthető ( χ ² = 157,26, DF = 63, p < 0.001; CFI = 0,970; TLI = 0,957; RMSEA = 0,036, RMSEA 90% CI = 0.029 – 0.044). A skála konvergens validitását a Beck Depresszió Kérdőívvel való korrelációja alátámasztja ( r = 0,36; p < 0,001). Konklúzió: A DAS pszichometriai vizsgálatai közül ez idáig alkalmazott legnagyobb klinikai elemszámú vizsgálatát mutatja be a ta nulmány. Az eredmények alapján a DAS rövidített változata, a DAS-14 megfelelő pszicho metriai tulajdonságokkal rendelkezik alkalmazható a hangulatzavarok diagnosz tikájában.
... Using a multistage sample of the Russian adult population, Bobak et al. (1998) found that perceived control over life was strongly related to poor self-rated health and low physical functioning, concluding that psycho-social factors rooted in labor market disintegration were crucial to the postsocialist mortality crisis. Comparing data from surveys of the adult population conducted in 1988 and 1995 in Hungary, Kopp et al. (2000) also found a significant decrease in perceived control at the workplace, significantly correlated with depressive symptoms and lower self-rated health. A subsequent survey using data on Hungarian adults robustly linked the lack of control, high weekend workloads, and job insecurity to premature cardiovascular mortality (Kopp et al. 2006). ...
An unprecedented mortality crisis struck Eastern Europe during the 1990s, causing around seven million excess deaths, representing one of the largest demographic catastrophes seen outside famine or war in recent history. Even though life expectancy has improved since then, the postsocialist mortality crisis has left lasting wounds, contributing to deep health inequalities that continue to exist until today. This chapter reviews the extant evidence about the upstream political-economic causes. It shows that violent social dislocations wrought by rapid economic change and attendant public policies were central factors in the postsocialist mortality crisis. We pay special attention to the recent quasi-experimental evidence on the role of privatization and deindustrialization. Reviewing and evaluating the main competing alternative explanations, the chapter demonstrates that a political economy of health approach that moves beyond individualistic, biological, and psychological explanations is necessary to understand health crises properly. Dysfunctional health behavior in the form of alcohol and drug abuse is a crucial but only proximate and not ultimate cause. In most cases, it is on a shared causal pathway linking upstream economic dislocations to individual ill health. We conclude by pointing out the insightful parallels with the Deaths of Despair epidemic plaguing North America.
... Using a multistage sample of the Russian adult population, Bobak et al. (1998) found that perceived control over life was strongly related to poor self-rated health and low physical functioning, concluding that psychosocial factors rooted in labor market disintegration were crucial for the postsocialist mortality crisis. Comparing data from surveys conducted in 1988 and 1995 in Hungary representing the adult population, Kopp et al. (2000) also found a large decrease in perceived control at the workplace, which was significantly correlated with depressive symptoms and worse self-rated health. A subsequent survey using data on Hungarian adults robustly linked the lack of control, high weekend workloads, and job insecurity to premature cardiovascular mortality (Kopp et al. 2006). ...
A socially patterned epidemic of deaths of despair is a signal feature of American society in the twenty-first century, involving rising mortality from substance use disorders and self-harm at the bottom of the class structure. In the present review, we compare this population health crisis to that which ravaged Eastern Europe at the tail end of the previous century. We chart their common upstream causes: violent social dislocations wrought by rapid economic change and attendant public policies. By reviewing the extant social scientific and epidemiological literature, we probe a collection of dominant yet competing explanatory frameworks and spotlight avenues for future sociological contributions to this growing but underdeveloped domain of research. Deaths of despair are deeply rooted in socioeconomic dislocations that shape health behavior and other proximate causes of health inequality; therefore, sociology has great untapped potential in analyzing the social causes of deaths of despair. Comparative sociological research could significantly extend the extant public health and economics scholarship on deaths of despair by exploring the variegated lived experience of socioeconomic change in different institutional contexts, relying on sociological concepts such as fundamental causes, social reproduction, social disintegration, alienation, or anomie.
Expected final online publication date for the Annual Review of Sociology, Volume 48 is July 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
... Ez a megközelítés megjelenik Kopp a "tanult sikeresség" meghatározásában is, mely szerint a "tanult sikeresség (eredményesség) -mint készség -elsajátítása a hallgatói időszak alatt növeli a hallgatók megküzdőképességét, az élettel való elégedettségét, a magasabb jóllét érzetet és megelőzésként hathat a stressz okozta megbetegedések kialakulására. A későbbi, segítő munkájukat is hatékonyabbá teheti, ha a hozzájuk fordulókban is ezt az attitűdöt tudják kialakítani" (Kopp et al. 2000). A pedagógus, mint minta, tehát kulcs a gyermekek és a hallgatók személyiségfejlődésében. Bagdy megfogalmazásában: "A pedagógus alkotómunkája az emberformálás" (Bagdy, 2002). ...
A tanulmány célja bemutatni a well-being készségek jelentőségét a pedagógus hallgatók személyes és szakmai hatékonyságában. A felsőoktatásban elindult paradigmaváltás; a Világgazdasági Fórum Education 4.0 iránymutatásai és a The European University of Well-Being hálózatának megalakulás is igazolja, hogy a jóllét, egy olyan alapvető erőforrás, amely meghatározza az egyetemi hallgatók eredményességét, segíti az önmegvalósítást és a kreatív gondolkodást, valamint olyan készségekkel, attitűddel ruházza fel a hallgatót, amelyekkel képes adekvátan reagálni a társadalmi és gazdasági változásokra. A pedagógusképzésben ez különös jelentős, hiszen a pedagógus személyes jólléte multiplikátor hatással bír; így képes befolyásolni az általa formált gyermekek hangulatát, érzelmi fittségét, mentális és érzelmi jóllétét. A jövő generációi számára meghatározó, hogy milyen attitűdöt, szemléletet mintáz abban az időszakban, amikor a személyiség rugalmasan formálható. Jelen tanulmány is igazolja, hogy a pedagógus képzésben ezen készségek tudatos fejlesztése nagyon időszerű; az eredmények alátámasztják, hogy a hallgatók általános jólléte nem megfelelő.
... Importantly, CKD means more than bearing the physical burden of renal failure, therefore just educating patients about the illness does not fulfill the aim of complex, holistic care [9,15]. According to the biopsychosocial Model of Health the individual's psychological and social factors, his/her thoughts, feelings, and values play significant role in the course of disease [17,18]. CKD with its treatment is complex, intrusive, life-long illness. ...
Background
Multidisciplinary education including psychosocial care (MDE) may alleviate high burden of chronic kidney disease (CKD). Family support also has utmost importance, yet, MDE has rarely been provided jointly for patients and their relatives.Methods
We organized intensive, 1-week-long boarding MDE and lifestyle camps for CKD stage III–V patients and their relatives and assessed the rate of CKD progression, proportion of participants’ home-based dialysis choice, transplant activity, and improvement of their coping and attitude evaluated by written narratives. Outcome was compared to 40 controls with similarly advanced CKD, under standard of care on our outpatient clinic.ResultsIn 60 predialysis patients, serum creatinine 12 months before participation was 281 [IQR 122] µmol/l, right before MDE 356 [IQR 141] µmol/l, 12 months after MDE 388 [IQR 284] µmol/l, eGFR decreased from 18.5 [IQR 10] ml/min to 14.0 [IQR 7] ml/min and 13.0 [IQR 8] ml/min, respectively. Twelve months’ changes before and after MDE differed significantly (p = 0.005 for creatinine; p = 0.003 for eGFR). Decreased progression was found in comparison to controls (p = 0.004; 0.016, respectively) as well. During follow-up, MDE patients compared to controls chose PD as dialysis modality more often (p = 0.004), and were more active in renal transplantation (p = 0.026). Based on narratives, MDE enhanced participants’ disease-specific knowledge and ability for coping. It also improved sympathy, helpfulness, and the mutual responsibilities of family members.Conclusions
Our unique MDE programme with participation of the closest relatives enhanced the effectiveness of education and strengthened family support, which contributed to favorable CKD outcome, increased activity in home-based dialysis selection and transplant activity.
... A WEF első pontjaként kijelölt Globális polgár képességek fejlesztése megjelenik Kopp a "tanult sikeresség" meghatározásában is, mely szerint a "tanult sikeresség (eredményesség) -mint készség -elsajátítása a hallgatói időszak alatt növeli a hallgatók megküzdőképességét, az élettel való elégedettségét, a magasabb jóllét érzetet és megelőzésként hathat a stressz okozta megbetegedések kialakulására. A későbbi, segítő munkájukat is hatékonyabbá teheti, ha a hozzájuk fordulókban is ezt az attitűdöt tudják kialakítani" [24] [25]. A pedagógus mint minta tehát kulcs a gyermekek és a hallgatók személyiségfejlődésében. Bagdy megfogalmazásában: "A pedagógus alkotómunkája az emberformálás [26]. ...
... Physical ill health is detrimental to mental health as much as poor mental health contributes to poor physical health. For example, malnourishment in infants can increase the risk of cognitive deficits; heart disease and cancer can increase the risk of depression (Marmot et al., 1999;Blane et al., 1996); mood disorders can lead to an increased risk of accidents, injuries and poor physical and role function (Wells et al 1989); learned helplessness, hopelessness and depression are associated with decreased immunological activity and an increased risk of tumour growth and infections (Kopp, 2000). Because of this interrelationship, often outcomes of interventions to improve physical health lead to improved mental health and vice versa (Herman and Jané-Llopis, 2005). ...
... A Black-riport kiterjedt ajánlásait a helyzet javítására az akkori konzervatív kormány ugyan nem fogadta el, de a dokumentumnak alapvető szerepe volt abban, hogy az egészségi állapot egyenlőtlenségei az azt követő évtizedek során Nagy-Britanniában (Acheson Report), Európában (Mackenbach Report) és globálisan (az EVSZ egészségjelentései) is a tudományos és az egészségügyi döntéshozói érdeklődés előterébe kerültek. Magyarországon a budapesti halálozás kerületek közti egyenlőtlenségeiről a rendszerváltás előtt Józan Péter (1986), az országos egészségi egyenlőtlenségekről a rendszerváltás évében Orosz Éva jelentetett meg úttörő jelentőségű közleményt (Orosz, 1990), amelyet az elmúlt húsz évben számos hazai szakember elemzései követtek (Kopp et al., 2000;Egészség-Monitor, 2008;Juhász et al., 2010). ...
... Such factors are more likely to be salient in neighbourhoods with high levels of poverty [37] and, hence, residents experience unfulfilled needs and dissatisfaction that may be risk factors for depression. In situations of high material deprivation, cognitions relating to hopelessness, loss of control and helplessness have been linked to depression outcomes [38]. ...
Background
Depression contributes substantially to the burden of disease in South Africa. Little is known about how neighbourhoods affect the mental health of the people living in them. Methods
Using nationally representative data (N=11,955) from the South African National Income Dynamics Study and the South African Indices of Multiple Deprivation (SAIMD) modelled at small-area level, this study tested associations between neighbourhood-level deprivation and depression, after controlling for individual-level covariates. ResultsResults showed a significant positive association between neighbourhood-level deprivation and depression using the composite SAIMD (β = 0.31 (0.15); p=0.04) as well as the separate deprivation domains. Living environment deprivation (β =0.53 (0.16); p=0.001) and employment deprivation (β = 0.38 (0.13); p=0.004), respectively, were the two most salient domains in predicting this relationship. Conclusions
Findings supported the hypothesis that there is a positive association between living in a more deprived neighbourhood and depression, even after controlling for individual-level covariates. This study suggests that alleviating structural poverty could reduce the burden of depression in South Africa.
... Social support. We administered a version of Caldwell's Support Dimension Scale adapted to the Hungarian context (Caldwell, Pearson, & Chin, 1987;Kopp, Skrabski, & Szedma´k, 2000). A low level of social support has been found to be one of the most important risk factors of suicidal behaviour in Hungary (Kopp & Szedma´k, 1997). ...
In recent years, suicide rates in Hungary have been among the highest in the European Union. Attempted suicide rates in the Roma population are 2-3 times higher than in the non-Roma population. Since individuals making multiple attempts have a higher pro-bability of eventual death by suicide, and there are limited data on suicidal behaviour of the Roma population, the aim of this study was to explore the sociodemographic and psychological background factors of multiple suicide attempts in the Hungarian Roma population. Semistructured interviews were conducted with 150 individuals admitted to hospital toxicology departments, who made suicide attempts by deliberate self-poisoning, 65 of whom were multiple attempters. Detailed information regarding the current attempt and previous suicidal acts was recorded. Patients also completed the Shortened Beck Depression, the Beck Hopelessness Questionnaire, and the Social Support Questionnaire. Independent samples t-tests were used to evaluate differences in psychological variables between the Roma ( N = 90) and non-Roma ( N = 60) groups. Stepwise linear regression and odds ratios analyses were performed to identify potential background factors of multiple suicide attempts. There was a significantly higher level of previous suicidal events among the Roma in the sample population (3.53 vs. 0.84, p < .001). Roma ethnicity was found to be a strong predictor of multiple suicide attempts. Current major depression, hopelessness, and diagnosed mood disorder were identified as significant risk factors of repeated attempts. Smoking (OR = 5.4), family history of suicide (OR = 4.9), and long-term unemployment (OR = 4.6) were additional risk factors among Roma patients. A thorough understanding of the ethnicity-specific risk factors for multiple suicide attempts could facilitate the development of effective intervention and postvention programmes.
... Furthermore, it is not clear if the observed health inequalities are driven primarily by factors that cannot be influenced by policy makers in the short term (such as schooling attainment and household wealth), or by other factors such as the accessibility and quality of health care. The linkage between the health status and socioeconomic characteristics of adults is found to be strong in transition economies (Gilmore, McKee, and Rose 2002;Kopp, Skrabski, and Szedmak 2000;Bobak et al. 1998;Bobak et al. 2000;Leinsalu 2002;Wroblewska 2002;Thompson, Miller, and Witter 2003). But this literature might be overstating the impact of socioeconomic characteristics on health because the estimated relationships are subject to omitted-variables bias: none of the papers listed above consider household health environment (e.g., humidity, cold, noise, polluted air, poor water quality, etc.) or availability of health facilities in the community as determinants of healthiness. 1 This approach is inconsistent with the theoretical formulations of the determinants of health status, which acknowledge the possible role of local environmental factors (Strauss and Thomas 1998). ...
... N. Rimashevskaya believes that the reforms of the 1990s impaired the social / demographic development due to the significant deterioration of the habitat and the living standard, social tension and instability, insurmountable difficulties in the adaptation to the transition to market [1]. Some researchers tried to explain the negative effects of the social changes on the health of the population by the deformations which emerged in the socio-economic structures of the communities [2]. W. Cockerham, on the contrary, insists that the reason of the bad health of the population is the traditional lifestyle of the population of post-communist countries, which contradicts the new economic market relations [3]. ...
The article presents the results of a research into the interrelation between of welfare and the public health of the Russian population in the context of economic volatility. The authors review the indicators used both in Russian and international practice for the assessment of the public sentiments dynamics. The concept of “socio-psychological potential of a region” is shown to be the indicator of the public health. Based on this concept, the pattern of the potential has been formed. It has been developed a methodology for the assessment of the socio-psychological potential of a region, which is based on the central idea of the integrated estimation of the potential of a region as a whole and also from the point of its separate components. The article provides the assessment of the potential of the constituent entities of the Russian Federation. The authors determine the nature and strength of the relationships between the welfare indicators and the level of the socio-psychological potential of the subjects of the Russian Federation based on the construction of correlation matrices, and besides they identify regional patterns and trends.
... Egy 0-tól (nagyon elégedetlen) 10-ig (rendkívül elégedett) terjedő Likert-skálán értékelhették válaszaikat a páciensek a következő kérdésre: "Egészében véve, mennyire volt elégedett a(z) …… által nyújtott szolgáltatásokkal?" Továbbá felmértük azt is, hogy a betegek nyitottak-e beszélni betegségi állapotukról -ennek kiderítésére egy 0-val (nem) vagy 1-el (igen) megválaszolható zárt kérdést alkalmaztunk: "Nyitott-e a betegségéről folytatott további beszélgetésre?" Pszichoszociális változók. A depresszióra utaló tünetek meglétét és súlyosságát mértük fel a Beck-féle Depressziós Skála 9-itemes rövidített változatának segítségével (BDI) (Beck et al 1961;Kopp et al 1998;Kopp et al 2000). Jelen tanulmányban megfelelő volt ennek a skálának a belső konzisztenciája (Cronbach α = 0,87). ...
... Ad esempio, gli studi inglesi di Whitehall I e II (Marmot et al., 1991), tra i più noti, evidenziavano come condizioni lavorative caratterizzate da basso controllo e alto carico di lavoro fossero dannose per la salute e come il rischio di morte nei lavoratori non specializzati fosse 2,5 volte superiore rispetto a quello dei vertici aziendali. Kopp et al. (2000) trovavano che, in una coorte di 12.640 soggetti rappresentativa della popolazione ungherese, le variazioni di PIL, le diseguaglianze di reddito e la depressione, misurata con la Beck Depression Inventory-BDI (Beck, Ward, Mendelson, Mock e Erbaugh, 1961), spiegavano il 78,6% della varianza di mortalità tra gli uomini. ...
Riassunto L'articolo persegue il fine di delineare una storia dei principali sviluppi scientifici della Medicina Comportamentale, a partire dalla nascita negli anni '70, fino a oggi. Quasi ogni branca della Medicina è stata interessata dalla Medicina Comportamentale e questo articolo vuole mostrarne i motivi di fondo. Area multi-disciplinare autonoma, la Medicina Comportamentale è emersa a seguito della convergenza di alcuni nuovi problemi con nuove opportunità: la diffusione delle malattie cronico-degenerative, il fallimento della psicosomatica, l'aumento dei costi dell'assistenza medica si incontrarono con il successo delle terapie comportamentali, l'affermazione del biofeedback (BFB) e lo sviluppo delle scienze del comportamento. Un interesse centrale venne assunto dai comportamenti di rilevanza per la salute o salutotropi. Vengono forniti esempi tratti dai campi della cardiologia e dell'obesiologia. In seguito, la diffusione delle ricerche sullo stress, comprese quelle di epidemiologia sociale, nonché un interesse verso un paradigma salutogenetico piuttosto che nei confronti di quello patogenetico dominante, hanno consentito di integrare molti contributi sperimentali di orientamento più sociale e cognitivo, dando luogo a un viraggio scientifico chiamato Medicina Psicosociale; questa nuova espressione copre un'area meno definita ma ancora ampiamente sovrapposta alla Medicina Comportamentale, in cui si riconosce una più chiara affermazione del Modello Bio-Psicosociale (MBPS), già implicito nella nota definizione di salute dell'OMS del 1948. Parole chiave: Storia della scienza, Medicina Comportamentale, Medicina Psicosociale, Paradigma salutogenetico, Biofeedback, Comportamenti salutotropi, Stress, Modello bio-psicosociale. Abstract Behavioural Medicine and its developments A history of the most prominent scientific developments of Behavioural Medicine (BM) is outlined, from its beginnings in the '70s up to today. Behavioural Medicine has been involved in almost every branch of Medicine so far, and this paper aims to show the basic reasons. As an autonomous multidisciplinary area, Behavioural Medicine emerged as a convergence of new problems with new opportunities: the spreading of chronic-degenerative diseases, the failure of psychosomatics, and the rising costs of medical care could intercept the success of behaviour therapies, the spreading of bio-feedback (BFB) and the developments of behavioural sciences. Health behaviours received a paramount interest; examples are drawn from the fields of behavioural cardiology and obesiology. Afterwards, the dissemination of research studies on stress, and a rising interest towards a Psicoterapia Cognitiva e Comportamentale
... Greater life satisfaction was significantly associated with better SRH [13]. The strongest predictor of SRH in our study was depression, especially for women and the elderly, which was consistent with previous studies [12,46,47]. Therefore, the depression much be considered for when dealing with health problems, especially for women and the elderly. ...
Background
Self-rated health (SRH) is not only used to measure health status and health inequalities, but also as a strong predictor of morbidity and mortality. The purpose of this study was to: 1) evaluate the factors that account for variations in self-rated health among Chinese citizens; and to 2) explore the process through which socio-economic status may impact self-rated health.
Methods
Data were derived from the Chinese General Social Survey (CGSS) (2013). Determinants of self-rated health were analyzed along four main dimensions: demographic characteristics, socio-economic status, lifestyle, and psychosocial factors. Multivariate odds ratios for good self-rated health were calculated for different variables in order to analyze the determinants. Binary logistic regression analysis was performed to assess the extent to which lifestyle and psychosocial factors explained the association between socio-economic status and self-rated health.
Results
About 65% of the survey respondents reported good self-rated health. Women, the elderly, married or single respondents and residents of Western China were less likely to report good self-rated health. Respondents who were engaged in work, had higher household income, reported high social class and higher socio-economic status compared with peers were more likely to report good self-rated health. Normal weight and physically active respondents along with those reporting a happy life, no depression, and good relationships with families and friends were related to good self-rated health. We also found the effect of socio-economic status on self-rated health was partly explained by lifestyle and psychosocial factors.
Conclusion
The present findings support the notion that both socio-economic status and lifestyle as well as psychosocial factors were related with good self-rated health. The interventions targeting these factors could improve the health status of the population. The depression was the most influential predictor of self-rated health, especially for the women and the elderly. Although lifestyle and psychosocial factors explained partly the the association between socio-economic status and health, the reason why socio-economic difference exists in health must be further explored. What’s more, it needs to be further studied why the same determinant has different influence strengths on the health of different groups of people.
... A "tanult sikeresség" (eredményesség) -mint készség -elsajátítása a hallgatói időszak alatt növeli a hallgatók megküzdőképességét, az élettel való elégedettségét, a magasabb jól-lét érzetet és megelőzésként hathat a stressz okozta megbetegedések kialakulására. A későbbi, segítő munkájukat is hatékonyabbá teheti, ha a hozzájuk fordulókban is ezt az attitűdöt tudják kialakítani [13,14]. ...
Introduction:
Studies on well-being of students in higher education are in the centre of international research interest, because adult health as a value plays an important role in the life of future generation.
Aim:
The authors studied variables that affect the value of well-being (satisfaction with life, student success, satisfaction with academic infrastructure, sports and financial situation of parents) among medical and health science students starting their studies.
Method:
The Hungarian version of the Word Health Organization WBI-5 (General Well-Being Index, 5-item version) were used. This questionnaire has a high internal reliability (Cronbach's alpha: 0.778).
Results:
The unrotated principal component analysis of the questionnaire survey confirmed the homogeneity of the database utility (Kaiser-Meyer-Olkin-index = 0.748; Bartlett test<0.0001). On the basis of stepwise linear regression (R = 0.458, R(2) = 0.21, F = 16.33, p = 0.001, VIF values around 1) showed (i) a positive relationship with explanatory variables such as faculty and sport activity, satisfaction with life scale and university infrastructure, and (ii) a negative relationship with gender and parental substance.
Conclusion:
The authors conclude that short Well-Being Index is a reliable and valid instrument to measure positive quality of life of medical students. Furthermore, the Well-Being Index can help university faculties and lecturers to deploy the student facilities and to eliminate the harm of stress situations. Orv. Hetil., 2016, 157(44), 1762-1768.
... Per fare un solo esempio, in una coorte di 12.640 sog getti rappresentativa della popolazione ungherese, le variazioni di PIL, le diseguaglianze di reddito e la depressione (misurata mediante il Beck Depression Inventory) spiegavano il 78,6 % della varianza di mortalità tra gli uomini. (Kopp et al., 2000). ...
Dalla fine della seconda guerra mondiale non vi sono stati fortunatamente nuovi conflitti generali, come quelli che hanno devastato il mondo nel XX secolo. Tuttavia, le guerre locali si sono susseguite in maniera ininterrotta in alcune parti del mondo, mentre in altre la " strategia della tensione ", legata ad attentati con o senza sicura attribuzione, hanno mantenuto un clima di incertezza e di paura. È stato così alimentato lo spettro di una terza guerra mondiale, stavolta combattuta con armi nucleari. La caduta del muro di Berlino ha ridisegnato la mappa dei poteri mondiali, ma è dall'11 settembre 2001 che il fenomeno bellico ha acquisito un nuovo profilo nella percezione dell'opinione pubblica: uno scontro di religioni, anzi più radicalmente, secondo molti, uno " scontro di civiltà ".
... The Beck Depression Scale -BDI (Beck et al., 1961;Kopp et al., 1998Kopp et al., , 2000 basically depicts elements that outline the clinical picture of depressive symptoms: social isolation, decisional incapacity, sleep disorders, intense fatigue, overreactions to minor physical symptoms, inability to work and feel joy, self-blame. Patients enrolled in the study were presented with a questionnaire with items scored from 0 (not at all) to 3 (very much). ...
... Badania prowadzone w krajach zachodnich [10][11][12][13][14][15][16][17][18][19] oraz w krajach post-komunistycznych [20][21][22][23][24] wykazały, że ryzyko zachorowania i zgonu jest zdecydowanie wyższe wśród ludności z niższych grup społecznych, o niższych dochodach i niższym wykształceniu. ...
trwania życia pomiędzy poszczególnymi województwami w związku ze
zróżnicowaniem współczynników natężenia zgonów. Duży wpływ na tę
sytuację niewątpliwie mają czynniki społeczno-ekonomiczne.
Cel pracy. Ocena zależności pomiędzy wartościami standaryzowanych
współczynników zgonów ogółem a wybranymi cechami społecznoekonomicznymi
mieszkańców poszczególnych województw:
przeciętnym miesięcznym wynagrodzeniem brutto, stopą bezrobocia
oraz odsetkiem osób z wyższym wykształceniem.
Materiał i metody. Przeprowadzono standaryzację współczynników
zgonów dla poszczególnych województw Polski w 2008 roku. Kierunek
i siłę zależności pomiędzy wartościami SDR a analizowanymi zmiennymi
społeczno-ekonomicznymi zmierzono przy pomocy współczynnika
korelacji rxy Pearsona. Do oceny dopasowania funkcji regresji do danych
empirycznych wykorzystano współczynnik determinacji R2.
Wyniki. Współczynniki rxy dla zależności pomiędzy wartościami
standaryzowanych wskaźników zgonów a analizowanymi cechami
społeczno-ekonomicznymi wynosiły: dla odsetka osób z wyższym
wykształceniem -0,29 (p>0,05), dla przeciętnego miesięcznego
wynagrodzenia brutto -0,17 (p>0,05), dla stopy bezrobocia 0,16
(p>0,05). Współczynnik determinacji R2 dla modelu regresji
wielorakiej uwzględniającego jednoczesny wpływ wszystkich trzech
analizowanych zmiennych zależnych na poziom umieralności wynosił
10,5% (p>0,05).
Wnioski. Wartości standaryzowanych współczynników zgonów
korelowały dodatnio ze stopą bezrobocia i ujemnie z odsetkiem osób
z wyższym wykształceniem i przeciętnym miesięcznym wynagrodzeniem
brutto. Najsilniejszą korelację z wartościami współczynników zgonów
wykazywał udział osób z wyższym wykształceniem.
... Setul de chestionare completate de pacienþi cuprinde urmãtoarele scale ºi întrebãri: Scala de Depresie Beck (Beck et al., 1961;Kopp et al., 1998Kopp et al., , 2000, conþine nouã afirmaþii, cu un punctaj de la 0 la 3 (0 = nu e deloc caracteristic, 1 = puþin caracteristic 2 = caracteristic ºi 3 = foarte caracteristic). Pe baza valorilor (0 = punctaj minimal ºi 60 = punctaj maximal) existã patru categorii de depresie: nu suferã de depresie (0-9 puncte), depresie non-clinicã (10-18 puncte), depresie moderatã (19-26 de puncte) ºi depresie severã (peste 26 de puncte) (Cronbach alpha = 0,86). ...
Objectives: Recent psychooncological literature evidences the multiple traumatic effects of cancer diagnosis disclosure but only few studies are concerned with the consequences of cancer diagnosis non-disclosure. The aims of this study were to measure prevalence of cancer diagnosis non-disclosure, to analyze demographic, medical and psychosocial factors that may explain the non-disclosure of cancer diagnosis to patients and to compare cancer disclosure and non-disclosure in relation to study variables.Methods: According to the tumour location, our heterogenic, mixed sample includes 420 adult oncology patients, 342 with malignant and 78 with benign tumours (average age 51.95 years). 238 women and 185 men completed our questionnaire which included standard measures of depressive symptoms (BDI), hopelessness, ways of coping and negative life events.Results-conclusion: Our results clearly show that patients who are not informed about their cancer diagnosis are significantly more depressed, hopeless and with lower levels of problem-focused coping compared to patients who are informed. Also, patients who were not told about their cancer diagnosis tended to be older, with a mandatory education or less and living in small communities. The odds of not being personally informed about cancer diagnosis were highly increased by malignant cancer diseases, clinical, severe depression and lack of chemotherapy treatment. Data were controlled for the most relevant demographic, social and oncological factors. Based on our research, we advocate for the development of new patient-focused services in oncology in Romania. Social work can be one of the comprehensive support sources by providing psychosocial and practical support to cancer patients and their families.
... For women, only the group working 60 or more hours per week showed higher odds. Thus, income level was linked to suicidal thoughts more for men than women, which is supported by reports that socioeconomic deprivation in men, but not women, has been strongly related to severity of depressive symptoms [31]. However, other studies have reported that household income might have more serious effects on depressive symptoms in women than men [32]. ...
Long working hours are a worldwide problem and may increase the risk of various health issues. However, the health effects of long working hours on suicidal thoughts have not been frequently studied. Our goal was to investigate the relationship between long working hours and suicidal thoughts in the rapidly developing country of Korea.
Data from 12,076 participants (7,164 men, 4,912 women) from the 4th and 5th Korean National Health and Nutrition Examination Surveys were used for the current analysis. Multivariate logistic regression models were used to estimate odds ratios and 95% confidence intervals for suicidal thoughts. Combined effects of long working hours and lower socioeconomic status or sleep disturbance were also estimated.
Compared to groups who worked less than 52 hours per week, odds ratios (95% confidence intervals) for suicidal thoughts in groups who worked 60 hours or more per week were 1.36 (1.09-1.70) for males and 1.38 (1.11-1.72) for females, even after controlling for household income, marital status, history of hypertension or diabetes mellitus, health-related behaviors, and past two weeks' experience of injury, intoxication, or acute or chronic diseases, as well as type of work. The combined effects of long working hours with lower socioeconomic status, or with sleep disturbance, were also significantly higher compared to participants who worked less than 52 hours per week with higher socioeconomic status, or with 6-8 hours of nighttime sleep.
In this study, long working hours were linked to suicidal thoughts for both genders. Additionally, the odds of those suicidal thoughts were higher for lower socioeconomic groups. To prevent adverse psychological health problems such as suicidal thoughts, a strategy regarding long working hours should be investigated.
Literature data show that acute, severe, and also chronic stress play an important role in the development of somatic and mental disorders. It is well documented in the literature that starting university studies results in anxiety in many ways for individuals. In this present work, we examined how perceived stress affects the appearance of depression and sleep disorders among a special group: the first-year undergraduates. In February 2020, 134 students completed a 14-question Perceived Stress Scale questionarre. In addition, the 13-question Beck Depression Scale and the 8-question Athens Insomnia Scale were used as measures to assess their current mental health status. Following the outbreak of the COVID-19 pandemic, the extent to which anxiety and depressive symptoms changed had become a major issue worldwide. In June 2020, we repeated our previous measures in the given population with the same methods. Our research clearly proved higher perceived stress values among undergraduate students, which were associated with high depressive symptom parameters and insomnia. However, unexpectedly, questionnaires completed during the quarantine period of the COVID pandemic showed lower perceived stress, which was accompanied by a decrease in depressive symptoms and insomnia.
Аналитический доклад подготовлен научным коллективом Института демографических исследований ФНИСЦ РАН. В докладе рассматриваются тенденции демографического развития стран бывшего СССР в 1991–2021 гг. В докладе дан комплексный анализ семейно-демографических и миграционных процессов, а также результативности семейной, демографической и миграционной политик стран бывшего СССР за тридцать лет, даны некоторые прогнозные оценки динамики численности населения в регионе на среднесрочную перспективу. При подготовке аналитического доклада были использованы данные Межгосударственного статистического комитета СНГ, национальных служб государственной статистики, Евростата, международных организаций системы ООН. Доклад адресован государственным служащим, научным сотрудникам, преподавателям университетов, аспирантам и студентам.
Using administrative data on a random 50% of the Hungarian population, including individual-level information on incomes, healthcare spending, and mortality for the 2003–2011 period, we develop new evidence on the distribution of healthcare spending and mortality in Hungary by income and geography. By linking detailed administrative data on employment, income, and geographic location with measures of healthcare spending and mortality we are able to provide a more complete picture than the existing literature which has relied on survey data. We compute mean spending and 5-year and 8-year mortality measures by geography and income quantiles, and also present gender and age adjusted results.
We document four patterns: (i) substantial geographic heterogeneity in healthcare spending; (ii) positive association between labor income and public healthcare spending; (iii) geographic variation in the strength of the association between labor income and healthcare spending; and (iv) negative association between labor income and mortality. In further exploratory analysis, we find no statistically significant correlation between simple county-level supply measures and healthcare spending. We argue that taken together, these patterns suggest that individuals with higher labor income are in better health but consume more healthcare because they have better access to services.
Our work suggests new directions for research on the relationship between health inequalities and healthcare spending inequalities and the role of subtler barriers to healthcare access.
This study assessed the gender differences in determinants of fair/poor self-rated health among African American churchgoers in Omaha, Nebraska. Using data collected from 353 African American (245 women and 108 men) by the Center for Reducing Health Disparities at the University of Nebraska Medical Center in 2017, univariate and multivariate logistic regressions were performed to examine the gender differences in the relationships between fair/poor self-rated health and potential health determinants. Overall, 14.3% of women and 17.6% of men reported fair/poor self-rated health. There was a significant association between depression and poor/fair self-rated health among women (p = 0.044) and men (p = 0.001). For women, the fully controlled model confirmed the crude association between perceived poor/fair self-rated health and heart disease (OR = 3.10) and education (OR = 2.19). For men, the final model identified significant determinants of perceived fair/poor self-rated health such as depression (OR = 12.51) and diabetes (OR = 3.89). When assessing gender differences in determinants of self-rated health, similarities are higher than differences between the two groups. In both groups, the presence of depression was the strongest determinant of poor health. Future research should assess the immunological aspects of the association between psychological factors and perceived chronic diseases.
A sport egészségi állapotra gyakorolt pozitív hatását számos tanulmány bizonyította már. Az egészségi állapot pedig alapvetően meghatározza az egyéni életminőséget is.
A tanulmány a vonatkozó szakirodalom feldolgozásával kísérletet tesz összefoglalni, hogy a sportfogyasztás, a jövedelmi színvonal és a jövedelemegyenlőtlenség, mint gazdasági tényezők, kiegészülve a gazdasági növekedésben kulcsszerepet játszó egészségi állapottal hogyan hatnak az egyéni életminőségre, mint a jólét egyik legfontosabb indikátorára.
Végül egy a szerző által fontosnak vélt kutatási irány megfogalmazására kerül sor.
AIMS: Health behaviours – alcohol drinking, smoking, poor diet and physical inactivity – are influenced by various psychosocial factors. Despite evidence linking work stress and personality constructs independently to health behaviours, only limited literature is available on the relationship between work stress, personality and health behaviours. The aims of the thesis are: (1) to examine the potential role of overcommitment (OC) personality in the relationship between work stress defined by the Effort–Reward Imbalance (ERI) model and health behaviours; (2) to investigate the potential role of perceived control (PC) in the relationship between ERI, OC and health behaviours. METHODS: This project used data from the HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study, which randomly selected people aged 45 to 69 years from population registers in Russia, Poland and the Czech Republic. A two–wave cohort study for drinking and smoking outcomes (n= 7,513) and a cross–sectional study for dietary outcomes (n= 11,012) were analysed by logistic regression and structural equation modelling. RESULTS: In terms of the potential role of OC in the relationship between ERI and health behaviours, OC and ERI may have bi–directional relationship; the effect of OC on ERI was stronger than the other direction in the middle–aged and older populations. Thus, antecedent role of OC in the relation between ERI and health behaviours was statistically significant, but mediator role of OC was not. With regards to the potential role of PC in the relationship between OC, ERI and health behaviours, both ERI and PC partially mediated the effects of OC on health behaviours; ERI and PC may have bi–directional relationship. CONCLUSION: This thesis will contribute to deeper understanding of intersecting pathways by which work stress (ERI) and personality constructs (OC and PC) jointly influence health behaviours, thereby providing insight into research, practice and policy
https://discovery.ucl.ac.uk/id/eprint/1522338/
Die gegenwärtige Psychiatrie geht von multifaktoriellen Modellen der Genese psychischer Erkrankungen aus. Daraus entsteht die Notwendigkeit unterschiedlicher, sich ergänzender Zugänge zum Gegenstand, um dessen biologischen, psychologischen und soziologischen Aspekten gerecht zu werden. Sie beinhaltet nicht nur psychosoziale Aspekte der Prädisposition, Manifestation, des Verlaufs und Ausgangs psychischer Erkrankungen, sondern auch Aspekte des Behandlungs- und Wissenschaftssystems Psychiatrie sowie der gesellschaftlichen Stigmatisierung psychisch Kranker. Die vorliegende Themenauswahl ist daher zwangsläufig selektiv.
This chapter focuses on disability and chronic illness. It draws on literature from medical sociology and disability studies to explore the meanings that individuals and families make of illness, incapacity, and bodily uncertainty, as well as broader questions around the social oppression which turns bodily impairments into handicaps and disability. The chapter works through a range of theoretical perspectives including arguments about the biographies of chronic illness, the social production of chronic illness, stigma and the social model of disability. A case study is discussed of disability in India. The chapter concludes that because the stigmatization faced by people living with long-term conditions is socially, culturally and environmentally shaped, we can be hopeful that their experiences may change.
„Gesundheitsförderung zielt aufeinen Prozess, alien Menschen ein höheres Maβ an Selbstbestimmung über ihre Gesundheit zu ermöglichen und sie damit zur Stärkung ihrer Gesundheit zu befähigen“ (WHO 1986).
Similarly to the international tendencies, the remarkable and increasing ageing of the population and the phenomenon of the “féminisation of ageing” are characteristic to Hungary, as well. Life expectancy of Hungarian women in 1900 was 38.2 years and that of men was 36.6 years (gender difference: 1.6 years), while these rates in 2000 were 75.6 and 67.1 years (gender difference: 8.5 years) (Table 1). In 1990 the rate of those older than 60 years was 18.9%, in 2001 this rate was 20.4%, while it is expected that by 2050 the rate of those older than 65 years will be more than 25% (Jeszenszky, 2003). The life expectancy is worse, and the gender difference is more remarkable in the East European region than in Western Europe. While in the 1970s the life expectancy of the Hungarian men and women was better than in the neighbouring Austria, today Austrian men live 7.7 years longer and Austrian women 5.2 years longer than their Hungarian counterparts.
Im Rahmen der Life-event Forschung zur Pathogenese und zum Verlauf depressiver Störungen haben sich einige psychosoziale Faktoren als relevante Moderatorvariablen erwiesen. Diese Faktoren können das Risiko, an einer Depression zu erkranken, vergrößern, indem sie zu einer erhöhten Vulnerabilität beitragen. Die Life-event-Forschung konnte belegen, daß depressive Erkrankungen häufig in der Folge eines kritischen Lebensereignisses, vor allem nach Verlusterfahrungen, auftreten, und daß vulnerable Menschen eher mit einer Depression auf ein kritisches Lebensereignis reagieren. Als Vulnerabilitätsfaktoren wurden beispielsweise negative Kindheitserlebnisse, geringes Selbstwertgefühl und schlechte Beziehungsqualität untersucht. Auch genetische Faktoren sind wesentlich.
The Oxford Texbook of Suicidology is the most comprehensive work on suicidology and suicide prevention that has ever been published.
Relationships between traditional gender-roles and prevalence of mental disorders are discussed by giving an overview over epidemiological data in this field. Gender refers to the social constructions of masculinity and femininity. It is a central determinant of health and illness, linking personal/social identity and societal conditions. There are different gender-related profiles of mental disorders, which are associated with risk factors, which evidently result in different consequences for males and females. These risk factors stem from the socioeconomic position (multiple roles vs. role reduction, unemployment, effort-reward-imbalance at work, marriage/separation) as well as from gender bias in medical institutions. Health risks are not only externally mediated by gender-roles, but may also develop due to the internalisation of masculine and feminine norms. This leads to different gender-related stress-response and coping strategies. Thus, gender-related concepts of health and illness, gender-related patterns of stress, and deficiences of normative socialisation add to affective and psychosomatic disorders in females, and to alcohol dependence, personality disorders, violence and suicide in males. The impact of gender on mental health has numerous implications for research, therapy, and health policies.
The paper provides a comprehensive review of the major contributing factors to depression for individuals with chronic musculoskeletal pain resulting from injuries at work. The review addresses current literature on such factors based on the biopsychosocial conceptualization of depression and pain. The four categories of contributing factors include: (1) biological factors (neurochemical and genetics aspects); (2) psychological factors (negative cognitive structures, learned helplessness and learned hopelessness); (3) social factors (stress and negative life events, family and social support, interpersonal, problem solving and coping skills); and (4) vocational factors (pain perceptions, activity interference, employment/compensation factors). The major aim of this review is to delineate the importance of understanding the unique factors of depression with clients with work-related chronic pain. Implications for practice for the rehabilitation counseling profession will be discussed.
This chapter explores the dynamics of changes in health indicators in Central and Eastern Europe over the last 20 years. It presents illustrations of the East-West health divide from different countries and compares groups of countries. It offers in-depth case studies from Bulgaria and Romania to represent further dimensions of the psychosocial and a sociocultural contextualization of health. The events in Eastern Europe illustrate the importance of bringing a contextual lens to health psychology phenomena. Behaviour change models need to take into account meanings of health and of health protective, preventive, or risk behaviours. Lifestyles cannot be conceptualized as purely individual choices, but are co-constructed within cultural values and contingent upon material conditions. Health care reform in Central and Eastern Europe needs to be undertaken in multiple directions simultaneously-structural and policy changes, health promotion, behavior change interventions, using participatory approaches coordinated with community groups-to ensure that health indicators will continue to improve.
Dégi, L. Cs. (2010). Daganatos distressz és életminőség - kutatási referenciák segítőknek. Studium Kiadó — Országos Tankönyvkiadó / Editura Didactică şi Pedagogică, Marosvásárhely - Bukarest (94 old.)
A long tradition of thought and practice has asserted important connections between psychological states and physical health. The possible mechanisms or paths of influence may have changed over time and varied across locations, but humans have long believed that how they think and what they feel may be intimately linked to whether they are healthy or sick. This chapter focuses on those ideas and practices that led to this tradition's eventual expression, in the late 20th century, in what came to be labeled health psychology. Beginning with developments in the mid to late 19th century, it tracks the convergence of thought and application that came together in the 20th century in a manner that made it possible to carve out a new area of disciplinary and professional expertise, that addressed health and disease from the perspective of the discipline of psychology.
http://www.editura.ubbcluj.ro/bd/ebooks/pdf/1853.pdf
Célkitûzés: Az onkopszichológiai szakirodalom hangsúlyozza a daganatos diagnózis tudo-másulvételének traumatikus hatását. Az onkológiai diagnózis közlésének elmulasztásával, a diagnózis ismeretének, illetve nem ismerésének következményeivel nagyon kevés tanul-mány foglalkozik. Vizsgálatunk alapvetô célja feltárni azt, hogy a daganatos betegek meny-nyire ismerik onkológiai diagnózisukat, milyen jelentôs különbségek vannak a diagnózi-sukat ismerô és nem ismerô páciensek között, illetve hogy hogyan lehet mérni a diagnózis nem ismerését, a diagnózis közlésének elmulasztását meghatározó (demográfiai, orvosi, pszichológiai és szociális) prognosztikai tényezôket. Módszer: Klinikai mintánkban 420 daganatos beteg van, 342 rosszindulatú (malignus), illetve 78 jóindulatú (benignus) onkológiai diagnózissal. 238 daganatos nôt és 182 dagana-tos férfit interjúvoltunk meg, akiknek az átlagéletkora 51,95 év. A kérdôívben szerepeltek a depressziót, a reménytelenséget, a megküzdési módokat és az életesemények számát mérô skálák. Az eredményeket a legfontosabb demográfiai-szociális és onkológiai ténye-zôkre korrigáltuk. A betegek kezelôorvosai kitöltöttek egy rövid, 9 kérdésbôl álló kérdôívet, melyben a daganat típusára, a daganat lelôhelyére, a kezelés módjaira kérdeztünk rá, va-lamint arra, hogy a betege ismeri-e a saját diagnózisát. Eredmények — konklúzió: Eredményeink arra mutattak rá, hogy a nem tájékoztatott pá-ciensek idôsebbek, izoláltabbak, alulképzettebbek és szignifikánsan depressziósabbak, reménytelenebbek, illetve alacsonyabb a problémaelemzô megküzdési képességük. A lo-gisztikus regresszióanalízis eredményei szerint a daganatos diagnózis nem ismerését, a tájékoztatás hiányát legnagyobb mértékben a tumor típusa (malignus) és a depresszió mértéke jelzik elôre. Eredményeink felhívják a figyelmet a daganatos diagnózis közlésének jelentôs orvosi, pszichológiai és szociális vonatkozásaira, illetve a páciensközpontú tájé-koztatás fontosságára.
In the article, the results of the research of correlation of welfare and public health of the population of Russia in the conditions of
economic instability are presented. The review of performance indicators of development of public sentiments of society applied both
in Russian and foreign practice is submitted. The concept content of the “social and psychological potential of a region” as an indicator
of public health of the population is opened. On the basis of this concept, the potential pattern is created. The evaluation method of
social and psychological potential of a region is developed, its main idea is an integrated assessment of both the potential of a region
in general and its separate components. The assessment of the condition of potential in territorial subjects of the Russian Federation
is given. Character and power of correlation between indicators of welfare and level of social and psychological potential of territorial
subjects of the Russian Federation on the basis of development of correlation matrixes are revealed, also, the regional consistent patterns
and tendencies are determined
There is a sharp divide in mortality between eastern and western Europe, which has largely developed over the past three decades and is caused mainly by chronic diseases in adulthood. The difference in life expectancy at birth between the best and worst European countries in this respect is more than 10 years for both sexes. The reasons for these differences in mortality are not clear and data currently available permit only speculation. The contributions of medical care and pollution are likely to be modest; health behaviour, diet, and alcohol consumption seem to be more important; smoking seems to have the largest impact. There is also evidence that psychosocial factors are less favourable in eastern Europe. Available data show socioeconomic gradients in all cause mortality within eastern European countries similar to those in the West. Determinants of the mortality gap between eastern and western Europe are probably related to the contrast in their social environments and may be similar to those underlying the social gradients in mortality within countries.
To examine the relation between health outcomes and the equality with which income is distributed in the United States.
The degree of income inequality, defined as the percentage of total household income received by the less well off 50% of households, and changes in income inequality were calculated for the 50 states in 1980 and 1990. These measures were then examined in relation to all cause mortality adjusted for age for each state, age specific deaths, changes in mortalities, and other health outcomes and potential pathways for 1980, 1990, and 1989-91.
Age adjusted mortality from all causes.
There was a significant correlation (r = -0.62 [corrected], P < 0.001) between the percentage of total household income received by the less well off 50% in each state and all cause mortality, unaffected by adjustment for state median incomes. Income inequality was also significantly associated with age specific mortalities and rates of low birth weight, homicide, violent crime, work disability, expenditures on medical care and police protection, smoking, and sedentary activity. Rates of unemployment, imprisonment, recipients of income assistance and food stamps, lack of medical insurance, and educational outcomes were also worse as income inequality increased. Income inequality was also associated with mortality trends, and there was a suggestion of an impact of inequality trends on mortality trends.
Variations between states in the inequality of the distribution of income are significantly associated with variations between states in a large number of health outcomes and social indicators and with mortality trends. These differences parallel relative investments in human and social capital. Economic policies that influence income and wealth inequality may have an important impact on the health of countries.
A two-stage cross-sectional survey was performed in a representative rural sample of the autonomous community of Cantabria, to investigate the social, medical and psychopathological factors associated with alcohol consumption. Alcohol consumption was investigated by means of a specific questionnaire. Mental and physical health was evaluated in the first-stage sample using: (1) the General Health Questionnaire, (2) the Cornell Medical Index. In the second stage all members of the sample were interviewed at home using the 140-item version of the Present State Examination (PSE-9). We found that 25.4% of males and 0.6% of females were consuming more than 63 alcohol units per week. Alcohol consumption was significantly associated with different social variables. Although it was possible to detect an increase in weekend drinking, especially in the heavy alcohol users, daily alcohol consumption, mainly around meals, was the predominant drinking pattern. We also found a significant inverse association between excessive alcohol consumption and the presence of physical or mental illness. Excessive alcohol use tended to be associated in males with depression and in females, with anxiety.
We examine the growing number of studies of survey respondents' global self-ratings of health as predictors of mortality in longitudinal studies of representative community samples. Twenty-seven studies in U.S. and international journals show impressively consistent findings. Global self-rated health is an independent predictor of mortality in nearly all of the studies, despite the inclusion of numerous specific health status indicators and other relevant covariates known to predict mortality. We summarize and review these studies, consider various interpretations which could account for the association, and suggest several approaches to the next stage of research in this field.
Recent studies have demonstrated that income inequality is related to mortality rates. It was hypothesized, in this study, that income inequality is related to reduction in social cohesion and that disinvestment in social capital is in turn associated with increased mortality.
In this cross-sectional ecologic study based on data from 39 states, social capital was measured by weighted responses to two items from the General Social Survey: per capita density of membership in voluntary groups in each state and level of social trust, as gauged by the proportion of residents in each state who believed that people could be trusted. Age-standardized total and cause-specific mortality rates in 1990 were obtained for each state.
Income inequality was strongly correlated with both per capita group membership (r = -.46) and lack of social trust (r = .76). In turn, both social trust and group membership were associated with total mortality, as well as rates of death from coronary heart disease, malignant neoplasms, and infant mortality.
These data support the notion that income inequality leads to increased mortality via disinvestment in social capital.
The Whitehall study of British civil servants begun in 1967, showed a steep inverse association between social class, as assessed by grade of employment, and mortality from a wide range of diseases. Between 1985 and 1988 we investigated the degree and causes of the social gradient in morbidity in a new cohort of 10 314 civil servants (6900 men, 3414 women) aged 35-55 (the Whitehall 11 study). Participants were asked to answer a self-administered questionnaire and attend a screening examination. In the 20 years separating the two studies there has been no diminution in social class difference in morbidity: we found an inverse association between employment grade and prevalence of angina, electrocardiogram evidence of ischaemia, and symptoms of chronic bronchitis. Self-perceived health status and symptoms were worse in subjects in lower status jobs. There were clear employment-grade differences in health-risk behaviours including smoking, diet, and exercise, in economic circumstances, in possible effects of early-life environment as reflected by height, in social circumstances at work (eg, monotonous work characterised by low control and low satisfaction), and in social supports. Healthy behaviours should be encouraged across the whole of society; more attention should be paid to the social environments, job design, and the consequences of income inequality.
Aims
Social relations have been repeatedly linked to coronary heart disease in men, even after careful control for standard risk factors. Women have rarely been studied and results have not been conclusive. We investigated the role of social support in the severity and extent of coronary artery disease in women.
Methods and Results
One hundred and thirty-one women, aged 30 to 65 years, who were hospitalized for an acute coronary event and were included in the Stockholm Female Coronary Risk Study, were examined with com-puter assisted quantitative coronary angiography. Angio-graphic measures included presence of stenosis greater than 50% in at least one coronary artery (severity) and the number of stenoses greater than 20% within the coronary tree (extent). Social factors included two measures of social support, which were previously shown to predict coronary disease in prospective studies of men. After adjustment for age, lack of social support was associated with both measures of coronary artery disease. With further adjustment for smoking, education, meno-pausal status, hypertension, high density lipoprotein and body mass index, the risk ratio for stenosis greater than 50% in women with poor as compared to those with strong social support was 2·5 (95% confidence interval 1·2 to 5·3;P=0·003). Also, women with poor social support had more stenoses obstructing at least 20% of the coronary lumen with multivariate adjustment, but the difference from women with strong support was only of borderline significance (P=0·09).
Conclusion
The findings suggest that lack of social support contributes to the severity of coronary artery disease in women, independent of standard risk factors.The European Society of Cardiology
• Longitudinal research in Stirling County, Atlantic Canada, indicated that during the 1950s and 1960s the prevalence of depression was significantly and persistently higher in the "low" socioeconomic status population than at other socioeconomic status levels. Anxiety was found to show a less clear picture. Incidence of depression after the study started was also higher among those who were initially in the low socioeconomic status group, supporting the view that the stress of poverty may be causally related to depression. There was also a trend for prior depression to be associated with subsequent downward social mobility, supporting the view that the concentration of depressed people at the lower end of the social hierarchy may result from handicapping aspects of the illness. Neither of these trends was statistically significant. More striking was evidence that, irrespective of socioeconomic status, depression carried a substantial risk for poor clinical course and outcome. Both depression and poverty tended to be chronic, and, accordingly, their association at the end of the study was influenced by their association at its beginning. The stability of the relationship between poverty and depression warrants the attention of caregivers and policymakers and raises new questions about strategies for the study of causal sequences.
Using multiple regression, the main and interactive effects of stress, social support, locus of control, and gender on psychological adjustment were investigated. In order to understand the complex interactions found, the adjustment effects of stress and social support were examined within four subgroups: internal and external men and women college students. Both social support and adjustment were assessed with multiple measures. Stress was more strongly related to levels of adjustment for women than for men. The relationships between social support and adjustment varied depending on which social support measure was used, which adjustment measure was used, as well as the locus of control orientation and gender of the subject. External men were the least able to use social support to aid adjustment. In contrast to previous investigations, there were no two-way stress X locus of control interactions. The importance of investigating the interactions of stress-moderating variables in specific subgroups is discussed.
Throughout the world, wealth and income are becoming more concentrated. Growing evidence suggests that the distribution of income–in addition to the absolute standard of living enjoyed by the poor–is a key determinant of population health. A large gap between rich people and poor people leads to higher mortality through the breakdown of social cohesion. The recent surge in income inequality in many countries has been accompanied by a marked increase in the residential concentration of poverty and affluence. Residential segregation diminishes the opportunities for social cohesion. Income inequality has spillover effects on society at large, including increased rates of crime and violence, impeded productivity and economic growth, and the impaired functioning of representative democracy. The extent of inequality in society is often a consequence of explicit policies and public choice. Reducing income inequality offers the prospect of greater social cohesiveness and better population health.
Growth of syngeneic P815 mastocytoma in DBA/2J male mice was evaluated as a result of various stress regimens. A single session
of inescapable shock resulted in earlier tumor appearance, exaggeration of tumor size, and decreased survival time in recipient
animals. Escapable shock had no such effects. The effects of the inescapable shock were mitigated if mice received long-term
shock treatment.
Although health is closely associated with income differences within each country there is, at best, only a weak link between national mortality rates and average income among the developed countries. On the other hand, there is evidence of a strong relationship between national mortality rates and the scale of income differences within each society. These three elements are coherent if health is affected less by changes in absolute material standards across affluent populations than it is by relative income or the scale of income differences and the resulting sense of disadvantage within each society. Rather than socioeconomic mortality differentials representing a distribution around given national average mortality rates, it is likely that the degree of income inequality indicates the burden of relative deprivation on national mortality rates.
The Whitehall study of British civil servants begun in 1967, showed a steep inverse association between social class, as assessed by grade of employment, and mortality from a wide range of diseases. Between 1985 and 1988 we investigated the degree and causes of the social gradient in morbidity in a new cohort of 10,314 civil servants (6900 men, 3414 women) aged 35-55 (the Whitehall II study). Participants were asked to answer a self-administered questionnaire and attend a screening examination. In the 20 years separating the two studies there has been no diminution in social class difference in morbidity: we found an inverse association between employment grade and prevalence of angina, electrocardiogram evidence of ischaemia, and symptoms of chronic bronchitis. Self-perceived health status and symptoms were worse in subjects in lower status jobs. There were clear employment-grade differences in health-risk behaviours including smoking, diet, and exercise, in economic circumstances, in possible effects of early-life environment as reflected by height, in social circumstances at work (eg, monotonous work characterised by low control and low satisfaction), and in social supports. Healthy behaviours should be encouraged across the whole of society; more attention should be paid to the social environments, job design, and the consequences of income inequality.
To assess trends in health in Eastern Europe, age-standardised mortality rates since 1950 in four Eastern European countries (German Democratic Republic, Poland, Czechoslovakia, and Hungary) were compared with those in two Western European countries (Federal Republic of Germany and England and Wales). In the Eastern European countries mortality rates had increased or were virtually unchanged since the mid-1960s, especially in middle aged and elderly men. Death rates in males in Poland, Czechoslovakia, and Hungary in the mid to late 1980s were as high as those in the two Western European countries in the early 1950s. There was a shorter time lag for females. This poor health record in Eastern Europe will need to be addressed by the policy makers in the new democracies.
An inverse relation between socio-economic class and occurrence of ischemic heart disease (IHD) in advanced societies is an often replicated finding from empirical studies. Yet, the processes which produce these effects remain an open question. One promising explanation concerns the prevalence of stressful working life, especially of distinct 'job strain' occupations. Based on these considerations, we develop a refined concept of work-related socio-emotional distress which considers a mismatch between high workload and low control over occupational status (e.g. job insecurity, poor promotion prospects, status inconsistency) as crucial distress-provoking conditions. Moreover, we assume that the effect of this condition on IHD risk is substantially increased by the presence of a distinct individual pattern of coping with work demand ('need for control'). Based on data from a 6.5 years prospective study on IHD incidence (n = 21) in a cohort of 416 middle-aged blue-collar men this concept is tested using logistic regression analysis. Results indicate that status inconsistency [multivariate odds ratio (o.r.): 4.4], job insecurity (o.r. 3.4), work pressure (o.r. 3,4) and 'need for control' (o.r. 4,5) independently predict IHD occurrence after adjusting for major confounding somatic and behavioral coronary risk factors. In conclusion, a refined model of work-related socio-emotional distress substantially contributes to the explanation of high IHD incidence among blue-collar men.
On the basis of a study of 5,871 persons representative of the Hungarian population over the age of 20 by age, sex, place of residence and occupation, an analysis was made of the relationships between neurosis risk, suicidal behaviour, drinking habits and social and lifestyle characteristics. Measured by the Juhász Neurosis Rating Scale, the proportion of those at neurosis risk in the population was 23.6%, but considerable regional differences were found. Suicide attempts and the suicide rate by county proved relatively independent of each other. In the counties with higher suicides rates (South-East Hungary) and in the counties around the capital which have high rates of suicide attempts the proportion of those at neurosis risk was very high. The closest correlation with suicide attempts was found in the case of suicide in the family. Where there had been a suicide in the family, 26% of the subjects attempted suicide in the course of their life and where there had been no suicide, the proportion of persons making attempts was only 1%.
our understanding. In this review, we start with why we look at social class and touch on the issues of what social class is and its meaning. Drawing largely on data from England and Wales, we examine trends over time. We use data from England and Wales not only because they are close at hand, but, for better or worse, these nationally collected data derive from a long tradition of social class analysis. Given that in England and Wales, as in many countries, division into social class is based on occupation, it is reasonable to ask whether the relation of social class to disease is similar in the two sexes. We then examine the generality of social class findings in different cultures. Patterns of mortality from specific diseases are not always the same as mortality from all causes. The reasons for the remarkably widespread and persisting social differences in health and disease are not clear. We consider different types of explanation.
The objective of this study was to determine whether the much-repeated finding of a relationship between socioeconomic status and health status is explained by individuals' health practices. The investigation was carried out using data tapes from the 1977 Health Interview Survey in which a one-third subsample of adults was asked a series of questions related to the seven nonmedical health practices identified in the Alameda County Study. The group selected for analysis comprised 15,892 white, responding adults. With age controlled statistically, perceived health status was found to be associated with socioeconomic status, whether the indicator was educational level, family income, or occupation, and to number of positive health practices. When number of health practices, in addition to age and other socioeconomic indicators was controlled for, the association was still positive and significant. The finding of an independent contribution by socioeconomic status to health status emphasizes that individual health habits are not the only influence on health status.
Certain aspects of daily life-style were predictive of future health status among survivors in a 9-year longitudinal study. In a sample of 3,892 white adults under the age of 70, cigarette smoking, alcohol consumption, physical exercise, hours of sleep per night, and weight in relation to height are significantly associated with overall health outcomes 9 years later, controlling for initial level of health. An index of health practices combining these five elements is associated with future health status within subgroups defined by socioeconomic level. These findings do not appear to be due to selective panel attrition or measurement error in the health indicator.
This study analyzes the ways 100 community-residing men and women aged 45 to 64 coped with the stressful events of daily living during one year. Lazarus's cognitive-phenomenological analysis of psychological stress provides the theoretical framework. Information about recently experienced stressful encounters was elicited through monthly interviews and self-report questionnaires completed between interviews. At the end of each interview and questionnaire, the participant indicated on a 68-item Ways of Coping checklist those coping thoughts and actions used in the specific encounter. A mean of 13.3 episodes was reported by each participant. Two functions of coping, problem-focused and emotion-focused, are analyzed with separate measures. Both problem- and emotion-focused coping were used in 98% of the 1,332 episodes, emphasizing that coping conceptualized in either defensive or problem-solving terms is incomplete- both functions are usually involved. Intraindividual analyses show that people are more variable than consistent in their coping patterns. The context of an event, who is involved, how it is appraised, age, and gender are examined as potential influences on coping. Context and how the event is appraised are the most potent factors. Work contexts favor problem-focused coping, and health contexts favor emotion-focused coping. Situations in which the person thinks something constructive can be done or that are appraised as requiring more information favor problem-focused coping, whereas those having to be accepted favor emotion-focused coping. There are no effects associated with age, and gender differences emerge only in problem-focused coping: Men use more problem-focused coping than women at work and in situations having to be accepted and requiring more information. Contrary to the cultural stereotype, there are no gender differences in emotion-focused coping.
We previously reported that major depression in patients in the hospital after a myocardial infarction (MI) substantially increases the risk of mortality during the first 6 months. We examined the impact of depression over 18 months and present additional evidence concerning potential mechanisms linking depression and mortality.
Two-hundred twenty-two patients responded to a modified version of the National Institute of Mental Health Diagnostic Interview Schedule (DIS) for a major depressive episode at approximately 7 days after MI. The Beck Depression Inventory (BDI), which measures depressive symptomatology, was also completed by 218 of the patients. All patients and/or families were contacted at 18 months to determine survival status. Thirty-five patients met the modified DIS criteria for major in-hospital depression after the MI. Sixty-eight had BDI scores > or = 10, indicative of mild to moderate symptoms of depression. There were 21 deaths during the follow-up period, including 19 from cardiac causes. Seven of these deaths occurred among patients who met DIS criteria for depression, and 12 occurred among patients with elevated BDI scores. Multiple logistic regression analyses showed that both the DIS (odds ratio, 3.64; 95% confidence interval [CI], 1.32 to 10.05; P = .012) and elevated BDI scores (odds ratio, 7.82; 95% CI, 2.42 to 25.26; P = .0002) were significantly related to 18-month cardiac mortality. After we controlled for the other significant multivariate predictors of mortality in the data set (previous MI, Killip class, premature ventricular contractions [PVCs] of > or = 10 per hour), the impact of the BDI score remained significant (adjusted odds ratio, 6.64; 95% CI, 1.76 to 25.09; P = .0026). In addition, the interaction of PVCs and BDI score marginally improved the model (P = .094). The interaction showed that deaths were concentrated among depressed patients with PVCs of > or = 10 per hour (odds ratio, 29.1; 95% CI, 6.97 to 122.07; P < .00001).
Depression while in the hospital after an MI is a significant predictor of 18-month post-MI cardiac mortality. Depression also significantly improves a risk-stratification model based on traditional post-MI risks, including previous MI, Killip class, and PVCs. Furthermore, the risk associated with depression is greatest among patients with > or = 10 PVCs per hour. This result is compatible with the literature suggesting an arrhythmic mechanism as the link between psychological factors and sudden cardiac death and underscores the importance of developing screening and treatment programs for post-MI depression.
A substantial body of research relates socioeconomic, behavioral, social, and psychological factors to the development and progression of a wide variety of diseases. The search for shared pathways that link these factors leads to the investigation of upstream determinants, as opposed to biologic pathways, but these have been little studied by biobehavioral researchers. Available data suggest that socioeconomic factors structure the development and maintenance of behavioral, social, and psychological factors; however, we know little of how this takes place. A consideration of the ways in which socioeconomic position influences the everyday texture of people's lives could advance our understanding of both macroeconomic and microeconomic influences on health, and lead to new, community-centric approaches to intervention. Such a research agenda would help to advance the scientific foundations for reducing the primary origins of disease, which are social and economic.
Since the mid-1960s, rates of premature mortality have increased among men in all Eastern European countries, giving rise to an East-West health divide. The paper examines the existing data concerning the possible role of levels of smoking, fats consumption and/or environmental factors in explaining this phenomenon. An overview is offered of the key ways in which social experience in Eastern Europe has diverged from that in the West and it is argued that such an overview is pre-requisite for understanding the deteriorating health of men in the East. The importance of the 'incongruity' between aspirations and the means of achieving them is highlighted, as is the centrality of family-based coping strategies. It is argued that the devaluing of the public sphere and valorization of the private domain contribute to the greater health vulnerability of men under in Eastern Europe. The importance of the private sphere is reflected in the fact that the rise of premature male mortality has been overwhelmingly concentrated in the non-married population in the East European countries for which data is currently available.
Lifetime history of major depressive disorder is more than double in ever smokers than in never smokers. Conversely, adjusted odds ratios of nicotine dependence are significantly elevated for major depressive disorder alone (3,11) or associated with an anxiety disorder (4,38). There is also a significant relationship between depressive symptoms' severity (CES-D) and ever smoking. A history of major depressive disorder is associated with a lower chance to quit smoking. One of the reasons is that smokers who try to quit smoking experience more withdrawal symptoms--including a depressive mood--and relapse more frequently if they have a history of major depressive disorder. Few trials experimenting the usefulness of antidepressants in smoking cessation were published. Only a limited trial concerning doxepin showed a significant action on withdrawal symptoms and abstinence rate at 4 weeks. Other trials with fluoxetine and moclobemide failed to show clearly a significant effect on abstinence rate, perhaps because the medication was initiated too soon before quit day. The nature of the association between smoking and depression has been explored in recent studies, which used a cohort follow-up or the evaluation of a female twin population. The conclusions were that there is probably no causal relationship but rather that the association arises largely from common familial factors that are probably genetic, at least in women. Concurrently, tobacco smoke has monoamine oxidase inhibitory properties, and smokers have lower monoamine oxidase activity than no smokers. Hence, it is possible that smoking has antidepressant properties. While smoking prevalence regularly decreases, one can assume that the relative risk of depressive disorder will increase in smokers.
We examined the relationship among low, moderate, and high levels of hopelessness, all-cause and cause-specific mortality, and incidence of myocardial infarction (MI) and cancer in a population-based sample of middle-aged men. Participants were 2428 men, ages 42 to 60, from the Kuopio Ischemic Heart Disease study, an ongoing longitudinal study of unestablished psychosocial risk factors for ischemic heart disease and other outcomes. In 6 years of follow-up, 174 deaths (87 cardiovascular and 87 noncardiovascular, including 40 cancer deaths and 29 deaths due to violence or injury), 73 incident cancer cases, and 95 incident MI had occurred. Men were rated low, moderate, or high in hopelessness if they scored in the lower, middle, or upper one-third of scores on a 2-item hopelessness scale. Age-adjusted Cox proportional hazards models identified a dose-response relationship such that moderately and highly hopeless men were at significantly increased risk of all-cause and cause-specific mortality relative to men with low hopelessness scores. Indeed, highly hopeless men were at more than three-fold increased risk of death from violence or injury compared with the reference group. These relationships were maintained after adjusting for biological, socioeconomic, or behavioral risk factors, perceived health, depression, prevalent disease, or social support. High hopelessness also predicted incident MI, and moderate hopelessness was associated with incident cancer. Our findings indicate that hopelessness is a strong predictor of adverse health outcomes, independent of depression and traditional risk factors. Additional research is needed to examine phenomena that lead to hopelessness.
We analysed the relationships between socioeconomic factors, severity of depressive symptomatology, and sickness absence rate in an active (working and studying) population of 20,902 persons representative of the Hungarian population over the age of 16 by age, sex, and place of residence. The severity of depression was very closely correlated with sick leave. Hierarchical log linear analysis was performed to investigate the interactive effects of socioeconomic factors, severity of depressive symptomatology, and sickness absence rate. Material socioeconomic factors such as housing situation, access to a car, and owning properties had no direct impact on sick leave, unless mediated by the effect of depression. All of the measured socioeconomic factors, with the exception of place of residence, were closely connected with depressive symptomatology, and depression appeared to mediate between socioeconomic factors and higher sickness absence rate. A vicious circle might be hypothesized between depression and a socially deprived situation, which plays a significant causal role in ill health.
There is suggestive evidence that depression increases risk of myocardial infarction (MI), but there are no prospective studies in which the measure of depression corresponds to clinical criteria. This study examines prospectively whether a major depressive episode increases the risk of incident MI and evaluates the role of psychotropic medication use in this relationship.
The study is based on a follow-up of the Baltimore cohort of the Epidemiologic Catchment Area Study, a survey of psychiatric disorders in the general population. A history of major depressive episode, dysphoria (2 weeks of sadness), and psychotropic medication use were assessed in 1981, and self-reported MI was assessed in 1994. Sixty-four MIs were reported among 1551 respondents free of heart trouble in 1981. Compared with respondents with no history of dysphoria, the odds ratio for MI associated with a history of dysphoria was 2.07 (95% CI, 1.16 to 3.71), and the odds ratio associated with a history of major depressive episode was 4.54 (95% CI, 1.65 to 12.44), independent of coronary risk factors. In multivariate models, use of barbiturates, meprobamates, phenothiazines, and lithium was associated with an increased risk of MI, whereas use of tricyclic antidepressants and benzodiazepines was not. Among individuals with no history of dysphoria, only lithium use was significantly associated with MI.
These data suggest that a history of dysphoria and a major depressive episode increase the risk of MI. The association between psychotropic medication use and MI is probably a reflection of the primary relationship between depression and MI.
Throughout the world, wealth and income are becoming more concentrated. Growing evidence suggests that the distribution of income-in addition to the absolute standard of living enjoyed by the poor-is a key determinant of population health. A large gap between rich people and poor people leads to higher mortality through the breakdown of social cohesion. The recent surge in income inequality in many countries has been accompanied by a marked increase in the residential concentration of poverty and affluence. Residential segregation diminishes the opportunities for social cohesion. Income inequality has spillover effects on society at large, including increased rates of crime and violence, impeded productivity and economic growth, and the impaired functioning of representative democracy. The extent of inequality in society is often a consequence of explicit policies and public choice. Reducing income inequality offers the prospect of greater social cohesiveness and better population health.
Literature and folk wisdom have long linked depression and death; however, only recently have scientific studies examined the relation between them. Beginning in the 1970s, investigators compared mortality among patients treated for major depression and the general population. Nine of ten studies found an increased mortality from cardiovascular disease among depressed patients. However, such studies confound the relation between depression and its treatment. Community surveys circumvent this difficulty, but as these studies began to appear, other investigations revealed the strong association between depression and cigarette smoking, which made obvious a need to control for smoking. The first study to do this appeared in 1993, and not only did a relation between depression and mortality persist, but a relation between depression and the development of ischemic disease was revealed. In the past 2 years, six more community surveys have followed populations initially free of disease, and five have observed an increased risk of ischemic heart disease among depressed persons. Another research strategy is to start with subjects who have preexisting cardiovascular disease. Here, too, depression has consistently been associated with a worse outcome. In one well-designed study, patients with depression in the period immediately after a myocardial infarction were 3.5 times more likely to die than nondepressed patients. The basis of this association remains speculative. However, it is likely that the changes in the autonomic nervous system and platelets that are seen in depression account for a substantial portion of the association.
Coronary heart disease (CHD) mortality is four times higher in 50-year-old Lithuanian men than in 50-year-old Swedish men. The difference cannot be explained by standard risk factors. The objective of this study was to examine differences in psychosocial risk factors for CHD in the two countries.
The LiVicordia study is a cross-sectional survey comparing 150 randomly selected 50-year-old men in each of the two cities: Vilnius, Lithuania, and Linköping, Sweden. As part of the study, a broad range of psychosocial characteristics, known to predict CHD, were investigated.
In the men from Vilnius compared with those from Linköping, we found a cluster of psychosocial risk factors for CHD; higher job strain (p <.01), lower social support at work, lower emotional support, and lower social integration (p values <.001). Vilnius men also showed lower coping, self-esteem, and sense of coherence (p values < .001), higher vital exhaustion, and depression (p values < .001). Quality of life and perceived health were lower and expectations of ill health within 5 to 10 years were higher in Vilnius men (p values < .001). Correlations between measurements on traditional and psychosocial risk factors were few and weak.
The Vilnius men, representing the population with a four-fold higher CHD mortality, had unfavorable characteristics on a cluster of psychosocial risk factors for CHD in comparison with the Linköping men. We suggest that this finding may provide a basis for possible new explanations of the differences in CHD mortality between Lithuania and Sweden.
This article reviews the burgeoning literature on the relationship of mood disorders and heart disease. Major depression and depressive symptoms, although commonly encountered in medical populations, are frequently underdiagnosed and undertreated in patients with cardiovascular disease (CVD). This is of particular importance because several studies have shown depression and its associated symptoms to be a major risk factor for both the development of CVD and death after an index myocardial infarction. This review of the extant literature is derived from MEDLINE searches (1966-1997) using the search terms "major depression," "psychiatry," "cardiovascular disease," and "pathophysiology." Studies investigating pathophysiological alterations related to CVD in depressed patients are reviewed. The few studies on treatment of depression in patients with CVD are also described. Treatment of depression in patients with CVD improves their dysphoria and other signs and symptoms of depression, improves quality of life, and perhaps even increases longevity. Recommendations for future research are proposed.
This study proposes to assess the differences of two psychosocial risk indicators for coronary artery disease (CAD), ie, depressive symptoms and vital exhaustion.
In a representative, stratified, nation-wide sample of the population of Hungary over the age of 16 years (N = 12,640), analyses were made of whether those risk indicators were differentially related to several illness behaviors (including history of cardiovascular treatment and cardiovascular sick days), cognitions, mood states, and socioeconomic characteristics that may generally be associated with increased CAD risk. The sample was stratified by age, sex, and composition of the population of all counties in Hungary.
Although depressive symptoms and vital exhaustion correlated strongly, there were clear and significant differences in strength of association between depressive symptoms, vital exhaustion and several variables under study. Dysfunctional cognitions, hostility, lack of purpose in life, low perceived self-efficacy, illegal drug use, alcohol and drug abuse, several forms of subjective disability complaints and history of treatment because of congenital disorders, and chronic skin and hematological disorders were more often associated with depressive symptoms, whereas loss of energy, use of stimulants, chest-pain-related disabilities, history of treatment because of cardiovascular disorders, and self-reported cardiovascular sick days were significantly more often associated with vital exhaustion.
Vital exhaustion and depressive symptomatology are differentially associated with relevant external criteria. Vital exhaustion is associated with perceived cardiovascular complaints and history of cardiovascular treatment, whereas depressive symptomatology seems to be more closely connected to disabilities and complaints related to alcohol, drug, and congenital-disorder, and to dysfunctional cognitions and hostility.
In men, high levels of endogenous testosterone (T) seem to encourage behavior intended to dominate--to enhance one's status over--other people. Sometimes dominant behavior is aggressive, its apparent intent being to inflict harm on another person, but often dominance is expressed nonaggressively. Sometimes dominant behavior takes the form of antisocial behavior, including rebellion against authority and low breaking. Measurement of T at a single point in time, presumably indicative of a man's basal T level, predicts many of these dominant or antisocial behaviors. T not only affects behavior but also responds to it. The act of competing for dominant status affects male T levels in two ways. First, T rises in the face of a challenge, as if it were an anticipatory response to impending competition. Second, after the competition, T rises in winners and declines in losers. Thus, there is a reciprocity between T and dominance behavior, each affecting the other. We contrast a reciprocal model, in which T level is variable, acting as both a cause and effect of behavior, with a basal model, in which T level is assumed to be a persistent trait that influences behavior. An unusual data set on Air Force veterans, in which data were collected four times over a decade, enables us to compare the basal and reciprocal models as explanations for the relationship between T and divorce. We discuss sociological implications of these models.
This is a cross-sectional study using records from the National Health Interview Survey linked to Census geography. The sample is restricted to white males ages 25-64 in the United States from three years (1989-1991) of the National Health Interview Survey. Perceived health is used to measure morbidity. Individual covariates include income-to-needs ratio, education and occupation. Contextual level measures of income inequality, median household income and percent in poverty are constructed at the US census county and tract level. The association between inequality and morbidity is examined using logistic regression models. Income inequality is found to exert an independent adverse effect on self-rated health at the county level, controlling for individual socioeconomic status and median income or percent poverty in the county. This corresponding effect at the tract level is reduced. Median income or percent poverty and individual socioeconomic status are the dominant correlates of perceived health status at the tract level. These results suggest that the level of geographic aggregation influences the pathways through which income inequality is actualized into an individuals' morbidity risk. At higher levels of aggregation there are independent effects of income inequality, while at lower levels of aggregation, income inequality is mediated by the neighborhood consequences of income inequality and individual processes.
Crime is seldom considered as an outcome in public health research. Yet major theoretical and empirical developments in the field of criminology during the past 50 years suggest that the same social environmental factors which predict geographic variation in crime rates may also be relevant for explaining community variations in health and wellbeing. Understanding the causes of variability in crime across countries and across regions within a country will help us to solve one of the enduring puzzles in public health, viz. why some communities are healthier than others. The purpose of this paper is to present a conceptual framework for investigating the influence of the social context on community health, using crime as the indicator of collective wellbeing. We argue that two sets of societal characteristics influence the level of crime: the degree of relative deprivation in society (for instance, measured by the extent of income inequality), and the degree of cohesiveness in social relations among citizens (measured, for instance, by indicators of 'social capital' and 'collective efficacy'). We provided a test of our conceptual framework using state-level ecologic data on violent crimes and property crimes within the USA. Violent crimes (homicide, assault, robbery) were consistently associated with relative deprivation (income inequality) and indicators of low social capital. Among property crimes, burglary was also associated with deprivation and low social capital. Areas with high crime rates tend also to exhibit higher mortality rates from all causes, suggesting that crime and population health share the same social origins. Crime is thus a mirror of the quality of the social environment.
Behavioural sciences applied to a changing society
- M S Kopp
- A Skrabski
Kopp, M. S., & Skrabski, A Â (1996). Behavioural sciences applied to a changing society. Budapest: Biblioteca Septem Artium Liberalium.
Social relations and extent and severity of coronary artery disease Depression, psycho-tropic medication and risk of myocardial infarction
- K Horsten
- M Wamala
- S P Mittleman
- M A Kirkeeide
- R Svanes
- L Schenck-Gustafsson
- K M Armenian
- H K Gallo
- J J Eaton
The relationship of depression to cardiovascular disorders. Archives of General Psychiatry, 55, 580±592. Orth-Gome r, K., Horsten, M., Wamala, S. P., Mittleman, M. A., Kirkeeide, R., Svanes, B., Rydea n, L., & Schenck-Gustafsson, K. (1998). Social relations and extent and severity of coronary artery disease. European Heart Journal, 19, 1648±1656. Pratt, L. A., Ford, D. E., Crum, R. M., Armenian, H. K., Gallo, J. J., & Eaton, W. W. (1996). Depression, psycho-tropic medication and risk of myocardial infarction, Prospective data from the Baltimore ECA follow-up.
Depression and the course of coronary artery disease Alcohol consumption in a rural area of Cantabria Self-rated health and mortality: A review of twenty-seven community studies
- A H Glassman
- P A S Shapiro
- J L Vazguez-Barquero
- L E L Gaite
- Y Benyamini
Glassman, A. H., & Shapiro, P. A. (1998). Depression and the course of coronary artery disease. American Journal of Psychiatry, 155(1), 4±11. Herrera-Castanedo, S., Vazguez-Barquero, J. L., & Gaite, L. (1996). Alcohol consumption in a rural area of Cantabria. Social Psychiatry and Psychiatric Epidemiology, 31(34), 199±206. Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behaviour, 38, 21±37.
Helplessness: On depression, devel-opment and death
- M E P Seligman
Seligman, M. E. P. (1975). Helplessness: On depression, devel-opment and death. San Francisco: Freeman.
The year before myocardial infarction Biobehavioural bases of coronary heart disease
- M S Kopp
M.S. Kopp et al. / Social Science & Medicine 51 (2000) 1351±1361 References Appels, A. (1983). The year before myocardial infarction. In T. M. Dembroski, H. Smidt, & G. Blumchen, Biobehavioural bases of coronary heart disease. Basel: Karger.
Depression et tabagisme Cognitive therapy and the emotional dis-orders Inequalities in health: The Black report
- H J Aubin
- S Tilikete
- D D Barrucand
- J N Morris
- C Smith
- C Towsend
- M Whitehead
Aubin, H. J., Tilikete, S., & Barrucand, D. (1996). Depression et tabagisme. Encephale, 22(1), 17±22. Beck, A. T. (1985). Cognitive therapy and the emotional dis-orders. New York: International Universities Press. Black, D., Morris, J. N., Smith, C., Towsend, C., & Whitehead, M. (1992). Inequalities in health: The Black report, health divide. London: Penguin.