Social Science & Medicine最新文献

Associations of war exposures, post-migration living difficulties and social support with (complex) PTSD: a cohort study of Ukrainian refugees resettled in Denmark

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-04-20 DOI: 10.1016/j.socscimed.2025.118080

Karen-Inge Karstoft , Ludvig Daae Bjørndal , Anne Agathe Pedersen , Nataliia Korchakova , Séamus A. Power , Thomas A. Morton , Vibeke J. Koushede , Marie H. Thøgersen , Brian J. Hall

Background

The war in Ukraine has forced millions of Ukrainians to flee their country, many after exposure to actions of war. Previous research found that both war exposures (WE) and post-migration living difficulties (PMLD) are associated with risk of PTSD. In the current study, we test associations between WE, PMLD and PTSD/Complex PTSD (CPTSD). Further, we test if the associations are moderated by social support.

Methods

In a representative prospective cohort study of adult Ukrainians arriving in Denmark in the first year after Russia's full-scale invasion (N = 4,229), we test associations between WE, PMLD, and (C)PTSD using multinomial logistic regression analysis. Interaction terms were added to assess if associations were moderated by SS.

Results

Prevalence of PTSD and CPTSD was 12.1 % and 12.2 %, respectively. We found statistically significant associations between family-related PMLD, health-related PMLD, and general PMLD and CPTSD (AORs from 1.25 to 1.56), and between health-related PMLD and family-related PMLD and PTSD (AORs from 1.18 to 1.35). WE were associated with PTSD (AOR (CI): 1.15 (1.07–1.25)), but not CPTSD (AOR (CI): 1.05 (0.97–1.13)). Social support was associated with CPTSD (AOR (CI): 0.69 (0.60–0.78)) but not PTSD (AOR (CI):0.94(0.83–1.07)). Interaction terms were significant only for PTSD, where social support attenuated the negative association between PMLD and PTSD.

Conclusion

PMLDs are important risk factors for post-trauma psychopathology in war refugees. Social support mitigates the negative association between PMLDs for PTSD, while low social support is an independent risk factor for CPTSD. Attention should be paid to refugees’ daily life challenges and social support networks.

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引用次数: 0

Ageing in place or stuck in place: A critical qualitative study on older adults’ independence across six municipalities in Norway

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-04-19 DOI: 10.1016/j.socscimed.2025.118098

Linda Aimée Hartford Kvæl

The concept of ageing in place (AIP) has garnered substantial international attention, especially with the global rise in the ageing population. Despite extensive research and policy support, the practical complexities of implementing AIP policy, particularly in diverse living situations, places, social contexts and evolving family structures, remain unclear. The purpose of this study was to critically examine the key factors influencing experiences of AIP among older individuals, family caregivers and municipal health and social care employees across six diverse Norwegian municipalities. This qualitative study utilised an explorative interpretative design, involving focus group interviews with municipal employees (N = 36) and semi-structured individual interviews with older persons (N = 17) and family caregivers (N = 18). The municipalities varied in several key dimensions, including population size, geographic extent, centrality, demographics and the economy. The reflexive thematic analysis identified four themes: i) Ageing-Related Preparation: Balancing Personal and Municipal Responsibility, ii) Access to Proper Services: Aligning the Person-Environment Fit, iii) Family Caregiving: Bridging the Gap between Services and Actual Needs, and iv) Transitional Housing: Supporting Aging in Place with Dignity. Together, these themes highlight the need to promote 'independence literacy' for older adults, ensuring they have the necessary knowledge, access, and support to live independently and maintain their quality of life while AIP. The findings urge a re-evaluation of local factors shaping safe and proper person–environment fit, emphasising access to proper services, caregiver support, housing options, resource allocation and the enhancement of skilled healthcare staff to optimise safe AIP. The findings may be relevant for policy makers, municipal leaders and health service employees in developing equitable AIP policies tailored to the local context.

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引用次数: 0

Impact of a cancer diagnosis on educational, employment, health-related quality of life, and social outcomes among young adults: A matched cohort study of 401 cancer survivors aged 15–24 in England

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-04-18 DOI: 10.1016/j.socscimed.2025.118078

R. Mattock , A. Martin , A.E. Beckett , O.C. Lindner , D. Stark , R.M. Taylor

Background

Globally, cancer incidence is rising fastest among young people. Existing literature on acute health shocks, including cancer diagnoses, focuses on older working-aged adults.

Methods

Matched cohort study involving 401 young cancer survivors (aged 15–24) in the BRIGHTLIGHT study and 765 UK Household Longitudinal Study controls without cancer between 2013 and 2018. Participants were matched on sex, age, ethnicity, index of multiple deprivation (IMD) quintile, non-cancer health conditions, and follow-up duration. Regression models assessed economic, educational, social, health-related quality of life (HRQoL), and mental health outcomes at 6(T1), 12–18(T2), and 24–36 months (T3) post-diagnosis.

Results

Compared to matched controls, those with cancer were: less likely to be in employment, education, or training at T1 (OR = 2.03, p < 0.001) but not at T3 (OR = 0.96, p = 0.18), because transitioning from unemployment or economic inactivity into education was more common (24 % vs 3 % between T1 and T3); less likely to live in parental households at T1 (OR = 0.54, p < 0.001) and T3 (OR = 0.59, p < 0.001); and more likely to experience relationship breakdown (23 % vs 12 % between T1 and T3). Differences in mental health and HRQoL declined over time (mean difference compared to matched controls: T1: −0.07, p < 0.001; T2 and T3: −0.01 p ≥ 0.55). Economic outcomes, mental health and HRQoL utility scores were persistently worse among more severe cancer cases.

Conclusions

Despite having initially poorer health and economic outcomes, cancer survivors in this cohort caught up with their peers within 3 years. Linked clinical data showed those with more severe diagnoses were affected most, indicating scope for improved psychosocial and economic support.

{"title":"Impact of a cancer diagnosis on educational, employment, health-related quality of life, and social outcomes among young adults: A matched cohort study of 401 cancer survivors aged 15–24 in England","authors":"R. Mattock , A. Martin , A.E. Beckett , O.C. Lindner , D. Stark , R.M. Taylor","doi":"10.1016/j.socscimed.2025.118078","DOIUrl":"10.1016/j.socscimed.2025.118078","url":null,"abstract":"<div><h3>Background</h3><div>Globally, cancer incidence is rising fastest among young people. Existing literature on acute health shocks, including cancer diagnoses, focuses on older working-aged adults.</div></div><div><h3>Methods</h3><div>Matched cohort study involving 401 young cancer survivors (aged 15–24) in the BRIGHTLIGHT study and 765 UK Household Longitudinal Study controls without cancer between 2013 and 2018. Participants were matched on sex, age, ethnicity, index of multiple deprivation (IMD) quintile, non-cancer health conditions, and follow-up duration. Regression models assessed economic, educational, social, health-related quality of life (HRQoL), and mental health outcomes at 6(T1), 12–18(T2), and 24–36 months (T3) post-diagnosis.</div></div><div><h3>Results</h3><div>Compared to matched controls, those with cancer were: less likely to be in employment, education, or training at T1 (OR = 2.03, p < 0.001) but not at T3 (OR = 0.96, p = 0.18), because transitioning from unemployment or economic inactivity into education was more common (24 % vs 3 % between T1 and T3); less likely to live in parental households at T1 (OR = 0.54, p < 0.001) and T3 (OR = 0.59, p < 0.001); and more likely to experience relationship breakdown (23 % vs 12 % between T1 and T3). Differences in mental health and HRQoL declined over time (mean difference compared to matched controls: T1: −0.07, p < 0.001; T2 and T3: −0.01 p ≥ 0.55). Economic outcomes, mental health and HRQoL utility scores were persistently worse among more severe cancer cases.</div></div><div><h3>Conclusions</h3><div>Despite having initially poorer health and economic outcomes, cancer survivors in this cohort caught up with their peers within 3 years. Linked clinical data showed those with more severe diagnoses were affected most, indicating scope for improved psychosocial and economic support.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"376 ","pages":"Article 118078"},"PeriodicalIF":4.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Working the boundaries of ‘whining’ – how patients and care professionals make sense of informal complaining practices

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-04-18 DOI: 10.1016/j.socscimed.2025.118112

Jelmer Brüggemann , Ann-Charlotte Nedlund , Lisa Guntram

This study investigates informal complaining in healthcare settings, that is, the kind of patient complaints that are expressed verbally to professionals in care encounters. In healthcare policies and the complaints literature, informal complaints receive little attention and are rarely studied as a distinct phenomenon. Building on the sociology of complaint, research on the good and bad patient, and scholarship on boundary work, we analyse focus groups with care professionals and interviews with patients in Sweden to study how these actors make sense of patients' informal complaining practices. We highlight the discursive work that patients and care professionals do around the boundaries of ‘whining’ – our analytic term to capture informal complaining practices that are demarcated as to-be-avoided. We argue that there are three dimensions to this work: they negotiate the validity and temporality of complaining and do so in relation to an identity of the ‘complainer’. Our analysis highlights the complexities of these negotiations and shows how informal complaining oftentimes is framed as a risky practice by patients and a problem by care professionals. These normative complexities get muddled further through their contrast to healthcare political discourses which emphasise complaints as valuable knowledge and patients as active subjects. Our study suggests that it is necessary for future research, complaint policies, and person-centred care to engage with the difficult and at times unwanted parts of informal complaining practices.

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引用次数: 0

Influence of sex on the incidence of colorectal cancer: considering the influence of gender mechanisms

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-04-18 DOI: 10.1016/j.socscimed.2025.118058

Amalia Martinez , Nadine Hamieh , Hélène Colineaux , Michelle Kelly-Irving , Pascale Grosclaude , Emmanuel Wiernik , Cyrille Delpierre , Sébastien Lamy

Context

Differences in colorectal cancer (CRC) incidence between men and women are documented, but the role of gender mechanisms in explaining these disparities remains underexplored. CRC, the third deadliest cancer worldwide, is often analyzed through “biological” sex differences, without a clear distinction between innate and socially acquired factors. Gender mechanisms, including social roles, behaviors, and access to healthcare, may significantly influence CRC risk.

Objective

This study quantifies the proportion of the effect of gender mechanisms on the relationship between sex assigned at birth and CRC incidence, adopting a social epidemiology approach.

Method

Using data from the CONSTANCES cohort and the French National Health Insurance database (SNDS), we identified relevant covariates with a Directed Acyclic Graph (DAG). Mediation analyses estimated the contribution of socioeconomic, behavioral, anthropometric and medical factors as gender-related mechanisms.

Results

Men have a higher risk of CRC compared to women (OR: 1.54 [1.33; 1.79]). Men exhibit lower cultural capital, higher social and economic capital, more frequent risk behaviors, and higher BMI. Gender mechanisms account for 30 % of the association between sex assigned at birth and CRC incidence, in the imputed data, and up to 50 % in the complete cases. Among the gender mechanisms, BMI emerged as the main mediator.

Conclusion

This study reveals that gender-based health inequalities in CRC incidence are partially explained by differences in exposure to social and behavioral risk factors. These findings underscore the importance of integrating gender dynamics into public health strategies for CRC prevention and intervention, focusing on addressing gender-based risk factor exposure.

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引用次数: 0

Mapping fertility trajectories: An endarkened narrative inquiry of Black women's fertility experiences and pathways through infertility treatment

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-04-18 DOI: 10.1016/j.socscimed.2025.118082

Isabel Morgan , Christine Tucker , Aunchalee E.L. Palmquist , Stephanie Baker , Larissa Jennings Mayo-Wilson , Chantel L. Martin , Natalie Hernandez , Lasha Clarke

While existing literature has documented barriers and facilitators to Black women’s access to infertility treatment, scholars have a limited understanding of the experiences of Black women who have initiated medically assisted reproduction (MAR), including medicated timed intercourse, intrauterine insemination, and in vitro fertilization. Informed by Black feminism and reproductive justice, this endarkened narrative inquiry leveraged data from the Fertility Equity Study at Morehouse School of Medicine to characterize 41 Black women’s infertility treatment outcomes and examine their trajectories through fertility care and infertility treatment. Our analysis provides greater nuance and understanding to Black women’s experiences navigating systems of care to address challenges related to conceiving or maintaining a pregnancy. The results indicate a lack of fertility benefits and out-of-pocket expenses as significant barriers at each stage of the treatment pathway. There is a need for legislation that mandates private and public (e.g., Medicaid) health insurance coverage for fertility treatments and associated costs, inclusive of medication, genetic screening (and other ancillary testing), and donor gametes. Additionally, integration of culturally congruent providers (including mental health practitioners), addressing reproductive health conditions, and providing fertility awareness counseling throughout the life course may optimize Black women’s fertility care and MAR experiences.

{"title":"Mapping fertility trajectories: An endarkened narrative inquiry of Black women's fertility experiences and pathways through infertility treatment","authors":"Isabel Morgan , Christine Tucker , Aunchalee E.L. Palmquist , Stephanie Baker , Larissa Jennings Mayo-Wilson , Chantel L. Martin , Natalie Hernandez , Lasha Clarke","doi":"10.1016/j.socscimed.2025.118082","DOIUrl":"10.1016/j.socscimed.2025.118082","url":null,"abstract":"<div><div>While existing literature has documented barriers and facilitators to Black women’s access to infertility treatment, scholars have a limited understanding of the experiences of Black women who have initiated medically assisted reproduction (MAR), including medicated timed intercourse, intrauterine insemination, and in vitro fertilization. Informed by Black feminism and reproductive justice, this endarkened narrative inquiry leveraged data from the Fertility Equity Study at Morehouse School of Medicine to characterize 41 Black women’s infertility treatment outcomes and examine their trajectories through fertility care and infertility treatment. Our analysis provides greater nuance and understanding to Black women’s experiences navigating systems of care to address challenges related to conceiving or maintaining a pregnancy. The results indicate a lack of fertility benefits and out-of-pocket expenses as significant barriers at each stage of the treatment pathway. There is a need for legislation that mandates private and public (e.g., Medicaid) health insurance coverage for fertility treatments and associated costs, inclusive of medication, genetic screening (and other ancillary testing), and donor gametes. Additionally, integration of culturally congruent providers (including mental health practitioners), addressing reproductive health conditions, and providing fertility awareness counseling throughout the life course may optimize Black women’s fertility care and MAR experiences.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"376 ","pages":"Article 118082"},"PeriodicalIF":4.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874940","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Are we gatekeeping trauma? A conceptual model to expand criterion A for invisible, identity-based, and systemic traumas

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-04-17 DOI: 10.1016/j.socscimed.2025.118090

Tanya C. Saraiya , Alexandria G. Bauer , Devin E. Banks , Delisa G. Brown , Amber M. Jarnecke , Chantel T. Ebrahimi , Donte L. Bernard

Since the inception of the criterion A framework into the posttraumatic stress disorder (PTSD) diagnosis in DSM-III, what qualifies as traumatic has been a fieldwide debate. Historically, social movements coinciding with advances in research have spurred improvements in the definition of criterion A, often by expanding the breadth of experiences that are considered trauma exposure. Contemporary issues of ongoing racial discrimination, ethno-violence, public health pandemics, warfare, oppression, and climate change warrant a re-examination of the criterion A definition. This critical review builds on prior critiques of criterion A and addresses (1) the limitations to the current criterion A definition in DSM-5 in capturing the experience of minoritized individuals; (2) three categories of trauma that are under-recognized in the current criterion A definition; and (3) the implications of expanding criterion A on clinical and research practice. We critically review three trauma categories that disproportionately affect minoritized individuals—invisible traumas, identity-based traumas, and systemic traumas. Evidence to date suggests that several traumatic experiences in these categories rise to the level of being traumatic, are associated with PTSD symptoms, and are prevalent among minoritized individuals. We discuss the implications of these traumas being omitted from criterion A and call for future work to critically examine the definition of criterion A in the PTSD diagnostic framework. Overall, this critical review captures traumas which remain undertreated, underdiagnosed, and under-represented by our current psychiatric nosology.

{"title":"Are we gatekeeping trauma? A conceptual model to expand criterion A for invisible, identity-based, and systemic traumas","authors":"Tanya C. Saraiya , Alexandria G. Bauer , Devin E. Banks , Delisa G. Brown , Amber M. Jarnecke , Chantel T. Ebrahimi , Donte L. Bernard","doi":"10.1016/j.socscimed.2025.118090","DOIUrl":"10.1016/j.socscimed.2025.118090","url":null,"abstract":"<div><div>Since the inception of the criterion A framework into the posttraumatic stress disorder (PTSD) diagnosis in DSM-III, what qualifies as traumatic has been a fieldwide debate. Historically, social movements coinciding with advances in research have spurred improvements in the definition of criterion A, often by expanding the breadth of experiences that are considered trauma exposure. Contemporary issues of ongoing racial discrimination, ethno-violence, public health pandemics, warfare, oppression, and climate change warrant a re-examination of the criterion A definition. This critical review builds on prior critiques of criterion A and addresses (1) the limitations to the current criterion A definition in DSM-5 in capturing the experience of minoritized individuals; (2) three categories of trauma that are under-recognized in the current criterion A definition; and (3) the implications of expanding criterion A on clinical and research practice. We critically review three trauma categories that disproportionately affect minoritized individuals—invisible traumas, identity-based traumas, and systemic traumas. Evidence to date suggests that several traumatic experiences in these categories rise to the level of being traumatic, are associated with PTSD symptoms, and are prevalent among minoritized individuals. We discuss the implications of these traumas being omitted from criterion A and call for future work to critically examine the definition of criterion A in the PTSD diagnostic framework. Overall, this critical review captures traumas which remain undertreated, underdiagnosed, and under-represented by our current psychiatric nosology.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"375 ","pages":"Article 118090"},"PeriodicalIF":4.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Abrasion: a phenomenological study of inequity in workplace-based assessment in pediatrics

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-04-17 DOI: 10.1016/j.socscimed.2025.118092

Hannah L. Kakara Anderson , Layla Abdulla , Pricilla Cabral , Marjan Govaerts , Dorene F. Balmer , Jamiu O. Busari

Despite the centrality of workplace-based assessments in medical education and practice, there is troubling evidence that workplace-based assessments are inequitable. This study investigated the experience of inequity in workplace-based assessment via a phenomenological study with learners (resident physicians) and assessors (physician supervisors) in one specialty in the United States, general pediatrics, from August 2023-June 2024. The authors used critical phenomenology to prompt and iteratively analyze participants' experiences with inequity in workplace-based assessment and their lifeworlds. To understand participants' lifeworlds, the authors applied Collins' domains of power framework to examine participants’ varied and unique locations within intersecting power relations. Participants described the phenomenon of inequity in workplace-based assessment as a type of abrasion, that is, an injury caused by friction that occurred when a workplace-based assessment excoriated their sense of self. Abrasion had three dimensions: physical, affective, and temporal. These findings suggest that inequity in workplace-based assessment cannot be tracked solely by measuring disparities in numbers, grades, differences in narrative language used in comments, and other common measures of inequity, rather, it can be characterized as an experienced, felt, phenomenon that has essential dimensions. These findings have major implications for how inequity is conceptualized and intervened upon in medical education.

{"title":"Abrasion: a phenomenological study of inequity in workplace-based assessment in pediatrics","authors":"Hannah L. Kakara Anderson , Layla Abdulla , Pricilla Cabral , Marjan Govaerts , Dorene F. Balmer , Jamiu O. Busari","doi":"10.1016/j.socscimed.2025.118092","DOIUrl":"10.1016/j.socscimed.2025.118092","url":null,"abstract":"<div><div>Despite the centrality of workplace-based assessments in medical education and practice, there is troubling evidence that workplace-based assessments are inequitable. This study investigated the experience of inequity in workplace-based assessment via a phenomenological study with learners (resident physicians) and assessors (physician supervisors) in one specialty in the United States, general pediatrics, from August 2023-June 2024. The authors used critical phenomenology to prompt and iteratively analyze participants' experiences with inequity in workplace-based assessment and their lifeworlds. To understand participants' lifeworlds, the authors applied Collins' domains of power framework to examine participants’ varied and unique locations within intersecting power relations. Participants described the phenomenon of inequity in workplace-based assessment as a type of abrasion, that is, an injury caused by friction that occurred when a workplace-based assessment excoriated their sense of self. Abrasion had three dimensions: physical, affective, and temporal. These findings suggest that inequity in workplace-based assessment cannot be tracked solely by measuring disparities in numbers, grades, differences in narrative language used in comments, and other common measures of inequity, rather, it can be characterized as an experienced, felt, phenomenon that has essential dimensions. These findings have major implications for how inequity is conceptualized and intervened upon in medical education.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"375 ","pages":"Article 118092"},"PeriodicalIF":4.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143848744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Equal before luck? Well-being consequences of personal deprivation and transition

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-04-17 DOI: 10.1016/j.socscimed.2025.117975

Joan Costa-Font , Anna Nicińska , Melcior Rossello Roig

Past trauma resulting from personal life shocks, especially during periods of particular volatility such as regime transition (or regime change), can give rise to significant long-lasting effects on people’s health and well-being. We study this question by drawing on longitudinal and retrospective data to examine the effect of past exposure to major individual-level shocks (specifically hunger, persecution, dispossession, and exceptional stress) on current measures of an individual’s health and mental well-being. We examine the effect of the timing of the personal shocks, alongside the additional effect of ‘institutional uncertainty’ resulting from regime change in post-communist European countries. Our findings are as follows. First, we document evidence of the detrimental effects of shocks on a series of relevant health and well-being outcomes. Second, we show evidence of more pronounced detrimental consequences of such personal shocks experienced by individuals living in formerly communist countries (which accrue to about 8% and 10% in the case of persecution and hunger, respectively) than in non-communist countries. The effects are robust and take place in addition to the direct effects of regime change and exposure to personal shocks.

{"title":"Equal before luck? Well-being consequences of personal deprivation and transition","authors":"Joan Costa-Font , Anna Nicińska , Melcior Rossello Roig","doi":"10.1016/j.socscimed.2025.117975","DOIUrl":"10.1016/j.socscimed.2025.117975","url":null,"abstract":"<div><div>Past trauma resulting from personal life shocks, especially during periods of particular volatility such as regime transition (or regime change), can give rise to significant long-lasting effects on people’s health and well-being. We study this question by drawing on longitudinal and retrospective data to examine the effect of past exposure to major individual-level shocks (specifically hunger, persecution, dispossession, and exceptional stress) on current measures of an individual’s health and mental well-being. We examine the effect of the timing of the personal shocks, alongside the additional effect of ‘institutional uncertainty’ resulting from regime change in post-communist European countries. Our findings are as follows. First, we document evidence of the detrimental effects of shocks on a series of relevant health and well-being outcomes. Second, we show evidence of more pronounced detrimental consequences of such personal shocks experienced by individuals living in formerly communist countries (which accrue to about 8% and 10% in the case of persecution and hunger, respectively) than in non-communist countries. The effects are robust and take place in addition to the direct effects of regime change and exposure to personal shocks.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"376 ","pages":"Article 117975"},"PeriodicalIF":4.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143864332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Measurement invariance and differential item functioning of a care staff proxy measure of nursing home resident dementia-specific quality of life (DEMQOL-CH): do care aides' first language, and care aides' and residents’ ethno-cultural background matter?

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-04-16 DOI: 10.1016/j.socscimed.2025.118089

Matthias Hoben , Sevilay Kilmen , Janice Keefe , Hannah M. O'Rourke , Sube Banerjee , Carole A. Estabrooks

Quality of life (QoL) is a priority goal of dementia care, but measuring QoL becomes increasingly difficult as a person's ability to self-report declines. QoL measurement is particularly challenging among Nursing home (NH) residents, due to their often advanced cognitive impairment. The DEMQOL-CH is a validated tool to assess NH residents' QoL, using care staff proxy reports. Care staff and residents often have diverse ethno-cultural backgrounds, which may affect the measurement of QoL. Our objective was to assess measurement invariance and differential item functioning (DIF) of the DEMQOL-CH based on care staff ethno-cultural background, language, and resident ethno-cultural background. In a convenience sample of 9 NHs in the Canadian province of Alberta, research assistants conducted structured interviews with 119 care staff between July and September 2021 to complete DEMQOL-CH assessments of 612 residents. We performed confirmatory factor analyses, multiple group item response theory analyses, and DIF analyses. Measurement of the overall DEMQOL-CH score was affected by care staff ethno-cultural background and language (lack of scalar measurement invariance), but not by resident ethno-cultural background. Six of the 31 DEMQOL-CH items had DIF based on both, care staff ethno-cultural background and language, 2 items had DIF based on care staff ethno-cultural background, 4 items had DIF based on care staff language. Resident ethno-cultural background did not lead to DIF. The lack of measurement invariance and the presence of DIF affects the comparability of DEMQOL-CH assessments collected from care staff with diverse ethno-cultural and/or language backgrounds. However, the extent of the issues identified is small and the tool's other psychometric properties are robust. Therefore, we suggest that it is reasonable to continue to use the DEMQOL-CH in its current form, with careful consideration of methods to deal with and adjust for measurement invariance.

{"title":"Measurement invariance and differential item functioning of a care staff proxy measure of nursing home resident dementia-specific quality of life (DEMQOL-CH): do care aides' first language, and care aides' and residents’ ethno-cultural background matter?","authors":"Matthias Hoben , Sevilay Kilmen , Janice Keefe , Hannah M. O'Rourke , Sube Banerjee , Carole A. Estabrooks","doi":"10.1016/j.socscimed.2025.118089","DOIUrl":"10.1016/j.socscimed.2025.118089","url":null,"abstract":"<div><div>Quality of life (QoL) is a priority goal of dementia care, but measuring QoL becomes increasingly difficult as a person's ability to self-report declines. QoL measurement is particularly challenging among Nursing home (NH) residents, due to their often advanced cognitive impairment. The DEMQOL-CH is a validated tool to assess NH residents' QoL, using care staff proxy reports. Care staff and residents often have diverse ethno-cultural backgrounds, which may affect the measurement of QoL. Our objective was to assess measurement invariance and differential item functioning (DIF) of the DEMQOL-CH based on care staff ethno-cultural background, language, and resident ethno-cultural background. In a convenience sample of 9 NHs in the Canadian province of Alberta, research assistants conducted structured interviews with 119 care staff between July and September 2021 to complete DEMQOL-CH assessments of 612 residents. We performed confirmatory factor analyses, multiple group item response theory analyses, and DIF analyses. Measurement of the overall DEMQOL-CH score was affected by care staff ethno-cultural background and language (lack of scalar measurement invariance), but not by resident ethno-cultural background. Six of the 31 DEMQOL-CH items had DIF based on both, care staff ethno-cultural background and language, 2 items had DIF based on care staff ethno-cultural background, 4 items had DIF based on care staff language. Resident ethno-cultural background did not lead to DIF. The lack of measurement invariance and the presence of DIF affects the comparability of DEMQOL-CH assessments collected from care staff with diverse ethno-cultural and/or language backgrounds. However, the extent of the issues identified is small and the tool's other psychometric properties are robust. Therefore, we suggest that it is reasonable to continue to use the DEMQOL-CH in its current form, with careful consideration of methods to deal with and adjust for measurement invariance.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"375 ","pages":"Article 118089"},"PeriodicalIF":4.9,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143844043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0