Social Science & Medicine最新文献_第10页

Following the power: social-class inequities in mortality from accidental poisonings, suicide, and chronic liver disease in the United States 跟随权力：美国意外中毒、自杀和慢性肝病死亡率的社会阶级不平等。

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-14 DOI: 10.1016/j.socscimed.2026.118991

Jerzy Eisenberg-Guyot , Candace M. Cosgrove , Alex Azan , Samuel R. Friedman , Seth J. Prins , Audrey Renson

Introduction

Hazardous working conditions fuel inequities in accidental-poisoning, suicide, and chronic-liver-disease mortality. Relational theories suggest such hazards flow from power imbalances between workers, managers, and employers – social classes demarcated by power over property and labor. However, to our knowledge, no US studies using relational measures have analyzed class inequities in the cause-specific mortality.

Methods

We used the Mortality Disparities in American Communities dataset, which links the 2008 American Community Survey to the National Death Index through December 31, 2019. We classified respondents as incorporated business owners, unincorporated business owners, managers, workers, or not in the labor force based on their employment, occupational, and business-ownership status. Then, using an inverse-probability-weighted Aalen-Johansen estimator, we estimated risk differences in the cause-specific mortality across classes at the end of follow-up, including by sex, race/ethnicity, and education.

Results

Our sample included 2,304,500 respondents and 10,870 accidental-poisoning, suicide, and chronic-liver-disease deaths. Compared to incorporated business owners, those not in the labor force, workers, and unincorporated business owners had, respectively, 8.9 (95 % CI: 8.0, 9.7), 0.9 (95 % CI: 0.4, 1.5), and 1.1 (95 % CI: 0.3, 1.9) greater 12-year age- and sex-adjusted risks of the cause-specific mortality per 1000. Managers' risks resembled incorporated business owners’. Inequities largely persisted after thorough sociodemographic adjustment. Among workers, risks were elevated among the unemployed and those with blue-collar or service occupations. Finally, inequities were greater among men and less-educated respondents than among women and more-educated respondents.

Discussion

We estimated considerable class inequities in the cause-specific mortality, adding to research connecting class relations to mortality inequities and worsening population health.

危险的工作条件加剧了意外中毒、自杀和慢性肝病死亡率方面的不平等。相关理论认为，这种危险来自于工人、管理者和雇主之间的权力不平衡——这些社会阶层是由对财产和劳动力的权力划分的。然而，据我们所知，没有美国研究使用相关措施分析了特定原因死亡率的阶级不平等。方法：我们使用了美国社区死亡率差异数据集，该数据集将2008年美国社区调查与截至2019年12月31日的国家死亡指数联系起来。我们根据受访者的就业、职业和企业所有权状况，将受访者分为注册企业所有者、非注册企业所有者、管理人员、工人或非劳动力。然后，使用反概率加权的aallen - johansen估计器，我们估计了随访结束时不同班级的特定原因死亡率的风险差异，包括性别、种族/民族和教育程度。结果：我们的样本包括2,304,500名受访者和10,870例意外中毒，自杀和慢性肝病死亡。与合并企业所有者相比，非劳动力、工人和非合并企业所有者的12年死亡率（经年龄和性别调整后）分别高出8.9 （95% CI: 8.0, 9.7）、0.9 （95% CI: 0.4, 1.5）和1.1 （95% CI: 0.3, 1.9）。管理者的风险类似于公司业主的风险。在彻底的社会人口调整之后，不平等现象在很大程度上仍然存在。在工人中，失业人员、蓝领或服务行业的风险较高。最后，男性和受教育程度较低的受访者的不平等程度高于女性和受教育程度较高的受访者。讨论：我们估计在特定原因死亡率方面存在相当大的阶级不平等，增加了将阶级关系与死亡率不平等和人口健康恶化联系起来的研究。

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引用次数: 0

Accountability as Self-Determination: Abolitionist conceptions of health, wellbeing, and safety 作为自决的责任：废除健康、幸福和安全的概念

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-14 DOI: 10.1016/j.socscimed.2026.118970

Cameron W. Rasmussen , Mimi E. Kim

Carceral paradigms and practices of punishment are widely understood to have devastating consequences for individual and community health. In response, abolitionist practitioners, organizers, and scholars have conceptualized forms of non-punitive accountability as a remedy to harm and violence, primarily through the practices and politics of restorative and transformative justice. Despite clear evidence punishment harms health and wellbeing, virtually no research has explored if and how accountability-based approaches may impact health and wellbeing for people who have caused harm. This conceptual article examines and theorizes accountability as one basis of how abolitionist politics and practice function as an affirmative social determinant of health. We argue that non-punitive accountability – understood through the theoretical, political and practice frameworks of abolition, and restorative and transformative justice – has the potential to positively impact health and wellbeing. Specifically, we assert that accountability practices adopted by groups and communities grounded in abolitionist politics and guided by principles of agency and self-determination, and commitments to challenging both state and interpersonal violence, can act as affirmative social determinants of health. Abolitionist frameworks for considering health and wellbeing are explored followed by a critical analysis of how agency in restorative justice and self-determination in transformative justice function both theoretically and practically — not only as key distinctions between accountability and punishment, but as foundational elements for improved health and wellbeing. We then analyze existing practice-based research that suggests a positive correlation between accountability and health and conclude with implications for practice, discourse, and future research.

人们普遍认为，惩罚的形式和做法对个人和社区健康具有破坏性后果。作为回应，废除主义实践者、组织者和学者们将非惩罚性问责的形式概念化，作为对伤害和暴力的补救措施，主要是通过恢复性和变革性司法的实践和政治。尽管有明确的证据表明惩罚会损害健康和福祉，但几乎没有研究探讨基于问责制的方法是否以及如何影响造成伤害的人的健康和福祉。这篇概念性的文章将问责制作为废除主义政治和实践如何作为健康的积极社会决定因素发挥作用的一个基础进行研究和理论化。我们认为，非惩罚性问责制-通过废除和恢复性和变革性司法的理论，政治和实践框架来理解-有可能对健康和福祉产生积极影响。具体而言，我们断言，以废除主义政治为基础，以代理和自决原则为指导的团体和社区采取的问责制做法，以及挑战国家和人际暴力的承诺，可以作为健康的积极社会决定因素。探讨了考虑健康和福祉的废除主义框架，然后批判性地分析了恢复性司法中的机构和变革司法中的自决如何在理论和实践中发挥作用-不仅是问责和惩罚之间的关键区别，而且是改善健康和福祉的基本要素。然后，我们分析了现有的基于实践的研究，这些研究表明问责制与健康之间存在正相关关系，并总结了对实践、话语和未来研究的启示。

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引用次数: 0

Nature, gender, trauma: The role of nature in recovering from intimate partner violence 自然，性别，创伤：自然在从亲密伴侣暴力中恢复中的作用

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-14 DOI: 10.1016/j.socscimed.2026.118992

Kimberley Kinder

Scholars in public health, urban planning, and social work embrace the notion that contact with nature promotes health and wellness, including in the context of trauma. This article analyzes the lived experiences of women recovering from Intimate Partner Violence (IPV) to explore two propositions: (a) contact with nature promotes trauma recovery for women and (b) access to nature as a healing aid is compromised by experiences of gender and trauma. Based on qualitative interviews with eighty IPV survivors, I found significant support for the first proposition: many participants experienced nature as an important source of support during the recovery process. However, I also found significant evidence for the second proposition: because access to nature is mediated by gender and violence, IPV creates negative feedback loops where the people most likely to experience IPV also have reduced access to nature as a wellness aid. Examining these gendered and trauma-related experiences reveals how power and inequity are woven into the natural environments often associated with healing.

公共卫生、城市规划和社会工作领域的学者都认为，与自然接触可以促进健康，包括在创伤的背景下。本文分析了从亲密伴侣暴力（IPV）中恢复的女性的生活经历，探讨了两个命题：(a)与自然的接触促进了女性的创伤恢复；(b)与自然的接触作为一种治疗手段，受到性别和创伤经历的损害。基于对80名IPV幸存者的定性访谈，我发现了对第一个命题的重要支持：许多参与者在恢复过程中将自然视为重要的支持来源。然而，我也发现了第二个命题的重要证据：因为接近自然是由性别和暴力介导的，IPV造成了负面反馈循环，在这种循环中，最有可能经历IPV的人也减少了接近自然作为健康援助的机会。研究这些性别和创伤相关的经历，揭示了权力和不平等是如何融入自然环境的，往往与愈合有关。

引用次数: 0

Empowerment or responsibilisation: Articulation work in English primary care coordination from the perspectives of patients and clinicians 授权或责任：从患者和临床医生的角度看英语初级保健协调的衔接工作。

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-13 DOI: 10.1016/j.socscimed.2026.118986

Mhorag Goff , Patrick Burch , Jonathan Hammond , Kath Checkland , Sally Jacobs

In many well-developed primary care systems patients increasingly receive care from multiple clinicians within networks of providers rather than a single general practice clinician. This makes formal coordination between clinicians and providers necessary and requires informal ‘articulation work’ from both clinicians and patients to organise coordination of tasks across episodes of care. This is often hidden ‘behind the scenes’.

We used qualitative data from interviews with patients (n = 55) and healthcare professionals and other practice staff (n = 57) from two linked studies in English general practice. These studies investigated aspects of implications of the organisational shift to primary care networks. Using these datasets, we explored expectations about the articulation work involved in coordinating care.

We found differing experiences of primary care coordination and differing expectations about who bears responsibility for the articulation work involved. Patients tend to assume a cyclical care process in which care coordination continues between interactions with the practice, maintaining a care cycle. In contrast, contemporary primary care processes are structured to be ‘acute by default’, with patients responsible for re-initiating care after each care episode. Increasing responsibilisation of patients adds to their burden of treatment. Without the knowledge or capacities for such work patients may experience failures in care coordination. Better aligning expectations about responsibilities for articulation work requires explicit communication, sensitivity and flexibility in identifying patients who may find this difficult, facilitated by an ongoing patient-clinician relationship.

在许多发达的初级保健系统中，患者越来越多地接受来自提供者网络内的多名临床医生的护理，而不是单一的全科医生。这使得临床医生和提供者之间的正式协调成为必要，并且需要临床医生和患者进行非正式的“衔接工作”，以组织跨期护理任务的协调。这通常隐藏在“幕后”。我们使用了来自两项英国全科医学相关研究的患者（n = 55）、医疗保健专业人员和其他执业人员（n = 57）访谈的定性数据。这些研究调查了组织转移到初级保健网络的影响方面。使用这些数据集，我们探讨了对协调护理中涉及的发音工作的期望。我们发现不同的初级保健协调经验和不同的期望谁承担责任的衔接工作所涉及的。患者倾向于假设一个周期性的护理过程，在这个过程中，护理协调在与实践的相互作用之间继续进行，维持一个护理周期。相比之下，当代初级保健过程的结构是“默认急性”，患者负责在每次护理后重新开始护理。患者责任的增加增加了他们的治疗负担。没有这种工作的知识或能力，患者可能会经历护理协调失败。更好地协调对发音工作责任的期望需要明确的沟通、敏感性和灵活性，以识别可能发现这一困难的患者，并通过持续的医患关系加以促进。

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引用次数: 0

Medicalizing the social determinants of health and the inadvertent reproduction of inequities through social-care program implementation in the United States 医疗化健康的社会决定因素和不平等的无意再现通过美国社会保健计划的实施

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-13 DOI: 10.1016/j.socscimed.2026.118981

Elizabeth J. Pfeiffer, Sara Mendez

Social scientists have long noted the influence of social, economic, and political factors—or the social determinants of health (SDOH)—that influence people's health. Healthcare providers and insurers, hospital administrators, clinicians, government, social services, and research agencies have put great efforts into developing policies that create knowledge and awareness, and promote social-risk screening and social-care programs in the United States. These programs screen patients for risks so health professionals can refer them to resources for help with their health-related social needs (HRSN). Federal policies have constructed the socioeconomic conditions of individuals as health problems—and driven SDOH medicalization. While commendable, such programs have not significantly improved patients' health, and the open questions are how and why this is the case. Our qualitative data help answer these questions and inform arguments about the benefits, limitations, and consequences of SDOH medicalization. In our research, we explore study participants' lived experiences of SDOH medicalization in one social-risk-screening-and-care program—from focus-group discussions with clinic staff, patients, and social service leaders collected in 2020–2021. Data provide empirical evidence that medicalization offered benefits but played a role in some unintended negative consequences, including the reproduction of already existing inequities that limited program effectiveness. Efforts to address the HRSN of individuals will be enhanced by policy and clinical work that tackle the intersecting social, economic, and political forces that create and sustain conditions that are harmful to human lives.

社会科学家早就注意到影响人们健康的社会、经济和政治因素——或健康的社会决定因素（SDOH）——的影响。在美国，医疗保健提供者和保险公司、医院管理人员、临床医生、政府、社会服务机构和研究机构在制定政策方面付出了巨大的努力，以创造知识和意识，并促进社会风险筛查和社会护理计划。这些项目筛查患者的风险，以便卫生专业人员可以将他们转介到与健康相关的社会需求（HRSN）的资源中寻求帮助。联邦政策将个人的社会经济状况构建为健康问题，并推动了SDOH的医疗化。虽然值得称赞，但这样的项目并没有显著改善患者的健康，而悬而未决的问题是如何以及为什么会出现这种情况。我们的定性数据有助于回答这些问题，并告知关于SDOH医疗化的好处、局限性和后果的争论。在我们的研究中，我们从2020-2021年收集的临床工作人员、患者和社会服务领导者的焦点小组讨论中，探索了研究参与者在一个社会风险筛查和护理项目中SDOH医疗化的生活经历。数据提供的经验证据表明，医疗化提供了好处，但在一些意想不到的负面后果中发挥了作用，包括再现已经存在的限制方案有效性的不平等现象。解决个人HRSN问题的努力将通过政策和临床工作得到加强，这些政策和临床工作将处理造成和维持对人类生命有害的条件的交叉社会、经济和政治力量。

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引用次数: 0

Dialogues of obstetric risk in the first trimester of pregnancy: Insights from a hospital ethnography 妊娠头三个月产科风险对话：来自医院人种学的见解

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-13 DOI: 10.1016/j.socscimed.2026.118985

Ana Cerezuela González, Carolina Remorini, Diana Marre Cifola

This study examines how obstetric risk is constructed and negotiated through interactions between healthcare professionals and pregnant women during the first trimester screening ultrasound consultation in a public maternity hospital in Spain. This pivotal consultation serves as both a key diagnostic tool for gestational complications and a significant emotional milestone for families. Through ethnography, primarily observations and informal conversations conducted between March and June 2023, the research explores how “risk” shapes decision-making in obstetrics.

Findings showed that the first trimester ultrasound consultation is a complex social space where medical risk assessment coexists with emotional and social implications of the first visual encounter with the unborn baby. While medical professionals prioritize formalized risk assessment, they also engage in emotional labor and communicative strategies, including subtly redirecting interactions. They also actively participate in the symbolic appropriation of the fetus, which helps bridge women's and clinician's realities through the acknowledgment of the ultrasound's social and emotional significance. Decisions are made under high uncertainty, where expert knowledge plays a central role, and social, cultural, and emotional contexts are not always fully integrated.

The study highlights communication gaps due to the disparity between professionals' and patients’ knowledge, particularly in high-risk scenarios, where statistics often fail to convey the deep personal meaning of potential adverse outcomes. Biomedicalization of pregnancy risks can introduce new forms of existential uncertainty for women, potentially limiting their autonomy. These findings illustrate the complexity of obstetric risk communication and the need to integrate social, emotional, and cultural dimensions into prenatal care.

本研究考察了在西班牙一家公立妇产医院，产科风险是如何构建的，并通过保健专业人员和孕妇之间的互动，在孕早期超声筛查咨询协商。这种关键的咨询既是妊娠并发症的关键诊断工具，也是家庭重要的情感里程碑。通过民族志，主要观察和2023年3月至6月期间进行的非正式谈话，该研究探讨了“风险”如何影响产科的决策。研究结果表明，孕早期超声咨询是一个复杂的社会空间，其中医疗风险评估与与未出生婴儿第一次视觉接触的情感和社会影响并存。虽然医疗专业人员优先考虑正式的风险评估，但他们也会参与情绪劳动和沟通策略，包括巧妙地重新定向互动。他们还积极参与对胎儿的象征性占有，通过承认超声波的社会和情感意义，这有助于弥合妇女和临床医生的现实。决策是在高度不确定的情况下做出的，在这种情况下，专业知识起着核心作用，社会、文化和情感背景并不总是完全整合在一起。该研究强调了由于专业人员和患者知识之间的差异而导致的沟通差距，特别是在高风险情况下，统计数据往往无法传达潜在不良后果的深刻个人含义。怀孕风险的生物医学化可能会给妇女带来新的生存不确定性，潜在地限制她们的自主权。这些发现说明了产科风险沟通的复杂性，以及将社会、情感和文化层面纳入产前护理的必要性。

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引用次数: 0

Close a pit, kill a community: An ecological analysis of coal mining history and deaths of despair in England and Wales 关闭一个矿井，杀死一个社区：对英格兰和威尔士煤矿开采历史和绝望死亡的生态学分析

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-13 DOI: 10.1016/j.socscimed.2026.118968

Eurwen H. Williams , Christopher W.N. Saville

Background

Deaths of despair (suicide, drug poisoning, alcohol-specific mortality) have been framed either as demand-side phenomena driven by social and economic dislocation or as driven by supply-side changes in access to harmful substances. We assess these explanations in England and Wales by testing whether deaths of despair are higher in places shaped by historical coal mining and whether any association persists beyond current deprivation.

Methods

We linked 2015–2023 mortality data for all 7264 middle super output areas (MSOAs, units of census geography in England and Wales) to a four-level measure of coalfield exposure (none, last pit closed <1946; 1946–1979; ≥1980). Poisson generalised linear mixed-effects models estimated rate ratios with offsets for the at-risk population, adjusting for age, sex, and period. We (1) estimated the association between coalfield exposure and deaths of despair; (2) tested heterogeneity by cause and sex; and (3) evaluated whether associations remained after adjustment for area-level deprivation.

Results

Former coalfield MSOAs had higher rates of all three types of deaths of despair than non-mining areas. Associations were strongest for alcohol-specific and drug-poisoning mortality, and survived adjustment for socioeconomic deprivation, albeit attenuated. Associations with suicide were smaller and concentrated in areas with post-1979 closures. Patterns were broadly similar for men and women.

Conclusions

Findings align with demand-side interpretations: place-based legacies of deindustrialisation are associated with elevated mortality even after accounting for current deprivation, indicating complex structural pathways. Policies should pair clinical responses with place-focused regeneration, rebuilding social and economic infrastructure in historically industrial communities.

绝望死亡（自杀、药物中毒、酒精导致的死亡）要么被认为是由社会和经济混乱造成的需求侧现象，要么被认为是由获取有害物质的供应侧变化造成的。我们对英格兰和威尔士的这些解释进行了评估，测试了在历史上开采煤矿的地方，绝望的死亡率是否更高，以及在目前的匮乏之外，是否存在任何关联。方法我们将2015-2023年所有7264个中等超级产出区（MSOAs，英格兰和威尔士的人口普查地理单位）的死亡率数据与煤田暴露的四级测量（无，最后一个矿井关闭<1946; 1946 - 1979;≥1980）联系起来。泊松广义线性混合效应模型估计了风险人群的率比，并对年龄、性别和时期进行了调整。我们(1)估计了煤田暴露与绝望死亡之间的关系；(2)按原因和性别检验异质性；(3)对区域剥夺调整后的关联性进行评价。结果原煤田msoa三种类型绝望死亡率均高于非矿区。酒精特异性死亡率和药物中毒死亡率的相关性最强，并且在社会经济剥夺调整后存活下来，尽管减弱。与自杀的关联较小，且集中在1979年后关闭的地区。男性和女性的模式大致相似。研究结果与需求侧解释一致：即使在考虑了当前的贫困因素后，基于地方的去工业化遗留问题仍与死亡率升高有关，表明了复杂的结构途径。政策应将临床反应与以地方为重点的再生结合起来，在历史上的工业社区重建社会和经济基础设施。

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引用次数: 0

Sociocultural identification of migrant forensic psychiatric inpatients facing mandatory repatriation – a hospital ethnography 面临强制遣返的移民法医精神病住院病人的社会文化鉴定——医院人种学

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-13 DOI: 10.1016/j.socscimed.2026.118984

Charlotte Clous , Hannah Jongsma , Anniek van Weeghel , Ria Reis , Wim Veling

In the Netherlands, terbeschikkingstelling (TBS) is a forensic psychiatric measure imposed on individuals who commit a criminal offence under diminished responsibility due to severe mental illness. For TBS patients without Dutch nationality, mandatory repatriation replaces resocialization as the final goal of TBS treatment, as they lose Dutch residency rights due to their offence. This article examines how this subgroup of TBS patients at a Dutch Centre for Transcultural Forensic Psychiatry reflect on and negotiate cultural identity at the intersection of criminal and migration law. Focusing on sociocultural identification, we adopt a dynamic and relational approach to cultural identity that attends to life histories, transnational social ties, institutional positioning and imposed categories of otherness reinforced by involuntary return policies. Data were gathered through in-depth life-course interviews, focus groups, and participant observation on four high-security wards between 2022 and 2024.

Participants' narratives reflect chronic uprootedness and cultural fragmentation, but also highlight forms of resilience, as identities are redefined through lived experiences of ‘having been places’ and situational forms of belonging within transnational social contexts. Cultural identity emerges as layered and fluid, dynamically shaped across multiple social fields, rather than anchored in fixed national or ethnic categories. By centring lived experiences from within a highly regulated institutional setting, this study offers qualitative insight into how cultural identity takes shape under conditions of constrained agency and prolonged uncertainty, and highlights the implications of these processes for forensic psychiatric care. Substantiated with the experiences of individuals whose voices are rarely heard, this article delivers a critical analysis of a system in which people risk being lost or caught between equally impossible future perspectives.

在荷兰，terbeschikkingstelling （TBS）是一种法医精神病学措施，适用于因严重精神疾病而减轻责任的刑事犯罪个人。对于没有荷兰国籍的TBS患者，强制遣返取代重新社会化作为TBS治疗的最终目标，因为他们因犯罪而失去荷兰居留权。本文探讨了荷兰跨文化法医精神病学中心的TBS患者如何在刑法和移民法的交叉点上反思和协商文化认同。关注社会文化认同，我们采用动态和关系的方法来研究文化认同，关注生活史、跨国社会关系、制度定位和由非自愿返回政策加强的强加的他者类别。通过深入的生命历程访谈、焦点小组和参与者观察，在2022年至2024年期间在四个高安全病房收集数据。参与者的叙述反映了长期的背井离乡和文化碎片化，但也突出了复原力的形式，因为身份通过“曾经在过的地方”的生活经历和跨国社会背景下的情境形式的归属感被重新定义。文化认同以分层和流动的形式出现，在多个社会领域中动态塑造，而不是固定在固定的国家或种族类别中。通过集中在高度监管的机构环境中的生活经验，本研究提供了定性的见解，了解文化认同是如何在受限的代理和长期不确定性的条件下形成的，并强调了这些过程对法医精神病学护理的影响。以那些声音很少被听到的个人的经历为依据，本文对一个系统进行了批判性的分析，在这个系统中，人们可能会迷失方向，或者被夹在同样不可能的未来前景之间。

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引用次数: 0

Pathways to personalisation: The practice of BRCA stratification 个性化的途径：BRCA分层的实践。

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-12 DOI: 10.1016/j.socscimed.2026.118973

Clara Felicity Fabian-Therond

Personalised medicine is gathering pace across advanced cancer settings in the UK NHS, and care pathways are becoming increasingly filled with different steps, stages and treatments. One key personalised medicine practice is stratifying patients according to their molecular profile. Nevertheless, understanding how this practice shapes lived experience of cancer patients remains an under-researched area. To shed light on this question this paper focuses on the practice of stratifying patients according to their BRCA gene prior to or at the beginning of a late-stage ovarian cancer personalised medicine pathway. I draw on interviews and observations with 17 ovarian cancer patients, who formed part of a larger comparative ethnographic study, which took place between 2020 and 2021 in a tertiary hospital in the South-East of England. Focus on this one practice made it possible to demonstrate how as well as being a diagnostic tool stratification is an affective technology that cultivates range of feelings including inclusion or exclusion, and novel kinds of ‘biosociality’ (Rabinow, 1999). These findings offer critical insight into the importance to separate and scrutinise its practices on long pathways to understand the lived and felt experience of care.

在英国国家医疗服务体系（NHS）的晚期癌症环境中，个性化医疗正在加快步伐，护理途径越来越多地充满了不同的步骤、阶段和治疗方法。一个关键的个性化医疗实践是根据患者的分子特征对患者进行分层。然而，了解这种做法如何影响癌症患者的生活经历仍然是一个研究不足的领域。为了阐明这个问题，本文着重于在晚期卵巢癌个体化治疗途径之前或开始时根据BRCA基因对患者进行分层的实践。我利用了对17名卵巢癌患者的采访和观察，这些患者是2020年至2021年在英格兰东南部一家三级医院进行的一项更大的比较人种学研究的一部分。关注这一实践，可以证明分层作为一种诊断工具，是一种情感技术，可以培养包括包容或排斥在内的一系列情感，以及新型的“生物社会性”（Rabinow, 1999）。这些发现提供了重要的见解，说明了在长期途径上分离和审查其实践的重要性，以了解护理的生活和感受体验。

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引用次数: 0

Early versus late entry into parenthood and mental health outcomes in Norway: A Bayesian longitudinal analysis of life satisfaction and depressive tendencies by gender and SES 挪威早期与晚期为人父母与心理健康结果：性别和社会经济地位对生活满意度和抑郁倾向的贝叶斯纵向分析

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-12 DOI: 10.1016/j.socscimed.2026.118949

Magnus Jørgensen , Bente Wold , Andreas Stenling

Background

Parenthood represents a major life transition with significant implications for mental health, particularly among females and individuals with lower socioeconomic status (SES). As fertility rates continue to decline across countries such as Norway, it has become increasingly important to understand the factors that promote positive parenthood experiences.

Aims

This study examines how parenthood affects mental health and whether these effects vary by timing of parenthood, gender, parental SES, and own SES, while accounting for selection into parenthood.

Methods

Data were drawn from the Norwegian Longitudinal Health Behavior Study (NLHBS), focusing on the 2000, 2007, and 2017 waves. Life satisfaction and depressive tendencies were assessed at ages 30 and 40. Bayesian multigroup structural equation models by gender were estimated to investigate associations between parenthood timing (age 23–30 and age 30–40), own and parental SES, and mental health.

Results

Early parenthood (age 23–30) was associated with higher life satisfaction at age 40 for both genders. Early parenthood was linked to lower depressive tendencies in midlife compared to later parenthood among females, but not among males. Selection effects were evident: higher life satisfaction at age 23 predicted early parenthood for both genders, and females’ own education at age 30 predicted later parenthood.

Conclusion

Parenthood was associated with greater life satisfaction in midlife. Between-gender and SES differences were not credible. Overall, the findings link parenthood to improved adult mental health in a Nordic context and emphasize the importance of preventive and health promotion efforts in addressing health-related selection into parenthood.

为人父母是一个重大的人生转变，对心理健康有着重要的影响，尤其是对女性和社会经济地位较低的个体而言。随着挪威等国家的生育率持续下降，了解促进积极生育经历的因素变得越来越重要。目的：本研究考察了为人父母对心理健康的影响，以及这些影响是否随着为人父母的时间、性别、父母的社会经济地位和自己的社会经济地位而变化，同时考虑了为人父母的选择。方法数据来自挪威纵向健康行为研究（NLHBS），重点关注2000年，2007年和2017年的浪潮。在30岁和40岁时对生活满意度和抑郁倾向进行评估。估计贝叶斯多组结构方程模型按性别调查生育时间（23-30岁和30-40岁），自己和父母的社会经济地位和心理健康之间的关系。结果早为人父母（23-30岁）与40岁时较高的生活满意度相关。与晚育的女性相比，早做父母的女性在中年时抑郁倾向较低，但在男性中则不然。选择效应很明显：23岁时较高的生活满意度预示着男性和女性更早为人父母，而女性在30岁时的受教育程度预示着更晚为人父母。结论为人父母与中年生活满意度相关。性别和社会经济地位的差异是不可信的。总的来说，研究结果将在北欧背景下为人父母与改善成人心理健康联系起来，并强调了预防和健康促进工作在解决与健康有关的选择为人父母方面的重要性。

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