Social Science & Medicine最新文献_第4页

Coping with stigma and choosing silence: Discrimination and concealment among public housing residents 面对污名选择沉默：公屋居民的歧视与隐瞒

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

Social Science & Medicine

Pub Date : 2026-01-06 DOI: 10.1016/j.socscimed.2026.118948

Gum-Ryeong Park , Jean Choi , Haitao Du

Public housing residents often face discrimination and stigma, yet little is known about how they respond and whether these responses influence their desire to conceal their housing status. This study examines the association between responses to discrimination and concealment behavior, with specific focus on gender and years in residence. Using data from the Seoul Public Rental Housing Panel Survey (SPRHPS), we analyze a sample of 5856 individuals observed from Wave 2 to Wave 4. The key outcome is the self-reported desire to conceal public housing residency. Responses to discrimination are categorized as: silent endurance, passive denial, or active resistance. We estimate both ordinary least squares (OLS) and individual fixed effects (FE) models to examine within-person changes while accounting for time-invariant individual traits. Interaction terms are included to assess heterogeneity by gender and years in residence. OLS models show that silent endurance (b = 0.535) and passive denial (b = 0.202) in response to discrimination are associated with concealment of public housing residency, while active resistance (b = 0.338) shows a weaker effect. In fixed effects models, the effects of silent endurance (b = 0.409) and passive denial (b = 0.164) remain significant, but active resistance becomes non-significant. Interaction analyses show stronger concealment effects of passive coping strategies among women and long-term residents. Our results reveal that passive responses to discrimination, including silent endurance and denial, are associated with one's tendency to conceal public housing residency. Efforts to mitigate public housing stigma through community education and inclusive activities are crucial for enhancing residents' social participation and psychological well-being.

公共住房居民经常面临歧视和耻辱，但很少有人知道他们如何应对，以及这些反应是否影响了他们隐瞒住房状况的愿望。本研究考察了对歧视和隐瞒行为的反应之间的关系，特别关注性别和居住年限。利用首尔公共租赁住房面板调查（SPRHPS）的数据，我们分析了从第二波到第四波观察到的5856个人的样本。关键的结果是自我报告的隐藏公共住房居住的愿望。对歧视的反应分为：沉默忍受、被动否认和积极抵抗。我们估计了普通最小二乘（OLS）和个体固定效应（FE）模型，以检查人体内的变化，同时考虑了时不变的个体特征。包括相互作用项以评估性别和居住年限的异质性。OLS模型显示，对歧视的沉默忍耐（b = 0.535）和被动拒绝（b = 0.202）与公共住房居住隐瞒相关，而主动抵抗（b = 0.338）的影响较弱。在固定效应模型中，沉默忍耐（b = 0.409）和被动拒绝（b = 0.164）的影响仍然显著，而主动抵抗的影响不显著。交互作用分析表明，女性和长期居民的被动应对策略的隐藏效应更强。我们的研究结果表明，对歧视的被动反应，包括沉默的忍受和否认，与一个人隐瞒公共住房居住的倾向有关。通过社区教育和包容性活动来减轻公共住房的污名对于提高居民的社会参与和心理健康至关重要。

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引用次数: 0

Diffusion of responsibility: Patient moral judgments of generative AI-informed clinical decisions 责任的分散：生成人工智能知情临床决策的患者道德判断。

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

Social Science & Medicine

Pub Date : 2026-01-06 DOI: 10.1016/j.socscimed.2026.118928

Wei Zhang , Jicheng Li , Fuxiang Guo , Chengyan Zhu , Magdalena Kludacz-Alessandri , Richard Evans

Background

As Generative Artificial Intelligence (GAI) becomes increasingly embedded into complex medical decision-making, it is anticipated that patients' psychological and behavioral responses will diverge significantly from those observed in traditional healthcare settings. This study, therefore, aims to investigate a key challenge for AI governance: how does GAI involvement in therapeutic decisions influence patients’ moral judgment of the physician when adverse outcomes occur?

Methods

A between-subjects vignette experiment was designed. A sample of 331 participants was recruited to evaluate a clinical scenario in which a physician prescribed a treatment leading to an adverse outcome. The experimental design orthogonally manipulated two variables critical for healthcare governance: (a) physician adherence to GAI-generated advice, and (b) the nature of the recommended regimen (personalized versus standard-of-care). Moral blame directed toward the physician served as the primary dependent variable. The data were analyzed using PROCESS Model 1 (v4.1) in SPSS 28 for moderated regression analysis.

Results

The analysis shows a significant diffusion of responsibility i.e., when an adverse outcome occurs, physicians who adhere to GAI advice incur significantly less moral blame than those who do not (p < 0.001). Furthermore, the type of GAI-endorsed treatment moderates this relationship (p < 0.05). The blame mitigation effect is substantially stronger when the regimen is personalized (p < 0.001) and attenuated, though remaining significant, under the standard-of-care condition (p < 0.05). Finally, perceived patient harm strongly and positively predicts moral blame (p < 0.001).

Conclusions

The findings demonstrate that following an adverse outcome, patients ascribe less moral culpability to physicians who incorporate GAI recommendations, an effect most pronounced for personalized treatment plans. This highlights a diffusion of responsibility in AI-mediated care. Ethical and sustainable GAI integration will, therefore, require the creation of clear frameworks for accountability, comprehensive physician training, and transparent patient communication.

Trial registration

Not Applicable.

背景：随着生成式人工智能（GAI）越来越多地嵌入到复杂的医疗决策中，预计患者的心理和行为反应将与传统医疗环境中观察到的明显不同。因此，本研究旨在探讨人工智能治理的一个关键挑战：当不良结果发生时，人工智能参与治疗决策如何影响患者对医生的道德判断？方法：设计受试者间小图像实验。331名参与者被招募来评估一个临床场景，在这个场景中，医生开了一种导致不良结果的治疗方法。实验设计正交地操纵了两个对医疗保健治理至关重要的变量：(a)医生对ai生成的建议的依从性，以及(b)推荐方案的性质（个性化与标准护理）。针对医生的道德责备是主要的因变量。数据分析使用SPSS 28中的PROCESS Model 1 （v4.1）进行适度回归分析。结果：分析显示了责任的显著分散，即，当不良结果发生时，坚持GAI建议的医生比不遵循GAI建议的医生承担的道德责任要少得多(p结论：研究结果表明，在不良结果发生后，患者认为采纳GAI建议的医生承担的道德责任更少，这一效应在个性化治疗计划中最为明显。这凸显了人工智能介导的医疗中责任的分散。因此，道德和可持续的GAI整合将需要建立明确的问责框架、全面的医生培训和透明的患者沟通。试验注册：不适用。

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引用次数: 0

Low socioeconomic status as a major risk factor for early-onset type 2 diabetes with limited lifestyle mediation: Cross-Sectional evidence from US and South Korean populations 低社会经济地位是早发性2型糖尿病的主要危险因素，生活方式调节有限：来自美国和韩国人群的横断面证据

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

Social Science & Medicine

Pub Date : 2026-01-05 DOI: 10.1016/j.socscimed.2026.118939

Siying Liu , Tingting Liu , Yanli Cao , Cihang Lu , Jiahui Guo , Jie Li , Qiqiang Guo , Jing Zhang , Yongze Li

This study aimed to examine the association between socioeconomic status (SES) and early- and late-onset type 2 diabetes (T2D), evaluate the mediating role of a healthy lifestyle in these associations, and further explore the contribution of various risk factors to different types of T2D. This study analyzed data from US NHANES, and Korean KNHANES, encompassing 20,655 US, and 26,575 Korean adults. SES was categorised as high, middle, or low based on income, education, employment, and insurance. A healthy lifestyle score included nonsmoking, no heavy drinking, regular physical activity, and a high-quality diet. Early-onset T2D was defined as diagnosis before age 40. In NHANES, early-onset T2D prevalence was 1.35 %, rising from 0.85 % (high SES) to 2.41 % (low SES); late-onset prevalence was 5.63 %, with similar SES gradients. Comparable patterns emerged in KNHANES. Low SES consistently increased the risk of early-onset T2D, with stronger associations observed compared to late-onset T2D. A healthy lifestyle only mediated the relationship between SES and late-onset T2D. In early-onset T2D, a healthy lifestyle did not have a significant protective effect. The strength of the associations between the risk factors for early-onset T2D was generally greater than that for late-onset T2D, especially for obesity and family history of diabetes. Low SES is a stronger risk factor for early-onset T2D, with lifestyle interventions proving insufficient to mitigate risk. Public health efforts should prioritize addressing social determinants, early screening, and targeted education for vulnerable youth, particularly those with low SES, obesity, or a family history of diabetes.

本研究旨在探讨社会经济地位（SES）与早、晚发型2型糖尿病（T2D）的关系，评估健康生活方式在这些关系中的中介作用，并进一步探讨各种危险因素对不同类型T2D的贡献。该研究分析了美国NHANES和韩国KNHANES的数据，包括20,655名美国成年人和26,575名韩国成年人。社会经济地位根据收入、教育、就业、保险等分为高、中、低三个等级。健康生活方式的评分包括不吸烟、不酗酒、有规律的体育锻炼和高质量的饮食。早发性T2D定义为40岁前诊断。在NHANES，早发性T2D患病率为1.35%，从0.85%（高SES）上升到2.41%（低SES）；晚发患病率为5.63%，具有相似的SES梯度。KNHANES也出现了类似的模式。低SES持续增加早发性T2D的风险，与晚发性T2D相比有更强的相关性。健康的生活方式仅介导SES与迟发性T2D之间的关系。在早发性T2D中，健康的生活方式没有显著的保护作用。早发性T2D的危险因素之间的关联强度一般大于晚发性T2D，尤其是肥胖和糖尿病家族史。低社会经济地位是早发性T2D的一个更强的危险因素，生活方式干预被证明不足以降低风险。公共卫生工作应优先解决社会决定因素、早期筛查和针对弱势青年的有针对性的教育，特别是那些低社会经济地位、肥胖或糖尿病家族史的青年。

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引用次数: 0

‘It's very hard, it's very very difficult ….’ Exploring the lived experiences of managing diabetes among young people living with type 1 diabetes in underserved communities in Ghana 这非常困难，非常非常困难....“探索加纳服务不足社区中患有1型糖尿病的年轻人管理糖尿病的生活经验

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

Social Science & Medicine

Pub Date : 2026-01-05 DOI: 10.1016/j.socscimed.2025.118919

Joseph Kangmennaang , Alhassan Siiba , Prince Ofori-Boateng , Nana Ama Barnes Amoa , Yacoba Atiase , Elizabeth Bankah

Sub-Saharan Africa (SSA) is undergoing an epidemiological transition which is driving increases in the risk and prevalence of diabetes and other non-communicable diseases (NCDs). In Ghana, while the prevalence of diabetes is generally increasing, type 1 diabetes mellitus (T1DM) is increasing at a higher rate (9.5 %) among young people compared to type 2 diabetes (4.9 %) mellitus (T2DM). T1DM differs from T2DM in that it is not readily preventable, children are often diagnosed late, or diagnoses are missed entirely, and living with T1DM requires a different approach to care. Young people living with diabetes (PLWDs) and their caregivers often have new responsibilities placed on them. Given the increasing burden of diabetes among young people, and the lack of targeted prevention strategies coupled with inadequate care for young PLWDs in Ghana, there is an urgent need to identify context-relevant challenges to guide the development of interventions aimed at improving diabetes management outcomes. As part of a larger research program exploring diabetes risks and management in underserved communities, this paper explores the barriers and facilitators of managing diabetes among young people. We conducted photovoice interviews with young PLWDs (n = 21) in Kumasi and Wa, Ghana. The key themes that emerged include sociocultural barriers and norms, the food environment, and embodied experiences including pains and scars from insulin injections. Overall, notwithstanding the insights generated from this study, further quantitative research may be useful to support the design of targeted preventive and management strategies for young people living with T1DM in Ghana and in other LMICs.

撒哈拉以南非洲（SSA）正在经历流行病转型，导致糖尿病和其他非传染性疾病的风险和流行率上升。在加纳，虽然糖尿病的患病率普遍上升，但与2型糖尿病（4.9%）相比，年轻人中1型糖尿病（T1DM）的增长率（9.5%）更高。1型糖尿病与2型糖尿病的不同之处在于，它不易预防，儿童往往诊断较晚，或诊断完全遗漏，并且1型糖尿病患者需要不同的护理方法。患有糖尿病的年轻人及其照顾者往往肩负着新的责任。鉴于加纳年轻人的糖尿病负担日益加重，缺乏有针对性的预防策略，加上对年轻糖尿病患者的护理不足，迫切需要确定与环境相关的挑战，以指导旨在改善糖尿病管理结果的干预措施的发展。作为一个更大的研究项目的一部分，探索在服务不足的社区糖尿病的风险和管理，本文探讨了在年轻人中管理糖尿病的障碍和促进因素。我们对加纳库马西和瓦的年轻plwd （n = 21）进行了照片语音采访。出现的关键主题包括社会文化障碍和规范，食物环境，以及胰岛素注射带来的疼痛和疤痕等具体体验。总的来说，尽管这项研究产生了一些见解，但进一步的定量研究可能有助于为加纳和其他中低收入国家患有T1DM的年轻人设计有针对性的预防和管理策略。

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引用次数: 0

Polygyny and help-seeking for intimate partner violence in Afghanistan: The mediating role of women's autonomy and the moderating effects of education and fear of the husband 阿富汗的一夫多妻制和亲密伴侣暴力的求助：妇女自主的中介作用以及教育和对丈夫的恐惧的调节作用

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

Social Science & Medicine

Pub Date : 2026-01-05 DOI: 10.1016/j.socscimed.2026.118945

Mohammad Fazel Akbary , Mohammad Baqir Marefat , Rashed Nawaz , Quanbao Jiang

Objectives

Intimate partner violence (IPV) remains a pervasive public health concern that undermines the physical, sexual, and psychological well-being of millions of women worldwide. This study examines the association between polygyny and help-seeking behavior in Afghanistan, focusing on the mediation role of women's autonomy, and moderating effects of educational attainment and fear of husband in this relationship.

Methods

Date were drawn from the 2015 Afghanistan Demographic and Health Survey (AFDHS) and included married and in-union women aged 15–49 who had been exposed to IPV (n = 10,284). Multiple imputation using chained equations was applied to address missing data. Bivariate regression, Generalized Structural Equation Modeling (GSEM), and bootstrapping with 5000 samples were conducted on this relationship.

Results

The result shows that only 19.48 % of women sought help for IPV in Afghanistan. Polygyny had a direct positive effect on help-seeking for IPV (β = 0.10, BCCI = −0.5271–0.4349) and an indirect effect via autonomy (β = 0.06, BCCI = 0.0074–0.0813). When education and fear of husband were included as moderators, the indirect effect reduced but stayed significant (β = 0.04, BCCI = 0.0244–0.0549), confirming moderated mediation.

Conclusion

These findings underscore the multi-layered complexity of help-seeking behavior for IPV in Afghanistan and the importance of contextualizing interventions within the broader socio-cultural and structural realities of women's lives. A culturally sensitive, and gender-transformative approach is crucial for breaking the cycles of silence, fear, and violence.

亲密伴侣暴力（IPV）仍然是一个普遍存在的公共卫生问题，它损害了全世界数百万妇女的身体、性和心理健康。本研究考察了阿富汗一夫多妻制与寻求帮助行为之间的关系，重点关注妇女自主性的中介作用，以及受教育程度和对丈夫的恐惧在这种关系中的调节作用。方法数据来自2015年阿富汗人口与健康调查（AFDHS），包括15-49岁暴露于IPV的已婚和同居妇女（n = 10,284）。采用链式方程进行多次插值，解决数据缺失问题。对这一关系进行了二元回归、广义结构方程模型（GSEM）和5000个样本的自举。结果在阿富汗，只有19.48%的妇女寻求过IPV的帮助。一夫多妻制对IPV寻求帮助有直接正向影响（β = 0.10, BCCI = - 0.5271 ~ 0.4349），对自主性有间接正向影响（β = 0.06, BCCI = 0.0074 ~ 0.0813）。当教育程度和对丈夫的恐惧作为调节因素时，间接效应降低，但仍然显著（β = 0.04, BCCI = 0.0244-0.0549），证实有调节的中介作用。这些发现强调了阿富汗IPV寻求帮助行为的多层次复杂性，以及在更广泛的社会文化和妇女生活结构现实中进行背景化干预的重要性。要打破沉默、恐惧和暴力的循环，采取具有文化敏感性和性别变革的方法至关重要。

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引用次数: 0

Serious psychological distress, unmet mental health treatment needs, and help-seeking among Asian American adults in New York City: A population-based study 纽约市亚裔美国成年人的严重心理困扰、未满足的心理健康治疗需求和寻求帮助：一项基于人群的研究

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

Social Science & Medicine

Pub Date : 2026-01-03 DOI: 10.1016/j.socscimed.2026.118931

Thinh Toan Vu , Zi Lian , Victoria Khanh Ngo , Rachel Suss , Jo-Anne Caton , Christina Norman

This study assessed serious psychological distress (SPD), unmet mental health treatment needs, and help-seeking among Asian American adults (AAs) in New York City (NYC), examining their associations with psychosocial factors. We also identified barriers to mental health treatment access and help-seeking sources. The 2023 Neighborhood Wellness Survey data, a representative sample of NYC adults, were analyzed. SPD was assessed using the Kessler Psychological Distress Scale (K6≥13). Multivariable regression models, adjusted for demographics, examined associations between psychosocial factors, SPD, unmet needs, and help-seeking. Among 6,648 AAs, the weighted and age-adjusted prevalence of SPD, unmet needs, and help-seeking were 7.4 %, 9.2 %, and 39.1 %, respectively. Racial/ethnic discrimination and social isolation were linked to higher odds of SPD and unmet needs, as well as greater probabilities of help-seeking. Financial strain was only associated with higher odds of SPD; stop/search/questioning by police was only associated with higher odds of unmet needs; and witnessing neighborhood violence was only associated with higher likelihood of help-seeking. Intimate partner violence and higher psychological distress severity were associated with higher odds of unmet needs and higher probabilities of help-seeking. Main barriers to mental health care among those with unmet needs were self-reliance without treatment (51.1 %), cost (46.4 %), and unawareness of available resources (41.7 %). Family/friends (30.0 %) were the primary support sources. AAs with higher levels of psychological stressors and psychological distress reported higher unmet needs and greater help-seeking. Enhancing mental health literacy and awareness of resources, reducing stigma, and improving access to affordable, culturally competent care is crucial, particularly for AAs facing violence, racial/ethnic discrimination, and police interactions.

本研究评估了纽约市亚裔美国成年人（AAs）的严重心理困扰（SPD）、未满足的心理健康治疗需求和寻求帮助的情况，研究了它们与社会心理因素的关系。我们还确定了心理健康治疗和求助渠道的障碍。研究人员分析了纽约市成年人的代表性样本——2023年社区健康调查数据。SPD采用Kessler心理困扰量表（K6≥13）进行评定。多变量回归模型经人口统计学调整后，检验了社会心理因素、SPD、未满足需求和寻求帮助之间的关系。在6648名AAs中，SPD、未满足需求和寻求帮助的加权患病率和年龄调整患病率分别为7.4%、9.2%和39.1%。种族/民族歧视和社会孤立与SPD的较高几率和未满足的需求以及更大的寻求帮助的可能性有关。经济压力只与SPD的高几率相关；被警察拦下/搜查/问话只会增加未满足需求的可能性；而目睹邻里暴力只会增加寻求帮助的可能性。亲密伴侣暴力和更高的心理困扰严重程度与更高的未满足需求的可能性和更高的寻求帮助的可能性相关。在那些需求未得到满足的人中，获得精神卫生保健的主要障碍是没有治疗的自力更生（51.1%）、费用（46.4%）和不了解可用资源（41.7%）。家人/朋友（30.0%）是主要的支援来源。心理压力源和心理困扰水平较高的AAs报告了更高的未满足需求和更多的寻求帮助。提高精神卫生素养和对资源的认识、减少污名和改善获得负担得起的、文化上合格的护理的机会至关重要，特别是对于面临暴力、种族/民族歧视和警察互动的精神保健师而言。

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引用次数: 0

Worthy of thinness: Moral reasoning and bureaucratic care in a state-funded bariatric surgery committee 值得瘦身：国家资助的减肥手术委员会的道德推理和官僚关怀。

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

Social Science & Medicine

Pub Date : 2026-01-02 DOI: 10.1016/j.socscimed.2025.118922

Hilla Nehushtan

In many countries, bariatric surgery is tightly rationed, yet Israel's publicly funded healthcare system provides comparatively broad access to this surgery. This ethnographic study examines how a bariatric surgery committee evaluates patient deservingness when financial constraints are sidelined. Based on ethnographic fieldwork conducted as part of a broader study (2014–2020) in a private hospital, including observations of over 200 candidates and in-depth interviews with 15 clinicians, this analysis examines the everyday practices of gatekeeping in a context where approval is relatively generous.

Findings indicate that the committee's mandate operates beyond its clinical scope, functioning as a symbolic, moral, and bureaucratic ritual. Professionals expect candidates to perform responsibility, insight, and self-discipline: candidates are required to reflect on past dieting challenges, demonstrate behavioural change, and endorse biomedical norms, all of which construct the perceived “worthy” patient. Tensions intensify around adolescents and candidates with mental health diagnoses, where clinicians negotiate trust, parental influence, and the boundaries of professional authority. These assessments unfold in Israel's informal, direct communication style, where empathy and care coexist with stigma from professionals and sporadic expressions of frustration from candidates.

The study demonstrates how moral economies of bureaucratic care and worth performances persist even in systems of broad access. When cost rationing recedes, informal norms, weight bias, clinician responsiveness, and candidate pressure all shape the interactions. By highlighting these dynamics, the study contributes to an understanding of how gatekeeping reproduces biomedical norms of worth, clarifying the sociocultural dynamics within universal-coverage health systems.

在许多国家，减肥手术是严格配给的，然而以色列的公共医疗保健系统提供了相对广泛的手术机会。这项人种学研究考察了减肥手术委员会如何评估患者在经济限制的情况下的价值。作为一项更广泛的研究（2014-2020年）的一部分，在一家私立医院进行了民族志实地调查，包括对200多名候选人的观察和对15名临床医生的深入访谈，本分析基于这一背景下看门人的日常实践。调查结果表明，该委员会的授权超出了其临床范围，其功能是象征性的、道德的和官僚的仪式。专业人士希望候选人表现出责任感、洞察力和自律：候选人需要反思过去的节食挑战，表现出行为改变，并支持生物医学规范，所有这些都构建了被认为是“有价值”的病人。在青少年和有心理健康诊断的候选人之间，紧张加剧，临床医生协商信任、父母的影响和专业权威的界限。这些评估在以色列非正式、直接的沟通方式中展开，在那里，同情和关怀与专业人士的耻辱和候选人偶尔表达的沮丧并存。该研究表明，官僚主义关怀和价值表现的道德经济如何在广泛准入的体系中持续存在。当成本配给减少时，非正式规范、权重偏差、临床医生的反应和候选人压力都会影响相互作用。通过强调这些动态，该研究有助于理解把关如何再现生物医学价值规范，澄清全民覆盖卫生系统内的社会文化动态。

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引用次数: 0

Between epistemic empowerment and moral anxiety: Chinese patients’ ambivalence toward AI-assisted diagnosis 在认知赋权与道德焦虑之间：中国患者对人工智能辅助诊断的矛盾心理

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

Social Science & Medicine

Pub Date : 2026-01-02 DOI: 10.1016/j.socscimed.2026.118929

Ronghui Yang

The rapid advancement of generative artificial intelligence (AI) has led an increasing number of Chinese patients to incorporate AI tools into their clinical encounters. While prior research has explored individual attitudes toward AI-mediated diagnosis, less is known about the broader socio-psychological dynamics that shape patient engagement with AI. Drawing on qualitative interviews with 60 Chinese stakeholders, this study examines patients' socio-psychological responses to AI-assisted diagnosis. Our findings reveal a persistent tension. On the one hand, patients experience epistemic empowerment. AI renders complex biomedical knowledge accessible, enables systematic verification of physicians’ recommendations, and supports more substantive participation in clinical decision-making. On the other hand, patients report moral unease grounded in Confucian norms. Many fear that invoking AI may appear self-serving, disrupt hierarchical interactional structures, or implicitly challenge professional authority. To navigate this dissonance, patients employ covert strategies, including authorship obscuration, third party endorsement, and discursive translation to preserve interpersonal harmony. While these strategies reduce immediate interactional friction, they can inadvertently undermine long-term trust by fostering implicit comparisons between clinicians and AI. As AI systems become increasingly accurate, comprehensive, and contextually adaptive, some patients may gradually transfer epistemic trust from clinicians to algorithmic judgments. In response, we advocate a clinician-stewarded, evidence-based integration of AI insights, supported by institutional protocols and governance structures that balance professional authority, workload recognition, and patient empowerment.

生成式人工智能（AI）的快速发展使得越来越多的中国患者将人工智能工具纳入他们的临床就诊。虽然之前的研究已经探讨了个人对人工智能介导的诊断的态度，但对影响患者与人工智能互动的更广泛的社会心理动态知之甚少。通过对60位中国利益相关者的定性访谈，本研究考察了患者对人工智能辅助诊断的社会心理反应。我们的发现揭示了一种持续的紧张关系。一方面，患者体验到认知赋权。人工智能使复杂的生物医学知识易于获取，能够系统地验证医生的建议，并支持更实质性地参与临床决策。另一方面，病人反映了基于儒家规范的道德不安。许多人担心，调用人工智能可能会显得自私，破坏等级互动结构，或者含蓄地挑战专业权威。为了应对这种不和谐，患者采用隐蔽的策略，包括作者模糊，第三方认可和话语翻译，以保持人际和谐。虽然这些策略减少了直接的互动摩擦，但它们可能会通过促进临床医生和人工智能之间的隐性比较，在无意中破坏长期信任。随着人工智能系统变得越来越准确、全面和情境适应性，一些患者可能会逐渐将认知信任从临床医生转移到算法判断。作为回应，我们主张在平衡专业权威、工作量识别和患者授权的机构协议和治理结构的支持下，由临床医生管理、以证据为基础的人工智能见解整合。

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引用次数: 0

An ethnographic study of diagnosis of physical illness in people with mental health conditions in the emergency department 急诊科精神疾病患者身体疾病诊断的人种学研究

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

Social Science & Medicine

Pub Date : 2026-01-02 DOI: 10.1016/j.socscimed.2026.118927

Elisa Liberati , Archana Jayaprakash , Rosie Lindsay , Janet Willars , John Gibson , Zoe Fritz , Annabel Price , Thea Hatfield , Natalie Richards , Mary Dixon-Woods , Graham Martin

People living with mental health conditions face reduced life expectancy, largely associated with under-diagnosed and under-treated physical illnesses. Inequalities in the way physical symptoms are diagnosed may be implicated in these outcomes, but, to date, studies have primarily understood these inequalities in terms of ‘diagnostic overshadowing’: the misattribution of physical symptoms to mental health conditions. In this paper, we use the candidacy framework to offer an extended analysis of the influences on diagnosis of physical health symptoms in people with mental health conditions presenting to the emergency department (ED)—a crucial node in the diagnostic pathway. We conducted a multi-site ethnography in three English EDs, including 284 h of non-participant observation and 43 interviews with clinicians, patients with mental health conditions, and accompanying persons. We found that, although the ED was seen as an open door, patients often struggled to have their physical symptoms recognised as legitimate concerns. Some delayed seeking care, feeling less deserving or anticipating dismissal; others tried to enhance their candidacy by downplaying their mental health history. The ED's operating conditions—throughput targets, overcrowded bays, and stretched staffing—favoured presentations that were clear-cut, straightforward, and urgent. This left little room for exploring more complex cases, such as those involving overlapping mental and physical health symptoms. Patients, clinicians and others recognised the risk that implicit bias might affect how physical symptoms in people with mental health conditions were interpreted, and they often sought to mitigate the impacts of such biases. This, however, could create its own risks, as different parties framed and reframed patients' presentations without full knowledge of the adjustments made by others—potentially impacting risks of both under-diagnosis and over-investigation in ways that were difficult to gauge. By applying the candidacy framework and examining the entire ED diagnostic pathway, our study illuminates a range of influences on diagnosis that extend beyond diagnostic overshadowing.

患有精神疾病的人面临预期寿命缩短的问题，这在很大程度上与未得到诊断和治疗的身体疾病有关。身体症状诊断方式的不平等可能与这些结果有关，但迄今为止，研究主要是从“诊断遮蔽”的角度来理解这些不平等：将身体症状错误地归因于精神健康状况。在本文中，我们使用候选资格框架提供了一个扩展的分析，对出现在急诊科（ED）的精神健康状况患者的身体健康症状诊断的影响-诊断途径中的关键节点。我们在三个英语急诊室进行了多地点人种志研究，包括284小时的非参与性观察和43次对临床医生、精神健康状况患者和陪同人员的访谈。我们发现，尽管急诊科被视为一扇敞开的大门，但患者往往很难将自己的身体症状视为合理的担忧。有些人推迟求医，觉得不值得，或者期待被解雇；其他人则试图通过淡化自己的精神病史来提高自己的候选资格。港务署的运作情况——吞吐量目标、过度拥挤的码头和人手紧张——倾向于清晰、直接和紧迫的表述。这给探索更复杂的病例留下了很少的空间，比如那些涉及精神和身体健康症状重叠的病例。患者、临床医生和其他人认识到，内隐偏见可能会影响对精神健康状况患者身体症状的解释，因此他们经常寻求减轻这种偏见的影响。然而，这可能会产生自身的风险，因为不同的各方在没有充分了解其他人所做调整的情况下，对患者的陈述进行了框架和重新定义——以难以衡量的方式，潜在地影响了诊断不足和过度调查的风险。通过应用候选资格框架和检查整个ED诊断途径，我们的研究阐明了一系列对诊断的影响，这些影响超出了诊断的阴影。

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引用次数: 0

Maternal education and the intergenerational transmission of birthweight: Evidence from Japan 母亲教育与出生体重的代际传递：来自日本的证据

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

Social Science & Medicine

Pub Date : 2025-12-31 DOI: 10.1016/j.socscimed.2025.118925

Chisako Yamane , Yoshiro Tsutsui

Background

Birthweight is a key indicator of health capital, influencing long-term outcomes such as education, income, and adult health. Previous studies have examined both its determinants and consequences, showing that low birthweight is associated with poor health, limited schooling, and lower socioeconomic status later in life. However, the pathways of birthweight's intergenerational transmission remain insufficiently understood, particularly the mediating role of maternal education. Moreover, most existing evidence comes from Western countries, and little is known about these mechanisms in Japan, where delayed childbirth and infertility treatments are increasingly common.

Methods

We conducted an original survey of Japanese mothers, collecting data on their own birthweight, their children's birthweight, and socioeconomic attributes. Using Structural Equation Modeling (SEM), we estimated direct and indirect effects through a path diagram linking maternal birthweight, education, age at childbirth, and pregnancy-related factors such as preterm birth and multiple pregnancies. Paternal factors were also examined.

Results

Maternal birthweight positively influenced both maternal education and child birthweight. However, maternal education had no direct effect on child birthweight and showed indirect negative effects through older maternal age and multiple pregnancies. Paternal education and age at childbirth showed weaker effects compared to maternal factors.

Conclusion

Our findings show birthweight is transmitted across generations, but maternal education does not necessarily strengthen this intergenerational transmission. Our analysis indicates that its indirect pathway—through delayed childbirth among highly educated women—increases risks to infant health. Addressing these risks will require comprehensive investments in maternal health, maternity and workplace support, fertility assistance, and education policies.

出生体重是健康资本的关键指标，影响教育、收入和成人健康等长期结果。之前的研究已经检查了它的决定因素和后果，表明低出生体重与健康状况不佳、受教育程度有限、晚年社会经济地位较低有关。然而，出生体重代际传递的途径仍然不够清楚，特别是母亲教育的中介作用。此外，大多数现有的证据来自西方国家，在日本，人们对这些机制知之甚少，在日本，延迟生育和不孕治疗越来越普遍。方法我们对日本母亲进行了一项原始调查，收集了她们自己的出生体重、她们孩子的出生体重和社会经济属性的数据。使用结构方程模型（SEM），我们通过连接产妇出生体重、教育、分娩年龄和妊娠相关因素（如早产和多胎妊娠）的路径图估计了直接和间接影响。父亲的因素也被检查。结果母亲出生体重对母亲受教育程度和儿童出生体重均有正向影响。然而，母亲教育对婴儿出生体重没有直接影响，并通过母亲年龄较大和多胎妊娠表现出间接的负面影响。与母亲因素相比，父亲的教育程度和分娩年龄的影响较弱。结论：我们的研究结果表明，出生体重是代际传递的，但母亲教育不一定会加强这种代际传递。我们的分析表明，其间接途径——在受过高等教育的妇女中延迟分娩——增加了婴儿健康的风险。要解决这些风险，就需要对孕产妇保健、孕产妇和工作场所支持、生育援助和教育政策进行全面投资。

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引用次数: 0