Árpád Skrabski

Social capital in a changing society: cross sectional associations with middle aged female and male mortality rates

Objectives: Social capital has been linked to self rated health and mortality rates. The authors examined the relations between measures of social capital and male/female mortality rates across counties in Hungary. Design: Cross sectional, ecological study. Setting: 20 counties of Hungary. Participants and methods: 12 640 people were interviewed in 1995 (the “Hungarostudy II” survey), representing the Hungarian population according to sex, age, and county. Social capital was measured by three indicators: lack of social trust, reciprocity between citizens, and help received from civil organisations. Covariates included county GDP, personal income, education, unemployment, smoking, and alcohol spirit consumption. Main outcome measure: Gender specific mortality rates were calculated for the middle aged population (45–64 years) in the 20 counties of Hungary. Results: All of the social capital variables were significantly associated with middle age mortality, but levels of mistrust showed the strongest association. Several gender differences were observed, namely male mortality rates were more closely associated with lack of help from civic organisations, while female mortality rates were more closely connected with perceptions of reciprocity. Conclusion: There are gender differences in the relations of specific social capital indicators to mortality rates. At the same time, perceptions of social capital within each sex were associated with mortality rates in the opposite sex.

Psychosocial risk factors, inequality and self-rated morbidity in a changing society

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.

Self-Rated Health, Subjective Social Status, and Middle-Aged Mortality in a Changing Society

In this study, the authors examined the relationships between self-rated health and subjective and objective socioeconomic status (as measured by income and education) in relation to middle-aged mortality differences in men and women across 20 counties in Hungary through a cross-sectional, ecological study. The authors interviewed 12,643 people in a Hungarostudy 2002 survey, profiling the Hungarian population according to gender, age, and county. They found that mean self-rated health and self-rated disability at the county level were significantly associated with middle-aged mortality differences among counties, with male mortality more closely associated with self-rated health. The authors also noted that self-rated health and socioeconomic status of the opposite gender were significantly associated with middle-aged mortality, but the strength of the association differed by gender. Finally, male middle-aged mortality was more strongly connected to female subjective and objective social status than female mortality was connected with male social status.

Social capital and collective efficacy in Hungary: cross sectional associations with middle aged female and male mortality rates

Objectives: Social capital, collective efficacy, and religious involvement have each been linked to population health. This study examined the relations between these measures and male/female mortality rates in Hungary. Design: Cross sectional, ecological study. Setting: 150 sub-regions of Hungary. Participants and methods: 12 643 people were interviewed in 2002 (the “Hungarostudy 2002” survey). Social capital was measured by lack of social trust, reciprocity between citizens, and membership in civil organisations. Collective efficacy was measured by survey items from the Project on Human Development in Chicago Neighborhoods. Religious involvement was measured by church attendance. Main outcome measure: Gender specific all cause mortality rates for the middle aged population (45–64 years) in the 150 sub-regions of Hungary, provided by the Central Statistical Office (CSO). Results: Social capital, collective efficacy, as well as religious involvement were each significantly associated with middle age mortality. After education, collective efficacy showed the strongest association with mortality in both men and women. Among men, socioeconomic status, collective efficacy, social distrust, competitive attitude, reciprocity, and membership of civic organisations explained 68.0% of the sub-regional variations in mortality rates. Among women the same variables explained only 29.3% of the variance in mortality rates. Religious involvement was protective among women. Conclusion: Collective efficacy and social capital are significant predictors of mortality rates in both men and women across sub-regions of Hungary. Gender differences in the relative importance of social factors may help to explain the differential impact of economic transformation on mortality rates for men and women in Central-Eastern European countries.

Chronic stress and social changes: socioeconomic determination of chronic stress.

Abstract:  In the last decades in the transforming societies of Central and Eastern Europe, premature mortality increased dramatically, especially among men. Increasing disparities in socioeconomic conditions have been accompanied by a widening socioeconomic gradient in mortality among men. Social cohesion and meaning in life may help to counterbalance the widening gap in material circumstances. Not the difficult social situation in itself, but the subjective experience of relative disadvantage, the prolonged negative emotional state, that is, chronic stress seems to be the most important risk factor. The health consequences of a low socioeconomic situation among men might be mostly explained by chronic stress caused by work and close‐partner–related factors, and the toxic components of this interaction are depression and hopelessness. In the case of women, the broader personal and family relations are the most important health‐related factors. Weekend workload, low social support at work and low control at work accounted for a large part of variation in male premature cardiovascular mortality rates, whereas job insecurity, high weekend workload, and low control at work contribute most markedly to variations in premature cardiovascular mortality rates among women. There are two general approaches that scientists and practitioners might take: train individuals and groups to use skills that will enable them to cope better with the stressful conditions that are damaging their health; and lobby governments to adopt policies that will result in decreased chronic stress on the societal level.

Socioeconomic factors, severity of depressive symptomatology, and sickness absence rate in the Hungarian population.

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.

Tobacco smoking in young adults from 21 European countries: Association with attitudes and risk awareness.

Information concerning tobacco smoking was obtained in a survey of 16,483 students aged 18-30 years from 21 European countries. Belief in the benefits to health of not smoking were also assessed. Risk awareness was measured in terms of knowledge of the links between smoking and disease. The overall age-adjusted prevalence of smoking was 33.1% in men and 29.0% in women, but wide variations were observed across country samples. Significant sex differences were found in only a minority of cases. The inclusion of respondents who stated that they had sometimes smoked in the past substantially reduced variations in prevalence across country samples. Beliefs in the health benefits of not smoking were consistently associated with smoking behaviour. Awareness of the link between smoking and lung cancer was uniformly high, but awareness of the role of smoking in heart disease varied considerably across country samples, and averaged only 64.4% in men and 62.9% in women. In the majority of countries, risk awareness was greater among smokers than non-smokers. The results suggest that in this selected sector of the population of young adults in Europe, sex differences in smoking are relatively minor, robust associations between attitudes and smoking behaviour can be identified, and there are major gaps in risk awareness.

Psychosocial determinants of premature cardiovascular mortality differences within Hungary

Objectives: The life expectancy gap between Central-Eastern European (CEE) countries, including Hungary, and Western Europe (WE) is mainly attributable to excess cardiovascular (CV) mortality in midlife. This study explores the contribution of socioeconomic, work related, psychosocial, and behavioural variables to explaining variations of middle aged male and female CV mortality across 150 sub-regions in Hungary. Design: Cross sectional, ecological analyses. Setting: 150 sub-regions of Hungary. Participants and methods: 12 643 people were interviewed in Hungarostudy 2002 survey, representing the Hungarian population according to sex, age, and sub-regions. Independent variables were income, education, control in work, job insecurity, weekend working hours, social support, depression, hostility, anomie, smoking, body mass index, and alcohol misuse. Main outcome measures: Gender specific standardised premature (45–64 years) total CV, ischaemic heart disease, and cerebrovascular mortality rates in 150 sub-regions of Hungary. Results: Low education and income were the most important determinants of mid-aged CV mortality differences across sub-regions. High weekend workload, low social support at work, and low control at work account for a large part of variation in male premature CV mortality rates, whereas job insecurity, high weekend workload, and low control at work contribute most noticeably to variations in premature CV mortality rates among women. Low social support from friends, depression, anomie, hostility, alcohol misuse and cigarette smoking can also explain a considerable part of variations of premature CV mortality differences. Conclusion: Variations in middle aged CV mortality rates in a rapidly changing society in CEE are largely accounted for by distinct unfavourable working and other psychosocial stress conditions.

Low socioeconomic status of the opposite sex is a risk factor for middle aged mortality

Objectives: To examine the relations between subjective social status, and objective socioeconomic status (as measured by income and education) in relation to male/female middle aged mortality rates across 150 sub-regions in Hungary. Design: Cross sectional, ecological analyses. Setting: 150 sub-regions of Hungary. Participants and methods: 12 643 people were interviewed in the Hungarostudy 2002 survey, representing the Hungarian population according to sex, age, and sub-regions. Independent variables were subjective social status, personal income, and education. Main outcome measure: For ecological analyses, sex specific mortality rates were calculated for the middle aged population (45–64 years) in the 150 sub-regions of Hungary. Results: In ecological analyses, education and subjective social status of women were more significantly associated with middle aged male mortality, than were male education, male subjective social status, and income. Among the socioeconomic factors female education was the most important protective factor of male mid-aged mortality. Subjective social status of the opposite sex was significantly associated with mid-aged mortality, more among men than among women. Conclusion: Pronounced sex interactions were found in the relations of education, subjective social status, and middle aged mortality rates. Men seem to be more vulnerable to the socioeconomic status of women than women to the effects of socioeconomic status of men. Subjective social status of women was an important predictor of mortality among middle aged men as was female education. The results suggest that improved socioeconomic status of women is protective for male health as well as for female health.

Neurotics at risk and suicidal behaviour in the Hungarian population

ABSTRACT: 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%.