David J. Pevalin

Emergence of Gender Differences in Depression During Adolescence: National Panel Results From Three Countries

OBJECTIVE Although the gender gap in depression among adults is well established, the age at which this phenomenon appears during adolescence is less clear. To address this, the authors present a cross-national examination of the emergence of the gender gap in depression during adolescence using national longitudinal panel data from Canada, Great Britain, and the United States. METHOD The two-wave, 1994-1996 Canadian National Population Health Survey uses a diagnostic measure across a 24-month interval, providing 12-month prevalence rates of major depressive disorder. The British Youth Panel measures depressive symptomatology across five annual waves beginning in 1995. The two-wave, 1995-1996 National Longitudinal Study of Adolescent Health uses a measure of depressive symptomatology across a 12-month interval. RESULTS Females have significantly higher rates of depression for each sample overall. When samples are decomposed by age, the gender gap in depression consistently emerges by age 14 across all three national samples, irrespective of the measure used or whether categorical cutoffs or untransformed scale scores are used to assess depressive symptomatology. CONCLUSIONS There is a consistent pattern in the onset of the gender gap in depression at age 14 across all three countries and measures. This consistency provides important etiologic clues concerning underlying causes of depression and identifies at what age diagnosis, treatment, and intervention strategies should be directed.

Health systems and the right to health: an assessment of 194 countries

60 years ago, the Universal Declaration of Human Rights laid the foundations for the right to the highest attainable standard of health. This right is central to the creation of equitable health systems. We identify some of the right-to health features of health systems, such as a comprehensive national health plan, and propose 72 indicators that reflect some of these features. We collect globally processed data on these indicators for 194 countries and national data for Ecuador, Mozambique, Peru, Romania, and Sweden. Globally processed data were not available for 18 indicators for any country, suggesting that organisations that obtain such data give insufficient attention to the right-to-health features of health systems. Where they are available, the indicators show where health systems need to be improved to better realise the right to health. We provide recommendations for governments, international bodies, civil-society organisations, and other institutions and suggest that these indicators and data, although not perfect, provide a basis for the monitoring of health systems and the progressive realisation of the right to health. Right-to-health features are not just good management, justice, or humanitarianism, they are obligations under human-rights law.

Marital transitions and mental health

Most research identifies marital disruption as a precursor for poor mental health but is generally unable to discount the potential selection effect of poor mental health leading to marital disruption. We use data from nine annual waves of the British Household Panel Survey to examine social selection and social causation as competing explanations. Mental health is measured using the general health questionnaire. We examine mental health at multiple time points prior to and after a marital transition through separation or divorce and compare this process to those who experience widowhood. All groups transitioning out of marriage have a higher prevalence of poor mental health afterwards but for those separated or divorced, poor mental health also precedes marital disruption, lending support to both social-causation and social-selection processes. The processes both preceding and after the transition to widowhood differ, with increased prevalence of disorder centering around the time surrounding the death itself.

Multiple applications of the GHQ-12 in a general population sample: an investigation of long-term retest effects.

Abstract  Background: Previous studies have indicated that the 60-, 30-, 28- and 12-item versions of the General Health Questionnaire (GHQ) are liable to retest effects, especially when administered multiple times with short intervals. The aim of this study was to examine data from a large general population sample for evidence of any retest effects over 7 yearly applications. Methods: A core panel was drawn from the British Household Panel Survey of those respondents who had completed the GHQ-12 seven times from 1991 to 1997 (n = 4749). The panel results were compared with cross-sectional data from the Health Surveys for England for the same years. The analyses were conducted separately for males and females broken down by age groupings. Results: No evidence of retest effects was found. For males, the panel results did not diverge significantly from the cross-sectional results. For females, the panel results did indicate a divergence from the cross-sectional results, but this was due to the age composition of the panel and differing age trajectories. Conclusion: The GHQ-12 is a consistent and reliable instrument when used in general population samples with relatively long intervals between applications.

Social precursors to onset and recovery from episodes of common mental illness

BACKGROUND Social disadvantage and lack of social support have been identified as important risk factors for the onset and continuance of episodes of common mental illness. This study aimed to identify the social precursors to episodes of and recovery from common mental illness in a large, general population sample over eight yearly intervals. METHOD The analytical samples were drawn from those aged > or = 16 in the British Household Panel Survey from 1991 to 1998. The samples were: (1) onset--over 42,000 paired years from 10,204 persons; (2) recovery--over 10,000 paired years from 4878 persons; and (3) 1812 spells with observed onset and recovery. Markov and discrete-time complementary log-log models were used. Common mental illness was measured using the 12-item General Health Questionnaire. RESULTS Sex, age, changes in marital and employment status, physical health, family care and social support were all associated with differential rates of onset and recovery. Severity of disorder was associated with less likelihood of recovery and longer time to recovery. CONCLUSIONS The study confirms many previous findings concerning social factors associated with onset and recovery. Low social support acted as expected by increasing chances of onset and decreasing chances of recovery. Other social factors such as separation or divorce, becoming and remaining unemployed, health limiting daily activities, caring for a sick relative all decreased chances of recovery. The chances of observing a change in state (either onset or recovery) decreased with the number of prior observations in that state. Reduced rates of recovery with increasing degrees of severity of distress was expected, but not previously demonstrated.

The Dynamics of Unhealthy Housing in the UK: A Panel Data Analysis

There is an abundance of evidence supporting a cross-sectional association between poor housing and poor health, but relatively few studies have examined the relationship between housing and health over time. Using contemporary longitudinal data from seven yearly waves (1996–2002) of the British Household Panel Survey, summary statistics and multivariate first-differences regression models, this study provides robust evidence of a dynamic relationship between housing conditions and health. Worsening housing conditions, measured in three domains, are independently associated with deterioration in health, especially the number of reported health problems in women. These findings add to the longitudinal evidence of the effect of housing conditions. It is concluded that improvements in housing conditions produce health benefits and the findings are important for proposed housing interventions to maximise health benefits and prioritise areas of housing investment.

Housing repossessions, evictions and common mental illness in the UK: results from a household panel study

Background: The numbers of housing repossessions and evictions in the UK are increasing. This study investigates whether repossessions and evictions increase the likelihood of common mental illness and examine patterns over time. Methods: Data come from the core longitudinal panel of the British Household Panel Survey (N = 12 390) of adults living in private households. Multivariate fixed-effects regression models are used with weighted data. Common mental illness is measured by the 12-item General Health Questionnaire. Results: Housing repossession is associated with an increased risk of common mental illness (adjusted odds ratio 1.61, 95% confidence interval 1.10 to 2.36), whereas eviction from rented property shows no increased risk (0.97, 0.76 to 1.20). The pattern over time shows a clear increase in the years before repossession. Conclusions: Repossession of owned property, although a relatively rare event in the panel, significantly increases the risk of common mental illness immediately after the event. In contrast, eviction from rented property is a more common event but is not associated with an increased risk of common mental illness. This difference in association may be due to losing the security of owned housing and the often transitory nature of the rented housing population.

Social exclusion in clients with comorbid mental health and substance misuse problems.

Abstract.Background:The concept of comorbid mental health problems and substance misuse has gained prominence in the last two decades, due in part to the closure of large psychiatric hospitals and to the increasing prevalence of drug use in the community. This client group has a dual requirement for both medical and social care needs and is at risk for social exclusion.Methods:A retrospective matched case-control study to examine aspects of social exclusion between service users who have comorbid diagnoses and those with a single diagnosis. Samples were drawn from the service users of a mental health Trust in the South-East of England, from both Adult Mental Health (n = 400) and Drug and Alcohol services (n = 190). Data were collected from Care Programme Approach assessment forms and medical records. McNemar’s χ2 and odds ratios via a conditional logit regression model are used to test for differences in the social exclusion indicators.Results:There were significant differences in social exclusion between the comorbid and singly diagnosed clients of the Adult Mental Health service, but differences were less pronounced between the comorbid and singly diagnosed clients of the specialist Drug and Alcohol service.Conclusions:Recent Government policy advocates treating comorbid clients within mainstream mental health services. Health care workers need to recognise the likelihood of high levels of social exclusion among clients with comorbid problems.

Cohabiting unions, repartnering and mental health.

BACKGROUND A considerable body of research has established that transitions out of marriage are generally deleterious for mental health and some have examined transitions out of cohabitation. In this study we depart from these established areas to investigate the effects of poor mental health on the duration and outcome of cohabitations and on the time to, and likelihood of, repartnering after both cohabitation and marriage. METHOD Samples came from the British Household Panel Survey, 1991--2001. These were: (1) 447 cohabiting spells; (2) 5571 paired person-years during cohabitation; (3) 508 spells after cohabitation; (4) 1197 person-year observations within those spells; (5) 869 spells after marriage; and (6) 2736 person-year observations within those spells. Life tables, log-rank tests, multinomial logit and proportional hazard models were used. Mental health was measured by the 12-item General Health Questionnaire. RESULTS Poor mental health increased the risk of dissolving a cohabiting union for both men and women. Poor mental health reduced the risk of repartnering after a cohabiting union but had no effect on the risk of repartnering after a marriage. Other factors such as past marital status, age and parental status also had significant effects. CONCLUSIONS This study provides evidence that poor mental health during a cohabiting union increases the chances of that union dissolving instead of turning into marriage and poorer mental health immediately after a transition out of a cohabiting union is associated with reduced chances of repartnering.

An Arabic Version of the Spiritual Well-Being Scale

This article reports on two studies to develop and validate an Arabic language version of the Spiritual Well-Being Scale (SWBS). The first study was a pilot study at a major government university in Jordan (N = 75, students). The second and main study was conducted in 5 large regional hospitals in Jordan (N = 63, patients). The SWBS was translated from English to Arabic and reviewed by an expert panel for language, cultural, and spiritual consistency. The Arabic version of the SWBS was revised after the results of the pilot study and further reviewed by an expert panel. The resulting data were subjected to descriptive and factor analysis. Results showed that the final version of the SWBS used in the main study had a two-factor structure consistent with previous studies. Descriptive data for a range of demographic variables are presented. Issues of inadequate translation and lack of variation in responses for some items are identified and the results discussed in light of dominant Islamic theological frameworks.