Sarah Missinne

The popular legitimacy of European healthcare systems: A multilevel analysis of 24 countries:

This paper provides an empirical study of the between-individual and between-country differences in the popular legitimacy of European healthcare systems. In order to explain two dimensions of popular legitimacy (satisfaction and support for state responsibility), we assess the impact of self-interest motives (income and personal health), ideology (egalitarianism) and institutional arrangements (level of service provision, and private and government health expenditure). For this purpose, data from the European Social Survey Round 4 (ESS-4, 2008–2009) are analysed by means of multilevel models. Universal high support for state responsibility is found, while satisfaction varies considerably, with particularly low levels found in Eastern European and former Soviet Union countries. It appears that individuals are not guided by self-interest motives and ideology alone. In addition to these factors interacting, the results suggest that state-provided healthcare might be in everyone’s interest. Introducing a patient perspective could advance our understanding of healthcare legitimacy.

Measurement equivalence of the CES-D 8 depression-scale among the ageing population in eleven European countries

Depression is one of the most prevalent mental disorders in later life. However, despite considerable research attention, great confusion remains regarding the association between ageing and depression. There is doubt as to whether a depression scale performs identically for different age groups and countries. Although measurement equivalence is a crucial prerequisite for valid comparisons across age groups and countries, it has not been established for the eight-item version of the Centre for Epidemiological Studies Depression Scale (CES-D8). Using multi-group confirmatory factor analysis, we assess configural, metric, and scalar measurement equivalence across two age groups (50-64 years of age and 65 or older) in eleven European countries, employing data from the Survey of Health, Ageing, and Retirement (SHARE). Results indicate that the construct of depression is comparable across age and country groups, allowing the substantive interpretation of correlates and mean levels of depressive symptoms.

Education, Mental Health, and Education–Labor Market Misfit

Higher-educated people experience enhanced mental health. We ponder whether the mental health benefits of educational attainment are limitless. At the individual level, we look at the impact of job-education mismatch. At the societal level, we hypothesize that diminishing economic returns on education limit its mental health benefits. Using a subsample of individuals aged 20 to 65 years (N = 28,288) from 21 countries in the European Social Survey (ESS 2006), we estimate the impact on depressive symptoms of characteristics at both the employee level (years of education and job-education mismatch) and the labor market/country level (the gap between the nontertiary and tertiary educated in terms of unemployment risks and earnings). The results show that educational attainment produces mental health benefits in most European countries. However, in some of the countries, these benefits are limited or even completely eliminated by education-labor market misfit.

The social norm of unemployment in relation to mental health and medical care use: the role of regional unemployment levels and of displaced workers

The relationships between unemployment, mental health (care) and medication use among 50–65 year-old men (N = 11,789) and women (N = 15,118) are studied in Europe. Inspired by the social norm theory of unemployment, the relevance of regional unemployment levels and workplace closure are explored, using multilevel analyses of data from the Survey of Health, Ageing and Retirement. In line with the social norm theory, the results show that – only for men – displaced workers are less depressed and use less medication than the non-displaced unemployed. However, they report more depressive symptoms than the employed, which supports the causal effect of unemployment on mental health. Non-displaced unemployed men are also more likely to consume medication than the displaced unemployed. In addition, using regional unemployment as a proxy for the social norm of unemployment can be questioned when studying mental health effects, as it seems to be a stronger measurement of labour market conditions than of the social norm of unemployment, especially during a recession.

The social gradient in preventive healthcare use: what can we learn from socially mobile individuals?

Little is known about the origins of the stratified nature of preventive health behaviour. In this paper, we introduce theory and methodology from the field of social mobility research. Intergenerational socially mobile individuals can provide insights into the central discussion about how health lifestyles or cultural health capital develop over the life course, as they have encountered different contexts of socialisation, each with its own characteristic health-related practices. We study the use of regular mammography screening by Belgian women using data from the Survey of Health, Aging and Retirement and we operationalise social mobility as occupational mobility using the International Standard Classification of Occupations (ISCO-88). By means of diagonal reference models, we are able to discern the effects of the social position of origin, the social position of destination and social mobility itself, contrary to the less rigorous linear regression approach that prevails in health behaviour research. As expected, the take up of mammography screening is strongly influenced by social position. It seems that both upwardly and downwardly mobile women adapt to the mammography screening practices in their position of destination. This study shows the potential for social mobility research to enrich the debate on health lifestyles.

Gender specific effects of financial and housework contributions on depression: A multi-actor study among three household types in Belgium

Abstract Studies that focus on the effects of both the division of household chores and of financial contributions on the mental health of couples are scarce. This paper expands on previous research by paying attention to the variation of this relationship among three types of households: Male breadwinner, one-and-a-half-earner and dual-earner. Using paired data from the 10th wave of the Panel Study of Belgian Households, collected in 2001, we perform separate linear regressions for men (N = 1054) and women (N = 1054). The results suggest that in one-and-a-half-earner households, women’s employment has a negative effect on their partner’s depression level and that in dual-earner households, the effect of women’s employment is only negative if men are not the major breadwinner. Crossover effects of depression between partners seem to mediate part of the aforementioned associations.

Spousal influence on mammography screening: A life course perspective

Recently, researchers have challenged the basic tenet that marriage is universally protective for all individuals. We scrutinize socio-economic differences between married couples to shed light on the mechanisms underlying the effects of marriage. We introduce the life course perspective to investigate if differences in positive health behavior between couples are related to their early life conditions. Within the theoretical framework of cultural health capital, we hypothesize that the accumulation of cultural health capital proceeds at the marriage level when partners provide each other with health-related information and norms. For this purpose, we examine the influence of the childhood preventive health care behavior of both wives and husbands on the initiation of mammography screening for a sample of Belgian women (N = 734). Retrospective life histories of both partners are provided by the Survey of Health, Ageing and Retirement (SHARE) and are examined by means of event history analysis. The results show that a partners cultural health capital affects the initiation of mammography screening by a woman in later life, even after her own cultural health capital and traditional measures of socio-economic status (SES) are taken into account. In line with cumulative advantage theory, it seems that inequalities in cultural health capital are accumulated at the marriage level. In order to shed further light on the spousal influence on health behavior, researchers should revert to early life in order to discern the attribution of premarital and marital conditions.

A cross-national comparative study on the influence of individual life course factors on mammography screening

OBJECTIVES Drawing on insights from the life course perspective, the aim of this paper is to gain a better understanding of persistent socioeconomic inequalities related to the uptake of mammography screening in 13 European countries. We examine whether these inequalities originate in childhood and relate them to the history and progression of each countrys screening programs. METHODS Retrospective data from the third wave of the Survey of Health, Ageing and Retirement (SHARELIFE) is analyzed by means of event-history analyses to examine the role of childhood preventive health behavior on mammography screening initiation. The results are framed within the context of policy developments concerning mammography screening in each of the separate European countries. RESULTS Childhood preventive health care behavior predicts mammography screening in 9 of the 13 countries after conventional measurements of socioeconomic position in childhood and adulthood are accounted for. Net effects of education and income are still found for respectively 6 and 7 countries, but in about half of these countries national screening programs are able to reduce the social gradient. Very strong cohort and period effects are found for every country. CONCLUSIONS In a substantial number of the European countries, socioeconomic inequalities in preventive health behavior originate in childhood, which point to the deeply rooted nature of these inequalities. A long-term perspective is essential to further unravel how health policies can reduce or eliminate these persistent inequalities.

The Role of Perceived Helpfulness in Predicting Subjective Unmet Need and the Frequency of Health Care Use

OBJECTIVES We scrutinize the health care use of divorcees, in order to explain why users of mental health care have a higher risk of perceiving an unmet need. We hypothesize that a perception of low helpfulness of received care heightens the risk of perceiving an unmet need and becoming a less frequent health care user. METHODS Three subsamples from the Divorce in Flanders survey are selected: those who contacted a general practitioner (n=816), a psychiatrist (n=205), or a psychologist (n=251) because of social or emotional problems. Logistic regressions are used in order to explore the correlates of subjective unmet need and the frequency of contact with a health care provider among each subsample. RESULTS show that patients who perceived that care was not helpful more often reported an unmet need and made less frequent use of health care. CONCLUSIONS These findings suggest that people are less inclined to seek further help when they perceive previous help as being ineffective.

Moving Towards a Better Understanding of Socioeconomic Inequalities in Preventive Health Care Use: A Life Course Perspective

The aim of this book chapter is to outline how the life course perspective can move forward the debate on socioeconomic inequalities in preventive health care use. Recent theoretical developments in medical sociology, including health lifestyle theory and cultural health capital theory, have implicitly encapsulated a longer-term view of an individual’s life, in order to develop a better understanding of the social causes of good health and conversely illness. I will elaborate more explicitly on how the five central principles of the life course perspective apply to preventive health care use, using the empirical example of mammography screening. Central and unanswered questions pertain to (i) the life stages that are important in the development of cultural health capital or a healthy lifestyle (life-span development); (ii) the temporality of socioeconomic inequalities in preventive health care (timing); (iii) the impact of different socialization contexts for healthy lifestyles or cultural health capital (structure-agency debate); (iv) the change in preventive health care use across policy implementations (time and place); and (v) the role of significant others for health care use (linked lives).