Social science & medicine
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Social science & medicine · Oct 2014
Acceptability and feasibility of using non-specialist health workers to deliver mental health care: stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and Uganda.
Three-quarters of the global mental health burden exists in low- and middle-income countries (LMICs), yet the lack of mental health services in resource-poor settings is striking. Task-sharing (also, task-shifting), where mental health care is provided by non-specialists, has been proposed to improve access to mental health care in LMICs. This multi-site qualitative study investigates the acceptability and feasibility of task-sharing mental health care in LMICs by examining perceptions of primary care service providers (physicians, nurses, and community health workers), community members, and service users in one district in each of the five countries participating in the PRogramme for Improving Mental health carE (PRIME): Ethiopia, India, Nepal, South Africa, and Uganda. ⋯ We found that task-sharing mental health services is perceived to be acceptable and feasible in these LMICs as long as key conditions are met: 1) increased numbers of human resources and better access to medications; 2) ongoing structured supportive supervision at the community and primary care-levels; and 3) adequate training and compensation for health workers involved in task-sharing. Taking into account the socio-cultural context is fundamental for identifying local personnel who can assist in detection of mental illness and facilitate treatment and care as well as training, supervision, and service delivery. By recognizing the systemic challenges and sociocultural nuances that may influence task-sharing mental health care, locally-situated interventions could be more easily planned to provide appropriate and acceptable mental health care in LMICs.
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Social science & medicine · Oct 2014
Predictors of suicides occurring within suicide clusters in Australia, 2004-2008.
A number of studies have investigated the presence of suicide clusters, but few have sought to identify risk and protective factors of a suicide occurring within a cluster. We aimed to identify socio-demographic and contextual characteristics of suicide clusters from national and regional analyses of suicide clusters. We searched the National Coroners Information System for all suicides in Australia from 2004 to 2008. ⋯ When the deceased was Indigenous, living outside a capital city, or living in the northern part of Australia (in particular, Northern Territory, Queensland and Western Australia) then there was an increased likelihood of their death occurring within a suicide cluster. These findings suggest that suicide clustering might be linked with geographical and Indigenous factors, which supported sociological explanations of suicide clustering. This finding is significant for justifying resource allocation for tackling suicide clustering in particular areas.
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Social science & medicine · Oct 2014
How does mental-physical multimorbidity express itself in lived time and space? A phenomenological analysis of encounters with depression and chronic physical illness.
Mental-physical multimorbidity (the co-existence of mental and physical ill health) is highly prevalent and associated with significant impairments and high healthcare costs. While the sociology of chronic illness has developed a mature discourse on coping with long term physical illness the impact of mental and physical health have remained analytically separated, highlighting the need for a better understanding of the day-to-day complexities encountered by people living with mental-physical multimorbidity. We used the phenomenological paradigm of the lived body to elucidate how the experience of mental-physical multimorbidity shapes people's lifeworlds. ⋯ The phenomenology of mental-physical multimorbidity was articulated through embodied and emotional encounters with day-to-day life in four ways: [a] participants' perception of lived time and lived space contracted; [b] time and [c] space were experienced as liminal categories, enforcing negative mood and temporal and spatial contraction; and [d] time and space could also be customised to reinstate agency and self-determination. Mental-physical multimorbidity negatively impacts on individuals' perceptions of lived time and lived space, leading to a loss of agency, heightened uncertainty, and poor well-being. Harnessing people's capacity to modify their experience of time and space may be a novel way to support people with mental-physical multimorbidity to live well with illness.
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Social science & medicine · Oct 2014
Racial/ethnic disparities in short sleep duration by occupation: the contribution of immigrant status.
Sleep duration, associated with increased morbidity/mortality, has been shown to vary by race and occupation. Few studies have examined the additional influence of immigrant status. Using a nationally-representative sample of 175,244 US adults from the National Health Interview Survey from 2004 to 2011, we estimated prevalence ratios (PRs) for short sleep duration (<7 h/per day) among US- and non-US born Blacks and Latinos by occupation compared to their White counterparts using adjusted Poisson regression models with robust variance. ⋯ The Black-White comparison was even higher for non-US born Black laborers (PR = 1.50 [95% CI: 1.24-1.80]). Similar for non-US born Latinos, Latinos born in the US had a higher short sleep prevalence in professional/management (PR = 1.14 [95% CI: 1.04-1.24]) and support services (PR = 1.06 [95% CI: 1.01-1.11]), but a lower prevalence among laborers (PR = 0.77 [95% CI: 0.74-0.81]) compared to Whites. Short sleep varied within and between immigrant status for some ethnicities in particular occupations, further illuminating the need for tailored interventions to address sleep disparities among US workers.
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Social science & medicine · Oct 2014
Modeling satisfaction amongst the elderly in different Chinese urban neighborhoods.
Rapidly aging populations constitute a critical issue for researchers and policymakers across the world; the challenges of a shifting demographic structure are particularly pertinent in the case of China. Population control strategies implemented in China in the late 1970s have substantially changed the social and demographic structure of Chinese cities and the traditional role of families in caring for elderly people. To meet the growing needs of elderly residents "aging in place," age-friendly environments and new types of senior services are required and encouraged. ⋯ Social support was found to be the primary factor affecting satisfaction amongst the urban elderly in Beijing. The research also highlights the need to differentiate between different types of neighborhoods, which can differ significantly in terms of the socio-economic attributes (i.e., family structure, income, and education) of their senior residents. As such, based on the path coefficients revealed by different structural equation models of various neighborhoods, four types of neighborhoods were identified: in Type 1 neighborhoods, the neighborhood environment and the senior services provided by communities were primary factors in elderly satisfaction; in Type 2 neighborhoods, the satisfaction of inhabitants was strongly influenced by personal attributes such as health and income; Type 3 neighborhoods were residence of low-income people where the level of social support was the foremost factor; and in Type 4, social support and the environment were both essential.