bluuebunny/crossref_metadata_2025 huggingface dataset:
Trends of risk behaviors in adolescents: a 10-year study in a representative sample of Tuscany, Italy
Authors: Lastrucci V , Lazzeretti M , Innocenti F , Berti A , Silvestri C , Schirripa A , Paoli S , Lorini C , Voller F , Bonaccorsi G
Published: October 2022

Background

The aim of the study was to evaluate the trends of prevalence of several health risk behaviors (HRBs) and health conditions over a 10-years period in a representative sample of adolescents of Tuscany Region, Italy.

Methods

The study had a repeated cross-sectional design, data from the last four survey waves of EDIT surveillance (2008-2018) were used. EDIT surveillance investigates HRBs in a representative sample of students attending the upper secondary schools of Tuscany. Prevalence of 17 HRBs and health conditions were considered and analyzed by age, sex, and socioeconomic status (SES).

Results

A total of 21.943 students were surveyed from 2008 to 2018. Declining trends in the participation in smoking, cocaine use, driving under the influence of alcohol and drugs, and problem gambling were observed, while alcohol abuse and at-risk sexual behaviors remained unchanged or increased during the study period. During the most recent survey males resulted more frequently involved in most of the HRBs, while females more frequently reported physical inactivity, regular smoking and not using a condom. Female participation in smoking and alcohol abuse behaviors, fruit and vegetables consumption, and bullying worsened over the study period. Smoking, poor dietary habits, physical inactivity, high distress level, and obesity were more frequently observed in low SES students than in high SES students.

Conclusions

In conclusion findings showed various different tendencies in adolescent participation in HRBs over the course of the last decade; concerning trends in at-risk sexual behaviors and alcohol consumption and females’ risk-taking behavior on the rise require careful monitoring and intervention.

Key messages

• Distinct tendencies according to sex, socio-economic condition and specific health risk behavior were observed in adolescent participation in health risk behaviors over the course of the last decade.

• Health promotion and prevention interventions tailored on specific health risk behaviors and population groups are needed.
Consequences of Housing Conditions on Maternal Health of Forced Migrant Women
Authors: Engelhardt M , Gaudion M , Kamhiye J , Al-Munjid R , Borde T
Published: October 2022

Background

Housing is a major social determinant and contextual factor of health. Forced migrants are restricted in their freedom of choosing and shaping their housing conditions. This qualitative study highlights the impact of housing restrictions on reproductive and maternal health from the lived experience of forced migrant women who recently gave birth to a child.

Methods

Qualitative problem-centered interviews were conducted with 33 refugee mothers (Mage = 31 years) 1-9 month postpartum. Interviewees came from 19 countries of origins, spoke 22 languages, and had lived in Germany for an average of three years. The mothers’ perspectives were complemented by 75 qualitative interviews with maternal health care professionals, (HCPs: midwives, gynecologists, social workers). Interview transcripts were analyzed via framework method regarding (1) type of housing: shared accommodation vs. private apartment, (2) region: rural vs. urban, (3) exhausting and supporting conditions as well as (4) consequences on maternal health.

Results

Interviewees living in shared accommodations reported exhausting conditions hindering self-determined upbringing of their newborn, e.g., confined living spaces, racism of staff, shared kitchen and bathrooms, lack of privacy, mobility, access to medical care, hygiene. Reported consequences on maternal health ranged from physical stress to social stress and mental stress (e.g., sleeping problems, depression, fear, worrying about health of the newborn). Interviewees living in private apartments showed higher autonomy and contentment. HCPs reported missing time and staff to provide adequate support.

Conclusions

Both refugee women and HCPs reported housing as main stressor during pregnancy and childbed, resulting in higher physical, social, and mental stress. Strategic social support for finding suitable private apartments for new families is needed as well as comprehensive visiting midwifery care in accommodations.

Key messages

• Living conditions in shared accommodations are unacceptable from a public health and human rights perspective, especially for women during pregnancy and childbed.

• Negative effects on maternal health and self-determination of families were shown.
Insufficient support and help for adolescents with disabilities during the COVID-19 pandemic
Authors: Holm ME , Sainio P , Sjöblom S , Nurmi-Koikkalainen P
Published: October 2022

Background

The COVID-19 pandemic may have increased the need for help and support for adolescents with disabilities. At the same time, moving to distance learning can reduce access to support services. Despite this, little is known about this issue. Thus, we investigated differences in the unmet need for help and support between adolescents with and without disabilities during the COVID-19 pandemic.

Methods

We analyzed large population-based data from the Finnish School Health Promotion study obtained during 2019 and 2021 (2019: n = 87,215; 2021: n = 91,560). The target group comprised adolescents from lower secondary schools in Finland (age: M = 15.3, SD = .64). Logistic regression models were applied to investigate differences in the unmet need for help and support between adolescents with and without disabilities.

Results

During the pandemic, adolescents with disabilities reported insufficient help and support related to their learning and well-being from teachers, school curators and psychologists, and school nurses and doctors more often than other adolescents (p < .001). Adolescents with disabilities reported more often than others that distance learning involved insufficient learning support (p < .001). Between 2019 and 2021, an increasing proportion of adolescents with disabilities felt that they had received insufficient help and support related to their well-being from nurses, doctors, psychologists, school curators, and teachers. To summarize, the COVID-19 pandemic reduced access to support and assistance for adolescents, particularly those with disabilities.

Conclusions

Policies in schools should be developed and resources secured so that support and help for adolescents with disabilities can be secured in exceptional circumstances. Insufficient support and assistance for adolescents with disabilities can impair their learning outcomes and health.

Key messages

• During the COVID-19 pandemic, adolescents with disabilities reported insufficient help and support related to their learning and well-being more often than other adolescents.

• In times of crisis, support and help for adolescents with disabilities must be guaranteed.
Impact of COVID-19 on University Students’ Quality of life and mental health in Greece
Authors: Vantarakis A , Fotini Tsami F , Kanellopoulou A , Alexopoulou-Prounia L , Tsapara A , Alexopoulos P , Katsadoros K
Published: October 2022

COVID-19 has a serious impact on people’s physical health and mental health. The COVID-19 pandemic has highlighted an increasing deterioration of university students’ quality of life and mental health due to several factors. The COVID-19 pandemic forced university students to take online classes, which may have bad impacts on students’ learning. In addition, the students lost many job opportunities during the pandemic. Faced with employment and study pressure and worried about the epidemic, university students were prone to increased overall negative emotion, anxiety and depression. Our study aims to conduct a timely assessment of the impact of the COVID-19 pandemic on the quality of life and mental health of University students. We conducted a cross sectional study using an online interview survey in students at public universities in Greece to better understand the effects of the pandemic on their quality of life and mental health. Three questionnaires were used (WHOQOL-BREF, IES-R and HADS). The data were analyzed with IBM SPSS 26. 1.266 university students from public Greek Universities participated in the study, 73.1% of which were female, 26,3% were male. We observed that 55,8% had a score lower in psychological domain and 52,3% in social domain of WHOQOL-BREF. Also 46.6% of the respondents had a score of 37+ on the IES-R questionnaire, 45% of the respondents had abnormal results regarding anxiety and 33.6% had abnormal results regarding depression. Due to the long-lasting pandemic and onerous measures such as lockdown and stay-at-home orders, the COVID-19 pandemic brings negative impacts on University education and quality of life of students. The findings of our study highlight the urgent need to develop interventions and preventive strategies to address the quality of life and mental health of University students.

Key messages

• There is a need for preventative measures for university students to ensure that their mental health and quality of life do not suffer.

• Female students reached higher levels of anxiety in the COVID-19 pandemic period.
Low resilience as risk factor of mental disorders during COVID-19 pandemic: A cohort study
Authors: Castellvi P , Llistosella M , Miranda-Mendizabal A , Recoder S , Calbo E , Casajuana-Closas M , Leiva D , Manolov R , Matilla-Santander N , Garcia-Forero C
Published: October 2022

Background

To analyze whether people with low resilience are at higher risk of mental health problems during the COVID-19 pandemic in Spanish adults.

Methods

A longitudinal cohort study was carried out. Resilience was measured pre/post-pandemic with the CD-RISC. Mental health problems assessed were: Major Depressive Episode (MDE), Generalized Anxiety Disorder (GAD), Suicidal Thoughts and Behaviors (STB), and Posttraumatic Stress Disorder (PTSD) symptoms.

Results

We found statistically significant differences between groups and resilience scores in MDE [F (3;48.40)=19.55], GAD [F(3;19.63)=6.45] and STB [F(3;111.74)=31.94]. Multivariable analyses showed individuals with very low resilience were at a 5-fold risk of Incidence of MDE and a 4-fold risk of STB. Persistent group presented a 21-fold risk of MDE and 54-fold risk of STB, respectively. No evidence of higher risk was found for GAD. Individuals with low resilience and exposed to COVID-19 did not have a significantly higher risk. Individuals with low resilience were at higher risk of PTSD in general population [β(95%CI)= -3.25(-3.969 to -2.54)], but not for individuals with COVID-19.

Conclusions

In the general population, having low or very low resilience increases the risk of suffering MDE, STB, and PTSD, but not GAD during the COVID-19 pandemic, but not in the population with COVID-19.

Key messages

• Resilience was a buffer of mental health problems in general population, but not in those exposed to COVID-19.

• Those with low resilience were at 21-fold risk of mental health problems before and during the first year of pandemic.
Building capacity for mental health resilience – local impact of the UK Better Mental Health Fund
Authors: Lie M , Visram S
Published: October 2022

Background

COVID-19 as a public mental health emergency has exacerbated existing mental health inequalities. The UK government invited local authorities with areas of high deprivation to apply for a year of funding, in order to address the mental health impacts of COVID-19 and incentivize investment in prevention and promotion interventions for better mental health. South Tyneside Council in North East England made a successful bid to the Better Mental Health Fund (BMHF), and distributed grants to 7 organisations delivering 13 programs. A qualitative evaluation of these programs aimed to answer the following questions:

1. How were the funded programs implemented?

2. What difference did they make to local beneficiaries?

3. How might these programs and their impacts be sustained into the future?

4. Has the BMHF led to any wider impacts on organisations and local communities?

Methods

In-depth interviews with individuals, pairs and groups were conducted online or in person with service providers and beneficiaries. Non-verbatim transcripts were made from recordings, checked with verbatim transcripts from Teams and Zoom, and analyzed thematically to generate a coding frame. Throughout the analysis, comparisons were made between organizations and programs.

Results

Fifteen interviews involving 22 participants lasting up to an hour each were conducted. The main themes identified as impactful were 1) community approaches based on supportive and good relationships between the local authority public health lead and participating organizations (mainly voluntary agencies), enabling 2) capacity-building for mental health resilience and 3) community empowerment. This was despite the short turnaround of the grant application process, limited time to deliver on targets, and anxieties about future sustainability.

Conclusions

Short-term funding can build capacity in mental health resilience in deprived areas if administered by public health leaders who relate well with provider organizations.

Key messages

• Public health leaders who relate well with provider organizations are key drivers of community health promotion strategies that include mental health capacity building.

• Qualitative methods used in evaluations can inform public health commissioning by capturing the benefits and challenges of short-term funding for interventions promoting community mental health.
Health-related behaviors during adolescence and subsequent anxiety and depression: the HUNT study
Authors: Kleppang AL , Vettore MV , Hartz I , Haugland SH , Stea TH
Published: October 2022

Background

Evidence on the predictors of common mental disorders using nationwide health registries are scarce in Norway. Identifying modifiable behaviours affecting mental health across the lifespan is paramount to develop tailored strategies to tackle mental illnesses. The aim of this study was to identify patterns of health-related behaviours in adolescence and their influence on anxiety and/or depression in adulthood.

Methods

This was a prospective study based on data from the Trøndelag Health Study (HUNT) and health register data (N = 2061). Patterns of health-related behaviours were assessed according to physical activity, consumption of wholegrain bread, fish, fruit, vegetables, and sugar sweetened beverages and insomnia. Participant’s use of healthcare system for anxiety and/or depression was recorded at least once in the health registries. The patterns of health-related behaviors were identified through latent class analysis. Multivariable logistic regression was used to test the association between patterns of health-related behaviors and depression or/and anxiety.

Results

Four classes of health-related behaviors were identified: class 1 (15.2%), class 2 (36.0%), class 3 (24.2%), class 4 (24.6%). Adolescents with unhealthy behaviors (classes 1, 2 and 3) had 82%, 34% and 84% higher odds of depression and/or anxiety during adolescence and early adulthood than those from the healthy-related behaviors group (class 4).

Conclusions

Our findings suggest that health-related behaviors are clustered among Norwegian adolescents. There was a meaningful association of the three patterns of unhealthy behaviors during adolescence with anxiety and depression in adulthood. Population strategies and policies aiming to tackle unhealthy behaviors among adolescents can positively impact on adult’s mental health.

Key messages

• Improving healthy behaviors during adolescence may reduce the burden of mental illness in adulthood.

• Population strategies and policies aiming to tackle unhealthy behaviors among adolescents can positively impact on adult’s mental health.
Anxiety and depression disorders in Portugal during the COVID-19 pandemic
Authors: Santos A , Rachadell J
Published: October 2022

Background

Mental disorders are a major contributor to the global burden of disease. During the first year of the pandemic by COVID-19, increases of 25% in the prevalence of anxiety and depression were reported globally. In Portugal, studies conducted during lockdown showed an increase in the prevalence of these disorders. However, previous studies have shown that negative life events, such as exposure to disasters or grief, later lead to resilience or recovery. It is therefore necessary to study the evolution of these disorders in order to adapt mental health measures.

Methods

The number of patients registered with “P76 - Depressive Disorder” and “P74 - Anxiety Disorder/anxiety state”, according to ICPC-2 criteria, and the total number of patients registered in the Portuguese Health Centers for the months of January 2019 to 2022 were obtained from the Portuguese NHS Information and Monitoring System (SIM@SNS). We calculated the percentage of patients with each of the disorders, individually and combined. Data by health regions were also obtained in order to compare the evolution within each region (North, Center, Lisbon and Tagus Valley, Alentejo and Algarve).

Results

Between January 2019 and 2022, the proportion of patients with anxiety disorder increased linearly from 8% to 9%. Similarly, the proportion of patients with depressive disorder increased from 11% to 12%. When considered together, anxiety and depression disorders affected 21% of users in mainland Portugal at the beginning of 2022. The Alentejo and Center regions have the highest prevalence of anxiety and depression (24.9% and 24%, respectively) and the Algarve region has the lowest (16.74%). The increases were consistent across health regions, with the largest increase in the North region (2.6%) and the smallest in the Central region (1.7%).

Conclusions

Anxiety and depression disorders increased in mainland Portugal during the years of the COVID-19 pandemic.

Key messages

• Mental health has been an important factor in public health since before the pandemic.

• Monitoring depression and anxiety levels in the general public can guide priorities after the pandemic.
Mental health surveillance of German adults in the COVID-19 pandemic: trends in depressive symptoms
Authors: Walther L , Junker S , Kersjes C , Damerow S , Mueters S , Thom J , Mauz E
Published: October 2022

Background

While literature on mental health in the COVID-19 pandemic has grown rapidly, studies reporting on developments beyond the first wave using continuous, population-based data are still scarce. We examined monthly estimates of depressive symptom levels in Germany’s adult population covering almost two years of the pandemic and the year prior.

Methods

We analyzed representative data from two population-based telephone surveys of German adults: “German Health Update (GEDA)” and “COVID-19 vaccination rate monitoring in Germany (COVIMO).” Core symptoms of depression measured using the Patient Health Questionnaire-2 (PHQ-2) were observed in approximately 1,000 randomly sampled participants monthly from April 2019 to December 2021. We estimated three-month moving means and proportions as well as smoothing curves to produce time series graphs. Statistical comparisons between specific time periods were used to verify results of visual inspection. Analyses were stratified by gender, age and level of education to assess potential time trend differences between subgroups.

Results

Both the mean population depressive symptom score and the proportion of the population with a positive PHQ-2 depression screen first decreased to below 2019 levels between the first wave and summer of the pandemic and then increased from autumn 2020, reaching levels significantly above 2019 in 2021 and remaining elevated. 2021 saw a 2.2% increase in positive screens compared to 2019. Women, the youngest and eldest adults, and those with a high level of education experienced a particular increase in depressive symptoms between 2019 and 2021. However, we found no corresponding changes in symptom level differences between population subgroups.

Conclusions

Our finding of elevated depressive symptoms among Germany’s adults following an increase in the second wave of the pandemic demonstrate the importance of continued surveillance to assess the further development of mental health in the ongoing crisis.

Key messages

• Monthly data from April 2019 to December 2021 suggests that depressive symptoms decreased at the start of the pandemic and then increased from autumn 2020, reaching levels above 2019 in 2021.

• Continued mental health surveillance is needed to assess the further development of mental health indicators in the ongoing crisis and its aftermath.
Mental health and well-being of students at TU Dresden
Authors: Girbig M , Huebner L , Kaempf D , Lesener T , Gusy B , Seidler A
Published: October 2022

Background

University life can be a particularly challenging phase in the development of young adults. Current research shows that mental disorders occur more frequently in students compared to workers of the same age. The coronavirus pandemic has exacerbated the problem. The TUDo! Study, done in cooperation with the FU Berlin, aimed to assess the health status of students at TU Dresden, with a focus on mental health.

Methods

In 2020/2021 students at TU Dresden (excluding students in the medical school) completed an online-based questionnaire. Validated questionnaires, e.g. the PHQ 4 (depressive disorder and generalized anxiety disorder) and the ERI student (student gratification crisis) were used. We evaluated descriptively and analytically, according to the questionnaire-specific specifications.

Results

A total of 2,683 students (12.3%) at the TU Dresden took part in the survey. The majority of study participants were female (n = 1,507; 56.7%) and had an average age of 22.9 years (SD = 4.3). 32.8% (n = 856/2,611) of the participating students reported a depressive syndrome and 32.5% (n = 848/2,612) a generalized anxiety disorder. Almost half of participating students (40,0%; n = 515/1,310) indicated an imbalance between effort (E) and reward (R) (ER ratio>1). 51.23% (n = 693/1,50) of respondents reported a decline of mental well-being because of the coronavirus pandemic.

Discussion

Unlike similar studies, this study shows that TU Dresden students were particularly affected with regards to perceived psychological stress and complaints. The existing differences seem to be partly due to the coronavirus pandemic. These results indicate that universities should regularly check their studying conditions and provide appropriate preventive measures.

Key messages

• Students are at higher risk than workers of the same age for mental health problems.

• Students reported a decline in mental well-being due to the coronavirus pandemic.
The effectiveness of interventions to prevent loneliness in the community-dwelling elderly population
Authors: Grillich L , Titscher V , Klingenstein P , Kostial E , Emprechtinger R , Sommer I
Published: October 2022

Background

Loneliness and social isolation have comparable health effects to widely acknowledged and established risk factors. Although the elderly are particularly affected, the effectiveness of interventions to prevent and/or mitigate social isolation and loneliness in the community-dwelling elderly is unclear. The aim of this review of reviews was to pool the findings of systematic reviews addressing the question of effectiveness.

Methods

Ovid MEDLINE®, Health Evidence, Epistemonikos and Global Health (EBSCO) were searched from January 2017 to November 2021. Two reviewers independently assessed each systematic review in two consecutive steps based on previously defined eligibility criteria and appraised the methodological quality using AMSTAR 2. One author extracted data from both systematic reviews and eligible studies; another checked this. We conducted meta-analyses to pool the study results. We report the results of the random-effects and common-effect models.

Results

We identified 5 systematic reviews containing a total of 30 eligible studies, 16 with a low or moderate risk of bias. Our random-effects meta-analysis indicates an overall SMD effect of 0.63 [95% CI: -0.10; 1.36] for loneliness and was unable to detect an overall effect of the interventions on social support [SMD: 0.00; 95% CI: -0.11; 0.12].

Discussion

The results show interventions can potentially reduce loneliness in the non-institutionalised, community-dwelling elderly population living at home. As confidence in the evidence is low, rigorous evaluation is recommended.

Key messages

• The meta-analysis indicates that psychosocial interventions have the potential to reduce loneliness in the community-dwelling elderly population.

• As confidence in the evidence is low, healthcare providers should only implement interventions that are, firstly, based on a sound theory of change and, secondly, subject to rigorous evaluation.
Mental health promotion in the school environment
Authors: Kouznetsov R , Jelastopulu E
Published: October 2022

Issue/problem

The practice took place in a private school with students from 9 to 15 years old. The purpose of the intervention was to promote the mental health of students. The school’s goal was to eliminate school bullying incidents. The phenomenon of school bullying has global dimensions.

Description of the problem

The teachers of the school did not consider that they should be involved in issues of mental health of the students and did not take steps to reduce the phenomena of school bullying. In the meetings with the students, which had duration of six months, concepts such as self-esteem, empathy, emotional intelligence, cooperation, respect, stress, failure were analyzed. The causes and consequences of school bullying were discussed. The aim of the meetings was to raise students’ awareness to the above issues, to understand themselves and others and to develop teamwork. In the meetings with the students, three basic principles were developed: Facilitate-Respect-Recognize.

Results

After the end of the practice in the school context, students, teachers and parents completed an evaluation questionnaire anonymously. It turned out that the meetings at school became a cause for discussion in the classroom by 100% and at home by 65%. The students stated that they would not allow school violence or bullying after the meetings. It is noteworthy that one in three teachers did not consider the promotion of mental health as part of their duties while the parents expected the teachers to fulfill this goal 100%.

Lessons

It would be especially useful to conduct training seminars for teachers on adult (to enable better communication channels with parents) and child mental health and conflict management. Respectively, the parents should be educated on issues of mental health and psychopedagogy. The innovation of this action was that it involved teachers, parents and students while similar initiatives seldom take place in a Greek school environment.

Key messages

• Promoting healthy interpersonal relationships at school between students and teachers.

• Recognizing children’s emotions promotes their mental health during school life.
Anxiety, depression, and lower quality of life among Danish women with polycystic ovarian syndrome
Authors: Abdelkarim V , Thapa S
Published: October 2022

Background

Polycystic Ovarian Syndrome (PCOS) is the most frequent hormonal/endocrine disorder in women of reproductive age and is one of the most common causes of infertility. Approximately 20% of Danish women of reproductive age are diagnosed with PCOS, and yet only a little attention has been paid to the psychological symptoms appearing in women with PCOS. The present study investigated anxiety, depression, and lower quality of life among Danish women of reproductive age who are diagnosed with PCOS.

Methods

This was a cross-sectional survey study among 326 Danish women who self-reported as being diagnosed with PCOS. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression, and the PCOS-QOL scale was used to measure the quality of life. Chi-square tests and logistic regression analyses were used for analyzing data.

Results

Sixty-six percent of women were found to have anxiety (n = 216), 41% of women had depression and 70% of women had low quality of life The most frequently reported symptoms were irregular menstrual cycle (86%), overweight (73%), and mood swings (65%), and irregular menstrual cycle, overweight and infertility were the were perceived of having higher severity. After adjusting for age, ethnicity, education, and income, the severity of symptoms, namely irregular menstrual cycle, infertility, overweight, and hirsutism, were independently and positively associated with depression, and severity of symptoms, namely irregular menstrual cycle, mood swings, and hirsutism, was independently and positively associated with anxiety. Lower quality of life was independently associated with both anxiety and depression.

Conclusions

Women with PCOS are at higher risk of anxiety, depression, and consequently, lower quality of life. Clinicians and other healthcare professionals should pay attention to the importance of mental health support in women with PCOS and work towards promoting it.

Key messages

• Women with PCOS are at higher risk of anxiety and depression, and lower quality of life.

• Health care professionals working with women with PCOS should be aware of this and be prepared to offer necessary support.
Distribution of Suicides in India: A Decadal Data Analysis (2011-2020)
Authors: Arif A
Published: October 2022

Background

India accounts for a significant proportion of suicide deaths globally. As per the Global Burden of Disease Study, India’s share of global suicides from 1990 to 2016 increased from 25·3% to 36·6% among women and 18·7% to 24·3% among men. However, medical factors are not the sole contributors to the suicide burden.

Methods

I analyze decadal data (2011-2020) on suicides in India provided by National Crime Records Bureau. This data contains the distribution of suicidal deaths based on age groups, causes, professions, gender, and residence zones.

Results

The analysis suggests that individuals aged ‘15-29 years’ were most affected (35.05%) by suicides, followed by those aged ‘30-44 years’ (32.61%). Family problems contribute to the highest burden of suicides among both these age groups. Such deaths can be attributed to personal reasons. Suicides due to dowry disputes are exclusive to women. Also, women report the highest instances of suicides due to marriage-related issues. While suicides due to drug abuse, bankruptcy, unemployment, poverty, and property disputes were mainly reported among males. In 2020, the rise in annual suicide rate was found to be highest among business persons (29.43%), especially tradesmen (49.9%) and vendors (26.11%) against other businesses (12.13%). Other professions which witnessed a steep rise in annual suicide rates in 2020 were agricultural laborers (17.90%) and daily wage earners (15.76%). This increase in suicide rates may be linked to economic reasons post lockdown imposition during the Covid-19 outbreak in 2020.

Conclusions

Women commit suicide mainly due to marriage-related causes, while men are more vulnerable to suicide due to economic factors. Not all suicides can be traced back to diagnosed mental illnesses. A significant proportion of suicides are attributed to personal, economic, and social problems. The insights generated from this analysis can help identify the vulnerable groups and target the much-needed interventions.

Key messages

• Suicide is a multifaceted problem involving various personal, economic, cultural, and social factors, besides medical reasons.

• Multidimensional strategies targeted at vulnerable groups could be potentially effective in curbing suicide rate.
Psychiatric Comorbidity Among Sexual and Gender Minority Youth and Young Adults at Risk for Suicide
Authors: van der Star A , Brady JP , Albright CA , Gonzales IV M , Garcia Alcaraz C , Cobian Aguilar R , Askew A , Blashill AJ , Wells KJ
Published: October 2022

Background

Compared with peers, young sexual and gender minorities (SGM) are at a four to seven-fold increased risk of attempting suicide. Prior epidemiological studies, mainly focusing on monomorbid inequalities and without conducting diagnostic clinical interviews, have been unable to report robust data on psychiatric comorbidities among those who attempted suicide. The purpose of this presentation is to describe the presence of current psychiatric comorbidities among SGM youth and young adults at elevated risk for repeat suicide attempts.

Methods

A diverse convenience sample of SGM youth and young adults with a lifetime history of suicide attempts and current suicidal ideation was recruited for an open-phase suicide prevention trial in San Diego, CA. At baseline, participants underwent a 15-module DIAMOND interview for adults or computerized K-SADS for minors, and a battery of self-report questionnaires.

Results

Among the 31 participants (Mage = 22 years [Range: 16, 29]; 100% sexual, 52% gender, and 61% racial/ethnic minority), 27 (87%) participants met criteria for any mood disorder, 24 (77%) for any anxiety disorder, 16 (52%) for any trauma or stress disorder, and 2 (6%) for any psychotic disorder. One (3%) participant did not meet criteria for any psychiatric diagnoses, while five (16%) met criteria for a single and 25 (81%) for multiple diagnoses. The average number of diagnoses was 3.2 (Range: 0, 7). Additionally, 20 (65%) participants met the cut-off for likely ADHD, 20 (65%) for possible borderline personality disorder, and 21 (68%) for likely body dysmorphic disorder, with 11 (35%) within the 90th percentile for reference eating disorder severity.

Conclusions

The degree of psychiatric comorbidities in the sample of SGM youth and young adults at elevated risk for suicide was high. Beside direct suicide risk mitigation efforts, suicide prevention programs that target young SGM with a history of attempts should screen for untreated psychiatric disorders.

Key messages

• LGBTQ+ youth and young adults at elevated risk for repeat suicide attempts experience a high degree of psychiatric comorbity.

• Beyond suicide risk mitigation, LGBTQ+ youth suicide prevention programs should focus on untreated psychiatric comorbidities.
Barriers to primary care access for asylum seekers and refugees in the UK: a systematic review
Authors: Harrington S , Sornalingam S , Evenden R , Singh N , Paudyal P
Published: October 2022

Background

Recent armed conflicts, in addition to the deterioration of humanitarian conditions across the world, has led to the biggest increase in civilian displacement since World War II. Exploration of the barriers and facilitators to primary healthcare access amongst asylum seekers and refugees (ASRs), from the perspective of both service users and service providers, is important for improving policy and practice to ensure more equitable health care.

Methods

Systematic searches of PubMed, EMBASE, MEDLINE, and CINHL databases were conducted to identify articles until May 2021 using a combination of relevant search terms. Studies were eligible if they were published in English and conducted in ASR populations in primary care settings the UK using qualitative approaches. Literature was thematically analysed using Braun and Clarke’s 6-step process. Quality assessment of included studies was conducted using the Mixed Methods Appraisal Tool.

Results

Nine studies were included in the review. Key themes identified included: accommodation within services; awareness of service navigation, negotiation and eligibility of care; accessibility; availability of appointments; acceptance; complexity within health needs; and cultural appropriateness. Healthcare professionals encounter barriers and facilitators within the healthcare setting, the overall healthcare system, and with regards to their understanding of migration policy. ASRs experience barriers and facilitators with regards to accessing and understanding the health system, cultural appropriateness of care, cost, stigma and prejudice, and availability of specialist services.

Conclusions

This study highlights the difficulties ASRs and healthcare professionals face in primary care settings, the need for consistent and unambiguous guidance that supports the cultural competence of the heath service, and the need for further research into the efforts made to eliminate health discrimination within primary care.

Key messages

• Barriers exist to primary healthcare amongst asylum seekers and refugees.

• Specialised and incorporated healthcare and support is needed due to unique social, cultural, and demographical differences of this population.
Health and equity: Venezuela’s and Brazil’s public health policies aimed at the LGBTQ+ population
Authors: Knihs de Camargo C , Moncada S , Nawal Huda N
Published: October 2022

Background

Public health policies aimed at the LGBTQ+ population within Latin America have been a theme of discussion among policymakers, governments, and society. Latin America’s conservative idiosyncrasy has delayed advances in this regard. A common factor has been inequity and difficulty in access to healthcare institutions by LGBTQ+ groups. Despite some improvements in some regions, there are still huge gaps between neighboring countries as in the case of Brazil and Venezuela. The aim of this study is to investigate and compare the existence and implementation of health policies aimed to improve the health equity of the LGBTQ+ population in both countries.

Methods

Scoping review in international journal databases and grey literature, such as official government websites, and NGOs reports.

Results

In Brazil, the “National Policy for comprehensive health of lesbians, gays, bisexuals and transgender populations” was created in 2011. Nonetheless, its implementation encounters challenges. The main difficulties are: under budgeting, lack of training of healthcare personnel, and challenges in monitoring and assessing proposed health interventions. In Venezuela, till today there is a lack of institutional protective policies and health policies directed at this population. Some examples include the impossibility to rectify documents to reflect transgender people’s identity, adequate protection from the law against civilian violations, same-sex marriage, and legal conditions for children of same-sex parents.

Conclusions

The points presented above restrain satisfactory access to health care, positioning the LGBTQ+ population in a vulnerable setting, and making it a challenge to achieve health equity. In order to strengthen the health care systems in both countries, breakthrough measures need to be taken to assure fundamental human rights.

Key messages

• Venezuela lacks basic institutional protective policies aimed towards LGBTQ+ population, while Brazil has a National LGBT Health Policy.

• Achieving health equity and assurance of rights to the LGBTQ+ population remains a challenge in both Brazil and Venezuela.
Digital health information and female adolescents with turkish migration background
Authors: Islertas Z , Bittlingmayer UH
Published: October 2022

Background

Youth with Turkish migration background (TRMB) are repeatedly classified as a vulnerable group. Digital health information, which is prepared and made available by various providers in a variety of ways, may represent an opportunity to promote the health of these adolescents. Empirical findings on wheter young people have access to digital health information and what role digital health information plays in their everyday lives are hard to find.

Methods

In the project ELMi, a project of the HLCA Consortium, funded by the BMBF, female adolescents with TRMB were interviewed. Individual interviews as well as a focus group discussion were conducted and evaluated according to the Qualitative Content Analysis.

Results

Female adolescents with TRMB have technical access to digital health information. They use New Media to obtain health information. When searching for digital health information, it is important for the adolescents to be able to find factual and comprehensibly formulated information quickly. German-language homepages are preferred by them. Parallel to the digital platform they regard female persons from their own social network as contact persons for health questions. They draw on their health-related knowledge and experience in order to be able to obtain answers to their own questions.

Conclusions

Digital health information and the health-related knowledge and experience of the female social network are considered as a health related resource. German-language electronic information with low-threshold content can represent an opportunity to reach female adolescents with TRMB

Key messages

• Female adolescents with TRMB demonstrate technical and content access to digital health information.

• Digital health information represents an opportunity to reach the target group.
Health in refugees and migrants who self-identify as sexual or gender minority
Authors: Mattelin E , Fröberg F , Korhonen L , Khanolkar AR
Published: October 2022

Background

In 2019, 80 million individuals were forcibly displaced. Yet, there is little knowledge on the health of refugees and migrants who self-identify as sexual- or gender minority (SGM). The aim was to examine health and health-related behaviors in refugee and migrant individuals who identify as SGM, and in comparison, to their heterosexual peers.

Methods

This study included 168,952 persons aged 16-84 who answered the Swedish National Public Health Survey in 2018 and 2020. Participants were grouped into White heterosexual, White SGM, migrant heterosexual, migrant SGM, refugee heterosexual, and refugee SGM. Outcomes included mental health (f.e. mental ill-health, suicidal ideation), general health, risky behaviors (f.e drug and alcohol use), and experiences of violence. Associations were analyzed using logistic and linear regression adjusting for sex, age, and educational level.

Results

Being an SGM, regardless of refugee or migrant minority status, was associated with worse general health and mental ill-health compared to heterosexual peers including suicidal ideation in refugee SGM (OR 2.42, 95 % CI 1.44-4.08). Both refugees and migrants had for example lower odds of drug and risk alcohol use compared to heterosexual peers but higher odds of risk gambling (OR 1.88, 1.49-2.37 for refugee SGM). Transgender refugees had high odds for risk gambling (OR 8.62, 1.94-38.40) and exposure to physical violence (OR 7.46, 2.97-18.70).

Conclusions

In this national population-based study, SGM have worse mental and general health regardless of being refugee or migrant minority. SGM refugees did not have worse health compared to migrant and White SGM and their heterosexual peers. While more research is needed, our study shows the need for public health personnel to be aware of potentially worse health and adverse experiences in SGM individuals, regardless of ethnic origin including refugees.

Key messages

• Our study provides evidence for poorer health outcomes in diverse SGM-groups.

• Policies tackling health in refugees and SGM are still inadequate.
Making blind spots visible: the lack of race-conscious research and data in public and global health
Authors: Meudec M , Affun-Adegbulu C , Cosaert T , Verdonck T
Published: October 2022

In Continental Europe, race-conscious research and data (RCRD) is not adequately deployed in support of policy-making and social change to tackle health disparities. One reason is a lack of national data systems based on race in many countries, another is that researchers or policymakers are unaccustomed to taking them into account. One consequence of this for public and global health is the adoption and implementation of policies that are ostensibly race-neutral but which in fact reproduce “methodological whiteness” (Bhambra, 2017) and create or exacerbate racial health inequities. Calls to decolonise public health recognize the importance of RCRD, yet race or ethnicity as a variable in research continues to be seen as a contentious issue for a number of reasons. First, while some researchers see it as a valuable tool for addressing health inequalities or the impact of institutionalized and systemic racism on racialized/ethnic minority groups, others oppose its use on the ground that it can lead to stigmatization or racial stereotyping. Second, RCRD is often seen as too difficult to implement in practice, due to challenges of finding appropriate approaches to conceptualisation, operationalisation, data (non)collection, and interpretation. Third, many researchers fear that the use of race and ethnicity in research may be instrumentalized against minorities in ways that are sometimes difficult to anticipate. This project aims to contribute to addressing this, by building expertise for RCRD and creating a knowledge network and community of practice for researchers working in Public and Global Health in Continental Europe. The project begins by examining how RCRD is used at the Institute of Tropical Medicine Antwerp, which is located in Belgium, Europe but has research collaborations on other continents. It then continues with a scoping review on the use of RCRD to address racial and ethnic health disparities more generally across Europe.

Key messages

• Race-conscious research and data are lacking in public and global health research and policy-making, leading to racial health disparities.

• Need to develop expertise and a network of researchers in race-conscious research and data in Europe.
Maternal and perinatal health in undocumented migrants: estimating access and outcomes through HMIS
Authors: Genovese E , Cantarutti A , Corrao G , Locatelli A
Published: October 2022

Background

Vulnerability and inequality are exacerbated in undocumented migrants, the most invisible to health systems.

Objectives

To estimate maternal and perinatal health needs in undocumented migrants and test a methodology for systematic monitoring & evaluation.

Methods

Population-based retrospective cohort study based on routine data through maternity records and temporary registration code in a sub-national Health Management Information System.

Results

420924 deliveries including 1524 undocumented migrants having accessed maternity care through the NHS in Lombardy Region (Italy) from 2016 to 2021 were included. Demographics and social determinants: undocumented migrants were born in Europe (non-EU) (36%), Americas (30%), Africa (6%), Western Pacific (3%), South-East Asia (2%), Italy (2%), were stateless (7%); 52% had no/low schooling, 92% were unemployed and 52% non-married, compared to 15%, 20%, and 44% Italians. Obstetric history and antenatal care: 22% undocumented migrants had a previous abortion and 15% a previous cesarean delivery; 58% had ≥5 antenatal visits, 67% first ANC visit in trimester 1, 64% ≥ 2 ultrasounds incl. first in trimester 1, 6% full laboratory tests, compared to 90%, 97%, 97%, and 66% Italians. Intra-partum and perinatal care: 45% undocumented migrants delivered in a public hospital with neonatal intensive care unit; 69% had a normal delivery, 5% instrumental delivery, 10% and 27% emergency and total cesarean section; 2.6% neonates had emergency resuscitation and 49% were breastfed <2h from birth. Outcomes: 81% physiological pregnancies, 2.3% severe hemorrhage, 4.8% intra-uterine growth retardation, 9.3% pre-term delivery, 17% small for gestational age, 7% low birth weight, 0.6% poor Apgar score, 3% malformations.

Conclusions

Maternal and perinatal health was poor in undocumented migrants, varying by birthplace. Social determinants, health coverage and outcomes showed vulnerability and inequality compared to the general population.

Key messages

• Tailored interventions are needed: outreach health promotion on safe motherhood and neonatal care, healthcare provider training, cultural mediation, translation, and functional language learning.

• A systematic monitoring and evaluation system needs to routinely collect, integrate, and analyze data on key indicators.