Restricted access to GPs had limited effect on consultations for mental health problems in deprived areas during COVID-19: A cohort study.

Background The stringent lockdown measures and limited physical access to GP care at the start of COVID-19 pandemic resulted into a decrease of mental health consultations. It raised concerns about the access of patients with mental health problems. The aim of this study is to investigate the mental health GP consultations amongst patients from deprived neighborhoods before and during COVID-19 pandemic, especially after the stringent lockdown in the Netherlands. Methods In an observational study (2018-2022), medical data of 360,645 patients were analyzed for the proportions of mental health consultations (segmented per month) by comparing the lockdown phase (March 2020-May 2020) and post-lockdown phase (June 2020-June 2022) with the pre-pandemic period the patients living in deprived and non-deprived neighborhoods. Results Analyzing a total of 759,863 mental health consultations showed that during the lockdown phase of COVID-19, less mental health problem consultations were observed than pre-pandemic. This decrease was not significant for patients from deprived neighborhoods, but the decrease was significant for patients from non-deprived neighborhoods, RR = 0.990; 95%CI=0.934-1.051 and RR = 0.918; 95%CI=0.885-0.953 respectively. Conversely, the number of post-lockdown phase consultations for patients in deprived neighborhoods was significantly increased compared to pre-pandemic levels (RR = 1.074;95%CI=1.002-1.152), but not for patients in non-deprived neighborhoods (RR = 1.000; 95%CI=0.959-1.043). This increase in post-lockdown phase consultations in deprived neighborhoods can be explained by the higher frequency of consultations per patient. Conclusions Consistently over time, demand for GP mental health care was and remains higher among patients from deprived neighborhoods, with an increase in post-lockdown consultations. Sufficient access to primary health care should be guaranteed to ensure treatment of mental health problems for social-economic disadvantaged groups. Key messages • Socioeconomic status has a negative sustainable impact on demand for mental health consultations in deprived neighbourhoods. • To ensure the treatment of mental health problems for social-economic disadvantaged groups, sufficient access to the primary health care should be guaranteed at all times.

Background Due to stringent lock-down measures imposed during COVID-19 pandemic the access to the primary care dropped significantly. This study aims to investigate the impact on GP consultations for diabetes mellitus (DM) and COPD during the pandemic. Methods In an observational study from January 2018-June 2022, anonymized medical records of 379.567 patients in Rotterdam, were analyzed for the impact on DM and COPD consultations during the lockdown (March-May 2020) and after the lockdown (June 2020-June 2022) compared to pre-pandemic levels. Results The study included 34.270 DM and 11.570 COPD patients. Until the COVID-19 pandemic, the patients living in deprived neighborhoods had comparisonly on average a higher number of consultations for DM (RR = 1.81, 95%CI=1.76-1.86) and COPD (RR = 1.48 95%CI=1.39-1.58). During the stringent lock-down there was almost same significant drop in both neighbourhoods in consultations for DM (RR = 0.85, 95%CI=0.79-0.92) and COPD (RR = 0.72, 95%CI=0.61-0.86). After the lockdown, the consultations for DM were higher and the HbA1c measurements were normalized compared to pre-pandemic levels in both neighbourhoods, (RR = 1.11, 95%CI=1.05-1.17) and (RR = 0.96, 95%CI=0.91-1.01) respectively. Conversely, the consultations for COPD and spirometry measurements remained significantly lower after the lockdown compared to pre-pandemic levels, (RR = 0.72, 95%CI=0.65-0.80) and (RR = 0.26, 95%CI=0.20-0.34) respectively. Surprisingly, the mean HbA1c value in the study population was significantly lower in the months after the lock-down (RR = 0.96, 95%CI=0.94-0.98) turning back to higher normal value at the end of 2021. Conclusions The recovery of primary care for chronic diseases after the lockdown phase was much faster for DM than for the COPD patients. The positive effect of lockdown on HbA1c was unfortunately temporary. More research is needed to know whether the decrease in chronic care has led to extra morbidity or mortality after 2 years of pandemic. Key messages • Diabetes mellitus’ care recovered soon for both deprived and non-deprived neighbourhoods after a significant drop during the lockdown. Lockdown seems to have a positive effect on disease management. • The significant delay in chronic care for COPD patients in both deprived and non-deprived neighbourhoods for almost two years, raises questions about the adverse health effects due to this delay.

To investigate differences in quality of preventive care provided by general practitioners (GPs) to patients at risk of stroke living in deprived and non-deprived neighbourhoods in the Rotterdam region. A 'deprivation score' was used to categorize neighbourhoods according to their deprivation status. Data on the process of patient care were collected by means of chart review and interviews with GPs. Cases of stroke (n=188) were retrospectively audited by an expert panel with guideline-based review criteria. To measure differences in quality of patient care between neighbourhoods, deprivation scores were related to scores for sub-optimal care. After adjustment for socio-demographic characteristics, patients in deprived neighbourhoods had an increased risk (OR 1.95 (95% CI: 0.98-3.90)) of having received sub-optimal preventive care if compared with patients in non-deprived neighbourhoods. This excess risk was limited to women (OR 3.57 (95% CI: 1.39-9.16) vs OR 1.01 (95% CI: 0.41-2.48) in men). Adjustment for socio-demographic characteristics and risk factor distribution did not change the OR for women to receive sub-optimal care significantly (OR 3.21 (95% CI: 1.24-8.31)). Sub-optimal care originated mainly from deficiencies in follow-up of treated hypertensive and diabetes patients and evaluation of patients' cardiovascular risk profile. Among treated hypertensive women in deprived neighbourhoods who received sub-optimal care, the mean number of deficiencies related to follow-up was almost double that of the corresponding group in non-deprived neighbourhoods. Quality of care to prevent stroke in general practice differs considerably between deprived and non-deprived neighbourhoods. Patients in deprived neighbourhoods, and women in particular, have almost twice the risk of receiving sub-optimal preventive care.

Socioeconomic inequalities have been associated with poorer mental health outcomes in children and adolescents during the COVID-19 pandemic. Despite numerous studies on individual risk factors, the impact of societal environment, such as neighborhood characteristics, on changes in mental health has rarely been investigated. This study investigates the effect of neighborhood deprivation on mental health problems and health-related quality of life (HRQoL) in children and adolescents during the COVID-19 pandemic in Hamburg, Germany. Data were derived from the prospective German COPSY Hamburg study. Children and adolescents aged between 11-20 years and their parents participated in the study, which took place in summer 2020 (T1) and summer 2022 (T2). Neighborhood deprivation was assessed by a neighborhood status index. Mental health problems and HRQoL were assessed using internationally validated and established instruments. The prevalence of mental health problems and impaired HRQoL was reported. Analysis of covariance was conducted to examine the effect of neighborhood deprivation of the districts in Hamburg on the (changes in) mental health problems and HRQoL while controlling for social individual-level indicators. The total sample included in the statistical analysis consisted of N = 2,645 families. Children and adolescents living in more deprived areas had higher levels of general mental health problems and depressive symptoms during the COVID-19 pandemic. However, differences in neighborhood deprivation did not relate to the HRQoL and the averaged changes in children and adolescents' mental health problems and HRQoL from summer 2020 to summer 2022. Neighborhood deprivation is associated with impaired mental health in youth during the COVID-19 pandemic. Children and adolescents' mental health and overall well-being should be addressed by health promotion measures to create a health-promoting living environment, including diverse neighborhoods. Future research should focus on uniform assessment methods and addressing additional neighborhood factors.

BackgroundChildren born in families with non-medical risk factors, such as deprivation, have higher odds of preterm birth (< 37 weeks of gestation) or being born small for gestational age (birth weight < 10th percentile). In addition, growing up they are at risk for growth and developmental problems. Preventive Child Healthcare (PCHC) monitors growth and development of babies and children. Early identification of children at risk could result in early interventions to prevent growth and developmental problems in later life. Therefore, we aimed to assess current practices in postnatal risk screening and care for non-medical risk factors and the collaboration with other healthcare professionals, in both deprived and non-deprived neighbourhoods in the Netherlands.MethodsEight out of ten invited PCHC organisations, from different areas in the Netherlands, consented to participate in this study. A questionnaire was designed and digitally distributed to professionals working at these organisations, where 370 physicians and nurses were employed. Data was collected between June and September 2016. Descriptive statistics, chi square tests and t-tests were applied.ResultsEighty-nine questionnaires were eligible for analyses. Twenty percent of the respondents were working in a deprived neighbourhood and 70.8% of the respondents were employed as nurse. Most of them performed screening for non-medical risk factors in at least 50% of their consultations. PCHC professionals working in deprived neighbourhoods encountered significantly more often families with non-medical risk factors and experienced significantly more communication problems than their colleagues working in non-deprived neighbourhoods. 48.2% of the respondents were satisfied with the current form of postnatal risk screening in their organisation, whereas 41.2% felt a need for a structured postnatal risk assessment. Intensified collaboration is preferred with district-teams, general practitioners and midwifes, concerning clients with non-medical risk factors.ConclusionThis study shows that postnatal screening for non-medical risk factors is part of current PCHC practice, regardless the neighbourhood status they are deployed. PCHC professionals consider screening for non-medical risk factors as their responsibility. Consequently, they felt a need for a structured postnatal risk assessment and for an intensified collaboration with other healthcare professionals.

Neighbourhood deprivation has been associated with poor health. The evidence for social causation, however, remains scarce because selective residential mobility may also create neighbourhood differences. The present study examined whether individuals had poorer health when they were living in a deprived neighbourhood compared to another time when the same individuals were living in a less deprived neighbourhood. Participants were from the British Household Panel Survey prospective cohort study with 18 annual measurements of residential location and self-reported health outcomes between 1991 and 2009 (n=137 884 person-observations of 17 001 persons in England). Neighbourhood deprivation was assessed concurrently with health outcomes using the Index of Multiple Deprivation at the geographically detailed level of Lower Layer Super Output Areas. The main analyses were replicated in subsamples from Scotland (n=4897) and Wales (n=4442). Multilevel regression was used to separate within-individual and between-individuals associations. Neighbourhood deprivation was associated with poorer self-rated health, and with higher psychological distress, functional health limitations and number of health problems. These associations were almost exclusively due to differences between different individuals rather than within-individual variations related to different neighbourhoods. By contrast, poorer health was associated with lower odds of moving to less deprived neighbourhoods among movers. The analysis was limited by the restricted within-individual variation and measurement imprecision of neighbourhood deprivation. Individuals living in deprived neighbourhoods have poorer health, but it appears that neighbourhood deprivation is not causing poorer health of adults. Instead, neighbourhood health differentials may reflect the more fundamental social inequalities that determine health and ability to move between deprived and non-deprived neighbourhoods.

Neighbourhood effects studies have demonstrated an association between area deprivation and smoking behaviour whereby people living in deprived neighbourhoods are more likely to smoke than those in non-deprived neighbourhoods. This evidence though is based largely upon data that ignores long term exposures to neighbourhood contexts and is confounded by neighbourhood selection bias. In this study, we investigate the temporal ordering of exposure to neighbourhood deprivation throughout childhood and whether associations between neighbourhood deprivation and cigarette smoking are due to compositional or contextual neighbourhood effects. Data come from a UK cohort study, the Avon Longitudinal Study of Parents and Children (ALSPAC). We use longitudinal measures of neighbourhood deprivation and self-reported smoking behaviour for 2744 children to examine the influence of neighbourhood deprivation on smoking status and smoking heaviness at age 17. Our results demonstrate that children who are born into and grow up in deprived neighbourhoods are up to twice as likely to be smokers at age 17 than those in non-deprived neighbourhoods. These associations are largely due to family socioeconomic position and the intergenerational transmission of smoking behaviour from parents to children; compositional rather than direct contextual ‘neighbourhood effects’. Our findings highlight the importance of considering longitudinal exposure to neighbourhood deprivation over cross sectional exposure. In conclusion, we find that it is the family rather than the neighbourhood into which a child is born that determines their smoking behaviour.

BackgroundPrevious studies have found that residents of deprived neighbourhoods have an increased risk of perceived stress compared to residents with similar sociodemographic and socioeconomic characteristics in non-deprived neighbourhoods. While stress may provide an explanatory pathway linking neighbourhood deprivation to health-risk behaviour, only limited research has been undertaken on whether perceived stress influences health-risk behaviour in deprived neighbourhoods. Moreover, it is uncertain whether perceived stress has a negative effect on the associations between socioeconomic status and health-risk behaviours in deprived neighbourhoods. The overall aim of this study was to compare perceived stress in deprived neighbourhood with that in the general population, and to examine whether perceived stress was associated with health-risk behaviours (including their co-occurrence) in deprived neighbourhoods. A further aim was to examine whether perceived stress modified the associations between socioeconomic status and health-risk behaviours.MethodsFour questions from the Perceived Stress Scale were used as indicators of perceived stress. Multiple logistic regression analyses were applied to cross-sectional data from 5113 adults living in 12 deprived neighbourhoods in Denmark. Data from 14,868 individuals from the nationally representative Danish Health and Morbidity Survey 2010 were used as a comparison group with regard to perceived stress.ResultsResidents of deprived neighbourhoods had higher odds of perceived stress than the general population. Associations between disposable income, economic deprivation, strain, and perceived stress were found in deprived neighbourhoods. Perceived stress was significantly associated with higher odds of health-risk behaviour, including a low intake of fruit or vegetables, daily smoking, physical inactivity, and the co-occurrence of health-risk behaviours, even after adjustment for demographic and socioeconomic characteristics. Perceived stress was more strongly associated with physical inactivity and having two or more health-risk behaviours among residents with medium/high socioeconomic status compared to residents with low socioeconomic status.ConclusionsOverall, the study showed a clear association between perceived stress and health-risk behaviour in deprived neighbourhoods. Future health promotion interventions targeting deprived neighbourhoods may benefit from incorporating stress reduction strategies to reduce health-risk behaviour. Further research is needed to fully understand the mechanism underlying the association between perceived stress and health-risk behaviour in deprived neighbourhoods.

Recent work in a number of countries has identified growing geographical inequalities in health between deprived and non-deprived neighbourhoods. The health gaps observed cannot be entirely explained by differences in the characteristics of individuals living in those neighbourhoods, which has led to a concerted international public health research effort to determine what contextual features of neighbourhoods matter. This article reports on access to potentially health-promoting community resources across all neighbourhoods in New Zealand. Prevailing international opinion is that access to community resources is worse in deprived neighbourhoods. Geographical Information Systems were used to calculate geographical access to 16 types of community resources (including recreational amenities, and shopping, educational and health facilities) in 38,350 small census areas across the country. The distribution of these access measures by neighbourhood socioeconomic deprivation was determined. For 15 out of 16 measures of community resources, access was clearly better in more deprived neighbourhoods. For example, the travel time to large supermarkets was approximately 80% greater in the least deprived quintile of neighbourhoods compared with the most deprived quintile. These results challenge the widely held, but largely untested, view that areas of high social disadvantage have poorer access to community resources. Poor locational access to community resources among deprived neighbourhoods in New Zealand does not appear to be an explanation of poorer health in these neighbourhoods. If anything, a pro-equity distribution of community resources may be preventing even wider disparities in neighbourhood inequalities in health.

Dutch’ figures on perinatal mortality and morbidity are poor compared to EU-standards. Considerable within-country differences have been reported too, with decreased perinatal health in deprived urban areas. We investigated associations between perinatal risk factors and adverse perinatal outcomes in 7,359 pregnant women participating in population-based prospective cohort study, to establish the independent role, if any, for living within a deprived urban neighbourhood. Main outcome measures included perinatal death, intrauterine growth restriction (IUGR), prematurity, congenital malformations, Apgar at 5 min < 7, and pre-eclampsia. Information regarding individual risk factors was obtained from questionnaires, physical examinations, ultrasounds, biological samples, and medical records. The dichotomous Dutch deprivation indicator was additionally used to test for unexplained deprived urban area effects. Pregnancies from a deprived neighbourhood had an increased risk for perinatal death (RR 1.8, 95% CI [1.1; 3.1]). IUGR, prematurity, Apgar at 5 min < 7, and pre-eclampsia also showed higher prevalences (P < 0.05). Residing within a deprived neighbourhood was associated with increased prevalence of all measured risk factors. Regression analysis showed that the observed neighbourhood related differences in perinatal outcomes could be attributed to the increased risk factor prevalence only, without a separated role for living within a deprived neighbourhood. Women from a deprived neighbourhood had significantly more ‘possibly avoidable’ risk factors. To conclude, women from a socioeconomically deprived neighbourhood are at an increased risk for adverse pregnancy outcomes. Differences regarding possibly avoidable risk factors imply that preventive strategies may prove effective.

To examine if cognitive ability moderates the effect of area (neighborhood) deprivation on young children's problem behavior. Data from the first two sweeps of the Millennium Cohort Study (MCS) in the UK were used. Children were clustered in small areas in nine strata in the UK and were aged 9months at Sweep 1 and 3years at Sweep 2. Neighborhood deprivation was measured with the Index of Multiple Deprivation at Sweep 1. Overall and specific problem behavior was measured with the Strengths and Difficulties Questionnaire at Sweep 2. To explore moderator specificity we used three indices of ability (verbal cognitive ability, non-verbal cognitive ability, and attainment of developmental milestones). Adjustment was made for child's age and sex, and for Sweep 1 family adversity (number of adverse life events), family structure, mother's social class and psychological distress, and family socio-economic disadvantage. We found both support for our main hypothesis, and evidence for specificity. Neighborhood deprivation was, even after adjustment for covariates, significantly associated with children's peer problems. However, verbal and non-verbal cognitive ability moderated this association. Neighborhood deprivation was related to peer problems even at preschool age. Although the effect of neighborhood deprivation on externalizing problems was mediated by family poverty and parental socio-economic position and although its effect on internalizing problems was mediated by parental mental health, its effect on difficulties with peers was independent of both parental and child characteristics. Cognitive ability moderated the effect of neighborhood deprivation on preschoolers' peer relationships difficulties.

This paper estimates, for six different age groups, whether and how migration influences inequalities in health between deprived and non-deprived neighbourhoods in the Netherlands. Data were accessed from the Netherlands Housing Survey 2006. Using multi-level logistic regression analyses, we compared the health of migrants with that of nonmigrants in the area of origin and assessed the role of demographic and socioeconomic characteristics. Next, we assessed the magnitude of health differences between deprived versus non-deprived areas among migrants and non-migrants. For many age groups, migrants into non-deprived areas were healthier and migrants into deprived areas had similar levels of health compared with non-migrant populations in the area of origin. These differences in health were not explained by demographic and socio-economic characteristics. For all ages and for people aged 25-34 years we found smaller area inequalities in health among migrants compared with non-migrants. For most other age groups, about equally large differences were observed. For most age groups, the results do not provide empirical support to the expectation that migration would enlarge health differences between deprived and non-deprived neighbourhoods.

BackgroundThere has been increasing interest in neighbourhoods’ influence on individuals’ health-risk behaviours, such as smoking, alcohol consumption, physical activity and diet. The aim of this review was to systematically review recent studies on health-risk behaviour among adults who live in deprived neighbourhoods compared with those who live in non-deprived neighbourhoods and to summarise what kind of operationalisations of neighbourhood deprivation that were used in the studies.MethodsPRISMA guidelines for systematic reviews were followed. Systematic searches were performed in PubMed, Embase, Web of Science and Sociological s using relevant search terms, Boolean operators, and truncation, and reference lists were scanned. Quantitative observational studies that examined health-risk behaviour in deprived neighbourhoods compared with non-deprived neighbourhoods were eligible for inclusion.ResultsThe inclusion criteria were met by 22 studies. The available literature showed a positive association between smoking and physical inactivity and living in deprived neighbourhoods compared with non-deprived neighbourhoods. In regard to low fruit and vegetable consumption and alcohol consumption, the results were ambiguous, and no clear differences were found. Numerous different operationalisations of neighbourhood deprivation were used in the studies.ConclusionSubstantial evidence indicates that future health interventions in deprived neighbourhoods should focus on smoking and physical inactivity. We suggest that alcohol interventions should be population based rather than based on the specific needs of deprived neighbourhoods. More research is needed on fruit and vegetable consumption. In future studies, the lack of a uniform operationalisation of neighbourhood deprivation must be addressed.

Neighborhood Deprivation and Adolescent Mental Health: The Protective Role of School Staffing Patterns.

Do the poorest neighbourhoods receive the poorest environmental services? This paper explores whether local environmental service provision in the UK achieves ‘territorial justice’ with respect to deprived and nondeprived neighbourhoods within cities. Territorial justice is argued to pertain when the distribution of service provision to neighbourhoods reflects levels of need for the service. Focusing on the provision of street-level environmental services in four British local authorities, the paper shows that poor and better-off neighbourhoods have different levels of need for environmental services. It then examines whether the services provided are commensurate with variations in need, using observed cleanliness levels within the neighbourhoods to assess this. The author argues that—despite an increasing policy and practice focus on targeting public services towards deprived neighbourhoods in the UK—environmental service provision does not yet take full account of the complex needs of poor places, meaning that they tend to be dirtier than their more affluent counterparts.