Poor Health Research Articles

Effectiveness of psychological interventions in endometriosis: a systematic review with meta-analysis.

Endometriosis is a chronic gynecological disease associated with chronic debilitating pain, poor mental health and quality of life. The objective of this paper is to evaluate the effectiveness of psychological interventions aimed at improving the pain, quality of life and mental health of women with endometriosis. A systematic review (SR) of the literature with meta-analysis (MA) was carried out. MEDLINE, Embase, PsycINFO and CENTRAL were searched to locate Randomized Controlled Trials (RCTs). The risk of bias assessment of each study was conducted using the Cochrane Collaboration's RoB 2.0 tool. Seven RCTs were included (N = 757). The data obtained suggest that psychological interventions reduce dyspareunia [standardized mean difference (SMD): -0.54, 95% CI: -0.86, -0.22] and dyschezia [mean difference (MD): -2.90, 95% CI: -4.55, -1.26] and increase mental health levels (SMD: 0.70, 95% CI: 0. 42, 0.99); they also point to a large reduction in levels of trait anxiety (MD: -6.63, 95% CI: -8.27, -4.99) and depression (MD: -2.49, 95% CI: -3.20, -1.79), and a likely reduction in state anxiety (MD: -9.72, 95% CI: -13.11, -6.33) experienced by women with endometriosis. It was also identified that psychological interventions probably slightly reduce pelvic pain and may increase physical health. However, most of the included studies have a high overall risk of bias or have certain concerns, which limit conclusions about the certainty of the evidence. The available evidence indicates that psychological interventions are effective in improving the pain, quality of life and mental health variables of women with endometriosis. https://www.crd.york.ac.uk/prospero/, CRD42024516100.

Precarious employment expectancy by history of mental-health-related sickness absence in Finland

Abstract Background Poor mental health may lead to labour market insecurity including precarious employment and vice versa. Less is known of how mental health is associated with cumulative engagement in precarious employment over the working career. We examined how the working career is expected to be distributed into precarious and other types of employment by history of mental-health-related sickness absence. Methods We used a register-based 70% population sample to examine wage-earners living in Finland in 2018. Applying the Sullivan method, we calculated the expectancy of precarious and non-precarious employment between age 25 and 63 (N = 1268666) based on a novel measure (score with items on temporariness, agency employment, multijob holding, underemployment and income level) and limited employment (due to which precariousness could not be assessed) among those with and without compensated (granted after 10 weekdays) sickness absence due to mental disorders in the past five years (mental SA history). Results Precarious employment expectancy was higher among those with than among those without a mental SA history (2.5 vs. 1.5 among men and 3.5 vs. 2.8 years among women). The difference in the limited employment expectancy was in the same direction, but much larger among men (6.5 vs. 3.3 among men and 4.4 vs. 3.4 years among women). Men with a mental SA history were expected to spend almost a fourth of their working career with either precarious or limited employment, whereas for men without such a history the number was 13%. Conclusions Individuals with mental disorders have notable accumulation of precarious employment over the working career. They also spend excessive time with limited employment, which may have similar elements as precarious employment and reflect broader labour market insecurity. Attempts should be made to ensure that insecure employment conditions among people with mental health problems do not further deteriorate their health and work ability. Key messages • People with mental disorders spend a disproportionate part of their working career either precariously employed or facing other insecurities in the labour market. • Interventions aiming to promote health and work ability should take into account the interplay between poor mental health and poor employment conditions.

Childhood socioeconomic status and depression in adulthood: systematic review

Abstract Background Low socioeconomic status (SES) is generally associated with poorer mental health, particularly depression. We carried out a systematic review to address the question of whether childhood SES is associated with depression in adulthood and the potential pathways which may explain this association. Methods We followed a systematic search strategy in PubMed and Scopus with specific inclusion and exclusion criteria. After removing duplicates, studies were screened for eligibility and quality was assessed independently by two assessors using the Newcastle-Ottawa scale. Results After the selection process, 20 observational studies (7 cohort and 13 cross-sectional) that examine the association between SES during childhood and depression in adulthood were included in the systematic review. The most common measures of childhood SES were parental education, occupation or family income, estimated subjectively and/or objectively. In 17 of the studies an inverse relationship between childhood SES and depression was shown. In 17 studies, models were employed to demonstrate the possible pathways which explain the relationship between childhood SES and depressive symptoms. The most important mediators were adult SES, psychosocial factors, childhood trauma and physical health. Conclusions Our findings reveal the long-term association between childhood socioeconomic conditions and depression later in life. Suboptimal childhood SES seems to be an important risk factor for depression in adulthood. Improving childhood socioeconomic conditions can potentially have lasting effects well beyond childhood. Key messages • Protecting children against the effects of socioeconomic adversity could reduce depression in adult life. • Policy makers should direct resources towards alleviating childhood disadvantage for promoting health in adulthood.

Unintended pregnancies in the context of intimate partner violence: Findings from the ELSA-Study

Abstract Intimate partner violence against women (IPV) is a widespread problem with serious consequences for victims and for society. Women affected by IPV have an empirically proven particular risk of unintended pregnancies. ELSA “Experiences and Living Conditions of Unintended Pregnant Women - Counselling and Care Services” is the first study in Germany to analyse the connections between the situations of women and unintended pregnancies. Using an online questionnaire, women from 1) a random representative sample of residents with a child under 6 years of age and 2) a sample of 662 women from abortion facilities or counselling centres were surveyed in 2021. The data (n = 5,101) were analysed in order to compare the life situation and needs of victimized versus non-victimized women. 333 women (6.5% of the total sample; 95% CI [6.2, 7.6]) reported IPV. Victimized women had a 5.6 times higher risk for an unintended pregnancy (95% CI [4.2, 7.5]) and 3.2 times higher risk for an abortion (95% CI [2.0, 5.0]). The pregnancy was sig. more frequently the result of forced sex (CV= .210***). Victims with unintended pregnancies had a sig. poorer mental health before (t(510) = 7.081***), during (t(510) = 5.501***) and after birth (t(456) = 5.234***) as well as before (t(503) = 4.905***), during (t(224) = 3.408) and after (t(503) = 3.352***) abortion. They were sig. more likely to report feelings of guilt and shame (CV = .182***), self-blame (CV = .149***) and anxiety (CV = .190***) after the pregnancy was determined and they received sig. more unsolicited information from the medical staff (CV = .254**). The result shows that victimized women are in an increased risk situation in the context of unintended pregnancies. Health care professionals can play a special role in prevention and intervention. Nationwide awareness-raising training, protocols and commitment are required. Key messages • The study confirms international findings on IPV and unintended pregnancies for Germany. • There is a need for a sensitive approach within the health system to enhance prevention.

Using diversity, equity and inclusion school practices to mitigate child health inequities in Canada

Abstract Background The burden of unhealthy lifestyle behaviours and mental disorders disproportionately affects children in deprived neighbourhoods. In Canada, school practices addressing diversity, equity and inclusion (DEI) are promoted to address such inequities. We aimed to assess whether DEI school practices can help mitigate the impact of neighbourhood deprivation on children’s lifestyle behaviours and mental health. Methods In 2023 we gathered survey data from 1497 grade 4-6 children (aged 9-12) in 22 elementary schools located in deprived neighbourhoods in Alberta, Canada. Children reported their diet, screen time, physical activity, and mental health. Principals reported on the implementation of DEI practices in schools (full vs. partial). School postal codes were used to derive tertiles of the Canadian Index of Multiple Deprivation, comprised of four dimensions that capture: 1) residential instability; 2) economic dependency; 3) ethno-cultural composition and 4) situational vulnerability of neighbourhoods. Results Overall, 45% of schools had fully implemented DEI practices. These schools were located in more deprived neighbourhoods for residential instability (55%), economic dependency (71%), ethno-cultural composition (60%), and situational vulnerability (64%). Children in more deprived neighbourhoods reported more sugar consumption, more screen time, and poorer mental health, compared to children in less deprived neighbourhoods. However, in those neighbourhoods where DEI practices were fully implemented, the adverse effects of neighbourhood deprivation were alleviated, whereby children reported less sugar consumption, less screen time, and better mental health. Conclusions The implementation of DEI school practices can help mitigate the adverse effects of neighbourhood deprivation on children’s physical and mental health, particularly in deprived neighbourhoods. Key messages • School practices targeting diversity, equity, and inclusion are more commonly implemented in schools located in deprived neighbourhoods. • Diversity, equity, and inclusion school practices mitigate the adverse effects of neighbourhood deprivation on children’s lifestyle behaviours and mental health.

Sexuality and Gender Diversity Among Adolescents in Australia, 2019-2021

Sexuality- and gender-diverse (SGD) young people experience substantial health disparities relative to cisgender heterosexual peers. Little is known about SGD adolescents younger than 15 years. To describe SGD prevalence and associated factors in a population-representative cohort of younger adolescents in Australia. This prospective cohort study was part of the Future Proofing Study, with enrollment of year 8 students at 134 Australian secondary schools from 2019 to 2021 and annual follow-ups for 5 years. Data were analyzed from June 20, 2023, to June 6, 2024. Outcomes of interest were baseline self-reported gender and sexuality identities, individual characteristics, and mental health and disability diagnoses, as well as school characteristics. Among 6388 participants, median (IQR) age was 13.9 (13.6-15.8), with a range of 10.7 to 17.5 years. Most participants attended school in a major city (76.0%), were born in Australia (91.4%), and spoke English at home (93.7%). Approximately half (3122 participants; 48.9% [95% CI, 45.2%-59.0%]) identified as female or girls, and 46.5% (2973 participants; 95% CI, 39.8%-53.4%) identified as male or boys. The overall proportion of transgender identity was 3.3% (95% CI, 2.7%-3.9%), with 23 participants (0.4%) identifying as transgender boys, 10 participants (0.2%) identifying as transgender girls, 117 participants (1.8%) identifying as transgender nonbinary, and 59 participants (0.9%) identifying as another transgender identity. The overall proportion of sexuality diversity was 12.0% (95% CI, 10.4%-13.8%). The proportion of cisgender participants who were sexuality-diverse (13.0% [95% CI, 11.4%-14.8%] of girls and 4.7% [95% CI, 3.7%-5.9%] of boys) was lower than the proportion among gender-diverse participants, which ranged from 30.0% (95% CI, 9.3%-64.1%) of transgender girls to 91.5% (95% CI, 81.3%-96.4%) of those with another diverse gender identity. Gender diversity and sexuality diversity were strongly associated (odds ratio [OR], 66.24; 95% CI, 38.23-114.80), and both were negatively associated with age (gender diversity: OR per 1-year older, 0.61; 95% CI, 0.49-0.76; sexuality diversity: OR per 1-year older, 0.78; 95% CI, 0.65-0.93) and positively with mental health diagnosis (gender diversity: OR, 2.41; 95% CI, 1.79-3.24; sexuality diversity: OR, 2.50; 95% CI, 2.10-2.98), and disability diagnosis (gender diversity: OR, 2.39; 95% CI, 1.68-3.40; sexuality diversity: OR, 1.96; 95% CI, 1.64-2.36). While there were significant associations between individual and school characteristics and responses to gender and sexuality identity items, patterns of association differed, with no consistent association with economic disadvantage. This cohort study of young adolescents found higher rates of SGD than among samples of older adolescents. The significant associations with younger age, poorer mental health, and disability underscored the urgent need for inclusive programs to promote a safe and welcoming environment in schools, health care settings, and communities.

Prevalence of Adverse Childhood Experiences Among Adolescents.

Adverse childhood experiences (ACEs) are preventable, potentially traumatic events with lifelong negative impacts. Population-level data on ACEs among adolescents have historically relied on parent reports and excluded abuse-related ACEs. We present the self-reported prevalence of ACEs among a large population-based sample of US high school students. Using cross-sectional, state-representative data from 16 states that included core ACE questions on their 2021 Youth Risk Behavior Survey, we estimate the prevalence of 8 individual (lifetime emotional, physical, or sexual abuse, physical neglect, witnessed intimate partner violence, household substance use, household poor mental health, incarcerated parent or guardian) and cumulative ACEs (0, 1, 2-3, ≥4) among a large population-based sample of adolescents, overall and by demographic characteristics (sex, race and ethnicity, age, sexual orientation). Emotional abuse (65.8%), household poor mental health (36.1%), and physical abuse (32.5%) had the highest prevalence. ACEs were very common, with 80.5% of adolescents experiencing at least 1 ACE and 22.4% experiencing ≥4 ACEs. Experiencing ≥4 ACEs was highest among adolescents who were female (27.7%), non-Hispanic multiracial (33.7%), non-Hispanic American Indian or Alaska Native (27.1%), gay or lesbian (36.5%), bisexual (42.1%), or who described their sexual identity some other way or were not sure of their sexual identity (questioning) (36.5%). Self-reported ACE estimates among adolescents exceed previously published parent-reported estimates. ACEs are not equally distributed, with important differences in individual and cumulative ACEs by demographic characteristics. Collecting ACE data directly from adolescents at the state level provides actionable data for prevention and mitigation.

The impacts of UK coronavirus virus job retention (furlough) scheme on mental health

Abstract Background In March 2020, the UK government introduced the pandemic-induced job retention scheme, known as furlough. The scheme provided grants to employers, to retain their workforce by subsidizing up to 80% of wages. While the scheme was aimed at preventing unemployment during lockdowns, it also came with wage loss, with implications for mental health for affected workers, although evidence is limited. Therefore, we aimed to explore the impact of the furlough scheme on mental health in the UK Methods We explored longitudinal data from the UK’s Understanding Society Survey between 2019 and 2021, including nine COVID waves. We matched a sample of furloughed and non-furloughed workers using various covariates. Mental health was measured using General Health Questionnaire (GHQ-12, scored 0-36). We estimated difference-in-differences models to explore the heterogeneous causal effects on mental health of workers participation and exit from the furlough scheme. We further considered the effects of being furloughed contrasted with becoming unemployed during the pandemic Results The estimated average treatment effect (-0.53 [95% CI: -0.91 - -0.16]) suggests that being furloughed had significant positive impact on mental health, while exiting from furlough due to changes requiring workers to work minimum hours increased the incidence of poor mental health 0.41 [95% CI: -0.11 - 0.92]. However, compared to becoming unemployed, being furloughed improved mental health by around -0.42 [95% CI: -0.75 - -0.09] GHQ points. Conclusions Policies that mitigate the economic impact of the pandemic also had psychological effects on the population. Even though there were mixed effects of coronavirus-induced social restrictions and lockdowns. Furlough reduced the psychological risks associated with the pandemic job loss, while exiting the scheme increased the incidence of poor mental health. This could be explained by substantial decline in the generosity of the scheme by up to 40%. Key messages • Job loss during the pandemic had deteriorating mental health effects. • Government contribution to furloughed workers’ wages minimizes the incidence of mental health distress.

Sarcopenia and associated factors among older adults at high risk of dementia

Abstract Background Sarcopenia and dementia share pathophysiological pathways and risk factors, including advanced age, physical inactivity, unhealthy diet, smoking and diabetes. Older adults at high risk of dementia may face increased susceptibility to sarcopenia, which can also exacerbate cognitive decline. Thus, this study aims to estimate the frequency of sarcopenia and its associated factors within this vulnerable population. Methods This cross-sectional analysis includes data from a subset of older adults (≥65 years of age) enrolled in the MIND-Matosinhos randomized controlled trial, a community-based cognitive decline prevention program. Per the European Working Group on Sarcopenia in Older People, probable sarcopenia is defined as low muscle strength (handgrip strength <16 kg for women and <27 kg for men). Sociodemographic, lifestyle and health-related data were collected via structured questionnaires. To assess factors associated with sarcopenia, odds ratios (OR) and respective confidence intervals (95% CI) were estimated using logistic regression. Results A total of 157 participants (58.6% female), with a median age of 73 years (range: 65 to 85 years), were included. The overall prevalence of sarcopenia was 21.7% (n = 34). After adjusting for sex, age and education, inadequate adherence to Mediterranean Diet (MD) (OR = 10.90; 95% CI:1.41-84.52), current smoking status (OR = 5.06; 95% CI:1.06-24.18) and poorer self-perceived health (OR = 2.74; 95% CI:1.03-7.28) were positively associated with sarcopenia. No other statistically significant associations were found. Conclusions The observed sarcopenia frequency underscores the need for enhanced screening and management of this condition in community settings and among those at dementia risk. Inadequate adherence to MD, smoking and poor self-perceived health, seem to be associated with sarcopenia in older adults at high risk of dementia. Sarcopenia prevention should involve a holistic approach to promoting a healthy lifestyle. Key messages • Sarcopenia was observed in 21.7% of older adults at high risk of dementia, indicating a significant burden on this vulnerable population. • Inadequate adherence to the Mediterranean diet, smoking and poor self-perceived health were associated with sarcopenia.

Association of Workplace Toilet Access with Urinary Tract Symptoms and Productivity Loss among Female

Abstract Purpose Lower urinary tract symptoms (LUTS) are prevalent among women, affecting not only their physical well-being but also their quality of working life. We investigate workplace toilet access related to LUTS among women in the Korean workforce. Materials and methods An online survey was conducted to determine the demographic characteristics, occupational risk factors, and urinary tract symptoms among employed Korean women. Occupational risk factors included three survey questions on access to toilets at work: A) enduring urinary symptoms at work; B) capability to use the toilet at will during work, and C) needing to use the toilet during work but were unable to. The LUTS were assessed using the overactive bladder symptom score (OABSS) and international consultation on incontinence questionnaire-urinary incontinence short form (ICIQ-SF). Health-related productivity losses (HRPL) were estimated using the work productivity and activity impairment (WPAI) questionnaire for urinary symptoms. Multiple logistic regression was used to determined the association between workplace toilet access and LUTS. In addition, generalised linear regression analysis was performed to assess HRPL according to workplace toilet access. Results Of the 1057 participants, 260 (24.6%) and 294 (27.81%) had overactive bladder and urinary incontinence, respectively. More than 50% reported poor access to toilet. Multiple logistic regression analysis showed that the lower the access to toilets in the workplace, the higher the incidence of LUTS and the higher HRPL. Conclusions Restricted access to toilets at work are associated with poor urinary health and loss of productivity. The results highlight the need for interventions to improve the workplace environment. Key messages • Restricted access to toilets at work are associated with poor urinary health and loss of productivity. • The results highlight the need for interventions to improve the workplace environment.

Targeted initiatives to tackle health inequalities, integrating the Leeds Health and Care Workforce

Abstract Deprivation and poor health are significant challenges in Leeds, with the poverty gap growing in parts of the city. The Leeds One Workforce approach to narrowing inequalities (NI) was co-designed in 2021 building on the innovative partnership approach already visible in the city. Its phased approach has seen interventions put in place to boost the opportunities for people from marginalised communities to develop their skills and remove barriers to careers in health and care and has global relevance for other localities experiencing high deprivation. The overall NI approach is supported by a long-term and wide-reaching evaluation plan which mobilises our partner organisations and intends to amplify best practice in getting people into careers and supporting this group to develop within the health and care workforce. We will present findings from embedded evaluations of initiatives across the city, and individual case studies, from those who have accessed NI interventions in Leeds. These will explore the relationships and contributions of partnership organisations and presence of any unexpected barriers or facilitators to these interventions. Linking with third-sector organisations and creating accessible pre-employment opportunities to develop core working skills is a vital part of the Leeds approach to recruiting people from priority wards. Additionally, supporting people into careers in health and care which suit their values, interests and personal circumstances, in addition to employing organisations with flexibility and openness towards their employees at their core is a strong factor in recruiting and retaining from areas of deprivation. Partnership working is essential to tackling health inequalities in places of high deprivation to address individual and systemic barriers to securing employment, ensure the best chance of success for community outreach programmes, and maximise efficiencies by combining the efforts of local organisations. Key messages • Leeds, UK is transforming approaches to narrowing health inequalities through partnership working across health and social care education and employment. • Current and future best practice will be explored to demonstrate transferable NI approaches.

Hand grip strength in older and very old people: Results of the study Gesundheit 65+

Abstract Background Functional capacity decreases with increasing age. Hand grip strength (HGS) is considered as an objective general measure of health and a parameter of muscle strength, a component of functional capacity and is part of the evaluation of frailty. HGS is important for many everyday functions, such as holding heavy objects or supporting oneself to prevent a fall. Low HGS is associated with a higher mortality risk. In our study we describe HGS in people aged 66 to 101 years in Germany and identify groups with low HGS. Methods Gesundheit 65+ is a longitudinal epidemiologic study of the health status of persons 65 years and older in Germany by the Robert Koch Institute. In 2022/23, one year after baseline, isometric HGS was measured during the examination part of the study using a hand-held dynamometer (Smedley, Scandidact, Denmark, 100 kg). Two values were recorded for each hand. Maximum HGS from all attempts was used for analyses. Weighted prevalence estimates and 95% confidence interval (CI) for grip strength are reported by sex, age-group, height, self-rated health, chronic conditions, and difficulties in activities of daily living (ADL). Results HGS was measured in 1,457 persons aged 66 to 101 (48% women). Mean maximum HGS was 28.8 kg (CI 28.4-29.3). HGS was significantly related to sex (men: 35.4 kg, CI 34.8-36.0, women 21.8 kg, CI 21.4-22.2) and age (66-79: 31.0 kg, CI 30.1-31.9, 80+: 23.9 kg, CI 23.0-24.7). In both sexes, shorter persons and persons with bad self-rated health, chronic conditions or difficulties in ADL showed lower HGS than their reference group. Conclusions HGS was reduced in very old people, people with support needs, and people with poor health or chronic diseases, identifying these people as important risk groups for preventive measures. These should aim to improve not only endurance but also strength in older and very old people. In the long term, this could also maintain independence and reduce serious injuries from falls. Key messages • We found sex and age-related differences in hand grip strength in older people in Germany. • Based on the results, planning of prevention and intervention could be enhanced.

Heterogeneity in health and lifestyle among preschool children with migrant background in Sweden

Abstract Background Parental country of birth and socioeconomic status affect children’s health, lifestyle, and access to care. But inequality patterns may vary depending on the outcome and indicator being studied. While prior studies have focused on single health outcomes, this study assessed the relationship between parental migrant status and a range of health and lifestyle indicators among 3-year-old children. Methods Using an outcome-wide approach, we analyzed data from cross-sectional population-based surveys of 3-year-old (2014-2018) in Northern Sweden, which included 9,099 children aged 33-42 months. The surveys were administered to parents. Logistic and linear regressions were performed to examine the association between parents’ place of birth and outcome indicators. Additionally, we controlled for parents’ income and education using multiple regression models. Results Children with at least one migrant parent were perceived by their parents to have poorer health (OR:1.5, CI:1.01-2.36) and more socio-emotional problems (OR: 2.8, CI: 2.20-3.59) compared to those with two Swedish parents. While there were no significant differences in estimated BMI, lifestyle indicators showed that these children consumed more sweets (OR:4.5, CI: 3.02-6.58), less milk (OR: 1.3, CI: 1.09-1.55), fewer vegetables (OR:1.6; CI: 1.22-2.05) and brushed their teeth less frequently (OR: 2.8, CI: 2.17-3.53). However, they spent more time playing outdoors on weekdays (OR:1.6, CI:1.22-2.00) and weekends (OR: 1.5, CI: 1.18-1.94), but screen time remained consistent between weekdays and weekends. Conclusions Parental migrant status has varying impacts on children’s health and lifestyle, with some indicators showing worse outcomes for children with migrant parents compared to those with Swedish parents, while others do not. An outcome-wide approach is crucial for targeted actions to strengthen protective factors and mitigate risk factors, and ultimately reduce inequalities in early childhood. Key messages • The link between parental migrant status and children’s well-being is complex. Not all indicators show worse outcomes, inequality patterns vary based on the specific outcome and indicator measured. • An outcome-wide approach is crucial to identify action areas for targeted interventions to reinforce protective factors and mitigate risk factors, and ultimately reduce inequalities during childhood.

Digital services as alternative for in-person visits among clients with long-term illnesses

Abstract Background For individuals managing long-term illnesses and often requiring complex care across health and social care sectors, the transition to digital platforms holds considerable potential to facilitate management of one’s health. This study examined factors among people with long-term illnesses associated with their perception that digital services had replaced in-person visits in health and social care. Methods A total of 11,012 Finnish residents with long-term illnesses necessitating regular care (56% female, mean age 56.9, SE .23) responded to a nationwide population survey between September 2022 and March 2023. The Inverse Probability Weighting method was used to correct for bias. Complex samples binary logistic regression was used to examine whether factors related to self-rated health, distress, digital skills and perceived benefits of digital services were associated with the replacement of in-person visits by digital services. The model was adjusted for age, gender, education, and urbanicity. Results Approximately one third (35.8%) of the respondents indicated that the use of digital services had replaced in-person visits within the past 12 months. Respondents in poor or moderate health (OR 1.17, 95% CI 1.02-1.34) had greater odds of reporting the replacement compared to those in good health. Those with proficient digital skills (OR 1.84, 1.57-2.14) and those perceiving more benefits in digital services (OR 1.56, 1.47-1.74) had greater odds of reporting of the replacement compared to their counterparts. Conclusions Transition to digital services could facilitate access to care for individuals with long-term illnesses perceiving their health poorer. Promoting digital skills and perceptions of benefits of digital services can significantly increase the use of digital services as substitutes of in-person visits and contribute to more efficient allocation of health and social care resources. Key messages • Especially those reporting poorer health seem to use digital services as replacements of in-person visits, offering the potential to optimize resource utilization in health and social services. • Promotion of digital skills and perceptions of the benefits of digital services could increase the use of digital services as replacements for traditional visits with health and social professionals.

JOBS Program Germany for health promotion among the unemployed

Abstract Aim The unemployed suffer from poorer health than the employed, especially in terms of mental health. At the same time, health promotion reaches unemployed less than employed. The “JOBS Program” is an intervention for the unemployed to promote health. It has shown positive effects in the USA and Finland. The aim of this confirmatory study (Hollederer & Jahn, 2023; Jahn & Hollederer, 2024) was to investigate whether the JOBS Program produces similar effects in Germany. Methods A multicenter randomized controlled trial was applied to compare an intervention group (IVG) with a waiting control group (WCG) before (T0; n = 94), shortly after (T1; n = 65) the intervention and about 6 months after the intervention (T2; n = 43). Fourteen JOBS Program trainings have been conducted. Additionally, JOBS Program trainers were interviewed via voluntary computer-assisted web interviews (resulting in 28 interviews). Results JOBS Program Germany was beneficial. Following changes in the primary outcomes were identified from T0 to T1: Compared to the WCG, a multivariate regression estimated that the IVG had (1) a 0.34 scale point higher level of self-rated general health (p = 0.025; scale range: 1-5 points), (2) a 14.52 scale point higher level of mental well-being (p = 0.004), and (3) a 2.74 scale point higher level of life satisfaction (p = 0.049). About 6 months after the training had been conducted (T2), participants in the JOBS training showed better general health status (0.41-point; p = 0.016) compared to the WCG. Furthermore, 78.5% of the JOBS Program trainers were rather or very satisfied with the theoretical contents and 85.7% with the practical implementation. A central obstacle to the implementation was the COVID-19 pandemic. Conclusions This study provides evidence for the effectiveness of the JOBS Program with respect to the above outcomes, and for older and long-term unemployed, suggesting the benefit of regular implementation for different groups of unemployed in Germany. Key messages • The results of the confirmatory study show positive effects of the JOBS Program on the general health status and unemployment-related mental burden among unemployed people in Germany. • The introduction of the JOBS Program as a nationwide intervention in Germany could be an intervention approach for the unemployed to achieve better health.

The Influence of Loneliness on Pain Outcomes for Adolescents: A Cross-Sectional Survey

ABSTRACT Background Loneliness, the perception that one’s social relationships do not meet the desire for social connection, is a risk factor for poor mental and physical health. Adolescents with chronic pain experience higher rates of peer loneliness which persists over time. Previous studies used a single loneliness measure, limiting our understanding of the nature of their loneliness. This study describes the types of peer loneliness (intimate, relational, and collective) experienced by these adolescents and the impact that peer loneliness has on pain-related outcomes. Methods A cross-sectional online survey was completed by 128 Canadian adolescents aged 12–18 years who experienced pain for at least 3 months. Validated measures captured demographics, pain-related characteristics, types of peer-related loneliness, measures of social well-being, and mental and physical health outcomes. Results Friedman’s tests of z-scores indicate that participants equally experienced dyadic, relational, and collective peer loneliness. MANCOVA revealed that those who identify as Black were lonelier after controlling for socioeconomic status. Multiple regression showed that loneliness was a robust predicter of worse scores on social well-being and mental health outcomes with males and females equally impacted by loneliness. Despite moderate correlations between loneliness and pain interference and pain intensity, loneliness did not predict school absences, suggesting that loneliness’ influence on physical pain outcomes may be temporally earlier (e.g. contribute to pain chronification). Conclusions Peer loneliness among adolescents with chronic pain negatively impacts their social well-being and mental health outcomes. Interventions addressing loneliness to target all three types of peer loneliness may be key to improving pain-related outcomes.

Experiences of discrimination in Finnish healthcare services

Abstract Background It has been found that foreign-born people report more discrimination than the general population. This study examines experiences of discrimination in Finnish healthcare, with a focus on individuals with a foreign background. Methods Two nationally representative cross-sectional data sets were used: MoniSuomi (n = 7838; response rate 44.1%) and Healthy Finland Surveys (n = 28154; response rate 46.3%). The outcome variable, experiences of discrimination, was predicted by means of stepwise logistic regression models covering (1) socioeconomic factors, (2) factors related to healthcare service need and use, and (3) migration-related factors. Results In healthcare services, migrants experienced discrimination more than twice as frequently as the general population (8.9% versus 3.6%, 95% CI = 8.0-9.8, 3.2-4.1). According to regression models, relevant factors were insufficient income, being female, studying as the main occupation and poor mental and physical health. Foreign background was not independently associated with discrimination. However, higher educational attainment, chronic disease, and use of occupational healthcare services increased the likelihood of experiencing discrimination only among those of foreign background and showed the opposite trend for the general population. All migration-related factors increased the risk of discrimination. Conclusions The findings underline the need for training on explaining the service system, overcoming language barriers, and working with forced migrants. The occupational healthcare workforce would particularly benefit from these interventions. The results inform the development of professionals’ training. Key messages • Migrants experience higher levels of discrimination in healthcare compared to the general population. Multiple factors explain this difference. • Healthcare professionals require training to better inform patients about the service system, to improve communication and to address the situation of forced migrants.

Loneliness and Social Isolation in Older Adults in Latvia and Iceland During COVID-19

Abstract Background The COVID-19 pandemic has significantly impacted the mental health and wellbeing of older populations across Europe, exacerbating feelings of loneliness and social isolation, known risk factors for poor physical and mental health outcomes. This study aims to understand the extent and implications of these changes in Latvia and Iceland, providing essential insights for targeted public health interventions. Methods This comparative study utilized data from two key sources: the Survey of Health, Ageing, and Retirement in Europe (SHARE) for Latvia and the HL20 study for Iceland, focusing on individuals aged 67 and above. Both quantitative surveys were conducted during the pandemic, offering data on health status, loneliness, and social isolation. A novel approach was applied in analyzing older populations to standardize comparisons between the two distinct datasets. This methodological innovation is part of a bilateral EEA initiative FM2021/23 aimed at strengthening research collaboration between Latvia and Iceland. Descriptive statistics and the Pearson Chi-square test were used to compare outcomes between the two countries and within demographic subgroups. Results The study revealed stark differences between the two countries: 80% of Latvian older adults reported social isolation compared to 42.7% in Iceland. Similarly, 45% of Latvians experienced loneliness versus 30% of Icelanders. Significant associations were found between social isolation, loneliness, and deteriorating mental and physical health, with worse outcomes noted in socially isolated individuals. Conclusions Our findings demonstrate a clear link between social isolation and adverse health outcomes among the older adults, exacerbated by the COVID-19 pandemic. The study supports the need for proactive public health measures in Latvia and Iceland, including the development of community engagement programs and mental health support services tailored to the needs of older adults. Key messages • Study shows significant health impact of social isolation among older adults in Latvia and Iceland, highlighting urgent need for targeted public health interventions. • Effective public health strategies and innovative digital outreach can mitigate adverse effects of loneliness and isolation observed in older populations.

Healthcare in police custody: a conceptual framework for measuring and improving quality of care

Abstract Background Individuals in police custody are often in poor (mental) health and can be in need of medical attention. The delivery of primary healthcare in police custody differs from other custodial and non-custodial settings, due to its short-term character and the reliance on custody officers and healthcare professionals to access care. Therefore, medical care for detainees in police custody requires its own standards and indicators to measure the quality of care. We aimed to develop a conceptual framework for (actionable) indicators to measure the quality of care for people detained in short-term police custody settings in the Netherlands. Methods We conducted a scoping review and consulted with experts. The scoping review involved Embase, Medline, PsycINFO, CINAHL, Criminal Justice Abstracts, PiCarta and Cochrane, and was supplemented with grey literature searches. We consulted twenty-seven stakeholders with a wide variety of expertise in the field of healthcare in police custody to discuss and validate the conceptual framework. Results The conceptual framework consists of 14 domains of structures (e.g. staff and facilities), processes (e.g. triage and coordination of care) and outcomes (e.g. effectiveness and satisfaction) that need to be considered when developing quality indicators for the healthcare provision in police custody. The scoping review yielded 68 publications providing information on common health issues and recommendations related to quality assurance or improvement. Conclusions The conceptual framework will guide the development of (actionable) quality indicators, which will be evaluated on relevance and measurability. These are crucial for monitoring care quality and enhancing a learning health systems approach. This study fills a gap in the existing scientific literature by shedding light on the factors contributing to the quality of primary healthcare provision for people detained in short-term custody settings. Key messages • The conceptual framework guides the development of (actionable) quality indicators for healthcare in police custody. • This study contributes to the creation of a learning health system for healthcare in short-term police custody settings.

Estimated lifetime impact of a school-based intervention for mental health: A microsimulation study

Abstract Background The prevalence of childhood mental health problems is increasing. School-based interventions have the potential to reduce poor mental health and mental health inequalities. Our aim was to estimate the long-term costs and benefits of the Incredible Years Teacher® Classroom Management (IY-TCM) intervention in primary schools compared to no intervention. Methods LifeSim, an existing microsimulation model, was used to estimate the lifetime costs and benefits of IY-TCM by linking short-term changes in SDQ based on a previous trial in primary schools (Cluster RCT: 2075 children aged 4-9 years with a 30-month follow-up) to long-term health, social, economic and wellbeing outcomes. Benefits were measured in quality adjusted life years and wellbeing adjusted life years. We examined subgroup based on deprivation, conduct scores and parental depression. Results Microsimulation modelling estimated small gains in lifetime outcomes including reduced conduct disorder in adolescence and depression in adulthood. Estimates indicate IY-TCM could be cost-effective with a large amount of uncertainty (Net monetary benefit (NMB)=£21, Estimated CI = -£195, £240). IY-TCM was estimated to be more cost-effective for those with high deprivation (NMB = £231, Estimation CI - -£99, £231) and high conduct problem scores (NMB=£315, Estimated CI = £45, £483). Total net social benefit for a typical year size group was estimated to be £111m. Conclusions IY-TCM could be cost-effective compared to no intervention with a large estimated social benefit supporting wider implementation of IY-TCM, but results indicate a large amount of uncertainty. Greater benefits and higher certainty of cost-effectiveness for children with conduct problems and those living in a deprived area suggest IY-TCM has the potential to reduce mental health inequalities and may be more cost-effective for schools with higher deprivation and/or a high prevalence of conduct problems. Key messages • The Incredible Years Teacher Classroom Management intervention for mental health in primary schools could be considered cost-effective but there is a large amount of uncertainty. • Greater benefits for children with conduct problems and those living in a deprived area indicates the intervention has the potential to reduce mental health inequalities.