Probability Sample Survey Research Articles

Primary care experiences of adults reporting learning disability: a probability sample survey.

Background Adults with learning disability face multiple adversities, but evidence on their needs and primary care experiences is limited. Aim To compare the characteristics and primary care experiences of adults reporting learning disability with those who did not. Design and setting An analysis of the 2022 General Practice Patient Survey, a national probability sample survey conducted in 2022 with people registered with NHS primary care in England. Method This analysis reports descriptive profiles, weighted and with 95% confidence intervals. Logistic regression models adjusting for gender, age, ethnicity, and area-level deprivation compared experiences of adults reporting learning disability with those who did not. Results Survey participants comprised 623,157 people aged 16 or older, including 6,711 reporting learning disability. Adults reporting learning disability were more likely to be male, younger, of mixed or multiple ethnicities, and live in more deprived areas. All chronic conditions included in the survey were more common in adults reporting learning disability, especially reported sensory, neurodevelopmental, neurological, and mental health conditions. Adults reporting learning disability were twice as likely to have a preferred GP, and less likely to find their practice's website easy to navigate. They were also less likely to have confidence and trust in their healthcare professional, or feel their needs were met. Conclusion Adults reporting a learning disability had a higher likelihood of chronic health conditions. Their reported experiences of primary care indicate that despite recent initiatives to improve services offered, further adaptations to the consistency and ease of access to primary care is needed.

Characteristics and primary care experiences of people who self-report as autistic: a probability sample survey of adults registered with primary care services in England

ObjectivesLittle is known about adults who self-report as autistic. This study aimed to profile the demographic characteristics, long-term health conditions and primary care experiences of adults who self-report as autistic...

Indirect victims of violence: Mental health and the close relatives of serious assault victims in England

An extensive body of evidence shows the impact of being the direct victim of a serious assault. However, much less is known about the impact on the family and close relatives of victims, who may be considered indirect victims. Based on analyses of the 2014 Adult Psychiatric Morbidity Survey, a face-to-face, cross-sectional probability-sample survey of 7519 adults aged 16 and over in England, this article estimates what proportion of the population was closely related to a victim of serious assault, and whether this experience was associated with a higher prevalence of feeling unsafe, depression and anxiety disorder, post-traumatic stress, self-harm, and suicidality. Descriptive and multivariable regression analyses were conducted, adjusting for complex survey design and potentially confounding factors. Results show that one in twenty adults (4.5%, n = 345) was closely related to a victim of serious assault (95% confidence interval (CI):4.0–5.2%). Close adult relatives of assault victims were more likely than the rest of the population to have been direct victims of violence and abuse themselves, to have experienced multiple other adversities, and to live in more deprived neighbourhoods. However, even when controlling for these experiences, relatives of victims had adjusted odds of feeling unsafe in the neighbourhood where they lived 2.36 times higher than the rest of the population (CI:1.26–4.44), and their odds of having a depressive or anxiety disorder were 1.37 times higher (0.99–1.90). These analyses indicate that relatives in England may already be vulnerable, with potential to also be further affected by the experiences of family members. To more fully account for the effects of violence in society, research with indirect victims of serious violence in the context of their own experiences of direct victimization and wider adversities is required. This could be factored into a broader remit for victim support services which includes support for victims’ families.

Violence against older people and associations with mental health: A national probability sample survey of the general population in England

BackgroundOfficial estimates of violence prevalence in England exclude older people. There are few studies of elder abuse and these excluded violence from acquaintances and strangers and lack comparability with younger adults. ObjectivesTo estimate prevalence of past-year violence victimisation in older people, identify factors associated with violence in older age, quantify the extent to which experience of violence in older people was associated with common mental disorder (CMD). Study design/methodsAnalysis of a 2014 general population probability sample survey of 2570 adults aged 60+ and 4484 16–59 year olds. Modified version of the Conflict Tactics Scale measured domestic violence and List of Threatening Experiences captured bullying and serious assault. CMD were assessed using the revised Clinical Interview Schedule. Associations were examined using regression models adjusted for childhood victimisation and other adversities. Results2.0 % (n = 52,CI:1.4–2.6) of older people experienced violence in the past year, with intimate partner violence the most prevalent form. Older people of non-white ethnicity, those who were socially isolated or lonely, and the formerly married were more likely to experience violence. Violence was associated with CMD in older people (adjusted odds ratio 2.2, CI:1.0–4.8), controlling for impairments, adversities and other factors. ConclusionViolence, especially from an intimate partner, is evident in later life and strongly associated with poor mental health. Better instruments for the identification of violence and abuse in older people in research and safe enquiry in practice settings are needed, with recognition of and attention to ethnic and other inequalities among older people in exposure.

Research Note: Cybercrime victimisation among older adults: a probability sample survey in England and Wales

Research Note: Cybercrime victimisation among older adults: a probability sample survey in England and Wales

Prevalence and nature of workplace bullying and harassment and associations with mental health conditions in England: a cross-sectional probability sample survey

BackgroundEvidence on workplace bullying and harassment (WBH) in the UK has not used probability-sample surveys with robust mental health assessments. This study aimed to profile the prevalence and nature of WBH in England, identify inequalities in exposure, and quantify adjusted associations with mental health.MethodsData were from the 2014 Adult Psychiatric Morbidity Survey, a cross-sectional probability-sample survey of the household population in England. Criteria for inclusion in the secondary analysis were being aged 16–70 years and in paid work in the past month (n = 3838). Common mental disorders (CMDs) were assessed using the Clinical Interview Schedule-Revised and mental wellbeing using the Warwick-Edinburgh Mental Wellbeing Scale. Analyses were weighted. We examined associations between past-year WBH and current CMD using multivariable regression modelling, adjusting for sociodemographic factors. Interaction terms tested for gender differences in associations. The study received ethical approval (ETH21220–299).ResultsOne in ten employees (10.6%, n = 444/3838) reported past-year experience of WBH, with rates higher in women (12.2%, n = 284/2189), those of mixed, multiple, and other ethnicity (21.0%, n = 15/92), and people in debt (15.2%, n = 50/281) or living in cold homes (14.6%, n = 42/234). Most commonly identified perpetrators of WBH were line managers (53.6%, n = 244/444) or colleagues (42.8%, n = 194/444). Excessive criticism (49.3%, n = 212/444), verbal abuse (42.6%, n = 187/444), and humiliation (31.4%, n = 142/444) were the most common types. WBH was associated with all indicators of poor mental health, including CMD (adjusted odds ratio [aOR] 2.65, 95% CI 2.02–3.49), and 11 of 14 mental wellbeing indicators, including lower levels of confidence (aOR 0.57, 0.46–0.72) and closeness to others (aOR 0.57, 0.46–0.72). Patterns of association between WBH and mental health were similar in men and women.ConclusionsThese findings reinforce a need for more cohesive UK legislation against WBH; guidance on recognition of bullying behaviours for employees, managers, and human resources, focusing on prevention and early intervention, and increased awareness of the impact of WBH on mental health among health service practitioners. Limitations include reliance on cross-sectional data collected before pandemic-related and other changes in workplace practices. Longitudinal data are needed to improve evidence on causality and the longevity of mental health impacts.

Mental Health–Related Outpatient Visits Among Adolescents and Young Adults, 2006-2019

Concerns over the mental health of young people have been increasing over the past decade, especially with the rise in mental health burden seen during the COVID-19 pandemic. Examining trends in mental health-related outpatient visits provides critical information to elucidate contributing factors, identify vulnerable populations, and inform strategies to address the mental health crisis. To examine characteristics and trends in mental health-related outpatient visits and psychotropic medication use among US adolescents and young adults. A retrospective cross-sectional analysis of nationally representative data from the National Ambulatory Medical Care Survey, an annual probability sample survey, was conducted from January 2006 to December 2019. Participants included adolescents (age 12-17 years) and young adults (age 18-24 years) with office-based outpatient visits in the US. Data were analyzed from March 1, 2023, to September 15, 2023. Mental health-related outpatient visits were identified based on established sets of diagnostic codes for psychiatric disorders. Temporal trends in the annual proportion of mental health-related outpatient visits were assessed, including visits associated with use of psychotropic medications. Analyses were stratified by age and sex. From 2006 to 2019, there were an estimated 1.1 billion outpatient visits by adolescents and young adults, of which 145.0 million (13.1%) were associated with a mental health condition (mean [SD] age, 18.4 [3.5] years; 74.0 million females [51.0%]). Mental health-related diagnoses were more prevalent among visits by male (16.8%) compared with female (10.9%) patients (P < .001). This difference was most pronounced among young adults, with 20.1% of visits associated with a psychiatric diagnosis among males vs 10.1% among females (P < .001). The proportion of mental health-related visits nearly doubled, from 8.9% in 2006 to 16.9% in 2019 (P < .001). Among all outpatient visits, 17.2% were associated with the prescription of at least 1 psychotropic medication, with significant increases from 12.8% to 22.4% by 2019 (P < .001). In this cross-sectional study, there were substantial increases in mental health-related outpatient visits and use of psychotropic medications, with greater overall burden among male patients. These findings provide a baseline for understanding post-pandemic shifts and suggest that current treatment and prevention strategies will need to address preexisting psychiatric needs in addition to the effects of the COVID-19 pandemic.

Mental health trajectories in adolescents during Covid‐19: ‘Are we all in this together’?

AbstractThis study used a longitudinal probability sample survey, Understanding Society: Covid‐19, to examine trajectories in adolescents' mental health, via the Strengths and Difficulties Questionnaire, at three timepoints during Covid‐19 with a particular emphasis on vulnerable groups (i.e., young carers, adolescent girls, BAME—Black, Asian and minority ethnic, and adolescents in financially strained households). Generally, self‐reports of emotional and total difficulties remained stable during the pandemic, although adolescents who had limited social support were far more likely to report severe emotional and total difficulties. Young people with pre‐existing mental and physical health conditions appeared more resilient, whereas vulnerable young people were hit the hardest during the pandemic. Compared to their less vulnerable peers, young carers, adolescent girls, Black or mixed‐race young people and adolescents in financially strained households were more likely to report reduced mental health during the pandemic. It is hoped that the findings will contribute to debates about the pandemic unveiling existing mental health inequalities in society, and to public policy in an era of perma‐crises as we currently face a cost of living crisis where public services are under enormous strain to reach those who need them most.

Factors and framing effects in support for net zero policies in the United Kingdom.

Achieving ambitious carbon reduction targets requires transformative change to society, with behaviour change playing an important role. Climate change mitigation ('net zero') policies are needed to accelerate and support such behaviour change. This study examined factors and framing effects in public support for net zero policies in the United Kingdom (UK), making use of a large probability sample (ntotal = 5,665) survey conducted in August 2021. It found that net zero policies are widely supported, with only taxes on red meat and dairy products being supported by less than half of the UK public. Climate worry and perceived fairness were the strongest and most consistent predictors of policy support for net zero policies. The results further suggest that support for net zero policies can be increased by emphasising the co-benefits of the policies, in particular where they are beneficial for health. However, the framing effects were very small. In contrast, public support for net zero policies is lower when potential lifestyle and financial costs are mentioned. This suggests that perceived fairness of the distribution of costs and lifestyle implications of policies are crucial for building and maintaining support for net zero.

Prevalence and nature of workplace bullying and harassment and associations with mental health conditions in England: a cross-sectional probability sample survey

BackgroundEvidence on workplace bullying and harassment (WBH) in the UK has not used probability-sample surveys with robust mental health assessments. This study aimed to profile the prevalence and nature of WBH in England, identify inequalities in WBH exposure, and quantify adjusted associations with mental health. MethodsData were from the 2014 Adult Psychiatric Morbidity Survey, a cross-sectional probability-sample survey of the household population in England, interviewed with verbal informed consent. Criteria for inclusion in the secondary analysis were being aged 16–70 years and in paid work in the past month (n=3838). Common mental disorders were assessed using the Clinical Interview Schedule-Revised and mental wellbeing using the Warwick-Edinburgh Mental Wellbeing Scale. Analyses were weighted. We examined associations between past-year WBH and current common mental disorders using multivariable regression modelling, adjusting for demographic and socioeconomic factors. Interaction terms tested for gender differences in associations. The study received ethics approval (ETH21220–299). FindingsOne in ten employees (10·6% (weighted), n=444/3838) reported past-year experience of WBH, with rates higher in women (12·2%, n=284/2189); those of mixed, multiple, and other ethnicity (21·0%, n=15/92); and people in debt (15·2%, n=50/281) or living in cold homes (14·6%, n=42/234). Most commonly identified perpetrators of WBH were line managers (53·6%, n=244/444) or colleagues (42·8%, n=194/444). Excessive criticism (49·3%, n=212/444), verbal abuse (42·6%, n=187/444), and humiliation (31·4%, n=142/444) were the most common types. WBH was associated with all adverse mental health indicators, including common mental disorders (adjusted odds ratio [aOR] 2·65, 95% CI 2·02–3·49), and 11 of 14 mental wellbeing indicators, including lower levels of confidence (aOR 0·57, 0·46–0·72) and of closeness to others (aOR 0·57, 0·46–0·72). Patterns of association between WBH and mental health were similar in men and women. InterpretationThese findings reinforce a need for more cohesive UK legislation at the national level; guidance on recognition of bullying behaviours for employees, managers, and human resources at the organisational level, focusing on prevention and early intervention, and increased awareness of the impact of WBH on mental health among health-service practitioners. Study limitations include reliance on cross-sectional data collected before pandemic-related and other major changes in workplace practices. Longitudinal data are needed to improve evidence on causality and the longevity of mental health impacts. FundingUK Prevention Research Partnership.

Vulnerable young people and post‐16 educational aspirations during Covid‐19

AbstractThis study used a longitudinal, probability sample survey, Understanding Society Covid‐19, to examine young people's post‐16 educational aspirations at the height of the Covid‐19 pandemic, with a particular emphasis on four vulnerable groups (namely, young carers; Black, Asian and Minority Ethnic young people; young people with long‐term illness and disability; and people with internalising and externalising behavioural difficulties). The findings from this study showed young carers and young people with health conditions to be less likely to choose A levels, despite reporting roughly equal levels of school engagement and school‐related support. The Covid‐19 pandemic has laid bare the obstacles often faced by young carers and young people with pre‐existing health conditions and behaviour difficulties. It is hoped that the findings will contribute to debates about social care and education and will have implications for public policy and action, especially as public services are under enormous strain and are less likely to reach those who need them most.

National Trends in Mental Health–Related Emergency Department Visits Among Youth, 2011-2020

There has been increasing concern about the burden of mental health problems among youth, especially since the COVID-19 pandemic. Trends in mental health-related emergency department (ED) visits are an important indicator of unmet outpatient mental health needs. To estimate annual trends in mental health-related ED visits among US children, adolescents, and young adults between 2011 and 2020. Data from 2011 to 2020 in the National Hospital Ambulatory Medical Care Survey, an annual cross-sectional national probability sample survey of EDs, was used to examine mental health-related visits for youths aged 6 to 24 years (unweighted = 49 515). Mental health-related ED visits included visits associated with psychiatric or substance use disorders and were identified by International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM; 2011-2015) and ICD-10-CM (2016-2020) discharge diagnosis codes or by reason-for-visit (RFV) codes. We estimated the annual proportion of mental health-related pediatric ED visits from 2011 to 2020. Subgroup analyses were performed by demographics and broad psychiatric diagnoses. Multivariable-adjusted logistic regression analyses estimated factors independently associated with mental health-related ED visits controlling for period effects. From 2011 to 2020, the weighted number of pediatric mental health-related visits increased from 4.8 million (7.7% of all pediatric ED visits) to 7.5 million (13.1% of all ED visits) with an average annual percent change of 8.0% (95% CI, 6.1%-10.1%; P < .001). Significant linearly increasing trends were seen among children, adolescents, and young adults, with the greatest increase among adolescents and across sex and race and ethnicity. While all types of mental health-related visits significantly increased, suicide-related visits demonstrated the greatest increase from 0.9% to 4.2% of all pediatric ED visits (average annual percent change, 23.1% [95% CI, 19.0%-27.5%]; P < .001). Over the last 10 years, the proportion of pediatric ED visits for mental health reasons has approximately doubled, including a 5-fold increase in suicide-related visits. These findings underscore an urgent need to improve crisis and emergency mental health service capacity for young people, especially for children experiencing suicidal symptoms.

Handling Missing Values in Surveys With Complex Study Design: A Simulation Study

Abstract The inverse probability weighting (IPW) method is commonly used to deal with missing-at-random outcome (response) data collected by surveys with complex sampling designs. However, IPW methods generally assume that fully observed predictor variables are available for all sampled units, and it is unclear how to appropriately implement these methods when one or more independent variables are subject to missing values. Multiple imputation (MI) methods are well suited for a variety of missingness patterns but are not as easily adapted to complex sampling designs. In this case study, we consider the National Survey of Morbidity and Risk Factors (EMENO), a multistage probability sample survey. To understand the strengths and limitations of using either missing data treatment method for the EMENO, we present an extensive simulation study modeled on the EMENO health survey, with the target analysis being the estimation of population prevalence of hypertension as well as the association between hypertension and income. Both variables are subject to missingness. We test a variety of IPW and MI methods in simulation and on empirical data from the survey, assessing robustness by varying missingness mechanisms, proportions of missingness, and strengths of fitted response propensity models.

Combining quota and probability sub-sampling within enumeration areas to produce more reliable estimates

Traditional surveys face increasing challenges due to rising non-response rates and the diminishing resources available to survey organizations. A recently proposed solution involves the combination of non-probability sample surveys (often cheaper) with probability sample surveys (more expensive), using the latter as a reference to weight the former. Considering a special case in which a single survey was designed and carried out by simultaneously using the two sampling approaches within a single field operation, this paper compared the use of quasi-randomization and sample matching methods to assign weights to the non-probability part of the sample. The quasi-randomization method provided the closest point estimates and smaller standard errors (on average) when compared to the benchmark estimates.

Longitudinal development of depression and anxiety during COVID-19 pandemic in Germany: Findings from a population-based probability sample survey.

The stress response to the COVID-19 pandemic might differ between early and later stages. Longitudinal data on the development of population mental health during COVID-19 pandemic is scarce. We have investigated mental health trajectories and predictors for change in a probability sample of the general population in Germany at the beginning and after 6 months of the pandemic. We conducted a longitudinal survey in a population-based probability sample of German adults. The current study analyzed data from a first assessment in May 2020 (T1; N = 1,412) and a second in November 2020 (T2; N = 743). Mental health was assessed in terms of anxiety and depression using the Patient Health Questionnaire-4 (PHQ-4). Mental health outcomes at T1 were compared with PHQ-4 norm data. Trajectories over time were investigated based on outcome classifications of PHQ-4 scores. Predictors of mental health outcomes and change were identified using multiple regression analysis. In spring 2020, participants showed significantly higher PHQ-4 scores as compared to the norm data, however, overall anxiety and depression remained low also 6 months later. 6.6% of respondents showed a mental health deterioration in autumn 2020, entering subclinical and clinical ranges, outweighing the proportion of people with improved outcomes. Sociodemographic variables associated with mental distress at T1 were mainly not predictive for change at T2. Even under prolonged pandemic-related stress, mental health remained mainly stable in the general population. Further development of the considerable subgroup experiencing deterioration of depression and anxiety should be monitored, in order to tailor prevention and intervention efforts.

Intimate partner violence, suicidality, and self-harm: a probability sample survey of the general population in England

Intimate partner violence (IPV) is a recognised risk factor for psychiatric disorders. There is little current evidence on IPV and self-harm and suicidality, and we therefore aimed to investigate the associations between experience of lifetime and past-year IPV with suicidal thoughts, suicide attempt, and self-harm in the past year. We analysed the 2014 Adult Psychiatric Morbidity Survey, a cross-sectional survey of 7058 adults (aged ≥16 years) in England, which used a multistage random probability sampling design and involved face-to-face interviews. Participants were asked about experience of physical violence and sexual, economic, and emotional abuse from a current or former partner, and about suicidal thoughts, suicide attempts, and self-harm. Other adversities were recorded through an adapted version of the List of Threatening Experiences. Multivariable logistic regression models quantified associations between different indicators of lifetime and past-year IPV, with past-year non-suicidal self-harm, suicidal thoughts, and suicide attempts. All analyses were weighted. Using weighted percentages, we found that a fifth (21·4%) of 7058 adults reported lifetime experience of IPV, and that 27·2% of women and 15·3% of men had experienced IPV. Among women, 19·6% had ever experienced emotional IPV, 18·7% physical IPV, 8·5% economic IPV, and 3·7% sexual IPV, which was higher than in men (8·6%, 9·3%, 3·6%, and 0·3%, respectively). Findings for ethnicity were unclear. Lifetime prevalence of IPV was higher in those living in rented accommodation or deprived neighbourhoods. Among people who had attempted suicide in the past year, 49·7% had ever experienced IPV and 23·1% had experienced IPV in the past year (including 34·8% of women and 9·4% of men). After adjusting for demographics, socioeconomics, and lifetime experience of adversities, the odds ratio of a past-year suicide attempt were 2·82 (95% CI 1·54-5·17) times higher in those who have ever experienced IPV, compared with those who had not. Fully adjusted odds ratios for past-year self-harm (2·20, 95% CI 1·37-3·53) and suicidal thoughts (1·85, 1·39-2·46) were also raised in those who had ever experienced IPV. IPV is common in England, especially among women, and is strongly associated with self-harm and suicidality. People presenting to services in suicidal distress or after self-harm should be asked about IPV. Interventions designed to reduce the prevalence and duration of IPV might protect and improve the lives of people at risk of self-harm and suicide. UK Prevention Research Partnership.

The European Union Statistics on Income and Living Conditions after 15 Years

AbstractThis data brief describes the European Union Statistics on Income and Living Conditions (EU-SILC). Detailed data on income and taxes are collected, as well as information on material deprivation, labour, housing, childcare, health, access to and use of services, and education. Although primarily a social policy instrument that addresses the information needs of policymakers and is used for social monitoring at the European level, EU-SILC is also closely geared to the needs of researchers and provides an excellent database for evidence-based research on a wide variety of aspects of income, income poverty, material poverty, health, and well-being in Europe. EU-SILC is composed of national probability sample surveys and is conducted annually. The target population comprises private households. Observation units are households and all current household members. EU-SILC provides cross-sectional and longitudinal data. The data are composed of a fixed core module, and annually changing ad-hoc modules. Launched in 2003 and revised with effect from 2021, EU-SILC is currently implemented in all EU Member States and in 11 non-EU countries. During the revision process, many suggestions from the research community were incorporated.

Effect of lockdown on mental health in Australia: evidence from a natural experiment analysing a longitudinal probability sample survey

BackgroundMany studies have examined population mental health during the COVID-19 pandemic but have been unable to isolate the direct effect of lockdowns. The aim of this study was to examine changes in the mental health of Australians aged 15 years and older during the COVID-19 pandemic using a quasi-experimental design to disentangle the lockdown effect.MethodsWe analysed data from ten annual waves (2011–20) of the longitudinal Household, Income and Labour Dynamics in Australia (HILDA) Survey to identify changes in the mental health of respondents from the pre-COVID-19 period (2011–19) to the COVID-19 period (2020). Difference-in-differences models were used to compare these changes between respondents in the state of Victoria who were exposed to lockdown at the time of the 2020 interviews (treatment group) and respondents living elsewhere in Australia (who were living relatively free of restrictions; control group). The models included state, year (survey wave), and person-specific fixed effects. Mental health was assessed using the five-item Mental Health Inventory (MHI-5), which was included in the self-complete questionnaire administered during the survey.FindingsThe analysis sample comprised 151 583 observations obtained from 20 839 individuals from 2011 to 2020. The treatment group included 3568 individuals with a total of 37 578 observations (34 010 in the pre-COVID-19 and 3568 in the COVID-19 period), and the control group included 17 271 individuals with 114 005 observations (102 867 in the pre-COVID-19 and 11 138 in the COVID-19 period). Mean MHI-5 scores did not differ between the treatment group (72·9 points [95% CI 72·8–73·2]) and control group (73·2 points [73·1–73·3]) in the pre-COVID-19 period. In the COVID-19 period, decreased mean scores were seen in both the treatment group (69·6 points [69·0–70·2]) and control group (70·8 points [70·5–71·2]). Difference-in-differences estimation showed a small but statistically significant effect of lockdown on MHI-5 scores, with greater decline for residents of Victoria in 2020 than for those in the rest of Australia (difference –1·4 points [95% CI –1·7 to –1·2]). Stratified analyses showed that this lockdown effect was larger for females (−2·2 points [–2·6 to –1·7]) than for males (−0·6 [–0·8 to –0·5]), and even larger for women in couples with children younger than 15 years (−4·4 points [–5·0 to –3·8]), and for females who lived in flats or apartments (−4·1 points [–5·4 to –2·8]) or semi-detached houses, terraced houses, or townhouses (−4·8 points [–6·4 to –3·2]).InterpretationThe imposition of lockdowns was associated with a modest negative change in overall population mental health. The results suggest that the mental health effects of lockdowns differ by population subgroups and for some might have exaggerated existing inequalities in mental health. Although lockdowns have been an important public health tool in suppressing community transmission of COVID-19, more research is needed into the potential psychosocial impacts of such interventions to inform their future use.FundingUS National Institutes of Health.

Men Who Pay For Sex: Prevalence and Sexual Health.

Men who pay for sex (MPS) are a vulnerable bridging population for spreading sexually transmitted infections (STI). However, their prevalence and sexual health are unknown in Germany. We analyzed data from 2336 men aged 18-75 years resident in Germany who completed the German Health and Sexuality Survey (GeSiD), a populationbased probability sample survey undertaken 2018-2019, using face-to-face interviews (participation rate: 30.2%). 26.9% (95% confidence interval [24.7; 29.2]) of all men reported ever paying for sex. On average, MPS had M = 19.9 [16.8; 22.9] lifetime sexual partners, among them M = 7.3 [5.3; 9.4] paid partners. MPS described their paid sex predominantly as vaginal intercourse in domestic brothels. Regarding socio - demographic characteristics, MPS differed from men not paying for sex (MNPS) in terms of age, immigration status, and sex education. Compared to MNPS, MPS reported significantly more HIV/STI risk-taking, including multiple sex partners in the past year (OR adjusted for age, immigration status, sex education; AOR 3.55) and STI diagnosis in the past 5 years (AOR 1.96) as well as more prevention behaviors (e.g., condom use in the past year: AOR 3.13). The prevalence of MPS suggests physicians should address the topic with their patients to protect and improve the sexual health of MPS and their paid and unpaid partners.

Health insurance coverage and access to care in China

ObjectiveThe study examined the relationship between health insurance coverage and access to needed healthcare including preventive, primary, and tertiary care among Chinese adult population.Data and methodsData for this study came from the 2018 China Health and Retirement Longitudinal Study (CHARLS), a population-based probability sample survey. Key measures included insurance coverage (high-, moderate-, low- and no-insurance), access to care (physical examination, physician visit, office visit, inpatient care, and satisfaction with care), and personal sociodemographics. Multiple-factor generalized linear mixed model was applied to estimate the odds ratio (OR) and the 95% confidence interval (CI) of HI coverage for the four indicators of access to care, after controlling for individual characteristics and aggregation among different villages.ResultsThe majority of Chinese adults had some health insurance with only 3.15% uninsured. However, most had low-coverage insurance (64.82%), followed by moderate-coverage insurance (16.70%), and high-coverage insurance (15.33%). Health insurance was significantly and positively associated with access to needed healthcare (preventive, primary, and tertiary). There was also a significant gradient association between extent of insurance coverage and access to care.ConclusionNot only health insurance mattered in enhancing access to care but that there was a significant gradient association between extent of insurance coverage and access to care with higher coverage relating to better access.