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      Reductions in the United Kingdom's Government Housing Benefit and Symptoms of Depression in Low-Income Households

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          Abstract

          Housing security is an important determinant of mental ill health. We used a quasinatural experiment to evaluate this association, comparing the prevalence of mental ill health in the United Kingdom before and after the government's April 2011 reduction in financial support for low-income persons who rent private-sector housing (mean reduction of approximately £1,220 ($2,315) per year). Data came from the United Kingdom's Annual Population Survey, a repeated quarterly cross-sectional survey. We focused our analysis on renters in the private sector, disaggregating data between an intervention group receiving the government's Housing Benefit ( n = 36,859) and a control group not receiving the Housing Benefit ( n = 142,205). The main outcome was a binary measure of self-reported mental health problems. After controlling for preexisting time trends, we observed that between April 2011 and March 2013, the prevalence of depressive symptoms among private renters receiving the Housing Benefit increased by 1.8 percentage points (95% confidence interval: 1.0, 2.7) compared with those not receiving the Housing Benefit. Our models estimated that approximately 26,000 (95% confidence interval: 14,000, 38,000) people newly experienced depressive symptoms in association with the cuts to the Housing Benefit. We conclude that reducing housing support to low-income persons in the private rental sector increased the prevalence of depressive symptoms in the United Kingdom.

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          Gender differences in depression in 23 European countries. Cross-national variation in the gender gap in depression.

          One of the most consistent findings in the social epidemiology of mental health is the gender gap in depression. Depression is approximately twice as prevalent among women as it is among men. However, the absence of comparable data hampers cross-national comparisons of the prevalence of depression in general populations. Using information about the frequency and severity of depressive symptoms from the third wave of the European Social Survey (ESS-3), we are able to fill the gap the absence of comparable data leaves. In the ESS-3, depression is measured with an eight-item version of the Center for Epidemiological Studies-Depression Scale. In the current study, we examine depression among men and women aged 18-75 in 23 European countries. Our results indicate that women report higher levels of depression than men do in all countries, but there is significant cross-national variation in this gender gap. Gender differences in depression are largest in some of the Eastern and Southern European countries and smallest in Ireland, Slovakia and some Nordic countries. Hierarchical linear models show that socioeconomic as well as family-related factors moderate the relationship between gender and depression. Lower risk of depression is associated in both genders with marriage and cohabiting with a partner as well as with having a generally good socioeconomic position. In a majority of countries, socioeconomic factors have the strongest association with depression in both men and women. This research contributes new findings, expanding the small existing body of literature that presents highly comparable data on the prevalence of depression in women and men in Europe. Copyright 2010 Elsevier Ltd. All rights reserved.
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            Natural Experiments in the Social Sciences

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              Natural experiments: an underused tool for public health?

              Policymakers and public health researchers alike have demanded better evidence of the effects of interventions on health inequalities. These calls have been repeated most recently in the UK in the final Wanless report, which spoke of the "almost complete lack of an evidence base on the cost-effectiveness of public health interventions", and pointed more generally to the limited evidence base for public health policy and practice. Wanless and others have suggested that the gaps may be partially filled by exploiting the opportunities offered by "natural experiments", such as changes in employment opportunities, housing provision, or cigarette pricing. Natural experiments have an important contributions to make within the health inequalities agenda. First, they can play an important role in investigating the determinants of health inequalities. Second, they can assist in the identification of effective interventions, an area where it is widely acknowledged that the evidence-base is currently sparsely populated. This paper discusses some of the benefits and limitations of using this type of evidence, drawing on two ongoing quasi-experimental studies as examples.

                Author and article information

                Journal
                Am J Epidemiol
                Am. J. Epidemiol
                aje
                amjepid
                American Journal of Epidemiology
                Oxford University Press
                0002-9262
                1476-6256
                15 September 2016
                08 September 2016
                08 September 2016
                : 184
                : 6
                : 421-429
                Author notes
                [* ]Correspondence to Dr. Aaron Reeves, Department of Sociology, Social Sciences Division, University of Oxford, Manor Road Building, Manor Road, Oxford OX1 3UQ, United Kingdom (e-mail: a.reeves@ 123456lse.ac.uk ).

                Abbreviations: APS, Annual Population Survey; CI, confidence interval; HB, Housing Benefit; LHA, Local Housing Allowance.

                Article
                kww055
                10.1093/aje/kww055
                5023793
                27613659
                1b5a4843-0f42-4257-8df7-c4e2b5f4c85a
                © The Author 2016. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 September 2015
                : 1 February 2016
                Funding
                Funded by: Wellcome Trust Investigator Award;
                Funded by: European Research Council;
                Award ID: 313590-HRES
                Categories
                Original Contributions
                Depression Symptoms
                Editor's choice

                Public health
                depression,housing,mental health,natural experiment
                Public health
                depression, housing, mental health, natural experiment

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