Explaining mental health inequalities in Northern Sweden: a decomposition analysis

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ABSTRACT

Background: There has been a substantial increase of income inequalities in Sweden over the last 20 years, which also could be reflected in health inequalities, including mental health inequalities. Despite the growing body of literature focusing on health inequalities in Sweden, income-related inequalities in mental health have received little attention. Particularly scarce are research from Northern Sweden and examinations of the social determinants of health inequalities.

Objectives: The present study seeks to provide evidence regarding inequalities in mental health in Northern Sweden. The specific aims were to (1) quantify the income-related inequality in mental health in Northern Sweden, and (2) determine the contribution of social determinants to the inequality.

Methods: The study population comprised 25,646 participants of the 2014 Health on Equal Terms survey in the four northernmost counties of Sweden, aged 16 to 84 years old. Income-related inequalities in mental health were quantified by the concentration index and further decomposed by applying Wagstaff-type decomposition analysis.

Results: The overall concentration index of mental health in Northern Sweden was

−0.15 (95% CI: −0.17 to −0.13), indicating income inequalities in mental health disfavoring the less affluent population. The decomposition analysis results revealed that socio-economic conditions, including employment status (31%), income (22.6%), and cash margin (14%), made the largest contribution to the pro-rich inequalities in mental health. The second-largest contribution came from demographic factors, mainly age (11.3%) and gender (6%). Psychosocial factors were of smaller importance, with perceived discrimination (8%) and emotional support (3.4%) making moderate contributions to the health inequalities. Conclusions: The present study demonstrates substantial income-related mental health inequalities in Northern Sweden, and provides insights into their underpinnings. These findings suggest that addressing the root causes is essential for promoting mental health equity in this region.

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Most cited references 37

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The development of instruments to measure the work disability assessment behaviour of insurance physicians

Romy Steenbeek, Antonius JM Schellart, Henny PG Mulders … (2011)

Background Variation in assessments is a universal given, and work disability assessments by insurance physicians are no exception. Little is known about the considerations and views of insurance physicians that may partly explain such variation. On the basis of the Attitude - Social norm - self Efficacy (ASE) model, we have developed measurement instruments for assessment behaviour and its determinants. Methods Based on theory and interviews with insurance physicians the questionnaire included blocks of items concerning background variables, intentions, attitudes, social norms, self-efficacy, knowledge, barriers and behaviour of the insurance physicians in relation to work disability assessment issues. The responses of 231 insurance physicians were suitable for further analysis. Factor analysis and reliability analysis were used to form scale variables and homogeneity analysis was used to form dimension variables. Thus, we included 169 of the 177 original items. Results Factor analysis and reliability analysis yielded 29 scales with sufficient reliability. Homogeneity analysis yielded 19 dimensions. Scales and dimensions fitted with the concepts of the ASE model. We slightly modified the ASE model by dividing behaviour into two blocks: behaviour that reflects the assessment process and behaviour that reflects assessment behaviour. The picture that emerged from the descriptive results was of a group of physicians who were motivated in their job and positive about the Dutch social security system in general. However, only half of them had a positive opinion about the Dutch Work and Income (Capacity for Work) Act (WIA). They also reported serious barriers, the most common of which was work pressure. Finally, 73% of the insurance physicians described the majority of their cases as 'difficult'. Conclusions The scales and dimensions developed appear to be valid and offer a promising basis for future research. The results suggest that the underlying ASE model, in modified form, is suitable for describing the assessment behaviour of insurance physicians and the determinants of this behaviour. The next step in this line of research should be to validate the model using structural equation modelling. Finally, the predictive value should be tested in relation to outcome measurements of work disability assessments.

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Status of implementation of Framework Convention on Tobacco Control (FCTC) in Ghana: a qualitative study

Ellis Owusu-Dabo, Ann McNeill, Sarah Lewis … (2010)

Background The Framework Convention on Tobacco Control (FCTC), a World Health Organization treaty, has now been ratified by over 165 countries. However there are concerns that implementing the Articles of the treaty may prove difficult, particularly in the developing world. In this study we have used qualitative methods to explore the extent to which the FCTC has been implemented in Ghana, a developing country that was 39th to ratify the FCTC, and identify barriers to effective FCTC implementation in low income countries. Methods Semi-structured interviews with 20 members of the national steering committee for tobacco control in Ghana, the official multi-disciplinary team with responsibility for tobacco control advocacy and policy formulation, were conducted. The Framework method for analysis and NVivo software were used to identify key issues relating to the awareness of the FCTC and the key challenges and achievements in Ghana to date. Results Interviewees had good knowledge of the content of the FCTC, and reported that although Ghana had no explicitly written policy on tobacco control, the Ministry of Health had issued several tobacco control directives before and since ratification. A national tobacco control bill has been drafted but has not been implemented. Challenges identified included the absence of a legal framework for implementing the FCTC, and a lack of adequate resources and prioritisation of tobacco control efforts, leading to slow implementation of the treaty. Conclusion Whilst Ghana has ratified the FCTC, there is an urgent need for action to pass a national tobacco control bill into law to enable it to implement the treaty, sustain tobacco control efforts and prevent Ghana's further involvement in the global tobacco epidemic.

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On correcting the concentration index for binary variables.

Ulf-G Gerdtham, Gustav Kjellsson (2013)

This article discusses measurement of socioeconomic inequalities in the prevalence of a health condition, in response to the recent exchange between Guido Erreygers and Adam Wagstaff, in which they discuss the merits of their own corrections to the frequently used concentration index. We first reconcile their debate and discuss the value judgments implicit in their indices. Next, we provide a formal definition of the previously undefined value judgment in Wagstaff's correction. Finally, we show empirically that the choice of index matters, as illustrated by comparisons between countries using data from the European Survey of Health, Ageing and Retirement. Copyright © 2012 Elsevier B.V. All rights reserved.

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Author and article information

Journal

Journal ID (nlm-ta): Glob Health Action

Journal ID (iso-abbrev): Glob Health Action

Journal ID (archive): ZGHA

Journal ID (publisher-id): zgha20

Title: Global Health Action

Publisher: Taylor & Francis

ISSN (Print): 1654-9716

ISSN (Electronic): 1654-9880

Publication date Collection: 2017

Publication date (Electronic): 31 May 2017

Volume: 10

Issue: 1

Electronic Location Identifier: 1305814

Affiliations

[ ^a ]Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University , Umeå, Sweden

Author notes

CONTACT Nada Amroussia naam0012@ 123456umu.se Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University , 901 85 Umeå, Sweden

Article

Publisher ID: 1305814

DOI: 10.1080/16549716.2017.1305814

PMC ID: 5496092

PubMed ID: 28562191

SO-VID: da9d7b2d-41a4-4a90-a416-b521e2c596f9

License:

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 use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 28 October 2016

Date accepted : 3 March 2017

Page count

Figures: 1, Tables: 2, References: 53, Pages: 11

Funding

Funded by: Forte- Swedish Research Council for Health, Working Life and Welfare

Award ID: 2014-2725

Award ID: 2014-0451

This work was funded by Forte – Swedish Research Council for Health, Working Life and Welfare [grant nos. 2014-2725, 2014-0451].

Explaining mental health inequalities in Northern Sweden: a decomposition analysis

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Emerald: Healthier Lives

Most cited references 37

The development of instruments to measure the work disability assessment behaviour of insurance physicians

Status of implementation of Framework Convention on Tobacco Control (FCTC) in Ghana: a qualitative study

On correcting the concentration index for binary variables.

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