Socioeconomic inequalities in mental health and wellbeing among UK students during the COVID-19 pandemic: Clarifying underlying mechanisms

Universities are seeing growing numbers of students with poor mental health and wellbeing. Given that lower socioeconomic status (SES) students typically have poorer mental health and wellbeing than their peers, this may be, in part, caused by an increase in the number of students attending university from lower SES backgrounds. However, less is known about how socioeconomic inequalities in mental health and wellbeing persist within university communities. Research investigating psychosocial factors that contribute to socioeconomic disparities in mental health and wellbeing suggests perceived control, inclusion, and perceived worth to be important underlying mechanisms. However, another strand of research suggests perceived competence may also play a mediating role in this relationship. Consequently, the present research seeks to examine fulfilment of perceived control, inclusion, perceived worth, and competence needs as potential mediators in the relationship between subjective SES and mental health and wellbeing in university students. Below, we report the results of a cross-sectional survey conducted among university students (n = 811) in the UK during a period of COVID-19 restrictions. In line with prior research, we found evidence of socioeconomic inequalities in mental health and wellbeing among students. Further, we found subjective SES predicted perceptions of control, inclusion, and competence. In turn, perceived control and competence predicted both positive and negative mental health and wellbeing, whilst inclusion predicted positive mental health and wellbeing only. Unexpectedly, we found no evidence that perceived worth acts as a mediator in this relationship, independently of perceived control, inclusion, and competence. As academic institutions continue to pursue policies to ‘widen participation’, they also have a responsibility to understand how socioeconomic inequalities in mental health and wellbeing are perpetuated within the university community. Research in this area marks a first step to improve socioeconomic equality within Higher Education

How, when, and why is social class linked to mental health and wellbeing? A systematic meta-review.

Meta-reviews synthesising research on social class and mental health and wellbeing are currently limited and focused on specific facets of social class (e.g., social capital) or mental health and wellbeing (e.g., mental health disorders), and none sought to identify mechanisms in this relationship. The present meta-review sought to (1) assess the overall relationship between social class and mental health and wellbeing, (2) determine the mechanisms that act in this relationship, and (3) evaluate the strength of evidence available. The protocol was prospectively registered on PROSPERO (CRD42021214731). We systematically searched twelve databases in September 2022 and identified 149 eligible reviews from 38,257 records screened. Quality of evidence was assessed with the JBI levels of evidence and risk of bias with the ROBIS tool. A large but low-quality evidence base points to class-based inequalities in mental health and wellbeing, with the strongest available evidence linking lower social positions to an increased risk of depression. In terms of different facets of stratification, the best available evidence suggests that deprivation (e.g., poverty), socioeconomic status, income, and subjective social status are consequential for individuals' mental health and wellbeing. However, high-quality evidence for the roles of education, occupation, other economic resources (e.g., wealth), and social capital is currently limited. Most reviews employed individual-level measures (e.g., income), as opposed to interpersonal- (e.g., social capital) or community-level (e.g., neighbourhood deprivation) measures. Considering mechanisms, we found some evidence for mediation via subjective social status, sense of control, and experiences of stress and trauma. There was also some evidence that higher socioeconomic status can provide a buffer for neighbourhood deprivation, lower social capital, and lower subjective social status. Future research employing experimental or quasi-experimental methods, and systematic reviews with a low risk of bias, are necessary to advance this area of research. [Abstract copyright: Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

A survey of prolapse practice in UK women’s health physiotherapists: what has changed in the last decade?

INTRODUCTION AND HYPOTHESIS: Prolapse is a common female problem, and conservative treatments such as pelvic floor muscle training (PFMT) are important options for women. Evidence supporting the effectiveness of PFMT for prolapse has grown over the last decade, and it was hypothesised that practice and practice guidelines would have developed in line with the evidence. To assess this, up-to-date information about the practice of physiotherapists working in women’s health regarding their treatment of prolapse was required. METHODS: An online survey sent to members of the Association of Chartered Physiotherapists in Women’s Health and the Chartered Physiotherapists Promoting Continence. Results were compared with those of an earlier survey undertaken in 2002. RESULTS: A 49 % response rate was achieved. The majority of respondents were senior physiotherapists (55 %) and had worked in women’s health for more than 10 years. Respondents were treating significantly more women with prolapse than a decade before: 36 % vs 14 % treated more than 50 women per year in 2002 and 2013 respectively (p < 0.001). Individualised PFMT (93 %), lifestyle advice (92 %) and biofeedback-assisted PFMT (83 %) were the most common treatment elements, with four being the average number of appointments. Forty-eight percent had changed their practice as a result of recent research; however, scepticism amongst medics, the referral of women directly for surgery, and constraints on resources were thought to be barriers to wider implementation of the evidence of PFMT for prolapse. CONCLUSIONS: There has been uptake of evidence-based prolapse practice by UK specialist physiotherapists in the last decade. Further research targeting the implementation of this evidence would be valuable in addressing potential barriers, and in supporting the need for physiotherapy in the treatment of prolapse

Social Class-Based Inequalities in Mental Health and Wellbeing: Broadening Conceptualisations, Examining Underlying Mechanisms, and Exploring the Higher Education Context

In this thesis, we aimed to develop our understanding of how social class-based inequalities in mental health and wellbeing operate in society. An extensive volume of literature has explored the relationship between specific aspects of social class, and particular dimensions of mental health and wellbeing. As a result, it is difficult to summarise and evaluate the overall relationship. Further, much less is known about why this relationship exists and how it plays out in historically “classed” environments, such as Higher Education (HE). Within HE, research suggests that working-class students and staff have profoundly different experiences compared to their middle-class peers, despite relative similarity in terms of income, education, and occupation. This raises broader questions around conceptualisations of social class, underlying mechanisms, and consequences for mental health and wellbeing that will be discussed in this thesis. First, we conducted a systematic meta-review to evaluate evidence suggesting a relationship between social class and mental health and wellbeing, and to identify potential mechanisms. A large but low-quality evidence base suggested higher social class results in better mental health and wellbeing, and further suggested psychosocial factors such as sense of control (i.e., autonomy) and social capital (i.e., inclusion) as mechanisms. Second, we explored the role of these psychosocial mechanisms within HE, and found significant indirect effects via autonomy, inclusion, and status in the relationship between social class and wellbeing. Finally, we explored the sociopolitical environment surrounding HE. We examined how policymakers might influence psychosocial mechanisms (i.e., control, inclusion, and status afforded by policymakers), and found indirect effects via inclusion and status. Taken together, this thesis suggests that we should employ a variety of measures, examine a variety of socioecological levels, and explore a variety of contexts to better map the relationship between social class and mental health and wellbeing