Ethnic inequalities in mental health and socioeconomic status among older women living with HIV: results from the PRIME Study.

OBJECTIVES: Women living with HIV in the UK are an ethnically diverse group with significant psychosocial challenges. Increasing numbers are reaching older age. We describe psychological and socioeconomic factors among women with HIV in England aged 45-60 and explore associations with ethnicity. METHODS: Analysis of cross-sectional data on 724 women recruited to the PRIME Study. Psychological symptoms were measured using the Patient Health Questionnaire 4 and social isolation with a modified Duke-UNC Functional Social Support Scale. RESULTS: Black African (BA) women were more likely than Black Caribbean or White British (WB) women to have a university education (48.3%, 27.0%, 25.7%, respectively, p<0.001), but were not more likely to be employed (68.4%, 61.4%, 65.2%, p=0.56) and were less likely to have enough money to meet their basic needs (56.4%, 63.0%, 82.9%, p<0.001). BA women were less likely to report being diagnosed with depression than WB women (adjusted odds ratio (aOR) 0.40, p<0.001) but more likely to report current psychological distress (aOR 3.34, p<0.05). CONCLUSIONS: We report high levels of poverty, psychological distress and social isolation in this ethnically diverse group of midlife women with HIV, especially among those who were BA. Despite being more likely to experience psychological distress, BA women were less likely to have been diagnosed with depression suggesting a possible inequity in access to mental health services. Holistic HIV care requires awareness of the psychosocial needs of older women living with HIV, which may be more pronounced in racially minoritised communities, and prompt referral for support including psychology, peer support and advice about benefits

Fichte and Hegel on Recognition

In this paper I provide an interpretation of Hegel’s account of ‘recognition’ (Anerkennung) in the 1802-3 System of Ethical Life as a critique of Fichte’s account of recognition in the 1796-7 Foundations of Natural Right. In the first three sections of the paper I argue that Fichte’s account of recognition in the domain of right is not concerned with recognition as a moral attitude. I then turn, in section four, to a discussion of Hegel’s critique and transformation of Fichte’s conception of recognition. Hegel’s transformation consists, I argue, in the claim that a comprehensive account of recognition in the domain of right must be concerned with recognition as a moral attitude

Republicanism and the political economy of democracy

Europe is experiencing rapidly accelerating poverty and social exclusion, following half a decade of financial crisis and austerity politics. The key problem behind Europe's malaise, in our view, is the economic disenfranchisement of large parts of its population in the winner-takes-all-society. This article proposes that we examine the contribution of republican political theory as a distinctive approach that provides us with the conceptual and normative resources to reclaim what we call the political economy of democracy, the constellation of political and economic institutions aimed at promoting broad economic sovereignty and individuals' capacities to govern their own lives. This article identifies three key ideas that together constitute a distinctively republican approach to political economy: (1) establish an economic floor; (2) impose an economic ceiling to counter excess economic inequality; and (3) democratize the governance and regulation of the main economic institutions

Classes of Intimate Partner Violence from Late Adolescence to Young Adulthood

Researchers do not agree on how intimate partner violence (IPV) emerges and changes from adolescence to young adulthood. This may be because change in these behaviors varies across individuals. The present study uses a longitudinal, person-centered approach to examine whether there are multiple classes or patterns of change in the perpetration of IPV during the transitional period from adolescence (age 18) to young adulthood (age 25) using data collected annually from a community sample of 484 participants. Latent class analysis was the analytic approach used. Results revealed three patterns for psychological IPV (Little-to-None, Minor/Increasing, and Extensive/Increasing) and two patterns for physical IPV (Little-to-None and Extensive). Patterns varied greatly in number of representatives, although they were more balanced in size for psychological than physical IPV. Variations in IPV behaviors were also revealed across classes, although as expected in a community sample, minor forms of IPV were more common than severe forms. In addition, classes differed in demographic and relationship status variables. These findings suggest that IPV may occur in multiple distinct patterns as opposed to one average pattern across a population. This suggests that interventions for IPV may need to be geared to differences in patterns to enhance their efficacy

Temporal Associations between Psychological and Physical Intimate Partner Violence: A Cross-Lag Analysis

The present study examined the relationship between psychological and physical forms of intimate partner violence (IPV) across four waves of data during the developmental period of young adulthood. The links from early psychological aggression to later physical aggression and from early physical aggression to later psychological aggression across waves were tested while controlling for their cross-time stabilities and concurrent associations. IPV data were collected annually from 434 young adult respondents involved in a romantic relationship at least once during the respective years from the ages of 22-25. On average, participants provided IPV data for three out of the four years covered by the study (M = 2.82; SD = 1.14). Results of a cross-lagged SEM model indicated significant cross-time stabilities as well as significant, positive concurrent associations for both forms of aggression. Most important to this study were the findings that, controlling for these stabilities and concurrent associations, early psychological aggression was a consistent positive predictor of later physical aggression across waves whereas the opposite direction from early physical aggression to later psychological aggression was either non-significant or significant and negative

Predicting Patterns of Intimate Partner Violence Perpetration from Late Adolescence to Young Adulthood

Saint-Eloi Cadely et al. (2017) found longitudinal patterns for the perpetration of both psychological and physical intimate partner violence (IPV), including actively and minimally aggressive patterns. The current study builds on these findings by examining four theory-derived variables (interparental aggression, social-information processing (SIP) biases, relationship insecurities (preoccupied and fearful), and discontinuity in relationship partner over time) as predictors of membership within these patterns using multinomial logistic regression. The analysis sample consisted of 484 participants who were romantically involved at least once during the 8 waves of data collection from the ages of 18-25. In predicting psychological IPV, more SIP biases, higher levels of a preoccupied insecurity, and less discontinuity in relationship partners over time differentiated the actively aggressive patterns from the minimally aggressive pattern. Additionally, two actively aggressive patterns of psychological IPV differed in terms of SIP biases and discontinuity in romantic partners. Specifically, more SIP biases and less discontinuity in romantic partnerships distinguished the extensively aggressive pattern from the pattern that mainly consisted of minor types of aggression. In predicting physical IPV, the aggressive pattern differed from the non-aggressive pattern in terms of more interparental aggression, more SIP biases and more relationship insecurities. The findings that developmental patterns of IPV can be predicted by social and psychological factors may aid both developmental theory and practice

Factors associated with use of psychiatric intensive care and seclusion in adult inpatient mental health services

Aims.Within acute psychiatric inpatient services, patients exhibiting severely disturbed behaviour can be transferred to a psychiatric intensive care unit (PICU) and/or secluded in order to manage the risks posed to the patient and others. However, whether specific patient groups are more likely to be subjected to these coercive measures is unclear. Using robust methodological and statistical techniques, we aimed to determine the demographic, clinical and behavioural predictors of both PICU and seclusion.Methods.Data were extracted from an anonymised database comprising the electronic medical records of patients within a large South London mental health trust. Two cohorts were derived, (1) a PICU cohort comprising all patients transferred from general adult acute wards to a non-forensic PICU ward between April 2008 and April 2013 (N = 986) and a randomly selected group of patients admitted to general adult wards within this period who were not transferred to PICU (N = 994), and (2) a seclusion cohort comprising all seclusion episodes occurring in non-forensic PICU wards within the study period (N = 990) and a randomly selected group of patients treated in these wards who were not secluded (N = 1032). Demographic and clinical factors (age, sex, ethnicity, diagnosis, admission status and time since admission) and behavioural precursors (potentially relevant behaviours occurring in the 3 days preceding PICU transfer/seclusion or random sample date) were extracted from electronic medical records. Mixed effects, multivariable logistic regression analyses were performed with all variables included as predictors.Results.PICU cases were significantly more likely to be younger in age, have a diagnosis of bipolar disorder and to be held on a formal section compared with patients who were not transferred to PICU; female sex and longer time since admission were associated with lower odds of transfer. With regard to behavioural precursors, the strongest predictors of PICU transfer were incidents of physical aggression towards others or objects and absconding or attempts to abscond. Secluded patients were also more likely to be younger and legally detained relative to non-secluded patients; however, female sex increased the odds of seclusion. Likelihood of seclusion also decreased with time since admission. Seclusion was significantly associated with a range of behavioural precursors with the strongest associations observed for incidents involving restraint or shouting.Conclusions.Whilst recent behaviour is an important determinant, patient age, sex, admission status and time since admission also contribute to risk of PICU transfer and seclusion. Alternative, less coercive strategies must meet the needs of patients with these characteristics

Judgment Aggregation with Abstentions under Voters' Hierarchy

International audienceSimilar to Arrow’s impossibility theorem for preference aggregation, judgment aggregation has also an intrinsic impossibility for generating consistent group judgment from individual judgments. Removing some of the pre-assumed conditions would mitigate the problem but may still lead to too restrictive solutions. It was proved that if completeness is removed but other plausible conditions are kept, the only possible aggregation functions are oligarchic, which means that the group judgment is purely determined by a certain subset of participating judges. Instead of further challenging the other conditions, this paper investigates how the judgment from each individual judge affects the group judgment in an oligarchic environment. We explore a set of intuitively demanded conditions under abstentions and design a feasible judgment aggregation rule based on the agents’ hierarchy. We show this proposed aggregation rule satisfies the desirable conditions. More importantly, this rule is oligarchic with respect to a subset of agenda instead of the whole agenda due to its literal-based characteristics