The development of socioeconomic inequalities in anxiety and depression symptoms over the lifecourse

Purpose: Socioeconomic inequalities in anxiety and depression widen with increasing age. This may be due to differences in the incidence or persistence of symptoms. This paper investigates the widening of inequalities in anxiety and depression over the lifecourse. Methods: Data were from the West of Scotland Twenty-07 Study, constituting three cohorts aged approximately 16, 36 and 56 years at baseline and re-visited at 5-yearly intervals for 20 years. Symptoms were measured using the Hospital Anxiety and Depression Scale. Adjusting for age and sex, multilevel models with pairs of interviews (n = 6,878) nested within individuals (n = 3,165) were used for each cohort to estimate associations between current symptoms and education or household social class for both those with and without earlier symptoms, approximating socioeconomic differences in incidence and persistence. Results: Inequalities in current symptom levels were present for both those with and without earlier symptoms. In the youngest cohort, those with less education were more likely to experience persistent depression and to progress from anxiety to depression. At older ages there were educational and social class differences in both the persistence and incidence of symptoms, though there was more evidence of differential persistence than incidence in the middle cohort and more evidence of differential incidence than persistence in the oldest cohort. Conclusions: Differential persistence and symptom progression indicate that intervening to prevent or treat symptoms earlier in life is likely to reduce socioeconomic inequalities later, but attention also needs to be given to late adulthood where differential incidence emerges more strongly than differential persistence

Prospective associations between cardiovascular reactions to acute psychological stress and change in physical disability in a large community sample

Exaggerated haemodynamic reactions to acute psychological stress have been implicated in cardiovascular disease outcomes, while lower reactions have been considered benign. This study examined, in a large cohort, the prospective associations between stress reactivity and physical disability. Blood pressure and pulse rate were measured at rest and in response to a stress task. Physical disability was assessed using the OPCS survey of disability at baseline and five years later. Heart rate reactivity was negatively associated with change in physical disability over time, such that those with lower heart rate reactivity were more likely to deteriorate over the following five years. These effects remained significant following adjustment for a number of confounding variables. These data give further support to the recent argument that for some health outcomes, lower or blunted cardiovascular stress reactivity is not necessarily protective

Neighbourhood deprivation and biomarkers of health in Britain: the mediating role of the physical environment

Background: Neighborhood deprivation has been consistently linked to poor individual health outcomes; however, studies exploring the mechanisms involved in this association are scarce. The objective of this study was to investigate whether objective measures of the physical environment mediate the association between neighborhood socioeconomic deprivation and biomarkers of health in Britain. Methods: We linked individual-level biomarker data from Understanding Society: The UK Household Longitudinal Survey (2010–2012) to neighborhood-level data from different governmental sources. Our outcome variables were forced expiratory volume in 1 s (FEV1%; n=16,347), systolic blood pressure (SBP; n=16,846), body mass index (BMI; n=19,417), and levels of C-reactive protein (CRP; n=11,825). Our measure of neighborhood socioeconomic deprivation was the Carstairs index, and the neighborhood-level mediators were levels of air pollutants (sulphur dioxide [SO2], particulate matter [PM10], nitrogen dioxide [NO2], and carbon monoxide [CO]), green space, and proximity to waste and industrial facilities. We fitted a multilevel mediation model following a multilevel structural equation framework in MPlus v7.4, adjusting for age, gender, and income. Results: Residents of poor neighborhoods and those exposed to higher pollution and less green space had worse health outcomes. However, only SO2 exposure significantly and partially mediated the association between neighborhood socioeconomic deprivation and SBP, BMI, and CRP. Conclusion: Reducing air pollution exposure and increasing access to green space may improve population health but may not decrease health inequalities in Britain

Evidence on the relationship between income and poor health: is the government doing enough?

The government’s report, Opportunity for All: Tackling Poverty and Social Exclusion (Department of Social Security, 1999), identified poor health as one of the major problems associated with low income. However, much of the available evidence on the relationship between income and health is of little help in forming policies to reduce health inequalities, as it has tended to be based on cross-section surveys and is therefore unable to shed much light on causal effects. Here, we make use of two British longitudinal datasets to examine the longer-term influences of income on health within a life-course perspective. We then use the results of our analysis to provide a brief critical assessment of the likely success of the government’s anti-poverty strategy in reducing health inequalities. A more detailed assessment of government policy in this respect can be found in Benzeval et al. (forthcoming).

Does Perceived Physical Attractiveness in Adolescence Predict Better Socioeconomic Position in Adulthood? Evidence from 20 Years of Follow Up in a Population Cohort Study

There is believed to be a 'beauty premium' in key life outcomes: it is thought that people perceived to be more physically attractive have better educational outcomes, higher-status jobs, higher wages, and are more likely to marry. Evidence for these beliefs, however, is generally based on photographs in hypothetical experiments or studies of very specific population subgroups (such as college students). The extent to which physical attractiveness might have a lasting effect on such outcomes in 'real life' situations across the whole population is less well known. Using longitudinal data from a general population cohort of people in the West of Scotland, this paper investigated the association between physical attractiveness at age 15 and key socioeconomic outcomes approximately 20 years later. People assessed as more physically attractive at age 15 had higher socioeconomic positions at age 36- in terms of their employment status, housing tenure and income - and they were more likely to be married; even after adjusting for parental socioeconomic background, their own intelligence, health and self esteem, education and other adult socioeconomic outcomes. For education the association was significant for women but not for men. Understanding why attractiveness is strongly associated with long-term socioeconomic outcomes, after such extensive confounders have been considered, is important. © 2013 Benzeval et al

How does money influence health?

This study looks at hundreds of theories to consider how income influences health. There is a graded association between money and health – increased income equates to better health. But the reasons are debated.<p></p> Researchers have reviewed theories from 272 wide-ranging papers, most of which examined the complex interactions between people’s income and their health throughout their lives.<p></p> Key points<p></p> This research identifies four main ways money affects people’s wellbeing:<p></p> Material: Money buys goods and services that improve health. The more money families have, the better the goods they can buy.<p></p> Psychosocial: Managing on a low income is stressful. Comparing oneself to others and feeling at the bottom of the social ladder can be distressing, which can lead to biochemical changes in the body, eventually causing ill health.<p></p> Behavioural: For various reasons, people on low incomes are more likely to adopt unhealthy behaviours – smoking and drinking, for example – while those on higher incomes are more able to afford healthier lifestyles.<p></p> Reverse causation (poor health leads to low income): Health may affect income by preventing people from taking paid employment. Childhood health may also affect educational outcomes, limiting job opportunities and potential earnings

Mixing modes and measurement methods in longitudinal studies

Across the world longitudinal studies are facing falling response rates, at the same time cost imperatives are bringing into question the feasibility of large scale regular face-to-face data collection. While, the rapid development of communications technology and associated cultural changes is assumed to mean that study participants will increasingly expect to be able to answer surveys when and how it suits them. All of these factors are driving longitudinal studies to combine different modes of data collection both to increase response and to reduce costs. Mixing modes of data collection either across individuals at one point in time or within individuals over time, presents longitudinal researchers with a range of methodological challenges in both data collection and analysis. Within CLOSER, and beyond, studies are investigating different aspects of the implications of mixed mode data collection, and giving data users varying degrees of support and advice about issues that should be of concern. Drawing on evidence from across CLOSER’s longitudinal studies, this report reviews the latest evidence gathered on the effect of mixing modes and measurement methods on response, measurement issues and survey costs. The review also focuses on the implications for analysis of measures collected in different ways either across individuals at the same point in time or within individuals over time. Building on these reviews, we identify what further research is required in relation to both the design and analysis of mixed mode data collection. The contents of this report is based on a CLOSER workshop held in November 2016 (http://www.closer.ac.uk/event/mixing-modes-measurement-methods-longitudinal-studies/). The workshop and report were funded by a CLOSER Innovation grant awarded to Michaela Benzeval and Annette Jäckle (University of Essex), and Kate Tilling and Dr Andy Skinner (University of Bristol) and are part of a series of three reports (see Jäckle, Gaia, & Benzeval, 2017; Stone & Skinner, 2017)

The income-health gradient: Evidence from self-reported health and biomarkers using longitudinal data on income

This paper adds to the literature on the income-health gradient by exploring the association of short- and long-term income with a wide set of self-reported health measures and objective nurse-administered and blood-based biomarkers as well as employing estimation techniques that allow for analysis 'beyond the mean' and accounting for unobserved heterogeneity. The income-health gradients are greater in magnitude in case of long-run rather than cross- sectional income measures. Unconditional quantile regressions reveal that the differences between the long-run and the short-run income gradients are more evident towards the right tails of the distributions, where both higher risk of illnesses and steeper income gradients are observed. A two-step estimator, involving a fixed-effects income model at the first stage, shows that the individual-specific selection effects have a systematic impact in the long-run income gradients in self-reported health but not in biomarkers, highlighting the importance of reporting error in self-reported health

Ethnic and racial harassment and mental health: Identifying sources of resilience

In this paper, using data from Understanding Society over the period 2009-2014, we find that ethnic minorities with lower socio-economic status and those who were born in the UK report worse mental health (GHQ). Those who report experiencing ethnic and racial harassment (ERH) also report worse mental health than those who do not. We also found that ethnic minorities living in areas with a higher proportion of co-ethnics reported better mental health. However, ethnic concentration was not protective; rather, ERH had a stronger negative association with mental health for UK born minorities living in such areas. . We identified additional resilience factors: number of close friends and having certain personality traits - higher levels of Openness to Experience and Conscientiousness. We also found those who attend religious services more frequently and have higher levels of Agreebleness and Extraversion are poorly equipped to deal with ethnic and racial harassment

Insomnia symptoms as a cause of type 2 diabetes incidence: a 20 year cohort study

Background: Insomnia symptoms are associated with type 2 diabetes incidence but are also associated with a range of potential time-varying covariates which may confound and/or mediate associations. We aimed to assess whether cumulative exposure to insomnia symptoms has a causal effect on type 2 diabetes incidence. Methods: A prospective cohort study in the West of Scotland, following respondents for 20 years from age 36. 996 respondents were free of diabetes at baseline and had valid data from up to four follow-up visits. Type 2 diabetes was assessed at the final visit by self-report, taking diabetic medication, or blood-test (HbA1c ≥ 6.5% or 48 mmol/mol). Effects of cumulative insomnia exposure on type 2 diabetes incidence were estimated with traditional regression and marginal structural models, adjusting for time-dependent confounding (smoking, diet, physical inactivity, obesity, heavy drinking, psychiatric distress) as well as for gender and baseline occupational class. Results: Traditional regression yielded an odds ratio (OR) of 1.34 (95% CI: 1.06-1.70) for type 2 diabetes incidence for each additional survey wave in which insomnia was reported. Marginal structural models adjusted for prior covariates (assuming concurrently measured covariates were potential mediators), reduced this OR to 1.20 (95% CI: 0.98-1.46), and when concurrent covariates were also included (viewing them as potential confounders) this dropped further to 1.08 (95% CI: 0.85-1.37). Conclusions: The association between cumulative experience of insomnia and type 2 diabetes incidence appeared confounded. Evidence for a residual causal effect depended on assumptions as to whether concurrently measured covariates were confounders or mediators