Validity of the 12-item version of the General Health Questionnaire in detecting depression in the general population

2016

Global Health Action

BackgroundIntersectionality has received increased interest within population health research in recent years, as a concept and framework to understand entangled dimensions of health inequalities, such as gender and socioeconomic inequalities in health. However, little attention has been paid to the intersectional middle groups, referring to those occupying positions of mixed advantage and disadvantage.ObjectiveThis article aimed to 1) examine mental health inequalities between intersectional groups reflecting structural positions of gender and economic affluence and 2) decompose any observed health inequalities, among middle groups, into contributions from experiences and conditions representing processes of privilege and oppression.DesignParticipants (N=25,585) came from the cross-sectional ‘Health on Equal Terms’ survey covering 16- to 84-year-olds in the four northernmost counties of Sweden. Six intersectional positions were constructed from gender (woman vs. men) and tertiles (low vs. medium vs. high) of disposable income. Mental health was measured through the General Health Questionnaire-12. Explanatory variables covered areas of material conditions, job relations, violence, domestic burden, and healthcare contacts. Analysis of variance (Aim 1) and Blinder-Oaxaca decomposition analysis (Aim 2) were used.ResultsSignificant mental health inequalities were found between dominant (high-income women and middle-income men) and subordinate (middle-income women and low-income men) middle groups. The health inequalities between adjacent middle groups were mostly explained by violence (mid-income women vs. men comparison); material conditions (mid- vs. low-income men comparison); and material needs, job relations, and unmet medical needs (high- vs. mid-income women comparison).ConclusionsThe study suggests complex processes whereby dominant middle groups in the intersectional space of economic affluence and gender can leverage strategic resources to gain mental health advantage relative to subordinate middle groups.

Section: Methodssupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

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Meddling with middle modalities: a decomposition approach to mental health inequalities between intersectional gender and economic middle groups in northern Sweden

Gustafsson

Sebastián

2016

Global Health Action

“…Long-term illness was measured by the question “Do you have any long term illness, discomfort following an accident, any reduced physical function or any other long term health problem?” (Yes/No). Mental health was measured by the General Health Questionnaire (GHQ)-12 [22, 23], which comprises twelve items each coded on a four-level Likert scale, which are summed up into an index (range = 36; Cronbach α = 0.89). Health complaints were based on ten self-reported general symptoms (covering musculoskeletal pain in neck; back; and extremities; headache; worries; tiredness; sleeping difficulties; eczema; tinnitus; bowel symptoms), scored on three-level Likert scales and summed up into one index (range = 20; Cronbach α = 0.72).…”

Section: Methodsmentioning

confidence: 99%

Equitable health services for the young? A decomposition of income-related inequalities in young adults’ utilization of health care in Northern Sweden

Waenerlund

Goicolea

et al. 2017

Int J Equity Health

BackgroundDespite the goal of the Swedish health system to offer health care according to the principle of horizontal equity, little is known about the equality in access to health care use among young people. To explore this issue, the present study aimed i) to assess horizontal inequity in health care utilization among young people in Northern Sweden; and ii) to explore the contribution of different factors to explain the observed inequalities.MethodsParticipants (N = 3016 youths aged 16–25 years) came from the “Health on Equal terms” survey conducted in 2014 in the four northernmost counties in Sweden. Concentration indices (C) and horizontal inequity indices (HI) were calculated to measure inequalities in the utilization of two health care services (general practitioners (GP) and youth clinics). The HI was calculated based on health care utilization and variables representing socioeconomic status (household income), health care needs factors and non-need factors affecting health care use. A decomposition analysis was carried out to explain the income-related inequalities.ResultsResults showed a significant positive income-related inequality for youth clinic utilization in women (C = 0.166) and total sample (C = 0.097), indicating that services were concentrated among the better-off. In contrast, general practitioner visits showed inequality pointing toward a higher utilization among less affluent individuals; significant in women (C = −0.079), men (C = −0.101) and pooled sample (C = −0.097). After taking health care needs into consideration, the utilization of youth clinics remained significantly pro-rich in women (HI = 0.121) and total sample (HI = 0.099); and consistently pro-poor for the GP visits in the pooled sample (HI = −0.058). The decomposition analyses suggest that socioeconomic inequalities explain a considerable portion of the pro-rich utilization of youth clinics services among young women. The corresponding analyses for GP visits showed that need factors and socioeconomic conditions accounted for the pro-poor concentration of GP visits.ConclusionThe distribution of GP visits among young people in Northern Sweden slightly favored the low-income group, and thus seems to meet the premises of horizontal equity. In contrast, the findings suggest substantial pro-rich horizontal inequity in the utilization of youth clinics among young women, which are largely rooted in socioeconomic inequalities.

“…Mental health was measured by the GHQ-12 [20, 21], covering twelve items with four Likert coded response options, with items summed up to form an index (range = 36; Cronbach α = 0.89). General physical health complaints were measured by ten general physical symptoms (musculoskeletal pain in neck; back; and extremities; headache; worries; tiredness; sleeping difficulties; eczema; tinnitus; bowel symptoms), which were scored on three-level Likert scales and summed up into an index (range = 20; Cronbach α = 0.72).…”

Section: Methodsmentioning

confidence: 99%

Embodying pervasive discrimination: a decomposition of sexual orientation inequalities in health in a population-based cross-sectional study in Northern Sweden

Gustafsson

Linander

2017

Int J Equity Health

BackgroundStudies from Sweden and abroad have established health inequalities between heterosexual and non-heterosexual people. Few studies have examined the underpinnings of such sexual orientation inequalities in health. To expand this literature, the present study aimed to employ decomposition analysis to explain health inequalities between people with heterosexual and non-heterosexual orientation in Sweden, a country with an international reputation for heeding the human rights of non-heterosexual people.MethodsParticipants (N = 23,446) came from a population-based cross-sectional survey in the four northernmost counties in Sweden in 2014. Participants completed self-administered questionnaires, covering sexual orientation, mental and general physical health, social conditions and unmet health care needs, and sociodemographic data was retrieved from total population registers. Sexual orientation inequalities in health were decomposed by Blinder-Oaxaca decomposition analysis.ResultsResults showed noticeable mental and general health inequalities between heterosexual and non-heterosexual orientation groups. Health inequalities were partly explained (total explained fraction 64-74%) by inequalities in degrading treatment (24-26% of the explained fraction), but to a considerable degree also by material conditions (38-45%) and unmet care needs (25-43%).ConclusionsPsychosocial experiences may be insufficient to explain and understand health inequalities by sexual orientation in a reputedly ‘gay-friendly’ setting. Less overt forms of structural discrimination may need to be considered to capture the pervasive material discrimination that seems to underpin the embodiment of sexual minority inequalities. This ought to be taken into consideration in research, policy-making and monitoring aiming to work towards equity in health across sexual orientations.