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Dissertation
Inequalities and inequities in mental health and care

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This dissertation aims at analyzing the relationship between socio-economic status (SES) and mental health and care. It attempts to understand how different socio-economic groups present unequal risk of mental disorders and to what extent different socio-economic groups use unequal quantity, type and quality of mental care. Since its earlier beginnings, psychiatric epidemiology has evidenced the association between socio-economic status and mental disorder. However, the numerous prevalence studies addressing depression have yielded inconsistent results. This calls for a thorough investigation of the sources of such heterogeneity. This dissertation attempts to achieve the following objectives: · To unfold methodological and contextual covariates influencing the SES/mental health relationship. · To assess the longitudinal influences of material deprivation on depression. · To assess the extent to which outpatient and inpatient mental care are fairly used. The methodological influences of socio-economic inequalities in mental health were tackled through a meta-analysis of previously published works. We built a database of previous published studies addressing the socio-economic factors of depression prevalence, incidence and persistence in adults population studies and being published in English, French, German and Spanish after 1979. The lower socio-economic group has 80% more prevalence of depression. Inequalities are more acute for persistent depression than for new episode. The results indicated that inequalities are much more pronounced when mental health is looked at from a subjective point of view or in terms of resulting disability. Social inequalities in mental health are also influenced by geographic context. Europe has a gradient 30% less pronounced than North-America. As the period of reference decreased, the gradient rose, suggesting that duration might be an explanatory factor. Geographical analysis of socio-economic inequalities in mortality is carried out with the death certificates of the Belgian National Institute of Statistics (NIS), covering all causes mortality and 11 specific mortality causes, from 1985 to 1993. Spatial concentration was computed through a Moran'I. We compare a simultaneous autoregressive model with a weighted-least-square model. Findings show that spatial concentration is pervasive, that suicide and mortality by liver cirrhosis are among the most correlated causes of death. Getting rid of spatial autocorrelation leads to significant change in the relationship between deprivation and mortality, suggesting the influence of contextual effects on socio-economic inequalities. The difficulty to move from correlation to causation between SES and depression owes partly to the difficulty of disentangling the direct effect of socio-economic status from other –and numerous- confounding factors such as family history, genetic endowment, cognitive abilities, early schooling experience, which, for most of them are rather stable overtime. The longitudinal analysis attempts to estimate the impact of time-varying socio-economic covariates on depression. The results show that material deprivation (and change of) does not affect the level or the risk of depression while social network does slightly. We found much stronger gradient with time invariant socio-economic factors such as educational level. Inequity in outpatient mental care was assessed with the data of the first Belgian Health Interview Survey (HIS), a cross-sectional household-health interview survey carried out in Belgium in 1997. The Minimum Psychiatric Summary, a case register of all psychiatric admissions in Belgium (1997-98), allowed us to carry out the study of inpatient inequalities of mental care. In terms of mental health services uses, inequalities arise in the setting were care is delivered: less well-off use more primary care and less specialised care, are more likely to be admitted in a non-teaching, psychiatric hospitals with long length of stay. The lower the socio-economic groups with mood disorders are less likely to receive the expected treatment such as antidepressant and psychotherapies. Finally, the outcomes of the hospitalisation, in terms of overall functioning and in terms of psychological symptoms are less favourable for the individuals of lower socio-economic status. Part of such unequal outcome is related to unequal treatment. We concluded that inequalities in health should be addressed in their geographical context, that early and stable socio-economic factors are more important than time-varying factors. Horizontal socio-economic inequities arise in the type of care used as well as in the appropriateness of care. However, for a given equal treatment and use, outcome inequalities remain so that it seems relevant to consider socio-economic status as a general vertical equity principle.

Maturation et vulnérabilité
Authors: ---
ISBN: 2294010744 9782294010743 Year: 2002 Publisher: Paris: Masson,

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Tending animals in the global village : a guide to international veterinary medicine.
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ISBN: 0683180517 047029213X 9786611317782 1281317780 0470292105 9780683180510 Year: 2002 Publisher: Philadelphia Lippincott


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Rapport sur la santé en Europe : 2002
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ISSN: 02508575 ISBN: 9289023651 9789289023658 Year: 2002 Volume: 97 Publisher: Genève Organisation mondiale de la Santé


Book
Assessing individuals with disabilities in educational, employment, and counseling settings
Authors: ---
Year: 2002 Publisher: Washington ; London : American Psychological Association,


Book
Hospital Care for the Uninsured in Miami-Dade County : Hospital Finance and Patient Travel Patterns (2002)
Authors: --- --- --- --- --- et al.
ISBN: 1598751352 Year: 2002 Publisher: Santa Monica : RAND Corporation,

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This study examines the extent to which uncompensated care is provided by hopitals in Miami-Dade County, USA, other than Jackson Memorial Hospital (JMH), and whether the greater access to surtax-funded care at JMH might cause patients to pass up facilities nearer to the homes.

Engendering international health : the challenge of equity.
Authors: --- ---
ISBN: 0262692732 0262194694 Year: 2002 Publisher: Cambridge MIT press

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Research on gender inequity in international health in both low- and high-income countries. Engendering International Health presents the work of leading researchers on gender equity in international health. Growing economic inequalities reinforce social injustices, stall health gains, and deny good health to many. In particular, deep-seated gender biases in health research and policy institutions combine with a lack of well-articulated and accessible evidence to downgrade the importance of gender perspectives in health. The book's central premise is that unless public health changes direction, it cannot effectively address the needs of those who are most marginalized, many of whom are women. The book offers evidence and analysis for both low- and high-income countries, providing a gender and health analysis cross-cut by a concern for other markers of social inequity, such as class and race. It details approaches and agendas that incorporate, but go beyond, commonly acknowledged issues relating to women's health; and it brings gender and equity analysis into the heart of the debates that dominate international health policy.

Keywords

Health --- Sexism in medicine. --- Social medicine. --- World health. --- Sex differences. --- Global Health. --- Health Care Reform. --- Health Services Accessibility --- Socioeconomic Factors. --- Women's Health. --- gender --- vrouwen --- armoede (kansarmoede, sociale ongelijkheid) --- gezondheid --- Woman's Health --- Womens Health --- Health, Woman's --- Health, Women's --- Health, Womens --- Healthcare Reform --- Health Care Reforms --- Healthcare Reforms --- Reform, Health Care --- Reform, Healthcare --- Reforms, Health Care --- Reforms, Healthcare --- Medicine --- Medical care --- Medical sociology --- Medicine, Social --- Public health --- Public welfare --- Sociology --- Medical ethics --- Medical sociologists --- Personal health --- Wellness --- Physiology --- Diseases --- Holistic medicine --- Hygiene --- Well-being --- Global health --- International health --- Medical geography --- Factors, Socioeconomic --- High-Income Population --- Inequalities --- Land Tenure --- Standard of Living --- Factor, Socioeconomic --- High Income Population --- High-Income Populations --- Inequality --- Living Standard --- Living Standards --- Population, High-Income --- Populations, High-Income --- Socioeconomic Factor --- Tenure, Land --- Economics --- One Health --- One Health Initiative --- One Medicine Initiative --- Worldwide Health --- International Health Problems --- World Health --- Health Initiative, One --- Health Problem, International --- Health Problems, International --- Health, Global --- Health, One --- Health, World --- Health, Worldwide --- Initiative, One Health --- Initiative, One Medicine --- International Health Problem --- Medicine Initiative, One --- Problem, International Health --- Problems, International Health --- World Health Organization --- economics. --- genre --- femmes --- pauvreté --- santé --- Social aspects --- International cooperation --- Sexism in medicine --- Social medicine --- World health --- Global Health --- Health Care Reform --- Socioeconomic Factors --- Women's Health --- International Health --- Health, International --- Healths, International --- International Healths --- Sex differences --- economics --- Social Inequalities --- Social Inequality --- Inequalities, Social --- Inequality, Social --- Economic and Social Factors --- Social and Economic Factors --- Socioeconomic Characteristics --- Characteristic, Socioeconomic --- Socioeconomic Characteristic

Emerging issues in Hispanic health : summary of a workshop
Authors: ---
ISBN: 0309085241 9786610183227 1280183225 030950323X 9780309503235 9780309085243 9781280183225 0309086728 9780309086721 0309169135 Year: 2002 Publisher: Washington, D.C. : National Academies Press,

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Keywords

Electronic books. -- local. --- Hispanic Americans -- Medical care. --- Medical care. --- Hispanic Americans --- Population Characteristics --- Health Surveys --- Sociology --- Ethnic Groups --- Health Care Quality, Access, and Evaluation --- Culture --- Patient Care Management --- Health Care --- Anthropology, Cultural --- Population Groups --- Data Collection --- Health Services Administration --- Social Sciences --- Persons --- Anthropology, Education, Sociology and Social Phenomena --- Epidemiologic Methods --- Health Care Evaluation Mechanisms --- Anthropology --- Named Groups --- Public Health --- Investigative Techniques --- Quality of Health Care --- Analytical, Diagnostic and Therapeutic Techniques and Equipment --- Environment and Public Health --- Health Status Indicators --- Cultural Characteristics --- Socioeconomic Factors --- Delivery of Health Care --- Health & Biological Sciences --- Ethnic Minorities & Public Health --- Medical care --- Delivery of health care --- Delivery of medical care --- Health care --- Health care delivery --- Health services --- Healthcare --- Medical and health care industry --- Medical services --- Personal health services --- Hispanics (United States) --- Latino Americans --- Latinos (United States) --- Spanish Americans in the United States --- Spanish-speaking people (United States) --- Spanish-surnamed people (United States) --- Public health --- Ethnology --- Latin Americans --- Spanish Americans (Latin America) --- Latinxs

The European health report 2002.
Author:
ISBN: 9289013656 9786610060818 9289013931 1280060816 0585477124 Year: 2002 Volume: no. 97 Publisher: Copenhagen : World Health Organization, Regional Office for Europe,

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This report provides Member States with essential public health information. It provides a picture of the health status and health determinants in the European Region and identifies areas for public health action for the Member States and the European public health community.

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