Socio-economic health inequalities: Their origins and implications

Abstract

Evidence attests to substantial variations in health contingent on socioeconomic position. It is argued that these effects cannot be dismissed as artefact nor can they be explained, in the main, by either social selection or an unequal distribution of accepted behavioural risk factors among different social groups. The most likely explanation would seem to be social causation. However, it is continuing social and material inequality that appears most implicated; accounts which locate the effects in childhood social and material causes are far less compelling. The persistence of socioeconomic health differentials into the materially better-off social strata and the possible determining role of relative as well as absolute living standards suggest that psychological, in addition to material, variables are likely to be involved. Isolating the key psychological variables and identifying the nature of their influences will not be easy tasks, although social relations, psychological stress, uplifts, and control have emerged as possible candidates. However, psychological mediators of this sort most probably constitute surface rather than basic causes. Socio-economic inequality, it is contended, remains the basic cause, and, as such, the proper target for intervention. Psychological interventions are unlikely to yield much in the way of dividends in this context and indeed could inadvertently contribute to victim blaming.     

Type D personality predicts poor medication adherence in myocardial infarction patients

Type D personality, the combination of negative affectivity (NA) and social inhibition (SI), is an emerging risk factor in cardiovascular disease. This study aimed to examine one possible behavioural mechanism to explain the link between Type D and ill-health. It was hypothesised that Type D personality would predict medication adherence in myocardial infarction (MI) patients. In a prospective study, 192 MI patients (54 females and 138 males) completed measures of Type D personality and provided demographic and medical information 1 week post-MI, and then 131 patients went on to complete a self-report measure of medication adherence 3 months post-MI. It was found that Type D personality predicts adherence to medication, after controlling for demographic and clinical risk factors. Critically, the constituent components of Type D, NA and SI, interact to predict medication adherence, after controlling for the effects of each component separately. Poor adherence to medication may represent one mechanism to explain why Type D cardiac patients experience poor clinical outcome, in comparison to non-Type D patients. Interventions, which target the self-management of medication, may be useful in these high-risk patients.     

The impact of assuming the primary caregiver role following traumatic spinal cord injury: An interpretative phenomenological analysis of the spouse's experience

This study aimed to explore the lived experience of assuming the primary caregiver role in a group of spouses of individuals living with a traumatic spinal cord injury (SCI) (injuries ranged from paraplegia to quadriplegia). Individual in-depth interviews were conducted with 11 participants who were both the spouse and primary caregiver of an individual with a SCI; of these, 10 were female and 1 was male. All interviews were transcribed verbatim and were subjected to interpretative phenomenological analysis (IPA). Here we present three inter-related master themes: ‘The emotional impact of SCI’; ‘Post-injury shift in relationship dynamics’ and ‘Impact of caregiving on identity’. Regarding the emotional impact of spinal injury, participants reported an almost instantaneous sense of loss, emptiness and grief during the injured person's rehabilitative period and feelings of anxiety were reported in anticipation of their return to the family home. A distinct change in role from spouse and lover to care provider was reported and this ultimately contributed to relationship change and a loss of former identity. The findings are discussed in relation to extant caregiver literature and recommendations for future caregiver support are highlighted.     

Yoga Practice May Buffer the Deleterious Effects of Abuse on Women's Self-Concept and Dysfunctional Coping

Women who experienced abuse as children or adults can suffer from symptoms such as dissociations, physiological regulation difficulties, and mood disturbances that might not respond to traditional interventions. Given the benefits of yoga, we hypothesized that yoga practice would ameliorate the negative impact of abuse on psychological functioning. Our findings suggest that frequent yoga practice might ameliorate the negative impact of abuse history on self-concept and coping skills. In addition, our findings suggest that women who incorporate yoga into other areas of life could get the greatest psychological benefits. Given the preliminary nature of this study, further research into the benefits of yoga on women who have child or adult abuse histories is warranted.     

The Effect of Gender and Self‐Care Behaviors on Counselors' Perceptions of Colleagues With Depression

This study examined the effects of gender and self‐care behaviors on counselors' perceptions of depressed colleagues. Three hundred and six respondents completed 1 of 8 versions of vignettes describing either a male or female counselor responding to his or her depressive symptoms through the use of antidepressants, counseling, alternative therapies, or no course of action. Target counselors who took antidepressants were perceived as more competent than counselors who practiced holistic measures and those who chose no course of action. Target counselors who sought personal counseling were perceived as more ethical than those choosing no course of action.     

Psychometric and Piagetian intelligences: Toward resolution of controversy

Whether “psychometric” and “Piagetian” kinds of intelligence, as measured by instruments designed to measure these constructs, are the same or different is regarded as a question of whether they have the same or different courses of development with age. While factor analysis may not be fully adequate for investigation of this question, use of this technique with variables reflecting chronological age variation must involve elimination of the age effect in order to assess relations among the constructs measured. Humphreys and Parsons (1979) were justified in partialing out age in their reanalysis of a study by Stephens, McLaughlin, Miller, and Glass (1972), to show that the two constructs are highly correlated and possibly identical in the sample studied. Reanalyses of studies by DeVries and Kohlberg (1977) and by DeVries (1974) yield somewhat conflicting results on the identity between psychometric and Piagetian intelligences. The former study does not yield a convincing separation between them, whereas the latter suggests that they can be distinguished, though substantially correlated and both loaded with a general factor. Problems in further investigating the issue are discussed.