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Biomedical subjects

Stephen Stansfeld

Publications and source records attributed to Stephen Stansfeld.

At least 19 recordsLinked to original sources
PubMed2007

Psychological distress after employment transitions: the role of subjective financial position as a mediator.

OBJECTIVE: To explore the extent to which the mental health effects of transitions into unemployment, or other forms of non-employment, and vice versa, are mediated by financial changes. METHODS: Longitudinal analysis of the British Household Panel Survey from 1991 to 2000. There were 89,264 person-years of observation from 14,686 individuals aged > or =16 years. Main outcome measure was psychological distress measured by the 12-item General Health Questionnaire. RESULTS: Transitions to unemployment were associated with increased risk of psychological distress for men (adjusted odds ratio (OR) 3.15 (95% confidence interval (CI) 2.50 to 3.98)) and for women (OR 2.60 (95% CI 1.97 to 3.43)). Women who left work to look after the family were also more likely to experience psychological distress (OR 1.72 (95% CI 1.45 to 2.05)). A reduced risk of psychological distress was seen for transitions from unemployment to paid employment for men (OR 0.52 (95% CI 0.41 to 0.68)) and for women (OR 0.68 (95% CI 0.69 to 1.40)). Financial difficulty partially mediated these relationships: men who became unemployed and were worse off financially were more likely to experience psychological distress (OR 4.19 (95% CI 3.20 to 5.50)) than men who were not (OR 1.48 (95% CI 0.95 to 2.33)). Conversely, the beneficial health effect for people who left unemployment and became employed was confined to those who were better off financially (OR 0.34 (0.25 to 0.48) for men). CONCLUSIONS: Changes in employment status have both direct and indirect effects, through changes in financial circumstances, on subsequent psychological distress. The results support the view that the direction of causation runs from employment transitions to financial difficulties and psychological distress.

Adaptation, Psychological↗
PubMed2006

Is attachment style a source of resilience against health inequalities at work?

The argument that 'indirect selection' is a contributory factor to health inequality has included ideas about personal characteristics that may originate in childhood and increase the likelihood of both poor health and disadvantaged social position in adulthood. The concept of protective resilience makes a similar but converse argument: that positive characteristics acquired at one phase of life may enable individuals to withstand later adversity. The increasing richness of data from longitudinal studies now allows us to examine these processes more closely over a longer period of life. In this paper we show that attachment style, a psychological characteristic thought to be associated with the style of parenting encountered during early childhood, may act as a source of resilience in the face of educational disadvantage. Men in mid-life who were not burdened with anxious or avoidant attachment styles seem to have been more likely to overcome the disadvantage of a lower level of educational attainment and progress up the ladder of Civil Service grades in the English Whitehall II study. As it is not strongly related to parents' social class, it can be argued that attachment style has acted as a source of upward social mobility which is also likely to reinforce better health in later life.

Adaptation, Psychological↗
PubMed2006

Racial discrimination, ethnicity and work stress.

BACKGROUND: Previous research has suggested higher work stress among minority ethnic workers. AIMS: To determine levels of work stress in three ethnic groups, consider the contribution of racial discrimination to the groups' profiles of occupational and demographic associations with stress, and assess the association between work stress and well-being. METHODS: A household quota sample design was used, and 204 black African-Caribbean, 206 Bangladeshi and 216 white (UK born) working people took part in structured interviews. RESULTS: More black African-Caribbean respondents reported high work stress than either Bangladeshi or white respondents. Reported racial discrimination among black African-Caribbean female respondents was strongly associated with perceived work stress. Among the black African-Caribbean respondents, women who reported experiencing racial discrimination at work had higher levels of psychological distress. CONCLUSIONS: Perceived work stress may be underpinned by exposure to racial discrimination at work among black African-Caribbean women, and this may affect their psychological well-being.

Adolescent↗
PubMed2006

Psychological distress among adolescents, and its relationship to individual, family and area characteristics in East London.

This paper identifies factors associated with variation in psychosocial distress among adolescents in a relatively deprived and ethnically diverse inner city setting in London, UK. The research draws on literature which discusses whether neighbourhood socio-economic conditions are associated with mental health, as well as attributes of individual adolescents and their families. We report an analysis of data from the Research with East London Adolescents: Community Health Survey (RELACHS). The survey collected data on mental health measured by the Strengths and Difficulties Questionnaire (SDQ), and on various aspects of individual and family circumstances. These data were linked with information about social and economic conditions in 'middle layer standard output areas' (MSOA) used for the population Census 2001, having a mean total population of 6767 in the study area. Census statistics including the Indices of Deprivation for 2004 proposed by the Office of the Deputy Prime Minister, were used to describe the socio-economic conditions within these areas. Although the socio-economic disparities among small areas were not typical of those across the whole of the country, there were differences in levels of deprivation and crime, social fragmentation, and ethnic composition. A Bayesian regression analysis using Gibbs sampling in the programme WinBugs investigated whether there was variability in SDQ at both individual and area (MSOA) level, and whether the predictor variables at both levels were significantly associated with SDQ. Individuals from Asian or Black ethnic groups, and those in families with harmonious relationships and no financial stress had significantly lower SDQ scores, i.e. better health. Those who had special educational needs or long standing illness, or were from reconstituted families had significantly worse SDQ scores. About 6% of the variation in SDQ was associated with area differences. However, this area variation was not related to differences in area indicators of socio-economic deprivation, crime or social fragmentation. There was a complex association between SDQ and ethnic composition of neighbourhoods.

Adolescent↗
PubMed2006

PINCHE's policy recommendations on noise: how to prevent noise from adversely affecting children.

BACKGROUND: Noise can have auditory and non-auditory effects on children. Very few noise episodes affect children's hearing instantaneously; most effects are long-term and cumulative. Describing the risks of noise on children's health and well-being in a life-course perspective can illustrate the prospects of cumulative effects. CONCLUSION: The policy recommendations the Policy Interpretation Network on Children's Health and Environment (PINCHE) prepared for each age group or setting are described here.

Advisory Committees↗
PubMed2006

Psychosocial work environment and mental health--a meta-analytic review.

OBJECTIVES: To clarify the associations between psychosocial work stressors and mental ill health, a meta-analysis of psychosocial work stressors and common mental disorders was undertaken using longitudinal studies identified through a systematic literature review. METHODS: The review used a standardized search strategy and strict inclusion and quality criteria in seven databases in 1994-2005. Papers were identified from 24,939 citations covering social determinants of health, 50 relevant papers were identified, 38 fulfilled inclusion criteria, and 11 were suitable for a meta-analysis. The Comprehensive Meta-analysis Programme was used for decision authority, decision latitude, psychological demands, and work social support, components of the job-strain and iso-strain models, and the combination of effort and reward that makes up the effort-reward imbalance model and job insecurity. Cochran's Q statistic assessed the heterogeneity of the results, and the I2 statistic determined any inconsistency between studies. RESULTS: Job strain, low decision latitude, low social support, high psychological demands, effort-reward imbalance, and high job insecurity predicted common mental disorders despite the heterogeneity for psychological demands and social support among men. The strongest effects were found for job strain and effort-reward imbalance. CONCLUSIONS: This meta-analysis provides robust consistent evidence that (combinations of) high demands and low decision latitude and (combinations of) high efforts and low rewards are prospective risk factors for common mental disorders and suggests that the psychosocial work environment is important for mental health. The associations are not merely explained by response bias. The impact of work stressors on common mental disorders differs for women and men.

Female↗
PubMed2005

Post-migration geographical mobility, mental health and health service utilisation among Somali refugees in the UK: a qualitative study.

Migration is known to be associated with poor health outcomes for certain marginalised and socially disadvantaged populations. This paper reviews a number of reasons why residential mobility in the 'host' country may be associated with poor mental health for refugee populations and reports on a qualitative study of Somalis living in London, UK, and their beliefs about the relationship between residential mobility, poor health and health service use. Two discussion groups were undertaken with 13 Somali professionals and four groups with 21 lay Somalis in East and South London, UK. Lay Somalis did not wish to move accommodation but felt they were forced to move. Some Somali professionals believed that the nomadic history of Somalis made them more likely to elect to move in order to escape problems of living, but this was not supported by the lay group. Frequent geographical movements were seen as stressful and undesirable, disrupted family life and child development and were detrimental to well being. Residential mobility was also perceived to interfere with health care receipt and therefore should be more comprehensively assessed in larger quantitative studies.

Adult↗
PubMed2005

Acculturation and health status among African-Caribbean, Bangladeshi and White British adolescents--validation and findings from the RELACHS study.

OBJECTIVE: This paper reports the validation process for research questions that measure cultural identity in a survey of adolescents from a multi-ethnic urban area. METHOD: Four questions that tapped preferred cultural origins of friends and clothing were used to classify subjects into categories for cultural identity described by Berry (1980). We assessed face, content and construct validity of these questions by: i) investigating the meaning of cultural identity from an African-Caribbean, Bangladeshi, and White British perspective in three focus groups; ii) asking participants to comment on the questions and their suitability for studies of cultural identity; and iii) using data from the Research with East London Adolescents: Community Health Survey (RELACHS) study of adolescents to test hypotheses about associations of acculturation with health outcomes (physical and mental) in order to assess whether these trends are consistent with previous research, and are in accord with trends predicted by the Berry model. RESULTS: Questions about the cultural origins of friends and clothing showed good face and content validity. However, only the questions on friendship choices showed some associations in the predicted directions, with some associations that were unexpected. The most significant findings were that, in comparison with marginalised pupils, for African-Caribbean pupils assimilation was associated with more tiredness (OR=40.7, 3.8-432.8,p<0.001) and traditionalism with less obesity (OR=0.1, 0.02-0.5, p<0.001). For Bangladeshi pupils integration was associated with a lower risk of depression (OR=0.4, 0.2-0.8, p<0.001). CONCLUSION: Questions on friendship choices can be used to assess cultural identity, but associations with health and health risk behaviours are different for each ethnic group.

Acculturation↗
PubMed2005

Psychotic symptoms in the general population of England--a comparison of ethnic groups (The EMPIRIC study).

BACKGROUND: There is considerable evidence that incidence of schizophrenia and other psychoses varies across ethnic groups in the UK, with particularly high rates for people of African-Caribbean origin. AIMS: The aims of this shady were to estimate in a community-based sample of people from ethnic minorities: 1) the prevalence of psychotic symptoms; and 2) risk factors for reporting psychotic symptoms. METHOD: Face-to-face interviews were carried out with a probabilistic sample of 4281 adults from six ethnic groups living in the UK. Psychotic symptoms were measured using the psychosis screening questionnaire (PSQ). RESULTS: There was a twofold higher rate of reporting psychotic symptoms on the PSQ in Black Caribbean people compared with Whites. Adjustment for demographic factors had little effect on this association. CONCLUSION: Prevalence rates of psychotic symptoms were higher in people from ethnic minorities, but were not consistent with the much higher first contact rates for psychotic disorder reported previously, particularly in Black Caribbeans.

Adolescent↗
PubMed2005

Socioeconomic factors in EU-funded studies of children's environmental health.

We performed a survey on socioeconomic factors in 27 studies of children's environmental health funded by EU FP4 and FP5. Parental education was the most common measure (74%). Socioeconomic factors were predominantly considered as confounder (74%) and less often as effect modifier (33%) or independent variable (37%). The awareness of the need to study the impact of socioeconomic factors further seems to have increased in recent years.

Child↗
PubMed2005

Ethnicity, socio-economic status, overweight and underweight in East London adolescents.

BACKGROUND: The developed world is experiencing an 'epidemic' of childhood obesity but little is known about the prevalence of obesity, or underweight, amongst adolescents from minority ethnic groups in the UK. An understanding of the prevalence of obesity and overweight in these populations is important since some ethnic groups may be particularly vulnerable to the adverse health effects associated with obesity. STUDY OBJECTIVES: To examine levels of extreme obesity, obesity, overweight and underweight amongst a representative sample of adolescents from different ethnic groups in East London and to explore the association between socio-economic status and body mass index (BMI). DESIGN: A school-based survey of adolescents aged 11-14. Obesity and overweight were estimated using the 1990 UK growth reference (UK 90) and the International Obesity Task Force (IOTF) cut-off points. Extreme obesity was defined as a BMI more than three SD above the UK 90 mean. Underweight was examined by looking at those with a BMI below the 15th or the 5th UK 90 percentiles. MAIN RESULTS: A total of 2,482 adolescents were surveyed (response rate 84%), 73% from non-white ethnic groups. Although there were significant differences in BMI between ethnic groups, high levels of overweight were seen in all ethnic groups. More than one-third were overweight and one-fifth were obese using the UK 90; and over a quarter were overweight and almost one-tenth were obese using the IOTF cut-offs. Two per cent were extremely obese. Indian males were at higher risk of being overweight than white British males. The prevalence of obesity and overweight was similar in white British and Bangladeshi males. Overall the prevalence of underweight was slightly lower than that predicted by the UK 90, but South Asian ethnic groups, especially males, had a higher prevalence of underweight than other groups. No associations between BMI and measures of socio-economic status were found in this relatively deprived population. CONCLUSIONS: The 'epidemic' of childhood obesity observed in the UK involves adolescents from all ethnic groups, although there are some differences between ethnic groups in the prevalence of overweight. Indian males appear to be at increased risk of being overweight. There is no evidence of a simultaneous increase in underweight amongst this population overall, but Bangladeshi, Indian and Pakistani boys appear to be at increased risk of being underweight.

Adolescent↗
PubMed2005

Cultural identity, acculturation, and mental health among adolescents in east London's multiethnic community.

STUDY OBJECTIVE: To investigate cultural identity as a risk factor for mental health problems among adolescents. DESIGN: A cross sectional school based population survey. Mental health problems were measured using the strengths and difficulties questionnaire. Pupils were classified into one of four cultural identity types on the basis of friendship and clothing choices. SETTING: East London. PARTICIPANTS: 2623 adolescents (aged 11-14) from a representative sample of 28 schools in east London. RESULTS: In comparison with marginalised adolescents who chose friends from neither their own or other cultures, fewer mental health problems were found among adolescents making culturally integrated friendship choices (friends from own and other cultures: OR = 0.6, 0.4 to 0.9), boys making integrated friendship choices (OR = 0.45, 0.22 to 0.91), and specifically among Bangladeshi pupils with integrated friendship choices (OR = 0.15, 0.04 to 0.55). CONCLUSION: As measures of cultural identity, integrated friendship choices overall, and specifically for boys and Bangladeshi pupils, are associated with lower levels of adolescent mental health problems.

Adolescent↗
PubMed2005

Racial/ethnic discrimination and common mental disorders among workers: findings from the EMPIRIC Study of Ethnic Minority Groups in the United Kingdom.

OBJECTIVES: We measured perceived discrimination and its association with common mental disorders among workers in the United Kingdom. METHODS: We conducted a secondary analysis of a national sample of 6 ethnic groups (n=2054). Discrimination was measured as reports of insults; unfair treatment at work; or job denial stemming from race, religion, or language. The outcome assessed was presence of common mental disorders. RESULTS: The risk of mental disorders was highest among ethnic minority individuals reporting unfair treatment (odds ratio [OR]=2.0; 95% confidence interval [CI]=1.2, 3.2) and racial insults (OR=2.3; 95% CI=1.4, 3.6). The overall greatest risks were observed among Black Caribbeans exposed to unfair treatment at work (OR=2.9; 95% CI=1.2, 7.3) and Indian (OR=3.1; 95% CI=1.4, 7.2), Bangladeshi (OR=32.9; 95% CI=2.5, 436.0), and Irish (OR=2.9; 95% CI=1.1, 7.6) individuals reporting insults. CONCLUSIONS: Racial/ethnic discrimination shows strong associations with common mental disorders.

Adult↗
PubMed2004

Common mental disorders and ethnicity in England: the EMPIRIC study.

BACKGROUND: There is little population-based evidence on ethnic variation in the most common mental disorders (CMD), anxiety and depression. We compared the prevalence of CMD among representative samples of White, Irish, Black Caribbean, Bangladeshi, Indian and Pakistani individuals living in England using a standardized clinical interview. METHOD: Cross-sectional survey of 4281 adults aged 16-74 years living in private households in England. CMD were assessed using the Revised Clinical Interview Schedule (CIS-R), a standardized clinical interview. RESULTS: Ethnic differences in the prevalence of CMD were modest, and some variation with age and sex was noted. Compared to White counterparts, the prevalence of CMD was higher to a statistically significant degree among Irish [adjusted rate ratios (RR) 2.09, 95% CI 1.16-2.95, p = 0.02] and Pakistani (adjusted RR 2.38, 95 % CI 1.25-3.53, p = 0.02) men aged 35-54 years, even after adjusting for differences in socio-economic status. Higher rates of CMD were also observed among Indian and Pakistani women aged 55-74 years, compared to White women of similar age. The prevalence of CMD among Bangladeshi women was lower than among White women, although this was restricted to those not interviewed in English. There were no differences in rates between Black Caribbean and White samples. CONCLUSIONS: Middle-aged Irish and Pakistani men, and older Indian and Pakistani women, had significantly higher rates of CMD than their White counterparts. The very low prevalence of CMD among Bangladeshi women contrasted with high levels of socio-economic deprivation among this group. Further study is needed to explore reasons for this variation.

Adolescent↗
PubMed2003

Ethnic variations in pathways to and use of specialist mental health services in the UK. Systematic review.

BACKGROUND: Inequalities of service use across ethnic groups are important to policy makers, service providers and service users. AIMS: To identify ethnic variations in pathways to specialist mental health care, continuity of contact, voluntary and compulsory psychiatric in-patient admissions; to assess the methodological strength of the findings. METHOD: A systematic review of all quantitative studies comparing use of mental health services by more than one ethnic group in the UK. Narrative analysis supplemented by meta-analysis, where appropriate. RESULTS: Most studies compared Black and White patients, finding higher rates of in-patient admission among Black patients. The pooled odds ratio for compulsory admission, Black patients compared with White patients, was 4.31 (95% CI 3.33-5.58). Black patients had more complex pathways to specialist care, with some evidence of ethnic variations in primary care assessments. CONCLUSIONS: There is strong evidence of variation between ethnic groups for voluntary and compulsory admissions, and some evidence of variation in pathways to specialist care.

Commitment of Persons with Psychiatric Disorders↗
PubMed2002

Gender differences in mental health: evidence from three organisations.

It is commonly observed that women report higher levels of minor psychiatric morbidity than men. However, most research fails to control for the gendered distribution of social roles (e.g. paid work and domestic work) and so does not compare men and women in similar positions. In this short report, we examine the distribution of minor psychiatric morbidity (measured by the 12 item General Health Questionnaire) amongst men and women working in similar jobs within three white-collar organisations in Britain, after controlling for domestic and socioeconomic circumstances. Data from self-completion questionnaires were collected in a Bank (n = 2,176), a University (n = 1,641) and the Civil Service (n = 6,171). In all three organisations women had higher levels of minor psychiatric morbidity than men, but the differences were not great; in only the Civil Service sample did this reach statistical significance. We conclude that generalisations about gender differences in minor psychiatric morbidity can be unhelpful, as these differences may vary depending on the context of the study.

Adult↗