[Everything is on the map: Integrated Mental Health Atlases as support tools for service planning. SESPAS Report 2020]. / Todo está en el mapa: Atlas Integrales de Salud Mental para la planificación de servicios. Informe SESPAS 2020.

OBJECTIVE: This article reviews the usability of the Integrated Atlases of Mental Health as a decision support tool for service planning following a health ecosystem research approach. METHOD: This study describes the types of atlases and the procedure for their development. Atlases carried out in Spain are presented and their impact in mental health service planning is assessed. Atlases comprise information on the local characteristics of the health care system, geographical availability of resources collected with the DESDE-LTC instrument and their use. Atlases use geographic information systems and other visualisation tools. Atlases follow a bottom-up collaborative approach involving decision-makers from planning agencies for their development and external validation. RESULTS: Since 2005, Integrated Atlases of Mental Health have been developed for nine regions in Spain comprising over 65% of the Spanish inhabitants. The impact on service planning has been unequal for the different regions. Catalonia, Biscay and Gipuzkoa, and Andalusia reach the highest impact. In these areas, health advisors have been actively involved in their co-design and implementation in service planning. CONCLUSIONS: Atlases allow detecting care gaps and duplications in care provision; monitoring changes of the system over time, and carrying out national and international comparisons, efficiency modelling and benchmarking. The knowledge provided by atlases could be incorporated to decision support systems in order to support an efficient mental health service planning based on evidence-informed policy.

Socioeconomic Inequalities in Health Through Lifestyles: Analysing Gender and Age Differences in Andalusia, Spain.

This research aims to analyse the association between socioeconomic status (SES) and self-rated health (SRH) through its relationship with lifestyle factors, as well as examining these effects stratified by gender and age groups. A cross-sectional study was performed with a representative sample from Andalusia (Southern Spain) composed of 1200 adults. The study analysed several variables related to lifestyle (healthy diet, physical activity and tobacco and alcohol consumption) and SES (education and income), along with SRH. The joint effects of SRH and the set of variables were studied by using a hierarchical linear regression analysis. Later a path analysis was carried out to test the impact of gender and age group on these associations. The results show that a better SRH was reported by men with lower age, higher SES, more frequent physical activity, healthy diet, and lower alcohol use compared with their counterparts. Income was directly related to better SRH through more physical activity, a healthier diet and less alcohol consumption. SES had a greater positive relationship with women's health than with men's health. In addition, a greater explained variance in SRH was observed in older women based on SES and lifestyle factors. Our findings provide some cross-sectional evidence of the social inequalities in health mediated through lifestyle factors, with gender and age differences. Therefore, socioeconomic inequalities should be addressed by public and social policies considering the gender and age gaps.

Methodological barriers to studying the association between the economic crisis and suicide in Spain.

BACKGROUND: The hypothetical relationship between economic recession and the increase in suicides in Spain is subject to various arguments. In addition to the inherent complexity of capturing and explaining the underlining mechanisms that could describe this causal link, different points of contention have been be identified. The period of this association and its possible starting points, the socioeconomic determinants that may explain the variation in suicide rate, and the data sources available are the main focus of controversy. The present study aims to identify the phases of association between different periods of economic recession and suicide rates, and compare the effect of different social determinants of health that have been mentioned in previous studies. METHODS: We have used interrupted time series analyses to assess the impact of economic recession on national rates of suicide mortality provided by the Spanish Statistical Office (1980-2014). In an attempt to consider the factors that have affected the study of suicide in Spain, different data sources/periods, predictors, and regions in Spain were analysed. RESULTS: The analysis revealed a positive and significant relationship between the Great Recession and suicide rates during the second period of economic recession (2011-2014), while appeared to decrease during the first recession period. However, the first decreasing trend was not statistically significant in the global analysis of the evolution of monthly suicide rates for the entire country. Both unemployment and per capita GDP were positively related to suicide trends. Finally, the regional analysis demonstrates a similar pattern in different Spanish areas. CONCLUSION: Although previous studies have mentioned the double-dip in the suicide rate associated with the corresponding period of double recession, our study only identify a positive relationship during the second recession period. These results points out that the major impact of economic problems might have had a delayed effect due to initial protection policies.

The impact of socio-economic status on self-rated health: study of 29 countries using European social surveys (2002-2008).

Studies show that the association between socio-economic status (SES) and self-rated health (SRH) varies in different countries, however there are not many country-comparisons that examine this relationship over time. The objective of the present study is to determine the effect of three SES measures on SRH in 29 countries according to findings in European Social Surveys (2002-2008), in order to study how socio-economic inequalities can vary our subjective state of health. In line with previous studies, income inequalities seem to be greater not only in Anglo-Saxon and Scandinavian countries, but especially in Eastern European countries. The impact of education is greater in Southern countries, and this effect is similar in Eastern and Scandinavian countries, although occupational status does not produce significant differences in southern countries. This study shows the general relevance of socio-educational factors on SRH. Individual economic conditions are obviously a basic factor contributing to a good state of health, but education could be even more relevant to preserve it. In this sense, policies should not only aim at reducing income inequalities, but should also further the education of people who are in risk of social exclusion.