Disability-related inequalities in the prevalence of loneliness across the lifespan: trends from Australia, 2003 to 2020.

BACKGROUND: Experiencing loneliness can be distressing and increasing evidence indicates that being lonely is associated with poor physical and mental health outcomes. Cross-sectional studies have demonstrated that people with disability have increased risk of experiencing loneliness compared to people without disability. However, we do not know if these inequalities have changed over time. This study investigated the prevalence of loneliness for people with disability in Australia annually from 2003 to 2020 to examine whether disability-related inequalities in loneliness have changed over time, and disaggregated results for subgroups of people with disability by age group, sex, and disability group. METHODS: We used annual data (2003-2020) from the Household, Income and Labour Dynamics in Australia Survey. Loneliness was measured by a single question assessing the subjective experience of loneliness. For each wave, we calculated population-weighted age-standardised estimates of the proportion of people experiencing loneliness for people with and without disability. We then calculated the absolute and relative inequalities in loneliness between people with and without disability for each wave. Analyses were stratified by 10-year age groups, sex, and disability group (sensory or speech, physical, intellectual or learning, psychological, brain injury or stroke, other). RESULTS: From 2003 to 2020, the prevalence of loneliness was greater for people with disability, such that people with disability were 1.5 to 1.9 times more likely to experience loneliness than people without disability. While the prevalence of loneliness decreased for people without disability between 2003 and 2020, the prevalence of loneliness did not decrease for people with disability during this period. Inequalities in loneliness were more substantial for people with intellectual or learning disabilities, psychological disability, and brain injury or stroke. CONCLUSION: This study confirms that people with disability have increased risk of loneliness compared to people without disability. We add to the existing evidence by demonstrating that disability-related inequalities in loneliness have persisted for two decades in Australia without improvement. Our findings indicate that addressing inequalities in loneliness for people with disability is a critical public health concern given that loneliness is associated with a wide range of poor health outcomes.

The wellbeing of women and men with and without disabilities: evidence from cross-sectional national surveys in 27 low- and middle-income countries.

BACKGROUND: Little is known about disability-related inequities in personal wellbeing (PWB) in low- and middle-income countries (LMICs). METHOD: Secondary analysis of data collected in Round 6 of UNICEF's Multiple Indicator Cluster Surveys (MICS) undertaken in 27 LMICs (n = 296,693 women, 66,557 men). Data were aggregated across countries by mixed effects multi-level modelling and meta-analysis. RESULTS: Women and men with disabilities were less likely than their non-disabled peers to report being happy and to be satisfied with their life. These differences were evident in all countries for women and in 18 of 22 countries for men. Aggregated data indicated that: (1) women with disabilities were 14-15% less likely to be happy and 17% less likely to be satisfied with their lives; (2) men with disabilities were 15-17% less likely to be happy and 17-19% less likely to be satisfied with their lives; (3) disability-related inequalities in personal wellbeing were reduced by 22-26% for women and 11-22% for men by adjusting for differences in living conditions. CONCLUSIONS: Future releases of MICS data could prove a valuable resource in monitoring country-level progress to realising Sustainable Development Goal 3 and the extent to which progress is equitable between women and men and between people with/without disabilities. Results also suggest that a significant proportion of the disability-related inequities in wellbeing may be accounted for by modifiable differences in their living conditions and life experiences.

Health and wellbeing outcomes associated with loneliness for people with disability: a scoping review.

BACKGROUND: Loneliness is a significant public health concern due to its detrimental impact on health and wellbeing. Despite people with disability reporting higher levels of loneliness than the general population, there has been little research into how this is affecting their health and wellbeing. In light of this, the aim of our study was to scope both the existing evidence about the health and wellbeing outcomes associated with loneliness for people with disability, as well as the conceptual frameworks and measures utilised in this field of research. METHODS: To conduct this scoping review, we followed the methodology outlined by JBI and searched MEDLINE, Scopus, Informit, Embase, and Web of Science for peer-reviewed, English-language articles published between 1 January 2000 and 8 February 2023. Two independent reviewers completed screening, full-text review and data extraction, with consensus sought at each stage. Data were analysed using content analysis and presented both numerically and narratively. RESULTS: Out of the initial 1602 publications identified in the scoping review, only nine were included after duplicate removal, title and abstract screening, and full-text review. This limited number of studies, with the earliest study one published in 2015, represents a key finding. Eight of the nine studies were quantitative, and all were conducted in high income countries. Most of these studies utilised a version of the University of Los Angles Loneliness Scale to measure loneliness and addressed specific impairment groups. Notably, most of the studies identified associations between loneliness and health and wellbeing outcomes for people with disability. CONCLUSIONS: This scoping review highlights the current scarcity of studies examining the effect that loneliness has on the health and wellbeing outcomes of people with disability. As most of the reviewed studies relied on loneliness measures designed for individuals without disability, they potentially overlook the unique life experiences of people with disability. Given that loneliness is an international public health concern, it is imperative that people with disability are not left behind or overlooked in efforts to address the impact of loneliness on health and wellbeing.

Disability and loneliness in the United Kingdom: cross-sectional and longitudinal analyses of trends and transitions.

BACKGROUND: Loneliness can have a detrimental impact on health, yet little is known about the association between disability and loneliness. METHODS: Secondary analysis of three waves of data collected between 2017 and 2020 by the UK's annual household panel study, Understanding Society. Direct age-standardisation was used to compare the prevalence of loneliness at each wave and the persistence of loneliness across all three waves for participants with/without disabilities aged 16-65 years. Transitional probabilities for the stability of loneliness, the stability of non-loneliness, the onset of loneliness and the offset of loneliness between consecutive waves were also estimated. RESULTS: At each wave, the prevalence of loneliness was significantly higher among respondents with disabilities than respondents without disabilities; these inequalities persisted with no evidence of change over time. The prevalence of persistent loneliness was 46% for respondents with disabilities compared with 22% for respondents without disabilities. Risk factors for the likelihood of persistent loneliness included disability, financial stress, not living as a couple, living in rented accommodation, being female and not being employed. The probability of the onset and stability of loneliness between successive waves were markedly higher for people with disabilities compared with people without disabilities. CONCLUSION: Adults with disabilities were more likely to experience loneliness, become lonely and remain lonely over time than their peers. Policies and interventions aimed at reducing loneliness should ensure that they are accessible and effective for people with disabilities. Further research is needed to explore the health outcomes of persistent loneliness among people with/without disabilities.

Parental Report of Signs of Anxiety and Depression in Children and Adolescents with and Without Disability in Middle- and Low-Income Countries: Meta-analysis of 44 Nationally Representative Cross-Sectional Surveys.

Population-based studies undertaken in high-income countries have indicated that children and adolescents with disabilities are more likely than their non-disabled peers to experience emotional difficulties such as anxiety and depression. Very little is known about the association between disability and emotional difficulties among children growing up in low and middle-income countries (LMICs). We aimed to estimate the strength of association between disability and two forms of emotional difficulties (anxiety, depression) in a range of LMICs and to determine whether the strength of this relationship was moderated by child age and gender. Secondary analysis of data collected in Round 6 of UNICEF's Multiple Indicator Cluster Surveys undertaken in 44 LMICs (combined n = 349,421). Data were aggregated across countries by both mixed effects multi-level modelling and restricted maximum likelihood meta-analysis. Young people with disabilities, when compared with their non-disabled peers, were approximately two and a half times more likely to be reported by parents to show daily signs of either anxiety or depression. The level of risk among young people with disabilities was highest in upper middle-income countries and lowest in low-income countries. We estimated that approximately 20% of young people with frequent anxiety or depression also had a disability. All approaches to mental health interventions (from primary prevention to clinical interventions) need to make reasonable accommodations to their services to ensure that the young people with emotional difficulties who also have a disability are not 'left behind'.

The impact of disability on employment and financial security following the outbreak of the 2020 COVID-19 pandemic in the UK.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic may have a greater impact on people with disabilities than non-disabled people. Our aim was to compare the short-term impact of the 2020 COVID-19 pandemic and first lockdown on the employment and financial security of working age adults with and without disabilities in the UK. METHODS: Secondary analysis of data collected in Wave 9 and the special April, May and June COVID-19 monthly surveys of 'Understanding Society', the UK's main annual household panel study. RESULTS: During the first 3 months of the introduction of the COVID-19 lockdown in the UK, respondents with disability were more likely than their peers to be working reduced hours and experience higher levels of financial stress. These differences were attenuated, but not eliminated, when estimates were adjusted to take account of pre-lockdown financial status. CONCLUSIONS: Working age adults with disability were particularly disadvantaged by the financial impact of the COVID-19 lockdown in the UK. The UN Secretary-General António Guterres has stated the need for a disability-inclusive COVID-19 government response. The results of our analysis suggest that these pleas have either not been heeded, or if measures have been implemented, they have so far been ineffectual in the UK.

Overt acts of perceived discrimination reported by British working-age adults with and without disability.

BACKGROUND: Exposure to discrimination can have a negative impact on health. There is little robust evidence on the prevalence of exposure of people with disabilities to discrimination, the sources and nature of discrimination they face, and the personal and contextual factors associated with increased risk of exposure. METHODS: Secondary analysis of de-identified cross-sectional data from the three waves of the UK's 'Life Opportunities Survey'. RESULTS: In the UK (i) adults with disabilities were over three times more likely than their peers to be exposed to discrimination, (ii) the two most common sources of discrimination were strangers in the street and health staff and (iii) discrimination was more likely to be reported by participants who were younger, more highly educated, who were unemployed or economically inactive, who reported financial stress or material hardship and who had impairments associated with hearing, memory/speaking, dexterity, behavioural/mental health, intellectual/learning difficulties and breathing. CONCLUSIONS: Discrimination faced by people with disabilities is an under-recognised public health problem that is likely to contribute to disability-based health inequities. Public health policy, research and practice needs to concentrate efforts on developing programs that reduce discrimination experienced by people with disabilities.

Disability, Loneliness and Health in the UK: cross-sectional survey.

BACKGROUND: Research has suggested that exposure to loneliness can have a powerful detrimental impact on health, including mental health. Addressing socially determined health inequity requires understanding of the situation of marginalized or vulnerable groups. People with disability are increasingly being recognized as one such group. Little population-based research has addressed the association between loneliness and health among working age adults with and without disability. METHODS: Secondary analysis of data collected in waves 8 and 9 of Understanding Society, the UK's main annual household panel study. RESULTS: Rates of exposure to substantial loneliness were 25.4% (95%CI 23.5-27.3%) among adults with persistent disability (disability at W8 and W9), 15.4% (13.3-17.5%) among adults with disability onset (disability at W9 only), 12.3% (10.1-14.5%) among adults with disability offset (disability at W8 only), and 6.9% (6.5-7.3%) among adults with no disability. Exposure to loneliness was positively associated with the incidence (GHQ-12) and prevalence (SF-12 Mental) of mental health problems, but not the prevalence of physical health problems (SF-12 Physical). Disability status appeared to moderate the association between loneliness and health, with the difference between the persistent disability and no disability group increasing with exposure to greater levels of loneliness. CONCLUSION: Loneliness may be an important determinant of the poorer mental health of working age adults with disability in the UK. Exposure rates are significantly higher than among the non-disabled population. The strength of association between exposure to loneliness and poorer mental health is greater for people with persistent disability than people with no disability.

Youth with disabilities are more likely than their peers to engage in hazardous child labour.

BACKGROUND: Little is known about the extent to which children and adolescents with disabilities are exposed to child labour. OBJECTIVE: To estimate prevalence rates and adjusted rate ratios of exposure to child labour among children and adolescents with/without disability in middle- and low-income countries and to determine whether these rates vary between functional limitations associated with disability. PARTICIPANTS AND SETTING: Nationally representative samples involving 142,499 children aged 5-14 from 15 countries. METHODS: Secondary analysis of data collected in UNICEF's Multiple Indicator Cluster Surveys. RESULTS: Overall children and youth with disability were not at significantly greater risk of exposure than children without disability to child labour when demographic and contextual factors were taken into account. However, children and youth with disability were at significantly greater risk of exposure than children without disability to hazardous child labour (adjusted relative risk [ARR] = 1.15 [1.10-1.21], P < 0.001). Specifically, children and youth with impairments related to poorer mental health or cognitive functioning were at significantly greater risk of exposure to hazardous child labour (e.g., ARR for learning impairment = 1.27 [1.14-1.42], P < 0.001). In contrast, children with impairments related to sensory functioning, mobility and expressive communication were at no greater risk of exposure than children with no disability. CONCLUSIONS: Children and youth with disability are at greater risk of exposure to hazardous child labour than children with no disability in middle- and low-income countries. Responses to eradicate hazardous child labour need to take account of the situation of children and youth with disability.

The feasibility of family-centred early intervention for children with disabilities in mainland China: Practitioners' perceptions.

BACKGROUND: Family-centred practice (FCP) has become a recommended practice for early intervention services for children with disabilities in many countries. However, its feasibility in Chinese context has been unclear. This study is the first to explore the perceptions of early intervention service practitioners about the implementation of FCP in mainland China. METHODS: Focus groups were employed to collect data from 37 early intervention practitioners who attended a workshop about FCP in Wuhan, China and two officers from the provincial disabled persons' federation. The data were analysed thematically. RESULTS: Four themes were identified: (a) family-centred early intervention is possible, (b) traditional concepts are not friendly towards FCP, (c) parents do not collaborate and (d) financing and personal resources are not sufficient to implement FCP. Chinese practitioners agreed with the philosophies of FCP; however, there was concern that widespread implementation may meet conceptual and practical challenges. CONCLUSIONS: The results highlighted practitioners were optimistic and keen for FCP implementation in the Chinese context, but to do so across China may still be some way in the future.

Redressing or entrenching social and health inequities through policy implementation? Examining personalised budgets through the Australian National Disability Insurance Scheme.

BACKGROUND: Increasing attention is being given to political agenda setting for the social determinants of health. While designing policies that can improve the social determinants of health is critical, so too is ensuring these policies are appropriately administered and implemented. Many policies have the potential to entrench or even expand inequities during implementation. At present little attention has been given to this in the social determinants of health literature. There is an international trend in the personalisation of funding for care services, from the National Health Service in the England to the Brukerstyrt Personlig Assistanse in Norway. Part of this trend is the Australian National Disability Insurance Scheme (NDIS). The NDIS has the potential to secure gains in health for hundreds of thousands of Australians living with a disability. However, policies are only as good as their implementation. METHODS: As part of a longitudinal study on the implementation of the Australian NDIS, we conducted a systematic document search of policy documents pertaining to the Scheme on the websites of government departments with auspice over the design and implementation of the scheme with the aim of examining issues of equity. RESULTS AND DISCUSSION: Scheme architects have argued that the NDIS has the potential to replace a piecemeal and fragmented set of state-determined services with an empowering model of user choice and control. However, without careful attention to both existing inequities and, diversity and difference across populations (e.g. different disability types and different localities), market based approaches such as the NDIS have the serious potential to entrench or even widen inequities. CONCLUSIONS: The research concluded that 'personalisation' approaches can widen inequities and inequalities unless careful consideration is given at both policy design and implementation stages.

The Social-Emotional Well-Being of Children of Mothers with Intellectual Impairment: A Population-Based Analysis.

BACKGROUND: Children of parents with intellectual impairment are thought to be at risk for poor social-emotional well-being. This study investigated the relationship between maternal intellectual impairment and poor child social-emotional well-being. METHOD: Secondary analysis of data from waves 2-4 of the Millennium Cohort Study (UK). Social-emotional well-being was measured by maternal report at Waves 2-4, with teacher and child self-report at Wave 4. Bivariate and multivariate analyses were conducted. RESULTS: Unadjusted, maternal intellectual impairment was associated with an elevated risk of overall poor social-emotional well-being at ages 3 and 5, but not at age 7. After controlling for individual, family and environmental characteristics, no statistically significant association was found between maternal intellectual impairment and poor child social-emotional well-being. CONCLUSIONS: Children of mothers with intellectual impairment are more likely than their peers to be exposed to adverse living conditions. These living conditions may explain, at least in part, why these children face a heightened risk of poor social-emotional well-being at ages 3 and 5. Improving the living conditions of mothers with intellectual impairment may offer a pathway to child social-emotional well-being.

The role of formal support in the lives of children of mothers with intellectual disability.

BACKGROUND: Mothers with intellectual disability face socioeconomic disadvantage and social isolation, which is associated with poorer child outcomes. Social services feature prominently in the lives of mothers with intellectual disability especially those without informal support; however, the role of formal support in the lives of their children has not been explored. METHODS: Seven children aged 7-11 years took part in semi-structured interviews to explore their social experiences. Stories about interactions at home, school and with peers were analysed to illuminate influences, including social support, in their lives. RESULTS: Formal support can provide an enduring relationship for children from socially restricted homes when it focuses on the child's abilities, interests and needs as distinct from those of their mother. Child-focused support can be from a paid worker or volunteer. CONCLUSIONS: Family support services need to apply a child focus to improve the well-being of children in vulnerable families.

Knowing What to Do and Being Able to Do It: Influences on Parent Choice and Use of Practices to Support Young People Living with Mental Illness.

A parent's response to a young person's mental illness can influence their recovery and wellbeing. Many parents devote considerable time and energy to supporting a young person experiencing mental illness and engage in numerous different practices to do so. Yet little is known about why parents use particular practices. This article explores this question through qualitative analysis of parent perspectives. Interviews with 32 parents of young people living with mental illness were analysed using constant comparative analysis. Findings suggest that parents' choice of and ability to carry out particular practices are shaped by: their knowledge and beliefs; their personal resources and constraints; and their social and service networks. Further, parents took active measures to optimize these influences. By understanding the complexity of their own potential influence on both knowing what to do and being able to do it, health professionals can better enable parents to support young adults experiencing mental illness.

Good, Bad or Absent: Discourses of Parents with Disabilities in Australian News Media.

BACKGROUND: News media frames public perceptions. As such, news media becomes a useful source of analysis to understand the presence (or otherwise) of people with disabilities, particularly intellectual disabilities, within parenting discourses in Australia. METHOD: Using Critical Discourse Analysis, this article examines major Australian newspapers over the period from January 2004 to December 2008, critiquing the construction of parenting and disability. A small number of articles are examined in close depth for tone, polarity syntactic and paradigmatic choice, deconstructing the underlying discourses that shape the article and thereby popular perceptions of parenting and disability. DISCUSSION: Discourses of care and child protection are emphasized in news articles about parenting, creating perceptions that negate the role of people with disabilities as parents. Such perceptions result in a systematic symbolic castration of people with intellectual disabilities from the role of parent in Australian society. CONCLUSION: By providing a framework for understanding the public perceptions of parents with disabilities (particularly intellectual disabilities), this paper demonstrates that changes are necessary in Australian media reporting on parents with disabilities to bring such reporting more closely in line with the United Nations Convention on the Rights of Persons with Disabilities, 2006.

Relationship between family quality of life and day occupations of young people with Down syndrome.

PURPOSE: To explore relationships between family quality of life, day occupations and activities of daily living (ADL) of young persons with Down syndrome. METHOD: Data were collected from 150 families with a young person with Down syndrome aged 16-30 years participating in the Down syndrome "Needs Opinions Wishes" database. Data described the young person's characteristics (including functional abilities, behaviour and day occupations) and family characteristics (including income, family and community supports and quality of life). RESULTS: Compared to families of young people attending open employment, families of young people participating in sheltered employment tended to report poorer family quality of life, after adjusting for personal characteristics, behaviour and income (coeff -6.78, 95 % CI -14.38, 0.81). Family supports reduced this relationship (coeff -6.00, 95 % CI -12.76, 0.76). Families of young people with greater functioning in ADL reported better family quality of life regardless of personal and environmental factors (coeff 0.45, 95 % CI 0.05, 0.85) and inclusion of family factors such as family supports reduced this association (coeff 0.29, 95 % CI -0.10, 0.67). CONCLUSIONS: Participation of young people with Down syndrome in open employment may positively influence family quality of life. Services that facilitate functioning in ADL and assist the families in accessing suitable family supports have the potential to positively influence family quality of life.

A Systematic Review of Interventions Addressing the Primary Prevention of Violence Against Women With Disability.

Women with disability experience significantly more violence and abuse than their nondisabled peers. Efforts to implement, evaluate, and scale-up strategies to prevent violence against women are rapidly expanding, but we know less about "what works" to prevent violence against women with disability. While secondary and tertiary prevention aim to identify violence early and prevent further occurrence, this review focuses on primary prevention. In the disability services sector, primary prevention is sometimes referred to as safeguarding and covers a range of activities that aim to address the underlying determinants of violence to prevent it from happening in the first place. The aim of this review is to identify and synthesize research on evaluated interventions addressing the primary prevention of violence against women with disability and explore evidence about their quality and effectiveness. A systematic search across the bibliographic databases of Medline, CINAHL, Embase, and PsychInfo for peer-reviewed literature published in English on or after January 1, 2010, yielded 483 papers of potential interest. Twelve studies met the inclusion criteria and were considered for review. Data were extracted and the quality of the studies was assessed using the Quality Assessment Tool for Quantitative Studies. Most studies reported outcomes from pre- and post-test research designs and received a weak rating of quality. Although interventions targeting awareness, knowledge, and skill development showed evidence of effectiveness, there is a distinct lack of program development that draws on known risk factors for violence such as the intersection of ableism and gender inequality.