Patterns and determinants of tobacco purchase behaviors among male cigarette smokers in Vietnam: A latent class analysis.

INTRODUCTION: Understanding smokers' purchasing patterns can aid in customizing tobacco control initiatives aimed at reducing the tobacco smoking prevalence. Therefore, this study identified cigarette purchase behavior among Vietnamese male smokers and associated demographic and consumption factors. METHODS: We analyzed a secondary dataset of male current tobacco smokers (n=3983) who participated in the Vietnam Global Adult Tobacco Survey in 2015. We applied the latent class analysis (LCA) to identify the classes of purchase behavior among cigarette smokers (n=1241). Multinomial logistic regression was performed to identify demographics (education level, ethnicity, partnership status, and household socioeconomic status) and cigarette consumption variables (smoking years and heavy smoking status) related to purchase behavior classes. The results are reported as an adjusted relative risk ratio (ARRR). RESULTS: The LCA identified four cigarette purchase behaviors classes: Class 1 (price-insensitive and purchased international brand: 44.4%), Class 2 (price-sensitive and purchased domestic brand: 27.6%), Class 3 (price-sensitive and purchased cigarettes in a street vendor: 18.6%), and Class 4: price-sensitive and purchased loose/carton cigarette: 9.4%). The poorer economic groups were more likely to belong to the three price-sensitive classes. Heavy smokers and those who had smoked for a longer period were more likely to belong to Class 3 (ARRR=2.33; 95% CI: 1.51-3.58 and ARRR=1.02; 95% CI: 1.001-1.05, respectively) and Class 4 (ARRR=2.94; 95% CI: 1.71-5.06 and ARRR=1.05; 95% CI: 1.02-1.08, respectively). CONCLUSIONS: Varied purchasing behaviors among male cigarette smokers, influenced by divergent price sensitivities and economic backgrounds, underscore the need for comprehensive tobacco control. Future efforts should include targeted policy interventions, behavior modification, and reshaping social norms.

How gender and low mental health literacy are related to unmet need for mental healthcare: a cross-sectional population-based study in Sweden.

BACKGROUND: Men are more likely to have unmet need for mental healthcare than women. However, an under-investigated aspect of the gender difference is the role of mental health literacy. This study investigated how combinations of gender and mental health literacy were related to two indicators of unmet need: not perceiving a need for mental healthcare despite poor mental health, and refraining from seeking mental healthcare. METHODS: This cross-sectional study was based on a questionnaire sent to a general population sample, aged 16-84 years, in Stockholm County, Sweden, in 2019. Of the 1863 respondents (38%), 1563 were included (≥18 years). The sample was stratified into four groups, men and women with low or high mental health literacy, using the third quartile of the Mental Health Knowledge Schedule. The likelihood of not perceiving a need for mental healthcare and refraining from seeking mental healthcare, at any time in life, were investigated by calculating odds ratios with 95% confidence intervals. RESULTS: Men with low mental health literacy were most likely to not perceive a need for mental healthcare, also when adjusting for age, education, and poor mental health (OR 5.3, 95% CI 3.6-7.7), and to refrain from seeking mental healthcare, also when adjusting for age and education (OR 3.3, 95% CI 1.7-6.4), followed by men with high mental health literacy (OR 1.9, 95% CI 1.5-2.4, and OR 1.5, 95% CI 1.0-2.2) and women with low mental health literacy (OR 1.9, 95% CI 1.2-2.9, and OR 2.1, 95% CI 1.1-3.9). Women with high mental health literacy were least likely (reference group). CONCLUSION: The results show differences in the likelihood of unmet need for mental healthcare based on combinations of gender and mental health literacy level, with men having low mental health literacy being most at risk, and women with high mental health literacy being least at risk. This challenges generalisations of a gender difference in unmet need by showing heterogeneity among men and women based on mental health literacy. Men with low mental health literacy may be particularly in need of targeted interventions to reduce potential individual and societal consequences of their unmet need.

Differences in how women and men in a Swedish population-based sample think about sick leave: A cross-sectional vignette study.

BACKGROUND: Gender differences in attitudes towards depression gives reason to believe that sociocultural gender norms play a role in other areas. OBJECTIVE: The aim was to test (i) if the likelihood to think that sick leave with depression symptoms is not reasonable varies between women and men, and (ii) if the likelihood to think sick leave is not reasonable varies depending on the gender of the individual with depression symptoms. METHODS: A study population of 3147 participants responded to a web-survey with a written case briefly describing a man or woman with symptoms of depression. Respondents were asked if they thought it is reasonable that the person was sick listed for two weeks. Logistic regression was used to analyse the data. RESULTS: After controlling for age, education, self-rated health, and respondent's own experience of sickness absence the adjusted OR was 1.45 (95% CI 1.25-1.67) for men being less likely to think sick-leave was reasonable. Gender difference decreased when adjusting for negative attitudes towards depression (adjusted OR 1.24, 95% CI 1.06-1.44). No difference was found between how women and men thought about sick leave in relation to the gender of the case described in the vignette. CONCLUSION: Men were more likely to think that sick leave was not reasonable with decreased OR after adjustment for negative attitudes towards depression. Gender norms might be part of the explanation for differences but are challenging to test. This study contributes to a bourgeoning research field on gendered attitudes and sick leave, in terms of theoretical reasoning and methodological choice.

Adopting a child perspective for exposome research on mental health and cognitive development - Conceptualisation and opportunities.

Mental disorders among children and adolescents pose a significant global challenge. The exposome framework covering the totality of internal, social and physical exposures over a lifetime provides opportunities to better understand the causes of and processes related to mental health, and cognitive functioning. The paper presents a conceptual framework on exposome, mental health, and cognitive development in children and adolescents, with potential mediating pathways, providing a possibility for interventions along the life course. The paper underscores the significance of adopting a child perspective to the exposome, acknowledging children's specific vulnerability, including differential exposures, susceptibility of effects and capacity to respond; their susceptibility during development and growth, highlighting neurodevelopmental processes from conception to young adulthood that are highly sensitive to external exposures. Further, critical periods when exposures may have significant effects on a child's development and future health are addressed. The paper stresses that children's behaviour, physiology, activity pattern and place for activities make them differently vulnerable to environmental pollutants, and calls for child-specific assessment methods, currently lacking within today's health frameworks. The importance of understanding the interplay between structure and agency is emphasized, where agency is guided by social structures and practices and vice-versa. An intersectional approach that acknowledges the interplay of social and physical exposures as well as a global and rural perspective on exposome is further pointed out. To advance the exposome field, interdisciplinary efforts that involve multiple scientific disciplines are crucial. By adopting a child perspective and incorporating an exposome approach, we can gain a comprehensive understanding of how exposures impact children's mental health and cognitive development leading to better outcomes.

Individual-, social- and policy- factors associated with smoking cessation among adult male cigarette smokers in Hanoi, Vietnam: a longitudinal study.

BACKGROUND: Nearly one-in-two Vietnamese men smoke cigarettes placing them among the highest tobacco consumers in the world. Despite the need for smoking cessation to curb the burden of tobacco-related diseases in Vietnam, this rate remains at less than 30%. Therefore, this study examines individual-, social- and policy factors associated with smoking cessation among adult male smokers in Vietnam. METHODS: We established a longitudinal International Tobacco Control study of male smokers in Hanoi, Vietnam, in September 2018. This paper analyses 1525 men who participated in baseline and one-year follow-up. We applied a weighted multivariable logistic regression to examine the association between smoking cessation and individual-, social- and policy predictors. RESULTS: At follow-up, 14.8% of participants had quit smoking for at least 30 consecutive days during the last year. Among the persistent smokers, 56.6% expressed intention to quit smoking. Factors associated with smoking cessation included a lower number of cigarettes smoked per day (aOR = 0.96, 95% CI: 0.94, 0.99) and having several attempts to quit smoking (aOR = 2.16, 95% CI 1.13, 4.12). Intention to quit smoking was associated with multiple quit attempts, a chronic condition diagnosis, more tobacco-related knowledge, greater self-efficacy, and more worries about their future health. The perceived impact of smoke-free policy and health warning labels were positively associated with intention to quit at any stage. CONCLUSIONS: Interventions aimed at increasing smoking cessation should focus on all aspects of individual, social, and policy factors. Persistent smokers are more motivated to quit if they have made multiple quit attempts, more self-efficacy of quitting and worried about their future health, indicating that increasing smokers' beliefs and knowledge may be important for behavioural change. Health warning labels and tobacco taxation policies should be maintained and promoted as they are perceived to be particularly useful for persistent smokers' intention to quit.

Healthcare professionals discourses on men and masculinities in sexual healthcare: a focus group study.

Studies have reported that men's uptake of sexual health services is low, that these services make them feel vulnerable, and that they experience sexual healthcare (SHC) as stressful, heteronormative, potentially sexualised and "tailored for women". They also suggest that healthcare professionals (HCPs) working in SHC view masculinity as problematic, and situated in private relationships. This study aimed to explore how HCPs construct the gendered social location in SHC, specifically in terms of masculinity and a perception that masculinity is situated in relationships. Critical Discourse Analysis was used to analyse transcripts from seven focus group interviews with 35 HCPs working with men's sexual health in Sweden. The study found that gendered social locations were discursively constructed in four ways: (I) by problematising and opposing masculinity in society; (II) through discursive strategies where a professional discourse on men and masculinity is lacking; (III) by constructing SHC as a feminine arena where masculinity is a visible norm violation; (IV) by constructing men as reluctant patients and formulating a mission to change masculinity. The discourses of HCPs constructed the gendered social location of masculinity in society as incompatible with SHC, and saw masculinity in SHC as a violation of feminine norms. Men seeking SHC were constructed as reluctant patients, and HCPs were seen as agents of change with a mission to transform masculinity. The discourses of HCPs risk othering men in SHC, which could prevent care on equal terms. A shared professional discourse on masculinity could create a common foundation for a more consistent, knowledge-based approach to masculinity and men's sexual health in SHC.

Association of stigmatizing attitudes with people's opinion of depression as a valid reason for sickness absence: A Swedish vignette study.

BACKGROUND: Depression is a common cause of sickness absence (SA) and also highly associated with stigma. Few studies have addressed the role of stigma in relation to SA. OBJECTIVE: To investigate if attitudes to depression were associated with the public's opinion of depression as a valid reason of SA. METHODS: The study population (n = 2413) originated from a web-based panel of citizens. The survey included a short vignette describing a person with symptoms of depression and the person's work tasks, followed by a question on recommendation of SA. Negative attitudes were measured by the Depression Stigma Scale. Logistic regressions were used to estimate the odds ratios (OR) for the likelihood of not recommending SA, controlling for individual and work-related co-variates. RESULTS: The crude association between negative attitudes and not recommending SA was OR 2.15 (95% CI, 1.76-2.62). In the fully adjusted model the OR was 1.76 (95% CI, 1.40 -2.21) for not recommending SA. CONCLUSIONS: Participants with negative attitudes to depression were more likely to not consider depression as a valid reason of sickness absence. The study supports theories on layered stigma; attitudes from one arena are related to other arenas. Future studies are needed to confirm our findings.

Notions About Men and Masculinities Among Health Care Professionals Working With Men's Sexual Health: A Focus Group Study.

Health care professionals' (HCPs) notions about gender may influence the provision and quality of care. If care-seeking men are met by HCPs holding idealized and stereotypical notions of masculinity, this could reinforce barriers to adequate care. This study explored notions about men and masculinities among HCPs working with men's sexual health in Sweden. Focus group interviews with 35 HCPs from primary health and sexual health clinics were analyzed using qualitative content analysis. The analysis resulted in three descriptive themes: (a) Contradictory masculinity-elusive but clear. Notions of masculinity as a phenomenon or concept were elusive, but masculine and un-masculine traits, behaviors, and qualities were clear. (b) Sexual health care is a social place where men and masculinities can be challenging. Male patients were associated with unwanted sexual tensions. Masculinity could challenge professionality. Seeking sexual health care was perceived as doing un-masculinity. (c) Regarding masculinity as irrelevant-a difficult ambition to achieve. Participants strived for gender-neutrality by regarding patients as humans, individuals, or patients rather than as men and masculine. The analysis also identified a theme of meaning: Notions of masculinity are situated relationally. HCPs situate masculinity in real and hypothetical relationships. Romantic and sexual preferences were used to define preferred masculinity. This study identified themes that showed how HCPs balanced professional and private notions of men and masculinity in their patient encounters. Increased gender awareness and training are needed to professionalize the management of gendered notions in encounters with men who seek care for sexual health problems.

Poorer mental well-being and prior unmet need for mental healthcare: a longitudinal population-based study on men in Sweden.

BACKGROUND: Depression and anxiety disorder contribute to a significant part of the disease burden among men, yet many men refrain from seeking care or receive insufficient care when they do seek it. This is plausibly associated with poorer mental well-being, but there is a lack of population-based research. This study investigated 1) if men who had refrained from seeking mental healthcare at any time in life had poorer mental well-being than those who sought care, 2) if those who had sought care but perceived it as insufficient had poorer mental well-being than those who had perceived care as sufficient, and 3) if these differences persisted after 1 year. METHODS: This longitudinal study used questionnaire data from a population-based sample of 1240 men, aged 19-64 years, in Sweden. Having refrained from seeking mental healthcare, or perceiving the care as insufficient, at any time in life, was assessed in a questionnaire, 2008. Current mental well-being was assessed in 2008 and 2009 using mean scores on the WHO (Ten) Well-being Index. Lower scores indicate poorer mental well-being. Group differences were calculated using t-tests and multivariable linear regression analysis. RESULTS: Of the men who had perceived a need for mental healthcare, 37% had refrained from seeking such care. They had lower mental well-being scores in 2008, compared to those who sought care. Of those seeking care, 29% had perceived it as insufficient. They had lower mental well-being scores in 2008, compared to those who perceived the care as sufficient, but this was not statistically significant when controlling for potential confounders. There were no differences in mental well-being scores based on care-seeking or perceived care-sufficiency in 2009. CONCLUSIONS: This population-based study indicates that men who have previously refrained from seeking mental healthcare, or perceived the care as insufficient, have poorer mental well-being. However, the lack of differences at the one-year follow-up contradicts these results. The results highlight the need for larger longitudinal studies, measuring care-seeking within a more specified time frame. This should be combined with efforts to increase men's mental healthcare-seeking and to provide mental healthcare that is perceived as sufficient.

Experiences of family violence and parental unavailability in childhood in relation to parental socioeconomic position and psychological problems: a cohort study of young Swedish women 1990-2013.

BACKGROUND: Despite the high prevalence and severe consequences for health and wellbeing, epidemiological research of neglected emotional needs during childhood is scarce and little is known about its relation to parental socioeconomic position (SEP). This study investigates the prevalence of family violence and parental unavailability in childhood and its association with parental SEP and parental psychological problems in four strata of young Swedish women examined 1990, 1995, 2000, and 2013. METHOD: The sample comprised 976 women (mean age 22, range 20-25) living in Sweden. Secular trends for family violence, parental rejection and unavailability were analyzed using logistic regression as a function of year of examination. The associations with parental SEP and parental psychological problems were assessed using logistic regression with results in terms of odds ratios (OR) and 95% confidence intervals. RESULTS: Gendered patterns were observed in the associations between parental psychological problems and family violence and parental unavailability. Maternal psychological problems were associated with maternal rejection OR 6.8 (3.5-13.0), maternal lack of time OR 2.4 (1.2-5.0), and paternal rejection OR 1.9 (1.1-3.5). Paternal psychological problems were associated with paternal rejection OR 4.0 (2.1-7.7), paternal lack of time OR 4.9 (2.3-10.6), and experiencing family violence OR 4.9 (2.1-11.6). Low and medium parental SEP were associated with experience of family violence in childhood OR 3.1 (CI 1.1-8.5) and OR 3.4 (1.7-6.9), respectively. No changes between 1990 and 2013 were observed for the prevalence of any of the outcomes. CONCLUSIONS: A stable prevalence of family violence and parental unavailability was reported by young women examined between 1990 and 2013. Lower socioeconomic position was associated with family violence while the association with parental unavailability was non-significant. Gendered patterns were observed in the association between parental psychological problems and family violence, where paternal but not maternal psychological problems were associated with family violence. Further, maternal psychological problems were associated with paternal rejection while paternal psychological problems were not associated with maternal rejection. Gendered patterns of parental unavailability need further studies.

To Live, Not Only Survive-An Ongoing Endeavor: Resilience of Adult Swedish Women Abused as Children.

Background: A significant proportion of individuals exposed to maltreatment in childhood adapt positively in adulthood despite the adversities, i.e., show resilience. Little is known about resources and processes related to adulthood that promote resilience. Since women are overrepresented as victims of intrafamilial violence, understanding resilience among adult women is important. Objective: To explore experiences of resilience among adult women who perceive well-being and well-functioning although being exposed to maltreatment during childhood. Participants and Setting: This study included 22 women with experiences of childhood maltreatment, mean age of 48 years, living in Sweden. Methods: Individual interviews were conducted and analyzed according to constructivist grounded theory. Results: The process of resilience was experienced as an ongoing endeavor to live, not only survive, an internal process that interacted with external processes involving social relations and conditions. This endeavor was built on four interrelated resources: establishing and maintaining command of life; employing personal resources; surrounding oneself with valuable people; and reaching acceptance. These worked together, not in a linear or chronological order, but in up and down ways, turns and straight lines (now and then), through the process from maltreatment to well-being. Conclusion: Resilience was found to rest on intrapersonal and interpersonal resources. Individual's inherent capabilities can be, depending on life circumstances and available resources, realized in a way that promote well-being and well-functioning despite severe adversities. Therefore, public health initiatives, social services, and policies should provide conditions that help women maltreated in childhood to live fully rather than merely to survive.

Promoting mental health in migrants: a GHQ12-evaluation of a community health program in Sweden.

BACKGROUND: Research increasingly highlight post-migration factors for migrants' mental health status. We investigated the association between participation in a health promotion program and changes in migrants' mental health, and if socio-demographic factors and length of time in the new home country, Sweden, influenced a potential association. METHODS: A five-week health promotion program named 'Hälsostöd' [Health Support], led by community health workers, was offered to migrants, primarily asylum seekers and newly arrived immigrants (N = 202). The framework for the program was salutogenic psycho-education, which focused on health effects of migration experiences, lifestyle and health, and the health care system. Mental health was measured at the start and end of the program. We analysed this follow up by using the recommended clinical cut off (i.e. > 11 of maximum 36, with higher scores indicating possible mental illness) in the 12- item version of the General Health Questionnaire (GHQ12). Chi Square test was used to analyse statistical significance of changes, and multinomial logistic regression to analyse associations to sociodemographic factors and length of stay in Sweden. RESULTS: The number of participants scoring above the clinical cut off after participation in the program (N = 79, 39.1%) was lower compared to the corresponding number before participation (N = 111, 55.0%), Chi Square = 10.17, p < .001. The majority of the participants had no change 72.3 (N = 146), 21.8% (N = 44) had a positive change, yet 5.9% (N = 12) had a negative change, compared to before participation in the program. None of the investigated sociodemographic factors showed to significantly influence the association. Length of stay in Sweden was trending, with participants with longer stay being more likely to have possible mental illness. CONCLUSION: We conclude that psycho-educative programs, similar to 'Hälsostöd', have potential for promoting asylum seekers' and newly arrived immigrants' mental health as the evaluation showed a considerable number of positive changes in participants. The result suggests the importance of offering immigrants health promotive programs in close connection with arrival to the new home country. Future research should clarify under what circumstances sociodemographic factors influence the effects of such programs.

Early pregnancy overweight/obesity and length of residence among immigrants in Sweden: a pooled analysis of Swedish population registers between 1992 and 2012.

OBJECTIVE: To examine whether the association between women's origin and early pregnancy overweight and obesity (OW/OB) varies by length of residence in Sweden. DESIGN: This cross-sectional observational study used pooled Swedish population register data from 1992 to 2012. Logistic regression models were run to estimate odds ratios (OR) of early pregnancy OW/OB and 95 % confidence intervals (95 % CI), comparing Swedish-born and immigrants by length-of-residence categories while adjusting for covariates. SETTING: Sweden. PARTICIPANTS: In total, 1 771 821 pregnant women, 315 992 of whom were immigrants. RESULTS: With longer residence in Sweden, more immigrant women from various origins exhibited higher odds of experiencing early OW/OB compared with Swedish-born women. Findings specifically showed increased odds of early pregnancy OW/OB with increasing length of residence for women born in Latin America, Europe-27 and Southeast Asia. For example, immigrant women from Latin America residing in Sweden for < 6 years showed similar odds as Swedish-born (OR≤ 5 years 0·92, 95 % CI 0·87, 0·98), while their longer residing counterparts showed higher odds than Swedish-born women (OR6-15 years1·21, 95 % CI 1·14, 1·28 and OR≥ 16 years 1·68, 95 % CI 1·59, 1·78). Mixed results were found for other origins. CONCLUSIONS: The current study suggests that host country conditions might play an important role in explaining OW/OB among some groups of immigrant women. Although further studies are needed to disentangle the mechanisms that generate these health inequalities, policy efforts should focus on immigrant reception and early integration to prevent pregnancy-related OW/OB.

Intimate partner violence, associations with perceived need for help and health care utilization: a population-based sample of women in Sweden.

Aim: To assess the association between physical intimate partner violence (physical IPV) in the past 5 years, perceived need for help and primary health care utilization due to mental health problems in a general population-based sample of women in Sweden. Methods: We performed structured follow-up interviews with 616 women between 1995 and 2015. Associations between physical IPV in the past 5 years and (i) perceived need for help and (ii) primary health care utilization due to mental health problems, were estimated by logistic regression analyses with crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results: Of the women who had experienced physical IPV in the past 5 years, 45.1% perceived a need for help but refrained from seeking care. After adjusting for sociodemographic factors, exposure to physical IPV in the past 5 years remained associated with perceived need for help (OR 3.54; CI 1.77-7.11). After adjusting for sociodemographic factors, the association between exposure to physical IPV and primary health care utilization did not remain statistically significant. Conclusions: Women exposed to physical IPV were more likely to perceive the need for help compared with unexposed women. A large proportion of IPV-exposed women in the general population may refrain from seeking care although they perceive a need for help. Future studies need to investigate potential barriers to mental health care seeking among women exposed to IPV. Routine questioning about IPV should be implemented in primary health care with improved referral to available support services.

Unmet Need for Mental Healthcare in a Population Sample in Sweden: A Cross-Sectional Study of Inequalities Based on Gender, Education, and Country of Birth.

This cross-sectional study investigated if gender, education, and country of birth were associated with perceived need and unmet need for mental healthcare (i.e., refraining from seeking care, or perceiving care as insufficient when seeking it). Questionnaire and register data from 2008 were collected for 3987 individuals, aged 19-64 years, in a random population-based sample from western Sweden. Descriptive statistics and logistic regression analyses were used. Men were less likely to perceive a need for care than were women, even after adjusting for mental well-being. Men were also less likely to seek care and perceiving care as sufficient. People with secondary education were less likely to seek care than those with university education. There were no statistically significant differences based on country of birth. The observed gender and education-based inequalities increases our understanding of where interventions can be implemented. These inequalities in unmet need for mental healthcare should be targeted by the healthcare system.

Political Ideology and Stigmatizing Attitudes Toward Depression: The Swedish Case.

BACKGROUND: Stigmatizing attitudes toward persons with mental disorders is a well-established and global phenomenon often leading to discrimination and social exclusion. Although previous research in the United States showed that conservative ideology has been related to stigmatizing attitudes toward mental disorders, there is reason to believe that this mechanism plays a different role in the context of a universal welfare state with a multi-party system such as Sweden. Furthermore, "mental disorders" may signify severe psychotic disorders, which may evoke more negative attitudes. This suggests the importance of specific studies focusing on the more common phenomenon of depression. This paper investigates the relationship between political ideology and stigmatizing attitudes toward depression in Sweden. METHODS: This study is part of the New Ways research program. Data were collected by the Laboratory of Opinion Research (LORE) at the University of Gothenburg in 2014 (N = 3246). Independent variables were political ideology and party affiliation. The dependent variable was the Depression Stigma Scale (DSS). Data were analyzed with linear regression analyses and analyses of variance. RESULTS: More conservative ideology (B = 0.68, standard error [SE] = 0.04, P<.001) and more conservative party affiliation (F(8 2920) = 38.45, P<.001) showed more stigmatizing attitudes toward depression. Item-level analyses revealed a difference where the supporters of the conservative party differed (P<.05) from supporters of the liberal party, with a higher proportion agreeing that "people could snap out of " depression if they wanted to; the populist right-wing party differed from the conservative party with a higher proportion agreeing on items displaying people with depression as "dangerous" and "unpredictable." Even self-stigma was highest among the populist right-wing party with 22.3% agreeing that "if I had depression I wouldn't tell…." CONCLUSION: Political ideology was associated with stigmatizing attitudes toward depression in Sweden. The results also confirm the need to distinguish between different forms of conservatism by observing social distance as being a more important driver among voters for the populist right-wing party compared with personal agency and responsibility among voters for the more traditional conservative party.

Suicidal ideation and attempts in population-based samples of women: temporal changes between 1989 and 2015.

BACKGROUND: Little is known about temporal changes in the prevalence of self-reported suicidal ideation and attempts within general populations of women. The aim of this study was to assess the prevalence of self-reported suicidal ideation and attempts over a 26 year period (1989-2015) among women from the general population aged 20-49 years. A further aim was to investigate associations between sociodemographic factors and lifetime suicidal ideation over this study period. METHODS: A total of 2072 structured personal interviews were performed with a stratified population-based sample of women between 1989 and 2015. Questions about lifetime suicidal ideation and attempts as well as sociodemographic factors were assessed at four data collection waves. Lifetime prevalence of suicidal ideation and attempts were compared through analysis of differences between two independent proportions and their 95% Confidence Intervals (CI). Associations between sociodemographic factors and lifetime suicidal ideation were estimated by weighted odds ratios (OR). RESULTS: Women aged 20-30 years reported higher lifetime prevalence of suicidal ideation in 2013-2015 compared to 1989-1991 (45 and 33% respectively). Rates of lifetime suicide attempts remained similar between these time points (3.5 and 3.1% respectively). Women aged 31-49 years reported higher lifetime prevalence of suicidal ideation in 2013-2015 compared to 2000-2002 (35.4 and 23.1% respectively). In this age group, lifetime suicide attempts increased from 0.0% in 2000-2002 to 3.6% in 2013-2015. Women aged 20-30 years who were single, unemployed or had low educational attainment had higher OR of lifetime suicidal ideation compared to the reference categories in most of the study waves. In 2013-2015, young students had lower OR of lifetime suicidal ideation (OR 0.34; 95% CI 0.17-0.69) compared to those with employment. Women aged 31-49 years, who were single, had higher OR of lifetime suicidal ideation (OR 2.61; 95% CI 1.06-6.44) than married, cohabiting women and this was observed in 2013-2015. CONCLUSION: The results raise a general concern about an increasing trend in suicidal ideation among young and middle-aged women. The current study expands on previous research by demonstrating that sociodemographic factors may show changing patterns in the associations with lifetime suicidal ideation over time.

Soil-transmitted Helminth infection in the Tiko Health District, South West Region of Cameroon: a post-intervention survey on prevalence and intensity of infection among primary school children.

INTRODUCTION: Soil-transmitted helminths (STH) infection remains a public health problem in sub-Saharan Africa with children being most vulnerable. STH infection may result in impairment, permanent disability or death. Annual mass deworming has been implemented in the Tiko Health District (THD), however, no study has assessed the current prevalence of STH infection. This study aimed to determine the prevalence, intensity of STH infections and associated risk factors among school children. METHODS: Two months after the school deworming exercise, 400 children were sampled from 10 schools in THD. Stool samples were collected and analyzed using the Kato-katz technique. Data on socio-demographic and behavioral factors were collected using questionnaires. Data were analyzed using SPSS and intensity of infection categorized following WHO recommendations. Descriptive data were calculated with frequencies (n) and proportions (%), prevalence and 95% confidence interval calculated for gender and age respectively. Differences in prevalence for socio-demographic characteristics and behavioral variables were calculated with Chi square (χ2). Independent sample t-test was used to compare the means in the number of eggs in feces between male and female school children. RESULTS: The prevalence of STH was 1% (95% CI: 0.02-1.98). Ascaris lumbricoides was the only STH species detected and all cases were of low intensities. The arithmetic mean egg intensity was 3.1egg per gram of faeces. Rates of infection were similar between gender and age. Site of defecation showed an association with STH infection (χ2 = 13.63, p=0.03). CONCLUSION: These findings suggested a low prevalence of STH infection which could be explained by the prior deworming of children, modification in environmental and behavioral factors. Questions on effectiveness of annual mass deworming in achieving STH elimination targets need to be investigated further.

The capacity to work puzzle: a qualitative study of physicians' assessments for patients with common mental disorders.

BACKGROUND: Entitlement to sickness benefits is a legal process requiring health-related reduced work capacity confirmed by a physician via a sickness certificate. However, there is a knowledge gap concerning physicians' clinical practice of work capacity assessments for patients with common mental disorders (CMD). Physicians claim more knowledge and skills in how to actually do the assessments. The aim of this study was to explore physicians' tacit knowledge of performing assessments of capacity to work and the need for sickness absence in patients with depression and anxiety disorders. METHODS: We performed a qualitative study with open-ended interviews and a short video vignette of a physician and a patient with depression as stimuli. Participating physicians (n = 24) were specialized in general practice, occupational health or psychiatry and experienced in treating patients with depression and anxiety. Interviews were audio-recorded and transcribed verbatim. Inductive content analysis was used as the analytical tool. RESULTS: Five categories were identified. Category 1 identified work capacity assessment as doing a jigsaw puzzle without any master model. The physicians both identified and created the pieces of the puzzle, mainly by facilitating strategies to make the patient a better supplier of essential information. The finished puzzle made up a highly individualized comprehensive picture required for adequate assessment. Categories 2-4 identified the particular essential pieces of information the participants used, relating to the patient's disorder, capacity in the work place and contextual everyday life. For the sickness absence assessment, apart from decreased work capacity, the physicians also took particulars of the work place into account; e.g. could the work place handle an employee with reduced capacity. CONCLUSIONS: Physicians' tacit knowledge of assessing work capacity and the need for sickness absence for patients with CMD was identified as doing a jigsaw puzzle. The physicians became identifiers and creators of the pieces of the puzzle using a broad palette of essential information. Our findings contribute to the knowledge gap on clinical assessment and can be used as an educational tool. Because they are based on the professions' tacit knowledge, acceptance of the model can be expected to be high.

Cause-specific mortality in Swedish males diagnosed with non-psychotic mental disorders in late adolescence: a prospective population-based study.

BACKGROUND: While risk of premature death is most pronounced among persons with severe mental illness, also milder conditions are associated with increased all-cause mortality. We examined non-psychotic mental (NPM) disorders and specific causes of natural death in a cohort of late adolescent men followed for up to 46 years. METHODS: Prospective cohort study of Swedish males (n=1 784 626) who took part in structured conscription interviews 1968-2005. 74 525 men were diagnosed with NPM disorders at or prior to conscription. Median follow-up time was 26 years. HRs for cause-specific mortality were calculated using Cox proportional hazards models. RESULTS: Risks in fully adjusted models were particularly elevated for death by infectious diseases (depressive and neurotic/adjustment disorders (HR 2.07; 95% CI 1.60 to 2.67), personality disorders (HR 2.90; 95% CI 1.96 to 4.28) and alcohol-related and other substance use disorders (HR 9.02; 95% CI 6.63 to 12.27)) as well as by gastrointestinal causes (depressive and neurotic/adjustment disorders (HR 1.64; 95% CI 1.42 to 1.89), personality disorders (HR 2.77; 95% CI 2.27 to 3.38) and alcohol-related/substance use disorders (HR 4.41; 95% CI 3.59 to 5.42)). CONCLUSION: Young men diagnosed with NPM disorders had a long-term increased mortality risk, in particular due to infectious and gastrointestinal conditions. These findings highlight the importance of early preventive actions for adolescents with mental illness.