Worries about inadequate medical treatment in case of a COVID-19 infection: the role of social inequalities, COVID-19 prevalence and healthcare infrastructure.

BACKGROUND: This study investigates individual and regional determinants of worries about inadequate medical treatment in case of a COVID-19 infection, an important indicator of mental wellbeing in pandemic times as it potentially affects the compliance with mitigation measures and the willingness to get vaccinated. The analyses shed light on the following questions: Are there social inequalities in worries about inadequate medical treatment in case of a COVID-19 infection? What is the role of the regional spread of COVID-19 infections and regional healthcare capacities? METHODS: Based on data derived from the German Socioeconomic Panel (SOEP), a representative sample of the German population aged 18 years and over, we estimated multilevel logistic regression models with individual-level (level 1) and regional-level (level 2) variables. The regional variables of interest were (a) the number of COVID-19 infections, (b) the number of hospital beds as an overall measure of the regional healthcare capacities, and (c) the number of free intensive care units as a measure of the actual capacities for treating patients with severe courses of COVID-19. RESULTS: Women, older respondents, persons with migrant background and those with a lower socioeconomic status were more likely to report worries about inadequate medical treatment in case of a COVID-19 infection. Moreover, respondents with chronic illness, lower subjective health and those who consider COVID-19 as a threat for their own health were more likely to report worries. In addition, also regional characteristics were relevant. Worries were more common in poorer regions with higher COVID-19 infections and worse health infrastructure as indicated by the number of hospital beds. CONCLUSIONS: The analysis not only indicates that several social groups are more concerned about inadequate medical treatment in case of a COVID-19 infection, but also highlights the need for considering regional-level influences, such as the spread of the virus, poverty rates and healthcare infrastructure, when analyzing the social and health-related consequences of the pandemic.

[Influence of partnership on burnout and gratification crisis in residents considering the distribution of house work and working time]. / Zum Einfluss von Partnerschaft auf Burnout und Gratifikationskrisen bei Ärzten und Ärztinnen in fachärztlicher Weiterbildung unter Berücksichtigung der Aufteilung von beruflicher Tätigkeit und Hausarbeit.

Background: Social support through the partner can have an impact on work related stress perception of physicians. So far, there is no empirical data on the association of gratification crisis and social support through the partner in physician's profession. Objectives: This study evaluates the effects of social support, in terms of distribution of house work and amount of working time within a partnership, on burnout and gratification crisis of residents. Material and Methods: Data acquisition was carried out within the multi-centric and prospective "KarMed" study in Germany at the end of the postgraduate training in 2016 (N = 433). The ERI and MBI scales were used. Results: Results yielded significant effects of distribution of house work and the amount of working time on gratification crisis and burnout. Conclusions: The satisfaction with the distribution of house work as well as working time in a partnership plays an important role for the wellbeing of residents. In terms of decreasing numbers of outpatient practices, the results of the present study underlie the relevance of work-life balance.

[Changes in well-being and private support for older people: a closer look at the impact of the COVID-19 pandemic in early summer 2020]. / Veränderungen von Wohlbefinden und privater Unterstützung für Ältere: ein Blick auf die Auswirkungen der COVID-19-Pandemie im Frühsommer 2020.

BACKGROUND: The pilot study "Health and Support in Times of Corona" (TU Dortmund University) collected data on support and well-being of individuals aged 40 plus years in the light of the first wave of the COVID-19 pandemic from May to July 2020. OBJECTIVE: The aim was to study the social and mental effects of the pandemic. We focused on individuals living in private households aged 40 years and older. Participants were asked about pandemic-related changes in receiving and providing support (e.g. personal care, help with household chores), problems arising in taking care of older persons and changes in well-being. MATERIAL AND METHODS: We conducted descriptive and multivariate analyses to show how support changed, problems with support came up and well-being changed in the light of the pandemic and how all this was related. RESULTS: Due to the pandemic older respondents in particular were no longer able to provide the necessary support for others. Especially women reported problems in taking care of older individuals. We found a decrease in well-being for all respondents but most significantly for women and individuals aged 80 years and older. Moreover, problems in the provision of care due to the pandemic and lower well-being were clearly linked. CONCLUSION: Our study showed significant changes in support patterns and well-being due to the COVID-19 pandemic. A substantial part of the respondents reported more loneliness and lower life satisfaction compared to before the pandemic, especially women supporting others. In these pandemic times, informal caregiving is severely hampered. Future pandemic-related measures should be carefully planned bearing such issues in mind.

[Health inequalities in old age : Theoretical perspectives and methodological challenges]. / Gesundheitliche Ungleichheiten im Alter : Theoretische Perspektiven und methodische Herausforderungen.

While it has been long known that health inequalities persist until higher ages, less is known about the underlying mechanisms and health trajectories over the life course. This article gives an overview on recent developments regarding theoretical concepts and methodological considerations in this field of research. It can be concluded that studies on the explanation of the social gradient in health are scarce and even less is known about societal contexts that enable healthy aging irrespective of the socioeconomic position. The existing evidence on causal mechanisms and developments over the life course warrants cautious interpretation due to selective study samples and cross-sectional study designs.

Gendered experiences of widowhood and depression across Europe: The role of loneliness and financial resources from a longitudinal perspective.

OBJECTIVE: This study analyses the gendered experiences of widowhood and its relation to depressive symptoms in four European regions. A special focus lies on the question whether loneliness and reduced financial contribute to the detrimental effect of widowhood on mental health. METHODS: Using waves 5,6 and 7 of the Survey of Health. Ageing and Retirement in Europe (SHARE), this study estimates fixed-effects linear regression models for the effect of widowhood on depressive symptoms with and without adjustment for potential mediating factors. RESULTS: There were no gender differences in the mental health consequences of widowhood irrespective of the regional context. Whereas loneliness was a major pathway through which widowhood exerts its negative consequences on mental health, reduced financial resources did not play a substiantial role. Moreover, the magnitude of the widowhood effect on depressive symptoms differed between European regions with stronger increases in Southern Europe. These regional differences were attenuated when accounting for inequalities in financial resources and loneliness. DISCUSSION: The findings support Attachment Theory, which postulates that it's mainly the loss of such an emotionally strong tie as one's spouse that leads to psychological distress following widowhood. Moreover, one can conclude that some contexts in Europe provide conditions that buffer the negative effect of widowhood on mental health at least to some extent.

The gender health gap in Europe's ageing societies: universal findings across countries and age groups?

We provide a systematic country and age group comparison of the gender gap in several generic health indicators and more specific morbidity outcomes. Using data from the Survey of Health, Ageing and Retirement (SHARE), we examined the gender gap in the prevalence of poor self-rated health, chronic health conditions, activity limitations, multimorbidity, pain, heart attacks, diabetes, and depression in three age groups (50-64, 65-79, and 80+) based on linear probability models with and without adjustment for covariates. While women were typically disadvantaged regarding poor self-rated health, chronic health conditions, activity limitations, multimorbidity, pain, and depression, men had a higher prevalence of heart attacks and diabetes. However, the gender gap's magnitude and sometimes even its direction varied considerably with some age trends apparent. Regarding some health indicators, the gender gap tended to be higher in Southern and Eastern Europe than in Western and Northern Europe. All in all, the presence of a gender health gap cannot be regarded as a universal finding as the gap tended to widen, narrow or even reverse with age depending on the indicator and country.

Gendered patterns of depression and its determinants in older Europeans.

BACKGROUND: Few studies consider multiple pathways for explaining the gendered patterns of depression in Europe's aged population, although ageing is often associated with an increased exposure to risk factors for depression, and the relevance of these risk factors is likely to differ between countries. METHODS: Based on the Survey of Health, Ageing and Retirement in Europe (SHARE), we assess the relevance of gender inequalities in the exposure to psychosocial, socio-economic, and health-related factors for explaining the gender gap in depression. Further, we investigate the association between depressive symptoms and these explanatory variables by gender and analyse whether their relevance differs between countries. RESULTS: Both the prevalence of depression by gender and the magnitude of the gender gap were low in Northern Europe and rather high in Southern Europe. Part of the gender gap was explained by psychosocial, socio-economic, and health-related factors but significant gender differences remained. Health-related factors were of outstanding importance for explaining within-country variation in depressive symptoms for both women and men. With regard to psychosocial and socio-economic factors, the results were less clear. CONCLUSION: The assessment of gender inequalities in depression and their determinants within different social policy contexts enables evidence-based interventions to reduce the gender gap and ensure high quality of life for older men and women. To that end, the reduction of health-related risk factors seems to be of utmost importance in all European countries, whereas interventions in the area of socio-economic and psychosocial risk factors should be gender- and context-specific.