scholarly journals How the COVID-19 pandemic affects transgender health care in upper-middle-income and high-income countries – A worldwide, cross-sectional survey

2020 ◽  
Author(s):  
Andreas Koehler ◽  
Joz Motmans ◽  
Leo Mulió Alvarez ◽  
David Azul ◽  
Karen Badalyan ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Health Care ◽  
Low Income ◽  
Social Group ◽  
High Income ◽  
Transgender People ◽  
Middle Income ◽  
Transgender Health ◽  
The Impact

AbstractBackgroundSince the beginning of the COVID-19 pandemic, access to medical care was restricted for nearly all non-acute medical conditions. Due to their status as a vulnerable social group and the inherent need for transition-related treatments (e.g., hormone treatment), transgender people are assumed to be affected particularly severely by the restrictions caused by the COVID-19 pandemic. This study aims to assess the impact of the COVID-19 pandemic on the health and health care of transgender people.Methods and findingsAs an ad hoc collaboration between researchers, clinicians, and 23 community organizations, we developed a web-based survey. The survey was translated into 26 languages, and participants were recruited via various social media and LGBTIQ-community sources. Recruitment started in May 2020. We assessed demographical data, physical and mental health problems (e.g., chronic physical conditions), risk factors (e.g., smoking), COVID-19 data (symptoms, contact history, knowledge and concerns about COVID-19), and the influence of the COVID-19 pandemic on access to transgender health care and health-related supplies. To identify factors associated with the experience of restrictions to transgender health care, we conducted multivariate logistic regression analysis.5267 transgender people from 63 higher-middle income and high-income countries participated in the study. Over 50% of the participants had risk factors for a severe course of a COVID-19 infection and were at a high risk of avoiding testing or treatment of a COVID-19 infection due to the fear of mistreatment or discrimination. Access to transgender health care services was restricted due to the COVID-19 pandemic for 50% of the participants. Male sex assigned at birth and a lower monthly income were significant predictors for the experience of restrictions to health care. 35.0% of the participants reported at least one mental health conditions. Every third participant had suicidal thoughts, and 3.2% have attempted suicide since the beginning of the COVID-19 pandemic. A limitation of the study is that we did not analyze data from low-income countries and access to the internet was necessary to participate.ConclusionsTransgender people are assumed to suffer under the severity of the pandemic even more than the general population due to the intersections between their status as a vulnerable social group, their high amount of medical risk factors, and their need for ongoing medical treatment. The COVID-19 pandemic can potentiate these vulnerabilities, add new challenges for transgender individuals, and, therefore, can lead to devastating consequences, like severe physical or mental health issues, self-harming behaviour, and suicidality.

Symptoms of Posttraumatic Stress Disorder among Health Care Workers in Earthquake-Affected Areas in Southwest China

2010 ◽  
Vol 106 (2) ◽  
pp. 555-561 ◽  
Author(s):  
Li Wang ◽  
Jianxin Zhang ◽  
Mingjie Zhou ◽  
Zhanbiao Shi ◽  
Ping Liu
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Health Care ◽  
Posttraumatic Stress Disorder ◽  
Posttraumatic Stress ◽  
Health Care Workers ◽  
Southwest China ◽  
Stress Disorder ◽  
Care Workers ◽  
The Impact

The symptoms of posttraumatic stress disorder and associated risk factors were investigated among health care workers in earthquake-affected areas in southwest China. 343 health care workers completed the Chinese version of the Impact of Event Scale–Revised 3 mo. after the Wenchuan Earthquake. The prevalence of probable PTSD was 19%. The significant risk factors identified for PTSD severity included being female, being bereaved, being injured, and higher intensity of initial fear. These findings suggest that PTSD is a common mental health problem among health care workers in earthquake-affected areas. The present information can be useful in directing, strengthening, and evaluating disaster-related mental health needs and interventions after an earthquake.

scholarly journals Food insecurity among people with severe mental disorder in a rural Ethiopian setting: a comparative, population-based study

2017 ◽  
Vol 28 (04) ◽  
pp. 397-407 ◽  
Author(s):  
K. Tirfessa ◽  
C. Lund ◽  
G. Medhin ◽  
Y. Hailemichael ◽  
A. Fekadu ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Food Insecurity ◽  
Low Income ◽  
World Health ◽  
Household Food Insecurity ◽  
Household Food ◽  
Food Insecurity Access ◽  
The Impact

Aim.In low-income African countries, ensuring food security for all segments of the population is a high priority. Mental illness is associated consistently with poverty, but there is little evidence regarding the association with food insecurity. The aim of this study was to compare the levels of food insecurity in people with severe mental disorders (SMD) with the general population in a rural African setting with a high burden of food insecurity.Method.Households of 292 community-ascertained people with a specialist-confirmed diagnosis of SMD (including schizophrenia and bipolar disorder) were compared with 284 households without a person with SMD in a rural district in south Ethiopia. At the time of the study, no mental health services were available within the district. Food insecurity was measured using a validated version of the Household Food Insecurity Access Scale. Disability was measured using the World Health Organisation Disability Assessment Schedule 2.0.Result.Severe household food insecurity was reported by 32.5% of people with SMD and 15.9% of respondents from comparison households: adjusted odds ratio 2.82 (95% confidence interval 1.62 to 4.91). Higher annual income was associated independently with lower odds of severe food insecurity. When total disability scores were added into the model, the association between SMD and food insecurity became non-significant, indicating a possible mediating role of disability.Conclusion.Efforts to alleviate food insecurity need to target people with SMD as a vulnerable group. Addressing the disabling effects of SMD would also be expected to reduce food insecurity. Access to mental health care integrated into primary care is being expanded in this district as part of the Programme for Improving Mental health carE (PRIME). The impact of treatment on disability and food insecurity will be evaluated.

The Impact of Health Care Financing on Family Budgets

1994 ◽  
Vol 24 (4) ◽  
pp. 691-714 ◽  
Author(s):  
Edith Rasell ◽  
Jared Bernstein ◽  
Kainan Tang
Keyword(s):  
Health Care ◽  
Low Income ◽  
Private Insurance ◽  
The Elderly ◽  
High Income ◽  
Medical Expenditure ◽  
Health Care Spending ◽  
Expenditure Survey ◽  
Low Income Families ◽  
The Impact

Although businesses, federal and state governments, and insurance companies are major funding sources for health care, they are just intermediate sources. Ultimately, individuals and families pay all health care costs through out-of-pocket spending, insurance premiums, or federal, state, and local taxes. Using a microsimulation model with data from the 1987 National Medical Expenditure Survey, the Internal Revenue Service's Individual Tax Model, and the Consumer Expenditure Survey, the authors examine the distribution of health care spending, by decile, among families and individuals. They find that the distribution of health expenditures is very regressive, with low-income families paying twice the share of income paid by high-income families. The distribution of out-of-pocket expenditures, which comprise 24 percent of total spending, is the most regressive, with low-income families paying 8.5 times the share of income paid by high-income families. Spending on premiums is also regressive, and the regressivity would increase if everyone had private insurance. Expenditures through the public sector are progressive. Regressivity is greater among the elderly than the nonelderly. Out-of-pocket expenditures account for 41 percent of all health care spending by the elderly. A more equitably financed health care system would increase the share of funding raised through progressive taxes, and decrease reliance on expenditures made out of pocket and on premiums.

scholarly journals Quantifying research output on poverty and non-communicable disease behavioural risk factors in low-income and lower middle-income countries: a bibliometric analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e014715 ◽  
Author(s):  
Luke Nelson Allen ◽  
Nicholas Fox ◽  
Alissa Ambrose
Keyword(s):  
Risk Factors ◽  
Impact Factor ◽  
Bibliometric Analysis ◽  
Low Income ◽  
Research Output ◽  
High Income ◽  
Middle Income ◽  
Middle Income Countries ◽  
Behavioural Risk Factors ◽  
Number Of Citations

ObjectivesLow-income and lower middle-income countries (LLMICs) bear a disproportionate burden of non-communicable diseases (NCDs). WHO has repeatedly called for more research on poverty and NCDs in these settings, but the current situation remains unquantified. We aimed to assess research output on poverty and NCD risk factors from these countries in relation to upper middle-income and high-income countries.DesignBibliometric analysis of primary research published between 1 January 1990 and 4 May 2017. We searched 13 databases, combining terms for poverty and NCD behavioural risk factors (tobacco, alcohol, diet and physical activity). Independent dual review was used to screen titles, abstracts and full papers. Two-tailed t-testing and multiple linear regression analyses were used to compare differences in means.Outcomes(1) Proportion of lead authors affiliated with institutions based in high and upper middle-income countries vs LLMICs. (2) Mean number of citations for publications from each region. (3) Mean journal impact factor for studies from each region.ResultsNinety-one (67%) of the 136 included studies were led by scientists affiliated with LLMIC-based institutions. These authors represented 17/83 LLMICs (20%), and their studies garnered 4.8 fewer citations per paper than studies led by high-income and upper middle-income-affiliated authors; however, this finding was non-significant (P=0.67). Papers led by authors based in high-income and upper middle-income countries were published in journals with a mean impact factor 3.1 points higher than those from LLMICs (4.9 vs 1.7) adjusting for year of publication and number of citations (P<0.001).ConclusionsMost poverty and NCD risk factor research is led by authors from a small number of LLMICs. These studies are being published in relatively low-impact journals, and the vast majority of LLMICs are not producing any research in this area that is vital to their social and economic development. The paucity of domestic evidence must be addressed to inform global policy.

scholarly journals Mental Health in low-and middle income countries (LMICs): Going beyond the need for funding

2018 ◽  
Vol 17 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Folashade T Alloh ◽  
Pramod Regmi ◽  
Igoche Onche ◽  
Edwin Van Teijlingen ◽  
Steven Trenoweth
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Global Mental Health ◽  
Poor Mental Health ◽  
Health Issues ◽  
Middle Income ◽  
Middle Income Countries ◽  
Mental Health Issues ◽  
The Impact ◽  
Low And Middle Income

Despite being globally recognised as an important public health issue, mental health is still less prioritised as a disease burden in many Low-and Middle-Income Countries (LMICs). More than 70% of the global mental health burden occurs in these countries. We discussed mental health issues in LMICs under themes such as abuse and mental illness, cultural influence on mental health, need for dignity in care, meeting financial and workforce gaps and the need for national health policy for the mental health sector. We highlighted that although mental health education and health care services in most LMICs are poorly resourced; there is an urgent need to address issues beyond funding that contribute to poor mental health. In order to meet the increasing challenge of mental health illness in LMICs, there is a need for effort to address cultural and professional challenges that contribute to poor mental health among individuals. We have a notion that mental health should be integrated into primary health care in LMICs. Creating awareness on the impact of some cultural attitudes/practices will encourage better uptake of mental health services and increase the ease when discussing mental health issues in these countries which can contribute to reducing the poor mental health in LMICs.

scholarly journals The impact of COVID-19 pandemic on physical and mental health of Asians: A study of seven middle-income countries in Asia

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246824
Author(s):  
Cuiyan Wang ◽  
Michael Tee ◽  
Ashley Edward Roy ◽  
Mohammad A. Fardin ◽  
Wandee Srichokchatchawan ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
General Population ◽  
Well Being ◽  
Physical Symptoms ◽  
Physical And Mental Health ◽  
Middle Income ◽  
Event Scale ◽  
Middle Income Countries ◽  
The Impact

The coronavirus disease (COVID-19) pandemic has impacted the economy, livelihood, and physical and mental well-being of people worldwide. This study aimed to compare the mental health status during the pandemic in the general population of seven middle income countries (MICs) in Asia (China, Iran, Malaysia, Pakistan, Philippines, Thailand, and Vietnam). All the countries used the Impact of Event Scale–Revised (IES-R) and Depression, Anxiety and Stress Scale (DASS-21) to measure mental health. There were 4479 Asians completed the questionnaire with demographic characteristics, physical symptoms and health service utilization, contact history, knowledge and concern, precautionary measure, and rated their mental health with the IES-R and DASS-21. Descriptive statistics, One-Way analysis of variance (ANOVA), and linear regression were used to identify protective and risk factors associated with mental health parameters. There were significant differences in IES-R and DASS-21 scores between 7 MICs (p<0.05). Thailand had all the highest scores of IES-R, DASS-21 stress, anxiety, and depression scores whereas Vietnam had all the lowest scores. The risk factors for adverse mental health during the COVID-19 pandemic include age <30 years, high education background, single and separated status, discrimination by other countries and contact with people with COVID-19 (p<0.05). The protective factors for mental health include male gender, staying with children or more than 6 people in the same household, employment, confidence in doctors, high perceived likelihood of survival, and spending less time on health information (p<0.05). This comparative study among 7 MICs enhanced the understanding of metal health in the general population during the COVID-19 pandemic.

scholarly journals Evidence-based mental health care and implementation science in low- and middle-income countries

2012 ◽  
Vol 21 (3) ◽  
pp. 241-244 ◽  
Author(s):  
G. Thornicroft
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Implementation Science ◽  
Low Income ◽  
Routine Practice ◽  
Evidence Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low And Middle Income

Although the evidence base for what to do about the mental health gap in low- and middle-income countries (LAMICs) has improved significantly over the last decade, mental health care in LAMICs still provide services to only a small minority of people with mental disorders. The problem is how to translate the relevant body of scientific knowledge into routine practice. It is clear from over two decades of research that the creation of evidence-based guidelines is necessary but not sufficient for evidence-based practice, whether in high- or low-income settings. In this Editorial, I discuss whether the recent development of ‘implementation science’ may offer an opportunity towards effective guideline implementation in low- and medium-income settings, so that clinical practice is more often based on evidence that does lead to patient benefit.

scholarly journals Free Trade Agreements and Environment for Sustainable Development: A Gravity Model Analysis

2019 ◽  
Vol 11 (3) ◽  
pp. 597 ◽  
Author(s):  
Xing Yao ◽  
Rizwana Yasmeen ◽  
Yunong Li ◽  
Muhammad Hafeez ◽  
Ihtsham Padda
Keyword(s):  
Free Trade ◽  
Low Income ◽  
Positive Impact ◽  
Group Analysis ◽  
Free Trade Agreements ◽  
Trade Agreements ◽  
High Income ◽  
Low Income Countries ◽  
Middle Income ◽  
The Impact

Free trade agreements (FTAs) have a key role in the global value chain. In the meantime, these are also disturbing the environmental balance of the world. The objective of this study is to check whether the trade is good or bad for the environments of countries that are bonded by trade agreements. This study examines the impact of FTAs on bilateral carbon emissions within the gravity framework. We find a positive impact of FTA agreements on bilateral CO2 pollution. However, in an income-based country group analysis, we find mixed evidence regarding FTAs. The analysis concerning high income countries indicates that free trade agreements are beneficial for high income countries, while, in the case of upper middle income and lower middle income countries, we find that the free trade agreements are not beneficial for their environments. These results of the effects of FTAs on bilateral CO2 pollution imply that low income countries have a greater pollution effect even after the implementation of an FTA due to lenient environmental standards. There is a need for developing countries to learn from high income countries, as their FTAs are beneficial for decreasing pollution.

scholarly journals Mental Health Care of Transsexual, Transgender and Gender Nonconforming People in Croatian Health System

2016 ◽  
Vol 9 (1) ◽  
pp. 26-26
Author(s):  
I. Zegura ◽  
◽  
G. Arbanas ◽  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Health System ◽  
Gender Transition ◽  
Transgender People ◽  
Transgender Health ◽  
Objective Health ◽  
Transgender Persons

Objective: Health and legal care of transgender people in Croatia is still at its beginnings. Further effort from the professional side is being engaged in order to establish complete health care of transgender people in Croatia. Design and Method: The aim was to examine if there are any differences in the levels of transgender persons quality of life, experienced violence and their present stage of gender transition and perceived level of social support and perceived quality of health care. Transgender clients who are in the process of gender transition within Croatian mental health system were asked to fill in the online questionnaire. Results: 80% of our transgender participants consider psychologists as the most competent and affirmative professionals concerning transgender health care. 15.6% say the same for psychiatrists and 4.4% consider endocrinologists as the most competent professionals to deal with transgender health issues. 28.8% of our participants are mostly or completely satisfied with mental health care, in contrast to only 6.6 % of those who are satisfied with medical health care. Conclusions: According to the facts that we have presented above, the agenda of health, mental health and legal care of transgender people in Croatia must be to build on permanent education, scientific work, ethical principles, standards of care and accessible health care. Minding the human rights of each patient, high quality of practice must be governed by the principles of competence in the work with transgender clients through affirmation of gender as personal construct of each client.

scholarly journals The impact of cash transfers on mental health in children and young people in low-income and middle-income countries: a systematic review and meta-analysis

2021 ◽  
Vol 6 (4) ◽  
pp. e004661
Author(s):  
Annie Zimmerman ◽  
Emily Garman ◽  
Mauricio Avendano-Pabon ◽  
Ricardo Araya ◽  
Sara Evans-Lacko ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Depressive Symptoms ◽  
Young People ◽  
Low Income ◽  
Meta Analysis ◽  
Cash Transfers ◽  
Middle Income ◽  
Children And Young People ◽  
The Impact

IntroductionAlthough cash transfer programmes are not explicitly designed to improve mental health, by reducing poverty and improving the life chances of children and young people, they may also improve their mental health. This systematic review and meta-analysis assessed the evidence on the effectiveness of cash transfers to improve the mental health of children and young people in low-income and middle-income countries.MethodsWe searched Pubmed, EBSCOhost, Scientific Electronic Library Online, ISI Web of Science and Social Sciences Citation Index and grey literature (from January 2000 to July 2020) for studies which quantitatively assessed the impact of cash transfers on mental health in young people (aged 0–24 years), using a design that incorporated a control group. We extracted Cohen’s d effects size and used a random-effects model for the meta-analysis on studies that measured depressive symptoms, I2 statistic and assessment of study quality.ResultsWe identified 12 116 articles for screening, of which 12 were included in the systematic review (covering 13 interventions) and seven in the meta-analysis assessing impact on depressive symptoms specifically. There was high heterogeneity (I2=95.2) and a high risk of bias (0.38, 95% CIs: −5.08 to 5.85; p=0.86) across studies. Eleven interventions (85%) showed a significant positive impact of cash transfers on at least one mental health outcome in children and young people. However, no study found a positive effect on all mental health outcomes examined, and the meta-analysis showed no impact of cash transfers on depressive symptoms (0.02, 95% CIs: −0.19 to 0.23; p=0.85).ConclusionCash transfers may have positive effects on some mental health outcomes for young people, with no negative effects identified. However, there is high heterogeneity across studies, with some interventions showing no effects. Our review highlights how the effect of cash transfers may vary by social and economic context, culture, design, conditionality and mental health outcome.

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