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This article tracks how a trope of middle-class household thrift, grounded on the autarchic Aristotelian oikos, has long fueled derogatory discourses in Britain aimed at low-income urban residents who practice quite different forms of thrift. Since the 1970s this trope has migrated across scales, proving a potent metaphor for national economic policy and planetary care alike, and morally and economically justifying both neoliberal welfare retraction compounded by austerity policies and national responses to excessive resource extraction and waste production. Both austerity and formal recycling schemes shift responsibility onto consumer citizens, regardless of capacity. Further, this model of thrift eclipses the thriftiness of low-income urban households, which emerges at the nexus of kin and waged labor, sharing, welfare, debt, conserving material resources through remaking and repair and, crucially, the fundamental need for decency expressed through kin care. Through a historicized ethnography of a London social housing estate and its residents, this paper excavates what happens as these different forms and scales of household thrift coexist, change over time, and clash. Ultimately, neoliberal policy centered on an inimical idiom of thrift delegitimizes and disentitles low-income urban households and undermines their ability to enact livelihood practices of sustainability and projects of dignity across generations.
Existing policy research has not comprehensively examined the processes by which young people experience social exclusion: that is, the relationships among different risk factors for exclusion, their actual experiences of exclusion, and outcomes that matter for their life chances. Drawing on data from a survey of Australian 13-14 year olds (N=3,535), this paper adapts the Bristol Social Exclusion Matrix to examine pathways from young people’s personal and family resources, their experience of participation (school engagement; bullying victimization; teacher support), and their life satisfaction – a predictive indicator of wellbeing and mental health in adulthood. The effects of other characteristics or risk factors for young people’s social exclusion (living with disability, being a young carer, identifying as Indigenous, and speaking a language other than English at home), are also examined. This paper shows that experience of exclusion mediates the relationship between young people’s personal and family resources and life satisfaction. Controlling for characteristics or risk factors does not change this relationship, suggesting that processes of social exclusion, enacted in interpersonal encounters, are driven by overarching structural factors. These findings are relevant for policy in Australia, and in other countries with similar policy regimes.
This chapter considers the contemporary social and military context of the composition of Coriolanus including civil unrest, governance, education, the influence of the classical world, and later conjecture that Shakespeare himself was a soldier. In considering the performance of the play and its afterlives, attention is paid to stage directions, sound, character, and the subsequent adaptation and appropriation of Coriolanus and his mother in other media – art, poetry, film – that focus on the military, civil, personal, and political conflicts at the heart of the play.
Depression treatments are typically less effective for young people than for adults. However, treatments rarely target loneliness, which is a key risk factor in the onset, maintenance and development of depression.
This study evaluated the efficacy of a novel loneliness intervention, Groups 4 Health (G4H), relative to the best-practice treatment of cognitive–behavioural therapy (CBT) in reducing loneliness and depression over a 12-month period (Australian New Zealand Clinical Trial Registry: ACTRN12618000440224).
The study was a phase 3 randomised non-inferiority trial comparing G4H with dose-controlled group CBT. Participants were 174 people aged 15–25 years experiencing loneliness and clinically significant symptoms of depression, who were not in receipt of adjunct treatment. Participants were recruited from mental health services in Southeast Queensland, Australia. Randomisation was conducted using computer software. Follow-up assessments and statistical analyses were masked to allocation. Both interventions consisted of five 75 min group-based psychotherapy sessions. The primary outcomes were depression and loneliness, with a non-inferiority margin of 2.20 for depression.
The trial enrolled 174 participants between 24 April 2018 and 25 May 2019, with 84 in the G4H condition and 90 in the CBT condition. All randomised participants were included in the intention-to-treat analyses (n = 174). The pre–post effect sizes for depression were dG4H = −0.71 and dCBT = −0.91. For loneliness, they were dG4H = −1.07 and dCBT = −0.89. At 12-month follow-up, the absolute difference between groups on depression was 1.176 (95% CI −1.94 to 4.29) and on loneliness it was −0.679 (95% CI −1.43 to 0.07). No adverse effects were observed.
G4H was non-inferior to CBT for depression and showed a slight advantage over CBT for loneliness that emerged after treatment completion.
The authors surveyed hospitals across the country on their policies regarding overlapping surgery, and found large variation between hospitals in how this practice is regulated. Specifically, institutions chose to define “critical portions” in a variety of ways, ultimately affecting not only surgical efficiency but also the autonomy of surgical trainees and patient experiences at these different hospitals.
Given the rising numbers of older adults in Canada experiencing falls, evidence-based identification of fall risks and plans for prevention across the continuum of care is a significant priority for health care providers. A scoping review was conducted to synthesize published international clinical practice guidelines (CPGs) and recommendations for fall risk screening and assessment in older adults (defined as 65 years of age and older). Of the 22 CPGs, 6 pertained to multiple settings, 9 pertained to community-dwelling older adults only, 2 each pertained to acute care and long-term care settings only, and 3 did not specify setting. Two criteria, prior fall history and gait and balance abnormalities, were applied either independently or sequentially in 19 CPG fall risk screening algorithms. Fall risk assessment components were more varied across CPGs but commonly included: detailed fall history; detailed evaluation of gait, balance, and/or mobility; medication review; vision; and environmental hazards assessment. Despite these similarities, more work is needed to streamline assessment approaches for heterogeneous and complex older adult populations across the care continuum. Support is also needed for sustainable implementation of CPGs in order to improve health outcomes.
Groups are increasingly used to deliver behavior change interventions, but such interventions are seldom based on theory and research on social group processes. A consequence of this is that existing group interventions are often heterogenous and difficult to evaluate. The social identity approach addresses important questions relevant to the design and delivery of group interventions for supporting behavior change. Drawing on this approach, the social identity model of behavior change explains how group processes can be harnessed in behavior change interventions. The model prioritizes the establishment of shared social identity among intervention group members and outlines how, through six core group resources, social identification can shape delivery of intervention content to achieve behavior change. Evidence for the key resources specified in the model is presented, and a step-by-step guide provided, to support the operationalization of the model’s principles in practice.
The Great Migration from the South and the rise of racial residential segregation strongly shaped the twentieth-century experience of African Americans. Yet, little attention has been devoted to how the two phenomena were linked, especially with respect to the individual experiences of the migrants. We address this gap by using novel data that links individual records from the complete-count 1940 Census to those in the 2000 Census long form, in conjunction with information about the level of racial residential segregation in metropolitan areas in 1940 and 2000. We first consider whether migrants from the South and their children experienced higher or lower levels of segregation in 1940 relative to their counterparts who were born in the North or who remained in the South. Next, we extend our analysis to second-generation Great Migration migrants and their segregation outcomes by observing their location in 2000. Additionally, we assess whether second-generation migrants experience larger decreases in their exposure to segregation as their socioeconomic status increases relative to their southern and/or northern stayer counterparts. Our study significantly advances our understanding of the Great Migration and the “segregated century.”
The social life of female chimpanzees (Pan troglodytes) differs between subspecies, with females in East African field sites often described as avoiding association to avoid competition, while females in Taï have been shown to be more gregarious, spending most of their time in close contact with each other, probably to avoid predation. This close association leads to increased levels of direct competition for resources, possibly increasing the benefit of having a higher dominance rank and challenging dominant group members. Female chimpanzees in Gombe have been shown to queue for rank rather than challenge others. Here, we show that female dyads in Taï do change their dominance rank at times, with at least six clear rank changes recorded in the Taï North and South communities. We discuss life events that could facilitate rank challenges. The increased flexibility in the female dominance hierarchy potentially adds a level of complexity not seen in East African chimpanzees.
Item 9 of the Patient Health Questionnaire-9 (PHQ-9) queries about thoughts of death and self-harm, but not suicidality. Although it is sometimes used to assess suicide risk, most positive responses are not associated with suicidality. The PHQ-8, which omits Item 9, is thus increasingly used in research. We assessed equivalency of total score correlations and the diagnostic accuracy to detect major depression of the PHQ-8 and PHQ-9.
We conducted an individual patient data meta-analysis. We fit bivariate random-effects models to assess diagnostic accuracy.
16 742 participants (2097 major depression cases) from 54 studies were included. The correlation between PHQ-8 and PHQ-9 scores was 0.996 (95% confidence interval 0.996 to 0.996). The standard cutoff score of 10 for the PHQ-9 maximized sensitivity + specificity for the PHQ-8 among studies that used a semi-structured diagnostic interview reference standard (N = 27). At cutoff 10, the PHQ-8 was less sensitive by 0.02 (−0.06 to 0.00) and more specific by 0.01 (0.00 to 0.01) among those studies (N = 27), with similar results for studies that used other types of interviews (N = 27). For all 54 primary studies combined, across all cutoffs, the PHQ-8 was less sensitive than the PHQ-9 by 0.00 to 0.05 (0.03 at cutoff 10), and specificity was within 0.01 for all cutoffs (0.00 to 0.01).
PHQ-8 and PHQ-9 total scores were similar. Sensitivity may be minimally reduced with the PHQ-8, but specificity is similar.
This poem, by the Irish poet and Nobel Laureate, Seamus Heaney, is as applicable to sustaining healthy communities as it is to sustaining marital harmony, which is the purpose for which it was originally written. As the scaffolding provided the foundational structure from which Heaney and his wife built the walls of their marriage, so too we can develop communities through our own collective efforts, drawing on support from health and social care practitioners of various persuasions where and when required. Once it is established, we can gain confidence from the fact that we can use what we have built together to help our communities to endure and thrive when they, too, are threatened by adversity.
Public health is defined by the UK’s Faculty of Public Health as ‘The science and art of promoting and protecting health and well being, preventing ill health and prolonging life through the organised efforts of society’.
This definition locates the causes of ill health and the remedies in the realms of personal and societal agency, and not only in the remit of health practitioners. Although the latter have a role as members of society to make prevention a reality for themselves, families and communities, they play a special part in preventing further ill health for people who suffer mental illness and are seeking help for it.
Other chapters in this book attend to the relational and social fabric that enables people to flourish; it is made of good and trusting relationships, and material conditions that permit thought about purpose and meaning beyond survival.
This chapter pulls together key matters in this book. Its title is a quote from a line given to one of the characters in Hamlet by Shakespeare. That sentence perfectly outlines the intention of Section 5 of this book and the function of this final chapter in which I endeavour to align theory, research and the practical impacts of the topics covered by this book with the circumstances in which we find health services as we near the close of the second decade of the twenty-first century. But, first, I return to Chapter 1, to recapture some of those circumstances. Then, I look at the matters on which I think we should focus in order to sustain healthcare services and incorporate the social agenda identified in this book.
Social relationships affect health. Of that we are certain. People who are more strongly connected live longer (e.g. Holt-Lunstad et al., 2010), are in better health (e.g. Boden-Albala et al., 2005) and experience better wellbeing (e.g. Helliwell & Putnam, 2004). None of us is immune to these effects although, clearly, poverty, inequality and age, among other factors, contribute to, and exacerbate the consequences of, social disconnection.
What is more remarkable, in the context of the evidence-base showing the profound impact of these effects, is the relatively limited investment in efforts to build and preserve the social capital of vulnerable communities, on health grounds. Recognising the potential benefits that social resources bring and the mechanisms through which they can emerge is important, but not enough. What is needed is a coherent approach to embed these resources in communities to ensure that the products of social connectedness can be sustained in the longer term.
This book’s roots are in an impactful seminar series hosted by the Royal College of Psychiatrists in which practitioners and scientists from a wide array of disciplines came together in 2014 to explore the social influences on our health and recovery from ill health. This volume echoes the evocative conversations in that College and is intended to rehearse research of potentially great impact. It presents practitioners, researchers, policymakers and students of a wide array of disciplines and roles with the material to support them in better harnessing what we now know about the impact of social factors on health. Thereby, the editors hope to influence how practitioners and the responsible authorities work together with members of the public and communities to design and deliver services. Our aspiration is to contribute to creating better-targeted approaches to promoting health and mental health and more effective and integrated interventions for people who have health problems or disorders.