Social Science & Medicine最新文献

{"title":"Associations of war exposures, post-migration living difficulties and social support with (complex) PTSD: a cohort study of Ukrainian refugees resettled in Denmark","authors":"Karen-Inge Karstoft ,&nbsp;Ludvig Daae Bjørndal ,&nbsp;Anne Agathe Pedersen ,&nbsp;Nataliia Korchakova ,&nbsp;Séamus A. Power ,&nbsp;Thomas A. Morton ,&nbsp;Vibeke J. Koushede ,&nbsp;Marie H. Thøgersen ,&nbsp;Brian J. Hall","doi":"10.1016/j.socscimed.2025.118080","DOIUrl":"10.1016/j.socscimed.2025.118080","url":null,"abstract":"<div><h3>Background</h3><div>The war in Ukraine has forced millions of Ukrainians to flee their country, many after exposure to actions of war. Previous research found that both war exposures (WE) and post-migration living difficulties (PMLD) are associated with risk of PTSD. In the current study, we test associations between WE, PMLD and PTSD/Complex PTSD (CPTSD). Further, we test if the associations are moderated by social support.</div></div><div><h3>Methods</h3><div>In a representative prospective cohort study of adult Ukrainians arriving in Denmark in the first year after Russia's full-scale invasion (N = 4,229), we test associations between WE, PMLD, and (C)PTSD using multinomial logistic regression analysis. Interaction terms were added to assess if associations were moderated by SS.</div></div><div><h3>Results</h3><div>Prevalence of PTSD and CPTSD was 12.1 % and 12.2 %, respectively. We found statistically significant associations between family-related PMLD, health-related PMLD, and general PMLD and CPTSD (AORs from 1.25 to 1.56), and between health-related PMLD and family-related PMLD and PTSD (AORs from 1.18 to 1.35). WE were associated with PTSD (AOR (CI): 1.15 (1.07–1.25)), but not CPTSD (AOR (CI): 1.05 (0.97–1.13)). Social support was associated with CPTSD (AOR (CI): 0.69 (0.60–0.78)) but not PTSD (AOR (CI):0.94(0.83–1.07)). Interaction terms were significant only for PTSD, where social support attenuated the negative association between PMLD and PTSD.</div></div><div><h3>Conclusion</h3><div>PMLDs are important risk factors for post-trauma psychopathology in war refugees. Social support mitigates the negative association between PMLDs for PTSD, while low social support is an independent risk factor for CPTSD. Attention should be paid to refugees’ daily life challenges and social support networks.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"376 ","pages":"Article 118080"},"PeriodicalIF":4.9,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ageing in place or stuck in place: A critical qualitative study on older adults’ independence across six municipalities in Norway","authors":"Linda Aimée Hartford Kvæl","doi":"10.1016/j.socscimed.2025.118098","DOIUrl":"10.1016/j.socscimed.2025.118098","url":null,"abstract":"<div><div>The concept of ageing in place (AIP) has garnered substantial international attention, especially with the global rise in the ageing population. Despite extensive research and policy support, the practical complexities of implementing AIP policy, particularly in diverse living situations, places, social contexts and evolving family structures, remain unclear. The purpose of this study was to critically examine the key factors influencing experiences of AIP among older individuals, family caregivers and municipal health and social care employees across six diverse Norwegian municipalities. This qualitative study utilised an explorative interpretative design, involving focus group interviews with municipal employees (N = 36) and semi-structured individual interviews with older persons (N = 17) and family caregivers (N = 18). The municipalities varied in several key dimensions, including population size, geographic extent, centrality, demographics and the economy. The reflexive thematic analysis identified four themes: i) Ageing-Related Preparation: Balancing Personal and Municipal Responsibility, ii) Access to Proper Services: Aligning the Person-Environment Fit, iii) Family Caregiving: Bridging the Gap between Services and Actual Needs, and iv) Transitional Housing: Supporting Aging in Place with Dignity. Together, these themes highlight the need to promote 'independence literacy' for older adults, ensuring they have the necessary knowledge, access, and support to live independently and maintain their quality of life while AIP. The findings urge a re-evaluation of local factors shaping safe and proper person–environment fit, emphasising access to proper services, caregiver support, housing options, resource allocation and the enhancement of skilled healthcare staff to optimise safe AIP. The findings may be relevant for policy makers, municipal leaders and health service employees in developing equitable AIP policies tailored to the local context.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"375 ","pages":"Article 118098"},"PeriodicalIF":4.9,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143859659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The voice of sacrifice: The silence of healthcare professionals in the service of productivity. The case of a French hospital","authors":"Antoine Glauzy ,&nbsp;Aude Montlahuc-Vannod","doi":"10.1016/j.socscimed.2025.118110","DOIUrl":"10.1016/j.socscimed.2025.118110","url":null,"abstract":"<div><div>For more than half a century, French hospitals have been subjected to the logics of New Public Management (NPM), which compel healthcare professionals to navigate increasing demands for economic efficiency. Rooted in a managerial ideology, these logics generate significant distress among healthcare professionals, who struggle to reconcile the socio-relational aspects of care with new standards of standardization dictated by performance tools and indicators. While this distress remains a taboo in hospital settings, this study examines how the silence surrounding professional suffering becomes a lever for productivity within these managerial frameworks. Drawing on ethnographic research conducted through observations and interviews in a French hospital specializing in severe liver and pancreatic diseases, our findings reveal that silence, initially imposed by a managerial culture that denies vulnerability, evolves into a resource for healthcare professionals. It allows them to transcend their subjectivity to meet productivity demands. Grounded in the theory of the psychodynamics of work, we argue that healthcare professionals use silence as a means of self-sacrifice, aiming to fulfill productivity expectations and conform to identity norms shaped by the organizational culture.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"377 ","pages":"Article 118110"},"PeriodicalIF":4.9,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143902193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a cancer diagnosis on educational, employment, health-related quality of life, and social outcomes among young adults: A matched cohort study of 401 cancer survivors aged 15–24 in England","authors":"R. Mattock ,&nbsp;A. Martin ,&nbsp;A.E. Beckett ,&nbsp;O.C. Lindner ,&nbsp;D. Stark ,&nbsp;R.M. Taylor","doi":"10.1016/j.socscimed.2025.118078","DOIUrl":"10.1016/j.socscimed.2025.118078","url":null,"abstract":"<div><h3>Background</h3><div>Globally, cancer incidence is rising fastest among young people. Existing literature on acute health shocks, including cancer diagnoses, focuses on older working-aged adults.</div></div><div><h3>Methods</h3><div>Matched cohort study involving 401 young cancer survivors (aged 15–24) in the BRIGHTLIGHT study and 765 UK Household Longitudinal Study controls without cancer between 2013 and 2018. Participants were matched on sex, age, ethnicity, index of multiple deprivation (IMD) quintile, non-cancer health conditions, and follow-up duration. Regression models assessed economic, educational, social, health-related quality of life (HRQoL), and mental health outcomes at 6(T1), 12–18(T2), and 24–36 months (T3) post-diagnosis.</div></div><div><h3>Results</h3><div>Compared to matched controls, those with cancer were: less likely to be in employment, education, or training at T1 (OR = 2.03, p &lt; 0.001) but not at T3 (OR = 0.96, p = 0.18), because transitioning from unemployment or economic inactivity into education was more common (24 % vs 3 % between T1 and T3); less likely to live in parental households at T1 (OR = 0.54, p &lt; 0.001) and T3 (OR = 0.59, p &lt; 0.001); and more likely to experience relationship breakdown (23 % vs 12 % between T1 and T3). Differences in mental health and HRQoL declined over time (mean difference compared to matched controls: T1: −0.07, p &lt; 0.001; T2 and T3: −0.01 p ≥ 0.55). Economic outcomes, mental health and HRQoL utility scores were persistently worse among more severe cancer cases.</div></div><div><h3>Conclusions</h3><div>Despite having initially poorer health and economic outcomes, cancer survivors in this cohort caught up with their peers within 3 years. Linked clinical data showed those with more severe diagnoses were affected most, indicating scope for improved psychosocial and economic support.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"376 ","pages":"Article 118078"},"PeriodicalIF":4.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The cost of being a legal patient: Judicial use of rape defendants' and victims’ psychiatric records in South Korea","authors":"Joohyun Park","doi":"10.1016/j.socscimed.2025.118108","DOIUrl":"10.1016/j.socscimed.2025.118108","url":null,"abstract":"<div><div>Mental health evidence in courts can either support or undermine the trustworthiness and accuracy of each party's claims. When defendants and victims of sex crimes against women present their medical evidence, how are their claims impacted differently? This paper examines the court's interpretation of defendants' and victims' psychiatric records in 821 South Korean court cases involving rape (2013–2023). The findings show that a defendant's credibility is discussed as a potential mitigating factor in determining their responsibility and treatability. In contrast, a victim's credibility is debated at the risk of dismissing the entire case, determining the occurrence of the crime and new harm. This structural imbalance is exacerbated when rape trials turn into false accusation trials, in which rape victims must use their psychiatric evidence to invalidate their own rape allegations. The paper highlights the asymmetrical cost of being a patient to speak up in court and discusses the consequences of diagnosis with the term <em>legal patient</em>.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"376 ","pages":"Article 118108"},"PeriodicalIF":4.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143877558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disability stigma resistance by parents at the intersection of psychosocial and structural levels","authors":"Alice Scavarda ,&nbsp;Graham Scambler","doi":"10.1016/j.socscimed.2025.118097","DOIUrl":"10.1016/j.socscimed.2025.118097","url":null,"abstract":"<div><div>In this paper we define and argue for the salience of the concept of ‘project stigma’ in the context of long-term illness and disability. In the opening section we briefly review the literature on long-term illness and disability as ‘personal tragedy’ and go on to discuss critiques of this limited and limiting narrative from disability theorists and, belatedly, medical sociologists. This prepares the ground for conceptual innovation around the notion of project stigma. This, in turn, is explored using a qualitative study of 63 parents of children with Down Syndrome and Autism conducted in North-West Italy. The paper closes by outlining and commending a programme of research arising out of a series of ideal types of modes of stigma resistance and its enactment that highlights important but neglected issues of stigma resistance at both psychosocial and structural levels.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"376 ","pages":"Article 118097"},"PeriodicalIF":4.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143877628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Working the boundaries of ‘whining’ – how patients and care professionals make sense of informal complaining practices","authors":"Jelmer Brüggemann ,&nbsp;Ann-Charlotte Nedlund ,&nbsp;Lisa Guntram","doi":"10.1016/j.socscimed.2025.118112","DOIUrl":"10.1016/j.socscimed.2025.118112","url":null,"abstract":"<div><div>This study investigates informal complaining in healthcare settings, that is, the kind of patient complaints that are expressed verbally to professionals in care encounters. In healthcare policies and the complaints literature, informal complaints receive little attention and are rarely studied as a distinct phenomenon. Building on the sociology of complaint, research on the good and bad patient, and scholarship on boundary work, we analyse focus groups with care professionals and interviews with patients in Sweden to study how these actors make sense of patients' informal complaining practices. We highlight the discursive work that patients and care professionals do around the boundaries of ‘whining’ – our analytic term to capture informal complaining practices that are demarcated as <em>to-be-avoided</em>. We argue that there are three dimensions to this work: they negotiate the <em>validity</em> and <em>temporality</em> of complaining and do so in relation to an <em>identity</em> of the ‘complainer’. Our analysis highlights the complexities of these negotiations and shows how informal complaining oftentimes is framed as a risky practice by patients and a problem by care professionals. These normative complexities get muddled further through their contrast to healthcare political discourses which emphasise complaints as valuable knowledge and patients as active subjects. Our study suggests that it is necessary for future research, complaint policies, and person-centred care to engage with the difficult and at times unwanted parts of informal complaining practices.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"376 ","pages":"Article 118112"},"PeriodicalIF":4.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143874782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manoeuvring rural mobility policy for active and sustainable travel","authors":"Chloe Asker ,&nbsp;Laura McGuire ,&nbsp;Tessa Pollard ,&nbsp;Stewart Barr ,&nbsp;Judith Green ,&nbsp;Cassandra Phoenix ,&nbsp;Cornelia Guell","doi":"10.1016/j.socscimed.2025.118074","DOIUrl":"10.1016/j.socscimed.2025.118074","url":null,"abstract":"<div><div>Promoting “slow mobilities” and low carbon transport alternatives, through supporting active and sustainable travel (AST, including walking, cycling, wheeling, and public transport), is a priority for both public health and net zero strategies. Using a situational analysis drawing on local and national documents and stakeholder interviews, we explore the policy ecology of local authority ambitions and practices for creating and implementing AST policy for rural communities. These are shaped by national agendas and messaging, as well as local concerns. Our analysis identified the ways in which stakeholders manoeuvre the friction points that inform, constrain, and shape the production and implementation of AST policy in the South West (SW) and North East (NE) of England. The marginality of rural concerns is reflected in a scarcity of funding, sitting alongside volatility in local and national decision making. Local contestation arises from these conditions, as turbulence in national government messaging shapes (and is shaped by) public and private responses to AST schemes. These friction points were found to operate on, and intersect at, different scales, requiring formal strategic and opportunistic tactical manoeuvres by those creating and implementing local policies, who are both bound by these forces, and work to challenge, resist, and facilitate them whilst managing contestation from communities and stakeholders. This study on AST policymaking contributes to broader literature across various disciplines on “slow mobilities” by offering a policy-oriented perspective. Our findings highlight that creating and implementing policy for rural mobility is a dynamic and demanding process, relying on the commitment and agility of local stakeholders.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"377 ","pages":"Article 118074"},"PeriodicalIF":4.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143894986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of sex on the incidence of colorectal cancer: considering the influence of gender mechanisms","authors":"Amalia Martinez ,&nbsp;Nadine Hamieh ,&nbsp;Hélène Colineaux ,&nbsp;Michelle Kelly-Irving ,&nbsp;Pascale Grosclaude ,&nbsp;Emmanuel Wiernik ,&nbsp;Cyrille Delpierre ,&nbsp;Sébastien Lamy","doi":"10.1016/j.socscimed.2025.118058","DOIUrl":"10.1016/j.socscimed.2025.118058","url":null,"abstract":"<div><h3>Context</h3><div>Differences in colorectal cancer (CRC) incidence between men and women are documented, but the role of gender mechanisms in explaining these disparities remains underexplored. CRC, the third deadliest cancer worldwide, is often analyzed through “biological” sex differences, without a clear distinction between innate and socially acquired factors. Gender mechanisms, including social roles, behaviors, and access to healthcare, may significantly influence CRC risk.</div></div><div><h3>Objective</h3><div>This study quantifies the proportion of the effect of gender mechanisms on the relationship between sex assigned at birth and CRC incidence, adopting a social epidemiology approach.</div></div><div><h3>Method</h3><div>Using data from the CONSTANCES cohort and the French National Health Insurance database (SNDS), we identified relevant covariates with a Directed Acyclic Graph (DAG). Mediation analyses estimated the contribution of socioeconomic, behavioral, anthropometric and medical factors as gender-related mechanisms.</div></div><div><h3>Results</h3><div>Men have a higher risk of CRC compared to women (OR: 1.54 [1.33; 1.79]). Men exhibit lower cultural capital, higher social and economic capital, more frequent risk behaviors, and higher BMI. Gender mechanisms account for 30 % of the association between sex assigned at birth and CRC incidence, in the imputed data, and up to 50 % in the complete cases. Among the gender mechanisms, BMI emerged as the main mediator.</div></div><div><h3>Conclusion</h3><div>This study reveals that gender-based health inequalities in CRC incidence are partially explained by differences in exposure to social and behavioral risk factors. These findings underscore the importance of integrating gender dynamics into public health strategies for CRC prevention and intervention, focusing on addressing gender-based risk factor exposure.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"376 ","pages":"Article 118058"},"PeriodicalIF":4.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An (un)restricted living: a qualitative exploration of the mental health and well-being of people living with HIV in England","authors":"Vasiliki Papageorgiou ,&nbsp;Lucy Cullen ,&nbsp;T Charles Witzel ,&nbsp;Alex Sparrowhawk ,&nbsp;Flavien Coukan ,&nbsp;Janey Sewell ,&nbsp;Alison Rodger ,&nbsp;Carl May ,&nbsp;Fiona Burns","doi":"10.1016/j.socscimed.2025.118109","DOIUrl":"10.1016/j.socscimed.2025.118109","url":null,"abstract":"<div><div>People living with HIV, who have access to treatment, now have normal life expectancy. However, stigma and discrimination continue to affect health and well-being. We conducted focus groups with people living with HIV (n = 37), and key informant interviews (n = 20) with clinical and non-clinical workers who support people with HIV between May and November 2023. We aimed to explore the ongoing challenges and concerns faced by people living with HIV in England to inform a new model of person-centred HIV care. Participants discussed living well in relation to: 1) an unrestricted living; 2) emotional sexual health and intimacy well-being; and 3) autonomy of health and healthcare. Aspirations for an unrestricted living revolved around experiencing life in the same way as others, rather than having to compromise a sense of self or negotiate experiences differently due to their HIV status. Participants also shared a desire to live fulfilled sex lives without fear of being stigmatised due to living with HIV, and of feeling deserving of a satisfying sex life and sexual intimacy. There was also a particular anxiety about sharing an HIV status with new sexual partners. Conversations around sex and intimacy needed to be opened up to cover topics including pleasure and sexual wellness. A compromised autonomy of health referred to physical health; for example, the need for daily medication. Autonomy of healthcare referred to the challenges of negotiating an often fragmented and fractured healthcare service. Some shared experiences of discrimination by non-HIV healthcare workers and a requirement to advocate for their needs which is a specific challenge for marginalised groups. Person-centred care, which uses an intersectional approach to delivering HIV care, would respond to the needs and aspirations of people with HIV and their whole self. This offers the potential to address HIV-related stigma which continues to hinder progress.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"377 ","pages":"Article 118109"},"PeriodicalIF":4.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}