Social Science & Medicine最新文献

{"title":"The “controlled flow” migration strategy and regimes of humanitarian care for people “in transit” through Darién, Panama","authors":"Madeline Baird ,&nbsp;K. Michelle Ordaz ,&nbsp;Carlos Franco-Paredes ,&nbsp;Amanda Gabster","doi":"10.1016/j.socscimed.2025.118578","DOIUrl":"10.1016/j.socscimed.2025.118578","url":null,"abstract":"<div><div>Since 2021, over one million people have traveled on foot across the Darién border region separating Panama and Colombia en route to the U.S.-Mexico border. Extreme physical conditions of the route, crossing rivers and mountains through the Darién Forest, present lethal vulnerabilities to violence and impacts on migrant health. As migration across Darién has increased and diversified, complex medical emergencies, including migrant death, sexual violence, and injury, present critical areas for social service response. Since 2016, the Panamanian State has implemented the “controlled flow” migration strategy and, in recent years, non-governmental organizations provide basic services through a system of migrant reception centers. Our research, based on ethnographic methods including participant observation, health surveys, and semi-structured interviews (n = 39) with migrant-serving officials examines the everyday conditions and limitations to the provision of care based on a medicalized response to violence after people traverse the treacherous terrain across the Darién Forest. We trace how migration policies in Panama construct violence and shape the possibilities for humanitarian care for migrant people “in transit” through Panama. This paper advances understanding of the impacts of border externalization on shaping mobility, migrant protection, and regimes of care in transit corridors along the route to the U.S. By analyzing the public health impact of a regional border regime, we deepen research on the nexus of migrant care and control that frames the humanitarian response to increased migration across Darién Province for people traveling to the U.S. southern border.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"385 ","pages":"Article 118578"},"PeriodicalIF":5.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145120785","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 moral dimension of professional socialization in the premedical years","authors":"Kaltri Hoxha ,&nbsp;Alexandra H. Vinson","doi":"10.1016/j.socscimed.2025.118561","DOIUrl":"10.1016/j.socscimed.2025.118561","url":null,"abstract":"<div><div>Recent medical sociology scholarship has highlighted the importance of the premedical years for shaping students' career expectations and trajectories. We advance research on professional socialization in the premedical years by elucidating its moral dimension through an investigation of how students prepare to take situational judgment tests, an application requirement introduced in the United States over the past ten years. These tests present students with challenging scenarios that often contain a moral dilemma. Drawing on qualitative analysis of online forum discussions of test scenarios (12 scenarios and 150 comments), we describe how premedical students negotiate the medical profession's expectations of them as moral actors. We find that students collectively negotiate the appropriateness of test responses in online forum discussions. Premedical students draw distinctions between how they would respond to test scenarios versus act “in real life” and attempt to collectively figure out what types of responses will help medical schools perceive them as good future doctors. Students also display frustration at the position such tests ask them to take vis-à-vis scenarios that present social problems or ask them to adhere to organizational policies or rules that students find to be overly interventionist. Our findings highlight the moral dimension of professional socialization, bringing sociology of health professions education into conversation with recent work on the sociology of morality.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"384 ","pages":"Article 118561"},"PeriodicalIF":5.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060272","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":"Trajectories of immigrant workers with work-related injuries: the path to mistrust","authors":"Maude Arsenault ,&nbsp;Bob White ,&nbsp;Daniel Côté","doi":"10.1016/j.socscimed.2025.118577","DOIUrl":"10.1016/j.socscimed.2025.118577","url":null,"abstract":"<div><div>In Quebec, injured workers are entitled to medical assistance, wage replacement, and rehabilitation. While many cases are resolved smoothly, ethnographic research reveals that immigrant workers may face disruptions that foster mistrust and hinder recovery. This study examines how mistrust shapes the rehabilitation experiences of immigrant workers and identifies its root causes and impacts. Based on ethnographic observations at a Montreal rehabilitation clinic and 21 in-depth interviews with injured immigrants workers conducted between 2020 and 2024, the research highlights how mistrust emerges from experiences of racism, discrimination, perceived betrayal, employer practices, conflicting medical opinions, and fraudulent behaviors. These factors, often intersecting across institutional systems, contribute to a cumulative burden that impedes recovery and well-being. The findings underscore the need for systemic changes to build trust and improve rehabilitation outcomes for immigrant workers.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"385 ","pages":"Article 118577"},"PeriodicalIF":5.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145160281","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":"“It's soul destroying to be honest”: A qualitative study of morally uninhabitable working environments and the responsibilization of healthcare professionals working in concurrent disorders","authors":"Jackson P. Loyal ,&nbsp;Ridhwana Kaoser ,&nbsp;Jack York ,&nbsp;Craig Norris ,&nbsp;Emily Jenkins ,&nbsp;Sean O'Callaghan ,&nbsp;Ruth Lavergne ,&nbsp;Will Small","doi":"10.1016/j.socscimed.2025.118590","DOIUrl":"10.1016/j.socscimed.2025.118590","url":null,"abstract":"<div><div>Healthcare professionals' wellbeing is crucial for healthcare system functioning and population health. Prolonged moral distress may result in burnout, undermining healthcare professionals' wellbeing, negatively impacting quality of patient care, and resulting in considerable healthcare system costs. We conducted 36 interviews with healthcare professionals working with patients with concurrent mental and substance use disorders in British Columbia, Canada, exploring their perceptions of the institutional constraints which shaped their experiences and caring practices. We conducted a reflexive thematic analysis of the interviews guided by the theoretical concept of responsibilization. While most participants found their work rewarding, many encountered institutional constraints which limited their ability to provide the standard of care to which they felt morally and ethically obligated. Prolonged exposure to such morally uninhabitable working environments resulted in participants' moral distress and burnout. Central to participants' narratives was the role of responsibilization in both contributing to and exacerbating moral distress and burnout. On top of their caring duties, participants perceived a need to over-function to offset institutional constraints within healthcare, and address their and their colleagues' moral distress and burnout without adequate institutional support. Findings demonstrate how individual-centered interventions are inadequate without proper institutional support, and have the potential to re-enact rather than rectify moral distress and burnout. Structural interventions are paramount to redress these occupational harms and protect healthcare professionals’ wellbeing.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"384 ","pages":"Article 118590"},"PeriodicalIF":5.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145118711","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":"Beyond past-due bills: The varieties of medical debt used to finance healthcare","authors":"Elizabeth C. Martin","doi":"10.1016/j.socscimed.2025.118592","DOIUrl":"10.1016/j.socscimed.2025.118592","url":null,"abstract":"<div><div>The high cost of medical care in the United States has led to widespread medical indebtedness in the population. While previous work has highlighted the reciprocal relationship between debt and health, we know less about how families use and experience diverse kinds of debt resulting from medical care. This article draws on in-depth interviews with women in the Midwest having trouble paying for healthcare to understand the ways they use debt to finance care for themselves and their families. I find that in addition to conventional medical debt—past-due bills or payment plans from providers—these women draw on multiple sources of credit in their pursuit of healthcare. Use of credit cards, loans or gifts from family and friends, and other consumer credit was widespread. Current measures of conventional medical debt might be underestimating the prevalence of debt acquired to pay for healthcare, especially among more advantaged households. I argue that researchers must adopt a broader definition of medical debt to encompass <em>all</em> the debt acquired to finance medical care to fully grasp the financial consequences of high medical costs in the US. I also argue that, like other types of debt, medical debt is a double-edged sword—a resource that means more people have access to care, but also a burden in an uncertain future.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"386 ","pages":"Article 118592"},"PeriodicalIF":5.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236465","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":"Refugee integration in national health systems of low- and middle-income countries (LMICs): evidence synthesis and future research agenda.","authors":"Amina Olabi, Natasha Palmer, Maria Paola Bertone, Giulia Loffreda, Ibrahim Bou-Orm, Lucas Sempe, Marcia Vera-Espinoza, Arek Dakessian, Paul Kadetz, Alastair Ager, Sophie Witter","doi":"10.1016/j.socscimed.2025.118546","DOIUrl":"https://doi.org/10.1016/j.socscimed.2025.118546","url":null,"abstract":"<p><p>This paper reviews evidence on healthcare responses for refugees, documenting the different approaches and their effectiveness and impact in particular in relation to supporting integrating refugees into national health systems. The review adopted a purposeful, iterative approach, utilizing electronic databases, grey literature, and reference lists from relevant studies. A total of 167 studies, primarily from low- and middle-income countries (LMICs), focusing on refugees and forcibly displaced persons with empirical data, were included. The review highlights a substantial literature on refugee health and healthcare access, with well-covered areas including delivery models, access barriers, gaps in coverage, and specific health services such as psychosocial care, non-communicable diseases, mental health, and maternal and child health. However, less attention is given to integration models, health system responses, and their impact on system resilience and social cohesion. Few studies examine the costs, feasibility, or sustainability of integration models, and little research focuses on health system perspectives or comparative analyses. Moreover, the host health system's status, capacity, and needs are often underexplored. Some countries are particularly well-represented in studies, e.g. Turkey, Jordan, Lebanon, Bangladesh, Democratic Republic of Congo (DRC), and Uganda. There is however a paucity of data that would provide the basis for more quantitative or analytical evaluation from a systems perspective. This gap highlights the need for further research on effective integration models, their operational aspects, and their long-term impact on local health systems' resilience and sustainability. To support this research agenda, we propose a conceptual framework to provide analytic guidance for future research on healthcare responses for refugees and health system integration.</p>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"385 ","pages":"118546"},"PeriodicalIF":5.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253385","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":"‘Fighting him’: Following distress in hostile housing regimes","authors":"Elizabeth Storer ,&nbsp;Nikita Simpson ,&nbsp;Ella Hubbard ,&nbsp;Suad Duale","doi":"10.1016/j.socscimed.2025.118581","DOIUrl":"10.1016/j.socscimed.2025.118581","url":null,"abstract":"<div><div>This study explores the psychological impacts of the UK housing crisis among a collective of Somali women in Birmingham. We build a framework from anthropological theories of social distress, applied through a participatory methodology consisting of housing biographies and therapeutic workshops. Research was conducted between June 2022–December 2023. Our findings reveal the cumulative forms of distress generated through poor housing, eviction and placement in temporary forms of accommodation. Such distress was articulated in multiple genres which spanned somatic, social reproductive, bureaucratic and psychological harms. Participants pushed back on biomedical categories of mental ill-health in relation to housing distress. We argue that hostile migratory contexts contour the expression of suffering generated through poor housing, particularly in relation to women's mental health. We suggest that ethnographic approaches can lead us beyond social determinants models, revealing forms of distress which accumulate across and within policy domains.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"385 ","pages":"Article 118581"},"PeriodicalIF":5.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145160347","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":"Adolescent loneliness and later-life depressive symptoms: The intersecting roles of gender and socioeconomic status","authors":"Keun Young Kwon ,&nbsp;NaKyung Nam ,&nbsp;Jinho Kim","doi":"10.1016/j.socscimed.2025.118588","DOIUrl":"10.1016/j.socscimed.2025.118588","url":null,"abstract":"<div><h3>Rationale</h3><div>Adolescent loneliness has emerged as a pressing public health issue in many developed countries, drawing increasing attention for its potential long-term psychological consequences.</div></div><div><h3>Objective</h3><div>This study examines the association between adolescent loneliness and depressive symptoms in adulthood and explores how gender and socioeconomic factors, such as college attainment and personal earnings, moderate this relationship.</div></div><div><h3>Methods</h3><div>Using data from the National Longitudinal Study of Adolescent to Adult Health, this study employs sibling fixed effects models to account for unobserved family-level confounding factors. Gender-stratified models and two- and three-way interaction models are used to investigate how gender and socioeconomic factors shape the relationship between adolescent loneliness and adult depressive symptoms.</div></div><div><h3>Results</h3><div>The positive association between adolescent loneliness and depressive symptoms remains significant after accounting for individual- and familial-level covariates, including sibling fixed effects (b = 0.988, p &lt; 0.001). This suggests that the relationship persists independently of unobserved family background characteristics. Gender-specific analyses indicate that college attainment significantly moderates this association for women, but not for men. A three-way interaction between loneliness, college attainment, and gender (b = −1.327, p &lt; 0.05) further supports the gendered moderating role of education. In contrast, personal earnings do not moderate the relationship in either gender.</div></div><div><h3>Conclusion</h3><div>The findings of this study highlight the potential long-term psychological consequences of adolescent loneliness and the importance of interventions across the lifespan. Efforts to support women with lower levels of education may be particularly important in mitigating the heightened psychological effects of loneliness and reducing mental health disparities.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"384 ","pages":"Article 118588"},"PeriodicalIF":5.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060917","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":"Health in justice or health injustice? Indigenous Māori experiences of primary care following release from New Zealand prisons: a national record study","authors":"Paula Toko King ,&nbsp;Frederieke Sanne Petrović-van der Deen ,&nbsp;Cheryl Davies ,&nbsp;Bridget Robson ,&nbsp;Sue Crengle ,&nbsp;Gabrielle Baker ,&nbsp;Julia Carr ,&nbsp;Natalie Paki Paki ,&nbsp;Tīria Pehi ,&nbsp;Marama Cole ,&nbsp;Bernadette Jones ,&nbsp;Tristram Ingham ,&nbsp;Jeannine Stairmand ,&nbsp;Belinda Tuari-Toma ,&nbsp;Christopher Kemp ,&nbsp;Marshall H. Chin ,&nbsp;Ruth Cunningham","doi":"10.1016/j.socscimed.2025.118543","DOIUrl":"10.1016/j.socscimed.2025.118543","url":null,"abstract":"<div><h3>Background</h3><div>Indigenous Māori experience mass imprisonment in New Zealand secondary to colonisation, coloniality and racism. In addition to high risks of morbidity and mortality, community re-entry from prison presents multiple challenges to accessing healthcare and other critical services. In New Zealand's publicly funded health and disability system, primary care acts as the entry point and gatekeeper to secondary services, facilitating linkages to other supports. Guided by lived experience and using deidentified linked national administrative data, we examined the primary care experiences of Māori over the 12-months post-release from prison.</div></div><div><h3>Results</h3><div>A total of 7398 Māori were released from prisons between June 1, 2021 and May 31, 2022. Over half experienced reimprisonment during the 12-months post-release. Only 76 % were enrolled with a primary health organisation meaning 24 % did not have access to subsidised primary care. Over 12-months, 47 % had accessed primary care consults, 63 % received medication, and 23 % had a community laboratory test. In the 12-months post-release, 26 % presented to an emergency department and 5 % were admitted for ambulatory sensitive hospitalisations.</div></div><div><h3>Conclusions</h3><div>Whilst our findings indicate that Māori released from prisons access primary care, there are financial barriers to access. We also found (across a range of access and quality measures) that primary care services are not meeting their high health needs, demonstrating governmental breach of Indigenous rights to health. High-quality primary care is critical to successful community re-entry and to preventing adverse outcomes. There is an urgent requirement for evidence-informed culturally safe strategies that guarantee equitable access to high-quality primary care, developed and designed in ways that privilege the views of Māori with lived experience of imprisonment, those of their families, and communities.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"384 ","pages":"Article 118543"},"PeriodicalIF":5.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082194","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":"Intersecting social inequalities in prenatal and postnatal care: Examining race, ethnicity, socioeconomic status, and geographic location","authors":"Neema Langa ,&nbsp;Kathryn Freeman Anderson ,&nbsp;Zelma Oyarvide Tuthill ,&nbsp;Annamaria Milazzo ,&nbsp;McClain Sampson ,&nbsp;Elizabeth Gregory ,&nbsp;Kimberly A. Pilkinton ,&nbsp;Regan S. Bennet ,&nbsp;Felicia N. York ,&nbsp;Quenette L. Walton","doi":"10.1016/j.socscimed.2025.118583","DOIUrl":"10.1016/j.socscimed.2025.118583","url":null,"abstract":"<div><div>Existing research document disparities in prenatal and postnatal care utilization. This research introduces a novel approach for examining maternal healthcare disparities by integrating multiple structural factors that inhibit care usage. Principally, we examine intersecting social inequalities to understand how race/ethnicity, socioeconomic status, and geographic location interactively shape obstetric care usage for individuals who give birth. Drawing data from the 2016–2021 Pregnancy Risk Assessment Monitoring System (PRAMS) (N = 177,480), the Gadson conceptual model, and intersectional approach, we examine the racial divide in the effects of documented education status and residence on obstetric care usage in the United States. We found a significantly lower likelihood of both prenatal and postnatal care utilization among marginalized racial/ethnic groups, including non-Latina Black, non-Latina ‘Other’, and Latinas, as compared to non-Latina White individuals. These groups also had lower utilization of adequate, adequate plus prenatal (more than recommended), and post-natal care (for only Latinas), even when highly educated (16 years of education and more). We further documented the rural-urban gaps in the effect of education where rural non-Latina Black individuals with more years of education (16 years and more), rural Latina and rural non-Latina other who are slightly educated (9–11 years of education) had a relatively lower likelihood of using adequate plus prenatal care, as compared to rural non-Latina White with similar education characteristics. We call for reforms in healthcare and other factors affecting health that prioritize inclusivity and equality, and reduce bias and perceptions of bias to improve maternal healthcare and outcomes among vulnerable groups.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"384 ","pages":"Article 118583"},"PeriodicalIF":5.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103121","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}