Documents Reeves, Aaron 21 results

"Background Many governments have introduced tougher eligibility assessments for out-of-work disability benefits, to reduce rising benefit caseloads. The UK government initiated a programme in 2010 to reassess all existing disability benefit claimants using a new functional checklist. We investigated whether this policy led to more people out-of-work with long-standing health problems entering employment.Method We use longitudinal data from the Labour Force Survey linked to data indicating the proportion of the population experiencing a reassessment in each of 149 upper tier local authorities in England between 2010 and 2013. Regression models were used to investigate whether the proportion of the population undergoing reassessment in each area was independently associated with the chances that people out-of-work with a long-standing health problem entered employment and transitions between inactivity and unemployment. We analysed whether any effects differed between people whose main health problem was mental rather than physical.Results There was no significant association between the reassessment process and the chances that people out-of-work with a long-standing illness entered employment. The process was significantly associated with an increase in the chances that people with mental illnesses moved from inactivity into unemployment (HR=1.22, 95% CI 1.03 to 1.45).Conclusions The reassessment policy appears to have shifted people with mental health problems from inactivity into unemployment, but there was no evidence that it had increased their chances of employment. There is an urgent need for services that can support the increasing number of people with mental health problems on unemployment benefits"

"Greece implemented the deepest austerity package in Europe during the Great Recession (from 2008), including reductions in severance pay and redundancy notice periods. To evaluate whether these measures worsened labour market participants' health status, we compared changes in self-reported health using two cohorts of employed individuals in Greece from the European Union Statistics on Income and Living Conditions. During the initial recession (2008–2009) we found that self-reported health worsened both for those remaining in employment and those who lost jobs. Similarly, during the austerity programme (2010–2011) people who lost jobs experienced greater health declines. Importantly, individuals who remained employed in 2011 were also 25 per cent more likely to experience a health decline than in 2009. These harms appeared concentrated in people aged 45–54 who lost jobs. Our study moves beyond existing findings by demonstrating that austerity both exacerbates the negative health consequences of job loss and worsens the health of those still employed."

"STOA, the European Parliament's technology assessment body, and the European Observatory on Health Systems and Policies recently organised a workshop on the impacts of the economic crisis on European health systems. Evidence of the impact of the recent financial crisis on health outcomes is only just beginning to emerge. Data suggests that this latest recession has led to more frequent poor health status, rising incidence of some communicable diseases, and higher suicide rates. Further, available data are likely to underestimate the broader mental health crisis linked to increased rates of stress, anxiety, and depression among the economically vulnerable. Not only does recession affect factors that determine health, but it also affects the financial capacity to respond. Many European governments have reduced public expenditure on health services during the financial crisis, while introducing or increasing user charges. The recession has driven structural reforms, and has affected the priority given to public policies that could be used to help protect population health. The current economic climate, while challenging, presents an opportunity for reforming and restructuring health promotion actions and taking a long-term perspective."

"Background
Economic insecurity correlates with adverse health outcomes, but the biological pathways involved are not well understood. We examine how changes in economic insecurity relate to metabolic, inflammatory and liver function biomarkers.
Methods
Blood analyte data were taken from 6520 individuals (aged 25–59 years) participating in Understanding Society. Economic insecurity was measured using an indicator of subjective financial strain and by asking participants whether they had missed any bill, council tax, rent or mortgage payments in the past year. We investigated longitudinal changes in economic insecurity (remained secure, increase in economic insecurity, decrease in economic insecurity, remained insecure) and the accumulation of economic insecurity. Linear regression models were calculated for nine (logged) biomarker outcomes related to metabolic, inflammatory, liver and kidney function (as falsification tests), adjusting for potential confounders.
Results
Compared with those who remained economically stable, people who experienced consistent economic insecurity (using both measures) had worsened levels of high-density lipoprotein (HDL)-cholesterol, triglycerides, C reactive protein (CRP), fibrinogen and glycated haemoglobin. Increased economic insecurity was associated with adverse levels of HDL-cholesterol (0.955, 95% CI 0.929 to 0.982), triglycerides (1.077, 95% CI 1.018 to 1.139) and CRP (1.114, 95% CI 1.012 to 1.227), using the measure of financial strain. Results for the other measure were generally consistent, apart from the higher levels of gamma-glutamyl transferase observed among those experiencing persistent insecurity (1.200, 95% CI 1.110 to 1.297).
Conclusion
Economic insecurity is associated with adverse metabolic and inflammatory biomarkers (particularly HDL-cholesterol, triglycerides and CRP), heightening risk for a range of health conditions."

" There are concerns that the recovery from the Great Recession in Europe has left growing numbers of people facing precarious housing situations. Yet, to our knowledge, there is no comparative measure of housing precariousness in contrast to an extensive body of work on labour market precariousness. Here, we draw on a comparative survey of 31 European countries from the 2012 wave of European Union Survey of Income and Living Conditions to develop a novel housing precariousness measure. We integrate four dimensions of housing precariousness: security, affordability, quality and access to services, into a scale ranging from 0 (not at all precarious) to 4 (most precarious). Over half of the European population report at least one element of housing precariousness; 14.7  percent report two dimensions and 2.8  percent three or more (equivalent to ~15  million people). Eastern European and small island nations have relatively greater precariousness scores. Worse precariousness tends to be more severe among the young, unemployed, single and those with low educational attainment or who live in rented homes and is associated with poor self-reported health. Future research is needed to strengthen surveillance of housing precariousness as well as to understand what policies and programmes can help alleviate it."

"Poverty alleviation programs, such as cash transfers and monetary grants, may not only lift people out of poverty but, some argue, may improve mental health as well. However, to date, the impact of such programs on children and adolescents' mental health is unclear. We carried out a systematic review and meta-analysis of poverty alleviation interventions providing monetary support and reporting mental health outcomes in 0–19 year olds in low-, middle-, and high-income countries. We searched 11 databases for research published between January 1, 1990 and June 1, 2020 and included interventions offering unconditional and/or conditional monetary support and reporting mental health outcomes. After screening 7,733 unique articles, we included 14 papers (16,750 children and adolescents at follow-up) in our narrative summary. We meta-analyzed data on internalizing symptoms from 8 papers (13,538 children and adolescents analyzed). This indicated a small but significant reduction in adolescents' internalizing problems postintervention compared to control (odds ratio 0.72, 95% confidence interval 0.59–0.88, p < .01; I2 = 67%, τ2 = 0.05, p < .01). Our narrative synthesis provides further support for the overall effectiveness of cash programs but also notes that monetary support alone may not be sufficient in extreme risk settings and that imposing conditions may be actively harmful for the mental health of adolescent girls. We provide causal evidence that monetary interventions reduce internalizing symptoms of adolescents experiencing poverty. We recommend that future programming thoughtfully considers whether to apply conditions as part of their interventions and highlight the importance of providing additional comprehensive support for children and adolescents living in extreme risk settings."

"Purpose
It is unclear how hospitals are responding to the mental health needs of the population in England, against a backdrop of diminishing resources. We aimed to document patterns in hospital activity by psychiatric disorder and how these have changed over the last 22 years.

Methods
In this observational time series analysis, we used routinely collected data on all NHS hospitals in England from 1998/99 to 2019/20. Trends in hospital admissions and bed days for psychiatric disorders were smoothed using negative binomial regression models with year as the exposure and rates (per 1000 person-years) as the outcome. When linear trends were not appropriate, we fitted segmented negative binomial regression models with one change-point. We stratified by gender and age group [children (0–14 years); adults (15 years +)].

Results
Hospital admission rates and bed days for all psychiatric disorders decreased by 28.4 and 38.3%, respectively. Trends were not uniform across psychiatric disorders or age groups. Admission rates mainly decreased over time, except for anxiety and eating disorders which doubled over the 22-year period, significantly increasing by 2.9% (AAPC = 2.88; 95% CI: 2.61–3.16; p < 0.001) and 3.4% (AAPC = 3.44; 95% CI: 3.04–3.85; p < 0.001) each year. Inpatient hospital activity among children showed more increasing and pronounced trends than adults, including an increase of 212.9% for depression, despite a 63.8% reduction for adults with depression during the same period.

Conclusion
In the last 22 years, there have been overall reductions in hospital activity for psychiatric disorders. However, some disorders showed pronounced increases, pointing to areas of growing need for inpatient psychiatric care, especially among children."

"Background
Adverse childhood experiences (ACEs) are strong risk factors for homelessness and poor health and functioning. We aimed to evaluate the lifetime prevalence of ACEs and their associations with health-related and functioning-related outcomes among homeless adults.
Methods
In this systematic review and meta-analysis, we searched from database inception to Nov 11, 2020, for original and peer-reviewed studies in English that documented lifetime prevalence of ACEs or associations between ACEs and health-related or functioning-related outcomes. We selected studies if they included a definable group of homeless adults and measured at least four ACE categories. We calculated pooled estimates of lifetime prevalence of one or more ACEs and four or more ACEs with random-effects models. We used the leave-one-out method in sensitivity analyses and studied meta-regressions to explore potential moderators of ACE prevalence. We also did a narrative summary of associations between ACEs and health-related and functioning-related outcomes, as there were too few studies on each outcome for quantitative meta-analysis. This study is registered with PROSPERO, CRD42020218741.
Findings
We identified 2129 studies through systematic search, of which 29 studies (16 942 individuals) were included in the systematic review, 20 studies (10 034 individuals) were included in the meta-analysis for one or more ACEs, and 15 studies (5693 individuals) were included in the meta-analysis for four or more ACEs. Studies included samples of adults experiencing homelessness in the USA, Canada, and the UK; participants in the included studies were predominantly male (65·2%) and mean ages ranged between 18·3 and 58·1 years, but many studies did not report race, ethnicity, and sexual and gender minority data. Lifetime prevalence of one or more ACEs among homeless adults was 89·8% (95% CI 83·7–93·7) and the lifetime prevalence of four or more ACEs was 53·9% (45·9–61·7). Considerable heterogeneity was identified in both meta-analyses (I2>95%). Of the potential moderators analysed, the ACE measurement tool significantly moderated the estimated lifetime prevalence of one or more ACEs and four or more ACEs, and age also significantly moderated the estimated lifetime prevalence of four or more ACEs. In the narrative synthesis, ACEs were consistently positively associated with high suicidality (two studies), suicide attempt (three studies), major depressive disorder (two studies), substance misuse (two studies), and adult victimisation (two studies).
Interpretation
The lifetime prevalence of ACEs is substantially higher among homeless adults than among the general population, and ACE exposure might be associated with prevalence of mental illness, substance misuse, and victimisation. Policy efforts and evidence-based interventions are urgently needed to prevent ACEs and address associated poor outcomes among this population."

"In this paper, we examine the mental health effects of lowering the UK's benefit cap in 2016. This policy limits the total amount a household with no-one in full-time employment can receive in social security. We treat the reduction in the cap as a natural policy experiment, comparing those at risk of being capped and those who were not, and examining the risk of experiencing poor mental health both before and after the cap was lowered. Drawing on data from ~900,000 individuals, we find that the prevalence of depression or anxiety among those at risk of being capped increased by 2.6 percentage points (95% confidence interval: 1.33–3.88) compared with those at a low risk of being capped. Capping social security may increase the risk of mental ill health and could have the unintended consequence of pushing out-of-work people even further away from the labour market."

"Background
Levels of child malnutrition and hunger across the world have decreased substantially over the past century, and this has had an important role in reducing mortality and improving health. However, progress has stalled. We examined whether family policies (eg, cash transfers from governments that aim to support households with children) are associated with reduced food insecurity.
Methods
In this observational analysis, we used a dataset of individual-level data that captured experience-based measures of food insecurity and sociodemographic characteristics collected by the Gallup World Poll in 142 countries for 2014–17. We then combined this dataset with indicators of the type and generosity of family policies in these countries, taken from the University of California, Los Angeles' World Policy Analysis Center. We used multilevel regression models to examine the association between the presence of family policies for households with children and the probability of reporting moderate or severe food insecurity or severe food insecurity (moderate or severe food insecurity was defined as a “yes” response to at least four of eight questions on the Gallup Food Insecurity Experience Scale, and severe food insecurity was defined as a “yes” response to at least seven questions). We controlled for multiple covariates, including individual-level measures of social position and country-level measures, such as gross domestic product. We further examined whether this association varied by household income level.
Findings
Using data from 503 713 households, we found that, on average, moderate or severe food insecurity is 4·09 percentage points (95% CI 3·50–4·68) higher in households with at least one child younger than 15 years than in households with no children and severe food insecurity is 2·20 percentage points (1·76–2·63) higher. However, the additional risk of food insecurity among households with children is lower in countries that provide financial support (either means-tested or universal) for families than for countries with little or no financial assistance. These policies not only reduce food insecurity on average, but they also reduce inequalities in food insecurity by benefiting the poorest households most.
Interpretation
In some countries, family policies have been cut back in the past decade and such retrenchment might expose low-income households to increased risk of food insecurity. By increasing investment in family policies, progress towards Sustainable Development Goal 2, zero hunger, might be accelerated and, in turn, improve health for all."