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Standard applications of psychology to addressing poverty involve the facilitation of decision-making orientations associated with flourishing, such as feeling high personal efficacy and regulating one’s behavior to fit long-term goals. Although such versions of agency and self-regulation may be helpful in Euro-American middle-class settings, their suitability is rarely considered for the kind of non-Western, nonaffluent settings in which the majority of the world’s population lives. In addressing this, we recommend analyzing how the accessibility and suitability of decision-making processes are shaped by the socioecological context in which decision-making takes place. Drawing on socioecological, cultural, and political psychology, we present a multilayered framework in which optimal decision-making mindsets are shaped by the material conditions, interpersonal relations, and societal discursive frames in which people are embedded. We illustrate the framework through the case study of migrant workers who caste marginalized in India, an emerging economy that is host to many behavioral anti-poverty efforts.
In this cross-sectional analysis, we examined associations between socioeconomic status (SES), body mass index (BMI), inflammation, diet, and cognitive performance. While low SES is associated with lower cognitive scores, the present study investigated whether these variables – specifically BMI, inflammatory biomarkers, and dietary intake – statistically mediate this relationship.
Methods:
The final sample included 109 young adults (mean age = 21.31; 65% female; 45% white). Analyses utilized a comprehensive neuropsychological battery, including the NIH Cognitive Toolbox and Kaufman Brief Intelligence Test, alongside biomarkers of inflammation (Interleukin (IL)-1β, IL-6, and tumor necrosis factor-α (TNF-α)), and self-reported dietary intake via the National Cancer Institute’s Diet History Questionnaire – Third Edition. A pre-registered analysis using bootstrapped standard errors across 5,000 bootstrapped replications in ‘lavaan’ tested whether (i) associations between SES and executive functioning and episodic memory were statistically mediated by a higher BMI and (ii) associations between BMI and executive functioning and episodic memory were statistically mediated by elevated inflammation and sugar or fat intake.
Results:
BMI did not account for the association between SES and cognition; however, BMI, fat intake, and sugar intake were inversely correlated with cognitive functioning. Sugar intake mediated the association between BMI and cognition, though this finding was not significant after adjusting for covariates. Inflammation did not mediate the relationship between BMI and cognition.
Conclusions:
These results provide support for a link between BMI and cognitive performance and preliminary evidence of a mediating role of sugar intake. Further longitudinal and experimental research is needed to extend these findings and characterize underlying mechanisms.
The psychological consequences of hospital admission for COVID-19, such as post-traumatic stress disorder (PTSD), are under-researched.
Aims
To describe the prevalence of, and risk factors for, psychological trauma symptoms in COVID-19 patients discharged from hospital.
Method
We used data from the Post-Hospitalisation COVID-19 (PHOSP-COVID) study of adults discharged from UK hospitals after COVID-19. Psychological trauma was assessed using the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) 5 and 12 months after discharge. We used log binomial regression to identify risk factors for probable PTSD.
Results
We describe 1565 study participants discharged from hospital between February 2020 and March 2021 following an admission for COVID-19. Most were male (61.3%), White (77.4%) and from more deprived areas (62%). Of these, 15% had probable PTSD (PCL-5 ≥34) at 5 months which was associated with being 18 to 50 years old (risk ratio: 3.0 (2.1– 4.3), p < 0.001), lower income (e.g. <£19,001, risk ratio 2.1, 95% CI: 1.5 – 2.8, p < 0.001), longer admission and a history of depression or anxiety. Out of 236, 136 (57.6%) with probable PTSD at 5 months still had probable PTSD at 12 months. Persistence was associated with intensive care unit (ICU) admission (risk ratio 1.3, 95% CI 1.1–1.6, p < 0.001) and higher anxiety and PCL-5 scores at 5 months.
Conclusions
Probable PTSD was common 5 months after admission for COVID-19 and was associated with lower socioeconomic status, longer admission and previous depression or anxiety. Over half remained symptomatic at 12 months, associated with ICU admission and higher 5-month PCL-5 scores.
Although potential immigrants had an opportunity to migrate abroad, some gradually become disenchanted with the future life they envisioned they would have in countries of immigration. Synthesizing their narratives illuminates a common sequence of processes, with immigrants first becoming bored and disappointed with a host society unlike what they had envisioned, then frustrated with the language barrier and sentiments of cultural alienation due to their unfamiliarity with cultural references, customs, and norms. Then even after they culturally assimilate, aspiring immigrants encounter both racial discrimination that they perceive as hostile and local gender norms that make it difficult to find a stable relationship. After working for several years, they gradually become aware of how they are unable to advance their career within their job as an immigrant. The social forces and restrictive immigration policies discussed earlier can lead aspiring immigrants to cut their losses from their immigration project out of the belief they will have a happier life as an ex-immigrant in their homeland than “just an immigrant.”
Deterrence also operates through a belief among potential immigrants that they need time to build sufficient socioeconomic status (SES) and social ties in their country of origin with which they can prove to foreign governments, family, and others in the country of origin they will return to their country when applying for an NIV and therefore enhance the opportunities they have to travel abroad. Many repeatedly defer migrating abroad because they devote time accumulating SES and social ties to meet several expectations of society, like the expectation that adult children complete a college education, obtain a “respectable” and stable job, purchase a home with a mortgage, marry, have and raise children, work enough to afford paying for the mortgage and sending their child to university, and increasingly take care of their parents as they age – all of which effectively tie up and therefore ground many individuals from going abroad. Others deterred from applying for a visa later often become especially eager to intentionally provide their children with preimmigration support to go abroad as what I conceptualize as second-generation emigrants.
Our understanding of international migration as a general phenomenon and in its various aspects is still limited to a relative deficiency in knowledge about a possibly even larger population of individuals that might have counterfactually immigrated but did not. This book examines the processes that prevent migration via the interaction between (a) specific government policies; and (b) societal forces emanating from the social networks in which potential immigrants are embedded. Additional data, empirical results, and theories about potential immigrants help us contribute three new theoretical frameworks to international migration: (1) the push-retain-pull-repel model, (2) the (im)mobility paradox, and (3) how might-have-been-immigrants who do not immigrate due to denial, deterrence, and disenchantment are stratified as unequally as immigrants are. Previous scholars have already discovered much about denial, deterrence, and disenchantment but no study has systematically and comparatively analyzed these three processes alongside each other. The outline of chapters for this book examines different aspects of denial, deterrence, and disenchantment.
Lower socioeconomic status (SES) is a risk factor for psychopathology. Youth living in low SES neighborhoods experience a myriad of stressors, particularly social stressors (e.g., discrimination), which may be particularly stressful for adolescents sensitive to peer feedback (i.e., blunted sensitivity to acceptance from peers). This study thus aimed to test whether neighborhood SES moderates the relationship between brain responses to peer feedback and affect outside of the lab, measured through ecological momentary assessment (EMA). To measure neural response to acceptance (relative to rejection), 13–18-year-old adolescents (N = 172) completed an event-related potential (ERP) task during which they received accepting or rejecting feedback from peers. They also rated their positive and negative affect via EMA for a week. Neighborhood SES moderated the relationship between brain responses to peer acceptance and negative affect. Specifically, for adolescents living in low SES neighborhoods, blunted brain response to acceptance was related to elevated negative affect. Prevention and intervention efforts (e.g., neighborhood/community interventions) may benefit from focusing on increasing hedonic responses to social feedback.
Inclusive fitness theory predicts that to maximize fitness, individuals should invest in kin, but relatives can also compete for resources. These opposing forces can have opposite effects on fertility, which was further constrained by marital and inheritance norms in traditional Western societies. How available resources influence this balance between helping and competing remains poorly understood. To investigate whether kin help or harm fertility, we used genealogical records from a population registry to study how relatives alive at age 15 were associated with marriage and lifetime number of children in Finnish people born 1752–1879, comparing landowning and landless individuals. Our results show that for focals born to landowning families, both older and younger siblings were associated with a higher age at first marriage, but the maternal grandmother and younger sisters were positively associated with fertility. These associations also differed by the focal’s sex. Among the landless, siblings were also relatively weakly associated with poor marital outcomes, but not with the lifetime number of children. Relatives were not associated with lifetime childlessness. These results suggest that a high level of resources may intensify both positive and negative associations between kin and fertility, possibly through inheritance patterns, competition for resources and childcare help.
Personal networks provide crucial support during crises, yet people are embedded in different network types that structure unequal access to such resources. The current study integrates these perspectives to examine whether—and how—network turnover contributed to disparities in mental health across socioeconomic status (SES) groups during the pandemic. Using two-wave panel data from the COVID-19 Pandemic and Social Network Panel Study (2020–2021), an egocentric network study of the college population in Wuhan, we employ random forests and spectral clustering to identify 7 types of core networks based on 43 network variables (i.e., Family, Friend, Restricted, Family & Community, School & Career, Just Activity, and Homebody). We find that as local social-distancing policies tightened, respondents increasingly shifted to Family and Friend networks and withdrew from School & Career and Just Activity. Individual fixed-effect models reveal that these network turnovers have heterogeneous mental health consequences net of observed and time-invariant unobserved confounders. Moving into Family and Friend networks yields the most favorable mental health outcomes for higher-SES groups, whereas benefits are less pronounced and even reversed among lower-SES groups. This pattern is consistent with SES-based differences in social support available in these network types. The current research advances an updated machine-learning approach for identifying personal network typologies. It also shows how the pandemic laid bare unequal resources embedded in personal networks and intensified health-related social inequality, underscoring the need to theorize network effects as contingent on individuals’ social status and the contexts in which networks are formed and embedded.
This report examines gender differences in trust-based social networks in contemporary China. Using data collected from a uniquely designed survey, respondents rate the trustworthiness of 24 prototypical social roles, enabling our construction of gender-specific networks. Community detection analysis reveals a tripartite structure in men’s networks – older-generation kin, same-generation kin and non-kin – versus a simpler kin/non-kin split among women. Two explanatory pathways are tested: cultural dispositions and life chance access. Matching analyses suggest cultural orientation as the primary driver: when men and women both embrace traditional ideas to the same degree, their network partitioning differences cease to exist. Further analyses suggest that the gender difference in social network partitioning lies in the fact that men are more traditionally oriented than women. This study highlights a gendered cultural configuration in which men appear relatively more “traditional” and women more “modern” as played out through gendered forms of social networking.
A novel approach of this book is its reliance on experimental evidence primarily drawn from well-controlled comparisons between completely illiterate and literate individuals, highlighting the mind-enhancing powers of reading. To properly interpret this evidence, it is necessary to clarify the evolving definitions of literacy and often inconsistent terminology used to describe individuals with varying literacy levels.
The goal of the present study is to understand whether youth with Noonan Syndrome Spectrum Disorder (NSSD) are at increased risk of neurocognitive difficulties when living in resource depleted communities.
Method:
Youth (5–17 years; Mage = 9.48 years) with NSSD (n = 140) and unaffected youth (4–15 years; Mage = 9.63 years; n = 85) were included. We ascertained the Child Opportunity Index Health and Environment Index (COI H/E) national-level Z-scores and assessed academic achievement and executive function. Multiple regressions were run to analyze the effects of diagnosis (whether the child had NSSD), COI H/E Z-scores, and diagnosis × COI H/E Z-score interaction on academic achievement (i.e., word reading, math, spelling, and sentence comprehension) and executive skills (i.e., performance-based working memory and processing speed and parent-rated measure of daily executive skills).
Results:
Diagnosis was a significant predictor in each model. COI H/E Z-score was a significant predictor of spelling and a marginally significant predictor of sentence comprehension scores. There was a significant diagnosis × COI H/E Z-score interaction for working memory, and marginally significant interactions for spelling and sentence comprehension scores. Higher H/E Z-scores were associated with better working memory in the NSSD group and better academic achievement in the unaffected group.
Conclusions:
While the effects of NSSD are large on all assessed domains, there is an additional burden of resource depletion on working memory abilities of youth with NSSD. Academic achievement in the NSSD group was lower than the unaffected group across resource-depleted/enriched environments, demonstrating the profound effects of NSSD on academic functioning.
In the aftermath of the assassination of UnitedHealthcare CEO Brian Thompson in December 2024, everyday Americans took to social media to share stories of the challenges they'd faced trying to navigate the American health insurance system. Why did this event strike such a nerve with the American public? For a topic as central to the lives of Americans as health care, there is no book that examines the impact of coverage denial, whereby health insurers decide whether to cover health services that appear to be within the scope of a plan's benefits – not until now. In Coverage Denied, health policy professor Miranda Yaver offers a sobering account of the ways in which coverage denials damage patient health and exacerbate inequalities along income, education, and racial lines. Combining rich interview material with original survey data, Yaver draws critical attention to the tens of millions of medical claims denied by health insurers every year, shining a necessary light on our inequitable health care system.
When Daniel spent years seeking diagnosis for his spinal cyst, he faced denial after denial and only felt compelled to fight his insurer because he had a family to support. Through survey and interview evidence, this chapter explores who is most vulnerable to being denied coverage by health insurers, and what accounts for these vulnerabilities. Highlighting the first patient-level analysis of coverage denials across public and private insurance, this chapter shows that those from marginalized groups – namely, women, LGBTQ patients, and those in worse health – are more vulnerable to experiencing coverage denials. Interestingly, though low health literacy might be expected to lead some patients to pursue care outside their insurance benefits, socioeconomic factors do not consistently correlate with greater vulnerability to coverage denial. This finding offers insights into the scope of defensive medicine amid medical malpractice concerns. Black and Hispanic patients appear to be particularly likely to experience repeated coverage denials, and, given the significant health literacy demands of appealing, patients from marginalized groups may be particularly ill-equipped to weather the storm.
Drawing on survey and interview evidence, this chapter explores the effect of coverage denials on patients’ health and economic security. Most Americans report an inability to pay an unexpected $1,000 bill, so, with notably expensive health care, denials can be devastating. Too often, when coverage is denied, patients abandon their treatments, a dynamic shown not only through physician surveys, but also through original survey evidence of patients, half of whom reported delaying or abandoning their prescribed care. Further, the people most likely to do so are typically Black or Hispanic or less affluent, and nearly half of patient respondents reported that their health condition declined. In fact, some patients may not survive at all. Marginalized patients are also more likely to postpone non-medical purchasing to accommodate unexpected health insurance barriers, suggesting the far-reaching consequences of prior authorization. The evidence shows not only that tools of managed care produce frequent coverage denials, but also that this practice shifts risk from insurers to patients, yielding new health and economic insecurities, especially for patients from marginalized backgrounds.
Delays and denials of health coverage are troubling in a country that underperforms across many health outcomes, but how do coverage denials impose a broader set of administrative burdens? Though KFF analyses highlight the number of denied ACA marketplace claims that are appealed, this chapter offers the first survey evidence of appeals and reversals at the patient level. Such an analysis helps to unpack not only the number of appeals, but also who appeals, and to what extent the admininistrative burdens of appealing are inequitable. Drawing on survey evidence, interviews with patients, and administrative data, this chapter shows how few patients understand they can appeal, and often they underestimate the odds of prevailing against health insurance giants. What’s more, not only are less affluent patients less likely to challenge denials, but also Black and Hispanic Medicaid patients and sicker patients are less likely to appeal successfully. That appealing – and doing so successfully – is so inequitably distributed offers new insights into the scope of this health policy problem and how it can deepen racial and socioeconomic divides in access to health benefits.
Major depressive disorder (MDD), smoking, and drinking frequently co-occur, with evidence suggesting these relationships may differ by sex. However, the direction of causality and the extent of sex-specific associations remain unclear. We investigated sex-specific genetic relationships between MDD and substance use phenotypes using genome-wide association studies (GWAS) from the UK Biobank and publicly available sex-stratified GWAS for MDD and problematic alcohol use (PAU). Causal effects were assessed using bidirectional, sex-stratified Mendelian randomization (MR). We further applied multivariable MR (MVMR) to evaluate the influence of socioeconomic status (SES). Genetic correlation analyses indicated significant shared genetic architecture between MDD and all substance use traits in sex-combined GWAS. In sex-specific analyses, the correlation between cigarettes per day and MDD was significantly stronger in females, and drinks per week were correlated with MDD only in females. MR analyses showed that genetic liability to MDD increased the risk of smoking initiation and PAU in females, and was associated with reduced alcohol drinking frequency in males. In contrast, no tested substance use trait showed evidence of a causal effect on MDD in either sex. MVMR adjusting for SES attenuated the association between MDD and smoking initiation. The effect on PAU in females remained. In males, the negative association between MDD and drinking frequency became non-significant after SES adjustment. These findings reveal sex-specific genetic and causal relationships between smoking, drinking, and MDD, and highlight the role of SES as a potential confounder. Incorporating sex and socioeconomic context is critical when examining these associations.
The rapidly growing burden of non-communicable diseases (NCDs) in sub-Saharan Africa necessitates a better understanding of access gaps along the care continuum. This study assessed the prevalence and inequality in unmet need for hypertension and diabetes care in Tanzania, South Africa, and Lesotho using a care cascade framework.
Methods:
We conducted a cross-sectional analysis of nationally representative Demographic Health Survey (DHS) datasets from Tanzania (2022), South Africa (2016), and Lesotho (2023/24), focusing on adults aged 15 years and older. The study estimated the proportion of adults with hypertension or diabetes who had not been screened, diagnosed, treated, or achieved disease control. Inequality was assessed using Erreygers Normalized Concentration Indices (ENCI), stratified by sex and residence.
Results:
Hypertension prevalence was 12.6% (95% CI: 11.7–13.4) in Tanzania, 46.7% (95% CI: 45.0–48.4) in South Africa, and 15.4% (95% CI: 13.8–17.2) in Lesotho. In Lesotho, 9.1% (95% CI: 7.8–10.6) of adults had diabetes. Unmet need was substantial across all countries: 96.5% for hypertension in Tanzania, 84.2% in South Africa, 65.8% in Lesotho, and 84.2% for diabetes in Lesotho. The care cascade framework revealed critical bottle-necks at screening and treatment stages. Inequality analyses revealed strong pro-poor gradients, particularly in screening (ENCIs: Tanzania −0.19, South Africa −0.17, Lesotho hypertension −0.15, Lesotho diabetes −0.24; all p < 0.01), with poor men experiencing the most disparities.
Conclusion:
Substantial and inequitable gaps exist in hypertension and diabetes care. Policy strategies should prioritize community-based screening, primary care integration, and equity-focused interventions targeting poor men to improve NCD outcomes in the region.
Low socioeconomic status (SES) is linked to pubertal development, mental health issues, and academic performance. However, the role of early pubertal development in the link between low SES and mental health and academic outcomes is unclear. Using longitudinal data from the ABCD Study (9–10 years at baseline, N = 9,848, 52.2% males) across four time points, we examined associations between household and neighborhood disadvantage, pubertal development, and mental health and academic achievement. Greater household and neighborhood disadvantage were associated with more advanced pubertal status at baseline in both males and females. Among females, higher pubertal status at baseline mediated the association between lower household income and neighborhood disadvantage with greater mental health problems and poorer school performance. Additionally, slower pubertal tempo attenuated the relationship between neighborhood disadvantage and these outcomes in females. These findings underscore the importance of considering both household and neighborhood contexts in shaping adolescent development and highlight pubertal development as a potential pathway underlying socioeconomic disparities in mental health and academic achievement.
Socioeconomic disadvantage has been established as a key risk factor for adverse child behavioral outcomes. Understanding how individual components of socioeconomic status (SES) interact with each other can elucidate protective factors and inform interventions and policies to promote positive developmental outcomes. This study examined the interactive effects of prenatal household income and neighborhood deprivation on child externalizing and internalizing problems (N = 793; Mage = 8.37 years; 51.2% females; 81.5% White). Results revealed an interaction effect between prenatal household income levels and neighborhood deprivation on child externalizing problems. Higher neighborhood deprivation was associated with higher child externalizing outcomes only at lower household income levels per person. Although no interaction between household income and neighborhood deprivation on child internalizing problems was observed, lower household income levels were independently associated with higher child internalizing problems. These findings underscore how prenatal individual- and neighborhood-level SES factors interact to shape children’s behavioral outcomes across childhood.