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Perspectives on Sexual and Reproductive... Mar 2020Societal views about sexuality and parenting among people with disabilities may limit these individuals' access to sex education and the full range of reproductive...
CONTEXT
Societal views about sexuality and parenting among people with disabilities may limit these individuals' access to sex education and the full range of reproductive health services, and put them at increased risk for -unintended pregnancies. To date, however, no national population-based studies have examined pregnancy -intendedness among U.S. women with disabilities.
METHODS
Cross-sectional analyses of data from the 2011-2013 and 2013-2015 waves of the National Survey of Family Growth were conducted; the sample included 5,861 pregnancies reported by 3,089 women. The proportion of pregnancies described as unintended was calculated for women with any type of disability, women with each of five types of disabilities and women with no disabilities. Multivariate logistic regression analyses were conducted to examine the relationship of disability status and type with pregnancy intendedness while adjusting for covariates.
RESULTS
A higher proportion of pregnancies were unintended among women with disabilities than among women without disabilities (53% vs. 36%). Women with independent living disability had the highest proportion of unintended pregnancies (62%). In regression analyses, the odds that a pregnancy was unintended were greater among women with any type of disability than among women without disabilities (odds ratio, 1.4), and were also elevated among women with hearing disability, cognitive disability or independent living disability (1.5-1.9).
CONCLUSIONS
Further research is needed to understand differences in unintended pregnancy by type and extent of disability. People with disabilities should be fully included in sex education, and their routine care should incorporate discussion of reproductive planning.
Topics: Adult; Cross-Sectional Studies; Disabled Persons; Female; Health Services Accessibility; Health Services for Persons with Disabilities; Humans; Intention; Logistic Models; Odds Ratio; Pregnancy; Pregnancy, Unplanned; Reproductive Behavior; Reproductive Health Services; Sex Education; United States
PubMed: 32096336
DOI: 10.1363/psrh.12130 -
Medical Care Jul 2020Many older adults receive caregiving; however, less is known about how a change in a care recipient's functional activity limitations [instrumental activities of daily...
BACKGROUND
Many older adults receive caregiving; however, less is known about how a change in a care recipient's functional activity limitations [instrumental activities of daily living (IADL) and basic activities of daily living (ADL)] as well as their cognitive impairment influence the amount of caregiving received.
METHODS
Using the Health and Retirement Study (2002-2014) we identified community-dwelling respondents with Alzheimer disease and related dementias (ADRD; n=674), cognitive impairment no dementia (CIND; n=530), and no cognitive impairment (n=6126). We estimated a series of two-part regression models to identify the association between care recipients' level of cognitive impairment, change in total number of IADL/ADL limitations and amount of caregiving received.
RESULTS
Persons with ADRD received 235.8 (SD=265.6) monthly hours of care compared with 26.0 (SD=92.6) and 6.0 (SD=40.7) for persons with CIND and no cognitive impairment, respectively. An increase in one IADL/ADL limitation resulted in persons with ADRD and CIND receiving 4.90 (95% confidence interval: 3.40-6.39) and 1.43 (95% confidence interval: 0.17-2.69) more hours of caregiving than persons with no cognitive impairment. Increases in total IADL/ADL limitations were associated with persons with ADRD, but not CIND, receiving more days of caregiving and having more caregivers than persons with no cognitive impairment.
CONCLUSIONS
Compared with persons with no cognitive impairment, increases in IADL/ADL limitations disproportionally increases the caregiving received for persons with ADRD. Policies and programs must pay attention to functional impairments among those living with ADRD.
Topics: Aged; Aged, 80 and over; Caregivers; Cognition Disorders; Cognitive Dysfunction; Disabled Persons; Female; Geriatric Assessment; Humans; Male; Physical Functional Performance
PubMed: 32287048
DOI: 10.1097/MLR.0000000000001323 -
Rehabilitation Psychology May 2020Health care providers' attitudes of marginalized groups can be key factors that contribute to health care access and outcome disparities because of their influence on...
PURPOSE/OBJECTIVE
Health care providers' attitudes of marginalized groups can be key factors that contribute to health care access and outcome disparities because of their influence on patient encounters as well as clinical decision-making. Despite a growing body of knowledge linking disparate health outcomes to providers' clinical decision making, less research has focused on providers' attitudes about disability. The aim of this study was to examine providers' explicit and implicit disability attitudes, interactions between their attitudes, and correlates of explicit and implicit bias. Research Method/Design: We analyzed secondary data from 25,006 health care providers about their disability attitudes. In addition to analyzing people's explicit and implicit attitudes (Disability Attitudes Implicit Association Test), we used Son Hing, Chung-Yan, Hamilton, & Zanna's (2008) model of two-dimensional prejudice to compare provider's explicit and implicit attitudes. Finally, we used linear regression models to examine correlates of providers' explicit and implicit attitudes.
RESULTS
While on average, provider's explicit attitudes ( = 4.41) indicated little prejudice, their implicit attitudes ( = 0.54) revealed they moderately preferred nondisabled people-they were aversive ableists. Correlates of providers' explicit and implicit attitudes also included age, gender, political orientation, and having relationships with disability (friends, family, and being a person with disability).
CONCLUSIONS/IMPLICATIONS
This study revealed that despite a majority of providers self-reporting not being biased against people with disabilities, implicitly, the overwhelming majority were biased. This study's findings can be used to better understand how provider disability bias can contribute to inequitable health care access and health outcomes for people with disabilities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Topics: Adult; Attitude of Health Personnel; Disabled Persons; Female; Health Personnel; Health Services for Persons with Disabilities; Humans; Male; Prejudice; Young Adult
PubMed: 32105109
DOI: 10.1037/rep0000317 -
British Medical Bulletin Jun 2024a sizable proportion of the working population has a disability that is not visible. Many choose not to disclose this at work, particularly in educational workplaces... (Review)
Review
INTRODUCTION
a sizable proportion of the working population has a disability that is not visible. Many choose not to disclose this at work, particularly in educational workplaces where disability is underrepresented. A better understanding of the barriers and facilitators to disclosure is needed.
SOURCES OF DATA
this scoping review is based on studies published in scientific journals.
AREAS OF AGREEMENT
the reasons underpinning disclosure are complex and emotive-in-nature. Both individual and socio-environmental factors influence this decision and process. Stigma and perceived discrimination are key barriers to disclosure and, conversely, personal agency a key enabler.
AREAS OF CONTROVERSY
there is a growing trend of non-visible disabilities within the workplace, largely because of the increasing prevalence of mental ill health. Understanding the barriers and facilitators to disability disclosure is key to the provision of appropriate workplace support.
GROWING POINTS
our review shows that both individual and socio-environmental factors influence choice and experience of disclosure of non-visible disabilities in educational workplaces. Ongoing stigma and ableism in the workplace, in particular, strongly influence disabled employees' decision to disclose (or not), to whom, how and when.
AREAS TIMELY FOR DEVELOPING RESEARCH
developing workplace interventions that can support employees with non-visible disabilities and key stakeholders during and beyond reasonable adjustments is imperative.
Topics: Humans; Workplace; Disabled Persons; Social Stigma; Disclosure
PubMed: 38437453
DOI: 10.1093/bmb/ldae004 -
Transactions of the Royal Society of... Dec 2019Neglected tropical diseases (NTDs) are a diverse group of infectious conditions that vary in their epidemiology, impact and control. They are among the most common...
Neglected tropical diseases (NTDs) are a diverse group of infectious conditions that vary in their epidemiology, impact and control. They are among the most common conditions globally, affecting approximately one billion people. Many NTDs have long-term consequences, such as visual and physical impairments. As a result, people with NTDs may have difficulties in carrying out activities or participating in society-in other words, NTDs can cause disabilities. Additionally, NTDs are often strongly linked to stigma and can have mental health consequences. It is therefore important to incorporate rehabilitation within NTD programmes. Rehabilitation can be conceptualized narrowly in terms of the provision of clinical services (e.g. physiotherapy and assistive devices) or, more broadly, including efforts to improve employment, overcome stigma and enhance social participation of people with disabilities. Approximately 15% of the global population has a disability, and this large group must be considered when designing NTD programmes. Improving the inclusion of people with disabilities may require adaptations to NTD programmes, such as making them physically accessible or training staff about disability awareness. Without incorporating disability within NTD programmes, the quality of life of people with NTDs will suffer and global targets for elimination and management of NTDs will not be met.
Topics: Disabled Persons; Disease Eradication; Global Health; Humans; Neglected Diseases; Quality of Life; Tropical Medicine
PubMed: 30892653
DOI: 10.1093/trstmh/trz001 -
Disability and Rehabilitation Jun 2023This article focuses on the risk that work disability policies lock people into work disability rather than promote durable health and return to work. We outline the...
PURPOSE
This article focuses on the risk that work disability policies lock people into work disability rather than promote durable health and return to work. We outline the concept of a as a heuristic device to explore this policy paradox inherent in the design of most social insurance systems.
MATERIALS AND METHODS
This is a conceptual paper drawing on examples from existing research.
RESULTS
We identify three manifestations of the disability trap: not overcoming disability; underperforming; and returning to work prematurely. The causes of these manifestations are identified as structural rather than based on malingering clients, while negative consequences are identified both on client and system levels.
CONCLUSION
We emphasize the need for systems built on trust and reasonable expectations, and the need for providing rehabilitation support independently of economic compensation. Universal basic income is introduced as a potential tool to ameliorate some of the consequences of the disability trap.Implications for rehabilitationCompensation systems focusing too prominently on early return to work may have counter-productive effects on rehabilitation.Overly suspicious assessment systems nurture a view of people as malingerers.Rehabilitation professionals need to be attentive to system-generated effects which may prevent overcoming work disability.
Topics: Humans; Disabled Persons; Rehabilitation, Vocational; Policy
PubMed: 35576235
DOI: 10.1080/09638288.2022.2074554 -
Psychosomatic Medicine 2020Despite the high prevalence of late-life depression and anxiety at threshold and subthreshold levels, their joint role in the disablement process remains unclear. This...
OBJECTIVE
Despite the high prevalence of late-life depression and anxiety at threshold and subthreshold levels, their joint role in the disablement process remains unclear. This study aims to examine the association of comorbid occurring depression and anxiety across the full spectrum of symptom severity with disability onset in older adults.
METHODS
The study included 3663 participants from the 2011 National Health and Aging Trends Study, who reported no limitations in self-care and mobility activities at baseline. Disability onset was defined as a report of receiving help from another person in any of the activities for 3 consecutive months. Depression and anxiety symptoms were measured using the four-item Patient Health Questionnaire, grouped into low, mild, and moderate/severe symptom groups. Cox proportional hazards models were used to estimate relative risks for disability onset over a 5-year period by depression/anxiety symptom groups.
RESULTS
A total of 1047 participants developed disability (24.6%; 6.0 per 1000 person-months). At baseline, one-fifth of the sample reported symptoms that were mild (n = 579 [14.9%]; 31.6% with disability onset) or moderate/severe (n = 156 [4.2%]; 38.1% with disability onset). After adjustment for sociodemographics, there was a dose-response relationship between depression/anxiety symptom groups and disability onset (mild versus low: hazard ratio [HR] = 1.43, 95% confidence interval [CI] = 1.20-1.70; moderate/severe versus low: HR = 1.94, 95% CI = 1.45-2.59). The increased risk remained significant after adjustment for health status variables for the mild symptom group (HR = 1.26, 95% CI = 1.07-1.49), but not for the moderate/severe symptom group (HR = 1.30, 95% CI = 0.94-1.79), possibly reflecting lower statistical power.
CONCLUSIONS
Findings suggest that the full spectrum of depression and anxiety symptoms are associated with increased risk for disability in late life. Their role in the disablement process warrants further investigation.
Topics: Aged; Aged, 80 and over; Aging; Anxiety; Anxiety Disorders; Comorbidity; Depression; Depressive Disorder; Disabled Persons; Female; Humans; Longitudinal Studies; Male; Medicare; Risk; United States
PubMed: 31688675
DOI: 10.1097/PSY.0000000000000763 -
Frontiers in Public Health 2024Individuals with disabilities are more vulnerable to depression development than the general population. This study sought to map the evidence on current knowledge of... (Review)
Review
Individuals with disabilities are more vulnerable to depression development than the general population. This study sought to map the evidence on current knowledge of depression, intervention strategies, and assessment tools among people with disabilities. This review was conducted following Arksey and O'Malley's scoping review methodology framework. An electronic search was performed on four English databases: PubMed, Cochrane Library, PsycINFO, and Web of Science. The original search returned 1802 results, with 1,116 from Web of Science, 626 from PubMed, 25 from Cochrane, and 35 from PsycINFO. After removing duplicates, 786 articles were chosen for the title and abstract screening processes. Finally, 112 full-text publications were deemed eligible, with 41 papers being included in this scoping review for analysis. A large proportion (32; 78.04%) of the studies chosen were cross-sectional, 14 (34.14%) of them reported general disability, 12 (29.26%) used a patient health questionnaire (PHQ-9) to measure depression, and 14 (34.14%) had interventions, including cognitive behavioral therapy, psychological counseling, social support, and physical activity. All interventions successfully reduced the severity of the depression. Cognitive behavioral therapies and psychological counseling were widely used interventions that had a significant impact on reducing depression. More randomized controlled trials are required, and they should focus on individuals with specific disabilities to provide disability-specific care that can improve the quality of life for disabled individuals.
Topics: Humans; Disabled Persons; Depression; Social Support; Cognitive Behavioral Therapy
PubMed: 38779421
DOI: 10.3389/fpubh.2024.1383078 -
International Archives of Occupational... Mar 2023An individual's quality of employment over time has been highlighted as a potential determinant of mental health. With mental ill-health greatly contributing to work...
OBJECTIVES
An individual's quality of employment over time has been highlighted as a potential determinant of mental health. With mental ill-health greatly contributing to work incapacities and disabilities in Belgium, the present study aims to explore whether mental health, as indicated by registered mental health-related disability, is structured along the lines of employment quality, whereby employment quality is assessed over time as part of individuals' labour market trajectories.
METHODS
Using administrative data from the Belgian Crossroads Bank for Social Security over 16 quarters between 2006 and 2009, transitions between waged jobs of varying quality (based on dimensions of income, working time, employment stability and multiple jobholding), self-employment, and unemployment are considered among individuals in the labour force aged 30-40 at baseline (n = 41,065 women and 45,667 men). With Multichannel Sequence Analysis and clustering, we constructed ideal types of employment trajectories. Fitting Cox regressions, we then evaluated individuals' hazard of experiencing a disability from a mental disorder between 2010 and 2016.
RESULTS
Our analysis highlights various gender-specific trajectories. Among both genders, individuals exposed to near-constant unemployment over the initial 4 years showed the highest hazard of subsequent mental health-related disability compared to a group characterised by stable full-time employment, single jobholding, and above-median income. Trajectories involving a higher probability of subsidised and non-standard employment and (potential) spells of unemployment and lower relative income were also strong predictors of cause-specific disabilities. Health selection and confounding might, however, be contributing factors.
CONCLUSIONS
Our study shows a gradient of mental disorders resulting in a disability along trajectory types. Our findings highlight the predictive power of labour market trajectories and their employment quality for subsequent mental disorder-related disability. Future research should examine the mechanisms, including selection effects in this association.
Topics: Female; Humans; Male; Mental Health; Belgium; Employment; Unemployment; Disabled Persons; Mental Disorders
PubMed: 36214912
DOI: 10.1007/s00420-022-01923-y -
Neurology India 2020Many neurological conditions may result in long-term disability. The measures of prevalence and mortality vastly understate the disability they cause. In the Persons...
Many neurological conditions may result in long-term disability. The measures of prevalence and mortality vastly understate the disability they cause. In the Persons with Disabilities Act 1995 (equal opportunities, protection of rights, and full participation), neurological conditions are ignored. Although Indian Disability Evaluation and Asessment Scale (IDEAS), which assesses psychiatric conditions, does include dementia as one of the neurodegenerative conditions. Additionally, according to the global burden of disease report, 33% of years lived with neurological disability and 13% of disability-adjusted life years (DALYs) are due to neurological and psychiatric disorders. In 2001, the World Health Organization (WHO) established a new definition of disability, declaring it an umbrella term with the following three major components; 1) impairments: problems in body function or structure, 2) activity limitations: difficulties encountered by a person in executing a task or action, and 3) participation restrictions: problems of involvement in life situations experienced by a person. Hence, an attempt was made to rectify the above concerns. To address the above mentioned concerns, we think that there is a need of a comprehensive format for neurological disabilities assessment which would also include objective neuropsychological assessments. As future directions, national level meetings are required to formulate 'Indian Standard Track for Assessing Neurological Disability' (I-STAND) and uniform guidelines for disability assessment in 'chronic neurological conditions' with a special focus on "neuropsychological disability".
Topics: Chronic Disease; Disability Evaluation; Disabled Persons; Female; Humans; India; Male; Nervous System Diseases; Prevalence; Quality-Adjusted Life Years
PubMed: 32129266
DOI: 10.4103/0028-3886.279709