RESUMEN
This study examined changes in physical and mental health quality-of-life and health services access before and after the onset of the COVID-19 pandemic among individuals of lower and higher socio-economic status (SES) in Australia. Difference-in-differences and logistic regression models were undertaken using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey and government data on COVID-19 lockdowns between January 2020 and February 2021. Individuals from higher SES reported larger decreases in mental health quality-of-life scores than those from lower SES after the onset of the pandemic. Those from lower SES reported less disruption with any health services (24.2% vs 30.4%; ORâ =â 0.68; pâ <â 0.001), specifically dental services (8.2% vs 15.4%; ORâ =â 0.51; pâ <â 0.001) and allied health services (5.9% vs 8.5%; ORâ =â 0.60; pâ <â 0.001), compared with those from higher SES. Additional days under lockdown were associated with reduced access to all health services (ORâ =â 1.19). Furthermore, long-term health conditions (higher SES: ORâ =â 1.54) and scores indicative of poorer physical (lower SES: ORâ =â 1.17; higher SES: ORâ =â 1.07) and mental health (lower SES: ORâ =â 1.16; higher SES: ORâ =â 1.12) were associated with increased health services disruption. While individuals from higher SES were more likely than those from lower SES to experience greater relative declines in mental health and increased disruption with health services access, individuals with a greater apparent need for health services, regardless of SES, may have faced inequalities in accessing these services during the COVID-19 pandemic.
Asunto(s)
COVID-19 , Accesibilidad a los Servicios de Salud , Calidad de Vida , Clase Social , Humanos , COVID-19/epidemiología , COVID-19/psicología , Australia , Masculino , Femenino , Persona de Mediana Edad , Adulto , SARS-CoV-2 , Anciano , Salud Mental , Adolescente , Adulto Joven , Pandemias , Control de Enfermedades Transmisibles , Factores SocioeconómicosRESUMEN
BACKGROUND: Health behaviours and mental illness have been found to be strongly correlated, both across and within individuals. However, establishing the precise nature of this link, particularly in terms of causality and its direction, remains a challenge. Much of the relevant existing research follow an experimental design and focus on measuring how changes in health behaviours affect mental health. OBJECTIVE: The study examines changes in mental health and health behaviours within individuals across time and evaluates the evidence for a causal pathway from psychological distress to risky health behaviours. METHOD: Using a population representative longitudinal survey providing data from Australian households, this study employs a fixed-effects panel model framework to account for unobserved time-invariant individual heterogeneity. An instrumental variable estimation strategy is employed to specifically evaluate the evidence of a causal pathway from psychological distress to risky health behaviours. RESULTS: The results confirm strong within-individual associations between psychological distress and health behaviours. Further evidence supports a causal relationship from psychological distress to health behaviours, though only for men and lifestyle habits. The case for a direct causal pathway is less straightforward when considering dietary habits, and potentially also for women. This lack of clarity suggests at least some of the observed within-individual associations reflect causal effects of psychological distress on risky health behaviours. CONCLUSIONS: Given the substantial burden of disease associated with unhealthy behaviours, further research examining potential causal pathways from mental health to health behaviours should be a priority, as there is the potential to reduce health burden through mental health improvements.