Narcotic offences and drug use disorders among young refugees in Norway.

AIMS: We examined the patterns of healthcare utilisation for drug use disorders (DUDs) and charges related to narcotics among young refugees in Norway considering the role of sex, country of origin and condition of arrival (accompanied versus unaccompanied minors). METHODS: Based on national registers, sex-stratified Cox regression models were used to estimate hazard ratios to assess the risk of being charged with a narcotics offence and the use of healthcare services related to DUDs. The sample consisted of 15,068 young refugees and 573,241 young Norwegians born in Norway to two Norwegian-born parents. All of the young people in the sample were born between 1983 and 1994. The follow-up period was from January 2008 to December 2015. RESULTS: Compared with their Norwegian peers, both male and female refugees showed either a similar or lower risk of receiving healthcare for DUDs. However, male refugees showed an increased risk of being charged with a narcotic offence, except those from Afghanistan and the former Yugoslavia. Accompanied male refugees were at a higher risk of being charged, while unaccompanied male refugees showed a lower risk. CONCLUSIONS: Young male refugees generally had a higher risk of being charged for narcotic offences while showing a similar risk of receiving healthcare for DUDs compared to Norwegian-born young people. However, young men from Afghanistan and the former Yugoslavia deviated from this pattern. This may be partially explained by the length of time spent in Norway. The results add support to previous qualitative studies suggesting that punitive drug policies may disproportionately affect men from minority groups. Further research controlling for parental household-level factors is warranted.

Health outcomes in young adulthood among former child refugees in Denmark, Norway and Sweden: A cross-country comparative study.

AIMS: This study aimed at comparing several health outcomes in young adulthood among child refugees who settled in the different immigration and integration policy contexts of Denmark, Norway and Sweden. METHODS: The study population included refugees born between 1972 and 1997 who immigrated before the age of 18 and settled in the three Nordic countries during 1986-2005. This population was followed up in national registers during 2006-2015 at ages 18-43 years and was compared with native-born majority populations in the same birth cohorts using sex-stratified and age-adjusted regression analyses. RESULTS: Refugee men in Denmark stood out with a consistent pattern of higher risks for mortality, disability/illness pension, psychiatric care and substance misuse relative to native-born majority Danish men, with risk estimates being higher than comparable estimates observed among refugee men in Norway and Sweden. Refugee men in Sweden and Norway also demonstrated increased risks relative to native-born majority population men for inpatient psychiatric care, and in Sweden also for disability/illness pension. With the exception of increased risk for psychotic disorders, outcomes among refugee women were largely similar to or better than those of native-born majority women in all countries. CONCLUSIONS: The observed cross-country differences in health indicators among refugees, and the poorer health outcomes of refugee men in Denmark in particular, may be understood in terms of marked differences in Nordic integration policies. However, female refugees in all three countries had better relative health outcomes than refugee men did, suggesting possible sex differentials that warrant further investigation.

Investigating the salmon bias effect among international immigrants in Sweden: a register-based open cohort study.

BACKGROUND: Studies of migration and health have hypothesized that immigrants may emigrate when they develop poor health (salmon bias effect), which may partially explain the mortality advantage observed among immigrants in high-income countries. We evaluated the salmon bias effect by comparing the health of immigrants in Sweden who emigrated with those who remained, while also exploring potential variation by macro-economic conditions, duration of residence and region of origin. METHODS: A longitudinal, open cohort study design was used to assess risk of emigration between 1992 and 2016 among all adult (18+ years) foreign-born persons who immigrated to Sweden between 1965 and 2012 (n = 1 765 459). The Charlson Comorbidity Index was used to measure health status, using information on hospitalizations from the Swedish National Patient Register. Poisson regression models were used to estimate incidence rate ratios (RRs) with 95% confidence intervals (CIs) for emigrating from Sweden. RESULTS: Immigrants with low (RR = 0.83; 95% CI: 0.76-0.90) moderate (RR = 0.70; 95% CI: 0.62-0.80) and high (RR = 0.62; 95% CI: 0.48-0.82) levels of comorbidities had decreased risk of emigration relative to those with no comorbidities. There was no evidence of variation by health status in emigration during periods of economic recession or by duration of residence. Individuals with low to moderate levels of comorbidities from some regions of origin had an increased risk of emigration relative to those with no comorbidities. CONCLUSIONS: The study results do not support the existence of a salmon bias effect as a universal phenomenon among international immigrants in Sweden.

Health Inequalities in the Diverse World of Self-Employment: A Swedish National Cohort Study.

With labor being a central social determinant of health, there is an increasing need to investigate health inequalities within the heterogenous and growing population in self-employment. This study aimed to longitudinally investigate the relationship between income level, self-employment status and multiple work-related health indicators in a Swedish national cohort (n = 3,530,309). The study investigated the relationship between self-employment status and health outcomes later in life. All poor health outcomes, with the exception of alcohol-related disorders, were more common in the self-employed population, compared to the group in regular employment. The income gradient, however, was more pronounced in the group with regular employment than the groups in self-employment. The study found clear connections between low income and poor health in all employment groups, but the gradient was more pronounced in the group in regular employment. This suggests that income has a weaker connection to other types of health promoting resources in the self-employed population. Potentially, lacking social and public support could make it difficult for unhealthy individuals to maintain low-income self-employment over a longer time period.

Unintended health consequences of Swedish parental leave policy (ParLeHealth): protocol for a quasi-experimental study.

INTRODUCTION: Sweden has long been praised for a generous parental leave policy oriented towards facilitating a gender-equitable approach to work and parenting. Yet certain aspects of Swedish parental leave could also be responsible for the maintenance of (or even the increase in) health inequalities. Using a 'Health in All Policies' lens, this research project aims to assess the unintended health consequences of various components of Sweden's parental leave policy, including eligibility for and uptake of earnings based benefits. METHODS AND ANALYSIS: We will use individual-level data from multiple Swedish registers. Sociodemographic information, including parental leave use, will be retrieved from the total population register, Longitudinal Integration Database for Health Insurance and Labour Market Studies and Social Insurance Agency registers. Health information for parents and children will be retrieved from the patient, prescribed drug, cause of death, medical birth and children's health registers. We will evaluate parents' mental, mothers' reproductive and children's general health outcomes in relation to several policy reforms aiming to protect parental leave benefits in short birth spacing (the speed premium) and to promote father's uptake (the father's quota) and sharing of parental leave days (the double days reform). We will also examine effects of increases in basic parental leave benefit levels. Using quasi-experimental designs, we will compare health outcomes across these reforms and eligibility thresholds with interrupted time series, difference-in-difference and regression discontinuity approaches to reduce the risk of health selection and assess causality in the link between parental leave use and health. ETHICS AND DISSEMINATION: This project has been granted all necessary ethical permissions from the Stockholm Regional Ethical Review Board (Dnr 2019-04913) for accessing and analysing deidentified data. The final outputs will primarily be disseminated as scientific articles published in open-access, high-impact peer-reviewed international journals, as well as press releases and policy briefs.

Rural life and suicide: Does the effect of the community context vary by country of birth? A Swedish registry-based multilevel cohort study.

Contextual factors varying by residence in rural or urban areas may have different effects on the suicide of residents by nativity, but evidence on the urban-rural gap in suicide according to nativity is lacking. This study aims to evaluate the effect of cross-level interaction between nativity and rurality of residence on suicide risk, at two levels of aggregation (municipalities/neighborhoods). Study design was nationwide register-based cohort study in Sweden, 2011-2016. Participants were all residents 20 years or older. We calculated Incidence Rate Ratios comparing suicide incidence by nativity using three-level (individuals, neighborhoods, and municipalities) Poisson regression, stratified by gender. Among men, suicide incidences were the highest among those born in other Nordic countries, followed by those born in Sweden, other European countries, Middle Eastern countries, and the rest of the world. Residing in rural areas was associated with high IRR of suicide regardless of nativity, compared to residing in urban areas. When evaluating rurality at municipality level, we observed an increased suicide risk from living in rural areas in men born in other European (rural-urban ratio of nativity-specific IRRs: 1.39) and other Nordic (1.37) countries, followed by native Swedes (1.22). When evaluating rurality at neighborhood level, rurality was associated with increased suicide risk in men for all nativities, with the foreign-born showing higher risk than the Swedish-born. Individual sociodemographic characteristics explained the excess suicide risk in rural municipalities, but not the excess risk in rural neighborhoods. Among women, urban residents showed higher suicide incidence than rural residents. We found no consistent patterning of interaction with nativities among women. Foreign-born individuals residing in rural municipalities may have less access to economic resources and employment opportunities. Furthermore, ethnic discrimination, stigma, and exclusion from social networks and community may be more common in rural neighborhood contexts, leading to an increased risk of suicide.

Social integration and mental health - a decomposition approach to mental health inequalities between the foreign-born and native-born in Sweden.

BACKGROUND: The increasing mental health inequalities between native- and foreign-born persons in Sweden is an important public health issue. Improving social integration has been stressed as a key strategy to combat this development. While a vast amount of studies have confirmed the importance of social integration for good mental health, less is known about the role of different types of social integration, and how they relate to mental health inequalities. This study aimed to examine the extent to which indicators of social integration explained mental health inequalities between the native- and foreign-born. METHODS: Based on the Health on Equal Terms survey from 2011/2015 in Västra Götaland, Sweden (n = 71,643), a non-linear Oaxaca-Blinder decomposition analysis was performed comparing native- and foreign-born individuals from Nordic-, European- and non-European countries. The General Health Questionnaire was used to assess psychological distress, while 11 items assessed employment conditions and economic disparities, social relations, and experiences of discrimination to measure different aspects of social integration. RESULTS: Differences in social integration explained large proportions of observed mental health differences between the native- and foreign-born. Important indicators included low levels of social activity (20%), trust in others (17%) and social support (16%), but also labour market disadvantages, such as being outside the labour market (15%), unemployment (10%) and experiencing financial strain (16%). In analyses stratified by region of origin, low trust in others and discrimination contributed to the mental health gap between the native-born and European-born (17 and 9%, respectively), and the native-born and non-European-born (19 and 10%, respectively). Precarious labour market position was a particularly important factor in the mental health gap between the native-born and Nordic-origin (22%), and non-European origin (36%) populations. CONCLUSION: Social integration factors play a central role in explaining the mental health inequality between natives and migrants in Sweden. Our findings suggest that public health actions targeting mental health gaps could benefit from focusing on inequalities in social and economic recourses between natives and migrants in Sweden. Areas of priority include improving migrants' financial strain, as well as increasing trust in others and social support and opportunities for civic engagement.

Effects of non-health-targeted policies on migrant health: a systematic review and meta-analysis.

BACKGROUND: Government policies can strongly influence migrants' health. Using a Health in All Policies approach, we systematically reviewed evidence on the impact of public policies outside of the health-care system on migrant health. METHODS: We searched the PubMed, Embase, and Web of Science databases from Jan 1, 2000, to Sept 1, 2017, for quantitative studies comparing the health effects of non-health-targeted public policies on migrants with those on a relevant comparison population. We searched for articles written in English, Swedish, Danish, Norwegian, Finnish, French, Spanish, or Portuguese. Qualitative studies and grey literature were excluded. We evaluated policy effects by migration stage (entry, integration, and exit) and by health outcome using narrative synthesis (all included studies) and random-effects meta-analysis (all studies whose results were amenable to statistical pooling). We summarised meta-analysis outcomes as standardised mean difference (SMD, 95% CI) or odds ratio (OR, 95% CI). To assess certainty, we created tables containing a summary of the findings according to the Grading of Recommendations Assessment, Development, and Evaluation. Our study was registered with PROSPERO, number CRD42017076104. FINDINGS: We identified 43 243 potentially eligible records. 46 articles were narratively synthesised and 19 contributed to the meta-analysis. All studies were published in high-income countries and examined policies of entry (nine articles) and integration (37 articles). Restrictive entry policies (eg, temporary visa status, detention) were associated with poor mental health (SMD 0·44, 95% CI 0·13-0·75; I2=92·1%). In the integration phase, restrictive policies in general, and specifically regarding welfare eligibility and documentation requirements, were found to increase odds of poor self-rated health (OR 1·67, 95% CI 1·35-1·98; I2=82·0%) and mortality (1·38, 1·10-1·65; I2=98·9%). Restricted eligibility for welfare support decreased the odds of general health-care service use (0·92, 0·85-0·98; I2=0·0%), but did not reduce public health insurance coverage (0·89, 0·71-1·07; I2=99·4%), nor markedly affect proportions of people without health insurance (1·06, 0·90-1·21; I2=54·9%). INTERPRETATION: Restrictive entry and integration policies are linked to poor migrant health outcomes in high-income countries. Efforts to improve the health of migrants would benefit from adopting a Health in All Policies perspective. FUNDING: Swedish Council for Health, Working Life, and Social Research; UK Medical Research Council; Scottish Government Chief Scientist Office.

Suicide risk among native- and foreign-origin persons in Sweden: a longitudinal examination of the role of unemployment status.

PURPOSE: Prior research has documented an association between unemployment and elevated suicide risk. Yet, few Swedish studies have explicitly considered how such risk may vary by different migration background characteristics among persons of foreign-origin, who often experience diverse forms of labor market marginalization. This study examines the extent to which unemployment status may differentially influence suicide risk among the foreign-origin by generational status, region of origin, age at arrival, and duration of residence. METHODS: Population-based registers were used to conduct a longitudinal, open cohort study of native-origin and foreign-origin Swedish residents of working age (25-64 years) from 1993 to 2008. Hazard ratios and 95% confidence intervals for suicide mortality were estimated using gender-stratified Cox proportional hazards models. RESULTS: Elevated suicide risk observed among foreign-origin unemployed groups was generally of a similar or lower magnitude than that found in unemployed native-origin, although unemployed second-generation Swedish men demonstrated significantly greater (p < 0.05) excess risk of suicide than that observed among their native-origin counterparts. Unemployed foreign-born men with a younger age at arrival and longer duration of residence demonstrated an increased risk of suicide, while those who arrived as adults, and a shorter duration of residence did not show any increased risk. Among foreign-born women, excess suicide risk persisted regardless of age at arrival and duration of residence in the long-term unemployed. CONCLUSIONS: Multiple migration background characteristics should be considered when examining relationships between employment status and suicide among the foreign-origin.

All-cause mortality, age at arrival, and duration of residence among adult migrants in Sweden: A population-based longitudinal study.

BACKGROUND: A mortality advantage has been observed among recently arrived immigrants in multiple national contexts, even though many immigrants experience more social disadvantage compared to natives. This is the first study to investigate the combined influence of duration of residence and age at arrival on the association between region of origin and all-cause mortality among the adult immigrant population in Sweden. METHODS: Using population-based registers, we conducted a follow-up study of 1,363,429 individuals aged 25-64 years from 1990 to 2008. Gompertz parametric survival models were fitted to derive hazard ratios (HR) for all-cause mortality. RESULTS: Compared to native Swedes, we observed a health advantage in all group of immigrants, with the exception of individuals from Finland. However, when information on age at arrival and duration of residence was combined, an excess mortality risk was found among immigrants who arrived before age 18, which largely disappeared after 15 years of residence in Sweden. Non-European immigrants over age 18 showed similar or lower mortality risks than natives in all categories of age at arrival, regardless of duration of residence. CONCLUSIONS: The findings suggest that the mortality advantage commonly observed among immigrants is not universal. Combined information on age at arrival and duration of residence can be used to identify sensitive periods and to identify possible selection bias. The study also suggests that young immigrants are a vulnerable subpopulation. Given the increased number of unaccompanied minors arriving in Europe, targeted health or integration policies should be developed or reviewed.

Employment status and risk of all-cause mortality among native- and foreign-origin persons in Sweden.

Background: The association between exposure to unemployment and increased risk of mortality is well established. Yet migrants and their children often experience a number of stressors in the country of residence which could exacerbate the negative effects of job loss or unemployment. This study examined the extent to which region of origin and generational status modified associations between employment status and risk of all-cause mortality. Methods: Using population-based registers, an open cohort of 2 178 321 individuals aged 25-64 years was followed from 1993 to 2008. Hazard ratios for mortality were calculated using Cox regression. Employment status and socio-demographic covariates were included as time-varying variables in all models. Results: Relative to employed native-origin Swedes, excess risk of mortality was found among most groups of unemployed persons. The excess risk of mortality found among African women exposed to long-term unemployment (HR = 3.26, 95% CI: 2.30-4.63), Finnish men exposed to short-and long-term unemployment (HR = 2.74, 95% CI: 2.32-3.24 and HR = 2.39, 95% CI: 2.12-2.69), and second generation Swedish men exposed to short-term unemployment (HR = 2.34, 95% CI: 2.06-2.64) was significantly greater (P < 0.05) than that found among their unemployed native-origin counterparts. Excess risk of mortality among the unemployed in other foreign-origin groups was of a similar or lower magnitude to that found in unemployed native-origin Swedes. A decreased risk of mortality was observed among the employed in nearly all foreign-origin groups. Conclusions: With some exceptions, mortality risk in foreign-origin individuals across all categories of employment status was generally similar to or lower than the risk observed in native-origin Swedes.

The Psychological Consequences of Pre-Emigration Trauma and Post-Migration Stress in Refugees and Immigrants from Africa.

Over 50 million people have been displaced, some as a result of conflict, which exposure can lead to psychiatric sequelae. The aims of this study were to provide estimates of pre-emigration trauma, post-migration stress, and psychological sequelae of immigrants and refugees from predominantly Sub-Saharan Africa who immigrated to Sweden. We also examined the predictors of the psychiatric sequelae as well as acculturation within the host country. A total of 420 refugees and immigrants were enrolled using stratified quota sampling. A battery of questionnaires including the Harvard Trauma Questionnaire, Post-Migration Living Difficulties Scale, the Cultural Lifestyle Questionnaire; and the Hopkins Checklist were administered. Descriptive statistics, Chi square analyses, Pearson correlations, analysis of variance, and logistic and linear regression were performed to test the aims of the study. Eighty-nine percent of participants reported at least one traumatic experience prior to emigration. Forty-seven percent of refugees reported clinically significant PTSD and 20 % reported clinically significant depressive symptoms. Males reported a significantly greater number of traumatic events [F(1, 198) = 14.5, p < 0.001] and post-migration stress than females [F(1, 414) = 5.3, p = 0.02], particularly on the financial, discrimination, and healthcare subscales. Females reported a higher prevalence of depressive symptoms when compared to males [F(1, 419) = 3.9, p = 0.05]. Those with a shorter duration in Sweden reported higher rates of PTSD [F(63, 419) = 1.7, p < 0.001]. The greater number of traumatic events was found to be significantly associated with the severity of PTSD symptoms [F(34, 419) = 9.6, p < 0.001]. Using regression analysis, 82 and 83 % of the variances associated with anxiety and depression, respectively, was explained by gender, education, religion, PTSD and post-migration stress. Sixty-nine percent of the variance associated with PTSD included education, number of traumatic events, depressive symptoms and post-migration stress. Forty-seven percent of the variance for acculturation was accounted for by a model that included age, education, duration in Sweden, anxiety, depression, and post-migration stress. These predictors were also significant for employment status with the exception of depressive symptoms. Multidimensional interventions that provide treatments to improve psychiatric symptoms in combination with advocacy and support to reduce stress (e.g., financial, access to health care) are recommended. The focus of the intervention may also be modified based on the gender of the participants.

Health inequalities among workers with a foreign background in Sweden: do working conditions matter?

Employment and working conditions are key social determinants of health, yet current information is lacking regarding relationships between foreign background status, working conditions and health among workers in Sweden. This study utilized cross-sectional data from the 2010 Swedish Level of Living Survey (LNU) and the Level of Living Survey for Foreign Born Persons and their Children (LNU-UFB) to assess whether or not health inequalities exist between native Swedish and foreign background workers and if exposure to adverse psychosocial and physical working conditions contributes to the risk for poor health among foreign background workers. A sub-sample of 4,021 employed individuals aged 18-65 was analyzed using logistic regression. Eastern European, Latin American and Other Non-Western workers had an increased risk of both poor self-rated health and mental distress compared to native Swedish workers. Exposure to adverse working conditions only minimally influenced the risk of poor health. Further research should examine workers who are less integrated or who have less secure labor market attachments and also investigate how additional working conditions may influence associations between health and foreign background status.

The development of practice guidelines for independent living donor advocates.

The practice recommendations discussed here are based on the findings of the national survey as well as the opinions of the authors. The recommendations that are proposed here are not exhaustive and are aspirational in intent and are likely to evolve with time. Practice guidelines are recommended for legal and regulatory issues (e.g., state or federal laws), consumer or public benefit (e.g., improving service delivery, avoiding harm to the patient, decreasing disparities in underserved or vulnerable populations), and for professional guidance (e.g., new role, professional risk management issues, advances in practice). Without such practice guidelines, donors, and indirectly the candidates, may be at increased risk for possible bias or undue harm.

Suicidal expression among school-attending adolescents in a middle-income sub-Saharan country.

We investigated correlates for suicidal expression among adolescents in the Seychelles. Data on 1,432 students (52% females) were derived from the Global School-based Health Survey. Participants were divided into three groups: those with no suicidal behavior (N = 1,199); those with suicide ideation/SI (N = 89); and those reporting SI with a plan to carry out a suicide attempt/SISP (N = 139), each within a 12-month recall period. Using multinomial logistic regression, we examined the strength of associations with social, behavioral and economic indicators while adjusting for covariates. Sixteen percent of school-attending adolescents reported a suicidal expression (10% with a plan/6.2% without). Those reporting SI were younger (relative risk ratio RRR = 0.81; CI = 0.68-0.96), indicated signs of depression (RRR = 1.69; CI = 1.05-2.72) and loneliness (RRR=3.36; CI = 1.93-5.84). Tobacco use (RRR = 2.34; CI = 1.32-4.12) and not having close friends (RRR = 3.32; CI = 1.54-7.15) were significantly associated with SI. Those with SISP were more likely to be female (RRR = 0.47; 0.30-0.74), anxious (RRR = 3.04; CI = 1.89-4.88) and lonely (RRR = 1.74; CI = 1.07-2.84). Having no close friends (RRR = 2.98; 1.56-5.69) and using tobacco (RRR = 2.41; 1.48-3.91) were also strongly associated. Having parents who were understanding was protective (RRR = 0.50; CI = 0.31-0.82). Our results suggest that school health promotion programs may benefit from targeting multiple factors associated with suicidal expression. More research, particularly multilevel designs are needed to identify peer and family influences which may modify associations with suicidality.

Randomized controlled trial of a collaborative care intervention to manage cancer-related symptoms: lessons learned.

BACKGROUND: Collaborative care interventions to treat depression have begun to be tested in settings outside of primary care. However, few studies have expanded the collaborative care model to other settings and targeted comorbid physical symptoms of depression. PURPOSE: The aims of this report were to: (1) describe the design and methods of a trial testing the efficacy of a stepped collaborative care intervention designed to manage cancer-related symptoms and improve overall quality of life in patients diagnosed with hepatobiliary carcinoma; and (2) share the lessons learned during the design, implementation, and evaluation of the trial. METHODS: The trial was a phase III randomized controlled trial testing the efficacy of a stepped collaborative care intervention to reduce depression, pain, and fatigue in patients diagnosed with advanced cancer. The intervention was compared to an enhanced usual care arm. The primary outcomes included the Center for Epidemiological Studies-Depression scale, Brief Pain Inventory, and Functional Assessment of Cancer Therapy (FACT)-Fatigue, and the FACT-Hepatobiliary. Sociodemographic and disease-specific characteristics were recorded from the medical record; Natural Killer cells and cytokines that are associated with these symptoms and with disease progression were assayed from serum. RESULTS: and Discussion The issues addressed include: (1) development of collaborative care in the context of oncology (e.g., timing of the intervention, tailoring of the intervention, ethical issues regarding randomization of patients, and changes in medical treatment over the course of the study); (2) use of a website by chronically ill populations (e.g., design and access to the website, development of the website and intervention, ethical issues associated with website development, website usage, and unanticipated costs associated with website development); (3) evaluation of the efficacy of intervention (e.g., patient preferences, proxy raters, changes in medical treatment, and inclusion of biomarkers as endpoints); and (4) analyses and interpretation of the intervention (e.g., confounding factors, dose and active ingredients, and risks and benefits of collaborative care interventions in chronically ill patients). LIMITATIONS: The limitations to the study, although not fully realized at this time as the trial is ongoing, include: (1) heterogeneity of the diagnoses and treatments of participants; and (2) inclusion of caregivers as proxy raters but not as participants in the intervention. CONCLUSIONS: Collaborative care interventions to manage multiple symptoms in a tertiary cancer center are feasible. However, researchers designing and implementing interventions that are web-based, target multiple symptoms, and for oncology patients may benefit from previous experiences.

Measuring depression and PTSD after trauma: common scales and checklists.

Traumatic injury is an important public health problem secondary to high levels of morbidity and mortality. Injured survivors face several physical, emotional, and financial repercussions that can significantly impact their lives as well as their family. Depression and posttraumatic stress disorder (PTSD) are the most common psychiatric sequelae associated with traumatic injury. Factors affecting the prevalence of these psychiatric symptoms include: concomitant TBI, the timing of assessment of depression and PTSD, the type of injury, premorbid, sociodemographic, and cultural factors, and co-morbid medical conditions and medication side effects. The appropriate assessment of depression and PTSD is critical to an understanding of the potential consequences of these disorders as well as the development of appropriate behavioural and pharmacological treatments. The reliability and validity of screening instruments and structured clinical interviews used to assess depression and PTSD must be considered. Common self-report instruments and structured clinical interviews used to assess depression and PTSD and their reliability and validity are described. Future changes in diagnostic criteria for depression and PTSD and recent initiatives by the National Institute of Health regarding patient-reported outcomes may result in new methods of assessing these psychiatric sequelae of traumatic injury.

Predictors of perceived ambiguity about cancer prevention recommendations: sociodemographic factors and mass media exposures.

Cancer prevention recommendations reaching the public today are often ambiguous-that is, of uncertain reliability, credibility, or adequacy-yet little is known about the factors that influence public perceptions of this ambiguity. We used data from the 2005 Health Information National Trends Survey, conducted by the U.S. National Cancer Institute, to explore how sociodemographic characteristics and self-reported mass media exposures relate to perceptions of ambiguity regarding recommendations for the prevention of colon, skin, and lung cancer. Various sociodemographic characteristics (age, education, race) and mass media exposures (television, radio, Internet, health news) were found to be associated with perceived ambiguity about cancer prevention recommendations, and many of these associations varied by cancer type. These findings have important implications for future health communication research and practice.