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Aims: Clinical studies show that women are more likely to be diagnosed with depression and anxiety, and to consume prescribed psychotropic drugs. Applying an intersectional perspective that considers age, education and social class, the present study assesses gender inequalities in the diagnosis of depression/anxiety and in psychotropic consumption. Methods: We analysed data from the 2018 Basque Country Health Survey (Spain; n=8014). Prevalence rates of poor mental health, diagnosis of depression/anxiety and psychotropic consumption were calculated for each sex by age and socio-economic status. Poisson regression models were calculated to estimate PRs of these variables in women, adjusted for age, mental health status and health-care visits, and for diagnosis of depression/anxiety in the case of psychotropic drug consumption. Results: Women were 2.48 times more likely than men to be diagnosed with depression or anxiety, and this difference remained significant after adjustments (prevalence ratio (PR)=1.86; 95% confidence interval (CI) 1.40–2.47). Women also took significantly more prescribed psychotropic drugs, even controlling for their poorer mental health, their higher prevalence of diagnosis and their more frequent health-care visits (PR=1.52; 95% CI 1.28–1.82). No gender inequalities were observed in those younger than 45 or with the highest level of education. Conclusions: Gender inequalities in the diagnosis and prescription of psychotropic drugs exist, and these cannot be explained by differences in mental-health status or health-care visit frequency. It seems, then, that medicalisation of mental health is occurring among women. Further evidence about the mechanisms that underlie the results is crucial to design truly gender-sensitive health policies that reduce medicalisation of women’s mental health.

During recent decades, a growing and preoccupying excess of medical interventions during childbirth, even in physiological and uncomplicated births, together with a concerning spread of abusive and disrespectful practices towards women during childbirth across the world, have been reported. Despite research and policy-making to address these problems, changing childbirth practices has proved to be difficult. We argue that the excessive rates of medical interventions and disrespect towards women during childbirth should be analysed as a consequence of structural violence, and that the concept of obstetric violence, as it is being used in Latin American childbirth activism and legal documents, might prove to be a useful tool for addressing structural violence in maternity care such as high intervention rates, non-consented care, disrespect and other abusive practices. Ces dernières décennies, un excès croissant et préoccupant d’interventions médicales pendant l’accouchement, même dans des naissances physiologiques et sans complications, parallèlement à une multiplication de pratiques violentes et irrespectueuses à l’égard des femmes pendant l’accouchement, a été rapporté de par le monde. En dépit de recherches et de décisions politiques pour corriger ces problèmes, il s’est révélé difficile de changer les pratiques obstétricales. Nous avançons que le taux excessif d’interventions médicales et le manque de respect à l’égard des parturientes devraient être analysés comme conséquence de la violence structurelle et que le concept de violence obstétricale, tel qu’il est utilisé dans l’activisme latino-américain de l’accouchement et dans les documents juridiques, peut être un outil précieux pour s’attaquer à la violence structurelle dans les soins maternels, comme les taux élevés d’intervention, les soins non consentis, le manque de respect et d’autres abus. Durante décadas recientes, se ha reportado un creciente y preocupante exceso de intervenciones médicas durante el parto, incluso en partos fisiológicos sin complicaciones, junto con un preocupante aumento de prácticas abusivas e irrespetuosas hacia las mujeres durante el parto en todo el mundo. A pesar de investigaciones y políticas formuladas para tratar estos problemas, ha resultado difícil cambiar las prácticas relacionadas con el parto. Argumentamos que las tasas excesivas de intervenciones médicas y la falta de respeto hacia las mujeres durante el parto deben analizarse como una consecuencia de la violencia estructural, y que el concepto de violencia obstétrica, tal como se utiliza en el activismo relacionado con el parto y en documentos jurídicos en Latinoamérica, podría ser una herramienta útil para abordar la violencia estructural en la atención materna, tales como altas tasas de intervención, cuidados sin consentimiento, falta de respeto y otras prácticas abusivas.

Purpose This paper asks whether the separation of mental health from its wider social context during the UK benefits assessment processes is a contributing factor to widely recognised systemic difficulties, including intrinsically damaging effects and relatively ineffective welfare-to-work outcomes. Methods Drawing on multiple sources of evidence, we ask whether placing mental health—specifically a biomedical conceptualisation of mental illness or condition as a discrete agent—at the core of the benefits eligibility assessment process presents obstacles to (i) accurately understanding a claimant’s lived experience of distress (ii) meaningfully establishing the specific ways it affects their capacity for work, and (iii) identifying the multifaceted range of barriers (and related support needs) that a person may have in relation to moving into employment. Results We suggest that a more holistic assessment of work capacity, a different kind of conversation that considers not only the (fluctuating) effects of psychological distress but also the range of personal, social and economic circumstances that affect a person’s capacity to gain and sustain employment, would offer a less distressing and ultimately more productive approach to understanding work capability. Conclusion Such a shift would reduce the need to focus on a state of medicalised incapacity and open up space in encounters for more a more empowering focus on capacity, capabilities, aspirations, and what types of work are (or might be) possible, given the right kinds of contextualised and personalised support.

This paper draws on qualitative research using focus groups involving 38 general practitioners (GPs). It explores their attitudes and feelings about (over-)medicalisation. Our main findings were that GPs had a complex representation of (over-)medicalisation, composed of many professional, social, technological, economic and relational issues. This representation led GPs to feel uncomfortable. They felt pressure from all sides, which led them to question their social roles and responsibilities. We identified four main GP-driven proposals to deal with (over-)medicalisation: (1) focusing on the communication in doctor–patient relationships; (2) grounding practices in evidence-based medicine; (3) relying on clinical skills, experience and intuition; and (4) promoting training, leadership bodies and social movements. Drawing on these proposals, we identify and discuss five paradigms that underpin GPs’ attitudes toward (over-)medicalisation: underlying social factors, preventing medicalisation, managing uncertainties, sharing medical decision-making and thinking about care as a rationale. We suggest that these paradigms constitute a defensive posture against GPs’ uncomfortable feelings. All five defensive paradigms were identified in our focus groups, echoing contemporary political debates on public health. This non-exhaustive framework forms the outline of what we call ordinary defensive medicine . GPs’ uncomfortable feelings are the origin of their defensive solutions and the manifestation of their vulnerability. This professional vulnerability can be shared with the patient’s vulnerability. In our view, this creates an opportunity to rediscover patient–doctor relationships and examine patients’ and doctors’ vulnerabilities together. “There are many cases in which—though the signs of a confusion of tongues between the patient and his doctor are painfully present—there is apparently no open controversy. Some of these cases demonstrate the working of two other, often interlinked, factors. One is the patient’s increasing anxiety and despair, resulting in more and more fervently clamouring demands for help. Often the doctor’s response is guilt feelings and despair that his most conscientious, most carefully devised examinations do not seem to throw real light on the patient’s “illness”, that his most erudite, most modern, most circumspect therapy does not bring real relief.” (Balint M. The Doctor, His Patient and the Illness. New York: International Universities; 2005. [1957].) “Theories about care put an unprecedented emphasis on vulnerability—taking up that challenge to transform what really counts in today’s hospitals implies letting colleagues inside previously closely guarded professional boundaries” (2, our translation).

Abstract This article addresses the interactions between medicalisation and juridification and their impact on the concepts of health and illness. Juridification, de-juridification, medicalisation and de-medicalisation are defined in many different ways and it is particularly interesting to see how they affect each other, impinging on individual freedom and contributing to shaping the definition of health and illness and their public understanding. Juridification and medicalisation are particularly affected by the shifting perceptions of the public and private interests at stake, even if the identification of the public or private interest is not an easy task, especially when ethically controversial issues come into play. Nevertheless, the private/public interest analysis is a crucial issue in the understanding of the interactions between these two concepts and in the identification of the boundary lines between them, giving an important key to the understanding of their influence on the rights and liberties at stake.

BackgroundSwedish labour care is becoming increasingly medicalised, with rising rates of intrapartum interventions such as induction and augmentation of labour, epidural analgesia, and caesarean section. This study aimed to explore the paradox of the increasing medicalisation of childbirth despite the vast evidence of the benefits of low-intervention physiological birth.MethodsFocused ethnography was used to study woman-midwife interactions during labour and birth and the everyday practices of midwives in two Swedish labour wards. After birth, the women and midwives were interviewed. Thematic analysis was used to analyse the data, and the study design and interpretation of results were informed by a social constructionist view of gender.ResultsThe analysis resulted in three themes, mirroring the pillars on which labour and birth care rests– the labour care organisation, the midwives, and the women who give birth. The organisation was hierarchical and based on traditional masculine values such as rationality, efficiency, and productivity. The midwives tried to balance the needs of the birthing women and the organisational demands of throughput. As action and technological skills are more noticeable and linked to masculinity, and thus more valued than the invisible feminine-coded emotional care work of supporting a woman in labour, the midwives became task-oriented and more focused on ‘doing’ than on ‘being’. This led to more birth interventions, less support for the birthing women, and to occupational stress and stress of conscience for the midwives. Normative expressions of femininity were observed in the birthing women, such as placing the needs of others before their own and acts of compliance, which sometimes led to unconsented interventions.ConclusionsWe suggest that societal gender norms and gender-based hierarchies in combination with modern society becoming progressively risk-laden and technology-oriented, have contributed to an increasingly medicalised and interventionist labour and birth care organisation, where physiological birth is rare. Awareness of how gender norms inform labour and birth care practice may be one way to make visible and to recognise all aspects of midwifery care, as well as help flatten hospital hierarchies, improve working conditions for midwives, promote physiological birth, and limit unnecessary and unconsented interventions for the birthing women.

Background Swedish labour care is becoming increasingly medicalised, with rising rates of intrapartum interventions such as induction and augmentation of labour, epidural analgesia, and caesarean section. This study aimed to explore the paradox of the increasing medicalisation of childbirth despite the vast evidence of the benefits of low-intervention physiological birth. Methods Focused ethnography was used to study woman-midwife interactions during labour and birth and the everyday practices of midwives in two Swedish labour wards. After birth, the women and midwives were interviewed. Thematic analysis was used to analyse the data, and the study design and interpretation of results were informed by a social constructionist view of gender. Results The analysis resulted in three themes, mirroring the pillars on which labour and birth care rests– the labour care organisation, the midwives, and the women who give birth. The organisation was hierarchical and based on traditional masculine values such as rationality, efficiency, and productivity. The midwives tried to balance the needs of the birthing women and the organisational demands of throughput. As action and technological skills are more noticeable and linked to masculinity, and thus more valued than the invisible feminine-coded emotional care work of supporting a woman in labour, the midwives became task-oriented and more focused on ‘doing’ than on ‘being’. This led to more birth interventions, less support for the birthing women, and to occupational stress and stress of conscience for the midwives. Normative expressions of femininity were observed in the birthing women, such as placing the needs of others before their own and acts of compliance, which sometimes led to unconsented interventions. Conclusions We suggest that societal gender norms and gender-based hierarchies in combination with modern society becoming progressively risk-laden and technology-oriented, have contributed to an increasingly medicalised and interventionist labour and birth care organisation, where physiological birth is rare. Awareness of how gender norms inform labour and birth care practice may be one way to make visible and to recognise all aspects of midwifery care, as well as help flatten hospital hierarchies, improve working conditions for midwives, promote physiological birth, and limit unnecessary and unconsented interventions for the birthing women.

Background Childbirth in Australia occurs predominantly in a biomedical context, with 97% of births occurring in hospital. A small percentage of women choose to birth outside the system – that is, to have a midwife attended homebirth with risk factors, or a freebirth, where the birth at home is intentionally unattended by any health professional. Method This study used a Grounded Theory methodology. Data from 13 women choosing homebirth and 15 choosing freebirth were collected between 2010 and 2014 and analysed over this time. Results The core category was ‘wanting the best and safest,’ which describes what motivated the women to birth outside the system. The basic social process, which explains the journey women took as they pursued the best and safest, was ‘finding a better way’. Women who gave birth outside the system in Australia had the countercultural belief that their knowledge about what was best and safest had greater authority than the socially accepted experts in maternity care. The women did not believe the rhetoric about the safety of hospitals and considered a biomedical approach towards birth to be the riskier birth option compared to giving birth outside the system. Previous birth experiences taught the women that hospital care was emotionally unsafe and that there was a possibility of further trauma if they returned to hospital. Giving birth outside the system presented the women with what they believed to be the opportunity to experience the best and safest circumstances for themselves and their babies. Conclusion Shortfalls in the Australian maternity care system is the major contributing factor to women’s choice to give birth outside the system. Systematic improvements should prioritise humanising maternity care and the expansion of birth options which prioritise midwifery-led care for women of all risk.

Purpose Several studies have shown socioeconomic inequalities in psychotropic medication use, but most of these studies are inspired by Andersen’s behavioural model of health care use, which strongly focusses on individuals’ needs. Andersen’s model pays little attention to health care use that is not based on need and insubstantially recognises the context dependentness of individuals. Medicalisation, however, is a context-dependent interactive process that not only interacts with need determinants, but also with non-need determinants that affect health care use. Therefore, this study will examine if psychotropic medication use is stratified, and whether this is not simply the result of differences in need for care, but also influenced by factors not based on need, initiating the stratified medicalisation of mental health symptoms. Methods Data from the Belgian Health Interview Survey (BHIS) are used. This study covers information from five successive waves: 2001, 2004, 2013, 2018. The weighted data represent a sample of the adult Belgian population. The research aims are analysed using stepwise Poisson regression models, where the models are also plotted to detect evolutions over time, using marginal means postestimation. Results The results reveal that educational inequalities in psychotropic medication use are significant and persistently visible over time. Even after entering need for care, educational inequalities remain significant. Conclusion This study shows that psychotropic medication use is stratified and that this is not simply the result of differences in need for care, but also influenced by factors linked to the stratified medicalisation of mental health symptoms.

At a time when lesbian, gay, bisexual, and transgender individuals-often referred to under the umbrella acronym LGBT-are becoming more visible in society and more socially acknowledged, clinicians and researchers are faced with incomplete information about their health status. While LGBT populations often are combined as a single entity for research and advocacy purposes, each is a distinct population group with its own specific health needs. Furthermore, the experiences of LGBT individuals are not uniform and are shaped by factors of race, ethnicity, socioeconomic status, geographical location, and age, any of which can have an effect on health-related concerns and needs. The Health of Lesbian, Gay, Bisexual, and Transgender People assesses the state of science on the health status of LGBT populations, identifies research gaps and opportunities, and outlines a research agenda for the National Institute of Health. The report examines the health status of these populations in three life stages: childhood and adolescence, early/middle adulthood, and later adulthood. At each life stage, the committee studied mental health, physical health, risks and protective factors, health services, and contextual influences. To advance understanding of the health needs of all LGBT individuals, the report finds that researchers need more data about the demographics of these populations, improved methods for collecting and analyzing data, and an increased participation of sexual and gender minorities in research. The Health of Lesbian, Gay, Bisexual, and Transgender People is a valuable resource for policymakers, federal agencies including the National Institute of Health (NIH), LGBT advocacy groups, clinicians, and service providers.