Inequalities in recovery or methodological artefact? A comparison of models across physical and mental health functioning

Salmela Jatta; Brunton-Smith Ian; Meadows Robert

doi:10.1016/j.ssmph.2022.101067

Inequalities in recovery or methodological artefact? A comparison of models across physical and mental health functioning

SSM Popul Health. 2022 Mar 5:17:101067. doi: 10.1016/j.ssmph.2022.101067. eCollection 2022 Mar.

Authors

Salmela Jatta¹, Brunton-Smith Ian², Meadows Robert²

Affiliations

¹ Department of Public Health, University of Helsinki, Tukholmankatu 8 B, PO Box 20, 00014, Helsinki, Finland.
² Department of Sociology, Elizabeth Fry Building (AD), University of Surrey, Guildford, Surrey, GU2 7XH, UK.

Abstract

Considerable attention has been paid to inequalities in health. More recently, focus has also turned to inequalities in 'recovery'; with research, for example, suggesting that lower grade of employment is strongly associated with slower recovery from both poor physical and poor mental health. However, this research has tended to operationalise recovery as 'return to baseline', and we know less about patterns and predictors when recovery is situated as a 'process'. This paper seeks to address this gap. Drawing on data from the UK Household Longitudinal Study, we operationalise recovery as both an 'outcome' and as a 'process' and compare patterns and predictors across the two models. Our analysis demonstrates that the determinants of recovery from poor health, measured by the SF-12, are robust, regardless of whether recovery is operationalised as an outcome or as a process. For example, being employed and having a higher degree were found to increase the odds of recovery both from poor physical and mental health functioning, when recovery was operationalised as an outcome. These variables were also important in distinguishing health functioning trajectories following a poor health episode. At one and the same time, our analysis does suggest that understandings of inequalities in recovery will depend in part on how we define it. When recovery is operationalised as a simple transition from poor health state to good, it loses sight of the fact that there may be inequalities (i) within a 'poor health' state, (ii) in how individuals are able to step into the path of recovery, and (iii) in whether health states are maintained over time. We therefore need to remain alert to the additional nuance in understanding which comes from situating recovery as a process; as well as possible methodological artefacts in population research which come from how recovery is operationalised.

Keywords: AMI, Acute myocardial infarction; APP, Average posterior probability; BIC, Bayesian information criterion; CI, Confidence interval; GBTM, Group-based trajectory modelling; GCSE, General Certificate of Secondary Education; Health inequalities; MCS, Mental component summary; OCC, Odds of correct classification; OR, Odds ratio; PCS, Physical component summary; Recovery; SES, Socioeconomic status; SF-12, 12-Item Short Form Survey; SF-36, 36-Item Short Form Survey; Socioeconomic inequalities; Trajectory modelling; United Kingdom.