Adult children of parents with mental illness: navigating stigma

The experiences of children who live with parental mental illness are becoming increasingly recognized. However, there remains a limited body of knowledge in relation to an individual's longer term experiences. This study sought adult children's experiences of childhood parental mental illness. It generated reflections of 13 adult children who had lived with parents with mental illness during their childhood. The narrative design of the study facilitated a voice for participants. The paper presents one main theme of the findings. The findings offer a unique insight into childhood awareness of social stigmas and children's behavioural changes to avoid disclosure of parental mental illness. Participants noted that they were aware of social stigmas associated with mental illness during their childhood. This contributed to their fear of disclosure to others that fuelled a culture of familial secrecy, reinforcing the children's own sense of difference. Further work is required to enhance community understanding about the familial journeys of parental mental illness and the impact of negative‐natured stigmas.     

The Fiscal Crisis of National Health Insurance in the Republic of Korea: In Search of a New Paradigm

In 2001, National Health Insurance (NHI) in Korea, the social insurance system for health care with universal population coverage, experienced a serious fiscal crisis as its accumulated surplus was depleted. This fiscal crisis is attributed to its chronic imbalance: health care expenditure has increased more rapidly than have insurance contributions. The recent failure in implementing pharmaceutical reform was a further blow to the deteriorating fiscal status of the NHI. Although the NHI has since recovered from the immediate fiscal crisis, this has mainly been because of a temporary increase in government subsidy into the NHI. The strong influence of the medical profession in health policy‐making remains a major barrier to the introduction of policy changes, such as a reform of the payment system to strengthen the fiscal foundations of the NHI. Korea also has to restructure its national health insurance in an era of very rapid population ageing. A new paradigm is called for in the governance of the NHI: to empower groups of consumers and payers in the policy and major decision‐making process of the NHI. The fiscal crisis in Korean national health insurance sheds light on the vulnerability of the social health insurance system to financial instability, the crucial role of provider payment schemes in health cost containment, the importance of governance in health policy, and the unintended burdens of health care reform on health care financing systems.     

Wealth,Race, and Mortality*

Objective. We explore, first, whether wealth relates to mortality risk independent of income and education, and second, whether wealth closes the black‐white gap in U.S. adult mortality while controlling for other socioeconomic and sociodemographic factors. Methods. We employ the Cox proportional hazards models on data from the 1992 wave of the Health and Retirement Study linked to deaths through 1998, to analyze pre‐retirement adult mortality in the United States. Results. The findings suggest that broader measures of SES, including wealth, are significant for understanding adult mortality. Further, vastly lower asset holdings among blacks, compared to whites, not only affects their financial well‐being but also their survival prospects. Conclusions. Research and social policies that aim to understand and close health disparities in the United States may be poorly conceived if they ignore the impact of wealth on premature adult mortality.     

Advocacy Coalitions and Health Politics in Korea

This article analyses the political dynamics underlying health care reform in Korea after the Asian economic crisis. The reform was a significant volte‐face in respect of the social policy paradigm, which now aims to enhance equity in National Health Insurance. The article pays special attention to the evolution of the advocacy coalition for equity in health policy and how it developed the two attributes required for successful policy change: institutional strength and the elaboration of policy rationale for reform. This process was not a simple linear development but a combination of setbacks and advances. The article also takes into consideration the structural conditions that set the policy environment over the course of the advocacy coalition's evolution since the 1960s. In short, the policy reform of 2000 was not a simple policy change in response to the economic crisis, but rather the outcome of the long‐term evolution of the advocacy coalition for equity in health policy.     

Economic crisis and social policy reform in Korea

The economic crisis that broke out in Korea in December 1997 has had a chilling impact on social development in the country. Today unemployment is the highest that Korea has experienced in the past thirty years. This paper aims to examine the impact of the economic crisis on social development and the role of public policy to mitigate the problems caused by the crisis. The economic crisis has hit vulnerable groups harder, increased the proportion of part-time and daily workers, and reversed the trend of steady improvement of income distribution. The economic crisis along with the trend of aging population, globalization, and competition calls for an expanded role of social policy, which the Korean government has neglected for a long time. The main targets of social policy reform in Korea include the expansion of government programs and safety nets for the unemployed and redesigning the national pension and health insurance scheme to provide adequate income security as well as to improve the system sustainability.     

Governing universal health insurance in Korea and Taiwan

This article examines policy responses to the rising costs of healthcare in the Republic of Korea and Taiwan from a governance perspective. It tries to answer why the two countries responded differently to a similar set of challenges facing their National Health Insurance (NHI). While Taiwan – in an attempt to contain costs – introduced a global budgeting system, Korea failed to do so. Governments in both countries attempted to establish a new mode of governance, bringing multiple stakeholders to health policy making in order to build social consensus. But the Korean government, as this article shows, could not resolve its policy deadlock because of a loss of trust between the government and the medical profession, caused by the separation reform of 2001. Even though Taiwan was better able than Korea to address the financial challenges of its NHI, the new mode of health governance is still on shaky ground. This article argues that because neither government now enjoys the exclusive power over health policy that they once did under the developmental state, it is essential to find a way in which different stakeholders can make the necessary compromises that will enable the NHI to run on a sustainable path for the future.     

Social Context in Mental Health Service Use Among Young Adults

Examining the sources of health communication that young adults with mental health challenges receive regarding service use is critical to curbing the societal concern of unmet mental health needs of this population. Semistructured interviews were conducted with 59 young adults, all of whom were diagnosed with a mood disorder and used public mental health services and additional public systems of care during childhood. Thematic analysis was utilized. Of the 59 participants, 45 nominated at least one supportive adult, with a total of 97 relationships analyzed. Results indicate that the majority of messages came from informal supports (e.g., family) who spoke positively about mental health services. Fewer messages came from formal supports (e.g., professionals). Messages included statements surrounding beliefs toward services, social norms (approval and disapproval), self-efficacy, and image considerations around using services. These findings can suggest ways that mental health service engagement interventions can leverage communication from informal supports. Future research can explore what messages young adults find most influential in persuading them to use mental health care consistently and the relationship between messages and health behavior.     

Co-parenting and parenting behaviour: The role of parent mental health for mothers and fathers in the postnatal period

The relationship between co-parenting, parent mental health and parenting remains unclear for parents during the postnatal period, particularly fathers. Therefore, the aim of the current study was to investigate these relationships for families in the postnatal period. Routinely collected self-report data from 138 mothers and 138 fathers participating in Family Foundations, a co-parenting intervention facilitated by a community health service in Melbourne, were used. Path analysis revealed that for mothers, more supportive co-parenting was associated with fewer mental health difficulties and, in turn, low parenting hostility and high parenting warmth. For fathers, supportive co-parenting was associated with fewer mental health difficulties, which was associated with low parenting hostility but not parenting warmth. Co-parenting was also directly associated with parenting warmth and hostility for fathers. The findings highlighted some key differences between mothers and fathers and the importance of interventions targeting the co-parenting relationship during early childhood.     

Social participation,health‐related behavior,and depression of older adults living alone in Korea

This study aims to identify the effects of social participation on depression among adults over 60 years old living alone in Korea, focusing on the mediating effect of health‐related behavior on the social participation–depression relationship. The study relies on secondary data analysis using the 6th wave of the Korea Longitudinal Study of Ageing, and structural equation modeling method was employed for analyses. The findings indicate that older adults' participation in religious and social gatherings decreases depressive symptoms. The study also finds that regular eating behavior, drinking, and exercise also act as significant mediators, as older adults' participation in social gatherings is associated with those health‐related behaviors and that they also reduce depression. The results suggest that social participation by older adults who live alone is crucial not only for providing them with support but also for encouraging health‐related activities that can have direct effects on their mental health. Implications for social work practice are also discussed.     

Beyond Rhetorical Differences: A Cohesive Account of Post‐devolution Developments in UK Health Policy

Health is perhaps the most significant policy area to be devolved to decision‐makers in Northern Ireland, Scotland and Wales. Consequently, there has been a great deal of interest in assessing the extent to which health policies (which already differed somewhat prior to devolution) have diverged since 1999. To date, analyses have tended to focus either on health care policies or on specific public health issues (e.g. health inequalities or tobacco control). The story that emerges from this body of work suggests health care policies have diverged significantly, whilst public health policies have remained remarkably similar. This article is one of the first to consider health care and public health policy alongside each other. It reassesses and updates previous analyses, incorporating developments relating to the 2010 general election and the 2007 and 2011 devolved administration elections. Drawing on a variety of textual sources (policy documents, research evidence and corporate literature), our findings differ from existing analyses in suggesting that, despite some noticeable differences in policy rhetoric, approaches to both health care provision and tackling public health problems remain similar. Looking to the future, the article concludes that the common economic challenges, combined with a tight fiscal policy (that remains excepted from devolution), means the similarities in health care provision across the UK are likely to remain more pronounced than the differences. However, current debate about the constitutional settlement, and in particular the prospect of greater fiscal freedoms for the devolved administrations, may provide opportunities for more meaningful divergence in health policy than has been possible hitherto.     

Relational Aggression in Middle Childhood: Predictors and Adolescent Outcomes

This study examined gender differences in the level and developmental course of relational aggression in middle childhood, as well as early predictors and outcomes of relational aggression, after controlling for concurrent physical aggression. Relational (RAgg) and Physical aggression (PAgg) scores for 558 boys and 545 girls at the ages of eight to 11 in the NICHD Study of Early Child Care and Youth Development (SECCYD) were created by combining the highest rating for each item across mother and teacher reports. Longitudinal analyses were conducted using latent curve models of RAgg with PAgg as a time‐varying covariate, with all parameters allowed to vary by gender. Boys and girls had different growth parameters of RAgg. Girls' RAgg intercept was higher, and the slope was not different from zero; boys' RAgg intercept was lower, and the slope declined. Mother–child conflict in early childhood predicted RAgg intercept for both boys and girls, but maternal harsh control and sensitivity were also uniquely predictive for girls whereas center care was uniquely predictive for boys. RAgg intercept predicted adolescent self‐reports of depression for girls and delinquency and risk‐taking for both boys and girls; the magnitude of the association with risk taking was significantly greater for boys.     

Trajectory and Predictors of Early Adolescent Alcohol Use

The aim of this study was to identify the developmental trajectory and predictors of Korean early adolescents’ alcohol use. The sample comprised 2844 adolescents who participated in the five‐wave longitudinal Korea Youth Panel Study, in which students were assessed annually from grade 4 (aged 11 years) in 2004 to grade 8 (aged 15 years) in 2008. Latent growth curve (LGC) modeling was conducted and a quadratic (J‐shaped) LGC model was supported. Personality‐ and environment‐system predictors, based on problem‐behavior theory, were specified to account for variation in intra‐individual changes in alcohol use. Self‐control, depressive affect, parental abuse, number of drinking friends, and gender significantly predicted the initial level of alcohol use. Self‐control, depressive affect, parental abuse, peer attachment, gender, and family structure predicted the quadratic slope that was associated with the rate of acceleration of alcohol use. These findings suggest that more effort needs to be directed toward the implementation of alcohol prevention programs early in elementary schools and practitioners who are involved in effective alcohol‐prevention and intervention programs that are aimed at delaying the initiation of alcohol use and reducing drinking during adolescence should consider various psychosocial factors.     

Is Food Insecurity Associated with Depressive Symptoms in South Korea?

Emerging studies have suggested a possible link between food hardship and depression; however, empirical knowledge is limited. In South Korea, more public discussion has been conducted regarding the prevalence and consequences of food insecurity on mental health. To begin to address the knowledge gap, we applied family stress theory and investigated the association of food insecurity with depression in South Korea. We employed observational data from the Korea Welfare Panel Study, the first data to draw on food insecurity information from a nationally representative sample in Korea. Our sample consisted of 744 non‐elderly household heads. The independent variable “food insecurity” was measured using a six‐item scale adapted from the United States Department of Agriculture Food Security Scale. The dependent variable “depression” was measured using 11 questions from the Center for Epidemiologic Studies Depression Scale adapted for Koreans. After controlling for income, material hardship, and other factors, our ordinary least squares regression findings show that food insecurity significantly predicts depression. Our findings are consistent whether food insecurity is measured on a continuum or in categorical groups. More research and empirical evidence should be shared to provide legitimate grounds for policy interventions that address and prevent food insecurity and mental health issues.     

Economic distress and health: A fixed effects analysis of low‐income persons in Singapore

Using fixed effects regressions, this study examined the transactional effects of different types of economic status on the physical and mental health of low‐income persons in Singapore. Among the economic variables considered, unemployment and arrears had the most significant effects. This signals the physical and psychological distress of being out of work and possessing arrears while income is low. The insignificant effects of poor health on household earnings suggest possible earnings supplementation by other household members. The findings imply the fruitfulness of dually improving employment prospects and health, work activation that takes into consideration mental health effects, increasing affordability of health services in liberal welfare systems, improving mental bandwidth through reducing arrears accounts, and short lag time from application to receipt of assistance. These implications point to a larger question on health and welfare systems in an increasingly uncertain economic environment for households in poverty. Key Practitioner Message: ? Employment and health are inter‐related: employment assistance incorporating physical and mental health interventions and vice versa can be more effective than either alone; ? Compared with decreasing arrears amounts, reducing the number of arrears can more effectively relieve mental distress; ? Effects between economic distress and health materialise quickly; minimising the lag time between application and receipt of assistance will provide great relief.     

The effects of physical and psychological health on life satisfaction among older adults with a physical disability in South Korea: focus on gender differences

This study aims to investigate whether (a) functional disabilities, self-rated health and depression influence life satisfaction among older adults with a physical disability, and (b) whether the effects of the predictors differ by gender. The study utilises 2008 Korea Welfare Panel Study data. The findings reveal that functional disabilities and depression are negatively associated with life satisfaction, whereas self-rated health is positively related with life satisfaction. In addition, the effects of functional disabilities and income on life satisfaction vary by gender. Implications for practice and policy are discussed.     

A panel study to examine the impact of multidimensional poverty on Korean adolescents' health

The study aims to explore the changes in adolescents' health during this significant transition from childhood to adulthood, and examines the impact of multidimensional poverty on their health. The study used panel data drawn from Seoul Child Panel Study, from 8th to 11th grade, and analysed the 908 adolescents using hierarchical linear modelling. Having consistent poverty, single parents and food insufficiency were significant predictors of physical and mental health problems, and these findings varied significantly by specific grade level. Implications for policies and practice to promote the health of adolescents in multidimensional poverty are identified.     

The relationship between adverse childhood experiences,health and life satisfaction in adults with care experience: The mediating role of attachment

Adverse childhood experiences (ACEs) are associated with a plethora of negative outcomes. Research has also found that adults who were separated from parental care and lived in alternative care settings during childhood have high levels of ACEs and are more likely to have poor outcomes. A growing body of research has supported the importance of attachment as a mechanism underlying the relationship between ACEs and adult wellbeing. However, little work has examined the role that attachment may play in the outcomes of adults who resided in residential and foster care during childhood. The current study examined the role of attachment avoidance and anxiety in the associations between ACEs and mental health, physical health, and life satisfaction in a sample of 529 adults with alternative care experience from 11 nations. Attachment avoidance partially mediated the relationship between ACEs and life satisfaction, mental health, and physical health. Attachment anxiety partially mediated the relationship between ACEs and life satisfaction and mental health, but not physical health. Taken together, the present study suggests that both attachment anxiety and avoidance play important, but unique, roles in understanding the relationship between ACEs and health and wellbeing for adults with care experience. Implications and limitations are discussed.     

Does financial development cause economic growth? Implication for policy in Korea

The causal relationship between financial development and economic growth is examined, utilizing the superexogeneity methodology. We use annual data for Korea during 1971–2002, during which Korea has experienced both phenomenal economic growth and a variety of financial liberalization and reforms. In our tests for superexogeneity, we find that financial development control causes economic growth, but the reverse is not true. Our empirical results provide evidence in favor of the ‘finance causes growth’ view for the case of Korea while rejecting the ‘growth causes finance’ view. The policy implication is that Korea should give policy priority to financial reform rather than economic growth, because only a decisive and accelerated pace of financial restructuring can ensure a sustainable growth in the medium or long term.     

Welfare reform and future challenges in the Republic of Korea: Beyond the developmental welfare state?

Since the economic crisis of 1997–98, the Republic of Korea has carried out vigorous social policy initiatives including the reform of the National Pension Programme and National Health Insurance. This paper seeks to answer whether the country's welfare state has moved beyond welfare developmentalism, by examining the cases of those two programmes. By the reform, the coverage of the National Pension Programme was extended to the whole population; and its financial sustainability and accountability were enhanced. Regarding National Health Insurance, efficiency reform was carried out on the management structure, while reform regarding financing was put on hold. These reforms were in clear contrast to the welfare developmentalism that used to place overwhelming emphasis on economic considerations. Despite these reforms, however, the Republic of Korea's welfare state faces the issues of ineffectual implementation and lack of financial sustainability of social policy. The National Pension Programme has failed to cover the majority of irregular workers, whose numbers are on the increase, and National Health Insurance needs to find a way to meet increasing health expenditure.     

Constructing prevention programmes with a Māori health service provider view

Mainstream approaches to chronic condition management and prevention inadequately address the needs of Māori, the Indigenous people of New Zealand. Māori health service providers (MHSPs) are uniquely placed to address the critical gap in the prevention of chronic conditions. In this paper, we report qualitative research findings investigating how prevention was being modelled, practiced and measured in selected MHSP settings. Results indicate barriers to achieving wellbeing through health service delivery. The dominant individualistic, medical conditions-focused discourse, along with responding to acute need, is a driver of service delivery norms.There are examples of shifts in organisational structure and delivery configurations that demonstrate that these norms are being challenged and reframed, in some form, by MHSPs. Consolidation of these approaches requires significant work and increased resources as well as a broader systems-level response that prioritises prevention.