Public Health and Primary Care, Leiden University Medical Centre, the Netherlands.
Public Health and Primary Care, Leiden University Medical Centre, the Netherlands.
Soc Sci Med. 2022 Feb;295:113122. doi: 10.1016/j.socscimed.2020.113122. Epub 2020 Jun 14.
This qualitative case study uses a life-course approach to explore syndemic vulnerability in a former fishing village in the Netherlands. Building on four years of fieldwork in a low-income neighborhood, we explored salient themes between and across families and generations. Elderly community members (>65 years) were interviewed to map village history and explore how contextual factors have affected family life, health, and wellbeing since the 1940s. We systematically traced and compared processes leading to or from syndemic vulnerability by studying seven families across three generations. Adults with at least one of clustering diseases, their parents (when possible), and their children participated in semi-structured life-course interviews. A complex interaction of endemic social conditions, sociocultural normative processes, learned health behaviors, and disheartening life events shaped families' predispositions for a syndemic of psychological distress, cardiometabolic conditions, and musculoskeletal pain. Educational attainment, continued social support, and aspirational capabilities emerged as themes related to decreasing syndemic vulnerability. This study demonstrates that syndemic vulnerability is potentially intergenerational and reveals the need for culturally sensitive and family-focused syndemic interventions. Future longitudinal research should focus on unravelling the pathogenesis of the clustering of psychological distress, cardiometabolic conditions, and musculoskeletal pain among young people.
本定性案例研究采用生命历程方法，探索荷兰一个前渔村的综合征易感性。基于四年在低收入社区的实地工作，我们探讨了家庭和代际之间的显著主题。老年社区成员（>65 岁）接受了采访，以绘制村庄历史图，并探讨自 20 世纪 40 年代以来，环境因素如何影响家庭生活、健康和幸福感。我们通过研究三代的七个家庭，系统地追踪和比较了导致或来自综合征易感性的过程。至少有一种聚类疾病的成年人、他们的父母（如果可能）以及他们的孩子参加了半结构化的生命历程访谈。地方性社会条件、社会文化规范过程、习得的健康行为以及令人沮丧的生活事件的复杂相互作用，塑造了家庭对心理困扰、心血管代谢状况和肌肉骨骼疼痛综合征易感性的倾向。教育程度、持续的社会支持和有抱负的能力成为与减少综合征易感性相关的主题。本研究表明，综合征易感性具有潜在的代际性，并揭示了需要进行文化敏感和以家庭为中心的综合征干预。未来的纵向研究应集中于揭示年轻人中心理困扰、心血管代谢状况和肌肉骨骼疼痛聚类的发病机制。
