Burden of psychosocial adversity and vulnerability in middle age: associations with biobehavioral risk factors and quality of life

Assessment of health, well-being and social connections: A survey of women living in Western Sydney

Strengthening the physical and social environment has been shown to support health and strengthen community action for health. In an attempt to improve the social factors that influence the health of individuals and the community, community interventions increasingly include strategies to build networks and social capital and develop resilience. This study was undertaken to identify the most appropriate strategies to strengthen friendships and the social support networks for women aged 18-39 years living in Villawood, an area of high disadvantage in South Western Sydney, Australia. Although the majority reported positively on their health, one-third reported feeling isolated, experienced low energy levels and felt unhappy and anxious over the past month. Women who described themselves as unemployed felt more isolated than women in home duties. Women who were employed or engaged in home duties had more contact with neighbours, and had more in common with their neighbours. Those who reported more contact with their neighbours perceived their mental health level as being higher. These results indicate that community development initiatives should include consultation with the community and consider the needs of socially isolated groups and those with the poorest health status.

The cumulative effect of rural and regional residence on the health of older adults

OBJECTIVE

This study considers whether rural status or living in a particular region of the United States has effects on mental and physical health. The analyses examine whether there are independent and interactive effects of rural status and region of residence on health, beyond individual level factors related to poverty.

METHODS

Ordinary least squares (OLS) regression models are used to examine the relationships between rural and regional residence and health across three time periods.

RESULTS

Negative health effects of rural residence were found only in the South region. Positive health effects of rural residence were found only in the Midwest region. There are no observed health risks associated with rural or regional residence across group.

DISCUSSION

The results indicate a cumulative risk of rural and Southern residence for older men and women. Living in a rural place in the midwestern United States seems to provide unique sources of health benefits.

Impact of psoriasis on health-related quality of life decreases over time: an 11-year prospective study

Although psoriasis typically affects patients for many years, studies quantifying impairment in health-related quality of life (HRQOL) owing to psoriasis over long periods are lacking. This study, which interviewed patients independent of psoriasis care, investigates change in the impact of psoriasis on HRQOL over 11 years and factors associated with change among 484 patients using the Impact of Psoriasis Questionnaire (IPSO). We determined changes in the impact of psoriasis on HRQOL using a psychometrically optimized version of the IPSO. In 1993, the patients were 53+/-11.4 years and 61.8% males. From 1993 to 2004, impact on most social aspects of HRQOL remained stable, but concerns related to physical appearance decreased (e.g., 36-13%, P = 0.001). Over 11 years, the proportion of patients with low overall impact of psoriasis increased significantly (43-53%, P < 0.001). Mean IPSO scores (range 0-22) decreased by one-fifth (5-4, P < 0.001). At follow-up, patients reporting poor health had mean improvement in HRQOL about three times greater than those in good health (P < 0.05). In this large cohort interviewed independent of treatments and psoriasis status, impact of psoriasis on HRQOL decreases over time. For chronic diseases, HRQOL is best measured over time and independently of seeking treatment.

Psychophysiological mediators of caregiver stress and differential cognitive decline

The authors examined relationships between chronic stress and cognitive decline and whether such relationships were mediated by psychophysiological factors. Ninety-six caregivers of spouses with Alzheimer's disease (AD) were compared with 95 similar noncaregiver spouses. All were free of diabetes. Although the groups started similarly, over 2 years caregivers declined by a small but significant amount (1 raw score point and 4 percentile points, each p<.05) on Shipley Vocabulary. In contrast, noncaregivers did not change. Higher hostile attribution (beta=-.09; p<.05) and metabolic risk (beta=-.10; p<.05) in caregivers mediated the cognitive decline. This is the first study of cognitive decline and mediators in caregivers. This work has implications for caregiver and care-recipient health and for research on cognition, psychophysiology, diabetes, and AD.

Caregiving and gingival symptom reports: psychophysiologic mediators

OBJECTIVE

We first assessed the association of caregiving with gingival symptom reports. We then assessed whether the observed relationship was mediated by psychophysiologic host factors.

METHODS

Caregivers of spouses with Alzheimer's disease (n = 123) were compared with demographically similar noncaregiver spouses (n = 117).

RESULTS

The percentage of caregivers (17%) who reported gingival symptoms was twice that of noncaregivers (8.5%) (p < .05), despite the fact that caregivers and noncaregivers did not differ in oral health care. The relationship between caregiving and gingival symptom reports was mediated by psychophysiologic variables. Caregivers were higher on hassles (p < .05), depressed mood (p < .05), and metabolic risk (insulin, glucose, obesity; p < .05) than were noncaregivers. Greater gingival symptom reports were also associated with greater hassles (p < .01), depressed mood (p < .001), and metabolic risk (p < .001). Measures of subcutaneous fat, inflammation, and frank diabetes were related to gingival symptom reports but not to caregiver status.

CONCLUSIONS

A higher percentage of caregivers reported gingival symptoms than noncaregivers. These results have implications for research on aging, psychophysiology, and chronic stress.

Why do poor adults rate their oral health poorly?

BACKGROUND

The reasons why socioeconomic circumstances are associated with oral health are not well understood. This study investigated whether psychosocial factors might play an explanatory role.

METHODS

Cross-sectional survey data were used from the 1999 National Dental Telephone Interview Survey together with information from an accompanying questionnaire sent to adult interviewees. Household income and self-rated oral health were assessed with single items and life dissatisfaction, personal constraint and perceived stress were evaluated with standard psychometric scales. Bivariate associations were tested using chi-square and ANOVA and odds ratios estimated for low self-rated oral health using logistic regression.

RESULTS

Response to the questionnaire was 64.6 per cent and analysis was limited to dentate adults (n = 3678). Low household income was positively associated with low self-rated oral health. Higher dissatisfaction with life, personal constraint and perceived stress scores were associated with low income and with low self-rated oral health. After adjusting for gender, age, income and missing teeth, adults with high personal constraint scores had greater odds of low self-rated oral health (OR 1.26; 1.10-1.43) as had adults with higher perceived stress scores (OR 1.69; 1.34-2.13).

CONCLUSION

Psychosocial factors are important in understanding pathways between socioeconomic position and oral health status.

Allostatic load: a mechanism of socioeconomic health disparities?

Although research on health disparities has been prioritized by the National Institutes of Health, the Institute of Medicine, and Healthy People 2010, little has been published that examines the biology underlying health disparities. Allostatic load is a multisystem construct theorized to quantify stress-induced biological risk. Differences in allostatic load may reflect differences in stress exposure and thus provide a mechanistic link to understanding health disparities. The purpose of this systematic review is to examine the construct of allostatic load and the published studies that employ it in an effort to understand whether the construct can be useful in quantifying health disparities. The published literature demonstrates that allostatic load is elevated in those of low socioeconomic status (SES) as compared to those of high SES. The reviewed articles vary in the justification for inclusion of variables. Recommendations for future research are made in the contexts of measurement, methodology, and racial composition of participants.

Subjective socioeconomic position, gender and cortisol responses to waking in an elderly population

Socioeconomic inequalities in morbidity and mortality exist, but the psychobiological pathways that link social status and health are less clear. It has previously been reported that socioeconomic status is inversely associated with the magnitude of the cortisol response to awakening (CAR) in men and women of working age. In the present study, we tested whether larger cortisol responses would be present in an older retired population, and whether the CAR differed between men and women. The extent to which adherence to saliva sample timing also affects the CAR was investigated. Ninety three men and women aged 65-80 years took saliva samples on waking, and then 10, 20, 30 and 60 min after waking. Subjective social status was assessed using the 'ladder' measure devised by Adler et al. (2000). Non-compliance was defined as a reported delay of 10 min or more between waking and taking the first saliva sample. Cortisol levels on waking were significantly higher in the non-compliant individuals, and the CAR was blunted compared with that of compliant participants. With non-compliant participants eliminated from the analyses, we found that low social status was associated with a larger CAR after adjusting for gender, waist/hip ratio, body mass index, smoking, time of waking, chronic illness, prescription medication, education and financial strain. No association was found between CAR and education or financial strain. Women also had significantly larger CARs, independent of socioeconomic position. The results highlight the importance of controlling for non-compliance and are consistent with the notion that higher socioeconomic position protects against stress-related activation of psychobiological pathways which may contribute to variation in disease risk evident in old age.

[Validation of food security and social support scales in an Afro-Colombian community: application on a prevalence study of nutritional status in children aged 6 to 18 months]

We conducted a cross-sectional study on 193 mothers of children 6 to 18 months of age in an African-Colombian community, with the objectives: (1) to adapt and validate the Community Childhood Hunger Identification Project scale, the DUKE-UNC-11 social support scale, and the Quebec Longitudinal Study of Child Development (QLSCD) partner support scale, and (2) to identify any existent relationship between nutritional status in infancy and both food insecurity and social support. We determined construct validity using factor analysis and theoretical models-based non-parametric correlations. Length-for-age and weight-for-length Z-results were calculated. Factor analyses reduced the hunger scale to one factor, the DUKE-UNC-11 scale to two factors, and the QLSCD scale to one factor. The Cronbach's alpha test ranged between 0.70 and 0.90. Both food insecurity and social support scales were correlated with mother's social conditions, and social support was positively associated with social networks and mother's self-perceived health status. Food insecurity, emotional-social support, and partner's negative support were associated with lower height-to-age and therefore a higher ratio of chronic malnutrition. The study supports the appropriateness of the instruments to measure the expressed concepts.

Promoting mental well‐being in Greenwich — a strategic approach

This article outlines the mental health promotion strategy developed by Greenwich teaching Primary Care Trust (tPCT). The strategy focuses on four themes: isolation, anxiety and depression, sleep, and stigma and discrimination. The aim is to address mental health promotion for all as well as targeted action for higher risk groups, in recognition of the great contrasts, diversity and significant economic inequalities that characterise the borough. A key challenge has been to integrate mental health promotion with wider agendas and it is intended that the strategy will inform other important areas of work in the borough, such as the neighbourhood renewal and health benefits regeneration programmes.

Psychosocial factors in the development of coronary artery disease

The fact that traditional risk factors only account for approximately two thirds of cases of coronary artery disease (CAD) has stimulated increasing interest in the relationship between CAD and psychosocial factors. Five areas--chronic stress, socioeconomic status (SES), personality, depression, and social support--have been most thoroughly examined. There is evidence to support a causal relationship between chronic stress, SES, depression, and social support and development of CAD. In this article, we discuss the epidemiologic evidence linking psychosocial factors and CAD, and review the effects of psychosocial factors on several pathophysiologic mechanisms that have been proposed as potential mediators of CAD. The hypothalamic-pituitary-adrenal axis, hypertension and cardiovascular reactivity, endothelial function, inflammatory markers, platelets, coagulation factors, fibrinogen, lipids, glucose metabolism, and lifestyle factors have all been implicated in this process. Recently, the first intervention trials have been carried out, although with initially disappointing results. Reducing the cardiovascular risk due to these psychosocial factors will be one of the major health care challenges in the future.