Psychological Well-being and Physical Health: Associations, Mechanisms, and Future Directions

Virtual and augmented reality applications to improve older adults' quality of life: A systematic mapping review and future directions

Objective

The use of virtual reality and augmented reality to improve older adults' quality of life has rapidly increased in recent years. This systematic mapping review aimed to provide a comprehensive overview of existing research that identifies and classifies current virtual reality and augmented reality applications that enhance the quality of life of older adults to increase the understanding of the impact of these technologies.

Methods

To reach this objective, a systematic mapping review was conducted of the studies published between 2009 and 2020 in major scientific databases, such as IEEE Xplore, Web of Science, Scopus, and PubMed. A total of 57 studies were analyzed and classified into four main quality of life domains: physical, cognitive, psychological, and social well-being.

Results

The findings showed that virtual reality and augmented reality have found their places in many quality of life studies of older adults. Although virtual reality and augmented reality applications are notably growing in the physical and cognitive well-being domains in training and rehabilitation settings, they are still in the early stages of development in psychological and social well-being research as well as healthcare settings. Our findings also revealed that virtual reality games, particularly motion-based exergames, and 3D augmented reality systems are the most common virtual reality and augmented reality types among the reviewed studies. Moreover, balance and attention were the most prevalent physical and cognitive functions when using motion-based and immersive virtual reality exergames and augmented reality systems and games, respectively, while confidence and interaction were the most dominant psychological and social functions.

Conclusion

This mapping review provides a comprehensive overview of potential areas for further research in this field, thereby assisting researchers, technologists, and health practitioners in expanding this field of research.

Exploring Personal Development Workshops' Effect on Well-Being and Interconnectedness

Introduction: Personal development workshops are increasingly popular. This study evaluated the relationships between the measures of well-being, interconnectedness, and extended perception in various workshops and explored which kinds of workshops and individual characteristics predicted changes in these outcomes. Materials and Methods: In a prospective, uncontrolled, within-participant design study, adult participants completed questionnaires and online tasks before and after personal development workshops. Three analyses were conducted: (1) examining the relationships between measures by using only pre-workshop measures using Spearman correlations; (2) exploring change scores pre- to post-workshop and workshop using Wilcoxon signed-rank test; (3) assessing workshop format and content, and individual characteristics as predictors of those change scores multivariate nonparametric regression. The following outcomes were collected: Well-being-Arizona Integrative Outcomes Scale, positive and negative affect, Dispositional Positive Emotions Scale-Compassion subscale, Sleep Quality Scale, Numeric Pain Rating Scale; Interconnectedness-Cloninger Self-Transcendence Scale, Inclusion of Nature in Self and Inclusion of the Other in Self; and Extended perception tasks-Intuition Jar, Quick Remote Viewing, Psychokinesis Bubble, and Time Estimation. The following potential predictor variables were collected: demographic, mental health, psychiatric and meditation history, Single General Self-Rated Health Question, Brief Five-Factor Inventory-10, and the Noetic Experience and Belief Scale. Workshop leaders also selected which format and content characteristics applied to their workshop. Results: Interconnectedness measures were significantly and positively correlated with well-being (ρ: 0.27 to 0.33), positive affect (ρ: 0.20 to 0.27), and compassion (ρ: 0.21 to 0.32), and they were negatively correlated with sleep disturbance (ρ: -0.13 to -0.16) and pain (ρ: -0.11 to -0.16). Extended perception task performance was not correlated with interconnectedness or well-being. General personal development workshops improved subjective interconnectedness, well-being, positive emotion, and compassion, and they reduced sleep disturbances, negative emotion, and pain (all p's < 0.00005). The lecture (p = 0.03), small groups (p = 0.001), pairs (p = 0.01), and discussion (p = 0.03) workshop formats were significant predictors of well-being outcomes. The workshop content categories of meditation (p = 0.0002) and technology tools (p = 0.01) were also predictive of well-being outcomes, with meditation being the most consistent predictor of positive well-being changes. Conscientiousness was the only significant individual characteristic predictor (p = 0.002), although it was associated with increases in some well-being measures and decreases in others. Conclusions: This study provides preliminary evidence for the positive relationship between the subjective sense of interconnectedness and multiple well-being measures and the beneficial effects of some personal development workshops.

Life satisfaction and coronary atherosclerosis: The SCAPIS study

BACKGROUND

There is an increasing interest in the potential health benefits of positive psychological states, especially with regard to cardiovascular health. Life satisfaction is thought to be a constituent component of psychological well-being; however, among the few previous studies that have investigated its associations with early stages of the cardiovascular disease process, only one small study has focused on coronary atherosclerosis. The present study aimed to explore associations between life satisfaction and coronary artery disease.

METHODS

The study used cross-sectional data from SCAPIS Malmö (n = 6251 randomly selected men and women, aged 50-64 years), including assessment of life satisfaction and coronary artery calcification. Adjustments were made for sociodemographic factors, depression, and cardiovascular risk factors as assessed with the SCORE instrument.

RESULTS

Higher levels of life satisfaction were associated with lower odds of increased coronary artery calcification. This association persisted after adjusting for sociodemographic factors and depression, but lost significance after adjusting for cardiovascular risk factors. Sub-analyses revealed a significant dose-response relationship between higher life satisfaction and lower grade of coronary calcification in all investigated coronary artery regions.

CONCLUSION

In this population-based sample, life satisfaction was associated with better coronary artery health. However, this association was largely explained by cardiovascular risk factors, indicating that life satisfaction is linked to coronary atherosclerosis through a decreased load of cardiovascular risk factors.

Adverse Impacts of Declining Financial and Health Literacy in Old Age

OBJECTIVES

Inadequate financial and health literacy presents a formidable public health and economic challenge in old age. This study investigated declining financial and health literacy in relation to decision making performance, scam susceptibility and psychological wellbeing.

DESIGN

Longitudinal study.

SETTING

A community-based cohort in Northeastern Illinois, USA.

PARTICIPANTS

One thousand fourty-six older adults who were free of dementia at baseline and underwent annual clinical and literacy assessments.

MEASUREMENTS

Financial and health literacy, decision making, scam susceptibility, and psychological wellbeing were assessed using validated instruments. Linear mixed effects models estimated person-specific rates of change in financial and health literacy, and multivariable regression analyses examined the associations of declining literacy with subsequent levels of decision making, scam susceptibility, and psychological wellbeing.

RESULTS

The mean age was 81 years and 76% were female. Over up to 10 years of annual follow-ups, the average financial and health literacy score dropped 1 percentage point a year. Substantial variability in decline was observed between participants. Faster decline in financial and health literacy was associated with poorer decision making, higher scam susceptibility, and lower psychological wellbeing. Notably, these associations were above and beyond the baseline literacy level and persisted even after controlling for cognition.

CONCLUSIONS

Most community-dwelling older adults experience decline in financial and health literacy over time, but decline is not inevitable. Declining literacy is related to poorer decision making, greater scam susceptibility and lower wellbeing. These findings suggest that efforts to mitigate declining financial and health literacy may promote independence and wellbeing in old age.

Dispositional Optimism and All-Cause Mortality in Older Adults: A Cohort Study

OBJECTIVE

Optimism is modifiable and may be associated with healthy aging. We aim to investigate whether dispositional optimism is associated with all-cause mortality in adults 70 years and older.

METHODS

Between 2010 and 2014, older adults free of serious cardiovascular disease and dementia were recruited through primary care physicians and enrolled in the Aspirin Reducing Events in the Elderly (ASPREE) clinical trial. Australian ASPREE participants were invited to participate in the ASPREE Longitudinal Study of Older Persons (ALSOP) that was running in parallel to ASPREE. Optimism was assessed at baseline using the Life Orientation Test-Revised. The association between optimism, divided into quartiles, and all-cause mortality was assessed using Cox proportional hazards models.

RESULTS

A total of 11,701 participants (mean [standard deviation] age = 75.1 [4.24] years; 46.6% men) returned the ALSOP Social questionnaire and completed the Life Orientation Test-Revised. During a median follow-up of 4.7 years, 469 deaths occurred. The fully adjusted model was not significant (hazard ratio = 0.78, 95% confidence interval = 0.58-1.06). There was evidence that age was an effect modifier of the association between optimism and longevity. Higher optimism was associated with lower mortality risk in the oldest individuals only (77+ years; hazard ratio = 0.61, 95% confidence interval = 0.39-0.96).

CONCLUSIONS

We observed no independent relationship between optimism and all-cause mortality in the total sample, although optimism seemed to be associated with lower risk among the oldest old (adults 77 years and older).

Morale and Perceived Threats as Predictors of Psychological Coping with Distress in Pandemic and Armed Conflict Times

The present study investigated predictors of psychological coping with adversity responses during the COVID-19 pandemic and an armed conflict. Two paired samples that represented the Israeli population that was exposed to both adversities were compared. Respondents rated five different psychological coping responses associated with the two adversities, such as anxiety or individual resilience. Perceived security, pandemic, economic, and political risks, as well as level of morale, were rated. Two major findings were disclosed by two path analyses. Morale improved the predictions of the varied coping responses in both the pandemic and conflict and was the best predictor of four out of five responses and the second-best predictor of the fifth response. Contrary to previous studies, our findings revealed that the concept of a single major predictor of coping responses under distress is an overgeneralization. In both cases, the coping responses were better explained by other perceived risks rather than by the risk of the investigated adversity. Rather than assume that a perceived security threat accounts for low levels of public moods, it is vital to study the antecedents of coping responses and to empirically examine additional potential predictors.

The Effects of Sport Activities and Environmentally Sustainable Behaviors on Subjective Well-Being: A Comparison Before and During COVID-19

This study examined the effects of sport activities and environmentally sustainable behaviors on the subjective well-being of working-age adults (18-64). Specifically, it analyzes the effects of different types of sport activities, including nature-based, natural resource-using, and nature-neutral sport activities and different types of environmentally sustainable behaviors such as recycling, ecological consumption, energy-saving, and mobility on subjective well-being. The study conducts comparisons between the period before the COVID-19 pandemic and during the first lockdown in Germany. Quantitative survey data were collected using a convenience sampling approach (n = 412). Sport activities were captured with the number of hours spent on nature-based, natural resource-using, and nature-neutral activities. Environmentally sustainable behaviors were measured across four areas, including recycling, ecological consumption, energy-saving, and mobility. Subjective well-being was measured using the scale of the World Health Organization (WHO-5). Differences between the periods before and during COVID-19 were analyzed using t-tests. A set of multivariate regression models were estimated with subjective well-being as the dependent variable and sport activities, environmentally sustainable behaviors, and socio-demographics as independent variables. The results show that nature-based and nature-neutral sport activities significantly decreased during the first COVID-19 lockdown, while environmentally sustainable behaviors increased. The regression analyses reveal that nature-based and nature-neutral sport activities as well as ecological consumption significantly added to individuals' subjective well-being in the pre- and during-COVID-19-period. A decrease in nature-based and nature-neutral sport activities significantly predicted a decrease in individuals' subjective well-being. The findings of this study might help people understand the role and importance of active living for psychosocial outcomes during the COVID-19 pandemic.

Psychometric Properties of Flourishing Scales From a Comprehensive Well-Being Assessment

In this article, we develop a measure of complete well-being. The framework is derived from the theoretical model of human flourishing understood as a state in which all aspects of a human life are favorable. The approach extends beyond psychological well-being and reflects the World Health Organization definition of health that not only considers the health of body and mind but also embraces the wholeness of the person. The Well-Being Assessment (WBA) is a comprehensive instrument designed to assess holistic well-being in six domains: emotional health, physical health, meaning and purpose, character strengths, social connectedness, and financial security. Although each of these domains is distinct, all of them are nearly universally desired, and all but financial security constitute ends in themselves. Data were collected from a representative sample of working adults. A sample of 276 employees participated in the pilot, 2,370 participated in the first wave and 1,209 in the second wave of the survey. The WBA showed a good fitting (40 items, six factors), satisfactory reliability, test-retest correlation, and convergent/discriminant validity in relation to stability over time and relevant health measures, as well as a good fit to the data that were invariant over time, gender, age, education, and marital status. The instrument can be of use for scientists, practitioners, clinicians, public health officials, and patients. Adoption of more holistic measures of well-being that go beyond psychological well-being may help to shift the focus from health deficiencies to health and well-being promotion.

Associations between lifetime classic psychedelic use and markers of physical health

BACKGROUND

In recent years, there has been significant research on the mental health effects of classic psychedelic use, but there is very little evidence on how classic psychedelics might influence physical health.

AIMS

The purpose of the present study was to investigate the associations between lifetime classic psychedelic use and markers of physical health.

METHODS

Using data from the National Survey on Drug Use and Health (2015-2018) with 171,766 (unweighted) adults aged 18 or above in the United States, the current study examined the associations between lifetime classic psychedelic use and three markers of physical health (self-reported overall health, body mass index, and heart condition and/or cancer in the past 12 months) while controlling for a range of covariates.

RESULTS

Respondents who reported having tried a classic psychedelic at least once in their lifetime had significantly higher odds of greater self-reported overall health and significantly lower odds of being overweight or obese versus having a normal weight. The association between lifetime classic psychedelic use and having a heart condition and/or cancer in the past 12 months approached conventional levels of significance, with lower odds of having a heart condition and/or cancer in the past 12 months for respondents who had tried a classic psychedelic at least once.

CONCLUSION

The results of the present study suggest that classic psychedelics may be beneficial to physical health. Future research should investigate the causal effects of classic psychedelics on physical health and evaluate possible mechanisms.

Assessing the Impact of an Intervention Project by the Young women's Christian Association of Malawi on Psychosocial Well-Being of Adolescent Mothers and Their Children in Malawi

Adolescent mothers in Malawi face psychosocial challenges such as low resilience level, low self-esteem, poor maternal-infant interaction, and exposure to intimate partner violence (IPV). Children of adolescent mothers often face numerous risks such as low birth-weight, stunted growth, infant death, low school enrolment, increased grade repetition, and dropouts that put them at greater risk of poor developmental outcomes and socio-emotional problems. This study assessed the impact of components of a community project conducted by the Young Women's Christian association of Malawi in providing psychosocial support to adolescent mothers and their children. The goals of the project were; (1) to improve early childhood development in babies born to adolescent mothers; and (2) to enhance the psychosocial well-being of adolescent mothers (self-esteem, resilience stress, and parenting skills). This descriptive mixed methods evaluation study comprised an intervention and control groups of adolescent mothers respectively. The project had 3 centers in southern region districts of Malawi. Target population was adolescent mothers 18 years of age and below. At baseline we enrolled 267 mothers and at the end of the project we had 211 mothers. The project involved monthly meetings with adolescent mothers imparting knowledge and skills and early childhood education activities. From July 2017 to June 2019, 58 sessions were conducted. In the first year the control group had no meetings, however they received the intervention in the second year. Overall results in the intervention group showed statistically significant increase in knowledge on parenting skills (p < 0.01), nutritional practice (p < 0.01), motor skills and cognitive functions in children (p < 0.01) as well as expressive language and socio-emotional capacities in children (p < 0.01), while the change in confidence and psychosocial well-being was not statistically significant (p = 0.8823). Community projects such as these enhance parenting skills and improve development of children born to adolescent mothers. Improving psychosocial support is complex and requires further research and a more holistic approach.

Enjoyment of life predicts reduced type 2 diabetes incidence over 12 years of follow-up: findings from the English Longitudinal Study of Ageing

BACKGROUND

Subjective well-being appears to be associated with reduced risk of type 2 diabetes (T2D). However, it is unknown whether this association is similar across different types of well-being. We examined the relationship between hedonic and eudaimonic well-being and incident T2D, and explored the role of sociodemographic, behavioural and clinical factors in these associations.

METHODS

We used data from 4134 diabetes-free participants from the English Longitudinal Study of Ageing (mean age =64.97). Enjoyment of life and purpose in life were assessed using items from the CASP-19 to reflect hedonic and eudaimonic well-being, respectively. Participants reported T2D diagnosis over 12 years. We used Cox proportional hazards regression analyses and also explored the percentage of association explained by different covariates.

RESULTS

Results revealed a protective role for enjoyment of life in T2D rate adjusting for sociodemographic (age, sex, wealth, ethnicity, marital status), behavioural (physical activity, smoking, alcohol consumption, body mass index) and clinical (hypertension, coronary heart disease and glycated haemoglobin) characteristics (HR =0.93, p=0.021, 95% CI (0.87, 0.99)). Sociodemographic, behavioural and clinical factors accounted for 27%, 27% and 18% of the association, respectively. The relationship between purpose in life and T2D was non-significant (adjusted HR =0.92, p=0.288, 95% CI (0.78, 1.08)).

CONCLUSION

This study illustrates how the link between subjective well-being and T2D varies between well-being components. It also demonstrates that sociodemographic, behavioural and clinical factors partially explain this association. Intervention studies examining whether changes in enjoyment of life can help delay T2D onset are warranted.

Mediterranean Diet Adherence and Subjective Well-Being in a Sample of Portuguese Adults

The Mediterranean diet (MD) and other lifestyle characteristics have been associated with well-being, a broad multiparameter concept that includes individual's subjective assessment of their own well-being (SWB). Some studies have suggested that diet influences SWB, thus, this work aimed to add novel information on the association of MD and SWB in a sample of Portuguese adults. Data on sociodemographic, economic, lifestyle, diet, and SWB were collected through a self-filled online questionnaire. MD adherence was assessed by the Mediterranean Diet Adherence Screener (MEDAS) score ]. Results showed a moderate adherence to the MD in 490 Portuguese adults (mean MEDAS of 7.4 ± 2.1). A higher MD adherence was found to be significantly positively associated with women, employed individuals, a higher number of meals per day, and those with frequent contact with nature (p-value < 0.0025, using Bonferroni adjustment). As a novelty, this study divided the participants into low SWB, medium SWB, and medium to high SWB profiles (3.9 ± 1.0; 6.2 ± 1.0; 8.2 ± 1.3, respectively; p-value < 0.05), which reported significantly increasing MEDAS scores (6.5 ± 2.1; 7.3 ± 2.1; 7.8 ± 1.9; respectively, p-value < 0.05).

Psychological Correlates of Sedentary Screen Time Behaviour Among Children and Adolescents: a Narrative Review

PURPOSE OF REVIEW

The aims of this narrative review were to (1) synthesise the literature on the relationship between screen time and important mental health outcomes and (2) examine the underpinning factors that can influence this association.

RECENT FINDINGS

Paralleling the rise of mental health issues in children and adolescents is the ubiquitous overuse of screens, but it is unclear how screen time is related to important mental health outcomes and whether this association differs by gender, age and screen type.

METHODS

Medline/PubMed, PsychINFO and Google Scholar databases were searched on December 2019 for articles published mainly in the last 5 years. The search focused on two main concepts: (i) screen time and (ii) mental health outcomes including anxiety, depression, psychological and psychosocial well-being and body image concerns.

RESULTS

Sixty studies were included in the review. Higher levels of screen time were associated with more severe depressive symptoms. We found moderate evidence for an association between screen time and poor psychological well-being and body dissatisfaction especially among females. Relationships between screen time and anxiety were inconsistent and somewhat gender specific. Social media use was consistently associated with poorer mental health. Higher levels of screen time are generally associated with poorer mental health outcomes, but associations are influenced by screen type, gender and age. Practitioners, parents, policy makers and researchers should collectively identify and evaluate strategies to reduce screen time, or to use screens more adaptively, as a means of promoting better mental health among children and adolescents.

Resilience and demographic characteristics predicting distress during the COVID-19 crisis

RATIONALE

Due to lack of vaccine or cure, the COVID-19 pandemic presents a threat to all human beings, undermining people's basic sense of safety and increasing distress symptoms.

OBJECTIVE

To investigate the extent to which individual resilience, well-being and demographic characteristics may predict two indicators of Coronavirus pandemic: distress symptoms and perceived danger.

METHOD

Two independent samples were employed: 1) 605 respondents recruited through an internet panel company; 2) 741 respondents recruited through social media, using snowball sampling. Both samples filled a structured online questionnaire. Correlations between psychological/demographic variables and distress and perceived danger were examined. Path analysis was conducted to identify predictive indicators of distress and perceived danger.

RESULTS

Significant negative correlations were found between individual/community resilience and sense of danger (-0.220 and -0.255 respectively; p < .001) and distress symptoms (- 0.398 and -0.544 respectively; p < .001). Significant positive correlations were found between gender, community size, economic difficulties and sense of danger (0.192, 0.117 and 0.244 respectively; p < .001). Gender and economic difficulties also positively correlated with distress symptoms (0.130 and 0.214 respectively; p < .001). Path analysis revealed that all paths were significant (p < .008 to .001) except between family income and distress symptoms (p = .12). The seven predictors explained 20% of sense of danger variance and 34% the distress symptoms variance. The most highly predictive indicators were the two psychological characteristics, individual resilience, and well-being. Age, gender, community size, and economic difficulties due to COVID-19 further add to predicting distress, while community and national resilience do not. .

CONCLUSIONS

Individual resilience and well-being have been found as the first and foremost predictors of COVID-19 anxiety. Though both predictors are complex and may be influenced by many factors, given the potential return of COVID-19 threat and other future health pandemic threats to our world, we must rethink and develop ways to reinforce them.

Exploring the social stressors and resources of husbands of women diagnosed with advanced breast cancer in their role as primary caregivers in Kumasi, Ghana

PURPOSE

We aimed to explore the experiences of husbands of women diagnosed with advanced breast cancer, highlighting their stressors and the resources they rely on to cope, in Kumasi, Ghana.

METHOD

An exploratory descriptive qualitative research design was adopted. Fifteen in-depth interviews with participants were conducted. After a participant's written consent, we audio-recorded the interview sessions and transcribed them verbatim. We managed and analysed the data manually.

RESULT

The experiences of husbands as primary caregivers of their wives diagnosed with advanced breast cancer have been broadly categorized under two main themes: stressors and resources. The analyses revealed that the burdens associated with the husband's primary caregiving roles threatened the marriage, their relationships with others, work, and finances. Regardless of the stressors, participants drew on a range of resources such as acceptance, marital obligation and commitment to marital vows, social support, and spirituality to cope.

CONCLUSION

The study is the first of our knowledge to explore the experiences of husbands acting as primary caregivers of their wives who are diagnosed with advanced breast cancer in Ghana. It revealed that they rely on specific resources to cope with the burdens associated with their role. Policies and programs aiming at assisting women diagnosed with advanced breast cancer to manage and cope with the disease should include the partners of the married ones by designing programs that help the husbands to understand the situation and adequately provide the care that promotes the quality of life of the husband, wife, and the family.

Profiles of resources and posttraumatic growth among cancer and psoriatic patients compared to non-clinical sample

BACKGROUND/OBJECTIVE

The aims of this study were to explore the heterogeneity of resources, as described by the Conservation of Resources (COR) theory, in a sample of cancer and psoriatic patients and to investigate whether heterogeneity within resources explains differences in Posttraumatic Growth (PTG) level within each of these clinical samples and in a non-clinical control group.

METHOD

The sample consisted of 925 participants, including 190 adults with a clinical diagnosis of gastrointestinal cancer, 355 adults with a medical diagnosis of psoriasis, and 380 non-clinical (without any chronic illnesses) adults, all of whom had suffered various adverse and traumatic events. The participants completed a COR evaluation questionnaire and a posttraumatic growth inventory.

RESULTS

A latent profile analysis revealed four different classes of psoriatic patients and five classes of cancer patients, all with different resources levels. Clinical subsamples differed substantially with PTG levels compared to healthy controls.

CONCLUSIONS

Our study did not find a sole pattern of PTG that fit all the individuals, even for those who experienced the same type of traumatic event. Psychological counseling, in chronic illness particularly, should focus on the heterogenetic profiles of patients with different psychosocial characteristics.

Measuring Positive Emotion Outcomes in Positive Psychology Interventions: A Literature Review

Accumulating evidence for the unique social, behavioral, and physical health benefits of positive emotion and related well-being constructs has led to the development and testing of positive psychological interventions (PPIs) to increase emotional well-being and enhance health promotion and disease prevention. PPIs are specifically aimed at improving emotional well-being and consist of practices such as gratitude, savoring, and acts of kindness. The purpose of this narrative review was to examine the literature on PPIs with a particular focus on positive emotion outcomes. We evaluated the evidence on the effects of PPIs on positive emotion specifically, and discussed the range of evidence regarding the relative responsiveness of emotion measures to PPIs in order to gain a better understanding of the specific emotional pathways through which PPIs influence psychological and physical well-being. We conclude with recommendations for best evaluating effects of PPIs on positive emotion outcomes.

Demedicalizing the Ethics of PrEP as HIV Prevention: The Social Effects on MSM

In order to demedicalize the ethics of pre-exposure prophylaxis (PrEP) as HIV prevention, I consider the social effects on men who have sex with men (MSM). The Centers for Disease Control and Prevention (CDC) considers MSM to be the highest risk group for contracting HIV in the USA. The ethics of using PrEP as HIV prevention among MSM, however, has both a medical dimension and a social dimension. While the medical dimension of the ethics of PrEP includes concerns about side effects, drug resistance and distribution, the social dimension of the ethics of PrEP includes concerns about stigmatization, sexual and romantic relationships and sexual freedom. The medical concerns of the ethics of PrEP may take precedence over the social concerns, but there is a growing body of literature that already addresses the medical concerns. Much less attention has been given to the social concerns of the ethics of PrEP, and in this article, I aim to fill this gap in the literature. Therefore, I focus on the often-overlooked social dimension of the ethics of PrEP to help understand the connection between the risks, relationships and communities of MSM using PrEP as HIV prevention.

A Web-Based Positive Psychological Intervention to Improve Blood Pressure Control in Spanish-Speaking Hispanic/Latino Adults With Uncontrolled Hypertension: Protocol and Design for the ¡Alégrate! Randomized Controlled Trial

BACKGROUND

Growing evidence links psychological well-being and resilience with superior cardiac health, but there remains a critical scientific gap about whether (or how) interventions that aim to cultivate psychological well-being reduce cardiac risk. Hispanic/Latino people in the United States have high cardiovascular disease risk and poorly controlled blood pressure (BP) compared with their peers of European ancestry, and they represent a population in need of new and innovative therapeutic approaches. As such, a focused intervention to boost psychological well-being holds promise as a novel therapeutic target for hypertension in Hispanic/Latino adults; to date, however, no research has explored whether a causal link is evident.

OBJECTIVE

The aim of this paper is to detail the protocol for the ¡Alégrate! (Be Happy!) intervention, a Phase II randomized controlled trial testing initial efficacy in improving BP of a web-based positive psychological intervention designed to boost psychological well-being in Spanish-speaking Hispanic/Latino people with hypertension.

METHODS

A total of 70 Hispanic/Latino people aged ≥18 years, fluent in Spanish, and with elevated BP (≥140/90 mm Hg) will be recruited in person from a single Federally Qualified Health Center in Chicago. Enrollees will be randomly assigned to 1 of 2 trial arms: (1) web-based positive psychological intervention or (2) an active control condition (eg, 3 times weekly emotion reporting). Our 5-week Spanish-language ¡Alégrate! intervention is web-based and delivers curricular content via didactic instruction, journaling, and assigned at-home practice-all accessed via our website using investigator-purchased tablet computers, with a unique username and password assigned to each enrollee. Targeted skills include noting daily positive events, positive reappraisal of stressful events, effective expression of gratitude, performing acts of kindness, and regular practice of mindfulness and meditation. The primary outcome is improvement in BP, both sitting values and 24-hour ambulatory readings, as measured at baseline and 5 and 12 weeks from baseline. Secondary outcomes include psychological well-being, engagement in healthy behaviors, and circulating levels of inflammatory markers. The outcomes of interest are collected by trained research staff through in-person interviews using the REDCap software.

RESULTS

Activities of the ¡Alégrate! intervention were funded in August 2017, and data collection is ongoing. We expect to submit trial results for peer-reviewed publications in 2021, soon after recruitment has been concluded and statistical analyses are finalized.

CONCLUSIONS

Findings will provide evidence on whether interventions to boost psychological well-being and resilience have downstream effects on BP control and cardiovascular health, particularly as they are deployed in the Spanish language with cultural tailoring and via a web-based platform. If effective, we will have an easily disseminatable application that can positively impact well-being profiles and BP control in Hispanic/Latino people, with the possibility of addressing health disparities of this US racial/ethnic minority group.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03892057; https://clinicaltrials.gov/ct2/show/NCT03892057.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/17721.

The Double-Burden Effect: Does the Combination of Informal Care and Work Cause Adverse Health Outcomes Among Females in China?

Objective: This study investigates the impact of informal care and work stress on women's health and further disentangles this effect through intensity and channel analysis. Method: This research uses the 2000-2015 China Health and Nutrition Survey and employs the propensity score matching model with fixed effects. Results: The care and work burden significantly increases the probability of women suffering from chronic diseases, being underweight or overweight, and self-reporting poor health by 0.63%, 1.69%, and 2.35%, respectively. This double-burden effect is exacerbated as the care and work hours increase. Women who care for more than 20 hr and work for more than 50 hr per week experience the most serious health decline. We further find that the double burden leads to health deterioration through channels of reduced exercise and increased psychological stress. Discussion: This study provides a reliable decision-making basis for policy makers to formulate strategies for informal caregivers in China.

Indoor Comfort and Symptomatology in Non-University Educational Buildings: Occupants’ Perception

The indoor environment in non-university classrooms is one of the most analyzed problems in the thermal comfort and indoor air quality (IAQ) areas. Traditional schools in southern Europe are usually equipped with heating-only systems and naturally ventilated, but climate change processes are both progressively increasing average temperatures and lengthening the warm periods. In addition, air renewal is relayed in these buildings to uncontrolled infiltration and windows’ operation, but urban environmental pollution is exacerbating allergies and respiratory conditions among the youth population. In this way, this exposure has a significant effect on both the academic performance and the general health of the users. Thus, the analysis of the occupants’ noticed symptoms and their perception of the indoor environment is identified as a potential complementary tool to a more comprehensive indoor comfort assessment. The research presents an analysis based on environmental sensation votes, perception, and indoor-related symptoms described by students during lessons contrasted with physical and measured parameters and operational scenarios. This methodology is applied to 47 case studies in naturally ventilated classrooms in southern Europe. The main conclusions are related to the direct influence of windows’ operation on symptoms like tiredness, as well as the low impact of CO2 concentration variance on symptomatology because they usually exceeded recommended levels. In addition, this work found a relationship between symptoms under study with temperature values and the environmental perception votes, and the special impact of the lack of suitable ventilation and air purifier systems together with the inadequacy of current thermal systems.

The Association of Optimism with Sleep Duration and Quality: Findings from the Coronary Artery Risk and Development in Young Adults (CARDIA) Study

Optimism is associated with better health outcomes with hypothesized effects due in part to optimism's association with restorative health processes. Limited work has examined whether optimism is associated with better quality sleep, a major restorative process. We test the hypothesis that greater optimism is associated with more favorable sleep quality and duration. Main analyses included adults aged 32-51 who participated in the Coronary Artery Risk Development in Young Adults (CARDIA) study (n = 3,548) during the fifth (Year 15: 2000-2001) and sixth (Year 20: 2005-2006) follow-up visits. Optimism was assessed using the revised Life-Orientation Test. Self-report measures of sleep quality and duration were obtained twice 5 years apart. A subset of CARDIA participants (2003-2005) additionally provided actigraphic data and completed the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Multivariate regression analyses were used to examine associations of optimism and sleep indicators. In cross-sectional analyses of 3548 participants, each standard deviation (SD) higher optimism score resulted in 78% higher odds of self-reporting very good sleep quality. Prospectively, a 1-SD higher optimism score was related to higher odds of reporting persistently good sleep quality across 5-years relative to those with persistently poor sleep [OR = 1.31; 95%CI:1.10,1.56]. In participant with supplementary data, each SD higher optimism score was marginally associated with 22% greater odds of favorable sleep quality [OR = 1.22; 95%CI:1.00,1.49] as measured by the PSQI, with possible mediation by depressive symptoms. Optimism was unrelated to objective actigraphic sleep data. Findings support a positive cross-sectional and prospective association between optimism and self-reported sleep behavior.

Positive Maternal Mental Health, Parenting, and Child Development

While maternal mental health is an important influence on child development, the existing literature focuses primarily on negative aspects of maternal mental health, particularly symptoms of depression, anxiety, or states of distress. We provide a review of the evidence on the potential importance of positive mental health for both mother and child. The evidence suggests that positive mental health is a distinct construct that is associated with improved birth outcomes and potentially with specific forms of parenting that promote both academic achievement and socioemotional function. We review studies that provide a plausible biological basis for the link between positive mental health and parenting, focusing on oxytocin-dopamine interactions. We caution that the evidence is largely preliminary and suggest directions for future research, noting the importance of identifying the operative dimensions of positive maternal mental health in relation to specific outcomes. We suggest that the inclusion of positive maternal mental health provides the potential for a more comprehensive understanding of parental influences on child development.

The association between psychological distress and angina pectoris: A population-based study

BACKGROUND

Psychological distress is an undifferentiated combination of symptoms that may be related to the occurrence of angina pectoris (AP). However, few studies have investigated the relationship between psychological distress and AP, particularly in Asian populations. The purpose of this study was to examine the relationship between psychological distress and AP in Taiwanese adults.

METHODS

We adopted a cross-sectional design to explore the data of the 2005-2008 Nutrition and Health Survey in Taiwan. In total, 2080 subjects (aged ≥ 19 years) responded to questionnaire interviews and underwent physical examinations. Each of the five dimensions of psychological distress (sleep disturbance, anxiety, hostility, depression, and feelings of inferiority) were scored (from 0-20) according to the Five-Item Brief Symptom Rating Scale (BSRS-5). A score ≥ 6 points indicated psychological distress. AP was evaluated using a modified Rose questionnaire.

FINDINGS

In total, 102 subjects (3.6%) had AP, and 231 subjects (8.8%) had symptoms of psychological distress. After adjusting for the basic data, metabolism, and lifestyle covariates, the BSRS-5 total score was associated with AP (odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.13-1.26, p < 0.001). Subjects with psychological distress had a higher risk of AP (OR = 2.97, 95% CI = 1.76-4.99, p < 0.001).

CONCLUSIONS

The presence of AP is associated with psychological distress. Health care providers should therefore be aware of the impact of psychological distress on AP. Our study findings can serve as a reference for AP assessments. Large scale longitudinal studies are needed to confirm a causal relationship between psychological distress and AP.

Antecedents of psychological well-being among workers within small and medium enterprises

Orientation: In the contemporary business environment, employee mental health is neglected, especially in mental health research and practice in African Small and Medium-sized Enterprises (SMEs). This occurs even though this sector is the largest contributor to developed economies. This study highlights the importance of psychological well-being in SME performance and the individual employee.Research purpose: To investigate the influence of perceived organisational support, career goal development and empowering leadership on the psychological well-being of SME employees in Gauteng province, South Africa.Motivation for the study: Despite increasing research on SMEs, few studies have investigated the impact of perceived organisational support, career goal development, and empowering leadership on psychological well-being in a Southern African context.Research approach/design and method: This study followed a quantitative approach, using the survey methodology where a structured questionnaire was administered to 250 SME employees. To evaluate the psychometric properties of measurement scales, a confirmatory factor analysis was performed. Structural equation modelling was used to test the hypotheses.Main findings: Perceived organisational support, career goal development and empowering leadership have a positive and significant impact on the psychological well-being of SME workers. A robust, positive and significant relationship exists between empowering leadership and psychological well-being.Practical/managerial implications: The results indicate that SME managers in South Africa should pay more attention to, or place greater emphasis on, supporting employees in their organisations, recognising and assisting them in achieving their goals, and empowering them to be happy at work. If the psychological well-being of employees is prioritised, SME business performance will ultimately improve.Contribution/value-add: This study contributes to the current body of Africa’s industrial psychology and mental health literature – a field that has received little research attention in developing countries like South Africa.

Poor emotional well-being is associated with rapid progression in amyotrophic lateral sclerosis

The study aimed to determine the impact of emotional well-being on disease aggressiveness and survival in amyotrophic lateral sclerosis (ALS). In 224 patients with ALS (without significant cognitive deficits) the revised ALS Functional Rating Scale (physical function), the ALS Assessment Questionnaire (ALSAQ-40) for health-related Quality of Life and survival data were collected. Data analysis comprised logistic regression, Kaplan-Meier curves analyses and Cox regression model. Most patients reported to be worried about how the disease will affect them in the future and 67% reported to feel depressed. Patients with good emotional well-being were characterized by better physical function (higher ALSFRS-R) and lower disease aggressiveness. The association between high emotional well-being and lower disease aggressiveness was confirmed in the univariate analysis and also after adjustment for known predictors of disease progression. In the Kaplan-Meier survival curve analysis the overall 1-year, 2-year and 3-year mortality did not significantly differ between patients with poor and good emotional well-being. Our study demonstrates an association between emotional well-being and disease progression. Knowing that subjective well-being is neither a necessary nor a sufficient cause of health, longitudinal studies are necessary to explore when well-being does and does not influence disease progress and survival in ALS.

"iAlegrate!"-A culturally adapted positive psychological intervention for Hispanics/Latinos with hypertension: Rationale, design, and methods

Growing evidence links psychological well-being (e.g., optimism) with superior cardiac health, but there remains a critical scientific gap as we do not know whether (or how) interventions to cultivate emotional well-being may reduce cardiac risk. Hispanics/Latinos in the U.S. have high cardiovascular disease risk and poorly controlled blood pressure (BP) compared to peers of European ancestry, and represent a population in need of new and innovative therapeutic approaches. This paper details the "¡Alégrate!" study, a cluster-randomized Phase II trial testing efficacy in improving BP of a culturally tailored positive psychological intervention designed to boost emotional well-being in Hispanics/Latinos with hypertension. A total of 126 Hispanics/Latinos aged ≥18 years, fluent in English or Spanish, and with elevated sitting BP (≥140/90 mmHg) will participate in one of two trial arms: (1) a positive psychological intervention, or (2) a wait-list control condition. The "¡Alégrate!" group-based intervention consists of 8 weekly 90-120-min sessions delivered in-person by a psychologist/social worker. Targeted skills include noting daily positive events, positive reappraisal of stressful events, effective expression of gratitude, performing acts of kindness, and regular practice of mindfulness and meditation, among others. The primary outcome is improvement in BP, both sitting values and 24-h ambulatory readings, as measured at baseline and 8- and 12-weeks post-baseline. Secondary outcomes include emotional well-being, engagement in healthful behaviors, and circulating levels of inflammatory markers. We hypothesize that BP control, psychological well-being, healthful behaviors, and chronic inflammation will be significantly better in the "¡Alégrate!" arm at follow up compared to the wait-list control group.

Human Flourishing in Cross Cultural Settings. Evidence From the United States, China, Sri Lanka, Cambodia, and Mexico

This paper investigates human flourishing in five culturally distinct populations. Empirical differences in human flourishing were examined using the recently proposed Flourish Index (FI) and Secure Flourish Index (SFI). Five domains for human flourishing are proposed for FI: (D1) happiness and life satisfaction; (D2) physical and mental health; (D3) meaning and purpose; (D4) character and virtue; and (D5) close social relationships. Specification of SFI was augmented by an additional financial and material stability domain (D6). Psychometric properties of FI and SFI were examined using data from the SHINE Well-Being Survey. Between June 2017 and March 2018, a total of 8,873 respondents participated in the study - in the US (4083 participants), Sri Lanka (1284 participants), Cambodia (587 participants), China (419 participants), and Mexico (2500 participants). US participants were customers of a financial institution, while non-US participants were clothing industry workers in the supply chain of a global brand. Exploratory and confirmatory factor models were used to validate the proposed indices. An exploratory approach informed analysis for item groupings. Confirmatory factor models were used to investigate the hierarchical structure of the indices. Configural, metric, and partial scalar measurement invariance were established, which not only supported the universal character of the indices but also validated use of the indices for culturally distinct populations. Findings from our study enrich our knowledge about human flourishing in five culturally distinct populations. With the exception of happiness and life satisfaction, respondents in the US, despite enjoying the highest financial and material stability, scored the lowest in all other domains of human flourishing. Respondents in China excelled in close social relationship and health domains. In addition to life satisfaction and happiness, character and virtue were relatively high in Cambodia. Respondents in Mexico, despite having the lowest scores in financial and material stability, had the greatest meaning and purpose to their lives. Respondents in Sri Lanka were the least happy and satisfied with life.

Changes in eudaimonic well-being and the conserved transcriptional response to adversity in younger breast cancer survivors

BACKGROUND

The conserved transcriptional response to adversity (CTRA), characterized by increased expression of proinflammatory genes and decreased expression of antiviral and antibody-related genes, is upregulated in the context of chronic adversity and distress and has been linked to cancer progression. Several studies suggest that the CTRA may also be down-regulated in association with some positive psychological states, particularly eudaimonic well-being. However, it is not clear if the link between inter-individual differences in the CTRA and eudaimonic well-being can be extended to intra-individual change. Using a standardized mindfulness-based intervention, the current study tested whether mindfulness-related increases in eudaimonic well-being related to intra-individual reduction in the CTRA in a sample of younger breast cancer survivors.

METHODS

Participants were 22 women who had been diagnosed and treated for early-stage breast cancer at or before age 50 (M_age = 46.6 years) and had no evidence of active disease. Women completed self-report questionnaires and provided peripheral blood samples before and after a 6-week mindfulness meditation intervention. Regression analyses were used to quantify associations between the magnitude of change in eudaimonic well-being and the magnitude of change in the global CTRA score.

RESULTS

Women reported significant increases in eudaimonic well-being and showed decreased expression of the pro-inflammatory subcomponent of the CTRA from pre- to post-intervention. The magnitude of increase in eudaimonic well-being was associated with the magnitude of decrease in the composite CTRA score, and this relationship was driven primarily by increased expression of the antiviral/antibody-related CTRA subcomponent. While the intervention was also associated with reduced depressive symptoms, there was no association between change in depressive symptoms and change in the overall CTRA composite score or either of its subcomponents.

CONCLUSIONS

Results are consistent with the hypothesis that eudaimonic well-being may be an important mechanism in interventions aimed at enhancing health in vulnerable groups, and contribute to our understanding of how psychological well-being may influence physical health in cancer patients.

Positive Affect and Health: What Do We Know and Where Next Should We Go?

Positive affect (PA) is associated with better health across a wide range of physical health outcomes. This review reflects on why the study of PA is an essential component of our understanding of physical health and expands on pathways that connect these two variables. To encourage forward movement in this burgeoning research area, measurement and design issues in the study of PA and health are discussed, as are the connections between PA and a range of different health outcomes. Plausible biological, social, and behavioral pathways that allow for positive feelings to get under the skin and influence physical wellness are detailed and framed in the context of several theoretical models. Finally, new directions for the field and important methodological and interpretative considerations that are essential to moving this important research area forward are explored.

Social media use and perceptions of physical health

Social networking activity is becoming more endemic in society and yet little is known about how the social comparison, occurring when we use these sites, affects perceptions of health. This study sought to determine in what way people who use Facebook (FB) interpret the comparison information they see on FB and whether this was associated with perceptions of physical health. Determining this association is important given the positive association between well-being, quality of life and physical health. Using a cross-sectional design, participants completed an electronic questionnaire measuring FB use, FB social comparison, self-esteem, depression, anxiety, life satisfaction and physical health. The data was analysed using Hierarchical Linear Regression to determine the association of social comparison on perceptions of physical health after controlling for other influencing factors. The results showed that participants were indeed socially comparing via FB. More positive upward comparison was reported, followed closely by positive downward and negative upward, with negative downward comparison perceived least. Analysis showed physical symptoms were associated with gender, anxiety, depression, FB use and positively interpreted upward comparison. Those who agreed more with the positively interpreted social comparison statements and who engaged more with FB also perceived more physical symptoms. These results showed that the perception of symptoms still occurred despite the positive comparison. These results have implications for perceptions of well-being for general users of FB and for vulnerable populations where more social comparison may occur.

Disease progression impacts health-related quality of life in amyotrophic lateral sclerosis

OBJECTIVES

To determine the impact of disease progression on health-related quality of life in amyotrophic lateral sclerosis (ALS).

METHODS

A total of 161 patients with ALS were enrolled. Assessments included the revised ALS Functional Rating Scale and the ALS Assessment Questionnaire (ALSAQ-40). Data analysis comprised linear regression and multivariate analyses.

RESULTS

ALSFRS-R score (β = 0.75, p < 0.001), depression (β = 0.08, p < 0.001), pain (β = 0.07, p < 0.001), hopelessness (β = 0.07, p = 0.001), and progression rate (β = 0.02, p = 0.02) explained 76% of the ALSAQ-40 summary index variance. Progression rate alone explained 7% of the ALSAQ-40 summary index variance. The subdomains of emotional well-being, followed by ADL, and finally communication and eating were most strongly influenced by progression rate.

CONCLUSION

Our study demonstrates the importance of physical health for emotional well-being. In particular, slower disease progression is associated with higher levels of emotional well-being in ALS.

Moving Beyond a One-Size-Fits-All View of Positive Affect in Health Research

Although the literature that connects positive affect (PA) to health has exploded over the last 20 years, the approach to studying this topic has remained simplistic. Specifically, researchers overwhelmingly rely on the principle that all PA is healthful, all of the time. Here, we review recent studies indicating that a more nuanced approach is valuable. In particular, we demonstrate that a more thoughtful approach to factors such as arousal, culture, timing, and measurement type results in a more complex picture of when PA is helpful and when it is not. Taking these issues into account also has implications for the types of mechanisms underlying these associations, as well as how other moderators might operate. Thus, we argue that considering these gradations will allow researchers to develop successful and theoretically based health interventions, untangle mixed findings, and enable a deeper understanding of the connection between PA and health.

Toxic Affect: Are Anger, Anxiety, and Depression Independent Risk Factors for Cardiovascular Disease?

Three negative affective dispositions—anger, anxiety, and depression—are hypothesized to increase physical disease risk and have been the subject of epidemiological studies. However, the overlap among the major negative affective dispositions, and the superordinate construct of trait negative affectivity (NA) are only beginning to be tested. Presented here is a narrative review of recent prospective studies that simultaneously tested anger, anxiety, depression, and trait NA as risk factors for cardiac outcomes. Anxiety and depression emerged as independent risk factors for premature heart disease in population studies of persons nominally healthy at baseline, and for recurrence/mortality among patients with existing heart disease. General trait NA also was a cardiac risk factor in population samples.