Family Relationships and Well-Being

Parent-Focused Psychotherapy for the Preventive Management of Chronicity in Anorexia Nervosa: A Case Series

Background: Anorexia nervosa (AN) is a complex eating disorder where involvement of family plays a central role in first line treatment in adolescents, but which is not so for adults where poor response to treatment is frequent. Given the reluctance of some patients to receive treatment, we set out to explore the hypothesis that certain family dynamics may be involved in the maintenance of the disorder. Methods: We aimed to understand what is underlying in the cases of patients who present clinical improvement with their parents, but not the ones who received a parent-focused psychotherapeutic intervention. We conducted a mixed methods study. On the one hand we performed a case series of 14 patients who dropped out of treatment while their parents actively attended the intervention, and on the other hand, we followed the evolution of the parents of those patients reluctant to continue treatment, through non-participant observation. Results: We present preliminary evidence where we found the parent-focused psychotherapeutic intervention was able to elicit a reflective function of the parents. We also observed that the intervention modified certain family dynamics that could be related to maintaining factors of the disorder. In patients, we found that in parallel to the assistance of their parents to psychotherapeutic treatment, and even when they were receiving no intervention, they showed significant clinical improvement of symptomatology and global functioning; we observed 9 of 14 of them who voluntarily decided to return to pharmacological treatment. Conclusions: This parent-focused intervention elicited changes in reflective functioning of participant parents; the intervention produced favorable changes in family dynamics, which we believe is probably related to improvement of global functioning, symptomatology, and insight of patients.

Associations between body dissatisfaction and relationship functioning among same-sex female couples: An actor-partner interdependence model

Nearly all past research about body dissatisfaction and romantic relationship factors is among heterosexual couples; little is known about these associations in sexual minority couples. The present study aimed to fill gaps in the current literature by using actor-partner interdependence models (APIMs) to examine dyadic patterns of association between body dissatisfaction and different aspects of relationship functioning among same-sex female couples. Participants were 163 same-sex female romantic dyads (326 women) between the ages of 18-35 years who completed measures of body dissatisfaction and relationship factors. Results from significance testing of actor and partner effects indicated higher levels of women's own body dissatisfaction were associated with lower levels of their own, but not their partner's, relationship satisfaction, closeness, sexual satisfaction, and intimacy/connectedness. Significance testing alone indicated that the association between one's own body dissatisfaction and their partner's relationship satisfaction was not significant. However, dyadic pattern testing identified a partner pattern for this effect, which suggests that the association between one's own body dissatisfaction and one's own relationship satisfaction is similar in magnitude and direction as that between an individuals' own body dissatisfaction and their partner's relationship satisfaction. In this study, women's own body dissatisfaction was found to be negatively associated with their own relationship functioning, which is consistent with findings of women in male-female couples. Thus, these findings highlight the important role that body dissatisfaction plays in women's relationship experiences. More research is needed to better understand potential cross-partner effects of body dissatisfaction and relationship factors in same-sex female couples. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A systematic review of the impact of inflammatory bowel disease (IBD) on family members

BACKGROUND AND AIMS

Inflammatory Bowel Disease (IBD) affects patients and their family members, but most reviews have focused only on patients themselves. This review synthesises evidence on the impact of IBD on family members.

METHODS

A systematic review was undertaken, searching six bibliographic databases, focusing on the impact of IBD on family members, coping strategies, and interventions. A narrative synthesis was conducted. This review was reported following the Preferred Reporting Items for Systematic Reviews (PRISMA).

RESULTS

3258 records were identified; 33 papers (2748 participants) were included. Three themes were identified: impact of IBD on family members; coping strategies for family members to overcome the impact of IBD; and the support needed by family members. IBD affects family members' well-being in many ways, including their emotional well-being, relationship with the patient, social life, work and finances, and leisure time and travel. Family members use adaptive coping patterns such as acceptance, developing resilience, and emotional support from others. Maladaptive coping patterns such as denial of diagnosis, self-distraction, and self-blame were also evident. Family members reported that they needed better information about IBD, support groups, and better access to a counsellor or psychologist. No studies assessed interventions to relieve family members' burden.

CONCLUSIONS

Family members of IBD patients require psychosocial support to facilitate better family function, cohesion, and enhanced coping strategies. Healthcare services should adopt a multidisciplinary care model with a bio-psycho-social approach including an IBD nurse, family therapist, and psychologist, to improve quality of life for patients and their families.

The Association between Stress and Children's Weight Status: A School-Based, Epidemiological Study

Given the evidence on how stress affects weight status in children, this research examined this association among Greek students aged 10−12 years old. Overall, 1452 children and their parents from several urban areas participated in an observational study conducted during the period 2014−2016. Participants completed validated questionnaires. International Obesity Task Force guidelines were used for children’s weight status classification. Descriptive statistics and nested logistic regression models were used. Multivariate correspondence analysis was also used to construct a score to evaluate the children’s stress levels. The overall prevalence of overweight/obesity was 27%. More than 80% of the children appeared to have a medium or high level of stress, mainly due to the school environment. School-related stress increased the odds of obesity in children. The association between stress and overweight/obesity status showed a consistent trend (adjusted odds ratios varied from 1.44 to 1.52, p-values < 0.01). Children’s weight status was associated with several school-related stressors. Although the school environment may play an aggravating role in the weight status of children, family plays a catalyst role in this direction. Therefore, actions have to be promoted in the school community so that children become more health literate on a public health level.

Meta-Research: How parenthood contributes to gender gaps in academia

Being a parent has long been associated with gender disparities in academia. However, details of the mechanisms by which parenthood and gender influence academic career achievement and progression are not fully understood. Here, using data from a survey of 7,764 academics in North America and publication data from the Web of Science, we analyze gender differences in parenthood and academic achievements and explore the influence of work-family conflict and partner support on these gender gaps. Our results suggest that gender gaps in academic achievement are, in fact, “parenthood gender gaps.” Specifically, we found significant gender gaps in most of the measures of academic achievement (both objective and subjective) in the parent group but not in the non-parent group. Mothers are more likely than fathers to experience higher levels of work-family conflict and to receive lower levels of partner support, contributing significantly to the gender gaps in academic achievement for the parent group. We also discuss possible interventions and actions for reducing gender gaps in academia.

Social support, perceived stigma, and depression among PLHIV on second-line antiretroviral therapy using structural equation modeling in a multicenter study in Northeast Ethiopia

Background

Depression has a multitude of clinical and public health consequences for HIV patients. The magnitude of HIV patients who failed first-line antiretroviral treatment and switched to second-line therapy is becoming a growing public health concern. However, unlike first-line therapy, to date, little attention has been given to mental health problems in such patients, particularly in the era of the COVID-19 pandemic. Thus, this research was conducted to determine the magnitude of depression and its determinants among HIV patients on second-line antiretroviral therapy.

Methods

A multi-centered cross-sectional study was conducted on 714 HIV patients on second-line therapy who were selected via systematic random sampling. Data were collected in personal interviews as well as document reviews. The nine-item patient health questionnaire score was used to assess depression, while the three-item Oslo Scale was used to assess social support. The associations between exogenous, mediating, and endogenous variables were identified simultaneously using structural equation modeling. Statistical significance was declared at a P-value less than 0.05, and the effect sizes were presented using 95% CI.

Results

Depression was reported in 27.7% of HIV patients on second-line therapy [95% CI: 24.7–31.1%]. Social support has a direct [\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\widehat{\beta }$$\end{document}β^ = − 0.9, (95% CI: − 1.11 to − 0.69)] and indirect [\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\widehat{\beta }$$\end{document}β^ = − 0.22, (95% CI: − 0.31 to − 0.13)] negative effect on depression. Perceived stigma was a mediator variable and significantly associated with depression [\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\widehat{\beta }$$\end{document}β^ = 0.40, (95% CI: 0.23–0.57)]. Co-morbid illness [\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\widehat{\beta }$$\end{document}β^ = 0.49, (95% CI: 0.35–0.63)], high viremia [\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\widehat{\beta }$$\end{document}β^ = 0.17, (95% CI: 0.08–0.26], moderate and high-risk substance use [\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\widehat{\beta }$$\end{document}β^ = 0.29, (95% CI: 0.18–0.39)], and not-workable functional status [\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\widehat{\beta }$$\end{document}β^ = 0.2, (95% CI: 0.1–0.31)] were all positively associated with depression.

Conclusions

This study revealed that there was a high prevalence of depression among HIV patients on second-line antiretroviral therapy. Social and clinical factors were associated with depression risk. As a result, screening, prevention, and control strategies, including psychosocial support, should be strengthened in routine clinical care.

Relationship between the COVID-19 Pandemic and the Well-Being of Adolescents and Their Parents in Switzerland

This study is based on two waves of data collected by the Swiss Household panel, the first one in 2019, before the beginning of the COVID-19 pandemic, and the second one in May-June 2020, just after the end of the partial lockdown that was decided by the Swiss government. We considered "couples" of adolescents (age 14-24, mean = 18.82, 51.96% female) and their parents living together (n = 431). Our main goal was to determine whether the evolution of the well-being among adolescents was similar to the evolution of the well-being among parents. Ten indicators of well-being were measured identically in both waves and for both adolescents and their parents. Results indicate that while almost all indicators of well-being decreased during partial lockdown for both adolescents and their parents, adolescents were more strongly impacted than their parents. Furthermore, the change observed in adolescents was virtually unaffected by the change observed in their parents, and vice versa. This research is a reminder that while different population groups may be affected differently by a sudden and extreme event, it is not only older people who will be most affected. Here, adolescents appear to have been more adversely affected than adults.

Siblings' Perspectives of the Impact of Child Sexual Abuse Disclosure on Sibling and Family Relationships

Child sexual abuse (CSA) may have significant consequences for siblings; however, limited research has been conducted on the impact of the abuse on sibling and family relationships following the disclosure of CSA. This study sought to investigate sibling responses to disclosures of CSA among a group of adult siblings in Ireland, and the impact on sibling and family relationships through an online survey. A thematic analysis was conducted on a sub-set of participants who responded to open-ended questions (n = 45). Three main themes were identified as follows: (a) intense emotional reactions, (b) relationship support and strain, and (c) managing family dynamics. CSA disclosure may have a substantial impact on sibling and family relationships. Supporting siblings in the aftermath of CSA disclosure is essential, both for the well-being of the individual who was sexually abused and for the wider family.

Like ripples on a pond: The long-term consequences of parental separation and conflicts in childhood on adult children's self-rated health

Objective

The aim of the study was to explore how different forms of conflict in childhood and parental separation additively and interactively predict self-rated health (SRH) in adulthood. Furthermore, a subsample analysis investigated how different family conflicts predict SRH in adulthood within the group of separated families, controlling for post-separation circumstances.

Background

Previous research shows that adult children from separated families have worse health compared to peers from intact families. Additionally, inter-parental conflicts are closely associated with parental separation and known to negatively influence children's health. Few studies have taken a broader perspective on conflicts and included conflicts beyond the inter-parental subsystem, such as within other family subsystems, into their analysis.

Methods

Data were based on Swedish Level of Living Survey (LNU). Using linear probability modelling the first analysis shows that SRH in adulthood varies depending on family type and the occurrence of conflict in childhood (n = 6,638). The study then explored variations in SRH within separated families (n = 934).

Results

The results show that adult children from separated families and families with different types of conflicts have worse SRH compared to their peers in intact families and families with no conflicts.

Conclusion

Parental separation has long-term consequences on children's SRH and this relationship is partly predicted by parent-child conflicts.

Implications

The results underline the importance of considering children's involvement when studying the separation process and its outcomes. They also suggest that interventions to help parents and children through a separation would benefit from a focus, not only on inter-parental conflicts but also, on parent-child conflicts, as well as parents' role modelling to prevent children from experiencing negative long-term health outcomes.

A Systematic Review of Black American Same-Sex Couples Research: Laying the Groundwork for Culturally-Specific Research and Interventions

ABSTRACTThis article presents the findings of a systematic review of the empirical literature related to Black American same-sex couples (BASCs). We found 16 articles that met inclusion criteria. Most articles were published in journals that focused on interdisciplinary studies, HIV/AIDS, and couples and families' studies. Approximately 63% of the articles reported external funding support. However, only one of these grants was awarded to a Black investigator. Articles predominately focused on BASCs composed of Black sexual minority men residing in major U.S. cities. Only 25% of the articles focused on couples where both partners were Black. Most studies were cross-sectional, used convenience samples, and were reported without mention of a theoretical framework that explicated the philosophical assumptions that guided the research. The articles focused on a range of topics such as resilience, relationship dynamics, couple-level social support, rituals with extended families, and partner-health associations. The implications of these findings for advancing culturally-specific behavioral and social science health research and interventions with BASCs are presented.

Acceptance Theory of Family Caregiving

Acceptance of roles in the care of older adults by a family caregiver depends on factors emanating from commitment to familial relationships, widespread cultural expectation, and debt of gratitude. This study aims to develop a theory that explains the acceptance of the role of caregiving of the older adults by the family caregiver necessary to predict behavioral adaptation and control caring phenomenon that favors successful meeting of caring expectation across trajectory phases and transitions. A deductive axiomatic approach to theory generation was utilized, resulting in four axioms that served as bases for four propositions. Acceptance Theory of Family Caregiving implies that older adults who expect their children to take care of them as they age have cultural influence and that the acceptance of the role will determine the caregiver's acceptance of consequences in the form of physical, economical, psychological, and spiritual aspects. In terms of preparedness, family members who accept the possibility of the decline of their older adults are more likely to be assume caregiving roles efficaciously. In the process that family members face in this so-called trajectory caregiving process, resources play a significant role. The developed theory suggests that the care of the older adult in the family caregiving process is determined by the acceptance of role assumption by the family caregiver across trajectory phases. This study highlights the vital implication of acceptance of role assumption to the outcomes of the caregiving process with respect to older adult care, prevention of family caregiver burden, and establishment of strong familial and social relationships.

An Analysis of the Relationship Between Religiosity and Psychological Well-Being in Chilean Older People Using Structural Equation Modeling

Using a representative sample, we explored the relationship of organizational (ORA), non-organizational (NORA), and intrinsic religiosity (IR) with depressive and anxious symptomatology and loneliness in Chilean older people, and examined mediating mechanisms. Structural Equation Modeling showed a direct effect between ORA and reduced depressive symptomatology and between IR and anxious symptomatology; for indirect effects, the relationship between ORA and depressive and anxious symptomatology was mediated by friends' social support network, while that between IR and the three outcomes studied was mediated by the family support network and resilience. NORA was not associated with any of the outcomes or mediating variables.

Psychosocial Experiences of Older Women in the Management of Urinary Incontinence: A Qualitative Study

Introduction

Urinary incontinence is a prevalent disorder amongst older women. Identifying the psychosocial experiences of older women in disease management can improve the patient care process. Hence, the present study aimed to determine the psychosocial experiences of older women in the management of urinary incontinence.

Methods

This qualitative study was conducted using conventional content analysis. The study data were collected via unstructured in-depth face-to-face interviews with 22 older women suffering from urinary incontinence selected via purposive sampling. Sampling and data analysis were done simultaneously and were continued until data saturation. The interviews were recorded, transcribed, and analyzed using the method proposed by Graneheim and Lundman.

Results

The results indicated that the older people with urinary incontinence had various psychosocial experiences while living with and managing this disease. Accordingly, four main themes were extracted from the data as follows: “problem incompatibility with the disease,” “mental impasse,” “facing social restrictions,” and “concealment and social escapism.”

Conclusion

The findings demonstrated that older people with urinary incontinence experienced significant psychosocial pressures while living with this disorder, which affected their psychosocial well-being. Thus, paying attention to these psychosocial experiences while supporting and taking care of these patients can positively impact their psychosocial health and quality of life.

The role of health facility and individual level characteristics on medication adherence among PLHIV on second-line antiretroviral therapy in Northeast Ethiopia: use of multi-level model

BACKGROUND

Medication adherence plays a pivotal role in achieving the desired treatment outcomes. The proportion of HIV patients on second-line antiretroviral therapy is becoming a growing public health concern. However, to date, little attention has been given to second-line antiretroviral medication adherence. Moreover, the association between health facility characteristics and medication adherence has yet not been tested. Thus, this research was conducted to determine the magnitude of medication adherence and examine the role of facility-level determinants among HIV patients on second-line ART.

METHODS

A cross-sectional study was conducted on 714 HIV patients on second-line therapy who were selected via systematic random sampling in twenty public health facilities. Medication adherence was measured using the six-item Simplified Medication Adherence Questionnaire (SMAQ) tool. Data were collected in a personal interview as well as document reviews. A multi-level binary logistic regression was used to uncover individual and facility-level determinants. The effect size was presented using an adjusted odds ratio (AOR), and statistical significance was declared at a P value less than 0.05.

RESULTS

The magnitude of optimal medication adherence among HIV patients on second-line antiretroviral therapy was 69.5% (65.9-72.7%). Medication adherence was positively associated with the use of adherence reminder methods [AOR = 3.37, (95% CI 2.03-5.62)], having social support [AOR = 1.11, (95% CI 1.02-1.23)], and not having clinical depression [AOR = 3.19, (95% CI 1.93-5.27). The number of adherence counselors [AOR = 1.20, (95% CI 1.04-1.40)], teamwork for enhanced adherence support [AOR = 1.82, (95% CI 1.01-3.42)], and caseloads at ART clinics were all significantly correlated with ARV medication adherence at the facility level.

CONCLUSIONS

A large proportion of HIV patients on second-line antiretroviral therapy had adherence problems. Both facility-level and individual-level were linked with patient medication adherence. Thus, based on the identified factors, individual and system-level interventions should be targeted.

Closeness as a mediator in providing and receiving social support on the social well-being of older persons in Kitui County, Kenya

Research on the social well-being (SWB) of older persons in relation to social support provided and received has generated considerable amount of scholarly debate. Social support received or provided has been found in literature to produce mixed effects (positive and negative) on SWB, necessitating further research. The current study provides Kenyan evidence to a corpus of research mostly focused on European and American studies, contributing to the current discussion on SWB. Thus, the aim of the present study is to investigate how closeness to close network members (CNM) influences older persons’ satisfaction with social support provided and received. The study adopted a descriptive cross-sectional study design and mixed methods approach. Chi-square analyses were conducted, and the results revealed that there was a significant relationship between closeness and satisfaction with providing social support with exact P value of 0.002. In addition, there was a significant relationship between closeness and satisfaction with received social support with exact P value of 0.000 (P<0.05). The research highlights that closeness to CNM enhances SWB when older persons provide or receive social support.

Post-Separation Physical Custody Arrangements in Germany: Examining Sociodemographic Correlates, Parental Coparenting, and Child Adjustment

Most children continue to live with their mother after a divorce or separation, yet paternal involvement in post-separation families has increased substantially in many Western nations. This shift has contributed to a growing share and more diverse set of post-separation parents opting for shared physical custody (SPC), which typically means that children alternate between the parental residences for substantive amounts of time. Profiling the case of Germany, where no legal regulations facilitating SPC are implemented to date, we examine the prevalence of SPC families, sociodemographic correlates of SPC, and its associations with parental coparenting and child adjustment. Using representative survey data sampled in 2019 (N = 800 minors of 509 separated parents), results revealed that only 6–8% of children practiced SPC. SPC parents were more likely to hold tertiary levels of schooling and to report a better coparenting relationship with the other parent. There was no link between SPC and child adjustment, yet conflictual coparenting was linked to higher levels of hyperactivity among SPC children. We conclude that the social selection into SPC and linkages between conflictual coparenting and hyperactivity among SPC children likely stem from the higher costs and the constant level of communication between the ex-partners that SPC requires.

Knowledge, Attitude, and Practices Among the General Population During the Later Stage of the COVID-19 Pandemic in Malaysia: A Cross-Sectional Study

Purpose

Patients and Methods

Results

Conclusion

The Complex Notion of the Capacity of a Child: Exploring the Term Capacity to Support the Meaningful Participation of Children in Family Law Proceedings

This article aims to explore the concept of capacity as necessitated by provisions within the UNCRC such as articles 12 and 5, which emphasize participation, and the evolving capacities of children. In family law proceedings when children are involved, age and capacity are considered in order to assess if the meaningful participation of that child is accessible. There is limited literature to indicate how the capacity of a child is determined, especially for children who are younger than twelve. Rather than relying on age to gauge capacity levels, this paper provides a unique, interdisciplinary evaluation of capacity through a combination of both legal and child development perspectives. This article aims to use a critical lens and rights-based approach to analyze the current literature regarding the capacities of children and proposes that a deeper understanding of what capacity entails is required in order to ensure the meaningful participation of children.

Family Participation to Promote Medication Adherence Among Thai-Muslim Older Adults With Hypertension: Action Research Study

INTRODUCTION

Nonadherence to antihypertensive medications has been found increasingly prevalent in Thailand, yet the critical cultural resources of Islamic belief systems and family support are seldom mobilized to support adherence. Our study aimed to develop, implement, and evaluate an Islamic-based intervention program to promote medication adherence among Muslim older adults with uncontrolled hypertension in southern Thailand.

METHOD

An action research with codesign and family participation principles was utilized. Within action research cycles, interviews with Thai-Muslim older adults, family primary caregivers, and health care professionals were undertaken alongside participant observations.

RESULTS

A qualitative audit demonstrated an improved medication adherence with all stakeholders expressing their desire to further engage and maintain the new intervention program.

DISCUSSION

Engaging with Islamic doctrine and concepts of family participation could support an improvement in antihypertensive medication adherence for Muslim older adults. Codesigning enables recognition of community belief systems, forming an important step toward improving community-based medication adherence.

Collaborative Approaches to Promote Family Caregiving for Thai-Muslim Older Adults

This action research study aimed to develop, implement and evaluate the feasibility of an Islamic-based intervention program that included three main Islamic tenets and concept of family collaboration to promote comprehensive homebound care for Thai-Muslim older adults in southern Thailand. Using action research cycles, interviews with five dyads of healthcare recipients (Thai-Muslim older adults and their family primary caregivers) and with seven Thai-Muslim healthcare professionals (five clinical nurses, a physician and a pharmacist) were undertaken alongside participant observations. Inadequate knowledge, insufficient skills, low family involvement, poor negotiation skills, and the need for better integration of Islamic doctrines were identified. Satisfaction was expressed with the program components and activities, with a qualitative audit data revealed that family primary caregivers felt that they had gained more self-confidence, increased their caregiving knowledge and improved their skills. All stakeholders expressed a desire to further engage and maintain this collaborative program. Engaging with Islamic doctrines and concepts of family collaboration support improvements in homebound care for Muslim older adults. Using on core values of Islamic moral belief systems provides an important and culturally sensitized framework for engaging healthcare providers and family members in the Muslim older adults' comprehensive homebound care.

Cutting the cord? Parenting emerging adults with chronic pain

The role of parent factors, such as distress and protective behaviors, on pain and functional outcomes of emerging adults living with chronic pain has been largely unexplored. The effects of helicopter parenting and developmental changes occurring during this transition period between adolescence and adulthood (commonly defined as the ages between 18 and 30 years) may exacerbate the pain experience and have the potential to influence chronic pain management. Clinical practice, with an additional focus on supporting the parent(s), may aid in meeting the needs of this population. In this paper, we review the available literature on (a) the socio-cultural shift in parenting over the past decade with a focus on helicopter parenting; (b) the impact of this parenting style on the pain experience and outcomes of emerging adults living with chronic pain; (c) provide recommendations for chronic pain management with a focus on the parent-emerging adult dyad; and (d) conclude with future research recommendations. This narrative review is the first to consider the impacts and outcomes of helicopter parenting on emerging adults with chronic pain.

Predictors of subjective well-being in Korean men and women: Analysis of nationwide panel survey data

Subjective well-being has been associated with sociodemographic characteristics, health, and satisfaction with family life. There is evidence on gender difference in subjective well-being and differential relationships of predictors between men and women worldwide. However, little is known about the gender gaps in subjective well-being in Korean adults. Using nationwide panel survey data, this study aims to examine predictors of subjective well-being in the Korean population and to investigate if there is a difference in the impact of some predictors between men and women. Generalized estimating equations were used to measure the relationship between subjective well-being and explanatory variables, using individual-level data from the Korean Welfare Panel Study (KOWEPS) between 2017 and 2020. Model 1 investigated sociodemographic variables. Model 2 added three health-related variables (such as disability, chronic disease, and subjective health status) and satisfaction with family life. Additional models included a range of interaction terms. In the 2020 KOWEPS, 10,758 respondents rated their subjective well-being scores on the Cantril ladder. The mean score of all respondents was 6.74 (SD = 1.66). In the analysis of the pooled sample, subjective well-being was higher in women than in men (Models 1-2, p < .01). Among all variables examined, satisfaction with family life was the most important predictor of subjective well-being (β = 1.3625; p < .01). Education level and employment status had significant interaction effects with gender on subjective well-being. In particular, higher education was more important for women and stable employment was more important for men.

Family Environment and Portuguese Adolescents: Impact on Quality of Life and Well-Being

Background: A healthy and supportive family environment leads to more positive results regarding adolescents’ development. The main objective of this study was to explore and analyze the relationship between adolescents’ quality of life (QoL) and their family environment/relationship. Method: The sample was collected as part of the Health Behavior in School-aged Children 2018 study, which included 8215 adolescents, 52.7% female, with a mean age of 14.36 years (SD = 2.28). Results: Girls are more involved in family activities (such as family meals), report being treated with fairness by their parents and feel less parental pressure to get good grades. Boys have a higher perception regarding their family affluence, better family relationships and support and better QoL. Having an above-average QoL is significantly related to high family affluence, better communication with both parents, greater involvement in family activities, greater perception of help from parents regarding decision-making, greater perception of being treated with fairness by parents and less pressure from parents to get good grades, as well as a better family relationship/support. Conclusion: It is important to determine the impact that parental divorce/separation or a weak parent–child relationship can have on adolescents. It is also necessary to consider the family relationship and structure when devising strategies and public policies related to the promotion of adolescents’ health and well-being.

What are the mental health impacts of epidemics on relatives of people affected, and relatives of healthcare workers: What interventions are available to support them? A systematic review and narrative synthesis

BACKGROUND

Previous research has mainly focused on the impacts of epidemics on those people who are directly affected by the epidemic infection, or of healthcare workers caring for them. Less is known about the impact on mental health of their relatives, and potential interventions to support them.

METHODS

Systematic review and narrative synthesis.

OUTCOMES

28 studies were identified, sixteen quantitative and twelve qualitative. One involved health workers' relatives, and the rest covered relatives of directly affected individuals. We found considerable burden of mental ill-health in both groups. Among relatives of healthcare workers, 29.4% reported symptoms consistent with probable anxiety disorder and 33.7% with probable depression. Prevalence rates for probable anxiety disorder ranged from 24-42% and probable depression 17-51% for the relatives of affected people. One study found a 2% prevalence of PTSD and another found odds of PTSS were significantly higher among relatives of affected individuals compared with the general population. Only two intervention studies were identified and both were descriptive in nature.

INTERPRETATION

Available evidence suggests relatives of people affected by infective outbreaks report mental ill-health. Having a relative who died particularly increased risk. Good outcomes for relatives of affected individuals were promoted by practical and social support, public health guidance that recognises the caring role of relatives, and being supported to see the positives as well as negatives in their situation. Good outcomes for relatives of health workers were promoted by perceived effectiveness of protective equipment. High quality evidence on potential interventions to support relatives is lacking.

FUNDING

No external funding sought.

Factors associated with general well-being among Lebanese adults: The role of emotional intelligence, fear of COVID, healthy lifestyle, coping strategies (avoidance and approach)

General well-being is best described as the state of mind that gives people happiness and satisfaction in life. This concept is influenced by behaviors and attitudes that individuals do on a daily basis. The purpose of this study was to understand how general well-being is correlated with other factors such as emotional intelligence, Covid-19-induced fear, healthy lifestyle, and coping strategies. This cross-sectional study was carried out between December 2020 and January 2021 during the COVID-19 pandemic when lockdown restrictions were implemented at different instances. A total of 470 individuals participated. The results of a linear regression, taking the general well-being schedule score as the dependent variable, showed that more avoidance coping (B = 1.05, t(459) =8.44, p < 0.001), higher healthy lifestyle scores (B = 0.45, t(459) = 5.45, p < 0.001), and more approach coping (B = 0.42, t(459) = 4.03, p < 0.001) were significantly associated with higher GWB schedule scores. Moreover, having more fear of COVID-19 (B = -0.62, t(459) = -5.09, p < 0.001) and female gender (B = -6.80, t(459) = -4.34, p < 0.001) were significantly associated with lower GWB schedule scores. To our knowledge, this is the first study in Lebanon to evaluate GWB and factors that predict it among the general population. Nevertheless, more comprehensive future studies with longitudinal designs, more diverse socio-demographic backgrounds of sampled population recruited via probability sampling, and more reliable and valid instruments utilized are warranted to confirm our findings and draw a more certain conclusion.

Considerations of Family Functioning and Clinical Interventions

Levels of family functioning are an important consideration in determining appropriate clinical and educational intervention approaches for families and older adults. Theoretical and applied approaches are reviewed with the emphasis on specific interventions that support different levels of family functioning and caregiving. Additionally, different dynamics within the family and their relations with aging family members are examined. This paper updates and expands discussions on levels of family functioning considerations by Sterns et al. using Blocher’s theory of level of human effectiveness. Further levels of family functioning include the theories developed by Bowen’s family systems theory. A present-day consideration is important for counseling, case management, caregiving, and treatment planning to assist families and their aging family member.

Correlates of Social Isolation Among Community-Dwelling Older Adults During the COVID-19 Pandemic

Background: The past year has severely curtailed social interactions among older adults given their high rates of COVID-19 morbidity and mortality. This study examined social, behavioral, and medical correlates of social isolation among community-dwelling older adults during the COVID-19 pandemic and stratified findings to explore unique differences in two typically neglected populations, African American and Hispanic older adults.

Methods: Working with community-based organizations and senior living centers, the research team administered a survey to older adults 55 years of age and older (n = 575). The survey assessed COVID-19 prevention behaviors, medical conditions, and lived experiences, including feelings of social isolation, in the target population. Responses to a previously validated social isolation question informed a dichotomous social isolation dependent variable. Multivariable logistic regression was used to adjust for sociodemographic characteristics, medical conditions, unmet caregiving needs, and COVID-19 prevention behaviors. Results from the regression model were stratified by race/ethnicity to examine correlates of social isolation in African American and Hispanic older adults, separately.

Results: Overall, female sex and a higher level of education were also positively associated with social isolation (OR = 2.46, p = 0.04; OR = 5.49, p = 0.02) while having insurance exhibited an inverse relationship (OR = 0.25, p = 0.03). Unmet caregiving needs were strongly associated with social isolation (OR = 6.41, p < 0.001) as was having any chronic conditions (OR = 2.99, p = 0.02). Diabetes was the single strongest chronic condition predictor of social isolation. Among minority older adults, a different pattern emerged. For Hispanic older adults, language, unmet caregiving needs, and social distancing were strongly associated with social isolation; while unmet caregiving needs, having 1+ chronic conditions and adhering to social distancing guidelines were significant predictors in African American older adults.

Conclusion: These findings suggest that social isolation affects older adults in a myriad of ways and support the need for culturally sensitive initiatives to mitigate the effect of social isolation in these vulnerable populations.

Support From Parents, Peers, and Teachers Is Differently Associated With Middle School Students' Well-Being

Parents, peers, and teachers provide a powerful context for school students’ well-being. However, a detailed and systematic analysis of how parental, peer, and teacher support relate to students’ well-being, measured by the dimensions self-worth, psychological and physical well-being, is still missing. To address this research gap, the following study investigates 733 adolescent German students from grades 7 and 8 (M_age = 13.97, SD = 0.41, 52% girls) with respect to their perceived supportive relationships at home and within the school context. The study considers gender, socioeconomic status, and school form as potential confounders. The results of the structural equation model, analyzed with the statistical software R, indicate that perceived teacher support was positively related to students’ self-worth and physical well-being, while peer support was related to psychological well-being. Students who perceived their parents as supportive reported higher well-being with respect to all three dimensions investigated.

Impact of Family Cohesion and Adaptability on Academic Burnout of Chinese College Students: Serial Mediation of Peer Support and Positive Psychological Capital

This study aimed to explore the association between the functioning of family environment (i.e., family cohesion and family adaptability) and academic burnout of Chinese college students as well as the mediating effects of the interpersonal resource (i.e., peer support) and intrapersonal resource [i.e., positive psychological capital (PsyCap)] in this relationship. A total of 1971 Chinese undergraduates were involved in an online questionnaire survey and data analysis. It was found that family cohesion and adaptability was negatively related to academic burnout. Mediation analyses demonstrated that family cohesion and adaptability did not directly affect academic burnout, but indirectly through increasing PsyCap (characterized by optimism, hope, resilience, and self-efficacy), and through enhancing peer support and then increasing PsyCap in serial. Meanwhile, the relationship between family cohesion and adaptability and academic burnout was not mediated by peer support alone. These findings highlight the family environment's crucial role in youth mental health and positive development in the college context.

A Randomized Controlled Trial of a Positive Family Holistic Health Intervention for Probationers in Hong Kong: A Mixed-Method Study

Introduction: Probationers, offenders with less serious and non-violent offences, and under statutory supervision, have low levels of self-esteem and physical health, and high level of family conflict, and poorer quality of family relationships. This study examined the effectiveness of the existing probation service and the additional use of a positive family holistic health intervention to enhance physical, psychological, and family well-being in probationers and relationships with probation officers. Methods: Probationers under the care of the Hong Kong Social Welfare Department were randomized into a care-as-usual control group (CAU), a brief intervention group (BI) receiving two 1-h individual sessions [of a brief theory-based positive family holistic health intervention integrating Zero-time Exercise (simple and easy-to-do lifestyle-integrated physical activity) and positive psychology themes of "Praise and Gratitude" in the existing probation service], or a combined intervention group (CI) receiving BI and a 1-day group activity with family members. The outcomes were physical activity, fitness performance, self-esteem, happiness, anxiety and depression symptoms, life satisfaction, quality of life, family communication and well-being, and relationships with probation officers. Self-administered questionnaires and simple fitness tests were used at baseline, 1-month and 3-month follow-up. Linear mixed model analysis was used to compare difference in the changes of outcome variables among groups, adjusted of sex, age, and baseline values. Focus group interviews were conducted. Thematic content analysis was used. Results: 318 probationers (51% male) were randomized into CAU (n = 105), BI (n = 108), or CI (n = 105) group. CAU showed enhanced physical activity, fitness performance and psychological health, and family communication with small effect sizes (Cohen's d: 0.19-0.41). BI and CI showed further improved physical activity, family communication and family well-being (Cohen's d: 0.37-0.70). Additionally, CI reported greater improvements in the relationships with probation officers than CAU with a small effect size (Cohen's d: 0.43). CI also reported greater increases in physical activity and family communication than BI with small to moderate effect sizes (Cohen's d: 0.38-0.58). Qualitative feedbacks corroborated the quantitative findings. Conclusion: Our trial provided the first evidence of the effectiveness of probation service and the additional use of an innovative, relatively low-cost, theory-based brief positive family holistic health intervention. This intervention may offer a new model for enhancing probation service. Trial Registration: The research protocol was registered at the National Institutes of Health (identifier: NCT02770898).

Mental distress of parents with chronic diseases during the COVID-19 pandemic in Australia: A prospective cohort study

OBJECTIVE

To-date there has been limited examination of the experience of the COVID-19 pandemic in parents who suffer from chronic physical conditions. We aimed to 1) examine whether presence of a chronic disease predicts differential latent distress profile memberships, and 2) assess factors that could predict different distress profiles in the sub-group of parents with a chronic disease.

METHODS

We used a sample of 1618 parents, from the longitudinal COVID-19 Pandemic Adjustment Study, who completed a measure of mental distress (Depression, Anxiety and Stress Scale) at 13 data collection points. Distress profiles were assessed with the latent profile analysis.

RESULTS

We identified four distinct mental distress profile memberships, with the most common membership characterised by very low (48.1%), followed by low (31.9%), moderate (15.7%), and high (4.3%) distress scores. A higher proportion of parents with chronic diseases belonged to profiles experiencing low (34.7% vs. 30.4%), moderate (18.7% vs. 14.1%), and high (5.5% vs. 3.7%) compared to very low (41.2% vs. 51.8%) distress levels than other parents. Residing in Victoria, younger age, lower levels of social support and appraisal of COVID as risk were associated with membership to higher compared to very low distress profiles.

CONCLUSION

Our findings highlight the importance of considering chronic disease co-morbidity as an additive risk factor in addressing mental health outcomes of parents during pandemic-like events, since parents with chronic conditions are more vulnerable to experiencing worse mental distress. Future interventions should focus on ways to strengthen social support and provide guidance for managing threat appraisal.

COVID-19 crisis: Influence of eHealth literacy on mental health promotion among Saudi nursing students

Objective

This study aims to determine the influence of eHealth literacy on mental health promotion among Saudi nursing students.

Method

This cross-sectional study was conducted from 19 April to 21 May 2020. A total of 468 nursing students responded to the self-administered online survey. Two instruments, namely, the eHealth Literacy Scale and the Positive Mental Health Scale, were used. Statistical tools such as frequency, percentage, mean, and standard deviation were used for the descriptive analysis. Multiple regression analysis was employed to analyse the relationship between eHealth literacy, health promotion, and its predictors.

Results

The results showed that 30.3% of nursing students were dissatisfied with their general health. Students perceived high self-assessed eHealth literacy and positive mental health. Students in the 4th year had lower scores than those of students in the 2nd year. Nursing students perceived that the quarantine and public social distancing lowered their mental health scores. Finally, the eHealth literacy mean scores resulted in a 0.21-point increase in the positive mental health scores.

Conclusion

The finding of the study shows that the eHealth literacy positively influnce the mental health status of Saudi Nursing students.

"Everything else is going to be ok if your spiritual wellness is well". A qualitative exploration of wellness amongst secondary school students in Fiji

Purpose

Adolescent wellness over the years has been a major public health concern. The adolescent period is stated to be a critical phase as developments occur in all areas of the individual. This study aims to explore secondary school students’ perceptions on knowledge of wellness, influences of wellness, prioritization of wellness dimensions and ideal adolescent wellness programmes in Fiji.

Method

This study qualitatively investigates adolescents in four purposively selected schools in Suva, Fiji. 31 students who enrolled into years 11 to 13 in the selected schools were interviewed in-depthly using a semi-structured, open-ended questionnaire. Data was transcribed and classified into categories, sub-themes and major themes.

Results

Participants’ responses indicated wellness perceived as multidimensional with no regard to dimensional balance. Family, peers and school support, social media, nutrition and physical activities are factors perceived to influence wellness. The availability of school counsellors, facilitation of effective school health programmes, and incorporation of wellness into the school curriculum were perceived as ideal ways to increase adolescent wellness.

Conclusions

This study provides important research findings of adolescent wellness for Fiji’s health sector, its policymakers and programme developers. Further studies are needed to understand the broad concept of wellness and its several dimensions.

Informal caregivers and psychosocial support: Analysis of European Dementia Policy documents

Various countries in Europe have different strategies for promoting care solutions for dementia challenges. The different approaches of Austria, Belgium, Czechia, Denmark, Finland, Germany, Gibraltar, Ireland, Israel, Malta, Nederland, Norway, Sweden and the United Kingdom (Scotland and Wales) were investigated. Dementia has a significant social, psychological and economic impact on the individual, family and society. As the disease progresses dementia sufferers become increasingly dependent. As many dementia sufferers are at home during the initial stages, the physical, emotional, and social demands of the dementia sufferers are often covered by informal caregivers. This study, therefore, aims to investigate the integration of psychosocial interventions for comprehensive care pertaining to informal caregivers of people with dementia in Europe. Furthermore, the study will highlight how implementation of technologies might enable psychosocial support of informal caregivers. The data is based on 15 national dementia strategies from various European countries. Data was based on preexisting coding systems with the predefined keywords and analyzed by qualitative content analysis by four of the authors. Our results show that psychosocial support is provided in various modalities and that informal caregivers need to be supported by a psychosocial approach. Due to this need the national dementia strategies should include measures to reduce the emotional burden of informal caregivers. Psychosocial support provided to informal caregivers in a comprehensive and systematic way is likely to enable informal caregivers to handle the emotional, cognitive, and behavioral consequences of the disease and its treatment, while helping to maintain their work-life balance.

"We Faced Every Change Together". Couple's Intimacy and Sexuality Experiences from the Perspectives of Transgender and Non-Binary Individuals' Partners

In recent years, there has been a growing interest in the study of transgender and non-binary (TGNB) individuals' romantic and sexual relationships. The present study explored, from TGNB people's partners' perspective, how the couple experiences sexuality and intimacy, the effects from gender dysphoria in these relational domains, and how dysphoria is managed. For this purpose, 99 partners of TGNB individuals were recruited for an online study. Participants were asked to answer the following open-ended questions: "In the intimacy and sexuality with your partner, are there any parts of your or your partner's body that are/were off-limits?" "How did you manage this before, during, and after transition?" The data were analyzed through thematic analysis, and four overarching themes emerged: 1) Positive Aspects of the Relationship; (2) Challenges; (3) Strategies to Manage Dysphoria; and (4) Expected Improvement through Access to Medical Affirmation. The results suggest that gender dysphoria is one of the main challenges in experiencing intimacy and sexuality, but TGNB individuals and their partners can rely on several relational and practical resources to navigate it and enjoy positive experiences with intimacy and sexuality. The findings provide valuable information about how TGNB individuals and their partners build healthy and fulfilling relationships, and they can help clinicians better understand both members' perspectives in these romantic couples in the context of couples' therapy and sexual counseling.

Non-spousal family support, marital status, and heart problems in adulthood

OBJECTIVES

Support from one's spouse has long been documented as a significant determinant of health for married individuals. However, non-spousal family support may play an important role in health particularly for unmarried individuals. Therefore, this study examined whether the association between non-spousal family support and diagnosis of heart problems differed by marital status and whether gender and education moderated these associations.

DESIGN

Data came from the first two waves of the Midlife in the United States (MIDUS) study. This study selected respondents who participated in both waves of MIDUS and were not diagnosed with a heart problem at Wave 1 (N = 3,119).

MAIN OUTCOME MEASURES

Participants reported whether they had any heart trouble. Discrete-time event history analysis was used to examine the risk of heart problems between MIDUS Waves 1 and 2.

RESULTS

A higher level of non-spousal family support was associated with a lower risk of developing a heart problem only among unmarried women and unmarried individuals with high school education or less, and not for married individuals.

CONCLUSION

Findings highlight the importance of considering specific sources of family support when studying heart health, and the health-protective role of non-spousal family support for those who are not married.

Consider the context: An analysis of personal social networks of caregivers of children participating in a paediatric weight management program

Social networks influence the health and well-being of children and families. This study aimed to identify and understand the social networks of caregivers of children participating in the KidFit Health and Wellness Clinic, a paediatric weight management program. An egocentric social network analysis was used. Caregivers with children enrolled in KidFit participated in semi-structured interviews by completing a personal network map and discussing the individuals in their social networks and their influence on them and their family. Twenty-two caregivers (90.9% mothers) completed the interview. Four structural patterns were identified within the networks: existence of a core, star-shaped network, well-connected network and existence of multiple clusters. Healthcare providers and family had the most influence within the caregivers' networks. With the exception of healthcare providers, individuals who communicated less frequently with caregivers tended to have less influence on caregivers. Internet resources, activity-related resources and social media were the top three services, resources or supports that caregivers reported accessing. It is important that practitioners working with children and families within paediatric settings recognize the unique sociocultural context of each family. Reconceptualising a care model that includes community and incorporates services, supports and resources beyond the clinic could enhance treatment.

Dental Nurses' Mental Health in Germany: A Nationwide Survey during the COVID-19 Pandemic

Several studies have found a rise in the rate of psychological discomfort among healthcare personnel since the COVID-19 pandemic outbreak. In this study, we analyzed the relationship between psychological variables of anxiety, depression, stress, avoidance, intrusion and hyperarousal and several factors among German dental nurses. For this poll, dental nurses were asked nationwide to take part via an online-based survey from July 2020 to January 2021. This survey gathered data on demographics, as well as psychological assessments through the Impact of Events Scale-Revised (IES-R) instrument, and the Depression Anxiety Stress Scales (DASS-21). The correlations between DASS-21/IES-R ratings and sociodemographic data were investigated using univariate analyses (Kruskal-Wallis and Mann-Whitney U tests). Single comparisons were performed using the Dunn-Bonferroni post hoc test if a relevant test result was significant followed by multiple linear regressions. Furthermore, 252 dental nurses took part in the study and showed overall normal or mild results of all psychological variables. Having immune-deficiency or chronic diseases, employment at a dental practice, being married, having no children and seeing the pandemic as a financial threat were presented as significant risk factors (p ≤ 0.05) with higher DASS-21 and IES-R scores. These results emphasize the aspects that must be considered to safeguard German dental nurses' mental wellbeing during the crisis.

‘Keeping silent to keep the peace’: changes in grandmother's access to their grandchildren following the loss of the son/father

Relations between grandmothers and their grandchildren following the loss of the son/father have not been studied to date. The present article focuses on this experience, as reflected in the stories of grandmothers (bereaved mothers) and spouses (widows) after the loss, and explores the perception of grandparenthood following the loss of the son/husband. Twenty semi-structured interviews were conducted with ten grandmothers (bereaved mothers) and spouses (widows) who were recruited as a convenience sample. Data were subjected to thematic analysis. The findings revealed three key patterns of the grandmother–grandchild relations, as perceived by the two groups of women. The patterns indicate complex relations between widows and bereaved mothers, which have implications for the access of the grandmothers to their grandchildren and for their perception of grandparenthood. The study sheds light on the patterns of relations in families that have lost the son/husband/father. The change in power balance between family members and the asymmetry in the family structure created by the absence of the son/husband affect grandparenthood relations. The study emphasises the role of the widows, as the middle generation, in shaping or mediating relationships following the loss. The findings stress the importance of clinical intervention with both the bereaved mothers and the widows.

The association between social support and medication adherence in patients with hypertension: A systematic review

Background:

Medication adherence is a primary determinant of treatment success in hypertensive patients. One of the challenges for healthcare providers that has received little attention is the impact of patients’ social supports on medication adherence.

Objective:

This review evaluates the impact of patients’ social supports on medication adherence in hypertensive patients.

Methods:

A systematic review methodology was used. Pubmed, CINAHL, Embase, and PsycINFO databases were searched systematically for relevant articles. The outcome measure in the studies was medication adherence in hypertension.

Results:

From 1155 articles, 238 were retained for further assessment, and finally, 14 met the inclusion criteria. Statistically significant positive associations between medication adherence and social support were found in nine studies (p<0.05).

Conclusions:

This review evaluated the impact of social support on medication adherence and highlighted gaps in the literature regarding the impact of social support on adherence. Family members or peer support may promote better adherence in some patient groups. This review suggests that healthcare providers may need to consider whether patients have appropriate social supports in place which will assist them adhering to and benefiting from treatment recommendations.

Barriers in health and social care access and navigation for elder orphans: a scoping review protocol

INTRODUCTION

Family members have traditionally been relied on to provide informal care to older adults. However, social and demographic changes are resulting in rising numbers of kinless and isolated elderly who are unable to rely on familial caregiving and are without assistance in navigating complex systems of health and social services. Research examining this vulnerable subset of the elderly population, identified as elder orphans, is limited, particularly within the context of health and social care access. The aim of this scoping review is to map and report the evidence available in identifying barriers and facilitating factors in health and social care access and system navigation by elder orphans.

METHODS AND ANALYSIS

Arksey and O'Malley's six-staged methodology framework will guide the conduct of this scoping review. The primary author will conduct a systematic search and an initial screen of titles and abstracts from six electronic databases (CINAHL Complete, ASSIA, Pubmed, Scopus, Web of Science and PsycINFO) from January 2005 to the date of commencement, to identify English language peer reviewed studies of various methodologies. Subsequently, two reviewers will independently screen a shorter list of studies for inclusion. We will also search the reference lists of eligible studies. Data from the selected studies will be extracted and charted by two independent reviewers. Findings will be summarised in a tabulated format and accompanied by a narrative synthesis.

ETHICS AND DISSEMINATION

As the scoping review methodology aims to synthesise information from publicly available materials, this study does not require ethical approval. The finalised scoping review will be submitted for publication to a scientific journal.

REGISTRATION

The present protocol has been registered with the Open Science Framework platform (registration ID: https://osf.io/7vjty/).

Partnership and mortality in mid and late life: Protection or selection?

The main goal of this paper is to address how different partnership statuses impact the likelihood of death among mature adults and elderly persons in Spain circa 2012 using a massive new dataset of administrative registers linked to census data. First, gross and net effects of having a partner on mortality risks of partnered and non-partnered persons are evaluated; then the characteristics and the importance of selection and protection effects of marriage and partnership with regard to the likelihood of death are assessed. We make use of exact matching methods in order to avoid the selection bias associated with the non-random assignment of persons to different partnership statuses. Protection effects decline gradually with age, but always remain positive. Selection effects show a far more pronounced decline with age leading to a pattern in which selection is much stronger than protection during the mature adult ages, but then disappear entirely and even become negative as people age. While both sexes show similar patterns, the protection effect is slightly higher among men while the selection effect is much higher among women, especially before 65 years of age.

The Interplay of Socioecological Determinants of Work-Life Balance, Subjective Wellbeing and Employee Wellbeing

Today's workers are struggling to achieve a balance between their work and personal life roles because of both specific needs and limited resources. This study explored the socioecological factors that influence work-life balance (WLB) and how they operate. The relationships between WLB, subjective wellbeing, employee wellbeing and quality time allocation were examined. A total of 1063 responses were received, using an online survey. The results show that relational, community and societal factors directly influenced the individual factors and were indirectly associated with perceived WLB. Individual factors (i.e., personal feelings, behaviours and health) were found to be the crucial determinants of an individual's perceived WLB. It was found that WLB positively correlated with employee wellbeing and quality and quantity of personal life-time. Subjective wellbeing was found to be a significant moderator in the relationship between WLB and its outcomes. This study demonstrated the process of how workers determine their own WLB by applying the socioecological framework for categorising the determinants and suggested new avenues that improve the whole wellbeing of workers and also foster long-term development of organisations.

Hearing Impairment and Mental Health Among Married Couples

OBJECTIVES

Disablement is a significant health problem and chronic stressor for older adults and is associated with negative mental health outcomes. Although some research has explored how disability extends beyond individuals to influence the mental health of their support networks, less population-based research has assessed the consequences of hearing impairment, a growing public health concern that affects 72.4% of people aged 65 and older. Moreover, although much research has examined the negative individual impact of hearing impairment, less population-based research has assessed its consequences on spouses. To fill this gap, the current study builds on gender, marriage, and stress proliferation research to examine (a) the association between own hearing impairment and spouses' depressive symptoms, and (b) whether this association varies by the gender of the spouse.

METHOD

Fixed-effects regression models were conducted using data from 5,485 couples (10,970 individuals) from 10 waves of the Health and Retirement Study (1998-2016).

RESULTS

Wives' fair or poor hearing is significantly associated with an increase in husbands' depressive symptoms, net of controls. However, husbands' fair or poor hearing is not associated with an increase in wives' depressive symptoms.

DISCUSSION

These findings suggest that hearing impairment can proliferate from one spouse to the other, but that this proliferation depends on gender. Health care providers need to be aware of the implications for husbands when treating women with hearing impairment.

'The Woman Gives': Exploring gender and relationship factors in HIV advance care planning among African American caregivers

AIMS AND OBJECTIVE

Advance care planning (ACP) is the communication process of documenting future healthcare preferences in case patients are unable to make healthcare decisions for themselves. Research suggests ACP discussions among persons living with HIV (PLHIV) are infrequent overall and may differ by gender and/or race.

BACKGROUND

Previous literature has displayed that African Americans are less likely than other racial groups to use advanced care planning, palliative care or hospice, but does not conclusively account for ACP among PLHIV. African American PLHIV rely on informal care that may be differ by gender and represents an important pathway to increase ACP.

DESIGN

The study was mixed methods and observational.

METHODS

Participants completed self-report surveys (N = 311) and were interviewed (n = 11). Poisson regression (quantitative) and grounded theory analyses (qualitative) were implemented, using COREQ checklist principles to ensure study rigor.

RESULTS

Less than half had discussed ACP (41.2%; N = 267). More ACP knowledge predicted 76% lower likelihood of ACP discussions among women. Men who spent more time caregiving in a given week were nearly 3 times more likely to discuss ACP than men who spent less time caregiving. Women were more likely than men to be caregivers and were also expected to serve in that role more than men_, which was qualitatively described as 'being a woman'.

CONCLUSIONS

The present study is one of few studies exploring ACP among caregivers in African American populations hardest hit by HIV. Results suggest that ACP skill building and education are critical for African Americans living with HIV to promote ACP discussions with their caregivers. Knowledge about ACP topics was low overall even when healthcare had recently been accessed. Support reciprocity and gender-specific communication skill building may facilitate ACP in African American HIV informal caregiving relationships.

RELEVANCE TO CLINICAL PRACTICE

Results underscore the need for ACP education which includes healthcare providers and caregivers, given African Americans' preference for life-sustaining treatments at end-of-life. ACP is crucial now more than ever, as COVID-19 complicates care for older adults with HIV at high risk of complications.