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Villarreal-Zegarra D, Paredes-Angeles R, Mayo-Puchoc N, Vilela-Estada AL, Copez-Lonzoy A, Huarcaya-Victoria J. An explanatory model of depressive symptoms from anxiety, post-traumatic stress, somatic symptoms, and symptom perception: the potential role of inflammatory markers in hospitalized COVID-19 patients. BMC Psychiatry 2022; 22:638. [PMID: 36210450 PMCID: PMC9548421 DOI: 10.1186/s12888-022-04277-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/05/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The context of the COVID-19 pandemic has harmed the mental health of the population, increasing the incidence of mental health problems such as depression, especially in those who have had COVID-19. Our study puts forward an explanatory model of depressive symptoms based on subjective psychological factors in those hospitalized for COVID-19 with and without biological markers (i.e., inflammatory markers). Therefore, we aim to evaluate the hypotheses proposed in the model to predict the presence of depressive symptoms. METHOD We conducted a cross-sectional study, using a simple random sampling. Data from 277 hospitalized patients with COVID-19 in Lima-Peru, were collected to assess mental health variables (i.e., depressive, anxiety, post-traumatic stress, and somatic symptoms), self-perception of COVID-19 related symptoms, and neutrophil/lymphocyte ratio (NLR) such as inflammatory marker. We performed a structural equation modeling analysis to evaluate a predictive model of depressive symptoms. RESULTS The results showed a prevalence of depressive symptoms (11.2%), anxiety symptoms (7.9%), somatic symptoms (2.2%), and symptoms of post-traumatic stress (6.1%) in the overall sample. No association was found between the prevalence of these mental health problems among individuals with and without severe inflammatory response. The mental health indicators with the highest prevalence were sleep problems (48%), low energy (47.7%), nervousness (48.77%), worry (47.7%), irritability (43.7%) and back pain (52%) in the overall sample. The model proposed to explain depressive symptoms was able to explain more than 83.7% of the variance and presented good goodness-of-fit indices. Also, a different performance between the proposed model was found between those with and without severe inflammatory response. This difference was mainly found in the relationship between anxiety and post-traumatic stress symptoms, and between the perception of COVID-19 related symptoms and somatic symptoms. CONCLUSIONS Results demonstrated that our model of mental health variables may explain depressive symptoms in hospitalized patients of COVID-19 from a third-level hospital in Peru. In the model, perception of symptoms influences somatic symptoms, which impact both anxiety symptoms and symptoms of post-traumatic stress. Thus, anxiety symptoms could directly influence depressive symptoms or through symptoms of post-traumatic stress. Our findings could be useful to decision-makers for the prevention of depression, used to inform the creation of screening tools (i.e., perception of symptoms, somatic and anxiety symptoms) to identify vulnerable patients to depression.
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Affiliation(s)
- David Villarreal-Zegarra
- grid.441978.70000 0004 0396 3283Escuela de Medicina, Universidad César Vallejo, Trujillo, Peru ,Instituto Peruano de Orientación Psicológica, Lima, Peru
| | | | | | | | - Anthony Copez-Lonzoy
- Instituto Peruano de Orientación Psicológica, Lima, Peru ,grid.441908.00000 0001 1969 0652Unidad de Investigación en Bibliometría, Universidad San Ignacio de Loyola, Lima, Peru ,PSYCOPERU Peruvian Research Institute of Educational and Social Psychology, Lima, Peru
| | - Jeff Huarcaya-Victoria
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Filial Ica, Peru. .,Departamento de Psiquiatría, Servicio de Psiquiatría de Adultos, Unidad de Psiquiatría de Enlace, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú.
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Villarreal-Zegarra D, Copez-Lonzoy A, Vilela-Estrada AL, Huarcaya-Victoria J. Depression, post-traumatic stress, anxiety, and fear of COVID-19 in the general population and health-care workers: prevalence, relationship, and explicative model in Peru. BMC Psychiatry 2021; 21:455. [PMID: 34530803 PMCID: PMC8445782 DOI: 10.1186/s12888-021-03456-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 08/14/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND This study has two aims. First, determine the fit of the fear model to COVID-19, anxiety, and post-traumatic stress in the general population and health-care workers. Second, determine which model best explains the relationship between depression and the triad of fear, anxiety, and post-traumatic stress in both groups. METHOD A cross-sectional study was conducted using self-reported questionnaires for anxiety, fear of COVID-19, depression, and post-traumatic stress. Information was collected from adults living in Lima, the capital and the most populous city in Peru. The explanatory models were evaluated using a structural equation model. RESULTS A total of 830 participants were included, including general population (n = 640) and health-care workers (n = 190). A high overall prevalence of depressive symptoms (16%), anxiety (11.7%), and post-traumatic stress (14.9%) were identified. A higher prevalence of depressive, anxious, or stress symptoms was identified in the general population (28.6%) compared to health-care workers (17.9%). The triad model of fear of COVID-19, anxiety, and stress presented adequate goodness-of-fit indices for both groups. A model was identified that manages to explain depressive symptoms in more than 70% of the general population and health-care workers, based on the variables of the triad (CFI = 0.94; TLI = 0.94; RMSEA = 0.06; SRMR = 0.06). In the general population post-traumatic stress mediated the relationship between anxiety and depression (β = 0.12; 95%CI = 0.06 to 0.18) which was significant, but the indirect effect of post-traumatic stress was not significant in health care workers (β = 0.03; 95%CI = - 0.11 to 0.19). LIMITATIONS The prevalence estimates relied on self-reported information. Other variables of interest, such as intolerance to uncertainty or income level, could not be evaluated. CONCLUSIONS Our study proposes and tests one model that explains more than 70% of depressive symptoms. This explanatory model can be used in health contexts and populations to determine how emotional factors can affect depressive symptoms.
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Affiliation(s)
- David Villarreal-Zegarra
- Escuela de Medicina, Universidad César Vallejo, Trujillo, Peru
- Instituto Peruano de Orientación Psicológica, Lima, Peru
| | - Anthony Copez-Lonzoy
- Instituto Peruano de Orientación Psicológica, Lima, Peru.
- Unidad de Investigación en Bibliometría, Universidad San Ignacio de Loyola, Lima, Peru.
- Asociación Peruana de Profesionales de las Adicciones, Lima, Peru.
| | - Ana L Vilela-Estrada
- Instituto Peruano de Orientación Psicológica, Lima, Peru
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeff Huarcaya-Victoria
- Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
- Departamento Académico de Psiquiatría, Universidad Nacional Mayor de San Marcos, Lima, Peru
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The epidemiology of population mental wellbeing in China. LANCET PUBLIC HEALTH 2020; 5:e631-e632. [PMID: 33271073 DOI: 10.1016/s2468-2667(20)30265-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 11/21/2022]
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Warghoff A, Persson S, Garmy P, Einberg EL. A Focus Group Interview Study of the Experience of Stress amongst School-Aged Children in Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114021. [PMID: 32516950 PMCID: PMC7312672 DOI: 10.3390/ijerph17114021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 12/22/2022]
Abstract
The study explored experiences of stress in children aged 10–12. An inductive qualitative design was used. Ten focus group interviews were conducted with Swedish schoolchildren (n = 42) aged 10–12. The interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis. The study identified one theme—“Body and mind react”—and three subthemes: (1) Friendships matters, (2) Parental stress affect, and (3) Trying to do my best. Stress often occurred in the children’s everyday environment. The children had experienced how stress could be expressed both physically and mentally, inside and outside school. The children also had the experience of seeing people in their environment being stressed, which could create feelings that affected the children. The experience of the children was also that stress can sometimes be good. Stress related to peers, family, school, and society was commonly experienced by children aged 10–12. Both positive and negative stress was reported.
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Affiliation(s)
- Alexandra Warghoff
- Faculty of Health Sciences, Kristianstad University, 291 88 Kristianstad, Sweden; (A.W.); (S.P.); (E.-L.E.)
| | - Sara Persson
- Faculty of Health Sciences, Kristianstad University, 291 88 Kristianstad, Sweden; (A.W.); (S.P.); (E.-L.E.)
| | - Pernilla Garmy
- Faculty of Health Sciences, Kristianstad University, 291 88 Kristianstad, Sweden; (A.W.); (S.P.); (E.-L.E.)
- Clinical Health Promotion Centre, Medical Faculty, Lund University, 221 00 Lund, Sweden
- Correspondence: ; Tel.: +46-44-2503877
| | - Eva-Lena Einberg
- Faculty of Health Sciences, Kristianstad University, 291 88 Kristianstad, Sweden; (A.W.); (S.P.); (E.-L.E.)
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Xu DD, Rao WW, Cao XL, Wen SY, An FR, Che WI, Bressington DT, Cheung T, Ungvari GS, Xiang YT. Prevalence of depressive symptoms in primary school students in China: A systematic review and meta-analysis. J Affect Disord 2020; 268:20-27. [PMID: 32158003 DOI: 10.1016/j.jad.2020.02.034] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/07/2020] [Accepted: 02/18/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUNDS Depression in children and adolescents is usually under-recognized. The findings of epidemiological studies on depressive symptoms in primary school students are inconsistent across studies. This study reports a systematic review and meta-analysis on the prevalence of depressive symptoms in primary school students in China. METHODS Literature search was performed in both international (PubMed, PsycINFO, EMBASE) and Chinese (China National Knowledge Internet, WANFANG Data and Chinese Biological Medical Literature) databases. The random-effects model was used to analyze data. RESULTS Twenty-seven studies involving 42,374 subjects were included. The pooled prevalence of depressive symptoms in Chinese primary school students was 17.2% (95% CI: 14.3%-20.5%). Subgroup analyses found that the prevalence significantly varied between geographic regions, with western China reporting the highest prevalence. Meta-regression analyses found that year of survey and study quality were significantly associated with the prevalence of depressive symptoms. CONCLUSIONS Given the high prevalence of depressive symptoms and its negative health outcomes, preventive measures, regular screening and effective treatments need to be implemented for this population.
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Affiliation(s)
- Dan-Dan Xu
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China; Department of Biology, Faculty of Sciences, Harbin University, Harbin, China
| | - Wen-Wang Rao
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Xiao-Lan Cao
- Shenzhen Key Laboratory for Psychological Healthcare & Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital & Shenzhen Mental Health Center, Shenzhen, China
| | - Si-Ying Wen
- Shenzhen Key Laboratory for Psychological Healthcare & Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital & Shenzhen Mental Health Center, Shenzhen, China
| | - Feng-Rong An
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Weng-Ian Che
- Unit of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Department of Public Health Science, Karolinska Institutet, Stockholm, Sweden
| | | | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia; University of Notre Dame Australia, Fremantle, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China; Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China.
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Yao XI, Ni MY, Cheung F, Wu JT, Schooling CM, Leung GM, Pang H. Change in moderate alcohol consumption and quality of life: evidence from 2 population-based cohorts. CMAJ 2020; 191:E753-E760. [PMID: 31285378 DOI: 10.1503/cmaj.181583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although the association of moderate alcohol consumption with specific disorders, such as cardiovascular disease and cancers, has been well documented, the evidence of the broader impact of alcohol consumption on health-related quality of life is less clear. Our objective was to examine the association of drinking patterns with changes in physical and mental well-being across populations. METHODS We conducted a multilevel analysis with multivariate responses in the population-representative FAMILY Cohort in the Hong Kong Special Administrative Region, China, to examine the association between alcohol drinking patterns across 2 waves (2009-2013) (i.e., quitters, initiators, persistent drinkers, persistent former drinkers and lifetime abstainers) and changes in physical and mental well-being (Physical and Mental Component Summary of the 12-Item Short Form Health Survey [SF-12]). Analyses were stratified by sex. We validated findings using a nationally representative cohort in the United States, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, 2001-2005). RESULTS In the FAMILY Cohort (n = 10 386; median follow-up 2.3 yr), the change in mental well-being was more favourable in female quitters than in lifetime abstainers (β = 1.44, 95% confidence interval [CI] 0.43 to 2.45; mean score change of +2.0 for quitters and +0.02 for lifetime abstainers). This association was validated in the NESARC (n = 31 079; median follow-up 3.1 yr) (β = 0.83, 95% CI 0.08 to 1.58; mean score change of -1.1 for quitters and -1.6 for lifetime abstainers). INTERPRETATION The change in mental well-being was more favourable in female quitters, approaching the level of mental well-being of lifetime abstainers within 4 years of quitting in both Chinese and American populations.
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Affiliation(s)
- Xiaoxin I Yao
- School of Public Health, Li Ka Shing Faculty of Medicine (Yao, Ni, Cheung, Wu, Schooling, Leung, Pang), and The State Key Laboratory of Brain and Cognitive Sciences (Ni), The University of Hong Kong, Hong Kong Special Administrative Region, China; Graduate School of Public Health and Health Policy (Schooling), City University of New York, New York, NY
| | - Michael Y Ni
- School of Public Health, Li Ka Shing Faculty of Medicine (Yao, Ni, Cheung, Wu, Schooling, Leung, Pang), and The State Key Laboratory of Brain and Cognitive Sciences (Ni), The University of Hong Kong, Hong Kong Special Administrative Region, China; Graduate School of Public Health and Health Policy (Schooling), City University of New York, New York, NY
| | - Felix Cheung
- School of Public Health, Li Ka Shing Faculty of Medicine (Yao, Ni, Cheung, Wu, Schooling, Leung, Pang), and The State Key Laboratory of Brain and Cognitive Sciences (Ni), The University of Hong Kong, Hong Kong Special Administrative Region, China; Graduate School of Public Health and Health Policy (Schooling), City University of New York, New York, NY
| | - Joseph T Wu
- School of Public Health, Li Ka Shing Faculty of Medicine (Yao, Ni, Cheung, Wu, Schooling, Leung, Pang), and The State Key Laboratory of Brain and Cognitive Sciences (Ni), The University of Hong Kong, Hong Kong Special Administrative Region, China; Graduate School of Public Health and Health Policy (Schooling), City University of New York, New York, NY
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine (Yao, Ni, Cheung, Wu, Schooling, Leung, Pang), and The State Key Laboratory of Brain and Cognitive Sciences (Ni), The University of Hong Kong, Hong Kong Special Administrative Region, China; Graduate School of Public Health and Health Policy (Schooling), City University of New York, New York, NY
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine (Yao, Ni, Cheung, Wu, Schooling, Leung, Pang), and The State Key Laboratory of Brain and Cognitive Sciences (Ni), The University of Hong Kong, Hong Kong Special Administrative Region, China; Graduate School of Public Health and Health Policy (Schooling), City University of New York, New York, NY
| | - Herbert Pang
- School of Public Health, Li Ka Shing Faculty of Medicine (Yao, Ni, Cheung, Wu, Schooling, Leung, Pang), and The State Key Laboratory of Brain and Cognitive Sciences (Ni), The University of Hong Kong, Hong Kong Special Administrative Region, China; Graduate School of Public Health and Health Policy (Schooling), City University of New York, New York, NY
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Cannizzaro E, Ramaci T, Cirrincione L, Plescia F. Work-Related Stress, Physio-Pathological Mechanisms, and the Influence of Environmental Genetic Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4031. [PMID: 31640269 PMCID: PMC6843930 DOI: 10.3390/ijerph16204031] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/18/2019] [Accepted: 10/19/2019] [Indexed: 12/16/2022]
Abstract
Work-related stress is a growing health problem in modern society. The stress response is characterized by numerous neurochemicals, neuroendocrine and immune modifications that involve various neurological systems and circuits, and regulation of the gene expression of the different receptors. In this regard, a lot of research has focused the attention on the role played by the environment in influencing gene expression, which in turn can control the stress response. In particular, genetic factors can moderate the sensitivities of specific types of neural cells or circuits mediating the imprinting of the environment on different biological systems. In this current review, we wish to analyze systematic reviews and recent experimental research on the physio-pathological mechanisms that underline stress-related responses. In particular, we analyze the relationship between genetic and epigenetic factors in the stress response.
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Affiliation(s)
- Emanuele Cannizzaro
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities "Giuseppe D'Alessandro", University of Palermo, via del Vespro 133, 90127 Palermo, Italy.
| | - Tiziana Ramaci
- Faculty of Human and Social Sciences, Kore University of Enna, 94100 Enna, Italy.
| | - Luigi Cirrincione
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities "Giuseppe D'Alessandro", University of Palermo, via del Vespro 133, 90127 Palermo, Italy.
| | - Fulvio Plescia
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities "Giuseppe D'Alessandro", University of Palermo, via del Vespro 133, 90127 Palermo, Italy.
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Dorrington S, Zavos H, Ball H, McGuffin P, Sumathipala A, Siribaddana S, Rijsdijk F, Hatch SL, Hotopf M. Family functioning, trauma exposure and PTSD: A cross sectional study. J Affect Disord 2019; 245:645-652. [PMID: 30445390 PMCID: PMC6362264 DOI: 10.1016/j.jad.2018.11.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/04/2018] [Accepted: 11/03/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Only a minority of trauma-exposed individuals go on to develop post traumatic stress disorder (PTSD). Previous studies in high income countries suggest that maladaptive family functioning adversities (MFFA) in childhood may partially explain individual variation in vulnerability to PTSD following trauma. We test in a lower middle-income setting (Sri Lanka) whether: (1) MFFA is associated with trauma exposure; (2) MFFA moderates the association between exposure to trauma and later (a) PTSD (b) other psychiatric diagnoses; and (3) any association between MFFA and PTSD is explained by experiences of interpersonal violence, cumulative trauma exposure or comorbid psychopathology. METHODS We conducted a population study of 3995 twins and 2019 singletons residing in Colombo, Sri Lanka. Participants completed the Composite International Diagnostic Interview, including nine traumatic exposures and a questionnaire on MFFA. RESULTS 23.4% of participants reported exposure to MFFA. We found that (1) MFFA was strongly associated with trauma exposure (2) MFFA moderates the association between trauma exposure and both (a) PTSD and (b) other DSM psychiatric diagnosis. (3) This was not explained by interpersonal violence, cumulative trauma exposure or other psychopathology. CONCLUSIONS MFFA moderates the association between trauma and PTSD, and the association between trauma and non-PTSD psychopathology.
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Affiliation(s)
- Sarah Dorrington
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK,South London and Maudsley NHS Foundation Trust, UK
| | - Helena Zavos
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK
| | | | - Peter McGuffin
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Athula Sumathipala
- Department of Primary Care and Health Services, Keele University, Staffordshire, UK
| | - Sisira Siribaddana
- Faculty of Medicine & Allied Science, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Fruhling Rijsdijk
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Stephani L. Hatch
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, UK.
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Childhood disadvantage, education, and psychological distress in adulthood: A three-wave population-based study. J Affect Disord 2018; 229:206-212. [PMID: 29324368 DOI: 10.1016/j.jad.2017.12.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/14/2017] [Accepted: 12/27/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND We assessed the mediating role of education in the association between childhood disadvantage and psychological distress in adulthood using longitudinal data collected in three waves, from 1994 to 2008, in the framework of the Tromsø Study (N = 4530), a cohort that is representative of men and women from Tromsø. METHODS Education was measured at a mean age of 54.7 years, and psychological distress in adulthood was measured at a mean age of 61.7 years. Ordinary least square regression analysis was used to assess the associations between childhood disadvantage, education, and psychological distress in adulthood. The indirect effects and the proportion (%) of indirect effects of childhood disadvantage (via education) on psychological distress in adulthood were assessed by mediation analysis. RESULTS Childhood disadvantage was associated with lower education and higher psychological distress in adulthood (p < 0.05). Lower education was associated with a higher psychological distress in adulthood (p < 0.05). A minor proportion (7.51%, p < 0.05) of the association between childhood disadvantage and psychological distress in adulthood was mediated by education. LIMITATIONS Childhood disadvantages were measured retrospectively. CONCLUSION The association between childhood disadvantage and psychological distress in adulthood is primarily independent of education.
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Sheikh MA. Confounding and Statistical Significance of Indirect Effects: Childhood Adversity, Education, Smoking, and Anxious and Depressive Symptomatology. Front Psychol 2017; 8:1317. [PMID: 28824498 PMCID: PMC5539245 DOI: 10.3389/fpsyg.2017.01317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/18/2017] [Indexed: 11/13/2022] Open
Abstract
The life course perspective, the risky families model, and stress-and-coping models provide the rationale for assessing the role of smoking as a mediator in the association between childhood adversity and anxious and depressive symptomatology (ADS) in adulthood. However, no previous study has assessed the independent mediating role of smoking in the association between childhood adversity and ADS in adulthood. Moreover, the importance of mediator-response confounding variables has rarely been demonstrated empirically in social and psychiatric epidemiology. The aim of this paper was to (i) assess the mediating role of smoking in adulthood in the association between childhood adversity and ADS in adulthood, and (ii) assess the change in estimates due to different mediator-response confounding factors (education, alcohol intake, and social support). The present analysis used data collected from 1994 to 2008 within the framework of the Tromsø Study (N = 4,530), a representative prospective cohort study of men and women. Seven childhood adversities (low mother's education, low father's education, low financial conditions, exposure to passive smoke, psychological abuse, physical abuse, and substance abuse distress) were used to create a childhood adversity score. Smoking status was measured at a mean age of 54.7 years (Tromsø IV), and ADS in adulthood was measured at a mean age of 61.7 years (Tromsø V). Mediation analysis was used to assess the indirect effect and the proportion of mediated effect (%) of childhood adversity on ADS in adulthood via smoking in adulthood. The test-retest reliability of smoking was good (Kappa: 0.67, 95% CI: 0.63; 0.71) in this sample. Childhood adversity was associated with a 10% increased risk of smoking in adulthood (Relative risk: 1.10, 95% CI: 1.03; 1.18), and both childhood adversity and smoking in adulthood were associated with greater levels of ADS in adulthood (p < 0.001). Smoking in adulthood did not significantly mediate the association between childhood adversity and ADS in adulthood. However, when education was excluded as a mediator-response confounding variable, the indirect effect of childhood adversity on ADS in adulthood was statistically significant (p < 0.05). This study shows that a careful inclusion of potential confounding variables is important when assessing mediation.
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Affiliation(s)
- Mashhood Ahmed Sheikh
- Health Services Research Unit, Department of Community Medicine, University of TromsøTromsø, Norway
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Childhood adversities and chronic conditions: examination of mediators, recall bias and age at diagnosis. Int J Public Health 2017; 63:181-192. [PMID: 28736801 DOI: 10.1007/s00038-017-1021-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/10/2017] [Accepted: 07/12/2017] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES The aim of this study was to (1) identify the influence of childhood socioeconomic status (CSES) on five chronic conditions: asthma, bronchitis, hypothyroid, migraine, and psychiatric disorders in later life; (2) determine the mediating role of childhood abuse (CA) in these associations, and (3) quantify recall bias due to respondent's mental health in these associations. METHODS 10,325 men and women from the Tromsø Study were followed for 13 years, and Poisson regression models were used. RESULTS Low CSES was associated with a 16-23% higher risk of chronic conditions, and CA was associated with a 16-58% higher risk of chronic conditions (p < 0.05). A minor proportion of the association between CSES and CA (3.98%, p < 0.05); CSES and chronic conditions (5.54-8.71%, p < 0.05); and CA and chronic conditions (9.51-19.52%, p < 0.05), were driven by recall bias due to the respondent's mental health. CA mediated the association between CSES and chronic conditions (9.58-25.06%, p < 0.05). CONCLUSIONS Low CSES and CA are associated with higher risk of chronic conditions in later life. A minor proportion of these associations are driven by recall bias.
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