Psychosocial variables and self-rated health in young adult obese women

Evaluating the association of self-reported psychological distress and self-rated health on survival times among women with breast cancer in the U.S

BACKGROUND

Psychological distress and self-rated health status may create additional complexities in patients already diagnosed with breast cancer. This study aims to assess the association of self-report-based assessment of psychological distress and self-rated health on survival times among women with breast cancer diagnoses.

METHODS

Seventeen-year data from the Integrated Public Use Microdata Series-National Health Interview Survey (IPUMS-NHIS) were pooled and analyzed. Women who were aged 30 to 64 years old, with breast cancer diagnosis were selected (n = 2,819). The outcome variable was time to death. The independent variables were self-reported assessment of psychological distress and self-rated health. Psychological distress was defined using the Kessler-6 scale while self-rated health was measured on a 3-point Likert scale: Poor, Fair, and Good-to-Excellent (referred to as good for brevity). We computed unadjusted and adjusted hazard ratios (HR) using Cox-Proportional Hazard regression models with sociodemographic characteristics and measures of health care access used as potential confounders. Significance was set at alpha = 0.05.

RESULTS

Women with breast cancer assessed as having psychological distress had 46% (Adjusted HR: 1.46; 95% CI: 1.02-2.09) increased risks of mortality. Also, women who rated their health as poor or fair had a significantly elevated mortality risk (Poor Health: Adjusted HR: 3.05; 95% CI: 2.61-4.69; Fair Health: Adjusted HR: 1.83; 95% CI: 1.43-2.35) as compared to women with good health status.

CONCLUSIONS

Self-reported psychological distress and fair and poor self-rated health are associated with reduced survival times among women with breast cancer diagnoses.

Loneliness among older adults living with HIV: the "older old" may be less lonely than the "younger old"

Loneliness is common among older (age 50+) people living with HIV (PLWH). However, little is known about the prevalence of loneliness across subgroups of older PLWH, and the factors that impact loneliness. An online questionnaire was used to collect data from 998 older PLWH. Of those, 61% were 50-59 years old and 39% were 60 or older. The majority were male (89%), gay (77%), and white (69%). Fifty-one percent of participants were classified as lonely. The prevalence of loneliness was lower in the older age group, 46.2% vs. 53.8% (Χ ² = 5.53, p = 0.02). Covariates associated with loneliness included being younger, being single, having at least a four-year college degree, living alone, screening positive for depression, using recreational drugs, smoking tobacco, having a lower quality of life, and not feeling close to friends. Logistic regression analysis showed that the "younger old" were at 26% greater risk of loneliness, after controlling for the effects of these covariates (RR 1.26, 95% CI: 1.06-1.45). Reasons why the "older old" were less lonely may include lower rates of depression and lower likelihood of feeling distant from friends. Understanding factors that protect the "older old" against loneliness may provide guidance for future interventions.

The relationship among social support, self-esteem, affect balance and loneliness in individuals with substance use disorders in China

This study analyzed the potential mediating role of self-esteem and affect balance on the relationship between social support and loneliness. Respondents were 426 substabce use disorders from the Shifosi and Dalianshan rehab facilities in China who had completed the Multidimensional Scale of Perceived Social Support, Rosenberg Self-Esteem Scale, Positive and Negative Affect Scales, and UCLA Loneliness Scale. The results indicated that self-esteem and affect balance fully mediated the relationship between perceived social support and loneliness and all the paths, ranging from social support through self-esteem and affect balance to loneliness, were significant. Finally, we analyzed possible approaches to decreasing individuals with substance use disorders' loneliness.

The Impact of Loneliness on Outcomes of Pulmonary Rehabilitation in Patients with COPD

Psychological factors such as negative affect have been demonstrated to impact course and treatment of chronic obstructive pulmonary disease (COPD). However, little is known about the respective impact of social factors. In several other chronic diseases, loneliness has been shown to predict morbidity, but little is known about its impact on COPD. Therefore, this study examined the associations between loneliness and outcome measures of a pulmonary rehabilitation program (PR). Before and after a 3-week inpatient PR program, patients with COPD (N = 104) underwent a 6-min walking test to measure functional exercise capacity. Loneliness was assessed with the Loneliness Scale. The Medical Outcomes Study 36-item short form, 9-item Patient Health Questionnaire, and 7-item General Anxiety Disorder questionnaire were administered as measures of health-related quality of life (HQoL), depression, and anxiety, respectively. Multiple regression analyses showed that at the start of PR, more loneliness was associated with worse levels of functional exercise capacity, HQoL, depression, and anxiety, but with greater improvements in functional exercise capacity and HQoL over the course of PR, even after controlling for age, sex, lung function, and smoking status. Patients with stronger decreases in loneliness from start to end of PR showed stronger improvements in functional exercise capacity and HQoL over the course of PR. The present study shows that subjective loneliness is associated with relevant treatment outcomes in patients with COPD undergoing pulmonary rehabilitation. Therefore, loneliness should be addressed in patients with COPD as it could play a significant role in their disease progression.

Anthropometric variables as predictors of aspects of quality of life in persons with central obesity

Objective

Central obesity has been shown to negatively influence the quality of life in centrally obese persons of both sexes. In a population of 740 centrally obese Asian-Indian adults, the present study was conducted to determine whether body mass index (BMI), waist circumference, hip circumference (HC), waist-hip ratio (WHR) and sagittal abdominal diameter (SAD) could predict different domains of quality of life. The differences based on gender and age were also determined. Linear regression analyses were carried out and the level of statistical significance (α) was set at 0.05.

Results

Body mass index, HC, WHR and SAD were significant predictors for different domains of quality of life as well as for the summated total quality of life. BMI was found to be the most important predictor among all predictors across age groups and both sexes.

The Impact of Punitive Immigrant Laws on the Health of Latina/o Populations

This study examines how anti-immigrant policies affect the physical health of Latina/os in the United States. Merging two unique datasets: sum of anti-immigrant policies by state from 2005-2011 and a 2011 Robert Wood Johnson Center for Health Policy nationally representative sample of Latina/os (n=1,200), we estimate a series of logistic regressions to understand how anti-immigrant legislations are affecting the health of Latina/os. Our modeling approach takes into consideration Latinos' diverse experience, context that is widely overlooked in datasets that treat Latina/os as a homogeneous ethnic group. Our findings suggest that an increase in anti-immigrant laws enacted by a state decreases the probability of respondents reporting optimal health, even when controlling for other relevant factors, such as citizenship status, language of interview, and interethnic variation. The implication and significance of this work has tremendous impacts for scholars, policy makers, health service providers and applied researchers interested in reducing health disparities among minority populations.

Using Gene Expression Analysis to Examine Changes in Loneliness, Depression and Systemic Inflammation in Lonely Chronically Ill Older Adults

Purpose

The purpose of this study was to evaluate the effectiveness of LISTEN (Loneliness Intervention) on loneliness, depression, physical health, systemic inflammation, and genomic expression in a sample of lonely, chronically ill, older adults.

Methods

This was a prospective, longitudinal randomized trial of LISTEN, a novel intervention based on theories of narrative and cognitive restructuring to target specific aspects of loneliness. Twenty-three older, lonely, chronically ill adults were recruited from a family medicine clinic in West Virginia. Participants were randomized to two groups, 13 in LISTEN group (Loneliness Intervention) and 10 in attention control (healthy aging education). Participants attended an enrollment session where they completed consent, survey data (including sociodemographics and chronic illness diagnoses), baseline physical measures, and blood sampling for gene expression analysis. After completing the 5 weekly sessions, all participants attended a 12 week post data collection meeting (17 weeks post-baseline) for survey completion, physical measures and blood sampling.

Results

The results of this study show that the LISTEN intervention improves measures of physical and psychosocial health. Specifically, subjects enrolled in LISTEN showed reductions in systolic blood pressure, as well as decreased feelings of loneliness and depression. These changes may be due, in part, to a reduction in systemic inflammation, as measured by interleukin-2.

Conclusion

This study provides support for the use of LISTEN in reducing loneliness in chronically ill, older adults. Further, while some of our results are inconclusive, it provides rationale to expand our study population to evaluate the relationship between loneliness and systemic inflammation. In the future, enhancing knowledge about the relationships among loneliness, chronic illness, systemic inflammation, and gene expression of these particular targets, and how these relationships may change over time with intervention will inform translation of findings to clinical settings.

The Health Consequences of Obesity in Young Adulthood

Young adults are gaining weight faster than any age group. This weight gain and the appearance of obesity-related comorbidities often commence in adolescence. Psychosocial distress and mental health issues are common and debilitating, and treatment approaches are likely to be similar to those for adolescents. At the same time, young adults may have physical morbidities which will continue and worsen throughout adulthood, such as hypertension, diabetes and polycystic ovarian syndrome. Health consequences of obesity are challenging to manage in young adults as their symptoms may be minimal, they are less likely to engage with healthcare due to other life priorities and their neurocognitive developmental stage makes therapy adherence difficult. Clinicians who manage young adults with obesity need to be aware of these age-specific challenges, as well as the sexual and reproductive health concerns that are present in this age group.

A Systematic Review of Loneliness and Common Chronic Physical Conditions in Adults

Loneliness is a prevalent and global problem for adult populations and has been linked to multiple chronic conditions in quantitative studies. This paper presents a systematic review of quantitative studies that examined the links between loneliness and common chronic conditions including: heart disease, hypertension, stroke, lung disease, and metabolic disorders. A comprehensive literature search process guided by the PRISMA statement led to the inclusion of 33 articles that measure loneliness in chronic illness populations. Loneliness is a significant biopsychosocial stressor that is prevalent in adults with heart disease, hypertension, stroke, and lung disease. The relationships among loneliness, obesity, and metabolic disorders are understudied but current research indicates that loneliness is associated with obesity and with psychological stress in obese persons. Limited interventions have demonstrated long-term effectiveness for reducing loneliness in adults with these same chronic conditions. Future longitudinal randomized trials that enhance knowledge of how diminishing loneliness can lead to improved health outcomes in persons with common chronic conditions would continue to build evidence to support the translation of findings to recommendations for clinical care.

The Feasibility and Acceptability of LISTEN for Loneliness

PURPOSE

The purpose of this paper is to present the initial feasibility and acceptability of LISTEN (Loneliness Intervention using Story Theory to Enhance Nursing-sensitive outcomes), a new intervention for loneliness. Loneliness is a significant stressor and known contributor to multiple chronic health conditions in varied populations. In addition, loneliness is reported as predictive of functional decline and mortality in large samples of older adults from multiple cultures. Currently, there are no standard therapies recommended as effective treatments for loneliness. The paucity of interventions has limited the ability of healthcare providers to translate what we know about the problem of loneliness to active planning of clinical care that results in diminished loneliness. LISTEN was developed using the process for complex intervention development suggested by the Medical Research Council (MRC) [1] [2].

METHODS

Feasibility and acceptability of LISTEN were evaluated as the first objective of a longitudinal randomized trial which was set in a university based family medicine center in a rural southeastern community in Appalachia. Twenty-seven older adults [(24 women and 3 men, mean age: 75 (SD 7.50)] who were lonely, community-dwelling, and experiencing chronic illness, participated. Feasibility was evaluated by tracking recruitment efforts, enrollment, attendance to intervention sessions, attrition, and with feedback evaluations from study personnel. Acceptability was assessed using quantitative and qualitative evaluation data from participants.

RESULTS

LISTEN was evaluated as feasible to deliver with no attrition and near perfect attendance. Participants ranked LISTEN as highly acceptable for diminishing loneliness with participants requesting a continuation of the program or development of additional sessions.

CONCLUSIONS

LISTEN is feasible to deliver in a primary healthcare setting and has the potential to diminish loneliness which could result in improvement of the long-term negative known sequelae of loneliness such as hypertension, depression, functional decline, and mortality. Feedback from study participants is being used to inform future trials of LISTEN with consideration for developing additional sessions. Longitudinal randomized trials are needed in varied populations to assess long-term health and healthcare system benefits of diminishing loneliness, and to assess the potential scalability of LISTEN as a reimbursable treatment for loneliness.

The Development of LISTEN: A Novel Intervention for Loneliness

PURPOSE

The purpose of this paper is to present the development of LISTEN (Loneliness Intervention using Story Theory to Enhance Nursing-sensitive outcomes), a new intervention for loneliness.

METHODS

LISTEN was developed using the Medical Research Council (MRC) framework for intervention development. Extensive literature review revealed that belonging, relating, placing in community, challenges, and meanings of coping were concepts significant to loneliness. Past interventions were limited but it was determined from a recent meta-analysis that enhanced effectiveness might result from interventions that targeted the poorly adapted cognitive processes of loneliness. These processes include social undesirability, stigma, and negative thoughts about self in relation to others. LISTEN is designed to be delivered in a determined logical sequence of 5 sessions, each focusing on the concepts relevant to loneliness as derived from the literature. For each session, intervention delivery is guided by the concepts from story theory (including intentional dialogue, nurse as listener, examination of self in relation to others and community, synthesizing concerns and patterns, and identifying messages) and the principles of cognitive restructuring (self-assessment of maladaptive cognitions, emotions, and behaviors, identifying challenges of changing, reconceptualization of self, new skill acquisition through group interaction, and identifying patterns of meaning in loneliness).

RESULTS

LISTEN is developed and the first randomized trial is complete with a sample of 27 lonely, chronically ill, community dwelling, and older adults. LISTEN was evaluated as feasible to deliver by the study team and acceptable for significantly diminishing loneliness by participants of the LISTEN groups who were compared to attention control groups (p < 0.5).

CONCLUSIONS

LISTEN has the potential to enhance health by diminishing loneliness which could result in improving the long-term negative known sequelae of loneliness. Future longitudinal randomized trials are needed in varied populations to assess long term health and healthcare system benefit of using LISTEN to treat loneliness.

Stress- and PTSD-associated obesity and metabolic dysfunction: a growing problem requiring further research and novel treatments

Posttraumatic stress disorder (PTSD) is a growing public health concern. More recently, evidence has indicated that PTSD leads to obesity and associated metabolic dysfunction. Possible mechanisms of this link are through dysfunction of the hypothalamic-pituitary-adrenal axis and related moderation of appetite hormones and neural activity, leading to changes in consumptive behaviors. Although research has been examining associations between PTSD and obesity, diabetes, cardiovascular disease, and metabolic syndrome, future research should delineate potential mechanisms for these associations and develop targeted treatments to reduce these metabolic outcomes.