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Zheng X, Yin Y, Yang L, Zhang X, Xiao S, Liang X, Lu J, Li X, Zhang M, Tian F, Zhang C. Socioeconomic status and depression in later life: longitudinal mediation effects of activities of daily living. BMC Psychiatry 2024; 24:625. [PMID: 39334068 PMCID: PMC11428304 DOI: 10.1186/s12888-024-06077-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 09/11/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Socioeconomic status (SES) is associated with both depression and activities of daily living (ADL and IADL). However, the role of ADL as a biological mechanism in the relationship between SES and late-life depression, examined through longitudinal data, remains understudied. This study explored the longitudinal mediation effects of basic ADL or IADL on the SES-depression link in older adults. METHODS Data from the China Health and Retirement Longitudinal Study (N = 4104) were utilized. Mediation analysis was performed using parallel process latent growth curve modeling. RESULTS The average age of participants was 57.76 years, and 55.7% being females. Significant linear growth over time was observed in ADL, IADL, and depression. Adjusting for covariates, SES was positively linked to the initial levels (intercepts) of ADL (βiADL=-0.100[-0.143, -0.057]), IADL (βiIADL=-0.140[-0.185, -0.095]), and depression (βiDEP=-0.103[-0.158, -0.048]). However, SES showed no significant correlation with the rate of change (slopes) in ADL, IADL, or depression (P > 0.05). The intercepts of ADL (βiDEP = 0.566[0.503, 0.629]) and IADL (βiDEP = 0.607[0.544, 0.670]) were positively correlated with the depression intercept but negatively with the depression slope. Conversely, the slopes of ADL and IADL were positively associated with the depression slope. These results suggest a negative indirect relationship between SES and the initial level of depression, but a positive indirect relationship with the rate of increase in depression through ADL (or IADL) intercept. CONCLUSIONS Higher SES is associated with a lower initial risk of depression and ADL difficulties. However, this same higher SES may relate to a faster increase in ADL difficulties and depression among middle-aged and older adults. The findings underscore the need for increased governmental healthcare funding and improved healthcare accessibility. Additionally, maintaining adequate sleep and physical activity can help prevent disability and reduce depression risk later in life, particularly among older adults with lower SES.
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Affiliation(s)
- Xiao Zheng
- Department of Health Management, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
- School of Health Management, Southern Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Philosophy and Social Sciences of Colleges and Universities in Guangdong Province for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Yu Yin
- Outpatient department, Air Force Medical Center, PLA, Beijing, China
| | - Lingli Yang
- Key Laboratory of Philosophy and Social Sciences of Colleges and Universities in Guangdong Province for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Xinyi Zhang
- School of Health Management, Southern Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Philosophy and Social Sciences of Colleges and Universities in Guangdong Province for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Shujuan Xiao
- School of Health Management, Southern Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Philosophy and Social Sciences of Colleges and Universities in Guangdong Province for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Xiaoyan Liang
- Department of Health Management, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
- Key Laboratory of Philosophy and Social Sciences of Colleges and Universities in Guangdong Province for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Jiaxin Lu
- Department of Health Management, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China
- Key Laboratory of Philosophy and Social Sciences of Colleges and Universities in Guangdong Province for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Xinru Li
- School of Health Management, Southern Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Philosophy and Social Sciences of Colleges and Universities in Guangdong Province for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Mengjie Zhang
- School of Health Management, Southern Medical University, Guangzhou, Guangdong, China
- Key Laboratory of Philosophy and Social Sciences of Colleges and Universities in Guangdong Province for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Feng Tian
- Department of Health Management, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China.
- Key Laboratory of Philosophy and Social Sciences of Colleges and Universities in Guangdong Province for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China.
| | - Chichen Zhang
- Department of Health Management, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), Foshan, Guangdong, China.
- School of Health Management, Southern Medical University, Guangzhou, Guangdong, China.
- Key Laboratory of Philosophy and Social Sciences of Colleges and Universities in Guangdong Province for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China.
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Senaratne DNS, Thakkar B, Smith BH, Hales TG, Marryat L, Colvin LA. The impact of adverse childhood experiences on multimorbidity: a systematic review and meta-analysis. BMC Med 2024; 22:315. [PMID: 39143489 PMCID: PMC11325707 DOI: 10.1186/s12916-024-03505-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 06/14/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have been implicated in the aetiology of a range of health outcomes, including multimorbidity. In this systematic review and meta-analysis, we aimed to identify, synthesise, and quantify the current evidence linking ACEs and multimorbidity. METHODS We searched seven databases from inception to 20 July 2023: APA PsycNET, CINAHL Plus, Cochrane CENTRAL, Embase, MEDLINE, Scopus, and Web of Science. We selected studies investigating adverse events occurring during childhood (< 18 years) and an assessment of multimorbidity in adulthood (≥ 18 years). Studies that only assessed adverse events in adulthood or health outcomes in children were excluded. Risk of bias was assessed using the ROBINS-E tool. Meta-analysis of prevalence and dose-response meta-analysis methods were used for quantitative data synthesis. This review was pre-registered with PROSPERO (CRD42023389528). RESULTS From 15,586 records, 25 studies were eligible for inclusion (total participants = 372,162). The prevalence of exposure to ≥ 1 ACEs was 48.1% (95% CI 33.4 to 63.1%). The prevalence of multimorbidity was 34.5% (95% CI 23.4 to 47.5%). Eight studies provided sufficient data for dose-response meta-analysis (total participants = 197,981). There was a significant dose-dependent relationship between ACE exposure and multimorbidity (p < 0.001), with every additional ACE exposure contributing to a 12.9% (95% CI 7.9 to 17.9%) increase in the odds for multimorbidity. However, there was heterogeneity among the included studies (I2 = 76.9%, Cochran Q = 102, p < 0.001). CONCLUSIONS This is the first systematic review and meta-analysis to synthesise the literature on ACEs and multimorbidity, showing a dose-dependent relationship across a large number of participants. It consolidates and enhances an extensive body of literature that shows an association between ACEs and individual long-term health conditions, risky health behaviours, and other poor health outcomes.
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Affiliation(s)
- Dhaneesha N S Senaratne
- Chronic Pain Research Group, Division of Population Health & Genomics, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK.
| | - Bhushan Thakkar
- Chronic Pain Research Group, Division of Population Health & Genomics, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Blair H Smith
- Chronic Pain Research Group, Division of Population Health & Genomics, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Tim G Hales
- Institute of Academic Anaesthesia, Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Louise Marryat
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Lesley A Colvin
- Chronic Pain Research Group, Division of Population Health & Genomics, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
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Ge T, Liu Y, Han Q, Cheng X, Jiang Q. Childhood intra- and extra-familial maltreatment and later-life trajectories of depressive symptoms: evidence from China. BMC Geriatr 2024; 24:598. [PMID: 38997623 PMCID: PMC11241985 DOI: 10.1186/s12877-024-05169-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 06/23/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Both late-life depression and childhood maltreatment have become major global public health issues, given their prevalence and social-economic and health consequences. However, previous studies have solely focused on the relationship of childhood maltreatment to average levels of depressive symptoms. The current study addresses this gap of knowledge by simultaneously examining the impacts of childhood intra- and extra-familial maltreatment on age trajectories of depressive symptoms in later life in the Chinese context. METHODS Hierarchical linear models were applied to data from the China Health and Retirement Longitudinal Study (2011-2018, N = 12,669 individuals aged 45 to 80, comprising N = 43,348 person-years). Depressive symptoms were measured by the CES-D-10 scale. Childhood intra-familial maltreatments were measured by physical abuse and emotional neglect, while extra-familial maltreatment was measured by peer bullying. All analyses were conducted separately by gender in Stata 16. RESULTS Childhood extrafamilial peer bullying (β = 1.628, p < 0.001), and intrafamilial physical abuse (β = 0.746, p < 0.001) and emotional neglect (β = 0.880, p < 0.001) were associated with higher later-life depressive symptoms levels in the whole sample. Peer bullying differences in depressive symptoms widened with age for both men and women. Physical abuse differences in depressive symptoms remained stable over the life course among men but increased among women. Emotional neglect differences in depressive symptoms decreased with age among men, while it increased first and then decreased among women. CONCLUSIONS Findings in this study suggest that childhood maltreatment is not only associated with later-life poorer mental health but contributes to increasing inequalities in mental health as people age, especially among peer-bullying victims and women.
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Affiliation(s)
- Tingshuai Ge
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Yixiao Liu
- School of Public Policy and Administration, Center for Public Economy & Public Policy, Chongqing University, Chongqing, China
| | - Qing Han
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Xinfeng Cheng
- School of Economics and Management, Xi'an Technological University, Xi'an, China
| | - Quanbao Jiang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
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Haczkewicz KM, Shahid S, Finnegan HA, Moninn C, Cameron CD, Gallant NL. Adverse childhood experiences (ACEs), resilience, and outcomes in older adulthood: A scoping review. CHILD ABUSE & NEGLECT 2024:106864. [PMID: 38926006 DOI: 10.1016/j.chiabu.2024.106864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 05/05/2024] [Accepted: 05/19/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Previous research has demonstrated a dose-response relationship between exposure to adverse childhood experiences (ACEs) and adverse outcomes in adulthood. Despite widely known associations, previous reviews have primarily focused on outcomes in younger and middle-aged adults exposed to ACEs to the exclusion of older adults and do not consider the potential role of resilience for understanding outcomes in older adulthood. OBJECTIVE The present scoping review aimed to examine the extent and nature of existing literature on the influence of ACEs and resilience on the cognitive, physical, mental, and social health outcomes among older adults. METHODS We conducted a search of five electronic databases (CINAHL, MEDLINE, PsycINFO, AgeLine, Scopus) using the following keywords: adversity, resilience, aging, and older adults. We limited our inclusion criteria to works published in English or French after 1998 as Felitti et al. published the first study describing ACEs in this year. RESULTS Of the 4926 studies screened, 27 studies met the inclusion criteria. Overall, results from the included studies indicated that exposure to adversity during childhood was associated with worse outcomes in older adulthood. Additionally, we found that resilience and resiliency-related factors (e.g., problem-focused coping strategies) mitigated or reduced harms associated with ACEs to improve outcomes in older adulthood. CONCLUSIONS Exposure to ACEs is associated with reduced functioning in later adulthood. Findings from this review indicate a need for further exploration into the role of ACEs, and the potential effects of resilience, on health outcomes in older adults to develop better individual- and population-level interventions for this group.
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Affiliation(s)
- Kelsey M Haczkewicz
- Department of Psychology and Centre on Aging and Health, University of Regina, 3737 Wascana Parkway, S4S 0A2, Canada
| | - Sheza Shahid
- Department of Psychology, University of Regina, 3737 Wascana Parkway, S4S 0A2, Canada
| | - Heather A Finnegan
- Department of Clinical Health Psychology, University of Manitoba (Bannatyne Campus), 771 Bannatyne Avenue, Canada
| | - Caroline Moninn
- Neil John Maclean Health Sciences Library, University of Manitoba, 727 McDermot Ave, R3E 3P5, Canada
| | - Courtney D Cameron
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - Natasha L Gallant
- Department of Psychology and Centre on Aging and Health, University of Regina, 3737 Wascana Parkway, S4S 0A2, Canada.
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Zhang G, Zhang H, Fu J, Zhao Y. Atherogenic Index of Plasma as a Mediator in the association between Body Roundness Index and Depression: insights from NHANES 2005-2018. Lipids Health Dis 2024; 23:183. [PMID: 38867232 PMCID: PMC11167922 DOI: 10.1186/s12944-024-02177-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 06/04/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Previous studies have shown a correlation between depression and obesity, as well as between depression and the Atherogenic Index of Plasma (AIP). However, there is limited research on the association between visceral obesity and depression, as well as the potential mediating role of AIP in this relationship. METHODS This study included 13,123 participants from the 2005-2018 National Health and Nutrition Examination Survey. Visceral obesity was measured with the Body Roundness Index (BRI), while depression was evaluated with the Patient Health Questionnaire-9. The AIP served as a marker for lipid disorders. To investigate the association between the BRI and depression, multivariate logistic regressions, restricted cubic spline models, subgroup analyses, and interaction tests were used. Additionally, a mediation analysis was conducted to explore the role of AIP in mediating the effect of BRI on depression. RESULTS There was a positive linear correlation between the BRI and depression. After controlling for all covariates, individuals in the highest BRI (Q4) group had an OR of 1.42 for depression (95% CI: 1.12-1.82) in comparison with individuals in the lowest BRI (Q1) group. Moreover, the AIP partially mediated the association between the BRI and depression, accounting for approximately 8.64% (95% CI: 2.04-16.00%) of the total effect. CONCLUSION The BRI was positively associated with depression, with the AIP playing a mediating role. This study provides a novel perspective on the mechanism that connects visceral obesity to depression. Managing visceral fat and monitoring AIP levels may contribute to alleviating depression.
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Affiliation(s)
- Genshan Zhang
- Department of Vascular Surgery, First Hospital of Lanzhou University, Lanzhou, 730030, China
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Haokun Zhang
- School of Public Health and Health Management, Gannan Medical University, Ganzhou, 341000, PR China
| | - Jie Fu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China.
| | - Yufeng Zhao
- Department of Vascular Surgery, First Hospital of Lanzhou University, Lanzhou, 730030, China.
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Ren Y, Yang S, Peng Y, Liu A, Zhu Z. Retrospective ACEs predict complex PTSD symptoms in a large sample of Chinese young adults longitudinally: the moderating role of self-compassion. BMC Psychiatry 2024; 24:425. [PMID: 38844888 PMCID: PMC11155039 DOI: 10.1186/s12888-024-05830-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 05/09/2024] [Indexed: 06/10/2024] Open
Abstract
This longitudinal study in Mainland China (2021-2022) explored the impact of adverse childhood experiences (ACEs) on complex posttraumatic stress disorder (CPTSD) symptoms, with a focus on the role of self-compassion. Among 18,933 surveyed university students, 21.2% reported experiencing at least one ACE. Results revealed a clear relationship between ACEs and CPTSD symptoms. Furthermore, self-compassion, particularly the dimensions of self-judgment and isolation, moderated the association between retrospective ACEs and posttraumatic stress disorder (PTSD) and disturbance in self-organization (DSO) symptoms. These findings highlight the enduring impact of ACEs on CPTSD symptoms and emphasize the importance of early identification and targeted interventions, especially addressing self-judgment and isolation, to mitigate CPTSD risk among young Chinese adults.
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Affiliation(s)
- Yizhen Ren
- Faculty of Psychology, Beijing Normal University, Beijing, 100875, China
| | - Shuhan Yang
- Faculty of Education, Yunnan Normal University, Kunming, 650500, China
| | - Yu Peng
- Students Mental Health Education & Counseling Center, Kunming University of Science and Technology, Kunming, 650500, China.
- Faculty of Social Sciences & Liberal Arts, UCSI University, Kuala Lumpur, 56000, Malaysia.
| | - Aiyi Liu
- Faculty of Psychology, Beijing Normal University, Beijing, 100875, China
| | - Zibin Zhu
- School of Philosophy, Psychology and Language Science, University of Edinburgh, Edinburgh, UK
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Yin H, Zhu Y, Tan L, Zhong X, Yang Q. The impact of adverse childhood experiences on depression in middle and late life: A national longitudinal study. J Affect Disord 2024; 351:331-340. [PMID: 38244797 DOI: 10.1016/j.jad.2024.01.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/05/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are one of the causes of depression in middle-aged and older adults, but the combined effects of ACEs, cognitive function and ability to perform activities of daily living (ADL) on depression have not been fully explored. METHODS This study was based on data from 4 waves (2013, 2014, 2015 and 2018) of data from the China Health and Retirement Longitudinal Study, including 10,995 middle-aged and older adults. ACEs were derived from the 2014 self-report life history module. A latent variable growth curve model was used to assess the mediating effect of cognitive function and ability to perform ADL in the relationship between ACEs and depression. RESULTS ACEs were significantly associated with lower initial cognitive status (β = -0.156, P < .001), worse ability to perform ADL (β = 0.051, P < .001) and higher severity of depression (β = 0.228, P < .001). The results of mediation analysis indicated that the association between ACEs and the intercept of depression was partly mediated by the initial level of cognitive function and ADL, and the association between ACEs and the slope of depression was total mediated by cognitive (intercept and slope) and ADL (intercept and slope). CONCLUSIONS ACEs were associated with higher severity of depression in part due to lower cognitive function and worse ability to perform ADL. Interventions that focus on reducing ACEs and improving cognitive level and ability to perform ADL may effectively reduce the incidence of depression among middle-aged and older individuals.
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Affiliation(s)
- Haojie Yin
- Department of Respiratory and Critical Care Medicine, Neijiang First People's Hospital, Neijiang, China
| | - Yan Zhu
- Department of Hepatobiliary Surgery, Neijiang First People's Hospital, Neijiang, China
| | - Limei Tan
- Department of Respiratory and Critical Care Medicine, Neijiang First People's Hospital, Neijiang, China
| | - Xianli Zhong
- Department of Hepatobiliary Surgery, Neijiang First People's Hospital, Neijiang, China
| | - Qing Yang
- Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
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Babatunde OA, Ramkumar SP, Nguyen SA, Okereke OI, Clark FA, Nagar A, Osazuwa-Peters N, Adjei Boakye E. Association between number of Adverse Childhood Experiences and depression among older adults is moderated by race. Prev Med 2024; 181:107921. [PMID: 38423302 DOI: 10.1016/j.ypmed.2024.107921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE This study aimed to assess the association between number of Adverse Childhood Experiences (ACE) and history of depression among older adults and to explore the interaction by race. METHODS This study was a cross-sectional analysis of the 2020 Behavioral Risk Factor Surveillance System (BRFSS) data among 60,122 older respondents (≥ 60 years old). The ACE score (zero, one, two-three, ≥four) included questions assessing exposure to eight types of ACEs before age 18. The outcome was the respondent's self-report depression diagnosed (yes/no). Multivariable logistic regression models examined the association between ACEs and depression stratified by race. Each model adjusted for age, smoking status, income, education, marital status, and body mass index. RESULTS In this sample of older adults, 47%, 23%, 19% and 10% reported having experienced zero, one, two-three, and four or more types of ACEs, respectively. Depression was reported by 16% of survey respondents. There was a significant interaction between ACE score and race and depression (p = 0.038). Respondents who experienced ≥4 ACEs had higher likelihood of reporting depression for all race/ethnicity groups: non-Hispanic Whites (aOR = 3.83; 95% CI: 3.07, 4.79), non-Hispanic Blacks (aOR = 3.39, 95% CI: 1.71, 6.71), or Hispanics (aOR = 12.61; 95% CI: 4.75, 33.43). This translated to a large effect size for non-Hispanic Whites and Hispanics although the magnitude was bigger for Hispanics. CONCLUSION The association between number of ACEs and depression was strongest for older adults who identify as Hispanic, but weaker and less consistent for adults who identify as White and Black.
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Affiliation(s)
| | | | - Sarah A Nguyen
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, LA, USA
| | - Olivia I Okereke
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Frank A Clark
- Prisma Health, Greer, SC, USA; University of South Carolina School of Medicine-Greenville, Greenville, SC, USA
| | - Anusuiya Nagar
- Prisma Health, Greer, SC, USA; University of South Carolina School of Medicine-Greenville, Greenville, SC, USA
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, USA; Duke University School of Medicine, Department of Population Health Sciences, Durham, NC, USA; Duke Cancer Institute, Durham, NC, USA
| | - Eric Adjei Boakye
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA; Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health System, Detroit, MI, USA
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Sarkar S, Jackson B, Manzo LL, Jeon S, Poghosyan H. Association between adverse childhood experiences and self-reported health-risk behaviors among cancer survivors: A population-based study. PLoS One 2024; 19:e0299918. [PMID: 38512934 PMCID: PMC10956880 DOI: 10.1371/journal.pone.0299918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/18/2024] [Indexed: 03/23/2024] Open
Abstract
AIMS Existing evidence shows that people who report Adverse Childhood Experiences (ACEs) are more likely to exhibit health-risk behaviors. However, limited research on this topic pertains to oncology population. We aim to address this knowledge gap by estimating the prevalence of ACEs and investigating their association with self-reported health-risk behaviors among adult cancer survivors living in the U.S. METHODS We conducted a secondary analysis using cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System ACE module. We included 4,126 adults, aged ≥18 years, with a history of cancer. The outcome variable was self-reported health-risk behaviors, which included cigarette smoking, e-cigarette use, and binge alcohol drinking. Self-reported ACEs history was the primary independent variable, comprised of 11 questions regarding child abuse and dysfunctional households. We conducted descriptive statistics and multivariable logistic regression to describe the relationship between the ACE history and health-risk behaviors. RESULTS Overall, 84.2% of cancer survivors self-reported as White, 58.4% were women, and 76.6% were aged 65+ years. Nearly two-thirds of the sample (63.2%) self-reported at least one ACE (prior to age 18) and 21.7% engaged in ≥1 health-risk-behaviors, such as cigarette smoking, binge alcohol drinking, or e-cigarette use. Experiencing ≥3 ACEs was associated with 145% increased odds of reporting at least one health-risk behavior (OR = 2.45, 95% CI [1.78-3.38]) when compared to those without a history of ACEs. Besides, survivors who were younger, divorced, less educated, and had low income had higher odds of reporting at least one health-risk behavior. CONCLUSIONS Overall, a history of ACEs is associated with health-risk behaviors. These all can negatively impact cancer survivors' overall well-being. Early screening for ACE during oncologic visits can be a protective measure for preventing health-risk behaviors among cancer survivors.
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Affiliation(s)
- Sayantani Sarkar
- Yale University School of Nursing, Orange, CT, United States of America
| | - Brianna Jackson
- Yale University School of Nursing, Orange, CT, United States of America
| | - Laura L. Manzo
- Yale University School of Nursing, Orange, CT, United States of America
- US Army, AMEDD Student Detachment, Joint Base San Antonio, Fort Sam Houston, TX, United States of America
| | - Sangchoon Jeon
- Yale University School of Nursing, Orange, CT, United States of America
| | - Hermine Poghosyan
- Yale University School of Nursing, Orange, CT, United States of America
- COPPER Center, Yale School of Medicine, New Haven, CT, United States of America
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Taylor K, Demakakos P. Adverse childhood experiences and trajectories of multimorbidity in individuals aged over 50: Evidence from the English Longitudinal Study of Ageing. CHILD ABUSE & NEGLECT 2024; 149:106653. [PMID: 38277873 DOI: 10.1016/j.chiabu.2024.106653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACE) are important for chronic diseases yet their association with multimorbidity remains understudied. Few studies consider the complexity of multimorbidity or observe multimorbidity development over time. OBJECTIVE We investigated whether ACE were associated with multimorbidity at baseline and over a 12-year follow-up period. PARTICIPANTS AND SETTING 5326 participants aged over 50 were obtained from the English Longitudinal Study of Ageing (ELSA). METHODS An ACE summary score was derived using eight ACE items measuring abuse, social care, and household dysfunction. From repeated measurements of 29 chronic conditions over a 12-year period (2008-2019) we derived two multimorbidity measures: number of chronic diseases and number of chronic disease categories. We used multinomial logistic regression to assess associations between ACE and both measures. Mixed effects models were estimated to examine trajectories of multimorbidity by ACE over time. RESULTS Graded associations between ACE and multimorbidity were observed. Compared to those without ACE, participants with ≥3 ACE had three times the risk of having ≥3 chronic diseases (RRR 3.06, 95 % CI 1.85-5.05) and falling into ≥3 chronic disease categories (RRR 2·93 95 % CI 1·74-4·95). Graded associations persisted during 12-year follow-up, though differences in multimorbidity between those with ≥3 ACE and those without ACE remained constant (B 0.02, 95 % CI 0·01-0·03, and B -0·01, 95 % CI -0·02-0·00, number of chronic conditions and chronic condition categories respectively). CONCLUSION ACE are associated with multimorbidity risk and complexity, associations arising before the age of 50. Early intervention amongst those with ACE could attenuate this association.
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Affiliation(s)
- Katherine Taylor
- Division of Biosciences, Medical Sciences Building, University College London, Gower Street, London WC1E 6BT, United Kingdom of Great Britain and Northern Ireland.
| | - Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom of Great Britain and Northern Ireland
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Zheng X, Xue B, Xiao S, Li X, Chen Y, Shi L, Liang X, Tian F, Zhang C. Development and validation of a multimorbidity risk prediction nomogram among Chinese middle-aged and older adults: a retrospective cohort study. BMJ Open 2023; 13:e077573. [PMID: 37940154 PMCID: PMC10632863 DOI: 10.1136/bmjopen-2023-077573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/18/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVES The aim of this study is to establish a self-simple-to-use nomogram to predict the risk of multimorbidity among middle-aged and older adults. DESIGN A retrospective cohort study. PARTICIPANTS We used data from the Chinese Longitudinal Healthy Longevity Survey, including 7735 samples. MAIN OUTCOME MEASURES Samples' demographic characteristics, modifiable lifestyles and depression were collected. Cox proportional hazard models and nomogram model were used to estimate the risk factors of multimorbidity. RESULTS A total of 3576 (46.2%) participants have multimorbidity. The result showed that age, female (HR 0.80, 95% CI 0.72 to 0.89), chronic disease (HR 2.59, 95% CI 2.38 to 2.82), sleep time (HR 0.78, 95% CI 0.72 to 0.85), regular physical activity (HR 0.88, 95% CI 0.81 to 0.95), drinking (HR 1.27 95% CI 1.16 to 1.39), smoking (HR 1.40, 95% CI 1.26 to 1.53), body mass index (HR 1.04, 95% CI 1.03 to 1.05) and depression (HR 1.02, 95% CI 1.01 to 1.03) were associated with multimorbidity. The C-index of nomogram models for derivation and validation sets were 0.70 (95% CI 0.69 to 0.71, p=0.006) and 0.71 (95% CI 0.70 to 0.73, p=0.008), respectively. CONCLUSIONS We have crafted a user-friendly nomogram model for predicting multimorbidity risk among middle-aged and older adults. This model integrates readily available and routinely assessed risk factors, enabling the early identification of high-risk individuals and offering tailored preventive and intervention strategies.
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Affiliation(s)
- Xiao Zheng
- Department of Health Management, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), Foshan, China
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Benli Xue
- School of Health Management, Southern Medical University, Guangzhou, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Shujuan Xiao
- School of Health Management, Southern Medical University, Guangzhou, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Xinru Li
- School of Health Management, Southern Medical University, Guangzhou, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Yimin Chen
- School of Health Management, Southern Medical University, Guangzhou, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Lei Shi
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Xiaoyan Liang
- Department of Health Management, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), Foshan, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Feng Tian
- Department of Health Management, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), Foshan, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Chichen Zhang
- School of Health Management, Southern Medical University, Guangzhou, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
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12
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Zheng X, Xue Y, Dong F, Shi L, Xiao S, Zhang J, Xue B, Qian Y, Zhu H, Man Q, Zhang C. The association between health-promoting-lifestyles, and socioeconomic, family relationships, social support, health-related quality of life among older adults in china: a cross sectional study. Health Qual Life Outcomes 2022; 20:64. [PMID: 35443689 PMCID: PMC9022255 DOI: 10.1186/s12955-022-01968-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 03/29/2022] [Indexed: 12/30/2022] Open
Abstract
Objectives Lifestyles, accounting for 53% in determining death, play a vital role in improving the health of older adults. Thus, this study aimed to explore the influencing factors of the health-promoting-lifestyles and interaction mechanisms among older adults. Methods A total of 8526 elders were selected by a three-stage stratified random cluster sampling method. Socioeconomic status, family relationships, social support, health-related quality of life (QOL), and health-promoting-lifestyles (HPLP) of older adults were assessed with the Social Support Rating Scale, the short form 36 health survey (SF-36) and Health-Promoting Lifestyle Profile. A structural equation model (SEM) was conducted to test the direct and indirect association between influencing factors with HPLP. Results In this study, there were 4901 older adults who were empty nesters, and 3625 were non-empty nesters. Of all respondents, the average QOL score of older adults was 62.28 ± 16.51, average social support score was 78.06 ± 7.50. The HPLP score of older adults was 105.9 ± 19.6, and the average score of subscales was 2.5 ± 0.5, which was at the medium level. Social support had a positive and direct effect on HPLP of older adults (total effect, 0.34). Meanwhile, social support mediated the relationship between socioeconomic (total effect, 0.17), QOL (total effect, 0.33) and HPLP. Family relationships had a small indirect effect on HPLP via social support (0.01). Conclusions Social support is the strongest influencing factor in the health-promoting-lifestyles among older adults, followed by socioeconomic, health-related quality of life and family support. Thus, maintaining higher social support was important to improve the HPLP of older adults.
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Affiliation(s)
- Xiao Zheng
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China.,School of Health Management, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, Guangdong, China
| | - Yaqing Xue
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China.,School of Health Management, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, Guangdong, China
| | - Fang Dong
- School of Health Management, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, Guangdong, China
| | - Lei Shi
- School of Health Management, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, Guangdong, China
| | - Shujuan Xiao
- School of Health Management, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, Guangdong, China
| | - Jiachi Zhang
- School of Health Management, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, Guangdong, China
| | - Benli Xue
- School of Health Management, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, Guangdong, China
| | - Yi Qian
- School of Health Management, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, Guangdong, China
| | - Hong Zhu
- Institute of Health Management Southern Medical University, Guangzhou, Guangdong, China
| | - Qiang Man
- School of International Education, Southern Medical University, Guangzhou, Guangdong, China.
| | - Chichen Zhang
- School of Health Management, Southern Medical University, No. 1023, South Shatai Road, Baiyun District, Guangzhou, Guangdong, China. .,Institute of Health Management Southern Medical University, Guangzhou, Guangdong, China. .,Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
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