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Moser N, Sahiti F, Gelbrich G, Cejka V, Kerwagen F, Albert J, Frantz S, Heuschmann PU, Störk S, Morbach C. Association between self-reported and objectively assessed physical functioning in the general population. Sci Rep 2024; 14:16236. [PMID: 39004682 PMCID: PMC11247090 DOI: 10.1038/s41598-024-64939-z] [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: 02/21/2024] [Accepted: 06/14/2024] [Indexed: 07/16/2024] Open
Abstract
Knowledge about a patient's physical fitness can aid in medical decision-making, but objective assessment can be challenging and time-consuming. We aimed to investigate the concordance of self-reported health status and physical functioning with the 6 minute walking distance (6MWD) as objective measure of physical performance. The prospective characteristics and course of heart failure stages A/B and determinants of progression (STAAB) cohort study iteratively follows a representative sample of residents of the city of Würzburg, Germany, aged 30-79 years, without a history of heart failure (HF). The 6MWD was measured in 2752 individuals (aged 58 ± 11 years, 51% women) from a population-based cohort under strictly standardized conditions. Self-reported health status and physical functioning were assessed from items of the short form 36 (SF-36). After the respective classification of self-reported health status and physical functioning into 'good', 'moderate', and 'poor', we determined the association of these categories with 6MWD by applying a generalized linear model adjusted for age and sex. Prevalence of self-reported good/moderate/poor general health and physical functioning was 41/52/7% and 45/48/7%, respectively. Mean 6MWD in the respective categories was 574 ± 70/534 ± 76/510 ± 87 m, and 574 ± 72/534 ± 73/490 ± 82 m, with significant sex-specific differences between all categories (all p < 0.001) as well as significant differences between the respective groups except for the categories 'moderate' and 'poor' health status in men. This cross-sectional analysis revealed a strong association between self-reported health status and physical functioning with the objective assessment of 6MWD, suggesting that physicians can rely on their patients' respective answers. Nevertheless, sex-specific perception and attribution of general health and physical functioning deserve further in-depth investigation. Decision-making based on self-reported health requires prospective evaluation in population-based cohorts as well as adult inpatients.
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Affiliation(s)
- Nicola Moser
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078, Würzburg, Germany
| | - Floran Sahiti
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078, Würzburg, Germany
- Department Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Götz Gelbrich
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078, Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - Vladimir Cejka
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078, Würzburg, Germany
| | - Fabian Kerwagen
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078, Würzburg, Germany
- Department Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Judith Albert
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078, Würzburg, Germany
- Department Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Frantz
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078, Würzburg, Germany
- Department Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Peter U Heuschmann
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078, Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - Stefan Störk
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078, Würzburg, Germany
- Department Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Caroline Morbach
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078, Würzburg, Germany.
- Department Medicine I, University Hospital Würzburg, Würzburg, Germany.
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Pitkänen J, Junna L, Martikainen P. Adolescent Psychiatric Inpatient Episodes and Subsequent Labor Market Trajectories. J Adolesc Health 2024; 74:1175-1183. [PMID: 38493397 DOI: 10.1016/j.jadohealth.2024.02.001] [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: 06/01/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE Adolescents with psychiatric disorders are known to be more often not in education, employment, or training (NEET) in young adulthood than their peers. However, since most of the available evidence is based on cross-sectional measurement of NEET, there is less evidence on the processes underlying these differences in labor market disadvantage. We assessed these processes by examining transitions between NEET and non-NEET states across young adulthood and the differences in these transitions by adolescent psychiatric inpatient treatment. METHODS We used longitudinal register data on all individuals born in Finland in 1980-1984 (N = 315,508) to identify psychiatric inpatient episodes between ages 10 and 19 and NEET between ages 20 and 34. We modeled the transitions between NEET and non-NEET states and the impact of psychiatric disorders on these transitions with multistate models. RESULTS Individuals who had psychiatric inpatient episodes in adolescence started their labor market careers as NEET twice as often as their peers. They were also more likely to transition into NEET states and less likely to transition out of NEET. In total, individuals with a history of psychiatric episodes spent from 1.8 to 6.9 more years as NEET between the ages 20 and 34 than their peers, depending on sex, baseline NEET, and diagnostic group. DISCUSSION Adolescents with severe psychiatric disorders are highly vulnerable in terms of labor market outcomes throughout their early adulthood. Supportive measures are required both at the start of employment trajectories and during later career stages.
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Affiliation(s)
- Joonas Pitkänen
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland.
| | - Liina Junna
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland
| | - Pekka Martikainen
- Helsinki Institute for Demography and Population Health, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland; Max Planck - University of Helsinki Center for Social Inequalities in Population Health, Helsinki, Finland; Max Planck Institute for Demographic Research, Rostock, Germany
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Chae WR, Kohring C, Rohde C, Köhler-Forsberg O, Otte C, Holstiege J. Eight-year nationwide study of the bidirectional association between type 2 diabetes and depression in nearly 8 million German outpatients. BMJ Open Diabetes Res Care 2024; 12:e003903. [PMID: 38719506 PMCID: PMC11085903 DOI: 10.1136/bmjdrc-2023-003903] [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: 11/09/2023] [Accepted: 03/23/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Research linking type 2 diabetes and depression mostly relied on hospital-based diagnoses or prescription data, overlooking many outpatient diagnoses. We aimed to quantify the risks of depression in individuals newly diagnosed with type 2 diabetes, and type 2 diabetes in those newly diagnosed with depression, while exploring potential risk differences depending on age, sex, and follow-up time. RESEARCH DESIGN AND METHODS We conducted a matched cohort study using German nationwide outpatient claims data from 2012 to 2022. Participants were individuals newly diagnosed with type 2 diabetes (N=294 642) or depression (N=1 271 537) in 2015, matched in a 1:4 ratio to controls without these conditions by age, sex, and region. The bidirectional risk was evaluated over an 8-year period using mixed-effects Cox proportional hazards models, adjusting for the Charlson Comorbidity Index, urbanicity, and area-level deprivation. RESULTS New type 2 diabetes diagnosis was associated with higher depression risk over 8 years (N=54 561 with depression, HR=1.23, 99% CI=1.21 to 1.24). Similarly, depression diagnosis was linked to an increased type 2 diabetes risk (N=71 848 with type 2 diabetes, HR=1.15, 99% CI=1.14 to 1.17). The association between depression and type 2 diabetes was stronger in younger age groups, especially under 34 years. Findings held across sex-stratified analyses. Time stratification showed a more pronounced association between type 2 diabetes and depression risk during the earlier follow-up quarters, whereas the risk of developing type 2 diabetes after depression diagnosis remained constant throughout the follow-up period. CONCLUSIONS Our findings confirm a bidirectional link between type 2 diabetes and depression, particularly in younger individuals. As type 2 diabetes and depression are frequent, future research needs to study whether preventive approaches can reduce the risk of developing this comorbidity.
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Affiliation(s)
- Woo Ri Chae
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Berlin, Germany
- DZPG, German Center for Mental Health, partner site Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Clinician Scientist Program, Berlin, Germany
| | - Claudia Kohring
- Central Research Institute of Ambulatory Health Care in Germany (Zi), Department of Epidemiology and Health Care Atlas, Berlin, Germany
| | - Christopher Rohde
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
| | - Christian Otte
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Berlin, Germany
- DZPG, German Center for Mental Health, partner site Berlin, Germany
| | - Jakob Holstiege
- Central Research Institute of Ambulatory Health Care in Germany (Zi), Department of Epidemiology and Health Care Atlas, Berlin, Germany
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Ni J, Yan Y, Du W, Tian Y, Fan L. Depressive symptoms, alone or together with physical comorbidity, are predictive of healthcare use and spending in older adults. J Psychosom Res 2023; 174:111482. [PMID: 37734253 DOI: 10.1016/j.jpsychores.2023.111482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 08/29/2023] [Accepted: 09/02/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE Depressive symptoms and physical comorbidity are common health problems in older adults and are both posing increasingly considerable challenges to global healthcare systems. This study investigated the relationships of depressive symptoms, alone or together with physical comorbidity, with healthcare utilization and spending among older adults, as well as examined sex differences. METHODS We used data of the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018 and enrolled 6519 participants. Depressive symptoms was operationalized following the Center for Epidemiological Studies Depression Scale and physical comorbidity was assessed according to the presence of 11 physical non-communicable diseases. The relationships of depressive symptoms and comorbidity with healthcare outcomes were examined using mixed-effects regression models. RESULTS Compared with the neither depressive symptoms nor physical comorbidity category, older adults classified as depressive symptoms-only, physical comorbidity-only or both conditions were all associated with elevated risks for healthcare use and spending (all OR/IRR > 1; all p < 0.001). Depressive symptoms and physical comorbidity in combination consistently led to higher risks for studied endpoints than either condition alone (outpatient visit: OR = 3.50, outpatient visit number: IRR = 3.39, inpatient visit: OR = 3.35, hospitalization days: IRR = 2.82, catastrophic health expenditure: OR = 1.70; all p-trend < 0.001). Stratification analyses revealed similar relationships irrespective of sex. CONCLUSION Depressive symptoms and physical comorbidity are separately and jointly associated with increased healthcare utilization and spending among Chinese older adults. These two conditions in combination lead to highest risks than either condition alone. Early screen for depressive symptoms, alone or together with physical comorbidity, may offer implications for appropriate policy interventions.
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Affiliation(s)
- Jinmeng Ni
- School of Public Health, Southeast University, Nanjing 210009, China
| | - Yuhan Yan
- Department of Geriatrics, General Hospital of Eastern Theater Command, Nanjing 210000, China
| | - Wei Du
- School of Public Health, Southeast University, Nanjing 210009, China
| | - Yong Tian
- School of Public Health, Southeast University, Nanjing 210009, China
| | - Lijun Fan
- School of Public Health, Southeast University, Nanjing 210009, China.
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Nair SC, Al Saraj Y, Sreedharan J, Vijayan K, Ibrahim H. Health literacy levels in patients with type 2 diabetes in an affluent Gulf country: a cross-sectional study. BMJ Open 2023; 13:e069489. [PMID: 36746537 PMCID: PMC9906167 DOI: 10.1136/bmjopen-2022-069489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES To identify health literacy levels in patients with type 2 diabetes mellitus in the United Arab Emirates (UAE). INTERVENTION Nationwide cross-sectional survey. SETTING AND PARTICIPANTS Individuals with type 2 diabetes mellitus attending outpatient diabetes clinics in all emirates of the UAE were surveyed between January 2019 and May 2020. Out of 832 patients approached, 640 met the inclusion criteria and agreed to participate. OUTCOME VARIABLES The outcome variable of interest was the health literacy level, which was measured using the Eastern-Middle Eastern Adult Health Literacy 13 Questionnaire. The association of health literacy level with age, gender and education was conducted using the Χ2 test. RESULTS Only 11% of respondents had adequate health literacy levels. Age and education were directly correlated with health literacy levels. Patients under age 50 years had statistically significant higher rates of marginal (106 of 238, 44.5%) and adequate literacy (67 of 238, 28.2%, p<0.001) than the older population. Participants with bachelor's or postgraduate degrees also had significantly higher adequate health literacy levels (24 of 79, 30.4%, p<0.001). CONCLUSIONS The low health literacy levels found in outpatients with diabetes may be a major challenge to optimising diabetes care in the UAE. In addition to health services strategies, targeted educational and behavioural interventions for the older population and those with less formal education are necessary.
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Affiliation(s)
- Satish Chandrasekhar Nair
- Academic Affairs, Tawam Hospital, Al Ain, UAE
- College of Medicine, United Arab Emirates University, Al Ain, UAE
| | - Yasir Al Saraj
- College of Dentistry, Loma Linda University, Loma Linda, California, USA
| | | | - Karthik Vijayan
- College of Medicine, Shri Satya Sai Medical College and Research Institute, Nellikuppam, India
| | - Halah Ibrahim
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, UAE
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Nair SC, Sreedharan J, Satish KP, Ibrahim H. Health literacy in a high income Arab country: A nation-wide cross-sectional survey study. PLoS One 2022; 17:e0275579. [PMID: 36197929 PMCID: PMC9534436 DOI: 10.1371/journal.pone.0275579] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Health literacy is a powerful predictor of health outcomes, but remains a global challenge. There is a paucity of published data and limited understanding of the health literacy of patients in the Middle East. The purpose of this study was to assess the patient health literacy levels in the United Arab Emirates (UAE) and identify associated demographic characteristics. METHODS A cross-sectional survey of adult patients attending public and private hospitals and primary care clinics was conducted across the UAE between January 2019 and May 2020. Chi-square test was used to analyze the association between health literacy and demographic variables. Ordinal regression was adopted to analyze the data for statistically significant independent variables. RESULTS 2349 of 2971 patients responded (79% response rate). Slightly less than one-quarter (23.9%) of patients surveyed demonstrated adequate health literacy. Over a third of women respondents (31.7%) possessed adequate health literacy, as compared to only 13% of men surveyed (p<0.001). Participant age was significantly (p<0.001) associated with health literacy levels, with approximately 50% of participants above age 50 years (51-75 years) demonstrating inadequate health literacy. Education was also positively correlated with health literacy. Adequate health literacy levels were twofold higher (30.5%, p<0.001) in patients with high school education, as compared to patients without secondary education. CONCLUSIONS The high proportion of patients with inadequate health literacy in our study confirms that the health literacy deficit is a challenge in the UAE. Targeted interventions are needed to improve health literacy, particularly for older individuals, to optimize healthcare utilization and improve individual and population health outcomes.
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Affiliation(s)
- Satish Chandrasekhar Nair
- Department of Academic Affairs, Tawam Hospital, Al Ain, United Arab Emirates
- College of Medicine, UAE University, Al Ain, United Arab Emirates
| | - Jayadevan Sreedharan
- Department of Community Medicine, College of Medicine, Gulf Medical University, Ajman, United Arab Emirates
| | | | - Halah Ibrahim
- Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates
- * E-mail:
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Singer S, Engesser D, Wirp B, Lang K, Paserat A, Kobes J, Porsch U, Mittag M, Taylor K, Gianicolo E, Maier L. Effects of a statutory reform on waiting times for outpatient psychotherapy: A multicentre cohort study. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Susanne Singer
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) University Medical Centre, Johannes Gutenberg University Mainz Mainz Germany
| | - Deborah Engesser
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) University Medical Centre, Johannes Gutenberg University Mainz Mainz Germany
| | - Bernhild Wirp
- Community‐based Practice for Psychotherapy Braunschweig Germany
| | - Klaus Lang
- Community‐based Practice for Psychotherapy Munich Germany
| | - Anke Paserat
- Community‐based Practice for Psychotherapy Dresden Germany
| | - Jörg Kobes
- Community‐based Practice for Psychotherapy Jena Germany
| | - Udo Porsch
- Mainz Psychoanalytic Institute (MPI) Mainz Germany
| | - Martina Mittag
- Community‐based Practice for Psychotherapy Stuttgart Germany
| | - Katherine Taylor
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) University Medical Centre, Johannes Gutenberg University Mainz Mainz Germany
| | - Emilio Gianicolo
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) University Medical Centre, Johannes Gutenberg University Mainz Mainz Germany
- Institute of Clinical Physiology National Research Council Lecce Italy
| | - Lena Maier
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI) University Medical Centre, Johannes Gutenberg University Mainz Mainz Germany
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Roxo L, Perelman J. Investigating unrecognized needs and structural barriers to treatment of depressive symptoms: A nationwide cross-sectional study in Portugal. Psychiatry Res 2022; 313:114623. [PMID: 35597138 DOI: 10.1016/j.psychres.2022.114623] [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: 02/22/2022] [Revised: 05/03/2022] [Accepted: 05/08/2022] [Indexed: 11/19/2022]
Abstract
This study assesses factors associated with perception of need and affordability concerns regarding mental health services (MHS), among 978 persons with meaningful depressive symptoms (Patient Health Questionnaire≥10). We used data from the 6th Portuguese National Health Interview Survey and used logistic regressions with gender, age, severity of symptoms, education, and income as explanatory variables. Health insurance was added as mediation variable. Unrecognized need (59.3% of the sample) was more likely amongst men, those over 65, high-educated, and those with moderate symptoms, compared to women, aged 18-34, low-educated, and those with severe symptoms. Among those reporting they needed MHS, 44.6% were not able to pay for them. Affordability concerns were more likely amongst men, those under 50, severely depressed, high-educated, and less likely amongst those within the highest income quintile. Adjusting for health insurance did not change the results in a meaningful way. Unrecognized need and affordability concerns are common among depressed persons in Portugal but seem unevenly distributed across social groups. Investing in the capacity of primary healthcare services to treat depression may be crucial to promote perception of need and reduce structural barriers.
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Affiliation(s)
- Luis Roxo
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal; Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal; Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal.
| | - Julian Perelman
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal; Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal; Comprehensive Health Research Centre (CHRC), Universidade NOVA de Lisboa, Lisbon, Portugal.
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