Impairment, disability, social support and depression among older parents in rural Thailand

Receiving financial support and its association with late-age depression: The mediating role of social engagement

OBJECTIVES

Researchers have long been concerned with the association between family financial support and depression in older adults. However, it remains unclear whether social engagement influences the relationship between depression and financial support in later life. Therefore, this study aims to examine the relationship between receiving financial support from family and others and depression among Indian older adults and to also explore the mediating effect of social engagement on this relationship.

SUBJECTS AND METHODS

Data from the Longitudinal Aging Study in India Wave 1 (2017-2018) was used for the empirical analysis. A total sample of 30,210 older adults aged 60 years and above were selected for the study. The study employs bivariate and binary logistic regression analysis. Further Karlson-Holm-Breen method was adopted for mediation analysis.

RESULTS

The adjusted prevalence of depression among older adults who did not receive financial support from family or others was nearly 33.8 % (men: 29.8 %, women: 37.4 %), compared to 29.9 % for those who received support (men: 27.6 %, women: 32 %). Older adults who received financial support had 21 % lower odds of depression (AoR: 0.79; 95 % CI: 0.73, 0.84) than those who did not. Additionally, the association between depression and receiving financial support was mediated by social engagement (17.3 %) with the mediating effect being higher among older women (29.3 %) than older men (13.5 %).

CONCLUSION

The study advances that although financial support plays a significant role in reducing depressive symptoms in older adults, social engagement also serves as an important mediator in this relationship. Enhancing opportunities for social engagement may amplify the protective effects of financial support, offering a more comprehensive approach to addressing mental health challenges among aging populations in India.

Comparing the role of social connectivity with friends and family in depression among older adults in China: evaluating the moderating effect of urban-rural status

Background

Social connectivity and support can reduce depressive symptoms. Few studies have examined urban-rural differences in the relationship between social support and depressive symptoms in the context of urbanization for Chinese older adults. The overall aim of this study is to examine urban-rural differences in the relationship between family support and social connectivity on depression among Chinese older adults.

Methods

This cross-sectional study used data from the 2010 Sample Survey on Aged Population in Urban/Rural China (SSAPUR). Depressive symptoms were measured using the Geriatric Depression Scale short-form (GDS-15). Family support was measured by structural, instrumental, and emotional support. Social connectivity was measured using the Lubben Social Network Scale-6 (LSNS-6). Descriptive analysis was conducted using chi-square and independent t-tests to examine urban-rural differences. Adjusted multiple linear regressions were conducted to examine the moderating effect of urban-rural status on the association between types of family support and social connectivity with depressive symptoms.

Results

In rural areas, respondents who felt their children exhibited filial piety (β = -1.512, p < 0.001) and had more social connectivity with family (β = -0.074, p < 0.001) were more likely to report fewer depression symptoms. In urban areas, respondents who received instrumental support from their children (β = -1.276, p < 0.01), who thought their children exhibited filial piety (β = -0.836, p < 0.01), and who had more social connectivity with friends (β = -0.040, p < 0.01) were more likely to report fewer depression symptoms. In the fully adjusted regression model, social connectivity with family was associated with decreased depressive symptoms, although to a lesser degree among urban-dwelling older adults (urban-rural interaction effect, β = 0.053, p < 0.05). Social connectivity with friends was similarly associated with decreased depressive symptoms, although this effect was greater among urban-dwelling older adults (urban-rural interaction effect, β = -0.053, p < 0.05).

Conclusion

The results of this study suggested that older adults both in rural and urban areas with family support and social connectivity were associated with fewer depression symptoms. Differences observed in the role of family and friend social connectivity by urban-rural status may provide practical information for developing targeted social support strategies for improving depressive symptoms among Chinese adults, and call for further mixed-methods research to disentangle mechanisms behind these differing associations.

Age-varying relationships between family support and depressive symptoms in Chinese community-dwelling older adults

BACKGROUND

Adequate family support is an important factor in reducing the risk of depressive symptoms in older adults. We aimed to explore the age-varying relationships of family support and depressive symptoms in community-dwelling older adults.

METHODS

A total of 22,163 person-waves of older adults aged 60 to 85 years from the China Health and Retirement Longitudinal Survey were included. Depressive symptoms were assessed by the Center for Epidemiological Studies Depression Scale. Family support was divided into instrumental family support and emotional family support. A Time-Varying Effects Model was utilized to analyze the age-varying relationships.

RESULTS

There were age-varying relationships between family support and depressive symptoms in community-dwelling older adults. Around age 70 was an important turning point of age. In instrumental family support, access to living care can reduce the risk of depressive symptoms in almost all age groups. At least medium-level financial support was required to be protective against depressive symptoms, and high-level financial support was necessary after age 70. In emotional family support, meeting children with high frequency was significantly associated with a lower risk of depressive symptoms before age 70. Contacting children with low or medium frequency added the risk of depressive symptoms before age 70.

LIMITATIONS

Limited sample size of participants aged 80 years and above, lack of assessment for expectations of family support.

CONCLUSIONS

Providing the appropriate type and intensity of family support for older adults at a suitable age was encouraged. Future research should further verify and explicate the age-varying relationships longitudinally.

Health related quality of life among people with mental illness: The role of socio-clinical characteristics and level of functional disability

Background

People with mental illness (PWMI) have declining health related quality of life (HRQoL), which is frequently equivalent to or greater than that of medical disorders. Although, HRQoL is rapidly being recognized as an essential treatment outcome indicator in modern psychiatry, research on the identification and significance of factors impacting QoL in PWMI is still in its early stages.

Objective

The aim of this study was to identify predictors of HRQoL among people with mental illness who underwent outpatient follow-up in Sidama region, southern Ethiopia.

Methods

We conducted a multicenter, cross-sectional study from April-1, to May-30, 2022. A total of 412 participants took part in the study, using an interviewer-administered structured questionnaire. The HRQoL was measured using the 12-item Short-Form Health Survey-Version 2 (SF-12v2) scale. To describe different variables, descriptive statistics were employed. To find independent HRQoL predictors, we used multivariable linear regression analysis. P-value of <0.05 were declared statistically significant at 95% confidence interval (CI).

Result

Out of 412 participants, nearly two-third 261 (63.3%) were male and nearly half 203 (49.3%) were diagnosed as schizophrenia. HRQoL was positively associated with social support (β = 0.321) and being single (β = 2.680). Conversely, functional disability (β = -0.545), being a student (β = -4.645) and jobless (β = -3.279) by occupation, and being diagnosed with depression (β = -2.839) were negatively impacted HRQoL among PWMI.

Conclusion

HRQoL of people with mental disorders in this study was significantly associated to social support, marital status, occupation, diagnosis and level of functional disability. Therefore, the mental health care system should develop HRQoL promoting measures that enhance PWMI functioning, social support and employment.

Assessment Tools of Biopsychosocial Frailty Dimensions in Community-Dwelling Older Adults: A Narrative Review

Frailty is a complex interplay between several factors, including physiological changes in ageing, multimorbidities, malnutrition, living environment, genetics, and lifestyle. Early screening for frailty risk factors in community-dwelling older people allows for preventive interventions on the clinical and social determinants of frailty, which allows adverse events to be avoided. By conducting a narrative review of the literature employing the International Narrative Systematic Assessment tool, the authors aimed to develop an updated framework for the main measurement tools to assess frailty risks in older adults, paying attention to use in the community and primary care settings. This search focused on the biopsychosocial domains of frailty that are covered in the SUNFRAIL tool. The study selected 178 reviews (polypharmacy: 20; nutrition: 13; physical activity: 74; medical visits: 0; falls: 39; cognitive decline: 12; loneliness: 15; social support: 5; economic constraints: 0) published between January 2010 and December 2021. Within the selected reviews, 123 assessment tools were identified (polypharmacy: 15; nutrition: 15; physical activity: 25; medical visits: 0; falls: 26; cognitive decline: 18; loneliness: 9; social support: 15; economic constraints: 0). The narrative review allowed us to evaluate assessment tools of frailty domains to be adopted for multidimensional health promotion and prevention interventions in community and primary care.

Self-determination and Physical Functioning as Mediators of the Association between Self-reported Sensory Impairments and Happiness among Older Adults

Introduction: The prevalence of vision and hearing impairments increases through age. This development is individually associated with physical functioning difficulties, self-determination issues, and lower levels of happiness. Method: This study examined how self-reported sensory impairments relate to happiness with physical autonomy and social engagement as mediators using structural equation modelling. Using the nationally representative 2017 Survey of Older Persons in Thailand, the analytic sample size was 34,195 with an age range of 60-103 years and a mean age of 69.6 years. Results: A negative association between subjective vision impairment and happiness was observed through the mediation of limitations in physical functioning and community activity. Subjective hearing impairment was observed to lack association with happiness taking into account all the mediating factors. Conclusion: The care needs of older adults in Thailand where the ageing of the population progresses could then differ depending on their health and well-being status.

The impact of resiliency on mental health and quality of life among older adults in Thailand

Purpose

The aim of this study was to examine the impact of resiliency and associated factors on the mental health and quality of life among older adults in Thailand.

Design/methodology/approach

This cross-sectional study was conducted with 1,800 older adults (M = 69.3, SD = 7.2) from nine provinces across all regions of Thailand. Each participant completed an anonymous paper-based survey that included demographic data, work activities, health behaviors, social support, Connor-Davidson Resilience Scale (CD-RISC), Depression, Anxiety, Stress Scale (DASS) and World Health Organization Quality of Life Assessment for Older Adults (WHOQOL-OLD).

Findings

Through hierarchical multiple regression, resiliency, social support, exercise and work hours per week were found to be significant predictors of mental health: depression (F (6, 520) = 19.38, p < 0.001, adjusted R2 = 0.17); anxiety (F (6, 520) = 18.64, p < 0.001, adjusted R2 = 0.17); stress (F (6, 521) = 12.91, p < .001, adjusted R2 = 0.12). Five predictors of quality of life were identified through hierarchical multiple regression: resiliency, social support, exercise, age and family economic status. These predictors explained 35% of the variance, F (5, 1655) = 178.44, p < 0.001, adjusted R2 = 0.35.

Originality/value

Based on the results of this study, a comprehensive Wellness Program was designed to improve the mental health and quality of life of older adults in Thailand. This Wellness Program included five components: Volunteer Program, Resiliency Building Program, Social Support Program, Exercise Program, and Financial Education Program.

Caregiver Burden and Associated Factors for the Respite Care Needs among the Family Caregivers of Community Dwelling Senior Citizens in Chiang Mai, Northern Thailand

BACKGROUND

Families are the backbone of caregiving for older adults living in communities. This is a tradition common to Thailand and many low- and middle-income countries where formal long-term care services are not so available or accessible. Therefore, population aging demands more and more young people engaging as family caregivers. Informal caregiving can become an unexpected duty for anyone anytime. However, studies measuring the burden of informal caregivers are limited. We aimed to determine the caregiver burden, both from the perspective of the caregivers as well as that of their care recipients.

METHOD

We used the baseline survey data from a cluster randomized controlled trial providing a community integrated intermediary care (CIIC) service for seniors in Chiang Mai, Thailand, TCTR20190412004. Study participants were 867 pairs of older adults and their primary family caregivers. Descriptive analysis explored the characteristics of the caregivers and binary logistic regression identified factors influencing the caregivers' burden.

RESULTS

The mean age of family caregivers was 55.27 ± 13.7 years and 5.5% indicated the need for respite care with Caregiver Burden Inventory (CBI) scores ≥24. The highest burden was noted in the time-dependence burden domain (25.7%). The significant associated factors affecting CBI ≥24 were as follows: caregivers older than 60 years, being female, current smokers, having diabetes, and caring for seniors with probable depression and moderate to severe dependency.

CONCLUSIONS

A quarter of caregivers can have their careers disturbed because of the time consumed with caregiving. Policies to assist families and interventions, such as respite service, care capacity building, official leave for caregiving, etc., may reduce the burden of families struggling with informal care chores. Furthermore, caregiver burden measurements can be applied as a screening tool to assess long-term care needs, complementing the dependency assessment. Finally, implementation research is required to determine the effectiveness of respite care services for older people in Thailand.

Mental health and burnout among teachers in Thailand

Purpose

This study investigated factors that impacted the mental health and burnout among kindergarten, primary and secondary school teachers in Thailand and presented a comprehensive intervention program to improve their wellbeing.

Design/methodology/approach

This cross-sectional survey study included 267 teachers from five public schools in Thailand. The survey instruments included the Depression, Anxiety and Stress Scale and the Maslach Burnout Inventory for Educators Survey, along with data on demographics, health behaviors, finances, professional work, relationships and resilience.

Findings

For teacher mental health, results indicated that family economics status, relationship quality and resilience were significant predictors of depression (R2 = 0.19); family economics status, classroom size and resilience significantly predicted anxiety (R2 = 0.13); family economics status, gender, sleep and resilience significantly predicted stress (R2 = 0.20). For teacher burnout, relationship quality and age were significant predictors of emotional exhaustion (R2 = 0.15); relationship quality and drinking significantly predicted depersonalization (R2 = 0.06); resilience and number of teaching hours significantly predicted personal accomplishment (R2 = 0.28).

Originality/value

Besides providing an in-depth examination of mental health and burnout among teachers, this is the first study in Thailand to propose a comprehensive Teacher Wellness Program. This program recommends personal and professional development plans that public health personnel and school administrators could utilize to improve mental health and reduce burnout among teachers.

A Longitudinal Study of Changes in Cognition Among Older Thais: Studying From the Kanchanaburi Demographic Surveillance System

Objectives: To examine the impacts of changes in social determinants of health (SDH) toward changes in cognition. Methods: Longitudinal data came from the Kanchanaburi Demographic Surveillance System (KDSS) collected in 2007 and 2011. Cognitive impairment was measured by category fluency and delayed recall. Generalized estimating equation (GEE) was used to investigate changes in cognition by taking SDH and other variables including age, gender, marital status, education, and depression into the model. Results: GEE revealed longitudinal effects of wealth index and working status against cognition. Older Thais living with richest wealth index (odds ratio [OR] = 0.54; 95% confidence interval [CI] = 0.31-0.94) and still being employed (OR = 0.65; 95% CI = 0.47-0.89) were less likely to have cognitive impairment. Discussion: Poorer wealth index and being unemployed were served as a risk factor for cognitive impairment over time. Increasing age was still the major risk for cognitive impairment.

Social support and depression among community dwelling older adults in Asia: a systematic review

OBJECTIVES

This review aims to: (1) explore the social support measures in studies examining the association between social support and depression among community-dwelling older adults in Asia and (2) the evidence of association.

DESIGN

A systematic review was conducted using electronic databases of CINAHL, PubMed, PsychINFO, Psychology and Behavioural Sciences Collection, SocINDEX and Web of Science for articles published until the 11th of January 2018.

ELIGIBILITY CRITERIA

All observational studies investigating the association between social support and depression among community-dwelling older adults in Asia were included.

PARTICIPANTS

Older adults aged 60 years and more who are living in the community.

EXPOSURE MEASURES

Social support.

OUTCOME MEASURES

Depression.

RESULTS

We retrieved16 356 records and screened 66 full-text articles. Twenty-four observational studies were included in the review. They consisted of five cohort studies and 19 cross-sectional studies. Social support was found to be measured by multiple components, most commonly through a combination of structural and functional constructs. Perceived social support is more commonly measured compared with received social support. Good overall social support, having a spouse or partner, living with family, having a large social network, having more contact with family and friends, having emotional and instrumental support, good support from family and satisfaction with social support are associated with less depressive symptoms among community-dwelling older adults in Asia.

CONCLUSIONS

There were 20 different social support measures and we applied a framework to allow for better comparability. Our findings emphasised the association between good social support and decrease depression among older adults. Compared with western populations, family support has a greater influence on depression among community-dwelling older adults in Asia. This indicates that the family institution needs to be incorporated into designed programmes and interventions when addressing depression in the Asian context. TRIAL : registration number : CRD42017074897.

Moving on from adversity: an understanding of resilience in rural Thai older people

OBJECTIVE

This study explored the concept of resilience in rural Thai older people.

METHOD

The study was exploratory and descriptive in design. Ethnographic fieldwork was undertaken in four rural Thai communities. Non-participant observation (340 h) and 35 semi-structured interviews with older people enabled the collection of qualitative data. Nvivo 10 was used to collate and organise the qualitative data. Data analysis was conducted thematically.

RESULTS

One major core theme and five qualitative sub-themes emerged from the data related to the theoretical construct of rural Thai elders' resilience. The subthemes of the core theme 'moving on' include: (1) keep doing a job and earning a living; (2) having Jai-Yai to fight for life; (3) accepting a situation (Plong and Taam-Jai); (4) expressing difficulty; and (5) connecting with people, beliefs and customs.

CONCLUSION

The concept of 'moving on' provides a subcultural viewpoint of older rural Thai people in the face of adversity in their everyday lives. Previous conceptions of resilience and older people focus on it being bouncing back from adversity. Bouncing back implies a setback, whereas 'moving on' found in this study is the process of continuous movement forward and getting on with one's life despite difficulties.

A review of the 10/66 dementia research group

BACKGROUND

In this review we discuss how the study of dementia epidemiology in Low- and Middle-Income Countries (LMICs) has changed in the last 20 years, and specifically to review the evidence created by the 10/66 Dementia Research Group (DRG) and discuss future directions for research.

METHODS

We identified and collated all the papers related to the 10/66 Dementia Research Group, including papers from groups who adopted the 10/66 methodology, that have been published in peer-reviewed journals.

RESULTS

Over 200 papers including data from Africa, Asia, Europe and Latin America and the Caribbean were identified by this review. Many of the findings revolved around the epidemiology of dementia, mental health and non-communicable diseases, including the cross-cultural development and validation of measurement tools of cognition and functioning, need for care, care arrangements and mental health. Social ageing, care dependence and caregiver interventions were also topics that the group had published on.

DISCUSSION

A body of evidence has been generated that has challenged the view, prevalent when the group started, that dementia is comparatively rare in LMICs. The experience of the 10/66 DRG has shown that descriptive epidemiological research can be important and impactful, where few data exist. Monitoring population trends in the prevalence and incidence of dementia may be our best chance to confirm hypotheses regarding modifiable risk factors of dementia.

'Call me if you need': Social support experiences under economic and social change

Social interactions play an important role in people's life and people's health but their scope and intensity tend to decrease with age, challenging social support dynamics and increasing the risk of social isolation and helplessness. In Portugal, policymakers still seem to rely on traditional social relations in eldercare, while contextual changes and trends are redefining family roles and behaviors and defying the established social support structure. In this work, we aim to examine the scope, structure and experiences of the informal social support network available in the country for stroke patients 6 months after their discharge from the acute care unit in the context of a larger study. The results seem to confirm the importance of family as a source of social support and shed light on different bonding experiences with non-kin social groups, such as neighbors and friends. A coordinated care provision, combining formal and informal support is vital and beneficial for patients, their caregivers and the care system.

Factors associated with social participation amongst elders in rural Sri Lanka: a cross-sectional mixed methods analysis

BACKGROUND

Populations of low and middle-income countries are ageing rapidly; there is a need for policies that support an increase in the duration of old age lived in good health. There is growing evidence that social participation protects against morbidity and mortality, but few studies explore patterns of social participation. Analysis of baseline quantitative and qualitative data from a trial of the impact of Elders' Clubs on health and well-being in the hill country of Sri Lanka provided an opportunity to better understand the extent of, and influences on, social participation among elders.

METHODS

We analysed data from 1028 baseline survey respondents and from 12 focus group discussions. Participants were consenting elders, aged over 60 years, living in Tamil tea plantation communities or Sinhala villages in 40 randomly selected local government divisions. We assessed participation in organised social activities using self-reported attendance during the previous year. Multivariable regression analyses were used to explore associations with community and individual factors. The quantitative findings were complemented by thematic analysis of focus group discussion transcripts.

RESULTS

Social participation in these poor, geographically isolated communities was low: 63% reported 'no' or 'very low' engagement with organised activities. Plantation community elders reported significantly less participation than village elders. Attendance at religious activities was common and valued. Individual factors with significant positive association with social participation in multivariable analyses were being younger, male, Sinhala, married, employed, and satisfied with one's health. Domestic work and cultural constraints often prevented older women from attending organised activities.

CONCLUSIONS

Elders likely to benefit most from greater social contact are those most likely to face barriers, including older women, the oldest old, those living alone and those in poor health. Understanding these barriers can inform strategies to overcome them. This might include opportunities for both informal and formal social contact close to elders' homes, consulting elders, providing childcare, improving physical access, advocating with elders' families and religious leaders, and encouraging mutual support and inter-generational activities. Influences on social participation are interrelated and vary with the history, culture and community environment. Further study is required in other low and middle-income country contexts.

The relationship between physical functional limitations, and psychological distress: Considering a possible mediating role of pain, social support and sense of mastery

The aim of this study was to examine associations between selected physical functional limitations related to performing daily activities and psychological distress. We also aimed to investigate if these associations vary across age (moderation), and to explore pain, sense of mastery and social support as potential moderators and mediators. The study was based on pooled data from two rounds (2008 and 2012) of a Norwegian nationally representative cross-sectional health survey (N = 8520) including individuals aged ≥ 16 years (Age groups = 16-44 and ≥ 45 years). Physical functional limitations comprised decreased ability to: i) climb stairs, ii) carry objects, or iii) both. Psychological distress was measured as anxiety and depressive symptoms occurring separately or in combination (CAD). Of respondents reporting physical functional limitations, 8-14% reported depressive symptoms, 5-7% anxiety symptoms, and 13-28% reported CAD. Physical functional limitations were significantly associated with all three forms of psychological distress, particularly among individuals 16-44 years, and were more strongly related to CAD than to anxiety or depression occurring separately. The association with CAD was twice as strong when both types of physical functional limitations were present. Pain, sense of mastery and social support were significant modifiers of depression, whereas all three were significant mediators of the relationship between physical functional limitations and anxiety, depression and CAD. Sense of mastery mediated the relationship between physical functional limitations and CAD, but most strongly among those 16-44 years. Social support was only a significant mediator among those [Formula: see text] 45 years. Close associations between physical functional limitations and psychological distress highlight special needs among individuals experiencing daily functional limitations. The results also suggest that pain, low social support, and low sense of mastery may contribute to aggravate psychological distress.

Social Epidemiology and Global Mental Health: Expanding the Evidence from High-Income to Low- and Middle-Income Countries

PURPOSE OF THE REVIEW

The vast majority of research on the social determinants of mental health has been generated from high-income country (HIC) populations, even as the greatest health disparities, and greatest disease burden, is observed in lower- and middle-income countries (LMICs). The goal of this review is to examine the evidence base on how key social epidemiology constructs relate to mental health in LMIC contexts. A special focus is on points of departure from the HIC knowledge base, gaps in overall understanding, and opportunities for social epidemiology to make a significant contribution.

RECENT FINDINGS

A growing body of literature suggests that there is significant heterogeneity, both in the direction and magnitude, of association between factors such as socioeconomic status, income inequality, gender, and social networks/supports and mental health in LMIC. For example, higher levels of education and being married can be risk factors for worse mental health among women in certain contexts. However, many studies have methodological limitations that make causal inference difficult. Poverty alleviation interventions offer a unique opportunity to examine the impact of improving economic resources and mental health.

SUMMARY

Much remains unknown about the impact of key social factors on mental health in LMIC. Findings from HICs may not apply to LMIC populations, since the meaning and distribution of a given social variable may differ significantly from what is commonly observed in HICs. These points of departure point to opportunities for social epidemiology to make a contribution to the field of global mental health.

World Health Organization disability assessment schedule 2.0: An international systematic review

PURPOSE

This systematic review examines research and practical applications of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a basis for establishing specific criteria for evaluating relevant international scientific literature. The aims were to establish the extent of international dissemination and use of WHODAS 2.0 and analyze psychometric research on its various translations and adaptations. In particular, we wanted to highlight which psychometric features have been investigated, focusing on the factor structure, reliability, and validity of this instrument.

METHOD

Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) methodology, we conducted a search for publications focused on "whodas" using the ProQuest, PubMed, and Google Scholar electronic databases.

RESULTS

We identified 810 studies from 94 countries published between 1999 and 2015. WHODAS 2.0 has been translated into 47 languages and dialects and used in 27 areas of research (40% in psychiatry).

CONCLUSIONS

The growing number of studies indicates increasing interest in the WHODAS 2.0 for assessing individual functioning and disability in different settings and individual health conditions. The WHODAS 2.0 shows strong correlations with several other measures of activity limitations; probably due to the fact that it shares the same disability latent variable with them. Implications for Rehabilitation WHODAS 2.0 seems to be a valid, reliable self-report instrument for the assessment of disability. The increasing interest in use of the WHODAS 2.0 extends to rehabilitation and life sciences rather than being limited to psychiatry. WHODAS 2.0 is suitable for assessing health status and disability in a variety of settings and populations. A critical issue for rehabilitation is that a single "minimal clinically important .difference" score for the WHODAS 2.0 has not yet been established.

Tipos de configuração familiar e condições de saúde física e psicológica em idosos

Investigamos relações entre configuração familiar (arranjo de moradia, chefia familiar e contribuição financeira para o sustento da família), idade, sexo e condições de saúde física (capacidade funcional, número de doenças e de sinais e sintomas, e envolvimento social) e saúde psicológica (depressão e ansiedade) em idosos, conforme autorrelato. A amostra probabilística tinha 134 idosos sem déficit cognitivo e os dados foram coletados por entrevista domiciliar. Foi feita análise de conglomerados mediante o método da partição (três agrupamentos). As variáveis que mais contribuíram para a formação dos grupos foram as atividades básicas (R2 = 0,732) e instrumentais da vida diária (R2 = 0,487), o número de doenças (R2 = 0,241) e a idade (R2 = 0,225). A configuração familiar predominante foi corresidência com os descendentes, sendo os idosos provedores e chefes de família. Foram encontradas relações entre configuração familiar, condições de saúde física e saúde psicológica. As mulheres apresentaram maior ônus financeiro e pior saúde física e psicológica do que os homens.

Psychosocial functioning in schizophrenia: are some symptoms or demographic characteristics predictors across the functioning domains?

This study aimed to examine symptoms/demographic characteristics as predictors for psychosocial functioning among individuals with schizophrenia. The Personal and Social Performance (PSP) scale was used to assess psychosocial functioning. Other measures of interest included were the Clinical Global Impression, Severity scale, and the Marder's five-factor model of the Positive and Negative Syndrome Scale. This study included 199 participants with non-acute stage schizophrenia. Spearman correlation coefficients and stepwise multiple linear regression analyses were applied to determine the correlates and predictors of PSP domain/total scores. Younger age, earlier age of schizophrenia onset, severe illness, positive symptoms, negative symptoms, disorganized thought, hostility/excitement, and anxiety/depression were found to significantly correlate with poor functioning. Severe illness and negative symptoms are the main predictors of greater impairment of socially useful activities, personal and social relationships, and self-care. Further prospective studies in other settings, which would include an increased number of variables such as neurocognitive function and social support, are warranted.

Predictors of quality of life among individuals with schizophrenia

PURPOSE

The study reported here aimed to evaluate both biological and psychosocial factors as predictors for quality of life as well as to examine the associations between the factors and quality of life in individuals with schizophrenia.

METHODS

Eighty individuals with schizophrenia were recruited to the study. The Thai version of the World Health Organization Quality of Life-BREF was utilized to measure the quality of life. The five Marder subscales of the Positive and Negative Syndrome Scale were applied. Other tools for measurement included the Calgary Depression Scale for Schizophrenia and six social support deficits (SSDs). Pearson/Spearman correlation coefficients and the independent t-test were used for the statistical analysis to determine the associations of variables and the overall quality of life and the four domain scores. A multiple linear regression analysis of the overall quality of life and four domain scores was applied to determine their predictors.

RESULTS

The Positive and Negative Syndrome Scale total score, positive symptoms, negative symptoms, disorganized thought, and anxiety/depression showed a significant correlation with the overall quality of life and most of the four domain scores. Depression, SSDs, and adverse drug events showed a significant correlation with a poorer overall quality of life. The multiple linear regression model revealed that negative symptoms, depression, and seeing a relative less often than once per week were predictors for the overall quality of life (adjusted R (2)=0.472). Negative symptoms were also found to be the main factors predicting a decrease in the four domains of quality of life - physical health, psychological, social relationships, and environment.

CONCLUSION

Negative symptoms, depression, and poor contact with relatives were the foremost predictors of poor quality of life in individuals with schizophrenia. Positive symptoms, negative symptoms, disorganized thought, anxiety/depression, SSDs, and adverse events were also found to be correlated with quality of life.

Proportion and factors associated with depressive symptoms among elderly in an urban slum in Bangalore

Depression among elderly is emerging as an important public health issue in developing countries like India. Published evidence regarding the magnitude and determinants of depression among elderly hailing from urban slum is currently limited. Hence, the current study was conducted to assess magnitude of the problem and identify factors associated with depression among the elderly in an urban slum. A cross-sectional study was done to cover total of 473 elderly persons from an urban slum in Bangalore, India. They were assessed for depression using Center for Epidemiologic Studies Depression scale. The overall prevalence of depression was found to be 37.8 (95% CI = 33.43-42.16). Multivariate analysis revealed that unemployment (self or children) (odds ratio (OR) 2.6; 95% confidence interval (CI) 1.41-4.72), illness of self (OR 2.2; 95% CI 1.45-3.21), female gender (OR 1.9; 95% CI 1.19-2.89), conflicts in family (OR 1.6; 95% CI 1.03-2.43), and marriage of children or grandchildren (OR 1.6; 95% CI 1.02-2.68) as independent risk factors. Depression among elderly is an important health issue of this area. Psychological intervention need to be provided for all elderly persons especially at the time of being diagnosed with any kind of illness. Strategies should be targeted to the females. The stressful life events need to be identified and remedial actions taken. This facility should be made available to them at the primary level of health care. There is a need to include screening of depression in our national health programs.

A pilot study of depression among older people in Rawalpindi, Pakistan

BACKGROUND

Depression is common among elderly in developed countries and it is more pronounced in institutional settings. In Pakistan there is a lack of empirical data on depression among this segment of the population particularly with reference to their living arrangements.The objectives of the present study are to report the magnitude of depression among elderly having two different residential arrangements and to examine the association of depression and its established demographic factors.

FINDINGS

Data were collected from 141 respondents. 108 were community residents (m = 57 and f = 51) and 33 were living in the care homes (m = 29 and f = 4).Prevalence of depression as assessed by Geriatric Depression Scale (GDS) among community and Care Homes (CHs) participants was 31.5 percent and 60.6 percent, respectively.On Centre of Epidemiological Studies Depression Scale (CES-D), 42.6 percent of the community and 69.7 percent of the CH respondents were deemed depressed. Before adjusting for any other potential risk factors the odds of being depressed was significantly increased if the study participants were living in CH, relatively older, female, not currently married, had low educational level, had lower Mini Mental State Examination (MMSE) scores, and reported lower perceived emotional and practical support. In a partially adjusted logistic regression model an increased risk of depression was not confounded by any of the above mentioned risk factors.However, the risk associated was not significant when it was adjusted for social support.

CONCLUSIONS

The findings of the current study are consistent with previous research and throws light on the dire need for interventions to address mental health needs of Pakistani elderly.Implications for improving the mental health status of elderly are also presented.

Mediating effect of social support on the association between functional disability and psychological distress in older adults in rural China: does age make a difference?

This study aimed to determine the prevalence of psychological distress among elderly people in rural China. Moreover, the mediating effect of social support on the association between functional disability and psychological distress and whether this effect varies with age would be examined. A total of 741 elderly people aged 60–89 years from a rural area of Shandong Province, China participated in a cross-sectional survey. Their psychological distress, perceived social support, enacted social support, and functional disability were assessed through questionnaires. A total of 217 (29.3%) rural elderly people had psychological distress. The functional disability of people ≥75 years old had smaller total effects (0.18) on their psychological distress than in people <75 years old (0.30). Moreover, most of the effects of functional disability on psychological distress among the people ≥75 years old were indirect (0.12; 66.67% of total effects) through the mediating effect of social support especially perceived support, while the direct effect of functional disability was insignificant. In contrast, most of the effects of functional disability on psychological distress among the people <75 years old were direct (0.29; 96.67% of total effects), while the mediating effect of social support was insignificant. In conclusion, the total effect of functional disability, especially the direct effect, on psychological distress decreases sharply with age. The mediating effect of social support on the association between functional disability and psychological distress varies with age and is only found in people ≥75 years.

Exploring the Relationships Among Performance-Based Functional Ability, Self-Rated Disability, Perceived Instrumental Support, and Depression

Data from the Women’s Health and Aging Study were used to test a model of factors explaining depressive symptomology. The primary purpose of the study was to explore the association between performance-based measures of functional ability and depression and to examine the role of self-rated physical difficulties and perceived instrumental support in mediating the relationship between performance-based functioning and depression. The inclusion of performance-based measures allows for the testing of functional ability as a clinical precursor to disability and depression: a critical, but rarely examined, association in the disablement process. Structural equation modeling supported the overall fit of the model and found an indirect relationship between performance-based functioning and depression, with perceived physical difficulties serving as a significant mediator. Our results highlight the complementary nature of performance-based and self-rated measures and the importance of including perception of self-rated physical difficulties when examining depression in older persons.

Assessment of social support and its association to depression, self-perceived health and chronic diseases in elderly individuals residing in an area of poverty and social vulnerability in rio de janeiro city, Brazil

Objectives

Social support (SS) influences the elderly ability to cope with the losses of ageing process. This study was aimed at assessing SS among elderly users of a primary healthcare unit in a poor and violent area of Rio de Janeiro City, and at verifying its association with depression, self-perceived health (SPH), marital status and chronic illnesses.

Methods

A cross-sectional study was performed based on a convenience sample of 180 individuals aged 60 years or older. SS was measured with part of the Brazilian version of Medical Outcomes Study's SS scale, and SPH and depression were assessed, respectively, through one question and the Brazilian version of the Structured Clinical Interview for DSM-IV Axis I Disorders. SS medians were calculated for the categories of SPH, depression, marital status and chronic illnesses variables, and differences were evaluated with the Kruskal-Wallis and Mann-Whitney tests. Additionally, Pearson's chi-square test and logistic regression were employed to identify unadjusted and adjusted associations between SS and those variables.

Results

The participant’s mean age was 73 years old, and level of education was 3 years of school education on average. They were predominantly females (73.3%), and non-married (55.0%). Among them, 74.4% perceived their SS as satisfactory, 55.0% perceived their health as good, 27.8% were diagnosed with major depression and 83.3% had hypertension. Especially for those depressed and with bad SPH, the medians of SS measure were much lower than for others, reaching an unsatisfactory level. Moreover, controlling for other factors, non-depressed individuals were more likely (OR = 2.32) to have satisfactory SS.

Conclusion

in the violent and poor area explored in this research low SS is highly prevalent in the elderly. Depressed individuals are more likely to have low SS and this condition should be investigated in depressed elderly. The reduced scale is useful for low education individuals.

Perceived social support among people with physical disability

Background

Disability is more based on social, rather than medical aspects. Lack of attention and social support may impact on participation of people with physical disability in various aspects and their return to normal life in the society.

Objectives

This study was conducted to determine perceived social support and related factors among physically disabled in the city of Tehran.

Patients and Methods

This cross-sectional study by using simple random sampling was conducted on 136 people with physically disabled who were covered by Welfare Organization of Tehran. The Norbeck social support questionnaire was used .Multiple linear regression analysis with the backward method was used to identify the adjusted association between perceived social support as dependent variable and demographic variables as independent variables.

Results

The present sample comprised of 68 (50%) male and 68 (50%) female with the mean age of 33 (SD = 8.9) years. Based on the results, mean of functional support was 135. 57 (SD = 98.77) and mean of structural support was 77.37 (SD = 52.37). Regression analysis model, demonstrates that variables of age and marital status remained in the model as significant predictors of functional support (P = 0.003, P = 0.004, respectively) and structural support (P = 0.002, P = 0.006, respectively).

Conclusions

Based on the results, participants in the study didn’t have favorable status with respect to perceived social support (in all dimensions) from their social network members. While, social support as one of the social determinants of health, plays an important role in improving psychological conditions in people’s lives; therefore, being aware of social support and designing effective interventions to improve it for the disabled is very important.

Physical and mental health among caregivers: findings from a cross-sectional study of Open University students in Thailand

BACKGROUND

Caregivers constitute an important informal workforce, often undervalued, facing challenges to maintain their caring role, health and wellbeing. Little is known about caregivers in middle-income countries like Thailand. This study investigates the physical and mental health of Thai adult caregivers.

METHODS

This report derives from distance-learning students working and residing throughout Thailand and recruited for a health-risk transition study in 2005 (N=87,134) from Sukhothai Thammathirat Open University. The cohort follow-up questionnaire in 2009 (N = 60,569) includes questions on caregiver status which were not available in 2005; accordingly, this study is confined to analysis of the 2009 data. We report cross-sectional associations between caregiver status and health.

RESULTS

Among the study participants in 2009, 27.5% reported being part-time caregivers and 6.6% reported being full-time caregivers. Compared to male non-caregivers, being a part-time or full-time male caregiver was associated with lower back pain (covariate-Adjusted Odds Ratios, AOR 1.36 and 1.67), with poor psychological health (AOR 1.16 and 1.68), but not with poor self-assessed health. Compared to female non-caregivers, being a part- or full-time female caregiver was associated with lower back pain (AOR 1.47 and 1.84), psychological distress (AOR 1.32 and 1.52), and poor self-assessed health (AOR 1.21 and 1.34).

CONCLUSIONS

Adult caregivers in Thailand experienced a consistent adverse physical and mental health burden. A dose-response effect was evident, with odds ratios higher for full-time caregivers than for part-time, and non-caregivers. Our findings should raise awareness of caregivers, their unmet needs, and support required in Thailand and other similar middle-income countries.

Psychological distress and mental health of Thai caregivers

BACKGROUND: As the proportion of elderly people within a population increases there is an accompanying increase in the role of informal caregivers. Many studies on caregivers report negative health outcomes but very few have addressed positive aspects of caregiving. This study examines characteristics of Thai caregivers, the distribution of psychological distress and mental health among caregivers, and the association between caregiver status and psychological distress. METHODS: This report is based on an ongoing national cohort study of 60,569 Thai adults. Caregiving was common in the cohort, and in 2009 6.6% were full-time and 27.5% were part-time caregivers. Outcomes of the study were reported using an international standard Kessler 6 for psychological distress and a national Thai Mental Health Indicator. Determinants included age, sex, marital status, household income, work status and urban-rural residence. Frequency of social contacts was also included as explanatory variable. RESULTS: Among cohort members, 27.5% were part-time caregivers and 6.6% were full-time caregivers. Compared to non-caregivers, full-time caregivers tended to be older, to be married, more likely to be in the lowest household income group, to be unpaid family members, and to reside in rural areas. We noted the seeming contradiction that when compared to non-caregivers, the caregivers reported higher psychological distress but higher positive mental health (i.e., self-esteem and content with life), higher positive mental capacity (i.e., coping with crises), and higher positive mental quality (i.e., helping others). After adjusting for possible covariates, part-time and full-time caregivers were more likely to report high psychological distress (Adjusted Odds Ratios, AOR 1.33 and 1.78 among males and 1.32 and 1.45 among females). Less contact with colleagues was associated with high psychological distress both in males and females (AOR 1.36 and 1.33). Less contact with friends was also associated with high psychological distress, especially among females (AOR 1.27 and 1.42). CONCLUSIONS: This study highlights caregivers in Thailand, the strong possibility of mental health benefits, some risks of associated psychological distress, and the positive role of keeping social contacts. Early identification of vulnerable caregivers is required to target effective health promotion.

Social participation and healthy ageing: a neglected, significant protective factor for chronic non communicable conditions

BACKGROUND

Low and middle income countries are ageing at a much faster rate than richer countries, especially in Asia. This is happening at a time of globalisation, migration, urbanisation, and smaller families. Older people make significant contributions to their families and communities, but this is often undermined by chronic disease and preventable disability. Social participation can help to protect against morbidity and mortality. We argue that social participation deserves much greater attention as a protective factor, and that older people can play a useful role in the prevention and management of chronic conditions. We present, as an example, a low-cost, sustainable strategy that has increased social participation among elders in Sri Lanka.

DISCUSSION

Current international policy initiatives to address the increasing prevalence of non-communicable chronic diseases are focused on cardiovascular disease, diabetes, respiratory disease and cancers, responsible for much premature mortality. Interventions to modify their shared risk factors of high salt and fat diets, inactivity, smoking and alcohol use are advocated. But older people also suffer chronic conditions that primarily affect quality of life, and have a wider range of risk factors. There is strong epidemiological and physiological evidence that social isolation, in particular, is as important a risk factor for chronic diseases as the 'lifestyle' risk factors, yet it is currently neglected. There are useful experiences of inexpensive and sustainable strategies to improve social participation among older people in low and lower middle income countries. Our experience with forming Elders' Clubs with retired tea estate workers in Sri Lanka suggests many benefits, including social support and participation, inter-generational contact, a collective voice, and facilitated access to health promotion activities, and to health care and social welfare services.

SUMMARY

Policies to address the increase in chronic non-communicable diseases should include consideration of healthy ageing, conditions that affect quality of life, and strategies to increase social participation. There are useful examples showing that it is feasible to catalyse the formation of Elders' Clubs or older people's associations which become self-sustaining, promote social participation, and improve health and well-being of elders and their families.

The Effects of Injury and Accidents on Self-rated Depression in Male Municipal Firefighters

Objectives

The present study aims to determine the causal relationship between self-rated depression and experiences of injury and accidents in municipal firefighters.

Methods

A panel survey of 186 municipal firefighters measured with depressive symptoms according to the Beck's depression index (BDI) was conducted. The effects of job-related injuries and accidents were evaluated using self-administered questionnaires that were taken once in a 12-month period from 2005 to 2006. Firefighters were classified into the Depression Group or Control Group based on follow-up BDI results with a cutoff level that was set to having "over mild depression."

Results

The depression Group was comprised of 17 (9.1%) workers, including 9 firefighters who met had sufficient BDI scores twice in the 2-year test period and newly sufficient BDI scores in the follow-up test. A significantly higher number of subjects in the Depression Group experienced injuries and accidents in the 2-year test period as compared to the Control Group (15.4% vs. 1.5%, p=0.04). Firefighters who experienced injuries and accidents in the 2-year test period had a 7.4 times higher risk of being in the Depression Group than those who had not. As compared to accidents, near-miss accidents revealed stronger risks related to being classified as in the Depression group (adjusted odds ratio [OR] = 4.58, 95% confidence interval [CI] = 1.15-18.18 vs. Adjusted OR = 4.22, 95% CI = 1.08-16.58).

Conclusion

The above results suggest that we should establish an effective program to promote mental health for groups at high risk for self-rated depression, including persons who have experienced consecutive injuries and accidents as well as near-miss injuries.

Impact of depression and social support on nonadherence to antipsychotic drugs in persons with schizophrenia in Thailand

BACKGROUND

Little is known about the effect of social support on nonadherence in persons with schizophrenia, especially in developing Asian countries where social support is considered to be imperative. Additionally, the role of depression as a mediator in the association between social support deficits and nonadherence has not been evaluated.

METHODS

This was a cross-sectional study conducted in 75 participants at a university hospital in Thailand. Logistic regression was used to determine whether depression and a deficit in social support were associated with nonadherence, and whether depression mediated this association.

RESULTS

There were strong relationships between nonadherence and major depressive episodes (odds ratio [OR] 9.5, confidence interval [CI] 2.3-38.9), living alone (OR 21.8, CI 3.5-143.0), and dissatisfaction with support from family (OR 10.0, CI 1.9-53.1). The OR of the association between social support deficits and nonadherence decreased by nearly one half after adjusting for depression.

DISCUSSION

Depression and social support deficits were significantly associated with nonadherence in persons with schizophrenia. Depression is important in mediating the association between social support deficits and nonadherence. Enhancing social support, as well as early detection and effective intervention for depression should be emphasized in interventions to improve adherence in persons with schizophrenia.