Relationship of age and gender to the prevalence and correlates of psychological distress in later life

Psychological distress symptoms in nurses and their intention to leave: A cross-sectional secondary data analysis

AIM

This study aimed to examine the psychological symptoms of distress among nurses in relation to their intention to leave.

DESIGN

This study was a secondary data analysis of a cross-sectional survey collected between November 2020 and March 2021.

METHODS

Chi-square was used to examine the associations between the demographic characteristics and intention to leave and psychological distress symptoms-feeling depressed, anxious and worried. Multiple linear regression analyses were performed to examine if work settings, position (staff, charge, administrators, educators/researchers and advanced practice registered nurses) and years of experience were associated with psychological distress and intention to leave. A mediation analysis examined if psychological distress mediated the relationship between years of experience and intention to leave.

RESULTS

Overall, psychological distress was significantly positively associated with intention to leave and negatively associated with years of experience. Nurses with less than 2 years of experience had increased psychological distress, while nurses with >25 years of experience had decreased psychological distress. Both groups of nurses had increased intention to leave compared to those with 16-25 years of experience. Psychological distress partially mediated intention to leave in nurses with less than 2 years of experience and more so among nurses with >25 years of experience.

CONCLUSIONS

This study suggests that nurses encounter psychological distress symptoms, such as feeling anxious, depressed and worried, that contribute to an increased intention to leave. Among the workplace locations, nurses practicing in nursing homes had the highest intention to leave.

IMPACT

The study emphasizes that organizations need to focus on mitigating distress across all levels of nurses to promote retention efforts and intention to stay.

REPORTING METHOD

The authors adhered to the STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient contribution. Completion of the survey in the original study (NWWS) implied consent from the participating nurses.

Chronic stress in old age: Psychometric properties of the Trier Inventory of Chronic Stress (TICS), based on a general population sample aged 60 and over

BACKGROUND

Chronic stress results from an imbalance of personal traits, resources and the demands placed upon an individual by social and occupational situations. This chronic stress can be measured using the Trier Inventory for Chronic Stress (TICS). The aims of the present study are to test the factorial structure of the TICS in a sample of elderly people, report its psychometric properties, and give norm values for elderly individuals.

METHODS

The TICS was answered by N = 790 healthy participants aged 60 to 99 years. The sample was selected by random-route sampling. Confirmatory factor analyses applying Robust Maximum Likelihood estimations (MLM) tested model fit and factorial structure. Reliability estimations and norm values are reported.

RESULTS

Confirmatory factor analyses replicate the reported nine-factor as well as the higher-order two-factor solution. Additionally, a general one-factor model was identified. All models provide acceptable model fit, with model comparison fit statistics corroborating the superiority of the nine-factor model. Reliability coefficients were good to very good.

CONCLUSION

The TICS can now also be used reliably in samples with elderly people. Its proposed nine-factor structure could be factorially validated and results in good scale reliability. Norm values for an elderly sample are now available.

Excess healthcare costs of psychological distress in young women: Evidence from linked national Medicare claims data

The prevalence of mental health disorders in young adults is increasing, yet there is limited empirical evidence on its economic consequences. We contribute to the literature by estimating the healthcare costs of psychological distress using panel data of young women (aged 18-23 years with a 5-year follow-up) from the Australian Longitudinal Study on Women's Health and linked administrative data from Medicare Australia. Our empirical strategy is based on the classical two-part model of healthcare costs with individual specific fixed-effects. We complement our analysis with a test for selection on unobservables to address potential concerns of endogeneity. We find that young women with psychological distress have 15% higher annual healthcare costs (excluding hospital costs) than women with no psychological distress. A large proportion of these costs is driven by the use of antidepressants and the services of psychiatrists and psychologists. We further find that women with psychological distress have higher out-of-pocket costs on these mental health related services compared to non-mental health specific services. Additionally, we show that the effect of psychological distress on healthcare costs is highest during the first 6 months of onset, which gradually decreases afterwards. The findings justify the importance of policy initiatives towards early prevention and treatment of psychological distress, especially among young women.

Psychological Distress Related to the COVID-19 Pandemic: The Protective Role of Hope

The COVID-19 outbreak and the worldwide lockdown measures had an impact on the global mental health and psychological well-being of the general population. Several studies attempted to investigate the protective and risk factors for psychological distress related to the pandemic. However, to date, little is known about the role of hope in this context. The aim of this study was to determine the relationship between hope and psychological distress related to the COVID-19 outbreak in the general population. The sample consisted of 504 Pakistani people who completed cross-sectionally the COVID-19 Peritraumatic Distress Index (CPDI) and the Adult Hope Scale (AHS). Bivariate Pearson correlation analysis was run to measure the relationship between hope and psychological distress; hierarchical regression analysis was run to investigate the association between demographics and hope with psychological distress. Higher levels of hope predicted lower levels of psychological distress. Being female, being older, lower level of education, urban residence, being married and living in nuclear family systems were associated with higher levels of psychological distress. The study highlights the protective role of hope on psychological distress related to COVID-19, contributing to knowledge on factors promoting positive mental health during emergency times and providing useful information for implementing effective public health policies and programmes.

Boys Do Cry: Age and Gender Differences in Psycho-Physiological Distress during the COVID-19 Pandemic in Italy

This article contributes to the quality of life literature by investigating gender and age gaps in psycho-physiological distress during the COVID-19 pandemic in Italy. Specifically, we investigate whether women experienced higher levels of distress than men, and if such gap can be explained by a greater negative reaction of women in the experience of a negative COVID-19 related event, such as the illness or death of a relative. Moreover, we explore whether age moderated or amplified the effect of a negative event on distress among women and men. To do so we rely on an ad hoc survey carried out between April 2020 and June 2021 in Italy, the first European country to be hit by the pandemic. Our results indicate that subjects who experienced the hospitalization or, more so, the death of a family member during the pandemic were more exposed to psycho-psychological distress compared to subjects who were not directly touched by COVID-19. Moreover, our results show that while women were on average more likely to express feelings of distress than men in absence of evident stressors, this gap disappeared among subjects who experience the death of a relative. Furthermore, our results indicate that experiencing a negative COVID-19 related event led to an increase in distress among all respondents except older men, who appeared to be the most resilient to the manifestation of any sign of distress. These results speak to important age and gender differences in the feelings and externalization of grief in the Italian context.

Gender differences in mental distress and affect balance during the first wave of COVID-19 pandemic in Spain

The COVID-19 pandemic is a major threat to the health and well-being of people around the world that has impacted freedom of movement, social interaction and the economy. The aim of the present work was twofold: first, to study the presence of mental distress, positive and negative experiences and affect balance in women and men in Spain in two different phases of the COVID-19 pandemic, the initial "first state of alarm" phase, characterized by maximum restrictions, and in the "new normal" phase with minimal restrictions, and second, to study the protective role of age, educational level, self-esteem, marital status and social support against mental distress, and as factors that increase the affect balance of women and men in the above mentioned phases of the first wave of the COVID- 19 pandemic in Spain. The study sample consisted of 652 women and 652 men from the general population, aged between 18 and 88 years, who were evaluated through self-reports. Results show greater mental distress in women than men but, strikingly, the magnitude of such differences were greater in the "new normal" phase than in the maximum restriction phase. In addition, in this last phase, women also experienced more negative feelings and less affect balance than men. High self-esteem and social support were also found to be protective factors for mental health, both in women and men, during the two phases of the pandemic studied. In conclusion, our study shows that the COVID-19 pandemic has especially impacted the well-being of women.

The Compounded Burden of Poverty on Mental Health for People with Disabilities

Using 2008-2017 National Health Interview Survey data (N = 127,973), we investigated the relationship between income and psychological distress, measured by the Kessler 6 (K6) Scale (range 0-24), net of education, employment, and other sociodemographic characteristics. Regression models allowed the association to differ by disability status and number of disabilities. Lower income predicted higher psychological distress for those with and without disabilities. However, the adverse association was stronger among people with disabilities. Compared to those with incomes at least four times the poverty threshold, poor individuals with disabilities scored 2.81 (95% CI = 2.55,3.67) points higher on the K6 Scale versus 0.58 (95% CI = 0.48,0.69) points higher for those without disabilities. Differences in associations by number of disabilities were not statistically significant. Nonetheless, those with multiple disabilities were still at increased risk of distress because they were disproportionately poor. People with disabilities who are poor are particularly disadvantaged and should be prioritized in outreach efforts.

Age-related differences in diagnostic categories, psychological states and oral health-related quality of life of adult temporomandibular disorder patients

OBJECTIVES

The peak prevalence of temporomandibular disorders (TMDs) may occur in middle age. This study determined the proportion of matured adults seeking TMD treatment and compared their diagnostic, psychological and oral health-related quality-of-life (OHRQoL) profiles to younger patients.

METHODS

Adult subjects were recruited from a tertiary TMD centre and assigned to three age groups, namely 18-44 years (young adults [YA]), 45-64 (middle-aged adults [MA]) and ≥65 (old adults [OA]). TMD diagnoses were established with the Diagnostic Criteria for TMDs and categorised as pain-related (PT), intra-articular (IT) and combined (CT) TMDs. Psychological states and OHRQoL were assessed with the Depression, Anxiety, and Stress Scale-21 (DASS-21) and Oral Health Impact Profile-TMDs (OHIP-TMDs). Demographic, DASS-21, and OHIP-TMDs data were analysed using chi-square test, one-way ANOVA and Pearson's correlation (P < .05).

RESULTS

Middle-aged (19.7%; 136/692) and old (4.0%; 28/692) adults comprised about a quarter of the TMD patients. Although gender distribution was comparable, significant differences in TMD categories were observed (P < .001). Pain-related TMDs were more prevalent in the MA/OA groups while intra-articular TMDs were more frequent in the YA group. No significant difference in DASS-21 and total OHIP scores was noted among three groups. However, the MA and OA groups had significantly lower OHRQoL in the physical pain domain. Correlations between DASS-21 and OHIP-TMDs scores varied with age and ranged from r_s  = 0.47-0.92.

CONCLUSIONS

Matured patients constituted a quarter of TMD cohort and presented higher frequencies of painful TMDs. They have similar psychological profiles to younger patients but experienced lower OHRQoL in physical pain domain.

Area-Level Walkability and the Geographic Distribution of High Body Mass in Sydney, Australia: A Spatial Analysis Using the 45 and Up Study

Improving the walkability of built environments to promote healthy lifestyles and reduce high body mass is increasingly considered in regional development plans. Walkability indexes have the potential to inform, benchmark and monitor these plans if they are associated with variation in body mass outcomes at spatial scales used for health and urban planning. We assessed relationships between area-level walkability and prevalence and geographic variation in overweight and obesity using an Australian population-based cohort comprising 92,157 Sydney respondents to the 45 and Up Study baseline survey between January 2006 and April 2009. Individual-level data on overweight and obesity were aggregated to 2006 Australian postal areas and analysed as a function of area-level Sydney Walkability Index quartiles using conditional auto regression spatial models adjusted for demographic, social, economic, health and socioeconomic factors. Both overweight and obesity were highly clustered with higher-than-expected prevalence concentrated in the urban sprawl region of western Sydney, and lower-than-expected prevalence in central and eastern Sydney. In fully adjusted spatial models, prevalence of overweight and obesity was 6% and 11% lower in medium-high versus low, and 10% and 15% lower in high versus low walkability postcodes, respectively. Postal area walkability explained approximately 20% and 9% of the excess spatial variation in overweight and obesity that remained after accounting for other individual- and area-level factors. These findings provide support for the potential of area-level walkability indexes to inform, benchmark and monitor regional plans aimed at targeted approaches to reducing population-levels of high body mass through environmental interventions. Future research should consider potential confounding due to neighbourhood self-selection on area-level walkability relations.

Fecal incontinence as a moderator between dietary intake and depressive symptoms among a sample of older adults obtained from the National Health and Nutrition Examination Survey (NHANES)

OBJECTIVES

Many studies have established a relationship between diet and mental health, as well as the importance of bowel health. Further, with increased evidence of a gut-brain bidirectional relationship, an indication of dysbiosis as a potential moderator between diet and depression may be a viable target for future interventions. The current study investigated the relationship between diet and depressive symptoms (DS) among older adults, as well as gender, and whether a symptom of dysbiosis, fecal incontinence severity (FIS), moderated this relationship.

METHOD

Using moderated regressions, we examined whether FIS moderates the relationship between diet and DS while controlling for covariates in the overall sample (N = 1918), as well as among the male (n = 841) and female sample (n = 1077). The dietary variables were reduced using a factor analysis.

RESULTS

Results indicated significant moderating effects of FIS between Component 4 and polyunsaturated fatty acids (PFA) in the overall sample. Component 4, protein, carbohydrates, and alcohol were significant in males only while PFA only in females. Further analysis of protein/carbohydrate ratio groups indicated significant differences within males. Higher scores of FIS were related to higher DS and less consumption of Component 4 nutrients, PFA, and protein. Males that consumed higher protein and carbohydrates resulted in lower DS with increased FIS.

CONCLUSION

Outcomes from the current study provide further evidence of the importance of healthy bowel function and the potential of modifying the diet to improve DS in older adults.

Psychological Distress and Social Functioning in Elderly Spanish People: A Gender Analysis

Psychological distress has been considered a key component in the psychosocial functioning and functional disability of the elderly, but the determining factors of social functioning and psychological distress in the elderly people are not yet fully known. The aim of this study is to perform a gender analysis of the relevance of psychological distress and psychosocial factors in the social functioning of the elderly. A cross-sectional study with a sample of 589 men and 684 women from the general Spanish population aged between 65 and 94 years was conducted. All participants were evaluated through questionnaires and scales that assess psychological distress, social functioning, stress, coping styles, self-esteem and social support. Results: Women scored higher than men in psychological distress, chronic stress, emotional coping and instrumental social support, whereas men scored higher than women in self-esteem and rational coping. Psychological distress was significantly associated in women and men with worse social functioning, which was also lower in older people and in women with lower self-esteem. Psychological distress has a considerable impact on the social functioning of the elderly, and gender is a relevant factor in the psychological distress experienced and its predictors.

Differences in Use of Government Subsidised Mental Health Services by Men and Women with Psychological Distress: A Study of 229,628 Australians Aged 45 Years and Over

This study examined factors associated with use of government subsidised mental health services by 229,628 men and women from the Sax Institute's 45 and Up Study. Logistical regression models assessed use of mental health services by gender and according to level of psychological distress. Approximately equal proportion of men and women had high psychological distress scores (approximately 7%) but only 7% of these men and 11% of these women used services. Use was associated with predisposing (younger age and higher education), enabling (private health insurance) and need factors (higher psychological distress scores). Associations were similar for men and women except urban area of residence, separated/divorced marital status, and smoking were associated with service use for women but not men. Results suggest some inequity in the use of services by those with higher levels of need and further efforts may be required to reach people with higher need but lower service use.

Walking as a Mediator of the Relationship of Social Support With Vitality and Psychological Distress in Older Adults

This study examined the mediating effect of walking on the relationship of social support with vitality and psychological distress. Data from a sample of 2,859 older adults were used. The older adults completed the 36-Item Short-Form Health Survey vitality scale, the Global Health Questionnaire, the International Physical Activity Questionnaire, and a social support attributes questionnaire. All social support variables were positively associated with vitality and negatively associated with psychological distress. Walking mediated the associations of appreciation for (3%) and frequency of (8%) social contacts, participation in group activities (19%), closeness from family and friends (8%), and concern from people around (6%) with vitality. Walking also mediated 33% of the association between participation in group activities and psychological distress. The main findings of this study suggest that participation in group activities, as part of social support, in later life is beneficial to improve older adults' vitality and reduces psychological distress, with walking being a strong mediator of these relationships.

Does Walkability Contribute to Geographic Variation in Psychosocial Distress? A Spatial Analysis of 91,142 Members of the 45 and Up Study in Sydney, Australia

Walkability describes the capacity of the built environment to promote walking, and has been proposed as a potential focus for community-level mental health planning. We evaluated this possibility by examining the contribution of area-level walkability to variation in psychosocial distress in a population cohort at spatial scales comparable to those used for regional planning in Sydney, Australia. Data on psychosocial distress were analysed for 91,142 respondents to the 45 and Up Study baseline survey between January 2006 and April 2009. We fit conditional auto regression models at the postal area level to obtain smoothed “disease maps” for psychosocial distress, and assess its association with area-level walkability after adjusting for individual- and area-level factors. Prevalence of psychosocial distress was 7.8%; similar for low (7.9%), low-medium (7.9%), medium-high (8.0%), and high (7.4%) walkability areas; and decreased with reducing postal area socioeconomic disadvantage: 12.2% (most), 9.3%, 7.5%, 5.9%, and 4.7% (least). Unadjusted disease maps indicated strong geographic clustering of psychosocial distress with 99.0% of excess prevalence due to unobserved and spatially structured factors, which was reduced to 55.3% in fully adjusted maps. Spatial and unstructured variance decreased by 97.3% and 39.8% after adjusting for individual-level factors, and another 2.3% and 4.2% with the inclusions of area-level factors. Excess prevalence of psychosocial distress in postal areas was attenuated in adjusted models but remained spatially structured. Postal area prevalence of high psychosocial distress is geographically clustered in Sydney, but is unrelated to postal area walkability. Area-level socioeconomic disadvantage makes a small contribution to this spatial structure; however, community-level mental health planning will likely deliver greatest benefits by focusing on individual-level contributors to disease burden and inequality associated with psychosocial distress.

Fruit and vegetable consumption and psychological distress: cross-sectional and longitudinal analyses based on a large Australian sample

OBJECTIVES

Growing evidence suggests a link between diet and mental health. This study aimed to investigate the association between fruit and vegetable consumption and the prevalence and incidence of psychological distress in middle-aged and older Australians.

DESIGN

Cross-sectional and prospective.

SETTING

New South Wales, Australia.

METHODS

A sample of 60 404 adults aged ≥45 years completed baseline (2006-2008) and follow-up (2010) questionnaires. Psychological distress was assessed at baseline and follow-up using the validated Kessler Psychological Distress Scale (K10), a 10-item questionnaire measuring general anxiety and depression. Psychological distress was defined as the presence of high-to-very high levels of distress (K10 score ≥22). Usual fruit and vegetable consumption was assessed using short validated questions. The association between baseline fruit and vegetable consumption and the prevalence or incidence of psychological distress was examined using logistic regression models.

RESULTS

At baseline, 5.6% reported psychological distress. After a mean 2.7 years of follow-up, 4.0% of those who did not report distress at baseline reported distress at follow-up. Baseline fruit and vegetable consumption considered separately or combined, was associated with a lower prevalence of psychological distress even after adjustment for sociodemographic characteristics and lifestyle risk factors. Baseline fruit and vegetable consumption, measured separately or combined, was associated with a lower incidence of psychological distress in minimally adjusted models. Most of these associations remained significant at medium levels of intake but were no longer significant at the highest intake levels in fully adjusted models.

CONCLUSIONS

Increasing fruit and vegetable consumption may help reduce psychological distress in middle-aged and older adults. However, the association of fruit and vegetable consumption with the incidence of psychological distress requires further investigation, including the possibility of a threshold effect between medium and higher consumption levels.

What types of social interactions reduce the risk of psychological distress? Fixed effects longitudinal analysis of a cohort of 30,271 middle-to-older aged Australians

BACKGROUND

Research on the impact of social interactions on psychological distress tends to be limited to particular forms of support, cross-sectional designs and by the spectre of omitted variables bias.

METHOD

A baseline sample with 3.4±0.95 years follow-up time was extracted from the 45 and Up Study. Change in the risk of psychological distress (Kessler Psychological Distress Scale) was assessed using fixed effects logistic regressions in relation to the number of times in the past week a participant: i) spent time with friends or family they did not live with; ii) talked to friends, relatives or others on the telephone; iii) attended meetings at social clubs or religious groups; and the count of people outside their home, but within one hour travel-time, participants felt close to. Separate models were fitted for men and women, adjusting for age, income, economic and couple status.

RESULTS

An increase in the number of social interactions was associated with a reduction in the risk of psychological distress, with some gender differences. Interactions with friends or family were important for women (adjusted OR 0.85, 95%CI 0.74, 0.98, p=0.024), whereas telephone calls were effective among men (adjusted OR 0.83, 95%CI 0.72, 0.96, p=0.011). Strong effects for the number of people that can be relied on were observed for men and women, but attendance at clubs and groups was not. No age-specific effects were observed.

LIMITATIONS

No indicator of positive mental health.

CONCLUSIONS

Policies targeting greater social interactions in middle-to-older age may help protect mental health.

Large-scale investment in green space as an intervention for physical activity, mental and cardiometabolic health: study protocol for a quasi-experimental evaluation of a natural experiment

INTRODUCTION

'Green spaces' such as public parks are regarded as determinants of health, but evidence from tends to be based on cross-sectional designs. This protocol describes a study that will evaluate a large-scale investment in approximately 5280 hectares of green space stretching 27 km north to south in Western Sydney, Australia.

METHODS AND ANALYSIS

A Geographic Information System was used to identify 7272 participants in the 45 and Up Study baseline data (2006-2008) living within 5 km of the Western Sydney Parklands and some of the features that have been constructed since 2009, such as public access points, advertising billboards, walking and cycle tracks, BBQ stations, and children's playgrounds. These data were linked to information on a range of health and behavioural outcomes, with the second wave of data collection initiated by the Sax Institute in 2012 and expected to be completed by 2015. Multilevel models will be used to analyse potential change in physical activity, weight status, social contacts, mental and cardiometabolic health within a closed sample of residentially stable participants. Comparisons between persons with contrasting proximities to different areas of the Parklands will provide 'treatment' and 'control' groups within a 'quasi-experimental' study design. In line with expectations, baseline results prior to the enhancement of the Western Sydney Parklands indicated virtually no significant differences in the distribution of any of the outcomes with respect to proximity to green space preintervention.

ETHICS AND DISSEMINATION

Ethical approval was obtained for the 45 and Up Study from the University of New South Wales Human Research Ethics Committee. Ethics approval for this study was obtained from the University of Western Sydney Ethics Committee. Findings will be disseminated through partner organisations (the Western Sydney Parklands and the National Heart Foundation of Australia), as well as to policymakers in parallel with scientific papers and conference presentations.

Older prisoners: psychological distress and associations with mental health history, cognitive functioning, socio-demographic, and criminal justice factors

BACKGROUND

The growth among older prisoner populations, including in Australia, necessitates an understanding of this group in order to generate effective management strategies. One particular concern is the mental well-being of older prisoners. This study aimed to determine the level of psychological distress among sentenced prisoners aged 50 years and older, to compare this level to that seen among younger prisoners and older people in the community, and to investigate which mental health history, cognitive functioning, socio-demographic, and criminal justice characteristics were associated with psychological distress.

METHODS

A cross-sectional survey of 173 older (M = 63 years) and 60 younger prisoners (M = 34 years) in two Australian jurisdictions was conducted. The Kessler Psychological Distress (K10) scale was administered with prisoners and additional data were collected from interviews and participant health and corrections files. K10 scores were compared to community norms using data from the Australian Health Survey.

RESULTS

Average K10 scores of the older prisoners were significantly lower than the younger prisoners' (p = 0.04), though the effect size was small (r = 0.1). Significantly, higher distress levels were observed in comparison to the general population (p < 0.001), with older prisoners being three times more likely to display very high levels of distress (12.3% vs. 3.7%). Higher psychological distress scores among older prisoners were significantly associated with female gender (p = 0.002) and a history of mental health issues (p = 0.002).

CONCLUSIONS

While the levels of distress seen among older prisoners were significantly lower than that of younger prisoners, their higher levels of distress in comparison to community norms demonstrate a need for correctional services to be attuned to the mental health of the expanding older prisoner population.

Gender, mental health, physical health and retirement: A prospective study of 21,608 Australians aged 55-69 years

OBJECTIVES

We examined retirement transitions by gender, and different associations between retirement, physical function and mental health.

METHODS

Data for 21,608 participants aged 55-69 from the 45 and Up Study were used. Generalised estimating equations were used to investigate longitudinal associations between retirement with psychological distress (Kessler score, K10) and physical dysfunction across two time points, by gender separately.

RESULTS

Retirement in men was associated with a 25% relative increase in mean physical dysfunction score (p<0.001) and a 2% relative increase in mean K10 score (p=0.004), although men with high physical dysfunction score had a 6% increase in mean K10 score (p=0.005) if retired. For women, retirement was associated with a 17% increase in mean physical dysfunction score (p<0.001), with no association observed with the K10 score. Results were adjusted for demographic and health covariates.

CONCLUSION

Retirement is associated with physical dysfunction over time. Retirement is not associated with psychological distress among women, but retirement is associated with psychological distress among men who have a high level of physical dysfunction. The findings point to the importance of attending to the physical and mental health needs, around the retirement period, particularly for men with poor physical health.

Partner status and mental and physical health of independently living men aged 70 years and older

AIM

To describe and compare the mental health and physical functioning of community-dwelling men aged 70 years and over who live alone, and those who live with their partner/spouse.

METHOD

Data were obtained from the baseline survey of the New South Wales 45 and Up Study. Mental health was measured using the Kessler Psychological Distress Scale and physical health was measured using the Medical Outcome Short Form 36 physical functioning scale.

RESULTS

37 690 community-dwelling men aged 70 years or over were included in the analyses. Men living alone were more likely to have high psychological distress scores and lower physical functioning scores compared to men living with a spouse/partner within each age group, except those 85 and over.

CONCLUSIONS

Specific health and welfare programs targeted to the increasing number of older men living alone may be needed to address their higher levels of psychological distress and lower levels of physical functioning.

Complementary and Integrative Medicine at Mayo Clinic

Complementary and alternative medicine (CAM) has gained acceptance throughout the industrialized world. The present study was performed to provide information about the use of CAM at Mayo Clinic, an academic medical center in Northern Midwest of the US. We retrospectively reviewed the electronic medical records of 2680 patients visiting the CAM program at Mayo Clinic, Rochester, between 1 July 2006 and 31 March 2011. Services provided included acupuncture, massage, integrative medical consultations and executive stress management training. Data including age, gender, race, diagnosis and the number of treatment/consultation sessions were collected to describe the use of CAM in our institute over the last several years. It was found that the mean (standard deviation) age of patient was 52.6 (15.5) years. Of those, 73.1% were female and 26.9% were male. Most patients were white. The number of patients referred to CAM increased significantly from 2007 to 2010. The three most common diagnostic categories were back pain (12.9%), psychological disorders (11.8%), and joint pain (9.6%). Back pain was the most common diagnosis for patients receiving acupuncture, and fibromyalgia was the most common for patients receiving massage therapy. Psychological disorders (i.e., stress) were the major diagnosis referred to both integrative medical consults and executive stress management training. These results suggest that the diseases related to pain and psychological disorders are the main fields of CAM use. It also shows the increasing trend of the use of CAM at an academic medical center in the US.

Gender differences in psychological distress in Spain

BACKGROUND AND AIMS

Epidemiological and community-based surveys consistently report gender differences in mental health. This study examines gender differences in psychological distress by analyzing the relevance of stress, coping styles, social support and the time use.

METHODS

Psychological tests were administered to a convenience sample of 1,337 men and 1,251 women from the Spanish general population, aged between 18 and 65 and with different socio-demographic characteristics, although both the women and men groups had similar age and educational levels.

RESULTS

Women had more psychological distress than men. Although psychological distress in the women and men groups have some common correlates such as more stress, more emotional and less rational coping and less social support, we find some gender differences. Work role dissatisfaction was more associated with distress in the men than in the women group. In addition, women's distress was associated with more daily time devoted to childcare and less to activities they enjoy, and men's distress was associated with more time devoted to housework and less to physical exercise.

CONCLUSIONS

Social roles traditionally attributed to women and men - and the differences in the use of time that such roles entail - are relevant in gender differences in psychological distress.

Retirement, age, gender and mental health: findings from the 45 and Up Study

OBJECTIVES

To examine the relationships of retirement and reasons for retirement with psychological distress in men and women at the age of 45-79 years.

METHOD

Data from 202,584 Australians participating in the large-scale 45 and Up Study was used. Psychological distress was measured by the Kessler psychological distress scale. Associations between different work status and reasons for retirement with psychological distress were assessed for men and women at different ages using logistic regression.

RESULTS

Being fully retired or unemployed was associated with the high levels of psychological distress compared to being in paid work for men and women aged 45-64 (p < 0.0001), and for men aged 65-74 years (p ≤ 0.0014). At the age of 75-79 years, there was no difference in psychological distress between different work statuses. Among retirees, retirement due to ill health, being made redundant or caring duty was associated with the high level of psychological distress.

CONCLUSION

The association between work and mental health underscores the importance of policies and strategies to encourage and enable people to continue in the workforce after age 55, particularly for men. Important reasons for retirement with worse mental health outcomes include redundancy, ill health and needing to care for family or a friend. These circumstances will affect whether a person can continue working and their risk of poor mental health, and both considerations should be addressed in developing approaches for maintaining older workers or assisting them with their retirement transition.

Does rising crime lead to increasing distress? Longitudinal analysis of a natural experiment with dynamic objective neighbourhood measures

Identifying 'neighbourhood effects' to support widespread beliefs that where we live matters for our health remains a major challenge due to the reliance upon observational data. In this study we reassess the issue of local crime rates and psychological distress by applying unobserved ('fixed') effects models to a sample of participants who remain in the same neighbourhoods throughout the study. Baseline data was extracted from the 45 and Up Study between 2006 and 2008 and followed up as part of the Social Economic and Environmental Factors (SEEF) Study between 2009 and 2010. Kessler 10 scores were recorded for 25,545 men and 29,299 women reported valid outcomes. Annual crime rates per 1000 (including non-domestic violence, malicious damage, break and enter, and stealing, theft and robbery) from 2006 to 2010 inclusive were linked to the person-level data. Change in exposure to crime among participants in this study, therefore, occurs as a result of a change in the local crime rate, rather than a process of neighbourhood selection. Gender stratified unobserved effects logistic regression adjusting for sources of time-varying confounding (age, income, employment, couple status and physical functioning) indicated that an increase in the risk of experiencing psychological distress was generally associated with an increase in the level of neighbourhood crime. Effect sizes were particularly high for women, especially for an increase in malicious damage (Odds Ratio Tertile 3 vs Tertile 1 2.40, 95% Confidence Interval 1.88, 3.05), which may indicate that damage to local built environment is an important pathway linking neighbourhood crime with psychological distress. No statistically significant association was detected for an increase in non-domestic violence, although the effect was in the hypothesised direction. In summary, the application of unobserved effects models to analyse data that takes into account the temporally dynamic characteristics of where people live warrants further investigation.

Measuring psychological distress in older Aboriginal and Torres Strait Islanders Australians: a comparison of the K-10 and K-5

OBJECTIVES

To assess the cross-cultural validity of two Kessler psychological distress scales (K-10 and K-5) by examining their measurement properties among older Aboriginal and Torres Strait Islanders and comparing them to those in non-Aboriginal individuals from NSW Australia.

METHODS

Self-reported questionnaire data from the 45 and Up Study for 1,631 Aboriginal and 231,774 non-Aboriginal people were used to examine the factor structure, convergent validity, internal consistency and levels of missing data of K-10 and K-5.

RESULTS

We found excellent agreement in classification of distress of Aboriginal participants by K-10 and K-5 (weighted kappa=0.87), high internal consistency (Cronbach's alpha K-10: 0.93, K-5: 0.88), and factor structures consistent with those for the total Australian population. Convergent validity was evidenced by a strong graded relationship between the level of distress and the odds of: problems with daily activities due to emotional problems; current treatment for depression or anxiety; and poor quality of life.

CONCLUSIONS AND IMPLICATIONS

K-10 and K-5 scales are promising tools for measuring psychological distress among Aboriginal and Torres Strait Islanders aged 45 and over in research and clinical settings.

Prevalence and correlates of depression among Australian women: a systematic literature review, January 1999- January 2010

Background

Little is known about the prevalence and correlates of depression among Australian women. This systematic review of depression among women in Australia, the largest identified to date, highlights the prevalence and correlates of depression across the life span.

Results

The report adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement (PRISMA). Six health related databases were selected: Medline, PsychInfo, SCOPUS, Cinhal, Informit and Cochrane Systematic Reviews. 1,888 initial articles were found, and 111 articles were considered relevant for review. Prevalence rates of depression among women ranged from 2.6% to 43.9%. Higher rates were reported for younger women, or specific population groups. Most significant correlates included, age, adverse life events, tobacco use, sole motherhood, and previous mental health problems.

Conclusions

Limitations include the scope of the investigation’s aims and inclusion criteria, and the failure to identify gender specific data in most studies. Publication bias was likely, given that only papers reported (or translated) in English were included. Despite the breadth of information available, there were noticeable gaps in the literature. Some studies reported on affective disorders, but did not specifically report on depression; it is concluded that each mental illness warrants separate investigation. It was also common for studies to report a total prevalence rate without separating gender. This report recommends that it is vital to separate male and female data. The report concludes that more research is needed among mid-age women, Indigenous women, non-heterosexual women and Culturally and Linguistically Diverse (CALD) women.

Psychological distress and quality of life in older persons: relative contributions of fixed and modifiable risk factors

BACKGROUND

With a rapidly ageing population and increasing life expectancy, programs directed at improving the mental health and quality of life (QOL) of older persons are extremely important. This issue may be particularly relevant in the aged-care residential sector, where very high rates of depression and poor QOL are evident. This study aims to investigate the fixed and modifiable risk factors of psychological distress and QOL in a cohort of Australians aged 60 and over living in residential and community settings.

METHODS

The study examined the relationship between demographic, health and lifestyle factors and the outcome variables of self-reported QOL and psychological distress (K10 scores) based on data from 626 Australians aged 60 and over from the 45 and Up Study dataset. Univariate and multivariate regression analyses (performed on a subset of 496) examined risk factors related to psychological distress and QOL adjusting for age and residential status.

RESULTS

Significant psychological distress was experienced by 15% of the residential sample and 7% of the community sample and in multivariate analyses was predicted by older age, more functional limitations, more time spent sleeping and lower levels of social support (accounting for 18% of the variance). Poorer QOL was predicted by more functional limitations and greater levels of psychological distress. Together these variables accounted for 35% of the variance in QOL ratings.

CONCLUSIONS

While psychological distress was more common in residential settings, programs targeting modifiable risk factors have the potential to improve QOL and reduce psychological distress in older persons living in both residential and community settings. In particular, promoting health and mobility, optimising sleep-wake cycles and increasing social support may reduce levels of psychological distress and improve QOL.

Do social interactions explain ethnic differences in psychological distress and the protective effect of local ethnic density? A cross-sectional study of 226 487 adults in Australia

BACKGROUND

A frequently proposed, but under-researched hypothesis is that ethnic density benefits mental health through increasing social interactions. We examined this hypothesis in 226 487 adults from 19 ethnic groups aged 45 years and older in Australia.

METHODS

Multilevel logit regression was used to measure the association between ethnicity, social interactions, own-group ethnic density and scores of 22+ on the Kessler scale of psychological distress. Self-reported ancestry was used as a proxy for ethnicity. Measures of social interactions included a number of times in the past week were (i) spent with friends or family participants did not live with; (ii) talked to someone on the telephone; (iii) attended meetings of social groups and (iv) how many people could be relied upon outside their home, but within 1 h of travel. Per cent own-group ethnic density was measured at the Census Collection District scale.

RESULTS

Psychological distress was reported by 11% of Australians born in Australia. The risk of experiencing psychological distress varied among ethnic minorities and by country of birth (eg, 33% for the Lebanese born in Lebanon and 4% for the Swiss born in Switzerland). These differences remained after full adjustment. Social interactions varied between ethnic groups and were associated with lower psychological distress and ethnic density. Ethnic density was associated with reduced psychological distress for some groups. This association, however, was explained by individual and neighbourhood characteristics and not by social interactions.

CONCLUSIONS

Social interactions are important correlates of mental health, but fully explain neither the ethnic differences in psychological distress nor the protective effect of own-group density.

The impact of socioeconomic status on changes in the general and mental health of women over time: evidence from a longitudinal study of Australian women

INTRODUCTION

Generally, men and women of higher socioeconomic status (SES) have better health. Little is known about how socioeconomic factors are associated with changes in health as women progress through mid-life. This study uses data from six survey waves (1996 to 2010) of the Australian Longitudinal Study on Women's Health (ALSWH) to examine associations between SES and changes in the general health and mental health of a cohort of women progressing in years from 45-50 to 59-64.

METHODS

Participants were 12,709 women (born 1946-51) in the ALSWH. Outcome measures were the general health and mental health subscales of the Medical Outcomes Study Short Form 36 Questionnaire (SF-36). The measure of SES was derived from factor analysis of responses to questions in the ALSWH baseline survey (1996) on school leaving age, highest qualifications, and current or last occupation. Multi-level random coefficient models, adjusted for socio-demographic factors and health behaviors, were used to analyze repeated measures of general health and mental health. Survey year accounted for changes in factors across time. In the first set of analyses we investigated associations between the SES index, used as a "continuous" variable, and general health and mental health changes over time. To illuminate the impact of different levels of SES on health, a second analysis was conducted in which SES scores were grouped into three approximately equal sized categories or "tertiles" as reported in an earlier ALSWH study. The least square means of general and mental health scores from the longitudinal models were plotted for the three SES tertiles.

RESULTS

The longitudinal analysis showed that, after adjusting for the effects of time and possible confounders, the general (mental) health of this cohort of mid-aged women declined (increased) over time. Higher SES women reported better health than lower SES women, and SES significantly modified the effects of time on both general and mental health in favor of higher SES women.

CONCLUSIONS

This study contributes to our current understanding of how socioeconomic and demographic factors, health behaviors and time impact on changes in the general and mental health of women progressing in years from 45-50 to 59-64.