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Zhao R, Wang J, Lou J, Liu M, Deng J, Huang D, Fang H. The effect of education level on depressive symptoms in Chinese older adults-parallel mediating effects of economic security level and subjective memory ability. BMC Geriatr 2024; 24:635. [PMID: 39075338 PMCID: PMC11287845 DOI: 10.1186/s12877-024-05233-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 07/19/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Depression in older adults needs urgent attention. Increased education level may reduce depressive symptoms in older adults, and that economic security level and subjective memory ability may also have an impact on depressive symptoms in older adults, but the mechanisms between education level and depressive symptoms in older adults are unclear. This study endeavors to investigate the parallel mediating roles of economic security level and subjective memory ability between education level and depressive symptoms in older adults. METHODS A total of 4325 older adults people aged 60 years and above were selected from the China Family Panel Studies (CFPS) as the study population, and all data were analyzed using SPSS 25.0 software. Spearman correlation analysis was used to explore the correlation between the variables. Model 4 from the SPSS macro was used to assess the parallel mediating role of economic security level and subjective memory ability in the relationship between education level and depressive symptoms in older adults. RESULTS Education level, economic security level, and subjective memory ability were significantly associated with depressive symptoms in older adults (p < 0.01). Educational level was a negative predictor of depressive symptoms (β=-0.134, P < 0.001). Education level was a positive predictor of economic security level (β = 0.467, P < 0.001) and subjective memory ability (β = 0.224, P < 0.001). Education level, economic security level, and subjective memory ability were significant negative predictors of depressive symptoms (β= -0.039, P < 0.05; β= -0.122, P < 0.001; β= -0.169, P < 0.001). Education level influenced depressive symptoms through parallel mediating effects of economic security level and subjective memory ability, with mediating effects accounting for 42.70% and 28.30% of the total effect, respectively. CONCLUSIONS Education level not only directly influences depressive symptoms in older adults, but also indirectly through the economic security level and subjective memory ability. Educational level can reduce depressive symptoms in older adults by increasing their economic security level and enhancing their subjective memory ability. The findings of this study emphasize the importance of improving the educational level of the population as it affects people's mental health in old age.
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Affiliation(s)
- Ruonan Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC KeyLab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Jian Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- NHC KeyLab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
| | - Jiaxu Lou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC KeyLab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Mei Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC KeyLab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Jiahui Deng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC KeyLab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
| | - Derong Huang
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Huiling Fang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC KeyLab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
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Saravanakumar P, Muhammad T, Paul R, Srivastava S. Explaining the Urban-Rural Difference in Late-Life Depression in India: Evidence from a Multivariate Decomposition Analysis Based on Longitudinal Aging Study in India, Wave 2017-18. Clin Gerontol 2024; 47:270-287. [PMID: 37700396 DOI: 10.1080/07317115.2023.2257179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
OBJECTIVES The study explored the associated factors of depression among older Indian adults and the influences of individual and socio-environmental factors in explaining the rural-urban difference in the prevalence of late-life depression. METHODS Data come from the Longitudinal Aging Study in India, with a sample of 30,637 older adults aged 60 and above. Multivariable logistic regression and nonlinear multivariate decomposition analyses were conducted to fulfill the objectives. RESULTS About 6.2% older adults in urban areas and 9.5% in rural areas were depressed. Older adults in rural areas had significantly higher likelihood to be depressed than those in urban areas. Poor self-rated health, multiple chronic conditions, functional difficulty, low life satisfaction, social inactivity, low satisfaction with living arrangement, ill-treatment and being widowed increased the risk of depression. Additionally, work status similar to urban older adults, physical activity, living arrangement satisfaction, self-rated health and ill-treatment would decrease the urban-rural difference in depression. CONCLUSIONS The study showed significant rural-urban difference in late-life depression, with a rural disadvantage. CLINICAL IMPLICATIONS The findings suggest the need for identifying at-risk populations and developing a framework of targeted policy interventions for mitigating the increased risk of late-life depression among older Indians and in rural areas in particular.
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Affiliation(s)
- Priya Saravanakumar
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - T Muhammad
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, India
| | - Ronak Paul
- Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Shobhit Srivastava
- Department of Survey Research & Data Analytics, International Institute for Population Sciences, Mumbai, India
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Zheng X, Tong L, Zhang C, Zhang C, Zhang C, Wan B. Modifiable risk factors of major depressive disorder: A Mendelian randomization study. PLoS One 2023; 18:e0289419. [PMID: 37535610 PMCID: PMC10399902 DOI: 10.1371/journal.pone.0289419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 07/18/2023] [Indexed: 08/05/2023] Open
Abstract
Identifying modifiable risk factors early on is essential to prevent major depressive disorder (MDD). This study systematically investigated the causal relationship between 19 modifiable risk factors and MDD. Single-nucleotide polymorphisms (SNPs) associated with 19 potentially modifiable risk factors were screened via the genome-wide association study (GWAS) enrolling individuals of European descent. Summary-level data for MDD (59,851 cases and 113,154 controls) were extracted from the UK Biobank. The inverse-variance-weighted (IVW) method was utilized as the primary analysis. Sensitivity analyses were performed using the MR-Egger method, the Maximum likelihood method, the MR-pleiotropy residual sum outlier (MR-PRESSO) method, and MR-robust adjusted profile score (MR-RAPS) method. MR-Egger regression, heterogeneity tests, pleiotropy tests, and leave-one-out tests were also performed to analyze sensitivity. The MR Steiger test was used to verify the directionality of the exposure to the outcome. Genetically predicted smoking initiation increased the risk of MDD (P = 6.00E-09), while smoking status: never and past tobacco smoking decreased the risk of MDD (all P < 0.01). In addition, education level was inversely associated with MDD risk (all P < 0.01). Genetically instrumented sleeplessness/insomnia, daytime naps, and nap during the day were positively related to the risk of MDD (all P < 0.01). Personal feelings, including guilt, hurt, tension, and worry too long after an embarrassing experience, had a suggestive increased risk for MDD (all P < 0.000). The remaining five modifiable risk factors were all causally associated with the risk of MDD, including neuroticism, neuroticism scores, body mass index (BMI), average total household income before tax, and types of physical activity in the last 4 weeks (all P < 0.01). All 19 potentially modifiable risk factors were causally associated with the risk of MDD. The main hypothesis of this MR study was that identifying and intervening in these 19 potentially modifiable risk factors could be beneficial to the prevention and treatment of MDD and further reduce mortality and economic burden.
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Affiliation(s)
- Xiaofei Zheng
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Li Tong
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chong Zhang
- Reproductive Medical Center, Hainan Women and Children's Medical Center, Haikou, China
| | - Chaoyang Zhang
- Department of General Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chao Zhang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Bangbei Wan
- Reproductive Medical Center, Hainan Women and Children's Medical Center, Haikou, China
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Johnson Pradeep R, Ekstrand ML, Selvam S, Heylen E, Mony PK, Srinivasan K. Risk factors for severity of depression in participants with chronic medical conditions in rural primary health care settings in India. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 3. [PMID: 33681860 PMCID: PMC7929528 DOI: 10.1016/j.jadr.2020.100071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Depression and chronic medical disorders are strongly linked. There are limited studies addressing the correlates of the severity of depression in patients with co-morbid disorders in primary care settings. This study aimed to identify the socio-demographic and disease-specific risk factors associated with the severity of depression at baseline among patients participating in a randomized controlled trial (HOPE study). Methods Participants were part of a randomized controlled trial in 49 primary care health centers in rural India. We included adults (≥ 30 years) with at least mild Depression or Anxiety Disorder and at least one Cardiovascular disorder or Type 2 Diabetes mellitus. They were assessed for the severity of depression using the PHQ-9, severity of anxiety, social support, number of co-morbid chronic medical illnesses, anthropometric measurements, HbA1c, and lipid profile. Results Proportionately there were more women in the moderate category of depression than men. Ordinal logistic regression showed co-morbid anxiety and a lower level of education significantly increased the odds of more severe depression, while more social support was significantly negatively associated with depression severity in women. In men, anxiety was positively associated with greater depression severity; while reporting more social support was negatively associated with depression. Limitations This is a cross-sectional study and thus, no causal conclusions are possible. Conclusions Anxiety and poor social support in both genders and lower educational levels in women were associated with increased severity of depression. Early identification of risk factors and appropriate treatment at a primary care setting may help in reducing the morbidity and mortality associated with depression.
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Affiliation(s)
- R Johnson Pradeep
- Department of Psychiatry, St John's Medical College, Sarjapur Road, Bangalore, Karnataka 560034, India
| | - Maria L Ekstrand
- Division of Mental Health and Neurosciences, St. John's Research Institute, St John's Medical College, Sarjapur Road, Bangalore, Karnataka 560034, India.,Division of Prevention Sciences, University of California, San Francisco, United States
| | - Sumithra Selvam
- Division of Epidemiology & Population Health, St John's Research Institute, St John's Medical College, Sarjapur Road, Bangalore, Karnataka 560034, India
| | - Elsa Heylen
- Division of Prevention Sciences, University of California, San Francisco, United States
| | - Prem K Mony
- Division of Epidemiology & Population Health, St John's Research Institute, St John's Medical College, Sarjapur Road, Bangalore, Karnataka 560034, India
| | - Krishnamachari Srinivasan
- Department of Psychiatry, St John's Medical College, Sarjapur Road, Bangalore, Karnataka 560034, India.,Division of Mental Health and Neurosciences, St. John's Research Institute, St John's Medical College, Sarjapur Road, Bangalore, Karnataka 560034, India
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da Costa Dias FL, Teixeira AL, Guimarães HC, Santos APB, Resende EDPF, Machado JCB, Barbosa MT, Caramelli P. The influence of age, sex and education on the phenomenology of depressive symptoms in a population-based sample aged 75+ years with major depression: the Pietà Study. Aging Ment Health 2021; 25:462-467. [PMID: 31791131 DOI: 10.1080/13607863.2019.1698517] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Late-life depression (LLD) is the most common mental disorder among the elderly, but its clinical features remain unclear, especially among older adults. We sought to investigate if age, sex and education could influence the severity or frequency of LLD symptoms. METHODS We evaluated 639 community-dwelling individuals aged 75+ years in Caeté (MG), Brazil. We used the Mini International Neuropsychiatric Interview to diagnose major depression according to DSM-IV criteria and the GDS-15 to measure depression severity. RESULTS Excluding 174 individuals diagnosed with dementia, 54 (11.6%) of the remaining 457 individuals were diagnosed with LLD; 77.8% of which were female. On average, these participants were aged 81.0 ± 4.8 years and had 2.7 ± 3.3 years of schooling. Symptom severity was not influenced by sociodemographic variables. Death/suicidal ideation was more frequent among men, while psychomotor disturbance was more present in women (p = 0.04 and p = 0.042). More educated individuals (≥ 4 years) also reported a higher frequency of psychomotor disturbance (p = 0.039). CONCLUSIONS Severity of depressive episode was not influenced by sociodemographic variables. Sex and educational level had a significant impact on symptom profiles.
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Affiliation(s)
- Filipi Leles da Costa Dias
- Post-Graduate Program in Adult Health, School of Medicine, Federal University of Minas Gerais, Belo Horizonte (MG), Brazil.,Cognitive and Behavioral Neurology Research Group, Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte (MG), Brazil.,Medical Sciences Faculty of Minas Gerais, Belo Horizonte (MG), Brazil
| | - Antônio Lúcio Teixeira
- Post-Graduate Program in Adult Health, School of Medicine, Federal University of Minas Gerais, Belo Horizonte (MG), Brazil.,Cognitive and Behavioral Neurology Research Group, Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte (MG), Brazil
| | - Henrique Cerqueira Guimarães
- Cognitive and Behavioral Neurology Research Group, Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte (MG), Brazil
| | - Ana Paula Borges Santos
- Post-Graduate Program in Adult Health, School of Medicine, Federal University of Minas Gerais, Belo Horizonte (MG), Brazil.,Cognitive and Behavioral Neurology Research Group, Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte (MG), Brazil
| | - Elisa de Paula França Resende
- Cognitive and Behavioral Neurology Research Group, Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte (MG), Brazil
| | | | - Maira Tonidandel Barbosa
- Cognitive and Behavioral Neurology Research Group, Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte (MG), Brazil
| | - Paulo Caramelli
- Post-Graduate Program in Adult Health, School of Medicine, Federal University of Minas Gerais, Belo Horizonte (MG), Brazil.,Cognitive and Behavioral Neurology Research Group, Department of Internal Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte (MG), Brazil
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Baird B, Oh KM, Douglas C, Weinstein AA. Health Literacy, Depression Literacy, and Depression among Older Korean Americans. JOURNAL OF HEALTH COMMUNICATION 2019; 24:525-535. [PMID: 31244411 DOI: 10.1080/10810730.2019.1632395] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to explore depression and its relationship with background characteristics, health literacy, and depression literacy among Korean Americans (KAs). A cross-sectional survey was conducted among 178 older KAs (age 60≥) in the Washington D.C. metro area in 2016. Three open-ended questions were included to obtain narrative responses for thoughts about depression and its symptoms, and the living situation that might be related to depression. Depression was measured on the Patient Health Questionnaire-9 translated into Korean. The rate of depression was 22.5% among older KAs. No relationship between health literacy and depression was shown. In the regression analysis with covariates, limited English proficiency, less family support, shorter length of U.S. residency, male, and higher depression literacy were significantly associated with higher odds of depression. On narrative questions, only 35% among respondents believed that depression was a mental status. The others described it as environmental or attitude problems such as stress or goals being set too high. Education about depression engaging older KAs immigrants with limited English, and their families are the important health issue in the Korean community.
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Affiliation(s)
- Byung Baird
- a School of Nursing, George Mason University , Fairfax , VA , USA
| | - Kyeung Mi Oh
- a School of Nursing, George Mason University , Fairfax , VA , USA
| | - Charlene Douglas
- a School of Nursing, George Mason University , Fairfax , VA , USA
| | - Ali A Weinstein
- b Department of Global and Community Health, George Mason University , Fairfax , VA , USA
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Ning H, Harrison TC, Zhao Y, Hu H, Chen H, Liao L, Yu R, Wu S, Feng H. Correlates of Depressive Symptoms Among Older Adults With Physical Functional Limitations: A Cross-Sectional Study in China. Res Gerontol Nurs 2019; 12:133-146. [DOI: 10.3928/19404921-20190306-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/31/2019] [Indexed: 12/20/2022]
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Prevalence of late-life depression and its correlates in a community-dwelling low-educated population aged 75+ years: The Pietà study. J Affect Disord 2019; 242:173-179. [PMID: 30189354 DOI: 10.1016/j.jad.2018.08.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/03/2018] [Accepted: 08/07/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND The number of individuals with advanced age is growing worldwide, especially in developing countries. Depression is the most common mental disorder in the elderly. The aim of this study was to evaluate the prevalence rates and the correlates of late-life depression (LLD) and clinically significant depressive symptoms (CSDS) in a population aged 75+ years. METHODS We evaluated 639 community-dwelling individuals aged 75+ years in Caeté (MG), Brazil, and used the MINI to diagnose LLD according to DSM-IV criteria and the GDS-15 to identify CSDS. Quality of life was assessed by the WHOQOL-OLD scale. RESULTS Overall, 639 individuals (64% female, with a mean age of 81.1 ± 5.2 and 2.6 ± 2.8 years of schooling) were evaluated; 70 (11.1%) were diagnosed with LLD and 146 (25.6%) with CSDS. Depressed subjects (both with LLD and CSDS) had poorer measures of quality of life. Logistic regression analyses showed that LLD was independently associated to a history of falls/fracture, a diagnosis of cognitive impairment-no dementia, the number of regular drugs used, lack of reading habit and, inversely, to systolic blood pressure. LIMITATIONS The use of MINI which has not been validated in the elderly. No information was available on the number of previous depressive episodes or on the age of first episode. CONCLUSION Both dimensional and categorical diagnoses of depression were prevalent among community-dwelling oldest-old individuals. Different clinical and personal variables were associated with depression, which negatively influenced the quality of life of the affected individuals.
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Abstract
UNLABELLED ABSTRACTBackground:The number of elderly individuals living in China is increasing rapidly. The aim of this study was to examine the potential risk factors of geriatric depression in rural areas. METHODS A repeated cross-sectional study was conducted between January 2015 and October 2016 in rural China. Nine hundred forty-five elderly individuals were included in both investigations. A generalized estimating equation (GEE) was used to examine the relationships between geriatric depression and socio-demographics, the number of chronic diseases, ADL (Activity of Daily Living) disability, cognitive impairment, and anxiety. RESULTS Among the participants, the majority was female (61.4%) and illiterate (81.5%) and had a general economic status (63.0%) and more than two kinds of chronic diseases (62.9%). The bivariate analysis indicated that geriatric depression was associated with social support, education level, economic status, ADL disability, anxiety disorders, and cognitive impairment at both survey time points. The GEE results showed that poor economic status (OR = 8.294, p < 0.001), the presence of more than two chronic diseases (OR = 1.681, p = 0.048), ADL disability (OR = 2.184, p < 0.001), cognitive impairment (OR = 1.921, p < 0.001), and anxiety (OR = 5.434, p < 0.001) were risk factors for geriatric depression in rural China; better social support (OR = 0.924, 95% CI = 0.899-0.949, p < 0.001) was found to be a protective factor. CONCLUSIONS Geriatric depression in rural China was associated with several socio-demographic, physical, and mental factors. Targeted interventions are essential to improve the psychological health of aged individuals in rural China.
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Shao P, Xu Y, Pan CW. Factors associated with and prevalence of depressive features amongst older adults in an urban city in eastern China. S Afr J Psychiatr 2017; 23:1064. [PMID: 30263196 PMCID: PMC6138213 DOI: 10.4102/sajpsychiatry.v23i0.1064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/30/2017] [Indexed: 11/30/2022] Open
Abstract
Background Mental health problems have become serious for older Chinese adults who have lived through the process of urbanisation. This current research aimed to determine the prevalence of and associated factors for depressive features in a community-based sample of older adults in China. Methods A community-based survey of 4077 adults aged 60 or older was conducted in Suzhou, China. Information including demographic characteristics, health behaviours, social support, disease histories and physical function was collected using a pre-designed questionnaire. Depressive features were assessed using the self-rating depression scale. Multivariate logistic regression analysis was performed to identify associated factors for depression. Results The overall prevalence of depressive features in the surveyed population was 47.4% (45.9% in men and 48.5% in women). In a multiple logistic regression analysis, the significant variables of depressive features were no fixed occupation (odds ratio [OR] = 0.28; 95% confidence interval [CI]: 0.21–0.37), doing non-technical and service work (OR = 0.23; 95% CI: 0.19–0.28) or being a manager and technical personnel (OR = 0.25; 95% CI: 0.19–0.32), physical activities (OR = 0.71; 95% CI: 0.61–0.82), never taking dietary supplements (OR = 0.73; 95% CI: 0.58–0.91), not having hobbies (OR = 1.34; 95% CI: 1.15–1.56), never interacting with neighbours (OR = 1.79; 95% CI: 1.28–2.50), cold relationship with a spouse (OR = 3.34; 95% CI: 1.18–9.45) and limited activities of daily living (OR = 2.27; 95% CI: 1.91–2.69). Conclusion There is an urgent need for public policy interventions to address depression in elderly people located in Suzhou in China.
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Affiliation(s)
- Ping Shao
- School of Public Health, Medical College of Soochow University, China.,Department of Health Management, Medical College of Hangzhou Normal University, China
| | - Yong Xu
- School of Public Health, Medical College of Soochow University, China
| | - Chen-Wei Pan
- School of Public Health, Medical College of Soochow University, China
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Zou H, Chen Y, Fang W, Zhang Y, Fan X. The mediation effect of health literacy between subjective social status and depressive symptoms in patients with heart failure. J Psychosom Res 2016; 91:33-39. [PMID: 27894460 DOI: 10.1016/j.jpsychores.2016.10.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/16/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Depressive symptoms are prevalent and cause adverse outcomes in heart failure. Previous studies have linked depressive symptoms with socioeconomic status. However, little is known about the mechanisms underlying this relationship. This study aimed to evaluate the association between socioeconomic status and depressive symptoms, and to examine whether access to healthcare, health literacy and social support mediated this relationship in patients with heart failure. METHODS Cross-sectional design was used to study 321 patients with heart failure recruited from a general hospital. Demographics, clinical data, depressive symptoms, socioeconomic status (i.e., education, employment, income, and subjective social status), access to healthcare, health literacy, and social support were collected by patient interview, medical record review or questionnaires. A series of logistic regressions and linear regressions were conducted to examine mediation. RESULTS The mean age of patients with heart failure was 63.6±10.6years. Fifty-eight patients (18%) had depressive symptoms. Lower subjective social status (OR=1.321, p=0.012) and lower health literacy (OR=1.065, p<0.001) were separately associated with depressive symptoms. When subjective social status and health literacy were entered simultaneously, the relationship between subjective social status and depressive symptoms became non-significant (OR=1.208, p=0.113), demonstrating mediation. Additionally, lower social support was associated with depressive symptoms (OR=1.062, p=0.007). CONCLUSIONS In patients with heart failure, health literacy mediated the relationship between subjective social status and depressive symptoms. Lower social support was associated with depressive symptoms. Interventions should take these factors into account.
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Affiliation(s)
- Huijing Zou
- School of Nursing, Shandong University, Jinan, Shandong Province, PR China
| | - Yuxia Chen
- School of Nursing, Shandong University, Jinan, Shandong Province, PR China
| | - Wenjie Fang
- School of Nursing, Shandong University, Jinan, Shandong Province, PR China
| | - Yanting Zhang
- School of Nursing, Shandong University, Jinan, Shandong Province, PR China
| | - Xiuzhen Fan
- School of Nursing, Shandong University, Jinan, Shandong Province, PR China.
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The Clinical Characteristics according to the Educational Level in the Elderly Patients with Mild Alzheimer's Disease Dementia. Dement Neurocogn Disord 2015. [DOI: 10.12779/dnd.2015.14.4.158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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