'Turbulence even in a bubble': a reflexive thematic analysis with family caregivers of people with dementia in the United Kingdom during and beyond the COVID-19 pandemic

OBJECTIVE

This study aimed to understand how family caregivers of people with dementia managed changes caused by COVID-19 restrictions and how they adjusted to the lifting of restrictions. A particular focus of the study was on understanding the impact of social isolation, a reduction of social interactions, and reduced access to healthcare services.

METHODS AND MEASURES

Fourteen voluntary caregivers (nine women) were interviewed using a semi-structured interview schedule.

RESULTS

Five themes were identified based on reflexive thematic analysis: (i) Outlets to cope with lockdown; (ii) 'Not all doom and gloom': A silver lining amid COVID-19; (iii) Optimism helps provide resilience; (iv) The challenges and joys of reopening; and (v) Caregiving toward a new normality.

CONCLUSION

The research highlighted difficulties reported by family caregivers and people with dementia during COVID-19, while also showing how such carers coped. Interviews also identified ways that family caregivers often used optimism to help navigate through lockdown and to tackle the reopening stage. Family caregivers in this study reported coping well overall, but welcomed the lifting of restrictions.

The Effects of Urban Green Space on Depressive Symptoms of Mid-Aged and Elderly Urban Residents in China: Evidence from the China Health and Retirement Longitudinal Study

The aim of this study is to assess the impacts of urban green space on depressive symptoms among Chinese urban residents aged 45 and older. In total, 7397 urban respondents were included in this study. Each respondent participated in the China Health and Retirement Longitudinal Study Wave 3 (2015). Environmental-level variables were retrieved from the National Bureau of Statistics database. Both unadjusted and adjusted methods were used in the multilevel regression analysis. Almost one-third of the sample population suffered from depressive symptoms (31.20%). The multilevel logistic regression model showed that green coverage ratio of city-built districts is negatively associated with the prevalence of depressive symptoms among urban mid-aged (OR = 0.79, p < 0.05) and elderly (OR = 0.75, p < 0.05) residents, and the public recreational green space helps to reduce elderly people’s depressive symptoms (OR = 0.77, p < 0.05). This study adds insights about the impact of green space and other environmental factors on depressive symptoms among mid-aged and elderly urban dwellers. It is important to provide enough and accessible overall urban green spaces; additionally, attention should also be paid to specific green space forms such as public recreational green space.

Optimism as a key to improving mental health in family caregivers of people living with Alzheimer's disease

Objective: The aim of the present work was to study the serial multiple mediating role of optimism, perceived social support and subjective burden in the relationship between objective burden and psychological distress in caregivers of people with Alzheimer´s Disease (AD).Method: One hundred and forty family caregivers of people living with AD were recruited from randomly selected Alzheimer Association Centres. They answered the General Health Questionnaire (GHQ), the Life Orientation Test-Revised (LOT-R), the Functional Social Support Questionnaire (DUKE.UNC), the Zarit Burden Interview (ZBI) and questions relating to gender, age and the amount of time spent on daily caregiving.Results: Results indicated that objective burden and subjective burden were both high in these caregivers. Optimism mediated on psychological distress through social support and through subjective burden with a full mediation role. When comparisons between indirect effects were performed, optimism was the mediator with the greatest effect between objective burden and psychological distress.Conclusion: This study highlights the indirect role of optimism and the advantages that interventions in optimism training in the early stages of the person with AD could produce. Thus, alleviating subjective burden and increasing perceived social support, which would lead to an improvement in the mental health of family caregivers of people with AD.

The Relation Between Steroid Secretion Patterns and the Androgen Receptor Gene Polymorphism on Physical Health and Psychological Well-Being-Longitudinal Findings From the Men's Health 40+ Study

Research is increasingly focusing on promoting healthy aging and the related extension of the health span by targeting crucial biological processes responsible for age-related conditions. While age-related gradual changes in steroid hormones such as testosterone, estradiol, or cortisol are well described in men, their interactions among each other or with genetic markers have not been sufficiently investigated with regard to physical health or psychological well-being. More specifically, the examination of age-related alterations in hormone interactions and the androgen receptor polymorphism, which modulates androgen action on target cells, in relation to physical health and psychological well-being represents a promising avenue for research on healthy aging in men. A total of 97 healthy aging men provided complete data on psychometric health measures as well as hormonal and genetic parameters at baseline and a 4-year follow-up assessment. Fasting saliva samples were taken at 8:00 am under standardized laboratory conditions, while the androgen receptor gene polymorphism was analyzed from dried blood spots. Longitudinal analyses revealed that psychological well-being and physical health remained stable over time. Analyses indicated that E2 moderated the course of psychological well-being, while the androgen receptor gene polymorphism moderated the course of physical health. Further, T was a strong predictor of physical health. These results suggest that the hypothalamic-pituitary-gonadal (HPG) axis might be important for the maintenance of psychological well-being in men, while physical health depends more on interindividual differences in the androgen receptor gene and T.

Psychobiological indicators of the subjectively experienced health status - findings from the Women 40+ Healthy Aging Study

BACKGROUND

Healthy aging is particularly important in women, as their life-span is generally longer than men's, leaving women at higher risk for age-related diseases. Understanding determinants of women's healthy aging is therefore a major public health interest. Clinical utility of previous research is limited, through its focus on either single psychosocial or biological predictors. The present study investigated psychobiological predictors of women's healthy aging, for the first time including positive psychological traits and biomarkers of healthy aging.

METHODS

Totally, 121 generally healthy women aged 40 to 75 were investigated cross-sectionally. Healthy aging was operationalized via self-rated health (SRH). To gain a nuanced view of the particularities at the upper end of the illness-wellness continuum, women with excellent SRH and those with good SRH were analyzed as distinct groups. Socioeconomic and sociodemographic variables, health behavior, resilience, optimism, and self-worth as well as menopausal symptoms, and levels of steroid hormones and gonadotropins were considered as predictors of SRH. Binary logistic regression analyses using the forward conditional method were performed with the two health status groups as dependent variable.

RESULTS

Women with a lower body mass index (BMI; OR = .59, 95% CI = .33-1.03), higher intensive physical activity (OR = 2.27, 95% CI = 1.06-4.86), and higher resilience (OR = 2.37, 95% CI = 1.34-4.18) were more likely to rate their health as excellent compared to good. No clinically significant differences could be found regarding endocrine levels.

CONCLUSION

Psychobiological indicators (lower BMI, intensive physical activity, higher resilience) discriminated SRH at the top level of the health spectrum. In healthy women, the predictive value of endocrine markers seems to be secondary. Interventions targeting these indicators could promote women's healthy aging.

Magnitude and sources of distress in mid-life adults with chronic medical illness: an exploratory mixed-methods analysis

Most mid-life adults have at least one chronic medical condition (CMC) and are at risk for developing additional CMCs. Stressors specific to this life stage may contribute to CMC development by hindering healthy behaviors. The goal of this study was to compare sources and intensity of distress, as they relate to health behaviors, between mid-life and non-mid-life adults with CMCs. We utilized a mixed-methods approach by analyzing quantitative self-report measures of psychiatric symptoms and psychological well-being, with in-depth, semi-structured qualitative interviews to identify sources of stress in three cohorts of patients with CMCs (heart failure, type 2 diabetes, and coronary artery disease). Between-group differences on self-report measures were compared via independent samples t-tests and relevant themes from interview transcripts were compared via chi-square analysis. We found that mid-life participants (n = 30) reported greater psychological distress (depression/anxiety) than non-mid-life (n = 62) participants (Hospital Anxiety and Depression Scale scores 13.8 [SD 7.3] vs. 10.6 [SD 6.6]; t(90)=2.13; p = .035), and qualitative analysis revealed several specific sources of stress significantly more common (p < .001) in mid-life adults. Interventions targeting the needs of this population could reduce distress, improve health behaviors, and have a major impact on public health.

The longitudinal relation of stress during the menopausal transition to fibrinogen concentrations: results from the Study of Women's Health Across the Nation

OBJECTIVE

Life course theory suggests that exposures during critical or sensitive periods have particularly profound effects on health. Most research on this subject has focused on the occurrence of such windows early in life. We investigated whether perimenopause, a period of dramatic neuroendocrine changes at midlife, represents a sensitive period for response to stress by evaluating the relation of perceived stress to fibrinogen, a biomarker for inflammation.

METHODS

The study sample was composed of participants in the Study of Women's Health Across the Nation, a longitudinal study on women's health during the menopausal transition (n = 3,287). We fitted linear mixed effects models to estimate the longitudinal relationship between stress and menopausal stage and the association between stress and fibrinogen over the menopausal transition.

RESULTS

Women in early and late perimenopause reported perceiving higher levels of stress than premenopausal women (P < 0.05), adjusted for confounding variables. This increased perception of stress during perimenopause, however, was unrelated to changes in fibrinogen.

CONCLUSIONS

Although neuroendocrine changes during the menopausal transition may exacerbate the negative health effects of stress, the findings of this study do not suggest such interaction, as measured by changes in fibrinogen. The significant association observed between perceived stress and menopause status, however, may still have important implications, given prior literature linking perceived stress with numerous health outcomes.

Psychobiological Protective Factors Modifying the Association Between Age and Sexual Health in Men: Findings From the Men's Health 40+ Study

Sexual health severely decreases with age. For males older than 40 years, erectile dysfunction (ED) is the most common sexual disorder. Although physical and psychological risk factors for ED have been identified, protective factors are yet to be determined. To date, no study has examined endocrine and psychosocial factors in parallel with regard to their modifying effect on the age-related increase in ED. Two hundred and seventy-one self-reporting healthy men aged between 40 and 75 years provided both psychometric data on sexual function and a set of potential psychosocial protective factors, and saliva samples for the analysis of steroid hormones and proinflammatory cytokines. Around 35% of the participants reported at least a mild form of ED. Direct associations with ED were identified for perceived general health, emotional support, relationship quality, intimacy motivation but not for steroid hormones or proinflammatory markers. Moderation analyses for the association between age and ED revealed positive effects for testosterone (T), dehydroepiandrosterone (DHEA), perceived general health, emotional support, intimacy motivation, and a negative effect for interleukin-6 (all p < .05; f² > .17). Group differences between older men with and without ED emerged for T, DHEA, and psychometric measures such as perceived general health, emotional support, satisfaction with life, and intimacy motivation (all p < .05; d > .3). Both psychosocial and endocrine parameters moderated the association between age and sexual health. Perceived general health, emotional support, intimacy motivation, and relationship quality emerged as psychosocial protective factors against ED. Higher T and DHEA and lower interleukin-6 levels also buffered against an age-related increase in ED.

The Swiss Preschoolers' health study (SPLASHY): objectives and design of a prospective multi-site cohort study assessing psychological and physiological health in young children

Background

Children’s psychological and physiological health can be summarized as the child’s thinking, feeling, behaving, eating, growing, and moving. Children’s psychological and physiological health conditions are influenced by today’s life challenges: Thus, stress exposure and lack of physical activity represent important health challenges in older children. However, corresponding evidence for young children is scarce. The aim of Swiss Preschoolers’ Health Study (SPLASHY) is to examine the role of stress and physical activity on children’s psychological and physiological health, particularly on cognitive functioning, psychological well-being, adiposity and motor skills in children at an early stage of childhood. We will also assess the role of child and environmental characteristics and aim to define sensitive time points.

Methods/design

In a total of 84 child care centers, children at preschool age (2–6 years) are recruited and are assessed immediately and one year later. Assessments include direct measurements of the children in the child care centers and at home as well as assessments of children’s behavior and environmental factors through informants (parents and child care educators).

Discussion

SPLASHY is one of the first studies in early childhood aiming to investigate the influence of stress and physical activity on children’s psychological and physiological health in a community-based longitudinal design.

Trial registration

Current Controlled Trials ISRCTN41045021 (date of registration: 21.03.14)

Moderators of Mother's Problems on Middle-Aged Offspring Depressive Symptoms

OBJECTIVES

Conservation of Resources (COR) theory postulates that individuals utilize various resources to manage stressful circumstances. Children employ many resources to cope with the problems of parents who suffer from disabilities, cognitive impairment, and functional limitations. This phenomenon is rarely explored among middle-aged offspring and their aging parents.

METHOD

Drawing from the Family Exchanges Study, we focus on a sample (N = 308) of middle-aged adults (mean age = 51) whose only living parent was their mother. We use multiple regression to examine maternal support and self-reported health as moderators of maternal problems on offspring depressive symptoms.

RESULTS

Participants whose mothers had few problems generally reported low levels of depressive symptoms. When mothers had high problems, results indicate a negative association between depressive symptoms and physical health. When maternal problems were high, the amount of support offspring receive from their mother had a negative association with offspring depressive symptoms. When mothers had low problems, receiving more maternal support was associated with lower depressive symptoms and receiving low support was associated with increased depressive symptoms.

DISCUSSION

Middle-aged offspring use both personal and family-based resources to buffer the psychological ramifications of their mother's problems. Our results provide a unique extension of COR theory.