Three-year prediction of depression and anxiety with a single self-rated health item

Mediating Effect of Heart Rate Variability on the Relationship Between Anxiety Symptoms and Blood Pressure in Patients with Primary Hypertension

Patients with hypertension (HTN) are at increased risk of developing cardiovascular disease, which can be reduced with blood pressure (BP) control. Anxiety can contribute to high BP and low heart rate variability (HRV). Although relationships between social support, self-rated health-status (SRHS), anxiety and measures of HRV and BP have been suggested, they have not been clearly established. This cross-sectional correlational study aimed to 1) examine relationships between social support, SRHS, and anxiety; and 2) examine if HRV mediated relationships between anxiety symptoms and BP. Patients with primary HTN were recruited from a cardiovascular outpatient clinic using convenience sampling (N = 300). Data included scale scores for SRHS, social support, and anxiety (Hospital Anxiety and Depression Scale). A handheld limb-lead electrocardiogram monitor measured HRV, using the ratio of low-frequency bands to high-frequency bands; an automatic sphygmomanometer measured systolic and diastolic blood pressure (SBP and DBP, respectively). Path analysis of structural equation models examined relationships between variables; the bootstrap method examined the mediating effects of HRV. Analysis showed scores for SRHS and social support had a direct effect on anxiety scores. Scores for anxiety directly affected HRV and BP. HRV also had a direct effect on BP. Bootstrapping indicated HRV mediated the relationship between anxiety symptoms and BP. The final model indicated SRHS, social support, and anxiety symptoms together explained 80% of SBP and 33% of DBP. These findings suggest HRV could be used to measure the effectiveness of strategies aimed at reducing anxiety and improving control of BP.

Positive sexuality, relationship satisfaction, and health: a network analysis

Introduction

Positive sexuality, defined as the happiness and fulfillment individuals derive from their sexual experiences, expressions, and behaviors, has been linked to relationship satisfaction and health. However, the intricate associations between positive sexuality and relationship functioning and health indicators have rarely been explored from a network perspective. This approach, by analyzing the interconnections among these factors within a broader system, can offer insights into complex dynamics and identify key variables for targeted interventions.

Methods

The present study applied network analysis to uncover interconnections between positive sexuality, relationship satisfaction, and health indicators, highlight the most relevant variables and explore potential gender-based differences in a sample of 992 partnered individuals (51% women, aged 18-71 years). Networks were estimated via Gaussian Graphical Models, and network comparison test was used to compare men and women.

Results

Results indicated that variables related to positive sexuality were more highly interconnected than the rest of the network. There were small-to-negligible connections between positive sexuality and relationship satisfaction variables, both of which had negligible or no connections with health. The network was globally invariant across gender, though a few connections were gender-specific. The most important variables, regardless of gender, related to pleasurable feelings during sexual intercourse.

Discussion

The findings underscore the importance of enhancing positive sexual experiences within intimate relationships and have implications for research and clinical practice in positive sexuality.

Age and Sex Differences in the Genetic Architecture of Measures of Subjective Health: Relationships With Physical Health, Depressive Symptoms, and Episodic Memory

OBJECTIVES

Subjective health (SH) is not just an indicator of physical health, but also reflects active cognitive processing of information about one's own health and has been associated with emotional health measures, such as neuroticism and depression. Behavior genetic approaches investigate the genetic architecture of SH, that is, genetic and environmental influences on individual differences in SH and associations with potential components such as physical, cognitive, and emotional health. Previous twin analyses have been limited by sex, sample size, age range, and focus on single covariates.

METHODS

The current analysis used data from 24,173 adults ranging in age from 40 to 90 years from the international Interplay of Genes and Environment across Multiple Studies consortium to investigate the genetic architecture of 3 measures of SH: self-rated health, health compared to others, and impact of health on activities. Independent pathways model of SH included physical health, depressive symptoms, and episodic memory, with age, sex, and country included as covariates.

RESULTS

Most or all of the genetic variance for SH measures were shared with physical health, depressive symptoms, and episodic memory. Genetic architecture of SH differed across measures, age groups (40-65, 66-90), and sexes. Age comparisons indicated stronger correlations with all 3 covariates in older adults, often resulting from greater shared genetic variance.

DISCUSSION

The predictive value of SH has been amply demonstrated. The higher genetic contributions to associations between SH and its components in older adults support the increasing conceptualization with age of SH as an intuitive summation of one's vital reserve.

Patient-reported outcome measures in early psychosis: A cross-cultural, longitudinal examination of the self-reported health and self-reported mental health measures in Chennai, India and Montreal, Canada

OBJECTIVE

Despite their acknowledged value, patient-reported outcome measures (PROMs) are infrequently used in psychosis, particularly in low-and middle-income countries. We compared ratings on two single-item PROMs, Self-Rated Health (SRH) and Self-Rated Mental Health (SRMH), of persons receiving similar early psychosis services in Chennai, India and Montreal, Canada. We hypothesized greater improvements in SRH and SRMH in the Chennai (compared to the Montreal) sample.

METHODS

Participants (Chennai N = 159/168 who participated in the larger study; Montreal N = 74/165 who participated in the larger study) completed the SRH and SRMH during at least two out of three timepoints (entry, months 12 and 24). Repeated measures proportional odds logistic regressions examined the effects of time (baseline to month 24), site, and relevant baseline (e.g., gender) and time-varying covariates (i.e., symptoms) on SRH and SRMH scores.

RESULTS

SRH (but not SRMH) scores significantly differed between the sites at baseline, with Chennai patients reporting poorer health (OR: 0.33; CI: 0.18, 0.63). While Chennai patients reported similar significant improvements in their SRH (OR: 7.03; CI: 3.13; 15.78) and SRMH (OR: 2.29, CI: 1.03, 5.11) over time, Montreal patients only reported significant improvements in their SRMH. Women in Chennai (but not Montreal) reported lower mental health than men. Higher anxiety and longer durations of untreated psychosis were associated with poorer SRH and SRMH, while negative symptoms were associated with SRH.

CONCLUSIONS

As hypothesized, Chennai patients reported greater improvements in health and mental health. The marked differences between health and mental health in Montreal, in contrast to the overlap between the two in Chennai, aligns with previous findings of clearer distinctions between mind and body in Western societies. Cross-context (e.g., anxiety) and context-specific (e.g., gender) factors influence patients' health perceptions. Our results highlight the value of integrating simple PROMs in early psychosis.

The influence of different sources of anticipated instrumental support on depressive symptoms in older adults

Objective

This study investigated how anticipated instrumental support sources and intergenerational support influence depressive symptoms in older Chinese adults.

Methods

We employed binary logistic regression on data from 7,117 adults aged ≥60 in the 2018 China Health and Retirement Longitudinal Study, controlling for gender, marital status, and self-rated health.

Results

38.89% of respondents exhibited depressive symptoms. Anticipated support from spouse and children, spouse only, children only, or other sources showed 52, 25, 46, and 40% lower odds of depression, respectively, compared with no anticipated support. Those providing financial support had 36% higher odds of depression than those without exchanges. However, those receiving financial support, receiving instrumental support, and receiving and providing financial and emotional support had 19, 14, 23, and 24% lower odds of depression.

Conclusion

Different anticipated instrumental support sources and intergenerational support influenced depression odds in older adults, suggesting potential benefits in promoting such support systems.

Impact of hearing loss on cognitive function in community-dwelling older adults: serial mediation of self-rated health and depressive anxiety symptoms

Background

Hearing loss can exacerbate cognitive decline; therefore, exploring the mechanisms through which hearing loss affects cognitive function is crucial. The current study aimed to investigate the impact of hearing loss on cognitive function and the mediating role played by self-rated health and depressive anxiety symptoms.

Methods

Using stratified whole-group random sampling, the study employed a cross-sectional design and included 624 participants aged ≥65 years from three communities in Urumqi, China. Cognitive function was assessed using the Mini-Mental State Examination. Hearing function and self-rated health were determined by self-report. The 15-item Geriatric Depression Scale and the 7-item Generalized Anxiety Disorder Scale were used to assess depressive anxiety symptoms. Serial mediation analysis was performed using AMOS 26.0.

Results

Hearing loss can not only negatively affect cognitive function in older adults directly (direct effect = -0.106; SE = 0.045; 95% confidence interval (CI): -0.201 to -0.016), but also indirectly affect the relationship between hearing loss and cognitive function through self-rated health and depressive anxiety symptoms. The results of the serial mediation analysis showed that the total indirect effect of self-rated health and depressive anxiety symptoms was -0.115 (95% CI: -0.168 to -0.070), and the total effect of the model was -0.221 (95% CI: -0.307 to -0.132), with the total indirect effect accounting for 52.04% of the total effect of the model.

Conclusion

Our study discovered that there is a partial mediation of the relationship between hearing loss and cognitive function by self-rated health and depressive anxiety symptoms. It is suggested that by enhancing self-rated health and ensuring good mental health, the decline in cognitive function among older adults with hearing loss can be delayed.

The relationship between pre-surgery self-rated health and changes in functional and mental health in older adults: insights from a prospective observational study

BACKGROUND

Elective surgeries are among the most common health stressors in later life and put a significant risk at functional and mental health, making them an important target of research into healthy aging and physical resilience. Large-scale longitudinal research mostly conducted in non-clinical samples provided support of the predictive value of self-rated health (SRH) for both functional and mental health. Thus, SRH may have the potential to predict favorable adaptation processes after significant health stressors, that is, physical resilience. So far, a study examining the interplay between SRH, functional and mental health and their relative importance for health changes in the context of health stressors was missing. The present study aimed at addressing this gap.

METHODS

We used prospective data of 1,580 inpatients (794 complete cases) aged 70 years or older of the PAWEL study, collected between October 2017 and May 2019 in Germany. Our analyses were based on SRH, functional health (Barthel Index) and self-reported mental health problems (PHQ-4) before and 12 months after major elective surgery. To examine changes and interrelationships in these health indicators, bivariate latent change score (BLCS) models were applied.

RESULTS

Our analyses provided evidence for improvements of SRH, functional and mental health from pre-to-post surgery. BLCS models based on complete cases and the total sample pointed to a complex interplay of SRH, functional health and mental health with bidirectional coupling effects. Better pre-surgery SRH was associated with improvements in functional and mental health, and better pre-surgery functional health and mental health were associated with improvements in SRH from pre-to-post surgery. Effects of pre-surgery SRH on changes in functional health were smaller than those of functional health on changes in SRH.

CONCLUSIONS

Meaningful changes of SRH, functional and mental health and their interplay could be depicted for the first time in a clinical setting. Our findings provide preliminary support for SRH as a physical resilience factor being associated with improvements in other health indicators after health stressors. Longitudinal studies with more timepoints are needed to fully understand the predictive value of SRH for multidimensional health.

TRIAL REGISTRATION

PAWEL study, German Clinical Trials Register, number DRKS00013311. Registered 10 November 2017 - Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013311 .

Health asymmetry as a predictor of depressive symptomatology over time among older European adults: A growth curve analysis

OBJECTIVE

Subjective (SH) and objective health (OH) measures are associated with depressive symptomatology in older adults. We explored whether the discrepancy between SH and OH (operationalised as 'health asymmetry' with four categories: 'health optimistic', 'health pessimistic' and 'good health realistic' and 'poor health realistic') may also relate to depressive symptomatology 1) cross-sectionally, and 2) longitudinally, among older European adults.

METHODS

Adults (n = 26,520), aged 50+, from 11 European countries, were assessed over six waves of data collection (2006-2020) in the SHARE study. A hierarchical multi-level growth curve model explored whether health asymmetry was associated with depressive symptomology at baseline, and with depressive symptom trajectories across time, accounting for country of origin.

RESULTS

At baseline, 11.8% of older adults were classified as health pessimistic, with 15.5% being health optimistic, 42.9% being poor health realistic and 29.8% being good health realistic. A positive linear trend in depressive symptomatology was noted across 14 years of SHARE data (β = 0.11, p < .001). Health pessimists displayed higher levels of depressive symptoms than both health realistic groups and health optimists. However, health pessimists experienced a less steep increase in depressive symptoms across time (β = -0.10, p < .001), relative to good health realists.

CONCLUSION

Health pessimists experience elevated levels of depressive symptoms, but show less growth in depressive symptomatology than expected. Further research is required to understand the underlying causes of the varying depressive symptom trajectories among these groups.

Like ripples on a pond: The long-term consequences of parental separation and conflicts in childhood on adult children's self-rated health

Objective

The aim of the study was to explore how different forms of conflict in childhood and parental separation additively and interactively predict self-rated health (SRH) in adulthood. Furthermore, a subsample analysis investigated how different family conflicts predict SRH in adulthood within the group of separated families, controlling for post-separation circumstances.

Background

Previous research shows that adult children from separated families have worse health compared to peers from intact families. Additionally, inter-parental conflicts are closely associated with parental separation and known to negatively influence children's health. Few studies have taken a broader perspective on conflicts and included conflicts beyond the inter-parental subsystem, such as within other family subsystems, into their analysis.

Methods

Data were based on Swedish Level of Living Survey (LNU). Using linear probability modelling the first analysis shows that SRH in adulthood varies depending on family type and the occurrence of conflict in childhood (n = 6,638). The study then explored variations in SRH within separated families (n = 934).

Results

The results show that adult children from separated families and families with different types of conflicts have worse SRH compared to their peers in intact families and families with no conflicts.

Conclusion

Parental separation has long-term consequences on children's SRH and this relationship is partly predicted by parent-child conflicts.

Implications

The results underline the importance of considering children's involvement when studying the separation process and its outcomes. They also suggest that interventions to help parents and children through a separation would benefit from a focus, not only on inter-parental conflicts but also, on parent-child conflicts, as well as parents' role modelling to prevent children from experiencing negative long-term health outcomes.

Prevalence and factors associated with comorbid depressive symptoms among people with low back pain in China: A cross-sectional study

BACKGROUND

Low back pain is a common medical condition among the general population that is associated with many adverse health effects when comorbid with depressive symptoms. However, little is known about depressive symptoms in the population with low back pain in China. Our study evaluated the prevalence of depressive symptoms and analyzed the factors associated with this condition in the Chinese population with low back pain.

METHODS

We conducted a cross-sectional analysis of data from the 2018 China Health and Retirement Longitudinal Study. We collected low back pain information for each participant and identified depressive symptoms using the brief version of the Center for Epidemiologic Studies Depression Scale. A wide range of sociodemographic and health-related characteristics of the subjects were extracted. We measured the prevalence of depressive symptoms comorbid with low back pain and analyzed the associated factors by multiple logistic regression.

RESULTS

A total of 5,779 respondents aged 45 and over with low back pain formed the sample, 41.8% of whom reported depressive symptoms. Multiple logistic regression analysis indicated greater vulnerability to depressive symptoms among females (OR = 1.41, 95% CI, 1.16-1.73), relatively younger persons (60-74 years: OR = 0.72, 95% CI, 0.63-0.83; ≥ 75 years: OR = 0.62, 95% CI, 0.49-0.79, reference: 45-59 years), those from the central and western regions (central: OR = 1.39, 95% CI, 1.18-1.64; western: OR = 1.56, 95% CI, 1.33-1.83), participants with extremely short sleep duration (OR = 2.74, 95% CI, 2.33-3.23), those with poor self-perceived health status (OR = 2.91, 95% CI, 2.34-3.63,), multisite pain (OR = 1.54, 95% CI, 1.20-1.98) and disability in activities of daily living (Basic: OR = 1.70, 95% CI, 1.47-1.98; Instrumental: OR = 1.95, 95% CI, 1.70-2.24).

CONCLUSION

Depressive symptoms were highly prevalent in the Chinese population ≥ 45 years with low back pain. More attention should be paid to the individuals at high-risk confirmed by this study to facilitate early identification and intervention against depressive symptoms.