The impact of chronic diseases on psychological distress among the older adults: the mediating and moderating role of activities of daily living and perceived social support

The role of metacognitive beliefs in generalised anxiety disorder in men who have sex with men living with HIV in Nigeria

Men who have sex with men (MSM) living with HIV tend to experience a range of mental health issues, in particular generalised anxiety disorder (GAD), often caused and maintained by psychosocial variables including HIV stigma, discrimination, self-esteem issues, substance abuse and loneliness. This is particularly problematic in countries like Nigeria where same sex activity is illegal and can result in up to 14 years imprisonment. An important psychological variable that may contribute to the experience of GAD are metacognitive beliefs. Participants (N = 311) completed measures to examine the relationship between these variables. Results indicated that metacognition was associated with, and significantly predicted, GAD in this population. Moderation analysis showed that the effect of HIV stigma on GAD was explained by the proposed interaction with metacognition. Findings suggest that metacognition may be an important variable in explaining GAD symptoms in MSM living with HIV in Nigeria.

Longitudinal Relationship Between Activities of Daily Living and Depression in Older Adults Based on Parallel Process Latent Growth Curve Model with Mediation

Objective: The parallel process latent growth curve model (PP-LGCM) was used to examine the longitudinal relationship between activities of daily living (ADL) and depression and further tested whether chronic diseases (CDs) were associated with depression via mediating variable ADL. Methods: A sample of 2014 Chinese older adults aged 60 and over from the China Health and Retirement Longitudinal Survey (CHARLS) was used. The activities of daily living scale, self-rating depression scale, and chronic diseases scale were used to investigate the ADL, depression, and CD levels of older adults. Following certain statistical analysis steps, we used SPSS 26 and Mplus 8.0 to perform statistical analysis on the data. Results: Firstly, ADL significantly declined in older adults from 2011 to 2018, while depression had a significant rise. Secondly, the intercept of ADL was correlated with the intercept of depression (r = 0.487, p < 0.001), and the slope of ADL was positively correlated with the slope of depression (r = 0.844, p < 0.001). Finally, the intercept of ADL mediated 39% of the association of chronic diseases and the intercept of depression. Conclusions: Our findings showed the trajectories of ADL and depression in older adults and demonstrated that ADL have various associations with depression in longitudinal development. In addition, the effect of chronic diseases on depression is partially mediated by ADL. The ADL play a partial mediating role between chronic diseases and depression in older adults, with an indirect effect of 39%, indicating that ADL are very important. Grasping the mediating mechanism of ADL will help alleviate depression levels in older adults with chronic diseases.

Assessment of stigma among patients living with Parkinson's disease: an exploratory study

OBJECTIVE

This cross-sectional study aims to assess the levels of stigma among patients with Parkinson's disease (PD) and identify the demographic and clinical factors influencing both internal and external stigma.

MATERIALS AND METHODS

A total of 200 patients diagnosed with PD were recruited from Beijing Tiantan Hospital between June 2023 and June 2024 using convenience sampling. Data were collected through face-to-face interviews, including demographic information, disease severity assessed via the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), and stigma levels measured using the 24-item Stigma Scale for Chronic Illness (SSCI). Statistical analyses included t-tests, ANOVA, correlation analysis, and multivariate linear regression.

RESULTS

The average SSCI score among PD patients was 58.74 ± 13.73, with significant variation based on age, gender, educational level, marital status, disease duration, and motor subtype. Patients aged under 60, male, with lower educational attainment, divorced or widowed, and with longer disease duration had higher SSCI scores. MDS-UPDRS Part I-III scores were positively correlated with both internal and external stigma (r = 0.4, 0.5, and 0.5, respectively, p < 0.001). Multivariate linear regression analysis identified MDS-UPDRS scores, age, self-care ability, marital status, disease duration, and motor subtype as independent predictors of stigma.

CONCLUSION

Stigma in PD is influenced by a combination of demographic and disease-related factors, particularly disease severity. Targeted interventions focusing on reducing motor and non-motor symptoms, as well as addressing social determinants, may help alleviate the stigma experienced by PD patients. These findings underscore the need for comprehensive management strategies that incorporate both clinical treatment and psychosocial support.

Hotspots and Trends in Research on Mental Health of the Rural Elderly: A Bibliometric Analysis Using CiteSpace

BACKGROUND

This study addresses the need for a systematic analysis of research trends and hotspots in the mental health of rural elderly populations, a field that has gained increasing attention due to the growing global aging population. The previous literature has explored specific issues such as loneliness, depression, and social support, and yet a comprehensive review of research development, key themes, and gaps remains lacking.

METHODS

Using CiteSpace software (CiteSpace 6.3.R1), this study conducts a bibliometric analysis of 1545 articles from the Web of Science Core Collection and 1793 articles from the China National Knowledge Infrastructure. The analysis identifies key themes, collaboration networks, and the evolution of research focus over time.

RESULTS

The results reveal that while Chinese research in this field is highly active and diverse, international collaboration is limited, underscoring the need for stronger global partnerships.

CONCLUSIONS

Emerging research areas, such as the impact of socioeconomic factors, intergenerational support, and rural healthcare policies, are identified. These findings provide valuable insights into the current state of research and highlight opportunities for future studies and policy-making aimed at improving the mental health and quality of life of rural elderly populations worldwide.

The effect of activities of daily living on anxiety in older adult people: the mediating role of social participation

Objective

Anxiety is a serious psychiatric illness in older adult people. Activities of daily living and social participation are important factors influencing anxiety in older adult people. Using social participation as a mediating variable, this study explored the influence of activities of daily living on anxiety in older adult people to provide scientific evidence for improving the psychological health of older adult people.

Methods

A multistage stratified random sampling method was used in this study to recruit older adult people. T tests and variance analysis were used for single factor analysis, and a multiple linear regression model was used for multifactor analysis. Pearson correlation analysis was used to study the correlation between activities of daily living and social participation and anxiety. The Process program was used to perform the bootstrap test.

Results

The mean anxiety score of the interviewed older adult individuals was 3.028 ± 4.606 points, and 28.66% of the older adult individuals had anxiety. There was a statistically significant difference in the anxiety scores of older adult people across sex, age, marital status, education level, and health insurance status (p < 0.05). After controlling for other variables, each one-point increase in the activities of daily living score significantly increased the anxiety score by 0.122 points (𝛽=0.122, p < 0.001), and each one-point increase in the social participation score significantly decreased the anxiety score by 0.058 points (𝛽= - 0.058, p < 0.001). According to the results of the mediating effect analysis, there was a significant positive relationship between activities of daily living and anxiety, and the total effect was established (𝛽=0.1719, p < 0.001). After controlling for social participation, there was a significant direct effect of activities of daily living on anxiety in older adult people (𝛽=0.1255, p < 0.001). A partial mediating effect of social participation on the relationship between activities of daily living and anxiety in older adult people was found. The indirect effect of social participation was 26.99%.

Conclusion

Activities of daily living and social participation are important factors affecting anxiety in older adult people. Health education should be increased to enhance the physical activity of older adult people to improve their activities of daily living, create a good atmosphere for their social participation, improve their motivation for and continuity of social participation.

Intergenerational support, activities of daily living, and the interaction on psychological distress in older adults

Objectives

The purpose of this study is to examine the effects of intergenerational support and activities of daily living (ADL) on psychological distress in older adults, and to analyse the effects of the interaction between ADL and intergenerational support on psychological distress in older adults.

Methods

A probability sample of 1,065 older adults aged 60 and above was conducted in Xuzhou, China, from 18 June to 26 August 2023. ADL was assessed using the ADL scale combined with the Barthel Index; Intergenerational support was measured using the Intergenerational Support Scale; and psychological distress was measured using the Kessler 10 scale. An ordered multichotomous logistic regression model was constructed to analyse the factors influencing psychological distress in the elderly. The interaction model was constructed by one-way analysis of variance to further analyse the effect of the interaction between financial support, instrumental support and emotional support and ADL on psychological distress in the elderly.

Results

Elderly living in rural areas, with an annual household income of less than 30,000 yuan, who engaged in manual labor before retirement, who did not receive financial support and who received instrumental support were more likely to experience psychological distress, and the higher the degree of restriction in ADL, the higher the risk of psychological distress. A significant interaction was observed between ADL and financial support (F = 221.570, p < 0.05), as well as between ADL and emotional support (F = 399.805, p < 0.01). Additionally, a significant interaction was found among ADL, financial support, and instrumental support (F = 227.187, p < 0.05).

Conclusion

(1) A significant association between place of residence, annual household income, occupation, financial support, instrumental support, ADL, and psychological distress in older adults; (2) When the level of ADL was moderate, the risk of psychological distress in older adults who received emotional support was significantly lower than that of older people who did not receive emotional intergenerational support; When the level of ADL was completely independent, financial support was beneficial in reducing psychological distress in the elderly; (3) the risk of psychological distress in the elderly who received instrumental support increased with the severity of ADL limitations, regardless of whether they received additional financial support.

The association between chronotype and social anxiety among Chinese university students: a moderated mediation analysis of loneliness and perceived social support

BACKGROUND

Social anxiety has been a burning problem among contemporary college students in China. Increasing evidence suggests that individual circadian typology-chronotype may play an important role in the development of social anxiety. However, little research has focused directly on examining the association between chronotype and social anxiety, and less is known about the mediating and moderating mechanisms underlying this relationship. The aim of the present study was to investigate the link between chronotype and social anxiety among Chinese college students, and to explore the mediating effect of loneliness and the moderating effect of perceived social support in the association between chronotype and social anxiety.

METHODS

A cross-sectional design was conducted among 1616 college students (16-29 years old) from several public universities in Northern China, including 1172 females (72.52%) and 444 males (27.48%), with an average age of 19.68 years old (SD = 1.49). All participants completed the standardized self-report questionnaires including the Social Avoidance and Distress Scale, Morningness-Eveningness Questionnaire, UCLA Loneliness Scale, and the Perceived Social Support Scale. Common method bias was performed using Harman's single-factor test. The mediation and moderation effects were analyzed using SPSS software and PROCESS macros.

RESULTS

Chronotype had a negative predictive effect on social anxiety in college students. Specifically, the greater the inclination of individuals' chronotypes toward evening preference, the more pronounced their symptoms of social anxiety would be. Loneliness served as a partial mediator in the relationship between chronotype and social anxiety, accounting for 30.0% of the total effect. In addition, perceived social support, particularly from friends and significant others, was found to play a moderating role in the process of loneliness affecting social anxiety among college students, while support from family did not. Interestingly, the perceived social support displayed a limited protective effect when college students suffered from higher levels of loneliness.

CONCLUSION

These findings deepened our understanding of how and when (or for "whom") chronotype is related to social anxiety, offering a theoretical foundation and practical insights for preventing and addressing social anxiety risk in young adult university students, particularly those with evening chronotypes.

The relationship between childhood hunger experiences and activities of daily living disability: a mediating role of depression

BACKGROUND

Hunger is an important public health issue. This study aims to explore the impact of childhood hunger experiences (CHEs) on activities of daily living (ADL) disability and to discover the mediating role of depression on this correlation.

METHODS

Data were derived from the China Health and Retirement Longitudinal Study 2011, 2013, 2015, 2018, and 2020. Depression was assessed using the Centre for Epidemiological Studies Depression Scale. ADL disability, basic ADL (BADL) disability and instrumental ADL (IADL) disability were assessed using the ADL scale. The relationships between CHEs, depression and ADL disability were estimated using probit methods, and the mediating effect of depression was estimated using the stepwise regression test and bootstrap methods.

RESULTS

A total of 9,905 sample were included in the study. The study found that CHEs increased ADL disability by approximately 9.1% (β = 0.091, 95% CI: 0.028, 0.154), and increased the probability of IADL disability by approximately 8.0% (β = 0.080, 95% CI: 0.016, 0.144). CHEs increased ADL disability by approximately 29.8% (β = 0.298, 95% CI: 0.202, 0.393) in samples under 60 years of age. CHEs indirectly increased ADL (β = 0.062, 95% CI: 0.000, 0.124) by increasing the probability of depression.

CONCLUSION

CHEs predicted ADL disability, and depression mediated this correlation. There is a need to focus on the impact of CHEs on mental and physical health. In particular, focusing on mental health is necessary to prevent impairment of physical functioning.

Ultrastructural features of psychological stress resilience in the brain: a microglial perspective

Psychological stress is the major risk factor for major depressive disorder. Sustained stress causes changes in behaviour, brain connectivity and in its cells and organelles. Resilience to stress is understood as the ability to recover from stress in a positive way or the resistance to the negative effects of psychological stress. Microglia, the resident immune cells of the brain, are known players of stress susceptibility, but less is known about their role in stress resilience and the cellular changes involved. Ultrastructural analysis has been a useful tool in the study of microglia and their function across contexts of health and disease. Despite increased access to electron microscopy, the interpretation of electron micrographs remains much less accessible. In this review, we will first present microglia and the concepts of psychological stress susceptibility and resilience. Afterwards, we will describe ultrastructural analysis, notably of microglia, as a readout to study the mechanisms underlying psychological stress resilience. Lastly, we will cover nutritional ketosis as a therapeutic intervention that was shown to be effective in promoting psychological stress resilience as well as modifying microglial function and ultrastructure.

Mental health, fall prevention behaviors, and home environments related to fall experiences among older adults from ethnic groups in rural Northern Thailand

Accidental falls pose significant threats to older adults' health and safety. This study investigates the associations between mental health, fall prevention behaviors, home environments, and yearly falls among older adults of various ethnicities. Conducted in rural ethnic areas of two provinces in northern Thailand, this cross-sectional study utilized multi-stage sampling to survey 462 older adults aged 60 and above, including Mien, Hmong, Karens, and indigenous people. Participants self-reported their history of accidental falls and provided mental health (GHQ-28) data. Univariate logistic regression highlighted associations between falls and mental health problems (OR = 14.87, 95%CI = 7.51-29.43) and the score of fall prevention behaviors (OR = 0.37, 95%CI = 0.31-0.45). Home environment factors, including floor type, floor risk factors, and stair safety features, were significantly related to falls (p < .05). Multivariable analysis identified gender, financial status, underlying disease, vision impairment, mental health problems, and fall prevention behaviors as independent predictors of past-year falls among ethnic older adults (p < .05), explaining 84.7 % of the variation in log odds of falling. This study underscores the heightened fall risks among ethnic minority older adults with mental health issues while emphasizing the protective role of fall prevention behaviors.

Effect of multimorbidity on depressive status in older Chinese adults: evidence from the China Health and Retirement Longitudinal Study (CHARLS)

OBJECTIVE

This study aims to further explore the relevant influencing factors of depression and explore the correlation between multimorbidity coexistence and depression to find the goals and methods of early intervention of depression in the elderly.

DESIGN

This study adopts a cross-sectional approach.

SETTING

The study population of this project came from the China Health and Retirement Longitudinal Study. Depression was grouped according to the 10-item version of Centre for Epidemiological Research Depression Scale. Chronic diseases, height, weight, grip strength, education, marital status, alcohol consumption, exercise and other indicators were included in the analysis.

PARTICIPANTS

2239 adults over 60 years of age were included.

RESULTS

The proportion of women in the depression group was higher (p<0.001). The depression group had a lower grip strength than the control group (p<0.05). The sleep duration was shorter in the depression group (p<0.001). There were differences in education, marital status and alcohol consumption in the depression group (p<0.05). The depression group might have more types of coexisting chronic diseases (p<0.001). The depression group was more likely to have hypertension, dyslipidaemia, chronic lung diseases, heart attack, stroke, stomach disease and memory-related disease. Grip strength was connected with the risk of depression in the elderly (0.971 (95% CI 0.959 to 0.984)). Sleep (0.827 (95% CI 0.785 to 0.872) and education level (0.790 (95% CI 0.662 to 0.942) were related to the risk of depression in the elderly. Concomitant chronic diseases could affect the risk of depression in the elderly (1.455 (95% CI 1.243 to 1.703)).

CONCLUSION

The coexistence of multiple chronic diseases and depression is very common in the elderly. The coexistence of multiple chronic diseases is more common in older women and older depressed people. With the increase in the number of chronic diseases, the risk of depression in the elderly is significantly increased.

The Impact of Chronic Diseases on Mental Health: An Overview and Recommendations for Care Programs

PURPOSE OF REVIEW

The current achievement of medical advancement is noteworthy; however, the occurrence of chronic diseases is increasing day by day, with a significant percentage of affected people are suffering from a mental health crisis. This article aims to present a thorough yet brief review of methods that can be employed to build the emotional wellness of chronic patients.

RECENT FINDINGS

The mental health care strategies include resilience-building, coping skills training, professional counseling, and lifestyle adaptations. Additionally, the article highlights the efficacy of several modern interventions, such as mindfulness-based therapies, cognitive behavioral therapy, eye movement desensitization, and recovery from stress therapy. The global burden of chronic illness emphasizes the pressing need to mitigate mental health problems among chronic patients. By providing actionable insights, our study clears the path for targeted interventions and holistic approaches for chronic disease patients. Moreover, the article suggests to policymakers and clinicians the need for collaboration and multifaceted interventions.

The relationship between health behaviors and quality of life: the mediating roles of activities of daily living and psychological distress

Objective

The aim of this study is to examine the role of activities of daily living performance (ADLs) and psychological distress in mediating the process by which health behaviors affect QOL.

Methods

A non-probabilistic study was conducted among 1,065 older adult people older than 60 years. Participants were assessed using the Barthel Index, Functional Activities Questionnaire (FAQ), Kessler Psychological Distress Scale (K10), Australian Active Survey, and EQ-VAS score. The SPSS22.0 software was used to analyze the differences in QOL scores among older adults with different demographic characteristics. Pearson correlation analysis was used to analyze the correlation between health behaviors, psychological distress, ADLs, and QOL. Amos23.0 software was used to construct structural equation model (SEM) to analyze the path of health behavior affecting QOL and the mediating role of BADLs, IADLs and psychological distress.

Results

(1) The direct effect of health behaviors on QOL was not significant in the model; (2) ADLs had multiple mediating effects on the relationship between health behaviors and QOL, and the incidence of ADL limitation was negatively correlated with the reported QOL in the older adult; (3) Psychological distress had a significant mediating effect on the relationship between health behaviors and QOL.

Conclusion

The results of this study elucidated the mechanisms of the correlation between health behaviors and QOL, and added to the existing literature. In addition, these mediating factors and indirect pathways have been identified as targets for intervention to improve the QOL of older adult individuals, which is important for achieving healthy aging.

Patient perceptions and preferences of minimally invasive treatment modalities in varicose veins: a cross-sectional survey

Purpose

Minimally invasive therapies (MIT) have gained popularity due to their capacity to reduce trauma, enhance aesthetic outcomes, and shorten recovery periods. This article explores patients' perceptions and preferences regarding MIT for varicose veins (VVs) while analyzing associated influencing factors to provide a better understanding.

Patients and methods

A cross-sectional survey at Zhejiang Rongjun Hospital was performed from January 2022 to June 2023, involving 305 participants with VVs. The questionnaire assessed patient demographics, VVs severity, prior treatment experiences, and treatment preferences. Statistical analyses, including chi-square and Kruskal-Wallis tests, were conducted to explore the correlations between patient characteristics, treatment preferences, and factors influencing these choices.

Results

Nearly half of the participants (44.3%) lacked information on any surgical options, whereas a slight majority (55.7%) possessed familiarity with at least one treatment modality, and only 9.8% knew of all six treatment methods presented. Patient surveys discerned that the majority (68.5%) declared an inadequate grasp of treatment methodologies to articulate a treatment preference. Among the 96 patients who made a treatment choice, 24.0% opted for traditional surgery, while 76.0% chose MIT and a higher preference for MIT among male patients compared to female patients (p = 0.006). The patients preferred treatment options for VVs significantly affected by vascular surgeon recommendations and the number of follow-up visits (r = 0.129, p = 0.024; r = 0.122, p = 0.033).

Conclusion

The study highlights limited awareness of MIT among Chinese patients with VVs. The insights emphasize the influential role of vascular surgeons' recommendations and suggest a growing predilection for less invasive treatments due to their advantages in recovery and aesthetics. Provider-patient communication, including education about available treatments and shared decision-making, is essential to align treatment plans with patient expectations and improve outcomes.

Decoding emotional resilience in aging: unveiling the interplay between daily functioning and emotional health

Background

EPs pose significant challenges to individual health and quality of life, attracting attention in public health as a risk factor for diminished quality of life and healthy life expectancy in middle-aged and older adult populations. Therefore, in the context of global aging, meticulous exploration of the factors behind emotional issues becomes paramount. Whether ADL can serve as a potential marker for EPs remains unclear. This study aims to provide new evidence for ADL as an early predictor of EPs through statistical analysis and validation using machine learning algorithms.

Methods

Data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) national baseline survey, comprising 9,766 samples aged 45 and above, were utilized. ADL was assessed using the BI, while the presence of EPs was evaluated based on the record of "Diagnosed with Emotional Problems by a Doctor" in CHARLS data. Statistical analyses including independent samples t-test, chi-square test, Pearson correlation analysis, and multiple linear regression were conducted using SPSS 25.0. Machine learning algorithms, including Support Vector Machine (SVM), Decision Tree (DT), and Logistic Regression (LR), were implemented using Python 3.10.2.

Results

Population demographic analysis revealed a significantly lower average BI score of 65.044 in the "Diagnosed with Emotional Problems by a Doctor" group compared to 85.128 in the "Not diagnosed with Emotional Problems by a Doctor" group. Pearson correlation analysis indicated a significant negative correlation between ADL and EPs (r = -0.165, p < 0.001). Iterative analysis using stratified multiple linear regression across three different models demonstrated the persistent statistical significance of the negative correlation between ADL and EPs (B = -0.002, β = -0.186, t = -16.476, 95% CI = -0.002, -0.001, p = 0.000), confirming its stability. Machine learning algorithms validated our findings from statistical analysis, confirming the predictive accuracy of ADL for EPs. The area under the curve (AUC) for the three models were SVM-AUC = 0.700, DT-AUC = 0.742, and LR-AUC = 0.711. In experiments using other covariates and other covariates + BI, the overall prediction level of machine learning algorithms improved after adding BI, emphasizing the positive effect of ADL on EPs prediction.

Conclusion

This study, employing various statistical methods, identified a negative correlation between ADL and EPs, with machine learning algorithms confirming this finding. Impaired ADL increases susceptibility to EPs.

The Association between Functional Dyspepsia and Metabolic Syndrome-The State of the Art

Functional dyspepsia is a common functional disorder of the gastrointestinal tract that is responsible for many primary care visits. No organic changes have been found to explain its symptoms. We hypothesize that modern lifestyles and environmental factors, especially psychological stress, play a crucial role in the high prevalence of functional dyspepsia and metabolic syndrome. While gastrointestinal tract diseases are rarely linked to metabolic disorders, chronic stress, obesity-related metabolic syndrome, chronic inflammation, intestinal dysbiosis, and functional dyspepsia have significant pathophysiological associations. Functional dyspepsia, often associated with anxiety and chronic psychological stress, can activate the neuroendocrine stress axis and immune system, leading to unhealthy habits that contribute to obesity. Additionally, intestinal dysbiosis, which is commonly present in functional dyspepsia, can exacerbate systemic inflammation and obesity, further promoting metabolic syndrome-related disorders. It is worth noting that the reverse is also true: obesity-related metabolic syndrome can worsen functional dyspepsia and its associated symptoms by triggering systemic inflammation and intestinal dysbiosis, as well as negative emotions (depression) through the brain-gut axis. To understand the pathophysiology and deliver an effective treatment strategy for these two difficult-to-cure disorders, which are challenging for both caregivers and patients, a psychosocial paradigm is essential.

Prevalence of depressive symptoms and correlates among individuals who self-reported SARS-CoV-2 infection after optimizing the COVID-19 response in China

Background

The burden of depression symptoms has increased among individuals infected with SARS-CoV-2 during COVID-19 pandemic. However, the prevalence and associated factors of depressive symptoms among individuals infected with SARS-CoV-2 remain uncertain after optimizing the COVID-19 response in China.

Methods

An online cross-sectional survey was conducted among the public from January 6 to 30, 2023, using a convenience sampling method. Sociodemographic and COVID-19 pandemic-related factors were collected. The depression symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Logistic regression analysis was performed to explore the associated factors with depressive symptoms.

Results

A total of 2,726 participants completed the survey. The prevalence of depression symptoms was 35.3%. About 58% of the participants reported experiencing insufficient drug supply. More than 40% of participants reported that they had missed healthcare appointments or delayed treatment. One-third of participants responded experiencing a shortage of healthcare staff and a long waiting time during medical treatment. Logistic regression analysis revealed several factors that were associated with depression symptoms, including sleep difficulties (OR, 2.84; 95% CI, 2.34-3.44), chronic diseases (OR, 2.15; 95% CI, 1.64-2.82), inpatient treatment for COVID-19 (OR, 3.24; 95% CI, 2.19-4.77), with COVID-19 symptoms more than 13 days (OR, 1.30, 95% CI 1.04-1.63), re-infection with SARS-CoV-2 (OR, 1.52; 95% CI, 1.07-2.15), and the increased in demand for healthcare services (OR, 1.32; 95% CI, 1.08-1.61).

Conclusion

This study reveals a moderate prevalence of depression symptoms among individuals infected with SARS-CoV-2. The findings underscore the importance of continued focus on depressive symptoms among vulnerable individuals, including those with sleeping difficulties, chronic diseases, and inpatient treatment for COVID-19. It is necessary to provide mental health services and psychological interventions for these vulnerable groups during the COVID-19 epidemic.

Chronic conditions and depressive symptoms in middle-aged and older Chinese adults: Roles of perceived social support and area of residence

BACKGROUND

Many studies have shown that having noncommunicable chronic diseases (NCDs) is strongly associated with depressive symptoms in elderly people; however, the mechanisms of this association are not fully understood. This study aims to investigate whether perceived social support (PSS) mediates the effect of NCDs on depressive symptoms and whether these relationships differ depending on where middle-aged and elderly people live.

METHODS

The study population was from the psychology and behavior investigation of Chinese residents (PBICR). A total of 8732 people aged 45 and older were included in the hypothetical modulated model. Perceived Social Support Scale (PSSS) and Patient Health Questionnaire-9 (PHQ-9) were used to evaluate PSS and depressive symptoms.

RESULTS

NCDs were positively related to depressive symptoms (β = 0.81, p < 0.01) and indirectly mediated through PSS (β = 0.08). Residency moderated the relationship between NCDs and PSS (β = -0.16, p < 0.01) and between NCDs and depressive symptoms (β = 0.29, p < 0.01). Specifically, the effect of NCDs on PSS and depressive symptoms was greater in rural middle-aged and older adults.

CONCLUSIONS

NCDs raise the risk of depressive symptoms in middle-aged and older Chinese, with PSS playing a partially protective role. In addition, the area of residence moderated the connection between the number of NCDs and PSS, NCDs, and depressive symptoms in middle-aged and older adults.

The 18-month efficacy of an Intensive LifeStyle Modification Program (ILSM) to reduce type 2 diabetes risk among rural women: a cluster randomized controlled trial

BACKGROUND

Many lifestyle interventions have demonstrated efficacy up to one-year follow-up, yet maintaining improvements at longer-term follow-up is a well-recognized worldwide challenge, especially in underserved areas. The purpose of this study is to compare the 18-month efficacy of an Intensive LifeStyle Modification Program to usual care in reducing the risk for type 2 diabetes (T2D) among women with a history of gestational diabetes mellitus (GDM).

METHODS

We conducted a two-arm, cluster randomized controlled trial among women with a history of GDM in China. A total of 16 towns (clusters) in two distinct rural areas in south-central China were randomly selected (8 towns per area) and assigned (1:1) to the intervention (Intensive LifeStyle Modification Program) or control (usual care) group with stratification in the two rural areas. The strategies for maintaining intervention effects were used (including setting recursive goals and providing a supportive environment, etc.) under the guidance of social cognitive theory. The primary outcome was a change in T2D risk; secondary outcomes included glycemic, weight-related, behavioral, and psychological variables. All outcomes were collected at baseline, 6, and 18 months. All participants entered the intention-to-treat analysis. Data were analyzed via generalized estimation equation models (accounting for clusters) at the individual level, with subgroup analysis included in the model.

RESULTS

The sample included 320 women from 16 clusters (20 women per cluster). At 18 months, the intervention group demonstrated a significant improvement in T2D risk score, fasting blood glucose, body mass index (BMI), waist circumference, intention to eat low glycemic index food, perceived stress, quality of life in psychological and environmental domains, and social support over time (p < 0.05) based on the intention-to-treat analysis set. Subgroup analysis showed a significant interaction effect on T2D risk score in subgroups of different BMI, waist circumference, and blood glucose (p < 0.05).

CONCLUSIONS

Over 18 months, the Intensive LifeStyle Modification Program reduced T2D risk among rural women with a history of GDM in China. Women who were overweight, had high abdominal adiposity, or had blood glucose intolerance benefited more from this intervention. This program serves as a potential diabetes prevention model for women with a history of GDM in low-resource settings worldwide.

TRIAL REGISTRATION

Registered on Chinese Clinical Trial Registry (ChiCTR1800015023) on 1st March 2018, http://www.chictr.org.cn/showproj.aspx?proj=25569.

Psychological distress, multimorbidity and health services among older adults in rural South Australia

OBJECTIVE

Psychological distress may relate to higher health services use. However, data on psychological distress and health services use among rural older adults are limited. This study investigates psychological distress in older adults (aged ≥60) and evaluates the relationship between psychological distress, multimorbidity and health services utilization.

DESIGN

A cross-sectional design was adopted using data on older adults (≥60) (n = 5920) from the South Australia's 2013-2017 population health survey. The Modified Monash Model MM2-7 was used to designate rural areas. The dataset provides information on reported physical health conditions, psychological distress, and patterns of health services use. The Kessler Psychological Distress Scale (K10) was used to compute scores for reported mental health disorders in this population.

RESULTS

The mean (SD) age of the study participants was 72.1 (8.1) years. Women constituted 58.8% of the sample. The mean (SD) score for psychological distress was 12.5 (3.6). One-fourth (33.7%) report one-chronic condition, 20.4% reported 2 chronic conditions and 13% had more than 3 chronic conditions. High psychological distress was associated with female gender (χ² = 14.4, p < 0.001), <80 years (χ² = 11.7, p = 0.019), lower education (χ² = 10.9, p = 0.027). Similarly, multimorbidity was associated with female gender (χ² = 51.1, p < 001), increasing age (χ² = 173.6, p < 0.001) and lower education (χ² = 28.8 p < 0.001). Psychological distress and multimorbidity were independently associated with health service use. High psychological distress was associated with general practitioner (GP) visit (odds ratio 3.6 (95% CI 2.6-5.1), p < 0.001), emergency department (ED) visit (odds ratio 2.5 (95% CI 1.2-5.0), p < 0.001) and hospital admission (odds ratio 2.3 (95% CI 1.3-4.3), p < 0.001). Multimorbidity was associated with general practitioner (GP) visit (odds ratio 6.8 (95% CI 5.6-8.3), p < 0.001), emergency department (ED) visit (odds ratio 2.5 (95% CI 1.4-4.3), p < 0.001) and hospital admission (odds ratio 3.1 (95% CI 1.9-5.1), p < 0.001). Model included age, gender, education, number of chronic condition and psychological distress.

CONCLUSION/IMPLICATION

Psychological distress and multimorbidity were independently associated with health services use. Thus, psychological distress, particularly in the presence of multimorbidity, presents an opportunity for intervention by clinicians that may reduce the demand on rural health services.

Prevalence of Frailty and Associated Factors Among Hospitalized Older Adults: A Cross-Sectional Study

This study aimed to estimate the prevalence of frailty and associated factors among hospitalized older adults. It consisted of 184 hospitalized older adults recruited between October 2019 to January 2020. We used the FRAIL scale, Geriatric Depression Scale-15, and the Pittsburg Sleep Quality Index to collect data. Descriptive statistics, independent group t-test, Chi-square (χ²) tests, and logistic regression were applied to statistical analysis. It found that the prevalence of frailty among hospitalized older adults was 39.7%. Depression (Mild: OR = 5.312, 95% CI [2.384-11.833]; Moderate: OR = 6.630, 95% CI [2.077-21.160]) and low activities of daily living (ADL) (Slight dependence: OR = 5.667, 95% CI [1.308-24.557]; Moderate dependence: OR = 15.188, 95% CI [3.342-69.016]; Severe dependence: OR = 5.872, 95% CI [2.645-13.038]) were independent predictors of frailty. Future studies on the interventions to reduce depression, improve ADL and delay the progression of frailty are encouraged. We should focus more on ADL, emotional and psychological state of hospitalized older adults to prevent frailty.

Urban-Rural Differences in Patterns and Associated Factors of Multimorbidity Among Older Adults in China: A Cross-Sectional Study Based on Apriori Algorithm and Multinomial Logistic Regression

Introduction: Multimorbidity has become one of the key issues in the public health sector. This study aimed to explore the urban–rural differences in patterns and associated factors of multimorbidity in China and to provide scientific reference for the development of health management strategies to reduce health inequality between urban and rural areas.

Methods: A cross-sectional study, which used a multi-stage random sampling method, was conducted effectively among 3,250 participants in the Shanxi province of China. The chi-square test was used to compare the prevalence of chronic diseases among older adults with different demographic characteristics. The Apriori algorithm and multinomial logistic regression were used to explore the patterns and associated factors of multimorbidity among older adults, respectively.

Results: The findings showed that 30.3% of older adults reported multimorbidity, with significantly higher proportions in rural areas. Among urban older adults, 10 binary chronic disease combinations with strong association strength were obtained. In addition, 11 binary chronic disease combinations and three ternary chronic disease combinations with strong association strength were obtained among rural older adults. In rural and urban areas, there is a large gap in patterns and factors associated with multimorbidity.

Conclusions: Multimorbidity was prevalent among older adults, which patterns mainly consisted of two or three chronic diseases. The patterns and associated factors of multimorbidity varied from urban to rural regions. Expanding the study of urban–rural differences in multimorbidity will help the country formulate more reasonable public health policies to maximize the benefits of medical services for all.