Family Relationships and Well-Being

A Care Paradox: The Relationship Between Older Adults' Caregiving Arrangements and Institutionalization and Mortality

We investigate how the type of caregiving arrangement is associated with older Americans' outcomes. We use the Health and Retirement Study (2004-2018) and discrete-time event history analysis to assess the odds of institutionalization or death over a 14-year period among older adults with limitations in Activities of Daily Living (ADLs; e.g., bathing). We consider caregiving arrangements as conventional (i.e., spouse or adult child), unconventional (e.g., extended family, employee, friend), or self-directed (i.e., no caregiver). We find a "care paradox" in that self-directing one's own care was associated with a lower risk of institutionalization or death compared with having conventional care (spouse/adult caregiver) and unconventional care (employee). Relative to conventional care, having an employee caregiver was associated with increased risk of institutionalization. Findings are still observed when controlling for level of impairment and various health-related factors. More research is needed to understand older adults who self-direct their own care.

Consequences of deferred action for childhood arrivals for parent health: Applying a social foreground perspective

Objective

This study applies a social foreground perspective to assess whether the Deferred Action for Childhood Arrivals (DACA) program impacted the self-rated health of coresident parents of DACA-eligible individuals.

Background

DACA status grants a temporary work permit and allows for a stay of deportation for undocumented persons who entered the United States as children. Although research points to the positive health benefits of DACA for its recipients, less is known about whether the program affects the health of family members, including parents.

Method

This study uses data from the National Health Interview Study (2008-2015) on foreign-born adults and their coresident parents. We applied a difference-in-differences design to examine whether the self-rated health of coresident mothers and fathers changed following the passage of DACA for DACA-eligible individuals.

Results

In contrast to expectations, DACA was associated with worse self-rated health among coresident, partnered parents. These results may be because DACA also decreased the likelihood of coresiding with parents and changed the composition of coresident parents themselves. Following DACA, fewer eligible offspring lived with parents overall, but among those that did, parents tended to be older and less healthy.

Conclusion

Findings underscore how DACA may be used as a resource to support older parents experiencing health challenges, in particular among older undocumented immigrants, who make up a growing share of the undocumented population in the United States.

Navigating end-of-life decision-making in nursing: a systematic review of ethical challenges and palliative care practices

OBJECTIVES

This systematic review aimed to synthesize evidence on the ethical dilemma's nurses encounter in end-of-life care and effective palliative care practices. The objectives were to understand key ethical issues, evaluate communication and decision-making strategies, and identify approaches to support nurses and patients.

METHODS

A comprehensive search of major databases was conducted according to the PRISMA guidelines. Studies directly relating to nursing ethics, challenges in end-of-life decision-making, and palliative care practices were included. The risk of bias was assessed using ROBVIS-II. Data on ethical issues, palliative interventions, and outcomes was extracted and analyzed thematically.

RESULTS

22 studies met the inclusion criteria. Key themes that emerged were: (1) Effective communication and involving patients in decision-making are essential but complex. (2) Nurses face dilemmas around balancing autonomy, beneficence and relational issues. (3) Integrating palliative care principles enhances symptom management and aligns care with patient values. (4) Education and organizational support are needed to equip nurses with skills and coping strategies.

CONCLUSION

Navigating end-of-life care requires addressing interconnected ethical, communication and support needs. While studies provided insights, further research is required on cultural competence training, standardized education programs and longitudinal evaluations.

Inter-generational impact: Exploring the influence of older sister-in-law's contraceptive choices on her peer contraception adoption in India

OBJECTIVE

Social network-based reproductive decisions are critical. This study compares the effect of an older peer contraceptionuse on her younger peer's use, as they share the closest social network within the household, and tend to influence one another for reproductive decisions. In this study we considered peers as two sister-in-law living in the same household.

METHODS

We used data from the fifth round of National Family Health Survey which was conducted between the year 2019 and 2021. We deployed multinomial multivariable logistic regression to find the association between older women contraception use on her younger peer. Also, an attempt has been made to determine contraceptive clustering within households in India and select states.

RESULTS

The multinomial analysis found that all the women in the household used the similar method, but still relied only on the female sterilization as the sole method for their family planning. The multinomial multivariable method found that younger peers were 3.42 time odds more likely to use permanent method if her older peer had used it previously. Also, it was found 11% increase in any modern contraception use of younger peer if all her older peer will use any modern contraceptives in India. For all the states, the contraception clustering within household ranged from 5% to 14%, with highest in Himachal (14%).

CONCLUSION

Empowering older women as peer educators in contraception workshops can foster informed discussions, dispel myths, and promote the use of modern contraceptive methods among younger peers. Integrating such initiatives into government existing policies like Mission Parivar Vikas is crucial for improving contraceptive uptake, with ASHA workers and community health volunteers playing a pivotal role in delivering targeted education within households.

Longitudinal Relationship Between Baseline Social Frailty and Cognitive Impairment in Older Adults: 14-Year Follow-Up Results From the Korean Longitudinal Study of Ageing

OBJECTIVES

This study aimed to investigate the longitudinal relationship between social frailty and cognitive impairment among community-dwelling older adults.

DESIGN

This retrospective cohort study is based on the first to eighth waves of the Korean Longitudinal Study of Ageing (2006-2020).

SETTING AND PARTICIPANTS

The participants were 2106 community-dwelling older adults aged 65 years or older and without cognitive impairment in 2006.

METHODS

Social frailty was assessed with 5 items including social support, social activity, social network, loneliness, and living alone (0 = social nonfrailty, 1 = social prefrailty, 2 or more = social frailty). Cognitive function was assessed using the Korean Mini-Mental State Examination, and scores below 24 indicated cognitive impairment. We used the generalized estimating equation to assess the longitudinal relationship between social frailty and cognitive impairment.

RESULTS

Of the 2106 participants, 515 (24.4%) had social frailty, 669 (31.8%) had social prefrailty, and 922 (43.8%) were social nonfrailty based on the baseline assessments. Relative to the social nonfrailty group, the odds ratios of the social prefrailty and social frailty groups for cognitive impairment were 1.30 (95% CI 1.10-1.54) and 1.41 (95% CI 1.16-1.71), respectively, during the follow-up. Subgroup analysis showed that social inactivity and loneliness were significantly associated with cognitive impairment.

CONCLUSIONS AND IMPLICATIONS

These findings highlight the need for health care providers to introduce and use available social resources for older adults with social frailty to increase the relationships between individual and social context. Social inactivity and loneliness were the major domains associated with cognitive impairment, and loneliness can be resolved by participating in social activities. Therefore, health care providers especially provide opportunities for social activities, such as group-based programs in the community, to reduce social frailty and cognitive impairment.

Food Insecurity and Family Dynamics: A Systematic Review

BACKGROUND

Undernutrition is related to numerous childhood outcomes. However, little research has investigated the relationship between food insecurity and family dynamics. This systematic review seeks to validate the evidence for a relationship between these 2 factors.

METHODS

A systematic literature review was conducted in Embase, PubMed, and Scopus. Inclusion criteria include peer-reviewed research articles published during or after 1996 in English, using standardized measures of family function and food insecurity. Exclusion criteria include measurement of parent or child characteristics without assessing household or family characteristics or demographics. Two reviewers independently voted using Covidence, and Alpha agreement was determined at each phase.

RESULTS

A total of 15 studies were included for data extraction after the initial search being completed in April 2022. All included studies were found to be appropriate in numerous categories for quality assessment. Primary findings from these studies show a potential relationship exists between food insecurity and family dynamics.

DISCUSSION

The findings in this review suggest that effects of food insecurity expand to various aspects of healthy family functioning. Unhealthy family dynamics in childhood can also expose children to trauma and lead to increased physical and mental health disorders in the future.

Longitudinal Associations of Family Relationship Quality With Chronic Pain Incidence and Persistence Among Aging African Americans

OBJECTIVES

This study examines how family relationships convey risk or resilience for pain outcomes for aging African Americans, and to replicate and extend analyses across 2 nationally representative studies of aging health.

METHODS

African American participants in Midlife in the United States (MIDUS, N = 755) and the Health and Retirement Study (HRS, N = 2,585) self-reported chronic pain status at 2006 waves and then again 10 years later. Logistic regression was used to estimate the odds of pain incidence and persistence explained by family, intimate partner, and parent-child strain and support, as well as average support and average strain across relationships.

RESULTS

On average, MIDUS participants were younger (M = 52.35, SD = 12.06; 62.1% female) than HRS (M = 66.65, SD = 10.92; 63.7% female). Family support and average support were linked to decreased odds of pain incidence in MIDUS, but only when tested without accounting for strain, whereas parent-child strain was a risk factor for pain incidence in HRS, as was average strain. Family support protected against pain persistence in MIDUS, whereas average support was linked to reduced odds of pain persisting in HRS.

DISCUSSION

Chronic pain outcomes are worse for African Americans for a number of reasons, but parent-child strain may contribute to the risk of new pain developing over time for older adults. Conversely, family support may offer a protective benefit for pain incidence and persistence among aging African Americans. Findings implicate family relationships as a potential target of pain management interventions.

Differentiating the relationships between traditional and new media use and sleep quality during the COVID-19 pandemic: roles of psychological distress and age

Background

Numerous studies have consistently demonstrated a decline in sleep quality during the COVID-19 pandemic. The primary objective of this study is to explore the impact of engaging with pertinent epidemic information through the media amid the COVID-19 crisis on individuals' sleep quality and the underlying mechanisms through which this influence operates.

Methods

An online cross-sectional study design was employed. A total of 1,063 British adults (36.2% males; M age = 38.85, SD age = 13.36, ranging from 18 to 77 years old) participated in the study and completed our questionnaires, which included media usage frequency during the pandemic, the 10-item Kessler Psychological Distress Scale (K10), the Insomnia Severity Index (ISI), and the Ten-item Personality Inventory (TIPI).

Results

Pearson's correlation analyses indicated that there was no significant correlation between COVID-19-related traditional media use (television, radio, newspaper) and psychological distress or sleep quality. However, exposure to information related to COVID-19 through new media use (Facebook, Tik Tok, Twitter) was correlated with greater psychological distress and poorer sleep quality. A moderated mediation analysis showed that psychological distress fully mediated the relationship between new media use and poor sleep, which was moderated by age, with the association between psychological distress and poor sleep quality being stronger among older adults.

Conclusion

Exposure to information of COVID-19 via new (but not traditional) media use deteriorated sleep quality through greater psychological distress, and this relationship was stronger among older adults.

How Shared Dietary Behaviors Within Asian American Families Are Influenced by Emotional Interaction Qualities: A Nationwide Cross-sectional Analysis

BACKGROUND

Asian American (AA) young adults face a looming diet-related non-communicable disease crisis. Interactions with family members are pivotal in the lives of AA young adults and form the basis of family-based interventions; however, little is known on the role of these interactions in shared family food behaviors. Through an analysis of 2021 nationwide survey data of 18-35-year-old AAs, this study examines how the quality of family member interactions associates with changes in shared food purchasing, preparation, and consumption.

METHOD

Interaction quality was assessed through 41 emotions experienced while interacting with family, and was categorized as positive (e.g., "I look forward to it"), negative (e.g., "I feel annoyed"), and appreciation-related (e.g., "I feel respected") interactions. Participants were also asked how frequently they ate meals, ate out, grocery shopped, and cooked with their family.

RESULTS

Among the 535 AAs surveyed (47.6% East Asian, 21.4% South Asian, 22.6% Southeast Asian), 842 unique family interactions were analyzed; 43.5% of interactions were with mothers, followed by siblings (27.1%), and fathers (18.5%). Participants most frequently ate meals with their family (at least daily for 33.5% of participants), followed by cooking (at least daily for 11.3%). In adjusted analyses, an increase in shared food behaviors was particularly associated with positive interactions, although most strongly with cooking together and least strongly with eating meals together; significant differences between ethnic subgroups were not observed.

CONCLUSION

Findings revealed the importance of family interaction quality when leveraging family relationships to develop more tailored, impactful AA young adult dietary interventions.

A Visualization Tool to Study Dyadic Caregiving Health Profiles

OBJECTIVES

Guided by a life course perspective and fundamental cause theory, this study aims to visualize co-trajectories of health between partners and examine how changes in one spouse's cognitive status can cohesively impact the health of the other spouse along three dimensions (functional, mental, and cognitive).

METHODS

Drawing longitudinal data from the Health and Retirement Study 2000-2016 (N = 3582), we measure women's health profiles by functional limitation (physical health), depression (mental health), and cognitive function (cognitive health). We use multivariate linear mixed models to summarize these paths in the same visual representation.

RESULTS

The approach provides a visualization tool that depicts data and model in the same spatial representation allowing assessment of model fit and comparison. This study advances the traditional life course studies by representing underlying processes as a multidimensional time vector of health outcomes.

DISCUSSION

The described approach provides a blueprint for studying complex health profiles or trajectories.

Poor-Quality Daily Social Encounters, Daily Stress, and Subjective Cognitive Decline Among Older Adults

Background and Objectives

Although prior research has shown that social relationships and daily stress are strongly associated with cognitive function, few studies have explored the link between the quality of daily social encounters and subjective cognitive decline (SCD). The present study explores whether the quality of older adults' daily social encounters is associated with SCD through daily stress.

Research Design and Methods

This study used data from 254 adults aged 70 or older (M age  = 76.5 years, SD = 4.4; 67.7% women) who completed the Einstein Aging Study, a 2-week experience sampling study. Multilevel mediation analyses were conducted to account for daily measurements nested within individuals. We tested the indirect effect of the quality of daily social encounters on SCD through daily stress levels.

Results

There was a significant positive association between ambivalent and neutral social encounters and daily stress levels at both the within- and between-person levels. Between-person daily stress was, in turn, associated with greater SCD. Specifically, there was a significant indirect path from ambivalent social encounters to SCD through daily stress.

Discussion and Implications

This study contributes to a more detailed understanding of how the quality of daily social encounters can influence cognition via increased exposure to daily stress. The findings suggest that emotional support may be crucial to preserving perceptions of older adults' cognitive functioning.

An exploratory study on material deprivation and loneliness among older adults in Hong Kong

BACKGROUND

Poverty, as a risk factor for loneliness, has been understudied, and there is a need to gain a better understanding of the relationship between poverty examined by material deprivation and loneliness among older adults in Hong Kong. It also aimed to explore the possible mediation and moderation effects of social support, social networks, neighborhood collective efficacy, and social engagement in the link between material deprivation and loneliness.

METHODS

1696 Chinese older adults aged 60 years and above (Mage = 74.61; SD = 8.71) participated in a two-wave study. Older adults reported their loneliness level, material deprivation, perceived level of social support, social network, neighborhood collective efficacy, social engagement, and sociodemographic information. Logistic regression was conducted to examine the effect of material deprivation on loneliness, as well as the mediation and moderation models.

RESULTS

The results indicated that material deprived older adults reported a significantly higher level of loneliness 2 years later when controlling for demographic variables, health-related factors, and loneliness at baseline. We also found that engagement in cultural activities partially mediated the effect of material deprivation and loneliness. Furthermore, neighborhood collective efficacy and engagement in cultural activities were significant moderators that buffer the relationship between material deprivation and loneliness.

CONCLUSIONS

Our results suggested the need to alleviate the negative impact of material deprivation on loneliness by developing interventions focused on promoting neighborhood collective efficacy and social engagement, which could be aimed at building meaningful bonds among Chinese older adults in Hong Kong.

A mixed-method systematic review of the perspectives of young people, carers and professionals on psychiatric diagnosis in childhood and adolescence

PROBLEM

The significance and complexities of a psychiatric diagnosis have been well-documented in existing literature. Despite the reliability and accuracy of such diagnoses, the impact and use of diagnostic labelling on young people remains unclear.

METHODS

A systematic review was conducted using six databases, identifying 13 studies that explored psychiatric diagnosis experiences in professionals, caregivers, and young people.

FINDINGS

This review focuses on three main themes related to psychiatric diagnosis in young people. The first theme is diagnostic subjectivity, which explores the accuracy, usefulness, potential harm and alternatives (e.g. psychological formulation) to psychiatric diagnosis in this population. The second theme is the utility of psychiatric diagnosis, which considers whether it helps young people access appropriate support and gain a better understanding of themselves and their presenting issues. The third theme is stigma, which examines the negative experiences and discrimination that young people may face due to their psychiatric diagnosis.

CONCLUSIONS

There is relatively limited literature which discusses the experience of psychiatric diagnosis in young people, caregivers and professionals. The available literature is difficult to compare due to discrepancies between methodologies and services, and there are several gaps i.e. a limited focus on the experience of young people themselves. Different views and experiences of psychiatric diagnosis among professionals, caregivers, and young people could impact young people's quality of life, access to healthcare, and identity development. The current literature needs to be more comprehensive to draw firm conclusions about young people's experiences with psychiatric diagnosis.

Expressed Emotion in Families of Children with Neurodevelopmental Disorders: A Mixed-Method Approach

Background

Family interaction plays a pivotal role in the overall well-being of each member of a family unit. It is foreseeable that a family caring for an individual with a mental or physical health condition could experience negative family interactions for various reasons. Expressed emotion refers to the family environment based on the relatives' interaction with the individual diagnosed with a specific illness. Expressed emotion in the families of a person with any form of mental condition could pose potential psychological distress and burden to family members, notably the primary caregivers.

Purpose

The current study intends to explore the expressed emotion of the primary caregivers toward children with neurodevelopmental disorders (NDDs). The association between expressed emotion, stress experienced by the caregiver, and the self-sufficiency of the child diagnosed with neurodevelopmental disorders was examined.

Methods

The Five-Minute Speech Sample (FMSS), Kingston Caregivers' Stress Scale (KCSS), and Waisman Activities of Daily Living (WADL) were used to assess expressed emotion, stress, and a child's self-sufficiency, respectively. The snowball sampling technique was adopted, and data were collected from 35 primary caregivers through telephonic interviews. A mixed-method research design was adopted, and the data were analyzed qualitatively and quantitatively.

Results

The findings reveal that there is a significant association between expressed emotion and caregivers' stress, expressed emotion, and the child's self-sufficiency and a significant relationship between the caregivers' stress and the child's self-sufficiency. The qualitative analysis suggests the influence of factors such as future concerns, family factors, and relationship strains contribute to expressed emotion.

Conclusion

It can be concluded that those primary caregivers who reported extreme caregivers' stress and low self-sufficiency in their child exhibited high negative expressed emotion and diverse individual and systemic factors influenced the display of high expressed emotion within the family.

Exploring parenthood in first episode of psychosis: the potential role of the offspring in the outcome of women

PURPOSE

The study aimed to explore the role of parenthood at first episode of psychosis (FEP) on recovery, with a focus on potential sex differences.

METHODS

Sociodemographic, clinical, and neurocognitive information was considered on 610 FEP patients form the PAFIP cohort (Spain). Baseline and three-year follow-up comparisons were carried out. Chi-square tests and ANCOVA analysis were performed controlling for the effect of age and years of education.

RESULTS

Men comprised 57.54% of the sample, with only 5.41% having offspring when compared to 36.29% of women. Parenthood was related to shorter duration of untreated illness (DUI) in women with children (12.08 months mothers vs. 27.61 months no mothers), showing mothers better premorbid adjustment as well. Childless men presented the worst premorbid adjustment and the highest cannabis and tobacco consumption rates. Mothers presented better global cognitive function, particularly in attention, motor dexterity and executive function at three-year follow-up.

CONCLUSIONS

Diminished parental rates among FEP men could be suggested as a consequence of a younger age of illness onset. Sex roles in caregiving may explain the potential role of parenthood on premorbid phase, with a better and heathier profile, and a more favorable long-term outcome in women. These characteristics may be relevant when adjusting treatment specific needs in men and women with and without offspring.

Aging Parents and the Ties That Bind: Intergenerational Relationship Quality Among Culturally Diverse Canadian Families

Drawing from a life course perspective, this paper examines mid/later-life parent-child relationship quality among ethnically diverse families. Focus is on the role of culture, child, and parental characteristics. Data are drawn from a study of 588 parents aged 50+ of a least one child aged 19-35 who reside in Metro Vancouver, B.C. from four Canadian cultural groups: British, Chinese, Persian/Iranian, and South Asian. Using OLS regression methods, we use two dependent variable scales: positive and negative support/interaction appraisals of the relationship. The positive relationship quality scale is associated with South Asian versus British-Canadian parents, mothers, those with greater income satisfaction, and daughters. The negative scale is inversely associated among South Asian versus British-Canadian parents, income satisfaction, parental health, and being unpartnered (vs. partnered). Interaction effects are found between gender and ethnicity. Implications for theorizing and applied recommendations for those who work with culturally diverse aging families are discussed.

Duration and timing of depression and risk of family dissolution: A register-based cohort study of newly-formed Danish families

BACKGROUND

Depression is detrimental to partnership stability. However, it remains unclear if and how the duration and timing of depression affect the risk of family dissolution.

METHODS

We conducted a Danish register-based cohort study of newly-formed cohabiting and married couples in 2008 and 2009, who were followed from the second year after family formation. Depressive episodes were defined by individual-level prescription patterns of antidepressant drugs (ATC codes N06A) in either partner. Family dissolution was characterized by the discontinuation of a shared residential address. Using Longitudinal Targeted Minimum Loss-based Estimation, we estimated the risk of family dissolution after 5 years of follow-up under various lengths and timings of depressive episodes.

RESULTS

There were 102,335 families included. The covariate-adjusted risk of family dissolution in families without depressive episodes was 30.0 % (95 % CI 29.6-30.4 %) and 35.5 % (95 % CI 29.5-41.5 %) in families with at least one depressive episode during follow-up. The risk of family dissolution increased with the duration of depressive episodes to 42.2 % (95 % CI 40.8-43.6 %) for five coherent years of depression. Depression shortly after family formation carried higher risk of family dissolution; this risk was 42.3 % (95 % CI 38.4-46.3 %) for depression experienced in the first year of family formation versus 32.9 % (95 % CI 31.8-34.0 %) in the fifth year of family formation.

LIMITATIONS

Proxy measures of depression by antidepressant prescriptions fails to identify milder depression. Annual measures of family dissolution precluded more fine-grained analyses of time-intervals.

CONCLUSIONS

Depression is disruptive to family stability, particularly with longer duration and early onset after family formation.

Factors Affecting Well-Being in Korean Young Adults Facing Material Deprivation: Testing the Reserve Capacity Model

Based on the reserve capacity model, the current study aims to explore the effect of material deprivation on well-being in Korean young adults using path analysis to investigate the mediating effects of loneliness, relationship satisfaction, perceived social support, and depression. Data from 2,041 young adults in the 2021 Youth Socio-Economic Reality Survey were included in a secondary analysis. According to the constructed path model, material deprivation, relationship satisfaction, perceived social support, and depression had significant direct effects on well-being. The indirect effect of material deprivation on well-being was statistically significant and sequentially mediated by loneliness, relationship satisfaction, and depression. Findings suggest the multidimensional effects of material deprivation on the mental health and well-being of Korean young adults through loneliness and relationship satisfaction-representing intrapersonal and interpersonal reserves, respectively. Policy support and multidimensional practical programs are needed to help materially deprived young adults build and maintain relationships and avoid feelings of loneliness and social isolation. [Journal of Psychosocial Nursing and Mental Health Services, 62(3), 29-38.].

Socioeconomic inequalities in child and adolescent mental health in Australia: the role of parenting style and parents' relationships

BACKGROUND

Socioeconomic inequalities in health and their determinants have been studied extensively over the past few decades. However, the role of parenting style and parents' couple relationships in explaining mental health inequalities is limited. Therefore, this study aims to investigate the distributional impact of parenting style (angry parenting, consistent parenting, and inductive parenting) and parents' couple relationships (e.g., argumentative, happy relationships) on socioeconomic inequalities and by extension on mental health status of Australian children and adolescents.

METHODS

This study utilized data from the Longitudinal Study of Australian Children (Waves 1-7), specifically focusing on intact biological parent families, while excluding single-parent and blended-family households. We applied the decomposition index and the Blinder Oaxaca method to investigate the extent of the contribution and temporal impact of parenting style and parents' couple relationships on the mental health status of Australian children and adolescents.

RESULTS

This study revealed that poor parenting style is the single most important factor that leads to developing mental health difficulties in children and adolescents, especially from low socioeconomic status, and it contributes almost 52% to socioeconomic inequalities in mental health status. Conversely, household income, maternal education, employment status, and parents' couple relationships contributed 28.04%, 10.67%, 9.28%, and 3.34%, respectively, to mental health inequalities in children and adolescents.

CONCLUSION

Overall, this study underscores the importance of parenting style and parents' couple relationships as significant predictors of mental health outcomes in children and adolescents. These results highlight the need for targeted interventions to support families from low socioeconomic backgrounds to address the significant mental health inequalities observed in the study population.

Exploring self-care practices of African American informal kinship caregivers

African American caregivers providing informal kinship care are vulnerable to chronic stress. Research has indicated stress increases individuals' risk for many adverse physical and mental health outcomes, including cardiovascular disease, Alzheimer's disease and depression. Given the adverse outcomes related to stress, identifying mechanisms to help these caregivers lower and manage their stress is critical to their overall health and well-being. This pilot qualitative study aimed to explore the self-care practices of 12 African Americans providing informal kinship care using a phenomenological approach. Three themes emerged: (a) behaviours to manage stress levels, (b) support network reminding caregivers to take care of themselves and (c) prioritizing my own needs. Specifically, our findings indicate that some caregivers have high-stress levels and engage in maladaptive coping behaviours. The children they cared for reminded them to take care of themselves by attending doctors' appointments or getting their nails done. Nevertheless, some caregivers prioritized their needs by participating in positive self-care behaviours, such as listening to jazz and gospel music and exercising. Prevention and intervention programs that focus on improving caregivers' health should consider the role of self-care practices.

The influence of parents' and partner's education on own health behaviours

The link between educational attainment and multiple health behaviours has been explained in various ways. This paper provides new insights into the social patterning in health behaviours by investigating the influence of parents' and partners' educational attainments on a composite indicator that integrates the four commonly studied lifestyle behaviours (smoking, alcohol, physical activity and BMI). Two key outcome indicators of interests were created to reflect both ends of the "healthy - unhealthy spectrum". Data was drawn from The Tromsø Study, conducted in 2015/16 (N = 21,083, aged 40-93 years). We controlled for two indicators of early life human capital and one personality trait variable. Partners' education attainments are relatively more important for avoiding unhealthy behaviour than choosing healthy behaviour; on the contrary, parents' education is more important for healthy behaviour. Heterogeneity by sex and age was also evident. The influences of partner's education on widening the socioeconomic contrasts in health behaviours were much stronger in the younger (40-59 years) age group. In conclusion, our results support the hypothesis that own health behaviour is affected by the educational attainments of our 'nearest and dearest' (i.e. spouse, mother, and father), net of own education. This study facilitates a better understanding of education-health behaviours nexus from a life course perspective and supports the importance of family-based interventions to improve healthy behaviours.

The mediating role of religion and loneliness on the association between reminiscence functions and depression: a call to advance older adults' mental health

BACKGROUND

Current literature lacks evidence about the relationship between reminiscence functions and depression and the mediating role of clinical constructs such as loneliness and religion. The study aimed to examine the mediating effects of loneliness and religion on the association between reminiscence functions and depression in a sample of older Jordanian adults.

METHODS

An anonymous online cross-sectional survey was employed to collect data from 365 older Jordanian adults. Convenience and snowball sampling methods were used to recruit participants through social media.

RESULTS

In the depression model, Bitterness Revival and Intimacy Maintenance factors, educational level, and Intrinsic Religiosity were statistically significant predictors of depression. Bitterness Revival and Intimacy Maintenance factors, work sector, and Intrinsic Religiosity were statistically significant predictors of loneliness. Loneliness has a negative, partial mediating effect on Intimacy Maintenance and depression.

CONCLUSION

Depression caused by significant losses in the Arab Jordanian environment might be mitigated by Intimacy Maintenance by reducing feelings of loneliness. Understanding how Intimacy Maintenance correlates with depression through loneliness could help psychiatric nurses develop psychosocial interventions that reduce depression among older adults.

Sibling support exchange in late adulthood moderates the long-term impact of childhood neglect on psychological outcomes

Objectives: Sibling relationships are often the longest-lasting and serve as a source of support and comfort for many older adults. The current study examined the moderating effect of sibling support exchange in the association between childhood maltreatment and mental health outcomes.Method: Using data from the Wisconsin Longitudinal Study (WLS), we analyzed a sample of older adults whose selected sibling was alive across the three data collections (baseline N = 4,041). Longitudinal multilevel regression models were estimated.Results: Key results showed that a history of neglect was associated with decreased psychological well-being, and all three forms of childhood maltreatment were related to increased depressive symptoms. We also found that sibling support exchange mitigated the negative mental health effects of childhood neglect.Conclusion: Our findings suggest that siblings may be uniquely positioned to support older adults who grew up in a neglectful family environment. Older adults may be encouraged to promote resilience by strengthening their sibling relationships.

Impact of Parental Mental Health and Poverty on the Health of the Next Generation: A Multi-Trajectory Analysis Using the UK Millennium Cohort Study

PURPOSE

Exposure to parental mental ill-health and poverty in childhood impact health across the lifecourse. Both maternal and paternal mental health may be important influences, but few studies have unpicked the complex interrelationships between these exposures and family poverty for later health.

METHODS

We used longitudinal data on 10,500 children from the nationally representative UK millennium cohort study. Trajectories of poverty, maternal mental health, and secondary caregiver mental health were constructed from child age of 9 months through to 14 years. We assessed the associations of these trajectories with mental health outcomes at the age of 17 years. Population-attributable fractions were calculated to quantify the contribution of caregivers' mental health problems and poverty to adverse outcomes at the country level.

RESULTS

We identified five distinct trajectories. Compared with children with low poverty and good parental mental health, those who experienced poverty and poor primary or secondary caregiver mental health (53%) had worse outcomes. Children exposed to both persistent poverty and poor caregiver mental health were at markedly increased risk of socioemotional behavioural problems (aOR 4.2; 95% CI 2.7-6.7), mental health problems (aOR 2.5; CI 1.6-3.9), and cognitive disability (aOR 1.7; CI 1.1-2.5). We estimate that 40% of socioemotional behavioural problems at the age of 17 were attributable to persistent parental caregivers' mental health problems and poverty.

DISCUSSION

More than half of children growing up in the UK are persistently exposed to either one or both of poor caregiver mental health and family poverty. The combination of these exposures is strongly associated with adverse health outcomes in the next generation.

Presenteeism and social interaction in the "new normal" in Japan: a longitudinal questionnaire study

BACKGROUND

Although social interaction and social support during the "new normal" due to coronavirus disease 2019 (COVID-19) may be related to presenteeism, the effect between these factors has not been clear for Japanese workers. The aim of this study was to describe the presenteeism of Japanese workers with reference to social interaction and social support following the lifestyle changes due to COVID-19 and to assess whether social interaction and social support affected their presenteeism.

METHODS

The data were obtained from internet panel surveys from October 2020. Descriptive statistics were calculated, and multiple linear regression was conducted using the data from the first, fourth and fifth surveys, which were conducted during October to November 2020, July to August 2021, and September to October 2021, respectively. To measure presenteeism, questions from "absenteeism and presenteeism questions of the World Health Organization's Heath and Work Performance Questionnaire", short version in Japanese was utilized. Multiple linear regressions were conducted to investigate the effects of social interaction and social support-related factors on presenteeism.

RESULTS

A total of 3,407 participants were included in the analysis. The mean score of absolute presenteeism from the fifth survey was 58.07 (SD = 19.71). More time spent talking with family, a larger number of social supporters and a higher satisfaction level for social support were associated with a higher absolute presenteeism score.

CONCLUSIONS

Our results suggested that social support reduced the presenteeism of the Japanese workers during the "new normal" due to the COVID-19 pandemic. Social interaction with family also relieved presenteeism.

Family Self-Care in Chronic Disease Management: An Evolving Care Pattern?

Introduction

Self-care emerges in the family context, despite being seen as an individual determinant of health. The family, understood as a system and social unit, converges to a pattern of self-care and not to a sum of it, assuming relevance at certain moments of the life cycle, particularly in the management of chronic disease.

Purpose

To perform the transposition of individual self-care to the family self-care, considering the current family's needs and characteristics, by adopting family self-care as the core concept of a care pattern as a determinant of family health.

Conclusion

The family unit is the most influential factor in the health status of individuals, and it will be through family self-care behaviors that families can be healthier by managing their diseases more effectively. They seek to achieve family health, maintaining health through health promotion and disease management practices, always mediated by family self-care behaviors.

Economic Resources and Health: A Bi-Directional Cycle for Resilience in Old Age

Objectives: The paper offers an expanded framework for conducting empirical research on resilient aging. Methods: We review the conceptual frameworks for resilient aging and incorporate the role of economic factors as resources that contribute to resilience, in addition to social and psychological factors emphasized in the existing literature. Moreover, the idea of reinforcing cycles of resilience is incorporated in the framework. Existing empirical evidence that supports the conceptual arguments is presented. Results: Examples from Mexico and other low-middle-income countries are included, as well as from high-income countries. Data requirements for applying the conceptual framework in empirical analysis and the state of data availability are examined. We illustrate the measures that are available for this purpose using the Mexican Health and Aging Study. Discussion: We discuss and conclude that the state of the field is rich in data to conduct empirical work on resilience in old age.

Are Social Vulnerability and Family Social Support Associated with Children's Psychiatric Symptoms?

Social influence can shape early childhood at different levels. We explored the association between social vulnerability and lifetime caregiver alcohol use with children's psychiatric symptoms. Multivariable logistic regression assessed the association between child psychiatric symptoms and social vulnerability among 1275 preschool child-caregiver pairs with lifetime caregiver alcohol used as a control variable. Of the children, 15.78% (95% CI 15.17-16.42) had internalizing symptoms, 2.49% (95% CI 2.19-2.83) had externalizing symptoms, and 9.36% (95% CI 8.88-9.86) had internalizing/externalizing symptoms. High social vulnerability was positively correlated with internalizing (aRRR 1.54; 95% CI 1.41-1.68) and internalizing/externalizing symptoms (aRRR 1.77; 95% CI 1.58-2.00). Low family support was strongly associated with internalizing/externalizing symptoms (aRRR 2.60; 95% CI 2.20-3.10). Lifetime caregiver alcohol use was positively correlated with all three psychiatric symptoms (aRRR 1.33; 95% CI 1.18-1.51; aRRR 1.13; 95% CI 1.06-1.59; and aRRR 1.26; 95% CI 1.12-1.42). Their association with children's mental health outcomes calls for social policy changes at the macrosystem level.

Exploring herbal remedy utilization for wound healing: Patterns, patient preferences, and implications for nursing practice

PURPOSE

The utilization of herbal remedies for wound healing is a notable aspect of traditional medicine practices. Understanding herbal use among patients yields insights for nursing care enhancement. This study aimed to investigate the utilization of herbal remedies for wound healing among diabetic patients.

METHODS

A total of 453 participants were enrolled, with demographic data, including age, sex, occupation, education level, residence, ethnic group, distance from health service, herbal use duration, and wound duration presented. Descriptive statistics were used to analyze the data, including means, standard deviations, ranges, and percentages.

FINDINGS

The average participant age was 55.39 years, with most being non-civil servant workers (60.3%) and having a low education level (67.1%). Indian almond wood (9.7%) and green betel (6.8%) were the most commonly used herbs for wound healing. Family members were the primary source of information (29.1%), and 43.7% obtained herbs from personal gardens. Although 94.2% of participants did not disclose herbal use to health liaisons, 53.4% used herbs specifically for wound healing. Users reported both positive and negative effects on wounds from various herbs, indicating variability in experiences. However, the consistency of herb usage by individual patients was uncertain.

CONCLUSIONS

The study identified diverse herbal remedies used for wound healing among patients, driven by familial recommendations. Usage pattern diversity and effects signal necessity for researching herb safety and efficacy. Clarifying the impact of consistent herb usage on wound healing is essential for understanding patients' preferences and practices.

IMPLICATIONS FOR CLINICAL PRACTICE

These findings emphasize the importance of open communication between patients and healthcare providers regarding herbal remedy use. Nurses should acknowledge patients' preferences for traditional healing practices while ensuring they receive evidence-based care. Patient-centered herbal strategies enhance nursing practice, fostering holistic wound care. Further research can guide nursing interventions, facilitate informed decision-making, and improve patient outcomes.

Depression among older adults in an urban slum of Raipur city - a community based cross-sectional study

BACKGROUND

Older adults are at risk of chronic, silent depressive changes and the vulnerability of older adults in urban slums of India is rarely exposed. The objective of this study was to estimate the prevalence of depression among the older adults in the urban slums of India and to study the factors associated with it.

METHODS

This was a community based analytical cross-sectional study conducted in Urban Field Practice Area of a tertiary care teaching hospital in Chhattisgarh, India among older adults more than or equal to 60 years of age selected using two stage, simple random sampling. The data was collected in a sample of 400 older adults by face-to-face interview using self-designed, semi-structured and pretested proforma that included validated Hindi version of Geriatric Depression Scale (GDS-15) and analyzed using SPSS v23.

RESULTS

The prevalence of depression among older adults was 51.5% in the present study; with 27%, 12.8% and 11.8% having mild, moderate and severe depression respectively. Number of family members, living status of spouse, emotional attachment to family members, conflict in family, loneliness, social isolation, marginal friendship ties, functional status, physical exercise, active complains and diastolic BP were independent predictors of depression in older adults.

CONCLUSION

Early identification of depression in older adults using GDS-15 and incorporation of social isolation and functionality assessment routinely by healthcare providers for all older adults attending the outpatient departments is the need of the hour. A holistic approach to care of older adults is vital as healthcare providers seek to understand the impact of multiple, complex, interconnected factors on overall health and well-being of older adults.

Nurse-led approaches to address social determinants of health and advance health equity: A new framework and its implications

BACKGROUND

The U.S. health care system is burdened by inefficiencies, longstanding health inequities, and unstainable costs. Within the nursing profession and the broader health care sector, there is growing recognition of the need for a paradigm shift that addresses persistent structural problems and advances health equity.

PURPOSE

Despite evidence of the importance of the social determinants of health (SDOH) in shaping inequitable health outcomes, practical tools for applying SDOH theory in the development of effective nurse-led programs to mitigate harmful SDOH remain scarce.

METHODS

We synthesize extant SDOH literature into a heuristic framework for conceptualizing core SDOH mechanisms, constructs, and principles.

FINDINGS

To illustrate how nurse scientists can use the framework to guide the development of programs for SDOH mitigation, we outline a three-step exemplar application to the U.S. Latino HIV epidemic.

DISCUSSION

Our framework can inform a paradigm shift toward nurse-led, multi-level SDOH mitigation across practice, education, and research.

Comparison of wellbeing structures based on survey responses and social media language: A network analysis

Wellbeing is predominantly measured through surveys but is increasingly measured by analysing individuals' language on social media platforms using social media text mining (SMTM). To investigate whether the structure of wellbeing is similar across both data collection methods, we compared networks derived from survey items and social media language features collected from the same participants. The dataset was split into an independent exploration (n = 1169) and a final subset (n = 1000). After estimating exploration networks, redundant survey items and language topics were eliminated. Final networks were then estimated using exploratory graph analysis (EGA). The networks of survey items and those from language topics were similar, both consisting of five wellbeing dimensions. The dimensions in the survey- and SMTM-based assessment of wellbeing showed convergent structures congruent with theories of wellbeing. Specific dimensions found in each network reflected the unique aspects of each type of data (survey and social media language). Networks derived from both language features and survey items show similar structures. Survey and SMTM methods may provide complementary methods to understand differences in human wellbeing.

Grief is a family affair: examining longitudinal associations between prolonged grief in parents and their adult children using four-wave cross-lagged panel models

BACKGROUND

Losing a parent or spouse in adulthood may result in prolonged grief disorder (PGD) symptoms. PGD levels in parents may affect PGD levels in their adult offspring and the other way around. However, research on transmission of PGD in parent-child dyads is lacking. Consequently, we aimed to examine temporal associations between PGD levels in parent and adult children.

METHODS

In doing so, we analyzed longitudinal self-report data on PGD levels (using the PG-13) assessed at 2, 11, 18, and 26 months after loss in 257 adult parent-child dyads from Denmark. Cross-lagged panel modeling was used for data-analyses.

RESULTS

Changes in PGD levels in parents significantly predicted PGD levels in adult children, but not vice versa. Small through moderate cross-lagged effects (β = 0.05 through 0.07) were found for PGD levels in parents predicting PGD levels in adult children at a subsequent time-point. These cross-lagged effects were found while taking into account the association between PGD levels in parents and adult children at the same time-point as well as the associations between the same construct over time and relevant covariates.

CONCLUSIONS

Pending replication of these findings in clinical samples and younger families, our findings offer tentative support for expanding our focus in research and treatment of PGD from the individual to the family level.

Caffeinated energy drink consumption among Emirati adolescents is associated with a cluster of poor physical and mental health, and unhealthy dietary and lifestyle behaviors: a cross-sectional study

Background

Consumption of caffeinated energy drinks (CED) has escalated during the last few years, especially among schoolchildren, with evident adverse health sequelae in this critical age group.

Objective

This study examined the prevalence of CED consumption and its associations with sleep, physical and mental health, and dietary and lifestyle habits among schoolchildren in the United Arab Emirates (UAE).

Method

A structured self-administered online questionnaire was developed and disseminated among schoolchildren aged 14-18 years, selected from schools of the seven emirates of the UAE.

Results

More than 4,500 (N= 4,648) responses received. A relatively low prevalence of CED consumption (20%) was found among schoolchildren in the UAE. However, those who reported CED consumption were more likely to report unhealthy dietary (skipping breakfast, frequent snacking, and eating fast foods, low fruit, and vegetable intake) and lifestyle behaviors (long screen time, poor sleep health), in addition to poor self-reported mental and physical health than non-users. CED consumption was significantly and variably associated with multiple sociodemographic factors such as students' nationality, parental companionship, sex, school type, education level (children's and parents'), daily allowance, academic performance, screen time, sleep quality parameters, self-reported physical and mental health, and parents' employment. Sources of knowledge about CED were social media (55%), friends/schoolmates (52%), and family members (52%). Students believed that CED constitute sugar (87%), caffeine (69%), artificial flavors (67%) sweeteners (54%), and stimulating components (43%). The majority (70%) of students reported that CED consumption increases the risks for heart disease, diabetes, high blood sugar (65%), addiction (64%), high blood pressure (59%), and obesity (57%).

Conclusion

These results offer important insights for health professionals, child health specialists, policymakers, and parents in the UAE regarding adolescents' attitudes, knowledge and behaviors toward CED consumption.

The relationship between intergenerational financial support and depressive symptoms among older adults: Evidence from China Health and Retirement Longitudinal Study, 2011-2018

OBJECTIVE

Aimed to investigate the effect of intergenerational financial support on depressive symptoms among older adults over time.

METHODS

Data were obtained from China Health and Retirement Longitudinal Study (CHARLS) 2011, 2013, 2015, and 2018. A finite distributed lag (FDL) model was employed, long-run cumulative effect was evaluated. 1426 respondents followed in four waves were included in FDL model. CES-D score was used to measure depressive symptoms, intergenerational financial support was defined as financial support received from older adults' children or grandchildren. Sociodemographic characteristics, health behaviors, social insurance, and social contact factors were controlled in the model.

RESULTS

More than a third older adults in China had a CES-D score of 10 or higher. Intergenerational financial support has a significant long-run cumulative negative effect on older adults' depressive symptoms (CES-D scores: coef. = -0.674, P < 0.001; % with CES-D scores ≥10: Coef. = -0.154, P = 0.018). While, the intergenerational financial support in previous period exhibited a significant negative association with depressive symptoms, the 2, 3, and 4 periods did not reach statistical significance.

CONCLUSIONS

Intergenerational financial support has a significant negative effect on older adults' depressive symptoms over time, while the effect may diminish. Programs need to be explored to support home-based eldercare to mitigate this diminished effect.

Outcomes and experiences after child custody loss among mothers who use drugs: A mixed studies systematic review

BACKGROUND

Mothers who use drugs are more likely to experience child custody loss than mothers who do not use drugs. The negative impact of removal on children has been well characterized in current literature while less is known about the impact of custody loss on mothers. The purpose of this mixed studies systematic review is to describe the state of science on the maternal outcomes and experiences after child custody loss among mothers who use drugs.

METHODS

PubMed, PsycINFO, CINAHL, and Social Work Abstract databases were systematically searched between June 2022 to January 2023. Article eligibility criteria centered on the outcomes and experiences of mothers who use drugs after losing child custody. Studies were analyzed using results-based convergent synthesis methodology for mixed studies reviews. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). A visual synthesis model was derived from combined results across all studies.

RESULTS

Of 2434 articles screened, 22 relevant scientific articles were selected for inclusion. Longitudinal, cohort studies (n=4) and a cross-sectional study (n=1) identified positive associations between custody loss and poorer mental health, increased drug use and overdose risk, less treatment engagement, and worsened social factors. Qualitative studies (n=17) identified themes that described re-traumatization after child custody loss and the development of coping mechanisms through identity negotiation.

CONCLUSION

Our findings indicate that child custody loss associated with drug use may exacerbate trauma and worsen maternal health. Immediate implications are provided for maternal health policy and practice in healthcare, child welfare, and legal professions.

The mediating effect of family health on the relationship between health literacy and mental health: A national cross-sectional survey in China

BACKGROUND

Mental health problems significantly affect people's well-being and result in a huge health burden. Health literacy and family health are critical to reducing people's mental health problems. However, limited studies have addressed their complex interaction. Thus, this study aims to elucidate the mediating effect of family health on the relationship between health literacy and mental health.

METHODS

A national cross-sectional study based on multistage random sampling was conducted from July 10 to Sep 15, 2021, in China. Information about the public's health literacy, family health, and the level of three common mental health problems (depression, anxiety, and stress) was collected. A structural equation model (SEM) was applied to explore the mediating effect of family health on the relationship between health literacy and mental health.

RESULTS

A total of 11,031 participants were investigated. Approximately 19.93 and 13.57% of participants experienced moderate or severe depressive and anxiety symptoms, respectively. The SEM showed that health literacy was directly associated with mental health, with higher health literacy resulting in lower levels of depression (coefficient: -0.018, p = .049), anxiety (coefficient: -0.040, p < .001), and stress (coefficient: -0.105, p < .001). In addition, family health played a significant mediating effect (p < .001) between health literacy and mental health, contributing to 47.5, 70.9, and 85.1% of the total effect of health literacy on personal stress, anxiety, and depression, respectively.

CONCLUSIONS

This study revealed that the improvement of health literacy is directly and indirectly associated with less likelihood of people's mental health problems via family health. Thus, future mental health interventions should be integrated and targeted both at individual level and the family level.

Older adults' experiences of social isolation and loneliness: Can virtual touring increase social connectedness? A pilot study

The present pilot study explored the research aim of understanding how independent-living older adults experience social isolation and loneliness and whether virtual tour digital technology can increase social connectedness (N = 10). Through triangulation of interviews, experiences, and feedback, this study contributes to the knowledge base on the well-being of our ageing populations and how digital technologies, specifically virtual tourism, can aid in this process. The key findings reveal that the participants in our study were moderately lonely but were open to embracing more digital technology, sharing how it is instrumental in facilitating social connection and life administration. Participating in virtual tour experiences was well accepted as participants expressed enjoyment, nostalgia, and interest in future use. However, its contribution to increasing social connections needs to be clarified and requires further investigation. Several future research and education directions are provided.

The Associations between Cognitive Function, Depressive Symptoms, and Contact with Adult Children in Older Couples

The aim of this study was to investigate the association between cognitive function and depressive symptoms in older couples while also examining the relationship between cognitive performance and the frequency of contact with adult children. A total of 96 couples volunteered for this study and provided their informed consent at enrollment. Participants completed a neuropsychological test battery consisting of five cognitive domains: attention, language and related functions, visuospatial functions, memory, and frontal/executive functions. Symptoms of depression were assessed using the short version of the Geriatric Depression Scale. The number of contacts with children was categorized into ≥1 per month and <1 per month. We found that the cognitive functions of husbands with depressed wives were significantly lower in the frontal/executive functions. In contrast, the wives' cognitive performance was not associated with the husbands' depressive symptoms. For couples who had contact with their adult children less than once a month, the odds of the husbands with lower cognitive performance were significantly higher, which was reflected in their scores in visuospatial and executive functions. Among older married couples, the cognitive functions of husbands may be influenced more by their wives' mental health and degree of contact with their adult children. This infers that wives and offspring may act as a buffer against the cognitive impairment of older married men.

The association between psychosocial factors, protective factors, and its associated triggers with psychological distress among Bolivian adolescents

The purpose of this study is to investigate the association between psychosocial factors, protective factors, and its associated triggers with psychological distress among Bolivian adolescents. This cross-sectional study was conducted by investigating the 2018 Bolivia global school-based student health survey (GSHS). The total number of students who participated in this survey was 7931, and the final sample was 7377. The mean age of the participants was 15.3 years (SD = 1.4). Psychological distress was assessed with a 2-item screener (loneliness and worry induced sleep disturbance). In all 22.3% of participants reported experiencing psychological distress, with 18.1% among adolescent males and 26.2% among adolescent females. In adjusted logistic regression analysis (AOR, 95% CI), there are two significant directions of association. One is the negative association, such as parental involvement as a protective factor. School adolescents who had more parental involvement were less likely to experience psychological distress. Parents understand problems or worries (0.64, 0.54-0.75, p < .001) and parents disregard privacy (0.69, 0.58-0.82, p < .001). On the other hand, many psycho-social factors are significantly positively associated with psychological distress. School adolescents who experience more psychosocial factors are more likely to experience psychological distress. Physical assault in the previous year (1.83, 1.59-2.11, p < .001), being bullied at school (1.27, 1.07-1.52, p < .01), being bullied outside of school (1.36, 1.15-1.61, p < .001), and being cyberbullied (1.60, 1.37-1.88, p < .001), were all significantly associated with psychological distress. Healthy relationships in a family, and interventions to reduce violence and bullying, should be encouraged and promoted.

Interactions between COVID-19 family home disruptions and relationships predicting college students' mental health over time

The present study tested whether family home disruptions during the COVID-19 pandemic in the Spring 2020 (Time 1; T1) informed mental health (i.e., posttraumatic stress disorder [PTSD], depressive, and anxiety symptoms) 7 months later in Fall 2020 at T2 and whether family relationship quality moderated relations. Multigroup path analysis models were used to test whether there were significant differences in relations by emerging adults' ethnic-racial backgrounds. Participants were 811 Black, Asian American, Latine, and White emerging adult college students (Mage = 19.95, SD = .33), and the majority (79.6%) who reported their gender identified as cisgender women. Results indicated that across all individuals, T1 family relationship quality moderated relations between T1 family home disruptions and T2 anxiety and depressive symptoms. At lower levels of T1 family relationship quality, family home disruptions predicted greater T2 depressive and anxiety symptoms. At higher levels of T1 family relationship quality, these relations were not significant. Findings highlight that family relationship quality is an important protective factor for diverse emerging adult college students. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychosocial Factors of Subjective Well-Being in Women with Eating Disorders

Eating disorders are known as the most lethal mental health conditions, and lately there has been a significant increase in the prevalence of these disorders. The aim of this research was to determine the perceived quality of professional support, the relationship between subjective well-being, loneliness, resilience, and the quality of family functioning, and the possibility of predicting subjective well-being based on knowledge of psychosocial factors in people with eating disorders. Eighty-six women with a diagnosed eating disorder participated in the online survey. The Diener Subjective Well-Being Scale, the UCLA Loneliness Scale, the Brief Resilience Scale, and the Self-Report Family Inventory were used to measure the constructs. Questions were constructed to collect information about the perceived quality and availability of professional support. Results showed lower levels of life satisfaction and flourishing and more frequent negative experiences. Reports of medium levels of loneliness, lower levels of flourishing, and lower perceived quality of family functioning were also obtained. Significant predictors of subjective well-being were loneliness and resilience, while family cohesion was significant in predicting positive and negative experiences and flourishing. These findings can contribute to the recognition of aspects existent prior to the development of the disorder, based on which experts can determine what to focus on in the treatment process.

The effects of regular dental scaling on the complications and mortality after stroke: a retrospective cohort study based on a real-world database

BACKGROUND

Previous observational studies have shown that people with dental scaling (DS) had decreased risk of stroke. However, limited information is available on the association between DS and poststroke outcomes. The present study aimed to evaluate the effects of regular DS on the complications and mortality after stroke.

METHODS

We conducted a retrospective cohort study of 49,547 hospitalized stroke patients who received regular DS using 2010-2017 claims data of Taiwan's National Health Insurance. Using a propensity-score matching procedure, we selected 49,547 women without DS for comparison. Multiple logistic regressions were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of poststroke complications and in-hospital mortality associated with regular DS.

RESULTS

Stroke patients with regular DS had significantly lower risks of poststroke pneumonia (OR 0.58, 95% CI 0.54-0.63), septicemia (OR 0.58, 95% CI 0.54-0.63), urinary tract infection (OR 0.68, 95% CI 0.66-0.71), intensive care (OR 0.81, 95% CI 0.78-0.84), and in-hospital mortality (OR 0.66, 95% CI 0.62-0.71) compared with non-DS stroke patients. Stroke patients with regular DS also had shorter hospital stays (p < 0.0001) and less medical expenditures (p < 0.0001) during stroke admission than the control group. Lower rates of poststroke adverse events in patients with regular DS were noted in both sexes, all age groups, and people with various types of stroke.

CONCLUSION

Stroke patients with regular DS showed fewer complications and lower mortality compared with patients had no DS. These findings suggest the urgent need to promote regular DS for this susceptible population of stroke patients.

Why Do Iranian Preschool-Aged Children Spend too Much Time in Front of Screens? A Preliminary Qualitative Study

There is evidence that Iranian preschool children are increasingly spending their time in front of screens (screen time: ST; time spent with any screen such as TVs, computers, tablets, smartphones, game consoles, or video games), but few studies have explored the possible causes of such an increase. Given this, the present study aimed to qualitatively explore determinants of excessive ST in Iranian children. To this end, parents of preschool children were interviewed, and their answers were qualitatively clustered to identify additional important factors. Key informant interviews were conducted with parents of preschool children in Tehran (Iran). A semi-structured interview was developed to assess child and family life, daily routine, family rules, family interactions, and home climate as possible contributing factors to ST. Parents' audiotaped statements were transcripted verbatim, coded, and clustered into main themes using thematic analysis with the MaxQda^® software. A total of 20 parents of children aged 2 to 7 were interviewed, and a total of 6 key themes and 28 subthemes were extracted from their interviews. The results of the analysis identified a broad range of both independent and interrelated factors leading to the development and maintenance of ST behaviors among preschool children. Our findings indicate that the central concept is the family. Considering screen-related behaviors, family life encompasses parental health literacy (e.g., parenting pattern, monitoring standards, thoughtful parenting), family psychological atmosphere (e.g., presence of parents, family norms, parent-parent and parent-child interaction, congruency/incongruency of parents with each other) and the digital structure of the home. The child's and parents' actions and characteristics can influence family interactions. A child's and parent's behavior is also influenced by social/cultural factors. Parents' behaviors and attitudes, family communications, and interactions contribute to healthy ST habits in children. It is not possible to examine the child's behavior without considering the family and the dominant environment, since the behavior of family members as a whole affects each family member. Given this, interventions should make parents aware of their role and responsibilities in reducing children's ST and consider the family system as a whole, and interventions also can benefit from considering the parental perceptions of children's behaviors.

COVID-19 infection and decline in outdoor activities associated with depression in older adults: A multicenter study in Vietnam

BACKGROUND

The coronavirus disease (COVID-19) pandemic has caused a serious global communicable disease burden. Although COVID-19 and its policy responses have significantly influenced older adults, the impact of COVID-19 on depression in the older population is not fully understood. We aimed to investigate whether a history of COVID-19 infection and a decline in outdoor activities during the COVID-19 pandemic were associated with depression among older adults in Vietnam.

METHODS

This multicenter cross-sectional study was conducted on 1,004 outpatients (aged ≥60 years; mean age 70.8 ± 7.3 years; men, 33.0%) visiting three hospitals for a comprehensive geriatric assessment between November 2021 and July 2022. Depression over the past week was evaluated using the 15-item Geriatric Depression Scale. History of COVID-19 infection and decline in outdoor activities were included as binary variables. We adjusted these two factors with sociodemographic and geriatric variables and comorbidities using a logistic regression analysis in separate models.

RESULTS

A total of 156 participants (15.5%) experienced depression. The proportion of mild, moderate, and severe depressive symptoms was 14.1%, 44.9%, and 41.0%, respectively. In the multivariate model, decline in outdoor activities (odds ratio [OR] 17.2, 95% confidence interval [CI] 9.15-32.2, p <0.001) and history of COVID-19 infection (OR 2.22, 95% CI 1.28-3.84, p = 0.004) were associated with depression. Additionally, we found that age ≥ 75 years, female sex, being underweight, limitations in functional status, poor sleep quality, and stroke were associated with depression. Of the associated factors, decline in outdoor activities had a moderate strength of association with depression (r = 0.419), while each of the remaining factors had a weak strength of association.

CONCLUSIONS

COVID-19 had a direct and indirect impact on depression in older adults, reflecting an association between both a history of COVID-19 infection and a decline in outdoor activities during the COVID-19 pandemic and depression in the older population.

Impact of work and coping factors on mental health: Australian truck drivers' perspective

INTRODUCTION

Truck driving is one of the most common male occupations worldwide. Drivers endure long working hours, isolation, separation from family, compromised sleep, and face rigid regulatory requirements. Studies have documented the work factors contributing to poor health outcomes, however these have not been explored in the Australian context. The aim of this grounded theory study was to explore the impact of work and coping factors on mental health of Australian truck drivers from their perspective.

METHODS

Recruitment used a purposive snowball sampling, through social media campaigns and direct email invites. Interview data were collected via phone/teleconference, audio recorded and typed verbatim. Inductive coding and thematic analysis were completed with triangulation of themes.

RESULTS

Seventeen interviews were completed (94% male). Six themes arose, two supporting (Connections; Coping methods), and four disrupting mental health (Compromised supports; Unrealistic demands; Financial pressures; Lack of respect). Drivers had concerns regarding the many things beyond their control and the interactions of themes impacting their health even further.

CONCLUSION

This study explored the impact of work and coping factors affecting truck driver mental health in Australia. Themes described the importance of connections and coping methods drivers had to support their health. Many factors that compromised their health were often outside their control. These results highlight the need for a multi-faceted collaboration between stakeholders; the driver, employing companies, policy makers/regulators and the public to address the negative impact of truck driving on mental health.

Psychological wellbeing in adult adoptees: current age and developmental tasks

Introduction

Studies about adult adoptees are normally focused on the differences in adjustment difficulties between them and non-adoptees. However, there has been less research about adoptees' positive and developmental adjustment in adulthood. The aim of this study is to test a model of the mediating role of adoptees' achievement of adulthood tasks in the relationship between current age and psychological wellbeing.

Materials and methods

The sample consisted of 117 adults who were adopted as children by Spanish families. Their current mean age is 28.3 years. Participants underwent an interview and completed Ryff's Psychological WellBeing Scales.

Results

Findings show that current age is directly and negatively related to psychological wellbeing [c' = -0.039, 95% CI (-0.078, -0.001)], and the relationship between these variables is mediated by adoptees' achievement of adulthood tasks [indirect effect = 0.035, 95% CI (.014, 0.059)].

Discussion

The findings support traditional theories about transitioning to adulthood, and adds relevant information about this transition in adoptees. Moreover, this work indicates a new way of assessing adoption success, based on long-term measures and normative variables. Services providers should account for the importance of supporting young people on their life transitions and promoting their wellbeing, especially among those who started from disadvantaged contexts.

Prediction of Chronic Stress and Protective Factors in Adults: Development of an Interpretable Prediction Model Based on XGBoost and SHAP Using National Cross-sectional DEGS1 Data

BACKGROUND

Chronic stress is highly prevalent in the German population. It has known adverse effects on mental health, such as burnout and depression. Known long-term effects of chronic stress are cardiovascular disease, diabetes, and cancer.

OBJECTIVE

This study aims to derive an interpretable multiclass machine learning model for predicting chronic stress levels and factors protecting against chronic stress based on representative nationwide data from the German Health Interview and Examination Survey for Adults, which is part of the national health monitoring program.

METHODS

A data set from the German Health Interview and Examination Survey for Adults study including demographic, clinical, and laboratory data from 5801 participants was analyzed. A multiclass eXtreme Gradient Boosting (XGBoost) model was constructed to classify participants into 3 categories including low, middle, and high chronic stress levels. The model's performance was evaluated using the area under the receiver operating characteristic curve, precision, recall, specificity, and the F1-score. Additionally, SHapley Additive exPlanations was used to interpret the prediction XGBoost model and to identify factors protecting against chronic stress.

RESULTS

The multiclass XGBoost model exhibited the macroaverage scores, with an area under the receiver operating characteristic curve of 81%, precision of 63%, recall of 52%, specificity of 78%, and F1-score of 54%. The most important features for low-level chronic stress were male gender, very good general health, high satisfaction with living space, and strong social support.

CONCLUSIONS

This study presents a multiclass interpretable prediction model for chronic stress in adults in Germany. The explainable artificial intelligence technique SHapley Additive exPlanations identified relevant protective factors for chronic stress, which need to be considered when developing interventions to reduce chronic stress.

Mothers' participation in family gatherings and social events with their children with autism spectrum disorder: A scoping review

INTRODUCTION

Participating in family gatherings can provide enjoyment and quality time together as a family. However, being the primary carers, mothers of children with autism spectrum disorder may experience this phenomenon differently. The purpose of this study is to explore how available literature describes mothers' experiences of participation in family gatherings and social events with their children with autism spectrum disorder.

METHODS

A scoping review was used to explore available literature and identify studies describing mothers' experiences of family gatherings and social events with their children. A thematic synthesis was performed to analyse and synthesise the findings.

RESULTS

A total of 8 articles were included for review. The analysis of the included studies resulted in one central theme-Negative experiences despite strategies-and four analytical themes: Feeling fear, stress, and anxiety; Avoiding family gatherings; Enjoying less and becoming less confident; and Using strategies.

CONCLUSION

These findings indicate that mothers of children with autism spectrum disorder experience difficulties during gatherings even when using strategies, hence limiting their participation.