A Twin Study on Perceived Stress, Depressive Symptoms, and Marriage

Genetic propensity to depression and the role of partnership status

Social relationships and genetic propensity are known to affect depression risk, but their joint effects are poorly understood. This study examined the association of a polygenic index for depression with time to antidepressant (AD) purchasing and the moderating role of partnership status. We analysed data from 30,192 Finnish individuals who participated in the FINRISK and Health 2000 and 2011 surveys and had register and medication data available. We measured genetic risk with a polygenic index (PGI) for depression. Depression was assessed through antidepressant purchases. We estimated an accelerated failure time model with partnership status as time-varying and different sets of confounder adjustments. The predicted cumulative hazard of antidepressant purchasing varied across PGI and partnership status. At follow-up year 10, being widowed was associated with the largest cumulative hazard of 0.34 (95%CI: 0.28-0.39) in the 80th and 0.20 (95%CI: 0.17-0.23) in the 20th PGI percentile, followed by divorced, single, married and cohabiting. Cohabiting was associated with a cumulative hazard of 0.19 (95%CI: 0.16-0.23) in the 80th and 0.11 (95%CI: 0.1-0.13) in the 20th PGI percentile. We found no evidence for an interaction between the PGI and partnership status. Results were robust to different model specifications, gender stratification, and the choice of PGI. Although antidepressant purchasing correlated with both PGI and partnership status, we found no evidence that partnership status could partially offset or amplify the association between the PGI for depression and antidepressant purchasing incidence.

Financial Strain and Psychological Distress Among Middle-Aged and Older Adults: A Moderated Mediation Model

This study investigates the association between financial strain and psychological distress among middle-aged and older adults, exploring how this association is mediated by sleep problems and moderated by marital status. A subsample of 12,095 adults aged 50 and older was selected from the 2018 National Health Interview Survey. Results showed that financial strain was associated with higher psychological distress, and sleep problems partially mediated this association. Marital status moderated the association between sleep problems and psychological distress, and between financial strain and psychological distress, but not between financial strain and sleep problems. These findings partially support the stress-buffering role of marriage. The study offers valuable insights into the complex relationship between financial strain, sleep problems, marital status, and psychological distress among middle-aged and older adults in the United States, highlighting the need for interventions targeting financial stressors and sleep problems, especially for unmarried individuals, to improve mental health outcomes in this population.

Bias in Gene-by-Environment Interaction Effects with Sum Scores; An Application to Well-being Phenotypes

In the current study, we investigated the influence of using skewed sum scores on estimated gene-by-environment interaction effects (GxE) for life satisfaction and happiness with perceived social support. To this end, we analyzed item-level data from a large adult twin sample (Ns between 3610 and 11,305) of the Netherlands Twin Register. Item response theory (IRT) models were incorporated in unmeasured (univariate) GxE models, and measured GxE models (with social support as moderator). We found that skewness introduced spurious GxE effects, with the largest effect for the most skewed variable (social support). Finally, in the IRT model for life satisfaction, but not for happiness, heritability estimates decreased with higher social support, while this was not observed when analyzing sum scores. Together, our results indicate that IRT can be used to address psychometric issues related to the use of sum scores, especially in the context of GxE, for complex traits like well-being.

Lifestyle, vulnerability to stress and prevailing health conditions of ambulatory older patients in a care facility

Background

Lifestyle and vulnerability to stress are major determinants of age-related health outcomes.

Objectives

To assess the lifestyle and health states of older adults, and evaluate their personality-related vulnerability to stress, to enable improved and targeted health promotional activities.

Methods

A hospital record review and a purposive cross-sectional study was conducted among 200 respondents who were ≥ 50 years old, and visited the General Hospital Oyo, South-western Nigeria. Descriptive statistics was performed using SPSS version 21. Analysis of vulnerability to stress was performed by the addition of scores from Marshal's personality stress prone test. Lifestyle were measured by frequencies and Chi-Square tests, while presence of chronic diseases was measured by respondents' past prescriptions, from the hospital case notes. P < 0.05 was considered statistically significant.

Results

A total of 200 respondents participated in the study. Majority, 156 (78.0%) were 50-59 years old and self-employed 96 (46.0%). Ninety-three (46.5%) smoked, 65 (32.3%) consumed alcohol, 128 (64.0%) had periodic exercise and 67 (33.3%) experienced insomnia. Majority (60.5%) were vulnerable to stress, and this was significantly associated with age (P=0.001), marital status (P=0.021), body weight (P=0.05), occupation (P=0.002) and income (P=0.002). From the retrospective study, most frequently prescribed drugs were anti-hypertensives 225 (69.7%), vitamins/minerals (49.5%), sedatives 158 (48.9%) and analgesics 158 (48.9%) respectively.

Conclusion

Periodic exercise, alcohol use, and smoking were reported at varying degrees. High prevalence of vulnerability to stress and use of anti-hypertensives were also observed, and vulnerability to stress was associated with selected socio-demographics. These findings reinforce the need for routine education of this category of populace on healthy lifestyle for improved health.

Depression and anxiety in persons with Von Willebrand disease

OBJECTIVE

We assessed sociodemographic and clinical characteristics associated with depression and anxiety in individuals with Von Willebrand disease (VWD) aged ≥12 years.

METHODS

The study collected data on patients' sociodemographic, joint problems and health-related quality of life (HRQoL) using EQ-5D-3L, 8-item patient health questionnaire for depression and 7-item Generalized Anxiety Disorder Questionnaire from participants in seven geographically diverse US haemophilia treatment centres.

RESULTS

Analyses included 77 participants. The rates of depression and anxiety were 63.6% and 58.3%, respectively. Persons with low VWF displayed higher rates of depression (86.7%) or anxiety (69.2%) compared to those with VWD (58.1%, p = .04 for depression, and 55.9%, p = .38 for anxiety). Logistic regression analyses demonstrated that having joint problems (odds ratio [OR] = 6.3, confidence interval [CI] = 2.0-20.1) was the most important variable associated with depression, followed by being single, divorced, widowed, or separated in adult participants or parents of participants age < 18 years (OR = 7.0, CI = 1.7-29.0. The most important variable associated with anxiety was being single or lacking a partner (OR = 10.8, CI = 2.5-47.5), followed by age 12-17 years old (OR = 6.7, CI = 1.6-26.9), or having worse health compared to 3-months ago (OR = 12.3, CI = 1.3-116.2). Mean covariates adjusted EQ visual analogue scale score was significantly lower among persons with depression (68.77 ± 3.15 vs. 77.58 ± 4.24, p = .03) than those without depression.

CONCLUSIONS

Our study revealed concerning levels of depression and anxiety in this VWD sample. Lack of social support was determined an important factor associated with depression and anxiety in this sample. Mental health screening is critical in VWD clinical evaluation and care.

COVID-19-associated mental health impact on menstruation physiology: A survey study among medical students in Jordan

BACKGROUND

The coronavirus disease 2019 pandemic has been an extraordinarily stressful situation in recent years. Stress is a physiological reaction to negative stimuli that is regulated by different neuroendocrine pathways. The female reproductive function is maintained by the menstrual cycle, which is negatively affected by hyperstimulation of stress signals.

OBJECTIVES

This study evaluates the effect of the coronavirus disease 2019 outbreak on menstrual function and mental health, exploring the relationship between them.

DESIGN

The current study uses a cross-sectional, survey-based design.

METHODS

During this cross-sectional study, an online self-completion questionnaire was conducted among a sample of 385 Jordanian female medical students during the pandemic. The survey compared menstrual characteristics, depression, anxiety, and stress 10 months after the coronavirus disease 2019 pandemic with 10 months prior. Paired t-test, McNemar's test, Pearson's correlation, and multiple linear regression model were employed to analyze data using SPSS software.

RESULTS

The mean age of female medical student respondents was 19.89 years. Data showed that the menstrual cycle length significantly increased during the coronavirus disease 2019 pandemic compared with 10 months prior (32.23 days versus 30.02 days, p = 0.019). The average number of heavy bleeding days also increased during the coronavirus disease 2019 pandemic (2.82 days versus 2.42 days, p = 0.002). The proportion of females with heavy bleeding amount was more than doubled during the pandemic of coronavirus disease 2019 compared with before (27.3% versus 10.4%, p = 0.000). Unpleasant menstrual signs such as nausea and/or vomiting, breast pain, and urinary urgency were significantly increased during the pandemic (p = 0.000, p = 0.008, and p = 0.024, respectively). During coronavirus disease 2019, a positive association between total Depression, Anxiety, and Stress Scale-21 Questionnaire score and heavy bleeding was identified (p < 0.05). The findings also indicated that mental disorders and the incidence of amenorrhea, nausea and/or vomiting, and urinary urgency were positively correlated during the coronavirus disease 2019 pandemic. The multiple regression analysis revealed associations between several menstrual characteristics such as amenorrhea and severity of bleeding with coronavirus disease 2019-related depression, anxiety, and stress.

CONCLUSION

This study revealed that the stress related to the pandemic of coronavirus disease 2019 could affect the female menstrual cycle and hence the quality of women's life. Therefore, this study could serve as a baseline for planning and introducing stress mitigation interventions in crisis situations to improve the physiological and mental well-being of females and improve their quality of life.

Depression, Anxiety, Stress, and Sexual Satisfaction in Couples

Sexual satisfaction is an important concept in relationships contributing to psychological general well-being. The present study examined dyadic associations between mental health variables, particularly depression, anxiety, and stress, and sexual satisfaction. Using data of 102 heterosexual married couples from Turkey (mean age = 30.06 years), we sought to investigate whether a person's depression, anxiety, and stress were associated with his or her own as well as the partner's sexual satisfaction. Actor-Partner Independence Model (APIM) analysis revealed that husbands' anxiety and stress were associated with their own sexual satisfaction and husbands' depression was associated with both their own and the wives' sexual satisfaction. Wives' depression and stress were associated with their own sexual satisfaction but not with the satisfaction of their husbands. Additionally, wives' anxiety was not neither associated with their own nor their husbands' sexual satisfaction.

The Association between Marital Status and Outcomes of Patients Hospitalized with Heart Failure

BACKGROUND

Little is known about the association between marital status and long-term outcomes of patients hospitalized with heart failure (HF). We aimed to examine the association between marital status and early as well as long-term outcomes of patients hospitalized with HF.

METHOD

We analyzed data of 4089 patients hospitalized with HF and were enrolled in the multicenter national survey in Israel between March and April 2003 and were followed until December 2014. Patients were classified into married (N = 2462, 60%) and unmarried (N = 1627, 40%).

RESULTS

Married patients were more likely to be males, younger, and more likely to have past myocardial infarction and previous revascularization. Also, they tended to have higher rates of diabetes mellitus (DM) and dyslipidemia, as well as smokers. Survival analysis showed that unmarried patients had higher mortality rates at 1 and 10 years (33% vs. 25%, at 1 year, 89% vs. 80% at 10 years, all p < 0.001). Consistently, multivariable analysis showed that unmarried patients had independently 44% and 35% higher risk of mortality at 1- and 10-year follow-up respectively (1-year HR = 1.44; 95%CI 1.14-1.81; p = 0.002, 10-year HR = 1.35; 95%CI 1.19-1.53; p ≤ 0.001). Other consistent predictors of mortality at both 1- and 10-year follow-up include age, renal failure, and advanced HF.

CONCLUSIONS

Being unmarried is independently associated with worse short- and long-term outcomes, particularly among women. Thus, attempts to intensify secondary preventive measures should focus mainly on unmarried patients and mainly women.

Sociodemographic Factors and Depressive Symptoms Among Cardiac Nurses: A Cross-Sectional Study

Background: The nursing profession is predisposed toward depressed mood and depressive symptoms. The multidirectionality and intensity of stressors in the nurses' occupational environment are of great significance in this respect. The study aimed to evaluate the impact of selected sociodemographic factors on depressive symptoms among cardiac nurses.

Methods: This cross-sectional study included 336 cardiac nurses (302 women and 34 men) and was conducted between December 2019 and September 2020 in four hospital cardiac units in Wroclaw, Poland. Sociodemographic data were collected using a self-developed survey. The following standardized instruments were used for the study outcomes: Patient Health Questionnaire-9 (PHQ-9) and Beck Depression Inventory (BDI).

Results: The study among cardiac nurses showed mild depression in 11.61%, moderate depression in 5.06%, and severe depression in 2.68%. Linear regression models showed that significant (p < 0.05) predictors of the PHQ-9 score included (1) higher occupational education (bachelor's degree), graduation “only” from medical high school or “other” education; (2) work experience of 16–20 years; (3) living in a relationship; (4) living in a rural area. Linear regression models showed that significant (p < 0.05) predictors of the BDI score included (1) higher occupational education (bachelor's degree); (2) graduation “only” from medical high school or “other” education; (3) living in a relationship.

Conclusions: Depressive symptoms are a significant problem among Polish cardiac nurses. The prevalence of depressive symptoms is affected by the education level, employment form, marital status, and place of residence.

Evaluating the Continued Integration of Genetics into Medical Sociology

The 2010 special issue of Journal of Health and Social Behavior, titled "Fifty Years of Medical Sociology," defined the contours of the medical sociological perspective. We use this as a backdrop to outline and assess the continued integration of genetics into medical sociology research. We contend that the explosion of genetic and epigenetic data in population health data sources has made the medical sociological perspective increasingly relevant to researchers outside of sociology, including public health, epidemiology, and quantitative genetics. We describe vast, underappreciated, and mostly unsolved challenges that limit the scientifically appropriate interest in incorporating genetics into existing paradigms. It is our hope that medical sociologists continue this integration but redouble efforts to maintain the core insights in social science research, such as the importance of environmental and structural (i.e., nonbiological) factors in determining health processes and outcomes and the use of rich, integrated, and rigorous empirical analyses.

"Anti-COVID-19" Medications, Supplements, and Mental Health Status in Indonesian Mothers with School-Age Children

Purpose

The COVID-19 pandemic affects all aspects of life and might cause stress for vulnerable groups such as mothers with school-age children, both housewives and working mothers. With the uncontrolled circulating information about medications, supplements, and herbs that are believed to treat COVID-19, self-medication and misused might escalate. Therefore, this study aims to determine the consumption of "anti-COVID" agents and the mental health of mothers with school-age children in Indonesia.

Methods

Online questionnaires regarding medications/supplements for COVID-19 prevention and treatment of "anti-COVID" consumption behavior and mental health using the Depression, Anxiety, and Stress Scales (DASS-21) were distributed among Indonesian mothers with school-age children. Data (n = 610) were analyzed; descriptive and association between sociodemographic factors, "anti-COVID" medications consumption, and mental health were presented.

Results

A quarter of the respondents were categorized as having mental disorders, with higher scores of DASS-21 was higher in the housewives' group. The incidence associated with age, family expenses, and marital status in the working mothers' group, and only with family expense in the housewives' group. Moreover, the result showed 80% of the respondents consumed "anti-COVID" medications or supplements to prevent COVID-19, with 75% did self-medication without consulting with a healthcare professional. Friends/family and social media were two primary sources of information regarding the "anti-COVID" products. In the housewives' group, their consumption behavior was influenced by education. Meanwhile in the working mothers' group, the consumption behavior was influenced by age, family income, and family expense. In addition, there was no association between the usage of medications/supplements with the respondents' mental health status.

Conclusion

This study showed the importance of controlling information and expanding the mother's knowledge to find the correct information to minimize the unwanted effect in the post COVID-19 pandemic. Increasing awareness of mental health issues in the community, especially in the vulnerable population such as mother with school-age children, is necessary to avoid detrimental effects that might occur in the future.

Perceived Stress in a Gender Perspective: A Survey in a Population of Unemployed Subjects of Southern Italy

Stressful life events, are differently handled by women and men. This study evaluates gender differences in perceived stress and health status among a sample of subjects going through a transition period from unemployment to work. This cross-sectional study enrolled 395 participants, 245 men (62%) and 150 (38%) women, between 19 and 67 years, that were going to be hired for a 6-month contract. Before being employed, all participants underwent a mandatory protocol consisting in a general medical check. Stress assessment was performed by using the Perceived Stress Scale (PSS). Most of the participants (68%) showed normal to low perceived stress level. But dividing the sample by gender, out of the remaining 32% with medium to high stress level, 11% male subjects and 22.7% females reported high perceived stress values. We found mean PSS values that are overlapping with those in the general population of developed countries. This study does not suggest an association between perceived stress and health or social parameters. However, our results highlight that the female gender is associated with higher stress level, pointing out the relevance of specific and designed interventions in the context of health promotion programs, especially in order to mitigate stress in more susceptible subjects.

The effects of marital status on outcome of heart failure population: a systematic review and meta-analysis

BACKGROUND

Traditional risk factors for worse outcome in heart failure (HF) are well-established. However, there are still many unknown risk factors for worse outcome in this population. Several studies have shown that unmarried status is associated with an increased risk of rehospitalization and mortality in HF patients. However, there is no systematic review or meta-analysis to confirm this association. We performed a systematic review and meta-analysis to explore the effect of marital status on outcome regarding mortality and rehospitalization in HF population.

METHODS

We searched the databases of MEDLINE and EMBASE from inception to July 2019. Included studies were published cohort studies or randomised controlled trials reporting rates of mortality and/or rehospitalization in HF patients, married and unmarried. Data from each study were combined using the random-effects model.

RESULTS

Ten studies were included in our meta-analysis. We found that unmarried status is associated with increased risk of mortality (pooled OR = 1.52, 95%CI = 1.30-1.78, p < .001), increased risk of rehospitalization (pooled OR = 1.80, 95%CI = 1.18-2.74, p = .007), and increased risk of combined endpoint of mortality and rehospitalization (pooled OR = 1.72, 95%CI = 1.36-2.17, p < .001).

CONCLUSIONS

Our meta-analysis demonstrated that being unmarried, divorced, and widowed is associated with a worse outcome in HF population regarding mortality and rehospitalization rate.

Examining the association between family status and depression in the UK Biobank

BACKGROUND

We examined associations between family status (living with a spouse or partner and number of children) and lifetime depression.

METHODS

We used data from the UK Biobank, a large prospective study of middle-aged and older adults. Lifetime depression was assessed as part of a follow-up mental health questionnaire. Logistic regression was used to estimate associations between family status and depression. We included extensive adjustment for social, demographic and other potential confounders, including depression polygenic risk scores.

RESULTS

52,078 participants (mean age = 63.6, SD = 7.6; 52% female) were included in our analyses. Living with a spouse or partner was associated with substantially lower odds of lifetime depression (OR = 0.67, 95% CI 0.62-0.74). Compared to individuals without children, we found higher odds of lifetime depression for parents of one child (OR = 1.17, 95% CI 1.07-1.27) and parents of three (OR = 1.11, 95% CI 1.03-1.20) or four or more children (OR = 1.27, 95% CI 1.14-1.42). Amongst those not cohabiting, having any number of children was associated with higher odds of lifetime depression. Our results were consistent across age groups, the sexes, neighbourhood deprivation and genetic risk for depression. Exploratory Mendelian randomisation analyses suggested a causal effect of number of children on lifetime depression.

LIMITATIONS

Our data did not allow distinguishing between non-marital and marital cohabitation. Results may not generalise to all ages or populations.

CONCLUSIONS

Living with a spouse or partner was strongly associated with reduced odds of depression. Having one or three or more children was associated with increased odds of depression, especially in individuals not living with a spouse or partner.

Perceived Stress and its Epidemiological and Behavioral Correlates in an Urban Area of Delhi, India: A Community-Based Cross-Sectional Study

BACKGROUND

Increasing stress has been recognized as a major public health problem in the developing world accelerated by an ongoing demographic, economic, and sociocultural transition. Our study objectives were to validate a Hindi version of the 10-item Perceived Stress Scale (PSS-10) and to also assess the extent of perceived stress and its correlates among an adult population in an urban area of Delhi.

METHODOLOGY

A community-based cross-sectional study was conducted in an urban resettlement colony of Delhi among 480 adult subjects aged 25--65 years, during the period from January to December 2015. The PSS-10 was translated into Hindi and validated in the study population. Data was analyzed using IBM SPSS Version 25.

RESULTS

A total of 243 (50.6%) men and 237 (49.4%) women were enrolled. The scale had an acceptable level of internal consistency (Cronbach's alpha = 0.731). A principal component analysis was run on the PSS-10 data, based on which a three-component structure was accepted, which explained 61% of the total variance. The mean PSS score was 19.25 (SD = 4.50) years. Perceived stress was highest in the 35--50 age group. On multivariate analysis, low socioeconomic status and a white-collar occupation were found to be associated with increased perceived stress (P < 0.001).

CONCLUSION

A high burden of perceived stress exists in residents of a low-income urban population in India.

Perceived stress and depression amongst older stroke patients: Sense of coherence as a mediator?

OBJECTIVE

This study aimed to explore the relationship between perceived stress, sense of coherence, and depression among older stroke patients.

METHODS

A demographic questionnaire, the Perceived Stress Scale (PSS), the Sense of Coherence Scale (SOC) and the Center for Epidemiologic Studies Depression Scale (CES-D) were distributed to 3000 older stroke patients from Neurology wards in six large general hospitals, and 2907 individuals completed the survey. Data analysis consisted of correlation, multiple linear regression, and structural equation modeling.

RESULTS

The total score of the SOC and perceived stress showed a negative correlation (r = -0.80, P ＜ 0.01), the total SOC of coherence and depression also resulted in a negative correlation (r = -0.77, P ＜ 0.01), and the total score of the perceived stress and depression resulted in a positive correlation (r = 0.82, P ＜ 0.01). The results of multiple regression analyses indicated that SOC mediated the association between perceived stress and depression, and the influence of perceived stress on depression was decreased by 16.0%with in the sense of being out of control dimension and was decreased by 12.3% within the feeling of tension dimension when sense of coherence was added to the model. The structural equation model confirmed that the sense of coherence had a partial mediation effect between perceived stress and depression.

CONCLUSION

SOC is the mediating variable between perceived stress and depression, and can reduce the influence of perceived stress on depression.

"We are Two of the Lucky Ones": Experiences with Marriage and Wellbeing for Same-Sex Couples

Happy marriages provide protective health benefits, and social support is a key factor in this association. However, previous research indicates one of the greatest differences between same- and different-sex couples is less social support for same-sex couples. Our goal was to examine the extent to which formal markers of couple status (e.g., marriage) impact wellbeing among same-sex married partners. Using a mixed-methods approach, data were collected from 218 primarily White gay and lesbian individuals in the Midwest. Quantitative analysis revealed individuals in a prior formal union with a different-sex partner reported the lowest levels of sexuality specific social support and acceptance. Qualitative analysis revealed four primary impacts of marriage on support from family, friends, and co-workers: no change, increased support, decreased support, and a synthesis of mixed support. Three mechanisms prompting change in the family were identified and are presented.