The relationship between depressive mood and subjective health in centenarians and near-centenarians: a cross-sectional study from Korean centenarian cohort

BACKGROUND

With the rapid increase in population longevity, more clinical attention is being paid to the overall health of long-lived people, especially centenarians. Subjective health, which is the perception of one's health status, predicts both mortality and declining physical function in older adults. The purpose of this study was to investigate the factors related to subjective health among centenarians and near-centenarians (ages ≥95) living in a rural area of South Korea.

METHODS

A total of 101 participants were enrolled from four different regions (Gurye, Gokseong, Sunchang, and Damyang), known as the Longevity Belt in Korea. Variables assessing physical and mental health, including the results of blood tests, were examined. Factors associated with good subjective health were identified with logistic regression analysis.

RESULTS

Fifty-six participants (59.6%) were subjectively healthy among the centenarians and near-centenarians. Logistic regression analysis revealed that depressive mood was the only factor associated with subjective health and was negatively correlated. The regression model explained 39% of the variance in subjective health.

CONCLUSIONS

These findings emphasize the importance of mental health at very advanced ages. Because depressive mood negatively correlates with subjective health, more attention is needed to prevent and manage mood symptoms of people of advanced ages, including centenarians.

Self-reported Versus Physician-reported Severity of Chronic Hand Eczema: Concordance Analysis Based on Data from the German Chronic Hand Eczema Patient Long-Term Management Registry

Self-assessment of general health status has a significant influence on patient-related outcomes. The aims of this study were to investigate and compare the level of agreement between patients' and dermatologists' assessments of the severity of chronic hand eczema. From the German registry "German Chronic Hand Eczema Patient Long-Term Management Registry" (CARPE), 1,281 pairs of patients with chronic hand eczema and their dermatologists were included. Of these, 788 pairs served as a comparison 2 years after baseline. Concordance analyses found that complete concordance between patients' and dermatologists' assessments were 16.62% at baseline and 11.47% at follow-up. Overall, patients assessed their chronic eczema at baseline as more severe than did the dermatologists; whereas, at follow-up, patients assessed their condition as less severe than the dermatologists' assessment. Bangdiwala's B showed lower values of concordance for womens' and older patients' self-assessment with the dermatologists' assessments. In conclusion, dermatologists should consider the patient's perspective and the individual's assessment of their chronic hand eczema in order to provide effective care in clinical practice.

Determinants of Self-Perceived Health: The Importance of Physical Well-Being but Also of Mental Health and Cognitive Functioning

With life expectancy increasing for the general population, public health promotion activities should be a priority to aim at a reduction of the burden and costs of hospitalization, disability, and lifelong treatment. This study aimed to explore the influence of parameters pertaining to different aspects of well-being, including physical and mental health and cognitive functioning, on self-perceived health, a predictor of chronic disease prevalence and mortality. We used data from the Survey of Health, Aging and Retirement in Europe (SHARE) project gathered between 2013 and 2017, obtaining a sample of 96,902 participants (63.23 ± 6.77 years). We found a strong association between the self-perceived health rating and not only physical health aspects but also mental health and cognitive functioning. In particular, BMI, chronic diseases and medications, muscle strength, and mobility issues had a strong effect on self-perceived health, as also did the quality of life, depression, and verbal fluency, while other aspects, such as individual characteristics, limitations in daily activities, and pain, among others only had a small effect. These results show that public health and prevention interventions should prioritize the targeting of all aspects of well-being and not only of physical health, acknowledging self-perceived health rating as a simple tool that could help provide a complete overview of psycho-physical well-being and functional status.

Can leisure and entertainment lifestyle promote health among older people living alone in China?-A simultaneous equation approach

Objectives

With the surging number of older people living alone, their lifestyles and health status have aroused increasing concern. This study aims to investigate whether a leisure and entertainment lifestyle (LEL) can improve the multidimensional health among older people living alone and try to identify the latent mechanisms among them.

Method

For this purpose, we extracted data from the Chinese General Social Survey (CGSS) and established a simultaneous equations model, comprising ordinary least square regression (OLS), two-stage least squares (2SLS), and the mediating effect model.

Results

Older people living alone in China reported relatively better mental health status (3.64 ± 1.07), followed by physical health (3.41 ± 1.26) and social health (2.75 ± 1.18). In the OLS model, LEL significantly improved the social health of older people living alone (β = 0.054, P < 0.01), followed by physical health (β = 0.042, P < 0.01) and mental health (β = 0.027, P < 0.01). After endogenous tests from 2SLS model and robustness tests, we found that more active LEL was associated with higher levels of physical health and mental health. However, LEL had no significant effect on the improvement of the social health of the older people living alone. Using the mediation analysis, exercise efficacy partially mediated the relationship of LEL with physical health and mental health, and the ratios were 19.75 and 24.85%, respectively. Similarly, positive life attitudes partially mediated the relationship between LEL and physical health, and LEL and mental health, with ratios of 10.65 and 26.83%, respectively.

Conclusion

Our findings suggested that LEL is significantly associated with better physical and mental health for older people living alone in China, and the association is mediated by exercise efficacy and positive attitudes toward life. Promoting more leisure and recreational activities, upgrading exercise efficacy, and encouraging positive life attitudes are necessary health promotion measures in active aging policies for the wellbeing of older people living alone.

Friendship in Later Life: Thirty Years of Progress and Inequalities

Studies examining the impact of social change on individual development and aging postulate the growing importance of flexible relationships, such as friendship. Although friendship is well known as a factor of well-being in later life, the prevalence of friendship in older adult networks and its unequal distribution has been examined only in few studies. Through secondary data analysis of two cross-sectional surveys carried out in Switzerland in 1979 and 2011, respectively, the increasing presence of close friends was confirmed. Our results show that this trend was part of a broader lifestyle change after retirement, with increasing social engagements. However, this trend does not include a general decrease in social inequalities in friendship opportunities. Overall, friendship increase among older adults has contributed to a polarization of living conditions, with a majority of active, healthy persons contrasting with a minority of individuals who accumulate penalties.

Assessing the Validity of Self-rated Health Across Ethnic Groups: Implications for Health Disparities Research

OBJECTIVES

This study examines the association between morbidity (i.e., chronic health conditions) and self-rated health (SRH) with the aim of testing the within-group and across-group validity of SRH across nine ethnic groups: non-Latinx White, Mexican, Puerto Rican, Cuban, African American, Afro-Caribbean, Chinese, Filipino, and Vietnamese Americans. In addition, we assess whether acculturation (i.e., nativity, years of US residency, language of interview) and health-related factors (e.g., mental disorder) account for ethnic distinctions in SRH.

DESIGN

Data are from the National Survey of American Life (NSAL) and the National Latino and Asian American Study (NLAAS) (N = 8338). Weighted proportions and means for SRH and chronic conditions are reported. Ordered logistic regression analysis is used to determine ethnic group patterns in SRH.

RESULTS

Despite evidence of within-group validity of SRH for each ethnic group, our results seriously challenge the across-group validity of SRH. For example, Chinese and Vietnamese respondents report lower SRH despite having fewer chronic conditions relative to non-Latinx Whites. Moreover, Mexican Americans report fewer chronic health problems but lower SRH compared to non-Latinx Whites. Acculturation factors (e.g., language of interview) partially explain the Mexican-White difference in SRH. Among Chinese Americans, completing an interview in English is associated with higher SRH relative to those who completed an interview in Chinese.

CONCLUSION

These findings have implications for health disparities research that uses SRH as the dependent measure. Studies that compare the health profiles of diverse ethnic groups should use the SRH measure with caution, as SRH does not align with ethnic patterns of morbidity.

The Hispanic Paradox: A Moderated Mediation Analysis of Health Conditions, Self-Rated Health, and Mental Health among Mexicans and Mexican Americans

This study investigates how mediating (e.g. history of health conditions) and moderating (e.g. self-rated health) factors are associated with nativity status on depression and anxiety in Mexican immigrants. Using data from the 2019 National Health Interview Survey (NHIS), results found a significant direct association between nativity status and anxiety and depression. Additionally, the association between nativity status and mental health was mediated by the history of health conditions, and self-rated health was a significant moderator in both mediation models. Study findings are discussed within the context of barriers to care, current literature, and strengths-based interventions. Future research can expand upon these findings by examining the specific types of physical and mental health conditions that may support the Hispanic Paradox, as well as how self-efficacy and internal locus of control are associated with the paradox within this population.

Factors affecting subjective health of child-rearing-aged Japanese adults, considering the effect of healthy life expectancy: A cross-sectional study

Objectives:

The extension of healthy life expectancy is an important policy issue in Japan. This study aimed to clarify the association between subjective health and healthy life expectancy and identify the factors that improve subjective health of child-rearing-aged adults in Japan.

Methods:

A cross-sectional study was conducted. We used data from 2718 participants of the Japanese General Social Survey 2009 Life Course Study. The mean age was 35.5 ± 4.10 years, and 56% were female. Multivariate logistic regression analysis was performed on subjective health, which was treated as a binary variable when calculating healthy life expectancy as an objective variable. The predictors were gender, age, marital status, number of family members living in the home, household income, mental health score, age of youngest child, and the person from whom one seeks help. The prefecture where the participants resided was treated as a control variable.

Results:

There was no association between individual subjective health and healthy life expectancy. Mental health score (measured by the Mental Health Inventory-5, MHI-5) was significantly associated with subjective health. With a MHI-5 score of ⩽ 10 points as the reference criterion, as the score increased, the odds ratio of subjective health increased, and for MHI-5 scores ⩾ 16 points, odds ratio was 14.14 (confidence interval: 7.57–26.38).

Conclusion:

Among the child-rearing-aged adults, prefectural healthy life expectancy was not associated with individual subjective health. Mental health was significantly associated with subjective health and may be underestimated in calculating healthy life expectancy.

Depressive Symptomology, Identity and Religious Practices among Catholics and Evangelicals: Differences between the Mapuche and Non-Indigenous Chilean Population

Background: Chile is a highly religious country. Although a majority of the population describes itself as Catholic, there has been a substantial growth in Evangelism, especially among indigenous people. In this context, the aim of this study is to analyse the relationship between Catholic and Evangelical religiosity in terms of identity and practices and depressive symptoms in the Mapuche and non-indigenous Chilean population. Methods: The study was conducted using secondary data from the Longitudinal Intercultural Relations Study of 2017, estimating linear regressions to explain variations on the PHQ-9 scale between the adult Mapuche and non-indigenous Chilean population by first including the controls variables, followed by religious identification, churchgoing, and prayer. Results: Social support, good health, and age showed a negative association with PHQ-9 in both groups. Being a woman and not having a partner were only positively related with depression in the non-indigenous group. A negative association was found between Evangelical religious identity and depressive symptoms among the Mapuche population, while churchgoing was negatively associated and prayer was positively associated with depression in the non-indigenous group. Conclusions: The findings confirm that religiosity is a protective factor against depressive symptomology in the Chilean population. However, the analysis reveals significant ethnic differences.

Autoavaliação ruim do estado de saúde: prevalência e fatores associados em mulheres privadas de liberdade

Resumo Objetivo Verificar a prevalência da autoavaliação ruim do estado de saúde em mulheres encarceradas e analisar os fatores associados. Método Trata-se de estudo transversal, realizado entre os anos de 2019 e 2020, por meio de censo, com participação de 99 mulheres. A análise dos fatores associados ao desfecho foi conduzida a partir de um modelo teórico de determinação com três blocos hierarquizados de variáveis. As variáveis foram ajustadas entre si dentro de cada bloco. Aquelas com nível de significância ≤ 0,20 foram incluídas no modelo de regressão de Poisson e ajustadas ao nível superior ao seu, considerando o nível de 5% de significância. Resultados A prevalência da autoavaliação ruim da saúde foi de 31,3% (IC95% = 22,8%–40,9%). Morbidade referida, presença de sintomas de ansiedade e a pior perspectiva em relação às condições de saúde pós-encarceramento foram as variáveis associadas com o desfecho. Considerações finais e implicações para a prática Os fatores associados à ocorrência do evento investigado poderão direcionar medidas que visem à redução dos impactos à saúde durante o período de encarceramento.

"Dedicated to being healthy": Young adults' deployments of health-focused cultural capital

Performances of "health" through diet, exercise, and body size are an increasingly important form of cultural capital transmitted to children. Yet less is known about how socioeconomically privileged young people internalize and deploy that capital or how those less privileged manage their relative lack of capital. How does health-focused cultural capital acquired in childhood shape socioeconomic inequalities, health behaviors, and understandings of health in young adulthood? Our analysis of 113 interviews found that health-focused cultural capital acquired in early life reinforced young adults' socioeconomic and health advantages by helping them claim discipline and morality on the basis of their health behaviors and body size. Two key phenomena tended to be present among our many socioeconomically privileged but not our fewer less privileged participants: family socialization into classed diet- and exercise-related health behaviors resulting in a classed appearance of health (despite less-than-ideal behaviors), and cohesive life course narratives linking these behaviors to hard work and moral worth. Less socioeconomically privileged participants' understandings of health and healthy behaviors were different, rarely linking health to worthiness and discipline. To understand the intergenerational transmission of socioeconomic attainment and health in US society, we must consider how behaviors and group-based norms, identities, and understandings of health coalesce in classed health lifestyles that convey cultural capital.

Migration and Health—Freedom of Movement and Social Benefits for Chinese Migrant Workers

This study utilized the concept of social right to understand factors affecting migrant workers’ health and healthcare in China. Using mixed methods, this study integrated findings from a survey of 817 migrant workers and a follow-up study of 30 intensive interviews to present an in-depth understanding of cumulative disadvantage of health and healthcare of rural-to-urban migrant workers. Our quantitative results indicated that migrant workers with no more than 5 years of working experience and having a good relationship with employers were 65% and 72.8% more likely to report good self-rated health as compared to their counterparts; those with work-related injury experience and low income were 41.6% and 53.6% less likely to report good self-rated health. Qualitative findings revealed the social contexts of the cumulative effect of the length of work experience and fear of medical cost on migrant workers’ declining health. Even though the participation rate for health insurance in China is reported to be over 99%, the lack of portability in health insurance and different reimbursement rates in health care access are structural barriers in health-seeking behaviors among Chinese migrant workers and in establishing sustainability in China’s healthcare system. This study adds to the literature by delineating the process of the unequal access to social rights in general, healthcare in particular as the major explanation for migrant workers’ poor health beyond the surface of China’s universal healthcare.

Black-White disparities in women's physical health: The role of socioeconomic status and racism-related stressors

Black women have elevated rates of multiple physical illnesses and conditions when compared to White women - disparities that are only partially explained by socioeconomic status (SES). Consequently, scholars have called for renewed attention to the significance of racism-related stress in explaining Black-White disparities in women's physical health. Drawing on the biopsychosocial model of racism as a stressor and the intersectionality perspective, this study examines the extent to which SES and racism-related stressors - i.e., discrimination, criminalization, and adverse neighborhood conditions - account for disparities in self-rated physical health and chronic health conditions between Black and White women. Results indicate that Black women have lower SES and report greater exposure to racism-related stressors across all domains. Moreover, I find that SES and racism-related stressors jointly account for more than 90% of the Black-White disparity in women's self-rated physical health and almost 50% of the Black-White disparity in chronic health conditions. Theoretical and policy implications of these findings are discussed.

Contribution of travel participation to social integration and life satisfaction after spinal cord injury

BACKGROUND

Research has found that participation in travel declines for people after spinal cord injury (SCI) because the traumatic injury usually results in impaired physical mobility and sensation, and barriers in the environment make travel more challenging. While travel participation can offer numerous physical, psychological, and emotional benefits, empirical evidence on positive outcomes of travel for people after SCI is scarce in the literature.

OBJECTIVE

To empirically examine the effects of travel participation on social integration and life satisfaction for people with SCI, along with other personal characteristics including income, self-perceived health status, levels of physical independence, occupational activities, and travel barriers.

METHODS

Cross sectional data are collected from 250 patients enrolled in a SCI Model System. Hierarchical regression analyses, followed by mediation analyses, are conducted to assess the effects of travel participation on social integration and life satisfaction.

RESULTS

Travel participation along with occupational activities is shown to significantly impact social integration, with participation in occupational activities partially mediating the relation from travel participation to social integration. The significant effect of travel participation on life satisfaction is fully mediated by social integration. Income and self-perceived health status both significantly contribute to social integration and life satisfaction.

CONCLUSIONS

Travel participation should be considered as an independent domain that directly impacts the social integration of people with SCI, which in turn enhances their life satisfaction. Systematic interventions with standard protocols for travel-related skill training and assessments procedures are needed for people after SCI.

Impacts of Social Participation on Self-Rated Health of Aging Women in China: With a Mediating Role of Caring for Grandchildren

Population aging is a global challenge and the degree of population aging is continuing to deepen in China. Under the active aging policy framework by WHO, great importance has been attached to aging women and participation is emphasized for the well-being of the elderly. This study aimed to investigate the relation between social participation and self-rated health status of aging women in China and whether caring for grandchildren mediated such an association. Adopting data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), this study used Oprobit regression, propensity score matching (PSM), and instrument variable regression to estimate the effects. The result showed that there was a positive association between social participation and self-rated health among aging women in China, and social activities that directly made contributions to others had the most significant impacts on self-rated health. Furthermore, the mediator analysis confirmed that caring for grandchildren played a role between social participation and self-rated health. In conclusion, to deal with population aging challenges, the society should recognize the value of intergenerational care for aging women and the government need to strengthen policy supports to guarantee platforms and opportunities for the elderly to participate in social activities.

Unequal Returns of Employment on Self-Rated Health: Asian-White Differences

BACKGROUND

Previous research has shown that employment status is one of the most powerful socioeconomic resources utilized to promote health and well-being. However, racial and ethnic minorities often experience diminished returns of socioeconomic resources compared to non-Hispanic Whites. This analysis explores the association between employment status and self-rated health among Asians and non-Hispanic Whites, and whether race or ethnicity moderates this association.

METHODS

We used data from the 2016 National Asian American Survey, a nationally representative survey of Asians from ten ethnic backgrounds. We measured the association between employment status and self-rated health, using race and ethnicity as the primary moderators. Age, gender, income, education, nativity status, and English proficiency were used as controls. Pooled (by race) and stratified (by ethnicity) logistic regressions were estimated.

RESULTS

The pooled logistic regressions showed that employment was associated with lower odds of poorer self-rated health among Asians and Whites. Race, however, moderated this relationship, indicating a stronger protective effect of employment for Whites. In the stratified logistic regressions, employment was not associated with lower odds of poorer self-rated health across all of the assessed Asian ethnic subgroups. Ethnicity moderated the association between employment and self-rated health, suggesting a stronger protective effect of employment for Whites than for Chinese, Hmong, Koreans, Japanese, and Filipinos.

CONCLUSION

The protective health benefits of employment do not operate the same for Whites and Asians. Discrimination and unequal labor market and working conditions may weaken the positive health returns of employment for Asians compared to their White counterparts.

Self-Rated Health and Subjective Economic Status in Life Satisfaction among Older Chinese Immigrants: A Cross-Sectional Study

This study examines the influence of self-rated health and subjective economic status on the life satisfaction of older Chinese immigrants in the United States. Data were obtained from a cross-sectional survey of 205 older Chinese immigrants aged 66 to 90 years living in Los Angeles and Honolulu. Ordinary Least Squares (OLS) regression analysis was employed to explore the independent effects of self-rated health and subjective economic status. The results demonstrated that self-rated health and subjective economic status were positively associated with life satisfaction. This cross-sectional study provides empirical evidence that self-rated health and subjective economic status are directly associated with subjective life satisfaction among older Chinese immigrants.

Integrating a diet quality screener into a cardiology practice: assessment of nutrition counseling, cardiometabolic risk factors and patient/provider satisfaction

Objective

We assessed factors related to the integration of an office-based diet quality screener: nutrition counselling, cardiometabolic risk factors and patient/physician satisfaction.

Methods

We evaluated the impact of a 10-item diet quality measure (self-rated diet quality question and a 9-item Mediterranean Diet Score (MDS)) prior to the cardiology visit on assessment of nutrition counselling, cardiometabolic risk factors and patient/provider satisfaction. Study staff trained the nine participating physicians on the purpose and use of the screener. To assess physician uptake of the diet quality screener, we reviewed all charts having a documented dietitian referral or visit and a 20% random sample of remaining participants that completed the screener at least once to determine the proportion of notes that referenced the diet quality screener and documented specific counselling based on the screener.

Results

Between December 2017 and August 2018, 865 patients completed the diet quality screener. Mean age was 59 (SD 16) years, 54% were male and mean body mass index was 27.4 (SD 6.0) kg/m². Almost one-fifth (18.5%) of participants rated their diet as fair or poor, and mean MDS (range 0–9) was moderate (mean 5.6±1.8 SD). Physicians referred 22 patients (2.5%) to a dietitian.

Conclusion

Integrating the screener into the electronic health record did not increase dietitian referrals, and improvements in screener scores were modest among the subset of patients completing multiple screeners. Future work could develop best practices for physicians in using diet quality screeners to allow for some degree of standardisation of nutrition referral and counselling received by the patients.

Self-reported health and the social body

Since the strong predictive power of self-reported health (SRH) for prospective health and social outcomes has been established, researchers have been in a quest to build a theoretical understanding of this widely used health measure. Current literature based predominantly in a biomedical perspective asserts a linear relationship between physical conditions and perception of health. Discrepancies from this expected relationship are considered an important weakness of SRH. Systematic discrepancies between physical conditions and reporting of SRH have been documented across different socio-economic groups. Evidence identified for educational groups shows that for the same level of health status, lower-educated groups report poorer levels of perceived health. This raised doubts whether it is useful to use SRH to measure social inequalities in health within and between countries. To date, sociologists of health have not engaged in the discussion of reporting heterogeneity in SRH. After reviewing existing evidence, we contend that the discrepancy in SRH reporting across social groups argued to be a weakness of SRH as a health measure is a strength from a sociological perspective. SRH as a social measure of health is a better predictor than objective measures of health precisely because it captures the lived experience of the embodied agent.

Comparing the differences in three measures of healthy life expectancy among prefectures in Japan

OBJECTIVE

An ecological study using secondary open data from Japanese government statistics was conducted. The study aimed to verify differences in three measures of healthy life expectancy (HLE); namely, disability-free life expectancy without activity limitation (DFLE-AL), life expectancy with self-perceived health (LE-SH), and disability-free life expectancy without care need (DFLE-CN).

RESULTS

Each HLE from 47 prefectures in 2010, 2013, and 2016 was extended over time. There were strong Cronbach's coefficient alpha (α) between DFLE-AL and LE-SH (Minimum α; 0.80, Maximum α; 0.90) as well as between LE and DFLE-CN (Minimum α; 0.92, Maximum α; 0.99) in both sexes in every data year. However, the other pairs had weaker associations. In regression analysis with each HLE as a dependent variable and aging rate, mortality, the proportion of unhealthy people as independent variables, the subjective unhealthy rate had significant standardized partial regression coefficients (β) in models with DFLE-AL and LE-SH as dependent variables (Minimum β; - 0.56, Maximum β; - 0.34). Therefore, DFLE-CN tended to differ from the other HLEs. The subjective unhealthy rate had a significant influence on DFLE-AL and LE-SH.

Self-rated worry is associated with hospital admission in out-of-hours telephone triage - a prospective cohort study

Objective

Telephone triage manages patient flow in acute care, but a lack of visual cues and vague descriptions of symptoms challenges clinical decision making. We aim to investigate the association between the caller’s subjective perception of illness severity expressed as “degree-of-worry” (DOW) and hospital admissions within 48 h.

Design and setting

A prospective cohort study was performed from January 24th to February 9th, 2017 at the Medical Helpline 1813 (MH1813) in Copenhagen, Denmark. The MH1813 is a primary care out-of-hours service.

Participants

Of 38,787 calls received at the MH1813, 11,338 met the inclusion criteria (caller being patient or close friend/relative and agreement to participate). Participants rated their DOW on a 5-point scale (1 = minimum worry, 5 = maximum worry) before talking to a call handler.

Main outcome measure

Information on hospitalization within 48 h after the call, was obtained from the Danish National Patient Register. The association was assessed using logistic regression in three models: 1) crude, 2) age-and-gender adjusted and 3) age, gender, co-morbidity, reason for calling and caller status adjusted.

Results

A total of 581 participants (5.1%) were admitted to the hospital, of whom 170 (11.3%) presented with a maximum DOW, with a crude odds ratio (OR) for hospitalization of 6.1 (95% confidence interval (CI) 3.9 to 9.6) compared to minimum DOW. Estimates showed dose-response relationship between DOW and hospitalization. In the fully adjusted model, the ORs decreased to 3.1 (95%CI 2.0 to 5.0) for DOW = 5, 3.2 (2.0 to 5.0) for DOW = 4, 1.6 (1.0 to 2.6) for DOW = 3 and 0.8 (0.5 to 1.4) for DOW = 2 compared to minimum DOW.

Conclusion

Patients’ self-assessment of illness severity as DOW was associated with subsequent hospital admission. Further, it may be beneficial in supporting clinical decision making in telephone triage. Finally, it might be useful as a measure to facilitate patient participation in the triage process.

Physical functioning and survival: Is the link weaker among Latino and black older adults?

Measures of physical functioning are among the strongest predictors of mortality, but no previous study has assessed whether the predictive value of such measures varies by race/ethnicity, as has been done for the simple self-rated health question. The current study tests whether the relationship between two measures of physical functioning (the number of self-reported functional limitations and measured walking speed) and mortality is weaker (has a lower hazard ratio) for Latinos and blacks than for whites. Data were drawn from the 1998-2014 waves of the Health and Retirement Study, with mortality follow-up through 2016. We used Cox hazard models with household random effects to test for interactions between race/ethnicity and these measures of physical functioning and verified earlier findings for self-rated health. The number of self-reported functional limitations is significantly related to mortality for all racial/ethnic groups, but has a substantially lower hazard ratio for blacks and Latinos than for whites, as hypothesized. This hazard ratio remains lower for blacks and Latinos after adjustment for sociodemographic characteristics and health conditions. These findings suggest that the higher rates of functional limitations observed among Latinos and blacks compared with whites may reflect a history of strenuous physical work, inadequately controlled pain, lower leisure-time physical activity, or untreated/under-treated mobility problems that can lead to reduced physical performance without necessarily having a substantial effect on mortality risk. On the other hand, we do not detect significant racial/ethnic differences in the association between measured walking speed and subsequent mortality. This may be the result of the smaller sample size for the walking speed tests, the more nuanced nature of the continuous walking speed measure, or the fact that the walking speed test captures only a subset of the limitations included in the self-reports.

Racial Non-equivalence of Socioeconomic Status and Self-rated Health among African Americans and Whites

Racial health inequities are not fully explained by socioeconomic status (SES) measures like education, income and wealth. The largest inequities are observed among African American and white college graduates suggesting that African Americans do not receive the same health benefits of education. African Americans do not receive the same income and wealth returns of college education as their white counterparts indicating a racial non-equivalence of SES that may affect health inequities. The aim of this study is to determine whether racial non-equivalence of SES mediates race inequities in self-rated health by education and sex. Using data from the 2007–2016 National Health and Nutrition Examination Survey in the United States, the mediation of the associations between race and self-rated health through household income ≥400% federal poverty line, homeownership, and investment income were assessed among college graduates and non-college graduates by sex. Indirect associations were observed among college graduate women (odds = 0.08, standard error (s.e.) = 0.03), and non-college graduate men (odds = 0.14, s.e. = 0.02) and women (odds = 0.06, s.e. = 0.02). Direct associations between race and self-rated health remained after accounting for household income and wealth indicators suggesting that race differences in income and wealth partially mediate racial inequities in self-rated health. This study demonstrates that the racial non-equivalence of SES has implications for health inequities, but the magnitude of indirect associations varied by sex. Other factors like discrimination, health pessimism and segregation should be considered in light of the racial non-equivalence of SES and racial inequities in self-rated health.

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Racial inequities in self-rated health increase in magnitude as educational attainment increases.

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College graduate African Americans have lower incomes and less wealth than whites.

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Racial inequities in self-rated health among college graduate women and men are mediated by income and wealth.

Correlates of Poor Self-Assessed Health Status among Socially Disadvantaged Populations in Poland

Self-assessment of health is recommended as valuable source of information about subjective health status. The present study was performed to evaluate the correlates of self-rated health status among beneficiaries of social care in Poland. This assessment could be crucial for the implementation of targeted preventive measures among this valuable population. The study population consisted of 1710 beneficiaries of social care from the Piotrkowski District. The relationship between self-rated health status and its correlates (sociodemographic, lifestyle factors, and health conditions) was examined using logistic regression, with a poor health rating as the outcome. Overall, 11% of respondents declared poor self-assessed health status. Men more often rated health status as poor (15%) as compared to women (8.5%) (p < 0.001). The odds of a poor assessment of health increased with age, being unemployed or disabled/retired (OR = 2.34 95%CI (1.34–4.19) or OR = 9.07 95%CI (3.68–22.37), respectively), and additionally with poor life satisfaction (OR = 5.14 95% CI (1.94–13.64)). Regarding lifestyle characteristics, only binge drinking was associated with poor health status assessment (OR = 12.62 95%CI (3.71–42.87)). In addition, having any illness or health problems decreased health status (OR = 4.26 95%CI (1.36–13.31)). Socially-disadvantaged populations, especially men who poorly rated their health status, still constituted a large percentage of the population, which is an important public health problem. Increasing knowledge about the correlates of health status will allow greater prevention strategies to be developed for the population.

Self-Rated Health and Structural Racism Indicated by County-Level Racial Inequalities in Socioeconomic Status: The Role of Urban-Rural Classification

Recent attention to the interrelationship between racism, socioeconomic status (SES) and health has led to a small, but growing literature of empirical work on the role of structural racism in population health. Area-level racial inequities in SES are an indicator of structural racism, and the associations between structural racism indicators and self-rated health are unknown. Further, because urban-rural differences have been observed in population health and are associated with different manifestations of structural racism, explicating the role of urban-rural classification is warranted. This study examined the associations between racial inequities in SES and self-rated health by county urban-rural classification. Using data from County Health Rankings and American Communities Surveys, black-white ratios of SES were regressed on rates of fair/poor health in U.S. counties. Racial inequities in homeownership were negatively associated with fair/poor health (β = -0.87, s.e. = 0.18), but racial inequities in unemployment were positively associated with fair/poor health (β = 0.03, s.e. = 0.01). The associations between structural racism and fair/poor health varied by county urban-rural classification. Potential mechanisms include the concentration of resources in racially segregated counties with high racial inequities that lead to better health outcomes, but are associated with extreme black SES disadvantage. Racial inequities in SES are a social justice imperative with implications for population health that can be targeted by urban-rural classification and other social contextual characteristics.

The relationship between gender roles and self-rated health: A perspective from an international study

OBJECTIVES

To examine the relationship between gender roles and self-rated health in older men and women from different contexts.

METHODS

2002 community-dwelling older adults from the International Mobility in Aging Study were recruited from 5 research sites. Gender role was measured with the 12-item Bem Sex Role Inventory, which categorized study participants into four gender roles: Masculine, Feminine, Androgynous, and Undifferentiated. Self-rated health was collapsed into a dichotomous variable (Very Good/Good and Fair/Poor/Very Poor). Prevalence risk ratios (PRR) of self-rated health relative to gender roles were estimated with Poisson regression models adjusted for all relevant confounders.

RESULTS

After complete adjustment, feminine (PRR 1.22 (95 % CI 1.01-1.49)) and undifferentiated (PRR 1.25 (95 % CI 1.05-1.50)) gender roles were associated with poorer relative self-rated health.

DISCUSSION

Gender roles confer independent risks and benefits for self-rated health in older adults.

Studying the impact of the Eurozone's Great Recession on health: Methodological choices and challenges

Europe's Great Recession provides an opportunity to study the impact of increased financial insecurity on health. A number of studies explored the impact of the Recession on health, but they often reached different conclusions. To understand the root of this debate, we undertook a systematic literature review. Articles were analysed thematically based on: geography, data type, operationalisations of wealth and health, and study design. A critical appraisal was also undertaken. Forty-two studies, published from January 2010 to October 2018, were included in our review. Twenty-six of the forty-two studies found that the Great Recession worsened physical health indicators in the Eurozone. In terms of geography, a large concentration of studies focussed on Spain and Greece, indicating that there may be a gap in understanding the health consequences for EU countries with less severe experiences of the Recession. Regarding data type, nearly all studies used secondary datasets, possibly meaning that studies were constrained by the data available. In terms of operationalisations of wealth and health, a majority of studies used single/simple measures of both, so that these multi-faceted concepts were not fully reflected. Further, fewer than half included studies used panel data, with the remaining studies unable to undertake more causal analyses. The results of the critical appraisal showed that lower-quality studies tended to not find a negative impact of the Recession on health, whereas higher quality studies generally did. In future, we recommend conducting cross-country comparisons, using (inter)nationally-representative panel data conducted over a minimum of a ten-year time horizon, and employing multi-faceted operationalisations of wealth and health. This could provide more common ground across studies, and a clearer indication of whether the Recession impacted health.

Associations Between Major and Everyday Discrimination and Self-Rated Health Among US Asians and Asian Americans

BACKGROUND

Asians and Asian Americans in the USA have historically and continue to experience everyday and major forms of discrimination. However, much less is known, on a population-level, concerning the relationship between experiences with major discrimination and health outcomes among this racial/ethnic minority group, while also accounting for the daily influence of everyday discrimination. This analysis explores the concurrent association of both forms of discrimination among the Asian population in the USA.

METHODS

Using data from the 2016 National Asian American Survey, a nationally representative sample of Asians from 10 ethnic subgroups, I examined the association between various forms of self-reported encounters with major as well as everyday discrimination-several of which relate to the unique, racialized experiences of Asians-and self-rated health. I ran three weighted logistic regression models examining the individual and concurrent association between major and everyday discrimination and self-rated health, controlling for relevant demographic and acculturation factors.

RESULTS

When assessed in isolation, unit increases in major and everyday discrimination were associated with poorer self-rated health. However, when examined concurrently, only higher levels of encounters with major forms of discrimination were associated with higher odds of poorer self-rated health.

CONCLUSIONS

Although everyday discrimination contributes to poorer health outcomes among Asians, a finding consistent with past research, instances of lifetime major discrimination should be viewed as a more toxic form of discrimination that may more negatively impact their perceived health status. Reducing instances of structural-level discrimination is therefore key toward the prevention of poorer health outcomes among this rapidly growing racial/ethnic minority group.

Multiple "Old Ages": The Influence of Social Context on Women's Aging Anxiety

Objectives

Dominant views of aging generate anxiety for many adults-especially women, who face greater disadvantages in later life compared with men. However, little is known about changes in these concerns over time and their variation across women. Employing a feminist perspective on age relations, our study examines three social contexts affecting women's aging anxiety-social location, health, and social relationships.

Method

Using a sample of women (n = 905) from Midlife in the United States (1995-1996; 2004-2006), logistic regression models examine predictors of over-time patterns in three aging anxiety sources-declining attractiveness, declining health, and reproductive aging.

Results

Women report more declining-health anxiety, and it remains more stable over time than do declining-attractiveness and reproductive aging anxiety-both of which tend to decrease with age. The effects of social context vary across anxiety sources; however, more favorable over-time patterns are often associated with more disadvantaged social locations (i.e., older ages, non-white, lower socioeconomic status)-but better health and social relationships.

Discussion

Our study, the first to examine over-time patterns in aging anxiety, illustrates women's multiple "old ages"-a reality manifesting in not only objective conditions of later life but also perceptions of aging. It provides insight on social and cultural processes shaping aging perceptions.

Trajectories of racial and gender health disparities during later midlife: Connections to personality

OBJECTIVE

We examined race/gender effects on initial levels and trajectories of self-reported physical and mental health, as well as the moderating role of personality. We hypothesized that health disparities would remain stable or decrease over time, and that at-risk personality traits (e.g., neuroticism) would have a more robust negative impact on health for Black participants.

METHOD

Analyses utilized 6 waves of data from a community sample of 1,577 Black and White adults (mean age 60 years), assessed every 6 months for 2.5 years. Using multigroup latent growth curve modeling, we examined initial levels and changes in health among White men, White women, Black men, and Black women.

RESULTS

Black participants reported lower initial physical health than Whites. Women's physical health was stable over time, whereas men's declined. There were no disparities in mental health. Higher agreeableness was associated with higher initial levels of physical health only among Black men and White women. All other personality traits were associated with physical and mental health similarly across race and gender.

CONCLUSIONS

Race and gender influence health trajectories. Most personality- health associations replicated across race and gender, except for agreeableness with physical health. An intersectional framework considering more than one aspect of social identity is crucial for understanding health disparities. Future studies may benefit from including large, diverse samples of participants and further examining the moderating effects of race and gender on personality associations with a variety of health outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Response styles confound the age gradient of four health and well-being outcomes

OBJECTIVES

Accurate representation of the association of health and well-being outcomes over age can inform us about how well the population is doing, where segments of the population may be in need, and allow hypothesis generation about correlates and causes of observed gradients. In this paper, we examine the possibility that response styles can impact associations between respondent age and four common, self-report variables: overall health; life satisfaction; pain intensity; and, fatigue level. Response styles (RSs) are defined as tendencies for people to use certain locations on response scales (e.g., extremes, middle) regardless of scale content. Although RSs have been shown in some circumstances to bias self-reports, often little attention is paid to this source of bias.

METHODS

A sample of 2000 Internet panelists completed an online questionnaire that included a set of heterogeneous items to compute measures of the following RSs: acquiescence, disacquiescence, midpoint responding, and extreme responding.

RESULTS

A total of 1839 participants formed the analytic sample and they had an average age of 54.4 (range: 21-89). RSs were associated with age and with the outcome variables. Moreover, the age pattern of the health and well-being variables was considerably altered when RSs were controlled. An alternative, item-response theory-based method of deriving measures of RSs confirmed many of the associations from the primary method of computing RS variables. Across the different self-report outcomes, disacquiescence had the greatest effect on the age patterns, and pain and fatigue were the outcomes most impacted by controlling for RSs.

DISCUSSION

In accord with prior research, we recommend greater consideration be given to RSs in aging research.

Investigating self-reported health by occupational group after a 10-year lag: results from the total Belgian workforce

Background

Belgium lacks a systematic overview of health differences by occupation. This is the first study to examine self-reported health among 27 occupational groups in Belgium with a lag time of 10 years.

Methods

Individual data are derived from an anonymous linkage between the 1991 and 2001 Belgian census. The total working population (25–55 years) is selected from the 1991 Belgian census. Self-reported health (1 = fair or (very) bad health; 0 = (very) good health) was obtained from the 2001 census. Logistic regression analysis was used to analyse the health of 1.5 million men and 1.0 million women by occupational group in 1991. The active sex-specific population in 1991 and 2001 was the reference group. Controls include age, activity status and housing status at the time of 2001 census.

Results

Both male and female workers in physically demanding occupations were more likely to report poor health. The three occupations with the highest age-adjusted Odds Ratios (OR) were extraction and building trade workers (OR_male 2.08 95% Confidence Interval (CI) 2.05–2.10; OR_female 2.15 CI 1.93–2.40); services elementary workers (OR_male 2.06 CI 2.03–2.10; OR_female 2.37 CI 2.34–2.41); and labourers in construction, manufacturing and transport (OR_male 1.90 CI 1.86–1.93; OR_female 2.21 CI 2.12–2.29). Men and women in teaching, scientific, health-related and managerial positions had the lowest age-adjusted ORs for poor self-reported health. The pattern in occupational health differences remained the same after controlling for activity status and socio-economic position.

Conclusions

Occupational health inequalities are apparent after a lag time of 10 years. The identification of types of workers in poor health provide valuable insights to future health promotion strategies in the Belgian workforce.

Self-rated health and depressive symptoms in older adults: A growth mixture modeling approach

OBJECTIVE

Self-Rated Health (SRH) and depressive symptoms are important indicators of global quality of life in older adults. Prior research suggests associations between SRH and depressive symptoms. The current study assessed latent groups in levels and trajectories of these two subjective health indicators and how the latent groups relate to each other.

METHODS

Participants from the Australian Longitudinal Study of Aging (N = 2,087, ages 65+) were assessed over six waves of data collection, spanning eight years.

RESULTS

Growth Mixture Models were run for SRH and depressive symptoms, each yielded three latent groups with similar patterns: for both SRH and depressive symptoms two groups differing in their level with worsening status over time, and a third stable, but poorer functioning group. Analysis of the assignment of the latent groups revealed a consistent pattern for the majority, but some people were high in depression and high in SRH and some were low in depression and low in SRH.

CONCLUSIONS

SRH and depressive symptoms yielded both three latent groups whose combination supported the expected assignment for the majority and an unexpected assignment for some people. This may be a result of a protective factor existing for one variable but not the other.

Self-Rated Health and Glycemic Control in Type 2 Diabetes: Race by Gender Differences

BACKGROUND

Although some studies have shown a link between self-rated health (SRH) and glycemic control in type 2 diabetes (DM), other studies have failed to support this association. The purpose of this study was to determine whether these equivocal findings can be explained by specific interactions between gender, race, and SRH, as suggested by the intersectionality literature.

METHODS

This cross-sectional study included 287 patients with DM (85 Black men, 78 Black women, 64 White men, and 60 White women). After adjusting for demographic and medical factors, we regressed HbA1c on SRH with and without interactions between gender, race, and SRH. We conducted additional subgroup analyses to further characterize gender by race group differences.

RESULTS

Although there was no main effect of SRH upon HbA1c (b = .16, 95% CI: .08-.39), we found a significant interaction between gender and SRH on HbA1c (b = -.50, 95% CI: -.97 to -.03). In race by gender-stratified models, SRH (b = .53, 95% CI: .00-1.07) was associated with HbA1c in Black men. SRH was not associated with HbA1c in White men, White women, or Black women.

CONCLUSION

Combined race and gender differences may exist in the link between SRH and glycemic control in DM. Specifically, Black men with DM may be more attuned to the relationship between their overall health and their glycemic control.

The Meaning and Predictive Value of Self-rated Mental Health among Persons with a Mental Health Problem

Self-rated health is a valid measure of health that predicts quality of life, morbidity, and mortality. Its predictive value reflects a conceptualization of health that goes beyond a traditional medical model. However, less is known about self-rated mental health (SRMH). Using data from the Medical Expenditure Panel Survey ( N = 2,547), we examine how rating your mental health as good-despite meeting criteria for a mental health problem-predicts outcomes. We found that 62% of people with a mental health problem rated their mental health positively. Persons who rated their mental health as good (compared to poor) had 30% lower odds of having a mental health problem at follow-up. Even without treatment, persons with a mental health problem did better if they perceived their mental health positively. SRMH might comprise information beyond the experience of symptoms. Understanding the unobserved information individuals incorporate into SRMH will help us improve screening and treatment interventions.

The age pattern of social inequalities in health at older ages: are common measures of socio-economic status interchangeable?

OBJECTIVES

Social inequalities in health have been largely documented in social science research. Members of the most disadvantaged groups experience worse health and higher mortality from birth throughout adulthood. However, it is not clear whether this association persists at older ages. Some studies have found a narrowing of the social gradient in health, at least when 'traditional' measures of socio-economic status (SES)-income, education, and occupation-are used. The main goal of the article is to highlight similarities and discrepancies in the age trend of social inequalities in health that arise when multiple measures of SES are considered.

STUDY DESIGN

The present study uses a longitudinal sample of over 7000 individuals age 50+ from the Survey of Health, Ageing, and Retirement in Europe to examine the age trend of social inequalities in health.

METHODS

By using growth curve models, individual trajectories of self-rated health and physical functioning were analyzed. SES is measured through wealth, income, and education.

RESULTS

The findings show that for both health outcomes, the choice of the indicator of SES is very consequential, as the age trend of social inequalities in health is substantially different for different measures of SES.

CONCLUSION

Using multiple measures of SES is recommended, as using only one measure would give only a partial account of the age trend of social inequalities in health. In particular, wealth seems to better capture individual's socio-economic position, as it is able to detect health gradients even where education and income fail to do so.

Measurement equivalence: a glossary for comparative population health research

Comparative population health studies are becoming more common and are advancing solutions to crucial public health problems, but decades-old measurement equivalence issues remain without a common vocabulary to identify and address the biases that contribute to non-equivalence. This glossary defines sources of measurement non-equivalence. While drawing examples from both within-country and between-country studies, this glossary also defines methods of harmonisation and elucidates the unique opportunities in addition to the unique challenges of particular harmonisation methods. Its primary objective is to enable population health researchers to more clearly articulate their measurement assumptions and the implications of their findings for policy. It is also intended to provide scholars and policymakers across multiple areas of inquiry with tools to evaluate comparative research and thus contribute to urgent debates on how to ameliorate growing health disparities within and between countries.

Standards of Comparison and Discordance in Rheumatoid Arthritis Global Assessments Between Patients and Clinicians

OBJECTIVE

Patient-physician discordance in health status ratings may arise because patients use temporal comparisons (comparing their current status with their previous status), while clinicians use social comparisons (comparing this patient's status to that of other patients, or to the full range of disease severity possible) to guide their assessments. We compared discordance between patients with rheumatoid arthritis (RA) and clinicians, using either the conventional patient global assessment (PGA) or a rating scale with 5 anchors describing different health states. We hypothesized that discordance would be smaller with the rating scale because clinicians likely used similar social comparisons when making global assessments.

METHODS

We prospectively studied 206 patients with active RA and assessed the PGA (range 0-100), rating scale (range 0-100), and evaluator global assessment (EGA; range 0-100) on each of 2 visits (total visits = 401). We compared the PGA/EGA discordance and the rating scale/EGA discordance at each visit.

RESULTS

The mean ± SD PGA/EGA discordance was 8.5 ± 22.4, and the mean ± SD rating scale/EGA discordance was 2.3 ± 24.0. The intraclass correlation, measuring agreement, was higher between the rating scale and EGA than between the PGA and EGA (0.39 versus 0.31). Agreement was larger at low levels of RA activity on both pairs of measures.

CONCLUSION

Discordance between patients' global assessments and evaluators' global assessments was smaller when patients used a social standard of comparison than when they marked the PGA, suggesting that differences in standards of comparison contribute to patient-clinician discordance when the PGA is used.

Gender and the structure of self-rated health across the adult life span

Despite the widespread use of self-rated health (SRH) in population health studies, the meaning of this holistic health judgment remains an open question. Gender differences in health, an issue of utmost importance in population research and policy, are often measured with SRH; the comparisons could be biased if men and women differ in how they form their health judgment. The aim of this study is to examine whether men and women differ in how health inputs predict their health rating across the adult life span. We use the 2002-2015 National Health Interview Survey data from US-born respondents aged 25-84. Ordered logistic models of SRH as a function of 24 health measures including medical conditions and symptoms, mental health, functioning, health care utilization, and health behaviors, all interacted with gender, test how the measures influence health ratings and the extent to which these influences differ by gender. Using a Bayesian approach, we then compare how closely a select health measure (K6 score) corresponds to SRH levels among men and women. We find little systematic gender difference in the structure of SRH: men and women use wide-ranging health-related frames of reference in a similar way when making health judgments, with some exceptions: mid-life and older men weigh physical functioning deficits and negative health behaviors more heavily than women. Women report worse SRH than men on average but this only holds through mid-adulthood and is reversed at older ages; moreover, the female disadvantage disappears when differences in socio-economic and health covariates are considered. Our findings suggest that the meaning of SRH is similar for women and men. Both groups use a broad range of health-related information in forming their health judgment. This conclusion strengthens the validity of SRH in measuring gender differences in health.

Pride, shame and health among adolescents - a cross-sectional survey

Background Pride and shame are important emotions known to influence identity development and psychological well-being in adolescence. Research evidence indicates that self-rated health (SRH) is a strong predictor of future health. This cross-sectional study, conducted during 2008-2009, aimed to investigate the associations between pride, shame and SRH among adolescent boys and girls. Methods The study sample comprised 705 adolescents in Sweden aged 17-18 years (318 boys and 387 girls) who completed a questionnaire that included items on SRH, shame and pride (participation rate 67%). Logistic regression analyses (univariable and multivariable) were used to investigate the associations between pride and shame as separate and combined constructs on SRH, adjusting for potential confounders (country of birth, parental educational level, school experience, having enough friends, mood in family and being active in associations). Results Pride and shame separately were significantly associated with SRH in both genders. Logistic regression analysis of the pride-shame model showed that the odds of having lower SRH were highest in boys and girls with lower pride-higher shame. In a multivariable logistic regression analysis of the pride-shame model the odds of having lower SRH remained significant in boys and girls with lower pride-higher shame [boys: odds ratio (OR) 3.51, confidence interval (CI) 1.40-8.81; girls: OR 2.70, CI 1.22-5.96] and in girls with lower pride-lower shame (OR 2.16, CI 1.02-4.56). Conclusion The emotions of shame and pride are associated with SRH in adolescence. Experiencing pride seems to serve as a protective mechanism in SRH in adolescents exposed to shame. We believe that this knowledge should be useful in adolescent health promotion.

Social correlates of health status, quality of life, and mood states in patients treated with cannabidiol for epilepsy

Social characteristics, such as socioeconomic status and race/ethnicity, play a role in the treatment and outcomes of patients with epilepsy (PWE), but little is known about how these factors affect patients receiving cannabidiol (CBD) to treat seizures. This exploratory study examined the sociodemographic profile of patients treated with CBD (n=80) and associations between social factors and patient-centered outcomes - overall health status, Quality of Life in Epilepsy-89 (QOLIE-89), and Profile of Mood States (POMS) - in this population. Associations were examined using Pearson correlations and multiple ordinary-least-squares regression (alpha=0.1). The sample was predominantly white (96%) and non-Hispanic/Latino (96%); 76% of patients had family incomes of $40,000+/year. Some patients/families reported experiencing food scarcity (13%), not being able to make ends meet (6%), or not being able to afford antiepileptic medications (8%). The patients' health ratings declined with age and income (p≤0.014), and there was a statistically significant interaction (p<0.055) between these variables: for example, a higher-income 10-year-old had a predicted health rating of 3 ("very good"), followed by a higher-income 40-year-old with a rating of 2 ("good"), a low-income 10-year-old with a rating of 1 ("fair"), and a low-income 40-year-old with a rating of 0 ("poor"). This is the first study reporting the social profile of patients taking pharmaceutical grade CBD for the treatment of epilepsy. The results suggest that despite free access to this treatment some patients may not be accessing CBD because of their socioeconomic situation or race/ethnicity. Larger, diverse samples and longitudinal data are needed to more accurately model social factors and patient-centered outcomes in PWE receiving CBD. This article is part of a Special Issue entitled "Cannabinoids and Epilepsy".

Depression, social support, and long-term risk for coronary heart disease in a 13-year longitudinal epidemiological study

Depression has been linked with long-term risk for a variety of physical health ailments, including coronary heart disease (CHD). Little is known about resilience factors that may attenuate this relationship. The current study assessed whether social support moderates the long-term risk for CHD associated with this disorder. Data were drawn from the Americans' Changing Lives study, a nationally representative longitudinal survey of adults in the United States. Participants (unweighted n=1636) completed initial assessments of functional social support, body mass index, recent history of major depression, CHD, hypertension, and diabetes. Participants were again assessed for CHD at a follow-up assessment 13 years later. Social support was found to moderate the relationship between depression and the occurrence of CHD 13 years later. Specifically, among individuals with low social support, depression was prospectively associated with CHD. In contrast, depression was not prospectively associated with CHD among individuals with high social support. The results indicate that social support may function as a resilience factor against the long-term cardiovascular risk associated with depression. Clinical interventions focusing on the development of social support systems are important not only for addressing depression itself, but also for associated long-term physical health outcomes.