Does the source of support matter for different health outcomes? Findings from the Normative Aging Study

Factors associated with the level of self-management in elderly patients with chronic diseases: a pathway analysis

BACKGROUND

To analyze the effects and pathways of factors such as psychological capital, family functioning, and sources of meaning in life on the level of self-management in elderly patients with chronic diseases and to provide a basis for the development of relevant nursing interventions in the future.

METHODS

Convenience sampling was used to select elderly patients with chronic diseases who underwent medical checkups and consultations at three community hospitals in Jinzhou city from March 2023 to October 2023, and the self-designed General Information Questionnaire (GIS), Psychological Capital of the Elderly Scale (PCE), Family Functioning Index Questionnaire (APGAR), Sources of Meaning of Life Scale for Older Adults(SMSE), and Self-Management Behavior of Chronic Patients Scale (SMCS) were used. SPSS 26.0 was used for data entry, one-way analysis, Pearson correlation analysis, and multiple linear regression were used to analyze the data, and Amos 17.0 was used to construct the structural equation model.

RESULTS

A total of 355 elderly patients with chronic diseases were included, and their self-management score was 74.75 ± 12.93, which was moderate. The results of the influencing factor analysis showed that the influencing factors of the self-management level of elderly chronic disease patients were age, years of illness, psychological capital, family functioning, and sources of meaning in life (p < 0.05). Path analysis revealed that sources of meaning in life were a partial mediator of the relationship between psychological capital and self-management, with an effect value of 0.166 (95% CI: 0.042,0.391), accounting for 37.6% of the total effect; life meaning was a partial mediator of family functioning and self-management level, with an effect value of 0.231 (95% CI: 0.040,0.452), accounting for 54.0% of the total effect. accounting for 54.0% of the total effect.

CONCLUSION

The self-management of elderly patients with chronic diseases is intermediate. Healthcare professionals should actively implement holistic healthcare management measures from the family aspect to help patients understand the meaning of life and improve the level of patients' psychological capital to improve the self-management level of elderly patients with chronic diseases.

How the interplay of late retirement, health care, economic insecurity, and electronic social contact affects the mental health amongst older workers?

The delayed retirement initiative has become increasingly emphasised to cope with the population ageing. Based on the social-ecological model, this study explores the interplay of late retirement, health care, economic insecurity, and electronic social contact on mental health of older workers. Using data from the Survey of Health, Ageing and Retirement in Europe (wave 8), results show that the late retirement, health care quality, and electronic social contact are all negatively associated with the mental health problems among older workers. Besides, the influence of health care quality and electronic social contact on mental health problems are buffered by the economic insecurity respectively. It is concluded that more targeted policy response is in need to achieve better health outcomes among older workers.

Perceived Relational Support Is Associated With Everyday Positive, But Not Negative, Affectivity in a U.S. Sample

Research suggests that perceived social support bolsters emotional well-being. We tested whether perceived support from friends, family, and spouses/partners was associated with reduced negative and greater positive affectivity (i.e., everyday affective baseline), and whether perceived strain in these relationships had opposite effects, accounting for age and relevant covariates. Using data from the third waves of the Midlife in the United States survey and National Study of Daily Experience (n = 1,124), we found negative affectivity was not tied to relational support nor strain, but instead was associated positively with neuroticism and negatively with conscientiousness. In contrast, positive affectivity was related positively to support from friends and family, conscientiousness, and extroversion, and negatively to strain among partners and neuroticism. Exploratory analyses within second-wave Midlife in Japan data (n = 657) suggest patterns for future cross-cultural study. Some relationship dynamics may vary, but perceived support might enhance emotional well-being by bolstering positive, rather than mitigating negative, emotionality.

Changes in depression trends during and after the COVID-19 pandemic among older adults in Korea

This study aimed to complement the previous studies conducted within a short period of time by examining the long-term trends in depression levels of older adults through a longitudinal study that includes the period following the onset of COVID-19. For analysis, this study used the data from the 12th (2017) through 16th (2021) Korea Welfare Panel Study, and 2,716 data of older adults 65 years and older were included. Variables included gender, age, equalized annual income (USD $), education background, residential area, living alone and disability status. As a result, two types of changes in depression were identified: the 'rapidly rising' type and the 'steadily increasing'. We found that the lower the equalized annual income, women, the lower the education, living in urban and living alone showed a higher likelihood of belonging to the 'rapidly rising' type. The result suggests that those at risk of depression are at much higher risk during and after the COVID-19 pandemic. It is also necessary to provide timely and effective guidelines to prevent depression in older adults when implementing policies in response to an outbreak of infectious diseases, such as COVID-19.

Efficiency of spoken word recognition slows across the adult lifespan

Spoken word recognition is a critical hub during language processing, linking hearing and perception to meaning and syntax. Words must be recognized quickly and efficiently as speech unfolds to be successfully integrated into conversation. This makes word recognition a computationally challenging process even for young, normal hearing adults. Older adults often experience declines in hearing and cognition, which could be linked by age-related declines in the cognitive processes specific to word recognition. However, it is unclear whether changes in word recognition across the lifespan can be accounted for by hearing or domain-general cognition. Participants (N = 107) responded to spoken words in a Visual World Paradigm task while their eyes were tracked to assess the real-time dynamics of word recognition. We examined several indices of word recognition from early adolescence through older adulthood (ages 11-78). The timing and proportion of eye fixations to target and competitor images reveals that spoken word recognition became more efficient through age 25 and began to slow in middle age, accompanied by declines in the ability to resolve competition (e.g., suppressing sandwich to recognize sandal). There was a unique effect of age even after accounting for differences in inhibitory control, processing speed, and hearing thresholds. This suggests a limited age range where listeners are peak performers.

Diversity in Social Communication and Support: Implications for Loneliness Among LGB Adults

BACKGROUND AND OBJECTIVES

Current research indicates that structural and functional social network attributes influence older adults' well-being. However, these linkages may vary by sexual orientation. This study examines how social communication diversity and support diversity are related to loneliness and differ between lesbian, gay, and bisexual (LGB) and heterosexual adults.

RESEARCH DESIGN AND METHODS

Using data from the American Association of Retired Persons Foundation's Loneliness and Social Connection Survey of adults 45+ (N = 3,009), including 10% who identified as LGB, we derive entropy scores, which capture the extent to which network size and quality of relationships are evenly distributed. A series of linear regressions were conducted to examine sexual orientation, social network indicators, and their interactions in predicting loneliness.

RESULTS

We found a positive association between social communication diversity and loneliness. This finding was qualified by the interaction with sexual orientation. In addition, we found a negative association between support diversity and loneliness, an effect that was stronger for LGB participants than for heterosexual participants. The effect of support diversity on loneliness was much stronger for LGB adults than heterosexual adults.

DISCUSSION AND IMPLICATIONS

While LGB adults tend to score higher on the loneliness scale overall, the findings suggest that communication and support diversity have uniquely different patterns of associations for sexual minority groups. This study highlights the importance of considering multiple dimensions of social networks and has implications for addressing loneliness for heterosexual and LGB adults.

The Relationship between Physical Activity and Mental Depression in Older Adults during the Prevention and Control of COVID-19: A Mixed Model with Mediating and Moderating Effects

BACKGROUND

Several studies have found a strong relationship between physical activity and mental depression in older adults. Despite this, the social isolation, limited physical activity, and decreased social interactions caused by the 2020 COVID-19 pandemic control measures of "home isolation and reduction unnecessary travel" had a significant mental impact on older adults.

OBJECTIVE

the goal of this study was to look into the complex effects of physical activity participation on mental health in older adults during COVID-19 prevention and control and the relationship between physical activity and mental depression in older adults through the mediating effect of self-efficacy and the moderating effect of social support.

METHODS

The Physical Activity Rating Scale (PARS-3), the Center for Streaming Depression Scale (CES-D), the Self-Efficacy Scale (GSES), and the Social Support Rating Scale (SSRS) were used to assess 974 older adults in five urban areas of Chengdu, China. The SPSS was used to analyze the collected data using mathematical statistics, linear regression analysis, and the AMOS to construct the research model.

RESULTS

The study's findings revealed that self-efficacy mediated the relationship between physical activity and mental depression in older adults (β = -0.101, 95%CI (-0.149, -0.058)), and social support moderated the relationship between physical activity and mental depression in older adults (t = -9.144, p < 0.01).

CONCLUSIONS

Physical activity reduces psychological depressive symptoms in older adults and modulates psychological depression in older adults via the mediation efficacy of self-efficacy and the moderating effect of social support.

Multi-level correlates of received social support among heart transplant recipients in the international BRIGHT Study: a secondary analysis

AIMS

Social support is critical in follow-up of patients after heart transplant (HTx) and positively influences well-being and clinical outcomes such as medication adherence. The purpose of this study was to (i) explore received social support variation (emotional and practical) in HTx recipients at country and centre level and (ii) to assess multi-level correlates.

METHODS AND RESULTS

Secondary data analysis of the multi-level cross-sectional BRIGHT study was conducted in 36 HTx centres in 11 countries. Received social support related to medication adherence was measured with emotional and practical sub-scales. The Conceptual Model of Social Networks and Health guided selection of patient, micro (interpersonal and psychosocial), meso (HTx centre) and macro-level (country health system) factors. Descriptive statistics, intraclass correlations, and sequential multiple ordinal mixed logistic regression analysis were used. A total of 1379 adult HTx recipients were included. Patient level correlates (female sex, living alone, and fewer depressive symptoms) and micro-level correlates (higher level of chronic disease management and trust in the healthcare team) were associated with better emotional social support. Similarly, patient level (living alone, younger age, and male sex), micro-level and meso-level (patient and clinician-rated higher level of chronic disease management) were associated with better practical social support. Social support varied at country and centre levels for emotional and practical dimensions.

CONCLUSIONS

Social support in HTx recipients varies by country, centre, and was associated with multi-level correlates. Qualitative and longitudinal studies are needed to understand influencing factors of social support for intervention development, improvement of social support, and clinical outcomes.

Association between disability, social support and depressive symptoms in Chinese older adults: A national study

Objective

Disability and social support can impact depressive symptoms of the elderly. Yet, studies infrequently discuss the moderating role of social support when evaluating the association between disability and depressive symptoms. The purpose of this study was to explore the association between disability, social support, and depressive symptoms among the Chinese elderly, and further examine the moderating effect of social support.

Materials and methods

Using the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS) data set, we finally selected 9,231 Chinese elderly after screening. The Center for Epidemiologic Studies Depression Scale (CESD-10) was used to evaluate depressive symptoms in the elderly. Disability was measured by basic activities of daily living (B-ADL) and instrumental activities of daily living (I-ADL). Social support included contact with family and friends, sick care, and money received, measured by five self-reported questions. We used multiple linear regression and moderating model to explore the association between disability, social support, and depressive symptoms.

Results

A total of 9,231 patients were included in this study, and approximately 26.75% of the elderly had depressive symptoms. Study found that depressive symptoms were associated with social support (β _B-ADL = -0.108, 95% CI: -0.168- -0.047; β _I-ADL = -0.098, 95% CI: -0.156- -0.039), β _B-ADL (β = 0.296, 95% CI: 0.248-0.343) and I-ADL (β = 0.174, 95% CI: 0.152-0.195). Moreover, the result also showed that social support moderated the effects of B-ADL ( β B - A D L * s o c i a l s u p p o r t = 0.034, 95% CI: 0.014-0.053, F = 11.57, p = 0.001) and I-ADL ( β I - A D L * s o c i a l s u p p o r t = 0.025, 95% CI: 0.017-0.033) on depressive symptoms.

Conclusions

The study suggests that disability and social support can affect depressive symptoms, and social support moderates the effect of disability on depressive symptoms. Therefore, taking effective measures to reduce the elderly disability rate of disability and increase their social support are necessary condition for realizing mental health.

The Moderating Effect of Social Support between Loneliness and Depression: Differences between the Young-Old and the Old-Old

This study aimed to investigate the moderation of social support in the association between loneliness and depression in different age groups of older adults. The sample consisted of 1532 community-dwelling adults aged 65 years or older, based on the data from the National Social Life, Health, and Aging Project (NSHAP), Wave 3 (2015-2016). Eleven items of the Center for Epidemiologic Studies Depression Scale (CES-D) were used to measure depressive symptoms. Similarly, a four-item scale was used to measure social support (each from spouse and family), and a three-item scale for loneliness. The results were as follows. Loneliness was associated with depression in both the young-old and the old-old groups. Spousal support and family support were associated with reduced depression in the young-old group, whereas only spousal support was associated with relieving depression in the old-old group. Social support had a significant moderating effect on the relationship between loneliness and depression in the old-old group, whereas it had no significant effect in the young-old group. From these results, it can be concluded that spousal support plays a significant role in seniors' mental health. The role of caregivers for a person's well-being grows later in life, so practitioners could help couples communicate with this consideration. In addition, regular contacts with family members and spousal support are recommended to prevent older old adults' depression.

Location and Provision of Support from Migrants to Left-behind Parents in Rural Cambodia

Cambodia is a country where labor migration has been consistently high, particularly out of rural areas. Migration increases the distance between parents and their children, which may lead to a reduction in sources of support. Based on these contemporary realities, it is important to understand the factors that impact provision of support from migrants to their parents. This study examines determinants of support provision, with a focus on migrant location. Based on family solidarity and altruism theories, other factors were considered that indicate migrant's ability to provide, the degree of parental vulnerability and degree of interaction. We hypothesized that the likelihood of migrant support provision to left-behind parents related to their location, ability to provide and needs of the household. Data were sourced from the 2011 Cambodian Rural Urban Migration Project (CRUMP) (N = 3700). In bivariate analysis, 77% of both international and rural to urban internal migrants provide monetary support. Rural to urban internal migrants are most likely, and international migrants least likely, to be providing instrumental support. When examining fully adjusted models, it is rural to urban internal migrants that are the most likely to provide both monetary and instrumental support. Both types of support are more likely to be provided by female migrants and to households headed by females. Results show that left-behind parents are not completely unsupported in rural Cambodia, but support provision may be impacted by other determinants. This study provides baseline information for policy makers to design suitable policies that may optimize the positive impact of migration for migrants and left-behind parents.

Aphasia and Friendship: The Role and Perspectives of Speech-Language Pathologists

Purpose Speech-language pathologists (SLPs) who work with people with aphasia focus on assessment and intervention to support improved communication outcomes for their clients. Friendship, a key component of quality of life, often depends on communicative interaction, and many people with aphasia report having reduced social circles. The purpose of this study was to explore the perceptions of SLPs working with clients with aphasia on their role in supporting friendship development and maintenance. Method An online survey composed of questions addressing SLP perspectives and goal setting, assessment, and treatment practices related to aphasia and friendship was distributed to SLPs across the United States. Survey data were analyzed using both quantitative and qualitative methods. Results Forty-seven SLPs completed the survey. While many SLPs reported that the friendships of their clients with aphasia were impacted by aphasia and that it was within their scope of practice to support friendship development and maintenance, many did not specifically assess or target friendship and friendship outcomes in the treatment plan. SLPs identified barriers and facilitators to focusing on friendship within the context of speech and language therapy. Conclusions Findings suggest the majority of participating SLPs were interested in addressing friendship with clients with aphasia; however, they experienced barriers in practice. Further examination of SLP perspectives and clinical practice regarding friendship and aphasia is warranted. Additionally, research investigating effective assessment and therapeutic methods that target friendship in aphasia is needed to support clinical practice and the well-being of clients with aphasia. Supplemental Material https://doi.org/10.23641/asha.15032217.

Spirituality and quality of life in older adults: a path analysis model

BACKGROUND

Study older adults' quality of life is becoming increasingly important in the assessment, quality improvement and allocation of health and social care service. The purpose of this study was to enhance knowledge on the relationship between modifiable (psychological variables) and non-modifiable variables (sociodemographic), and quality of life in elderly, regarding psychological and social variables in Portuguese context.

METHODS

This is a cross-sectional study, including 604 older adults from general community. 63.6% of the sample was composed by female gender with a mean age of 71.6(SD = 4.81). Participants completed the following instruments: Barthel Index to assess functionality; Satisfaction with Social Support Scale to assess social support; The Spiritual and Religious Attitudes in Dealing with Illness to assess spirituality and Short Form Health Survey 36, to assess mental and physical quality of life.

RESULTS

A path analysis model was performed where the presence of a chronic disease, age and functionality has a direct effect on physical quality of life and spirituality had a direct effect on mental quality of life. Social support mediated the relationship between functionality and mental quality of life, and in turn, functionality mediated the relationship between age and physical quality of life.

CONCLUSIONS

Results reinforce the effect of age and chronic disease as non-modifiable variables as well as functionality, spirituality and satisfaction with social support as modifiable variables, in the quality of life of older people. Social support, health and education programs in the community should be promoted in order to improve quality of life in this population. Strategies to promote functionality and enhance the social support network, especially in the elder with chronic illness, should be a priority.

Depression and Anxiety in patients undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome

Background and Objective

Depression and anxiety are very common in patients with cardiac diseases. Percutaneous coronary intervention (PCI) has not only decreased mortality but angina, heart failure and recurrent hospitalization all are improved. Therefore, anxiety and depression associated with fibrinolytic therapy in acute coronary syndrome (ACS) are expected to be decreased in the patient undergoing PCI. Therefore, the aim of this study was to determine prevalence of depression and anxiety in patients undergoing percutaneous coronary intervention for acute coronary syndrome.

Methods

This study was conducted at Larkana Satellite Center of National Institute of Cardiovascular Diseases (NICVD), Pakistan from August 2018 to December 2018. Patients who underwent cardiac intervention within one month were enrolled in this study. Patients were interviewed regarding their basic demographics, indication for intervention and procedure details. Symptoms of anxiety were assessed using the translation of inventory of SAS (Zung's Self-Rating Anxiety Scale). Patients were interviewed for depression by using Becks depression inventory (BDI).

Results

A total of 153 patients were included in this study out of which 118 (77.1%) were males and 35 (22.5%) were females. All were married except one. Diabetes mellitus (DM) was present in 61 (39.9%), hypertension (HTN) in 69 (45.15%), obesity in 15 (9.8%), and 40 (26.1%) were smokers. Depression was present in 16 (10.5%) patients and anxiety was present in 12 (7.5%) of patients. On analysis of the association of various factor with depression; non-diabetics, housewives, laborers and uneducated were found to be more depressed. While those who smoke or earn more than 50 thousand were found less likely to be depressed.

Conclusion

Both depression and anxiety were present in only 10.5% and 7.5% of the patients after percutaneous coronary intervention for acute coronary syndrome.

The Structure and Determinants of Intergenerational Support Exchange Flows in an Eastern European Setting

Although the provision, receipt, and bidirectionality of support exchanges are important for generational well-being, our understanding of them is lacking in Eastern Europe, a region undergoing swift population aging and social change. This study links intergenerational support exchanges to determinants in Romania, with a focus on proximity of adult children. Data are from the Romanian Aging and Migration Survey (N = 1,398). Analyses involve two stages. First, latent class analysis (LCA) is conducted to develop an intergenerational support typology. The second uses the typology as a dependent variable in multivariate equations predicting exchange determinants. LCA analysis yielded six propensity classes. Physical distance strongly predicts class membership. Having coresident adult children increases the likelihood of bidirectional exchange. Having an international migrant adult child reduces the chances, even with coresident adult children present. International migrant children lead to a higher probability of being a nonexchanger or receiving monetary support. There is a need for continued consideration of bidirectional exchange models in rapidly developing contexts.

Fear of falling and cognitive impairment in elderly with different social support levels: findings from a community survey in Central Vietnam

BACKGROUND

Fear of falling (FoF) in the elderly is one of the major public health concerns in this era of aging of the population. As there is limited evidence on how cognitive function may differ by social support level in relation to FoF among the elderly, this cross-sectional study aims to investigate the prevalence of FoF and the associations between cognitive impairment and FoF by the social support level, after adjustments for potential confounders.

METHODS

Data from the "Health needs assessment of elderly in Thua Thien Hue Province, Vietnam in 2018" survey of 725 elderly aged 60 years or older were used for analysis. FoF was assessed using the Fall Efficacy Scale-International. High FoF was defined as a score above 28. The Multidimensional Scale of Perceived Social Support was used to measure the perception of support. Logistic regression analysis was performed to investigate the association between cognitive function and FoF by social support levels (p < 0.05).

RESULTS

The prevalence of high FoF among the elderly was 40.8%. Female gender, advanced age, a marital status of single or formerly married, living alone, history of injury, history of falls, chronic diseases (arthritis and/or hypertension), limitations of the IADL and BADL, visual difficulty and walking difficulty, low social support, and cognitive impairment were all significantly associated with a high FoF. After adjustments for the age, gender, marital status, history of falls and health-related factors, cognitive impairment remained significantly associated with a high FoF among the elderly with a low to moderate social support level (OR = 2.97, 95% CI 1.49-5.89), but not in those with a high social support level.

CONCLUSIONS

A high FoF was associated with impairment of cognitive function among the elderly who perceived themselves as having low or moderate support levels, even after adjustments for socio demographic and physical functional factors. However, this association was not observed among the elderly who perceived themselves as having high social support levels. Fall prevention programs for the elderly with various levels of social support should be carefully devised, keeping in mind the cognitive function levels of the target recipients.

The effect of social assistance on kin relationships: evidence from Roma communities

This paper discusses the effects of social assistance on kinship relationships in Roma, a disadvantaged European minority population, and how variation in kin support affects self-reported health and reproductive success. Data were collected in 2016-7 in several rural Roma settlements in central Serbia. The sample consisted of 143 men and 221 women. Demographic information (e.g., age, gender, educational level, marital and reproductive history, level of socioeconomic status and residence pattern), social assistance history, health status, height, and weight were collected, in addition to kinship relationship dynamics. Receiving social assistance was consistently negatively associated with all measures of kin support, more so for Roma males than females while decreased kin support was found to result in poorer self-rated health and decline in reproductive success.

Social Support and Life Satisfaction of Ethnic Minority Elderly in China

Previous studies indicate that Han and ethnic minority groups in China are not homogeneous. However, little research has examined potential heterogeneity in the association between social support and life satisfaction across Han and ethnic minority elderly. Based on data from the 2014 China Longitudinal Aging Social Survey, this study uses ordered logit models with interaction terms to examine the relationship between social support and the life satisfaction of ethnic minority elderly and of elderly Han Chinese. We find that support from families and friends has a stronger association with the life satisfaction of ethnic minority elderly than their Han peers. For ethnic minority elderly, the patterns of family support varied according to rural or urban residence, with family support being less important to the life satisfaction of ethnic minority elderly living in urban communities than in rural areas. Our findings suggest that social policy should take this heterogeneity between ethnic groups into account.

Examining the Links Between Received Network Support and Marital Quality Among Mothers of Children with ASD: A Longitudinal Mediation Analysis

Employing a cohort sequential design and multilevel modeling, the direct and indirect effects (via depressed mood, emotional wellbeing, and perceived support) of received network support on marital quality were assessed over a 7-year period (child age 7-14) on 96 married or cohabiting mothers of children with ASD. Findings indicated several significant direct and indirect effects affecting change within mothers over time, with effects varying by whether the support source was a spouse or partner, family members, or friends. In addition, one moderated mediation effect was noted, with the indirect effect of received spousal support on marital quality via perceived spousal support retaining significance only at low and moderate levels of child problem behavior severity. Study strengths, limitations, and clinical implications are discussed.

Health delivery system for older adults in academic campus in India

Purpose

Residential academic campuses generally support a skewed population profile that favours a younger population, mainly the student community, and thereby marginalize the needs of the older people staying within the campus. Health delivery systems are often not in accordance with the needs of staff members co-habiting with their aged parents and relatives as well as older staff members themselves. This poses a serious problem, especially in India, where filial piety is a norm and many employees cohabit with their parents. Moreover, the Government of India has reformulated its retirement policy under which the age for superannuation of teaching staff has been enhanced. This in turn, has raised the older-younger ratio in campuses in recent years. The paper aims to discuss these issues.

Design/methodology/approach

To address these issues, a household survey was carried out on older people staying in a residential academic campus of India followed by a focus group discussion with family caregivers of the older people.

Findings

It was found that older people were a marginalized group in campus, as health delivery system and allied facilities were not consistent with their needs. As a result, they and their family caregivers faced various challenges.

Originality/value

This is the first study exploring the possibility of academic campuses in India to emerge as alternate sites for supporting older care.

Nature of Retirement and Loneliness: The Moderating Roles of Social Support

Drawing from the social convoy model, this study investigates whether the nature of retirement (voluntary or involuntary) influences loneliness among retirees, and how different social support types may affect this association. Data come from the 2014 Health and Retirement Study (N = 2,055). Five social support types were identified: weak, ambivalent, strong positive, children strain, and family strain. Involuntary retirement was associated with a higher level of loneliness; however, involuntarily retired individuals with strong positive social support had a relatively lower level of loneliness. Findings from this study suggest that social support may alleviate the negative impacts of involuntary retirement. Our research provides a theoretical basis for developing a practical program to reduce the negative impacts of involuntary retirement on well-being.

Racial/ethnic disparities in depression: Investigating how sources of support and types of integration matter

Although social support and social integration are key predictors of depression and exhibit racial/ethnic patterns in the US, previous research has not examined how they shape racial/ethnic disparities in depression. Applying hybrid models to data from the Americans' Changing Lives study from 1986 to 2002, this study analyzes how sources of social support (spouse and friend/relative) and types of social integration (informal/formal) explain black-white and Hispanic-white disparities in depression. We find that strong social support and high social integration are negatively associated with depression and that the patterns of social support and integration vary by race/ethnicity. The results of hybrid models show that social support from one's spouse and friend/relative account for over 25 percent of the black-white disparity, whereas formal social integration including religious groups widens the black-white differential by roughly 10 percent. However, Hispanic-white disparities in depression are mostly a result of the difference in socioeconomic status. The change in spousal support is the most powerful predictor for the change in depression across race/ethnicity groups. Our findings suggest that the racial/ethnic differences in sources of social support and types of social integration play important roles in shaping racial/ethnic disparities in depression.

Characterizing computer-mediated communication, friendship, and social participation in adults with traumatic brain injury

BACKGROUND

Adults with traumatic brain injury (TBI) report loss of friendship and reduced social participation after injury, but there is limited information regarding quantity of friends and methods of communication. Our objective was to characterize friendship networks, social participation, and methods of communication, including computer-mediated communication (CMC), used by adults with TBI compared to uninjured adults.

METHODS

Participants were 25 adults with TBI and 26 uninjured healthy comparisons (HC) adults, who completed the Participation Assessment with Recombined Tools-Objective (PART-O) and the Social Network Questionnaire (SNQ).

RESULTS

Adults with TBI had significantly fewer total friends and significantly lower levels of productivity and overall social participation. Face-to-face interaction was the preferred method of contact for both groups. Adults with TBI were significantly less likely to use texting as a primary method of communication than their uninjured peers, but used other methods of communication at similar rates.

CONCLUSION

Our study supports prior findings of reduced friendships and reduced social participation after TBI and adds new information about similarities and differences in communication methods between adults with and without TBI.

Friendship Quality, Friendship Quantity, and Social Participation in Adults with Traumatic Brain Injury

Adults with traumatic brain injury (TBI) often report reduced social participation and loss of friends, but little is known about quality of friendship after TBI. Our objective was to characterize social participation, friendship quantity, and friendship quality of adults with TBI and a comparison group of uninjured adults. Participants included 18 adults with moderate to severe TBI and 16 of their informant friends; and 18 uninjured adults and 11 of their informant friends. The main measures used were the Participation Assessment with Recombined Tools-Objective, the Social Network Questionnaire, and the McGill Friendship Questionnaire. Participants with TBI reported significantly less social participation and had fewer total friends, although this difference was not statistically significant. Adults with TBI differed from their friends on one measure of friendship quality, but reports for friendship quality were high in both groups. Adults with TBI reported overall high levels of friendship quality despite having lower levels of social participation compared with uninjured adults. Future research should investigate how the balance of quantity and quality of friendships relates to satisfaction with social participation and overall quality of life.

Social network members who engage in activities with older adults: Do they bring more social benefits than other members?

Active participation in social activities is important for the well-being of older adults. This study explored benefits of active social engagement by evaluating whether relationships that comprise active involvement (e.g., co-engagement in activities) bring more social benefits (i.e., social support, companionship, positive social influence) than other relationships that do not involve co-engagement. A total of 133 adults ages 60 years and older living in a rural Midwestern city in the United States were interviewed once and provided information on 1,740 social network members. Among 1,506 social relationships in which interactions occurred at least once a month, 52% involved engagement in social activities together and 35% involved eating together regularly. Results of the generalized linear mixed model showed that relationships involving co-engagement were significantly more likely to also convey social support (i.e., emotional, instrumental, informational), companionship, and social influence (encouragement for healthy behaviors) than relationships that do not involve co-engagement. Having more network members who provide companionship was associated with higher sense of environmental mastery, positive relations with others, and satisfaction with social network. Interventions may focus on maintaining and developing such social relationships and ensuring the presence of social settings in which co-engagement can occur. Future research may explore whether increasing co-engagement leads to enhanced sense of companionship and psychological well-being.

The relationship between social support networks and depression in the 2007 National Survey of Mental Health and Well-being

PURPOSE

Social isolation and low levels of social support are associated with depression. The purpose of the current study was to investigate the relationship between depression and social connectivity factors (frequency of contact and quality of social connections) in the 2007 Australian National Survey of Mental Health and Well-being.

METHODS

A national survey of 8841 participants aged 16-85 years was conducted. Logistic regression was used to investigate the relationship between social connectivity factors and 12-month prevalence of Major Depressive Disorder in the whole sample, as well as across three age groups: younger adults (16-34 years), middle-aged adults (35-54 years), and older adults (55+ years). Respondents indicated how often they were in contact with family members and friends (frequency of contact), and how many family and friends they could rely on and confide in (quality of support), and were assessed for Major Depressive Disorder using the World Mental Health Composite International Diagnostics Interview.

RESULTS

Overall, higher social connection quality was more closely and consistently associated with lower odds of the past year depression, relative to frequency of social interaction. The exception to this was for the older group in which fewer than a single friendship interaction each month was associated with a two-fold increased likelihood of the past year depression (OR 2.19, 95% CI 1.14-4.25). Friendship networks were important throughout life, although in middle adulthood, family support was also critically important-those who did not have any family support had more than a three-fold increased odds of the past year depression (OR 3.47, 95% CI 2.07-5.85).

CONCLUSIONS

High-quality social connection with friends and family members is associated with reduced likelihood of the past year depression. Intervention studies that target the quality of social support for depression, particularly support from friends, are warranted.

Associations between the structural and functional aspects of social relations and poor mental health: a cross-sectional register study

Background

Social relations influence mental health through different pathways. To capture the complexity of social relations, it is beneficial to consider both the structural (e.g., reachability of social network and social integration) and functional (e.g., instrumental and emotional support) aspects of the concept. Both aspects are rarely investigated simultaneously. This study aimed to examine the association between the structural and functional aspects of social relations and poor mental health.

Methods

The study was designed as a cross-sectional register study. We used data on mental health and social relations from 15,839 individuals aged 16–92 years with a mean age of 49.0 years (SD 17.9) who responded to The North Denmark Region Health Survey 2013 among residents in Northern Jutland, Denmark. The 12-Item Short-Form Health Survey measured mental health; a cut-off point of 44.5 was used to dichotomize participants into poor and good mental health. The categorization of social relations was inspired by Berkman et al.’s conceptual model of social relations and health. The analyses were performed with survey logistic regression.

Results

We found that 21.6% (n = 3422) of participants reported poor mental health, and 59% (n = 2020) of these were women. Being in contact with family and friends less than once a month statistically significantly increased the risk for poor mental health (Family OR = 1.78, 95% CI = 1.51–2.10 and Friends OR = 2.65, 95% CI = 2.30–3.06). The individuals who were not in contact with their network as often as they liked had a significantly higher risk for poor mental health (OR = 2.40, 95% CI = 2.20–2.62). Lack of instrumental support was associated with a higher risk for poor mental health (OR = 2.81, 95% CI = 2.26–3.48). We found an interaction between age and emotional support; the youngest population had the highest risk for poor mental health when they did not have access to emotional support (Young OR = 5.26, 95% CI = 3.91–7.09; Adult OR = 3.69, 95% CI = 3.17–4.30; and Elderly OR = 2.73, 95% CI = 2.23–3.34).

Conclusions

Both structural and functional aspects of social relations were associated with poor mental health in our study. Rarely being in contact with friends and a lack of network reachability were associated with poor mental health. Likewise, low levels of emotional and instrumental support were associated with poor mental health.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4871-x) contains supplementary material, which is available to authorized users.

Stress and wellbeing during chronic illness and partner death in later-life: the role of social support

Chronic illness and the death of a romantic partner are two of the most significant stressors reported by older adults, resulting in various physical and mental health consequences. Evidence suggests that social support is a key factor in understanding the association between chronic illness and widowhood and the wellbeing of older adults. Nevertheless, research into social support is often approached in an atheoretical manner when investigating these stressors in older adulthood. We attempt to address this theoretical chasm by proposing an integrative model to explain social support processes in older couples which draws on models of social support and attachment theory. Our model provides an important framework for understanding existing research findings as well as guiding future research.

Prevalence and Severity of Depression in a Pakistani Population with at least One Major Chronic Disease

INTRODUCTION

Diabetes, anaemia, hypertension and asthma are major contributors to morbidity in our society. Depression is the commonest psychological malady diagnosed in hospital settings. There tends to be some overlap between certain chronic systemic illnesses and depressive disorders, this point towards the need to determine relationships between them, if any.

AIM

To determine the prevalence and compare the severity of depression among individuals diagnosed with four of the most common chronic diseases in our community.

MATERIALS AND METHODS

This cross-sectional study was carried out among patients with chronic diseases visiting a tertiary care hospital in Karachi, Pakistan from August 2015 to August 2016. The Beck Depression Inventory-II*, a 21-item self-report instrument was used to assess the severity of depression. Categorical variables were compared using Chi-square test while intergroup comparisons were performed using one way ANOVA test. Logistic regression was employed to estimate the odds of Category B depression (moderate and severe levels of depression) in chronic diseases.

RESULTS

The prevalence of anaemia, hypertension, diabetes and asthma was 90%, 47%, 26% and 23% respectively. Predictors of Category B depression were anaemia (OR=4.21, 95% CI: 1.30-13.56) and diabetes (OR=2.03, 95% CI: 1.09-3.77). Asthma predicted Category B depression in males (OR=1.26, 95% CI: 0.29-5.42) but not in females (OR=0.77, 95% CI: 0.39-1.52). Individuals with hypertension were less likely to report Category B depression than non-hypertensive (OR=0.72, 95% CI 0.43-1.21). Female gender had a greater influence to develop Category B depression than males (OR= 2.96, 95% CI: 1.93-4.55).

CONCLUSION

Our study points towards a strong correlation between depression and chronic diseases especially anaemia and diabetes. This cautions medical practitioners against treatment of depressive disorders and chronic diseases as separate, independent entities.

"I've got somebody there, someone cares": what support is most valued following a stroke?

PURPOSE

There is often a need for increased support following a stroke. This study explored what types of support are provided by different network members and what support functions are most valued.

METHODS

Adults with first stroke were recruited from a stroke unit and participated in in-depth interviews 8-15 months poststroke. Framework Analysis was used to build thematic and explanatory accounts of the data.

RESULTS

Twenty-nine participants took part. Main themes to emerge were as follows: the spouse was the most important provider of support; children were a relatively stable source of support, although many participants expressed reservations about worrying a child; relatives and friends typically provided social companionship and emotional support rather than on-going practical support. The only universally valued support function was the sense that someone was concerned and cared. Other valued functions were as follows: social companionship including everyday social "chit chat"; practical support provided sensitively; and, for many, sharing worries and sensitive encouragement. The manner and context in which support was provided was important: support was easiest to receive when it communicated concern, and was part of a reciprocal, caring relationship.

CONCLUSIONS

As well as measuring supportive acts, researchers and clinicians should consider the manner and context of support. Implications for rehabilitation The manner in which support was provided mattered: support was easier to receive when it communicated concern. The spouse was the most important source of all support functions; children, relatives and friends were important providers of emotional and social companionship support. Researchers and clinicians should not only focus on what support is received, but also the context (e.g., contribution, reciprocity, quality of relationship) and manner (e.g., responsiveness, sensitivity) of the support.

Social support mediates the relationships between extraversion, neuroticism, and cognitive function in older adults

OBJECTIVES

We supplement existing findings on a link between social support and cognitive function in later life by considering the role of personality as an antecedent to both, and of social support as a mediator of the link between personality and cognitive function.

STUDY DESIGN

An observational cohort study.

METHODS

We evaluated social support using the Lubben Social Network Scale, across 624 adults aged over 60 years, and investigated this measure as a mediator of the relationships between extraversion and neuroticism at baseline 2007-2009, and cognitive function at follow-up, 2 years later. A half-longitudinal mediation design, within a structural equation modelling framework, was used.

RESULTS

There was a direct effect of extraversion, such that lower levels were related to higher scores of cognitive function. There was no significant direct effect of neuroticism on cognitive function at follow-up. Social support partially mediated the paths between both extraversion and neuroticism and cognitive function at follow-up. Decomposing the mediation effects by using social support subscales (measuring support from friends, relatives and neighbours) showed meaningful indirect effects for both predictors.

CONCLUSION

Results suggest that social support may offer a target for interventions for cognitively at-risk older adults and add to the existing empirical evidence describing the link between personality and cognitive function.

Systemic inflammatory markers and sources of social support among older adults in the Memory Research Unit cohort

Potential associations between systemic inflammation and social support received by a sample of 120 older adults were examined here. Inflammatory markers, cognitive function, social support and psychosocial wellbeing were evaluated. A structural equation modelling approach was used to analyse the data. The model was a good fit χ1082=256.13 , p < 0.001; comparative fit index = 0.973; Tucker-Lewis Index = 0.962; root mean square error of approximation = 0.021; standardised root mean-square residual = 0.074). Chemokine levels were associated with increased age ( β = 0.276), receipt of less social support from friends ( β = -0.256) and body mass index ( β = -0.256). Results are discussed in relation to social signal transduction theory.

Ethnic and Nativity Differences in the Social Support-Physical Health Association Among Black Americans

Despite an abundant literature on social support and health, relatively less is known about how support and its impact on physical health vary within the Black population. Using the National Survey of American Life (NSAL), this paper examines which sources and types of support are associated with physical health among African Americans, U.S.-born Caribbean Blacks and foreign-born Caribbean Blacks. The results showed that for U.S.-born Caribbean Blacks, being married was especially beneficial to health. Closeness to family was associated with better health while negative interactions with family members was associated with worse health for African Americans and foreign-born Caribbean Blacks. Different sources of instrumental support affected all three groups. Overall, the findings reveal that, among Black Americans, the association between social support and physical health is contingent upon ethnicity, nativity, and the ways in which social support and health are operationalized.

Help or Hindrance? How Family and Friends Influence Chronic Illness Self-Management among Older Adults

We contribute to knowledge about older adults with chronic illnesses by identifying positive and negative influences of family and friends on self-management. Thirteen focus groups were conducted in upstate New York with 84 African American and White men and women, 65 years old or older, with arthritis, diabetes, and/or heart disease. Specific positive and negative social network influences are discussed in the areas of disease management (medication management, dietary activities, physical activity, and health care appointments); decision-making about the illness; and psychosocial coping. Overall, we found many more positive than negative social network influences, and more negative influences from family members than from friends. We discuss differences between influences of family members versus friends, and point out a few suggestive differences by gender and race. We conclude with limitations of the study as well as implications for the design of self-management interventions involving family members and friends.

Health Change in Retirement

This study examined health change in retirement. Using multiactor panel data on 778 Dutch older workers who experienced the transition into retirement, ordinary least squares regression models were estimated to explain changes in medical consumption, the severity of health problems, and perceived health. The results show that retirement does not categorically harm or benefit health. Instead, health consequences vary across individuals and according to the health measures adopted. The results suggest that employees' failure to control retirement according to their wishes adversely affects health. Older workers who perceived retirement as involuntary showed decreases in perceived health. The results do not provide empirical support for the hypothesis that the health consequences of retirement differ according to working conditions or job characteristics or older workers' access to resources in terms of income and social contacts. Psychological factors play a role: Fear of retirement and self-efficacy are associated with health change in retirement.

Social ties and psychological well-being in late life: the mediating role of relationship satisfaction

OBJECTIVE

The current paper examines whether quantitative aspects of social support (i.e., support network characteristics) indirectly influence psychological well-being via older adults' qualitative perceptions of support (i.e., satisfaction with social relationships).

METHODS

A sample of 416 adults aged ≥60 was drawn from the Social Integration and Aging Study, a community-based survey conducted in a small US (Midwestern) city. The survey assessed social networks, social support, and physical and mental health among older adults.

RESULTS

Bootstrapping was used to examine mediation models. Greater support network size predicted lower perceived stress, fewer depressive symptoms, and better life satisfaction, yet this association was fully mediated by relationship satisfaction. For support network composition, greater proportion kin was associated with lower stress and better life satisfaction, though not depressive symptoms, however, relationship satisfaction did not mediate this link.

DISCUSSION

Findings highlight the complex interplay of support network characteristics and satisfaction, and suggest the greater import of support satisfaction for older adults' psychological well-being.

Concept of family insufficiency in the aged: critical literature analysis

OBJECTIVE

to identify the attributes of the "family insufficiency" concept of the aged in the literature.

METHOD

critical literature analysis.

RESULTS

family insufficiency is characterized as a complex process of psychosocial interaction, founded mainly on low social support of the aged and impaired family ties. Its antecedents are found in contemporary transformations within the family system, intergenerational conflicts, impaired family relationships and social vulnerability of the family. The consequences of family insufficiency include social vulnerability of the aged, decline of psychological and functional health, lower quality of life and unsuccessful aging. An original theoretical proposal was elaborated for the concept of family insufficiency in the elderly, with the identification of its attributes, antecedents and consequences.

CONCLUSION

the findings of this study constitute a theoretical advancement in the Family Insufficiency Syndrome in elderly people and provide data for future field research in developing the concept.

Receiving Instrumental Support in Late Parent-Child Relationships and Parental Depression

OBJECTIVES

This study investigates the role of gender, functional limitations, and social interaction in the association between instrumental support from adult children and parental depression. We apply self-determination theory to hypothesize about the role of physical needs and social resources on parental depression in a European context.

METHOD

A sample of 6,268 parents older than 65 who have nonresident children from the first wave of Survey of Health, Ageing and Retirement in Europe (2004) is analyzed. We estimate logistic regression models to test for the association between instrumental support and depression. Physical needs, gender, and social interaction are used as moderators.

RESULTS

Net of core factors that contribute to depression, including previous history of depression, there is a U-shaped pattern between receiving instrumental support and depression that persists across country regimes. For respondents with medium physical limitations, too little or too frequent support from children is associated with higher depression. For respondents with severe limitations, receiving at least some support is better than receiving none at all. The receipt of too frequent support from children increases the level of depression more for women than men. All interaction effects are comparable across country regimes.

DISCUSSION

Heterogeneity in physical needs and resources of older individuals must be taken into account when assessing the effects of instrumental support on mental health.

Quality of Life Is Related to Social Support in Elderly Osteoporosis Patients in a Chinese Population

OBJECTIVE

To explore the association between quality of life and social support in elderly osteoporosis patients in a Chinese population.

METHODS

A total of 214 elderly patients who underwent bone mineral density screening were divided into two groups: elderly patients with primary osteoporosis (case group, n = 112) and normal elderly patients (control group, n = 102). Quality of life and social support were compared between the two groups.

RESULTS

Quality of life and social support were significantly different between the case and control groups. The physical function, role-physical, bodily pain, general health, vitality, social-functioning, role-emotional and mental health scores in case group were significantly lower than those in the control group (P < 0.01). The objective support, subjective support, utilization of support, and total scores in case group were significantly lower than those in the control group (P < 0.01). Quality of life and social support were positively correlated in the case group (r = 0.672, P < 0.01).

CONCLUSION

Quality of life and social support in elderly patients with osteoporosis in China were poorer than in elderly patients without osteoporosis and were positively correlated. Our findings indicate that increased efforts to improve the social support and quality of life in elderly osteoporosis patients are urgently needed in China. Further longitudinal studies should be conducted to provide more clinical evidence to determine causative factors for the observed association between risk factors and outcomes.

The development of a three part model of psychological resilience

Psychological resilience has been defined as the ability of an individual to recover from a traumatic event or to remain psychologically robust when faced with an adverse event. This study investigated a sample of 176 police officers who were surveyed at commencement of their training in 1998/1999 (Time 1), 12 months later (Time 2), and at the end of 2009 (Time 3). A multidimensional model of psychological resilience (including environment, thoughts, feelings, behaviours, and physical activities) was evaluated in terms of the pathogenic outcomes of posttraumatic stress, psychological distress, and physical health at the three time points. A three part model of psychological resilience (environment, physical behaviours, and cognitions) was used to demonstrate that social support, adaptive health practices, adaptive coping, and optimism were effective when police officers were faced with adversity. The model provides initial understandings of the multidimensional nature of psychological resilience which requires further evaluation.

Relative contributions of naturalistic and constructed support: two studies of women with type 2 diabetes

Do distinct sources of social support have differential effects on health? Although previous research has contrasted family and friend support (naturalistic support), research on the relative effects of naturalistic support and constructed support (e.g., support groups) is extremely rare. Two studies of women with type 2 diabetes were conducted that assessed the independent effects of naturalistic and constructed support on physical activity and glycosylated hemoglobin (HbA1c). Participants were women diagnosed with type 2 diabetes from the intervention arms of two randomized controlled trials: primarily European American women (Study 1; N = 163) and exclusively Hispanic women (Study 2; N = 142). Measures assessed physical activity, HbA1c, and friend and family support at baseline and at 6 months, as well as group support after 6 months of intervention. In Study 1, only group support was related to increases in physical activity (ΔR(2) = .036). In Study 2, group support and family support showed independent effects on increases in physical activity (ΔR(2) = .047 and .060, respectively). Also, group support was related to decreases in HbA1c in Study 1 (ΔR(2) = .031) and Study 2 (ΔR(2) = .065). Overall, constructed (group) support was related to outcomes most consistently, but naturalistic (family) support showed some independent relation to physical activity improvement.

The roles of different sources of social support on emotional well-being among Chinese elderly

BACKGROUND

Social support has been widely known as a protective factor for the emotional well-being (EWB) of older adults, but less studies have investigated the roles of different sources of social support (i.e., family and friend support) on different facets of EWB (i.e., positive affect and negative affect) simultaneously.

METHODOLOGY AND FINDINGS

In this study, the associations between family/friend support and positive/negative affect were investigated in a sample of 700 Chinese elderly. The EWB and social support were measured with a 12-item affective wordlist (Kahneman et al., 2004) and a self-prepared questionnaire. The results showed that (1) the order of contact frequency and mutual support followed a hierarchical order from spouse, children, to friends; (2) zero-order correlations of both family support and friend support were associated with more positive affect and less negative affect; and when compared with the relative role of family and friend support, (3) spouse (children if spouse is not available) support had greater contribution on decreasing negative affect, while friend support had greater influence on increasing positive affect, even after controlling the demographic, self-rated health and life events variables.

CONCLUSION

Family and friend support play different roles on the two facets of EWB of the elderly. These results were better explained in light of the task specificity model rather than the hierarchical compensatory model. Moreover, positive affect may be enhanced by friend support (based on personal interests and selectable) rather than family support (bonded by kinship and not selectable), which added evidences to the socioemotional selectivity theory.

Effects of social ties on self-rated physical health among African American adults

OBJECTIVES

To examine associations between social ties and self-rated physical health among midlife and older African Americans.

METHODS

Cross-sectional analysis of the 2005-2006 Milwaukee African American oversample of the second Midlife Development in the United States (MIDUS II) study. Multivariate logistic regression examined associations between type of social ties (family or friends), their frequency (number of contacts), and their quality (support and strain) with betterself-rated physical health (SRPH). We defined better SRPH to include self-reports of good, very good, or excellent SRPH: this category was compared with fair or poor SRPH. Control variables included demographic factors; social engagement characteristics such as working, volunteering, and caregiving; and measures of social structure such as types of discrimination experience and ratings of neighborhood quality.

RESULTS

In adjusted results, each additional degree of family support was associated with better self-rated physical health (odds ratio [OR], 1.59; 95% confidence interval (CI], 1.14-2.22). Each additional reported incident of daily discrimination was associated with 9% lower odds of reporting better SRPH (OR, 0.91; CI, 0.83-0.99).

DISCUSSION

Results suggest quality of family support may contribute importantly to the health of African Americans. When working with midlife and older African Americans, providers should engage and support families as a vital resource to improve health.

Effects of depressive symptoms and family satisfaction on health related quality of life: the Hong Kong FAMILY study

OBJECTIVE

To examine the effect of depressive symptoms and satisfaction with family support (FS) on physical and mental Health Related Quality of Life (HRQoL).

METHODS

Data were obtained from the Hong Kong FAMILY Project baseline survey in 2009-2011, which included 16,039 community residents (age ≥ 20). The FS was measured using the Family Adaptation, Partnership, Growth, Affection, Resolve (APGAR, range 0-10) Questionnaire. HRQoL were assessed using the SF-12 version 2. Depressive symptoms were recorded using the Patient Health Questionnaire-9 (PHQ-9). Demographic and lifestyle variables, stressful life events, perceived neighborhood cohesion were also assessed.

RESULTS

In a multilevel regression model, socio-demographic and behavioral variables explained 21% and 19% of the variance in physical and mental HRQoL. The presence of depressive symptoms (PHQ-9 score ≥ 10, standardized coefficients, β of -1.73) and high FS (APGAR score 7-10, 1.15) were associated with mental HRQoL, after adjustment for age, education, household monthly income, drinking status, physical activity, chronic conditions, life stress and neighborhood cohesion. Not FS but the presence of depressive symptoms (β of -0.88) was associated with physical HRQoL. The presence of depressive symptoms in women than men were more associated with a poorer physical HRQoL (p<0.01) while depressive symptoms in men were associated with a decrease in mental HRQoL (p<0.001). The interaction between FS and depressive symptoms was nonsignificant in relation to HRQoL. Among those with depressive symptoms, high FS was associated with a better mental HRQoL (41.1 vs. 37.9, p<0.001) in women but not contribute to variance in men.

CONCLUSIONS

Higher FS and presence of depressive symptoms were significantly associated with HRQoL in general population in Hong Kong. Among those with depressive symptoms, high FS was associated with a favorable mental HRQoL in women but not men.