Chronic Stress, Coping, and Mental Health Among Older African Americans

Contribution of Involuntary Job Loss to the Burden of Depressive Symptoms Over Two Decades in a National Study of Aging Adults

OBJECTIVES

In recent decades, risk of job loss in America after age 50 has been high, potentially causing significant stress during the period preceding retirement. Yet no study has quantified the burden of clinically relevant depressive symptoms attributable to job loss in this age group over this period or identified the most vulnerable populations.

METHODS

Participants aged 50+ in the Health and Retirement Study (recruited 1992-2016) who were employed and scored <5 on the Center for Epidemiologic Studies-Depression 8-item scale (CESD-8) at baseline (N = 18,571) were followed for depressive symptoms until they first had CESD-8 ≥5 or died, or through the 2018 survey. Parametric g-formula analyses examined the difference in cumulative risk of having CESD-8 ≥5 if there had been no involuntary job loss compared to the observed scenario, adjusting for sex, race/ethnicity, age, and dynamic measures of recent marriage end (divorce or widowhood), having a working spouse, assets/debt, and health changes.

RESULTS

We estimated that risk of CESD-8 ≥5 would have been 1.1% (95% confidence interval [0.55, 1.37]) lower if no involuntary job loss had occurred; job loss accounted for 11% of the total burden among those who lost a job. Stronger associations were observed for women (1.2% [0.7, 1.8] vs men 0.5% [0.2, 1.1]), White respondents (1.0% [0.6, 1.5] vs Black respondents 0.5% [-0.1, 1.4]), and those in the lowest quartile of baseline assets (1.1% [0.4, 1.9] vs wealthiest quartile 0.5% [-0.4, 0.9]).

DISCUSSION

Involuntary job loss is associated with high depressive symptom burden in older persons, suggesting that screening and intervention soon after job loss may help mitigate depression.

Flourishing Among Elderly Population: The Role of Social Support and Gratitude

This paper sets out a framework for exploring flourishing in older age through the lens of social support and gratitude. Flourishing is a relatively new concept in positive psychology. Social support and gratitude are as potential predictors of flourishing among older individuals that considers hedonic and eudaimonic aspects of well-being. The current study evaluated the relationship between social support and gratitude associated with flourishing among elderly people. The proposed relationship was assessed among 413 elderly people from north India aged 60-90 years with a mean age of 67.94 years. The data were analysed using a two-step approach to structural equation modeling. The findings revealed that gratitude as a mediator in the relationship between social support and flourishing. Additionally, a significant indirect relationship was also found between perceived social support and flourishing via gratitude. To the best of our knowledge, the current study is one of the first studies that conceptualizes and assesses flourishing among older adults in India. The findings from the present study make important contributions to the existing literature on well-being among elderly population. It is suggested that health and social care professionals working with older adults adopt a comprehensive approach to identify and propel non-flourishing people toward flourishing in life.

Development and validation of a nomogram for predicting sever cancer-related fatigue in patients with cervical cancer

OBJECTIVE

Cancer-related fatigue (CRF) has been considered the biggest influencing factor for cancer patients after surgery. This study aimed to develop and validate a nomogram for severe cancer-related fatigue (CRF) patients with cervical cancer (CC).

METHODS

A cross-sectional study was conducted to develop and validate a nomogram (building set = 196; validation set = 88) in the Department of Obstetrics and Gynecology of a Class III hospital in Shenyang, Liaoning Province. We adopted the questionnaire method, including the Cancer Fatigue Scale (CFS), Medical Uncertainty in Illness Scale (MUIS), Medical Coping Modes Questionnaire (MCMQ), Multidimensional Scale of Perceived Social Support (MSPSS), and Sense of Coherence-13 (SOC-13). Binary logistic regression was used to test the risk factors of CRF. The R4.1.2 software was used to develop and validate the nomogram, including Bootstrap resampling method, the ability of Area Under Curve (AUC), Concordance Index (C-Index), Hosmer Lemeshow goodness of fit test, Receiver Operating Characteristic (ROC) curve, Calibration calibration curve, and Decision Curve Analysis curve (DCA).

RESULTS

The regression equation was Logit(P) = 1.276-0.947 Monthly income + 0.989 Long-term passive smoking - 0.952 Physical exercise + 1.512 Diagnosis type + 1.040 Coping style - 0.726 Perceived Social Support - 2.350 Sense of Coherence. The C-Index of the nomogram was 0.921 (95% CI: 0.877∼0.958). The ROC curve showed the sensitivity of the nomogram was 0.821, the specificity was 0.900, and the accuracy was 0.857. AUC was 0.916 (95% CI: 0.876∼0.957). The calibration showed that the predicted probability of the nomogram fitted well with the actual probability. The DCA curve showed when the prediction probability was greater than about 10%, the benefit of the nomogram was positive. The results in the validation group were similar.

CONCLUSION

This nomogram had good identifiability, accuracy and clinical practicality, and could be used as a prediction and evaluation tool for severe cases of clinical patients with CC.

Exploring self-care practices of African American informal kinship caregivers

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

A phenomenological, intersectional understanding of coping with ageism and racism among older adults

The aim of this qualitative, phenomenological study was to understand how older adults cope with experiences of ageism and racism through an intersectional lens. Twenty adults 60+ residing in the U.S. Mountain West who identified as Black, Hispanic/Latino(a), Asian-American/Pacific Islander, Indigenous, or White participated individually in a one-hour, semi-structured interview. A team of five coders engaged in an inductive coding process through independent coding followed by critical discussion. Peer debriefing enhanced credibility. Nine themes were organized by three umbrella categories: Coping with ageism: 1) distancing via self-determination/defying stereotypes, 2) distancing by helping others; Coping with racism: 3) resistance, 4) exhaustion; Coping with both ageism and racism: 5) increased awareness through aging, 6) healthy lifestyle, 7) education, 8) acceptance/ 'let it go', and 9) avoidance. Novel findings include how older adults may cope with ageism and racism via increased awareness through aging and with ageism specifically by helping peer older adults, although instances of internalized ageism were noted and discussed. The themes exemplify problem-focused (e.g., helping others) and emotion-focused (acceptance), as well as individual (e.g., self-determination) and collective (e.g., resistance) coping strategies. This study can serve as a resource for practitioners in applying a more nuanced understanding of the ways older adults cope with ageism and racism in later life.

Chronic stressors, coping strategies, and depressive symptoms: A comparison across older age groups

Late-life depression is a prevalent mental health problem among older adults. Variations may exist in the intensity of chronic stressors experienced by people in different older age groups and their effects on depressive symptoms. To examine differences among older adults by age group in the experienced intensity of chronic stressors in relation to coping strategies and depressive symptoms. Participants were 114 older adults. The sample was divided into three age groups: 65-72, 73-81, and 82-91. The participants completed questionnaires on coping strategies, depressive symptoms, and chronic stressors. Moderation analyses were conducted. The lowest levels of depressive symptoms were in the young-old age group and the highest levels were in the oldest-old age group. The young-old age group used more engaged and less disengaged coping strategies than the two other groups. The association between intensity of chronic stressors and depressive symptoms was stronger in the two older age groups compared to the youngest (moderating effect of age groups). Differences exist in the relationships among chronic stressors, coping strategies, and depressive symptoms by age groups in the older adult population. Professionals should be aware of the possible differences between age groups in depressive symptoms and the impact of stressors on depressive symptoms in different older adult age groups.

Did Resilience and Socioeconomic Status Predict Older Adults' Finding a Silver Lining in COVID?

Background and Objectives

The coronavirus disease 2019 (COVID-19) pandemic stretched our limits-physically, mentally, and economically. However, some older adults report that it led to positive changes. This study aims to understand whether prepandemic resilience, education, or income predicted older adults' subsequent likelihood of reporting positive changes in their lives during the pandemic.

Research Design and Methods

We use data from the National Social Life, Heath, and Aging Project, an ongoing panel study with a COVID-19 ancillary supplement (N = 2,650).

Results

The study results aligned with the fundamental cause theory. In demographically adjusted models including resilience, education, and income, as well as the effect of the pandemic on employment and a COVID-disruption score, the odds of reporting any positive change were 2.6 times higher for those with an associate degree (p < .01) and 4.7 times higher for those with a bachelor's or higher (p < .001), compared to those without a high school degree. In contrast, neither resilience nor income was significantly associated with endorsing a positive change. We also categorize specific changes thematically coded from open-ended responses and examine their demographic distributions. Categories include spirituality, home organization, hygiene practices, and increased quality time with others.

Discussion and Implications

These findings show that older adults with more education could navigate COVID-19 challenges in a way that improved their perspectives on at least one aspect of their lives.

Contemporary Research on Older Black Americans, a Special Issue of Journal of Aging and Health in Honor of the Life and Legacy of James S. Jackson

This special issue of the Journal of Aging and Health honors the memory of James Jackson by elevating his many research contributions to the physical and mental health of older Black Americans. The articles focus on the central problems and questions that James Jackson addressed throughout his illustrious career. All articles in the special issue focus on older Black Americans and include at least one of the following elements: (1) articles based on the National Survey of American Life, the data set for which James Jackson was the Principal Investigator; (2) articles that utilize the Environmental Affordances Model which was developed by James Jackson; (3) articles that include the Everyday Discrimination scale which was originally published by David Williams, James Jackson, and colleagues; (4) and articles based on the Health and Retirement Study (HRS), the data set for which James Jackson served as Editor for a special issue of The Gerontologist.