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Wang P, Cheng X, Zhang N, Liu H. Childhood adversity and depression of older adults: the moderating effect of social participation. Front Psychol 2024; 15:1376155. [PMID: 39149706 PMCID: PMC11324474 DOI: 10.3389/fpsyg.2024.1376155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 07/22/2024] [Indexed: 08/17/2024] Open
Abstract
Objective Examine the effect of childhood adversity on depression in older adults and the regulatory impact that social participation has on depression. Methods Based on 6,704 standard-compliant research subjects, single factor analysis, multiple linear regression model, and tendency score matching were used to analyze the impact of childhood adversity on depression in older adults and the regulatory effect of social participation. Results The depression rate is higher among women, young age, low education, unmarried, in agricultural households, older adults with low annual income, pre-retirement work type in agriculture, non-drinking, and those with two or more chronic diseases (p < 0.05). Children who experienced adversity as children are more likely to suffer from depression as adults (β = 0.513, 0.590, 0.954, 0.983, 1.221, 0.953, 0.718; p < 0.05). Through the tendency score, the result is matched with the endogenous test. As well, older adults are more likely to suffer psychological damage from a greater number of childhood adversities in their early years (β = 1.440, 2.646, 4.122; p < 0.001). It has been shown that social participation will reduce the negative impact of low-income family economic circumstances on depression among older adults of all ages (β = -0.459,-0.567; p < 0.01), aggravate depression resulting from "neighborhood void of mutual assistance" and "no more fun to play" for older adults of all ages (β = 1.024, 0.894; p < 0.01), and exacerbate depression resulting from "loneliness because there are no friends" for the oldest old (β = 0.476, 0.779; p < 0.05). Conclusion Older adults who experience childhood adversity are more likely to suffer from depression. Social participation plays a regulatory role in the relationship between childhood adversity and depression in older adults. For older adults' mental health to improve, family and social adversity should be prevented, and moderate participation in society should be encouraged.
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Affiliation(s)
- Ping Wang
- School of Management, Xi'an University of Science and Technology, Xian, China
| | - Xin Cheng
- School of Management, Xi'an University of Science and Technology, Xian, China
| | - Nan Zhang
- School of Management, Xi'an University of Science and Technology, Xian, China
| | - Huilin Liu
- Department of Rehabilitation, Xijing Hospital, Air Force Medical University, Xian, China
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2
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Reiner A, Steinhoff P. The association of social networks and depression in community-dwelling older adults: a systematic review. Syst Rev 2024; 13:161. [PMID: 38902787 PMCID: PMC11188217 DOI: 10.1186/s13643-024-02581-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/10/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Depression is a globally prevalent mental condition, particularly among older adults. Previous research has identified that social networks have a buffering effect on depression. Existing systematic reviews have either limited their research to specific geographic areas or provided evidence from over a decade ago. The vast body of recent literature particularly from the last decade emphasizes the need for a comprehensive review. This systematic review aims to analyze the association of structural aspects of social networks and depression in older adults. METHODS The electronic databases APA PsycINFO, ProQuest, PSYINDEX, PubMed, Scopus, SocINDEX, and Web of Science were searched from date of data base inception until 11 July 2023. Studies were eligible for inclusion if they reported on community-dwelling older adults (defined as a mean age of at least 60 years old), had an acceptable definition for depression, referred to the term social network in the abstract, and were published in English. Quality was appraised using the Newcastle Ottawa Scale for cross-sectional and longitudinal studies. Outcome data were extracted independently from each study and analyzed by direction of the relationship, social network domain and cross-sectional or longitudinal study design. RESULTS In total, 127 studies were included. The study categorizes structural network aspects into seven domains and finds that larger and more diverse networks, along with closer social ties, help mitigate depression. The literature on the relationships between depression and network density, homogeneity, and geographical proximity is scarce and inconclusive. DISCUSSION AND IMPLICATIONS: Despite inconsistent findings, this review highlights the importance of quantifying complex social relations of older adults. Limitations of this review include publication and language bias as well as the exclusion of qualitative research. Further research should use longitudinal approaches to further investigate the reciprocal relationship between social networks and depression. Following this review, interventions should promote the integration of older adults in larger and more diverse social settings. Other: This work was supported by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Grant [454899704]. This systematic review was pre-registered. The review-protocol can be accessed at https://doi.org/10.17605/OSF.IO/6QDPK .
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Affiliation(s)
- Amelie Reiner
- Institute of Sociology and Social Psychology, University of Cologne, Albertus-Magnus-Platz, 50923, Cologne, Germany.
| | - Paula Steinhoff
- Institute of Sociology and Social Psychology, University of Cologne, Albertus-Magnus-Platz, 50923, Cologne, Germany
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Yuan L, Yu B, Bing Y, Du M, Zhao Z, Sun J. Gender differences in depressive symptoms among Chinese older adults based on fairlie decomposition analysis. Heliyon 2023; 9:e21555. [PMID: 37954279 PMCID: PMC10637998 DOI: 10.1016/j.heliyon.2023.e21555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/14/2023] Open
Abstract
This study aimed to investigate the factors influencing depressive symptoms among Chinese older adults based on gender differences. Data from the eighth wave of Chinese Longitudinal Health Longevity Survey were used. We analyzed the influencing factors of depressive symptoms reported by older adults using the chi-squared test and logistic model. Fairlie decomposition analysis was performed to quantify the contribution level of each influencing factor. We found that 11.71 % of older adults met the CES-D-10 criteria for depressive symptoms. Females (13.89 %) reported a significantly higher level of depressive symptoms than males (9.24 %). Age, residence, sleeping time, exercise, activities of daily living functional disability, instrumental activity of daily living functional disability, and living status influenced depressive symptoms in older adults. Higher education and lower body mass index were only significant in male, whereas middle annual income and exercising were significant only in female. The Fairlie decomposition model explained the reasons for 75.64 % of the gender differences in depressive symptoms, with instrumental activity of daily living functional disability (33.60 %), age (-17.79 %), and education level (17.41 %) being major factors affecting gender differences in depressive symptoms. This is the first nationwide study to examine gender differences in depressive symptoms among older adults. These results provide a basis for relevant Chinese government departments to formulate policies to prevent and control depressive symptoms.
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Affiliation(s)
- Lei Yuan
- Department of Health Management, Faculty of Military Health Service, Naval Medical University, Shanghai, China
| | - Boyang Yu
- Department of Medical Health Service, General Hospital of Northern Theater Command of PLA, Shenyang, China
| | - Yan Bing
- Department of Health Management, Faculty of Military Health Service, Naval Medical University, Shanghai, China
| | - Maolin Du
- Department of Office, Naval Medical University, Shanghai, China
| | - Zhe Zhao
- Department of Health Management, Faculty of Military Health Service, Naval Medical University, Shanghai, China
| | - Jinhai Sun
- Department of Health Management, Faculty of Military Health Service, Naval Medical University, Shanghai, China
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4
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Lin X, Liu S, Hu Z, Xu H. Social activities and long-term depressive-symptoms trajectories among middle-aged and older adults in China: a population-based cohort study. Front Psychiatry 2023; 14:1131084. [PMID: 37663611 PMCID: PMC10469621 DOI: 10.3389/fpsyt.2023.1131084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 07/25/2023] [Indexed: 09/05/2023] Open
Abstract
Background The association between social activities and depressive symptoms remains unclear. This study aimed to explore the relationship between social activities at baseline and the long-term depressive-symptoms trajectories among a cohort of middle-aged and older adults in China. Methods This study included 13,258 participants aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms across four waves from 2011 to 2018 were evaluated using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Four types of social activities were assessed at baseline by self-report: (1) interacting with friends; (2) playing Mahjong, chess, and cards or attending a community club; (3) providing help to family, friends, or neighbors; and (4) attending a sporting or social event or club. Group-based trajectory modeling (GBTM) was used to map depressive-symptoms trajectories during the follow-up period. Results Not interacting with friends at baseline was associated with an increased risk of increasing (adjusted odds ratio [aOR]: 1.21, 95% confidence interval [CI]: 1.03, 1.41) and severe-stable (aOR: 1.35, 95% CI: 1.10, 1.65) depressive-symptoms trajectories. Participants who did not play Mahjong, cards, or chess and did not attend a sporting or social event or club at baseline were more likely to have mild-stable, decreasing, increasing, and severe-stable depressive-symptoms trajectories. Conclusion Social activities play an important role in long-term depressive-symptoms trajectories in middle-aged and older Chinese adults. Interacting with friends, attending sports, or social clubs may prevent depressive symptoms.
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Affiliation(s)
| | | | | | - Huilan Xu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
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5
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Effectiveness of Social Support for Community-Dwelling Elderly with Depression: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10091598. [PMID: 36141210 PMCID: PMC9498411 DOI: 10.3390/healthcare10091598] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/18/2022] [Accepted: 08/21/2022] [Indexed: 11/17/2022] Open
Abstract
Depression in the elderly is an important health factor that requires intervention in the form of social support resources. The purpose of this study was to conduct a systematic review, while synthesizing available evidence on what kind of social support, such as social participation and social connection/network, is effective for depression in the elderly. We performed a quality assessment of the included studies using the revised Risk of Bias for Non-randomized Studies tool and a meta-analysis of studies published up to 14 May 2021. Of the 3449 studies, 52 were relevant to this study. The various types of social resource applications reported in these were classified into three types: social support, social participation, and social connection/network. The social support group had significantly lower depression compared to the control group (0.72 [0.65, 0.81], p < 0.00001, I2 = 92%). There was a significant decrease in depression in the social participation group compared to the control group (0.67 [0.56, 0.80], p < 0.00001, I2 = 93%) (2.77 [1.30, 5.91], p = 0.008, I2 = 97%) (0.67 [0.56, 0.80], p < 0.00001, I2 = 93%). Finally, the social connection/network group showed decreased depression compared to the control group (2.40 [1.89, 3.05], p < 0.00001, I2 = 24%) (0.83 [0.76, 0.90], p < 0.00001, I2 = 94%). The results of this systematic review confirmed the effects of various social support interventions in reducing depression among the elderly living in the community.
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Lee H, Chu HS. The effects of changes in daily life due to the COVID-19 pandemic on the depressive symptoms among community-dwelling older adults in Korea. Int J Ment Health Nurs 2022; 31:974-984. [PMID: 35416403 PMCID: PMC9111562 DOI: 10.1111/inm.13008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 11/30/2022]
Abstract
This study aims to identify the effects of daily life changes due to the coronavirus disease 2019 pandemic on the depressive symptoms among community-dwelling older adults. This cross-sectional and secondary data analysis study collected and analysed the data of 72 335 older adults aged older than 65 who participated in the 2020 Korean Community Health Survey. Changes in daily life due to the coronavirus disease 2019 pandemic were measured by changes in physical activity, sleep duration, consumption of instant foods or soda drinks, alcohol consumption, smoking, and social contact compared to before the pandemic as perceived by the participants. The Patient Health Questionnaire-9 was used to assess depressive symptoms, and multiple logistic regression analysis was conducted to explore the relationship between the two. After adjusting for socio-demographic and health-related factors, changes in daily life due to the coronavirus disease 2019 pandemic that affected depressive symptoms in older adults living in the community were observed. This study confirmed that changes in daily life due to the coronavirus disease 2019 pandemic negatively affected the mental health of older adults. Thus, there is a need to improve social support and care systems, by including non-face-to-face programmes using remote communication technology. It will allow older adults to maintain their daily lives and mental health during the COVID-19 pandemic.
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Affiliation(s)
- Hanyi Lee
- College of Nursing, Hanyang University, Seoul, South Korea
| | - Hyeon Sik Chu
- College of Nursing, Hanyang University, Seoul, South Korea.,Department of Neurology, Hanyang University Hospital, Seoul, South Korea
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Liu CC, Lin YT, Cheng KC, Pan HH, Chiou CP. Predictors of Depression Level among Community-Dwelling Elderly Persons. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159414. [PMID: 35954771 PMCID: PMC9367993 DOI: 10.3390/ijerph19159414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 12/03/2022]
Abstract
Elderly people in the community have difficulty taking care of themselves because of their inability to care for themselves in daily life as well as their poor social support system, which leads to loneliness, resulting in depression. The primary objective was to investigate the level of depression and related factors among community-dwelling elderly persons (CDEP). This was a cross-sectional study, and 150 participants were interviewed. The questionnaires included demographics, the Functional Independence Measure, the Interpersonal Support Evaluation List, the UCLA Loneliness Scale, and the Geriatric Depression Scale Short Form. It was found that participants with different levels of depression accounted for 26%, and education level, living status, chronic disease, daily life function, social support, and loneliness were all significant factors influencing the depression level among the CDEP that could significantly predict 63.4% of the variation in depression level. Nursing staff must understand the level of depression and its influencing factors, encourage the elderly in the community to increase social networks, and integrate leisure into their lives, thereby enhancing the sense of value and meaning of life and reducing feelings of loneliness and depression.
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Affiliation(s)
- Chin-Chen Liu
- Department of Family Medicine, E-Da Dachang Hospital, Kaohsiung City 82445, Taiwan;
| | - Yi-Tung Lin
- Department of Nursing, E-Da Hospital, Kaohsiung City 82445, Taiwan;
| | - Kung-Chuan Cheng
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung City 83340, Taiwan;
| | - Hsueh-Hsing Pan
- School of Nursing, National Defense Medical Center, Taipei City 11420, Taiwan
- Correspondence: (H.-H.P.); (C.-P.C.); Tel.: +886-2-87923100 (ext. 18166) (H.-H.P.); +886-9-21299091 (C.-P.C.)
| | - Chou-Ping Chiou
- School of Nursing, I-Shou University, No. 8, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, Kaohsiung City 84020, Taiwan
- Correspondence: (H.-H.P.); (C.-P.C.); Tel.: +886-2-87923100 (ext. 18166) (H.-H.P.); +886-9-21299091 (C.-P.C.)
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8
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Gender Differences in Correlates of Loneliness among Community-Dwelling Older Koreans. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127334. [PMID: 35742581 PMCID: PMC9224515 DOI: 10.3390/ijerph19127334] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022]
Abstract
Background: Despite a relatively large number of studies exploring late-life loneliness, few studies have compared gender differences in the correlates of loneliness of older adults. Thus, we examined the gender differences in correlates of loneliness among community-dwelling older adults. Methods: This study was a secondary analysis of data from a parent study conducted among community-dwelling Koreans 65 years of age or older. Loneliness was measured by the 20-item Revised University of California Los Angeles Loneliness Scale. As potential correlates, demographic, health-related, and social variables were included. Multivariate hierarchical regression analyses were performed separately by gender. Results: Men were more likely to be lonely than women, after controlling for demographic, health-related, and social variables. A social network of family ties and being married were found to be inversely correlated with loneliness in men but not in women. A social network of friendship ties and participation in a variety of community activities were inversely correlated with loneliness in both men and women. Conclusions: A social network of family ties and being married may help reduce late-life loneliness, particularly among men. This study highlights the importance of considering gender differences in the design of strategies for preventing and alleviating late-life loneliness.
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9
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Yu X, Liu S. Stressful Life Events and Chinese Older People Depression: Moderating Role of Social Support. Front Public Health 2022; 9:768723. [PMID: 34976928 PMCID: PMC8718507 DOI: 10.3389/fpubh.2021.768723] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/29/2021] [Indexed: 01/18/2023] Open
Abstract
Aim: This study analyzes the effects of retrospective stressful life events on current depression among Chinese older people and how these effects are moderated by social support. Stressful life events comprise bereavement, divorce, health adversities, accidents, and financial losses due to fraud. Data and Method: Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS) of the 2015 panel, and responses from 9,619 older people aged over 60 years were used. The least-squares regression method was applied to measure the linear effects. Propensity score matching minimized selection bias and enabled the measurement of the net effects of stressful life events. The bias-corrected matching estimator was also used to correct the inexact matching bias from propensity score matching. Result: Experienced stressful life events and exposure to cumulative stressful life events were found to lead to depression in older people. When older people experienced stressful life events but with more social activities, and higher satisfaction and frequent contact with children, their depressive levels were lower. The results of the propensity score matching showed that stressful life events resulted in depression in older people. Furthermore, individuals with family support were able to moderate stressful life events effects; however, the moderating effects of social activity separately were negligible. In sum, with the moderating role of family support and social activity, the average differences in older people depression caused by stressful life events decreased. Conclusion: Experiencing stressful life events is detrimental to the psychological health of the older people. Social support, including family support and social activity, has buffered detrimental effects on depression caused by stressful life events. Interpretations: The study underscores the need to supply effective interventions for the older people who experienced stressful life events. First, society should improve the capability of community care centers to supply mental health services. Second, family members should pay attention to mental condition of older people, and specific support should concord with the needs of Chinese older people. In addition, support suppliers can move from being confined to kinship relationships to close relationships, such as the community partners and neighbors.
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Affiliation(s)
- Xiao Yu
- Northeast Asian Research Center, Jilin University, Changchun, China.,Northeast Asian Studies College, Jilin University, Changchun, China
| | - Shu Liu
- Northeast Asian Research Center, Jilin University, Changchun, China.,Northeast Asian Studies College, Jilin University, Changchun, China
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10
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Geng GL, Yang WW, Shi XL, Hua JN, Cui M, Yang CFY, Geng ZH, Qian XY. Factors Associated With Informational Support in Transitional Care for Older Adults With Chronic Diseases: A Cross-Sectional Study. Clin Nurs Res 2021; 31:329-339. [PMID: 34628980 DOI: 10.1177/10547738211051881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To evaluate the current situation and associated factors of informational support for older adults with chronic diseases in transitional care. Study was conducted in five hospitals of five different cities in Jiangsu Province, China. A random cluster sample of 800 older adults with chronic diseases responded to the informational support questionnaire of transitional care survey. Descriptive analysis, t-tests, variance analysis, and stepwise multiple linear regression were used to analyze data. The STROBE statement for observational studies was applied. Total score of ISQTC for older adults with chronic diseases was (44.05 ± 17.21). Marital status, educational level, past occupation, close friends, medical insurance, complications, and exercise habits were significantly correlated with informational support. The level of informational support in transitional care for older adults with chronic diseases was low. Clinical staff should periodically and primarily assess their informational support, help find information resources for those who have low initial informational support, and identify which information they preferred to carry out accurate transitional care.
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Affiliation(s)
| | | | - Xiao-Liu Shi
- Nantong University, Jiangsu, China.,Affiliated Hospital of Nantong University, Jiangsu, China
| | - Jia-Ning Hua
- Nantong University, Jiangsu, China.,Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu, China
| | - Min Cui
- Nantong University, Jiangsu, China
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Why Nursing Home Residents Use Social Network Systems: An Attachment Perspective. Healthcare (Basel) 2021; 9:healthcare9081037. [PMID: 34442174 PMCID: PMC8394999 DOI: 10.3390/healthcare9081037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/13/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022] Open
Abstract
Most long-term care facilities can offer residents’ with sufficiently material and physical care, but psychological support may not be always provided due to the tight financial budget or labor resources. Residents’ isolation and loneliness then become a big issue, especially for the residents. Social network systems (SNS) have been proved to be a more effective information transmission channel for thoughts, perspectives, and information sharing than traditional channels such as microblogging, e-mails, or telephones. This study conducted a quasi-experiment to identify factors that influence residents’ intention of using SNS and the impacts of SNS on them in a long-term care facility. The results showed that residents’ attached motivation of personal interacting is a significant factor that influences their intention to use the social network platform. Meanwhile, both the loneliness and depression scales of the participants were decreased significantly.
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Nguyen Hang Nguyet V, Nguyen Thi Khanh H, Nguyen Thanh L, Duong Minh D, Pham Quoc T. Factors associated with depression among the elderly living in rural Vietnam 2019: Recommendations to remove barriers of psychological service accessibility. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2020. [DOI: 10.1080/00207411.2020.1855050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Van Nguyen Hang Nguyet
- Department of Health Informatics, Hanoi University of Public Health (HUPH), Hanoi, Vietnam
| | | | - Luong Nguyen Thanh
- Center for Public Health and Ecosystem Research, Hanoi University of Public Health (HUPH), Hanoi, Vietnam
| | - Duc Duong Minh
- Department of Population & Reproductive Health, Hanoi University of Public Health (HUPH), Hanoi, Vietnam
| | - Thanh Pham Quoc
- Department of Health Informatics, Hanoi University of Public Health (HUPH), Hanoi, Vietnam
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