What is the relationship between falls, functional limitations, and depressive symptoms among Chinese older adults? The role of living alone

OBJECTIVES

Although the association between falls and depressive symptoms is well documented, the mechanisms underlying this association remain largely unexplored. We investigated the mediation role of functional limitations in the association between falls and depressive symptoms among Chinese older adults and determined whether the living arrangement (living alone or not) is a significant moderator of the above-mentioned mediation pathway.

STUDY DESIGN

Cross-sectional study.

MAIN OUTCOME MEASURES

Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale short form (CESD-10), on which higher scores indicate higher levels of depressive symptoms.

RESULTS

We used the harmonized China Health and Retirement Longitudinal Study national baseline data (2011-2012 year) involving 7410 participants aged 60 years and over. After adjusting for covariates (e.g., age and sex), the effects of falls on depressive symptoms were seen to be mediated by functional limitations among Chinese older adults (β = 0.82, p < .001). The moderated mediation analysis, which assesses whether an indirect effect is conditional on values of a moderating variable, found that the mediation effect was contingent upon the living arrangement (β = -0.60, p = .029). Specifically, the levels of functional limitations and depressive symptoms were higher for people with falls who were living with others relative to those living alone.

CONCLUSIONS

These results suggest that functional limitations are an important intervening variable that links falls to depressive symptoms among Chinese older adults. Interventions to promote older adults' physical function and prevent falls are recommended to decrease the risk of depressive symptoms. These interventions can particularly benefit those who live with others.

Mediational mechanisms involved in the relation between attachment insecurity and depression: A meta-analysis

BACKGROUND

Several studies have investigated the intermediate variables or mediators through which attachment insecurity influence the development of depression. However, there has not been a systematic synthesis of this literature to date. The current meta-analytic review aimed at identifying such mediators and quantifying their effect size.

METHODS

We systematically searched Medline, Pubmed, Psycinfo, Embase, Proceedings Web of Science and ProQuest Dissertations & Theses Global up until May 2019. 108 studies met inclusion criteria (i.e., investigated intermediate variables that explain the effect of attachment insecurity [exposure] on depressive symptoms [outcome]). Standardized regression coefficients of the indirect and total paths of mediation models of 80 studies were pooled using the inverse of their variance as a weight. Studies were coded and ranked for quality.

RESULTS

Dysfunctional attitudes (β = 0.10, 95% CI = 0.01 to 0.20), self-criticism (β = 0.17, 95% CI = 0.04 to 0.28), low self-compassion (β = 0.16, 95% CI = 0.02 to 0.29), and cognitive hyperactivating regulation strategies (β = 0.13, 95% CI = 0.05 to 0.20), such as repetitive thinking (β = 0.17, 95% CI = 0.07 to 0.28), and particularly, brooding rumination β = 0.20, 95% CI = 0.07 to 0.32), mediated the association between insecure attachment and depressive symptoms. Indirect effects were only significant among adult populations.

LIMITATIONS

The methodological quality of studies was mostly moderate to low and analyses revealed considerable heterogeneity.

CONCLUSION

Our findings support the direct targeting of cognitive-emotional psychological mechanisms in prevention programs and treatment of depression. More longitudinal studies are needed to clarify the interplay of such mediators along with other interpersonal factors between insecure attachment and depression.

Attachment and social support in romantic dyads: A systematic review

OBJECTIVE

Taking a dyadic perspective, this systematic review examined the relationship between attachment constructs and differences in support behavior in romantic couples.

METHOD

Four databases were searched including PsychINFO, Embase, OVOID MEDLINE, and AMED. Out of 2,401 unique references, 43 met the study inclusion criteria.

RESULTS

The review findings offer validation for an attachment-based model of support processes in couples. Maladaptive support behaviors were more likely to occur when one or both members of a romantic dyad had an insecure attachment. Individuals with an avoidant or anxious attachment were more likely to provide poor quality support, and when receiving support, to interpret it in a negative manner.

CONCLUSION

We recommend therapeutic interventions to help individuals with insecure attachments to follow more adaptive ways of support seeking, so social relationships are more able to offer a buffering effect against the development of mental health problems.

Social Support for Diabetes Self-Management via eHealth Interventions

eHealth interventions have been increasingly used to provide social support for self-management of type 2 diabetes. In this review, we discuss social support interventions, types of support provided, sources or providers of support, outcomes of the support interventions (clinical, behavioral, psychosocial), and logistical and clinical considerations for support interventions using eHealth technologies. Many types of eHealth interventions demonstrated improvements in self-management behaviors, psychosocial outcomes, and clinical measures, particularly HbA1c. Important factors to consider in clinical application of eHealth support interventions include participant preferences, usability of eHealth technology, and availability of personnel to orient or assist participants. Overall, eHealth is a promising adjunct to clinical care as it addresses the need for ongoing support in chronic disease management.

Nation-Level Moderators of the Extent to Which Self-Efficacy and Relationship Harmony Predict Students’ Depression and Life Satisfaction

Previous two-nation comparisons have provided evidence that self-efficacy may be a protective factor against depression in individualist cultures, whereas relationship harmony may be a stronger protective factor in collectivist cultures. However, wider sampling and more specific measures of cultural difference are required to test these conclusions. Student ratings of depression and life satisfaction were surveyed in 10 samples drawn from nine nations. Culture-level individualism positively moderated the relationship of self-efficacy to low depression. However, culture-level collectivism negatively moderated the linkage of relationship harmony to depression. To better understand these effects, four separate nation-level predictors derived from dimensions of self-construal were employed. Effects of self-efficacy were strongest where cultural models of selfhood emphasized self-direction (vs. receptiveness to influence); effects of relationship harmony were strongest where cultural models of selfhood emphasized dependence on others (vs. self-reliance). These results illustrate the value of unpackaging the diffusely defined concept of individualism-collectivism.

Prevalence and Correlates of Psychological Aggression in Male and Female College Students From Mainland China: An Exploratory Study

Using data from 209 college students from 2 universities in Mainland China, the prevalence and correlates of psychological aggression perpetration for men and women were examined. Results indicated that 82.8% of men and 90.4% of women had committed at least one act of psychological aggression against his or her current romantic partner over the course of their relationship. Being a victim of physical assault from his partner and higher levels of stress were associated with men’s perpetration of psychological aggression. For women, physical assault victimization, greater alcohol use, and higher levels of shame were all related to psychological aggression perpetration. The results suggest the need for additional research to understand the development of psychological aggression within this population and to further adapt and refine intervention programs to reduce such violence.