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Kiaris H. Nontraditional models as research tools: the road not taken. Trends Mol Med 2024:S1471-4914(24)00191-6. [PMID: 39069395 DOI: 10.1016/j.molmed.2024.07.005] [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: 05/31/2024] [Revised: 07/07/2024] [Accepted: 07/10/2024] [Indexed: 07/30/2024]
Abstract
Historical reasons resulted in the almost exclusive use of a few species, most prominently Mus musculus, as the mainstream models in biomedical research. This selection was not based on Mus's distinctive relevance to human disease but rather to the pre-existing availability of resources and tools for the species that were used as models, which has enabled their adoption for research in health sciences. Unless the utilization and range of nontraditional research models expand considerably, progress in biomedical research will remain restricted within the trajectory that has been set by the existing models and their ability to provide clinically relevant information.
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Affiliation(s)
- Hippokratis Kiaris
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy and Peromyscus Genetic Stock Center, University of South Carolina, Columbia, SC, USA.
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2
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Guler Y, Genc O, Yildirim A, Erdogan A, Akgun H, Acar G, Guler A, Kirma C. Templer's death anxiety scale on the relationship between white coat hypertension and anxiety: A cross-sectional study. J Hum Hypertens 2024; 38:561-567. [PMID: 38844549 DOI: 10.1038/s41371-024-00920-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 05/17/2024] [Accepted: 05/29/2024] [Indexed: 07/13/2024]
Abstract
The relationship between white coat hypertension (WCH) and anxiety remains not fully elucidated. This study aims to investigate the correlation between WCH and Templer's Death Anxiety Scale (T-DAS) questionnaire. Asymptomatic individuals with a familial history of sudden cardiac death or acute myocardial infarction within the last year, who presented at our cardiology outpatient clinic, were enrolled in this prospective, single-center, cross-sectional study. Among those with elevated blood pressure in the outpatient clinic setting, participants were categorized into normotensive and WCH groups through 24-hour ambulatory blood pressure monitoring. Demographic features, laboratory parameters, and T-DAS scores were documented. Logistic regression and sensitivity analyses were conducted to ascertain WCH occurrence. Among 324 consecutive participants, 90 were diagnosed with WCH. T-DAS scores were significantly elevated in the WCH subgroup, particularly among those seeking early medical attention following bereavement. Multivariable logistic regression highlighted gender, BMI, heart rate, T-DAS, and admission time as independent correlates of WCH. Significantly, T-DAS exhibited the third most substantial contribution to the regression analysis, following admission time and heart rate. The multivariable logistic regression analysis incorporating T-DAS exhibited high robustness, discrimination, fit, and calibration, with a Brier score of 0.106, adjusted R2 of 0.576, and C-statistic of 0.905 (95% CI: 0.871-0.940, p < 0.001). T-DAS, with a threshold of >8, demonstrated 48% sensitivity and 90% specificity in detecting WCH. Additionally, decision curve analysis verified that the model including T-DAS offers a net benefit in detecting WCH. This study unveils a potential association between WCH and death anxiety.
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Affiliation(s)
- Yeliz Guler
- Basaksehir Cam & Sakura City Hospital, Department of Cardiology, Istanbul, Turkey.
| | - Omer Genc
- Basaksehir Cam & Sakura City Hospital, Department of Cardiology, Istanbul, Turkey
| | - Abdullah Yildirim
- University of Health Sciences, Adana City Training and Research Hospital, Department of Cardiology, Adana, Turkey
| | - Aslan Erdogan
- Basaksehir Cam & Sakura City Hospital, Department of Cardiology, Istanbul, Turkey
| | - Huseyin Akgun
- Basaksehir Cam & Sakura City Hospital, Department of Cardiology, Istanbul, Turkey
| | - Gamze Acar
- Basaksehir Cam & Sakura City Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ahmet Guler
- Basaksehir Cam & Sakura City Hospital, Department of Cardiology, Istanbul, Turkey
| | - Cevat Kirma
- Kartal Koşuyolu Training and Research Hospital, Department of Cardiology, İstanbul, Turkey
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3
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Baumbach A, Hughes MC, Liu Y. Challenges and Coping Strategies in Transitioning From Caregiving to Widowhood: A Systematic Review. Res Aging 2024:1640275241254396. [PMID: 38742924 DOI: 10.1177/01640275241254396] [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: 05/16/2024]
Abstract
Ninety-one percent of surviving spouses in the U.S. cared for their spouses before they died. This review explores the challenges of the transition from caregiving to widowhood and different coping strategies used by widowed spousal caregivers. A systematic review of literature on the transition from caregiving to widowhood was conducted using four major academic search engines. Overall, 280 articles were identified, with 22 meeting the inclusion criteria. Challenges for widowed caregivers included experiencing care burden, letting go of the caregiver role, grief, and triggers. Widowed caregivers' coping strategies included social support and services use, filling the time gap, finding spirituality, and engaging in unhealthy behaviors. Future research is needed to determine the efficacy of widowed caregivers' coping strategies. Concerted and collaborative action by health professionals, community organizations, and policymakers is needed to develop programs and other approaches to support widowed caregivers.
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Affiliation(s)
- Abby Baumbach
- School of Family and Consumer Sciences, Northern Illinois University, DeKalb, IL, USA
| | - M Courtney Hughes
- School of Health Studies, Northern Illinois University, DeKalb, IL, USA
| | - Yujun Liu
- School of Family and Consumer Sciences, Northern Illinois University, DeKalb, IL, USA
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4
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Hossain B, James KS. Widowhood status, morbidity, and mortality in India: evidence from a follow-up survey. J Biosoc Sci 2024; 56:574-589. [PMID: 37881942 DOI: 10.1017/s0021932023000226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
A known health effect of widowhood is an increased mortality risk among surviving spouses, with gender- and age-specific observations. While morbidity conditions with socio-economic factors may exacerbate the effect of widowhood on mortality, no research has attempted to predict mortality among the widowed over the married population with the presence of morbidity in India. Thus, the present study concurrently examines marital status and health in the Indian setting, bringing substantial empirical evidence to explore the link between marital status, morbidity, and mortality. The study used prospective data from India Human Development Survey (IHDS) wave 1 (2004-2005) and wave 2 (2011-2012). In total, 82,607 individuals aged 25 years and above were considered for the analysis. To present the preliminary findings, descriptive statistics and bivariate analysis were used. Using multivariable logistic regression, the interaction effect of marital status and morbidity status was estimated to predict the likelihood of mortality. Across all socio-economic groups, widowed individuals reporting any morbidity had a higher mortality proportion than married people. Young widowers with any morbidity are more susceptible to increased mortality. Asthma among young widowers and cardiovascular diseases among elderly widowers significantly elevate the probability of mortality. However, older widowed women with diabetes had a lower probability of mortality than older married women with diabetes. The widowers' disadvantage in mortality and morbidity may be attributable to less care-receiving and the greater incidence of unhealthy lifestyle practices during the post-widowhood period, indicating the need for more research.
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Affiliation(s)
- Babul Hossain
- International Institute for Population Sciences (IIPS), Mumbai, India
| | - K S James
- International Institute for Population Sciences (IIPS), Mumbai, India
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5
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Hollingshaus M, Smith KR, Meeks H, Ornstein K, Iacob E, Tay D, Stephens C, Utz RL. Mortality risk following end-of-life caregiving: A population-based analysis of hospice users and their families. Soc Sci Med 2024; 348:116781. [PMID: 38547806 DOI: 10.1016/j.socscimed.2024.116781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/07/2024] [Accepted: 03/10/2024] [Indexed: 04/29/2024]
Abstract
Experiencing the death of a family member and providing end-of-life caregiving can be stressful on families - this is well-documented in both the caregiving and bereavement literatures. Adopting a linked-lived theoretical perspective, exposure to the death and dying of one family member could be conceptualized as a significant life stressor that produces short and long-term health consequences for surviving family members. This study uses familial-linked administrative records from the Utah Population Database to assess how variations in family hospice experiences affect mortality risk for surviving spouses and children. A cohort of hospice decedents living in Utah between 1998 and 2016 linked to their spouses and adult children (n = 37,271 pairs) provides an ideal study population because 1) hospice typically involves family members in the planning and delivery of end-of-life care, and 2) hospice admission represents a conscious awareness and acknowledgment that the decedent is entering an end-of-life experience. Thus, hospice duration (measured as the time between admission and death) is a precise measure of the family's exposure to an end-of-life stressor. Linking medical records, vital statistics, and other administrative microdata to describe decedent-kin pairs, event-history models assessed how hospice duration and characteristics of the family, including familial network size and coresidence with the decedent, were associated with long-term mortality risk of surviving daughters, sons, wives (widows), and husbands (widowers). Longer hospice duration increased mortality risk for daughters and husbands, but not sons or wives. Having other family members in the state was protective, and living in the same household as the decedent prior to death was a risk factor for sons. We conclude that relationship type and sex likely modify the how of end-of-life stressors (i.e., potential caregiving demands and bereavement experiences) affect health because of normative gender roles. Furthermore, exposure to dementia deaths may be particularly stressful, especially for women.
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Affiliation(s)
- Mike Hollingshaus
- Senior Demographer, Kem C. Gardner Policy Institute, David Eccles School of Business, University of Utah, United States.
| | - Ken R Smith
- Distinguished Professor Emeritus, Department of Family and Consumer Studies, University of Utah, United States.
| | - Huong Meeks
- Assistant Professor, Pediatrics, University of Utah, United States.
| | | | - Eli Iacob
- Assistant Research Professor, College of Nursing, University of Utah, United States.
| | - Djin Tay
- Assistant Professor, College of Nursing, University of Utah, United States.
| | - Caroline Stephens
- Associate Professor, College of Nursing, University of Utah, United States.
| | - Rebecca L Utz
- Professor, Sociology Department, University of Utah, United States.
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Strand BH, Håberg AK, Eyjólfsdóttir HS, Kok A, Skirbekk V, Huxhold O, Løset GK, Lennartsson C, Schirmer H, Herlofson K, Veenstra M. Spousal bereavement and its effects on later life physical and cognitive capability: the Tromsø study. GeroScience 2024:10.1007/s11357-024-01150-y. [PMID: 38594472 DOI: 10.1007/s11357-024-01150-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/31/2024] [Indexed: 04/11/2024] Open
Abstract
Spousal bereavement is associated with health declines and increased mortality risk, but its specific impact on physical and cognitive capabilities is less studied. A historical cohort study design was applied including married Tromsø study participants (N=5739) aged 50-70 years with baseline self-reported overall health and health-related factors and measured capability (grip strength, finger tapping, digit symbol coding, and short-term recall) at follow-up. Participants had data from Tromsø4 (1994-1995) and Tromsø5 (2001), or Tromsø6 (2007-2008) and Tromsø7 (2015-2016). Propensity score matching, adjusted for baseline confounders (and baseline capability in a subset), was used to investigate whether spousal bereavement was associated with poorer subsequent capability. Spousal bereavement occurred for 6.2% on average 3.7 years (SD 2.0) before the capability assessment. There were no significant bereavement effects on subsequent grip strength, immediate recall, or finger-tapping speed. Without adjustment for baseline digit symbol coding test performance, there was a negative significant effect on the digit symbol coding test (ATT -1.33; 95% confidence interval -2.57, -0.10), but when baseline digit symbol coding test performance was taken into account in a smaller subsample, using the same set of matching confounders, there was no longer any association (in the subsample ATT changed from -1.29 (95% CI -3.38, 0.80) to -0.04 (95% CI -1.83, 1.75). The results in our study suggest that spousal bereavement does not have long-term effects on the intrinsic capacity components physical or cognition capability to a notable degree.
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Affiliation(s)
- Bjørn Heine Strand
- Department for Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway.
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
| | - Asta K Håberg
- Department for Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Harpa Sif Eyjólfsdóttir
- Aging Research Center (ARC), Karolinska Institutet, Stockholm, Sweden
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Stockholm University, Stockholm, Sweden
| | - Almar Kok
- Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life Programme, Amsterdam, The Netherlands
| | - Vegard Skirbekk
- Department for Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Gøril Kvamme Løset
- NOVA - Norwegian Social Research, Oslo Metropolitan University, Oslo, Norway
| | - Carin Lennartsson
- Aging Research Center (ARC), Karolinska Institutet, Stockholm, Sweden
- Swedish Institute for Social Research (SOFI), Stockholm University, Stockholm, Sweden
| | - Henrik Schirmer
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Cardiology, Akershus, University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Katharina Herlofson
- NOVA - Norwegian Social Research, Oslo Metropolitan University, Oslo, Norway
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Halloran EC. Adult Development and Associated Health Risks. J Patient Cent Res Rev 2024; 11:63-67. [PMID: 38596352 PMCID: PMC11000702 DOI: 10.17294/2330-0698.2050] [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: 04/11/2024] Open
Abstract
Much has been learned about adult development in recent decades. Adults go through stages of development (emerging adulthood, young adulthood, middle adulthood, post-retirement, and very old age) with certain challenges at each stage. Viewing patients through a developmental lens is part of providing patient-centered care. Knowing the prominent issues, stressors, and risks at each stage of development is important in understanding patients. This knowledge can help customize medical advice to patients regarding obesity, disability, sleep, substance use, relationships, and age-related declines. This paper summarizes an updated view of adult development and discusses its relevance to health risks and patient-centered care practices at different stages.
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Affiliation(s)
- Elizabeth C Halloran
- Family Medicine Residency Program, Bon Secours Mercy Health - St. Vincent Medical Center, Toledo, OH
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8
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Hawes FM, Tavares JL, Ronneberg CR, Miller EA. The Effects of Religiosity on Depression Trajectories After Widowhood. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:1240-1257. [PMID: 35139669 DOI: 10.1177/00302228211051509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This longitudinal study analyzed data from the 2006-2016 waves of the nationally representative Health and Retirement Study (HRS). Trajectories of depression among older adults ≥ 50 years (N = 1254) were examined over time to explore patterns of depression among those entering widowhood and the potential impact of religiosity on depressive symptoms during various stages of widowhood. Ordinary least squares (OLS) regression analysis was used to examine the association between widowhood and depression and the role of religiosity as a moderator of this association. Older adults experienced a statistically significant increase in depressive symptomology after the onset of widowhood, and depressive symptomology decreased post widowhood, but did not return to pre-widowhood levels. Additionally, high religious service attendance and higher intrinsic religiosity were both associated with lower depressive symptomology. High religious service attendance moderated the relationship between widowhood and depression among widowed older adults living alone.
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Affiliation(s)
- Frances M Hawes
- Health Care Administration Department, University of Wisconsin Eau Claire, Eau Claire, WI, USA
| | - Jane L Tavares
- LeadingAge LTSS Center, University of Massachusetts Boston, Boston, MA, USA
| | - Corina R Ronneberg
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Edward Alan Miller
- Department of Gerontology and Gerontology Institute. University of Massachusetts Boston, Boston, MA, USA
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9
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Hamadeh RR, Alshammari YA. Bereavement and Grief Among Employees in an Arab University Setting: A Cross-Sectional Study. Cureus 2024; 16:e55659. [PMID: 38586729 PMCID: PMC10997206 DOI: 10.7759/cureus.55659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Several mental health outcomes develop following bereavement. Little research has examined bereavement in the workplace and the associated risk factors, particularly in Arab populations. OBJECTIVES The objectives of this cross-sectional study were to determine the sociodemographic characteristics of bereaved employees, measure the prevalence of their dysfunction, establish the type of closeness and conflict in their relationship with the deceased, determine the available resources to the bereaved, and determine the proportion of bereaved employees who needed help. METHODS A study was conducted on Arabian Gulf University employees (91) in Bahrain. The revised Two Track Bereavement Questionnaire (TTBQ3-CG11) was utilized to assess bereavement outcomes. RESULTS The response rate of the study was 28%. The composition of the study population was as follows: 51.6% males, 37.4% in the age range of 40-49 years, 86.8% married, 39.6% Bahraini, and 51.6% academicians. Over half of the participants had biopsychosocial dysfunction, 35.2% had active relational grief and trauma (ARGT), 36.3% had a conflict with the deceased, and half were close to the deceased. Total TTBQ3-CG11 scores showed that 28.6% of the bereaved had a low score (14-22), 61.5% medium (23-28), and 9.9% high (29 or more), with more females than males in the high category. The majority reported receiving adequate support from the administration and colleagues following their loss. CONCLUSION There is a need to establish bereavement policies and procedures at tertiary educational institutes. This study may inform future policies to advance bereavement services in the educational institutions of the region.
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Affiliation(s)
- Randah R Hamadeh
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, BHR
| | - Yousef A Alshammari
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, BHR
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10
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Wang SH, Wu H, Hsu LY, Lin MC, Fan CC, Chen PC, Hsu CC, Wu CS. Widowhood and mortality risk in Taiwan: a population-based matched cohort study. Int J Epidemiol 2024; 53:dyae034. [PMID: 38553032 DOI: 10.1093/ije/dyae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 02/17/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Studying the causes of death among deceased spouses and surviving partners may provide insights into the underlying mechanisms of the association between widowhood and mortality. This study investigated the mortality risk of widowhood in Taiwan, examined the association of the cause of death between widowed individuals and their deceased spouses and explored potential modifying effects by age, gender and duration after widowhood. METHODS This matched cohort study utilized Taiwan's National Health Insurance claims database and National Death Registry. In total, 204 010 widowed men and 596 136 widowed women were identified with a mean follow-up period of 6.9 and 7.9 years, respectively, and 816 040 comparison men and 2 384 544 comparison women were selected. RESULTS Widowhood was associated with an increased mortality risk, with widowed men having a 1.32 increased risk and widowed women having a 1.27 increased risk. Age at spousal death and duration modified the associations after widowhood. The widowed individuals are more likely to die by the same cause as the deceased spouse if they died by suicide, accident, endocrine, gastrointestinal disorders or infection. CONCLUSIONS The study suggests that healthcare policies and interventions should be developed to improve widowed individuals' health and overall welfare.
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Affiliation(s)
- Shi-Heng Wang
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Huijing Wu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan
| | - Le-Yin Hsu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Graduate Program of Data Science, National Taiwan University and Academia Sinica, Taipei, Taiwan
| | - Mei-Chen Lin
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan
| | - Chun-Chieh Fan
- Center for Population Neuroscience and Genetics, Laureate Institute for Brain Research, Tulsa, OK, USA
- Department of Radiology, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Pei-Chun Chen
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan
| | - Chih-Cheng Hsu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Chi-Shin Wu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Miaoli, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Yunlin Branch, Yunlin, Taiwan
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11
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Hossain B, James KS. Economics of widowhood mortality in adult women in India. Soc Sci Med 2024; 340:116450. [PMID: 38043440 DOI: 10.1016/j.socscimed.2023.116450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 11/07/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
The economic consequence of widowhood on health is well-established, demonstrating that economic factors can significantly link with health outcomes, even the risk of mortality for widows. However, empirical evidence is restricted only to developed countries. Thus, this study assesses the role of economic factors (paid work, pension and household economic status) on the mortality of widows in broad age groups in India. We used two waves of the India Human Development Survey (IHDS), a nationally representative prospective dataset in India for 42,009 women (married and widows) aged 25 years and above at IHDS wave 1 whose survival status was observed between two waves. Further, 6,953 widows were considered for sub-sample analysis in this study. Logistic regression and propensity score matching (PSM) were applied to understand the association and causality between economic factors and mortality for widows. Poor household economic status, paid regular work, and receiving a widowed pension were significantly associated with lower mortality risk for young widows. In comparison, unpaid and paid regular work was linked with lower mortality risk for old widows. The result of causal analysis suggests that receiving a widows' pension had a slight impact on mortality reduction for young widows while engaging in paid regular work significantly reduced the mortality of old widows. This research confirms that the link between economic factors and mortality among widows is age dependent in the Indian context.
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Affiliation(s)
- Babul Hossain
- International Institute for Population Sciences, India.
| | - K S James
- International Institute for Applied Systems Analysis (IIASA), Laxenburg, Austria.
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12
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Naderi A, Liles K, Burns T, Chavez B, Huynh-Dam KT, Kiaris H. Pair bonding and disruption impact lung transcriptome in monogamous Peromyscus californicus. BMC Genomics 2023; 24:789. [PMID: 38114920 PMCID: PMC10729396 DOI: 10.1186/s12864-023-09873-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023] Open
Abstract
Social interactions affect physiological and pathological processes, yet their direct impact in peripheral tissues remains elusive. Recently we showed that disruption of pair bonds in monogamous Peromyscus californicus promotes lung tumorigenesis, pointing to a direct effect of bonding status in the periphery (Naderi et al., 2021). Here we show that lung transcriptomes of tumor-free Peromyscus are altered in a manner that depends on pair bonding and superseding the impact of genetic relevance between siblings. Pathways affected involve response to hypoxia and heart development. These effects are consistent with the profile of the serum proteome of bonded and bond-disrupted Peromyscus and were extended to lung cancer cells cultured in vitro, with sera from animals that differ in bonding experiences. In this setting, the species' origin of serum (deer mouse vs FBS) is the most potent discriminator of RNA expression profiles, followed by bonding status. By analyzing the transcriptomes of lung cancer cells exposed to deer mouse sera, an expression signature was developed that discriminates cells according to the history of social interactions and possesses prognostic significance when applied to primary human lung cancers. The results suggest that present and past social experiences modulate the expression profile of peripheral tissues such as the lungs, in a manner that impacts physiological processes and may affect disease outcomes. Furthermore, they show that besides the direct effects of the hormones that regulate bonding behavior, physiological changes influencing oxygen metabolism may contribute to the adverse effects of bond disruption.
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Affiliation(s)
- A Naderi
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - K Liles
- Department of Mathematics and Computer Sciences, Claflin University, Orangeburg, SC, USA
| | - T Burns
- Department of Biology, Claflin University, Orangeburg, SC, USA
| | - B Chavez
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - K-T Huynh-Dam
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - H Kiaris
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA.
- Peromyscus Genetic Stock Center, University of South Carolina, Columbia, SC, USA.
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13
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Harrop E, Medeiros Mirra R, Goss S, Longo M, Byrne A, Farnell DJJ, Seddon K, Penny A, Machin L, Sivell S, Selman LE. Prolonged grief during and beyond the pandemic: factors associated with levels of grief in a four time-point longitudinal survey of people bereaved in the first year of the COVID-19 pandemic. Front Public Health 2023; 11:1215881. [PMID: 37794891 PMCID: PMC10546414 DOI: 10.3389/fpubh.2023.1215881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/16/2023] [Indexed: 10/06/2023] Open
Abstract
Background The COVID-19 pandemic has been a devastating and enduring mass-bereavement event, with uniquely difficult sets of circumstances experienced by people bereaved at this time. However, little is known about the long-term consequences of these experiences, including the prevalence of Prolonged Grief Disorder (PGD) and other conditions in pandemic-bereaved populations. Methods A longitudinal survey of people bereaved in the UK between 16 March 2020 and 2 January 2021, with data collected at baseline (n = 711), c. 8 (n = 383), 13 (n = 295), and 25 (n = 185) months post-bereavement. Using measures of Prolonged Grief Disorder (PGD) (Traumatic Grief Inventory), grief vulnerability (Adult Attitude to Grief Scale), and social support (Inventory of Social Support), this analysis examines how participant characteristics, characteristics of the deceased and pandemic-related circumstances (e.g., restricted visiting, social isolation, social support) are associated with grief outcomes, with a focus on symptoms of PGD. Results At baseline, 628 (88.6%) of participants were female, with a mean age of 49.5 (SD 12.9). 311 (43.8%) deaths were from confirmed/suspected COVID-19. Sample demographics were relatively stable across time points. 34.6% of participants met the cut-off for indicated PGD at c. 13 months bereaved and 28.6% at final follow-up. Social isolation and loneliness in early bereavement and lack of social support over time strongly contributed to higher levels of prolonged grief symptoms, while feeling well supported by healthcare professionals following the death was associated with reduced levels of prolonged grief symptoms. Characteristics of the deceased most strongly associated with lower levels of prolonged grief symptoms, were a more distant relationship (e.g., death of a grandparent), an expected death and death occurring in a care-home. Participant characteristics associated with higher levels of prolonged grief symptoms included low level of formal education and existence of medical conditions. Conclusion Results suggest higher than expected levels of PGD compared with pre-pandemic times, with important implications for bereavement policy, provision and practice now (e.g., strengthening of social and specialist support) and in preparedness for future pandemics and mass-bereavement events (e.g., guidance on infection control measures and rapid support responses).
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Affiliation(s)
- Emily Harrop
- Division of Population Medicine, Marie Curie Research Centre, Cardiff University, Cardiff, United Kingdom
| | | | - Silvia Goss
- Division of Population Medicine, Marie Curie Research Centre, Cardiff University, Cardiff, United Kingdom
| | - Mirella Longo
- Division of Population Medicine, Marie Curie Research Centre, Cardiff University, Cardiff, United Kingdom
| | - Anthony Byrne
- Division of Population Medicine, Marie Curie Research Centre, Cardiff University, Cardiff, United Kingdom
| | | | - Kathy Seddon
- Division of Population Medicine, Marie Curie Research Centre, Cardiff University, Cardiff, United Kingdom
| | - Alison Penny
- National Bereavement Alliance, London, United Kingdom
| | - Linda Machin
- School of Medicine, Keele University, Keele, United Kingdom
| | - Stephanie Sivell
- Division of Population Medicine, Marie Curie Research Centre, Cardiff University, Cardiff, United Kingdom
| | - Lucy E. Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Linde S, Egede LE. Community Social Capital and Population Health Outcomes. JAMA Netw Open 2023; 6:e2331087. [PMID: 37624595 PMCID: PMC10457711 DOI: 10.1001/jamanetworkopen.2023.31087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023] Open
Abstract
Importance While the association between economic connectedness and social mobility has now been documented, the potential linkage between community-level economic connectedness and population health outcomes remains unknown. Objective To examine the association between community social capital measures (defined as economic connectedness, social cohesion, and civic engagement) and population health outcomes (defined across prevalence of diabetes, hypertension, high cholesterol, kidney disease, and obesity). Design, Setting, and Participants This cross-sectional study included communities defined at the zip code tabulation area (ZCTA) level in all 50 US states. Data were collected from January 2021 to December 2022. Main Outcomes and Measures Multivariable regression analyses were used to examine the association between population health outcomes and social capital. Adjusted analyses controlled for area demographic variables and county fixed effects. Heterogeneities within the associations based on the racial and ethnic makeup of communities were also examined. Results In this cross-sectional study of 17 800 ZCTAs, across 50 US states, mean (SD) economic connectedness was 0.88 (0.32), indicating friendship sorting on income; the mean (SD) support ratio was 0.90 (0.10), indicating that 90% of ties were supported by a common friendship tie; and the mean (SD) volunteering rate was 0.08 (0.03), indicating that 8% of individuals within a given community were members of volunteering associations. Mean (SD) ZCTA diabetes prevalence was 10.8% (2.9); mean (SD) high blood pressure prevalence was 33.2% (6.2); mean (SD) high cholesterol prevalence was 32.7% (4.2), mean (SD) kidney disease prevalence was 3.0% (0.7), and mean (SD) obesity prevalence was 33.4% (5.6). Regression analyses found that a 1% increase in community economic connectedness was associated with significant decreases in prevalence of diabetes (-0.63%; 95% CI, -0.67% to -0.60%); hypertension (-0.31%; 95% CI, -0.33% to -0.29%); high cholesterol (-0.14%; 95% CI, -0.15% to -0.12%); kidney disease (-0.48%; 95% CI, -0.50% to -0.46%); and obesity (-0.28%; 95% CI, -0.29% to -0.27%). Second, a 1% increase in the community support ratio was associated with significant increases in prevalence of diabetes (0.21%; 95% CI, 0.16% to 0.26%); high blood pressure (0.16%; 95% CI, 0.13% to 0.19%); high cholesterol (0.16%; 95% CI, 0.13% to 0.19%); kidney disease (0.17%; 95% CI, 0.13% to 0.20%); and obesity (0.08%; 95% CI, 0.06% to 0.10%). Third, a 1% increase in the community volunteering rate was associated with significant increases in prevalence of high blood pressure (0.02%; 95% CI, 0.01% to 0.02%); high cholesterol (0.03%; 95% CI, 0.02% to 0.03%); and kidney disease (0.02%; 95% CI, 0.01% to 0.02%). Additional analyses found that the strength of these associations varied based on the majority racial and ethnic population composition of communities. Conclusions and Relevance In this study, higher economic connectedness was significantly associated with better population health outcomes; however, higher community support ratios and volunteering rates were both significantly associated with worse population health. Associations also differed by majority racial and ethnic composition of communities.
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Affiliation(s)
- Sebastian Linde
- Medical College of Wisconsin, Department of Medicine, Division of General Internal Medicine, Milwaukee
- Center for Advancing Population Sciences, Medical College of Wisconsin, Milwaukee
| | - Leonard E. Egede
- Medical College of Wisconsin, Department of Medicine, Division of General Internal Medicine, Milwaukee
- Center for Advancing Population Sciences, Medical College of Wisconsin, Milwaukee
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15
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Mutedzi B, Nkhoma K, Langhaug L, Hunt J, Harding R. Improving bereavement outcomes in Zimbabwe: results of a feasibility cluster trial of the 9-cell bereavement tool. Pilot Feasibility Stud 2023; 9:127. [PMID: 37480142 PMCID: PMC10360285 DOI: 10.1186/s40814-023-01313-2] [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: 03/21/2021] [Accepted: 05/02/2023] [Indexed: 07/23/2023] Open
Abstract
CONTEXT Despite high mortality rates from both communicable and non-communicable diseases, bereavement is under-researched in African countries. The 9-cell bereavement tool was designed to assist individuals to reflect on their feelings about bereavement and identify resources in families and communities to manage bereavement. This study aimed to determine the feasibility of implementing the 9-cell bereavement tool and recruitment to experimental evaluation. METHODS A feasibility cluster randomized trial with embedded qualitative interviews was conducted in two comparable neighbourhoods in Chitungwiza, Zimbabwe. Community leaders identified potential community lay bereavement supporters (interventionists). Each community lay bereavement supporter recruited two to three recently bereaved community members (trial participants). Following baseline data collection, the communities were randomly allocated to intervention or wait-list control. Self-administered questionnaires were completed at T0 (month 0), T1 (3 months) and T2 (6 months). Grief, mental health and social support were assessed. Focus group discussions with selected interventionists described training impact and intervention processes. Quantitative and qualitative analyses were performed. RESULTS Implementation of the nine-cell bereavement tool and recruitment to experimental evaluation were successful. Implementation of the tool and the recruitment of study participants were conducted within the intended timeframe of 3 weeks. In line with the suggested sample size, the study was able to recruit and retain at least 75% of the trial participants for the total duration of the study. CONCLUSION The feasibility cluster trial was successfully implemented and assessed. Through the published protocol, the literature review and the results of this study, it has been noted that there is an urgent need to carry out a full trial in this subject matter, not only as a contribution to the currently sparse literature in this regard, but for the enormous potential public health benefit in supporting and saving lives in many more under-resourced and under-supported countries. TRIAL REGISTRATION Protocol registration: http://www.isrctn.com/ISRCTN16484746 . Protocol publication: https://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/s40814-019-0450-5.
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Affiliation(s)
- Barbara Mutedzi
- Island Hospice and Healthcare, 6 Natal Road, Belgravia, Harare, Zimbabwe.
| | - Kennedy Nkhoma
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK
| | - Lisa Langhaug
- Zvitambo Maternal and Child Health Research Institute, 16 McLaughlin Road, Harare, Zimbabwe
| | | | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, London, SE5 9PJ, UK
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16
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Timmins L, Pitman A, King M, Gao W, Johnson K, Yu P, Braybrook D, Roach A, Marshall S, Day E, Rose R, Clift P, Almack K, Yi DH, Bristowe K, Harding R. Does the impact of bereavement vary between same and different gender partnerships? A representative national, cross-sectional study. Psychol Med 2023; 53:3849-3857. [PMID: 35620818 PMCID: PMC10317796 DOI: 10.1017/s0033291722000496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/05/2022] [Accepted: 02/10/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Data suggest poorer bereavement outcomes for lesbian, gay and bisexual people, but this has not been estimated in population-based research. This study compared bereavement outcomes for partners of same-gender and different-gender decedents. METHODS In this population-based, cross-sectional survey of people bereaved of a civil partner or spouse 6-10 months previously, we used adjusted logistic and linear regression to investigate outcomes of interest: (1) positive screen on Inventory of Complicated Grief (ICG), (2) positive screen on General Health Questionnaire (GHQ), (3) grief intensity (ICG) and (4) psychiatric symptoms (GHQ-12). RESULTS Among 233 same-gender partners and 329 of different-gender partners, 66.1% [95% confidence interval (CI) 60.0-72.2] and 59.2% [95% CI (53.9-64.6)] respectively screened positive for complicated grief on the ICG, whilst 76.0% [95% CI (70.5-81.5)] and 69.3% [95% CI (64.3-74.3)] respectively screened positive on the GHQ-12. Same-gender bereaved partners were not significantly more likely to screen positive for complicated grief than different-gender partners [adjusted odds ratio (aOR) 1.56, 95% CI (0.98-2.47)], p = 0.059, but same-gender bereaved partners were significantly more likely to screen for psychiatric caseness [aOR 1.67 (1.02, 2.71) p = 0.043]. We similarly found no significant association of partner gender with grief intensity [B = 1.86, 95% CI (-0.91to 4.63), p = 0.188], but significantly greater psychological distress for same-gender partners [B = 1.54, 95% CI (-0.69-2.40), p < 0.001]. CONCLUSIONS Same-gender bereaved partners report significantly more psychological distress. In view of their poorer sub-clinical mental health, clinical and bereavement services should refine screening processes to identify those at risk of poor mental health outcomes.
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Affiliation(s)
- Liadh Timmins
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Alexandra Pitman
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - Wei Gao
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Katherine Johnson
- Social and Global Studies Centre, Royal Melbourne Institute of Technology, Melbourne, Australia
| | - Peihan Yu
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Debbie Braybrook
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Anna Roach
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Steve Marshall
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
- King's College Hospital, London, UK
| | | | - Ruth Rose
- Patient & Public Involvement, Peacehaven, UK
| | - Paul Clift
- Patient & Public Involvement, London, UK
| | - Kathryn Almack
- School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | - Deok Hee Yi
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Katherine Bristowe
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Richard Harding
- Department of Palliative Care Policy & Rehabilitation, King's College London, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute, Bessemer Road, London, UK
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17
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Valenti K. LGBT+-specific experiences of partner bereavement suggest avoiding assumptions, promoting agency in disclosure and using inclusive communication as key to safe, accessible, supportive care. Evid Based Nurs 2023; 26:107. [PMID: 36737225 DOI: 10.1136/ebnurs-2022-103678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Korijna Valenti
- General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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18
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Song H, Shang Y, Fang F, Almqvist C, Pedersen NL, Magnusson PKE, Larsson H, Valdimarsdóttir UA. Mortality among twin individuals exposed to loss of a co-twin. Int J Epidemiol 2023; 52:600-610. [PMID: 35849345 PMCID: PMC10114119 DOI: 10.1093/ije/dyac145] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 06/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although the death of a child, sibling or spouse has been associated with elevated risk of mortality, less is known about the survival of twin siblings exposed to a co-twin loss. METHODS In a Swedish population-based sibling-matched cohort, we compared the mortality of 5548 twin individuals who lost their co-twin between 1932 and 2011 with that of 27 740 age-matched and sex-matched twin individuals without such a loss and 6772 full siblings of these exposed twin individuals. Cox regression models were used to estimate the hazard ratios (HRs) of all-cause and cause-specific mortality. RESULTS We found increased risk of all-cause mortality among twin individuals exposed to a co-twin loss compared with matched unexposed twin individuals (HR = 1.30, 95% CI: 1.18-1.43) and their full siblings (HR = 1.10, 95% CI: 0.96-1.27) after adjusting for multiple covariates. The all-cause mortality risk was greater for loss of a co-twin due to unnatural deaths (HR = 1.54, 95% CI: 1.17-2.03) than natural deaths (HR = 1.26, 95% CI: 1.14-1.40). For cause-specific mortality, co-twin loss was associated with a higher risk of unnatural deaths both among twin individuals who lost their co-twin due to unnatural deaths (HR = 1.98, 95% CI: 1.27-3.10) and those whose loss was due to natural deaths (HR = 1.48, 95% CI: 1.07-2.06). The risk elevations were generally stronger for loss of a monozygotic co-twin than loss of a dizygotic co-twin. CONCLUSION Loss of a co-twin, especially a monozygotic co-twin, was associated with increased mortality, particularly of unnatural causes, among the surviving twin individuals. The excess mortality is likely attributable to both shared disease susceptibility within the twin pair and the adverse health sequelae of bereavement.
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Affiliation(s)
- Huan Song
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Yanan Shang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, China
- Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, University of Southern California, Los Angeles, USA
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Unnur A Valdimarsdóttir
- Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA
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Abstract
OBJECTIVES We analyzed whether marital status and experiences of marital loss or gain were associated with self-perceptions of aging (SPA), a major psychosocial mechanism of healthy aging. METHOD We used data from 7028 participants of the Health and Retirement Study. Participants reported their marital status and their positive and negative SPA on two occasions 4 years apart. We ran general linear models to analyze differences in SPA between men and women who remained married, became divorced or widowed, or remarried following divorce or widowhood. RESULTS Participants who experienced marital loss had lower positive SPA than participants who remained marred. Participants who experienced marital gain had lower negative SPA than participants who remained married. None of the associations differed between men and women. DISCUSSION Results suggest that it may not be marital status itself, but rather the transition into or out of marriage, that impacts how people appraise their own aging.
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Affiliation(s)
- Shelbie G. Turner
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Dakota D. Witzel
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Robert S. Stawski
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Karen Hooker
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
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20
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Einiö E, Metsä-Simola N, Peltonen R, Martikainen P. Does the suddenness matter? Antidepressant use before and after a spouse dies suddenly or expectedly of stroke. Scand J Public Health 2023; 51:75-81. [PMID: 34609220 PMCID: PMC9900187 DOI: 10.1177/14034948211042501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aims: Changes in mental health at the time of widowhood may depend on the expectedness of spousal death, but scant evidence is available for spousal deaths attributable to stroke. Methods: Using register-linkage data for Finland, we assessed changes in antidepressant use before and after spousal death for those whose spouses died suddenly of stroke between 1998 and 2003 (N=1820) and for those whose spouses died expectedly of stroke, with prior hospitalisation for cerebrovascular disease (N=1636). We used both population-averaged logit models and individual fixed-effects linear probability models. The latter models control for unobserved time-invariant heterogeneity between the individuals. Results: Our study indicates that the suddenness of a spouse's death from stroke plays a role in the well-being of the surviving spouse. Increases in antidepressant use appeared larger following widowhood for those whose spouses died suddenly of stroke relative to those whose spouses had a medical history of cerebrovascular disease. Conclusions: The suddenness of a spouse's death from stroke plays a role for the surviving spouse. The results suggest multifaceted timings of distress surrounding spousal death, depending on the suddenness of a spouse's death from stroke.
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Affiliation(s)
- Elina Einiö
- Population Research Unit, Department of
Social Research, Faculty of Social Sciences, University of Helsinki, Finland,Elina Einiö, Population Research Unit,
Department of Social Research, Faculty of Social Sciences, University of
Helsinki, P.O. Box 18, 00014 Helsinki, Finland. E-mail:
| | - Niina Metsä-Simola
- Population Research Unit, Department of
Social Research, Faculty of Social Sciences, University of Helsinki, Finland
| | - Riina Peltonen
- Population Research Unit, Department of
Social Research, Faculty of Social Sciences, University of Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Department of
Social Research, Faculty of Social Sciences, University of Helsinki, Finland,Laboratory of Population Health, Max
Planck Institute for Demographic Research, Germany,Department of Public Health Sciences,
Stockholm University, Sweden
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21
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Bristowe K, Timmins L, Braybrook D, Marshall S, Pitman A, Johnson K, Day E, Clift P, Rose R, Yi D, Yu P, Gao W, Roach A, Almack K, King M, Harding R. LGBT+ partner bereavement and appraisal of the Acceptance-Disclosure Model of LGBT+ bereavement: A qualitative interview study. Palliat Med 2023; 37:221-234. [PMID: 36428276 PMCID: PMC9896255 DOI: 10.1177/02692163221138620] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Support from social networks is vital after the death of a partner. Lesbian, gay, bisexual and/or transgender (LGBT+) people can face disenfranchisement and isolation in bereavement. The Acceptance-Disclosure Model (of LGBT+ bereavement) posits that experiences are shaped by the extent to which individuals feel able to disclose their bereavement to others, and whether that loss is acknowledged appropriately. AIM To explore LGBT+ specific experiences of partner bereavement; determine decision-making processes regarding disclosure of relationships/identities; and appraise the Acceptance-Disclosure Model using primary qualitative data. DESIGN Exploratory in-depth qualitative interview study positioned within a social constructivist paradigm. Data were analysed using inductive and deductive reflexive thematic analysis. SETTING/PARTICIPANTS 21 LGBT+ people from across England bereaved of their civil partner/spouse. RESULTS Participants described LGBT+ specific stressors in bereavement: lack of recognition of their loss; inappropriate questioning; unwanted disclosure of gender history; and fears of discrimination when accessing support. Disclosure of LGBT+ identities varied across social networks. Some participants described hiding their identities and bereavement to preserve relationships, and challenging intersections between LGBT+ identities and other aspects of culture or self. These findings provide primary evidence to support the Acceptance-Disclosure Model. CONCLUSIONS LGBT+ people face additional stressors in bereavement. Not all LGBT+ people want to talk directly about their relationships/identities. Sensitive exploration of support needs, aligned with preferences around disclosure of identities, can help foster trust. Five recommendations for inclusive practice are presented. Further research should consider whether the Acceptance-Disclosure Model has utility to explain bereavement experiences for other isolated or disenfranchised groups.
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Affiliation(s)
- Katherine Bristowe
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
| | | | - Debbie Braybrook
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
| | - Steve Marshall
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Alexandra Pitman
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St. Pancras Hospital, London, UK
| | - Katherine Johnson
- Social and Global Studies Centre, Royal Melbourne Institute of Technology, Melbourne, VIC, Australia
| | | | - Paul Clift
- Patient and Public Involvement, London, UK
| | - Ruth Rose
- Patient and Public Involvement, London, UK
| | - Deokhee Yi
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
| | - Peihan Yu
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
| | - Anna Roach
- Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, London, UK
| | - Kathryn Almack
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
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22
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Wang H, Smith-Greenaway E, Bauldry S, Margolis R, Verdery AM. Mourning in a Pandemic: The Differential Impact of COVID-19 Widowhood on Mental Health. J Gerontol B Psychol Sci Soc Sci 2022; 77:2306-2316. [PMID: 35753008 PMCID: PMC9278192 DOI: 10.1093/geronb/gbac085] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES The death of a spouse is an established predictor of mental health decline that foreshadows worsening physical health and elevated mortality. The millions widowed by COVID-19 worldwide may experience even worse health outcomes than comparable pre-pandemic widows given the particularities of dying, mourning, and grieving during a pandemic defined by protracted social isolation, economic precarity, and general uncertainty. If COVID-19 pandemic bereavement is more strongly associated with mental health challenges than pre-pandemic bereavement, the large new cohort of COVID-19 widow(er)s may be at substantial risk of downstream health problems long after the pandemic abates. METHODS We pooled population-based Survey of Health, Ageing and Retirement in Europe data from 27 countries for two distinct periods: (1) pre-pandemic (Wave 8, fielded October 2019-March 2020; N = 46,266) and (2) early pandemic (COVID Supplement, fielded June-August 2020; N = 55,796). The analysis used a difference-in-difference design to assess whether a spouse dying from COVID-19 presents unique mental health risks (self-reported depression, loneliness, and trouble sleeping), compared with pre-pandemic recent spousal deaths. RESULTS We find strong associations between recent spousal death and poor mental health before and during the pandemic. However, our difference-in-difference estimates indicate those whose spouses died of COVID-19 have higher risks of self-reported depression and loneliness, but not trouble sleeping, than expected based on pre-pandemic associations. DISCUSSION These results highlight that the millions of COVID-19 widow(er)s face extreme mental health risks, eclipsing those experienced by surviving spouses pre-pandemic, furthering concerns about the pandemic's lasting impacts on health.
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Affiliation(s)
- Haowei Wang
- Population Research Institute, Department of Sociology and Criminology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Emily Smith-Greenaway
- Department of Sociology, University of Southern California, Los Angeles, California, USA
| | - Shawn Bauldry
- Department of Sociology, Purdue University, West Lafayette, Indiana, USA
| | - Rachel Margolis
- Department of Sociology, University of Western Ontario, London, Ontario, Canada
| | - Ashton M Verdery
- Address correspondence to: Ashton M. Verdery, PhD, Population Research Institute, Department of Sociology and Criminology, The Pennsylvania State University, Oswald Tower, University Park, PA 16802, USA. E-mail:
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Simons RL, Ong ML, Lei MK, Klopach E, Berg M, Zhang Y, Philibert R, Gibbons FX, Beach SR. Shifts in lifestyle and socioeconomic circumstances predict change—for better or worse—in speed of epigenetic aging: A study of middle-aged black women. Soc Sci Med 2022; 307:115175. [DOI: 10.1016/j.socscimed.2022.115175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 11/28/2022]
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Aquino T, Brand JE, Torche F. Unequal effects of disruptive events. SOCIOLOGY COMPASS 2022; 16:e12972. [PMID: 38895138 PMCID: PMC11185416 DOI: 10.1111/soc4.12972] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/07/2022] [Indexed: 06/21/2024]
Abstract
Disruptive events have significant consequences for the individuals and families who experience them, but these effects do not occur equally across the population. While some groups are strongly affected, others experience few consequences. We review recent findings on inequality in the effects of disruptive events. We consider heterogeneity based on socioeconomic resources, race/ethnicity, the likelihood of experiencing disruption, and contextual factors such as the normativity of the event in particular social settings. We focus on micro-level events affecting specific individuals and families, including divorce, job loss, home loss and eviction, health shocks and deaths, and violence and incarceration, but also refer to macro-level events such as recession and natural disasters. We describe patterns of variation that suggest a process of resource disparities and cumulative disadvantage versus those that reflect the impact of non-normative and unexpected shocks. Finally, we review methodological considerations when examining variation in the effect of disruptive events.
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Affiliation(s)
- Taylor Aquino
- University of California, Los Angeles, California, USA
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25
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Gerber K, Brijnath B, Lock K, Bryant C, Hills D, Hjorth L. 'Unprepared for the depth of my feelings' - Capturing grief in older people through research poetry. Age Ageing 2022; 51:6547546. [PMID: 35284925 PMCID: PMC9171723 DOI: 10.1093/ageing/afac030] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background Older people are more likely to experience bereavements than any other age group. However, in healthcare and society, their grief experiences and support needs receive limited attention. Through innovative, arts-based research poetry, this study aimed to capture older people’s bereavement stories and the effects of grief on their physical and mental health. Method Semi-structured in-depth interviews with 18 bereaved older adults were analysed using thematic and poetic narrative analysis, following a five-step approach of immersion, creation, critical reflection, ethics and engagement. Results Research poems were used to illustrate three themes of bereavement experiences among older adults: feeling unprepared, accumulation of losses and ripple effects of grief. While half of participants reported that the death of their family member was expected, many felt unprepared despite having experienced multiple bereavements throughout their life. Instead, the accumulation of losses had a compounding effect on their health and well-being. While these ripple effects of grief focussed on emotional and mental health consequences, many also reported physical health effects like the onset of a new condition or the worsening of an existing one. In its most extreme form, grief was connected with a perceived increased mortality risk. Conclusions By using poetry to draw attention to the intense and often long-lasting effects of grief on older people’s health and well-being, this article offers emotional, engaging and immersive insights into their unique bereavement experiences and thereby challenges the notion that grief has an expiry date.
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Affiliation(s)
- Katrin Gerber
- National Ageing Research Institute Melbourne Ageing Research Collaboration, , Melbourne, Australia
- University of Melbourne Melbourne School of Psychological Sciences, , Melbourne, Australia
| | - Bianca Brijnath
- National Ageing Research Institute Melbourne Ageing Research Collaboration, , Melbourne, Australia
- Curtin University School of Allied Health, , Perth, Australia
- University of Western Australia School of Social Sciences, , Perth, Australia
| | - Kayla Lock
- National Ageing Research Institute Melbourne Ageing Research Collaboration, , Melbourne, Australia
| | - Christina Bryant
- University of Melbourne Melbourne School of Psychological Sciences, , Melbourne, Australia
| | - Danny Hills
- Federation University School of Health, , Ballarat, Australia
| | - Larissa Hjorth
- School of Media and Communication, RMIT University , Melbourne, Australia
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Effect of Spousal Loss on Depression in Older Adults: Impacts of Time Passing, Living Arrangement, and Spouse's Health Status before Death. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413032. [PMID: 34948641 PMCID: PMC8700949 DOI: 10.3390/ijerph182413032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 11/16/2022]
Abstract
In addition to increasing the mortality among older adults, spousal death (SD) increases their risk of depression. This study explored the factors affecting depression among widowed older adults to provide health care strategies for successful aging. A total of 710 adults older than 60 years completed a questionnaire before and after their spouses’ deaths. The survey data included age, sex, ethnic group, education level, financial station socioeconomic status, SD (including time point), smoking status, alcohol consumption, self-rated health status, Center for Epidemiologic Studies Depression Scale score, mobility, and degree of support from relatives and friends. The proportion of participants with depression after SD was 1.7 times that of before SD (p < 0.0001). Worsened mobility (odds ratio [OR] = 1.3, p < 0.01), low self-rated health status (OR = 0.5, p < 0.01), and a high degree of support from relatives and friends (OR = 1.5, p < 0.01) had a significant positive correlation with depression after SD. The proportion of depression that occurred within 6 months after SD was 6.0 times higher than that of depression before SD. Participants who lived alone after losing their spouses who were healthy before their deaths exhibited a significantly increased proportion of depression after their spouses’ deaths. Male sex, spouse’s health, and the period of 6 months after SD are risk factors for depression in older adults. The maintenance of mobility, positive self-rated health status, and a shorter period of depression after a spouse’s death result in more favorable adaptability among women. Social workers or family members should focus on older adults whose spouses died unexpectedly or within the last 6 months. Living with family members after SD can alleviate depression in older adults.
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Lin JL, Lipstein EA, Wittenberg E, Tay D, Lundstrom R, Lundstrom GL, Sediqzadah S, Wright DR. Intergenerational Decision Making: The Role of Family Relationships in Medical Decision Making. MDM Policy Pract 2021; 6:23814683211039468. [PMID: 34734118 PMCID: PMC8559218 DOI: 10.1177/23814683211039468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/06/2021] [Indexed: 12/12/2022] Open
Abstract
A symposium held at the 42nd annual Society for Medical Decision Making conference on October 26, 2020, focused on intergenerational decision making. The symposium covered existing research and clinical experiences using formal presentations and moderated discussion and was attended by 43 people. Presentations focused on the roles of pediatric patients in decision making, caregiver decision making for a child with complex medical needs, caregiver involvement in advanced care planning, and the inclusion of spillover effects in economic evaluations. The moderated discussion, summarized in this article, highlighted existing resources and gaps in intergenerational decision making in four areas: decision aids, economic evaluation, participant perspectives, and measures. Intergenerational decision making is an understudied and poorly understood aspect of medical decision making that requires particular attention as our society ages and technological advances provide new innovations for life-sustaining measures across all stages of the lifespan.
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Affiliation(s)
- Jody L Lin
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Ellen A Lipstein
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Eve Wittenberg
- Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Djin Tay
- College of Nursing, University of Utah, Salt Lake City, Utah
| | | | | | - Saadia Sediqzadah
- Department of Psychiatry, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Davene R Wright
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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Hsiao YH, Lee MC, Yeh CJ, Tai CJ, Lee SS. Social Participation and Survival in Widowed Persons: Results of the Taiwan Longitudinal Study on Aging. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010974. [PMID: 34682721 PMCID: PMC8535271 DOI: 10.3390/ijerph182010974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 12/24/2022]
Abstract
It has been considered that widowed persons have a higher risk of death. This study intended to explore whether social participation could improve this trend. A longitudinal study database was constructed to explore the trend of survival and its change with social participation in widowed persons. The Taiwan Longitudinal Study on Aging (TLSA), based on four consecutive waves of longitudinal follow-up data in 1999, 2003, 2007, and 2011 was linked with the National Death Registry from 1999 through 2012. In total, there were 1417 widowed persons and 4500 nonwidowed persons included in this study, excluding divorced and never-married people. The survival trend analysis was carried out with social participation as the main predictive factor stratified for comparative analysis. Our results showed that the widowed were older than the nonwidowed, were female-dominant, had a lower education level, were more economically stressed, and were less likely to engage in regular exercise, and thus showed generally poorer health; for example, being more vulnerable to having chronic diseases, disability with the Activities of Daily Living (ADL), cognitive impairment with the Short Portable Mental State Questionnaire (SPMSQ), and depression with The Center for Epidemiological Studies-Depression (CES-D). The death risk of the widowed was significantly higher than that of the nonwidowed, but the death trend for those with social participation was significantly lower than that of their counterparts in both the widowed and nonwidowed. After matching with gender and age for widowed persons, the widowed with social participation had a significantly lower risk of death (adjusted hazard ratio (HR), 0.83; 95% confidence interval (CI), 0.71–0.98) compared to the widowed without social participation. It was concluded that social participation can improve the death risk for the widowed, and it is worthily included in health promotion plans and social welfare services for widowed persons.
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Affiliation(s)
- Yu-Han Hsiao
- Department of Public Health, Chung Shan Medical University, Taichung 40201, Taiwan; (Y.-H.H.); (C.-J.Y.)
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung 40343, Taiwan;
| | - Meng-Chih Lee
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung 40343, Taiwan;
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli 35053, Taiwan
- College of Management, Chaoyang University of Technology, Taichung 41331, Taiwan
| | - Chih-Jung Yeh
- Department of Public Health, Chung Shan Medical University, Taichung 40201, Taiwan; (Y.-H.H.); (C.-J.Y.)
| | - Chi-Jung Tai
- Department of Family Medicine, Pingtung Hospital, Ministry of Health and Welfare, Pingtung 90054, Taiwan
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Correspondence: (C.-J.T.); (S.-S.L.)
| | - Shiuan-Shinn Lee
- Department of Public Health, Chung Shan Medical University, Taichung 40201, Taiwan; (Y.-H.H.); (C.-J.Y.)
- Correspondence: (C.-J.T.); (S.-S.L.)
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Ford CL, Young LJ. Harnessing the healing power of love. Trends Mol Med 2021; 27:833-834. [PMID: 34364786 PMCID: PMC8605763 DOI: 10.1016/j.molmed.2021.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/22/2021] [Indexed: 12/15/2022]
Abstract
A recent paper by Naderi et al. published in eLife shows that pair bonding in monogamous mice is protective against tumor growth, likely via changes in serum factors and cancer cell transcription. We propose that studying the pathway linking social stimuli to cancer cell gene regulation offers a means to identify novel pharmacological targets.
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Affiliation(s)
- Charles L. Ford
- Center for Translational Social Neuroscience, Silvio O. Conte Center for Oxytocin and Social Cognition, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
| | - Larry J. Young
- Center for Translational Social Neuroscience, Silvio O. Conte Center for Oxytocin and Social Cognition, Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA,Correspondence: (L.J. Young)
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30
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Wei D, Janszky I, Fang F, Chen H, Ljung R, Sun J, Li J, László KD. Death of an offspring and parental risk of ischemic heart diseases: A population-based cohort study. PLoS Med 2021; 18:e1003790. [PMID: 34587153 PMCID: PMC8480908 DOI: 10.1371/journal.pmed.1003790] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The death of a child is an extreme life event with potentially long-term health consequences. Knowledge about its association with ischemic heart diseases (IHDs) and acute myocardial infarction (AMI), however, is very limited. We investigated whether the death of an offspring is associated with the risk of IHD and AMI. METHODS AND FINDINGS We studied parents of live-born children recorded in the Danish (1973 to 2016) and the Swedish (1973 to 2014) Medical Birth Registers (n = 6,711,952; mean age at baseline 31 years, 53% women). We retrieved information on exposure, outcomes, and covariates by linking individual-level information from several nationwide registers. We analyzed the abovementioned associations using Poisson regression. A total of 126,522 (1.9%) parents lost at least 1 child during the study period. Bereaved parents had a higher risk of IHD and AMI than the nonbereaved [incidence rate ratios (IRRs) (95% confidence intervals (CIs)): 1.20 (1.18 to 1.23), P < 0.001 and 1.21 (1.17 to 1.25), P < 0.001, respectively]. The association was present not only in case of losses due to CVD or other natural causes, but also in case of unnatural deaths. The AMI risk was highest in the first week after the loss [IRR (95% CI): 3.67 (2.08 to 6.46), P < 0.001], but a 20% to 40% increased risk was observed throughout the whole follow-up period. Study limitations include the possibility of residual confounding by socioeconomic, lifestyle, or health-related factors and the potentially limited generalizability of our findings outside Scandinavia. CONCLUSIONS The death of an offspring was associated with an increased risk of IHD and AMI. The finding that the association was present also in case of losses due to unnatural causes, which are less likely to be confounded by cardiovascular risk factors clustering in families, suggests that stress-related mechanisms may also contribute to the observed associations.
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Affiliation(s)
- Dang Wei
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Imre Janszky
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hua Chen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Rickard Ljung
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Swedish Medical Products Agency, Uppsala, Sweden
| | - Jiangwei Sun
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jiong Li
- Department of Clinical Medicine - Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Krisztina D. László
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Shi J, Tarkiainen L, Martikainen P, van Raalte A. The impact of income definitions on mortality inequalities. SSM Popul Health 2021; 15:100915. [PMID: 34527804 PMCID: PMC8433258 DOI: 10.1016/j.ssmph.2021.100915] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022] Open
Abstract
Income is a strong predictor of adult mortality. Measuring income is not as simple as it may sound. It can be conceptualized at the individual or the household level, with the former better reflecting an individual's earning ability, and the latter better capturing living standards. Furthermore, respondents are often grouped into income categories based on their positions in the income distribution, and this operationalization can be done on the basis of age-specific or total population income distributions. In this study, we look at how four combinations of different conceptualizations (individual vs. household) and operationalizations (age-specific vs. total population) of income can affect mortality inequality estimates. Using Finnish registry data, we constructed period life tables for ages 25+ from 1996 to 2017 by gender and for four income definitions. The results indicated that the slope index of inequality for life expectancy varied by 1.1-5.7 years between income definitions, with larger differences observed for women than for men. The overall age patterns of relative index of inequality for mortality rates yielded by the four definitions were similar, but the levels differed. The period trends across income definitions were consistent for men, but not for women. We conclude that researchers should pay particular attention to the choice of the income definitions when analyzing the association between income and mortality, and when comparing the magnitude of inequality across studies and over time.
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Affiliation(s)
- Jiaxin Shi
- Max Planck Institute for Demographic Research, Rostock, Germany
- Leverhulme Centre for Demographic Science, Department of Sociology, University of Oxford, Oxford, United Kingdom
| | - Lasse Tarkiainen
- Population Research Unit, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Max Planck Institute for Demographic Research, Rostock, Germany
- Population Research Unit, University of Helsinki, Helsinki, Finland
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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Fagundes CP, Wu EL. Biological mechanisms underlying widowhood's health consequences: Does diet play a role? COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2021; 7:100058. [PMID: 35757059 PMCID: PMC9216459 DOI: 10.1016/j.cpnec.2021.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/01/2021] [Accepted: 05/02/2021] [Indexed: 11/29/2022] Open
Abstract
The loss of a spouse is a highly stressful event that puts older adults at increased risk for morbidity and mortality. The risk is highest in the first year to 18 months post-loss; nevertheless, widow(er)s, in general, are at heightened risk of cardiovascular disease (CVD) related morbidity and mortality, and to a lesser extent, non-CVD related morbidity and mortality. The primary goal of this article is to argue for a perspective that considers diet and emotion-induced autonomic, neuroendocrine, and immune dysregulation, in unison, to understand the mechanisms underlying morbidity and mortality in early widowhood. Toward this end, we first summarize our previously published work, as well as work from other investigatory teams, showing that compared with those who were not bereaved, widow(er)s have higher levels of pro-inflammatory cytokine production and more dysregulated autonomic and neuroendocrine activity than non-widow(er)s, independent of health behaviors such as diet. We highlight that a major gap in our current understanding of the biobehavioral mechanisms that underlie the widowhood effect is the role of diet and hypothesize that the adverse health impact of grief and associated negative emotions and diet may be more than additive. Therefore, we propose that diet may be a pathway by which widow(er)s are at higher CVD risk requiring further investigation. Losing a spouse is highly stressful event; it increases one’s risk for morbidity and mortality, especially within the first 18 months post-loss. Widow(er)s are at risk of cardiovascular disease (CVD)- and non-CVD related morbidity and mortality. The role of diet is a major gap in our understanding of the biobehavioral mechanisms that underlie the widowhood effect. Diet clearly impacts CVD, and widow(er)s' eating habits are altered for at least the first two years post-loss. The adverse health impact of stress and diet may be more than additive; it may be synergistic.
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33
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Wang H, Verdery AM, Margolis R, Smith-Greenaway E. Bereavement from COVID-19, Gender, and Reports of Depression among Older Adults in Europe. J Gerontol B Psychol Sci Soc Sci 2021; 77:e142-e149. [PMID: 34252179 PMCID: PMC8411377 DOI: 10.1093/geronb/gbab132] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives The coronavirus disease 2019 (COVID-19) pandemic has left older adults around the world bereaved by the sudden death of relatives and friends. We examine if COVID-19 bereavement corresponds with older adults’ reporting depression in 27 countries and test for variations by gender and country context. Method We analyze the Survey of Health, Ageing and Retirement in Europe COVID-19 data collected between June and August 2020 from 51,383 older adults (age 50–104) living in 27 countries, of whom 1,363 reported the death of a relative or friend from COVID-19. We estimate pooled multilevel logit regression models to examine if COVID-19 bereavement is associated with self-reported depression and worsening depression, and we test whether national COVID-19 mortality rates moderate these associations. Results COVID-19 bereavement is associated with significantly higher probabilities of both reporting depression and reporting worsened depression among older adults. Net of one’s own personal loss, living in a country with the highest COVID-19 mortality rate is associated with women’s reports of worsened depression but not men’s. However, the country’s COVID-19 mortality rate does not moderate associations between COVID-19 bereavement and depression. Discussion COVID-19 deaths have lingering mental health implications for surviving older adults. Even as the collective toll of the crisis is apparent, bereaved older adults are in particular need of mental health support.
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Affiliation(s)
- Haowei Wang
- Population Research Institute, The Pennsylvania State University
| | - Ashton M Verdery
- Population Research Institute, The Pennsylvania State University
| | - Rachel Margolis
- Department of Sociology, University of Western Ontario, Canada
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Johannesen EJD, Róin Á. Transition to Widowhood Among Older Adults in Rural Areas: A Study From the Faroe Islands. OMEGA-JOURNAL OF DEATH AND DYING 2021; 87:519-533. [PMID: 34128418 DOI: 10.1177/00302228211024119] [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
Studies have shown that losing a spouse can cause both physical and mental suffering for the bereaved. This qualitative study aimed to gather knowledge about how men and women in the Faroe Islands, a small-scale society in the North Atlantic Ocean, managed the transition to widowhood. Five women and three men were interviewed, their age varying from 67 to 74 years. A hermeneutic analytic method was applied. Our findings showed that managing the transition to widowhood followed two tracks, namely the process of loss and the process of restoration. For participants locked in either process, the transition caused severe disruption in daily living, while participants who managed to oscillate between the two processes appeared to manage the transition to widowhood and get on with their lives. Our findings, and those from other studies, point to the need to offer structured individual support for people who have lost their life partner.
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Affiliation(s)
- Elsa J D Johannesen
- Department of Health and Nursing Science, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - Ása Róin
- Department of Health and Nursing Science, University of the Faroe Islands, Tórshavn, Faroe Islands
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Partnership and mortality in mid and late life: Protection or selection? Soc Sci Med 2021; 279:113971. [PMID: 33984691 DOI: 10.1016/j.socscimed.2021.113971] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/21/2021] [Accepted: 04/24/2021] [Indexed: 11/22/2022]
Abstract
The main goal of this paper is to address how different partnership statuses impact the likelihood of death among mature adults and elderly persons in Spain circa 2012 using a massive new dataset of administrative registers linked to census data. First, gross and net effects of having a partner on mortality risks of partnered and non-partnered persons are evaluated; then the characteristics and the importance of selection and protection effects of marriage and partnership with regard to the likelihood of death are assessed. We make use of exact matching methods in order to avoid the selection bias associated with the non-random assignment of persons to different partnership statuses. Protection effects decline gradually with age, but always remain positive. Selection effects show a far more pronounced decline with age leading to a pattern in which selection is much stronger than protection during the mature adult ages, but then disappear entirely and even become negative as people age. While both sexes show similar patterns, the protection effect is slightly higher among men while the selection effect is much higher among women, especially before 65 years of age.
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Schurz M, Uddin LQ, Kanske P, Lamm C, Sallet J, Bernhardt BC, Mars RB, Bzdok D. Variability in Brain Structure and Function Reflects Lack of Peer Support. Cereb Cortex 2021; 31:4612-4627. [PMID: 33982758 PMCID: PMC8408465 DOI: 10.1093/cercor/bhab109] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/02/2021] [Accepted: 03/24/2021] [Indexed: 01/10/2023] Open
Abstract
Humans are a highly social species. Complex interactions for mutual support range from helping neighbors to building social welfare institutions. During times of distress or crisis, sharing life experiences within one's social circle is critical for well-being. By translating pattern-learning algorithms to the UK Biobank imaging-genetics cohort (n = ~40 000 participants), we have delineated manifestations of regular social support in multimodal whole-brain measurements. In structural brain variation, we identified characteristic volumetric signatures in the salience and limbic networks for high- versus low-social support individuals. In patterns derived from functional coupling, we also located interindividual differences in social support in action-perception circuits related to binding sensory cues and initiating behavioral responses. In line with our demographic profiling analysis, the uncovered neural substrates have potential implications for loneliness, substance misuse, and resilience to stress.
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Affiliation(s)
- Matthias Schurz
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6525 EN Nijmegen, The Netherlands
- Wellcome Centre for Integrative Neuroimaging, Department of Experimental Psychology, University of Oxford, Oxford OX1 3SR, UK
- Institute of Psychology, University of Innsbruck, 6020 Innsbruck, Austria
- Address correspondence to Matthias Schurz, PhD, Donders Institute for Brain, Cognition, & Behaviour, Radboud University, Montessorilaan 3, B.0305, 6525 HR Nijmegen, Netherlands. and Danilo Bzdok, MD, PhD, Montreal Neurological Institute, 3801 rue University, Bureau #872D, Montréal (Québec) H3A 2B4, Canada.
| | - Lucina Q Uddin
- Department of Psychology, University of Miami, Coral Gables, Florida 33124, USA
- Neuroscience Program, University of Miami Miller School of Medicine, Miami, Florida 33136, USA
| | - Philipp Kanske
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, 01187 Dresden, Germany
- Max Planck Institute for Human Cognitive and Brain Sciences, 04103 Leipzig, Germany
| | - Claus Lamm
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, 1010 Vienna, Austria
| | - Jérôme Sallet
- Wellcome Centre for Integrative Neuroimaging, Department of Experimental Psychology, University of Oxford, Oxford OX1 3SR, UK
- University of Lyon, Univ Lyon 1, INSERM, Stem Cell and Brain Research Institute U1208, 69500 Bron, France
| | - Boris C Bernhardt
- McConnell Brain Imaging Centre (BIC), Montreal Neurological Institute (MNI), McGill University, Montreal, Quebec H3A 2B4, Canada
| | - Rogier B Mars
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, 6525 EN Nijmegen, The Netherlands
- Wellcome Centre for Integrative Neuroimaging, Centre for Functional MRI of the Brain (FMRIB), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK
| | - Danilo Bzdok
- McConnell Brain Imaging Centre (BIC), Montreal Neurological Institute (MNI), McGill University, Montreal, Quebec H3A 2B4, Canada
- Department of Biomedical Engineering, Faculty of Medicine, School of Computer Science, McGill University, Montreal, Quebec H3A 2B4, Canada
- Mila-Quebec Artificial Intelligence Institute, Montreal, Quebec H2S 3H1, Canada
- Address correspondence to Matthias Schurz, PhD, Donders Institute for Brain, Cognition, & Behaviour, Radboud University, Montessorilaan 3, B.0305, 6525 HR Nijmegen, Netherlands. and Danilo Bzdok, MD, PhD, Montreal Neurological Institute, 3801 rue University, Bureau #872D, Montréal (Québec) H3A 2B4, Canada.
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Naderi A, Soltanmaohammadi E, Kaza V, Barlow S, Chatzistamou I, Kiaris H. Persistent effects of pair bonding in lung cancer cell growth in monogamous Peromyscus californicus. eLife 2021; 10:e64711. [PMID: 33960931 PMCID: PMC8104960 DOI: 10.7554/elife.64711] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
Epidemiological evidence suggests that social interactions and especially bonding between couples influence tumorigenesis, yet whether this is due to lifestyle changes, homogamy (likelihood of individuals to marry people of similar health), or directly associated with host-induced effects in tumors remains debatable. In the present study, we explored if tumorigenesis is associated with the bonding experience in monogamous rodents at which disruption of pair bonds is linked to anxiety and stress. Comparison of lung cancer cell spheroids that formed in the presence of sera from bonded and bond-disrupted deer mice showed that in monogamous Peromyscus polionotus and Peromyscus californicus, but not in polygamous Peromyscus maniculatus, the disruption of pair bonds altered the size and morphology of spheroids in a manner that is consistent with the acquisition of increased oncogenic potential. In vivo, consecutive transplantation of human lung cancer cells between P. californicus, differing in bonding experiences (n = 9 for bonded and n = 7 for bond-disrupted), and nude mice showed that bonding suppressed tumorigenicity in nude mice (p<0.05), suggesting that the protective effects of pair bonds persisted even after bonding ceased. Unsupervised hierarchical clustering indicated that the transcriptomes of lung cancer cells clustered according to the serum donors' bonding history while differential gene expression analysis pointed to changes in cell adhesion and migration. The results highlight the pro-oncogenic effects of pair-bond disruption, point to the acquisition of expression signatures in cancer cells that are relevant to the bonding experiences of serum donors, and question the ability of conventional mouse models to capture the whole spectrum of the impact of the host in tumorigenesis.
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Affiliation(s)
- Asieh Naderi
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South CarolinaColumbiaUnited States
| | - Elham Soltanmaohammadi
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South CarolinaColumbiaUnited States
| | - Vimala Kaza
- Peromyscus Genetic Stock Center, University of South CarolinaColumbiaUnited States
| | - Shayne Barlow
- Department of Physiology, Pharmacology, and Neuroscience, School of Medicine and Department of Laboratory Animal Resources, University of South CarolinaColumbiaUnited States
| | - Ioulia Chatzistamou
- Department of Pathology, Microbiology and Immunology, School of Medicine, University of South CarolinaColumbiaUnited States
| | - Hippokratis Kiaris
- Department of Drug Discovery and Biomedical Sciences, College of Pharmacy, University of South CarolinaColumbiaUnited States
- Peromyscus Genetic Stock Center, University of South CarolinaColumbiaUnited States
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Lewis TT, Van Dyke ME, Matthews KA, Barinas-Mitchell E. Race/Ethnicity, Cumulative Midlife Loss, and Carotid Atherosclerosis in Middle-Aged Women. Am J Epidemiol 2021; 190:576-587. [PMID: 33034337 DOI: 10.1093/aje/kwaa213] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 09/25/2020] [Accepted: 10/05/2020] [Indexed: 12/30/2022] Open
Abstract
African-American women have elevated rates of cardiovascular disease compared with women of other races or ethnicities, and race/ethnicity-related stressors may play a role. We examined the association between a race/ethnicity-related stressor, midlife loss, and a marker of cardiovascular risk, carotid intima media thickness (IMT), in 1,410 African-American, White, Chinese, and Hispanic women from the Study of Women's Health Across the Nation. Participants were queried about losses annually over 12 years (1996-2013), with IMT assessed in year 12-13 via ultrasound. Linear regression models were used to examine associations between cumulative upsetting losses and IMT, adjusting for covariates. In minimally adjusted models in the full cohort, 3 or more upsetting losses (vs. none) were associated with IMT (β = 0.03, 95% confidence interval (CI): 0.01, 0.05; P = 0.0003). Results were more robust among African-American women (β = 0.042, 95% CI: 0.01, 0.07; P < 0.01) than White (β = 0.014, 95% CI: -0.01, 0.03; P = 0.21), Chinese (β = 0.036, 95% CI: -0.03, 0.10; P = 0.25), or Hispanic (β = 0.036, 95% CI: -0.07, 0.14; P = 0.51) women, although associations among women from racial/ethnic minorities overall were of similar magnitude. Results persisted in fully adjusted models (P for interaction with race/ethnicity = 0.04). Midlife loss may be a pathway through which race/ethnicity influences cardiovascular risk for African-American women and, potentially, Chinese and Hispanic women.
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Smith-Greenaway E, Alburez-Gutierrez D, Trinitapoli J, Zagheni E. Global burden of maternal bereavement: indicators of the cumulative prevalence of child loss. BMJ Glob Health 2021; 6:e004837. [PMID: 33824177 PMCID: PMC8030478 DOI: 10.1136/bmjgh-2020-004837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/01/2021] [Accepted: 03/07/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND We provide country-level estimates of the cumulative prevalence of mothers bereaved by a child's death in 170 countries and territories. METHODS We generate indicators of the cumulative prevalence of mothers who have had an infant, under-five-year-old or any-age child ever die by using publicly available survey data in 89 countries and an indirect approach that combines formal kinship models and life-table methods in an additional 81 countries. We label these measures the maternal cumulative prevalence of infant mortality (mIM), under-five mortality (mU5M) and offspring mortality (mOM) and generate prevalence estimates for 20-44-year-old and 45-49-year-old mothers. RESULTS In several Asian and European countries, the mIM and mU5M are below 10 per 1000 mothers yet exceed 200 per 1000 mothers in several Middle Eastern and African countries. Global inequality in mothers' experience of child loss is enormous: mothers in high-mortality-burden African countries are more than 100 times more likely to have had a child die than mothers in low-mortality-burden Asian and European countries. In more than 20 African countries, the mOM exceeds 500 per 1000 mothers, meaning that it is typical for a surviving 45-49-year-old mother to be bereaved. DISCUSSION The study reveals enormous global disparities in mothers' experience of child loss and identifies a need for more research on the downstream mental and physical health risks associated with parental bereavement.
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Affiliation(s)
- Emily Smith-Greenaway
- Sociology & Spatial Sciences, University of Southern California, Los Angeles, California, USA
| | | | | | - Emilio Zagheni
- Max Planck Institute for Demographic Research, Rostock, Germany
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Abstract
With few exceptions, greater disparities in mortality risk by socio-economic status (SES) have been found among men than among women. Most research has also shown that the higher mortality risk after widowhood (the widowhood effect) is greater for men. However, a different picture appears when examining these associations jointly. Based on Swedish register data, this study shows that widowhood weakens, or even reverses, the sex differences in socio-economic disparities in mortality. The overall findings also indicate that higher SES elevates the widowhood effect for men but diminishes it for women, and that the widowhood effect is greater for women than men in the lowest SES categories. These results imply that men with higher SES are more vulnerable after widowhood, perhaps because of their previous relatively privileged situation. The disadvantage of widows in lower SES categories may reflect exposure to financial strains after spousal loss and inequalities in the healthcare system.
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Brenner MH, Bhugra D. Acceleration of Anxiety, Depression, and Suicide: Secondary Effects of Economic Disruption Related to COVID-19. Front Psychiatry 2020; 11:592467. [PMID: 33384627 PMCID: PMC7771384 DOI: 10.3389/fpsyt.2020.592467] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/16/2020] [Indexed: 12/23/2022] Open
Abstract
The SARS-CoV-2 (COVID-19) pandemic has contributed to increasing levels of anxiety, depression and other symptoms of stress around the globe. Reasons for this increase are understandable in the context of individual level factors such as self-isolation, lockdown, grief, survivor guilt, and other factors but also broader social and economic factors such as unemployment, insecure employment and resulting poverty, especially as the impacts of 2008 recession are still being felt in many countries further accompanied by social isolation. For those who are actively employed a fear of job and income loss and those who have actually become ill and recovered or those who have lost family and friends to illness, it is not surprising that they are stressed and feeling the psychological impact. Furthermore, multiple uncertainties contribute to this sense of anxiety. These fears and losses are major immediate stresses and undoubtedly can have long-term implications on mental health. Economic uncertainty combined with a sense of feeling trapped and resulting lack of control can contribute to helplessness and hopelessness where people may see suicide as a way out. Taking a macro view, we present a statistical model of the impact of unemployment, and national income declines, on suicide, separately for males and females over the life cycle in developed countries. This impact may reflect a potent combination of social changes and economic factors resulting in anomie. The governments and policymakers have a moral and ethical obligation to ensure the physical health and well-being of their populations. While setting in place preventive measures to avoid infections and then subsequent mortality, the focus on economic and social recovery is crucial. A global pandemic requires a global response with a clear inter-linked strategy for health as well as economic solutions. The models we have constructed represent predictions of suicide rates among the 38 highly industrialized OECD countries over a period of 18 years (2000-2017). Unemployment has a major effect on increasing suicide, especially in middle-aged groups. However, the impact of economic decline through losses of national income (GDP per capita) are substantially greater than those of unemployment and influence suicide throughout the life course, especially at the oldest ages.
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Affiliation(s)
- M. Harvey Brenner
- Johns Hopkins University Bloomberg School of Public Health, Health Policy and Management, Baltimore, MD, United States
- University of North Texas Health Science Center, Fort Worth, TX, United States
- Medizinische Hochschule Hannover, Hanover, Germany
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Halpern-Manners A, Raymo JM, Warren JR, Johnson KL. School performance and mortality: The mediating role of educational attainment and work and family trajectories across the life course. ADVANCES IN LIFE COURSE RESEARCH 2020; 46:100362. [PMID: 33456423 PMCID: PMC7808718 DOI: 10.1016/j.alcr.2020.100362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Evidence of a strong negative correlation between adolescent academic performance and mortality points to the importance of not only cognitive, but also non-cognitive, skills in predicting survival. We integrated two bodies of research to evaluate expectations regarding the role of educational attainment and trajectories of employment and marriage experience in mediating relationships between high school class rank and longevity. In particular, we used data from the Wisconsin Longitudinal Study (n = 9,232) to fit parametric mortality models from age 55 to age 77. Multiple mediator models allowed for quantification of the degree to which the association between high school class rank and mortality is mediated by life trajectories and educational attainment. Our results show that high school class rank is a statistically significant and substantively meaningful predictor of survival beyond age 55 and that this relationship is partially, but not fully, mediated by trajectories of employment and marriage experience across the life course. Higher educational attainment also mediates a substantial part of the relationship, but to varying degrees for men and women.
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I Don't Want to Go Back: Examining the Return to Physical Workspaces During COVID-19. J Occup Environ Med 2020; 62:953-958. [PMID: 32858556 DOI: 10.1097/jom.0000000000002012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We study employee perspectives on return to physical workspaces to ultimately inform employers' and policy makers' decision making around the return to work during COVID-19. METHODS We tested the three-component conceptual model using survey data collected in the United States in May 2020 from samples of energy workers (N = 333). RESULTS Women, non-Caucasians, and employees living in multi-generational households were less willing to return. Concerns about childcare were negatively related to willingness to return, whereas organizational strategies for mitigating COVID-19 transmission at work were positively related to willingness to return. COVID-19 infections in an employees' network were also negatively related to employees' willingness to return. CONCLUSIONS Blanket policies may miss the nuanced needs of different employee groups. Employers and policy makers should adopt flexible approaches to ensure a return to workspaces that addresses employee concerns and needs.
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44
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Fenger-Grøn M, Paulsen Møller I, Schou Pedersen H, Frost L, Sandbæk A, Davydow DS, Johnsen SP, Vinter N. Death of a Partner and Risks of Ischemic Stroke and Intracerebral Hemorrhage: A Nationwide Danish Matched Cohort Study. J Am Heart Assoc 2020; 9:e018763. [PMID: 33198551 PMCID: PMC7763796 DOI: 10.1161/jaha.120.018763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Stress has been reported to trigger stroke, and the death of a loved one is a potentially extremely stressful experience. Yet, previous studies have yielded conflicting findings of whether bereavement is associated with stroke risk, possibly because of insufficient distinction between ischemic stroke (IS) and intracerebral hemorrhage (ICH). We therefore examined the associations between bereavement and IS and ICH separately in contemporary care settings using nationwide high‐quality register resources. Methods and Results The study cohort included all Danish individuals whose partner died between 2002 and 2016 and a reference group of cohabiting individuals matched 1:2 on sex, age, and calendar time. Cox proportional hazards regression was used to estimate adjusted hazard ratios (aHRs) and corresponding 95% CIs during up to 5 years follow‐up. During the study period, 278 758 individuals experienced partner bereavement, of whom 7684 had an IS within the subsequent 5 years (aHR, 1.11; CI, 1.08–1.14 when compared with nonbereaved referents) and 1139 experienced an ICH (aHR, 1.13; CI, 1.04–1.23). For ICH, the estimated association tended to be stronger within the initial 30 days after partner death (aHR, 1.66; CI, 1.06–2.61), especially in women (aHR, 1.99; CI, 1.06–3.75), but the statistical precision was low. In absolute numbers, the cumulative incidence of IS at 30 days was 0.73 per 1000 in bereaved individuals versus 0.63 in their referents, and the corresponding figures for ICH were 0.13 versus 0.08. Conclusions Statistically significant positive associations with partner bereavement were documented for both IS and ICH risk, for ICH particularly in the short term. However, absolute risk differences were small.
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Affiliation(s)
| | - Ida Paulsen Møller
- Diagnostic Centre University Research Clinic for Innovative Patient Pathways Silkeborg Regional Hospital Silkeborg Denmark
| | | | - Lars Frost
- Diagnostic Centre University Research Clinic for Innovative Patient Pathways Silkeborg Regional Hospital Silkeborg Denmark.,Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Annelli Sandbæk
- Steno Diabetes Center, Aarhus and Department of Public Health Aarhus University Aarhus Denmark
| | | | - Søren P Johnsen
- Danish Center for Clinical Health Services Research Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Nicklas Vinter
- Diagnostic Centre University Research Clinic for Innovative Patient Pathways Silkeborg Regional Hospital Silkeborg Denmark.,Department of Clinical Medicine Aarhus University Aarhus Denmark.,Danish Center for Clinical Health Services Research Department of Clinical Medicine Aalborg University Aalborg Denmark
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Matta S, Hsu JW, Iwashyna TJ, Baum MY, Langa KM, Nicholas LH. Identifying Cohabiting Couples in Administrative Data: Evidence from Medicare Address Data. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2020; 21:238-247. [PMID: 34149307 DOI: 10.1007/s10742-020-00229-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Marital status is recognized as an important social determinant of health, income, and social support, but is rarely available in administrative data. We assessed the feasibility of using exact address data and zip code history to identify cohabiting couples using the 2018 Medicare Vital Status file and ZIP codes in the 2011-2014 Master Beneficiary Summary Files. Medicare beneficiaries meeting our algorithm displayed characteristics consistent with assortative mating and resembled known married couples in the Health and Retirement Study linked to Medicare claims. Address information represents a promising strategy for identifying cohabiting couples in administrative data including healthcare claims and other data types.
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Affiliation(s)
- Sasmira Matta
- The Wharton School, University of Pennsylvania, Department of Health Care Management and Economics, 3641 Locust Walk, Philadelphia, PA 19106.,Leonard Davis Institute of Health Economics, 3641 Locust Walk, Philadelphia, PA 19106
| | - Joanne W Hsu
- Board of Governors of the Federal Reserve System, Constitution Ave NW & 20 Street Northwest, Washington, DC 20551
| | - Theodore J Iwashyna
- University of Michigan Pulmonary and Critical Care Medicine, 1500 E Medical Center Dr SPC 5360, Ann Arbor, MI 48109.,University of Michigan Institute for Social Research, 426 Thompson Street, Ann Arbor, MI 48104
| | - Micah Y Baum
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, 624 N. Broadway, Baltimore, MD 21205
| | - Kenneth M Langa
- University of Michigan Institute for Social Research, 426 Thompson Street, Ann Arbor, MI 48104.,University of Michigan Department of Internal Medicine, 1500 E Medical Center Dr SPC 5368, Ann Arbor, MI 48109
| | - Lauren Hersch Nicholas
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, 624 N. Broadway, Baltimore, MD 21205.,The Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205
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Chen Z, Ying J, Ingles J, Zhang D, Rajbhandari-Thapa J, Wang R, Emerson KG, Feng Z. Gender differential impact of bereavement on health outcomes: evidence from the China Health and Retirement Longitudinal Study, 2011-2015. BMC Psychiatry 2020; 20:514. [PMID: 33092555 PMCID: PMC7583229 DOI: 10.1186/s12888-020-02916-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/13/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Bereavement is the experience of an individual following the death of a person of significance to the individual, most often referring to the spouse. Increased morbidity, health care utilization, and mortality are known to be associated with bereavement. Given China's growing population of older adults, there is a critical need to assess the health consequences of bereavement. METHOD We use data from the China Health and Retirement Longitudinal Study to examine the impact of bereavement on mental health and quality of life among a sample of mid- and older-aged adults. We use propensity score matching to construct a matching sample and difference-in-differences method to estimate the impact of bereavement on mental health and self-assessed health. RESULTS We find bereavement is associated with increased depression symptoms among women (1.542 point or 0.229 standard deviations of Center for Epidemiologic Studies Depression (CES-D) 10 score) but not consistently for men over time. No statistically significant effect of bereavement on self-assessed health is found. CONCLUSIONS Our results show a harmful impact of bereavement on mental health among older women in China and point to the need for a comprehensive policy on survivor benefits in China, particularly for rural older women.
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Affiliation(s)
- Zhuo Chen
- College of Public Health University of Georgia, Wright Hall 305B, 100 Foster Rd, Athens, GA, 30602, USA.
- University of Nottingham Ningbo China, Ningbo, 315100, Zhejiang, China.
| | - Jiahui Ying
- College of Public Health University of Georgia, Wright Hall 305B, 100 Foster Rd, Athens, GA, 30602, USA
| | - Justin Ingles
- College of Public Health University of Georgia, Wright Hall 305B, 100 Foster Rd, Athens, GA, 30602, USA
| | - Donglan Zhang
- College of Public Health University of Georgia, Wright Hall 305B, 100 Foster Rd, Athens, GA, 30602, USA
| | - Janani Rajbhandari-Thapa
- College of Public Health University of Georgia, Wright Hall 305B, 100 Foster Rd, Athens, GA, 30602, USA
| | - Ruoxi Wang
- Huazhong University of Science and Technology of China, Wuhan, 430074, Hubei, China
| | - Kerstin Gerst Emerson
- College of Public Health University of Georgia, Wright Hall 305B, 100 Foster Rd, Athens, GA, 30602, USA
| | - Zhanchun Feng
- Huazhong University of Science and Technology of China, Wuhan, 430074, Hubei, China
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Barclay KJ, Thorén RD, Hanson HA, Smith KR. The Effects of Marital Status, Fertility, and Bereavement on Adult Mortality in Polygamous and Monogamous Households: Evidence From the Utah Population Database. Demography 2020; 57:2169-2198. [PMID: 32935302 PMCID: PMC7732802 DOI: 10.1007/s13524-020-00918-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Although the associations among marital status, fertility, bereavement, and adult mortality have been widely studied, much less is known about these associations in polygamous households, which remain prevalent across much of the world. We use data from the Utah Population Database on 110,890 women and 106,979 men born up to 1900, with mortality follow-up into the twentieth century. We examine how the number of wife deaths affects male mortality in polygamous marriages, how sister wife deaths affect female mortality in polygamous marriages relative to the death of a husband, and how marriage order affects the mortality of women in polygamous marriages. We also examine how the number of children ever born and child deaths affect the mortality of men and women as well as variation across monogamous and polygamous unions. Our analyses of women show that the death of a husband and the death of a sister wife have similar effects on mortality. Marriage order does not play a role in the mortality of women in polygamous marriages. For men, the death of one wife in a polygamous marriage increases mortality to a lesser extent than it does for men in monogamous marriages. For polygamous men, losing additional wives has a dose-response effect. Both child deaths and lower fertility are associated with higher mortality. We consistently find that the presence of other kin in the household—whether a second wife, a sister wife, or children—mitigates the negative effects of bereavement.
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Affiliation(s)
- Kieron J Barclay
- Max Planck Institute for Demographic Research, Rostock, Germany. .,Department of Sociology, Stockholm University, Stockholm, Sweden. .,Swedish Collegium for Advanced Study, Uppsala, Sweden.
| | | | - Heidi A Hanson
- Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Ken R Smith
- Population Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.,Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, USA
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Abstract
BACKGROUND Due to its young age structure and taboos on widow remarriage, India has a large and relatively young female widow population. Many of India’s widows are in prime working ages. India has one of the lowest female labor force participation rates in the world. OBJECTIVE This paper calculates the effect of widowhood on the labor force participation of Indian widows. The analysis documents how labor force participation changes associated with widowhood vary by age, caste/religion, relation to head of household, rural/urban status, and region. METHODS Using the India Human Development Survey (IHDS), the analysis tracks 3,217 women who experience the loss of their spouse between the two survey waves. Individual fixed effects regressions are used to measure the association between the transition to widowhood and changes in the number of days worked in the past year. RESULTS Widowhood was associated with a decrease in days worked for older women; but for women widowed before age 52, widowhood was associated with a large increase in the number of days they worked. Widows who joined the labor force were more likely to gain employment in permanent and salaried work than married women. Widows who resided with their in-laws or who became the household head after their husband’s death saw increases in their work participation whereas those who lived in households headed by their adult children experienced negative widowhood effects on their work participation. CONTRIBUTION These findings highlight the important link between marital status and female employment in India.
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Bzdok D, Dunbar RIM. The Neurobiology of Social Distance. Trends Cogn Sci 2020; 24:717-733. [PMID: 32561254 PMCID: PMC7266757 DOI: 10.1016/j.tics.2020.05.016] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/20/2020] [Accepted: 05/29/2020] [Indexed: 12/11/2022]
Abstract
Never before have we experienced social isolation on such a massive scale as we have in response to coronavirus disease 2019 (COVID-19). However, we know that the social environment has a dramatic impact on our sense of life satisfaction and well-being. In times of distress, crisis, or disaster, human resilience depends on the richness and strength of social connections, as well as on active engagement in groups and communities. Over recent years, evidence emerging from various disciplines has made it abundantly clear: perceived social isolation (i.e., loneliness) may be the most potent threat to survival and longevity. We highlight the benefits of social bonds, the choreographies of bond creation and maintenance, as well as the neurocognitive basis of social isolation and its deep consequences for mental and physical health.
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Affiliation(s)
- Danilo Bzdok
- Department of Biomedical Engineering, McConnell Brain Imaging Centre (BIC), Montreal Neurological Institute (MNI), Faculty of Medicine, McGill University, Montreal, Canada; Quebec Artificial Intelligence Institute (Mila), Montreal, Canada.
| | - Robin I M Dunbar
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
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Abstract
Purpose of review a)The purpose of this systematic review was to characterize the studies published on grief interventions for bereaved older adults in the last 5 years. Grief intervention studies were included that exclusively focused on older adults as well as those that included older adults in their samples, in order to summarize the most up-to-date treatment options available for bereaved older adults. Recent findings b)Twenty-four articles that investigated grief interventions in older adults were identified. Generally, findings suggest viable treatment approaches for bereaved older adults are those incorporating behavioral activation and guidance on restoration-oriented coping. However, similar to studies of broader adult populations, grief interventions had small effects on grief-related symptoms in older adults. Few studies examined age as a moderator of treatment effects. Studies varied greatly by study design, sample size, and outcomes measured, which all likely impacted the efficacy of results. Summary c)This review suggests that, while there has been a growing focus on older adults, who have unique vulnerabilities in bereavement, the evidence-base of efficacious interventions for this population is limited. Given the need for specialized bereavement support for older adults will increase in the coming years, future research should prioritize rigorous investigations of grief treatment options leveraging technology to increase access and incorporate techniques that enhance engagement in life and connectedness for this vulnerable population.
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