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Rong J, Zhang N, Wang Y, Cheng P, Zhao D. Development and validation of a nomogram to predict the depressive symptoms among older adults: A national survey in China. J Affect Disord 2024; 361:367-375. [PMID: 38897299 DOI: 10.1016/j.jad.2024.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 05/21/2024] [Accepted: 06/14/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Depressive symptoms (DS) have become a global public health problem. However, a risk prediction model for DS in the elderly population has not been established. The purpose of this study was to develop and validate a predictive nomogram to screen for DS in the elderly population. METHODS A cross-sectional data of 3396 participants aged 60 and over were obtained from the China Health and Retirement Longitudinal Study 2018 (CHARLS). Participants were divided into the development and validation set. Predictive factors were selected through a single-factor analysis, and then a predictive model nomogram was established. The discrimination, calibration, and clinical validity were evaluated using the receiver operating characteristic (ROC) curves, Hosmer-Lemeshow tests, and decision curve analyses (DCA). RESULTS A total of 2379 and 1017 participants were included in the development and validation set, respectively. The analysis found that gender, residence, dyslipidemia, self-rated health, and ADL disability were risk factors for DS in older adults, and were included in the final model. This nomogram showed an acceptable predictive performance as evaluated by the area under the ROC curve with values of 0.684 (95 % confidence interval (CI): 0.663-0.706) and 0.687 (95 % CI: 0.655-0.719) in the development and validation set, respectively. The calibration curve indicated that the model was accurate, and DCA demonstrated a good clinical application value. CONCLUSION Five factors were selected to establish a nomogram for predicting DS in older adults. The nomogram has a good evaluation performance and can be used as a reliable tool to predict DS among older adults.
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Affiliation(s)
- Jian Rong
- Department of Scientific Research, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, PR China
| | - Ningning Zhang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Yu Wang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Pan Cheng
- Department of Scientific Research, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, PR China
| | - Dahai Zhao
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Anhui, China.
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Malak MZ, Khalifeh AH. The Relationship Between Quality of Life and Depressive Symptoms Among Jordanian Community-Dwelling Older Adults. Exp Aging Res 2023:1-16. [PMID: 37990905 DOI: 10.1080/0361073x.2023.2286873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 11/19/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE The current study aimed to examine the relationship between depressive symptoms and quality of life among Jordanian community-dwelling older adults. METHODS A cross-sectional, descriptive correlational design was used. A convenience sample (N = 602) was selected to recruit the participants in the Amman governorate during the period from August to November 2021. RESULTS Findings demonstrated that the mean (SD) age of older adults was 67.5 (7.0) years and 51.5% of participants were females. Also, 54.1% of the participants experienced moderate to severe depressive symptoms with a total mean (SD) score was 8.57 on a scale of 0 to 15, while the mean (SD) for the quality of life scale was 12.12 (3.85) on a scale of 4 to 20. Significant differences existed in quality of life and depressive symptoms based on marital status (p < .001), educational level (p < .001), working status (p < .01), income (p < .001), and chronic disease (p < .01). Quality of life and its domains were negatively associated with depressive symptoms (B= - 0.596, p < .001). Also, marital status, working, educational level, income, and chronic disease were associated with depressive symptoms. CONCLUSION Strategies to improve quality of life should be promoted to minimize depressive symptoms among older adults and consider significant demographic factors.
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Affiliation(s)
- Malakeh Z Malak
- Community Health Nursing, Faculty of Nursing, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Anas H Khalifeh
- Department of Community & Mental Health Nursing, Faculty of Nursing, Zarqa University, Zarqa, Jordan
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Torres LSS, Oliveira ACDS, Araújo MPD, de Carvalho MDS, Barbosa LBDSF, Dantas BADS, Martínez CSG, de Miranda FAN, Mendes FRP, Torres GDV. Determinants of socioeconomic factors for quality of life and depressive symptoms in community-dwelling older people: A cross-sectional study in Brazil and Portugal. PLoS One 2023; 18:e0287163. [PMID: 37310938 DOI: 10.1371/journal.pone.0287163] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/31/2023] [Indexed: 06/15/2023] Open
Abstract
Our aim was to analyze the association between socioeconomic status and quality of life (QoL) among older people with depressive symptoms treated through the Primary Health Care (PHC) system in Brazil and Portugal. This was a comparative cross-sectional study with a nonprobability sample of older people in the PHC in Brazil and Portugal conducted between 2017 and 2018. To evaluate the variables of interest, the socioeconomic data questionnaire, the Geriatric Depression Scale and the Medical Outcomes Short-Form Health Survey were used. Descriptive and multivariate analyses were performed to test the study hypothesis. The sample consisted of n = 150 participants (Brazil n = 100 and Portugal n = 50). There was a predominance of woman (76.0%, p = 0.224) and individuals between 65 and 80 years (88.0%, p = 0.594). The multivariate association analysis showed that in the presence of depressive symptoms, the QoL mental health domain was most associated with the socioeconomic variables. Among the prominent variables, woman group (p = 0.027), age group 65-80 years (p = 0.042), marital status "without a partner" (p = 0.029), education up to 5 years (p = 0.011) and earning up to 1 minimum wage (p = 0.037) exhibited higher scores among brazilian participants. The portuguese participants showed an association between the general health status domain and woman group (p = 0.042) and education up to 5 years (p = 0.045). The physical functioning domain was associated with income of up to 1 minimum wage (p = 0.037). In these domains, the portuguese participants exhibited higher scores than the brazilian participants. We verified the association between socioeconomic profile and QoL in the presence of depressive symptoms, which occurred mainly among woman, participants with low levels of education and low income, with QoL aspects related to mental, physical and social health and self-perceived health. The group from Brazil had higher QoL scores than the group from Portugal.
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Affiliation(s)
| | | | | | | | | | - Bruno Araújo da Silva Dantas
- School of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, State of Rio Grande do Norte, Brazil
| | | | - Francisco Arnoldo Nunes de Miranda
- Department of Nursing and Graduate Program in Nursing, Federal University of Rio Grande do Norte, Natal, State of Rio Grande do Norte, Brazil
| | | | - Gilson de Vasconcelos Torres
- CNPQ Researcher (PQ1D) and Department of Nursing, Federal University of Rio Grande do Norte, Natal, State of Rio Grande do Norte, Brazil
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Global prevalence of depression in older adults: A systematic review and meta-analysis of epidemiological surveys. Asian J Psychiatr 2023; 80:103417. [PMID: 36587492 DOI: 10.1016/j.ajp.2022.103417] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/10/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The reported prevalence of depressive symptoms (depression hereafter) among older adults varied widely across different studies. This was a meta-analysis to systematically examine the global prevalence of depression among older populations and its associated factors. METHODS A systematic literature search was performed in PubMed, EMBASE, PsycINFO, and Web of Science. Due to the differences in demographic and clinical characteristics between studies, random-effects model was used to calculate the pooled prevalence of depression and its 95% confidence interval (95% CI). RESULTS In total, 55 studies with 59,851 individuals met the study criteria and were included in the analyses. The overall prevalence of depression was 35.1% (95%CI: 30.2-40.4%). Subgroup analyses revealed that different sampling methods (Q=10592.49, p = 0.037), Geriatric Depression Scale versions (Q=13712.55, p < 0.001) and income levels (Q=14.028, P < 0.001) were significantly associated with the pooled prevalence of depression in older adults. In the meta-regression analyses, time of survey (B=0.012, z = 2.30, p = 0.029) was positively associated, and mean age (B=-0.018, z = 2.10, p = 0.044) was negatively associated with the prevalence of depression in older populations. The funnel plot and Egger's test did not reveal any significant publication bias (Egger's test: t = 1.93, p = 0.059). CONCLUSION This meta-analysis found that over a third of older populations globally had depression. Effective preventive measures, regular screening and timely interventions are needed to address this highly prevalent public health problem among older adults.
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Zhu X, Yang F. The association among eHealth literacy, depressive symptoms and health-related quality of life among older people: A cross-section study. Int J Older People Nurs 2023; 18:e12497. [PMID: 35945904 DOI: 10.1111/opn.12497] [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: 08/16/2021] [Revised: 07/12/2022] [Accepted: 07/25/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND eHealth literacy can facilitate the uptake of benefits of health for older persons. The aim of this study was to examine the association of eHealth literacy with depression, health-related quality of life (HRQoL) among older persons. METHODS A survey of 6183 participants (aged 60 years and above) from 17 communities was conducted in June 2019. Participants answered questions related to basic information, eHealth literacy scale (eHEALS), geriatric depression scale and the short-form health survey (SF-36). Mediation model and a linear regression analysis were performed to explore the association between the eHEALS scores and related factors. RESULTS The mean score of eHEALS was 21.17 (SD = 8.25). eHEALS was significant higher in men, those with living in the city, those with high educated and stable income and those with living with children, as compared to their counterparts, respectively. Moreover, chronic diseases and depressive symptoms negatively associated with eHEALS, while actively obtaining health information and physical activity positively influenced eHEALS. Furthermore, depressive symptoms had direct and indirect effects on HRQoL, as mediated by eHealth literacy. CONCLUSIONS The eHEALS acts as a mediator between depressive symptoms and HRQoL. As eHealth literacy is a protector for older people, efforts to improve the older persons' eHealth literacy could help to maintain health status. Therefore, healthcare providers formulate effective programs to improve eHealth literacy for older persons, which can bring benefits for health ageing.
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Affiliation(s)
- Xinhong Zhu
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
| | - Fen Yang
- School of Nursing, Hubei University of Chinese Medicine, Wuhan, China
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Quality of Life in Community-Dwelling Older People with Functional and Nutritional Impairment and Depressive Symptoms: A Comparative Cross-Sectional Study in Brazil and Portugal. Geriatrics (Basel) 2022; 7:geriatrics7050096. [PMID: 36136805 PMCID: PMC9498901 DOI: 10.3390/geriatrics7050096] [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: 08/09/2022] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background: The interaction of quality of life (QoL) with functionality, nutrition and depression has been studied, but few studies have compared different realities. Our objective was to compare the associations of QoL with impaired functionality, nutritional status and depressive symptoms among older people patients treated in primary health care (PHC) in Brazil and Portugal. Methods: Cross-sectional, comparative study was conducted with primary data from PHC services in Brazil and Portugal with users over 65 years old. Participants’ scores were classified as “impaired” and “preserved” for QoL, functional decline, nutrition and depression. We used Pearson’s chi-square test, Fisher’s exact test and the Mann–Whitney U test. Results: Our sample had a total of 150 PHC users. We found lower QoL scores in Brazil, which were associated with the risk of functional decline for the domains Physical Functioning, General Health Perceptions, Mental Health dimensions and Physical Health. Nutritional impairment in the group from Portugal included the domains of Vitality and Social Role Functioning. For depressive impairment, Portugal showed an association with the domains Mental Health, Vitality and Social Role Functioning. Conclusions: QoL was associated with functional and nutritional impairment and depressive symptoms, highlighting physical, mental and social characteristics related to the perception of well-being.
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Wang H, Zhang H, Chen Y, Cai M, Guo C, Chen P. Association between walking speed and cognitive domain functions in Chinese suburban-dwelling older adults. Front Aging Neurosci 2022; 14:935291. [PMID: 35978947 PMCID: PMC9377637 DOI: 10.3389/fnagi.2022.935291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo examine the relationship among walking speed, cognitive impairment, and cognitive domain functions in older men and women living in a Chinese suburban community.MethodsIn total, 625 elderly (72.54 ± 5.80 years old) men (n = 258) and women (n = 367) from the Chongming district of Shanghai participated in this study. All participants had Mini-Mental State Examination (MMSE), 4-m walking test, medical history questionnaire, and physical examination. They were grouped according to walking speed (>0.8 vs. ≤ 0.8 m/s) with the stratification of sex. The odds ratio (OR) and the 95% confidence interval (CI) were assessed using the chi-square test and logistic regression analysis.ResultsAround 11.6% of men and 14.2% of women had slow walking speeds. After adjusting for age, body mass index (BMI), education level, spouse, faller, the Geriatric Depression Scale (GDS) score, heart disease, stroke, arthritis, and low back pain, walking speed was negatively related to cognitive impairment in men (OR 0.11 [95% CI: 0.01, 0.94]; p = 0.043). In addition, the relationship between walking speed and impaired orientation was significant in both men (OR 0.003 [95% CI: 0.001, 0.05]; p < 0.001) and women (OR 0.15 [95% CI: 0.03, 0.75]; p = 0.021).ConclusionThe relationship between walking speed and cognitive impairment was only significant in men, but the association with impaired orientation was found in both men and women. Assessing the walking speed of the elderly is beneficial, which may help with early detection and early therapeutic prevention of cognitive impairment.
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Affiliation(s)
- Hong Wang
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Hui Zhang
- Jiangwan Hospital of Shanghai Hongkou District, Shanghai University of Medicine and Health Science Affiliated First Rehabilitation Hospital, Shanghai, China
| | - Yaoxin Chen
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Ming Cai
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Cailian Guo
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Peijie Chen
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
- *Correspondence: Peijie Chen
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Pequeno NPF, Cabral NLDA, Oliveira ÂGRC, Crispim SP, Rocha C, Marchioni DM, Lima SCVC, Lyra CDO. Chronic diseases and emotional disorders are associated with low perception of quality of life in food insecurity/security. Front Public Health 2022; 10:893601. [PMID: 35923966 PMCID: PMC9340216 DOI: 10.3389/fpubh.2022.893601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Understanding individual perception of Quality of Life (QoL) can help combat social and health inequalities. We aimed to identify factors associated with Low Perceived Quality of Life (LPQoL) in 295 adults and older adults with food security and food insecurity, in the city of Natal, Brazil. A cross-sectional study was conducted from June to December 2019, with collection of data on socioeconomic demographic status, lifestyle information, non-communicable diseases (NCDs) and risk factors, emotional disorders, food (in) security and quality of life. To assess food insecurity, the Brazilian Scale of Food Insecurity—EBIA was used, and the WHOQOL-Bref questionnaire was used to assess quality of life. Poisson's Regression was used to verify associations between variables and LPQoL, stratifying the sample into food secure (FS) and food insecure (FI) groups. In the FI group, being overweight, older adult, having no partner, drinking alcoholic beverages twice a week or more, and not having daily availability of water were associated with LPQoL, and in the FS group, having diabetes, monthly family income in the 1st and 2nd tertiles, and never having studied was associated with LPQoL. Reporting emotional disorders and sleeping < 7 h/day were associated with LPQoL in both FI and FS groups. LPQoL was associated with the occurrence of NCDs and risk factors, and emotional disorders, regardless of the food security measure. However, the lack of adequate access to water highlights the social vulnerability of the FI group.
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Affiliation(s)
- Nila Patrícia Freire Pequeno
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
- *Correspondence: Nila Patrícia Freire Pequeno
| | - Natália Louise de Araújo Cabral
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil
- Federal Institute of Education, Science and Technology of Sertão Pernambucano, Petrolina, Brazil
| | | | | | - Cecília Rocha
- School of Nutrition, Centre for Studies in Food Security, Ryerson University, Toronto, ON, Canada
| | - Dirce Maria Marchioni
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | | | - Clélia de Oliveira Lyra
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil
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Zhao L, Wang J, Deng H, Chen J, Ding D. Depressive Symptoms and ADL/IADL Disabilities Among Older Adults from Low-Income Families in Dalian, Liaoning. Clin Interv Aging 2022; 17:733-743. [PMID: 35574289 PMCID: PMC9091470 DOI: 10.2147/cia.s354654] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to assess the prevalence of depressive symptoms and ADL/IADL disabilities and explore their correlation and associated factors for depressive symptoms among community-dwelling older adults from low-income families in Dalian, Liaoning Province, China. Methods This cross-sectional study included 522 participants aged 60 years and older from low-income families in Dalian. The 30-Item Geriatric Depression Scale was employed to measure depressive symptoms. The Katz ADL Scale and IADL Scale were used to evaluate the performance of activities necessary for independent life. SPSS 22.0 was employed to analyze the data. Logistic regression was used to estimate the relationship between depressive symptoms and ADL/IADL disabilities in five models. Results The prevalence of depressive symptoms among older people from low-income families in Dalian was 57.3%. A total of 19.0% had difficulties performing ADLs, and 40.2% had difficulties performing IADLs. Logistic regression analysis revealed that ADL/IADL disabilities were associated with depressive symptoms even after controlling for people’s sociodemographic characteristics, welfare, health conditions and informal care. The following factors were associated with depressive symptoms: education, self-reported health, number of chronic diseases, and emotional support from families. Conclusion Given that older people from low-income families in Dalian have a notable prevalence rate of depressive symptoms, and ADL/IADL disabilities were independently associated with these symptoms, it is crucial to give priority to this particular group in geriatric health services due to economic and health disparities.
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Affiliation(s)
- Lu Zhao
- Department of Medical Sociology, School of Humanities and Social Sciences, Dalian Medical University, Dalian, 116044, People’s Republic of China
| | - Junting Wang
- Department of Social Medicine, School of Public Health, Dalian Medical University, Dalian, 116044, People’s Republic of China
| | - Haoyuan Deng
- Department of Nutrition and Food Health, School of Public Health, Dalian Medical University, Dalian, 116044, People’s Republic of China
| | - Junfeng Chen
- Department of Social Medicine, School of Public Health, Dalian Medical University, Dalian, 116044, People’s Republic of China
- Correspondence: Junfeng Chen; Ding Ding, Department of Social Medicine, School of Public Health, Dalian Medical University, No. 9 West Section Lvshun South Road, Dalian, 116044, People’s Republic of China, Tel +86 13009493030; +86 18249517190, Email ;
| | - Ding Ding
- Department of Social Medicine, School of Public Health, Dalian Medical University, Dalian, 116044, People’s Republic of China
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Yan Z, Chang L, Zhang Q, Li C, Li Y. Depression and Opioid Misuse in Elderly Individuals With Chronic Pain: A Latent Class Analysis. Pain Manag Nurs 2022; 23:602-607. [DOI: 10.1016/j.pmn.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/09/2022] [Accepted: 02/03/2022] [Indexed: 10/18/2022]
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Zhang M, Zhu W, He X, Liu Y, Sun Q, Ding H. Correlation between functional disability and quality of life among rural elderly in Anhui province, China: a cross-sectional study. BMC Public Health 2022; 22:397. [PMID: 35216578 PMCID: PMC8881859 DOI: 10.1186/s12889-021-12363-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 11/30/2021] [Indexed: 11/22/2022] Open
Abstract
Objective We aimed to explore the correlation between functional disability and quality of life (QoL). And exploring the interaction of functional disability, basic demographic characteristics and health-related information on QoL among the rural elderly in Anhui Province. Methods This study used multi-stage stratified cluster sampling in rural Anhui Province from January to July 2018 to conduct a cross-sectional survey of older adults who met the inclusion criteria. The Five-Dimensional European Quality Of Health Scale (EQ-5D) and the WHO Disability Assessment Schedule (WHODAS2.0) scale were used to evaluate the QoL and functional disability, and the basic demographic characteristics of the survey subjects were also collected. Using binary logistic and Classification and regression tree model (CART) models to analyze the data, explore the relationship between functional disability and QoL in the elderly. Results A total of 3491 older adults were included in the survey, and 3336 completed the entire survey, with an effective response rate of 95.56%. After adjusting for covariables, those who had limited in dimension of mobility (AOR=2.243, 95%CI: 1.743-2.885), getting along (AOR=1.615, 95%CI: 1.173-2.226), life activities (AOR=2.494, 95%CI:1.928-3.226), and social participation (AOR=2.218, 95%CI: 1.656-2.971) had a lower QoL. However, the dimension of cognition (AOR=0.477, 95%CI: 0.372-0.613) is a protective factor for QoL. Additionally, we also observe that 96.3% of those who were unemployed and limited in both mobility and life activities dimensions had a lower QoL, but among those who were robust in both mobility and social participation dimensions and not suffer from chronic diseases, 56.3% had a higher QoL. Conclusions Our findings indicate that special attention should be paid to the elderly who are unemployed, have limited in cognition, getting along, social participation, mobility, life activities and cognition robust to improve their QoL. This research is of great significance for formulating targeted strategies and measures to improve the QoL for rural elderly. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12363-7.
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Affiliation(s)
- Min Zhang
- Department of Health Service Management, School of Health Management, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Weizheng Zhu
- Department of Health Service Management, School of Health Management, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Xinran He
- Department of Health Service Management, School of Health Management, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yuyang Liu
- Department of Health Service Management, School of Health Management, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Qian Sun
- Department of Health Service Management, School of Health Management, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Hong Ding
- Department of Health Service Management, School of Health Management, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
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12
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Chen X, Mo Q, Yu B, Bai X, Jia C, Zhou L, Ma Z. Hierarchical and nested associations of suicide with marriage, social support, quality of life, and depression among the elderly in rural China: Machine learning of psychological autopsy data. Front Psychiatry 2022; 13:1000026. [PMID: 36226103 PMCID: PMC9548573 DOI: 10.3389/fpsyt.2022.1000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To identify mechanisms underpinning the complex relationships between influential factors and suicide risk with psychological autopsy data and machine learning method. DESIGN A case-control study with suicide deaths selected using two-stage stratified cluster sampling method; and 1:1 age-and-gender matched live controls in the same geographic area. SETTING Disproportionately high risk of suicide among rural elderly in China. PARTICIPANTS A total of 242 subjects died from suicide and 242 matched live controls, 60 years of age and older. MEASUREMENTS Suicide death was determined based on the ICD-10 codes. Influential factors were measured using validated instruments and commonly accepted variables. RESULTS Of the total sample, 270 (55.8%) were male with mean age = 74.2 (SD = 8.2) years old. Four CART models were used to select influential factors using the criteria: areas under the curve (AUC) ≥ 0.8, sensitivity ≥ 0.8, and specificity ≥ 0.8. Each model included a lead predictor plus 8-10 hierarchically nested factors. Depression was the first to be selected in Model 1 as the lead predictor; After depression was excluded, quality of life (QOL) was selected in Model 2; After depression and QOL were excluded, social support was selected in Model 3. Finally, after all 3 lead factors were excluded, marital status was selected in Model 4. In addition, CART demonstrated the significance of several influential factors that would not be associated with suicide if the data were analyzed using the conventional logistic regression. CONCLUSION Associations between the key factors and suicide death for Chinese rural elderly are not linear and parallel but hierarchically nested that could not be effectively detected using conventional statistical methods. Findings of this study provide new and compelling evidence supporting tailored suicide prevention interventions at the familial, clinical and community levels.
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Affiliation(s)
- Xinguang Chen
- Global Health Institute, Xi'an Jiaotong University, Xi'an, China
| | - Qiqing Mo
- Department of Social Medicine, School of Public Health, Guangxi Medical University, Nanning, China.,Guilin People's Hospital, Guilin, China.,Department of Epidemiology, Universtiy of Florida, Gaineville, FL, United States
| | - Bin Yu
- Department of Biostatistics and Epidemiology, School of Public Health, Wuhan University, Wuhan, China
| | - Xinyu Bai
- Department of Social Medicine, School of Public Health, Guangxi Medical University, Nanning, China.,People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Cunxian Jia
- Department of Epidemiology, School of Public Health, Cheeloo Medical College, Shandong University, Jinan, China
| | - Liang Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhenyu Ma
- Department of Social Medicine, School of Public Health, Guangxi Medical University, Nanning, China
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Rong J, Wang X, Ge Y, Chen G, Ding H. Association between functional disability and depressive symptoms among older adults in rural China: a cross-sectional study. BMJ Open 2021. [PMCID: PMC8719149 DOI: 10.1136/bmjopen-2020-047939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
ObjectivesThe aim of this study was to explore the relationship between functional disability and depressive symptoms, focusing on whether an interaction exists between functional disability, demographic characteristics and depressive symptoms among older adults in rural China.DesignA cross-sectional study using multistage, stratified random sampling.SettingData from 18 villages in Anhui Province of China between January to July 2018.Participants3491 Chinese participants aged 60 and over.Primary and secondary outcome measuresThe 30-item Geriatric Depression Scale and WHO Disability Assessment Schedule 2.0 were used to evaluate depressive symptoms and functional disability, respectively. Data were analysed using SPSS statistics V.25.0 program with χ2 test, Mann-Whitney U test, binary logistic regression analysis and classification and regression tree (CART) model.ResultsThe prevalence of depressive symptoms in 3336 interviewed older people was 52.94%. After adjustment, subjects who had problems in mobility domain (adjusted OR (AOR) 1.842, 95% CI 1.503 to 2.258), getting along domain (AOR 1.616, 95% CI 1.299 to 2.010), life activities domain (AOR 1.683, 95% CI 1.370 to 2.066) and participation domain (AOR 3.499, 95% CI 2.385 to 4.987) had an increased depressive symptoms risk. However, cognition domain (AOR 0.785, 95% CI 0.647 to 0.953) negatively correlated with depressive symptoms. Additionally, the CART model showed that those who had problems in mobility domain, getting along domain and were unemployed, the possibility of having depressive symptoms was the highest.ConclusionsMore attention should be paid to unemployed older adults, and those with problems in participation, life activities, getting along and mobility and no problems in cognition to maintain a good psychological state.
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Affiliation(s)
- Jian Rong
- Department of Scientific Research, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xueqin Wang
- Department of Medical Engineering, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yanhong Ge
- Department of Health Service Management, Anhui Medical University, Hefei, Anhui, China
| | - Guimei Chen
- Department of Health Service Management, Anhui Medical University, Hefei, Anhui, China
| | - Hong Ding
- Department of Health Service Management, Anhui Medical University, Hefei, Anhui, China
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Tang T, Jiang J, Tang X. Prevalence of depressive symptoms among older adults in mainland China: A systematic review and meta-analysis. J Affect Disord 2021; 293:379-390. [PMID: 34246000 DOI: 10.1016/j.jad.2021.06.050] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/13/2021] [Accepted: 06/19/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND To date, the reported prevalence of late-life depression in China has varied considerably, and the pooled overall prevalence of depressive symptoms among older adults in China and the tendency of the rate to change in the past 30 years have remained unknown. Thus, our study was designed to form an accurate and comprehensive picture of the recent prevalence of depressive symptoms among older adults in China. METHODS Literature searches were conducted independently by two investigators in English- and Chinese-language databases from database inception to January 2020. The prevalence of depressive symptoms was analysed with a random effects model. RESULTS In the 81 eligible studies (n = 261,697) identified, the pooled overall prevalence of depressive symptoms among older adults in China was 20.0% (95% CI, 17.5%-22.8%), with high heterogeneity, Q = 22,947.0, I2 = 99.7%, p < .001. Subgroup analyses revealed significant differences in the prevalence of late-life depression depending upon gender, marital status, socio-economic status, and measurement scale(s) used. Meta-regression indicated that the prevalence of depressive symptoms among older adults in China increased from the 1990s to the 2000s but slightly decreased from the 2000s to the 2010s. LIMITATIONS Significant heterogeneity among the studies reviewed was unavoidable, and the findings was not generalisable to all regions in China. CONCLUSIONS Depressive symptoms are common among older adults in China, and policies should be developed that consider vulnerable older adults in particular.
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Affiliation(s)
- Tan Tang
- School of Ethnology and Sociology, Yunnan University, Kunming, Yunnan, 650091, China
| | - Jianling Jiang
- Department of Social Work, The Chinese University of Hong Kong, New Territories, HongKong, 999077, China.
| | - Xinfeng Tang
- Department of Psychology, Renmin University of China, Beijing, 100872, China
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Brasileiro LEE, Paiva ALDM, de Medeiros MYD, Jerez-Roig J, de Souza DLB. Incidence of depression and depressive symptoms and their predictive factors in community-dwelling older adults: a systematic review and meta-analysis protocol. BMJ Open 2021; 11:e052147. [PMID: 34285013 PMCID: PMC8292800 DOI: 10.1136/bmjopen-2021-052147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Faced with the continuous growth in the number of older people at a global level, some concerns are raised about the way people age. Health conditions such as depressive symptoms and depression have a direct or indirect impact on the quality of life of this population segment. The objective of this study is to verify the incidence of the various presentations of the depressive spectrum in the community-dwelling older population, as well as to analyse the predictive factors. METHODS AND ANALYSIS This systematic review and meta-analysis protocol follows the recommendation of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Searches will be conducted in PubMed, Web of Science, Scopus, Latin-American and Caribbean Literature on Health Sciences, Scientific Electronic Library Online and Cochrane databases, as well as grey literature. The search strategy involves terms related to ageing and the depressive spectrum found in observational studies. There will be no language restriction and the material included will be the ones whose publications took place until December 2020. ETHICS AND DISSEMINATION Formal ethical approval is not required on this research, since it only aims secondary data. After publishing the results in a scientifically supported journal, our findings may be disseminated to fill in the gaps and guide the production of more effective public policies directed at a more adequate care to the older population at a global level. The search process began in January 2021 and it is expected that all stages of the review will be completed by 30 November 2021. PROSPERO REGISTRATION NUMBER CRD42019121616.
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Affiliation(s)
| | | | | | - Javier Jerez-Roig
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O). Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
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Ge M, Zhu D, Lee H. WITHDRAWN: Health risk assessment of rural older population. Work 2021:WOR205350. [PMID: 34275921 DOI: 10.3233/wor-205350] [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: 11/15/2022] Open
Abstract
Ahead of Print article withdrawn by publisher.
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Affiliation(s)
- Minshu Ge
- The school of Finace, RenMin University of China, Beijing, China
| | - Dan Zhu
- Shanghai National Accounting Institute, Shanghai, China
| | - Hallie Lee
- Economic management Department, DePauw University, Greencastle, USA
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Zhang Z, He P, Liu M, Zhou C, Liu C, Li H, Zhang Y, Li Q, Ye Z, Wu Q, Wang G, Liang M, Qin X. Association of Depressive Symptoms with Rapid Kidney Function Decline in Adults with Normal Kidney Function. Clin J Am Soc Nephrol 2021; 16:889-897. [PMID: 34052796 PMCID: PMC8216614 DOI: 10.2215/cjn.18441120] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/25/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES The relationship of depressive symptoms with kidney function remains poorly investigated. We aimed to evaluate the prospective association between depressive symptoms and rapid decline in kidney function in Chinese adults with normal kidney function. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A total of 4763 participants with eGFR≥60 ml/min per 1.73 m2 at baseline were enrolled from the China Health and Retirement Longitudinal Study. Baseline depressive symptoms were determined using a ten-item Center for Epidemiologic Studies Depression scale with a cutoff score of greater than or equal to ten to define high depressive symptoms. The GFR was estimated by a combination of serum creatinine and cystatin C. The primary outcome was rapid decline in kidney function, defined as an annualized decline in eGFR of ≥5 ml/min per 1.73 m2. Secondary outcome was defined as an annualized decline in eGFR of ≥5 ml/min per 1.73 m2 and to a level of <60 ml/min per 1.73 m2 at the exit visit. RESULTS During a median follow-up of 4 years (interquartile range, 3.92-4.00), 260 (6%) participants developed rapid decline in kidney function. Overall, there was a significant positive association between baseline depressive symptoms and rapid decline in kidney function (per five-scores increment; adjusted odds ratio, 1.15; 95% confidence interval, 1.03 to 1.28) after adjustments for major demographic, clinical, or psychosocial covariates. Consistently, compared with participants with low depressive symptoms (total Center for Epidemiologic Studies Depression scale score less than ten), a significantly higher risk of rapid decline in kidney function was found among those with high depressive symptoms (total Center for Epidemiologic Studies Depression scale score greater than or equal to ten; adjusted odds ratio, 1.39; 95% confidence interval, 1.03 to 1.88). Similar results were found for the secondary outcome (per five-scores increment; adjusted odds ratio, 1.26; 95% confidence interval, 1.06 to 1.51). CONCLUSIONS High depressive symptoms were significantly associated with a higher risk of rapid kidney function decline among Chinese adults with normal kidney function.
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Affiliation(s)
- Zhuxian Zhang
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Panpan He
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Mengyi Liu
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chun Zhou
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chengzhang Liu
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China,Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Huan Li
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yuanyuan Zhang
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qinqin Li
- Institute of Biomedicine, Anhui Medical University, Hefei, China
| | - Ziliang Ye
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Qimeng Wu
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Guobao Wang
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Min Liang
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xianhui Qin
- National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Yang JJ, Cai H, Xia L, Nie W, Zhang Y, Wang S, Shi Y, Ng CH, Liu H, Xiang YT. The Prevalence of Depressive and Insomnia Symptoms, and Their Association With Quality of Life Among Older Adults in Rural Areas in China. Front Psychiatry 2021; 12:727939. [PMID: 34658962 PMCID: PMC8515482 DOI: 10.3389/fpsyt.2021.727939] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/24/2021] [Indexed: 01/13/2023] Open
Abstract
Background: There are few studies on the epidemiology of depression, insomnia, and their association with quality of life (QOL) in older adults living in rural China. This study examined the prevalence of depressive and insomnia symptoms, and their association with QOL in community-dwelling older adults in a rural area in Anhui province, China. Methods: This was a cross-sectional study conducted in the rural areas of four cities (Hefei, Huaibei, Anqing, and Xuancheng) in Anhui province between July and October, 2019 using random sampling method. All community-dwelling residents from the selected villages who met the study entry criteria were invited to participate in this study. Depressive and insomnia symptoms and QOL were assessed with the Chinese version of self-reported Center for Epidemiological Survey Depression Scale (CES-D), the Insomnia Severity Index (ISI) and the 26-item World Health Organization Quality of Life Brief version (WHOQOL-BREF), respectively. Results: A total of 871 older adults were included. The prevalence of overall depressive symptoms, insomnia symptoms, and comorbid depressive and insomnia symptoms were 34.0% [95% confidence intervals (95% CI): 30.8-37.1%], 45.7% (95% CI: 42.4-49.0%) and 20.3% (95% CI: 17.6-23.0%), respectively. Older adults with depressive symptoms, insomnia symptoms, and comorbid depressive and insomnia symptoms had lower scores in QOL compared to those without. Depressive symptoms were positively associated with living with families [Odd Ratio (OR) = 1.82, 95% CI: 1.31-2.54] and negatively associated with current drinking (OR = 0.49, 95% CI: 0.33-0.72). Insomnia symptoms were negatively associated with fair and good financial status (fair: OR = 0.53, 95% CI = 0.38-0.75; good: OR = 0.30, 95% CI = 0.14-0.64) and current drinking (OR = 0.64, 95% CI = 0.45-0.93), and positively associated with more frequent major medical conditions (OR = 1.32, 95% CI = 1.16-1.51). Comorbid depressive and insomnia symptoms were positively associated with living with families (OR = 2.02, 95% CI = 1.36-3.00), and negatively associated with fair and good financial status (fair: OR = 0.61, 95% CI = 0.41-0.89; good: OR = 0.34, 95% CI = 0.12-0.95) and current drinking (OR = 0.57, 95% CI = 0.35-0.92). Conclusion: Depressive and insomnia symptoms were common in older adults living in rural areas in China. Considering the negative health outcomes caused by depressive and insomnia symptoms, regular screening and effective treatments should be developed for this population.
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Affiliation(s)
- Juan-Juan Yang
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Hong Cai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macao, SAR China.,Centre for Cognitive and Brain Sciences, University of Macau, Taipa, Macao, SAR China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Taipa, Macao, SAR China
| | - Lei Xia
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Weicheng Nie
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Yulong Zhang
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Song Wang
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Yudong Shi
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, VA, Australia
| | - Huanzhong Liu
- Department of Psychiatry, School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macao, SAR China.,Centre for Cognitive and Brain Sciences, University of Macau, Taipa, Macao, SAR China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Taipa, Macao, SAR China
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