Developing the perceived social support scale for older adults: A mixed-method study

Treatment gap and barriers to access mental healthcare among women with postpartum depression symptoms in Pakistan

Background and Objectives

Postpartum depression (PPD) is prevalent among women after childbirth, but accessing mental healthcare for PPD is challenging. This study aimed to assess the treatment gap and barriers to mental healthcare access for women with PPD symptoms living in Punjab, Pakistan.

Methods

A multicenter cross-sectional study was conducted in five populous cities of Punjab from January to June 2023 by administering the questionnaire to the women using stratified random sampling. A total of 3,220 women in first 6 months postpartum were screened using the Edinburgh Postnatal Depression Scale. Of them, 1,503 women scored thirteen or above, indicating potential depressive disorder. Interviews were conducted to explore help-seeking behavior and barriers to accessing mental healthcare. Descriptive statistics along with nonparametric tests (e.g., Kruskal-Wallis, Mann-Whitney U) were used and group differences were examined. Scatter plot matrices with fitted lines were used to explore associations between variables. Classification and regression tree methods were used to classify the importance and contribution of different variables for the intensity of PPD.

Results

Only 2% of women (n = 33) with high PPD symptoms sought mental healthcare, and merely 5% of women (n = 75) had been in contact with a health service since the onset of their symptoms. 92.80% of women with PPD symptoms did not seek any medical attention. The majority of women, 1,215 (81%), perceived the need for mental health treatment; however, 91.23% of them did not seek treatment from healthcare services. Women who recently gave birth to a female child had higher mean depression scores compared to those who gave birth to a male child. Age, education, and birth location of newborn were significantly associated (p  <  0.005) with mean barrier scores, mean social support scores, mean depression scores and treatment gap. The results of classification and regression decision tree model showed that instrumental barrier scores are the most important in predicting mean PPD scores.

Conclusion

Women with PPD symptoms encountered considerable treatment gap and barriers to access mental health care. Integration of mental health services into obstetric care as well as PPD screening in public and private hospitals of Punjab, Pakistan is critically needed to overcome the treatment gap and barriers.

Design and psychometric properties of the family support for older people questionnaire

Background and objectives

The population of older people is increasing across the world. Older people need care and support from their families to be able to live independently. This study aimed to design and evaluate the psychometric properties of the family support for older people (FSOP) questionnaire.

Methods

In this instrument development study using a mixed-methods design, the psychometric properties of the FSOP questionnaire in terms of validity and reliability were evaluated.

Results

The FSOP questionnaire consisted of 50 items in six domains. It was shown to have appropriate qualitative and quantitative validities (score > 1.5). The indicators of content validity (CVR > 0.62, ICVI ≥ 0.80, and SCVI > 0.94) and confirmatory factor analysis (indexes of χ²/df = 2.50, CFI = 0.96, GFI = 0.97, AGFI = 0.96, NNFI = 0.96, PNFI = 0.89, TLI = 0.96, and RMSEA = 0.06) were satisfactory. Cronbach's alpha coefficient for reliability was 0.94, indicating an optimal score.

Conclusions

Healthcare providers and family caregivers are suggested to use the FSOP questionnaire for improving the quality of life of older people at home.

How tablets/applications enhance social connections and social support in people with dementia: A qualitative systematic review

The 2020 Lancet issue identified social isolation as one of 12 modifiable risk factors for dementia and revealed that enhanced social connections and social support can effectively reduce the incidence of social isolation. During the COVID-19 pandemic, technology attracted an increasing amount of attention, and it is necessary to synthesize ideas from existing evidence. First, we explored how people with dementia experienced changes in social connection and social support due to tablet/app use. Second, we explored the attitudes of people with dementia towards tablets and mobile applications. Third, we explored the feasibility of using tablets and mobile applications to enhance social connection and social support among people with dementia. We systematically searched the PubMed, Web of Science, Cochrane Library, Embase, CINAHL, CNKI, WanFang, and VIP databases. Two reviewers independently screened the titles and abstracts of studies, extracted the data and performed critical appraisals of each included study. The data synthesis was conducted using thematic analysis. A total of nine studies were included. Eight studies used mobile applications via tablets, and one study collected textual data from Twitter for analysis. Four themes were synthesized: (1) change from the perspective of caregivers; (2) growth of nonsingle aspects; (3) emotional feeling of belonging; and (4) feasibility of using digital technology. Tablet- and mobile application-based interventions can enhance both online and offline social connections and provide multiple types of social support among people with dementia. People with dementia have positive attitudes towards tablets and mobile applications. Overall, it is feasible for people with dementia to use technology.

Comparing the impact of social support on the life satisfaction of widowed and non-widowed elders

Aim

To compare differences in life satisfaction between widowed and non-widowed elders based on social support.

Methods

A total of 4,560 widowed and 3,655 non-widowed elders were selected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS-2018). Ordinal logistic regression models and t-tests were performed using SPSS v20.

Results

Both widowed and non-widowed elders had high levels of life satisfaction. Personal characteristics had a significant impact on the life satisfaction of both widowed and non-widowed elders. Endowment insurance, social trust, residence, self-rated health, and living with family had a significant impact on the life satisfaction of widowed elders (p < 0.001), while endowment insurance, government subsidy, and self-rated health significantly impacted non-widowed elders (p < 0.001). Self-rated health had the greatest impact on the life satisfaction of widowed and non-widowed elders (OR = 4.62/4.45), followed by endowment insurance (OR = 1.24/1.32).

Conclusion

Social support can significantly improve life satisfaction, but its impact is heterogeneous. Informal social support plays a greater role in improving the life satisfaction of widowed elders, but formal social support plays a greater role in the life satisfaction of non-widowed elders.

Living Arrangement of Older Adults and its Effect on Five-Year Survival

INTRODUCTION

Given the impact of living alone on health outcomes, this study was conducted to assess the living arrangement of senior adults and its effect on the mortality.

MATERIAL AND METHODS

This cohort study carried out on elderly people aged 60 years and over. Demographic characteristics, the number of comorbid disorders and living condition-as being alone or living with other people-were collected. The mini-mental state examination questionnaire, the geriatric depression scale, the Katz index of activities of daily living, the Lawton instrumental activities of daily living scale, and a modified version of Duke social support index were used for data collection. The participants were followed for five years, and their survival was assessed.

RESULTS

Out of the 500 examined individuals, 100 (20.0%) were living alone. During 5 years of follow-up, sixteen (19.8%) of the people who died were living alone. The adjusted effect of age (P<0.001), male gender (P=0.004), the number of comorbidities (P=0.031), the person's social support (P=0.028) and dependence to others to do complex daily activities (P=0.020) on the mortality of the participants was significant, however, other factors including living alone, illiteracy, cognitive impairment and depression did not show such a statistically significant effect (P>0.05).

CONCLUSION

Living arrangement, itself, did not show a significant effect on the mortality of older adults.

Differences of medically unexplained symptoms among patients of different ages and sexes in the psychological clinic of a general hospital and the influencing factors of MUS: A cross-sectional study

OBJECTIVE

To analyse differences in sex, age, depression, insomnia, psychological stress, resilience, and perceived social support among patients with medically unexplained symptoms (MUS) in a psychological clinic of a general hospital, and to explore the influencing factors of MUS.

METHODS

This is a cross-sectional study. Seven hundred forty-six first-time patients were assessed with the integrated psychosomatic comprehensive evaluation system (IPS) to evaluate their MUS, depression, insomnia, psychological stress, resilience, and perceived social support. The psychological characteristics were compared with regard to sex and age group (<25 years, low age group; 26-44 years, middle age group; >45 years, high age group). The relationships between age and MUS were explored, and how psychological stress affects MUS was analyzed using the mediator effect model.

RESULTS

Different age groups had significant differences in sex, MUS, depression, psychological stress, resilience, and perceived social support. In further pairwise comparison, no significant difference existed in depression, psychological stress, resilience and perceived social support in the middle and low age groups, depression and psychological stress were higher than those in the high age group, resilience and perceived social support were lower than those of the high age group. MUS were higher in the middle age group than in the low age group. No significant difference existed between the two groups and the high age group. Age, severity of MUS, and perceived social support were significantly different between the sexes. Differences in MUS between men and women in different age groups were analyzed using two-factor analysis of variance. It revealed no interaction between sex and different age groups on MUS. The main effect analysis showed that the effects of different age groups on MUS were statistically significant. Based on pairwise comparative analysis, the MUS score in the low age group was lower than that in the middle age group. To clarify a nonlinear relationship between age and MUS, threshold effect analysis was conducted. The results indicated that the piecewise linear regression model could better depict the relationship between age and MUS. The inflection point was at the age of 60 years. Before the age of 60 years, MUS increased with age. No significant correlation existed between age and MUS after the age of 60 years. To understand the influencing factors of MUS, the intermediary effect model was analyzed using MUS as the dependent variable, psychological stress as the independent variable, resilience as mediator variable M1, perceived social support as mediator variable M2, and depression as mediator variable M3. Resilience, perceived social support, and depression had significant mediator effects on the effects of psychological stress on MUS with a total indirect effect of 69.81%.

CONCLUSION

The middle age group had greater MUS than the low age group. Before the age of 60 years, MUS increased with increasing age. Women had more severe MUS than men. Resilience, perceived social support, and depression had significant mediating effects on the effects of perceived stress on MUS. These findings suggest that clinicians should make more comprehensive and detailed evaluations and timely intervention for middle-aged and female patients. Improving psychological resilience and social support can reduce the impact of psychological stress on MUS. Therefore, psychotherapy and multidisciplinary comprehensive treatment are very important for patients is very important for patients.