A six-month follow-up study of maternal anxiety and depressive symptoms among Japanese

Background

Maternal psychological distress has been widely studied, but epidemiologic data based on follow-up studies of maternal psychological distress remain insufficient in Japan. The objective of this study was to estimate the prevalence of anxiety and depressive symptoms among child-rearing women in Japan at two time-points after childbirth.

Methods

A self-administered questionnaire was delivered on two occasions to 2,657 women who had given birth in 2004: first when their infants were 3-4 months old and then again when their infants were 9-10 months old. The questionnaire included the Hospital Anxiety and Depression Scale (HADS; Japanese version) to estimate the level of maternal psychological distress.

Results

The total percentage of women with anxiety symptoms as assessed by a HADS score of 8+ was 26.2 % at 3-4 months of age, and 26.1 % at 9-10 months. Among the women without anxiety symptoms at 3-4 months, 11.6 % showed anxiety symptoms at 9-10 months. The total percentage of depressive symptoms was 19.0 % at 3-4 months, and 24.0 % at 9-10 months. Among the women without depressive symptoms at 3-4 months, 14.0 % showed depressive symptoms at 9-10 months.

Conclusion

Anxiety symptoms in mothers appeared to persist from 3-4 months to 9-10 months after childbirth, while depressive symptoms tended to be more common at 9-10 months after childbirth. Nevertheless, the prevalence of anxiety symptoms was higher than that of depressive symptoms.Key words: Maternal Welfare, Anxiety, Depression, Asian Continental Ancestry Group     

Health Literacy,Cognitive Ability,and Functional Health Status among Older Adults

Objective

To investigate whether previously noted associations between health literacy and functional health status might be explained by cognitive function.

Data Sources/Study Setting

Health Literacy and Cognition in Older Adults (“LitCog,” prospective study funded by National Institute on Aging). Data presented are from interviews conducted among 784 adults, ages 55–74 years receiving care at an academic general medicine clinic or one of four federally qualified health centers in Chicago from 2008 to 2010.

Study Design

Study participants completed structured, in-person interviews administered by trained research assistants.

Data Collection

Health literacy was measured using the Test of Functional Health Literacy in Adults, Rapid Estimate of Adult Literacy in Medicine, and Newest Vital Sign. Cognitive function was assessed using measures of long-term and working memory, processing speed, reasoning, and verbal ability. Functional health was assessed with SF-36 physical health summary scale and Patient Reported Outcomes Measurement Information System short form subscales for depression and anxiety.

Principal Findings

All health literacy measures were significantly correlated with all cognitive domains. In multivariable analyses, inadequate health literacy was associated with worse physical health and more depressive symptoms. After adjusting for cognitive abilities, associations between health literacy, physical health, and depressive symptoms were attenuated and no longer significant.

Conclusions

Cognitive function explains a significant proportion of the associations between health literacy, physical health, and depression among older adults. Interventions to reduce literacy disparities in health care should minimize the cognitive burden in behaviors patients must adopt to manage personal health.     

Prevalence of Physical Activity Among Adults in a Metropolitan Nigerian City: A Cross-Sectional Study

Background

Baseline information on physical activity is relevant to controlling the epidemic of chronic noncommunicable diseases occurring in many African countries. However, standardized data on physical activity are lacking in Nigeria. We assessed the prevalence of physical activity and its relationships with sociodemographic characteristics in a subnational sample of Nigerian adults.

Methods

A cross-sectional survey was conducted among a representative sample of 934 adults (age, 20–82 years) living in metropolitan Maiduguri, Nigeria. Physical activity was measured using the validated Nigerian version of the International Physical Activity Questionnaire (Hausa IPAQ-SF). Using the World Health Organization (WHO) guideline, participants were classified as sufficiently active or insufficiently active. Sociodemographic correlates of sufficient physical activity were identified using multinomial logistic regression.

Results

Overall, 68.6% of Nigerian adults were sufficiently active. There was no significant difference (P > 0.05) in prevalence of physical activity between men (68.0%) and women (69.3%), but physical activity tended to decrease with increasing age category, especially among men. Physical activity prevalence was positively associated with being married (OR = 1.52, CI = 1.04–4.37) and blue collar work (OR = 2.19, CI = 1.16–4.12) and negatively associated with car ownership (OR = 0.38, CI = 0.17–0.86) and higher income (OR = 0.54, CI = 0.10–0.95).

Conclusions

The prevalence of physical activity varied between sociodemographic subgroups of Nigerian adults; thus, public health policies and interventions based on ecologic models of health behaviors may be warranted in promoting physical activity in Nigeria.Key words: physical activity, sociodemographic characteristics, IPAQ, Nigerian adults     

Peer Reviewed: Self-Rated Depression and Physician-Diagnosed Depression and Anxiety in Florida Adults: Behavioral Risk Factor Surveillance System, 2006

Introduction

Our purpose was to determine the prevalence and correlates of self-reported symptoms of depression and physician-diagnosed depression and anxiety in Florida adults by using the 2006 Florida Behavioral Risk Factor Surveillance System (BRFSS).

Methods

The BRFSS is an ongoing, state-based telephone health survey of noninstitutionalized adults that uses random-digit dialing. In 2006, an Anxiety and Depression Module was administered in Florida. Eight questions were used to examine current depression. Two additional questions assessed health care provider diagnosis of depressive and anxiety disorders. We used SUDAAN version 9.0 to evaluate the data to accommodate the complex sampling design.

Results

Approximately 9% of Florida adults experienced current depression; about 13% had had a diagnosis of depression in their lifetime and 11% had a diagnosis of anxiety in their lifetime. Approximately 44% of respondents with current depression had not had a diagnosis of depression. Current depression and lifetime diagnosis of depression and anxiety were independently associated with sociodemographic variables (being a woman, young, previously married or never married, or unemployed or unable to work), adverse health behaviors (current or former smoking, physical inactivity, or obesity), and chronic health conditions (history of a stroke, diabetes, or asthma). Although the prevalence of depression among non-Hispanic blacks and people with low education levels is higher, members of these groups are less likely than members of other sociodemographic groups to have had depression diagnosed by a physician.

Conclusion

Depression and anxiety are associated with sociodemographic disadvantages and chronic conditions and risk factors. Knowing the prevalence of depression and anxiety, both self-rated and physician-diagnosed, is useful in identifying unmet mental health needs among subpopulations.     

Peer Reviewed: Anthropometric Measures,Presence of Metabolic Syndrome,and Adherence to Physical Activity Guidelines Among African American Church Members,Dallas, Texas, 2008

Introduction

The low prevalence of physical activity among African Americans and high risk of cardiovascular disease lends urgency to assessing the association between metabolic syndrome, abdominal obesity, and adherence to current physical activity guidelines. Few studies have examined this association among African American adults.

Methods

We examined the association between demographic characteristics, anthropometric measures, and metabolic syndrome and adherence to the 2008 Department of Health and Human Services guidelines for moderate and vigorous physical activity. Participants were 392 African American church members from congregations in Dallas, Texas. Physical activity levels were assessed via a validated questionnaire (7-Day Physical Activity Recall), and metabolic syndrome was determined on the basis of the American Heart Association/National Heart, Lung, and Blood Institute diagnostic criteria. We used bivariate and multinomial logistic regression to examine the associations.

Results

Meeting guidelines for vigorous physical activity was significantly and independently associated with the absence of metabolic syndrome among women (odds ratio, 4.71; 95% confidence interval, 1.63-13.14; P = .003), after adjusting for covariates. No association was found between meeting moderate or vigorous physical activity guidelines and metabolic syndrome among men. Meeting physical activity guidelines was not associated with body mass index or waist circumference among this sample of predominantly overweight and obese African American church members.

Conclusion

Results indicate that meeting the 2008 guidelines for vigorous physical activity is associated with the absence of metabolic syndrome among African American women. This finding might suggest the need to integrate vigorous physical activity into interventions for African American women as a preventive therapy for cardiovascular risk.      

The Determinants of Participation in Physical Activity in Malaysia

Objectives

In light of the importance of physical activity, the aim of the present study is to examine the factors affecting participation in physical activity among adults in Malaysia.

Methods

A logistic regression model and the Third National Health and Morbidity Survey consisting of 30,992 respondents were used.

Results

Age, income, gender, education, marital status, region, house locality, job characteristics, and medical conditions are significantly associated with participation in physical activity. In particular, old individuals, high income earners, females, the well-educated, widowed or divorced individuals, East Malaysians, urban dwellers, the unemployed, and individuals who are not diagnosed with hypercholesterolemia are less likely to be physically active than others.

Conclusion

Because sociodemographic and health factors play an important role in determining physical activity, the government should take them into account when formulating policy.     

Physical activity in climacteric women: comparison between self-reporting and pedometer

OBJECTIVE

To compare two methods of assessing physical activity in pre-, peri- and postmenopausal women.

METHODS

Cross-sectional study nested in a cohort of pre-, peri- and postmenopausal women in a city in Southern Brazil. The participants completed a questionnaire that included sociodemographic and clinical data. Physical activity was assessed using a digital pedometer and the International Physical Activity Questionnaire, short version. The participants were classified into strata of physical activity according to the instrument used. For statistical analysis, the Spearman correlation test, Kappa index, concordance coefficient and Bland-Altman plots were used.

RESULTS

The concordance (k = 0110; p = 0.007) and the correlation (rho = 0.136, p = 0.02) between the International Physical Activity Questionnaire, short version, and pedometer were weak. In Bland-Altman plots, it was observed that differences deviate from zero value whether the physical activity is minimal or more intense. Comparing the two methods, the frequency of inactive women is higher when assessed by pedometer than by the International Physical Activity Questionnaire - short version, and the opposite occurs in active women.

CONCLUSIONS

Agreement between the methods was weak. Although easy to use, Physical Activity Questionnaire - short version overestimates physical activity compared with assessment by pedometer.     

Body Mass Index,Physical Activity,and Fracture Among Young Adults: Longitudinal Results From the Thai Cohort Study

Background

We investigated risk factors for fracture among young adults, particularly body mass index (BMI) and physical activity, which although associated with fracture in older populations have rarely been investigated in younger people.

Methods

In 2009, 4 years after initial recruitment, 58 204 Thais aged 19 to 49 years were asked to self-report fractures incident in the preceding 4 years. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% CIs for associations of fracture incidence with baseline BMI and physical activity.

Results

Very obese women had a 70% increase in fracture risk (OR = 1.73, 95% CI 1.21–2.46) as compared with women with a normal BMI. Fracture risk increased by 15% with every 5-kg/m² increase in BMI. The effects were strongest for fractures of the lower limbs. Frequent purposeful physical activity was also associated with increased fracture risk among women (OR = 1.52, 95% CI 1.12–2.06 for 15 episodes/week vs none). Neither BMI nor physical activity was associated with fracture among men, although fracture risk decreased by 4% with every additional 2 hours of average sitting time per day (OR = 0.96, 95% CI 0.93–0.99).

Conclusions

The increase in obesity prevalence will likely increase fracture burden among young women but not young men. While active lifestyles have health benefits, our results highlight the importance of promoting injury prevention practices in conjunction with physical activity recommendations, particularly among women.Key words: fracture, obesity, body size, physical activity, prevention, epidemiology, young adults     

Lifestyle factors,direct and indirect costs for a Brazilian airline company

OBJECTIVE

To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil.

METHODS

In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking), was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors.

RESULTS

Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs.

CONCLUSIONS

Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population.     

Support from advisors on child rearing for alleviating maternal anxiety and depressive symptoms among Japanese women

Background

Accumulating evidence suggests that social support is an important factor with regard to maternal psychological distress. The associations between the contextual factors in terms of social support and the risk of maternal psychological distress have not been adequately studied in Japan. The objective of this study was to examine the association of the presence of advisors on child rearing with maternal anxiety and depressive symptoms among Japanese women at 2 time points after childbirth.

Methods

A self-administered questionnaire that included items regarding the conditions of child rearing and a scale to estimate psychological distress was delivered to 2657 mothers when their infants were 3-4 months and 9-10 months old in 2004-2005. Multivariate logistic regression analysis was conducted for the statistical analyses.

Results

From the multivariate odds ratio, an environment with a few close advisors on child rearing was associated with the risks of maternal anxiety and depressive symptoms at 3-4 months and 9-10 months. The presence of few professional advisors on child rearing was also related to the risk of maternal depressive symptoms at the 2 time periods. The companionship of other child-rearing individuals was related to depressive symptoms at 9-10 months.

Conclusion

An environment without advisors on child rearing was associated with maternal psychological distress. A similarity between the observations at the 2 time points was that the presence of personal and professional advisors was related to maternal anxiety and/or depressive symptoms. It was noted that the need for other child-rearing companions increases as the child grows older.Key words: Social Support, Mothers, Anxiety, Depression, Asian Continental Ancestry Group     

Depressive symptoms in institutionalized older adults

OBJECTIVE

To estimate the prevalence of depressive symptoms among institutionalized elderly individuals and to analyze factors associated with this condition.

METHODS

This was a cross-sectional study involving 462 individuals aged 60 or older, residents in long stay institutions in four Brazilian municipalities. The dependent variable was assessed using the 15-item Geriatric Depression Scale. Poisson’s regression was used to evaluate associations with co-variables. We investigated which variables were most relevant in terms of presence of depressive symptoms within the studied context through factor analysis.

RESULTS

Prevalence of depressive symptoms was 48.7%. The variables associated with depressive symptoms were: regular/bad/very bad self-rated health; comorbidities; hospitalizations; and lack of friends in the institution. Five components accounted for 49.2% of total variance of the sample: functioning, social support, sensory deficiency, institutionalization and health conditions. In the factor analysis, functionality and social support were the components which explained a large part of observed variance.

CONCLUSIONS

A high prevalence of depressive symptoms, with significant variation in distribution, was observed. Such results emphasize the importance of health conditions and functioning for institutionalized older individuals developing depression. They also point to the importance of providing opportunities for interaction among institutionalized individuals.     

Vaginal Douching in Cambodian Women: Its Prevalence and Association With Vaginal Candidiasis

Background

We determined the prevalence of vaginal douching (cleansing of the vagina with liquid) in a sample of Cambodian women, and examined the associations of douching with genitourinary symptoms and infections, after controlling for potential confounding factors, including genitourinary symptoms and sociodemographic factors.

Methods

A total of 451 adolescent and adult females aged 15 to 49 years who attended 17 maternal and child health (MCH) clinics in 7 provinces of Cambodia in 2001 were consecutively enrolled as a part of the Sexually Transmitted Infection Sentinel Survey. Sociodemographic factors, genitourinary symptoms, and frequency of douching were assessed by face-to-face interviews using a structured questionnaire. Vaginal infections were examined by using standard diagnostic procedures specific to each pathogen.

Results

The proportion of participants who douched at least once a week was 76.7% (n = 346). Douching was significantly more prevalent in urban than in rural women (85.7%, n = 198 vs 67.3%, n = 148; P < 0.001). Frequency of douching was significantly associated with genitourinary symptoms, which were most prevalent in participants who douched from several times a week to once a day; genitourinary symptoms were less prevalent in those who douched more than once a day. Douching was significantly associated with vaginal candidiasis, but not with trichomoniasis or bacterial vaginosis, and this association persisted even after controlling for sociodemographic factors and genitourinary symptoms.

Conclusions

Vaginal douching was very common among Cambodian women visiting MCH clinics. Further investigations are warranted to elucidate the reasons for douching. In addition, women should be informed that douching may endanger their reproductive health.Key words: reproductive health, vaginal douching, vaginal candidiasis, Cambodia     

The prognostic value of depressive symptoms, fear-avoidance, and self-efficacy for duration of lost-time benefits in workers with musculoskeletal disorders

Background

The psychological factors of depressive symptoms, fear‐avoidance, and self‐efficacy are deemed to be important in the work disability process. However, the prognostic value of these factors for time on benefit is not well understood.

Aims

To analyse the prognostic value of psychological factors for the number of days on total compensation benefit over a 12 month period.

Methods

In a longitudinal study of 187 workers receiving total compensation benefits due to musculoskeletal disorders, the prognostic value of psychological factors measured 4–5 weeks post‐injury for duration on total compensation benefit over 12 months was analysed. Cox proportional hazard regression analyses were conducted. Special emphasis was given to variable selection and to the analysis of confounding effects of potential prognostic variables.

Results

The final model indicated that increased depressive symptoms and poorer physical health significantly increase the number of days on total benefit. Confounders included in the final model were pain and fear of income loss. In the final model the impact of fear‐avoidance ceased to be significant when work related variables were included in the fully adjusted model. This illustrates that interrelationships between variables must be taken into account when building multivariate prognostic models. The addition of work related variables to the model did not result in any major changes in the adjusted model, which suggests that when measured 4–5 weeks post‐injury, psychological and physical health factors are strong predictors of time on benefits, while work conditions are less important.

Conclusion

Results suggest that the presence of depressive symptoms and poor physical health in workers on benefit due to musculoskeletal disorders increases the number of days on total compensation benefits significantly, when controlling for confounding variables.     

Peer Reviewed: Health Status,Physical Disability,and Obesity Among Adult Mississippians With Chronic Joint Symptoms or Doctor-Diagnosed Arthritis: Findings From the Behavioral Risk Factor Surveillance System, 2003

Introduction

The purpose of this study was to analyze 2003 Mississippi Behavioral Risk Factor Surveillance System (BRFSS) data to describe the health of Mississippians with arthritis or chronic joint pain. For this study, we made statistical estimates of the extent of arthritis burden among the respondents and delineated measurable differences in sociodemographic factors, health status, and the prevalence of associated risk factors. Our findings compare health-related quality of life, physical activity, and key demographic characteristics and obesity rates, controlling for differences among the subgroups by age, sex, educational attainment, income, and race/ethnicity.

Methods

Respondents to Mississippi’s 2003 BRFSS were assigned to 1 of 5 distinct and mutually exclusive subgroups: 1) those with intermittent joint symptoms (IJS), 2) those with chronic joint symptoms (CJS), 3) those with doctor-diagnosed arthritis without CJS (DDA − CJS), 4) those with doctor-diagnosed arthritis with chronic joint symptoms (DDA + CJS), and 5) those with no joint symptoms (NJS). To determine the prevalence of arthritis and the continuum of disease progression, we compared the health-related quality of life, physical activity, and obesity of the respondents.

Results

Respondents with DDA + CJS were older than those with NJS (mean age, 57.1 years vs 38.7 years); they were more likely to be female (60.5% vs 51.7%), to have a high school diploma or less education (59.3% vs 45.4%), to be in fair to poor health (odds ratio [OR], 10.0), to be physically inactive (OR, 2.7), and to be overweight or obese (OR, 2.5).

Conclusion

Health status, physical disability, and weight control may be substantially improved through heightened levels of physical activity. However, in spite of the potential for marked improvement, adult Mississippians, especially those clients with DDA + CJS, remain reluctant to commit to exercise regimens. Findings from this study suggest a need to encourage Mississippians with DDA + CJS to engage in some regular physical activity, which could reduce the damaging effects of disease and improve their health. Increasing the health care resources earmarked for arthritis self-help and physical activity programs is one potential avenue to address the problem.     

Peer Reviewed: Depression, Diabetes, and Chronic Disease Risk Factors Among US Women of Reproductive Age

Introduction

Depression and chronic disease have implications for women''s overall health and future pregnancies. The objective of this study was to estimate the prevalence and predictors of diabetes and chronic disease risk factors among reproductive-age women with depression.

Methods

We used population-based data from the 2006, 2008, and 2010 Behavioral Risk Factor Surveillance System to examine prevalence of diabetes and prediabetes, binge and heavy drinking, smoking, overweight and obesity, and physical inactivity among 69,043 women aged 18 to 44 years with current major or minor depression, a past depression diagnosis, or no depression. In a multivariable logistic regression model, we calculated adjusted odds ratios (AORs) and 95% confidence intervals (CIs) of 1, 2, and 3 or more chronic disease risk factors by depression status.

Results

We found that 12.8% of reproductive-aged women experienced both current depression and 1 or more chronic disease risk factors. Compared to women with no depression, currently depressed women and those with a past diagnosis had higher prevalence of diabetes, smoking, binge or heavy drinking, obesity, and physical inactivity (P < .001 for all). Odds of 3 or more chronic conditions and risk factors were elevated among women with major (AOR, 5.7; 95% CI, 4.3-7.7), minor (AOR, 4.7; 95% CI, 3.7-6.1), and past diagnosis of depression (AOR, 2.8; 95% CI, 2.4-3.4).

Conclusion

Depressed women of reproductive age have high rates of chronic disease risk factors, which may affect their overall health and future pregnancies.     

Sociodemographic and Lifestyle Factors are Associated with the Use of Dietary Supplements in a Korean Population

Objective

The use of dietary supplements has been increasing rapidly in Korea over the last decade. The aim of this study was to investigate associations between the pattern of dietary supplement use and the sociodemographic/lifestyle characteristics of Korean consumers.

Methods

Participants were asked to complete a self-administered questionnaire on their sociodemographic and lifestyle characteristics, perceived health status, and regular dietary supplement use.

Results

A total of 697 men and 832 women completed the questionnaire. Of the respondents, 44.3% of the men and 53.2% of the women used some kind of dietary supplement regularly. Dietary supplement users were more likely to be women (P < 0.001), to be older than 50 years (P < 0.001), to have a higher household income (P = 0.003), to engage in moderate or vigorous physical activity (P < 0.032), to perceive themselves as healthy (P = 0.026), and to have received a diagnosis of a chronic disease (P < 0.001). In addition, the type of dietary supplements used varied with respect to sociodemographic and lifestyle factors. Among dietary supplement users, men preferred ginseng, and older respondents were more likely to use carbohydrate supplements and less likely to use lipid supplements. Those who had a lower BMI, were ex-smokers, or were nondrinkers preferred either vitamins or minerals. Those who were highly physical active or were nondrinkers tended to prefer either vitamin/mineral complexes or carbohydrate supplements.

Conclusions

The use of dietary supplements was related to sociodemographic and lifestyle factors in a Korean population.Key words: sociodemographics, lifestyle, dietary supplements, factors