Lifetime cumulative adversity, mental health and the risk of becoming a smoker

We analyze the effect of stress exposure on the transition to heavy smoking, in a community sample of 1747 young adults in Miami, Florida. The effects of distal life stress are assessed in the context of recent stress exposure. Distal stress exposure predicts smoking independently of recent stress. Intervening stressful events do not appreciably mediate the influence of distal stress. We investigate the extent to which stress effects may be mediated by psychiatric and substance dependence disorders. We conclude that the effect of social stress on the risk for smoking is additive over time. The significant independent effect of early stress exposure implies that youths who are at greater risk for eventual heavy smoking may be identified at ages considerably younger than peak initiation age.     

The impact of cumulative childhood adversity on young adult mental health: measures, models, and interpretations

Research studies investigating the impact of childhood cumulative adversity on adult mental health have proliferated in recent years. In general, little attention has been paid to the operationalization of cumulative adversity, with most studies operationalizing this as the simple sum of the number of occurrences of distinct events experienced. In addition, the possibility that the mathematical relationship of cumulative childhood adversity to some mental health dimensions may be more complex than a basic linear association has not often been considered. This study explores these issues with 2 waves of data drawn from an economically and racially diverse sample transitioning to adulthood in Boston, Massachusetts, USA. A diverse set of childhood adversities were reported in high school and 3 mental health outcomes -- depressed mood, drug use, and antisocial behavior -- were reported 2 years later during the transition to adulthood. Our results suggest that both operationalization and statistical modeling are important and interrelated and, as such, they have the potential to influence substantive interpretation of the effect of cumulative childhood adversity on adult mental health. In our data, total cumulative childhood adversity was related to depressive symptoms, drug use, and antisocial behavior in a positive curvilinear manner with incremental impact increasing as adversities accumulate, but further analysis revealed that this curvilinear effect was an artifact of the confounding of high cumulative adversity scores with the experience of more severe events. Thus, respondents with higher cumulative adversity had disproportionately poorer mental health because of the severity of the adversities they were exposed to, not the cumulative number of different types of adversities experienced. These results indicate that public health efforts targeting prevention of childhood adversities would best be aimed at the most severe adversities in order to have greatest benefit to mental health in young adulthood.     

The association between social network factors and mental health at different life stages

Objectives

Psychosocial factors are important determinants of an individual’s health. This study examines the association between health scores and social network factors on mental health across different life stages.

Methods

Data were drawn from the Household Income and Labour Dynamics in Australia survey for adolescents (n = 1739), adults (n = 10,309) and seniors (n = 2287). Hierarchical regression modelling was applied to examine effects within and across age groups. All the variables were derived from the self-completion questionnaire.

Results

The social network factors were statistically significant predictors of mental health outcomes for all three life stages. For adolescents, the three social network factors were statistically significant with social isolation having the largest impact (β = ?.284, p < .001), followed by social connection (β = .084, p < .001) and social trust having a similar effect (β = .073, p < .001). For adults social isolation had the highest impact (β = ?.203, p < .001), followed by social connection (β = .110, p < .001) and social trust (β = .087, p < .001).The results for seniors were social isolation (β = ?.188, p < .001), social connection (β = .147, p < .001) and social trust (β = .032, p < .05).

Conclusions

After adding the social network factors, the models improved significantly with social isolation playing the most significant role across all life stages, whereas the other social network factors played a differentiated role depending upon the life stage. These findings have practical implications in the design of mental health interventions across different life stages.

     

A genetic perspective on the association between exercise and mental health

Regular exercise is associated with better mental health. This association is widely assumed to reflect causal effects of exercise. In this paper we propose that two additional mechanisms contribute to the association between exercise and mental health in the population-at-large: genetic pleiotropy and gene-by-exercise interaction. Both mechanisms assume heritability of exercise behavior and a partial overlap between the genes influencing exercise behavior and mental health. We review a number of large-scale studies in monozygotic and dizygotic twins that support these assumptions. Based on the importance of genetic factors in exercise behavior we develop a model for gene-by-exercise interaction that explains differences in voluntary exercise behavior by differential genetic sensitivity to the mental health benefits of exercise. We focus on the genetic modulation of acute mood effects of exercise and longer-term effects on self-esteem through genetic effects on exercise ability. If correct, our model calls for a change from ‘population-based’ to ‘personalized’ intervention strategies.     

The experience of chronic illness and post-traumatic stress disorder: the consequences of cumulative adversity

In this paper the experiences of the chronically ill are examined to explore the impact of post-traumatic stress disorder (PTSD), accumulated burden of adversity and trauma spectrum disorder on subsequent illness and coping behaviors. Individuals experiencing chronic diseases have been studied with regard to depression, anxiety and a variety of coping maladaptions, but negligible attention has been given to the PTSD potential of chronic disease over the life course. Yet, growing evidence suggests that the traumatogenic potential of chronic diseases, some sudden and unexpected onsets, and the traumatogenic changes in life circumstance, may produce maladaptive illness coping over the life course. More importantly, attention needs to focus on the additive effect of co-morbid life events and the traumatic potential of invasive medical therapies. Consideration of PTSD and a continuum of cumulative adversity provide a more complex and fully drawn understanding of the circumstances surrounding chronic illness coping and reasons for maladaptive coping following invasive therapies and changes in the disease trajectory. The pathophysiology that produces a chronic diseases does not begin at symptom onset, and the psychosocial strategies to cope with a chronic illness, whether efficacious or maladaptive, also do not begin at symptom onset, but develops over the life course.     

Rapid change, climate adversity and the next 'big dry': older farmers' mental health

Objective: To describe the experiences of older farmers in the face of prolonged drought and rapid change. Design: Content analysis of issues and priorities raised in semi‐structured community forums. Setting: Rural centres in NSW. Participants: One hundred and fifty older farmers, their families, Industry and Investment NSW, rural financial and mental health services, the Country Women's Association and other non‐government agencies. Intervention: Five public forums organised under the Rural Adversity Mental Health Program. Results: Prolonged drought caused pressures on farmers that compounded the usual stresses of farming and of ageing. These were experienced in the context of rapid social and industry change, fuel price volatility and the insidious threat of climate change. Three main themes were articulated: loss, government compliance pressures and difficulties accessing and/or inappropriate services. Conclusion: Older farmers felt an overwhelming sense of loss: of profitability and professional success, community status, physical well‐being and comfort, the ability to participate in the modern world and, above all, of relationships (partners, children and friends moving away). They interpreted government compliance requirements as evidence of community and government loss of trust in famers. They resisted using the few mental health services that might be available, fearing being labelled as ‘crazy’ and discouraged by the culturally inappropriate way in which services were offered. Older farmers would benefit from joint services related to health and well‐being simultaneously with modern business management offered in trusted, comfortable settings.     

The association between residential area characteristics and mental health outcomes among men and women in Belgium

Aim  

Recently, interest has grown in the association between contextual factors and health outcomes. This study questions whether mental health complaints vary according to the socio-economic characteristics of the residential area where people live. The gender-specific patterns are studied.     

农村青少年逆境与累积逆境的发生状况研究

[目的]调查山东省农村青少年逆境及累积逆境的现状.[方法]采用方便抽样的方法,对山东省东、中、西部六个地区的1 200名农村青少年进行问卷调查,问卷主要包括一般资料问卷和青少年逆境调查问卷(包括家庭逆境、社区逆境、学校逆境和个体逆境四个方面).[结果]考试紧张焦虑(51.7%)、父母物质滥用(34.8%)、目击交通事故...     

微量元素碘与人体健康的关系

碘是人类必需的微量元素,是人体合成甲状腺激素的主要原料,维持一定水平的甲状腺激素对保证机体正常发育、尤其是脑发育,以及生命活动有着重要作用。碘摄入量过低或过高均会对人体健康带来危害,因此,适宜的碘摄入在碘缺乏病防治中具有重要的意义。     

The association between culture, climate and quality of care in primary health care teams

BACKGROUND: Culture and climate represent shared beliefs and values that may influence quality of care in health care teams, and which could be manipulated for quality improvement. However, there is a lack of agreement on the theoretical and empirical relationships between climate and culture, and their relative power as predictors of quality of care. This study sought to examine the association between self-report measures of climate and culture in primary care teams and comprehensive measures of quality of care. METHODS: The data were derived from a cross-sectional survey of 492 professionals in 42 general practices in England. Self-report measures of culture (the Competing Values Framework) and climate (the Team Climate Inventory) were used, together with validated measures of quality of care from medical records and self-report. RESULTS: The majority of practices could be characterized as 'clan' culture type. Practices with a dominant clan culture scored higher on climate for participation and teamwork. There were no associations between culture and quality of care, and only limited evidence of associations between climate and quality. CONCLUSIONS: The current analysis would not support the hypothesis that culture and climate are important predictors of quality of care in primary care. Although larger studies are required to provide a definitive test, the results may suggest the need for a more complex model of the associations between culture, climate and outcomes, and further research may be required into the interaction between culture and climate with other determinants of behaviour such as internal and external incentives.     

The association between gravidity and primary biliary cirrhosis

PURPOSE: Primary biliary cirrhosis is an autoimmune disease with female predominance that leads to liver failure. The goal of this study was to identify reproductive risk factors associated with this disease. METHODS: We compared 182 cases of PBC with 225 age- and sex-matched friend controls to examine the role of reproductive factors. The survey instrument was developed using standardized questions obtained from the National Health and Nutrition Examination Survey (NHANES) III. RESULTS: A total of 126/182 cases (69%) and 141/225 (62.6%) friend controls responded to the survey. More cases than controls reported ever having genitourinary infection [adjusted odds ratio (OR) = 2.12, 95% confidence interval (CI) 1.01, 4.42] among those without a personal or family history of autoimmune disease. The most notable finding was that cases reported significantly more pregnancies than controls (p = 0.008). The adjusted OR for each additional pregnancy among those without a personal or family history of autoimmune disease was 1.40 (95% CI 1.14, 1.7). More controls (24.4%) than cases (16.0%) were nulliparous. Cases reported having five or more children (16.0%) with double the frequency of controls (8.2%). CONCLUSIONS: The association reported herein, between primary biliary cirrhosis and gravidity, is particularly significant because of the overwhelming female predominance.     

The association between subjective social status and mental health among Asian immigrants: investigating the influence of age at immigration

This paper examines how age at immigration influences the association between adult subjective social status and mental health outcomes. The age when people immigrate shapes the capacity and efficiency at which they learn and use a new language, the opportunities to meet and socialize with a wide range of people, and respond to healthy or stressful environments. We hypothesize that adult subjective social status will be more predictive of health outcomes among immigrants who arrive in the US in mid- to late-adulthood compared with immigrants who arrive earlier. To investigate this hypothesis, data on immigrants are drawn from the US first national survey of mental health among Asian Americans (N=1451). Logistic regression is used to estimate the relationships between adult subjective social status and mood dysfunction, a composite of anxiety and affective disorder symptoms. As predicted, age at immigration moderated the relationship between adult subjective social status and mood dysfunction. Adult subjective social status was related to health among immigrants arriving when they were 25 years and older, but there was no association between subjective social status and mental health among immigrants arriving before the age of 25 years.     

The association between self-assessed health status and individual health practices

We report the association between single health practices and self-assessed health status. Data were collected by telephone survey applied to all adults in a sample of households in metropolitan St. John's; questionnaires were completed for 3,300 subjects. Five health practices--smoking, exercise, sleep, weight and drinking--as defined by previous studies were compared with self-assessed health status--good or poor--using logistic regression; linear and quadratic functions were fitted, plots were prepared and the direction and strength of the associations studied using odds and odds ratios. For sleep, smoking, weight and exercise, our results confirm the definitions used in previous studies. Current non-drinkers in our sample do not report good health as frequently as moderate drinkers. Breakfast--which was analyzed by conventional cross-tabulation--showed no association with health status.     

A genetic perspective on the association between exercise and mental health in the era of genome-wide association studies

Regular exercise is associated with mental health throughout the life course but the chain-of-causality underlying this association remains contested. I review results from genetically informative designs that examine causality, including the discordant monozygotic twin design, multivariate genetic models, Mendelian Randomization, and stratification on polygenic risk scores. Triangulation across the results from these and the standard designs for causal inference (RCT, prospective studies) in the extant literature supports the existence of causal effects of exercise on mental health as well as residual confounding by genetic factors that independently influence participation in regular exercise and mental health outcomes. I present an update of our earlier model for the genetic determinants of voluntary exercise behaviour. The model allows causal effects of regular exercise on mental health to co-exist with genetic pleiotropy through differences in the genetic sensitivity to the mental health benefits of exercise. The model encourages research on strategies that use genomic information to improve the success of interventions on regular exercise behaviour.     

A challenge for primary health care: mental health care implementation

The objective of this study was to evaluate mental health care provided within a primary health care setting. The study was conducted in a Primary Health Care Center (PHC) in the city of Sao Paulo, Brazil. A comparative study was made between pediatricians' diagnosis of mental health problems and those identified by the Child Behavior Checklist (CBCL) in children (5-11 years) from August to October 2000. Eleven pediatricians were interviewed for more in-depth analysis. The study analyzed 411 patient charts and held 206 interviews with the children's parents. Analysis of the resulting data shows that the pediatricians provided a diagnosis of mental health problems in 17.5% of the children examined. When compared with probable mental health problems identified by the CBCL, only 25.3% of the children were diagnosed by the physician as having mental health problems. Interviews with pediatricians identified difficulties in the definition and conceptualization of mental health problems, lack of organization in the referral system, and insufficient technical support.