HIV阳性男男性行为者抑郁现状及相关因素研究

目的 了解HIV阳性男男性行为者（men who have sex with men, MSM）抑郁现状及相关因素,为提高其心理健康水平提供依据。方法 采用方便抽样的方法,于2016年7-8月在南京市某医院对参加抗病毒治疗的 HIV阳性MSM进行问卷调查。采用logistic回归分析抑郁的相关因素。结果 抑郁症状发生率为38.6%（134/347）。多因素logistic回归分析显示,高社会支持（OR=0.955,95%CI:0.914~0.998）和高自尊（OR=0.788,95%CI:0.731~0.849）的HIV阳性MSM发生抑郁的可能性较小。 确诊时间＜12 月（OR=1.943,95%CI:1.080~3.493）和高感知歧视者（OR=1.049,95%CI:1.021~1.078）更有可能出现抑郁症状。结论 HIV阳性MSM抑郁症状的发生率较高,尤其是新发感染者。需要制定心理干预、咨询、治疗相结合的综合服务模式,以减少歧视,提高社会支持水平,缓解他们的负性情绪,从而改善其生存质量。     

中国女同性恋人群抑郁现状及影响因素

目的  了解中国女同性恋(女同)人群抑郁状况,探讨影响女同人群抑郁症状发生的因素,为更好地进行女同人群的健康教育和后续心理干预提供建议和参考。方法  2018年7月1日―2018年12月30日,通过问卷星对女同人群进行网络问卷调查。描述其抑郁状况分布,并用χ²检验、独立样本t检验进行单因素分析,用Logistic回归分析模型分析女同人群抑郁症状的影响因素。结果  56.1%的女同存在抑郁症状。研究结果显示,和与家人同住相比,与女性朋友同住(OR=0.399, 95% CI: 0.182~0.872, P=0.021)、社会支持(OR=0.953, 95% CI: 0.926~0.980, P=0.001)和心理韧性(OR=0.934, 95% CI: 0.895~0.975, P=0.002)水平高的女同更不容易抑郁;少数民族(OR=5.849, 95% CI: 1.474~23.206, P=0.012)、童年期不良经历(OR=1.317, 95% CI: 1.065~1.628, P=0.011)是抑郁症状发生的危险因素。结论  中国女同人群抑郁症状发生率较高,应关注性少数群体的心理状况,重视社会支持的积极作用,提供更多精神卫生资源,促进其心理健康。     

Perceived Experiences of Discrimination in Health Care: A Barrier for Cancer Screening Among American Indian Women with Type 2 Diabetes

PurposeBreast and cervical cancer-mortality disparities are prominent among American Indian women. These disparities, in part, may result from patients perceived experiences of discrimination in health care. This report evaluates the impact of perceived discrimination on screening for breast and cervical cancer in a sample of 200 American Indian women with type 2 diabetes.MethodsData were collected from patient report and medical records. Prevalence of breast and cervical cancer screening were assessed. Unadjusted and adjusted logistic regression analyses were used to assess associations between perceived discrimination, cancer screening status, and patients' health care-seeking behaviors.FindingsSubstantial proportions of AI women in our sample were behind the recommended schedules of screening for breast and cervical cancer. Adjusted estimates revealed that perceived discrimination was significantly associated with not being current for clinical breast examination and Pap test, and was close to statistical significance with not being current for mammography. The number of suboptimal health care-seeking behaviors increased with higher mean levels of perceived discrimination.ConclusionsAmong AI women, perceived discrimination in health care may negatively influence use of breast and cancer screening services, and health care-seeking behaviors. More research is needed among AIs to examine features of health care systems related to the phenomenon patients perceived experience of discrimination.     

Physical activity,resilience, and depressive symptoms in adolescence

Promoting mental health by facilitation of physical activity and resilience is of great importance in adolescence. This cross-sectional study investigated the association between physical activity and resilience, in relation to depressive symptoms among adolescents. Resilience is based on five factors: personal competence, social competence, structured style (planning, structure, and daily routines), social resources, and family cohesion.Norwegian adolescents 13–18 years old (N = 1100; 51% girls and 49% boys) participated in the study. Girls scored lower in physical activity, and higher in social resources and depressive symptoms than boys, while boys scored higher in personal competence and structured style. For both genders the hierarchical multiple regression analysis showed a negative association between the resilience factors and depressive symptoms. Higher levels of physical activity were associated with lower levels of depressive symptoms for girls. There was no significant association between physical activity and depressive symptoms among boys. There was, however, an interaction effect for boys indicating that the association between structured style, and depressive symptoms depends on the frequency of physical activity.Acknowledging the association between physical activity, resilience, and the outcome of depressive symptoms may be important in developing health promotion programs for young people, especially girls.     

Violence and Other Stressful Life Events as Triggers of Depression and Anxiety: What Psychosocial Resources Protect African American Mothers?

Understanding the risk and protective factors related to maternal mental health problems is important for improving the well-being of mothers and children, particularly in African American populations which may be at greater risk for maternal depression and resulting child behavior problems. This study explored whether three psychosocial resources??emotional resilience, social support, and ethnic identity??serve as protective factors in the face of specific stressful events that may trigger African American mothers?? depression and anxiety symptoms. Standard self-report measures of depression, anxiety, negative life events, community violence, abuse, emotional resilience, social support, and ethnic identity were administered to African American mothers (N = 209) of 2?C18 month-old children. Linear regression models revealed main effects of negative life events and abuse on increased depression and anxiety symptoms, while emotional resilience and social support predicted decreased symptoms. There was also a significant interaction revealing a protective-reactive effect of ethnic identity on the associations of witnessed community violence with depression and anxiety symptoms. It is important for primary care providers to screen African American mothers for negative life events and abuse to identify those at increased risk for maternal depression and anxiety symptoms. Treatment programs should target emotional resilience, enhanced social support, and stronger ethnic group affiliation, which may be most effective at preventing mental health problems among mothers exposed to relative lower levels of community violence.     

Breast cancer literacy and health beliefs related to breast cancer screening among American Indian women

ABSTRACT

The purpose of this article is to examine the health beliefs and literacy about breast cancer and their relationship with breast cancer screening among American Indian (AI) women. Using the Health Belief Model (HBM) and hierarchical logistic regression with data from a sample of 286 AI female adults residing in the Northern Plains, we found that greater awareness of breast cancer screening was linked to breast cancer screening practices. However, perceived barriers, one of the HBM constructs, prevented such screening practices. This study suggested that culturally relevant HBM factors should be targeted when developing culturally sensitive breast cancer prevention efforts.     

Cancer screening and risk factor rates among American Indians

OBJECTIVES: We examined cancer screening and risk factor patterns in California using 4 different statistical tabulations of American Indian and Alaska Native (AIAN) populations. METHODS: We used the 2001 California Health Interview Survey to compare cancer screening and risk factor data across 4 different tabulation approaches. We calculated weighted prevalence estimates by gender and race/ethnicity for cancer screening and risk factors, sociodemographic characteristics, and access to care variables. We compared AIAN men and women with members of other racial groups and examined outcomes among AIAN men and women using the 4 tabulation methods. RESULTS: Although some differences were small, in general, screening and risk factor rates among American Indians/Alaska Natives were most similar to rates among Whites when the most inclusive multiracial tabulation approach was used and least similar when the more exclusive US census "single-race" approach was used. CONCLUSIONS: Racial misclassification and undercounting are among the most difficult obstacles to obtaining accurate and informative data on the AIAN population. Our analysis suggests some guidelines for overcoming these obstacles.     

Match between culture and social support: Acculturation moderates the relationship between social support and well-being of Chinese American breast cancer survivors

Purpose

Social support does not always lead to health benefits; the outcomes depend on the match between the need and the provision of social support. Culture shapes individuals’ preference of social support types (e.g., supportive communication, social companionship, and tangible support). The present study examined how the association between social support and well-being may vary as a function of acculturation among minority cancer survivors.

Methods

One hundred and twenty-three Chinese American breast cancer survivors were invited to complete a questionnaire package.

Results

Findings showed that acculturation moderated the association of social support subtypes with psychological and physical well-being. Higher emotional/information support was associated with better quality of life and less physical symptoms among highly acculturated cancer survivors but more physical symptoms among those who were less acculturated. Tangible support was associated with more physical symptoms among highly acculturated cancer survivors but less physical symptoms among those who are less acculturated. Positive social interaction was associated with better quality of life and less physical symptoms among less acculturated cancer survivors but not associated with quality of life or physical symptoms among their highly acculturated counterparts.

Conclusion

The findings pointed to the significance of acculturation in breast cancer experience among minority women, especially its interplay with social support transactions.

     

肺癌患者社会支持、心理适应与抑郁症状关系

目的探讨肺癌患者抑郁症状发生率及与领悟社会支持、心理适应的关系,了解患者心理健康状况,提出干预措施,促进患者身心康健。方法于2013年2月-2014年1月采用流调用抑郁自评问卷、领悟社会支持量表及简明癌症患者心理适应问卷对169例肺癌患者进行匿名调查。结果66.91%的肺癌患者存在抑郁症状;领悟社会支持、积极态度与肺癌患者的抑郁症状发生率呈负相关（β=-0.189,-0.194,P<0.05）,负面情绪与抑郁症状发生率呈正相关（β=0.526,P<0.05）,且心理适应在领悟社会支持和抑郁症状之间可能存在中介作用。结论肺癌患者抑郁症状发病率较高且抑郁症状较严重,应给予肺癌患者更多社会支持,从而帮助肺癌患者提高应对能力降低其抑郁水平。     

Psychosocial correlates of depressive symptoms among Japanese high school students.

PURPOSE: To determine the psychosocial factors associated with the presence and persistence of depressive symptoms among high school students in Okinawa, Japan. METHODS: The study sample was 3202 students from 12 public senior high schools. Students completed self-administered questionnaires from October through December 1997. We measured depressive symptomatology using the Center for Epidemiologic Studies Depression Scale. We asked students to report whether they had depressive symptoms at any time in the immediate past week, and whether those symptoms persisted for 5-7 days. The psychosocial variables examined were life stressors, perceived social support, health practices, self-esteem, and Locus of Control. The relationship between the psychosocial factors and depressive symptoms was examined using hierarchical multiple regression analyses. RESULTS: After controlling for the effects of demographic and other psychosocial variables, presence of depressive symptoms was positively associated with life stressors in the domains of friends, family, and teachers. Similarly, persistence of depressive symptoms was also positively associated with life stressors in the domains of friends and teachers. Presence and persistence of depressive symptoms were negatively associated with positive health practices, more social support, high self-esteem, and internal Locus of Control. CONCLUSIONS: The psychosocial variables associated with presence and persistence of depressive symptoms were remarkably consistent. Life stressors might be risk factors; on the contrary, positive health practices, perceived social support, high self-esteem, and internal Locus of Control might be protective factors of depressive symptoms among Japanese adolescents.     

Confronting oral health disparities among American Indian/Alaska Native children: the pediatric oral health therapist

American Indian and Alaska Native (AIAN) children are disproportionately affected by oral disease compared with the general population of American children. Additionally, AIAN children have limited access to professional oral health care. The Indian Health Service (IHS) and AIAN tribal leaders face a significant problem in ensuring care for the oral health of these children.We discuss the development and deployment of a new allied oral health professional, a pediatric oral health therapist. This kind of practitioner can effectively extend the ability of dentists to provide for children not receiving care and help to confront the significant oral health disparities existing in AIAN children.Resolving oral health disparities and ensuring access to oral health care for American Indians and Alaska Natives is a moral issue-one of social justice.     

Prevalence and predictors of depressive symptoms among rural older Australians and Americans

OBJECTIVE: To examine the predictors of depressive symptoms among older married rural Australian and American men and women, using comparable measures from two separate studies. DESIGN: Postal survey for Australians; telephone interviews for Americans. SETTING: Rural Australia (six states and two territories) and America (Virginia). PARTICIPANTS: Older married rural men and women, aged 65 years and over, in Australia (n = 216) and America (n = 156). MAIN OUTCOME MEASURES: Whether predictors of depressive symptoms, specifically demographic factors, health, pain, functional limitations and social networks, differed according to nationality or sex. RESULTS: Approximately one-third of older rural Australian (37%) and Americans (28%) reported recently experiencing depressive symptoms. For Australian men and women, pain was the strongest predictor of depressive symptoms. For American women, dissatisfaction with social support predicted depressive symptoms, whereas no variable predicted depressive symptoms in American men. CONCLUSIONS: In the context of a globally ageing population, the fact that nearly one in three older rural people on two continents described themselves as recently feeling depressed is a troubling finding of considerable importance to both practitioners and policy-makers. The findings raise questions about the cultural acceptance, definition and manifestations of symptoms of depression in rural communities, as well as the role of different public health and support systems in the two countries.     

Mental health challenges and resilience among mothers with intellectual and developmental disabilities

BackgroundMothers with intellectual and developmental disabilities (IDD) frequently experience mental health problems. Yet, they are excluded from broader women's mental health efforts, and few services exist to support their unique mental health needs.ObjectivesOur objective was to identify key risk, protective, and resilience factors that affect mental health among mothers with IDD.MethodsWe interviewed mothers with IDD on: (1) a quantitative measure to assess demographics and depressive symptoms and (2) qualitative focus groups on parenting and mental health (analyzed through thematic analysis). There were three focus groups, for a total sample of 12 mothers with IDD.ResultsThe 12 women in the sample had a total of 28 children, with a mean age of 11.3 years (SD = 9.9). The mean depressive symptom score in the sample was 13.8 (SD = 5.5), with 7 women scoring above the cut-off for clinically significant symptoms. Nine thematic categories were identified, organized into risks, protective factors, and resilience factors. Risks were parenting stress, life stressors, feelings of powerlessness with the child welfare system, and feeling judged. Protective factors were formal and informal supports. Resilience factors were motherhood enjoyment, having a good family life, and wishing to be independent.ConclusionsEfforts to improve mental health among mothers with IDD should minimize risks that undermine adaptive capabilities and promote resilience to restore efficacy of protective systems. Better training of service-providers working with individuals with IDD, using strength-based approaches and developing alternative, autonomy-building sources of support in the form of peer support groups is recommended.     

Disparities in chronic disease risk factors and health status between American Indian/Alaska Native and White elders: findings from a telephone survey, 2001 and 2002

We compared prevalence estimates of chronic disease risk factors and health status between American Indian/Alaska Native (AIAN) and White elders. We used 2001 and 2002 Behavioral Risk Factor Surveillance System data to estimate the prevalence of smoking, physical inactivity, obesity, diagnosed diabetes, and general health status. For all health behavior and status measures, American Indians/Alaska Natives reported greater risk than did Whites. Risk factors among AIAN elders need to be addressed to eliminate disparities in chronic diseases.     

Research careers for American Indian/Alaska Native nurses: pathway to elimination of health disparities

The health status of American Indians/Alaska Natives lags behind that of the US population. American Indian/Alaska Native (AIAN) nurses are on the front lines of health services for AIAN people. They have the potential to make scientific contributions as well, but are under-represented among researchers working to understand health disparities.The AIAN MS-to-PhD Nursing Science Bridge, at the University of Minnesota, in partnership with the Universities of North Dakota and Oklahoma, provides support for AIAN nurses during the critical training transition from masters of science to doctoral programs. Partner schools collaborate with AIAN elders, medicine people/spiritual leaders, and academic consultants to (1) foster academic success and strengthen the AIAN identity of students during their research training and (2) bring about institutional change to optimize student experiences. Future research programs developed by this cadre of AIAN nurse scientists will contribute scientifically sound, culturally acceptable knowledge to effectively improve the health of AIAN people.     

The Syndemic Effects of Intimate Partner Violence, HIV/AIDS, and Substance Abuse on Depression among Low-Income Urban Women

Intimate partner violence (IPV), HIV/AIDS, and substance use are epidemics among low-income urban women that have been described together as the “SAVA syndemic” because of their co-occurring nature. This study examines the synergistic or “syndemic” effect of these three health issues on depression among urban women and evaluates social support as a protective factor that might reduce depressive symptoms associated with the Substance Abuse, Violence, and AIDS (SAVA) syndemic. Data from 445 urban women were collected through in-person interviews. All women were over the age of 18, not pregnant, English speaking, and reported having a main partner in the past year. Twenty-five percent had experienced all three factors of the SAVA syndemic (were HIV-positive, had experienced IPV in the past year, and had used cocaine or heroin in their lifetime). HIV-positive status, hard drug use, IPV, and low levels of social support were all individually associated with greater depressive symptoms. When controlling for demographics and other SAVA factors, IPV and hard drug use in the past 30 days remained associated with depressive symptoms, as did low social support. However, social support did not modify the effect of the SAVA factors on depression. Compared to women who experienced no SAVA factors, women who had experienced all three factors were 6.77 times more likely to have depressive symptoms. These findings confirm that IPV is significantly associated with depressive symptoms and that the syndemic impact of IPV, substance use, and HIV could have even more extreme effects on depression outcomes.     

Psychosocial work environment and mental health: Job-strain and effort-reward imbalance models in a context of major organizational changes

This study explored the association between the two job-stress models, job-strain and effort-reward imbalance, and mental health outcomes in a working population exposed to major organizational changes. The cross-sectional study was based on 680 subjects, 504 men and 176 women. Psychosocial factors at work included: psychological demands, decision latitude, social support, effort, reward, and overcommitment. Mental health outcomes were depressive symptoms (CES-D) and psychiatric disorders (GHQ-12). Job strain, low decision latitude, effort-reward imbalance, and low reward (especially job instability) were found to be associated with depressive symptoms and/or psychiatric disorders among men. Overcommitment at work was a risk factor for both men and women. Social support at work played a role to reduce depressive symptoms for women. These findings emphasize the deleterious effects of psychosocial work environment on mental health during major organizational changes.     

Spirituality and social support on health behaviors of african american undergraduates

OBJECTIVES: To examine the role of spirituality and perceived social support as protective factors for preventing health-compromising behaviors among African American college students. METHODS: Two hundred eleven African American college students completed a spirituality, perceived social support, and health behavior questionnaire. RESULTS: Low spiritual well-being significantly increased the odds of smoking and alcohol use. Low perceived parental support increased the odds of alcohol use whereas low perceived support from friends decreased the odds of alcohol use. CONCLUSIONS: Spirituality and perceived social support may serve as protective factors for smoking and alcohol use among African American college students.     

Depressive Symptoms Among Reservation-based Pregnant American Indian Adolescents

Objectives To examine rates and correlates of depressive symptoms among pregnant reservation-based American Indian (AI) adolescents from the Southwestern United States (N = 53). Methods Data were derived from a study evaluating a home-visiting program designed to promote positive parenting among young families. Participants included a volunteer, convenience sample of expectant mothers who completed behavioral and mental health self-report questionnaires. Depressive symptoms were assessed using the Center for Epidemiological Studies-Depression scale (CES-D). Three risk domains were analyzed in relation to depressive symptoms: sociodemographics, family relations, and psychosocial functioning. Results Forty-seven percent of expectant mothers scored at or above the widely accepted clinical cutoff score of 16 on the CES-D; 30% scored at or above 20, a score more likely to reflect elevated depressive symptoms among adolescents; and almost 20% scored at or above 28 (one standard deviation above the mean), a score suggestive of clinical depression. Higher levels of depressive symptoms were associated with less use of public assistance, external locus of control, less social support, and lower self-esteem. Conclusions Data suggest that a large proportion of pregnant AI adolescents reported elevated depressive symptoms, though rates are similar to non-pregnant AI adolescent samples.     

The relationship between social support, stress, and health among women on Detroit's East Side.

A conceptual model of the stress process has been useful in examining relationships between numerous social determinants (e.g., chronic stress), protective factors (e.g., social support), and health status. In this article, the authors examine multiple sources of chronic stress, instrumental and emotional support, and health outcomes among a random sample (N = 679) of predominantly low-income African American women who reside on Detroit's east side. The findings suggest that a number of chronic stressors have an impact on depressive symptoms and general health and that even though instrumental and emotional support each have a significant effect over and above the effects of the stressors, when both are included in the model, instrumental support, and not emotional support, remains as a significant predictor of health outcomes. These findings suggest the need for health education interventions and policy strategies that strengthen social support and aim at macro-level changes necessary to reduce chronic stressful conditions.