Demographic Variables, Control, Stress, Support and Health among the Elderly

This article examines possible psychosocial factors that are expected to influence the health of community elderly people. A probability random sample of 240 Chinese elderly people living in a metropolitan Taiwanese city were interviewed at home. They answered questionnaires including measures for demographic variables (gender, age, marital status and education), locus of control, life stress, perceived social support and various indicators of physical and mental health. Multivariate analyses with structural modeling found that (a) age and education had direct effects on physical health; (b) stress and social support had direct effects on both physical and mental health; (c) control had a direct effect on physical but not mental health; and (d) stress, social support and control were also important mediators in the process of health and adjustment among the elderly people.     

PREDICTORS OF THE PHYSICAL AND PSYCHOLOGICAL INTEGRATION OF HOMELESS ADULTS WITH PROBLEMATIC SUBSTANCE USE

This study examined predictors of physical and psychological integration in homeless adults with problematic substance use. Homeless adults with problematic substance use (n = 115) in Ottawa, Canada, completed questionnaires regarding their demographics (age, gender, Aboriginal ethnicity), health and social functioning (physical health, mental health, alcohol use problems, drug use problems, social skills), environmental factors (satisfaction with personal safety, social support), physical integration, and psychological integration. Participants reported low physical integration (i.e., participation in activities in the community) and did not feel strongly psychologically integrated (i.e., sense of belonging). The final models accounted for 36% and 19% of the variance in physical and psychological integration, respectively. Higher levels of social skills and social support were associated with greater physical integration. Higher levels of mental health functioning and satisfaction with safety were related to greater psychological integration. Implications of the findings for community support services are discussed.     

Treatment satisfaction, perceived treatment effectiveness, and dropout among older users of mental health services

Objectives: To examine the rates and correlates of treatment satisfaction, perceived treatment effectiveness, and dropout among older users of mental health services. Method: We used data from the Canadian Community Health Survey‐Mental Health and Well‐Being (CCHS‐1.2), which includes 12,792 individuals aged ≥55 years. The average age of these participants was 67 years and 53.2% were female. We examined the rates of treatment satisfaction, perceived treatment effectiveness, and dropout for those who had used mental health services in the past year, and used logistic regression to examine the correlates of these outcomes. Results: Of the older adults included in the CCHS‐1.2, 664 (5.3%) had used mental health services in the past year. The majority of these were satisfied with services (88.5%) and perceived treatment to be effective (83.6%), which is likely why only 15.5% dropped out in the past year. In logistic regression models, social support was significantly and positively related to both treatment satisfaction and perceived effectiveness. Perceived treatment effectiveness was the only variable related to dropout, with lower levels of perceived effectiveness associated with greater odds of dropping out of treatment. Conclusions: Results from this study indicate that older adults have very good self‐reported treatment outcomes. The modest influence of individual characteristics on treatment outcomes suggests the potential importance of contextual characteristics. © 2011 Wiley Periodicals, Inc. J Clin Psychol 67:1197–1209, 2011.     

Perceptions of Mental and Physical Illnesses in North-western Ethiopia: Causes, Treatments, and Attitudes

Four hundred and fifty adults (mean age 34 years; 55 percent males) from northwestern Ethiopia were interviewed to explore their causal beliefs about, perceived importance of various treatments for, and attitudes towards, six mental and three physical illnesses. Principal components analysis identified four meaningful illness causal belief dimensions: Psychosocial Stressors, Supernatural Retribution, Biomedical Defects, and Socio-Environmental Deprivation. Psychosocial Stressors and Supernatural Retribution were rated more important causes of mental than physical illnesses. Prayer and home/family care were suggested more strongly for treating mental than physical illnesses. Systematic associations were found between causal beliefs, treatment beliefs, and attitudes towards patients. Respondents' educational level was negatively related with traditional beliefs and positively related with favorable attitudes towards patients. It is concluded that causal beliefs, perceived importance of treatments, and attitude towards patients among northwestern Ethiopians are meaningfully interrelated. Implications for health services and research are discussed.     

离退休老年人生活质量及心理状态调查

目的：探讨离退休老年人的生活质量和心理状态。方法：采用老年人生活质量调查表及心理健康测查表对816例离退休老年人进行测查。结果：影响离退休老年人生活质量的因素依次为心理卫生，健康状 况，经济收入，社会交往等。不论男女其各分量表除HMA外，其余各量表离退休老年人与常模比较均有显著性差异（P＜0．01），离退休老年人各量表分明显高于常模，可能与离退休老年人躯体不适，精神活动不足和某些人心理压力及个性有关，而干部人员较工人人员的心理问题多，生活满意度低，结论：离退休老年人存在明显的心理问题，个性问题和生活质量问题，改善退休老年人的生活质量和心理有利于离退休老年人身心健康。     

Psychosocial and health belief variables associated with frequent attendance in primary care

BACKGROUND: The reasons for high use of primary care, and in particular the role of psychosocial factors, remain unclear. METHODS: We identified and interviewed 236 frequent attenders and 420 normal users, matched by age and sex, of a public Health Centre in Granada, Spain. Users were questioned about mental health (GHQ-28), social support (Duke-UNC-11), family dysfunction (family APGAR) and health beliefs (health belief model, locus of health control and medical care expectations). We also measured a set of individual, social and illness variables. RESULTS: Multiple logistic regression analyses showed that mental health was the main factor associated with frequent attender status (odds ratio = 3.1; 2.4-3.9). The association was stronger than that between frequent attender status and perceived illness, and between the former and reported chronic illness. Family dysfunction and perceived susceptibility to and severity of disease were also significantly but more weakly associated with frequent attender status. Affective support was more strongly associated with FA status than was confidant support, but both associations disappeared when mental health and family function were controlled for. CONCLUSIONS: Our findings document the association of psychosocial factors and primary health care use. We suggest that the effective management of mental health problems from a family-based approach may reduce primary health care high use.     

How Is the Suicide Ideation in the Korean Armed Forces Affected by Mental Illness,Traumatic Events,and Social Support?

BackgroundSuicide is one of the leading causes of death in the military as in the general population. To mitigate such a serious public health problem, identifying the risk or protective factors of suicide behaviors is crucial.MethodsWe analyzed the representative data of the 2014 Korean Armed Forces to explore the relationship between past year adverse events (PAE), accumulated lifetime trauma (ALT), mental illness vulnerability, perceived social support, and suicidal ideation in the previous year.ResultsAmong the 6,377 subjects, 3.7% of males and 6.2% of females reported suicidal ideation in the previous year. Multivariate analytic models identified significant associations of PAE and ALT with suicidal ideation with a dose-response pattern. The mental illness vulnerability showed the most significant association with suicidal ideation even after controlling PAE or ALT. We found that perceived social support may be potentially linked with a reduced risk of suicidal ideation.ConclusionThis Korean military representative data demonstrates mental illness vulnerability; PAE; and lifetime trauma as significant risk factors of suicidal ideation, while perceived social support was found as a potential protective factor. Given the importance of the prevention of suicide in the military, those risk and protective factors may be used to screen soldiers at risk of suicide and provide further support on mental health services as needed.     

利用结构方程模型研究老年糖尿病患者健康相关生命质量与临床表现之间的关系

目的以Wilson-Cleary模型为向导构建结构方程模型（SEM）,了解老年糖尿病患者的健康相关生命质量（HRQOL）与临床表现之间的相互关系。方法自行设计调查问卷,选择来本院诊断治疗的450例老年糖尿病患者作为研究人群,运用SF-36生活质量调查表、老年人多功能评估问卷（OMFAQ）、医疗社会支持量表（MOS-SSS）、兰特心理健康量表（RMHI）和临床结果（与糖尿病有关的特征和生理数据）进行评估,构建机构方程模型。采用拟合优度的指标来评估路径模型的整体,配合卡方检验处理数据。结果心理困扰、收入和充足社会保障等四个因素,可通过一般健康感知对HRQOL产生直接影响（66%变异量）;而症状、身体功能状态和心理状态等三个因素,则通过一般健康感知对HRQOL产生间接的影响（64%的变异量）。另外,症状、年龄、性别和体力活动等四个因素通过身体功能状态间接影响HRQOL（72%的变异量）。结论提高社会和财政支持或提供其他干预措施,可有效地提高老年糖尿病患者身体素质和心理抗压能力,并提高他们的HRQOL。     

The effects of caregiving resources on the incidence of depression over one year in family caregivers of disabled elderly

The purpose of the study was to investigate the over-time effects of physical, psychological and social resources on the incidence of depression in family caregivers of the disabled elderly. Data were collected twice at a one-year interval from 1,141 primary caregivers of a disabled older person in an urban area of Japan using a self-reported questionnaire survey. The questionnaire included physical health as an indicator of physical resources, caregiving satisfaction and intention to care as indicators of psychological resources, and instrumental and emotional support network and formal home care service utilization as indicators of social resources. The mental health outcome measure was the General Health Questionnaire 12-item version (GHQ-12). Complete data on 235 non-depressed female caregivers were separated into 3 groups according to the relationship type (wife, daughter and daughter-in-law) and analyzed separately. Multivariate logistic regression models controlling for duration of caregiving, care-recipient's gender, ADL dependency and behavioral problems demonstrated that significant predictors of depression were caregiving satisfaction and intention to care in wives, caregiving satisfaction in daughters, and physical health and emotional support network in daughters-in-law. Noteworthy, intention to care increased the risk of depression in wives, while decreasing the risk of depression in daughters-in-law. The findings indicate that the effects of caregivers' resources on mental health may differ by relationship type.     

Ageing and mental health in a developing country: who cares? Qualitative studies from Goa, India

BACKGROUND: While there is a growing body of epidemiological evidence on the prevalence of mental illnesses in late-life in developing countries, there is limited data on cultural perceptions of mental illnesses and care arrangement for older people. METHOD: This qualitative study used focus group discussions with older people and key informants to investigate the status of older people and concepts of late-life mental health conditions, particularly dementia and depression, in Goa, India. RESULTS: Vignettes of depression and dementia were widely recognized. However, neither condition was thought to constitute a health condition. Dementia was construed as a normal part of ageing and was not perceived as requiring medical care. Thus, primary health physicians rarely saw this condition in their clinical work, but community health workers frequently recognized individuals with dementia. Depression was a common presentation in primary care, but infrequently diagnosed. Both late-life mental disorders were attributed to abuse, neglect, or lack of love on the part of children towards a parent. There was evidence that the system of family care and support for older persons was less reliable than has been claimed. Care was often conditional upon the child's expectation of inheriting the parent's property. Care for those with dependency needs was almost entirely family-based with little or no formal services. Unsurprisingly, fear for the future, and in particular 'dependency anxiety' was commonplace among older Goans. CONCLUSIONS: There is a need to raise awareness about mental disorders in late-life in the community and among health professionals, and to improve access to appropriate health care for the elderly with mental illness. The study suggests directions for the future development of locally appropriate support services, such as involving the comprehensive network of community health workers.     

Are specialist mental health services being targeted on the most needy patients? The effects of setting up special services in general practice.

BACKGROUND: Around 25% of patients with psychoses lose contact with specialist psychiatric services, despite the government's policy to focus the efforts of community teams on this group. AIM: To identify patient and practice factors associated with continuing contact and loss of contact with specialist services. METHOD: Cross-sectional comparison was made of patients in and out of specialist contact, through detailed interviews with 102 patients among 26 south west London practices. Associations were sought between contact with specialist services and patient factors (illness severity, social functioning, quality of life, needs for care, and satisfaction with general practitioner [GP] services) and practice factors (size, location, fundholding status, training status, and the presence of mental health professionals on site). RESULTS: Thirty-one (30%) patients were currently out of specialist contact. No significant differences were found between those in and out of contact on any measures of diagnosis or psychiatric history. Those in contact had significantly more symptoms, poorer social functioning, poorer quality of life, and more needs for care. The proportion out of contact was significantly higher in two practices that had employed their own mental health professionals to provides services on site for severe mental illnesses. Two factors remained significant predictors of contact in a logistic regression model: whether or not the patient's practice offered a special service on site, and greater patient needs for care. CONCLUSIONS: Secondary mental health services are being targeted towards the more needy patients. The provision of special services in practices can shift care further away from secondary care while still meeting patients' needs.     

Influence of social participation on life satisfaction and depression among Chinese elderly: Social support as a mediator

This study explored the influences of social participation and the mediating effects of social support on the mental health of Chinese elderly based on data from the 2012 China Longitudinal Aging Social Survey (CLASS). The participants comprised 696 older adults in CLASS, including 340 (48.9%) male and 354 (50.9%) female. The mean age of the sample was 68 (standard deviation = 7.08). The results of structural equation modeling showed that social participation was significantly associated with the life satisfaction and depression of the elderly. A high level of social participation was associated with more social support and consequently predicted few depressive symptoms among older adults. However, social support was not significantly associated with life satisfaction of the elderly. Our findings provided cross‐cultural evidence for theories, and had significant implications for social work practice and social policy.     

民族地区农村老年人心理健康状况及其影响因素研究

目的了解民族地区农村老年人心理健康现状,探究民族地区农村老年人心理健康影响因素。方法本研究采用访谈和测量法对150多位民族地区农村老年人心理健康状况及其影响因素进行研究。运用SPSS17.0统计软件对收集的数据进行处理分析。结果①民族地区农村老年人躯体化(t=3.563,P<0.01)、强迫症(t=2.348,P<0.05)、抑郁(t=5.255,P<0.01)、焦虑(t=4.817,P<0.01)、敌对(t=2.630,P<0.05)、恐怖(t=2.321,P<0.05)、偏执(t=2.928,P<0.01)、精神性病(t=2.989,P<0.01)因子得分与城镇老年人存在显著的差异;②民族地区老年人社会支持的获得呈年龄上的阶段性特征;③民族地区老年人的受教育程度与心理健康总分显著相关(r=-0.441,P<0.01)、年龄与精神性病因子显著相关(r=0.306,P<0.05),另外来自家人的支持与心理健康关系密切。结论①民族地区农村老年人心理健康状况较差;②受教育程度、年龄等人口学变量以及社会支持是民族地区农村老年人心理健康的重要影响因素。     

Pediatric head trauma: parent, parent-child, and family functioning 2 weeks after hospital discharge

OBJECTIVE: To investigate effects of pediatric head trauma on parent mental health, parent-child relationship and family functioning 2 weeks after discharge. METHODS: Ninety-seven mothers and 37 fathers of 106 preschool children hospitalized with head injury completed Mental Health Inventory (MHI), Parenting Stress Index, Family Adaptability and Cohesion Evaluation Scales II (FACES II) and Multidimensional Scale of Perceived Social Support (MSPSS) 2 weeks after discharge, and perceived injury severity, Parental Concerns Scale (PCS), Parental Stressors Scale: Pediatric Intensive Care Unit (PSS: PICU), and MHI 24-48 h after hospital admission. RESULTS: Mental health after discharge was related to social support and baseline mental health. Mothers' parental distress was related to perceived injury severity and social support. Greater family cohesion was related to baseline mental health, social support, and being in a two-parent family for mothers, and to social support for fathers. CONCLUSIONS: Parents' mental health and social support were important for parent mental health and family cohesion after discharge. Perceived injury severity and parent reactions to hospitalization also played a role.     

Somatization among older primary care attenders

BACKGROUND: The importance of somatization among older primary care attenders is unclear. We aimed to establish the prevalence, persistence and associations of somatization among older primary care attenders, and the associations of frequent attendance. METHOD: One hundred and forty primary care attenders over 65 years were rated twice, 10 months apart, on measures of somatization, psychiatric status, physical health and attendance. RESULTS: The syndrome of GMS hypochondriacal neurosis had a prevalence of 5% but was transient. Somatized symptoms and attributions were persistent and associated with depression, physical illness and perceived poor social support. Frequent attenders (top third) had higher rates of depression, physical illness and somatic symptoms, and lower perceived support. CONCLUSION: Somatization is common among older primary care attenders and has similar correlates to younger primary care somatizers. Psychological distress among older primary care attenders is associated with frequent attendance. Improved recognition should result in benefits to patients and services.     

湖南丧偶老人的心理健康状况和社会支持

目的:了解湖南丧偶老人的心理健康状况和社会支持现状,探讨二者的相关性。方法:采取定额抽样的方法,用老年人心理健康量表和社会支持量表对湖南307名老年人进行问卷调查及统计分析。结果:丧偶老人的心理健康状况和社会支持现状均低于非丧偶老人(t=7.391,8.089;P0.05),并且存在显著差异;丧偶老人的心理健康状况和社会支持显著相关(r=0.504,P0.05)。结论:丧偶老人的心理健康状况和社会支持呈正相关关系,应通过各种渠道丰富丧偶老人的社会支持来源,提高丧偶老人对社会支持的利用度,以改善丧偶老人的心理健康状况。     

Perceived social support among depressed elderly, middle-aged, and young-adult samples: cross-sectional and longitudinal analyses

BACKGROUND: A number of studies have concluded that the perceived quality of support is more strongly associated with mental health than with the actual structure of personal networks. This study examined clinical, historical, and phenomenological variables associated cross-sectionally and longitudinally with perceived social support. METHODS: Participants included elderly, middle-aged, and young-adult depressed samples derived from the Duke Clinical Research Center for the Study of Depression in Late Life. RESULTS: Cross-sectional multivariate analyses revealed that perceived social support was: (1) for the elderly associated with pessimistic thinking, being divorced, having strange ideas, the degree of social interaction, and instrumental support; (2) for middle-age associated with dysthymia, divorce, pessimistic thoughts, social interaction, and instrumental support; and (3) among young adults with instrumental support only. Longitudinal multivariate analyses indicated that only perceived social support at Time 1 predicted perceived social support 1 year later among elderly and middle-aged subjects, whereas only instrumental support predicted perceived social support 1 year later among the young-adult sample. LIMITATIONS: The small number of subjects among the young-adult sample limit conclusions regarding this group. In addition, only patients provided data. Future studies should consider using multiple informants to enhance the accuracy of reported social support. CONCLUSIONS: Our findings indicate that in addition to whatever else they do for depressed patients, clinicians must endeavor to address relationship or social support difficulties, especially in the elderly.     

初中生的社会支持状况及其与心理健康的关系

目的：探讨初中生在社会支持的来源、性别和年级方面的特点及与其心理健康状况的关系。方法：使用社会支持问卷和心理健康调查问卷，调查548名初中生（从初一到初三年级）。结果：同性朋友在初中生社会支持方面的地位明显高于其他重要社会他人（F=110．2，P〈0．01），是初中生社会支持最主要的来源；初中生社会支持的性别（F=2．88，P〈0．05）、年级差异（F=4．43，P〈0．01）显著，成人（主要是母亲）是初一年级社会支持的首要来源，同性朋友是初二、初三年级社会支持的首要来源；女生感受到的母亲的社会支持高于男生，男生感受到的同性朋友和父亲的社会支持高于女生。同性朋友的肯定与支持、对与教师关系满意度、与父亲的冲突及受到的惩罚、母亲的肯定与支持和对与母亲关系满意度对初中生的心理健康状况有显著的预测作用（P〈0．01）。结论：同性朋友在初中生的社会关系中有重要意义，从初一到初二是初中生社会支持状况发生转折的时期；社会支持与初中生的心理健康状况有密切联系。     

Resilience to suicide ideation: A cross‐cultural test of the buffering hypothesis

Depression and suicide ideation are common in student populations across the world. The present study investigated factors buffering the association between depression and suicide ideation. A total of 2,687 Chinese students and 601 German students took part in the investigation. Social support, satisfaction with life, self‐efficacy, psychosocial stress resistance, and positive mental health were considered as resilience factors moderating the association between depressive symptoms and suicide ideation within both samples. Positive mental health moderated the impact of depressive symptoms on suicide ideation in German and Chinese students. Life satisfaction moderated the impact of depressive symptoms on suicide ideation in German students. Social support moderated the impact of depressive symptoms on suicide ideation in Chinese students. No interaction effects were found for self‐efficacy and psychosocial stress resistance. Positive mental health, satisfaction with life, and perceived social support seem to confer resilience and should be taken into account, when assessing individuals for suicide risk.     

Suicide and attempted suicide among older adults in Western Australia

BACKGROUND: Suicide rates are high in later life. Risk factors include male sex and depressive illness. This study investigated the relationship between suicidal behaviour and contact with mental health services among the elderly in Western Australia. METHODS: Record linkage was used to obtain records of hospital admissions and mental health service contacts for all suicide attempts and deaths in the period 1980-95. Standardized incidence ratios were calculated for the elderly, general population and people with mental health service contacts. Cox regression was used to evaluated potential risk factors for elderly people who were in contact with mental health services. RESULTS: People over 60 years of age accounted for 15% of suicides and 4.6% of attempted suicides. Suicide rates were 3.3 times higher in males and 4.4 times higher in females when compared to the general population of elderly people. For attempted suicide, the rate was 5.8 times higher in males and 6.6 times higher in females with prior contact with mental health services. Highest risk of suicide was found in patients with diagnoses of affective psychoses (RR = 3.7), adjustment reaction (RR = 3.2) or depressive disorder (RR = 2.8). The diagnosis of cancer was associated with decreased risk of suicide (RR = 3.6) and attempted suicide (RR = 1.9). CONCLUSIONS: Suicide rates are high among the elderly in Western Australia. Suicide is significantly associated with the diagnosis of mood disorder. Suicide attempts are less common, and are associated most strongly with mood and personality disorders. The decreased risk of self-harm behaviour among patients with cancer warrants further investigation.