Direct and Indirect Associations Between the Built Environment and Leisure and Utilitarian Walking in Older Women

Background

The built environment predicts walking in older adults, but the degree to which associations between the objective built environment and walking for different purposes are mediated by environmental perceptions is unknown.

Purpose

We examined associations between the neighborhood built environment and leisure and utilitarian walking and mediation by the perceived environment among older women.

Methods

Women (N = 2732, M _age = 72.8 ± 6.8 years) from Massachusetts, Pennsylvania, and California completed a neighborhood built environment and walking survey. Objective population and intersection density and density of stores and services variables were created within residential buffers. Perceived built environment variables included measures of land use mix, street connectivity, infrastructure for walking, esthetics, traffic safety, and personal safety. Regression and bootstrapping were used to test associations and indirect effects.

Results

Objective population, stores/services, and intersection density indirectly predicted leisure and utilitarian walking via perceived land use mix (odds ratios (ORs) = 1.01–1.08, 95 % bias corrected and accelerated confidence intervals do not include 1). Objective density of stores/services directly predicted ≥150 min utilitarian walking (OR = 1.11; 95% CI = 1.02, 1.22). Perceived land use mix (ORs = 1.16–1.44) and esthetics (ORs = 1.24–1.61) significantly predicted leisure and utilitarian walking,

Conclusions

Perceived built environment mediated associations between objective built environment variables and walking for leisure and utilitarian purposes. Interventions for older adults should take into account how objective built environment characteristics may influence environmental perceptions and walking.

     

Perceptions of Neighborhood Park Quality: Associations with Physical Activity and Body Mass Index

Background

Parks are important resources for physical activity (PA), yet few studies have examined how perceptions of park characteristics relate to PA and health.

Purpose

This study investigated associations between perceptions of neighborhood park quality and overall moderate-to-vigorous PA (MVPA), park-based PA, and body mass index (BMI).

Methods

Data were collected via questionnaire from 893 households in Kansas City, Missouri.

Results

The newly developed neighborhood park quality scale demonstrated good test–retest and internal reliability. Residents’ perceptions of neighborhood park quality were related to PA and health outcomes. Perceiving parks as a benefit was positively related to overall MVPA and park-based PA and negatively related to BMI. Perceptions of well-used parks were positively related to BMI, while perceived cleanliness was negatively related to park-based PA.

Conclusions

Better measuring and understanding how perceptions of local parks are associated with PA and health can improve appreciation of how parks facilitate active living.

     

Physical Activity in Older Adults: an Ecological Approach

Background

Studies identifying correlates of physical activity (PA) at all levels of the ecological model can provide an empirical basis for designing interventions to increase older adults’ PA.

Purpose

Applying ecological model principles, this study concurrently examined individual, psychosocial, and environmental correlates of older adults’ PA to determine whether built environment factors contribute to PA over and above individual/demographic and psychosocial variables.

Methods

Using a cross-sectional observational design, 726 adults, aged ≥66 years, were recruited from two US regions. Explanatory variables included demographics, self-efficacy, social support, barriers, and environmental variables measured by using geographic information systems (GIS) and self-report. Outcomes included reported walking for errands and leisure/exercise and accelerometer-measured daily moderate to vigorous PA (MVPA). Analyses employed mixed-model regressions with backward elimination.

Results

For daily MVPA, the only significant environmental variable was GIS-based proximity to a park (p < 0.001) after controlling for individual/demographic and psychosocial factors. Walking for errands was positively related to four environmental variables: reported walking/cycling facilities (p < 0.05), GIS-based intersection density (p < 0.01), mixed land use (p < 0.01), and private recreation facilities (p < 0.01). Walking for leisure/exercise was negatively related to GIS-based mixed land use (p < 0.05). Non-Hispanic white race/ethnicity, self-efficacy, and social support positively related to all three PA outcomes (p < 0.05).

Conclusions

Correlates of older adults’ PA were found at all ecological levels, supporting multiple levels of influence and need for multilevel interventions. Environmental correlates varied by PA outcome. Walking for errands exhibited the most environmental associations.

     

The epidemiology of current depression in Macau,China: towards a plan for mental health action

Purpose

Macau is a Special Administrative Region in China that has experienced tremendous development in its gambling industry during its post-colonial years. To inform mental health planning, this study presents the first population estimates and correlates of the current depression in Macau.

Methods

A population-representative sample of 1068 Macau Chinese citizens aged 18 or above responded to a household telephone survey in January, 2015. The Patient Health Questionnaire-9 measured the current depression. Logistic regression models assessed the association between depression and potential correlates.

Results

Overall, 8.0% (95% CI 6.3–9.7) of persons reported the current depression. A higher but non-significant proportion of women reported depression than men (9.3 vs. 6.6%) and older women reported higher prevalence (13.4%) than other demographic groups. Persons who were unemployed (OR = 4.9, 2.3–10.5), separated or divorced (OR = 3.1, 1.1–8.9), and reported poor self-rated health (OR = 5.0, 2.8–9.0), low quality of life (OR = 6.2, 3.1–12.7), lower social standing (OR = 2.4, 1.4–4.0), lower community trust (OR = 1.9, 1.2–3.1), lower perceived fairness (OR = 2.3, 1.4–3.8), lower social cohesion (OR = 3.8, 2.3–6.2), and lower social integration (OR = 3.0, 1.9–5.0) had greater odds of depression than their comparison group.

Conclusions

The current study demonstrated the burden of depression among Macau adults disproportionately affects women during emerging adolescence and old age, and men during middle adulthood. Key strategies to improve mental health services in Macau are discussed.

     

Family socioeconomic position in early life and onset of depressive symptoms and depression: a prospective cohort study

Purpose

To investigate whether low parental socioeconomic position (SEP) at birth is associated only with early-onset depressive symptoms in offspring.

Methods

This prospective cohort study used data on 9193 individuals (4768 females, 4425 males) from the Avon Longitudinal Study of Parents and Children. Depressive symptoms during three age periods (10–12, 12–16, 16–20 years) were assessed using the Short Mood and Feelings Questionnaire, and ICD-10 depression at age 18 was assessed using the Clinical Interview Schedule-Revised.

Results

Low SEP was associated with increased incidence rates of depressive symptoms in all age periods, with indicators of low standard of living showing the strongest associations. For instance, incidence rate ratios for material hardship were 1.75 (95% CI [1.42–2.15]) at 10–12 years, 1.36 (1.16–1.61) at 12–16 years and 1.39 (1.21–1.59) at 16–20 years. Low SEP was also associated with increased odds of ICD-10 depression at 18 years, ranging from OR = 1.20 (95% CI [0.94–1.52]) for manual social class to 1.74 (1.35–2.24) for material hardship.

Conclusions

There was no evidence that depressive symptoms can be “subtyped” by the age of onset, because the association with low SEP was evident for early- and later-onset symptoms. If socioeconomic inequalities in early life have long-term adverse impacts on mental health, policies addressing these inequalities could benefit the mental health of the population.

     

Religious Service Attendance and Lower Depression Among Women—a Prospective Cohort Study

Objective

Previous studies on the association between religious service attendance and depression have been mostly cross-sectional, subject to reverse causation, and did not account for the potential feedback between religious service attendance and depression. We prospectively evaluated evidence whether religious service attendance decreased risk of subsequent risk of depression and whether depression increased subsequent cessation of service attendance, while explicitly accounting for feedback with potential effects in both directions.

Method

We included a total of 48,984 US nurses who were participants of the Nurses’ Health Study with mean age 58 years and who were followed up from 1996 to 2008. Religious service attendance was self-reported in 1992, 1996, 2000, and 2004. Depression was defined as self-reported physician-diagnosed clinical depression, regular anti-depressant use, or severe depressive symptoms. Multivariate logistic regression and marginal structural models were used to estimate the odds ratio of developing incident depression, adjusted for baseline religious service attendance, baseline depression, and time-varying covariates.

Results

Compared with women who never attended services, women who had most frequent and recent religious service attendance had the lowest risk of developing depression (odds ratio [OR] = 0.71, 95 % confidence interval [CI] 0.62–0.82). Compared with women who were not depressed, women with depression were less likely to subsequently attend religious services once or more per week (OR = 0.74, 95 % CI 0.68–0.80).

Conclusions

In this study of US women, there is evidence that higher frequency of religious service attendance decreased the risk of incident depression and women with depression were less likely to subsequently attend services.

     

Prospective associations between recalled parental bonding and perinatal depression: a cohort study in urban and rural Turkey

Purpose

Recalled experiences of parental bonding may be important in the aetiology of perinatal depression. We hypothesized that lower recalled parental bonding would be associated with perinatal depression.

Method

In a cohort study of perinatal depression in Turkey, 677 women were recruited in their third trimester. Parental Bonding Inventory (PBI) scores at baseline were investigated as predictors of depression on the Edinburgh Postnatal Depression Scale (EPDS) at 4, 14 and 21 months after childbirth in mothers without depression at baseline.

Results

Poor parental bonding scores, apart from paternal control and overprotection, were independently associated with antenatal depression. Incident postnatal depression at 4 months was predicted by parental overprotection, at 14 months by parental care and overprotection, and at 21 months by paternal control and overprotection.

Conclusions

Less satisfactory parenting recalled in the antenatal period was an independent predictor of postnatal depression; however, the different bonding subscales varied as predictors according to the timing of the depression assessment after childbirth.

     

Association between obesity and depressive symptoms in Mexican population

Purpose

Obesity and depression are among the leading causes of disability in Mexico, but their association has not been explored yet. The aim of the current study was to investigate the association between obesity and depression in Mexican population.

Methods

We used data from the health and nutrition survey (ENSANUT 2012), which is representative of the Mexican population. Obesity was determined using the body mass index (BMI) and abdominal obesity by measuring waist circumference. Depressive symptoms were reported using the Center for Epidemiological Studies Depression Scale Short-Form (CES-D-SF, scale 0–21). Regression analyses were performed between obesity and depression, adjusting for gender, age, living with a partner, education, and diabetes history.

Results

Obese women had 1.28 (95% CI 1.07–1.53) times the odds of having depression in comparison with normal-weight women, whereas no association was found for men (OR 0.94; 95% CI 0.74–1.19). A significant association between BMI and depressive symptoms score (β?=?0.05, 95% CI 0.02–0.07) was present in women, but no association was found for men (β?=???0.02, 95% CI ??0.05 to 0.00). There was a statistically significant association between waist circumference and depression scores again for women (β?=?0.03, 95% CI 0.01–0.04) but not for men (β?=?0.00, 95% CI ??0.01 to 0.01). No associations were found between abdominal obesity and depression for both genders. No association was found between different obesity severity levels and depression for both genders.

Conclusion

Obesity was associated with depression in Mexican women, whereas no association was found between obesity and depression in men.

     

The longitudinal association between external locus of control,social cognition and adolescent psychopathology

Purpose

To investigate the longitudinal associations between social cognitive ability an external locus of control (externality) and adolescent psychopathology.

Methods

7058 participants from a prospective population-based cohort provided data on externality, social communication, and emotion perception between 7 and 16 years and psychotic experiences and depressive symptoms at 12 and 18 years. Bivariate probit modelling was used to investigate associations between these risk factors and psychopathological outcomes.

Results

Externality was associated with psychopathology at 12 (psychotic experiences OR 1.23 95% CI 1.14, 1.33; depression OR 1.12 95% CI 1.02, 1.22) and 18 years (psychotic experiences OR 1.38 95% CI 1.23, 1.55; depression OR 1.40 95% CI 1.28, 1.52). Poor social communication was associated with depression at both ages (12 years OR 1.22 95% CI 1.11, 1.34; 18 years OR 1.21 95% CI 1.10, 1.33) and marginally associated with psychotic experiences. There was marginal evidence of a larger association between externality and psychotic experiences at 12 years (p?=?0.06) and between social communication and depression at 12 years (p?=?0.03).

Conclusions

Externality was more strongly associated with psychotic experiences. At 18 years change in externality, between 8 and 16 years were associated with a larger increase in the risk of depression. Poor social communication was more strongly associated with depression.

     

Utilization of psychiatric care and antidepressants among people with different severity of depression: a population-based cohort study in Stockholm,Sweden

Purpose

To identify how severity of depression predicts future utilization of psychiatric care and antidepressants.

Methods

Data derived from a longitudinal population-based study in Stockholm, Sweden, include 10443 participants aged 20–64 years. Depression was assessed by Major Depression Inventory and divided into subsyndromal, mild, moderate and severe depression. Outcomes were the first time of hospitalization, specialized outpatient care and prescribed drugs obtained from national register records. The association between severity of depression and outcomes was tested by Cox regression analysis, after adjusting for gender, psychiatric treatment history and socio-environmental factors.

Results

The cumulative incidences of hospitalizations, outpatient care and antidepressants were 4.0, 11.2, and 21.9% respectively. Compared to the non-depressed group, people with different severity of depression (subsyndromal, mild, moderate and severe depression) all had significantly higher risk of all three psychiatric services (all log-rank test P?<?0.001). Use of psychiatric care and antidepressants increased by rising severity of depression. Although the associations between severity of depression and psychiatric services were significant, the dose relationship was not present in people with previous psychiatric history or after adjusting for gender and other factors.

Conclusions

People with subsyndromal to severe depression all have increased future psychiatric service utilization compared to non-depressed people.

     

Self-Expansion is Associated with Better Adherence and Obesity Treatment Outcomes in Adults

Background

Previous studies have shown that self-expansion (e.g., increasing positive self-content via engaging in novel, rewarding activities) is associated with smoking cessation and attenuated cigarette-cue reactivity.

Purpose

This study examined whether self-expansion is associated with better adherence, weight loss, and physical activity (PA) outcomes within a weight loss intervention.

Methods

Participants from Shape Up Rhode Island 2012, a Web-based community wellness initiative, took part in a randomized controlled trial that involved a 12-week behavioral weight loss intervention [1]. At baseline and post-intervention, objective weights and self-reported self-expansion and PA were obtained from 239 participants. Treatment adherence was assessed objectively.

Results

Self-expansion during treatment was significantly associated with percent weight loss including clinically significant weight loss (i.e., 5 %), minutes of PA, and treatment adherence. These results held after controlling for relevant covariates.

Conclusions

This is the first study to show that self-expansion is associated with better behavioral weight loss outcomes including weight loss, adherence, and PA. These results suggest that self-expansion is a promising novel target for future research which could inform health interventions.

     

Teachers’ support and depression among Japanese adolescents: a multilevel analysis

Purpose

Depression is a major cause of suicide among adolescents. Therefore, childhood and adolescent depression is an important public health concern. This study explored factors as class and individual levels that may influence depression among adolescents in Japan.

Methods

A questionnaire survey among junior high school students (N = 2968) from two cities in Japan was conducted. Depression was assessed using the Depression Self-Rating Scale for Children; teachers’ support was assessed using the Scale of Expectancy for Social Support. The class average score of teachers’ support was calculated to indicate what we termed the “homeroom teachers' support.” Multilevel analysis was applied to clarify the relation between homeroom teachers' support and depression.

Results

Finally, 2466 students completed the questionnaire without missing variables (valid response rate, 83.1%). There was no random effect of the teachers' support at the class level on depression, although there was a significant association between teachers' support and depression for 9th graders (β = ?0.12, p = 0.009). Moreover, there were significant associations between economic status, having a best friend, and experiencing unforgettable stress at the individual level and depression in all grades.

Conclusions

There was no significant random effect of homeroom teachers' support in class level although there might be marginal negative association between teacher's support and depression. It is suggested that homeroom teachers need to promote population approaches to mental health.

     

The pervasive effect of youth self-report of hunger on depression over 6 years of follow up

Purpose

We used longitudinal data to clarify the association between self-report of hunger and subsequent depression risk among youth and young adults, accounting for other risk factors.

Methods

Youth self-report of ever experiencing hunger data were collected from cycles 4–6 of the National Longitudinal Survey of Children and Youth cohort of Canadian youth 16 years and older (n?=?4139). Data on depressive symptoms (CES-D 12) were collected over three cycles (2004–2009, cycles 6–8). We used multivariable regression based on generalized estimating equations (GEE) to examine prior youth hunger on later depression risk, adjusting for time-stable, time-varying, and lagged variables (e.g., depressive symptoms in previous cycle), thereby clarifying the temporal relationship.

Results

The prevalence of youth hunger experience and depression risk reached 5.9 and 15.0%, respectively. The adjusted odds ratio of depression for participants reporting hunger was 2.31 (95% CI 1.54, 3.46) and changed little [2.17 (95% CI 1.29, 3.67)] after accounting for previous CES-D 12 scores, suggesting a temporal relationship in which hunger contributes to depression risk. Unlike never-hungry youth, depression in ever-hungry youth remained comparatively elevated over time.

Conclusions

Our models support an independent and temporal relationship between youth self-report of hunger and depression in adolescence and young adulthood.

     

Gender Differences in Self-Report Physical Activity and Park and Recreation Facility Use Among Latinos in Wake County,North Carolina

Background

Lack of physical activity (PA) may be a cause of Latinos’ health problems. Latinas may be especially at risk, and public parks and recreation services may be a logical place to address PA deficiencies.

Purpose

The objectives of our study were to investigate Latino gender differences related to (1) self-reported work/household and leisure-time PA, (2) perceptions about PA and parks/recreation services, (3) parks/recreation services behaviors, (4) and preferences for activities/programming.

Methods

This is a cross-sectional survey completed by 457 Latinos.

Results

Significant gender differences were found for work/household PA but not for leisure-time PA. Use of parks and recreation services were similar between genders, but Latinos stayed significantly longer per visit. Latinos and Latinas significantly differed on park activities and preferences for recreational services.

Conclusions

Even though parks/recreation services are viewed as viable options for Latinos’ PA, the study identified gender differences that inform health promotion interventions to be more effective in targeting Latinos.

     

Early vulnerabilities for psychiatric disorders in elementary schoolchildren from four Brazilian regions

Purpose

The purpose of the study is to identify early vulnerabilities for psychiatric disorders among Brazilian elementary school children, controlling for familial and community adversities.

Methods

This is a cross-sectional study examining the association between child psychiatric disorders and potential early vulnerabilities (disability, low intellectual quotient, and negative dimensions of the temperament trait self-directedness (low resourcefulness, low purposefulness, low enlightened second nature), controlling for the potential confounders: familial and community adversities. Sample: Four probabilistic samples of second-to-sixth grade students from public schools in four towns from different Brazilian regions (N = 1620). The following instruments were applied: the K-SADS-PL (to assess child/adolescent psychiatric disorders); the Ten-Question Screen (to measure child disability); three structured questions used as proxy of self-directedness; and the reduced version of the WISC-III to measure IQ. To evaluate familial/community adversities: Self-Report Questionnaire—SRQ-20 (to assess maternal/primary caretaker anxiety/depression); questions derived from structured questionnaires (to measure child abuse, marital physical violence, neighborhood violence); Brazilian Association of Research Companies questionnaire (to evaluate poverty/socioeconomic status). Trained psychologists interviewed mothers/primary caretakers and evaluated children/adolescents individually.

Results

A final logistic regression model showed that children/adolescents with low resourcefulness, low purposefulness, low enlightened second nature, lower IQ and disability were more likely to present any child psychiatric disorders.

Conclusion

Early vulnerabilities such as low IQ, presence of disability, and dimensions of temperament were associated with psychiatric disorders among Brazilian elementary school children, after controlling for familial and ecological confounders. These early vulnerabilities should be considered in mental health prevention/intervention programs in low-middle-income countries like Brazil.

     

Pilot study of enhanced social support with automated telephone monitoring after psychiatric hospitalization for depression

Background

Following discharge, patients hospitalized for depression are at high risk for poor retention in outpatient care and adverse outcomes.

Aims

Pilot tests a post-hospital monitoring and enhanced support program for depression.

Method

48 patients at a Veterans Affairs Medical Center discharged following a depression-related inpatient stay received weekly visits or phone calls for 6 months from their choice of either a family member/friend (n = 19) or a certified peer support specialist (n = 29). Participants also completed weekly automated telephone monitoring calls assessing depressive symptoms and antidepressant medication adherence.

Results

Over 90% of participants were more satisfied with their care due to the service. The mean change from baseline to 6 months in depression symptoms was ?7.9 (p < 0.05) according to the Patient Health Questionnaire and ?11.2 (p < 0.05) according to the Beck Depression Inventory-II for those supported by a family member/friend, whereas those supported by a peer specialist had mean changes of ?3.5 (p < 0.05) and ?1.7 (p > 0.10), respectively.

Conclusions

Increased contact with a chosen support person coupled with automated telephone monitoring after psychiatric hospitalization is an acceptable service for patients with depression. Those who received the service, and particularly those supported by a family member/friend, experienced reductions in symptoms of depression.

     

Maintaining Healthy Behavior: a Prospective Study of Psychological Well-Being and Physical Activity

Background

Although higher psychological well-being has been linked with a range of positive biological processes and health outcomes, the prospective association between psychological well-being and physical activity among older adults has been understudied.

Purpose

We tested whether higher baseline psychological well-being predicted higher levels of physical activity over time.

Methods

Prospective data were from the English Longitudinal Study of Aging, a nationally representative sample of English adults over the age of 50. Our sample included 9986 adults who were assessed up to six times across an average of 11 years.

Results

After adjusting for sociodemographic factors, each standard deviation increase in baseline psychological well-being was associated with higher median physical activity in linear regression models that examined physical activity across all six waves (β = 0.20; 95% confidence interval [CI] 0.18–0.21) and in linear mixed effect models that examined repeated measures of physical activity over the entire follow-up period (β = 0.20; 95% CI 0.19–0.21). Further, higher baseline psychological well-being was associated with a slower rate of decline in physical activity among people who were active at baseline (hazard ratio [HR] = 0.79, 95% CI 0.76–0.82) and increasing physical activity among people who were inactive at baseline (HR = 1.28, 95% CI 1.22–1.35). Findings were maintained after adjusting for baseline health status and depression.

Conclusions

Psychological well-being was independently associated with attaining and maintaining higher physical activity levels over 11 years, suggesting that it may be a valuable target for interventions aimed at helping older adults acquire more physical activity.

     

Socioeconomic deprivation and the clinical management of self-harm: a small area analysis

Purpose

Socioeconomic deprivation is associated with increased rates of self-harm but its association with levels of clinical care has not previously been explored. The aim of the current study was to investigate socioeconomic differences in the clinical management of people who self-harm.

Methods

Cross-sectional analysis of 3607 people presenting to a large inner-city hospital following self-harm.

Results

People living in the least deprived quintile were more likely to receive a psychosocial assessment (most vs. least deprived: 63.51 vs. 70.14%). This effect persisted in our fully adjusted model (OR 1.45, CI 1.15–1.82, p = 0.002). Mediation analysis suggested this association was in large part explained by higher rates of self-discharge in people presenting from areas of higher deprivation.

Conclusions

Compared to those from more deprived areas, people from less deprived areas are more likely to receive a psychosocial assessment when presenting to hospital following self-harm. The occurrence of higher rates of self-discharge from emergency departments among those from more deprived areas may explain the association.

     

Education as a social pathway from parental socioeconomic position to depression in late adolescence and early adulthood: a Finnish population-based register study

Purpose

There is inconsistent evidence for social differentials in the risk of depression in youth, and little is known about how education at this age influences the risk. We assess how parental socioeconomic position (SEP) and education predict depression from late adolescence to early adulthood, a time of major educational transitions.

Methods

We followed a nationally representative 20 % sample of Finnish adolescents born in 1986–1990 (n = 60,829) over two educational transitory stages at the age of 17–19 and 20–23 covering the years 2003–2011. We identified incident depression using health care register data. We estimated the risk of depression by parental SEP and personal education using Cox regression, adjusting for family structure, parental depression and the individual’s own psychiatric history.

Results

Lower parental income was associated with up to a twofold risk of depression. This effect was almost fully attributable to other parental characteristics or mediated by the individual’s own education. Educational differences in risk were attenuated following adjustment for prior psychiatric history. Adjusted for all covariates, not being in education increased the risk up to 2.5-fold compared to being enrolled in general upper secondary school at the age of 17–19 and in tertiary education at the age of 20–23. Vocationally oriented women experienced a 20 % higher risk than their academically oriented counterparts in both age groups.

Conclusions

Education constitutes a social pathway from parental SEP to the risk of depression in youth, whereby educational differences previously shown in adults are observed already before the establishment of adulthood SEP.