Bidirectional association between mental health and physical activity in older adults: Whitehall II prospective cohort study

ObjectiveTo investigate longitudinal and bidirectional associations between mental health and physical activity from midlife into old age.MethodsAnalysis was based on data from 6909 participants (aged 45 to 69 in 1997/99) from the Whitehall II cohort in the UK. Latent growth curve analysis examined possible bidirectional associations between the SF-36 Mental Component Summary and weekly physical activity measured at three time-points over ten years.ResultsMental health and physical activity were associated at baseline (β = 0.17, 95% CI 0.13, 0.21) and associations persisted into old age. In the latent growth curve model, both mental health and physical activity increased and their rates of change ‘moved together’ over time (β = 0.24, 95% CI 0.11, 0.37). Relatively high baseline levels of either variable were associated with slightly slower increases in the other outcome (β = − 0.02, 95% CI − 0.03, − 0.01; β = − 0.07, 95% CI − 0.11, − 0.13), which are thought to reflect regression to the mean. However, those who started high on either variable remained the most advantaged at end of follow-up.ConclusionsFrom midlife to old age, greater physical activity is associated with better mental health and vice versa. These findings suggest persistent longitudinal and bidirectional associations between physical activity and mental health.     

The role of cognitive ability (intelligence) in explaining the association between socioeconomic position and health: evidence from the Whitehall II prospective cohort study

Associations among cognitive ability, socioeconomic position, and health have been interpreted to imply that cognitive ability could explain social inequalities in health. The authors test this hypothesis by examining three questions: Is cognitive ability related to health? To what extent does it explain social inequalities in health? Do measures of socioeconomic position and cognitive ability have independent associations with health? Relative indices of inequality were used to estimate associations, using data from the Whitehall II study (baseline, 1985-1988), a British prospective cohort study (4,158 men and 1,680 women). Cognitive ability was significantly related to coronary heart disease, physical functioning, and self-rated health in both sexes and additionally to mental functioning in men. It explained some of the relation between socioeconomic position and health: 17% for coronary heart disease, 33% for physical functioning, 12% for mental functioning, and 39% for self-rated health. In analysis simultaneously adjusted for all measures of socioeconomic position, cognitive ability retained an independent association only with physical functioning in women. These results suggest that, although cognitive ability is related to health, it does not explain social inequalities in health.     

Effects of physical activity on cognitive functioning in middle age: evidence from the Whitehall II prospective cohort study

OBJECTIVES: We examined the association between physical activity and cognitive functioning in middle age. METHODS: Data were derived from a prospective occupational cohort study of 10308 civil servants aged 35-55 years at baseline (phase 1; 1985-1988). Physical activity level, categorized as low, medium, or high, was assessed at phases 1, 3 (1991-1994), and 5 (1997-1999). Cognitive functioning was tested at phase 5, when respondents were 46-68 years old. RESULTS: In both prospective (odds ratio [OR] = 1.65; 95% confidence interval [CI]=1.30, 2.10) and cross-sectional (OR=1.79; 95% CI=1.38, 2.32) analyses, low levels of physical activity were a risk factor for poor performance on a measure of fluid intelligence. Analyses aimed at assessing cumulative effects (summary of physical activity levels at the 3 time points) showed a graded linear relationship with fluid intelligence, with persistently low levels of physical activity being particularly harmful (OR=2.21; 95% CI=1.37, 3.57). CONCLUSIONS: Low levels of physical activity are a risk factor for cognitive functioning in middle age, fluid intelligence in particular.     

Smoking and mental health: cross-sectional and cohort studies in an occupational setting in Japan

BACKGROUND: The relationship between smoking and mental health remains unclear. METHODS: We carried out a cross-sectional study and a cohort study on the possible association of smoking and mental health in 782 workers. Using a questionnaire including the 30-item General Health Questionnaire (GHQ-30) and items related to the smoking state, the association between smoking and mental health was evaluated separately in males and females. The subjects were classified into smokers and nonsmokers, and changes in the GHQ score during a 2-year follow-up period were evaluated. To control potential confounding factors, multiple regression analyses were performed. RESULTS: The cross-sectional study showed no difference in the GHQ score between smokers and nonsmokers among males but a significantly higher GHQ score for smokers than nonsmokers among females. This difference among females was confirmed to be significant by multiple regression analysis. The 2-year cohort study showed a decrease in the GHQ score in each group and no reduction in the difference in the GHQ score between smokers and nonsmokers among females. CONCLUSIONS: No difference was observed in mental health between smokers and nonsmokers in males. However, in females, smokers showed poorer mental health than nonsmokers, and this difference remained unchanged even after 2 years.     

Unfairness and health: evidence from the Whitehall II Study

OBJECTIVE: To examine the effects of unfairness on incident coronary events and health functioning. DESIGN: Prospective cohort study. Unfairness, sociodemographics, established coronary risk factors (high serum cholesterol, hypertension, obesity, exercise, smoking and alcohol consumption) and other psychosocial work characteristics (job strain, effort-reward imbalance and organisational justice) were measured at baseline. Associations between unfairness and incident coronary events and health functioning were determined over an average follow-up of 10.9 years. PARTICIPANTS: 5726 men and 2572 women from 20 civil service departments in London (the Whitehall II Study). MAIN OUTCOME MEASURES: Incident fatal coronary heart disease, non-fatal myocardial infarction and angina (528 events) and health functioning. RESULTS: Low employment grade is strongly associated with unfairness. Participants reporting higher levels of unfairness are more likely to experience an incident coronary event (HR 1.55, 95% CI 1.11 to 2.17), after adjustment for age, gender, employment grade, established coronary risk factors and other work-related psychosocial characteristics. Unfairness is also associated with poor physical (OR 1.46, 95% CI 1.20 to 1.77) and mental (OR 1.54, 95% CI 1.19 to 1.99) functioning at follow-up, controlling for all other factors and health functioning at baseline. CONCLUSIONS: Unfairness is an independent predictor of increased coronary events and impaired health functioning. Further research is needed to disentangle the effects of unfairness from other psychosocial constructs and to investigate the societal, relational and biological mechanisms that may underlie its associations with health and heart disease.     

Effect of retirement on cognitive function: the Whitehall II cohort study

According to the ‘use it or lose it’ hypothesis, a lack of mentally challenging activities might exacerbate the loss of cognitive function. On this basis, retirement has been suggested to increase the risk of cognitive decline, but evidence from studies with long follow-up is lacking. We tested this hypothesis in a cohort of 3433 civil servants who participated in the Whitehall II Study, including repeated measurements of cognitive functioning up to 14 years before and 14 years after retirement. Piecewise models, centred at the year of retirement, were used to compare trajectories of verbal memory, abstract reasoning, phonemic verbal fluency, and semantic verbal fluency before and after retirement. We found that all domains of cognition declined over time. Declines in verbal memory were 38% faster after retirement compared to before, after taking account of age-related decline. In analyses stratified by employment grade, higher employment grade was protective against verbal memory decline while people were still working, but this ‘protective effect’ was lost when individuals retired, resulting in a similar rate of decline post-retirement across employment grades. We did not find a significant impact of retirement on the other cognitive domains. In conclusion, these findings are consistent with the hypothesis that retirement accelerates the decline in verbal memory function. This study points to the benefits of cognitively stimulating activities associated with employment that could benefit older people’s memory.     

Initiation and cessation of mental healthcare after mental health screening in primary care: a prospective cohort study

Patient-centeredness and therapeutic relationship are widely explored as a means to address the challenge of chronic disease and multi-morbidity management, however research focusing on the perspective of doctors is still rare. In this study, we aimed to explore the impact of the patient’s chronic disease(s) on their healthcare provider. A qualitative approach was taken using semi-structured interviews with general practitioners working in outpatient clinics either in individual practices or in a hospital setting in Geneva, Switzerland. Codes were developed through an iterative process and using grounded theory an inductive coding scheme was performed to identify the key themes. Throughout the analysis process the research team reviewed the analysis and refined the coding scheme. Twenty interviews, 10 in each practice type, allowed for saturation to be reached. The following themes relevant to the impact of managing chronic diseases emerge around the issue of feeling powerless as a doctor; facing the patient’s socio-economic context; guidelines versus the reality of the patient; time; and taking on the patient’s burden. Primary care practitioners face an emotional burden linked with their powerlessness and work conditions, but also with the empathetic bond with their patients and their circumstances. Doctors seem poorly prepared for this emotional strain. The health system is also not facilitating this with time constraints and guidelines unsuitable for the patient’s reality. Chronic disease and multi-morbidity management is a challenge for healthcare providers. This has its roots in patient characteristics, the overall health system and healthcare providers themselves. Structural changes need to be implemented at different levels: medical education; health systems; adapted guidelines; leading to an overall environment that favors the development of the therapeutic relationship.     

Effort-reward imbalance model and self-reported health: cross-sectional and prospective findings from the GAZEL cohort

Psychosocial factors at work have been found to be significant contributors to health, especially cardiovascular health. This study is aimed at exploring the relationship between psychosocial factors at work as defined by the effort-reward imbalance (ERI) model and self-reported health, using alternative formulations of this model, and comparing cross-sectional and prospective analyses for a large occupational cohort of men and women. The French version of the ERI model was used to measure the three scales of effort, reward, and overcommitment. Self-reported health was used as health outcome. Covariates included chronic diseases, frequent depressive symptoms, and personal, occupational, and behavioural factors. The cross-sectional and prospective analyses concerned, respectively, 10175 and 6286 workers. Men and women were analysed separately. Cross-sectional analysis revealed that ERI was significantly associated with self-reported health whatever the formulation used (ratio over one, quartiles, continuous ratio, or log-transformed ratio) for both genders. When effort and reward were studied as two separate variables, reward was a significant risk factor for both genders, whereas effort was for men only. Overcommitment was also found to be a risk factor for self-reported health for both sex. Prospective analysis showed that ERI was a significant predictor of poor self-reported health for men and women for two formulations (continuous ratio and log-transformed ratio). For both genders, effort did not predict self-reported health, but reward did. Overcommitment was predictive of poor self-reported health for men only. Our results highlighted the predictive effects of the ERI model on self-reported health in a 1-year follow-up study. They urged to explore various formulations of the ERI model. They also underlined the need for longitudinal study design and separate analyses for men and women in the field of psychosocial factors at work.     

Gender differences in the relationship of partner's social class to behavioural risk factors and social support in the Whitehall II study

In most countries health inequality in women appears to be greater when their socio-economic position is measured according to the occupation of male partners or spouses than the women's own occupations. Very few studies show social gradients in men's health according to the occupation of their female partners. This paper aims to explore the reasons for the differences in social inequality in cardiovascular disease between men and women by analysing the associations between own or spouses (or partners) socio-economic position and a set of risk factors for prevalent chronic diseases. Study participants were married or cohabiting London based civil servants included in the Whitehall II study. Socio-economic position of study participants was measured according to civil service grade; socio-economic position of the spouses and partners according to the Registrar General's social class schema. Risk factors were smoking, diet, exercise, alcohol consumption, and measures of social support. In no case was risk factor exposure more affected by the socio-economic position of a female partner than that of a male study participant. Wives' social class membership made no difference at all to the likelihood that male Whitehall participants were smokers, or took little exercise. Female participants' exercise and particularly smoking habit was, in contrast, related to their spouse's social class independently of their own grade of employment. Diet quality was affected equally by the socio-economic position of both male and female partners. Unlike the behavioural risk factors, the degree of social support reported by women participants was in general not strongly negatively affected by their husband or partner being in a less advantaged social class. However, non-employment in the husband or partner was associated with relatively lower levels of positive, and higher negative social support, while men with non-working wives or partners were unaffected. Studying gender differences in health inequality highlights some of the problems in health inequality research more broadly. We are brought face to face with the fact that the development of conceptual models that can be applied consistently to aetiology in both men and women are still at an early stage of development. Closer attention is needed to the different processes behind material power and 'emotional power' within the household when investigating gender differences in health and risk factors.     

Aging, retirement, and changes in physical activity: prospective cohort findings from the GLOBE study

There is increased recognition that determinants of health should be investigated in a life-course perspective. Retirement is a major transition in the life course and offers opportunities for changes in physical activity that may improve health in the aging population. The authors examined the effect of retirement on changes in physical activity in the GLOBE Study, a prospective cohort study known by the Dutch acronym for "Health and Living Conditions of the Population of Eindhoven and surroundings," 1991-2004. They followed respondents (n = 971) by postal questionnaire who were employed and aged 40-65 years in 1991 for 13 years, after which they were still employed (n = 287) or had retired (n = 684). Physical activity included 1) work-related transportation, 2) sports participation, and 3) nonsports leisure-time physical activity. Multinomial logistic regression analyses indicated that retirement was associated with a significantly higher odds for a decline in physical activity from work-related transportation (odds ratio (OR) = 3.03, 95% confidence interval (CI): 1.97, 4.65), adjusted for sex, age, marital status, chronic diseases, and education, compared with remaining employed. Retirement was not associated with an increase in sports participation (OR = 1.12, 95% CI: 0.71, 1.75) or nonsports leisure-time physical activity (OR = 0.80, 95% CI: 0.54, 1.19). In conclusion, retirement introduces a reduction in physical activity from work-related transportation that is not compensated for by an increase in sports participation or an increase in nonsports leisure-time physical activity.     

Future uncertainty and socioeconomic inequalities in health: the Whitehall II study

Over the past 20 years, socioeconomic inequalities in mortality have widened, while job security and financial security have decreased. This paper examines the Whitehall II study, a longitudinal study of white-collar British civil servants. In the Whitehall II cohort socioeconomic gradients in morbidity and cardiovascular risk factors at Phase 5 (1997-99) were generally steeper than at Phase 1 (1985-88). We examine the contribution of job and financial insecurity to these at Phase 5 in 6770 women and men, all of whom were white-collar civil servants at Phase 1. Steep, inverse employment grade gradients were observed for all health measures at Phase 5, except cholesterol and systolic blood pressure in women. Gradients in the sub-population of non-employed participants tended to be steeper than gradients for participants in employment, although, with the exception of self-rated health and General Health Questionnaire (GHQ) score in men, differences were non-significant. Steep gradients in job insecurity were observed among employed participants (p相似文献   

Building health: an epidemiological study of "sick building syndrome" in the Whitehall II study

Objectives

Sick building syndrome (SBS) is described as a group of symptoms attributed to the physical environment of specific buildings. Isolating particular environmental features responsible for the symptoms has proved difficult. This study explores the role and significance of the physical and psychosocial work environment in explaining SBS.

Methods

Cross sectional data on the physical environment of a selection of buildings were added to individual data from the Whitehall II study—an ongoing health survey of office based civil servants. A self‐report questionnaire was used to capture 10 symptoms of the SBS and psychosocial work stress. In total, 4052 participants aged 42–62 years working in 44 buildings were included in this study.

Results

No significant relation was found between most aspects of the physical work environment and symptom prevalence, adjusted for age, sex, and employment grade. Positive (non‐significant) relations were found only with airborne bacteria, inhalable dust, dry bulb temperature, relative humidity, and having some control over the local physical environment. Greater effects were found with features of the psychosocial work environment including high job demands and low support. Only psychosocial work characteristics and control over the physical environment were independently associated with symptoms in the multivariate analysis.

Conclusions

The physical environment of office buildings appears to be less important than features of the psychosocial work environment in explaining differences in the prevalence of symptoms.     

Childhood social hardships and fertility: a prospective cohort study

PurposeTo examine the effect of lifetime social hardships on fertility.MethodsUsing the British National Child Development Study, a longitudinal cohort study, the impact of exposure to childhood hardships on becoming pregnant, reported infertility, and time-to-pregnancy was investigated. In total, 6477 women reported on whether they had become pregnant by 41 years, and 5198 women had data on at least one pregnancy. Factor analysis was used to identify six types of childhood hardships (as reported by parent, child, social worker, or teacher); retrospective report of child abuse was also examined. Logistic regression and discrete failure-time analysis was used to adjust for potential confounders.ResultsNever-married women were more likely to have become pregnant at some point if they had experienced more childhood hardships. Retrospectively, reported child abuse was associated with an increased likelihood of having been told that one was unable to have children. Among ever-married women, childhood hardships were associated with reduced fecundability, but the association was weakened by adjustment for adult social class.ConclusionsThe relationship between childhood adversity and adult fertility is complex. Future research should investigate pathways between characteristics of adversities and fertility.     

Associations between unemployment and major depressive disorder: evidence from an international, prospective study (the predict cohort)

Unemployment is known to be associated with poor mental health, but it is not clear how strongly unemployment leads to onset of diagnosed clinical depression (causation), or if depression raises the risks of becoming unemployed (health selection), or indeed if both pathways operate. We therefore investigate the direction of associations between clinical depression and unemployment in a cross-cultural prospective cohort study. 10,059 consecutive general practice attendees (18–75 years) were recruited from six European countries and Chile between 2003 and 2004 and followed up at six, 12 and (in a subset) 24 months. The analysis sample was restricted to 3969 men and women who were employed or unemployed and seeking employment and had data on depression measures. The outcomes were depressive episodes, assessed using the Depression Section of the Composite International Diagnostic Interview (CIDI) and self-reported employment status. Among 3969 men and women with complete data on depression and unemployment, 10% (n = 393) had depression symptoms and a further 6% (n = 221) had major depression at 12 months. 11% (n = 423) of the sample were unemployed by 6 months. Participants who became unemployed between baseline and 6 months compared to those employed at both times had an adjusted relative risk ratio for 12-month depression of 1.58 (95% Confidence Interval 0.76, 3.27). Participants with depression at baseline and 6 months compared to neither time had an odds ratio for 6-month unemployment of 1.58 (95% Confidence Interval 0.97, 2.58). We found evidence that causation and (to a lesser extent) health selection raise the prevalence of depression in the unemployed. Unemployed adults are at particular risk for onset of major clinical depression and should be offered extra services or screened. Given the trend for adults with depression to perhaps be at greater risk of subsequent unemployment, employees with depressive symptoms should also be supported at work as a precautionary principle.     

Effect of intensity and type of physical activity on mortality: results from the Whitehall II cohort study

Objectives. We examined the association of intensity and type of physical activity with mortality.Methods. We assessed the duration of physical activity by intensity level and type in 7456 men and women from the Whitehall II Study by questionnaire in 1997–1999 (mean ±SD age = 55.9 ±6.0 years) and 5 years later. All-cause mortality was assessed until April 2009.Results. A total of 317 participants died during the mean follow-up of 9.6 years (SD = 2.7). Reporting at least 1 hour per week of moderate activity was associated with a 33% (95% confidence interval [CI] = 14%, 45%) lower risk of mortality compared with less than 1 hour. For all physical activity types examined, except housework, a duration of physical activity greater than 0 (≥ 3.5 hours for walking) was associated with lower mortality in age-adjusted analyses, but only the associations with sports (hazard ratio [HR] = 0.71; 95% CI = 0.56, 0.91) and do-it-yourself activity (HR = 0.68; 95% CI = 0.53, 0.98) remained in fully adjusted analyses.Conclusions. It is important to consider both intensity and type of physical activity when examining associations with mortality.The dose-response association between physical activity and all-cause mortality is well established,^1,2 but few studies have investigated whether the different types of leisure-time physical activity are equally beneficial.^3–5 There are a variety of ways to expend energy, such as sports, walking, and domestic physical activity, and different types of activities require different levels of energy expenditure.⁶ Sports activities have been clearly shown to be associated with a lower risk of mortality.^3,5,7,8 However, less is known about less intensive physical activities, particularly those that are a part of daily living and leisure. Two recent reports showed “global domestic activity” to protect against all-cause mortality,^3,5 and a previous article on Finnish data suggested that specific types of domestic physical activity may have a protective effect.⁴ Our objective in the present study was to examine the associations of mortality with intensity, in terms of mild, moderate, and vigorous activity, and type of physical activity, specifically, walking, sports, housework, gardening, and do-it-yourself activities.     

Adult socioeconomic position,C-reactive protein and interleukin-6 in the Whitehall II prospective study

Background Prior studies on the association of inflammatory markers, such as C-reactive protein (CRP) and interleukin-6 (IL-6), with socioeconomic position (SEP) have been cross-sectional. Thus, the question of whether socioeconomic differences in CRP and IL-6 change over time remains unanswered. We examined the relationship between SEP and changes over 12 years in CRP and IL-6. Methods Data were for 4,750 middle-aged (mean 49.0 years, SD 5.9) civil servants from phases 3 and 7 of the Whitehall II study. Adult SEP was based on last known Civil Service employment grade. Covariates included sociodemographics, behavioural and biological risk factors, presence of diseases/illnesses, prescribed medications, work-related factors, labour market status and early life factors. Results Steep socioeconomic gradients observed at Phase 3 (p < 0.001) persisted in both CRP and IL-6 12 years later after adjustment for other risk factors. Adjustment for behavioural (diet and smoking), biological (mainly body mass index and total : HDL cholesterol ratio) and early life factors resulted in considerable attenuation but the inverse socioeconomic gradients remained statistically significant. Although CRP and IL-6 concentrations increased substantially over the 12-year period at every level of SEP, CRP and IL-6 did not change differentially according to SEP. Conclusion Despite overall increases in CRP and IL6, relative differences by SEP remained unchanged so that socioeconomic gradients in both sexes persisted over the period observed.