受助人员社会支持、应付方式与心理健康状况的相关研究

目的探讨受助人员社会支持、应付方式与心理健康状况的相关性。方法随机抽取180名受助人员和172名健康人员,运用社会支持评定量表、应付方式问卷和SCL-90症状自评量表进行问卷调查,并作对照研究。结果受助人员在社会支持总分、客观支持、主观支持和对支持的利用度得分以及解决问题和求助的应付方式得分都明显低于对照组(P<0.01),在自责的应付方式得分和SCL-90总分以及各因子得分明显高于对照组(P<0.01),而在幻想、退避和合理化应付方式得分和对照组差异无显著性(P>0.05)。客观支持、自责、解决问题、合理化4个指标对SCL-90总分有显著性影响(P<0.01)。结论社会支持及应付方式的选择情况与受助人员的心理健康水平有显著性相关。     

广泛性焦虑症患者应对方式、社会支持与心理健康的关系

目的 探讨广泛性焦虑症患者应对方式、社会支持与心理健康的关系.方法 采用一般情况问卷、简易应对方式问卷(SCSQ)、社会支持评定量表(SSRS)、症状自评量表(SCL-90),对221例广泛性焦虑症患者进行问卷调查.结果 (1)广泛性焦虑症患者SCL-90得分与积极应对、主观支持、客观支持、支持利用度得分呈负相关(P＜0.05),与消极应对正相关(P＜0.01).(2)结构方程模型分析结果显示:积极应对对社会支持有直接(正向)效应(β=0.47,P＜0.01),对SCL-90得分有直接(负向)效应(β=-0.28,P＜0.01);消极应对对社会支持有直接(负向)效应(β=-0.23,P＜0.01),对SCL-90得分有直接(正向)效应(β=0.22,P＜0.01);社会支持对SCL-90得分有直接(负向)效应(β=-0.33,P＜0.01);积极应对和消极应对还可以通过社会支持间接影响心理健康.结论 应对方式对广泛性焦虑患者的心理健康有直接效应和间接效应;社会支持作为中介变量调节应对方式与心理健康的关系.运用积极应对、减少消极应对既可直接改善患者的心理健康水平,又可通过提高患者的社会支持来改善患者心理健康状况.     

The impact of childhood parental quality on mental health outcomes in older adults

Objective: Parental bonding is cited as a determinant of mental health outcomes in childhood, adolescence and early-mid adulthood. Examination of the long-term impact for older adults is limited. We therefore examine the long-term risk of perceived poor parental bonding on mental health across the lifespan and into early-old age.

Methods: Participants (N = 1255) were aged 60–64 years of age and drawn from the Australian Life Histories and Health study. Quality of parental bonding was assessed with the Parental Bonding Instrument (PBI). Self-reported history of doctors’ mental health diagnoses and current treatment for each participant was recorded. Current depression was assessed with the Centre for Epidemiologic Studies Depression-8 (CESD-8). Due to known gender differences in mental health rates across the lifespan, analyses were stratified by sex.

Results: A bi-factor analysis of the PBI in a structural equation framework indicated perceived Poor Parental Quality as a risk for both ever and current depression for both sexes. For males, Over-Protective Fathers were a risk for ever and current depression, whilst overall Poor Parental Quality was a risk for reporting current depression treatment. Whilst a number of the risks associated with current depression and treatment were attenuated when controlling for current mood, parental quality remained a significant risk for having reported a lifetime diagnosis for depression and anxiety for men.

Conclusion: Our results extend the existing literature base and demonstrate that mental health risk attributed to poor perceived parental quality continues across the life-course and into early-old age.     

A cross-sectional study on the health related quality of life of depressed Chinese older people in Shanghai

BACKGROUND: With an increasing life expectancy, there is a rapidly growing sector that is aging. Depression is the most prevalent functional mental disorder of older population. It is estimated that about 21% of the older population in Shanghai are suffering from depression. AIM: This study investigated the self-rated health related quality of life of community-dwelling older people diagnosed with depression in Shanghai, and to examine the relationships between this and mental and physical health, functional status and social support. METHODS: A cross-sectional survey was conducted in two community centres with a convenience sample of 71 participants. Measures included subjective perception of health related quality of life, level of depression, cognitive function, number of medical conditions, activities of daily living, functional abilities, and social support. The majority of the participants were female (n=52, 73.23%), and married (n=51, 71.8%). RESULTS: A higher level of depression was related to a poorer health related quality of life. Participants were least satisfied with their physical health. The level of depression, activities of daily living and satisfaction with social support were predictors of health related quality of life ratings. CONCLUSION: The study identified how depression affects the bio-psychosocial status of Chinese older people. Findings are discussed in light of the socio-cultural environment in Shanghai.     

Birth factors and common mental health problems in young adults

Background Birth-related factors have been associated with adult chronic disease. Whilst the potential association between these factors and depression in adulthood was been described rather less is known about the role of these exposures in the development of anxiety. Method Cross-sectional population-based survey recruited adults aged 18–25 years. Participants were classified on the basis of responses to the Hospital Anxiety and Depression Scale. Birth-related exposures were determined by hospital medical record review. A proportional odds model was used to assess associations between birth factors and anxiety and depression. Results No significant associations were found between birth factors and anxiety. Significant associations were found between depression with low birth weight (odds ratio 2.88, 95% confidence interval 1.26–6.59) and neonatal admission to ITU (3.12, 1.25, 7.78). Conclusion Low birth weight and neonatal intensive care unit admission are significantly associated with depression in adults. Other birth related variables were not significantly associated with either depression or anxiety.     

The role of coping humor in the physical and mental health of older adults

Objectives: This study examined the associations among coping humor, other personal/social factors and the health status of community-dwelling older adults.

Method: Survey questionnaires were completed with 73 community-dwelling older adults. Included were measures of coping humor, spirituality, self-efficacy, social support and physical and mental health status.

Results: Correlations across all variables showed coping humor to be significantly associated with social support, self-efficacy, depression and anxiety. Forward stepwise regression analyses showed that coping humor and self-efficacy contributed to outcome variance in measures of mental health status. Contrary to expectation, neither social support nor spirituality contributed to the total outcome variance on any of the dependant measures.

Conclusion: The importance of social support, self-efficacy and spirituality in determining the quality of life of older adults is well supported in the literature. Coping humor as a mechanism for managing the inevitable health stresses of aging has received less attention. This study shows that coping humor and self efficacy are important factors for explaining health status in older adults. Correlations among coping humor, self efficacy and social support suggest that a sense of humor may play an important role in reinforcing self-efficacious approaches to the management of health issues.     

Social support and mental health status of older people: a population-based study in Iran-Tehran

Objectives: To investigate direct and stress-buffering associations between social support from family and the mental health of older people in Iran, a country which has recently undergone an exceptionally fast fertility transition and is consequently experiencing rapid population ageing.

Method: A cross-sectional stratified random survey of 800 people aged 60+ years resident in Tehran was conducted. In total, 644 people responded. The Social Provisions Scale and the General Health Questionnaire were used to measure perceived social support and mental health, respectively. Multilevel mixed-effects models were used to examine the hypotheses.

Results: The findings supported the hypothesis of a direct association between perceived and received social support and mental health. However, we did not find strong evidence to suggest that social support buffered the effects of stress arising from limitations of physical functioning. Lack of help doing paperwork was associated with worse mental health for women but not men. Source of support did not seem to be important.

Conclusion: Our results indicated that in Tehran, as in Western settings, social support is important for the mental well-being of older people. Recommendations for policy and further research priorities based on the study findings were provided.     

Availability of mental health services for older adults: a cross-cultural comparison of the United States and Turkey

Researchers conducted a cross-cultural study using qualitative methods (based on a phenomenological approach) to explore the availability of mental health services (MHS) for older adults in the United States and Turkey. Using purposive sampling, semi-structured in-depth interviews were conducted with administrators (n=24) from a wide-range of sites (nursing homes, hospice, senior centers) in a rural area of North Central Florida, United States and Ankara, Turkey. Interview questions focused on types of staff employed; integration of MHS with other services provided; community promotion of services; coordination, cooperation and communication with other service providers; and administrators' perceptions of barriers in the provision of MHS for older adults. Interestingly, employing on-site mental health staff was a much more popular practice in Turkey compared to the United States with three times as many Turkish sites having on-site mental health professionals. As anticipated, administrators in both countries cited inadequate funding as the most common barrier to MHS provision. Potential solutions to MHS barriers in both countries are discussed.     

Patterns of tobacco use and tobacco-related psychiatric morbidity and substance use among middle-aged and older adults in the United States

Objectives: To examine prevalence of tobacco use and identify psychiatric symptoms and substance use correlates of tobacco use comparing adults 50–64 years of age with those 65+ years of age (N?=?10,891).

Methods: Data were from the 2008–2009 US National Surveys on Drug Use and Health.

Results: Past-year tobacco use was one-half as frequent among adults aged 65+ years (14.1%) compared to adults aged 50–64 years (30.2%); the latter group surpassed the former in rates of cigarette smoking (24.8% vs. 10.6%), daily cigarette smoking (16.5% vs. 7.1%), cigar smoking (7.4% vs. 2.3%), and smokeless tobacco use (2.5% vs. 1.7%). Increased odds of cigarette smoking were noted among men, whites, African Americans, and those who had less education, had lower income, were not currently married, or were binge drinkers or illicit/non-medical drug users. In controlled analyses, odds ratio in those 65+ years of age who had smoked during the past year was 2.2 for binge drinking and 3.5 for illicit or non-medical drug use. Odds ratio of binge drinking among those 65+ years of age for cigar smokers during the past year was 3.1. Past-year cigarette smoking was not associated with reports of symptoms of depression or anxiety in the 65+ age group.

Conclusions: Tobacco use is less prevalent among adults 65+ years of age yet continues to be strongly associated with binge drinking and illicit or non-medical drug use. Preventive efforts to decrease these substance use problems should include programs to decrease tobacco use.     

The association of mental conditions with blood glucose levels in older adults with diabetes

Objectives: People with diabetes must engage in several self-care activities to manage blood glucose; cognitive function and other affective disorders may affect self-care behaviors. We examined the executive function domain of cognition, depressive symptoms, and symptoms of generalized anxiety disorder (GAD) to determine which common mental conditions can co-occur with diabetes are associated with blood glucose levels.

Methods: We conducted a cross-sectional in-person survey of 563 rural older adults (age 60 years or older) with diabetes that included African Americans, American Indians, and Whites from eight counties in south-central North Carolina. Hemoglobin A1C (A1C) was measured from a finger-stick blood sample to assess blood glucose control. Executive function, depressive symptoms, and symptoms of GAD were assessed using established measures and scoring procedures. Separate multivariate linear regression models were used to examine the association of executive function, depressive symptoms, and symptoms of GAD with A1C.

Results: Adjusting for potential confounders including age, gender, education, ethnicity, marital status, history of stroke, heart disease, hypertension, diabetes knowledge, and duration of diabetes, executive function was significantly associated with A1C levels: every one-unit increase in executive function was associated with a 0.23 lower A1C value (p?=?0.02). Symptoms of depression and GAD were not associated with A1C levels.

Conclusions: Low executive function is potentially a barrier to self-care, the cornerstone of managing blood glucose levels. Training aids that compensate for cognitive impairments may be essential for achieving effective glucose control.     

Fear of falling and emotional regulation in older adults

Abstract

Objectives: Fear of falling is common amongst older adults with and without a prior experience of falling. It is related to decreased quality of life, isolation, and institutionalisation. It also poses a risk for future falls when activity is avoided because of fear of falling and muscle deconditioning occurs. Relatively little is known about the psychological factors underpinning fear of falling. This study explored the relationship between emotion regulation and fear of falling in community dwelling older adults.

Method: A sample of 117 older adults (>65 years) were recruited from community based exercise classes, falls reduction classes, NHS and charity organisations. Self-reported measures included the Falls Efficacy Scale-International (FES-I), the Fear of Falling Behaviour Questionnaire (FFABQ), the Difficulties in Emotion Regulation Scale (DERS) and the Hospital and Anxiety Depression Scale (HADS).

Results: A significant positive correlation was found between emotion regulation and fear of falling, as well as between emotional regulation and fear-related avoidance behaviour. A regression model found that after controlling for depression and age, emotion regulation was no longer significantly related to fear of falling.

Conclusions: Fear of falling is associated with emotion regulation difficulties in community dwelling older adults. However, this link no longer exists once depression is controlled for. The key clinical implication is the importance of the assessment of depression in older adults with a fear of falling. Future research should use a longitudinal design to further unpick the causal relationships between these variables.     

Sense of coherence mediates the relationship between the religious meaning system and coping styles in Polish older adults

Objectives: The links between religiousness and coping are complex, and previous research indicates that they may be mediated by coherence-related structures. The aim of this study was to examine whether sense of coherence (SOC) is a mediator in the relationships between the religious meaning system and coping styles in Polish older adults.

Method: In this study, 212 older adults (118 women and 94 men) participated. Their ages ranged from 65 to 79 years (M = 71.04; SD = 2.26). The group was a representative sample of Polish older adults in terms of social status, gender, and age. They completed three measures: the Religious Meaning System Questionnaire, the Sense of Coherence Scale (SOC-29), and the Coping Inventory for Stressful Situations.

Results: Findings showed that the religious meaning system had significant relationships with SOC and three coping styles: emotion-oriented coping, avoidance-oriented coping, and social diversion. In addition, SOC mediated the relations between the religious meaning system and three coping styles: the emotion-oriented, avoidance-oriented, and social diversion.

Conclusions: The positive associations between meaning-oriented religiousness, SOC, and coping styles imply that their underlying mechanisms are based on the structures of significance and comprehension. The character of mediational relations (i.e. mediator vs. suppressor) depended on the emotional and social coping strategies used by older adults.     

Worries,psychosocial resources,and depressive symptoms among the South Korean oldest old

Objectives: Few Korean studies have explored factors that influence depressive symptoms, a condition that is likely to increase with age. This study examines how worries, psychosocial resources, specifically family support, are related to depressive symptoms among a sample of the oldest old in South Korea. The buffering effects of psychosocial resources previously identified as reducing the impact of worries on depression in the younger old age group were also examined.

Method: Interviews were conducted with 213 community-dwelling oldest old in Seoul, Korea in 2007. 193 of these had children and were included in the analysis. Multiple regression analysis was used to test the hypotheses.

Results: Greater worries were significantly related to greater severity of depressive symptoms among South Korean oldest old. Psychosocial resources including mastery, emotional support from adult children, and instrumental support from adult children had main effects on depressive symptoms. Emotional support from adult children had a powerful buffering effect on the relationship between worries and depressive symptoms.

Conclusion: Worries and certain aspects of social support are important in understanding the depressive symptoms of South Korean oldest old. Incorporating filial support into the development of services for this age group could be helpful to treating their symptoms of depression.     

Feasibility of mental health screening and intervention in the HUNT population study

Background

The aim of the current study was to investigate feasibility, response, and consequences of mental health screening and intervention in a population study setting.

Methods

In the Intervention study against Depression and Anxiety in Nord-Trøndelag (IDANT), all GPs and psychiatric nurses were invited to a psychiatric educational programme prior to the Health Study of Nord-Trøndelag County, Norway (HUNT 2, 1995–1997). Included in the HUNT 2 was the Hospital Anxiety and Depression rating Scale (HADS). All participants scoring 25 points or above (99th percentile, n = 654) were defined as the Psychiatric High Risk Group, (PHRG) and received a written notification regarding their high scores with a request to see their GP and to participate in the IDANT.

Results

In total 422 (64%) baseline forms could be retrieved in the IDANT. However, only 177 (27%) were returned by the GPs. Three out of four participants in the PHRG were already recognised by their GPs as patients with mental disorders prior to the IDANT. Negative reactions to the notification letter or to the invitation to the IDANT were uncommon, still only half of the subjects in the PHRG participated in the study. However, as a consequence of the IDANT in 64% of the cases the GPs started new treatment, revised ongoing treatment, or referred the respondents.

Conclusions

Though attitude towards psychiatry among GPs and participants was generally positive, response to the IDANT study was inadequate. Relatively few new cases were detected, yet the results indicate that the GPs altered their psychiatric care and practice markedly within the PHRG. Whether the educational programme had an impact on psychiatric services in the county in general cannot be answered in this study.     

Caring for mental illness in the United States: a focus on older adults.

OBJECTIVE: The authors compared rates of common mental disorders and the use of primary care and specialty mental health services among younger and older adults. METHODS: They used data from 9,585 respondents to the HealthCare for Communities (HCC) Household Telephone Survey. Mental disorders during the past year, including depression, dysthymia, and generalized anxiety disorder, were identified with a short questionnaire. The survey also collected information about sociodemographic and insurance status, perceived need for mental health care, and use of health services. RESULTS: Older adults (age 65 and older) were significantly less likely than younger adults (18-29) or middle-aged adults (30-64) to meet diagnostic criteria for a mental disorder (8% versus 15% in each of the younger age-groups). Older adults who met diagnostic criteria for mental disorders were less likely to perceive a need for mental health care, to receive specialty mental health care or counseling, or to receive referrals from primary care to mental health specialty care than young or middle-aged adults. CONCLUSION: Few older adults with mental disorders use mental health services, particularly specialty mental health services. The lack of perceived need for mental health care may contribute to low rates of mental health service use among older adults.