Health-Related Quality of Life of Latin-American Immigrants and Spanish-Born Attended in Spanish Primary Health Care: Socio-Demographic and Psychosocial Factors

Background

This study compares the health-related quality of life of Spanish-born and Latin American-born individuals settled in Spain. Socio-demographic and psychosocial factors associated with health-related quality of life are analyzed.

Methods

A cross-sectional Primary Health Care multi center-based study of Latin American-born (n = 691) and Spanish-born (n = 903) outpatients from 15 Primary Health Care Centers (Madrid, Spain). The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) was used to assess health-related quality of life. Socio-demographic, psychosocial, and specific migration data were also collected.

Results

Compared to Spanish-born participants, Latin American-born participants reported higher health-related quality of life in the physical functioning and vitality dimensions. Across the entire sample, Latin American-born participants, younger participants, men and those with high social support reported significantly higher levels of physical health. Men with higher social support and a higher income reported significantly higher mental health. When stratified by gender, data show that for men physical health was only positively associated with younger age. For women, in addition to age, social support and marital status were significantly related. Both men and women with higher social support and income had significantly better mental health. Finally, for immigrants, the physical and mental health components of health-related quality of life were not found to be significantly associated with any of the pre-migration factors or conditions of migration. Only the variable “exposure to political violence” was significantly associated with the mental health component (p = 0.014).

Conclusions

The key factors to understanding HRQoL among Latin American-born immigrants settled in Spain are age, sex and social support. Therefore, strategies to maintain optimal health outcomes in these immigrant communities should include public policies on social inclusion in the host society and focus on improving social support networks in order to foster and maintain the health and HRQoL of this group.     

The Effect of Intra- and Intergenerational Caregiving on Subjective Well-Being – Evidence of a Population Based Longitudinal Study among Older Adults in Germany

Objective

To examine whether intra- and intergenerational caregiving affect subjective well-being (SWB) of the caregivers longitudinally.

Methods

Data were drawn from the German Ageing Survey (DEAS), which is a population-based longitudinal study of individuals living in Germany aged 40 and over. The waves in 2002, 2008 and 2011 were used (with 10,434 observations). SWB was examined in a broad sense, covering affective (AWB) and cognitive well-being (CWB), positive (PA) and negative affect (NA) as well as functional and mental health. While intragenerational caregiving was defined as providing care for spouse/partner, intergenerational caregiving was defined as providing care for mother, father, mother-in-law, father-in-law, partner’s mother or partner’s father.

Results

Fixed effects regressions adjusting for sociodemographic factors, social network, self-efficacy and morbidity showed that intergenerational informal care did not affect the various SWB outcome measures. Intragenerational caregiving affected CWB (women) and mental health (total sample and men), whereas it did not affect the other outcome variables.

Conclusion

Our findings highlight the importance of intragenerational caregiving for mental health (men) and cognitive well-being (women). Consequently, interventions to avoid mental illness due to intragenerational caregiving are urgently needed.     

Factors Associated with Fear of Falling among Community-Dwelling Older Adults in the Shih-Pai Study in Taiwan

Background

Fear of falling is an important risk indicator for adverse health related outcomes in older adults. However, factors associated with fear of falling among community-dwelling older adults are not well-explored.

Objectives

To explore the quality of life and associated factors in fear of falling among older people in the Shih-Pai area in Taiwan.

Methods

This community-based survey recruited three thousand eight hundred and twenty-four older adults aged ≥ 65 years. The measurements included a structured questionnaire, including quality of life by using Short-Form 36, and information of fear of falling, fall history, demographics, medical conditions, insomnia, sleep quality, depression and subjective health through face-to-face interviews.

Results

A total of 53.4% of participants reported a fear of falling. The rate of fear of falling was higher in female subjects. Subjects with fear of falling had lower Short Form-36 scores both for men and women. Falls in the previous year, older age, insomnia, depression and worse subjective health were correlates of fear of falling for both sexes. Male-specific associations with fear of falling were the accessibility of medical help in an emergency, diabetes mellitus and stroke. In parallel, cardiovascular diseases were a female-specific correlate for fear of falling.

Conclusions

Fear of falling is prevalent among community-dwelling older adults. It is seems that there are gender differences in fear of falling with respect to the prevalence and associated factors in older adults. Gender differences should be considered when planning prevention and intervention strategies for fear of falling among older people.     

Effect of Health Literacy on Quality of Life amongst Patients with Ischaemic Heart Disease in Australian General Practice

Background

Appropriate understanding of health information by patients with cardiovascular disease (CVD) is fundamental for better management of risk factors and improved morbidity, which can also benefit their quality of life.

Objectives

To assess the relationship between health literacy and health-related quality of life (HRQoL) in patients with ischaemic heart disease (IHD), and to investigate the role of sociodemographic and clinical variables as possible confounders.

Methods

Cross-sectional study of patients with IHD recruited from a stratified sample of general practices in two Australian states (Queensland and South Australia) between 2007 and 2009. Health literacy was measured using a validated questionnaire and classified as inadequate, marginal, or adequate. Physical and mental components of HRQoL were assessed using the Medical Outcomes Study Short Form (SF12) questionnaire. Analyses were adjusted for confounders (sociodemographic variables, clinical history of IHD, number of CVD comorbidities, and CVD risk factors) using multiple linear regression.

Results

A total sample of 587 patients with IHD (mean age 72.0±8.4 years) was evaluated: 76.8% males, 84.2% retired or pensioner, and 51.4% with up to secondary educational level. Health literacy showed a mean of 39.6±6.7 points, with 14.3% (95%CI 11.8–17.3) classified as inadequate. Scores of the physical component of HRQoL were 39.6 (95%CI 37.1–42.1), 42.1 (95%CI 40.8–43.3) and 44.8 (95%CI 43.3–46.2) for inadequate, marginal, and adequate health literacy, respectively (p-value for trend = 0.001). This association persisted after adjustment for confounders. Health literacy was not associated with the mental component of HRQoL (p-value = 0.482). Advanced age, lower educational level, disadvantaged socioeconomic position, and a larger number of CVD comorbidities adversely affected both, health literacy and HRQoL.

Conclusion

Inadequate health literacy is a contributing factor to poor physical functioning in patients with IHD. Increasing health literacy may improve HRQoL and reduce the impact of IHD among patients with this chronic CVD.     

Prevalence and Patterns of Multi-Morbidity in Serbian Adults: A Cross-Sectional Study

Introduction

Like many developing countries, Serbia is facing a growing burden of chronic diseases. Within such public health issue, multi-morbidity requires a special attention.

Aims

This study investigated the prevalence of multi-morbidity in the Serbia population and assessed the co-occurrence of chronic diseases by age and gender.

Methods

We analyzed data from the 2013 National Health Survey, which included 13,103 individuals ≥ 20 years old. Multi-morbidity patterns were identified by exploratory factor analysis of data on self-reported chronic diseases, as well as data on measured body weight and height. The analysis was stratified by age and gender.

Results

Multi-morbidity was present in nearly one-third of respondents (26.9%) and existed in all age groups, with the highest prevalence among individuals aged 65 years and older (47.2% of men and 65.0% of women). Six patterns of multi-morbidity were identified: non-communicable, cardio-metabolic, respiratory, cardiovascular, aggregate, and mechanical/mental/metabolic. The non-communicable pattern was observed in both genders but only in the 20–44 years age group, while the aggregate pattern occurred only in middle-aged men. Cardio-metabolic and respiratory patterns were present in all age groups. Cardiovascular and mechanical/mental/metabolic patterns showed similar presentation in both men and women.

Conclusions

Multi-morbidity is a common occurrence among adults in Serbia, especially in the elderly. While several patterns may be explained by underlying pathophysiologies, some require further investigation and follow-up. Recognizing the complexity of multi-morbidity in Serbia is of great importance from both clinical and preventive perspectives given that it affects one-third of the population and may require adjustment of the healthcare system to address the needs of affected individuals.     

Work Content and Serious Mental Illness among Middle-Aged Men: Results from a 6-Year Longitudinal Study in Japan

Objective

The present study aimed to determine prospective associations between work content after a working life of more than 20 years and serious mental illness among Japanese men aged 50 to 59 years, using a nationwide population-based survey.

Methods

Data were extracted from a national longitudinal survey of middle-aged and elderly persons previously conducted by the Ministry of Health, Labour and Welfare in Japan. We analyzed data across 10 work content categories for Japanese men who had been working in the same job type or industry for over 20 years. As part pf the survey, participants completed the Kessler (K)6 scale each year to determine their level of psychological distress (with scores ≥13 indicating serious mental illness). Cox discrete time proposal hazard regression analysis was used to examine potential associations between work content and serious mental illness from 2005 to 2010. Further adjustments were made for other sociodemographic characteristics and lifestyle factors.

Results

The current study involved a total of 11,942 participants with a mean (± standard deviation [SD]) of follow-up was 3.4 (± 2.0) years, during which time 892 participants (7.5%) had been classified as having a new-onset serious mental illness. Men who had worked in service jobs and in manufacturing jobs at baseline were more likely to develop serious mental illness than those in managerial jobs (hazard ratio 1.37, 1.30, 95% confidence intervals 1.04–1.80, 1.02–1.65) after adjustment for confounding variables.

Conclusion

These findings suggest that Japanese men aged 50 to 59 years who have worked in service and manufacturing jobs after a working life of over 20 years have an increased risk of serious mental illness during follow-up. Identifying the most at-risk work content category after a working life of over 20 years would be an essential part of providing more effective interventions for psychological distress among Japanese men in this age group.     

The Changing Gender Differences in Life Expectancy in Chinese Cities 2005-2010

Objectives

To analyze the gender difference in life expectancy in Chinese urban people and explore the age-specific and cause-specific contributions to the changing gender differences in life expectancy.

Methods

Data of life expectancy and mortality were obtained from “Annual statistics of public health in China.” The gender difference was analyzed by decomposition method, including age-specific decomposition and cause-specific decomposition.

Results

Women lived much longer than men in Chinese urban areas, with remarkable gains in life expectancy since 2005, respectively. The gender difference reached a peak in 2007. Mortality difference between men and women in the 60–79 age group made the largest contributions to the gender gap in life expectancy in all 6 years. Among causes of death, cancers, circulatory diseases and respiratory diseases made the largest contributions to the gender gap. 33–38% of the gender gap were caused by cancers, among which lung cancer contributed 0.6 years of the overall gap. The contribution of cancers to the gender gap reduced over time, mostly influenced by the narrowing effect of liver cancer on gender gap. Traffic accidents and suicide were the external causes influencing the gender gap, contributing 10–16% of the overall difference.

Conclusion

Public health efforts to reduce excess mortalities for cancers, circulatory disease, respiratory diseases, and suicide among men in particular might further narrow the gender gap in life expectancy in Chinese cities.     

Gender Differentials in Self-Rated Health and Self-Reported Disability among Adults in India

Background

The extant literature on gender differentials in health in developed countries suggests that women outlive men at all ages, but women report poorer health than men. It is well established that Indian women live longer than men, but few studies have been conducted to understand the gender dimension in self-rated health and self-reported disability. The present study investigates gender differentials in self-rated health (SRH) and self-reported disability (SRD) among adults in India, using a nationally representative data.

Methods

Using data on 10,736 respondents aged 18 and older in the 2007 WHO Study on Global Ageing and Adult Health in India, prevalence estimates of SRH are calculated separately for men and women by socio-economic and demographic characteristics. The association of SRH with gender is tested using a multinomial logistic regression method. SRD is assessed using 20 activities of daily living (ADL). Further, gender differences in total life expectancy (TLE), disability life expectancy (DLE) and the proportion of life spent with a disability at various adult ages are measured.

Results

The relative risk of reporting poor health by women was significantly higher than men (relative risk ratio: 1.660; 95% confidence Interval (CI): 1.430–1.927) after adjusting for socio-economic and demographic characteristics. Women reported higher prevalence of severe and extreme disability than men in 14 measures out of a total20 ADL measures. Women aged less than 60 years reported two times more than men in SRD ≥ 5 ADLs. Finally, both DLE and proportion of life spent with a disability were substantially higher for women irrespective of their ages.

Conclusion

Indian women live longer but report poorer health than men. A substantial gender differential is found in self-reported disability. This makes for an urgent call to health researchers and policy makers for gender-sensitive programs.     

Posttraumatic Stress Reactions in Parents of Children Esophageal Atresia

Objective

The aim of this study was to investigate psychological stress in parents of children with esophageal atresia and to explore factors associated with the development of Posttraumatic Stress disorder (PTSD).

Design

Self-report questionnaires were administered to parents of children with EA. Domains included: (1) sociodemographic data, current personal difficulties, assessment scales for the quality of life and for the global health status of the child (2) French-validated versions of the Perinatal Posttraumatic Stress disorder Questionnaire and of the State-Trait Anxiety Inventory. Associations between PTSD and severity of the neonatal course, presence of severe sequelae at 2 years of age, and quality of life and global health status of children according to their parents’ perception were studied.

Setting

A Tertiary care University Hospital

Results

Among 64 eligible families, 54 parents of 38 children (59%) participated to the study. PTSD was present in 32 (59%) parents; mothers were more frequently affected than fathers (69 vs 46%, p = 0.03). Four mothers (8%) had severe anxiety. PTSD was neither associated with neonatal severity nor with severe sequelae at 2 years. Parents with PTSD rated their child’s quality of life and global health status significantly lower (7.5 vs 8.6; p = 0.01 and 7.4 vs 8.3; p = 0.02 respectively).

Conclusions

PTSD is frequent in parents of children with esophageal atresia, independently of neonatal severity and presence of severe sequelae at 2 years of age. Our results highlight the need for a long-term psychological support of families.     

Assessment of Disability among the Elderly in Xiamen of China: A Representative Sample Survey of 14,292 Older Adults

Background

The unprecedented number of elderly individuals in China presents a serious public health challenge. Limited data are available on the prevalence of disability or factors resulting in disability among the elderly in China.

Objective

We aimed to assess the prevalence of disability and related risk factors among the elderly of Xiamen, China.

Methods

A cross-sectional study was performed on individuals who were ≥60 years of age. The subjects were recruited by multi-stage sampling; a total of 14,292 valid questionnaires were received. Study measurements included activities of daily living (ADL), demographics, and health status. The ADL was assessed by the Katz Index Scale to evaluate disability. Chi-square tests and binary logistic regression were used to identify factors associated with disabilities.

Results

Among the valid participants, 4.27% had at least one disability. Bathing was the most frequently reported disability and feeding was the least frequently reported disability. Disabilities were significantly associated with female gender, older age, unmarried status, living with family, urban residence, illiteracy, poor economic status, self-rated bad health, chronic illnesses, lower life satisfaction, bad mood, and feelings of loneliness.

Conclusion

Functional disability among the elderly requires more public attention. Culturally appropriate policies and programs are also needed to address the care for the disabled elderly.     

Relationship of the Perceived Social and Physical Environment with Mental Health-Related Quality of Life in Middle-Aged and Older Adults: Mediating Effects of Physical Activity

Background

Mental health conditions are among the leading non-fatal diseases in middle-aged and older adults in Australia. Proximal and distal social environmental factors and physical environmental factors have been associated with mental health, but the underlying mechanisms explaining these associations remain unclear. The study objective was to examine the contribution of different types of physical activity in mediating the relationship of social and physical environmental factors with mental health-related quality of life in middle-aged and older adults.

Methods

Baseline data from the Wellbeing, Eating and Exercise for a Long Life (WELL) study were used. WELL is a prospective cohort study, conducted in Victoria, Australia. Baseline data collection took place in 2010. In total, 3,965 middle-aged and older adults (55–65 years, 47.4% males) completed the SF-36 Health Survey, the International Physical Activity Questionnaire, and a questionnaire on socio-demographic, social and physical environmental attributes. Mediation analyses were conducted using the MacKinnon product-of-coefficients test.

Results

Personal safety, the neighbourhood physical activity environment, social support for physical activity from family or friends, and neighbourhood social cohesion were positively associated with mental health-related quality of life. Active transportation and leisure-time physical activity mediated 32.9% of the association between social support for physical activity from family or friends and mental health-related quality of life. These physical activity behaviours also mediated 11.0%, 3.4% and 2.3% respectively, of the relationship between the neighbourhood physical activity environment, personal safety and neighbourhood social cohesion and mental health-related quality of life.

Conclusions

If these results are replicated in future longitudinal studies, tailored interventions to improve mental health-related quality of life in middle-aged and older adults should use a combined strategy, focusing on increasing physical activity as well as social and physical environmental attributes.     

Relative Risk of Acute Myocardial Infarction in People with Schizophrenia and Bipolar Disorder: A Population-Based Cohort Study

Objective

Despite high mortality associated with serious mental illness, risk of acute myocardial infarction (AMI) remains unclear, especially for patients with bipolar disorder. The main objective was to investigate the relative risk of AMI associated with schizophrenia and bipolar disorders in a national sample.

Method

Using nationwide administrative data, an 11-year historic cohort study was assembled, comprised of cases aged 18 and above who had received a diagnosis of schizophrenia or bipolar disorder, compared to a random sample of all other adults excluding those with diagnoses of serious mental illness. Incident AMI as a primary diagnosis was ascertained. Hazard ratios stratified by age and gender were calculated and Cox regression models were used to adjust for other covariates.

Results

A total of 70,225 people with schizophrenia or bipolar disorder and 207,592 people without serious mental illness were compared. Hazard ratios in men adjusted for age, income and urbanization were 1.15 (95% CI 1.01~1.32) for schizophrenia and 1.37 (1.08~1.73)for bipolar disorder, and in women, 1.85 (1.58~2.18) and 1.88(1.47~2.41) respectively. Further adjustment for treated hypertension, diabetes and hyperlipidaemia attenuated the hazard ratio for men with schizophrenia but not the other comparison groups. Hazard ratios were significantly stronger in women than men and were stronger in younger compared to older age groups for both disorders; however, gender modification was only significant in people with schizophrenia, and age modification only significant in people with bipolar disorder.

Conclusions

In this large national sample, schizophrenia and bipolar disorder were associated with raised risk of AMI in women and in the younger age groups although showed differences in potential confounding and modifying factors.     

Social Rhythm and Mental Health: A Cross-Cultural Comparison

Background

Social rhythm refers to the regularity with which one engages in social activities throughout the week, and has established links with bipolar disorder, as well as some links with depression and anxiety. The aim of the present study is to examine social rhythm and its relationship to various aspects of health, including physical health, negative mental health, and positive mental health.

Method

Questionnaire data were obtained from a large-scale multi-national sample of 8095 representative participants from the U.S., Russia, and Germany.

Results

Results indicated that social rhythm irregularity is related to increased reporting of health problems, depression, anxiety, and stress. In contrast, greater regularity is related to better overall health state, life satisfaction, and positive mental health. The effects are generally small in size, but hold even when controlling for gender, marital status, education, income, country, and social support. Further, social rhythm means differ across Russia, the U.S., and Germany. Relationships with mental health are present in all three countries, but differ in magnitude.

Conclusions

Social rhythm irregularity is related to mental health in Russia, the U.S., and Germany.     

Effect of Dietary Patterns on Muscle Strength and Physical Performance in the Very Old: Findings from the Newcastle 85+ Study

Background

Healthy diet has been associated with better muscle strength and physical performance in cross-sectional studies of older adults but the effect of dietary patterns (DP) on subsequent decline, particularly in the very old (aged 85+), has not been determined.

Objective

We investigated the association between previously established DP and decline in muscle strength and physical performance in the very old.

Design

791 participants (61.8% women) from the Newcastle 85+ Study were followed-up for change in hand grip strength (HGS) and Timed Up-and Go (TUG) test over 5 years (four waves 1.5 years apart). Mixed models were used to determine the effects of DP on muscle strength and physical performance in the entire cohort and separately by sex.

Results

Previously we have established three DP that varied in intake of red meats, potato, gravy and butter and differed with key health and social factors. HGS declined linearly by 1.59 kg_F in men and 1.08 kg_F in women (both p<0.001), and TUG slowed by 0.13 log₁₀-transformed seconds (log₁₀-s) in men and 0.11 log₁₀-s in women per wave after adjusting for important covariates (both p<0.001), and also showed a nonlinear change (p<0.001). Men in DP1 (‘High Red Meat’) had worse overall HGS (β = -1.70, p = 0.05), but men in DP3 (‘High Butter’) had a steeper decline (β = -0.63, p = 0.05) than men in DP2 (‘Low Meat’). Men in DP1 and women in DP3 also had overall slower TUG than those in DP2 (β = 0.08, p = 0.001 and β = 0.06, p = 0.01, respectively), but similar rate of decline after adjusting for sociodemographic, lifestyle, health, and functioning factors. The results for HGS and TUG were not affected by participants’ cognitive status.

Conclusions

DP high in red meats, potato and gravy (DP1), or butter (DP3) may adversely affect muscle strength and physical performance in later life, independently of important covariates and cognitive status.     

Chronic Pain in the Japanese Community—Prevalence,Characteristics and Impact on Quality of Life

Background

Chronic pain is recognized as a public health problem that affects the general population physically, psychologically, and socially. However, there is little knowledge about the associated factors of chronic pain, such as the influence of weather, family structure, daily exercise, and work status.

Objectives

This survey had three aims: 1) to estimate the prevalence of chronic pain in Japan, 2) to analyze these associated factors, and 3) to evaluate the social burden due to chronic pain.

Methods

We conducted a cross-sectional postal survey in a sample of 6000 adults aged ≥20 years. The response rate was 43.8%.

Results

The mean age of the respondents was 57.7 years (range 20–99 years); 39.3% met the criteria for chronic pain (lasting ≥3 months). Approximately a quarter of the respondents reported that their chronic pain was adversely influenced by bad weather and also oncoming bad weather. Risk factors for chronic pain, as determined by a logistic regression model, included being an older female, being unemployed, living alone, and no daily exercise. Individuals with chronic pain showed significantly lower quality of life and significantly higher psychological distress scores than those without chronic pain. The mean annual duration of absence from work of working-age respondents was 9.6 days (range 1–365 days).

Conclusions

Our findings revealed that high prevalence and severity of chronic pain, associated factors, and significant impact on quality of life in the adult Japanese population. A detailed understanding of factors associated with chronic pain is essential for establishing a management strategy for primary care.     

Impact of Multimorbidity on Disability and Quality of Life in the Spanish Older Population

Background

Population aging is closely related to high prevalence of chronic conditions in developed countries. In this context, health care policies aim to increase life span cost-effectively while maintaining quality of life and functional ability. There is still, however, a need for further understanding of how chronic conditions affect these health aspects. The aim of this paper is to assess the individual and combined impact of chronic physical and mental conditions on quality of life and disability in Spain, and secondly to show gender trends.

Methods

Cross-sectional data were collected from the COURAGE study. A total of 3,625 participants over 50 years old from Spain were included. Crude and adjusted multiple linear regressions were conducted to detect associations between individual chronic conditions and disability, and between chronic conditions and quality of life. Separate models were used to assess the influence of the number of diseases on the same variables. Additional analogous regressions were performed for males and females.

Results

All chronic conditions except hypertension were statistically associated with poor results in quality of life and disability. Depression, anxiety and stroke were found to have the greatest impact on outcomes. The number of chronic conditions was associated with substantially lower quality of life [β for 4+ diseases: −18.10 (−20.95,−15.25)] and greater disability [β for 4+ diseases: 27.64 (24.99,30.29]. In general, women suffered from higher rates of multimorbidity and poorer results in quality of life and disability.

Conclusions

Chronic conditions impact greatly on quality of life and disability in the older Spanish population, especially when co-occurring diseases are added. Multimorbidity considerations should be a priority in the development of future health policies focused on quality of life and disability. Further studies would benefit from an expanded selection of diseases. Policies should also deal with gender idiosyncrasy in certain cases.     

A Systematic Review on Health Resilience to Economic Crises

Background

The health effects of recent economic crises differ markedly by population group. The objective of this systematic review is to examine evidence from longitudinal studies on factors influencing resilience for any health outcome or health behaviour among the general population living in countries exposed to financial crises.

Methods

We systematically reviewed studies from six electronic databases (EMBASE, Global Health, MEDLINE, PsycINFO, Scopus, Web of Science) which used quantitative longitudinal study designs and included: (i) exposure to an economic crisis; (ii) changes in health outcomes/behaviours over time; (iii) statistical tests of associations of health risk and/or protective factors with health outcomes/behaviours. The quality of the selected studies was appraised using the Quality Assessment Tool for Quantitative Studies. PRISMA reporting guidelines were followed.

Results

From 14,584 retrieved records, 22 studies met the eligibility criteria. These studies were conducted across 10 countries in Asia, Europe and North America over the past two decades. Ten socio-demographic factors that increased or protected against health risk were identified: gender, age, education, marital status, household size, employment/occupation, income/ financial constraints, personal beliefs, health status, area of residence, and social relations. These studies addressed physical health, mortality, suicide and suicide attempts, mental health, and health behaviours. Women’s mental health appeared more susceptible to crises than men’s. Lower income levels were associated with greater increases in cardiovascular disease, mortality and worse mental health. Employment status was associated with changes in mental health. Associations with age, marital status, and education were less consistent, although higher education was associated with healthier behaviours.

Conclusions

Despite widespread rhetoric about the importance of resilience, there was a dearth of studies which operationalised resilience factors. Future conceptual and empirical research is needed to develop the epidemiology of resilience.     

Associations between Skeletal Growth in Childhood and Cognitive Function in Mid-Life in a 53-Year Prospective Birth Cohort Study

Background

Several studies have found that shorter stature (height and limb length) in late life is associated with dementia and cognitive impairment. The extent to which childhood environment and early life cognitive function accounts for these associations is not clear.

Methods

We investigated associations of adult trunk height and leg length with cognitive function in middle age, analysing data from the MRC National Survey of Health and Development: a cohort followed from birth to age 53, 1677 of whom had data on all covariates. The four cognitive tests measured verbal ability, word list memory, verbal fluency and speed/concentration. Early life environmental measures included parental education, poverty, parental divorce, physical health, cognitive ability at age 15, own education and own adult social class.

Results

After adjusting for gender, shorter trunk length was associated with lower cognitive function on all four tests and shorter leg length with lower verbal intelligence and word list memory. These associations were only partially attenuated following adjustment for childhood adversity/health but were substantially accounted for by cognitive ability at age 15.

Conclusions

Shorter stature was associated with lower cognitive function at age 53, the majority of this association being accounted for by cognitive function at age 15. Reduced cognitive reserve may well account for later associations between anthropometric measures and dementia.     

Structural Pathways between Child Abuse,Poor Mental Health Outcomes and Male-Perpetrated Intimate Partner Violence (IPV)

Background

Violent trauma exposures, including child abuse, are risk factors for PTSD and comorbid mental health disorders. Child abuse experiences of men exacerbate adult male-perpetrated intimate partner violence (IPV). The relationship between child abuse, poor mental health and IPV perpetration is complex but research among the general population is lacking. This study describes the relationship and pathways between history of child abuse exposure and male-perpetrated IPV while exploring the potentially mediating effect of poor mental health.

Methods

We analysed data from a randomly selected, two-stage clustered, cross-sectional household survey conducted with 416 adult men in Gauteng Province of South Africa. We used multinomial regression modelling to identify associated factors and Structural Equation Modelling (SEM) to test the primary hypothesis that poor mental health (defined as abusing alcohol or having PTSD or depressive symptoms) mediates the relationship between child abuse and IPV perpetration.

Results

Eighty eight percent of men were physically abused, 55% were neglected, 63% were emotionally abused and 20% were sexually abused at least once in their childhood. Twenty four percent of men had PTSD symptoms, 24% had depressive symptoms and 36% binge drank. Fifty six percent of men physically abused and 31% sexually abused partners at least once in their lifetime. Twenty two percent of men had one episode and 40% had repeat episodes of IPV perpetration. PTSD symptomatology risk increased with severity of child trauma and other trauma. PTSD severity increased the risk for binge drinking. Child trauma, other trauma and PTSD symptomatology increased the severity of depressive symptoms. PTSD symptomatology was comorbid with alcohol abuse and depressive symptoms. Child trauma, having worked in the year before the survey, other trauma and PTSD increased the risk of repeat episodes of IPV perpetration. Highly equitable gender attitudes were protective against single and repeat episodes of IPV perpetration. There was a direct path between the history of child trauma and IPV perpetration and three other indirect paths showing the mediating effects of PTSD, other trauma and gender attitudes.

Conclusions

Child trauma is a risk factor for both poor mental health and male-perpetrated IPV among men in Gauteng. Male-perpetrated IPV in these settings should be explained through a combination of the Trauma, Feminist, and Intergenerational Transmission of Family Violence theories. Prevention interventions for male- perpetrated IPV in South Africa need to incorporate strategies and therapies to address poor mental health conditions.