Exploring the psychometric properties of the CES-D-10 and its practicality in detecting depressive symptomatology in 27 low- and middle-income countries

Adherence to 24-h movement guidelines and its associations with dietary behavior and mental health among university students from five ASEAN countries

OBJECTIVE

Despite growing evidence linking 24-h movement behaviors to health outcomes, there is limited research examining these relationships among university students in Southeast Asia. Therefore, the purpose of this study was to examine the prevalence and associations of adherence to 24-h movement guidelines (HMG) with dietary behaviour and mental health among university students in ASEAN.

METHODS

A multi-center cross-sectional survey was conducted in 2015 included 3223 university students from five ASEAN nations-Indonesia, Malaysia, Myanmar, Thailand, and Vietnam-aged 18 to 30 years, selected by stratified random sampling. Established measures included demographics, social support, perceived stress, self-rated health status, body mass index, six dietary behaviours, eight mental health outcomes, and adherence to 24-h movement guidelines (24-HMG) was assessed based on self-reported physical activity (≥ 150 min/week), sedentary time (≤ 480 min/day), screen time (≤ 180 min/day), and sleep duration (7-9 h). The relationship between dietary behaviours, mental health indicators and meeting the 24-HMG number was investigated using logistic regression models, adjusted for relevant confounders.

RESULTS

Among 3,223 participants, 11.7% met all three 24-h movement guidelines, while 13.1% met none, and 37.6% met either one or two guidelines. Adherence to all guidelines was higher among males, participants aged 22-30 years, and those from lower-income countries (Indonesia, Myanmar, and Vietnam). Multiple logistic regression analyses, adjusted for relevant confounders, revealed that meeting more movement guidelines was associated with: Increased odds of healthy dietary behaviors (fruit and vegetable intake: Adjusted Odds Ratio-AOR: 1.96, 95% Confidence intervals-CI: 1.35-2.83; breakfast intake: AOR: 2.48, 95% CI: 1.84-3.34; meal frequency: AOR: 1.83, 95% CI: 1.36-2.45; low soft drink intake: AOR: 2.20, 95% CI: 1.54-3.14; high sugared coffee or tea intake: AOR: 0.39, 95% CI: 0.24-0.61; low fast food intake: AOR: 1.46, 95% CI: 1.08-1.96; and low snacking: AOR: 2.71, 95% CI: 2.00-3.66), and Decreased odds of mental health issues (depressive symptoms: AOR: 0.43, 95% CI: 0.26-0.70; suicidal behaviour: AOR: 0.66, 95% CI: 0.47-0.93; pathological internet use: AOR: 0.60, 95% CI: 0.45-0.81; hazardous or harmful alcohol use: AOR: 0.44, 95% CI: 0.29-0.66; illicit drug use: AOR: 0.38, 95% CI: 0.20-0.73; and had poorer sleep quality: AOR: 0.33, 95% CI: 0.16-0.68). No significant associations were found between guideline adherence and PTSD symptoms or tobacco use (p > 0.05).

CONCLUSIONS

This is the first study to look at the prevalence, correlates, and relationships between 24-HMG adherence and dietary behaviour and mental health outcomes among university students in ASEAN. This pioneering study among ASEAN university students demonstrates that adherence to 24-h movement guidelines is associated with better dietary behaviours and mental health outcomes in a dose-response manner. Future university health policies should incorporate 24-h movement guidelines into existing health promotion strategies, particularly in resource-limited settings.

Exploring disparities in depressive symptoms between rural and urban middle-aged and elderly adults in China: evidence from CHARLS

The study was to investigate the relevant factors that were associated with differences in depressive symptoms between urban and rural middle-aged and elderly population in China, measuring the contribution of related influencing factors. We constructed binary logistic regression models to investigate the primary factors influencing depressive symptoms and employed Fairlie models to examine these factors contributing to the differences in depressive symptoms between urban and rural middle-aged and elderly individuals. The proportion of depressive symptoms among middle-aged and older individuals in China was 38.16%, with findings indicating that rural areas exhibited higher rates (44.47%) of depressive symptoms compared to urban areas (31.85%). The Fairlie decomposition analysis demonstrated 53.51% of the disparities in depressive symptoms could be accounted for, which was mainly linked to differences in self-reported health status (19.16%), education level (14.45%), insurance (8.28%), instrumental activities of daily living dysfunction (6.16%), gender (-3.72%), sleep time (2.35%), falling history (2.31%), age (-2.17%), physical examination (2.03%), and chronic disease condition (-0.50%). The prevalence of depressive symptoms in rural middle-aged and elderly was greater than urban, linked to demographics, lifestyle, health status and social status. This study aided policymakers in reducing health disparities and designing targeted mental health interventions for vulnerable populations.

Depressive symptoms among the oldest-old in China: a study on rural-urban differences

BACKGROUND

In China, In China, depression among the oldest-old (aged 80 + years) is a major public health issue. As the gap in development between urban and rural China widens, the aim of this study was to demonstrated whether there are disparities in the incidence of depressive symptoms between the urban and rural oldest-old (aged 80+) in China and to quantify the contribution of relevant influencing factors.

METHODS

The study evaluated data on 5,116 oldest adults (female, 55.88%; male, 44.12%) from the 2018 Chinese Longitudinal Healthy Longevity Survey. A chi-square test analyzed the distribution characteristics of related indicators among the oldest-old adults in the two areas. Multiple linear regression was applied to exploring the influencing factors of depressive symptoms in the oldest-old (aged 80+) adults in different regions. The Blinder-Oaxaca decomposition method quantified the four categories of influencing factors (demographic characteristics, sociological characteristics, personal lifestyle, personal lifestyle) of the differences in depressive symptoms and estimated their contributions among urban and rural oldest-old (aged 80+) adults.

RESULTS

14.60% of oldest-old (aged 80+) adults reported having depressed symptoms, with rural oldest-old (aged 80+) adults reporting more of these symptoms (15.70%) than urban oldest-old (aged 80+) adults (12.25%). In urban areas, age (90-99: β = -0.583, 95%CI = -1.008 to -0.158), annual income (rich: β = -0.699, 95%CI = -1.368 to -0.029), smoking (yes: β = -0.752, 95%CI = -1.376 to -0.127), exercise (yes: β = -1.447, 95%CI = -1.828 to -1.065), self-rated health status (good: β = -2.994, 95% CI = -3.362 to -2.625) were protective factors against depressive symptoms, and married status (other: β = 1.222, 95%CI = 0.564 to 1.880) were risk factors. In rural areas, education level (1-6: β = -0.374, 95%CI =  -0.686 to -0.062), annual income (poor: β = -0.374, 95%CI = -0.721 to -0.026; rich: β = -0.781, 95%CI = -1.115 to -0.447), exercise (yes: β = -0.844, 95%CI = -1.143 to -0.545) and SRH status (good: β = -3.023, 95%CI = -3.274 to -2.772) were protective factors, whereas body mass index (BMI) (< 18.5: β = 0.532, 95%CI = 0.221 to 0.842) and married status (widowed: β = 0.630, 95%CI = 0.283 to 0.978) were risk factors. The Blinder-Oaxaca decomposition showed that 90.47% of the factors, such as age (90-99, 1.90%), living status (living in an institution, -12.35%), annual income (rich, 42.69%), smoking (yes, -5.56%), exercise (yes, 37.45%), and SRH (good, 19.09%) could significantly explain the depressive symptoms differences between the two populations (p < 0.05).

CONCLUSIONS

The oldest-old (aged 80+) adults in rural areas had a higher prevalence of depressive symptoms than that in urban areas, mostly attributed to variations in income, marital status, physical activity, and health status. These findings can help government agencies design targeted and precise intervention strategies (e.g., health education, improving medical security, and providing sports venues and equipment) to improve mental health and lower the risk of depression among the oldest population.

LUTS/BPH increases the risk of depressive symptoms among elderly adults: A 5-year longitudinal evidence from CHARLS

OBJECTIVE

The prevalence of Lower Urinary Tract Symptoms suggestive of Benign Prostatic Hyperplasia (LUTS/BPH) is notably high and potentially elevates the likelihood of depressive symptoms. This study was designed to employ both cross-sectional and longitudinal methodologies to explore the correlation between LUTS/BPH and depressive symptoms among middle-aged and elderly men in China.

METHODS

This investigation utilized data from the China Health and Retirement Longitudinal Study (CHARLS), with the initial dataset from 2015 serving as the baseline and subsequent data from 2018 and 2020 facilitating longitudinal analysis. The study encompassed a baseline cohort of 5156 men aged 45 years and above, and an expansive longitudinal analytical sample of 23,530 participants spanning from 2015 to 2020. The assessment of depressive symptoms was conducted using the 10-item Center for Epidemiological Studies Depressive Symptoms Scale (CESD-10). To investigate the factors associated with LUTS/BPH, the relationship between LUTS/BPH and depressive symptoms, and to evaluate the incidence rate of depressive symptoms onset based on LUTS/BPH status, multivariate logistic analyses and logistic regression models were employed.

RESULTS

Our results reveal a markedly higher incidence of depressive symptoms among individuals with LUTS/BPH, at 30.16 %, compared to 22.94 % in those without LUTS/BPH. This pattern was consistent in both mild and moderate depressive symptoms categories. However, the prevalence of severe depressive symptoms did not exhibit a significant disparity between the two groups. Longitudinal analysis spanning from 2015 through 2018 and 2020 further corroborated these observations. Individuals with LUTS/BPH showed a substantially higher incidence of depressive symptoms across all severity levels compared to those without LUTS/BPH. Specifically, the presence of LUTS/BPH was linked to a 53 % heightened risk of mild depressive symptoms, a 45 % increase in moderate depressive symptoms, and an alarming 229 % surge in severe depressive symptoms risk between 2015 and 2018. Additionally, from 2015 to 2020, there was a 30 % increased risk for mild depressive symptoms, a 41 % rise for moderate depressive symptoms, and a 106 % escalation in the risk of severe depressive symptoms among those with LUTS/BPH.

CONCLUSION

In middle-aged and older Chinese adults, LUTS/BPH were correlated with an elevated risk of depressive symptoms.

Development and validation of a nomogram to predict depression in older adults with heart disease: a national survey in China

Background

Comorbid depression, frequently observed in heart disease patients, has detrimental effects on mental health and may exacerbate cardiac conditions. The objective of this study was to create and validate a risk prediction nomogram specifically for comorbid depression in older adult patients suffering from heart disease.

Methods

The 2018 data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) was analyzed and 2,110 older adult patients with heart disease aged 60 and above were included in the study. They were randomly divided in a 7:3 ratio into a training set (n = 1,477) and a validation set (n = 633). Depression symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10) and the participants were categorized into depressed (n = 687) and non-depressed (n = 1,423) groups. We collected information regarding general demographics, lifestyle habits, and medical history of the included patients. LASSO regression and binary logistic regression analyses were performed to identify independent risk factors and construct the depression prediction nomogram. Receiver operating characteristic curve analysis and the Hosmer-Lemeshow test were used to assess the model's discrimination and calibration. Decision curve analysis helped evaluate the clinical utility of the predictive nomogram.

Results

Based on the LASSO and multivariable regression analyses, education level, quality of life, sleep quality, frequency of watching TV, and history of arthritis were identified as independent risk factors for comorbid depression in the older adult heart disease patients. A nomogram model was constructed with these five independent risk factors. The nomogram showed good clinical performance with an area under the curve (AUC) value of 0.816 (95% CI: 0.793 to 0.839). The calibration curves and Hosmer-Lemeshow goodness-of-fit test (training setχ t 2 = 4.796, p = 0.760; validation setχ v 2 = 7.236, p = 0.511) showed its satisfactory. Clinical usefulness of the nomogram was confirmed by decision curve analysis.

Conclusions

A five-parameter nomogram for predicting depression in older adult heart disease patients was developed and validated. The nomogram demonstrated high accuracy, discrimination ability, and clinical utility in assessing the risk of depression in the older adult patients with heart disease.

Depression and suicidal ideation among Black individuals in Canada: mediating role of traumatic life events and moderating role of racial microaggressions and internalized racism

PURPOSE

Although suicidal ideation (SI) is a serious concern in Canada, its prevalence and related factors among Black individuals are poorly documented. Using data from the Mental Health of Black Communities in Canada project (BeCoMHeal), this study aimed to assess the prevalence of SI in Black individuals aged 15-40 years old in Canada, the mediating role of traumatic life events in the association between depression and SI, and the moderating role of racial microaggressions and internalized racism.

METHODS

Eight hundred and sixty participants aged between 15 and 40 years (Mage =24.96, SD = 6.29) completed the online questionnaire assessing sociodemographic data, depression symptoms, traumatic life events, racial microaggressions, internalized racism, and SI.

RESULTS

Findings showed that 25.7% of the participants reported having experienced SI (26.5% women, 22.7% men, 𝛘2 = 1.08, p = .299). The moderated-mediation model revealed that traumatic life events fully mediated the association between depression and SI (B = 0.12, p = .004; 95% CI, [0.04, 0.20]) and that racial microaggressions (B = - 0.03, p = .042; 95% CI [-0.07, - 0.00]) and internalized racism (B = 0.06, p = .006; 95% CI [0.02, 0.10]) moderated this relationship.

CONCLUSION

These findings underscore the importance of addressing racial microaggressions and internalized racism in therapy contexts among Black individuals to mitigate the potential negative impacts on their mental health. They also emphasize the need to develop effective, culturally sensitive, and racially adapted suicide prevention and intervention programs for Black communities in Canada.

Decomposition and comparative analysis of differences in depressive symptoms between urban and rural older adults: Evidence from a national survey

OBJECTIVES

The aim of this study was to investigate the factors influencing urban-rural differences in depressive symptoms among old people in China and to measure the contribution of relevant influencing factors.

DESIGN

A cross-sectional research. The 2018 data from The Chinese Longitudinal Health Longevity Survey (CLHLS).

SETTING

Twenty-three provinces in China.

PARTICIPANTS

From the 8th CLHLS, 11,245 elderly participants were selected who met the requirements of the study.

MEASUREMENTS

We established binary logistic regression models to explore the main influencing factors of their depressive symptoms and used Fairlie models to analyze the influencing factors of the differences in depressive symptoms between the urban and rural elderly and their contribution.

RESULTS

The percentage of depressive symptoms among Chinese older adults was 11.72%, and the results showed that rural older adults (12.41%) had higher rates of depressive symptoms than urban (10.13%). The Fairlie decomposition analysis revealed that 73.96% of the difference in depressive symptoms could be explained, which was primarily associated with differences in annual income (31.51%), education level (28.05%), sleep time ( - 25.67%), self-reported health (24.18%), instrumental activities of daily living dysfunction (20.73%), exercise (17.72%), living status ( - 8.31%), age ( - 3.84%), activities of daily living dysfunction ( - 3.29%), and social activity (2.44%).

CONCLUSIONS

The prevalence of depressive symptoms was higher in rural than in urban older adults, which was primarily associated with differences in socioeconomic status, personal lifestyle, and health status factors between the urban and rural residents. If these factors were addressed, we could make targeted and precise intervention strategies to improve the mental health of high-risk elderly.

Depressive symptoms and all-cause mortality among middle-aged and older people in China and associations with chronic diseases

Introduction

It remains unclear whether depressive symptoms are associated with increased all-cause mortality and to what extent depressive symptoms are associated with chronic disease and all-cause mortality. The study aims to explore the relationship between depressive symptoms and all-cause mortality, and how depressive symptoms may, in turn, affect all-cause mortality among Chinese middle-aged and older people through chronic diseases.

Methods

Data were collected from the China Health and Retirement Longitudinal Study (CHARLS). This cohort study involved 13,855 individuals from Wave 1 (2011) to Wave 6 (2020) of the CHARLS, which is a nationally representative survey that collects information from Chinese residents ages 45 and older to explore intrinsic mechanisms between depressive symptoms and all-cause mortality. The Center for Epidemiological Studies Depression Scale (CES-D-10) was validated through the CHARLS. Covariates included socioeconomic variables, living habits, and self-reported history of chronic diseases. Kaplan-Meier curves depicted mortality rates by depressive symptom levels, with Cox proportional hazards regression models estimating the hazard ratios (HRs) of all-cause mortality.

Results

Out of the total 13,855 participants included, the median (Q1, Q3) age was 58.00 (51.00, 63.00) years. Adjusted for all covariates, middle-aged and older adults with depressive symptoms had a higher all-cause mortality rate (HR = 1.20 [95% CI, 1.09-1.33]). An increased rate was observed for 55-64 years old (HR = 1.23 [95% CI, 1.03-1.47]) and more than 65 years old (HR = 1.32 [95% CI, 1.18-1.49]), agricultural Hukou (HR = 1.44, [95% CI, 1.30-1.59]), and nonagricultural workload (HR = 1.81 [95% CI, 1.61-2.03]). Depressive symptoms increased the risks of all-cause mortality among patients with hypertension (HR = 1.19 [95% CI, 1.00-1.40]), diabetes (HR = 1.41[95% CI, 1.02-1.95]), and arthritis (HR = 1.29 [95% CI, 1.09-1.51]).

Conclusion

Depressive symptoms raise all-cause mortality risk, particularly in those aged 55 and above, rural household registration (agricultural Hukou), nonagricultural workers, and middle-aged and older people with hypertension, diabetes, and arthritis. Our findings through the longitudinal data collected in this study offer valuable insights for interventions targeting depression, such as early detection, integrated chronic disease care management, and healthy lifestyles; and community support for depressive symptoms may help to reduce mortality in middle-aged and older people.

The Effects of a Healthy Lifestyle on Depressive Symptoms in Older Chinese Adults: The Mediating Role of Psychological Resilience

Objectives This study aimed to validate the interrelationships and potential pathways of influence between healthy lifestyles, psychological resilience, and depressive symptoms in the Chinese elderly population. Methods We utilized data from the Chinese Elderly Health Influential Factors Tracking Survey 2018 and included 9448 samples for the study after screening according to the qualifying conditions. The interrelationships among healthy lifestyles, psychological resilience and depressive symptoms were analyzed using stepwise regression, and the robustness of mediation effects was assessed using Sobel and Bootstrap test. Results Among Chinese older adults, healthy lifestyles were negatively associated with depressive symptoms (β = -0.310, 95% CI: -0.405, -0.215), positively associated with psychological resilience (β = 0.137, 95% CI:0.071, 0.023), and psychological resilience was negatively associated with depressive symptoms (β = -1.014, 95% CI: -1.037, -0.990). Conclusions Psychological resilience partially mediated the association between healthy lifestyles and depressive symptoms, with the mediating effect accounting for 44.8% of the total effect. Our study contributes to the understanding of the relationship between healthy lifestyles and depressive symptoms in the elderly population and emphasizes the important role of psychological resilience. It is recommended that the government and policymakers improve depressive symptoms among older adults through comprehensive measures such as promoting healthy lifestyles and education, providing psychological support services, and creating a favorable environment.

Chewing difficulties mediated association between edentulism and depressive symptoms among middle aged and older population

BACKGROUND

Depression is a major health condition among the aging population. Previous studies indicated that edentulism was a risk factor for depression. The link between edentulism and depression has not been fully clarified.

OBJECTIVES

This study aimed to estimate whether chewing difficulties play a mediating role in the association between edentulism and depression among middle-aged and older populations with national cross-sectional data.

METHODS

Data were obtained from the latest fourth wave of the China Health and Retirement Longitudinal Study (CHARLS). The outcome variable was set as depression, which was measured by the Center for Epidemiologic Studies Depression Scale (CES-D-10). Independent and mediated variables were separately set as self-assessed edentulism and chewing difficulties. The nearest neighbour propensity score matching (PSM) method was used to construct a matching group to balance the basic characteristics of individuals with and without edentulism with minimised bias in the estimation. Causal mediation analysis was performed to estimate the degree of contribution of chewing difficulties to the association between edentulism and depression. Several sensitivity analyses were performed to evaluate the robustness of the primary result.

RESULTS

A total of 15 853 individuals remained for analysis. After PSM, 809 individuals with edentulism and 2628 without edentulism remained for analysis. Among the matched individuals, the mean age was 66.3 ± 9.2 years, 58.5% were female, 78.8% lived in rural areas, 23.5% had edentulism, 51.1% had depressive symptoms, and 50.1% had chewing difficulties. Logistic regression results showed that a higher incidence of edentulism was associated with a higher rate of depression (OR: 1.39, 95% CI: 1.19-1.63) in the matching group. Causal mediation analysis results indicated that the average mediation effect of chewing difficulties on the association between edentulism and depression was 0.010 (95% CI: 0.005-0.015), and the average direct effect was 0.072 (95% CI: 0.036-0.11). The mediation proportion of chewing difficulties was 11.7% (95% CI: 0.079-0.21).

CONCLUSION

A higher prevalence of edentulism was associated with a higher rate of depression among middle-aged and elderly populations. Chewing difficulties moderately mediated the association between edentulism and depression. Fundamental oral function should not be neglected to improve mental health among the aging population.

Sociocultural factors in relation to mental health within the Inuit population of Nunavik

OBJECTIVE

Built on the Inuit determinants approach of health, this study aimed to identify sociocultural factors associated with mental health among Inuit of Nunavik to guide programs and services.

METHODS

The data were collected through the Qanuilirpitaa? 2017, a survey characterized by the involvement of several Inuit representatives. Depressive symptoms (10-item Center for Epidemiologic Studies-Depression scale, CES-D), lifetime suicide ideation and attempts, and past-year ideation were self-reported mental health indicators. Sociocultural factors represented four thematic domains: social support, community activities, traditional practices, and cultural identity. Analyses tested whether the sociocultural factors were associated with indicators of mental health using weighted multivariate regressions.

RESULTS

Among the sociocultural factors considered, family cohesion and weekly hunting/fishing activities were associated with lower depression scores. Community cohesion and lower cultural identity (centrality scale) were associated with a lower likelihood of past-year and lifetime ideation while family cohesion was related to a lower likelihood of lifetime attempts. People with psychological distress (higher CES-D, suicidal ideation or attempts) were more likely to participate in healing and wellness activities.

CONCLUSION

Although limited by their cross-sectional character, these analyses, based on the community component of the Qanuilirpitaa?, suggest that strengthening of family and community cohesion, and support of regular hunting and fishing deserve further attention as potential cumulative preventive avenues for Inuit mental health.

Sex differences in the psychometric properties of the Center for Epidemiological Studies-Depression (CES-D) Scale in older Filipinos

The literature has yet to fully account for sex differences in the symptomatology and measurement of depressive symptoms, especially in developing settings like the Philippines. Thus, we established the factor structure and assessed the reliability of the 11-item version of the Center for Epidemiological Studies-Depression (CES-D) Scale for assessing depressive symptoms in older Filipino men and women. Using cross-sectional data from 5,209 community-dwelling Filipinos aged 60 and above from a nationally representative survey, Confirmatory Factor Analysis (CFA) and methods in Item Response Theory (IRT) were applied to provide complementary insights into the properties of the scale and its individual items. CFA supported the multidimensionality of the scale. The scale is also sex-invariant, but the relationship between the subfactors and the higher-order factor may differ between men and women. In addition, findings from IRT analysis confirmed the overall utility of the CES-D scale, but positively stated items were found to be internally inconsistent with the rest of the scale. The scale is desirably informative for assessing more severe symptoms, although sex differences were found in the precision of individual items. In general, the 11-item CES-D Scale is an adequate multidimensional tool for assessing moderate to severe depressive symptoms in the older population, especially in older men.

Association between the domestic use of solid cooking fuel and increased prevalence of depression and cognitive impairment in a big developing country: A large-scale population-based study

Background

Previous studies have suggested that air pollution affects physiological and psychological health. Using solid fuel at home is a significant source of indoor air pollution. The associations between solid fuel use and depressive symptoms and cognitive health were unclear among older adults from low- and middle-income countries (LMICs).

Methods

To evaluate the association of solid fuel use with depressive symptoms and cognitive health among older adults, we obtained data from the Longitudinal Aging Study in India (LASI) and excluded subjects younger than 60 years and without critical data (solid fuel use, depressive symptoms, and cognitive health). The 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to assess depressive symptoms, with more than ten indicative of depression. Cognitive health was assessed using measures from the Health and Retirement Study (HRS), and subjects with the lowest 10th percentile were considered to have cognitive impairment. The participants' responses defined solid fuel use. Multivariable logistic regression, linear regression, subgroup analysis, and interaction tests were performed to appraise the relationship between solid fuel use and depression and cognitive impairment.

Results

A total of 29,789 participants over 60 years old were involved in this study. Almost half of the participants (47.5%) reported using solid fuel for home cooking. Compared with clean fuel use, solid fuel use was related to an increased prevalence of depression [odds ratio (OR) 1.09, 95% CI 1.03-1.16] and higher CES-D-10 scores (β 0.23, 95% CI 0.12-0.35) after fully adjusted covariables. Using solid fuel was also related to a higher risk of cognitive impairment (OR 1.21, 95% CI 1.11-1.32) and a lower cognitive score (β -0.63, 95% CI -0.79 to -0.47) compared with those who used clean fuel. In the subgroup analysis, the prevalence of depression increased in females and non-smokers. The association of solid fuel use with depression and cognitive impairment exists in subgroups of BMI, economic status, caste, living area, education, and drinking.

Conclusions

The use of solid fuel at home was associated with an increased prevalence of depression and cognitive impairment among older adults in India.

Depressive symptoms faced by non-native international medical students in China during COVID-19

This study examines depressive symptoms faced by non-native international medical students studying in China during the COVID-19 pandemic. The targeted population for this cross-sectional study included non-native medical students studying in Chinese universities. This study used convenience sampling. An online, self-administered questionnaire was distributed to international medical students studying in Chinese universities from February 2020 to June 2021. The questionnaire collected demographic data, information regarding struggles faced, and used the CES-D-10 Likert scale to assess both the challenges and depression symptoms, respectively. By analyzing the 1,207 students’ responses, the study found that students with poor Chinese language were two times more likely to suffer from depressive symptoms (OR = 2.67; value of p 0.00). Moreover, female students were found more prone (76.35%) than their male counterparts (44.96%). The study found that food adaptability, health issues, accommodation issues, and financial issues were related factors contributing to depressive symptoms among non-native international medical students during the COVID-19 pandemic. The study tried to highlight the factors that resulted in depressive symptoms among non-native international medical students, and the findings may help diplomatic representatives take necessary actions to help their citizens during this difficult time.

Factors Associated With Depression Among Family Caregivers of Patients With Stroke in Indonesia: A Cross-Sectional Study

BACKGROUND

Strokes may lead to increased dependency, which may impact the daily lives of patients with stroke and their family caregivers. Caring for a poststroke family member in Indonesia may differ from other countries in terms of extending beyond the provision of hands-on care. Contradictions and gaps in the factors affecting caregiver depression have been highlighted in a review of the relevant literature. Few studies have examined comprehensively the contradictory factors, uncovered factors, and cultural and spiritual values affecting this phenomenon.

PURPOSE

This study was designed to identify the factors associated with depression in family caregivers of patients with stroke in Indonesia. We examined the following factors related to caregiver depression: demographic characteristics of the caregiver and care recipient, functional ability of the patient, caregiver self-efficacy, knowledge regarding stroke care, and spiritual values.

METHODS

In this cross-sectional study, 157 primary caregivers completed questionnaires involving depression factors during face-to-face interviews. The data were analyzed using multiple logistic regression.

RESULTS

The prevalence of depression among the participants was 56.7%. The overall mean ages of the participants and their care recipients were 43.6 and 57.1 years, respectively. In this study, 65.6% of the participants were female, and 70.1% lacked knowledge regarding stroke care. In the early caregiving phase, caregiver depression was more likely to occur in female caregivers with back pain and long care hours. Self-efficacy in achieving respite time was found to be associated with a lower risk of depression.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Caregivers' gender, presence of back pain, sufficient respite time, and time since stroke occurrence should be considered when providing knowledge, skills, and coping strategies to caregivers to help them adapt to their caregiving role, maintain their quality of life, and prevent the onset of depression. Understanding the factors influencing caregiver depression may help nursing professionals identify individuals at a higher risk of depression early on and provide critical follow-up and early access to supportive counseling.

Relationship between handgrip strength, depression and cognitive functioning among older adults: Evidence from longitudinal ageing study in India

BACKGROUND

Handgrip strength (HGS) is a frequent and general indicator of muscle strength and it may affect several aspects of mental health among older people. This study explored the association of HGS with depression and cognitive impairment among community-dwelling older adults in resource-constrained setting of India.

METHOD

Data were drawn from the Longitudinal Ageing Study in India (LASI), and the analysis was conducted on 27,707 older adults aged 60 years and above. Outcome measures included depression (assessed by the Short Form Composite International Diagnostic Interview (CIDI-SF) and the Center for Epidemiological Studies-Depression (CES-D) scales) and cognitive impairment. Descriptive statistics and mean scores of HGS were reported and multivariable linear regression analyses were conducted to test the research hypotheses of the study.

RESULTS

Mean score of HGS was 24.33 (SD: 7.22) for males and 15.94 (SD: 5.14) for females. Mean age was 68.86 (SD: 7.19) and 68.40 (SD: 7.31) years among males and females respectively. Older participants who had weak HGS were significantly more likely to be depressed in CIDI-SF scale (B: 0.06, CI: 0.01-0.13) and CES-D scale (B: 0.02, CI: 0.01-0.03) in comparison to those who had strong HGS after adjusting for a large number of confounders. Older participants who had weak HGS were significantly more likely (B: 0.92, CI: 0.76-1.07) to have cognitive impairment compared to those who had strong HGS.

CONCLUSION

The findings highlight the independent association of HGS with major depression, depressive symptoms and cognitive impairment that have implications on promoting resistance-training programs among aged population.

The role of religiosity and religious participation in the relationship between depressive symptoms and cognitive impairment among older Indian adults

Due to different nature of social engagements of older adults in South Asian countries specially attributed to the traditional family-based care and support, beneficial effects of religiosity and religious involvement on mental health and cognitive function in older age might be different than those in the Western world. Yet, there is a paucity of research in these countries on the role of religion in moderating the relationship between late life depression and cognition. This study explored the association of depressive symptoms with cognitive impairment and the moderating effects of religiosity and religious participation in those associations among older Indian adults. A cross-sectional study was conducted on data that were drawn from the Longitudinal Ageing Study in India wave-1, collected during 2017-2018. The sample size comprised of 31,464 older adults aged 60 years and above. Shortened 10-item Centre for Epidemiologic Studies Depression Scale was used to measure depressive symptoms. Items from the Mini-Mental State Examination and the cognitive module of the China Health and Retirement Longitudinal Study and the Mexican Health and Aging Study were adapted for measuring cognitive impairment. Moderated multiple linear regression models were used to test the research hypotheses of the study. The proportion of older adults who reported religion as less important to them was 21.24%, whereas, only 19.31% of the respondents participated in religious activities. The mean score of cognitive impairment (on a scale of 0-43) in the current sample was 19.43 [confidence interval (CI): 19.32-19.53] among men and 23.55 [CI: 23.44-23.66] among women. Older adults with depressive symptoms had significantly higher likelihood of cognitive impairment [aCoef: 0.18, CI: 0.16-0.20] in comparison to older adults with no depressive symptoms. Older individuals who were religious were significantly less likely to have cognitive impairment [aCoef: - 0.43, CI: - 0.61 to - 0.25] than their non-religious counterparts. Compared to older adults who did not participate in religious activities, those who participated in religious activities were less likely [aCoef: - 0.52, CI: - 0.69 to - 0.34] to have cognitive impairment. Further, significant moderating effects of religiosity and religious participation in the relationship between depressive symptoms and cognitive impairment were observed. The current study contributes to advancing knowledge about the mental health benefits of religiosity and religious participation by focusing on older adults in India who culturally have limited chances to participate in social activities. The findings suggest that older adults with depressive symptoms may participate in religious activities which may reduce their chances of cognitive impairment. This protective effect of religiosity and religious participation on late life cognitive health has important implications for promoting alternative social support mechanisms for older adults in terms of enhancing their mental wellbeing and contributing to active aging.

Association between work-family conflict and depressive symptoms in female workers: An exploration of potential moderators

Work-family conflict (WFC), an inter-role conflict between work and family, negatively affects mental health. Using a nationally representative systematic sample, this study aimed to investigate the association between WFC, depressive symptoms, and potential moderators in the association of adult female workers. Data of 4714 female workers (aged ≥19 years) were obtained cross-sectionally from the 2018 nationwide Korean Longitudinal Survey of Women and Families (KLoWF). WFC was assessed using a 7-item questionnaire, based on which scores were classified into high (>75th percentile score) and low (≤75th percentile score) levels of WFC. Significant depressive symptoms were defined as a score of ≥10 on the 10-item version of the Center for Epidemiologic Studies for Depression Scale. Female workers with high WFC levels were more likely to have depressive symptoms than those with low WFC levels (odds ratio = 2.29, 95% confidence interval = 1.91-2.74). In stratified analyses, high WFC levels were associated with the highest odds of depressive symptoms in the following groups: young adults (19-39 years), those with a college degree or above or with high income, never-married individuals, those with a family size of three or a single child, nonstandard workers, and pink-collar workers. This study replicated and extended previous findings on the association between WFC and depressive symptoms. The association was moderated by age, education and income levels, marital status, family size, number of children, and job conditions.

Gender discrimination in workplace and depressive symptoms in female employees in South Korea

BACKGROUND

Workplace gender discrimination (WGD) may have long-term negative impacts on female workers' mental health. We aimed to investigate the association between WGD and the prevalence of depressive symptoms using a nationally representative sample of female employees in South Korea.

METHODS

Data of 3190 adult female employees were obtained from the 2018 nationwide Korean Longitudinal Survey of Women and Families. Women's perception of WGD was assessed using a 6-item questionnaire. Respondents were classified into high, medium, and low levels of WGD according to the 25th and 75th percentile scores. A score of ≥10 on the 10-item version of the Center for Epidemiologic Studies for Depression Scale was defined as having significant depressive symptoms.

RESULTS

A high level of WGD was significantly associated with a higher odds ratio (OR) for depressive symptoms compared to the low level (OR = 1.87, 95% confidence interval = 1.45-2.41). In the subgroup analyses, high WGD levels were associated with the highest OR for depressive symptoms in the following subgroups: younger age (19-39 years), those with a college degree, non-standard workers, pink collar workers, those with a workplace size of 10-29 employees, those with high levels of job autonomy, or low levels of emotional labor.

LIMITATIONS

Causal interpretation is limited owing to the study's cross-sectional design.

CONCLUSIONS

A high level of perceived WGD was associated with depressive symptoms among female employees. Certain groups of female employees may be particularly vulnerable to the detrimental effects of WGD on depression.

Association between using social media WeChat and depressive symptoms among middle-aged and older people: findings from a national survey

Objectives

We aimed to assess the characteristics and health status of a study sample using social media WeChat and to identify the association between social media usage and depressive symptoms among people aged 45 and older in China.

Methods

Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were measured by the 10-item form of the Center for Epidemiologic Studies Depression Scale (CES-D-10). The propensity score matching method (PSM) was performed to balance the characteristics of WeChat users and non-WeChat users. Multilevel logistic regression was used to test the association between the incidence of depressive symptoms and WeChat usage by introducing covariates step by step. Sensitivity analysis was conducted to estimate the robustness of the primary findings.

Results

A total of 5415 matching cases out of 11,338 total sample were used in this study to generate the final analysis. A multilevel logistic regression model showed that a significantly lower incidence of depression was related to WeChat usage after adjusting for all possible covariates (OR: 0.76, 95% CI: 0.62–0.94). The most popular WeChat functions used by the study population were watching news (80.4%), posting Moment messages (75.5%), chatting with friends (66.0%), and watching videos (65.2%). The sensitivity analysis yielded similar findings to the primary analyses.

Conclusions

Using social media WeChat showed an association with lower depressive symptoms among people aged ≥45 and older in our study sample. Further studies need to be explored on the promotion and education of social media WeChat usage, targeting the improvement of mental health-related issues through social network connections.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03054-y.

What Is the Optimal Cut-Off Point of the 10-Item Center for Epidemiologic Studies Depression Scale for Screening Depression Among Chinese Individuals Aged 45 and Over? An Exploration Using Latent Profile Analysis

Background

The main objective of the current study was to gain insight into the heterogeneity and profiles of depressive symptoms in Chinese individuals aged 45 and over and to determine the optimal cut-off point for the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) to provide a reference for future practical application.

Methods

The participants were 16,997 Chinese community-dwelling adults aged 45 years or older who completed survey interviews for the 2018 China Health and Retirement Longitudinal Study. The current study utilised latent profile analysis (LPA) to identify distinct profiles based on participants' responses to CES-D-10 items, and receiver operating characteristic (ROC) curve analyses were applied to determine the optimal cut-off point for the CES-D-10 scale.

Results

A three-profile solution was suggested as the optimum and included a "minimal depression" group (63.1%), "mild depression" group (23.4%) and "moderate-severe depression" group (13.5%); 36.9% (95% CI: 36.2 ∼ 37.6%) were considered at risk for probable depression. The "minimal depression" group was viewed as "non-cases," and the remaining were viewed as "cases" that served as the reference standard for the ROC analysis, which obtained an AUC value of 97.8% (95% CI: 97.7-98.0%) and identified an optimal cut-off point of 10 (sensitivity:91.93%, specificity: 92.76%, and accuracy: 92.45).

Conclusion

The identification of these distinct profiles underscores the heterogeneity in depressive symptoms among Chinese middle-aged and older adults. The CES-D-10 scale was demonstrated to have acceptable psychometric properties, with a cut-off point of 10 recommended for future research and practical application.

Perceptions of green space usage, abundance, and quality of green space were associated with better mental health during the COVID-19 pandemic among residents of Denver

BACKGROUND

The COVID-19 pandemic has impacted both physical and mental health. This study aimed to understand whether exposure to green space buffered against stress and distress during the COVID-19 pandemic while taking into account significant stressors of the pandemic.

METHODS

We leveraged a cross-sectional survey on green space exposure and mental health among residents of Denver, CO that ran from November 2019 through January 2021. We measured objective green space as the average NDVI (normalized difference vegetation index) from aerial imagery within 300m and 500m of the participant's residence. Perceived green space was measured through Likert scores on five questions about vegetation near the home that captured perceived abundance, visibility, access, usage, and quality of green space. We used generalized linear models to assess the relationship between each green space exposure variable and perceived stress (PSS-4), depression (CES-D-10), or anxiety (MMPI-2) adjusted for sociodemographic and COVID-19 impact variables.

RESULTS

We found significantly higher depression scores for all covid periods compared to the "before covid" period, and significantly higher anxiety scores during the "fall wave" compared to earlier periods. Adjusted for sociodemographic and pandemic stressors, we found that spending a lot of time in green space (usage) was significantly associated with lower anxiety and depression. We also observed significantly lower depression scores associated with NDVI in both buffers (objective abundance) and significantly lower anxiety scores with perceived abundance of green space. There was some evidence of lower anxiety scores for people reporting having high quality green spaces near the home (quality). We did not observe significant associations for any green space metric and perceived stress after adjustment for confounding variables.

CONCLUSION

Our work provides further evidence of mental health benefits associated with green space exposure during the COVID-19 pandemic even after adjustment for sociodemographic variables and significant pandemic-related stressors.

Prevalence and correlates of multiple behavioural risk factors of non-communicable diseases among university students from 24 countries

BACKGROUND

Globally non-communicable diseases (NCDs) are on the increase. The goal of the study was to estimate the prevalence and correlates of multiple behavioural risk factors of NCDs among university students from 24 countries.

METHODS

In a cross-sectional study, the sample included 18 017 university students from countries in Africa, the Americas and Asia.

RESULTS

indicate that prevalence of single behavioural NCD risk indicators were 38.2% for physical inactivity, 80.5% for inadequate fruit and vegetables intake, 23.1% for having overweight/obesity, 10.5% for heavy alcohol use and 11.8% for current tobacco use. Students had on average 1.6 (SD = 0.9), and 15.9% had three or more behavioural NCD risk factors. In adjusted linear regression, male sex was positively and stronger beliefs in health benefits were negatively associated with multiple behavioural NCD risk factors.

CONCLUSIONS

A high prevalence and co-occurrence of behavioural risk factors of NCDs was discovered. Several behavioural NCD risk factors, such as male sex and low health behaviour benefits beliefs, were found that could be utilized in targeted interventions.

Prevalence and correlates of depression among Black individuals in Canada: The major role of everyday racial discrimination

BACKGROUND

Depression is a common mental health problem causing significant disability globally, including in Canada. Prevalence estimates for depression within Black communities in Canada are unknown. This study determined the prevalence of depression in a sample of Black Canadians and the association between everyday racial discrimination experiences and depression.

METHODS

We analyzed data collected from the Black Community Mental Health project in Canada. Participants provided sociodemographic information and completed measures assessing depressive symptomology, everyday racial discrimination, and social support. The prevalence of depressive symptomatology was computed across sociodemographic variables and categories of everyday racial discrimination. Different regression models were conducted to examine the relationship between depressive symptoms and everyday racism controlling for sociodemographic factors.

RESULTS

In total, 65.87% of participants reported severe depressive symptoms, with higher rates among women, those who are employed, and those born in Canada. The linear regression models showed that everyday racial discrimination is the best predictor of depressive symptoms, with a final model explaining 25% of the variance. A logistic regression model demonstrated that those experiencing a high level of racial discrimination are 36.4 more likely to present severe depressive symptoms when compared to those reporting a low level of discrimination.

CONCLUSIONS

Rates of depressive symptoms among Black individuals are nearly six times the 12-month prevalence reported for the general population in Canada. Racial discrimination, which significantly predicts greater depressive symptomatology, is consistent with earlier studies in the United States and suggests that Canadian colorblind policies may inadvertently reinforce racial discrimination with detrimental effects on mental health.

Impact of the COVID-19 pandemic on change in sleep patterns in an exploratory, cross-sectional online sample of 79 countries

OBJECTIVES

To describe changes in sleep patterns during the coronavirus disease 2019 (COVID-19) pandemic, develop profiles according to these patterns, and assess sociodemographic, economic, COVID-19 related, and sleep and mental health factors associated with these profiles.

DESIGN, SETTING, AND PARTICIPANTS

A 25-minute online survey was distributed worldwide through social media from 5/21/2020 to 7/1/2020.

MEASUREMENTS

Participants reported sociodemographic/economic information, the impact of the pandemic on major life domains, insomnia and depressive symptoms, and changes in sleep midpoint, time-in-bed, total sleep time (TST), sleep efficiency (SE), and nightmare and nap frequency from prior to during the pandemic. Sleep pattern changes were subjected to latent profile analysis. The identified profiles were compared to one another on all aforementioned factors using probit regression analyses.

RESULTS

The sample of 991 participants (ages: 18-80 years; 72.5% women; 60.3% residing outside of the United States) reported significantly delayed sleep midpoint, reductions in TST and SE, and increases in nightmares and naps. Over half reported significant insomnia symptoms, and almost two-thirds reported significant depressive symptoms. Latent profile analysis revealed 4 sleep pattern change profiles that were significantly differentiated by pre-pandemic sleep patterns, gender, and various COVID-19-related impacts on daily living such as severity of change in routines, and family stress and discord.

CONCLUSIONS

In an international online sample, poor sleep and depressive symptoms were widespread, and negative shifts in sleep patterns from pre-pandemic patterns were common. Differences in sleep pattern response to the COVID-19 crisis suggest potential and early targets for behavioral sleep health interventions.

Psychometric evaluation of the Drive for Muscularity Scale among weightlifters in Jamaica

PURPOSE

This study aimed to evaluate the psychometric properties of the Drive for Muscularity Scale (McCreary and Sasse, J Am Coll Health 48(6): 297-304, 2000) (DMS) among a sample of Jamaican male weightlifters.

METHODS

205 weightlifters (M_age = 28.49, SD = 9.61) from rural and urban areas in Jamaica, completed the DMS, the Depression, Anxiety and Stress Scale-21 Items (DASS-21) and the Body Areas Satisfaction Scale (BASS) in a cross-sectional design. Confirmatory factor analysis was performed on the DMS and conventional fit indices used to determine model fit. Measurement invariance was examined for urban and rural participants. Correlations between the DMS scores and the DASS-21 and BASS were determined to examine the validity of the scale.

RESULTS

Confirmatory factor analysis of the original 2-factor model (muscularity-oriented body image and muscularity behaviors) resulted in overall good fit (CFI = .94, TLI = 0.93, RMSEA = 0.06 [0.05, 0.08], SRMR = 0.08). Also, measurement invariance was observed between weightlifters from rural and urban areas. The DMS was principally correlated with specific body areas previously associated with male's body dissatisfaction (muscle tone, upper torso and weight) (r_s = 0.17 to .47). The DMS showed significant weak to moderate negative correlations with the DASS-21 (r_s = - 0.16 to - 0.32). Adequate levels of internal consistency were observed (omega = 0.75-0.88).

CONCLUSION

The DMS showed to be a valid instrument to evaluate the drive for muscularity in Jamaican weightlifters and has utility in informing further research, diagnosis and treatment of body image-related pathologies.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Assessing mental health in a context of extreme poverty: Validation of the rosenberg self-esteem scale in rural Haiti

A widening evidence base across low- and middle-income countries (LMICs) points towards mutually reinforcing linkages between poverty and mental health problems. The use of validated and culturally relevant measures of mental health outcomes is crucial to the expansion of evidence. At present, there is a paucity of measures that have been tested and validated in contexts of extreme poverty. Using data from adult women living in extreme poverty in rural Haiti this study assesses the cross-cultural validity of the widely used Rosenberg Self-Esteem Scale (RSES) and its applicability in assessing linkages between poverty and mental health outcomes. We find no evidence for a one-dimensional 10-factor structure of the RSES within our data and agree with other authors that the standard self-esteem model does not fit well in this cultural context. Comparisons with another widely used measure of mental health-the K6 measure-indicate that the RSES cannot be used as a proxy for mental health outcomes. We conclude that the use of the RSES in different cultural contexts and with samples with different socioeconomic characteristics should be undertaken with caution; and that greater consideration of the validity of psychosocial constructs and their measurement is vital for gaining robust and replicable insights into breaking the cycle between poverty and mental health problems.

Associations of serious physical injuries with posttraumatic stress and depressive symptoms: a cross-sectional survey among university students in 26 countries

Background

Evidence of the relationship between serious physical injury and poor mental health among university students from low- and middle-income countries is limited. The aim of the study is to assess the association between serious physical injury and posttraumatic stress disorder (PTSD) and depressive symptoms in university students from low- and middle-income countries.

Methods

In a cross-sectional survey, 18,382 university students from 26 countries responded to a short screening scale for DSM-IV PTSD, Center for Epidemiologic Studies Depression Scale as well as questions on injury and sociodemographics.

Results

The overall prevalence of past 12-month serious physical injury was 24.7%. In adjusted logistic regression analysis, compared to having no past 12-month serious physical injury, having a past 12-month serious injury was associated with 1.35 (95% CI 1.18, 1.56) times higher odds for PTSD symptoms and 1.49 (95% CI 1.32, 1.67) times higher odds for depressive symptoms in university students.

Conclusion

Compared to students who had not sustained a serious physical injury in the past 12 months, students with an injury had significantly higher PTSD and depressive symptoms. Mental health support of students who sustained physical injuries may prevent PTSD and depressive symptoms.

The Relationship between Food Security Status and Sleep Disturbance among Adults: A Cross-Sectional Study in an Indonesian Population

Background: The relationship between food insecurity and the experience of sleep disturbance has received little attention among researchers, although food insecurity is associated with poor physical and mental health globally. This study aimed to investigate the relationship between food security status and sleep disturbance among adults 20–64 years old. Methods: The study’s population-based sample included 20,212 Indonesian adults who participated in the fifth wave of the Indonesia Family Life Survey (IFLS5) in 2014. Dietary intake data, gathered using a food frequency questionnaire (FFQ), were used to assess the food security status. Sleep disturbance was assessed using the 10-item Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire. We used multiple linear and logistic regression models to test the study hypothesis. Results: A higher likelihood of experiencing sleep disturbance was recorded in people aged older than 56 years (OR = 1.78, 95% CI: 1.17–2.72, p = 0.007), people with depressive symptoms (OR = 3.57, 95% CI: 2.77–4.61, p < 0.001), and food-insecure people (OR = 1.32, 95% CI: 1.02–1.70, p = 0.036). A lower likelihood of experiencing sleep disturbance was recorded in people with low educational attainment (OR = 0.41, 95% CI: 0.30–0.57, p < 0.001). Sleep disturbance was dependent on the food consumption groups and food security status among men (p = 0.004). Conclusions: Sleep disturbance may be affected by the food-insecure status of adults, and later, may lead to serious health outcomes.

Associations of physical partner violence and sexual violence victimization on health risk behaviours and mental health among university students from 25 countries

BACKGROUND

The study aimed to investigate the associations between physical partner violence victimization (IPV) and/or sexual violence victimization and various health risk behaviours and mental health in university students in 25 countries.

METHODS

Using a cross-sectional study design, 18,335 university students with a median age of 20 years from 25 countries in Africa, the Americas and Asia, replied to self-reported measures of interpersonal violence, health compromising behaviours, mental health measures and protective factors.

RESULTS

In adjusted logistic regression analysis, physical IPV and/or sexual violence victimization was associated, among men and/or among women, with sexual risk behaviours (multiple sexual partners, alcohol use in the context of sex, diagnosed with HIV and pregnancy), violence related behaviour (in a physical fight and carrying a weapon), poor mental health (depression, loneliness, post-traumatic stress disorder, sleeping problem and short sleep), addictive behaviour (binge drinking, tobacco and drug use), and other health risk behaviour (skipping breakfast and frequent salt intake).

CONCLUSIONS

We found evidence that physical IPV and/or sexual violence victimization among female and/or male university students was associated with 4 of 5 sexual risk behaviours, 2 violence related behaviours, 5 of 5 poor mental health indicators, 3 of 3 addictive behaviours and 2 of 7 other health risk behaviours.

Association between Depressive Symptoms and Food Insecurity among Indonesian Adults: Results from the 2007-2014 Indonesia Family Life Survey

BACKGROUND

Depressive symptoms and food insecurity are two of the public health concerns in developing countries. Food insecurity is linked to several chronic diseases, while little is known about the association between food insecurity and depressive symptoms among adults. A person with limited or uncertain availability or access to nutritionally sufficient, socially relevant, and safe foods is defined as a food-insecure person.

MATERIALS AND METHODS

Data were obtained from 8613 adults who participated in the Indonesia Family Life Survey (IFLS) in 2007 and 2014. The 10 items of the food frequency questionnaire (FFQ) were used in food consumption score analysis to assess food insecurity based on the concept of the World Food Program (WFP). Depressive symptoms were assessed using 10 items of the self-reported Center for Epidemiologic Studies Depression (CES-D) questionnaire. A linear and multiple logistic regression model with a generalized estimating equation was used to test the hypothesis while accounting for the health behaviors and sociodemographic characteristics.

RESULTS

Food consumption score was negatively associated with CES-D 10 score (β-coefficients: -9.71 × 10-3 to -1.06 × 10-2; 95% CIs: -7.46 × 10-3 to -1.26 × 10-2). The borderline and poor food consumption group was positively associated with the depressive symptoms, both in the unadjusted and adjusted models (exponentiated β-coefficients: 1.13 to 1.18; 95% CIs: 1.06 to 1.28). Conclusions: Depressive symptoms were positively significantly associated with food insecurity. Thus, health professionals must be aware of the issue, and should consider health and nutrition programs for adults at risk of food insecurity.