Improvements in social functioning reported by a birth cohort in mid-adult life: A person-centred analysis of GHQ-28 social dysfunction items using latent class analysis

Updating the study protocol: Insight 46 - a longitudinal neuroscience sub-study of the MRC National Survey of Health and Development - phases 2 and 3

BACKGROUND

Although age is the biggest known risk factor for dementia, there remains uncertainty about other factors over the life course that contribute to a person's risk for cognitive decline later in life. Furthermore, the pathological processes leading to dementia are not fully understood. The main goals of Insight 46-a multi-phase longitudinal observational study-are to collect detailed cognitive, neurological, physical, cardiovascular, and sensory data; to combine those data with genetic and life-course information collected from the MRC National Survey of Health and Development (NSHD; 1946 British birth cohort); and thereby contribute to a better understanding of healthy ageing and dementia.

METHODS/DESIGN

Phase 1 of Insight 46 (2015-2018) involved the recruitment of 502 members of the NSHD (median age = 70.7 years; 49% female) and has been described in detail by Lane and Parker et al. 2017. The present paper describes phase 2 (2018-2021) and phase 3 (2021-ongoing). Of the 502 phase 1 study members who were invited to a phase 2 research visit, 413 were willing to return for a clinic visit in London and 29 participated in a remote research assessment due to COVID-19 restrictions. Phase 3 aims to recruit 250 study members who previously participated in both phases 1 and 2 of Insight 46 (providing a third data time point) and 500 additional members of the NSHD who have not previously participated in Insight 46.

DISCUSSION

The NSHD is the oldest and longest continuously running British birth cohort. Members of the NSHD are now at a critical point in their lives for us to investigate successful ageing and key age-related brain morbidities. Data collected from Insight 46 have the potential to greatly contribute to and impact the field of healthy ageing and dementia by combining unique life course data with longitudinal multiparametric clinical, imaging, and biomarker measurements. Further protocol enhancements are planned, including in-home sleep measurements and the engagement of participants through remote online cognitive testing. Data collected are and will continue to be made available to the scientific community.

Sex Differences in Depression and Anxiety Symptoms: Measurement Invariance, Prevalence, and Symptom Heterogeneity Among University Students in South Africa

Adequate measurement is an essential component of the assessment of mental health disorders and symptoms such as depression and anxiety. The present study investigated sex-specific differences in the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). This comprehensive cross-sectional design study pursued four objectives: measurement invariance of PHQ-9 and GAD-7 between male and female; depression and anxiety prevalence differences; cross-sex differences in the relationship between depression and anxiety; and a comparison of symptom heterogeneity. A sample of 1966 (male = 592; female = 1374; mean age = 21 years) students from South Africa completed the PHQ-9 and the GAD-7. Data analyses for measurement invariance, latent class analysis, inter-variable correlations and group comparisons were conducted in Mplus. The two-dimensional PHQ-9 achieved scalar invariance, while the GAD-7 yielded metric invariance. The somatic and non-somatic latent dimensions of depression were compared and showed no significant difference between male and female groups. The positive relationship between depression and anxiety was also not significantly different between the two groups. While the PHQ-9 symptoms formed three classes in the male group, and four classes in the female group, the GAD-7 had the same number of classes (three) and a similar pattern between the two groups. These findings hold implications for the measurement, assessment and understanding of symptom manifestation and distribution, as well as the treatment of depression and anxiety in South Africa.

Principles of Researching Health Disparities in Longitudinal Cohort Studies Enrolling Children

Health disparities are defined on the basis of specific populations that, when compared to the general population, have a significant disparity on the rate of disease incidence, prevalence, morbidity, mortality, or survival. People that experience health disparities can be defined by multiple criteria. As the diversity of the United States broadens and increases, research on the origins and causes of health disparities becomes more important to support a healthy general population. Children are particularly sensitive to and vulnerable to health disparities due to the potentially life long consequences of events during periods of critical organ, intellectual and social development. The concept of health justice whereby each individual has the opportunity to realize their full health potential can only be realized with proper understanding and relevant data to frame practice, policy and actions. The National Children's Study (NCS) was a longitudinal birth cohort study designed to incorporate the principles of the Federal Collaboration on Health Disparities Research in consultation with subject matter experts, community representatives, and ongoing evaluation to ensure high quality and relevant data on factors that impact health outcomes. The NCS developed and tested a model of enrolling a diverse population, capturing and integrating data using a life course framework, constructing individual profiles, then aggregating individuals into groups based on profiles and outcomes. This approach is applicable to other longitudinal cohort studies.

Investigating the sexual quality of life and its relationship with general health in older men in Iran

INTRODUCTION

Sexual problems in elder people are considered as a public health concern and can affect their overall health and quality of life. This study aimed to investigate the sexual quality of life and its relationship with general health in older men in the west of Iran.

METHODS

This was a cross-sectional study among 362 older men aged 60 years or older attending Comprehensive Health Care Centers in Ilam, Iran. Samples selected through Quota sampling method and simple random sampling. Data were collected using the Sexual Quality of Life Questionnaire-Male and General Health Questionnaire-28.

RESULTS

The mean ± standard deviation (SD) of age was 69.9 ± 8.1 years. The mean ± SD score of sexual quality of life and general health of older men was 46.6 ± 14.6 and 19.2 ± 9.7, respectively. A positive and significant association was found between sexual quality of life and general health (P < 0.001, r = -0.41). Moreover, general health, age, sleep problems, and the level of education were the important predictors for sexual quality of life in elder men (P < 0.05).

CONCLUSION

According to the results, the sexual quality of life of participants was at a moderate level. Since only some factors influencing the sexual quality of life were ascertained, further studies are required to investigate all factors influencing older men's sexual quality of life.

Psychological Distress and Social Functioning in Elderly Spanish People: A Gender Analysis

Psychological distress has been considered a key component in the psychosocial functioning and functional disability of the elderly, but the determining factors of social functioning and psychological distress in the elderly people are not yet fully known. The aim of this study is to perform a gender analysis of the relevance of psychological distress and psychosocial factors in the social functioning of the elderly. A cross-sectional study with a sample of 589 men and 684 women from the general Spanish population aged between 65 and 94 years was conducted. All participants were evaluated through questionnaires and scales that assess psychological distress, social functioning, stress, coping styles, self-esteem and social support. Results: Women scored higher than men in psychological distress, chronic stress, emotional coping and instrumental social support, whereas men scored higher than women in self-esteem and rational coping. Psychological distress was significantly associated in women and men with worse social functioning, which was also lower in older people and in women with lower self-esteem. Psychological distress has a considerable impact on the social functioning of the elderly, and gender is a relevant factor in the psychological distress experienced and its predictors.

Greater variation in affect is associated with lower fasting plasma glucose

Background

Depression and bipolar illness are associated with a 2–3 fold increase in the prevalence of diabetes. However, it is unknown whether variation in mood affects glucose metabolism. The aim of this study was to assess whether changes in affect were related to fasting plasma glucose and glycated haemoglobin.

Methods

379 men and 441 women who took part in the 2003 Health Survey for England and had valid data for GHQ12 and fasting blood glucose were included. Mood variability was assessed by the General Health Questionnaire 12 (GHQ12). Fasting plasma glucose and glycated haemoglobin (HbA_1c) were measured by standard laboratory methodology and their relationship to variability assessed using linear regression.

Results

There was a significant inverse relationship between fasting blood glucose, but not HbA_1c, and variability score (R² = 0.327, p = 0.02) after adjusting for sociodemographic factors, anthropometric measurements, lifestyle, and use of medication.

Conclusion

This study has shown an inverse association between changes in affect and fasting plasma glucose. This unexpected finding suggests that the association between affect and glucose is more complex than previously thought. Fasting blood glucose may reflect the operation of homeostatic mechanisms that are disturbed in certain mental states and are associated, therefore, with altered risk of diabetes and related metabolic conditions. This may have implications for the management of those with such conditions and with mental disorders.

Comparing the Effects of Group and Home-based Physical Activity on Mental Health in the Elderly

BACKGROUND

The present study focuses on comparing the effects of home-based (HB) and group-based (GB) physical activity on mental health in a sample of older adults in Shahr-e-kord.

METHODS

In this quasi-experimental study, a twice-weekly physical activity program for 2 months was provided either individually at home or in a group format for 181 people who were divided into two groups (HB and GB). The outcome, mental health, was measured with the 28-item General Health Questionnaire (GHQ-28).

RESULTS

Mental health status improved after participation in the physical activity program. The decrease in GHQ-28 total score in GB group, 3 months after intervention, was 3.61 ± 2.28 (P < 0.001). In HB group, this reduction was 1.20 ± 2.32 during the same period (P < 0.001). The difference of these "before-after differences" between the two groups in the GHQ-28 and all its subscales was statistically significant (P < 0.001). Also, the effects of GB physical activity on mental health compared with HB physical activity, adjusted for related baseline variables, were significant.

CONCLUSIONS

These findings reveal the probable effects of GB rather than HB physical activity on mental health among the elderly.

Using latent class analysis to model prescription medications in the measurement of falling among a community elderly population

Background

Falls among the elderly are a major public health concern. Therefore, the possibility of a modeling technique which could better estimate fall probability is both timely and needed. Using biomedical, pharmacological and demographic variables as predictors, latent class analysis (LCA) is demonstrated as a tool for the prediction of falls among community dwelling elderly.

Methods

Using a retrospective data-set a two-step LCA modeling approach was employed. First, we looked for the optimal number of latent classes for the seven medical indicators, along with the patients’ prescription medication and three covariates (age, gender, and number of medications). Second, the appropriate latent class structure, with the covariates, were modeled on the distal outcome (fall/no fall). The default estimator was maximum likelihood with robust standard errors. The Pearson chi-square, likelihood ratio chi-square, BIC, Lo-Mendell-Rubin Adjusted Likelihood Ratio test and the bootstrap likelihood ratio test were used for model comparisons.

Results

A review of the model fit indices with covariates shows that a six-class solution was preferred. The predictive probability for latent classes ranged from 84% to 97%. Entropy, a measure of classification accuracy, was good at 90%. Specific prescription medications were found to strongly influence group membership.

Conclusions

In conclusion the LCA method was effective at finding relevant subgroups within a heterogenous at-risk population for falling. This study demonstrated that LCA offers researchers a valuable tool to model medical data.

Characterizing longitudinal patterns of physical activity in mid-adulthood using latent class analysis: results from a prospective cohort study

The authors aimed to describe how longitudinal patterns of physical activity during mid-adulthood (ages 31-53 years) can be characterized using latent class analysis in a population-based birth cohort study, the Medical Research Council's 1946 National Survey of Health and Development. Three different types of physical activity-walking, cycling, and leisure-time physical activity-were analyzed separately using self-reported data collected from questionnaires between 1977 and 1999; 3,847 study members were included in the analysis for one or more types of activity. Patterns of activity differed by sex, so stratified analyses were conducted. Two walking latent classes were identified representing low (52.8% of males in the cohort, 33.5% of females) and high (47.2%, 66.5%) levels of activity. Similar low (91.4%, 82.1%) and high (8.6%, 17.9%) classes were found for cycling, while 3 classes were identified for leisure-time physical activity: "low activity" (46.2%, 48.2%), "sports and leisure activity" (31.0%, 35.3%), and "gardening and do-it-yourself activities" (22.8%, 16.5%). The classes were reasonably or very well separated, with the exception of walking in females. Latent class analysis was found to be a useful tool for characterizing longitudinal patterns of physical activity, even when the measurement instrument differs slightly across ages, which added value in comparison with observed activity at a single age.

A latent class analysis of job satisfaction and turnover among practicing pharmacists

BACKGROUND

Research on job satisfaction and turnover using latent class analysis (LCA) has been conducted in other disciplines. LCA has seldom been applied to social pharmacy research and may be especially useful for examining job situation constructs in pharmacy organizations.

OBJECTIVE

The objective of the study was to determine the probability of turnover among practicing pharmacists using LCA.

METHODS

Using a cross-sectional descriptive design, 2400 randomly selected pharmacists with active licenses in Florida were surveyed. A model was created using LCA, then fit indices were used to determine whether underlying "job satisfaction clusters" were present. Once identified, these clusters along with the covariate practice site were modeled on a distal outcome turnover.

RESULTS

A 5-class model appeared to best fit the data: a "pseudo-satisfied" class that contained 8% of the sample, a "career-goal" class that contained 11% of the sample, a "satisfied class" that contained 44% of the sample, a "job-expectation" class that contained 3% of the sample, and an "unsatisfied class" that contained 17% of the sample. In terms of predicting the distal outcome "turnover," the calculated odds ratios indicate that compared with class 3 or the satisfied group, class 2 was 14 times more likely, class 4 was 17 times more likely, and class 5 was 26 times more likely to state that they do not intend to be employed with their current employer 1 year from now.

CONCLUSION

The LCA method was found to be effective for finding relevant subgroups with a heterogeneous at-risk population for turnover. Results from the analysis indicate that job satisfaction may be parsed into smaller, more interpretable and useful subgroups. This result holds great promise for practitioners and researchers, alike.

Psychometric evaluation and predictive validity of Ryff's psychological well-being items in a UK birth cohort sample of women

Background

Investigations of the structure of psychological well-being items are useful for advancing knowledge of what dimensions define psychological well-being in practice. Ryff has proposed a multidimensional model of psychological well-being and her questionnaire items are widely used but their latent structure and factorial validity remains contentious.

Methods

We applied latent variable models for factor analysis of ordinal/categorical data to a 42-item version of Ryff's psychological well-being scales administered to women aged 52 in a UK birth cohort study (n = 1,179). Construct (predictive) validity was examined against a measure of mental health recorded one year later.

Results

Inter-factor correlations among four of the first-order psychological well-being constructs were sufficiently high (> 0.80) to warrant a parsimonious representation as a second-order general well-being dimension. Method factors for questions reflecting positive and negative item content, orthogonal to the construct factors and assumed independent of each other, improved model fit by removing nuisance variance. Predictive validity correlations between psychological well-being and a multidimensional measure of psychological distress were dominated by the contribution of environmental mastery, in keeping with earlier findings from cross-sectional studies that have correlated well-being and severity of depression.

Conclusion

Our preferred model included a single second-order factor, loaded by four of the six first-order factors, two method factors, and two more distinct first-order factors. Psychological well-being is negatively associated with dimensions of mental health. Further investigation of precision of measurement across the health continuum is required.