Gender differences in social support and physical health

Social support receipt as a predictor of mortality: A cohort study in rural South Africa

The mechanisms connecting various types of social support to mortality have been well-studied in high-income countries. However, less is known about how these relationships function in different socioeconomic contexts. We examined how four domains of social support-emotional, physical, financial, and informational-impact mortality within a sample of older adults living in a rural and resource-constrained setting. Using baseline survey and longitudinal mortality data from HAALSI, we assessed how social support affects mortality in a cohort of 5059 individuals aged 40 years or older in rural Mpumalanga, South Africa. Social support was captured as the self-reported frequency with which close social contacts offered emotional, physical, financial, and informational support to respondents, standardized across the sample to increase interpretability. We used Cox proportional hazard models to evaluate how each support type affected mortality controlling for potential confounders, and assessed potential effect-modification by age and sex. Each of the four support domains had small positive associations with mortality, ranging from a hazard ratio per standard deviation of support of 1.04 [95% CI: 0.95,1.13] for financial support to 1.09 [95% CI: 0.99,1.18] for informational support. Associations were often stronger for females and younger individuals. We find baseline social support to be positively associated with mortality in rural South Africa. Possible explanations include that insufficient social support is not a strong driver of mortality risk in this setting, or that social support does not reach some necessary threshold to buffer against mortality. Additionally, it is possible that the social support measure did not capture more relevant aspects of support, or that our social support measures captured prior morbidity that attracted support before the study began. We highlight approaches to evaluate some of these hypotheses in future research.

Prospective association between social isolation, loneliness and lung function among Chinese middle-aged and older adults

OBJECTIVE

Previous research has highlighted a heightened occurrence of social isolation and loneliness in older adults diagnosed with chronic lung diseases. Nevertheless, there exists a dearth of studies that have explored the influence of impoverished social relationships on lung function. This study aimed to examine the longitudinal association between social isolation, loneliness and lung function over 4 years among middle-aged and older Chinese adults.

METHODS

This study employed two waves (2011 and 2015) of data from the China Health and Retirement Longitudinal Study (CHARLS). The analysis was limited to participants aged 45 years and above and stratified based on gender (3325 men and 3794 women). The measurement of peak expiratory flow (PEF) served as an indicator for assessing lung function. Lagged dependent variable regression models, accounting for covariates, were employed to explore the relationship between baseline social isolation and loneliness and the subsequent PEF.

RESULTS

For women, social isolation was significantly associated with the decline in PEF at follow-up (β = -.06, p < .001) even after adjusting for all covariates; no significant correlation was observed between loneliness and PEF. Among men, there was no significant association found between either social isolation or loneliness and PEF.

CONCLUSIONS

Social isolation is prospectively associated with worse lung function in middle-aged and older Chinese women but not men. The results highlight the importance of promoting social relationships in public health initiatives, especially in groups that are more vulnerable.

Perceived social support and COVID-19 impact on quality of life in college students: an observational study

BACKGROUND

The purposes of this study were to assess the current status of perceived social support and COVID-19 impact on quality of life, to investigate the association of perceived social support with the COVID-19 impact on quality of life, and to examine differences in perceived social support between better and worse COVID-19 impact on quality of life for the total sample and by gender.

METHODS

Participants included 1296 university students (399 male, 871 female, 22 transgender, non-binary, or other) with a mean age of 21.5 (SD  =  2.6 years) from a large public university in the Midwest region of the US. Students voluntarily completed two questionnaires and demographic information via Qualtrics based on a cross-sectional study design. The Multidimensional Scale of Perceived Social Support (MSPSS) is a 12-item survey used to assess an individual's perception of social support from significant others, friends, and family. The COVID-19-Impact on Quality of Life scale (COVID-19 QoL) is a 6-item scale used to assess the impact of COVID-19 on quality of life. Data was analyzed using descriptive statistics, multiple linear regression, independent t-tests, and ANCOVA.

RESULTS

Multiple linear regression showed that perceived social support from family was a significant predictor of COVID-19 QoL (F = 35.154, p < .01) for the total sample. Further, t-test demonstrated significant differences between males and females on perceived social support (t = -2.184, p < .05) as well as COVID-19 QoL (t = -5.542, p < .01). Results of ANCOVA demonstrated a significant group effect on perceived social support for both males (F = 10.054, p < .01, η² = .025) and females (F = 5.978, p < .05, η² = 0.007), indicating that the better quality of life group scored higher on perceived social support than low quality of life.

CONCLUSIONS

Social support from family may act as a key buffer for quality of life during the fall semester of 2020, amid the COVID-19 pandemic in college students. With social interactions restricted during COVID-19, maintained access to social support is highly important.KEY MESSAGESSocial support is a crucial contributing factor to the impact of COVID-19 on quality of life, and support from social relationships may buffer these challenging and unpredictable times.The COVID-19 pandemic may have impacted the quality of life of males and females differently.

Adherence to treatment and harmful effects of medication shortages in the context of severe crises: scale validation and correlates

BACKGROUND

Medication shortage is a public health problem, affecting patients' outcomes mainly through the difficulty in maintaining adherence, particularly in the context of a severe economic crisis. There is a need for a new scale that assesses the effect of medication shortage on adherence.

AIM

To develop and validate a scale to evaluate the harmful impact of medication shortage among the general Lebanese population and assess its correlates and association with medication adherence.

METHODS

A questionnaire was used to assess medication shortage harmful effects and patients' adherence, allowing to generate the Harmful Impact of Medication Shortage scale (HIMS). The factor analysis, convergent validity and reliability of the generated scale were assessed, followed by multivariable regressions to evaluate its correlates.

RESULTS

The developed HIMS scale is a 9-item tool, used to assess how difficult it was for people to deal with medication shortages and their harmful effects on treatment. It was significantly and inversely linked to treatment adherence and affected by the patients' socioeconomic status and the type of chronic disease.

CONCLUSION

The Harmful Impact of Medication Shortage scale could be an efficient tool to measure the detrimental effects of medication shortages among the Lebanese adult population with chronic diseases, particularly affecting treatment adherence. Future studies and evidence are still needed to confirm our findings and help build global mitigation policies addressing medication shortages.

Attachment insecurity, heart rate variability, and perceived social support in a diverse sample of young adults

Psychological and physical factors are robustly associated with perceived social support. Drawing from the literature on attachment style in adults and psychophysiology, we examined the possibility that the interaction of attachment insecurity and resting heart rate variability (HRV) was associated with perceived social support in a diverse sample of young adults living in the U.S (N = 145, Mage = 20.45) that was majority Latino (n = 77). Analyses revealed three key findings. First, in the overall sample, attachment avoidance and attachment anxiety were negatively associated with perceived social support, but in the Latino sample, only attachment avoidance was negatively associated with perceived social support. Second, HRV was not associated with perceived social support in the overall sample nor in the Latino sample. Third, attachment insecurity and HRV interacted to predict perceived social support only in the Latino sample such that, for those with lower levels of HRV, attachment anxiety was positively associated with perceived social support. This study underscores the importance of examining both psychological and physiological processes with careful consideration of ethnicity/culture in order to better understand perceived social support.

The relationship between social support, self-efficacy, and asthma outcomes in older adults

OBJECTIVE

There has been a call for research examining factors that influence asthma outcomes in older adults because of the notable disparities observed in this age group. Social support and self-efficacy are resources that factor into asthma outcomes. The current study aimed to examine the relationship between these resources (independently and jointly) and asthma control and quality of life.

METHODS

Older adults with moderate-severe asthma were recruited from NYC. Data were obtained during in-person interviews via validated measures of social support, asthma self-efficacy, asthma control, and asthma quality of life. Linear regression evaluated self-efficacy in the relationship between social support and asthma outcomes.

RESULTS

In a sample of 359 older adults (M = 68.04, 47.9% Hispanic, 26.5% Black, and 25.6% other), social support had an inverse association with asthma control. As social support increased, asthma control decreased (β = 0.95, t(356) = -3.13, p = .002). Self-efficacy significantly moderated this relationship (β = 0.01, t(356) = 2.37, p = .018). For individuals with low or moderate asthma self-efficacy, more received social support was associated with worse asthma control (β = -0.33, t(356) = -4.66, p < .0001; β = -0.20, t(356) = -3.21, p = .0014, respectively). For individuals with high self-efficacy, no relationship was found between received social support and asthma control (β = -0.10, t(356)= -1.20, p =.23). For asthma quality of life, higher levels of received social support were associated with worse quality of life (β = -0.88, t(356) = -2.64, p = .009), but this association was not significantly moderated by self-efficacy (β = 0.01, t(356) = 1.90, p = .0582).

CONCLUSIONS

For older adults with asthma, receiving more social support is associated with worse asthma outcomes, especially for older adults with lower asthma self-efficacy.

Disparities in transitions of acute stroke care: The transitions of care stroke disparities study methodological report

OBJECTIVE

The Transitions of Stroke Care Disparities Study (TCSD-S) is an observational study designed to determine race-ethnic and sex disparities in post-hospital discharge transitions of stroke care and stroke outcomes and to develop hospital-level initiatives to reduce these disparities to improve stroke outcomes.

MATERIALS AND METHODS

Here, we present the study rationale, describe the methodology, report preliminary outcomes, and discuss a critical need for the development, implementation, and dissemination of interventions for successful post-hospital transition of stroke care. The preliminary outcomes describe the demographic, stroke risk factor, socioeconomic, and acute care characteristics of eligible participants by race-ethnicity and sex. We also report on all-cause and vascular-related death, readmissions, and hospital/emergency room representations at 30- and 90-days after hospital discharge.

RESULTS

The preliminary sample included data from 1048 ischemic stroke and intracerebral hemorrhage discharged from 10 comprehensive stroke centers across the state of Florida. The overall sample was 45% female, 22% Non-Hispanic Black and 21% Hispanic participants, with an average age of 64 ± 14 years. All cause death, readmissions, or hospital/emergency room representations are 10% and 19% at 30 and 90 days, respectively. One in 5 outcomes was vascular-related.

CONCLUSIONS

This study highlights the transition from stroke hospitalization as an area in need for considerable improvement in systems of care for stroke patients discharged from hospital. Results from our preliminary analysis highlight the importance of investigating race-ethnic and sex differences in post-stroke outcomes.

Screening and identification of key biomarkers of depression using bioinformatics

We aimed to identify the molecular biomarkers of MDD disease progression to uncover potential mechanisms of major depressive disorder (MDD). In this study, three microarray data sets, GSE44593, GSE12654, and GSE54563, were cited from the Gene Expression Omnibus database for performance evaluation. To perform molecular functional enrichment analyses, differentially expressed genes (DEGs) were identified, and a protein-protein interaction network was configured using the Search Tool for the Retrieval of Interacting Genes/Proteins and Cytoscape. To assess multi-purpose functions and pathways, such as signal transduction, plasma membrane, protein binding, and cancer pathways, a total of 220 DEGs, including 143 upregulated and 77 downregulated genes, were selected. Additionally, six central genes were observed, including electron transport system variant transcription factor 6, FMS-related receptor tyrosine kinase 3, carnosine synthetase 1, solute carrier family 22 member 13, prostaglandin endoperoxide synthetase 2, and protein serine kinase H1, which had a significant impact on cell proliferation, extracellular exosome, protein binding, and hypoxia-inducible factor 1 signaling pathway. This study enhances our understanding of the molecular mechanism of the occurrence and progression of MDD and provides candidate targets for its diagnosis and treatment.

Thriving together: the benefits of women's social ties for physical, psychological and relationship health

The relationship between social support and well-being is well established in social psychology, with evidence suggesting that these benefits are especially prominent among women. When faced with an environmental stressor, women are more likely to adopt a tend-and-befriend strategy rather than fight-or-flight. Furthermore, female friendships tend to be higher in self-disclosure and more frequently relied on for social support, which is associated with physical and psychological benefits. Women are also more effective at providing social support, further augmenting those benefits. We begin with an overview of the characteristics of women's social ties and how they can be especially useful in times of stress. We then transition to the benefits of female social networks even in the absence of negative events and incorporate research from health and social psychology to consider the positive implications of having strong social bonds and the negative implications of lacking such bonds. Additionally, we consider cross-cultural differences in tendencies to seek out social support and its subsequent benefits, as well as the need for more research with culturally diverse samples. It remains unclear the extent to which patterns of social support benefits for women vary cross-culturally. This article is part of the theme issue 'Cooperation among women: evolutionary and cross-cultural perspectives'.

Satisfaction with life and associated factors among elderly people living in two cities in northwest Ethiopia: a community-based cross-sectional study

OBJECTIVE

This study aimed to determine the level of life satisfaction and identify associated factors among elderly people living in two cities in northwest Ethiopia.

DESIGN

Community-based cross-sectional study.

SETTING

Two cities in northwest Ethiopia (Gondar and Bahir Dar).

PARTICIPANTS

816 elderly people age 60 years and above living in Gondar and Bahir Dar, northwest Ethiopia. Systematic random sampling was used to select study participants.

MAIN OUTCOME MEASURE

Level of life satisfaction. Considering the mean and SD, three levels of satisfaction appeared to suffice as the basis for analysis and discussion: 23.5-34.4 dissatisfied, 34.5-56.5 averagely satisfied and 56.6-67.5 satisfied. Multivariable ordinal regression analysis was done to control the confounders. Since the outcome variable has an ordinal category, ordinal regression analysis is appropriate. A p≤0.05 and AOR (adjusted OR) with a 95% CI were considered to determine the statistically significant variables and strength of the association.

RESULTS

The mean age of the respondents was 68.2 years with an SD±7.2. The level of life satisfaction was: dissatisfied 17.2%, moderately satisfied 63.8% and well satisfied 19.0%. Overall, 45.8% (95% CI 42.2% to 49.2%) of the participants had a score equal to or above the mean. Regarding associated factors; retired current occupation (AOR=2.23, 95% CI 1.09 to 4.55), good self-rated health status (AOR=2.54, 95% CI 1.29 to 4.99), having no chronic disease (AOR=1.48, 95% CI 1.03 to 2.11), somewhat-good (AOR=2.15, 95% CI 1.12 to 4.13) and good (AOR=4.51, 95% CI 2.40 to 8.45) self-perception on ageing life, moderate functional impairment on daily living activities (AOR=5.43, 95% CI 1.81 to 16.24), high sense of coherence (AOR=3.80, 95% CI 2.04 to 7.08), house rent as a source of finance (AOR=2.60, 95% CI 1.49 to 4.52) and high perceived social support (AOR=2.13, 95% CI 1.44 to 3.16) had statistically significant association with the life satisfaction.

CONCLUSION

The life satisfaction level in our study group was lower than in some more highly developed countries. To improve the level of life satisfaction in Ethiopia, a holistic programme of nursing care for elderly people, particularly as concerns about their health and psychosocial conditions is crucial in both community and clinical settings.

The relationship between perceived stress and support with blood pressure in urban Haiti: A cross-sectional analysis

Haiti is a low-income country whose population lives under repeated and chronic stress from multiple natural disasters, civil unrest, and extreme poverty. Stress has been associated with cardiovascular (CVD) risk factors including hypertension, and the impact of stress on blood pressure may be moderated by support. The distribution of stress, support, and their association with blood pressure has not been well described in low-income countries. We measured stress and support using validated instruments on cross-sectional enrollment data of a population-based cohort of 2,817 adults living in Port-au-Prince, Haiti between March 2019 and April 2021. Stress was measured using the Perceived Stress Scale, while support was measured using the Multidimensional Scale of Perceived Social Support. Continuous scores were categorized into three groups for stress (low (1-5), moderate (6-10), high (11-16), and five groups for support (low (7-21), low-moderate (22-35), moderate (36-49), moderate-high (50-64), high (65-77)). Linear regression models were used to quantify the associations between: 1) support and stress adjusting for age and sex, and 2) stress and blood pressure adjusting for age and sex. A moderation analysis was conducted to assess if support moderated the relationship between stress and blood pressure. The cohort included 59.7% females and the median age was 40 years (IQR 28-55). The majority had an income <1 US dollar per day. The median stress score was moderate (8 out of 16 points, IQR 6-10), and median support score was moderate to high (61 out of 77 points, IQR 49-71). Stress was higher with older ages (60+ years versus 18-29 years: +0.79 points, 95% CI 0.51 to 1.08) and in females (+0.85 points, 95% CI +0.65 to +1.06). Support was higher in males (+3.29 points, 95% CI 2.19 to 4.39). Support was inversely associated with stress, adjusting for age and sex (-0.04 points per one unit increase in support, 95% CI -0.04 to -0.03). Stress was not associated with systolic or diastolic blood pressure after adjustment for age and sex. Support did not moderate the association between stress and blood pressure. In this urban cohort of Haitian adults living with chronic civil instability and extreme poverty, perceived levels of stress and social support were moderate and high, respectively. Contrary to prior literature, we did not find an association between stress and blood pressure. While support was associated with lower stress, it did not moderate the relationship between stress and blood pressure. Participants reported high levels of support, which may be an underutilized resource in reducing stress, potentially impacting health behaviors and outcomes.

Attachment voices promote safety learning in humans: A critical role for P2

Humans have evolved to seek the proximity of attachment figures during times of threat in order to obtain a sense of safety. In this context, we examined whether or not the voice of an intimate partner (termed "attachment voice") could reduce fear-learning of conditioned stimuli (CS+) and enhance learning of safety signals (CS-). Although the ability to learn safety signals is vital for human survival, few studies have explored how attachment voices affect safety learning. To test our hypothesis, we recruited thirty-five young couples and performed a classic Pavlovian conditioning experiment, recording behavioral and electroencephalographic (EEG) data. The results showed that compared with a stranger's voice, the voices of the partners reduced expectancy of the unconditioned stimulus (a shock) during fear-conditioning, as well as the magnitude of P2 event-related potentials within the EEG responses, provided the voices were safety signals. Additionally, behavioral and EEG responses to the CS+ and CS- differed more when the participants heard their partner's voice than when they heard the stranger's voice. Thus, attachment voices, even as pure vowel sounds without any semantic information, enhanced acquisition of conditioned safety (CS-). These findings may provide implications for investigating other new techniques to improve clinical treatments for fear- and anxiety-related disorders and for psychological interventions against the mental health effects of the public health emergency.

The Dyadic Health Influence Model

Relationship partners affect one another's health outcomes through their health behaviors, yet how this occurs is not well understood. To fill this gap, we present the Dyadic Health Influence Model (DHIM). The DHIM identifies three routes through which a person (the agent) can impact the health beliefs and behavior of their partner (the target). An agent may (a) model health behaviors and shape the shared environment, (b) enact behaviors that promote their relationship, and/or (c) employ strategies to intentionally influence the target's health behavior. A central premise of the DHIM is that agents act based on their beliefs about their partner's health and their relationship. In turn, their actions have consequences not only for targets' health behavior but also for their relationship. We review theoretical and empirical research that provides initial support for the routes and offer testable predictions at the intersection of health behavior change research and relationship science.

Socioeconomic status and depressive symptoms in older people with the mediation role of social support: A population-based longitudinal study

BACKGROUND

Depressive symptoms has become an increasingly important public health issue, contributing to disability and disease burden around the world. Higher socioeconomic status (SES) has been found to be associated with lower prevalence of depression, but there are few studies about the older Chinese adults with long-term follow up and rigorous prospective design. Meanwhile, there is little conclusive evidence about the mechanisms through which SES influences the onset of depressive symptoms.

OBJECTIVE

To prospectively examine the association of baseline socioeconomic factors with the risks of developing depressive symptoms during 7-year follow up in older Chinese population, and to study the mechanism by which SES impacts the prevalence of depressive symptoms.

METHODS

A total of 5677 individuals over 45 years who participated in an ongoing nationally representative prospective cohort study, China Health and Retirement Longitudinal Study, were free from depressive symptoms at baseline, and completed 7-year follow-up were included. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale score. Cox proportional hazards regression models were used to examine the association of SES and the incidence of depressive symptoms in 2011 to 2018. Generalized structural equation model was used to analyze the mediation effects of social support on the relation between SES and depressive symptoms.

RESULTS

During the 7-year follow-up, 2398 (42.2%) cases were identified as depressive symptoms. Compared with the lowest level of household income, participants with the highest level of household income had a 20% reduction in risk (95% CI, 0.70-0.92, P < 0.001). Participants who had junior high school or above education had a 41% lower risk of depressive disorders compared with illiterate participants (95% CI, 0.52-0.69, P < 0.001). The relationship between SES and depressive symptoms was partially mediated by the social support, where higher social support was negatively associated with depressive symptoms. The proportion of mediation effect was even larger for women compared with men.

CONCLUSION

Socioeconomic factors were independently associated with the development of depressive symptoms, and the relationship was partially mediated by social support. Social support could be an effective intervention to alleviate the negative effects of lower SES on mental health. Multiple-level policies should precisely target low-SES groups, and timely intervention to promote social support for this group should be used to reduce the influence of depression on individuals, family as well as the whole society.

Social isolation, rather than loneliness, is associated with cognitive decline in older adults: the China Health and Retirement Longitudinal Study

BACKGROUND

Social isolation and loneliness have each been associated with cognitive decline, but most previous research is limited to Western populations. This study examined the relationships of social isolation and loneliness on cognitive function among Chinese older adults.

METHODS

This study used two waves of data (2011 and 2015) from the China Health and Retirement Longitudinal Study (CHARLS) and analyses were restricted to those respondents aged 50 and older. Social isolation, loneliness, and cognitive function were measured at baseline. Follow-up measures on cognitive function were obtained for 7761 participants (mean age = 60.97, s.d. = 7.31; male, 50.8%). Lagged dependent variable models adjusted for confounding factors were used to evaluate the association between baseline isolation, loneliness, and cognitive function at follow-up.

RESULTS

Loneliness was significantly associated with the cognitive decline at follow-up (episodic memory: β = -0.03, p < 0.01; mental status: β = -0.03, p < 0.01) in the partially adjusted models. These associations became insignificant after additional confounding variables (chronic diseases, health behaviors, disabilities, and depressive symptoms) were taken into account (all p > 0.05). By contrast, social isolation was significantly associated with decreases in all cognitive function measures at follow-up (episodic memory: β = -0.05, p < 0.001; mental status: β = -0.03, p < 0.01) even after controlling for loneliness and all confounding variables.

CONCLUSIONS

Social isolation is associated with cognitive decline in Chinese older adults, and the relationships are independent of loneliness. These findings expand our knowledge about the links between social relationships and the cognitive function in non-Western populations.

Non-spousal family support, marital status, and heart problems in adulthood

OBJECTIVES

Support from one's spouse has long been documented as a significant determinant of health for married individuals. However, non-spousal family support may play an important role in health particularly for unmarried individuals. Therefore, this study examined whether the association between non-spousal family support and diagnosis of heart problems differed by marital status and whether gender and education moderated these associations.

DESIGN

Data came from the first two waves of the Midlife in the United States (MIDUS) study. This study selected respondents who participated in both waves of MIDUS and were not diagnosed with a heart problem at Wave 1 (N = 3,119).

MAIN OUTCOME MEASURES

Participants reported whether they had any heart trouble. Discrete-time event history analysis was used to examine the risk of heart problems between MIDUS Waves 1 and 2.

RESULTS

A higher level of non-spousal family support was associated with a lower risk of developing a heart problem only among unmarried women and unmarried individuals with high school education or less, and not for married individuals.

CONCLUSION

Findings highlight the importance of considering specific sources of family support when studying heart health, and the health-protective role of non-spousal family support for those who are not married.

Health related quality of life in adult cancer survivors: Importance of social and emotional support

BACKGROUND

Adult cancer survivors (ACS) are at increased risk for developing various comorbid conditions and having poor health-related quality of life (HRQOL) when compared to adults with no history of cancer. The effect of social and emotional support on HRQOL among ACS is not fully elucidated. The purpose of this study was to understand the role of social and emotional support on HRQOL in ACS and to examine if the association between social and emotional support and HRQOL is modified by gender, time since cancer diagnosis, or marital status.

METHODS

Data for this study were obtained from the 2009 Behavioral Risk Factor Surveillance System. Statistical analysis was based on ACS with complete data (n = 23,939) on all variables considered. Multivariable logistic regression models were used to model the association between social and emotional support and indicators of HRQOL (i.e., general health, physical health, mental health, and activity limitation). To examine if gender, marital status, or the number of years since cancer diagnosis modify the association, separate stratified analyses were conducted.

RESULTS

When compared to ACS who reported that they Rarely/Never received social and emotional support, those who reported that they Always received were 32 % less likely to report Fair/Poor General health, 23 % less likely to report frequent unhealthy days of Physical health, 73 % less likely to report frequent unhealthy days of Mental health and 38 % less likely to report frequent unhealthy days of Activity limitation. Social and emotional support was positively associated with all four domains of HRQOL among ACS who were female, unmarried, or greater than 5 years since cancer diagnosis, while this positive association was evident only with one or two domains of HRQOL among their corresponding counterparts (i.e., male, married, less than 5 years since diagnosis).

CONCLUSIONS

Social and emotional support is an important factor directly related to a better HRQOL, but it is modified by gender, marital status, and time since diagnosis. Findings from this study should inform health care providers about the importance of a support system for ACS in improving their overall quality of life.

Differences in menopausal symptoms and female sexual function by region and ethnicity in West Texas and Central Arizona: a cross-sectional survey

OBJECTIVE

To evaluate menopausal symptoms and sexual problems in Hispanic and non-Hispanic women in two Southwest areas.

METHODS

An anonymous survey including the Green Climacteric Scale (GCS), Female Sexual Function Index (FSFI), and demographics was distributed to English and Spanish-speaking women age 40 to 60 in Scottsdale, Arizona, and West Texas. FSFI for sexually active women and GCS scores for the Hispanic and non-Hispanic women in Texas were analyzed with multivariable analysis and compared between Texas and Arizona for Non-Hispanic participants.

RESULTS

Predominantly non-Hispanic women (70%), average age 51.5 (SD = 7.25) completed questionnaires (199 West Texas, 163 Scottsdale). A majority of sexually active women (88%) were found to be at risk of sexual dysfunction. Within the Texas cohort, GCS score was estimated to be 3.49 points lower (less symptoms) in Hispanic versus non-Hispanic participants [95% CI -6.58 to -0.40, P = 0.03], and FSFI score was estimated to be 2.31 points lower (more symptoms) in Hispanic versus non-Hispanic participants [95% CI -4.49 to -0.14, P = 0.04]. Among non-Hispanic women, GCS scores were lower (less symptoms) in Texas versus Arizona by 10.25 points [95% CI -14.83 to -5.66, P < 0.01], while FSFI scores were higher overall (less symptoms) in Texas by 3.65 points [95% CI 0.53-6.77), P = 0.02]. All FSFI and GCS scores were adjusted for multiple variables.

CONCLUSIONS

In a group of menopausal women from the Southwest, most reported symptoms were consistent with FSD, and the degree of sexual problems appeared to be greater in the Hispanic participants from Texas.

Egocentric network characteristics of persons with Type 1 diabetes and their relationships to perceived social support and well-being

Objectives: The size of one's support network is positively related to health and well-being. It is therefore important to understand this association in people with Type 1 diabetes, as this could inform interventions. Moreover, the type of support (emotional, instrumental, informational) offered likely varies by gender of both the person seeking support and offering support. We thus examine the relationship between the composition of (perceived) social support networks and well-being in a sample of 121 persons with Type 1 diabetes. Design: An egocentric social network survey, combined with survey measures. Main outcome(s): The size and composition of support networks and well-being. Measures: Participants indicated the type of support individuals in their contact network offered and their gender, alongside measures of perceived social support and well-being. They indicated which individuals offered which types of support (emotional, instrumental, informational). Results: Perceived support was associated with the actual size of the emotional support network. Further, the size of the emotional support network was associated with well-being. Using multilevel models we examined assortment by gender in social support networks. Compared to women, men were more inclined to list the opposite gender as support, especially for emotional and informational support. Conclusion: Mapping out an individual's multidimensional support network paints a more complete picture of support than single item measures of support. We therefore recommend relying on a social network methodology to gain a more complete understanding of support networks. The findings highlight that an association exists between emotional network size and wellbeing. Given the potential implications of this finding for the quality of life of diabetes patients, it is important to establish the causality of this relationship.

The influence of social support on cognitive health in older women: a Women's Health Initiative study

Social support is associated prospectively with cognitive decline and dementia among the elderly; however, little is known about the impact of social support on healthy neurological aging. The current study investigates whether perceived social support has an influence on neurological health among a large sample of healthy postmenopausal women. Social support and neuropsychological outcomes were measured annually for six years through the Women's Health Initiative Study of Cognitive Aging. In postmenopausal women, higher perceived social support was associated with significantly better overall neuropsychological functioning at baseline, especially in the domains of short-delay figural memory, short-delay verbal memory, and semantic fluency. No significant associations were found between social support and longitudinal changes in neuropsychological function over a median follow-up period of six years. Additionally, there was no significant relationship between social support and regional brain volumes. These findings suggest that social support is related to performance in a subset of neuropsychological domains and contributes to the existing literature that points to the importance of social support as a modifiable lifestyle factor that has the potential to help protect against the decline of cognitive aging, specifically among older adult women.

Social isolation, loneliness and functional disability in Chinese older women and men: a longitudinal study

OBJECTIVE

This study investigated whether loneliness or social isolation is associated with the onset of functional disability over 4 years among Chinese older populations.

SETTING AND SUBJECTS

This study used data from the China Health and Retirement Longitudinal Study (CHARLS). Functional status was assessed by activities of daily living (ADL) and instrumental activities of daily living (IADL). Analyses were conducted with data from two waves (2011 and 2015) and were restricted to those respondents aged 50 and older and free of functional disability at baseline [n = 5,154, mean age (SD) = 60.72 (7.51); male, 52.3%].

METHOD

Social isolation, loneliness and covariates were measured at baseline. Follow-up measures of new-onset ADL and IADL disability were obtained 4 years later. We stratified the sample by gender, and then used binary logistic regressions to evaluate the associations between baseline isolation, loneliness and new-onset ADL and IADL disability.

RESULTS

For women, baseline social isolation was significantly associated with new-onset ADL (OR = 1.18, 95% CI = 1.07-1.30) and IADL (OR = 1.11, 95% CI = 1.01-1.21) disability; no significant association between loneliness and ADL or IADL disability was found. For men, neither social isolation nor loneliness was found to be significantly associated with ADL or IADL disability.

CONCLUSION

This longitudinal study found that social isolation, rather than loneliness, was significantly associated with functional disability over 4 years among women (but not men) in China. These findings expand our knowledge about the association between social relationships and functional status among non-Western populations.

Predictors of change in BMI over 10 years among midlife and older adults: Associations with gender, CVD risk status, depressive symptoms, and social support

RATIONALE

Change in BMI is recognized as a key health indicator among midlife and older adults, though predictors of BMI change in this group have received little attention.

OBJECTIVE

The aim of this study was to examine relations between hypothesized predictors (i.e., gender, cardiovascular disease [CVD] risk status, depressive symptoms, social support) and BMI change over 10 years, among midlife and older adults.

METHODS

Participants were adults ages 50-74 at baseline (N = 5,688, 64% women) who completed four assessments over 10 years. Gender, CVD risk status (i.e., diagnosis of hypertension, type 2 diabetes, or both), depressive symptoms, and perceived social support were assessed at baseline, and BMI was calculated from height and weight reports at all assessments. Multilevel models tested for concurrent and prospective relations between predictors and BMI change (effect size estimates as semipartial correlation coefficients, sr), as well as whether observed relations were further moderated by baseline BMI category (underweight, healthy weight, overweight, or obese).

RESULTS

Baseline BMI was higher among those with (vs. without) CVD risk, higher (vs. lower) depressive symptoms, and lower (vs. higher) social support; all of these relations were moderated by gender (ps < 0.05, srs 0.03-0.32). Moreover, BMI showed significant change over 10 years, and BMI variability during this time was higher among women (vs. men) and those with (vs. without) CVD risk (ps < 0.0001). BMI change also differed by CVD risk status, and this relation was moderated by gender, baseline depressive symptoms, and baseline BMI category (ps < 0.05, srs 0.03-0.08).

CONCLUSIONS

Although the predictors of interest were not associated with steady BMI decreases (which are associated with long term health risks for older adults), findings reveal unique patterns of change in BMI among subgroups of midlife and older adults, and may allow for early identification of those with noteworthy BMI changes after age 50.

Pregnancy loss experiences of couples in a phenomenological study: Gender differences within the Turkish sociocultural context

Despite the high prevalence of miscarriage and stillbirth, prenatally bereaved couples tend to experience a sense of isolation or loneliness after their loss. The purpose of this study was to describe the prenatal loss experiences of partners from a sociocultural perspective. Data were gathered via semi-structured interviews with 10 couples (n = 20). The findings of the study reflected the inner experiences of partners, how sociocultural context has impacted their grief experiences, and how women's and men's grief reactions differ within this sociocultural context.

Couples After Renal Transplantation: Impact of Sex and Relationship Quality on Adherence in a Prospective Study

BACKGROUND

In patients after kidney transplantation, nonadherence to immunosuppressant medication is a common problem. Identifying factors that influence adherence could optimize medical care and prevent nonadherence. Kidney transplantation is a stressful situation for the patient and also for the relatives. The recipients of renal transplants as well as the family system have to be taken into account as potential impact factors.

METHODS

Fifty-six couples with a renal transplant recipient were investigated regarding adherence, relationship satisfaction, social support, and quality of life. Moreover, sex and role differences (patient vs partner) as well as differences within the couple were analyzed. Impact factors on adherence were identified.

RESULTS

Female recipients of renal transplant reported higher relationship satisfaction than male recipients, female spouses, and male spouses. Physical quality of life was lower in renal transplant recipients compared with caregivers. For male renal transplant recipients, significant predictors of adherence, such as social support, relationship quality, and quality of life emerged, whereas for female renal transplant recipients mental quality of life and education level were found to influence adherence.

CONCLUSIONS

The study reveals the importance of relationship functioning of couples after kidney transplantation, as well as considering sex and role differences. There is a need to examine the posttransplantation nonadherence risk profile of women and men separately.

Social isolation and cognitive decline among older adults with depressive symptoms: prospective findings from the China Health and Retirement Longitudinal Study

OBJECTIVES

Identifying potentially modifiable risk factors of cognitive decline among people with depressive symptoms could provide insight into strategies for improving treatment effect of depression and prevention of dementia. Quite a few studies have examined the association between social isolation and cognitive function directly among depressed older adults and the results are still mixed. The aim is to examine the association of social isolation and cognitive decline among older adults with depressive symptoms in a non-Western country.

METHODS

This study used data from the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were measured by the Chinese version of the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) (elevated depressive symptom cutoff≥10). Social isolation was assessed based on responses to four items: marital status, residence, contact with children, and social activity. Lagged dependent variable regressions adjusted for confounding factors were used to evaluate the association between baseline social isolation and follow-up cognitive function.

RESULTS

A number of 2,507 participants [mean age (SD)=61.37 (7.26); male, 41.0%] with increased depressive symptoms were available for the present study. Baseline social isolation was significantly associated with 4-year episodic memory (β=-0.08, p<0.001) in depressed women, but not men (β=-0.03, p=0.350). No significant association between baseline social isolation and follow-up mental status was found for women (β=-0.04, p=0.097) or men (β=0.01, p=0.741).

DISCUSSION

This longitudinal study found that social isolation was significantly associated with memory decline over 4 years among depressed women (but not men) in China.

Gender and stress-buffering of social capital toward depression among precarious workers in South Korea

BACKGROUND

Precarious work is featured with disadvantaged job conditions such as to employment contract, job description, and occupational environment, and has been recognized as an emerging social risk for mental health. Social capital deserves further attention, believed to buffer stress produced by precarious employment. Yet, recent evidence suggests that the mental health benefits of social capital vary by gender, as gender norms that oblige women to assume a caregiving burden may nullify the benefits of a richer social capital.

OBJECTIVE

Our study focused on two types of social capital, bonding and bridging, testing their stress-buffering effects, as focusing on the posited gender-moderated effects of social capital.

METHODS

We analyzed 333 precarious workers in South Korea. Chi-square tests and t-tests are used to compare socio-demographic factors, depressive symptoms, and daily stressors by gender. Multiple regression analyses were used to test significance of an interaction term between daily stress and sub-domains of social capital by gender.

RESULTS

Male workers with higher bonding and higher bridging social capital reported lower depressive symptoms. Yet, female workers gained no direct benefit from higher bonding social capital and those with higher bridging social capital reported even higher depressive symptoms when their daily stress was lower.

CONCLUSIONS

Our findings support the notion that social capital is not universally beneficial and female precarious workers lacking resources seem to suffer despite increased social participation.

Social isolation, rather than loneliness, is associated with cognitive decline in older adults: the China Health and Retirement Longitudinal Study

BACKGROUND

Social isolation and loneliness have each been associated with cognitive decline, but most previous research is limited to Western populations. This study examined the relationships of social isolation and loneliness on cognitive function among Chinese older adults.

METHODS

This study used two waves of data (2011 and 2015) from the China Health and Retirement Longitudinal Study and analyses were restricted to those respondents aged 50 and older. Social isolation, loneliness, and cognitive function were measured at baseline. Follow-up measures on cognitive function were obtained for 7761 participants (mean age = 60.97, s.d. = 7.31; male, 50.8%). Lagged dependent variable models adjusted for confounding factors were used to evaluate the association between baseline isolation, loneliness, and cognitive function at follow-up.

RESULTS

Loneliness was significantly associated with the cognitive decline at follow-up (episodic memory: β = -0.03, p < 0.01; mental status: β = -0.03, p < 0.01) in the partially adjusted models. These associations became insignificant after additional confounding variables (chronic diseases, health behaviors, disabilities, and depressive symptoms) were taken into account (all p > 0.05). By contrast, social isolation was significantly associated with decreases in all cognitive function measures at follow-up (episodic memory: β = -0.05, p < 0.001; mental status: β = -0.03, p < 0.01) even after controlling for loneliness and all confounding variables.

CONCLUSIONS

Social isolation is associated with cognitive decline in Chinese older adults, and the relationships are independent of loneliness. These findings expand our knowledge about the links between social relationships and the cognitive function in non-Western populations.

Gender Differences in the Associations Between Informal Caregiving and Wellbeing in Low- and Middle-Income Countries

Background: Health risks among informal caregivers have received inadequate attention in low and middle income countries. We examined cross-sectional data from 28611 adults 18 years and older in Ghana, India, Mexico, Russia and South Africa in the WHO Study on Global AGEing and Adult Health (SAGE) to examine gender differences in informal caregiving and wellbeing. Methods: Wellbeing was measured by self-rated health, difficulties with tasks, self-reported and diagnosed depression and anxiety. Informal caregiving was specific to adults and constructed as categorical variable with the respondent as: the main caregiver, non-caregiver but an adult in the household needs care, and no-one ill in the household; multinomial gender-stratified regression models assessed adjusted relative risk ratios (ARRRs). Results: Female caregivers were more likely to report moderate difficulties with life tasks [ARRR = 1.45 (95% CI: 1.01, 2.08)], feel mild-moderate anxiety [ARRR = 1.64 (95% CI: 1.22, 2.22)], and report feeling severely depressed [ARRR = 1.86 (95% CI: 1.28, 2.69)] compared to female non-caregivers. Even when women were not caregivers, having someone ill at home was associated with extreme difficulties with life tasks [ARRR = 2.32 (95% CI: 1.33, 4.04)]. Male caregivers, compared to no-one ill in the household, were more likely to report mild-moderate anxiety [ARRR = 1.8 (95% CI: 1.2, 3.7)] and severe-extreme anxiety [ARRR = 2.22 (95% CI: 1.07, 4.6)]. Conclusions: Caregiving for older adults results in greater health burdens, particularly mental health, for both women and men, though evidence shows that these burdens may be prominent and manifest in more diverse ways for women relative to men.

Perceived barriers and primary care access experiences among immigrant Bangladeshi men in Canada

OBJECTIVE

The study aimed to explore the experience of male members of a rapidly grown community of Bangladeshi immigrants while accessing primary healthcare (PHC) services in Canada.

DESIGN

A qualitative research was conducted among a sample of Bangladeshi immigrant men through a community-based participatory research approach. Focus group discussions were conducted to collect the qualitative data where thematic analysis was applied.

SETTING

The focus group discussions were held in various community centres such as individual meeting rooms at public libraries, community halls and so on arranged in collaboration with community organisations while ensuring complete privacy.

PARTICIPANT

Thirty-eight adults, Bangladeshi immigrant men, living in Calgary were selected for this study and participated in six different focus groups. The sample represents mostly married, educated, Muslim, Bangla speaking, aged over 25 years, full-time or self-employed and living in an urban centre in Canada >5 years.

RESULT

The focus groups have highlighted long wait time as an important barrier. Long wait at the emergency room, difficulties to get access to general physicians when feeling sick, slow referral process and long wait at the clinic even after making an appointment impact their daily chores, work and access to care. Language is another important barrier that impedes effective communication between physicians and immigrant patients, thus the quality of care. Unfamiliarity with the healthcare system and lack of resources were also voiced that hinder access to healthcare for immigrant Bangladeshi men in Canada. However, no gender-specific barriers unique to men have been identified in this study.

CONCLUSION

The barriers to accessing PHC services for Bangladeshi immigrant men are similar to that of other visible minority immigrants. It is important to recognise the extent of barriers across various immigrant groups to effectively shape public policy and improve access to PHC.

Relationship Between Gender, Stress, and Quality of Social Support

BACKGROUND

Research suggests that gender differences exist in both stress and how social support is utilized and that the relationship between stress and social support may not be linear.

METHODS

An internet survey of n = 1080 participants was conducted evaluating quality and quantity of social support, gender, age, and perceived stress and coping.

RESULTS

Reported quality of social support, gender, and age significantly predicted perceived stress and that there was a curvilinear interaction between the quality of social support and gender which significantly predicted perceived stress.

CONCLUSION

The current findings supported Taylor's Tend and Befriend theory that females have higher reported stress levels, a larger support network, and report more quality in their social support.Practitioner points:  • Males and females may manifest stress differently in their relationships. • When working with males and females in practice it may be important to understand the depth and breadth of their social networks and how they utilize those networks. • Females indicate higher levels of stress and greater social support quality. • It is important to understand that one's social network can be an important source of support (a coping mechanism) but that it can also serve as a stressor in some cases.

Religion, Life Expectancy, and Disability-Free Life Expectancy Among Older Women and Men in the United States

OBJECTIVES

Existing literature shows religion is associated with health and survival separately. We extend this literature by considering health and survival together using a multistate life table approach to estimate total, disability-free, and disabled life expectancy (LE), separately for women and men, for 2 disability measures, and by 2 indicators of religion.

METHOD

Data come from the Health and Retirement Study (1998-2014 waves). Predictors include importance of religion and attendance at religious services. The disability measures are defined by ADLs and IADLs. Models control for sociodemographic and health covariates.

RESULTS

Attendance at religious services shows a strong and consistent association with life and health expectancy. Men and women who attend services at least once a week (compared with those who attend less frequently or never) have between 1.1 and 5.1 years longer total LE and between 1.0 and 4.3 years longer ADL disability-free LE. Findings for IADL disability are similar. Importance of religion is related to total and disabled LE (both ADL and IADL), but the differentials are smaller and less consistent. Controlling for sociodemographic and health factors does not explain these associations.

DISCUSSION

By estimating total, disability-free, and disabled LE, we are able to quantify the advantage of religion for health. Results are consistent with previous studies that have focused on health and mortality separately.

Americans' Health Mindsets: Content, Cultural Patterning, and Associations With Physical and Mental Health

BACKGROUND

Health mindsets are mental frameworks that help people recognize, organize, interpret, and respond to health-relevant information. Although mindsets shape health behaviors and outcomes, no study has examined the health mindsets of ethnically and socioeconomically diverse Americans.

PURPOSE

We explored the content, cultural patterning, and health correlates of diverse Americans' health mindsets.

METHODS

Two studies surveyed approximately equal numbers of African American, Asian American, European American, and Latinx American men and women of lower and higher socioeconomic status (SES). Study 1 (N = 334) used open-ended questions to elicit participants' mindsets about the definitions, causes, and benefits of health. Study 2 (N = 320) used Study 1's results to develop a closed-ended instrument.

RESULTS

In Study 1, open-ended questioning revealed six overarching mindset themes: behavioral, medical, physical, psychological, social, and spiritual. The most prevalent mindsets were psychological definitions, behavioral causes, and psychological benefits. Participants mentioned more cause themes than definition or benefit themes, and mindset theme mentions correlated with worse health. Older participants mentioned more themes than younger, women mentioned more definition themes than men, and low-SES participants mentioned more cause themes than high-SES participants. In Study 2, closed-ended scales uncovered more complex and positive health mindsets. Psychological and spiritual benefit mindsets correlated with good mental health. African Americans and women endorsed the widest array of mindsets, and the spiritual benefit mindset partially explained the superior mental health of African Americans.

CONCLUSIONS

Many Americans hold simplistic, illness-focused health mindsets. Cultivating more complex, benefit-focused, and culturally appropriate health mindsets could support health.

Perceived social support and the risk of cardiovascular disease and all-cause mortality in the Women's Health Initiative Observational Study

OBJECTIVE

Previous studies have shown social support to be inversely associated with cardiovascular disease (CVD) in men, whereas fewer studies have assessed the relationship in women. The purpose of this study was to evaluate the relationship between perceived social support and cardiovascular outcomes among postmenopausal women enrolled in the Women's Health Initiative Observational Study.

METHODS

We examined the relationships between perceived social support and (1) incident coronary heart disease (CHD), (2) total CVD, and (3) all-cause mortality. Participants were Women's Health Initiative Observational Study women, ages 50 to 79 years, enrolled between 1993 and 1998 and followed for up to 10.8 years. Social support was ascertained at baseline via nine questions measuring the following functional support components: emotional/informational, tangible, positive social interaction, and affectionate support.

RESULTS

Among women with prior CVD (n = 17,351) and no prior CVD (n = 73,421), unadjusted hazard ratios ranged from 0.83 to 0.93 per standard deviation increment of social support. Adjustment for potential confounders, such as smoking and physical activity levels, eliminated the statistical significance of the associations with CHD and CVD. However, for all-cause mortality and among women free of baseline CVD, the association was modest but remained statistically significant after this adjustment (hazard ratio = 0.95 [95% confidence interval, 0.91-0.98]). No statistically significant association was observed among women with a history of CVD.

CONCLUSIONS

After controlling for potential confounding variables, higher perceived social support is not associated with incident CHD or CVD. However, among women free of CVD at baseline, perceived social support is associated with a slightly lower risk of all-cause mortality.

Gender difference in the association of coping styles and social support with psychological distress among patients with end-stage renal disease

Objectives

The study aimed to explore the association of coping styles and social support with psychological distress among patients with end-stage renal disease (ESRD) as well as gender differences in these associations.

Methods

A cross-sectional study of 769 ESRD patients was conducted at 25 hospitals in Qiqihar City, China. All information was collected using structured questionnaires that were self-administered by the patients. Patients' psychological health status, coping styles and perceived social support were measured using the 12-item General Health Questionnaire, the Medical Coping Modes Questionnaire and the Multidimensional Scale of Perceived Social Support. Student's t test, analysis of variance (ANOVA) and binary logistic regression analysis were used for data analysis.

Results

A total of 72.3% of participants reported psychological distress, and the prevalence of distress was higher in females (77.0%) than in males (68.8%). The usage of the acceptance-resignation coping style was positively related to psychological distress (B = 0.459, P < 0.001). Social support level was negatively associated with psychological distress (B = -0.049, P < 0.001). The use of the confrontation style was negatively related to psychological distress in females (OR = 0.87, 95% CI [0.78-0.96]) but not in males (OR = 0.98, 95% CI [0.91-1.06]) (P for interaction term = 0.007).

Conclusions

Greater use of the acceptance-resignation style and lower social support are related to a higher risk of psychological distress. Greater use of the confrontation style is related to a lower risk of psychological distress in females but not in males.

Understanding Computer-Mediated Support Groups: A Revisit Using a Meta-Analytic Approach

The increasing popularity of computer-mediated support groups (CMSGs) has drawn scholarly attention in recent decades. Fifteen empirical controlled studies have been published since Rains and Young's meta-analysis, showing mixed results, with a large variation of effect sizes ranging from -.77 to 1.33 in Cohen's d. To provide a better understanding of CMSGs, the current study meta-analyzed these 15 newly published studies along with the studies included in Rains and Young's meta-analysis, and tested study design and demographic moderators that have not been examined before. In addition, the study also revisited group size as a moderator and provided updated results with a larger sample size. Theoretical and practical implications of findings are discussed.

Social relations in late adolescence and incident coronary heart disease: a 38-year follow-up of the Swedish 1969-1970 Conscription Cohort

OBJECTIVES

Increasing evidence suggests that low social support is associated with an elevated risk of coronary heart disease (CHD). Earlier studies in this field were conducted in predominantly middle-aged or older samples; thus, the associations reported previously may have been confounded by subclinical manifestations of the disease. We investigated whether social relationships in late adolescence, that is, well before symptoms of subclinical disease manifest, are associated with CHD during a 38-year follow-up.

SETTING

Sweden.

PARTICIPANTS

Men born 1949-1951 and conscripted for military service in Sweden during 1969-1970 (n=49 321). At conscription, participants completed questionnaires about social relationships, lifestyle and health-related factors and underwent a medical examination.

PRIMARY AND SECONDARY OUTCOME MEASURES

CHD, acute myocardial infarction (AMI).

RESULTS

We found no relationship between having no confidant and frequency of confidential discussions with friends and the risk of CHD or AMI in the first 30 years of follow-up. However, after 30 years, men with no confidant at baseline had increased CHD and AMI risks relative to those having a confidant; the childhood socioeconomic status-adjusted HR and 95% CIs (CI) were 1.25 (1.10 to 1.41) and 1.27 (1.08 to 1.49), respectively. The frequency of confidential discussions with friends had an inverse U-shaped relationship with the outcomes after 30 years; the HR (95% CI) for 'sometimes' versus 'quite often' was 1.16 (1.04 to 1.29) for CHD and 1.16 (1.01 to 1.33) for AMI. These associations persisted after adjusting for mental ill-health, lifestyle factors and systolic blood pressure. A low number of friends in late adolescence was not related to an increased CHD or AMI risk.

CONCLUSIONS

Not having a confidant in late adolescence was associated positively, while the frequency of confidential discussions with friends had an inverse U-shaped relationship with CHD and AMI after 30 years of follow-up, suggesting that these associations are not due to subclinical disease manifestations.

Retired Elite Athletes' Physical Activity, Physiological, and Psychosocial Outcomes During Single- and Double-Player Exergaming

McDonough, DJ, Pope, ZC, Zeng, N, Lee, JE, and Gao, Z. Retired elite athletes' physical activity, physiological, and psychosocial outcomes during single- and double-player exergaming. J Strength Cond Res 33(12): 3220-3225, 2019-Elite athletes (i.e., athletes who play sport professionally) are a population who commonly exceed recommended physical activity (PA) guidelines and have higher health statuses compared with the general population. However, elite athletes transitioning into retirement often become physically inactive given they no longer require long hours of training and competition, and their physiological and psychosocial health suffers as a result. Therefore, this study's purpose was to examine differences in retired elite athletes' acute PA, physiological, and psychosocial outcomes during single- and double-player exergaming. Twenty retired Olympic athletes (18 females; (Equation is included in full-text article.)= 27.3 ± 4.3 years) participated in 2 separate 20-minute exergaming sessions (a): Xbox 360 Reflex Ridge single player and (b) Xbox 360 Reflex Ridge double player. Subjects' situational interest, enjoyment, and self-efficacy were examined using validated questionnaires; rating of perceived exertion (RPE) using the modified Borg RPE scale; and moderate-to-vigorous PA, steps, and energy expenditure tracked using ActiGraph GT3X+ accelerometers. Repeated-measures analysis of variances revealed no significant differences for any outcome between the 2 exercise sessions except for RPE (F (1, 38) = 4.6; p < 0.05; η = 0.11), which was higher in the single-player session compared with the double-player session (10.3 ± 2.3; 8.7 ± 1.6, respectively). Observations indicated double-player exergaming to be perceived as less intense than single-player exergaming despite similar PA and physiological outcomes, suggesting retired elite athletes may better adhere to exergaming in a double-player mode.

Risk and Resiliency in the Relationship Between Widowhood and Depressive Symptoms Among Older Mexican Americans

This study examined the association between widowhood and depressive symptoms and the extent to which the association is contingent upon risk and resiliency, including immigration status, functional limitations, financial strains, and intergenerational support, among older Mexican Americans. The sample included 344 parent-child pairs reported by 83 respondents. Clustered regression analysis showed that widowhood elevated risks for depressive symptoms. We found that having some functional limitations, having more children and living in the same city with children exacerbated the adverse effects of widowhood on depressive symptoms. We also found that living in the same city with children increased the detrimental effects of widowhood on the depressive symptoms in men, whereas we did not find this pattern in women. The findings highlight the heterogeneity within the widowed Mexican American older adults. Implications for future research and practice are discussed.

The Impact of Living Alone and Intergenerational Support on Depressive Symptoms Among Older Mexican Americans: Does Gender Matter?

The study examined gender differences in the impact of living alone and intergenerational support on depressive symptoms among Mexican American older adults. The sample included 335 parent-adult child pairs which are nested within 92 Mexican American respondents, because each respondent reported their specific relationships with each child. Clustered regression analysis showed gender differences in the impact of living alone and intergenerational support on depressive symptoms among Mexican American older adults. In general, older men provided and received less intergenerational support than older women, but their depressive symptoms were more susceptible to living alone and different types of intergenerational support. Factors such as living alone, receiving instrumental support were associated with more depressive symptoms in older men than inolder women, whereas older men benefited more from the emotional closeness with children than older women. The findings highlight the need for a gender-specific approach to future research on this topic.

Something Old, Something New: When Gender Matters in the Relationship between Social Support and Health

This paper investigates how social support differentially benefits self-rated health among men and women hospitalized with heart disease. Using cross-sectional data about patients admitted to a university hospital, we examine the extent to which gender moderates effects for the frequency of contact with family, friends, and neighbors on health and whether these effects differ between those with new versus established diagnoses. We find that gender differentiates the effect of nonmarital family contact on health but only when heart disease is newly diagnosed. When newly diagnosed, more frequent contact with family is associated with better self-rated health for women but not men. Men and women with preexisting diagnoses benefit equally from more frequent contact with family.

Social Support and Pain Outcomes After Trauma Exposure Among Older Adults: A Multicenter Longitudinal Study

OBJECTIVES

Certain forms of social support have been shown to improve pain-coping behaviors and pain outcomes in older adults with chronic pain, but little is known about the effect of social support on pain outcomes in older adults following trauma exposure.

METHODS

We analyzed data from a prospective longitudinal study of adults aged 65 years and older presenting to an emergency department after a motor vehicle collision (MVC) to characterize the relationship between perceived social support and MVC-related pain after trauma overall and by subgroups based on sex, depressive symptoms, and marital status.

RESULTS

In our sample (N=176), patients with low perceived social support had higher pain severity 6 weeks after MVC than patients with high perceived social support after adjustment for age, sex, race, and education (4.2 vs. 3.2, P=0.04). The protective effect of social support on pain severity at 6 weeks was more pronounced in men and in married individuals. Patients with low social support were less likely to receive an opioid prescription in the emergency department (15% vs. 32%, P=0.03), but there was no difference in opioid use at 6 weeks (22% vs. 20%, P=0.75).

DISCUSSION

Among older adults experiencing trauma, low perceived social support was associated with higher levels of pain at 6 weeks.

Brain-to-brain coupling during handholding is associated with pain reduction

The mechanisms underlying analgesia related to social touch are not clear. While recent research highlights the role of the empathy of the observer to pain relief in the target, the contribution of social interaction to analgesia is unknown. The current study examines brain-to-brain coupling during pain with interpersonal touch and tests the involvement of interbrain synchrony in pain alleviation. Romantic partners were assigned the roles of target (pain receiver) and observer (pain observer) under pain-no-pain and touch-no-touch conditions concurrent with EEG recording. Brain-to-brain coupling in alpha-mu band (8-12 Hz) was estimated by a three-step multilevel analysis procedure based on running window circular correlation coefficient and post hoc power of the findings was calculated using simulations. Our findings indicate that hand-holding during pain administration increases brain-to-brain coupling in a network that mainly involves the central regions of the pain target and the right hemisphere of the pain observer. Moreover, brain-to-brain coupling in this network was found to correlate with analgesia magnitude and observer's empathic accuracy. These findings indicate that brain-to-brain coupling may be involved in touch-related analgesia.

Mortality Differences by Partnership Status in England and Wales: The Effect of Living Arrangements or Health Selection?

This article investigates the relationship between partnership status and mortality in England and Wales. Using data from the Office for National Statistics Longitudinal Study for the period between 2001 and 2011, we examine whether married people have lower mortality levels than unmarried individuals; whether individuals who cohabit have mortality levels similar to those of married or single persons; and how much the fact that married couples live with someone rather than alone explains their low mortality. Our analysis shows first that married individuals have lower mortality than unmarried persons. Second, men and women in premarital unions exhibit mortality levels similar to those of married men and women, whereas mortality levels are elevated for post-marital cohabitants. Third, controlling for household size and the presence of children reduces mortality differences between married and unmarried non-partnered individuals, but significant differences persist. The study supports both protection and selection theory. The increase in mortality differences by age between never-married cohabitants and married couples is likely a sign of the long-term accumulation of health and wealth benefits of marriage. Similar mortality levels of cohabiting and married couples at younger ages suggest that healthier individuals are more likely to find a partner.

The association of social support networks and loneliness with negative perceptions of ageing: evidence from the Irish Longitudinal Study on Ageing (TILDA)

It is well known that negative ageing perceptions have various detrimental effects on indicators of successful ageing, but less is known about the role of social support networks and loneliness in ageing perceptions. The objective of this study was therefore to assess the association of social networks, relationship quality and loneliness with negative ageing perceptions in late life. Cross-sectional data on 6,912 adults aged ⩾50 years from the first wave of the Irish Longitudinal Study on Ageing (TILDA) were analysed. Ageing perceptions were assessed with the Brief Ageing Perceptions Questionnaire. Information on social support networks, loneliness and socio-demographics were obtained using standard questions. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression scale. Multivariable linear regression was conducted to assess the associations. Social isolation, poor relationship quality (with spouse, children, other family members or friends) and loneliness were all significantly associated with negative ageing perceptions even after adjustment for all potential confounders including depressive symptoms. Our study indicates that targeting integration into social support networks and improving relationship quality may potentially reduce the extent to which older individuals adopt negative ageing perceptions. Future studies with prospective design are warranted to understand the temporal direction and causal association of social support networks and loneliness with negative ageing perceptions.