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Ko S, Park S, Kim J, Subramanian SV, Kim R. Spousal multimorbidity and depressive symptoms among older Indian couples: Do one's own health status and sex matter? GeroScience 2024; 46:885-896. [PMID: 37233884 PMCID: PMC10828161 DOI: 10.1007/s11357-023-00822-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023] Open
Abstract
With the aging population, increases in non-communicable diseases that require chronic management pose a substantial economic and social burden to individuals with multimorbid conditions and their spousal caregivers. However, little is known about the crossover effect of spousal multimorbidity on mental health outcomes in the context of low- and middle-income countries, and whether it depends on one's own health status and sex. We examined the association between spousal multimorbidity and depressive symptoms using data on 6,158 older couples (12,316 individuals aged 60 years or above) from the Longitudinal Aging Study in India (LASI) 2017-18. Overall, 23.4% of the sample were multimorbid and 27.0% reported having depressive symptoms in the past week. Multivariable logistic regression models showed that spousal multimorbidity was associated with depressive symptoms, even after accounting for one's own multimorbidity status (OR: 1.23; 95% CI: 1.06-1.44). However, this association varied by sex. Among males, their own multimorbidity status was associated with 60% higher odds of having depressive symptoms (OR: 1.60; 95% CI: 1.28-2.00), but spousal multimorbidity was not. Furthermore, for males, the association between spousal multimorbidity and depressive symptoms was contingent upon the presence of their own multimorbidity. Among females, spousal multimorbidity was significantly associated with depressive symptoms, regardless of their own multimorbidity status. Our findings indicate that interventions to promote healthy aging should expand the formal caregiving system and consider family-based approaches to minimize the crossover health consequences of chronic morbidity in conjugal relationships, especially for females.
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Affiliation(s)
- Soohyeon Ko
- Department of Public Health Sciences, Graduate School of Korea University, Seoul, Republic of Korea
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea
| | - Sungchul Park
- Division of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea
- BK21 Four R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
| | - Jinho Kim
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea
- Division of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea.
- Division of Health Policy and Management, College of Health Science, Korea University, Seoul, Republic of Korea.
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Tseng CF, Miller DL, Huerta P, PettyJohn ME, Yzaguirre MM, Agundez JC, Wittenborn AK. Recruitment strategies in couple intervention studies: A systematic review of recruitment methods and sample characteristics in the United States from 2015 to 2020. FAMILY PROCESS 2023; 62:880-898. [PMID: 37086013 DOI: 10.1111/famp.12885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 05/03/2023]
Abstract
Including diverse participants in couple intervention studies is critical for developing an evidence base that informs best practices for all potential clients. Research has shown that subgroups of clients respond differently to different interventions and that interventions that have been adapted to fit the needs of a given population are more effective than non-adapted interventions. Unfortunately, couple intervention samples often exclude participants with marginalized identities and culturally adapted couple intervention research is limited. The lack of information about best practices for diverse client subgroups perpetuates mental and relational health disparities. We conducted a systematic review to examine recruitment strategies and sampling characteristics of diverse races/ethnicities, incomes, ages, and sexual identities. We reviewed articles published between January 2015 and December 2020. Articles were eligible for inclusion in our review if they implemented an intervention with couples in the United States. Of 4054 articles identified, 54 articles were eligible for our review. Findings suggest that couple intervention studies lack diversity across multiple identity domains (i.e., races/ethnicities, incomes, ages, and sexual identities). Further, descriptions of recruitment strategies are often vague, limiting opportunities to better understand methods used to recruit diverse samples.
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Affiliation(s)
- Chi-Fang Tseng
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Debra L Miller
- Community Mental Health for Central Michigan, Mt. Pleasant, Michigan, USA
| | - Patricia Huerta
- Human Development and Family Science, East Carolina University, Greenville, North Carolina, USA
| | - Morgan E PettyJohn
- Center for Violence Prevention, University of Texas Medical Branch, Galveston, Texas, USA
| | - Melissa M Yzaguirre
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - J C Agundez
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Andrea K Wittenborn
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
- Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, Michigan, USA
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3
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Fitzgerald M, Morgan AA. Marital quality and depression as mediators linking childhood maltreatment to adult physical health. CHILD ABUSE & NEGLECT 2023; 141:106189. [PMID: 37163970 DOI: 10.1016/j.chiabu.2023.106189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/08/2023] [Accepted: 04/02/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Childhood maltreatment is known to influence adult physical health among midlife adults. Evidence suggests that depressive symptoms mediate the association. However, research has discounted the role of marital quality in understanding health outcomes among adults maltreated in childhood. OBJECTIVE To advance this line of inquiry, we examined the relationship between marital quality and depressive symptoms in a sequential mediation model linking childhood maltreatment to adult physical health over ten years. PARTICIPANTS AND SETTING Our sample consisted of midlife adults (n = 550) from three waves of the Midlife Development in the United States (MIDUS) study. The majority (n = 91.4 %) were white. At MIDUS 2, the mean age was 54.84 (SD = 10.78) and the mean age at MIDUS 3 was 63.96 (SD = 10.81). METHODS Structural equation modeling was used to examine the degree to which marital quality and depressive symptoms mediated the relationship between childhood maltreatment and adult physical outcomes. Bootstrapping procedures were used to estimate the indirect effects. RESULTS The serial mediation effects from maltreatment to adult physical health through marital quality and depressive symptoms were significant. Likewise, the simple indirect effects from maltreatment to subjective evaluations and the number of chronic health conditions through depressive symptoms were also significant. CONCLUSIONS Childhood maltreatment is linked to adult physical health problems through marital quality and depressive symptoms, suggesting that the quality of adult marriages may play a critical role in health outcomes. Improving the quality of marriages may reduce risk factors, such as depression, that potentate future physical health problems.
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Affiliation(s)
- Michael Fitzgerald
- Department of Human Development and Family Science, Oklahoma State University, Stillwater, OK, United States of America
| | - Amy A Morgan
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, United States of America.
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West JS, Smith SL, Dupre ME. The impact of hearing loss on trajectories of depressive symptoms in married couples. Soc Sci Med 2023; 321:115780. [PMID: 36801754 PMCID: PMC10478395 DOI: 10.1016/j.socscimed.2023.115780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/29/2022] [Accepted: 02/13/2023] [Indexed: 02/16/2023]
Abstract
Hearing loss is a prevalent chronic stressor among older adults and is associated with numerous adverse health outcomes. The life course principle of linked lives highlights that an individual's stressors can impact the health and well-being of others; however, there are limited large-scale studies examining hearing loss within marital dyads. Using 11 waves (1998-2018) of the Health and Retirement Study (n = 4881 couples), we estimate age-based mixed models to examine how 1) one's own hearing, 2) one's spouse's hearing, or 3) both spouses' hearing influence changes in depressive symptoms. For men, their wives' hearing loss, their own hearing loss, and both spouses having hearing loss are associated with increased depressive symptoms. For women, their own hearing loss and both spouses having hearing loss are associated with increased depressive symptoms, but their husbands' hearing loss is not. The connections between hearing loss and depressive symptoms within couples are a dynamic process that unfolds differently by gender over time.
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Affiliation(s)
- Jessica S West
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA.
| | - Sherri L Smith
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA; Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, NC, USA
| | - Matthew E Dupre
- Center for the Study of Aging and Human Development, Duke University, Durham, NC, USA; Department of Population Health Sciences, Duke University, Durham, NC, USA; Department of Sociology, Duke University, Durham, NC, USA
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Irani E, Park S, Hickman RL. Negative marital interaction, purpose in life, and depressive symptoms among middle-aged and older couples: evidence from the Health and Retirement Study. Aging Ment Health 2022; 26:860-869. [PMID: 33769159 PMCID: PMC8742630 DOI: 10.1080/13607863.2021.1904831] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Negative marital interaction and purpose in life have been associated with depressive symptoms. Yet, these associations have not been fully explored in a dyadic context. This study examines the actor (intra-individual) and partner (cross-spousal) effects of negative marital interaction on depressive symptoms in couples and the potential mediating role of purpose in life. METHODS Data came from 1186 heterosexual married couples who participated in the 2016 (T1) and 2018 (T2) waves of the Health and Retirement Study and completed the psychosocial questionnaire in 2016. Structural equation modeling was used to estimate the direct and indirect associations among T1 negative marital interaction, T1 purpose in life, and T2 depressive symptoms at the actor and partner levels. Models controlled for age, race, educational level, self-rated health, and length of marriage. RESULTS At the actor level, a greater negative marital interaction was associated with significantly lower levels of purpose in life for husbands and wives. Negative marital interaction was also associated with depressive symptoms for wives. Purpose in life mediated the relationship between negative marital interaction and depressive symptoms. At the partner level, wives' negative marital interaction was negatively associated with husbands' purpose in life, independent of husbands' own effects. CONCLUSION The findings support the dominant marital discord model of depression and highlight gender differences in the cross-spousal effects of negative marital interaction on purpose in life. Positive psychology interventions can be beneficial to promote purpose in life and subsequently improve mental health outcomes among couples.
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Affiliation(s)
- Elliane Irani
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Sumin Park
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Ronald L. Hickman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
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Renn BN, Johnson M, Powers DM, Vredevoogd M, Unützer J. Collaborative care for depression yields similar improvement among older and younger rural adults. J Am Geriatr Soc 2021; 70:110-118. [PMID: 34536286 DOI: 10.1111/jgs.17457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/13/2021] [Accepted: 08/06/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Depressive disorders are among the most prevalent mental health conditions; however, significant barriers to treatment access persist. This study examined differences in depression outcomes between younger and older adults in a large-scale implementation demonstration of the collaborative care model (CoCM). METHODS Secondary data analysis of a longitudinal, observational implementation demonstration at eight primary care clinics across low-resourced rural or frontier areas of the Western United States. Seven of these clinics were federally qualified health centers. The sample consisted of 3722 younger (18-64 years) and older (65+ years) adult primary care patients diagnosed with unipolar depression. All participants received depression treatment via CoCM, which enhances usual primary care and makes efficient use of specialists by using a behavioral healthcare manager and a psychiatric consultant to support primary care providers. Clinics were followed for up to 27 months. Patients were followed until they completed treatment or dropped out. The Patient Health Questionnaire (PHQ-9) assessed depressive symptoms at baseline (enrollment) and at most follow-up contacts. The primary treatment outcome was a change between a patient's first and last recorded PHQ-9 scores. RESULTS Across both age groups, there was an average overall reduction of 6.9 points on the PHQ-9. Older adults demonstrated a greater decrease in depression scores of 2.06 points (95% CI -2.98 to -1.14, p < 0.001) on the PHQ-9 compared with younger adults. Estimates were robust when adjusting for gender, race, and clinic. CONCLUSIONS CoCM resulted in meaningful improvement in depressive symptoms across age groups.
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Affiliation(s)
- Brenna N Renn
- Department of Psychology, University of Nevada, Las Vegas, Nevada, USA
| | - Morgan Johnson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Diane M Powers
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Mindy Vredevoogd
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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Polenick CA, Birditt KS, Turkelson A, Bugajski BC, Kales HC. Discordant Chronic Conditions and Depressive Symptoms: Longitudinal Associations Among Middle-Aged and Older Couples. J Gerontol B Psychol Sci Soc Sci 2021; 76:451-460. [PMID: 31792532 DOI: 10.1093/geronb/gbz137] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Individuals often manage chronic conditions in middle and later life that may diminish well-being. Little is known, however, about discordant conditions (i.e., two or more conditions with competing self-management requirements) among older couples and their links to depressive symptoms. We considered discordant conditions at both the individual level and the couple level (i.e., between spouses), along with their long-term implications for depressive symptoms. METHODS The U.S. sample included 1,116 middle-aged and older couples drawn from five waves (2006-2014) of the Health and Retirement Study. Longitudinal actor-partner interdependence models evaluated whether individual-level and couple-level discordant chronic health conditions were concurrently linked to depressive symptoms, and whether these associations became stronger over time. Models controlled for age, minority status, education, prior wave depressive symptoms, and each partner's baseline report of negative marital quality and number of chronic conditions in each wave. RESULTS Wives and husbands reported significantly greater depressive symptoms when they had individual-level discordant conditions about 2 years after baseline, and these links intensified over time. Beyond this association, husbands had significantly greater depressive symptoms when there were couple-level discordant conditions. DISCUSSION Individual-level and couple-level discordant conditions may have lasting implications for depressive symptoms during midlife and older adulthood.
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Affiliation(s)
- Courtney A Polenick
- Department of Psychiatry, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.,Institute for Social Research, University of Michigan, Ann Arbor
| | - Kira S Birditt
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Angela Turkelson
- Institute for Social Research, University of Michigan, Ann Arbor
| | | | - Helen C Kales
- Department of Psychiatry, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.,Department of Veterans Affairs, HSR&D Center for Clinical Management Research (CCMR), Ann Arbor, Michigan
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8
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Polenick CA, Birditt KS, Turkelson A, Kales HC. Individual-Level and Couple-Level Discordant Chronic Conditions: Longitudinal Links to Functional Disability. Ann Behav Med 2021; 54:455-469. [PMID: 31858110 DOI: 10.1093/abm/kaz061] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Multiple chronic conditions may erode physical functioning, particularly in the context of complex self-management demands and depressive symptoms. Yet, little is known about how discordant conditions (i.e., those with management requirements that are not directly related and increase care complexity) among couples are linked to functional disability. PURPOSE We evaluated own and partner individual-level discordant conditions (i.e., discordant conditions within individuals) and couple-level discordant conditions (i.e., discordant conditions between spouses), and their links to levels of and change in functional disability. METHODS The U.S. sample included 3,991 couples drawn from nine waves (1998-2014) of the Health and Retirement Study. Dyadic growth curve models determined how individual-level and couple-level discordant conditions were linked to functional disability over time, and whether depressive symptoms moderated these links. Models controlled for age, minority status, education, each partner's baseline depressive symptoms, and each partner's number of chronic conditions across waves. RESULTS Wives and husbands had higher initial disability when they had their own discordant conditions and when there were couple-level discordant conditions. Husbands also reported higher initial disability when wives had discordant conditions. Wives had a slower rate of increase in disability when there were couple-level discordant conditions. Depressive symptoms moderated links between disability and discordant conditions at the individual and couple levels. CONCLUSIONS Discordant chronic conditions within couples have enduring links to disability that partly vary by gender and depressive symptoms. These findings generate valuable information for interventions to maintain the well-being of couples managing complex health challenges.
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Affiliation(s)
- Courtney A Polenick
- Department of Psychiatry, University of Michigan, Ann Arbor, MI.,Institute for Social Research, University of Michigan, Ann Arbor, MI.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI
| | - Kira S Birditt
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Angela Turkelson
- Institute for Social Research, University of Michigan, Ann Arbor, MI
| | - Helen C Kales
- Department of Psychiatry, University of Michigan, Ann Arbor, MI.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.,Department of Veterans Affairs, HSR&D Center for Clinical Management Research (CCMR), Ann Arbor, MI
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9
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The Magnifying Effect of Marital Satisfaction on the Dyadic Effect of Disabilities on Life Satisfaction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105352. [PMID: 34069781 PMCID: PMC8157226 DOI: 10.3390/ijerph18105352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 11/26/2022]
Abstract
(1) Background. Extending previous work, the present study examined whether marital satisfaction would magnify the dyadic effect of disabilities on life satisfaction among older married couples. (2) Methods. With responses collected from 11,694 participants (5847 couples; Mage = 63.36 years, median: 62 years) in a large-scale survey study in China in 2015, the actor-partner interdependence model (APIM) analyses were conducted to examine how marital satisfaction moderated the actor and partner effects of disabilities on life satisfaction. In addition, mixed linear model analyses were conducted to examine the gender effect. (3) Results. The results showed that marital satisfaction magnified the negative association between disabilities and life satisfaction with different patterns for each gender. Specifically, husbands’ disabilities significantly negatively predicted their own levels of life satisfaction among those with higher marital satisfaction but not among those with lower marital satisfaction. In contrast, for wives, spousal disabilities significantly predicted lower levels of life satisfaction among those with higher marital satisfaction but not among those with lower marital satisfaction. (4) Conclusions. The evidence for the magnifying effect of marital satisfaction obtained in the present study implicates the importance of taking dyadic dynamics in close relationships into account in health care research.
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Polenick CA, Birditt KS, Turkelson A, Kales HC. Chronic condition discordance and physical activity among midlife and older couples. Health Psychol 2021; 40:11-20. [PMID: 33370150 PMCID: PMC8097977 DOI: 10.1037/hea0001040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Chronic conditions in middle and later life are associated with lower physical activity. Yet little is known about chronic condition discordance (i.e., the extent to which conditions have nonoverlapping self-management requirements) within older individuals and couples and its implications for physical activity. We determined how the degrees of chronic condition discordance at the individual level and the couple level (i.e., between spouses) were linked to moderate physical activity across an 8-year period. METHOD The U.S. sample included 1,621 couples from five waves of the Health and Retirement Study (2006-2014). Dyadic growth curve models estimated how individual-level and couple-level chronic condition discordance were linked to initial levels of and rates of change in moderate activity. Models controlled for age, minority status, education, and own and partner reports of baseline negative marital quality, time-varying depressive symptoms, and time-varying number of chronic conditions. RESULTS A considerable proportion of wives (25.4%) and husbands (18.9%) reported moderate activity less than once a week. When individuals (wives: β = -0.10; husbands: β = -0.09) or their spouses (wives: β = -0.04; husbands: β = -0.05) had greater individual-level chronic condition discordance, lower initial moderate activity was reported. When husbands had greater individual-level discordance, both wives (β = -0.16) and husbands (β = -0.19) had a faster rate of decline in moderate activity over time. Couple-level chronic condition discordance was not significantly linked to moderate activity. CONCLUSIONS These findings suggest the importance of promoting physical activity among individuals and couples managing complex chronic conditions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Courtney A. Polenick
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI 48109
- Institute for Social Research, University of Michigan, Ann Arbor, MI 48104
| | - Kira S. Birditt
- Institute for Social Research, University of Michigan, Ann Arbor, MI 48104
| | - Angela Turkelson
- Institute for Social Research, University of Michigan, Ann Arbor, MI 48104
| | - Helen C. Kales
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
- Department of Psychiatry and Behavioral Sciences, UC Davis Health, Sacramento, CA 95817
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Birk JL, Kronish IM, Moise N, Falzon L, Yoon S, Davidson KW. Depression and multimorbidity: Considering temporal characteristics of the associations between depression and multiple chronic diseases. Health Psychol 2019; 38:802-811. [PMID: 31008648 DOI: 10.1037/hea0000737] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Depression frequently co-occurs with multiple chronic diseases in complex, costly, and dangerous patterns of multimorbidity. The field of health psychology may benefit from evaluating the temporal characteristics of depression's associations with common diseases, and from determining whether depression is a central connector in multimorbid disease clusters. The present review addresses these issues by focusing on 4 of the most prevalent diseases: hypertension, ischemic heart disease, arthritis, and diabetes. METHOD Study 1 assessed how prior chronic disease diagnoses were associated with current depression in a large, cross-sectional, population-based study. It assessed depression's centrality using network analysis accounting for disease prevalence. Study 2 presents a systematic scoping review evaluating the extent to which depression was prospectively associated with the onset of the 4 prevalent chronic diseases. RESULTS In Study 1 depression had the fourth highest betweenness centrality ranking of 26 network nodes and centrally connected many existing diseases and unhealthy behaviors. In Study 2 depression was associated with subsequent incidence of ischemic heart disease and diabetes across multiple meta-analyses. Insufficient information was available about depression's prospective associations with incident hypertension and arthritis. CONCLUSIONS Depression is central in patterns of multimorbidity and is associated with incident disease for several of the most common chronic diseases, justifying the focus on screening and treatment of depression in those at risk for developing chronic disease. Future research should investigate the mediating and moderating roles of health behaviors in the association between depression and the staggered emergence over time of clusters of multimorbid chronic diseases. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Jeffrey L Birk
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center
| | - Louise Falzon
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center
| | - Sunmoo Yoon
- General Medicine, Department of Medicine, Columbia University Irving Medical Center
| | - Karina W Davidson
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center
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12
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Bazargan M, Smith JL, Cobb S, Barkley L, Wisseh C, Ngula E, Thomas RJ, Assari S. Emergency Department Utilization among Underserved African American Older Adults in South Los Angeles. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071175. [PMID: 30986915 PMCID: PMC6479964 DOI: 10.3390/ijerph16071175] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/21/2019] [Accepted: 04/01/2019] [Indexed: 12/14/2022]
Abstract
Objectives: Using the Andersen’s Behavioral Model of Health Services Use, we explored social, behavioral, and health factors that are associated with emergency department (ED) utilization among underserved African American (AA) older adults in one of the most economically disadvantaged urban areas in South Los Angeles, California. Methods: This cross-sectional study recruited a convenience sample of 609 non-institutionalized AA older adults (age ≥ 65 years) from South Los Angeles, California. Participants were interviewed for demographic factors, self-rated health, chronic medication conditions (CMCs), pain, depressive symptoms, access to care, and continuity of care. Outcomes included 1 or 2+ ED visits in the last 12 months. Polynomial regression was used for data analysis. Results: Almost 41% of participants were treated at an ED during the last 12 months. In all, 27% of participants attended an ED once and 14% two or more times. Half of those with 6+ chronic conditions reported being treated at an ED once; one quarter at least twice. Factors that predicted no ED visit were male gender (OR = 0.50, 95% CI = 0.29–0.85), higher continuity of medical care (OR = 1.55, 95% CI = 1.04–2.31), individuals with two CMCs or less (OR = 2.61 (1.03–6.59), second tertile of pain severity (OR = 2.80, 95% CI = 1.36–5.73). Factors that predicted only one ED visit were male gender (OR = 0.45, 95% CI = 0.25–0.82), higher continuity of medical care (OR = 1.39, 95% CI = 1.01–2.15) and second tertile of pain severity (OR = 2.42, 95% CI = 1.13–5.19). Conclusions: This study documented that a lack of continuity of care for individuals with multiple chronic conditions leads to a higher rate of ED presentations. The results are significant given that ED visits may contribute to health disparities among AA older adults. Future research should examine whether case management decreases ED utilization among underserved AA older adults with multiple chronic conditions and/or severe pain. To explore the generalizability of these findings, the study should be repeated in other settings.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA.
- Department of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
| | - James L Smith
- Department of Family Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
| | - Sharon Cobb
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA.
- School of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - Lisa Barkley
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA.
| | - Cheryl Wisseh
- Department of Pharmacy Practice, West Coast University, Los Angeles, CA 90004, USA.
| | - Emma Ngula
- Department of public health, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90095, USA.
| | - Ricky J Thomas
- Department of Emergency Medicine, UC Davis Medical Center, University of California, Davis, Sacramento, CA 95817, USA.
| | - Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA 90059, USA.
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