Social support and coronary heart disease: epidemiologic evidence and implications for treatment

Age-induced changes in affective prosody comprehension and its relationship with general cognitive ability and social support utilization among older adults

Aging can impact emotional recognition, affecting older adults' mental health and social function. This study examined how aging affects affective prosody comprehension (APC: understanding emotions through speech) across seven emotions (happiness, surprise, sadness, anger, fear, disgust, and neutrality) and its relationship with cognitive function (via the Montreal Cognitive Assessment) and social support (via the Social Support Rating Scale) in 199 cognitively normal older adults. We found that older adults had lower APC accuracy and more errors, often mistaking negative emotions for neutral or positive ones. APC accuracy was significantly associated with social support, and a partial least squares (PLS) cognitive component fully mediated the relationship between the APC component and social support utilization, explaining 61.7% of the total effect. These results suggest that declines in APC during aging are linked to social support utilization through cognitive function, offering insights for interventions to improve social and cognitive health in older adults.

Pathways of how health literacy and social support are associated with health outcomes in 17 European countries: Results of mediation analyses

OBJECTIVES

To estimate and compare (1) how social support (SS) acts as a mediator for the association between health literacy (HL) and health outcomes, and (2) how HL acts as a mediator for the association between SS and health outcomes.

STUDY DESIGN

Mediation analyses.

METHODS

Data from the Health Literacy Survey 2019 (HLS19) were analyzed including 42,445 participants in 17 European countries. Four mediation models were tested with two health outcomes: self-reported health (SRH) and health-related limitations (Global Activity Limitations Indicator, GALI). In two models, SS was the mediator between HL and SRH and in the other two models HL was the mediator between SS and GALI.

RESULTS

SS is a significant mediator of the association between HL and SRH in all countries and between HL and GALI in eight countries. Up to 25-30 % of the total effect was mediated by SS. In addition, HL is a significant mediator of the association between SS and SRH in 15 countries and between SS and GALI in eight countries. With regard to SRH, SS may be regarded as the more relevant mediator between HL and SRH; whereas for GALI, HL can be considered the mediating factor between SS and GALI, as the proportions mediated were higher in the respective models in most countries.

CONCLUSIONS

Both HL and SS may serve as significant mediators in the models of both health measures, but to different extents. Planning interventions to mutually improve SS and HL may help communities improve health.

Do adult children increase the chances of receiving the recommended hospital treatment among older adults with heart disease?

BACKGROUND

We investigated whether having children and their socioeconomic resources are associated with receiving coronary angiogram (CAG) and coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) among older adults with non-ST elevation myocardial infarction (NSTEMI) and unstable angina pectoris.

METHODS

The study included 13 046 older adults diagnosed with first-time NSTEMI and unstable angina pectoris between 2002 and 2018. Logistic regression analyses were used to examine the associations of having children and their socioeconomic resources with receiving a CAG examination within the first 3 days of their diagnosis and CABG or PCI within 30 days of their diagnosis following CAG examination, respectively, adjusted for sociodemographic factors.

RESULTS

Within 3 days, 7158 older adults (54.9%) received a CAG, and of those, 4514 older adults (63.1%) received CABG or PCI within 30 days after their diagnosis following CAG examination. In the adjusted analyses, having children was associated with 21% (OR: 1.21, 95% CI 1.08; 1.36) higher odds of receiving CAG within 3 days and 20% (OR: 1.20, 95% CI 1.01; 1.42) higher odds of receiving CABG or PCI within 30 days after being diagnosed with NSTEMI and unstable angina pectoris, respectively, compared with those not having children. In adults with children aged ≥30 years, having children with short education was associated with 13% lower odds (OR: 0.87, 95% CI 0.77; 0.99) of receiving CAG, compared with older adults with children with long education.

CONCLUSION

Older adults with children had higher odds of receiving examination and treatment after diagnosis with NSTEMI or unstable angina pectoris. Older adults with children with short education had lower odds of receiving examination compared with older adults with children with long education.

Racial/ethnic differences in the associations between social support and cardiovascular morbidity and mortality in the Multi-Ethnic Study of Atherosclerosis (MESA)

BACKGROUND

Despite the established link between social support and cardiovascular disease (CVD) outcomes, few studies have examined racial/ethnic variation in these associations. This study utilized data from the Multi-Ethnic Study of Atherosclerosis (MESA) to investigate racial/ethnic differences in perceived social support and in the link between support and incident hard CVD events and mortality.

METHOD

Participants (N = 6,814) were 45-84 years of age who identified as White, Black, Hispanic/Latino, or Chinese without known clinical CVD at baseline (2000-2002). Racial/ethnic differences in perceived support (overall, emotional, informational, and instrumental) were tested using multiple regression with adjustments for demographic, socioeconomic, lifestyle/psychosocial, and clinical risk factors, and immigration history. Racial/ethnic differences in the association between perceived support and incident CVD events or mortality were tested using Cox proportional hazards models with progressive adjustments for the same covariates.

RESULTS

At baseline, the mean age was 62.15 years (SD = 10.23); 38.5% identified as White, 27.8% as Black, 22.0% as Hispanic/Latino, and 11.8% as Chinese. Black and Hispanic/Latino participants reported higher levels of overall support, emotional support, and informational support than White participants (p's < 0.05). Chinese participants reported less informational support (p = .010) than White participants. Higher informational support was associated with decreased risk for hard CVD events. This association did not differ by race/ethnic group.

CONCLUSION

Despite racial/ethnic differences in perceptions of support, perceived informational support was protective against CVD for participants of all racial/ethnic backgrounds.

The Association between Social Support and Musculoskeletal Health in Community-Dwelling Older Adults: Findings from the Hertfordshire Cohort Study

Previous studies suggest social support is associated with musculoskeletal health in later life. We explored this relationship further in community-dwelling older adults, by considering associations between different aspects of social support and musculoskeletal health in community-dwelling adults. Participants from the Hertfordshire Cohort Study reported level of confiding/emotional, practical, and negative support using the Close Persons Questionnaire. Muscle strength was measured by grip strength dynamometry, and physical capability by timed up-and-go, chair rises, and walking speed tests. Bone mineral density (BMD) was assessed using dual-energy x-ray absorptiometry. Linear regression, adjusted for age, sex, body mass index (BMI), alcohol, smoking, physical activity, social class, and diet, was used for analysis. 1842 men and women (mean age 65.7 years) participated. Low emotional support correlated with weaker grip strength and poorer physical capability tests, although estimates were not robust to adjustment for confounders. Low practical support was linked to shorter timed up-and-go (β - 0.171, 95%CI - 0.319, - 0.024) and walking speed times (β - 0.157, 95%CI - 0.306, - 0.007), following adjustment for confounders. Negative support (i.e. the perceived inadequacy of the support received) was associated with lower grip strength (β - 0.145, 95%CI - 0.223, - 0.067) and slower walking speeds (β 0.159, 95%CI 0.004, 0.314). No social support exposures were associated with BMD. Different types of social support are linked to various measures of musculoskeletal health in older adults. Limited requirement for practical support correlated with better physical capability, while negative support correlated with poorer outcomes. No social support measure was associated with BMD.

Prediction of physical activity and nutritional behaviors based on social cognitive theory in middle-aged population at risk of coronary artery disease in Bandar Abbas

Coronary artery disease (CAD) is the most common cardiovascular disease and the main cause of mortality in developing countries. Since physical activity and nutritional behaviors are modifiable risk factors in people at risk of CAD, the present study aims to explore the effect of an intervention based on the social cognitive theory (SCT) on physical activity and nutritional behaviors in middle-aged population at risk of CAD in the city of Bandar Abbas. The present cross-sectional study was conducted on 519 middle-aged subjects who visited the healthcare centers in Bandar Abbas, southern Iran, in 2023. The sampling was simple randomization. The data were collected using the general physical activity questionnaire, nutritional behavior questionnaire and a questionnaire based on the social cognitive theory (SCT). Descriptive statistics were used to describe the demographic features of the sample. Pearson correlation coefficient was used to test the relationship between the variables of study. Multiple linear regression was used to test the effect of the SCT constructs on physical activity and nutrition behaviors. All statistical analyses and hypothesis testing were done in SPSS 21, at a significance level of 0.05. A total number of 519 subjects participated in this study, whose average age was 44.23 ± 7.14 years. The results of Pearson correlation test showed a statistically significant positive correlation between nutritional behaviors and the constructs of self-efficacy, collective efficacy, outcome expectations, observational learning, normative beliefs, barriers and opportunities, reinforcement and punishment, and behavioral intention. There was also a significant positive correlation between physical activity and self-efficacy, normative beliefs, social support and behavioral intention. Social support, self-efficacy, normative beliefs, observational learning, behavioral skills and knowledge were found to be the predictors of physical activity. Reinforcement and punishment, normative beliefs, collective efficacy, social support and barriers and opportunities were the predictors of nutritional behaviors in the middle-aged population. As the results of the study showed, it is suggested to increase physical activity in the middle-aged population at risk of CAD using appropriate strategies to strengthen social support through family and friends, improve self-efficacy, identify positive and negative normative beliefs. Plans should be made to improve observational learning, increase behavioral skills, and increase knowledge to improve nutritional behaviors, use appropriate strategies to provide timely and appropriate rewards and punishments, identify and strengthen positive normative beliefs, improve collective efficacy, and increase social support. To this aim, families and other individuals around the middle-aged population can help remove barriers and create opportunities.

Association of anxiety and recurrent cardiovascular events: investigating different aspects of anxiety

AIMS

While elevated levels of anxiety are associated with worse prognosis of cardiovascular disease (CVD), this association may vary between different aspects of anxiety. The aim of this study was to analyse self-reported behavioural, physiological, affective, and cognitive aspects of anxiety and their relation to the risk of recurrent CV events.

METHODS AND RESULTS

This prospective cohort study utilized data from the U-CARE Heart trial. Participants (N = 935, post myocardial infarction) answered the Hospital Anxiety and Depression Scale (HADS: Anxiety subscale) and the Cardiac Anxiety Questionnaire (CAQ: Fear, Avoidance & Attention subscales). HADS Anxiety reflected physiological aspects, CAQ Fear reflected cognitive and affective aspects, CAQ Avoidance reflected behavioural aspects, and CAQ Attention reflected cognitive aspects of anxiety. Cox regression was used to estimate the risk between anxiety and recurrent major adverse cardiac event (MACE). During the follow-up period (mean 2.9 years), 124 individuals (13%) experienced a specified MACE endpoint. HADS Anxiety and CAQ Total were both associated with increased risk of MACE [hazard ratio (HR) = 1.52, 95% confidence interval (CI): 1.15-2.02 and HR = 1.30, 95% CI: 1.04-1.64, respectively]. Among the CAQ subscales, there was support for an association between Avoidance and risk of MACE (HR = 1.37, 95% CI 1.15-1.64), but not for Attention and Fear.

CONCLUSION

The results support that anxiety is associated with an increased risk of recurrent MACE in post-myocardial infarction patients. The association between anxiety and risk was strong for the aspects of anxiety relating to behaviour and physiology, while the support for an association with cognitive and affective aspects was lacking.

Social support and the burden of physical and psychiatric comorbidities in the patients with late-onset epilepsy in China: A cross-sectional study

INTRODUCTION

Epilepsy is the third most common neurological disorder in elderly people. Patients with epilepsy (PWEs) are more likely to have comorbidities. Social support is very important for PWEs. However, there are many gaps in the research on social support in older PWEs, especially the correlation between social support and comorbidities.

METHODS

A cross-sectional study was conducted in three hospitals in China. Social support was assessed using the Social Support Rate Scale. The burden of physical comorbidities was assessed using the CCI, and global disability was assessed using the mRS. The NDDIE was used to assess depression, the GAD7 was used for anxiety, the CDR was used for cognitive status, and the NPI was used for psychotic symptoms.

RESULTS

A total of 154 older PWEs participated in the study. There were 97 patients with at least one physical comorbidities. The burden of physical comorbidities was negatively correlated with overall social support (Adj. r = -0.35, P < 0.001) and global disability (Adj. r = -0.45, P < 0.001). In terms of psychiatric comorbidities, anxiety, depression, and cognitive status were not correlated with overall social support (Adj. r = -0.03, -0.02, and -0.11, P > 0.05). Psychotic symptoms were correlated with overall social support (Adj. r = -0.20, P < 0.05). The overall burden of psychiatric comorbidities was associated with overall social support (r = 0.30, P < 0.01).

DISCUSSION

Neurologists and social workers should consider more personalized biopsychosocial care to improve the quality of life of older PWEs.

The Association between Social Support, Metabolic Syndrome, and Incidence of Cardio-Cerebrovascular Diseases in Older Adults: The ARIRANG Study

PURPOSE

We investigated the association between social support, metabolic syndrome, and incident cardio-cerebrovascular disease (CCVD) in rural Koreans aged ≥50 years.

MATERIALS AND METHODS

We conducted a prospective study using the Korean Genome and Epidemiology Study on Atherosclerosis Risk of Rural Areas in the Korean General Population (KoGES-ARIRANG) dataset. From the baseline of 5169 adults, 1682 participants were finally included according to the exclusion criteria. For outcomes, myocardial infarction, angina, and stroke were included. For independent variables, the social support score and metabolic syndrome were used. Descriptive statistics and multivariate logistic regression were performed to investigate the association among the variables. Paired t-test was conducted to analyze the longitudinal variation of social support scores.

RESULTS

During the 6.37 years of median follow-up, 137 participants developed CCVD. The adjusted odds ratio (aOR) of metabolic syndrome with persistently high social support was 2.175 [95% confidence interval (CI): 1.479-3.119]. The aOR of metabolic syndrome with persistently low social support was 2.494 (95% CI: 1.141-5.452). The longitudinal variation of the social support score of persistently high social support group was increased significantly by 4.26±26.32. The score of the persistently low social support group was decreased by 1.34±16.87 with no statistical significance.

CONCLUSION

The presence of metabolic syndrome increases the likelihood of developing onset CCVD. Within the metabolic syndrome positive group, when social support was persistently low, the cohort developed more cardio-cerebrovascular disease compared to the persistently higher social support group. The social support score of the persistently low social support group could be improved through proper intervention. To prevent CCVD, metabolic syndrome components and low social support should be improved in the study participants.

Taking appreciation to heart: appreciation at work and cardiovascular risk in male employees

Introduction

While perceived appreciation at work has been associated with self-reported health and wellbeing, studies considering biological health markers are lacking. In this study, we investigated whether appreciation at work would relate to coronary heart disease (CHD) risk as well as the specificity of this proposed association.

Methods

Our study comprised a total of 103 male participants, including apparently healthy, medication-free, non-smoking men in the normotensive to hypertensive range (n = 70) as well as medicated hypertensive and CHD patients (n = 33). CHD risk was assessed by blood pressure [mean arterial pressure (MAP)], the diabetes marker glycated hemoglobin A1c (HbA1c), blood lipids [total cholesterol (TC)/high-density lipoprotein-cholesterol (HDL-C) ratio], coagulation activity (D-dimer and fibrinogen), and inflammation [interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP)]. Perceived appreciation at work, as well as potentially confounding psychological factors (social support, self-esteem, and work strain due to a lack of appreciation), were measured by self-report questionnaires.

Results

We found higher appreciation at work to relate to lower overall composite CHD risk (p's ≤ 0.011) and, in particular, to lower MAP (p's ≤ 0.007) and lower blood lipids (p's ≤ 0.031) in medication-free participants as well as all participants. This overall association was independent of confounding factors, including related psychological factors (p's ≤ 0.049).

Discussion

Our findings indicate that appreciation at work might be an independent health-promoting resource in terms of CHD risk. Implications include that encouraging appreciation at work may help reduce the development and progression of CHD.

Clinical Pathway for Coronary Atherosclerosis in Patients Without Conventional Modifiable Risk Factors: JACC State-of-the-Art Review

Reducing the incidence and prevalence of standard modifiable cardiovascular risk factors (SMuRFs) is critical to tackling the global burden of coronary artery disease (CAD). However, a substantial number of individuals develop coronary atherosclerosis despite no SMuRFs. SMuRFless patients presenting with myocardial infarction have been observed to have an unexpected higher early mortality compared to their counterparts with at least 1 SMuRF. Evidence for optimal management of these patients is lacking. We assembled an international, multidisciplinary team to develop an evidence-based clinical pathway for SMuRFless CAD patients. A modified Delphi method was applied. The resulting pathway confirms underlying atherosclerosis and true SMuRFless status, ensures evidence-based secondary prevention, and considers additional tests and interventions for less typical contributors. This dedicated pathway for a previously overlooked CAD population, with an accompanying registry, aims to improve outcomes through enhanced adherence to evidence-based secondary prevention and additional diagnosis of modifiable risk factors observed.

Social network interventions to support cardiac rehabilitation and secondary prevention in the management of people with heart disease

BACKGROUND

Globally, cardiovascular diseases (CVD, that is, coronary heart (CHD) and circulatory diseases combined) contribute to 31% of all deaths, more than any other cause. In line with guidance in the UK and globally, cardiac rehabilitation programmes are widely offered to people with heart disease, and include psychosocial, educational, health behaviour change, and risk management components. Social support and social network interventions have potential to improve outcomes of these programmes, but whether and how these interventions work is poorly understood.  OBJECTIVES: To assess the effectiveness of social network and social support interventions to support cardiac rehabilitation and secondary prevention in the management of people with heart disease. The comparator was usual care with no element of social support (i.e. secondary prevention alone or with cardiac rehabilitation).  SEARCH METHODS: We undertook a systematic search of the following databases on 9 August 2022: CENTRAL, MEDLINE, Embase, and the Web of Science. We also searched ClinicalTrials.gov and the WHO ICTRP. We reviewed the reference lists of relevant systematic reviews and included primary studies, and we contacted experts to identify additional studies.  SELECTION CRITERIA: We included randomised controlled trials (RCTs) of social network or social support interventions for people with heart disease. We included studies regardless of their duration of follow-up, and included those reported as full text, published as abstract only, and unpublished data.

DATA COLLECTION AND ANALYSIS

Using Covidence, two review authors independently screened all identified titles. We retrieved full-text study reports and publications marked 'included', and two review authors independently screened these, and conducted data extraction. Two authors independently assessed risk of bias, and assessed the certainty of the evidence using GRADE. Primary outcomes were all-cause mortality, cardiovascular-related mortality, all-cause hospital admission, cardiovascular-related hospital admission, and health-related quality of life (HRQoL) measured at > 12 months follow-up.  MAIN RESULTS: We included 54 RCTs (126 publications) reporting data for a total of 11,445 people with heart disease. The median follow-up was seven months and median sample size was 96 participants. Of included study participants, 6414 (56%) were male, and the mean age ranged from 48.6 to 76.3 years. Studies included heart failure (41%), mixed cardiac disease (31%), post-myocardial infarction (13%), post-revascularisation (7%), CHD (7%), and cardiac X syndrome (1%) patients. The median intervention duration was 12 weeks. We identified notable diversity in social network and social support interventions, across what was delivered, how, and by whom.  We assessed risk of bias (RoB) in primary outcomes at > 12 months follow-up as either 'low' (2/15 studies), 'some concerns' (11/15), or 'high' (2/15). 'Some concerns' or 'high' RoB resulted from insufficient detail on blinding of outcome assessors, data missingness, and absence of pre-agreed statistical analysis plans. In particular, HRQoL outcomes were at high RoB. Using the GRADE method, we assessed the certainty of evidence as low or very low across outcomes. Social network or social support interventions had no clear effect on all-cause mortality (risk ratio (RR) 0.75, 95% confidence interval (CI) 0.49 to 1.13, I2 = 40%) or cardiovascular-related mortality (RR 0.85, 95% CI 0.66 to 1.10, I2 = 0%) at > 12 months follow-up. The evidence suggests that social network or social support interventions for heart disease may result in little to no difference in all-cause hospital admission (RR 1.03, 95% CI 0.86 to 1.22, I2 = 0%), or cardiovascular-related hospital admission (RR 0.92, 95% CI 0.77 to 1.10, I2 = 16%), with a low level of certainty. The evidence was very uncertain regarding the impact of social network interventions on HRQoL at > 12 months follow-up (SF-36 physical component score: mean difference (MD) 31.53, 95% CI -28.65 to 91.71, I2 = 100%, 2 trials/comparisons, 166 participants; mental component score MD 30.62, 95% CI -33.88 to 95.13, I2 = 100%, 2 trials/comparisons, 166 participants).  Regarding secondary outcomes, there may be a decrease in both systolic and diastolic blood pressure with social network or social support interventions. There was no evidence of impact found on psychological well-being, smoking, cholesterol, myocardial infarction, revascularisation, return to work/education, social isolation or connectedness, patient satisfaction, or adverse events.  Results of meta-regression did not suggest that the intervention effect was related to risk of bias, intervention type, duration, setting, and delivery mode, population type, study location, participant age, or percentage of male participants.  AUTHORS' CONCLUSIONS: We found no strong evidence for the effectiveness of such interventions, although modest effects were identified in relation to blood pressure. While the data presented in this review are indicative of potential for positive effects, the review also highlights the lack of sufficient evidence to conclusively support such interventions for people with heart disease. Further high-quality, well-reported RCTs are required to fully explore the potential of social support interventions in this context. Future reporting of social network and social support interventions for people with heart disease needs to be significantly clearer, and more effectively theorised, in order to ascertain causal pathways and effect on outcomes.

Sabotage, Collusion, and Being a Feeder: Towards a New Model of Negative Social Support and Its Impact on Weight Management

PURPOSE OF REVIEW

Whilst research indicates the positive impact of social support across a number of health domains, including weight management, not all social support is beneficial.

RECENT FINDINGS

This paper reviews the evidence for both positive and negative social support in the context of behavioural interventions and surgery for obesity. It then presents a new model of negative social support focusing on sabotage ('active and intentional undermining of another person's weight goals'), feeding behaviour ('explicit over feeding of someone when they are not hungry or wishing not to eat'), and collusion ('passive and benign negative social support to avoid conflict') which can be conceptualised within the context of relationships as systems and the mechanisms of homeostasis. There is increasing evidence for the negative impact of social support. This new model could form the basis of further research and the development of interventions for family, friends, and partners to maximise weight loss outcomes.

Interpersonal Stressors and Resources for Support: Associations with Lower Urinary Tract Symptoms and Impact Among Women

Background: This study utilizes Coronary Artery Risk Development in Young Adults (CARDIA) data to examine whether women's perceived emotional support and interpersonal stressors are associated with lower urinary tract symptoms (LUTS) and their impact on quality of life. Materials and Methods: Emotional support was assessed at baseline/year 0 (1985-86), year 2 (1987-88), year 15 (2000-01), and year 20 (2005-06); interpersonal stressors were assessed at years 15 and 20. In 2012-13, LUTS and impact were assessed. LUTS/impact category (a composite variable ranging from bladder health to mild, moderate, and severe LUTS/impact) was regressed on trajectory groups of emotional support from years 0 to 20. Separately, LUTS/impact was regressed on mean emotional support and interpersonal stressors across years 15-20. Analyses were adjusted for age, race, education, and parity (n = 1104). Results: In comparison to women whose support trajectory from years 0 to 20 was consistently high, women whose support decreased from high to low had over twice the odds (odds ratio [OR] = 2.72; 95% confidence interval [CI] = 1.76-4.20) of being classified into a more burdensome LUTS/impact category. Mean support and interpersonal stressors across years 15-20 were independently associated with lower odds (OR = 0.59; 95% CI = 0.44-0.77) and greater odds (OR = 1.52; 95% CI = 1.19-1.94), respectively, of being classified into a more burdensome LUTS/impact category. Conclusions: In the CARDIA cohort, quality of women's interpersonal relationships, assessed between 1985-86 and 2005-06, was associated with LUTS/impact assessed in 2012-13. Additional research collecting LUTS/impact data at multiple time points is needed to test potential bidirectional associations of emotional support and interpersonal stressors with LUTS/impact, as well as potential mechanisms of association.

Stress and social isolation, and its relationship to cardiovascular risk in young adults with intellectual disability

PURPOSE

Stress produces many physiological changes, some of which may contribute to the development of cardiovascular disease (CVD). Individuals with intellectual disability (ID) are exposed to multiple and stressful challenges everyday which may put them at increased cardiovascular risk. This current study aimed to establish whether adults with ID experience higher levels of subjective stress and encounter different stressors (including social isolation) than the general population, and whether there is a relationship between stress and cardiometabolic profile in this population.

METHODS

Adults with ID (n = 35) aged 18-45 years completed the Subjective Stress Survey, and underwent a physiological assessment to measure blood pressure, metabolic profile and subclinical CVD risk factors, and were compared to a control group (n = 29). Multiple regression was used to investigate whether cardiometabolic parameters were predicative of SSS scores.

RESULTS

Findings showed adults with ID have higher perceived stress levels (total score ID: 21.3 ± 11.4 vs control: 13.9 ± 9.0, p = 0.006), which is elicited by unique stressors, when compared to people without ID. Stress was strongly associated with increased social isolation (r = -0.38, p = 0.002) and with obesity in females with mild ID (r = 0.72). Regression showed that arterial stiffness was predictive of total SSS score (p = 0.038).

CONCLUSIONS

Adults with ID aged 18-45 years report higher levels of perceived stress when compared to people without ID.Implications for RehabilitationReducing stress in this young population may prevent development of arterial stiffness, and consequently lower the risk of cardiometabolic morbidity and mortality.There are unique targets for stress management in young adults with intellectual disability, including supporting decision-making and improving self-efficacy.Improving community integration and reducing social isolation may decrease perceived stress in young adults with intellectual disability.

Effectiveness of a Health Coaching Intervention for Patient-Family Dyads to Improve Outcomes Among Adults With Diabetes: A Randomized Clinical Trial

IMPORTANCE

More than 75% of US adults with diabetes do not meet treatment goals. More effective support from family and friends ("supporters") may improve diabetes management and outcomes.

OBJECTIVE

To determine if the Caring Others Increasing Engagement in Patient Aligned Care Teams (CO-IMPACT) intervention improves patient activation, diabetes management, and outcomes compared with standard care.

DESIGN, SETTING, AND PARTICIPANTS

This randomized clinical trial was conducted from November 2016 to August 2019 among participants recruited from 2 Veterans Health Administration primary care sites. All patient participants were adults aged 30 to 70 years with diabetes who had hemoglobin A1c (HbA1c) levels greater than 8% of total hemoglobin (to convert to proportion of total hemoglobin, multiply by 0.01) or systolic blood pressure (SBP) higher than 150 mm Hg; each participating patient had an adult supporter. Of 1119 recruited, 239 patient-supporter dyads were enrolled between November 2016 and May 2018, randomized 1:1 to receive the CO-IMPACT intervention or standard care, and followed up for 12 to 15 months. Investigators and analysts were blinded to group assignment.

INTERVENTIONS

Patient-supporter dyads received a health coaching session focused on dyadic information sharing and positive support techniques, then 12 months of biweekly automated monitoring telephone calls to prompt dyadic actions to meet diabetes goals, coaching calls to help dyads prepare for primary care visits, and after-visit summaries. Standard-care dyads received general diabetes education materials only.

MAIN OUTCOMES AND MEASURES

Intent-to-treat analyses were conducted according to baseline dyad assignment. Primary prespecified outcomes were 12-month changes in Patient Activation Measure-13 (PAM-13) and UK Prospective Diabetes Study (UKPDS) 5-year diabetes-specific cardiac event risk scores. Secondary outcomes included 12-month changes in HbA1c levels, SBP, diabetes self-management behaviors, diabetes distress, diabetes management self-efficacy, and satisfaction with health system support for the involvement of family supporters. Changes in outcome measures between baseline and 12 months were analyzed using linear regression models.

RESULTS

A total of 239 dyads enrolled; among patient participants, the mean (SD) age was 60 (8.9) years, and 231 (96.7%) were male. The mean (SD) baseline HbA1c level was 8.5% (1.6%) and SBP was 140.2 mm Hg (18.4 mm Hg). A total of 168 patients (70.3%) lived with their enrolled supporter; 229 patients (95.8%) had complete 12-month outcome data. In intention-to-treat analyses vs standard care, CO-IMPACT patients had greater 12-month improvements in PAM-13 scores (intervention effect, 2.60 points; 95% CI, 0.02-5.18 points; P = .048) but nonsignificant differences in UKPDS 5-year cardiac risk (intervention effect, 1.01 points; 95% CI, -0.74 to 2.77 points; P = .26). Patients in the CO-IMPACT arm also had greater 12-month improvements in healthy eating (intervention effect, 0.71 d/wk; 95% CI, 0.20-1.22 d/wk; P = .007), diabetes self-efficacy (intervention effect, 0.40 points; 95% CI, 0.09-0.71 points; P = .01), and satisfaction with health system support for the family supporter participants' involvement (intervention effect, 0.28 points; 95% CI, 0.07-0.49 points; P = .009); however, the 2 arms had similar improvements in HbA1c levels and in other measures.

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial, the CO-IMPACT intervention successfully engaged patient-supporter dyads and led to improved patient activation and self-efficacy. Physiological outcomes improved similarly in both arms. More intensive direct coaching of supporters, or targeting patients with less preexisting support or fewer diabetes management resources, may have greater impact.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02328326.

Comparing the effectiveness of Family Support for Health Action (FAM-ACT) with traditional community health worker-led interventions to improve adult diabetes management and outcomes: study protocol for a randomized controlled trial

BACKGROUND

Diabetes self-management education and support (DSMES) programs have struggled to deliver sustainable, effective support for adults with diabetes (AWDs) to improve self-management behaviors, achieve glycemic goals, and reduce risk for complications. One largely untapped resource for this support is AWDs' social networks. Fifty to 75% of AWDs have an unpaid family member or friend ("support person") who provides ongoing help with diabetes management. However, DSMES interventions to date lack structured and effective approaches to directly engage support persons in AWDs' diabetes management.

METHODS

This parallel arm randomized trial is designed to determine the effectiveness of Family Support for Health Action (FAM-ACT), a novel community health worker (CHW)-delivered program focused on educating and supporting patients with type 2 diabetes (T2D) and their support persons (SPs), relative to an established, CHW-delivered, individual patient-focused DSMES and care management (I-DSMES) intervention. Both interventions were developed using a community-based participatory research (CBPR) approach. The study will be conducted in partnership with an urban Federally Qualified Health Center (FQHC) serving a low-income, Latino/a community, with target enrollment of 268 dyads consisting of an FQHC patient with T2D with high HbA1c and an SP. Patient-SP dyads will be randomized to receive FAM-ACT or I-DSMES over 6 months. The primary outcome is change in patient HbA1c from baseline to 6 months. Secondary patient outcomes include 12-month change in HbA1c, changes in patient blood pressure, diabetes self-management behaviors, diabetes distress, patient activation, diabetes self-efficacy, and perceptions of and satisfaction with SP support for diabetes. Secondary SP outcomes include self-efficacy for helping the patient with diabetes management and SP distress about the patient's diabetes. We also will assess the effect of the COVID-19 pandemic on patient's ability to manage diabetes.

DISCUSSION

This study will inform scalable, evidence-based approaches that leverage family support to help AWDs improve and sustain self-management strategies that underpin optimal management of multiple diabetes complication risk factors. The protocol is designed for and evaluated with a low-income and predominantly Latino/a community, which may increase applicability to other similar communities. The COVID-19 pandemic presented several challenges to study protocol and intervention delivery; modifications made to address these challenges are described.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03812614. Registered on 18 January 2019.

Sex differences in the blood-brain barrier: Implications for mental health

Prevalence of mental disorders, including major depressive disorder (MDD), bipolar disorder (BD) and schizophrenia (SZ) are increasing at alarming rates in our societies. Growing evidence points toward major sex differences in these conditions, and high rates of treatment resistance support the need to consider novel biological mechanisms outside of neuronal function to gain mechanistic insights that could lead to innovative therapies. Blood-brain barrier alterations have been reported in MDD, BD and SZ. Here, we provide an overview of sex-specific immune, endocrine, vascular and transcriptional-mediated changes that could affect neurovascular integrity and possibly contribute to the pathogenesis of mental disorders. We also identify pitfalls in current literature and highlight promising vascular biomarkers. Better understanding of how these adaptations can contribute to mental health status is essential not only in the context of MDD, BD and SZ but also cardiovascular diseases and stroke which are associated with higher prevalence of these conditions.

The social determinants of health associated with cardiometabolic diseases among Asian American subgroups: a systematic review

Background

Asian Americans represent one of the fastest-growing immigrant groups in the U.S. and are at high risk for cardiometabolic diseases (CMDs), including type 2 diabetes, hypertension, coronary artery disease, and stroke. Despite the growth of Asians in the U. S, there is a gap in understanding the heterogeneity of CMDs across Asian subgroups and how these might be affected by the social determinants of health (SDOH), or the environment in which people live and work.

Objective

The purpose of this systematic review is to examine the current literature on CMDs among Asian Americans and identify the SDOH that are associated with the incidence and/or prevalence of CMDs among specific Asian subgroups.

Methods

PubMed, Embase, Web of Science were searched for articles published in Jan 2000-Nov 2020. The reproducible strategy yielded 2732 articles. The articles were reviewed based on the following inclusion criteria: (1) observational study published in the U.S., (2) adult population includes specific Asian subgroups, (3) exposures include SDOH, and (4) outcomes include a CMD, defined as type 2 diabetes, hypertension, coronary artery disease, or stroke.

Results

In this review, 14 studies were identified and organized into four key themes: acculturation (n = 9), socioeconomic status (SES) (n = 6), social context (n = 2), and health literacy (n = 1). The most represented Asian subgroups in the literature were Chinese, Filipino, and South Asians. Acculturation was the most described social factor in the included reviews. Seven studies found associations between higher acculturation levels and higher prevalence of CMD. However, the measure of acculturation varied by study and included various combinations of the country of birth, number of years residing in the U.S., and English proficiency. The effects of SES, measured as income level and educational attainment, varied by racial subgroups. One study found that higher levels of education were associated with CMD among South Asians.

Conclusion

Acculturation, SES, social context, and health literacy impact the risk of CMD among Asian Americans; these vary across subgroups. Future research disentangling SDOHs on the risk of CMDs by Asian subgroup is necessary to provide better informed preventive practices and interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07646-7.

Perceived social support and ambulatory blood pressure during daily life: a meta-analysis

Perceived social support has been linked to lower rates of morbidity and mortality. However, more information is needed on the biological mechanisms potentially responsible for such links. The main aim of this paper was to conduct a meta-analytic review of the association between perceived social support and awake ambulatory blood pressure (ABP) which is linked to cardiovascular morbidity and mortality. The review identified 12 studies with a total of 3254 participants. The omnibus meta-analysis showed that higher perceived social support was not significantly related to lower ABP (Zr = -0.052, [ -0.11, 0.01]). In addition, there was evidence of significant bias across several indicators. Future research will be needed to explore the boundary conditions linking social support to ABP and its implications for theoretical models and intervention development.

Multilevel modeling, prevalence, and predictors of hypertension in Ghana: Evidence from Wave 2 of the World Health Organization's Study on global AGEing and adult health

BACKGROUND AND AIMS

Hypertension is a major public health issue, an important risk factor for cardiovascular diseases and stroke, especially in developing countries where the rates remain unacceptably high. In Africa, hypertension is the leading driver of cardiovascular disease and stroke deaths. Identification of critical risk factors of hypertension can help formulate targeted public health programs and policies aimed at reducing the prevalence and its associated morbidity, disability, and mortality. This study attempts to develop multilevel regression, an in-depth statistical model to identify critical risk factors of hypertension.

METHODS

This study used data on 4667 individuals aged ≥18 years from the nationally representative World Health Organization Study on global AGEing and adult health (SAGE) Ghana Wave 2 conducted in 2014/2015. Multilevel regression modeling was employed to identify critical risk factors for hypertension based on systolic blood pressure (SBP) (ie, SBP > 140 mmHg). Of the 4667, 27.3% were hypertensive. Final data on 4381 individuals residing in 3790 households were analyzed using multilevel models, and results were presented as adjusted odds ratios (aOR) and their associated 95% confidence intervals (CI).

RESULTS

Risk factors for hypertension identified were age (aOR) = 5.4, 95% CI: 4.11-7.09), obesity (aOR = 1.51, 95% CI: 1.19-1.91), marital status (aOR = 0.75, 95% CI: 0.64-0.89), perceived health state (moderate; aOR = 1.38, 95% CI: 1.15-1.65 and bad/very bad; aOR = 1.35, 95% CI: 1.0-1.83), and difficulty with self-care (aOR = 1.64, 95% CI: 1.1-2.44). We found unobserved significant differences in the likelihood of hypertension prevalence between different households.

CONCLUSION

Addressing the problem of obesity, targeting specific interventions to those aged over 50 years, and improvement in the general health of Ghanaians are paramount to reducing the prevalence and its associated morbidity, disability, and mortality. Lifestyle modification in the form of dietary intake, knowledge provision supported with strong public health message, and political will could be beneficial to the management and prevention of hypertension.

Prognostic value of a brief loneliness questionnaire for patients with coronary heart disease: Proposal for a prediction model

BACKGROUND

In patients with coronary heart disease (CHD), loneliness is associated with increased risk of morbidity and mortality. No predictive tool is available to detect patients who are influenced by loneliness to a degree that impacts mortality.

AIM

To: (i) propose a prediction model that detects patients influenced by loneliness to a degree that increases one-year all-cause mortality, (ii) evaluate model classification performance of the prediction model, and (iii) investigate potential questionnaire response errors.

METHOD

A cohort of patients with CHD (n = 7169) responded to a national cross-sectional survey, including two questions on loneliness. Information on cohabitation and follow-up information on one-year all-cause mortality were obtained from national registers. Prediction model development was based on the prognostic values of item responses in the questionnaire on loneliness and of cohabitation, evaluated with Cox-proportional Hazards Ratio (HR). Item responses which significantly predicted one-year mortality were included in the high-risk loneliness (HiRL) prediction model. Sensitivity, specificity and likelihood ratio were calculated to evaluate model classification performance. Sources of response errors were evaluated using verbal probing technique in an additional cohort (n = 7). The TRIPOD checklist has been used to ensure transparent reporting.

RESULTS

Two item responses significantly predicted one-year mortality HR = 2.24 (95%CI = 1.24-4.03) and HR = 2.65 (95%CI = 1.32-5.32) and were thus included in the model. Model classification performance showed a likelihood ratio of 1.89. Response error was evaluated as low.

CONCLUSION

Based on the prognostic value in a loneliness questionnaire, a prediction model suitable to screen patients with CHD for high-risk loneliness was suggested.

RELEVANCE TO CLINICAL PRACTICE

The HiRL prediction model is a short and easy-to-use screening tool that offers clinical staff to identify patients with CHD who are influenced by loneliness to a degree that impacts mortality. However, further evaluation of model performance and questionnaire validation is recommended before integrating the model into clinical practice.

Social Support as a Mediator of the Personality-Physical Functioning Relationship in a National Sample of African Americans: A Two-Wave Longitudinal Study

The present study investigates whether social support mediates the relationship between personality traits and physical functioning among African Americans over 2.5 years. Data were collected from a national probability sample of African American adults (analytic sample N = 312). Telephone surveys included measures of the five-factor model personality traits, social support, and physical functioning. Personality traits were assessed at Time 1 (T1), and social support and physical functioning were assessed 2.5 years later at Time 2 (T2). Physical functioning was assessed using the SF-12 at T2. Results indicated that T2 social support mediated the relationship between T1 personality traits and T2 physical functioning for the traits of conscientiousness, extraversion, agreeableness, and neuroticism, but not for openness to experience. This information may be useful to healthcare providers and community members in developing strategies targeting personality traits in cultivating social support for health promotion.

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.

Cross-National Study of Worrying, Loneliness, and Mental Health during the COVID-19 Pandemic: A Comparison between Individuals with and without Infection in the Family

Objective: The objective of this study was to examine differences in worry, loneliness, and mental health between those individuals infected by COVID-19 or having someone their family infected, and the rest of the population. Methods: A cross-sectional online survey was conducted in Norway, UK, USA, and Australia during April/May 2020. Participants (n = 3810) were recruited via social media postings by the researchers and the involved universities. Differences between those with and without infection in the family were investigated with chi-square tests and independent t-tests. Multiple regression analyses were used to assess associations between sociodemographic variables and psychological outcomes (worry, loneliness, and mental health) in both groups. Results: Compared to their counterparts, participants with infection in the family reported higher levels of worries about themselves (p < 0.05) and their family members (p < 0.001) and had poorer mental health (p < 0.05). However, the effect sizes related to the differences were small. The largest effect (d = 0.24) concerned worries about their immediate family. Poorer psychological outcomes were observed in those who were younger, female, unemployed, living alone and had lower levels of education, yet with small effect sizes. Conclusions: In view of the small differences between those with and without infection, we generally conclude that the mental health effects of the COVID-19 situation are not limited to those who have been infected or have had an infection within the family but extend to the wider population.

Optimizing Healthcare Through Digital Health and Wellness Solutions to Meet the Needs of Patients With Chronic Disease During the COVID-19 Era

The COVID-19 pandemic exposed and exacerbated longstanding inefficiencies and deficiencies in chronic disease management and treatment in the United States, such as a fragmented healthcare experience and system, narrowly focused services, limited resources beyond office visits, expensive yet low quality care, and poor access to comprehensive prevention and non-pharmacological resources. It is feared that the addition of COVID-19 survivors to the pool of chronic disease patients will burden an already precarious healthcare system struggling to meet the needs of chronic disease patients. Digital health and telemedicine solutions, which exploded during the pandemic, may address many inefficiencies and deficiencies in chronic disease management, such as increasing access to care. However, these solutions are not panaceas as they are replete with several limitations, such as low uptake, poor engagement, and low long-term use. To fully optimize digital health and telemedicine solutions, we argue for the gamification of digital health and telemedicine solutions through a pantheoretical framework-one that uses personalized, contextualized, and behavioral science algorithms, data, evidence, and theories to ground treatments.

Social-life factors associated with participation in screening and further assessment of colorectal cancer: A nationwide ecological study in Japanese municipalities

The burden of colorectal cancer in developed countries is high, and it is a major public health concern in Japan. Improving the quality of evidence on colorectal cancer screening participation and further assessment participation rates is important to reduce this burden. This study examined the social-life factors that influence colorectal cancer screening programs in Japan, particularly the effects of the proportion of elderly people and social capital, using a municipality-level national database and existing health reports. Data from a national municipality-based study were analyzed to identify social-life factors associated with participation in colorectal cancer screening and further assessment. Administrative data on the Japanese municipal screening programs were drawn from the Report on Regional Public Health Services and Health Promotion Services 2017. Available data used as predictors of interest for all 1719 municipalities as of 2017 were from the national census, statistical reports on the land area by prefecture and municipality, municipal financial surveys, a survey of physicians, dentists and pharmacists, and other databases. The mean rate of participation in colorectal cancer screening was 13.8%, and that of further assessment was 73.6%. Multiple linear regression analyses of the two outcomes showed that the proportion of elderly people was most significantly positively associated with colorectal cancer screening programs (β = 0.51 for participation, β = 0.13 for further assessment participation), and the proportion of single-elderly-person households was most significantly negatively associated (β = −0.45 and −0.19, respectively). It is suggested that the health behaviors required for participation in colorectal cancer programs in Japanese elderly populations are greatly affected by family members.

•

The disease burden of colorectal cancer is increasing in developed countries.

•

An ecological study of the colorectal cancer screening program was conducted.

•

The proportion of elderly people was positively associated with the screening rates.

•

The single-elderly-person households was negatively associated with the screening rates.

Mental health, quality of life, wellbeing, loneliness and use of social media in a time of social distancing during the COVID-19 outbreak. A cross-country comparative study

BACKGROUND

The COVID-19 outbreak raised questions about how people experience their mental health, quality of life (QoL), wellbeing and loneliness in the context of social distancing, and the use of social media during this time.

AIMS

To examine the experience of mental health, QoL, wellbeing and loneliness and use of social media among people living in Norway, USA, UK and Australia.

METHODS

A cross-country comparative survey of people living in Norway, USA, UK and Australia. Relevant statistical analyses were used to examine differences between the countries and to explore associations between demographic, mental health and psychosocial variables and use of social media.

RESULTS

There were 3810 respondents from four countries, of which 50 - 74% showed a high level of emotional distress. The Norwegian population reported significantly better mental health, QoL and wellbeing and lower levels of loneliness compared to the other countries. High-frequent use of social media after the COVID-19 outbreak was associated with poorer mental- and psychosocial health.

CONCLUSIONS

The results suggest that the COVID-19 outbreak took a toll on people's experience of mental health, QoL, wellbeing and experienced loneliness, and high-frequent use of social media was associated with these factors.

Social Support and Cognition: A Systematic Review

Although the influence of social support in health is a widely acknowledged factor, there is a significant gap in the understanding of its role on cognition. The purpose of this systematic review was, therefore, to determine the state-of-the-art on the literature testing the association between social support and cognition. Using six databases (WoS, PubMed, ProQuest, PsycINFO, Scopus and EBSCOhost), we identified 22 articles published between 1999 and 2019 involving an empirical quantitative focus which meet the inclusion criteria. Data extraction was performed following PRISMA recommendations. To summarize the extracted data, we used a narrative synthesis approach. Despite limitations, there is overall preliminary evidence of a relevant positive association between social support and cognition. Our results demonstrate there is enough information for an outbreak of experimental research in the area and an expansion of this body of knowledge. We argue that the present evidence lays the foundations for a more comprehensive theoretical model, one that corresponds with the complexity of the topic and possibly considers models derived from social interaction and active inference theories.

Effectiveness of social network interventions to support cardiac rehabilitation and secondary prevention in the management of people with heart disease

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effectiveness of social network and social support interventions to support cardiac rehabilitation and secondary prevention in the management of people with heart disease. As a secondary output of this review, and to assist in conceptualising future research focused on social network and social support interventions, we aim to develop a logic model theorising the relationship between social networks or social support and heart disease outcomes. We will draw on existing models of social support for health (e.g. Berkman 2000), as well as established approaches to theorising and implementing behaviour change (e.g. Michie 2011).

A longitudinal examination of social support as a mediator of the personality-health relationship in a national sample of African Americans

The present study investigates whether social support mediates the relationship between personality traits and health among African Americans over a five-year period, filling a gap in the literature on longitudinal tests of the personality-health association. Data were collected from a national probability sample of African American adults (N = 200). Personality was assessed at Time 1 (T1), social support was assessed 2.5 years later (T2), and physical functioning was examined 5 years (T3) after T1. Telephone surveys included measures of the Five Factor Model personality traits (T1), social support (T2), and physical functioning (T3). Results suggested that relationships between the T1 personality traits and T3 physical functioning were not mediated by T2 social support. Secondary analyses found that among all T1 personality traits, higher openness and lower neuroticism uniquely predicted higher T2 social support. Further, among T1 personality traits, higher conscientiousness uniquely predicted better T3 physical functioning. This information may be useful to healthcare providers and community members in developing prevention and intervention strategies for African Americans.

Future Time Perspective and Perceived Social Support: The Mediating Role of Gratitude

Future time perspective, perceived social support, and dispositional gratitude are topics of interest that positively influence people’s psychological health. Although gratitude has been positively associated with future time perspective and social support, this is the first study to investigate its mediating role in the relationships of future time perspective with perceived social support. A convenience sample of 1256 adults (55.1% women), mean age 34.55 years (SD = 13.92), completed self-reported measures of future time perspective (conceptualized as remaining time and opportunities), dispositional gratitude, and received and given social support. Results indicated that higher dispositional gratitude mediated the relationship between the perception of more remaining time and opportunities and greater perception of received and given social support. These findings highlight the importance of considering dispositional characteristics to better understand the impact of perceived future on the individuals’ subjective experience of social exchanges. Interventions addressing future time perspective and dispositional gratitude might have beneficial effects on individuals’ social well-being.

Effect of Care Capacity on Stroke Patients' Recovery in Activities of Daily Living: A Multi-Hospital Study

BACKGROUND

This study aimed to investigate whether care capacity for patients following stroke contributes to improved activities of daily living (ADL) at discharge from hospital based on the degree of stroke severity.

DESIGN

Retrospective, observational, longitudinal study.

SETTING

Acute phase hospitals.

PARTICIPANTS

From 2005 to 2011, 5006 patients with stroke at acute phase hospitals were registered in a database. There were 2501 individuals from 11 hospitals who met the following four criteria: (1) a pre-stroke modified Rankin Scale (mRS) score of 0-3; (2) admission to hospital within 7 days of suffering a stroke; (3) ischemic or hemorrhagic stroke; and (4) staying in hospital for 8-60 days.

MAIN OUTCOME MEASURES

The main outcome measure was the Functional Independence Measure (FIM, version 3.0) score at discharge. The FIM is an internationally used scale, which is used as an ADL outcome assessment scale for after rehabilitation.

RESULTS

Among patients with stroke, those with care capacity had higher FIM scores at hospital discharge than did those without care capacity (unstandardized coefficient = 2.3, P = 0.015). Examination of this relationship by stroke severity showed that the FIM score at discharge was only significantly higher in patients who suffered from a moderate to severe stroke (unstandardized coefficient = 7.0, P = 0.040). No associations were observed in patients who suffered from minor, moderate, or severe stroke.

CONCLUSIONS

These results suggest that care capacity facilitates total recovery of the FIM, especially among patients who suffer from a moderate to severe stroke.

Reducing the Length of the Multidimensional Scale of Perceived Social Support

Abstract. The Multidimensional Scale of Perceived Social Support (MSPSS) is a widely used 12-item measure that assesses perceived social support from three sources: friends, family, and significant others. Previously published psychometric properties indicate that a shorter version of this scale may adequately assess perceived social support and reduce participant burden. The current studies sought to develop such a reduced scale across two studies. Study 1 examined a sample of spouses of US military personnel ( N = 5,436) randomly separated into exploratory and confirmatory samples. In the exploratory sample, we developed a 6-item reduced MSPSS using multidimensional item response theory. In the confirmatory sample, the reduced MSPSS fit the hypothesized structure and was highly correlated with the full MSPSS. Study 2 administered the full and reduced MSPSS separately within a sample of undergraduate students ( N = 188). The reduced MSPSS had high correlations with the full measure ( r = .90) and fit the hypothesized factor structure. Across both studies, correlations with related constructs were similar between the reduced and full MSPSS, demonstrating almost no loss of construct validity. Overall, the reduced MSPSS captured perceived social support with little loss of information. This reduced scale may be useful for minimizing survey length and participant burden.

Social Support, Strain, and Glycemic Control: A Path Analysis

Social support and strain have been linked with many health outcomes. However, less is known about whether these psychosocial factors are associated with Type 2 diabetes risk. This study uses the Midlife in the United States (MIDUS) dataset to examine the relationship between social support and strain from friends, family members, and spouse/partners and blood hemoglobin A1c levels in married/cohabiting adults who have not been diagnosed with diabetes. In addition, health locus of control is examined as a possible mediator. The study's findings suggest that support from friends is negatively associated with HbA1c levels, indicating a relationship between better glycemic control and social support from friends, and an indirect association for spouse/partner support. A direct effect for internal health locus of control was also found.

Social Support and Antibody Responses to Vaccination: A Meta-Analysis

BACKGROUND

Social support and social integration have been linked to lower rates of morbidity and mortality. However, the biological mechanisms responsible for such links need greater attention. Vaccine paradigms provide an integrative window into immune system involvement in the protective influence of social support/integration.

PURPOSE

The main aim of this article was to conduct a meta-analytic review of the association between social support/social integration and antibody responses to vaccines. Exploratory analyses also examined effect sizes and confidence intervals as a function of several factors to inform future research.

METHOD

A literature search was conducted using the ancestry approach and with PsycInfo, Medline, and the Psychology and Behavioral Science Collection by crossing the exact keywords of social support or social integration with vaccine or antibodies. The review identified nine studies with a total of 672 participants.

RESULTS

The omnibus meta-analysis showed that social support/social integration was related to higher antibody levels following vaccination, but the average effect size was small and the lower bound of the confidence interval included zero (Zr = 0.06 [-.04, .15]). These results did not appear to differ much as a function of the operationalization of social relationships, participant age, or follow-up period, although effect sizes appeared larger for studies using a primary antigen.

CONCLUSIONS

These data provide some evidence that social support may be linked to antibody responses to vaccines. However, effect sizes are mostly small and zero overall effect cannot be ruled out. Future studies would benefit from larger sample sizes and greater consideration of methodological issues associated with secondary immune responses to antigen.

The Association Between Perceived Stress and Hypertension Among Asian Americans: Does Social Support and Social Network Make a Difference?

Prior research suggests that stress plays role in the etiology and progression of hypertension. To lend a more accurate depiction of the underlying mechanisms between stress and hypertension, this study aims to assess the associations between perceived stress and hypertension across varying levels of social support and social network among Asian Americans. We conducted a cross-sectional study using data on 530 Chinese, Korean and Vietnamese Americans recruited from a liver cancer prevention program in the Washington D.C.-Baltimore metropolitan area. Hypertension prevalence was 29.1%. Individuals with high perceived stress were 61% more likely to have hypertension compared to those with low levels of perceived stress (odds ratio 1.61, 95% confidence interval 1.15, 2.46). There was no evidence that social support and social network acted as effect modifiers. Social support had a direct beneficial effect on hypertension, irrespective of whether individuals were under stress. The relationship between perceived stress and hypertension was modified by gender and ethnicity whereby a significant positive association was only observed among male or Chinese participants. Our study highlights the importance of understanding the associations between stress, social support, and hypertension among Asian American subgroups. Findings from the study can be used to develop future stress management interventions, and incorporate culturally and linguistically appropriate strategies into community outreach and education to decrease hypertension risk within the Asian population.

The Multidimensional Scale of Perceived Social Support (MSPSS): Reliability and Validity of Russian Version

Objective: To assess factorial and construct validity along with reliability of the Russian version of the Multidimensional Scale of Perceived Social Support (MSPSS) in cardiac patients.Methods: The study included 1018 patients with coronary artery disease. All patients were offered the opportunity to complete a questionnaire to detect psychosocial risk and protective factors, including the MSPSS.Results: Internal consistency of the Russian version of the MSPSS was high: Cronbach's alpha coefficient in the group of patients with stable angina was .91 vs. .90 in the group with acute coronary syndrome. The three-factor structure of the MSPSS was proved with exploratory and confirmatory factor analyses. As expected, the Russian version of the MSPSS was negatively correlated with measures of anxiety and depression, and positively correlated with curiosity.Conclusions: The Russian version of MSPSS corresponds closely with the English version in reliability, consistency, and internal structure. Test-retest reliability was satisfactorally high and construct validity was supported with the results of the correlation analysis.Clinical Implications: Our study confirms that MSPSS questionnaire is a high valid tool to estimate social support and it can be successfully applied to define social support in patients with cardiac pathology.

Psychosocial markers of pre-hospital decision delay and psychological distress in acute coronary syndrome patients

Objectives Both pre-hospital decision delay - the time patients wait before seeking medical attention after symptoms have started - and high psychological distress after the cardiac episode predict poor prognosis of patients with acute coronary syndromes (ACS). We aimed to identify psychosocial markers of these prognostic factors. Design A cross-sectional study of 102 consecutive, clinically stable ACS survivors. Methods Participants completed a questionnaire measuring pre-hospital decision delay, psychological distress, and several known psychosocial factors related to cardiovascular health: type D personality, resilience, social support, and concerns during the cardiac event. Multiple linear regression and mediation analyses were conducted. Results Type D personality and fewer concerns about the serious consequences of delaying help-seeking were related to more psychological distress post-ACS, and these relationships were mediated by longer pre-hospital decision delay. In contrast, resilience was related to lower psychological distress. Social support and social concerns about help-seeking were not related to the outcome variables. Conclusions Type D personality may be a risk factor for more delayed help-seeking for an ACS and higher psychological distress after the cardiac event. Resilience, in contrast, emerged as a potential protective factor of patients' mental health after the cardiac event. Pre-hospital decision delay was related to thinking about serious consequences (e.g., complications, protecting one's family) but not about social concerns (e.g., wasting other people's time) during the cardiac episode. Statement of Contribution What is already known on this subject? Longer pre-hospital decision delay, that is waiting longer to seek medical attention after symptoms have started, predicts poor prognosis of acute coronary syndrome patients. High psychological distress post-ACS, such as the development of anxiety and/or depression, also predicts poor prognosis of these patients. What does this study adds? This study identifies several psychosocial markers of longer prehospital decision delay and high psychological distress post-ACS. Prehospital decision delay was related to thinking about serious consequences (e.g., complications, protecting one's family) but not about social concerns (e.g., wasting other people's time) during the cardiac episode. Type D personality and fewer concerns about the serious consequences of delaying help-seeking were related to more psychological distress, and these relationships were mediated by longer prehospital decision delay. Resilience was related to lower psychological distress post-ACS.

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.

Explaining the Relationship Between Personality and Health in a National Sample of African Americans: The Mediating Role of Social Support

Though associations between personality and health have been previously observed, less is known about why such relationships exist. The present study examines whether social support mediated the relationship between personality traits and health among African Americans. We hypothesized that social support would help explain the relationship between each of the five-factor model traits and physical functioning. Data were collected from a national probability sample of 803 African American adults using a telephone survey including measures of the five-factor model personality traits, social support, and physical functioning. Results of mediational analyses suggested that higher openness to experience, conscientiousness, extraversion, and agreeableness, and lower neuroticism predicted higher social support. Higher openness, conscientiousness, extraversion, and lower neuroticism, but not agreeableness, predicted higher physical functioning. The relationships between physical functioning and personality traits were at least partially mediated by social support. This study reinforces the importance of identifying the mechanisms underlying the personality-health relationship. This information may be useful to community members and health care providers in developing prevention and treatment strategies for African Americans.

Measuring social support in psychiatric patients and controls: Validation and reliability of the shortened Close Persons Questionnaire

Although previous studies have underlined the protective role of social support for physical and psychological health, no self-report questionnaires are validated for measuring social support in large-scale psychiatric epidemiological studies. In the current study, we aim to validate the shortened version of the Close Persons Questionnaire (CPQ), a self-report questionnaire that is administered twice to measure social support received from the partner (CPQ-p) as well as from a close friend/family member (CPQ-f). Data of psychiatric patients (n = 1891) and controls (n = 1872) from three Dutch epidemiological studies that assessed determinants of psychopathology were used to validate the shortened CPQ. This included determining factor structure and reliability for the different scales. Using multigroup confirmatory factor analyses, a four-factor model proved to be the best fitting model for both the CPQ-p and CPQ-f. The resulting subscales -emotional support, practical support, negative support experiences, inadequacy of support-showed moderate to good reliability for both the CPQ-p and the CPQ-f, and were all correlated with other social measures in the expected directions. The shortened version of the CPQ proves to be a valid and reliable measure of social support for both psychiatric patients and controls. Further research is needed to assess usability of the shortened version of the CPQ for clinical practice.

Interplay of Self-efficacy and Social Support in Predicting Quality of Life in Cardiovascular Patients in Pakistan

The primary objective of the present study was to assess independent and interactive relations of perceived social support and self-efficacy with four quality of life (QOL) domains namely physical, psychological, social, and environmental in cardiovascular disease (CVD) patients from a South Asian region. Participants were 172 (age 22-60 years) patients recruited from three major government sector hospitals from the fifth biggest city of South Asia. It was found that overall CVD patients had a better QOL in psychological and environmental domains compared to social and psychological. Furthermore, findings from hierarchical regression analyses indicated that perceived social support and self-efficacy were positively associated with the four QOL domains. Besides main effects, a synergistic interaction between social support and self-efficacy emerged indicating that perceived social support was strongly associated with physical and social QOL in CVD patients who had higher self-efficacy levels, while, perceived social support was weakly associated with the physical and social QOL in CVD patients who had lower self-efficacy levels.

Predictive model for quality of life in patients with recurrent coronary artery disease

Background:

The aims of this study were to construct and verify a model that explains the quality of life in patients with recurrent coronary artery disease.

Methods:

Participants were 212 patients with recurrent coronary artery disease undergoing percutaneous coronary intervention. Data were collected through structured questionnaires from 21 December 2016–30 April 2017, and were analyzed using SPSS 23.0 and AMOS 23.0.

Results:

The model’s fit indices were adequate. Type D personality, symptom experience, and resilience had a direct effect on quality of life, while type D personality, cardiac function status, social support, and resilience had an indirect effect on quality of life. Type D personality, cardiac function status, social support, symptom experience, and resilience explained 55% of the total variance in quality of life. Thus, type D personality, cardiac function status, social support, symptom experience, and resilience affected the quality of life in patients with recurrent coronary artery disease.

Conclusions:

Systematic and integrated intervention programs considering factors related to quality of life may be useful for improving quality of life for patients with recurrent coronary artery disease.

Social support for patients with coronary artery disease after percutaneous coronary intervention

BACKGROUND

To assess how social support relates to parameters of patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI), and how social support affects patient's prognosis within 1 year after surgery.

METHODS

The study included 739 male and 236 female patients (975) who underwent PCI. To determine level of social support, the Multidimensional Scale of Perceived Social Support was used. The mean duration of a prospective follow-up was 12.0 ± 1.7 months. The Cox multivariate regression proportional hazard model was used to estimate the hazard ratio (HR) of death from all causes and cardiovascular disease (CVD).

RESULTS

A low level of social support in 5.7% of patients was observed, while 30.5% had a moderate level and 63.8% had a high level. Patients with low and moderate levels of social support were older than those with high level. Among patients with high levels of social support, more were male compared to patients with moderate level. During observation, 24 patients died from all causes (2.5%), while 21 (2.2%) died from CVD. In the multivariate Cox regression model the HR of social support for all causes of death was 0.97 (95% confidence interval, [CI], 0.94-0.99, p = 0.007), while death from CVD was 0.97 (95% CI, 0.94-1.00, p = 0.048). For patients with low level of social support, the HR for death from all causes was 4.52 (95% CI, 1.37-14.95, p = 0.013), while death from CVD was 3.66 (95% CI, 0.94-14.25, p = 0.061).

CONCLUSION

Social support level was associated with age and gender, and significantly and independently affected CAD patients' risk of death after PCI.