Low mental health literacy and its association with depression, anxiety and poor sleep quality in Chinese elderly

Psychache status and associated contributing factors among the Hakka elderly in Fujian, China

BACKGROUND

Little is known about the state of psychological distress of the elderly in China, and research on specific subgroups such as Hakka older adults is almost lacking. This study investigates psychache and associated factors among Hakka elderly in Fujian, China.

METHODS

The data analysed in this study were derived from China's Health-Related Quality of Life Survey for Older Adults 2018. The Chinese version of the Psychache Scale (PAS) was used to assess the frequency and intensity of psychache in Hakka older adults. Generalized linear regression analysis was conducted to identify the main socio-demographic factors associated with psychache overall and its frequency and intensity.

RESULTS

A total of 1,262 older adults participated, with mean scores of 18.27 ± 6.88 for total PAS, 12.50 ± 4.79 for PAS-Frequency and 5.77 ± 2.34 for PAS-Intensity. On average, females scored higher than males on PAS-Frequency (β = 0.84, 95% CI = 0.34, 1.35) and PAS-Intensity (β = 0.48, 95% CI = 0.22, 0.73). Older adults currently living in towns (β = -2.18, 95% CI = -2.81, -1.54), with their spouse only (β = -3.71, 95% CI = -4.77, -2.65), or with children (β = -3.24, 95% CI = -4.26, -2.22) were more likely to score lower on PAS-Frequency. Conversely, older adults who were regular sleepers (β = -1.19, 95% CI =-1.49, -0.88) or lived with their spouse only (β = -1.25, 95% CI = -1.78, -0.72) were more likely to score lower on PAS-Intensity.

CONCLUSION

Among Hakka elderly, we found a higher frequency and greater intensity of psychache in females, those with poor health status, irregular sleepers, rural residents, solo dwellers, those with below CNY 10,000 in personal savings, and the medically uninsured. The study's findings indicate that policymakers should give more attention to the susceptible population and implement practical interventions to reduce their psychological burden.

Factors Predicting Mental Health Literacy in Older Adults: A Community-Based Cross-Sectional Study

PURPOSE

To determine mental health literacy (MHL) levels of older adults and the predictive factors of MHL.

METHOD

This cross-sectional study was conducted between October and December 2022, with 410 older adults aged ≥65 years. A Personal Information Form and the Mental Health Literacy Scale were used for data collection. Independent samples t test, analysis of variance, and multiple linear regression were used to analyze the data.

RESULTS

Significant predictors of MHL in older adults were being aged 65 to 69 years, being female, being a university graduate, having an income more than expenses, receiving information from a health professional, interest in mental health, having friends or family members with mental illness, and good perception of health.

CONCLUSION

Older adults were found to have low levels of MHL. Mental health professionals should focus on community-based education and interventions to increase the MHL levels of older adults. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Patterns of unhealthy lifestyle and their associations with depressive and anxiety symptoms among Chinese young adults: A latent class analysis

BACKGROUND

There is little evidence on the association between patterns of unhealthy lifestyle and mental health among young adults.

METHOD

This study included a total of 28,978 young adults aged 18 to 44 years old in Guangdong province in south China, which was conducted from September to December in 2022. We used latent class analysis to classify the patterns of unhealthy lifestyle among young adults and used multiple logistic regression to explore their associations with depressive and anxiety symptoms.

RESULT

The weighted prevalence of depressive and anxiety symptoms were 28.0 % and 19.5 %, respectively. The cumulative effect of unhealthy lifestyles on depressive and anxiety symptoms was significant. Five patterns of unhealthy lifestyle were classified. Compared to the relatively healthy lifestyle class, the class with more unhealthy lifestyles (OR = 6.54, 95 % CI: 5.70-7.51) and insufficient sleep (OR = 6.16, 95 % CI: 4.92-7.70) had higher risk for depressive and anxiety symptoms. Meaningfully, having adequate mental health literacy could reduce the risk of depressive and anxiety symptoms from unhealthy lifestyle by half.

LIMITATIONS

The cross-section design study limited causal inferences, and the self-report information may lead to recall bias.

CONCLUSIONS

Unhealthy lifestyles have a negative impact on depressive and anxiety symptoms through independent, cumulative and combined effects, and they could be interrelated. Unhealthy lifestyle patterns differed in younger population by socio-demographic characteristics and mental health literacy. Health-care professionals and policymakers may provide programs to intervene multiple unhealthy lifestyles and improve mental health literacy by integrating healthy lifestyle education to promote youngers' mental health.

Healthier Dietary Patterns Are Associated with Better Sleep Quality among Shanghai Suburban Adults: A Cross-Sectional Study

BACKGROUND

More is to be explored between dietary patterns and sleep quality in the Chinese adult population.

METHODS

A cross-sectional study including 7987 Shanghai suburban adults aged 20-74 years was conducted. Dietary information was obtained using a validated food frequency questionnaire. Adherence to a priori dietary patterns, such as the Chinese Healthy Eating Index (CHEI), Dietary Approaches to Stop Hypertension (DASH) diet and Mediterranean diet (MD), was assessed. Sleep quality was assessed from self-reported responses to the Pittsburgh Sleep Quality Index (PSQI) questionnaire. Logistic regression models adjusting for confounders were employed to examine the associations.

RESULTS

The overall prevalence of poor sleep (PSQI score ≥ 5) was 28.46%. Factor analysis demonstrated four a posteriori dietary patterns. Participants with a higher CHEI (ORQ4 vs. Q1: 0.81, 95% CI: 0.70-0.95), DASH (ORQ4 vs. Q1: 0.70, 95% CI: 0.60-0.82) or MD (ORQ4 vs. Q1: 0.75, 95% CI: 0.64-0.87) had a lower poor sleep prevalence, while participants with a higher "Beverages" score had a higher poor sleep prevalence (ORQ4 vs. Q1: 1.18, 95% CI: 1.02-1.27).

CONCLUSIONS

In Shanghai suburban adults, healthier dietary patterns and lower consumption of beverages were associated with better sleep quality.

Topics Included in Health Literacy Studies in Asia: A Systematic Review

The study aimed to review general and specific health literacy studies in different countries in Asia to understand the progress of health literacy researches in the region. English-published studies with quantitative measurements of health literacy were collected through a systematic search in PubMed, Cochrane Library, Embase, and Web of Science, without publication dates limitation. A total of 156 articles on general health literacy, oral, mental, disease-specific health literacy, and eHealth literacy were collected. General health literacy was the most covered topic in 89 articles, followed by eHealth Literacy. Health literacy studies have been conducted in 16 countries and have been increasingly concerned in most of the countries in Asia. China had the largest number of articles, followed by Taiwan. Four studies had participants from more than one country. Education, age, health status, incomes, and living/residential area were significantly associated with health literacy levels in 156 studies, with the prevalence of 55.8%, 28.2%, 20.5%, 17.9%, and 10.9%, respectively. Lower health literacy was related to poorer health outcomes or lower quality of life in 71 studies.

The association between satisfaction with life and anxiety symptoms among Chinese elderly: a moderated mediation analysis

BACKGROUND

Previous studies have suggested that certain personal psychological variables (e.g., life satisfaction and cognitive function) and physical variables (e.g., body mass index [BMI]) are significantly associated with individuals' anxiety symptoms. However, relevant research on elderly is lagging and no studies have yet investigated the combined impact of these variables on anxiety. Thus, we conducted the present study to investigate the potential moderator role of BMI and the potential mediator role of cognitive function underlying the relationship between life satisfaction and anxiety symptoms in Chinese elderly based in Hong Kong.

METHODS

Sixty-seven elderly aged 65 years old and above were recruited from the local elderly community centres in this pilot study. Each participant underwent a systematic evaluation using the Satisfaction with Life Scale (SWLS), Hong Kong Version of the Montreal Cognitive Assessment (HK-MoCA), and the Hamilton Anxiety Rating Scale (HAM-A) and were measured for their body weight and height. Regression analysis using the bootstrapping method was employed to test the hypothesized moderated mediation model.

RESULTS

Our findings demonstrated the overall model accounted for 23.05% of the variance in scores of HAM-A (F (8, 57) = 2.134, p = 0.047) in Chinese elderly. There was a significant association between life satisfaction and anxiety symptoms (p = 0.031), indicating that individuals with higher life satisfaction were associated with less anxiety symptoms. Moreover, this relationship was positively moderated by BMI (b = 0.066, 95% CI [0.004, 0.128]), especially in Chinese elderly with BMI at a lower level (b = -0.571, 95% CI [-0.919, -0.224]) and an average level (b = -0.242, 95% CI [-0.460, -0.023]). No significant mediator role was detected for cognitive function (b = -0.006, 95% CI [-0.047, 0.044]) in our model.

CONCLUSIONS

Our findings suggest that increased life satisfaction can reduce anxiety symptoms among Chinese elderly as their BMI decreases (when BMI ranged between "mean - 1SD" and "mean" of the population). The significant interaction between psychological and physical factors underlying anxiety symptoms found in this study, presents a promising opportunity for translation into multi-level psychological and physical interventions for the management of anxiety in ageing patients during clinical practice.

Mental health literacy and suicidal ideation among Chinese college students: The mediating role of depressive symptoms and anxiety symptoms

BACKGROUND

Mental health literacy (MHL) is essential to mental health. Symptoms of depression and anxiety are significant antecedents and closely related to suicide among college students. Few studies have explored the mediating role of depressive and anxiety symptoms between MHL and suicidal ideation.

METHODS

5578 college students were included in the analysis. The online Wenjuanxing platform was used to collect data from November 2020 to March 2021. The bootstrapping method was used to test the mediating role of depressive and anxiety symptoms in the links between MHL and suicidal ideation.

RESULTS

Approximately 18.8 % of Chinese college students in our study reported having suicidal ideation. MHL exhibited a significant and negative correlation with depressive symptoms, anxiety symptoms, and suicidal ideation, whereas depressive and anxiety symptoms correlated significantly and positively with suicidal ideation. Compared with the lowest MHL quartile, the 3rd and 4th quartiles of MHL were associated with a significantly lower risk of suicidal ideation after adjusting for various confounding factors. Depressive and anxiety symptoms partially mediated the relationship between MHL and suicidal ideation, and the mediating effect of depressive symptoms was significantly greater than that of anxiety symptoms.

LIMITATIONS

This study was a cross-sectional survey. Future longitudinal studies on this relation are needed.

CONCLUSIONS

Depressive and anxiety symptoms mediate the relationship between MHL and suicidal ideation. Comprehensive school-based specific psychological education programs are needed to improve college students' MHL and change their attitudes toward mental health services.

Global prevalence of poor sleep quality in military personnel and veterans: A systematic review and meta-analysis of epidemiological studies

Poor sleep quality is prevalent among members of the military but rates of poor sleep quality vary between studies. This study examined the global prevalence of poor sleep quality in military personnel and veterans as well as possible moderators of prevalence differences between studies. PubMed, EMBASE, Web of Science, and PsycINFO were systematically searched from their inception dates to September 1, 2022. Studies were included if they were conducted on military personnel and/or veterans and prevalence estimates of poor sleep quality could be generated from assessments with standardized tools. A random-effects model was used to calculate the pooled prevalence and its 95% confidence intervals (CIs). Fifty-nine studies (N = 28,100) were included for analysis with sample sizes ranging from 14 to 8481. Two studies were rated as "high quality" (3.39%), while 57 were rated as "moderate quality" (96.61%). The overall pooled prevalence of poor sleep quality in military personnel and veterans was 69.00% (95% CI: 62.33-75.30%); pooled rates were 57.79% (95% CI: 49.88-65.50%) and 82.88% (95% CI: 74.08-90.21%) for active duty personnel and veterans, respectively. Subgroup analyses indicated study region, study design, sampling method, Pittsburg Sleep Quality Index cut-off values, and service type moderated prevalence of poor sleep quality. Meta-regression analyses indicated sample size, mean age, depression and posttraumatic stress disorder (PTSD) were associated with prevalence differences between studies. Poor sleep quality was more common in both active duty military personnel and veterans who were older and those who reported PTSD or depression. Regular monitoring of sleep quality and sleep hygiene should be promoted in this population. More relevant studies in middle- and low-income countries should also be conducted.

The relationship between living alone or not and depressive symptoms in older adults: a parallel mediation effect of sleep quality and anxiety

BACKGROUND

With modernization and ageing in China, the population of older adults living alone is increasing. Living alone may be a potential risk factor for depressive symptoms. However, no parallel mediation model analysis has investigated the mediating factors for living alone or not (living arrangements) and depressive symptoms.

METHODS

This cross-sectional study included a total number of 10,980 participants from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), 1699 of whom lived alone and 9281 of whom did not live alone. Binary logistic regression and parallel mediation effect model were used to explore the relationship between living alone or not and depressive symptoms and possible mediation effects. Bootstrap analysis was used to examine the mediation effect of living alone or not on depressive symptoms.

RESULTS

Compared to the participants who were not living alone, the living alone group had a higher rate of depressive symptoms. The binary logistic regression showed that after adjusting for other covariates, the risk of depressive symptoms was approximately 0.21 times higher for living alone compared to not living alone (OR = 1.21, 95% CI: 1.06, 1.37). Further, the results of the bootstrap analysis supported the partial mediating role of sleep quality and anxiety. Mediation analysis revealed that sleep quality and anxiety partially mediate the relationship between living alone and depressive symptoms (β = 0.008, 95% CI [0.003, 0.014]; β = 0.015, 95% CI [0.008, 0.024], respectively).

CONCLUSIONS

Sleep quality and anxiety were identified as partially parallel mediators between living alone or not and depressive symptoms. Older adults living alone with poorer sleep quality and more pronounced anxiety were positively associated with higher levels of depressive symptoms. Older adults living alone should be encouraged to engage in social activities that may improve sleep quality, relieve anxiety, and improve feelings of loneliness caused by living alone. Meanwhile, older adults living alone should receive attention and support to alleviate their depressive symptoms.

Depression and quality of life among Macau residents in the 2022 COVID-19 pandemic wave from the perspective of network analysis

Background

In the summer of 2022, Macau experienced a surge of COVID-19 infections (the 618 COVID-19 wave), which had serious effects on mental health and quality of life (QoL). However, there is scant research on mental health problems and QoL among Macau residents during the 618 COVID-19 wave. This study examined the network structure of depressive symptoms (hereafter depression), and the interconnection between different depressive symptoms and QoL among Macau residents during this period.

Method

A cross-sectional study was conducted between 26th July and 9th September 2022. Depressive symptoms were measured with the 9-item Patient Health Questionnaire (PHQ-9), while the global QoL was measured with the two items of the World Health Organization Quality of Life-brief version (WHOQOL-BREF). Correlates of depression were explored using univariate and multivariate analyses. The association between depression and QoL was investigated using analysis of covariance (ANCOVA). Network analysis was used to evaluate the structure of depression. The centrality index "Expected Influence" (EI) was used to identify the most central symptoms and the flow function was used to identify depressive symptoms that had a direct bearing on QoL.

Results

A total 1,008 participants were included in this study. The overall prevalence of depression was 62.5% (n = 630; 95% CI = 60.00-65.00%). Having depression was significantly associated with younger age (OR = 0.970; p < 0.001), anxiety (OR = 1.515; p < 0.001), fatigue (OR = 1.338; p < 0.001), and economic loss (OR = 1.933; p = 0.026). Participants with depression had lower QoL F (1, 1,008) =5.538, p = 0.019). The most central symptoms included PHQ2 ("Sad Mood") (EI: 1.044), PHQ4 ("Fatigue") (EI: 1.016), and PHQ6 ("Guilt") (EI: 0.975) in the depression network model, while PHQ4 ("Fatigue"), PHQ9 ("Suicide"), and PHQ6 ("Guilt") had strong negative associations with QoL.

Conclusion

Depression was common among Macao residents during the 618 COVID-19 wave. Given the negative impact of depression on QoL, interventions targeting central symptoms identified in the network model (e.g., cognitive behavioral therapy) should be developed and implemented for Macau residents with depression.

The prevalence of anxiety and its key influencing factors among the elderly in China

INTRODUCTION

With the rapid aging population, the mental health of older adults is paid more and more attention. Anxiety is a common mental health illness in older adults. Therefore, the study aimed to explore the current situation of anxiety and its factors among the elderly in China.

METHODS

Based on the data from 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), a total of 10,982 respondents aged 60 and above were selected. Generalized Anxiety Disorder (GAD-7) scale was used to assess the anxiety. Univariate and multivariate analysis were used to analyze the influencing factors of anxiety. Random forest was established to rank the importance of each influencing factors.

RESULTS

The results showed that the prevalence of anxiety among the elderly was 11.24%. Anxiety was mainly associated with 14 factors from five aspects: sociodemographic characteristics, health status, psychological state, social trust and social participation, among which loneliness related to psychological status was the most important factor.

DISCUSSION

The revelation of this study is that the present situation of anxiety among the elderly cannot be ignored, and it is necessary to take measures to prevent and control it from many aspects.

Prevalence of insomnia and its association with quality of life among Macau residents shortly after the summer 2022 COVID-19 outbreak: A network analysis perspective

BACKGROUND

The latest wave of the coronavirus disease 2019 (COVID-19) pandemic in Macau began on 18 June 2022 and was more serious than previous waves. Ensuing disruption from the wave is likely to have had a variety of negative mental health consequences for Macau residents including increased risk for insomnia. This study investigated the prevalence and correlates of insomnia among Macau residents during this wave as well as its association with quality of life (QoL) from a network analysis perspective.

METHODS

A cross-sectional study was conducted between 26 July and 9 September 2022. Univariate and multivariate analyses explored correlates of insomnia. Analysis of covariance (ANCOVA) examined the relationship between insomnia and QoL. Network analysis assessed the structure of insomnia including "Expected influence" to identify central symptoms in the network, and the flow function to identify specific symptoms that were directly associated with QoL. Network stability was examined using a case-dropping bootstrap procedure.

RESULTS

A total of 1,008 Macau residents were included in this study. The overall prevalence of insomnia was 49.0% (n = 494; 95% CI = 45.9-52.1%). A binary logistic regression analysis indicated people with insomnia were more likely to report depression (OR = 1.237; P < 0.001) and anxiety symptoms (OR = 1.119; P < 0.001), as well as being quarantined during the COVID-19 pandemic (OR = 1.172; P = 0.034). An ANCOVA found people with insomnia had lower QoL (F_(1,1,008) = 17.45, P < 0.001). "Sleep maintenance" (ISI2), "Distress caused by the sleep difficulties" (ISI7) and "Interference with daytime functioning" (ISI5) were the most central symptoms in the insomnia network model, while "Sleep dissatisfaction" (ISI4), "Interference with daytime functioning" (ISI5), and "Distress caused by the sleep difficulties" (ISI7) had the strongest negative associations with QoL.

CONCLUSION

The high prevalence of insomnia among Macau residents during the COVID-19 pandemic warrants attention. Being quarantined during the pandemic and having psychiatric problems were correlates of insomnia. Future research should target central symptoms and symptoms linked to QoL observed in our network models to improve insomnia and QoL.