Physical limitation and emotional well-being: gender and marital status variations

Enhancing well-being in later life: the interplay of mobility limitation, psychological adaptation, and assistive technology

Purpose: The experience of mobility limitations can compromise well-being in older adulthood. This study aimed to investigate the psychological mechanisms through which mobility limitations affect well-being and to evaluate how assistive technology might support these underlying processes among older adults.

Materials and methods: Using data from the 2015-2017 rounds of the National Health and Aging Trends Study (N = 5,091), we conducted mediation analysis to determine if dispositional tenacity and flexibility in 2016 linked mobility limitations in 2015 to well-being in 2017. Moderation analysis evaluated whether assistive technology use in 2015 supported tenacity and flexibility in the subsequent year.

Results: In 2015, 693 (13.6%) and 685 (13.5%) older adults reported mobility limitations when going outside and getting around inside, respectively. Mobility limitations had negative direct and indirect associations with well-being through pathways of reduced dispositional tenacity and flexibility. In the context of going outside, assistive technology use mitigated the impact of mobility limitation and supported the dual processes of tenacity and flexibility. However, for getting around inside, assistive technology use was associated with reduced dispositional tenacity and flexibility and further exacerbated the negative impact of mobility limitation.

Conclusions: This study highlights the psychological mechanisms that connect mobility limitations to well-being. Findings suggest that deploying tailored assistive technology may protect older adults' well-being by supporting their psychological adaptation to age-related challenges.

Volunteering during early retirement reduces depression

As individuals age, they often face deteriorating health and significant lifestyle changes, including retirement. While retirement can alter individuals' economic and social roles, potentially increasing the risk of depression, involvement in volunteer activities has been found to be beneficial for retirees. Using data from the Health and Retirement Study, we apply the parametric g-formula to simulate an intervention aimed at estimating the effect of volunteering on depression, and to assess the mediating role of limitations in activities of daily living. Our results show that engagement in volunteering reduces the probability of depression by approximately 5% in the whole population, with larger gains among early retirees. The results hold irrespective of gender, and indicate that the benefits are greater for women. Our findings show that about 10% of the positive impact of volunteering on depression operates via a reduction in the likelihood of experiencing limitations in activities of daily living. Therefore, we conclude that the benefits of volunteering extend to improving the overall health of both individuals and the population. Our simulated intervention targeting early retirees may be a viable public health strategy for protecting individuals against depression, while also enabling them to contribute to the public good.

Relationship between socioeconomic status and social network with loneliness: a cross-sectional study of China older adults with activity of daily living disabilities

OBJECTIVES

The objective of this study is to explore the relationship between loneliness and socioeconomic status and social networks in older adults with activity of daily living (ADL) disabilities in China and investigate people who are more likely to feel lonely.

DESIGN

Cross-sectional study.

SETTING

This study was conducted in six districts of Nantong, Jiangsu, China.

PARTICIPANTS

A total of 880 older adults with ADL disabilities who participated in long-term care insurance and had an ADL score of less than 40 were investigated by the convenient sampling method.

PRIMARY OUTCOME MEASURES

The UCLA Loneliness Scale (V.3) was used to assess loneliness.

RESULTS

Among 880 participants, the mean age was 80.64 years (SD 10.29) and 59.43% were females. The mean score of loneliness was 44.70 (SD=10.01), and the majority suffered from moderate (39.89%) or moderate to severe (40.11%) loneliness. Regression showed that lower loneliness was associated with being females (β=-1.534, 95% CI: -2.841 to -0.228), married (β=-3.554, 95% CI: -4.959 to -2.149), often communicating with children (β=-3.213, 95% CI: -4.519 to -1.908), having more than two friends (β=-5.373, 95% CI: -6.939 to -3.808) and receiving home-based rehabilitation once a day (β=-3.692, 95% CI: -5.642 to -1.743). Participants who lived in rural areas (β=1.926, 95% CI: 0.658 to 3.193) and were unemployed before retirement (β=4.691, 95% CI: 1.485 to 7.898) experienced higher loneliness for older adults with ADL disability. The classification and regression tree model showed fewer friends and communication with children sometimes, and living in rural areas felt more lonely.

CONCLUSIONS

The poorer socioeconomic status and social network among older adults with ADL disability perceived more loneliness. Attention should be paid to the loneliness status of such vulnerable people, particularly those with ADL disabilities living in rural areas and having fewer social networks.

Demographic and Audiological Characteristics of Candidates for Over-the-Counter Hearing Aids in the United States

OBJECTIVES

This report presents descriptive data on the demographic and audiological characteristics of US adults with perceived mild-to-moderate hearing loss, the primary candidates for over-the-counter (OTC) hearing aids.

DESIGN

The analyses are descriptive and present population-weighted responses for various self-reported demographic and audiological variables for adults with mild or moderate perceived hearing trouble. Results of pure-tone audiometry and immittance measures are also presented. Nationally representative datasets from the National Health and Nutrition Examination Surveys (NHANES) for 2011 to 2012, 2015 to 2016, and 2017 to 2020, the three most recent NHANES datasets with audiological information, were used.

RESULTS

The NHANES datasets indicated that there are 49.5 million adults in the United States with perceived mild-to-moderate hearing trouble. Results indicated that OTC hearing-aid candidates are most frequently 50 to 69 years of age, married, and identify as non-Hispanic White race/ethnicity. Most of these individuals graduated from high school, had several risk factors for hearing loss, had not had a hearing test in the past 5 years, and had never used hearing aids or assistive listening devices previously. The typical audiometric profile was a bilaterally symmetrical sloping hearing loss with slight to mild hearing loss above 2000 Hz. Group data showed normal immittance measures and absence of otoscopic abnormalities except for the presence of excessive (not impacted) cerumen in about 13% of the OTC hearing-aid candidates.

CONCLUSIONS

Tens of millions of US adults have perceived mild-to-moderate hearing trouble but have not pursued assistance, either through obtaining a hearing test or acquiring prescription hearing aids.

Divorce and physical health: A three-level meta-analysis

Divorce is often considered a major and stressful life transition. Given that divorcees are overrepresented in primary care and there is a association between individuals' physical health and psychological adjustment, potential post-divorce health problems are of concern. Yet, empirical evidence is lacking on the magnitude of the overall physical health risk after divorce, on possible differences across specific pathologies, and on factors that may increase or reduce this risk. The current meta-analysis addresses these issues. We identified 94 studies including u = 248 relevant effect sizes, based on N = 1,384,507 participants. Generally, compared to married individuals, divorcees showed significantly worse self-reported health (OR = 1.20, [1.08-1.33]), experienced more physical symptoms (OR = 1.34, [1.17-1.53]), and had a higher risk for diabetes (OR = 1.18 [1.05-1.33]), joint pathologies (OR = 1.24, [1.14-1.34]), cardiovascular (OR = 1.24, [1.09-1.41]) and cerebrovascular conditions (OR = 1.31, [1.14-1.51]), and sexually transmitted diseases (OR = 2.48, [1.32-4.64]). However, they had no increased risk of hypertension, hypercholesterolemia, cancer and cancer development, disabilities or limitations, or cognitive pathologies. Nor did divorcees significantly differ from married individuals when aggregating all pathologies to measure overall physical health problems (OR = 1.14, [0.85 to 1.54]). Yet, moderation analyses revealed that being female, unemployed, childless, or having a lower education constitutes a higher risk for overall physical health problems after divorce. The same applied to having a heavy alcohol consumption, lack of exercise, and being overweight. Our meta-analysis shows that divorcees are at heightened risk of certain pathologies, with sexually transmitted diseases as a particular post-divorce hazard. These findings call for more awareness among counsellors and physicians on divorcees' health conditions and the characteristics that make divorcees even more vulnerable to health problems.

Leisure as social engagement: does it moderate the association between subjective wellbeing and depression in later life?

Objectives

To investigate the role of leisure (as social engagement) in moderating the association between subjective wellbeing and depressive symptoms among older Indians.

Methods

The sample included data from 39,538 older adults (aged 55-80) from the Longitudinal Aging Study in India (LASI, Wave-1), 2017-2018. Individual level questionnaire was used to examine the relationship among social engagement, subjective wellbeing, and depressive symptoms. Moderating effects of leisure activities were estimated through interaction analysis and linear multivariable modeling.

Results

Low participation in social engagement activities (or leisure) was associated with greater likelihood of depressive symptoms. Leisure activities positively and significantly moderated the subjective wellbeing among older adults with depressive symptoms. Results suggest a significant wealth gradient where affluent older Indians having a clear advantage in heightened levels of social engagement and subsequently lower likelihood of depressive symptoms. Additionally, being in an urban area, co-residence in a "joint" household and belonging to the dominant social groups in terms of caste and religious categories are associated with gains in wellbeing.

Discussion

The direct and indirect effects of social engagement suggest that depressive symptoms can be mitigated while enhancing overall wellbeing of older adults. This holds promise for social policy in redirecting efforts to develop age-friendly initiatives and social infrastructure that enhance the link between engagement and wellbeing.

Health, Suicidal Thoughts, and the Life Course: How Worsening Health Emerges as a Determinant of Suicide Ideation in Early Adulthood

Poor physical health places adults at greater risk for suicide ideation. However, the linkage between health and suicidal thoughts may emerge and become established during early adulthood, concomitant with other social processes underlying suicidality. Using nationally representative survey data from Waves III through V of the National Longitudinal Study of Adolescent to Adult Health (n = 8,331), we examine the emergence of health as a predictor of suicide ideation across the early adult life course (ages 18-43). We find that worsening health does not significantly predict suicide ideation until young adults approach the transition into midlife. Our findings suggest this may be due to the increasing severity of health problems, reduced social network engagement, and disruption of social responsibilities later in early adulthood. Our findings underscore the need for social science research to examine the relationship between mental and physical health from a life course perspective.

Investigating the Link Between IADL and Depressive Symptoms in Older Adults: A Cross-Sectional Serial Mediation Model

OBJECTIVES

There is a dearth of research on the psychological processes that underlie the negative relation between impaired instrumental activities of daily living (IADL) and depressive symptoms in older adults. Drawing on the stress process model and the resilience framework, we investigated whether purpose in life and resilience serially mediate the relationship between impaired IADL and depressive symptoms.

METHODS

We recruited 111 cognitively healthy community-dwelling older adults (ages 54-85; M = 66.5) who scored a minimum of 25 points on the Mini-Mental State Examination.

RESULTS

We found that purpose in life and resilience serially mediated the relationship between IADL and depressive symptomatology in older adults. This association held true when we controlled for covariates. Additional sensitivity analyses also supported these findings.

CONCLUSIONS

This study extends our understanding of how IADL limitations contribute to depressive symptoms. Using a community-dwelling, cognitively healthy sample, we demonstrate that functional limitations indirectly influence older adults' depressive symptoms through a decreased sense of purpose in life and decreased resilience.

CLINICAL IMPLICATIONS

Our findings have implications for intervention programs that aim to alleviate IADL limitations and mental health issues in an aging population and promote healthy aging by improving psychosocial resources (i.e., purpose in life and resilience).

Association between physical activity, sedentary time, and physical fitness of female college students in China

BACKGROUND

Prior research has highlighted the importance of Physical Activity (PA), Sedentary Time (ST), and Physical Fitness (PF) for health. However, there is limited research on the association between PA, ST, and PF in the context of female college students, particularly in Eastern cultures. Therefore, the purpose of this study was to investigate the association between PA, ST, and PF among Eastern female college students to inform policy and practice.

METHODS

The study was conducted from February to May 2022 at East China Normal University, Shanghai, China. A total of 512 Chinese female college students participated in this study through snowball sampling. Participants' PA and ST were investigated using the International PA Questionnaire, and PF was measured using the Chinese National Student Physical Fitness Test. Independent samples t-test and binary logistic regression were used to compare the differences in PF between Active Participants (AP) and Inactive Participants (IP), as well as between Low Sedentary Participants (LSP) and High Sedentary Participants (HSP). Multinomial logistic regression was used to compare the differences in PF between Active and Low Sedentary Participants (ALSP), Active and High Sedentary Participants (AHSP), Inactive and Low Sedentary Participants (ILSP), and Inactive and High Sedentary Participants (IHSP). Data analysis was performed using Statistical Package for the Social Sciences version 28. The level of significance was set at 0.05.

RESULTS

AP showed significantly higher cardiorespiratory fitness (p < 0.05) and overall fitness (p < 0.01) than IP. Compared to IP, AP was less likely to be classified as unfit in terms of cardiorespiratory fitness [Odds Ratio (OR), 0.57; 95% Confidence Interval (CI), 0.38-0.85; p < 0.05]. Compared to IHSP, ALSP (OR, 0.44; 95% CI 0.25-0.76; p < 0.01) and AHSP (OR, 0.54; 95% CI 0.32-0.93; p < 0.05) were less likely to be classified as unfit in terms of cardiorespiratory fitness. Furthermore, compared to IHSP, AHSP (OR, 1.66; 95% CI 1.02-2.70; p < 0.05) and ILSP (OR, 2.09; 95% CI 1.16-3.77; p < 0.05) were more likely to be classified as unfit in terms of their flexibility.

CONCLUSION

There was a positive association between PA, cardiorespiratory fitness, and overall fitness. There was also an association between cardiorespiratory fitness, flexibility, and the combination of PA and ST. These findings suggest that both PA and ST can influence different PF items. Therefore, we recommend that public health policy and practice for college female students should consider PF items when selecting different PA and ST intervention strategies.

Association between poor self-reported health and unmarried status among adults: examining the hypothesis of marriage protection and marriage selection in the Indian context

Background

The link between marital status and health differences has long been a topic of debate. The substantial research on marriage and health has been conducted under two important hypotheses: marital protection and marriage selection. While the majority of evidence on the marriage-health relationship using these hypotheses comes from developed countries, there is a lack of evidence from Asia, particularly from India.

Objectives

The current study examines theoretical frameworks of marriage i.e., marital protection and marriage selection in the Indian setting concurrently, bringing substantial empirical evidence to explore the link between marriage and health, considering this subject in the context of self-reported health (SRH). Secondly, this study will aid in investigating age and gender differences in marriage and health.

Methods

Using the Study on Global AGEing and Adult Health (SAGE), a cohort study of individuals aged 50 years and older with a small section of individuals aged 18 to 49 for comparative reasons, the present study population was 25 years and above individuals with complete marital information. Logistic regressions were employed to explore the connection between marital status and self-reported health. In the marriage protection hypothesis, the follow-up poor SRH was the dependent variable, whereas the initial unmarried status was the independent variable. For the marriage selection effects, initial poor SRH as the independent variable and follow-up unmarried status as the dependent variable had considered.

Results

Examining the marital protection hypothesis, the initial unmarried status (OR: 2.14; CI at 95%: 1.17, 3.92) was associated with the followed-up SRH transition from good to poor between 2007 and 2015 for young men, while initial unmarried status was linked with a lower likelihood of stable good SRH and a higher likelihood of stable poor SRH status across all age categories among women. Focusing on the marriage selection hypothesis, among young men, a significant association exists between the initial poor SRH and departure in marital status from married to unmarried. Young women with initial poor SRH (OR: 0.68; CI at 95%: 0.40, 1.00) had lower odds of stable married. In comparison, women with initially poor SRH, irrespective of age, were more likely to have higher odds of being stably unmarried.

Conclusion

Marriage indeed protects health. There are also shreds of evidence on health-selected marital status in India. Taken together, the aspect of marital protection or marriage selection is gender and age-specific in India. The findings contribute to a more comprehensive understanding of the relationship between marriage and health, which may have significant implications for health-related public policies aimed at unmarried women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14170-0.

The psychosocial experiences of girls with visual impairment about the ideal spouse and marriage

Mate choice is one of the biggest psychological, social, and emotional changes in the life of every human being. This issue is associated with challenges and problems for people especially blind and visual impairment (VI) people. Although marriage leads to many changes and transformations in the life of blind and VI people, it is essential for meeting psychological, social, emotional, and sexual needs. Accordingly, this study aimed to analyze the psychosocial experiences of VI girls about the ideal husband and marriage. This qualitative study was conducted with a descriptive phenomenological approach. The data were collected through targeted interviews with 20 single girls with VI who were members of the White Cane Society of Tehran in 2021. The collected data were analyzed using Colaizzi’s seven-step method. Four main themes were extracted from the participants’ experiences, including “experience of love and freedom,” “criteria for selecting an ideal spouse,” “fear and worry about the marriage,” and “stigma and strict public judgments.” Following the findings of the study, it can be argued that paying attention to the experience of girls with VI can shed light on their criteria for mate choice and marriage and clarify their needs and demands. This perspective helps mental health professionals and rehabilitation counseling experts to meet their needs through social welfare planning and family awareness programs.

Mental Health Benefits and Detriments of Caregiving Demands: A Nonlinear Association in the Canadian Longitudinal Study on Aging

Objectives

This study examines whether the association between caregiving demands and mental health is non-linear and also, whether this non-linear association is contingent on the marital status of the caregiver.

Methods

We analyze the data from the Canadian Longitudinal Study on Aging, applying OLS regression and quadratic interaction terms.

Results

A lower level of demands is salubriously associated with symptoms of depression and life satisfaction, but this association becomes deleterious at higher levels of demands. Moreover, a connection to a marital partner extends the benefits of caregiving demands and stems the adverse consequences.

Discussion

This research shows that acts of caregiving may not themselves be detrimental. Instead, the degree and way in which caregiving relates to mental health may vary by both the extent of the demands of the caregiving role and familial relationships in which caregivers are embedded.

Prospective Associations of Leisure-Time Physical Activity With Psychological Distress and Well-Being: A 12-Year Cohort Study

OBJECTIVE

This study aimed to investigate the associations of leisure-time physical activity with psychological distress and well-being, and potential mediators.

METHODS

We used data from the 1970 British Cohort Study (n = 5197; 2688 men), including waves 34y (2004), 42y (2012), and 46y (2016). Participants reported leisure-time physical activity frequency and intensity (exposure) at age 34 years (baseline); cognition (vocabulary test), body mass index, disability, mobility and pain perception (potential mediators) at age 42 years; and psychological distress (Malaise Inventory) and well-being (Warwick-Edinburgh scale) at age 46 years. Baseline confounders included sex, country, education, employment status, alcohol use, tobacco smoking, and psychological distress. Main analyses included logistic regression and mediation models.

RESULTS

Higher leisure-time physical activity intensity at baseline was associated with lower psychological distress at 46y (β = -0.038 [95% confidence interval {CI} =-0.069 to -0.007]), but not leisure-time physical activity frequency. Baseline leisure-time physical activity frequency and intensity were associated with higher psychological well-being at 46y (frequency: β = 0.089 [95% CI = 0.002 to 0.176]; intensity: β = 0.262 [95% CI = 0.123 to 0.401]); and total: β = 0.041 [95% CI = 0.013 to 0.069]). Only body mass index at 42y partially mediated the association between leisure-time physical activity frequency (15.7%) and total leisure-time physical activity (6.2%) at 34y, with psychological well-being at 46y.

CONCLUSIONS

Our findings highlight the role of leisure-time physical activity in psychological distress and well-being, with greater effect sizes associated with higher frequency and intensity of leisure-time physical activity. Future interventions should consider examining potential mediators of the association of leisure-time physical activity with psychological well-being, such as body mass index.

Association between physical limitations and depressive symptoms among Indian elderly: marital status as a moderator

BACKGROUND

Depression among the elderly is well-documented and associated with socio-economic factors, physical and mental health conditions. Few studies have focused on older adults' physical limitations and depressive symptoms. However, very little is known about marital status' role in such associations, especially in India. The present study examines the association between physical limitations and self-reported depressive symptoms and moderating role of marital status in such association separately for men and women.

METHODS

The present study used data from the Longitudinal Ageing Study in India (LASI) wave 1, 2017-2018, a nationally and state representative longitudinal large-scale survey of ageing and health. For the present research, a total sample of 20,806 older adults aged 60+ years was selected after excluding missing values. Along with descriptive statistics, binary logistic regression analysis and interaction effect of marital status were applied to examine the association between physical limitations (functional limitations and mobility difficulty) with the depressive symptoms separately for men and women.

RESULTS

About 58, 50, and 45% elderly reported having depressive symptoms and had difficulty in 2+ ADLs, 2+ IADLs, and 2+ mobility difficulties, respectively. By the marital status, the prevalence of depressive symptoms was higher among currently unmarried than currently married, irrespective of type and number of physical limitations. The unadjusted, marital and multivariate-adjusted association suggested that elderly with more than two ADLs, IADLs, and mobility difficulty had higher odds of depressive symptoms. The gender stratified interaction effect of marital status and physical limitations on depressive symptoms indicated that currently unmarried elderly, particularly unmarried older women with 2+ ADLs (OR = 2.85; CI 95% = 1.88-3.09), 2+ IADLs (OR = 2.01; CI 95% = 1.74-2.31) and 2+ mobility difficulty (OR = 2.20; CI 95% = 1.86-2.60) had higher odds of depressive symptoms. However, such association was only valid for unmarried men having mobility difficulty.

CONCLUSION

The study highlights that the elderly with physical limitations such as ADLs, IADLs, and mobility difficulty require attention and care. Although married elderly are less likely to have depressive symptoms even with all the mentioned physical limitations, unmarried women are more vulnerable to have depressive symptoms with physical limitations.

Predicting Depression From Hearing Loss Using Machine Learning

OBJECTIVES

Hearing loss is the most common sensory loss in humans and carries an enhanced risk of depression. No prior studies have attempted a contemporary machine learning approach to predict depression using subjective and objective hearing loss predictors. The objective was to deploy supervised machine learning to predict scores on a validated depression scale using subjective and objective audiometric variables and other health determinant predictors.

DESIGN

A large predictor set of health determinants from the National Health and Nutrition Examination Survey 2015-2016 database was used to predict adults' scores on a validated instrument to screen for the presence and severity of depression (Patient Health Questionnaire-9 [PHQ-9]). After model training, the relative influence of individual predictors on depression scores was stratified and analyzed. Model prediction performance was determined by prediction error metrics.

RESULTS

The test set mean absolute error was 3.03 (95% confidence interval: 2.91 to 3.14) and 2.55 (95% confidence interval: 2.48 to 2.62) on datasets with audiology-only predictors and all predictors, respectively, on the PHQ-9's 27-point scale. Participants' self-reported frustration when talking to members of family or friends due to hearing loss was the fifth-most influential of all predictors. Of the top 10 most influential audiometric predictors, five were related to social contexts, two for significant noise exposure, two objective audiometric parameters, and one presence of bothersome tinnitus.

CONCLUSIONS

Machine learning algorithms can accurately predict PHQ-9 depression scale scores from National Health and Nutrition Examination Survey data. The most influential audiometric predictors of higher scores on a validated depression scale were social dynamics of hearing loss and not objective audiometric testing. Such models could be useful in predicting depression scale scores at the point-of-care in conjunction with a standard audiologic assessment.

Types of multidimensional vulnerability and well-being among the retired in the U.S

BACKGROUND

An extensive study investigated the risk factors for low well-being in post-retirement. Most previous studies have taken a unidimensional perspective, focusing on single factors such as financial status, physical health, and mental health.

OBJECTIVE

Drawing on the vulnerability framework, we first identify and describe the empirical subgroups of vulnerability among retirees in the United States across four major domains of later life: material, physical, social, and mental vulnerability. Then, we investigate the association between vulnerability profiles and well-being.

METHOD

The sample included 3,158 retirees aged 65+ who participated in the Health and Retirement Study (HRS). Latent class analysis was utilized to identify the heterogeneous subgroups of vulnerability, and then a series of OLS regression analyses was conducted to examine the relationship between patterns of vulnerability and well-being.

RESULTS

Five vulnerability patterns were identified: material vulnerable (12%), health & social vulnerable (14%), material, health & social vulnerable (6%), least vulnerable (34%), and social vulnerable (35%). The health & social vulnerable group had the strongest negative influence on well-being among all subgroups. As the largest subgroup, the social vulnerable group's negative influence on well-being stood out, with a stronger effect than that of material privation experienced by those in the material vulnerable group.

CONCLUSION

By empirically identifying subgroups of differential vulnerability patterns among retirees, this study showed that post-retirement vulnerability reflects complex interactions among multiple disadvantages. Findings of this study enhance understanding of the disparities in well-being within the retired population, pointing to the possibility of targeted policy and program development.

Expanding the Role Repertoire While Aging: A Drama Therapy Model

Drama therapy has been found to improve various facets of mental health while aging. It provides opportunities for personal growth and creative expression and enhances group relationships. Drama therapy is a widely acknowledged way to explore the life stories in late life. However, only a handful of studies have empirically explored the value of drama therapy for the aging population. This conceptual analysis was designed to address this need by developing a new integrative model of drama therapy. The analysis is based on the review of the results of four studies that explored the integration of life-review and playback theater as a drama therapy approach for older adults. The therapeutic process focused on the exploration of life-crossroads stories, a short unique technique which enables the participants to craft a harmonious view of their life stories in a short-term dramatic creative group process. Combining the four results yielded a multidimensional model which points to three potential transformative routes: the evolution of the life story, the evolution of improvised dramatic expression, and the expansion of social engagement. The transformative routes are described through the lens of role theory in drama therapy.

Gender and Age Differences in Loneliness: Evidence for People without and with Disabilities

This study examines the relationships between loneliness, gender, and age for people without and with disabilities (moderate versus severe) in Germany. Using data taken from the German Socio-Economic Panel (SOEP) for the years 2013 and 2017 and using the UCLA (University of California, Los Angeles) Loneliness Scale, in general we found that males report lower loneliness scores as compared to those for females. Furthermore, we found a strong association between loneliness and the individual's age, but with differences according to gender and disability status. For example, for males with severe disabilities levels of loneliness decrease with age, whereas for females with severe disabilities the opposite result is found. In addition, we found that participation in leisure activities and having a higher frequency of contacts with family, friends, and social online networks (measured by the relational time index) contribute to reducing loneliness for all individuals. From a public policy perspective, it is necessary to undertake the design, promotion, and implementation of instrumental, emotional, and social support measures for people with disabilities (in particular for females that are severely limited in their daily activities), which can contribute to reducing their loneliness scores and increasing their levels of life satisfaction.

Multimorbidity, Loneliness, and Social Isolation. A Systematic Review

No systematic review has appeared so far synthesizing the evidence regarding multimorbidity and loneliness, social isolation, or social frailty. Consequently, our aim was to fill this gap. Three electronic databases (PubMed, PsycINFO, and CINAHL) were searched in our study. Observational studies examining the link between multimorbidity and loneliness, social isolation, and social frailty were included, whereas disease-specific samples were excluded. Data extraction included methods, characteristics of the sample, and the main results. A quality assessment was conducted. Two reviewers performed the study selection, data extraction, and quality assessment. In sum, eight studies were included in the final synthesis. Some cross-sectional and longitudinal studies point to an association between multimorbidity and increased levels of loneliness. However, the associations between multimorbidity and social isolation as well as social frailty remain largely underexplored. The quality of the studies included was rather high. In conclusion, most of the included studies showed a link between multimorbidity and increased loneliness. However, there is a lack of studies examining the association between multimorbidity and social isolation as well as social frailty. Future studies are required to shed light on these important associations. This is particularly important in times of the COVID-19 pandemic.

Psychological Well-Being and Parent-Child Relationship Quality in Relation to Child Autism: An Actor-Partner Modeling Approach

Parents of children with autism spectrum disorder (ASD) often report poor psychological well-being, including a high level of parenting stress and depressive symptoms. Little is known about the extent to which poor parent psychological well-being alters the emotional quality of the parent-child relationship in a context of child ASD. This study examined the association between actor (one's own) and partner (one's partner's) level of parenting stress and depressive symptoms and the emotional quality of the parent-child relationship using a Five Minute Speech Sample (FMSS) in 150 families of children with ASD, aged 5-12 years (85.7% male). Mothers and fathers were aged 38.69 (SD = 5.62) and 40.76 (SD = 6.19), respectively; 76% of mothers and 68% of fathers had a college degree. Structural equation modeling, using Analysis of Moment Structures software, was used to test Actor-Partner Interdependence Models. Results indicated that mother's level of parenting stress and depressive symptoms were associated with her own FMSS Warmth and Criticism toward the child with ASD 12 months later in negative and positive directions. Mother's level of parenting stress was also negatively associated with father's FMSS Warmth toward the child with ASD 12 months later. Finally, father's level of parenting stress was positively associated with his FMSS Criticism toward the child with ASD. Overall, findings indicate that the mother-child and father-child relationship are both impacted by parent psychological well-being in families of children with ASD; however, actor effects are stronger for mothers and partner effects were only found for fathers. Implications for interventions are discussed.

The Psychological Consequences of Disability over the Life Course: Assessing the Mediating Role of Perceived Interpersonal Discrimination

We examine whether perceived interpersonal discrimination mediates the association between disability and psychological well-being (depression, negative and positive affect) and how these processes differ across the life course. Data are from two waves (2004-2006; 2013-2014) of the Midlife in the United States (MIDUS; N = 2,503). Perceived discrimination accounts for 5% to 8% of the association between disability and the three mental health outcomes. Moderated mediation analyses reveal significant age differences; perceived discrimination is a stronger explanatory mechanism among midlife (ages 40-64) relative to older (age 65+) adults. Disability stigma takes a heightened psychological toll at midlife, a life stage when adults are expected to be able-bodied and interact with a diverse social network, which may be a source of interpersonal mistreatment. Among older adults, for whom impairment is expected and common, the psychological impact of disability may operate through other pathways. We discuss implications for research and practice.

Exploring the contingent associations between functional limitations and depressive symptoms across residential context: a multilevel panel data analysis

Objectives: This study examines the multilevel relationship between functional limitations and depressive symptoms among community-dwelling US older adults, and how it is moderated by community environmental characteristics (neighborhood fear, social cohesion, structural disadvantage and residential stability).Method: Data come from two waves of National Social Life, Health and Aging Project (NSHAP) collected in 2005/2006 and 2010/2011, consisting of 2,261 individuals aged 57-85 (mean = 68.5; SD = 7.5) nested in 100 regional areas. Two-level hierarchical linear models are fitted to test if and to what extent limited physical capacity and neighborhood measures are interactively related to depressive symptoms.Results: Adjusting for confounders (e.g. age, gender, education, employment status, social support), we find a significant positive relationship between functional limitations and depressive symptoms. At the aggregate level, socially cohesive neighborhoods are negatively related to depression. Several cross-level interactions are also observed. First, the association between poor functional health and depression is greater in neighborhoods perceived to be less safe. It is also stronger in places with more structural disadvantages. Lastly, the physical impairment-depression link is more pronounced where there is higher residential stability, i.e., greater proportion of long-term residents.Conclusion: Our study bridges an important empirical gap in the literature. Prior studies have rarely investigated how the connection between functional limitations and depressive symptoms among older adults is conditioned by neighborhood characteristics. By using multilevel analysis of population-based longitudinal data, we show that physical space (neighborhood community) plays a critical role in understanding this important, yet understudied, relationship.

Profiling obesity phenotypes and trajectories in older adults of the Quebec NuAge cohort on nutrition and successful aging: A cluster analysis

Obesity in older adults results from several interacting factors. Consequently, interventions have shown mitigated effects. We determined (a) the different subgroups of older adults with obesity based on clusters of associated comorbidities and (b) the trajectory of these clusters to assess their stability over 3 years and factors contributing to transitions. Obese men (n = 193; body mass index [BMI] = 33.15 ± 2.69 kg/m² ) and women (n = 220; BMI = 33.71 ± 3.71 kg/m² ) aged between 68 and 82 years were studied. Outcome variables were body composition, strength, physical capacity (PC), nutrition, psychological and physical health and social participation. Cluster analyses, stratified by sex, were used to identify obesity profiles at baseline and follow-up. Three profiles were identified, based on general health (GH), psychological health (PH) and PC: Cluster 1: healthy obese (GH+, PH+, PC+); Cluster 2: obese with low PC (GH+/-, PH+/-, PC-); Cluster 3: unhealthy obese (GH-, PH-, PC-). After 3 years, 61.2% and 70.2% of men and women remained in their initial cluster, compared to 20.4% and 13.7% who transitioned towards a worse health cluster and 18.3% and 16.0% who transitioned towards a more favourable cluster, partly explained by changes in physical health for men and physical health and PH for women. The results of this study show that targeting physical function in men and physical health and PH functions in women could prevent further health decline in older adults with obesity. Further studies are needed to investigate the role of these clusters in the prediction of cardiometabolic complications and mortality.

Health and Union Dissolution among Parenting Couples: Differences by Gender and Marital Status

Poor health may destabilize romantic unions by impeding fulfillment of family responsibilities, increasing stress, and causing financial strain. We hypothesized that the associations of health characteristics with union stability for parenting couples vary by the gender of the partner in poor health and the couple's marital status because of gender and marital status differences in family responsibilities and health-related coping behaviors. Using longitudinal data from the Fragile Families and Child Wellbeing Study (n = 2,997), we examined how three health measures predicted union dissolution for urban married and cohabiting couples with young children. Fathers' depression at baseline predicted dissolution for all parenting couples, as did either partner developing depression between baseline and the following interview. For married parents, fathers' health-related work limitations and mothers' poor self-rated health also predicted dissolution. Associations between health conditions and dissolution differ by gender and marital status, possibly reflecting varying social norms about family responsibilities.

The association between loneliness and health - a survey-based study among middle-aged and older adults in Denmark

BACKGROUND

While the association between overall poor health and loneliness among older adults continues to be examined closely, less attention has been given to middle-aged adults. This paper examines the relationship between loneliness and health as measured by self-rated health, physical ability and multi-morbidity in a large sample of Danish adults between the ages of 52-92 years. Furthermore, it identifies vulnerable groups with regard to the year of birth and gender.

METHOD

We apply the survey-study method, using data collected by The Danish National Centre for Social Research in 2012. We analysed the association between loneliness and health in 9154 Danish adults through multi-variate regression analyses adjusting for the year of birth, gender, marital status, cohabitation status, employment status and home ownership.

RESULTS

We found that loneliness was associated with increased risks of poor self-rated health (OR, 2.58; 95% Cl, 1.20-3.35), limited physical abilities (OR, 1.91; 95% Cl, 1.58-2.32) and multiple diagnoses (OR, 1.77; 95% Cl, 1.48-2.12). Lonely middle-aged adults (52-62 years of age) had an increased risk of having limited physical abilities.

CONCLUSION

Among middle-aged and older Danish adults, loneliness was strongly associated with poor self-rated health, limited physical ability and multi-morbidity.

Daily Couple Experiences and Parent Affect in Families of Children with Versus Without Autism

We examined daily couple experiences in 174 couples who had a child with autism spectrum disorder (ASD) relative to 179 couples who had a child without disabilities and their same-day association with parent affect. Parents completed a 14-day daily diary in which they reported time with partner, partner support, partner closeness, and positive and negative couple interactions and level of positive and negative affect. One-way multivariate analyses of covariance and dyadic multilevel models were conducted. Parents of children with ASD reported less time with partner, lower partner closeness, and fewer positive couple interactions than the comparison group. Daily couple experiences were more strongly associated with parent affect in the ASD than comparison group. Findings have implications for programs and supports.

Depression in later life: A closer look at the gender gap

Gender differences in depressive symptoms have been extensively documented, with women reporting a higher number of depressive symptoms than men. However, studies offer different explanations for why such a gap exists. The goal of the current paper is to analyze how much of the observed gender gap in depression may be attributed to (1) compositional versus (2) reporting differences or (3) differences in reactivity to adversities. We contribute to this literature by testing, net of compositional differences, whether the relationship between reporting behavior and depressive symptoms is gendered and whether accounting for the possibility of gender-specific reactivity alters the structure of the gender gap at older ages. Our results show that the observed gender gap in depression (1) only partially derives from compositional differences; (2) is not an artifact of a gender-specific reporting style; and remarkably (3) men appear more sensitive to adversities.

Disability and Activity-related Emotion in Later Life: Are Effects Buffered by Intimate Relationship Support and Strain?

We use daily diary data from the Disability and Use of Time supplement to the 2013 Panel Study of Income Dynamics ( n = 1,162) to evaluate (1) the extent to which marital/partner support and strain moderate the effects of disability on five activity-related emotions (happiness, calm, sadness, frustration, worry) and overall negative and positive emotion among older married, cohabiting, and dating persons and (2) whether such patterns differ significantly by gender. Marital support buffers against negative emotions and increases feelings of calm among severely impaired women. By contrast, support intensifies negative emotions and decreases feelings of calm among severely impaired men. Relationship strain also intensifies the effect of severe impairment on men's frustration, sadness, worry, and negative mood but has negligible effects on the negative emotions of men with low impairment and women. Frequent support and criticism may threaten highly impaired older men's sense of autonomy and emotional well-being.

Sexual orientation differences in functional limitations, disability, and mental health services use: Results from the 2013-2014 National Health Interview Survey

OBJECTIVES

The authors investigated sexual orientation differences in risk for mental health morbidity, functional limitations/disability, and mental health services use among adults interviewed in the nationally representative 2013-2014 National Health Interview Survey.

METHOD

Respondents were 68,816 adults (67,152 heterosexual and 1,664 lesbian, gay, and bisexual [LGB] individuals), age 18 and older. Fully structured interviews assessed sexual orientation identity, health status, and services use. Using sex-stratified analyses while adjusting for demographic confounding, the authors compared LGB and heterosexual individuals for evidence of mental health-related impairments and use of mental health services.

RESULTS

LGB adults, as compared to heterosexual adults, demonstrated higher prevalence of mental health morbidity and functional limitations. However, this varied by gender with LGB women evidencing elevated risk for both mental health and substance abuse (MHSA) and non-MHSA limitations. Among men, sexual orientation differences clustered among MHSA-related limitations. Overall, LGB adults were more likely than heterosexual adults to use services, with the source of functional limitations moderating these effects among men.

CONCLUSION

MHSA-related morbidity is a significant concern among LGB individuals and is associated with higher levels of functional limitations/disability. The findings highlight that LGB persons use MHSA-related treatment at higher rates than heterosexuals do, and, among men, are more likely to do so absent MHSA or non-MHSA-related functional limitations. This presents a unique set of concerns within the integrated care setting, including the need to deliver culturally competent care sensitive to the context of probable sex differences among LGB individuals. (PsycINFO Database Record

FUNCTIONAL LIMITATION AND DEPRESSIVE SYMPTOMATOLOGY: CONSIDERING PERCEIVED STIGMA AND DISCRIMINATION WITHIN A STRESS AND COPING FRAMEWORK

This study examines whether perceived stigma and discrimination moderate the associations between functional limitation, psychosocial coping resources, and depressive symptoms among people with physical disabilities. Using two waves of data from a large community study including a representative sample of persons with physical disabilities (N=417), an SEM-based moderated mediation analysis was performed. Mediation tests demonstrate that mastery significantly mediates the association between functional limitation and depressive symptoms over the study period. Moderated mediation tests reveal that the linkage between functional limitation and mastery varies as a function of perceived stigma and experiences of major discrimination and day-to-day discrimination, however. The implications of these findings are discussed in the context of the stress and coping literature.

Health sensitivity: Age differences in the within-person coupling of individuals' physical health and well-being

Well-being and physical health are central indicators of quality of life in old age. Research from a between-person difference perspective finds that people in better health than their peers also report higher well-being than their peers. However, we know very little about whether changes in one domain are accompanied by changes in the other domain, particularly at the within-person level. In the present study, we introduce the construct of health sensitivity, that is, how susceptible an individuals' well-being is to changes in physical health. In doing so, we used 9-wave longitudinal data covering 17 years from the Health and Retirement Study (N = 21,689; 50-109 year olds; 55% women) and applied multilevel modeling to examine the covariation of central indicators of well-being (depressive affect) and health (functional limitations) simultaneously at both the between-person and within-person level. At the within-person level, we found evidence of health sensitivity-on occasions when a typical person experienced more functional limitations than usual, he or she also reported more depressive affect-and that health sensitivity decreased with age. Survival analysis revealed that health sensitivity was related to mortality hazards, controlling for mean levels of health and well-being. We discuss the theoretical importance of examining within-person associations between health and well-being and consider practical implications. (PsycINFO Database Record

Physical Disability and Increased Loneliness among Married Older Adults: The Role of Changing Social Relations

Examining the social context of disablement, we investigated how changes in social relations affect loneliness among married older men and women. With longitudinal data on 914 married persons from the National Social Life, Health, and Aging Project (NSHAP), we found that changes in the quality of marital and nonmarital relations moderate the effect of disability on loneliness in unexpected ways. Increases in negative marital quality buffer the effect of physical disability, while increases in nonmarital support exacerbate it. Although not predicted by existing theory, these findings are consistent with some prior work suggesting that health-related stressors, like physical disability, condition the meaning of changes in social relations. We find, however, that negative social relations ameliorate loneliness only among disabled married men; disabled married women experience increased loneliness under similar circumstances. These differences have not been previously identified. We conclude by discussing the gendered nature of the social context of disablement.

Disability, Health Insurance and Psychological Distress among US Adults: An Application of the Stress Process

Structural resources, including access to health insurance, are understudied in relation to the stress process. Disability increases the likelihood of mental health problems, but health insurance may moderate this relationship. We explore health insurance coverage as a moderator of the relationship between disability and psychological distress. A pooled sample from 2008-2010 (N=57,958) was obtained from the Integrated Health Interview Series. Chow tests were performed to assess insurance group differences in the association between disability and distress. Results indicated higher levels of distress associated with disability among uninsured adults compared to their peers with public or private insurance. The strength of the relationship between disability and distress was weaker for persons with public compared to private insurance. As the Affordable Care Act is implemented, decision-makers should be aware of the potential for insurance coverage, especially public, to ameliorate secondary conditions such as psychological distress among persons who report a physical disability.

Is marital status associated with quality of life?

BACKGROUND

The divorce rate has been increasing rapidly in Korea; the single rate and trends in divorce are also changing rapidly. This study aimed to examine the relationship between marital status and quality of life (QOL) in an attempt to understand these changes. We also investigated the relationship between QOL and marital status by age group.

METHODS

We used data from the Community Health Survey (2008: n = 200,800; 2009: n = 227,700; 2010: n = 229,229) administered by the Korean Centers for Disease Control and Prevention. After excluding 63,527 participants with incomplete information on QOL and/or marital status, the final analysis involved 594,202 participants. The analysis used t-tests and Chi-square tests to compare demographic variables between men and women, and ANOVA to compare QOL scores among comparison groups. We also performed a multilevel analysis on the relationship between QOL and marital status while accounting for the provincial differences.

RESULTS

The multilevel analysis by marital status showed that single men had significantly worse QOL (both EQ-VAS and EQ-5D) than married men. On the other hand, the QOL measured by EQ-VAS was better in single women than in married, and separated or divorced women. When QOL was assessed using EQ-5D, single and separated or divorced women had worse scores than married women. In the analysis by age group, the QOL of married men under the age of 30 years was lower than that of single men or men with marriage problems as measured by EQ-VAS. However, among 40-69-year-old men, married men had the highest QOL values. Similarly, for women in their 30s, single women had the highest EQ-VAS values, but for 40-69-year-old women, single women had lower EQ-VAS scores than married women.

CONCLUSION

There was significant relationship between marital status and QOL, and this relationship appeared to differ by gender and age.

Sociological Scholarship on Gender Differences in Emotion and Emotional Well-Being in the United States: A Snapshot of the Field

This article provides a brief overview of scholarship on gender differences in emotion and emotional well-being among adults in the United States, highlighting major substantive findings, methodological innovations, and theoretical developments that have emerged in the sociologies of emotion and mental health. Sociological research consistently finds that men report more frequent positive and less frequent negative feelings than women as well as gender differences in both the experience and expression of emotional distress. Sociologists attribute these gendered patterns of emotion to the larger social, economic, and cultural context surrounding women and men. Overall, by identifying macro- and meso-level social causes of microlevel emotional processes, sociologists have made significant contributions to knowledge about gender differences in emotion and emotional well-being in the US.