Socioeconomic health disparities revisited: coping flexibility enhances health-related quality of life for individuals low in socioeconomic status

A quality of life index for the rural periphery of Sri Lanka using GIS multi-criteria decision analysis techniques

Spatial evaluation of the region is associated with the assessment of the Quality of Life (QoL). Despite numerous research endeavoring to define, measure, quantify, and map the quality of life, there exists a consistent fault in Sri Lanka. Hence, the objective of this study was to construct a QoL index and determine the spatial disparities of QoL from the Polpitigma town to its periphery. The assessment was conducted by employing 20 geographical factors that quantify QoL using the Geographic Information Systems (GIS). The evaluation assigned weights to each criterion based on the assessments of both local residents and experts, utilizing the Multi-Criteria Decision Analysis (MCDA) and the Analytical Hierarchy Process (AHP). The findings indicated that cultural factors made a greater contribution compared to the environment,service functions,security and socioeconomic factors. Within the study area, the region with a higher quality of life (HQoL) only covered 4.5% (17.3 km2), whilst the lower QoL zone encompassed 63.8% (252 km2). And also, the distance from the town is a crucial factor in determining the spatial variations in QoL. The derived model can serve as a road map for local-level planning, as it has been validated and shown to have an accuracy of 74% through the Receiver operating characteristic (ROC) curve. Considering the lack of previous research in this field, this study offers a crucial contribution in enhancing the QoL for underprivileged communities in the study area by improving employment, income, and accessibility to physical infrastructure, public utility services, and cultural and recreational facilities. Especially the findings of this study can efficiently guide decisions for the distribution of financial resources to enhance the QoL in impoverished rural communities on the rural periphery of DS.

Levels of health expenditure and payment coping mechanisms for persons living with diabetes and hypertension both singly and in comorbidity in Enugu, Southeast, Nigeria

Context:

The burden of diabetes mellitus (DM) and hypertension (HTN) both singly and in comorbidity has gained increased attention, especially in developing countries and this has great socioeconomic consequences. In Nigeria, the prevalence of both diseases is known to be increasing, while government health expenditure (HE) is not.

Aim:

The study examined the levels of expenditure and payment coping mechanisms for persons living with diabetes and HTN both singly and in comorbidity in Enugu, Nigeria.

Methods:

The study was a quantitative, cross-sectional, descriptive study done among patients attending the medical outpatient clinics. HTN and DM are the two noncommunicable diseases that were considered in this study. Data were separated into those with diabetes, HTN, or both. A descriptive analysis of sociodemographic characteristics was done. Analysis was done by estimating the direct and indirect costs. The catastrophic HE was also conducted. The mean, Chi-square, and P value were calculated in each group to assess differences in association.

Results:

Respondents were 817 with a mean age of 62.3 years. Respondents’ mean monthly income after food expenditure was N39465.43 ($129.0). One month earlier, 36.5%, 32.4%, and 31.1% of respondents spent more than 10% of their income on diabetes, HTN and in comorbidity, respectively, while in the current visit, 43.2%, 22.8%, and 32.0% of respondents spend more than 10% of their income on diabetes, HTN, and in comorbidity, respectively.

Conclusion:

The study shows that out-of-pocket is a major method of payment for diabetes and HTN. Therefore, the two diseases need to be included in the national safety net.

Effect of personality traits on socioeconomic inequalities in health, a population-based study

OBJECTIVES

This study aimed to estimate the effects of positive personality traits (PTs) in income and self-rated dental and general health (SRDH and SRGH) associations in a large South Australian sample.

METHODS

Cross-sectional analyses were conducted using self-reported data collected from 3578 adults (2015-2016). Multivariable regression models assessed the main effects and interactions of the Ten-Item Personality Inventory (TIPI) and income with SRDH and SRGH. Prevalence ratios (PR) of poor health ratings were estimated using Poisson regression.

RESULTS

Among all respondents, high-income individuals with stronger Conscientiousness scores had the lowest prevalence of poor SRGH (0.8%), while those with stronger Extraversion (2.9%) and Agreeableness scores (3.4%) had the lowest prevalence of poor SRDH. Poor SRGH was related to weak Conscientiousness (PR = 6.9, 95% CI [2.3-20.8]) and Emotional Stability scores (PR = 6.0, 95% CI [2.0-18.3]), while poor SRDH was associated with weak Extraversion (PR = 2.3, 95% CI [1.2-4.5]), Agreeableness (PR = 1.8, 95% CI [1.0-3.2]) and Conscientiousness scores (PR = 2.1, 95% CI [1.1-4.0]). Among low-income people, poor health ratings were less prevalent in those with stronger positive PTs scores versus weaker scores. Among low-income respondents, poor SRGH was lower in individuals with stronger versus weaker Conscientiousness scores (10.9% vs 16.2%), and poor SRDH showed lower prevalence in participants with stronger versus weaker Agreeableness scores (18.1% vs 22.6%).

CONCLUSION

Findings showed the association between PTs and the prevalence of poor SRDH and SRGH. Stronger positive PTs modified the self-rated health inequalities associated with low income in a representative sample of the South Australian population.

Socioeconomic Disparities in Individual-Level Quality-Adjusted Life Years throughout Remaining Lifetimes: A National Representative Longitudinal Survey in China

Socioeconomic disparities in health within and across low- and middle-income countries pose a significant global public health concern. While prior research has demonstrated the importance of socioeconomic status on health outcomes, few studies have employed comprehensive measures of individual-level health such as quality-adjusted life years (QALYs) in exploring the quantitative relationship. In our study, we employed QALYs to measure individual-level health, using health-related quality of life scores based on the Short Form 36 and predicted remaining life years through individual-specific Weibull survival analysis. We then constructed a linear regression model to explore the socioeconomic factors that influence QALYs, providing a predictive model of individual-level QALYs throughout remaining lifetimes. This practical tool can help individuals predict their remaining healthy life years. Using data from the China Health and Retirement Longitudinal Study between 2011 and 2018, we found that education and occupation were the primary factors influencing health outcomes among individuals aged 45 and above, while income appeared to have less of an impact when education and occupation were simultaneously controlled for. To promote the health status of this population, low- and middle-income countries should prioritize the long-term advancement of their population's education while controlling unemployment rates in the short term.

The impact of covid-19 lockdown on the Quality of life, meaningful activities, and frailty in community-dwelling octogenarians: A study in Belgium

OBJECTIVES

To investigate the impact of COVID-19 lockdown on quality of life (QoL), meaningful daily activities, and (pre)frailty in community-dwelling octogenarians.

METHODS

Cross-sectional design with bivariate and multiple linear regression modeling using a stepwise approach examining the level of QoL during the COVID-19 lockdown in a group of 215 community-dwelling octogenarians (M_age = 86.49 ± 3.02). A comprehensive set of biopsychosocial variables (FRAIL scale, general health, engagement in meaningful activities survey, questions on loneliness, and feelings) were used as explaining variables.

RESULTS

Particularly, a decrease in daily activities, social activities, and an increase in free times activities were observed, but the decrease in QoL could be explained by the meaningfulness in activities, together with experiencing emptiness in life, taking ≥ 4 medications a day and feeling down or depressed.

CONCLUSIONS

We tried to understand which components contribute to and might affect a person's QoL caused by restrictions imposed by the governance and its influence on the lives of the community-dwelling octogenarians. As such, this output could be a baseline for the development of minimally impacting countermeasures during future lockdowns.

CLINICAL IMPLICATIONS

Studying lifestyle changes and thus also variables related to QoL during a pandemic, may support policymakers and practitioners to develop relevant interventions.

Personality traits and income inequalities in self-rated oral and general health

The association of low income with poor health is widely recognized, but why some low-income individuals do not experience poor health remains unclear. The aim of this study was to determine whether greater positive personality trait scores modify the association between income and oral and general health-related quality of life (OHRQoL and HRQoL) among a representative sample of the South Australian population. Cross-sectional self-rated questionnaire data from a sample of 3645 adults in 2015-2016 were used for secondary analysis. In four factorial ANOVA models, the main effects, interaction, and effect modification of personality traits [measured using the Ten-Item Personality Inventory (TIPI)] on the association between income and OHRQoL [measured using the Oral Health Impact Profile (OHIP-14)] and HRQoL [measured using the European Quality of Life indicator (EQ-5D-3L)] were assessed. In the low-income group, participants with greater TIPI scale scores had lower means for the OHIP-14 and the EQ-5D-3L (better OHRQoL and HRQoL). Greater emotional stability scores modified the association between low income and HRQoL and OHRQoL. Stronger positive personality traits, such as emotional stability, appear to ameliorate the adverse effect of income inequalities in health.

Social determinants of vulnerability in the population of reproductive age: a systematic review

Background

The health of an (unborn) child is largely determined by the health and social determinants of its parents. The extent to which social determinants of parents or prospective parents affect their own health depends partly on their coping or resilience abilities. Inadequate abilities allow negative effects of unfavourable social determinants to prevail, rendering them vulnerable to adverse health outcomes. Addressing these determinants in the reproductive-aged population is therefore a key approach in improving the health of the future generation. This systematic review aims to synthesise evidence on social determinants of vulnerability, i.e., inadequate coping or low resilience, in the general population of reproductive age.

Methods

The databases EMBASE, Medline, PsycINFO, CINAHL, Google Scholar, Web of Science, and Cochrane Library, were systematically searched from database inception to December 2th 2021.

Observational studies examining social determinants and demographics in relation to vulnerability among the general population of reproductive age (men and women aged 18-40 years), conducted in a high-income country in Europe or North America, Australia or New Zealand were eligible for inclusion. Relevant data was extracted from each included article and findings were presented in a narrative and tabulated manner.

Results

We identified 40,028 unique articles, of which 78 were full text reviewed. Twenty-five studies were included, of which 21 had a cross-sectional study design (84%). Coping was the most frequently assessed outcome measure (n = 17, 68%). Thirty social determinants were identified. Overall, a younger age, lower socioeconomic attainment, lack of connection with the social environment, and adverse life events were associated with inadequate coping or low resilience.

Conclusions

This review shows that certain social determinants are associated with vulnerability in reproductive-aged individuals. Knowing which factors make people more or less vulnerable carries health-related implications. More high-quality research is needed to obtain substantial evidence on the strength of the effect of these social conditions in this stage of life.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13651-6.

Coping Flexibility and Alcohol-Related Outcomes: Examining Coping Motives as Mediators

Background: Coping has been implicated in the etiology and treatment of problem drinking. Traditional, static measurement of coping styles (e.g., approach, avoidance, social support) may fail to capture how adaptive a given coping style may be. Coping flexibility is an emerging construct, associated with psychological health, and one that may shed light on coping's role in drinking risk. Coping flexibility includes (1) discontinuation of an ineffective coping strategy ("Discontinuation") and (2) production of an alternative strategy ("Implementation"). This study is the first to our knowledge to examine its association to drinking outcomes. Further, because coping deficits are theorized to lead to drinking through coping motives, we also examined mediated pathways from coping flexibility to alcohol outcomes via coping motives. Methods: College students (N = 528) completed an online assessment. Data were analyzed using path analysis. Control variables included sex and coping styles. Results: In path analytic models, Implementation was negatively associated with alcohol use and, indirectly via coping motives, negatively associated with alcohol consequences. The direct effect on alcohol use remained when controlling for coping styles and sex, but the mediational pathway was no longer significant. Conclusions: This study provides some evidence for the protective role of coping flexibility in alcohol use behavior, which may have implications for how best to address coping skills in alcohol interventions. The direct effect of Implementation on drinking suggests that there may be utility in teaching clients a flexible approach to coping in treatment. Replication, particularly with longitudinal designs, is needed.

Living with a chronic disease: insights from patients with a low socioeconomic status

Background

Little is known about how patients with low socioeconomic status (SES) experience their chronic disease, and how it impacts health-related quality of life (HRQoL). Compared to their more affluent counterparts, worse outcomes have been reported. A better understanding of the domains of HRQoL that are relevant to these specific populations is therefore needed. We explored the experiences of living with a chronic disease in low SES persons.

Methods

A qualitative interview study was performed in Flanders, Belgium. Semi-structured interviews were conducted in chronically ill patients, selected through purposive sampling. Interviews were audio-recorded and transcribed verbatim. Analysis followed an inductive and iterative approach.

Results

Fifteen patients were interviewed. Six major themes were identified: a heavy bag to carry, loss of autonomous life, inner and outer loneliness, emotional imbalance, unmet need for support, and coping strategies. Patients experienced their illness as an additional problem on top of all other problems (i.e. financial/social problems, traumatic life events). In general, the disease burden and non-disease burden were mutually reinforcing, resulting in greater dependency, greater risk of social isolation, greater psychological distress, and greater risk of impaired HRQoL.

Conclusions

This study is the first to provide detailed insight into the experiences of living with a chronic disease in low SES persons. A conceptual model is proposed that can be used in daily clinical practice to raise awareness among clinicians and health care providers that the patient’s needs go beyond the disease itself. Future research is needed to validate and test the model.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01578-7.

Relationship of Coping Strategies and Quality of Life: Parallel and Serial Mediating Role of Resilience and Social Participation among Older Adults in Western Philippines

Growing old is frequently linked with various challenges. Hence, it is important to understand how to age successfully. Drawing on the concept that an individual's quality of life (QOL) is influenced by their demographics, coping strategies, resilience, and social participation, the current study reports on the findings of these variables among older adults in the Western Philippines. A total of 392 volunteer older adults were surveyed. Aside from the demographics such as age, gender, marital status, average monthly income, educational attainment, and health status, the data collected also included the 30-item coping strategies for the elderly, 14-item resilience scale, 12-item social participation scale, and 35-item older people's QOL scale. Structural equation modeling was used to verify the parallel and serial mediating role of resilience and social participation within the relationship between coping strategies and QOL. Findings show that coping strategies alone are not enough to improve QOL. The only way to improve QOL is through resiliency, as well as the ability to participate in social activities. In essence, the QOL of older adults can be improved by encouraging them to have more social participation, and at the same time, understand how it takes to become resilient.

How have people been coping during the COVID-19 pandemic? Patterns and predictors of coping strategies amongst 26,016 UK adults

BACKGROUND

Individuals face increased psychological distress during the COVID-19 pandemic. However, it's unknown whether choice of coping styles are influenced by COVID-19 in addition to known predictors.

METHODS

Data from 26,016 UK adults in the UCL COVID-19 Social Study were analysed from 12/4/2020 15/5/2020. Regression models were used to identify predictors of coping styles (problem-focused, emotion-focused, avoidant, and socially-supported): model 1 included sociodemographic variables, model 2 additionally included psychosocial factors, and model 3 further included experience of COVID-19 specific adverse worries or events.

RESULTS

Sociodemographic and psychosocial predictors of coping align with usual predictors of coping styles not occurring during a pandemic. However, even when controlling for the wide range of these previously known predictors specific adversities were associated with use of specific strategies. Experience of worries about finances, basic needs, and events related to Covid-19 were associated with a range of strategies, while experience of financial adversities was associated with problem-focused, emotion-focused and avoidant coping. There were no associations between coping styles and experiencing challenges in meeting basic needs, but Covid-19 related adversities were associated with a lower use of socially-supported coping.

CONCLUSIONS

This paper demonstrates that there are not only demographic and social predictors of coping styles during the COVID-19 pandemic, but specific adversities are related to the ways that adults cope. Furthermore, this study identifies groups at risk of more avoidant coping mechanisms which may be targeted for supportive interventions.

Regulatory Flexibility of Sustaining Daily Routines and Mental Health in Adaptation to Financial Strain: A Vignette Approach

A vignette approach was adopted to investigate flexibility of sustaining daily routines and whether and how this ability was related to mental health at different levels of financial strain. Three separate studies were conducted with community-dwelling adults (N = 1685) in the USA. In Study 1, we drafted, tested, and modified vignettes with reference to pilot data on the relevance of the scenarios and response options. In Study 2, regulatory flexibility of sustaining daily routines, as calculated in term of context sensitivity and responsiveness to feedback, was formulated correlations with self-reported instruments to demonstrate its concurrent validity, discriminant validity, and criterion-related validity. In Study 3, path analysis examined the associations of regulatory flexibility of sustaining daily routines with psychological distress and well-being, and the moderating effects of subjective financial strain on the associations. Results showed that the inverse associations of context sensitivity and responsiveness to feedback with depressive symptoms were stronger at medium/high levels relative to lower levels of perceived financial strain. The inverse association between context sensitivity and positive affect was significant only at higher levels of strain. Our findings could provide a feasible direction for developing scalable behavioral interventions for potential mental health problems, especially among those with a lower socioeconomic status.

Testing of a Dual Process Model to Resolve the Socioeconomic Health Disparities: A Tale of Two Asian Countries

A wealth of past studies documented that individuals of lower socioeconomic status (SES) are more susceptible to both acute and chronic life stress than those of higher SES, but some recent evidence documents that not all individuals from the lower SES group experience immense stress. The present study was grounded in theories of coping and psychological adjustment, and a dual process model was formulated to address some resolved issues regarding socioeconomic disparities in health. For a robust test of the proposed dual process model, data were collected from two Asian countries—Hong Kong and Indonesia—with different socioeconomic heritage and conditions. Consistent with the predictions of our model, the present findings revealed that coping flexibility was a psychological mechanism underlying the positive association between social capital and health for the lower SES group, whereas active coping was a psychological mechanism underlying this positive association for the higher SES group. These patterns of results were largely replicable in both Asian samples, providing robust empirical support for the proposed dual process model.

Adjustment to a "New Normal:" Coping Flexibility and Mental Health Issues During the COVID-19 Pandemic

The Coronavirus Disease 2019 (COVID-19) pandemic is an unprecedented health crisis in terms of the scope of its impact on well-being. The sudden need to navigate this "new normal" has compromised the mental health of many people. Coping flexibility, defined as the astute deployment of coping strategies to meet specific situational demands, is proposed as an adaptive quality during this period of upheaval. The present study investigated the associations between coping flexibility and two common mental health problems: COVID-19 anxiety and depression. The respondents were 481 Hong Kong adults (41% men; mean age = 45.09) who took part in a population-based telephone survey conducted from April to May 2020. Self-report data were assessed with the Coping Flexibility Interview Schedule, COVID-19-Related Perception and Anxiety Scale, and Center for Epidemiological Studies Depression Scale. Slightly more than half (52%) of the sample met the criteria for probable depression. Four types of COVID-19 anxiety were identified: anxiety over personal health, others' reactions, societal health, and economic problems. The results consistently revealed coping flexibility to be inversely associated with depression and all four types of COVID-19 anxiety. More importantly, there was a significant interaction between perceived likelihood of COVID-19 infection and coping flexibility on COVID-19 anxiety over personal health. These findings shed light on the beneficial role of coping flexibility in adjusting to the "new normal" amid the COVID-19 pandemic.

Psychological interventions to foster resilience in healthcare students

BACKGROUND

Resilience can be defined as maintaining or regaining mental health during or after significant adversities such as a potentially traumatising event, challenging life circumstances, a critical life transition or physical illness. Healthcare students, such as medical, nursing, psychology and social work students, are exposed to various study- and work-related stressors, the latter particularly during later phases of health professional education. They are at increased risk of developing symptoms of burnout or mental disorders. This population may benefit from resilience-promoting training programmes.

OBJECTIVES

To assess the effects of interventions to foster resilience in healthcare students, that is, students in training for health professions delivering direct medical care (e.g. medical, nursing, midwifery or paramedic students), and those in training for allied health professions, as distinct from medical care (e.g. psychology, physical therapy or social work students).

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, waiting list, usual care, and active or attention control, in adults (18 years and older), who are healthcare students. Primary outcomes were resilience, anxiety, depression, stress or stress perception, and well-being or quality of life. Secondary outcomes were resilience factors.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only).

MAIN RESULTS

We included 30 RCTs, of which 24 were set in high-income countries and six in (upper- to lower-) middle-income countries. Twenty-two studies focused solely on healthcare students (1315 participants; number randomised not specified for two studies), including both students in health professions delivering direct medical care and those in allied health professions, such as psychology and physical therapy. Half of the studies were conducted in a university or school setting, including nursing/midwifery students or medical students. Eight studies investigated mixed samples (1365 participants), with healthcare students and participants outside of a health professional study field. Participants mainly included women (63.3% to 67.3% in mixed samples) from young adulthood (mean age range, if reported: 19.5 to 26.83 years; 19.35 to 38.14 years in mixed samples). Seventeen of the studies investigated group interventions of high training intensity (11 studies; > 12 hours/sessions), that were delivered face-to-face (17 studies). Of the included studies, eight compared a resilience training based on mindfulness versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. universities, foundations), or a combination of various sources (four studies). Seven studies did not specify a potential funder, and three studies received no funding support. Risk of bias was high or unclear, with main flaws in performance, detection, attrition and reporting bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare students receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.43, 95% confidence interval (CI) 0.07 to 0.78; 9 studies, 561 participants), lower levels of anxiety (SMD -0.45, 95% CI -0.84 to -0.06; 7 studies, 362 participants), and lower levels of stress or stress perception (SMD -0.28, 95% CI -0.48 to -0.09; 7 studies, 420 participants). Effect sizes varied between small and moderate. There was little or no evidence of any effect of resilience training on depression (SMD -0.20, 95% CI -0.52 to 0.11; 6 studies, 332 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.15, 95% CI -0.14 to 0.43; 4 studies, 251 participants; very-low certainty evidence). Adverse effects were measured in four studies, but data were only reported for three of them. None of the three studies reported any adverse events occurring during the study (very-low certainty of evidence).

AUTHORS' CONCLUSIONS

For healthcare students, there is very-low certainty evidence for the effect of resilience training on resilience, anxiety, and stress or stress perception at post-intervention. The heterogeneous interventions, the paucity of short-, medium- or long-term data, and the geographical distribution restricted to high-income countries limit the generalisability of results. Conclusions should therefore be drawn cautiously. Since the findings suggest positive effects of resilience training for healthcare students with very-low certainty evidence, high-quality replications and improved study designs (e.g. a consensus on the definition of resilience, the assessment of individual stressor exposure, more attention controls, and longer follow-up periods) are clearly needed.

Psychological interventions to foster resilience in healthcare professionals

BACKGROUND

Resilience can be defined as the maintenance or quick recovery of mental health during or after periods of stressor exposure, which may result from a potentially traumatising event, challenging life circumstances, a critical life transition phase, or physical illness. Healthcare professionals, such as nurses, physicians, psychologists and social workers, are exposed to various work-related stressors (e.g. patient care, time pressure, administration) and are at increased risk of developing mental disorders. This population may benefit from resilience-promoting training programmes.

OBJECTIVES

To assess the effects of interventions to foster resilience in healthcare professionals, that is, healthcare staff delivering direct medical care (e.g. nurses, physicians, hospital personnel) and allied healthcare staff (e.g. social workers, psychologists).

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, 11 other databases and three trial registries from 1990 to June 2019. We checked reference lists and contacted researchers in the field. We updated this search in four key databases in June 2020, but we have not yet incorporated these results.

SELECTION CRITERIA

Randomised controlled trials (RCTs) in adults aged 18 years and older who are employed as healthcare professionals, comparing any form of psychological intervention to foster resilience, hardiness or post-traumatic growth versus no intervention, wait-list, usual care, active or attention control. Primary outcomes were resilience, anxiety, depression, stress or stress perception and well-being or quality of life. Secondary outcomes were resilience factors.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies, extracted data, assessed risks of bias, and rated the certainty of the evidence using the GRADE approach (at post-test only).

MAIN RESULTS

We included 44 RCTs (high-income countries: 36). Thirty-nine studies solely focused on healthcare professionals (6892 participants), including both healthcare staff delivering direct medical care and allied healthcare staff. Four studies investigated mixed samples (1000 participants) with healthcare professionals and participants working outside of the healthcare sector, and one study evaluated training for emergency personnel in general population volunteers (82 participants). The included studies were mainly conducted in a hospital setting and included physicians, nurses and different hospital personnel (37/44 studies). Participants mainly included women (68%) from young to middle adulthood (mean age range: 27 to 52.4 years). Most studies investigated group interventions (30 studies) of high training intensity (18 studies; > 12 hours/sessions), that were delivered face-to-face (29 studies). Of the included studies, 19 compared a resilience training based on combined theoretical foundation (e.g. mindfulness and cognitive-behavioural therapy) versus unspecific comparators (e.g. wait-list). The studies were funded by different sources (e.g. hospitals, universities), or a combination of different sources. Fifteen studies did not specify the source of their funding, and one study received no funding support. Risk of bias was high or unclear for most studies in performance, detection, and attrition bias domains. At post-intervention, very-low certainty evidence indicated that, compared to controls, healthcare professionals receiving resilience training may report higher levels of resilience (standardised mean difference (SMD) 0.45, 95% confidence interval (CI) 0.25 to 0.65; 12 studies, 690 participants), lower levels of depression (SMD -0.29, 95% CI -0.50 to -0.09; 14 studies, 788 participants), and lower levels of stress or stress perception (SMD -0.61, 95% CI -1.07 to -0.15; 17 studies, 997 participants). There was little or no evidence of any effect of resilience training on anxiety (SMD -0.06, 95% CI -0.35 to 0.23; 5 studies, 231 participants; very-low certainty evidence) or well-being or quality of life (SMD 0.14, 95% CI -0.01 to 0.30; 13 studies, 1494 participants; very-low certainty evidence). Effect sizes were small except for resilience and stress reduction (moderate). Data on adverse effects were available for three studies, with none reporting any adverse effects occurring during the study (very-low certainty evidence).

AUTHORS' CONCLUSIONS

For healthcare professionals, there is very-low certainty evidence that, compared to control, resilience training may result in higher levels of resilience, lower levels of depression, stress or stress perception, and higher levels of certain resilience factors at post-intervention. The paucity of medium- or long-term data, heterogeneous interventions and restricted geographical distribution limit the generalisability of our results. Conclusions should therefore be drawn cautiously. The findings suggest positive effects of resilience training for healthcare professionals, but the evidence is very uncertain. There is a clear need for high-quality replications and improved study designs.

Association of socioeconomic status and health-related behavior with elderly health in China

Previous health studies have focused on the correlation between socioeconomic status (SES) and health. We pooled data from the Chinese Longitudinal Healthy Longevity Survey (N = 9765) conducted in 2011, and examined the association of SES and health-related behavior with elderly health in China. The cumulative health disadvantage of the elderly caused by SES can be relieved by lifelong health-related behavior. In the same SES, the odds of self-rated health (SRH) as “good,” mini-mental state examination (MMSE) as “not impaired,” and activities of daily living (ADLs) as “not impaired” among the elderly who exercised regularly, were 46.9%, 28.6%, and 62.3% lower for the elderly who rarely exercised. The elderly who started doing regular exercise from 30 years old, achieved higher SRH, ADL, and MMSE scores to some extent. The health improvement advantage for the elderly who started doing regular exercises after 60 years old, was reduced. However, the odds of SRH as “good,” MMSE as “not impaired,” and ADLs as “not impaired” were still 3.4%, 12.5%, and 17.8%, respectively, higher than the respondents who never exercised. The health-related behaviors not only promote elderly health improvement, but its duration has also been found to be associated with the extent of health improvement.

Diabetes in South African older adults: prevalence and impact on quality of life and functional disability - as assessed using SAGE Wave 1 data

BACKGROUND

Diabetes is a chronic disease with severe late complications. It is known to impact the quality of life and cause disability, which may affect an individual's capacity to manage and maintain longer-term health and well-being.

OBJECTIVES

To examine the prevalence of self-report diabetes, and association between diabetes and each of health-related quality of life and disability amongst South Africa's older adults. To study both the direct relationship between diabetes and these two measures, as well as moderation effects, i.e. whether associations between other factors and these measures of well-being differed between individuals with diabetes and those without.

METHODS

Secondary analyses of data on participants aged 50 years and older from the Study on global AGEing and adult health (SAGE) in South Africa Wave 1 (2007-2008) were conducted. Prevalence of self-reported diabetes was assessed. Multivariable regressions describe the relationships between each of quality of life (WHOQoL) and disability (WHODAS), and diabetes, while controlling for selected socio-demographic characteristics, health risk behaviours and co-morbid conditions. In the regression models, we also investigated whether diabetes moderates the relationships between these additional factors and WHOQoL/WHODAS.

RESULTS

Self-reported diabetes prevalence was 9.2% (95% CI: 7.8,10.9) and increased with age. Having diabetes was associated with poorer WHOQoL scores (additive effect: -4.2; 95% CI: -9.2,0.9; p-value <0.001) and greater disability (multiplicative effect: 2.1; 95% CI: 1.5,2.9; p-value <0.001). Lower quality of life and greater disability were both related to not being in a relationship, lower education, less wealth, lower physical activity and a larger number of chronic conditions.

CONCLUSIONS

Diabetes is associated with lower quality of life and greater disability amongst older South Africans. Attention needs to be given to enhancing the capacity of health systems to meet the changing needs of ageing populations with diabetes in SA as well as facilitating social support networks in communities.

Attending, learning, and socioeconomic disadvantage: developmental cognitive and social neuroscience of resilience and vulnerability

We review current findings associating socioeconomic status (SES), development of neurocognitive functions, and neurobiological pathways. A sizeable interdisciplinary literature was organized through a bifurcated developmental trajectory (BiDeT) framework, an account of the external and internal variables associated with low SES that may lead to difficulties with attention and learning, along with buffers that may protect against negative outcomes. A consistent neurocognitive finding is that low-SES children attend to information nonselectively, and engage in late filtering out of task-irrelevant information. Attentional preferences influence the development of latent inhibition (LI), an aspect of learning that involves reassigning meaningful associations to previously learned but irrelevant stimuli. LI reflects learning processes clarifying the relationship between neurobiological mechanisms related to attention and socioeconomic disadvantage during child development. Notably, changes in both selective attention and typical LI development may occur via the mesocorticolimbic dopamine (MsCL-DA) system. Chaotic environments, social isolation, and deprivation associated with low SES trigger stress responses implicating imbalances in the MsCL-DA and consolidating anxiety traits. BiDeT describes plausible interactions between socioemotional traits and low-SES environments that modify selective attention and LI, predisposing individuals to vulnerability in cognitive development and academic achievement. However, positive role models, parental style, and self-regulation training are proposed as potential promoters of resilience.

Number of Chronic Medical Conditions Fully Mediates the Effects of Race on Mortality; 25-Year Follow-Up of a Nationally Representative Sample of Americans

BACKGROUND

Despite the well-established literature on the effects of race and socioeconomic status (SES) on mortality, limited information exists on mediators of these effects. Taking a life-course epidemiology approach, and using a nationally representative sample of adults in the USA, the current study has two aims: (1) to assess the effects of race and SES at baseline on all-cause mortality over a 25-year follow-up and (2) to test whether the number of chronic medical conditions (CMCs) as a time-varying covariate mediates the effects of race and SES on all-cause mortality.

METHODS

Data came from the Americans' Changing Lives (ACL) Study, a nationally representative longitudinal cohort of US adults 25 and older. The study followed 3361 Blacks or Whites for all-cause mortality for up to 25 years from 1986 to 2011. The predictors of interest were race and SES (education and family income) at baseline measured in 1986. Confounders included baseline age and gender. CMC was the potential time-varying mediator measured in 1986, 1989, 1991, 2001, and 2011. We ran Cox proportional hazard models with and without CMC as time-varying covariates.

RESULTS

In separate models, race and SES were predictors of all-cause mortality. In the model that tested the combined effect of race and SES, SES but not race was predictive of all-cause mortality. We also found evidence suggesting that CMC fully mediates the effect of race on all-cause mortality. Number of CMC only partially mediated the effect of SES on mortality.

CONCLUSION

The number of CMC fully mediates the effects of race and partially mediates the effects of SES on all-cause mortality in the USA. Mortality prevention for minority populations will benefit tremendously from elimination of CMC disparities as well as enhancement of CMC management by minority populations. Elimination of the gap due to SES may be more challenging than the elimination of the racial gap in mortality.