Association between Multitype Child Maltreatment and Life Satisfaction: The Mediating Effects of Health Literacy and Perceived Stress.

Introducing the Australian Child Maltreatment Study: baseline evidence for a national public health challenge.

Purpose– The purpose of this paper is to determine whether multi-type child maltreatment is associated with health-risk behaviours and mental ill-health in adolescence.Design/methodology/approach– In total, 406 15-16-year-old students from Maltese schools answered the “Child maltreatment physical and mental health” questionnaire (Nguyenet al., 2010). This assessed demographics, health risk behaviour, mental health and child maltreatment.Findings– Of the four categories of maltreatment measured (physical, sexual, emotional and neglect), 27.4 per cent of the young people experienced one type, 16.6 per cent two types, 11.1 per cent three and 6.5 per cent four. For health-risk behaviours, there were positive relationships between multi-type maltreatment and school fights (r=0.27,p<0.01), breaking school rules (r=0.19,p<0.01), illicit drug use (r=0.14,p<0.05) and alcohol use (r=0.10,p<0.05). As regards mental health, multi-type maltreatment was positively associated with depression (r=0.38,p<0.01) and anxiety (r=0.23,p<0.01), and negatively associated with self-esteem (r=−0.26,p<0.01).Practical implications– Early recognition of multi-type maltreatment and its consequences enables providers of children's services to offer the required diverse range of services. Additionally, policy makers should ensure the adoption of multi-sectoral and collaborative inter-agency approaches so as to effectively and holistically manage child maltreatment, not only during the acute childhood phase but also during adolescence and adulthood, when consequences are expected to emerge.Originality/value– This study raises awareness about the prevalence of multi-type child maltreatment in Malta. It also highlights the negative association between cumulative exposure to multi-type child maltreatment and mental health outcomes and risky behaviours.

Child maltreatment is a risk factor for mental disorders and decreased life satisfaction during adolescence. We investigated whether child maltreatment would link to life satisfaction both directly and through psychological symptoms, whether these relations would change from admission to discharge after treatment, and which types of maltreatment, symptoms and facets of life satisfaction would be most influential in adolescent inpatients with internalizing mental disorders. N = 896 adolescent receiving inpatient psychotherapeutic treatment completed questionnaires on child maltreatment experiences, current psychopathology and subjective life satisfaction at admission and discharge (n = 765). Main diagnoses were affective (n = 322), eating (n = 447), obsessive–compulsive (n = 70) and anxiety disorders (n = 57). Network models of child maltreatment, psychopathology and life satisfaction nodes were estimated at admission and discharge and compared using network comparison tests. Potential causal shortest pathways were investigated using directed acyclic graphs.Network models were stable with no significant differences between admission and discharge. Strongest nodes of each cluster were “emotional abuse” (child maltreatment), “worthlessness”, “thinking about dying” and “feeling lonely” (psychopathology) and “satisfied with life” (life satisfaction) at both admission and discharge. Emotional neglect showed direct connections to life satisfaction, indicating its relevance for therapeutic interventions. At both admission and discharge, “sexual abuse” indirectly predicted lower life satisfaction through psychological symptoms. In conclusion, child maltreatment is directly and indirectly connected to life satisfaction in adolescents with mental disorders. Emotional abuse and neglect were especially important in linking child maltreatment to life satisfaction and psychopathology.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10802-024-01172-2.

Introduction Burn injuries occur with a disproportionately higher frequency in vulnerable groups. Their health literacy (HL), defined as the way patients obtain, process, and understand health information, may be an important factor that influences access, care, and recovery after burns. This study aims to determine the current levels of health literacy and variables associated with poor health literacy for outpatients treated at two regional burn centres. Methods All eligible patients presenting to two tertiary outpatient burn centers were asked to participate. The Newest Vital Sign health literacy assessment tool and a sociodemographic survey were administered. The NVS scores were divided into poor (0-2), moderate (3-4), and adequate (5-6) health literacy. We first compared health literacy rates between sites using non-parametric Chi-squared test. We then developed a multivariable regression model using a stepwise construction with poor health literacy as our dependent variable. Included in the exploratory model were income, education level, working status, and age. Results Forty-nine patients with a mean age of 46.6 years (SD=17.4) were included; 57% (29/49) of patients identified as male. Most of the burn injuries (78%, 38/49) were less than 10% total body surface area. HL rates were poor, moderate, and adequate in 35% (17/49), 18% (9/29), and 47% (23/29), respectively. There were no differences in health literacy between the 2 sites. Age was the only independent predictor of poor health literacy in burn patients, with advanced age being associated with worse health literacy (95% CI: 1.001-1.119, p< 0.05). Income, education level and working status did not independently predict health literacy rates (Table 1). Conclusions More than half of patients treated at burn outpatient clinics have only poor or moderate health literacy. This study further suggests that older adults may be most at risk. This trend is consistent across two regional burn centres. This study highlights the importance of health literacy among patients with burn injury and stresses the importance of personalized and literacy-adjusted discussions surrounding care. Our next project will address the impact of health literacy on adherence to recommended therapies. Applicability of Research to Practice Poor health literacy is a barrier to obtaining burn care and is an important social determinant of health. We should identify factors associated with poor health literacy among patients with burn injury and improve the delivery of health information.

Health literacy: An opportunity for nurses to lead by example

Life satisfaction mediates the association between childhood maltreatment and depressive symptoms: a study in a sample of Brazilian adolescents

The present study was designed to explore the relationship between physical exercise and sleep quality. Specifically, it investigates the extent to which this relationship is mediated by a sequential process involving health literacy and life satisfaction. Data on physical exercise, sleep quality, health literacy, and life satisfaction were collected from a sample of 12,646 college students (study participants) using a questionnaire. Statistical analyses were performed using SPSS and AMOS software, including descriptive statistics, correlation analysis, and regression analysis. Correlation analyses revealed a weak positive correlation between physical exercise and sleep quality (r = 0.290), a significant positive correlation between physical exercise and health literacy (r = 0.203, p < 0.01), and a significant positive correlation between physical exercise and life satisfaction (r = 0.374, p < 0.01). Conversely, sleep quality exhibited a significant negative correlation with health literacy (r = -0.091, p < 0.01) and a significant negative correlation with life satisfaction (r = -0.228, p < 0.01). Health literacy and life satisfaction were significantly positively correlated (r = 0.352, p < 0.01). Regression analysis indicated that physical exercise did not directly and significantly predict sleep quality (β = -0.010). This study exhibits a complete mediation effect. However, mediation analysis revealed a significant indirect effect of physical exercise on sleep quality through health literacy (95% CI: [-0.022, -0.013]) and life satisfaction (95% CI: [-0.024, -0.015]). Furthermore, a significant chain-mediating effect was observed, wherein physical exercise influenced sleep quality sequentially through health literacy and life satisfaction (95% CI: [-0.018, -0.013]). The non-significant direct effect of physical exercise on sleep quality and the significant indirect impact suggest that the relationship between physical exercise and sleep quality is primarily mediated through health literacy and life satisfaction. These findings highlight the crucial role of health literacy and life satisfaction as mediators in this relationship. While physical exercise did not exert a direct and significant effect on sleep quality in this study, the significant mediating roles of health literacy and life satisfaction suggest potential avenues for intervention. Specifically, these findings imply that multifaceted approaches, encompassing strategies to promote physical activity, enhance health literacy, and improve life satisfaction, may improve sleep quality among college students.

This study presents the most comprehensive national prevalence estimates of diverse gender and sexuality identities in Australians, and the associations with five separate types of child maltreatment and their overlap (multi-type maltreatment). Using Australian Child Maltreatment Study (ACMS) data (N = 8503), 9.5% of participants identified with a diverse sexuality and .9% with a diverse gender. Diverse identities were more prevalent in the youth cohort, with 17.7% of 16-24years olds identifying with a diverse sexuality and 2.3% with a diverse gender. Gender and sexuality diversity also intersect - for example, with women (aged 16-24 and 25-44) more likely than men to identify as bisexual. The prevalence of physical abuse, sexual abuse, emotional abuse, neglect and exposure to domestic violence was very high for those with diverse sexuality and/or gender identities. Maltreatment was most prevalent for participants in the youth cohort with diverse gender identities (90.5% experiencing some form of child maltreatment; 77% multi-type maltreatment) or diverse sexualities (85.3% reporting any child maltreatment; 64.3% multi-type maltreatment). The strong association found between child maltreatment and diverse sexuality and gender identities is critical for understanding the social and mental health vulnerabilities of these groups, and informing services needed to support them.

Although some studies have explored the relationships between childhood maltreatment and life satisfaction, few studies have explored the pathways between those two variables in a sample of student preschool teachers. The current study, thus, attempts to explore the relationships between childhood maltreatment and life satisfaction in Chinese student preschool teachers and to examine the roles of resilience and social support in those relationships. A total of 1218 students majoring in early childhood education were recruited from three Chinese universities to attend this study. Self-reported questionnaires were used to collect data, and structural equation modeling was used to perform data analysis. Results showed that childhood maltreatment was negatively associated with life satisfaction in Chinese student preschool teachers; resilience and social support mediated those relationships. The findings suggest that childhood maltreatment not only has a direct relationship with life satisfaction, but also has an indirect relationship with life satisfaction via resilience and social support. Childhood maltreatment should be considered when enrolling student preschool teachers, and increasing levels of resilience and social support should be meaningful approaches when cultivating student preschool teachers who have experienced childhood maltreatment.

To understand status of health literacy among diabetics and their health management behaviors, and analyze the relationship of health literacy and health management. A two-staged cluster randomized sampling method was used to investigate 1 130 diabetics in Beijing, Ningbo and Xiamen from October to November in 2012. All participants should be diagnosed by primary hospital and above and have lived in the community over six months. Diabetic patients who indicated that they had severely impaired vision or cognitive disorder, or had severe physical deterioration, or did not live in the address provided were excluded. A total of 1 130 questionnaires were sent out and 1 083 eligible questionnaires were taken back, accounting for 96.87%. Multivariate logistic regression was adopted to analyze the association between health literacy and health management behaviors and blood glucose level. Among those participants, 47.7% (517) were men, 52.3% (566) were women, the age was (67.0 ± 9.5). According to diabetes health literacy scores, 73.7% (798/1 083) of them were classified as poor health literacy and 26.1% (283/1 083) as essential health literacy. Health literacy was associated with health management behaviors independently, demonstrating that the probability of utilizing health education, free physical examination, lifestyle guidance, monitoring blood glucose on their own, measuring blood glucose more than once a week and taking hypoglycemic agent regularly among diabetics with essential health literacy were 1.40 (95%CI:1.03-1.91), 1.65 (95%CI: 1.19-2.28), 2.70 (95%CI:1.98-3.69), 2.05 (95%CI:1.34-3.15), 2.56 (95%CI:1.85-3.56) , 1.48 (95%CI:1.07-2.06) times of those in diabetics with poor health literacy (P < 0.05). Health literacy may affect health management behaviors among diabetics. More activities targeted on diabetics with low health literacy were suggested to improve their' health literacy and their skills about diabetes mellitus management.

Background Life expectancy in patients with congenital heart disease (CHD) and patients with early acquired cardiovascular disease (CVD) has increased due to improved treatments during the last decades. As life expectancy increases, focus on long term quality of life and life satisfaction as well as determining focus areas of preventive initiatives becomes essential. Purpose To investigate whether poor life satisfaction in adolescents and young adults with CHD or significant CVD is 1) associated with physical and mental challenges and 2) inversely associated with social support and self-efficacy have a protective effect against low life satisfaction. Methods Data from a Danish nationwide cross-sectional study was used to identify all patients with either CHD or significant CVD (e.g., arrhythmia, ischemia) aged 15–24 years with at least one contact to a Danish hospital department of cardiology between 2014–2018. Life satisfaction was measured on a scale of 0–10 and dichotomized into good life satisfaction if the score was &amp;gt;6. Using a logistic regression model with interaction terms for sex and adjusted for age and comorbidities, we estimated the association between physical challenges (New York Heart Association classification, NYHA), mental challenges (concentration limitations or memory limitations), social support, self-efficacy, and life satisfaction. Results 1961 patients were included, 58% had CHD. Median age was 20 years and 50% were female. NYHA-class III or IV were significantly associated with poor life satisfaction (OR: 0.42 [95CI: 0.26; 0.70]) (Figure 1). Likewise, self-reported memory limitations (OR: 0.79 [95CI: 0.68; 0.91]) and concentration difficulty (OR: 0.60 [95CI: 0.51; 0.70]) were associated with poor life satisfaction (Figure 1). In contrast, reported high self-efficacy (OR: 1.67 [95CI: 1.32; 2.12]) and good social support (OR: 2.16 [95CI: 1.60; 2.93]) were both associated with high life satisfaction (Figure 1). Finally, the association between NYHA class III (OR: 0.94 [95CI: 0.34; 2.59]), memory limitations (OR: 0.79 [95CI: 0.58; 1.07]), concentration limitations (OR: 0.71 [95CI: 0.49; 1.04]), and life satisfaction was not significant among individuals with high self-efficacy but remained significant among individuals with good social support. Conclusions In adolescents and young adults with CHD or early acquired heart disease, reported physical and mental challenges were associated with reduced self-reported life satisfaction. Both reported high self-efficacy and good social support were associated with increased life satisfaction. High self-efficacy among individuals reduced the negative association between mental or physical challenges and life satisfaction. These findings highlight the need for increased focus on promoting self-efficacy and the need for good social support in adolescents and young adults with functional limitations from their CHD or CVD in order to improve their long-term life satisfaction. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): Danish Heart Foundation

This study aims to explore the impact of physical exercise on university students' life satisfaction and analyses the chain mediation effect of general self-efficacy and health literacy, providing empirical reference and theoretical foundation for the comprehensive enhancement and optimization of students' mental health. Based on data from the "China University Student Physical Activity and Health Tracking Survey" (CPAHLS-CS) 2024, the measurement scales used included the Physical Activity Rating Scale (PARS-3), the Satisfaction with Life Scale (SWLS), the General Self-Efficacy Scale (GSES), and the 9-item Short Form Health Literacy Scale (HLS-SF9). A total of 4575 valid samples were analyzed. A significant positive correlation was found between physical exercise and life satisfaction (r = 0.137, P < 0.01). The total effect of physical exercise on university students' life satisfaction was significant, with an effect value of 0.045 (95%CI = [0.035, 0.054]). The chain mediation effect of general self-efficacy and health literacy in the relationship between physical exercise and life satisfaction was significant, with an effect value of 0.005 (95%CI = [0.004, 0.006]), accounting for 11.4% of the total effect. The direct effect of physical exercise on life satisfaction had a standardized regression coefficient of 0.001, which was not significant. University students' life satisfaction is closely related to physical exercise, general self-efficacy, and health literacy. General self-efficacy and health literacy play a full mediating role in the effect of physical exercise on life satisfaction.

ObjectiveThis study aims to explore the impact of physical exercise on university students’ life satisfaction and analyses the chain mediation effect of general self-efficacy and health literacy, providing empirical reference and theoretical foundation for the comprehensive enhancement and optimization of students’ mental health.MethodBased on data from the “China University Student Physical Activity and Health Tracking Survey” (CPAHLS-CS) 2024, the measurement scales used included the Physical Activity Rating Scale (PARS-3), the Satisfaction with Life Scale (SWLS), the General Self-Efficacy Scale (GSES), and the 9-item Short Form Health Literacy Scale (HLS-SF9). A total of 4575 valid samples were analyzed.ResultsA significant positive correlation was found between physical exercise and life satisfaction (r = 0.137, P < 0.01). The total effect of physical exercise on university students’ life satisfaction was significant, with an effect value of 0.045 (95%CI = [0.035, 0.054]). The chain mediation effect of general self-efficacy and health literacy in the relationship between physical exercise and life satisfaction was significant, with an effect value of 0.005 (95%CI = [0.004, 0.006]), accounting for 11.4% of the total effect. The direct effect of physical exercise on life satisfaction had a standardized regression coefficient of 0.001, which was not significant.ConclusionUniversity students’ life satisfaction is closely related to physical exercise, general self-efficacy, and health literacy. General self-efficacy and health literacy play a full mediating role in the effect of physical exercise on life satisfaction.

Health literacy, an important factor in public and personal health, is regarded as the core of patient-centered care. Older people with high health literacy are more likely to maintain a healthier lifestyle, with good control and management of chronic diseases, than those lacking or with poor health literacy. Purpose: The present study investigated the validity and reliability of the Taiwan Longitudinal Study on Aging (TLSA) Health Literacy Scale. We also evaluated the health literacy of middle-aged and older Taiwanese adults, and its probable association with health outcomes and life satisfaction. Method: We analyzed the internal consistency reliability of the nine items of the 2015 TLSA Health Literacy Scale, and their relationship with the demographic variables. Brody Instrumental Activities of Daily Living (IADL) and the Life Satisfaction Index were used for criterion validity. Moreover, exploratory factor analysis was used to examine the construct validity and to test the known-group validity. Results: The TLSA health literacy scale has good internal consistency reliability. Criterion-related validity was supported by the fact that the health literacy score was significantly correlated with the IADL and Life Satisfaction Index. Factor analysis indicated a three-factor structure. Known-group validity was supported by the results, showing that middle-aged and older people with good self-reported health status had better health literacy. Conclusions: The TLSA health literacy scale is a reliable and valid instrument for measuring health literacy in middle-aged and older people.

To assess the relationship between health literacy and compliance, disease awareness, and disease progression in patients with glaucoma. A cross-sectional observational study of 204 English-speaking patients treated for glaucoma for at least 1 year at Kresge Eye Institute was conducted. Health literacy was assessed using the standardized Test of Functional Health Literacy in Adults (TOFHLA). An oral questionnaire assessed patients' demographic information and glaucoma understanding. A retrospective medical record review was conducted to record parameters indicating glaucoma severity. One hundred two participants (50%) were categorized as having poor functional health literacy (mean [SD] TOFHLA score, 18.4 [7.5]) and 102 participants (50%) had adequate health literacy (mean [SD] TOFHLA score, 42.8 [5.1]). The poor health literacy group showed significant differences in income, education, medication compliance, glaucoma understanding, and missed appointments compared with the adequate health literacy group (P < .001). Patients with poor health literacy showed a greater visual field loss on initial presentation (mean deviation [SD], -10.58 [9.3] dB) compared with the adequate health literacy group (mean deviation [SD], -7.79 [6.9] dB; P = .02) and significantly worse visual field parameters when comparing pattern SDs on the recent and the initial visual fields (pattern SD change [SD], 0.19 [2.5] dB in the poor health literacy group vs -0.7 [2.2] dB in the adequate health literacy group; P = .02). Patients with poor health literacy had poorer compliance, worse disease understanding, and greater disease progression compared with the adequate health literacy group, highlighting the need to promote health literacy in patients with glaucoma.