Association Of Psychosocial Factors Research Articles

Psychosocial factors mediate social inequalities in health-related quality of life among children and adolescents

BackgroundThe present analysis aimed to assess the mediating role of psychosocial and behavioural factors in socio-economic inequalities in health-related quality of life (HRQoL) among children and adolescents.MethodsCross-sectional data was drawn from the randomly selected SEROCoV-KIDS cohort study in Geneva, Switzerland. Associations of socio-economic conditions (parents’ highest education, household financial situation) with HRQoL, psychosocial (parent–child relationship, school difficulties, friends, extracurricular activities) and behavioural factors (screen time, physical activity, green spaces time, sleep duration), along with associations of psychosocial and behavioural factors with HRQoL, were evaluated with generalized estimating equations. Counterfactual mediation analyses were conducted to test pathways linking socio-economic conditions to HRQoL.ResultsOf 965 children and 816 adolescents, those with disadvantaged financial circumstances were more likely to have a poor HRQoL (adjusted Odds Ratio [aOR]: 3.80; 95% confidence interval [CI]: 1.96–7.36 and aOR: 3.66; 95%CI: 2.06–6.52, respectively). Psychosocial characteristics mediated 25% (95%CI: 5–70%) and 40% (95%CI: 18–63%) of financial disparities in HRQoL among children and adolescents, respectively. Health behaviours were weakly patterned by socio-economic conditions and did not contribute to financial differences in HRQoL.ConclusionsThese findings provide empirical evidence for mechanisms explaining socio-economic disparities in child HRQoL and could inform interventions aimed to tackle health inequalities.

Interactive effects of outdoor fine particulate matter and metabolic, behavioural, and psychosocial risk factors on cardiovascular disease: analysis of the PURE-China cohort study

Abstract Background Long-term PM2.5 exposure has been associated with an elevated risk of cardiovascular disease (CVD) and its associated risk factors.[1–4] There is a paucity of studies investigating the interactive effects of PM2.5 exposure and a comprehensive list of risk factors including metabolic, behavioural, and psychosocial risk factors on CVD risk.[5] Purpose This study aims to examine the interactive effects of PM2.5 exposure and metabolic, behavioural, and psychosocial risk factors on incident CVD. Methods The Prospective Urban Rural Epidemiology (PURE)-China cohort study is a population-based cohort study recruiting participants aged 35–70 years from 115 communities in 12 provinces of China between 2005 and 2009, and followed up until August 31, 2021.[6] Participants’ metabolic, behavioural, and psychosocial risk factor information was recorded. PM2.5 concentrations were extracted from a 1x1 km2 global model.[7,8] For this analysis, we included participants aged 35–70 years at baseline without a history of CVD, with at least one follow-up visit. The primary outcome was a composite of major cardiovascular events (CVD deaths, myocardial infarction, stroke, and heart failure). Additive interaction was measured by relative excess risk due to interaction (RERI), the proportion of disease attributable to interaction (AP), and the synergy index (SI).[9,10] To comply with the additive interaction method, we classified concentrations of PM2.5 into low and high levels by the median of 3-year average PM2.5 concentration (45.7 μg/m3, IQR: 33.7-74). Cox proportional hazard models were used to assess the associations of metabolic, behavioural, and psychosocial risk factors on incident CVD by PM2.5 concentrations. Results The PURE-China study recruited 47 931 participants, of which 39 329 are eligible for this analysis. During the median follow-up period of 11.9 years (IQR: 9.6-12.6), 1462 and 2155 major CVD events had occurred in the low and high PM2.5 group respectively. There was a synergistic interaction between PM2.5 and the systolic blood pressure (SBP) for CVD: RERI: 0.363, 95% CI: 0.196-0.531; AP: 0.098, 95% CI: 0.081-0.115; SI: 1.155, 95% CI: 1.132-1.177; high LDL cholesterol: RERI: 0.219, 0.003-0.436; AP: 0.135, 0.008-0.263; SI: 1.549, 0.947-2.533. A significant synergistic interaction was also identified between PM2.5 and household air pollution (RERI: 0.457, 0.292-0.622; AP: 0.277, 0.184-0.37; SI: 3.362, 1.409-8.019). Interactions between PM2.5 and low grip strength on CVD were significantly synergistic, but antagonistic between PM2.5 and low physical activity (RERI: -0.248, -0.485--0.012; AP: -0.174, -0.349-0.001; SI: 0.633, 0.412-0.971). Conclusion Addictive interaction was between PM2.5 and SBP, high LDL cholesterol, household air pollution, low grip strength and low physical activity on incident CVD, indicating the benefit of coordinated control strategies for metabolic, physical, and environmental risk factors for the prevention of CVD.

Social Inequalities in mental health service use and perceived helpfulness: A global analysis across 111 countries

Abstract Social inequalities in mental health are evident in the prevalence of mental health problems, but also the utilisation and patents’ perceived benefits of treatment. However, the extent of these disparities on a global scale and whether there are country-level differences in the predictors of mental health service use remain unknown. This study uses data from the Wellcome Global Monitor 2020, a nationally representative survey encompassing 111 countries and 117,088 individuals. We examine the association of socio-economic factors (such as household income and education), psycho-social factors (including stigma perception and trust in health professionals), and country-level variables (such as GDP, Gini coefficient, and health expenditure) with mental health service use and perceived effectiveness of treatment. Multi-level logistic regression models were employed for analysis. The utilisation of mental health professions of people with depression or anxiety symptomology is higher in HICs (predicted probability of 62% CI[0.60 - 0.65]) compared to LIMCs (predicted probability of 33% CI[0.31 - 0.34]). Higher country GDP (OR = 1.26 CI[1.08-1.47]) and health expenditure (OR = 1.11 CI[1.04-1.19] per percentage of health expenditure) are associated with higher treatment utilisation. On the individual level, those in the wealthiest quintile are more likely to engage with mental health professionals (OR = 1.25[1.14-1.36]) and perceive this treatment as highly beneficial (OR = 1.23[1.07-1.40]). Trust in healthcare practitioners and perceived stigma are also associated with mental healthcare use. This analysis shows strong patterns of mental healthcare use and perceived benefits depending on the wealth of the country, health expenditure and individual socio-economic status. Moreover, disparities in treatment utilization and effectiveness are also influenced by trust in healthcare professionals and perceived mental health stigma.

Association of psychosocial state with subsequent risk of dementia: a prospective cohort study based on the UK Biobank

BackgroundMultiple psychosocial factors have been associated with dementia, while the individual or joint effects of various psychosocial states on dementia remain unrevealed due to the complex interplay between those factors. Here, the authors examined the associations of psychosocial factors and patterns with subsequent risk of dementia, and if the associations could be modified by genetic susceptibility to dementia.MethodsUK Biobank dementia-free participants were followed from one year after recruitment (median date: 24 January, 2010) until 31 October, 2022. Psychosocial states were measured by 22 items related to five dimensions, including psychiatric history, recent stressful life events, current psychiatric symptoms, social contact, and individual socioeconomic state. We identified clusters of individuals with distinct psychosocial patterns using latent class analysis. Cox proportional hazards models were used to evaluate the association between psychosocial items, as well as psychosocial patterns, and risk of dementia. We further performed stratification analyses by apolipoprotein E (APOE) genotype, polygenic risk score (PRS) of dementia, and family history of dementia.ResultsOf 497,787 included participants, 54.54% were female. During a median follow-up of 12.70 years, we identified 9,858 (1.98%) patients with newly diagnosed dementia. We identified seven clusters with distinct psychosocial patterns. Compared to individuals with a pattern of ‘good state’, individuals with other unfavorable patterns, featured by varying degrees of poor psychological state (‘fair state’ and ‘mildly, moderately, and extremely poor psychological state’), low social contact or socioeconomic state (‘living alone’ and ‘short education years’), were all at an increased risk of dementia (hazard ratios [HR] between 1.29 and 2.63). The observed associations showed no significant differences across individuals with varying APOE genotypes, levels of PRS, and family histories of dementia.ConclusionUnfavorable psychosocial patterns are associated with an increased risk of dementia, independent of genetic susceptibility. The findings highlight the importance of surveillance and prevention of cognitive decline among individuals with suboptimal psychosocial state.

Association of psychosocial factors with sleep quality among aging adults in India: Moderating role of functional limitations and negative feelings

ABSTRACT Sleep is one of the vital factors in physiological and psychological health and well-being. Good quality of sleep is essential for healthy aging and functioning. However, there is a lack of understanding of the role of psychosocial factors in sleep quality among aging adults in India. Further, with an increasing proportion of aging population in India, it becomes critical to understand the determinants of sleep quality among aging adults. The present study also explored the moderating role of negative feelings and functional limitations between psychosocial factors and sleep quality. The study used secondary data from the Longitudinal Ageing Study in India (LASI) wave –1 (2017–2018). A sample of 16,152 middle-aged and older adults was included in the study. Descriptive statistics, multiple regression, and moderation analysis were conducted to get an insight into the impacts of the predictors on individuals’ sleep quality. The results of the study suggest lower everyday discrimination (β = -.065, 99% CI [-.083, -.048]), good life satisfaction (β = -.009, 95% CI [-.017, -.002]), lower negative feelings (β = .1, 99% CI [.091, .109]), and functional limitations (β = .22, 99% CI [.197, .244]) was associated with good sleep quality. Furthermore, negative feelings and functional limitations acted as moderators in unadjusted models, while only functional limitations acted as moderators between life satisfaction and sleep quality, spirituality, and sleep quality in the fully adjusted model. This study implies the need for various measures to improve the sleep quality of aging adults by focusing on physical, psychological, and social domains of health and well-being.

Associations of psychosocial factors and cardiovascular health measured by Life's Essential 8: The Atherosclerosis Risk in Communities (ARIC) study.

Few studies investigate whether psychosocial factors (social isolation, social support, trait anger, and depressive symptoms) are associated with cardiovascular health, and none with the American Heart Association's new definition of cardiovascular health, Life's Essential 8 (LE8). Therefore, we assessed the cross-sectional associations of psychosocial factors with Life's Essential 8 and individual components of Life's Essential 8. We included 11,311 Atherosclerosis Risk in Communities cohort participants (58% females; 23% Black; mean age 57 (standard deviation: 6) years) who attended Visit 2 (1990-1992) in this secondary data analysis using cross-sectional data from the ARIC cohort study. Life's Essential 8 components included diet, physical activity, nicotine exposure, sleep quality, body mass index, blood lipids, blood glucose, and blood pressure. Life's Essential 8 was scored per the American Heart Association definition (0-100 range); higher scores indicate better cardiovascular health. Associations of categories (high, moderate, and low) of each psychosocial factor with continuous Life's Essential 8 score and individual Life's Essential 8 components were assessed using multivariable linear regressions. 11% of participants had high Life's Essential 8 scores (80-100), while 67% and 22% had moderate (50-79) and low Life's Essential 8 scores (0-49) respectively. Poor scores on psychosocial factor assessments were associated with lower Life's Essential 8 scores, with the largest magnitude of association for categories of depressive symptoms (low β = Ref.; moderate β = -3.1, (95% confidence interval: -3.7, -2.5; high β = -8.2 (95% confidence interval: -8.8, -7.5)). Most psychosocial factors were associated with Life's Essential 8 scores for diet, physical activity, nicotine, and sleep, but psychosocial factors were not associated with body mass index, blood lipids, blood glucose, or blood pressure. Less favorable measures of psychosocial health were associated with lower Life's Essential 8 scores compared better measures of psychosocial health among middle-aged males and females.

Post-traumatic stress disorder symptoms following exposure to acute psychological trauma in children aged 8–16 years in South Africa: protocol for the Sinethemba longitudinal study

IntroductionChildren exposed to trauma are vulnerable to developing post-traumatic stress disorder (PTSD) and other adverse mental health outcomes. In low-and middle-income countries (LMICs), children are at increased risk of exposure...

Association of psychosocial risk factors and liver transplant evaluation outcomes in metabolic dysfunction-associated steatotic liver disease.

The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a standardized psychosocial assessment tool used in liver transplantation (LT) evaluation and has been primarily studied in patients with alcohol-associated liver disease. We aimed to evaluate the relationship between SIPAT score and metabolic syndrome severity and LT waitlist outcomes in a large cohort of patients with metabolic dysfunction-associated steatotic liver disease (MASLD). We performed a single-center retrospective cohort study of patients with MASLD evaluated for LT from 2014-2021. The utility of the previously defined total SIPAT cut-off (<21 [excellent/good candidates] vs ≥21 [minimally acceptable/high risk candidates]) was studied. Multivariable logistic regression analyses examined associations between continuous SIPAT score and LT waitlisting outcomes. Youden's J statistic was used to identify the optimal SIPAT cut-off for MASLD patients. A total of 480 patients evaluated for transplant with MASLD were included. Only 9.4% of patients had SIPAT score ≥21. Patients with SIPAT score ≥21 had higher hemoglobin A1c compared to patients with lower psychosocial risk (median (IQR): 7.8 (6.0-9.7) vs 6.6 (5.8, 7.9); p=0.04). There were no other differences in metabolic comorbidities between SIPAT groups. Increasing SIPAT score was associated with decreased odds of listing (OR: 0.82 per five-point increase; p=0.003) in multivariable models. A SIPAT of ≥12 was identified as the optimal cut-off in this population, resulting in an adjusted OR for listing of 0.53 vs SIPAT <12 (p=0.001). In this large cohort of MASLD patients evaluated for LT, few patients met the previously defined high SIPAT cut-off for transplant suitability. Nevertheless, increasing SIPAT score was associated with waitlist outcome. Our suggested SIPAT cut-off of ≥12 for MASLD patients warrants further external validation using data from other centers.

Mapping 15-year depressive symptom transitions in late life: population-based cohort study.

The longitudinal course of late-life depression remains under-studied. To describe transitions along the depression continuum in old age and to identify factors associated with specific transition patterns. We analysed 15-year longitudinal data on 2745 dementia-free persons aged 60+ from the population-based Swedish National Study on Aging and Care in Kungsholmen. Depression (minor and major) was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision; subsyndromal depression (SSD) was operationalised as the presence of ≥2 symptoms without depression. Multistate survival models were used to map depression transitions, including death, and to examine the association of psychosocial (social network, connection and support), lifestyle (smoking, alcohol consumption and physical activity) and clinical (somatic disease count) factors with transition patterns. Over the follow-up, 19.1% had ≥1 transitions across depressive states, while 6.5% had ≥2. Each additional somatic disease was associated with a higher hazard of progression from no depression (No Dep) to SSD (hazard ratio 1.09; 1.07-1.10) and depression (Dep) (hazard ratio 1.06; 1.04-1.08), but also with a lower recovery (HRSSD-No Dep 0.95; 0.93-0.97 [where 'HR' refers to 'hazard ratio']; HRDep-No Dep 0.96; 0.93-0.99). Physical activity was associated with an increased hazard of recovery to no depression from SSD (hazard ratio 1.49; 1.28-1.73) and depression (hazard ratio 1.20; 1.00-1.44), while a richer social network was associated with both higher recovery from (HRSSD-No Dep 1.44; 1.26-1.66; HRDep-No Dep 1.51; 1.34-1.71) and lower progression hazards to a worse depressive state (HRNo Dep-SSD 0.81; 0.70-0.94; HRNo Dep-Dep 0.58; 0.46-0.73; HRSSD-Dep 0.66; 0.44-0.98). Older people may present with heterogeneous depressive trajectories. Targeting the accumulation of somatic diseases and enhancing social interactions may be appropriate for both depression prevention and burden reduction, while promoting physical activity may primarily benefit recovery from depressive disorders.

Association of Psychosocial Factors with Exercise Engagement in Adult Users of Primary Health Care

Association of Psychosocial Factors with Exercise Engagement in Adult Users of Primary Health Care

Associations of mood, stress, and social support with sleep duration and daytime sleepiness among adolescents in semi-rural Georgia

ObjectiveAdolescents are at greater risk for poor sleep compared to childhood; however, there is limited data regarding psychosocial determinants of adverse sleep health among semi-rural adolescents. We investigated associations of mood, stress, and social support with self-reported sleep duration and daytime sleepiness among adolescents. MethodsAdolescents (n = 254) in semi-rural Georgia self-reported depressive and anxiety symptoms, stress, social support, sleep duration and daytime sleepiness in November 2020. Multinomial linear and logistic models were fit to examine associations of psychosocial factors with sleep duration and sleepiness; and effect modification by social support was tested after adjustment for covariates. ResultsMost participants were non-Hispanic White (55 %), female (53 %), and approximately 35 % were eligible for free-reduced lunch. Mean sleep duration (± SD) and daytime sleepiness was 8.04 ± 1.36 and 5.17 ± 2.37, respectively; and 42 % of participants reported insufficient sleep (<8 h). Depressive (β = 0.13, 95 % CI: 0.08, 0.18) and anxiety (β = 1.20, 95 % CI 0.51, 1.88) symptoms, and stress (β = 1.97, 95 % CI 1.21, 2.74) were associated with higher sleepiness scores. The psychosocial factors were associated with higher odds of insufficient sleep duration, but not continuous sleep duration. Higher social support was associated with lower sleepiness, but not sleep duration. There was no observed effect modification by social support. ConclusionsExperiences of psychosocial factors were associated with more sleepiness and insufficient sleep, while social support was associated with less sleepiness. Future studies should explore intervention strategies to enhance mood and social support and reduce stress to improve sleep among semi-rural adolescents.

A Qualitative Analysis of the Association of Treatment Outcomes, Psychosocial Factors, and Multimorbidity in Severe Hypertensive Patients Attending Health Institutions in Southeast Nigeria

Severe hypertension is associated with a two-fold increase in relative risk of death. Interventions to date fail to achieve sustained improvement in blood pressure, particularly in regional areas of high social disparity. Growing evidence points to multiple psychological, social and morbidity factors as contributors to the onset of and trajectory of hypertension. This study aims to examine the association of psychosocial factors and multimorbidity with response to treatment and treatment outcomes in the management of severe hypertensive patients providing updated knowledge and recommendations to improve their quality of care. We employed a hospital based comparative cross-sectional study using a quantitative and qualitative approach. Semi-structured questionnaires were used to collect information from 733 severe hypertensive patients attending cardiology clinics in two tertiary health institutions in southeastern Nigeria. Data collected was transcribed, coded, and analysed with IBM SPSS version 23 software with appropriate descriptive tools used in presenting findings. We observed a significant association between age of the respondents and their response to treatment. Overweight/obese respondents were 1.5times less likely to respond to treatment. These findings add to existing knowledge provoking thoughtful discussions among relevant public health actors and stakeholders to update management policies for severe hypertension.

Sex and Psychosocial Differences in Acute Stress Symptoms Prior to Open-Heart Surgery.

Acute stress symptoms can occur while cardiac patients await open-heart surgery (OHS). The distress leads to poor outcomes. This study aimed to investigate the association of sex and psychosocial factors (quality-of-life and character strengths). Our study cohort included 481 pre-OHS patients (female 42%; mean age 62 years).Medical indices/factors were obtained from the Society of Thoracic Surgeon's nationaldatabase. Multiple regression analyses were performed following pre-planned stepsand adjusting medical factors. Our findings revealed that sex differences in trauma-related symptoms wereassociated with poor mental well-being, alongside comorbidities. Both mental well-beingand comorbidity factors were directly related to acute stress symptoms, whiledispositional optimism had an inverse association with this outcome. To improve OHS outcomes, our findings suggest healthcare providers be attentive topre-OHS acute stress symptoms, pay greater attention to the emotional well-being oftheir female patients, and develop supportive interventions to enhance personalitystrengths.

Understanding the Influence of Psychosocial Factors and Multimorbidity on Patient Outcomes in Severe Hypertensive Patients Attending Health Institutions in Southeastern Nigeria

Hypertension is a prevalent problem worldwide and it is an important risk factor for a variety of health conditions. Severe hypertension (180+ systolic or 110+ diastolic) is associated with a two-fold increase in relative risk of death. Interventions to date fail to achieve sustained improvement in blood pressure, particularly in regional areas of high social disparity. Growing evidence points to multiple psychological, social and morbidity factors as contributors to the onset of and trajectory of hypertension. The main objective of this study is to examine the association of psychosocial factors and multimorbidity with response to treatment and treatment outcomes in the management of severe hypertensive patients providing additional knowledge and recommendations to improve their quality of care. We conducted cross-sectional research, using interview self-administered semi-structured questionnaires. Data collected was transcribed, coded, and analyzed thematically. Findings were presented in tables, charts, and in narrations as appropriate. Results: There was a significant association between age of the patients and response to treatment in severe hypertension. Overweight/obesity was noted to be significantly associated with response to treatment. In this study, the burden of psychosocial factors and multimorbidity’s in the management of severe hypertension is highlighted. There is a need for effective monitoring and surveillance to monitor progress in reducing the prevalence of severe hypertension and in increasing the awareness for the treatment and management of hypertension.

Factors associated with suicidal ideation among puerperal women in the context of public health: integrative review

Objective: To synthesize scientific evidence about the factors associated with suicidal ideation in the puerperal period in the context of public health. Methods: Integrative review conducted by the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, carried out in July 2022, in the Medical Literature Analysis and Retrieval System Online, Web of Science, Latin American and Caribbean Literature in Health Sciences, Nursing Database, Spanish Bibliographic Index of Health Sciences, PsycINFO and Cumulative Index to Nursing and Allied Health Literature. Results: Seven studies were selected to compose this review. Factors associated with suicidal ideation in the puerperal period were younger, single, unemployed women, having an unemployed partner, having experienced intimate partner violence, having faced stressful events during pregnancy, previous experiences of abortion and marital dissatisfaction, depressive symptoms and other mental disorders (mood disorders, hypomanic symptoms, neuroticism and psychoticism). High self-esteem aimed to reduce ideas of suicide during the postpartum period. Being primigravid, having a harmonious relationship with the mother-in-law, and marital satisfaction were presented as protective factors. Conclusion: The synthesis of the studies showed the association of psychosocial, physiological and sociodemographic factors with suicidal ideation among puerperal women, as well as protective factors.

Positive psychosocial factors may protect against perceived stress in people with systemic lupus erythematosus with and without trauma history

ObjectiveTrauma history is associated with SLE onset and worse patient-reported outcomes; perceived stress is associated with greater SLE disease activity. Stress perceptions vary in response to life events and may...

Patterns and Factors Associated With Alcohol Misuse Among Young Black Men Who Have Sex With Men in New York City.

Alcohol misuse is a significant health concern among gay, bisexual, same-gender-loving, and other men who have sex with men (MSM). Yet, little is known about the severity and predictors of alcohol misuse among self-reported young Black MSM. This study aimed to identify patterns of and factors associated with alcohol misuse in a sample of young Black MSM living in New York City. Baseline data from a randomized controlled trial aimed at improving the uptake of HIV testing among 250 MSM aged 18 to 29 were analyzed. Log-binominal regression analyses were conducted to assess the association of demographic and psychosocial factors with alcohol misuse in the past year and past 3 months among young Black MSM. Overall, 33.2% and 28.0% of young Black MSM in the study experienced alcohol misuse in the past year and past 3 months, respectively. In the adjusted model, factors positively associated with past-year alcohol misuse included marijuana use, a history of drug use, and having one-two or more than two male sex partners. Likewise, participants who used marijuana and those with one-two or more than two male partners were more likely to report past 3-month alcohol misuse. No significant association was found between positive screening for depressive symptoms, chemsex, internalized homophobia, and the likelihood of having alcohol misuse. The high prevalence of alcohol misuse underscores the importance of raising awareness of alcohol misuse and designing alcohol risk reduction programs that jointly address HIV risk among young Black MSM.

Psychosocial Factors and Glycemic Control in Young Adults With Youth-Onset Type 2 Diabetes

Youth-onset type 2 diabetes is associated with poor glycemic control and early onset of complications. Identification of psychosocial factors associated with poor glycemic control is needed to inform efficacious interventions. To identify psychosocial factors associated with glycated hemoglobin (HbA1c) levels in young adults with youth-onset type 2 diabetes. For the iCount cohort study, HbA1c levels were measured twice (at baseline [T1] and at 1 year [T2]) during the last years (2017-2019) of the observational phase of the multicenter Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY2) study. Participants were young adults who had been diagnosed with type 2 diabetes during childhood or adolescence. Data were analyzed from December 2021 to September 2023. Glycemic control was examined categorically (high [≥8.0%] vs low [<8.0%] HbA1c), continuously (HbA1c level), and over time (change in HbA1c: decreased ≥0.5%, remained stable, or increased ≥0.5%). Psychosocial measures included beliefs about medicines, depression and anxiety symptoms, diabetes distress, diabetes self-efficacy, self-management support, and unmet material needs. Multivariable logistic and linear regression models evaluated the association of each psychosocial factor with the probability of T2 HbA1c of 8.0% or greater, T2 HbA1c level, and change in HbA1c. Of the 411 TODAY2 participants approached, 381 enrolled in the iCount study, and 348 with T1 and T2 HbA1c data comprised the analysis group. The 348 participants had a mean (SD) age of 26.1 (2.5) years and a mean (SD) HbA1c of 9.4% (2.8%). Most participants (229 [65.8%]) were women. In adjusted multivariable regressions, greater beliefs that diabetes medicines are necessary (odds ratio [OR], 1.19 [95% CI, 1.03-1.37]; P = .02), concerns about medicines (OR, 1.20 [95% CI, 1.00-1.45]; P = .049), diabetes distress (OR, 1.08 [95% CI, 1.02-1.15]; P = .006), and high distress (OR, 2.18 [95% CI, 1.15-4.13]; P = .02) increased the odds of high HbA1c at T2. Greater support (OR, 0.67 [95% CI, 0.46-0.97]; P = .04) and diabetes self-efficacy (OR, 0.91 [95% CI, 0.84-0.99]; P = .02) decreased the odds of high HbA1c at T2. Diabetes distress was associated with higher HbA1c level at T2 (coefficient, 0.08 [95% CI, 0.02-0.13]; P = .01). Beliefs that diabetes medicines are necessary (OR, 1.20 [95% CI, 1.03-1.39]; P = .02) and concerns about medicines (OR, 1.22 [95% CI, 1.00-1.47]; P = .048) increased the odds of an HbA1c decrease of at least 0.5% over 1 year. In this cohort study of young adults with youth-onset type 2 diabetes, beliefs about medicines, high diabetes distress, low diabetes self-efficacy, and self-management support were associated with high HbA1c over time. Future research should assess whether interventions that address these factors result in improved glycemic control in this at-risk group.

Physical and psychosocial work-related exposures and the occurrence of disorders of the shoulder: A systematic review update

This review is an update of a previous systematic review and assesses the evidence for the association of work-related physical and psychosocial risk factors and specific disorders of the shoulders. Medline, Embase, Web of Science Core Collection, Cochrane Central and PsycINFO were searched and study eligibility and risk of bias assessment was performed by two independent reviewers. A total of 14 new articles were added with the majority focusing on rotator cuff syndrome (RCS) with seven studies. Nine articles reported psychosocial exposures in addition to physical exposures. The strongest evidence was found for the association between elevation, repetition, force and vibration and the occurrence of SIS and tendinosis/tendonitis. Evidence also suggests that psychosocial exposures are associated with the occurrence of RCS and tendinosis/tendonitis. Other findings were inconsistent which prevents drawing strong conclusions.

Association of Psychosocial Risk Factors With Quality of Life and Readmissions 1 Year After LVAD Implantation

BackgroundAmong patients with advanced heart failure (HF), treatment with a left ventricular assist device (LVAD) improves health-related quality of life (HRQOL). We investigated the association between psychosocial risk factors, HRQOL, and outcomes after LVAD implantation. MethodsA retrospective cohort (n=9832) of adults aged ≥ 19 years who received durable LVAD between 2008 – 2017 was identified using the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). Patients were considered to have psychosocial risk factors if ≥1 of the following were present: 1) substance abuse; 2) limited social support; 3) limited cognitive understanding; 4) repeated non-adherence; and 5) major psychiatric disease. Multivariable logistic and linear regression models were used to evaluate the association between psychosocial risk factors and change in Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 scores from baseline to 1-year, persistently poor HRQOL (KCCQ-12 score < 45 at baseline and 1-year), and 1-year rehospitalization. ResultsAmong the final analytic cohort, 2024 (20.6%) patients had ≥1 psychosocial risk factors. Patients with psychosocial risk factors were associated with a smaller improvement in KCCQ-12 scores from baseline to 1-year (Mean ± SD, 29.1 ± 25.9 vs 32.6 ± 26.1, p=0.015) for a difference of -3.51 (95% confidence interval [CI]: -5.88 to -1.13). Psychosocial risk factors were associated with persistently poor HRQOL (adjusted odds ratio [aOR] 1.35, 95% confidence interval [CI] 1.04 – 1.74), and 1-year all-cause readmission (adjusted hazard ratio [aHR] 1.11, 95% CI 1.05 – 1.18). Limited social support, major psychiatric disorder, and repeated non-adherence were associated with persistently poor HRQOL, while major psychiatric disorder was associated with 1-year rehospitalization. ConclusionThe presence of psychosocial risk factors is associated with lower KCCQ-12 scores and higher risk for readmission at 1-year after LVAD. While these associations are statistically significant, further research is needed to determine whether these differences are clinically meaningful.