ENRICHD Social Support Instrument Research Articles

Unraveling the Link between Self-efficacy and self-management in Breast Cancer Patients during the COVID-19 Pandemic: A Cross-sectional Study

Background: The COVID-19 pandemic necessitates that cancer patients take on a more active role in self-managing their illness and adjusting to the altered healthcare resources. To perform self-management behaviors, patients may need an adequate level of self-efficacy. However, little is known about breast cancer patients’ self-efficacy and self-management in pandemic times. Aim: This study aimed to assess the self-efficacy and self-management of breast cancer patients undergoing therapy during the COVID-19 pandemic and identify their associations. Methods: A descriptive-analytical, cross-sectional design was used. One hundred and eight breast cancer patients undergoing treatment were recruited from the National Cancer Center in Indonesia. Participants completed questionnaires that consisted of the Cancer Behavior Inventory, the Depression Anxiety Stress Scale, the Enrichd Social Support Instrument, and the Self-Management Assessment Scale. Data were analyzed using multiple regression. Results: The study found that 45.4% and 42.6% of breast cancer patients under treatment had a low level of self-efficacy and self-management, respectively. Self-efficacy is positively associated with self-management in breast cancer patients (p=0.001) after controlling for various factors, including cancer stage, psychological factors, and social support. The factor most related to self-management is self-efficacy, as measured by the odds ratio (OR), which was 16.713 (95% CI: 4.424-63.137), while the ORs of social support and stage were 4.968 (95% CI: 1.785-13.831) and 0.190 (95% CI: 0.044-0.820), respectively. Conclusion: It can be concluded that self-efficacy is strongly and positively associated with self-management in breast cancer patients undergoing treatment. Therefore, nursing interventions focusing on enhancing patients’ self-efficacy are needed.

Development of Gambling Behaviour and Its Relationship with Perceived Social Support: A Longitudinal Study of Young Adult Male Gamblers

Young adult men who gamble frequently face an elevated risk of developing gambling-related problems. So far, little is known about how changing levels of perceived social support interact with the course of gambling behaviour and gambling-related problems in this population. Using data from a prospective single-arm cohort study (Munich Leisure Time Study), we applied hierarchical linear models to investigate the longitudinal association of changes in perceived emotional and social support (hereafter PESS; operationalized as ENRICHD Social Support Instrument score) with gambling intensity, gambling frequency, and fulfilled criteria for gambling disorder. Pooling data from three time points (baseline, 12-month and 24-month follow-ups) to assess two 1-year intervals, these models disentangle the associations of (a) “level of PESS” (cross-sectional, between participants) and (b) “changes in individual PESS” (longitudinally, within-participants). Among the 169 study participants, higher levels of PESS were associated with fewer gambling-related problems (− 0.12 criteria met; p = 0.014). Furthermore, increasing individual PESS was associated with lower gambling frequency (− 0.25 gambling days; p = 0.060) and intensity (− 0.11 gambling hours; p = 0.006), and fewer gambling-related problems (− 0.19 problems; p < 0.001). The results suggest a mitigating influence of PESS on gambling behaviour and gambling-related problems. Increasing individual PESS appears more decisive for this pathway than high initial levels of PESS. Treatment and prevention strategies that activate and reinforce beneficial social resources in people with gambling-related problems are recommended and promising.

Long-Term Changes in Poststroke Depressive Symptoms: Effects of Functional Disability and Social Support.

Long-term changes in specific depressive symptoms have rarely been studied in stroke patients. Such changes and the effects of social support and functional disability on specific symptoms after a long-term follow-up period (LTP) were investigated. The Montgomery-Åsberg Depression Rating Scale (MADRS), ENRICHD Social Support Instrument, and modified Rankin Scale (mRS) for functional disability were administered at baseline, a 6-month follow-up, and an LTP (35-83 months). Effects of social support and poor functional outcome (mRS score of 3 to 6) on the 10 single items included on the MADRS were identified. Among 222 patients, mRS score, total MADRS score, and all single-item scores except "concentration difficulties," "inability to feel," and "suicidal thoughts" improved at the 6-month follow-up. From the 6-month follow-up to the LTP, the total MADRS score and half of the single-item scores worsened, although the functional outcome measure continued to improve. In multivariable linear regression tests, low social support was associated with "reduced sleep" (standardized β=0.20; 95% CI=0.06 to 0.34, p=0.005) and "pessimistic thoughts" (standardized β=0.16, 95% CI=0.03 to 0.30, p=0.019), and poor functional outcome was associated with all specific symptoms (standardized β values=0.18-0.43, all p<0.02) except "reduced sleep." Although total MADRS and single-item scores improved in parallel with improvements in functional outcome at the 6-month follow-up, these scores worsened afterward. The lack of social support and presence of functional disability were both associated with total MADRS scores. However, specific symptoms were differentially affected, suggesting that tailored strategies should be applied to manage depression in stroke patients.

Abstract P405: Low Social Support Mediates the Effect of Marital Stress on 12-month Cardiac-Specific Quality of Life in Young Adults With Acute Myocardial Infarction

Background: Marital stress is associated with worse cardiac outcomes in young adults (≤55 years) with acute myocardial infarction (AMI), but whether psychosocial factors mediate this association remains largely unknown. We conducted a mediation analysis to investigate whether marital stress worsened quality of life (QoL) after AMI by increasing the likelihood of depression or low social support. Methods: There were 1,037 married/partnered AMI survivors aged 18-55 years enrolled in the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study (2008-2012) (67% women, mean age 47 years). Marital stress was measured by the Stockholm Marital Stress Scale at 1 month post-AMI; categorized as absent/moderate or severe. Depression (Patient Health Questionnaire-9 score ≥10), low social support (ENRICHD Social Support Instrument score ≤3 on ≥2 items and total score ≤18), and cardiac-specific QoL (Seattle Angina Questionnaire) were assessed at 1 year post-AMI. Natural direct and indirect effects of marital stress, depression, and low social support on QoL were estimated by causal mediation analysis with bias-corrected bootstrapped confidence intervals. Baseline QoL, sex, age, race, and socioeconomic factors (education, income, employment, and insurance status) were entered as covariates in all models. Results: There was a statistically significant direct effect from severe marital stress to lower 1-year cardiac-specific QoL after adjusting for covariates ( Figure ). Low social support and depression mediated 14.7% and 11.1% of the total relationship between marital stress and QoL, respectively; however, only the mediating effect through low social support was statistically significant. Conclusion: Marital stress was significantly associated with worse 1-year cardiac-specific QoL, and this effect was partially mediated by low social support. Interventions to decrease marital stress that also screen and provide resources for social support may help to improve AMI outcomes.

Which Protective Factors Are Associated with the Mental Health of Syrian Students in Germany? A Register-Based Cross-Sectional Study

The aim of this online, register-based cross-sectional study was to investigate the frequency of psychological distress and protective factors among 136 Syrian students in Germany. The survey measured depression and anxiety (Patient Health Questionnaire-4), post-traumatic stress (Impact of Event-Scale-6), as well as resources social support (ENRICHD Social Support Instrument), optimism (Optimism-Pessimism-2 Scale) and religiosity (Duke Religion Index). A total of 26.50% of the sample were female. A total of 38.93% met criteria for clinically relevant depressive respectively generalized anxiety symptoms and 15.72% showed prominent PTSD scores. Participants screened positive for mental distress reported significantly less social support (p = 0.001) and less optimism (p = 0.002) than participants without mental distress. In multiple regression analyses, higher levels of feeling welcome in Germany, social support and intrinsic religiosity were significantly associated with lower levels of depression and generalized anxiety. Significant associations with lower PTSD levels were found with higher levels of social support and optimism. The results show that Syrian students in Germany are more psychologically burdened compared to other Syrian refugee samples, except for PTSD. This suggests that besides the stress caused by flight and trauma, stressors such as studying and social isolation could be considered as additional impediments for mental health and require intervention measures.

Derivation and validation of a predictive model for chronic stress in patients with cardiovascular disease.

Chronic stress in patients with cardiovascular disease (CVD), including peripheral artery disease (PAD), is independently associated worse outcomes. A model that can reliably identify factors associated with risk of chronic stress in patients with CVD is needed. In a prospective myocardial infarction (MI) registry (TRIUMPH), we constructed a logistic regression model using 27 patient demographic, socioeconomic, and clinical factors, adjusting for site, to identify predictors of chronic stress over 1 year. Stress at baseline and at 1-, 6- and 12-month follow-up was measured using the 4-item Perceived Stress Scale (PSS-4) [range 0-16, scores ≥6 depicting high stress]. Chronic stress was defined as at least 2 follow-up PSS-4 scores ≥6. We identified and validated this final model in another prospective registry of patients with symptomatic PAD, the PORTRAIT study. Our derivation cohort consisted of 4,340 patients with MI (mean age 59.1 ± 12.3 years, 33% females, 30% non-white), of whom 30% had chronic stress at follow-up. Of the 27 factors examined, female sex, current smoking, socioeconomic status, and economic burden due to medical care were positively associated with chronic stress, and ENRICHD Social Support Instrument (ESSI) score and age were inversely related to chronic stress. In the validation cohort of 797 PAD patients (mean age 68.6±9.7 years, 42% females, 28% non-white, 18% chronic stress) the c-statistic for the model was 0.77 and calibration was excellent. We can reliably identify factors that are independently associated with risk of chronic stress in patients with CVD. As chronic stress is associated with worse outcomes in this population, our work identifies potential targets for interventions to as well as the patients that could benefit from these.

The moderating effect of cognitive function on the association between social support and depressive symptoms among community-dwelling older adults: Cross-sectional and longitudinal analyses

BackgroundThe moderating effect of cognitive function on the association between social support and late-life depressive symptoms has not been thoroughly investigated. Identifying cognitive function as a possible moderator of this association might help plan community-based interventions for late-life depressive symptoms. MethodsParticipants were community-dwelling older adults who visited a community-based mental health center. The ENRICHD Social Support Instrument and the Montgomery-Asberg Depression Rating Scale were used to evaluate social support and depressive symptoms, respectively. Cognitive function was assessed using the Korean version of the Mini-Mental State Examination. Data from 1088 and 506 participants were included in the cross-sectional and longitudinal analyses, respectively. Multiple linear regression analysis was performed to assess the effects of social support on depressive symptoms and the possible moderating effect of cognition. ResultsAfter adjusting for possible confounders, greater social support at baseline was associated with fewer depressive symptoms in both cross-sectional (estimate = −0.25 standard error [SE] = 0.03, P < 0.001) and longitudinal analyses (estimate = −0.11, SE = 0.05, P = 0.014). Moreover, the association between social support and depressive symptoms was significantly moderated by cognitive function (P for interaction < 0.001 for cross-sectional analysis, and P for interaction = 0.011 for longitudinal analysis). LimitationsThe tool for assessing social support was self-reported. There may have been a selection bias in the study sample. ConclusionsGreater social support was associated with fewer late-life depressive symptoms in both analyses. However, social support may have less benefits for alleviating depressive symptoms in older adults with cognitive decline.

Factors related to health-related quality of life in patients with acute coronary syndrome in West Java, Indonesia: A correlational study.

Although acute coronary syndrome impacts patients' health-related quality of life, a dearth of studies explore this issue in Indonesia. Thus, understanding factors associated with health-related quality of life among patients with acute coronary syndrome is a necessity. This study aimed to examine the relationships between age, pain, dyspnea, functional status, self-efficacy, social support, and health-related quality of life in patients with acute coronary syndrome in West Java, Indonesia. This study employed a descriptive correlational study involving 186 patients with acute coronary syndrome purposively selected in the outpatient clinics of the top referral public hospital. Data were collected in 2020 using validated instruments: Rose Questionnaire for Angina (RQA), Rose Dyspnea Scale (RDS), Seattle Angina Questionnaire (SAQ), General Self-efficacy Scale (GSE), ENRICHD Social Support Instrument (ESSI), and MacNew Health-Related Quality of Life. Data were analyzed using descriptive statistics and Spearman-rank correlation. Overall, the health-related quality of life in patients with acute coronary syndrome was high (Mean = 4.97, SD = 0.92), including in its subscales: emotional (Mean = 4.94, SD = 0.88), physical (Mean = 5.07, SD = 1.12), and social (Mean = 5.05, SD = 1.55) subscales. Significant factors related to health-related quality of life were pain (r = 0.296, p <0.001), functional status (r = 0.601, p <0.001), dyspnea (r = -0.438, p <0.001), and self-efficacy (r = 0.299, p <0.001). Meanwhile, age and social support had no significant relationships with health-related quality of life (p = 0.270, p = 0.059). Interestingly, social support was significantly correlated with the emotional subscale of health-related quality of life (r = 0.156, p = 0.034). Functional status, pain, and self-efficacy were positively correlated with health-related quality of life, while dyspnea had a negative association. This finding serves as basic information for nurses and other healthcare professionals to consider the related factors identified in this study to improve nursing interventions in order to increase health-related quality of life among patients with acute coronary syndrome.

Short report: Social support access among single caregivers with children on the autism spectrum

BackgroundCaregivers of children with autism are more likely to experience parenting stress than parents of neurotypical children. Research on parenting stress focuses on partnered caregivers and little is known about the comparative social support experienced by single caregivers. AimTo explore differences in perceived social support between single versus partnered caregivers of adolescent and adult children on the autism spectrum. Methods and ProceduresA cross-sectional, quantitative study using the ENRICHD Social Support Instrument (ESSI) as a measure of perceived social support. Univariate and multivariable analyses were conducted to examine the association between caregiver relationship status and perceived social support. Outcomes and ResultsThere were statistically significant associations between relationship status and perceived social support, with single caregivers perceiving less social support than partnered caregivers (p < .001). Conclusions and ImplicationsSingle caregivers of adolescent and adult children on the autism spectrum perceive less social support than partnered caregivers. Service providers should routinely evaluate the support access of this single caregivers and target support services to address the distinct needs of this population.

Prevalence and biopsychosocial factors associated with depressive symptoms among patients living with systemic lupus erythematosus in clinical settings in urban Thailand

BackgroundDepressive symptoms are globally recognized as a significant mental health problem in patients with chronic disease, particularly those with systemic lupus erythematosus (SLE). The purpose of this study was to estimate the prevalence and examine biopsychosocial factors of depressive symptoms among patients with SLE.MethodsThis cross-sectional study was conducted among 185 participants diagnosed with SLE and received treatment for at least 3 months, aged 18–59 years attending the outpatient clinic of a university hospital, Bangkok, Thailand. Depressive symptoms were measured by the Thai version of the Patient Health Questionnaire-9. We assessed Demographic data, the Systemic Lupus Erythematosus Activity Index, the Systemic Lupus International Collaborating Clinics Damage Index, Numeric Rating Scale, Fatigue Severity Scale, Body Image Scale, and the ENRICHD Social Support Instrument. Data were collected from March to May 2021. Multivariable logistic regression was used to analyze the data.ResultsThe proportion of the participants with depressive symptoms was 43.2%, which 8.1% of those patients presented moderate to severe depressive symptoms. In a multivariable logistic regression model, SLE patients with depressive symptoms were more likely to be severe pain (aOR = 12.11, 95% CI: 1.35, 108.46), fatigue (aOR = 2.36, 95%CI: 1.08, 5.14), taking prednisolone ≥15 mg daily (aOR = 5.75, 95%CI: 1.76, 18.80), low satisfied of body image (aOR = 12.49, 95%CI: 2.23, 69.80), and low social support (aOR = 17.96, 95% CI: 1.86, 173.77). Disease flare, organ damage, and family income sufficiency did not significantly increase the risk of depressive symptoms in patients with SLE.ConclusionsThe findings highlight depressive symptoms in patients with SLE. Therefore, the health professional should be concerned about the perception of body image, level of social support, fatigue, and pain while treating patients with SLE. Public health screening programs to identify depressive symptoms in patients with SLE are needed. In addition, a high dose of prednisolone should be considered if required, along with monitoring.

Post-traumatic stress symptoms during the first and second COVID-19 lockdown in Greece: Rates, risk, and protective factors.

The aim was to (i) compare the rates of perceived stress, post‐traumatic stress symptoms (PTSS) and other potential correlates (i.e., resilience, social support, coping strategies, and loneliness) in the general population between the two COVID‐19 lockdowns in Greece and (ii) explore risk and protective factors of PTSS. Online data were collected amid the first (timepoint 1‐T1) and second lockdown (timepoint 2‐T2) by 1009 and 352 participants, respectively. The PTSD Checklist for DSM‐5 and the Perceived Stress Scale measured levels of PTSS and perceived stress. The Brief Resilience Scale, the COPE, the revised UCLA Loneliness Scale, and the ENRICHD Social Support Instrument measured resilience, coping strategies, loneliness, and social support, respectively. Higher levels of PTSS and perceived stress were reported during T2, compared to T1. Clinically significant levels of PTSS were presented by 26.1% and 35.5% of the participants during T1 and T2, respectively. Higher levels of loneliness and use of maladaptive coping strategies and lower levels of social support, resilience and use of adaptive coping strategies were also found. During both lockdowns, PTSS were predicted by perceived stress, loneliness, reduced resilience and the coping strategies of denial and self‐blame. PTSS were associated with younger age, female gender, being single, not having children, and the evaluation of the pandemic as a crisis. The findings highlight the significant public mental health concerns during the COVID‐19 lockdowns. Understanding the risk and protective factors against PTSS and focusing on vulnerable populations should be prioritized by the governments worldwide in the development of evidence‐based interventions.

Social Support between Diabetes Patients and Non-Diabetes Persons in Yangon, Myanmar: A Study Applying ENRICHD Social Support Instrument.

Diabetes patients, due to the chorionic nature of the disease, need complex and long-term care for control and prevention of complications. The patients themselves find it difficult to adopt appropriate disease management after diagnosis and they need social support from family, friends, and their environment, especially in lower- and middle-income countries where medical service is limited, and they need self-care of disease and lifestyle modification. In Myanmar, however, the study for social support among diabetes patients is still limited. Therefore, we conducted a case-control study to investigate the social support among diabetes patients and the association between socioeconomic factors in Yangon, which has the highest prevalence of diabetes in Myanmar. Social support between diabetes patients who came to diabetes special clinics and non-diabetes community control was assessed by applying transculturally translated ENRICHD Social Support Instrument (ESSI). Among the diabetes patients’ group, more than 70% had high perceived social support, specifically higher level of informational and emotional social support. Robust multiple regression models revealed significant positive associations between total social support and independent variables: p value < 0.001 for monthly household income and being married, and p value < 0.05 for household number and frequency of having meals together with family. These findings suggest that perceived social support among patients with diabetes may be mainly affected by the patients’ family conditions, such as household income and living with a spouse, in Myanmar culture.

Long-Term Changes in Post-Stroke Depression, Emotional Incontinence, and Anger.

Background and Purpose Long-term changes in post-stroke depression (PSD), post-stroke emotional incontinence (PSEI), and post-stroke anger (PSA) have rarely been studied. Methods This is a sub-study of EMOTION, a randomized, placebo-controlled trial, that examined the efficacy of escitalopram on PSD, PSEI, and PSA in patients with stroke. We interviewed patients at the long-term period (LTP) using predefined questionnaires: Montgomery-Åsberg depression rating scale (MADRS) for PSD, modified Kim’s criteria for PSEI, and Spielberger trait anger scale for PSA. Additionally, the ENRICHD Social Support Instrument (ESSI) for the social support state and the modified Rankin Scale (mRS) were measured. We investigated the changes in and factors behind PSD, PSEI, and PSA at LTP. Results A total of 222 patients were included, and the median follow-up duration was 59.5 months (interquartile range, 50 to 70). Compared to the data at 6 months post-stroke, the prevalence of PSEI (11.7% at 6 months, 6.3% at LTP; P=0.05) and mean anger score (21.62, 16.24; P<0.01) decreased, while the prevalence of PSD (35.6%, 44.6%; P=0.03) and mean MADRS (6.16, 8.67; P<0.01) increased at LTP. ESSI was associated with PSD and PSA, but not with PSEI. The effect of the baseline National Institutes of Health Stroke Scale score on PSD decreased over time. The effect of low social support on PSD was greater than that of mRS at LTP. Conclusions The prevalence and degree of PSD significantly increased, while those of PSEI and PSA decreased at LTP. PSD in this stage appeared to be more closely associated with a lack of social support than patients' physical disabilities.

Indoor nocturnal noise is associated with body mass index and blood pressure: a cross-sectional study

BackgroundStudies have demonstrated that noise is associated with various health problems, such as obesity and hypertension. Although the evidence of the associations of noise with obesity and hypertension is inconsistent, there seems to be a stronger association of the latter. This study aimed to investigate the associations of noise with body mass index (BMI) and blood pressure in adults living in multi-story residential buildings.MethodsA cross-sectional study was conducted in Hong Kong from February 2018 to September 2019. The Weinstein Noise Sensitivity Scale, Pittsburgh Sleep Quality Index, ENRICHD Social Support Instrument, Patient Health Questionnaire, Perceived Stress Scale, and Hospital Anxiety and Depression Scale were administered to the participants. BMI and blood pressure were assessed. Nocturnal noise exposure and total sleep duration were measured for a week.ResultsFive hundred adults (66.4% female), with an average age of 39 years (range: 18–80), completed the study. The average levels of nocturnal noise, BMI, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were 51.3 dBA, 22.2 kg/m2, 116.0 mmHg, and 75.4 mmHg, respectively. After adjusting for sociodemographic characteristics, nocturnal noise was associated with BMI (b = 0.54, 95% CI: 0.01 to 1.06, p = 0.045) and SBP (b = 2.90, 95% CI: 1.12 to 4.68, p = 0.001). No association was detected between nocturnal noise and DBP (b = 0.79, 95% CI: − 0.56 to 2.13, p = 0.253). Specifically, higher nocturnal noise was associated with higher BMI (b = 0.72, 95% CI: 0.07 to 1.38, p = 0.031) and SBP (b = 3.91, 95% CI: 2.51 to 5.31, p < 0.001) in females but only higher SBP (b = 3.13, 95% CI: 1.35 to 4.92, p < 0.001) in males. The association between noise and SBP remained significant (b = 2.41, 95% CI: 0.62 to 4.20, p = 0.008) after additionally adjusting for lifestyle, diagnosis of hypertension, psychometric constructs, and sleep.ConclusionsIndoor nocturnal noise was associated with BMI and blood pressure in females but only blood pressure in males. It is important to control nocturnal noise or use soundproofing materials in buildings to reduce noise exposure.

Noise sensitivity associated with nonrestorative sleep in Chinese adults: a cross-sectional study

BackgroundNonrestorative sleep is a common sleep disorder with a prevalence ranging from 1.4 to 35%, and is associated with various psychological and physical health issues. Noise exposure and noise sensitivity have been proposed to contribute to nonrestorative sleep. This study aimed to examine the relationships among noise, noise sensitivity, nonrestorative sleep, and physiological sleep parameters in Chinese adults.MethodsA cross-sectional household survey was conducted with randomly selected Chinese adults based on a frame stratified by geographical districts and types of quarters in Hong Kong. We administered a battery of questionnaires, including the Nonrestorative Sleep Scale, the Weinstein Noise Sensitivity Scale, the ENRICHD Social Support Instrument, the Patient Health Questionnaire, and the Perceived Stress Scale to assess nonrestorative sleep, noise sensitivity, social support, somatic symptoms and stress, respectively. Anxiety and depression were evaluated by the Hospital Anxiety and Depression Scale while sociodemographic and lifestyle characteristics were assessed with an investigator-developed sheet. Nocturnal noise level and physiological sleep parameters were measured during nighttime for a week by noise dosimetry and actigraphy, respectively. A structured multiphase linear regression was conducted to estimate associations.ResultsA total of 500 adults (66.4% female) with an average age of 39 years completed this study. Bivariate regressions showed that age, marital status, occupation, family income, season, exercise, cola and soda consumption, social support, somatic symptoms, stress, depression, noise sensitivity, total sleep time, and awakenings were associated with nonrestorative sleep. In the multivariable analysis, family income, season, exercise, social support, somatic symptoms, stress, and depression remained associated with nonrestorative sleep. Specifically, a one-unit increase of noise sensitivity was associated with 0.08 increase in nonrestorative sleep (95% confidence interval [CI]: 0.01, 0.15, p = 0.023). Nocturnal noise was negatively associated with time in bed (b = − 1.65, 95% CI: − 2.77, − 0.52, p = 0.004), total sleep time (b = − 1.61, 95% CI: − 2.59, − 0.62, p = 0.001), and awakenings (b = − 0.16, 95% CI: − 0.30, − 0.03, p = 0.018), but was not associated with nonrestorative sleep.ConclusionsNonrestorative sleep was predicted by noise sensitivity in addition to family income, season, exercise, social support, somatic symptoms, stress, and depression.

The association between nonrestorative sleep and health-related quality of life in Chinese adults: a cross-sectional study.

Sleep problems are prevalent among the general population and can cause various health problems, which may lead to decreased quality of life. However, little is known about nonrestorative sleep and its implications. This study aimed to examine the association between nonrestorative sleep and health-related quality of life (HRQL) in Chinese adults. Data were collected through a cross-sectional study of 500 adults in Hong Kong (66.4% female, average age of 39years). The Short-Form-12 Health Survey version 2 (SF-12v2), Nonrestorative Sleep Scale (NRSS), Pittsburgh Sleep Quality Index, ENRICHD Social Support Instrument, Patient Health Questionnaire, Perceived Stress Scale, and Hospital Anxiety and Depression Scale were administered. Objective sleep parameters were based on participants' sleep condition over 1week, as measured using an ActiGraph GT9X Link. Mean standardized scores for the physical component summary (PCS) and mental component summary (MCS) of the SF-12v2 and the NRSS were 50.33 ± 6.50, 49.00 ± 9.03, and 64.77 ± 12.75, respectively. After adjusting for sociodemographic and lifestyle characteristics, sleep quality, objective sleep parameters, social support, somatic symptoms, stress, anxiety, and depression, NRSS scores were associated with PCS (b = 0.12, 95%CI: 0.06 to 0.18, p < 0.001) and MCS (b = 0.08, 95%CI: 0.02 to 0.15, p = 0.013) scores. Furthermore, associations of NRSS score with PCS as well as MCS scores were stronger in women than in men. Nonrestorative sleep is a potentially modifiable risk factor for poor HRQL. Thus, interventions to relieve or decrease nonrestorative sleep could be beneficial for improving HRQL.

Social support as a moderator of healthcare adherence and distress in long-term hematopoietic cell transplantation survivors.

Treatment with hematopoietic cell transplantation (HCT) has potentially severe effects on physical and psychosocial functioning. Poor social support has been linked with physical morbidity and mortality as well as psychological distress in HCT survivors. This study tested a theory-driven hypothesis that social support buffers adverse effects of health stressors of comorbidities and graft-versus-host disease (cGVHD) on distress and adherence to recommended healthcare among long-term HCT survivors. This cross-sectional study analyzed baseline data from a randomized controlled trial in adult survivors 3-18years post-HCT. Data included medical records and patient-reported outcomes including cancer and treatment distress (CTXD), healthcare adherence (HCA), comorbidity index, cGVHD, ENRICHD Social Support Instrument (ESSI), Social Activity Log, and Health Self-Efficacy. We tested hypothesized models for HCA and CTXD using blocked hierarchical linear regressions. Among the 781 HCT survivors completing baseline assessment, 38% had > 3 comorbidities, 8% had moderate-severe cGVHD, 30% reported low social support, 30% reported elevated distress, and 49% reported low healthcare adherence. Social support and self-efficacy were directly related to both adherence and distress. Regression models supported the hypothesized moderated relationships for distress but not for healthcare adherence. The two tested models confirm that the health stressors of comorbidities and cGVHD are moderated by better social support and self-efficacy in their associations with lower distress but without moderating effects for healthcare adherence. Social support and self-efficacy confer protective benefits on healthcare adherence and psychological distress. Interventions are needed that focus on maintaining social networks or finding new networks if necessary. NCT00799461.

Factors affecting frailty among community-dwelling older adults: A multi-group path analysis according to nutritional status

BackgroundFrailty is highly prevalent in older adults. Malnutrition is a common problem in older adults and is related to frailty. ObjectivesThe aim was to investigate a structural frailty model, to verify the factors which affect the frailty of older adults, and to evaluate the moderating effects of nutritional status on frailty through multi-group analysis. DesignSecondary analysis as a descriptive survey. SamplesData were prospectively collected from 1,374 older adults (age ≥ 70) from the Korean Frailty and Aging Cohort Study in 2017. MethodsFrailty was measured by the FRAIL scale [robust (score 0), pre-frailty (score 1–2), frailty (score 3–5)], and nutritional status was evaluated by the Mini Nutritional Assessment (MNA) [well-nourished (score ≥ 24), risk of malnutrition (score 17–23.5), malnourished (score < 17)]. Other domains were evaluated with the hand grip strength test, Short Physical Performance Battery (SPPB), short form of the Geriatric Depression Scale (GDS), Mini-Mental State Examination (MMSE), and ENRICHD Social Support Instrument (ESSI). The frailty model was developed by confirming the relationship among the influencing factors of frailty. To evaluate the different frailty pathways according to nutritional status in multi-group analysis, participants were divided into two subgroups according to the mean MNA score. Subgroups were classified into a well-nourished group (n = 851) for scores equal to or higher than the average score, and a malnourished group (n = 523) for scores lower than the average score. The path analysis was performed using the AMOS 23.0 program. ResultsThe frailty model's fit indices were adequate. In the model, the most influential factor for frailty was depression, followed by SPPB, age, polypharmacy, cognitive function, and female sex. In the multi-group analysis according to nutritional status, the malnourished group significantly increased in frailty as SPPB scores decreased. In addition, SPPB scores and cognitive function significantly decreased with increasing age in the malnourished group when compared to the well-nourished group. ConclusionDepression, SPPB, age, polypharmacy, cognitive function, and female sex were found to be important factors that affect frailty. Malnourished older adults are more likely to suffer from physical impairment, lower cognitive function, and frailty. Vigorous efforts are needed to improve nutritional status in older adults, which ultimately might improve functional outcomes and frailty.

Different dimensions of social support differentially predict psychological well-being in late life: opposite effects of perceived emotional support and marital status on symptoms of anxiety and of depression in older outpatients in Italy.

Social support is important to psychological well-being in late life. However, findings in the literature regarding its effects are mixed, less information is available for anxiety than for depressive symptoms, and few studies have been carried out in Italy. Therefore, the aim of this study was to investigate the influence of social support on symptoms of anxiety and of depression in a sample of geriatric outpatients in Italy. This cross-sectional study consecutively enrolled 299 outpatients without dementia (age ≥ 65, all neuropsychologically tested). Social support was assessed with the ENRICHD Social Support Instrument and by interview. Symptoms of anxiety and of depression were evaluated with short versions of the State-Trait Personality Inventory Trait Anxiety and Geriatric Depression scales. The relationship between social support and psychological well-being was examined by multiple linear regression models with socio-demographic and clinical variables, including cognitive performance, as potential confounders. Perceived emotional support was a negative predictor of symptoms of anxiety (standardised beta coefficient (β) -0.288, standard error (SE) 0.074, P < 0.001) and symptoms of depression (β -0.196, SE 0.040, P < 0.001). On the contrary, marital status (i.e. being married) was a positive predictor of symptoms of anxiety (β 0.199, SE 0.728, P = 0.003) and symptoms of depression (β 0.142, SE 0.384, P = 0.035). Different dimensions of social support differentially affect psychological well-being. The protective effect of perceived emotional support is consistent with social cognitive models of health. The harmful effect of being married may be capturing the distress of the pre-bereavement period. Alternatively, it may reflect oppression by gender roles within marriage in a predominantly female sample in a traditional society. Our findings provide insight into the relationship between social support and psychological well-being, and identify potential targets for psychosocial interventions promoting mental health in late life.

Effects of a Person-Centered Nursing Intervention for Frailty among Prefrail Community-Dwelling Older Adults.

This study examined the effects of a person-centered nursing intervention program for frailty (PNIF) targeting community-dwelling prefrail older people in South Korea. The study participants were 40 community-dwelling older adults (≥65 years) who were classified as prefrail on the Cardiovascular Health Study (CHS) frailty index. The intervention group (n = 20) received group intervention sessions two days/week for twelve weeks and the control group (n = 20) attended lectures about frailty prevention one day/week for four weeks. The evaluation instruments included the CHS Frailty Index, a JAMAR® hydraulic hand dynamometer, the Short Physical Performance Battery (SPPB), the Korean version of the Community Healthy Activities Model Program for Seniors Questionnaire (K-CHAMPS), the Mini Nutritional Assessment (MNA), the Geriatric Depression Scale Short Form-Korea Version (GDSSF-K), the ENRICHD Social Support Instrument (ESSI), and the Goal Attainment Scale (GAS). Significant differences were found in the CHS Frailty Index (p < 0.001), left-hand grip strength (p = 0.022), right-hand grip strength (p = 0.009), SPPB (p = 0.007), K-CHAMPS (p = 0.009), MNA (p = 0.018), and GDSSF-K (p = 0.001) between the two groups after 12 weeks. No significant between-group differences in ESSI scores were observed. The PNIF effectively improved grip strength, physical function, physical activity, and nutritional status, reduced depression, and prevented frailty among community-dwelling older adults.