Fewer Years Of Education Research Articles

Long-term outcomes among African–American and white women with breast cancer: What is the impact of comorbidity?

We examined the association between comorbidity and long-term mortality from breast cancer and other causes among African-American and white women with breast cancer. A total of 170 African-American and 829 white women aged 40-84years were followed for up to 28years with median follow-up of 11.3years in the Health and Functioning in Women (HFW) study. The impact of the Charlson Comorbidity Score (CCS) in the first few months following breast cancer diagnosis on the risk of mortality from breast cancer and other causes was examined using extended Cox models. Median follow-up was significantly shorter for African-American women than their white counterparts (median 8.5years vs. 12.3years). Compared to white women, African-American women had significantly fewer years of education, greater body mass index, were more likely to have functional limitations and later stage at breast cancer diagnosis, and fewer had adequate financial resources (all P<0.05). Proportionately more African-American women died of breast cancer than white women (37.1% vs. 31.4%, P=0.15). A positive and statistically significant time-varying effect of the Charlson Comorbidity Score (CCS) on other-cause mortality persisted throughout the first 5years of follow-up (P<0.001) but not for its remainder. Higher CCS was associated with increased risk of other-cause mortality, but not breast cancer specific mortality; the association did not differ among African-American and white women.

Association of Age at Depression Onset with Cognitive Functioning in Individuals with Late-Life Depression and Executive Dysfunction

To compare patterns of cognitive performance in older adults with late-onset depression (LOD;≥65 years of age) with that of older adults with early-onset depression (EOD;<65 years). Participants were 171 adults aged 60 years or older with major depression and executive dysfunction who were participating in a randomized psychotherapy trial. Participants included 72 LOD and 99 EOD individuals. Cognitive performance on measures of verbal learning, memory, and executive functioning were evaluated. Demographic and clinical characteristics, severity of cerebrovascular risk factors, and disability ratings were also compared between groups. The LOD group was older and had fewer previous episodes of depression and lower severity of depression compared with EOD participants. The LOD group demonstrated poorer performance on measures of verbal learning (F(1,161)= 4.28, p= 0.04) and memory (F(1,160)= 4.65, p= 0.03) than the EOD group. Linear regression analysis demonstrated that LOD and fewer years of education were significant predictors of poorer verbal learning (F(7,114)= 6.25, p<0.001) and memory (F(7,113)=7.24, p<0.001). Performance on measures of executive functioning, severity of vascular risk factors, and disability ratings did not differ between the two groups. In older adults with depression and executive dysfunction, LOD was associated with poorer performance on measures of verbal learning and memory. Aging-related brain changes associated with LOD may play a more important role, leading to dysfunction in these cognitive domains than a history of recurrent depressive episodes in older adults with a dysexecutive syndrome.

Predictors of perceived higher quality patient-provider communication in patients with rheumatoid arthritis

A sample of 150 patients with rheumatoid arthritis (RA) participated in a predictive, descriptive, cross-sectional study which compared contextual factors of patients who perceived higher quality communication with those who perceived lower quality, and determined the predictive power of contextual factors for higher quality patient-provider communication. A validated, self-report scale measured patient perception of quality of patient-provider communication. Data were analyzed using chi-square tests of association, two-sample t-tests, and multiple linear regression. There were no differences in external environmental or internal personal factors between those who perceived higher and lower quality of communication. From the linear regression, patients with fewer years of education (p = .008), those taking a greater number of RA medications (p = .03), and those living in an urban area (p = .04) perceived the quality of communication more positively. The findings from this study suggest that contextual factors (years of education, residence, and the number of medications) may affect RA patient perception of the quality of patient-provider communication. This underscores the need for development of appropriate and effective interventions to improve communication and optimize RA patient outcomes.

The Onset of Depression During the Great Recession: Foreclosure and Older Adult Mental Health

We examined neighborhood-level foreclosure rates and their association with onset of depressive symptoms in older adults. We linked data from the National Social Life, Health, and Aging Project (2005-2006 and 2010-2011 waves), a longitudinal, nationally representative survey, to data on zip code-level foreclosure rates, and predicted the onset of depressive symptoms using logit-linked regression. Multiple stages of the foreclosure process predicted the onset of depressive symptoms, with adjustment for demographic characteristics and changes in household assets, neighborhood poverty, and visible neighborhood disorder. A large increase in the number of notices of default (odds ratio [OR] = 1.75; 95% confidence interval [CI] = 1.14, 2.67) and properties returning to ownership by the bank (OR = 1.62; 95% CI = 1.06, 2.47) were associated with depressive symptoms. A large increase in properties going to auction was suggestive of such an association (OR = 1.45; 95% CI = 0.96, 2.19). Age, fewer years of education, and functional limitations also were predictive. Increases in neighborhood-level foreclosure represent an important risk factor for depression in older adults. These results accord with previous studies suggesting that the effects of economic crises are typically first experienced through deficits in emotional well-being.

Family and Community Determinants of Educational Attainment in Mexico

Using hierarchical linear modeling, this article investigates the effect of gender, parental capital, and community context on school-age children's educational attainment in Mexico. Data come from the Mexican Migration Project; this study investigates the contribution of various micro- and macro-level determinants. To measure schooling, the amount of education completed by two different age groups of children in Mexico was examined. In sum, male respondents were found to attain fewer years of education than females, contrary to the gender-effect model. But the study lends firm support to the parental capital model which stresses the significance of parental education and household wealth. The community context argument was marginally upheld for younger respondents but exerted a more meaningful impact on older respondents, signaling the need to emphasize age and community ecological factors in assessing educational outcomes in Mexico.

Early Detection of Mild Alzheimer’s Disease in Filipino Elderly: Validation of the Montreal Cognitive Assessment-Philippines (MoCA-P)

Background: The Montreal Cognitive Assessment (MoCA) is a useful instrument employed by clinicians to detect cognitive impairment and diagnose probable Alzheimer’s Disease (AD) while in its early stages. Methods: A cross-sectional study was conducted to determine the diagnostic validity of the Philippine version of the MoCA (MoCA-P) among 1385 community-dwelling Filipino elderly from Marikina City, Metro Manila. Results: 509 controls and 97 elderly with probable AD and a Clinical Dementia Rating (CDR) global score of 0.5 were included in the analysis. Analysis of variance showed that the AD group was older (p < 0.05) and had fewer years of education (p < 0.05). The optimal cut-off score to differentiate controls from those with probable AD was 20/21, with a sensitivity of 0.835 and a specificity of 0.723, and area under the curve (AUC) of 0.89 (p < 0.001). The positive and negative likelihood ratios were 3.01 and 0.23, respectively; and pre- and post-test odds were 0.0951 and 0.2224, respectively. Logistic regression showed that the odds of scoring < 20 on the MoCA-P increased with advancing age and with education at ≤7 years (p < 0.05). Two points are added to the MoCA-P score for those with ≤7 years of education. Conclusion: The MoCA-P is a valid instrument for the early detection of mild AD among the Filipino elderly.

Cortico-amygdala coupling as a marker of early relapse risk in cocaine-addicted individuals.

Addiction to cocaine is a chronic condition characterized by high rates of early relapse. This study builds on efforts to identify neural markers of relapse risk by studying resting-state functional connectivity (rsFC) in neural circuits arising from the amygdala, a brain region implicated in relapse-related processes including craving and reactivity to stress following acute and protracted withdrawal from cocaine. Whole-brain resting-state functional magnetic resonance imaging connectivity (6 min) was assessed in 45 cocaine-addicted individuals and 22 healthy controls. Cocaine-addicted individuals completed scans in the final week of a residential treatment episode. To approximate preclinical models of relapse-related circuitry, separate seeds were derived for the left and right basolateral (BLA) and corticomedial (CMA) amygdala. Participants also completed the Iowa Gambling Task, Wisconsin Card Sorting Test, Cocaine Craving Questionnaire, Obsessive-Compulsive Cocaine Use Scale and Personality Inventory. Relapse within the first 30 days post-treatment (n = 24) was associated with reduced rsFC between the left CMA and ventromedial prefrontal cortex/rostral anterior cingulate cortex (vmPFC/rACC) relative to cocaine-addicted individuals who remained abstinent (non-relapse, n = 21). Non-relapse participants evidenced reduced rsFC between the bilateral BLA and visual processing regions (lingual gyrus/cuneus) compared to controls and relapsed participants. Early relapse was associated with fewer years of education but unrelated to trait reactivity to stress, neurocognitive and clinical characteristics or cocaine use history. Findings suggest that rsFC within neural circuits implicated in preclinical models of relapse may provide a promising marker of relapse risk in cocaine-addicted individuals. Future efforts to replicate the current findings and alter connectivity within these circuits may yield novel interventions and improve treatment outcomes.

Psychological features of North Korean female refugees on the MMPI–2: Latent profile analysis.

This study examined the heterogeneity in the Minnesota Multiphasic Personality Inventory-2nd Edition (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) profiles of North Korean female refugee population (N = 2,163) using latent profile analysis (LPA). The North Korean female refugee sample arrived at Hanawon, South Korea's resettlement center for North Korean refugees in 2008 and 2009 and took the MMPI-2 as part of an initial psychological screen. The analysis, which included the T scores of the 6 validity scales and the 10 standard clinical scales, identified 4 classes with distinctive psychological features: Class 1 (nonclinical), Class 2 (demoralized), Class 3 (somatized), and Class 4 (detached). The 4 covariates entered into the model (age, education, affiliation with a religion, and the number of forced repatriations) impacted the likelihood of belonging to certain classes. As hypothesized, older age, fewer years of education, and more incidents of forced repatriation predicted higher proneness to psychopathology. However, contrary to our expectation, having a religious faith did not emerge as a salient protective factor. The current LPA results revealed distinct heterogeneous subgroups that previous research on the MMPI and MMPI-2 profiles of refugee populations overlooked with the assumption of a homogeneous sample. Clinical implications for the treatment of North Korean female refugees and the limitations of the study are discussed.

The Effect of Mandatory Seat Belt Laws on Seat Belt Use by Socioeconomic Position

AbstractWe investigated the differential effect of mandatory seat belt laws on seat belt use among socioeconomic subgroups. We identified the differential effect of legislation across higher versus lower education individuals using a difference‐in‐differences model based on state variations in the timing of the passage of laws. We find strong effects of mandatory seat belt laws for all education groups, but the effect is stronger for those with fewer years of education. In addition, we find that the differential effect by education is larger for mandatory seat belt laws with primary rather than secondary enforcement. Our results imply that existing socioeconomic differences in seat belt use would be further mitigated if all states upgraded to primary enforcement.

Examining the Influence of Three Types of Social Support on the Mental Health of Mexican Caregivers of Individuals with Traumatic Brain Injury

The aim of this study was to examine the influence of three types of social support (appraisal, belonging, and tangible) on caregiver mental health (anxiety, burden, depression, and satisfaction with life) among Mexican caregivers of individuals with traumatic brain injury. This is a cross-sectional study of 90 family caregivers from Hospital Civil Fray Antonio Alcade in Guadalajara, Mexico. More months spent caregiving was associated with decreases in all three types of social support. Older age and fewer years of education were associated with lower appraisal social support. More hours per week spent caregiving was associated with lower caregiver state anxiety and greater satisfaction with life. Appraisal, belonging, and tangible social support were all significantly correlated with more salubrious caregiver mental health outcomes, except satisfaction with life. Appraisal social support independently predicted lower caregiver depression. Particularly in Latin America, strong social support networks and family connections seem closely tied to key mental health outcomes such as depression. Rehabilitation interventions aimed at strengthening perceptions of social support of caregivers of individuals with traumatic brain injury that specifically target availability of advice may improve mental health and contribute to more optimal informal care for individuals with traumatic brain injury.

Physical activity in patients with stable coronary heart disease: an international perspective.

AimsDespite the known benefits of regular exercise, the reasons why many coronary heart disease (CHD) patients engage in little physical activity are not well understood. This study identifies factors associated with low activity levels in individuals with chronic CHD participating in the STABILITY study, a global clinical outcomes trial evaluating the lipoprotein phospholipaseA2 inhibitor darapladib.Methods and resultsPrior to randomization, 15 486 (97.8%) participants from 39 countries completed a lifestyle questionnaire. Total physical activity was estimated from individual subject self-reports of hours spend each week on mild, moderate, and vigorous exercise, corresponding approximately to 2, 4, and 8 METS, respectively. Multivariate logistic regression evaluated clinical and demographic variables for the lowest compared with higher overall exercise levels, and for individuals who decreased rather than maintained or increased activity since diagnosis of CHD. The least active 5280 subjects (34%) reported exercise of ≤24MET.h/week. A total of 7191 subjects (46%) reported less exercise compared with before diagnosis of CHD. The majority of participants were either ‘not limited’ or ‘limited a little’ walking 100 m (84%), climbing one flight of stairs (82%), or walking 1 km/½ mile (68%), and <10% were limited ‘a lot’ by dyspnoea or angina. Variables independently associated with both low physical activity and decreasing exercise after diagnosis of CHD included more co-morbid conditions, poorer general health, fewer years of education, race, and country (P < 0.001 for all).ConclusionIn this international study, low physical activity was only partly explained by cardiovascular symptoms. Potentially modifiable societal and health system factors are important determinants of physical inactivity in patients with chronic CHD.

Serum levels of 25-hydroxyvitamin D are associated with cognitive impairment in type 2 diabetic adults

Hypovitaminosis D is highly prevalent in type 2 diabetes. The aim of this study is to determine the serum levels of 25-hydroxyvitamin D [25(OH)D] in type 2 diabetic patients with and without mild cognitive impairment (MCI), and examine the relationship of 25(OH)D and MCI with other clinical factors. One hundred and sixty-five diabetic patients were enrolled in this study. Among whom, 95 patients were considered as MCI [Montreal Cognitive Assessment score (MoCA) < 26] and the other 70 as no MCI (MoCA ≥ 26). Subjects were assessed clinically. Diabetic patients with MCI had a longer duration of DM, fewer years of education, elevated fasting blood glucose (FBG), resistant index (RI) of carotid, and lower levels of 25(OH)D {[17.35 (13.02-25.92) vs 28.00 (19.67-34.30)] ng/ml, P < 0.001}. The MoCA score was positively correlated with log10[25(OH)D], education year, and inversely correlated with duration of DM, history of hypertension, intima-media thickness (IMT), FBG, max-RI, and min-RI. Log10[25(OH)D] was positively correlated with MoCA score, and inversely correlated with IMT, in multivariate regression analysis adjusted for age, sex, and education year, 25(OH)D (β = 0.210, P = 0.003), history of hypertension (β = -0.191, P = 0.007), IMT (β = -0.194, P = 0.007), and FBG (β = -0.157, P = 0.026) independently predicted MoCA score. In conclusion, our results suggest that levels of serum 25(OH)D are inversely associated with the cognitive impairment in diabetic patients. Vitamin D may be a potential protective factor for cognitive impairment in patients with type 2 diabetes.

A Brief and Feasible Paper-Based Method to Screen for Neurocognitive Impairment in HIV-Infected Patients

Practical screening methods are necessary to detect neurocognitive impairment (NCI) in HIV-infected patients. We aimed to find a brief and feasible paper-based tool to facilitate the diagnosis of an HIV-associated neurocognitive disorder. A total of 106 HIV-infected outpatients with variable clinical characteristics were recruited in a multicenter investigation. NCI was diagnosed using a standardized neuropsychological tests battery (7 areas, 21 measures, ∼2 hours). Multiple score combinations were compared to find a paper-based method that took ≤10 minutes to apply. The presence of NCI was considered the gold standard for comparisons, and the sensitivity and specificity were calculated. Subjects were mostly middle-aged (median, 44 years) men (87%) on antiretroviral treatment. NCI was detected in 51 individuals (48%) and was associated with lower nadir CD4 count (P < 0.001), receiving antiretroviral therapy (P = 0.004), fewer years of education (P = 0.009), and presence of comorbidities (P < 0.001). The score combination that showed the highest sensitivity (74.5%) and specificity (81.8%) detecting NCI included 3 measures of attention/working memory, executive functioning, and verbal fluency (part A of Trail Making Test, part B of Trail Making Test, and Controlled Oral Word Association Test scores). A broader paper-based selection of measures covering 7 areas indicated a sensitivity of 100% and a specificity of 96.3% (7 measures, ∼35 minutes). The combination of the 3 measures presented in this study seems to be a rapid and feasible screening mean for NCI in HIV-infected patients. This approach, combined with screening for potential comorbidities and daily functioning interference, could help in the initial stages of a HIV-associated neurocognitive disorder diagnosis and in settings with limited access to neuropsychological resources.

Very low levels of education and cognitive reserve

We conducted a clinicopathologic study in a large population with very low levels of education to determine whether very few years of education could contribute to cognitive reserve and modify the relation of neuropathologic indices to dementia. In this cross-sectional study, we included 675 individuals 50 years of age or older from the Brazilian Aging Brain Study Group. Cognitive abilities were evaluated through a structured interview with an informant at the time of autopsy, including the Clinical Dementia Rating (CDR) scale. Neuropathologic examinations were performed using immunohistochemistry and following internationally accepted criteria. Multivariate linear regression models were conducted to determine whether the association between cognitive abilities (measured by CDR sum of boxes) and years of education was independent of sociodemographic variables and neuropathologic indices, including neuritic plaques, neurofibrillary tangles, lacunar infarctions, small-vessel disease, and Lewy bodies. In addition, interaction models were used to examine whether education modified the relation between neuropathologic indices and cognition. Mean education was 3.9 ± 3.5 years. Formal education was associated with a lower CDR sum of boxes (β = -0.197; 95% confidence interval -0.343, -0.052; p = 0.008), after adjustment for sociodemographic variables and neuropathologic indices. Furthermore, education modified the relationship of lacunar infarcts with cognitive abilities (p = 0.04). Even a few years of formal education contributes to cognitive reserve.

Structural MRI measures in Alzheimer's disease and effects of ethnicity

Alzheimer's disease (AD) affects populations worldwide, and there are increasing numbers of AD-focused international neuroimaging studies. For these global cohorts, ethnicity may be a confounding factor. Morphometric differences have been found between European and Japanese brains, though the implications for common AD neuroimaging biomarkers, such as hippocampal volume and cortical thickness, are unknown and should be investigated. 65 local Chinese participants (33 AD, 32 elderly controls) were recruited, and a matching Caucasian cohort was downloaded from ADNI. All participants underwent T1-weighted MPRAGE scanning with ADNI's protocol in 3T Philips Achieva scanners, and the raw images were processed using FreeSurfer v5.1. Cortical thickness was compared between groups with FreeSurfer's GLM analysis tools. Hippocampal volumes were corrected for intracranial volume and analysed using multivariate GLM, with age, gender and years of education as covariates. There were no significant differences between the two ethnicities for age, gender, MMSE and ADAS-cog scores, but local Chinese had significantly fewer years of education than Caucasians (4.8±3.8 vs. 15.8±3.3). Several clusters in the bilateral cingulate and precuneus regions showed cortical thinning in Chinese patients whereas Caucasian patients only had thinning in the inferior temporal regions compared to their respective controls. Between ethnicities, clusters in the left parietal area were thicker in Caucasian patients, whereas Chinese controls had thicker paracentral cortices than Caucasian controls. When combined, patients had cortical thinning in the bilateral temporal regions (all results significant at p<0.01). Controls had larger relative hippocampal volumes than patients (0.27±0.05 vs. 0.19±0.04), and Chinese subjects had larger relative hippocampal volumes than Caucasian subjects, regardless of diagnosis (0.28±0.05 vs. 0.23±0.03 for controls, 0.20±0.04 vs. 0.17±0.02 for patients). Chinese subjects have larger relative hippocampal volumes than Caucasian subjects, but Chinese AD patients also display a greater degree of hippocampal atrophy and cortical thinning. As none of these trends are reflected in the cognitive test scores, this may be indicative of a protective effect from lifestyle, despite fewer years of education. Future analyses could include a cohort of North American Chinese subjects. If the effect is persistent, ethnicity should be taken into account in global population studies.

Cerebrovascular disease and higher prevalence of dementia in individuals with fewer years of education: A neuropathological study

Cerebrovascular disease and higher prevalence of dementia in individuals with fewer years of education: A neuropathological study

Work-related mechanical risk factors for long-term sick leave: a prospective study of the general working population in Norway

The overall evidence for work-related mechanical exposures as risk factors for long-term sick leave (LTSL) in the general working population is limited. The study cohort was randomly drawn from the general population in Norway, aged 18-69 years (n = 12 255, response at baseline = 60.9%). Eligible respondents were interviewed in 2009 and were registered with an active employee relationship of at least 100 actual working days in 2009 and 2010 (n = 6758). The outcome of interest was medically confirmed LTSL ≥40 working days during 2010. In total, 9.4% (635 individuals) were classified with LTSL during 2010. The risk of LTSL was higher in women, employees with fewer years of education, regular smokers, employees with chronic health complaints and employees with LTSL during 2009. After adjusting for these factors, we estimated that 24.6% of LTSL cases were attributable to work-related mechanical exposure. Mechanical risk factors were neck flexion, hand/arm repetition, standing, working with upper body bent forward and awkward lifting. The odds ratio for highest exposure levels ranged from 1.32 (95% confidence interval 1.04-1.69) for standing to 2.15 (95% confidence interval 1.24-3.73) for awkward lifting. A test for trend was statistically significant for all contributing factors (P ≤ 0.05), except standing. No psychosocial factors acted as major confounders related to any of the mechanical risk factors. This study underlines the importance of work-related mechanical exposures as risk factors for LTSL in the general working population. An exposure-response relationship was indicated for 5 of the 10 factors evaluated.

Bereavement among Hospice Caregivers of Cancer Patients One Year following Loss: Predictors of Grief, Complicated Grief, and Symptoms of Depression

Informal caregivers are an integral part of end-of-life care for hospice patients with cancer. Although adjustment following loss is highly individual, many caregivers have significant psychological distress after the death of a loved one. This study investigated risk factors that may predict psychological distress, which could aid hospice bereavement departments in targeting bereavement services. Demographic characteristics, patient impairment, caregiver baseline symptoms of depression, and caregiver resources were assessed among 188 cancer patient-caregiver dyads. Regression analyses identified predictors of symptoms of depression, grief, and complicated grief one year following loss. Over 50% of bereaved caregivers had clinically significant depressive symptoms one year after death of their relative. Caregivers with fewer years of education and more baseline symptoms of depression had significantly worse grief, complicated grief, and depression. Younger patient age was a significant predictor of poorer outcomes for grief and complicated grief; and less patient impairment was a significant predictor of more post-loss symptoms of depression. Lower social support satisfaction was correlated with worse grief and complicated grief but was not a significant multivariate predictor of poorer outcomes. Despite having access to hospice bereavement services, many former caregivers had high psychological distress one year following loss. Bereavement departments could consider utilizing readily available risk factors to target services to former caregivers who may benefit from bereavement services. Bereavement departments might also consider including brief, standardized screenings of caregiver depression in initial risk assessments. Future studies should investigate evidence-based approaches for assessment and interventions among highly distressed former hospice caregivers.

Correlates of cognitive impairment in older Vietnamese

Objectives: This study examined correlates of cognitive functioning and possible cognitive impairment among older adults living in Da Nang, Vietnam and surrounding rural areas.Methods: The analytic sample consisted of 489 adults, 55 and older stratified by gender, age, and residence in a rural or urban area. The sample was 46% rural, 44% women, with a mean age of 69.04. Interviews were conducted in individuals’ homes by trained interviewers. The dependent variable was a Vietnamese version of the mini mental status examination (MMSE). A multiple linear regression was run with the MMSE continuous scores reflecting cognitive functioning, while a binary logistic regression was conducted with an education-adjusted cut-off score reflecting possible cognitive impairment. Age, gender, education, material hardship, depressive symptoms Center for Epidemiologic Studies - Depression Scale, war injury, head trauma, diabetes, cardiovascular and cerebrovascular disease conditions served as correlates, controlling for marital status and rural/urban residence.Results: About 33% of the sample scored below the standard cutoff of 23 on the MMSE. However, only 12.9% of the sample would be considered impaired using the education-adjusted cut-off score. Cognitive functioning and possible cognitive impairment as indicated by MMSE scores were significantly associated with being older, completing fewer years of education, and material hardship. Gender, depressive symptoms, and cerebrovascular disease were associated with cognitive functioning, but not cognitive impairment.Conclusion: These results show that social characteristics, physical illness, and mental health are associated with cognitive functioning. The study also raises questions about the need for standardization of screening measures on Vietnamese populations.

Depressive Symptoms in Bereaved Parents in the 2008 Wenchuan, China Earthquake: A Cohort Study

This study sought to expand the literature on bereavement and response to natural disasters by reporting the prevalence, severity, and correlates of depressive symptoms among bereaved and nonbereaved parents of the 2008 Wenchuan Earthquake in China. Bereaved (n= 155) and nonbereaved (n= 35) parents from the Xiang'e township in China were interviewed at 18 months (Wave 1) and 24 months (Wave 2) following the earthquake. From Wave 1 to Wave 2, rates of probable depression fell for both bereaved (65.8% to 44.5%) and nonbereaved parents (34.3% to 20.0%). The depression index of both groups also decreased, but only significantly among bereaved parents. Of bereaved parents, those with fewer years of education had more severe symptoms at both waves. Depressive symptom severity of bereaved mothers improved over time, but that of bereaved fathers remained unchanged. Not becoming pregnant again after the earthquake was significantly linked to worse depressive symptoms in both waves, but this was not significant when age was added to the model. Bereaved parents may need more postearthquake supportive services, with fathers, individuals with fewer years of education, and parents who are not able to become pregnant again after the earthquake being particularly vulnerable.