Kessler 6-item Psychological Distress Scale Research Articles

Association between low MCV in early pregnancy and perinatal mental health in the Japan Environment and Children's Study and the possible effect of iron deficiency

BackgroundPostpartum anemia and iron deficiency are associated with postpartum depression. This study investigated the association between a low mean corpuscular volume (MCV) without anemia (which implies early-stage iron deficiency) in early pregnancy and perinatal mental health outcomes. MethodsThe fixed data from the Japan Environment and Children's Study (JECS), a Japanese nationwide birth cohort, were used. Perinatal mental health was assessed using the Kessler 6-item psychological distress scale (K6) in mid-pregnancy and the Edinburgh Postnatal Depression Scale (EPDS) at 1- and 6-months postpartum. ResultsAmong the 3635 women with MCVs <85 fL in early pregnancy, the proportions of women with K6 scores ≥13 in mid-pregnancy and EPDS scores ≥9 at 1- and 6-months postpartum were 2.7 %, 12.8 %, and 9.9 %, respectively, compared with the 33,242 women with MCVs ≥85 fL at 1.9 %, 11.9 %, and 9.0 %, respectively. Multivariate logistic regression models showed that an MCV <85 in early pregnancy was associated with a K6 score ≥ 13 in mid-pregnancy and an EPDS score ≥ 9 at 1- and 6-months postpartum (adjusted odds ratio (95 % confidence interval): 1.48 (1.16–1.87), 1.14 (1.01–1.28), and 1.09 (0.95–1.24), respectively). LimitationsLow MCV values do not necessarily represent iron deficiency. Ferritin, currently the best indicator of iron deficiency, was not measured in the JECS. ConclusionsThis study results suggest that a low MCV without anemia in early pregnancy is associated with a slightly increased risk of perinatal mental health deterioration.

Smaller household size and higher prevalence of serious psychological distress in younger people and never-married people: a nationwide cross-sectional survey in Japan.

Small-member households are increasing worldwide. However, most previous studies have focused on older people and living alone. Using the latest national survey data, we investigated a dose-response relationship between household size and serious psychological distress (SPD). We analyzed data from the 2019 Comprehensive Survey of Living Conditions in Japan. The study participants were 405,560 community-dwelling adults aged 20 or older. Household size was classified into 5 or more, 3 or 4, two, and one (i.e., living alone). SPD was defined as ≥13 points based on the Kessler 6-item Psychological Distress Scale. We used multivariable logistic regressions and included age, education, equivalent household expenditures, housing tenure, employment contract, smoking, and illness under treatment as covariates. After stratified analyses by age and gender, a dose-response relationship between smaller household size and more common SPD was significant for younger, but not for older people (p-trend was <0.001 in men aged 20-59 and women aged 20-39). After stratified analyses by gender and marital status, a dose-response relationship was significant only for the never-married group in both genders (p-trend was <0.001 in never-married men and women). Smaller households were associated with higher prevalence of SPD in younger adults and in never-married individuals, regardless of gender. Our findings suggest a need to focus on younger people and never-married people to reduce the mental health risks due to small household sizes.

Social isolation, social media use, and poor mental health among older adults, California Health Interview Survey 2019–2020

BackgroundOlder adults’ engagement on social media may be a resource to reduce loneliness and improve mental health. Purpose: This study aimed to examine loneliness and social media use and its association with severe psychological distress among older adults and whether social media use moderated the association of loneliness on severe psychological distress among older adults.MethodsThis study is a secondary analysis of the 2019–2020 California Health Interview Survey. The Kessler 6-item Psychological Distress Scale (K6) assessed symptoms of psychological distress, with a K6 score ≥ 13 associated with severe mental illness. Loneliness was measured using a revised Three Item Loneliness Scale (TILS) score. Multiple regression analyses were conducted to examine associations between loneliness and severe psychological distress.ResultsLoneliness, health status, and identification as Asian, remained strong predictors of severe psychological distress among older adults when adjusting for other factors. In bivariate analysis, high-frequent social media users, but did not remain significant when accounting for covariates. Social media use did not moderate the association between loneliness and severe psychological distress.ConclusionThis study underscores the significant impact of loneliness on poor mental health among older adults, emphasizing that while frequent social media use correlates with severe psychological distress, it may not alleviate the association of loneliness on poor mental health, thus highlighting the urgent need to address social isolation and promote genuine social connectedness, particularly among Asian older adults.

Association between lifestyle habits and presenteeism.

Presenteeism is affected by work-related and individual factors. Among individual factors, the effect of combining various lifestyle habits on presenteeism is unknown. This study aimed to determine the relationship between changes in multiple good lifestyle habits with a change in presenteeism and to examine the effect of psychological factors on this relationship. We performed a 1-year retrospective cohort study on employees of large Japanese companies. Data were collected from health check-ups and a self-administered questionnaire. Changes in presenteeism were measured using the Quality and Quantity method. Changes in lifestyle habits were measured using a modified form of Breslow's seven health practices. Psychological factors were measured using the Kessler 6-Item Psychological Distress Scale. Linear regression was used for statistical analysis. The number of practised lifestyle habit changes was negatively correlated with a change in presenteeism. This result was consistent when adjusted for age, sex and company (B, -0.010; P < 0.05), but became non-significant when additionally adjusted for psychological distress (B, -0.006). When analysed separately, only an improvement in the body mass index (B, -0.054; P < 0.05) and a worsened sleep habit (B, 0.040; P < 0.01) influenced a change in presenteeism. This study suggests that improving various practised lifestyle habits in combination, rather than improving a single lifestyle habit, is beneficial in reducing presenteeism. Our finding that psychological distress altered the relationship of practised lifestyle habit changes with presenteeism indicates the importance of organizational-level intervention in presenteeism.

Association between psychological distress and disability-free life expectancy in the older Japanese adults

BackgroundOur study aimed to investigate the association between psychological distress and disability-free life expectancy (DFLE). MethodsIn 2006, a cohort study was conducted of 12,365 Japanese individuals aged ≥65 years, who were followed-up for 13 years. Psychological distress was measured using the Kessler 6-item psychological distress scale and was categorized into no (0–4), mild (5–9), moderate (10−12), and serious distress (13–24). The number of participants was 1277 (22.4 %) for mild distress, 330 (5.8 %) for moderate, and 208 (3.6 %) for serious in men, and was 1635 (24.6 %), 467 (7.0 %), and 384 (5.8 %) in women. Sex-specific DFLE was defined as the mean years a person could expect to live without disability and calculated by Interpolated Markov Chain (IMaCh) software. ResultsCompared to no distress, DFLE loss per person was 1.21, 2.61, and 4.43 years for mild, moderate, and serious distress respectively in men. At population level, DFEL loss (i.e., DFLE loss per person×number of participants) was 1545.17, 861.30, and 921.44 years for mild, moderate, and serious distress respectively in men. Accordingly, 46.4 % of the total DFLE loss was attributable to mild distress, 25.9 % to moderate, and 27.7 % to serious in men. Similarly, the results were 42.2 %, 25.4 %, and 32.4 % in women. LimitationsPsychological distress was measured only once at baseline, and 2409 participants were excluded from the analysis because of missing data on exposure. ConclusionsAt population level, almost half of the total DFLE loss could be attributable to mild distress, underscoring the importance of population strategy for all levels of distress in promoting healthy aging.

Psychological distress in later life and incident dementia: The Ohsaki Cohort 2006 Study

BackgroundThe role of reverse causation in the association between psychological distress and incident dementia remains unclear. We investigated whether psychological distress is a risk factor for, or prodromal symptom of, dementia. MethodsA longitudinal analysis of psychological distress with incident dementia was conducted among 12,076 Japanese individuals (age ≥65 years) followed for 5.7 years. Psychological distress was measured using the Kessler 6-item psychological distress scale (0–24 points) at baseline, with participants categorized into four psychological distress groups: no (0–4), mild (5–9), moderate (10–12), and serious (13–24). Dementia cases were retrieved from the public Long-term Care Insurance database. Cox proportional hazards model was used to estimate the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95%CIs) for incident dementia. Stratified analysis was conducted by cognitive function (higher or lower) at baseline. ResultsDuring 60,240 person-years of follow-up, 997 individuals developed dementia. A dose-response association was found between psychological distress and dementia; however, the stratified analysis indicated that this association depended on cognitive function at baseline. Among those with higher cognitive function at baseline, a significantly elevated dementia risk was observed only for serious psychological distress (HR: 2.04, 95%CI: 1.24–3.36). Among those with lower cognitive function, both moderate (HR: 1.30, 95%CI: 1.00–1.68) and serious (HR: 1.79, 95%CI: 1.37–2.34) psychological distress showed an increased dementia risk. ConclusionThe association between late-life psychological distress and incident dementia is partly explained by reserve causation, whereby mild and moderate distress could be a prodromal symptom of dementia.

Effect of Diversity Education on Young Adolescents in Japan: Toward the "Do No Harm" Principle.

This study evaluated the impact of a semi-structured diversity education program on young adolescents, which included five 45-min sessions facilitated by schoolteachers using an instructors' manual. The study compared changes in knowledge and attitude related to diversity, self-esteem, and mental health among participants before and after the program. The participants were 776 junior high school students. Self-esteem and mental health conditions were assessed with the Rosenberg Self-Esteem Scale (RSES) and Kessler 6-Item Psychological Distress Scale (K6). The ratio of those who answered the knowledge and attitude questions correctly increased significantly for most questions, while the ratio decreased significantly for two questions. The RSES scores improved significantly after the program, but the difference was very small. Mental health, as measured by K6, became significantly worse after the program. A logistic regression analysis indicated that lower K6 scores before the program and worse academic grades had significantly higher odds ratios; being a girl, not having a disability, and having close friends were associated with worse K6 scores after the program. Further, this indicates the importance of developing processes based on evidence and the "nothing about us without us" principle.

Trajectories of psychological distress during the COVID-19 pandemic among community-dwelling older adults in Quebec: A longitudinal study.

The COVID-19 pandemic and its associated public health measures may increase the risk for psychological distress among vulnerable older adults. This longitudinal study aimed to identify predictors of psychological distress trajectories among community-dwelling older adults in Quebec, Canada. The study spanned four time points across 13months and three waves of the COVID-19 pandemic. The sample included 645 community-dwelling older adults ages 60years and older in Quebec. Participants completed telephone-based interviews that included the Kessler 6-item Psychological Distress Scale (K6) to assess psychological distress at each time point as well as information on socioeconomic, medical, psychological and COVID-19 related factors. Group-based trajectory modelling was used to identify distinct trajectories of psychological distress across time. Three group-based trajectories of psychological distress were identified: the resilient (50.5%), reactive (34.9%), and elevated distress groups (14.6%). Individuals with mobility issues, insomnia symptoms, COVID-19 related acute stress, general health anxiety, increased loneliness symptoms, and those unable to use technology to see others were more likely to be in the reactive and elevated groups than the resilient group. Those with past mental health problems had uniquely increased odds of being in the reactive group compared to the resilient group. Individuals living in poverty and those who reported taking psychotropic medication had increased odds of being in the elevated distress group compared to the resilient group. These findings characterized distinct trajectories of psychological distress in older adults and identified risk factors for elevated distress levels.

Psychological distress and digital health service use during COVID-19: A national Australian cross-sectional survey.

Previous research suggests that the COVID-19 pandemic caused significant disruption to the lives and mental health of Australians. In response, health services adapted rapidly to digital modes of treatment, prevention and care. Although a large amount of research emerged in the first year of the pandemic, the longer-term mental health impacts, contributing factors, and population-level utilization of digital health services are unknown. A population-based online survey of 5,100 Australians adults was conducted in October 2021. Psychological distress was assessed with the Kessler 6-item Psychological Distress Scale. Additional survey questions included use and satisfaction with digital health services. Where available, data were compared with our previous survey conducted in 2018, permitting an examination of pre- and post-pandemic digital health service utilization. In 2021, almost a quarter (n = 1203, 23.6%) of respondents reported serious levels of psychological distress; participants with pre-existing health related conditions, of younger age, lower educational attainment, those who lost their job or were paid fewer hours, or living in states with lockdown policies in place were at highest risk of serious psychological distress. Almost half of all respondents (n = 2177, 42.7%) reported using digital health technologies in 2021, in contrast to just 10.0% in 2018. In 2021, respondents with serious psychological distress were significantly more likely to consult with a healthcare professional via telephone/videoconferencing (P < 0.001), access healthcare via a telephone advice line (P < 0.001), or via an email or webchat advice service (P < 0.001) than those with no serious psychological distress. Those with and without psychological distress were highly satisfied with the care they received via digital health technologies in 2021. Rates of serious psychological distress during the second year of the pandemic remained high, providing further evidence for the serious impact of COVID-19 on the mental health of the general population. Those with psychological distress accessed digital mental health services and were satisfied with the care they received. The results highlight the continued need for mental health support and digital health services, particularly for people living with chronic conditions, younger adults and people most impacted by the COVID-19 pandemic, both in the short term and beyond.

Healthcare-related correlates of preoperative psychological distress among a mixed surgical and cancer-specific sample

ObjectivePreoperative distress is commonly experienced by surgical patients and is associated with adverse health-related outcomes. Research suggests preoperative distress may be elevated among cancer surgery patients relative to other surgical groups and there appears to be greater recognition of the adverse impacts of distress for these patients. This study examined associations between preoperative distress and postoperative healthcare-related correlates (e.g., length of stay, re-hospitalization) among a large, mixed surgical sample, and separately among cancer surgery patients with active cancer. MethodsWe analyzed secondary data from the Vascular Events In Non-cardiac Surgery Patients Cohort Evaluation (VISION) study – Mental Health Supplement (N = 997; n = 370 active cancer/cancer surgery). The Kessler 6-item Psychological Distress Scale assessed preoperative distress on the day of surgery. Multivariable regressions examined associations between distress and healthcare-related correlates. For significant relationships, we examined associations between anxiety and depressive subscales of distress with the correlates of interest. ResultsAmong the full surgical sample, after adjustment, preoperative distress was associated with a greater length of stay (b = 0.01, 95% CI [0.00–0.02], R2 = 0.15, f2 = 0.18) and increased odds of re-hospitalization (AOR = 1.07, 95%CI [1.01–1.13]). Results were comparable among cancer surgery patients (length of stay: b = 0.02, re-hospitalization: AOR = 1.11). Post-hoc analyses revealed associations between anxiety symptoms and re-hospitalization (AOR range: 1.13–1.26) and between depressive symptoms and length of hospital stay (b range: 0.02–0.04, R2 range: 0.07–0.15, f2 range: 0.07–0.18). ConclusionsFindings suggest preoperative distress may be associated with greater postoperative healthcare needs. Results support the importance of screening for distress in the perioperative period.

The Relationship between Psychological Distress and Physical Frailty in Japanese Community-Dwelling Older Adults: A Cross-Sectional Study.

Older adults' mental health and physical frailty have been a frequent research focus, but few studies have investigated the relationship between them. To investigate the association between mental health and physical frailty in community-dwelling older Japanese people. Cross-sectional study from the Itoshima Frail Study. Itoshima City, Fukuoka, Japan. A total of 919 community-dwelling older individuals aged 65-75 years. Physical frailty was measured based on five criteria proposed by the Fried scale, and the subjects were classified into three groups: robust, pre-frailty, and frailty. Psychological distress was used to assess the subjects' mental health, with the Kessler 6-Item Psychological Distress Scale (K6) score; the subjects were divided into three groups based on their K6 score: 0-1, 2-4, and ≥5. Psychological distress was defined by K6 score ≥5. Ordinal logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (CIs) between the psychological distress and physical frailty status. Psychological distress was identified in 190 subjects (20.7%). Forty-six subjects (5.0%) presented with physical frailty, and 24 subjects (2.6%) had both psychological distress and physical frailty. With the increase in the K6 score, more subjects had pre-frailty and physical frailty (p<0.001). Significant positive associations were observed between psychological distress and the risks of pre-frailty (OR 2.94, 95%CI: 1.95-4.43) and frailty (OR 10.71, 95%CI: 4.68-24.51), even in a multivariable-adjusted analysis. In a subgroup analysis of components of frailty, one-point increment in K6 score was associated with higher odds of shrinking and fatigue. A severe psychological distress was associated with increased risks of physical frailty and the frailty sub-items of shrinking and fatigue in community-dwelling older Japanese adults.

Association of subjective health and abnormal cervical cytology in Japanese pregnant women: An adjunct study of the Japan Environment and Children's Study

This study examines the association between abnormal cervical cytology and subjective health in pregnant women, as an adjunct to the Japan Environment and Children's Study, which cross-sectionally analyzed a subset of the prospective cohort. A total of 3024 pregnant women at a childbirth facility whose medical records of cervical cytology in the first trimester of pregnancy were transcribed and who responded to the subjective health questionnaire were included herein. They were classified into excellent, good, fair, and poor groups based on their subjective health. Cervical cytology results obtained from perinatal medical records were classified into normal and abnormal cytology based on the Bethesda classification. Logistic regression analysis adjusted for baseline characteristics, including age, pre-pregnancy body mass index, parity, and other possible confounding factors, was used. Of 3024 pregnant women, 106 (3.5%) had abnormal cytology, with the prevalence being 1.3%, 3.7%, 3.9%, and 4.0%, respectively (p = 0.055) in the poor, fair, good, and excellent groups. The baseline characteristics, namely age, history of gynecological diseases, Kessler 6-item psychological distress scale score, and history of mental illness, were significantly different between groups. Compared to the poor group, the other three groups had a significantly higher abnormal cytology risk after adjusting for confounding factors (Fair: adjusted OR [aOR] = 3.6, 95% CI [1.0–12.1]; Good: aOR = 4.6 [1.3–15.5]; Excellent: aOR = 4.6 [1.2–17.8]). This study encourages young women to undergo cervical cancer screening because they are at risk for cervical cancer even if they think that they are healthy, and preventive activities like regular screening are essential.

Mental health outcomes and their association to race and ethnicity in acne patients: A population-based study

Mental health outcomes and their association to race and ethnicity in acne patients: A population-based study

Suicidal Ideation and Predictors of Psychological Distress during the COVID-19 Pandemic in Eswatini: A Population-Based Household Telephone Survey.

The unpredictability of the COVID-19 pandemic can induce psychological distress in individuals. We investigated perceived stressors, prevalence of psychological distress and suicidal ideation, and predictors of psychological distress among adults during the COVID-19 pandemic in Eswatini. This study was a cross-sectional, population-based household telephone survey of 993 conveniently sampled adults (18+ years) from all the four administrative regions of Eswatini. Data were collected between 9 June and 18 July 2020 during the first wave of the COVID-19 pandemic, when the country was under a partial lockdown. COVID-19-related psychological distress was assessed using the Kessler 6-item Psychological Distress Scale (K6). We performed weighted modified Poisson regression analyses to identify significant predictors of moderate/severe psychological distress (K6 scores: ≥5). The weighted prevalences of moderate (K6 scores: 5–12) and severe psychological distress (K6 scores: ≥13) were 41.7% and 5.4%, respectively. Participants reported several perceived COVID-19-related stressors, including worries and fears of the contagion-specific death, serious need for food and money, and concerns about loss of income or business. The weighted prevalence of suicidal ideation was 1.5%. Statistically significant predictors of increased risk for moderate/severe psychological distress included living in the Hhohho and Manzini regions; feeling not well informed about COVID-19; feeling lonely; having received COVID-19 food or financial relief from the government; feeling burdened by the lockdown; being married; and being youth (18–24 years). The results call for the government to urgently augment the provision of mental health services during the pandemic. Mental health practitioners and programs may use several stressors and risk factors identified in this study to inform interventions and government policies aimed at reducing psychological distress induced by the pandemic.

Association between heaviness of cigarette smoking and serious psychological distress is stronger in women than in men: a nationally representative cross-sectional survey in Japan

BackgroundHigher smoking prevalence in people with serious psychological distress (SPD) is well-recognized. However, gender and age differences in the association between heaviness of cigarette smoking and SPD have not been fully investigated.MethodsWe used anonymized data from a nationally representative survey in Japan (33,925 men and 37,257 women). SPD was measured using the Kessler 6-item Psychological Distress Scale and defined as ≥ 13 points. Multiple logistic regression analyses stratified by gender and age-groups (20–44 years, 45–64 years, and ≥ 65 years) were used to estimate adjusted odds ratio (aOR) and 95% confidence interval (CI) for SPD.ResultsAfter adjusting for sociodemographic confounders including education, equivalent household expenditures, and employment contract, women had a significant association between heavier smoking and more frequent SPD: compared to never-smokers, aORs (95% CIs) of ex-smokers, current light smokers who smoked 1–10 cigarettes per day (CPD), current moderate smokers 11–20 CPD, and current heavy smokers ≥ 21 CPD were 1.22 (0.92–1.63), 1.52 (1.25–1.84), 1.75 (1.46–2.09), and 2.22 (1.59–3.10), respectively (P-trend < 0.001). A significant positive association among women was consistent across all age-groups. Among men, there was no association between heaviness of cigarette smoking and SPD in all age-groups, and only current heavy smokers aged 20–44 years had a significantly higher OR for SPD (aOR, 1.37 [95% CI, 1.02–1.85]) than never-smokers.ConclusionsThere was a positive association between heaviness of cigarette smoking and SPD only among women, but not among men. For female smokers experiencing mental disorders, there is a need not only to improve mental health services but also to improve smoking-cessation support.

Association of habitual exercise with adults’ mental health following the Fukushima Daiichi nuclear power plant accident: the Fukushima Health Management Survey

IntroductionThe Great East Japan Earthquake and the Fukushima Daiichi nuclear power plant accident in March 2011 impacted survivors’ mental health. This study examined whether exercise habits and mental health conditions were associated, and whether the degree of the effect varied depending on time. MethodsA self-administered questionnaire was sent annually to former residents (born before April 1, 1998) in registered evacuation areas. Exercise habit was evaluated by participants’ exercise frequency, and responses were categorized into “almost never,” “once a week,” and “twice a week and more.” Data were tracked during three periods: fiscal year (FY) 2011–2012, 2012–2013, and 2013–2014. The association between baseline habitual exercise and new onset of psychological distress was assessed using the Japanese version of the Kessler 6-item Psychological Distress Scale and logistic regression analysis. ResultsA total of 1304 (5.7%) of 22,741, 1060 (4.7%) of 22,709, and 759 (3.6%) of 21,220 respondents had psychological distress in FY 2011–2012, 2012–2013, and 2013–2014, respectively. An association between exercise and psychological distress was observed in men in FY 2011–2012 (P for trend: 0.010) and in women in FY 2013–2014 (P for trend: 0.026). “Almost never” was associated with onset of psychological distress in men in FY 2011–2012 [odds ratio (OR): 1.317, 95% confidence interval (CI): 1.054–1.645] and in women in FY 2013–2014 (OR: 1.296, 95% CI: 1.027–1.636). ConclusionsExercise habit was associated with psychological distress, and its effect in time varied according to sex.

Differences in Depression and Distress Between Acne Patients on Isotretinoin vs Oral Antibiotics.

Background Little is known regarding differential effects of systemic anti-acne treatments on mental health. Objective To determine whether differences exist in mental health outcomes between acne patients treated with isotretinoin versus oral antibiotics (doxycycline, minocycline, or tetracycline). Methods Population study utilizing the 2004-2017 Medical Expenditure Panel Survey. Depressive symptoms were assessed using Patient Health Questionnaire 2 (PHQ-2); psychological distress was measured by the Kessler 6-Item Psychological Distress Scale (K6). Acne patients completed both the PHQ-2 and K6 during treatment with isotretinoin or oral antibiotics. Lower scores on both measures indicate better mental health outcomes. Results After adjusting for socio-demographic characteristics, patients on isotretinoin had fewer depressive symptoms than patients on oral antibiotics, as measured by mean PHQ-2 scores (isotretinoin 0.280 vs oral antibiotics 0.656, difference=0.337, Pl0.01). The adjusted comparison also showed patients on isotretinoin had less psychological distress than patients on oral antibiotics, as measured by K6 scores (isotretinoin 2.494 vs oral antibiotics 3.433, difference=0.759, P=0.043). Limitations No direct assessment of acne severity. Conclusion Acne patients on isotretinoin experienced less depressive symptoms and psychological distress as compared to oral antibiotics. J Drugs Dermatol. 2021;20(2):172-177. doi:10.36849/JDD.2021.5559.

Psychological Distress and Alzheimer's Disease Mortality in the United States: Results from the 1997-2014 National Health Interview Survey-National Death Index Record Linkage Study.

Objective: This study examines the association between psychological distress and Alzheimer's disease mortality among US adults aged ≥45. Methods: We analyzed the Kessler 6-item psychological distress scale as a risk factor for Alzheimer's mortality using the pooled 1997-2014 National Health Interview Survey (NHIS)- National Death Index (NDI) database (N = 265,089). Cox regression was used to model mortality as a function of psychological distress and sociodemographic and behavioral covariates. Results: The Alzheimer's mortality risk was 97% higher (HR = 1.97; 95% confidence interval [CI] = 1.37, 2.84) in adults with serious psychological distress compared with those without psychological distress, controlling for sociodemographic covariates. The relative mortality risk remained statistically significant (HR = 1.49; 95% CI = 1.04, 2.13) after additional adjustment for smoking, alcohol consumption, health status, activity limitation, and body mass index. Discussion: US adults had significantly higher risks of Alzheimer's disease mortality at higher psychological distress levels. These findings underscore the significance of addressing psychological well-being as a strategy for reducing Alzheimer's disease mortality.

Self-reported health without clinically measurable benefits among adult users of multivitamin and multimineral supplements: a cross-sectional study

ObjectiveMultiple clinical trials fail to identify clinically measurable health benefits of daily multivitamin and multimineral (MVM) consumption in the general adult population. Understanding the determinants of widespread use of MVMs...

COVID-19 outbreak–related psychological distress among healthcare trainees: a cross-sectional study in China

ObjectivesThe COVID-19 outbreak has caused enormous strain on healthcare systems, and healthcare trainees, which comprise the future healthcare workforce, may be a vulnerable group. It is essential to assess the...