Personality And Total Health Research Articles

Neighbourhood environments and cognitive health in the longitudinal Personality and Total Health (PATH) through life study: A 12-year follow-up of older Australians

BackgroundUrban neighbourhood environments may impact older adults’ cognitive health. However, longitudinal studies examining key environmental correlates of cognitive health are lacking. We estimated cross-sectional and longitudinal associations of neighbourhood built and natural environments and ambient air pollution with multiple cognitive health outcomes in Australian urban dwellers aged 60+ years. MethodsThe study included 1160 participants of the PATH Through Life study (60+ cohort) who were followed up for 12 years (four assessments; 2001/02 to 2013/15) and with data on socio-demographics, health, cognitive functions and diagnoses, and full residential address. Neighbourhood environmental features encompassed population and street-intersection densities, non-commercial land use mix, transit points, presence of blue space, percentages of commercial land, parkland and tree cover, and annual average PM2.5 and NO2 concentrations. All exposures except for tree cover were assessed at two time points. Generalised additive mixed models estimated associations of person-level average, and within-person changes in, exposures with cognitive functions. Multi-state hidden Markov models estimated the associations of neighbourhood attributes with transitions to/from mild cognitive impairment (MCI). ResultsDense, destination-rich neighbourhoods were associated with a lower likelihood of transition to MCI and reversal to no MCI. Positive cross-sectional and longitudinal associations of non-commercial land use mix, street intersection density and percentage of commercial land were observed especially with global cognition and processing speed. While access to parkland and blue spaces were associated with a lower risk of transition to MCI, the findings related to cognitive functions were mixed and supportive of an effect of parkland on verbal memory only. Higher levels of PM2.5 and NO2 were consistently associated with steeper declines and/or decreases in cognitive functions and worse cognitive states across time. ConclusionTo support cognitive health in ageing populations, neighbourhoods need to provide an optimal mix of environmental complexity, destinations and access to the natural environment and, at the same time, minimise ambient air pollution.

Investigating the association between Work Family Conflicts (WFC) and suicidal ideation in an Australian community-based cohort study

BackgroundSuicidal ideation, a significant public health issue, necessitates further investigation of its correlates and precursors. Extensive research highlights the association between Work Family Conflicts (WFC) and psychological distress, including depression. However, research examining the correlation between high WFC experiences and suicidal ideation is sparse. This study explores the association between WFC and suicidal ideation within an occupation non-specific community sample. MethodsCommunity-based, representative data from the Australian-based Personality and Total Health (PATH) Through Life project formed the basis of this study. Participants eligible for the study (N = 1312) were employed either full-time or part-time and took part in an online questionnaire. Importantly, the data include robust measures of WFC, active suicidal ideation, and depression. ResultsAfter adjusting for psychosocial job characteristics, history of suicidal ideation, and other socio-demographic factors, high WFC was associated with increased odds of active suicidal ideation (Model 4: OR: 1.58, CI: 1.04–2.40). Further, supplementary analyses indicated that depression is an important component of this relationship. Analyses exploring an interaction effect by gender showed that while a significant association between high WFC and suicidality was observed among men after adjustment for all covariates, this association was not evident for women. LimitationsA small number of participants reported suicidal ideation, potentially affecting the statistical power to detect significant effects. WFC was measured at one time-point, prohibiting the exploration of its causal and/or chronic impact on suicidal ideation. ConclusionWe find evidence that high WFC is linked to increased active suicidal ideation – specifically for men.

Investigating the association between work family conflict (WFC) and generalized anxiety disorder (GAD) in an Australian community-based cohort study.

Difficulties managing work and family demands are common and have been found to be associated with stress and poor mental health. However, very few studies have examined Work Family Conflict (WFC) in connection with diagnosable anxiety disorders (and none with Australian representative data). The current study investigated whether high WFC was significantly associated with a diagnosis of Generalised Anxiety Disorder (GAD) after controlling for a broad range of socio-demographic contextual factors, related psychosocial job, family and individual characteristics, and prior anxiety symptom history. Data was analysed from an Australian population-based community cohort - the Personality and Total Health (PATH) Through Life project. Eligible participants (N = 1159) were employed full-time or part-time, with data collected by both online questionnaire and face-to-face interview. Presence of Generalised Anxiety Disorder (GAD) in the past 12-months was diagnosed by the GAD module in the Composite International Diagnostic Interview (CIDI) (based on DSM-IV criteria) and severe anxiety symptoms were measured using the Patient Health Questionnaire (PHQ) 7-item 'other anxiety' model. The findings consistently showed that those experiencing high WFC had higher odds of a GAD diagnosis (final adjusted model: CIDI: OR: 2.55, CI: 1.38-4.70) as well as clinical levels of anxiety symptoms (PHQ: OR:2.61, CI:1.44,4.72). This was the case after controlling for an extensive range of covariates. This is one of the first studies to show that WFC is associated with greater likelihood of GAD. The challenge of juggling both work and family can have far-reaching impacts - not just increasing distress broadly, but also potentially increasing the likelihood of clinically diagnosable anxiety.

Estimating Gender Differences in the Association between Cognitive Resilience and Mild Cognitive Impairment Incidence

Introduction: Recent evidence suggests that the influence of verbal intelligence and education on the onset of subjective cognitive decline may be modulated by gender, where education contributes less to cognitive resilience (CR) in women than in men. This study aimed to examine gender differences in the association between CR and mild cognitive impairment (MCI) incidence in an Australian population-based cohort. Methods: We included 1,806 participants who had completed at least the first two waves and up to four waves of assessments in the Personality and Total Health (PATH) Through Life study (baseline: 49% female, male = 62.5, SD = 1.5, age range = 60–66 years). CR proxies included measures of educational attainment, occupation skill, verbal intelligence, and leisure activity. Discrete-time survival analyses were conducted to examine gender differences in the association between CR proxies and MCI risk, adjusting for age and apolipoprotein E4 status. Results: Gender differences were only found in the association between occupation and MCI risk, where lower occupation skill was more strongly associated with higher risk in men than in women (odds ratio [OR] = 1.30, 95% confidence interval [CI] [1.07, 1.57]). In both genders, after adjusting for education and occupation, one SD increase in leisure activity was associated with lower MCI risk by 32% (OR = 0.76, 95% CI [0.65, 0.89]). Higher scores in verbal intelligence assessment were associated with reduced risk of MCI by 28% (OR = 0.78, 95% CI [0.69, 0.89]). Conclusion: Occupational experience may contribute to CR differently between genders. Life course cognitive engagement and verbal intelligence may be more protective against MCI than education and occupation for both men and women.

Childhood adversity is associated with anxiety and depression in older adults: A cumulative risk and latent class analysis

BackgroundThe long-lasting influence of childhood adversity on mental health is well documented; however empirical research examining how this association extends into older adults is limited. This study operationalises adversity using cumulative risk and latent class analysis (LCA) models to assess how adversity exposure and typologies may predict anxiety and depression in older adults. MethodsData came from the Personality and Total Health (PATH) Through Life Project (N = 2551, age 60–66). Participants retrospectively reported their childhood experiences of domestic adversity on a 17-item scale. Mental health was measured using four validated questionnaires of depression and anxiety. ResultsLinear and generalised additive models (GAM) indicated a dose-response relationship, where a greater number of cumulative adversities were associated with poorer scores on all four mental health measures. LCA identified a four-class solution; with high adversity and high parental dysfunction being associated with poorer mental health outcomes while moderate parental dysfunction and low adversity groups scored at healthy levels. Women reported higher overall anxiety than men, but no notable interactions between ACEs and gender were observed. Patterns revealed by LCA were similar to patterns shown by the cumulative risk model. LimitationsThere is a large time gap from childhood to assessment, making our study susceptible to recall bias. Also, our findings were based on cross-sectional data, limiting causal inferences. ConclusionChildhood adversity had independent and additive contributions to depression and anxiety in older adulthood, and both cumulative risk and person-centred approaches captured this relationship.

CHILDHOOD ADVERSITY IS ASSOCIATED WITH MENTAL HEALTH BUT NOT COGNITIVE DECLINE IN OLDER ADULTS

Abstract Objective The aim of this study was to examine the association between childhood adversity and mental health and cognition in older adults. Methods The sample included older Australian adults from the Personality and Total Health (PATH) Through Life Project (N = 2551). Childhood adversity was measured using a 17-item scale of domestic adversities (e.g., poverty, neglect, physical abuse, verbal abuse) and modelled using cumulative risk analysis (LCA). Mental health was measured using four validated depression and anxiety questionnaires and cognitive impairment was determined by a clinically validated algorithmic diagnostic criteria. The association between childhood adversity and late-life mental health was estimated using generalised additive models, and the association with cognition utilised multiple logistic regressions. Models were adjusted for gender, race, and education. Results Generalised additive models indicated that a greater number of cumulative adversities were associated with poorer scores on all four mental health measures. No notable interactions between ACEs and gender were observed. In contrast, there was no association between childhood adversity and cognitive impairment in any of the tested logistic regression models. No gender differences were observed and no interactions with education or genotype were found. Conclusion Consistent with prevailing literature, our study provides additional evidence for the enduring effects of domestic childhood adversity on anxiety and depression in older adulthood. Furthermore, the absence of associations between early adversity and cognitive impairment indicates that other factors might play a more prominent role in determining late-life cognitive outcomes.

THE RELATIONSHIP BETWEEN CHILDHOOD ADVERSITY AND MENTAL HEALTH IN OLDER ADULTS

Abstract Background There is a need to understand how early adversity is linked with mental health in older adults. The aim of this study was to 1) explore the optimal way to operationalise a scale of adverse childhood experiences (ACEs) and 2) examine the association between ACEs with depression and anxiety in older adulthood. Methods Data were from Wave 1 of the Personality and Total Health (PATH) Through Life Project (N = 7485, 51% women). Older adults aged 60–65 reported their childhood experiences of domestic adversity on a 17-item scale (e.g., physical abuse, neglect, poverty). Depression and anxiety were assessed using four validated screening instruments (GDS, GAS, MCS-12, PHQ-9). Three approaches to scoring the ACE scale were compared: i) cumulative risk, ii) factor analysis, and iii) latent class analysis (LCA). Confirmatory factor analysis (CFA) of the dimensional model of adversity and psychopathology was examined. Linear regression models estimated associations between ACEs and mental health, adjusting for age, race, education, and gender. Results Childhood adversity was associated with late life depression and anxiety using the cumulative risk approach. CFA examined latent factors of threat and deprivation in our dataset, which were highly correlated, leading to problems with multicollinearity when estimating associations. Finally, LCA revealed six classes of ACEs: high adversity, low adversity, low affection, authoritarian upbringing, high parental dysfunction, and moderate parental dysfunction. High adversity and high parental dysfunction were associated with higher levels of depression and anxiety symptoms compared to other latent classes.

The impact of mild cognitive impairment on decision-making under explicit risk conditions: Evidence from the Personality and Total Health (PATH) Through Life longitudinal study.

Previous research has indicated that cognition and executive function are associated with decision-making, however the impact of mild cognitive impairment (MCI) on decision-making under explicit risk conditions is unclear. This cross-sectional study examined the impact of MCI, and MCI subtypes, on decision-making on the Game of Dice Task (GDT), among a cohort of older adults. Data from 245 older adult participants (aged 72-78 years) from the fourth assessment of the Personality and Total Health Through Life study were analyzed. A diagnostic algorithm identified 103 participants with MCI, with subtypes of single-domain amnestic MCI (aMCI-single; n = 38), multi-domain amnestic MCI (aMCI-multi; n = 31), and non-amnestic MCI (n = 33), who were compared with an age-, sex-, education-, and income-matched sample of 142 cognitively unimpaired older adults. Decision-making scores on the GDT (net score, single number choices, and strategy changes) were compared between groups using nonparametric tests. Participants with MCI showed impaired performance on the GDT, with higher frequencies of single number choices and strategy changes. Analyses comparing MCI subtypes indicated that the aMCI-multi subtype showed increased frequency of single number choices compared to cognitively unimpaired participants. Across the sample of participants, decision-making scores were associated with measures of executive function (cognitive flexibility and set shifting). MCI is associated with impaired decision-making performance under explicit risk conditions. Participants with impairments in multiple domains of cognition showed the clearest impairments. The GDT may have utility in discriminating between MCI subtypes.

Cumulative risk, factor analysis, and latent class analysis of childhood adversity data in a nationally representative sample

BackgroundChildhood adversity is a multifaceted construct that is in need of comprehensive operationalisation. ObjectiveThe aim of this study was to explore the optimal method to operationalise a scale of adverse childhood experiences (ACEs). Participants and settingData were from Wave 1 of the Personality and Total Health (PATH) Through Life Project (N = 7485, 51% women). Participants from three age groups (20–25, 40–45, 60–65) retrospectively reported their childhood experiences of domestic adversity on a 17-item scale (e.g., physical abuse, verbal abuse, neglect, poverty). MethodsWe compared three approaches to operationalising the 17-item scale: a cumulative risk approach, factor analysis, and latent class analysis (LCA). The cumulative risk and dimensional models were represented by a unidimensional and two-dimensional model respectively using confirmatory factor analysis (CFA). ResultsThe cumulative risk approach and LCA were viable approaches to operationalising ACE data in PATH. CFA of the dimensional model produced latent factors of threat and deprivation that were highly correlated, potentially leading to problems with multicollinearity when estimating associations. LCA revealed six classes of ACEs: high adversity, low adversity, low affection, authoritarian upbringing, high parental dysfunction, and moderate parental dysfunction. ConclusionOur study found multiple latent classes within a 17-item questionnaire assessing domestic adversity. Using both the cumulative method and latent class approach may be a more informative approach when examining the relationship between ACEs and later health outcomes. Future ACE studies may benefit by considering multi-dimensional approaches to operationalising adversity.

Evaluation of blood pressure and cognitive function using individual participant data meta‐analysis: The Life‐Course Blood Pressure Cognition (LCBP‐COG) study

AbstractBackgroundThe prognostic significance of various blood pressure (BP) indices (i.e. systolic BP [SBP], diastolic BP [DBP], pulse pressure [PP] and mean arterial pressure [MAP]) on cardio‐ and cerebrovascular health vary across age groups. We examined the association between baseline BP indices in mid‐ and late‐life and cognitive function over a 9‐15 year period.MethodWe performed pooled analyses of data from 3 longitudinal cohort studies. The Personality and Total Health (PATH) Through Life study of adults initially aged 40‐44 and 60‐64 years in Australia, and Victoria Longitudinal Study (VLS) of adults initially aged 55‐85 years in Canada, included four waves of data collection every 4‐5 years. The Gothenburg H70 Birth cohort study of adults initially aged 70 years included three waves of data collection every 4‐5 years. The association between baseline BP and cognitive decline on the Mini‐Mental State Examination (MMSE) was categorized using the reliable change index (Duff K. 2012) and analyzed using logistic regression adjusted for age, sex, and study. Additional analyses examined relationships between baseline BP and repeated cognitive measures of memory, attention and processing speed, and executive function, using linear mixed models (PATH and H70). Only participants with complete BP and cognitive measures were included.ResultData from 2912 participants (mean baseline age 54.3 years, range 40 to 83 years, 1395 (47.9%) male) were included. Examining baseline BP and age, we observed SBP increasing with age until a small decrease at around 80 years. DBP and MAP also showed an increase with age until early late‐life (around 60 years) and were lower at older ages, PP consistently increased (Figure 1). There were no relationships between baseline BP measures and MMSE. For PATH only, higher SBP (P=0.002), DBP (P=0.0007) and MAP (P=0.0006) at age 40 years, and higher DBP (P=0.004) at 60 years, were associated with greater annual deterioration in attention and processing speed (symbol‐digit‐modalities test) over the subsequent decade (Figure 2).ConclusionHigher BP in midlife and DBP in early late‐life, were associated with a greater decline in measures of attention and processing speed. We observed no associations between BP and MMSE decline.

1212Examining the relationship between childhood adversity and mental health in older adults

Abstract Background There is a need to understand how early adversity is linked with mental health in older adults. The aim of this study was to 1) explore the optimal way to operationalise a scale of adverse childhood experiences (ACEs) and 2) examine the association between ACEs with depression and anxiety in older adulthood. Methods Data were from Wave 1 of the Personality and Total Health (PATH) Through Life Project (N = 7485, 51% women). Older adults aged 60-65 reported their childhood experiences of domestic adversity on a 17-item scale (e.g., physical abuse, neglect, poverty). Depression and anxiety were assessed using four validated screening instruments (GDS, GAS, MCS-12, PHQ-9). Three approaches to scoring the ACE scale were compared: i) cumulative risk, ii) factor analysis, and iii) latent class analysis (LCA). Linear regression models estimated associations between ACEs and mental health, adjusting for age, race, education, and gender. Results Childhood adversity was associated with late life depression and anxiety using the cumulative risk approach. Factor analysis produced latent factors of threat and deprivation, which were highly correlated, leading to problems with multicollinearity when estimating associations. Finally, LCA revealed three classes of ACEs: high adversity, low adversity, and parental maladjustment. High adversity and parental maladjustment were associated with higher levels of depression and anxiety symptoms compared to low adversity. Conclusion Different approaches to operationalising childhood adversity reveal that ACE exposure is associated with depression and anxiety in older adults. Future studies will utilise these methods to investigate links with cognitive decline and dementia.

Trends in anticholinergic and opioid dispensing in older adults from 2004 to 2015: Results from the Personality and Total Health (PATH) Through Life Study.

Due to potential adverse effects, guidelines recommend that anticholinergics and opioids be avoided in older adults unless necessary. This study examines the dispensing trends of these medications among older Australians. Data of 2222 PATH study (60+ cohort) participants were analysed. Medication dispensing data were obtained from the Pharmaceutical Benefits Scheme from April 2004 to March 2015. Temporal trends of prescriptions dispensed were assessed using joinpoint regression analysis. Of all dispensed prescriptions, 5.5% were for anticholinergics and opioids, and 46.2% of anticholinergics dispensed were anti-depressants. Anticholinergic dispensing trend increased in 2004-2015 (annual per cent change, APC=3.4%), particularly for moderately anticholinergic medications (APC=6.8%). Dispensing trend for opioids increased in 2004-2011 (APC=11.3%) and declined in 2011-2015 (APC=-4.4%). While guidelines urge caution in prescribing these medications to older adults, dispensing increased over time in this study population.

Higher diastolic blood pressure aged 40‐44 is associated with declining cognition and increasing white matter lesions over 8‐12 year follow up.

AbstractBackgroundBackground: High midlife blood pressure (BP) is an accepted risk factor for later life cognitive decline and dementia. However, the changing patterns of systolic and diastolic (DBP) blood pressure from our 40s to our 60s highlight the need for a more sophisticated understanding of the relationships between BP during the midlife period and cognition as well as brain measures, including white matter lesion (WHL) volume as a marker of small vessel disease.MethodThe Personality and total health (PATH) study is an Australian longitudinal population based cohort with four waves of follow‐up at approximately 4‐year intervals (W1‐4). Data was used from two PATH cohorts, one aged 40‐44 at W1 (40s) and the other aged 60‐64 at W1 (60s) and included the subset of participants with BP (W1), neuropsychological testing (W1, W4), imaging (MRI)(40s W2, W4, 60s W1, W4). Linear regression models with relevant adjustment, including antihypertensive use, were used to examine the relationship between baseline BP and change in imaging and cognition over time. P≤0.01 was taken as significant.ResultData were available for 492 participants,’40s’: 218 (53% female) ‘60s’: 274 (42%). Key findings were that higher DBP at ages 40‐44 was associated with a significant decline in performance over the subsequent 12 years on the symbol digit modalities test (slope‐0.7 (95% CI ‐1.2, ‐0.3) p=0.002) and to a lesser extent, trail making A (0.9 (0.2, 1.6)p=0.01) per 10mmHg increment. There were no associations for recall, digit span or dexterity tests. There were no associations for the 60s. Higher DBP aged 60‐64 was associated with a 31% (95% CI 13%, 51%) increase in WML over 12 years (p<0.001) per 10mmHg and a similar but less strong relationship (13% (3%, 24%) in the 40s over 8 years (p=0.008). There were no relationships between change in hippocampal or total brain volume. There were no significant relationships for SBP.ConclusionHigher DBP was associated with decline in processing speed in the 40s and growth of WML overall. The next step is to examine the relationship between change in BP and change in cognition and imaging measures.

The Effect of Cumulative Anticholinergic Use on the Cognitive Function of Older Adults: Results from the Personality and Total Health (PATH) Through Life Study.

Multiple comorbidities are common in older adults, resulting in polypharmacy that often includes medications with anticholinergic properties. These medications have multiple side effects, which are more pronounced in the older population. This study examined the association between the use of anticholinergics and changes in the cognitive function of older adults. The study population consisted of 2,222 individuals aged 65-69 years at baseline from the Personality and Total Health (PATH) Through Life Study in Australia. Medication data were obtained from the Pharmaceutical Benefits Scheme (PBS). Cognitive measures were obtained from neuropsychological battery assessment. Exposure to cumulative anticholinergic use was quantified to a total standardized daily dose (TSDD). The association between change in cognitive measures between baseline and 4-year follow-up, and cumulative use of anticholinergic was assessed through generalized linear models. During the study period, 18.6% (n = 413) of participants filled at least one prescription for anticholinergics. Compared to those not on anticholinergics, participants on anticholinergics were more likely to be woman (62.7% compared to 45.1%) and spent lesser time engaging in vigorous physical activity (0.4 h/week compared to 0.9 h/week). Cumulative use of anticholinergic resulting in a TSDD exceeding 1,095 was significantly associated with poorer performance in Trail Making Test Part B (Model 1: β = 5.77, Model 2: β = 5.33, Model 3: β = 8.32, p < .01), indicating impairment in processing speed. In our study, except for speed of processing, other cognitive domains measured were not affected by cumulative anticholinergic use over a 4-year period.

Workplace Bullying and Suicidal Ideation: Findings from an Australian Longitudinal Cohort Study of Mid-Aged Workers.

Workplace bullying adversely affects mental health, yet little is known about the outcomes for suicidal ideation. The current study used Australian population-based data to investigate the association between workplace bullying and suicidal ideation. The sample included 1488 employed participants aged 52–58 from wave 4 of the Personality and Total Health (PATH) Through Life Study. Workplace bullying was measured in two ways: (a) a single item asked about experiences of bullying ‘currently’, ‘previously in the current workplace’ and ‘in a past workplace’, and (b) 15 items asked about bullying behaviours experienced in the past 6 months. Suicidal ideation was measured using items from the Psychiatric Symptom Frequency Scale (PSF) and the Patient Health Questionnaire-9 (PHQ-9). Psychosocial job quality, both current and prior, was adjusted for. Current and past experiences of workplace bullying were associated with increased risk of suicidal ideation. Current experiences were no longer associated after adjusting for concurrent indicators of psychosocial job stress, although a tendency for increased ideation remained. Reported prior experience of workplace bullying in a past workplace remained associated with higher odds of suicidal ideation after adjusting for prior psychosocial job stressors and excluding individuals with prior suicidal ideation. Being bullied at work is associated with increased risk of suicidal thoughts, although this occurs within the broader influence of other psychologically stressful employment conditions.

Is the association between poor job control and common mental disorder explained by general perceptions of control? Findings from an Australian longitudinal cohort.

Objectives This study sought to examine the influence of general perceptions of control on the association between job control and mental health. Methods We used four waves of data from a cohort of mid-aged adults from the Personality and Total Health (PATH) Through Life Study (baseline N=2106). Key measures included job control and likelihood of experiencing a common mental disorder (anxiety and/or depression). The data were analyzed using longitudinal random-intercept regression models, controlling for a range of potential confounders including general perceptions of control (ie, not isolated to the work context) via a measure of mastery. The analyses isolated the effect of within-person changes in job control on mental health (apart from between-person differences). Results The results show that the effect of job control remained significant after adjusting for general perceptions of control and other confounders. The within-person effect in the model demonstrated that, when workers had low job control, they were twice as likely to experience a common mental disorder [odds ratio (OR) 2.04, 95% confidence interval (CI) 1.53‒2.73]. Conclusions Individuals' general perceptions of control in life does not account for the association between low job control and poor mental health. The findings add a new layer of evidence to the literature demonstrating that lack of autonomy at work is an independent predictor of employees' mental health. Increasing employee control should be integrated into workplace strategies to promote mental health.

Volunteering benefits life satisfaction over 4 years: The moderating role of social network size

ObjectivesSocial engagement benefits emotional well‐being, but the mechanisms need to be better understood. Using volunteering as an example of social engagement, we first examined whether volunteering would be longitudinally beneficial to life satisfaction in older adulthood and the moderating role of changes in the social network size in such a relationship as a potential mechanism. Second, we investigated motivations to volunteer in order to promote more volunteering in older adulthood.MethodsA sample of 1,591 older participants from the Personality and Total Health (PATH) through life study (PATH) was assessed (Age: Mean = 66.54-years, SD = 1.50-years, 48% female). PATH is a four‐wave longitudinal project with a 4‐year interval between each two waves. Data from PATH Waves 3 and 4 were used to examine the relationship between volunteering and life satisfaction changes and the moderating role of changes in the social network size. Data from PATH Waves 2, 3, and 4 were used to examine the motivations to short‐term and long‐term volunteer.Results and ConclusionWe found that longer volunteering time was associated with a higher level of increase in life satisfaction during the 4‐year interval. Life satisfaction increased more in participants who lost more friends than in participants who lost fewer friends. Consistent with socioemotional selectivity theory, emotional goals were positively associated with more short‐term and long‐term volunteering behaviours. These findings provide scientific insight into the mechanisms and motives underlying the positive effects of volunteering on life satisfaction in old age.

Out-of-pocket costs, primary care frequent attendance and sample selection: Estimates from a longitudinal cohort design

This paper examines the effect of out-of-pocket costs on subsequent frequent attendance in primary care using data from the Personality and Total Health (PATH) Through Life Project, a representative community cohort study from Canberra, Australia. The analysis sample comprised 1197 respondents with two or more GP consultations, and uses survey data linked to administrative health service use (Medicare) data which provides data on the number of consultations and out-of-pocket costs. Respondents identified in the highest decile of GP use in a year were defined as Frequent Attenders (FAs). Logistic regression models that did not account for potential selection effects showed that out-of-pocket costs incurred during respondents’ prior two consultations were significantly associated with subsequent FA status. Respondents who incurred higher costs ($15–$35; or >$35) were less likely to become FAs than those who incurred no or low (<AUS$15 per consultation) costs, with no difference evident between the no and low-cost groups. However, a counterfactual model that adjusted for factors associated with the selection into payment levels did not find an influence of payment, with only a non-significant gradient in the expected direction. Hence these findings raise doubts that price drives FA behaviour, suggesting that co-payments are unlikely to affect the number of GP consultations amongst frequent attenders.

Trajectories of BMI change impact glucose and insulin metabolism

Background and aimsThe aim of this study was to examine, in a community setting, whether trajectory of weight change over twelve years is associated with glucose and insulin metabolism at twelve years. Methods and resultsParticipants were 532 community-living middle-aged and elderly adults from the Personality and Total Health (PATH) Through Life study. They spanned the full weight range (underweight/normal/overweight/obese). Latent class analysis and multivariate generalised linear models were used to investigate the association of Body Mass Index (BMI, kg/m2) trajectory over twelve years with plasma insulin (μlU/ml), plasma glucose (mmol/L), and HOMA2 insulin resistance and beta cell function at follow-up. All models were adjusted for age, gender, hypertension, pre-clinical diabetes status (normal fasting glucose or impaired fasting glucose) and physical activity. Four weight trajectories were extracted; constant normal (mean baseline BMI = 25; follow-up BMI = 25), constant high (mean baseline BMI = 36; follow-up BMI = 37), increase (mean baseline BMI = 26; follow-up BMI = 32) and decrease (mean baseline BMI = 34; follow-up BMI = 28). At any given current BMI, individuals in the constant high and increase trajectories had significantly higher plasma insulin, greater insulin resistance, and higher beta cell function than those in the constant normal trajectory. Individuals in the decrease trajectory did not differ from the constant normal trajectory. Current BMI significantly interacted with preceding BMI trajectory in its association with plasma insulin, insulin resistance, and beta cell function. ConclusionThe trajectory of preceding weight has an independent effect on blood glucose metabolism beyond body weight measured at any given point in time.

Variation in symptoms of depression and anxiety in midlife women by menopausal status

ObjectivesTo examine the association between menopausal status and the risk of symptoms of depression and anxiety in a community-based sample of Australian midlife women. Study designFemale participants (mean age 50.6±1.5) who were premenopausal (n=237), perimenopausal (n=249) or naturally postmenopausal (n=225) were drawn from the Personality and Total Health (PATH) Through Life Project, a longitudinal study. Main outcome measuresSymptoms of depression and anxiety were measured using the Goldberg Depression Scale and Goldberg Anxiety Scale. Generalised linear regression models with a negative binomial log link were used. ResultsRelative to premenopause and after adjusting for all relevant covariates, being perimenopausal was associated with increased risk of greater symptoms of depression (incidence rate ratio [IRR]=1.29, p=0.001), while being postmenopausal was associated with increased risk of greater symptoms of anxiety (IRR=1.15, p=0.041). Being perimenopausal or postmenopausal was associated with an increased risk of greater symptoms of depression (IRR=1.35, p=0.008; IRR=1.31, p=0.029) and anxiety (IRR=1.22, p=0.030; IRR=1.32, p=0.006) in women without a history of probable major depressive disorder or generalised anxiety disorder. Risk of symptoms did not differ with menopausal status in women with this history. ConclusionsMenopausal status is associated with the risk of symptoms of depression and anxiety. There is a greater likelihood of increased symptoms of depression during perimenopause and symptoms of anxiety during postmenopause. In women without a history of depression or anxiety, the perimenopause and postmenopausal stages are associated with increased risk of greater symptoms of anxiety and depression relative to premenopause.