Secure base and mental health in children: a narrative review.

Background and Objective: Childhood is a crucial period for the formation of an individual's attachment type. Previous studies focused more on how to directly intervene in children's mental health problems such as depression, and less on how to improve children's mental health from the perspective of attachment relationship. Secure base, as one of the core concepts of attachment theory, plays an important role in the whole process of children's psychological development. In this article, we review the concept of the secure base, describe current clinical practice and suggest future directions. Methods: A literature search was performed within electronic databases such as Web of Science, PubMed, and CNKI. Chinese and English articles focusing on the secure base and attachment relationship among children were retrieved. Their publication dates were set from the inception of the database to August 6, 2024. Key Content and Findings: While the secure base significantly impacts early childhood, a safe base may also be established through group and teacher-student relationships to activate individual secure attachment schemas. Most prior studies concentrated on the mother-child bond, with limited exploration of the father's role in the family dynamic. Furthermore, children's secure attachment development is not only influenced by parents' secure base script knowledge (SBSK) but also by intergenerational transmission. The underlying structure of secure base scripting knowledge plays a distinct role in middle childhood mental health. Conclusions: The mechanism by which family structure, the functional division of family roles, and the potential structure of safe-base script knowledge influence children's secure attachment development at various stages warrants further elucidation, including investigating cross-gender and cross-cultural stability. To facilitate the development of children's secure attachment pathways, it is essential to consider different attachment styles within parents and diverse family structures (including those in lesbian, gay, bisexual). From a clinical psychotherapy perspective, this review offered novel insights and practical guidance on how the secure base mechanism impacts children's mental health, with the overarching goal of mitigating the risk of mental health problems.

Psychological resilience and related factors among primary care workers in Wuhan, China: A cross-sectional study.

Purpose: Primary medical workers constitute a high-risk group for mental health problems, and psychological resilience might protect them from the negative psychological impacts of their work. Therefore, this study aimed to investigate the current situation of psychological resilience among primary care workers in Wuhan, China, as well as related factors. Methods: In this cross-sectional study, a total of 417 primary care workers (30.0 % men; 38.5 ± 8.5 years old) were randomly selected to complete a questionnaire. The brief version of the National Mental Health Literacy Questionnaire and the Psychological Resilience Scale were used to assess participants' mental health literacy and psychological resilience, respectively. Multiple linear regression was performed to identify factors associated with the psychological resilience of primary care workers. Results: More than four-fifths of the primary care workers included in this study exhibited appropriate levels of mental health knowledge. In terms of mental health skills, participants' attainment rates, ranging from high to low, were 60.9 % for distracting attention, 45.3 % for interpersonal support and 43.9 % for cognitive reappraisal. The average psychological resilience score obtained by primary care workers was 27.81 ± 5.71, and the factors associated with increased psychological resilience included being male, being older, and possessing higher mental health skills, including skills pertaining to interpersonal support and distracting attention. Conclusion: The psychological resilience of primary care workers in Wuhan is at a moderate level and thus requires further improvement. Although these medical staff exhibit appropriate levels of mental health knowledge, their mental health skills are relatively poor, despite the fact that interpersonal support and distracting attention are significantly associated with psychological resilience. Hence, interventions targeting mental health skills are recommended to promote psychological resilience among primary care workers.

Efficacy and acceptability of music therapy for post-traumatic stress disorder: a systematic review and meta-analysis of randomized controlled trials.

Background: Music therapy is increasingly examined in randomized controlled trials (RCTs) and shows potential in treating post-traumatic stress disorder (PTSD).Objective: This systematic review and meta-analysis critically evaluates the current clinical evidence supporting the efficacy and acceptability of music therapy for PTSD.Method: RCTs comparing music therapy in addition to care as usual (CAU) versus either CAU alone or CAU combined with standard psychotherapy/pharmacotherapy for PTSD were retrieved from major English - and Chinese-language databases. Standardized mean differences (SMDs) for post-treatment PTSD symptom scores and risk differences (RDs) for retention rates upon treatment completion were calculated to assess the efficacy and acceptability of music therapy, respectively. The Cochrane risk of bias (RoB) tool 2.0 and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) were used to assess the RoB of included studies and certainty of the evidence, respectively.Results: Nine studies, incorporating 527 PTSD patients, were included, all with high RoB. The post-treatment PTSD symptom scores were significantly lower in the music therapy group than the inactive control group (SMD = -1.64, P < .001), but comparable between the music therapy group and the active control group (SMD = -0.28, P = .330). The retention rates did not differ significantly between the music therapy group and both control groups (RD = 0.03, P = .769; RD = 0.16, P = .829). The GRADE rated certainty level of evidence as low.Conclusions: Although meta-analytic findings suggest that music therapy is effective in reducing post-traumatic symptoms in individuals with PTSD, with its therapeutic effect comparable to that of standard psychotherapy, the low level of certainty limits its generalizability. More methodologically stringent studies are warranted to strengthen the clinical evidence for the efficacy and acceptability of music therapy for PTSD.

This systematic review critically appraised the existing methodologically rigorous evidence for the efficacy and acceptability of music therapy for post-traumatic stress disorder (PTSD).The post-treatment PTSD symptom scores were significantly lower in the music therapy group than the inactive control group and comparable between the music therapy group and the active control group.The post-treatment retention rates did not differ significantly between the music therapy group and both the inactive and active control groups.

Prevalence of prolonged grief disorder and its symptoms among bereaved individuals in China: a systematic review and meta-analysis.

Background: The prevalence of prolonged grief disorder (PGD) and its symptoms among the bereaved population in China vary considerably. Aims: This meta-analysis aims to estimate the prevalence of PGD and its symptoms among bereaved individuals in China. Methods: We conducted a literature search in major Chinese and English databases from their inception to 4 October 2023, for cross-sectional studies on the prevalence of PGD or its symptoms in bereaved Chinese individuals. The risk of bias of the included studies and certainty of the evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data ('JBI checklist') and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE), respectively. The 'metaprop' package in R V.4.1.2 was used to synthesise the prevalence. Results: A total of 28 studies involving 10 994 bereaved individuals were included in the analysis, with JBI checklist scores between 3 and 7. The combined prevalence (95% confidence interval) of PGD and its symptoms was 8.9% (4.2% to 17.6%) and 32.4% (18.2% to 50.8%), respectively. PGD and its symptoms were most prevalent among those who had lost their only child (22.7%) and those bereaved by earthquakes (80.4%), respectively. The GRADE system assigned a very low certainty level to the evidence for the pooled prevalence of PGD and its symptoms. Conclusions: The pooled prevalence of PGD and its symptoms indicate a potential high need for grief counselling services among bereaved individuals in China. This need is particularly pronounced in those who have lost their only child and those bereaved due to earthquakes. Further methodologically rigorous studies are needed to provide more accurate prevalence estimates. PROSPERO registration number: CRD42023432553.

Elevated levels of loneliness in migrant children compared to nonmigrant children in urban China: a systematic review and meta-analysis of comparative studies.

PURPOSE OF REVIEW: About one in four children in China is a migrant child. This population has a higher risk of experiencing loneliness. However, existing studies present conflicting findings regarding the levels of loneliness among migrant children as compared to local urban children in urban China. This review performs a meta-analysis of studies comparing loneliness levels between these two groups. RECENT FINDINGS: A literature search of major Chinese- and English-language databases revealed 27 eligible comparative studies. These studies reported the means and standardized deviations of loneliness scores for both migrant and nonmigrant children in urban China. Meta-analysis results showed that migrant children experienced significantly higher levels of loneliness than their urban nonmigrant counterparts [standardized mean difference (SMD) = 0.21, P  < 0.001]. Subgroup analysis revealed that studies enrolling migrant children from migrant children's schools had significantly higher pooled SMDs than those enrolling children from public schools (0.346 vs. 0.120, P  = 0.047). SUMMARY: Migrant children in urban China experience higher levels of loneliness compared to their local urban peers. Efforts to create a socially inclusive, migrant-friendly environment and reduce social isolation among migrant children are crucial to help alleviate their feelings of loneliness.

Flexibility Retained: Unimpaired Updating of Expectations in Schizophrenia.

Flexibly and actively updating expectations based on feedback is crucial for navigating daily life. Previous research has shown that people with schizophrenia (PSZ) have difficulty adjusting their expectations. However, there are studies suggesting otherwise. To explore this further, we used a novel trial-based expectation updating paradigm called attribute amnesia. In the task, the participants needed to report the location of a target stimulus among distractors in pre-surprise trials. In the surprise trial, they were unexpectedly asked to report the identity of the target before reporting its location. Afterward, control trials were conducted whereby the participants were asked the same questions as in the surprise trial. Notably, the surprise trial and control trials were nearly identical, except that the participants expected to be asked about identity information in the control trials but not in the surprise trial. Thus, an improvement in identity reporting accuracy in the control trials in comparison with the surprise trial indicated active updating of expectations. In the current study, a total of 63 PSZ and 60 healthy control subjects (HCS) were enrolled. We found that both the PSZ and the HCS were unable to report information that they had fully attended to (i.e., identity) in the surprise trial. However, both groups showed a significant improvement in reporting identity information even in the first control trial. Critically, there was no significant difference in the magnitude of improvement between the two groups. The current findings indicate that PSZ have the ability to update their expectations as quickly and flexibly as HCS, at least in the context of the current task. The possible factors that might contribute to the discrepancy regarding expectation updating are discussed.

Both people living in the COVID-19 epicenter and those who have recently left are at a higher risk of loneliness.

There is little empirical data on the heightened risk of loneliness among individuals residing in the COVID-19 epicenter or those who have recently left. This study compared the risk of loneliness in individuals residing in Wuhan, the COVID-19 epicenter in China, and those who had recently left during the initial outbreak period to those living in non-epicenter regions. During the COVID-19 outbreak in China in 2020, three samples were obtained using snowball sampling. The samples included 2882 epicenter residents, 1028 left residents, and 2963 non-epicenter residents. Loneliness was assessed using the six-item De Jong Gierveld Loneliness Scale, with a score of two or more indicating the presence of loneliness. 53.5% and 55.2% of epicenter and recently left residents, respectively, experienced loneliness, which was significantly higher than the 43.9% observed in non-epicenter residents. After adjusting for covariates, the risk of loneliness remained statistically significant for both epicenter and left residents (OR = 1.35, P < 0.001 and OR = 1.20, P = 0.017, respectively), when compared to non-epicenter residents. Individuals residing in the COVID-19 epicenter, as well as those who have recently left, are at a heightened risk of loneliness during the outbreak. These individuals need psychosocial support to mitigate their risk of loneliness and promote their psychological wellbeing.

The Psychological Network of Loneliness Symptoms Among Chinese Residents During the COVID-19 Outbreak.

Purpose: Social distancing measures implemented during the COVID-19 pandemic have contributed to increased levels of loneliness, but the specific interactions between loneliness symptoms in the context of the pandemic remain unknown. This study characterized the psychological network of loneliness symptoms in residents during the initial wave of COVID-19 outbreak in China. Patients and Methods: The study recruited 8472 Chinese residents (61.5% women, aged 33.0±10.6 years) through online snowball sampling. The Six-item De Jong Gierveld Loneliness Scale (DJGLS) was used to measure loneliness symptoms. Central symptoms of and bridge symptoms between emotional and social loneliness subscales were identified based on centrality and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedures. Results: The nodes in the loneliness network were separated into two groups, corresponding to the social and emotional loneliness domains of the DJGLS. The strongest direction association was between "no reliable people" and "no trustworthy people" (edge weight=0.546). "No trustworthy people" has the highest node strength (1.047) in the loneliness network, followed by "emptiness sense" (0.767) and "no reliable people" (0.749). "Feeling of rejection" (1.672) and "no close people" (0.403) showed the first and second highest bridge strengths, respectively. Both the stability and accuracy tests supported robustness of the whole network. Conclusion: Interventions targeting central symptoms "no trustworthy people" and "emptiness sense" and central bridge symptom "feeling of rejection" may be effective for alleviating the overall level of loneliness in pandemic-affected Chinese residents.

Loneliness in older Chinese adults amid the COVID-19 pandemic: Prevalence and associated factors.

INTRODUCTION: Data on loneliness among older adults in China during the COVID-19 pandemic are still scarce. This study aimed to examine the prevalence of loneliness and identify its associated factors among older Chinese adults during the COVID-19 pandemic. METHODS: During the COVID-19 pandemic, 1268 older Chinese adults (aged 50+ years) were recruited through snowball sampling. The Chinese version of the validated six-item De Jong Gierveld Loneliness Scale was used to assess participants' recent feelings of loneliness, and a cut-off score of two or more was used to indicate the presence of loneliness. RESULTS: Loneliness was experienced by 37.9% of the participants in recent days. Factors significantly associated with loneliness included male sex (vs. female, OR: 1.62, p < .001), an education level of middle school and below (vs. college and above, OR: 1.50, p = .007), residing in the COVID-19 epicenter (vs. other provinces, OR: 1.48, p = .004), concern about contracting COVID-19 (OR: 1.68, p = .001), poor knowledge of COVID-19 (OR: 2.39, p = .012), and physical health problems (OR: 1.65, p < .001). DISCUSSION: Loneliness is common among older Chinese adults amid the COVID-19 pandemic. Targeted intervention programs may be more effective in reducing loneliness among older adults who are worried about contracting COVID-19, have poor COVID-19 knowledge, and experience physical health problems.

Stigma toward mental disorders and associated factors among community mental health workers in Wuhan, China.

BACKGROUND: Stigma toward mental disorders (STMD) is a significant barrier to mental health service delivery. To improve the provision of mental health services for community-dwelling residents in China, this study investigated STMD and its associated factors in community mental health workers (CMHWs) in Wuhan, China. METHODS: In this cross-sectional study, a total of 3869 CMHWs (22.9% men and 37.1 ± 8.4 years old) were randomly selected through multistage sampling and invited to participate in this survey. The perceived devaluation-discrimination scale (PDD) and the National Mental Health Literacy Questionnaire (NMHLQ) were used to assess STMD and mental health knowledge, respectively. The presence of STMD was indicated by a mean item score of 3.0 or higher on the PDD. Multiple logistic regression was used to identify factors associated with STMD. RESULTS: Of the CMHWs, 41.9% had poor mental health knowledge (NMHLQ score < 80), and 18.5% exhibited STMD. In multiple regression analysis, factors significantly associated with STMD were social workers (vs. primary care physicians, OR = 1.44, p < .001), poor self-rated capacity to handle common mental health problems (vs. good, OR = 1.57, p < .001), and poor mental health knowledge (vs. NMHLQ score ≥ 80, OR = 1.46, p < .001). CONCLUSION: STMD is common among Chinese CMHWs. To reduce STMD among CMHWs, training programs in mental health care skills and mental health education may be necessary.

Relationship between left-behind status and cognitive function in older Chinese adults: a prospective 3-year cohort study.

Background: Due to the inaccuracy of the traditional geographical distance-based definition of left-behind status, data on the negative effect of left-behind status on cognitive function among older adults are controversial. Aims: This study examined the cross-sectional and longitudinal associations of left-behind status with cognitive function in older Chinese adults. The left-behind status definition was based on the frequency of face-to-face parent-child meetings. Methods: Data from a nationally representative sample of 8 682 older adults (60+ years) in 2015 (5 658 left behind and 3 024 non-left behind), of which 6 933 completed the follow-up in 2018, were obtained from the China Health and Retirement Longitudinal Study. Left-behind older adults were broadly defined as those aged 60+ years who had living adult children and saw their children less than once per month. The cognitive function was assessed with a composite cognitive test with higher total scores indicating better cognitive function. Results: Left-behind older adults had significantly lower cognitive test scores than non-left-behind older adults in both 2015 (11.1 (6.0) vs 13.2 (5.9), t=15.863, p<0.001) and 2018 (10.0 (6.6) vs 12.4 (6.7), t=14.177, p<0.001). After adjusting for demographic factors, lifestyle factors, chronic medical conditions and the baseline cognitive test score (in the longitudinal analysis only), on average, the cognitive test score of left-behind older adults was 0.628 lower than their non-left-behind counterparts in 2015 (t=5.689, p<0.001). This difference in cognitive test scores attenuated to 0.322 but remained significant in 2018 (t=2.733, p=0.006). Conclusions: Left-behind older Chinese adults have a higher risk of poor cognitive function and cognitive decline than their non-left-behind counterparts. Specific efforts targeting left-behind older adults, such as encouraging adult children to visit their parents more regularly, are warranted to maintain or delay the progression of cognitive decline.

The relationship between physical activity and depression among community-dwelling adults in Wuhan, China.

Background: While the association between physical activity (PA) and depression has been established, there is limited research on the effect of PA on the risk of depression among Chinese individuals. Thus, this study aimed to investigate the relationship between PA and depression among Chinese individuals. Methods: We used a stratified random sampling approach to recruit participants from five urban districts in Wuhan, China. A total of 5,583 permanent residents aged 18 years or older completed questionnaires, which included the International Physical Activity Questionnaire Short Form (IPAQ-SF) to measure PA, and the 9-item Patient Health Questionnaire (PHQ-9) to evaluate depressive symptoms. To control for potential confounders, multiple logistic regression was employed to assess the association of PA with depression. Results: The depression group had significantly lower weekly PA levels, measured in metabolic equivalent of task-minutes per week (MET-min/w), compared to the non-depression group [1,770 (693-4,200) MET-min/w vs. 2,772 (1,324-4,893) MET-min/w, p < 0.001]. In the fully adjusted model, the moderate and high PA level groups had lower odds ratios (ORs) for depressive symptoms compared to the low PA level group [OR (95% confidence interval (CI)) = 0.670 (0.523-0.858), 0.618 (0.484-0.790), respectively]. Among males, moderate and high levels of PA were associated with lower risk of depression compared to low PA levels [OR (95% CI) = 0.417 (0.268-0.649), 0.381 (0.244-0.593), respectively]. However, this association was not observed in females [OR (95% CI) = 0.827 (0.610-1.121), 0.782 (0.579-1.056), respectively]. The study found a significant interaction between PA levels and gender in relation to depression (P for interaction = 0.019). Conclusion: The findings suggest a negative association between PA and risk of depressive symptoms, indicating that moderate to high levels of PA may serve as a protective factor against depressive symptoms.

The Effect of Consultation-Liaison Psychiatry on Postoperative Delirium in Elderly Hip Fracture Patients in the General Hospital.

OBJECTIVE: The low recognition rate of postoperative delirium has gradually aroused clinical attention in China. The present study was to investigate the impact of consultation-liaison psychiatry on postoperative delirium in elderly hip fracture patients. METHODS: From March 2012 to September 2013, 89 patients with hip fractures hospitalized in Wuhan Mental Health Center were included in this prospective study as the consultation-liaison group. A total of 81 patients selected from August 2010 to February 2012 were defined as the conventional group. The delirium was evaluated using the confusion assessment method (CAM) recommended by the American Psychiatric Association guidelines. RESULTS: There was no difference of sex, age, trauma, surgical methods, and anesthesia between two groups (p > 0.05). The consultation rate of consultation-liaison group was significantly higher than that of conventional group (37.07% vs 17.28%, p < 0.05). After the consultation, there were 26 cases (78%) and nine cases (64%) of delirium in the consultation-liaison and conventional group, respectively (p > 0.05). In the consultation-liaison group, three patients (9.09%) were diagnosed with anxiety and three patients (9.09%) were diagnosed with depression, while in the conventional group, three patients (21.42%) were diagnosed with communication and one patient (7.14%) was diagnosed with depression. In addition, this study showed the incidence of delirium in consultation-liaison group was significantly higher than that of conventional group (29.21% vs 11.11%, p < 0.05). The average hospital stay in consultation-liaison group was significantly lower than that of conventional group (11.42 ± 2.63 vs. 15.17 ± 2.38 days, p < 0.01). CONCLUSION: Consultation-liaison psychiatry could improve the recognition rate of postoperative delirium in elderly hip fracture patients, shorten hospitalization time. The training of mental health knowledge for non-psychiatrists could improve the ability of early identification and treatment of delirium.

Clinical insomnia among elderly primary care attenders in Wuhan, China: A multicenter cross-sectional epidemiological study.

Background and objectives: Integrating sleep health into primary care is a promising approach to narrow the treatment gap for insomnia in older adults but data regarding the epidemiological characteristics of insomnia among elderly primary care attenders (EPCAs) are very limited. This study examined the prevalence and correlates of clinical insomnia among Chinese EPCAs. Methods: By using two-stage consecutive sampling method, a total of 757 EPCAs were recruited from seven urban and six rural primary care centers in Wuhan, China. The Insomnia Severity Index (ISI) and the Geriatric Depression Scale (15 item version) were administered to assess insomnia severity and depressive symptoms, respectively. Results: The two-week prevalence of clinical insomnia (ISI score ≥ 15) was 28.9%. Significant correlates of clinical insomnia were: female sex (vs. male, OR = 2.13, P < 0.001), fair and poor family relationship (vs. good, OR = 1.59, P = 0.028), hypertension (OR = 1.67, P = 0.004), heart disease (OR = 1.73, P = 0.048), arthritis (OR = 2.72, P = 0.001), and depressive symptoms (OR = 4.53, P < 0.001). Conclusion: The high prevalence of clinical insomnia among Chinese EPCAs suggests a high level of sleep health need in older patients in China's primary care settings. Considering the many negative outcomes associated with insomnia, it is necessary to integrate sleep health into primary care in China.

Prevalence of prolonged grief disorder and its symptoms in Chinese parents who lost their only child: A systematic review and meta-analysis.

Background: Parents who lost their only child and cannot have a second child ("Shidu") have been a large population in China. Prolonged grief disorder (PGD) in Shidu parents is of clinical and public health concern but the reported PGD prevalence varies widely. To facilitate the planning of grief counseling services, this meta-analysis estimated prevalence of PGD and its symptoms and identified subgroups at elevated risk for PGD. Methods: We searched English and Chinese literature databases to identify cross-sectional surveys reporting prevalence of PGD or PGD symptoms in Chinese Shidu parents. The Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data ("JBI") was used to assess risk of bias of included studies. Results: Seven studies with a total of 2,794 Shidu parents were included and their JBI scores ranged from five to eight. The pooled prevalence of PGD and PGD symptoms was 20.9% and 75.0%, respectively. Greater risk of PGD was observed in mothers [vs. fathers, OR (odds ratio) = 1.89, P = 0.001] and in parents with religious beliefs (vs. without religious beliefs, OR = 1.65, P = 0.040). More severe PGD symptoms were presented in parents whose only child died from accidents [vs. illness, MD (mean difference) = 3.99, P < 0.001]. Deceased children of PGD parents were older than those of non-PGD parents (MD = 1.64, P = 0.035) and PGD parents had a shorter duration since the loss than non-PGD parents (MD = -3.26, P = 0.013). Conclusions: PGD is prevalent among Shidu parents. Grief counseling services for Shidu parents would be more effective if they target those who are mothers and have religious beliefs and those whose children died from accidents, lost children are older, and loss occurs more recently.

Depressive disorders in older Chinese adults with essential hypertension: A classification tree analysis.

Background: Although there has been accumulating evidence on the elevated risk of depression in hypertensive patients, data regarding depressive disorders in older adults with hypertension and the interplay between factors associated with depression in this population are very limited. Disentangling the mutual influences between factors may help illuminate the pathways involved in the pathogenesis of the comorbidity of depression in hypertension. This study investigated the prevalence of depressive disorders in older Chinese adults with hypertension and examined major correlates of depressive disorders and the interactions between correlates by using classification tree analysis (CTA). Methods: In total, 374 older adults with essential hypertension were enrolled from seven urban and six rural primary care centers in Wuhan, China, and interviewed with the Chinese Mini-international Neuropsychiatric Interview 5.0. Family relationship and feelings of loneliness were assessed with standardized questions. A checklist was used to assess the presence of six major medical conditions: diabetes mellitus, heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, chronic gastric ulcer, and arthritis. Results: The 1-month prevalence rate of depressive disorders was 25.7%. The CTA model identified four major correlates of depressive disorders: loneliness was the most salient, followed by arthritis, family relationship, and heart disease. There were statistically significant interactions between loneliness and arthritis, loneliness and family relationship, and arthritis and heart disease. Conclusion: Over one out of every four older Chinese adults with hypertension suffer from depressive disorders. Collaborative multidisciplinary management services are needed to reduce the burden of depression in hypertensive older adults, which may include social work outreach services to promote family relationship, mental health services to relive loneliness, and primary care services to manage arthritis and heart disease.

Anxiety symptoms in older Chinese adults in primary care settings: Prevalence and correlates.

Background: Integrating mental health services into primary care is a potentially cost-effective way to decrease the treatment gap for anxiety in older adults but data on the epidemiology of anxiety symptoms in older Chinese adults in primary care settings have been very limited. This study investigated the prevalence and correlates of anxiety symptoms in Chinese older primary care patients. Methods: A total of 753 older primary care patients (≥65 years) were consecutively recruited from 13 primary care clinics in Wuhan, China, and interviewed with the validated Chinese version of the short form of the Geriatric Anxiety Inventory (GAI-SF). Results: The prevalence of anxiety symptoms (GAI-SF ≥ 3) in older primary care patients was 21.1%. Statistically significant correlates of anxiety symptoms were female sex (vs. male, OR = 1.85, P = 0.002), poor economic status (vs. good, OR = 2.31, P = 0.013), fair and poor family relationship (vs. good, OR = 1.85, P = 0.006), hypertension (OR = 2.01, P < 0.001), chronic gastric ulcer (OR = 6.82, P < 0.001), and Parkinson's disease (OR = 7.83, P = 0.031). Conclusions: Anxiety symptoms are prevalent among older adults attending primary care clinics. Efforts for preventing or reducing anxiety symptoms in older primary care patients may be more useful to target those who are women, have poor financial status, don't have a good family relationship, suffer from hypertension, have chronic gastric ulcer, and suffer from Parkinson's disease.

Prevalence and correlates of suspected dementia in older adults receiving primary healthcare in Wuhan, China: A multicenter cross-sectional survey.

Background: Integrating the management of dementia into primary healthcare is a cost-effective way to reduce the burden of dementia but the clinical epidemiology of dementia in primary healthcare settings remains unclear. This study investigated the prevalence and correlates of suspected dementia in Chinese older adults receiving primary healthcare. Methods: In this multicenter cross-sectional survey, a total of 773 older adults (≥65 years) were consecutively recruited from seven urban and six rural primary care clinics in Wuhan, China, and interviewed with the validated Chinese version of the Brief Community Screening Instrument for Dementia (BCSI-D). Participants with suspected dementia were those who were screened positive on the BCSI-D. Results: The prevalence of suspected dementia in older primary healthcare adults was 26.8%. Factors significantly associated with suspected dementia were female sex (OR = 1.95, P < 0.001), age-group of 75+ (OR = 1.68, P = 0.004), poor financial status (OR = 4.79, P < 0.001), rural residence (OR = 1.47, P = 0.032), no regular physical exercise (OR = 1.74, P = 0.002), and stroke and other cerebrovascular diseases (OR = 1.97, P = 0.015). Conclusions: Chinese older adults receiving primary healthcare are at high risk of suspected dementia. Screening and intervention efforts for dementia in primary healthcare settings may be more useful to target older adults who are women, are 75 years and above, have poor economic status, are rural residents, have no exercise habit, and suffer from cerebrovascular diseases.