Disclosing non-visible disabilities in educational workplaces: a scoping review.

INTRODUCTION: a sizable proportion of the working population has a disability that is not visible. Many choose not to disclose this at work, particularly in educational workplaces where disability is underrepresented. A better understanding of the barriers and facilitators to disclosure is needed. SOURCES OF DATA: this scoping review is based on studies published in scientific journals. AREAS OF AGREEMENT: the reasons underpinning disclosure are complex and emotive-in-nature. Both individual and socio-environmental factors influence this decision and process. Stigma and perceived discrimination are key barriers to disclosure and, conversely, personal agency a key enabler. AREAS OF CONTROVERSY: there is a growing trend of non-visible disabilities within the workplace, largely because of the increasing prevalence of mental ill health. Understanding the barriers and facilitators to disability disclosure is key to the provision of appropriate workplace support. GROWING POINTS: our review shows that both individual and socio-environmental factors influence choice and experience of disclosure of non-visible disabilities in educational workplaces. Ongoing stigma and ableism in the workplace, in particular, strongly influence disabled employees' decision to disclose (or not), to whom, how and when. AREAS TIMELY FOR DEVELOPING RESEARCH: developing workplace interventions that can support employees with non-visible disabilities and key stakeholders during and beyond reasonable adjustments is imperative.

Association between perceived value of adopting new behaviors and incident disability among Japanese community-dwelling older adults.

OBJECTIVES: This longitudinal observational cohort study aimed to clarify the relationship between perceived value (PV) to adopt new behaviors and incident disability in community-dwelling older adults. METHOD: Participants were 5073 community-dwelling older adults aged ≥65 years in Japan (Mage = 74.0 ± 5.6 years; female = 55.1%). The mean follow-up time was 34.5 months. Baseline data were collected during health checkups in a prospective cohort study. Measurements included engagement in physical activity (PA), cognitive activity (CA), and social activity (SA), PV, health and physical conditions, and demographic characteristics. PV was assessed by asking whether participants thought it was valuable to adopt new behaviors related to PA, CA, and SA. Participants were classified as having higher/lower PV, PA, CA, and SA. Cox proportional hazard models were used to analyze the association between PV and incident disability. PV was examined both as an independent variable and in combination as follows: higher PV and higher PA/CA/SA (high/high); lower PV and higher PA/CA/SA (low/high); higher PV and lower PA/CA/SA (high/low); and lower PV and lower PA/CA/SA (low/low). RESULTS: Higher PV was significantly associated with a lower hazard ratio (HR) for incident disability. The low/high, high/low, and low/low significantly increased the HR compared to high/high in the analyses of PV & PA and CA. The analysis of PV & SA showed that only low/low increased the HR compared to high/high. CONCLUSION: Having both higher PV and higher activity engagement may contribute to preventing disability development. Both support for activities and value education in older adults may be needed.

Body map stories from Colombia: experiences of people affected by leprosy and the influence of peers during diagnosis and treatment.

INTRODUCTION: Almost one third of people affected by leprosy in Colombia suffer from disability, which often results from delayed diagnosis and treatment. We aimed to explore the experience of people affected by leprosy during the process of diagnosis and treatment and if and how this experience was influenced by peers. METHODS: A qualitative study using body map stories was conducted from October 2019 to February 2020 in Colombia. Adult people affected by leprosy were recruited through patient associations in different cities. We conducted three sessions with an average duration of 2-3 h per participant, during which the participants created a painted map of their body and chose symbols to represent their experience, while being engaged in an informal interview. The sessions were audio recorded, transcribed verbatim and analyzed thematically by an interdisciplinary team, consisting of physicians, social workers and a person affected by leprosy. RESULTS: The 17 study participants (11 female) were aged 20 to 70 years. Leprosy-related manifestations ranged from no to advanced disability. Some participants were active members of associations for people affected by leprosy. Three main themes were identified during analysis: (1) A long pathway to diagnosis, (2) Therapy as a double-edged sword and (3) The influence of other people affected by leprosy. The participants described an often years-long process until being diagnosed, which was marked by insecurities, repeated misdiagnosis, and worsening mental and physical health. Delayed diagnosis was related to late health care seeking, but also to inadequate health communication, lack of leprosy-related knowledge and negligence among health care workers. A high desire to cure motivated the participants to take their medication rigorously, despite the high treatment burden. Support from peers, either within the own social environment or provided from associations, contributed to a faster diagnosis and increased therapy adherence. Peers helped to recognize the symptoms, urged patients to seek care, recommended physicians with leprosy-related knowledge and provided a realistic example of both disease severity and curability. CONCLUSION: People affected by leprosy experience a significant burden during the process of diagnosis and treatment. Involving well-trained peers could foster early diagnosis, treatment compliance and prevention of disability.

Leaving no one behind: addressing the sexuality of people with disabilities.

Addressing the sexuality of individuals with disabilities is important within the framework of global health and societal inclusivity. Despite comprising 16% of the world's population, this demographic faces sexual autonomy inequality. Acknowledging this intersection is pertinent for achieving inclusive healthcare and upholding the commitments of the 1994 International Conference on Population and Development and the 2006 United Nations Convention on the Rights of Persons with Disabilities. Dispelling stereotypes and promoting dialogue are key to empowering individuals with disabilities and ensuring equitable access to sexual health resources. Integrating sexual health and rights into broader healthcare systems is vital for creating an inclusive society where no one is left behind. This article advocates for the need to address the specific sexual health needs and rights of individuals with disabilities, to implement inclusive policies, and to foster a healthcare environment that respects and supports their autonomy and dignity.

"Nothing about us, without us": stakeholders perceptions on strategies to improve persons with disabilities' sexual and reproductive health outcomes in Ghana.

BACKGROUND: Persons with disabilities (PwDs) experience various adverse sexual and reproductive health (SRH) outcomes. However, there is a paucity of evidence on the strategies to improve their SRH outcomes. This study, therefore, used a pluralistic approach to explore PwDs and healthcare providers' (HPs) perspectives on how to improve the SRH of PwDs in Ghana. METHODS: In-depth interviews were conducted with 62 purposively selected stakeholders (37 PwDs and 25 HPs) in the Kumasi Metropolis and Offinso North District. The data was subjected to reflexive thematic analysis. RESULTS: Six major themes were generated from the data: Training for disability-sensitive and inclusive healthcare, Healthcare inclusivity - 'nothing about us, without us', Raising awareness for accessibility and equity, Impactful continuous monitoring and evaluation, Vital empowerment for self-reliance and Educating for disability-inclusive healthcare environment. These recommendations were synthesised to develop the THRIVE model-a comprehensive data driven framework from stakeholders that emphasises the importance of factors such as Training for disability-sensitive and inclusive healthcare, Healthcare inclusivity - 'nothing about us, without us', Raising awareness for accessibility and equity, Impactful continuous monitoring and evaluation, Vital empowerment for self-reliance and Enforcement of physical accessibility to improve their SRH outcomes. CONCLUSION: Using the evidence based THRIVE model could facilitate the development and strengthening of existing interventions and policies including the disability Act 715 to improve the SRH access and outcomes of PwDs in Ghana and other low-and middle-income countries.

Psychometric characteristics of a questionnaire to assess perceived disability in people with epilepsy.

It has been determined that quality of life in epilepsy is closely related to the perceived disability experienced by individuals with the diagnosis. However, this measure is seldom considered in healthcare processes. The objective of the present study is to establish the psychometric properties of the Perceived Disability Questionnaire in individuals diagnosed with epilepsy within a Latin American context. A cross-sectional, analytical study was conducted involving 325 participants, aged 12 years and older (M 40.42 years), individuals diagnosed with epilepsy in Colombia. The main psychometric properties of the instrument were explored to account for its factorial validity and reliability. The Perceived Disability Questionnaire exhibits high reliability (α = 0.878) and the three subscales comprising the final version of the questionnaire (Dissatisfaction, Pessimism, and Self-Disdain) explain 45.393 % of the total variance in relation to beliefs of disability associated with the diagnosis of epilepsy; the questionnaire significantly correlates with the Quality of Life in Epilepsy Inventory (QOLIE-10). Adequate psychometric properties of the instrument are found, which allows for its proposal as a tool in epilepsy care processes within the Colombian context.

Health and disability - a multi-group latent class analysis of the World Health Organization Disability Assessment Schedule 2.0 among those with mental and physical health conditions.

BACKGROUND: This study aims to identify disability classes among people with schizophrenia spectrum disorder, depression, anxiety or diabetes via the WHODAS 2.0; investigate the invariance of disability patterns among the four diagnostic groups; and examine associations between disability classes and sociodemographic variables. METHODS: Patients seeking treatment for schizophrenia spectrum disorder, depression, anxiety or diabetes (n=1076) were recruited. Latent class analysis was used to identify disability classes based on WHODAS 2.0 responses. Measurement invariance was tested using multi-group latent class analysis. Associations between classes and sociodemographic variables were tested via multinomial logistic regression. RESULTS: A five-class solution was identified; examination of model invariance showed that the partially constrained five-class model was most appropriate, suggesting that class structure was consistent while class membership differed across diagnostic groups. Finally, significant associations were found between class membership and ethnicity, education level, and employment status. CONCLUSIONS: The results show the feasibility of using the WHODAS 2.0 to identify and compare different disability classes among people with mental or physical conditions and their sociodemographic correlates. Establishing a typology of different disability profiles will help guide research and treatment plans that tackle not just clinical but also functional aspects of living with either a chronic psychiatric or physical condition.

Validation of the Optimal University of California Los Angeles Loneliness Scale Cutoff Score in Screening for the Prevention of Disability Occurrence Among Older Japanese Adults.

OBJECTIVES: The association between loneliness and disability is a growing public health priority. While the University of California Los Angeles Loneliness Scale (UCLA-LS) has been internationally used as an indicator for assessing loneliness, its optimal cutoff point in relation to disability occurrence has not yet been examined. Therefore, we aimed to determine the optimal cutoff point of the UCLA-LS regarding future disability. METHODS: This longitudinal cohort study was conducted in Tokai City, Aichi Prefecture, Japan. Overall, 4536 community-dwelling older adults (age: 73.8 ± 5.5 years; females: 55.2%) were followed up for 2 years. The area under the curve of the receiver operating characteristic analysis was calculated to evaluate the optimal cutoff point of the UCLA-LS in relation to future disability occurrence using the Youden index, which maximized the sensitivity and specificity of the UCLAS-LS. A survival analysis was conducted to test this cutoff value's external validity, using the presence or absence of disability occurrence as the dependent variable. RESULTS: The cutoff score of the UCLA-LS in relation to future disability was 44 points. An association was found between new disability occurrence and loneliness based on this cutoff value (hazard ratio: 1.67, 95% confidence interval: 1.29-2.16). CONCLUSIONS: Although cultural context should be taken into account, the optimal cutoff scores for the loneliness scale related to disability identified in this study may be a useful indicator for early recognition of loneliness as a global public health problem and for promoting social participation as one of the disability prevention strategies.

Emotional demands at work and risk of disability pension: a nationwide cohort study in Denmark.

INTRODUCTION: Working in emotionally demanding jobs is associated with an increased risk of temporarily leaving the labour market due to long-term sickness absence. We tested whether employees working in emotionally demanding jobs are also at higher risk of permanently leaving the labour market due to disability pension compared with employees working in jobs that are not emotionally demanding. METHODS: We conducted a 10-year cohort study in the workforce in Denmark (n=1 670 825), aged 30-59 years at baseline, by linking job exposure matrices with nationwide registries on social transfer payments and covariates. Using Cox regression, we analysed the risk of disability pension in relation to emotional demands in the full population and sex stratified. Multivariable adjusted models included sex, age, cohabitation, migration background, household disposable income and other work environmental factors (physical workload, influence, possibilities for development and role conflicts). RESULTS: We identified 67 923 new cases of disability pension during 15 649 743 person-years of follow-up (mean follow-up: 9.4 years). We found an increasing risk of disability pension with higher levels of emotional demands, with HRs of 1.20, 1.23 and 1.73 for medium-low, medium-high and high emotional demands, respectively, compared with low emotional demands in the most adjusted model. There was an exposure-response association in women and a tendency towards an exposure-response association in men. DISCUSSION: In this nationwide cohort study, we found an increased risk of permanent exit from the labour market due to disability pension in women and men working in emotionally demanding jobs.

Trajectory patterns and factors associated with acceptance of disability in young and middle-aged breast cancer patients: a longitudinal study.

PURPOSE: To explore the trajectories of acceptance of disability in young and middle-aged breast cancer patients based on a latent class growth analysis, investigate factors associated with each trajectory, and identify whether return to normal living differs in different trajectories. METHODS: Young and middle-aged patients newly diagnosed with breast cancer who underwent surgery were followed up at baseline, and 1, 3, and 6 months in China. Participants completed sociodemographic information questionnaires, the Adaptation of Disability Scale Revised, and the Reintegration to Normal Living Index. A latent class growth analysis was used to explore the trajectories of acceptance of disability. RESULTS: Among 212 patients newly diagnosed with breast cancer, the mean age of patients was 45.44 years. The majority of participants were with invasive carcinoma (77.8%). Three classes were identified: high acceptance of disability increasing group (high-increasing, 13.7%), moderate acceptance of disability stable group (moderate-stable, 67.9%), and moderate acceptance of disability decreasing group (moderate-decreasing, 18.3%). Being unemployed or retired and receiving endocrine therapy are risk factors associated with acceptance of disability. Carcinoma in situ is a protective factor associated with acceptance of disability. Participants diagnosed with carcinoma in situ and who not receive endocrine therapy were more likely to be in high-increasing group. Unemployed participants before surgery were more likely to be in moderate-decreasing group. Moreover, the Reintegration to Normal Living Index scores had significant differences from baseline to 6 months of follow-up. The high-increasing group had the highest average Reintegration to Normal Living Index scores than the moderate-stable group and the moderate-decreasing group, showing similar patterns at four timepoints. CONCLUSION: We identified three trajectories of acceptance of disability. Dynamic and individualized intervention should be continuously provided to ensure patients acquire adequate medical resources to comprehensively increase acceptance of disability.

"She Couldn't Say the Word Penis": Experiences of 2SLGBTQ+ People with Developmental and Intellectual Disabilities with Sex Education in Alberta, Canada.

This exploratory qualitative study sought to better understand the experiences of Two-Spirit, lesbian, gay, bisexual, transgender, queer (2SLGBTQ+) disabled people when learning about sexuality, sexual orientation, and gender identity. We conducted 31 semi-structured, in-depth interviews with adults labeled/with developmental and intellectual disabilities in Alberta, Canada. Findings showed a significant lack of comprehensive sex education available to 2SLGBTQ+ disabled people. Sexual and gender identities were rarely discussed in formal school-based education settings and most parents and caregivers did not feel comfortable addressing these topics either. As a result, many participants had to do their own research and use other sources for information and advice. Participants then provided recommendations in terms of what they wish they had learned in sex education as well as potentially effective ways of delivering that content to disabled people.

Mapping the 12-item World Health Organization disability assessment schedule 2.0 (WHODAS 2.0) onto the assessment of quality of life (AQoL)-4D utilities.

PURPOSE: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a widely used disability-specific outcome measure. This study develops mapping algorithms to estimate Assessment of Quality of Life (AQoL)-4D utilities based on the WHODAS 2.0 responses to facilitate economic evaluation. METHODS: The study sample comprises people with disability or long-term conditions (n = 3376) from the 2007 Australian National Survey of Mental Health and Wellbeing. Traditional regression techniques (i.e., Ordinary Least Square regression, Robust MM regression, Generalised Linear Model and Betamix Regression) and machine learning techniques (i.e., Lasso regression, Boosted regression, Supported vector regression) were used. Five-fold internal cross-validation was performed. Model performance was assessed using a series of goodness-of-fit measures. RESULTS: The robust MM estimator produced the preferred mapping algorithm for the overall sample with the smallest mean absolute error in cross-validation (MAE = 0.1325). Different methods performed differently for different disability subgroups, with the subgroup with profound or severe restrictions having the highest MAE across all methods and models. CONCLUSION: The developed mapping algorithm enables cost-utility analyses of interventions for people with disability where the WHODAS 2.0 has been collected. Mapping algorithms developed from different methods should be considered in sensitivity analyses in economic evaluations.

An investigation of the longitudinal trajectory patterns of health-related quality of life among Australians with disabilities: explaining disability types and properties.

BACKGROUND: Research on health-related quality of life (HRQoL) trajectory patterns for people with disabilities (PwD) is scant. Understanding the HRQoL trajectory patterns for PwDs and investigating their relationship with disability types and socioeconomic factors can have important implications for Australia's welfare policy. METHODS: We analysed data from waves 11 to 21 of the Household, Income and Labour Dynamics in Australia (HILDA) survey of respondents aged 15 + years of the PwDs. The analytic sample consists of 3724 self-reported disabled individuals and 34,539 observations in total. The SF-6D utility score is our HRQoL measure. Group-based trajectory modelling was utilised to identify trajectory groups, and multinomial logistic regression was employed to determine the baseline factors associated with trajectory group membership. RESULTS: The study identified four distinct types of HRQoL trajectories (high, moderate improving, moderate deteriorating and low HRQoL trajectories). Psychosocial disability types followed by physical disability types had a high Relative Risk Ratio (RRR) in the low group compared with high trajectory group membership of PwDs (psychosocial: 6.090, physical: 3.524). Similar, results followed for the moderate improving group albeit with lower RRR (psychosocial: 2.868, Physical: 1.820). In the moderate deteriorating group, the disability types were not significant as this group has a similar profile to high group at the baseline. Compared with males, females had a higher RRR in low and moderate versus high improving HRQoL trajectories (low: 1.532, moderate improving: 1.237). Comparing the richest class to the poorest class, socioeconomic factors (income and education) predicted significantly lower exposure for the richer class to the low and medium HRQoL trajectories groups (RRR < 1). CONCLUSION: Different forms of disability, demographic and socioeconomic factors have distinct effects on the HRQoL trajectories of disabled individuals. Healthcare and economic resource efficiency might be improved with targeted government policy interventions based on disability trajectories.

Disabled from work and depressed: cognitive factors associated with exacerbated or attenuated depression over the COVID-19 pandemic.

BACKGROUND: People who were disabled from working reported substantially worse depression in recent research [1] despite adjustment for demographic covariates, cognitive-appraisal processes, and COVID-specific stressors, thus motivating the present work. OBJECTIVE: This study sought to "drill down" to understand employment-group differences (employed, retired, unemployed, disabled) in cognitive factors, and how these factors played into paths to depression during COVID early in the pandemic and depression trajectories over 15.5 months of follow-up. METHODS: This longitudinal cohort study (n = 771) included chronically ill and general-population samples in the United States, characterized into the same depression-trajectory groups as the earlier study [1]. The Quality-of-Life Appraisal Profilev2 Short-Form assessed cognitive-appraisal processes. COVID-specific scales assessed hardship, worry, and social support. Chi-square, Analysis of Variance, classification and regression tree, and random effects modeling investigated factors associated with reported depression over time specifically by employment group, rather than in the whole sample which was the focus of the earlier study. RESULTS: Disabled participants were disproportionately represented in the stably depressed trajectory group, reporting more hardship and worry, and lower social support than employed and retired participants (p < 0.0001). They were more likely to focus on health goals, problem goals, and emphasizing the negative (p < 0.001). They had different paths and cut-points to depression than employed/unemployed/retired participants. Even mild endorsement of emphasizing the negative and recent changes predicted higher depression. COVID-specific stressors and cognitive-appraisal processes were less implicated in depression among disabled participants compared to others. CONCLUSIONS: Disabled participants were at greater risk of stable depression during the COVID pandemic. Small increases in emphasizing the negative were a path to worse depression, and disabled participants' depression may be less reactive to external circumstances or ways of thinking.

A predictive model for depression in Chinese middle-aged and elderly people with physical disabilities.

BACKGROUND: Middle-aged and older adults with physical disabilities exhibit more common and severe depressive symptoms than those without physical disabilities. Such symptoms can greatly affect the physical and mental health and life expectancy of middle-aged and older persons with disabilities. METHOD: This study selected 2015 and 2018 data from the China Longitudinal Study of Health and Retirement. After analyzing the effect of age on depression, we used whether middle-aged and older adults with physical disabilities were depressed as the dependent variable and included a total of 24 predictor variables, including demographic factors, health behaviors, physical functioning and socialization, as independent variables. The data were randomly divided into training and validation sets on a 7:3 basis. LASSO regression analysis combined with binary logistic regression analysis was performed in the training set to screen the predictor variables of the model. Construct models in the training set and perform model evaluation, model visualization and internal validation. Perform external validation of the model in the validation set. RESULT: A total of 1052 middle-aged and elderly persons with physical disabilities were included in this study, and the prevalence of depression in the elderly group > middle-aged group. Restricted triple spline indicated that age had different effects on depression in the middle-aged and elderly groups. LASSO regression analysis combined with binary logistic regression screened out Gender, Location of Residential Address, Shortsightedness, Hearing, Any possible helper in the future, Alcoholic in the Past Year, Difficulty with Using the Toilet, Difficulty with Preparing Hot Meals, and Unable to work due to disability constructed the Chinese Depression Prediction Model for Middle-aged and Older People with Physical Disabilities. The nomogram shows that living in a rural area, lack of assistance, difficulties with activities of daily living, alcohol abuse, visual and hearing impairments, unemployment and being female are risk factors for depression in middle-aged and older persons with physical disabilities. The area under the ROC curve for the model, internal validation and external validation were all greater than 0.70, the mean absolute error was less than 0.02, and the recall and precision were both greater than 0.65, indicating that the model performs well in terms of discriminability, accuracy and generalisation. The DCA curve and net gain curve of the model indicate that the model has high gain in predicting depression. CONCLUSION: In this study, we showed that being female, living in rural areas, having poor vision and/or hearing, lack of assistance from others, drinking alcohol, having difficulty using the restroom and preparing food, and being unable to work due to a disability were risk factors for depression among middle-aged and older adults with physical disabilities. We developed a depression prediction model to assess the likelihood of depression in Chinese middle-aged and older adults with physical disabilities based on the above risk factors, so that early identification, intervention, and treatment can be provided to middle-aged and older adults with physical disabilities who are at high risk of developing depression.

Trajectories of work disability among individuals with anxiety-, mood/affective-, or stress-related disorders in a primary healthcare setting.

BACKGROUND: Anxiety-, mood/affective-, or stress-related disorders affect up to one-third of individuals during their lives and often impact their ability to work. This study aimed to delineate trajectories of work disability (WD) among individuals diagnosed with anxiety-, mood/affective-, or stress-related disorder in primary healthcare and to examine associations between trajectory group membership and sociodemographic, clinical, and clinical-related factors. METHODS: The study population included working-age individuals, aged 22-62 years, living in Stockholm County, Sweden, who experienced a new episode of any anxiety-, mood/affective, or stress-related disorder in primary healthcare in 2017 (N = 11,304). Data were obtained from Swedish national and regional registers and were linked using pseudonymised unique personal identification numbers. The primary outcome was days with WD (sum of sickness absence and disability pension days) during the three years before and three years after a diagnosis of anxiety-, mood/affective-, or stress-related disorders in primary healthcare. A zero-inflated Poisson group-based trajectory model was used to identify groups of individuals with similar patterns of WD over the study period, with a multinomial logistic regression used to examine associations of sociodemographic, clinical, and clinical-related factors with trajectory group membership. RESULTS: Four distinct trajectory groups were found, high increasing (5.1%), with high levels, from 16 to 80 days of WD in six-monthly intervals during follow-up, peak (11.1%), with a peak in WD, up to 32 days of WD, around the time of the diagnosis, low increasing (12.8%), with an increase in days of WD from 4 to 22 during the study period, and constant low (71.1%), with almost no WD over the study period. In multinomial regression models, diagnostic category, psychotropic medication use, a diagnosis of a psychiatric disorder within secondary healthcare, age at diagnosis, and occupation were associated with WD trajectory groups. CONCLUSIONS: Around two-thirds of individuals treated for a new episode of any anxiety-, mood/affective-, or stress-related disorder in primary healthcare have an excellent prognosis regarding WD. Several sociodemographic and clinical characteristics were associated with group membership; these factors could identify individuals at risk of long-term welfare dependency and who might benefit from interventions to promote a return to work.

Association between depressive symptoms and sarcopenia among middle-aged and elderly individuals in China: the mediation effect of activities of daily living (ADL) disability.

BACKGROUND: Depressive symptoms and sarcopenia, often observed among middle-aged and elderly individuals, are significant health concerns in China, particularly given the country's rapidly aging population. Depressive symptoms, characterized by persistent feelings of sadness and loss of interest, can significantly impact quality of life. Little is known about the underlying pathway connecting these two conditions. METHODS: The data for this study were derived from the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were evaluated using the Centre for Epidemiological Studies Depression (CSED) scale. Logistic regression analyses were employed to investigate the association between depressive symptoms, activities of daily living (ADL) disability, and sarcopenia, while adjusting for potential confounding factors. The selection of predictor variables, including social activity, chronic diseases, demographic factors, and lifestyle habits, was based on their known associations with mental health, physical functioning and sarcopenia. These variables were included to ensure a comprehensive adjustment for potential confounding factors and to provide a more accurate estimation of the relationship between depressive symptoms and sarcopenia. Additionally, mediation analysis was conducted to assess the mediating role of ADL disability in the relationship between depressive symptoms and sarcopenia. RESULTS: A comprehensive study was conducted on a total of 8,238 participants aged 45 years and older, comprising 3,358 men and 4,880 women. Logistic regression analyses were conducted to identify significant associations between depressive symptoms (OR = 1.30, P = 0.0269,95%CI = 1.03-1.63), ADL disability (OR = 1.94, P < 0.001,95%CI = 1.37-2.75) and sarcopenia. The results revealed significant relationships among these variables. Furthermore, mediation effect analyses demonstrated that ADL disability partially mediated the association between depressive symptoms and sarcopenia (estimated indirect effect: 0.006, 95% CI: 0.003, 0.008, proportion of mediation effect: 20.00%). CONCLUSIONS: The study underscores a significant association between depressive symptoms and sarcopenia among middle-aged and elderly individuals in China, with ADL disability acting as a mediator. These findings offer novel insights for targeted health interventions. Future interventions should effectively combat sarcopenia by integrating psychological support with muscle-strengthening exercise programs. By addressing both depressive symptoms and ADL disability, clinicians and public health professionals can enhance outcomes for this demographic. Collaborative efforts across disciplines are essential for providing comprehensive health management tailored to the needs of middle-aged and elderly individuals. Future research should longitudinally assess the impact of such integrated interventions on sarcopenia prevention and depressive symptom alleviation. Additionally, investigating the role of social and environmental factors in mediating this relationship is crucial for developing more effective health strategies for this vulnerable population.

Experiential Aspects of Participation in Employment and Mobility for Adults With Physical Disabilities: Testing Cross-Sectional Models of Contextual Influences and Well-Being Outcomes.

OBJECTIVE: To use structural equation modeling to test research- and theory-informed models of potential predictors and outcomes of subjective experiences of employment and mobility participation in a national sample of people with physical disabilities. DESIGN: Cross-sectional survey. SETTING: Canada. PARTICIPANTS: English or French-speaking adults with a physical impairment affecting mobility and restricting activities or participation, and who participated in employment (n=457) or mobility (n=711) life domains. INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Participants completed standardized measures of perceived health, and employment-specific and/or mobility-specific measures of perceived abilities, social support, accessibility and policies (predictor variables); the Measure of Experiential Aspects of Participation (MeEAP) in employment and/or mobility; and standardized measures of emotional well-being, social well-being and life satisfaction (outcome variables). RESULTS: Analyses using structural equation modeling showed that in both employment and mobility domains, perceived health, abilities, social support, and accessibility were positively related to experiential aspects of participation. Participation experiences were positively related to social well-being, emotional well-being, and life satisfaction. CONCLUSIONS: Results support and extend current theorizing on participation experiences among adults with physical disabilities. Intrapersonal and environmental factors may play a role in optimizing participation experiences in employment and mobility which, in turn, may lead to better well-being and life satisfaction. These results emphasize the importance of conceptualizing participation from an experiential perspective and provide a basis for advancing theory and practice to understand and improve the participation experiences and well-being of adults living with physical disabilities.

Assessing the Adequacy of the Physical, Social, and Attitudinal Environment to the Specific Needs of Young Adults With Cerebral Palsy: The European Adult Environment Questionnaire.

OBJECTIVES: To present the development of the European Adult Environment Questionnaire (EAEQ), to assess to what extent it covers the International Classification of Functioning, Disability and Health (ICF), and to describe the adequacy of the physical, social, and attitudinal environment to the specific needs of young adults with cerebral palsy (CP). DESIGN: Cross-sectional. SETTING: Administrative regions in France, Germany, Italy, Portugal, and Sweden. PARTICIPANTS: Young adults with CP (N=357), with varying severity profiles, aged 19-28 years at time of interview (2018-20). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): Physical, social, and attitudinal environment unmet needs. RESULTS: Relevant environmental factors (EFs) for young adults with CP were identified during focus groups in England and Portugal. EFs were mapped to the ICF environmental classification and the EAEQ analytical structure resulted from this linking procedure. It comprised 61 items, linked to 31 ICF environmental classification categories, and covered 4 of its 5 chapters. Content validity assessed with the bandwidth index (percentage coverage of ICF Core Sets for adults with CP) was satisfactory (79.3%). A descriptive analysis was carried out. Participants had a mean age of 24 years, 56% were men, 38% had severely limited mobility. Less than 16% reported unmet needs for EFs relating to home, college/work/day placement, and communication in the Products and technology chapter. Unmet needs were higher (>20%) for the other items in the Public use and Land development categories. Social support, attitudes, and understanding of relatives were often adequate to the participants' needs. The proportion of unmet needs varied by sex (women were more often concerned) and raised with increasing gross motor impairment. CONCLUSION: The EAEQ describes in detail the adequacy of the environment to the specific needs of young adults with CP. Its ICF-based structure opens up possibilities for use in a universal conceptual framework.

Loneliness and Coping Styles Among Athletes With Disabilities During the COVID-19 Pandemic.

The study aimed to assess loneliness experiences among athletes with disabilities (AWD) during the different phases of the pandemic and to understand its relationship with coping styles. Ninety-one AWD participated in a longitudinal study spanning 10 months, covering three time points: April (A), June (Time B), and November (Time C) 2021. The study used the Coping Inventory for Stressful Situations and the revised University of California Los Angeles Loneliness Scale-Revised (UCLA-R) to measure coping mechanisms and feelings of loneliness, respectively. Loneliness levels peaked during the most intense phase of the pandemic, showing significant differences between consecutive time points (χ2 = 20.29, p < 0.001, d = 0.24). The most robust regression models were built in Time B, using the "intimate contacts" dimension of loneliness as the dependent variable and "emotion-oriented coping", "avoidance-oriented coping", and "impairment" as independent variables, explaining 44% of the variance (p < 0.001). Loneliness among Paralympic athletes fluctuated during various phases of the pandemic. The findings highlight the significant influence of coping styles, particularly emotional styles which heightened perceived loneliness, and task-oriented styles which reduced it, on athletes' experiences of loneliness. These results underscore the need for longitudinal studies to delve deeper into the relationship between loneliness and mental health. Moreover, they stress the importance of developing tailored interventions that promote effective coping mechanisms in AWD during challenging times amid to COIVID-19.