Projections of human kinship for all countries.

Demographers have long attempted to project future changes in the size and composition of populations, but have ignored what these processes will mean for the size, composition, and age distribution of family networks. Kinship structures matter because family solidarity-a crucial source of informal care for millions of people around the world-is conditional on kin being alive. Here, we present innovative projections of biological kin for the 1950 to 2100 period and discuss what they imply for the availability of informal care. Overall, we project that the number of living kin for individuals will decline dramatically worldwide. While a 65-yo woman in 1950 could expect to have 41 living kin, a 65-yo woman in 2095 is projected to have just 25 [18.8 to 34.7] relatives (lower and upper 80% projection intervals). This represents a 38% [15 to 54] global decline. The composition of family networks is also expected to change, with the numbers of living grandparents and great-grandparents markedly increasing, and the numbers of cousins, nieces and nephews, and grandchildren declining. Family networks will age considerably, as we project a widening age gap between individuals and their kin due to lower and later fertility and longer lifespans. In Italy, for example, the average age of a grandmother of a 35-yo woman is expected to increase from 77.9 y in 1950 to 87.7 y [87.1 to 88.5] in 2095. The projected changes in kin supply will put pressure on the already stretched institutional systems of social support, as more individuals age with smaller and older family networks.

Social relationships and their impact on health-related quality of life in a long-term breast cancer survivor cohort.

BACKGROUND: Health-related quality of life (HRQOL) has become increasingly important for breast cancer survivors, but clinically relevant declines often persist for many years after treatment. This study aimed to investigate whether social relationships can mitigate or prevent this decline in HRQOL. METHODS: Data were used from the German population-based Mamma Carcinoma Risk Factor Investigation (MARIE) cohort of 2022 breast cancer cases with follow-up information for more than 15 years after diagnosis. Correlations between social integration, social support, and global health status (GHS) as an overall measure of HRQOL were analyzed, and linear regression analysis was performed with structural equation modeling. RESULTS: The majority of participants reported high levels of social integration and social support and moderate levels of GHS. Social integration 5 years after diagnosis was associated with GHS 5 years after diagnosis (ß = 1.12; 95% CI, 0.25-1.99), but no longitudinal effects were found. Social support 5 years after diagnosis was associated with better GHS 5 years (ß = 0.42; 95% CI, 0.36-0.48) and 10 years after diagnosis (ß = 0.12; 95% CI, 0.02-0.22), whereas social support 10 years after diagnosis was associated with GHS 10 years (ß = 0.29; 95% CI, 0.20-0.39) and 15 years after diagnosis (ß = 0.10; 95% CI, 0.01-0.21). CONCLUSIONS: These results confirm that social relationships positively influence HRQOL in long-term breast cancer survivors and that their association should receive more attention clinically and beyond routine care.

Social supports in patients with cancer attending an Irish cancer center: a cross-sectional study.

A positive association has been demonstrated between social supports, quality of life, and survival outcomes in cancer. This study assessed levels of social supports among patients with cancer in an Irish institution, with an age- and gender-specific stratification. The study highlights relatively low levels of perceived socio-emotional support and social connectedness, but good levels of tangible and informational support in our cohort of patients with cancer. Cancer clinicians should consider social supports as a factor when deciding upon cancer therapies and surveillance programs, and link in available support services for individuals with low levels of social supports where feasible.

Associations of social support, living arrangements, and residential stability with cancer screening in the United States.

PURPOSE: Social support has been linked to increased use of preventive care services. Living arrangements and residential stability may be important structural sources of social support, but few studies have examined their impact on cancer screening. METHODS: Data were from the 2021 National Health Interview Survey. Participants were classified as up-to-date or not with female breast cancer (BC), cervical cancer (CVC), and colorectal cancer (CRC) screening recommendations. Multivariable logistic regression was used to model associations between screening and residential stability (< 1 year, 1-3 years, 4-10 years, 11-20 years, or > 20 years), living arrangement (with spouse/partner only, children only, both, or neither), and perceived social support (rarely/never, sometimes, usually, or always available), overall and stratified by sex (CRC) and age group (CVC). RESULTS: The adjusted odds of BC (odds ratio [OR] 0.61, 95% CI 0.45-0.81) and CVC (OR 0.76, 95% CI 0.60-0.96) screening were lowest for those who reported never/rarely vs. always having social support. The adjusted odds of BC (OR 1.44, 95% CI 1.22-1.70) and CRC (ORFEMALE = 1.42, 95% CI 1.20-1.68; ORMALE = 1.61, 95% CI 1.35-1.90) screening were higher for those living with a spouse/partner only vs. those living with neither spouse/partner nor children. Less residential stability was associated with increased CVC screening among females 21-34 years of age, but not BC or CRC screening. CONCLUSIONS: Social support measures were associated with screening to varying degrees by site and age, but higher perceived social support and living with a spouse/partner only demonstrated a consistent positive association. Interventions that mobilize social support networks and address the unmet social needs of parents/caregivers may improve cancer control.

The Impact of Kinlessness on Older Adults with Advanced Heart Failure.

Markers of social health, including kinlessness, social isolation and loneliness, have important implications for quality of life and health for older adults. As the population ages, there is a growing cohort of kinless older adults without living partners or children, particularly among disadvantaged groups. Kinlessness has been associated with worse mental and physical health, significant unmet care needs, increased risk of dementia, higher rates of long-term placement, and higher mortality rates than those for patients with kin. Although other markers of social health have been studied in patients with heart failure, little is known about kinlessness in this population of patients. This review outlines the data on kinlessness and its impact on patients' outcomes, and it proposes novel interventions to mitigate its effects.

Association of social support and health status outcomes in peripheral artery disease.

OBJECTIVE: A critical goal in the care of patients with peripheral artery disease (PAD) is to optimize their health status; that is, their symptoms, function, and quality of life. Social support has been proposed to be a predictor of disease-specific health status in patients with PAD. However, the prevalence of low perceived social support, the association with health status outcomes, and the interaction with other biopsychosocial variables, is unknown. Our aim was to assess the association of baseline perceived social support with health status at 12 months in patients with PAD. METHODS: The Patient-Centered Outcomes Related Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories (PORTRAIT) registry, which enrolled patients with PAD in the United States, the Netherlands, and Australia from 2011 to 2015, was used. Perceived social support was assessed at baseline with the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Social Support Inventory (ESSI), and disease-specific (Peripheral Artery Disease Questionnaire [PAQ]) and generic health status (Euro-Quality of Life Visual Analog Scale [VAS] and EQ-5D-3L Index) questionnaires were assessed at baseline and 12 months. Low social support was defined as a score of ≤3 on two items and an ESSI score of ≤18. A hierarchical mixed level linear regression model adjusting for biopsychosocial variables was used to assess the association between low perceived social support and the ESSI score with health status at 12 months. RESULTS: A total of 949 patients were included (mean age, 67.64 ± 9.32 years; 37.9% female), with low social support being present in 18.2%. Patients with low social support were more likely to not be married or to be living alone (50.0% vs 77.5%; P < .001); have more financial constraints; have more depressive, stress, and anxiety symptoms; and have lower disease-specific and generic health status at baseline and at 12 months. In the unadjusted model, low social support was associated with a -7.02 (95% confidence interval [CI], -10.97 to -3.07) point reduction in the PAQ, -7.43 (95% CI, -10.33 to -4.54) in the VAS, and -0.06 (95% CI, -0.09 to -0.03) in the EQ-5D-3L Index. Adjusting for biopsychosocial factors minimally attenuated these associations (PAQ: -6.52; 95% CI, -10.55 to -2.49; P = .002; VAS: -5.39; 95% CI, 8.36 to -2.42; P < .001; EQ-5D-3L Index: -0.04; 95% CI, -0.07 to 0.01; P = .022). The ESSI per-point score was associated with a decrease of 0.51 (95% CI, 0.18-0.85; P = .003) in PAQ and 0.46 (95% CI, 0.12-0.61; P = .004) in the VAS. CONCLUSIONS: Among patients with PAD, low social support was frequent and associated with a lower health status at 1 year independent of other biopsychosocial variables. Improving social support could improve health status and outcomes in PAD.

How Social Connectedness Helps Patients Stay Home After Hospital at Home Enrollment: A Mixed Methods Study.

BACKGROUND: While enrolled in Hospital at Home (HaH) programs, patients rely on their social network to provide supportive behaviors that are routinely provided by hospital staff in the inpatient setting. OBJECTIVE: This study investigated how social connectedness is associated with patient outcomes in a HaH program. DESIGN: The explanatory iterative sequential mixed methods design included an electronic health record review to collect quantitative measures to describe the severity of patient illness and healthcare utilization and then qualitative interviews to explain quantitative findings. PARTICIPANTS: The quantitative phase included 100 patients (18 years or older) admitted to the hospital who were subsequently enrolled in the HaH program. In the qualitative phase, 33 of the 100 patients participated in semi-structured interviews. ANALYSIS: Qualitative data was analyzed using the Sort & Sift, Think & Shift method. Integrated analysis included merged data displays of healthcare utilization data and patient descriptions of their care and genogram-type illustrations to enable variable-oriented analysis of structural support. We then examined patient narratives by two variables: life course and care elevation, to understand differences in the trajectories of six subsets of patients as identified by the quantitative data. KEY RESULTS: Three factors prompted patients to enroll in HaH: low attention from hospital staff during hospital stay; loneliness and isolation during hospital stay; and family encouragement to enroll. After discharge, social support within the home structure facilitated recovery during HaH. Conversely, HaH patients with limited support within the home were more likely to be readmitted. CONCLUSIONS: Structural social connectedness facilitates patient recovery in HaH. Before enrolling patients in HaH, clinicians should take an in-depth social history, including questions about social/familial roles, household responsibilities, and technology acceptance. Clinicians should engage formal and informal caregivers in these conversations early and communicate a clear picture of what caregivers should do to support the patient through recovery.

Development and validation of a nomogram for predicting sever cancer-related fatigue in patients with cervical cancer.

OBJECTIVE: Cancer-related fatigue (CRF) has been considered the biggest influencing factor for cancer patients after surgery. This study aimed to develop and validate a nomogram for severe cancer-related fatigue (CRF) patients with cervical cancer (CC). METHODS: A cross-sectional study was conducted to develop and validate a nomogram (building set = 196; validation set = 88) in the Department of Obstetrics and Gynecology of a Class III hospital in Shenyang, Liaoning Province. We adopted the questionnaire method, including the Cancer Fatigue Scale (CFS), Medical Uncertainty in Illness Scale (MUIS), Medical Coping Modes Questionnaire (MCMQ), Multidimensional Scale of Perceived Social Support (MSPSS), and Sense of Coherence-13 (SOC-13). Binary logistic regression was used to test the risk factors of CRF. The R4.1.2 software was used to develop and validate the nomogram, including Bootstrap resampling method, the ability of Area Under Curve (AUC), Concordance Index (C-Index), Hosmer Lemeshow goodness of fit test, Receiver Operating Characteristic (ROC) curve, Calibration calibration curve, and Decision Curve Analysis curve (DCA). RESULTS: The regression equation was Logit(P) = 1.276-0.947 Monthly income + 0.989 Long-term passive smoking - 0.952 Physical exercise + 1.512 Diagnosis type + 1.040 Coping style - 0.726 Perceived Social Support - 2.350 Sense of Coherence. The C-Index of the nomogram was 0.921 (95% CI: 0.877∼0.958). The ROC curve showed the sensitivity of the nomogram was 0.821, the specificity was 0.900, and the accuracy was 0.857. AUC was 0.916 (95% CI: 0.876∼0.957). The calibration showed that the predicted probability of the nomogram fitted well with the actual probability. The DCA curve showed when the prediction probability was greater than about 10%, the benefit of the nomogram was positive. The results in the validation group were similar. CONCLUSION: This nomogram had good identifiability, accuracy and clinical practicality, and could be used as a prediction and evaluation tool for severe cases of clinical patients with CC.

"Queer people are excellent caregivers, but we're stretched so very thin": Psychosocial wellbeing and impacts of caregiving among LGBTQI cancer carers.

BACKGROUND: LGBTQI (lesbian, gay, bisexual, transgender, queer and/or intersex) communities are increasingly recognized as a vulnerable and high-risk population in oncology. LGBTQI cancer carers, including carers who are LGBTQI and other carers of LGBTQI people, experience many of the same stressors as LGBTQI patients but their support needs are often overlooked in the cancer literature. METHOD: This mixed-methods study examined distress and quality of life in LGBTQI cancer carers. Online surveys were completed by 129 carers and 31 carers took part in a one-to-one semi-structured interview. Analyses of variance (ANOVAs) tested for differences in psychosocial outcomes and carer experiences by gender, sexuality, age, carer relationship and carer/patient LGBTQI status. Reflexive thematic analysis of interviews and open-ended survey responses facilitated in-depth examination of subjective experiences. RESULTS: 42.6% of participants reported high or very high distress. Distress was significantly positively correlated with discrimination in cancer care, health impact, financial impact and lack of family support; it was negatively correlated with comfort in LGBTQI sexuality and gender identity, social support and quality of life. Four themes were identified in thematic analysis of qualitative data: (1) Identity on the sidelines: LGBTQI sexuality and gender pushed aside during cancer caregiving; (2) Fear of being shut-out: rejection and exclusion of LGBTQI cancer carers; (3) Lack of support for LGBTQI caregivers; and (4) Closer and stronger relationships due to a culture of mutual caregiving. CONCLUSIONS: LGBTQI cancer carers must contend with typical caregiving demands whilst also managing additional minority stressors, including discrimination, rejection from family, isolation from LGBTQI communities, and invisibility in healthcare and support services. Despite this, LGBTQI carers showed resilience in building their own mutually supportive networks to rally around the person with cancer, which were reported to ameliorate psychosocial vulnerabilities. Service providers need to recognize the needs of LGBTQI cancer carers through inclusive and reflective practices. This will facilitate trust and patient and carer sexuality and gender identity disclosure, with positive consequences for wellbeing and satisfaction with cancer care.

Longitudinal study of peer victimization, social support, and mental health during early adolescence.

BACKGROUND: Peer victimization predicts the development of mental health symptoms in the transition to adolescence, but it is unclear whether and how parents and school environments can buffer this link. METHODS: We analyzed two-year longitudinal data from the Adolescent Brain Cognitive Development (ABCD) study, involving a diverse sample of 11 844 children across the United States (average at baseline = 9.91 years; standard deviation = 0.63; range = 8.92-11.08; complete case sample = 8385). Longitudinal associations between peer victimization and two-year changes in mental health symptoms of major depression disorder (MDD), separation anxiety (SA), prodromal psychosis (PP), and attention-deficit/hyperactivity disorder (ADHD) were examined including a wide range of covariates. Mixed linear models were used to test for the moderating effects of parental warmth and prosocial school environment. RESULTS: 20% of children experienced peer victimization. Higher exposure to peer victimization was associated with increases in MDD, SA, and ADHD symptoms. Parental warmth was associated with decreases in MDD symptoms but did not robustly buffer the link between peer victimization and mental health symptoms. Prosocial school environment predicted decreases in PP symptoms and buffered the link between peer victimization and MDD symptoms but amplified the link between peer victimization and SA and ADHD symptoms. CONCLUSIONS: Peer victimization is associated with increases in mental health symptoms during the transition to adolescence. Parental warmth and prosocial school environments might not be enough to counter the negative consequences of peer victimization on all mental health outcomes.

Social processes as the missing link: cross-sectionally testing a conceptual model on social mediators of early psychopathological development.

BACKGROUND: Research suggests that most mental health conditions have their onset in the critically social period of adolescence. Yet, we lack understanding of the potential social processes underlying early psychopathological development. We propose a conceptual model where daily-life social interactions and social skills form an intermediate link between known risk and protective factors (adverse childhood experiences, bullying, social support, maladaptive parenting) and psychopathology in adolescents - that is explored using cross-sectional data. METHODS: N = 1913 Flemish adolescent participants (Mean age = 13.8; 63% girls) were assessed as part of the SIGMA study, a large-scale, accelerated longitudinal study of adolescent mental health and development. Self-report questionnaires (on risk/protective factors, social skills, and psychopathology) were completed during class time; daily-life social interactions were measured during a subsequent six-day experience-sampling period. RESULTS: Registered uncorrected multilevel linear regression results revealed significant associations between all risk/protective factors and psychopathology, between all risk/protective factors and social processes, and between all social processes and psychopathology. Social processes (social skills, quantity/quality of daily social interactions) were uniquely predicted by each risk/protective factor and were uniquely associated with both general and specific types of psychopathology. For older participants, some relationships between social processes and psychopathology were stronger. CONCLUSIONS: Unique associations between risk/protective factors and psychopathology signify the distinct relevance of these factors for youth mental health, whereas the broad associations with social processes support these processes as broad correlates. Results align with the idea of a social pathway toward early psychopathology, although follow-up longitudinal research is required to verify any mediation effect.

Associations between weight self-stigma and healthy diet and physical activity among adults with type 2 diabetes: Cross-sectional results from the second Diabetes MILES - Australia (MILES-2) study.

AIMS: To examine associations between weight self-stigma and healthy diet or physical activity, and potential moderating effects of self-esteem, diabetes self-efficacy, and diabetes social support, among adults with type 2 diabetes. METHODS: Diabetes MILES-2 data were used, an Australian cross-sectional online survey. Participants with type 2 diabetes who considered themselves overweight, and reported concern about weight management (N = 726; 48% insulin-treated), completed the Weight Self-Stigma Questionnaire (WSSQ; total score and subscales: self-devaluation, fear of enacted stigma), measures of diabetes self-care (diet, exercise), and hypothesised psychosocial moderators (self-esteem, diabetes self-efficacy, and diabetes social support). Adjusted linear regression tested associations and interaction effects, separately by insulin treatment status. RESULTS: Greater weight self-stigma (WSSQ total) was associated with less optimal dietary self-care (both groups: ß = -0.3), and with a lower level of exercise (non-insulin only: ß = -0.2; all p < 0.001). All hypothesised moderators were negatively associated with weight self-stigma (range r = -0.2 to r = -0.5). Positive associations were identified between the hypothesised moderators and self-care behaviours (strongest between diet and diabetes self-efficacy, r = > 0.5). No significant interaction effects were observed. CONCLUSIONS: This study provides novel evidence of negative associations between weight self-stigma and self-care behaviours among adults with type 2 diabetes. Weight self-stigma is a demonstrated barrier to self-care behaviours in type 2 diabetes cohorts. Acknowledgement and strategies to address weight self-stigma are needed in clinical care and health programmes.

Association between experienced stigma, anxiety, depression and loneliness among people with drug-resistant tuberculosis in Lagos Nigeria: The moderating role of social support.

BACKGROUND: This study assessed the moderating effect of social support on the association between experienced stigma versus anxiety, depression and loneliness among people with drug-resistant tuberculosis. METHODS: A descriptive cross-sectional study was conducted among 203 adults on treatment for drug-resistant tuberculosis for at least 8 weeks. Validated scales were used to assess experienced stigma, anxiety, depression, loneliness and social support. Partial correlations and hierarchical multiple regression were used to determine the moderating effect of social support on the association between experienced stigma versus anxiety, depression and loneliness. The interaction was visualised using slope analysis. RESULTS: Anxiety, loneliness and depression were reported by 148 (72.9%), 114 (56.2%) and 128 (63.1%) of the 203 participants, respectively. Experienced stigma was positively associated with depression (B = 0.428, p < 0.001), anxiety (B = 0.374, p < 0.001) and loneliness (B = 0.285, p = 0.001). Social support was negatively associated with depression (B = -0.255, p < 0.001), anxiety (B = -0.406, p < 0.001) and loneliness (B = -0.270, p = 0.001). The impact of experienced stigma on depression was different at low (B = 0.567, SE = 0.115, p < 0.001) and high (B = 0.275, SE = 0.253, p = 0.024) groups of social support. Similarly, at low social support, the effect of experienced stigma on loneliness (B = 0.491, SE = 0.250, p < 0.001) and anxiety (B = 0.254, SE = 0.060, p = 0.044) was different compared to the effect of experienced stigma on loneliness (B = 0.275, SE = 0.253, p = 0.024) and anxiety (B = 0.127, SE = 0.094, p = 0.307) at high group of social support. CONCLUSION: In this study, social support reduced the effects of experienced stigma on anxiety, depression and loneliness suggesting that improving social support among people with drug-resistant tuberculosis is crucial in reducing the negative effects of stigma on anxiety, depression and loneliness.

Glucocorticoid response to naturalistic interactions between children and dogs.

Although research has shown that pets appear to provide certain types of social support to children, little is known about the physiological bases of these effects, especially in naturalistic contexts. In this study, we investigated the effect of free-form interactions between children (ages 8-10 years) and dogs on salivary cortisol concentrations in both species. We further investigated the role of the child-dog relationship by comparing interactions with the child's pet dog to interactions with an unfamiliar dog or a nonsocial control condition, and modeled associations between survey measures of the human-animal bond and children's physiological responses. In both children and dogs, salivary cortisol decreased from pre- to post-interaction; the effect was strongest for children interacting with an unfamiliar dog (compared to their pet dog) and for the pet dogs (compared to the unfamiliar dog). We found minimal evidence for associations between cortisol output and behaviors coded from video, but children scoring higher on survey measures of the human-animal bond exhibited the greatest reductions in cortisol when interacting with dogs. Self-reported loneliness was not related to cortisol or the human-animal bond, but measures of both loneliness and the human-animal bond were higher among children who participated after the onset of the COVID-19 pandemic, relative to those who participated before the pandemic. This study builds on previous work that investigated potential stress-buffering effects of human-animal interaction during explicit stressors and demonstrates important physiological correlates of naturalistic interactions between children and dogs, similar to those that occur in daily life.

The dynamics of sociality and glucocorticoids in wild male Assamese macaques.

For males of gregarious species, dominance status and the strength of affiliative relationships can have major fitness consequences. Social dynamics also impose costs by affecting glucocorticoids, mediators of homeostasis and indicators of the physiological response to challenges and within-group competition. We investigated the relationships between dominance, social bonds, seasonal challenges, and faecal glucocorticoid metabolite (fGC) measures in wild Assamese macaques (Macaca assamensis) at Phu Khieo Wildlife Sanctuary, Thailand, combining behavioural data with 4129 samples from 62 adult males over 15 years. Our previous work on this population suggested that increased competition during the mating season was associated with elevated fGC levels and that, unusually for male primates, lower rank position correlated with higher fGC levels. With a much larger dataset and dynamic measures of sociality, we re-examined these relationships and additionally tested the potentially fGC-attenuating effect of social support. Contrary to our previous study, yet consistent with the majority of work on male primates, dominance rank had a positive relationship with fGC levels, as high status correlated with elevated glucocorticoid measures. fGC levels were increased at the onset of the mating season. We demonstrated an fGC-reducing effect of supportive relationships in males and showed that dynamics in affiliation can correlate with dynamics in physiological responses. Our results suggest that in a system with intermediate contest potential, high dominance status can impose physiological costs on males that may potentially be moderated by social relationships. We highlight the need to consider the dynamics of sociality and competition that influence hormonal processes.

Rural-urban disparities in psychosocial functioning in epithelial ovarian cancer patients.

OBJECTIVE: Although rural residence has been related to health disparities in cancer patients, little is known about how rural residence impacts mental health and quality of life (QOL) in ovarian cancer patients over time. This prospective longitudinal study investigated mental health and QOL of ovarian cancer patients in the first-year post-diagnosis. METHOD: Women with suspected ovarian cancer completed psychosocial surveys pre-surgery, at 6 months and one-year; clinical data were obtained from medical records. Histologically confirmed high grade epithelial ovarian cancer patients were eligible. Rural/urban residence was categorized from patient counties using the USDA Rural-Urban Continuum Codes. Linear mixed effects models examined differences in psychosocial measures over time, adjusting for covariates. RESULTS: Although disparities were not observed at study entry for any psychosocial variable (all p-values >0.22), urban patients showed greater improvement in total distress over the year following diagnosis than rural patients (p = 0.025) and were significantly less distressed at one year (p = 0.03). Urban patients had a more consistent QOL improvement than their rural counterparts (p = 0.006). There were no differences in the course of depressive symptoms over the year (p = 0.17). Social support of urban patients at 12 months was significantly higher than that of rural patients (p = 0.04). CONCLUSION: Rural patients reported less improvement in psychological functioning in the year following diagnosis than their urban counterparts. Clinicians should be aware of rurality as a potential risk factor for ongoing distress. Future studies should examine causes of these health disparities and potential long-term inequities and develop interventions to address these issues.

Spontaneous miscarriage and social support in predicting risks of depression and anxiety: a cohort study in UK Biobank.

BACKGROUND: It is still unclear whether social support can moderate the high risk of depression and anxiety due to spontaneous miscarriage. OBJECTIVE: This study prospectively investigated the associations of spontaneous miscarriage with risks of depression and anxiety, and evaluated the interactions between spontaneous miscarriage and the degree of social support in relation to depression and anxiety risks. STUDY DESIGN: A total of 179,000 participants from the UK Biobank with pregnancy experience and without depression or anxiety at baseline were included. Spontaneous miscarriage was defined by self-report from participants at enrollment or by International Classification of Diseases codes. The degree of social support was defined as the number of social support factors including living with a spouse or partner, participation in social activities, and confiding. Cox proportional hazards models were used to evaluate the joint association of spontaneous miscarriage and social support with the risks of depression and anxiety. RESULTS: During a median follow-up of 12.3 years, 4939 depression incidents and 5742 anxiety incidents were documented. For participants with 1, 2, and ≥3 spontaneous miscarriages, hazard ratios (95% confidence intervals) for depression were 1.10 (1.02-1.19), 1.31 (1.14-1.50), and 1.40 (1.18-1.67), respectively (P trend <.001), compared with participants without a history of spontaneous miscarriage, after adjustment for covariates. For anxiety, the hazard ratios (95% confidence intervals) were 1.07 (1.00-1.15), 1.04 (0.90-1.19), and 1.21 (1.02-1.44), respectively (P trend=.01). Moreover, we found that the risk of depression associated with a combination of spontaneous miscarriage and low degree of social support in later life was greater than the sum of the risks associated with each individual factor, indicating significant interactions on an additive scale (P interaction=.03). CONCLUSION: Spontaneous miscarriage is associated with higher risks of depression and anxiety, and the risk of depression is further increased when there is also low degree of social support.

Prevalence and risk factors for postpartum depression two months after cesarean delivery: a prospective multicenter study.

BACKGROUND: The prevalence and risk factors of postpartum depression after cesarean delivery remain unclear. OBJECTIVE: To assess the prevalence of postpartum depression and its risk factors 2 months after cesarean delivery. METHODS: Prospective ancillary cohort study of the Tranexamic Acid for Preventing Postpartum Hemorrhage after Cesarean Delivery (TRAAP2) trial, conducted in 27 French hospitals in 2018-2020 and enrolling women undergoing cesarean delivery before or during labor at 34 or more weeks of gestation. After randomization, characteristics of the cesarean delivery, postpartum blood loss, and immediate postpartum period, including memories of delivery and postoperative pain, were prospectively collected. Women's characteristics, particularly any psychiatric history, were collected from medical records. Two months after childbirth, a postpartum depression provisional diagnosis was defined as a score of 13 or higher on the Edinburgh Postnatal Depression Scale, a validated self-administered questionnaire. The corrected prevalence of postpartum depression was calculated with the inverse probability weighting method to take nonrespondents into account. Multivariate logistic regression analyzed associations between potential risk factors and postpartum depression. A sensitivity analysis used an EPDS cutoff value of 11 or higher. RESULTS: The questionnaire was returned by 2793/4431 women (63.0% response rate). The corrected prevalence of postpartum depression provisional diagnosis was 16.4% (95% confidence interval (CI), 14.9-18.0%) with an EPDS score of 13 or higher and 23.1% (95%CI, 21.4-24.9%) with a cutoff value of 11 or higher. Characteristics associated with a higher risk of postpartum depression were pre-pregnancy characteristics such as young age (aOR 0.83, 95%CI 0.74-0.93 for each 5-year increase in maternal age) and non-European country of birth (aOR 2.58, 95%CI 1.85-3.59 for North Africa; aOR 1.57, 95%CI 1.09-2.26 for Sub-Saharan Africa and aOR 1.99, 95%CI 1.28-3.10 for other country of birth; reference: Europe) and some aspects of the cesarean delivery, notably its timing and context, emergency before labor (aOR 1.70, 95%CI 1.15-2.50; reference: before labor without emergency) and during labor after induction of labor (aOR 1.36, 95%CI 1.03-1.84; reference: before labor without emergency). Also at higher risk were women reporting high intensity pain during the postpartum stay (aOR 1.73, 95%CI 1.32-2.26) and bad memories of delivery on day 2 postpartum (aOR 1.67, 95%CI 1.14-2.45). Conversely, women who had social support in the operating room had a lower risk of postpartum depression (aOR 0.73, 95%CI 0.53-0.97). CONCLUSION: Around one woman in six had postpartum depression symptoms 2 months after cesarean delivery. Some cesarean-related obstetric factors may increase this risk: cesareans before labor for emergency situations or during labor after medically indicated induction of labor, severe postoperative pain and bad memories of delivery before discharge. Specific subgroups of at-risk women could benefit from early screening or intervention to reduce the onset of postpartum depression. Perinatal professionals should pay particular attention to postoperative pain management.

Concurrent and prospective associations between family socioeconomic status, social support and salivary diurnal and hair cortisol in adolescence.

BACKGROUND: Exposure to socioeconomic adversity is hypothesized to impact hypothalamic-pituitary-adrenal (HPA) axis activity and cortisol secretion, but existing evidence is inconsistent. Yet, few studies have investigated this association using a developmental approach that considers potential protective contextual factors. This study examined the role of stability and changes in family socioeconomic status (SES) in the prediction of multiple cortisol indicators and tested whether social support moderated these associations. METHODS: Participants were part of a population-based sample of twin pairs recruited at birth. Family SES was assessed in early childhood (ages 0-5) and mid-adolescence (age 14). Social support was assessed at ages 14 and 19. Diurnal cortisol (n = 569) was measured at age 14 at awakening, 30 min later, in the afternoon and evening over four non-consecutive days. Hair cortisol concentration (HCC, n = 704) was measured at age 19. All data were collected before the pandemic and multilevel regression models were conducted to account for the nested data structure. RESULTS: Youth exposed to lower family SES levels in childhood and mid-adolescence had a flatter diurnal slope and higher HCC compared with those who experienced upward socioeconomic mobility in mid-adolescence. Contrastingly, mid-adolescence SES showed no association with the diurnal slope or HCC for youth from higher-SES households in early childhood. Moreover, youth raised in higher-SES families in early childhood had a higher CAR in mid-adolescence if they reported greater social support in mid-adolescence. Social support also moderated the SES-cortisol association in mid-adolescence, with higher-SES youth showing higher awakening cortisol secretion when reporting more social support. CONCLUSIONS: Our findings support the hypothesis that early socioeconomic adversity sensitizes HPA axis activity to later socioeconomic disadvantage, which may bear consequences for socioemotional and behavioral functioning.

Positive psychological capital, post-traumatic growth, social support, and quality of life in patients with systemic lupus erythematosus: A cross-sectional study.

OBJECTIVE: This study aimed to investigate the correlation between positive psychological capital, post-traumatic growth, social support, and quality of life (QOL) in patients with systemic lupus erythematosus (SLE). METHODS: A cross-sectional study was conducted at the First Affiliated Hospital of Xinjiang Medical University from October 2022 to May 2023. A sample of 330 hospitalized SLE patients was selected for this study. The collected data included demographic information, the SLE disease activity index, the Positive Mental Capital Questionnaire, the Chinese version of the Post-Traumatic Growth Scale, the Social Support Rating Scale, and the Chinese version of the Lupus Quality of Life Scale. RESULTS: The QOL score among the 330 SLE patients was measured as M(P25, P75) of 105 (83.00,124.00). Positive psychological capital, post-traumatic growth, and social support demonstrated significant positive correlations with the QOL in SLE patients (p < 0.05). Multiple linear regression analysis revealed that literacy, disease level, disease duration, occupation, marital status, psychological capital, social support, and post-traumatic growth were influential factors associated with the QOL in SLE patients. CONCLUSION: Medical professionals should be attentive to the psychological well-being of SLE patients and should consider implementing early psychological interventions. These interventions are crucial for enhancing the QOL for individuals diagnosed with SLE.