Who is at Risk? Social Support, Relationship Dissolution, and Illness in a Rural Context.

This study focuses on a cohort of adults (40-plus) in rural South Africa to unpack associations between physical health and receipt of social support, and the extent to which these associations were moderated by marital status. We use logistic regression to estimate the odds of having received emotional, physical, or financial support separately for men (N = 2247) and women (N = 2609). Our results suggest having an Activity of Daily Living (ADL) limitation or having at least one chronic condition was not significantly associated with social support receipt for women, but having an ADL limitation was associated with reduced odds of receiving financial support among men. Although marital status was strongly and significantly associated with receipt of social support for both men and women, marital status moderated the relationship between health indicators and social support receipt only for men. Our findings suggest that when men, but not women, experience a marital dissolution and are suffering from a disability or a chronic condition, their networks respond by providing needed social support.

Support in times of need: How depressive symptoms can impact receipt of social support among aging adults in rural South Africa.

The relationship between mental health and receipt of social support is not well understood in low- and middle-income countries. In this paper, we focus on a cohort of older adults (40-plus) in rural South Africa to unpack associations between mental health and receipt of social support, and the extent to which marital status modifies these associations. We use baseline data from a population-based study, Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI), conducted between 2014 and 2015. Our results suggest that men and women who report depressive symptoms are less likely to receive social support: women are less likely to receive emotional and financial support, and men are less likely to receive physical and financial support. Both men and women who are married or partnered are more likely to receive social support than their non-married counterparts. The association between depressive symptomology and receipt of social support differs for women who are separated/divorced and for men who are widowed. Specifically, the association between having depressive symptoms and receiving physical or financial support is more positive for separated/divorced women than their married/cohabiting counterparts; for men, the association between having depressive symptoms and receiving physical support is more positive for widowed men than their married/cohabiting counterparts. Our findings speak to the complicated associations between social support, marriage and mental health in later life and the different experiences that men and women may have.

Aging well in an aging world: The impact of material conditions, culture, and societal disruptions.

The world's population is aging, but quality of life in older adulthood is unequally distributed. Using measures of self-rated health and subjective well-being from Wave 6 (2010-2014) of the World Values Survey, we examine the individual and social factors that shape older adulthood in 57 countries. In addition to examining inequalities in health and well-being for older adults between countries, we examine the differences between older (50 and over) and younger adults (under 50) within countries. Aging well is not simply a fact of country wealth or personal income. We conduct multi-level analyses to determine which individual-level factors and which country-level factors impact health and well-being, and how these differ across age. We consider three sets of country-level factors: material conditions, culture, and societal disruptions. Overall, we find that older adults feel less healthy than younger adults, but older adults in countries that have experienced a transition to independence during their adulthood feel much less healthy than their under-50 counterparts. The same is true for life satisfaction. Although older adults do not necessarily feel more dissatisfied with their lives than do younger adults, they are much more dissatisfied in countries that transitioned. We conclude with a discussion of the implications of how altered life expectations affect aging.

Policy Shift: South Africa's Old Age Pensions' Influence on Perceived Quality of Life.

Noncontributory pensions serve as an important resource for poverty-affected households in low- and middle-income countries. This study explores how a recent policy change to pension receipt influences perceived quality of life among older South Africans. We use survey data from the longitudinal World Health Organization Study on global AGEing and adult health and from the Agincourt Health and Socio-Demographic Surveillance System census. We find pension receipt to have a positive impact on both men's and women's perceived quality of life. These findings hold when controlling for prior well-being status. We find a significant moderating factor of physical limitations on the relationship between pension receipt and quality of life. Individuals reporting the highest levels of physical limitation report a larger increase in their quality of life upon pension receipt than those with less severe physical limitations. We conclude that despite the well-documented household income-pooling in this population, pension receipt still leads to a significant positive impact on pensioners' perceived quality of life.

Living Arrangements, Disability and Gender of Older Adults Among Rural South Africa.

Objective: A limited understanding exists of the relationship between disability and older persons' living arrangements in low and middle-income countries (LMICs). We examine the associations between living arrangements, disability, and gender for individuals older than 50 years in rural South Africa. Method: Using the Study on global AGEing and adult health (SAGE) survey and Agincourt Health and socio-Demographic Surveillance System (HDSS) data, we explore older persons' self-reported disability by living arrangements and gender, paying particular attention to various multigenerational arrangements. Results: Controlling for past disability status, a significant relationship between living arrangements and current disability remains, but is moderated by gender. Older persons in households where they may be more "productive" report higher levels of disability; there are fewer differences in women's than men's reported disability levels across living arrangement categories. Discussion: This study underscores the need to examine living arrangements and disability through a gendered lens, with particular attention to heterogeneity among multigenerational living arrangements. Some living arrangements may take a greater toll on older persons than others. Important policy implications for South Africa and other LMICs emerge among vibrant debates about the role of social welfare programs in improving the health of older individuals.

The Role of Older Persons' Environment in Aging Well: Quality of Life, Illness, and Community Context in South Africa.

Purpose of the Study: This article evaluates the influence of local district conditions on subjective quality of life of older South African adults. Policymakers increasingly recognize that "successful" aging policies must not only address physical health needs but also factors that influence subjective well-being. Design and Methods: To investigate the influence of area-level distribution of "public goods" on well-being in a low- and middle-income setting, nationally representative WHO-Study of Global AGEing and Adult Health (WHO-SAGE) survey data is combined with district-level data that captures built resources and health system distribution. Multilevel regression modeling is utilized to explore how community context, including built resources and health infrastructure quality, influence older persons' quality of life and how chronic health conditions may moderate this relationship while controlling for important individual characteristics. Results: While controlling for individual and district level factors, it is found community level provision of built resources of basic services (i.e., water, sanitation, electricity, housing) has a modest but significant impact on older persons' subjective well-being. Further, this effect on older persons' perceptions of quality of life is moderated by individual chronic health status; individuals with a chronic health condition do not receive an equivalent benefit from district built condition like those without an illness do. Implications: This work adds to the literature concerning the effect of environments in low- and middle-income countries on older adults' subjective well-being. It also adds to the growing literature on the complex relationship between subjective well-being and health in diverse contexts.

Who Benefits--Or Does not--From South Africa's Old Age Pension? Evidence from Characteristics of Rural Pensioners and Non-Pensioners.

Social protection grants play a critical role in survival and livelihoods of elderly individuals in South Africa. Rarely is it possible to assess how well a social program reaches its target population. Using a 2010 survey and Agincourt Health Demographic Surveillance System census data we conduct multivariate logistic regression to predict pension receipt in rural South Africa. We find only 80% of age-eligible individuals report pension receipt. Pension non-recipients tend to be male, have poor socio-economic status, live in smaller households, be of Mozambican origin, and have poorer physical function; while older persons living in households receiving other grants are more likely to report pension receipt. We conclude that a reservoir of older persons exists who meet eligibility criteria but who are not yet receiving pensions. Ensuring that they and their households are properly linked to all available social services--whether for child or old-age social grants--is likely to have beneficial and synergistic effects.

Dependent or Productive? A New Approach to Understanding the Social Positioning of Older South Africans Through Living Arrangements.

South Africa's population is aging. Most of the older Black South Africans continue to live in extended household structures with children, grandchildren, and other kin. They also constitute a source of income through a means-tested noncontributory state-funded pension available at age 60. Using census data from the Agincourt Health and Demographic Surveillance System in 2000, 2005, and 2010, we develop a typology of living arrangements that is reflective of the social positioning of elderly persons as dependent or productive household members and analyze changes in the distribution over time. Older persons, in general, live in large, complex, and multigenerational households. Multigenerational households with "productive" older persons are increasing in proportion over the period, although there are few differences by gender or pension eligibility at any time point.

Social cohesion and self-rated health: The moderating effect of neighborhood physical disorder.

Using data from the Los Angeles Family and Neighborhood Survey and its companion datasets, we examined how neighborhood disorder, perceived danger and both individually perceived and contextually measured neighborhood social cohesion are associated with self-rated health. Results indicate that neighborhood disorder is negatively associated with health and the relationship is explained by perceived cohesion and danger, which are both also significant predictors of health. Further, individually perceived cohesion emerges as a more important explanation of self-rated health than neighborhood-level social cohesion. Finally, neighborhood disorder and perceived cohesion interact to influence health, such that cohesion is especially beneficial when residents live in neighborhoods characterized by low to moderate disorder; once disorder is at high levels, cohesion no longer offers protection against poor health. We interpret our findings as they relate to prior research on neighborhoods, psychosocial processes, and health, and discuss their implications for intervention efforts that address disorder in urban communities.

The impact of pensions on health and wellbeing in rural South Africa: does gender matter?

Unique to Africa, a means-tested non-contributory pension is available to South Africans. In 2006, women over 60 and men over 65 were pension-eligible. To explore the effect of the pension for health and wellbeing indicators of rural South African men and women, we analyze data from the WHO-INDEPTH Study of Global Ageing and Adult Health Survey, carried out in the Agincourt sub-district by the MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) in 2006. Because pension receipt was not measured directly, our findings represent intent-to-treat (ITT) rather than treatment-on-the-treated (TOT) effects using age as an indicator for intent-to-treat. Overall, women report poorer wellbeing compared to men. However, women have a "honeymoon" period at ages 60-64, the first years of pension-eligibility, in which they report lower levels of worry and sadness, and higher overall happiness, life satisfaction, and quality of life as compared to younger and older women. For men, in contrast, reports of wellbeing worsen in the pre-pension years, followed by a similar but not as prominent pattern of favorable reports in the five years following pension-eligibility, and a decline in the next five-year period. Thus, while pensions continue to enhance financial wellbeing, our results suggest that their effect on social wellbeing may be gendered and transitory. Further research is needed to improve understanding of these dynamics.

Efficacy of two versions of emotion-focused therapy for resolving child abuse trauma.

This study evaluated and compared emotion-focused therapy for trauma (EFTT) with imaginal confrontation (IC) of perpetrators (n=20) and EFTT with empathic exploration (EE) of trauma material (n=25). Clients were women and men with histories of different types of childhood maltreatment (emotional, physical, and sexual abuse; emotional neglect). Clients were randomly assigned to treatment condition. Outcome measures assessed symptom distress, self and interpersonal problems, and abuse resolution. Results indicated statistically and clinically significant improvements on eight measures at posttest, maintenance of gains at follow-up, and no statistically significant differences between conditions. There were higher rates of clinically significant change in IC and a lower attrition rate for EE (7% vs. 20%). More severe personality pathology negatively influenced some dimensions of outcome, particularly in EE.

Comparison of the psychosocial typology of children with below average IQ to that of children with learning disabilities.

This study investigates the subtypal patterns of psychosocial functioning of children with below average IQ (BAIQ) using the application of both Q-factor analysis and profile-matching. The results suggest that the psychosocial dimensions of children with BAIQ are quite similar to those of children with LD in a general sense. Many of the same subtypes were derived, and the proportions of children displaying normal, mild, and severe levels of psychopathology were not significantly different from those of children with LD. There were some minor differences, however: For example, children with BAIQ exhibited a greater tendency to display psychopathology with internalizing features. Consistent with previous research involving children with LD, there were no changes in either type or severity of psychopathology with advancing years.