Risk factors for suicide reattempt: a systematic review and meta-analysis.

BACKGROUND: Suicide is one of the main external causes of death worldwide. People who have already attempted suicide are at high risk of new suicidal behavior. However, there is a lack of information on the risk factors that facilitate the appearance of reattempts. The aim of this study was to calculate the risk of suicide reattempt in the presence of suicidal history and psychosocial risk factors and to estimate the effect of each individual risk factor. METHODS: This systematic review and meta-analysis were conducted following the PRISMA-2020 guidelines. Studies on suicide reattempt that measured risk factors were searched from inception to 2022. The risk factors studied were those directly related to suicide history: history of suicide prior to the index attempt, and those that mediate the transition from suicidal ideation to attempt (alcohol or drug misuse, impulsivity, trauma, and non-suicidal self-injury). RESULTS: The initial search resulted in 11 905 articles. Of these, 34 articles were selected for this meta-analysis, jointly presenting 52 different effect sizes. The pooled effect size across the risk factors was significant (OR 2.16). Reattempt risk may be increased in presence of any of the following risk factors: previous history, active suicidal ideation, trauma, alcohol misuse, and drug misuse. However, impulsivity, and non-suicidal self-injury did not show a significant effect on reattempt. CONCLUSION: Most of the risk factors traditionally associated with suicide are also relevant when talking about suicide reattempts. Knowing the traits that define reattempters can help develop better preventive and intervention plans.

COVID-19 and common mental health symptoms in the early phase of the pandemic: An umbrella review of the evidence.

BACKGROUND: There remains uncertainty about the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on mental health. This umbrella review provides a comprehensive overview of the association between the pandemic and common mental disorders. We qualitatively summarized evidence from reviews with meta-analyses of individual study-data in the general population, healthcare workers, and specific at-risk populations. METHODS AND FINDINGS: A systematic search was carried out in 5 databases for peer-reviewed systematic reviews with meta-analyses of prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms during the pandemic published between December 31, 2019 until August 12, 2022. We identified 123 reviews of which 7 provided standardized mean differences (SMDs) either from longitudinal pre- to during pandemic study-data or from cross-sectional study-data compared to matched pre-pandemic data. Methodological quality rated with the Assessment of Multiple Systematic Reviews checklist scores (AMSTAR 2) instrument was generally low to moderate. Small but significant increases of depression, anxiety, and/or general mental health symptoms were reported in the general population, in people with preexisting physical health conditions, and in children (3 reviews; SMDs ranged from 0.11 to 0.28). Mental health and depression symptoms significantly increased during periods of social restrictions (1 review; SMDs of 0.41 and 0.83, respectively) but anxiety symptoms did not (SMD: 0.26). Increases of depression symptoms were generally larger and longer-lasting during the pandemic (3 reviews; SMDs depression ranged from 0.16 to 0.23) than those of anxiety (2 reviews: SMDs 0.12 and 0.18). Females showed a significantly larger increase in anxiety symptoms than males (1 review: SMD 0.15). In healthcare workers, people with preexisting mental disorders, any patient group, children and adolescents, and in students, no significant differences from pre- to during pandemic were found (2 reviews; SMD's ranging from -0.16 to 0.48). In 116 reviews pooled cross-sectional prevalence rates of depression, anxiety, and PTSD symptoms ranged from 9% to 48% across populations. Although heterogeneity between studies was high and largely unexplained, assessment tools and cut-offs used, age, sex or gender, and COVID-19 exposure factors were found to be moderators in some reviews. The major limitations are the inability to quantify and explain the high heterogeneity across reviews included and the shortage of within-person data from multiple longitudinal studies. CONCLUSIONS: A small but consistent deterioration of mental health and particularly depression during early pandemic and during social restrictions has been found in the general population and in people with chronic somatic disorders. Also, associations between mental health and the pandemic were stronger in females and younger age groups than in others. Explanatory individual-level, COVID-19 exposure, and time-course factors were scarce and showed inconsistencies across reviews. For policy and research, repeated assessments of mental health in population panels including vulnerable individuals are recommended to respond to current and future health crises.

Longitudinal Impact of the COVID-19 Pandemic on Stress and Occupational Well-Being of Mental Health Professionals: An International Study.

BACKGROUND: Increased levels of occupational stress among health professionals during the COVID-19 pandemic have been documented. Few studies have examined the effects of the pandemic on mental health professionals despite the heightened demand for their services. METHOD: A multilingual, longitudinal, global survey was conducted at 3 time points during the pandemic among members of the World Health Organization's Global Clinical Practice Network. A total of 786 Global Clinical Practice Network members from 86 countries responded to surveys assessing occupational distress, well-being, and posttraumatic stress symptoms. RESULTS: On average, respondents' well-being deteriorated across time while their posttraumatic stress symptoms showed a modest improvement. Linear growth models indicated that being female, being younger, providing face-to-face health services to patients with COVID-19, having been a target of COVID-related violence, and living in a low- or middle-income country or a country with a higher COVID-19 death rate conveyed greater risk for poor well-being and higher level of stress symptoms over time. Growth mixed modeling identified trajectories of occupational well-being and stress symptoms. Most mental health professions demonstrated no impact to well-being; maintained moderate, nonclinical levels of stress symptoms; or showed improvements after an initial period of difficulty. However, some participant groups exhibited deteriorating well-being approaching the clinical threshold (25.8%) and persistently high and clinically significant levels of posttraumatic stress symptoms (19.6%) over time. CONCLUSIONS: This study indicates that although most mental health professionals exhibited stable, positive well-being and low stress symptoms during the pandemic, a substantial minority of an already burdened global mental health workforce experienced persistently poor or deteriorating psychological status over the course of the pandemic.

Coping with COVID: risk and resilience factors for mental health in a German representative panel study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic might affect mental health. Data from population-representative panel surveys with multiple waves including pre-COVID data investigating risk and protective factors are still rare. METHODS: In a stratified random sample of the German household population (n = 6684), we conducted survey-weighted multiple linear regressions to determine the association of various psychological risk and protective factors assessed between 2015 and 2020 with changes in psychological distress [(PD; measured via Patient Health Questionnaire for Depression and Anxiety (PHQ-4)] from pre-pandemic (average of 2016 and 2019) to peri-pandemic (both 2020 and 2021) time points. Control analyses on PD change between two pre-pandemic time points (2016 and 2019) were conducted. Regularized regressions were computed to inform on which factors were statistically most influential in the multicollinear setting. RESULTS: PHQ-4 scores in 2020 (M = 2.45) and 2021 (M = 2.21) were elevated compared to 2019 (M = 1.79). Several risk factors (catastrophizing, neuroticism, and asking for instrumental support) and protective factors (perceived stress recovery, positive reappraisal, and optimism) were identified for the peri-pandemic outcomes. Control analyses revealed that in pre-pandemic times, neuroticism and optimism were predominantly related to PD changes. Regularized regression mostly confirmed the results and highlighted perceived stress recovery as most consistent influential protective factor across peri-pandemic outcomes. CONCLUSIONS: We identified several psychological risk and protective factors related to PD outcomes during the COVID-19 pandemic. A comparison of pre-pandemic data stresses the relevance of longitudinal assessments to potentially reconcile contradictory findings. Implications and suggestions for targeted prevention and intervention programs during highly stressful times such as pandemics are discussed.

Risk of SARS-CoV-2 infection, severe COVID-19 illness and COVID-19 mortality in people with pre-existing mental disorders: an umbrella review.

INTRODUCTION: The COVID-19 pandemic has posed a serious health risk, especially in vulnerable populations. Even before the pandemic, people with mental disorders had worse physical health outcomes compared to the general population. This umbrella review investigated whether having a pre-pandemic mental disorder was associated with worse physical health outcomes due to the COVID-19 pandemic. METHODS: Following a pre-registered protocol available on the Open Science Framework platform, we searched Ovid MEDLINE All, Embase (Ovid), PsycINFO (Ovid), CINAHL, and Web of Science up to the 6th of October 2021 for systematic reviews on the impact of COVID-19 on people with pre-existing mental disorders. The following outcomes were considered: risk of contracting the SARS-CoV-2 infection, risk of severe illness, COVID-19 related mortality risk, risk of long-term physical symptoms after COVID-19. For meta-analyses, we considered adjusted odds ratio (OR) as effect size measure. Screening, data extraction and quality assessment with the AMSTAR 2 tool have been done in parallel and duplicate. RESULTS: We included five meta-analyses and four narrative reviews. The meta-analyses reported that people with any mental disorder had an increased risk of SARS-CoV-2 infection (OR: 1.71, 95% CI 1.09-2.69), severe illness course (OR from 1.32 to 1.77, 95%CI between 1.19-1.46 and 1.29-2.42, respectively) and COVID-19 related mortality (OR from 1.38 to 1.52, 95%CI between 1.15-1.65 and 1.20-1.93, respectively) as compared to the general population. People with anxiety disorders had an increased risk of SAR-CoV-2 infection, but not increased mortality. People with mood and schizophrenia spectrum disorders had an increased COVID-19 related mortality but without evidence of increased risk of severe COVID-19 illness. Narrative reviews were consistent with findings from the meta-analyses. DISCUSSION AND CONCLUSIONS: As compared to the general population, there is strong evidence showing that people with pre-existing mental disorders suffered from worse physical health outcomes due to the COVID-19 pandemic and may therefore be considered a risk group similar to people with underlying physical conditions. Factors likely involved include living accommodations with barriers to social distancing, cardiovascular comorbidities, psychotropic medications and difficulties in accessing high-intensity medical care.

Effectiveness of a scalable, remotely delivered stepped-care intervention to reduce symptoms of psychological distress among Polish migrant workers in the Netherlands: study protocol for the RESPOND randomised controlled trial.

BACKGROUND: The COVID-19 pandemic has negatively affected the mental health of international migrant workers (IMWs). IMWs experience multiple barriers to accessing mental health care. Two scalable interventions developed by the World Health Organization (WHO) were adapted to address some of these barriers: Doing What Matters in times of stress (DWM), a guided self-help web application, and Problem Management Plus (PM +), a brief facilitator-led program to enhance coping skills. This study examines whether DWM and PM + remotely delivered as a stepped-care programme (DWM/PM +) is effective and cost-effective in reducing psychological distress, among Polish migrant workers with psychological distress living in the Netherlands. METHODS: The stepped-care DWM/PM + intervention will be tested in a two-arm, parallel-group, randomized controlled trial (RCT) among adult Polish migrant workers with self-reported psychological distress (Kessler Psychological Distress Scale; K10 > 15.9). Participants (n = 212) will be randomized into either the intervention group that receives DWM/PM + with psychological first aid (PFA) and care-as-usual (enhanced care-as-usual or eCAU), or into the control group that receives PFA and eCAU-only (1:1 allocation ratio). Baseline, 1-week post-DWM (week 7), 1-week post-PM + (week 13), and follow-up (week 21) self-reported assessments will be conducted. The primary outcome is psychological distress, assessed with the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS). Secondary outcomes are self-reported symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), resilience, quality of life, and cost-effectiveness. In a process evaluation, stakeholders' views on barriers and facilitators to the implementation of DWM/PM + will be evaluated. DISCUSSION: To our knowledge, this is one of the first RCTs that combines two scalable, psychosocial WHO interventions into a stepped-care programme for migrant populations. If proven to be effective, this may bridge the mental health treatment gap IMWs experience. TRIAL REGISTRATION: Dutch trial register NL9630, 20/07/2021, https://www.onderzoekmetmensen.nl/en/trial/27052.

Addressing mental health problems among persons without stable housing in the context of the COVID-19 pandemic: study protocol for a randomised trial. RESPOND - France.

BACKGROUND: The COVID-19 pandemic has had an impact on population-wide mental health and well-being. Although people experiencing socioeconomic disadvantage may be especially vulnerable, they experience barriers in accessing mental health care. To overcome these barriers, the World Health Organization (WHO) designed two scalable psychosocial interventions, namely the web-based Doing What Matters in Times of Stress (DWM) and the face-to-face Problem Management Plus (PM+), to help people manage stressful situations. Our study aims to test the effectiveness of a stepped-care program using DWM and PM + among individuals experiencing unstable housing in France - a majority of whom are migrant or have sought asylum. METHODS: This is a randomised controlled trial to evaluate the effectiveness and cost effectiveness of a stepped-care program using DWM and PM + among persons with psychological distress and experiencing unstable housing, in comparison to enhanced care as usual (eCAU). Participants (N = 210) will be randomised to two parallel groups: eCAU or eCAU plus the stepped-care program. The main study outcomes are symptoms of depression and anxiety measured using the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS). DISCUSSION: This randomised controlled trial will contribute to a better understanding of effective community-based scalable strategies that can help address the mental health needs of persons experiencing socioeconomic disadvantage, whose needs are high yet who frequently have limited access to mental health care services. TRIAL REGISTRATION: this randomised trial has been registered at ClinicalTrials.gov under the number NCT05033210.

Connecting and feeling: Associations between social factors and emotions in nine countries.

We aimed to explore the distribution of positive and negative emotions across nine low-, middle- and high-income countries; and the association between social factors and these emotions. Data were drawn from the SAGE and the COURAGE studies, with 52,553 participants. Emotions were assessed through the day reconstruction method.Sociodemographic characteristics and social factors were also measured. Multiple linear regressions were performed. Finland, China and African countries showed significantly lower scores on the negative emotions, whereas positive emotions were more homogeneous across countries. Loneliness was positively associated with negative emotions and negatively associated with positive ones; frequent social participation was related with higher scores in positive emotions; and lower trust with higher levels of feeling rushed, irritated, depressed and less calm. The extent to which each emotion was felt varied across countries, but there seems to exist an association of social factors with the emotions.

Late-life disability trajectories in Yoruba Nigerians and the Spanish population: a state space model in continuous time.

OBJECTIVES: We compared the trajectory of activities of daily living (ADL) in a nationally representative sample of older Nigerians with their Spanish peers and identified factors to explain country-specific growth models. METHODS: Data from two household multistage probability samples were used, comprising older adults from Spain (n = 2,011) and Nigeria (n = 1,704). All participants underwent assessment for ADL. Risk factors including sex, household income, urbanicity, years of education, depression, alcohol consumption and smoking were assessed using validated methods. State-space model in continuous time (SSM-CT) methods were used for trajectory comparison. RESULTS: Compared with Nigerians (µADL80=0.44, SE = 0.015, p < 0.001), Spanish older adults had higher disability scores (µADL80=1.23, SE = 0.021, p < 0.001). In SSM-CT models, the rate of increase in disability was faster in Nigerians (Nigeria: ß = 0.061, p<.01; Spain: ß = 0.028, p < 0.010). An increasing course of disability in the Spanish sample was predicted by female sex, lower education and depression diagnosis. CONCLUSION: The rate of increase in disability was faster in older Nigerians living in an economically disadvantaged context.

Episodic Memory and Verbal Fluency Tasks: Normative Data from Nine Nationally Representative Samples.

OBJECTIVE: This study aims to generate country-specific norms for two episodic memory tasks and a verbal fluency test among middle-aged and older adults using nationally representative data from nine low-, middle-, and high-income countries. METHOD: Data from nine countries in Africa, Asia, Europe, and Latin America were analyzed (n = 42,116; aged 50 years or older). Episodic memory was assessed with the word list memory (three trials of immediate recall) and word list recall (delayed recall). Verbal fluency was measured through the animal naming task. Multiple linear regression models with country-specific adjustments for gender, age, education, and residential area were carried out. RESULTS: Both age and education showed high influence on test performance (i.e. lower cognitive performance with increasing age and decreasing years of education, respectively), while the effect of sex and residential area on cognitive function was neither homogeneous across countries nor across cognitive tasks. CONCLUSIONS: Our study provided sex-, age-, education-, and residential area-specific regression-based norms that were obtained from one of the largest normative study worldwide on verbal recall and fluency tests to date. Findings derived from this study will be especially useful for clinicians and researchers based at countries where cognitive norms are limited.

From childhood financial hardship to late-life depression: socioeconomic pathways.

OBJECTIVE: Childhood financial hardship is associated with depression throughout the life course, including older adulthood. However, it is still unclear the extent to which occupation, education level and household income are mediators of this association. We aimed to examine the association between childhood financial hardship and late-life depression, and potential socioeconomic mediators using community-based data. METHODS: A nationally representative sample of 3623 non-institutionalized older Spanish adults aged 50+ was used. The associations between childhood financial hardship and depression, socioeconomic mediator variables and confounding variables such as chronic physical conditions, number of close people, and loneliness, were assessed through logistic regression models. Mediation analyses of socioeconomic variables were carried out. RESULTS: Older Spanish adults who experienced a poor childhood financial situation were nine times more likely to obtain a lower level of education than those with a good childhood financial situation, and about three times more likely to suffer from depression. Participants' education level mediated about 35-40% of the association between childhood financial hardship and late-life depression whereas we found no significant mediation effect of household income and occupation skill. CONCLUSION: Improving access to the educational system during the life course might result in a reduction in the prevalence of depression in the general population of older adults and particularly among individuals with low socioeconomic status.

Mediators of the socioeconomic status and life satisfaction relationship in older adults: a multi-country structural equation modeling approach.

OBJECTIVES: Socioeconomic status (SES) relates to life satisfaction in old age, although the underlying mechanisms remain unclear. Health and subjective social status have shown to be related to both SES and life satisfaction. This study aims to test the mediating role of health and subjective social status in old age, and to analyze if these potential mediations vary among three European countries with different socioeconomic characteristics and welfare regimes. METHOD: The sample comprised 7,272 participants aged 50+ from COURAGE in Europe study, a household survey carried out in 2011-2012 on nationally representative samples from Finland, Poland, and Spain. A Multiple Indicators, Multiple Causes approach based on multi-group Structural Equation Modeling was implemented to test mediating effects. RESULTS: The structural invariance model showed an adequate fit (CFI = 0.971, RMSEA = 0.061). Health and subjective social status invariantly mediated the relationship between SES and life satisfaction across countries with different socioeconomic characteristics and welfare regimes. SES direct effects explained 0.83-0.85% of life satisfaction variance, whilst indirect effects explained 2.29-2.36% of life satisfaction variance via health, 3.30-3.42% via subjective social status, and 0.06% via both mediating variables. CONCLUSION: Policies aimed at increasing the SES of the older adults may entail multiple benefits, resulting in better subjective social status, health, and life satisfaction outcomes, thus fostering healthy aging of the population.

Relationship between subjective well-being and healthy lifestyle behaviours in older adults: a longitudinal study.

Objectives: People who report better subjective well-being tend to be healthier in their daily behaviours. The objective of this study is to assess whether different components of subjective well-being are prospectively associated with different healthy lifestyle behaviours and to assess whether these associations differ by age.Method: A total of 1,892 participants aged 50+ living in Spain were interviewed in 2011-12 and 2014-15. Life satisfaction was measured with the Cantril Self-Anchoring Striving Scale. Positive and negative affect were assessed using the Day Reconstruction Method. Physical activity was assessed with the Global Physical Activity Questionnaire version 2. The remaining healthy lifestyle behaviours were self-reported. Generalised Estimating Equations (GEE) models were run.Results: Not having a heavy episodic alcohol drinking was the healthy lifestyle behaviour most fulfilled (97.97%), whereas the intake of five or more fruits and vegetables was the least followed (33.12%). GEE models conducted over the 50-64 and the 65+ age groups showed that a higher life satisfaction was significantly related to a higher physical activity in both groups. Relationships between a higher negative affect and presenting a lower level of physical activity, and a higher positive affect and following the right consumption of fruits and vegetables and being a non-daily smoker, were only found in the older group.Conclusion: The relationship between subjective well-being and healthy lifestyle behaviours was found fundamentally in those aged 65+ years. Interventions focused on incrementing subjective well-being would have an impact on keeping a healthy lifestyle and, therefore, on reducing morbidity and mortality.

Cross-national prevalence and factors associated with suicide ideation and attempts in older and young-and-middle age people.

Objectives: To report prevalence estimates of 12-month suicide ideation and attempts in young-and-middle age adults and older people, as well as their respective associated factors.Methods: A total of 52,150 community-dwelling adults who completed the adapted version of the Composite International Diagnostic Interview-Depression Module were included from SAGE and COURAGE in Europe studies. The presence of 12-month suicide ideation and attempts was measured among the participants who screened positively in the Depression Module. Global and national prevalence estimates of 12-month suicide ideation and attempts were calculated according to the total sample. Logistic regression analyses were conducted to separately determine factors associated with suicidal ideation and with suicide attempts in young-and-middle age adults and older adults.Results: Higher estimates of 12-month suicidal ideation were found for high-income countries and people aged 65 years and older. Higher negative affect, higher disability, and presence of food insecurity were associated with 12-month suicidal ideation and suicide attempts for young-and-middle-adults and older adults. Higher isolation, being female, and greater number of chronic health conditions were also related to 12-month suicidal ideation in both age groups. Younger age was associated with 12-month suicidal ideation for older people, and with suicide attempts in the young-and-middle age group. Finally, higher income was related to lower rates of 12-month suicidal ideation for the young-and-middle age group.Conclusions: Older people are at increased risk of suicidal ideation globally and of suicide attempts in some countries. There were common and different factors related to suicide in adults and older adults.

Are loneliness and social isolation associated with cognitive decline?

OBJECTIVE: This study aimed to examine the association of loneliness and social isolation on cognition over a 3-year follow-up period in middle- and older-aged adults. METHODS: Data from a Spanish nationally representative sample were analyzed (n = 1691; aged 50 years or older). Loneliness, social isolation, and cognition (immediate recall, delayed recall, verbal fluency, forward digit span, backward digit span, and a composite cognitive score) were assessed both at baseline and at follow-up. Adjusted generalized estimating equations models were performed. RESULTS: Loneliness was significantly associated with lower scores in the composite cognitive score, immediate and delayed recall, verbal fluency, and backward digit span (B = -0.14 to B = -3.16; P < .05) and with a more rapid decline from baseline to follow-up in two out of six cognitive tests. Higher social isolation was associated with lower scores in the composite cognitive score, verbal fluency, and forward digit span (B = -0.06 to B = -0.85; P < .05). The effect of loneliness and social isolation on cognition remained significant after the exclusion of individuals with depression. CONCLUSIONS: Both loneliness and social isolation are associated with decreased cognitive function over a 3-year follow-up period. The development of interventions that include the enhancement of social participation and the maintenance of emotionally supportive relationships might contribute to cognitive decline prevention and risk reduction.

Sociodemographic Indicators of Health Status Using a Machine Learning Approach and Data from the English Longitudinal Study of Aging (ELSA).

BACKGROUND Studies on the effects of sociodemographic factors on health in aging now include the use of statistical models and machine learning. The aim of this study was to evaluate the determinants of health in aging using machine learning methods and to compare the accuracy with traditional methods. MATERIAL AND METHODS The health status of 6,209 adults, age <65 years (n=1,585), 65-79 years (n=3,267), and >80 years (n=1,357) were measured using an established health metric (0-100) that incorporated physical function and activities of daily living (ADL). Data from the English Longitudinal Study of Ageing (ELSA) included socio-economic and sociodemographic characteristics and history of falls. Health-trend and personal-fitted variables were generated as predictors of health metrics using three machine learning methods, random forest (RF), deep learning (DL) and the linear model (LM), with calculation of the percentage increase in mean square error (%IncMSE) as a measure of the importance of a given predictive variable, when the variable was removed from the model. RESULTS Health-trend, physical activity, and personal-fitted variables were the main predictors of health, with the%incMSE of 85.76%, 63.40%, and 46.71%, respectively. Age, employment status, alcohol consumption, and household income had the%incMSE of 20.40%, 20.10%, 16.94%, and 13.61%, respectively. Performance of the RF method was similar to the traditional LM (p=0.7), but RF significantly outperformed DL (p=0.006). CONCLUSIONS Machine learning methods can be used to evaluate multidimensional longitudinal health data and may provide accurate results with fewer requirements when compared with traditional statistical modeling.

Machine learning methodologies versus cardiovascular risk scores, in predicting disease risk.

BACKGROUND: The use of Cardiovascular Disease (CVD) risk estimation scores in primary prevention has long been established. However, their performance still remains a matter of concern. The aim of this study was to explore the potential of using ML methodologies on CVD prediction, especially compared to established risk tool, the HellenicSCORE. METHODS: Data from the ATTICA prospective study (n = 2020 adults), enrolled during 2001-02 and followed-up in 2011-12 were used. Three different machine-learning classifiers (k-NN, random forest, and decision tree) were trained and evaluated against 10-year CVD incidence, in comparison with the HellenicSCORE tool (a calibration of the ESC SCORE). Training datasets, consisting from 16 variables to only 5 variables, were chosen, with or without bootstrapping, in an attempt to achieve the best overall performance for the machine learning classifiers. RESULTS: Depending on the classifier and the training dataset the outcome varied in efficiency but was comparable between the two methodological approaches. In particular, the HellenicSCORE showed accuracy 85%, specificity 20%, sensitivity 97%, positive predictive value 87%, and negative predictive value 58%, whereas for the machine learning methodologies, accuracy ranged from 65 to 84%, specificity from 46 to 56%, sensitivity from 67 to 89%, positive predictive value from 89 to 91%, and negative predictive value from 24 to 45%; random forest gave the best results, while the k-NN gave the poorest results. CONCLUSIONS: The alternative approach of machine learning classification produced results comparable to that of risk prediction scores and, thus, it can be used as a method of CVD prediction, taking into consideration the advantages that machine learning methodologies may offer.

Measurement invariance of the WHOQOL-AGE questionnaire across three European countries.

PURPOSE: Developing valid and reliable instruments that can be used across countries is necessary. The present study aimed to test the comparability of quality of life scores across three European countries (Finland, Poland, and Spain). METHOD: Data from 9987 participants interviewed between 2011 and 2012 were employed, using nationally representative samples from the Collaborative Research on Ageing in Europe project. The WHOQOL-AGE questionnaire is a 13-item test and was employed to assess the quality of life in the three considered countries. First of all, two models (a bifactor model and a two-correlated factor model) were proposed and tested in each country by means of confirmatory factor models. Second, measurement invariance across the three countries was tested using multi-group confirmatory factor analysis for that model which showed the best fit. Finally, differences in latent mean scores across countries were analyzed. RESULTS: The results indicated that the bifactor model showed more satisfactory goodness-of-fit indices than the two-correlated factor model and that the WHOQOL-AGE questionnaire is a partially scalar invariant instrument (only two items do not meet scalar invariance). Quality of life scores were higher in Finland (considered as the reference category: mean = 0, SD = 1) than in Spain (mean = - 0.547, SD = 1.22) and Poland (mean = - 0.927, SD = 1.26). CONCLUSIONS: Respondents from Finland, Poland, and Spain attribute the same meaning to the latent construct studied, and differences across countries can be due to actual differences in quality of life. According to the results, the comparability across the different considered samples is supported and the WHOQOL-AGE showed an adequate validity in terms of cross-country validation. Caution should be exercised with the two items which did not meet scalar invariance, as potential indicator of differential item functioning.

Housing conditions and risk of physical function limitations: a prospective study of community-dwelling older adults.

Background: Poor housing conditions have been associated with an increased risk of morbidity and mortality in old age. Methods: Prospective cohort of 1602 older adults followed from 2012 to 2015. Poor conditions were defined as living in a walk-up building, lacking piped hot water or heating, feeling frequently cold at home, lacking a bathtub/shower, a refrigerator, a washing machine, an own room or a landline. Frailty was assessed with the Fried criteria, lower extremities performance with the Short Physical Performance Battery (SPPB), and disability in instrumental activities of daily living (IADL) with the Lawton and Brody questionnaire. Results: During follow-up, 55 individuals (4.2%) developed frailty and 107 (7.2%) IADL disability. Mean (SD) SPPB values at baseline and at follow-up were 8.5 (2.5) and 8.6 (2.4), respectively. After multivariate adjustment, participants who lived in homes with ≥1 poor conditions showed a higher risk of frailty (odds ratio [OR] = 2.02; 95% confidence interval [95% CI]: 1.09-3.75) and transportation disability (OR = 3.50; 95% CI: 1.38-8.88). Lacking heating and feeling frequently cold were associated with an increased risk of exhaustion (OR = 2.34; 95% CI: 1.00-5.48) and transportation disability (OR = 3.31; 95% CI: 1.07-10.2), respectively. Conclusions: Prevention programs targeting functional limitations in older adults should ensure that they live in suitable housing conditions.