Purposes of Internet Use and Its Impacts on Physical and Psychological Health of Korean Older Adults.

Older adults engage in online activities for various purposes. An increasing number of studies are establishing connections between the purposes of internet use and their impacts on health outcomes. This study aimed to examine how the purposes of internet use affect self-rated health and depressive symptoms among Korean older adults. A nationally representative survey of community-dwelling older adults in Korea was used in the analysis (n = 5094). Instrumental internet use (using the internet to access various forms of information, services, and other resources) in Korean older adults was as common as interpersonal communication use, and the purposes of internet use were mainly for information seeking for everyday needs and engaging in various activities for enjoyment. Internet use for interpersonal communication and instrumental purposes was significantly associated with depressive symptoms and self-rated health. Internet use for instrumental purposes had a greater impact on self-rated health (ß = -0.186) and depressive symptoms (ß = -0.160) compared with the impacts of interpersonal communication internet use on self-rated health (ß = -0.101) and depressive symptoms (ß = -0.047). The findings highlighted the necessity of designing interventions that take into account the different purposes of internet use for older adults in order to maximize its benefits, paying special emphasis for information seeking online.

Physical Activity Pattern of Adults With Metabolic Syndrome Risk Factors: Time-Series Cluster Analysis.

Background: Physical activity plays a crucial role in maintaining a healthy lifestyle, and wrist-worn wearables, such as smartwatches and smart bands, have become popular tools for measuring activity levels in daily life. However, studies on physical activity using wearable devices have limitations; for example, these studies often rely on a single device model or use improper clustering methods to analyze the wearable data that are extracted from wearable devices. Objective: This study aimed to identify methods suitable for analyzing wearable data and determining daily physical activity patterns. This study also explored the association between these physical activity patterns and health risk factors. Methods: People aged >30 years who had metabolic syndrome risk factors and were using their own wrist-worn devices were included in this study. We collected personal health data through a web-based survey and measured physical activity levels using wrist-worn wearables over the course of 1 week. The Time-Series Anytime Density Peak (TADPole) clustering method, which is a novel time-series method proposed recently, was used to identify the physical activity patterns of study participants. Additionally, we defined physical activity pattern groups based on the similarity of physical activity patterns between weekdays and weekends. We used the χ2 or Fisher exact test for categorical variables and the 2-tailed t test for numerical variables to find significant differences between physical activity pattern groups. Logistic regression models were used to analyze the relationship between activity patterns and health risk factors. Results: A total of 47 participants were included in the analysis, generating a total of 329 person-days of data. We identified 2 different types of physical activity patterns (early bird pattern and night owl pattern) for weekdays and weekends. The physical activity levels of early birds were less than that of night owls on both weekdays and weekends. Additionally, participants were categorized into stable and shifting groups based on the similarity of physical activity patterns between weekdays and weekends. The physical activity pattern groups showed significant differences depending on age (P=.004) and daily energy expenditure (P<.001 for weekdays; P=.003 for weekends). Logistic regression analysis revealed a significant association between older age (≥40 y) and shifting physical activity patterns (odds ratio 8.68, 95% CI 1.95-48.85; P=.007). Conclusions: This study overcomes the limitations of previous studies by using various models of wrist-worn wearables and a novel time-series clustering method. Our findings suggested that age significantly influenced physical activity patterns. It also suggests a potential role of the TADPole clustering method in the analysis of large and multidimensional data, such as wearable data.

Predicting Habitual Use of Wearable Health Devices Among Middle-aged Individuals With Metabolic Syndrome Risk Factors in South Korea: Cross-sectional Study.

BACKGROUND: Prevention of the risk factors for metabolic syndrome (MetS) in middle-aged individuals is an important public health issue. Technology-mediated interventions, such as wearable health devices, can aid in lifestyle modification, but they require habitual use to sustain healthy behavior. However, the underlying mechanisms and predictors of habitual use of wearable health devices among middle-aged individuals remain unclear. OBJECTIVE: We investigated the predictors of habitual use of wearable health devices among middle-aged individuals with risk factors for MetS. METHODS: We proposed a combined theoretical model based on the health belief model, the Unified Technology of Acceptance and Use of Technology 2, and perceived risk. We conducted a web-based survey of 300 middle-aged individuals with MetS between September 3 and 7, 2021. We validated the model using structural equation modeling. RESULTS: The model explained 86.6% of the variance in the habitual use of wearable health devices. The goodness-of-fit indices revealed that the proposed model has a desirable fit with the data. Performance expectancy was the core variable explaining the habitual use of wearable devices. The direct effect of the performance expectancy on habitual use of wearable devices was greater (ß=.537, P<.001) than that of intention to continue use (ß=.439, P<.001), and the total effect estimate of the performance expectancy was 0.909 (P<.001), including the indirect effect (ß=.372, P=.03) on habitual use of wearable devices via intention to continue use. Furthermore, performance expectancy was influenced by health motivation (ß=.497, P<.001), effort expectancy (ß=.558, P<.001), and risk perception (ß=.137, P=.02). Perceived vulnerability (ß=.562, P<.001) and perceived severity (ß=.243, P=.008) contributed to health motivation. CONCLUSIONS: The results suggest the importance of the users' performance expectations for wearable health devices for the intention of continued use for self-health management and habituation. Based on our results, developers and health care practitioners should find better ways to meet the performance expectations of middle-aged individuals with MetS risk factors. They also should generate device use easier and find a way to encourage users' health motivation, thereby reducing users' effort expectancy and resulting in a reasonable performance expectancy of the wearable health device, to induce users' habitual use behaviors.

Health-Related Indicators Measured Using Earable Devices: Systematic Review.

BACKGROUND: Earable devices are novel, wearable Internet of Things devices that are user-friendly and have potential applications in mobile health care. The position of the ear is advantageous for assessing vital status and detecting diseases through reliable and comfortable sensing devices. OBJECTIVE: Our study aimed to review the utility of health-related indicators derived from earable devices and propose an improved definition of disease prevention. We also proposed future directions for research on the health care applications of earable devices. METHODS: A systematic review was conducted of the PubMed, Embase, and Web of Science databases. Keywords were used to identify studies on earable devices published between 2015 and 2020. The earable devices were described in terms of target health outcomes, biomarkers, sensor types and positions, and their utility for disease prevention. RESULTS: A total of 51 articles met the inclusion criteria and were reviewed, and the frequency of 5 health-related characteristics of earable devices was described. The most frequent target health outcomes were diet-related outcomes (9/51, 18%), brain status (7/51, 14%), and cardiovascular disease (CVD) and central nervous system disease (5/51, 10% each). The most frequent biomarkers were electroencephalography (11/51, 22%), body movements (6/51, 12%), and body temperature (5/51, 10%). As for sensor types and sensor positions, electrical sensors (19/51, 37%) and the ear canal (26/51, 51%) were the most common, respectively. Moreover, the most frequent prevention stages were secondary prevention (35/51, 69%), primary prevention (12/51, 24%), and tertiary prevention (4/51, 8%). Combinations of ≥2 target health outcomes were the most frequent in secondary prevention (8/35, 23%) followed by brain status and CVD (5/35, 14% each) and by central nervous system disease and head injury (4/35, 11% each). CONCLUSIONS: Earable devices can provide biomarkers for various health outcomes. Brain status, healthy diet status, and CVDs were the most frequently targeted outcomes among the studies. Earable devices were mostly used for secondary prevention via monitoring of health or disease status. The potential utility of earable devices for primary and tertiary prevention needs to be investigated further. Earable devices connected to smartphones or tablets through cloud servers will guarantee user access to personal health information and facilitate comfortable wearing.

[A Longitudinal Study of the Reciprocal Relationship between Depression and Income among Korean Older Men and Women].

PURPOSE: This study examined the reciprocal relationships between depression and income, and gender differences in these relationships among older adults in South Korea. METHODS: Using 2015 to 2019 of the Korea Welfare Panel Study (KoWePS), we studied 6,070 older adults (2,394 men and 3,676 women) aged 60 years over in 2015. The generalized estimating equation was employed to explore the effect of an individual income on depression and the reverse causal link-that of depression on income. RESULTS: The study found the reciprocal relationships between income and depression. Income has a significant impact on depression. Higher-income was linked to decreased risks of the Center for Epidemiologic Studies Depression (CES-D) scores among older adults (B = -0.121, p < 0.001). Estimates of the reverse causal link show that higher CES-D scores were also linked to income reduction among Korean older adults (B = -0.007, p < 0.001). In addition, we also observed gender differences in the impact of income on depression but not in the reverse causal link. Income has more detrimental to psychological consequence for older men (B = -0.108, p < 0.001) than older women (B = -0.057, p < 0.001). CONCLUSION: The finding implies that both psychological and social protection policies for the elderly are needed in view of gender perspective.

Effects of Simulated Laughter Therapy Using a Breathing Exercise: A Study on Hospitalized Pulmonary Tuberculosis Patients.

This study evaluated the effects of simulated laughter therapy on physical symptoms, pulmonary function, depression, and health-related quality of life (HRQOL) among pulmonary tuberculosis patients. This quasi-experimental study assigned tuberculosis patients of hospital A to a laughter group (n = 26) and those of hospital B to a control group (n = 26). The eight-week laughter therapy, held twice a week in a 60-min group session, included laughter, entertainment, music-related chorusing, breathing exercises, and meditation. The values of physical symptoms, pulmonary function, depression, and HRQOL from before and after the therapy were analyzed using the paired t-test and the Mann−Whitney U-test. To verify group differences between the experiment and control group, the Wilcoxon signed-rank test and the analysis of covariance (ANCOVA) were employed. Unlike the control group, laughter therapy decreased physical symptoms (t = 7.30, p < 0.01) and increased pulmonary function (t = −3.77, p < 0.01). Psychological health also improved, including depression (t = 10.46, p < 0.01) and HRQOL (t = −9.31, p < 0.01) in the experimental group but not in the control group. Group differences of changes in physical symptoms, pulmonary function, depression, and HRQOL were also significant. Simulated laughter therapy can help moderate depression and physical symptoms and enhance pulmonary function among tuberculosis patients.

Social Network Types and Depressive Symptoms among Older Korean Men and Women.

This study explores the social network types of older Korean men and women, and the relationship of those networks to depressive symptoms. A population of 4608 older adults who participated in the Living Profiles of Older People Survey (LPOPS) were included in the study. Seven criterion variables-marital status, living arrangements, frequency of contact with children, close friends, and close relatives, participation in social activities, and total network size-were included in a K-means cluster analysis. Multivariable logistic regression analysis of the impact of social network type on depressive symptoms was conducted. We identified two "diverse type" social networks (diverse-married and diverse-unmarried) in women, and one diverse type and one "social-activity-focused type" network in men. Family focused type and two "restricted type" social networks (restricted-couple-focused, and restricted-unmarried) were identified in both men and women. The restricted-unmarried and restricted-couple-focused networks were associated with more depressive symptoms in both men and women. However, the family focused type was associated with more depressive symptoms only in women. The results indicated that social network types, and their impact on depressive symptoms, differ by gender. There is a need for further research on gender differences in the social network types of older adults across diverse cultures.

Gender Differences in the Impact of Intergenerational Support on Depressive Symptoms among Older Adults in Korea.

Background: This study examined the relationship between intergenerational support patterns and depressive symptoms among older men and women in Korea. Methods: A nationally representative survey of non-institutionalized, community-dwelling older adults in Korea was used. A total of 7531 older adults (3592 men and 3939 women) was included in the analysis. Results: We observed gender differences in the impact of financial support exchanges on depressive symptoms. A lack of mutual financial support significantly increased the risk of depressive symptoms by 3.83 times (95% CI 2.34-6.24) in men and 1.73 times (95% CI 1.06-2.83) in women. Men who received financial support were more likely to experience depressive symptoms (OR (Odds Ratio), 1.81, 95% CI 1.36-2.42), whereas women who provided financial support were more likely to experience depressive symptoms (OR 2.82, 95% CI 1.21-6.56). The lack of an exchange of emotional support was significantly associated with depressive symptoms in both men (OR 1.49, 95% CI 1.17-1.90) and women (OR 1.87, 95% CI 1.50-2.34). Conclusions: We discuss the evidence of gender differences in intergenerational support exchange patterns and their impact on depressive symptoms within the context of Korean cultures and suggest that future research should be conducted on gender differences in the impact of intergenerational support on mental health across diverse societies.

Social Networking Site Usage and Its Impact on Depressive Symptoms among Older Men and Women in South Korea.

Background: We examined the rate of social networking site (SNS) usage and the relationship between SNS usage and depressive symptoms among older men and women in South Korea. Methods: The data were obtained from the Living Profiles of Older People Survey (LPOPS), which comprises a nationally representative sample of non-institutionalized Korean older adults living in the community. A total of 10,073 older persons (4286 men and 5787 women) were included in the analysis. Results: A total of 26.0% of the total study population reported to use social network sites. Of the men and women, 32.6 and 21.1%, respectively, used SNS. A higher educational level and higher equivalent household income, lower number of chronic illnesses, no limitation in daily activities, living with others, and having good relationships with friends and neighbors were associated with higher SNS usage among older men and women. SNS usage was significantly associated with reduced depression scores in older men, but not in women. Conclusions: The difference in SNS usage between older men and women might be partially explained by differential exposure to digital technologies and disadvantages in education and economic opportunities. Education programs for digitalization and opportunities to engage with technology need to be provided.

[Predictive Model for Quality of Life of the Older Men Living Alone].

PURPOSE: This study aimed to construct and test a predictive model that explains and predicts the quality of life in older men living alone. METHODS: A self-report questionnaire was used to collect data from 334 older adult men living along aged 65 years or over living in Jeollanam-do provinces. The endogenous variables were depression, self-rated health, instrumental activity of daily life, health promotion behaviors, the number of social participation activities and quality of life. Data were analyzed using the SPSS 21.0 and AMOS 21.0 programs. RESULTS: The final model with 14 of the 8 analysed paths showed a good fit to the empirical data: χ² = 173.26(p < .001, df = 53), normed χ² 3.27, GFI = .92, NFI = .90, CFI = .93, TLI = .89, RMSEA = .08 and SRMR = .06. Activities had direct effect on quality of life of older men living alone and social support had both direct and indirect effects. Meanwhile, function and socioeconomic status showed only indirect effects. The variables included in the eight significant paths explained 83.7% of variance in the prediction model. CONCLUSION: Instrumental activities of daily living and social support effect directly on quality of life in the older men living alone. Findings suggest that health care providers including community nurses need to provide social support as well as empowerment programs of instrumental activities of daily living and health promotion for improving quality of life of the older men living alone.

Psychometric properties of the Korean version of the Copenhagen Burnout Inventory in Korean homecare workers for older adults.

BACKGROUND: Despite the increasing number of homecare workers, a reliable and valid tool with which to measure burnout among Korean homecare workers is still lacking. The aim of this study was to examine the reliability and construct validity of the Korean version of the Copenhagen Burnout Inventory (CBI-K). METHODS: The study population consisted of 465 homecare workers. Data were collected in 2016 through a self-administered questionnaire including the three subscales of the CBI-K, the Center for Epidemiologic Studies Depression Scale (CESD-10), a measure of work-life conflict, and questions about respondents' sociodemographic characteristics. RESULTS: The confirmatory factor analyses results showed that the model fit indices of the refined three-factor model, in which the PB, WRB, and CRB subscales each contained six items, were acceptable (CFI = 0.924, SRMR = 0.049, RMSEA = 0.091). Furthermore, based on the results for construct reliability, discriminant validity of the refined three-factor model and job characteristics of homecare workers, we proposed that an abbreviated two-factor scale using the PB and CRB subscales could be used, with appropriate model fit indices (CFI = 0.950, SRMR = 0.047, RMSEA = 0.084). Each of the PB, WRB, and CRB subscales of CBI-K were associated with depressive symptoms even after controlling for covariates. CONCLUSIONS: The CBI-K has adequate reliability and validity for use with homecare workers. To increase its practicality, we suggest a refined form comprising only PB and CRB subscales can be used rather than a three-factor model.

Gender Differences in the Prevalence and Correlates of Elder Abuse in a Community-Dwelling Older Population in Korea.

BACKGROUND: We examined gender differences in the prevalence estimates and correlates of elder abuse in a community-dwelling older population in Korea. METHODS: We analyzed responses from the Living Profiles of Older People Survey (LPOPS), which comprises a nationally representative sample of non-institutionalized Korean older adults living in the community. A total of 10,184 older persons (4179 men and 6005 women) were included in the analysis. RESULTS: The overall rate of elder abuse was 9.9%, and emotional elder abuse was the most frequent type. Of the men and women subjects, 8.8 and 10.6%, respectively, had experienced elder abuse. We observed significant gender differences in the correlates of elder abuse. Educational attainment was significantly associated with elder abuse in men but not in women. Poor self-rated health was significantly associated with elder abuse in women but not in men. Household income and relationship with children were significantly associated with elder abuse in both men and women. CONCLUSION: Our results suggest that the factors that make elderly persons vulnerable to elder abuse may differ by gender. A better understanding of the risk factors for elder abuse across genders will facilitate the development of elder abuse prevention strategies, practices, and policies.

Impact of Living Alone on Depressive Symptoms in Older Korean Widows.

We examined the relationship between living alone and the prevalence of depressive symptoms in older Korean widows and assessed the individual contributions of health, social ties, and socioeconomic factors to the development of depressive symptoms. The study was a secondary analysis using data from widows, 65 years of age and older, who participated in the Living Profiles of Older People Survey (LPOPS). A logistic regression analysis was used to evaluate the contributions of health, social ties, and socioeconomic factors to the development of depressive symptoms. Working status and equivalent household income were significantly associated with depressive symptoms in both those living with others and those living alone. Adjustment for health status and social ties did not change the impact of living alone on the prevalence of depressive symptoms. However, adjustment for equivalent household income eliminated the negative association between living alone and depressive symptoms. Our findings indicate that economic resources are more important than health and social ties for alleviating the negative impact of living alone on the development of depressive symptoms in older widows.

Socio-demographic and Psychological Correlates of Posttraumatic Growth among Korean Americans with a History of Traumatic Life Experiences.

This study examined socio-demographic and psychological correlates of posttraumatic growth (PTG) among Korean Americans (KAs) with traumatic life experiences. A total of 286 KAs were included. Being a woman or having a lower annual household income had positive associations with PTG, while having no religion had a negative association with it. In addition, praying and visiting a mental health professional for coping with stress or for psychological problems was positively associated with PTG. Higher resilience scores increased PTG, while depressive symptoms decreased it. We suggest reinforcing help seeking behaviors and accessibility to care facilities, and gender specific strengthening programs for enhancing PTG among KAs.

Prospective Study on the Impact of Fear of Falling on Functional Decline among Community Dwelling Elderly Women.

Fear of falling (FOF) is expected to have effects on functional decline in the elderly. In this study, we examined over 2 years the effect of change in FOF on functional decline in community dwelling elderly. We conducted a secondary analysis using data from elderly women, 70 years of age and older, who participated in the Korean Longitudinal Study of Aging (KLoSA). Participants were divided into four categories according to change in FOF between the 2010 and 2012 surveys. Multiple logistic regression analysis was conducted regarding the effects of changes in FOF on functional decline after controlling for variables as known risk factors for functional decline. Rates of functional decline were highest in the "consistently having FOF" group, whereas they were lowest in the "consistently no FOF" group in both 2010 and 2012. Characteristics independently associated with functional decline were change in FOF, depressive symptoms, low frequency of meeting friends, and fear-induced activity avoidance. Longer exposure to FOF was associated with an increased risk of functional decline. FOF is an important health problem that deserves attention in its own right. Public health approaches for elderly persons should address early detection, prevention, and intervention programs for FOF.

[Prediction Model for Health-Related Quality of Life in Hospitalized Patients with Pulmonary Tuberculosis].

PURPOSE: This study was conducted to construct and test a structural equation model of health-related quality of life (HRQoL) among hospitalized patients with pulmonary tuberculosis (PTB). METHODS: Participants were 256 patients with PTB who were 20 years or older and admitted in two national tuberculosis hospitals. The patients participated in pulmonary function testing and responded to structured questionaries. RESULTS: The goodness-of-fit statistics of the final hypothetical model were as follows: χ²/df=2.19, RMSEA=.07, SRMR=.05, GFI=.95, NFI=.95, CFI=.96, TLI=.92, and PCFI=.52. Symptoms and general health perception had significant direct effects, and subjective economic status, social support and stigma had significant indirect effect on HRQoL of hospitalized patients with PTB. These variables explained 64% of variance in the prediction model. CONCLUSION: Findings suggest that strategies and intervention for physical symptoms and depressive symptoms are crucial to improve the quality of life in hospitalized patients with PTB. The development of various social support programs is also recommended.

Gender differences in exposure and vulnerability to psychosocial and behavioral factors of suicide attempt among Korean adolescents.

INTRODUCTION: This study examined gender differences in suicide attempts and their association with exposure and vulnerability to psychosocial, behavioral, and structural factors among Korean adolescents. METHODS: Data of 74 854 adolescents, taken from the 2010 Korea Youth Risk Behavior Survey, were used. Logistic regression analysis was used to assess the contribution of differential exposure to psychosocial, behavioral, and structural factors for gender differences of suicidal attempt. RESULTS: Gender differences were observed in the degree of exposure to the various factors. Females were more likely to report psychosocial problems, whereas males were more likely to report experience of smoking and drinking alcohol and to engage in vigorous physical activity. Stress and unhappiness were significantly associated with suicide attempts in both males and females, and gender differences in these variables were nonsignificant. Depressive symptoms were associated with a higher risk of suicide attempts, and this relationship was significantly stronger for males. The effects of cigarette smoking and risky drinking were significantly stronger in females. DISCUSSION: Greater exposure to perceived stress, feelings of unhappiness, depression, and higher vulnerability of smoking and heavy drinking accounted for higher suicide attempts of female adolescents. Higher exposure to health-related behaviors and greater vulnerability to depressive symptoms in male were also noted. In conclusion, differences in exposure and vulnerability to psychosocial and behavioral factors may partly explain gender differences in suicide attempts among Korean adolescents.

Socio-demographic and Health Behavioral Correlates of Depressive Symptoms among Korean Americans.

This study identifies the associations between socio-demographic characteristics and help seeking behaviors for depressive symptoms among adult Korean Americans (KAs). Using survey data from 230 residents of the New York City, Teaneck, New Jersey, and Philadelphia areas, simple and multiple logistic regression analyses were performed to assess the association between depressive symptoms and the covariates. Women were at much lower risk of depressive symptoms than were men, even after adjusting other covariates (OR 0.45, 95% CI 0.21-0.96). Having no health insurance (OR 4.02, 95% CI 1.28-12.61) and having experience in seeking professional help for mental health problems during the last year were significantly associated with depressive symptoms (OR 2.96, 95% CI 1.29-6.80). The findings suggest more attention to the risk of depression of KA men and further efforts on understanding the unique contribution of socio-demographic factors and health-related behaviors on depressive symptoms among KAs.

Widowhood and depressive symptoms among Korean elders: the role of social ties.

OBJECTIVES: This study examines the impact of social ties on the relationship between widowhood and depressive symptoms among the older Korean population. METHOD: Data were derived from the baseline survey of the Korean Longitudinal Study of Aging. The sample consisted of 1,953 men and 2,469 women aged ≥60 years who were married and had at least 1 child. The 10-item Center for Epidemiological Studies Depression Scale was the outcome measure. Multiple linear regression was used to evaluate the influence of social ties as the mediators and moderators on the relationship between widowhood and depressive symptoms. RESULTS: The quality of relationship between women and their children accounted for 51.52% of the difference in depressive symptoms between married and widowed women, but only 11.36% between married and widowed men. The interaction of widowhood and the quality of relationships with children was significant only among men, and the interaction of this status and cohabitation with married children was significant only among women. DISCUSSION: The quality of relationship with children plays an important mediating role in the relationship between widowed status and depressive symptoms among Korean men and women elders. Cohabitation with children may buffer mental distress for such women, and qualitatively good relationships with children may be important as moderators for the mental health of older Korean men after bereavement.

Socioeconomic status, social support and self-rated health among lone mothers in South Korea.

OBJECTIVES: This study examined the association of socioeconomic status and social support with the differences in self-rated health between lone and partnered mothers in South Korea. METHOD: Data came from women living with their children in the baseline survey of Korean Longitudinal Survey of Women and Family (N = 6,370) that yielded a very high response rate (95.8%). RESULTS: Compared to partnered mothers, lone mothers had a significantly higher risk of poor/fair health after adjusting for mediating factors (living natural parent, emotional support from siblings, social activities, educational attainment, equivalized household income, and subjective economic status). When all factors were individually included in the base model, each factor contributed to this difference. Subjective economic status explained 28.0% of the excess risk of poor/fair health among women in the lone compared to the partnered status. All factors combined accounted for 41.4% of the excess risk among lone mothers. CONCLUSIONS: The findings clearly indicate that lone mothers have poorer self-rated health than partnered mothers do, but this detrimental effect cannot be entirely explained by the socioeconomic and social support-mediating factors.