Exploring the relationship between depression and different multimorbidity patterns among older people covered by long-term care insurance in Shanghai, China.

BACKGROUND: Depression is common in patients with multimorbidity, but little is known about the relationship between depression and multimorbidity. The purpose of our research was to investigate multimorbidity patterns and their association with depression in a sample of older people covered by long-term care insurance in Shanghai, China. METHOD: This was a population-based cross-sectional study, with 1871 participants aged ≥60 years old who are covered by Shanghai long-term care insurance. Multimorbidity was defined as the presence of two or more chronic diseases at the same time. We collected information on chronic conditions using a self-reported medical history, and we used the 30-item Geriatric Depression Scale (GDS-30) to evaluate depressive symptoms. Patterns of multimorbidity were identified with exploratory factor analysis, using oblimin rotation. Logistic regression was used to estimate the relationship between multimorbidity patterns and depressive symptoms. RESULTS: Among the participants, the prevalence of multimorbidity was 64.7%, and the prevalence of depression was 64.6%. Hypertension, cardiovascular disease, cerebrovascular disease (CVD), and cataracts showed strong associations with depression when co-occurring with other conditions. Three patterns of multimorbidity were identified: a musculoskeletal pattern, cardiometabolic pattern, and degenerative disease pattern. Among these, the cardiometabolic (adjusted odds ratio (AOR) 1.223; 95% confidence interval (CI) 1.102, 1.357) and degenerative disease (AOR 1.185; 95% CI 1.071, 1.311) patterns were associated with a higher risk of depressive symptoms. CONCLUSION: Two of three multimorbidity patterns were found to be associated with depression. Physical and psychological dimensions require greater attention in the care of older adults who are covered by long-term care insurance.

Institutional Satisfaction and Anxiety Mediate the Relationship Between Social Support and Depression in Hypertension Patients in Elderly Caring Social Organizations: A Cross-Sectional Study.

Background: Depression is a prevalent health condition among hypertension patients in elderly caring social organizations (SOs). Patients with hypertension and depression symptoms have worse health outcomes than those without depression. As the population ages, chronic and mental health issues such as depression of hypertension patients in elderly caring SOs have become prominent. However, the combined effects of social support, institutional satisfaction, and anxiety on depression among hypertension individuals in elderly caring SOs remain unclear. This study aimed to explore the mediating effects of institutional satisfaction and anxiety on the relationship between social support and depression among hypertension patients in elderly caring SOs in Anhui Province, China. Methods: A cross-sectional study was conducted using a multi-stage stratified random sampling method. A questionnaire was used to collect data on demographic characteristics, the satisfaction of elderly caring SOs, social support, anxiety, and depression. A multiple linear regression model was utilized to investigate depression-related factors, and structural equation modeling (SEM) was employed to examine the relationships between social support, institutional satisfaction, anxiety, and depression among patients with hypertension in elderly caring SOs. Results: Our results indicated that the mean scores of social support were 20.19 ± 6.98 and 1.92 ± 3.18 for anxiety, and 6.24 ± 5.03 for depression; besides, 33.3% of participants were very satisfied with elderly caring SOs, 48.5% were satisfied, and only 6.0% were dissatisfied or very dissatisfied. Comorbid chronic diseases were significantly associated with depression. Institutional satisfaction was directly negatively related to depression, whereas anxiety was directly positively correlated with depression. Social support had an indirect negative association with depression by the mediating effects of institutional satisfaction and anxiety. Conclusions: The study highlights the importance of social support in maintaining mental health among hypertension patients residing in elderly caring SOs. To alleviate depression among hypertension patients in elderly caring SOs, strategies that target enhancing social support, institutional satisfaction, and anxiety reduction should be prioritized. More importantly, more attention should be paid to patients with comorbid chronic diseases.

Mediation role of perceived social support and burnout on financial satisfaction and turnover intention in primary care providers: a cross-sectional study.

BACKGROUND: Turnover intention is a major cause of reduced team morale and low work efficiency. It hinders work performance and reduces the quality of medical services. This study aimed to investigate the relationship between financial satisfaction and turnover intention and its mediators among primary care providers. METHODS: Multi-stage random cluster sampling was used to select 1241 participants from four counties and three districts in Anhui province, China. Data were collected using a self-administered questionnaire. Turnover intention was assessed with a turnover intention assessment scale. Perceived social support and burnout were measured with the 12-item Perceived Social Support Scale and the Chinese version of the Maslach Burnout Inventory, respectively. Structural equation modeling was used for data analysis. RESULTS: The findings showed high turnover intention among primary care providers (mean score 14.16 ± 4.337), and most providers reported low financial satisfaction (mean score 2.49 ± 0.990). The mean perceived social support score was 64.93 ± 13.229, and only 6.1% of primary care providers reported no burnout. Compared with participants with high financial satisfaction, those with low financial satisfaction were more likely to report higher turnover intention (ß = - 0.216, p < 0.001), less perceived social support (ß = 0.181, p < 0.001), and more severe burnout (ß = - 0.123, p < 0.05). Turnover intention may be related to perceived social support (ß = - 0.147, p < 0.001) and burnout (ß = 0.239, p < 0.001). Furthermore, the effect of financial satisfaction on turnover intention was significantly mediated by perceived social support (ß = - 0.027, p < 0.001) and burnout (ß = - 0.029, p < 0.05). CONCLUSIONS: Turnover intention is associated with financial satisfaction, with this association mediated by perceived social support and burnout. A reasonable mechanism needs to be established to improve financial satisfaction and perceived social support and reduce burnout among primary care providers.

Association between multimorbidity patterns and disability among older people covered by long-term care insurance in Shanghai, China.

BACKGROUND: Functional disability and multimorbidity are common among older people. However, little is known about the relationship between functional disability and different multimorbidity combinations. We aimed to identify multimorbidity patterns and explore the associations between these patterns and functional disability. METHODS: We investigated a multi-stage random sample of 1871 participants aged ≥60 years and covered by long-term care insurance in Shanghai, China. Multimorbidity was defined as the simultaneous presence of two or more chronic diseases in an individual. Participants completed scales to assess basic and instrumental activities of daily living (BADL and IADL, respectively). Multimorbidity patterns were identified via exploratory factor analysis. Binary logistic regression models were used to determine adjusted associations between functional disability and number and patterns of multimorbidity. RESULTS: Multimorbidity was present in 74.3% of participants. The prevalence of BADL disability was 50.7% and that of IADL disability was 90.7%. There was a strong association between multimorbidity and disability. We identified three multimorbidity patterns: musculoskeletal, cardio-metabolic, and mental-degenerative diseases. The cardio-metabolic disease pattern was associated with both BADL (OR 1.28, 95%CI 1.16-1.41) and IADL (OR 1.41, 95%CI 1.19-1.68) disability. The mental-degenerative disease pattern was associated with BADL disability (OR 1.55, 95%CI 1.40-1.72). CONCLUSIONS: Multimorbidity and functional disability are highly prevalent among older people covered by long-term care insurance in Shanghai, and distinct multimorbidity patterns are differentially associated with functional disability. Appropriate long-term healthcare and prevention strategies for older people may help reduce multimorbidity, maintain functional ability, and improve health-related quality of life.

Current status and related factors of turnover intention of primary medical staff in Anhui Province, China: a cross-sectional study.

BACKGROUND: The shortage of primary medical staff is an important issue in the management of health human resources, and it is also a problem that all countries in the world need to face together. Since 2009, China has implemented a new series of medical system reforms and the shortage and loss of primary medical staff have been alleviated accordingly. However, China has a large population and it is difficult to distribute health human resources evenly across regions. This study aimed to explore the current status of turnover intention and its relationship with psychological capital, social support, and job burnout, as well as how these factors influence turnover intention of primary medical staff in Anhui province, China. METHODS: Using structured questionnaires to collect data, including demographic characteristics, turnover intention, psychological capital, social support, and Chinese Maslach Burnout Inventory scale. A total of 1152 primary medical workers of Anhui were investigated. Data were analyzed by t-test, analysis of variance (ANOVA), Pearson correlation analysis, and multiple linear regression model. RESULTS: Total scores of turnover intention, psychological capital, social support, and job burnout of subjects were 14.15 ± 4.35, 100.09 ± 15.98, 64.93 ± 13.23 and 41.07 ± 9.437, respectively. Multiple linear regression showed the related factors of turnover intention were age, job position, work unit, and scores of job burnout. Pearson correlation showed psychological capital and social support were negatively correlated with turnover intention, while the score of job burnout was positively correlated with turnover intention. CONCLUSION: The improvement of psychological capital and social support and the reduction of job burnout may play an important role in reducing turnover intention of primary medical staff. Primary medical managers should strengthen the humanistic care for primary medical staff, optimize the incentive mechanism, and improve internal management of medical institutions for stability.

Incentive Preferences and Its Related Factors Among Primary Medical Staff in Anhui Province, China: A Cross-Sectional Study.

Background: The shortage of primary medical staff is a major problem in the management of health human resources across many developing countries. By determining their preferences for various motivational and related factors, we examined the correlation between staff's motivation preference levels and staff turnover and turnover intention. This study aimed to further improve the incentive mechanism and to provide a reference for healthcare managers to formulate management strategies for the primary medical staff team. Methods: A self-reported questionnaire survey was conducted to collect data. The basic survey content included demographic characteristics. The absolute level questionnaire and relative level questionnaire on the factors affecting motivation preference were used as the main assessment scales. A total of 1,112 primary health workers in Anhui Province were investigated. T-test, analysis of variance (ANOVA), exploratory factor analysis, and multiple linear regression analysis were performed to analyze the data. Results: The survey respondents (45.1%) reported being satisfied with their relationship with colleagues, and other social relationships (46.9%). The Kaiser Meyer Olkin (KMO) value for the absolute preference degree for motivational factors was 0.951. Two factors (economic and non-economic factors), after using the maximum variance rotation axis method, explained 81.25% of the total variance. The regression analysis showed that primary medical staff members with low monthly income (B = -0.157) have a higher preference for non-economic factors; the higher the educational background (B = 0.133), the higher their preference for economic factors. In addition, with the increase in participants' age (B = -0.250), the preference for motivational factors gradually decreased. Conclusion: Both economic and non-economic factors play an important role in enhancing the enthusiasm of primary medical workers and improving their work attitude. Managers should use their influence to stabilize the primary medical staff.