Bedtime negative affect, sleep quality and subjective health in rural China.

BACKGROUND: The overall level of negative affect (NeA) has been linked to impaired health. However, whether the diurnal timing of NeA matters and whether the NeA-health relationship is mediated by sleep quality remain unclear. METHODS: Using a longitudinal dataset (2006, 2009 and 2014 waves) consisting of 1959 participants, we examined the within-person impact of both bedtime NeA and non-bedtime NeA measured by Day Reconstruction Method (DRM) on subjective health measured by Visual Analogue Scale (VAS), and the mediating effect of sleep quality on the NeA-health relationships by fixed effect models. RESULTS: Bedtime NeA predicted poorer health, while non-bedtime NeA was unrelated to health. The deleterious impact of bedtime NeA reduced and became non-significant after sleep quality was controlled for. Bedtime NeA also significantly predicted impaired sleep quality. CONCLUSIONS: Bedtime NeA is a stronger predictor of poorer health than non-bedtime NeA, and the deleterious influence of bedtime NeA on health seems to operate through poor sleep quality. Therefore, interventions to reduce bedtime NeA could potentially improve subsequent sleep quality, thereby protecting people to some extent from impaired health status.

Could diabetes prevention programmes result in the widening of sociodemographic inequalities in type 2 diabetes? Comparison of survey and administrative data for England.

BACKGROUND: The NHS Diabetes Prevention Programme (DPP) in England is a behavioural intervention for preventing type 2 diabetes mellitus (T2DM) among people with non-diabetic hyperglycaemia (NDH). How this programme affects inequalities by age, sex, limiting illnesses or disability, ethnicity or deprivation is not known. METHODS: We used multinomial and binary logistic regression models to compare whether the population with NDH at different stages of the programme are representative of the population with NDH: stages include (1) prevalence of NDH (using survey data from UK Household Longitudinal Study (n=794) and Health Survey for England (n=1383)); (2) identification in primary care and offer of programme (using administrative data from the National Diabetes Audit (n=1 267 350)) and (3) programme participation (using programme provider records (n=98 024)). RESULTS: Predicted probabilities drawn from the regressions with demographics as each outcome and dataset identifier as predictors showed that younger adults (aged under 40) (4% of the population with NDH (95% CI 2.4% to 6.5%)) and older adults (aged 80 and above) (12% (95% CI 9.5% to 14.2%)) were slightly under-represented among programme participants (2% (95% CI 1.8% to 2.2%) and 8% (95% CI 7.8% to 8.2%) of programme participants, respectively). People living in deprived areas were under-represented in eight sessions (14% (95% CI 13.7% to 14.4%) vs 20% (95% CI 16.4% to 23.6%) in the general population). Ethnic minorities were over-represented among offers (35% (95% CI 35.1% to 35.6%) vs 13% (95% CI 9.1% to 16.4%) in general population), though the proportion dropped at the programme completion stage (19% (95% CI 18.5% to 19.5%)). CONCLUSION: The DPP has the potential to reduce ethnic inequalities, but may widen socioeconomic, age and limiting illness or disability-related inequalities in T2DM. While ethnic minority groups are over-represented at the identification and offer stages, efforts are required to support completion of the programme. Programme providers should target under-represented groups to ensure equitable access and narrow inequalities in T2DM.

Household wealth, neighbourhood deprivation and frailty amongst middle-aged and older adults in England: a longitudinal analysis over 15 years (2002-2017).

BACKGROUND: frailty is a condition of reduced function and health due to ageing processes and is associated with a higher risk of falls, hospitalisation, disability and mortality. OBJECTIVE: to determine the relationship between household wealth and neighbourhood deprivation with frailty status, independently of demographic factors, educational attainment and health behaviours. DESIGN: population-based cohort study. SETTING: communities in England. SUBJECTS: in total 17,438 adults aged 50+ from the English Longitudinal Study of Ageing. METHODS: multilevel mixed-effects ordered logistic regression was used in this study. Frailty was measured using a frailty index. We defined small geographic areas (neighbourhoods) using English Lower layer Super Output Areas. Neighbourhood deprivation was measured by the English Index of Multiple Deprivation, grouped into quintiles. Health behaviours included in this study are smoking and frequency of alcohol consumption. RESULTS: the proportion of respondents who were prefrail and frail were 33.8% [95% confidence interval (CI) 33.0-34.6%] and 11.7 (11.1-12.2)%, respectively. Participants in the lowest wealth quintile and living in the most deprived neighbourhood quintile had 1.3 (95% CI = 1.2-1.3) and 2.2 (95% CI = 2.1-2.4) times higher odds of being prefrail and frail, respectively, than the wealthiest participants living in the least deprived neighbourhoods Living in more deprived neighbourhood and poorer wealth was associated with an increased risk of becoming frail. Those inequalities did not change over time. CONCLUSIONS: in this population-based sample, living in a deprived area or having low wealth was associated with frailty in middle-aged and older adults. This relationship was independent of the effects of individual demographic characteristics and health behaviours.

A prospective analysis examining frailty remission and the association with future falls risk in older adults in England.

BACKGROUND: Previous research has shown older adults experience dynamic changes in frailty status. This study aimed to determine the occurrence of sustained frailty remission and how remission is associated with falls risk. METHODS: Participants who contributed data to the analysis were in the English Longitudinal Study of Ageing from Waves 1 to 8 (2002-2017). Frailty was defined across waves using the frailty index and categorised into robust, pre-frail and frail. We classified participants who improved their frailty category from Wave 1 (2002) to Wave 2 (2004) and sustained/improved category again into Wave 3 (2006) and compared them with those who were either robust or frail across Waves 1-3. Cox proportional hazard modelling was used to determine the risk of incident falls reported at Waves 4-8, with results expressed as hazard ratios and 95% confidence intervals. RESULTS: Of 2,564 participants, 389 (15·2%) improved frailty category and sustained this during Waves 2-3, 1,489 (58·1%) remained robust and 686 (26·8%) remained frail during Waves 1-3. During the 10-year period (Waves 4-8), a total of 549 participants reported a fall. Compared with those who remained frail during Waves 1-3, those who with sustained frailty remission had a lower risk of future falls (HR 0·41; 95% CI = 0·36-0·45). CONCLUSIONS: Frailty remission is possible and can be sustained across 5 years. There is a lower risk of future falls in those who sustain frailty remission compared with those who remain frail.

Prediction of bullying at work: A data-driven analysis of the Finnish public sector cohort study.

AIM: To determine the extent to which change in (i.e., start and end of) workplace bullying can be predicted by employee responses to standard workplace surveys. METHODS: Responses to an 87-item survey from 48,537 Finnish public sector employees at T1 (2017-2018) and T2 (2019-2020) were analyzed with least-absolute-shrinkage-and-selection-operator (LASSO) regression. The predictors were modelled both at the individual- and the work unit level. Outcomes included both the start and the end of bullying. Predictive performance was evaluated with C-indices and density plots. RESULTS: The model with best predictive ability predicted the start of bullying with individual-level predictors, had a C-index of 0.68 and included 25 variables, of which 6 remained in a more parsimonious model: discrimination at work unit, unreasonably high workload, threat that some work tasks will be terminated, working in a work unit where everyone did not feel they are understood and accepted, having a supervisor who was not highly trusted, and a shorter time in current position. Other models performed even worse, either from the point of view of predictive performance, or practical useability. DISCUSSION: While many bivariate associations between socioeconomic characteristics, work characteristics, leadership, team climate, and job satisfaction were observed, reliable individualized detection of individuals at risk of becoming bullied at workplace was not successful. The predictive performance of the developed risk scores was suboptimal, and we do not recommend their use as an individual-level risk prediction tool. However, they might be useful tool to inform decision-making when planning the contents of interventions to prevent bullying at an organizational level.

Understanding the longitudinal dynamics of rural-urban mental health disparities in later life in China.

OBJECTIVES: Understanding longitudinal patterns of rural-urban mental health disparities is vital for effective intervention and policy development in China. However, few studies have estimated separate effects of birth-cohort and ageing and examined the role of community resources on health inequalities. METHODS: Drawing data from the China Health and Retirement Longitudinal Study (2011-2018), this study employed multilevel modelling to identify the mental health trajectories of rural, peri-urban, urban older adults by cohort and the community effects. RESULTS: The changes in the mental health gap between rural, peri-urban and urban older adults over time varied by birth cohorts. Among younger cohorts aged under 65, the mental health disparities between rural, peri-urban and urban residents increased as they got older. Underdeveloped community infrastructure greatly explained the rural health disadvantage. CONCLUSION: The study indicates increasing rural-urban health disparities at the onset of later life. Improving community infrastructure in rural and peri-urban areas is vital to minimise rural-urban health gaps.

Home modifications and disability outcomes: A longitudinal study of older adults living in England.

Background: There is limited evidence on the protective effect of housing modifications on disability outcomes among older adults. We examined whether external and internal housing modifications reduce the risk of a range of disability outcomes among older adults living in England. Methods: We analysed adults aged 60 and over from the English Longitudinal Study of Ageing, initially recruited in 2002/03. The longitudinal sample consisted of 32,126 repeated observations from 10,459 individuals across 6 waves with an average follow-up of 11·3 years. Participants were asked if their homes had external (widened doorways, ramps, automatic doors, parking and lift) and internal (rails, bathroom/kitchen modifications, chair lift) housing modifications. Mobility impairment was measured through reported difficulties in 10 activities including walking, climbing, getting up, reaching and lifting. Five disability outcomes were analysed (falls in the previous two years, pain, poor self-rated health, no social activities, and moving home within next two years) using two-way fixed effect models, controlling for key risk factors for disability. Findings: Greater mobility impairments increased the probability of falls, pain and poor self-rated health although this effect was significantly moderated by external housing modifications. Among older adults with severe mobility impairments, external housing modifications reduced the probability of falls by 3% (1%-6%), pain by 6% (4%-8%), and poor health by 4% (2%-5%). Moreover, external housing modifications reduced the probability of no social activities by 6% (5%-7%) and moving home by 4% (2%-5%) even among those without any mobility impairments. Internal housing modifications had similar, but less consistent effects on the disability outcomes. Interpretation: There was strong evidence that external housing modifications protected against a range of disability outcomes. Studies on reducing disability in ageing populations need to consider the role of housing modifications as key interventions to promote healthy ageing in place. Funding: Economic and Social Research Council ES/R008930/1 and ES/S012567/1.

Genetic Variants Associated With Resilience in Human and Animal Studies.

Resilience is broadly defined as the ability to maintain or regain functioning in the face of adversity and is influenced by both environmental and genetic factors. The identification of specific genetic factors and their biological pathways underpinning resilient functioning can help in the identification of common key factors, but heterogeneities in the operationalisation of resilience have hampered advances. We conducted a systematic review of genetic variants associated with resilience to enable the identification of general resilience mechanisms. We adopted broad inclusion criteria for the definition of resilience to capture both human and animal model studies, which use a wide range of resilience definitions and measure very different outcomes. Analyzing 158 studies, we found 71 candidate genes associated with resilience. OPRM1 (Opioid receptor mu 1), NPY (neuropeptide Y), CACNA1C (calcium voltage-gated channel subunit alpha1 C), DCC (deleted in colorectal carcinoma), and FKBP5 (FKBP prolyl isomerase 5) had both animal and human variants associated with resilience, supporting the idea of shared biological pathways. Further, for OPRM1, OXTR (oxytocin receptor), CRHR1 (corticotropin-releasing hormone receptor 1), COMT (catechol-O-methyltransferase), BDNF (brain-derived neurotrophic factor), APOE (apolipoprotein E), and SLC6A4 (solute carrier family 6 member 4), the same allele was associated with resilience across divergent resilience definitions, which suggests these genes may therefore provide a starting point for further research examining commonality in resilience pathways.

The validity of the residuals approach to measuring resilience to adverse childhood experiences.

BACKGROUND: Resilience is broadly defined as the ability to maintain or regain functioning in the face of adversity. Recent work to harmonise the quantification and definition of resilience quantifies resilience as the residual variance in psychosocial functioning that remains after accounting for adversity exposure. However, there have been no published studies that have formally investigated the validity of this approach. Considering this, we examine the construct and predictive validity of the residuals approach using participants from the Avon Longitudinal Study of Parents and Children (ALSPAC), a multigenerational, longitudinal cohort study. METHODS: We regressed exposures of adolescent adversity on adolescent psychopathology scores using the Strength and Difficulties Questionnaire and obtained the residual variance. We investigated construct validity by analysing whether previously identified demographic and resilience factors significantly predicted resilience. Predictive validity of resilience was investigated by comparing the predictive power of resilience with other determinants of psychosocial functioning on two developmental outcomes: depressive symptoms at 18 years, measured by the Short Moods and Feelings Questionnaire, and NEET (Not in Employment, Education or Training) status at 17 and 23 years. The associations between depressive symptoms at 18, resilience, ACEs and covariates were tested using multiple linear regression. NEET status at 17 and 23 were run as separate binary multiple logistic regression models to test associations with resilience and known demographics previously associated with NEET status. RESULTS: Seven previously identified protective factors, including self-esteem, positive sibling relationship, temperament, and positive perception of school, significantly predicted resilience to adolescent psychopathology, thus providing strong construct validity. Resilience significantly predicted a reduction in depressive symptoms at 18 years, and significantly decreased the likelihood of having NEET status at both 17 years and 23 years, even after taking into account early childhood adversity and other risk factors. None of the socioeconomic factors were significantly associated with resilience. CONCLUSIONS: Our study demonstrates that the residuals method of operationalising resilience has good construct and predictive validity yet recommend replication studies. It has the potential to advance research into the mechanisms and modifiability of resilience. TRIAL REGISTRATION: Not applicable.

Biological costs and benefits of social relationships for men and women in adulthood: The role of partner, family and friends.

Despite numerous studies on social relationships and health, the empirical focus has often been on middle-aged or older adults, even though young adulthood is a period of considerable change in social networks. We investigated whether the associations between social relationships and allostatic load, a multisystem physiological dysregulation index that reflects chronic stress responses, vary by type of relationship and stages of the lifecourse. Relationships with spouse/partner, immediate family and friends were assessed in terms of emotional support and social strain. Poisson regression models on multiple imputed data sets from waves 2-3 (2010-2012) of the UK Household Longitudinal Study (N = 10,380) were estimated. Social strain, particularly from partners and immediate family, appeared to elicit greater stress related dysregulation during early adulthood (age 21-34 years), corresponding to a predicted difference in the allostatic load index (range 0-12) between high and low strained relationships of 1.1 (95% CI: 0.5-1.6) among young women and 0.6 (95% CI: -0.04 to 1.2) among young men. There was little evidence of an association between allostatic load and any of the social relationships among older men and women. Models of social relationships over the lifecourse need to take account of how stressful social relationships become biologically embedded in early adulthood.

Adverse employment histories and allostatic load: associations over the working life.

BACKGROUND: Most studies on the health impact of occupational stress use single-point measures of stress at work. This study analyses the associations of properties of entire employment trajectories over an extended time period with a composite score of allostatic load (AL). METHODS: Data come from the French CONSTANCES cohort, with information on adverse employment histories between ages 25 and 45 and a composite score of AL (based on 10 biomarkers, range 0-10) among people aged 45 or older (47 680 women and 45 035 men). Data were collected by questionnaires (including retrospective employment histories) or by health examinations (including blood-based biomarkers). We distinguish six career characteristics: number of temporary jobs, number of job changes, number of unemployment periods, years out of work, mode occupational position and lack of job promotion. RESULTS: For both men and women, results of negative binomial regressions indicate that adverse employment histories are related to higher levels of AL, particularly histories that are characterised by a continued disadvantaged occupational position, repeated periods of unemployment or years out of work. Findings are adjusted for partnership, age and education, and respondents with a health-related career interruption or early retirement are excluded. CONCLUSIONS: Our study highlights physiological responses as a mechanism through which chronic stress during working life is linked to poor health and calls for intervention efforts among more disadvantaged groups at early stages of labour market participation.

The mental health impact of COVID-19 and lockdown-related stressors among adults in the UK.

BACKGROUND: The COVID-19 pandemic in the UK and subsequent lockdown may have affected the mental health of the population. This study examines whether there was an increase in the prevalence and incidence of common mental disorders (CMD) in the UK adult population during the first months of lockdown and whether changes in CMD were associated with stressors related to the pandemic and lockdown. METHODS: Longitudinal data from the UK Household Longitudinal Study waves 10-11: 2019-2020 and waves 1-4 of the COVID-19 monthly surveys in April (n = 17 761) to July 2020 (n = 13 754), a representative sample of UK adult population, were analysed. CMD was measured using the 12-item General Health Questionnaire (GHQ-12) (cut-off >2). Changes in CMD were analysed in relation to COVID-19 and social stressors. RESULTS: Around 29% of adults without CMD less than a year earlier had a CMD in April 2020. However, by July 2020, monthly incidence of CMD had reduced to 9%. Most employment, financial and psychological 'shocks' were at their highest levels in April and reduced steadily in later months. Despite the lifting of some lockdown conditions by July, stressors related to loneliness, unemployment, financial problems and domestic work continued to influence CMD. CONCLUSION: Some COVID-19 policy responses such as furloughing may have been effective in mitigating the increase in CMD for some groups of employees. Despite some reduction in levels of pandemic and lockdown-related stressors by the middle of 2020, loneliness and financial stressors remained key determinants of incidence in CMD among the UK adult population.

The role of workplace accommodations in explaining the disability employment gap in the UK.

There has been limited theoretical and empirical research into the role of workplace accommodations in enabling workers with and without impairments to remain in work. This study used the International Classification of Functioning, Disability and Health (ICF) model to examine (a) whether workplace accommodations enable workers, particularly those with different impairments, to remain economically active; and (b) the predictors of the onset of work accommodations. Data from two waves of a large-scale longitudinal survey of disability in Great Britain, the Life Opportunities Survey (2009-2012) were analysed. 2307 workers with an impairment and 4308 workers without an impairment were followed up for a year. Work accommodations appear to enable workers with impairments to remain economically active, especially those with mental impairments. There was no difference in the employment rates of workers with and without mental impairments who had two or more work accommodations, in contrast to the 10% employment gap between workers with and without mental impairments who did not have any work accommodations. While there was no gender difference in the disability employment gap, barriers to employment related to caregiving were much greater for women compared to men. Moreover, only workers with incident pain impairments were associated with an increase in their work accommodations, not workers with incident mental impairments. Despite the evidence that workers with mental impairments could benefit considerably from workplace accommodations, they are less likely to have their workplace adjusted. The ICF model is particularly useful in analysing the role of work accommodations because it considers a much wider range of factors that are relevant not just to workers with different types of impairments, but are also relevant to the wider group of workers who use workplace accommodations.

The Role of Facets of Job Satisfaction in the National and Socioeconomic Differences in Overall Job Satisfaction: A Comparison Between Studies of Civil Servants in Great Britain and Japan.

OBJECTIVE: To explore national and socioeconomic differences in overall job satisfaction, we examined whether those differences can be explained by what job-related factors. METHODS: Our datasets for this study are from the Whitehall II study and the Japan Civil Servant Study. Of the participants who were 5540 cases, with 3250 people from Great Britain and 2290 from Japan. RESULTS: The odds ratio for job dissatisfaction was more than double in Japan compared with Britain. However, after adjusting the related factors-especially the facets of job satisfaction variables-the difference was reversed. Also, regarding the occupational differences, lower occupational grades had lower risks of overall job dissatisfaction, after adjusting for related factors. CONCLUSIONS: The national and socioeconomic differences in overall job satisfaction were strongly related to facets of job satisfaction rather than job stress factors.

Subjective Wellbeing in Rural China: How Social Environments Influence the Diurnal Rhythms of Affect.

Although the diurnal rhythms of affect influence people's health and behavior, there is a lack of evidence from rural China, where the types and timing of social activities may differ from Western contexts. In this study, a total of 2847 Chinese rural residents from three provinces of China are interviewed using the abbreviated Day Reconstruction Method (DRM) questionnaire. Diurnal rhythms of three affective subjective wellbeing (SWB) indicators-positive affect (PoA), negative affect (NeA), and net affect are analyzed by multilevel models. Our results show PoA and net affect generally increase in magnitude throughout the day with two peaks around noon and in the evening, respectively; whereas, there is an overall decline in NeA as the day passes with two troughs occurring at lunchtime and in the evening. These patterns, however, flatten considerably, with the lunchtime peaks in PoA and net affect (and trough in NeA) disappearing entirely, after further controlling for two social environmental factors-activity type and the quality of social interaction. This study, set in rural China, corroborates the diurnal rhythms of affect from prior Western research to some extent, and highlights that social environmental factors have a significant effect on diurnal rhythms of affect in the rural Chinese context. It is possible that the diurnal rhythms of affect could change in response to stimulation from the environment. Improving some social environmental factors, such as organizing pleasant activities and creating a friendly interactive environment, could contribute to the increase in positive affect and decline in negative affect, thereby enhancing the quality of life.

Does the association between cognition and education differ between older adults with gradual or rapid trajectories of cognitive decline?

Education is associated with improved baseline cognitive performance in older adults, but the association with maintenance of cognitive function is less clear. Education may be associated with different types of active cognitive reserve in those following different cognitive trajectories. We used data on n = 5642 adults aged >60 from the English Longitudinal Study of Aging (ELSA) over 5 waves (8 years). We used growth mixture models to test if the association between educational attainment and rate of change in verbal fluency or immediate recall varied by latent class trajectory. For recall, 91.5% (n = 5164) of participants were in a gradual decline class and 8.5% (n = 478) in a rapid decline class. For fluency, 90.0% (n = 4907) were in a gradual decline class and 10.0% (n = 561) were in a rapid decline class. Educational attainment was associated with improved baseline performance for both verbal fluency and recall. In the rapidly declining classes, educational attainment was not associated with rate of change for either outcome. In the verbal fluency gradual decline class, education was associated with higher (an additional 0.05-0.38 words per 2 years) or degree level education (an additional 0.04-0.42 words per 2 years) when compared to those with no formal qualifications. We identified no evidence of a protective effect of education against rapid cognitive decline. There was some evidence of active cognitive reserve for verbal fluency but not recall, which may reflect a small degree of domain-specific protection against age-related cognitive decline.

The longitudinal relationship between loneliness, social isolation, and frailty in older adults in England: a prospective analysis.

BACKGROUND: It is estimated that about 10% of people aged 65 and older are frail. Loneliness and social isolation are linked to increased mortality and poorer functional capacity. We assessed trends in frailty status associated with loneliness and social isolation over 14 years in a representative sample of English older adults. METHODS: In this longitudinal study, we used data from the English Longitudinal Study of Ageing (ELSA), which was designed to recruit a representative sample of adults aged 50 years and older living in private households in England. We analysed Waves 2-8 (covering June, 2004, to June, 2017). Frailty was defined using the frailty index, analysed continuously and as pre-specified categories, to categorise individuals as being non-frail (≤0·08), pre-frail (>0·08 to <0·25), or frail (≥0·25 to 1·00). Loneliness was measured using the UCLA 3-item Loneliness Scale and social isolation was measured following a previous ELSA approach, and both sets of scores were categorised into low, medium, or high. Linear mixed methods and Cox proportional hazard modelling were used, adjusted for confounders. FINDINGS: The study sample consisted of 9171 participants at the baseline of Wave 2 (4083 male and 5088 female), with similar numbers in subsequent waves. In the fixed effect model, adjusted for marital status, age, gender, wealth, and smoking status, respondents with higher levels of loneliness had a higher frailty index score (ß coefficient 0·006, 95% CI 0·006 to 0·007; p<0·0001), as did those with a higher level of social isolation (ß 0·002, <0·001 to 0·002; p<0·0001). Increasing age was associated with an increased frailty index, adjusted for loneliness and social isolation independently. Compared with a low level of loneliness, there was a higher risk of developing frailty with medium loneliness (hazard ratio [HR] 1·57, 95% CI 1·49 to 1·65; p<0·0001) and high loneliness (HR 2·62, 2·49 to 2·76; p<0·0001). Compared with a low level of social isolation, there was a higher risk of developing frailty with medium social isolation (HR 1·12, 1·05 to 1·20; p<0·0001) and high social isolation (HR 1·32, 1·22 to 1·43; p<0·0001). INTERPRETATION: Both loneliness and social isolation increase the risk of developing frailty. Understanding these mechanisms might offer opportunities to attenuate this risk. FUNDING: None.

Cognitively stimulating activities and risk of probable dementia or cognitive impairment in the English Longitudinal Study of Ageing.

OBJECTIVES: To examine the association between cognitive stimulating activities (CSA) in later life (internet/email use, employment, volunteering, evening classes, social club membership and newspaper reading) and risk of cognitive impairment or dementia using marginal structural models to account for time-varying confounding affected by prior exposure. METHODS: Data were used from the English Longitudinal Study of Ageing waves 1 (2002) to 7 (2014), a nationally representative sample of adults in England aged ≥50. Self-reported participation in CSAs were measured as binary exposures from waves 2 (2004) to 6 (2012), with final sample sizes between n = 3937 and n = 2530 for different CSAs. Baseline exposure and covariates were used to create inverse probability of treatment and censoring weights (IPTCW). IPTCW repeated measures Poisson and linear regression were used to estimate each CSAs effect on risk of probable cognitive impairment or dementia at wave 7 (defined as a score of ≤11/27 on a modified telephone interview for cognitive status (TICS-27)). Results were compared to standard regression adjustment. RESULTS: Internet use at any wave (Risk ratios between 0.62 and 0.69) and volunteering in waves 3 to 6 (RRs between 0.516 and 0.633) were associated with reduced risk of cognitive impairment in IPTCW models. Standard estimates were similar for both internet use and volunteering.Newspaper reading (RR 95% Confidence interval 0.74-0.99) and social club membership (RR 95% CI 0.54-0.86) at wave 6 were significantly associated with risk of cognitive impairment in standard models, but not in the IPTCW models (RR 95% CI 0.82-1.11 and 0.60-1.08 respectively). Employment and evening classes were not associated with cognitive impairment in either model. CONCLUSIONS: We found that volunteering and internet use were associated with reduced risk of cognitive impairment. Associations between newspaper reading or social club membership and cognitive impairment may be due to time-varying confounding affected by prior exposure.

Going beyond the mean in examining relationships of adolescent non-cognitive skills with health-related quality of life and biomarkers in later-life.

Several studies have established associations between early-life non-cognitive skills and later-life health and health behaviours. However, no study addresses the more important policy concern about how this relationship varies along the health distribution. We use unconditional quantile regression to analyse the effects of adolescent non-cognitive skills across the distributions of the health-related quality of life at age 50 and biomarkers at age 45 years. We examine the effects of measures of conscientiousness, agreeableness and neuroticism recorded at age 16 for 3585 individuals from the National Child Development Study. Adolescent conscientiousness is positively associated with ability to cope with stress and negatively associated with risk of cardiovascular disease in middle-age. Adolescent agreeableness is associated with higher health-related quality of life and lower physiological 'wear and tear', but negatively associated with ability to cope with stress in middle-age. Adolescent neuroticism is associated with lower health-related quality of life, higher physiological 'wear and tear', and a higher risk of cardiovascular disease in middle-age. All of these associations are stronger at the lower end of the health distribution except for the cardiovascular risk biomarkers. These associations are robust to correcting for attrition using inverse probability weighting and consistent with causal bounds assuming proportional selection on observables and unobservables. They suggest policies that improve non-cognitive skills in adolescence could offer most long-term health benefit to those with the poorest health.

Psychotropic medication before and after disability retirement by pre-retirement perceived work-related stress.

BACKGROUND: Retirement has been associated with improved mental health, but it is unclear how much this is due to the removal of work-related stressors. We examined rates of psychotropic medication use before and after the transition to disability retirement due to mental, musculoskeletal and other causes by pre-retirement levels of perceived work stress (effort-reward imbalance, ERI). METHODS: Register-based date and diagnosis of disability retirement of 2766 participants of the Finnish Public Sector study cohort were linked to survey data on ERI, social- and health-related covariates, and to national records on prescribed reimbursed psychotropic medication, measured as defined daily doses (DDDs). Follow-up for DDDs was 2-5 years before and after disability retirement. We assessed differences in the levels of DDDs before and after retirement among those with high vs. low level of pre-retirement ERI with repeated measures regression. RESULTS: Those with high (vs. low) levels of ERI used slightly more psychotropic medication before disability retirement due to mental disorders [rate ratio (RR) 1.14, 95% confidence intervals (CI) 0.94-1.37], but after retirement this difference attenuated (RR 0.94, 95% CI 0.80-1.10, P for interaction 0.02). Such a change was not observed for the other causes of disability retirement. CONCLUSIONS: The level of psychotropic medication use over the transition to disability retirement due to mental, but not musculoskeletal or other, causes was modified by pre-retirement perceived work-related stress. This suggests that among people retiring due to mental disorders those who had stressful jobs benefit from retirement more than those with low levels of work-related stress.