Association of handgrip strength with suicidal ideation among adults aged ≥50 years from low- and middle-income countries.

INTRODUCTION: This study aimed to investigate the association between handgrip strength and suicidal ideation in representative samples of adults aged ≥50 years from six LMICs (China, Ghana, India, Mexico, Russia, and South Africa). METHODS: Cross-sectional, community-based data from the World Health Organization's Study on Global Aging and Adult Health were analyzed. Handgrip strength quintiles by sex were created based on the average value of two handgrip measurements of the dominant hand. Self-reported information on past 12-month suicidal ideation was collected. Multivariable logistic regression analysis was conducted to assess associations. RESULTS: Data on 34,129 individuals were analyzed [mean (SD) age 62.4 (16.0) years; age range 50-114 years; 52.1% females]. After adjustment for potential confounders, in the overall sample, compared to the handgrip strength quintile with the highest values [Quintile 1 (Q1)], Q2, Q3, Q4, and Q5 were associated with significant 2.15 (95% CI = 1.05-4.39), 2.78 (95% CI = 1.06-7.32), 3.53 (95% CI = 1.68-7.42), and 6.79 (95% CI = 2.80-16.48) times higher odds for suicidal ideation. CONCLUSIONS: Lower handgrip strength was significantly and dose-dependently associated with higher odds for suicidal ideation in adults aged ≥50 years from LMICs. Future longitudinal studies are needed to understand the underlying mechanisms, and whether increasing general muscular strength and physical function may lead to reduction in suicidal ideation.

Sarcopenia and Mild Cognitive Impairment in Older Adults from Six Low- and Middle-Income Countries.

BACKGROUND: Little is known about the relationship between sarcopenia and mild cognitive impairment (MCI) in low- and middle-income countries (LMICs). OBJECTIVE: This study aimed to investigate this association among community-dwelling adults aged≥65 years from six LMICs. METHODS: Cross-sectional, nationally representative data from the Study on Global Ageing and Adult Health (SAGE) were analyzed. These data were obtained in China, Ghana, India, Mexico, Russia, and South Africa in 2007-2010. Participants were considered to have sarcopenia if they had low skeletal muscle mass (i.e., lower skeletal mass index) and a weak handgrip strength. MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. Multivariable logistic regression analysis was conducted to assess associations. RESULTS: The final analytical sample consisted of 12,912 individuals aged≥65 years with preservation in functional abilities without stroke (mean [standard deviation] age 72.2 [10.8] years; 45.2% males). The overall prevalence of sarcopenia and MCI were 11.3% and 18.1%, respectively. After adjusting for potential confounders, there was a positive association between sarcopenia and MCI in all countries (i.e., odds ratio [OR] > 1) with the exception of South Africa, and the overall estimate was OR = 1.60 (95% confidence interval [CI] = 1.32-1.93) with a low level of between-country heterogeneity (I2 = 0.0%). CONCLUSION: There was a positive association between sarcopenia and MCI in this sample of older adults living in LMICs. Causality should be assessed in future longitudinal research, while the utility of sarcopenia as a marker of MCI should also be investigated.

Association between food insecurity and depression among older adults from low- and middle-income countries.

BACKGROUND: To examine the association between self-reported food insecurity and depression in 34,129 individuals aged ≥50 years from six low- and middle-income countries (LMICs) (China, Ghana, India, Mexico, Russia, and South Africa). METHODS: Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Self-reported past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview were used for the endorsement of past 12-month DSM-IV depression. Multivariable logistic regression analysis and meta-analysis were conducted to assess associations. RESULTS: In total, 34,129 individuals aged ≥50 years [mean (SD) age, 62.4 (16.0) years; 52.1% females] were included in the analysis. Overall, the prevalence of moderate and severe food insecurity was 6.7% and 5.1%, respectively, while the prevalence of depression was 6.0%. Meta-analyses based on countrywise estimates showed that overall, moderate food insecurity (vs. no food insecurity) is associated with a nonsignificant 1.69 (95% confidence interval [CI] = 0.82-3.48) times higher odds for depression, while severe food insecurity is significantly associated with 2.43 (95% CI = 1.65-3.57) times higher odds for depression. CONCLUSIONS: In this large representative sample of older adults from six LMICs, those with severe food insecurity were over two times more likely to suffer from depression (compared with no food insecurity). Utilizing lay health counselors and psychological interventions may be effective mechanisms to reduce depression among food-insecure populations. Interventions to address food insecurity (e.g., supplemental nutrition programs) may reduce depression at the population level but future longitudinal studies are warranted.

Mild cognitive impairment is associated with fall-related injury among adults aged ≥65 years in low- and middle-income countries.

OBJECTIVES: There is a scarcity of data on the association between mild cognitive impairment (MCI) and falls, especially from low- and middle-income countries (LMICs) where 70% of all older adults reside. Thus, we investigated the association between MCI and fall-related injury among older adults residing in six LMICs (China, Ghana, India, Mexico, Russia, South Africa). DESIGN: Cross-sectional, community-based data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. METHODS: The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria, and information on past 12-month fall-related injury was also collected. Multivariable logistic regression analysis was conducted to assess associations. RESULTS: The analytical sample consisted of 13,623 individuals aged ≥65 years [mean (SD) age 72.3 (10.9) years; 45.6% males]. The prevalence of fall-related injury was higher among those with MCI (6.3%) vs. no MCI (4.1%). After adjustment for potential confounders, MCI was associated with a 1.53 (95%CI = 1.12-2.07) times higher odds for fall-related injury. CONCLUSIONS: MCI was associated with higher odds for fall-related injury among older adults in LMICs. Future studies are warranted to investigate the mechanisms underlying this association and to elucidate whether targeting those with MCI can lead to reduced risk for falls among older adults.

Psychotic experiences and psychiatric treatment utilization in Buenos Aires.

OBJECTIVE: Psychotic experiences are associated with psychiatric treatment utilization, though findings have not been entirely consistent. Furthermore, it is unclear how psychotic experiences relate to specific types of psychiatric treatment, and whether mental illness moderates these associations. METHODS: In total, 1,036 adult residents of Buenos Aires were recruited through convenience sampling in public places. Multivariable logistic regression models examined the associations between psychotic experiences and psychiatric treatment, adjusted for age, sex and education. Analyses were then stratified by diagnosis of mental illness. RESULTS: Approximately 17.95% (N = 186) of the sample reported at least one psychotic experience over the past week, about 22.39% (N = 232) of the sample was receiving some psychiatric or psychological treatment and 8.59% (N = 89) was receiving psychopharmacological treatment. In the total sample, psychotic experiences were associated with greater odds of being in psychiatric/psychological treatment (adjusted odds ratio (AOR): 1.52; 95% confidence interval (CI): 1.05-2.21) and psychopharmacological treatment (AOR: 2.49; 95% CI: 1.52-4.09), adjusted for age, sex and education. Mental illness did not moderate the association between psychotic experiences and psychiatric/psychological treatment, but did moderate the association between psychotic experiences and psychopharmacological treatment. Among people with mental disorders, psychotic experiences were associated with greater odds of receiving psychopharmacological treatment (AOR: 14.63; 95% CI: 1.73-123.45) versus people without mental disorders (AOR: 1.75; 95% CI: 0.98-3.15). CONCLUSION: Psychotic experiences are associated with psychiatric treatment utilization, particularly psychopharmacological treatment among people with a co-occurring mental illnesses. Translational research should explore the utility of psychosis screens in assessing need for medication or clinical responsiveness to medications.

Psychiatric problems among returned migrants in Mexico: updated findings from the Mexican Migration Project.

PURPOSE: Migration is often a stressful process that can have deleterious effects on health. We study the potential mental health consequences of migration by comparing Mexican migrants to the United States who have since returned to Mexico with Mexicans who have never migrated. METHODS: Data from the Mexican Migration Project were used to compare returned migrants and non-migrants in Mexico for the years 2007-2016 (N = 7716). Random intercept logistic regression models were used to estimate the associations between characteristics of migration and psychiatric problems. Coarsened exact matching was implemented to account for the selection bias inherent to migration. RESULTS: Relatively healthier Mexicans were more likely to migrate to the United States, regardless of their documentation status. Returned migrants in Mexico who traveled to the United States while undocumented were significantly more likely to report that they experienced psychiatric problems when compared with non-migrant Mexicans, even after adjusting for demographic, socioeconomic, pre-migration health, and community-level factors. CONCLUSIONS: Undocumented return migrants in Mexico are at-risk of developing psychiatric problems, despite evidence that suggests migrants tend to be healthier than non-migrants before they travel to the United States. Mental health services should encompass strategies for migrants on both sides of the border.

Stress Sensitivity and Psychotic Experiences in 39 Low- and Middle-Income Countries.

Stress has a central role in most theories of psychosis etiology, but the relation between stress and psychosis has rarely been examined in large population-level data sets, particularly in low- and middle-income countries. We used data from 39 countries in the World Health Survey (n = 176 934) to test the hypothesis that stress sensitivity would be associated with psychotic experiences, using logistic regression analyses. Respondents in low-income countries reported higher stress sensitivity (P < .001) and prevalence of psychotic experiences (P < .001), compared to individuals in middle-income countries. Greater stress sensitivity was associated with increased odds for psychotic experiences, even when adjusted for co-occurring anxiety and depressive symptoms: adjusted odds ratio (95% CI) = 1.17 (1.15-1.19) per unit increase in stress sensitivity (range 2-10). This association was consistent and significant across nearly every country studied, and translated into a difference in psychotic experience prevalence ranging from 6.4% among those with the lowest levels of stress sensitivity up to 22.2% among those with the highest levels. These findings highlight the generalizability of the association between psychosis and stress sensitivity in the largest and most globally representative community-level sample to date, and support the targeting of stress sensitivity as a potential component of individual- and population-level interventions for psychosis.