Attributional styles are associated with care burden in geriatric depression: older adults and their caregivers in Taiwan.

BACKGROUND: Given the rising prevalence of depression among older adults and the associated increase in caregiving responsibilities, understanding factors influencing caregiver burden is crucial. Previous research has not extensively explored the impact of caregivers' attributional styles, that is, how individuals interpret the causes of life events, on their care burden. AIM: This study examined the relationship between caregivers' attributional styles and their care burden for older patients with depression. METHODS: This cross-sectional study enrolled older adults aged ≥ 65 years diagnosed with depression and their caregivers. Depression was diagnosed according to the DSM-V criteria for Major Depressive Disorder or Persistent Depressive Disorder. Caregivers completed the Chinese Depression Caregiver Burden Scale (CDCBS) to assess care burden, the Hamilton Depression Rating Scale (HAM-D) to evaluate patient symptom severity, the Center for Epidemiological Studies Depression Scale (CES-D) for measuring caregivers' depression, and the Chinese Depression Patient Caregiver Attribution Style Scale (CDPCAS) to assess attributional styles. Hierarchical regression analysis was used to identify the factors independently associated with the caregiver's subjectively assessed care burden. RESULTS: The sample included 146 caregivers of geriatric patients with depression. Most depression patients were women (74.7%) with a mean age of 74.3 years, whereas the mean age of caregivers was 57.7 years. Hierarchical regression analysis identified that caregivers' gender (ß = - 0.14, p = .044), educational level (ß = 0.19, p = .008), caregivers' own depression assessed by the Center for Epidemiological Studies Depression Scale (ß = 0.41, p < .001), and attributional styles, particularly manipulation (ß = 0.29, p < .001) and illness/stress attributional style (ß = 0.23, p = .002) as independent factors associated with care burden. Patient symptom severity assessed using the Hamilton Depression Scale was not significantly correlated with care burden after controlling for attributional styles. CONCLUSIONS: Certain attributional styles, particularly the manipulation and illness/stress attributional styles, significantly increased self-reported care burden. These findings highlight the need for educational resources to change the attribution style, along with support systems and accessible mental health services for caregivers to potentially ease the care burden.

Development and validation of a geriatric depression knowledge scale for older adults with depression.

Poor adherence to antidepressants increases the risk of suicide, while greater mental health awareness promotes seeking appropriate treatment, highlighting the urgent need to assess depression knowledge. This study aimed to develop and assess the psychometrics of a Geriatric Depression Knowledge Scale (GDKS) for older adults with depression. In phase 1, 18 items were generated through an intensive literature review and clinical experiences. Phase 2 involved assessing content and face validities of the GDKS. In phase 3, a cross-sectional study (206 older adults, 100 psychiatric professionals) determined construct validity, internal consistency, and test-retest reliability. GDKS demonstrated excellent content and face validity. Older participants scored significantly lower than psychiatric professionals, confirming excellent construct validity. Reliability was evident with a Kuder-Richardson formula 20 score of 0.72 and a 4-week test-retest reliability of 0.86 (p < 0.01). The GDKS provides a reliable tool for evaluating geriatric depression knowledge in psychiatric outpatient settings.

Trajectories of social support are associated with health outcomes and depressive symptoms among older Taiwanese adults with diabetes following hip-fracture surgery.

OBJECTIVE: This study examined trajectories of social support and their relationships with health outcomes over 2 years post hip-fracture surgery for older adults with diabetes mellitus (DM). METHODS: This was a secondary analysis of data derived from a clinical trial, which included 158 hip fractured older adults with DM who had completed the Medical Outcomes Study Social Support Survey at 1-, 12-, 18-, and 24-months following hospital discharge. Health outcomes for self-care, physical and nutritional status, mental health, and depression were assessed at 3-month intervals up to 24-months after hospital discharge. Trajectories of social support were derived with latent class analysis while hierarchical linear models were employed to assess the associations of social-support trajectory with health outcomes. RESULTS: Four social-support trajectories were derived for persons with DM following hip-fracture surgery: poor and declining (n = 18, 11.4%), moderate and stable (n = 29, 18.4%), high but declining (n = 34, 21.5%), and high and stable (n = 77, 48.7%). Relative to those in the poor and declining group, participants in the high and stable trajectory group performed better in Activities of Daily Living and quadriceps muscle power, had better mental Health-Related Quality of Life and nutritional status, and had fewer depressive symptoms. These differences persisted over the 2 years following hospital discharge. CONCLUSIONS: These results suggest social support for persons with DM should be continually assessed following hip-fracture surgery.

Validity and Reliability of the Chinese Version of the Edinburgh Postnatal Depression Scale for Fathers of Newborns.

Studies often use the Edinburgh Postnatal Depression Scale (EPDS) or the Beck Depression Inventory-II (BDI-II) as a screening tool for depression in new mothers or fathers following the birth of an infant, but no studies have evaluated EPDS as a predictor of postnatal depression for new fathers in a Chinese population. This study aimed to test the validity and reliability of a Chinese version of the EPDS for fathers of newborns in Taiwan. The study included 368 parents with newborns ≤2 months of age and without any health problems. Construct and criterion-related validities were assessed and Cronbach's alpha was used for measuring internal consistency reliability. The receiver operating characteristic (ROC) curve analyzed the optimal cutoff score for the EPDS. Scores for the Chinese EPDS were significantly higher for fathers who were >34 years of age, employed in a professional occupation, and participated in feeding their infant (p < .05). Mean scores among the fathers for the EPDS and BDI-II were significantly correlated (r = .64, p < .001). The Cronbach's alpha was .83 for the EPDS; ROC curve analysis revealed the optimal cutoff of the EPDS was ≥8 points and the area under the ROC curve was 0.91. The EPDS had good validity and reliability and should therefore be considered suitable for the evaluation of postnatal depression in fathers of newborn infants in Taiwan.

Benzodiazepines in Patients with Heart Failure and Reduced Ejection Fraction.

Background: In patients with heart failure (HF), anxiety or insomnia is prevalent and associated with poor clinical outcomes. Benzodiazepines (BZDs) are one of the most commonly prescribed medications for anxiety or insomnia in Taiwan. Evidence regarding the effects of BZDs on patients with heart failure and reduced ejection fraction (HFrEF) is inconclusive. Objectives: To evaluate whether BZDs can mitigate the adverse effects of anxiety or insomnia on the prognosis of patients with HFrEF. Methods: Patients with HFrEF were identified from the Chang Gung Research Database between January 1, 2007 and December 31, 2018. Those who received BZD prescriptions were defined as the BZD group; patients in the BZD group were then paired with those who had never been prescribed BZDs after matching for age, sex, and baseline left ventricular ejection fraction, defined as the no-BZD group. Propensity score matching was used to balance baseline characteristics. Cox proportional hazards model and the Fine-Gray subdistribution hazard model were used to examine the association between BZD prescription and the risks of adverse cardiovascular outcomes. Results: After propensity score matching, there were 1,941 patients in both BZD and no-BZD groups. The composite of cardiovascular (CV) death or HF hospitalization (HFH) occurred in 64.4% and 54.4% of the patients in the BZD and no-BZD groups, respectively [hazard ratio (HR): 1.44; 95% confidence interval (CI): 1.32-1.56], which was mainly driven by HFH (HR: 1.52; 95% CI: 1.39-1.67). Conclusions: In the patients with HFrEF, those who received BZD were at a higher overall risk of CV death and HFH.

Better nutrition trajectory improves recovery following a hip fracture surgery for older persons with diabetes mellitus.

BACKGROUND: Influences of nutritional status on hip fractured persons with diabetes mellitus (DM) following surgery have not been reported. AIMS: To explore the trajectory groups of nutritional status and their influences on post-operative recovery for older persons with hip fracture and DM. METHODS: A total of 169 patients with DM and hip fracture from a clinical trial were included in this analysis. Mini Nutritional Assessment was used to assess the nutritional status of the participants. Outcome variables included self-care ability, muscle strength, depressive symptoms, health related quality of life, and cognitive function, which were collected before discharge and 1-, 3-, 6-, 12-, 18-, and 24-months following hospital discharge. RESULTS: Among hip fractured older persons with DM, within two years following surgery there were three nutritional trajectory groups: malnourished (28.3%), at-risk of malnutrition (41.9%) and well-nourished (29.8%). A decline in nutritional status, especially for the malnourished group, was seen in the second year. A better nutritional trajectory was associated with better recovery outcomes, including self-care ability, health related quality of life, cognitive function and less depressive symptoms. DISCUSSION: Close to 30% of hip fractured persons with DM were considered to have a malnourished trajectory over 2 years following surgery. A poor nutritional trajectory was associated with poor mental health and physical recovery. CONCLUSIONS: Continuous nutrition assessment during the first 2 years following hip fracture surgery for older persons with DM is important. Development and implementation of interventions targeting the malnourished trajectory group are suggested.

Predicting Hazardous Alcohol Drinking Behaviors in Family Members of Hazardous Alcohol-Drinker Patients.

Family members of hazardous or harmful alcohol drinkers suffer many consequences of their relative's alcohol-drinking behaviors and risk developing their own hazardous alcohol drinking behaviors. Studies of alcohol-related healthcare problems have mainly focused on patients, with few studies on their family members. This cross-sectional study explored factors predicting hazardous alcohol drinking behaviors in family members of hazardous alcohol-drinker patients. Participants were recruited from four randomly chosen hospitals in Taiwan. Data were collected using self-report questionnaires on family members' alcohol use, perceived stress, coping mechanisms, social support, health, quality of life, protective factors against hazardous alcohol drinking, facilitative factors for hazardous alcohol drinking, and demographics. The 318 family members who participated in this study were divided by their Chinese-version Alcohol Use Disorders Identification Test scores into two groups: hazardous alcohol drinkers (score ≥ 8) and non-hazardous alcohol drinkers (score < 8). Significant factors predicting hazardous alcohol drinking behaviors were found by logistic regression to be the frequency of using general coping mechanisms (OR = 1.29, p < 0.01), the frequency of using strategies to cope with patients' drinking-related behaviors (OR = 0.89, p < 0.01), factors protecting against hazardous alcohol drinking (OR = 0.76, p < 0.01) and factors facilitating hazardous alcohol drinking (OR = 1.52, p < 0.01). Interventions should be designed for family members of hazardous alcohol drinkers to address these four significant predictors.

A family care model for older persons with hip-fracture and cognitive impairment: A randomized controlled trial.

BACKGROUND: Dementia and hip fracture are both associated with substantial disability and mortality. However, few studies have explored the effects of intervention programs on post-operative recovery of older persons with hip fracture and cognitive impairment. OBJECTIVE: To examine the effects of a family-centered care model for older persons with hip fracture and cognitive impairment and their family caregivers. DESIGN: Single-blinded clinical trial. SETTING: A 3000-bed medical center in Taiwan. PARTICIPANTS: Older persons hip fracture and cognitive impairment (N = 152); 76 in the intervention group, and 76 in the usual-care control group. METHODS: A family-centered care model consisting of geriatric assessment, discharge planning, in-home rehabilitation, and family caregiver-training for dementia care. Outcomes were assessed 1-, 3-, 6- and 12-months following hospital discharge for older persons with hip fracture and cognitive impairment. Assessed outcomes were self-care ability (performance of activities of daily living and instrumental activities of daily living), nutritional status, self-rated health, health-related quality of life and self-efficacy, and competence of the family caregivers. RESULTS: Relative to patients who received usual care, those who received the family-centered care intervention had a greater rate of improvement in self-rated health (ß = 1.68, p < .05) and nutritional status (ß = 0.23, p < .05), especially during the first 6 months following hospital discharge. Relative to family caregivers who received usual care, those who received family-centered care had a higher level of competence (ß = 7.97, p < .01), a greater rate of improvement in competence (ß = 0.57, p < .01), and a greater rate of improvement in self-efficacy (ß = 0.74, p < .05) 3 months following hospital discharge. CONCLUSIONS: A family-centered care model enhanced family caregivers' self-efficacy and competence but did not improve the physical recovery of the participants with hip fracture and dementia. We suggest adding an educational component to include geriatric assessment, discharge planning, in-home rehabilitation, and family caregiver-training for dementia care and assessing family caregiver outcomes in interventions for older persons with hip fracture and cognitive impairment. TRIAL REGISTRATION: Registered with www.clinicaltrials.gov (NCT03894709) Tweetable abstract: A family-centered care model consisting of geriatric assessment, discharge planning, in-home rehabilitation, and family caregiver-training for dementia care of older persons with hip fracture and cognitive impairment enhanced family caregivers' self-efficacy and competence.

Development and validation of a caregiving needs inventory for family members before their older relative's knee joint-replacement surgery.

PURPOSE: This study had two purposes: to develop an instrument for assessing family members' caregiving needs before their older relative's knee joint-replacement surgery and to determine instrument psychometrics. METHODS: In phase 1 of this validation study, we generated 34 items based on previous interviews with 138 family caregivers of patients with knee osteoarthritis (OA), an intensive literature review, and the authors' clinical experiences. In phase 2, we examined the content and face validities of the 34-item Family Members' Caring Needs Inventory (inventory) to develop a 32-item inventory. In phase 3, 150 family members of outpatients with knee OA were recruited from three hospitals in northern Taiwan and surveyed with the inventory to determine its internal consistency reliability and test-retest reliability. RESULTS: The final 30-item inventory had excellent content and face validities. Its factor analysis yielded a five-factor solution, accounting for 82.9% of the variance. The inventory had Cronbach's α = 0.97 and intraclass correlation coefficient = 0.93, indicating very high internal consistency reliability and test-retest reliability. CONCLUSIONS: The inventory was perceived as easy to complete and yielded highly acceptable validity and reliability levels. After cross-cultural adaptation, this tool may be used to assess family members' caregiving needs before their relative's knee-replacement surgery.IMPLICATIONS FOR REHABILITATIONThe role of family members and spouses in supporting patients with osteoarthritis (OA) is crucial.After cross-cultural adaptation, the Family Members' Caring Needs Inventory may be used by health care providers to assess and provide relevant information to meet the needs of family members caring for an older relative with knee OA.This assessment and specific caregiving information for family members of older knee OA patients may promote patients' quality of life and decrease their OA-related burden.

Associations between estradiol and testosterone and depressive symptom scores of the Patient Health Questionnaire-9 in ovariectomized women: a population-based analysis of NHANES data.

BACKGROUND: Women are well known to be susceptible to developing affective disorders, yet little attention has been given to effects of ovariectomy-reduced hormones and links with depression. This population-based cross-sectional study aimed to investigate possible associations between ovariectomy-reduced hormones and depression symptom scores of the Patient Health Questionnaire-9 (PHQ-9) in ovariectomized women. METHODS: Data of PHQ-9 scores, demographics and comorbidities of ovariectomized women were extracted from the U.S. National Health and Nutrition Examination Survey (NHANES) database (2013-2016) and were analyzed retrospectively. RESULTS: Among ovariectomized women in the NHANES database, serum estradiol levels were significantly positively associated with PHQ-9 scores (ß = 0.014, 95% CI: 0.001, 0.028, P = 0.040), whereas serum testosterone was negatively associated with PHQ-9 scores (ß = -0.033, 95% CI: - 0.048, - 0.018, P < 0.001) after adjusting for confounders. Further stratified analyses revealed that serum estradiol was positively associated with PHQ-9 only among women with history of estrogen use. Serum testosterone levels were negatively associated with PHQ-9 among women with or without prior estrogen use but this was only observed among women aged < = 60 years (ß = - 0.057, - 0.076, - 0.038, P < 0.001). CONCLUSIONS: Serum estradiol and testosterone are associated with PHQ-9 scores indicative for depression in ovariectomized women. The associations are modified by age and history of estrogen use. Future prospective studies are warranted to confirm these findings, carefully addressing possible confounding of age-related dementia.

Weight control in older adults with knee osteoarthritis: a qualitative study.

BACKGROUND: Knee osteoarthritis (OA) affects mostly older adults and its primary risk factor is obesity. This study sought to understand weight-control strategies, facilitators of and barriers toward weight control in older adults with knee OA who preferred not to undergo physician-recommended total knee arthroplasty. METHODS: For this qualitative descriptive study, older outpatients (N = 118) were recruited from orthopedic clinics at three hospitals. Data were collected through face-to face, individual in-depth interviews using a semi-structured interview guide and analyzed using content analysis. RESULTS: Among participants, only 25.4% had body weight in the normal range and 55.9% reported having controlled their weight. Their most common weight-control strategies were to control diet and to exercise and control diet together. Weight control was facilitated by desiring good health, wanting to improve walking or movement, perceiving that they had gained weight, wanting to look good, and advice from healthcare providers. Common barriers to participants' weight control were perceiving that dietary control was not needed, controlling appetite was difficult, dietary control was difficult, and not eating was physically uncomfortable. CONCLUSIONS: Our findings help healthcare providers understand how older adults with knee OA perceive weight control and serve as a reference for developing weight-control programs. Health care providers can integrate these identified facilitators and barriers into a weight-control intervention program. The importance of weighing oneself every day, the meaning of body mass index, consulting with a dietician regularly to control weight, and providing appropriate knowledge about aging and weight control should also be included in any weight-control intervention program.

Subjective memory complaints predict poorer functional recovery during the first year following hip-fracture surgery among elderly adults.

OBJECTIVES: Subjective memory complaints (SMCs) in the elderly are associated with poor recovery in performing activities of daily living. This study was designed to examine SMCs and their association with recovery and health outcomes of older persons within 1 year following hospital discharge after hip-fracture surgery. METHODS: Data were collected between 2012 and 2015 from 194 hip-fractured elders in northern Taiwan. SMCs were assessed by the Prospective and Retrospective Memory Questionnaire. Recovery outcomes included self-care ability (activities of daily living [ADLs] and instrumental activities of daily living [IADLs]), physical function (range of motion and maximal muscle strength), cognitive function, delirium, depressive symptoms, and health-related quality of life (HRQoL). Outcomes were assessed before discharge and 1, 3, 6, and 12 months afterwards. Associations of SMCs with participants' recovery outcomes were examined by the generalized estimating equation approach. RESULTS: Participants with SMCs had significantly poorer recovery outcomes than those without SMCs. Additionally, the interaction term for time-by-SMC was significant on ADLs, IADLs, maximal strength of quadriceps muscles, maximal strength of hip abductor muscles, ankle dorsiflexion, and HRQoL, suggesting that negative associations with SMCs increased over time. Participants with SMCs were at significantly higher risk for cognitive impairment and delirium than those without SMCs. CONCLUSIONS: Participants with SMCs not only had worse recovery than those without SMCs, but their rate of recovery was also slower during the first year following hip-fracture surgery. Therefore, SMCs need to be assessed to identify patients at high risk for worse recovery outcomes following hip fracture.

The caregivers' dilemma: Care burden, rejection, and caregiving behaviors among the caregivers of patients with depressive disorders.

Taking care of depressed patients significantly impacts caregivers' lives, both objectively and subjectively. The effects of caregivers' burden on their responses to their patients has yet to be investigated. The aim of this study is to explore the relationships among caregivers' subjective and objective burden, depression, frequency of caregiving behaviors, and rejective attitude. A cross-sectional study was conducted among 134 caregivers of patients diagnosed with depressive disorders. We administered questionnaire to assess caregivers' demographics, care burden, reassurance seeking, depression, rejective attitude and caring behaviors. Both caregivers' objective and subjective burdens were associated with their depressive symptoms. Rejection towards patients was determined by the caregivers' level of depressive symptoms, subjective feeling of sadness, and anger, rather than by their objective burden. On the other hand, the frequency of caregiving behavior was determined by perceived reassurance seeking and anger, rather than by caregivers' depression or objective burden. These findings suggest that caregivers' subjective burden plays a more salient role in predicting their rejection and frequency of caregiving behaviors toward the patients than objective burden. The caregivers in this study could recognize their rejective attitude toward depressed patients but still had difficulty withdrawing their care when they were already in distress.

Comparison of Anthropometric Measures for Evaluating the Association Between Hypogonadism and Hypothalamic-Pituitary-Gonadal Hormones in a Taiwanese Population.

To investigate the degree of association between levels of sex hormones and anthropometric indices in male population. A cross-sectional survey was conducted between July 2014 and July, 2016, in a men's health polyclinic in Taiwan. Body mass index, waist circumference, waist-to-height ratio (WHtR), and conicity index were tested. Serum total testosterone, free testosterone, and dehydroepiandrosterone sulfate (DHEA-S) were measured. Decreased testosterone levels were correlated with the four indices (r = -0.09 to -0.27, p < 0.01). In hypogonadism group, DHEA-S deficiency was associated with older age, higher anthropometric indices, and chronic illness. The areas under the receiver operating characteristic curves of hypogonadism and DHEA-S deficiency by the four anthropometric indices ranged from 52.5% to 65.9%. Logistic regression analysis revealed that obesity, defined by the four indices, was associated with increased risk of hypogonadism. Moreover, obesity was also associated with increased risk and DHEA-S deficiency. Anthropometric indices analyzed are associated with lower testosterone and DEAH-S deficiency. A WHtR of 0.5 is suggested to be a simple and reliable indicator of hypogonadism and DHEA-S deficiency.

Effects of a diabetes-specific care model for hip fractured older patients with diabetes: A randomized controlled trial.

OBJECTIVES: To examine the effects of a diabetes-specific care model for hip fractured elderly with diabetes mellitus (DM). METHODS: A randomized controlled trial was implemented in a 3000-bed medical center in northern Taiwan. Older adults (age ≥ 60) with DM who had hip-fracture surgery (N = 176) were recruited and randomly assigned to diabetes-specific care (n = 88) and usual care (n = 88). Usual care entailed one or two in-hospital rehabilitation sessions. Diabetes-specific care comprised an interdisciplinary care (including geriatric consultation, discharge planning, and in-home rehabilitation) and diabetes-specific care (including dietary and diabetes education, blood pressure control, dyslipidemia management, a glycemic treatment regimen, and rehabilitation exercises). Outcomes including heart rate variability; rehabilitation outcomes; activities of daily living and instrumental activities of daily living were assessed before discharge and 1, 3, 6, 12, 18, 24 months afterwards. RESULTS: Patients who received diabetes-specific care had significantly higher hip-flexion range of motion (b = 5.24, p < .01), peak-force quadriceps strength of the affected limb (b = 2.13, p < .05), higher total heart rate variability in terms of the time-domain parameter for the mean squared difference between two adjacent normal R-R intervals (b = 11.35, p < .05), and frequency-domain parameters, such as low frequency (b = 42.17, p < .05), and the high frequency-to-low frequency ratio (b = 0.11, p < .01). CONCLUSIONS: Our diabetes-specific care model enhanced hip-flexion range of motion, peak quadriceps strength of the affected limb, and overall heart rate variability, indicating dynamic responses to environmental changes during the 24 months following hospital discharge, above and beyond the effects of usual care.

Diabetic neuropathies influence recovery from hip-fracture surgery in older persons with diabetes.

BACKGROUND/OBJECTIVES: To explore the impact of diabetic peripheral neuropathy (DPN) on the recovery of older persons with diabetes mellitus (DM) after hip-fracture surgery. DESIGN, SETTING, PARTICIPANTS: Secondary data for this study came from a clinical trial on the effectiveness of a DM-specific care model for 176 older persons (age ≥ 60) with DM over 2 years following hip-fracture surgery at a medical center in Taiwan. In the original trial, the experimental group (n = 88) received DM-specific care comprising diabetes care plus subacute care, and the control group (n = 88) received only usual care. MEASUREMENTS: DPN was assessed using the Michigan Neuropathy Screening Instrument. Outcomes of self-care ability in activities of daily living (ADL), health-related quality of life (HRQoL), and depressive symptoms were assessed 1, 3, 6, 12, 18, 24 months following hospital discharge using the Chinese Barthel Index and Chinese-version instrumental ADL (IADL) scale; the SF-36 Taiwan version; and the Chinese-version Geriatric Depression Scale, short form, respectively. RESULTS: After controlling for covariates, participants with DPN had 8.38 fewer points in ADL performance, 0.49 fewer points in IADL performance, and 2.33 fewer points in the physical component summary (PCS) of HRQoL than participants without DPN at 3 months following discharge. During the first year following discharge, the rate of improvement increased less for PCS (ß = -0.45, p < 0.05), but more for the mental component summary (ß = 0.49, p < 0.05) for those with DPN than for those without. During the second year, the rate of decline in physical function-related HRQoL increased slightly more for those with DPN than for those without (ß = 0.03, p < 0.05). CONCLUSION: DPN adversely affected ADL performance, IADL performance, and physical function-related health outcomes for older persons recovering from hip-fracture surgery. These results suggest that older patients with DM recovering from hip-fracture surgery should be assessed and managed for DPN.

Mindfulness training enhances flow state and mental health among baseball players in Taiwan.

OBJECTIVE: To examine the effect of mindfulness-based training on performance and mental health among a group of elite athletes. METHODS: This study aimed to evaluate the effect of mindful sport performance enhancement (MSPE) on mental health, flow state, and competitive state anxiety using a 4-week workshop. We recruited an amateur baseball team (N=21) in Taiwan, and collected information by self-reported questionnaires administered before, immediately after, and at a 4-week follow-up. The primary outcome was to evaluate sports performance by flow state and competitive state anxiety, which included self-confidence, somatic anxiety, and cognitive anxiety. The secondary outcome was to explore whether MSPE intervention can improve anxiety, depression, sleep disturbance, and eating disorders. RESULT: After the workshop and follow-up 1 month later, we found improvements in flow state (P=0.001; P=0.045), cognitive anxiety in competitive anxiety (P=0.056; P=0.008), global eating disorder (P=0.009; P<0.001), marked shape concern (P=0.005; P<0.001), and weight concern (P=0.007; P<0.001). Scores of sleep disturbance (P=0.047) showed significant improvement at follow-up. We also found significant association between flow state and mindfulness ability (P<0.001). CONCLUSION: This is the first mindfulness intervention to enhance athletes' performance in Taiwan, and also the first application of MSPE for team sports. Our study results suggested that mindfulness ability is associated with flow state, and that MSPE is a promising training program for strengthening flow state and mental health.

The association between exposure to second-hand smoke and major depressive disorder in perimenopausal women: results from apopulation-based study.

PURPOSE: The aim of this study was to test the hypothesis that exposure to second-hand smoke (SHS) would be positively associated with major depressive disorder (MDD) in perimenopausal women from a population-based perspective, after adjustment for all potential confounders. METHODS: This study used the National Health and Nutrition Examination Survey (NHANES) database, 2005-2012, to report on MDD in perimenopausal women. RESULTS: The odds ratio (OR) for MDD increased when there was a smoker was in the home, as compared to not having a smoker in the home (aOR = 2.97, 95% confidence interval [CI] = 1.15-7.67); however, in the non-poor group, the OR for MDD showed no difference between those who had or did not have a smoker in their home. For participants who self-rated their health condition as excellent, very good or good, the OR for MDD increased; it also increased if there were smokers in the home, as compared to those without smokers in the home (aOR = 2.58, 95% CI = 1.08-6.14). CONCLUSIONS: The present study results augment our understanding of the clinical and public health significance of SHS, as well as the role of various socioeconomic and self-rated health conditions, in perimenopausal women. Key messages An increasing OR for MDD was demonstrated with regard to health status such as CVD, chronic respiratory tract disease, arthritis, thyroid problems, lower eGFR, fair or poor self-rated health condition, and elevated CRP level. Participants who self-rated their health condition as excellent, very good or good had an increased OR for MDD. The OR also increased if the women had smokers in their home versus women who did not have smokers in the home.

Trajectories in postoperative recovery of elderly hip-fracture patients at risk for depression: A follow-up study.

OBJECTIVES: This secondary-analysis study aimed to identify distinct developmental depressive-symptom trajectories among elderly hip-fracture patients at risk for depression, examine the associations of trajectories with potential risk factors and care models, and explore the effect of trajectory membership on recovery outcomes. METHOD: Longitudinal data were obtained for 179 patients in a randomized controlled trial. These patients were included if their Geriatric Depression Scale short form scores were ≥ 5 before discharge or 1, 3, 6, or 12 months following discharge. Individuals who followed similar developmental depressive-symptom trajectories were identified by group-based trajectory modeling. Associations between trajectory-group membership and postoperative outcomes over the 12 months following discharge were evaluated by the generalized estimating equations method. RESULTS: We identified a progressively lower-risk group and a fluctuating higher-risk group. Patients' membership in the progressively lower-risk group was associated with receiving a comprehensive care model featuring psychological and physical interventions. Membership in this group was associated with better postoperative outcomes and fewer emergency department visits or hospital readmissions. Patients were more likely to belong to the fluctuating higher-risk group if they had more comorbidities or worse prefracture mobility. Patients in the fluctuating higher-risk group not only had higher levels of depressive symptoms, but also a greater likelihood of poor postoperative recovery outcomes. CONCLUSIONS: Depressive symptoms in elderly hip-fracture patients may be alleviated by postoperative comprehensive care that features both psychological and physical interventions. Patients with increasing depressive status should be targeted for early interventions. (PsycINFO Database Record