Bidirectional and cross-lag relationship between social media use and psychological wellbeing: evidence from an Indian adolescent cohort study.

INTRODUCTION: In an online era like today, the relationship between social media and depression among adolescents and young adults is erratic and still continues to be a debatable subject. The study aims to examine the association and bi-directional relationship between social media usage and depressive symptoms among the adolescent boys and girls in India. METHODS: The study uses data from two waves of Understanding the Lives of Adolescents and Young Adults (UDAYA) project survey conducted in two Indian states of Uttar Pradesh and Bihar. Depression was measured by a Patient Health Questionnaire. Logistic regression has been used for analyzing the data comprising the same time period, whereas the bidirectional relationship between two time periods has been evaluated by Cross-Lagged Path Model. RESULT: Findings suggest that the percentage of moderate depressive symptoms increased from 1.7% to 3.0% from Wave 1 to Wave 2. Depression among adolescent girls increased slightly from wave 1 to wave 2 whereas a slight decrement was noticed in the moderate form of depressive symptom among adolescent girls using social media for the two waves. Socioeconomic factors like education, age, gender played an important role in affecting depression among adolescents in both the Wave of the survey. The path relationship reveals that social media users in Wave 1 [ß=0.22, p<0.001] were positively associated with social media users in Wave 2. Similar patterns were observed for depressive symptoms at both the waves of the survey. However, cross lagged relations between social media use and depression could not be established between the survey periods. CONCLUSION: A significant degree of association was found between social media use and depression among adolescent boys and girls in the study. The present study concludes that factors like age, gender and education showed significant relationships with social media use and depression.

The role of self-efficacy and parental communication in the association between cyber victimization and depression among adolescents and young adults: a structural equation model.

BACKGROUND: With the rapid advancement and revolutionization of information and communication technologies, adolescents and young adults use smartphones, the internet, and social networking services more frequently, as a result, the problem of cyber-bullying sharply increases, and eventually it causes psychological issues and negative thoughts in the victims. This study aimed to examine the role of self-efficacy and parental communication in the relationship between cyber victimization and depression among adolescents and young adults in India. METHODS: Secondary data analysis was performed on a cross-sectional dataset obtained from the Understanding the Lives of Adolescents and Young Adults (UDAYA) wave 2 survey. The sample included 16,292 adolescent and young adult boys and girls aged 12-23 years. Karl Pearson Correlation coefficient analysis was done to examine the correlation between outcome variable (depressive symptoms), mediator variables (self-efficacy and parental communication) and key explanatory variable (cyber victimization). Further, structural equation modeling technique was applied to examine the hypothesized pathways. RESULTS: Adolescents and young adults being victims of cyber-bullying [ß = 0.1357, p < 0.001] and those witnessed inter-parental violence were positively [ß = 0.0026, p < 0.001] correlated with depressive symptoms. Self-efficacy and parental communication were negatively related to depressive symptoms among adolescents and young adults. There was a significant positive relationship between cyber victimization [ß = 0.258, p < 0.001] and depressive symptoms. Cyber victimization was positively related to self-efficacy [ß = 0.043, p < 0.001] among adolescents and young adults. Self-efficacy [ß= -0.150, p < 0.001] and parental communication [ß=-0.261, p < 0.001] reduced depressive symptoms among the participants. CONCLUSIONS: The findings suggest that adolescents and young adults who are victims of cyber-bully may have depressive symptoms and their mental health can be improved through the enhancement of self-efficacy and increased parental communication. Improved peer attitudes and familial support for empowering cyber victims should be taken into account while framing programs and interventions.

Adverse childhood experiences and health risk behaviours among adolescents and young adults: evidence from India.

BACKGROUND: Adverse childhood experiences (ACEs) are traumatic and stressful events that occur in childhood. These experiences at home, school, or in the community may damage the cognitive health and emotional skills of children and adolescents. OBJECTIVE: The present study examines the association between Adverse childhood experiences and risky health behaviour indicators while controlling other background characteristics among boys and girls. This study also assesses outcomes in the aggregate to estimate the impact of cumulative adversity on various risky health behavioural factors among boys and girls among adolescents and young adults (age group 13-23) in India. DATA AND METHODS: Data were drawn from the second wave of the "Understanding the lives of adolescents and young adults (2018-2019)" survey. Bivariate and logistic regression analysis were conducted to fulfill the objective. RESULTS: The findings show that nearly 30% of boys and 10% of girls had violent behaviour. Substance use prevalence was much higher among boys (34.11%) than girls (6.65%). More boys had negative gender attitudes. The majority of the study participants had multiple ACEs. Boys who experienced more than three or more childhood adversity had two times higher odds (OR: 2.04; CI: 1.01-4.16) of the early sexual debut, while the same figure for girls was thirteen times (OR: 13.13; CI: 3.95-43.69) than their male counterparts. CONCLUSION: The study findings underlined the need for implementing outcome-oriented approaches to adolescents' health care and behavioural risks. Therefore, identifying and intervening with adolescents and young adults who are at the highest risk of engaging in risky behaviors early in life may reduce the risk of these behaviors persisting into adulthood. In order to avoid health risk behavior in later stages among adolescents and young adults, policymakers need to focus on ACEs as risk factors and take action to reduce this burden. A potential model could be to create awareness among family members, caregivers, and communities to be more empathetic toward the children.

Early life factors associated with the experiences of pain in later life: evidence from a population based study in India.

BACKGROUND: The influence of early life factors is becoming increasingly apparent as studies investigate how experiences, resources, and constraints in childhood affect health and well-being later in life. The present study contributes to this literature by examining the association between several early life factors and self-reported pain among older adults in India. METHODS: Data come from the 2017-18 wave 1 of the Longitudinal Ageing Study of India (LASI). The sample size includes 28,050 older adults aged 60 and above (13,509 men and 14,541 women). Pain is a self-reported, dichotomous measure where participants responded to whether they were often troubled with pain and whether this experience interfered with their ability to carry out daily household chores. Early life factors, which are retrospective accounts of experiences, included the respondent's position in birth order, their health status, school absenteeism, being bedridden, family socioeconomic status (SES), and their parent's experience with chronic disease. Logistic regression analysis is employed to examine the unadjusted and adjusted average marginal effects (AME) of selected domains of early life factors associated with the probability of experiencing pain. RESULTS: 22.8% of men and 32.3% of women reported pain that interfered with daily activities. Pain was higher among men (AME: 0.01, confidence interval (CI): 0.01-0.03) and women (AME: 0.02, CI: 0.01-0.04) with third or fourth birth order compared to counterparts with first birth order. Both men (AME: -0.02, CI: -0.04-0.01) and women (AME: -0.07, CI: -0.09 - -0.04) having a fair childhood health status reported a lower probability of pain. The probability of pain was higher among both men (AME: 0.03, CI: 0.01-0.07) and women (AME: 0.07, CI: 0.03-0.13) who were bedridden due to sickness in their childhood. Similarly, the pain likelihood was higher among men who missed school for more than a month due to health problems (AME: 0.04, CI: -0.01-0.09). Men and women with poor financial condition in their childhood reported (AME: 0.04, CI: 0.01-0.07) a higher probability of experiencing pain relative to their peers who reported a more financially advantaged early life. CONCLUSIONS: Findings of the present study add to the empirical literature on the association between early life factors and later life health and well-being. They also are pertinent to health care providers and practitioners working in pain management, as this knowledge better positions them to identify older adults most susceptible to pain. Moreover, findings of our study underscore that the interventions to ensure health and well-being in later life must start far earlier in the life course.

The effects of cyberbullying victimization on depression and suicidal ideation among adolescents and young adults: a three year cohort study from India.

BACKGROUND: Cyberbullying victimisation is considered a global public health issue concerning the psychological development of adolescents that oftentimes persists into adulthood. The current study explored the longitudinal relationship between cyberbullying victimisation and depression and suicidal ideation among adolescents and young adults, given the scarcity of such studies in poor-resource settings like India. METHODS: Data were drawn from the "Understanding the Lives of Adolescents and Young Adults" (UDAYA- 2015-16 and 2018-19) surveys conducted in two most-populated Indian states of Uttar Pradesh and Bihar. Bivariate and logistic regression analysis was conducted to fulfil the objectives of the study using a sample of 4428 and 11,864 adolescent (aged 10-19 years) male and female cohorts, respectively. RESULTS: The prevalence of cyberbullying victimization increased from 3.8% to 6.4% among female respondents and 1.9% to 5.6% among male respondents over three years. About 33% of females and 16.6% of males had depressive symptoms in their young adulthood. Nearly 7.5% females compared to 2.3% of males, reported that they have seriously considered attempting suicide in the past one year. Adolscents who experienced cyberbullying victimization were 2.07 times more likely to have depressive symptoms comapared to those who did not experience cyberbullying victimization. Similarly, adolescents who experienced cyberbullying victimization were 2.50 times more likely to have suicidal ideation than their counterparts with no experience of cyberbullying victimization. CONCLUSION: The findings suggest that cyberbullying victims are at higher risk of depressive symptoms and suicidal thoughts and these adverse effects persist for longer period. Therefore, cyberbullying and related mental health problems need to be addressed with more efficient strategies such as increased awareness of nuances of online harassments among adolescent and young adult population.

The association of smartphone screen time with sleep problems among adolescents and young adults: cross-sectional findings from India.

BACKGROUND: Although sleep problem is a growing public health issue with the advancement of technology, especially among adolescents and young adults, it received little attention. The study aimed to examine the association of screen time on smartphone with sleep problems among adolescents and young-adults in India. METHODS: We used data from the "Understanding the lives of adolescents and young-adults" (UDAYA, 2018). The effective sample size for the study was 16,292 adolescents and young adults (males-4428 and females-11,864). Descriptive statistics and bivariate analysis with percentages and chi-square test were used to report the preliminary results. Multivariable logistic regression analysis was conducted to examine the association between smartphone screen time and sleep problems, separately for adolescents and young adults. RESULTS: Nearly 15.6% of males and 23.5% of females had sleep problems in their adolescence in the last 15 days, while these percentage were high among young-adults (18.4% males and 33.24% females). Adolescents [AOR: 1.55; CI: 1.21-1.99] and young adults [AOR: 1.48; CI: 1.24-1.75], who spent more than 2 h on smartphone had higher odds of reporting sleep problems than those who did not use smartphone in the last 24 hours. Adolescent females who used smartphone for less or equal to 2 h and three or more hours respectively, had 2.11 [AOR: 2.11; CI: 1.63-2.73] and 2.94 times [AOR: 2.94; CI: 1.97-4.38] higher odds of reporting sleep problems than adolescent males who did not use smartphones. Additionally, among the young adult females, the odds of sleep problems were 1.66 times [AOR: 1.66; CI: 1.55-2.38] and 2.36 times [AOR: 2.36; CI: 1.59-3.51] greater than the non-users young adult males. CONCLUSION: The increased time spent on mobile phones's screen among adolescents and young-adults, particularly in females is associated with a higher likelihood of reporting sleeping problems. The current findings have important implications for adolescence and young-adults' mental health programmes. The findings can also be used to further inform how different strategies need to be developed for better sleep outcome during adolescence and young-adults.

An assessment of the role of socio-economic, maternal and service utilization factors in increasing self-reported maternal complications in India.

BACKGROUND: Self-reported maternal complications are associated with maternal morbidity, deliveries by C-section, postpartum depression, and maternal death. Thus, it is necessary to examine the contribution of socio-demographic and maternal characteristics, as well as service utilization in the rising self-reporting of maternal complications (difficulty with daylight vision, convulsions, swelling of the legs, body or face, heavy vaginal bleeding or high fever) in India. The study aimed at examining the factors that have influenced the increasing prevalence of maternal complications between 2005-06 and 2015-16 in India. METHODS: Data from the two most recent rounds of the National Family Health Survey, which covered a sample of 36,850 and 190,898 women respectively who delivered in the last five years preceding the survey has been used. Logistic regression analysis was performed to carve out the factors which significantly contributed to maternal complications among women aged 15 - 49 years in India. With the help of the Fairlie decomposition technique, the study quantified the contribution of factors which influenced the changes in maternal complications in the period from 2005-06 to 2015-16. RESULTS: A significant increase was seen in the prevalence of maternal complications - from 43.6% to 53.7% between the years 2005-06 and 2015-16. About 21% of the increase could be explained by certain maternal, households level factors, service utilization and birth outcomes. For example, service utilization, in which 13% was attributed to the place of delivery and 6% to postnatal care, was the major contributor to the increase in maternal complications from 2005-06 to 2015-16). This was followed by individual-level factors like education (2%), body mass index (4%) and tobacco use,. It was also found that household-level factors like standard of living (-3.7%) and region (-1.4%), and birth weight contributed to the reduction of complications during the period. CONCLUSION: The increase in the prevalence of maternal complications in India could be attributed mainly attributed to increase in reporting behavior, an outcome of increased utilization of maternal healthcare services, and increase in BMI. However, reduced prevalence of maternal complications can be attributed to the decrease in the prevalence of low-birth-weight babies and tobacco use among women in India.

Cross-lagged relationships between exposure to intimate partner violence, depressive symptoms and suicidal thoughts among adolescent and young married women.

BACKGROUND: High rates of depression and suicidal ideation are found in women experiencing intimate partner violence (IPV), but their temporal relationship is unclear. This study explores the bidirectional causality between IPV victimization, depressive symptoms, and suicidal thoughts among adolescent and young married women in India. METHODS: Data sourced from the UDAYA longitudinal survey in India, comprising 3,965 women aged 15-22. Employing Pearson's correlation coefficient, we analyzed the relationship between variables. Additionally, a two-wave cross-lagged autoregressive panel model explored the bidirectional link between IPV, depressive symptoms, and suicidal ideation. RESULTS: Approximately 25 % and 45 % of the participants reported some form of partner violence at baseline and at follow-up after three years, respectively. Exposure to IPV at baseline was significantly associated with depressive symptoms at follow-up [ß = 0.10, p < 0.001], and the association between depressive symptoms at baseline and IPV at follow-up was statistically not significant [ß = -0.02, 95 % CI: -0.06-0.02]. Similarly, exposure to IPV at baseline was significantly associated with suicidal thoughts at follow-up [ß = 0.24, p < 0.001], and the association between suicidal thoughts at baseline and IPV at follow-up was statistically not significant [ß = 0.003, 95 % CI: -0.001-006]. CONCLUSIONS: The findings suggest that exposure to IPV is consistently and strongly associated with depressive symptoms and suicidal thoughts in adolescent and young married women. However, the reciprocal relationships did not hold true in this study, implying that reducing IPV during adolescence could potentially minimize the prevalence of depressive symptoms and suicidal thoughts during young adulthood.

Natural and human-made disaster and associated health outcomes among community-dwelling older adults in India: Findings from LASI, 2017-18.

BACKGROUND: Droughts, flash floods, rail accidents, and riots are relatively regular occurrences for those living in many low- and middle-income countries like India. While such natural and human-made disasters put everyone in harm's way, their toll on specific segments of society-like older adults-is the heaviest. Therefore, in this study, we examine (1) the prevalence of natural and human-made disasters in India and (2) the association between natural and human-made disasters and several physical and mental health outcomes among older Indians. METHODS: A cross-sectional study was conducted utilizing data come from the 2017-18 wave 1 of the nationally representative Longitudinal Ageing Study in India, comprising a sample of 29,333 older adults (14,120 males and 15,213 females) aged 60 years and above. Multivariate random intercept multilevel logistic regression analysis is used to examine the association between natural and human-made disasters and poor self-rated health, difficulty in activities of daily living, difficulty in instrumental activities of daily living, communicable diseases, non-communicable diseases, depressive symptoms, and psychiatric disorder. RESULTS: Overall, 3.58% of older adults reported that they have encountered any type of natural or human-made disaster in the past five years. Compared to those who did not experience any (natural or human-made) disaster, older adults who experienced any disaster had a higher prevalence of poor self-rated health (33.4% vs 23.31%), difficulty in activities of daily living (33.94% vs 23.00%), difficulty in instrumental activities of daily living (60.09% vs 47.70%), communicable diseases (49.57% vs 25.86%), depressive symptoms (17.30% vs 8.06%) and psychiatric disorders (3.42% vs 2.78%). After adjusting for the selected variables and the contextual effect, the odds of poor self-rated health (1.64 [1.40, 1.92]), difficulty in activities of daily living and instrumental activities of daily living (1.89 [1.61, 2.21] and 1.63 [1.40, 1.89]), communicable and non-communicable diseases (2.12 [1.83, 2.46] and 1.38 [1.20, 1.60]), depressive symptoms and psychiatric disorder (1.67 [1.55, 2.05] and 1.52 [1.33, 2.18]) were significantly higher among older adults who experienced a natural or human-made disaster than their counterparts without such an experience. CONCLUSIONS: Relative to their non-exposed counterparts, older Indians who survived natural or human-made disasters endured an inflated risk of poor self-rated health, functional difficulties, communicable and non-communicable diseases, depressive symptoms, and psychiatric disorders. As such, post-disaster efforts should be grounded in policies and programs that address disaster-related trauma and diseases and improve the functional, physical, and psychological facets of health among older disaster survivors.

Examining the relationship between risky sexual behavior and suicidal thoughts among unmarried adolescents in India.

Addressing the problem of suicidal thoughts in adolescents requires understanding the associated risk factors. Multiple studies have shown that risky sexual behavior affected the adolescents' psychological health that leads to their suicidal thoughts, behaviors and attempts. This study aimed to identify the association between various risky sexual behaviours and suicidal thoughts among unmarried adolescents in India. We used data collected from 4221 unmarried adolescent boys and 5987 unmarried adolescent girls aged 10-19 years, from the two rounds of the Understanding the Lives of Adolescents and Young Adults (UDAYA) survey. Descriptive analysis was done to observe changes in the selected variables from wave-1 to wave-2. Random effect regression analysis was used to estimate the association of suicidal thoughts among unmarried adolescents with their risky sexual behaviours. The percentage of adolescent boys having suicidal thoughts increased from 1.35% in wave 1 to 2.19% in wave 2. Among adolescent girls, the percentage increased from 2.92% in wave 1 to 5.05% in wave 2. A proportion of 3.26% adolescent boys had more than one sexual partner during wave 1 whereas in wave 2, it rose to 8.71%, while in case of adolescent girls, the estimates only increased from 0.26% at wave 1 to 0.78% at wave 2. Nearly 4.55% boys and 1.37% girls had early sexual debut. Almost five percentage boys were sexually active at wave 1 whereas in wave 2, it rose to 13.56%, while among adolescent girls, the estimates decreased from 1.54% at wave 1 to 1.51% at wave 2. Contraceptive use increased over time among both adolescent boy and girls. Also, a large proportion of adolescent boys reported watching pornography (27.08% at waive 1 and 49.39% at wave 2) compared to adolescent girls (4.46% at wave 1 and 13.10% at wave 2). Adolescents who had more than one sexual partner [Coef: 0.04; p < 0.001], exposed to early sexual debut [Coef; 0.019; p < 0.01], sexually active [Coef: 0.058; p < 0.001] and reported watching pornography [Coef: 0.017; p < 0.001] were more likely to have suicidal thoughts. Adolescent boys and girls with risky sexual behaviors are likely to be at a higher risk of suicidal ideation, and thus, they should be treated with special care and attention by local healthcare practitioners.

Relational dynamics associated with adolescent and young adult (13 to 23 years of age) partner violence: The role of inter-parental violence and child abuse.

PURPOSE: The study aimed to examine the effect of witnessing inter-parental violence and experiencing childhood abuse on victimization of intimate partner violence (IPV) after marriage among adolescent and young girls. METHOD: Data were drawn from the second wave of the Understanding the lives of adolescents and young adults (UDAYA) survey (2018-2019). The sample size was 5480 married adolescent and young girls aged 13-23 years. The outcome variable of the study was the victimization of IPV. Descriptive statistics, bivariate analysis and structural equation modelling (SEM) were performed. RESULT: A total of 39% of married adolescent and young girls experienced physical violence, followed by sexual violence (35%) and emotional violence (28%) by their partner. Around 30% of respondents witnessed inter-parental violence, and 32% of the participants were beaten by their parents during childhood. Participants who had witnessed inter-parental violence were significantly correlated with experiencing childhood abuse, and this association was positively correlated with exposure to IPV in adolescence and young adulthood. Further, the parameter estimates of the indicators of IPV were highest for emotional violence (1.10) followed by physical violence (1.00) and sexual violence (0.62). Witnessing inter-parental violence significantly increases parents' physical violence to adolescents and young adult girls (ß = 0.49, P<0.001, CI: 0.47-0.51). No tie between witnessing inter-parental violence and childhood abuse mediates their effect on later victimization of IPV. CONCLUSION: The findings indicate that witnessing inter-parental violence is a strong risk factor for IPV victimization among adolescent and young adult girls. Our findings advocate prerequisite collaborative effort with multiple service providers for greater empowerment at national, state, community, and family levels to achieve SDG goals pertaining to eliminating violence against women.

Prevalence and factors associated with undiagnosed and uncontrolled heart disease: A study based on self-reported chronic heart disease and symptom-based angina pectoris among middle-aged and older Indian adults.

BACKGROUND: This study aimed to examine the prevalence of heart diseases and angina pectoris and associated factors among middle-aged and older Indian adults. Additionally, the study examined the prevalence and associated factors of undiagnosed and uncontrolled heart disease among middle-aged and older adults based on self-reported chronic heart disease (CHD) and symptom-based angina pectoris (AP). METHODS: We used cross-sectional data from the first wave of the Longitudinal Ageing Study of India, 2017-18. The sample consists of 59,854 individuals (27, 769 males and 32,085 females) aged 45 years and above. Maximum likelihood binary logistic regression models were employed to examine the associations between morbidities, other covariates (demographic factors, socio-economic factors and behavioral factors) and heart disease and angina. RESULTS: A proportion of 4.16% older males and 3.55% older females reported the diagnosis of heart diseases. A proportion of 4.69% older males and 7.02% older females had symptom-based angina. The odds of having heart disease were higher among those who were hypertensive and who had family history of heart disease, and it was higher among those whose cholesterol levels were higher. Individuals with hypertension, diabetes, high cholesterol and family history of heart disease were more likely to have angina than their healthy counterparts. The odds of undiagnosed heart disease were lower but the odds of uncontrolled heart disease were higher among those who were hypertensive than non-hypertensive individuals. Those having diabetes were less likely to have undiagnosed heart disease while among the diabetic people the odds of uncontrolled heart disease were higher. Similarly, higher odds were observed among people with high cholesterol, having stroke and also among those who had a history of heart disease than their counterparts. CONCLUSIONS: The present study provided a comparative prevalence of heart disease and agina and their associations with chronic diseases among middle-aged and older adults in India. The higher prevalence of undiagnosed and uncontrolled heart disease and their risk factors among middle-aged and older Indians manisfest alarming public health concerns and future health demand.