Social participation, psychological resilience and depression among widowed older adults in China.

BACKGROUND: Depression has become a challenging public health problem, and the loss of a spouse is one of the main causes of depression in older adults. Social participation and psychological resilience are protective factors that reduce depressive symptoms in adults. The purpose of this study was to explore the influences of social participation and psychological resilience on the depression of Chinese widowed older adults. METHODS: We carried out a cross-sectional study on 790 community-dwelling widowed older adults in Shaanxi, China, in 2019. A structured face-to-face interview was used to collect data. We used the ordinary least squares model (OLS), the generalized propensity score matching (GPSM) and the mediation model to test the relationship between social participation, psychological resilience and depression. RESULTS: We find a U-shaped relationship between social participation and depression, with the increase in social participation scores, the average depression level decreased and then increased. The psychological resilience of the widowed older adults was negatively associated with depression. The higher their psychological resilience, the lower their depression level. Among the four factors of psychological resilience, factor 2 (optimism and positive acceptance of change) and factor 3 (secure relationships and tolerance of negative affect) of psychological resilience were protective factors for depression after adjusting for demographic variables and physical health conditions. Psychological resilience plays a mediating role, as evident in factor 2 and factor 3 mediating the relationship between social participation and depression. CONCLUSION: An appropriate level of social participation will relieve the depression of widowed older adults. Social participation can reduce the depression level of widowed older adults by improving their psychological resilience. Community and family could reduce depression by intervening in the social participation of widowed older adults. Active social participation is crucial because it has a protective and resilient impact, which can help people recover from the stress of losing a spouse.

Widowed Young: The Role of Stressors and Protective Factors for Resilience in Coping with Spousal Loss.

While distressing, late life spousal loss is considered a normative life event and most demonstrate resilient recovery from grief. However, for 5-7% of the population spousal loss comes early, before the age of 50, and little is known about the factors that influence adjustment in this population. We used the DPM integrative framework to examine correlates and predictors of mental wellbeing and grief intensity in an international sample of 603 young widows and widowers. Contrary to existing bereavement research, loss-orientated stressors (e.g., expectedness and cause of death) did not predict bereavement outcomes. Employment and financial wellbeing were the only statistically significant restoration-orientated stressors associated with coping, mental wellbeing and grief intensity. We found no significant associations between parental status and coping or bereavement outcomes. Loss-orientated coping, followed by inter and intrapersonal protective factors for resilience and financial wellbeing were the greatest predictors of grief intensity. Loss-orientated coping was highest in early bereavement, the greatest predictor of grief intensity and associated with being unemployed, financial insecurity and decreased protective factors for resilience. Restoration-orientated coping was highest in later bereavement, was a weak predictor of grief intensity and associated with being employed, increased financial wellbeing and protective factors for resilience. Overall, we found the young-widowed population is at heightened risk of poor adjustment. Almost two-thirds reported decreased functioning, probable depression with high rates of psychological distress. Nearly half met diagnostic criteria for prolonged grief disorder. We discuss implications for research and clinical practice.

Effectiveness of resilience training intervention on psychological capital of the underprivileged widowed women of Fasa City, Iran.

INTRODUCTION: Women heads of households (widows or divorcees) are vulnerable groups in society who face various psychological problems and have less resilience than other women. Therefore, the present study was conducted to determine the effectiveness of resilience educational intervention on the psychological capital of poor widows in Fasa city, south Iran. MATERIALS AND METHODS: In this quasi-experimental study, 120 widows covered by Imam Khomeini Relief Foundation were selected by a simple random sampling method based on a random Efron algorithm (Efron coin) and randomly assigned into two interventions and control groups (60 people each) in the second half of 2021. About 8 training sessions on resilience and psychological capital were held for the experimental group through training clips, audio transmissions, and podcasts. Data were collected using demographic characteristics forms, widowers' resilience assessment questionnaires, and Luten's psychological capital scale for testing and control before and two months after the intervention. Data were analyzed with Chi-square test, independent and paired t-test using SPSS V. 26 software. RESULTS: There were differences between the two groups at pretest in demographic variables and psychological capital and its subscales, and resilience and its subscales (P ≥ 0.05).. But two months after the educational intervention, a statistically significant increase was observed in the experimental group in these variables compared to the control group (p < 0.05). It indicates that there was an improvement in the outcomes from pretest to post-test within the intervention and no change in the outcomes over time within the control group. DISCUSSION AND CONCLUSION: Using a resilience-based educational approach as a novelty of this research to promote psychological capital and resilience can increase resilience and psychological capital in widows. Then, considering the positive effect of this educational approach and the low cost of this intervention, it seems that the implementation of such interventions should be included in the plans related to widows.

Dyadic Relationships between a Surviving Parent and Children in Widowed Families: A Systematic Scoping Review.

The death of a family member affects not only individual family members but also their relationships and interactions. Grief has been studied mostly as an intrapersonal experience. Adopting the family perspective, this systematic scoping review focused on parent-child relationships in widowed families so as to identify what is already known on this topic and the research gaps for future study. The review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Four databases (Web of Science, Psycinfo, PubMed, and CINAHL Plus) were searched. Search terms were combinations of two concepts: (1) loss of a parent (20 terms) and (2) parent-child (eight terms). 5,419 studies were identified during the search, of which 36 studies were included in the review following two rounds of screening. Four research themes emerged, and the aggregated findings were identified: (a) The surviving parent and children are likely to become closer following the loss of a parent, while other relevant factors need to be taken into account; (b) Better parent-child relationships play a protective role in children's adjustment to loss; (c) The surviving parent and children's adjustment to loss are interdependent; (d) Through parenting, communication style, coping strategy, and other attributes, the surviving parent can influence their children's adjustment. Gender and age differences were identified in parent-child relationships. The findings further justify the importance of a family perspective when conducting research and practice on bereavement. Several research gaps were identified. Existing studies paid insufficient attention to children's agency and bidirectional relationships, and the interaction process and its role underlying parent-child bidirectional causality. A conceptual framework of parent-child relationships in widowed families is proposed based on these findings.

La muerte de un miembro de la familia afecta no solo a los miembros individuales de la familia, sino también sus relaciones e interacciones. El duelo se ha estudiado habitualmente como experiencia intrapersonal. Adoptando la perspectiva familiar, esta revisión sistemática exploratoria se centró en las relaciones entre progenitor e hijos en familias donde había fallecido uno de los progenitores con el objetivo de identificar lo que ya se sabe sobre este tema y las deficiencias en las investigaciones para futuros estudios. La revisión sigue las pautas de la extensión para revisiones sistemáticas exploratorias de los Ítems de Referencia para Publicar Revisiones Sistemáticas Exploratorias y Metaanálisis (PRISMA-ScR). Se realizaron búsquedas en cuatro bases de datos (Web of Science, Psycinfo, PubMed y CINAHL Plus). Los términos buscados fueron combinaciones de dos conceptos: (1) pérdida de un progenitor (20 términos) y (2) progenitor-hijo (ocho términos). Se identificaron 5419 estudios durante la búsqueda, de los cuales 36 se incluyeron en la revisión después de dos rondas de selección. Surgieron cuatro temas de investigación y se indicaron los resultados colectivos: a. El progenitor superviviente y los hijos tienden a desarrollar un vínculo más estrecho después de la muerte del otro progenitor, si bien es necesario tener en cuenta otros factores relevantes; b. Una mejor relación entre progenitores e hijos desempeña un papel protector en la adaptación de los hijos a la pérdida; c. La adaptación a la pérdida del progenitor superviviente y de los hijos es independiente; d. Mediante la crianza, el estilo de comunicación, la estrategia de afrontamiento y otros atributos, el progenitor superviviente puede influir en la adaptación de sus hijos. Se identificaron las diferencias de género y de edad en las relaciones entre progenitores e hijos. Los resultados justifican además la importancia de una perspectiva familiar a la hora de llevar a cabo investigaciones y prácticas sobre la pérdida de un ser querido. Se detectaron varias deficiencias en las investigaciones. Los estudios existentes prestaron poca atención a la voluntad de los hijos y a las relaciones bidireccionales, así como al proceso de interacción y su papel detrás de la causalidad bidireccional entre progenitores e hijos. Sobre la base de estos resultados, se propone un marco conceptual de relaciones entre padres e hijos en familias donde falleció uno de los progenitores.

Aging and social networks: A perspective on gender disparity in India.

In India, the "feminization of aging" is one of the areas in which prejudice most frequently occurs. Noticeably, poverty, isolation, changes in residential care, and weak institutional support push women into several vulnerabilities. This study demonstrates that elderly women are often denied basic rights and are compelled to reside in old-age homes; the situation is worse for elderly widowed women. We examine the claims that the lives of elderly women are more precarious due to their lower literacy, limited social exposure, and monetary dependence. Being women, old, and widowed, they are affected by triple vulnerabilities that require concrete policy implications.

Living in a Paradox: How Older Single and Widowed Black Women Understand Their Sexuality.

The current phenomenological study explored how single and/or widowed older Black women understand their sexuality in the context of their Black matriarchal role and through their relational interactions with their children, families, friends, and their extended social networks. The women spoke about their sexuality in the contexts of Black matriarchy, concept of self, and communication. Black matriarchy was defined as the tenacity with which, as Black women and Black mothers, participants occupied a centralized role in their families, while concept of self reflected heavily on conflicting perceptions they held of their understanding of themselves as sexual beings. Regarding communication, many participants felt constrained in self-disclosing their sexual feelings and relationship status. Living in a paradox exemplified our interpretation of the women' struggles as they tried to balance the expectations of the roles they occupied in society with their own identity as a sexual being. Our findings offer a nuanced exploration of the various dimensions about how they understand themselves by providing invaluable insight into their world as older Black women. The implications for policy and practice pertain to assessing the fundamental historical and contemporary issues that older Black women face while simultaneously considering the convergence of race, gender, and sexuality.

Life Came to a Full Stop: The Experiences of Widowed Fathers.

This study investigated how the death of the mother affected four Danish families. In-depth interviews were undertaken with both children (N = 7, 7-19 years) and fathers (N = 4, average age: 46 years) within the same families. The results presented in this article focus on the experiences of the fathers. Thematic analyses as set out by Braun and Clarke resulted in three overall themes: Coping with Loss, Transitions, and Mismatch between Experienced Needs and Provided Help. The results bear witness to a group of bereaved individuals experiencing heavy demands on their time and mental resources while trying to cope with their own grief and that of their children simultaneously. This is especially the case for the three men with younger children. Implications for practice are highlighted, such as a need for focusing on the individual and not offering a one-size-fits-all approach to bereavement support.

Fathers Raising Motherless Children: Widowed Men Give Voice to Their Lived Experiences.

Little is known about the experiences of widowed men with dependent children. With such limited knowledge it is not clear how mental health professionals can assist this population. In this qualitative case study the researcher describes the experiences of ten widowed fathers from the Southeastern United States as they struggle with their new parenting responsibilities after the death of their wives and their children's mothers. The researcher used an inductive constant comparative method to reveal themes. The interview data revealed three themes: Ways to Cope, Concerns, and Newfound Respect. These themes and their subcategories are presented together with suggestions on how to assist widowers with dependent children.

'People insult her as a sexy woman': sexuality, stigma and vulnerability among widowed and divorced women in Oromiya, Ethiopia.

Widowed and divorced women, sometimes referred to as 'female heads of household', are one of the most impoverished and marginalised groups in the world. Widowed and divorced women are often overlooked in the literature or are seen primarily as economically or socially marginalised beings; their sexuality is rarely addressed. In an effort to understand the experiences and challenges faced by such women, we conducted and analysed four focus-group discussions, seven in-depth interviews and four interactive activities with 32 widowed and divorced women and with 25 other community members in Oromiya, Ethiopia. Findings indicate that women experienced high levels of community stigma in relation to their sexuality. Participants' fear of community stigma, and the actions they took to avert it, further served to marginalise them within their community and had negative impact on their economic, social and health support systems and, ultimately, on their overall well-being. Future interventions need to acknowledge sexual stigma as a driving force in the many challenges these women face. Further programmatic work is needed to reduce stigma related to widowed and divorced women's sexuality and to decrease their vulnerability to rape.

Correlation between marital status and the prognosis of older patients with cerebrovascular disease in intensive care units: A retrospective cohort study.

Background and Aims: Marital status has been shown to be associated with mortality, but evidence in critically ill elder intensive care unit (ICU) patients with cerebrovascular diseases (CeVD) is limited. This study was to explore the correlation between marital status and the prognosis of patients with CeVD aged 65 years and over in the ICU. Methods: In the present study, 3564 patients were enrolled in the Medical Information Mart for Intensive Care IV database (version 2.2). Patients were divided into four groups based on marital status: married, single, divorced, and widowed. The primary outcome was all-cause mortality as patients were followed up for 3-, 6-, 9-, and 12-month. All-cause mortality risk for patients with different marital status was compared. Univariate and multivariable logistic regression analyses, survival curves and stratified analyses were performed to determine the correlation between marital status and mortality in critically ill patients with CeVD aged ≥65 years. Results: Of the patients, 51.2% (1825/3564) were married, followed by 23.8% (847/3564) were widowed, 18.2% (647/3564) were single, and 6.9% (245/3567) were divorced. Compared with the married, the unmarried had a higher proportion of female (p < 0.001), older (p < 0.001), and less proportion of mechanical ventilation (p = 0.045). Multivariate analyses showed that no differences were observed for mortality risk among different marital statuses (p > 0.05), while at late follow-up, widowed had a significance higher mortality risk than the married (9-month: odds ratio [OR]: 1.30, 95% confidence interval [CI]: 1.05-1.61, p = 0.02; 12-month: OR: 1.38, 95% CI: 1.12-1.71, p = 0.003). Stratified analyses indicated a stable correlation between marital status and 12-month mortality rate in sub-analysis for gender (p = 0.46) and age (p = 0.35). Conclusion: Marital status is associated with long-term prognosis in older patients with CeVD admitted to ICU. Widowed people should receive more societal attention irrespective of sex or age.

The Impacts of Spirituality and Religious Participation on the Emotional Well-Being of Widowed Older Adults in Southeast Nigeria.

Background and Objectives: The population of older individuals in Africa is increasing, and at a rapid rate. Although the numbers of these individuals increase, many African countries, including Nigeria, are devoid of state-sponsored welfare systems that address their well-being. This situation has placed the bulk of support on the family members including spouses. Studies have shown that spouses are considered to be veritable sources of support in later life. However, spousal death tends to reduce the perceived support including emotional support, which usually occasions lower well-being, life dissatisfaction, and higher mortality rates. This study ascertains the impact of spirituality/religious participation on the emotional well-being of widowed older adults. Research Design and Methods: The study was conducted in Enugu State, southeast Nigeria. The study implemented a qualitative approach to collect data from 71 widowed older adults, aged 60 and older. The thematic analytical method was used to analyze the generated data. Results: Participating in spiritual/religious activities like prayers, church programs/activities reading, studying, and meditating on the word of God have enabled the widowed older adults to buffer some of the emotional challenges. Discussion and Implications: Older adults should be encouraged to participate in spiritual and religious activities. Religious leaders should also make every effort to organize activities that will address the emotional needs of these individuals.

How does social support affect subjective well-being among Chinese widowed older adults?

Background: Social support (SS) is an important factor influencing subjective well-being (SWB) in older adults. This is especially true for the special group of widowed older adults (WOA). Widowhood means that older adults have lost their most important SS, and therefore, the search for a guardian from outside the spouse becomes a central issue in ensuring the SWB of WOA. Methods: The data for this paper were obtained from CGSS 2021, a large national social survey in China. We operationalized SWB as an individual's overall perception of his or her experience of happiness using 'affective well-being' (i.e., emphasizing an individual's positive affective experiences), and scores were calculated using a Likert scale. This study used linear regression modeling to examine the impact of SS on the SWB of WOA (aged 60 and above). Results: It was found that, first, this study presents the role of different circles of SS on the SWB of WOA, fully highlighting the importance of social context. Specifically, daughters, neighbors, and relatives constitute the guardians of the SWB for WOA in rural, whereas daughters and friends constitute the guardians of the SWB for WOA in rural. Second, the protective resources provided by the guardians not only serve as a buffer for WOA in distress but also reduce the likelihood of negative events occurring, thereby increasing WOA's SWB. Discussion: This paper partially corroborates the findings of established studies on the topic of SS and SWB among older adults and the above findings not only help us to further explain the relationship between SS and SWB theoretically but also help us to rationalize the construction of SS for WOA practically.

Differences in Physical Activity, Sedentary Behavior, and Mental Health of the Older Population in South Korea Based on Marital Status and Gender.

The primary purpose of the present study was to assess differences in physical activity (PA), sedentary behavior (SB), and mental health (i.e., depression, suicidal thoughts, and cognitive function) by marital status (i.e., married and widowed) within an aging population in South Korea. PA, SB, and mental health were evaluated in 9092 older adults by comparing the married group (n = 5773, 73.2 ± 5.9 years, 63.5%) to the widowed group (n = 3319, 75.8 ± 6.8 years, 36.5%). Between-group differences in PA, SB, depression, and cognitive function were tested using independent t-tests, and the association between marital status and gender was evaluated using two-way ANOVA. Suicidal thoughts were analyzed using a Mann-Whitney U-test. Older adults in the widowed group participated in significantly less PA (p < 0.001) and had higher SB (p < 0.001) per week, especially the widows, who had significantly less PA (p < 0.01) and had higher SB (p < 0.001) compared to married women. Participants in the widowed group experienced more depression (p < 0.001) and suicidal thoughts (p < 0.001) and had significantly lower cognitive function compared to participants in the married group (p < 0.001). Between the two groups, widowers were more vulnerable to all mental health factors compared to those in the married group. At the same time, widows were only more vulnerable to depression and cognitive function compared to women in the married group. Findings indicated that the presence of a spouse is strongly associated with higher PA levels, lower SB, and better mental health among older adults. Spouses are the primary social supports and play a major role in the health and emotional well-being of the aging population. Given the importance of the spouse, our study suggests that health educators working with older widows should prioritize several different forms of social support to benefit their physical and mental health.

Effects of multimorbidity patterns and socioeconomic status on catastrophic health expenditure of widowed older adults in China.

Background: The high multimorbidity and lower socioeconomic status (SES) of older adults, can lead to catastrophic health expenditures (CHEs) for older adults' households. However, whether widowed older adults will bear such a financial burden has yet to be explored. The aim of this study was to investigate the influence of multimorbidity patterns and SES on CHE in Chinese widowed older adults. Methods: Data was obtained from the 2018 China Health and Retirement Longitudinal Study (CHARLS). This is a cross-sectional study. A total of 1,721 widowed participants aged 60 years and older were enrolled in the study. Latent class analysis was performed based on 14 self-reported chronic diseases to identify multimorbidity patterns. The logistic model and Tobit model were used to analyze the influence of multimorbidity patterns and SES on the incidence and intensity of CHE, respectively. Results: About 36.72% of widowed older adults generated CHE. The incidence and intensity of CHE were significantly higher in the cardiovascular class and multisystem class than in the minimal disease class in multimorbidity patterns (cardiovascular class, multisystem class, and minimal disease class). Among SES-related indicators (education, occupation and household per capita income), respondents with a middle school and above education level were more likely to generate CHE compared to those who were illiterate. Respondents who were in the unemployed group were more likely to generate CHE compared to agricultural workers. In addition, respondents aged 70-79 years old, geographically located in the east, having other medical insurance, or having fewer family members are more likely to generate CHE and have higher CHE intensity. Conclusion: Widowed older adults are at high risk for CHE, especially those in the cardiovascular and multisystem disease classes, and those with low SES. Several mainstream health insurances do not provide significant relief. In addition, attention should be paid to the high-risk characteristics associated with CHE. It is necessary to carry out the popularization of chronic disease knowledge, improve the medical insurance system and medical service level, and provide more policy preferences and social support to widowed older adults.

The vocal dialogue in 9/11 pregnant widows and their infants: Specificities of co-regulation.

Mothers who were pregnant and widowed on September 11, 2001, and their 4-6-month infants (in utero on 9/11) were filmed during face-to-face interaction and their vocal dialogues were examined via microanalysis. Mothers were White, well-educated, mean age 34.3 years, and far from the World Trade Center site on 9/11; infants were 4-6 months, half female. We examined the bi-directional, moment-by-moment co-regulation of the timing of vocal dialogue, and particularly turn taking, in mother-infant and stranger-infant interactions, with time-series models. We analyzed the contingent coordination of durations of (1) vocalizations of the turn-holder, and (2) switching-pauses at the moment of the turn exchange. The switching pause is an aspect of the rhythm of the turn-holder who, after taking a turn, yields the floor to the partner through the switching pause. Turn taking is the lynchpin of dialogue, and the bi-directional contingent coordination of the switching-pause regulates the turn exchange. Both partners showed signs of risk and resilience. The 9/11 mothers did not coordinate the timing of turn taking with their infants, a highly unusual finding. In contrast, the 9/11 infants did coordinate the timing of turn taking with their mothers, and with the "stranger," forms of resilience. We propose that the 9/11 mother's difficulty coordinating with the infant's turn taking rhythm is a mode of transmission of her trauma to the infant. This work expands our knowledge of the specificities of co-regulation in the context of the 9/11 trauma.

Marital Status and Subclinical Coronary Atherosclerosis in Asymptomatic Individuals.

Background Data are limited on the association between marital status and subclinical coronary atherosclerosis. This study investigated the influence of marital status on subclinical coronary atherosclerosis detected by coronary computed tomographic angiography in an asymptomatic population. Methods and Results This retrospective study analyzed 9288 asymptomatic individuals (mean age, 53.7±8.0 years; 6041 [65%] men) with no history of coronary artery disease who voluntarily underwent coronary computed tomographic angiography during a general health examination. Marital categories were married (n=8481) versus unmarried (n=807), comprising never married (n=195), divorced (n=183), separated (n=119), and widowed (n=310) individuals. The degree and extent of subclinical coronary atherosclerosis were evaluated by coronary computed tomographic angiography; ≥50% diameter stenosis was defined as significant. Logistic regression and propensity score matching analyses were used to determine the association between marital status and subclinical coronary atherosclerosis. After adjustment for cardiovascular risk factors, no significant differences were observed in the adjusted odds ratio (OR) of unmarried status for any coronary plaque (OR, 1.077; 95% CI, 0.899-1.291), calcified plaque (OR, 1.058; 95% CI, 0.881-1.271), noncalcified plaque (OR, 0.966; 95% CI, 0.691-1.351), mixed plaque (OR, 1.301; 95% CI, 0.884-1.917), and significant coronary artery stenosis (OR, 1.066; 95% CI, 0.771-1.474). Similarly, in the 2:1 propensity-score matched population (n=2398), no statistically significant differences were observed for the OR of marital status for any subclinical coronary atherosclerosis (P>0.05 for all). Conclusions In this large cross-sectional study, marital status was not associated with an increased risk of subclinical coronary atherosclerosis.

Comparing the impact of social support on the life satisfaction of widowed and non-widowed elders.

Aim: To compare differences in life satisfaction between widowed and non-widowed elders based on social support. Methods: A total of 4,560 widowed and 3,655 non-widowed elders were selected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS-2018). Ordinal logistic regression models and t-tests were performed using SPSS v20. Results: Both widowed and non-widowed elders had high levels of life satisfaction. Personal characteristics had a significant impact on the life satisfaction of both widowed and non-widowed elders. Endowment insurance, social trust, residence, self-rated health, and living with family had a significant impact on the life satisfaction of widowed elders (p < 0.001), while endowment insurance, government subsidy, and self-rated health significantly impacted non-widowed elders (p < 0.001). Self-rated health had the greatest impact on the life satisfaction of widowed and non-widowed elders (OR = 4.62/4.45), followed by endowment insurance (OR = 1.24/1.32). Conclusion: Social support can significantly improve life satisfaction, but its impact is heterogeneous. Informal social support plays a greater role in improving the life satisfaction of widowed elders, but formal social support plays a greater role in the life satisfaction of non-widowed elders.

Short versions of the Geriatric Depression Scale (GDS) among widowed older people in Taiwan: Comparing their psychometric properties.

OBJECTIVE: To compare the psychometric properties of different short versions of the Geriatric Depression Scale (GDS) among community-dwelling widowed older people. METHODS: A cross-sectional design was conducted between February 2018 and August 2019 in southern Taiwan (n = 330). The GDS short versions included Hoyl et al's 5-item version, Molloy et al's 5-item version and van Marwijk et al's 4-item version. RESULTS: All GDS short versions had satisfactory internal consistency (α = 0.83-0.90), with strong item loading embedded in the same construct of depression (0.43-0.72). The activity of daily living (ADL) scores had strong associations with van Marwijk et al's 4-item version (absolute standardised coefficient [|ß|] = 0.15-0.59), Hoyl et al's 5-item version (|ß| = 0.16-0.45) and Molloy et al's 4-item version (|ß| = 0.09-0.40). CONCLUSIONS: Hoyl et al's 5-item version was found to be more suitable than the other two versions of the GDS to assess the precise construct of depression. Meanwhile, van Marwijk et al's 4-item version can be used when the focus is on ADL performance. However, the conclusion should be interpreted with caution since the results were derived only from a widowed population in Taiwan. More research on this topic among other populations is thus needed to corroborate our conclusion.

Social Participation and Survival in Widowed Persons: Results of the Taiwan Longitudinal Study on Aging.

It has been considered that widowed persons have a higher risk of death. This study intended to explore whether social participation could improve this trend. A longitudinal study database was constructed to explore the trend of survival and its change with social participation in widowed persons. The Taiwan Longitudinal Study on Aging (TLSA), based on four consecutive waves of longitudinal follow-up data in 1999, 2003, 2007, and 2011 was linked with the National Death Registry from 1999 through 2012. In total, there were 1417 widowed persons and 4500 nonwidowed persons included in this study, excluding divorced and never-married people. The survival trend analysis was carried out with social participation as the main predictive factor stratified for comparative analysis. Our results showed that the widowed were older than the nonwidowed, were female-dominant, had a lower education level, were more economically stressed, and were less likely to engage in regular exercise, and thus showed generally poorer health; for example, being more vulnerable to having chronic diseases, disability with the Activities of Daily Living (ADL), cognitive impairment with the Short Portable Mental State Questionnaire (SPMSQ), and depression with The Center for Epidemiological Studies-Depression (CES-D). The death risk of the widowed was significantly higher than that of the nonwidowed, but the death trend for those with social participation was significantly lower than that of their counterparts in both the widowed and nonwidowed. After matching with gender and age for widowed persons, the widowed with social participation had a significantly lower risk of death (adjusted hazard ratio (HR), 0.83; 95% confidence interval (CI), 0.71-0.98) compared to the widowed without social participation. It was concluded that social participation can improve the death risk for the widowed, and it is worthily included in health promotion plans and social welfare services for widowed persons.

Diabetes Mellitus and Marital Status: Evidence from the National Longitudinal Mortality Study on the Effect of Marital Dissolution and the Death of a Spouse.

PURPOSE: This study evaluates the full impact of marital status on diabetes mellitus by stratifying the analysis by gender, including socioeconomic covariates and, unlike most studies, extending marital status by separating out previously conflated status categories. METHODS: Release 5 of the National Longitudinal Mortality Study (NLMS) was used for the data. Logistic regression was applied to the data from 1990 to 2011. The effective sample size consists of 1,384,507 individuals age 18 and above recruited into the study (via the Current Population Surveys), 3,955 of whom had died of diabetes mellitus by 2011. RESULTS: For minority men and non-Hispanic white men, divorced/separated status was significantly related to diabetes mortality, respectively (OR=1.318, CI=1.010, 1.719; and OR=1.283, CI=1.054, 1.562). For minority women and non-Hispanic white women, widowed status was related to diabetes mortality, respectively (OR=1.349, CI=1.107, 1.643; and OR=1.262, CI=1.113, 1.431). CONCLUSION: Contrary to recent epidemiological studies in which divorced/separated and widowed status were combined into one covariate, this United States study finds that divorced/separated men and widowed women are at increased risk for diabetes mellitus mortality, and that among these populations at risk, minorities are at higher risk than whites. The study highlights the importance of marital status and gender differences in the risk of death from diabetes.