OBJECTIVES:To map and summarize evidence on means restriction activities that have been implemented for the prevention of suicide across Australia. Further, to provide an overview of the impact of the activities on suicide rates and ascertain barriers/challenges, costs, and any other relevant associated information. METHODS:We conducted a scoping review of the literature following JBI-formerly known as Joanna Briggs Institute-methodology for scoping reviews and recommendations by Cochrane Rapid Reviews. Four databases were searched for identifying all published material in English. Gray literature was searched through Google Scholar and state-based and national health commission websites. RESULTS:We identified five publications addressing means restriction activities implemented for suicide prevention. All studies describe restriction of access to places where there had been suicides by jumping from a height. The studies concluded that mean restriction activities were valuable in the prevention of suicide by jumping. Further, we reviewed four additional publications describing activities that restricted access to means (e.g., firearms legislation) but where the intervention was not aimed at suicide prevention per se, albeit suicide rates were reported. CONCLUSION:Despite there being few studies available, our review identifies evidence on means restriction activities for the prevention of suicide implemented within Australia and provides a summary of implemented interventions that have been reported to be associated with a decrease in suicide rates. In particular, the apparent benefit of structural interventions at jumping sites supports their broader adoption: any such future activities require careful evaluation.
Young-onset dementia (YOD), with symptom onset before 65, is an area of increasing public health importance. YOD research in Asia-Pacific remains under-represented in the global YOD research landscape. This scoping review aimed to comprehensively map the existing YOD literature from Asia-Pacific and provide an overview of the research topics explored to date. We followed the PRISMA extension for scoping reviews guidelines and searched Scopus and PsycINFO, using predefined search terms, from their inception to December 31, 2024. Empirical studies involving participants with YOD, or family carers of people with YOD, living in Asia-Pacific, were included. 437 publications were identified. Fourteen of the 42 Asia-Pacific countries/territories have published YOD research, with Japan, Australia, South Korea, and China contributing 82.2% of YOD research in the region. The volume of YOD publications in the Asia-Pacific region increased steadily from the early 2010s. Most studies were case reports/series (34.8%) and quantitative (59.2%), with 5.9% using qualitative or mixed-methods. The YOD research landscape is mostly focused on disease biology such as genetics, neuroimaging, and neuropathology. Despite the impacts of YOD on individuals and their families, only 11.4% of publications, mainly from Australia, examined psychosocial impacts and support services. There is a need for research in the Asia-Pacific region to better understand the journey of YOD and to co-create interventions and services that address the needs of those affected. Potential policy implications include explicit inclusion of YOD within national and regional dementia policies, with acknowledgement that psychosocial impacts of YOD are insufficiently addressed by older age-based dementia frameworks.
Current understanding of mental health problems among aviation pilots remains limited. Pilots are exposed to distinctive occupational stressors, and when psychological distress occurs, they may be reluctant to disclose symptoms or seek timely assistance because of concerns about stigma, loss of income, licensing restrictions, or medical disqualification from flying. Pilot mental health is therefore not only an occupational health issue, but also a critical component of aviation safety governance. Although the vast majority of mental health conditions do not lead to flight safety events, in rare circumstances, severe psychological crises that remain unidentified or unsupported may result in catastrophic outcomes, including aircraft-assisted pilot suicide. These tragic events underscore the potential safety implications of pilot mental health and highlight the urgent need for greater attention to this critical issue. This article argues that prevention should be centered on system-level measures, including confidential peer support, carefully governed digital tools, destigmatized safety cultures, and harmonized data infrastructures.
BACKGROUND:Hikikomori, particularly among young adults, has gained growing attention. This study explored the nonlinear associations of loneliness and insomnia with subclinical hikikomori among college students. METHODS:A total of 6514 college students were assessed in this study. The University of California Los Angeles Loneliness Scale (UCLA-LS), the seven-item Insomnia Severity Index questionnaire (ISI-7), and the 1-month version of the HQ-25 (HQ-25M) were used to measure loneliness, insomnia, and subclinical hikikomori, respectively. Restricted cubic spline (RCS) models were utilized to characterize the nonlinear relationships between different measures. RESULTS:After adjusting for confounders, the RCS models revealed that loneliness and insomnia had significant nonlinear relationships with hikikomori, with both showing a dose-response pattern. A J-shaped relationship was observed between loneliness and subclinical hikikomori, with an inflection point at UCLA-LS = 50.15. Additionally, a significant nonlinear relationship between insomnia and subclinical hikikomori was also found, with an inflection point at ISI-7 = 4.08. Scores above these thresholds for UCLA-LS and ISI-7 were associated with increased risk of hikikomori. Subgroup analyzes did not reveal any significant moderating effects. Regarding the associations of loneliness and insomnia with the risk of subclinical hikikomori, the inflection points for participants with a history of psychiatric problems and perceived poor health status were lower than those in the other groups. CONCLUSIONS:Given the adverse impacts of hikikomori on college students, it is important to develop appropriate preventive and treatment strategies to address loneliness and insomnia in this vulnerable population.
Purpose Perinatal mood disorders are associated with adverse maternal and neonatal outcomes and affect 15%-20% of pregnant people. Guidelines recommend SSRIs when non-pharmacological therapies are ineffective, yet antenatal depression remains undertreated. This study aimed to assess the attitudes, knowledge, and practices of general practitioners (GPs) and midwives on SSRI use in pregnancy.Methods A knowledge, attitudes, and practice survey was developed in QualtricsXM and distributed to New Zealand-registered GPs and midwives between May 2023 and October 2024 using convenience sampling.Results Responses from 119 GPs and 62 midwives were analyzed. Discomfort managing antenatal depression was reported by 11% of GPs and 36% of midwives. Knowledge of SSRI risks in pregnancy varied among respondents. Average concern regarding the use of SSRIs in pregnancy and the risk of adverse outcomes was low, but there was considerable variation. In the case vignette, recommended actions differed: 53% advised maintaining treatment, 13% suggested dose reduction, and 24% recommended switching antidepressants. Patient counseling was limited, and appropriate written patient information was rarely provided.Conclusions This study highlights variability in knowledge, attitudes, and practices among GP's and midwives regarding SSRIs during pregnancy. Further training, improved access to patient information, and decision aids could enhance patient-centered care and ensure pregnant people receive balanced, evidence-based guidance on SSRI use.
Background Variation in primary care quality across social groups contributes to health inequalities. We examined achievement rates for quality-of-care indicators among patients attending primary care practices in England, comparing rates for patients living in the most and least deprived areas. Methods We analysed electronic health records from 2.2 million patients in 2019/2020, registered with 300 practices contributing to the Clinical Practice Research Datalink (CPRD) Aurum database. Patients were grouped by neighbourhood deprivation using the 2019 Index of Multiple Deprivation. We assessed inequality in 35 quality-of-care indicators from the Quality and Outcomes Framework pay-for-performance scheme for 607 126 patients with a relevant long-term condition, calculating differences in (a) age-sex adjusted achievement rates (overall inequality) and (b) rates further adjusted for common practice fixed effects (within-practice inequality) obtained by logistic regression. Rates were calculated for all patients with relevant conditions (population achievement) and the subset not excluded from the scheme by practices (reported achievement). Results There was no consistent socioeconomic pattern in reported achievement of individual indicators overall (across all practices), but within-practice reported achievement was significantly lower for patients in more deprived areas for eight indicators. Population achievement was significantly lower for patients in more deprived areas for 13 indicators, reflecting higher exclusion rates. Population achievement was higher in more deprived areas for one indicator. The largest inequalities were for influenza vaccination (chronic obstructive pulmonary disease and stroke) and haemoglobin A1c (HbA1c) control (diabetes). Conclusion Within the same practice, patients from more deprived areas are less likely to receive recommended care for key quality of care indicators.
BACKGROUND:Contextual factors influence how older adults perceive and adapt to chronic health conditions. We examined the impact of chronic health conditions on trajectories of depressive symptoms among older Chinese adults and investigated whether age-friendly communities buffer this effect. METHODS:We used panel data from the China Health and Retirement Longitudinal Study from 2011 to 2018, including 6122 adults aged ≥50 years (22 198 observations). Factor analysis of mixed data (FAMD) was performed to construct composite variables of community characteristics. The cross-level interactions between community variables and multimorbidity were included in growth curve models to assess the moderating effects. RESULTS:Individuals with multimorbidity had Centre for Epidemiologic Studies Depression Scale (CES-D) scores that were, on average, 1.60 points higher (95% CI 1.31 to 1.89) than those without chronic conditions, indicating a relatively modest effect size. Associations with depressive symptoms were weaker in more favourable community environments and among individuals with higher participation (all P for interaction<0.001). For multimorbidity, β coefficients were smaller in areas with better infrastructure (1.50 vs 1.73), stronger social services (1.47 vs 1.85) and higher participation (1.47 vs 2.09). A similar pattern was observed for individuals with a single condition, with smaller β coefficients in areas with better infrastructure (0.41 vs 0.79), stronger social services (0.35 vs 0.78) and higher participation (0.35 vs 0.89). CONCLUSION:Age-friendly environments may ameliorate the effects of multimorbidity on depressive symptoms. Interventions can target modifiable community-level factors to better support older adults with chronic conditions.
BACKGROUND:Adequate education funding is important to reduce the socioeconomic inequality in educational attainment, an important social determinant of health. Over the past decade, there have been reductions in public funding for schools in England, despite the introduction of a national funding formula (NFF) policy, aimed at reducing historical differences in school funding. We assessed the impact of school spending cuts on student attainment at age 16, additionally by deprivation and pre-NFF and post-NFF policy implementation. METHODS:Our longitudinal ecological study covers the period 2014/2015 to 2022/2023, analysed at local authority (LA) level. Our exposure was secondary school spending per pupil using school-level data, aggregated by LA and inflation adjusted. Our outcome was General Certificate of Secondary Education (GCSE) attainment using average GCSE Attainment 8 scores across LAs. We used correlated random-effects regression to quantify the association between change in spending and change in GCSE attainment. We additionally analysed the association between spending cuts and attainment by LA deprivation, and before and after the NFF policy. FINDINGS:Between 2015 and 2023, per pupil school spending decreased by 13% from £6367 to £5556, while average GCSE attainment declined by 2.1 points from 48.5 to 46.4. A 10% spending cut was associated with a 0.42-point decrease in average attainment (95% CI 0.19 to 0.66). The estimates are different across LA deprivation quintile-based groups. Most deprived LAs had a greater impact (0.54; 95% CI 0.17 to 0.92), compared with least deprived LAs (-0.04; 95% CI -0.46 to 0.38). The association after the NFF policy was not different from the pre-NFF period (p=0.639). CONCLUSION:School spending cuts were associated with decreased GCSE attainment across England, with a bigger impact in socioeconomically disadvantaged areas. Against a backdrop of spending cuts, NFF introduction did not narrow inequities in attainment. More equitable school investment is critical to improving attainment and reducing inequalities across the life course.
BACKGROUND:Air pollution exposure has been linked to ischaemic stroke (IS), yet the sensitive life stages for pollution-related IS risk and the interplay of genetic susceptibility remain unclear. METHODS:We analysed 404 234 IS-free participants from a large UK prospective cohort. Exposures to PM2.5, SO2 and O3 were estimated across five life stages (toddlerhood, childhood, adolescence, youth and middle-aged to older adulthood) and cumulatively from birth. Bayesian life-course models identified sensitive exposure windows and quantile g-computation estimated mixture effects. Gene-environment interactions with polygenic risk scores (PRSs) were evaluated using relative excess risk due to interaction (RERI), attributable proportion (AP) and synergy index (S). RESULTS:During a median follow-up of 13.6 years, 8130 IS cases occurred. Associations between air pollutants and IS varied by life stage, with stronger associations observed in middle-aged to older adulthood (HRs: 1.586 (95% CI 1.554 to 1.618) for PM2.5, 1.180 (1.167-1.193) for SO2, 1.588 (1.552-1.624) for O3). For cumulative exposures, elevated risks were seen from toddlerhood to older adulthood (HRs: 1.139-1.313). Mixture effects were most pronounced in toddlerhood (HR=2.829, 95% CI 2.623 to 3.052), largely driven by SO2 (weight=0.500). Bayesian life-course models suggested PM2.5 (25.2%) and O3 (24.5%) had greater relative contributions in childhood and adolescence whereas SO2 (45.9%) contributed more in later life. Higher pollutant exposure and elevated PRS were associated with higher IS risk (RERI>0, AP>0 and S>1). CONCLUSIONS:Air pollution associations with IS risk vary across life stages and may be influenced by genetic susceptibility, supporting a life-course prevention approach.
OBJECTIVES:Cognitive decline among middle-aged and older adults is an increasing public health concern, and household cooking fuel use has been suggested as a potential environmental risk factor. This study examined the association between household cooking fuel and long-term cognitive function trajectories. METHODS:Data were obtained from 6306 respondents in the China Health and Retirement Longitudinal Study (CHARLS) between 2011 and 2020. Cognitive function was assessed using standardised measures of episodic memory and mental status. Group-based trajectory modelling was used to identify distinct cognitive function trajectories over time. Multinomial logistic regression was applied to examine the association between household cooking fuel type and trajectory membership. Subgroup analyses were conducted by marital status and sensitivity analyses using propensity score matching (PSM) were performed to assess the robustness of the findings. RESULTS:Four distinct cognitive function trajectories were identified. Compared with clean fuel users, individuals using solid fuels were significantly more likely to belong to lower or declining cognitive trajectories. Results from the PSM analysis were consistent with the main findings. CONCLUSION:Household solid fuel use is associated with unfavourable cognitive function trajectories among middle-aged and older adults. Expanding access to cleaner household energy and reducing exposure to cooking-related smoke may be relevant public health strategies for ageing populations.
Introduction Sex disparities in suicide mortality persist worldwide, with male rates 2-4 times higher than female rates, but age-specific patterns over time remain insufficiently understood. Aim To examine long-term trends in suicide mortality in Spain (2000-2023), focusing on sex-specific and age-specific differences and the evolution of the male-to-female suicide rate ratio. Methods We conducted a longitudinal study using national mortality data from the Spanish Statistical Office. Crude and age-adjusted suicide rates were calculated by sex and age group. Joinpoint regression assessed temporal trends and male-to-female rate ratios across 15 age groups. Results The overall age-adjusted rate showed no significant change (average annual percent change: -0.4%), with a significant decrease among men (-0.7%) and stable overall rates among women, while increases were observed in selected female age groups. Rates increased with age, particularly among men aged 70+. The male-to-female ratio widened with age, reaching 10.74 in the 95+ group, but narrowed over the study period in four age groups (15-29, 50-54, 75-79, 80-84), mainly due to declining male rates. Conclusion Despite modest changes over time, marked age-related sex disparities persist. Older men remain the highest-risk group, while increases among women in midlife warrant targeted prevention.
BACKGROUND:Depressive symptoms and sleep problems are prevalent among older adults with depression. To reduce their adverse impact, it is important to understand the changes in symptom patterns as the Coronavirus disease 2019 (COVID-19) pandemic emerged. This longitudinal study examined the interactive changes between depressive symptoms and sleep problems among older adults with depression before and during the COVID-19 pandemic from a network perspective in the USA. METHODS:This network analysis study was based on data from the three waves (2016, 2018, and 2020) of the Health and Retirement Study (HRS). Depressive symptoms were measured using the eight-item version of the Center for Epidemiologic Studies Depression Scale (CESD-8), and sleep problems were assessed with the four-item Jenkins Sleep Scale (JSS-4). The study examined central symptoms and bridge symptoms within the network model. RESULTS:A total of 2905 older adults with depression were included in the analyses. The prevalence of depressive symptoms did not significantly change in the study wave during the COVID-19 compared to the pre-pandemic waves. "Feeling Depressed" was the most central symptom of the depression-sleep problems network in the 2016 wave, while "Feeling Sad" was the most central symptom in both the 2018 and 2020 waves. Additionally, "Feeling Loneliness" was the key bridge symptom of the depression-sleep problems network in the 2016 wave, while "Not Enjoying Life" was the key bridge symptom in the 2018 wave, and "Feeling Rested in Morning" was the key bridge symptom in the 2020 wave. CONCLUSION:The findings highlighted that central and bridge symptoms were potential targets in treating depressive symptoms and sleep problems among older adults with depression across the study period in the USA.
BACKGROUND:Depressive symptoms can contribute to poor cardiovascular health (CVH) but prior research largely focused on individual-based studies. Yet, health behaviours and outcomes are interlinked within social relationships, particularly in spouses. This study examined how depressive symptoms in opposite-sex spouses may jointly and uniquely impact CVH over time. METHODS:We analysed 4360 opposite-sex spousal dyads in the Health and Retirement Study-a prospective cohort of middle-aged and older adults (2004-2016). Depressive symptoms were measured at baseline (2004/2006) using the 8-item Center for Epidemiologic Studies-Depression scale. CVH scores (range: 0-100; higher scores=better CVH), based on body mass index, blood pressure, fasting glucose, total cholesterol and smoking were assessed across three follow-up waves (2006/2008-2014/2016; 8-year follow-up period). We used the Actor-Partner Interdependence Model and latent growth curve modelling to examine how both spouses' depressive symptoms were associated with subsequent CVH, adjusting for sociodemographics and prior cardiovascular disease. RESULTS:In wives, a one-unit increment in depressive symptoms at baseline was associated with lower CVH scores (β=-1.25; 95% CI -1.60 to -0.91) at Wave 2. Similar associations were observed in husbands (β=-1.19; 95% CI -1.58 to -0.81). Wives' depressive symptoms were also associated with lower husbands' CVH scores (β=-0.39; 95% CI -0.70 to -0.07), while husbands' depressive symptoms were associated with faster CVH decline in wives over time (β=-0.08; 95% CI -0.14 to -0.03). No other significant spousal effects were found. CONCLUSION:Depressive symptoms in both spouses may contribute to one's own and one's partner's CVH, with distinct gender-specific patterns. These results may inform targeted dyadic interventions to optimise CVH in middle-aged and older opposite-sex couples.
BACKGROUND:Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality worldwide, with heightened risks in conflict-affected settings. In the West Bank, political instability and healthcare barriers may increase adverse birth outcomes but hospital-based evidence remains limited. This study estimated hospital-based PTB prevalence in selected public hospitals and identified maternal, household and healthcare determinants. METHODS:A cross-sectional study was conducted between April and August 2025 in purposively selected governmental hospitals across the northern, central and southern West Bank. Women delivering singleton live births were approached consecutively within 24-48 hours post partum. Data were collected using a structured interviewer-administered questionnaire and medical record abstraction. PTB was defined as birth before 37 completed weeks. Multivariable logistic regression estimated adjusted ORs (aORs) and 95% CIs. RESULTS:Among 1235 eligible women, 174 had PTBs, yielding a hospital-based prevalence of 14.1% (95% CI 12.1% to 16.3%). Higher odds of PTB were observed among women aged 19-24 years (aOR 1.90, 95% CI 1.07 to 3.37) and 25-34 years (aOR 1.72, 95% CI 1.06 to 2.79), households with <three members (aOR 2.40, 95% CI 1.20 to 4.80) and residents of the northern West Bank (aOR 3.67, 95% CI 2.07 to 6.52). Reporting safe access to healthcare was associated with lower odds of PTB (aOR 0.67, 95% CI 0.46 to 0.98). CONCLUSION:PTB is highly prevalent in selected public hospitals in the West Bank, influenced by structural, social and geographic factors. Policies improving healthcare access and addressing regional disparities are essential to reduce PTB in conflict-affected settings.
Background People have come to rely on restaurants and takeaway foods, and less on cooking at home. We examined the association between home cooking and dementia incidence, ascertained through administrative long-term care records, and whether the benefits of home cooking differ by cooking skills.Methods Participants in the Japan Gerontological Evaluation Study, a population-based cohort study, were followed for 6 years. The incidence of dementia was ascertained in 10 978 participants through data from the public long-term care insurance system, which captures functionally significant cognitive impairment requiring care. Cooking frequency and skills were assessed in a baseline survey. Participants with high and low frequencies of home cooking were matched in men and women based on demographic, socioeconomic and health-related factors using propensity score matching. Fine-Grey competing risk models were used, with death treated as a competing event.Results During the follow-up, 1195 dementia cases were found. A total of 1347 male and 321 female pairs were matched between high (at least once a week) and low (less than once a week) cooking frequencies. The subdistribution hazard ratio (SHR) for high cooking frequency (vs low cooking frequency) was 0.77 (95% CI 0.61 to 0.98) in men and 0.73 (95% CI 0.54 to 0.98) in women. The benefits of higher cooking frequency were more pronounced in those with low cooking skills (SHR 0.33, 95% CI 0.13 to 0.84).Conclusions Creating an environment where people can cook meals when they are older may be important for the prevention of dementia.
Background Older adults typically have higher sedentary behaviour (SB) and lower physical activity (PA) than younger adults. Studies on replacing SB with PA in relation to all-cause mortality in racially diverse older adults remain limited.Methods This study included 122 966 older adults from the China Kadoorie Biobank (CKB) and 207 212 older adults from the UK Biobank (UKB). SB and PA were assessed using baseline questionnaires, with PA classified as light (LPA), moderate (MPA) or vigorous (VPA) based on metabolic equivalents. Cox proportional hazards models and isotemporal substitution models were used to examine the associations between replacing SB with different PA intensities and all-cause mortality.Results Longer SB (per 30 min/day increase) was associated with a higher risk of all-cause mortality in both cohorts (CKB: HR 1.013, 95% CI 1.010 to 1.017; UKB: HR 1.012, 95% CI 1.009 to 1.015). PA of any intensity was associated with a reduced risk of all-cause mortality. In the CKB, replacing 30 min/day of SB with an equivalent duration of PA showed comparable protective associations (LPA: HR 0.963, 95% CI 0.958 to 0.968; MPA: HR 0.967, 95% CI 0.961 to 0.972; VPA: HR 0.965, 95% CI 0.960 to 0.971). In the UKB, replacing 30 min/day of SB with VPA was associated with the largest reduction in mortality risk (HR: 0.950, 95% CI 0.931 to 0.970).Conclusions Replacing SB with PA of any intensity was associated with reduced all-cause mortality risk in older adults, with variations across populations. These findings highlight the need for population-specific PA recommendations to promote healthy ageing.
Aim Causal inference relies on correct background knowledge, which epidemiologists generally understand to come from academic experts. Our community-engaged study augments scientific domain knowledge with lived/living experience to co-construct the directed acyclic graph (DAG) underpinning our team's research question about ageing and HIV. We outline our team's process for co-creating the community-based DAG and describe qualitative reflections from team members regarding these methods. Our overarching goal was to expand expert knowledge to include community expertise by engaging peer researchers in DAG co-development.Methods We assembled a team of quantitative and qualitative researchers, including a diverse group of peer researchers living with HIV. The team co-constructed a DAG, illustrated by a peer researcher-artist, combining the lived/living experience of peer researchers with subject-matter expertise from academic researchers. The DAG was refined with input from epidemiologists. Qualitative researchers transcribed DAG co-development sessions to understand how peer researchers engaged with this tool.Results Qualitative reflections allowed the study team to critically analyse our process. Peer researchers found drawing the DAG intuitive. Having a visual representation of causal relationships led to active discussion and greater understanding. The complexity of the DAG enmeshed with temporal ordering humanised the research; seeing the web of covariates resonated as a reflection of a person's life journey. One peer researcher found that incorporating diverse perspectives meant upholding unique expertise and not only platforming academic expertise.Conclusions Co-constructing DAGs incorporating lived/living experience is reasonable and possible. Co-constructing DAGs may strengthen epidemiologic studies by reconceptualising the traditional epidemiologic definition of expert knowledge.
BACKGROUND:Post-stroke depression (PSD) is a common neuropsychiatric complication in stroke survivors. However, gender differences in the prevalence and correlates of PSD are underexplored. This study examined gender differences in PSD prevalence and their demographic and clinical correlates among older stroke survivors. METHODS:Data from a large national survey conducted in China during 2017-2018 were analyzed. Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale. Univariate and multivariate analyses examined the demographic and clinical correlates of PSD by gender. RESULTS:A total of 1123 older stroke survivors (65 years of age or above), including 578 males (51.5%) and 545 females (48.5%), were included. The overall PSD prevalence was 34.28% (95% CI = 31.52%-37.15%), with significantly higher prevalence in females (38.71%; 95% CI: 34.62%-42.96%) compared to males (30.10%; 95% CI: 26.42%-34.05%). In males, engaging in recent physical exercise (OR: 0.604; 95% CI: 0.389-0.936; p = 0.024) was associated with a lower PSD risk, while more activity limitations (OR: 1.727; 95% CI: 1.131-2.639; p = 0.011) and severe anxiety (OR: 1.455; 95% CI: 1.334-1.586; p < 0.001) were associated with higher risk. In females, recent physical exercise (OR: 0.370; 95% CI: 0.235-0.581; p < 0.001) was linked to lower PSD risk, while heart disease (OR: 1.698; 95% CI: 1.136-2.539; p = 0.010) and severe anxiety (OR: 1.516; 95% CI: 1.372-1.674; p < 0.001) were associated with higher risk. CONCLUSION:This study highlights the gender differences in PSD prevalence and correlates among older Chinese stroke survivors. Tailored interventions are needed to address PSD, with future research focusing on targeted screening and intervention.
BACKGROUND:Housing affordability stress is a significant determinant of psychological health among young adults in urban settings. However, prior studies often rely on a single indicator, limiting understanding of how objective financial burdens and subjective experiences of affordability stress relate to depressive symptoms and suicidal ideation. This study addresses these gaps by jointly examining objective and subjective housing affordability stress. METHODS:We used longitudinal data from the Seoul Young Adult Panel Study (2021-2024), comprising 5155 individuals and 13 735 person-wave observations. Objective housing affordability stress was defined as allocating 30% or more of total household expenditures to housing, while subjective affordability stress captured self-reported difficulty paying housing-related expenses. Individual fixed-effects regression models were estimated to examine within-person associations between housing affordability stress and depressive symptoms and suicidal ideation. RESULTS:Both objective and subjective housing affordability stress were significantly associated with higher depressive symptoms and increased likelihood of suicidal ideation. Subjective affordability stress showed a stronger association with depressive symptoms than objective measures. When the two measures were considered jointly, individuals experiencing both objective and subjective affordability stress had the highest levels of depressive symptoms and suicidal ideation, indicating an additive effect of dual affordability stress. CONCLUSIONS:Objective and subjective measures of housing affordability stress capture distinct yet complementary dimensions of housing-related hardship and identify different at-risk groups. A joint measurement approach provides a more comprehensive assessment of housing-related psychological health risks among urban young adults than reliance on a single indicator.
