Objective: The aim of this study was to verify the role of spiritual well-being as a moderator of the effect of living arrangement on depressive state in the elderly. Methods: We conducted a cross-sectional study using semi-structured interviews in Okinawa on 2010. Four hundreds thirteen (165 men, 248 women) participants were asked about 5-item Geriatric Depression Scale (GDS-5) as dependent variable, living arrangements (living alone or living with others) as independent variable, spiritual rating scale for elderly as mediating variable, and demographic and socioeconomic variables as control variables. The main and interaction effects were assessed using hierarchical multiple regression and simple slope analyses. Results: The proportion of elderly who living alone was 26.6% (n 110), and they were significantly higher scores of GDS-5 than the elderly who living with others (P 0.001). Significant negative correlation was found between depressive state and spiritual well-being (r 0.27, P 0.001), and the result indicated that the elderly with higher spiritual well-being were lower depressive state. Results of hierarchical regression analysis showed that the correlation between living arrangement and spiritual well-being was positively associated with increased risk for depressive state (β 0.10, P 0.037). Simple slope analyses revealed that the elderly who living alone had significantly higher depressive state scores than those who living with others only in low spiritual well-being (P 0.002), but not in high spiritual well-being (P 0.445). Conclusions: Our findings suggest that spiritual well-being might play an important role in preventing the elderly who living alone from depression, and interventions aimed at promoting spiritual well-being in the elderly who living alone may lead to improvements in mental health.
Background Village health volunteers (VHVs) are responsible for providing primary care in the communities of Laos. Unlike other districts, in Xepon more than 90% of VHVs are male and therefore experience difficulties interacting with pregnant women. To improve outreach to pregnant women, especially among ethnic minorities, a new project was implemented by local municipalities in 2017: newly selected female VHVs were paired to work with existing male VHVs. The objective of this study was to compare the postnatal depressive symptoms of ethnic minority mothers supported by pair-VHVs and single-VHVs in remote rural areas of Lao People’s Democratic Republic (PDR). Methods A cross-sectional study was conducted in March 2019. Mothers who had delivered a baby within 1 year preceding the study were recruited from 36 villages. Of the 305 mothers, 227 responded. The questionnaires included (1) demographic characteristics such as age, economic status, and birth experience; (2) self-decision to go to a health center/hospital to receive antenatal care; (3) type of VHVs (pair or single), support, and information from VHVs during pregnancy, support from husband and relationship with husband; (4) the Edinburgh Postnatal Depression Scale (EPDS). A Mann-Whitney U test, chi-square test, and multiple linear regression analysis were performed. Ethical approval was obtained from the University of the Ryukyus and National Ethics Committee for Health Research of Lao PDR. Results The average total EPDS score was 5.5 among mothers supported by pair-VHV and 7.0 among mothers supported by single-VHV. Results of the multiple linear regression analysis showed that the EPDS score was significantly lower among mothers supported by pair-VHV (β=−1.18, p <0.05) even after adjusting for economic and biological factors. Conclusions Mothers supported by pair-VHV had a significantly lower EPDS score than those supported by single-VHVs in this study area, suggesting that the support of male and female VHV pairs contributed to improving mental health status among ethnic minority mothers in remote rural areas of Lao PDR. Expanding the program to train female VHVs working with male VHVs is necessary for improving maternal and child health in a rural district of Lao PDR.
Objective: This study aimed to clarify the association between sense of filial responsibility, local residents' subjective economic status, and attachment to the local community, and to contribute to local community policies and measures including support systems for elderly in need of care and family. Methods: We conducted in-home interviews in 2015 in Okinawa, Japan. A total of 2,663 local residents were selected, and after invalid responses were excluded, 1,656 responses (62.2%) were analyzed. Participants were asked about demographic variables (sex, age, marital status, birth order, subjective health, living arrangement), subjective economic status, attachment to the local community, and sense of filial responsibility (such as caring for and supporting their elderly parents). Results: Age, marital status, birth order, and attachment to the local community were positively associated with sense of filial responsibility. Participants with low subjective economic status had low sense of filial responsibility. Even if subjective economic status was low, participants with high attachment to the local community had significantly high sense of filial responsibility. Moreover, participants with high attachment to the local community provided and received more instrumental support than participants with low attachment to the local community. Conclusions: Our findings suggest that high attachment to the local community can form a support system in local areas, and that support systems in turn help local residents when they support their parents. In light of these findings, measures for creating networks between local residents, as well as improvement of the physical environment, are necessary for local community planning.Key words: sense of filial responsibility, attachment to the local community, subjective economic status, social support, social capital 親扶養意識,地域愛着,経済状況,ソーシャルサポート,ソーシャル・キャピタル 1 琉球大学医学部保健学科
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