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Inequality on the frontline: A multi-country study on gender differences in mental health among healthcare workers during the COVID-19 pandemic
- Diana Czepiel, Clare McCormack, Andréa T.C. da Silva, Dominika Seblova, Maria F. Moro, Alexandra Restrepo-Henao, Adriana M. Martínez, Oyeyemi Afolabi, Lubna Alnasser, Rubén Alvarado, Hiroki Asaoka, Olatunde Ayinde, Arin Balalian, Dinarte Ballester, Josleen A.l. Barathie, Armando Basagoitia, Djordje Basic, María S. Burrone, Mauro G. Carta, Sol Durand-Arias, Mehmet Eskin, Eduardo Fernández-Jiménez, Marcela I. F. Frey, Oye Gureje, Anna Isahakyan, Rodrigo Jaldo, Elie G. Karam, Dorra Khattech, Jutta Lindert, Gonzalo Martínez-Alés, Franco Mascayano, Roberto Mediavilla, Javier A. Narvaez Gonzalez, Aimee Nasser-Karam, Daisuke Nishi, Olusegun Olaopa, Uta Ouali, Victor Puac-Polanco, Dorian E. Ramírez, Jorge Ramírez, Eliut Rivera-Segarra, Bart P.F. Rutten, Julian Santaella-Tenorio, Jaime C. Sapag, Jana Šeblová, María T. S. Soto, Maria Tavares-Cavalcanti, Linda Valeri, Marit Sijbrandij, Ezra S. Susser, Hans W. Hoek, Els van der Ven
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- Journal:
- Cambridge Prisms: Global Mental Health / Volume 11 / 2024
- Published online by Cambridge University Press:
- 04 March 2024, e34
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Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with prior data suggesting women may be particularly vulnerable. Our global mental health study aimed to examine factors associated with gender differences in psychological distress and depressive symptoms among HCWs during COVID-19. Across 22 countries in South America, Europe, Asia and Africa, 32,410 HCWs participated in the COVID-19 HEalth caRe wOrkErS (HEROES) study between March 2020 and February 2021. They completed the General Health Questionnaire-12, the Patient Health Questionnaire-9 and questions about pandemic-relevant exposures. Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-relevant stressors, including insufficient personal protective equipment and less support from colleagues, while men reported increased contact with COVID-19 patients. At the country level, HCWs in countries with higher gender inequality reported less mental health problems. Higher COVID-19 mortality rates were associated with increased psychological distress merely among women. Our findings suggest that among HCWs, women may have been disproportionately exposed to COVID-19-relevant stressors at the individual and country level. This highlights the importance of considering gender in emergency response efforts to safeguard women’s well-being and ensure healthcare system preparedness during future public health crises.
15 Does Subjective Socioeconomic Status Mediate the Relationship Between Objective Socioeconomic Status and Neuropsychological Test Performance Across Race and Ethnicity?
- Foysal B Uddin, Justina F Avila-Rieger, Dominika Seblova, Adam Brickman, Jennifer J Manly
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 430-431
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Objective:
Socioeconomic disadvantage is a chronic stressor associated with several biological markers of health (e.g., inflammation) as well as early-onset cognitive aging. Studies examining socioeconomic status (SES) and its link with health outcomes exhibit no uniformity in the way in which SES is measured and defined. Also, studies have found that subjective socioeconomic status (SSES), defined by a subjective SES scale, was more consistently and strongly related to psychological functioning and health-related outcomes than objective socioeconomic status (OSES), defined by a composite score of education, household income, and occupation. The goal of the current study was to assess whether SSES mediates the relationship between OSES and neuropsychological test performance similarly across racial and ethnic groups.
Participants and Methods:Participants were 1,912 middle-aged older adults (13% non-Hispanic white, 17% non-Hispanic Black, 69% Hispanic/Latinx) from the Offspring study. Participants are the adult children of participants in the Washington Heights Inwood Columbia Aging Project, a community-based cohort study of aging and dementia representing the ethnic/racial diversity of upper Manhattan. Participants on average were 56.5 years of age and 67% were women. Measures of verbal learning and memory (SRT immediate and delayed recall), verbal fluency (animal and letter fluency), and attention/working memory (digit span forward and backward) were administered. OSES was characterized by years of formal education completed. SSES was measured by the MacArthur Scale of Subjective Social Status. The scale measures perceptions of one’s social standing relative to others. We conducted separate stratified mediation analyses for each neuropsychological outcome across each racial and ethnic group. All models were adjusted for age.
Results:Participants with higher OSES demonstrated higher neuropsychological test scores (effect size associations ranged from .29 to .45) and reported higher SSES (b=.109 95% CI: .08, .14). Lower SSES was associated with lower neuropsychological test scores (effect-size range .06 to .13). In stratified analyses, the relationship between OSES and SSES was strongest for White participants (b=.13 [.01, .24]) compared with Latinx (b=.06 [.02, .11]) and Black (b=.06 [-.03, .16]) participants. Associations between SSES and neuropsychological outcomes were only reliable for White participants on SRT Immediate and Delayed Recall and Animal Fluency and for Black participants on Digit Span Forward. In mediation analyses, SSES mediated the relationship between OSES and Immediate Recall (indirect effect b=.18 [.001, .45]; 39% mediated), Delayed Recall (indirect effect b=.05 [.004, .09]; 44% mediated), and Animal Fluency (indirect effect b=.09 [.01, .20]; 22% mediated) for White participants. There was no evidence of mediation in Black or Latinx participants.
Conclusions:The relationship between OSES and SSES was strongest for White participants compared to Black and Latinx participants. Even though perception of social status predicted lower cognitive test scores among Black and Latinx adults, it is only a part of the indirect pathway linking OSES to cognitive function among White adults. It is likely that mechanisms related to tangible resources that benefit health (as opposed to perceived inequity) are in the pathway linking education to cognition among Black and Latinx, and thus intervening on systems of inequality throughout the life course has the most promise for improving brain health in those communities.
17 Emotional and Instrumental Support as Protective Factors in Cognitive Aging Among Black and Hispanic/Latinx Older Adults
- Emily P Morris, A. Zarina Kraal, Shellie-Anne Levy, Franchesca Arias, Ruijia Chen, Dominika Seblova, Marcia P. Jimenez, Mateo Farina, Zvinka Zlatar, Marianne Chanti-Ketterl, Yi Lor, Evan Fletcher, Jennifer J. Manly, Maria Glymour
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 330-331
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Objective:
Social support may protect against Alzheimer’s disease and related dementias (ADRD), potentially through emotional or instrumental support elements. Black and Hispanic/Latinx older adults bear a disproportionate burden of ADRD. However, independent effects of emotional and instrumental support on cognition, a primary indicator of ADRD risk, are largely understudied in these groups. Guided by the differential vulnerability hypothesis – the theoretical framework which posits that systemic racism disadvantages Black and Hispanic/Latinx individuals’ health – we hypothesize that emotional and instrumental support may be particularly important to protect against worse cognition for Black and Hispanic/Latinx older adults, who often have fewer resources due to these inequalities (e.g., wealth, educational opportunities) to otherwise maintain health. Using the NIH Toolbox Emotion Module measures of emotional (e.g., the extent to which individuals can rely on others in challenging times) and instrumental support (e.g., the extent to which individuals can rely on others for assistance in daily activities), we aimed to identify positive social support factors (i.e., emotional and instrumental support) that may protect against ADRD risk (i.e., longitudinal executive function and memory performance) among Black and Hispanic/Latinx older adults.
Participants and Methods:Participants were 362 Black and 265 Hispanic/Latinx adults aged 65-89 (63% female, average age=75) from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study who completed baseline and up to two additional waves of assessments (every 1.5 years), including questionnaires, neuropsychological evaluations, and the NIH toolbox. Predictors included baseline covariates (i.e., age, language of test administration, gender, education, income, self-rated health) and NIH toolbox emotional and instrumental support variables. Outcomes were baseline and longitudinal memory (visual and verbal episodic memory) and executive functioning (verbal fluency and working memory) composites from the Spanish and English Neuropsychological Assessment Scales (SENAS). Latent growth curve models were conducted separately in Black and Hispanic/Latinx participants to estimate effects of emotional and instrumental support on baseline cognition and subsequent change in each domain.
Results:Black participants reported greater emotional support. There were no group differences in levels of instrumental support. Greater instrumental support was associated with better initial memory (standardized β= .194, 95%CI: [.063, .325]) among Black participants but not among Hispanic/Latinx participants. In Hispanic/Latinx participants, greater emotional support was associated with better initial executive functioning (standardized β= .215, 95%CI: [.079, .350]. Emotional support was not associated with either cognitive domain in Black participants. There were no associations between emotional or instrumental support on cognitive change in either group.
Conclusions:Results point to differences between Black and Hispanic/Latinx older adults in the impact of specific aspects of social support on different cognitive domains. Positive associations between instrumental support and baseline memory in Black participants and between emotional support and executive functioning in Hispanic/Latinx participants suggest unique cognitive consequences of social support across groups. Differences in the role of specific types of social supports may be useful in identifying intervention targets specifically for Black and Hispanic/Latinx older adults, who are disproportionately affected by ADRD. Future research will examine these constructs using multiple group models to test these associations more rigorously.
5 Association of Discrimination to Cognition Among US-Born and Immigrant Latinx
- Shana S. Samuel, Dominika Seblova, Adam M. Brickman, Jennifer J. Manly, Desiree A Byrd
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 89-90
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Objective:
Neuropsychology is in a nascent stage of understanding the mechanisms that link social forces, psychosocial experiences, and brain health. Discrimination is associated with lower quality of life, higher stress, and worse physical health outcomes in Latinx, but contradictory findings in prior research complicate our understanding of its relationship to cognition. These contradictory results may be explained by heterogeneity within the broad category of Latinx, a cultural identity that requires more nuanced conceptualization. Immigration status is a primary social identifier for Latinx people that carries significant stigma. However, prior research found enculturation promotes better physical and mental health outcomes in immigrants compared to their US-born counterparts, which may protect immigrant Latinx from the cognitive costs of discrimination. The current study hypothesized that the effect of discrimination on cognition will be stronger in US-born Latinx compared to immigrant Latinx.
Participants and Methods:We partnered with 1,023 neurologically healthy, community dwelling Latinx adults (M age=56.1(±10.7); M education=12.5(±3.7); 69% women) in a prospective cohort study in NYC investigating risks factors for Alzheimer’s disease. Immigration status was determined by self-report of birthplace. Measures of attention, language, and memory were administered by bilingual examiners in the participants’ self-selected preferred language of English (n = 388) or Spanish (n=635). Discrimination, measured with the Everyday Discrimination Scale and Major Experiences of Discrimination Scale, was chronicity coded to weigh experiences of discrimination according to yearly chronicity. Linear regression models were employed for US-born and immigrant participants to assess the relationship between both discrimination measures and each cognitive measure.
Results:Compared to US-born Latinx (n = 224), immigrant Latinx (n = 799; primarily from the Dominican Republic) were older, had fewer years of school, had lower income, and were much more likely to have chosen to be assessed in Spanish. Immigrants reported experiencing significantly fewer everyday and major experiences of discrimination than nonimmigrants. In unadjusted models, discrimination did not predict cognitive performance among US-born Latinx. Among immigrant Latinx, more major experiences of discrimination across the lifetime predicted better phonemic (F(2,362) = 4.167, p<0.05, R2=0.017) and semantic fluency (F(2,362) = 3.304, p<0.05, R2=0.013) but was not associated with measures of attention or memory.
Conclusions:Discrimination is an important life stressor for Latinx people living in the US, particularly when its impact is summed across intersectional identities. The current study is among the first to explore the potential cognitive impact of discrimination within a group of Latinx adults. The described relationship between discrimination and language performance in this cohort may be confounded by the language in which cognitive tests were administered. Future studies should consider how discrimination measures may be limited in their ability to accurately capture the experiences of US-born and immigrant Latinx groups and expand the measurement of cognition to additional domains.
Rural Older Adults in Disasters: A Study of Recovery From Hurricane Michael
- Patricia A. Fletcher, Dreamal L. Worthen, Mary Helen McSweeney-Feld, Allison Gibson, Dominika Seblova, Lisandra Pagán, M. Isabela Troya, Mei Lan Fang, Brenda Owusu, Charlene Lane, Mineko Wada, Erin R. Harrell, Aline Viana
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- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 16 / Issue 6 / December 2022
- Published online by Cambridge University Press:
- 21 October 2021, pp. 2602-2606
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Objective:
This study aims for a greater understanding of how older adults (age 65 and older) in Jackson County, Florida, are prepared for and cope with the effects of a natural disaster.
Methods:A multidisciplinary, international research team developed a survey examining: (1) resources available to individuals aged 65+ in rural communities for preparing for a disaster; (2) challenges they face when experiencing a disaster; and (3) their physical, social, emotional, and financial needs when it strikes. The survey was administered with older adults (65+) in Jackson County, Florida, following Hurricane Michael in 2018. The descriptive, multivariate logistic, and linear regression analyses were performed to examine the relationship between respondents’ demographic information and needs, concerns, and consequences of disaster.
Results:Results indicated (n = 139) rural community-dwelling older adults rely on social support, community organizations, and trusted disaster relief agencies to prepare for and recover from disaster-related events.
Conclusions:Such findings can be used to inform the development of new interventions, programs, policies, practices, and tools for emergency management and social service agencies to improve disaster preparedness and resiliency among older populations in rural communities.