Marital status, marital transition and health behaviour and mental health outcomes among middle-aged and older adults in Thailand: A national longitudinal study.

OBJECTIVES: The aim of this study was to assess the longitudinal association between marital status, marital transition, mental ill-health, and health risk behaviours among middle-aged and older adults in Thailand. METHODS: We analyzed prospective cohort data of participants 45 years and older from three consecutive waves in 2015, 2017, and in 2020 (analytic sample, n = 2863) of the Health, Aging and Retirement in Thailand (HART) study. Sociodemographic and health variables were assessed by self-report. RESULTS: Being single was positively associated with current smoking among men and transitioning to widowed or divorced was associated with incident current smoking among women. Divorced or separated was positively associated with current alcohol use among men and transitioning to marriage was associated with incident alcohol use among women. Being single or widowed was positively associated with underweight and negatively associated with obesity among women. Men who were divorced, single, or widowed had higher odds of having depressive symptoms and among women, transitioning to being widowed or divorced or separated was associated with incident depressive symptoms. Among both men and women, being divorced, single or widowed were positively associated with poor quality of life/happiness, and among men being divorced, single or widowed was positively associated with loneliness, and among women, being single or widowed was positively associated with loneliness. Among men, being single was positively associated with having an emotional or psychiatric disorder. CONCLUSION: We found among men and/or women that being unmarried was associated with several health risk behaviours and mental-ill health indicators.

Longitudinal associations of loneliness with mental ill-health, physical ill-health, lifestyle factors and mortality in ageing adults in Thailand.

OBJECTIVES: The aim of this study was to assess the longitudinal association between loneliness, mental and physical ill-health indicators, lifestyle factors and mortality among middle-aged and older adults in Thailand. METHODS: We analyzed prospective cohort data of participants 45 years and older from three consecutive waves in 2015 (n = 5616), 2017 (n = 3600), and in 2020 (n = 2863) of the Health, Aging and Retirement in Thailand (HART) study. Loneliness was assessed with a single item. To assess the longitudinal associations between loneliness and health outcomes between 2015 (baseline), 2017 (first follow-up) and 2020 (second follow-up), we conducted Generalized Estimating Equations analysis (GEE). RESULTS: The proportion of loneliness was 21.6% in 2015, 23.8% in 2017 and 21.3% in 2020. In the adjusted GEE logistic regression model, loneliness was positively associated with mental ill-health (poor self-rated mental health status, poor quality of life/happiness, depressive symptoms, and insomnia symptoms), physical ill-health (poor self-rated physical health status, hypertension, kidney disease, osteoporosis, and ADL disability), and lifestyle factors (physical inactivity, and having underweight). Furthermore, in adjusted Cox proportional hazards regression, loneliness was associated with mortality. In adjusted logistic regression, compared to without loneliness in all three study waves, having loneliness in one wave and/or two to three waves was positively associated with incident mental ill-health (incident poor self-rated mental health status, incident poor quality of life/happiness, incident depressive symptoms, and incident insomnia symptoms), incident physical ill-health (incident poor self-rated physical health status, incident diabetes, incident kidney disease, and incident ADL disability), and incident lifestyle factors (having incident underweight). CONCLUSION: We found that loneliness was associated with several mental and physical ill-health indicators, lifestyle factors and mortality. Enhanced screening and treatment of loneliness may reduce mental and physical ill-health indicators in Thailand.

Prevalence and determinants of incident and persistent depressive symptoms among middle-aged and older adults in Thailand: prospective cohort study.

BACKGROUND: There are no longitudinal studies investigating determinants of incident and persistent depressive symptoms in Southeast Asia. AIMS: To estimate the proportion and correlates of incident and persistent depressive symptoms in a prospective cohort study among middle-aged and older adults (≥45 years) in Thailand. METHOD: We analysed longitudinal data from the Health, Aging, and Retirement in Thailand (HART) surveys in 2015 and 2017. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Logistic regression was used to calculate predictors of incident and persistent depressive symptoms. RESULTS: In total, 290 of 4528 participants without depressive symptoms in 2015 had incident depressive symptoms in 2017 (9.8%) and 76 of 640 adults had persistent depressive symptoms (in both 2015 and 2017) (18.3%). In adjusted logistic regression analysis, having diabetes (adjusted odds ratio AOR = 1.48, 95% CI 1.07-2.05), musculoskeletal conditions (AOR = 1.56, 95% CI 1.01-2.41) and having three or more chronic conditions (AOR = 2.55, 95% CI 1.67-3.90) were positively associated and higher subjective economic status (AOR = 0.47, 95% CI 0.31-0.72) and social participation (AOR = 0.66, 95% CI 0.49-0.90) were inversely associated with incident depressive symptoms. Having a cardiovascular disease (AOR = 1.55, 95% CI 1.01-2.39) and having three or more chronic conditions (AOR = 2.47, 95% CI 1.07-5.67) were positively associated and social participation (AOR = 0.48, 95% CI 0.26-0.87) was inversely associated with persistent depressive symptoms. CONCLUSIONS: One in ten middle-aged and older adults had incident depressive symptoms at 2-year follow-up. The prevalence of incident and/or persistent depression was higher in people with a lower subjective economic status, low social participation, diabetes, musculoskeletal disorders, cardiovascular conditions and a higher number of chronic diseases.

Bidirectional Association Between Probable Depression and Multimorbidity Among Middle-Aged and Older Adults in Thailand.

Introduction: The purpose of this study was to assess the bidirectional association between multimorbidity (MM) and probable depression in a longitudinal study in Thailand. Methods: We analyzed longitudinal data of participants 45 years and older from two consecutive waves (in 2015 and 2017) of Health, Aging, and Retirement in Thailand (HART). Probable depression was assessed using the Center for Epidemiological Studies Depression scale. Logistic regression analysis was conducted to assess the association between baseline probable depression and incident physical MM, and baseline physical MM and incident probable depression. Results: In all, 2712 participants without MM at baseline and 2684 without probable depression at baseline were included. At follow-up 15.6% of probable depression cases and 11.4% of nonprobable depression cases developed physical MM, and at follow-up 13.3% of physical MM cases and 8.9% of nonphysical MM cases developed probable depression. In the final logistic regression analysis, adjusted for age, sex, marital status, income, education, body mass index, physical activity, smoking tobacco, alcohol use, and social engagement, probable depression at baseline was positively associated with incident physical MM (aOR: 1.50, 95% CI: 1.09 to 2.06), and physical MM at baseline was positively associated with incident probable depression (aOR: 1.47, 95% CI: 1.07 to 2.02). Discussion: Baseline physical MM increases the risk of incident probable depression and baseline probable depression increases the risk of incident physical MM among middle-aged and older adults in Thailand.

Bidirectional association between functional disability and multimorbidity among middle-aged and older adults in Thailand.

Objectives: The purpose of this study was to assess the bidirectional association between multimorbidity (MM) and functional disability among middle-aged and older adults in a longitudinal study in Thailand. Methods: We analyzed longitudinal data of participants aged 45 years and older from two consecutive waves (in 2015 and 2017) of the Health, Aging, and Retirement in Thailand (HART). Functional disability was assessed with a 4-item activity of daily living (ADL) scale. Logistic regression analysis was conducted to assess the association between baseline functional disability and incident MM (≥2), and baseline morbidity and incident functional disability. Results: The results indicate that a total of 1,716 individuals without morbidity at baseline and 3,529 without functional disability at baseline were included. At follow-up, 16.7 and 20.0% of functional disability cases and 7.1 and 3.6% of nonfunctional disability cases developed 2 morbidities and 3 or more morbidities, respectively, and 6.6% of MM cases and 4.0% of non-MM cases developed a functional disability. In the final logistic regression model adjusted for education, income, age, marital status, sex, smoking tobacco, body mass index (BMI), alcohol use, physical activity, and social engagement, functional disability at baseline was positively associated with incident MM (≥2) (adjusted odds ratio [aOR]: 2.58, 95% CI: 1.42-4.72), and MM (≥3) at baseline was positively associated with incident functional disability (aOR: 1.97, 95% CI: 1.13-3.43). Conclusion: Multimorbidity and functional disability were bidirectionally associated.

Prevalence and Associated Factors of Successful Ageing among People 50 Years and Older in a National Community Sample in Thailand.

The aim of the study was to assess the prevalence and associated factors of successful ageing (SA) among people 50 years and older in Thailand. We analyzed national cross-sectional data (5092 men and women 50 years or older) from the Health, Aging and Retirement in Thailand (HART) study in 2015. The SA measures included (1) life satisfaction, (2) social engagement, (3) no major illness, (4) no probable depression, and (5) absence of functional disability. The sample included 5092 participants (median age 67 years, interquartile range 60 to 78 years). The prevalence of SA was 60.0% in adults 50 years and older, ranging from 43.8% in Krabi province to 80.2% in Pathum Thani province, 58.1% (≥60 years), and 56.3% (≥65 years), and the prevalence of the components of SA was 92.3% without major illness, 96.1% without functional disability, 87.5% without probable depression, 91.3% social engagement, and 82.3% high life satisfaction. In multivariable Poisson regression analysis, Buddhist religion (adjusted Prevalence Ratio (aPR): 1.50, 95% Confidence Interval (CI): 1.25 to 1.79), high subjective economic status (aPR: 1.29, 95% CI: 1.11 to 1.49), and physical activity (≥150 min/week) (aPR: 1.11, 95% CI: 1.01 to 1.24) were positively associated and increasing age (aPR: 0.993, 95% CI: 0.989 to 0.997) was negatively associated with SA. Almost two in three older adults in Thailand were successfully ageing. Factors associated with SA included being Buddhist, younger age, higher subjective economic status, and higher engagement in physical activity. These identified factors should be incorporated into health promotion intervention programs in Thailand.