Positive mental health in adults with bipolar disorder: exploring social support subtypes, negative social interactions and potential to flourish.

BACKGROUND: Bipolar disorder (BD) (i.e., BD-I or BD-II) is a serious mental illness (SMI) that can cause significant life challenges, but its impact and management may be mediated by psychosocial factors. This study's primary objectives were to investigate whether adults with BD differ from those without in terms of social support, negative social interactions (NSIs), and positive mental health (PMH). Secondly, examine whether gender differences exist in terms of these variables, as well as whether specific social support subscales and NSI predict PMH for those with BD. METHODS: Using data extracted from a national Canadian survey, 563 adults reporting a lifetime BD diagnosis were compared to a matched, non-BD sample using the Social Provisions Scale 10 Items (SPS-10), the NSI Scale, and the Mental Health Continuum - Short Form (MHC-SF) Scale. For the BD sample, males and females were compared based on study variables, and hierarchical regressions were subsequently performed to assess whether SPS-10 subscales and NSIs predicted PMH. RESULTS: Respondents with BD reported significantly lower SPS-10 and PMH scores, and significantly higher NSI scores. Within the BD sample, females reported significantly higher SPS-10 and NSIs scores, and 'social integration' and 'reassurance of worth' positively predicted PMH, while NSI uniquely predicted lower PMH levels for both males and females. CONCLUSIONS: The results implicate specific psychosocial factors and gender in the degree to which adults with BD might flourish, particularly in terms negative relationships. The implications of social erosion and the bi-directionality of social support are also considered.

Generalized Anxiety Disorder in Canadian Adults: to what Extent Might Social Support Subdomains and Negative Social Interactions Predict Psychological Distress?

Generalized anxiety disorder (GAD) may involve persistent and unwarranted anxiety, fear, and rumination, combined with various somatic symptoms (e.g., fatigue, dizziness, muscle tension, and nausea) which may compel many to withdraw socially. While studies report an inverse relationship between social support and psychological distress among adults with GAD, those that assess the distinct influence of negative social relations, particularly by sex are limited. The primary aims of this study were to (a) assess and compare respondents with a lifetime of GAD in terms of levels of perceived social support (using the Social Provisions Scale - 10 Items (SPS-10) Scale), negative social interactions (using the Negative Social Interaction (NSI) Scale) and psychological distress (using the Kessler Psychological Distress Scale (K10)), and (b) determine whether SPS-10 subdomains and NSIs predict psychological distress. Compared with a matched sample without GAD, respondents with GAD were more likely to be single, divorced, and have lower incomes. Respondents with GAD also had lower overall SPS-10 scores, and lower scores for each subdomain (i.e., 'guidance', 'reliable alliance', 'reassurance of worth', 'attachment', and 'social integration'), and higher NSI and K10 scores. Although no difference in psychological distress was observed between men and women with GAD, men had lower SPS-10 scores (overall and for each subdomain), while women had higher NSIs scores. A subsequent hierarchical regression for respondents with GAD revealed that 'social integration' and 'reassurance of worth' predicted lower psychological distress, while higher NSI scores predicted higher psychological distress. Finding implications and future research are discussed.

The impact of perceived social support and coping on distress in a sample of Atlantic Canadian health professional students during COVID-19 compared to pre-COVID peers.

PURPOSE: Students pursuing higher education and health professional (HP) programs (e.g., nursing, pharmacy, social work, medicine) experience stressors including academic pressures, workload, developing professional competencies, professional socialization, the hidden curriculum, entering clinical practice and navigating relationships with colleagues. Such stress can have detrimental effects on HP students physical and psychological functioning and can adversely affect patient care. This study examined the role of perceived social support and resilience in predicting distress of Atlantic Canadian HP students during the COVID-19 pandemic and compared the findings to a pre-COVID population of age and sex matched Canadians. METHOD: Second year HP students (N = 93) completed a survey assessing distress, perceived social support, and resilience and open-ended questions on student awareness of supports and counselling available to them, their use/barriers to the services, and the impact of COVID-19 on their personal functioning. HP student responses were also compared with age and sex matched Canadian peers from data collected prior to COVID-19. RESULTS: It was found that HP students reported moderate to severe psychological distress, and while they reported high levels of social support on a measure of perceived social support they also reported that the COVID-19 pandemic made them feel isolated and that they lacked social support. It was found that the sample of HP students reported significantly higher psychological distress than the mean scores of the age and sex matched sample of Canadian peers. CONCLUSIONS: These findings call for creation of more tailored interventions and supports for HP students.

The financial impact of cancer on Canadian young adults.

PURPOSE: To explore the financial impact of cancer in young adults (YAs) compared to matched non-cancer peers. METHODS: Five hundred seventy-five YAs from the Young Adults with Cancer in their Prime (YACPRIME) study reported on out-of-pocket cancer costs and missed work. YA cancer survivors were compared to matched peers without cancer on key financial indices based on current age (< 35 vs. 35 + years) and time since diagnosis (< 5 vs. 5 + years). Descriptive statistics, Chi-square tests, and prevalence ratios (PR) were used to compare groups on financial variables. RESULTS: Almost 60% of YA survivors spent at least $100/month on cancer-related expenses, and 49% missed at least one year of work. YA survivors were more likely to have outstanding credit card ((< 35 (PR = 1.37, p = 0.001); 35 + (PR = 1.33, p = 0.001)) and line of credit (< 35 (PR = 1.42, p = 0.008); 35 + (PR = 1.27, p = 0.016)) balances. Home ownership was higher among non-cancer peers ((< 35: PR = 1.42, p < 0.001); 35 + (PR = 1.69, p < 0.001); < 5 years (PR = 1.39, p < 0.001); 5 + years (PR = 1.41, p = 0.005)). YA survivors were more likely to not own assets ((< 5 years (PR = 2.25, p < 0.001); 5 + years (PR = 2.25, p = 0.004)). Those diagnosed within 5 years had higher rates of payday loans (PR = 3.91, p = 0.021). CONCLUSION: While exploratory, results suggest that YAs are disadvantaged compared to their peers in type and value of assets owned and debts carried. IMPLICATIONS FOR CANCER SURVIVORS: Survivorship care plans for YA survivors should include resources to manage the financial impacts of cancer.

Positive mental health in Canadian adults who have experienced childhood sexual abuse: exploring the role of social support.

PURPOSE: Childhood sexual abuse (CSA) is predictive of poorer mental health, greater psychiatric disorder risk, and lower positive mental health (PMH) during adulthood, outcomes potentially moderated by social support. The current study aimed to explore whether Canadian adults who have experienced CSA differ from those who have not in terms of PMH and social support. Within the CSA sample, it was further investigated whether gender differences exist with respect to PMH and social support, and if particular social support subscales predict PMH. METHOD: Using data from the 2012 Canadian Community Health Survey - Mental Health (CCHS-MH), 1,328 adults between 20 and 64 years reporting CSA were profiled and compared in terms of sociodemographic and socioeconomic factors, using an age, sex, and frequency matched sample of non-CSA adults. Social Provisions Scale (SPS), and the Mental Health Continuum - Short Form (MHC-SF) means were subsequently compared between the CSA and non-CSA samples, and Hierarchical regressions were conducted for CSA males and females separately to examine whether SPS subscales predicted PMH after controlling for age and income. RESULTS: Canadian adults reporting CSA had significantly lower PMH and social support (overall and for particular subscales). For adult CSA females, guidance, social integration, and reassurance of worth predicted higher PMH, while attachment and reassurance of worth predicted higher PMH scores for CSA males. CONCLUSION: Adults who have experienced CSA are at risk for lower PMH and social support. Gender differences are also evident in social support subtypes that predict PMH which have important clinical implications.

Emergent Challenges and Opportunities to Sustaining Age-friendly Initiatives: Qualitative Findings from a Canadian Age-friendly Funding Program.

Age-friendly initiatives often are motivated by a single funding injection from national or sub-national governments, frequently challenging human and financial resources at the community level. To address this problem, this paper examines the challenges and opportunities to sustaining age-friendly programs in the context of a Canadian age-friendly funding program. Based on a qualitative thematic content analysis of interview data with 35 age-friendly committee members drawn from 11 communities, results show that age-friendly sustainability may be conceptualized as an implementation gap between early development stages and long-term viability. Consistent over-dependence on volunteers and on committees' limited capacity may create burnout, limiting sustainability and the extent to which communities can truly become "age-friendly". To close this implementation gap while still remaining true to the grass-roots intention of the global age-friendly agenda, sustainable initiatives should include community champions, multi-disciplinary and cross-sector collaborations, and systemic municipal involvement.

Exploring Social Context and Psychological Distress in Adult Canadians with Cannabis Use Disorder: To What Extent Do Social Isolation and Negative Relationships Predict Mental Health?

The objectives of this study were to explore perceived social support, negative social interactions, and psychological distress in Canadian adults who experience lifetime abuse, or dependence on cannabis (ADC), and to determine whether, and the extent to which variables of interest predict psychological distress. Data were extracted from a cross-sectional, national datafile representing a sample of 1503 individuals who met the criteria for a lifetime prevalence of ADC. Levels of perceived overall social support, and several subtypes were measured using the Social Provisions Scale (SPS), negative social interactions were assessed using the Negative Social Interaction (NSI) scale, and psychological distress was examined using the Kessler Psychological Distress Scale (K10). It was observed that Canadians with ADC had significantly lower SPS scores (overall, and by subtype) and significantly higher NSI and K10 scores compared with the overall Canadian adult sample. An exploratory stepwise regression revealed that NCI scores were the most significant, positive predictor of psychological distress, which alone accounted for 20 percent of the variance, followed by reassurance of worth, attachment, and social integration which were inversely related to psychological distress. With the recent legalization of cannabis in Canada, the results of this study suggest that abuse may strongly link with negative social consequences that might serve to exacerbate psychological distress. As such, it might be beneficial to clearly understand one's social context when considering medicinal purposes of cannabis for mental health symptom management. Further, the findings also suggest that patients with cannabis addiction will likely benefit from receiving particular forms of social support. Limitations of this study and future research are considered.

Examination of Gender Differences in the Influence of Social Support on Psychological Distress in Canadian Adults with Bipolar Disorder.

The objectives of this study were to determine whether gender differences exist in how social support, and different types of support, impact psychological distress among Canadian adults with bipolar I and bipolar II disorder (BD), to examine whether females and males with BD differ in their perceived levels of support and distress compared to females and males without BD, and to investigate whether females and males with BD perceive different levels of support and distress. Using a cross-sectional, national datafile, 281 females and 282 males (20-64 years) who reported being diagnosed with BD were investigated using the Social Provisions Scale (SPS) and the Kessler Psychological Distress Scale (K10). It was found that females and males with BD had significantly lower SPS scores and significantly higher K10 scores than females and males without BD, females with BD perceive significantly higher overall support, as well as higher attachment and guidance compared to males with BD, and support in the form of social integration and was associated with decreased psychological distress for both males and females with BD. Furthermore, reassurance of worth was an additional predictor of decreased distress for males, while guidance was an additional predictor of decreased distress for females. Despite the limitations, which include self-reported diagnosis of BD and potential exclusion of those who are not diagnosed but have BD, these findings suggest that different types of social support may serve as protective factors for psychological distress among females and males with BD.

Prevalence and factors associated with high levels of distress in young adult cancer survivors compared to matched peers.

OBJECTIVE: Young adulthood can be a difficult period of development and disruption of age-related milestones can impact psychological well-being. This study examined whether psychological distress differs in young adult (YA) cancer survivors compared to their non-cancer peers and identified factors related to high distress in YA cancer survivors. METHODS: Canadian YAs (n = 448) diagnosed between the ages of 15 and 39 were compared with age-, sex-, and education-matched controls (n = 448) randomly sampled from the 2012 Canadian Community Health Survey-Mental Health. The primary measure was the Kessler Psychological Distress Scale (K10). Groups were compared using independent-samples t tests and chi-square tests of independence. Logistic regression was used to examine the factors associated with high (moderate/severe) distress for YA cancer survivors. RESULTS: YA cancer survivors reported significantly higher distress than their matched peers (24.89 vs. 15.75; p < .0005). In the multivariate model, greater years of education were associated with a decreased likelihood of high distress (adjusted odds ratio (AOR) = 0.84, p = .001). Compared with those working, those in school (AOR = 6.81, p = .003) or not in school/working (AOR = 4.13, p < .0005) reported higher distress. Psychological factors associated with high distress in YA cancer survivors included body image dissatisfaction (AOR = 1.09, p < .0005), poor social support (AOR = 5.19, p = .011), and elevated fears of cancer recurrence (maladaptive: AOR = 6.39, p = .001; clinical: AOR = 12.31, p < .0005). CONCLUSIONS: YA cancer survivors experience significantly greater distress than their non-cancer peers. This distress is associated with modifiable factors such as body image dissatisfaction, social support, and fear of cancer recurrence, illustrating key areas for intervention.

Beyond the curriculum: a cross-sectional study of medical student psychological distress, and health care needs, practices and barriers.

INTRODUCTION: Medical students report significant levels of distress, and are reluctant to seek help despite health care needs, often citing factors associated with the medical school environment beyond training, generally termed the 'hidden curriculum'. OBJECTIVES: The primary objectives of the current study were to establish the level of psychological distress in a sample of medical students enrolled in an Atlantic Canadian medical school, explore factors that predict the psychological distress, examine health care needs, concerns, and practices, and consider potential barriers to care. METHODS: Instruments assessing distress (i.e., the Kessler Psychological Distress scale), predictors of distress (i.e., the Perceived Medical School Stress scale), and health care needs and practices (i.e., the Medical Student Health Survey) were administered to 180 medical students. Distress was also compared to three age, sex, and frequency matched Canadian Community Health Survey (CCHS) samples representing the general Canadian population, full time university/college students, and those reporting Anxiety Disorder diagnosed by a healthcare provider. RESULTS: Medical students reported significantly higher levels of psychological distress than each comparison group, which was significantly predicted by training year, and three PMSS subscales, i.e., "Medical school controls my life", "Is more a threat than a challenge", and "Long hours and responsibilities associated with clinical training". Eighty-six percent of students reported health care needs ranging from common complaints to mental illness, with many either seeking services outside their training institution, consulting with peers, or not attaining care, primarily for reasons of confidentiality and/or non-permissive training schedules. CONCLUSIONS: Medical student psychological distress is significant, and while it may reflect rigors of training, it is also linked with stigma, perceptions that the curriculum is controlling and can often be considerably overwhelming. As a function of this environment, students may not be adequately attending to their own health issues.

Examining the Influence of Social Support on Psychological Distress in a Canadian Population with Symptoms of Mania.

Individuals who experience symptoms of mania in the form of a manic episode (ME) are at a greater risk of experiencing psychological distress. Given that a ME is a period during which one can become extremely socially dysfunctional, the potential influence of social support is especially important to explore. The primary objective of this study was to examine whether perceived social support predicts psychological distress in a sample of Canadian adults who have self-reported ME symptoms within the last 12-months. Using a cross-sectional, national datafile, 220 Canadians between 20 and 64 years who met the criteria for a ME within the last 12-months were investigated using the Social Provisions Scale (SPS), and the Kessler Psychological Distress Scale (K10). Results indicated that the ME sample experienced significantly higher distress and significantly lower perceived social support than the adult Canadian population. Further, social support in the form of reassurance of worth was associated with lower levels of psychological distress, but only for the male ME sample, and the overall (male and female combined) ME sample. Despite some limitations, this study adds to the research on mania as its own experience outside of comorbidities and indicates the important and specific role social support plays in terms of psychological well-being.

The Influence of Socioeconomic Status on Psychological Distress in Canadian Adults With ADD/ADHD.

OBJECTIVE: The primary purpose of this study was to examine the relationship between socioeconomic status (SES) and psychological distress in individuals self-reporting a diagnosis of attention deficit disorder (ADD)/ADHD. METHOD: This correlational study encompasses cross-sectional data from 488 male and female adults (20-64 years) who reported that they have been diagnosed with ADD/ADHD. Psychological distress was measured with the Kessler Psychological Distress Scale (K10). RESULTS: Adults with ADD/ADHD and high incomes have significantly lower K10 scores than Canadians with ADD/ADHD and low incomes. Income, but not education, was significant in predicting psychological distress among the sample. Canadian adults with ADD/ADHD have an increased risk for developing psychological distress and comorbid psychiatric disorders. CONCLUSION: The findings suggest that negative outcomes associated with ADD/ADHD are not necessarily pervasive. High income may serve as a protective factor for psychological distress among adults with ADD/ADHD.

The influence of social support on psychological distress in Canadian adults with bipolar disorder.

INTRODUCTION: Individuals with bipolar I disorder (BD-I) and bipolar II disorder (BD-II) are at higher risk for experiencing high levels of psychological distress and low levels of social support. OBJECTIVES: The primary objectives of this study were to examine perceived social support and psychological distress among Canadian adults with self-reported BD-I or BD-II as diagnosed by a health professional and explore the relationship between types of social support and psychological distress within this sample. METHODS: Using a cross-sectional, national datafile, 563 Canadian male and female adults (20-64 years) who reported being diagnosed with BD-I or BD-II were investigated using the Social Provisions Scale (SPS), and the Kessler Psychological Distress Scale (K10). RESULTS: It was observed that while the BD-I or BD-II sample had significantly lower SPS scores and significantly higher K10 scores than the overall Canadian sample, age and support in the form of reassurance of worth and social integration were associated with decreased psychological distress. Further, a diagnosis of BD-I and BD-II was found to moderate the effect of social support on psychological distress. CONCLUSIONS: Despite the limitations, which include self-reported diagnosis of BD-I and BD-II and potential exclusion of those who are not diagnosed but have BD-I or BD-II, these findings suggest that reassurance of worth and social integration may act as protective factors for psychological distress among individuals with BD-I or BD-II.

A decade's difference: 10-year change in insomnia symptom prevalence in Canada depends on sociodemographics and health status.

INTRODUCTION: Insomnia is recognized as a public health issue. The objectives of this study were to characterize and compare the prevalence of insomnia symptoms in the Canadian population in 2002 and 2012, and to identify sociodemographic and psychosocial predictors of trouble sleeping. METHODS: Data from adult participants in the Canadian Community Health Survey-Mental Health cycles 2000-2002 (n = 34,118) and 2011-2012 (n = 23,089) were used. Participants responded to the question "How often do you have trouble going to sleep or staying asleep?", with those who indicated "most of the time" or "all of the time" classified as having insomnia symptoms. Logistic regressions, adjusted for covariates, were used to examine differences between cycles. RESULTS: The unadjusted prevalence of insomnia symptoms increased from 15.6% to 17.1% between 2002 and 2012, representing an absolute increase of 1.5%. The likelihood of insomnia symptoms was significantly influenced by age, sex, education, physical health, and mental health status. A 3-way year-age-sex interaction was statistically significant such that women aged 40-59 demonstrated approximately 29% increased likelihood of insomnia symptoms from 2002 to 2012. This was reduced to 24% when adjusted for physical and mental health. There were no significant differences for men across age groups. CONCLUSION: Over a 10-year period, the prevalence of insomnia symptoms increased in Canada. This trend appears to be driven in part by greater levels of insomnia symptoms among middle-aged women.

Prevalence and Correlates of Self-Reported ADD/ADHD in a Large National Sample of Canadian Adults.

OBJECTIVE: The objective of this study was to examine the prevalence and correlates of self-reported attention deficit disorder (ADD)/ADHD in Canadian adults. METHOD: Prevalence of self-reported ADD/ADHD was examined in a large national sample of Canadians ( n = 16,957). Demographic variables, lifetime, and current psychiatric comorbidities were then compared in a group of adults with self-reported ADD/ADHD ( n = 488) and an age- and gender-matched control group ( n = 488). RESULTS: The prevalence of self-reported ADD/ADHD was 2.9%. Significantly higher lifetime and current prevalence rates of major depressive disorder, bipolar I and II disorders, generalized anxiety disorder, and substance use disorders were observed in the ADD/ADHD group compared with the control group. Within the ADD/ADHD group, lifetime and 12-month prevalence rates of major depressive disorder and generalized anxiety disorder were significantly higher in women, whereas lifetime and current rates of some substance use disorders were significantly higher in men. CONCLUSION: In a national sample of Canadian adults, self-reported ADD/ADHD was associated with significant psychiatric comorbidity. Gender differences were also noted.

Good for All? Hardly! Attending Church Does Not Benefit Religiously Unaffiliated.

The existing literature addressing Religion and Spirituality supports the idea that attending church is positively associated with health outcomes. However, within this literature there has been an impoverished effort to determine whether the Religiously Unaffiliated will report these positive relationships. Using representative data from Ontario (N = 3620), the relationships between Religious/Spiritual variables (Attendance, Prayer/Meditation, and Religiosity) and health outcomes (Happiness, Self-Rated Health, and Satisfaction with Life) were assessed. Results focused on three recurring trends: the Religiously Unaffiliated experienced attending church less positively than Christians; when compared at the highest level of Attendance, the Religiously Unaffiliated were less healthy than Christians; and when only considering the Religiously Unaffiliated, Religious/Spiritual variables were not significant and positive predictors of health outcomes. The discussion focused on the need to delineate between how Christians and the Religiously Unaffiliated experience Religious/Spiritual variables, and the need to stop over-generalizing the positive relationship between Religious/Spiritual variables and health.

What's God Got to Do with It? How Religiosity Predicts Atheists' Health.

The relationship between atheism and health is poorly understood within the Religion/Spirituality-health literature. While the extant literature promotes the idea that Attendance, Prayer, and Religiosity are connected to positive health outcomes, these relationships have not been established when controlling for whether a person is an atheist. Data from the 2008-2012 American General Social Survey (n = 3210) were used to investigate this relationship. Results indicated that atheists experienced Religiosity more negatively than non-atheists. Additionally, results demonstrated that non-belief in God was not related to better or worse perceived global health, suggesting that belief in God is not inherently linked to better reported health.

Social anxiety disorder in the Canadian population: exploring gender differences in sociodemographic profile.

The present study examined the prevalence and sociodemographic profile of Canadians with social anxiety disorder using data from the Canadian Community Health Survey Cycle 1.2 (N = 36,984). Social anxiety disorder was assessed using the World Mental Health Composite International Diagnostic Interview and sociodemographic variables were explored by gender. Results suggested significant gender differences for prevalence, comorbid depression, marital status, living arrangements, employment status in the past 12 months, and self-reported mental health status. These observations suggest that individuals with social anxiety disorder experience life disruption, and that of all socially anxious respondents, females may be experiencing more distress than males.

Challenges and opportunities for using administrative data to explore changes in health status: a study of the closure of the Newfoundland cod fishery.

The closure of the cod fishery in Newfoundland and Labrador has had dramatic social and economic impacts on fishing communities in the province. Following a limited closure in 1992, a more extensive closure followed in 1994, which is still in force today, although income support provided to displaced fishery workers ended in 1999. A population-based study was conducted in 2004/2005 using 7 different sources of administrative and survey data to investigate a range of social, demographic, and health changes in fishing communities affected by the closure of the cod fishery from the period 1991 to 2001. Findings of this study extend our understanding of the impact of the fishing moratorium in Newfoundland. This article also presents both the challenges to and opportunities for using administrative and survey data to explore the impact of the fishery closure on the health and well-being of Newfoundland fishing communities. One of the most significant challenges to using administrative and survey databases was the inconsistencies in how communities were identified across the various databases. Although not without limitations, administrative data is a cost-effective means to explore the impact of socioeconomic change on a population's health status.

'They had the right to know.' Genetic risk and perceptions of responsibility.

The idea that people should be responsible for their health is not new. The construction of health as a moral issue has often been applied to voluntary health risks. With the advent of predictive genetic testing, however, people may also bear responsibility for their genetic risks. Drawing upon 24 semi-structured interviews with at risk persons and their family members, this study explored perceptions of responsibility associated with genetic risk for the adult-onset disorder, Huntington disease (HD). Qualitative data analysis suggested that decisions around genetic risk were often influenced by obligations to other family members. Some participants felt responsible to determine their genetic risks through testing, particularly for at risk offsprings. Responsibility to current and future partners, to plan for a future that might include HD and to communicate genetic risk to other family members also emerged as important dimensions of genetic responsibility. It is argued that perceptions of responsibility in this context may constrain some of the choices of those who live with genetic risk having implications for test decisions, post-test adjustment and family relationships.