Estimating anticipatory, immediate, and delayed effects of disability registration on depressive symptoms.

PURPOSE: This study examines (a) whether disability registration has anticipatory, immediate, and delayed effects on depressive symptoms and (b) how these effects differ by gender. RESEARCH METHOD/DESIGN: Using data from the Korea Welfare Panel Study spanning over 16 waves between 2005 and 2020, this study employed the individual-level fixed effects models to estimate the trajectories of depressive symptoms before and after the registration of physical disability, for a cohort of 20,054 individuals. Furthermore, gender-stratified fixed effects models were used to examine gender differences. RESULTS: Compared to the preregistration reference period (i.e., 4 or more years before disability registration), there was a sustained rise in depressive symptoms leading up to the year of registration, indicating the presence of anticipatory effects. After disability registration, depressive symptoms consistently remained at a statistically higher level than during the initial reference period, with a gradual return to the baseline level of depressive symptoms over time. These anticipatory, immediate, and delayed effects of disability registration were notably more pronounced among men than women. CONCLUSION/IMPLICATIONS: To develop more effective mental health interventions for people with disability, policymakers should consider gendered trajectories of depressive symptoms before and after disability registration. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The link between disability and social participation revisited: Heterogeneity by type of social participation and by socioeconomic status.

BACKGROUND: While prior literature explores the impact of disability on social participation, the distinct characteristics of diverse social activities could further complicate this relationship. Furthermore, this relationship may exhibit heterogeneity when considering socioeconomic status (SES). OBJECTIVE: This study aims to investigate whether the relationship between disability and social participation differs depending on the type of social participation, and to what extent this relationship is moderated by SES. METHODS: Data from seven waves of the Korean Longitudinal Study of Ageing were analyzed. Various types of social participation, including socializing, leisure, volunteer, political, and religious activities, were considered. Individual fixed effects models were employed to account for unobserved individual-level heterogeneity. To investigate the potential moderating role of SES, an interaction term between disability and SES was included. RESULTS: Disability was associated with a decrease in social participation (b = -0.088). When differentiating types of social participation, the associations were negative for socializing and leisure activities (b = -0.092 and b = -0.012, respectively) and positive for volunteer activities (b = 0.012). The negative association between disability and social participation was generally stronger among higher-SES groups than lower-SES groups. Specifically, the negative association with leisure activities was more pronounced among the high-education groups. In contrast, the positive association with volunteer activities was more evident among the low-education group. CONCLUSIONS: Disability has a negative association with engagement in socializing and leisure activities and a positive association with engagement in volunteer activities. Policymakers should consider the role of SES in complicating the relationship between disability and social participation.

Telehealth Use Among Older Adults With Sensory, Cognitive, and Physical Impairments: A Substitute or Supplement to Traditional Care?

OBJECTIVES: Telehealth use flourished during the COVID-19 pandemic, as older patients faced obstacles to seeking in-person care. Heavy reliance on telehealth may continue postpandemic, due to increased Medicare investments in its use. However, it is unclear if older adults with disabilities face obstacles to effective telehealth use. We evaluate (a) how sensory, physical, and cognitive impairments affect older adults' use of telehealth only, traditional in-person care only, neither, or both (i.e., combined care); and (b) whether these patterns differ on the basis of socioeconomic and social resources that may facilitate telehealth use. METHOD: Data are from the Self-Administered Questionnaire in the 2020 wave of the Health and Retirement Study (n = 4,453). We estimated multinomial logistic regression models to evaluate associations between impairments and health care service use and tested 2-way interaction terms to evaluate moderation effects. RESULTS: Persons without impairments were most likely to use combined care, considered the optimal form of care. Persons with vision or cognitive impairment were more likely to use telehealth or traditional care only, whereas persons with 3 or more physical limitations were least likely to use telehealth alone, relative to combined care. Patterns did not differ significantly on the basis of any of the potential moderators. DISCUSSION: We discuss implications for health care policy and practice, in light of reimbursement changes proposed by the Centers for Medicare and Medicaid Services for telehealth services. These proposals include the elimination of voice-only services which may be particularly beneficial to vision-impaired older adults.

The Effect of Physical Limitations on Depressive Symptoms Over the Life Course: Is Optimism a Protective Buffer?

OBJECTIVES: We examined the extent to which optimism buffers the effects of physical limitations on depressive symptoms across 4 mid- and later-life age groups (ages 40-49, 50-64, 65-74, 75 and older at baseline). Analyses are motivated by stress theories, which propose that the protective effects of coping resources are evidenced only at high levels of stress. We further explore whether these purportedly protective effects diminish with age, as health-related stressor(s) intensify and become irreversible. METHODS: We use data from 2 waves (2004-2006 and 2013-2014) of the Health and Retirement Study (HRS, n = 4,515) and Midlife in the United States (MIDUS, n = 2,138). We estimate ordinary least squares regression models with 3-way interaction terms to examine prospectively the benefits of optimism as a coping resource for persons with physical limitations across 4 age groups. Physical limitations are assessed with a composite measure encompassing mobility and activity of daily living limitations. RESULTS: In HRS and MIDUS, persons with 3+ limitations reported significantly more depressive symptoms than persons with 0-2 limitations, yet these disparities diminished at higher levels of optimism. Buffering effects of optimism vary by age. For midlife and young-old persons with 3+ limitations, optimism is strongly and inversely related to depressive symptoms at follow-up. Comparable protective effects are not evident among the oldest sample members. DISCUSSION: Stress and coping models should consider more fully factors that limit older adults' capacity to deploy purportedly protective personal resources. Investments in structural or institutional supports may be more effective than interventions to enhance positive thinking.

Self-esteem as a mediator in the relationship between perceived age stigma and emotional well-being among Korean older adults: the moderation effect of marital status.

OBJECTIVES: This study examined whether self-esteem mediates the association between perceived age stigma and emotional well-being (loneliness and emotional isolation) among Korean older adults and how these processes differ by marital status. METHODS: Using the 2018 Age Integration and Generation Integration Survey, a cross-sectional national survey of Korean adults, we analyzed data from 266 adults aged 60 and older. RESULTS: Older adults who perceived greater age stigma reported higher levels of loneliness and emotional isolation. Self-esteem played a significant indirect role in the association between perceived age stigma and the two emotional well-being outcomes. Moderated mediation analyses further revealed significant differences by marital status: self-esteem was a more powerful mechanism among unmarried older adults relative to their married counterparts. CONCLUSIONS: The findings suggest that efforts to minimize public and internalized stigmatization of older adults and improve their self-esteem may be critical for their emotional well-being.

Physical Disability and Older Adults' Perceived Food and Economic Insecurity During the COVID-19 Pandemic.

OBJECTIVES: We examined whether older adults with physical disability were vulnerable to three types of perceived economic insecurity (difficulty paying regular bills, difficulty paying medical bills, and income loss) and two types of perceived food insecurity (economic obstacles and logistical obstacles) during the early months of the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the extent to which associations are moderated by three personal characteristics (age, sex, and race/ethnicity) and two pandemic-specific risk factors (job loss and COVID-19 diagnosis). METHOD: Data are from a random 25% subsample of Health and Retirement Study participants who completed a COVID-19 module introduced in June 2020. We estimated logistic regression models to predict each of five self-reported hardships during the pandemic. RESULTS: Bivariate analyses showed that persons with three or more functional limitations were more likely to report both types of food insecurity, and difficulty paying regular and medical bills since the start of the pandemic, relative to those with no limitations. After controlling for health conditions, effects were no longer significant for paying medical bills, and attenuated yet remained statistically significant for other outcomes. Patterns did not differ significantly on the basis of the moderator variables. Job loss substantially increased the risk of economic insecurity but not food insecurity. DISCUSSION: Older adults with more functional limitations were vulnerable to economic and food insecurity during the pandemic, potentially exacerbating the physical and emotional health threats imposed by COVID-19. Supports for older adults with disability should focus on logistical as well as financial support for ensuring their food security.

Physical Disability at Work: How Functional Limitation Affects Perceived Discrimination and Interpersonal Relationships in the Workplace.

Adults with disability have significantly lower rates of labor force participation relative to persons without disability, although it is unclear whether this disparity extends to subjective workplace experiences. Using data from the 2004 to 2006 wave of the National Survey of Midlife Development in the United States (n =2,030), we evaluate: (1) whether U.S. workers with physical disability report higher levels of perceived job discrimination and unequal workplace opportunities and lower levels of supervisor and coworker support and (2) whether these patterns differ by sex, age, and occupation group. We find that workers with physical disability fare significantly worse on all four outcomes net of covariates. Disability takes a particularly large toll on men's perceived workplace opportunities and white-collar employees' relationships with coworkers. Young adult workers (ages 30-39) with disability report significantly more support from their supervisor relative to their counterparts without disability. We discuss implications for research and policy.

Birth intentions among US fathers with disabilities.

BACKGROUND: Men's birth intention is an indicator of their sexual health and plays an important role for their child's health and development; however, birth intendedness in fathers with disabilities has been unknown. OBJECTIVE: This study examines disparities in birth intendedness among fathers with and without disabilities and explores whether the differences vary by marital status or race/ethnicity. METHODS: Data from the 2011-2017 National Survey of Family Growth (NSFG) were used to examine pregnancy intendedness for fathers with (n = 380) and without disabilities (n = 1,324) about their last birth in the five years preceding the interview. Multinomial regression models estimated the odds ratios of fathers' disability status on birth intention controlling for covariates. Interaction effects of disability status by marital status or race/ethnicity were also tested. RESULTS: Fathers with disabilities were 1.89 (95% CI = 1.21, 2.95) times as likely to report their last birth as unwanted versus intended compared to those without disabilities after adjusting for covariates. Although married fathers without disabilities were less likely to report unintended birth than their unmarried counterparts, the protective effect of marriage was not evident among fathers with disabilities. CONCLUSIONS: Disabled fathers are at a higher risk of unintended birth compared to nondisabled fathers. These findings highlight the need to increase access to family planning services for disabled men. Further research is needed to better understand the risk factors that contribute to disabled fathers' unintended birth and how these are linked to their child and family well-being.

Contraceptive use at first sexual intercourse among adolescent and young adult women with disabilities: The role of formal sex education.

OBJECTIVES: This study examines receipt of formal sex education as a potential mechanism that may explain the observed associations between disability status and contraceptive use among young women with disabilities. STUDY DESIGN: Using the 2011-2017 National Survey of Family Growth, we analyzed data from 2861 women aged 18 to 24 years, who experienced voluntary first sexual intercourse with a male partner. Women whose first intercourse was involuntary (7% of all women reporting sexual intercourse) were excluded from the analytic sample. Mediation analysis was used to estimate the indirect effect of receipt of formal sex education before first sexual intercourse on the association between disability status and contraceptive use at first intercourse. RESULTS: Compared to nondisabled women, women with cognitive disabilities were less likely to report receipt of instruction in each of 6 discrete formal sex education topics and received instruction on a fewer number of topics overall (B = -0.286, 95% CI = -0.426 to -0.147), prior to first voluntary intercourse. In turn, the greater number of topics received predicted an increased likelihood of contraceptive use at first voluntary intercourse among these women (B = 0.188, 95% CI = 0.055-0.321). No significant association between noncognitive disabilities and receipt of formal sex education or contraceptive use at first intercourse was observed. CONCLUSIONS: Given the positive association between formal sex education and contraceptive use among young adult women with and without disabilities, ongoing efforts to increase access to formal sex education are needed. Special attention is needed for those women with cognitive disabilities.

The Psychological Consequences of Disability over the Life Course: Assessing the Mediating Role of Perceived Interpersonal Discrimination.

We examine whether perceived interpersonal discrimination mediates the association between disability and psychological well-being (depression, negative and positive affect) and how these processes differ across the life course. Data are from two waves (2004-2006; 2013-2014) of the Midlife in the United States (MIDUS; N = 2,503). Perceived discrimination accounts for 5% to 8% of the association between disability and the three mental health outcomes. Moderated mediation analyses reveal significant age differences; perceived discrimination is a stronger explanatory mechanism among midlife (ages 40-64) relative to older (age 65+) adults. Disability stigma takes a heightened psychological toll at midlife, a life stage when adults are expected to be able-bodied and interact with a diverse social network, which may be a source of interpersonal mistreatment. Among older adults, for whom impairment is expected and common, the psychological impact of disability may operate through other pathways. We discuss implications for research and practice.

Effects of parenting adults with disabilities on later-life health: The role of intergenerational ambivalence.

According to family systems theory, strains from parenting an adult with disabilities may spill over to parents' relationships with their other children and disrupt family dynamics and their well-being in later-life. This study examined whether parental ambivalence toward their nondisabled children is greater in families of adults with disabilities (developmental disabilities [DD] or serious mental illnesses [SMI]) than families without any adult children with disabilities. The study also investigated whether ambivalence mediates the associations between having an adult child with DD or SMI and parents' health. Data were from the 2011 Wisconsin Longitudinal Study in which aging parents (Mage = 71; n = 6,084) were asked about their relationship with each of their adult children. Multilevel regression models and multilevel structural equation models were estimated to analyze the data. Our findings showed that parents of an adult with SMI felt greater ambivalence toward their nondisabled adult children than comparison group parents of adult children without disabilities, whereas no significant differences were found between parents of an adult child with DD and comparison group parents. Parental ambivalence toward their nondisabled adult children played a significant indirect role in the negative association between having a child with SMI and parental physical and mental health. The findings have implications for clinical practice with aging families of adults with disabilities and suggest the need for additional research to better understand intergenerational parent-adult child dynamics in these families. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Perceived interpersonal and institutional discrimination among persons with disability in the U.S.: Do patterns differ by age?

RATIONALE: One-third of U.S. adults have an activity-limiting health condition and this proportion increases with age. However, it is unclear whether functional limitation renders one vulnerable to institutional and interpersonal discrimination, and whether this vulnerability differs over the life course. Stigma theories suggest disability would be more discrediting to younger persons relative to older adults, as it violates cultural norms and expectations regarding able-bodied working-age adults. OBJECTIVE: We evaluate whether U.S. adults with functional impairment report higher levels of perceived interpersonal mistreatment and institutional discrimination relative to persons without impairment, and whether these patterns differ across age groups. METHOD: We use data from the second wave of the National Survey of Midlife Development in the United States (MIDUS II), collected between 2004 and 2006 (n = 3931). We estimate OLS and logistic regression models to predict interpersonal and institutional discrimination, respectively. RESULTS: Persons with impairment report more frequent encounters of disrespectful treatment, insults, and being treated as if they have a character flaw, and elevated odds of workplace- and service-related discrimination, net of sociodemographic, and physical and mental health characteristics. Effects are significantly larger among early (age 40-49) and late (age 50-64) midlife versus older (age 65+) adults. CONCLUSIONS: We discuss implications for policy and practice, and underscore that stigmatization processes may further amplify health and socioeconomic disparities between those with versus without functional limitations.

Do disability, parenthood, and gender matter for health disparities?: A US population-based study.

BACKGROUND: Existing research has documented adverse health outcomes among parents with disabilities relative to parents without disabilities, but little is known about whether parenthood adds unique stress and health consequences for people with disabilities. Less is known about whether the effects of parenthood differ between mothers and fathers with disabilities. OBJECTIVES: This paper examined health-related quality of life, obesity, and health behaviors between US parents and nonparents with and without disabilities. We also explored differences in health outcomes separately for men and women by one's parental and disability status. METHODS: An analytic sample of parents and nonparents aged 18-64, with and without disabilities, were derived from the 2016 Behavioral Risk Factor Surveillance System (9,117 parents and 33,961 nonparents with disabilities). Multivariate logistic regression analyses were applied, controlling for individuals' socio-demographic characteristics and their history of chronic conditions. RESULTS: Parents with disabilities, compared to parents without disabilities and nonparents with and without disabilities, were at higher risk of reporting frequent physical distress, obesity, smoking, and insufficient sleep. Among those with disabilities, fathers were more likely than nonfathers to report poor or fair health, frequent physical and mental distress, and obesity; these differences were not evident between mothers and nonmothers with disabilities. CONCLUSIONS: The findings suggest the urgent need for policies and programs to address the health-related needs of parents with disabilities, as well as the need for targeted programs to support fathers with disabilities.

Lifelong Parenting of Adults With Developmental Disabilities: Growth Trends Over 20 Years in Midlife and Later Life.

This research examined how parenting adults with developmental disabilities affects parental well-being beyond midlife and into old age. Parents of adults with developmental disabilities ( n = 249) and parents of adults without disabilities ( n = 9,016), studied in their early 50s and mid-60s, were longitudinally tracked into their early 70s. Compared to parents of adults without disabilities, parents of adults with disabilities showed a pattern of normative functioning in their 50s, followed by poorer well-being in their mid-60s, and further declines in health and well-being into the early 70s. Aging parents who co-resided with their adult child with disabilities were particularly vulnerable, experiencing a steeper increase in depressive symptoms and body mass index (BMI) than parents whose child with disabilities lived away from home.

Fate of Fecal Indicators in Resource-Oriented Sanitation Systems Using Nitrifying Bio-Treatment.

Hygienic fecal treatment in resource-oriented sanitation (ROS) systems is an important concern. Although the addition of nitrifying microorganisms is a sustainable fecal treatment method in ROS systems, it is essential to examine the cleanliness of this method. In this study, we investigated the fate of fecal indicators in source-separated fecal samples through tracking Escherichia coli and total coliforms. The effects of adding different amounts of Nitrosomonas europaea bio-seed, along with a constant amount of Nitrobacter winogradskyi bio-seed, were studied. In intact feces samples, the pathogen population underwent an initial increase, followed by a slight decrease, and eventually became constant. Although the addition of nitrifying microorganisms initially enhanced the pathogen growth rate, it caused the reduction process to become more efficient in the long-term. In addition to a constant concentration of 10,000 cells of N. winogradskyi per 1 g feces, a minimum amount of 3000 and 7000 cells of N. europaea per 1 g feces could completely remove E. coli and total coliforms, respectively, in less than 25 days. Increasing the amount of bio-seeds added can further reduce the time required for total pathogen removal.

Well-being of Sibling Caregivers: Effects of Kinship Relationship and Race.

Purpose of the Study: This study examined whether caregiving has a differential effect on the well-being of sibling caregivers relative to other caregiving groups and whether race moderates this effect. Design and Methods: Using the National Survey of Midlife Development in the United States, 631 family caregivers (including 61 sibling caregivers) and 4,944 noncaregivers were identified. Hierarchical regression analyses were conducted to estimate the effect of the caregiver-care recipient relationship and its interaction with race on caregivers' well-being (i.e., depressive symptoms, self-rated health, life satisfaction, and perceived control over life). Results: Caregivers in general reported poorer well-being than noncaregivers, but sibling caregivers were less affected by caregiving than parent or spouse caregivers. Among sibling caregivers, caregiving took a significantly greater toll on non-Hispanic White caregivers than those from minority groups with respect to depressive symptoms and life satisfaction. Implication: The findings suggest that the experience of sibling caregivers is significantly shaped by their cultural background.

The Relative Risk of Divorce in Parents of Children With Developmental Disabilities: Impacts of Lifelong Parenting.

We prospectively examined the risk of divorce in 190 parents of children with developmental disabilities compared to 7,251 parents of children without disabilities based on a random sample drawn from the community and followed longitudinally for over 50 years. A significant interaction between the parental group status and number of children was found: In the comparison group, having a larger number of children was related to an increased risk of divorce, whereas the number of children did not increase divorce risk among parents of children with developmental disabilities.