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BACKGROUND: The aim of the present study was to investigate associations between food insecurity with suicidal ideation and suicide attempts in adults aged =50?years from six low- and middle-income countries (LMICs). METHODS: Cross-sectional, community-based data from the World Health Organisation's Study on Global Aging and Adult Health were analyzed. Self-reported information on past 12-month suicidal ideation and suicide attempts was collected. Past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable logistic regression analysis was conducted to assess the association between food insecurity and suicidal ideation or suicide attempts. RESULTS: The final analytical sample included 34,129 individuals aged =50?years [mean (SD) age 62.4 (16.0) years; 52.1% females]. Compared to no food insecurity, severe food insecurity was associated with a significant 2.78 (95%CI?=?1.73-4.45) times higher odds for suicidal ideation, while moderate and severe food insecurity were associated with 2.59 (95%CI?=?1.35-4.97) and 5.15 (95%CI?=?2.52-10.53) times higher odds for suicide attempts, respectively. LIMITATIONS: The cross-sectional design, the use of self-reported wish to die as a measure of suicide ideation, and that suicidal ideation and suicide attempts were only assessed among those who had depressive symptoms, could be considered limitations of our study. CONCLUSIONS: Food insecurity was positively associated with suicidal ideation and suicide attempts. Targeting food insecurity among older adults in LMICs may lead to reduction in suicidal ideation and suicide attempts, although future longitudinal studies are warranted to confirm this.

PURPOSE: There is a paucity of literature identifying factors that influence the back and neck pain (BNP)-workplace absenteeism relationship. Therefore, this study aimed to investigate the association between BNP and workplace absenteeism and potential mediating variables in a large sample of the US population. METHODS: Nationally representative data collected in 2019 from the RAND American Life Panel (ALP) were used for this retrospective study. Workplace absenteeism was defined as the number of days of absence in the past 12 months for health-related reasons (count variable), while BNP corresponded to the presence of back pain due to spinal stenosis, back pain due to other causes, or neck pain (dichotomous variable). Control variables included sex, age, ethnicity, marital status, education, occupation, annual family income, health insurance, obesity, and diabetes. There were eight influential variables (depression, anxiety, sleep disorder, alcohol dependence, opioid dependence, walking difficulty, standing difficulty, and sitting difficulty). The association between BNP and workplace absenteeism was analyzed using a negative binomial regression model. RESULTS: There were 1,471 adults aged 22-83 years included in this study (52.9% of men; mean [standard deviation] age 44.5 [13.0] years). After adjusting for control variables, BNP was positively and significantly associated with workplace absenteeism (incidence rate ratio = 1.40, 95% confidence interval: 1.07-1.83). Walking, standing, and sitting difficulties individually explained between 24 and 43% of this association. CONCLUSIONS: Workplace interventions focusing on the management of BNP and overcoming difficulties in walking, standing, and sitting, potentially utilizing exercise, therapy, and ergonomic interventions, may prevent absenteeism.

BACKGROUND: There is a scarcity of literature on the association between physical multimorbidity (i.e., =2 chronic physical conditions) and depression among older adults, especially from low- and middle-income countries (LMICs). In addition, the mediators in this association are largely unknown. Therefore, we aimed to examine this association among adults aged =50 years from six LMICs (China, Ghana, India, Mexico, Russia, and South Africa), and to identify potential mediators. METHODS: Cross-sectional, nationally representative data from the Study on Global Ageing and Adult Health were analyzed. Depression was defined as past-12 months DSM-IV depression or receiving depression treatment in the last 12 months. Information on 11 chronic physical conditions were obtained. Multivariable logistic regression and mediation analyses were conducted. RESULTS: Data on 34,129 individuals aged =50 years were analyzed [mean (SD) age 62.4 (16.0) years; maximum 114 years; 52.1% females]. Compared to no chronic conditions, 2, 3, 4, and =5 chronic conditions were associated with 2.55 (95% CI = 1.90-3.42), 3.12 (95% CI = 2.25-4.34), 5.68 (95% CI = 4.02-8.03), and 8.39 (95% CI = 5.87-12.00) times higher odds for depression. Pain/discomfort (% mediated 39.0%), sleep/energy (33.2%), mobility (27.5%), cognition (13.8%), perceived stress (7.3%), disability (6.7%), loneliness (5.5%), and food insecurity (1.5%) were found to be significant mediators in the association between physical multimorbidity and depression. CONCLUSIONS: Older adults with physical multimorbidity are at increased odds of depression in LMICs. Future studies should assess whether addressing the identified potential mediators in people with physical multimorbidity can lead to reduction in depression in this population.

BACKGROUND: The aims of the present study were to examine prospective associations of multimorbidity (i.e., =2 chronic conditions) at baseline with incident and persistent anxiety over a two-year follow-up period among Irish older adults, and to quantify the extent to which sleep, pain, and disability mediate the multimorbidity-anxiety relationship. METHODS: Data from The Irish Longitudinal Study on Aging (TILDA) conducted between 2009 and 2011 with a follow-up after two years were analyzed. The baseline survey was anxiety referred to score?=?8 on the anxiety section of the Hospital Anxiety and Depression Scale. Lifetime diagnosis of 14 chronic conditions was obtained. Outcomes were incident and persistent anxiety at two-year follow-up. RESULTS: Data on 5871 adults aged =50?years at baseline were analyzed [Mean (SD) age 63.3 (9.0) years; 51.2% women]. After adjustment for potential confounders, compared to no chronic physical conditions at baseline, =3 chronic conditions were associated with a significant 1.89 (95% CI?=?1.16-3.08) times higher risk for new onset anxiety at follow-up. Furthermore, having 1, 2, and =3 conditions at baseline were associated with significant 1.48 (95% CI 1.02, 2.14), 1.74 (95% CI 1.19, 2.53), and 1.84 (95% CI 1.27, 2.68) times higher risk for persistent anxiety at follow-up. Sleep problems, pain, and disability were identified as significant mediators, explaining 22.9%-37.8% of the associations. CONCLUSION: Multimorbidity was associated with both new onset and persistent anxiety among Irish older adults. Future interventional studies should examine whether addressing the identified mediators may lead to lower risk for incident or persistent anxiety among those with physical multimorbidity.

Public health restrictions, in response to the COVID-19 pandemic, have had potentially wide-ranging, unintended effects on health-related behaviours such as diet and physical activity and also affected mental health due to reduced social interactions. This study explored how health-related behaviours and mental health were impacted in a sample of the UK public during the first set of COVID-19 public health restrictions. Two online surveys were administered in the UK, one within the first three months of the restrictions (Timepoints 1 (T1-involving pre-pandemic recall) and 2/T2) and another ten weeks later (Timepoint 3/T3). Moderate-vigorous physical activity (MVPA), outdoor time, sitting time, screen time and sexual activity were self-reported. Diet was assessed using the Dietary Instrument for Nutrition Education questionnaire. Mental health was measured using the short-form Warwick-Edinburgh Mental Wellbeing Scale and Becks' Anxiety and Depression Inventories. Differences between timepoints were explored using the Friedman, Wilcoxon signed-rank, McNemar and McNemar-Bowker tests. Two hundred and ninety-six adults (74% under 65 years old; 65% female) provided data across all timepoints. Between T1 and T2, MVPA, time outdoors and sexual activity decreased while sitting, and screen time increased (p < 0.05). Between T2 and T3, saturated fat intake, MVPA, time outdoors, and mental wellbeing increased while sitting, screen time and anxiety symptoms decreased (p < 0.05). This study found that depending on the level of COVID-19 public health restrictions in place, there appeared to be a varying impact on different health-related behaviours and mental health. As countries emerge from restrictions, it is prudent to direct necessary resources to address these important public health issues.

BACKGROUND: Physical multimorbidity (i.e., =2 chronic conditions) may induce feelings of wish to die (WTD), but there is limited literature on this topic, while the mediators in this association are largely unknown. Thus, the aim of the present study was to investigate this association and its mediators among older Irish adults.; METHODS: Cross-sectional, nationally representative data from Wave 1 of the Irish Longitudinal Study on Ageing 2009-2011 were analyzed. Information on self-reported lifetime diagnosis of 14 chronic physical conditions were obtained. WTD was defined as answering affirmatively to the question "In the last month, have you felt that you would rather be dead?" Multivariable logistic regression and mediation analyses were conducted.; RESULTS: Data on 2941 adults aged =65years [mean (SD) age 73.2 (5.2) years; 45.0% males] were analyzed. Physical multimorbidity was associated with 3.39 (95%CI 1.58, 7.28) times higher odds for WTD. This association was largely explained by pain (% mediated 28.1%), followed by depression (19.4%), sleep problems (18.4%), perceived stress (13.0%), loneliness (10.4%), anxiety (8.1%), and disability (7.2%).; CONCLUSIONS: Multimorbidity was associated with increased odds for WTD among Irish older adults. Addressing the identified mediators may contribute to reducing feelings of WTD among older adults with multimorbidity. Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.

BACKGROUND: We aimed to investigate associations of unclean cooking fuels with depression and anxiety symptoms in a large sample of adults aged =65years from six low- and middle-income countries (LMICs).; METHODS: Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Unclean cooking fuel referred to kerosene/paraffin, coal/charcoal, wood, agriculture/crop, animal dung, and shrubs/grass. Depression referred to DSM-IV depression based on past 12-month symptoms or receiving depression treatment in the last 12months. Anxiety symptoms referred to severe/extreme problems with worry or anxiety in the past 30days. Multivariable logistic regression analysis and meta-analysis were conducted.; RESULTS: Data on 14,585 people aged =65years were analyzed [mean (SD) age 72.6 (11.5) years; maximum age 114years; 55.0% females]. After adjustment for potential confounders, unclean cooking fuel was associated with a significant 2.52 (95%CI=1.66-3.82) times higher odds for depression with a low level of between-country heterogeneity (I2=0.0%). For anxiety symptoms, unclean fuel use was not significantly associated with anxiety symptoms (OR=1.13; 95%CI=0.77-1.68; I2=0.0%).; LIMITATIONS: 1. Cross-sectional design. 2. Self-reported measures. 3. No information about outdoor pollution exposure, personal exposure, and smoke composition of different cooking fuels.; CONCLUSIONS: Unclean cooking fuel was significantly associated with higher odds for depression, but not anxiety, with little observed variability between settings. Findings from the present study provide further support and call for action in appropriate implementation of the United Nations Sustainable Goal 7, which advocates affordable, reliable, sustainable, and modern energy for all. Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.

Food insecurity has been shown to be associated with fast-food consumption. However, to date, studies on this specific topic are scarce. Therefore, the aim of the present study was to investigate the association between food insecurity and fast-food consumption in adolescents aged 12-15 years from sixty-eight countries (seven low-income, twenty-seven lower middle-income, twenty upper middle-income, fourteen high-income countries). Cross-sectional, school-based data from the Global School-based Student Health Survey were analysed. Data on past 30-d food insecurity (hunger) and fast-food consumption in the past 7 d were collected. Multivariable logistic regression and meta-analysis were conducted to assess associations. Models were adjusted for age, sex and BMI. There were 180 164 adolescents aged 12-15 years (mean age 13·8 (sd 1·0) years; 50·8 % boys) included in the analysis. Overall, severe food insecurity (i.e. hungry because there was not enough food in home most of the time or always) was associated with 1·17 (95 % CI 1·08, 1·26) times higher odds for fast-food consumption. The estimates pooled by country-income levels were significant in low-income countries (adjusted OR (aOR) = 1·30; 95 % CI 1·05, 1·60), lower middle-income countries (aOR = 1·15; 95 % CI 1·02, 1·29) and upper middle-income countries (aOR = 1·26; 95 % CI 1·07, 1·49), but not in high-income countries (aOR = 1·04; 95 % CI 0·88, 1·23). The mere co-occurrence of food insecurity and fast-food consumption is of public health importance. To tackle this issue, a strong governmental and societal approach is required to utilise effective methods as demonstrated in some high-income countries such as the implementation of food banks and the adoption of free school meals.

BACKGROUND: Physical inactivity is strongly associated with obesity, which in turn is a major risk factor for many non-communicable diseases. We examined associations between physical inactivity and obesity in Spanish adults with vision and hearing difficulties and explored differences between men and women. METHODS: Data from the Spanish National Health Survey 2017 were analyzed [n = 23 089 adults (15-103 years, mean age 53.4 ± 18.9 years, 45.9% men)]. Participants self-reported difficulties in seeing and hearing. Physical inactivity (exposure) was evaluated with the International Physical Activity Questionnaire Short Form. Obesity (outcome) was defined as body mass index =30 kg m-2 based on self-reported weight and height. The association between physical inactivity and obesity was assessed with multivariable logistic regression in people with difficulties seeing and hearing, adjusting for significant covariates. RESULTS: Multivariable logistic regression analyses showed that the association between physical inactivity and obesity was stronger in those with difficulty hearing (OR 1.778, 95% CI 1.215-2.602) compared with difficulty seeing (OR 1.375, 95% CI 1.076-1.756). Gender-stratified analyses showed significant association between physical inactivity and obesity in men who reported difficulty hearing (OR 2.319, 95% CI 1.441-3.735) and difficulty seeing (OR 1.556, 95% CI 1.079-2.244), but not in women. CONCLUSIONS: A significant association between physical inactivity and obesity was observed in Spanish men with vision and hearing difficulties. Physical activity has an important role in the prevention of obesity in men with seeing and hearing difficulties. Active steps should be taken to encourage physical activity to reduce the risk of obesity in people with sensory impairments.

BACKGROUND: Consumption of unhealthy foods may have changed during the COVID-19 pandemic. This study explored how dietary fat intake was impacted in a sample of the UK public who were social distancing during the COVID-19 pandemic. METHODS: Data were collected from a UK COVID-19 online survey. Fat intake was measured using the Dietary Instrument for Nutrition Education questionnaire. Anxiety and depressive symptoms were assessed using Becks' Anxiety and Depression Inventories, while the short-form Warwick-Edinburgh Mental Well-being Scale assessed mental well-being. Differences between individuals who increased versus decreased fat intake were explored using chi-square or independent sample t-tests. Association between fat intake and mental health was explored using adjusted linear regression models. RESULTS: Eight hundred and eighty-seven adults were included. Approximately, 34% recorded medium-to-high levels of fat consumption during social distancing. Around 48% reported decreased fat intake during social distancing compared to usual levels, while 41.3% documented increased fat intake. Fat intake was not significantly associated (P > 0.05) with any measures of mental health. CONCLUSIONS: A higher proportion of a sample of UK adults social distancing during the COVID-19 pandemic recorded decreased fat intake when compared to levels prior to social distancing. There appeared to be no associations between fat intake and mental health.

BACKGROUND: There are no prospective studies on the association between multimorbidity and urinary incontinence (UI), while mediators in this association are unknown. Thus, we aimed to (i) investigate the longitudinal association between multimorbidity and UI in a large sample of Irish adults aged =50 years and (ii) investigate to what extent physical activity, polypharmacy, cognitive function, sleep problems, handgrip strength and disability mediate the association. METHODS: Data on 5,946 adults aged =50 years old from the Irish Longitudinal Study on Aging were analysed. The baseline survey was conducted between 2009 and 2011 and follow-up after 2 years was conducted. Information on self-reported occurrence of UI in the past 12 months and lifetime diagnosis of 14 chronic conditions were obtained. Multivariable logistic regression and mediation analysis were conducted. RESULTS: After adjustment for potential confounders, compared to having no chronic conditions at baseline, having three (odds ratio [OR] = 1.79; 95% confidence interval [CI] = 1.30-2.48) and four or more (OR = 1.86; 95% CI = 1.32-2.60), chronic conditions were significantly associated with incident UI. Mediation analysis showed that polypharmacy, sleep problems and disability explained 22.7, 17.8 and 14.7% of the association between multimorbidity (i.e. two or more chronic conditions) and incident UI, respectively. CONCLUSION: A greater number of chronic conditions at baseline were associated with a higher risk for incident UI at 2-year follow-up among adults aged =50 years in Ireland. Considering the effects of different medications on UI and improving sleep quality and disability among people aged =50 years with multimorbidity may reduce the incidence of UI.

Limited literature has investigated the association between food insecurity and sarcopenia in low- and middle-income countries (LMICs). Therefore, the aim of the present study was to investigate the association between food insecurity and sarcopenia among adults aged =65 years in six LMICs. Community-based cross-sectional data of the Study on Global Ageing and Adult Health were analyzed. Sarcopenia was defined as the presence of low skeletal muscle mass based on indirect population formula, and either slow gait or low handgrip strength. In the past, 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable logistic regression analysis was conducted. The final sample consisted of 14,585 individuals aged =65 years (mean (SD) age 72.6 (11.5) years; 55.0% females). The prevalence of sarcopenia among those with no food insecurity was 13.0% but this increased to 24.4% among those with severe food insecurity. After adjustment for potential confounders, compared to no food insecurity, severe food insecurity was associated with 2.05 (95%CI = 1.12-3.73) times higher odds for sarcopenia. In this large representative sample of older adults from multiple LMICs, it was found that severe food insecurity is associated with higher odds for sarcopenia. Addressing food insecurity in such settings may be an effective strategy to curb the high prevalence of sarcopenia in LMICs.

BACKGROUND: Data on the association between visual difficulty and physical activity (PA) from low- and middle-income countries (LMICs) are scarce. Thus, the aim of the study was to investigate the association between visual difficulty and PA among adults from 36 LMICs, and to assess the mediators in this association. METHODS: Cross-sectional, community-based, predominantly nationally representative data from the World Health Survey were analysed. The final sample included 199,110 individuals aged =18 years [mean (SD) age 38.6 (16.1) years; 49.4% males]. Visual difficulty referred to having severe/extreme difficulties in seeing and recognizing a person that the participant knows across the road. Low PA was defined as not complying with PA recommendations of 150 min of moderate-vigorous PA per week. Multivariable logistic regression, meta-analysis, and mediation analysis were conducted to assess associations. RESULTS: Meta-analysis based on country-wise multivariable logistic regression analysis showed that overall, visual difficulty is associated with a 1.53 (95% CI = 1.38-1.71) times higher odds for low PA. Particularly strong associations were observed in males (OR = 1.72; 95% CI = 1.45-2.05) and adults aged =65 years (OR = 1.95; 95% CI = 1.67-2.29). Interpersonal activities, cognition, and sleep/energy explained >10% of the association between visual difficulty and low PA. CONCLUSIONS: In conclusion, we found evidence that especially in the case of males and older adults with visual difficulties in LMICs, there were low levels of engagement with PA. Addressing issues such as interpersonal activities, cognition, and sleep/energy in people with visual difficulties may increase levels of PA.

OBJECTIVE: The association between violence victimization and suicide attempts in a large representative sample of adolescents from low- and middle-income-countries (LMICs) of multiple continents has never been investigated. Therefore, the aim of the present study was to examine the relationship between being a victim of physical attacks (independent variable) and suicide attempts (dependent variable) in a sample of 117,472 students aged 12-15 years [mean (SD) age 13.8 (0.9) years; girls 49.4%] from thirty-eight LMICs in Africa, the Americas, and Asia. METHODS: Cross-sectional data from the Global School-based Student Health Survey (GSHS) were analyzed. Self-reported data on past 12-month suicide attempts and exposure to physical attacks were collected. Logistic regression and meta-analysis were conducted. RESULTS: The overall prevalence of suicide attempts and physical attacks were 10.1% and 39.4%, respectively. Overall, the results of the meta-analysis based on country-wise estimates adjusted for potential confounders (i.e., age, sex, food insecurity, alcohol consumption, bullying victimization, anxiety-induced sleep problems, low parental support/involvement, loneliness) showed that physical attacks were associated with a 1.71 (95%CI = 1.62-1.81) times higher odds for suicide attempt. CONCLUSIONS: In this large sample of adolescents from multiple LMICs, violence victimization was associated with significantly increased odds of suicide attempts. Future longitudinal studies are required to assess causality, and whether addressing exposure to violence can positively impact on adolescent suicide rates.

BACKGROUND: The aim was to assess the impact of COVID-19 self-isolation/social distancing on mental health, and potential correlates, among a sample of the UK population. METHODS: A cross-sectional study. Mental health was measured using the Beck Anxiety and Depression Inventory. Mental wellbeing was measured using The Short Warwick-Edinburgh Mental Well-being Scale. Data collected on predictors included sex, age, marital status, employment, annual income, region, current smoking, current alcohol consumption, physical multimorbidity, any physical symptoms experienced during self-isolation/social distancing, and the number of days of self-isolation/social distancing. The association between potential predictors and poor mental health was studied using a multivariable logistic regression. RESULTS: 932 participants were included. Factors associated with poor mental health were sex (reference: male; female: OR=1.89, 95%CI=1.34-2.68), age (18-24 years: reference;45-54 years: OR=0.27, 95%CI=0.14-0.53; 55-64 years: OR=0.24, 95%CI=0.12-0.47; 65-74years: OR=0.10, 95% CI=0.05-0.22; and =75years: OR=0.08,95% CI=0.03-0.24),annual income (