Publications by authors named "Almar A L Kok"

21 Publications

  • Page 1 of 1

Psychosocial factors and cancer incidence (PSY-CA): Protocol for individual participant data meta-analyses.

Brain Behav 2021 Sep 2:e2340. Epub 2021 Sep 2.

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.

Objectives: Psychosocial factors have been hypothesized to increase the risk of cancer. This study aims (1) to test whether psychosocial factors (depression, anxiety, recent loss events, subjective social support, relationship status, general distress, and neuroticism) are associated with the incidence of any cancer (any, breast, lung, prostate, colorectal, smoking-related, and alcohol-related); (2) to test the interaction between psychosocial factors and factors related to cancer risk (smoking, alcohol use, weight, physical activity, sedentary behavior, sleep, age, sex, education, hormone replacement therapy, and menopausal status) with regard to the incidence of cancer; and (3) to test the mediating role of health behaviors (smoking, alcohol use, weight, physical activity, sedentary behavior, and sleep) in the relationship between psychosocial factors and the incidence of cancer.

Methods: The psychosocial factors and cancer incidence (PSY-CA) consortium was established involving experts in the field of (psycho-)oncology, methodology, and epidemiology. Using data collected in 18 cohorts (N = 617,355), a preplanned two-stage individual participant data (IPD) meta-analysis is proposed. Standardized analyses will be conducted on harmonized datasets for each cohort (stage 1), and meta-analyses will be performed on the risk estimates (stage 2).

Conclusion: PSY-CA aims to elucidate the relationship between psychosocial factors and cancer risk by addressing several shortcomings of prior meta-analyses.
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http://dx.doi.org/10.1002/brb3.2340DOI Listing
September 2021

The joint effects of clinically relevant depressive symptoms and cardiovascular risk factors on incident cardiovascular disease among older adults in the community.

J Psychosom Res 2021 Jul 16;149:110572. Epub 2021 Jul 16.

Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands. Electronic address:

Objective: To determine if there is a synergistic effect between clinically relevant depressive symptoms and cardiovascular risk factors that disproportionately increases the risk of cardiovascular disease (CVD) among older adults with depressive symptoms.

Methods: Data were obtained from the Longitudinal Aging Study Amsterdam, a longitudinal cohort study. N = 3091 respondents with up to seven years of follow-up were included. Incident CVD was based on self-report, medication use, general practitioners' diagnoses and causes of death. A score of ≥16 points on the Center for Epidemiological Studies Depression Scale indicated clinically relevant depressive symptoms. Risk factors included were sex, education, obesity, smoking, alcohol use, physical inactivity and diabetes mellitus. Data were analysed with Cox regression models. Measures of multiplicative and additive interaction were calculated to determine if the presence of both depressive symptoms and a risk factor amplified the risk of CVD.

Results: Of all participants, 12.6% had clinically relevant depressive symptoms and, after a median follow-up of six years, 15.7% developed CVD. Only the additive interaction between physical inactivity and depressive symptoms was statistically significant and explained 40.6% of the CVD risk among inactive persons with depressive symptoms.

Conclusion: In the general population, we did not detect synergistic effects for most risk factors. However, older adults with clinically relevant depressive symptoms and a physically inactive lifestyle appeared to be at a particularly high risk to develop CVD and may represent an important target for cardiovascular prevention.
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http://dx.doi.org/10.1016/j.jpsychores.2021.110572DOI Listing
July 2021

Long-Term Gender-Affirming Hormone Therapy and Cognitive Functioning in Older Transgender Women Compared With Cisgender Women and Men.

J Sex Med 2021 08 8;18(8):1434-1443. Epub 2021 Jul 8.

Amsterdam University Medical Centers, location VUmc, Department of Medical Psychology, Amsterdam, the Netherlands.

Background: Long-term gender-affirming hormone therapy (GHT) in older transgender individuals could have beneficial effects on cognitive functioning. Cardiovascular risk factors and psychological factors are known determinants of cognition. Despite the rising number of older transgender individuals, only few studies have examined cognitive functioning in this population.

Aim: We aimed to assess differences in cognitive functioning between transgender women, and non-transgender (cisgender) women and men, and investigated the contribution of cardiovascular risk factors and psychological factors on these differences.

Methods: In this study, 37 transgender women (age range 55 to 69) receiving GHT for at least ten years (range 10.2 to 41.6) were examined, and their cognitive functioning was compared to an age and education level matched cohort consisting of 222 cisgender women and men from the Longitudinal Aging Study Amsterdam. Linear regression analyses were performed.

Outcomes: Cognitive functioning was assessed by neuropsychological tests including Mini-Mental State Examination (MMSE), Category Fluency animals, Letter Fluency D, 15-Word test (15WT) immediate and delayed recall. Additionally, cardiovascular risk factors and psychological factors such as cardiovascular disease, hypertension, antihypertensive use, statin use, diabetes mellitus, overweight, smoking, alcohol consumption, psychopharmaceutical use, anxiety and depression symptoms were collected.

Results: Transgender women had higher MMSE scores compared with cisgender women (+0.9, 95% CI 0.4 to 1.5), and cisgender men (+1.1, 95% CI 0.4 to 1.8). On all other tests transgender women performed similar to cisgender men. Transgender women performed at a lower level than cisgender women on 15WT immediate recall, -5.5, 95% CI -7.6 to -3.4, and 15WT delayed recall, -2.7, 95% CI -3.7 to -1.7, and equal to cisgender women on Fluency animals and Fluency D. Cardiovascular and psychological factors (i.e., cardiovascular disease and depression symptoms) partly explained differences on MMSE score between transgender women and cisgender-control groups.

Clinical Implications: The results of this study do not indicate a need for tailored hormone treatment strategies for older transgender women, based on cognitive aspects after long-term GHT.

Strengths & Limitations: As one of the first studies, this study compared older transgender women to a large cohort of cisgender men and women regarding cognitive functioning and took into account numerous potential influencing factors. Limitations include difference in test procedures and the cross-sectional design of the study.

Conclusion: Cognitive differences between transgender women and cisgender women and men were small, albeit significant. This may suggest that long-term GHT effects on cognitive functioning in older transgender women are minimal. van Heesewijk JO, Dreijerink KMA, Wiepjes CM, et al. Long-Term Gender-Affirming Hormone Therapy and Cognitive Functioning in Older Transgender Women Compared With Cisgender Women and Men. J Sex Med 2021;18:1434-1443.
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http://dx.doi.org/10.1016/j.jsxm.2021.05.013DOI Listing
August 2021

Steeling or sensitizing? A longitudinal examination of how ongoing accumulation of negative life events affects depressive symptoms in older adults.

J Gerontol B Psychol Sci Soc Sci 2021 Jun 25. Epub 2021 Jun 25.

Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands.

Objectives: To examine whether: 1) as people age, accumulation of negative events increases ('sensitizing') or decreases ('steeling') the detrimental effects of subsequent events on depressive symptoms, and 2) how particular psychosocial factors are associated with the strength of these steeling or sensitizing effects.

Method: We used data from six measurement waves from 2,069 adults aged 55-84 (M=68.0) at baseline in the Longitudinal Aging Study Amsterdam, the Netherlands. We included 18 different life events across the life course. Using hybrid multilevel models, we tested whether the effects of proximate life events (<3 years) on depressive symptoms (measured by the CES-D) were moderated by previous cumulative events (childhood until previous measurement wave). Additionally, we tested whether education, mastery, emotional support, neuroticism, having strong faith, and loneliness were associated with the strength of steeling/sensitizing effects.

Results: Cumulative and proximate life events were independently associated with more depressive symptoms. Interaction effects indicated that the more cumulative life events, the weaker the effects of recent life events, suggesting a 'steeling' effect. Unexpectedly, three-way interaction effects showed that higher mastery and lower neuroticism were associated with weaker steeling effects. These effects were predominantly attributable to within-person changes rather than to fixed between-person differences. Results from analyses with event severity scores were similar.

Conclusions: As a population, older adults appear to become more resilient against new stressors as they accumulate experience in dealing with negative life events. Findings on mastery tentatively suggest that accepting limits to one's own control over life circumstances may foster a steeling effect.
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http://dx.doi.org/10.1093/geronb/gbab114DOI Listing
June 2021

Common variants in Alzheimer's disease and risk stratification by polygenic risk scores.

Nat Commun 2021 06 7;12(1):3417. Epub 2021 Jun 7.

Servei de Neurologia, Hospital Universitari i Politècnic La Fe, Valencia, Spain.

Genetic discoveries of Alzheimer's disease are the drivers of our understanding, and together with polygenetic risk stratification can contribute towards planning of feasible and efficient preventive and curative clinical trials. We first perform a large genetic association study by merging all available case-control datasets and by-proxy study results (discovery n = 409,435 and validation size n = 58,190). Here, we add six variants associated with Alzheimer's disease risk (near APP, CHRNE, PRKD3/NDUFAF7, PLCG2 and two exonic variants in the SHARPIN gene). Assessment of the polygenic risk score and stratifying by APOE reveal a 4 to 5.5 years difference in median age at onset of Alzheimer's disease patients in APOE ɛ4 carriers. Because of this study, the underlying mechanisms of APP can be studied to refine the amyloid cascade and the polygenic risk score provides a tool to select individuals at high risk of Alzheimer's disease.
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http://dx.doi.org/10.1038/s41467-021-22491-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8184987PMC
June 2021

An examination of reciprocal effects between cardiovascular morbidity, depressive symptoms and loneliness over time in a longitudinal cohort of Dutch older adults.

J Affect Disord 2021 06 31;288:122-128. Epub 2021 Mar 31.

Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands.

Background: Unidirectional studies suggest that the effects between cardiovascular disease, depressive symptoms and loneliness are reciprocal, but this has not been tested empirically. The aim was to study how cardiovascular morbidity, depressive symptoms and loneliness influence each other longitudinally.

Methods: Data from 2979 older adults from the Longitudinal Aging Study Amsterdam were analysed. Depressive symptoms (≥16 points on the Center for Epidemiologic Studies Depression Scale), loneliness (≥3 points on the De Jong Gierveld Loneliness Scale) and cardiovascular morbidity were measured five times during 13-year follow-up. With structural equation modelling, a full cross-lagged panel model was compared to nine nested models reflecting different sets of temporal effects.

Results: The best-fitting cross-lagged panel model showed reciprocal risk increasing effects between depressive symptoms and loneliness and a risk increasing effect of cardiovascular morbidity on depressive symptoms.

Limitations: A cross-lagged panel model has technical limitations, such as that the chosen time lag may not be appropriate for each effect. In addition, differential loss to follow-up and collider bias may have led to an underestimation of the effects.

Conclusions: Reciprocal effects tend to occur only between depressive symptoms and loneliness. Their interplay with cardiovascular morbidity seems more complex and mostly indirect, highlighting the potential of interventions to reduce depressive symptoms, loneliness and cardiovascular morbidity in concert to improve health at old age.
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http://dx.doi.org/10.1016/j.jad.2021.03.081DOI Listing
June 2021

Physical comorbidity in Older-Age Bipolar Disorder (OABD) compared to the general population - a 3-year longitudinal prospective cohort study.

J Affect Disord 2021 06 26;288:83-91. Epub 2021 Mar 26.

Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands; GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Neuroscience Research Institute, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.

Background: The aim of this study was to examine the accumulation of chronic physical diseases in Older-Age Bipolar Disorder (OABD) as well as in individuals from the general aging population over a 3-year period.

Methods: This prospective longitudinal study compared 101 patients with OABD receiving outpatient care (DOBi cohort) with 2545 individuals from the general aging population (LASA cohort). The presence of eight major chronic diseases was asked at baseline and 3-year follow-up. Total number of diseases was the main outcome measure. Self-rated health (SRH, scale 1-5) was examined as a secondary outcome. Multilevel linear modelling of change was performed to estimate and test the observed change in both samples.

Results: At baseline, the number of chronic diseases was lower (b= -0.47, p<0.01) and self-rated health comparable (b=0.27, p=0.13) in DOBi than in LASA. Over 3 years the number of chronic diseases increased faster in DOBi than in LASA (b=0.51 versus b=0.35, p(interaction)=0.03). When corrected for employment, depressive symptoms, waist circumference, smoking, and alcohol use, this difference was no longer significant. SRH decreased faster in DOBi than in LASA (b=-0.24 versus b=-0.02, p(interaction)=0.04).

Limitations: Information on chronic diseases was collected using self-report.

Conclusions: A faster accumulation of chronic physical diseases and a faster decline in health perception was observed in OABD than in participants from the general population. The observed differences could partly be attributed to baseline differences in psychosocial, lifestyle, and health behaviour factors. Our findings urgently call for the use of integrated care in BD.
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http://dx.doi.org/10.1016/j.jad.2021.03.057DOI Listing
June 2021

Capturing Subjective Age, Subjective Life Expectancy, and Their Links With Older Adults' Health: The Dutch Longitudinal Aging Study Amsterdam.

J Aging Health 2021 Aug-Sep;33(7-8):633-644. Epub 2021 Mar 31.

Amsterdam Public Health Research Institute, Epidemiology and Data Science, 1209Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

This study compares the associations of two subjective lifetime perspectives, subjective age (SA) and subjective life expectancy (SLE), with physical performance, self-rated health, and depressive symptoms. 64 91-year-old participants were selected from three waves of the Longitudinal Aging Study Amsterdam (2008/09, 2011/12, 2015/16; = 1822 participants, = 3500 observations) that included graphical and numerical measures of SA and SLE. We used generalized estimating equations to examine their associations with health. Associations of SA/SLE with health were weaker for physical performance than for self-rated health and depressive symptoms. The associations of SA and SLE with physical performance were of similar magnitude but with self-rated health depended on the type of measure. Depressive symptoms, instead, showed a stronger association with SA than with SLE. Graphical measures showed weaker associations than numerical measures. The way in which subjective lifetime perspectives and health are conceptualized and measured influences the strength of their associations.
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http://dx.doi.org/10.1177/08982643211004001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8236662PMC
March 2021

The mental health impact of the COVID-19 pandemic on people with and without depressive, anxiety, or obsessive-compulsive disorders: a longitudinal study of three Dutch case-control cohorts.

Lancet Psychiatry 2021 02 8;8(2):121-129. Epub 2020 Dec 8.

Department of Psychiatry, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, Netherlands; Geestelijke gezondheidszorg (GGZ) InGeest Specialized Mental Health Care, Amsterdam, Netherlands.

Background: The impact of the COVID-19 pandemic on mental health in people with pre-existing mental health disorders is unclear. In three psychiatry case-control cohorts, we compared the perceived mental health impact and coping and changes in depressive symptoms, anxiety, worry, and loneliness before and during the COVID-19 pandemic between people with and without lifetime depressive, anxiety, or obsessive-compulsive disorders.

Methods: Between April 1 and May 13, 2020, online questionnaires were distributed among the Netherlands Study of Depression and Anxiety, Netherlands Study of Depression in Older Persons, and Netherlands Obsessive Compulsive Disorder Association cohorts, including people with (n=1181) and without (n=336) depressive, anxiety, or obsessive-compulsive disorders. The questionnaire contained questions on perceived mental health impact, fear of COVID-19, coping, and four validated scales assessing depressive symptoms, anxiety, worry, and loneliness used in previous waves during 2006-16. Number and chronicity of disorders were based on diagnoses in previous waves. Linear regression and mixed models were done.

Findings: The number and chronicity of disorders showed a positive graded dose-response relation, with greater perceived impact on mental health, fear, and poorer coping. Although people with depressive, anxiety, or obsessive-compulsive disorders scored higher on all four symptom scales than did individuals without these mental health disorders, both before and during the COVID-19 pandemic, they did not report a greater increase in symptoms during the pandemic. In fact, people without depressive, anxiety, or obsessive-compulsive disorders showed a greater increase in symptoms during the COVID-19 pandemic, whereas individuals with the greatest burden on their mental health tended to show a slight symptom decrease.

Interpretation: People with depressive, anxiety, or obsessive-compulsive disorders are experiencing a detrimental impact on their mental health from the COVID-19 pandemic, which requires close monitoring in clinical practice. Yet, the COVID-19 pandemic does not seem to have further increased symptom severity compared with their prepandemic levels.

Funding: Dutch Research Council.
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http://dx.doi.org/10.1016/S2215-0366(20)30491-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7831806PMC
February 2021

Ignoring competing events in the analysis of survival data may lead to biased results: a nonmathematical illustration of competing risk analysis.

J Clin Epidemiol 2020 06 9;122:42-48. Epub 2020 Mar 9.

Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC-Location VU University Medical Center, Amsterdam, the Netherlands.

Objective: Competing events are often ignored in epidemiological studies. Conventional methods for the analysis of survival data assume independent or noninformative censoring, which is violated when subjects that experience a competing event are censored. Because many survival studies do not apply competing risk analysis, we explain and illustrate in a nonmathematical way how to analyze and interpret survival data in the presence of competing events.

Study Design And Setting: Using data from the Longitudinal Aging Study Amsterdam, both marginal analyses (Kaplan-Meier method and Cox proportional-hazards regression) and competing risk analyses (cumulative incidence function [CIF], cause-specific and subdistribution hazard regression) were performed. We analyzed the association between sex and depressive symptoms, in which death before the onset of depression was a competing event.

Results: The Kaplan-Meier method overestimated the cumulative incidence of depressive symptoms. Instead, the CIF should be used. As the subdistribution hazard model has a one-to-one relation with the CIF, it is recommended for prediction research, whereas the cause-specific hazard model is recommended for etiologic research.

Conclusion: When competing risks are present, the type of research question guides the choice of the analytical model to be used. In any case, results should be presented for all event types.
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http://dx.doi.org/10.1016/j.jclinepi.2020.03.004DOI Listing
June 2020

Psychosocial and Health-Related Factors Associated With Discordance Between 13-Year Trajectories of Self-Reported Functional Limitations and Performance-Based Physical Functioning in Old Age.

J Aging Health 2020 10 5;32(9):1084-1097. Epub 2019 Nov 5.

Amsterdam UMC-Vrije Universiteit Amsterdam, The Netherlands.

The objective of this study was to examine correlates of discordance between 13-year trajectories of self-reported functional limitations and performance-based physical functioning in older adults. We included 2,135 participants from the population-based Longitudinal Aging Study Amsterdam, the Netherlands, followed across 1995-2008. Self-reported functional limitations included six (instrumental) activities of daily living. Performance-based functioning was a composite of four tests. We used latent class growth analysis and multinomial logistic regression to examine discordance and its correlates. Patterns of discordance and concordance (41% concordance, 46% "overestimation" of daily functioning, 13% "underestimation") appeared to be persistent over 13 years. Older age, male sex, cognitive impairment, absence of pain, and light alcohol use were associated with overestimation. Younger age, female sex, and lower self-rated health were associated with underestimation. Factors associated with overestimation partly differ from those associated with underestimation. Factors that are highly stable over time are particularly good indicators of persistent discordance.
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http://dx.doi.org/10.1177/0898264319884404DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731649PMC
October 2020

Psychological Resilience in the Context of Disability: A Study With Turkish and Moroccan Young-Old Immigrants Living in the Netherlands.

Gerontologist 2020 02;60(2):259-269

Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands.

Background And Objectives: The disability paradox postulates that some individuals with severe functional limitations demonstrate psychological resilience, that is, good mental health and quality of life. Resilience to disabilities has been linked to psychological (e.g., mastery) and social factors (e.g., social provisions). It is, however, less clear whether cultural factors can provide additional resources for resilience building in older immigrants. We investigated the extent to which sociodemographic, psychosocial, and cultural factors contributed to psychological resilience to disabilities among immigrants of Turkish and Moroccan descent in the Netherlands.

Research Design And Method: The sample included 478 older immigrants aged 55-65 years. Data were analyzed using latent profile analysis and multinomial logistic regressions.

Results: Five categories were identified: (a) High physical and emotional functioning; (b) High physical but poor emotional functioning; (c) Low physical but high emotional functioning (resilient); (d) Low physical and emotional functioning; and (e) Low physical and very low emotional functioning. Resilient functioning (reference category) was associated with poorer Dutch language proficiency, lower levels of loneliness, greater mastery, and more religious coping.

Discussion And Implications: Findings provide support for the disability paradox and highlight social provisions, mastery, and religiosity/spirituality as important resources for psychological resilience in older labor migrants. Poor Dutch language proficiency is discussed as a potential factor contributing to severe functional limitations in the resilient category.
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http://dx.doi.org/10.1093/geront/gnz129DOI Listing
February 2020

The Longitudinal Aging Study Amsterdam: cohort update 2019 and additional data collections.

Eur J Epidemiol 2020 Jan 25;35(1):61-74. Epub 2019 Jul 25.

Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands.

The Longitudinal Aging Study Amsterdam (LASA) is a prospective cohort study of older adults in the Netherlands, initially based on a nationally representative sample of people aged 55-84 years. The study has been ongoing since 1992, and focuses on the determinants, trajectories and consequences of physical, cognitive, emotional and social functioning. Strengths of the LASA study include its multidisciplinary character, the availability of over 25 years of follow-up, and the cohort-sequential design that allows investigations of longitudinal changes, cohort differences and time trends in functioning. The findings from LASA have been reported in over 600 publications so far (see www.lasa-vu.nl). This article provides an update of the design of the LASA study and its methods, on the basis of recent developments. We describe additional data collections, such as additional nine-monthly measurements in-between the regular three-yearly waves that have been conducted among the oldest old during 2016-2019, and the inclusion of a cohort of older Turkish and Moroccan migrants.
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http://dx.doi.org/10.1007/s10654-019-00541-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7058575PMC
January 2020

Longitudinal Examination of Emotional Functioning in Older Adults After Spousal Bereavement.

J Gerontol B Psychol Sci Soc Sci 2020 09;75(8):1668-1678

Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam, The Netherlands.

Objectives: This study examined trajectories of emotional functioning in three domains (depressive symptoms, emotional, and social loneliness) for individuals who experienced spousal bereavement and investigated cross-domain adaptation. We hypothesized that emotional difficulties after bereavement would be more detectable in emotional loneliness than depressive symptoms or social loneliness.

Methods: Using latent class growth analysis, we modeled changes in depressive symptoms, emotional loneliness, and social loneliness from 12 years pre- to 12 years post-bereavement on data from 686 older adults to identify trajectories indicating adaptive and maladaptive functioning in each domain.

Results: Most participants reported depressive symptoms below the clinically relevant threshold by showing a resilient (15.5%) or a slightly elevated (53.5%) trajectory post-bereavement. One third (31%) reported clinically relevant depressive symptoms. More than half of the sample reported emotional loneliness post-bereavement, varying form prolonged (17%), increasing and prolonged (28.3%), and chronically high (8.9%) levels. Remaining participants displayed resilience (13.5%) or recovery (32.3%). Social loneliness showed four trajectories: very low and resilient (43.3%), low and resilient (27.5%), increasing (20.2%), and chronically high (9%) levels. One third of participants maintained adaptive, whereas 12% displayed maladaptive, functioning across all domains post-bereavement.

Discussion: An increase in emotional loneliness was the most commonly observed change after spousal bereavement. This highlights the central role of emotional loneliness in depression after bereavement.
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http://dx.doi.org/10.1093/geronb/gbz039DOI Listing
September 2020

Factors across life associated with remaining free from functional limitations despite lifelong exposure to socioeconomic adversity.

J Epidemiol Community Health 2019 06 19;73(6):529-536. Epub 2019 Mar 19.

MRC Unit for Lifelong Health and Ageing, University College London, London, UK.

Background: There are substantial socioeconomic inequalities in functional limitations in old age. Resilience may offer new insights into these inequalities by identifying constellations of factors that protect some individuals from developing functional limitations despite socioeconomic adversity.

Methods: Data from 1973 participants in the Medical Research Council National Survey of Health and Development (Great Britain), followed from birth until age 60-64, were used. Functional limitations were defined as reporting difficulty with at least 1 of 16 activities at age 60-64. Lifetime socioeconomic adversity was based on socioeconomic trajectories, categorised into three adversity levels. Analysis of covariance and regression models were used to compare psychosocial factors and health-related behaviours between a 'Resilient' group (high adversity but no functional limitations) and five groups with other combinations of adversity and limitations.

Results: Prevalence of functional limitations in high, intermediate and low adversity groups was 44%, 30% and 23% in men, and 61%, 55% and 49% in women, respectively. Compared with the other high adversity group, the resilient group had a lower prevalence of childhood illness (12% vs 19%) and obesity throughout ages 43-64 (70% vs 55%). Partially adjusted models also showed higher adolescent self-management, lower neuroticism, higher prevalence of volunteer work and physical activity (age 60-64) and lower prevalence of smoking (age 43) in the resilient. Marital status and contact frequency were not associated with resilience.

Conclusion: Results suggest protection against childhood illness, health-behavioural factors and self-regulation as targets for interventions across life that may particularly benefit those with long-term exposure to socioeconomic adversity.
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http://dx.doi.org/10.1136/jech-2018-211736DOI Listing
June 2019

"Tough Times Have Become Good Times": Resilience in Older Adults With a Low Socioeconomic Position.

Gerontologist 2018 09;58(5):843-852

Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.

Background And Objectives: This qualitative study applied a resilience perspective to socioeconomic inequalities in the functioning of older adults. We aimed to gain insight into how some older adults managed to age successfully despite having a low socioeconomic position (SEP) throughout their lives.

Research Design And Methods: Semistructured interviews were conducted with 11 resilient adults over the age of 79 years participating in the Longitudinal Aging Study Amsterdam, the Netherlands. Participants were defined as resilient on the basis of having a low lifetime SEP and favorable trajectories of physical, mental, and social functioning. Grounded Theory coding techniques were applied to identify themes reflecting distinct ways in which participants dealt with what they indicated were the most significant adversities in their lives. The analysis focused on experiences linked to socioeconomic conditions.

Results: Six themes reflecting psychological, behavioral, and social factors were derived from the data: drawing support from social contacts; investing in younger generations; taking actions to manage or improve socioeconomic conditions; putting the impact of a low SEP into perspective; persevering; and resigning oneself to adversity.

Discussion And Implications: Findings suggest that successful aging despite a low SEP throughout one's lifetime requires considerable psychological and social resources. In addition, resignation and specific manifestations of generativity are identified as new elements of resilience. These findings may help to reduce the stereotyping of older adults with a low SEP, and nuance the heroic image of resilience as something that is primarily attributable to extraordinary individual abilities or efforts.
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http://dx.doi.org/10.1093/geront/gny007DOI Listing
September 2018

Smoking Cessation and 16-year Trajectories of Functional Limitations Among Dutch Older Adults: Results from the Longitudinal Aging Study Amsterdam.

J Gerontol A Biol Sci Med Sci 2018 11;73(12):1722-1728

Academic Medical Center, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, the Netherlands.

Background: This study examined whether smoking cessation in middle age and old age is associated with following a successful trajectory of functional limitations over time in Dutch older adults.

Methods: We used 16-year longitudinal data from 645 participants of the Longitudinal Aging Study Amsterdam. Three types of trajectories regarding functional limitations over time were defined: successful (high initial level of functioning and limited decline), late decline (high initial level of functioning and late onset of decline), and early decline (lower initial level of functioning and early onset of decline). Smoking cessation status was self-reported and categorized into: early quitters (stopped in middle age [35-40 years]), late quitters (already smoked in middle age and stopped in old age [≥55 years]), and continued smokers (smoked in middle age and still smoking in old age). Multinomial Logistic Regression Analyses were used to assess the association between smoking cessation and trajectory membership.

Results: The sample (55-85 years at baseline) consisted of 20.3% early quitters, 22.9% late quitters, and 56.8% continued smokers. After adjustment for confounders, the model showed that late quitters were less likely to follow an early decline trajectory instead of a successful trajectory compared to continued smokers (odds ratio [OR] = 0.48, 95% confidence interval [CI] = 0.24-0.97). After adjustment for clinically relevant level of depressive symptoms, this association remained substantial but was no longer statistically significant (OR = 0.50, 95% CI = 0.24-1.02).

Conclusions: Although not statistically significant in the full model, the observed associations suggest that smoking cessation in old age may have an important impact on daily functioning in old age.
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http://dx.doi.org/10.1093/gerona/gly009DOI Listing
November 2018

The impact of conscientiousness, mastery, and work circumstances on subsequent absenteeism in employees with and without affective disorders.

BMC Psychol 2017 Mar 29;5(1):10. Epub 2017 Mar 29.

Department of Psychiatry, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands.

Background: High numbers of employees are coping with affective disorders. At the same time, ambitiousness, achievement striving and a strong sense of personal control and responsibility are personality characteristics that are nowadays regarded as key to good work functioning, whereas social work circumstances tend to be neglected. However, it is largely unkown how personality characteristics and work circumstances affect work functioning when facing an affective disorder. Given the high burden of affective disorders on occupational health, we investigate these issues in the context of affective disorders and absenteeism from work. The principal aim of this paper is to examine whether particular personality characteristics that reflect self-governance (conscientiousness and mastery) and work circumstances (demands, control, support) influence the impact of affective disorders on long-term absenteeism (>10 working days).

Methods: Baseline and 1-year follow-up data from 1249 participants in the Netherlands Study of Depression and Anxiety (NESDA) in 2004-2006 was employed. Multivariate logistic regression analyses were performed, including interaction effects between depressive, anxiety, and comorbid disorders and personality and work circumstances.

Results: In general, mastery and conscientiousness increased nor diminished odds of subsequent long-term absenteeism, whereas higher job support significantly decreased these odds. Interaction effects showed that the impact of affective disorders on absenteeism was stronger for highly conscientious employees and for employees who experienced high job demands.

Conclusions: Affective disorders may particularly severely affect work functioning of employees who are highly conscientious or face high psychological job demands. Adjusting working conditions to their individual needs may prevent excessive work absence.
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http://dx.doi.org/10.1186/s40359-017-0179-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372251PMC
March 2017

The Effects of Life Events and Socioeconomic Position in Childhood and Adulthood on Successful Aging.

J Gerontol B Psychol Sci Soc Sci 2017 Mar;72(2):268-278

Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.

Objectives: Building on social stress theory, this study has 2 aims. First, we aim to estimate the effects of stressful life events in childhood and adulthood on Successful Aging (SA). Second, we examine how unequal exposure to such life events between individuals with different socioeconomic position (SEP) contributes to socioeconomic inequalities in SA.

Method: We used 16-year longitudinal data from 2,185 respondents aged 55-85 years in 1992 in the Dutch nationally representative Longitudinal Aging Study Amsterdam. Measurement of SA was based on earlier work, in which we integrated trajectories in 9 indicators of functioning into an index of SA. Using path analysis, we investigated direct and indirect effects of parental and adulthood SEP as well as of self-reported childhood and adulthood life events on SA.

Results: Almost all included life events had negative direct effects on SA. Parental SEP had no direct effect on SA, whereas adulthood SEP had. Higher Parental SEP increased the likelihood of parental problems and parental death in childhood, resulting in negative indirect effects on SA. Higher adulthood SEP had both positive and negative indirect effects on SA, through increasing the likelihood of divorce and unemployment, but decreasing the likelihood of occupational disability.

Discussion: SEP and particular stressful life events are largely, but not entirely independent predictors of SA. We found that high and low SEP may increase exposure to particular events that negatively affect SA. Findings suggest that low (childhood) SEP and stressful life events are interrelated factors that may limit individual opportunities to age successfully.
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http://dx.doi.org/10.1093/geronb/gbw111DOI Listing
March 2017

Socioeconomic inequalities in a 16-year longitudinal measurement of successful ageing.

J Epidemiol Community Health 2016 11 17;70(11):1106-1113. Epub 2016 May 17.

Department of Epidemiology & Biostatistics, Medical Faculty F-Wing, VU University Medical Center, Amsterdam, The Netherlands VU University Amsterdam, Faculty of Social Sciences, Department of Sociology, Amsterdam, The Netherlands.

Background: This study examines to what extent education, occupation and income are associated with the multidimensional process of successful ageing, encompassing trajectories of physical, mental and social functioning in old age.

Methods: We employed 16-year longitudinal data from 2095 participants aged 55-85 years at baseline in the Dutch, nationally representative Longitudinal Aging Study Amsterdam. For 9 indicators of successful ageing, separate Latent Class Growth models were used to identify subgroups of older adults with a 'successful' trajectory. A 'Successful Aging Index' expressed the number of indicators for which individual respondents had a successful trajectory (range 0-9). Using multivariate regression models, we investigated associations between socioeconomic position and the Successful Ageing Index, and with separate indicators of successful ageing.

Results: Higher education, occupational skill level and income were independently associated with higher numbers of successful trajectories. Education (β=0.09) was a slightly stronger correlate of successful ageing than income (β=0.08). Analyses of separate indicators of successful ageing showed that cognitive functioning, functional limitations and emotional support given were associated with all three components of socioeconomic position, while other indicators were associated with only one (eg, life satisfaction) or none (eg, social loneliness). For some indicators of successful ageing, socioeconomic inequalities were present at baseline, and also increased or decreased during follow-up.

Conclusions: Education, occupation and income represent distinct socioeconomic life course factors, each of which contribute in a specific way to inequalities in successful ageing. Physical and cognitive functioning were associated more strongly with socioeconomic position than social and emotional functioning.
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http://dx.doi.org/10.1136/jech-2015-206938DOI Listing
November 2016

Capturing the Diversity of Successful Aging: An Operational Definition Based on 16-Year Trajectories of Functioning.

Gerontologist 2017 04;57(2):240-251

Department of Epidemiology and Biostatistics, Medical Faculty F-Wing, VU University Medical Center, Amsterdam, the Netherlands.

Purpose Of The Study: To determine the prevalence and extent of successful aging (SA) when various suggestions proposed in the previous literature for improving models of SA are incorporated into one holistic operational definition. These suggestions include defining and measuring SA as a developmental process, including subjective indicators alongside more objective ones, and expressing SA on a continuum.

Design And Methods: Data were used from 2,241 respondents in the Longitudinal Aging Study Amsterdam, a multidisciplinary study in a nationally representative sample of older adults in the Netherlands. Latent class growth analysis was used to identify successful 16-year trajectories within nine indicators of physical, cognitive, emotional, and social functioning. SA was quantified as the number of indicators in which individual respondents showed successful trajectories (range 0-9).

Results: Successful trajectories were characterized by stability, limited decline, or even improvement of functioning over time. Of the respondents, 39.6% of men and 29.3% of women were successful in at least seven indicators; 7% of men and 11% of women were successful in less than three indicators. Proportions of successful respondents were largest in life satisfaction (>85%) and smallest in social activity (<25%). Correlations of success between separate indicators were low to moderate (range r = .02-.37).

Implications: Many older adults age relatively successfully, but the character of successful functioning over time varies between indicators, and the combinations of successful indicators vary between individuals.
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http://dx.doi.org/10.1093/geront/gnv127DOI Listing
April 2017
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