Fabrizio D'Esposito

Stressful life events and the onset of chronic diseases among Australian adults: findings from a longitudinal survey

OBJECTIVES This article examines the link between stressful life events and illness by considering both onset and reoccurrence of chronic illnesses. Using longitudinal data, we estimate the extent to which life events increase the likelihood of depression or anxiety, type 2 diabetes, cancer, coronary heart disease, circulatory disease, asthma and emphysema among Australian adults aged ≥21 years. METHODS Longitudinal data were obtained from the nationally representative Household, Income and Labour Dynamics in Australia panel survey collected at waves 3 (2003), 7 (2007) and 9 (2009). Participants (N = 9222) answered life events questions relating to the preceding 12 months and chronic illnesses lasting (or expected to last for) 6 months. Weighted pooled and random effects logistic regressions were performed, controlling for confounders and previous illness, and also performed on subsamples delineated by reported illnesses in wave 3. RESULTS Work-related stress [odds ratio (OR) = 1.54, P < 0.001] was positively associated with the onset of depression or anxiety. Personal stress increased the likelihood of the onset of depression or anxiety (OR = 1.70, P < 0.001), type 2 diabetes (OR = 1.47, P < 0.05) and circulatory diseases (OR = 1.72, P < 0.05), while family-related stress increased the likelihood of the onset of heart (OR = 1.32, P < 0.01) and circulatory diseases (OR = 1.32, P < 0.05). CONCLUSIONS Independent of personal characteristics and key health measures (body mass index, hypertension and disability), these findings suggest that work-related, personal and family-related stressful life events contribute to the development and/or course of chronic diseases.

Maternal postnatal mental health and later emotional-behavioural development of children: The mediating role of parenting behaviour

BACKGROUND Maternal postnatal mental health difficulties have been associated with poor outcomes for children. One mechanism by which parent mental health can impact on childrens outcomes is via its effects on parenting behaviour. METHOD The longitudinal relationships between maternal postnatal distress, parenting warmth, hostility and child well-being at age seven were examined for 2200 families participating in a population-based longitudinal study of Australian children. RESULTS The relationship between postnatal distress and childrens later emotional-behavioural development was mediated by parenting hostility, but not parenting warmth, even after accounting for concurrent maternal mental health. Postnatal distress was more strongly associated with lower parenting warmth for mothers without a past history of depression compared with mothers with a past history of depression. CONCLUSIONS These findings underscore the contribution of early maternal well-being to later parenting and child outcomes, highlighting the importance of mental health and parenting support in the early parenting years. Implications for policy and practice are discussed.

Fathers’ Postnatal Mental Health and Child Well-Being at Age Five: The Mediating Role of Parenting Behavior

Fathers’ postnatal mental health is associated with emotional and behavioral outcomes for children in early childhood. The aim of this study was to examine whether parenting behavior mediated the relationship between fathers’ postnatal psychological distress and emotional–behavioral outcomes for children at age 5. The sample consisted of 2,025 fathers participating in Growing Up In Australia: The Longitudinal Study of Australian Children. Data collected when the children were aged 0 to 12 months and 4 to 5 years were used. Results revealed that the relationship between fathers’ postnatal distress and children’s outcomes was mediated by parenting hostility (angry and frustrated reactions toward the child such as yelling), and this remained significant after controlling for fathers’ concurrent mental health and mothers’ postnatal mental health. These findings underscore the important contribution of fathers’ postnatal mental health to later parenting behavior and child outcomes. Implications for policy and practice focused on improving mental health and parenting support to fathers in the early childhood period is discussed.

Baseline characteristics of participants in the Kerala Diabetes Prevention Program: a cluster randomized controlled trial of lifestyle intervention in Asian Indians

To describe the baseline characteristics of participants in the Kerala Diabetes Prevention Program.

Cluster randomised feasibility trial to improve the Control of Hypertension In Rural India (CHIRI): a study protocol

Introduction Hypertension is emerging in rural populations of India. Barriers to diagnosis and treatment of hypertension may differ regionally according to economic development. Our main objectives are to estimate the prevalence, awareness, treatment and control of hypertension in 3 diverse regions of rural India; identify barriers to diagnosis and treatment in each setting and evaluate the feasibility of a community-based intervention to improve control of hypertension. Methods and analysis This study includes 4 main activities: (1) assessment of risk factors, quality of life, socioeconomic position and barriers to changes in lifestyle behaviours in ∼14 500 participants; (2) focus group discussions with individuals with hypertension and indepth interviews with healthcare providers, to identify barriers to control of hypertension; (3) use of a medicines-availability survey to determine the availability, affordability and accessibility of medicines and (4) trial of an intervention provided by Accredited Social Health Activists (ASHAs), comprising group-based education and support for individuals with hypertension to self-manage blood pressure. Wards/villages/hamlets of a larger Mandal are identified as the primary sampling unit (PSU). PSUs are then randomly selected for inclusion in the cross-sectional survey, with further randomisation to intervention or control. Changes in knowledge of hypertension and risk factors, and clinical and anthropometric measures, are assessed. Evaluation of the intervention by participants provides insight into perceptions of education and support of self-management delivered by the ASHAs. Ethics and dissemination Approval for the overall study was obtained from the Health Ministrys Screening Committee, Ministry of Health and Family Welfare (India), institutional review boards at each site and Monash University. In addition to publication in peer-reviewed articles, results will be shared with federal, state and local government health officers, local healthcare providers and communities. Trial registration number CTRI/2016/02/006678; Pre-results.

A peer-support lifestyle intervention for preventing type 2 diabetes in India: A cluster-randomized controlled trial of the Kerala Diabetes Prevention Program

Background The major efficacy trials on diabetes prevention have used resource-intensive approaches to identify high-risk individuals and deliver lifestyle interventions. Such strategies are not feasible for wider implementation in low- and middle-income countries (LMICs). We aimed to evaluate the effectiveness of a peer-support lifestyle intervention in preventing type 2 diabetes among high-risk individuals identified on the basis of a simple diabetes risk score. Methods and findings The Kerala Diabetes Prevention Program was a cluster-randomized controlled trial conducted in 60 polling areas (clusters) of Neyyattinkara taluk (subdistrict) in Trivandrum district, Kerala state, India. Participants (age 30–60 years) were those with an Indian Diabetes Risk Score (IDRS) ≥60 and were free of diabetes on an oral glucose tolerance test (OGTT). A total of 1,007 participants (47.2% female) were enrolled (507 in the control group and 500 in the intervention group). Participants from intervention clusters participated in a 12-month community-based peer-support program comprising 15 group sessions (12 of which were led by trained lay peer leaders) and a range of community activities to support lifestyle change. Participants from control clusters received an education booklet with lifestyle change advice. The primary outcome was the incidence of diabetes at 24 months, diagnosed by an annual OGTT. Secondary outcomes were behavioral, clinical, and biochemical characteristics and health-related quality of life (HRQoL). A total of 964 (95.7%) participants were followed up at 24 months. Baseline characteristics of clusters and participants were similar between the study groups. After a median follow-up of 24 months, diabetes developed in 17.1% (79/463) of control participants and 14.9% (68/456) of intervention participants (relative risk [RR] 0.88, 95% CI 0.66–1.16, p = 0.36). At 24 months, compared with the control group, intervention participants had a greater reduction in IDRS score (mean difference: −1.50 points, p = 0.022) and alcohol use (RR 0.77, p = 0.018) and a greater increase in fruit and vegetable intake (≥5 servings/day) (RR 1.83, p = 0.008) and physical functioning score of the HRQoL scale (mean difference: 3.9 score, p = 0.016). The cost of delivering the peer-support intervention was US

Cultural adaptation of a peer-led lifestyle intervention program for diabetes prevention in India: the Kerala diabetes prevention program (K-DPP)

22.5 per participant. There were no adverse events related to the intervention. We did not adjust for multiple comparisons, which may have increased the overall type I error rate. Conclusions A low-cost community-based peer-support lifestyle intervention resulted in a nonsignificant reduction in diabetes incidence in this high-risk population at 24 months. However, there were significant improvements in some cardiovascular risk factors and physical functioning score of the HRQoL scale. Trial registration Australia and New Zealand Clinical Trials Registry ACTRN12611000262909.

Father mental health during the early parenting period: results of an Australian population based longitudinal study

BackgroundType 2 diabetes mellitus (T2DM) is now one of the leading causes of disease-related deaths globally. India has the world’s second largest number of individuals living with diabetes. Lifestyle change has been proven to be an effective means by which to reduce risk of T2DM and a number of “real world” diabetes prevention trials have been undertaken in high income countries. However, systematic efforts to adapt such interventions for T2DM prevention in low- and middle-income countries have been very limited to date. This research-to-action gap is now widely recognised as a major challenge to the prevention and control of diabetes. Reducing the gap is associated with reductions in morbidity and mortality and reduced health care costs. The aim of this article is to describe the adaptation, development and refinement of diabetes prevention programs from the USA, Finland and Australia to the State of Kerala, India.MethodsThe Kerala Diabetes Prevention Program (K-DPP) was adapted to Kerala, India from evidence-based lifestyle interventions implemented in high income countries, namely, Finland, United States and Australia. The adaptation process was undertaken in five phases: 1) needs assessment; 2) formulation of program objectives; 3) program adaptation and development; 4) piloting of the program and its delivery; and 5) program refinement and active implementation.ResultsThe resulting program, K-DPP, includes four key components: 1) a group-based peer support program for participants; 2) a peer-leader training and support program for lay people to lead the groups; 3) resource materials; and 4) strategies to stimulate broader community engagement. The systematic approach to adaptation was underpinned by evidence-based behavior change techniques.ConclusionK-DPP is the first well evaluated community-based, peer-led diabetes prevention program in India. Future refinement and utilization of this approach will promote translation of K-DPP to other contexts and population groups within India as well as other low- and middle-income countries. This same approach could also be applied more broadly to enable the translation of effective non-communicable disease prevention programs developed in high-income settings to create context-specific evidence in rapidly developing low- and middle-income countries.Trial registrationAustralia and New Zealand Clinical Trials Registry: ACTRN12611000262909. Registered 10 March 2011.