ابعاد کنترل روانشناختی والدین: ارتباطات با پرخاشگری فیزیکی و رابطه پیش دبستانی در روسیه

Objective The effect of age on psychological distress remains controversial and it is unclear how a chronic medical illness influences this association. We aimed to compare the level of psychological distress between younger and older patients with chronic medical conditions attending hospital specialty clinics and to test whether a different pattern emerges when comparisons with individuals without long-term conditions are made. Methods In 519 individuals without chronic medical conditions and 949 patients with established severe chronic medical illnesses, we compared psychological distress (GHQ-28 and SCL-90R) between younger (< 65, N = 1040) and older (≥ 65, N = 428) participants after controlling for gender, marital status, education and primary diagnosis in multiple logistic regression models. Results Among the healthy participants, a greater proportion of older individuals presented mild/moderate psychological distress (p = .026), predominantly depressive and somatization symptoms. Among the medical patients, both age groups presented elevated levels of psychological distress, but a greater proportion of younger patients had severe psychological distress (p = .016), predominantly depressive, anxiety and hostility symptoms. Younger patients reported similarly high levels of somatization symptoms compared to older patients. The odds of being assessed with severe psychological distress were significantly greater for younger individuals with physical illnesses, independently of gender, marital status, education and primary diagnosis. Conclusions Medical patients from both age groups had significant psychological distress symptoms scores. Younger patients with chronic medical illnesses were more vulnerable to severe psychological distress, including symptoms of anxiety, depression, hostility and somatization. Therefore, clinicians should direct efforts to recognize these symptoms in order to prevent further functional impairment.

Late adulthood is a life cycle phase that must be viewed from three perspectives: decline, change and development [1]. Despite notable inter-individual differences, old age is characterized by altered physical appearance, increased prevalence of physical illnesses, loss of friends and loved ones, as well as loss of role functioning, status and power [2], [3] and [4]. Despite these occurrences, several late-life aspects can still be a source of considerable wisdom and pleasure [3]. Conceivably, individuals might, in certain circumstances, cope with these life stressors in a more mature way protecting themselves from the development of psychological distress symptoms [5]. Therefore, there is ongoing controversy about the effects of aging on psychological distress development and whether its prevalence differs between younger and older individuals. A review of community surveys did not elucidate a consistent pattern across studies regarding age differences in the occurrence of anxiety and/or depression [6]. The most commonly observed trend was an initial rise across age groups followed by a drop. However, there were studies showing U-shaped trends, linear increases or decreases, or no differences across age groups [6]. Such controversy persists according to recent community surveys. Some studies have shown age-related decreases in the prevalence of psychological distress [7] and [8]. Nevertheless, other investigations failed to confirm such findings [9], [10] and [11]. These discrepant findings can be at least partially explained by two important factors, namely: (i) age-related bias on the measurement of psychological distress symptoms and (ii) different patterns of exposure to risk factors across age groups [6] and [12]. A well-known risk factor for the development of psychological distress (i.e., depression and/or anxiety) is the presence of a chronic medical condition. The prevalence rates of major depression tended to increase from 2–5% in community settings [13] to 5–10% in primary care [14], and to 6–14% among medical/surgical inpatients [15], [16], [17] and [18]. Our previous study in patients with rheumatologic diseases revealed a point prevalence of Major Depression of 25.4% [19]. Importantly, a number of studies have shown that depression and/or anxiety lead to negative outcomes in chronic medical conditions through different and interacting pathways, such as enhanced symptom burden, decreased adherence, increased disability and adversely affecting quality of life [18]. The prevalence of chronic diseases increases with age. However, age-related effects on the prevalence of psychological distress among individuals facing chronic medical conditions remain unclear. Primary care studies have shown that elderly patients had a lower probability of having a mental disorder [20]. Conversely, a recent Australian population survey found that young individuals experience a higher prevalence of psychological distress, regardless of the presence of chronic medical conditions [21]. Finally, another recent study in a representative sample of community-dwelling adults in the United States reported that although those presenting with one or more health-related disabilities were more likely to have a comorbid anxiety disorder, there were no significant differences between younger and older adults in the prevalence of mental comorbidity [22]. These findings illustrate that sampling procedures might influence the effects of age on the prevalence of mental disorders among the medically ill across different studies. Since patients with more severe disease forms receive care in hospital or specialty clinics, large-scale studies in such settings might shed more light on these inconsistencies. Although a limited number of studies in patients attending hospital specialty clinics included age as a variable possibly contributing to psychological distress development [23], [24] and [25], age-related differences in psychological distress have not been well addressed in the medical outpatient population [26]. To the best of our knowledge no study has systematically investigated differences in psychological distress between younger and older patients attending hospital specialty clinics and whether different prevalence figures emerge when comparisons with people without any primary medical condition are made. These comparisons are important for planning mental health care for different age groups of patients with severe chronic physical illnesses. Therefore, the present study aims to compare psychological distress symptom scores between younger and older patients with chronic medical conditions attending hospital specialty clinics and to test whether a different pattern emerges when comparisons with people without chronic diseases are made.