四川省农村居民就医行为及影响因素研究

目的　分析四川省农村居民就医行为现状,并基于安德森卫生服务利用模型探索四川省农村居民就医行为影响因素。方法　 于2019年7月在四川省Z市采用多阶段随机抽样的方法抽取调查对象进行入户面对面访谈。运用多水平统计模型分析四川省农村居民就医行为的影响因素。结果　四川省农村居民患病后就医比例为58.42%。倾向因素中,年龄≥75岁（OR = 3.732,95%CI:1.303～10.692）的农村居民患病后就医比例更高;促进资源中,家庭经济情况高水平（OR = 2.206,95%CI:1.211～4.018）会促进农村居民就医,到达最近医疗机构时间＜20 min（OR = 0.540,95%CI:0.316～0.922）和≥30 min （OR = 0.418,95%CI:0.213～0.818）会阻碍其就医;需要因素中,自评疾病严重程度为严重（OR = 4.651,95%CI:2.568～8.422）的农村居民患病后就医比例更高。结论　四川省农村居民患病后就医行为发生率低。倾向因素、促进资源、需要因素都对四川省农村居民的就医行为有重要影响,且倾向因素和需要因素影响更为显著。     

养老机构老年人口腔疾病就医行为影响因素分析

目的调查分析上海市浦东新区沪东社区养老机构老年人口腔疾病的就医行为和影响因素,为社区卫生服务中心改进老年人口腔疾病卫生服务提供依据。方法整群抽取沪东社区2所养老机构的390名老年人进行问卷调查,对369份有效问卷进行统计分析。结果 369名养老机构老年人中,口腔疾病就医率为68.56%,不同年龄段的差异有统计学意义。不就医的原因从高到低依次为交通(44.83%)、等候时间(23.28%)、就医流程(18.96%)和费用(12.93%),费用因素在不同年龄段的差异有统计学意义。就医目的从高到低依次为恢复功能(52.57%)、缓解疼痛(23.32%)、美观(17.00%)和保健预防(7.11%),缓解疼痛和恢复功能在不同年龄段的差异有统计学意义。选择的就医医疗机构主要为社区医院,不同年龄段间的差异有统计学意义。选择医疗机构的首要依据从高到低依次为距离(44.66%)、服务技术水平(27.67%)、价格(21.74%)和服务环境(5.93%),距离、价格和技术在不同年龄段间的差异有统计学意义。结论老年人口腔疾病就医行为受年龄因素影响。要重视不同年龄段老年人的口腔疾病医疗行为和影响因素,合理配置社区口腔卫生服务资源,正确引导就医。     

慢性病共病对中国老年人就医机构选择行为影响

目的 了解慢性病共病对中国老年人就医机构选择行为的影响,为优化就医秩序、增强基层慢性病管理能力提供理论依据。方法 收集2020年中国家庭追踪调查数据（CFPS）中4 508名≥60岁老年人的相关数据,应用Stata 17.0统计软件采用Probit回归模型和倾向得分匹配（PSM）方法分析慢性病共病对中国老年人就医机构选择行为的影响。结果 中国4 508名≥60岁老年人中,慢性病共病者748例,慢性病共病率为16.59%;选择基层医疗机构就医者2 536人（56.26%）,选择非基层医疗机构就医者1 972人（43.74%）。在控制了性别、年龄、文化程度、婚姻状况、户籍类型、月退休金、就医满意度、是否参加医疗保险、与子女的感情、子女是否提供经济支持、子女是否提供照料支持、自评健康状况、健康变化情况、近2周是否身体不适和是否能自我照顾等倾向、使能、需求因素后,Probit回归分析结果显示,中国慢性病共病老年人更倾向于选择非基层医疗机构就医（β=–0.130,95%CI=–0.237～–0.022）;慢性病共病对老年人就医选择的平均处理效应估计结果显示,使用K近邻匹配、核匹配和半径匹配3种方...     

四川省城乡居民就医行为现状及其影响因素分析

目的了解四川省城乡居民就医行为的现状及其影响因素。方法基于2018年四川省卫生服务调查数据描述四川省城乡居民两周内患病就诊及就诊机构选择的基本特征,采用多水平logistic回归分析居民两周内患病是否就诊以及就诊机构选择的影响因素。结果居民两周患病率为41.7%,其中选择就诊的比例为46.4%;影响居民患病后是否就诊以及就诊机构选择的因素主要是居民是否患有慢性病、自感患病伤的严重程度、病伤的持续天数和患者受教育程度(均P<0.05);基本医疗保险类型是就诊机构选择的重要影响因素(P<0.05);居民选择就诊机构并无城乡差异,但少数民族地区的居民选择基层医疗机构就诊的可能性是非少数民族地区居民的2.627倍(P<0.001)。结论四川省居民两周患病后就诊的比例较低,应进一步完善不同类型基本医疗保险制度,提高基层医疗机构服务水平并加强健康教育,合理规范居民就医行为。     

衡阳市居民就医行为及其影响因素分析

目的 了解衡阳市社区居民就医行为及其影响因素,为促进居民有序就医及建立就医决策支持系统提供参考依据.方法 2019-03-25-2019-08-25,采用多阶段抽样对衡阳市1 017名社区居民进行问卷调查.问卷内容包括调查对象基本情况、就医选择情况及影响就医的因素.结果56.0％的居民选择三级医院就诊,83.6％的居民...     

武汉市社区老年人社会支持与就医行为的研究

目的对武汉市社区老年人社会支持与就医行为的现状进行研究。方法采用分层整群随机抽样的方法对武汉市9个社区的908名60岁以上的老年人进行了调查。结果武汉市社区老年人的生活主要靠其亲属照顾，其中64．76％是配偶，26．76％是子女。对于患大病，3.19％选择社区卫生服务点看病，78，08％选择去综合医院，10．46％去专科医院。0.99％去私人诊所，2.75％人去药店买药，4.55％采用其他方式看病。影响社区老年人家庭关系的因素有年龄、原职业、健康状况、家庭经济收入、受教育年限和家庭人均居住面积。结论亲属是社区老年人社会支持的主要来源；仍有不少老年人就医意识淡薄；社区老年保障体系有待进一步完善。     

沈阳市某社区老年人口腔疾病就医行为及其相关影响因素调查分析

目的了解沈阳市某社区老年人口腔疾病就医行为,并分析其相关影响因素,以便为相关对策的制定提供一定的借鉴。方法 2016年6-12月在沈阳市某社区选取年龄≥60岁的老年人,对其口腔疾病就医行为及其相关影响因素进行现场问卷调查。结果本研究共调查364例老年人,有就医行为254人、未就医110人,就医率69.78%。年龄、月收入、学历均对老年人的就医行为有影响,差异具有统计学意义(P<0.05)。老年人选择私人口腔诊所为首选就医机构的比例较高,但是随着月收入和学历的增高,选择省市级大型医院或口腔医院就医的比例增高,差异具有统计学意义(P<0.05)。高龄老年人以就诊环境和流程作为医疗机构的首要依据,而高学历老年人以医疗水平作为选择医疗机构的首要依据,差异具有统计学意义(P<0.05)。未就医的原因主要是费用,在不同年龄的老年人中差异具有统计学意义(P<0.05)。结论沈阳市社区老年人口腔疾病就医行为不高,就医的医疗机构以私人口腔诊所为主,影响其就医的主要原因为费用问题,相关部门应共同协作,采取针对性的措施,以提高老年人对口腔疾病的认识,提高其就医率,使其口腔疾病能够得到及时诊治。     

西藏地区中老年人就医行为及其影响因素研究

目的 了解西藏地区中老年人就医行为及其影响因素,为合理配置当地卫生资源,进一步提高当地中老年人群的健康水平提供相关研究依据。方法 根据西藏地区第六次国家卫生服务调查研究,采用多阶段分层整群随机抽样,通过建立二分类多水平logistic回归模型探讨西藏地区中老年人就诊行为的可能影响因素。结果 研究结果显示西藏地区中老年人两周就诊率为15.96%,在控制其他因素不变的情况下,经济状况较好(中等收入：OR=1.512,95%CI:1.098～2.083;高收入：OR=1.392,95%CI:1.019～1.903)、患病持续时间较短(OR=0.959,95%CI:0.935～0.984)、患病严重程度较重(一般：OR=1.946,95%CI:1.512～2.506;严重：OR=2.818,95%CI:2.167～3.664)、患慢性病(OR=1.759,95%CI:1.232～2.514)的患者在两周内患病后就诊的比例更高;与医疗机构距离较远(2～<4km:OR=0.694,95%CI:0.497～0.971)、健康状况分值较高(OR=0.985,95%CI:0.979～0.991)的...     

中国就业流动人口就医行为及其影响因素分析

目的 了解我国18~59岁就业流动人口就医状况及其影响因素,为制定流动人口卫生服务相关政策提供依据。方法 利用2012年中国慢性病及其危险因素监测流动人口专题调查数据,该调查采用按行业分层多阶段整群抽样的方法在全国31个省（自治区、直辖市）和新疆生产建设兵团的170个县（区、团）开展,以面对面访谈的方式,询问调查对象的人口学基本信息、健康状况及调查前6个月的就医行为。选取最近6个月内有过身体不适的18~59岁就业流动人口作为分析对象。对数据进行复杂加权后,采用多项logistic回归模型,对就业流动人口就医行为及其影响因素进行分析。结果 共有11 134人纳入分析。流动人口去医疗机构治疗、自我治疗、不治疗的人数及比例分别为4 950人（44.5%）、3 880人（34.8%）、2 304人（20.7%）。多项logistic回归分析结果显示,在流动人口中,女性去医疗机构治疗是男性的1.275倍（95% CI：1.100~1.477）;东部、中部、西部的流动人口去医疗机构治疗分别是东北地区流动人口的2.153倍（95% CI：1.669~2.777）、2.310倍（95% CI：1.777~3.002）、2.177倍（95% CI：1.695~2.796）;年收入>25 000元的流动人口去医疗机构治疗是年收入≤ 25 000元流动人口的1.255倍（95% CI：1.088~1.448）;6个月内最近一次身体严重不适的流动人口去医疗机构治疗是身体不适不严重的流动人口的8.076倍（95% CI：6.091~10.707）;在户籍地和流入地都参加医疗保险的流动人口去医疗机构治疗是在两地都没有参加医疗保险的流动人口的1.566倍（95% CI：1.250~1.961）。新生代流动人口相对于老生代流动人口其去医疗机构治疗和自我治疗的发生比为1.369（95% CI：1.157~1.619）和1.240（95% CI：1.042~1.475）;已婚/同居流动人口相对于丧偶/离婚/分居流动人口,其去医疗机构治疗和自我治疗的发生比为1.590（95% CI：1.057~2.391）和1.815（95% CI：1.209~2.725）。身体不适越严重的流动人口,其选择的医疗机构的级别越高（P<0.05）。结论 就业流动人口去医疗机构治疗率较低。性别、新、老两代流动人口、婚姻状况、流入地区、年收入、6个月内最近一次身体不适程度、参加医疗保险的方式是影响就业流动人口就医行为的主要因素。     

武汉市社区老年人社会支持与就医行为的研究

目的对武汉市社区老年人社会支持与就医行为的现状进行研究。方法采用分层整群随机抽样的方法对武汉市9个社区的908名60岁以上的老年人进行了调查。结果武汉市社区老年人的生活主要靠其亲属照顾,其中64.76%是配偶,26.76%是子女。对于患大病,3.19%选择社区卫生服务点看病,78.08%选择去综合医院,10.46%去专科医院,0.99%去私人诊所,2.75%人去药店买药,4.55%采用其他方式看病。影响社区老年人家庭关系的因素有年龄、原职业、健康状况、家庭经济收入、受教育年限和家庭人均居住面积。结论亲属是社区老年人社会支持的主要来源;仍有不少老年人就医意识淡薄;社区老年保障体系有待进一步完善。     

The Association between Frailty and Healthcare Expenditure among Chinese Older Adults

ObjectivesThe purpose of this study was to examine whether frailty could explain variability in healthcare expenditure beyond multimorbidity and disability among Chinese older adults.DesignCross-sectional.Setting and ParticipantsParticipants were 5300 community-dwelling adults age at least 60 years from the China Health and Retirement Longitudinal Study.MethodsFrailty was identified by the physical frailty phenotype approach that has been created and validated among Chinese older adults. Five criteria were used: slowness, weakness, exhaustion, inactivity, and shrinking. Persons were classified as “nonfrail” (0 criteria), “prefrail” (1‒2 criteria), or “frail” (3‒5 criteria). Healthcare expenditure was measured based on participants’ self-report and was classified into 3 types: outpatient expenditure, inpatient expenditure, and self-treatment expenditure. The association of frailty and healthcare expenditure was analyzed using a 2-part regression model to account for excessive zero expenditures.ResultsFrailty was associated with higher odds of incurring outpatient, inpatient, and self-treatment expenditure. Among persons with non-zero expenditure, prefrail and frail persons, on average, had US $30.62 [95% confidence interval (CI) 8.41, 52.82] and US $60.60 (95% CI 5.84, 115.36) higher outpatient expenditure than the nonfrail, adjusting for sociodemographics, multimorbidity, and disability. After adjustment for all covariates, prefrail persons, on average, had US $3.34 (95% CI 0.54, 6.13) higher self-treatment expenditure than the nonfrail.Conclusions and ImplicationsFrailty is an independent predictor of higher healthcare expenditure among older adults. These findings suggest that timely screening and recognition of frailty are important to reduce healthcare expenditure among older adults.     

我国农村人群就医行为影响因素分析

目的：探讨我国农村人群就医行为影响因素之间的数量关系。方法：运用灰色关联分析法,对年我国农村人群就医行为影响因素进行定量分析。结果：与农村人群就医行为相关的4类因素中,疾病特征影响最为明显。结论：用灰色关联分析法分析我国农村人群就医行为影响因素结果可靠,简便易行。     

Ethnic Disparities in Self-Reported Oral Health Status and Access to Care among Older Adults in NYC

There is a growing burden of oral disease among older adults that is most significantly borne by minorities, the poor, and immigrants. Yet, national attention to oral heath disparities has focused almost exclusively on children, resulting in large gaps in our knowledge about the oral health risks of older adults and their access to care. The projected growth of the minority and immigrant elderly population as a proportion of older adults heightens the urgency of exploring and addressing factors associated with oral health-related disparities. In 2008, the New York City Health Indicators Project (HIP) conducted a survey of a representative sample of 1,870 adults over the age of 60 who attended a random selection of 56 senior centers in New York City. The survey included questions related to oral health status. This study used the HIP database to examine differences in self-reported dental status, dental care utilization, and dental insurance, by race/ethnicity, among community-dwelling older adults. Non-Hispanic White respondents reported better dental health, higher dental care utilization, and higher satisfaction with dental care compared to all other racial/ethnic groups. Among minority older adults, Chinese immigrants were more likely to report poor dental health, were less likely to report dental care utilization and dental insurance, and were less satisfied with their dental care compared to all other racial/ethnic groups. Language fluency was significantly related to access to dental care among Chinese immigrants. Among a diverse community-dwelling population of older adults in New York City, we found significant differences by race/ethnicity in factors related to oral health. Greater attention is needed in enhancing the cultural competency of providers, addressing gaps in oral health literacy, and reducing language barriers that impede access to care.     

Factors Influencing Dietary Intake Frequencies and Nutritional Risk among Community-Residing Older Adults

Abstract

Older adult (OA) dietary practices may be placing them at nutritional risk. This cross-sectional study examined the dietary intake frequencies (DIF) and nutritional risk (NR) using the Dietary Screening Tool (DST) of OA attending community-based nutrition education and physical activity programs. Most were white females aged 60–80 years. The majority (80.1%) were classified as “at NR” or “at possible NR.” Participants had “low” lean protein, dairy, and processed meat DIF and “moderate” whole fruit and juice, total and whole grains, vegetables and added fats, sugars, and sweets DIF. State influenced whole fruit and juice (p?≤?.001) and vegetable (p?=?.021) DIF, age influenced processed meat DIF (p?=?.001), and gender influenced NR (p?=?.006), vegetable (p?=?.022), and processed meat (p?=?.033) DIF. Results indicate that OA participating in lifestyle interventions are at NR. When developing future nutrition education programs, educators should consider sociodemographic factors to promote dairy and protein-rich foods to OA at NR.     

Dietary Patterns and Risk Factors of Frailty in Lebanese Older Adults

Factors associated with frailty, particularly dietary patterns, are not fully understood in Mediterranean countries. This study aimed to investigate the association of data-driven dietary patterns with frailty prevalence in older Lebanese adults. We conducted a cross-sectional national study that included 352 participants above 60 years of age. Sociodemographic and health-related data were collected. Food frequency questionnaires were used to elaborate dietary patterns via the K-mean cluster analysis method. Frailty that accounted for 15% of the sample was twice as much in women (20%) than men (10%). Identified dietary patterns included a Westernized-type dietary pattern (WDP), a high intake/Mediterranean-type dietary pattern (HI-MEDDP), and a moderate intake/Mediterranean-type dietary pattern (MOD-MEDDP). In the multivariate analysis, age, waist to height ratio, polypharmacy, age-related conditions, and WDP were independently associated with frailty. In comparison to MOD-MEDDP, and after adjusting for covariates, adopting a WDP was strongly associated with a higher frailty prevalence in men (OR = 6.63, 95% (CI) (1.82–24.21) and in women (OR = 11.54, 95% (CI) (2.02–65.85). In conclusion, MOD-MEDDP was associated with the least prevalence of frailty, and WDP had the strongest association with frailty in this sample. In the Mediterranean sample, a diet far from the traditional one appears as the key deleterious determinant of frailty.     

武汉市居民保健食品服用行为及影响因素分析

目的：分析消费者保健食品服用行为和影响因素,为居民理性消费保健食品提供参考依据。方法在武汉市6个区抽取1530名保健食品消费者进行保健食品服用状况的调查。结果在调查对象中,每天服用保健食品者占3.6%;服用不到3个月的占62.5%,能坚持1年及以上的仅占8.19%;仅服用1种保健食品的比例为53.9%;服用保健食品最主要的原因是为了“提高自身免疫力”(39.7%),其次是“补充营养元素”(38.2%)。影响保健食品服用的因素主要有年龄、是否相信保健食品的疗效、是否有必要了解保健食品知识、购买意愿和服用意愿。结论武汉市居民服用保健食品行为相对较为理性,保健食品消费要考虑居民的消费认知和消费意愿。     

Position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior: Food and Nutrition Programs for Community-Residing Older Adults

Given the increasing number and diversity of older adults and the transformation of health care services in the United States, it is the position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior that all older adults should have access to evidence-based food and nutrition programs that ensure the availability of safe and adequate food to promote optimal nutrition, health, functionality, and quality of life. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, in partnership with other practitioners and nutrition educators, should be actively involved in programs that provide coordinated services between the community and health care systems that include regular monitoring and evaluation of programming outcomes. The rapidly growing older population, increased demand for integrated continuous support systems, and rising cost of health care underscore the need for these programs. Programs must include food assistance and meal programs, nutritional screening and assessment, nutrition education, medical nutrition therapy, monitoring, evaluation, and documentation of evidence-based outcomes. Coordination with long-term care services and support systems is necessary to allow older adults to remain in their homes; improve or maintain their health and manage chronic disease; better navigate transitions of care; and reduce avoidable hospital, acute, or long-term care facility admissions. Funding of these programs requires evidence of their effectiveness, especially regarding health, functionality, and health care–related outcomes of interest to individuals, caregivers, payers, and policy makers. Targeting of food and nutrition programs involves addressing unmet needs for services, particularly among those at high risk for poor nutrition. Registered dietitian nutritionists and nutrition and dietetics technicians, registered must increase programmatic efforts to measure outcomes to evaluate community-based food and nutrition services.Position StatementIt is the position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior that older adults should have access to evidence-based food and nutrition programs that ensure the availability of safe and adequate food to promote optimal nutrition, health, functionality, and quality of life. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, in partnership with other practitioners and nutrition educators, should be actively involved in programs that provide coordinated services between the community and health care systems that include regular monitoring and evaluation of programming outcomes. The rapidly growing older population, increased demand for integrated continuous support systems, and rising cost of health care underscore the need for these programs.     

Social Factors of Dietary Risk Behavior in Older German Adults: Results of a Multivariable Analysis

With this analysis, we aimed to examine the associations between social factors and dietary risk behavior in older adults. Data were collected through a full-population postal survey of German adults aged 65 years or older (n = 1687, 33% response proportion, 52% female, mean age = 76 years). Using principal component analysis (PCA), a data-driven Dietary Risk Behavior Index (DRB) was computed. Dietary risk behavior was defined as consumption frequencies of vegetables/fruit, whole grains, and dairy products below national dietary recommendations. By performing a multiple linear regression, we analyzed associations between sociodemographic, socioeconomic, psychosocial, and behavioral factors and dietary risk behavior. Physical activity, female gender, socioeconomic status, social support, and age (in the male sample) were negatively associated with dietary risk behavior. Alcohol consumption and smoking were positively associated with dietary risk behavior. A group-specific analysis revealed a higher goodness-of-fit for the low socioeconomic status group, older adults aged 65–79 years, and women. A comprehensive understanding of the relationships between social factors and dietary risk behavior in older adults assists the group-specific targeting of dietary-related interventions. Demand-oriented dietary interventions should account for underlying social conditions to reduce inequity in dietary risk behavior among older adults. The results of this work may be transferable to municipalities in high-income European countries.     

Development and Validation of a Nomogram for Predicting the 6-Year Risk of Cognitive Impairment Among Chinese Older Adults

ObjectiveAlthough some people with mild cognitive impairment may not suffer from dementia lifelong, about 5% of them will progress to dementia within 1 year in community settings. However, a general tool for predicting the risk of cognitive impairment was not adequately studied among older adults.DesignProspective cohort study.SettingCommunity-living, older adults from 22 provinces in China.ParticipantsWe included 10,066 older adults aged 65 years and above (mean age, 83.2 ± 11.1 years), with normal cognition at baseline in the 2002–2008 cohort and 9354 older adults (mean age, 83.5 ± 10.8 years) in the 2008–2014 cohort of the Chinese Longitudinal Healthy Longevity Survey.MethodsWe measured cognitive function using the Chinese version of the Mini-Mental State Examination. Demographic, medical, and lifestyle information was used to develop the nomogram via a Lasso selection procedure using a Cox proportional hazards regression model. We validated the nomogram internally with 2000 bootstrap resamples and externally in a later cohort. The predictive accuracy and discriminative ability of the nomogram were measured by area-under-the-curves and calibration curves, respectively.ResultsEight factors were identified with which to construct the nomogram: age, baseline of the Mini-Mental State Examination, activities of daily living and instrumental activities of daily living score, chewing ability, visual function, history of stroke, watching TV or listening to the radio, and growing flowers or raising pets. The area-under-the-curves for internal and external validation were 0.891 and 0.867, respectively, for predicting incident cognitive impairment. The calibration curves showed good consistency between nomogram-based predictions and observations.Conclusions and ImplicationsThe nomogram-based prediction yielded consistent results in 2 separate large cohorts. This feasible prognostic nomogram constructed using readily ascertained information may assist public health practitioners or physicians to provide preventive interventions of cognitive impairment.     

Association between Dietary Patterns and Depression in Chinese Older Adults: A Longitudinal Study Based on CLHLS

(1) Objective: This study aimed to investigate the relationship between dietary patterns and depression in Chinese older adults. (2) Method: A cohort study was conducted on the relationship between dietary patterns and the risk of depression in older adults based on the China Health and Longevity Longitudinal Survey (CLHLS) from 2011 to 2014. Exploratory factor analysis was used to identify dietary patterns. The relationship between dietary patterns and the risk of depression after four years was examined using logistic regression, and subgroup analysis was carried out to determine whether the association differed by gender. (3) Results: A total of 2873 older adults were included in our cohort study. Three dietary patterns were identified: vegetable–egg–bean–milk pattern, meat–fish pattern, and salt-preserved vegetable–garlic pattern. The vegetable–egg–beans–milk pattern was negatively correlated with the risk of geriatric depression development (adjusted OR = 0.65 (95%CI: 0.49–0.87)), and the salt-preserved vegetable–garlic pattern was positively associated with aged depression risk (adjusted OR = 1.33 (95CI: 1.00–1.77)). The meat–fish pattern was not associated with the risk of depression in older adults. These associations were consistent in both men and women. (4) Conclusions: In this cohort study, the vegetable–egg–beans–milk dietary pattern was associated with lower risk of depression, while the salt-preserved vegetable–garlic dietary pattern was associated with higher risk of depression, and there were no gender differences in these associations.