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Tiet Hanh Dao Tran Thesis STRESSFUL LIFE EVENTS, MODIFIABLE LIFESTYLE FACTORS, DEPRESSIVE SYMPTOMS, HEALTH-RELATED QUALITY OF LIFE, AND CHRONIC DISEASE AMONG OLDER WOMEN IN VIETNAM AND AUSTRALIA: A CROSS-CULTURAL COMPARISON Dao Tran Tiet Hanh BNS, BA, MNS, MAppSc. (research) Prof. Helen Edwards Dr. Charrlotte Seib Prof. Debra Anderson Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy School of Nursing Faculty of Health Queensland University of Technology 2017 Keywords Australia Chronic disease: Hypertension, Coronary heart disease, Type 2 diabetes, Stroke, Arthritis, Osteoporosis, Breast cancer, Depression Cross-cultural comparison Depressive symptoms Diet: Vegetable consumption, fruit consumption Exercise Health-related quality of life Mental health Modifiable lifestyle factors: Vegetable and fruit consumption, smoking, alcohol and caffeine drinking, physical activity level, exercise, body max index Older women Perceived stress Physical activity Physical health Sleeping disturbance Social support Stressful life events Structural Equation Modelling Vietnam i Abstract There has been a dramatic increase in the number of older people all over the world. Older people usually experience lower health-related quality of life (HRQOL), and an increased number of chronic conditions than those in younger age groups. Among older people, women appear to be more vulnerable to stress, to have different lifestyles, lower HRQOL and higher risk for certain chronic conditions than men. These areas need more concern in healthcare. Exposure to stressful life events (SLEs) contributes to changes in lifestyle, to the development of depressive symptoms, and consequently to decreased health. This pattern has been investigated in several populations, including older Australian women, but few studies have modelled the impact of SLEs on health. Vietnamese older women have different culture, historical and socio-economic changes than Australian women, and this may influence their lifestyle and health. Knowledge about their SLEs, social support, modifiable lifestyle factors, depressive symptoms, HRQOL, and chronic disease is still unclear. This research investigated SLEs, perceived stress, social support, modifiable lifestyle factors, depressive symptoms, HRQOL, and chronic diseases as experienced by older women in Vietnam. The research also explored the impact of SLEs on modifiable lifestyle factors, depressive symptoms, HRQOL, and chronic diseases and the role of perceived stress and social support on the relationship between SLEs and health among older women in Vietnam. Finally, the research compared findings about SLEs, modifiable lifestyle factors, depressive symptoms, HRQOL, and chronic disease from the Vietnamese dataset with those from an Australian dataset. This research included three studies: (1) A pilot study, which developed the Vietnamese versions of the research instruments and tested their translation ii equivalence and psychometric properties on Vietnamese older women (n=33); (2) A cross-sectional study, which investigated SLEs, perceived stress, social support, modifiable lifestyle factors, depressive symptoms, HRQOL, and chronic disease among older women in Vietnam (n=440); and (3) A cross-cultural comparison study of SLEs, modifiable lifestyle, depressive symptoms, HRQOL, and chronic disease among older women in Vietnam and Australia (n=624). This research found that the Vietnamese and Australian older women were exposed to SLEs differently. Compared to the Australians, the Vietnamese reported lower likelihood of healthy eating, consuming alcohol and caffeine, smoking tobacco and exercise. However, Vietnamese reported more sleep problems, major depressive symptoms, lower physical health, and more chronic conditions. The prevalence of stroke, T2DM, arthritis, and osteoporosis among the Vietnamese were similar to those among the Australians. However, the Vietnamese older women were more likely to have high blood pressure and coronary heart disease, but less likely to have obesity and breast cancer than those in Australia. This research also found that exposure to SLEs could influence health, especially mental health, through several pathways. The patterns by which SLEs influenced health were different for the older women in Vietnam and Australia. Perceived stress had stronger influences on health than SLEs. Perceived stress also mediated the impact of the SLEs on diet habits, sleep disturbance, depressive symptoms, and mental health. Social support reduced impact of SLEs on perceived stress, depression and mental health. Despite the limitations, findings from this research highlighted the importance of interventions to manage stress and promote healthy lifestyle and health, and to support chronic disease management for healthier ageing among older women. The iii implications gained from this research can be useful for other Asian and Western countries that have similar characteristics to the study research populations. iv Related publications, presentations, awards, and certificates PEER-REVIEWED JOURNAL PAPERS Seib, C., Whiteside, E., Lee, K., Humphreys, J., Dao Tran, T. H., Chopin, L., & Anderson, D. (2014). Stress, lifestyle, and quality of life in midlife and older Australian women: Results from the Stress and the Health of Women Study. Women's Health Issues, 24(1), e43-52. doi:10.1016/j.whi.2013.11.004 Dao-Tran, T.-H., Anderson, D., & Seib, C. (2017). The Vietnamese version of the Perceived Stress Scale (PSS-10): Translation equivalence and psychometric properties among older women. BMC Psychiatry, 17, 53. doi.org/10.1186/s12888- 017-1221-6 Dao Tran, T.H., Anderson, D., Seib, C. (2016) How do stressful life events impact on modifiable lifestyle, depressive symptoms, physical and mental health among Vietnamese older women? BMC Psychiatry, under review Dao Tran, T.H., Anderson, D., Lee, J., Seib, C. (2017) Personal characteristics, lifestyles, chronic diseases and health-related quality of life of Vietnamese older women. BMC Women’s health, under review Dao Tran, T.H., Seib, C. (2016) Prevalence and correlates of sleep disturbance among Vietnamese older women. Journal of Clinical Nursing, under review CONFERENCE PRESENTATIONS Dao Tran, T.-H., Seib, C. & Anderson, D., (2015). Stressful life events and health among elderly women in Vietnam. Oral presentation at The Aging & Society: v The Fifth Interdisciplinary Conference, Washington D.C., USA from November 5 to 6, 2015. Dao Tran, T.-H., Anderson, D., & Seib, C. (2016). The impact of stressful life events on modifiable lifestyle factors, depressive symptoms, and general health among Vietnamese older women. Oral presentation at Faculty of Health Three Minute Thesis (3MT) Competition 23/8/2016. Dao Tran, T.H., Nguyen, P., Seib, C. (2016) Prevalence and correlates of depression among Vietnamese older women. Oral presentation at Hội nghị khoa học kỹ thuật thường niên lần thứ 33 năm 2016, HCMC, Vietnam, 28/10/2016. Published in Tạp chí hội nghị khoa học kỹ thuật thường niên lần thứ 33 năm 2016, HCMC, Vietnam Dao Tran, T.-H., Anderson, D., & Seib, C. (2016). Sleeping disturbance among older women in Vietnam: Results from the Vietnamese Women’s Wellness Research Program. Oral presentation at the 21st International Council on Women’s Health Issues (ICOWHI) Congress, in Baltimore, Maryland, USA, from November 6 to 9, 2016. AWARDS 1-3/2017 Write-up scholarship award awarded by Queensland University of Technology for writing publiscation 9/2015 Queensland University of Technology Grant-in-Aid (Travel Grant), providing $2000 AUD to travel for overseas conference presentation. 8/2015 Graduate Scholar Awards awarded by “The Aging & Society: The Fifth Interdisciplinary Conference, Washington D.C, USA,” vi providing a conference fee waiver, an opportunity to chair the conference parallel sessions, and to provide technical assistance in the sessions, besides presenting my own research paper. 2013-2016 Queensland University of Technology Postgraduate Research Award (QUTPRA), providing tuition fee waiver, and living allowance for PhD study in the School of Nursing, Queensland University of Technology, Brisbane, Australia. CERTIFICATES Certificate of completion of the Sessional Career Advancement Development (SCAD) Program (17-24/3/2015) from QUT Human Resources Department Certificate of completion of the “Leadership and Communication” course (5/2015) from ANT LEAP–Learning employment aptitudes program Certificate of completion of the “Project Management” course (5/2015) from ANT LEAP–Learning employment aptitudes program Certificate of completion of Teaching Advantage Program (11/2016) from QUT Learning and Teaching vii Table of Contents Keywords .......................................................................................................................................... i Abstract ............................................................................................................................................ ii Related publications, presentations, awards, and certificates .............................................................. v Table of Contents........................................................................................................................... viii List of Figures ................................................................................................................................. xi List of Tables .................................................................................................................................
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