Sakurako S. Okuzono’s research while affiliated with Massachusetts Department of Public Health and other places

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Publications (30)


Resilience in development: Neighborhood context, experiences of discrimination, and children's mental health
  • Article

August 2023

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32 Reads

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7 Citations

Development and Psychopathology

Sakurako S Okuzono

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Joseph Wilson

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An understanding of child psychopathology and resilience requires attention to the nested and interconnected systems and contexts that shape children's experiences and health outcomes. In this study, we draw on data from the National Survey of Children's Health, 2016 to 2021 (n = 182,375 children, ages 3- to 17 years) to examine associations between community social capital and neighborhood resources and children's internalizing and externalizing problems, and whether these associations were moderated by experiences of racial discrimination. Study outcomes were caregiver-report of current internalizing and externalizing problems. Using logistic regression models adjusted for sociodemographic characteristics of the child and household, higher levels of community social capital were associated with a lower risk of children's depression, anxiety, and behaviors. Notably, we observed similar associations between neighborhood resources and child mental health for depression only. In models stratified by the child's experience of racial/ethnic discrimination, the protective benefits of community social capital were specific to those children who did not experience racial discrimination. Our results illustrate heterogeneous associations between community social capital and children's mental health that differ based on interpersonal experiences of racial/ethnic discrimination, illustrating the importance of a multilevel framework to promote child wellbeing.


Sense of Coherence and Incident Dementia in Older Japanese Adults: The Japan Gerontological Evaluation Study

August 2023

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18 Reads

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2 Citations

Journal of the American Medical Directors Association

Jiaqi Li

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Kokoro Shirai

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Sakurako S. Okuzono

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[...]

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Hiroyasu Iso

Objectives: The sense of coherence refers to effectively using available resources to manage stress and promote overall health. Previous studies have linked it to various health outcomes; however, evidence regarding its association with the risk of incident dementia is limited. Hence, this study aimed to fill this research gap using data from a large-scale population survey. Design: Prospective cohort study. Setting and participants: This study included 31,556 participants aged 65 years and older who were free from dementia and disabilities. The participants were enrolled in the 2010 baseline survey of the XXXX, and were followed up until the end of 2019. Methods: The sense of coherence was assessed using a 6-item short-version questionnaire. Incident dementia cases were ascertained through the public long-term care insurance database in Japan. Results: During a median follow-up of 8.3 years, 4326 incident dementia cases were identified. After adjusting for conventional risk factors, the hazard ratios (95% CIs) for each quintile compared to the lowest quintile of the sense of coherence were 0.82 (0.75-0.90), 0.75 (0.68-0.83), 0.76 (0.68-0.84), and 0.78 (0.70-0.87), respectively. The multivariable hazard ratio (95% CI) per 1-SD increment was 0.91 (0.88-0.95). These inverse associations did not exhibit any gender differences (P for gender interaction = .11) and were further confirmed after excluding early incident cases. Similar associations were found for its components; the corresponding multivariable hazard ratios (95% CIs) per 1-SD increment were 0.94 (0.91-0.97) for comprehensibility, 0.92 (0.89-0.95) for manageability, and 0.93 (0.90-0.97) for meaningfulness. Conclusions and implications: Moderate and above sense of coherence was associated with the lower risk of dementia among the older population, suggesting a beneficial role of stress management in maintaining the cognitive health of older adults.


Pre-disaster Characteristics of Analytic Samples in 2010, Iwanuma, Miyagi, Japan, 2010-2016 (n = 602) a .
Do Adverse Childhood Experiences Modify the Association Between Disaster-Related Trauma and Cognitive Disability?
  • Article
  • Full-text available

July 2023

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39 Reads

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5 Citations

American Journal of Epidemiology

Background: Identifying subpopulations that are particularly vulnerable to long-term adverse health consequences of disaster-related trauma is needed. We examined whether child adversities (ACEs) potentiate the association between disaster-related trauma and subsequent cognitive disability among older adult disaster survivors. Methods: Data were from a prospective cohort study of older adults who survived the 2011 Great East Japan Earthquake. The baseline survey predated the disaster by 7 months. We included participants who completed follow-up surveys (2013 and 2016) and did not have a cognitive disability before the disaster (n=602). Disaster-related traumas (i.e., home loss, loss of friends, or pets) and ACEs were retrospectively assessed in 2013. Cognitive disability levels in 2016 were objectively assessed. Results: After adjusting for pre-disaster characteristics using a machine learning-based estimation approach, home loss (0.19, 95%CI=0.09, 0.28) was, on average, associated with greater cognitive disability. Among individuals with ACEs, home loss was associated with even higher cognitive disability levels (0.64, 95%CI=0.24, 1.03). Loss of friends (0.18, 95%CI=0.05, -.32) and pets (0.13, 95%CI=0.02, 0.25) were associated with higher cognitive disability levels only among those with ACEs. Conclusion: Our findings suggest that individuals with a history of ACEs may be particularly vulnerable to adverse health consequences of specific disaster related.

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Kaplan–Meier survival curves for participants in the Jackson Heart Study 2001–2018, stratified by level of social integration
Social integration and risk of mortality among African-Americans: the Jackson heart study

May 2023

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73 Reads

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2 Citations

Social Psychiatry and Psychiatric Epidemiology

Objective Evidence suggests that greater social integration is related to lower mortality rates. However, studies among African-Americans are limited. We examined whether higher social integration was associated with lower mortality in 5306 African-Americans from the Jackson Heart Study, who completed the Berkman-Syme Social Network Index in 2000–2004 and were followed until 2018. Methods We estimated hazard ratios (HR) of mortality by categories of the Social Network Index (i.e., high social isolation, moderate social isolation [reference group], moderate social integration, high social integration) using Cox proportional hazard models. Covariates included baseline sociodemographics, depressive symptoms, health conditions, and health behaviors. Results Compared with moderate isolation, moderate integration was associated with an 11% lower mortality rate (HR = 0.89, 95% confidence interval [CI] 0.77, 1.03), and high integration was associated with a 25% lower mortality rate (HR = 0.75, 95% CI 0.64, 0.87), controlling for sociodemographics and depressive symptoms; compared with moderate isolation, high isolation was related to a 34% higher mortality rate (HR = 1.34, 95% CI 1.00, 1.79). Further adjustment of potential mediators (health conditions and health behaviors) only slightly attenuated HRs (e.g., HRmoderate integration = 0.90, 95% CI 0.78, 1.05; HRhigh integration = 0.77, 95% CI 0.66, 0.89). Conclusion Social integration may be a psychosocial health asset with future work needed to identify biobehavioral processes underlying observed associations with mortality among African-Americans.


Bidirectional associations between posttraumatic stress symptoms and sleep quality among older survivors of the 2011 Great East Japan Earthquake and Tsunami

April 2023

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16 Reads

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2 Citations

Sleep

Study objectives: We sought to examine the bidirectional associations between posttraumatic stress symptoms (PTSS) and sleep quality in a sample of older disaster survivors. Methods: We used 4 waves (2010, 2013, 2016 & 2020) of the Iwanuma Study, which included pre-disaster information and 9-years of follow-up data among older survivors of the 2011 Great East Japan Earthquake and Tsunami. Poisson regression analysis was used to examine the bidirectional associations between sleep problems and PTSS. Results: Individuals reporting sleep problems before the disaster were more likely to develop PTSS after exposure to disaster trauma, while there was no effect modification, i.e., prevalence ratio for sleep problems did not differ by the magnitude of disaster damages. Individuals reporting sleep problems after the disaster were less likely to recover from PTSS, and more likely to develop delayed onset of PTSS five years after the disaster. While individuals who recovered from PTSS nine years after the disaster were still at slightly higher risk of having sleep problems compared to those who never had PTSS, none of the sleeping problems were found to be significantly prevalent after Bonferroni correction. Conclusions: Pre-disaster sleep problems predicted PTSS onset independently of experiences of disaster trauma. The association between PTSS and sleep problems was bidirectional. Intervening to mitigate lingering sleep problems may benefit the recovery of disaster survivors from post-traumatic symptoms.


Parent-child separation and cardiometabolic outcomes and risk factors in adulthood: A systematic review

March 2023

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52 Reads

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6 Citations

Psychoneuroendocrinology

Background: Parent-child separation has been associated with negative mental health across childhood and adulthood, yet little is known about the long-term impacts for cardiovascular health. This systematic review synthesized and evaluated the quality of the literature examining the association between exposures to parent-child separation and cardiometabolic outcomes in adulthood. Methods: Following a registered protocol, online databases (Pubmed, PsycInfo, and Web of Science) were searched for relevant studies. Studies were included if they (a) defined the exposure before age 18 as institutionalization, foster care placement, parental incarceration, separation due to parents migrating for economic reasons, or asylum and war; and (b) quantified the association between parent-child separation and cardiometabolic events and diagnoses (e.g., coronary heart disease, diabetes) and risk factors (e.g., body mass index, fat distribution, serum-based metabolic markers, inflammatory markers in adulthood (≥ age 18). Studies lacking an unexposed comparison group were excluded. The risk for bias in each study was assessed with a modified Newcastle-Ottawa Scale. Results: Of the 1938 studies identified, 13 met our inclusion criteria. Two of the four studies examining associations between parent-child separation and cardiometabolic events and diagnoses found positive associations with coronary heart disease and diabetes. Amongst the 13 studies examining associations with any type of adult cardiometabolic risk factors, eight studies reported at least one positive association. Sub-analyses considering separate reasons for parent-child separation provided clearer insights: War evacuation was associated with hypertension and high blood pressure across four studies from the same cohort; out-of home care experiences largely evidenced null results across five different studies, and two studies on parental incarceration suggested positive associations with elevated inflammation, BMI and blood pressure. Conclusions: The connections between parent-child separation and adult cardiometabolic outcomes and risk factors are currently inconsistent. The results may depend on the reason for separation, age of assessment, analytic differences and other psychosocial variables that are often unmeasured in this literature.


Residential instability during adolescence and health and wellbeing in adulthood: A longitudinal outcome-wide study

March 2023

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58 Reads

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3 Citations

Health & Place

Although prior research suggests that residential instability during adolescence can have long-term impacts on health and wellbeing, few studies have identified a robust comparison group and considered a broad set of outcomes. To address these knowledge gaps, we examined the associations between residential instability during adolescence and a wide range of adult health and wellbeing outcomes using an outcome-wide design in the National Longitudinal Study of Adolescent to Adult Health. We defined residential instability as two or more moves between Waves I and II (ages 13-18 years). We assessed outcomes at ages 33-43 years (Wave V) in nine domains: biomarkers, physical health, health behaviors, psychological distress, psychological wellbeing, social behaviors, social wellbeing, trauma/victimization, and socioeconomic attainment. Results of doubly-robust targeted maximum likelihood estimation, adjusting for pre-exposure values of the outcome variables and cofounders (Wave I), showed little evidence of an association for certain outcomes, all of which disappeared after accounting for multiple comparisons. Our results suggest that residential instability in adolescence does not lead to worse health and wellbeing in adulthood, but rather, outcome differences between groups are due to pre-existing differences prior to residential instability in adolescence.


Post-Disaster Mental Health and Dietary Patterns among Older Survivors of an Earthquake and Tsunami

February 2023

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32 Reads

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6 Citations

The Journal of Nutrition Health and Aging

Objectives Research suggests that cardiometabolic disease risks are elevated among survivors of natural disasters, possibly mediated by changes in diet. Using the Brief Dietary History Questionnaire, we examined (1) dietary patterns among older survivors of the 2011 Great East Japan Earthquake and Tsunami, and (2) the contribution of posttraumatic stress symptoms (PTSS)/depressive symptoms, as well as relocation to temporary housing on dietary patterns and (3) gender differences in the associations.Design, Setting and ParticipantsData came from a prospective cohort study of 1,375 survivors aged 65–89 years (44.6% male).MeasurementsPTSS/depression onset was evaluated in 2013, 2.5 years after the disaster. Dietary data was collected with a self-administered brief-type diet history questionnaire in 2020. A principal component analysis identified three posterior dietary patterns.ResultsDiet 1 consisted of high intake of vegetables, soy products, and fruits; Diet 2 consisted of carbohydrate-rich foods and snacks/sweets; Diet 3 consisted of high intake of alcoholic beverages, meat, and seafood. Least-squares linear regression revealed that individuals with PTSS/depression were less likely to exhibit Diet 1, while individuals with PTSS were more likely to exhibit Diet 2&3. Especially, males who had depression showed an unhealthy dietary pattern. Those who have lived in a trailer-style temporary housing reported less consumption of Diet 3.Conclusion Survivors of disaster with symptoms of mental illness tended to exhibit less healthy dietary patterns after 9 years. Diet varied by type of post-disaster mental illness, gender, and current social circumstances. We lacked pre-disaster BDHQ data, which is a limitation.


ASSOCIATIONS BETWEEN CUMULATIVE STRESS AND COGNITIVE FUNCTION IN HRS AND ELSA

December 2022

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29 Reads

Innovation in Aging

Despite growing research linking stressors with poorer cognition, less research explicitly considers stress from several sources, which often co-occurs and accumulate to influence health. We used the Global Gateway Harmonized data (HRS: n=8,888; mean age: 74 years; ELSA: n=6,715; mean age: 65 years) to examine whether higher cumulative stress is associated with lower levels of and faster decline in cognitive function. We fit linear mixed effect models to assess the stress-cognition associations. After adjusting for all covariates, baseline cumulative stress was associated with lower baseline cognitive function in both HRS (β=-0.02, 95%CI -0.04, -0.01) and ELSA (β=-0.03, 95%CI -0.05, -0.01). Unexpectedly, higher baseline cumulative stress was associated with slower cognitive decline in HRS (βtime*stress=0.001, 95%CI 0.002,0.01) but not in ELSA. The stress-cognition associations may differ among adults in the US and the UK. Future research should investigate how cumulative stress may operate differently to influence cognitive function across different populations.


The social determinants of ideal cardiovascular health: A global systematic review

October 2022

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37 Reads

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15 Citations

Annals of Epidemiology

This systematic review synthesizes research published from January 2010-July 2022 on the social determinants of ideal cardiovascular health (CVH) carried out around the world and compares trends in high-income countries (HICs) to those in low- and middle-income countries (LMICs). 41 studies met inclusion criteria (n=28 HICs, n=13 LMICs). Most were from the United States (n=22) and cross-sectional (n=33), and nearly all evaluated associations among adults. Among studies conducted in LMICs, all were from middle-income countries and none were carried out in low-income countries. Education (n=24) and income/wealth (n=17) were the most frequently examined social determinants in both HICs and LMICs. Although most studies assessed ideal CVH using reliable and valid methods (n=24), only 7 used criteria pre-defined by the American Heart Association to characterize ideal levels of each CVH metric. Despite heterogeneity in how outcome measures were derived and analyzed, consistent associations were evident between multiple markers of higher social status (i.e., greater education, income/wealth, socioeconomic status, racial/ethnic majority status) and greater levels of ideal CVH across both country contexts. Gaps in the literature include evidence from LMICs and HICs other than the United States, longitudinal research, and investigations of a wider array of social determinants beyond education and income/wealth.


Citations (21)


... Psychological and social factors play a significant role in the varying prevalence of insomnia during pregnancy, with psychological factors often being linked to some social factors. Pan Chen and Eric S Kim suggest that enhancing overall well-being can be an effective way to alleviate negative psychological symptoms (77,78). Therefore, enhancing the focus on women during pregnancy is crucial for safeguarding their health (79). ...

Reference:

Evaluating the global prevalence of insomnia during pregnancy through standardized questionnaires and diagnostic criteria: a systematic review and meta-analysis
Connected communities: Perceived neighborhood social cohesion during adolescence and subsequent health and well-being in young adulthood-An outcome-wide longitudinal approach
  • Citing Article
  • July 2024

Journal of Community Psychology

... One study did not find a significant relationship between overall COI scores and anxiety and depression scores in a sample of adolescents aged 13-16 years old [37]. Another study using the Adolescent Brain Cognitive Development (ABCD) Study sample at baseline (youths aged 9-10) examined both the Area Deprivation Index (ADI) quintiles and the COI quintiles to examine relations with Child Behavior Checklist (CBCL) scores [38]. Greater neighborhood resources were associated with fewer externalizing symptoms, but adjusting for child-and family-level factors rendered the association between the COI and externalizing nonsignificant. ...

Comparing two measures of neighborhood quality and internalizing and externalizing behaviors in the adolescent brain cognitive development study

Social Psychiatry and Psychiatric Epidemiology

... Disasters occur in Indonesia, both natural and non-natural disasters (Bachri et al., 2024;Danar, 2024;Herbanu et al., 2024;Lumban-Gaol et al., 2024;Niman et al., 2024;Oktora, 2024;Opabola & Galasso, 2024;Setiawan & Mahendra, 2024;Setyonugroho & Maki, 2024). Disaster nutrition is an interesting topic of current issues to develop (Aslam, 2024;Fatmah, 2024;Lassa, 2024;Le, 2024;Marzban, 2024;Yazawa, 2024). Given the importance of disaster mitigation, preventive measures such as disaster training are a necessity. ...

Association of disaster-related damage with inflammatory diet among older survivors of the Great East Japan Earthquake and Tsunami
  • Citing Article
  • January 2024

The British journal of nutrition

... 6 The most cited study relevant to the scale of climate anxiety in the South is subtitled a 'global survey'. 7 This project recruited 15 543 young people (aged [16][17][18][19][20][21][22][23][24][25], of whom results were reported for 10,000. Participants were from 10 nations, including four in the South (Brazil, India, Nigeria and the Philippines). ...

A systematic review of the effects of chronic, slow-onset climate change on mental health
  • Citing Article
  • January 2024

Nature Mental Health

... Previous studies have conceptualized regulatory flexibility as the amount of the numerical variability observed in the frequency use of distinct strategies (Cheng et al., 2014;Blanke et al., 2020). For instance, using a standard deviation-based algorithm , 2024bBlanke et al., 2020), lower variability (displaying high evenness in scores across strategies) suggests all strategies are used at a fairly equal frequency across situations, greater variability (displaying high unevenness in scores across strategies) suggests only a few strategies are frequently used, and moderate variability (displaying moderate unevenness in scores across strategies) suggests several strategies are used with varied frequencies and possibly reflects an effort to find the best strategy for each situation. Emerging research shows the predictive value of such variability in long-term health outcomes, such as longevity , 2024b. ...

A long and resilient life: the role of coping strategies and variability in their use in lifespan among women
  • Citing Article
  • November 2023

Anxiety, Stress, and Coping

... AI/AN families living in cities that border tribal reservations may experience this to a greater extent, as the residents from the dominant cultural group may have closer historical and political relations with the nearby tribe, and greater access to stereotypes about American Indian or Indigenous peoples [66]. Lack of community belonging, prejudice, and discrimination are related to poor child mental health and lower academic achievement for adolescents and young adults in both AI/AN reservation communities and other minoritized communities [67][68][69], with some evidence of negative impacts on EF and related skills [70,71]. Parent's experiences of racial discrimination can also manifest as vicarious racism and have been shown to impact their children's mental health and cognitive development [72]. ...

Resilience in development: Neighborhood context, experiences of discrimination, and children's mental health
  • Citing Article
  • August 2023

Development and Psychopathology

... Symptoms of anxiety and depression were measured by the 7-item Generalized Anxiety Disorder Scale (GAD-7) [29], and the 9-item Patient Health Questionnaire-9 (PHQ-9) [30], respectively, with a cut-off point for caseness of ≥ 5. In a sub-analyses for assessing the risks associated with varying degrees of anxiety and depression, we re-classified the GAD-7 and PHQ-9 scores into three categories: normal (0-4), mild (5)(6)(7)(8)(9), and moderate to severe (≥ 10). In line with our previous work [23], stress-related disorder was defined as experiencing a probable acute stress disorder (i.e., a dissociation cluster score of ≥ 9 and a total score ≥ 28 encompassing reexperiencing, avoidance, and arousal clusters, measured by the 19-item Acute Stress Disorder Scale [31]) at recruitment and/or probable posttraumatic stress disorder (PTSD, endorsing at least moderate levels for 1 intrusion symptom, 1 avoidance symptom, 2 negative alterations in cognitions and mood, and hyperarousal symptoms, according to the 20-item Posttraumatic Stress Disorder Checklist for DSM-5 ), at any follow-up. ...

Do Adverse Childhood Experiences Modify the Association Between Disaster-Related Trauma and Cognitive Disability?

American Journal of Epidemiology

... And our results manifest that migrant owners were associated with poorer self-rated health compared with migrant renters, which is consistent with previous literature (Jia et al., 2023;Zhou & Guo, 2023b). Also, in line with past literature Lee et al., 2023), social integration could improve health status. As hypothesized (H1), our results demonstrated that the association between housing tenure and self-rated health was partly mediated by social integration after adjustment for sociodemographic and socioeconomic factors. ...

Social integration and risk of mortality among African-Americans: the Jackson heart study

Social Psychiatry and Psychiatric Epidemiology

... Post-disaster sleep problems are thought to interfere with the brain's ability to process memories and emotions, potentially slowing the recovery process for individuals suffering from PTSD. Many PTSD patients use alcohol and other substances to cope with sleep disturbances, which can negatively affect both sleep and PTSD symptoms [10,26]. Additionally, the environmental and social problems resulting from earthquakes, such as the destruction of homes, hospitals, and schools, the challenges of survival in temporary shelters, and ongoing aftershocks in the area, are believed to have a more severe impact on PTSD and sleep hygiene in this population compared to other populations who are experiencing traumatic events. ...

Bidirectional associations between posttraumatic stress symptoms and sleep quality among older survivors of the 2011 Great East Japan Earthquake and Tsunami
  • Citing Article
  • April 2023

Sleep

... For instance, emerging evidence examines long-term consequences of parent-child separation, a common type of ACE, on cardiovascular health in adults. 37 Fourth, because of the cross-sectional design, the study cannot support causality between ACEs and sleep duration. Finally, although not inherently a limitation of our study, it is important to note that the NSCH data we used did not have participants falling into all of the sleep duration categories (none aligned with scores of 70 or 90). ...

Parent-child separation and cardiometabolic outcomes and risk factors in adulthood: A systematic review
  • Citing Article
  • March 2023

Psychoneuroendocrinology