{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T08:07:52Z","timestamp":1784275672389,"version":"3.55.0"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>The Hajj pilgrimage demands optimal physical and psychological readiness because of various factors, such as the physical health conditions that could influence the stress experienced during the pilgrimage. This study\u2019s aim was to analyze the association between comorbidity status and stress levels in Hajj pilgrims.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MATERIALS AND METHODS:<\/jats:title>\n                    <jats:p>A cross-sectional study was conducted among 5362 prospective Hajj pilgrims from North Sumatra Province for the 2024 Hajj season. Stress levels were measured using the Perceived Stress Scale-10 and categorized as mild stress or moderate-to-severe stress. Data on comorbidity and respondent characteristics were collected using a structured questionnaire. Bivariate analysis was performed using the Chi-square test, while multivariate analysis employed binary logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      The prevalence of moderate-to-severe stress was higher in pilgrims with comorbidities. Multivariate analysis revealed that having one comorbidity (odds ratio (OR) =1.29; 95% confidence interval (CI): 1.06\u20131.56) and two or more comorbidities (OR = 1.33; 95% CI: 1.04\u20131.71) was significantly associated with increased risk of stress. Of specific comorbidities, digestive disorders showed a trend toward increased stress risk (OR = 1.23; 95% CI: 0.97\u20131.56;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.1). Ages 40\u201359 years and \u226560 years, as well as higher education, were associated with increased stress risk, while being married and engagement in moderate physical activity showed protective effect.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>Comorbidity status, in terms of both the number and type of comorbidities, is independently associated with increased stress risk in Hajj pilgrims. Health promotion programs should integrate a biopsychosocial approach paying particular attention to pilgrims with comorbid conditions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jfcm.jfcm_145_26","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T08:00:09Z","timestamp":1784275209000},"page":"180-187","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Comorbidity status and stress levels during the 2024 Hajj season: A Logistic regression analysis of Hajj pilgrims in North Sumatra"],"prefix":"10.4103","volume":"33","author":[{"given":"Rustika","family":"Rustika","sequence":"first","affiliation":[{"name":"Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzy","family":"Indharty","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasnida","family":"Hasnida","sequence":"additional","affiliation":[{"name":"Department of Psychology, Faculty of Psychology, University of Sumatera Utara, Medan, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desvi Y.","family":"Mukhtar","sequence":"additional","affiliation":[{"name":"Department of Psychology, Faculty of Psychology, University of Sumatera Utara, Medan, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora V.","family":"Nasution","sequence":"additional","affiliation":[{"name":"Provincial Health Office of North Sumatra, Medan, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elman","family":"Boy","sequence":"additional","affiliation":[{"name":"Department of Family Medicine and Primary Care Specialization, Faculty of Medicine and Health Sciences, Muhammadiyah University of North Sumatra, Medan, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ristrini","family":"Ristrini","sequence":"additional","affiliation":[{"name":"Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joko","family":"Irianto","sequence":"additional","affiliation":[{"name":"Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane K.","family":"Propiona","sequence":"additional","affiliation":[{"name":"Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iin","family":"Nurlinawati","sequence":"additional","affiliation":[{"name":"Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wahyu P.","family":"Nugraheni","sequence":"additional","affiliation":[{"name":"Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad R.","family":"Akbar","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Sumedang, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asep","family":"Kusnali","sequence":"additional","affiliation":[{"name":"Research Center for Public Health and Nutrition, National Research and Innovation Agency, Bogor, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"key":"R1-20260717","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.47197\/retos.v67.114961","article-title":"Physical fitness of prospective pilgrims: Hajj and Umrah gymnastics","volume":"67","author":"Ihsan","year":"2025","journal-title":"Retos"},{"key":"R2-20260717","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1007\/s10389-019-01110-3","article-title":"Prevalence of psychiatric disorders in Hajj pilgrims using MINI as a diagnostic tool","volume":"29","author":"Alzahrani","year":"2021","journal-title":"J Public Health"},{"key":"R3-20260717","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/13674676.2024.2374353","article-title":"The relationship between mindfulness and religious faith: Validation of the Mindfulness during Worship Scale (MWS) in a British Muslim sample","author":"Yousaf","year":"2025","journal-title":"Ment Health Relig Cult"},{"key":"R4-20260717","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1186\/s12877-025-06690-2","article-title":"Cognitive impairment among older adults\u2019 pilgrims during Hajj: A cross-sectional study of prevalence and associated factors","volume":"25","author":"Alkhotani","year":"2025","journal-title":"BMC Geriatr"},{"key":"R5-20260717","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3390\/rel12010036","article-title":"After hajj: Muslim pilgrims refashioning themselves","volume":"12","author":"Al-Ajarma","year":"2021","journal-title":"Religions"},{"key":"R6-20260717","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3390\/ijerph22101472","article-title":"Knowledge of health services access among hajj pilgrims in Saudi Arabia during the 1445 H (2024 G) season and its associated demographic and health-related factors","volume":"22","author":"Alsaleh","year":"2025","journal-title":"Int J Environ Res Public Health"},{"key":"R7-20260717","first-page":"1","article-title":"Religious tourists\u2019 satisfaction with services and their impacts on spirituality in the post-COVID-19 Era","volume":"14","author":"Hassan","year":"2022","journal-title":"Sustain"},{"key":"R8-20260717","doi-asserted-by":"crossref","first-page":"263","DOI":"10.2991\/jegh.k.200411.001","article-title":"An evaluation of health policy implementation for hajj pilgrims in Indonesia","volume":"10","author":"Rustika","year":"2020","journal-title":"J Epidemiol Glob Health"},{"key":"R9-20260717","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1126\/science.847460","article-title":"The need for a new medical model: A challenge for biomedicine","volume":"196","author":"Engel","year":"1977","journal-title":"Science"},{"key":"R10-20260717","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.mad.2024.111956","article-title":"Exploring the interplay between stress mediators and skin microbiota in shaping age-related hallmarks: A review","volume":"220","author":"Duarte","year":"2024","journal-title":"Mech Ageing Dev"},{"key":"R11-20260717","doi-asserted-by":"crossref","first-page":"1901","DOI":"10.1111\/1467-9566.13816","article-title":"Chronic illness as cultural disruption: The impact of chronic illness on religious and cultural practice","volume":"46","author":"Cluley","year":"2024","journal-title":"Sociol Health Illn"},{"key":"R12-20260717","doi-asserted-by":"crossref","first-page":"385","DOI":"10.2307\/2136404","article-title":"A global measure of perceived stress","volume":"24","author":"Cohen","year":"1983","journal-title":"J Health Soc Behav"},{"key":"R13-20260717","doi-asserted-by":"crossref","first-page":"166","DOI":"10.4103\/bjoa.bjoa_251_20","article-title":"Effectiveness of mindfulness-based intervention technique in reducing stress levels of anesthesiology and intensive therapy residents","volume":"5","author":"Sugiharto","year":"2021","journal-title":"Bali J Anesthesiol"},{"key":"R14-20260717","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1258\/mi.2008.008021","article-title":"Stress, health and ageing: A focus on postmenopausal women","volume":"14","author":"Wolf","year":"2008","journal-title":"Menopause Int"},{"key":"R15-20260717","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3390\/jcm14217775","article-title":"Prevalence and predictors of falls among younger and older adult pilgrims during the hajj mass gathering: An age-stratified cross-sectional study","volume":"14","author":"Alhasan","year":"2025","journal-title":"J Clin Med"},{"key":"R16-20260717","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1177\/109019817400200407","article-title":"The health belief model and sick role behavior","volume":"2","author":"Becker","year":"1974","journal-title":"Health Educ Monogr"},{"key":"R17-20260717","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1097\/00006842-197609000-00003","article-title":"Presidential address-1976. Social support as a moderator of life stress","volume":"38","author":"Cobb","year":"1976","journal-title":"Psychosom Med"},{"key":"R19-20260717","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1177\/1359105317691589","article-title":"Physical activity intensity and subjective well-being in healthy adults","volume":"24","author":"Panza","year":"2019","journal-title":"J Health Psychol"},{"key":"R20-20260717","doi-asserted-by":"crossref","first-page":"105641","DOI":"10.1016\/j.neubiorev.2024.105641","article-title":"Physical activity and prevention of mental health complications: An umbrella review","volume":"160","author":"Rahmati","year":"2024","journal-title":"Neurosci Biobehav Rev"},{"key":"R21-20260717","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3390\/ijerph20031719","article-title":"Physical activity, seasonal sensitivity and psychological well-being of people of different age groups living in extreme environments","volume":"20","author":"Alvarado","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"R22-20260717","doi-asserted-by":"crossref","first-page":"e0317555","DOI":"10.1371\/journal.pone.0317555","article-title":"Exploring the prevalence of chronic diseases and health status among international Hajj pilgrims","volume":"20","author":"Samarkandi","year":"2025","journal-title":"PLoS One"},{"key":"R23-20260717","doi-asserted-by":"crossref","first-page":"111647","DOI":"10.1016\/j.diabres.2024.111647","article-title":"Recommendations for management of diabetes and its complications during Hajj (Muslim Pilgrimage) \u2013 2024 update","volume":"212","author":"Ibrahim","year":"2024","journal-title":"Diabetes Res Clin Pract"},{"key":"R24-20260717","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.jiph.2017.06.004","article-title":"Morbidity and mortality amongst Indian Hajj pilgrims: A 3-year experience of Indian Hajj medical mission in mass-gathering medicine","volume":"11","author":"Khan","year":"2018","journal-title":"J Infect Public Health"},{"key":"R25-20260717","doi-asserted-by":"crossref","first-page":"252","DOI":"10.22442\/jlumhs.191840637","article-title":"The hajj: Hazards of heat exposure and prevalence of heat illnesses among pilgrims","volume":"18","author":"Qari","year":"2019","journal-title":"J Liaquat Univ Med Health Sci"},{"key":"R26-20260717","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1370\/afm.722","article-title":"Barriers to self-management and quality-of-life outcomes in seniors with multimorbidities","volume":"5","author":"Bayliss","year":"2007","journal-title":"Ann Fam Med"},{"key":"R27-20260717","first-page":"e99335","article-title":"Diarrheal illnesses and their association with hygiene practices and food and water sources among domestic pilgrims during the 2022 Hajj season","volume":"17","author":"Alrukban","year":"2025","journal-title":"Cureus"},{"key":"R28-20260717","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3390\/nu17223519","article-title":"Dietary modulation of the enteric nervous system: From molecular mechanisms to therapeutic applications","volume":"17","author":"Wang","year":"2025","journal-title":"Nutrients"},{"key":"R30-20260717","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/s10484-007-9034-x","article-title":"Psychophysiological effects of breathing instructions for stress management","volume":"32","author":"Conrad","year":"2007","journal-title":"Appl Psychophysiol Biofeedback"},{"key":"R32-20260717","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1002\/j.2040-4603.2021.tb00156.x","article-title":"Air hunger: A primal sensation and a primary element of dyspnea","volume":"11","author":"Banzett","year":"2021","journal-title":"Compr Physiol"},{"key":"R33-20260717","first-page":"1","article-title":"Prevalence and correlates of stress, anxiety, and depression in patients with chronic diseases: A cross-sectional study","volume":"30","author":"Swathi","year":"2023","journal-title":"Middle East Curr Psychiatry"},{"key":"R34-20260717","doi-asserted-by":"crossref","first-page":"626","DOI":"10.3390\/healthcare9060626","article-title":"Medication handling and storage among pilgrims during the hajj mass gathering","volume":"9","author":"Yezli","year":"2021","journal-title":"Healthcare (Basel)"},{"key":"R35-20260717","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.11124\/JBIES-20-00243","article-title":"Risk factors for hypertensive crisis in adult patients: A systematic review","volume":"19","author":"Benenson","year":"2021","journal-title":"JBI Evid Synth"},{"key":"R36-20260717","doi-asserted-by":"crossref","first-page":"328","DOI":"10.4103\/hm.HM-D-24-00068","article-title":"From heart to mind: Research advances in the link between coronary artery disease and mental stress \u2013 A narrative review","volume":"9","author":"Li","year":"2025","journal-title":"Hear Mind"},{"key":"R37-20260717","doi-asserted-by":"crossref","first-page":"4963","DOI":"10.1097\/MS9.0000000000003391","article-title":"Integrating mental health and cardiovascular wellness: Synergistic impacts and the promise of comprehensive care models","volume":"87","author":"Singh","year":"2025","journal-title":"Ann Med Surg (Lond)"}],"container-title":["Journal of Family and Community Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.4103\/jfcm.jfcm_145_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T08:00:15Z","timestamp":1784275215000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.4103\/jfcm.jfcm_145_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":34,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/jfcm.jfcm_145_26","relation":{},"ISSN":["2230-8229","2229-340X"],"issn-type":[{"value":"2230-8229","type":"print"},{"value":"2229-340X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2026-04-20","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-22","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}