Mortality, morbidity and medical resources utilization of patients with schizophrenia: A case-control community-based study

Patients with schizophrenia have higher level of mortality and physical comorbidity compared to control population. However the association to primary-, secondary- and tertiary-medical resources utilization is not clear. We used a retrospective community-based cohort of patients with schizophrenia (n=1389; age 37.53 years, 64.3% males) and, age-, gender-, and socioeconomic status-matched controls (n=4095; age 37.34 years; 64.3% males) who were followed-up for nine years. Mortality rate of patients was almost twice as high as that of matched controls (7% versus 3.8%). Diagnoses of ischemic heart disease and hypertension were more prevalent among controls than patients (8.2% versus 5%, and 21.6% versus 15.8%, respectively). Tertiary medical resources utilization was higher among patients with schizophrenia than control population (mean hospital admissions per year: 0.2 versus 0.12, emergency department visits: 0.48 versus 0.36). Patients that died were more likely to have cardiovascular disease, to be admitted to general hospital and to spend more days in hospital than patients that did not die. There is a discrepancy between lower rates of cardiovascular disease diagnoses but higher rates of mortality and tertiary medical resources utilization among patients with schizophrenia when compared to control population. This may stem from an under-diagnosis and, eventually, under-treatment of these patients.

Physiotherapy for people with mental health problems in Sub-Saharan African countries: a systematic review

Background

There is a need for psychosocial interventions to address the escalating mental health burden in Sub-Saharan Africa (SSA). Physiotherapists could have a central role in reducing the burden and facilitating recovery within the multidisciplinary care of people with mental health problems. The aim of this systematic review was to explore the role of physiotherapists within the current mental health policies of SSA countries and to explore the current research evidence for physiotherapy to improve functional outcomes in people with mental health problems in SSA.

Methods

The Mental Health Atlas and MiNDbank of the World Health Organization were screened for the role of physiotherapy in mental health plans. Next, we systematically searched PubMed from inception until August 1st, 2017 for relevant studies on physiotherapy interventions in people with mental health problems in SSA. The following search strategy was used: "physiotherapy" OR "physical therapy" OR "rehabilitation" AND "mental" OR "depression" OR "psychosis" OR "schizophrenia" OR "bipolar" AND the name of the country.

Results

The current systematic review shows that in 22 screened plans only 2 made reference to the importance of considering physiotherapy within the multidisciplinary treatment. The current evidence (N studies = 3; n participants = 94) shows that aerobic exercise might reduce depression and improve psychological quality of life, self-esteem, body image and emotional stress in people with HIV having mental health problems. In people with depression moderate to high but not light intensity aerobic exercise results in significantly less depressive symptoms (N = 1, n = 30). Finally, there is evidence for reduction in post-traumatic stress symptoms (avoidance and arousal), anxiety and depression following body awareness related exercises (N = 1, n = 26).

Conclusions

Our review demonstrated that physiotherapy is still largely neglected in the mental health care systems of SSA. This is probably due to poor knowledge of the benefits of physiotherapy within mental health care by policymakers, training institutes, and other mental health care professionals in SSA. Based on the current scientific evidence, this paper recommends the adoption of physiotherapy within mental health care services and investment in research and in training of professionals in SSA.

Catechol-O-Methyltransferase (COMT) Val158Met Polymorphism and Eating Disorders: Data From a New Biobank and Meta-Analysis of Previously Published Studies

OBJECTIVES

We investigated whether catechol-O-methyltransferase (COMT) Val158Met polymorphism is associated with eating disorders (EDs).

METHODS

We conducted a systematic literature search of studies published until 15 January 2017 and added data from the Italian 'Biobanca Veneta per i Disturbi Alimentari' biobank, performing a meta-analysis comparing COMT Val158Met genotype and allele frequencies in EDs and anorexia nervosa (AN) or bulimia nervosa (BN) patients versus controls.

RESULTS

Ten studies plus Biobanca Veneta per i Disturbi Alimentari (ED: n = 920, controls: n = 261 controls) with 3541 ED patients (AN = 2388; BN = 233) and 3684 controls were included. There were no significant group differences in COMT Val158Met alleles and genotype frequencies between patients and controls, for all EDs pooled together [range of odds ratios (ORs): 0.96-1.04, p-values: 0.46-0.97, I²  = 0%] and when analysing separately patients with AN (ORs: 0.94-1.04, p-values: 0.31-0.61, I²  = 0%) or BN (ORs: 0.80-1.09, p-values: 0.28-0.64, I²  = 0-44%).

CONCLUSIONS

Meta-analysing data results from 11 studies and 7225 subjects show that COMT Val158Met polymorphism is not associated with EDs. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Correlates of low physical activity across 46 low- and middle-income countries: A cross-sectional analysis of community-based data

Physical inactivity accounts for 5.5% of all avoidable global deaths. However, a paucity of multinational studies, particularly in low- and middle-income countries (LMICs), has investigated correlates of physical activity (PA). Thus, we assessed the correlates of PA using cross-sectional, community-based data of the World Health Survey including 46 LMICs. PA was assessed by the International Physical Activity Questionnaire (IPAQ) and participants were dichotomized into those who do (≥150min moderate-vigorous PA per week) and do not (<150min=low PA) comply with the World Health Organization (WHO) PA recommendations. Multivariable logistic regression was used to assess the PA correlates. The prevalence of low PA in 206,356 persons (mean age 38.4years; 49.6% males) was 29.2% (95%CI=28.3%-30.0%). In the overall sample, female sex, not married/cohabiting, high education and wealth, unemployment, and urban setting were significant sociodemographic correlates of low PA. In terms of other correlates, inadequate fruit and vegetable intake, subsyndromal depression, worse sleep/energy and cognition, visual impairment, hearing problems and asthma were associated with not meeting the WHO recommendations. There were some variations in the correlates depending on age and sex. Interventions should be developed that operate at multiple levels of influence and take into account age- and gender-related PA patterns in order to assist people in LMICs to comply with the WHO PA recommendations. Researchers, funding bodies, practitioners and policymakers in education, mental and physical health, and urban planning have a critical role to play.

Sedentary behavior and anxiety: Association and influential factors among 42,469 community-dwelling adults in six low- and middle-income countries

OBJECTIVE

This study investigated the association between sedentary behavior (SB) and anxiety, and explored factors that influence this relationship in six low- and middle-income countries.

METHOD

Cross-sectional data were analyzed from the World Health Organization's Study on Global Ageing and Adult Health. Multivariable linear and logistic regression analyses were conducted to assess the association between anxiety and self-reported SB. Potentially influential factors were examined with mediation analysis.

RESULTS

The sample consisted of 42,469 adults aged≥18years (50.1% female; mean age 43.8years). After adjusting for sociodemographics and country, people with anxiety engaged in 24 (95%CI=7-41) more minutes per day of SB than non-anxious individuals; the corresponding figure for the elderly (≥65years) was much higher (55min; 95% CI=29-81). Anxiety was associated with a 2.0 (95%CI=1.5-2.7) times higher odds for high SB (i.e., ≥8h/day). Overall, the largest proportion of the high SB-anxiety relationship was explained by mobility limitations (46.8%), followed by impairments in sleep/energy (44.9%), pain/discomfort (31.7%), disability (27.0%), cognition (13.3%), and physical activity levels (6.3%).

CONCLUSIONS

Anxiety was significantly associated with high SB, particularly among older adults. Future longitudinal studies are warranted to disentangle the potentially complex interplay of factors that may influence the anxiety-SB relationship.

Food addiction: Prevalence, psychopathological correlates and associations with quality of life in a large sample

OBJECTIVE

To determine the prevalence of food addiction in a large Brazilian non-clinical sample. Sociodemographic and psychopathological correlates of food addiction as well as associations with quality (QoL) domains were also investigated.

METHODS

This cross-sectional study obtained data from a Brazilian anonymous web-based research platform (N = 7639; 71.3% females). Participants provided sociodemographic data and completed the modified Yale Food Addiction Scale 2.0, PHQ-9, hypomania checklist (HCL-32), Fagerström Test for Nicotine Dependence, AUDIT, modified Skin picking-Stanford questionnaire, Minnesota impulsive disorders interview, Symptom Checklist-90-Revised inventory (SCL-90R), early trauma inventory self report-short form, and the WHO Quality of Life instrument-Abbreviated version (WHOQOL-Bref). Associations were adjusted to potential confounders through multivariable models.

RESULTS

The prevalence of food addiction was 4.32% (95%CI: 3.89-4.80%), and was more common among females. Food addiction was associated with a positive screen for a major depressive episode (OR = 4.41; 95%CI: 3.46-5.62), bipolar spectrum disorder (OR = 1.98; 95%CI: 1.43-2.75), and skin picking disorder (OR = 2.02; 95%CI: 1.31-3.09). Food addiction was also independently associated with exposure to early life psychological and sexual abuse (P = 0.008) as well as with reduced physical, psychological, social, and environment QoL (all P < 0.001).

CONCLUSIONS

Food addiction may be common in low and middle-income countries, though possibly less prevalent than in the US. Food addiction was associated with co-occurring mood disorders and skin picking disorder as well as with early life psychological and sexual abuse. Finally, food addiction was independently associated with broad reductions in QoL. Public health efforts towards the early recognition and management of food addiction are warranted.

Pro-inflammatory dietary pattern is associated with fractures in women: an eight-year longitudinal cohort study

In this study, during 8 years of follow-up, we reported that higher dietary inflammatory index values were associated with a higher risk of incident fractures in women, but not in men, after adjusting for potential confounders.

INTRODUCTION

Inflammation is a key risk factor for many adverse outcomes in older people. While diet is a potential source of inflammation, little is known about the impact of inflammatory diet on fractures. Thus, we investigated whether higher Dietary Inflammatory Index (DII)™ ® scores are associated with fractures in a cohort of North American people.

METHODS

This longitudinal study with a follow-up of 8 years included 3648 participants (1577 males and 2071 females; mean age = 60.6 years) with/at risk of knee osteoarthritis participating with in the Osteoarthritis Initiative. DII scores were calculated using the validated Block Brief 2000 Food Frequency Questionnaire, categorized into sex-specific quintiles. Information on fractures was obtained through self-reported history of fractures at hip, spine, and forearm. The relationship between baseline DII score and incident fracture was assessed through a Cox's regression analysis, adjusted for potential baseline confounders, and reported as hazard ratios (HRs).

RESULTS

During 8 years of follow-up, 560 individuals developed fractures (15.4%). Adjusting for 10 potential confounders, women in the highest DII score quintile (i.e., most pro-inflammatory diet) had a significantly higher risk for fractures (HR = 1.46; 95% CI = 1.02-2.11) compared to women in the lowest quintile. An increase in one standard deviation of DII scores significantly predicted fracture onset in women (adjusted HR = 1.14; 95% CI = 1.02-1.27). The association between DII score and fractures was not significant among men or in the sample as whole.

CONCLUSION

Pro-inflammatory diet is associated with a higher incidence of fractures in women but not men.

Impact of aerobic exercise on muscle mass in patients with major depressive disorder: a randomized controlled trial

OBJECTIVE

Sarcopenia leads to physical function impairment and at least to increasing all-cause mortality. There are notes on reduced muscle mass in patients with major depressive disorder (MDD). Whether an exercise intervention counteracts low muscle mass in patients with MDD has not been studied so far. Therefore, our study aimed at examining effects of regular aerobic exercise training on muscle mass in patients with MDD.

PARTICIPANTS AND METHODS

Thirty inpatients with MDD were included in the study, of which 20 received an additional supervised exercise program. Ten patients obtained treatment as usual. Muscle mass was measured using MRI before and 6 weeks after the training period (3 times per week for 45 minutes).

RESULTS

We found a significant effect of the exercise intervention on the amount of muscle mass depending on age, body mass index, and the physical activity score (P=0.042).

CONCLUSION

Among other positive effects, regular exercise increases muscle mass in patients with MDD and, therefore, should be recommended as an additional treatment tool.

Physical activity and suicidal ideation: A systematic review and meta-analysis

BACKGROUND

A potential approach to suicide prevention that has not been closely examined, but which holds promise in terms of widespread dissemination without major side-effects, is physical activity (PA). This systematic review and meta-analysis set out to: (a) explore associations between PA and suicidal ideation (SI) levels, and (b) investigate the effect of PA interventions on SI.

METHODS

Major electronic databases were searched from inception up to 05/2017 to identify quantitative studies reporting an association between PA and SI. A quantitative correlates synthesis and random effects meta-analysis were conducted.

RESULTS

Fourteen of 21 studies in adults (67%) (n = 130,737), 7/14 (50%) in adolescents (n = 539,170) and 2/3 (67%) in older adults (n = 50,745) found a significant negative association between PA- and SI-levels. Pooled adjusted meta-analysis of 14 effect sizes over eight studies and 80,856 people found that those who were "active" versus those who were "inactive" were less likely to have SI (OR = 0.87, 95%CI = 0.76-0.98). Additionally, meeting PA guidelines conferred a significant protective effect against SI (OR = 0.91, 95%CI = 0.51-0.99, P = 0.03; N studies = 3, n people = 122,395), while not meeting guidelines was associated with increased SI (OR = 1.16, 95%CI = 1.09-1.24, P < 0.001; N = 4, n = 78,860). Data from the intervention studies (N = 3, n = 121) was mixed and limited.

LIMITATIONS

Our findings are based mainly on cross-sectional studies, while the majority of studies did not include a rigorous physical activity assessment.

CONCLUSIONS

The current study suggests that higher PA levels are associated with lower SI. However, the associations observed need to be confirmed in prospective observational studies and controlled trials.

Blockade of the angiotensin system improves mental health domain of quality of life: A meta-analysis of randomized clinical trials

OBJECTIVE

It is unclear whether blockade of the angiotensin system has effects on mental health. Our objective was to determine the impact of angiotensin converting enzyme inhibitors and angiotensin II type 1 receptor (AT1R) blockers on mental health domain of quality of life.

STUDY DESIGN

Meta-analysis of published literature.

DATA SOURCES

PubMed and clinicaltrials.gov databases. The last search was conducted in January 2017.

STUDY SELECTION

Randomized controlled trials comparing any angiotensin converting enzyme inhibitor or AT1R blocker versus placebo or non-angiotensin converting enzyme inhibitor or non-AT1R blocker were selected. Study participants were adults without any major physical symptoms. We adhered to meta-analysis reporting methods as per PRISMA and the Cochrane Collaboration.

DATA SYNTHESIS

Eleven studies were included in the analysis. When compared with placebo or other antihypertensive medications, AT1R blockers and angiotensin converting enzyme inhibitors were associated with improved overall quality of life (standard mean difference = 0.11, 95% confidence interval = [0.08, 0.14], p < 0.0001), positive wellbeing (standard mean difference = 0.11, 95% confidence interval = [0.05, 0.17], p < 0.0001), mental (standard mean difference = 0.15, 95% confidence interval = [0.06, 0.25], p < 0.0001), and anxiety (standard mean difference = 0.08, 95% confidence interval = [0.01, 0.16], p < 0.0001) domains of QoL. No significant difference was found for the depression domain (standard mean difference = 0.05, 95% confidence interval = [0.02, 0.12], p = 0.15).

CONCLUSIONS

Use of angiotensin blockers and inhibitors for the treatment of hypertension in otherwise healthy adults is associated with improved mental health domains of quality of life. Mental health quality of life was a secondary outcome in the included studies. Research specifically designed to analyse the usefulness of drugs that block the angiotensin system is necessary to properly evaluate this novel psychiatric target.

Osteoarthristis Increases the Risk of Cardiovascular Disease: Data from the Osteoarthritis Initiative

OBJECTIVES

Although osteoarthritis (OA) is a common condition in older adults, the role of OA in increasing cardiovascular disease (CVD) incidence is still debated. The aim of this study was to investigate the association between OA and the onset of CVD in a large database of American adults.

DESIGN

Longitudinal.

SETTING

Community-dwelling.

PARTICIPANTS

People with OA or at high risk of OA.

MEASUREMENTS

Osteoarthritis was defined as the presence of OA of the hand, knee, hip, back/neck or of other sites. CVD was defined as self-reported presence of heart attack, heart failure, stroke and other cerebral atherosclerotic conditions, and peripheral artery disease.

RESULTS

A total 4,265 persons without CVD (mean age=60.8 years, females=59.2%) at baseline were analyzed (1,775 with OA versus 2,490 without). Over a mean of 8.2 years, according to an adjusted Cox's regression analysis for 11 potential baseline confounders, study participants with OA of any joint had a significantly higher risk of developing CVD compared to those without OA (Hazard ratio (HR): =1.27; 95% CI: 1.03-1.56). The presence of hand OA was associated with a higher risk of developing CVD (HR=1.31; 95%CI: 1.01-1.68) with respect to those who had no OA. Knee, hip and back/neck OA did not, instead, increase the risk of developing CVD. The association between OA and CVD was significant in the women, but not in the men.

CONCLUSIONS

OA, in particular, when it affects the hand and in women, was associated with a higher risk of developing CVD.

Monoclonal gammopathy of undetermined significance and bone health outcomes: a systematic review and exploratory meta-analysis

Monoclonal gammopathy of undetermined significance (MGUS) is a common condition in the elderly. A number of studies have investigated the relationship between MGUS and bone health outcomes including bone mineral density (BMD), osteoporosis and fractures, but no meta-analysis exists. We conducted a systematic review and exploratory meta-analysis comparing bone health outcomes in patients with MGUS. Two independent authors searched PubMed and Scopus from inception until 19 October 2016. A meta-analysis of cross-sectional and longitudinal studies investigating fractures and BMD was conducted. Standardised mean differences (SMD) ± 95% confidence intervals (CIs) were calculated for BMD, and risk ratios (RRs) were calculated for prevalent and incident fractures. Of 174 initial hits, 10 studies of moderate methodological quality were eligible, including 8711 individuals with MGUS vs. 52,865 controls. Compared to controls, subjects with MGUS showed significantly lower values for radial cortical volumetric BMD (1 study; SMD = -5.45, 95% CI: -7.24 to -3.66), but not at the lumbar spine, femoral neck or hip. The incidence of fractures was higher in people with MGUS (n = 7466) vs. controls (n = 52,304) (RR = 1.36, 95% CI 1.28-1.44, I ² = 0%) over a median of 12.5-year follow-up. The incidence of vertebral fractures was particularly elevated (RR = 2.50, 95% CI 1.53-4.06) although limited to two studies. In conclusion, although with limitations, our preliminary meta-analysis suggests that patients with MGUS are at higher risk of fractures despite evidence for differences in BMD being equivocal. Future longitudinal research is required to confirm our findings and determine if fracture prevention interventions are warranted in people with MGUS.

Depression, sleep problems, and perceived stress among informal caregivers in 58 low-, middle-, and high-income countries: A cross-sectional analysis of community-based surveys

Caregiving has been associated with adverse health outcomes. However, there is a paucity of multi-country, population-based studies on mental health outcomes of caregivers especially from low- and middle-income countries (LMICs). Thus, we assessed the association of caregiving with depression, sleep problems, and perceived stress in 10 high-, 27 middle-, and 21 low-income countries. Cross-sectional community-based data of the World Health Survey including 258,793 adults aged ≥18 years were analyzed. Multivariable logistic and linear regression analyses were conducted to explore the association of past 12-month caregiving with past 12-month DSM-IV depression, and past 30-day perceived stress [range 0 (low)-100 (high)] and severe/extreme sleep problems. Nearly 20% of the individuals were engaged in caregiving with particularly high rates observed in high-income countries (HICs) (e.g., Finland 43.3%). Across the entire sample, after adjustment for potential confounders, caregivers had a significantly higher likelihood of having depression (OR = 1.54; 95%CI = 1.37-1.73), sleep problems (OR = 1.37; 95%CI = 1.25-1.50), while their mean perceived stress score was 3.15 (95%CI = 2.46-3.84) points higher. These associations tended to be stronger in HICs. A greater number of caregiving activities was associated with a greater likelihood of depression, sleep problems, and perceived stress regardless of country income levels. In conclusion, caregiving has a negative impact on mental health worldwide with possibly greater effects in HICs. Given the growing contribution of caregivers in long-term care, interventions and policies to alleviate the mental health burden of caregivers are urgently needed to maintain sustainable and effective care practices.

Randomised control trial of the effectiveness of an integrated psychosocial health promotion intervention aimed at improving health and reducing substance use in established psychosis (IMPaCT)

BACKGROUND

People with psychosis have a reduced life expectancy of 10-20 years, largely due to cardiovascular disease. This trial aimed to determine the effectiveness of a modular health promotion intervention (IMPaCT Therapy) in improving health and reducing cardiovascular risk in psychosis.

METHODS

A multicentre, two arm, parallel cluster RCT was conducted across five UK mental health NHS trusts. Community care coordinators (CC) were randomly assigned to training and supervision in delivering IMPaCT Therapy or treatment as usual (TAU) to current patients with psychosis (cluster). The primary outcome was the physical and mental health subscales of the Short form-36 (SF-36) questionnaire.

RESULTS

Of 104 care coordinators recruited, 52 (with 213 patients) were randomised to deliver IMPaCT therapy and 52 (with 193 patients) randomised to TAU. Of 406 patients, 318 (78%) and 301 (74%) attended 12- and 15-month follow-up respectively. IMPaCT therapy showed no significant effect on the physical or mental health component SF-36 scores versus TAU at 12 or 15 months. No effect was observed for cardiovascular risk indicators, except for HDL cholesterol, which improved more with IMPACT therapy than TAU (Treatment effect (95% CI); 0.085 (0.007 to 0.16); p = 0.034). The 22% of patients who received >180 min of IMPACT Therapy in addition to usual care achieved a greater reduction in waist circumference than did controls, which was clinically significant.

CONCLUSION

Training and supervising community care coordinators to use IMPaCT therapy in patients with psychosis is insufficient to significantly improve physical or mental health quality of life. The search for effective, pragmatic interventions deliverable in health care services continues.

TRIAL REGISTRATION

The trial was retrospectively registered with ISRCTN registry on 23/4/2010 at ISRCTN58667926 ; recruitment started on 01/03/2010 with first randomization on 09.08.2010 ISRCTN58667926 .

Physical activity and metabolic disease among people with affective disorders: Prevention, management and implementation

BACKGROUND

One in ten and one in three of people with affective disorders experience diabetes and metabolic syndrome respectively. Physical activity (PA) and sedentary behaviour (SB) are key risk factors that can ameliorate the risk of metabolic disease among this population. However, PA is often seen as luxury and/or a secondary component within the management of people with affective disorders.

METHODS

The current article provides a non-systematic best-evidence synthesis of the available literature, detailing a number of suggestions for the implementation of PA into clinical practice.

RESULTS

Whilst the evidence is unequivocal for the efficacy of PA to prevent and manage metabolic disease in the general population, it is in its infancy in this patient group. Nonetheless, action must be taken now to ensure that PA and reducing SB are given a priority to prevent and manage metabolic diseases and improve wider health outcomes. PA should be treated as a vital sign and all people with affective disorders asked about their activity levels and if appropriate advised to increase this. There is a need for investment in qualified exercise specialists in clinical practice such as physiotherapists to undertake and oversee PA in practice. Behavioural strategies such as the self-determined theory should be employed to encourage adherence. Funding is required to develop the evidence base and elucidate the optimal intervention characteristics.

CONCLUSION

PA interventions should form an integral part of the multidisciplinary management of people with affective disorders and our article outlines the evidence and strategies to implement this in practice.

The relationship between the dietary inflammatory index and prevalence of radiographic symptomatic osteoarthritis: data from the Osteoarthritis Initiative

PURPOSE

To investigate whether higher dietary inflammatory index (DII^®) scores were associated with higher prevalence of radiographic symptomatic knee osteoarthritis in a large cohort of North American people from the Osteoarthritis Initiative database.

METHODS

A total of 4358 community-dwelling participants (2527 females; mean age 61.2 years) from the Osteoarthritis Initiative were identified. DII^® scores were calculated using the validated Block Brief 2000 Food-Frequency Questionnaire and scores were categorized into quartiles. Knee radiographic symptomatic osteoarthritis was diagnosed clinically and radiologically. The strength of association between divided into quartiles (DII^®) and knee osteoarthritis was investigated through a logistic regression analysis, which adjusted for potential confounders, and results were reported as odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

Participants with a higher DII^® score, indicating a more pro-inflammatory diet, had a significantly higher prevalence of radiographic symptomatic knee osteoarthritis compared to those with lower DII^® score (quartile 4: 35.4% vs. quartile 1: 24.0%; p < 0.0001). Using a logistic regression analysis, adjusting for 11 potential confounders, participants with the highest DII^® score (quartile 4) had a significantly higher probability of experiencing radiographic symptomatic knee osteoarthritis (OR 1.40; 95% CI 1.14-1.72; p = 0.002) compared to participants with the lowest DII^® score (quartile 1).

CONCLUSIONS

Higher DII^® values are associated with higher prevalence of radiographic symptomatic knee osteoarthritis.

Depression and pain: primary data and meta-analysis among 237 952 people across 47 low- and middle-income countries

BACKGROUND

Depression and pain are leading causes of global disability. However, there is a paucity of multinational population data assessing the association between depression and pain, particularly among low- and middle-income countries (LMICs) where both are common. Therefore, we investigated this association across 47 LMICs.

METHODS

Community-based data on 273 952 individuals from 47 LMICs were analysed. Multivariable logistic and linear regression analyses were performed to assess the association between the International Classification of Diseases, 10th Revision depression/depression subtypes (over the past 12 months) and pain in the previous 30 days based on self-reported data. Country-wide meta-analysis adjusting for age and sex was also conducted.

RESULTS

The prevalence of severe pain was 8.0, 28.2, 20.2, and 34.0% for no depression, subsyndromal depression, brief depressive episode, and depressive episode, respectively. Logistic regression adjusted for socio-demographic variables, anxiety and chronic medical conditions (arthritis, diabetes, angina, asthma) demonstrated that compared with no depression, subsyndromal depression, brief depressive episode, and depressive episode were associated with a 2.16 [95% confidence interval (CI) 1.83-2.55], 1.45 (95% CI 1.22-1.73), and 2.11 (95% CI 1.87-2.39) increase in odds of severe pain, respectively. Similar results were obtained when a continuous pain scale was used as the outcome. Depression was significantly associated with severe pain in 44/47 countries with a pooled odds ratio of 3.93 (95% CI 3.54-4.37).

CONCLUSION

Depression and severe pain are highly comorbid across LMICs, independent of anxiety and chronic medical conditions. Whether depression treatment or pain management in patients with comorbid pain and depression leads to better clinical outcome is an area for future research.

Frailty and incident depression in community-dwelling older people: results from the ELSA study

OBJECTIVE

Frailty and pre-frailty are two common conditions in the older people, but whether these conditions could predict depression is still limited to a few longitudinal studies. In this paper, we aimed to investigate whether frailty and pre-frailty are associated with an increased risk of depression in a prospective cohort of community-dwelling older people.

METHODS

Four thousand seventy-seven community-dwelling men and women over 60 years without depression at baseline were included from the English Longitudinal Study of Ageing. Frailty status was defined according to modified Fried's criteria (weakness, weight loss, slow gait speed, low physical activity and exhaustion) and categorized as frailty (≥3 criteria), pre-frailty (1-2 criteria) or robustness (0 criterion). Depression was diagnosed as ≥4 out of 8 points of Center for Epidemiologic Studies Depression Scale, after 2 years of follow-up.

RESULTS

Over a 2-year follow-up, 360 individuals developed depression. In a logistic regression analysis, adjusted for 18 potential baseline confounders, pre-frailty (odds ratio (OR) = 0.89; 95% confidence interval (CI), 0.54-1.46; p = 0.64) and frailty (OR = 1.22; 95% CI, 0.90-1.64; p = 0.21) did not predict the onset of depression at follow-up. Among the criteria included in the frailty definition, only slow gait speed (OR = 1.82; 95% CI, 1.00-3.32; p = 0.05) appeared to predict a higher risk of depression.

CONCLUSIONS

Among older community dwellers, frailty and pre-frailty did not predict the onset of depression during 2 years of follow-up, when accounting for potential confounders, whilst slow gait speed considered alone may predict depression in the older people. Copyright © 2017 John Wiley & Sons, Ltd.

Cholesterol and triglyceride levels in first-episode psychosis: systematic review and meta-analysis

BackgroundThe extent of metabolic and lipid changes in first-episode psychosis (FEP) is unclear.AimsTo investigate whether individuals with FEP and no or minimal antipsychotic exposure show lipid and adipocytokine abnormalities compared with healthy controls.MethodWe conducted a meta-analysis of studies examining lipid and adipocytokine parameters in individuals with FEP and no or minimal antipsychotic exposure v. a healthy control group. Studies reported fasting total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides and leptin levels.ResultsOf 2070 citations retrieved, 20 case-control studies met inclusion criteria including 1167 patients and 1184 controls. Total cholesterol and LDL cholesterol levels were significantly decreased in patients v. controls, corresponding to an absolute reduction of 0.26 mmol/L and 0.15 mmol/L respectively. Triglyceride levels were significantly increased in the patient group, corresponding to an absolute increase of 0.08 mmol/L. However, HDL cholesterol and leptin levels were not altered in patients v. controls.ConclusionsTotal and LDL cholesterol levels are reduced in FEP, indicating that hypercholesterolaemia in patients with chronic disorder is secondary and potentially modifiable. In contrast, triglycerides are elevated in FEP. Hypertriglyceridaemia is a feature of type 2 diabetes mellitus, therefore this finding adds to the evidence for glucose dysregulation in this cohort. These findings support early intervention targeting nutrition, physical activity and appropriate antipsychotic prescription.

Correlates of children's independent outdoor play: Cross-sectional analyses from the Millennium Cohort Study

Time spent outdoors is associated with higher levels of physical activity. To date, correlates of independent outdoor play have not been investigated. This study aimed to identify potential demographic, behavioural, environmental and social correlates of children's independent outdoor play. Data were from the Millennium Cohort Study when children were aged 7 years. Parents reported whether their children played out unsupervised (yes/no) as well as the above mentioned correlates of unsupervised outdoor play. Children's physical activity levels were measured using waist worn accelerometry. Multiple logistic regression was used to examine associations between correlates and odds of independent (unsupervised) outdoor play. Adjusted multiple linear regression was used to estimate associations between independent outdoor play and objective measures of physical activity. Activity was measured as average daily moderate-to-vigorous activity, steps, and sedentary behaviour. 3856 (n = 29%) participants were categorised as engaging in independent outdoor play. Older age, being white British, being in poverty, living in close proximity to both family friends and family, having fewer internalising problems, having more externalising conduct problems and fewer pro-social behaviours were associated with higher odds of independent outdoor play. Independent outdoor play was associated with > 2 additional minutes of moderate-to-vigorous activity (B = 2.21 95% CI, 1.09 to 3.34), > 330 additional steps per day (B = 336.66 95% CI 209.80 to 463.51), and nearly 5 min less time spent sedentary per day (B = - 4.91 95% CI - 7.54, - 2.29) Younger children, those from a higher socio-economic-status, those isolated in location from family friends and family, and those with high levels of prosocial behaviour have lower levels of independent outdoor play. Independent outdoor play was associated with higher levels of physical activity and less time sedentary. Future interventions to promote independent outdoor play should target such populations.

Physical activity is associated with the physical, psychological, social and environmental quality of life in people with mental health problems in a low resource setting

There is a growing recognition of the importance of encouraging patients with mental health problems to become more active as an efficacious strategy to reduce the disability-associated burden. The aim of the current study was to investigate if there are differences in quality of life (QoL) outcomes between people with mental health problems that do and do not meet the recommendations of 150min per week of physical activity. 109 (36♀) Ugandan in- and outpatients (mean age = 34.2 ± 10.2 years) (depression = 7, bipolar disorder = 31, schizophrenia = 21, alcohol use disorder = 50) completed the Physical Activity Vital Sign (PAVS) method and World Health Organization Quality of Life Assessment brief version. Those who did not achieve the minimum physical activity recommendations as assessed by the PAVS (n = 63) had a lower physical, psychological, social and environmental QoL. The current data offer further evidence that the PAVS method might be an important risk identification tool in people with mental health problems. The feasibility and acceptability of the PAVS may help promote the importance of physical activity assessment and prescription as a core part of the treatment of mental health problems in LMICs.

Remission and recovery from first-episode psychosis in adults: systematic review and meta-analysis of long-term outcome studies

BackgroundRemission and recovery rates for people with first-episode psychosis (FEP) remain uncertain.AimsTo assess pooled prevalence rates of remission and recovery in FEP and to investigate potential moderators.MethodWe conducted a systematic review and meta-analysis to assess pooled prevalence rates of remission and recovery in FEP in longitudinal studies with more than 1 year of follow-up data, and conducted meta-regression analyses to investigate potential moderators.ResultsSeventy-nine studies were included representing 19072 patients with FEP. The pooled rate of remission among 12301 individuals with FEP was 58% (60 studies, mean follow-up 5.5 years). Higher remission rates were moderated by studies from more recent years. The pooled prevalence of recovery among 9642 individuals with FEP was 38% (35 studies, mean follow-up 7.2 years). Recovery rates were higher in North America than in other regions.ConclusionsRemission and recovery rates in FEP may be more favourable than previously thought. We observed stability of recovery rates after the first 2 years, suggesting that a progressive deteriorating course of illness is not typical. Although remission rates have improved over time recovery rates have not, raising questions about the effectiveness of services in achieving improved recovery.