Comprehensive meta-analysis of excess mortality in depression in the general community versus patients with specific illnesses

The Effectiveness of a Mobile Phone-Based Physical Activity Program for Treating Depression, Stress, Psychological Well-Being, and Quality of Life Among Adults: Quantitative Study

BACKGROUND

Depression is a substantial global health problem, affecting >300 million people and resulting in 12.7% of all deaths. Depression causes various physical and cognitive problems, leading to a 5-year to 10-year decrease in life expectancy compared with the general population. Physical activity is known to be an effective, evidence-based treatment for depression. However, people generally have difficulties with participating in physical activity owing to limitations in time and accessibility.

OBJECTIVE

To address this issue, this study aimed to contribute to the development of alternative and innovative intervention methods for depression and stress management in adults. More specifically, we attempted to investigate the effectiveness of a mobile phone-based physical activity program on depression, perceived stress, psychological well-being, and quality of life among adults in South Korea.

METHODS

Participants were recruited and randomly assigned to the mobile phone intervention or waitlist group. Self-report questionnaires were used to assess variables before and after treatment. The treatment group used the program around 3 times per week at home for 4 weeks, with each session lasting about 30 minutes. To evaluate the program's impact, a 2 (condition) × 2 (time) repeated-measures ANOVA was conducted, considering pretreatment and posttreatment measures along with group as independent variables. For a more detailed analysis, paired-samples 2-tailed t tests were used to compare pretreatment and posttreatment measurements within each group. Independent-samples 2-tailed t tests were conducted to assess intergroup differences in pretreatment measurements.

RESULTS

The study included a total of 68 adults aged between 18 and 65 years, who were recruited both through web-based and offline methods. Of these 68 individuals, 41 (60%) were randomly assigned to the treatment group and 27 (40%) to the waitlist group. The attrition rate was 10.2% after 4 weeks. The findings indicated that there is a significant main effect of time (F_1,60=15.63; P=.003; η_p²=0.21) in participants' depression scores, indicating that there were changes in depression level across time. No significant changes were observed in perceived stress (P=.25), psychological well-being (P=.35), or quality of life (P=.07). Furthermore, depression scores significantly decreased in the treatment group (from 7.08 to 4.64; P=.03; Cohen d=0.50) but not in the waitlist group (from 6.72 to 5.08; P=.20; Cohen d=0.36). Perceived stress score of the treatment group also significantly decreased (from 2.95 to 2.72; P=.04; Cohen d=0.46) but not in the waitlist group (from 2.82 to 2.74; P=.55; Cohen d=0.15).

CONCLUSIONS

This study provided experimental evidence that mobile phone-based physical activity program affects depression significantly. By exploring the potential of mobile phone-based physical activity programs as a treatment option, this study sought to improve accessibility and encourage participation in physical activity, ultimately promoting better mental health outcomes for individuals with depression and stress.

A personalized intervention to prevent depression in primary care based on risk predictive algorithms and decision support systems: protocol of the e-predictD study

The predictD is an intervention implemented by general practitioners (GPs) to prevent depression, which reduced the incidence of depression-anxiety and was cost-effective. The e-predictD study aims to design, develop, and evaluate an evolved predictD intervention to prevent the onset of major depression in primary care based on Information and Communication Technologies, predictive risk algorithms, decision support systems (DSSs), and personalized prevention plans (PPPs). A multicenter cluster randomized trial with GPs randomly assigned to the e-predictD intervention + care-as-usual (CAU) group or the active-control + CAU group and 1-year follow-up is being conducted. The required sample size is 720 non-depressed patients (aged 18-55 years), with moderate-to-high depression risk, under the care of 72 GPs in six Spanish cities. The GPs assigned to the e-predictD-intervention group receive brief training, and those assigned to the control group do not. Recruited patients of the GPs allocated to the e-predictD group download the e-predictD app, which incorporates validated risk algorithms to predict depression, monitoring systems, and DSSs. Integrating all inputs, the DSS automatically proposes to the patients a PPP for depression based on eight intervention modules: physical exercise, social relationships, improving sleep, problem-solving, communication skills, decision-making, assertiveness, and working with thoughts. This PPP is discussed in a 15-min semi-structured GP-patient interview. Patients then choose one or more of the intervention modules proposed by the DSS to be self-implemented over the next 3 months. This process will be reformulated at 3, 6, and 9 months but without the GP-patient interview. Recruited patients of the GPs allocated to the control-group+CAU download another version of the e-predictD app, but the only intervention that they receive via the app is weekly brief psychoeducational messages (active-control group). The primary outcome is the cumulative incidence of major depression measured by the Composite International Diagnostic Interview at 6 and 12 months. Other outcomes include depressive symptoms (PHQ-9) and anxiety symptoms (GAD-7), depression risk (predictD risk algorithm), mental and physical quality of life (SF-12), and acceptability and satisfaction ('e-Health Impact' questionnaire) with the intervention. Patients are evaluated at baseline and 3, 6, 9, and 12 months. An economic evaluation will also be performed (cost-effectiveness and cost-utility analysis) from two perspectives, societal and health systems.

Trial registration

ClinicalTrials.gov, identifier: NCT03990792.

All-cause and cause-specific mortality among people with bipolar disorder: a large-scale systematic review and meta-analysis

OBJECTIVE

Bipolar disorder (BD) is associated with premature mortality. All-cause and specific mortality risks in this population remain unclear, and more studies are still needed to further understand this issue and guide individual and public strategies to prevent mortality in bipolar disorder Thus, a systematic review and meta-analysis of studies assessing mortality risk in people with BD versus the general population was conducted. The primary outcome was all-cause mortality, whilst secondary outcomes were mortality due to suicide, natural, unnatural, and specific-causes mortality.

RESULTS

Fifty-seven studies were included (BD; n = 678,353). All-cause mortality was increased in people with BD (RR = 2.02, 95% CI: 1.89-2.16, k = 39). Specific-cause mortality was highest for suicide (RR = 11.69, 95% CI: 9.22-14.81, k = 25). Risk of death due to unnatural causes (RR = 7.29, 95% CI: 6.41-8.28, k = 17) and natural causes (RR = 1.90, 95% CI: 1.75-2.06, k = 17) were also increased. Among specific natural causes analyzed, infectious causes had the higher RR (RR = 4,38, 95%CI: 1.5-12.69, k = 3), but the analysis was limited by the inclusion of few studies. Mortality risk due to respiratory (RR = 3.18, 95% CI: 2.55-3.96, k = 6), cardiovascular (RR = 1.76, 95% CI: 1.53-2.01, k = 27), and cerebrovascular (RR = 1.57, 95% CI: 1.34-1.84, k = 13) causes were increased as well. No difference was identified in mortality by cancer (RR = 0.99, 95% CI: 0.88-1.11, k = 16). Subgroup analyses and meta-regression did not affect the findings.

CONCLUSION

Results presented in this meta-analysis show that risk of premature death in BD is not only due to suicide and unnatural causes, but somatic comorbidities are also implicated. Not only the prevention of suicide, but also the promotion of physical health and the prevention of physical conditions in individuals with BD may mitigate the premature mortality in this population. Notwithstanding this is to our knowledge the largest synthesis of evidence on BD-related mortality, further well-designed studies are still warranted to inform this field.

Real-world treatment modalities, health care resource utilization, and costs among commercially insured patients with newly diagnosed major depressive disorder in the United States

BACKGROUND: In the United States, major depressive disorder (MDD) is one of the most prevalent mental health disorders. Treatment guidelines for MDD recommend pharmacologic and nonpharmacologic therapies tailored to the patient's disease severity, level of function, and comorbid health conditions. While previous studies examined real-world pharmacologic treatment patterns and costs among patients with MDD, few have examined the use of nonpharmacologic treatments and their association with health care resource utilization (HCRU) and cost. OBJECTIVE: To describe prevalence and associations between patient/provider characteristics and treatment modality and characterize HCRU and cost by treatment modality for patients with newly diagnosed MDD. METHODS: Commercially insured US patients, aged 18-62 years with newly diagnosed MDD between January 1, 2017, and September 30, 2019, were retrospectively identified from the Healthcare Integrated Research Database. Eligible patients were continuously enrolled in the health plan for 1 year before and 2 years after the first MDD diagnosis (index date). Those with co-occurring schizophrenia, bipolar disorder, postpartum depression, substance use disorder, and any prior MDD treatments were excluded. Treatment modalities assessed in the 2-year post-index period included antidepressant only (Rx-only), nonpharmacologic only (non-Rx-only), both antidepressant and nonpharmacologic (combination), and no treatment. HCRU and costs were assessed in the 2-year post-index period by treatment modality. Regression models identified associations between patient/provider characteristics and treatment modality, and the relationship between treatment modality and MDD severity changes. RESULTS: In total, 12,657 patients were included (mean age: 36 years; 60% female). During follow-up, 34% of patients received Rx-only, 25% received non-Rx-only, 28% received combination, and 13% received no treatment. MDD severity at diagnosis (26% mild, 54% moderate, 20% severe) was available for 51% of patients. Post-index inpatient hospitalizations were 11% for those with Rx-only, 10% for non-Rx-only, 16% for combination, and 29% for no treatment, whereas all-cause mean monthly total costs were $792, $633, $786, and $1,292, respectively. In multinomial logistic regression, age, sex, geographic region and urbanicity of patient residence, socioeconomic status, diagnosing provider specialty, and initial diagnosis location were significantly associated (P < 0.05) with treatment modality. In multivariable logistic regression, recipients of Rx-only (odds ratio = 2.03, P < 0.01) or combination (odds ratio = 3.26, P < 0.01) had higher odds of improving MDD severity than patients who received no treatment. CONCLUSIONS: In this real-world sample of commercially insured patients, we observed variations in outcomes by treatment modality and an association between treatment modality and disease severity. Further research is needed to explore the underlying causal relationships between treatment modality and patient outcomes. Study Registration: https://doi.org/10.17605/OSF.IO/YQ6B3 DISCLOSURES: Dr Grabner is an employee of Carelon Research, which received funding from the Innovation and Value Initiative for the conduct of the study on which this manuscript is based. Ms Pizzicato and Mr Yang were employees of Carelon Research at the time the study was conducted. Dr Grabner is a shareholder of Elevance Health. Drs Xie and Chapman are employees of the Innovation and Value Initiative.

Preventing the onset of depressive disorders in low-and middle-income countries: An overview

Depressive disorders constitute an important and costly public health problem and worldwide most of the disease burden is suffered in low-and middle-income countries (LMICs). Treatments only have limited possibilities to reduce the disease burden of depressive disorders. Prevention may be one of the alternative ways to further reduce the disease burden of depressive disorders. In this paper, the results of a subgroup analysis of a previous meta-analysis on the effect of preventive interventions on the incidence of depressive disorders was undertaken. Only 6% of all trials examining the possibility to prevent the onset of major depression have been conducted in LMICs, and these studies find significantly smaller effects than those in high-income settings. It is too early, therefore, to consider implementing and disseminating preventive interventions in LMICS. However, in optimal conditions and assuming that evidence-based preventive interventions will be developed, investments should be made into treatment, universal, selective and indicated prevention, as well as in social institutions focusing on larger risk factors for mental health problems.

Polyphenols as novel interventions for depression: exploring the efficacy, mechanisms of action, and implications for future research

Numerous animal and human studies have assessed the relationship between polyphenols and outcomes related to depression. However, no comprehensive synthesis of the main findings has been conducted. The aim of this manuscript was to systematically review the available evidence from animal and human studies on the association and the effects of dietary polyphenols on depression and provide recommendations for future research. We based our review on 163 preclinical animal, 16 observational and 44 intervention articles assessing the relationship between polyphenols and outcomes related to depression. Most animal studies demonstrated that exposure to polyphenols alleviated behaviours reported to be associated with depression. However, human studies are less clear, with some studies reporting and inverse relationship between the intake of some polyphenols, and polyphenol rich foods and depression risk and symptoms, while others reporting no association or effect. Hence, while there has been extensive research conducted in animals and there is some supporting evidence in humans, further human studies are required, particularly in younger and clinical populations.

Pandemic Depression: COVID-19 and the Mental Health of the Self-Employed

We investigate the effect of the COVID-19 pandemic on self-employed people’s mental health. Using representative longitudinal survey data from Germany, we reveal differential effects by gender: whereas self-employed women experienced a substantial deterioration in their mental health, self-employed men displayed no significant changes up to early 2021. Financial losses are important in explaining these differences. In addition, we find larger mental health responses among self-employed women who were directly affected by government-imposed restrictions and bore an increased childcare burden due to school and daycare closures. We also find that self-employed individuals who are more resilient coped better with the crisis.

The efficacy and safety of buprenorphine for the treatment of depression: A systematic review and meta-analysis

BACKGROUND

Depressive disorders are common. Many patients with major depression do not achieve remission with available treatments. Buprenorphine has been raised as a potential treatment for depression as well as suicidal behavior but may pose certain risks.

METHODS

A meta-analysis comparing the efficacy, tolerability, and safety of buprenorphine (or combinations such as buprenorphine/samidorphan) versus control in improving symptoms in patients with depression. Medline, Cochrane Database, PsycINFO, Excerpta Medica Database and The Cumulative Index to Nursing and Allied Health Literature were searched from inception through January 2, 2022. Depressive symptoms were pooled using Hedge's g with 95% Confidence Intervals (CI). Tolerability, safety, suicide outcomes were summarized qualitatively.

RESULTS

11 studies (N = 1699) met inclusion criteria. Buprenorphine had a small effect on depressive symptoms (Hedges' g 0.17, 95%CI: 0.05-0.29). Results were driven by six trials of buprenorphine/samidorphan (N = 1,343, Hedges's g 0.17, 95%CI: 0.04-0.29). One study reported significant improvement in suicidal thoughts (Least Squares Mean Change: -7.1, 95%CI: -12.0 - 2.3). Most studies found buprenorphine was well-tolerated with no evidence of abuse behavior or dependency.

CONCLUSIONS

Buprenorphine may have a small benefit for depressive symptoms. Future research should clarify the dose response relationship between buprenorphine and depression.

Prospective associations between joint categories of physical activity and insomnia symptoms with onset of poor mental health in a population-based cohort

BACKGROUND

Physical inactivity and insomnia symptoms are independently associated with increased risk of depression and anxiety; however, few studies jointly examine these risk factors. This study aimed to prospectively examine the joint association of physical activity (PA) and insomnia symptoms with onset of poor mental health in adults.

METHODS

Participants from the 2013 to 2018 annual waves of the Household Income and Labour Dynamics in Australia panel study who had good mental health (Mental Health Inventory-5 >54) in 2013, and who completed at least 1 follow-up survey (2014-2018), were included (n = 10,977). Poor mental health (Mental Health Inventory-5 ≤ 54) was assessed annually. Baseline (2013) PA was classified as high/moderate/low, and insomnia symptoms (i.e., trouble sleeping) were classified as no insomnia symptoms/insomnia symptoms, with 6 mutually exclusive PA-insomnia symptom groups derived. Associations of PA-insomnia symptom groups with onset of poor mental health were examined using discrete-time proportional-hazards logit-hazard models.

RESULTS

There were 2322 new cases of poor mental health (21.2%). Relative to the high PA/no insomnia symptoms group, there were higher odds (odds ratio and 95% confidence interval (95%CI)) of poor mental health among the high PA/insomnia symptoms (OR = 1.87, 95%CI: 1.57-2.23), moderate PA/insomnia symptoms (OR = 1.93, 95%CI: 1.61-2.31), low PA/insomnia symptoms (OR = 2.33, 95%CI: 1.96-2.78), and low PA/no insomnia symptoms (OR = 1.14, 95%CI: 1.01-1.29) groups. Any level of PA combined with insomnia symptoms was associated with increased odds of poor mental health, with the odds increasing as PA decreased.

CONCLUSION

These findings highlight the potential benefit of interventions targeting both PA and insomnia symptoms for promoting mental health.

Depression at the intersection of race/ethnicity, sex/gender, and sexual orientation in a nationally representative sample of US adults: A design-weighted MAIHDA

This study examined how race/ethnicity, sex/gender, and sexual orientation intersect to socially pattern depression among US adults. We used repeated, cross-sectional data from the 2015-2020 National Survey on Drug Use and Health (NSDUH; n=234,772) to conduct design-weighted multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) for two outcomes: past-year and lifetime major depressive episode (MDE). With 42 intersectional groups constructed from seven race/ethnicity, two sex/gender, and three sexual orientation categories, we estimated group-specific prevalence and excess/reduced prevalence attributable to intersectional effects (i.e., two-way or higher interactions between identity variables). Models revealed heterogeneity between intersectional groups, with prevalence estimates ranging from 3.4-31.4% (past-year) and 6.7-47.4% (lifetime). Model main effects indicated that people who were Multiracial, White, women, gay/lesbian, or bisexual had greater odds of MDE. Additive effects of race/ethnicity, sex/gender, and sexual orientation explained most between-group variance; however, approximately 3% (past-year) and 12% (lifetime) were attributable to intersectional effects, with some groups experiencing excess/reduced prevalence. For both outcomes, sexual orientation main effects (42.9-54.0%) explained a greater proportion of between-group variance relative to race/ethnicity (10.0-17.1%) and sex/gender (7.5-7.9%). Notably, we extend MAIHDA to calculate nationally representative estimates to open future opportunities to quantify intersectionality with complex sample survey data.

Cardiology and lifestyle medicine

Poor lifestyle habits, such as physical inactivity and poor diets, are highly prevalent within society and even more so among patients with chronic disease. The need to stem poor lifestyle habits has led to the development of a new field of Lifestyle Medicine, whose mission is to prevent, treat, and even reverse chronic diseases through lifestyle interventions. Three fields within Cardiology relate to this mission: Cardiac Rehabilitation, Preventive Cardiology, and Behavioral Cardiology. Each of these three fields have contributed substantially to the reduction of cardiovascular disease (CVD) morbidity and mortality. The historic contributions of these three cardiac fields are reviewed as well as the challenges each of these fields has faced in optimizing the application of lifestyle medicine practices. A shared agenda between Cardiology and the American College of Lifestyle Medicine could further the utilization of behavioral interventions. This review suggests seven steps that could be shared by these organizations and other medical societies. First, there is a need to develop and promulgate the assessment of lifestyle factors as "vital signs" during patient visits. Second, developing a strong partnership between the fields of Cardiology and Physiatry could improve important aspects of cardiac care, including a potential redesign of cardiac stress testing. Third, behavioral evaluations should be optimized at patients' entrée points into medical care since these may be considered "windows of opportunity". Fourth, there is a need to broaden cardiac rehabilitation into inexpensive programs and make this program eligible for patients with risk factors but no known CVD. Fifth, lifestyle medicine education should be integrated into the core competencies for relevant specialties. Sixth, there is a need for inter-societal advocacy to promote lifestyle medicine practices. Seventh, the well-being effects of healthy lifestyle behaviors, such as their impact on one's sense of vitality, should be emphasized.

The pursuit of health: A vitality based perspective

The larger number of adults who enter their senior years with a high burden of chronic diseases has led to new metrics designed to promote health pro-activity, such as the calculation of one's "healthspan". These efforts call for re-evaluation as to what is meant by "health". A large body of epidemiologic and clinical investigation identifies that good health is shaped by specific health behaviors (aerobic exercise, resistance training, sleep, and good diet quality) and four psychological determinants (positive emotions, positive mindsets, purposeful living, and social connectivity). In common, each of these determinants produce "vitality", which can be defined as having the pleasing sensation of feeling energetic. Having a strong sense of vitality produces a sense of agency, provides resilience, and serves as a leading indicator of good health. Importantly, vitality can be assessed as a single item "vital sign" in clinical practice and can be promoted by recommending simple steps to patients, such as suggesting that they initiate walking or other aerobic activities. Because health habits and psychological determinants of health are inter-related, such simple steps can initiate a "virtuous cycle" of health improvement. An emphasis on vitality can also encourage patients to become more cognizant of their level of energy and manage it through health-promoting behaviors rather than quick fix behaviors. Finally, vitality assessment and prescription can promote more successful aging. In sum, an updated and more clinically useful definition of health recognizes that it is a dynamic entity that is influenced at any time by one's engagement in physical and psychological practices that promote health. Accordingly, an updated definition of health is proposed: good health is characterized by physical and psychological well-being and is associated with vitality.

Assessment of bidirectional relationships between depression and rheumatoid arthritis among adults: a two-sample Mendelian randomization study

OBJECTIVE

Increasing evidence shows that depression is associated with rheumatoid arthritis (RA). However, the causality and direction of this association remain unclear, because links between the two diseases might be caused by shared environmental confounding factors. Our study aims to understand a putative causal link between the two diseases.

METHODS

We retrieved summary statistics from meta-analyses of non-overlapping genome-wide association studies (GWASes) for depression (n = 807,553, 246,363 cases and 561,190 controls) and RA (n = 58,284, 14,361 cases and 42,923 controls). We combined Mendelian randomization (MR) estimates from each genetic instrument using inverse-variance weighted (IVW) meta-analysis, with alternate methods (e.g., simple median approach, weighted median approach, and MR-Egger regression) and conducted sensitivity analyses to assess the robustness of MR analyses.

RESULTS

We found no evidence of causal relationships between depression and RA across all MR methods (IVW OR, 1.028 for RA; 95% CI, 0.821-1.287; P = 0.810) or vice versa (IVW OR, 0.999 for depression; 95% CI, 0.984-1.014; P = 0.932), indicating the links between the two diseases might be due to confounders.

CONCLUSION

Despite the results, to optimize treatment outcomes of RA patients, we still emphasize depression should be managed as part of routine clinical care to optimize treatment outcomes of RA.

Life-Weariness, Wish to Die, Active Suicidal Ideation, and All-Cause Mortality in Population-Based Samples of Older Adults

OBJECTIVES

To investigate potential differences in the strength of associations between different levels of passive and active suicidal ideation and all-cause mortality in older adults.

DESIGN

Prospective cohort study.

SETTING

Population-based samples of older adults in Gothenburg, Sweden.

PARTICIPANTS

Older adults aged 79 and above who participated in any wave of the Gothenburg H70 Birth Cohort Studies or the Prospective Population Study of Women between 1986 and 2015 (n = 2,438; 1,737 women, 701 men; mean age 86.6).

MEASUREMENTS

Most intense level of passive or active suicidal ideation during the past month: life-weariness, wish to die, or active suicidal ideation. The outcome was all-cause mortality over 3 years.

RESULTS

During follow-up, 672 participants (27.6%) died. After adjustments for sex, age, and year of examination, participants who reported a wish to die (HR 2.01; 95% CI 1.55-2.60) as the most intense level of ideation, but not participants who reported life-weariness (HR 1.40; 95% CI 0.88-2.21) or active suicidal ideation (HR 1.10; 95% CI 0.69-1.76) were at increased risk of all-cause mortality. Reporting a wish to die remained associated with mortality in a fully adjusted model, including somatic conditions, dementia, depression, and loneliness (HR 1.70; 95% CI 1.27-2.26).

CONCLUSION

In older adults, reporting a wish to die appears to be more strongly associated with all-cause mortality than either life-weariness or active suicidal ideation.

Time trends in depression prevalence among Swedish 85-year-olds: repeated cross-sectional population-based studies in 1986, 2008, and 2015

BACKGROUND

Octogenarians of today are better educated, and physically and cognitively healthier, than earlier born cohorts. Less is known about time trends in mental health in this age group. We aimed to study time trends in the prevalence of depression and psychotropic drug use among Swedish 85-year-olds.

METHODS

We derived data from interviews with 85-year-olds in 1986-1987 (N = 348), 2008-2010 (N = 433) and 2015-17 (N = 321). Depression diagnoses were made according to the Diagnostic and Statistical Manual of Mental Disorders. Symptom burden was assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS). Information on psychotropic drug use, sociodemographic, and health-related factors were collected during the interviews.

RESULTS

The prevalence of major depression was lower in 2015-2017 (4.7%, p < 0.001) and 2008-2010 (6.9%, p = 0.010) compared to 1986-1987 (12.4%). The prevalence of minor depression was lower in 2015-2017 (8.1%) compared to 2008-2010 (16.2%, p = 0.001) and 1986-1987 (17.8%, p < 0.001). Mean MADRS score decreased from 8.0 in 1986-1987 to 6.5 in 2008-2010, and 5.1 in 2015-2017 (p < 0.001). The reduced prevalence of depression was not explained by changes in sociodemographic and health-related risk factors for depression. While psychoactive drug use was observed in a third of the participants in each cohort, drug type changed over time (increased use of antidepressants and decreased use of anxiolytics and antipsychotics).

CONCLUSIONS

The prevalence of depression in octogenarians has declined during the past decades. The decline was not explained by changes in known risk factors for depression. The present study cannot answer whether changed prescription patterns of psychoactive drugs have contributed to the decline.

Mediating role of personality traits in the association between multi-dimensional adverse childhood experiences and depressive symptoms among older adults: A 9-year prospective cohort study

BACKGROUND

To explore the mediating role of personality traits in the correlation between multi-dimensional adverse childhood experiences (ACEs) and depressive symptoms in older adults.

METHODS

This cohort study used data from the English Longitudinal Study of Ageing, and included 4050 older adults without depressive symptoms in 2010-2011. Multi-dimensional ACEs were evaluated in 2006-2007. Personality traits were assessed using the Midlife Development Inventory in 2010-2011. Depressive symptoms were measured using the 8-item version of the Center for Epidemiologic Studies Depression Scale during 2012-2019. Cox proportional hazard model was used to explore the associations between ACEs and depressive symptoms. The package named "mediation" in R was used to test mediating role of personality traits.

RESULTS

ACEs in each dimension significantly increased the risk of depressive symptoms (all P-values < 0.05). The association of maltreatment (18.18 %) and household dysfunction (19.69 %) with depressive symptoms was significantly mediated by neuroticism. The correlation between poor parent-child bonding and depressive symptoms was significantly mediated by neuroticism (19.43 %), conscientiousness (4.84 %), and extroversion (8.02 %).

LIMITATIONS

ACEs were retrospectively assessed based on participants' memories, which may induce recall bias.

CONCLUSIONS

Maltreatment and household dysfunction may induce depressive symptoms by increasing neuroticism. Poor parent-child bonding may induce depressive symptoms by increasing neuroticism and reducing conscientiousness and extraversion. In addition to reducing the occurrence of ACEs, reducing neuroticism of individuals with maltreatment and household dysfunction in childhood, and reducing neuroticism, and increasing conscientiousness and extraversion of individuals with poor parent-child bonding in childhood might help to decrease their risk of depressive symptoms.

Association between depressive symptoms and the risk of all-cause and cardiovascular mortality among US adults

Depression is a preventable and treatable mental health condition. Therefore, there are important clinical implications for identifying people with the highest mortality risk in a nationally representative sample. This study included 26,207 participants aged ≥18 years from the 2005-2014 National Health and Nutrition Examination Survey in USA. We investigated the association between depressive symptoms (defined as Patient Health Questionnaire 9 scores ≥10) and all-cause and cardiovascular disease (CVD) mortalities, adjusted for multiple factors (sociodemographic in Model 1, behavioral added in Model 2, and metabolic syndrome added in Model 3) and stratified by age and sex. During an average follow-up of 69.15 months (standard deviation [SD] 34.45), 1872 (7.3%) participants had died (person-years in the non-depressive and depressive groups, 12.12/1000 and 16.43/1000, respectively). Depressive symptoms increased all-cause (crude hazard ratio [HR] 1.37, 95% confidence interval [CI], 1.33-1.58) and CVD mortalities (crude HR 1.64, 95% CI, 1.20-2.24). Although the significance of all-cause mortality and CVD mortality was maintained in Models 1 (HR 1.58 and 2.08) and 2 (HR 1.48 and 1.79), it was not maintained in Model 3. Current smoking and lower physical activity were associated with reduced strength of the association between depression and all-cause mortality risk. The effect of depression on mortality risk was particularly pronounced in middle-aged men and older women. Our findings suggest that depressive symptoms increase mortality risk, even after adjusting for behavioral factors. Depression-induced mortality risk is particularly high among middle-aged men and older women.

Efficacy and moderators of short-term psychodynamic psychotherapy for depression: A systematic review and meta-analysis of individual participant data

BACKGROUND

Short-term psychodynamic psychotherapy (STPP) is frequently used to treat depression, but it is unclear which patients might benefit specifically. Individual participant data (IPD) meta-analyses can provide more precise effect estimates than conventional meta-analyses and identify patient-level moderators. This IPD meta-analysis examined the efficacy and moderators of STPP for depression compared to control conditions.

METHODS

PubMed, PsycInfo, Embase, and Cochrane Library were searched September 1st, 2022, to identify randomized trials comparing STPP to control conditions for adults with depression. IPD were requested and analyzed using mixed-effects models.

RESULTS

IPD were obtained from 11 of the 13 (84.6%) studies identified (n = 771/837, 92.1%; mean age = 40.8, SD = 13.3; 79.3% female). STPP resulted in significantly lower depressive symptom levels than control conditions at post-treatment (d = -0.62, 95%CI [-0.76, -0.47], p < .001). At post-treatment, STPP was more efficacious for participants with longer rather than shorter current depressive episode durations.

CONCLUSIONS

These results support the evidence base of STPP for depression and indicate episode duration as an effect modifier. This moderator finding, however, is observational and requires prospective validation in future large-scale trials.

Association between excess mortality in depressive status and frailty among older adults: A population-based Kyoto-Kameoka prospective cohort study

OBJECTIVES

Frailty has been shown to be a mediator of the risk of excess death due to depression in older adults, although this relationship has not been sufficiently investigated. Our objective was to evaluate this relationship.

METHODS

We used data from 7,913 Japanese people aged≥65 years who participated in the Kyoto-Kameoka prospective cohort study and who provided valid responses to the Geriatric Depression Scale-15 (GDS-15) and the World Health Organization-Five Well-Being Index (WHO-5) in mail-in surveys. Depressive status was assessed using the GDS-15 and WHO-5. Frailty was evaluated using the Kihon Checklist. Data on mortality were collected from February 15, 2012, to November 30, 2016. We evaluated the relationship between depression and all-cause mortality risk using a Cox proportional-hazards model.

RESULTS

The prevalence of depressive status assessed by GDS-15 and WHO-5 was 25.4% and 40.1%, respectively. In total, 665 deaths were recorded during a median follow-up period of 4.75 years (35,878 person-years). After adjusting for confounders, we found that depressive status assessed by the GDS-15 had a higher risk of mortality than those without it (hazard ratio [HR] 1.62, 95% confidence interval [CI] 1.38-1.91). This association was moderately weaker when adjusted for frailty (HR 1.46, 95% CI 1.23-1.73). Similar results were observed when depression was assessed with the WHO-5.

CONCLUSION

Our findings suggest that the risk of excess death due to depressive status in older adults may be partially explained by frailty. This indicates a need to focus on improving frailty besides conventional depression treatments.

Electroacupuncture Alleviates Depressive-like Behavior by Modulating the Expression of P2X7/NLRP3/IL-1β of Prefrontal Cortex and Liver in Rats Exposed to Chronic Unpredictable Mild Stress

Depression is a complex clinical disorder associated with poor outcomes. Electroacupuncture (EA) has been demonstrated to have an important role in both clinical and pre-clinical depression investigations. Evidence has suggested that the P2X7 receptor (P2X7R), NLRP3, and IL-1β play an important role in depressive disorder. Our study is aimed at exploring the role of EA in alleviating depression-like behaviors in rats. We therefore investigated the effects of EA on the prefrontal cortex and liver of rats subjected to chronic unpredictable mild stress (CUMS) through behavior tests, transmission electron microscopy, Nissl staining, HE staining, immunohistochemistry and Western blotting. Five weeks after exposure to CUMS, Sprague-Dawley (SD) rats showed depression-like behavior. Three weeks after treatment with brilliant blue G (BBG) or EA, depressive symptoms were significantly improved. Liver cells and microglia showed regular morphology and orderly arrangement in the BBG and EA groups compared with the CUMS group. Here we show that EA downregulated P2X7R/NLRP3/IL-1β expression and relieved depression-like behavior. In summary, our findings demonstrated the efficacy of EA in alleviating depression-like behaviors induced by CUMS in rats. This suggests that EA may serve as an adjunctive therapy in clinical practice, and that P2X7R may be a promising target for EA intervention on the liver–brain axis in treatment of depression.

Using filled prescription sequences to rank antidepressants: A nationwide replication study

Ranking antidepressants according to their acceptability (i.e., a combination of both efficacy and tolerability) in the general population may help choosing the best first-line medication. This study aimed to replicate the results of a proof-of-concept study ranking anti-depressants according to the proportion of filled prescription sequences consistent with a continuation of the first treatment versus those consistent with a change. We used a nationwide cohort from the French national health data system (SNDS) to support the use of this method as a widely available tool to rank antidepressant treatments in real life settings. About 1.2 million people were identified as new antidepressant users in the SNDS in 2011. The outcome was clinical acceptability as measured by the continuation/failure ratio over the six-month period following the introduction of the first-line treatment. Continuation was defined as at least two refills of the same treatment. Failure was defined as a psychiatric hospitalization, death or at least one filled prescription of another antidepressant, an antipsychotic medication, or a mood-stabilizer. Adjusted Odds Ratios (aOR) and 95% Confidence Interval (CI) were computed through multivariable binary logistic regressions. We ranked antidepressant medications according to clinical acceptability. Escitalopram again was the most acceptable option, and the five following antidepressants were the same as in the replication sample of the proof-of-concept study, in order Fluoxetine, Paroxetine, Sertraline, Citalopram and Venlafaxine with aOR (95% CI) for continuation ranging from 0.79 (0.77-0.81) to 0.66 (0.64-0.67). The present study provides evidence that filled prescription sequences is a widely available, robust and reproductible tool to rank antidepressant treatments in real life settings.

Association of depression with all-cause and cardiovascular mortality among US adults with high and low baseline risk of cardiovascular disease

The intervention of depression was considered a prevention and treatment option for cardiovascular disease (CVD). However, evidence regarding whether association of depression with mortality differed among people at high or low risk of CVD yielded conflicting results. We aimed to investigate associations between depression and all-cause and CVD mortality among 3854 and 3044 US adults at high and low baseline risk of CVD, respectively. Among participants at high risk of CVD, depression and per 5-point increase in PHQ-9 score were associated with 81% (HR=1.81, 95%CI: 1.15-2.86) and 33% (HR=1.33, 95%CI: 1.14-1.55) increased all-cause mortality, respectively. We did not find statistically significant associations between depression (HR=1.40, 95%CI: 0.67-2.95) and PHQ-9 score (HR=1.28, 95%CI: 1.00-1.63) with CVD mortality due to a small number of mortality events. Among people with low risk of CVD, each 5-point increment in PHQ-9 score was associated with all-cause mortality (HR=1.26, 95%CI: 1.02-1.56), while there was no statistically significant association of depression with all-cause mortality (HR=1.69, 95%CI: 0.75-3.81) and CVD mortality (HR=1.99, 95%CI: 0.83-4.81). This study found that depression was associated with all-cause mortality among individuals at a high baseline risk of CVD, but no significant association was observed in people at a low baseline risk of CVD.

Impact of nonalcoholic fatty liver disease-related metabolic state on depression

Nonalcoholic fatty liver disease (NAFLD), also recently referred as metabolic (dysfunction)-associated fatty liver disease (MAFLD), is characterized by hepatocyte steatosis in the setting of metabolic risk conditions and in the absence of an underlying precursor, for instance alcohol consumption, hepatotropic viruses and hepatotoxic drugs. A possible association between NAFLD and depression has been proposed, owing to intersecting pathophysiological pathways. This narrative review aimed to summarize the current evidence that illustrate the potential pathophysiological and clinical linkage between NAFLD-related metabolic state and depression. Prefrontal cortex lesions are suggested to be a consequence of liver steatosis-associated systematic hyperinflammatory state, a phenomenon also occurring in depression. In addition, depressive symptoms are present in neurotransmitter imbalances. These abnormalities seem to be correlated with NAFLD/MAFLD, in terms of insulin resistance (IR), ammonia and gut dysbiosis' impact on serotonin, dopamine, noradrenaline levels and gamma aminobutyric acid receptors. Furthermore, reduced levels of nesfatin-1 and copine-6-associated BDNF (brain-derived neurotrophic factor) levels have been considered as a probable link between NAFLD and depression. Regarding NAFLD-related gut dysbiosis, it stimulates mediators including lipopolysaccharides, short-chain fatty acids and bile acids, which play significant role in depression. Finally, western diet and IR, which are mainstay components of NAFLD/MAFLD, are, also, substantiated to affect neurotransmitters in hippocampus and produce neurotoxic lipids that contribute to neurologic dysfunction, and thus trigger emotional disturbances, mainly depressive symptoms.

Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta-analysis including 409 trials with 52,702 patients

Cognitive behavior therapy (CBT) is by far the most examined type of psychological treatment for depression and is recommended in most treatment guide-lines. However, no recent meta-analysis has integrated the results of randomized trials examining its effects, and its efficacy in comparison with other psychotherapies, pharmacotherapies and combined treatment for depression remains uncertain. We searched PubMed, PsycINFO, Embase and the Cochrane Library to identify studies on CBT, and separated included trials into several subsets to conduct random-effects meta-analyses. We included 409 trials (518 comparisons) with 52,702 patients, thus conducting the largest meta-analysis ever of a specific type of psychotherapy for a mental disorder. The quality of the trials was found to have increased significantly over time (with increasing numbers of trials with low risk of bias, less waitlist control groups, and larger sample sizes). CBT had moderate to large effects compared to control conditions such as care as usual and waitlist (g=0.79; 95% CI: 0.70-0.89), which remained similar in sensitivity analyses and were still significant at 6-12 month follow-up. There was no reduction of the effect size of CBT according to the publication year (<2001 vs. 2001-2010 vs. >2011). CBT was significantly more effective than other psychotherapies, but the difference was small (g=0.06; 95% CI: 0-0.12) and became non-significant in most sensitivity analyses. The effects of CBT did not differ significantly from those of pharmacotherapies at the short term, but were significantly larger at 6-12 month follow-up (g=0.34; 95% CI: 0.09-0.58), although the number of trials was small, and the difference was not significant in all sensitivity analyses. Combined treatment was more effective than pharmacotherapies alone at the short (g=0.51; 95% CI: 0.19-0.84) and long term (g=0.32; 95% CI: 0.09-0.55), but it was not more effective than CBT alone at either time point. CBT was also effective as unguided self-help intervention (g=0.45; 95% CI: 0.31-0.60), in institutional settings (g=0.65; 95% CI: 0.21-1.08), and in children and adolescents (g=0.41; 95% CI: 0.25-0.57). We can conclude that the efficacy of CBT in depression is documented across different formats, ages, target groups, and settings. However, the superiority of CBT over other psychotherapies for depression does not emerge clearly from this meta-analysis. CBT appears to be as effective as pharmacotherapies at the short term, but more effective at the longer term.

Cost-Utility Analysis of Esketamine for Patients with Treatment-Resistant Depression in Italy

AIM

Major depressive disorder is considered one of the most frequent diseases in the general population, and treatment-resistant depression (TRD) represents the subset with more significant clinical and social impact. Large, robust phase III studies have shown safety and efficacy of esketamine nasal spray plus SSRI/SNRI antidepressants (ADs) compared with SSRI/SNRI plus placebo nasal spray in patients with TRD. The main aim of this study was to perform a cost-utility analysis comparing esketamine plus ADs with ADs alone in TRD patients, from the societal perspective in Italy. A secondary analysis focused on the National Healthcare Service (NHS) perspective.

METHODS

A Markov multistate model has been developed to estimate quality-adjusted life years and economic outcomes of both treatment strategies over 5 years considering the initiation of esketamine in the different treatment lines, from 3 to 5 (3L-5L). The model has been populated with data from literature and real-world evidence. The analysis from the societal perspective considered direct healthcare costs and patients' productivity losses. In addition to the incremental cost-utility ratio (ICUR), the incremental net monetary benefit (INMB) has been calculated as (incremental benefit × WTP) - incremental cost and by applying a willingness-to-pay (WTP) of 50,000€/QALY. Deterministic and probabilistic sensitivity analyses have been performed to assess the robustness of the model results.

RESULTS

From the societal perspective, the ICUR ranged between 16,314€ and 22,133€ per QALY according to the different treatment lines, while it was over the threshold of 100,000€/QALY for the NHS perspective. The INMB was positive and ranged from 2259€ to 2744€ across treatment lines in the societal perspective; the INMB begins to occur earlier when moving towards subsequent lines of treatment (3.9 years for 3L, 3.6 years for 4L and 3.5 years for 5L). The analyses showed also that the advantage in terms of INMB is maintained for a wide range of societal preferences expressed by WTP thresholds, and in particular for values above 22,200€, 16,400€ and 17,100€ for 3L, 4L and 5L, respectively.

CONCLUSION

The study showed that esketamine may be a cost-effective opportunity from the societal perspective for the management of patients with treatment-resistant depression. In the future, data collected from observational studies or registries, which can include the collection of productivity losses and also costs sustained by the patients, will be able to provide further evidence in order to improve the reliability of the model results.

Depressive symptoms and mortality-findings from Helsinki birth cohort study

BACKGROUND

Individuals with depression and depressive symptoms have a higher mortality rate than non-depressed individuals. The increased comorbidity and mortality associated with depression has remained largely unexplained. The underlying pathophysiological differences between depressive subtypes, melancholic and non-melancholic, may provide some explanation to this phenomenon.

METHODS

One thousand nine hundred and ninety five participants (mean age 61 years) from the Helsinki Birth Cohort Study were recruited for this prospective study and followed up for a mean of 14.1 years. Information regarding medical history, lifestyle, and biochemical parameters were obtained. Depressive symptoms were assessed using the Beck Depression Inventory. Standardized mortality ratios were calculated.

RESULTS

Participants were followed up for a total of 28,044 person-years. The melancholic depressive group had an increased adjusted risk of mortality [HR 1.49 (95% CI: 1.02-2.20)] when compared to the non-depressive group. Comparing mortality to the whole population of Finland using standardized mortality ratios (SMR) both the non-melancholic [1.11 (95% CI: 0.85-1.44)] and melancholic depressive [1.26 (95% CI: 0.87-1.81)] groups had higher mortality than the non-depressive group [0.82 (95% CI: 0.73-0.93)].

CONCLUSIONS

Melancholic depressive symptoms are most strongly related to a higher mortality risk.

Late-life depression and multimorbidity trajectories: the role of symptom complexity and severity

INTRODUCTION

as late-life depression is associated with poor somatic health, we aimed to investigate the role of depression severity and symptom phenotypes in the progression of somatic multimorbidity.

METHODS

we analysed data from 3,042 dementia-free individuals (60+) participating in the population-based Swedish National Study on Aging and Care in Kungsholmen. Using the baseline clinical assessment of 21 depressive symptoms from the Comprehensive Psychopathological Rating Scale, we: (i) diagnosed major, minor (in accordance with DSM-IV-TR) and subsyndromal depression; (ii) extracted symptom phenotypes by applying exploratory network graph analysis. Somatic multimorbidity was measured as the number of co-occurring chronic diseases over a 15-year follow-up. Linear mixed models were used to explore somatic multimorbidity trajectories in relation to baseline depression diagnoses and symptom phenotypes, while accounting for sociodemographic and behavioural factors.

RESULTS

in multi-adjusted models, relative to individuals without depression, those with major (β per year: 0.33, 95% confidence interval [CI]: 0.06-0.61) and subsyndromal depression (β per year: 0.21, 95%CI: 0.12-0.30) experienced an accelerated rate of somatic multimorbidity accumulation, whereas those with minor depression did not. We identified affective, anxiety, cognitive, and psychomotor symptom phenotypes from the network analysis. When modelled separately, an increase in symptom score for each phenotype was associated with faster multimorbidity accumulation, although only the cognitive phenotype retained its association in a mutually adjusted model (β per year: 0.07, 95%CI: 0.03-0.10).

CONCLUSIONS

late-life major and subsyndromal depression are associated with accelerated somatic multimorbidity. Depressive symptoms characterised by a cognitive phenotype are linked to somatic health change in old age.

The impact of social determinants of health on obesity and diabetes disparities among Latino communities in Southern California

BACKGROUND

Social determinants of health (SDoH) describe the complex network of circumstances that impact an individual before birth and across the lifespan. SDoH contextualize factors in a community that are associated with chronic disease risk and certain health disparities. The main objective of this study was to explore the impact of SDoH on the prevalence of obesity and diabetes, and whether these factors explain disparities in these health outcomes among Latinos in Southern California.

METHODS

We utilized three composite indices that encompass different SDoH: the Healthy Places Index (HPI), Social Vulnerability Index (SVI), and CalEnviroScreen (CES). Univariate linear regression models explored the associations between index scores with adult obesity, adult diabetes, and childhood obesity.

RESULTS

Communities with lower HPI scores were associated with higher prevalence of metabolic disease and a greater proportion of Latino residents. Cities in the lowest decile of HPI scores had 71% of the population identifying as Latino compared to 12% in the highest decile. HPI scores explained 61% of the variability in adult obesity (p < 0.001), 41% of the variability in childhood obesity (p < 0.001), and 47% of the variability in adult diabetes (p < 0.001). Similar results were observed when examining SVI and CES with these health outcomes.

CONCLUSIONS

These results suggest that Latinos in Southern California live in communities with adverse SDoH and face a greater burden of adult obesity, diabetes, and childhood obesity.

Effects of psychological treatment for depression among people not actively seeking help: a meta-analysis

Although psychological treatments have been found to be effective for depression in adults, many individuals with depression do not actively seek help. It is currently unclear whether psychological treatments are effective among those not actively seeking help. Besides, little is known about the proportion of patients who completed a screening questionnaire who end up in a clinical trial. Therefore, we conducted a meta-analysis of 52 randomized trials comparing psychotherapies for adults with a diagnosis or elevated symptoms of depression against control conditions (care-as-usual, waiting list, and other inactive treatment). Only studies recruiting participants who do not actively seek help (participants who have been recruited through screening instead of advertisements and clinical referrals) were included. To obtain an overall effect estimate of psychotherapy, we pooled all post-test differences with a random-effects model. We found that psychological treatments had a moderate to high effect on reducing depressive symptoms compared to control groups [g = 0.55; 95% confidence interval (CI) 0.41-0.69]. Heterogeneity was high (I² = 75%; 95% CI 68-80). At 12 months' follow-up, the effects were small but significant (6-8 months: g = 0.33; 95% CI 0.14-0.52; 9-12 months: g = 0.24; 95% CI 0.11-0.37). As a secondary outcome, we found that 13% of patients who completed a screening questionnaire met the inclusion criteria for depression and agreed to be randomized in the trial. Based on the current evidence, psychological treatments for depression might be effective for depressed patients who are not actively seeking help.

Serum levels of carnosine may be associated with the duration of MDD episodes

BACKGROUND

Major depressive disorder (MDD) is a recurrent disorder that incurs a high societal burden. However, the etiology of MDD remains unclear. The functioning of several systems associated with the etiopathogenesis of MDD, such as inflammatory and stress systems, is partially modulated by the dipeptide carnosine.

METHODS

The study comprised 99 MDD patients and 253 non-depressed controls aged 20-71 years. Fasting serum samples were analyzed using ultra-performance liquid chromatography coupled to mass spectrometry to determine the serum levels of carnosine and its constituent, histidine. We compared these metabolites in three different settings: 1) MDD patients vs. non-depressed controls and 2) remitted vs. non-remitted MDD patients, as well as 3) changes in the metabolite levels during the follow-up period within a) the remitted group and b) the non-remitted group. In addition, we assessed the possible effect of medications on the measured metabolites.

RESULTS

We observed higher serum levels of carnosine in the MDD group compared to the control group at baseline (OR = 1.895, 95%CI = 1.223-2.937, p = 0.004). Elevated serum levels of carnosine were also associated with a longer duration of the depressive episode (Z = 0.406, p = 0.001). However, the use of any antipsychotic medication (n = 36) was associated with lowered carnosine levels (p = 0.010 for use vs. non-use). At the follow-up, remitted and non-remitted participants displayed no significant differences in their carnosine levels (Z = -0.14, p = 0.891) or histidine (Z = -1.39 p = 0.164).

CONCLUSIONS

An increase in circulating carnosine may characterize depressive episodes and may represent a protective homeostatic reaction against MDD-related oxidative stress and inflammation.

Exploring the role of ketone bodies in the diagnosis and treatment of psychiatric disorders

In recent times, advances in the field of metabolomics have shed greater light on the role of metabolic disturbances in neuropsychiatric conditions. The following review explores the role of ketone bodies and ketosis in both the diagnosis and treatment of three major psychiatric disorders: major depressive disorder, anxiety disorders, and schizophrenia. Distinction is made between the potential therapeutic effects of the ketogenic diet and exogenous ketone preparations, as exogenous ketones in particular offer a standardized, reproducible manner for inducing ketosis. Compelling associations between symptoms of mental distress and dysregulation in central nervous system ketone metabolism have been demonstrated in preclinical studies with putative neuroprotective effects of ketone bodies being elucidated, including effects on inflammasomes and the promotion of neurogenesis in the central nervous system. Despite emerging pre-clinical data, clinical research on ketone body effectiveness as a treatment option for psychiatric disorders remains lacking. This gap in understanding warrants further investigating, especially considering that safe and acceptable ways of inducing ketosis are readily available.

Late-Onset Depression but not Early-Onset Depression may Increase the Risk of All-Cause Mortality in Older Age: 8-Year Follow-Up of the Salus in Apulia Study

OBJECTIVES

Individuals with late-life depression (LLD) may have shorter survival, but there is a lack of findings in population-based settings about health-related outcomes of LLD and its subtypes: early-onset depression (EOD) and late-onset depression (LOD). We aimed to evaluate the risk of all-cause mortality of individuals with LLD and its subtypes in an older population-based cohort. Moreover, we investigated whether inflammatory, cognitive, genetic features and multimorbidity could modify the effect of this association.

DESIGN

Longitudinal population-based study with 8-year follow-up.

SETTING AND PARTICIPANTS

We analyzed data on a sample of 1479 participants, all aged >65 years, in the Salus in Apulia Study.

METHODS

LLD was diagnosed through DSM-IV-TR criteria and LOD and EOD according to the age of onset. Multimorbidity status was defined as the copresence of 2 or more chronic diseases.

RESULTS

The overall prevalence of LLD in this older sample from Southern Italy was 10.2%, subdivided into 3.4% EOD and 6.8% LOD. In multivariable Cox models adjusted for age, gender, education, global cognition, apolipoprotein E ε4 allele, physical frailty, interleukin-6, and multimorbidity, LLD showed a greater risk of all-cause mortality. LOD differed from EOD regarding gender, education, cognitive dysfunctions, and diabetes mellitus. There was a significantly increased risk of all-cause mortality for participants with LOD (hazard ratio:1.99; 95% CI 1.33-2.97) in the time of observation between enrollment date and death date (7.31 ± 2.17 months).

CONCLUSIONS AND IMPLICATION

In older age, individuals with LOD but not with EOD had a significantly decreased survival, probably related to increased inflammation, multimorbidity, and cognitive impairments.

Agreement for diagnosis of depression and anxiety between self-assessment with e-questionnaire and psychiatric telephone interview among post-COVID-19 patients

BACKGROUND

Psychological disorders, such as depression and anxiety, are common among individuals who have experienced coronavirus disease 2019 (COVID-19); however, diagnosis may be challenging and subjected to invalidity. This study aimed to examine agreement between online self-assessment and psychiatric telephone interview among COVID-19 survivors.

MATERIALS AND METHODS

This cross-sectional descriptive study was carried out from March to June 2021 in Afzalipour Hospital, Kerman, Iran. The inpatients confirmed with COVID-19 were contacted within the first week after discharge and were asked to fill the Hospital Anxiety and Depression scale (HADS) and socio-demography questionnaire. They were later interviewed using Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A). Agreement between the data extracted from self-report and telephone interview was analyzed using Cohen's kappa coefficient, sensitivity, and specificity.

RESULTS

Out of 200 post-COVID patients, 60 participants completed all assessments. Prevalence of depression was observed to be 88% via telephone interview and 45% via self-assessment. Moreover, 83% of the participants were diagnosed with anxiety according to the telephone interview, in comparison to 31% diagnosed with anxiety using self-report questionnaire. The agreement between online self-assessment and telephone interview for depression and anxiety was not significant (κ = 0.08 and κ = 0.1, respectively).

CONCLUSION

The discordance between online self-report and clinician's assessment via phone contact interview indicates that using self-report evaluations is not sufficient as the single assessment tool for mental health monitoring and reflects the need to employ multiple assessments for diagnosis of psychiatric problems in pandemics.

Cost-effectiveness of esketamine nasal spray compared to intravenous ketamine for patients with treatment-resistant depression in the US utilizing clinical trial efficacy and real-world effectiveness estimates

OBJECTIVE

The aim of this study was to estimate the cost-effectiveness of esketamine nasal spray relative to intravenous ketamine for patients with treatment-resistant depression (TRD) in the US.

METHODS

We used a Markov model with a 1-month cycle length, and we estimated quality-adjusted life years (QALYs), costs (2020 USD), and incremental cost-effectiveness ratios (ICER) of esketamine relative to ketamine over a 3-year time horizon, from both the healthcare sector and patient perspectives. We ran the model using efficacy estimates from both clinical trial and real-world effectiveness (RWE) data. One-way and probabilistic sensitivity analyses (PSAs) were performed to evaluate the robustness of findings.

RESULTS

Over a 3-year time horizon, the use of esketamine yielded 1.98 QALYs (RWE/clinical trial efficacy), and the use of ketamine yielded 2.03 QALYs (clinical trial efficacy) or 1.99 QALYs (RWE). Esketamine was dominated by ketamine using the healthcare perspective. ICERs were above $150,000/QALY threshold with the patient perspective. Under the healthcare perspective, PSA showed there are no scenarios where esketamine was cost-effective compared to ketamine. With the patient's perspective, the probability that esketamine was cost-effective compared to ketamine was 0.0055 (clinical trial efficacy) and 0.35 (RWE).

LIMITATIONS

The data utilized for efficacy have limitations. The time horizon may fail to capture longer-term costs and benefits.

CONCLUSIONS

In this decision analytic model evaluating esketamine versus ketamine for TRD, we found esketamine unlikely to be cost-effective under a healthcare sector perspective. Under a patient perspective, esketamine had similar effectiveness and was less costly than ketamine due to insurance coverage.

Association of domain-specific physical activity with depressive symptoms: A population-based study

BACKGROUND

It remains unclear whether all physical activity (PA) domains (e.g., occupation-related PA [OPA], transportation-related PA [TPA], and leisure-time PA [LTPA]) have equivalent beneficial relationships. We aimed to investigate the associations of OPA, TPA, and LTPA with depressive symptoms in adults.

METHODS

We included and analyzed 31,221 participants (aged ≥18 years) from the cross-sectional 2007-2018 U.S. National Health and Nutrition Examination Survey (NHANES). The PA domains were assessed by a self-report questionnaire and categorized based on the PA guidelines. Depressive symptoms were measured by the nine-item Patient Health Questionnaire.

RESULTS

Participants achieving PA guidelines (≥150 min/week) were 26% (odds ratio [OR] 0.74, 95% confidence interval [CI] 0.68-0.80) and 43% (OR 0.57, 95% CI 0.51-0.62) less likely to have depressive symptoms depending on total PA and LTPA, respectively, while OPA or TPA did not demonstrate lower risks of depressive symptoms. LTPA at levels of 1-149, 150-299, and ≥300 min/week was associated with 31% (OR 0.69, 95% CI 0.60-0.78), 43% (OR 0.57, 95% CI 0.49-0.67), and 51% (OR 0.49, 95% CI 0.43-0.55) lower odds of depressive symptoms, respectively.

CONCLUSION

LTPA, but not OPA or TPA, was associated with a lower risk of depressive symptoms at any amount, suggesting that significant mental health would benefit from increased PA, even at levels below the recommendation.

Clinical Spectrum and Trajectory of Innovative Therapeutic Interventions for Insomnia: A Perspective

Increasing incidences of insomnia in adults, as well as the aging population, have been reported for their negative impact on the quality of life. Insomnia episodes may be associated with neurocognitive, musculoskeletal, cardiovascular, gastrointestinal, renal, hepatic, and metabolic disorders. Epidemiological evidence also revealed the association of insomnia with oncologic and asthmatic complications, which has been indicated as bidirectional. Two therapeutic approaches including cognitive behavioral therapy (CBT) and drugs-based therapies are being practiced for a long time. However, the adverse events associated with drugs limit their wide and long-term application. Further, Traditional Chinese medicine, acupressure, and pulsed magnetic field therapy may also provide therapeutic relief. Notably, the recently introduced cryotherapy has been demonstrated as a potential candidate for insomnia which could reduce pain, by suppressing oxidative stress and inflammation. It seems that the synergistic therapeutic approach of cryotherapy and the above-mentioned approaches might offer promising prospects to further improve efficacy and safety. Considering these facts, this perspective presents a comprehensive summary of recent advances in pathological aetiologies of insomnia including COVID-19, and its therapeutic management with a greater emphasis on cryotherapy.

Depression, aging, and immunity: implications for COVID-19 vaccine immunogenicity

The aging process can have detrimental effects on the immune system rendering the elderly more susceptible to infectious disease and less responsive to vaccination. Major depressive disorder (MDD) has been hypothesized to show characteristics of accelerated biological aging. This raises the possibility that depressed individuals will show some overlap with elderly populations with respect to their immune response to infection and vaccination. Here we provide an umbrella review of this literature in the context of the SARS CoV-2 pandemic. On balance, the available data do indeed suggest that depression is a risk factor for both adverse outcomes following COVID-19 infection and for reduced COVID-19 vaccine immunogenicity. We conclude that MDD (and other major psychiatric disorders) should be recognized as vulnerable populations that receive priority for vaccination along with other at-risk groups.

Marital experiences and depressive symptoms among older adults in rural South Africa

This paper advances the understanding of how marital transitions may influence mental health by investigating these associations among a population of rural, Black South Africans aged 40+ that was directly impacted by apartheid. Using two waves of data from 4,176 men and women in Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI), we investigated associations between marital experiences and depressive symptoms, by gender, and explored whether economic resources is a moderator of these associations. We found that experiencing a marital dissolution was associated with more depressive symptoms than remaining married for both men and women. We also found that men, but not women, report greater depressive symptoms if they remained separated/divorced, remained widowed, or remained never married between waves. We found no evidence that a decline in wealth moderated the impact of marital dissolution on depressive symptoms for women or men. These findings suggest that the documented benefits of marriage for mental health, and differences by gender in those benefits, may extend to older, rural South Africans, despite the unique experiences of this population.

Testosterone Replacement Therapy in the Treatment of Depression

BACKGROUND

Depression is a common disorder that affects millions globally and is linked to reduced quality of life and mortality. Its pathophysiology is complex and there are several forms of treatment proposed in the literature with differing side effect profiles. Many patients do not respond to treatment which warrants augmentation with other treatments and the investigation of novel treatments. One of these treatments includes testosterone therapy which evidence suggests might improve depressed mood in older patients with low levels of testosterone and helps restore physical impairments caused by age-related hormonal changes.

OBJECTIVE

The objective of this review is to synthesize information regarding clinical depression, its treatment options, and the efficacy and safety of testosterone treatment for the treatment of depression.

METHODS

This review utilized comprehensive secondary and tertiary data analysis across many academic databases and published work pertaining to the topic of interest.

RESULTS

Within some subpopulations such as men with dysthymic disorder, treatment resistant depression, or low testosterone levels, testosterone administration yielded positive results in the treatment of depression. Additionally, rodent models have shown that administering testosterone to gonadectomized male animals reduces symptoms of depression. Conversely, some studies have found no difference in depressive symptoms after treatment with testosterone when compared with placebo. It was also noted that over administration of testosterone is associated with multiple adverse effects and complications.

CONCLUSION

The current evidence provides mixed conclusions on the effectiveness of testosterone therapy for treating depression. More research is needed in adult men to see if declining testosterone levels directly influence the development of depression.

Personalised depression forecasting using mobile sensor data and ecological momentary assessment

INTRODUCTION

Digital health interventions are an effective way to treat depression, but it is still largely unclear how patients' individual symptoms evolve dynamically during such treatments. Data-driven forecasts of depressive symptoms would allow to greatly improve the personalisation of treatments. In current forecasting approaches, models are often trained on an entire population, resulting in a general model that works overall, but does not translate well to each individual in clinically heterogeneous, real-world populations. Model fairness across patient subgroups is also frequently overlooked. Personalised models tailored to the individual patient may therefore be promising.

METHODS

We investigate different personalisation strategies using transfer learning, subgroup models, as well as subject-dependent standardisation on a newly-collected, longitudinal dataset of depression patients undergoing treatment with a digital intervention ( N = 65 patients recruited). Both passive mobile sensor data as well as ecological momentary assessments were available for modelling. We evaluated the models' ability to predict symptoms of depression (Patient Health Questionnaire-2; PHQ-2) at the end of each day, and to forecast symptoms of the next day.

RESULTS

In our experiments, we achieve a best mean-absolute-error (MAE) of 0.801 (25% improvement) for predicting PHQ-2 values at the end of the day with subject-dependent standardisation compared to a non-personalised baseline ( MAE = 1.062 ). For one day ahead-forecasting, we can improve the baseline of 1.539 by 12 % to a MAE of 1.349 using a transfer learning approach with shared common layers. In addition, personalisation leads to fairer models at group-level.

DISCUSSION

Our results suggest that personalisation using subject-dependent standardisation and transfer learning can improve predictions and forecasts, respectively, of depressive symptoms in participants of a digital depression intervention. We discuss technical and clinical limitations of this approach, avenues for future investigations, and how personalised machine learning architectures may be implemented to improve existing digital interventions for depression.

Multimorbidity and depressive symptoms in older adults and the role of social support: Evidence using Canadian Longitudinal Study on Aging (CLSA) data

Background

The rising prevalence of multimorbidity poses challenges to health systems globally. The objectives of this study were to investigate: 1) the association between multimorbidity and depressive symptoms; and 2) whether social support plays a protective role in this association.

Methods

A prospective population-based cohort study was conducted to analyze baseline and 3-year follow-up data of 16,729 community dwelling participants aged 65 and above in the Canadian Longitudinal Study of Aging (CLSA). Multimorbidity was defined as having three or more chronic conditions. The 10-item Center for Epidemiologic Studies Depression scale (CESD-10) was used to measure depressive symptoms. The 19-item Medical Outcomes Study (MOS) Social Support Survey was employed to assess perceived social support. Multivariate logistic regression models were used to examine the association between multimorbidity, social support and depressive symptoms.

Results

Multimorbidity was very common among participants with a prevalence of 70.6%. Fifteen percent of participants had depressive symptoms at baseline. Multimorbidity was associated with increased odds of having depressive symptoms at 3-year follow-up (adjusted odds ratio, aOR = 1.51, 95% CI 1.33, 1.71), and developing depressive symptoms by follow-up among those with no depressive symptoms at baseline (aOR = 1.65, 95% CI 1.42, 1.92). Social support was consistently associated with decreased odds of depressive symptoms, regardless of level of multimorbidity.

Conclusion

Multimorbidity was positively associated with depressive symptoms over time, but social support served as a protective factor. As a modifiable, protective factor, emphasis should be placed in clinical practice to assess social support and refer patients to appropriate services, such as support groups. Similarly, health policy should focus on ensuring that older adults have access to social support opportunities as a way to promote mental health among older adults. Community organizations that offer social activities or support groups play a key role in this respect and should be adequately supported (e.g., with funding).

The temporal experience in depression: from slowing down and delayed help seeking to the emergency setting and length of treatment

The present paper discusses the 'time' dimension in depression, from the phenomenological experience to the diagnostic criteria, from delayed help seeking to the emergency room, from a (non) timely follow-up to (non) adherence to treatment. The temporal experience is fundamentally disturbed in depression and recent neurophenomenological findings help in better understanding this dimension. The duration of symptoms needed to fulfil diagnostic criteria are somewhat arbitrary. Depression dramatically decreases life expectancy mainly through increased non-suicidal mortality. The time from help seeking to getting treatment (between delayed help seeking and the emergency room) is contradictory and the length of treatment (from too short to too long) suggests that taking better account of these phenomena could improve depression treatment.

Depressive symptomology and cancer incidence in men and women: Longitudinal evidence from the HUNT study

BACKGROUND

Depressive symptoms and mood disorders are associated with a host of physical conditions. However, it is inconclusive whether depressive symptoms are also associated with cancer onset. The aim of this study was to investigate whether depressive symptoms are associated with cancer incidence in a large population-based sample of men and women.

METHODS

This study examined data from waves two (HUNT 2, 1995-97) and three (HUNT 3, 2006-08) of the Trøndelag Health Study (HUNT). Depressive symptoms were ascertained using the Hospital Anxiety and Depression Scale (HADS-D ≥ 8), cancer onset was identified via linkage with the Cancer Registry of Norway, death records by the national Cause of Death Register (CDR), and information on lifestyle and demographic factors was self-reported. Cox-proportional hazard regression models were used to test associations. Unadjusted, age-adjusted and multivariable best models accounting for smoking, education, marital status and current employment are presented.

RESULTS

Men and women (n = 61,985; 46.0 % men) were followed from baseline over a period of 778,802 person-years. During the 20-year study period, there were 6856 (11.1 %) individuals with incident cancers and 12,480 (20.1 %) deaths (n = 2498 attributed to cancer). For men with depressive symptoms, 505 (15.3 %) developed incident cancer during the follow-up period, whereas among those without depressive symptoms, 3164 (12.5 %) developed incident cancer. Following adjustment for age, depressive symptomology was not significantly associated with risk of overall cancer onset, nor among prostate, colon or melanoma subtypes. Depressive symptoms were associated with an increased risk of bronchus and lung cancer both before (HR 1.90, 95 % CI 1.43-2.50, p ≤0.001) and after adjustment for age (HR 1.38, 95 % CI 1.04-1.80, p = 0.025). However, further adjustment for additional possible confounders explained this association. For women with depressive symptoms, 384 (11.2 %) developed incident cancer during the follow-up period, whereas among those with no depressive symptomology, 2803 (9.3 %) developed incident cancer. After accounting for age, depressive symptomology was not associated with risk of overall cancer onset, nor among breast, colon, lung and bronchus, or melanoma subtypes. Additional analyses evaluating relationship of depression symptom severity and cancer onset did not alter findings for men or women.

LIMITATIONS

This report is limited by the post-hoc study design and subsequent non-randomised nature. Future prospective studies are required.

CONCLUSION

These results suggest that depressive symptoms are not associated with an increased risk of overall or site-specific cancer onset in these men and women. Given the increased co-occurrence of other medical conditions such as cardiovascular disease, diabetes, stroke and musculoskeletal disorders in people with depression, the role of clinically diagnosed depression and other psychiatric disorders in association with cancer onset necessitates further consideration.

Association of Urinary Iodine Concentration with Depressive Symptoms among Adults: NHANES 2007-2018

The association between iodine status and depressive symptoms has not been investigated in the general population. Therefore, we drew 8935 participants from the National Health and Nutrition Examination Survey (NHANES) 2007-2018 to explore their association. In NHANES, Inductively Coupled Plasma Dynamic Reaction Cell Mass Spectroscopy was utilized to measure urinary iodine concentration (UIC), and Patient Health Questionnaire-9 was used to assess depressive symptoms. Meanwhile, we fitted logistic regression and restricted cubic spline models. We found that high UIC was associated with a higher prevalence of depressive symptoms than the normal UIC group (OR: 1.50, 95% CI: 1.04-2.16). This association was particularly pronounced and further strengthened among females (OR: 1.90, 95% CI: 1.19-3.01) and participants aged 40-59 (OR: 1.90, 95% CI: 1.11-3.25). Moreover, we found that low UIC was associated with a high prevalence of depressive symptoms among females (OR: 1.50, 95% CI: 1.02-2.18). Moreover, the dose-response relationship between UIC and depressive symptoms presented a general trend of decreased, steady transiently, and then increased. We found that participants with high UIC had a higher prevalence of depressive symptoms than those with normal UIC. Meanwhile, we also found that females with low UIC had higher odds of reporting depressive symptoms.

Association of depression with mortality in nationwide twins: The mediating role of dementia

BACKGROUND

The differential impact of depression across different periods in life on mortality remains inconclusive. We aimed to examine the association of depression that occurs at different age with all-cause mortality, and to explore the roles of dementia, as well as genetic and early-life environmental factors, in this association.

METHODS

From the Swedish Twin Registry, 44,919 twin individuals were followed for up to 18 years. Depression was ascertained using the National Patient Registry and categorized as early-life (<45 years), midlife (45-64 years), and late-life (≥65 years) depression according to the age of the first diagnosis. Deaths were identified through the Cause of Death Register. Generalized estimating equation, generalized structural equation, and conditional logistic regression were used for unmatched, mediation, and co-twin matched analyses, respectively.

RESULTS

In unmatched analyses, the multivariate-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of mortality were 1.71 (1.46-2.00) for depression at any age, 1.72 (1.36-2.17) for early-life, 1.51 (1.19-1.90) for midlife, and 4.10 (2.02-8.34) for late-life depression. Mortality was significantly higher in individuals with late-life depression than those with earlier-life depression (p < 0.05). The mediation analysis showed that 59.83% of the depression-mortality association was mediated by dementia. No significant difference in ORs between the unmatched and co-twin matched analyses was observed (p = 0.09).

CONCLUSIONS

Depression is associated with an increased risk of all-cause mortality, and dementia mediates approximately 60% of the impact of depression on mortality in late life. Genetic and early-life environmental factors may not play a significant role in the depression-mortality association.

Association of the depressive scores, depressive symptoms, and conversion patterns of depressive symptoms with the risk of new-onset chronic diseases and multimorbidity in the middle-aged and elderly Chinese population

BACKGROUND

The relationship between depressive symptoms (DS) and their conversion patterns over time and the new-onset risk of diseases in the middle-aged and elderly population has not been extensively studied.

METHODS

Based on The China Health and Retirement Longitudinal Study participants in 2013, we established 13 cohorts involving 12 types of chronic diseases and multimorbidity, who were identified by face-to-face questionnaires. We retrospectively assessed their DS during 2011 and 2013 through the 10-item Center for Epidemiological Studies Depression Scale (CES-D), which were classified into never, newly developed, relieved, and persistent DS, and these participants were followed from 2013 to 2018.

FINDINGS

CES-D scores were new-onset risk factors for 9 diseases. The new-onset risk of diseases increased with higher CES-D scores. When CES-D scores were higher than approximately 6, the hazard ratios (HRs) of emergent diseases were greater than 1. DS was independent new-onset risk factors for 8 diseases, with HRs (95% CI) ranging from 1.2635 (1.0061-1.5867) to 1.5231 (1.0717-2.165). Persistent DS was an independent risk factor for most diseases but might be an independent protective factor for new-onset cancer (HR, 95% CI: 0.276, 0.106-0.723).

INTERPRETATION

DS is closely associated with new-onset risk of chronic diseases and multimorbidity, and awareness of the risk associated with pre-DS status (6<CES-D<12) should be raised. chronic disease risks were almost lower with newly developed and relieved DS than with persistent DS, suggesting the potential benefits of active management of DS to reduce the risk of emergent diseases in middle-aged and elderly population.

FUNDING

National Natural Science Foundation of China.

Overweight, obesity, and individual symptoms of depression: A multicohort study with replication in UK Biobank

OBJECTIVES

Obesity is associated with increased risk of depression, but the extent to which this association is symptom-specific is unknown. We examined the associations of overweight and obesity with individual depressive symptoms.

METHODS

We pooled data from 15 population-based cohorts comprising 57,532 individuals aged 18 to 100 years at study entry. Primary analyses were replicated in an independent cohort, the UK Biobank study (n = 122,341, age range 38 to 72). Height and weight were assessed at baseline and body mass index (BMI) was computed. Using validated self-report measures, 24 depressive symptoms were ascertained once in 16 cross-sectional, and twice in 7 prospective cohort studies (mean follow-up 3.2 years).

RESULTS

In the pooled analysis of the primary cohorts, 22,045 (38.3 %) participants were overweight (BMI between 25 and 29.9 kg/m2), 12,025 (20.9 %) class I obese (BMI between 30 and 34.9 kg/m2), 7,467 (13.0 %) class II-III obese (BMI ≥ 35 kg/m2); and 7,046 (12.3 %) were classified as depressed. After multivariable adjustment, obesity class I was cross-sectionally associated with 1.11-fold (95 % confidence interval 1.01-1.22), and obesity class II-III with 1.31-fold (1.16-1.49) higher odds of overall depression. In symptom-specific analyses, robust associations were apparent for 4 of the 24 depressive symptoms ('could not get going/lack of energy', 'little interest in doing things', 'feeling bad about yourself, and 'feeling depressed'), with confounder-adjusted odds ratios of having 3 or 4 of these symptoms being 1.32 (1.10-1.57) for individuals with obesity class I, and 1.70 (1.34-2.14) for those with obesity class II-III. Elevated C-reactive protein and 21 obesity-related diseases explained 23 %-31 % of these associations. Symptom-specific associations were confirmed in longitudinal analyses where obesity preceded symptom onset, were stronger in women compared with men, and were replicated in UK Biobank.

CONCLUSIONS

Obesity is associated with a distinct set of depressive symptoms. These associations are partially explained by systemic inflammation and obesity-related morbidity. Awareness of this obesity-related symptom profile and its underlying biological correlates may inform better targeted treatments for comorbid obesity and depression.

The reliability, validity and screening effect of the happiness index scale among inpatients in a general hospital

BACKGROUND

The Happiness Index Scale (HIS) is a newly developed scale by our group to screen for common psychological illnesses among general hospital inpatients. This study aimed to analyze the reliability, validity and screening effect of the HIS and to explore its clinical application.

METHODS

From April 1, 2021, to December 31, 2021, a total of 8405 continuous inpatients were enrolled from different departments of a large tertiary general hospital with 1385 inpatient beds in Guangzhou, Guangdong Province, China. Using a cross-sectional survey design, each participant was assessed with the Patient Health Questionnaire 9(PHQ-9), Generalized Anxiety Disorder 7 items(GAD-7), Athens Insomnia Scale (AIS), Columbia Suicide Severity Rating Scale (C-SSRS) and HIS within 24 h of admission. McDonald's ω coefficient, the Guttman split-half coefficient and the test-retest reliability coefficient were used to evaluate the reliability of the HIS and the construct validity and criterion validity of the validity tests. Scores on the PHQ-9, GAD-7, AIS, and C-SSRS were used as the gold standard tools to analyze the screening effect of the HIS.

RESULTS

The HIS exhibited very good reliability, with a McDonald's ω coefficient of 0.825, a Guttman split-half coefficient of 0.920 and a test-retest reliability coefficient of 0.745 (P < 0.05). Confirmatory factor analysis showed a satisfactory model fitting index with a χ²/df = 2.602, a root mean squared error of approximation (RMSEA) of 0.014, a standardized root mean square residual (SRMR) of 0.010, a comparative fit index (CFI) of 0.992, and a Tucker-Lewis index (TLI) of 0.983. The correlation coefficient between the total score of each dimension of the scale and the corresponding criterion was 0.854 ~ 0.949 (P < 0.001). The HIS showed a very good distinguishing effect. The average HIS score of inpatients who screened positive for psychological problems was significantly higher than that of inpatients who screened negative for psychological problems (t = 3790.619, P < 0.001). The effect size was very large (Cohens d = 2.695, 95% CI = 2.630 ~ 2.761). Approximately 90.2% of the positive and negative screening results of the HIS were matched with the gold standard tools, with a kappa value of 0.747 (P < 0.001). The screening effect test showed a sensitivity (true positive rate) of 92.9% and a specificity (true negative rate) of 89.5%.

CONCLUSION

The HIS exhibited satisfactory reliability and validity and a clinically meaningful screening effect with a much shorter version compared to the commonly used screening scales. Thus, it could potentially be useful as the first screening step to rule out psychological conditions for inpatients in general hospitals or to remind medical teams of further psychological concerns.

Associations of depression and regional brain structure across the adult lifespan: Pooled analyses of six population-based and two clinical cohort studies in the European Lifebrain consortium

OBJECTIVE

Major depressive disorder has been associated with lower prefrontal thickness and hippocampal volume, but it is unknown whether this association also holds for depressive symptoms in the general population. We investigated associations of depressive symptoms and depression status with brain structures across population-based and patient-control cohorts, and explored whether these associations are similar over the lifespan and across sexes.

METHODS

We included 3,447 participants aged 18-89 years from six population-based and two clinical patient-control cohorts of the European Lifebrain consortium. Cross-sectional meta-analyses using individual person data were performed for associations of depressive symptoms and depression status with FreeSurfer-derived thickness of bilateral rostral anterior cingulate cortex (rACC) and medial orbitofrontal cortex (mOFC), and hippocampal and total grey matter volume (GMV), separately for population-based and clinical cohorts.

RESULTS

Across patient-control cohorts, depressive symptoms and presence of mild-to-severe depression were associated with lower mOFC thickness (r_symptoms = -0.15/ r_status = -0.22), rACC thickness (r_symptoms = -0.20/ r_status = -0.25), hippocampal volume (r_symptoms = -0.13/ r_status = 0.13) and total GMV (r_symptoms = -0.21/ r_status = -0.25). Effect sizes were slightly larger for presence of moderate-to-severe depression. Associations were similar across age groups and sex. Across population-based cohorts, no associations between depression and brain structures were observed.

CONCLUSIONS

Fitting with previous meta-analyses, depressive symptoms and depression status were associated with lower mOFC, rACC thickness, and hippocampal and total grey matter volume in clinical patient-control cohorts, although effect sizes were small. The absence of consistent associations in population-based cohorts with mostly mild depressive symptoms, suggests that significantly lower thickness and volume of the studied brain structures are only detectable in clinical populations with more severe depressive symptoms.

The trajectories of depressive symptoms and subsequent incident dementia, coronary heart diseases, stroke and all-cause mortality

BACKGROUND

Evidence suggests the occurrence of depressive symptoms in mid- to late-life inflates the risk for ageing-related morbidity compared to people without depressive symptoms. The eventual association between depressive symptoms in mid- to late-life and long-term (over 10-year) risks for incident dementia, coronary heart disease (CHD), stroke, and morbidity is to be established.

METHODS

This longitudinal cohort study utilized Health and Retirement Study (HRS) of U.S residents aged ≥ 50 years who were interviewed every 2-year during follow-up (average follow-up: 11.6 ± 2.85 years). Trajectories of depressive symptoms were assessed by the Center for Epidemiologic Studies Depression (CES-D) scale from 1994 to 2000 at baseline. Incident dementia, CHD, stroke and all-cause mortality were determined from 2000 to 2018.

RESULTS

Among 7810 individuals who were free from dementia, CHD and stroke, five trajectories of depressive symptoms were identified: non-depressed (36.7 %), mild (48.8 %), worsening (7.8 %), improving (4.1 %) and persistent (2.7 %). Compared with those in the non-depressed group, participants with mild, worsening and persistent depressive symptoms had significantly greater hazards of incident dementia (multivariable adjusted hazard ratios and 95 % confidence intervals: 1.32 [1.17-1.48], 1.58 [1.30-1.93], 2.82 [2.17-3.67], respectively), CHD (1.13 [1.03-1.24], 1.47 [1.25-1.73], 1.34 [1.03-1.74], respectively), stroke (1.30 [1.12-1.52], 1.58 [1.23-2.04], 1.71 [1.16-2.53], respectively) and all-cause mortality (1.17 [1.07-1.27], 1.46 [1.27-1.68], 1.66 [1.35-2.06], respectively). The hazards of incident events, except for CHD, were not significantly greater in individuals with improving depressive symptoms.

CONCLUSIONS

The present findings suggest even sub-clinical threshold depressive symptoms were associated with the hazards of ageing related diseases while such associations were not significant with managed depressive symptoms.