Depression and cardiovascular disease in elderly: Current understanding

The mechanisms underlying the negative effect of depression on life satisfaction among the elderly: the roles of ostracism and economic income

OBJECTIVES

Depression is prevalent among older persons, which seriously threatens their life satisfaction. This study aimed to explore the internal mechanisms by which depression influences life satisfaction among the elderly, as well as the mediating and moderating effects of ostracism and economic income, respectively, in a sample of rural older adults across China.

DESIGN

This was a cross-sectional survey conducted as part of the project "Thousands of People and Hundreds of Villages (2019)."

SETTING

Participants were rural older adults from 31 provincial-level administrative units across China.

PARTICIPANTS

The sample composed of 1,754 participants aged 60 years and over.

MEASUREMENTS

Depression was assessed with the depression subscale of the Depression Anxiety Stress Scales, life satisfaction with the Satisfaction with Life Scale, ostracism with the Ostracism Experience Scale (OES), and economic income and other control variables with related demographic scales. Moderation and mediation analyses were performed using the regression-based approach as conducted by Hayes ().

RESULTS

Depression negatively predicted life satisfaction among the elderly. Ostracism played a partially mediating role between depression and life satisfaction. Economic income moderated the effect of depression and ostracism on life satisfaction: High economic income weakened the negative effect of depression on life satisfaction and enhanced the negative effect of ostracism on life satisfaction.

CONCLUSION

Improving depressed elderly people's interpersonal relationships and financial support could improve their life satisfaction.

Exercise for depression and depressive symptoms in older adults: an umbrella review of systematic reviews and Meta-analyses

OBJECTIVES

We aimed to gather and update the evidence on the impact of exercise on late-life depression.

METHOD

We conducted an umbrella review of meta-analyses of randomized controlled trials (RCTs) that assessed the effects of an exercise intervention for depression in older adults (e.g. 60+). Searches were conducted in Scopus, Web of Science, Embase, PubMed, BIREME, LILACS, SciELO, Cochrane Library for Systematic Reviews, and Opengray.eu. Methodological quality was assessed using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR 2). Data analysis was performed with RStudio (version 4.0.2) and the generic inverse-variance method was used to pool the effect sizes from the included studies.

RESULTS

Twelve meta-analyses of 97 RCTs were included. The AMSTAR 2 rating was considered critically low in five studies, low in six studies, and high in one study. The effect size expressed by the standardized mean difference (SMD) varied between studies from -0.90 (95% CI = -1.51; -0.28) to -0.14 (95% CI = -0.36; 0.07) in favor of the exercise intervention. Pooling of the effect sizes produced a statistically significant moderate effect in which exercise was associated with lower levels of depression and depressive symptoms (OR = 2.24, 95% CI 1.77; 2.84).

CONCLUSION

Our findings suggest that exercise produces a moderate improvement in depression and depressive symptoms in older patients. We recommend providing physical activity for older adults.

KEY-POINTS

We investigated the effects of exercise interventions for depression in older adults.

Supplemental data for this article can be accessed online at https://doi.org/10.1080/13607863.2021.1951660.

Factors associated with depressive and anxiety symptoms in older adults during the COVID-19 pandemic: a Brazilian study

Objectives: Older adults are one of the most vulnerable age groups to the social distance measures imposed by the COVID-19 pandemic. This study aimed to assess factors associated with depressive and anxiety symptoms in Brazilian older adults during the pandemic.Method: This cross-sectional online study assessed 380 older adults (over 60 years of age) living in Brazil, from 26th May 2020 to 29th June 2020. A self-reported questionnaire included sociodemographic data, lifestyle, health characteristics, and the COVID-19 related variables. The Geriatric Depression Scale (GDS) and the Geriatric Anxiety Inventory (GAI) were also applied. Data were analyzed via logistic regression models, using a hierarchical approach.Results: The prevalence of depressive symptoms according to GDS was 28.7% (95% CI = 24.4%, 33.4%) and the prevalence of anxiety symptoms according to GAI was 26.1% (95% CI = 21.9%, 30.7%). Physically inactive older adults, the ones who were in social isolation for more days, feel much vulnerable to contracting COVID-19, and never or almost never receive support from family/friends were more likely to have depressive symptoms. Being female, physically inactive or physically active 1-3 times/week, feel very vulnerable to contracting COVID-19 and never or almost never receive support from family/friends were associated with the anxiety symptoms.Conclusion: A high prevalence of depressive and anxious symptoms was identified in Brazilian older adults. The data can help in planning interventions aimed at older adults, also including their families, health professionals, and the whole society.

Unmet Healthcare Needs Predict Depression Symptoms among Older Adults

Risk factors for depression in older adults include significant interpersonal losses, increasing social isolation, and deteriorating physical abilities and health that require healthcare. The effects of unmet healthcare needs on depression in older adults are understudied. This study aimed to analyze the association between unmet healthcare needs and symptoms of depression, sleep, and antidepressant medication while controlling for other significant factors among older adults. For this study, we used a multinational database from The Survey of Health, Ageing and Retirement in Europe (SHARE), containing data of individuals aged 50 and older. The final sample used in this research consisted of 39,484 individuals from 50 to 100 years (mean − 71.15, SD ± 9.19), 42.0 percent of whom were male. Three path models exploring relationships between symptoms of depression at an older age and unmet healthcare needs were produced and had a good model fit. We found that unmet healthcare needs were directly related to depression, activity limitations were related to depression directly and through unmet healthcare needs, whereas financial situation mostly indirectly through unmet healthcare needs. We discuss how depression itself could increase unmet healthcare needs.

Risk factors related to psychological distress among elderly patients with cardiovascular disease

AIM

Psychological distress is associated with poor prognosis in patients with cardiovascular disease (CVD). However, factors related to psychological distress in elderly patients with CVD is less understood. We aimed to investigate the rate of psychological distress in elderly patients with CVD in comparison with that of patients without CVD and to examine the clinical, socioeconomic, and lifestyle factors associated with this condition.

METHODS AND RESULTS

Data from a nationwide population-based study in Japan of patients aged ≥ 60 years were extracted, and 1:1 propensity score matching was conducted of patients with and without CVD. Psychological distress was assessed using the K6 scale, on which a score ≥ 6 was defined as psychological distress. Of the 24,388 matched patients, the rate of psychological distress was significantly higher among patients with CVD compared to those without CVD (29.8% vs. 20.5%, p < 0.0001). The multivariate analysis revealed that female sex, comorbidities except hypertension, current smoking, daily sleep duration of < 6  h versus ≥ 8  h, home renter versus owner, retired status, having a walking disability, and lower monthly household expenditure were independently associated with psychological distress. Walking disability was observed in greatest association with psychological distress (odds ratio 2.69, 95% confidence interval 2.46-2.93).

CONCLUSION

Elderly patients with CVD were more likely to have psychological distress compared to those without CVD. Multiple factors, including clinical, socioeconomic, and lifestyle variables, were associated with psychological distress. These analyses may help health care providers to identify high risk patients with psychological distress in a population of older adults with CVD.

Quality of life in liver transplant recipients during the Corona virus disease 19 pandemic: A multicentre study

BACKGROUND

Liver transplant recipients require specific clinical and psychosocial attention given their frailty. Main aim of the study was to assess the quality of life after liver transplant during the current pandemic.

METHODS

This multicentre study was conducted in clinically stable, liver transplanted patients. Enrollment opened in June and finished in September 2021. Patients completed a survey including lifestyle data, quality of life (Short Form health survey), sport, employment, diet. To examine the correlations, we calculated Pearson coefficients while to compare subgroups, independent samples t-tests and ANOVAs. To detect the predictors of impaired quality of life, we used multivariable logistic regression analysis.

RESULTS

We analysed data from 511 patients observing significant associations between quality of life's physical score and both age and adherence to Mediterranean diet (p < .01). A significant negative correlation was observed between mental score and the sedentary activity (p < .05). Female patients scored significantly lower than males in physical and mental score. At multivariate analysis, females were 1.65 times more likely to report impaired physical score than males. Occupation and physical activity presented significant positive relation with quality of life. Adherence to Mediterranean diet was another relevant predictor. Regarding mental score, female patients were 1.78 times more likely to show impaired mental score in comparison with males. Sedentary activity and adherence to Mediterranean diet were further noteworthy predictors.

CONCLUSIONS

Females and subjects with sedentary lifestyle or work inactive seem to show the worst quality of life and both physical activity and Mediterranean diet might be helpful to improve it.

The Footprint of Kynurenine Pathway in Cardiovascular Diseases

Kynurenine pathway is the main route of tryptophan metabolism and produces several metabolites with various biologic properties. It has been uncovered that several cardiovascular diseases are associated with the overactivation of kynurenine pathway and kynurenine and its metabolites have diagnostic and prognostic value in cardiovascular diseases. Furthermore, it was found that several kynurenine metabolites can differently affect cardiovascular health. For instance, preclinical studies have shown that kynurenine, xanthurenic acid and cis-WOOH decrease blood pressure; kynurenine and 3-hydroxyanthranilic acid prevent atherosclerosis; kynurenic acid supplementation and kynurenine 3-monooxygenase (KMO) inhibition improve the outcome of stroke. Indoleamine 2,3-dioxygenase (IDO) overactivity and increased kynurenine levels improve cardiac and vascular transplantation outcomes, whereas exacerbating the outcome of myocardial ischemia, post-ischemic myocardial remodeling, and abdominal aorta aneurysm. IDO inhibition and KMO inhibition are also protective against viral myocarditis. In addition, dysregulation of kynurenine pathway is observed in several conditions such as senescence, depression, diabetes, chronic kidney disease (CKD), cirrhosis, and cancer closely connected to cardiovascular dysfunction. It is worth defining the exact effect of each metabolite of kynurenine pathway on cardiovascular health. This narrative review is the first review that separately discusses the involvement of kynurenine pathway in different cardiovascular diseases and dissects the underlying molecular mechanisms.

Prevalence and influencing factors of depressive symptoms among rural-to-urban migrant workers in China: A systematic review and meta-analysis

BACKGROUND

Rural-to-urban migrant workers are a large group in China, and they are often more prone to mental health problems, especially depression. We expected to use meta-analysis to estimate the prevalence of depressive symptoms and the influencing factors of depressive symptoms among rural-to-urban migrant workers in China.

METHODS

PubMed, Web of Science, Embase, Scopus, CINAHL Complete, PsycARTICLES, CNKI, Wan Fang, CBM, and Cochrane were searched on October 16, 2021. The data were analyzed using OR and random effect model in Revman5.3 and STATA 15 Software.

RESULTS

We included 30 studies involving 43,884 rural-to-urban migrant workers. The prevalence of depressive symptoms among rural-to-urban migrant workers in China was 0.28 (95% CI:0.22, 0.34); Results of the meta-analysis showed that working hours, sleep status, self-rated health, financial condition, job satisfaction, marriage, and social support were correlated with depressive symptoms.

LIMITATIONS

The systematic review and meta-analysis included only cross-sectional studies, and more types of original studies on depressive symptoms of rural-to-urban migrant workers in China should be carried out in the future.

CONCLUSION

The prevalence of depressive symptoms among rural-to-urban migrant workers in China is 28%. Government departments can intervene early in the process to promote the mental health of this group based on influencing factors of depressive symptoms among rural-to-urban migrant workers in China.

The association between leftover food consumption and depression among older adults: Findings from a cross-sectional study

BACKGROUND

Leftover food consumption is very prevalent among the Chinese older adults, however, the potential effects of leftover eating consumption on depression have not yet been investigated.

OBJECTIVES

The study aims to determine the association between leftover consumption on depression among older adults.

METHODS

Data of leftover consumption frequency was collected in a cross-sectional study with a provincial representative sample of 5992 older adults (aged 60 or older) in 2019. Depression symptoms were assessed by the 9-item screener Patient Health Questionnaire (PHQ-9). Multiple logistic regression models were applied to analyze the association of the frequency of leftover eating consumption and the presence and the severity of depression.

RESULTS

After controlling for all the covariates, the participants who consume leftover food everyday had higher risk of having depression symptom comparing to those who had the lowest frequency of leftover eating (OR: 1.675, 95% CI: 1.435-1.956, p < 0.001). The participants who consume leftover food every day was also associated with more severe depression symptoms (OR: 1.621, 95% CI: 1.397-1.881, p < 0.001), when comparing to the reference group. The associations seemed stronger in men than women.

LIMITATIONS

The causal relationship between leftover consumption behavior and depression could not be determined due to the cross-sectional design. Moreover, the variety or handling method of the leftover food was not specified.

CONCLUSION

Leftovers eating frequency was associated with the presence and severity of depression symptoms among older adults.

The effect of childhood socioeconomic status on depressive symptoms in middle-old age: the mediating role of life satisfaction

BACKGROUND

Some studies have shown that childhood socioeconomic status (SES) can influence the development and progression of depression in adulthood. This study aimed to analyze the effects of childhood SES on depressive symptoms in individuals of middle-old age and examine the potential mediating role of life satisfaction based on national data in China.

METHODS

Data were derived from the 2018 China Health and Retirement Longitudinal Study (CHARLS) data. A total of 17,129 individuals who were aged 45 years and older were included. The dependent variable was depressive symptoms in middle-old age. Childhood SES was the independent variable, and life satisfaction was the mediator. This study controlled four factors: general demographic characteristics, adult SES, childhood adversity and health and living status. Pearson correlations and hierarchical multiple regression analysis were performed, and the Baron and Kenny method was used to test the mediating role.

RESULTS

The score of depressive symptoms among all participants was 7.88 ± 6.65. Gender, age, adult SES, childhood adversity and health and living status all affected the development of depression symptom in middle-aged and elderly individuals in China. After adjusting for all covariates, the higher the childhood SES, the lower the depressive symptom score (β = - 0.422, P < 0.001). Life satisfaction had a partial mediating effect between childhood SES and depressive symptoms. Low childhood SES may improve life satisfaction (β = 0.051, P < 0.001) and life satisfaction indirectly decreases depressive symptom scores (β = - 0.403, P < 0.001).

CONCLUSIONS

Life satisfaction was a partial mediator between childhood SES and depressive symptoms in middle and old age. Improving life satisfaction may serve as an intervention to reduce the incidence of depression symptoms in the future.

Integrating Metabolomics and Network Analysis for Exploring the Mechanism Underlying the Antidepressant Activity of Paeoniflorin in Rats With CUMS-Induced Depression

Background: Paeoniflorin (PF) represents the major bioactive constituent of the traditional Chinese medicine plant Paeonia suffruticosa (Ranunculaceae), which has a long history as a folk medicine in Asian. Paeoniflorin, a bitter pinene monoterpene glycoside, has antidepressant effects, but its potential therapeutic mechanism has not been thoroughly explored.

Methods: Experimental depression in rats was established by the chronic unpredictable mild stress (CUMS) combined with orphan method, and the efficacy of paeoniflorin on depression was evaluated by the sucrose preference test and open field test. The antidepressant mechanism of paeoniflorin was investigated by metabolomic and network pharmacology. The relevant pathways of biomarkers highlighted in metabolomics were explored, and the possible targets of paeoniflorin in the treatment of depression were further revealed through network analysis. The binding activity of paeoniflorin to key targets was verified by molecular docking.

Results: Metabolomics showed that rats with CUMS-induced depression had urine metabolic disorders, which were reversed by paeoniflorin through the regulation of metabolic pathways. Metabolites that play a key role in the function of paeoniflorin include citric acid, thiamine monophosphate, gluconolactone, 5-hydroxyindoleacetic acid and stachyose. Key predicted targets are SLC6A4, TNF, IL6 and SLC6A3. An important metabolic pathway is the Citrate cycle (TCA cycle).

Conclusion: Network integrative analysis in this study showed that paeoniflorin could improve depressive-like symptoms in model rats with CUMS-induced depression and overall correct the disordered metabolic profile through multiple metabolic pathways.

Pinocembrin Decreases Atrial Fibrillation Susceptibility in a Rodent Model of Depression

Background

Depression is often comorbid with cardiovascular diseases and contributes to the development and maintenance of atrial fibrillation (AF). Ample research demonstrated that pinocembrin had protective effects on the neuropsychiatric and cardiovascular systems via its pharmacological properties. However, whether pinocembrin protects from AF in depression models is not known. The present research investigated antiarrhythmic effects of pinocembrin and the underlying mechanisms in depressed rats.

Methods

One hundred and ten male Sprague Dawley rats were randomly divided into six groups: the CTL group (the normal rats administered saline), the CTP group (the normal rats administered pinocembrin), the MDD group (the depressed rats administered saline), the MDP group (the depressed rats administered pinocembrin), the MDA group (the depressed rats administered apocynin), and the MPA group (the depressed rats administered both pinocembrin and apocynin). Chronic unpredictable mild stress (CUMS) was performed for 28 days to establish the depression model. Pinocembrin was administered via gavage from Day 8 to Day 28, and apocynin was administered via intraperitoneal injection from Day 1 to Day 28. The effects were evaluated using behavioral measurements, in vitro electrophysiological studies, whole-cell patch-clamp recordings, biochemical detection, Western blot, and histological studies.

Results

Pinocembrin treatment significantly attenuated the abnormality of heart rate variability (HRV), the prolongation of action potential duration (APD), the shortening of the effective refractory period (ERP), the reduction of transient outward potassium current (I_to), and the increase in L-type calcium current (I_Ca–L), which increase susceptibility to AF in a rat model of depression. Compared to the depressed rats, pinocembrin also increased the content of Kv4.2, Kv4.3, and atrial gap junction channel Cx40 and decreased the expression level of Cav1.2, which ameliorated oxidative stress and inhibited the ROS/p-p38MAPK pro-apoptotic pathway and the ROS/TGF-β1 pro-fibrotic pathway.

Conclusion

Pinocembrin is a therapeutic strategy with great promise for the treatment of AF in depressed patients by reducing oxidative stress.

Association of the time spent on social media news with depression and suicidal ideation among a sample of Lebanese adults during the COVID-19 pandemic and the Lebanese economic crisis

The main objectives were to associate between social media news consumption during these unstable times and depression, as well as suicidal ideation among a sample of Lebanese adults, in addition to associate between fear of Covid-19, depression and suicidal ideation. Secondary objectives aimed to check the mediating effect of depression in the association between time spent on social media to get the news and the presence of suicidal ideation. This is a cross-sectional study executed between April and May 2021. It involved 402 Lebanese citizens aged 18 years and above, selected randomly from all Lebanese districts. Having cancer (Beta = 0.20) or lung disease (Beta = 0.27), more fear of COVID-19 (Beta = 0.16), a higher time spent on social media for news (Beta = 0.13) and a higher household crowding index (Beta = 0.29) were significantly associated with more depression, whereas having a pet in the house (Beta = -0.13) and working in the medical field (Beta = -0.17) were significantly associated with less depression. Higher depression (aOR = 1.19) was significantly associated with higher odds of having suicidal ideation, whereas more fear of COVID-19 (aOR = 0.84) and older age (aOR = 0.96) were significantly associated with less odds of having suicidal ideation. Depression did not mediate the association between time spent on social media to get the news and suicidal ideation. This study showed that more time spent on social media reading the news is associated with higher depression but not suicidal ideation. Fear of Covid-19 is associated with more depression, but less suicidal ideation. Further studies are needed to identify the causality between social media news consumption, depression and suicidal ideation. Moreover, awareness campaigns should be organized to teach people how to consume social media news in a responsible way, without letting it affect their emotions directly, which may cause psychological disorders.

Validation of the five-item version of the Geriatric Depression Scale (GDS-5) in a Turkish elderly population

BACKGROUND

Late-life depression is a geriatric syndrome which should be taken seriously. Many clinical scales have been developed for the screening of geriatric depression. Most of these have been validated at different times and in diverse populations. A five-question version of the Geriatric Depression Scale (GDS-5) was developed in 1997. This test has been validated and used in different populations. In the present study, we plan to validate the GDS-5 for the Turkish elderly population.

METHODS

Patients aged 60 years and older who applied to the Geriatrics Clinic of our hospital between November 2018 and November 2019 were included in the study. We compared the effectiveness of Yesavage Geriatric Depression Scale-30 (YGDS-30) and GDS-5 in screening depression, based on Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) depression criteria.

RESULTS

Four hundred participants were included in the study. A significant positive correlation was found between the DSM-5 scale and the GDS-5 scale (rho = 0.726, P <0.001). According to DSM-5, YGDS-30 and GDS-5, 112 participants (28%), 154 patients (%38.5) and 199 patients (%49.8) were diagnosed with depression respectively. When the cut-off value was taken as ≥2, the sensitivity, specificity, positive predictive and negative predictive values for the GDS-5 scale were determined as 96%, 68%, 54%, and 98%, respectively. We obtained these diagnostic measures with 95% confidence intervals.

CONCLUSION

This study demonstrated the validity and reliability of the GDS-5 for Turkish elderly populations. This five-question scale will be significant in daily use to screen for depression in elderly individuals with multiple problems.

Gender differences in the association of depression trajectories with executive and memory functions: Evidence from the longitudinal study of the Survey of Health, Ageing and Retirement in Europe (2004-2017)

Gender differences in depression trajectories and their effects on cognitive function are poorly understood. This article aims to identify depression trajectories in both genders and further explore the association of depression trajectories with executive and memory functions by gender. A total 3990 participants aged 50 years or older with repeated measurements from waves 1 to 7 (wave 3 excluded) of the Study of the Survey of Health, Ageing and Retirement in Europe (SHARE) were included. Group-based trajectory modeling (GBTM) was conducted to identify the optimal number of depression trajectories. Generalized estimating equation (GEE) models were used to examine the relation of depression trajectories to cognitive function after stratification by gender. Three distinct depression trajectories were identified in both genders, but the patterns of trajectories among genders were nonidentical. The trajectories of depression in males were characterized by non-low, moderate, persistent-depressive symptoms but with an unstable trend, while in females, they were characterized by non-low, moderate, persistent-depressive symptoms and with a worsening trend. The prevalence of persistent high depression in women (20.08%) was higher than that in men (3.13%). Moderate and persistent high depression trajectories were negatively associated with episodic memory (β = -0.53 and -0.72, respectively, p < 0.001) and verbal fluency in females (β = -0.96 and -1.47, p=0.01 and < 0.001, respectively). Older women had a greater frequency of developing depression than older men. Gender differences in depression trajectories existed. Moderate and persistent high depression trajectories exerted a negative effect on some domains of cognitive impairment only in females.

The associations between sleep behaviors, lifestyle factors, genetic risk and mental disorders: A cohort study of 402 290 UK Biobank participants

BACKGROUND

Sleep behaviors were believed to be associated with mental disorders (MD). However, the underlying mechanism of such association relationship, especially the role of multiple lifestyle factors in it remains unclear.

METHODS

A total of 402,290 participants from UK Biobank who don't have MD at baseline were included. They were divided into poor, intermediate and healthy sleep patterns according to the sleep score, which was calculated based on the data collecting from five sleep behaviors. Cox proportional hazard model was used to estimate the associations between sleep behaviors and MD. The associations were further estimated when taking lifestyle factors such as physical activity, coffee intake, tea intake and genetic susceptibility into account.

RESULTS

Healthy sleep pattern was associated with lower risk of overall MD status (HR,0.41, 95%CI,0.39-0.43), depressive disorders (HR,0.34, 95%CI,0.31-0.37) and anxiety disorders (HR,0.46, 95%CI,0.41-0.79), compared with poor sleep pattern. And in each subgroup of physical activity, tea intake, coffee intake, age and genetic risk scores (GRS), healthy sleep pattern could partly offset the risk of diseases.

CONCLUSIONS

Our study suggested healthy sleep behaviors could diminish the negative effect from genetic predisposition and lifestyle factors on the risk of MD, highlighting the benefit of healthy sleep pattern.

Relationship between Depressive Symptoms and Weather Conditions

Background: Weather is a well-known factor worldwide in psychiatric problems such as depression, with the elderly and females being particularly susceptible. The aim of this study was to detect associations between the risk of depressive symptoms (DS) and weather variables. Methods: 6937 participants were assessed in the baseline survey of the Health Alcohol Psychosocial Factors in Eastern Europe (HAPIEE) study during 2006−2008. To assess the risk of DS, a multivariate logistic model was created with predictors such as socio-demographic factors, health behaviors, and weather variables. Results: DS were found in 23.4% of the respondents, in 15.6% of males and in 29.9% in females. A higher risk of DS (by 25%) was associated with November−December, a rising wind speed, and relative humidity (RH) < 94% and snowfall during the cold period occurring 2 days before the survey. A higher air temperature (>14.2 °C) predominant during May−September had a protective impact. A higher risk of DS in males was associated with lower atmospheric pressure (<1009 hPa) 2 days before. Females were more sensitive to the monthly variation, snowfall, and RH. Conclusions: The findings of our study suggest that some levels of weather variables have a statistically significant effect on DS.

Association of depressive symptoms with marital status among the middle-aged and elderly in Rural China-Serial mediating effects of sleep time, pain and life satisfaction

OBJECTIVE

This study aimed to explore the potential effect of sleep time, pain and life satisfaction on the association between marital status and depressive symptoms.

METHODS

This study included 9780 individuals aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS) in 2015. Regression analysis was used to explore the mediating effect of targeted mediators on the association between marital status and depressive symptoms. Bootstrap method was used to examine the statistical significance of the mediating effects.

RESULTS

In the mediation model incorporating sleep time, pain and life satisfaction as mediators between marital status and depressive symptoms, the direct effect of marital status on depressive symptoms was statistically significant (p < 0.001, 95% CI = 0.699, 1.428). Approximately 39.28% (Indirect effect/Total effect) of the significant association between marital status and depressive symptoms was mediated by sleep time, pain, and life satisfaction.

LIMITATIONS

Limitations include non-representativeness other than rural residents and unclear cause-and-effect relationship.

CONCLUSIONS

Those separated/divorced/widowed/never-married middle-aged and elderly individuals might be high risk population of depressive symptoms. It could be possible to relieve the depressive symptoms of these people by guaranteeing sufficient sleep, relieving pain and improving life satisfaction.

Potential Mechanisms and Clinical Effectiveness of Acupuncture in Depression

Major depressive disorder is the most common mental disorder with significant economic burden and limited treatments. Acupuncture has emerged as a promising non-pharmacological treatment for reducing depressive symptoms. However, the potential mechanisms and clinical effectiveness of acupuncture are not fully understood. This review aimed to: (1) summarize the available evidence on the mechanisms and clinical effectiveness of acupuncture for depression, and then (2) compare with pharmacological interventions, guiding future studies. Studies with animal models of depression and patients have shown that acupuncture could increase hippocampal and network neuroplasticity and decrease brain inflammation, potentially to alleviating depressive disorders. Overall clinical studies indicated that acupuncture could relieve primary depression, particularly milder cases, and was helpful in the management of post-stroke depression, pain-related depression, and postpartum depression both as an isolated and adjunct treatment. It was emphasized that acupuncture combined with antidepressant pharmacological treatment not only enhanced the improvement of primary and secondary depressive symptoms but also reduced the side effects of the medical treatment, which is the main cause for high dropout rates with drug treatment. In summary, substantial evidence from animal and human researches supported the beneficial effect of acupuncture in depression. However, most clinical trials of acupuncture were small, and it is unclear whether their findings can be generalized, so more studies are needed.

Validation of the Patient Health Questionnaire-9 for Screening Depressive Disorders among Korean Employees: A Longitudinal Study of the National Health Examination Data

This nationwide longitudinal study examined the screening utility of the Patient Health Questionnaire-9 (PHQ-9) for Korean workers (aged 20, 30, 40, 50, 60, and 70 years) who completed the questionnaire in 2018. Data on disease names and health-related behaviors were collected from the National Health Insurance Service (NHIS). Follow-up began on 1 January 2018, and the primary endpoint was the hospitalization date for depression, self-harm, or suicide or 31 December 2019. Of the 766,351 participants, 741,423 received depression screening. Those screened were classified into normal (n = 716,760) and high-risk groups (n = 24,663) based on PHQ-9 scores. The incidence of hospital admissions for depression, self-harm, or suicide in the non-screened, normal, and high-risk groups was analyzed, and the PHQ-9's validity was examined. There were more females in the high-risk group than in the normal group, and the income distribution differed. The two-year cumulative incidence was highest for the high-risk group (4.21%), followed by the normal (0.89%) and non-screened groups (0.80%). The PHQ-9's sensitivity was low (males: 14.2%; females: 13.8%). Its specificity for males and females was 97.1% and 96.3%, respectively. Our findings may help develop a system to prevent suicides and hospitalizations attributed to workplace depression.

Dietary inflammatory index and depression risk in patients with chronic diseases and comorbidity

BACKGROUND

The coexistence of depression and chronic diseases can lead to greater disability and increased mortality. The objective of this study was to examine the association between Dietary Inflammatory Index (DII) and depression in patients with chronic diseases and comorbidity.

METHODS

Multivariable logistic regression analysis was used to investigate the relationship between DII and depression. Dose response relationship was analyzed using a generalized additive model with the smoothing plot.

RESULTS

A total of 7870 chronic diseases patients were enrolled. In multivariate model, the highest quintile of DII was associated with increased risk of depression in patients with diabetes (OR:1.73, 95CI%: 1.17, 2.57), hypertension (OR:1.93, 95CI%: 1.47, 2.52), coronary heart disease (OR:2.65, 95CI%: 1.18, 5.94). The dose response relationship curve suggested the DII tended to be linearly associated with depression in patients with chronic diseases and comorbidity, and the ORs for risk of depression increased with the increase of DII. Furthermore, in patients had at least one chronic comorbidity, the subgroup analysis results showed that those who age<60 years or male participants had higher risk of depression, with ORs (95% CIs) of 2.60 (1.81, 3.74) and 2.51 (1.65, 3.81), respectively.

CONCLUSION

The current study demonstrates that a higher DII is associated with an increased risk of depression in participants with chronic diseases and comorbidity, especially among those less than 60 years and men. Considering diet as a modifiable factor, limiting pro-inflammatory diet or encouraging anti-inflammatory diet may be an effective way to prevent depression and reduce depressive symptoms.

Associations between depression and cognition, mild cognitive impairment and dementia in persons with diabetes mellitus: A systematic review and meta-analysis

AIMS

This systematic review aimed to examine whether persons with diabetes and depression had poorer cognition and higher dementia risk than persons with diabetes only. Moreover, the impact of timing, frequency of depressive episodes throughout life, and antidepressant treatment were examined.

METHODS

PubMed, Embase and PsycINFO were searched to obtain observational studies between August 2015 and June 2021 that examined the association between depression and cognition, mild cognitive impairment or dementia in people with diabetes. Studies published before August 2015 were retrieved from a previous systematic review. Findings were pooled using meta-analyses.

RESULTS

10 out of 19 included articles were appropriate for the meta-analyses. Persons with diabetes and depression experienced greater declines in executive function (SMD = -0.39 (-0.69, -0.08)), language (SMD = -0.80 (-1.52, -0.09)), memory (SMD = -0.63 (-1.12, -0.14)) and overall cognition (SMD = -0.77 (-1.33, -0.20)), and greater dementia risk (HR = 1.82 (1.79, 1.85)) than persons with diabetes only. No significant differences were observed for complex attention. No studies examined the role of timing and frequency of depressive episodes and antidepressant treatment.

CONCLUSION

In persons with diabetes, depression is associated with worse cognition and higher dementia risk. The potential mitigating effect of antidepressant treatment remains unclear.

Association of childhood maltreatment and cortisol with the severity and stability of depression symptoms

BACKGROUND

Little is known about patterns of depression symptoms over time in older adults. This study aims to assess the association of childhood maltreatment and cortisol levels with latent classes of depression symptoms over ten years in older adults.

METHODS

A total of 752 participants (mean age 61.7±9.5, female 18%) in the Second Manifestations of ARTerial disease-Memory, depression and aging (SMART-Medea) study provided up to twenty measures of depression symptoms over ten years based on the Patient Health Questionnaire-9 (PHQ-9). At baseline, salivary cortisol was measured, and childhood maltreatment was assessed. Responses to the PHQ-9 were indicators in a latent class analysis. Multinomial regression determined associations between class membership and cortisol and maltreatment, adjusting for age, sex, and education.

RESULTS

Four distinct classes were identified; never depressed (n=275, 37%), energy/sleep difficulties (n=237, 32%), mild depression symptoms (n=152, 20%) and fluctuating severe depression (n=88, 12%). Childhood maltreatment was associated with mild depression symptoms (OR=1.95, 95% CI: 1.17-3.25) and fluctuating severe depression (OR=3.50, 95% CI: 1.99-6.15). Blunted morning cortisol was associated with energy/sleep difficulties (OR=0.98, 95% CI: 0.95-1.00) and fluctuating severe depression (OR=0.96, 95% CI: 0.92-0.99). There was no evidence for interaction between maltreatment and cortisol.

LIMITATIONS

There is limited generalizability due to the cohort consisting of participants with atherosclerosis and being mostly male. This study utilizes retrospective self-reporting of childhood maltreatment.

CONCLUSION

Childhood maltreatment and blunted morning cortisol independently contribute to a worse depression course. Blunted morning cortisol may contribute to sub-clinical depression symptoms, specifically difficulties with energy levels and sleep.

Comorbid anxiety and depression, depression, and anxiety in comparison in multi-ethnic community of west China: prevalence, metabolic profile, and related factors

OBJECTIVES

To identify the prevalence, lifestyle factors, chronic disease status, and assessing the metabolic profile, comparing key differences in a cohort of subjects aged at least 50 years old among depression combined anxiety, depression and anxiety in a multi-ethnic population in west China.

METHODS

A large multi-ethnic sample of 6838 participants aged 50 years old (mean age 62.4 ± 8.3 years) from West China Health and Aging Trend (WCHAT) study was analyzed. We categorized all participants into four groups: (a) comorbid anxiety and depression symptomology (CAD), (b) anxiety only, (c) depression only, or (d) neither depression nor anxiety. Different variables like anthropometry measures, life styles, chronic disease and blood test were collected. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15). GDS-15 scores ≥5 indicate depression. Anxiety status was assessed using Generalized Anxiety Disorder (GAD-7) instrument and the scores ≥5 was considered as having anxiety. Different variables like anthropometry measures, life styles, cognitive function and chronic disease comorbidities were collected and serum parameters were tested. Multivariable logistic regression adjusted for age, sex, and ethnicity was done to compare between those with the mental outcomes and without.

RESULTS

The proportions of CAD, anxiety and depression were 9.0%, 12.8% and 10.6% respectively with ethnic diversity. The 'comorbid' group shown greater frequency of being female, having a lower educational level, higher prevalence of being single/divorced/widowed, drinking alcohol and smoking, more chronic disease profile and cognitive decline compared with individuals with only one disorder. And the metabolic profile showed differences in albumin, total protein, creatinine, uric acid, thyroid hormones in comparing CAD symptomology and the 'neither symptomology'.

CONCLUSIONS

Yi, Qiang and Uyghur ethnic groups have a higher prevalence of mental disease compared with Han in west China. And these mental disease had a distinct risk factor profile in age, sex, educational level, chronic disease and cognitive function. Vitamin D levels were lower among those with mental disease compared to those without.

Vascular depression in Black Americans: A systematic review of the construct and its cognitive, functional, and psychosocial correlates

Objective: Vascular burden is associated with cognitive deficits and a form of late-life depression, vascular depression (VaDep), which is marked by decreased white matter integrity, executive dysfunction, poor treatment response, and functional disability. Older Black Americans represent a vulnerable population at risk of developing VaDep, but the literature in this group is limited. Thus, the goal of this systematic review is to summarize the existing literature that informs our understanding of VaDep in older Black Americans, including cognitive, functional, and psychosocial outcomes. Method: Following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, studies were identified that examined the relationship between vascular disease or vascular risk factors and that either had a sample of at least 75% Black participants or conducted race-specific analyses. Thirty studies met all inclusion criterion based on review of both authors. Results: Overall, studies support the construct of VaDep in older Black Americans. There is preliminary support for VaDep-related cognitive and functional deficits, and mixed findings regarding racial disparities in prevalence of VaDep. Conclusion: This review underscores the need for further neuroimaging and neuropsychological research in Black older adults with comorbid depression and vascular disease. Findings also highlight the importance of screening for depressive symptoms in Black individuals with multiple vascular risk factors.

Association of residential greenness with geriatric depression among the elderly covered by long-term care insurance in Shanghai

Residential greenness exposure has been linked to a number of physical and mental disorders. Nevertheless, evidence on the association between greenness and geriatric depression was limited and focused on developed countries. This study was aimed to investigate whether the relationship between residential greenness exposure and geriatric depression exists among the elderly with long-term care insurance (LTCI) in Shanghai, China. In 2018, a total of 1066 LTCI elderly from a cross-sectional survey completed a questionnaire in Shanghai. Residential greenness indicators, including normalized difference vegetation index (NDVI) and soil-adjusted vegetation index (SAVI), were calculated from the Landsat 8 imagery data in different buffers (100-m, 300-m, and 500-m). Mediation analysis by perceived social support was conducted to explore potential mechanisms underlying the associations. In the fully adjusted model, one IQR increase of NDVI and SAVI in the 300-m buffer size was associated with an 11.9% (PR: 0.881, 95% CI: 0.795, 0.977) and 14.7% (PR: 0.853, 95% CI: 0.766, 0.949) lower prevalence of geriatric depression, respectively. Stronger association was observed in the elderly with lower education level, living in non-central area, and lower family monthly income. Perceived social support significantly mediated 40.4% of the total effect for NDVI 300-m buffer and 40.3% for SAVI 300-m buffer to the greenness-depression association, respectively. Our results indicate the importance of residential greenness exposure to geriatric depression, especially for the elderly with lower education level, living in non-central area, and lower family monthly income. Perceived social support might mediate the association. Well-designed longitudinal studies are warranted to confirm our findings and investigate the underlying mechanisms.

The Predictive Effect of Negative Psychological Emotions of Anxiety and Depression on the Poor Prognosis of CHD Patients with Stent Implantation and the Improvement of Clinical Intervention Measures

OBJECTIVE

To explore the predictive effect of negative emotions such as anxiety and depression on the poor prognosis of coronary heart disease (CHD) patients with stent implantation and to seek the improvement of clinical intervention measures.

METHODS

A total of 303 patients with CHD and PCI were recruited from February 2019 to April 2021. The risk factors of CHD such as anxiety and depression, age, sex, smoking and drinking, BMI, hypertension, diabetes, dyslipidemia, and family history of CHD were collected. Meanwhile, clinical data such as laboratory examination, angiography, diseased vessels, and stent types were collected. The patients were followed up for 1 year, and the medical records, hospitalization records, or death records were checked by telephone interview once a month. Major adverse cardiovascular events (MACE) such as emergency and causes, readmission times and causes, new nonfatal myocardial infarction, stent restenosis, heart failure, arrhythmia, and death were recorded. The incidence of anxiety and depression in patients after PCI was counted, and Cox regression was applied to analyze the influence and prediction of anxiety and depression on MACE in patients with CHD stent implantation and improve clinical intervention measures.

RESULTS

Compared with those without MACE, anxiety (56.25% vs 30.63%), depression (62.5% vs 22.88%, P < 0.01), anxiety combined with depression (46.88% vs 15.50%, P < 0.01), and hypertension history (71.8% vs 39.11%, P < 0.01) were more common in patients with MACE. Uncorrected Cox proportional hazard regression found that people with anxiety had a higher risk of developing MACE than those without anxiety (HR 3.181, P < 0.01). Multiple Cox proportional hazard regression analysis of anxiety showed that anxiety was an independent predictor of cumulative MACE (P < 0.01). The risk of developing MACE in patients with anxiety was 3.742 times higher than that in patients without anxiety (P < 0.01). Uncorrected Cox hazard regression analysis showed that people with depression had a higher risk of developing MACE than those without depression (HR 5.434, P < 0.01). Furthermore, the results also uncovered that depression was an independent predictor of cumulative MACE (P < 0.01). The risk of MACE in patients with depression was 3.087 times higher than that in patients without depression (P < 0.01). Cox hazard regression showed that the risk of MACE in patients with anxiety and depression was significantly higher than that in patients without anxiety and depression (HR 4.642, P < 0.01). After screening, it was found that anxiety with depression could predict the occurrence of MACE (P < 0.01). The risk of MACE in patients with anxiety and depression was 3.702 times higher than that in patients without anxiety and depression (P < 0.01). Cox regression analysis showed that the risk of MACE with only anxiety and depression was 2.793 times higher than that without anxiety and depression (95% CI 0.914 8.526), with no statistical significance (P > 0.05), and the risk of MACE with depression without anxiety was significantly higher than that without anxiety and depression (P < 0.01). The risk of MACE in patients with anxiety and depression was 7.303 times higher than that in patients without anxiety and depression (P < 0.01).

CONCLUSION

Negative emotions such as anxiety and depression can increase the risk of poor prognosis of patients with CHD. Therefore, in clinical work, in addition to routine treatment and nursing during hospitalization, it is recommended to screen patients with depression in CHD patients. Medical staff should use simple and effective assessment tools in time and take active measures to improve the depression of patients. This trial is registered with ChiCTR2200055645.

Perceived Academic Stress and Depression: The Mediation Role of Mobile Phone Addiction and Sleep Quality

BACKGROUND

Although academic stress is a well-known risk factor for students' depression, little is known about the possible psychological mechanisms underlying this association. In this study, we investigated the prevalence of depression and sleep disturbance among Chinese students, examined the relationship between perceived academic stress and depression, considered if mobile phone addiction and sleep quality is a mediator of this relationship, and tested if mobile phone addiction and sleep quality together play a serial mediating role in the influence of perceived academic stress on depression.

METHOD

A cross-sectional survey was conducted among students from September to December 2018 in Heilongjiang Province, China. The final analysis included 5,109 students. Mobile phone addiction, sleep quality, and depressive symptoms were assessed using the Mobile Phone Addiction Index, Pittsburgh Sleep Quality Index, and Center for Epidemiologic Studies-Depression scales, respectively. The serial mediation model was used to analyse the relationship between perceived academic stress, mobile phone addiction, sleep quality, and depression.

RESULTS

Among all participants, the prevalence of depressive symptoms and sleep disturbance was 28.69 and 27.95%, respectively. High school students showed the highest scores of perceived academic stress (2.68 ± 1.06), and the highest prevalence of depressive symptoms (33.14%) and sleep disturbance (36.47%). The serial mediation model indicated that perceived academic stress was a significant predictor of depression (B = 0.10, SE = 0.02, 95% CI = 0.06 - 0.13). Additionally, mobile phone addiction (B = 0.08, 95% boot CI = 0.06-0.11) and sleep quality (B = 0.27, 95% boot CI = 0.22-0.33) played a mediating role between perceived academic stress and depression. Mobile phone addiction and sleep quality together played a serial mediating role in the influence of perceived academic stress on depression (B = 0.11, 95% boot CI = 0.08-0.14). Furthermore, the indirect effect (i.e., the mediating effect of mobile phone addiction and sleep quality) was significant and accounted for 64.01% of the total effect.

CONCLUSIONS

Our research results underscore the need for stakeholders-including family members, educators, and policy makers-to take preventative intervention measures to address depression among Chinese students, especially high school students.

Anxiety faintly and depression remarkably correlate with recurrence in acute ischemic stroke patients: A study with 3-year longitude evaluation and follow-up

Clinical value of anxiety and depression in acute ischemic stroke (AIS) is rarely studied. Thus, the aim of this study was to explore longitudinal changes of anxiety and depression, as well as their correlation with recurrence in AIS.A total of 120 AIS patients and 120 controls were enrolled in the study. Furthermore, comparison of the hospital anxiety and depression scale (HADS) score or rate between AIS and controls was determined by Mann-Whitney U test or Chi-square test. In AIS patients, change of HADS scores or linear trend of anxiety and depression rate over time were determined by Friedman test or Mantel-Haenszel Chi-square test. Moreover, correlation of anxiety and depression with the recurrence rate was analyzed by log-rank test.HADS for anxiety score, anxiety rate, HADS for depression score and depression rate were all elevated in AIS patients compared with controls (all P < .001). In AIS patients, HADS for anxiety score was elevated from discharged from hospital (M0) to month (M) 36 (P = .027), while anxiety rate was not (P = .107). Besides, HADS-D score and rate were both increased from M0 to M36 (both P < .001). Moreover, accumulating recurrence rate was 6.7%, 11.7%, and 17.5% at 1 year, 2 years, and 3 years, respectively. Additionally, anxiety at M24 (P = .033), depression at M0, M12, M24, and M36 (all P < .05) were all correlated with increased accumulating recurrence rate.Continuous monitoring of anxiety and depression might be beneficial for the management of AIS prognosis.

Association between social phobia and the risk of arrhythmia using the Korean National Sample Cohort: a retrospective cohort study

BACKGROUND

Social phobia shares symptoms with arrhythmias, such as palpitations and chest discomfort. However, it is unclear how social phobia is associated with the actual risk of arrhythmia. This study aimed to investigate whether social phobia is associated with the risk of arrhythmia using a nationally representative sample cohort.

METHODS

This retrospective cohort study assessed data from the 2002-2013 Korean National Health Insurance Service National Sample Cohort. Using 1:3 propensity score matching for sex, age, income, and insurance status, 1514 patients with social phobia and 4542 control group patients were included in the study. Social phobia and arrhythmia were defined per the International Classification of Diseases, 10th revision. Using cox proportional hazard regression, hazard ratios (HRs) were calculated to estimate the risk of arrhythmia in patients with social phobia.

RESULTS

There were statistically significant associations between social phobia history and elevated risks of arrhythmia. Patients with social phobia had a higher risk of arrhythmia after adjusting with covariates (HR = 1.78, 95%CI = 1.25-2.55). Among different types of arrhythmias, atrial fibrillation and flutter presented the highest risk (HR = 2.20, CI = 1.06-4.57) compared to paroxysmal tachycardia (HR = 1.07, CI = 0.39-2.91) and other cardiac arrhythmias (HR = 1.83, CI = 1.16-2.89).

CONCLUSION

This study identified the association between social phobia and the risk of arrhythmia in a South Korean representative cohort. These results suggest that social phobia should be treated properly to reduce arrhythmia risks.

Illness anxiety disorder and its relationship with social health in the elderly, Isfahan, Iran

Background:

The present study investigated the prevalence of illness anxiety disorder and its relationship with social health in the elderly population.

Materials and Methods:

This cross-sectional study was conducted on 400 elderly people in Isfahan referred to the educational health service in 2020. In addition to demographic characteristics, they answered the 36-item Evans hypochondriasis questionnaire and the 28-item social health questionnaire.

Results:

Four hundred elderly participants with a mean age of 68.1 ± 6.6 (range: 60–89) were included in the study. One hundred and ninety-nine (49.8%) were female and 201 (50.3%) were male. Only 24.3% of the geriatrics were in the healthy group and 21.2% in the borderline category. Seventy-two of the geriatric population (18%) had poor social health and 299 of this population (74.8%) had moderate social health, and the social health status of 29 elderlies (7.3%) was favorable. There was an inverse relationship between hypochondriasis score and total social health score and its dimensions (P < 0.05).

Conclusion:

High prevalence of hypochondriasis was observed in the geriatrics compared to global studies. Most of the elderly population had moderate social health. Gender and education do not affect hypochondriasis and social health in the elderly. People with higher social health scores were clearly less likely to get hypochondriasis. Therefore, by improving the various dimensions of social health of the geriatrics, we can help reduce the prevalence of hypochondriasis in this age group.

Association between single and multiple cardiometabolic diseases and depression: A cross-sectional study of 391,083 participants from the UK biobank

Background

Individual cardiometabolic diseases (CMDs) are associated with an increased risk of depression, but it's unclear whether having more than one CMD is associated with accumulative effects on depression. We aimed to assess the associations between CMDs and depression and determine the accumulative extent.

Methods

In this cross-sectional study based on UK Biobank, participants with available information on CMDs and depression were enrolled. The history of CMDs was derived from self-reported medical history and electrical health-related records. Depression status was assessed by the aggregation of self-reported history and antidepressant use, depression (Smith), and hospital inpatient diagnoses. Logistic regression models were fitted to assess the association between the number or specific patterns of CMDs and depression and to test the accumulative effect of CMD number, adjusting for confounding factors.

Results

391,083 participants were enrolled in our analyses. After multivariable adjustments, CMDs of different number or patterns were associated with a higher risk of depression compared with the reference group (all P < 0.001). In the full-adjusted model, participants with one [odds ratio (OR) 1.26, 95% confidence interval (CI) 1.23-1.29], two (OR 1.50, 95% CI 1.44-1.56), and three or more (OR 2.13, 95% CI 1.97-2.30) CMD(s) had an increased risk of depression. A significant, accumulative dose-related relationship between the number of CMDs and depression was observed (OR 1.25, 95% CI 1.24-1.27). The dose-dependent accumulative relationship was consistent in stratified analyses and sensitivity analyses.

Conclusions

CMDs were associated with a higher risk of depression, and there was an accumulative relationship between CMD number and depression.

Factor Structures of Patient Health Questionnaire-9 Instruments in Exploring Depressive Symptoms of Suburban Population

BACKGROUND

This study aims to examine the psychometric properties of the nine-item Patient Health Questionnaire (PHQ-9) and assess the relationship between the PHQ-9 domain and demographics and health behaviors in Vietnamese people.

MATERIALS AND METHODS

The PHQ9 was administered to 899 participants. Exploratory factor and reliability analyses were performed. Tobit regression and Ordered logistic regression were further performed to determine factors associated with the PHQ-9 score and characteristics of depression.

RESULTS

The 2-factor model of PHQ-9, including factor 1 "Somatic" and factor 2 "Cognitive/Affective," showed good psychometric properties. The Cronbach's alpha value showed high internal consistency in two factors (0.84 and 0.80, respectively). Gender, health behavior exercising, drinking, and health status had associations with both factors of the PHQ-9 model.

CONCLUSION

The PHQ-9 scale is a valid and reliable instrument to assess depression in the Vietnam population. This scale can be a useful screening tool for depression; however, further validation studies in other populations are required.

Longitudinal trends in the prevalence and treatment of depression among adults with cardiovascular disease: An analysis of national health and nutrition examination survey 2009-2020

OBJECTIVES

To assess the contemporary prevalence and decadal trends of depression and antidepressant use among adults with cardiovascular disease (CVD) in the United States, as well as their risk factors from 2009 to 2020.

MATERIALS AND METHODS

We used the National Health and Nutrition Examination Survey data to calculate the weighted prevalence of depression and antidepressant use. Adults aged 20 years or older with CVD were included. Depression and CVD were assessed by the Patient Health Questionnaire (PHQ-9) and self-report, respectively.

RESULTS

A total of 3,073 eligible participants with CVD aged >20 years were included. The overall prevalence of depression defined by PHQ-9 score ≥10 was 15.7% (95% CI 13.8-17.5), with a steady trend during 2009-March 2020 (p = 0.777). Female gender (aOR 1.78, 95% CI 1.20-2.64) and sleep disorder (aOR 2.62, 95% CI 1.78-3.86) were independent risk factors for depression in CVD patients, while high education level, high income, longer sleep duration, and non-current smokers were considered protective factors. The weighted prevalence of antidepressant use among depressed patients with CVD was 38.6%, which also remained unchanged during the survey period (p = 0.699). Participants with normal sleep pattern and duration were significantly less likely to take antidepressants (p = 0.003).

CONCLUSION

The longitudinal trends in the prevalence of depression among CVD patients in the United States have been stable over the past decade, despite being significantly higher in women, and those with sleep disorders. Overall, antidepressant use was fairly low. Aggressive screening and tailored treatment are recommended for specific vulnerable subpopulations to improve their clinical outcomes.

Anxiety symptoms during COVID-19 in older adults with psychiatric disorders

OBJECTIVE

During the COVID-19 pandemic, older people and patients with psychiatric disorders had an increased risk of being isolated. The French National Authority for Health has recommended a reinforced follow-up of these patients. Cross-sectional studies reported an increased risk of developing anxiety and depression during pandemic. The aim of our study was to identify factors associated with higher anxiety during the pandemic in older patients with psychiatric disorders.

METHODS

STERACOVID is a multicenter cohort study with 117 patients followed-up by phone in two French geriatric psychiatry units. In this work, we used cross-sectional data from a prospective follow-up conducted between January and May 2021.

RESULTS

We found that coping strategies, personality, and living conditions were associated with general anxiety (GA) level during the pandemic period. Higher GA was associated with less positive thinking coping strategy, more avoidance strategies, a lower level of extraversion, a higher level of neuroticism, more time spent watching the news, a higher feeling of loneliness, and a lack of physical contact.

FINDINGS

Our study identified factors associated with a poorer experience of pandemic crisis. Special attention should be paid to patients with a high level of neuroticism and a high feeling of loneliness. Support could aim to help patients use more functional strategies: reducing avoidance strategies and increasing positive thinking. Finally, reducing time watching news could also be an interesting prevention perspective.

CLINICAL TRIAL REGISTRATION

clinicaltrials.gov, identifier NCT04760795.

Stress, Personality, Attachment, and Coping Strategies During the COVID-19 Pandemic: The STERACOVID Prospective Cohort Study Protocol

BACKGROUND

Due to the lockdown linked to the COVID-19 pandemic, the French National Authority for Health has recommended reinforced follow-up of psychiatric patients, with particular attention to people over 65 years. Cross-sectional studies reported an increased risk of anxiety, depression, and suicide during this period. Older people with psychiatric disorders are at higher risk of developing severe COVID-19 and worsening their psychiatric symptoms.

OBJECTIVE

The main objective is to evaluate the link between coping strategies and the onset of post-traumatic stress disorder (PTSD) after lockdown. The secondary objective is to assess the psychological factors influencing lockdown experiences such as personality, attachment type, or coping strategies.

METHOD/DESIGN

this is a multicenter cohort study including 117 patients followed up by phone in two French geriatric psychiatry units. Sociodemographic variables, psychiatric diagnoses, lockdown conditions, coping strategies, anxiety, and depressive symptoms reported during the first lockdown will be collected retrospectively from the medical file. A first prospective assessment including personality traits, attachment type, and traumatic life events will be conducted at 12 months (T1). Follow-up visits assessing anxious-depressive symptoms and PTSD will be made 18 (T2) and 24 months (T3) after the first lockdown. The primary outcome measure is PTSD symptoms. Secondary outcomes measures are coping strategies, generalized anxiety, anxiety about the COVID-19 pandemic, and quality of life.

DISCUSSION

This study aims to determine if the type of coping strategies usually employed have an impact on the onset of PTSD after a lockdown period. It will also determine if these coping strategies are influenced by other factors such as sociodemographic variables, lockdown conditions, particular personality traits, attachment type, and traumatic life events. This study could help identify factors associated with a poorer experience of lockdowns and pandemic crisis in elderly patients followed in a psychiatric center, and guide support in future similar situations.

TRIAL REGISTRATION

ClinicalTrials.gov: http://clinicaltrials.gov/show/NCT04760795, Registered 18 February 2021.

Association between Depression and Clinical Outcomes following Percutaneous Coronary Intervention: A Meta-Analysis

BACKGROUND

Several studies suggested that depression was associated with poor prognosis following percutaneous coronary intervention (PCI) in coronary heart disease (CHD), whereas other studies showed that there were no associations between depression and poor outcomes.

OBJECTIVES

Considering these problems, this meta-analysis was conducted to evaluate the relationship between depression and clinical outcomes after PCI.

METHODS

Articles published before July 2021 were analyzed from the databases: PubMed, Web of Science, EMBASE, Medline, and Google Scholar. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed to generate a pooled effect size and 95% CI with a random or fixed effects model. Q test and I2 were used to assess heterogeneities between studies.

RESULTS

The meta-analysis indicated that depression was associated with a higher risk of major adverse cardiac events (MACE) after PCI with a random effects model (HR = 1.89, 95% CI: 1.33-2.68, I2 = 57.0%, p = 0.023). The study indicated that depression was associated with a higher risk of all-cause mortality after PCI with a fixed effects model (HR = 1.71, 95% CI: 1.43-2.05, I2 = 0.0%, p = 0.756). The study indicated no significant association between depression and risk of repeat revascularization after PCI with a random effects model (HR = 2.10, 95% CI: 0.96-4.58, I2 = 68.9%, p = 0.022).

CONCLUSION

Results indicated that depression is associated with adverse clinical outcomes in CHD patients' post-PCI. Appropriate mental health check and psychological treatment may be necessary for the prognosis of CHD patients who receive PCI.

Major depressive symptoms in breast cancer patients with ovarian function suppression: a cross-sectional study comparing ovarian ablation and gonadotropin-releasing hormone agonists

BACKGROUND

Ovarian function suppression (OFS) is indicated in premenopausal women with early or metastasis breast cancer, which may be achieved with similar effect by gonadotropin-releasing hormone agonists (GnRHa) or ovarian ablation (OA). We examined whether there were differences in major depressive symptoms outcomes and its associated factors between gonadotropin-releasing hormone agonists (GnRHa) and ovarian ablation (OA) in premenopausal breast cancer patients.

METHODS

Premenopausal breast cancer patients from seven hospitals who received OFS participated in the study between June 2019 and June 2020. The correlated variable was the type of ovarian suppression, categorized as either OA (n = 174) or GnRHa (n = 389). Major depressive symptoms was evaluated using the Patient Health Questionnaire (PHQ-9), and the Female Sexual Function Index questionnaire was used to assess sexual function.

RESULTS

A total of 563 patients completed the surveys. The mean PHQ-9 sum score was slightly lower in the GnRHa cohort than in the OA cohort (11.4 ± 5.7 vs. 12.8 ± 5.8, P = 0.079). There were significantly fewer patients with major depressive symptoms (PHQ-9 ≥ 15) in the GnRHa cohort (31.1% vs. 40.2%, Exp (B)=1.805, P=0.004). Further, breast-conserving surgery and sexual dysfunction were negatively correlated with major depressive symptoms [mastectomy vs. breast-conserving: Exp (B) = 0.461, P <0.001;[sexual dysfunction vs. normal: Exp (B) = 0.512, P = 0.001].

CONCLUSIONS

This is the first study to demonstrate that GnRHa results in more favorable depressive symptoms outcomes than OA. Moreover, most patients preferred alternatives to their OFS treatment. These findings can contribute to improving and alleviating the adverse effects of OFS.

Antihypertensive Drug Use and the Risk of Depression: A Systematic Review and Network Meta-analysis

Background: Although numerous cohort studies have reported an association between antihypertensives use and depression, the exact effect of antihypertensives on depression remains unclear.

Objective: To clarify the association between antihypertensives use and risk of depression.

Methods: We retrieved relevant literature using PubMed database until August 30, 2021. Four main classes of antihypertensives, thus, angiotensin antagonists, beta blockers, calcium channel blockers and diuretics were studied. The incidence of depression was pooled based on a single drug category. Network meta-analyses were conducted to comprehensively assess the effects of the four classes of antihypertensives on the risk of depression.

Results: A total of nine out of 9,557 studies involving 414,873 subjects were retrieved. The pooled results showed a positive association between the use of calcium channel blockers and symptoms of depression [odds ratio (OR): 1.09, 95% confidence interval (CI):1.06–1.13], while use of the angiotensin antagonists, beta blockers and diuretics was not associated with risk of depression. Subgroup analysis suggested a significant relationship between beta blockers usage and risk of depression in cohort studies (OR:1.21, 95% CI: 1.16–1.26). The results of network meta-analysis indicated that all other three classes of drugs increased the risk of depression: angiotensin antagonists (OR: 1.30, 95% CI: 1.04–1.63), beta blockers (OR: 1.53, 95% CI: 1.22–1.91), and calcium channel blockers (OR: 1.40, 95% CI: 1.12–1.75), compared with diuretics.

Conclusion: In conclusion, our results indicate that the use of angiotensin antagonists, beta blockers and calcium channel blockers are potential risk factors of depression.

Increased depression risk in patients with abdominal aortic aneurysm: a nationwide cohort study

Purpose

Abdominal aortic aneurysm (AAA) is a critical disease. Most studies of AAA consider reoperation rate, complications, or mortality, but do not consider a patient's mental state. However, there is a possibility of interaction between AAA and depression in disease development and prognosis. We investigated the incidence and risk ratio of depression in patients with AAA using nationwide data.

Methods

We selected subjects from National Health Insurance System database who were diagnosed with AAA between 2009 and 2015 and survived at least 1 year after diagnosis or AAA surgery (n = 10,373). We determined the control group using propensity score matching by age and sex. The control group had about 3 times the number of subjects as the AAA cohort (n = 31,119).

Results

The incidence of depression was 1.4 times higher in the AAA group than the control group. We further analyzed the incidence of depression in the AAA group according to treatment modalities (nonsurgical vs. surgical or nonsurgical vs. open surgical aneurysm repair vs. endovascular aneurysm repair) but found no significant difference among them. The incidence of depression was significantly higher in patients aged <65 years than in patients aged ≥65 years (hazard ratio, 1.539 vs. 1.270; P < 0.001).

Conclusion

The incidence of depression was higher in the AAA group, with an especially high risk for depression in patients aged <65 years. The psychiatric status of patients with AAA should be carefully monitored for clinicians to intervene when appropriate.

New Insights into Depressive Disorder with Respect to Low-Grade Inflammation and Fish Oil Intake

Unipolar depression has been recognized as one of the major diseases by the World Health Organization in the 21st century. The etiology of depression is complicated and includes genetic factors, stress, aging, and special physical status (pregnancy, metabolic syndrome, and trauma). Numerous animal and human studies have demonstrated that n-3 polyunsaturated fatty acids (n-3 PUFAs) are highly correlated to cognition and depression. These nutritional antidepressants, including EPA and DHA, have a range of neurobiological activities contributing to their potential antidepressant effects. Our preclinical and clinical studies have indicated that n-3 PUFA supplementation in addition to standard antidepressant medications may provide synergistic neuroprotective and antioxidant/inflammatory effects. To translate our preliminary findings into clinical application, this paper reviews the existing evidence on the antidepressant effects of n-3 PUFAs and the potential underlying mechanisms, which include modulation of chronic lowgrade inflammation and the corresponding changes in peripheral blood immune biomarkers.

The global prevalence of major depressive disorder (MDD) among the elderly: A systematic review and meta-analysis

BACKGROUND

Major depressive disorder is characterized by a depressed mood or feeling of sadness, loss of interest or pleasure in everyday activities. Depressed individuals have a cognitive impairment, low self-esteem, difficulty making decisions, feeling helpless and hopeless. The factors that have been associated with depression include the lack of social support, living in rural areas, suffering from chronic diseases, smoking, and alcohol abuse. This study aimed to investigate the global prevalence of major depressive disorder in the elderly.

METHOD

The electronic database such as Web of Science (WoS), Scopus, SID, PubMed, Google Scholar, Mag Iran, and IranDoc were systematically searched for studies reporting the prevalence of major depressive disorderin the elderly published up to March 2021. Meta-analysis was performed using Comprehensive Meta-Analysis (CMA) software. Heterogeneity between the studies was evaluated using the I² index. Begg and Mazumdar rank correlation test was used to assess publication bias.

RESULT

A total of 20 studies involving 18953 participants were included in this study. The global prevalence of major depression in the elderly was 13.3 % (95 % CI: 8.4-20.3 %). In the subgroup analysis, the prevalence of major depression in elderly women was 11.9 % (95 % CI: 7.6-18.6) and men 9.7 % (95 % CI: 5.2-17.3). No comparison was made between the two sexes, but based on the confidence intervals and large overlap, the two groups are not statistically different. Among continents, Australia had the highest prevalence of major depression in the elderly at 20.1 % (CI: 14.5-27.2 %). This was followed by Europe at 12.9 % (95 % CI: 5.1-28.9 %).

CONCLUSION

Major depressive disorder has a growing trend in the elderly population of the world. The prevalence of major depression in the elderly depends on various clinical and demographic factors such as age and gender. Therefore, mental health and the quality of life (QoL) of the elderly are important. The present study emphasizes the importance of social support in mental health that can reduce depression in the elderly.

Effect of the Interaction between Depression and Sleep Disorders on the Stroke Occurrence: An Analysis Based on National Health and Nutritional Examination Survey

OBJECTIVE

To investigate the effect of the interaction between depression and sleep disorders on the stroke occurrence based on the data from the National Health and Nutritional Examination Survey (NHANES).

METHODS

Seven cycles of 2-year NHANES data (2005-2018) were analyzed in this study. Univariate analysis was first performed between the stroke and nonstroke patients, and then, multivariate logistic regression models were conducted to analyze the association of depression, sleep disorders, and their interactions with stroke occurrence.

RESULTS

A total of 30473 eligible participants were included in this study, including 1138 (3.73%) with stroke and 29335 (96.27%) with nonstroke. Except sex, the differences were all significant between the stroke and nonstroke patients in baseline information (all P < 0.001). Depression (odds ratio (OR): 2.494, 95% confidence interval (CI): 2.098-2.964), depression severity (moderate, OR: 2.013, 95% CI: 1.612-2.514; moderately severe, OR: 2.598, 95% CI: 1.930-3.496; severe, OR: 5.588, 95% CI: 3.883-8.043), and sleep disorders (OR: 1.677, 95% CI: 1.472-1.910) were presented to be associated with an increased risk of stroke after correcting all the confounders. The logistic regression analysis showed that there was a synergic, additive interaction between depression and sleep disorders on the stroke occurrence, and the proportion of stroke patients caused by this interaction accounted for 27.1% of all the stroke patients.

CONCLUSION

Depression, depression severity, and sleep disorders are all independently associated with a high risk of stroke. The interaction between depression and sleep disorders can synergistically increase the stroke occurrence.

Effects of semi-purified diet on depressive behaviors in aged mice

Diet is a key modifiable factor influencing the composition of gut microbiota. There are two types of commercially available diets for experimental animals: non-purified and semi-purified diets. Non-purified diets are composed of complex ingredients from multiple sources, while semi-purified diets are formulated with refined ingredients. Accumulating evidence has demonstrated a link between the gut microbiota and depression, and feed ingredients may influence depressive physiology and behaviors. To test this hypothesis, we examined how chronic non-purified (CRF-1) and semi-purified (AIN-93G) diets affected phenotypes, including depressive behaviors, plasma corticosterone levels, and small-intestine microbiota in young (2 months old) and aged (22 months old) inbred C57BL/JJcl mice. In young mice, similar phenotypes were associated with non-purified and semi-purified diets. However, in aged mice, semi-purified diets increased depressive behaviors in the tail suspension (P < 0.05) and forced swimming tests (P < 0.01). The corticosterone levels were similar between the two diets under normal rearing conditions. However, immediately after exposure to the stressful conditions of the forced swimming test, the corticosterone levels in the aged mice fed the semi-purified diet were higher than those of mice fed the non-purified diet (P < 0.05). There were fewer Lactobacillales in the small intestines of aged mice fed the semi-purified diet compared to those fed the non-purified diet (P < 0.01). Further, α-diversity was lower in aged mice fed the semi-purified versus non-purified diet (P < 0.01). Our results indicate that host physiology and gut microbiota differed according to whether the aged mice were fed a non-purified or semi-purified diet. Specifically, those fed the semi-purified diet were more vulnerable to stress than age-matched mice fed the non-purified diet. Our findings indicate that researchers should consider the effects of feed ingredients on depressive physiology and behaviors, and select diets that are appropriate for their particular research design. Further, identification of the ingredients in non-purified diets could facilitate examination of the mechanisms by which gut microbiota composition might increase resistance to stress and depression.

Prospective association between depressive symptoms and stroke risk among middle-aged and older Chinese

BACKGROUND

This study aimed to assess the association between baseline symptoms and changes in depressive symptoms and stroke incidents.

METHODS

We used data from the Chinese Health and Retirement Longitudinal Study conducted in 2013, 2015, and 2018. In total, 10,100 individuals aged ≥45 years and without a history of stroke in 2013 were included. Depressive symptoms were measured using the 10-item version of the Center for Epidemiological Studied Depression scale (elevated depressive symptoms cutoff ≥10). Changes of depressive symptoms were assessed by two successive surveys (stable low/no, recent onset, recently remitted, and stable high depressive symptoms). We assessed whether baseline depressive symptoms and changes of them were associated with stroke incidents reported through 2018. Logistic regression analyses adjusted for age, gender, education, marital status and other potential confounders were performed.

RESULTS

For the analysis of baseline depressive symptoms and stroke (n = 10,100), 545 (5.4%) reported stroke incidents in the following 5-year period. Individuals with elevated depressive symptoms in 2013 experienced a markedly higher stroke risk (odds ratio (OR) = 1.53, 95% confidence interval (CI) = 1.28-1.84) compared with those without elevated depressive symptoms. In the analysis of changes in depressive symptoms (n = 8491, 430 (5.1%) stroke events), participants with stable high (OR = 2.01, 95% CI = 1.58-2.56) and recent-onset (OR = 1.39, 95% CI = 1.04-1.85) depressive symptoms presented higher stroke risk compared to those with stable low/no depressive symptoms, while recently remitted symptoms (OR = 1.12, 95% CI = 0.80-1.57) were not associated with stroke risk.

CONCLUSIONS

In conclusion, stable high and newly started depressive symptoms were associated with increased stroke risk, whereas the improvement of depressive symptoms was not related to increase in stroke risk, suggesting that stroke risk may be decreased by effective management of depressive symptoms.

The Association of Cardiometabolic Disease with Psychological Factors in Colombian People during the COVID-19 Pandemic: A Cross-Sectional Study

During the COVID-19 pandemic, psychological disorders have been documented in the population, and their exacerbation in vulnerable populations such as those with Cardiometabolic Diseases (CD) might challenge health systems. This study determined psychological factors associated with CD in Colombian adults during the COVID-19 pandemic. For this purpose, 284 persons were evaluated, 142 without CD and 142 with CD. Sociodemographic data were collected, and the International Physical Activity Questionnaire (IPAQ), the SF-12v2, the Pittsburgh Sleep Quality Index (PSQI) and the Zung Self-Rating Depression Scale (ZSDS), which were integrated into an online form, were used. Through a simple and multiple logistic regression model, it was shown that CD was associated with low sleeping quality (LSQ) (OR = 3.51) and with depressive symptoms (DS) (OR = 1.98). In addition, in the group with CD, the presence of DS was related to BMI (OR = 2.45), and LSQ was related to living with persons at risk for COVID-19 (OR = 3.64) and BMI (OR = 5.88). In conclusion, this study showed that people with CD have a higher chance of presenting DS and LSQ. Furthermore, living with people at risk for COVID-19 was related to the presence of LSQ.

Urban-rural differences in the association between social activities and depressive symptoms among older adults in China: a cross-sectional study

BACKGROUND

Participation in social activities has positive health effects among older adults; however, few studies have investigated the association between social activity and depressive symptoms among Chinese older adults. This study aimed to examine the association between social activities and depressive symptoms among older adults in China regarding urban-rural differences.

METHODS

Data were collected from 8255 respondents from the 2015 China Health and Retirement Longitudinal Study. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale. Type and frequency of social activities were collected via a questionnaire. Multivariate logistic regression analysis was used to explore the relationship between social activities and depressive symptoms.

RESULTS

In our study, the prevalence of depressive symptoms was lower in urban older adults compared with rural older adults (25.2% vs. 40.7%). After adjustment for all covariates, our results indicated that interacting with friends almost weekly or almost daily (almost weekly: OR = 0.568, 95%CI: 0.337-0.955; almost daily: OR = 0.664, 95%CI: 0.453-0.973) and participating in community organizations almost daily were inversely associated with depressive symptoms among urban older adults (OR = 0.107, 95%CI: 0.012-0.952). Interacting with friends almost daily (OR = 0.847, 95% CI: 0.720-0.996) and participation in hobby groups either almost every week or almost daily were both inversely associated with depressive symptoms among rural older adults (almost weekly: OR = 0.683, 95%CI: 0.518-0.902; almost daily: OR = 0.567, 95%CI: 0.440-0.731). Participating in sports groups almost daily was inversely associated with depressive symptoms among both urban and rural older adults (urban: OR = 0.664, 95%CI: 0.445-0.991; rural: OR = 0.506, 95%CI: 0.366-0.700).

CONCLUSIONS

Our findings indicated that there is a cross-sectional association between participation in social activities and depressive symptoms among Chinese older adults, and the association differed between urban and rural older adults. This implies that participation in social activities may be significant for alleviating depressive symptoms of older adults. When encouraging older adults to participate in social activities, the government should consider urban-rural differences and take effective measures accordingly. Longitudinal studies are needed to examine the causal relationships between social activities and depressive symptoms among older adults.

Effects of aerobic exercise training on mental health and arterial stiffness in middle-aged and older adults

BACKGROUND

Aging is associated with deterioration of arterial function and mental health, which are known as cardiovascular risk factors. The present study investigated the effect of aerobic exercise training on mental health and arterial stiffness in middle-aged and older adults.

METHODS

Twenty-nine healthy middle-aged and older adults were assigned to either the aerobic exercise training (N.=14) or the control groups (N.=15). The aerobic exercise training group completed 12 weeks of moderate aerobic exercise training for 3-4 session per week (30-60 minutes). The control group did not change their levels of physical activity. Before and after the 12-week period, the General Health Questionnaire (GHQ) and carotid β-stiffness index, peak oxygen uptake were measured.

RESULTS

At the onset of the 12-week period, the GHQ score, Carotid Β-Stiffness Index, and other key variables did not differ significantly between the aerobic exercise and control groups. The 12-week of aerobic exercise training increased peak oxygen uptake. The GHQ score and Carotid Β-Stiffness Index were decreased after the 12-week period in the aerobic exercise training group; however, no significant improvements were observed in the control group.

CONCLUSIONS

We conclude that 12 weeks of aerobic exercise enhance mental health and decrease arterial stiffness in healthy middle-aged and older adults.