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Kuring JK, Mathias JL, Ward L, Tachas G. Inflammatory markers in persons with clinically-significant depression, anxiety or PTSD: A systematic review and meta-analysis. J Psychiatr Res 2023; 168:279-292. [PMID: 37931509 DOI: 10.1016/j.jpsychires.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/30/2023] [Accepted: 10/06/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Depression, anxiety and PTSD appear to be risk factors for dementia, but it is unclear whether they are causal or prodromal. The inflammatory-mediated neurodegeneration hypothesis suggests a causal link, proposing that mental illness is associated with an inflammatory response which, in turn, triggers neurodegenerative changes that lead to dementia. Existing meta-analyses have yet to examine inflammatory markers in depression, anxiety or PTSD with the view to exploring the inflammatory-mediated neurodegeneration hypothesis. The current meta-analysis therefore examined whether: a) depression, anxiety and PTSD are individually associated with inflammation, independently of comorbid mental illnesses and physical health problems with known inflammatory responses, and b) there are any similarities in the inflammatory profiles of these disorders in order to provide a basis for exploring inflammation in people with dementia who have a history of clinically-significant anxiety, depression or PTSD. METHODS PubMed, EMBASE, PsycINFO and CINAHL searches identified 64 eligible studies. RESULTS Depression is associated with an inflammatory response, with tentative evidence to suggest anxiety and PTSD are also associated with inflammation. However, the specific response may differ across these disorders. LIMITATIONS The data for anxiety, PTSD and multiple inflammatory markers were limited. CONCLUSIONS Depression, anxiety, and PTSD each appear to be associated with an inflammatory response in persons who do not have comorbid mental or physical health problems that are known to be associated with inflammation. Whether this inflammatory response underlies the increased risk of dementia in persons with a history of depression and anxiety, and possibly PTSD, remains to be determined.
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Affiliation(s)
- J K Kuring
- Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia
| | - J L Mathias
- Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia.
| | - L Ward
- Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, Australia
| | - G Tachas
- Antisense Therapeutics Ltd, Melbourne, Australia
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Lee S, Lee KH, Park KM, Park SJ, Kim WJ, Lee J, Kronbichler A, Smith L, Solmi M, Stubbs B, Koyanagi A, Jacob L, Stickley A, Thompson T, Dragioti E, Oh H, Brunoni AR, Carvalho AF, Radua J, An SK, Namkoong K, Lee E, Shin JI, Fusar-Poli P. Impact of data extraction errors in meta-analyses on the association between depression and peripheral inflammatory biomarkers: an umbrella review. Psychol Med 2023; 53:2017-2030. [PMID: 34749836 DOI: 10.1017/s0033291721003767] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Accumulating evidence suggests that alterations in inflammatory biomarkers are important in depression. However, previous meta-analyses disagree on these associations, and errors in data extraction may account for these discrepancies. METHODS PubMed/MEDLINE, Embase, PsycINFO, and the Cochrane Library were searched from database inception to 14 January 2020. Meta-analyses of observational studies examining the association between depression and levels of tumor necrosis factor-α (TNF-α), interleukin 1-β (IL-1β), interleukin-6 (IL-6), and C-reactive protein (CRP) were eligible. Errors were classified as follows: incorrect sample sizes, incorrectly used standard deviation, incorrect participant inclusion, calculation error, or analysis with insufficient data. We determined their impact on the results after correction thereof. RESULTS Errors were noted in 14 of the 15 meta-analyses included. Across 521 primary studies, 118 (22.6%) showed the following errors: incorrect sample sizes (20 studies, 16.9%), incorrect use of standard deviation (35 studies, 29.7%), incorrect participant inclusion (7 studies, 5.9%), calculation errors (33 studies, 28.0%), and analysis with insufficient data (23 studies, 19.5%). After correcting these errors, 11 (29.7%) out of 37 pooled effect sizes changed by a magnitude of more than 0.1, ranging from 0.11 to 1.15. The updated meta-analyses showed that elevated levels of TNF- α, IL-6, CRP, but not IL-1β, are associated with depression. CONCLUSIONS These findings show that data extraction errors in meta-analyses can impact findings. Efforts to reduce such errors are important in studies of the association between depression and peripheral inflammatory biomarkers, for which high heterogeneity and conflicting results have been continuously reported.
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Affiliation(s)
- San Lee
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Mee Park
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Sung Jong Park
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Jae Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinhee Lee
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | | | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ontario, Canada
- Department of Mental Health, The Ottawa Hospital, Ontario, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ontario, Canada
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- ICREA, Pg. Lluis Companys 23, Barcelona, Spain
| | - Louis Jacob
- Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Andrew Stickley
- Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, Huddinge 141 89, Sweden
| | - Trevor Thompson
- Department of Psychology, University of Greenwich, London SE109LS, UK
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Hans Oh
- School of Social Work, University of Southern California, CA, USA
| | - Andre R Brunoni
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry, Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27) and National Institute of Biomarkers in Neuropsychiatry (INBioN), Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
- Departamento de Clínica Médica, Hospital Universitario, Faculdade de Medicina da USP, São Paulo, Brazil
| | - Andre F Carvalho
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Joaquim Radua
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institute, Stockholm, Sweden
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain
| | - Suk Kyoon An
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kee Namkoong
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Lee
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, King's College London, London, UK
- OASIS service, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
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Association of trauma exposure with proinflammatory activity: a transdiagnostic meta-analysis. Transl Psychiatry 2014; 4:e413. [PMID: 25050993 PMCID: PMC4119223 DOI: 10.1038/tp.2014.56] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/02/2014] [Accepted: 05/22/2014] [Indexed: 12/15/2022] Open
Abstract
Exposure to psychological trauma (for example, childhood/early life adversity, exposure to violence or assault, combat exposure, accidents or natural disasters) is known to increase one's risk of developing certain chronic medical conditions. Clinical and population studies provide evidence of systemic inflammatory activity in trauma survivors with various psychiatric and nonpsychiatric conditions. This transdiagnostic meta-analysis quantitatively integrates the literature on the relationship of inflammatory biomarkers to trauma exposure and related symptomatology. We conducted random effects meta-analyses relating trauma exposure to log-transformed inflammatory biomarker concentrations, using meta-regression models to test the effects of study quality and psychiatric symptomatology on the inflammatory outcomes. Across k=36 independent samples and n=14,991 participants, trauma exposure was positively associated with C-reactive protein (CRP), interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α (mean rs =0.2455, 0.3067, 0.2890, and 0.2998, respectively). No significant relationships were noted with fibrinogen, IL-2, IL-4, IL-8, or IL-10. In meta-regression models, the presence of psychiatric symptoms was a significant predictor of increased effect sizes for IL-1β and IL-6 (β=1.0175 and 0.3568, respectively), whereas study quality assessment scores were associated with increased effect sizes for IL-6 (β=0.3812). Positive correlations between inflammation and trauma exposure across a range of sample types and diagnoses were found. Although reviewed studies spanned an array of populations, research on any one specific psychiatric diagnosis was generally limited to one or two studies. The results suggest that chronic inflammation likely represents one potential mechanism underlying risk of health problems in trauma survivors.
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