The association between loss of work ability and depression: a focus on employment status

The relationship between chronotype and treatment time of day on post-treatment depression symptom severity for depressed patients receiving cognitive behavioural therapy

BACKGROUND

Major depressive disorder (MDD) represents a serious public health problem that affects a quarter billion individuals worldwide. Consequently, there is a need to identify modifiable factors of services that support treatment success. The relationship between circadian preferences (i.e., chronotype), treatment time of day, and outcomes is an understudied research area. Executing optimal treatment timing based on these factors could lead to substantial returns on a modifiable variable.

METHOD

The present study evaluated the associations between chronotype and treatment time of day on post-treatment depression symptom severity. In a tertiary setting, outpatients with MDD (n = 227) received 14 sessions of cognitive behavioural therapy in a group format, at one of three time of days: morning, afternoon, or evening. Participants completed measures of depression and chronotype at baseline and post-treatment.

RESULT

Statistically significant increases in morningness were found for the afternoon and evening groups, but not the morning group. There was no significant interaction effect between pre-treatment morningness-eveningness scores and treatment time of day on post-treatment depression scores nor treatment response. However, there was a significant interaction effect of change in morningness-eveningness scores and post-treatment depression severity in the afternoon group.

LIMITATIONS

The lack of a control group limits conclusions drawn.

CONCLUSION

The results suggest that individual circadian phase may impact treatment outcomes in relation to time of day. Further intentionally designed research is warranted to improve understanding of predictors, moderators, and mediators of patient outcomes based on treatment time of day and circadian phase and amplitude.

High-Frequency Cognitive Control Training for Depression: Case Report

BACKGROUND

Cognitive control training (CCT) has gained attention in recent years as a preventative intervention in the context of major depressive disorder. To date, uncertainty exists around the working mechanisms of CCT and how its effects unfold overtime.

OBJECTIVE

This study aimed to examine cognitive and affective transfer effects following an unusually high number of training sessions.

METHODS

This case report presents data of a participant completing a large amount of training sessions (n=55) over the course of 1 year in 2 training phases: 10 initial sessions, followed by 45 additional sessions. Reliable change indices were calculated for several self-report questionnaires, measuring cognitive and affective functioning.

RESULTS

Cognitive task performance suggests improved cognitive functioning after training (accuracy scores increased from 43/181, 24% at baseline to 110/181, 61% shortly after training), which was maintained at follow-up (accuracy scores around 50%). Reliable change indices suggest a decrease in depressive symptoms (Beck Depression Inventory-II score decreased from 23 at baseline to 3 following initial training). Similarly, burnout symptoms following CCT showed a similar decrease. Maladaptive emotion regulation strategies displayed high variability, decreasing after periods of training but increasing when no training was performed. However, no changes in repetitive negative thinking were observed. Thematic analysis from an in-depth interview focusing on CCT adherence and user experience pointed to the importance of independency and accessibility of CCT in perceived agency, as well as the need for clear feedback mechanisms following training.

CONCLUSIONS

Training task performance indicates further increases in performance beyond typical amounts of training sessions (10-20 sessions), hinting that more sessions could be beneficial for continued improvement in cognitive functioning. In line with previous research, CCT decreased depressive symptomatology. However, its effects on emotion regulation remain unclear. Further mechanistic studies into the temporal unfolding of CCT effects are necessary to investigate potential working mechanisms.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05166798; https://clinicaltrials.gov/study/NCT05166798.

Psychological problems and work ability in unemployed people diagnosed with a mental illness

BACKGROUND

Research shows that unemployed individuals are more often affected by mental illness, and that mental illness can impede an individual's work ability, creating a significant obstacle to (re)entering the workforce.

AIMS

The objective of this study is to examine the relationships between psychological symptoms and work ability in unemployed individuals with mental illnesses (UMIs). This will enable us to identify the symptoms that are most relevant for future research and application.

METHOD

Our study is based on a sample from the project LIPSY, which aims to maintain and/or restore the employability of UMIs. We conducted regression analyses with the outcome variable work ability in a sample of unemployed individuals with a mental illness (ICD-10: F-diagnosis). In the initial analysis, age, gender, education, and cohabitation status were used as predictors; in the final model, all nine symptom dimensions (SCL-90) were added, that is, (1) Somatization, (2) Obsessive-Compulsive, (3) Interpersonal Sensitivity, (4) Depression, (5) Anxiety, (6) Anger-Hostility, (7) Phobic Anxiety, (8) Paranoid Ideation, and (9) Psychoticism.

RESULTS

Our sample comprised 402 participants, with a mean age of 35.7 years, 52.5% were female. In the final analysis, we found significant positive associations between education, Paranoid Ideation, and work ability, and a significant negative one between Depression and work ability, but no other significant associations.

CONCLUSIONS

The elevated scores on all SCL-90 dimensions, along with the associations between two dimensions and work ability, underscore the need for psychological screening, diagnosis, prevention, and therapy (Depression) as well as additional public health attention and research (Paranoid Ideation) in this high-risk population.

The impact of job fitness on depressive symptoms in Korean middle-aged and older population: a longitudinal study

Purpose

This study aimed to determine the impact of job fitness on depression and depressive symptoms in Korean middle-aged and older population.

Methods

We collected data from the Korean Longitudinal Study of Aging (KLoSA), and performed a longitudinal analysis on 3,185 individuals with jobs at baseline. The dependent variable, depressive symptoms was measured by CES-D10 score, and the main variable of interest, job fitness was classified into nine groups according to job satisfaction and education level. To determine whether the estimate of depressive symptoms over the past week and depression changed over time, we applied the Generalized Estimating Equation (GEE) model.

Results

In the fully adjusted model, the impact of job fitness on depression and depressive symptoms was statistically significant. Compared to those with a suitable job level and a medium educational level, those with a large gap between job and educational levels were more likely to develop depression and depressive symptoms. It was also found that satisfaction with job content was a crucial factor affecting depression in the middle-aged and older adults.

Conclusion

Our findings demonstrated that job fitness significantly influenced depression, even after accounting for the effect of job satisfaction caused by a mismatch in job-education fitness. Since work demands and responsibility are difficult to quantify or qualify, job-education fitness could serve as a valuable tool to predict the extent of depression deterioration in individuals.

Impact of Long-Term Depression on Employment Outcomes: A Systematic Review and Case Series From Iraq on Career Trajectory and Job Stability

Background Long-term forms of depression, especially chronic and episodic, make it very hard for any individual to maintain a steady job or develop in his/her workplace, which reduces the ability to gain financial security. The purpose of this study is to investigate and thoroughly examine the impact of long-term depression on career trajectories and job stability using a methodical evaluation of the literature supplemented with case studies. Methodology This study combined a systematic review of available literature with a detailed case series analysis. The literature search was conducted systematically in three major databases, namely, PubMed, PsycINFO, and Scopus. The systematic review synthesized findings from studies that assessed the relationship between chronic and episodic long-term depression and employment-related outcome measures, i.e., job stability, upward career mobility, and socioeconomic status. The studies published between 2000 and 2024 were included and qualified. The case series contributed qualitative depth using eight personal experiences illustrating how the use of self-workplace dynamics interacted with depressive symptoms to shape employment. Results The systematic review provided consistent evidence that depression negatively influences employment status, such as decreased income and an increased rate of unemployment and disability claims. The current investigation included 29 studies, which were chosen after a rigorous screening process that included identifying 10,651 records and removing irrelevant or duplicate entries. The case series underlined further that it is the role of support executed by the workplace and societal stigma that mitigates or exaggerates these outcomes. In cases, people whose careers were disrupted by depression (job loss, low productivity, and long-term financial pressure) evidenced a huge change. Conclusions The effects of chronic and episodic long-term depression interfered with employment and socioeconomic well-being and, in fact, expanded beyond the individual to affect larger societal factors. Healthcare providers should collaborate with employers to ensure affected individuals receive appropriate accommodations in the workplace along with responses to mental health concerns. Further, policymakers should create inclusive policy environments to address the demands of people concerning job security and access to mental health related to depression. In addition, they should promote anti-stigma campaigns targeted at the reduction of societal and workplace discrimination against mental health issues.

Trajectories of depression and predictors in lung cancer patients undergoing chemotherapy: growth mixture model

BACKGROUND

Depression is prevalent among lung cancer patients undergoing chemotherapy, and the symptom cluster of fatigue-pain-insomnia may influence their depression. Identifying characteristics of patients with different depression trajectories can aid in developing more targeted interventions. This study aimed to identify the trajectories of depression and the fatigue-pain-insomnia symptom cluster, and to explore the predictive factors associated with the categories of depression trajectories.

METHODS

In this longitudinal study, 187 lung cancer patients who were undergoing chemotherapy were recruited and assessed at the first (T1), second(T2), and fourth(T3) months using the Patient Health Questionnaire-9 (PHQ-9), the Brief Pain Inventory (BPI), the Brief Fatigue Inventory (BFI), and the Athens Insomnia Scale (AIS). Growth Mixture Model (GMM) and Latent Class Analysis (LCA) were used to identify the different trajectories of the fatigue-pain-insomnia symptom cluster and depression. Binary logistic regression was utilized to analyze the predictive factors of different depressive trajectories.

RESULTS

GMM identified two depressive trajectories: a high decreasing depression trajectory (40.64%) and a low increasing depression trajectory (59.36%). LCA showed that 48.66% of patients were likely members of the high symptom cluster trajectory. Binary logistic regression analysis indicated that having a history of alcohol consumption, a higher symptom cluster burden, unemployed, and a lower monthly income predicted a high decreasing depression trajectory.

CONCLUSIONS

Depression and fatigue-pain-insomnia symptom cluster in lung cancer chemotherapy patients exhibited two distinct trajectories. When managing depression in these patients, it is recommended to strengthen symptom management and pay particular attention to individuals with a history of alcohol consumption, unemployed, and a lower monthly income.

Permanent unfitness for work and mental disorders: a multicentric cross-sectional study of 2,788 unfit employees

In France, Mental Disorders (MD) are the second most common medical cause of unfitness-for-work notices. The main objective is to describe the MD causing permanent medically unfitness at the workstation. A cross-sectional multicenter survey was conducted among employees followed by 323 physicians from occupational health services of the South of France in 2017. The MD responsible for unfitness for the job were coded according to the ICD-10 nomenclature and their occupational origin was estimated by each physician. On 359,966 employees screened, 2,788 were unfitted. Among the 2,779 unfitness cases which were analysed, 985 were unfitted for MD. The incidence rate of unfitness for MD was 2.78 unfit per 1,000 employees followed. Representing 36.8% (985 cases) of all grounds for unfitness, MD were estimated to be work-related in 614 (63.6%) of cases. The main MD were 449 (45.6%) cases of major depressive episodes, 227 (23.0%) anxiety disorders and 131 (13.3%) recurrent depressive disorders. Their occupational origin was mentioned in 296 (67.3%), 168 (74.7%), 62 (49.6%) cases and the link with a Burnout (BO) in 166 (38.3%), 61 (27.9%) and 41 (34.2%) cases respectively among 364 all pathologies reported to a BO. Unfitness for MD was more common among women (ORa = 1.79 95% CI [1.50-2.13]), working in trade, transport, accommodation and catering (ORa = 1.47 95% CI [1.04-2.09]) and increase with age (ORa = 4.24 95% CI [2.73-6.60] for over 55). Major depressive episodes represent the MD most frequently responsible for unfitness and the most related to occupational origin.

The Association of Multidimensional Sleep Health With HbA1c and Depressive Symptoms in African American Adults With Type 2 Diabetes

OBJECTIVE

Sleep is important for diabetes-related health outcomes. Using a multidimensional sleep health framework, we examined the association of individual sleep health dimensions and a composite sleep health score with hemoglobin A1c (HbA1c) and depressive symptoms among African American adults with type 2 diabetes.

METHODS

Participants (N = 257; mean age = 62.5 years) were recruited through local churches. Wrist-worn actigraphy and sleep questionnaire data assessed multidimensional sleep health using the RuSATED framework (regularity, satisfaction, alertness, timing, efficiency, duration). Individual sleep dimensions were dichotomized into poor or good sleep health and summed into a composite score. HbA1c was assessed using the DCA Vantage™ Analyzer or A1CNow® Self Check. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Regression models examined the association of individual sleep dimensions and composite sleep health with HbA1c and depressive symptoms.

RESULTS

Higher composite sleep health scores were associated with a lower likelihood of having greater than minimal depressive symptoms (PHQ-9 ≥ 5) (odds ratio [OR] = 0.578, 95% confidence interval [CI] = 0.461-0.725). Several individual sleep dimensions, including irregularity (OR = 1.013, CI = 1.005-1.021), poor satisfaction (OR = 3.130, CI = 2.095-4.678), and lower alertness (OR = 1.866, CI = 1.230-2.833) were associated with a greater likelihood of having depressive symptoms. Neither composite sleep health scores nor individual sleep dimensions were associated with HbA1c.

CONCLUSIONS

Better multidimensional sleep health is associated with lower depressive symptoms among African American adults with type 2 diabetes. Longitudinal research is needed to determine the causal association between multidimensional sleep health and depressive symptoms in this population.

TRIAL REGISTRY

ClinicalTrials.gov identifier NCT04282395.

Study on a Bayes evaluation of the working ability of petroleum workers in the Karamay region, Xinjiang, China

Objectives

Use Bayes statistical methods to analyze the factors related to the working ability of petroleum workers in China and establish a predictive model for prediction so as to provide a reference for improving the working ability of petroleum workers.

Materials and methods

The data come from the health questionnaire database of petroleum workers in the Karamay region, Xinjiang, China. The database contains the results of a health questionnaire survey conducted with 4,259 petroleum workers. We established an unsupervised Bayesian network, using Node-Force to analyze the dependencies between influencing factors, and established a supervised Bayesian network, using mutual information analysis methods (MI) to influence factors of oil workers’ work ability. We used the Bayesian target interpretation tree model to observe changes in the probability distribution of work ability classification under different conditions of important influencing factors. In addition, we established the Tree Augmented Naïve Bayes (TAN) prediction model to improve work ability, make predictions, and conduct an evaluation.

Results

(1) The unsupervised Bayesian network shows that there is a direct relationship between shoulder and neck musculoskeletal diseases, anxiety, working age, and work ability, (2) The supervised Bayesian network shows that anxiety, depression, shoulder and neck musculoskeletal diseases (Musculoskeletal Disorders, MSDs), low back musculoskeletal disorders (Musculoskeletal Disorders, MSDs), working years, age, occupational stress, and hypertension are relatively important factors that affect work ability. Other factors have a relative impact on work ability but are less important.

Conclusion

Anxiety, depression, shoulder and neck MSDs, waist and back MSDs, and length of service are important influencing factors of work ability. The Tree Augmented Naïve Bayes prediction model has general performance in predicting workers’ work ability, and the Bayesian model needs to be deepened in subsequent research and a more appropriate forecasting method should be chosen.

The mediating role of work-family conflicts in the association between work ability and depression among Egyptian civil workers

BACKGROUND

Work ability and work-family conflicts (total-WFCs) were associated with the risk of depression among the working population.

METHODS

We recruited 3104 Egyptian civil workers between October 2019 and January 2020. The Work Ability Index (WAI), Center for Epidemiologic Studies-Depression (CES-D) and Midlife Development in the United States questionnaires were used to collect the data. Following Baron and Kenny criteria, the mediation effect of total-WFCs on the association between WAI and CES-D scores was tested by multivariable linear regression models.

RESULTS

Findings revealed a high prevalence of depressive symptoms (CES-D score ≥ 16) among Egyptian civil servants (43.4%). There were negative relationships between WAI score and both CES-D score (B = -0.70, P < 0.001) and total-WFCs score (B = -0.22, P < 0.001). Moreover, WAI score was still significantly associated with CES-D score after controlling for total-WFCs score (B = -0.40, P < 0.001) that suggests partial mediation. We estimated that ~44%, 38% and 20% of the total effect of work ability on the risk of depressive symptoms were mediated by total-WFCs, family-to-work conflict and work-to-family conflict, respectively.

CONCLUSIONS

Interventions aiming for mitigation total-WFCs can help improve employees' mental health and reduce the risk of impaired work ability-related depression.

Inflammatory markers and risk factors of RA patients with depression and application of different scales in judging depression

To evaluate the association of inflammatory markers and depression in RA patients and the risk factors in RA with depression, a cross-sectional study was conducted in a cohort of RA patients from southern China.Two hundred-fifteen RA patients were enrolled. The demographic and disease-related characteristics were recorded and inflammatory markers in sera were measured. RA patients were guided to fill out PHQ-9 scale by themselves, the psychological state was evaluated by psychiatry experts and graded according to the HAMD-17 scale. The consistency of the two scales in judging depression was evaluated. RA with depression group had HAMD-17 scores greater than 7. The levels of CRP, ESR, fibrinogen, SAA, IL-2, IL-6, TNF-α, IFN-γ, IL-4, and IL-10 were measured and compared. Logistic regression analysis was performed to find the risk factors of RA with different depression levels. One hundred-five (48.84%) RA patients had HAMD-17 scores greater than 7. High consistency was found between HAMD-17 and PHQ-9 in predicting depression. RA patients with depression were more likely to have tender joints, lower income, no employment, higher disease activity, joint deformities and glucocorticoid treatment. The depressed RA patients had higher serum levels of IL-6, CRP, fibrinogen, and SAA. IL-6, CRP, fibrinogen, and SAA were positive correlated with depression in RA patients. PHQ-9 can replace HAMD-17 in clinical application to judge depression.

Associations between depressive complaints and indicators of labour participation among older Dutch employees: a prospective cohort study

PURPOSE

European policy measures have led to an increased net labour participation of older employees. Yet, via different routes (for instance disability schemes) employees still often leave the labour market early. Mental health may be an important factor hindering labour participation. Aims of this study are twofold: first, to examine the relationship between mental health-particularly depressive complaints-and indicators of labour participation among older employees over a 2-year follow-up period and second, to explore the impact of different work contexts when studying this relation.

METHODS

A subsample of older employees (aged > 45 years; n = 1253) from the Maastricht Cohort Study was studied. Depressive complaints were assessed using the Hospital Anxiety and Depression scale. Logistic and Cox regression analyses covered 2 years of follow-up and were also stratified for relevant work-related factors.

RESULTS

Employees with mild depressive complaints showed statistically significantly higher risks for poor mental workability (HR 2.60, 95% CI 1.14-5.92) and high psychological disengagement levels (HR 2.35, 95% CI 1.21-4.57) over time compared to employees without depressive complaints. Within various work contexts, for instance in which employees perform physically demanding work or have high psychological job demands, significantly stronger associations were found between depressive complaints and poor mental workability over time.

CONCLUSIONS

This study shows strong longitudinal associations between depressive complaints and indicators of labour participation, also within different work contexts over time. Results provide valuable input for developing preventive measure aiming to enhance sustainable labour participation of older employees.

Physical activity and ability to meet different work requirements among adult working men with or without current depressive symptoms

Purpose

To examine the relationship between leisure-time physical activity (LTPA) and ability to meet different work requirements among adult working men with or without current depressive symptoms.

Methods

We measured LTPA with the long version of the International Physical Activity Questionnaire (IPAQ). The Work Ability Index (WAI) and Beck Depression Inventory (BDI) were used to assess the work ability and depression of 921 Finnish employed male volunteers. Participants were divided into three groups according to the WAI for their work requirements: mental (MENT), physical (PHYS), and an equal amount of mental and physical work (BTH).

Results

When adjusted for age, BMI and employment years, there was a significant difference in weekly LTPA between WAI groups {p = 0.003, [F (2902) = 5.58]}, but not for depression. It appeared that participants with depressive symptoms scored lower WAI in each group regardless of LTPA. In addition, a linear relationship was found between higher LTPA and WAI in nondepressed workers in the PHYS [p = 0.011, β = 0.10 (95% CI 0.03–0.18)] and BTH [p = 0.027, β = 0.19 (95% CI 0.03–0.34)] groups. Among workers with depressive symptoms, similar linearity was found in BTH [p = 0.003, β = 0.20 (95% CI 0.03–0.55)]. In group-wise comparison, work requirements {p = 0.001, [F (2902) = 11.2]} and depressive symptoms {p < 0.001, [F (1902) = 177.0]} related with lower WAI.

Conclusion

Depressive symptoms were associated with lower work ability regardless of the job description. Therefore, higher levels of weekly LTPA was linked with better work ability among nondepressed working men. Workers with depressive symptoms in jobs that require extensive mental or physical work might need more than exercise to improve work ability.

Electronic supplementary material

The online version of this article (10.1007/s00420-020-01595-6) contains supplementary material, which is available to authorized users.

The moderating role of psychosocial working conditions on the long-term relationship between depressive symptoms and work ability among employees from the Baby Boom generation

Objective

Mental disorders have been identified as a leading cause for reduced work ability in industrialized countries. Identification of workplace factors that can increase the work ability of employees with depressive symptoms from the Baby Boom generation is, therefore, highly relevant. This study thus aims to investigate whether changes in psychosocial working conditions can moderate the negative association between depressive symptoms and work ability.

Methods

Two waves with a 3-year time lag of the German lidA cohort study with 3609 participants born in 1959 and 1965 (aged 46 and 52 years at first wave) were analyzed. Self-report data about depressive symptoms at baseline and changes of working conditions from baseline to follow-up were used to calculate main and interaction effects on perceived work ability at follow-up. These analyses were controlled for baseline work ability and working conditions.

Results

Depressive symptoms were predictive for an unfavorable course of work ability from baseline to follow-up (B = − 0.173, 95% CI = − 0.219 to − 0.128). However, no interaction effect between depressive symptoms and psychosocial working conditions was found. Instead, independent from the level of depressive symptoms, a decrease in quantitative demands (B = − 0.279, 95% CI = − 0.326 to − 0.232) and increases in leadership quality (B = 0.242, 95% CI = 0.192–0.292) and development opportunities (B = 0.177, 95% CI = 0.127–0.277) were related to a more favorable course of work ability. Only small effects were found for social support (B = 0.057, 95% CI = 0.008–0.106) and job control (B = 0.043, 95% CI = − 0.005–0.091).

Conclusions

The results indicate that the lagged and negative effect of depressive symptoms on work ability was not moderated by changes in psychosocial working conditions. However, the promotion of favorable working conditions may contribute to a positive development of work ability among employees from the Baby Boom generation independently from the level of depressive symptoms.

Electronic supplementary material

The online version of this article (10.1007/s00420-020-01570-1) contains supplementary material, which is available to authorized users.

Unshrouding the Sphere from the Clouds: Towards a Comprehensive Conceptual Framework for Sustainable Employability

Sustainable employability refers to individuals’ long-term abilities to work and remain employed. Despite its societal importance in the light of aging populations and rapidly changing skill demands, sustainable employability still requires further definition and conceptualization. As such, the present paper aims to define and conceptualize sustainable employability comprehensively by reviewing existing studies on the concept. Additionally, the paper discusses and integrates sustainable employment, sustainable work, and sustainable work ability into our broad framework of sustainable employability. The resulting conceptual framework positions sustainable employability as an inherently longitudinal multidimensional individual characteristic that is the outcome of complex interactions between individual-, work- and work environmental characteristics. This framework enables researchers to identify the employment characteristics that promote sustainable employability and thereby comprise sustainable employment. Finally, the framework links to notions of person-environment fit, and job- and organizational design to create a basis for future research on sustainable employability.

Factors associated with depressive symptoms among elderly Koreans: the role of health status, work ability, financial problems, living alone, and family relationships

OBJECTIVES

The purpose of this study was to explore predictors of depressive symptoms in elderly Koreans.

METHODS

The data from Korean Welfare Panel survey of Korean Institute for Health and Social Affairs in 2015 was used in this study. Six thousand four hundred and seventy-one elderly adults aged 60-99 participated in this study. Mean age of subjects was 74.37 years (SD = 8.27) and participants were 2569 male (39.7%) and 3902 female (60.3%).

RESULTS

Multiple hierarchical regression analysis indicated that perceived health status, family relationships, living alone, financial problems, work ability, gender, age, marital status, and religion are significant predictors of elderly depressive symptoms. In particular, perceived health status, family relationships, and work ability were powerful predictors of depressive symptoms in Korean elderly. The total explanatory amount of the regression model was 28.7%.

CONCLUSIONS

This study suggests that researchers and clinicians should consider together factors associated with health status, interpersonal relationships, economic status, work, and socio-demographic variables in order to prevent elderly depression.

COVID-19: Review of a 21st Century Pandemic from Etiology to Neuro-psychiatric Implications

COVID-19 is a severe infectious disease that has claimed >150,000 lives and infected millions in the United States thus far, especially the elderly population. Emerging evidence has shown the virus to cause hemorrhagic and immunologic responses, which impact all organs, including lungs, kidneys, and the brain, as well as extremities. SARS-CoV-2 also affects patients', families', and society's mental health at large. There is growing evidence of re-infection in some patients. The goal of this paper is to provide a comprehensive review of SARS-CoV-2-induced disease, its mechanism of infection, diagnostics, therapeutics, and treatment strategies, while also focusing on less attended aspects by previous studies, including nutritional support, psychological, and rehabilitation of the pandemic and its management. We performed a systematic review of >1,000 articles and included 425 references from online databases, including, PubMed, Google Scholar, and California Baptist University's library. COVID-19 patients go through acute respiratory distress syndrome, cytokine storm, acute hypercoagulable state, and autonomic dysfunction, which must be managed by a multidisciplinary team including nursing, nutrition, and rehabilitation. The elderly population and those who are suffering from Alzheimer's disease and dementia related illnesses seem to be at the higher risk. There are 28 vaccines under development, and new treatment strategies/protocols are being investigated. The future management for COVID-19 should include B-cell and T-cell immunotherapy in combination with emerging prophylaxis. The mental health and illness aspect of COVID-19 are among the most important side effects of this pandemic which requires a national plan for prevention, diagnosis and treatment.

Employers With Metabolic Syndrome and Increased Depression/Anxiety Severity Profit Most From Structured Exercise Intervention for Work Ability and Quality of Life

BACKGROUND

Major depressive disorder and anxiety disorders are associated with less productivity, earlier retirement, and more sick-days at the workplace. These associations also exist for patients with metabolic syndrome. For both, exercise is a generally recommended part of multimodal treatments. However, for individuals with metabolic syndrome, in which depression and anxiety is more prevalent and severe, evidence for the efficacy of exercise interventions is limited.

METHODS

Company employees with diagnosed metabolic syndrome (n=314, age: 48 ± 8 yrs) were randomized to a 6-month exercise intervention (150 min per week) or wait-list control. Participants received individual recommendations for exercise activities by personal meetings, telephone, or via a smartphone app. Physical activities were supervised and adapted using activity monitor data transferred to a central database. Work ability (work ability index), depression severity and anxiety severity [hospital anxiety and depression scale (HADS)], and health-related quality of live [short form 36 (SF-36)] were assessed.

RESULTS

We included 314 subjects from which 287 finished the intervention. Total work ability, depression- and anxiety severity, and the mental component score of the SF-36 improved after 6 months exercise compared to controls. After baseline stratification for normal (HADS scores 0-7) and increased depression- and anxiety scores (HADS scores 8-21) individuals with increased severity scores had similar age, body composition, blood lipids, and cardiorespiratory fitness compared to those with normal scores, but lower total work ability and component sum scores of health-related quality of life. After 6 months total work ability increased in the exercise group compared to controls with the magnitude of the observed increase being significantly greater for subjects with increased depression- and anxiety severity at baseline compared to those with normal severity scores.

CONCLUSIONS

A 6-month exercise intervention for company employees with metabolic syndrome showed strongest effects on self-perceived work ability in individuals with mild to severe depression- and anxiety severity. This suggests exercise programs offered to workers with metabolic syndrome not only reduces individual disease risk but may also reduce healthcare and employers costs arising from metabolic syndrome and mental disease conditions.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, identifier NCT03293264.

Passive and mentally-active sedentary behaviors and incident major depressive disorder: A 13-year cohort study

BACKGROUND

Regular physical activity reduces the risk of depression onset and is an effective treatment for mood disorders. Recent studies have reported that sedentary behavior (SB) increases the risk of depression in adults, but relationships of different types of SBs with depression have not been examined systematically. We explored longitudinal relationships of passive (e.g. watching TV) and mentally-active (e.g. office-work) SBs with incident major depressive disorder (MDD).

METHODS

Self-report questionnaires were completed by 40,569 Swedish adults in 1997; responses were linked to clinician-diagnosed MDD obtained from medical registers until 2010. Relationships between passive, mentally-active and total SBs with incident MDD were explored using survival analysis with Cox proportional hazards regression. Models controlled for leisure time moderate-vigorous physical activity and occupational physical activity. Moderating effects of gender were examined.

RESULTS

In fully-adjusted models, including only non-depressed adults at baseline, those reporting ≥ 3 h of mentally-active SBs on a typical day (versus < 3 h) had significant lower hazards of incident MDD at follow-up (HR = 0.74, 95% CI = 0.58-0.94, p = 0.018). There was a non-significant positive relationship of passive SBs with incident MDD (HR = 1.20, 95% CI = 0.96-1.52, p = 0.106). The association between total SBs (passive and mentally-active combined) was not significant (HR = 0.91, 95% CI = 0.75-1.10, p = 0.36). Gender did not moderate these associations.

LIMITATIONS

Physical activity and SBs were self-reported.

CONCLUSION

Mentally-active SBs may have beneficial effects on adults' mental well-being. These effects are largely independent of habitual physical activity levels.

Identification of Depression and Screening for Work Disabilities among Long-Term Unemployed People

The study explores whether clinical screening targeted at work disabilities among long-term unemployed people reveals eligible individuals for a disability pension and the importance of depression in granting the disability pensions. A total of 364 participants of the screening project were considered as eligible to apply for disability pension. Among them, 188 were diagnosed as clinically depressed. They were classified into those with earlier depression diagnosis (n = 85), those whose depression had not been diagnosed earlier (n = 103), and those without diagnosed depression (n = 176). The association of this ‘Depression identification pattern’ with being granted a disability pension was explored by logistic regression analyses. Compared to those with earlier diagnosis, those whose depression had not been diagnosed earlier were granted disability pension more commonly (72% vs. 54% OR 2.2, p = 0.012). Corresponding figures of the undepressed were 73%, OR 2.3, p = 0.002. The adjustments did not affect the results. Clinical examination of the long-term unemployed people in terms of work disability seems to be worthwhile. In particular, the examination reveals new depression diagnoses, which contribute more to the award of disability pension than depression diagnosed earlier by regular health care. Novel ways to detect depression among the unemployed should be implemented in the health and employment services.

Factors Related to Unemployment in Europe. A Cross-Sectional Study from the COURAGE Survey in Finland, Poland and Spain

Background: Research addressing the impact of a large number of factors on unemployment is scarce. We aimed to comprehensively identify factors related to unemployment in a sample of persons aged 18-64 from Finland, Poland and Spain. Methods: In this cross-sectional study, factors from different areas were considered: socio-demographic indicators, health habits, chronic conditions, health state markers, vision and hearing indicators, and social networks and built environment scores. Results: Complete data were available for 5003 participants, mean age 48.1 (SD 11.5), 45.4% males. The most important factors connected to unemployment were health status indicators such as physical disability (OR = 2.944), self-rated health (OR = 2.629), inpatient care (OR = 1.980), and difficulties with getting to the toilet (OR = 2.040), while the most relevant factor related to employment were moderate alcohol consumption (OR = 0.732 for non-heavy drinkers; OR = 0.573 for infrequent heavy drinkers), and being married (OR = 0.734), or having been married (OR = 0.584). Other factors that played a significant role included presence of depression (OR = 1.384) and difficulties with near vision (OR = 1.584) and conversation hearing (OR = 1.597). Conclusions: Our results highlight the importance of selected factors related to unemployment, and suggest public health indications that could support concrete actions on modifiable factors, such as those aimed to promote physical activity and healthy behaviors, tackling depression or promoting education, in particular for the younger.