Urban environment, physical inactivity and unhealthy dietary habits correlate to depression among elderly living in eastern Mediterranean islands: the MEDIS (MEDiterranean ISlands Elderly) study

Relationship between atherosclerotic burden and depressive symptoms in hypertensive patients: A cross-sectional study based on the NHANES database

OBJECTIVE

The relationship between atherosclerotic burden, depressive symptoms, and clinically relevant depression (CRD) in hypertensive patients is unclear. In this study, we used the atherosclerotic index of plasma (AIP) to quantify atherosclerotic burden and explore its association with depressive symptoms and CRD in hypertensive patients.

METHODS

Hypertension-diagnosed patients were extracted from the National Health and Nutrition Examination Survey (NHANES) database. The relationships between AIP and depressive symptoms and CRD risk in patients were examined through the weighted logistic regression and the weighted linear regression models. Restrictive cubic spline curves were employed to analyze potential nonlinear associations between AIP and outcome indicators. Additionally, subgroup analyses and intergroup interaction tests were conducted.

RESULTS

The AIP was considerably associated with the severity of depressive symptoms in hypertensive patients, according to the findings of weighted linear regression. Weighted logistic regression analysis showed that high AIP was significantly associated with a high risk of clinically relevant depression in hypertensive patients. This trend was consistent across various subgroups within the population.

CONCLUSION

AIP was observed to be a significant risk factor for clinically relevant depression in hypertensive patients. Atherosclerotic burden in hypertensive patients was significantly associated with the severity of their depressive symptoms.

Associations between fruit and vegetable intakes and incident depression in middle-aged and older adults from 10 diverse international longitudinal cohorts

BACKGROUND

Emerging observational evidence supports a role for higher fruit and vegetable intake in protecting against the development of depression. However, there is a scarcity of research in older adults or in low- to middle-income countries (LMICs).

METHODS

Participants were 7801 community-based adults (mean age 68.6 ± 8.0 years, 55.8 % female) without depression, from 10 diverse cohorts, including four cohorts from LMICs. Fruit and vegetable intake was self-reported via comprehensive food frequency questionnaire, short food questionnaire or diet history. Depressive symptoms were assessed using validated measures, and depression defined applying validated cut-offs. The associations between baseline fruit and vegetable intakes and incident depression over a follow-up period of three to nine years were examined using Cox regression. Analyses were performed by cohort with results meta-analysed.

RESULTS

There were 1630 cases of incident depression (21 % of participants) over 40,258 person-years of follow-up. Higher intake of fruit was associated with a lower risk of incident depression (HR 0.87, 95%CI [0.77, 0.99], I2 = 4 %). No association was found between vegetable intake and incident depression (HR 0.93, 95%CI [0.84, 1.04], I2 = 0 %).

LIMITATIONS

Diverse measures used across the different cohorts and the modest sample size of our study compared with prior studies may have prevented an association being detected for vegetable intake.

CONCLUSIONS

Our study supports a role for fruit, but not vegetable intake in protecting against depression. Research investigating different types of fruits and vegetables using standardised measures in larger cohorts of older adults from low- and middle-income countries is warranted.

Influence of Adherence to the Mediterranean Diet and Level of Physical Activity with Liver Steatosis in People Aged > 50 Years and with a BMI > 25 kg/m2: Association with Biochemical Markers

BACKGROUND

The main objective of this study is to determine the accuracy of different biochemical markers of hepatic steatosis and to correlate liver steatosis with adherence to the Mediterranean diet and level of physical activity.

METHODS

A cross-sectional study was carried out, including subjects over 50 years of age, with a BMI > 25 kg/m2, but excluding any patient with documented hepatic pathology other than hepatic steatosis. Participants were divided into two groups: patients with hepatic steatosis diagnosed by ultrasound (SG) and a control group of individuals without hepatic steatosis (CG). The level of physical activity was recorded by the IPAQ-SF questionnaire and the adherence to the Mediterranean diet was recorded using the PREDIMED questionnaire. Biochemical markers analyzed included the Hepatic steatosis index (HSI), AST-to-Platelet ratio (APRI) and Fibrosis-4 (FIB-4).

RESULTS

A total of 116 patients were included, 71 belonging to the SG and 45 to the CG. A total of 58.6% of the patients showed low adherence to the Mediterranean diet, 35.4% moderate adherence and 6% high adherence. The median estimated physical activity was 495 METS, with most participants reporting light activity. In the SG, significantly higher HSI values were observed (p < 0.001). A cut-off point of a HSI of 40 was established, with a sensitivity of 73.2% and a specificity of 65.8%. Significantly higher FIB-4 values (p = 0.039) were also observed in the SG. A cut-off point of FIB-4 was set at 0.27, with a sensitivity of 69% and a specificity of 57.9%. Patients in the SG showed lower scores in the PREDIMED. Patients in the SG tended to show lower METS scores. However, the higher number of patients with intense activity in the CG group stands out (p = 0.008).

CONCLUSIONS

The HSI and FIB-4 showed a significant correlation with liver steatosis. Hepatic steatosis is associated with low adherence to the Mediterranean diet and patients with hepatic steatosis tended to have lower METS scores.

Efficacy of whole system ayurveda management protocol in major depressive disorder- A randomized controlled clinical trial

BACKGROUND

Major Depressive Disorder (MDD) is one of the common depressive disorder. MDD has high comorbidity and has greater implications on quality of life. Whole system Ayurveda management protocol (WSAP) is explored for it's possible role in management of MDD.

OBJECTIVE

To evaluate the efficacy of Whole system Ayurveda management protocol on Major Depressive Disorder.

MATERIAL AND METHODS

Study was a randomized controlled trial. Total 50 patients of MDD meeting the DSM V criteria, age group 20-70 years of either sex participated in the study. They were randomly divided into two groups, control group received Escitalopram 10 mg twice a day and Ayurveda group was on WSAP. Interventions were for 60 days. Assessments were done through various clinical parameters like Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Brief psychiatric rating scale (BPRS), Pittsburgh Sleep Quality Index (PSQI), WHO Quality of Life- BREF (WHOQOL-BREF), Clinical Global Improvement scale (CGI), UKU Side effect scale. Assessments during intervention was on every 15th day.

RESULTS

Study showed that Ayurveda group produced significant outcome improvement compared to control group in HDRS (p = 0.01), HARS (p = 0.03), PSQI (p = 0.03), WHOQOL-Bref (p < 0.001) and UKU side effect scale (p = 0.02). Both the group showed improvements in all the parameters except in WHOQOL-Bref where Ayurveda group only showed improvements (p < 0.001). Effect size showed large effect in WHOQOL-Bref. Mild side effects were reported in control group and none in Ayurveda group.

CONCLUSION

WSAP was effective in management of MDD and had better side effect profile. Further studies needed.

A review on linking stress, depression, and insulin resistance via low-grade chronic inflammation

Stress is a disturbance in homeostasis caused by psychological, physiological, or environmental factors. Prolonged reactions to chronic stress can be detrimental, resulting in various metabolic abnormalities, referred to as metabolic syndrome (MS). There is a reciprocal increased risk between MS and major depressive disorder. Recent studies established an association between inflammation and insulin signaling in type 2 diabetes mellitus with depression. In the present review, we discuss chronic low-grade inflammation, pathways of insulin resistance, and brain glucose metabolism in the context of neuroinflammation and depression. Specific attention is given to psychotropic drugs such as bupropion, mirtazapine, and nefazodone, anti-inflammatory drugs like Celecoxib (COX-2 inhibitor), Etanercept, adalimumab, IL-4Ra antagonist, Anti-IL- 17A antibody (Ixekizumab) and lifestyle modifications including exercise, dietary changes, and sleep hygiene. These therapeutic solutions offer potential in treating depression by targeting metabolic conditions like insulin resistance and inflammatory pathways. The article further explains the significance of a nutrition and antioxidants-rich diet, emphasizing the role of omega-3 fatty acids, vitamin D, zinc, and polyphenols, to improve immunity and activate anti-inflammatory signaling pathways.

Exploring Loneliness, Fear and Depression among Older Adults during the COVID-19 Era: A Cross-Sectional Study in Greek Provincial Towns

BACKGROUND

With the onset of the COVID-19 pandemic, life changed abruptly for older adults in Greece. Social isolation, lockdowns, the fear of serious illness and death, all contributed to an increased risk of developing depression.

OBJECTIVE

To explore the presence and severity of depression in older adults in Greek provincial towns during the pandemic and to explore any possible relationships with loneliness and fear.

METHODS

A convenience sample of 200 participants aged >65, completed a socio-demographic form, the Revised UCLA Loneliness Scale, the Geriatric Depression-15 Scale (GDS-15) and the COVID-19 Fear Scale (FCV-19S). Data were collected from April to May 2022.

RESULTS

The average age of participants was 76.6 years and 35.5% of the participants presented depressive symptoms (mean prevalenceof depression 5 ± 3.7). A moderate to low level of loneliness (mean value 39 ± 11.3) and a moderate level of COVID-19 fear (mean value 18.9 ± 6.5) were also experienced. Higher levels of loneliness were found among participants with lower perceived health status and among those participants registered in Primary Health and Social Care (PHSC) services. Loneliness was positively correlated with depression (r = 0.7, p < 0.001), and increased loneliness and depression were associated with an increase in fear of COVID-19 (r = 0.2, p = 0.01 for both).

CONCLUSIONS

During the pandemic, older adults experienced loneliness, fear of COVID-19 and depression which were positively associated with each other. It is imperative to develop PHSC policies that are aimed at addressing the mental health problems of the older population, which have been caused by the COVID-19 pandemic, through developing their resilience, offering psychological support and promoting social connections.

One-year follow-up of the effectiveness of a lifestyle modification programme as an adjuvant treatment of depression in primary care: A randomised clinical trial

BACKGROUND

An estimated 280 million individuals suffer from depression. Brief group interventions in Primary Healthcare Centres (PHCs) are recommended. One goal of these interventions is to educate people about healthy lifestyle habits, as they prevent the development of depression. This study aims to analyse the one-year follow-up results about the effectiveness of a Lifestyle Modification Programme (LMP) and an LMP plus Information and Communication Technologies (LMP + ICTs) when compared to Treatment as Usual (TAU).

METHODS

We conducted an open-label, multicentre, pragmatic, randomised clinical trial. A total of 188 individuals that visited a general practitioner and met the inclusion criteria were randomised. LMP consisted of six weekly 90-minute group sessions focusing on lifestyle improvement. LMP + ICTs was a hybrid of the LMP format with the inclusion of a wearable smartwatch. We used linear mixed models (with a random intercept and an unstructured covariance) to evaluate the effectiveness of the interventions, and an intention-to-treat analysis and Multiple Imputation technique for handling missing data.

RESULTS

LMP + ICTs showed a statistically significant reduction on depressive symptoms (b = -2.68, 95 % CI = [-4.239, -1.133] p = .001) and sedentarism (b = -37.38, 95 % CI [-62.930, -11.833], p = .004) compared to TAU.

LIMITATIONS

Most of the dropouts were due to time restrictions.

CONCLUSIONS

In long-term, LMPs plus ICTs administered in PHCs to people suffering from depression were effective in reducing depressive symptomatology and sedentarism comparing to TAU. More research is needed to enhance adherence to lifestyle recommendations. These promising programmes could be easily implemented in PHCs.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Registry (NCT03951350).

Gut Microbiota in Anxiety and Depression: Unveiling the Relationships and Management Options

The gut microbiota is critical for maintaining human health and the immunological system. Several neuroscientific studies have shown the significance of microbiota in developing brain systems. The gut microbiota and the brain are interconnected in a bidirectional relationship, as research on the microbiome-gut-brain axis shows. Significant evidence links anxiety and depression disorders to the community of microbes that live in the gastrointestinal system. Modified diet, fish and omega-3 fatty acid intake, macro- and micro-nutrient intake, prebiotics, probiotics, synbiotics, postbiotics, fecal microbiota transplantation, and 5-HTP regulation may all be utilized to alter the gut microbiota as a treatment approach. There are few preclinical and clinical research studies on the effectiveness and reliability of various therapeutic approaches for depression and anxiety. This article highlights relevant research on the association of gut microbiota with depression and anxiety and the different therapeutic possibilities of gut microbiota modification.

A study on the impact of Internet use on depression among Chinese older people under the perspective of social participation

Purpose

This study aimed to evaluate the role of social participation in the relationship between internet use and depressive symptoms among Chinese older adults and investigate how the internet use interact with social participation to reduce the risk of depressive symptoms.

Methods

Based on the survey from the China Health and Retirement Longitudinal Study (CHARLS) in 2018, we identified 4645 subjects and used the Ordinary Least Square method (OLS) and Propensity Score Matching method (PSM) to identify the association between Internet use and depression of older people, and further test how social participation played a role in the relationship.

Results

The level of depression of older people was significantly reduced in those who using internet in China, and the effect was still robust under different identification methods. The mental health was improved when using internet because of the increase of social participation and social capital. Further, The positive effect was stronger especially in those who were female, living in rural areas, has low education attainments and were 70–79 years old.

Conclusions

The popularity of internet use has a positive effect on the depressive symptoms of Chinese older adults. Effective measures were encouraged to improve the friendliness of internet for older people and promote the popularization of the Internet and older group, achieving the spiritual well-being of them in the Internet society.

Associations between increased circulating endothelial progenitor cell levels and anxiety/depressive severity, cognitive deficit and function disability among patients with major depressive disorder

The association of major depressive disorder (MDD) with cardiovascular diseases (CVDs) through endothelial dysfunction is bidirectional. Circulating endothelial progenitor cells (cEPCs), essential for endothelial repair and function, are associated with risks of various CVDs. Here, the relationship of cEPC counts with MDD and the related clinical presentations were investigated in 50 patients with MDD and 46 healthy controls. In patients with MDD, a battery of clinical domains was analysed: depressed mood with Hamilton Depression Rating Scale (HAMD) and Montgomery–Åsberg Depression Rating Scale (MADRS), anxiety with Hamilton Anxiety Rating Scale (HAMA), cognitive dysfunction and deficit with Digit Symbol Substitution Test (DSST) and Perceived Deficits Questionnaire-Depression (PDQ-D), somatic symptoms with Depressive and Somatic Symptom Scale (DSSS), quality of life with 12-Item Short Form Health Survey (SF-12) and functional disability with Sheehan Disability Scale (SDS). Immature and mature cEPC counts were measured through flow cytometry. Increased mature and immature cEPC counts were significantly associated with higher anxiety after controlling the confounding effect of systolic blood pressure, and potentially associated with more severe depressive symptoms, worse cognitive performance and increased cognitive deficit, higher social disability, and worse mental health outcomes. Thus, cEPCs might have pleiotropic effects on MDD-associated symptoms and psychosocial outcomes.

Depression Levels Influence the Rate of Asthma Exacerbations in Females

Background: Anxiety and depression are common psychological disturbances among asthmatic patients. The aim of the present study is the assessment of anxiety and depression in asthmatic patients and their correlation with symptoms control level and number of exacerbations per year. Methods: One hundred patients with asthma diagnosis, according to the Global Initiative for Asthma (GINA), aged > 18 years old, having a stable disease, were included. Emotional status was evaluated using the Hospital Anxiety Depression Scale (HADS). Patients were followed up for a year to assess the number and severity of exacerbations. Results: Most of our patients were female (58%), middle-aged (mean = 54 ± 13), and married (81%), with low frequency of smoking habits (smokers, ex-smokers and non-smokers were 26%, 30% and 37%, respectively) and low levels of both anxiety and depression [median (interquartile range (IQR)) = 4(2) and median (IQR) = 4(2), respectively]. At the low and moderate level of the depression subscale, female patients experienced asthma exacerbations more frequently compared to male patients (adjusted Incidence Rate Ratio (aIRR) = 4.30; 95% Confidence Interval (CI): 1.94–9.53 and aIRR = 1.82; 95% CI: 1.07–3.13, respectively). Conclusions. Clinicians should evaluate asthma patients for depression, as gender differentially influences outcomes among those with low and moderate levels of depression, with female asthmatics presenting more frequent exacerbations.

Mediterranean diet adherence is associated with better cognitive status and less depressive symptoms in a Greek elderly population

PURPOSE

To evaluate the Mediterranean diet (MD) adherence of an elderly Greek population, and its association with the grade of cognitive decline and psychological status.

METHODS

Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), and Mediterranean diet score (MedDietScore) questionnaires were used to assess the impact of MD adherence on cognitive abilities and psychological state of a Greek elderly population.

PARTICIPANTS

2092 men and women over 65 years old (mean age 74.97 ± 8.41 years) from seven different Greek cities RESULTS: 34.4% of the study population showed cognitive impairment, while 32.3% of the participants had depressive symptoms. More than half of the participants (52.1%) showed very low or low MD adherence. Higher MD adherence was significantly associated with better MMSE and GDS scores. Moreover, higher MD adherence was significantly associated with younger age, female gender, higher educational level, and better anthropometric parameters. MD adherence was independently associated with cognitive and psychological status, and gender after adjustment for potential confounders.

CONCLUSION

Higher MD adherence is strongly associated with better cognitive status and less depressive symptomatology. Public health policies are recommended to focus on the promotion of the MD, as a crucial strategy to reduce the risk of cognitive impairment and depression.

How Health Habits Influence the Physiological Response During a Physical Activity in Extreme Temperatures?

Background: The purpose of the study was to determine to what degree the health habits of university students influence their physiological response during a 10-min high-intensity exercise. Methods: We conducted a cross-sectional cohort study with 59 health science students, in which we analyzed their adherence to a Mediterranean and low-fat diet, as well as their activity levels. We correlated these factors with the physiological response (lactic acid and heart rate) and a series of anthropometric parameters in intense physical activity (cardiopulmonary resuscitation (CPR) for 10 min) in three scenarios: extreme cold, extreme heat and a control situation at room temperature. Results: The results of this study demonstrate that in university students, a greater adherence to the Mediterranean diet was associated with a better response to physical exercise, in this case, 10-min CPR, in hostile environments. Conclusions: Following healthy eating guidelines improves physical performance and delays the appearance of fatigue; both are important aspects for a better performance of CPR.

Intolerance of Uncertainty and Loneliness in Older Adults During the COVID-19 Pandemic

OBJECTIVE

The COVID-19 pandemic imposed a psychological burden on people worldwide, including fear and anxiety. Older adults are considered more vulnerable during public health emergency crises. Therefore, the aim of the present study was to investigate the psychological response of older adults during the acute phase of the pandemic in Greece.

METHOD

This cross-sectional study was part of a larger three-day online survey. A total of 103 participants over the age of 60 fulfilled inclusion criteria. The survey included sociodemographic questions and six psychometric scales: the Fear of COVID-19 Scale (FCV-19S), the Brief Patient Health Questionnaire (PHQ-9) depression scale, the Generalized Anxiety Disorder scale (GAD-7), the Athens Insomnia Scale (AIS), the Intolerance of Uncertainty Scale (IUS-12), and the De Jong Gierveld Loneliness Scale (JGLS).

RESULTS

A significant proportion of the participants reported moderate to severe depressive symptoms (81.6%), moderate to severe anxiety symptoms (84.5%), as well as disrupted sleep (37.9%). Women reported significantly higher levels of COVID-19-related fear, more severe depressive symptoms and sleep disturbances, as well as higher levels of intolerance of uncertainty. Participants living alone showed higher levels of loneliness. Intolerance of uncertainty was shown to modulate levels of loneliness.

CONCLUSIONS

During the quarantine, attention was promptly drawn upon the risks related with older people's loneliness. Studies identifying factors that may contribute to loneliness during a public health emergency facilitate the implementation of supportive interventions. Preparedness to address and manage older people's loneliness may limit this deleterious emotional response during the pandemic, as well as at the post-COVID-19 phase.

The Role of the Gut Microbiota in Dietary Interventions for Depression and Anxiety

There is emerging evidence that an unhealthy dietary pattern may increase the risk of developing depression or anxiety, whereas a healthy dietary pattern may decrease it. This nascent research suggests that dietary interventions could help prevent, or be an alternative or adjunct therapy for, depression and anxiety. The relation, however, is complex, affected by many confounding variables, and is also likely to be bidirectional, with dietary choices being affected by stress and depression. This complexity is reflected in the data, with sometimes conflicting results among studies. As the research evolves, all characteristics of the relation need to be considered to ensure that we obtain a full understanding, which can potentially be translated into clinical practice. A parallel and fast-growing body of research shows that the gut microbiota is linked with the brain in a bidirectional relation, commonly termed the microbiome-gut-brain axis. Preclinical evidence suggests that this axis plays a key role in the regulation of brain function and behavior. In this review we discuss possible reasons for the conflicting results in diet-mood research, and present examples of areas of the diet-mood relation in which the gut microbiota is likely to be involved, potentially explaining some of the conflicting results from diet and depression studies. We argue that because diet is one of the most significant factors that affects human gut microbiota structure and function, nutritional intervention studies need to consider the gut microbiota as an essential piece of the puzzle.

Fruit and Vegetable Intake and Mental Health in Adults: A Systematic Review

The role of a properly balanced diet in the prevention and treatment of mental disorders has been suggested, while vegetables and fruits have a high content of nutrients that may be of importance in the case of depressive disorders. The aim of the study was to conduct a systematic review of the observational studies analyzing association between fruit and vegetable intake and mental health in adults. The search adhered to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and the review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42019138148). A search for peer-reviewed observational studies published until June 2019 was performed in PubMed and Web of Science databases, followed by an additional manual search for publications conducted via analyzing the references of the found studies. With respect to the intake of fruit and/or vegetable, studies that assessed the intake of fruits and/or vegetables, or their processed products (e.g., juices), as a measure expressed in grams or as the number of portions were included. Those studies that assessed the general dietary patterns were not included in the present analysis. With respect to mental health, studies that assessed all the aspects of mental health in both healthy participants and subjects with physical health problems were included, but those conducted in groups of patients with intellectual disabilities, dementia, and eating disorders were excluded. To assess bias, the Newcastle-Ottawa Scale (NOS) was applied. A total of 5911 studies were independently extracted by 2 researchers and verified if they met the inclusion criteria using a 2-stage procedure (based on the title, based on the abstract). After reviewing the full text, a total of 61 studies were selected. A narrative synthesis of the findings from the included studies was performed, which was structured around the type of outcome. The studies included mainly focused on depression and depressive symptoms, but also other characteristics ranging from general and mental well-being, quality of life, sleep quality, life satisfaction, flourishing, mood, self-efficacy, curiosity, creativity, optimism, self-esteem, stress, nervousness, or happiness, to anxiety, minor psychiatric disorders, distress, or attempted suicide, were analyzed. The most prominent results indicated that high total intake of fruits and vegetables, and some of their specific subgroups including berries, citrus, and green leafy vegetables, may promote higher levels of optimism and self-efficacy, as well as reduce the level of psychological distress, ambiguity, and cancer fatalism, and protect against depressive symptoms. However, it must be indicated that the studies included were conducted using various methodologies and in different populations, so their results were not always sufficiently comparable, which is a limitation. Taken together, it can be concluded that fruits and/or vegetables, and some of their specific subgroups, as well as processed fruits and vegetables, seems to have a positive influence on mental health, as stated in the vast majority of the included studies. Therefore, the general recommendation to consume at least 5 portions of fruit and vegetables a day may be beneficial also for mental health.

Effect of food-related behavioral activation therapy on food intake and the environmental impact of the diet: results from the MooDFOOD prevention trial

Purpose

Food-based dietary guidelines are proposed to not only improve diet quality, but to also reduce the environmental impact of diets. The aim of our study was to investigate whether food-related behavioral activation therapy (F-BA) applying Mediterranean-style dietary guidelines altered food intake and the environmental impact of the diet in overweight adults with subsyndromal symptoms of depression.

Methods

In total 744 adults who either received the F-BA intervention (F-BA group) or no intervention (control group) for 12 months were included in this analysis. Food intake data were collected through a food frequency questionnaire at baseline and after 6 and 12 months. Greenhouse gas emissions (GHGE), land use (LU), and fossil energy use (FEU) estimates from life-cycle assessments and a weighted score of the three (pReCiPe score) were used to estimate the environmental impact of each individual diet at each timepoint.

Results

The F-BA group reported increased intakes of vegetables (19.7 g/day; 95% CI 7.8–31.6), fruit (23.0 g/day; 9.4–36.6), fish (7.6 g/day; 4.6–10.6), pulses/legumes (4.0 g/day; 1.6–6.5) and whole grains (12.7 g/day; 8.0–17.5), and decreased intake of sweets/extras (− 6.8 g/day; − 10.9 to − 2.8) relative to control group. This effect on food intake resulted in no change in GHGE, LU, and pReCiPe score, but a relative increase in FEU by 1.6 MJ/day (0.8, 2.4).

Conclusions

A shift towards a healthier Mediterranean-style diet does not necessarily result in a diet with reduced environmental impact in a real-life setting.

Trial registration

ClinicalTrials.gov. Number of identification: NCT02529423. August 2015.

Electronic supplementary material

The online version of this article (10.1007/s00394-019-02106-1) contains supplementary material, which is available to authorized users.

Association between tea consumption and depressive symptom among Chinese older adults

Background

Despite accumulating evidence on the protective effect of tea consumption against depression, studies specifically focusing on the elderly population are yet limited. This paper examined the association between the frequency and duration of tea drinking and depressive symptoms of older adults by gender and age groups, based on a nationally representative sample in China.

Method

The study employed the panel data from 2005, 2008/2009, 2011/2012 and 2014 waves of Chinese Longitudinal Healthy Longevity Survey (CLHLS). We used the frequency and consistency of tea drinking behaviors to identify four types of tea consumption amongst Chinese seniors. Depressive symptoms were assessed by a five-item scale. Linear mixed effects models were applied.

Results

We found that consistent and frequent tea-drinking was associated with significantly less depressive symptoms, and such impact was partially mediated by socioeconomic status, health behavior, physical health, cognitive function, and social engagement. However, the association was only significant for males and the oldest-old, rather than females and younger elders.

Conclusions

Consistent and frequent tea-drinking may effectively reduce the risk of depressive symptoms for the Chinese elderly. The promotion of the traditional lifestyle of tea drinking could be a cost-effective way towards healthy aging for China.

Electronic supplementary material

The online version of this article (10.1186/s12877-019-1259-z) contains supplementary material, which is available to authorized users.

Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies

With depression being the psychiatric disorder incurring the largest societal costs in developed countries, there is a need to gather evidence on the role of nutrition in depression, to help develop recommendations and guide future psychiatric health care. The aim of this systematic review was to synthesize the link between diet quality, measured using a range of predefined indices, and depressive outcomes. Medline, Embase and PsychInfo were searched up to 31st May 2018 for studies that examined adherence to a healthy diet in relation to depressive symptoms or clinical depression. Where possible, estimates were pooled using random effect meta-analysis with stratification by observational study design and dietary score. A total of 20 longitudinal and 21 cross-sectional studies were included. These studies utilized an array of dietary measures, including: different measures of adherence to the Mediterranean diet, the Healthy Eating Index (HEI) and Alternative HEI (AHEI), the Dietary Approaches to Stop Hypertension, and the Dietary Inflammatory Index. The most compelling evidence was found for the Mediterranean diet and incident depression, with a combined relative risk estimate of highest vs. lowest adherence category from four longitudinal studies of 0.67 (95% CI 0.55-0.82). A lower Dietary Inflammatory Index was also associated with lower depression incidence in four longitudinal studies (relative risk 0.76; 95% CI: 0.63-0.92). There were fewer longitudinal studies using other indices, but they and cross-sectional evidence also suggest an inverse association between healthy diet and depression (e.g., relative risk 0.65; 95% CI 0.50-0.84 for HEI/AHEI). To conclude, adhering to a healthy diet, in particular a traditional Mediterranean diet, or avoiding a pro-inflammatory diet appears to confer some protection against depression in observational studies. This provides a reasonable evidence base to assess the role of dietary interventions to prevent depression. This systematic review was registered in the PROSPERO International Prospective Register of Systematic Reviews under the number CRD42017080579.

Relationships between Social Capital, Social Capital Satisfaction, Self-Esteem, and Depression among Elderly Urban Residents: Analysis of Secondary Survey Data

The role that psychological variables play in depression among elderly urban residents has received little research attention. Therefore, the purpose of this study was to examine the relationships between social capital, social capital satisfaction, self-esteem, and depression among elderly urban residents. We used the responses provided by 701 elderly persons to scales assessing social capital (i.e., network, trust), social capital satisfaction, self-esteem, and depression, as part of the Korea Welfare Panel Study (KOWEPS). We conducted a confirmatory factor analysis and tested the validity of a proposed statistical model using structural equation modeling (SEM). The results showed that trust in social capital, social capital satisfaction, and self-esteem were significantly related to depression. Further, social capital satisfaction and self-esteem fully and partially mediated the relationship between trust and depression, respectively. These findings serve as an empirical base upon which social welfare policies can be founded that benefit elderly urban residents with weak social capital, low social capital satisfaction, and poor self-esteem.

Adherence to the Mediterranean diet and risk of depression: a systematic review and updated meta-analysis of observational studies

CONTEXT

More than 300 million people worldwide have been diagnosed with depression, which is a leading cause of disability and disease burden. Elucidating dietary patterns that may reduce the risk of depression could help reduce the incidence of other diseases.

DATA SOURCES

PubMed/MEDLINE, ISI Web of Science, Scopus, Embase, and Google Scholar databases were searched to identify relevant publications up to May 2018.

STUDY SELECTION

All observational studies that considered the Mediterranean diet as the exposure variable and depression as the main outcome or as one of the outcome variables were included in this systematic review and meta-analysis. Two authors independently screened 3229 publications. A total of 14 observational studies were included in the meta-analysis.

DATA EXTRACTION

Two authors independently extracted the data and assessed the risk of bias.

RESULTS

The studies in the meta-analysis included a total of 56 043 participants. When 5 effect sizes from 4 cohort studies were combined, no significant association was observed between adherence to the Mediterranean diet and risk of depression (overall hazard ratio = 0.95; 95%CI, 0.79-1.16). When 3 effect sizes from 3 cohort studies that reported β coefficients were combined, again no significant association was found (β = -0.00; 95%CI, -0.12, 0.12). However, when 9 effect sizes from 9 cross-sectional studies were combined, an inverse significant association was found between adherence to the Mediterranean diet and risk of depression (overall odds ratio = 0.72; 95%CI, 0.60-0.87).

CONCLUSIONS

The analysis of cohort studies revealed no significant association was found between adherence to the Mediterranean diet and risk of depression. However, an inverse significant association between adherence to the Mediterranean diet and odds of depression in cross-sectional studies.

Do Sociodemographic Factors and Urban Green Space Affect Mental Health Outcomes Among the Urban Elderly Population?

The mounting mental health issues faced by elderly urban residents increase the social and economic costs to society associated with dementia and depression. Therefore, it is necessary to identify the characteristics of elderly urban residents suffering from mental health issues, to address these issues more effectively. We used 2015 Community Health Survey data from the Korea Centers for Disease Control and Prevention to identify the demographic and social characteristics of 11,408 elderly urban residents in relation to stress levels and symptoms of depression in seven metropolitan areas in Korea, and to calculate the odds ratio for urban green space. We found that the prevalence of these mental health issues generally decreased in relation to the ratio of green space of an area. These findings suggest identifying elderly people who are vulnerable to certain mental health issues based on demographic and social characteristics and demonstrate that the ratio of urban green space within a community is an important component in improving mental health outcomes for elderly urban residents. These findings have policy implications for assisting elderly people vulnerable to certain mental health issues and for establishing a green welfare policy targeting this population.

Lifestyle multidomain intervention, omega-3 supplementation, or both for reducing the risk of developing clinically relevant depressive symptoms in older adults with memory complaints? Secondary analysis from the MAPT trial

BACKGROUND

We tested the associations of a lifestyle multidomain intervention (MI), omega-3 supplementation (O3) or their combination with the change of clinically meaningful depressive symptoms in older adults.

METHODS

Secondary analysis of the 3-year Multidomain Alzheimer Preventive Trial (MAPT), in which 1679 people, ≥70 years with memory complaints were randomized into: MI, O3, MI + O3, or placebo. MI was composed of nutritional and physical activity counselling and cognitive training. O3 supplementation corresponded to a daily dose of 1000 mg of omega-3. Discrete-time cox regressions were performed for each outcome. Three binary variables of incidence of depressive symptoms were created from the 15-item geriatric depression scale (GDS-15): minimum clinically meaningful depressive symptoms (≥2-point increase in GDS-15), moderate depressive symptoms (GDS-15 ≥ 5), and severe depressive symptoms (GDS-15 ≥ 10) DS.

RESULTS

Discrete-time cox proportional hazards have found no associations for all of the analysis. The incidence of severe depressive symptoms across groups were, respectively: 1.1, 2.4, 2.3 and 2.5 per 100 person year for MI + O3, for O3, for MI, for placebo. There was a trend for a decreased risk of developing severe DS compared to placebo in the MI + O3 group (p = 0.085 after adjustment).

CONCLUSIONS

To conclude, we did not find any association of a lifestyle multidomain intervention with the onset of clinically depressive symptoms in older adults with memory complaints. A study with a more intensive multidomain intervention might bring further insights on this topic.

Mediterranean diet and wellbeing: evidence from a nationwide survey

OBJECTIVE

Although there is some evidence of the association between specific food groups, such as plant foods, and subjective wellbeing, this is the first study to assess the relationship between adherence to the Mediterranean dietary pattern and subjective wellbeing.

DESIGN

Data were collected in 2014-2015, within the Edad con Salud project, a follow-up study of a multistage clustered survey on a representative sample of the population of Spain. The final sample comprised 2397 individuals with ages ranging from 21 to 101 years.

MAIN OUTCOME MEASURES

Experienced wellbeing (positive and negative affect) was measured using the Day Reconstruction Method, and evaluative wellbeing was assessed with the Cantril Self-Anchoring Striving Scale.

RESULTS

A higher adherence to the Mediterranean diet showed a small but statistically significant inverse relationship with negative affect (β = -0.076, p=.001), and direct with evaluative wellbeing (β = 0.053, p=.015), whereas it was not related to positive affect. Several components of the Mediterranean diet were independently associated with wellbeing.

CONCLUSION

The results suggest that adherence to a dietary pattern such as the Mediterranean diet, and not only the isolated consumption of its components, is associated with a better subjective wellbeing.

The Role of Physical Exercise and Omega-3 Fatty Acids in Depressive Illness in the Elderly

Background:

In adulthood, depression is the most common type of mental illness and will be the second leading cause of disease by 2020. Major depression dramatically affects the function of the central nervous system and degrades the quality of life, especially in old age.

Several mechanisms underlie the pathophysiology of depressive illness, since it has a multifactorial etiology. Human and an-imal studies have demonstrated that depression is mainly associated with imbalances in neurotransmitters and neurotrophins, hypothalamic-pituitary-adrenal axis alterations, brain volume changes, neurogenesis dysfunction, and dysregulation of in-flammatory pathways. Also the gut microbiota may influence mental health outcomes.

Although depression is not a consequence of normal aging, depressive disorders are common in later life, even if often undi-agnosed or mis-diagnosed in old age. When untreated, depression reduces life expectancy, worsens medical illnesses, en-hances health care costs and is the primary cause of suicide among older people. To date, the underpinnings of depression in the elderly are still to be understood, and the pharmacological treatment is the most commonly used therapy.

Objective:

Since a sedentary lifestyle and poor eating habits have recently emerged as crucial contributors to the genesis and course of depression, in the present review, we have focused on the effects of physical activity and omega-3 fatty acids on depressive illness in the elderly.

Results:

A growing literature indicates that both exercise and dietary interventions can promote mental health throughout one’s lifespan.

Conclusion:

There thus emerges the awareness that an active lifestyle and a balanced diet may constitute valid low-cost pre-vention strategies to counteract depressive illness in the elderly.

Adherence to the Mediterranean Diet Is Associated with Physical Activity, Self-Concept and Sociodemographic Factors in University Student

(1) Background: The aim of this study was to assess adherence to the Mediterranean diet (MD) and to examine the relationship between MD adherence, physical activity, self-concept, and other sociodemographic factors; (2) Methods: A cross-sectional study (N = 597; 18.99 ± 0.64 years) was conducted in a sample of university students from Ceuta, Melilla, and Granada (Spain). Religious beliefs and place of residence were directly reported, while physical activity and adherence to the MD were self-reported using the Physical Activity Questionnaire for Adolescents (PAQ-A) and the Mediterranean Diet Quality Index (KIDMED) respectively. Self-concept was evaluated using the Five-Factor Self-Concept Scale; (3) Results: Of those students reporting high levels of habitual physical activity, 82.3% also reported high adherence to the MD, with 17.7% reporting a medium adherence. Of students reporting no physical activity, 25.7% also reported medium adherence to the MD. No significant associations were found between the MD and religious beliefs. It was observed that the university campus was associated with the level of adherence to the MD (p = 0.030), with adherence being lowest in Ceuta and Melilla. Finally, the MD was associated with academic (p = 0.001) and physical self-concept (p = 0.005); 4) Conclusions: The MD should be promoted to university students, particularly those studying at Ceuta and Melilla, given the present findings of lower MD adherence. In addition, as higher MD adherence was also highlighted with more positive self-concept, its promotion would be beneficial in wider educational contexts.

Mediterranean diet and depression among older individuals: The multinational MEDIS study

BACKGROUND

Depression has been linked to a large and growing economic and societal burden worldwide. In Europe, depression is one of the most frequent mental disorders across all age groups, but particularly in people aged 65 years and over, and higher depressive symptoms have been reported among individuals with chronic diseases (e.g., diabetes and heart disease).

AIM

To evaluate the role of adherence to the Mediterranean diet (MedDiet) in depression in a sample of older people living in the Mediterranean basin.

METHODS

Standard procedures were used to determine socio-demographic, lifestyle, and clinical characteristics of the participants, as well as their dietary habits, and depressive symptoms were evaluated using the Geriatric Depression Scale (GDS). Multi-adjusted logistic and linear regression analyses were carried out to evaluate the associations between participants' characteristics and depression.

RESULTS

Participants classified as having mild or severe depression were less educated and physically active, and more diabetic, and they reported less adherence to the MedDiet. Adherence to the MedDiet was associated with the absence of depression [(OR, 95% CI): 0.65, 0.50-0.85]. In addition, daily tea drinking was also related to the absence of depression [(OR, 95% CI): 0.51, 0.40-0.65].

CONCLUSIONS

Greater adherence to the MedDiet and daily tea drinking seem to have a beneficial effect on depressive symptoms in older adults.

Mental health problems in relation to eating behavior patterns, nutrient intakes and health related quality of life among Iranian female adolescents

Aims

To identify the association between mental health problems, eating behavior patterns, nutrient intakes and health related quality of life (HRQoL) among Iranian female adolescents.

Materials and methods

The current cross-sectional study conducted among three high-schools randomly selected from 10-day-public high schools in the selected sub-county from Tabriz city-Iran between December 2015 through March 2016. Participants were a sample of 107 adolescent girls aged 15–17 years old. Anthropometric parameters were measured and assessments of HRQoL, mental health problems and eating behavioral patterns were performed by Short Form 36 (SF-36), Strengths and Difficulties Questionnaires (SDQ) and Eating Behavioral Pattern Questionnaire (EBPQ) respectively. Dietary intake was assessed using a semi-quantitative Food-Frequency Questionnaire (FFQ) adapted for the Iranian society. Quality of life was measured with HRQoL questionnaire. Quantitative analysis using independent sample t test was performed for comparison of continuous variables between two subgroups (unlikely, possible/probable) of each category of mental health problem. Multiple logistic regression was used to measure the potential predictors (e.g. eating patterns and HRQoL) of mental health problems in two models of crude and adjusted for age and body mass index (BMI). P values less than 0.05 were considered as statistically significant.

Results

Indicators of conduct problems and hyperactivity disorders were the most prevalent mental health problems among female adolescents (25.2% and 18.6% respectively). The prevalence of hyperactivity disorders among female adolescents was 35.5%. Female adolescents in high scores of ‘snacking and convenience’, ‘planning ahead’ and ‘meal skipping’ eating patterns were more likely to have indicators of emotional disorders (P < 0.05). Also, being in the high tertile of ‘low fat eating’ pattern made adolescents less likely to have hyperactivity disorders (P < 0.05). Moreover, according to our finding, high scores of vitality and mental health components of HRQoL were associated with reduced likelihood of emotional disorders, conduct disorders and hyperactivity disorders. No significant difference in terms of BMI and nutrient intakes in different categories of mental health problems according to SDQ scoring was identified.

Conclusions

In the current study unhealthy eating patterns including ‘snacking and convenience’, ‘planning ahead’ and ‘meal skipping’ eating patterns were positive predictors of “emotional disorders” while “low fat” eating pattern was negative predictor of hyperactivity disorders.

The Effect of Leisure Activity Diversity and Exercise Time on the Prevention of Depression in the Middle-Aged and Elderly Residents of Taiwan

Previous studies have confirmed that activity participation is beneficial to mental health, but few studies focus on older adults' depression. Based on the theory of social integration, this study examined the effects of leisure activity diversity and exercise time on depression in late adulthood. Subjects in the 2011 Survey of Health and Living Status of the Middle-Aged and Elderly in Taiwan were extracted. A series of logistic regressions were conducted to discern factors related to the odds of having depression. Among study subjects (N = 3727; age ≥ 58), 20.9% indicated an inclination of having depression (CESD-10 score ≥ 8). This study found that participating in diverse leisure activities and longer exercise time decreases older adults' risk of having depression. Additionally, the results confirmed that depression is positively correlated with chronic diseases. Consequently, efforts should be continually spent on encouraging older adults' participation in activities to reduce the prevalence of depression.

Association of Selective Serotonin Reuptake Inhibitors and Bone Mineral Density in Elderly Women

Depression and osteoporosis are 2 common comorbidities in geriatric patients. There are concerns about the deleterious effects of selective serotonin reuptake inhibitor (SSRI) antidepressant use on bone mineral density (BMD). We examined the association between SSRI use and BMD in elderly women (≥65 yr) referred to a geriatric osteoporosis clinic for bone health evaluation. Cross-sectional analyses using the general linear model were performed on data collected retrospectively from August 2010 to April 2015. A total of 250 women were seen during the study period. Of these, 140 women had complete data on BMD measurements: 22 (15.7%) used an SSRI and 118 (84.3%) did not. The 2 groups, SSRI users and SSRI nonusers, did not differ significantly across any of the covariates tested (age, ethnicity, body mass index, and past and present osteoporosis treatment medications). After adjusting for covariates, there was no difference in the BMDs at the femoral neck (p = 0.887) or the spine (p = 0.275) between the 2 groups. Similarly, no difference was seen in the T-scores between SSRI users and nonusers at the femoral neck (p = 0.924) or at the spine level (p = 0.393). Our study did not show an association between SSRI use and BMD among elderly women referred for bone health evaluation. Other studies in the literature have been inconclusive, and therefore, robust longitudinal studies are needed to further assess the interaction between SSRI use and predictors of fracture such as BMD, bone turnover markers, and genes involved in bone turnover. Until then, clinicians should closely monitor the bone health of long-term SSRI users.

Fruits and vegetables intake and its subgroups are related to depression: a cross-sectional study from a developing country

BACKGROUND

The association of fruits and vegetables (FV) specific subgroups consumption and depression has not been investigated in healthy adult populations. Therefore, the aim of our study was to determine the relationship between intake of FV as well as their subgroups and depression.

METHODS

This cross-sectional study was conducted on 400 women attending healthcare centers. The scores of depression, anxiety, and stress were measured using the 21-item depression, anxiety and stress scales questionnaire. The participants' anthropometric and physical activity data were collected and the 147-item semi-quantitative FFQ was used for estimating the FV intake.

RESULTS

After adjustment for confounding variables, the participants in the lower quartiles of total FV, total vegetables, total fruits, citrus, other fruits and green leafy vegetables intake were more likely to experience depression compared to those in the higher quartiles (p trend < 0.03).

CONCLUSION

Our findings suggest that higher intake of total FV and some of its specific subgroups might be associated with depression.

Prevalence of Dementia, Depression, and Mild Cognitive Impairment in a Rural Area of the Island of Crete, Greece

The studies on the prevalence of dementia, depression, and mild cognitive impairment (MCI) in Greece are sparse and show major variations of prevalence depending on geographical areas, nutritional habits, and the way of living. The aim of this door-to-door study was to find the prevalence of dementia, depression, and MCI in a rural Greek population. Four hundred and forty-three individuals older than 61years following the application of specific criteria were diagnosed with: normal cognition, depression, MCI with and without depression, and dementia with and without depression. Four diagnostic methods were used, 2 of which included Mungas correction for age and education. After Mungas adjustment, the results were as follows-depression: 33.9%; MCI: 15.3%; MCI with depression: 8.6%; dementia: 2.0%; and dementia with depression: 7.2%. Dementia is less prevalent compared to global data and other Greek areas. Mild cognitive impairment is more prevalent than dementia. High percentages of depression may be related to low education.

Diet quality, disordered eating and health-related quality of life in Greek adolescents

Purpose

Health-related quality of life (HRQOL) is a subjective multi-dimensional concept referring to an individual’s perception of health and well-being in domains related to physical, mental, emotional and social functioning. The current study aims at investigating possible associations between dietary quality, disordered eating attitudes and HRQOL in Greek adolescents.

Design/methodology/approach

A total of 400 students (198 boys; 202 girls), 14-17 years old, were recruited from five high schools in the area of Kallithea in Athens, Greece. Standard anthropometric measurements were taken, and obesity classification was conducted using the International Obesity Task Force (IOTF) cut-off points. Students completed the KIDMED index, which evaluates the degree of adherence to the Mediterranean diet (MedDiet) as a diet quality index, the EAT-26 questionnaire, which assesses disordered eating attitudes and the KIDSCREEN-27 questionnaire for children and adolescents assessing perceived HRQOL.

Findings

Disordered eating attitudes are significantly negatively correlated with the total score of HRQOL (p < 0.01) and with the subcategories: psychological well-being (p < 0.01), parents and autonomy (p < 0.01) and school environment (p < 0.001), whereas adherence to the MedDiet was positively correlated with all the components and total score of HRQOL. Linear regression analysis revealed that adherence to the MedDiet (p < 0.05), total number of meals/day (p < 0.01) and number of meals with the family (p < 0.05) were significant predictors of HRQOL in adolescents.

Research limitations/implications

The convenient sampling of 400 students was conducted from five schools, from one municipality of Athens, Greece.

Originality/value

Adherence to the MedDiet positively affects important components of HRQOL in adolescents, whereas disordered eating attitudes has a negative effect. Identifying adolescents with low HRQOL is highly important because it could result in an early detection of individualised healthcare needs and possible non-diagnosed ill-health problems.

Prevalence of Mental Disorders in the Elderly in the Community of Madrid: Results of the Mentdis_ICF65+ Study

The MentDis_ICF65+ Project is an epidemiological study of mental disorders in people 65 to 85 years old in several European cities, including Madrid. Its aim is to determine the lifetime, 12-month, and 1-month prevalence of the main mental disorders in the elderly. The relationship of age and sex with each mental disorder was examined. The sample was collected through random sampling of people over 65 in Madrid, and consisted of 555 persons between 65 and 85 years old. The CIDI65+ was administered. Estimates of prevalence and odds ratios (OR) were made using sample frequencies and according to sex and age. Excluding nicotine dependence, 40.12% of the sample was found to have suffered a mental disorder at some time in their lives, 29.89% in the past year, and 17.70% were currently suffering from a mental disorder. The disorders with the highest prevalence rates were anxiety disorders, alcohol-related disorders, and mood disorders. Elderly women had a higher risk of suffering an anxiety disorder (OR men/women 0.42; CI 0.25-0.68) with a significance level of p < .001, while elderly men were more affected by any substance-related disorder (OR men/women 3.96; CI 1.62-11.07) with a significance level of p < .001. Each disorder's prevalence decreased with age (OR 65-74/75-85, 1.85; CI 1.25-2.75) with a significance level of p < .01. Results show higher prevalence rates than previous studies reported. The main implications of this study, and the need to adapt mental health services for people over 65, are highlighted.

Are Dietary Patterns Associated with Depression in U.S. Adults?

Nutrition is one of the most important modifiable determinants for and consequences of both mental and physical heath. Depression has become an increasingly important public health issue. We tested whether dietary patterns derived from food group intake are associated with depression in U.S. adults in a cross-sectional study with national population. This study included 4180 men and 4196 women aged 20-79 years in the 2007-2010 National Health and Nutrition Examination Surveys (NHANES), with complete data of one 24-h dietary recall, sociodemographics, lifestyles, and Patient Health Questionnaires (PHQ-9) for screening depression. Two major dietary patterns identified by factor analysis were investigated for their associations with presence of depression (PHQ-9 score ≥10) by using linear and multivariate logistic regressions. One of two major patterns, labeled "Western" dietary pattern was characterized by high intakes of nonwhole grain, white potatoes, cheese, meat, discretionary oil and fat, and added sugar; the second dietary pattern that was labeled "Healthy" dietary pattern was characterized by high intakes of whole grains, vegetables, fruits, fish, nuts and seeds. The "Western" dietary pattern was not significantly associated with depression in both men and women. The "Healthy" dietary pattern scores were inversely associated with the PHQ-9 depression scores and odd ratios (ORs) of depression after adjustment for covariates in women but not in men. The OR of depression in women with the highest quintile of "Healthy" dietary pattern scores was 0.60 (95% confidence interval [CI]: 0.42-0.85, P < .001) compared to the lowest quintile as a reference. These findings warrant future interventions or clinical trials in elucidating causal and effect relations of depression and dietary patterns, an important public health concern.

Depression, Anxiety and Symptoms of Stress among Baccalaureate Nursing Students in Hong Kong: A Cross-Sectional Study

This study examines the prevalence of depression, anxiety and symptoms of stress among baccalaureate nursing students in Hong Kong. Recent epidemiological data suggest that the prevalence of mild to severe depression, anxiety and stress among qualified nurses in Hong Kong stands at 35.8%, 37.3% and 41.1%, respectively. A total of 661 nursing students were recruited to participate in our cross-sectional mental health survey using the Depression, Anxiety and Stress Scale 21. Multiple logistic regression was used to determine significant relationships between variables. Working in general medicine, being in financial difficulty, having sleep problems, not having leisure activity and perceiving oneself in poor mental health were significant correlates of past-week depression, anxiety and stress. Year of study, physical inactivity and family crisis in the past year correlated significantly with depression. Imbalanced diets significantly correlated with anxiety. Stress was significantly associated with a lack of alone time. This is the first study to confirm empirically that clinical specialty, financial difficulties and lifestyle factors can increase nursing students’ levels of depression and anxiety and symptoms of stress. Prevention, including the early detection and treatment of mental disorder, promises to reduce the prevalence of these indicators among this group.

mHealth For Aging China: Opportunities and Challenges

The aging population with chronic and age-related diseases has become a global issue and exerted heavy burdens on the healthcare system and society. Neurological diseases are the leading chronic diseases in the geriatric population, and stroke is the leading cause of death in China. However, the uneven distribution of caregivers and critical healthcare workforce shortages are major obstacles to improving disease outcome. With the advancement of wearable health devices, cloud computing, mobile technologies and Internet of Things, mobile health (mHealth) is rapidly developing and shows a promising future in the management of chronic diseases. Its advantages include its ability to improve the quality of care, reduce the costs of care, and improve treatment outcomes by transferring in-hospital treatment to patient-centered medical treatment at home. mHealth could also enhance the international cooperation of medical providers in different time zones and the sharing of high-quality medical service resources between developed and developing countries. In this review, we focus on trends in mHealth and its clinical applications for the prevention and treatment of diseases, especially aging-related neurological diseases, and on the opportunities and challenges of mHealth in China. Operating models of mHealth in disease management are proposed; these models may benefit those who work within the mHealth system in developing countries and developed countries.

Dietary patterns and depressive symptoms in a Taiwanese population aged 53 years and over: Results from the Taiwan Longitudinal Study of Aging

AIM

The present study aimed to examine the associations between dietary patterns and depressive symptoms in a Taiwanese population aged 53 years and over, and evaluate the longitudinal impacts of dietary patterns on depressive symptoms.

METHODS

Data were from the Taiwan Longitudinal Study of Aging.

RESULT

Depressive symptoms were identified in 23% of adults aged ≥53 years. Multivariate logistic regression analysis showed that a Western dietary pattern, which was characterized by frequent consumption of meat/poultry and eggs, with infrequent consumption of fish, beans/legumes, vegetables and fruit, was cross-sectionally associated with a high risk of depressive symptoms (P < 0.05). A traditional dietary pattern, which was characterized by frequent consumption of meat/poultry and eggs with infrequent consumption of fish, increased by 60% the risk of depressive symptoms during the subsequent 8 years (P < 0.05). A healthy dietary pattern, which was characterized by frequent consumption of fish, vegetables and fruits, was not significantly associated with subsequent depressive symptoms.

CONCLUSIONS

Dietary patterns correlate with depressive symptoms in a Taiwanese population aged 53 years and over. The Western and traditional dietary patterns, characterized by frequent consumption of meat/poultry and eggs, and infrequent consumption of fish, increased the risk of current and subsequent depressive symptoms. Geriatr Gerontol Int 2016; 16: 1289-1295.

Perception of Exercise Lifestyle as a Valid Tool for Prevention and Treatment of Depression in Rural Communities

BACKGROUND

This study examines perception of exercise lifestyle prescription as a valid treatment for depression among rural patients at a primary care clinic in Texas.

METHODS

The researchers created a depression and exercise survey completed by 104 patients ages 18 and up living in central, economically disadvantaged rural Texas. Logistic regression was used to analyze data obtained.

RESULTS

There was a significant difference (p = 0.01) in perception of exercise as a valid treatment for depression as a function of demographic variables, however not as a function of exercise duration (p = 0.12) in the rural primary care clinic's patients. Even though it was not a statistically significant finding, there was a positive correlation found between the amount of exercise engaged in per day and the likelihood to have a positive perception of exercise prescription as a tool in depression prevention and treatment.

CONCLUSION

Participants between ages 40 to 59 years old, female, and of Hispanic ethnicity independently are most likely to perceive exercise lifestyle as a valid treatment for depression. This is the first study to look specifically at patient perception of exercise as a valid treatment tool for depression not only in rural areas, but also in the nation. Findings from this pilot study may help healthcare service providers learn how to best incorporate exercise prescription into depression prevention and treatment in rural areas, leading to reducing depression epidemics.

Evaluation of Nutritional Status of Patients with Depression

Aims and Objectives. Our goal was to determine nutritional status, body composition, and biochemical parameters of patients diagnosed with depression based on DSM-IV-TR criteria. Methods. A total of 59 individuals, aged 18–60 years admitted to Mental Health Centre of Kayseri Education and Research Hospital, were included in the study. The participants were randomly assigned to two groups; depression group (n = 29) and control group (n = 30). Anthropometric measurements, some biochemical parameters, demographic data, and 24-hour dietary recall were evaluated. Results. 65.5% of depression and 60.0% of control group were female. Intake of vitamins A, thiamine, riboflavin, B6, folate, C, Na, K, Mg, Ca, P, Fe, Zn, and fibre (p < 0.05) were lower in depression group. Median levels of body weight, waist circumference, hip circumference, waist-to-hip ratio (p < 0.05) were significantly higher in depression group. Fasting blood glucose levels, serum vitamins B12, and folic acid (p < 0.05) in depression group were lower than controls. Serum insulin and HOMA levels of two groups were similar. Conclusion. Some vitamin B consumption and serum vitamin B12 and folic acid levels were low while signs of abdominal obesity were high among patients with depression. Future research exploring nutritional status of individuals with depression is warranted.

Depressive symptoms in late life in urban and semi-urban areas of South-West Greece: An undetected disorder?

OBJECTIVE

The objective of this study was to estimate the prevalence and probable under-diagnosis of depressive symptoms in elderly of an urban and semi-urban area in Greece.

MATERIALS AND METHODS

A cross-sectional study was conducted among the members of 4 days care centers for older people (KAPI), three in the municipality of Patras, West-Greece, and in one in Tripolis, Peloponnese, Greece. A total of 378 individuals took part in the study, aged >60 years. A questionnaire was developed to collect basic demographic data, including three questions from the European Health Interview Survey, regarding self-reported or by a physician-diagnosed depression. Moreover, to all participants the Greek validated version of the Geriatric Depression Scale-15 (GDS-15) was applied, to screen for depressive symptoms.

RESULTS

According to GDS-15, 48.1% of the studied population screened positive for depressive symptoms (38.6% moderate, 9.5% severe), whereas having ever been affected with chronic depression reported 19.0% by themselves. In 162 members of KAPI of Patras and in 106 of Tripolis, who never reported have been affected by depression and depressive symptoms were observed in 27.7% and 44.7%, respectively. In 28 individuals from Patras, who reported not to know if they have depression and in 10 from Tripolis, depressive symptoms were observed in 60.7% and 90%, respectively, applying the GDS-15.

CONCLUSION

Except the high prevalence, the present study reveals a remarkable under-detection of depressive symptoms in older adults. Various interventions in primary care are necessary so as to increase detection rates of depression among the elderly.

Metabolic syndrome and major depression

Major depression is associated with a 4-fold increased risk for premature death, largely accounted by cardiovascular disease (CVD). The relationship between depression and CVD is thought to be mediated by the so-called metabolic syndrome (MeS). Epidemiological studies have consistently demonstrated a co-occurrence of depression with MeS components, ie, visceral obesity, dyslipidemia, insulin resistance, and hypertension. Although the exact mechanisms linking MeS to depression are unclear, different hypotheses have been put forward. On the one hand, MeS could be the hallmark of the unhealthy lifestyle habits of depressed patients. On the other, MeS and depression might share common alterations of the stress system, including the hypothalamus-pituitary-adrenal (HPA) axis, the autonomic nervous system, the immune system, and platelet and endothelial function. Both the conditions induce a low grade chronic inflammatory state that, in turn, leads to increased oxidative and nitrosative (O&NS) damage of neurons, pancreatic cells, and endothelium. Recently, neurobiological research revealed that peripheral hormones, such as leptin and ghrelin, which are classically involved in homeostatic energy balance, may play a role in mood regulation. Metabolic risk should be routinely assessed in depressed patients and taken into account in therapeutic decisions. Alternative targets should be considered for innovative antidepressant agents, including cytokines and their receptors, intracellular inflammatory mediators, glucocorticoids receptors, O&NS pathways, and peripheral mediators.