Overeating and food addiction in Major Depressive Disorder: Links to peripheral dopamine

Depression and obesity: Focus on factors and mechanistic links

Major depressive disorder (MDD) is defined as mood disorder causing a persistent loss of interest and despair for two weeks or greater, with related symptoms. Depression can interfere with daily life and can cause those affected to not work, study, eat, sleep, and enjoy previously enjoyed hobbies and life events as they did previously. If untreated, it can become a serious health condition. Depression is multifactorial with a variety of factors influencing the condition. These factors include: (1) poor diet and exercise, (2) socioeconomic status, (3) gender, (4) biological clocks, (5) genetics and epigenetics, and (6) personal stressors. Treatment of depressive disorders is thus also multifactorial and utilizes the following therapies: (1) diet and exercise, (2) bright light therapy, (3) cognitive behavioral therapy, and (4) pharmaceutical therapy. Obesity is defined as body mass index over 30 and above, is believed to be causally linked to MDD through both psychological and molecular means. Atypical depression, a common form of MDD, is most strongly correlated with a high proclivity for obesity. Obesity and depression have a bidirectional relationship, a patient experiencing either condition singularly is more likely to develop the other due to the neural links between the two, including emotional lability, physical health of the brain, hormones, cytokine secretion, appetite, diet and feeding habits, inflammatory state. In individuals consuming a high fat diet (HFD) commonly ingested by those with obesity, the gut-microbiome is altered leading to systemic inflammation and the dysregulation of mood and the HPA axis impacting their neural health. The purpose of this paper is to examine the interplay of potential molecular, psychological, societal, and environmental causal factors of depressive disorders and how obesity perpetuates depression. A secondary aim of this paper is to examine current interventions that may help improve those affected by both conditions.

Depression Symptoms Linked to Multiple Oral Health Outcomes in US Adults

BACKGROUND

Individuals with mental illness have poor oral health compared to those without mental health conditions. However, the literature is still lacking regarding the specifics of this relationship.

OBJECTIVE

This study aims at examining the relationship between depression and oral health problems such as oral conditions, access to dental care, and oral hygiene measures.

METHODS

A cross-sectional study using a secondary data analysis of 9,693 participants from the 2017 to March 2020 prepandemic National Health and Nutrition Examination Survey (NHANES). The independent variable was severity of depressive symptoms as measured by the Patient Health Questionnaire-9 (PHQ-9). Proportional odds and binary logistic regression were used to calculate crude and adjusted odds ratios (AORs) between depression and 8 oral health outcomes and oral hygiene-related behaviors.

RESULTS

After adjusting for sociodemographics, health conditions, and behaviors, individuals with depression were significantly more likely to have dental aches in the past year (AOR = 1.70; 95% confidence interval [CI], 1.13-2.56), difficulty getting dental care when needed (AOR = 1.93; 95% CI, 1.45-2.58), and difficulty at their jobs due to a problem in their mouth (AOR = 1.63; 95% CI, 1.07-2.49) compared to individuals without depression.

CONCLUSION

Individuals with depressive symptoms often neglect oral hygiene and self-care practices and are less likely to seek medical care for oral health problems, making them at increased risk of poor oral health outcomes. These findings can be applied by dentists, psychologists, and therapists to increase awareness of links between depression and oral health and to encourage patients with depression to seek oral hygiene preventative care.

KNOWLEDGE TRANSFER STATEMENT

Health care professionals can be on the frontline in creating awareness in the general public about the links between depression and oral health and hygiene. Applying the findings from this study can help communicate about the relationship between depression and poor oral health and relieve some burden on the American health care sector, which often struggles to provide medical care to patients with depression and oral health issues.

Risk factors for depression in China based on machine learning algorithms: A cross-sectional survey of 264,557 non-manual workers

BACKGROUND

Factors related to depression differ depending on the population studied, and studies focusing on the population of non-manual workers are lacking. Thus, we aimed to identify the risk factors related to depression in non-manual workers in China.

METHOD

A large-scale cross-sectional survey was conducted between January 1, 2015 and December 31, 2020, which included 264,557 non-manual workers from one large physical examination institution in China. The Patient Health Questionnaire (PHQ-2) was used to measure depression. A total of 73 variables covering aspects of sociodemographic characteristics, general examination data, health history, symptoms, eating habits, work situation, general sleep conditions and laboratory findings were included in the collection and analysis. Machine learning algorithms of neural networks and logistic regressions were used to assess the risk of depression and explore its factors.

RESULTS

Age, feeling fatigue, sleep quality, overeating, waist-to-hip ratio (WHR), and high-density lipoprotein cholesterol (HDLC) were found to be factors of depression. Two prediction models for depression among Chinese non-manual workers were developed with good AUC (0.820), accuracy (0.943), sensitivity (0.743-0.773), and specificity (0.700-0.729).

LIMITATIONS

Data were collected at one time point only, meaning that this study cannot explain the causality of the factor on depression.

CONCLUSIONS

Our finding that age, feeling fatigue, sleep quality, overeating, WHR, and HDL-C were risk factors for depression in non-manual workers may provide strong evidence for health care facilities to develop preventive measures or government policies for non-manual workers.

Reliability and validity of the modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) in a sample of individuals with depressive disorders

BACKGROUND

Food addiction (FA) is strongly associated with depressive symptoms. The reliability and validity of the Modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) were not previously determined in clinical samples in Brazil. This study aimed to assess the psychometric properties of the Brazilian version of the mYFAS 2.0 in adult individuals with depressive disorders.

METHODS

The data stems from a survey investigating FA in a convenience sample of subjects diagnosed with a depressive disorder. Participants answered mYFAS 2.0 and scales for binge eating, depressive and anxiety symptoms, and alcohol and nicotine use. Height and weight were measured to calculate the Body Mass Index (BMI). We evaluated the factor structure, reliability, convergent, discriminant, criterion, and incremental validity.

RESULTS

The sample encompassed 303 participants with a mean age of 37.03 ± 11.72 years, 84.16% of whom were women. The Cronbach's alpha for the mYFAS 2.0 was satisfactory (alpha = 0.915). The best goodness-of-fit model was a single factor, and mYFAS 2.0 showed convergent validity with binge eating and discriminant validity with the alcohol and nicotine use measures. Food addiction presented a weak positive correlation with depressive and anxiety symptoms and BMI. Three food addiction symptoms provided the best balance between sensitivity (80.95%) and specificity (74.81%). Incremental validity over binge eating symptoms was confirmed (t = 4.040, β = 0.681, p < 0.001).

CONCLUSIONS

The Brazilian mYFAS 2.0 performed satisfactorily in this clinical sample of participants with a depressive disorder. These findings suggest it may be a brief, useful, and valid food addiction screening tool for this group.

Omega-3 Polyunsaturated Fatty Acids in Depression

Omega-3 polyunsaturated fatty acids have received considerable attention in the field of mental health, in particular regarding the treatment of depression. This review presents an overview of current research on the role of omega-3 fatty acids in the prevention and treatment of depressive disorders. The existing body of evidence demonstrates that omega-3 fatty acids, in particular eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have antidepressant effects that can be attributed to their modulation of neuroinflammation, neurotransmitter function, and neuroplasticity. Nevertheless, clinical trials of omega-3 supplementation have yielded inconsistent results. Some studies have demonstrated significant reductions in depressive symptoms following omega-3 treatment, whereas others have shown minimal to no beneficial impact. A range of factors, encompassing dosage, the ratio of EPA to DHA, and baseline nutritional status, have been identified as having a potential impact on the noted results. Furthermore, it has been suggested that omega-3 fatty acids may act as an adjunctive treatment for those undergoing antidepressant treatment. Notwithstanding these encouraging findings, discrepancies in study designs and variability in individual responses underscore the necessity of further research in order to establish uniform, standardized guidelines for the use of omega-3 fatty acids in the management of depressive disorders.

The burden of overweight/obesity and weight-related behaviors attributable to food addiction in emerging adults

While food addiction has been positively associated with excess weight and disordered eating behaviors, this has not been examined in representative samples of emerging adults, who are at elevated risk for these outcomes. This study investigated relationships of food addiction with weight outcomes, weight perception, and weight-control behaviors in emerging adults and estimated the population attributable fraction to food addiction. Data from an observational cohort study were collected in seven annual waves from 2010 to 2016. A nationally representative sample of 2785 10th grade students was recruited from schools within each U.S. census region (73% participation) (mean ± SD baseline age = 16.3 ± 0.5years). Wave 7 retention was 81% (n = 2323, 60% female, mean ± SD = 22.6 ± 0.5 years). Outcomes included current BMI, BMI change from baseline - wave 7, increased weight status in wave 7 (increased weight status from baseline-wave 7), perceived overweight, dieting, any weight-control behavior, and extreme weight-control behaviors. Food addiction was measured in wave 7 using the modified Yale Food Addiction Scale. Relative risk of the outcomes associated with food addiction, and population attributable fraction, were estimated using adjusted log-binomial or robust Poisson regression analyses accounting for the complex survey design. Food addiction prevalence was 4.7%. Participants with food addiction were primarily females (91%); food addiction was uncorrelated with other sociodemographics. Food addiction was associated with 48%-167% increased RR for all outcomes, but these were attenuated after adjustment for confounders (31%-64%). The population attributable fraction for food addiction ranged from 2% (high wave 7 BMI) - 5% (extreme weight-control behaviors). Although the population attributable fraction estimates indicate that the public health burden of these outcomes attributable to food addiction may be relatively minor, food addiction may signal the presence of several adverse mental health symptoms.

Early life adversity impacts alterations in brain structure and food addiction in individuals with high BMI

Obesity and food addiction are associated with distinct brain signatures related to reward processing, and early life adversity (ELA) also increases alterations in these same reward regions. However, the neural mechanisms underlying the effect of early life adversity on food addiction are unknown. Therefore, the aim of this study was to examine the interactions between ELA, food addiction, and brain morphometry in individuals with obesity. 114 participants with high body mass index (BMI) underwent structural MRIs, and completed several questionnaires (e.g., Yale Food Addiction Scale (YFAS), Brief Resilience Scale (BRS), Early Traumatic Inventory (ETI)). Freesurfer 6 was applied to generate the morphometry of brain regions. A multivariate pattern analysis was used to derive brain morphometry patterns associated with food addiction. General linear modeling and mediation analyses were conducted to examine the effects of ELA and resilience on food addiction in individuals with obesity. Statistical significance was determined at a level of p < 0.05. High levels of ELA showed a strong association between reward control brain signatures and food addiction (p = 0.03). Resilience positively mediated the effect of ELA on food addiction (B = 0.02, p = 0.038). Our findings suggest that food addiction is associated with brain signatures in motivation and reward processing regions indicative of dopaminergic dysregulation and inhibition of cognitive control regions. These mechanistic variabilities along with early life adversity suggest increased vulnerability to develop food addiction and obesity in adulthood, which can buffer by the neuroprotective effects of resilience, highlighting the value of incorporating cognitive appraisal into obesity therapeutic regimens.

Association between type 2 diabetes and depressive symptoms after a 1-year follow-up in an older adult Mediterranean population

OBJECTIVES

To examine the cross-sectional association between baseline depressive symptoms and the presence of type 2 diabetes (T2D), and its association with glycated hemoglobin (HbA1c) and other metabolic variables, and the prospective association of depressive symptoms and HbA1c after 1 year of follow-up.

METHODS

n = 6224 Mediterranean older adults with overweight/obesity and metabolic syndrome (48% females, mean age 64.9 ± 4.9 years) were evaluated in the framework of the PREDIMED-Plus study cohort. Depressive symptoms were assessed using the Beck Depression Inventory-II and HbA1c was used to measure metabolic control.

RESULTS

The presence of T2D increased the likelihood of higher levels of depressive symptoms (χ2 = 15.84, p = 0.001). Polynomial contrast revealed a positive linear relationship (χ2 = 13.49, p = 0.001), the higher the depressive symptoms levels, the higher the prevalence of T2D. Longitudinal analyses showed that the higher baseline depressive symptoms levels, the higher the likelihood of being within the HbA1c ≥ 7% at 1-year level (Wald-χ2 = 24.06, df = 3, p < .001, for the full adjusted model). Additionally, depressive levels at baseline and duration of T2D predicted higher HbA1c and body mass index, and lower physical activity and adherence to Mediterranean Diet at 1 year of follow-up.

CONCLUSIONS

This study supports an association between T2D and the severity of depressive symptoms, suggesting a worse metabolic control from mild severity levels in the short-medium term, influenced by lifestyle habits related to diabetes care. Screening for depressive symptoms and a multidisciplinary integrative therapeutic approach should be ensured in patients with T2D.

Ghrelin and depressive symptoms in patients with first-episode drug-naïve major depressive disorder: The mediating role of hypothalamic-pituitary-adrenal axis

BACKGROUND

Major depressive disorder (MDD) is one of the global burdens of disease, and its pathogenesis remains unclear. An increasing amount of research indicates that ghrelin regulates mood in patients with MDD. Still, current results are inconsistent, and the mechanisms underlying how ghrelin modulates depressive symptoms are inconclusive, especially in first-episode drug-naïve MDD patients. Therefore, this study aims to investigate the relationship and potential mechanism between ghrelin and first-episode drug-naïve MDD.

METHODS

Ninety first-episode drug-naïve MDD patients and 65 healthy controls (HCs) were included. Hamilton Depression Scale (HAMD-17) as a measure of depressive symptoms. Plasma levels of ghrelin and hypothalamic-pituitary-adrenal axis (HPA-axis) hormones were measured in all participants.

RESULTS

Compared to HCs, the ghrelin levels were higher in the MDD (p < .001) and still showed significance after covarying for sex, age, and Body Mass Index (BMI). Ghrelin was positively related to corticotropin-releasing-hormone (CRH) levels (r = .867, p < .001), adrenocorticotropic hormone (ACTH) levels (r = .830, p < .001), and cortisol levels (r = .902, p < .001) in partial correlation analysis. In addition, there was a positive correlation between HAMD total score and ghrelin levels (r = .240, p = .026). Other than that, the HAMD total score also had a positive correlation with the CRH (r = .333, p = .002) and cortisol (r = .307, p = .004) levels. Further mediation analysis demonstrated that the relationship between ghrelin and HAMD total score was mediated by CRH (ab-path; β = .4457, 95% CI = 0.0780-1.0253, c-path; β = .2447, p = .0260, c'-path; β = -.2009, p = .3427).

CONCLUSIONS

These findings revealed that plasma ghrelin provides a pivotal link to depressive symptoms in first-episode drug-naive MDD patients. CRH mediated the relationship between ghrelin and HAMD total score. It might provide new insights into understanding the pathogenesis of MDD, contributing to intervention and treatment from this approach.

Th17 Cells, Glucocorticoid Resistance, and Depression

Depression is a severe mental disorder that disrupts mood and social behavior and is one of the most common neuropsychological symptoms of other somatic diseases. During the study of the disease, a number of theories were put forward (monoamine, inflammatory, vascular theories, etc.), but none of those theories fully explain the pathogenesis of the disease. Steroid resistance is a characteristic feature of depression and can affect not only brain cells but also immune cells. T-helper cells 17 type (Th17) are known for their resistance to the inhibitory effects of glucocorticoids. Unlike the inhibitory effect on other subpopulations of T-helper cells, glucocorticoids can enhance the differentiation of Th17 lymphocytes, their migration to the inflammation, and the production of IL-17A, IL-21, and IL-23 in GC-resistant disease. According to the latest data, in depression, especially the treatment-resistant type, the number of Th17 cells in the blood and the production of IL-17A is increased, which correlates with the severity of the disease. However, there is still a significant gap in knowledge regarding the exact mechanisms by which Th17 cells can influence neuroinflammation in depression. In this review, we discuss the mutual effect of glucocorticoid resistance and Th17 lymphocytes on the pathogenesis of depression.

Food addiction as a mediator between depressive symptom severity and body mass index

Depression is associated with an increased risk of cardiometabolic disease linked to weight gain driven by complex interactions between multiple risk factors, including overeating behaviours. However, risk factors that mediate the relationship between depressive symptoms and weight gain remain to be fully elucidated. This study examined food addiction symptoms as a potential mediator on the relationship between depressive symptom severity and adiposity as measured by body mass index (BMI), and evaluated whether this relationship was contingent on appetite symptom profile and sex. In a sample of 628 adults, depressive symptom severity was assessed using the Centre for Epidemiological Studies Depression Scale (CES-D), and food addiction symptoms were measured using the Yale Food Addiction Scale (YFAS, version 2). Participant demographics, including BMI, appetite presentations and sex, were assessed using self-report questions. Mediation and moderated mediation analyses were performed to determine relationships between variables. The prevalence of depressogenic food addiction in the present sample was 21.7%. After accounting for age and averaged amount of exercise, food addiction symptoms fully mediated the relationship between depressive symptom severity and BMI. Appetite symptom profile was a significant moderator of this relationship, with effects more pronounced in those with increased appetite compared to decreased or unchanged appetite. While sex was not a significant moderator, being male or female was associated with higher food addiction scores. This study supports food addiction symptoms as an important behavioural risk factor for increased adiposity linked to greater depressive symptom severity, particularly in those experiencing increased appetite during a depressive episode. Assessment and monitoring of food addiction symptoms may have utility in reducing the risk of increased BMI and adverse health outcomes in those experiencing more severe depressive symptoms.

Prevalence and Factors Associated with Subclinical Hypothyroidism in Major Depressive Disorder Patients with Dyslipidemia

Background

Major depressive disorder (MDD) is a common psychiatric disorder with a high prevalence of comorbidity with subclinical hypothyroidism. The aim of this study was to investigate the prevalence and factors influencing the comorbidity of subclinical hypothyroidism in patients with dyslipidemic MDD who were hospitalized for the first time in a Chinese population.

Methods

The study incorporated 708 first-time hospitalized MDD patients, all with dyslipidemia. Data collection encompassed socio-demographic information, blood pressure, fasting blood glucose (FBG), lipid, and thyroid hormone levels. Participants were evaluated using the Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), and Positive Symptom Subscale (PSS).

Results

The prevalence of subclinical hypothyroidism in dyslipidemic MDD patients with the first hospitalization was 39.97%. The course of the disease, age at onset, HAMA score, and low-density lipoprotein cholesterol (LDL-C) were risk factors for subclinical hypothyroidism in dyslipidemic MDD patients. The course of disease, age at onset, HAMA score, HAMD score, FBG, and systolic blood pressure (SBP) levels were observed to influence serum Thyroid Stimulating Hormone (TSH) levels.

Conclusion

MDD patients with dyslipidemia have a high prevalence of subclinical hypothyroidism, and the outcome is associated with anxiety, fasting glucose, and lipids. This study provides a potential biomarker for the identification of co-morbid subclinical hypothyroidism in MDD patients with dyslipidaemia.

The Relationship between Diet and the Occurrence of Depressive Symptoms in a Community Example with High Rates of Social Deprivation: A Cross-Sectional Study

Research suggests that various biological and psychosocial mechanisms are involved in the heterogeneous and complex relationship between dietary patterns and depressive symptoms. The occurrence of depressive symptoms is thought to be related to socioeconomic status (SES), with those with lower SES being more likely to experience persistent depression. The aim of the undertaken study was to investigate whether socioeconomic and health variables are associated with dietary assessment in a population with high rates of social deprivation and whether a relationship exists between dietary assessment and depressive symptoms (DS). The respondents' nutrition was evaluated through a qualitative method, using the Perinumeric Periodic Table questionnaire by Starzyńska. At the same time, the prevalence of DS was assessed employing the Patient Health Questionnaire-9 (PHQ-9). In the DS screening (PHQ-9 ≥ 10), in the entire study population, the risk of DS was 16.1% (n = 605). In our entire study population, up to 61.2% (n = 2297) of the respondents exhibited poor dietary patterns. In the multivariate model, women with almost adequate or poor dietary assessment were 1.62 and 2.18 times more likely to score at least 10 on the PHQ-9 questionnaire, as compared to women whose dietary assessment was good or adequate. In conclusion, it was determined that sociodemographic variables affect nutritional habits. Women who lived in rural areas limited to a vocational education had significantly poorer diets. Moreover, men, younger men, smokers, and those without chronic diseases were characterized by a poorer dietary assessment. Additionally, women who had a better dietary assessment were significantly more likely to have lower scores on the questionnaire assessing the occurrence of DS (PHQ-9 10).

Food addiction, hormones and blood biomarkers in humans: A systematic literature review

BACKGROUND

Food addiction may play a role in rising obesity rates in connection with obesogenic environments and processed food availability, however the concept of food addiction remains controversial. While animal studies show evidence for addictive processes in relation to processed foods, most human studies are psychologically focussed and there is a need to better understand evidence for biological mechanisms of food addiction in humans. Several key hormones are implicated in models of food addiction, due to their key roles in feeding, energy metabolism, stress and addictive behaviours. This systematic literature review examines evidence for relationships between food addiction, hormones and other blood biomarkers.

METHODS

A series of literature searches was performed in Scopus, PsychInfo, MedLine, ProQuest, CINAHL and Web of Science. A total of 3111 articles were found, of which 1045 were duplicates. Articles were included if they contained a psychometric measurement of food addiction, such as the Yale Food Addiction Scale, as well as addressed the association between FA and hormones or blood biomarkers in humans. Articles were assessed for eligibility by two independent reviewers.

RESULTS

Sixteen studies were identified that examined relationships between food addiction and blood biomarkers, published between 2015 and 2021. Significant findings were reported for leptin, ghrelin, cortisol, insulin and glucose, oxytocin, cholesterol, plasma dopamine, thyroid stimulating hormone (TSH), haemoglobin A1c (HbA1c), triglyceride (TG), amylin, tumour necrosis factor alpha (TNF- α) and cholecystokinin (CCK). Methodological issues included small sample sizes and variation in obesity status, sex and mental health-related comorbidities. Due to methodological limitations, definite connections between FA, hormones and other blood biomarkers cannot yet be determined.

CONCLUSION

This systematic review identified preliminary evidence linking FA symptoms to hormones and other blood biomarkers related to feeding, addiction, and stress. However, due to the small number of studies and methodological limitations, further research is needed to evaluate biopsychosocial models of FA and to resolve controversies.

Influence of intra-abomasal administration of L-DOPA on circulating catecholamines and feed intake in cattle

Dopamine has multiple physiological functions including feed intake control in which it can act as an anorectic or orexigenic agent. This study had the objective to evaluate intra-abomasal administration of L-DOPA (levodopa; L-3,4-dihydroxyphenylalanine) from -Mucuna pruriens on circulating catecholamines, indicators of energy metabolism and feed intake in cattle. Eight Holstein steers (340 ± 20 kg) fitted with ruminal cannula were used in a replicated 4 x 4 Latin Square design experiment. Intra-abomasal infusion of L-DOPA at 0, 0.5, 1 and 2 mg/kg BW was carried out for seven days and blood samples were collected at 0, 30, 60, 120, 240 and 480 min from L-DOPA infusion on day 7. The area under the curve (AUC) of plasma L-DOPA and free dopamine increased quadratically with the administration of L-DOPA. However, the AUC of plasma total dopamine had a positive linear response with the increase of L-DOPA. Conversely, the serum 5-hydroxytriptophan (5-HTP), plasma serotonin, serum serotonin, serum tyrosine, plasma glucose and plasma free fatty acids were not affected by the intra-abomasal infusion of L-DOPA. The circulating concentration of the epinephrine, norepinephrine, serotonin, glucose and free fatty acids did not change with L-DOPA infusion. It can be concluded that intra-abomasal L-DOPA administration produced a strong increase in circulating dopamine with no change in energy metabolites and feed intake in cattle.

The relationship between nutrition and depression in the life process: A mini-review

Depression is one of the leading health problems, and >300 million people have a major depressive disorder and this number is getting increasing. Depression complicates the management of existing chronic diseases and the management of complications that may arise. A person's mental state can affect their food preferences, and food preferences can also affect their mental state. In this paper, depression and eating behavior, diet quality, folic acid, vitamin B12, vitamin B6, vitamin D, omega-3 fatty acids, magnesium, selenium, zinc and copper, prebiotics and probiotics are discussed. Research on the subject emphasizes that diet quality may also affect the occurrence of depression. However, studies also indicated that dietary nutrients such as folic acid, vitamin B12, vitamin B6, omega-3 fatty acids, zinc, selenium, and magnesium might be associated with the risk of depression.

Prevalence of suicide attempts and correlates among first-episode and untreated major depressive disorder patients with comorbid dyslipidemia of different ages of onset in a Chinese Han population: a large cross-sectional study

BACKGROUND

Patients with dyslipidemia are at increased risk for suicide, especially those with major depressive disorder (MDD). Few studies have investigated the independent effects of suicide attempts on comorbid dyslipidemia in patients with MDD. Moreover, there are no comparisons of differences in factors associated with suicide attempts among patients with MDD with dyslipidemia at different ages of onset. The aim of this study was to investigate the prevalence of suicide attempts and associated variables in first episode and untreated patients with MDD with comorbid dyslipidemia at different ages of onset.

METHODS

We recruited 1718 patients with first-episode untreated MDD in this study. Demographical and clinical data were collected, and lipid profiles, thyroid function, and blood glucose levels were measured. The Hamilton Depression Scale 17 (HAMD-17), Hamilton Anxiety Scale (HAMA), Clinical Global Impression Severity Scale (CGI), and Positive and Negative Syndrome Scale (PANSS) positive subscale were assessed for depression, anxiety and illness severity, as well as psychotic symptoms, respectively.

RESULTS

The percentage of patients with MDD with comorbid dyslipidemia was 61% (1048/1718). Among patients with MDD with comorbid dyslipidemia, the incidence of suicide attempts was 22.2% (170/765) for early adulthood onset and 26.5% (75/283) for mid-adulthood onset. Independent factors associated with suicide attempts in early adulthood onset patients with MDD with dyslipidemia were as follows: HAMA score (B = 0.328, P < 0.0001, OR = 1.388), Suspicion /persecution (B = -0.554, P = 0.006, OR = 0.575), CGI (B = 0.878, P < 0.0001, OR = 2.406), systolic blood pressure (B = 0.048, P = 0.004, OR = 1.049), hallucinatory behavior (B = 0.334, P = 0.025, OR = 1.397), and TPOAb (B = 0.003, p < 0.0001, OR = 1.003). Independent factors associated with suicide attempts in mid-adulthood onset patients with MDD with comorbid dyslipidemia were as follows: HAMA score (B = 0.182, P < 0.0001, OR = 1.200), CGI (B = 1.022, P < 0.0001, OR = 2.778), and TPOAb (B = 0.002, P = 0.009, OR = 1.002).

CONCLUSION

Our findings suggest an elevated risk of suicide attempts in patients with MDD with comorbid dyslipidemia. The incidence of suicide attempts was similar in the early- and mid-adulthood onset subgroups among patients with MDD with dyslipidemia, but the factors associated with suicide attempts were different in these two subgroups.

A molecular framework for autistic experiences: Mitochondrial allostatic load as a mediator between autism and psychopathology

Molecular autism research is evolving toward a biopsychosocial framework that is more informed by autistic experiences. In this context, research aims are moving away from correcting external autistic behaviors and toward alleviating internal distress. Autism Spectrum Conditions (ASCs) are associated with high rates of depression, suicidality and other comorbid psychopathologies, but this relationship is poorly understood. Here, we integrate emerging characterizations of internal autistic experiences within a molecular framework to yield insight into the prevalence of psychopathology in ASC. We demonstrate that descriptions of social camouflaging and autistic burnout resonate closely with the accepted definitions for early life stress (ELS) and chronic adolescent stress (CAS). We propose that social camouflaging could be considered a distinct form of CAS that contributes to allostatic overload, culminating in a pathophysiological state that is experienced as autistic burnout. Autistic burnout is thought to contribute to psychopathology via psychological and physiological mechanisms, but these remain largely unexplored by molecular researchers. Building on converging fields in molecular neuroscience, we discuss the substantial evidence implicating mitochondrial dysfunction in ASC to propose a novel role for mitochondrial allostatic load in the relationship between autism and psychopathology. An interplay between mitochondrial, neuroimmune and neuroendocrine signaling is increasingly implicated in stress-related psychopathologies, and these molecular players are also associated with neurodevelopmental, neurophysiological and neurochemical aspects of ASC. Together, this suggests an increased exposure and underlying molecular susceptibility to ELS that increases the risk of psychopathology in ASC. This article describes an integrative framework shaped by autistic experiences that highlights novel avenues for molecular research into mechanisms that directly affect the quality of life and wellbeing of autistic individuals. Moreover, this framework emphasizes the need for increased access to diagnoses, accommodations, and resources to improve mental health outcomes in autism.

Psychometric validity of the Montgomery and Åsberg Depression Rating Scale for Youths (MADRS-Y)

BACKGROUND

Because of all the serious consequences of major depressive disorder (MDD), it is important to screen for MDD in adolescents. The aim of this study was to test the psychometric properties of the newly developed self-report depression scale MADRS-Y for adolescents in a normative Swedish sample.

METHODS

The study included 620 adolescents in the age range of 12-20 years old. The normative sample was randomly split into two equal parts, to perform principal component analysis (PCA) on sample one and confirmatory factor analysis (CFA) on sample two. We investigated the psychometrics.

RESULTS

The result from the PCA suggested that all 12 potential items should be used, and the items loaded on the same construct of depression. The CFA supported the one-factor structure with good fit indices. Measurement invariance was confirmed, allowing interpretation regardless of gender or age differences. Reliability was good, α .89, for both samples separately. Test-retest reliability was good to excellent (intraclass correlation coefficients = .87 and .91). Evidence of convergent and discriminant validity was shown.

CONCLUSIONS

The results in the current study suggest that the MADRS-Y is a brief, reliable, and valid self-report questionnaire of depressive symptoms for adolescents in the general population.

Why do we not reverse the path? Stress can cause depression, reduction of brain-derived neurotrophic factor and increased inflammation

The aim of this paper is to describe the direction of the link between stress, depression, increased inflammation and brain-derived neurotrophic factor (BDNF) reduction. We hypothesize that severe stress or prolonged stress can be the driving factor that promote the onset of depression. Both stress and depression, if not resolved over time, activate the production of transcription factors that will switch on pro-inflammatory genes and translate them into cytokines. This cascade fosters systemic chronic inflammation and reduced plasma BDNF levels. Since people with depression have a 60% increased risk of developing type 2 diabetes (T2D) and show high levels of inflammation and low levels of BDNF, we hypothesize possible reasons that might explain why T2D, depression and dementia are often associated in the same patient.

Mediating effect of self-control in the relationship between psychological distress and food addiction among college students

Psychological distress is a possible trigger contributing to food addiction, which is characterized by a loss of behavioral control and compulsive food intake. However, little is known about its underlying mechanisms. Self-control, an important self-regulation skill, may mediate the effect of psychological distress on food addiction. A cross-sectional survey was used to explore the direct relationship between psychological distress and food addiction, and the mediating role of self-control in this relationship. Food addiction, psychological distress, and self-control were evaluated using the Chinese versions of the Yale Food Addiction Scale 2.0, Depression-Anxiety-Stress Scale, and Self-control Scale, respectively. Correlation analyses showed that food addiction was positively correlated with psychological distress, but negatively related to self-control. Structural equation modeling revealed the mediating role of self-control in the relationship between food addiction and psychological distress. As a significant predictor of food addiction, psychological distress may induce food addiction directly or indirectly through the effect of self-control. These findings provide a deeper understanding of the relationship between psychological distress and food addiction, and the underlying mechanism. As such, psychological distress and self-control should be included in prevention and intervention strategies to address food addiction among college students.

Physical intimate partner violence and dietary patterns in pregnancy: a Brazilian cohort

Little is known about the repercussions of intimate partner violence (IPV) on nutritional outcomes in pregnancy, especially regarding diet. The aim was to investigate whether the occurrence of physical IPV at any time during pregnancy is associated with gestational dietary patterns. 161 adult pregnant women were enrolled in a prospective cohort study in Rio de Janeiro, Brazil. Overall and severe physical IPV were measured to evaluate IPV at any time during pregnancy. Three gestational dietary patterns ("Healthy", "Common-Brazilian", and "Processed") were established by principal component analysis. The effect of physical IPV was tested in relation to the score of adherence to each of the dietary patterns. The occurrence of overall and severe physical IPV at any time during pregnancy was 20.4% and 6.8%, respectively. Women living in intimate relationships in which overall and severe physical IPV occurred had an average increase of 0.604 units (95%CI 0.149-1.058) and 1.347 units (95%CI 0.670-2.024), respectively, in the Processed dietary pattern adherence score. No association with "Healthy" and "Common-Brazilian" dietary patterns was observed. Physical IPV was associated with greater adherence to a dietary pattern of lower nutritional quality.

Chronic Restraint Stress Decreases the Excitability of Hypothalamic POMC Neuron and Increases Food Intake

Stress activates the hypothalamic-pituitary-adrenal system, and induces the release of glucocorticoids, stress hormones, into circulation. Many studies have shown that stress affects feeding behavior, however, the underlying circuitry and molecular mechanisms are not fully understood. The balance between orexigenic (simulating appetite) and anorexigenic (loss of appetite) signals reciprocally modulate feeding behavior. It is suggested that proopiomelanocortin (POMC) and neuropeptide Y (NPY) neurons in the arcuate nucleus (ARC) of the hypothalamus are the first-order neurons that respond to the circulating signals of hunger and satiety. Here, we examined a chronic restraint stress model and observed an increase in food intake, which was not correlated with anhedonia. We investigated whether stress affects the properties of POMC and NPY neurons and found that chronic restraint stress reduced the excitatory inputs onto POMC neurons and increased the action potential threshold. Therefore, our study suggests that chronic stress modulates the intrinsic excitability and excitatory inputs in POMC neurons, leading to changes in feeding behavior.

The Prevalence of ''Food Addiction'' during the COVID-19 Pandemic Measured Using the Yale Food Addiction Scale 2.0 (YFAS 2.0) among the Adult Population of Poland

The announcement of the coronavirus pandemic by the World Health Organization (WHO), ongoing restrictions and isolation led to a break with the daily routine, and suspension of social contacts, but also imposed new challenges on the population related to maintaining healthy eating habits. The purpose of the study was to assess the prevalence of “food addiction” (FA) during the COVID-19 pandemic in Poland in relation to several variables including depression. The method of analysis was a questionnaire containing original questions and the Yale Food Addiction Scale 2.0 (YFAS). A total of 1022 Polish residents aged 18–75 participated in the study (N = 1022; 93.7% women, 6.3% men). The prevalence of FA during the COVID-19 pandemic measured with the YFAS 2.0 scale was 14.1%. The average weight gain during the pandemic in 39% of respondents was 6.53 kg. Along with the increase in the value of the BMI index, the intensity of “food addiction” increased in the study group. People with depression had statistically significantly more FA symptoms than healthy people. This work may motivate future research to evaluate the association and potential overlap of “food addiction” and problem eating behaviors during the pandemic and the obesity problem.

Influencing mechanisms of lifestyle and dietary factors on chronic diseases among community residents: updated evidence in Shanghai, China

OBJECTIVES

This study aimed to determine the risk factors for chronic diseases and to identify the potential influencing mechanisms from the perspectives of lifestyle and dietary factors. The findings could provide updated and innovative evidence for the prevention and control of chronic diseases.

DESIGN

A cross-sectional study.

SETTING

Shanghai, China.

PARTICIPANTS

1005 adults from Yangpu district of Shanghai participated in the study, and responded to questions on dietary habits, lifestyle and health status.

RESULTS

Residents suffering from chronic diseases accounted for about 34·99 % of the respondents. Logistic regression analysis showed that age, diet quality, amount of exercise and tea drinking were related to chronic diseases. Age > 60 and overeating (Diet Balance Index total score > 0) had negative additive interaction on the occurrence of chronic disease, while overexercise (Physical Activity Index > 17·1) and tea drinking had negative multiplicative interaction and negative additive interaction on the occurrence of chronic disease. Diet quality, physical activity and tea drinking were incomplete mediators of the relationship between types of medical insurance residents participating in and chronic diseases.

CONCLUSIONS

The residents in Yangpu District of Shanghai have a high prevalence of chronic diseases. Strengthening access of residents to health education and interventions to prevent chronic diseases and cultivating healthy eating and exercise habits of residents are crucial. The nutritional environment of the elderly population should be considered, and the reimbursement level of different types of medical insurance should be designed reasonably to improve the accessibility of medical and health services and reduce the risk of chronic diseases.

Cortisol in relation to problematic eating behaviours, adiposity and symptom profiles in Major Depressive Disorder

Aims

Major Depressive Disorder (MDD) is associated with an increased risk of chronic disease related to weight gain, problematic eating behaviours and neuroendocrine changes. MDD is frequently associated with altered hypothalamic-pituitary-adrenal axis activity and cortisol secretion, where cortisol has been implicated in regulating energy balance, food intake and depressogenic weight changes. However, little research has examined the relationships between cortisol, adiposity and depressogenic problematic eating behaviours.

Method

Plasma cortisol concentrations were compared between 37 participants with MDD reporting appetite/weight loss, 43 participants with MDD reporting appetite/weight gain, and 60 healthy controls, by sex. Associations between cortisol, indices of adiposity and problematic eating behaviours were then assessed after accounting for demographic variables and depressive symptoms. Depressive symptoms were assessed using the Depression subscale of the Depression, Anxiety and Stress Scale, and eating behaviours with the Dutch Eating Behaviours Questionnaire and Yale Food Addiction Scale.

Results

Participants with MDD reporting appetite/weight loss had higher cortisol compared to controls, and marginally higher cortisol than those with MDD reporting appetite/weight gain. Cortisol negatively and significantly accounted for unique variance in body mass index and waist circumference after accounting for variance associated with age, sex and depressive symptoms, however it was not a significant predictor of problematic eating behaviours, such as emotional eating or food addiction. Cortisol concentrations did not differ between sexes.

Conclusion

The results indicate that cortisol is related to lower indices of adiposity and depressogenic symptoms of appetite/weight loss but is not related to problematic eating behaviours and appetite increases in MDD. These findings provide further evidence that the melancholic and atypical subtypes of MDD are associated with differential neuroendocrine and anthropometric indices, as well as behavioural and symptom profiles. Further research investigating the temporal nature of the identified relationships may assist in facilitating the development of improved interventions for individuals affected by weight changes in MDD.

Relations Between Mood States and Eating Behavior During COVID-19 Pandemic in a Sample of Italian College Students

The fear of contagion during the COVID-19 pandemic has been indicated as a relevant cause of psychological pathologies occurring in this period. Food represents a compensating experience, distracting from the experiences of uncertainty, fear and despair, causing alterations in eating habits and behaviors. The study aims at evaluating the relations between fear of a pandemic, mood states and eating disorders in Italian college students, taking into account gender differences. During the lockdown for the pandemic, a sample of 469 college students equally distributed by gender, was recruited online using a questionnaire including the FCV-19S for the assessment of fear of COVID-19, the profile of mood states (POMS) for the evaluation of different emotional states, the eating disorder inventory-2 (EDI-2) and the binge eating scale (BES) to evaluate the presence of the levels of eating disorders. As expected, all emotive states measured by POMS (tension, depression, anger, tiredness, confusion) resulted significantly correlated with the fear of COVID-19. Women were more exposed to fear of COVID-19 showing greater tension, fatigue, depression and confusion, and a significantly higher total mood disturbance score than males. Regarding the EDI-2 and BES variables, tension and anxiety resulted significantly correlated also with bulimic behavior, while depression with interoceptive awareness, impulsivity, and binge eating behaviors, without gender differences. In conclusion, the negative impact of the fear of COVID-19 on the emotional profile and eating behavior suggests the need to implement strategies against psychological distress during the pandemic emergency, and to design psycho-educational interventions aimed at modifying the lifestyle for preventing risks of mental disorders fostering health-oriented behaviors.

Stress-induced alterations of mesocortical and mesolimbic dopaminergic pathways

Our ability to develop the cognitive strategies required to deal with daily-life stress is regulated by region-specific neuronal networks. Experimental evidence suggests that prolonged stress in mice induces depressive-like behaviors via morphological, functional and molecular changes affecting the mesolimbic and mesocortical dopaminergic pathways. Yet, the molecular interactions underlying these changes are still poorly understood, and whether they affect males and females similarly is unknown. Here, we used chronic social defeat stress (CSDS) to induce depressive-like behaviors in male and female mice. Density of the mesolimbic and mesocortical projections was assessed via immuno-histochemistry combined with Sholl analysis along with the staining of activity-dependent markers pERK and c-fos in the ventral tegmental area (VTA), nucleus accumbens (NAc) and medial prefrontal cortex (mPFC). Our results show that social stress decreases the density of TH+ dopaminergic axonal projections in the deep layers of the mPFC in susceptible but not resilient male and female mice. Consistently, our analyses suggest that pERK expression is decreased in the mPFC but increased in the NAc following CSDS in males and females, with no change in c-fos expression in both sexes. Overall, our findings indicate that social defeat stress impacts the mesolimbic and mesocortical pathways by altering the molecular interactions regulating somatic and axonal plasticity in males and females.

Plasma prolactin is higher in major depressive disorder and females, and associated with anxiety, hostility, somatization, psychotic symptoms and heart rate

Background

Major Depressive Disorder (MDD) is linked to poor physical health including an increased risk of developing cardiometabolic disease (CMD), yet the underlying physiology of this relationship is not clear. One pathophysiological mechanism that may underlie this relationship is neuroendocrine dysregulation, including that of the hormone prolactin. Prolactin has a role in the regulation of stress, and it is linked to anxiety, hostility, and weight gain, which are all implicated in MDD and increased CMD risk. However, little research has examined plasma prolactin in association with psychological symptoms of MDD or biometric indices of CMD risk. Method: Plasma samples of 120 participants (n ​= ​60 meeting DSM-5 criteria for MDD and n ​= ​60 control; age and sex matched) were analysed to assess prolactin concentration. Biometric data (BMI, waist circumference, blood pressure and heart rate) were collected, and participants completed the Brief Symptom Inventory (BSI) and Depression Anxiety Stress Scale (DASS).

Results

Plasma prolactin was higher in participants with MDD versus controls (8.79 ​± ​5.16 ​ng/mL and 7.03 ​± ​4.78 ​ng/mL, respectively; F ​= ​4.528, p ​= ​0.035) and among females versus males (9.14 ​± ​5.57 ​ng/mL and 6.31 ​± ​3.70 ​ng/mL, respectively; F ​= ​9.157, p ​= ​0.003). Prolactin was correlated with several psychological symptoms including anxiety, hostility and somatization, and with heart rate, but not with any other biometric measures.

Conclusions

The results of this study indicate that neuroendocrine dysregulation in MDD may extend to the hormone prolactin, with prolactin being specifically associated with a subset of related psychometric and cardiovascular measures.

•

Plasma prolactin is higher in major depressive disorder group than in controls.

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Plasma prolactin is significantly higher in females versus males.

•

Prolactin is significantly correlated with heart rate.

•

Prolactin is correlated with paranoid ideation, anxiety, hostility, somatization.

Current Status of Evidence for a New Diagnosis: Food Addiction-A Literature Review

Food addiction is considered an important link for a better understanding of psychiatric and medical problems triggered by dysfunctions of eating behaviors, e. g., obesity, metabolic syndrome, binge eating disorder, or bulimia nervosa. At behavioral level, food addiction has high degrees of similarity with other eating disorders, a phenomenon that creates difficulties in finding specific diagnostic criteria. Food addiction has been also described as "eating addiction" or "eating dependence" by several researchers, who placed the emphasis on the behavior and not on the food itself. High-sodium foods, artificially flavored-foods, rich carbohydrate- and saturated fats-containing foods are triggers for the activation of the same neural pathways, therefore they act similarly to any drug of abuse. Food addiction is considered a disorder based on functional negative consequences, associated distress and potential risks to both psychological well-being and physical health. A clinical scale was validated for the quantification of the eating addiction severity, namely the Yale Food Addiction Severity Scale (YFAS), constructed to match DSM IV criteria for substance dependence. Using this instrument, a high prevalence of food addiction was found in the general population, up to 20% according to a meta-analytic research. The pathogenesis of this entity is still uncertain, but reward dysfunction, impulsivity and emotion dysregulation have been considered basic mechanisms that trigger both eating dysfunctions and addictive behaviors. Genetic factors may be involved in this dependence, as modulators of higher carbohydrate and saturate fat craving. Regarding the existence of potential therapeutic solutions, lorcaserin, antiepileptic drugs, opioid antagonists, antiaddictive agents are recommended for obesity and eating disorders, and they may be intuitively used in food addiction, but clinical trials are necessary to confirm their efficacy. In conclusion, a better understanding of food addiction's clinical profile and pathogenesis may help clinicians in finding prevention- and therapeutic-focused interventions in the near future.

Factors affecting food addiction in adult women: the effect of depression, body mass index, and body image

ABSTRACT Objective Food addiction, an increasingly prevalent disorder, involves multiple physiological and psychological factors. It is often associated with obesity and psychiatric disorders. This study aimed to determine the main factors affecting food addiction in women. Methods In total, 383 adult women were evaluated using an anamnesis form to record participant demographic information and anthropometric measurements, along with the Yale Food Addiction Scale, Beck Depression Inventory, and body perception scale. We created a model according to Beck Depression Inventory, body mass index, age, body perception scale, and marital status, which were thought to influence Yale Food Addiction Scale. Results Mean participant age was 30.13±10.84 years. Food addiction scores of the participants showed significant positive correlations with body weight, body mass index, and depression scores, and significant negative correlations with the body perception scale scores (p<0.05). The results revealed that the Yale Food Addiction Scale score is affected by the Beck Depression Inventory and body mass index. Increase in Beck Depression Inventory and body mass index increased the Yale Food Addiction Scale score by 0.054 and 0.076 units, respectively. Conclusion The main factors affecting emotional eating in women are coexistence of high scores of depression and high body mass index. It is determined that people can have depression, food addiction and obesity at the same time.

Negative Affectivity and Emotion Dysregulation as Mediators between ADHD and Disordered Eating: A Systematic Review

Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with disordered eating, especially addictive-like eating behavior (i.e., binge eating, food addiction, loss of control overeating). The exact mechanisms underlying this association are unclear. ADHD and addictive-like eating behavior are both associated with negative affectivity and emotion dysregulation, which we hypothesized are mediators of this relationship. The purpose of this systematic review was to review the evidence related to this hypothesis from studies assessing the relationship between childhood or adulthood ADHD symptomatology, negative affectivity, emotion dysregulation and addictive-like eating behavior. The systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations. The literature search was conducted in PubMed and PsycINFO (publication date: January 2015 to August 2020; date of search: 2 September 2020). Out of 403 potentially relevant articles, 41 were retained; 38 publications reported that ADHD and disordered eating or addictive-like eating behavior were significantly associated, including 8 articles that suggested a mediator role of negative affectivity or emotion dysregulation. Sixteen publications reported that the association between ADHD symptomatology and disordered eating or addictive-like eating behavior differed according to gender, eating behavior and ADHD symptoms (hyperactivity, impulsivity and inattention). We discuss the practical implications of these findings and directions future research.

The Impact of Retrospective Childhood Maltreatment on Eating Disorders as Mediated by Food Addiction: A Cross-Sectional Study

Background: The current study aimed to test whether food addiction (FA) might mediate the relationship between the presence of a history of childhood maltreatment and eating disorder (ED) symptom severity. Methods: Participants were 231 patients with ED presenting between May 2017 and January 2020 to a daycare treatment facility for assessment and management with mainly the Eating Disorder Inventory-2 (EDI-2), the Child Trauma Questionnaire (CTQ), and the Yale Food Addiction Scale (YFAS 2.0). Results: Participants had a median age of 24 (interquartile range (IQR) 20–33) years and manifested anorexia nervosa (61.47%), bulimia nervosa (16.88%), binge-eating disorders (9.09%), and other types of ED (12.55%). They were grouped into those likely presenting FA (N = 154) and those without FA (N = 77). The group with FA reported higher scores on all five CTQ subscales, as well as the total score of the EDI-2 (p < 0.001). Using mediation analysis; significant indirect pathways between all CTQ subscales and the EDI-2 total score emerged via FA, with the largest indirect effect emerging for physical neglect (standardized effect = 0.208; 95% confidence interval (CI) 0.127–0.29) followed by emotional abuse (standardized effect = 0.183; 95% CI 0.109–0.262). Conclusion: These results are compatible with a model in which certain types of childhood maltreatment, especially physical neglect, may induce, maintain, and/or exacerbate ED symptoms via FA which may guide future treatments.

Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint

Converging evidence from both animal and human studies have implicated hedonic eating as a driver of both binge eating and obesity. The construct of food addiction has been used to capture pathological eating across clinical and non-clinical populations. There is an ongoing debate regarding the value of a food addiction "diagnosis" among those with eating disorders such as anorexia nervosa binge/purge-type, bulimia nervosa, and binge eating disorder. Much of the food addiction research in eating disorder populations has failed to account for dietary restraint, which can increase addiction-like eating behaviors and may even lead to false positives. Some have argued that the concept of food addiction does more harm than good by encouraging restrictive approaches to eating. Others have shown that a better understanding of the food addiction model can reduce stigma associated with obesity. What is lacking in the literature is a description of a more comprehensive approach to the assessment of food addiction. This should include consideration of dietary restraint, and the presence of symptoms of other psychiatric disorders (substance use, posttraumatic stress, depressive, anxiety, attention deficit hyperactivity) to guide treatments including nutrition interventions. The purpose of this review is to help clinicians identify the symptoms of food addiction (true positives, or "the signal") from the more classic eating pathology (true negatives, or "restraint") that can potentially elevate food addiction scores (false positives, or "the noise"). Three clinical vignettes are presented, designed to aid with the assessment process, case conceptualization, and treatment strategies. The review summarizes logical steps that clinicians can take to contextualize elevated food addiction scores, even when the use of validated research instruments is not practical.

The Impact of Psychological Resources on Body Mass Index in Obesity Surgery Candidates

BACKGROUND

Obesity surgery is the therapy of choice for severely obese patients. The results are promising, but at the same time obesity surgery represents a physical and psychological challenge for patients and care givers. In order to give psychosocial support adequately, more knowledge of effects of psychological profiles is required. Research is often deficit and symptom oriented. Psychological resources (competences) of individuals are often neglected. However, after surgery patients have to cope with the altered anatomic condition and therefore psychological resources are essential for a successful development and my influence also the surgical outcome. The interplay of eating behavior, depression, and psychological resources and their influence on weight are yet undetermined.

METHODS

A cross-sectional study in consecutive obesity surgery candidates was performed. One hundred twenty-seven participants were included (90 female, 37 male; mean BMI 49.85 kg/m²; range 36.7-84.2 kg/m²). After conducting semi-structured clinical interviews psychological resources, depression and eating behavior were assessed via three questionnaires: Essener Ressourcen-Inventar (ERI), Patient Health Questionnaire depression module (PHQ-d), and Eating Disorder Examination-Questionnaire (EDE-Q). To evaluate the influence of psychological resources on BMI mediation models and path analyses were performed.

RESULTS

Psychological resources do not influence BMI directly. Path analyses revealed depression as well as depression/eating behavior as mediating dimension. A first path showed that higher psychological resources are associated with less depressive symptoms and lower BMI. On the other side, a second path showed that higher psychological resources are related to less depression and by means of more conscious and controlled eating behavior to a lower BMI.

CONCLUSION

Psychological resources seem to be relevant in the context of obesity surgery. Good psychological resources show plausible associations with less depression and a more adequate eating behavior. The evaluation of psychological resources in obesity surgery candidates allows the identification of patients at risk. Competences of patients should be addressed in the context of surgery. Our findings build a foundation for a more individualized supportive treatment for obesity surgery candidates. Improving impaired psychological resources may help in the coping process after surgery and is supposed to lead to an even higher weight loss.

Relationships Between Depressive Symptoms, Other Psychological Symptoms, and Quality of Life

Depressive disorders are common, heterogeneous conditions involving physical and psychological symptoms, and substantial impairment in quality of life (QoL). However, relationships between depressive symptoms and QoL are poorly understood, and little research has directly compared relationships between subtypes of depressive symptoms, other psychological symptoms and QoL. This research aimed to examine how symptoms of depression and other mental health conditions are related to QoL. Participants (N=559) completed the World Health Organization Quality of Life - BREF questionnaire, demographic information, the Brief Symptom Inventory, the Beck Depression Inventory II, and the Depression, Anxiety and Stress Scales. Relationships between psychological symptoms and QoL were assessed using correlations and linear multiple regressions. QoL was inversely related to all types of psychopathology. Depressive symptoms were the strongest predictors of lower overall QoL. Both somatic and psychological depressive symptoms negatively predicted QoL, with somatic symptoms being stronger predictors. Conclusions: While many types of psychological symptoms were negatively correlated with QoL, depressive symptoms, particularly somatic symptoms, were the strongest predictors of impaired QoL. These findings provide new information about specific relationships between symptom profiles and QoL which may lead to greater understanding of the underlying mechanisms and to improved interventions.