Epidemiology of depression at Traditional Chinese Medicine Hospital in Shanghai, China

Paeoniflorin alleviates depression by inhibiting the activation of NLRP3 inflammasome via promoting mitochondrial autophagy

Depression ranks among the most common neuropsychiatric disorders globally. Current studies examining the roles of inflammation and mitochondrial autophagy in the antidepressant efficacy of paeoniflorin (PF) are sparse. This study aimed to elucidate PF's antidepressant mechanism by promoting autophagy and inhibiting NLRP3 inflammasome activation using chronic unpredictable mild stimulation (CUMS)-induced C57BL/6 mouse models in vivo and corticosterone (CORT)-induced HT22 cell models in vitro. Results demonstrated that PF enhanced the viability of HT22 cells following CORT exposure, restored mitochondrial membrane potential (MMP), reduced reactive oxygen species accumulation, increased LC3 fluorescence intensity, and suppressed inflammatory cytokine secretion and inflammation activation. Additionally, PF ameliorated depressive behaviors induced by CUMS and improved damage in hippocampal neurons. It also reduced the expression of NLRP3, ASC, Caspase-1, IL-1β, and the assembly of the NLRP3 inflammasome. Moreover, PF upregulated the expression of autophagy-related proteins in the hippocampus, facilitating the clearance of damaged mitochondria and enhancing autophagy. The role of autophagy in PF's antidepressant effects was further confirmed through the use of the autophagy inhibitor 3-methyladenine (3-MA), which reduced the efficacy of PF. In conclusion, PF effectively improved depressive behaviors in CUMS-induced mice and reduced NLRP3-mediated inflammation both in vivo and in vitro, likely via the induction of autophagy.

Exploring influential factors in the self-assessment of life satisfaction among Chinese elderly: a structural equation modeling analysis

The aging problem is becoming more and more prominent globally. Attention to the quality of life and related health improvement among the elderly has become an important issue in modern society. This study utilized a tracking survey conducted in 2017-2018, involving 9,327 Chinese older adults, to examine health influencing factors, and applied structural equation modeling to analyze the influencing factors on the self-assessment of life satisfaction among older adults in different regions (cities, counties, and villages) in China. This study revealed that economic status, psychological status, personal situation, life behaviors, and child care are important influences on older people's self- assessed life satisfaction. There is a positive correlation between economic status, psychological status, child care and the results of the self-assessment of life satisfaction of the elderly. Psychological status and child care have a greater impact on the self-assessment of life satisfaction among the elderly in urban areas compared to villages and towns. The influence of economic status on the self-assessment of life satisfaction of the elderly is lower in urban areas than in rural areas. There is a significant difference in the influence of personal situations on the self-assessment of life satisfaction among the elderly. Additionally, older individuals tend to report higher levels of self-assessment of life satisfaction. Furthermore, female elderly individuals tend to report higher levels of satisfaction compared to males. Findings from this study indicate that improving health self-assessment in older adults requires targeted efforts based on different geographic areas of life and the age stages of older adults, and more attention needs to be paid to men who are just entering old age.

Efficacy and safety of non-pharmacological therapy under the guidance of TCM theory in the treatment of anxiety in patients with myocardial infarction: A protocol for systematic review and meta-analysis

BACKGROUND

With the increasing pressures of modern life and work, combined with a growing older population, the incidence of comorbid anxiety and myocardial infarction (MI) is increasing. Anxiety increases the risk of adverse cardiovascular events in patients with MI and significantly affects their quality of life. However, there is an ongoing controversy regarding the pharmacological treatment of anxiety in patients with MI. The concomitant use of commonly prescribed selective serotonin reuptake inhibitors (SSRIs) and antiplatelet medications such as aspirin and clopidogrel may increase the risk of bleeding. Conventional exercise-based rehabilitation therapies have shown limited success in alleviating anxiety symptoms. Fortunately, non-pharmacological therapies based on traditional Chinese medicine (TCM) theory, such as acupuncture, massage, and qigong, have demonstrated promising efficacy in treating MI and comorbid anxiety. These therapies have been widely used in community and tertiary hospital settings in China to provide new treatment options for patients with anxiety and MI. However, current studies on non-pharmacological TCM-based therapies have predominantly featured small sample sizes. This study aims to comprehensively analyze and explore the effectiveness and safety of these therapies in treating anxiety in patients with MI.

METHOD

We will systematically search six English and four Chinese databases by employing a pre-defined search strategy and adhering to the unique rules and regulations of each database to identify studies that fulfilled our inclusion criteria, to qualify for inclusion, patients must be diagnosed with both MI and anxiety, and they must have undergone non-pharmacological TCM therapies, such as acupuncture, massage, or qigong, whereas the control group received standard treatments. The primary outcome measure will be alterations in anxiety scores, as assessed using anxiety scales, with secondary outcomes encompassing the evaluations of cardiopulmonary function and quality of life. We will utilize RevMan 5.3 to conduct a meta-analysis of the collected data, and subgroup analyses will be executed based on distinct types of non-pharmacological TCM therapies and outcome measures.

RESULTS

A narrative summary and quantitative analysis of the existing evidence on the treatment of anxiety patients with MI using non-pharmacological therapies guided by Traditional Chinese Medicine theory.

CONCLUSION

This systematic review will investigate whether non-pharmacological interventions guided by TCM theory are effective and safe for anxiety in patients with MI, and provide evidence-based support for their clinical application.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022378391.

The Association between Socio-Demographics and Mental Distress Following COVID-19 Vaccination—Mediation of Vaccine Hesitancy

The COVID-19 vaccine has been administered to over 200 countries and regions. With the unprecedented vaccination scale and speed, vaccination correlated mental health issues should be paid precise attention to. This study aims to assess the association between socio-demographic factors and mental health following vaccination and to analyze the mediation effect of vaccine hesitancy. This study recruited 2112 individuals who took two doses of the COVID-19 vaccine in Shanghai. Structural equation modeling was performed to assess factors associated with anxiety and depression of the vaccinated individuals and the underlying mechanism. The results yielded that vaccine hesitancy partially mediated/suppressed the effect from gender and employment status to anxiety/depression and fully mediated the effects from education to anxiety/depression. This study advanced the understanding of mental health disparity among different socio-demographic groups after vaccination and the impact of vaccine hesitancy on the vaccinated population’s mental health. The finding offered insights into the possible mental vulnerability of people holding a hesitant attitude before vaccination and suggested that vaccine hesitancy played a crucial role in people’s mental health after vaccination. Health promotion programs can target vaccine hesitancy to prevent unfavorable mental health consequences among specific populations.

The Utilization of Chinese Herbal Products for Hyperthyroidism in National Health Insurance System (NHIRD) of Taiwan: A Population-Based Study

Background. Traditional Chinese Medicine (TCM) relieves associated symptoms of hyperthyroidism such as heat intolerance, palpitations, tremor, anxiety, weight loss, increased frequency of bowel movements, and shortness of breath. However, there are no studies regarding the core prescription patterns of herbal formula and single herbs for hyperthyroidism in Taiwan. Materials and Methods. This is a retrospective, observational study using the National Health Insurance Research Database (NHIRD) in Taiwan to analyze the prescription patterns of TCM. Demographic factors, such as sex, age, occupational status, and residential area, and the risk factors for hyperthyroidism were also studied. Results. The outpatient or/and inpatient services for hyperthyroidism receive 17,707 cases in a year. Overall, there were 13,394 newly diagnosed patients. TCM was used in 73% of the patients, and 77.3% of the patients were females. The acceptability of TCM was higher among female patients. Most patients were diagnosed with hyperthyroidism between the ages of 30 and 49 years. The most common comorbidity identified was diabetes mellitus. The most commonly prescribed Chinese herbal product (CHP) formula was Jia-Wei-Xia-Yao-San, while Xia-Ku-Cao was the most commonly prescribed single CHP. There was a high coprescription rate for Xuan-Shen, Bei-Mu, and Mu-Li. Conclusion. This study describes the core prescription pattern of TCM used in the treatment of patients with hyperthyroidism in Taiwan. The most frequently used CHPs could be potential candidates for future pharmacologic studies or clinical trials.

Association between parental control and subclinical depressive symptoms in a sample of college freshmen: Roles of empathy and gender

BACKGROUND

College freshmen are at high-risk for depressive symptoms after experiencing drastic transitions in a new environment. Perceived parental control has proved as a prominent role in an adolescent's mental health. However, the further understandings of the mechanisms underlying the relation between perceived parental control and freshmen's depressive symptoms are urgent.

METHODS

A total of 4,297 Chinese freshmen (57% female) were recruited. They completed the self-report Parental Bonding Instrument (PBI), Interpersonal Reactivity Index (IRI), and University Personality Inventory (UPI), which assess parental control, empathy and depressive symptoms, respectively. The data were analysed using correlation analysis and a test of moderated mediation.

RESULTS

The results showed positive association between parental control and depressive symptoms, partially mediated by empathy. The relation between parental control and affective empathy, was moderated by gender. Specifically, maternal control had a more significant positive effect on males' personal distress. Moreover, the influence of paternal control was also greater for males, with a negative effect on empathic concern and positive on personal distress.

CONCLUSIONS

Parental control significantly positively predicted college freshmen's depressive symptoms, and empathy played a partially mediating role. In addition, the relations between parental control and affective empathy were moderated by freshmen's gender. The findings of this study provide a better understanding of how parental control is related to freshmen's depressive symptoms, offering a theoretical basis for promoting the development of adolescents' mental health and supporting the design of effective psychological interventions to relieve their depressive symptoms.

Reliability and validity of the Chinese version of the Patient Health Questionnaire-9 (C-PHQ-9) in patients with psoriasis: a cross-sectional study

OBJECTIVE

To evaluate the clinical reliability and validity of the Chinese version of the Patient Health Questionnaire-9 (C-PHQ-9) in patients with psoriasis.

DESIGN

Cross-sectional study.

SETTING

Tertiary care centre.

PARTICIPANTS

Patients with psoriasis who have not been diagnosed with depression (n=148; mean age 43.37±17.46 years; 31.19% female).

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measures considered in this study were the C-PHQ-9 and the Hamilton Depression Scale (HAMD). The American Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) was used as the gold standard for the diagnosis of depression. Cronbach's α and test-retest reliability after 1 week were evaluated using reliability analysis, and criterion and structural validity were assessed using validity analysis. Receiver operating characteristic (ROC) analysis was performed to identify the best demarcation score and diagnostic accuracy.

RESULTS

Compared with DSM-V (27.27%), both C-PHQ-9 (39.19%) and HAMD (31.01%) had higher rates for detecting depression. The mean completion time for C-PHQ-9 evaluation (2.02±0.84 min) was significantly less than that for HAMD (23.37±3.21 min, p<0.001). The Cronbach's α coefficient for the C-PHQ-9 was 0.938. The correlation coefficients of the nine items with the total scale ranged from 0.540 to 0.854, and the mean inter-item correlation coefficients ranged from 0.376 to 0.933. After a week, the retest coefficient was 0.955 (p<0.01). Principal component factor analysis showed that C-PHQ-9 identified a unifactorial structure. The best cut-off point was 9 points, with a sensitivity of 98.00% and a specificity of 90.80%. The area under the ROC curve was 0.979 (95% CI 0.968 to 0.991).

CONCLUSION

C-PHQ-9 has good reliability and validity in patients with psoriasis and can be used for primary screening of patients with psoriasis and depression. This scale has obvious time and labour advantages over the HAMD and should be considered for use in clinical practice.

Upward social comparison on mobile social media and depression: The mediating role of envy and the moderating role of marital quality

BACKGROUND

The use of mobile social media enables individuals to learn about others' lives, which may lead to upward social comparison. Evidence has shown that upward social comparison on mobile social media can have negative effect for individuals' mental health, such as a higher risk of depression. Previous studies on this issue have mainly focused on adolescents and college students, but less on married adults' well-being. Moreover, mechanisms underlying this association have not been well-documented.

METHODS

A total of 514 Chinese married adults (62% female) were recruited from 26 regions in China. They completed measures of upward social comparison on mobile social media, envy, marriage quality and depression.

RESULTS

The results showed a positive association between upward social comparison on mobile social media and depression, which was completely mediated by envy. The direct effect of upward social comparison on depression, and the relation between upward social comparison and envy, were both moderated by marital quality. More specifically that upward social comparison on mobile social media was more strongly associated with depression and envy in adults with lower marital quality.

LIMITATIONS

This study only focused on the interpersonal factor (i.e., marriage quality) as a moderating variable, not investigating the potential moderating roles of personality factors and other interpersonal factors. In addition, the cross-sectional in design could not examine the causal relationships among the variables.

CONCLUSIONS

High marriage quality can protect married adults from the adverse effects of upward social comparison on mobile social media.

Nelumbo nucifera Gaertn Stems (Hegeng) Improved Depression Behavior in CUMS Mice by Regulating NCAM and GAP-43 Expression

Background

Nelumbo nucifera Gaertn stem (Hegeng [HG]) is a traditional Chinese medicine that is used to treat mental symptoms in East Asia. However, scientific evidence is generally lacking to support this traditional claim. Aim of the Study. This study's aim is to investigate the antidepression effect of HG and to further explore the possible molecular mechanisms that are involved in its actions. Materials and Methods. HG aqueous extract was administered intragastrically for 21 days after the chronic unpredictable mild stress (CUMS) procedure, and its effect on memory, learning, and emotion was assessed using animal behavioral tests. HG aqueous extract was characterized using HPLC. Immunofluorescence was used to measure the neural cell-adhesion molecule (NCAM) and growth-associated protein-43 (GAP-43) expression.

Results

Depression-like behaviors increased in the CUMS group compared with the control (CON) group, while they were reduced in the high-dose HG (H-HG) and fluoxetine (FLU) groups (p < 0.05). Additionally, NCAM and GAP-43 expression was reduced in the CUMS group compared with the CON group, but it increased in the H-HG and FLU groups (p < 0.05).

Conclusions

These findings show the potential antidepressant effects of HG through mechanisms involving regulation of NCAM and GAP-43. This provides a new theoretical basis for its potential application as an antidepressant-like agent.

Healthcare utilisation for eating disorders among patients with depression: a cross-sectional study in Taiwan

OBJECTIVES

Although depressed patients may have a comorbid eating disorder (ED), to date, no study has focused on healthcare utilisation among this population. This study was designed to investigate the characteristics of healthcare service utilisation among depressed patients with ED.

DESIGN

A cross-sectional study.

SETTING

This population-based study used claims data from Taiwan's National Health Insurance Research database between 2001 and 2012.

PARTICIPANTS

The study involved 1270 participants. These included 254 depressed individuals with ED and 1016 propensity score-matched depressed individuals without ED.

OUTCOME MEASURES

We tracked each patient for a 1 year period to evaluate their healthcare service utilisation, including outpatient visits, inpatient days, and costs for psychiatry and non-psychiatry services. We performed a Mann-Whitney U test to compare outcome variables in healthcare service utilisation between the two groups.

RESULTS

Patients with both depression and ED had significantly more outpatient visits (32.2 vs 28.9, p=0.023), outpatient costs (US$1089 vs US$877, p<0.001) and total costs (US$1356 vs US$1296, p<0.001) than comparison patients. For psychiatric services, patients with depression and ED had more outpatient visits (11.0 vs 6.8, p<0.001), outpatient costs (US$584 vs US$320, p<0.001) and total costs (US$657 vs US$568, p<0.001) than those without ED. For non-psychiatric services, there was no significant difference for all utilisation. This indicates that the total costs were about 1.0-fold greater for depression patient with ED than those without ED.

CONCLUSION

Depression patients with ED had more outpatient visits, outpatient costs and total costs of healthcare services than those without ED.

Antidepressant-like activity of icariin mediated by group I mGluRs in prenatally stressed offspring

OBJECTIVE

The present study was performed to identify antidepressant-like activity of icariin in prenatally stressed male rats.

METHODS

The effects of icariin on PRS-induced depression were examined using sucrose preference test (SPT) and forced swimming test (FST) in male offspring, and measuring protein and mRNA expressions of group I mGluRs receptors and EAAT2 via western blotting and quantitative real-time PCR assays.

RESULTS

The results indicated that prenatal restraint stress (PRS) resulted in several behavioral anomalies. Treatment with icariin relieved the elevated protein and mRNA levels of group I mGluR receptors as well as the diminished protein and mRNA levels of EAAT2 in the PRS male offspring.

CONCLUSIONS

Collectivity, the data support that icariin ameliorates PRS-induced depressive-like behavior via regulating expression of mGluR1, mGluR5 and EAAT2 in the hippocampus.

Suicide Risk in the Hospitalized Elderly in Turkey and Affecting Factors

OBJECTIVE

This study aimed to investigate the suicide risk among the elderly hospitalized and treated because of physical illnesses, and the factors affecting the risk.

METHODS

The study has a cross-sectional design. It was conducted with 459 elderly people hospitalized and treated in a public hospital between May 25, 2015 and December 4, 2015. Data were collected with the Personal Information Form, Suicide Probability Scale and Hospital Anxiety and Depression Scale. For the analysis, descriptive statistics, the chi-square test, Fisher's exact test and logistic regression analysis were used.

RESULTS

In the study, 24.0% of the elderly were at high risk for suicide. Suicide risk was even higher among the elderly in the 60-74 age group, living alone, drinking alcohol, perceiving his/her religious beliefs as weak, being treated for cancer, having the diagnosis 11 years or over, having a history of admission to a psychiatry clinic, and being at risk for anxiety and depression.

CONCLUSION

In the study, approximately one out of every four elderly people was at high risk for suicide. Therefore, older people should be assessed for suicide risk and programs targeting to prevent the elderly from committing suicide should be organized.

Depression among migrant workers in Al-Qassim, Saudi Arabia

BACKGROUND

Mental disorders are common among migrant workers. There is no data on depression in Saudi Arabia among them; although, they are a third of the population.

OBJECTIVE

To determine the prevalence of depression and to assess its relationship with duration of stay and living condition in a sample of migrant workers.

METHODS

A cross-sectional survey of 400 migrant workers was conducted in Al-Qassim region of Saudi Arabia. Exposure and covariate factors were assessed with a standardized questionnaire, depression with the CES-D (Center for Epidemiological Studies on Depression) scale, and physical indices (e.g. weight, height, and blood pressure) with a general examination. Logistic regression was used to identify significant correlates of depression.

RESULTS

Depression prevalence was 20%; it did not vary by duration of stay or living condition but by age, stress, and self-reported health. In the multivariate model, those who reported 'moderate' or 'high' levels of stress were 1.7 (95% CI: 0.9, 3.1) and 3.9 (95% CI: 1.7, 9.1) times more likely to have depression (reference ='low' level), respectively. Similarly, those who rated their health either 'good' or 'fair to very poor' were 3.4 (95% CI: 1.9, 6.1) and 4.8 (95% CI: 2.3, 10.1) times more likely to have depression (reference ='excellent/very good'), respectively.

LIMITATIONS

The data were collected from one company and pertained to only male participants, and the study design could not establish temporal sequence between the exposure and outcome variables.

CONCLUSION

Depression is considerably high in this population; a large-scale and nationally representative survey is needed to validate the findings.

A cross-sectional study on risk factors and their interactions with suicidal ideation among the elderly in rural communities of Hunan, China

OBJECTIVES

To identify risk factors, and their interactions, for suicidal ideation among the elderly in rural communities of Hunan and to provide some scientific basis for suicide prevention.

DESIGN, SETTING AND PARTICIPANTS

A cross-sectional survey was conducted among the elderly in rural communities in China's Hunan Province. Thirteen areas were selected by multi-staged cluster random sampling, and 1887 rural elders were investigated via face-to-face interviews.

MAIN OUTCOME MEASURES

Measures included sociodemographic information, suicidal ideation, activities of daily living (ADL), major depression disorder (MDD), drinking, stressful life events and social support. Non-conditional logistic regression was preformed to explore the influencing factors for suicidal ideation, and additive interaction was used to analyse the interaction between risk factors.

RESULTS

Incidence of suicidal ideation among the elderly was 14.5% (95% CI 12.9% to 16.1%) in rural communities of Hunan. The independent influencing factors for suicidal ideation were annual personal income (OR 3.14; 95% CI 2.15 to 4.59), MDD (OR 17.04; 95% CI 11.91 to 24.39), chronic diseases (OR 2.99; 95% CI 1.84 to 4.85) and ADL (OR 2.00; 95% CI 1.37 to 2.94). Additive interactions were detected between MDD and ADL with a relative excess risk of interaction (RERI) of 21.18 (95% CI 5.47 to 36.89), and between MDD and annual personal income with an RERI of 35.00 (95% CI 9.00 to 61.00).

CONCLUSIONS

The independent risk factors for suicidal ideation are annual personal income (≤2200 CNY), MDD, chronic diseases and disabled ADL status. MDD has additive interactions with ADL and annual personal income. These findings have significant implications for the prediction and prevention of suicidal behaviours.