Seasonal and meteorological associations with depressive symptoms in older adults: A geo-epidemiological study

Effects of seasonality in emergency admissions for mental disorders: two years of clinical experience

OBJECTIVES

This retrospective study, conducted in Turin, Italy, between January 2021 and February 2023, investigates the impact of seasonal heatwaves on emergency department (ED) admissions for mental disorders.

METHODS

Through the analysis of data from 2,854 patients, this research found a significant link between the occurrence of heatwaves, especially from June to August, and an elevated rate of ED admissions for psychiatric conditions.

RESULTS

The data indicate a clear seasonal pattern, with admissions peaking during the hot months and diminishing in the colder months. Particularly, the study delineates an enhanced correlation between heatwaves and admissions for severe psychiatric disorders, such as bipolar disorder, major depression, personality disorders, and schizophrenia, accounting for 1,868 of the cases examined. This correlation was most pronounced among individuals aged 50-59 years.

CONCLUSIONS

The results of this study highlight a critical association between the incidence of seasonal heatwaves and an uptick in ED visits for psychiatric disorders, with a distinct impact on severe cases. It underscores the urgency for healthcare systems to anticipate seasonal fluctuations in psychiatric ED admissions and to allocate resources effectively to support patients during peak periods.

Association Between Sunlight Exposure and Mental Health: Evidence from a Special Population Without Sunlight in Work

Purpose

In recent years, mental health problems have become the most serious social problems worldwide. Past studies have proposed that some links exist between sunlight and mental health; however, relevant studies examining low-dose sunlight exposure populations are lacking. We conducted a study among a group of operating room nurses (ORNs) who work long hours in operating rooms and have limited sunlight exposure. We aim to add to and refine previous researches on the association between mental health and sunlight exposure in community population.

Patients and Methods

A total of 787 ORNs were interviewed and analyzed. Mental health, sunlight exposure duration, sociodemographic and work-related variables, and chronic diseases were evaluated. The Kessler 10 scale (K10) was used to assess participants' mental health status, and their sunlight exposure duration was assessed using their self-reports. Multiple linear regression analysis was adopted to examine the association between sunlight exposure and mental health.

Results

The average K10 score of ORNs was 25.41. ORNs exhibit poorer mental health than other populations. Poor mental health was negatively associated with greater sunlight exposure hours per day (β=-0.378) and sleep regularity (β=-3.341). Poor mental health was positively associated with chronic disease (β=3.514).

Conclusion

This study indicated that the positive association between sunlight exposure and mental health existed. Appropriate enhancement of sunlight exposure will be beneficial to mental health. Hospitals, related organizations and individuals should pay greater attention to ORNs' mental health and sunlight exposure conditions. More policy recommendations as well as building structure recommendations should be proposed.

The effects of weather on depressive symptoms in patients after cardiac surgery

Patients with cardiovascular disease have depression more often than the general population does. The aim of the study was to detect the associations between the psychological state and weather variables in patients who underwent coronary artery bypass grafting or valve surgery. The prospective study was performed during 2008-2012 in Kaunas, Lithuania. The psychological state of 233 patients was assessed by using the Symptom Checklist-90-Revised instrument. The assessment was carried out at 1.5 months, 1 year, and 2 years after the surgery. A sample of 531 measurements of psychological states was used. To investigate the relationships between psychological scores and daily weather variables, a mixed linear model was used adjusting for sex, the type of surgery, age, the marital status, the presence of arterial hypertension, diabetes, major depressive disorders, dysthymic disorders, agoraphobia, smoking before surgery, and myocardial infarction in the anamnesis. The mean somatisation score and air temperature on the second day prior to the survey were found to have a negative correlation in the multivariate model. Lower mean scores of anxiety and depression were linked to hotter days (air temperature >16.25°C on the second day) that did not occur in July or August. During colder days (air temperature <0.35°C), a higher mean score of anxiety and phobic anxiety was observed. A higher mean score of somatizations, depression, and anxiety was seen on the second day after the day with wind speed ≤2.85 kt and on the day after the day with relative humidity <66%. Both a decrease and an increase in daily atmospheric pressure were associated with a higher depression score. Our results confirm that among patients after open heart surgery, psychosomatic complaints are related to some weather changes. The obtained results can help to determine the complexity of weather patterns linked to poorer psychological health.

Long-Term Apparent Temperature, Extreme Temperature Exposure, and Depressive Symptoms: A Longitudinal Study in China

Temperature is increasingly understood to impact mental health. However, evidence of the long-term effect of temperature exposure on the risk of depressive symptoms is still scarce. Based on the China Health and Retirement Longitudinal Study (CHARLS), this study estimated associations between long-term apparent temperature, extreme temperature, and depressive symptoms in middle-aged and older adults. Results showed that a 1 °C increase or decrease from optimum apparent temperature (12.72 °C) was associated with a 2.7% (95% CI: 1.3%, 4.1%) and 2.3% (95% CI: 1.1%, 3.5%) increased risk of depressive symptoms, respectively. This study also found that each percent increase in annual change in ice days, cool nights, cool days, cold spell durations, and tropical nights was associated with higher risk of depressive symptoms, with HRs (95%CI) of 1.289 (1.114-1.491), 2.064 (1.507-2.825), 1.315 (1.061-1.631), 1.645 (1.306-2.072), and 1.344 (1.127-1.602), respectively. The results also indicated that people living in northern China have attenuated risk of low apparent temperature. Older people were also observed at higher risk relating to more cool nights. Middle-aged people, rural residents, and people with lower household income might have higher related risk of depressive symptoms due to increased tropical nights. Given the dual effect of climate change and global aging, these findings have great significance for policy making and adaptive strategies for long-term temperature and extreme temperature exposure.

Exploring the association between precipitation and hospital admission for mental disorders in Switzerland between 2009 and 2019

While several studies proved the relationship between increasing temperatures and poor mental health, limited evidence exists on the effect of other weather factors, such as precipitation. This study assessed the impact of precipitation on hospital admissions for mental disorders in Switzerland between 2009-2019. We defined different precipitation events based on the duration (daily precipitation ≥1mm for 2, 3, or 4 days; PP.2/PP.3/PP.4) and intensity (≥90th percentile for 2 consecutive days; PEP90.2). First, we conducted aggregated time-stratified case-crossover analysis in eight main Swiss cities with distributed lag models to assess the association up to 3 days after the exposure. Then, we pooled the estimates in each city using a multivariate random effects meta-analysis for all hospital admissions and by subgroups (sex, age, diagnosis). Evidence of an association between precipitation and hospital admission for mental disorders was not found in Switzerland (PP.2: 1.003[0.978-1.029]; PP.3: 1.005[0.985-1.026]; PP.4: 0.994[0.960-1.030]; PEP90.2: 1.000[0.953-1.050]). Although the results were highly uncertain, we found an indication of increasing risks of hospital admission with increasing intensity of precipitation in warmer seasons (PP.2: 1.001[0.971-1.032] vs PEP90.2: 1.014[0.955-1.078]), while the risks of hospital admission slightly increased by the duration in colder season (PP.2: 1.009[0.981-1.039]; PP.3: 1.008[0.980-1.036]; PP.4: 1.017[0.956-1.081]). Overall, risks tend to be higher in people aged < 65 years. Duration of the events may influence more than intensity in females, while opposite patterns were observed in males. Risks tended to be larger but still uncertain for schizophrenia, mood disorders, and adult personality disorders. An indication of a negative association was found in neurotic disorders and null risks in the remaining groups. Although our findings did not show a clear association between precipitation and mental disorders, further research is required to clarify the role of precipitation and the potential implications of climate change and extreme precipitation events on mental health.

Explainable Gated Recurrent Unit to explore the effect of co-exposure to multiple air pollutants and meteorological conditions on mental health outcomes

Mental health conditions have the potential to be worsened by air pollution or other climate-sensitive factors. Few studies have empirically examined those associations when we faced to co-exposures, as well as interaction effects. There would be an urgent need to use deep learning to handle complex co-exposures that might interact in multiple ways, and the model performance reinforced by SHapely Additive exPlanations (SHAP) enabled our predictions interpretable and hence actionable. Here, to evaluate the mixed effect of short-term co-exposure, we conducted a time-series analysis using approximately 1.47 million hospital outpatient visits of mental disorders (i.e., depressive disorder-DD, Schizophrenia-SP, Anxiety Disorder-AD, Bipolar Disorder-BD, Attention Deficit and Hyperactivity Disorder-ADHD, Autism Spectrum Disorder-ASD), with matched meteorological observations from 2015 through 2019 in Nanjing, China. The global insights of gated recurrent unit model revealed that most of input features with similar effect size caused the illness risk of SP and ASD increase, and most markedly, 73% of relative humidity, 44.6 µg/m³ of NO₂, and 14.1 µg/m³ of SO₂ at 5-year average level associated with 2.27, 1.14, and 1.29 visits increase for DD, SP, and AD, respectively. Both synergic and antagonistic effect among informative paired-features were distinguished from local feature dependence. Interestingly, variation tendencies of excessive visits of bipolar disorder when atmospheric pressure, PM_2.5, and O₃ interacted with one another were inconsistent. Our results provided added qualitative and quantitative support for the conclusion that short-term co-exposure to ambient air pollutants and meteorological conditions posed threats to human mental health.

The Psychosocial Impact of Chronic Facial Dermatoses in Adults

INTRODUCTION

Skin diseases have negative psychological and social consequences, especially when they are chronic and affect a visible area of the body, such as the face.

OBJECTIVES

The purpose of this study is to investigate and compare the psychosocial impact of three common chronic dermatoses of the face: acne, rosacea, and seborrheic dermatitis.

METHODS

The Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), and Social Appearance Anxiety Scale (SAAS) were used to compare acne, rosacea, and seborrheic dermatitis patients and healthy controls. The relationships between DLQI, HADS, and SAAS results were investigated, as well as their associations with disease duration and severity.

RESULTS

The study included 166 acne patients, 134 rosacea patients, 120 seborrheic dermatitis patients, and 124 controls. The patient groups had significantly higher DLQI, HADS, and SAAS scores than the control group. Rosacea patients had the highest DLQI and SAAS scores, as well as the highest anxiety prevalence. Patients with seborrheic dermatitis had the highest rate of depression. The DLQI, HADS, and SAAS results were moderately correlated with each other, but their relationship with disease duration and severity was insignificant or weak at best.

CONCLUSIONS

Chronic facial dermatoses have a detrimental impact on mood and quality of life. Although patients with acne, rosacea, and seborrheic dermatitis have distinct lesions, the outcomes in terms of quality of life, anxiety, and depression are largely similar. Furthermore, these patients report similar levels of social anxiety as a result of their overall appearance.

Effects of sunshine duration on daily outpatient visits for depression in Suzhou, Anhui Province, China

Previous epidemiological studies have reported seasonal variation patterns of depression symptoms, which may be influenced by bad weather conditions, such as a lack of sunlight. However, evidence on the acute effects of sunshine duration on outpatient visits for depression is limited, especially in developing countries, and the results are inconsistent. We collected daily outpatient visits for depression from the local mental health centre in Suzhou, Anhui Province, China, during 2017-2019. We defined the 5th and 95th sunshine percentiles as short and long sunshine durations, respectively. A quasi-Poisson generalized linear regression model combined with a distributed lag nonlinear model was used to quantitatively assess the effects of short and long sunshine durations on outpatient visits for depression. Stratified analyses were further performed by gender, age and number of visits to identify vulnerable populations. A total of 26,343 depression cases were collected during the study period. An approximate U-shaped exposure-response association was observed between sunshine duration and depression outpatient visits. The cumulative estimated relative risks (RRs) for short and long sunshine durations at lag 0-21 days were 1.53 [95% confidence intervals (CI): 1.14, 2.06] and 1.13 (95% CI: 0.88, 1.44), respectively. Moreover, a short sunshine duration was associated with a greater disease burden than a long sunshine duration, with attributable fractions (AFs) of 16.64% (95% CI: 7.8%, 23.89%) and 2.24% (95% CI: -2.65%, 5.74%), respectively. Subgroup analysis showed that males, people aged less than 45 years and first-visit cases may be more susceptible to a lack of sunlight. For a long sunshine duration, no statistically significant associations were found in any population groups. Our study found that a short sunshine duration was associated with an increased risk of depression. The government, medical institutions, family members and patients themselves should fully recognize the important role of sunlight and take active measures to prevent depression.

Prevalence of depression and depressive symptoms at high altitudes: A systematic review and meta-analysis

BACKGROUND

The aim of the present study was to determine the prevalence of depression or depressive symptoms in people residing in high-altitude regions.

METHODS

Eleven databases were searched for studies on depression and depressive symptoms: PubMed, ISI Web of Science, CINAHL, Embase, Scopus, PsycINFO, Psychology and Behavioral Sciences Collection, Psychology Database, Academic Search Ultimate, SciELO and LILACS. Systematic review and meta-analysis were performed based on the inclusion of these articles measuring the prevalence of depressive symptoms in people living at high altitude (≥1500 m above sea level [masl]). The protocol was registered in PROSPERO (CRD42021271069).

RESULTS

Eight articles with >40,000 participants from 4 different countries were included. Among the samples treated, the combined prevalence of depressive symptoms was 17.9 % (I²: 99 %) and the only estimate by subpopulation at the country level was possible for China, with >36,000 participants, being 28.7 % (I²: 4 %).

LIMITATIONS

Considerable heterogeneity was reported in the estimation of overall prevalence due to the quality of the studies and the instruments used to screen for depressive symptoms.

CONCLUSION

Almost two out of every 10 people living at high-altitude regions suffer from depressive symptoms. Therefore, it is necessary to adapt interventions to this condition and further research in the field is required.

Effects of extreme precipitation on hospital visit risk and disease burden of depression in Suzhou, China

Background

The purpose of this study was to explore the impact of extreme precipitation on the risk of outpatient visits for depression and to further explore its associated disease burden and vulnerable population.

Methods

A quasi-Poisson generalized linear regression model combined with distributed lag non-linear model (DLNM) was used to investigate the exposure-lag-response relationship between extreme precipitation (≥95th percentile) and depression outpatient visits from 2017 to 2019 in Suzhou city, Anhui Province, China.

Results

Extreme precipitation was positively associated with the outpatient visits for depression. The effects of extreme precipitation on depression firstly appeared at lag4 [relative risk (RR): 1.047, 95% confidence interval (CI): 1.005–1.091] and lasted until lag7 (RR = 1.047, 95% CI: 1.009–1.087). Females, patients aged ≥65 years and patients with multiple outpatient visits appeared to be more sensitive to extreme precipitation. The attributable fraction (AF) and numbers (AN) of extreme precipitation on outpatient visits for depression were 5.00% (95% CI: 1.02–8.82%) and 1318.25, respectively.

Conclusions

Our findings suggested that extreme precipitation may increase the risk of outpatient visits for depression. Further studies on the burden of depression found that females, aged ≥65 years, and patients with multiple visits were priority targets for future warnings. Active intervention measures against extreme precipitation events should be taken to reduce the risk of depression outpatient visits.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14085-w.

Metaphyseal fixation in revision knee arthroplasty: a systematic review of the literature and meta-analysis of mid-long-term outcomes of metaphyseal sleeves and cones

Metaphyseal augmentation has in recent years formed a key strategy in management of bone loss in revision knee arthroplasty. There are studies reporting excellent short-term results, however long- term data is lacking. There is also a paucity of studies comparing the most frequently utilised augments, metaphyseal sleeves, and cones. We conducted a systematic review and meta-analysis to evaluate and compare the mid to long term outcomes of metaphyseal cones and sleeves. We conducted systematic search of 4 databases (Medline, Embase, CINALH and PubMed). Seventeen studies were found to be eligible for inclusion of which ten investigated metaphyseal sleeves and the remaining seven investigated cones. Mean follow up across all studies was 6.2 years. The total number of patients included in the studies was 1319 and the number of knees operated on was 1431. We noted a higher revision rate of metaphyseal cones when compared to sleeves 10.85% vs 6.31 (p=0.007). Reoperation rates were also higher in cones compared to sleeves, 13.78% vs 3.68% (p<0.001). Prosthetic joint infection was the most common reason for revision. The difference in conversion rates, based on augment location was statistically significant p=0.019. When undertaking further sub-analysis; there was no statistically significant difference when comparing revision rates of; tibial vs femoral augments p=0.108, tibial vs tibial & femur p=0.54 but a difference was seen between femoral vs tibial & femoral augments p=0.007. Based on our data, metaphyseal sleeves demonstrate significantly lower revision rates compared to metaphyseal cones. However overall, both demonstrate reliable mid to long-term outcomes.

Correlations in radiographic and MAKO Total Knee Robotic-Assisted Surgery intraoperative limb coronal alignment

Robotic-assisted arthroplasty has become increasingly established in recent years. The aim of the study is to determine if intraoperative coronal alignment during robotic-assisted total knee arthroplasty correlates with radiographic alignment. We prospectively compared the pre- and postoperative limb alignment values measured on long leg standing radiographs with intraoperative robotic-assisted measurements for 100 patients who underwent primary total knee arthroplasty. Two-tailed bivariate Pearson correla- tions were performed to evaluate the strength of the association between radiographic and robotic- assisted alignment. The intraclass correlation coeffi- cient (ICC) was used to estimate interrater reliability. There was a male/female ratio of 1.16 and the mean age was 67 years (range 42-88). Robotic-assisted measurements slightly overestimated the degree of varus relative to radiographs. Radiographic and robotic-assisted measurements were strongly correlated (r = 0.915, p < 0.001) preoperatively, with a difference of 1.6 ± 3.2°. The average measure ICC was 0.996 with a 95% confidence interval from 0.995 to 0.997 (p < 0.001). Postoperatively a bigger difference was measured (3.1° ± 1.9°), comparing radiographic and MAKO alignment. A moderate correlation was observed between the postoperative radiographic and MAKO outcome alignment (r = 0.604, p < 0.001). The average measure ICC was 0.977 with a 95% confidence interval from 0.967 to 0.984 (p < 0.001). There is a strong correlation in the preoperative set- ting between radiographic and robotic-assisted lower limb alignment and a moderate correlation in the post-operative setting. The values measured by the MAKO Total Knee application were considerably more in varus.

Recent Techniques in Determining the Effects of Climate Change on Depressive Patients: A Systematic Review

Climate change is amongst the most serious issues nowadays. Climate change has become a concern for the scientific community as it could affect human health. Researchers have found that climate change potentially impacts human mental health, especially among depressive patients. However, the relationship is still unclear and needs further investigation. The purpose of this systematic review is to systematically evaluate the evidence of the association between climate change effects on depressive patients, investigate the effects of environmental exposure related to climate change on mental health outcomes for depressive patients, analyze the current technique used to determine the relationship, and provide the guidance for future research. Articles were identified by searching specified keywords in six electronic databases (Google Scholar, PubMed, Scopus, Springer, ScienceDirect, and IEEE Digital Library) from 2012 until 2021. Initially, 1823 articles were assessed based on inclusion criteria. After being analyzed, only 15 studies fit the eligibility criteria. The result from included studies showed that there appears to be strong evidence of the association of environmental exposure related to climate change in depressive patients. Temperature and air pollution are consistently associated with increased hospital admission of depressive patients; age and gender became the most frequently considered vulnerability factors. However, the current evidence is limited, and the output finding between each study is still varied and does not achieve a reasonable and mature conclusion regarding the relationship between the variables. Therefore, more evidence is needed in this domain study. Some variables might have complex patterns, and hard to identify the relationship. Thus, technique used to analyze the relationship should be strengthened to identify the relevant relationship.

The ongoing effects of the COVID-19 pandemic on perceived physical activity, physical function and mood of older adults in the U.K: A follow-up study (March 2020-June 2021)

Coronavirus (COVID-19) and its variants, continue to spread globally more than two years after the discovery of the wild-type virus in Wuhan, China. Following the onset of COVID-19, fluctuating restrictions have likely impacted the daily lives of older adults living in the United Kingdom (UK). Subsequently, the longer term effects of COVID-19 on physical activity levels, perceived physical function and mood of older adults are unclear. Therefore, the present study aimed to follow a group of older adult's living in the UK for one year, to monitor physical activity levels, perceived physical function and mood. A longitudinal, mixed-methods, observational study was conducted using self-administered, online surveys at 3-month intervals between March 2020 and June 2021. A total of 100 participants (46 males [age: 76 ± 5 years] and 54 females [age:74 ± 4 years]) completed all surveys. Bayesian analysis allowed calculation of direct probabilities whilst incorporating our prior knowledge. Throughout this period, older adults maintained or increased their pre-lockdown physical activity levels despite a decrease in intensity of effort of physical activity tasks, whilst sitting time increased at two of the follow-up time-points. Furthermore, perceived physical function decreased (ps = 91.78%;>1.21 AU) and mood undulated in a pattern that reflected the tightening and easing of restrictions. Despite total physical activity being maintained, perceived physical function decreased by a small but clinically meaningful margin.

Associations of long-term solar insolation with specific depressive symptoms: Evidence from a prospective cohort study

Evidence suggests that sunlight counteracts depression, but the associations of long-term sunlight exposure with specific symptoms of depression are not well known. We evaluated symptom-specific associations of average 1-year solar insolation with DSM-5 depressive symptoms in a representative cohort of Finnish adults. The sample included 1,845 participants from the Cardiovascular Risk in Young Finns Study with data on DSM-5 depressive symptoms, place of residence and covariates. Daily recordings of global solar radiation were obtained from the Finnish Meteorological Institute. Each participant's residential zip code on each day one year prior to the assessment of depressive symptoms was linked to the solar radiation data, and 1-year average daily solar insolation was calculated. Associations of the average 1-year solar insolation with depressive symptoms were assessed with linear and logistic regression analyses adjusting for season, sex, age, as well as individual- and neighborhood-level socioeconomic characteristics. Average daily solar insolation over one year prior to the depressive symptom assessment was not associated with the total number of depressive symptoms reported by participants. In symptom-specific analyses, participants exposed to higher levels of solar insolation in their residential neighborhood were less likely to report suicidal thought (OR = 0.61, 95% CI, 0.39-0.94), and more likely to report changes in appetite (OR = 1.24, 95% CI, 1.00-1.54), changes in sleep (OR = 1.30, 95% CI, 1.06-1.59) and feelings of worthlessness/guilt (OR = 1.33, 95% CI = 1.07-1.65). These findings suggest that solar insolation may contribute to symptom-specific differences in depression. Studies in other populations residing in different geographical locations are needed.

Longitudinal changes in mental health following the COVID-19 lockdown: Results from the Survey of Health, Ageing and Retirement in Europe

Background

Methods

Results

Conclusion

Prevalence and Risk Factors Associated With Postpartum Depressive Symptoms Among Women in Vientiane Capital, Lao PDR

Postpartum depression (PPD), the onset of depressive episodes after childbirth, is the most common psychological condition following childbirth, and a global public health concern. If undiagnosed and/or untreated, postpartum depression can have negative effects on maternal and child health, however, there are few studies on the prevalence of postpartum depression in low- and middle-income countries. To contribute to filling this gap, this study examined the prevalence and risk factors associated with postpartum depressive symptoms among women after delivery in Vientiane Capital, Lao PDR. The study was a cross-sectional design, with multistage sampling used to identify women between 4 and 24 weeks after giving birth (N = 521). The Edinburgh Postnatal Depression Scale was used to identify women with postpartum depressive symptoms. Univariate and multivariate logistic regressions identified risk factors associated with postpartum depressive symptoms. The prevalence of postpartum depressive symptoms among participants was 21.3%. Associated factors were having at least 2-3 living children (AOR: 1.9, 95% CI: 1.1-3.0), experiencing mental health problems during pregnancy (AOR: 3.3, 95% CI: 1.4-7.6), experiencing conflicts with family members (AOR: 2.5, 95% CI: 1.5-4.0), the experience of intimate partner violence (AOR: 2.6, 95% CI: 1.3-5.5), and receiving moderate social support (AOR: 5.6, 95% CI: 3.2-10.0). In contexts where access to mental health specialists has severely constrained maternal and child healthcare providers at primary health care must be supported to develop the necessary skills to identify risk factors and symptoms and offer basic essential services for postpartum depressive symptom (PDS). The study identified a high proportion of mothers with postnatal depressive symptoms, highlighting the need to screen and treat mothers who present with PDS, as not doing so exposes mother and their children to a range of negative health and social outcomes. Addressing the stigma associated with mental health illness and mental health illness and domestic violence that prevents women from seeking healthcare, must also be developed, implemented, and evaluated.

Relationship between Depressive Symptoms and Weather Conditions

Background: Weather is a well-known factor worldwide in psychiatric problems such as depression, with the elderly and females being particularly susceptible. The aim of this study was to detect associations between the risk of depressive symptoms (DS) and weather variables. Methods: 6937 participants were assessed in the baseline survey of the Health Alcohol Psychosocial Factors in Eastern Europe (HAPIEE) study during 2006−2008. To assess the risk of DS, a multivariate logistic model was created with predictors such as socio-demographic factors, health behaviors, and weather variables. Results: DS were found in 23.4% of the respondents, in 15.6% of males and in 29.9% in females. A higher risk of DS (by 25%) was associated with November−December, a rising wind speed, and relative humidity (RH) < 94% and snowfall during the cold period occurring 2 days before the survey. A higher air temperature (>14.2 °C) predominant during May−September had a protective impact. A higher risk of DS in males was associated with lower atmospheric pressure (<1009 hPa) 2 days before. Females were more sensitive to the monthly variation, snowfall, and RH. Conclusions: The findings of our study suggest that some levels of weather variables have a statistically significant effect on DS.

Association between altitude and depression in Peru: An 8-year pooled analysis of population-based surveys

BACKGROUND

In high altitude regions, people experience biological, inflammatory and brain structure changes that increase the risk of depressive symptoms. The aim of this study was to determine the association between altitude and depressive symptoms in the Peruvian population, adjusting by demographic, socioeconomic and exposure to health risk factors.

METHODS

We performed a cross-sectional analytical study of data collected annually by the Demographic and Family Health Survey during the period 2013-2020. The presence of depressive symptoms during the last 14 days prior to the survey were measured using scores obtained from the Patient Health Questionnaire-9 (PHQ-9). A generalized linear model (GLM) of gamma family and log link function was used to report the crude and adjusted β coefficients. A quantile regression model was performed as a sensitivity analysis.

RESULTS

Data from a total of 215,409 participants were included. After adjusting for demographic, socioeconomic and health risk exposures, the GLM showed that an increase in every 100 m of altitude of residence was positively and significantly associated with the depressive symptoms score (β=0•01 [95% confidence interval: 0•01-0•01]).

LIMITATIONS

The length of residence in high altitude areas of the population included cannot be established, requiring future research to determine if the results of the present study are similar in native people or permanent residents of high altitude regions.

CONCLUSIONS

Altitude was positively associated with depressive symptom scores. Our results will allow the development of mental health interventions based on factors that increase the likelihood of depressive symptoms in high-altitudes.

Seasonal variation in fall-related emergency department visits by location of fall - United States, 2015

INTRODUCTION

In the United States, fall-related emergency department (ED) visits among older adults (age 65 and older) have increased over the past decade. Studies document seasonal variation in fall injuries in other countries, while research in the United States is inconclusive. The objectives of this study were to examine seasonal variation in older adult fall-related ED visits and explore if seasonal variation differs by the location of the fall (indoors vs. outdoors), age group, and sex of the faller.

METHODS

Fall-related ED visit data from the National Electronic Injury Surveillance System-All Injury Program were analyzed by season of the ED visit, location of the fall, and demographics for adults aged 65 years and older.

RESULTS

Total fall-related ED visits were higher during winter compared with other seasons. This seasonal variation was found only for falls occurring outdoors. Among outdoor falls, the variation was found among males and adults aged 65 to 74 years. The percentages of visits for weather-related outdoor falls were also higher among males and the 65-74 year age group.

CONCLUSIONS

In 2015, there was a seasonal variation in fall-related ED visits in the United States. Weather-related slips and trips in winter may partially account for the seasonal variation.

PRACTICAL IMPLICATIONS

These results can inform healthcare providers about the importance of screening all older adults for fall risk and help to identify specific patients at increased risk during winter. They may encourage community-based organizations serving older adults to increase fall prevention messaging during winter.

Seasonality of cognitive function in the general population: the Rotterdam Study

Seasonal variation in cognitive function and underlying cerebral hemodynamics in humans has been suggested, but not consistently shown in previous studies. We assessed cognitive function in 10,276 participants from the population-based Rotterdam Study, aged 45 years and older without dementia, at baseline and at subsequent visits between 1999 and 2016. Seasonality of five cognitive test scores and of a summary measure of global cognition were determined, as well as of brain perfusion. Using linkage with medical records, we also examined whether a seasonal variation was present in clinical diagnoses of dementia. We found a seasonal variation of global cognition (0.05 standard deviations [95% confidence interval: 0.02–0.08]), the Stroop reading task, the Purdue Pegboard test, and of the delayed world learning test, with the best performance in summer months. In line with these findings, there were fewer dementia diagnoses of dementia in spring and summer than in winter and fall. We found no seasonal variation in brain perfusion. These findings support seasonality of cognition, albeit not explained by brain perfusion.

Do psychiatric diseases follow annual cyclic seasonality?

Seasonal affective disorder (SAD) famously follows annual cycles, with incidence elevation in the fall and spring. Should some version of cyclic annual pattern be expected from other psychiatric disorders? Would annual cycles be similar for distinct psychiatric conditions? This study probes these questions using 2 very large datasets describing the health histories of 150 million unique U.S. citizens and the entire Swedish population. We performed 2 types of analysis, using “uncorrected” and “corrected” observations. The former analysis focused on counts of daily patient visits associated with each disease. The latter analysis instead looked at the proportion of disease-specific visits within the total volume of visits for a time interval. In the uncorrected analysis, we found that psychiatric disorders’ annual patterns were remarkably similar across the studied diseases in both countries, with the magnitude of annual variation significantly higher in Sweden than in the United States for psychiatric, but not infectious diseases. In the corrected analysis, only 1 group of patients—11 to 20 years old—reproduced all regularities we observed for psychiatric disorders in the uncorrected analysis; the annual healthcare-seeking visit patterns associated with other age-groups changed drastically. Analogous analyses over infectious diseases were less divergent over these 2 types of computation. Comparing these 2 sets of results in the context of published psychiatric disorder seasonality studies, we tend to believe that our uncorrected results are more likely to capture the real trends, while the corrected results perhaps reflect mostly artifacts determined by dominantly fluctuating, health-seeking visits across a given year. However, the divergent results are ultimately inconclusive; thus, we present both sets of results unredacted, and, in the spirit of full disclosure, leave the verdict to the reader.

Should we expect psychiatric disorders to show a cyclic annual pattern? This study reveals that psychiatric diseases’ annual patterns were remarkably similar across the studied diseases in both the US and Sweden, with the magnitude of annual variation significantly higher in Sweden than in the US for psychiatric, but not infectious, diseases.

Community-Level Participation in Volunteer Groups and Individual Depressive Symptoms in Japanese Older People: A Three-Year Longitudinal Multilevel Analysis Using JAGES Data

BACKGROUND

The current study aimed to investigate the contextual effect of volunteer group participation on subsequent depressive symptoms in older people.

METHODS

We analyzed the longitudinal data of 37,552 people aged 65 years and older in 24 municipalities surveyed in the Japan Gerontological Evaluation Study. Volunteer group participation of older people was assessed in 2013 by one question and depressive symptoms were assessed by the Geriatric Depression Scale 15 in 2016. To investigate a contextual effect, we aggregated individual-level volunteer group participation by each residence area as a community-level independent variable. We conducted a two-level multilevel Poisson regression analysis using the Random Intercepts and Fixed Slopes Model.

RESULTS

The average proportion of community-level volunteer group participation was 10.6%. The results of the Poisson regression analysis showed that community-level volunteer group participation reduced the risk for the onset of depressive symptoms by 13% with a 10 percentage point increase in participation, after adjusting for sex, age, population density, total annual sunshine hours and annual rainfall (incident rate ratio, 0.87; 95% confidence interval, 0.78-0.98).

CONCLUSIONS

Older people living in areas with higher volunteer group participation had a lower risk of developing depressive symptoms regardless of whether or not they participated in a volunteer group.

Beneficial Effects of Early Time-Restricted Feeding on Metabolic Diseases: Importance of Aligning Food Habits with the Circadian Clock

The importance of metabolic health is a major societal concern due to the increasing prevalence of metabolic diseases such as obesity, diabetes, and various cardiovascular diseases. The circadian clock is clearly implicated in the development of these metabolic diseases. Indeed, it regulates physiological processes by hormone modulation, thus helping the body to perform them at the ideal time of day. Since the industrial revolution, the actions and rhythms of everyday life have been modified and are characterized by changes in sleep pattern, work schedules, and eating habits. These modifications have in turn lead to night shift, social jetlag, late-night eating, and meal skipping, a group of customs that causes circadian rhythm disruption and leads to an increase in metabolic risks. Intermittent fasting, especially the time-restricted eating, proposes a solution: restraining the feeding window from 6 to 10 h per day to match it with the circadian clock. This approach seems to improve metabolic health markers and could be a therapeutic solution to fight against metabolic diseases. This review summarizes the importance of matching life habits with circadian rhythms for metabolic health and assesses the advantages and limits of the application of time-restricted fasting with the objective of treating and preventing metabolic diseases.

Sea surface temperature variability and ischemic heart disease outcomes among older adults

Ischemic heart disease (IHD) is one of the leading causes of death worldwide. While extreme summer surface air temperatures are thought to be a risk factor for IHD, it is unclear whether large-scale climate patterns also influence this risk. This multi-national population-based study investigated the association between summer Pacific and Atlantic sea surface temperature (SST) variability and annual acute myocardial infarction (AMI) or IHD event rates among older adults residing in North America and the United Kingdom. Overall, a shift from cool to warm phase of the El Niño Southern Oscillation (ENSO) was associated with reduced AMI admissions in western Canada (adjusted rate ratio [RR] 0.89; 95% CI, 0.80-0.99), where this climate pattern predominatly forces below-normal cloud cover and precipitation during summertime, and increased AMI deaths in western United States (RR 1.09; 95% CI, 1.04-1.15), where it forces increased cloud cover and precipitation. Whereas, the Atlantic Multidecadal Oscillation (AMO) during a strong positive phase was associated with reduced AMI admissions in eastern Canada (RR 0.93; 95% CI, 0.87-0.98) and increased IHD mortality during summer months in the United Kingdom (RR 1.08; 95% CI, 1.03-1.14). These findings suggest that SST variability can be used to predict changes in cardiovascular event rates in regions that are susceptible.

Free GP care and psychological health: Quasi-experimental evidence from Ireland

There is considerable ambiguity in the literature on the effect of health insurance on health. While the majority of previous analyses have examined physical health outcomes, analyses of the broader dimensions of health such as psychological health and wellbeing have been less frequent. Using data from the Irish Longitudinal Study on Ageing (TILDA) and a difference-in-differences research design, we examine the impact of free general practitioner (GP) care on psychological health among the older population and explore potential mechanisms. While we find no impact of public health insurance expansions on quality of life, life satisfaction, depression, and worry, the removal of GP fees for all those 70+ leads to a significantly lower level of perceived stress. The impact is mainly driven by poorer, sicker and single individuals. Further analyses show that removing GP fees leads to greater access to GP services and lower levels of financial stress.

Intraday weather conditions can influence self-report of depressive symptoms

The weather is arguably one of the most common topics in daily conversation. However, it is also a well-known factor in psychiatric problems worldwide such as depression, where particularly elders and females are prone to the condition. Previous studies have mostly focused on the association between long-term climate/season change and depressive symptoms to test the belief that people feel depressed when the weather is bad. Yet, little is known about the relationship between intraday weather conditions and depressive symptoms. This study aimed to decompose this association and explore age and gender differences in depressive symptoms' report under different intraday weather conditions. We analyzed data with a total sample size of 20,987 individuals aged 15-96 years obtained via the China Labor-force Dynamic Survey (CLDS) project in 2016. The surveyors filled in the intraday weather conditions (i.e., sunny, cloudy, overcast, light rain, moderate rain, and heavy rain) in the questionnaire with depression being self-reported using the Center for Epidemiologic Studies Depression (CES-D) Scale. In the survey, 17.3% [95% confidence interval (CI) = 16.8%, 17.8%] individuals were assessed to have depressive symptoms (CES-D scores >15). Overcast day was the peak weather condition for depressive symptoms, while gender and age differences of depressive symptoms were biggest in the weather condition of moderate rain. Multivariate logistic regression revealed that female and middle-old age individuals were more likely to report having depressive symptoms, and people under overcast day were more likely to report having depressive symptoms compared to under sunny day [odds ratio (OR) = 1.25, 95%CI = 1.11, 1.39]. This intraday weather conditions-depression link was significant in males and middle-old age individuals but not in females and youngsters.

Sensitivity to Climate and Weather Changes in Euthymic Bipolar Subjects: Association With Suicide Attempts

BACKGROUND

Climate and weather are known to affect multiple areas of human life, including mental health. In bipolar disorder (BD), seasonality represents an environmental trigger for mood switches, and climatic variables may contribute to recurrences. Several studies reported seasonal and climatic-related variations in the rate of suicide attempts. Suicide risk is relevant in BD, with approximately 25% of patients attempting suicide. Therefore, this study aimed to assess sensitivity to weather and climatic variations in BD subjects and its relationship with lifetime suicide attempts.

METHODS

Three hundred fifty-two euthymic BD and 352 healthy control subjects, homogeneous with respect to socio-demographic characteristics, were enrolled. All participants were administered the METEO-Questionnaire (METEO-Q) to evaluate susceptibility to weather and climatic changes. We also investigated the potential relationship between sensitivity to climate and weather and lifetime suicide attempts in BD patients.

RESULTS

METEO-Q scores and the number of subjects reaching the cut-off for meteorosensitivity/meteoropathy were significantly higher in BD patients. Within the clinical group, BD subjects with lifetime suicide attempts obtained higher METEO-Q scores, with no differences between BD-I and BD-II. The number of suicide attempts directly correlated with METEO-Q scores. The presence of suicide attempts was associated with the physical and psychological symptoms related to weather variations.

DISCUSSION

Our findings support the relevance of sensitivity to weather and climate variations in a large sample of BD subjects and point out the association of this feature with lifetime suicide attempts.

Incidence of the Acute Symptom of Chronic Periodontal Disease in Patients Undergoing Supportive Periodontal Therapy: A 5-Year Study Evaluating Climate Variables

Although patients under supportive periodontal therapy (SPT) have a stable periodontal condition, the acute symptom of chronic periodontal disease occasionally occurs without a clear reason. Therefore, in the present study, to obtain a better understanding of this relationship in patients undergoing SPT, we hypothesized that the acute symptom of chronic periodontal disease might be affected by climate factors. We conducted a questionnaire study and carried out oral examinations on patients undergoing SPT who had been diagnosed as having the acute symptom of chronic periodontal disease. We collected climate data from the local climate office in Okayama city, Japan. We predicted parameters that affect the acute symptom of chronic periodontal disease with unidentified cause and divided patients into high and low groups in terms of climate predictors. Then we defined the cut-off values of parameters showing significant differences in the incidence of the acute symptom of chronic periodontal disease. The incidence of the acute symptom of chronic periodontal disease with unidentified cause was significantly different when the cases were classified according to the maximum hourly decrease in barometric pressure (1.5 and 1.9 hPa) (p = 0.04 and p = 0.03, respectively). This suggests that climate variables could be predictors of the acute symptom of chronic periodontal disease. Therefore, gaining a better understanding of these factors could help periodontal patients undergoing SPT prepare to avoid the acute symptom of chronic periodontal disease.

Colder Weather and Fewer Sunlight Hours Increase Alcohol Consumption and Alcoholic Cirrhosis Worldwide

Risk of alcoholic cirrhosis is determined by genetic and environmental factors. We aimed to investigate if climate has a causal effect on alcohol consumption and its weight on alcoholic cirrhosis. We collected extensive data from 193 sovereign countries as well as 50 states and 3,144 counties in the United States. Data sources included World Health Organization, World Meteorological Organization, and the Institute on Health Metrics and Evaluation. Climate parameters comprised Koppen-Geiger classification, average annual sunshine hours, and average annual temperature. Alcohol consumption data, pattern of drinking, health indicators, and alcohol-attributable fraction (AAF) of cirrhosis were obtained. The global cohort revealed an inverse correlation between mean average temperature and average annual sunshine hours with liters of annual alcohol consumption per capita (Spearman's rho -0.5 and -0.57, respectively). Moreover, the percentage of heavy episodic drinking and total drinkers among population inversely correlated with temperature -0.45 and -0.49 (P < 0.001) and sunshine hours -0.39 and -0.57 (P < 0.001). Importantly, AAF was inversely correlated with temperature -0.45 (P < 0.001) and sunshine hours -0.6 (P < 0.001). At a global level, all included parameters in the univariable and multivariable analysis showed an association with liters of alcohol consumption and drinkers among population once adjusted by potential confounders. In the multivariate analysis, liters of alcohol consumption associated with AAF. In the United States, colder climates showed a positive correlation with the age-standardized prevalence of heavy and binge drinkers. Conclusion: These results suggest that colder climates may play a causal role on AAF mediated by alcohol consumption.

Seasonality and symptoms of depression: A systematic review of the literature

AIMS

Lay opinions and published papers alike suggest mood varies with the seasons, commonly framed as higher rates of depression mood in winter. Memory and confirmation bias may have influenced previous studies. We therefore systematically searched for and reviewed studies on the topic, but excluded study designs where explicit referrals to seasonality were included in questions, interviews or data collection.

METHODS

Systematic literature search in Cochrane database, DARE, Medline, Embase, PsychINFO and CINAHL, reporting according to the PRISMA framework, and study quality assessment using the Newcastle-Ottawa scale. Two authors independently assessed each study for inclusion and quality assessment. Due to large heterogeneity, we used a descriptive review of the studies.

RESULTS

Among the 41 included studies, there was great heterogeneity in regards to included symptoms and disorder definitions, operationalisation and measurement. We also observed important heterogeneity in how definitions of 'seasons' as well as study design, reporting and quality. This heterogeneity precluded meta-analysis and publication bias analysis. Thirteen of the studies suggested more depression in winter. The remaining studies suggested no seasonal pattern, seasonality outside winter, or inconclusive results.

CONCLUSIONS

The results of this review suggest that the research field of seasonal variations in mood disorders is fragmented, and important questions remain unanswered. There is some support for seasonal variation in clinical depression, but our results contest a general population shift towards lower mood and more sub-threshold symptoms at regular intervals throughout the year. We suggest future research on this issue should be aware of potential bias by design and take into account other biological and behavioural seasonal changes that may nullify or exacerbate any impact on mood.

Investigating the effect of climatic parameters on mental disorder admissions

The main objective of this study was to evaluate the role of climatic parameters and phenomena including the monthly number of dusty/rainy/snowy/foggy days, cloudiness (Okta), horizontal visibility, and barometric pressure (millibar) on major depressive disorder, bipolar, schizophrenia, and schizoaffective admissions. The monthly data related to the number of admissions in Farshchian hospital and climatic parameters from March 2005 to March 2017 were extracted. Random forest regression and dynamic negative binomial regression were used to examine the relationship between variables; the statistical significance was considered as 0.05. The number of dusty/rainy/snowy/foggy days, cloudiness, and the number of days with vision less than 2 km had a significant positive relationship with admissions due to schizophrenia (p < 0.05). Barometric pressure had a negative effect on schizophrenia admissions (p < 0.001). The number of dusty/rainy/snowy/foggy days and cloudiness had a significant effect on schizoaffective admissions (p < 0.05). Bipolar admissions were negatively associated with rainy days and positively associated with dusty days and cloudiness (p < 0.05). The number of rainy/dusty/snowy days and cloudiness had a positive significant effect on major depressive disorder admissions. The results of the present study confirmed the importance of climatic parameter variability for major depressive disorder, bipolar, schizophrenia, and schizoaffective admissions.

Variability of the Prevalence of Depression in Function of Sociodemographic and Environmental Factors: Ecological Model

Major depression etiopathogenesis is related to a wide variety of genetics, demographic and psychosocial factors, as well as to environmental factors. The objective of this study is to analyze sociodemographic and environmental variables that are related to the prevalence of depression through correlation analysis and to develop a regression model that explains the behavior of this disease from an ecological perspective. This is an ecological, retrospective, cross-sectional study. The target population was 1,148,430 individuals over the age of 16 who were registered in Aragon (Spain) during 2010, with electronic medical records in the community’s primary health care centers. The spatial unit was the Basic Health Area (BHA). The dependent variable was the diagnosis of Depression and the ecological independent variables were: Demographic variables (gender and age), population distribution, typology of the entity, population structure by sex and age, by nationality, by education, by work, by salary, by marital status, structure of the household by number of members, and state of the buildings. The results show moderate and positive correlations with higher rates of depression in areas having a higher femininity index, higher population density, areas with a higher unemployment rate and higher average salary. The results of the linear regression show that aging +75 and rural entities act as protective factors for depression, while urban areas and deficient buildings act as risk factors. In conclusion, the ecological methodology may be a useful tool which, together with the statistical epidemiological analysis, can help in the political decision making process.

Assessing Effect Modification of Excess Winter Death by Causes of Death and Individual Characteristics in Zhejiang Province, China: A Multi-Community Case-Only Analysis

Mortality in many parts of the world has a seasonal pattern, with a marked excess of deaths during winter. To date, however, there is very little published evidence on the nature of this wintertime excess in low- and middle-income countries. In this study, we aimed to quantify the extent of the death peak in winter and to assess effect modification on excess winter death (EWD) by individual characteristics and cause of deaths in China. We used a Cosinor model to examine seasonal patterns for specific causes of deaths and a case-only analysis of deaths in winter compared with other seasons to assess effect modification by individual characteristics. A total of 398,529 deaths were investigated between January 2010 and December 2013 in Zhejiang Province, China. Deaths peaked in winter, and overall mortality was around 30% higher in winter than in summer. Although diseases of the respiratory and circulatory systems were highly seasonal, surprisingly we observed that deaths from mental and behavioral disorders exhibited greater fluctuation. Males, the elderly and illiterate individuals suffered high EWD. EWDs were also particularly common in emergency rooms, at home, on the way to hospitals, and in nursing homes/family wards. This study highlighted the high EWD in some previously unreported groups, indicating new information to facilitate the targeting of necessary preventive measures to those at greatest risk in order to mitigate wintertime death burdens.

Air Pollution Has a Significant Negative Impact on Intentional Efforts to Lose Weight: A Global Scale Analysis

BACKGROUND

Air pollution causes many diseases and deaths. It is important to see how air pollution affects obesity, which is common worldwide. Therefore, we analyzed data from a smartphone application for intentional weight loss, and then we validated them.

METHODS

Our analysis was structured in two parts. We analyzed data from a cohort registered to a smartphone application in 10 large cities of the world and matched it with the annual pollution values. We validated these results using daily pollution data in United States and matching them with user information. Body mass index (BMI) variation between final and initial login time was considered as outcome in the first part, and daily BMI in the validation. We analyzed: daily calories intake, daily weight, daily physical activity, geographical coordinates, seasons, age, gender. Weather Underground application programming interface provided daily climatic values. Annual and daily values of particulate matter PM10 and PM2.5 were extracted. In the first part of the analysis, we used 2,608 users and then 995 users located in United States.

RESULTS

Air pollution was highest in Seoul and lowest in Detroit. Users decreased BMI by 2.14 kg/m² in average (95% confidence interval, -2.26 to -2.04). From a multilevel model, PM10 (β=0.04, P=0.002) and PM2.5 (β=0.08, P<0.001) had a significant negative effect on weight loss when collected per year. The results were confirmed with the validation (β_AQI*time=1.5×10⁻⁵; P<0.001) by mixed effects model.

CONCLUSION

This is the first study that shows how air pollution affects intentional weight loss applied on wider area of the world.

Seasonality of depressive symptoms in women but not in men: A cross-sectional study in the UK Biobank cohort

BACKGROUND

We examined whether seasonal variations in depressive symptoms occurred independently of demographic and lifestyle factors, and were related to change in day length and/or outdoor temperature.

METHODS

In a cross-sectional analysis of >150,000 participants of the UK Biobank cohort, we used the cosinor method to assess evidence of seasonality of a total depressive symptoms score and of low mood, anhedonia, tenseness and tiredness scores in women and men. Associations of depressive symptoms with day length and mean outdoor temperature were then examined.

RESULTS

Seasonality of total depressive symptom scores, anhedonia and tiredness scores was observed in women but not men, with peaks in winter. In women, increased day length was associated with reduced reporting of low mood and anhedonia, but with increased reporting of tiredness, independent of demographic and lifestyle factors. Associations with day length were not independent of the average outdoor temperature preceding assessment.

LIMITATIONS

This was a cross-sectional investigation - longitudinal studies of within-subject seasonal variation in mood are necessary. Outcome measures relied on self-report and measured only a subset of depressive symptoms.

CONCLUSION

This large, population-based study provides evidence of seasonal variation in depressive symptoms in women. Shorter days were associated with increased feelings of low mood and anhedonia in women. Clinicians should be aware of these population-level sex differences in seasonal mood variations in order to aid recognition and treatment of depression and subclinical depressive symptoms.

Association between low serum 25-hydroxyvitamin D and depression in a large sample of Chinese patients with type 2 diabetes mellitus

BACKGROUND

Because of the absence of data on the direct association between vitamin D and depression in patients with diabetes, we examined the association between vitamin D state (assessed by 25-hydroxyvitamin D [25(OH)D]) and the prevalence of depression in adult patients with type 2 diabetes mellitus(T2DM).

METHOD

Cross-sectional data were obtained from 2786 patients with T2DM recruited from a Chinese diabetes registry. Patients' records were reviewed to obtain data pertaining to age, sex, Body Mass Index (BMI), marital status, level of education, smoking status, duration of diabetes mellitus, use of insulin, and presence of additional illnesses. A multiple logistic regression analysis adjusted for potential confounders was used to assess independent associations between serum levels of 25 (OH)D and depression (defined by the Patient Health Questionnaire-9).

RESULTS

Using the PHQ-9 cutoff value of ≥10, 5.71% (159/2786; 95% CI: 4.85-6.57%) were considered to have depression. The serum 25(OH)D levels were significantly lower in diabetic patients with depression than those patients without depression [10.2(IQR, 7.6-15.2)ng/ml vs. 14.6(IQR, 10.7-19.8)ng/ml, respectively; P<0.0001]. Multivariate logistic regression analysis considering traditional risk factors and other biomarkers showed an inverse relationship between serum 25 (OH)D levels and depression when serum 25 (OH)D were used as a continuous variable (OR, 0.84; 95% CI, 0.77-0.90; P<0.001). Compared with the first quartile of serum 25 (OH)D levels, the second quartile OR for depression was 0.83 (95% CI, 0.75-0.92, P=0.012). For the third and fourth quartiles, it was 0.40 (95% CI, 0.33-0.52, P<0.001) and 0.15 (95% CI, 0.08-0.22; P<0.001), respectively.

CONCLUSIONS

We observed a significant negative association between serum levels of 25 (OH)D and depression in Chinese patients with T2DM.

Meteorological analysis of symptom data for people with seasonal affective disorder

It is thought that variation in natural light levels affect people with Seasonal Affective Disorder (SAD). Several meteorological factors related to luminance can be forecast but little is known about which factors are most indicative of worsening SAD symptoms. The aim of this meteorological analysis is to determine which factors are linked to SAD symptoms. The symptoms of 291 individuals with SAD in and near Groningen have been evaluated over the period 2003-2009. Meteorological factors linked to periods of low natural light (sunshine, global radiation, horizontal visibility, cloud cover and mist) and others (temperature, humidity and pressure) were obtained from weather observation stations. A Bayesian zero adjusted auto-correlated multilevel Poisson model was carried out to assess which variables influence the SAD symptom score BDI-II. The outcome of the study suggests that the variable sunshine duration, for both the current and previous week, and global radiation for the previous week, are significantly linked to SAD symptoms.

Factors Contributing to Unexpected Retirement and Unemployment in Adults Over 50 Years Old in Ireland

Older adults are increasingly important to maintaining stable workforces. As such, factors contributing to early workforce exit must be identified. This study aimed to identify predictors of unexpected retirement and unemployment at older age, with respect to psychological constructs, resulting adverse behaviors, and health-related factors reflecting functional status. Data were extracted from The Irish Longitudinal Study on Ageing (TILDA) to predict unexpected retirement and unemployment in older adults in Ireland. Increasing age, increasing number of impairments in activities of daily living, and frailty status of “pre-frail/frail” (relative to non-frail) increased the likelihood of unexpected retirement; while greater numbers of physical limitations and “pre-frail/frail” status significantly predicted unemployment at older age. Pre-frail/frail status or reduced physical capability for everyday tasks may adversely affect older individuals’ ability to obtain and/or maintain employment. These findings advance the current understanding of factors associated with unexpected retirement and unemployment at older ages. Findings may aid in identifying strategies to extend working life and to aid at-risk older adults, and may inform components of care on which to focus to minimize loss of function and mobility, and maintain independence, with aging.

Antiseizure, antidepressant, and antipsychotic medication prescribing in elderly nursing home residents

OBJECTIVE

The incidence of epilepsy is highest in the elderly and the prevalence of epilepsy is higher in nursing home residents than in other cohorts. Co-medications that act in the central nervous system (CNS) are frequently prescribed in this population. The objective was to identify the most commonly prescribed antiseizure drugs (ASDs) and determine the frequency of use of antipsychotic and antidepressant medications in elderly nursing home residents receiving ASDs.

METHODS

Data were obtained from a pharmacy database serving 18,752 patients in Minnesota and Wisconsin nursing homes. Prescribing information was available on ASD, antidepressant, and antipsychotic drugs on one day in October 2013. The frequency distribution by age, formulation, trademarked/generic drugs, route of administration, and multiple drug combinations were determined.

RESULTS

Overall, 66.8% of 18,752 residents received at least one CNS-active drug as classified by the Generic Product Identifier classification system. For those 65years and older, ASDs were prescribed for 14.3% residents. Gabapentin comprised 7.3%; valproate 3.0%; levetiracetam 1.8%; and phenytoin 0.9%. An antidepressant was used in 64.2% of persons prescribed an ASD. Antidepressant use varied for specific ASDs and ranged from 50 to 75%. An antipsychotic medication was used in 30% of persons prescribed an ASD and ranged from 16.8 to 54.2% for specific ASDs. Both antidepressant and antipsychotic use occurred in 22.2% of persons prescribed an ASD, respectively.

SIGNIFICANCE

The pattern of CNS-active drug use has changed from previous years in this geographic region. Use of phenytoin has declined markedly, but antidepressant use has increased substantially. The CNS side effect profile of these medications and the possible long-term consequences in this population can greatly complicate their therapy.

Effects of climatic variables on weight loss: a global analysis

Several studies have analyzed the effects of weather on factors associated with weight loss. In this study, we directly analyzed the effect of weather on intentional weight loss using global-scale data provided by smartphone applications. Through Weather Underground API and the Noom Coach application, we extracted information on weather and body weight for each user located in each of several geographic areas on all login days. We identified meteorological information (pressure, precipitation, wind speed, dew point, and temperature) and self-monitored body weight data simultaneously. A linear mixed-effects model was performed analyzing 3274 subjects. Subjects in North America had higher initial BMIs than those of subjects in Eastern Asia. During the study period, most subjects who used the smartphone application experienced weight loss in a significant way (80.39%, p-value < 0.001). Subjects who infrequently recorded information about dinner had smaller variations than those of other subjects (β_{freq.users dinner*time} = 0.007, p-value < 0.001). Colder temperature, lower dew point, and higher values for wind speed and precipitation were significantly associated with weight loss. In conclusion, we found a direct and independent impact of meteorological conditions on intentional weight loss efforts on a global scale (not only on a local level).

Physical Activity Levels and Well-Being in Older Adults

The objective of this study was to identify the interconnectedness of different intensity levels of physical activity and psychological (life satisfaction and positive affect) and physical (physical health) well-being. Participants were from the National Study of Midlife in the United States with assessments in 2004 and aged 25 to 74 living in the United States were included in the analyses. We conducted bivariate correlations to examine significant relationships among the study variables. In addition, after multicollinearity among the independent variable was checked, a series of hierarchical regression analyses with physical health, positive affect, and life satisfaction as criterion variables were conducted. The results showed that light physical activities were positively associated with physical health and life satisfaction in summer, whereas light physical activities and all dependent variables were positively correlated in winter. Furthermore, engaging in moderate physical activities was positively related only with physical health. Meanwhile, vigorous physical activities were not associated with life satisfaction, physical health, and positive affect in summer and winter.

Association between completed suicide and environmental temperature in a Mexican population, using the Knowledge Discovery in Database approach

BACKGROUND AND OBJECTIVE

Suicide is a worldwide health problem and climatological characteristics have been associated with suicide behavior. However, approaches such as the Knowledge Discovery in Database are not frequently used to search for an association between climatological characteristics and suicide. The aim of the present study was to assess the association between weather data and suicide in a Mexican population.

METHODS

We used the information of 1357 patients who completed suicide from 2005 to 2012. Alternatively, weather data were provided by the National Water Commission. We used the Knowledge Discovery in Database approach with an Apriori algorithm and the data analyses were performed with the Waikato Environment for Knowledge Analysis software. One hundred rules of association were generated with a confidence of 0.86 and support of 1.

RESULTS

We found an association between environmental temperature and suicide: days with no rain and temperatures between 30 °C and 40 °C (86-104 °F) were related to males completing suicide by hanging.

CONCLUSIONS

In the prevention of suicidal behavior, the Knowledge Discovery in Database could be used to establish climatological characteristics and their association with suicide. This approach must be considered in future prevention strategies.