Adolescent socioeconomic status and depressive symptoms in later life: Evidence from structural equation models

Medical ethics in childbirth: a structural equation modeling approach in south of Iran

BACKGROUND

The existence of a valid instrument to evaluate the attitude of mothers towards compliance with medical ethics during childbirth can lead to appropriate interventions to create a positive attitude. The purpose of this study is to determine the construct validity of the MEAVDQ (Medical Ethics Attitude in Vaginal Delivery Questionnaire).

METHODS

The study was carried out with 350 women. The main research instrument was MEAVDQ. This 59-item questionnaire comprises three parts A, B, J. Part A is concerned with the first principles. Part B deals with the second and third principles and part J addresses the fourth principle of medical ethics. Structural Equations Modeling (SEM) was used to determine the construct validity of MEAVDQ.

RESULTS

The results of SEM revealed that there was a positive correlation between structures A and B. The relationship between structures B and J was also positive and significant. On the other hand, there was a direct and indirect relationship between structures A and J. One-unit increase in structure A led to 0.16 (95% CI: 0.01, 0.33) direct increase in structure J. Also, one-unit increase score increases in structure A caused 0.39 indirect rise (95% CI: 0.26, 0.53) in structure J with the mediating role of the structure B.

CONCLUSIONS

It can be suggested to midwifery policy maker and midwives that respect for the first principle of medical ethics and autonomy is the most important principle of medical ethics in childbirth. By respecting the autonomy of mothers, a positive birth experience can be created for them.

Family Income and Child Depression: The Chain Mediating Effect of Parental Involvement, Children's Self-Esteem, and Group Differences

Family income is an important factor that affects depression in children and can indirectly be associated with children's development through family and individual factors. However, few studies have examined the mechanism of multiple risk factors. Therefore, this study focused on the relationship between family income and child depression, as well as the chain mediating the roles of parental involvement and children's self-esteem both in single-parent families and intact families. A total of 1355 primary school students completed questionnaires that assessed family income, parental involvement, children's self-esteem, and depression. The results showed that family income influenced child depression through both the mediating roles of parental involvement and children's self-esteem and the chain mediating role of parental involvement and children's self-esteem. Meanwhile, family income only influenced child depression through chain mediation in single-parent families. The group differences in the mechanism of depression provide a reference for empirical research on depression intervention in children from different family structures.

Familial genetic and environmental transmission of depression: A multi-informant twin family study

The phenomenon of familial clustering in depression is well established, yet the mechanisms by which depression is transmitted within families remain poorly understood. In the current study, we investigate the familial genetic and environmental transmission of depression by incorporating data from both adolescent twins and their parents. A total of 987 twin families were recruited from the Beijing Twin Study. Depression assessments were conducted for both adolescents and their parents. Twins' depression was assessed through reports from both the twins themselves and their parents, while parental depression was assessed by parental self-report. We employed a nuclear twin family model to examine genetic and environmental influences on adolescent depression. Our results, based on both self- and parent-report, demonstrate significant additive and dominant genetic influences on depression. We also found mild yet significant sibling environmental influences, while familial environmental influences were absent. Notably, parent-reported depression showed higher heritability but lower unique environmental influences compared with self-reported depression. These results highlight the important role of genetic transmission and sibling environmental transmission in explaining depression. Our study delineates the underlying mechanism of familial transmission in depression and can inform early treatments to halt transmission during adolescence.

Social inequality in the association between life transitions into adulthood and depressed mood: a 27-year longitudinal study

Background

Few studies have considered the life-course development of depressive symptoms in relation to life transitions in early-adulthood and whether these might affect depressive trajectories differently depending on specific indicators of parental socioeconomic status (SES). In the present work, we explore these questions using the adolescent pathway model as a guiding framework to test socially differential exposure, tracking and vulnerability of the effects of life transitions on depressed mood across different socioeconomic backgrounds.

Methods

Latent growth modeling was used to estimate the associations between indicators of parental SES (parental education and household income) and depressed mood from age 13 to 40 with life transitions (leaving the parental home, leaving the educational system, beginning cohabitation, attaining employment) as pathways between the two. Our analyses were based on a 27-year longitudinal dataset (n = 1242) of a Norwegian cohort with 10 time points in total. To make socioeconomic comparisons, three groups (low, mid, and high) were made for parental education and income respectively.

Results

Depressed mood decreased from age 13 to 40. The low and high parental education groups showed a stable difference in depressed mood during early adolescence, which decreased in young adulthood and then increased slightly in mid-adulthood. The low household income group showed higher depressed mood across young adulthood compared to the medium and higher household income groups. For life transitions, leaving the parental home and beginning cohabitation was associated with an added downturn of the trajectory of depressed mood when adjusting for other transitions. However, adolescents with high parental education showed a relatively stronger decrease in depressed mood when leaving the parental home. Similarly, adolescents with a high household income showed a relatively stronger decrease in depressed mood when leaving the educational system.

Conclusions

Depressed mood decreased over time and developed differently depending on parental education and household income. Life transitions were generally associated with reductions in depressed mood across time, but lower SES youths were not found to be more socially vulnerable these effects.

Depressive Symptoms and Their Longitudinal Impact on Physical Activity and Sedentary Behaviors Among Mexican-Heritage Youth

The purpose of this study is to examine the longitudinal impact of depressive symptoms on physical activity (PA) levels, sedentary behavior, and screen time among first-generation, Mexican-heritage youth. Mexican-heritage families were recruited by promotoras de salud from colonias in Hidalgo County, Texas. Participants (n = 200 youth, 116 families in final sample) completed at-home, interviewer-administered surveys once during the summer (June-July) and once during the fall (August-December). Youth PA and sedentary behaviors were assessed using a validated 7-day recall instrument. The validated Center for Epidemiology Studies-Depression Child scale was used to assess depression symptoms. Linear mixed-effects models were used to analyze the relationships of PA and sedentary behavior with depressive symptoms. Results showed that those depression symptoms were significantly associated with decreased number of self-reported minutes of sitting and screen time over time in the full sample and among male youth. Depression symptoms also significantly decreased the number of self-reported active and moderate to vigorous PA minutes over time among male youth. Researchers can build on our findings by identifying the mechanisms driving the relationships between depression and PA/sedentary behavior. Public health-programing efforts should intentionally consider the impact that depressive symptoms have on PA.

Observational longitudinal association between waking movement behaviours and psychological distress among adolescents using isotemporal analysis: DADOS study

This study aimed to examine the impact of reallocating time spent in waking movement behaviours at baseline on indicators of psychological distress at 24-month follow-up using isotemporal substitution regression models among a sample of Spanish adolescents. The DADOS (Deporte, ADOlescencia y Salud) study is a 3-year longitudinal observational research project carried out between years 2015-2017. The analyses included 197 adolescents (91 girls) aged 13.9 ± 0.3 years at baseline. Waking movement behaviours were assessed by a wrist-worn GENEActiv triaxial accelerometer and expressed as minutes/day of light physical activity (LPA), moderate-vigorous physical activity (MVPA) and time spent in sedentary behaviour (SB). The Behaviour Assessment System for Children and Adolescents (level 3 for adolescents) was used to assess psychological distress indicators (i.e., anxiety, social stress, and risk of depression). Results showed significant associations only for girls. The substitution of 10 min/day of SB or LPA at baseline with 10 min/day of MVPA was associated with lower levels of anxiety (both p ≤ 0.01) and social stress (both p < 0.05) at follow-up. The substitution of 10 min/day of SB with 10 min/day of LPA was associated with higher levels of anxiety at follow-up (p = 0.01). These findings highlight the need of specific physical activity recommendations for mental health paying special attention to sex-differences.

Multiple pathways linking early socioeconomic circumstances and depressive symptoms in late Middle age in the U.S

Objectives: A growing number of life course studies are examining the influence of earlier life experiences on morbidity, disability, and mortality in mid-old age.Method: Drawing from the social pathway model, this study expands the life course literature by utilizing data collected over 35 years from the National Longitudinal Survey of Youth, 1979 Cohort, spanning four life course phases (childhood, young adulthood, middle adulthood, and late-middle adulthood). Through structural equation analyses with a phantom model, we estimated depressive symptoms in late middle age as a result of pathway effects starting with childhood socio-economic status (SES) which effect young adulthood and middle adulthood. The multi-pathway life course model includes three potential mediators of middle adulthood: health risk behaviors, social activity, and negative life events.Results: We found limited support for a direct effect of childhood SES disadvantage on depressive symptoms in middle age. Instead, much of the effects of childhood SES on later-year depressive symptoms appear to be mediated by SES in young adulthood. Further, the long-term pathway is mediated through the influence of health risk behaviors and negative life events in middle adulthood.Conclusion: Our findings do not propose this chain is permanent and irreversible; rather, this study highlights the possibility that interventions focused on promoting health behaviors and improving living conditions for people from socioeconomically disadvantaged backgrounds could help reduce the instance of depression in middle age and health outcomes along the life course could be improved.

Association between functional disability and depressive symptoms among older adults in rural China: a cross-sectional study

Objectives

The aim of this study was to explore the relationship between functional disability and depressive symptoms, focusing on whether an interaction exists between functional disability, demographic characteristics and depressive symptoms among older adults in rural China.

Design

A cross-sectional study using multistage, stratified random sampling.

Setting

Data from 18 villages in Anhui Province of China between January to July 2018.

Participants

3491 Chinese participants aged 60 and over.

Primary and secondary outcome measures

The 30-item Geriatric Depression Scale and WHO Disability Assessment Schedule 2.0 were used to evaluate depressive symptoms and functional disability, respectively. Data were analysed using SPSS statistics V.25.0 program with χ2 test, Mann-Whitney U test, binary logistic regression analysis and classification and regression tree (CART) model.

Results

The prevalence of depressive symptoms in 3336 interviewed older people was 52.94%. After adjustment, subjects who had problems in mobility domain (adjusted OR (AOR) 1.842, 95% CI 1.503 to 2.258), getting along domain (AOR 1.616, 95% CI 1.299 to 2.010), life activities domain (AOR 1.683, 95% CI 1.370 to 2.066) and participation domain (AOR 3.499, 95% CI 2.385 to 4.987) had an increased depressive symptoms risk. However, cognition domain (AOR 0.785, 95% CI 0.647 to 0.953) negatively correlated with depressive symptoms. Additionally, the CART model showed that those who had problems in mobility domain, getting along domain and were unemployed, the possibility of having depressive symptoms was the highest.

Conclusions

More attention should be paid to unemployed older adults, and those with problems in participation, life activities, getting along and mobility and no problems in cognition to maintain a good psychological state.

No associations in preregistered study of youth depression and functional connectivity of fronto-parietal and default mode networks

Adolescence is characterized by vulnerability to the onset of major depressive disorder (MDD). The goal of this preregistered study was to assess neural correlates of depression symptoms in young adolescents, both cross-sectionally and longitudinally. The default mode network (DMN) is believed to support internal attention towards self-referential thoughts, while the fronto-parietal network (FPN) is theorized to support cognitive control and regulation of attention. As MDD diagnosis has been associated with heightened connectivity within DMN regions and diminished connectivity within FPN regions relative to healthy controls, our study builds upon group-difference analyses by using dimensional measures of depression severity. Our preregistered hypotheses were that within-DMN functional connectivity would be positively associated with concurrent depression severity, while within-FPN functional connectivity would be negatively associated with concurrent depression severity. Preregistered analyses also examined between DMN-FPN connectivity as an alternative predictor variable, and assessed the longitudinal associations between all three functional connectivity measures and change in depression severity over three subsequent waves. Multiple regression models tested cross-sectional analyses and hierarchical linear models tested longitudinal analyses. One hundred and twenty-four youth completed a resting state functional MRI. Their depression severity was assessed at the time of the scan and at three follow-up sessions. None of the predictor variables were associated with concurrent depression severity, nor with the slope of depression symptom trajectories in longitudinal analyses. These negative results add to extant cross-sectional studies, and may inform future investigations of brain correlates of depression psychopathology in youth.

Built form and depression among the Chinese rural elderly: a cross-sectional study

OBJECTIVES

Few data on the association between housing structure and depression among rural elders in China are available. We examined the impact of built forms on depression.

DESIGN

This is a cross-sectional study.

SETTING

A representative sample of rural residents aged 60 years or older in China.

PARTICIPANTS

A total of 5090 older adults in 2019 in rural Suzhou, China.

OUTCOME MEASURES

Associations of built form with odds of probable and possible depression.

RESULTS

There was significant difference among elders living in varied sizes of house. Older age (vs 60-64 years: 75-79 years AdjOR, 1.737; 95% CI, 1.309 to 2.305; ≥80 years AdjOR, 2.072; 95% CI, 1.439 to 2.981), male sex (AdjOR, 0.719; 95% CI, 0.593 to 0.871), single (AdjOR, 1.303; 95% CI, 1.032 to 1.646), self-care disability (AdjOR, 4.761; 95% CI, 3.960 to 5.724), three or more chronic diseases (AdjOR, 2.200; 95% CI, 1.657 to 2.920), living alone (AdjOR, 1.443; 95% CI, 1.059 to 1.966), living in cottage (AdjOR, 1.426; 95% CI, 1.033 to 1.967), living space (vs <50 m2: 201-250 m2 AdjOR, 0.566; 95% CI, 0.359 to 0.893; >250 m2 AdjOR, 0.337; 95% CI, 0.223 to 0.511) and space per person (vs <30 m2: 30- m2 AdjOR, 0.502; 95% CI, 0.362 to 0.697; 40- m2 AdjOR, 0.473; 95% CI, 0.347 to 0.646; 50- m2 AdjOR, 0.418; 95% CI, 0.339 to 0.515) were associated with risk of depression among Chinese rural elders.

CONCLUSION

The built form was significantly and meaningfully associated with depression among Chinese rural elders. More attention should be paid to preventing mental illness among the rural elderly living in the small housing area and cottages in China.

Does substance use explain social differences in terms of depression? Findings from the Constances cohort

BACKGROUND

The role of alcohol, tobacco and cannabis use in social differences in terms of depression is poorly understood.

METHOD

We have applied mediation and moderated-mediation models stratified by gender to a population-based sample (N = 37,192) of French men and women from the Constances cohort with baseline and follow-up measures of depressive states. We have examined whether socioeconomic status (SES, measured by education and income) differences in the prevalence of depressive states may be explained by both differences in prevalence of substance use according to SES (mediating effects) and differential effects of substance use on depressive state according to SES (moderating effects).

RESULTS

In the mediation models, substance use only explained 5.3% and 2.4% of the association between low education and depressive state in men and women respectively, and was not a significant mediator for income. Moderated mediation models showed robust moderation effects of education and income in both men and women. The association of tobacco use with depressive symptoms, which was the only substance for which a mediation effect remained and for which the moderation effect of SES was the strongest, was significantly higher in participants with low SES.

LIMITATIONS

The partially cross-sectional nature of the data restricts the possibility of drawing causality with regards to associations between SES and substance use.

CONCLUSION

Targeting substance use, particularly tobacco, can especially reduce depression risk in individuals of low SES.

Relationship of Frailty Markers and Socioeconomic Status to Incidence of Depressive Symptoms in a Community Cohort

OBJECTIVES

This study aimed to examine the relationship between frailty markers and socioeconomic status (SES) to incidence of depressive symptoms using a nationally representative sample of middle-age and older adults.

DESIGN

Cohort study with a 4-year follow-up; 89.1% of the participants were followed for 2 years and 73.4% for 4 years.

SETTING AND PARTICIPANTS

A total of 6641 participants from the China Health and Retirement Longitudinal Study (CHARLS) were included in the analyses.

METHODS

The outcome was incident depressive symptoms. Educational level and occupational status were used to assess SES. Physical frailty status was evaluated using 2 frailty markers, namely weakness and slowness. Two-item questionnaire was used to assess social frailty. Cox regression models were used to examine the relationship between frailty markers and SES to incidence of depressive symptoms, with sociodemographic characteristics, lifestyle information, self-rated health status, medical histories, and depressive symptoms score at baseline adjusted.

RESULTS

Infrequent social activity [hazard ratio (HR) 1.09, 95% confidence interval (CI) 1.00‒1.19], weakness (HR 1.15, 95% CI 1.03‒1.28), and slowness (HR 1.19, 95% CI 1.01‒1.41) were associated with incidence of depressive symptoms. SES was associated with depressive symptoms not only through social frailty (β = 0.01, 95% CI 0.002‒0.011) and physical frailty (β = 0.01, 95% CI 0.001‒0.012) separately but also through social frailty and physical frailty sequentially. Furthermore, the effect of weakness and slowness on depressive symptoms occurred in participants with lower educational level and doing agricultural work, while the effect of infrequent social activity occurred in participants with higher educational level and doing nonagricultural work.

CONCLUSIONS/IMPLICATIONS

SES is associated with depressive symptoms, in which frailty partly mediates the association. The effect of frailty on depressive symptoms varied across SES. Integrated and comprehensive intervention strategies, including assessing socioeconomic circumstances as well as improving frailty, are suggested in prevention of depressive symptoms.

Dietary Restrictions and Depressive Symptoms: Longitudinal Results from the Constances Cohort

Cross-sectional results have suggested a linear association between the number of dietary exclusions and depressive symptoms. This longitudinal study aimed to examine the direction of this association. Methods: In the population-based Constances cohort, depressive symptoms were defined by a score ≥19 on the Centre of Epidemiologic Studies-Depression (CES-D) scale. Diet was measured with a 24-item qualitative food frequency questionnaire (FFQ). Both variables were available at inclusion (from 2012 to 2014) and on follow-up (2015 for the CES-D and 2017 for diet). Food exclusion was categorized into five different groups: No exclusion, exclusion of one, two, three, or ≥4 food groups according to the self-reported number of food groups rarely or never consumed. Logistic regressions were conducted, either taking depressive symptoms as the outcome on follow-up with dietary exclusions at baseline as predictor or with the opposite, adjusting for age, sex, education, income, alcohol intake, smoking, physical activity, and anemia. The path analysis included outcomes and covariates in one model. Results: The median follow-up was three years. A total of 29,337 participants (53.4% women, 48.15 ± 12.9 y.o.) had complete CES-D data and 25,356 (53.56% women, 49.05 ± 12.8 y.o.) FFQ data. Dietary exclusion at inclusion predicted depressive symptoms at follow-up (odds ratio [95% confidence interval]: 2.35 [1.62–3.40] for ≥4 excluded items compared to no exclusions). Depressive symptoms at inclusion predicted dietary exclusions at follow-up (3.45 [1.93–6.16] for ≥4 excluded items). In the path analysis, the standardized estimate of the association between dietary exclusions at inclusion and depressive symptoms at follow-up was by far higher than the opposite (0.1863 and 0.00189, respectively, both p < 0.05). Conclusions: The association of dietary exclusion with subsequent depression is stronger than the opposite association.

Association between Health-Related Physical Fitness and Self-Rated Risk of Depression in Adolescents: Dados Study

Depression is the most common mental disorder, affecting around 5% of adolescents. Physical fitness is considered a powerful marker of physical and mental health. The scientific results on the relationship between physical fitness and depression in the adolescent population are mixed. Therefore, the aim of the current study was to analyse the association between objectively assessed physical fitness and self-rated risk of depression in a group of adolescents. A total of 225 participants (44% girls), aged 13.9 ± 0.3 years, from the Deporte, ADOlescencia y Salud (DADOS) study were included in the analyses. Field-based Assessing Levels of Physical fitness and Health in Adolescents (ALPHA) health-related fitness test battery was used to objectively assess physical fitness components. The Behavior Assessment System for Children (BASC) level 3 was used to evaluate self-rated risk of depression. Our results showed that self-rated risk of depression was inversely associated with cardiorespiratory fitness (β = −0.172), as well as positively associated with body mass index (β = 0.146) and waist circumference (β = 0.137) (all p < 0.05). Adolescents with low levels of cardiorespiratory fitness had significantly higher odds of self-rated risk of depression (OR = 7.17; 95% CI, 1.51–33.95). These findings suggest that health-related physical fitness, particularly cardiorespiratory fitness and body composition, is associated with depression in adolescents.

The relationship between mental disorders and actual and desired subjective social status

AIMS

Mental disorders are associated with lower subjective social status (SSS), but a more nuanced understanding of this relationship is needed. We examined the influence of disorder age of onset and recency on SSS and studied whether mental disorders are also associated with the discrepancy between actual and desired SSS.

METHOD

Data are from the baseline and second wave of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2). Mental disorders were assessed with the Composite International Diagnostic Interview (CIDI 3.0), while both actual and desired SSS were assessed with a ten-rung ladder. Linear regression was used to examine the association between mental disorders and SSS.

RESULTS

Of 5303 participants, 2237 had a lifetime mental disorder at baseline. These participants reported significantly lower actual SSS (6.28) at follow-up than healthy participants (6.66, B = -0.38 [95% CI -0.48 to -0.27], p < 0.001) and a significantly greater actual-desired SSS discrepancy (1.14 v. 1.05 after controlling for actual SSS, B = 0.09 [0.01-0.17], p = 0.024). Lower age of onset of the first mental disorder was marginally significantly associated with lower actual SSS (B = 0.006 [0.000-0.012], p = 0.046). More recent disorders were also associated with lower actual SSS (B = 0.015 [0.005-0.026], p = 0.005), such that participants whose disorder remitted ⩾6 years before baseline were statistically indistinguishable from healthy participants.

CONCLUSIONS

Lifetime mental disorders are associated with lower actual SSS and a slightly greater discrepancy between actual and desired SSS. However, people with mental disorders in (long-term) remission have a similar social status as healthy participants.

Lower socioeconomic status is associated with an increased prevalence of comorbid anxiety and depression among patients with irritable bowel syndrome: results from a multicenter cohort

Background/Aims: Anxiety and depression are common comorbid psychiatric disorders in IBS patients, but the population-level determinants influencing these comorbidities in IBS patients are poorly understood. We sought to determine whether there was an association between comorbid affective disorders and socioeconomic status among irritable bowel syndrome (IBS) patients. Methods: We assembled a retrospective cohort of 1074 IBS patients with comorbid Generalized Anxiety Disorder (GAD) and/or Major Depressive Disorder (MDD) seen at two tertiary referral centers between 2007 and 2015. IBS patients with comorbid GAD and/or MDD were matched 3:1 by age, sex, and race to controls with IBS and no history of comorbid GAD and/or MDD. Socioeconomic status was approximated by patient zip codes. Results: IBS patients in the lowest socioeconomic group were more likely to be diagnosed with GAD and/or MDD compared to controls (OR = 1.38, p = .0004). The median average per capita income for comorbid GAD/MDD IBS patient cohort was also significantly lower than the control IBS patient cohort ($39,880.50 vs. $41,277.00, p = .02). Conclusions: Among IBS patients, the presence of comorbid Generalized Anxiety Disorder and/or Major Depressive Disorder is associated with lower socioeconomic status and lower average per capita income. These findings speak to a biopsychosocial model of illness, which should be considered by clinicians in the care of IBS patients.