Relationship between sedentary behavior and depression: A mediation analysis of influential factors across the lifespan among 42,469 people in low- and middle-income countries

The relationship between sedentary behavior and depression in older adults: A systematic review and meta-analysis

BACKGROUND

The association between sedentary behavior and depression in older adults has been reported in several studies; however, study results on the relationship between the different types of sedentary behavior and depression are not uniform. The purpose of this study was to quantitatively review the association between depression and total sedentary behavior, mentally active sedentary behavior, and passive sedentary behavior.

METHODS

We systematically searched for observational studies on the association between sedentary behavior and depression in older adults using PubMed, Embase, and Web of Science databases. A random effects model was used to combine odds ratios (ORs) and 95 % confidence intervals (CIs). In addition, we performed subgroup and sensitivity analyses to explore potential sources of heterogeneity.

RESULTS

Five longitudinal and 10 cross-sectional studies with a total of 144,161 participants were included in the meta-analysis. The OR of total sedentary behavior associated with depression was 1.49 (95 % CI 1.24-1.79). The combined OR value of mentally active sedentary behavior and depression was 0.82 (95 % CI 0.69-0.97), and no association was found between passive sedentary behavior and the risk of depression.

LIMITATIONS

We were unable to find dose-response relationships between the different types of sedentary behavior and depression because there were too few studies with raw data to analyze.

CONCLUSION

Total sedentary behavior may increase the risk of depression in older adults, whereas mentally active sedentary behavior is associated with a lower risk of depression. Differentiating between the types of sedentary behavior can inform interventions to prevent or ameliorate depression in older adults.

Cognitive Vulnerability to Mood Deterioration in an Exercise Cessation Paradigm

Mood deterioration in response to exercise cessation is well-documented, but moderators of this effect remain unknown. This study tested the hypothesis that physically active individuals with higher levels of cognitive vulnerability (i.e., tendencies towards negative thought content and processes in response to stress or negative mood states) are at greater risk for increased anxiety and depressive symptoms when undergoing exercise cessation. Community adults meeting recommended physical activity guidelines (N=36) participated in a 4-week prospective, longitudinal study with 2 weeks each of maintained exercise and exercise cessation. Cognitive vulnerability measures included dysfunctional attitudes, brooding rumination, and cognitive reactivity (i.e., change in dysfunctional attitudes over a dysphoric mood induction). Anxiety and depression symptoms increased during exercise cessation. Brooding emerged as a risk factor for increases in Tension scores on the Profile of Mood States-Brief during exercise cessation. Future studies should explore brooding as a mediator (i.e., potential mechanism) of exercise-induced mood deterioration.

Mediation of the association between depression and coronary heart disease by metabolic syndrome components

BACKGROUND

Depression is associated with incident coronary heart disease (CHD) via a pathway that may be causal, but the mechanisms underlying this association are unclear. We assessed the extent to which metabolic syndrome (MetS) and its components (i.e., elevated waist circumference, low high-density lipoprotein [HDL] cholesterol, elevated triglycerides, elevated blood pressure, and elevated fasting plasma glucose) may mediate this association.

METHODS

Data were Framingham Heart Study Research Materials obtained from the National Heart, Lung, and Blood Institute (NHLBI) Biologic Specimen and Data Repository Information Coordinating Center. We used Cox proportional hazards regression to estimate adjusted hazard ratios (aHR) representing the total effect (aHRTE) of probable depression, measured via the Centers for Epidemiological Studies - Depression scale, on incident CHD over approximately 18 years. Using inverse odds ratio weighting, we decomposed this estimate into natural direct effects (aHRNDE) and natural indirect effects (aHRNIE) through potential mediators (measured approximately three years after depression).

RESULTS

Probable depression was associated with incident CHD (aHRTE=1.45, 95% confidence interval [CI]: 0.93, 2.25), and elevated waist circumference partially mediated this association (aHRNDE=1.34, 95% CI: 0.76-2.32; aHRNIE=1.08, 95% CI: 0.63-1.91). We did not find evidence of additional mediation by additional MetS components.

CONCLUSIONS

Elevated waist circumference appears to play a role in the association between depression and CHD.

Lessons and Untapped Potential of Smartphone-Based Physical Activity Interventions for Mental Health: Narrative Review

BACKGROUND

Physical activity has well-known and broad health benefits, including antidepressive and anxiolytic effects. However, only approximately half of Americans meet even the minimum exercise recommendations. Individuals with anxiety, depression, or related conditions are even less likely to do so. With the advent of mobile sensors and phones, experts have quickly noted the utility of technology for the enhanced measurement of and intervention for physical activity. In addition to being more accessible than in-person approaches, technology-driven interventions may uniquely engage key mechanisms of behavior change such as self-awareness.

OBJECTIVE

This study aims to provide a narrative overview and specific recommendations for future research on smartphone-based physical activity interventions for psychological disorders or concerns.

METHODS

In this paper, we summarized early efforts to adapt and test smartphone-based or smartphone-supported physical activity interventions for mental health. The included articles described or reported smartphone-delivered or smartphone-supported interventions intended to increase physical activity or reduce sedentary behavior and included an emotional disorder, concern, or symptom as an outcome measure. We attempted to extract details regarding the intervention designs, trial designs, study populations, outcome measures, and inclusion of adaptations specifically for mental health. In taking a narrative lens, we drew attention to the type of work that has been done and used these exemplars to discuss key directions to build on.

RESULTS

To date, most studies have examined mental health outcomes as secondary or exploratory variables largely in the context of managing medical concerns (eg, cancer and diabetes). Few trials have recruited psychiatric populations or explicitly aimed to target psychiatric concerns. Consequently, although there are encouraging signals that smartphone-based physical activity interventions could be feasible, acceptable, and efficacious for individuals with mental illnesses, this remains an underexplored area.

CONCLUSIONS

Promising avenues for tailoring validated smartphone-based interventions include adding psychoeducation (eg, the relationship between depression, physical activity, and inactivity), offering psychosocial treatment in parallel (eg, cognitive restructuring), and adding personalized coaching. To conclude, we offer specific recommendations for future research, treatment development, and implementation in this area, which remains open and promising for flexible, highly scalable support.

Association between tuberculosis and psychotic experiences: Mediating factors and implications for patient care in low- and middle-income countries

Background

Tuberculosis may play a role in the aetiology of psychosis. However, little is known about the association between tuberculosis and psychotic experiences (PEs) or the mediating factors of this association.

Methods

We analysed cross-sectional data from 48 low- and middle-income countries of the World Health Survey (WHS). Tuberculosis assessment was based on past 12-month symptoms of active tuberculosis. We assessed four types of past 12-month PEs with the Composite International Diagnostic Interview. We performed multivariable multinomial logistic regression and mediation analysis.

Results

We analysed data on 224 842 individuals aged ≥18 years (mean age = 38.3 years, standard deviation = 16.0; 50.7% women). Tuberculosis was associated with 1.84 (95% confidence interval (CI) = 1.41-2.40), 2.18 (95%CI = 1.58-3.03), and 3.79 (95%CI = 2.88-4.98) times higher odds for 1, 2, and ≥3 PEs, respectively. The mediation analysis showed that the association between tuberculosis and at least one PE is mainly explained by anxiety (31.5%), sleep/energy (27.8%), and pain/discomfort (23.5%).

Conclusions

Tuberculosis was associated with increased odds of PEs. Factors such as affect, sleep, and pain should be considered in tuberculosis patients to target those who might be particularly vulnerable to PEs, and consequently, to psychotic disorders and other adverse effects of PE.

Factors That Influence Meeting the Recommended Weekly Physical Activity Target Among Older People With Physical Multimorbidity: Evidence From 6 Low- and Middle-Income Countries

BACKGROUND

There is a scarcity of studies on the association between physical multimorbidity and lower levels of physical activity among older adults from low- and middle-income countries, while the potential mediating variables in this association are largely unknown.

METHODS

Cross-sectional, community-based, nationally representative data from the World Health Organization Study on global AGEing and adult health were analyzed. Data on 11 chronic physical conditions were collected. Scoring <150 minutes of moderate- to high-intensity physical activity per week was considered low physical activity. Multivariable logistic regression and mediation analysis were done to assess associations and quality of life measures which might influence these associations.

RESULTS

Data on 14,585 people aged ≥65 years were analyzed (mean [SD] age 72.6 (11.5) y, maximum age 114 y; 55.0% women). After adjustment for potential confounders, compared with no chronic conditions, ≥3 conditions were associated with a significant 1.59 to 2.42 times higher odds for low physical activity. Finally, mobility mediated the largest proportion of the association between ≥3 chronic physical conditions and low physical activity (mediated percentage 50.7%), followed by activities of daily living disability (30.7%), cognition (24.0%), affect (23.6%), and pain/discomfort (22.0%).

CONCLUSIONS

Physical multimorbidity was associated with higher odds for low physical activity among older adults residing in low- and middle-income countries. Mobility, disability, cognition, affect, and pain/discomfort explained the largest proportion of this association. Given the universal benefits of regular and sustained participation in physical activity, it would be prudent to implement interventions among older people with physical multimorbidity to increase levels of physical activity. Future studies should assess the impact of addressing the identified potential mediators among people with multimorbidity on physical activity levels.

Prevalence and factors associated with depression and anxiety among older adults: A large-scale cross-sectional study in China

BACKGROUND

To determine the prevalence of depression and anxiety among older adults in China, and explore the associated factors.

METHODS

This cross-sectional study recruited participants between October 2022 and December 2022. The sample collection utilized a multi-stage stratified equal probability random sampling method. This study included 8436 older adults who underwent interviews utilizing standardized assessment instruments. The assessment of depressive symptoms employed the Patient Health Questionnaire 9, while the evaluation of anxiety utilized the Generalized Anxiety Disorder 7. Multivariate logistic regression was conducted to determine the odds ratio and 95 % confidence interval (CI).

RESULTS

The weighted prevalence rates for depression and anxiety were 2.79 % (95 % CI: 2.38 %-3.28 %) and 1.39 % (95 % CI: 1.12 %-1.74 %), respectively. Older adults who were female, widowed, had irregular dietary habits, spent <1 h per day using electronic devices for socializing and entertainment, engaged in >8 h of sedentary behavior per day, and had chronic diseases (cardiovascular disease, cerebrovascular disease, insomnia, and Chronic gastroenteritis) displayed a higher likelihood of encountering symptoms indicative of depression and anxiety. Conversely, older adults living in rural areas and those who walked daily were less prone to experience symptoms of depression and anxiety.

CONCLUSIONS

This study suggests that the psychological well-being of older adults should be cared for when treating chronic diseases. Moreover, families, communities, and clinics should recognize that supporting regular diets, providing social engagement and recreational activities, encouraging physical activity, and minimizing sedentary behavior can reduce the risk of depression and anxiety.

A qualitative study of perceived barriers and facilitators to interrupting sedentary behavior among adults living with obesity

Introduction

Both obesity and sedentary behavior (SB) are associated with negative health consequences including cardiovascular disease, diabetes, certain cancers and all-cause mortality. To date, perceived barriers and facilitators to interrupting SB in adults living with obesity have not been identified.

Objective

This study aimed to identify these perceived barriers and facilitators by conducting a behavioral analysis underpinned by the theoretical domains framework (TDF) and the Capability, Opportunity, Motivation-Behavior (COM-B) model to enhance knowledge and inform future intervention development.

Methods

A purposive and snowball sample (N = 21) of adults living with obesity took part in semi-structured interviews, guided by the TDF, to investigate perceived barriers or facilitators to interrupt SB. Transcribed interviews were inductively coded using reflexive thematic analysis. Key themes and subthemes were generated by grouping similar and recurring codes. Finally, subthemes were mapped to the TDF and COM-B.

Results

Five key themes were identified, which influence SB across all domains of living. These relate to (i) physical and mental wellbeing; (ii) motivational readiness; (iii) roles, responsibilities and support; (iv) weight bias and stigma; and (v) the environment. These themes were then deductively mapped to all 14 TDF domains and all six of the COM-B constructs.

Conclusion

A complex interplay of individual, societal and policy factors contributes to the development and habituation of SB patterns in adults living with obesity. Factors identified in this study could assist in the development of interventions, strategies and policies designed to interrupt or reduce sedentary behavior in this population.

The global burden of cardiovascular diseases and type 2 diabetes attributable to low physical activity, 1990-2019: an analysis from the global burden of disease study

Background

Cardiovascular diseases (CVD) and type 2 diabetes (T2D) account for the majority of the burden of noncommunicable disease caused by low physical activity (LPA). In order to inform future interventions, this study aims to assess the burden and trends in mortality and disability-adjusted life years (DALYs) of CVD and T2D attributable to LPA by year, location, sex, and age from 1990 to 2019.

Methods

Mortality, DALYs, and their age-standardised rates (ASMR, ASDR) for CVD and T2D attributable to LPA were retrieved from Global Burden of Disease (GBD) 2019. The estimated annual percentage changes (EAPCs) were calculated using linear regression model to describe the trend over time.

Results

From 1990 to 2019, the number of deaths caused by both CVD and T2D due to LPA increased significantly globally. However, the overall ASMR and ASDR for CVD declined over this same period [EAPC for ASMR (CVD) = -1.44 (95% CI: -1.50-1.38), EAPC for ASDR (CVD) = -1.30 (95% CI: -1.35 to -1.25)]. In terms of disparities, ASMR (CVD) and ASDR (CVD) in North Africa and the Middle East were consistently higher than the global average; also, the sex difference in ASMR was greatest in Central Asia. ASMR among people aged 25-44 in high Socio-Demographic Index (SDI) region has increased significantly over the past three decades. ASMR (T2D) due to LPA showed an increasing trend year by year, with EAPC = 0.26 (95% CI: 0.13-0.39), and this rate increased faster in males than in females. Consistent with cardiovascular diseases, ASMR of type 2 diabetes attributable to LPA increased among people aged 25-44, while decreased in other age groups in high SDI region.

Conclusion

Interventions targeting LPA are warranted in controlling the burden of cardiovascular diseases and type 2 diabetes. Countries should adapt strategies to their local contexts, considering the sex and age differences among their populations. The 25-44 age group should be given special attention to prevent the disease burden from worsening among younger people.

The association between screen time and depression symptoms severity among adults with diabetes: A cross-sectional study

OBJECTIVE

To investigate the association between time spent on screen-based sedentary behavior (SBSB) and depression symptom severity (DSS) among adults with type 2 diabetes.

METHODS

A cross-sectional study employing secondary data collected by Qatar Biobank (QBB) on 2386 adults with type 2 diabetes aged ≥ 18 years. Self-reported data on DSS measured using the Patient Health Quationnaire-9 and daily time spent on SBSB per week was used.

RESULTS

After adjusting for covariates, including physical activity and sleep duration, subjects who spent 2-4 h or > 4 h a day on SBSB watching TV or other devices other than computers during weekdays had increased odds of higher DSS than subjects who spent < 1 h by 44% (95% Confidence interval (CI) 13-83%) and 52% (95% CI 17-96%), respectively. Subjects who spent > 4 h a day on SBSB using computers during weekdays had increased odds of higher DSS by 115% (95% CI 56-196%) than subjects who spent < 1 h. Similar associations were observed between time spent on SBSB using the mentioned devices during weekends and DSS.

CONCLUSION

Increase in time spent on SBSB is independently associated with increased DSS among adults with type 2 diabetes regardless of the equipment used or timing of the week.

Food insecurity and subjective cognitive complaints among adults aged ≥ 65 years from low- and middle-income countries

PURPOSE

To date, no study has investigated the association between food insecurity and subjective cognitive complaints (SCC). Thus, the aims of the present study were to examine this association among older adults in low- and middle-income countries (LMICs), and to identify the potential mediators in this association, given the importance of SCC in dementia risk among older people, and the projected particularly large increase in dementia in this setting.

METHODS

Cross-sectional, community-based, nationally representative data from the World Health Organization (WHO) Study on global AGEing and Adult Health (SAGE) collected between 2007 and 2010 were analyzed. Two questions on subjective memory and learning complaints in the past 30 days were used to create a SCC scale ranging from 0 (No SCC) to 100 (worse SCC). Past 12 month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable linear regression and mediation (Karlson-Holm-Breen method) analyses were conducted to assess associations.

RESULTS

Data on 14,585 individuals aged ≥ 65 years [mean (SD) age 72.6 (11.5) years; 55.0% females] were analyzed. Severe food insecurity (vs. no food insecurity) was associated with 9.16 (95% CI = 6.95-11.37) points higher mean SCC score. Sleep/energy (mediated% 37.9%; P < 0.001), perceived stress (37.2%; P = 0.001), and depression (13.7%; P = 0.008) partially explained the association between severe food insecurity and SCC.

CONCLUSION

Food insecurity was associated with SCC among older adults in LMICs. Future studies should assess whether addressing food insecurity among older adults in LMICs can improve cognitive health.

Combined effect of left ventricular ejection fraction and obesity on sedentary behavior in patients with coronary artery disease

Sedentary behavior has been associated with poor adherence to treatment in patients with coronary artery disease. Low left ventricular ejection fraction and obesity have been separately linked to increased sedentary behavior in patients with coronary artery disease. However, the combined effect of low left ventricular ejection fraction and obesity on sedentary behavior in patients with coronary artery disease has not been thoroughly investigated. Therefore, this study aimed to examine the combined influence of left ventricular ejection fraction and obesity on sedentary behavior in patients with coronary artery disease. This descriptive cross-sectional study enrolled 200 inpatients aged ≥ 20 years who were diagnosed with coronary artery disease at a tertiary hospital in Korea between March and August 2022. Data were collected using structured questionnaires, and multivariate logistic regression analysis was performed to determine the combined effect of left ventricular ejection fraction and obesity on sedentary behavior in patients with coronary artery disease. Among the 111 patients with sedentary behavior, 38 (34.2%) had both low left ventricular ejection fraction and obesity, whereas only 11 (12.4%) of the 89 patients without sedentary behavior had both low left ventricular ejection fraction and obesity. In multivariate logistic regression analysis, patients with coronary artery disease who had both low left ventricular ejection fraction and obesity had the highest risk of sedentary behavior compared to those without either low left ventricular ejection fraction or obesity (odds ratio = 13.98, 95% confidence interval = 5.19-37.69, P < .001). The co-existence of low left ventricular ejection fraction and obesity in patients with coronary artery disease may be associated with sedentary behavior. Therefore, evaluating both left ventricular ejection fraction and obesity when assessing sedentary behavior in patients with coronary artery disease may be valuable in implementing patient-centered approaches for the secondary prevention and management of sedentary behavior in patients with coronary artery disease. However, further prospective cohort studies with larger sample sizes are required to establish causal relationships and explore interventions to mitigate sedentary behavior in this population.

Association Between Pain and Sarcopenia Among Adults Aged ≥65 Years from Low- and Middle-Income Countries

BACKGROUND

Pain may increase the risk for sarcopenia, but existing literature is only from high-income countries, while the mediators of this association are largely unknown. Thus, we aimed to investigate the association between pain and sarcopenia using nationally representative samples of older adults from 6 low- and middle-income countries (LMICs), and to identify potential mediators.

METHODS

Cross-sectional data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Sarcopenia was defined as having low skeletal muscle mass and weak handgrip strength, while the presence and severity of pain in the last 30 days were self-reported. Multivariable logistic regression and mediation analyses were performed. The control variables included age, sex, education, wealth, and chronic conditions, while affect, sleep/energy, disability, social participation, sedentary behavior, and mobility were considered potential mediators.

RESULTS

Data on 14,585 adults aged ≥65 years were analyzed (mean [SD] age 72.6 [11.5] years; 55.0% females). Compared to no pain, mild, moderate, severe, and extreme pain were associated with 1.42 (95% confidence interval [CI] = 1.05-1.94), 1.43 (95%CI = 1.02-2.00), 1.92 (95%CI = 1.09-3.37), and 2.88 (95%CI = 1.10-7.54) times higher odds for sarcopenia, respectively. Disability (mediated percentage 18.0%), sedentary behavior (12.9%), and low mobility (56.1%) were significant mediators in the association between increasing levels of pain and sarcopenia.

CONCLUSIONS

Higher levels of pain were associated with higher odds for sarcopenia among adults aged ≥65 years in 6 LMICs. Disability, sedentary behavior, and mobility problems were identified as potential mediators. Targeting these factors in people with pain may decrease the future risk of sarcopenia onset, pending future longitudinal research.

Pain and mild cognitive impairment among adults aged 50 years and above residing in low- and middle-income countries

BACKGROUND

Previous studies on the association between pain and cognitive decline or impairment have yielded mixed results, while studies from low- and middle-income countries (LMICs) or specifically on mild cognitive impairment (MCI) are scarce. Thus, we investigated the association between pain and MCI in LMICs and quantified the extent to which perceived stress, sleep/energy problems, and mobility limitations explain the pain/MCI relationship.

METHODS

Data analysis of cross-sectional data from six LMICs from the Study on Global Ageing and Adult Health (SAGE) were performed. MCI was based on the National Institute on Aging-Alzheimer's Association criteria. "Overall in the last 30 days, how much of bodily aches or pain did you have?" was the question utilized to assess pain. Associations were examined by multivariable logistic regression analysis and meta-analysis.

RESULTS

Data on 32,715 individuals aged 50 years and over were analysed [mean (SD) age 62.1 (15.6) years; 51.7% females]. In the overall sample, compared to no pain, mild, moderate, and severe/extreme pain were dose-dependently associated with 1.36 (95% CI = 1.18-1.55), 2.15 (95% CI = 1.77-2.62), and 3.01 (95% CI = 2.36-3.85) times higher odds for MCI, respectively. Mediation analysis showed that perceived stress, sleep/energy problems, and mobility limitations explained 10.4%, 30.6%, and 51.5% of the association between severe/extreme pain and MCI.

CONCLUSIONS

Among middle-aged to older adults from six LMICs, pain was associated with MCI dose-dependently, and sleep problems and mobility limitations were identified as potential mediators. These findings raise the possibility of pain as a modifiable risk factor for developing MCI.

Physical multimorbidity, suicidal ideation, and suicide attempts among adults aged ≥50 years from low- and middle-income countries

OBJECTIVES

The association between physical multimorbidity and suicidal ideation or suicide attempts among older adults from low- and middle-income countries (LMICs) is largely unknown. We aimed to assess this association as well as its mediators using nationally representative data from six LMICs.

METHODS

Cross-sectional, community-based data from the Study on Global Aging and Adult Health were analyzed. A total of 11 chronic physical conditions were assessed. Self-reported information on past 12-month suicidal ideation and suicide attempts was also collected. Multivariable logistic regression and mediation analyses were conducted.

RESULTS

The final sample consisted of 34,129 adults aged ≥50 years (mean [SD] age 62.4 (16.0) years; maximum age 114 years; 52.1% females). In the overall sample, physical multimorbidity was associated with increased odds for suicidal ideation (OR = 2.99; 95% CI = 2.06-4.34) and suicide attempts (OR = 2.79; 95% CI = 1.58-4.95), with the association being stronger in males than females. The association between multimorbidity and suicidal ideation or suicide attempts was largely mediated by pain/discomfort (mediated% 33.3%-44.2%), sleep/energy (28.2%-33.8%), and mobility limitations (26.6%-34.8%).

CONCLUSIONS

Physical multimorbidity among older adults in LMICs was associated with a substantially increased risk for suicidal ideation and suicide attempts. Addressing the identified mediators in people with physical multimorbidity may aid in the prevention of suicidal ideation and suicide attempts.

Biopsychosocial Response to the COVID-19 Lockdown in People with Major Depressive Disorder and Multiple Sclerosis

BACKGROUND

Changes in lifestyle, finances and work status during COVID-19 lockdowns may have led to biopsychosocial changes in people with pre-existing vulnerabilities such as Major Depressive Disorders (MDDs) and Multiple Sclerosis (MS).

METHODS

Data were collected as a part of the RADAR-CNS (Remote Assessment of Disease and Relapse-Central Nervous System) program. We analyzed the following data from long-term participants in a decentralized multinational study: symptoms of depression, heart rate (HR) during the day and night; social activity; sedentary state, steps and physical activity of varying intensity. Linear mixed-effects regression analyses with repeated measures were fitted to assess the changes among three time periods (pre, during and post-lockdown) across the groups, adjusting for depression severity before the pandemic and gender.

RESULTS

Participants with MDDs (N = 255) and MS (N = 214) were included in the analyses. Overall, depressive symptoms remained stable across the three periods in both groups. A lower mean HR and HR variation were observed between pre and during lockdown during the day for MDDs and during the night for MS. HR variation during rest periods also decreased between pre- and post-lockdown in both clinical conditions. We observed a reduction in physical activity for MDDs and MS upon the introduction of lockdowns. The group with MDDs exhibited a net increase in social interaction via social network apps over the three periods.

CONCLUSIONS

Behavioral responses to the lockdown measured by social activity, physical activity and HR may reflect changes in stress in people with MDDs and MS. Remote technology monitoring might promptly activate an early warning of physical and social alterations in these stressful situations. Future studies must explore how stress does or does not impact depression severity.

Combined influence of sedentary behaviours and chronic pain on depressive symptoms in older Korean adults with hypertension

AIMS

Depressive symptoms in hypertensive patients are linked to poor adherence to treatment. Sedentary behaviours and chronic pain can increase blood pressure and depressive symptoms, respectively. However, the impact of their coexistence on depressive symptoms in older adults with hypertension has not yet been investigated. This study aimed to identify the combined influence of sedentary behaviours and chronic pain on depressive symptoms in older adults with hypertension in Korea.

METHODS AND RESULTS

This cross-sectional study used data from the sixth Korea National Health and Nutrition Examination Survey from January to December 2014. The survey adopted multistage stratified sampling by geographical region, gender, and age. For the data analysis, a total of 573 patients with hypertension aged 65 years or older were included. Approximately, 61.0% of depressed older patients had both sedentary behaviours and chronic pain compared with patients without depressive symptoms. In multivariate logistic regression analysis, compared with patients without either sedentary behaviours or chronic pain, older adults with hypertension who presented both sedentary behaviours, and chronic pain had the highest risk of depressive symptoms (odds ratio = 13.86, 95% confidence interval = 5.87-32.71; P < 0.001).

CONCLUSION

Coexistence of sedentary behaviours and chronic pain in older hypertensive patients may lead to depressive symptoms. Evaluating both sedentary behaviours and chronic pain when assessing depressive symptoms in patients with hypertension would be beneficial in planning a patient-centred approach for controlling blood pressure. More prospective cohort studies with larger samples are required to identify the causal relationships.

Poor Agreement between Responses to the International Physical Activity Questionnaire and Objective ActiGraph® Data among Persons with Major Depressive or Bipolar Disorders

The purpose of this research was to investigate the degree of agreement between data from the International Physical Activity Questionnaire-Short Form (IPAQ) and accelerometer (ActiGraph^®) readings for physical activity (PA), classified as moderate, vigorous, and moderate-vigorous PA, and sedentary behavior (SB) in participants with major depressive or bipolar disorder. Following a cross-sectional observational design (n = 30), participants used an accelerometer for 4 to 7 days (minimum of 10 h per day) and answered the IPAQ (for the same period as accelerometer use). Our results suggest significant differences (p < 0.05) when comparing the ActiGraph^® and IPAQ data: for moderate PA, 155 min vs. 25 min per week; for moderate-vigorous PA, 157 min vs. 50 min per week; and for SB, 8 h vs. 3 h per day. Spearman's correlation coefficients (ActiGraph^® and IPAQ) were low for moderate PA, vigorous PA, and moderate-vigorous PA (rho = 0.03 to 0.13). The Bland-Altman plot showed a bias of -75 min for moderate PA, 9 min for vigorous PA, -66 min for moderate-vigorous PA, and -5 h for SB. Considering the differences observed and the objectivity of the ActiGraph^® measurements, whenever possible, we recommend ActiGraph^® measurements of PA and SB for these clinical groups.

Predictors of non-stepping time in people with chronic stroke

BACKGROUND

Sedentary time is an independent construct from active time. Previous studies have examined variables associated with sedentary time to inform behavior change programs; however, these studies have lacked data sets that encompass potentially important domains.

OBJECTIVES

The purpose of this study was to build a more comprehensive model containing previously theorized important predictors of sedentary time and new predictors that have not been explored. We hypothesized that variables representing the domains of physical capacity, psychosocial, physical health, cognition, and environmental would be significantly related to sedentary time in individuals post-stroke.

METHODS

This was a cross-sectional analysis of 280 individuals with chronic stroke. An activity monitor was used to measure sedentary (i.e. non-stepping) time. Five domains (8 predictors) were entered into a sequential linear regression model: physical capacity (6-Minute Walk Test, assistive device use), psychosocial (Activities Specific Balance Confidence Scale and Patient Health Questionnaire-9), physical health (Charlson Comorbidity Index and body mass index), cognition (Montreal Cognitive Assessment), and environmental (Area Deprivation Index).

RESULTS

The 6-Minute Walk Test (β = -0.39, p < .001), assistive device use (β = 0.15, p = .03), Patient Health Questionnaire-9 (β = 0.16, p = .01), and body mass index (β = 0.11, p = .04) were significantly related to non-stepping time in individuals with chronic stroke. The model explained 28.5% of the variability in non-stepping time.

CONCLUSIONS

This work provides new perspective on which variables may need to be addressed in programs targeting sedentary time in stroke. Such programs should consider physical capacity, depressive symptoms, and physical health.

Exercise intensity and energy expenditure of a multicomponent home-based training program: Xiangya hospital circuit training (X-CircuiT)

Introduction

Our previous studies showed that Xiangya Hospital Circuit Training (X-CircuiT) effectively improved physical fitness and reversed pre-frailty in community-dwelling older adults. This study aimed to explore the generalizability and applicability of X-CircuiT in different aged populations in the context of exercise intensity and energy expenditure.

Methods

We prospectively recruited 72 community-dwelling sedentary adults, twelve adults divided into 6 age groups ranging from 20 to 80 years old and separated by decades. Cardiopulmonary exercise testing was performed to determine peak heart rate (HR_peak). An individual HR-oxygen consumption regression equation was fit for each participant, and then a session of remote heart rate monitored X-CircuiT was performed. Exercise intensity (%HR_peak) and energy expenditure of X-CircuiT among the six age groups were assessed. Further sub-analysis was conducted by dividing the participants by peak metabolic equivalent (MET) values, <5 METs, 5–7 METs, and more than 7METs to explore the relationship between maximum exercise capacity and exercise intensity of X-CircuiT.

Results

The average %HR_peak of X-CircuiT for subjects in the 20–29, 30–39, 40–49, 50–59, 60–69, and 70–80 age groups were 54 ± 6, 59 ± 8, 60 ± 8, 62 ± 5, 66 ± 10, and 67 ± 13, respectively (p = 0.008); and the average energy expenditure was 121.9 ± 26.5, 123.3 ± 33.8, 129.2 ± 40.9, 130.9 ± 31.8, 146.8 ± 29.0, and 125.0 ± 28.4 kcal, respectively. The average %HR_peak for the warm-up, aerobic, acupoint patting, resistance, and stretching stages in overall subjects was 61 ± 9, 70 ± 10, 70 ± 10, 63 ± 9, and 57 ± 9, respectively. Furthermore, when subjects were divided by peak METs, it was found that the lower the peak METs, the greater the value of the relative exercise intensity indicators. The aerobic and acupoint stages of X-CircuiT could illicit a response of high intensity for those with peak METs <5, moderate intensity in those with peak METs of 5–7, and low-intensity for those with peak METs of more than 7.

Conclusion

Xiangya Hospital Circuit Training followed the principle of low-intensity warm-up and medium-intensity training with multicomponent exercise training. It is classified as a moderate-intensity exercise for sedentary middle-aged and older adults, or those with a maximum exercise capacity of 5–7 METs, and is classified as a low-intensity exercise for young people.

Vascular-Metabolic Risk Factors and Psychological Stress in Patients with Chronic Tinnitus

Little is known about molecular correlates of chronic tinnitus. We examined interrelationships between vascular−metabolic risk factors, perceived stress, and other routine blood values in patients with chronic tinnitus. Two-hundred patients (51% female) were screened for 49 blood parameters pertaining to vascular−metabolic risk, immune function, and redox processes. They further completed perceived stress- and tinnitus-related distress questionnaires. Following descriptive analyses, gender-specific sets of age- and tinnitus-severity-adjusted regression models investigated associations between perceived stress and blood parameters. Patients reported mildly elevated levels of perceived stress. Elevated levels of total cholesterol (65% and 61% of female and male patients, respectively), non-HDL-c (43/50%), LDL-c (56/59%), and lipoprotein_a (28/14%) were accompanied by high rates of overweight (99/100%) and smoking (28/31%). A low-level inflammatory state was accompanied by reduced reactive oxygen species (ROS)-neutralizing capacity (reduced co-enzyme Q10 and SOD1 levels). Most vascular risk factors were not correlated with perceived stress, except for fibrinogen (ß = −0.34) as well as C-reactive protein (ß = −0.31, p < 0.05) in men, and MCV (ß = −0.26, p < 0.05) in women. Interrelations between blood parameters and stress levels need to be investigated within psychobehavioural frameworks across varying distress levels. Alongside psychological interventions, a low-level inflammatory state may be a route for pharmacological therapeutics.

Melatonin and melatonin-agonists for metabolic syndrome components in patients treated with antipsychotics: A systematic review and meta-analysis

OBJECTIVE

Metabolic side effects are a limiting factor in the use of antipsychotics, which remain the cornerstone of long-term management of patients with severe mental illness. There is contrasting evidence on a possible role of melatonin and melatonin-agonists in attenuating antipsychotic-induced metabolic abnormalities.

DESIGN

We conducted a systematic review (PubMed, PsycInfo, Cochrane databases, up to August 2020) and a random-effect meta-analysis of double-blind, randomized placebo-controlled trials (RCTs) involving melatonin and melatonin-agonists in the treatment of antipsychotic-induced metabolic changes. The primary outcome was the standardized mean difference (SMD) of composite metabolic outcomes built with metabolic syndrome components. Secondary outcomes were individual metabolic syndrome components, and other anthropometric, glucose metabolism, lipid profile, and psychopathology measures.

RESULTS

Out of the initial 41 studies, six documented five separate RCTs randomizing 248 patients (126 to melatonin/ramelteon, 122 to placebo) affected by schizophrenia-spectrum disorders and bipolar disorder. Melatonin/ramelteon outperformed placebo on the primary outcome (SMD -0.28, 95% CI = -0.39 ÷ -0.168), as well as on all individual components of metabolic syndrome (systolic blood pressure MD -3.266, 95% CI = -6.020 ÷ -0.511; fasting glucose MD -3.766, 95% CI = -5.938 ÷ -1.593; triglycerides MD -9.800, 95% CI = -19.431 ÷ -0.169; HDL MD 2.995, 95% CI = 0.567 ÷ 5.423), except waist circumference.

CONCLUSIONS

Melatonin/ramelteon augmentation may be beneficial for non-anthropometric metabolic syndrome components in patients treated with antipsychotics.

Associations between sedentary behaviour patterns and depression among people aged 60 and older in Hebei Province of China

BACKGROUND

Sedentary behaviours (SBs) are now considered a risk factor for depression. Older adults are sedentary most of the time and are at a high risk of depression. However, not all types of SBs have adverse effects on mental health. Passive SBs (such as watching TV) increase the risk of depression, whereas mentally active SBs (such as using the internet and reading) decrease the risk of depression. The aim of this study was to explore the associations between type of SBs (i.e., passive and mentally active SBs) and depression among people aged 60 years and older in the Hebei Province of China.

METHODS

This cross-sectional study used data from the baseline survey of the Community-based Cohort Study on Nervous System Diseases. A total of 2679 older adults aged ≥60 years from the Hebei Province of China were included in this study. The type and time spent on SBs were self-reported. Watching TV was defined as a passive SB, whereas internet use, reading, and social SBs (including communicating with others and playing chess) were defined as mentally active SBs. Depression was evaluated using the Geriatric Depression Scale. The maximal possible score was 30 points, and ≥ 11 points indicated depression. Logistic regression analysis was used to assess the relationship between SBs and depression. Covariates included sex, age, education, employment, smoking, alcohol consumption, sleep duration, domestic work, physical exercise, body mass index (BMI), and chronic diseases.

RESULTS

At baseline, the participants who spent two or more hours and 0 h on passive SBs (i.e., TV viewing) had a greater risk of depression (=0 h: adjusted OR = 2.09, 95% CI = 1.18-3.76; 2-3 h: OR = 2.21, 95% CI = 1.16-4.16; > 3 h: OR = 3.59, 95% CI = 1.93-6.68) than the participants who spent 1-2 h on passive SBs. The participants who spent > 1 h on mentally active SBs had a lower risk of depression (adjusted OR = 0.26, 95% CI = 0.06-0.71) than the participants who did not engage in mentally active SBs. Not all mentally active SBs were linked to depression. The participants who engaged in social SBs had a lower risk of depression (adjusted OR: 0.24, 95% CI: 0.06-0.66) than the participants who did not engage in social SBs.

CONCLUSIONS

Spending 2 h or more per day on passive SBs (watching TV) was associated with a high risk of depression among people aged 60 years and older in the Hebei Province of China. Mentally active SBs (predominantly social SBs) could reduce the risk of depression. Some participants with depression probably did not watch TV. These findings suggested that spending more time on social SBs (such as communicating with others and playing chess) rather than watching TV may have important public health implications for preventing and managing depression among older Chinese adults. Moreover, society should attend to the mental health of elderly adults who do not watch TV as they may be more prone to suffer from depressive symptoms.

Depressive Symptoms Associated With Musculoskeletal Pain in Inactive Adults During COVID-19 Quarantine

BACKGROUND

Depression has been associated with episodes of musculoskeletal pain. However, it is not clear whether such relationships could be mitigated according to the physical activity level.

AIM

To describe, during the COVID-19 pandemic, the relationship between depression and musculoskeletal pain according to the physical activity levels.

DESIGN

Cross-sectional study.

METHODS

This research was conducted in Brazil between May 5 and March 17, 2020. Participants (N = 1872; 58% women) were invited through social media to answer a structured online questionnaire. Depressive symptoms were assessed through self-report of perception of depression during quarantine. Musculoskeletal pain was assessed based on the Nordic questionnaire identifying nine possible pain points in the body. Physical activity was assessed based on the weekly frequency, intensity, and duration of each session of physical activity the participants engaged in during COVID-19. The logistic binary regression analyzed the associations between depressive symptoms and musculoskeletal pain according to the participants' level of physical activity.

RESULTS

Depressive symptoms were associated with pain in six different regions of the body in physically inactive participants. In physically inactive participants, those with depressive symptoms 1.51 (95% CI = 1.04-2.19) and 2.78 (95% CI = 1.81-4.26) times more likely to have pain in one or two and ≥three regions body regions, respectively. In active participants, depressive symptoms were not associated with pain.

CONCLUSION

During the COVID-19 pandemic, depression was associated with musculoskeletal pain in physically inactive participants.

Psychotic experiences among informal caregivers: findings from 48 low- and middle-income countries

PURPOSE

Informal caregivers may be at high risk for psychotic experiences (PE) due to caregiving related stress, sleep issues, or other potential mechanisms, but this has not been previously investigated in the general adult population. Thus, we examined the association between caregiving and PE, and its mediators, in a large sample of adults from 48 low- and middle-income countries (LMICs).

METHODS

Cross-sectional, community-based data from the World Health Organization (WHO) World Health Survey were analyzed. Informal caregivers referred to those who provided help to a relative or friend (adult or child) in the past year, because this person has a long-term physical or mental illness or disability, or is getting old and weak. PE were assessed using the WHO Composite International Diagnostic Interview psychosis screen. Multivariable logistic regression and mediation analyses were conducted.

RESULTS

Data on 224,842 individuals were analyzed. The mean (SD) age was 38.3 (16.0) years (range 18-120 years) and 50.7% were females. After adjustment for age, sex, and country, in the overall sample, caregiving was associated with 1.67 (95%CI = 1.56-1.79) times higher odds for PE. Sleep/energy explained the largest proportion of the association between caregiving and PE (13.9%), followed by pain/discomfort (11.5%), perceived stress (7.6%), depression (6.2%), and cognition (3.5%).

CONCLUSION

Caregivers in LMICs are at higher risk of PE. Future studies are warranted to gain a further understanding of the underlying mechanisms, and to assess whether addressing the identified mediators can lead to lower risk for PE among caregivers.

Trajectories of common mental disorders symptoms before and during the COVID-19 pandemic: findings from the ELSA-Brasil COVID-19 Mental Health Cohort

AIM

Evidence indicates most people were resilient to the impact of the COVID-19 pandemic on mental health. However, evidence also suggests the pandemic effect on mental health may be heterogeneous. Therefore, we aimed to identify groups of trajectories of common mental disorders' (CMD) symptoms assessed before (2017-19) and during the COVID-19 pandemic (2020-2021), and to investigate predictors of trajectories.

METHODS

We assessed 2,705 participants of the ELSA-Brasil COVID-19 Mental Health Cohort study who reported Clinical Interview Scheduled-Revised (CIS-R) data in 2017-19 and Depression Anxiety Stress Scale-21 (DASS-21) data in May-July 2020, July-September 2020, October-December 2020, and April-June 2021. We used an equi-percentile approach to link the CIS-R total score in 2017-19 with the DASS-21 total score. Group-based trajectory modeling was used to identify CMD trajectories and adjusted multinomial logistic regression was used to investigate predictors of trajectories.

RESULTS

Six groups of CMD symptoms trajectories were identified: low symptoms (17.6%), low-decreasing symptoms (13.7%), low-increasing symptoms (23.9%), moderate-decreasing symptoms (16.8%), low-increasing symptoms (23.3%), severe-decreasing symptoms (4.7%). The severe-decreasing trajectory was characterized by age < 60 years, female sex, low family income, sedentary behavior, previous mental disorders, and the experience of adverse events in life.

LIMITATIONS

Pre-pandemic characteristics were associated with lack of response to assessments. Our occupational cohort sample is not representative.

CONCLUSION

More than half of the sample presented low levels of CMD symptoms. Predictors of trajectories could be used to detect individuals at-risk for presenting CMD symptoms in the context of global adverse events.

Depression Among Patients with Chronic Pain, in Jimma Town Public Hospitals, Ethiopia

Introduction

The co-occurrence of depression and chronic pain causes additive adverse effects on patients” outcomes, response to treatment, and poorer functioning. Despite this, there is a dearth of studies in developing countries. Therefore, this study aimed to provide a new insight into the understanding of the prevalence and associated factors between chronic pain and depression among patients with chronic pain in Jimma town public hospitals.

Methods

Institution-based cross-sectional study was conducted in Jimma town public hospitals. A total of 422 sampled patients with chronic pain participated in the study. Depression was assessed using the PHQ-9 scale. The coded data were entered to Epi Data version 3.1 and exported into SPSS version 23.0 for analysis. Logistic regression analysis model was used to identify factors independently associated with depression.

Result

The prevalence of depression among chronic pain patients was found to be 43.3%. The number of presenting compliant (AOR = 3.092, 95% CI: 1.684-5.678), history of depression (AOR = 0.319, CI: 0.133-0.766), pain intensity (AOR = 5.296, 95% CI: 2.018-13.901), pain location (AOR = 0.318, 95% CI: 0.158-0.638), pain persistence (AOR = 5.163, 95% CI: 2.784-9.576), the extent the pain compromised the respondent quality of life (AOR = 3.816, 95% CI: 1.685-8.643), and episodes of the pain associated with activities (AOR = 0.247, 95% CI: 0.138-0.442) were significantly associated with depression among patients with chronic pain.

Conclusion

This study has shown a high prevalence of depression among patients with chronic pain. Furthermore, depression was associated with various pain-related factors. Hence, effective screening and management of depression among chronic pain patients’ needs noteworthy attention.

Body Mass Index and Mild Cognitive Impairment Among Middle-Aged and Older Adults from Low- and Middle-Income Countries

BACKGROUND

The effect of weight modification on future dementia risk is currently a subject of debate and may be modified by age.

OBJECTIVE

The aim of the present study was to investigate the association between body mass index (BMI) status with mild cognitive impairment (MCI) (a preclinical stage of dementia) in middle-aged and older adults residing in six low- and middle-income countries using nationally representative data.

METHODS

Cross-sectional data from the Study on Global Ageing and Adult Health (SAGE) were analyzed. MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. BMI (kg/m2) was based on measured weight and height and categorized as: underweight (<18.5), normal (18.5-24.9), overweight (25.0-29.9), and obese (≥30.0). Multivariable logistic regression analysis and meta-analysis were conducted to assess associations.

RESULTS

Data on 32,715 individuals aged ≥50 years with preservation in functional abilities were analyzed [mean (SD) age 62.1 (15.6) years; 51.7% females]. Among those aged 50-64 years, compared to normal weight, underweight (OR = 1.44; 95% CI = 1.14-1.81), overweight (OR = 1.17; 95% CI = 1.002-1.37), and obesity (OR = 1.46; 95% CI = 1.09-1.94) were all significantly associated with higher odds for MCI. In those aged ≥65 years, underweight (OR = 0.71; 95% CI = 0.54-0.95) and overweight (OR = 0.72; 95% CI = 0.55-0.94) were associated with significantly lower odds for MCI, while obesity was not significantly associated with MCI.

CONCLUSION

The results of the study suggest that the association between BMI and MCI is likely moderated by age. Future longitudinal studies are required to confirm or refute the present findings before recommendations for policy and practice can be made.

Digital Interventions on Healthy Lifestyle Management: Systematic Review

BACKGROUND

Digital interventions have tremendous potential to improve well-being and health care conveyance by improving adequacy, proficiency, availability, and personalization. They have gained acknowledgment in interventions for the management of a healthy lifestyle. Therefore, we are reviewing existing conceptual frameworks, digital intervention approaches, and associated methods to identify the impact of digital intervention on adopting a healthier lifestyle.

OBJECTIVE

This study aims to evaluate the impact of digital interventions on weight management in maintaining a healthy lifestyle (eg, regular physical activity, healthy habits, and proper dietary patterns).

METHODS

We conducted a systematic literature review to search the scientific databases (Nature, SpringerLink, Elsevier, IEEE Xplore, and PubMed) that included digital interventions on healthy lifestyle, focusing on preventing obesity and being overweight as a prime objective. Peer-reviewed articles published between 2015 and 2020 were included. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and a framework for an evidence-based systematic review. Furthermore, we improved the review process by adopting the Rayyan tool and the Scale for the Assessment of Narrative Review Articles.

RESULTS

Our initial searches identified 780 potential studies through electronic and manual searches; however, 107 articles in the final stage were cited following the specified inclusion and exclusion criteria. The identified methods for a successful digital intervention to promote a healthy lifestyle are self-monitoring, self-motivation, goal setting, personalized feedback, participant engagement, psychological empowerment, persuasion, digital literacy, efficacy, and credibility. In this study, we identified existing conceptual frameworks for digital interventions, different approaches to provide digital interventions, associated methods, and execution challenges and their impact on the promotion of healthy lifestyle management.

CONCLUSIONS

This systematic literature review selected intervention principles (rules), theories, design features, ways to determine efficient interventions, and weaknesses in healthy lifestyle management from established digital intervention approaches. The results help us understand how digital interventions influence lifestyle management and overcome the existing shortcomings. It serves as a basis for further research with a focus on designing, developing, testing, and evaluating the generation of personalized lifestyle recommendations as a part of digital health interventions.

Association between physical and mental health variables among software professionals working at home: a secondary analysis

TRIAL REGISTRATION

Clinical Trials Registry India identifier CTRI/2021/03/032146.

Objectively measured far vision impairment and sarcopenia among adults aged ≥ 65 years from six low- and middle-income countries

BACKGROUND

There are currently no studies on visual impairment and sarcopenia. We investigated the cross-sectional association between objectively measured far vision impairment and sarcopenia in a nationally representative sample of older adults aged 65 years and over from six low- and middle-income countries (LMICs).

METHODS

Cross-sectional, community-based data from the study on global ageing and adult health (SAGE) were analyzed. Far vision acuity was measured using the tumbling E LogMAR chart and classified as: no vision impairment (6/12 or better); mild vision impairment (6/18 or better but worse than 6/12); moderate vision impairment (6/60 or better but worse than 6/18); severe vision impairment (worse than 6/60). Sarcopenia was defined as having low skeletal muscle mass and either a slow gait speed or a weak handgrip strength. Associations were assessed with multivariable logistic regression.

RESULTS

Fourteen thousand five hundred and eighty five individuals aged ≥ 65 years were included in the analysis [mean (SD) age 72.6 (11.5) years; 54.1% females]. After adjustment for multiple potential confounders, compared to those with no vision impairment, the OR (95% CI) for sarcopenia in those with mild, moderate, and severe vision impairment were 1.10 (0.87-1.40), 1.69 (1.25-2.27), and 3.38 (1.69-6.77), respectively. The estimates for females and males were similar.

CONCLUSIONS

The odds for sarcopenia increased with increasing severity of far vision impairment among older people in LMICs. The mere co-occurrence of these conditions is concerning, and it may be prudent to implement interventions to address/prevent sarcopenia in those with far vision impairment through the promotion of physical activity and appropriate nutrition.

Psychological, mobility, and satisfaction variables mediate the relationship between baseline back pain intensity and long-term outcomes in individuals who underwent lumbar spine surgery

BACKGROUND

In patients who receive spine surgery, pain is relational to disability and quality of life, but exactly how this influence is mediated is not fully understood. Mediation analyses allow an understanding of a known relationship by exploring the underlying mechanism or processes by which one variable influences another.

OBJECTIVES

To determine the mediating influence of psychological, mobility, and satisfaction variables on the relationship between preoperative back pain intensity and 12-month disability and quality of life in individuals who underwent lumbar spine surgery.

DESIGN

This mediation analysis study used data from the Quality Outcomes Database (QOD) Lumbar Spine Surgical Registry.

METHODS

There were included individuals who received lumbar spine surgery for degenerative spine conditions. The exposure variable was preoperative back pain intensity. Mediator variables were depression/anxiety, mobility, and satisfaction. Outcomes included disability and quality of life. Separate multiple mediator models were conducted using the Hayes PROCESS, Model 4 with bias-corrected bootstrapping (5000 samples) to predict disability and quality of life.

RESULTS

26,130 individuals (n = 13,740 males, mean age 60.2 [SD = 13.8) were included. We observed a significant indirect effect through the mediators (anxiety/depression, mobility and satisfaction), for both disability (b = 0.31, 95%CI = 0.26, 0.35) and quality of life (b = -0.44, 95%CI = -0.48, -0.41).

CONCLUSION

Our study suggests that the relationship between preoperative back pain intensity (exposure) and long-term disability and quality of life (outcomes) is partially mediated by anxiety/depression, mobility, and patient satisfaction in individuals who received lumbar spine surgery.

Sedentary Behavior and Associated Factors Among Working Adults in Eastern Ethiopia

Background: Sedentary behavior is a major risk factor for non-communicable diseases. Due to changes in lifestyle, sedentary behavior is increasing in sub-Saharan Africa. However, information on the extent of sedentarism among various segments of the population is scant in low-income countries. The objective of this study was to assess the extent of high sedentary behavior and associated factors among working adults in eastern Ethiopia.

Methods: A crosssectional study was conducted among 1,164 working adults at Haramaya University from December 2018 to February 2019. Data were collected through face-to-face interviews using the WHO STEPS and sedentary behavior questionnaire. All reported sedentary activities were added to calculate the total number of hours spent on sedentary behavior, which was then dichotomized into two categories. Those who had ≥8 sedentary hours per day were categorized as having high sedentary behavior. The prevalence ratio (PR) with 95% confidence intervals (CIs) was calculated. Factors associated with outcome variables were identified using Poisson regression with a robust variance statistical model.

Results: The prevalence of high sedentary behavior was 20.3% (95% CI, 18.0–22.7%) among the study participants. The prevalence of high sedentary behavior was associated with age 45–54 years adjusted PR (APR: 2.00; 95% CI = 1.01–3.97) and 55–64 years (APR: 2.16; 95% CI = 1.03–4.57), being a non-manual worker (APR: 2.11; 95% CI = 1.46–3.05), frequent khat chewers (APR: 1.57; 95% CI = 1.22–2.01), with body mass index of ≥25 kg/m² (APR: 1.93; 95% CI = 1.53–2.44), and regular alcohol drinker (APR: 1.39; 95% CI = 1.11–1.76).

Conclusion: One-fifth of working adults had high sedentary behavior. Factors associated with high sedentary behaviors were older age, being a non-manual worker, substance-use behaviors, and having a high body mass index.

Sleep problems and mild cognitive impairment among adults aged ≥50 years from low- and middle-income countries

BACKGROUND

The limited available literature suggests that sleep problems are linked to an increased risk of mild cognitive impairment (MCI). However, this association has been little studied to date in low-income settings.

OBJECTIVE

To investigate the association between sleep problems and MCI in a large sample of adults from six low-and middle-income countries (LMICs).

DESIGN

Cross-sectional.

SETTING

Study on Global Ageing and Adult Health (SAGE).

SUBJECTS

32,715 individuals aged ≥50 years with preservation in functional abilities [age range 50-114 years; 51.7% females].

METHODS

MCI was defined using the National Institute on Aging-Alzheimer's Association criteria. Sleep problems were assessed by the question "Overall in the last 30 days, how much of a problem did you have with sleeping, such as falling asleep, waking up frequently during the night or waking up too early in the morning?" and categorized as "None", "Mild", "Moderate", "Severe/Extreme". Multivariable logistic regression analysis and meta-analysis were conducted.

RESULTS

Compared to no sleep problems, mild, moderate, and severe/extreme sleep problems were associated with significant 1.40, 1.83, and 2.69 times higher odds for MCI with similar associations being observed between age groups and sex. Severe/extreme sleep problems were positively associated with MCI (i.e., OR > 1) in the six countries studied with the overall estimate being OR = 1.80 (95% CI = 1.50-2.16), and a low level of between-country heterogeneity was observed (I² = 28.2%).

CONCLUSIONS

Sleep problems were associated with higher odds for MCI. Interventions to improve sleep quality among middle-aged and older adults in LMICs may be an effective strategy in reducing risk of MCI and dementia.

Perceptions on activity behavior during the COVID-19 pandemic "second wave" among US adults: results of a short online survey

Purpose

COVID-19 pandemic has disrupted the lives of people of all nations. This study examined physical activity (PA) behavior, barriers and facilitators to PA during the COVID-19 pandemic.

Methods

This cross-sectional study assessed adults using a survey comprised of two parts: (a) demographics and general health and; (b) PA-related questions. The survey link was disseminated via email and various social media, and was active from September to October 2020.

Results

A total of 277 adults (Mean ± SD; age = 32.6 ± 13.6 years, BMI = 27.1 ± 16.5 kg/m²) were evaluated. A majority of the sample was female (67%), single (53%) and White (70%). About a third of the participants reported good mental and physical health, with a similar amount reporting weight gain during the pandemic. Participants further reported on average 271 min of PA/week, and 5.7 h/day of sitting time. Overall, 41.5% of the participants reported a decrease in PA during the COVID-19 pandemic, but those not meeting PA recommendations reported higher rates (67.9%) of decrease in levels of PA than their active counterparts (23.6%); x² (2, N = 277) = 55.757, p < 0.01. Over 50% of the participants reported engaging in PA at home, with significantly more females (43.5%) than males (17.6%) making use of live stream PA/exercise session opportunities; x² (2, N = 277) = 18.896, p < 0.001. “Closed gyms” and “more time” were reported as the main negative and positive factors, respectively, affecting PA during the pandemic.

Conclusions

Our findings suggest that PA behavior was negatively affected in US adults during the COVID-19 pandemic, and that “closed gym” (i.e., barrier), and “more time” (i.e., facilitator), were the main factors reported affecting PA participation. Given the well-known public health importance of PA, it is paramount that public health initiatives focus on providing not only educational but also environmental opportunities and support for PA during this period.

The Comparison of Physical Activity, Sedentary Behavior, and Mental Health between Early Menopausal Women and Age-Matched General Middle-Aged Women

The current study is to examine the differences in physical activity (PA), sedentary behavior (SB), and mental health (i.e., stress, depression, and suicidal behaviors) between early menopausal women and age-matched general middle-aged women. Among 1348 participants in South Korea, 674 participants who experienced menopause before the age of 45 were defined as the early menopausal group, and 674 women who experienced menopause from 45 years to 55 years were classified as the general group by matching age based on early menopausal women. PA, SB, and mental health were evaluated by using the Global Physical Activity Questionnaire (GPAQ). An independent t-test was used to compare the associations of PA, SB, and mental health between the two groups. To demonstrate the predictors of early menopause, variables in the study were analyzed by multinomial logistic regression. The main findings were that moderate-to-vigorous PA (MVPA) and light PA (LPA) had significant differences between the two groups, but SB had no significant differences. In mental health, only perceived stress had significant differences in this study. The moderate level of stress in the early menopausal group was twice as high as that of the general group, and the severe level of stress was even 2.6 times higher than the general group. PA plays an essential role in mitigating the causes of mortality and the risk of various chronic diseases and improving quality of life; thus, the main findings of this study could be important to provide insights on the corresponding impact between early menopausal women and PA to encourage their healthy lifestyle. Further longitudinal studies are needed to examine the mechanisms underlying the effects of PA, SB, and mental health on early menopausal women.

Decreased self-reported appetite following insular cortex resection in patients with epilepsy

Entrenched deep within the Sylvian fissure, the insula has long been considered one of the least understood regions of the human brain, in part due to its restricted accessibility. However, recent evidence suggests that the insula plays a key role in gustation, interoception, cognitive and emotional processes, and likely integrates these different functions to contribute to the homeostatic control of food intake. In the past decade, our team has identified the insula as a potential site of epileptogenicity, which can be successfully treated by microsurgical resection. While most surgeries are successful in controlling insular epileptic seizures and lead to few postoperative deficits, the subtle changes that may occur in food-related experiences are still unknown. Using a self-report questionnaire, the present study sought to fill this gap by assessing changes in appetite in patients who underwent unilateral partial or complete insular resections (n = 17) as part of their epilepsy surgery. We compared them to a group of patients who underwent temporal lobe epilepsy surgery (n = 22) as a lesion-control group. A majority (59%) of the insular patients reported an alteration in appetite, with most of these changes being characterized by a persistent reduction. Such changes were rarely reported following temporal lobectomy (14%). While they significantly differed in terms of appetite changes, both groups were similar when examining post-surgical changes in weight, diet, exercise and eating habits. Insular patients with altered appetite also showed behavioral signs of dysfunctional interoceptive and gustatory functions, corroborating the idea that these systems play a role in the regulation of feeding behaviours. This research pushes our understanding of the mechanisms underlying food intake and could lead to avenues for the treatment of eating disorders.

Association between Food Insecurity and Sarcopenia among Adults Aged ≥65 Years in Low- and Middle-Income Countries

Limited literature has investigated the association between food insecurity and sarcopenia in low- and middle-income countries (LMICs). Therefore, the aim of the present study was to investigate the association between food insecurity and sarcopenia among adults aged ≥65 years in six LMICs. Community-based cross-sectional data of the Study on Global Ageing and Adult Health were analyzed. Sarcopenia was defined as the presence of low skeletal muscle mass based on indirect population formula, and either slow gait or low handgrip strength. In the past, 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable logistic regression analysis was conducted. The final sample consisted of 14,585 individuals aged ≥65 years (mean (SD) age 72.6 (11.5) years; 55.0% females). The prevalence of sarcopenia among those with no food insecurity was 13.0% but this increased to 24.4% among those with severe food insecurity. After adjustment for potential confounders, compared to no food insecurity, severe food insecurity was associated with 2.05 (95%CI = 1.12-3.73) times higher odds for sarcopenia. In this large representative sample of older adults from multiple LMICs, it was found that severe food insecurity is associated with higher odds for sarcopenia. Addressing food insecurity in such settings may be an effective strategy to curb the high prevalence of sarcopenia in LMICs.

Effects of cycling workstation to get tertiary employee moving on their overall health: study protocol for a REMOVE trial

BACKGROUND

Sedentary behaviour (SB) and low levels of physical activity (PA) are predictors of morbidity and mortality. Tertiary employees spend a considerable amount of their daily time seated and new efficient strategies to both reduce sedentary time and increase physical activity are needed. In that context, the REMOVE study aims at evaluating the health effects of a 24-week cycling desk intervention among office workers.

METHODS

A prospective, open-label, multicentre, two-arm parallel, randomized controlled trial (RCT) will be conducted in office-sitting desk workers. Office workers (N = 80) who have 0.8 full time equivalent hours (FTE) and 75% of this time in a sitting position will be recruited from tertiary worksites in Clermont-Ferrand, France. Subjects will be randomly assigned to one of the two following interventions: (i) PPM6: performance of two 30 min of cycling desk (using portable pedal exercise machine-PPM) per working day for 6 months or (ii) CTL_PPM3: 3 months with no intervention (control) followed by 3 months during which workers will be asked to complete two 30 min of PPM per working day. At baseline (T0), at 3 months (T1) and at 6 months (T2) after the start of the interventions, primary outcomes; 7-day PA and SB (3D-accelerometers), secondary outcomes; body composition (bioelectrical impedance), physical fitness (aerobic fitness, upper and lower limb strength), metabolic outcomes (fasting blood samples), self-perceived stress, anxiety, quality of life at work and job strain (questionnaires), tertiary outcomes; resting metabolic rate and cycling energy expenditure (indirect calorimetry) and eating behaviours (questionnaires) will be measured. An ergonomic approach based on observations and individual interviews will be used to identify parameters that could determine adherence.

DISCUSSION

The REMOVE study will be the first RCT to assess the effects of cycling workstations on objectively measured PA and SB during working and non-working hours and on key physiological and psychological health outcomes. This study will provide important information regarding the implementation of such cycling workstations in office workers and on the associated potential health benefits.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04153214 . Registered on November 2019, version 1.

Sedentary behaviour research in adults: A scoping review of systematic reviews and meta-analyses

Sedentary behaviour research is rapidly growing. Scoping reviews are important to inform policy and practice.The aim of this scoping a review was to map the available evidence from systematic reviews and meta-analyses of sedentary behaviour research on adults (≥18 years), within the phases of the behavioural epidemiology framework, and to identify bibliometric parameters of studies included in this review. Nine bibliographic databases were searched. Studies were screened and relevant information (e.g., general information, inclusion criteria, findings and reporting quality) was extracted independently by two authors. In total, 108 systematic reviews and/or meta-analyses of sedentary behaviour research in adults (≥18 years) were included. Most papers (91.7%) were published between 2010 and 2020. Studies on the relationship of sedentary behaviour with health (53.7%) and interventions to reduce sedentary behaviour (25.9%) were most common. Forty-five (41.7%) studies reported quality assessment with categorization, and 887 out of 1268 (70%) included primary studies were categorized having moderate-to-high quality. Sedentary behaviour research on adults (≥18 years) has grown exponentially in the last decade and demonstrates strength in several stages of the behavioural epidemiology framework. However, more research should focus on the measurement, prevalence/epidemiology and determinants of sedentary behaviour, to better inform policy development.

Association of objective visual impairment with suicidal ideation and suicide attempts among adults aged ≥50 years in low/middle-income countries

BACKGROUND

There is currently limited literature on the association between visual impairment and suicidal thoughts and behaviours, especially among older adults from low/middle-income countries (LMICs). Thus, we aimed to investigate the associations of objectively measured distance visual impairment with suicidal ideation and suicide attempts among adults aged ≥50 years from six LMICs and to identify potential mediators.

METHODS

Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health were analysed. Objective distance visual acuity was measured using the tumbling E logMAR chart, and vision impairment was categorised as none, mild, moderate and severe. Self-reported information on past 12-month suicidal ideation and suicide attempts was also collected. Multivariable logistic regression and mediation analysis were conducted.

RESULTS

Data on 34 129 individuals aged ≥50 years (mean (SD) age, 62.4 (16.0) years; 47.9% men) were analysed. After adjustment for potential confounders, compared with no visual impairment, severe visual impairment was significantly associated with suicidal ideation (OR=9.50; 95% CI=2.47 to 36.52). Moderate and severe visual impairment were significantly associated with a 2.22 (95% CI=1.14 to 4.35) and 11.50 (95% CI=1.44 to 91.88) times higher odds of suicide attempts, respectively. Disability, poor self-rated health, mobility and loneliness explained 14.0%, 9.3%, 7.2% and 6.3% of the association between moderate/severe visual impairment and suicide attempts, respectively.

CONCLUSION

Interventions to reduce suicidal ideation and suicide attempts among older adults with visual impairment in LMICs are required, targeting identified mediators, while using tested strategies for suicide prevention per se in LMICs may yield beneficial outcomes.

Associations between mentally-passive and mentally-active sedentary behaviours during adolescence and psychological distress during adulthood

It is unclear if different types of sedentary behaviour during the adolescence are differentially associated with psychological distress during adolescence and adulthood. It is also unknown what may mediate this potential proposed association. The current study aimed to analyse the association of mentally-active and mentally-passive sedentary behaviours during adolescence (16y) with subsequent psychological distress during adulthood (42y), and to examine the role of potential mediators (42y). Data from the 1970 British Cohort Study was used (N = 1787). At age 16y participants reported time and frequency in mentally-passive (TV-viewing and watching movies) and mentally-active (reading books, doing homework and playing computer games) sedentary behaviours, psychological distress and organized sports participation. At 42y, participants reported cognition (vocabulary test), TV-viewing, psychological distress, self-rated health, body mass index and employment status. Education was collected throughout the follow-up years. Logistic regression and mediation models assessed associations. Multiple imputation using chained equations was used to assess the impact of missing data. Mentally-passive sedentary behaviour in adolescence was a risk factor for psychological distress during adulthood in complete-cases analysis [OR:1.44(95%CI:1.09-1.90)], which was confirmed by the model with multiple imputation. Mentally-active sedentary behaviour at 16y was not associated with psychological distress at 42y. Adult TV-viewing during weekends (24.7%), and self-rated health (19.0%) mediated the association between mentally-passive sedentary behaviour during adolescence and psychological distress during adulthood. However, the mediation was not clear in the models with multiple imputation. Mentally-passive sedentary behaviour during adolescence was associated with elevated psychological distress during adulthood and this association was mediated TV-viewing and self-rated health in adulthood.

Active Travel and Mild Cognitive Impairment among Older Adults from Low- and Middle-Income Countries

Active travel may be an easily achievable form of physical activity for older people especially in low- and middle-income countries (LMICs), but there are currently no studies on how this form of physical activity is associated with a preclinical state of dementia known as mild cognitive impairment (MCI). Therefore, we aimed to investigate the association between active travel and MCI among adults aged ≥50 years from six LMICs. Cross-sectional, community-based data from the World Health Organization’s Study on Global Ageing and Adult Health were analyzed. The definition of MCI was based on the National Institute on Ageing-Alzheimer’s Association criteria. Active travel (minutes/week) was assessed with questions of the Global Physical Activity Questionnaire (GPAQ) and presented in tertiles. Multivariable logistic regression analysis was conducted to assess the association between active travel and MCI. Data on 32715 people aged ≥50 years (mean age 62.4 years; 52.1% females) were analyzed. Compared to the highest tertile of active travel, the lowest tertile was associated with 1.33 (95%CI = 1.14–1.54) times higher odds for MCI overall. This association was particularly pronounced among those aged ≥65 years (OR = 1.70; 95%CI = 1.32–2.19) but active travel was not associated with MCI among those aged 50–64 years. In conclusion, low levels of active travel were associated with a significantly higher odds of MCI in adults aged ≥65 years in LMICs. Promoting active travel among people of this age group in LMICs via tailored interventions and/or country-wide infrastructure investment to provide a safe environment for active travel may lead to a reduction in MCI and subsequent dementia.

Associations between sedentary behavior and happiness: An analysis of influential factors among middle-aged and older adults from six low- and middle-income countries

OBJECTIVES

Higher levels of sedentary behavior (SB) may be associated with decreased happiness but there are no studies on this topic. Thus, we investigated this association, and its influential factors among middle-aged and older adults using nationally representative datasets from six low- and middle-income countries (LMICs).

STUDY DESIGN

Community-based cross-sectional data from the Global Ageing and Adult Health study were analyzed. SB was assessed with the Global Physical Activity Questionnaire. Multivariable ordinal logistic regression and mediation analyses were performed.

MAIN OUTCOME MEASURES

Happiness was assessed with a cross-culturally validated single-item question (5-point scale) with higher scores indicating higher levels of happiness.

RESULTS

The final sample included 34,129 adults aged 50 years or more (mean age = 62.4 ± SD 16 years; 51.9 % female). After adjusting for multiple confounders, increased time spent in SB (hours/day) was associated with lower happiness levels (OR = 0.96; 95 % CI = 0.94-0.98). Mobility limitations, cognitive complaints, pain/discomfort, sleep problems and disability explained the largest proportion of the association between SB and happiness.

CONCLUSIONS

SB was linked with lower levels of happiness in middle-aged and older adults from LMICs, although a high level of between-country heterogeneity was observed. Longitudinal and interventional studies among older people in LMICs are warranted to assess directionality and the potential for reduction in SB to improve mental well-being in this population.

Adherence to aerobic and muscle-strengthening exercise guidelines and associations with psychological distress: A cross-sectional study of 14,050 English adults

Physical activity (PA) is beneficial for the prevention and management of psychological distress. However, no studies have investigated which combination/s of PA prescribed in the current global guidelines (i.e. aerobic moderate-to-vigorous PA [MVPA] and muscle-strengthening exercise [MSE]) are most strongly linked to reduced psychological distress. This study aimed to examine how PA guidelines adherence is associated with psychological distress. Using cross-sectional data of adults (n = 14,050) who participated in the 2012-2016 Health Survey for England, four categories of self-reported PA guidelines adherence were created: meeting none, only MSE, only aerobic MVPA, meeting both (exposure variables). Psychological distress (outcome) was measured using the General Health Questionnaire-12. The likelihood of experiencing high levels of psychological distress (cut-point of ≥4) across guidelines adherence categories was examined using logistic regression models adjusted for sociodemographic and lifestyle factors. About 17% of adults experienced high levels of psychological distress; 37.5% did not adhere to any PA guidelines (category 1), 1.3% met only MSE (category 2), 35.5% met only aerobic MVPA (category 3), and 25.7% met both guidelines (category 4). Compared to category 1, the likelihood of experiencing high psychological distress was lowest in category 4 (OR = 0.65, 95% CI: 0.54-0.77) followed by category 3 (OR = 0.78, 95% CI: 0.67-0.90), while it did not differ in category 2 (OR = 1.24, 95% CI: 0.75-2.05). This is the first study to identify the association between PA guidelines adherence and psychological distress in a large population sample. Findings suggest that meeting both aerobic MVPA and MSE guidelines might be most beneficial for mental health.

Parent-adolescent congruence in phubbing and adolescents' depressive symptoms: A moderated polynomial regression with response surface analyses

BACKGROUND

With the widespread of smartphones, there is an increased interest in exploring the influences of phubbing in modern society. However, little research has examined the impact of parent phubbing (Pphubbing) or adolescent phubbing (Aphubbing) on adolescent development. This conceptual and empirical work aims to explore the unique and joint impacts of Pphubbing and Aphubbing on adolescents' depressive symptoms.

METHOD

Participants were 3322 students from 64 classes of a senior high school. The data were analyzed with polynomial regressions and response surface analyses.

RESULTS

The results showed that Pphubbing was positively related to Aphubbing. Pphubbing and Aphubbing were both positively associated with adolescents' depressive symptoms. In addition, when Pphubbing and Aphubbing were in congruence, adolescents' depressive symptoms would increase as the former two increased. Moreover, adolescents' depressive symptoms would decrease as the discrepancy between parent and adolescent increased. Meanwhile, attachment avoidance moderated the congruence and incongruence effects of parent-adolescent phubbing on adolescents' depressive symptoms.

LIMITATIONS

This study used cross-sectional data, which cannot infer causality.

CONCLUSION

The effect between parent-adolescent congruence in phubbing and adolescents' depressive symptoms is significant, and it is moderated by attachment avoidance.

Perceived change in physical activity levels and mental health during COVID-19: Findings among adult twin pairs

Background

Physical distancing and other COVID-19 pandemic mitigation strategies may have unintended consequences on a number of health behaviors and health outcomes. The purpose of this study was to investigate the association between perceived change in physical activity or exercise and mental health outcomes over the short-term in response to COVID-19 mitigation strategies in a sample of adult twins.

Methods

This was a cross-sectional study of 3,971 identical and same-sex fraternal adult twins (909 pairs, 77% identical) from the community-based Washington State Twin Registry. Participants in this study completed an online survey examining the impact of COVID-19 mitigation on a number of health-related behaviors and outcomes, administered between March 26 and April 5, 2020. In the present study, the exposure was perceived change in physical activity or exercise. The outcomes were levels of perceived anxiety and stress.

Results

More twin pairs reported a decrease in physical activity levels (42%) than those reporting no change (31%) or increased physical activity levels (27%). A perceived decrease in physical activity or exercise was associated with higher stress and anxiety levels. However, the physical activity–stress relationship was confounded by genetic and shared environmental factors. On the other hand, the physical activity–anxiety relationship held after controlling for genetic and shared environmental factors, although it was no longer significant after further controlling for age and sex, with older twins more likely to report lower levels of anxiety and females more likely to report higher levels of anxiety.

Conclusions

Strategies to mitigate the COVID-19 pandemic may be impacting physical activity and mental health, with those experiencing a decrease in physical activity also having higher levels of stress and anxiety. These relationships are confounded by genetic and shared environmental factors, in the case of stress, and age and sex, in the case of anxiety.

Maternal depression and inflammation during pregnancy

BACKGROUND

Maternal depression during pregnancy increases the risk for adverse developmental outcomes in children. However, the underpinning biological mechanisms remain unknown. We tested whether depression was associated with levels of and change in the inflammatory state during pregnancy, if early pregnancy overweight/obesity or diabetes/hypertensive pregnancy disorders accounted for/mediated these effects, and if depression added to the inflammation that typically accompanies these conditions.

METHODS

We analyzed plasma high-sensitivity C-reactive protein (hsCRP) and glycoprotein acetyls at three consecutive stages during pregnancy, derived history of depression diagnoses before pregnancy from Care Register for Healthcare (HILMO) (N = 375) and self-reports (N = 347) and depressive symptoms during pregnancy using the Center for Epidemiological Studies Depression Scale completed concurrently to blood samplings (N = 295). Data on early pregnancy body mass index (BMI) and diabetes/hypertensive pregnancy disorders came from medical records.

RESULTS

Higher overall hsCRP levels, but not change, during pregnancy were predicted by history of depression diagnosis before pregnancy [HILMO: mean difference (MD) = 0.69 standard deviation (s.d.) units; 95% confidence interval (CI) 0.26-1.11, self-report: MD = 0.56 s.d.; 95% CI 0.17-0.94] and higher depressive symptoms during pregnancy (0.06 s.d. per s.d. increase; 95% CI 0.00-0.13). History of depression diagnosis before pregnancy also predicted higher overall glycoprotein acetyls (HILMO: MD = 0.52 s.d.; 95% CI 0.12-0.93). These associations were not explained by diabetes/hypertensive disorders, but were accounted for and mediated by early pregnancy BMI. Furthermore, in obese women, overall hsCRP levels increased as depressive symptoms during pregnancy increased (p = 0.006 for interaction).

CONCLUSIONS

Depression is associated with a proinflammatory state during pregnancy. These associations are mediated by early pregnancy BMI, and depressive symptoms during pregnancy aggravate the inflammation related to obesity.

Factors Associated with Depression in Middle-Aged and Elderly People in Romania

The objectives of this study were the determination of the prevalence of self-reported depressive symptoms by the Geriatric Depression Scale and the influences of variable income, physical activity, socialization and sexual activity. A total of 601 patients aged 55–93 years with a mean age of 67.32 years and a median age of 67 years participated in this study between 2016 and 2017. Non-cooperative people and individuals with strong auditory or visual sensory deficits, severe cognitive deficits, or disorders accompanied by psychotic elements with serious somatic pathology were excluded from the interviews. Employing the SPSS GENLIN procedure, an ordinal logistic model was used. Over ½ of the respondents are within the categories of moderate and severe depression, almost half of the respondents feel that their family incomes are not enough or make it hard to meet their needs, approximately 10% think they are sedentary, over ½ participate in no sexual activity, and over ¼ do not frequently respond with pleasure to partner-initiated sexual relationships. Those who were in the higher depression category perceived their income to be extremely low (p = .001), perceived themselves as sedentary (p < .001), infrequently met with friends or neighbours in their leisure time (p = .002), and had lower sexual interest (p < .001). Middle-aged adults and older adults should learn about the health benefits of physical activity, socialization and sexual activity. Social policies must take into account this low-income segment. Poverty itself can be a contributor to depressive states, and additionally, due to their low incomes, elderly people are at risk of benefiting less from pharmacotherapy and psychotherapy.

Factors Associated With Loneliness: An Umbrella Review Of Observational Studies

BACKGROUND

Evidence provides inconsistent findings on risk factors and health outcomes associated with loneliness. The aim of this work was to grade the evidence on risk factors and health outcomes associated with loneliness, using an umbrella review approach.

METHODS

For each meta-analytic association, random-effects summary effect size, 95% confidence intervals (CIs), heterogeneity, evidence for small-study effect, excess significance bias and 95% prediction intervals were calculated, and used to grade significant evidence (p<0.05) from convincing to weak. For narrative systematic reviews, findings were reported descriptively.

RESULTS

From 210 studies initially evaluated, 14 publications were included, reporting on 18 outcomes, 795 studies, and 746,706 participants. Highly suggestive evidence (class II) supported the association between loneliness and incident dementia (relative risk, RR=1.26; 95%CI: 1.14-1.40, I² 23.6%), prevalent paranoia (odds ratio, OR=3.36; 95%CI: 2.51-4.49, I² 92.8%) and prevalent psychotic symptoms (OR=2.33; 95%CI: 1.68-3.22, I² 56.5%). Pooled data supported the longitudinal association between loneliness and suicide attempts and depressive symptoms. In narrative systematic reviews, factors cross-sectionally associated with loneliness were age (in a U-shape way), female sex, quality of social contacts, low competence, socio-economic status and medical chronic conditions.

LIMITATIONS

Low quality of the studies included; mainly cross-sectional evidence.

CONCLUSIONS

This work is the first meta-evidence synthesis showing that highly suggestive and significant evidence supports the association between loneliness and adverse mental and physical health outcomes. More cohort studies are needed to disentangle the direction of the association between risk factors for loneliness and its related health outcomes.