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Oi K, Frazier C. Testing of significant changes in big-five personality factors over time in the presence and absence of memory impairment and life-related stress. Sci Rep 2024; 14:19555. [PMID: 39174737 PMCID: PMC11341689 DOI: 10.1038/s41598-024-70388-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 08/16/2024] [Indexed: 08/24/2024] Open
Abstract
This study tests whether memory impairment and perceived increases in stress due to life changes independently contribute to similar personality changes, such as increased neuroticism and decreased conscientiousness. Longitudinal data from 12,912 participants aged 50+ from the Health and Retirement Study (2006-2020) were analyzed using Latent Growth Curve Models (LGCMs). Six LGCMs were simultaneously estimated to examine how changes in personality across three data points spanning 8 years are predicted by both the classification of memory impairment (MI) statuses assessed via the Telephone Interview for Cognitive Status and estimated increases in life stress. Decreases were observed in all Big Five personality factors (B = - 0.240/- 0.510, SE = 0.085/0.089) over the 8-year period. No significant differences in personality changes were found between MI cases and non-MI cases. Increased life stress was significantly associated with a rise in neuroticism (B = 0.587, SE = 0.094) and reductions in conscientiousness, extraversion, agreeableness, and openness (B ranges from - 0.223 to - 0.497). The findings emphasize adaptive/developmental shifts in personality in response to life stress rather than neuropathological ones related to memory impairment. Clinical assessment of personality changes in mid-to-late life should first consider psychological maladaptation to situational threats and challenges.
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Affiliation(s)
- Katsuya Oi
- Department of Sociology, Northern Arizona University, SBS Castro 308 5 E McConnell Dr, Flagstaff, AZ, 86011, USA.
| | - Cleothia Frazier
- Department of Sociology, The Pennsylvania State University, Oswald Tower, University Park, PA, 16802, USA
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2
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Armstrong M, Castellanos J, Christie D. Chronic pain as an emergent property of a complex system and the potential roles of psychedelic therapies. FRONTIERS IN PAIN RESEARCH 2024; 5:1346053. [PMID: 38706873 PMCID: PMC11066302 DOI: 10.3389/fpain.2024.1346053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
Despite research advances and urgent calls by national and global health organizations, clinical outcomes for millions of people suffering with chronic pain remain poor. We suggest bringing the lens of complexity science to this problem, conceptualizing chronic pain as an emergent property of a complex biopsychosocial system. We frame pain-related physiology, neuroscience, developmental psychology, learning, and epigenetics as components and mini-systems that interact together and with changing socioenvironmental conditions, as an overarching complex system that gives rise to the emergent phenomenon of chronic pain. We postulate that the behavior of complex systems may help to explain persistence of chronic pain despite current treatments. From this perspective, chronic pain may benefit from therapies that can be both disruptive and adaptive at higher orders within the complex system. We explore psychedelic-assisted therapies and how these may overlap with and complement mindfulness-based approaches to this end. Both mindfulness and psychedelic therapies have been shown to have transdiagnostic value, due in part to disruptive effects on rigid cognitive, emotional, and behavioral patterns as well their ability to promote neuroplasticity. Psychedelic therapies may hold unique promise for the management of chronic pain.
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Affiliation(s)
- Maya Armstrong
- Department of Family & Community Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Joel Castellanos
- Division of Pain Medicine, Department of Anesthesiology, University of California, San Diego, CA, United States
| | - Devon Christie
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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3
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Vaheb S, Mokary Y, Yazdan Panah M, Shaygannejad A, Afshari-Safavi A, Ghasemi M, Shaygannejad V, Moases Ghaffary E, Mirmosayyeb O. Multiple sclerosis and personality traits: associations with depression and anxiety. Eur J Med Res 2024; 29:171. [PMID: 38475891 DOI: 10.1186/s40001-024-01772-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/06/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Depression and anxiety are commonly observed in people with multiple sclerosis (pwMS). There is a growing body of literature supporting the hypothesis that personality traits can influence the mood disorders. This study aimed to investigate the personality traits and their relationships with depression and anxiety among pwMS. METHODS 234 pwMS were involved in this cross-sectional study. Personality traits, depression, and anxiety were assessed using the NEO Five-Factor Inventory (NEO-FFI) and Hospital Anxiety and Depression Scale (HADS), respectively. Pearson's correlation coefficient and generalized linear model were employed to evaluate the relationships between demographic and clinical characteristics, NEO-FFI, and HADS subscales. RESULTS In pwMS, longer disease duration was significantly associated with lower level of conscientiousness (β = - 0.23, p = 0.008) and agreeableness (β = - 0.2, p = 0.01). Moreover, higher expanded disability status scale (EDSS) of pwMS had a significant relationship with higher level of neuroticism (β = 0.89, p = 0.01). Increased level of neuroticism was significantly correlated with lower level of extraversion (r = - 0.28, p < 0.001), openness (r = - 0.37, p < 0.001), agreeableness (r = - 0.31, p < 0.001), and conscientiousness (r = - 0.45, p < 0.001). PwMS with higher level of conscientiousness showed more extraversion (r = 0.23, p < 0.001), openness (r = 0.61, p < 0.001), and agreeableness (r = 0.41, p < 0.001). Elevated level of neuroticism was significantly associated with higher level of anxiety (β = 0.47, p < 0.001) and depression (β = 0.11, p < 0.001) among pwMS. CONCLUSION The co-occurrence of depression and anxiety is probably associated with neuroticism among pwMS. Additionally, the impact of personality traits extends to influencing key disease aspects such as physical disability and disease duration in MS.
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Affiliation(s)
- Saeed Vaheb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yousef Mokary
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mohammad Yazdan Panah
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Aysa Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Afshari-Safavi
- Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Majid Ghasemi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Elham Moases Ghaffary
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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4
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Ma A, Tan S, Chen J, Lou H. Stress events and stress symptoms in Chinese secondary school students: gender and academic year characteristics of the relationship. Front Public Health 2024; 12:1360907. [PMID: 38476484 PMCID: PMC10927803 DOI: 10.3389/fpubh.2024.1360907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/12/2024] [Indexed: 03/14/2024] Open
Abstract
Objective To explore the relationship between stress events and stress symptoms and their gender and academic year characteristics in Chinese secondary school students. Methods 4,995 secondary school students were investigated by the Adolescent Self-rating Life Events Checklist (ASLEC) and the Calgary Symptoms of Stress Inventory (C-SOSI). Results First, there were significant differences in all dimensions and total scores of stress events and stress symptoms between boys and girls in secondary school and between junior high school students and senior high school students. Second, the dimensions and total scores of stress events in secondary school students are positively correlated with the dimensions and total scores of stress symptoms. Third, the influence of punishment on the stress symptoms of secondary school boys is the most obvious, and the influence of punishment, adaption, relationship stress, and learning stress on the stress symptoms of secondary school girls is the most obvious. The influence of punishment on the stress symptoms of junior high school students is the most obvious, and the influence of punishment and relationship on the stress symptoms of senior high school students is the most obvious. Conclusion Stress events and stress symptoms of Chinese secondary school students have significant differences in gender and academic year. The same stress event has different influence mechanisms on the stress symptoms of Chinese secondary school students of different genders and different academic years.
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Affiliation(s)
| | | | | | - Hu Lou
- School of Sports Science, Nantong University, Nantong, China
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5
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Williams MK, Waite L, Van Wyngaarden JJ, Meyer AR, Koppenhaver SL. Beyond yellow flags: The Big-Five personality traits and psychologically informed musculoskeletal rehabilitation. Musculoskeletal Care 2023; 21:1161-1174. [PMID: 37434350 DOI: 10.1002/msc.1797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Psychosocial variables are known to play an important role in musculoskeletal pain. Recent efforts incorporating psychological theory into rehabilitative medicine, as part of patient-centred care or psychologically informed physical therapy, have gained broader acceptance. The fear-avoidance model is the dominant psychosocial model and has introduced a variety of phenomena which assess psychological distress (i.e., yellow flags). Yellow flags, such as fear, anxiety and catastrophizing, are useful concepts for musculoskeletal providers but reflect a narrow range of psychological responses to pain. OBJECTIVE Clinicians lack a more comprehensive framework to understand psychological profiles of each patient and provide individualised care. This narrative review presents the case for applying personality psychology and the Big-Five trait model (extraversion, agreeableness, conscientiousness, neuroticism and openness to experience) to musculoskeletal medicine. These traits have strong associations with various health outcomes and provide a robust framework to understand patient emotion, motivation, cognition and behaviour. KEY RESULTS High conscientiousness is associated with positive health outcomes and health promoting behaviours. High neuroticism with low conscientiousness increases the odds of negative health outcomes. Extraversion, agreeableness and openness have less direct effects but have positive correlations with important health behaviours, including active coping, positive affect, rehabilitation compliance, social connection and education level. CLINICAL APPLICATION The Big-Five model offers an evidence-based way for MSK providers to better understand the personality of their patients and how it relates to health. These traits offer the potential for additional prognostic factors, tailored treatments and psychological intervention.
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Affiliation(s)
- Matthew K Williams
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, Texas, USA
| | - Lennie Waite
- Department of Psychology, University of St. Thomas, Houston, Texas, USA
| | - Joshua J Van Wyngaarden
- Army-Baylor University, Doctoral Program in Physical Therapy, Baylor University, San Antonio, Texas, USA
| | - Andrew R Meyer
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, Texas, USA
| | - Shane L Koppenhaver
- Department of Health, Human Performance, and Recreation, Baylor University, Waco, Texas, USA
- Doctoral Program in Physical Therapy, Baylor University, Waco, Texas, USA
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6
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Li W, Chen J, Liu Y, Liu Y, Hu X, Mu F, Liu C, Zhang Y, Liu Y. The mediating effects of dysfunctional attitudes and moderating effect of sex between stressful life events and depressive symptoms among Chinese college students. Sci Rep 2023; 13:10910. [PMID: 37407699 DOI: 10.1038/s41598-023-38103-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 07/03/2023] [Indexed: 07/07/2023] Open
Abstract
Stressful life events (SLEs) closely correlates with depressive symptoms. Although vulnerability-stress model suggests SLEs interacted with dysfunctional attitudes (DA) to predict depression, the mediation role of DA is poorly understood. Therefore, this study intended to investigate the mediating role of DA and the moderating role of sex between SLEs and self-reported depression. A cross-sectional survey was conducted with a sample of 7769 Chinese college students. Participants were assessed in terms of self-reported SLEs, DA and depression variables. Results showed that there were significant sex differences in both SLE and DA. DA mediated the association between SLE and self-reported depression. The moderated mediation model analysis showed that the interaction of SLEs and sex significantly predicted DA in mediator variable model and self-reported depression in dependent variable model. Results indicated that DA partially mediated the association between SLEs and self-reported depression, and sex moderates the association between SLEs and both DA and self-reported depression, which females have bigger changes of DA and depressive symptoms across low and high levels of SLEs than males.
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Affiliation(s)
- Wenfu Li
- School of Mental Health, Jining Medical University, Jining, 272013, China.
| | - Jingting Chen
- Teachers' Union, Jining Medical University, Jining, 272067, China
| | - Yujia Liu
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Yanzhi Liu
- School of Clinical Medicine, Jining Medical University, Jining, 272013, China
| | - Xiaoran Hu
- Graduate School of Arts and Sciences, Columbia University, New York, 10027, USA
| | - Fuqin Mu
- School of Mental Health, Jining Medical University, Jining, 272013, China
| | - Chuanxin Liu
- School of Mental Health, Jining Medical University, Jining, 272013, China
| | - Ying Zhang
- School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Yan Liu
- School of Mental Health, Jining Medical University, Jining, 272013, China.
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Wang X, Wang S. The Bridge between Cybervictimization and Suicidal Ideation among Adolescents: A Vicious Cycle of Hopelessness. J Youth Adolesc 2023; 52:996-1009. [PMID: 36629988 DOI: 10.1007/s10964-022-01726-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/16/2022] [Indexed: 01/12/2023]
Abstract
Cybervictimization has been shown to relate to suicidal ideation. However, few studies have fully clarified the directionality of this relationship, and little is known about the potential mediating and moderating mechanisms of this relationship. To address these gaps, the current study tested bidirectional relationships among cybervictimization, hopelessness, and suicidal ideation across three years using a cross-lagged design and examined whether these relationships varied by openness, family socioeconomic status, perceived economic stress, and sex. A total of 2,407 Chinese adolescents (50.23% female, Mage = 12.75, SD = 0.58 at baseline) from seven schools participated in the present study. The results indicated that cybervictimization was related to hopelessness and suicidal ideation. There was a vicious cycle between cybervictimization and hopelessness after controlling the effects of cyberbullying at T1. There were significant reciprocal relationships between hopelessness and suicidal ideation. Hopelessness at T2 mediated the relationship between cybervictimization at T1 and suicidal ideation at T3. Openness moderated the relationships among cybervictimization, hopelessness, and suicidal ideation. Family socioeconomic status, perceived economic stress, and sex did not play a moderating role. These findings will help to understand that intervening with hopelessness is a promising way to reduce adolescents' cybervictimization and suicidal ideation, and promoting adolescents' openness is an effective approach to alleviate the negative outcome of cybervictimization.
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Affiliation(s)
- Xingchao Wang
- School of Educational Science, Shanxi University, No. 92 Wucheng Road, Taiyuan, 030006, China.
| | - Shiyin Wang
- School of Educational Science, Shanxi University, No. 92 Wucheng Road, Taiyuan, 030006, China
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8
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Chiappelli J, Adhikari BM, Kvarta MD, Bruce HA, Goldwaser EL, Ma Y, Chen S, Ament S, Shuldiner AR, Mitchell BD, Kochunov P, Wang DJJ, Hong LE. Depression, stress and regional cerebral blood flow. J Cereb Blood Flow Metab 2023; 43:791-800. [PMID: 36606600 PMCID: PMC10108192 DOI: 10.1177/0271678x221148979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 01/07/2023]
Abstract
Decreased cerebral blood flow (CBF) may be an important mechanism associated with depression. In this study we aimed to determine if the association of CBF and depression is dependent on current level of depression or the tendency to experience depression over time (trait depression), and if CBF is influenced by depression-related factors such as stressful life experiences and antidepressant medication use. CBF was measured in 254 participants from the Amish Connectome Project (age 18-76, 99 men and 154 women) using arterial spin labeling. All participants underwent assessment of symptoms of depression measured with the Beck Depression Inventory and Maryland Trait and State Depression scales. Individuals diagnosed with a unipolar depressive disorder had significantly lower average gray matter CBF compared to individuals with no history of depression or to individuals with a history of depression that was in remission at time of study. Trait depression was significantly associated with lower CBF, with the associations strongest in cingulate gyrus and frontal white matter. Use of antidepressant medication and more stressful life experiences were also associated with significantly lower CBF. Resting CBF in specific brain regions is associated with trait depression, experience of stressful life events, and current antidepressant use, and may provide a valuable biomarker for further studies.
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Affiliation(s)
- Joshua Chiappelli
- Maryland Psychiatric Research
Center, Department of Psychiatry, University of Maryland School of Medicine,
Baltimore, MD, USA
| | - Bhim M Adhikari
- Maryland Psychiatric Research
Center, Department of Psychiatry, University of Maryland School of Medicine,
Baltimore, MD, USA
| | - Mark D Kvarta
- Maryland Psychiatric Research
Center, Department of Psychiatry, University of Maryland School of Medicine,
Baltimore, MD, USA
| | - Heather A Bruce
- Maryland Psychiatric Research
Center, Department of Psychiatry, University of Maryland School of Medicine,
Baltimore, MD, USA
| | - Eric L Goldwaser
- Maryland Psychiatric Research
Center, Department of Psychiatry, University of Maryland School of Medicine,
Baltimore, MD, USA
| | - Yizhou Ma
- Maryland Psychiatric Research
Center, Department of Psychiatry, University of Maryland School of Medicine,
Baltimore, MD, USA
| | - Shuo Chen
- Maryland Psychiatric Research
Center, Department of Psychiatry, University of Maryland School of Medicine,
Baltimore, MD, USA
| | - Seth Ament
- Maryland Psychiatric Research
Center, Department of Psychiatry, University of Maryland School of Medicine,
Baltimore, MD, USA
| | - Alan R Shuldiner
- Department of Medicine, University
of Maryland School of Medicine, Baltimore, MD, USA
| | - Braxton D Mitchell
- Department of Medicine, University
of Maryland School of Medicine, Baltimore, MD, USA
- Geriatrics Research and Education
Clinical Center, Baltimore Veterans Administration, Baltimore, MD, USA
| | - Peter Kochunov
- Maryland Psychiatric Research
Center, Department of Psychiatry, University of Maryland School of Medicine,
Baltimore, MD, USA
| | - Danny JJ Wang
- Laboratory of Functional MRI
Technology, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck
School of Medicine, University of Southern California, Los Angeles, CA,
USA
| | - L Elliot Hong
- Maryland Psychiatric Research
Center, Department of Psychiatry, University of Maryland School of Medicine,
Baltimore, MD, USA
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9
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Efrati Y. Compulsive Sexual Behavior in Adolescents: The Roles of Personality, Attachment Orientations, Cognitive Mechanisms, and Psychopathology. COGNITIVE THERAPY AND RESEARCH 2023. [DOI: 10.1007/s10608-023-10359-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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10
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Olivieri F, Prattichizzo F, Lattanzio F, Bonfigli AR, Spazzafumo L. Antifragility and antiinflammaging: Can they play a role for a healthy longevity? Ageing Res Rev 2023; 84:101836. [PMID: 36574863 DOI: 10.1016/j.arr.2022.101836] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 12/25/2022]
Abstract
One of the most exciting challenges of the research on aging is to explain how the environmental factors interact with the genetic background to modulate the chances to reach the extreme limit of human life in healthy conditions. The complex epigenetic mechanisms can explain both the interaction between DNA and environmental factors, and the long-distance persistence of lifestyle effects, due to the so called "epigenetic memory". One of the most extensively investigated theories on aging focuses on the inflammatory responses, suggesting that the age-related progression of low-grade and therefore for long time subclinical, chronic, systemic, inflammatory process, named "inflammaging", could be the most relevant risk factor for the development and progression of the most common age-related diseases and ultimately of death. The results of many studies on long-lived people, especially on centenarians, suggested that healthy old people can cope with inflammaging upregulating the antiinflammaging responses. Overall, a genetic make-up coding for a strong antiinflammaging response and an age-related ability to remodel key metabolic pathways to cope with a plethora of antigens and stressors seem to be the best ways for reach the extreme limit of human lifespan in health status. In this scenario, we wondered if the antifragility concept, recently developed in the framework of business and risk analysis, could add some information to disentangle the heterogeneous nature of the aging process in human. The antifragility is the property of the complex systems to increase their performances because of high stress. Based on this theory we were wondering if some subjects could be able to modulate faster than others their epigenome to cope with a plethora of stressors during life, probably modulating the inflammatory and anti-inflammatory responses. In this framework, antifragility could share some common mechanisms with anti-inflammaging, modulating the ability to restrain the inflammatory responses, so that antifragility and antiinflammaging could be viewed as different pieces of the same puzzle, both impinging upon the chances to travel along the healthy aging trajectory.
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Affiliation(s)
- Fabiola Olivieri
- Department of Clinical and Molecular Sciences, DISCLIMO, Università Politecnica Delle Marche, Ancona, Italy; Clinica di Medicina di Laboratorio e di Precisione, IRCCS INRCA, Ancona, Italy.
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11
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Ontological Adaptation in Transition to Adulthood: A Theoretical Framework for Integrating Phenomenology and Neuroscience in Psychosis Research. J Nerv Ment Dis 2023; 211:95-99. [PMID: 36716063 PMCID: PMC9897446 DOI: 10.1097/nmd.0000000000001602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In this theoretical review, the neurodevelopmental model of psychotic disorders is considered within the framework of ontological development, referring to the individual-level construction of a sense of reality regarding identity and worldview. Following Erikson's theory of development, the challenge of forging a personal and social identity is a developmental process typical of late adolescence and early adulthood. Accompanying this process is a developmentally normal increase in exploratory and risk-taking behavior, which sometimes includes challenging and defying cultural norms. Although many aspects of ontological adaptation are developmentally appropriate, we argue that psychopathology such as psychosis can be rooted in an abnormal deviation of this process, in which aberrant salience accelerates the typical drive to develop a meaningful sense of identity, leading to delusion formation. By placing psychosis onset within a broader context of normal development, this model offers a humanistic approach for understanding experiences of new onset of psychotic disorders.
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Bruce HA, Kochunov P, Kvarta MD, Goldwaser EL, Chiappelli J, Schwartz A, Lightner S, Endres J, Yuen A, Ma Y, Van der Vaart A, Hatch KS, Gao S, Ye Z, Wu Q, Chen S, Mitchell BD, Hong LE. Frontal white matter association with sleep quality and the role of stress. J Sleep Res 2023; 32:e13669. [PMID: 35698853 PMCID: PMC9748025 DOI: 10.1111/jsr.13669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 02/03/2023]
Abstract
An important measure of brain health is the integrity of white matter connectivity structures that link brain regions. Studies have found an association between poorer sleep quality and decreased white matter integrity. Stress is among the strongest predictors of sleep quality. This study aimed to evaluate the association between sleep quality and white matter and to test if the relationship persisted after accounting for stress. White matter microstructures were measured by diffusion tensor imaging in a population of Old Order Amish/Mennonite (N = 240). Sleep quality was determined by the Pittsburgh Sleep Quality Index. Current stress levels were measured by the perceived stress scale. Exposure to lifetime stress was measured by the lifetime stressor inventory. Microstructures of four white matter tracts: left and right anterior limbs of internal capsule, left anterior corona radiata, and genu of corpus callosum were significantly correlated with sleep quality (all p ≤ 0.001). The current stress level was a significant predictor of sleep quality (p ≤ 0.001) while lifetime stress was not. PSQI remained significantly associated with white matter integrity in these frontal tracts (all p < 0.01) after accounting for current stress and lifetime stress, while current and lifetime stress were not significant predictors of white matter in any of the four models. Sleep quality did not have any substantial mediation role between stress and white matter integrity. Sleep quality was significantly associated with several frontal white matter tracts that connect brain structures important for sleep regulation regardless of current or past stress levels.
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Affiliation(s)
- Heather A Bruce
- Department of Psychiatry, Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Peter Kochunov
- Department of Psychiatry, Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Mark D Kvarta
- Department of Psychiatry, Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Eric L Goldwaser
- Department of Psychiatry, Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Joshua Chiappelli
- Department of Psychiatry, Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Adina Schwartz
- Department of Psychiatry, Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Samantha Lightner
- Department of Psychiatry, Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Jane Endres
- Department of Psychiatry, Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Alexa Yuen
- Department of Psychiatry, Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Yizhou Ma
- Department of Psychiatry, Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Andrew Van der Vaart
- Department of Psychiatry, Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Kathryn S Hatch
- Department of Psychiatry, Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Si Gao
- Department of Psychiatry, Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Zhenyao Ye
- Department of Psychiatry, Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Qiong Wu
- University of Maryland, College Park, Maryland, USA
| | - Shuo Chen
- Department of Psychiatry, Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Braxton D Mitchell
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Geriatrics Research and Education Clinical Center, Baltimore Veterans Administration Medical Center, Baltimore, Maryland, USA
| | - L Elliot Hong
- Department of Psychiatry, Maryland Psychiatric Research Center, School of Medicine, University of Maryland, Baltimore, Maryland, USA
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Xu Q, Li D, Dong Y, Wu Y, Cao H, Zhang F, Xia Y, Chen J, Wang X. The Relationship Between Personality Traits and Clinical Decision-Making, Anxiety and Stress Among Intern Nursing Students During COVID-19: A Cross-Sectional Study. Psychol Res Behav Manag 2023; 16:57-69. [PMID: 36647549 PMCID: PMC9840395 DOI: 10.2147/prbm.s387682] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/21/2022] [Indexed: 01/11/2023] Open
Abstract
Purpose The aim of this study was to investigate whether the personality traits of intern nursing students could serve as valid predictors of their psychological status and clinical decision making. Additionally, we aimed to understand the psychological state of intern nursing students during the regular epidemic prevention and control stage of COVID-19. Participants and Methods This study was designed as a cross-sectional survey. A total of 181 intern nursing students involved in clinical placements participated in this study. Participants provided relevant data by completing the Big Five Inventory-44, the Self-Rating Anxiety Scale, the Perceived Stress Scale 14, and the Clinical Decision-Making in Nursing Scale. Results The results showed that neuroticism (β = -0.282, p < 0.01) and openness (β = 0.302, p < 0.001) played significant roles in predicting clinical decision-making skills among intern nursing students. Regression analysis also showed extraversion (β = -0.249, p < 0.01), openness (β = 0.2, p < 0.01), and neuroticism (β = 0.391, p < 0.001) could significantly predict stress in intern nursing students. The agreeableness (β = -0.354, p < 0.001) and neuroticism (β = 0.237, p < 0.01) could also predict the anxiety of intern nursing students. Additionally, some intern nursing students still suffered from anxiety and stress in the context of the ongoing pandemic. Conclusion Personality traits are good predictors of clinical decision-making, anxiety and stress among intern nursing students. In conclusion, the openness in personality traits of intern nursing students should be valued and cultivated in clinical work, which will benefit the development of nursing talents.
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Affiliation(s)
- Qin Xu
- Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China,Wuxi School of Medicine, Jiangnan University, Wuxi, People’s Republic of China
| | - Dan Li
- Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China,Wuxi School of Medicine, Jiangnan University, Wuxi, People’s Republic of China
| | - Yongning Dong
- Wuxi School of Medicine, Jiangnan University, Wuxi, People’s Republic of China
| | - Yi Wu
- Wuxi School of Medicine, Jiangnan University, Wuxi, People’s Republic of China
| | - Hong Cao
- Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China,Wuxi School of Medicine, Jiangnan University, Wuxi, People’s Republic of China
| | - Feng Zhang
- Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China,Wuxi School of Medicine, Jiangnan University, Wuxi, People’s Republic of China
| | - Yanping Xia
- Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China
| | - Jing Chen
- Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China,Wuxi School of Medicine, Jiangnan University, Wuxi, People’s Republic of China,Correspondence: Jing Chen; Xuesong Wang, No. 1000 Hefeng Road, Binhu District, Wuxi, People’s Republic of China, Email ;
| | - Xuesong Wang
- Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China,Wuxi School of Medicine, Jiangnan University, Wuxi, People’s Republic of China
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14
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Ewen ACI, Rief W, Wilhelm M. Exploring the path of persisting dysfunctional expectations-Development of the immunization scale IMS. Front Psychol 2022; 13:1033078. [PMID: 36570994 PMCID: PMC9773141 DOI: 10.3389/fpsyg.2022.1033078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives Persistent dysfunctional expectations seem to be core features of mental disorders. The aim of this study was to develop a questionnaire that assesses mechanisms responsible for the consistency of dysfunctional expectations. Processes before (i.e., assimilation) and after (i.e., immunization) expectation-violating experiences have been considered. Design The Immunization Scale (IMS) is constructed and validated with the help of an explorative (EFA) and confirmatory factor analysis (CFA) in two conducted studies. Materials and methods For the first study, the initially formulated 75-item version was completed online by 230 (range 18-69) participants from a convenience sample. For the second study, 299 (range 18-62) participants completed the reduced scale at the first measurement point, 75 participants thereof also 1 month later. For validity and reliability analyses, participants in both studies provided demographic information, the Beck Depression Inventory (BDI-II), the Depressive Expectation Scale (DES), the Beck Anxiety Inventory (BAI), and the German version of the Acceptance and Action Questionnaire (FAH-II). Results The initial 75 items were reduced to 23 items. The EFA revealed three main factors, namely, negative expectations, assimilation, and cognitive immunization. The three-factor structure could be confirmed in study 2 by the CFA. Reliability measures showed an excellent internal consistency for the entire IMS. A very good test-retest reliability was found. Significant correlations resulted between the IMS and DES, BDI-II, BAI, and FAH-II, the highest for DES and FAH-II. Conclusion Psychometric properties of the IMS are promising. Future studies should verify the reliability and validity measures in other population samples. The IMS can be very useful in expectation research, especially in the examination of expectation-focused therapy.
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15
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Yang SW, Koo M. The Big Five Personality Traits as Predictors of Negative Emotional States in University Students in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16468. [PMID: 36554348 PMCID: PMC9779468 DOI: 10.3390/ijerph192416468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/27/2022] [Accepted: 12/07/2022] [Indexed: 06/01/2023]
Abstract
Negative emotional states, such as stress, anxiety, and depression, are prevalent in university students. Personality traits have been shown to be associated with a wide range of behaviors in students, such as academic motivation, achievement, and social well-being. The aim of this study was to investigate the association between the Big Five personality traits and negative emotion states in university students in Taiwan. A cross-sectional study was conducted on 580 university students in Taiwan. Negative emotional states were evaluated using the Depression Anxiety Stress Scale-21 (DASS-21) and the Big Five personality traits were measured using the 48-item Big Five Inventory. A hierarchical linear regression analysis was used to assess the factors associated with DASS-21 scores. Neuroticism (standardized beta [std. β] = 0.45, p < 0.001) and openness (std. β = 0.12, p = 0.003) were significantly associated with DASS-21 scores, while agreeableness (std. β = -0.10, p = 0.007) was significantly and inversely associated with DASS-21 scores. Personality traits could be used to identify students at risk of negative emotional states and to undertake appropriate preventive strategies.
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Affiliation(s)
- Shih-Wei Yang
- Department of Education, National Chiayi University, Chiayi City 600355, Taiwan
- Department of Styling and Cosmetology, Tainan University of Technology, Tainan City 710302, Taiwan
| | - Malcolm Koo
- Graduate Institute of Long-Term Care, Tzu Chi University of Science and Technology, Hualien City 970302, Taiwan
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
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16
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López-Taboada I, Sal-Sarria S, Vallejo G, Coto-Montes A, Conejo NM, González-Pardo H. Sexual dimorphism in spatial learning and brain metabolism after exposure to a western diet and early life stress in rats. Physiol Behav 2022; 257:113969. [PMID: 36181786 DOI: 10.1016/j.physbeh.2022.113969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/17/2022] [Accepted: 09/22/2022] [Indexed: 01/06/2023]
Abstract
Prolonged daily intake of Western-type diet rich in saturated fats and sugars, and exposure to early life stress have been independently linked to impaired neurodevelopment and behaviour in animal models. However, sex-specific effects of both environmental factors combined on spatial learning and memory, behavioural flexibility, and brain oxidative capacity have still not been addressed. The current study aimed to evaluate the impact of maternal and postnatal exposure to a high-fat and high-sugar diet (HFS), and exposure to early life stress by maternal separation in adult male and female Wistar rats. For this purpose, spatial learning and memory and behavioural flexibility were evaluated in the Morris water maze, and regional brain oxidative capacity and oxidative stress levels were measured in the hippocampus and medial prefrontal cortex. Spatial memory, regional brain oxidative metabolism, and levels of oxidative stress differed between females and males, suggesting sexual dimorphism in the effects of a HFS diet and early life stress. Males fed the HFS diet performed better than all other experimental groups independently of early life stress exposure. However, behavioural flexibility evaluated in the spatial reversal leaning task was impaired in males fed the HFS diet. In addition, exposure to maternal separation or the HFS diet increased the metabolic capacity of the prefrontal cortex and dorsal hippocampus in males and females. Levels of oxidative stress measured in the latter brain regions were also increased in groups fed the HFS diet, but maternal separation seemed to dampen regional brain oxidative stress levels. Therefore, these results suggest a compensatory effect resulting from the interaction between prolonged exposure to a HFS diet and early life stress.
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Affiliation(s)
- Isabel López-Taboada
- Laboratory of Neuroscience, Department of Psychology, Faculty of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003, Oviedo, Spain; Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Av. del Hospital Universitario s/n, 33011 Oviedo, Spain
| | - Saúl Sal-Sarria
- Laboratory of Neuroscience, Department of Psychology, Faculty of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003, Oviedo, Spain; Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain
| | - Guillermo Vallejo
- Methodology area, Department of Psychology, Faculty of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Oviedo, Spain
| | - Ana Coto-Montes
- Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Av. del Hospital Universitario s/n, 33011 Oviedo, Spain; Department of Morphology and Cell Biology, Faculty of Medicine, University of Oviedo, Julián Clavería s/n, 33006 Oviedo, Spain
| | - Nélida M Conejo
- Laboratory of Neuroscience, Department of Psychology, Faculty of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003, Oviedo, Spain; Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Av. del Hospital Universitario s/n, 33011 Oviedo, Spain.
| | - Héctor González-Pardo
- Laboratory of Neuroscience, Department of Psychology, Faculty of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003, Oviedo, Spain; Institute of Neurosciences of the Principality of Asturias (INEUROPA), Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Av. del Hospital Universitario s/n, 33011 Oviedo, Spain
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Carreira-Míguez M, Navarro-Jiménez E, Clemente-Suárez VJ. Behavioral Patterns of Depression Patients and Control Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9506. [PMID: 35954861 PMCID: PMC9368084 DOI: 10.3390/ijerph19159506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/27/2022] [Accepted: 07/30/2022] [Indexed: 12/21/2022]
Abstract
Behavioral and multifactorial factors, such as psychological, nutritional, dental pathology, and physical activity habits, are factors that control depression. The objective of the present study was to analyze the differences in the behavioral, psychological, nutritional, dental pathology, and physical activity patterns of the depressed and control population. Forty-eight participants with depression (45.7 ± 12.0) and one hundred participants in a control group without any pathology or medication (48.9 ± 7.9) were interviewed using an online questionnaire. The multifactorial items of psychology, oral behavior, nutritional habits, and physical activity profile were analyzed through a set of questionnaires. The results showed how the depression group showed significantly higher psychological measures related to personality, anxiety, depression, loneliness, perceived stress, and psychological inflexibility than the control group. The control group showed significantly higher weekly vitality, vitality at the end of the week, weekly frequency of juice, wine, coffee, fresh vegetable salad, and Bristol scale than the depression group. Higher values of migraine headache, weekly soft drink frequency, and digestion after meals were found in the depression group. In addition, patients with depression also presented poor dental health, presenting higher rates of gastritis or heartburn, dry mouth, dental sensitivity, and sick days per year than the control group. Both groups presented a pattern of low physical activity. This information allows a better understanding of a multifactorial disease, as well as the creation of intervention and prevention protocols for this disease at a behavioral and lifestyle level.
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Affiliation(s)
- María Carreira-Míguez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street s/n, 28670 Madrid, Spain;
| | | | - Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street s/n, 28670 Madrid, Spain;
- Grupo de Investigación en Cultura, Educación y Sociedad, Universidad de la Costa, Barranquilla 080002, Colombia
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18
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Interleukin-6-white matter network differences explained the susceptibility to depression after stressful life events. J Affect Disord 2022; 305:122-132. [PMID: 35271870 DOI: 10.1016/j.jad.2022.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Stressful life events (SLEs) are well-established proximal predictors of the onset of depression. However, the fundamental causes of interindividual differences in depression outcomes are poorly understood. This study addressed this depression susceptibility mechanism using a well-powered sample of adults living in China. METHODS Healthy participants with SLEs (n = 185; mean = 47.51 years, 49.73% female), drawn from a longitudinal study on the development of depression, underwent diffusion tensor imaging, interleukin-6 (IL-6) level measurement, and trimonthly standardized clinical and scale evaluations within a two-year period. RESULTS Receiver operating characteristic analyses indicated that reduced feeder connection and HIP.R nodal efficiency improved the predictive accuracy of post-SLEs depression (ORfeeder = 0.623, AUC = 0.869, P < 0.001; ORHIP = 0.459, AUC = 0.855, P < 0.001). The successfully established path analysis model confirmed the significant partial effect of SLEs-IL-6-white matter (WM) network differences-depression (onset and severity) (x2/8 = 1.453, goodness-of-fit [GFI] = 0.935, standard root-mean-square error of approximation [SRMR] = 0.024). Females, individuals with lower exercise frequency (EF) or annual household income (AHI) were more likely to have higher IL-6 level after SLEs (βint-female⁎SLEs = -0.420, P < 0.001; βint-exercise⁎SLEs = -0.412, P < 0.001; βint-income⁎SLEs = -0.302, P = 0.005). LIMITATIONS The sample size was restricted due to the limited incidence rate and prospective follow-up design. CONCLUSIONS Our results suggested that among healthy adults after SLEs, those who exhibited abnormal IL-6-WM differences were susceptible to developing depression. Females, lower AHI or EF might account for an increased risk of developing these abnormal IL-6-WM differences.
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Hou F, Han X, Wang Q, Zhou S, Zhang J, Shen G, Zhang Y. Cross-Sectional Associations between Living and Built Environments and Depression Symptoms among Chinese Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105819. [PMID: 35627355 PMCID: PMC9140945 DOI: 10.3390/ijerph19105819] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 02/04/2023]
Abstract
In this study, we explored the cross-sectional associations between living and built environments and depression among older Chinese adults. Data from 5822 participants were obtained. Depression symptoms were evaluated through the use of the Patient Health Questionnaire (PHQ-9), with a score higher than 4 categorized as having depression symptoms. The living environment was assessed by asking about dust in the environment and barrier-free facilities. We considered the presence of amenities within a 10 min walking distance and the proportion of green space within an 800 m distance from participants’ dwellings to reflect the built environment. Data were analyzed by multilevel logistic regression. Participants living in a non-dusty environment with proximity to green space had a lower risk of depression (non-dusty environment: OR = 0.784, 95% CI = 0.642, 0.956; green space: OR = 0.834, 95% CI = 0.697, 0.998). However, having no access to barrier-free facilities and hospital proximity increased the depression risk (barrier-free facilities: OR = 1.253, 95% CI = 1.078, 1.457; hospital: OR = 1.318, 95% CI = 1.104, 1.574). Dusty environments, access to barrier-free facilities and proximity to hospitals and green spaces were associated with depression symptoms among older Chinese adults.
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Affiliation(s)
- Fangfang Hou
- School of Health Service Management, Anhui Medical University, Hefei 230032, China; (F.H.); (X.H.); (Q.W.); (S.Z.); (J.Z.)
| | - Xiao Han
- School of Health Service Management, Anhui Medical University, Hefei 230032, China; (F.H.); (X.H.); (Q.W.); (S.Z.); (J.Z.)
| | - Qiong Wang
- School of Health Service Management, Anhui Medical University, Hefei 230032, China; (F.H.); (X.H.); (Q.W.); (S.Z.); (J.Z.)
| | - Shuai Zhou
- School of Health Service Management, Anhui Medical University, Hefei 230032, China; (F.H.); (X.H.); (Q.W.); (S.Z.); (J.Z.)
| | - Jingya Zhang
- School of Health Service Management, Anhui Medical University, Hefei 230032, China; (F.H.); (X.H.); (Q.W.); (S.Z.); (J.Z.)
| | - Guodong Shen
- Department of Geriatrics, The First Affiliated Hospital of University of Science and Technology of China, Gerontology Institute of Anhui Province, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
- Anhui Provincial Key Laboratory of Tumor Immunotherapy and Nutrition Therapy, Hefei 230001, China
- Correspondence: (G.S.); (Y.Z.); Tel.: +86-551-62282371 (G.S.); +86-551-65161220 (Y.Z.)
| | - Yan Zhang
- School of Health Service Management, Anhui Medical University, Hefei 230032, China; (F.H.); (X.H.); (Q.W.); (S.Z.); (J.Z.)
- Correspondence: (G.S.); (Y.Z.); Tel.: +86-551-62282371 (G.S.); +86-551-65161220 (Y.Z.)
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