Associations between pain and depressive symptoms: A longitudinal study of Chinese adolescents

Association between pain intensity and depressive status in patients with hip fracture: An observational study

Identifying depression symptoms in patients with hip fractures and studying the relationship between depression and pain intensity and pain location in hip fracture patients is of great significance for disease recovery in hip fracture patients. This cohort study analyzed 5 wave data from the China Health and Retirement Longitudinal Study in 2011, 2013, 2015, 2018, and 2020, focusing on 1222 patients with hip fractures. The study utilized the CESD-10 Depression Scale to assess depressive symptoms in hip fracture patients and conducted analyses to explore the relationship between depression symptoms, pain, and pain intensity, including binary logistic regression and examination of interaction terms between pain variables and pain intensity in key body parts. Depression symptoms are strongly associated with pain intensity in hip fracture patients, particularly in key body areas. Severe pain significantly increases the risk of depressive symptoms. Moreover, absence of pain in other key body parts is linked to depressive symptoms. Multivariate analysis reveals that higher education levels, marriage, urban residence, and self-rated good health serve as protective factors against depression, while diabetes and heart disease pose significant risks for depressive symptoms in hip fracture patients. Hip fracture pain can induce discomfort and trigger depressive symptoms, showing varied trajectories among patients. Pain intensity predicts the course of depressive symptoms, emphasizing the importance of tailored pain management strategies including medication, physical therapy, and nonpharmacological interventions. Personalized rehabilitation and mental health plans should be designed based on individual patient needs and differences.

Longitudinal associations between subjective cognitive impairment, pain and depressive symptoms in home-dwelling older adults: Modelling within-person effects

OBJECTIVES

Cognitive impairment, pain and depressive symptoms are common and interrelated factors in older adults. However, the directionality and specificity of their association remains unclarified. This study explored whether these factors prospectively increase reciprocal risk and examined the longitudinal association between these factors and quality of life (QoL).

METHODS

This study used longitudinal data from The Older Persons and Informal Caregivers Survey Minimal Data Set (TOPICS-MDS; the Netherlands). Older adults self-reported cognitive impairment, pain, depressive symptoms and QoL at baseline and after 6 and 12 months of follow-up. The Random Intercept Cross-Lagged Panel Model was used to assess the prospective association between the three factors, while a multilevel linear regression analysis in a two-level random intercept model was used to examine the longitudinal associations between the three factors and QoL at the within-person level.

RESULTS

The data of 11,582 home-dwelling older adults with or without subjective cognitive impairment were analysed. At the within-person level, pain at 6 months was associated with subsequent depressive symptoms (β = 0.04, p = 0.024). The reverse association from depression to pain, and longitudinal associations between pain and subjective cognitive impairment and between depressive symptoms and subjective cognitive impairment were non-significant. Pain, depressive symptoms and subjective cognitive impairment showed a significant association with poor QoL 6 months later.

CONCLUSIONS

A directional relationship was observed from pain to depressive symptoms. Pain reduction holds a potential benefit in the prevention of depressive symptoms, ultimately optimising the QoL of older adults.

Starting a Romantic Relationship, Breakups, and Sleep: A Longitudinal Study of Chinese Adolescents

BACKGROUND

Epidemiological data on the association between romantic experiences and sleep in adolescents are limited. This study examined the associations of starting a romantic relationship (SRR) and romantic breakups with insomnia symptoms and sleep duration in adolescents.

METHODS

A total of 7,072 Chinese adolescents were surveyed in November-December 2015 and 1 year later. A self-administered questionnaire was used to assess SRR, romantic breakups, sleep duration, insomnia symptoms, depressive symptoms, substance use, and demographics.

RESULTS

The mean age of the sample was 14.58 (SD = 1.46) years and half were female. SRR only, breakups only, and both (SRR + breakups) in the past year were reported by 7.0%, 8.4%, and 15.4% of the sample, respectively. At the baseline and 1-year follow-up, 15.2% and 14.7% of the sample had insomnia symptoms and 47.7% and 42.1% reported short sleep duration (<7 h/night), respectively. After adjusting for depressive symptoms, substance use, and demographics, SRR and breakups were significantly associated with 35-45% increased odds of insomnia symptoms at baseline. SRR + breakups were significantly associated with short sleep duration (OR = 1.28, 95%CI = 1.05-1.56). SRR (OR = 1.61, 95%CI = 1.16-2.23) and breakups (OR = 1.43, 95%CI = 1.04-1.96) were significantly associated with increased odds of incident insomnia symptoms at 1-year follow-up. These associations were stronger in younger adolescents (<15 years) than in older adolescents (≥15 years), especially in girls.

CONCLUSIONS

The findings suggest that SRR and breakups are associated with insomnia symptoms and short sleep duration, underscoring the importance of romantic relationships education and management of romantic stress for healthy sleep especially in early adolescent girls.

Association of changes in sleep duration and quality with incidence of depression: A cohort study

BACKGROUND

The longitudinal relationship between sleep duration, sleep quality, and their changes with the risk of depressive symptoms is unclear. We examined the association between sleep duration, sleep quality, and their changes with incident depressive symptoms.

METHODS

A total of 225,915 Korean adults without depression at baseline with a mean age of 38.5 years were followed for an average of 4.0 years. Sleep duration and quality were assessed using the Pittsburgh Sleep Quality Index. The presence of depressive symptoms was assessed using the Center for Epidemiologic Studies Depression scale. Flexible parametric proportional hazard models were used to determine hazard ratios (HRs) and 95 % confidence intervals (CIs).

RESULTS

In total, 30,104 participants with incident depressive symptoms were identified. Multivariable-adjusted HRs (95 % CIs) for incident depression comparing sleep durations of ≤5, 6, 8, and ≥9 h with 7 h were 1.15 (1.11-1.20), 1.06 (1.03-1.09), 0.99 (0.95-1.03), and 1.06 (0.98-1.14), respectively. A similar trend was observed in patients with poor sleep quality. Compared with participants with persistently good sleep quality, participants with persistently poor sleep quality or who developed poor sleep quality were associated with the risk of incident depressive symptoms [HRs (95 % CIs) of 2.13 (2.01-2.25) and 1.67 (1.58-1.77), respectively].

LIMITATIONS

Sleep duration was assessed using self-reported questionnaire and the study population may not reflect general population.

CONCLUSIONS

Sleep duration, sleep quality and their changes were independently associated with incident depressive symptoms in young adults, suggesting that inadequate sleep quantity and quality play a role in depression risk.

Effects of pain and depression on the relationship between household solid fuel use and disability among middle-aged and older adults

Household air pollution (HAP) is suggested to increases people's risk of disability, but mediating mechanisms between HAP and disability remains under-investigated. The aim of this study was to investigate the underlying mechanisms between household air pollution and disability in middle-aged and older adults (i.e., older than 45 years) using a nationally representative prospective cohort. In total, 3754 middle-aged and older adults were selected from the China Health and Retirement Longitudinal Study. Correlation analysis and logistic regression analysis were employed to estimate the association between HAP, pain, depression and disability. Finally, three significant mediation pathways through which HAP directly impacts disability were found: (1) pain (B = 0.09, 95% CI 0.01, 0.02), accounting for 15.25% of the total effect; (2) depression (B = 0.07, 95% CI 0.004, 0.02), accounting for 11.86% of the total effect; (3) pain and depression (B = 0.04, 95% CI 0.003, 0.01), accounting for 6.78% of the total effect. The total mediating effect was 33.89%. This study clarified that HAP can indirectly affect disability through the respective and serial mediating roles of pain and depression. These findings potentially have important implications for national strategies concerning the widespread use of clean fuels by citizens.

Associations between Insomnia, Daytime Sleepiness, and Depressive Symptoms in Adolescents: A Three-Wave Longitudinal Study

BACKGROUND

Insomnia, daytime sleepiness, and depressive symptoms are prevalent in adolescents. This three-wave prospective study examined the associations between the three symptoms in adolescents.

METHODS

A total of 6995 schoolchildren in 7th and 10th grades (Mean age = 14.86 years) participated in a longitudinal study of behavior and health in Shandong, China. Standardized rating scales were used to assess symptoms of insomnia, daytime sleepiness, and depression in November-December in 2015, 1 year later, and 2 years later.

RESULTS

Insomnia was cross-sectionally associated with 10-14-fold increased odds of daytime sleepiness and 5-9-fold increased odds of depression. Daytime sleepiness was associated with 4-5-fold increased odds of depression. Insomnia, daytime sleepiness, or depression at a later time point was significantly predicted by itself at earlier time points. Insomnia was a significant predictor of daytime sleepiness and depression and a mediator between depression and daytime sleepiness. Daytime sleepiness was a significant predictor of insomnia and a mediator between depression and insomnia. Depression was a significant predictor of insomnia and daytime sleepiness and a mediator between insomnia and daytime sleepiness.

CONCLUSIONS

Insomnia, daytime sleepiness, and depressive symptoms were highly comorbid in adolescents. The associations of insomnia with daytime sleepiness and depression were bidirectional. Depression predicted daytime sleepiness, but not vice versa. Further research is needed to understand the underlying neurobiological mechanisms between insomnia, daytime sleepiness, and depression during adolescence.

A longitudinal study of bidirectional associations between frequent pain and insomnia symptoms in adolescents

BACKGROUND

Chronic pain and insomnia symptoms are prevalent in adolescents. This study examined the prospective associations between pain and insomnia symptoms in a large sample of adolescents.

METHODS

A total of 7072 adolescents (mean age = 14.6 years) participated in a longitudinal study of behavior and health in Shandong, China. A baseline survey was conducted in November-December of 2015, and a follow-up survey was conducted one year later. A self-administered questionnaire was used to assess headache, stomachache, other nonspecific pain, depression, substance use, and family environment. The Youth Self-Rating Insomnia Scale was used to measure insomnia symptoms.

RESULTS

At baseline and 1-year follow-up, frequent pain was reported by 8.4% and 7.8% of the sample, respectively; moderate to severe insomnia symptoms were reported by 15.2% and 14.8%, respectively. Logistic regression analyses showed that frequent pain at baseline was significantly associated with increased odds of incident insomnia symptoms at 1-year follow-up (odds ratio [OR] = 1.70, 95% confidence interval [CI] = 1.23-2.34) while adjusting for adolescent and family covariates. On the other hand, insomnia symptoms at baseline were significantly associated with increased odds of incident frequent pain at 1-year follow-up (OR = 2.00, 95% CI = 1.50-2.68). The 3 types of pain (ie, headache, stomachache, and other nonspecific pain) had similar associations with insomnia symptoms.

CONCLUSIONS

The findings suggest that the associations between frequent pain and insomnia are bidirectional, independent of multiple adolescent and family covariates. These findings stress the importance of assessment and management of both pain and insomnia symptoms in adolescents in routine clinical practice and school-based intervention programs.