Associations between sex hormones, sleep problems and depression: A systematic review

Gender-related alterations of serum trace elements and neurometabolism in the anterior cingulate cortex of patients with major depressive disorder

BACKGROUND

It is widely known that sex differences have a significant impact on patients with major depressive disorder (MDD). This study aims to evaluate the sex-related connection between serum trace elements and changes in neurometabolism in the anterior cingulate cortex (ACC) of MDD patients.

METHODS

109 untreated MDD patients and 59 healthy controls underwent proton magnetic resonance spectroscopy (1H-MRS) under resting conditions. We measured metabolic ratios in the ACC from both sides. Additionally, venous blood samples were taken from all participants to detect calcium (Ca), phosphorus, magnesium (Mg), copper (Cu), ceruloplasmin (CER), zinc (Zn), and iron (Fe) levels. We performed association and interaction analyses to explore the connections between the disease and gender.

RESULTS

In individuals with MDD, the Cu/Zn ratio increased, while the levels of Mg, CER, Zn and Fe decreased. Male MDD patients had lower Cu levels, while female patients had an increased Cu/Zn ratio. We observed significant gender differences in Cu, CER and the Cu/Zn ratio in MDD. Male patients showed a reduced N-acetyl aspartate (NAA)/phosphocreatine + creatine (PCr + Cr) ratio in the left ACC. The NAA/PCr + Cr ratio decreased in the right ACC in patients with MDD. In the left ACC of male MDD patients, the Cu/Zn ratio was inversely related to the NAA/PCr + Cr ratio, and Fe levels were negatively associated with the GPC + PC/PCr + Cr ratio.

CONCLUSIONS

Our findings highlight gender-specific changes in Cu homeostasis among male MDD patients. The Cu/Zn ratio and Fe levels in male MDD patients were significantly linked to neurometabolic alterations in the ACC.

Total testosterone plays a crucial role in the pathway from hypothyroidism to broad depression in women

BACKGROUND

Depression tends to develop in correlation with hypothyroidism, however it's unclear how testosterone traits contribute to this association. We examined the causal association between depression, testosterone traits, and hypothyroidism using Mendelian randomization (MR).

METHOD

We conducted univariable and multivariable MR studies using summary-level statistics from genome-wide association studies (GWAS) of Hypothyroidism (n = 213,990), broad depression (n = 322,580), probable major depressive disorder (probable MDD) (n = 174,519), and International Classification of Diseases (ICD)-9 or ICD-10-coded MDD (n = 217,584) from European ancestry. The inverse variance weighted (IVW) method was used as the main MR analysis.

RESULTS

In univariate MR analysis, there is a positive causal relationship between hypothyroidism and broad depression (P = 0.0074; OR = 1.0066; 95%CI: 1.0018-1.0114) and probable MDD (P = 0.0242; OR = 1.0056; 95%CI: 1.0007-1.0105). In females, there is a causal relationship between hypothyroidism and decreased total testosterone (P < 0.001; OR = 0.9747; 95%CI: 0.9612-0.9885) and sex hormone binding globulin (SHBG) levels (P = 0.0418; OR = 0.9858; 95%CI: 0.9723-0.9995). In females, there is an inverse causal relationship between total testosterone and broad depression (P = 0.0349; OR = 0.9898; 95%CI: 0.9804-0.9993). Furthermore, in multivariate MR analysis, after adjusting for total testosterone in females, hypothyroidism only has a positive causal relationship with probable MDD, and the relationship with broad depression is no longer significant. Most notably, after adjusting for hypothyroidism, the inverse causal effect of female total testosterone levels on broad depression becomes more significant (P = 0.0154; OR = 0.9878; 95%CI: 0.9780-0.9977).

CONCLUSION

Hypothyroidism increases the risk of broad depression and probable MDD development. Total Testosterone appears to play an important role in the relationship between hypothyroidism and broad depression in female.

Sleep disturbances and incident risk of major depressive disorder in a population-based cohort

Sleep disturbances are well-known symptoms of major depressive disorder (MDD). However, the prospective risk of MDD in the presence of sleep disturbances in a general population-based cohort is not well known. This study investigated associations between both polysomnography (PSG)-based or subjective sleep features and incident MDD. Participants representative of the general population who had never had MDD completed sleep questionnaires (n = 2000) and/or underwent PSG (n = 717). Over 8 years' follow-up, participants completed psychiatric interviews enabling the diagnosis of MDD. Survival Cox models were used to analyze associations between sleep features and MDD incidence. A higher Epworth Sleepiness Scale and presence of insomnia symptoms were significantly associated with a higher incidence of MDD (hazard ratio [HR] [95 % confidence interval (CI)]: 1.062 [1.022-1.103], p = 0.002 and 1.437 [1.064-1.940], p = 0.018, respectively). Higher density of rapid eye movements in rapid eye movement (REM) sleep was associated with a higher incidence of MDD in men (HR 1.270 [95 % CI 1.064-1.516], p = 0.008). In women, higher delta power spectral density was associated with a lower MDD incidence (HR 0.674 [95 % CI 0.463-0.981], p = 0.039). This study confirmed the associations between subjective and objective sleep features and the incidence of MDD in a large community dwelling cohort.

Exposure to a mixture of metal(loid)s and sleep quality in pregnant women during early pregnancy: A cross-sectional study

Biological characteristics of pregnant women during early pregnancy make them susceptible to both poor sleep quality and metal/metalloid exposure. However, the effects of metal(loid) exposure on sleep quality in pregnant women remain unknown and unexplored. We aimed to examine the relationship between exposure to a mixture of metal(loid)s and pregnant women's sleep quality during early pregnancy. We recruited 493 pregnant women in the first trimester from prenatal clinics in Jinan, Shandong Province, China, and collected their spot urine samples. All urine specimens were assessed for eight metal(loid)s: arsenic (As), cadmium (Cd), iron (Fe), zinc (Zn), molybdenum (Mo), lead (Pb), selenium (Se), and mercury (Hg). We used the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality. Linear regression, logistic regression, generalized additive models (GAMs), quantile g-computation, and Bayesian kernel machine regression (BKMR) were applied to investigate the relationships between metal(loid) exposure and sleep quality. The results from single metal(loid) models, quantile g-computation models, and BKMR models consistently suggested that Fe was positively related to women's sleep quality. Moreover, in the quantile g-computation models, As was the most critical contributor to the negative effects of the metal(loid) mixture on sleep quality. In addition, we found significant As by Fe interaction for scores of PSQI and habitual sleep efficiency, Pb by Fe interaction for PSQI and sleep latency, and Hg by Fe interaction for PSQI, suggesting the interactive effects of As and Fe, Pb and Fe, Hg and Fe on sleep quality and specific sleep components. Our study provided the first-hand evidence of the effects of metal(loid) exposure on pregnant women's sleep quality. The underlying mechanisms need to be explored in the future.

The psychological side of menopause: evidence from the comorbidity network of menopausal, anxiety, and depressive symptoms

OBJECTIVE

Numerous studies have uncovered a correlation between menopausal, anxiety, and depressive symptoms. How these symptoms interrelate and influence each other, however, remains unclear. This study aimed to identify the associations between menopausal, anxiety, and depressive symptoms using network analysis.

METHODS

The participants comprised 423 women (Mage = 49.21 ± 4.01 y; range, 40-60 y) recruited from a menopause clinic at a tertiary hospital in Beijing, China. Demographic characteristics and menopausal, anxiety, and depressive symptoms were obtained through self-report questionnaires. Two networks were established: a partial correlation network and a Bayesian network.

RESULTS

The menopausal symptom of nervousness exhibited a robust association with anxiety symptoms in both networks. Within the partial correlation network, the depressive symptom of tiredness emerged as a pivotal symptom, facilitating the co-occurrence of menopausal and depressive symptoms. Bayesian network analysis exhibited that the depressive symptom of a loss of interest was related to certain menopausal symptoms through depressive symptoms of tiredness and motor problems, both serving as critical links between menopausal symptoms and depression. Notably, four menopausal symptoms-arthralgia/myalgia, formication, sexual complaints, and urinary tract infection-appeared independent of other menopausal, anxiety, and depressive symptoms.

CONCLUSIONS

Both psychological (eg, fatigue) and somatic (eg, hot flashes, headaches, and dizziness) menopausal symptoms demonstrate strong associations with depression. In providing optimal support for women's health during menopause, psychological interventions aimed at depression, particularly among those experiencing a loss of interest or pleasure in activities, should complement conventional therapies.

The effect of mindfulness-based stress reduction program applied to postmenopausal women on insomnia and quality of life

This study aimed to determine the effect of the mindfulness-based stress reduction program applied to postmenopausal women on insomnia and quality of life. A quasi-experimental pretest-posttest control group design was used. The sample of the study consisted of a total of 151 postmenopausal women, including 73 in the experimental group and 78 in the control group. In the study, the mindfulness-based stress reduction program (MBSR) was applied to the women in the experimental group for eight weeks, and then the women repeated the program individually for another eight weeks. The second measurement data were collected eight weeks after the collection of the first measurement data, and the third measurement data were collected 16 weeks later. The mean score obtained from the second measurement application of the Women's Health Initiative Insomnia Rating Scale (WHIIRS) was lower in the experimental group than in the control group (p < .05). In addition, the mean scores from the second and third measurement applications of the Menopause-Specific Quality of Life Questionnaire (MENQOL) were lower in the experimental group than in the control group (p < .05). The MBSR program reduced postmenopausal women's insomnia and improved their quality of life. This program can be used safely to treat insomnia and improve the quality of life of postmenopausal women. NCT05202054 (date: 21.01.2022).

Female rodents in behavioral neuroscience: Narrative review on the methodological pitfalls

Since the NIH 'Sex as biological variable' policy, the percentage of studies including female subjects have increased largely. Nonetheless, many researchers fail to adequate their protocols to include females. In this narrative review, we aim to discuss the methodological pitfalls of the inclusion of female rodents in behavioral neuroscience. We address three points to consider in studies: the manipulations conducted only in female animals (such as estrous cycle monitoring, ovariectomy, and hormone replacement), the consideration of males as the standard, and biases related to interpretation and publication of the results. In addition, we suggest guidelines and perspectives for the inclusion of females in preclinical research.

Prevalence and factors associated with poor sleep quality among nurses in COVID-19 wards

The COVID-19 pandemic has significantly impacted the working conditions of nurses, leading to a detrimental effect on their sleep quality. This cross-sectional study aimed to investigate the prevalence of poor sleep quality and its associated factors among nurses working in COVID-19 wards in Kermanshah, Iran. A total of 97 nurses were selected through simple random sampling from COVID-19 wards. Data was collected using a demographic information sheet and the Pittsburgh Sleep Quality Index. Descriptive and inferential statistical methods, including chi-square and multiple logistic regression, were used for data analysis. The results showed that 74.2% (n = 72) of the nurses experienced poor sleep quality. Significant associations were found between poor sleep quality and work experience (p = 0.045) as well as the type of work shift (p = 0.001). However, no significant relationships were observed between poor sleep quality and factors such as age, sex, body mass index, overtime hours per month, physical activity, or underlying diseases. The high prevalence of poor sleep quality among nurses working in COVID-19 wards underscores the necessity of implementing targeted interventions to address this issue. In this regard, in addition to periodic shift schedule changes and reductions in working hours, it is necessary to adopt purposeful measures to improve working conditions and enhance the physical and mental health of nurses. These measures may include providing sufficient human resources to reduce the workload and fatigue of nurses, appropriate scheduling of working hours, and the implementation of stress management programs.

Sleep disturbance in rodent models and its sex-specific implications

Sleep disturbances, encompassing altered sleep physiology or disorders like insomnia and sleep apnea, profoundly impact physiological functions and elevate disease risk. Despite extensive research, the underlying mechanisms and sex-specific differences in sleep disorders remain elusive. While polysomnography serves as a cornerstone for human sleep studies, animal models provide invaluable insights into sleep mechanisms. However, the availability of animal models of sleep disorders is limited, with each model often representing a specific sleep issue or mechanism. Therefore, selecting appropriate animal models for sleep research is critical. Given the significant sex differences in sleep patterns and disorders, incorporating both male and female subjects in studies is essential for uncovering sex-specific mechanisms with clinical relevance. This review provides a comprehensive overview of various rodent models of sleep disturbance, including sleep deprivation, sleep fragmentation, and circadian rhythm dysfunction. We evaluate the advantages and disadvantages of each model and discuss sex differences in sleep and sleep disorders, along with potential mechanisms. We aim to advance our understanding of sleep disorders and facilitate sex-specific interventions.

Disturbed sex hormone milieu in males and females with major depressive disorder and low-grade inflammation

Sex hormones have biological effects on inflammation, and these might contribute to the sex-specific features of depression. C-reactive protein (CRP) is the most widely used inflammatory biomarker and consistent evidence shows a significant proportion (20-30 %) of patients with major depressive disorder (MDD) have CRP levels above 3 mg/L, a threshold indicating at least low-grade inflammation. Here, we investigate the interplay between sex hormones and CRP in the cross-sectional, observational Biomarkers in Depression Study. We measured serum high-sensitivity (hs-)CRP, in 64 healthy controls and 178 MDD patients, subdivided into those with hs-CRP below 3 mg/L (low-CRP; 53 males, 72 females) and with hs-CRP above 3 mg/L (high-CRP; 19 males, 34 females). We also measured interleukin-6, testosterone, 17-β-estradiol (E2), progesterone, sex-hormone binding globulin (SHBG), follicle-stimulating and luteinising hormones, and calculated testosterone-to-E2 ratio (T/E2), free androgen and estradiol indexes (FAI, FEI), and testosterone secretion index. In males, high-CRP patients had lower testosterone than controls (p = 0.001), and lower testosterone (p = 0.013), T/E2 (p < 0.001), and higher FEI (p = 0.015) than low-CRP patients. In females, high-CRP patients showed lower SHGB levels than controls (p = 0.033) and low-CRP patients (p = 0.034). The differences in testosterone, T/E2 ratio, and FEI levels in males survived the Benjamini-Hochberg FDR correction. In linear regression analyses, testosterone (β = -1.069 p = 0.033) predicted CRP concentrations (R2 = 0.252 p = 0.002) in male patients, and SHBG predicted CRP levels (β = -0.628 p = 0.009, R2 = 0.172 p = 0.003) in female patients. These findings may guide future research investigating interactions between gonadal and immune systems in depression, and the potential of hormonal therapies in MDD with inflammation.

An influence of menopausal symptoms on mental health, emotion perception, and quality of life: a multi-faceted approach

PURPOSE

The menopausal transition brings with it many physical, cognitive, and affective changes in a woman's life, impacting quality of life. Whereas prior work has examined impact on general mental health and cognitive function, research on basic affective processing during menopause remains scarce.

METHODS

Using a median-split procedure, this pre-registered study examined the impact of stronger (N = 46 women) vs. milder (N = 47 women) menopausal symptoms using a behavioural task of subjective emotion perception (embody) and a passive eye tracking viewing task of emotional faces in addition to self-report questionnaires. After 3 months, participants completed the questionnaires again to examine whether objective measures of emotion perception (eye tracking) might predict mental health at follow-up.

RESULTS

As anticipated, women with stronger vs. milder menopausal symptoms reported increased symptoms of anxiety, depression, stress, emotion regulation difficulties, and lower quality of life during both time points. While no evidence was found in the behavioural task, eye tracking data indicated blunted emotion perception in women with high menopausal symptoms, while women with low symptoms spent more time looking at happy faces relative to fearful or surprised faces. Although eye tracking or hormonal data did not predict mental health at follow-up, a higher estradiol/FSH ratio indicated a higher quality of life.

CONCLUSIONS

This study documented an impact of the menopausal transition and strength of menopausal symptoms in particular on objective emotion perception as well as mental health and quality of life in women suffering from stronger vs. milder menopausal symptoms. Clinical implications are discussed.

The Impact of Sleep on Haematological Parameters in Firefighters

Sleep is a vital process that impacts biological functions such as cell renewal, bone regeneration, and immune system support. Disrupted sleep can interrupt erythropoiesis, leading to fewer red blood cells, reduced haemoglobin concentration, and decreased haematocrit levels, potentially contributing to haematological disorders. This is particularly concerning for shift workers for example firefighters. While previous studies have explored sleep's adverse effects on various professions, research specific to firefighters is limited. This study investigates the relationship between sleep quality and haematological parameters among firefighters in Northeast Portugal. From a sample of 201 firefighters, variations in red blood cells, haemoglobin, and haematocrit values were linked to sleep quality. The study utilised non-parametric tests (Wilcoxon-Mann-Whitney, Spearman's correlation) to explore the connection between sleep quality and haematological profile. The impact of covariates on haematological parameters was assessed using non-parametric ANCOVA (Quade's). A multiple regression analysis was employed to further understand how sleep quality and various confounding variables impact haematological levels. Findings suggest a negative link between sleep quality and haematological levels, meaning that as sleep quality deteriorates, there is a tendency for haematological levels to decrease, as indicated by Spearman's correlation (rRBC = -0.157, pRBC = 0.026; rHb = -0.158, pHb = 0.025; rHCT = -0.175, pHCT = 0.013). As observed in scientific literature, the correlation found suggests a possible inhibition of erythropoiesis, the process responsible for red blood cell production. Despite firefighters presenting a haematological profile within the reference range (RBC: 5.1 × 106/mm3 (SD ± 0.4), Hb: 15.6 g/dL (SD ± 1.3), 47% (SD ± 1.0), there is already an observable trend towards lower levels. The analysis of co-variables did not reveal a significant impact of sleep quality on haematological levels. In conclusion, this study underscores the importance of sleep quality in determining haematological parameters among firefighters. Future research should investigate the underlying mechanisms and long-term implications of poor sleep quality on firefighter health. Exploring interventions to enhance sleep quality is vital for evidence-based strategies promoting firefighter well-being.

Longitudinal associations between biopsychosocial stress indicators and sleep in older Puerto Rican adults

OBJECTIVES

To examine the association of biopsychosocial stress indicators (perceived stress, perceived discrimination, stressful life events, and allostatic load) with sleep outcomes (sleep duration and insomnia symptoms) and to examine sex and age interactions for associations between stress and sleep in older Puerto Rican adults.

METHODS

Secondary analyses were performed with 830 participants (72% female) from wave 2 (2006-2011) of the Boston Puerto Rican Health Study (BPRHS), a prospective population-based cohort study (45-75years at baseline) and Boston Puerto Rican Osteoporosis Study (BPROS) (2007-2012), an ancillary study of the BPRHS. Recruitment occurred in randomly selected census blocks using door-to-door and community-based activities. In-home data collection visits included a baseline assessment and follow-up interviews. Questionnaires assessed perceived stress, discrimination, stressful life events, and sleep. Allostatic load indicators were measured objectively. Regression models controlled for sociodemographic, behavioral, and health factors, with interaction analyses, followed by sex- and sex-by-age-stratified analyses.

RESULTS

In the prior 2years, participants with chronic stress had 50% greater odds of reporting nonoptimal sleep duration (<7 or >9 hours). Life events trajectories were significantly related to insomnia symptoms. Men ≥65years who experienced chronic stress had greater insomnia symptoms than women, or than men with low stress or acute stress.

CONCLUSIONS

Stressful life events may affect sleep duration and insomnia symptoms among older Puerto Rican adults, particularly men 65 years and older who experienced chronic stress. Given the differences in sleep patterns experienced by older adults and their relationships with health outcomes, identifying methods to support sleep health among those with chronic stress is important.

Associations between smoking, sex steroid hormones, trouble sleeping, and depression among U.S. adults: a cross-sectional study from NHANES (2013-2016)

BACKGROUND

Dose-response and nonlinear relationships of cigarette exposure with sleep disturbances and depression are warranted, and the potential mechanism of sex hormones in such associations remains unclear.

METHODS

Cigarette exposure, trouble sleeping, and depression were assessed by standard questionnaires, and the levels of cotinine and sex steroid hormones were determined among 9900 adults from the National Health and Nutrition Examination Survey (NHANES). Multiple linear regression, logistic regression, and mediation models were conducted to evaluate the associations between smoking, sex steroid hormones, trouble sleeping, and depression.

RESULTS

With never smokers as a reference, current smokers had a higher prevalence of trouble sleeping (OR = 1.931, 95% CI: 1.680, 2.219) and depression (OR = 2.525, 95% CI: 1.936, 3.293) as well as testosterone level (β = 0.083, 95% CI: 0.028, 0.140). Pack-years of smoking and cigarettes per day were positively associated with the prevalence of trouble sleeping and depression as well as testosterone level (Ptrend <0.05). The restricted cubic spline model showed linear relationships of cotinine with trouble sleeping, depression, and testosterone. The positive associations of cigarettes per day with trouble sleeping and depression were greater in females than that in males (Pmodification <0.05). However, the potential role of sex hormones was not observed in the association of cotinine with trouble sleeping or depression (Pmediation >0.05).

CONCLUSION

Smoking may induce sex hormone disturbance and increase the risk of sleep problems and depression symptoms, and ceasing smoking may reduce the risk of such complications.

Sex differences in the relationship between depression and Alzheimer's disease-mechanisms, genetics, and therapeutic opportunities

Depression and Alzheimer's disease (AD) are prevalent neuropsychiatric disorders with intriguing epidemiological overlaps. Their interrelation has recently garnered widespread attention. Empirical evidence indicates that depressive disorders significantly contribute to AD risk, and approximately a quarter of AD patients have comorbid major depressive disorder, which underscores the bidirectional link between AD and depression. A growing body of evidence substantiates pervasive sex differences in both AD and depression: both conditions exhibit a higher incidence among women than among men. However, the available literature on this topic is somewhat fragmented, with no comprehensive review that delineates sex disparities in the depression-AD correlation. In this review, we bridge these gaps by summarizing recent progress in understanding sex-based differences in mechanisms, genetics, and therapeutic prospects for depression and AD. Additionally, we outline key challenges in the field, holding potential for improving treatment precision and efficacy tailored to male and female patients' distinct needs.

Sleep quality and mental health differences following Syria-Turkey earthquakes: A cross-sectional study

BACKGROUND

This study explores the lasting mental health impact of the Syria-Turkey earthquakes in 2023 on a population affected by conflict and trauma. It analyzes pre- and post-event mental health and sleep quality differences, identifying predictors of outcomes.

AIMS

Studying the 2023 Syria-Turkey earthquakes' enduring mental health impact on conflict-affected individuals, this research informs better support and interventions for disaster survivors.

METHODS

This longitudinal, cross-sectional study examined the enduring mental health impact of the Syria-Turkey earthquakes. The present study involved N = 1,413 Syrian survivors, aged 18 years or older, who actively participated by contributing both pre- and post-earthquake data. A meticulously designed digital questionnaire with established metrics assessed sleep disturbances, depressive symptoms, and anxiety levels. Stratification variables (age, gender, education, marital status) were used for subgroup analysis. Arabic versions of PHQ-9, PSQI, and GAD-2 proved reliable for measuring depression, sleep quality, and anxiety.

RESULTS

The majority of participants were female (73.6%) with tertiary education (83.3%). Post-earthquake, a higher percentage reported poor sleep quality (67.7% vs. 59.7%, p < .001) and increased prevalence of MDE (66.1% vs. 56%, p < .001). GAD did not differ significantly. Post-earthquake, women had a higher likelihood of poor sleep quality (OR: 1.58, 95% CI [1.19, 2.10], p < .001) and MDE (OR: 1.55, 95% CI [1.18 to 2.04], p = .003). Predictors varied before and after earthquakes; age and education were significant predictors of poor sleep quality, MDE, and GAD.

CONCLUSION

This study reveals higher rates of poor sleep quality and major depressive episodes among earthquake-affected individuals, especially women. Age, education, and gender contribute to these outcomes. Targeted interventions and comprehensive mental health support are crucial for post-earthquake recovery.

The prevalence of menstrual cycle symptoms and their association with mental health and sleep in German exercising women and athletes

OBJECTIVES

Menstrual cycle symptoms are very common in female athletes. However, more evidence about the association between menstrual cycle characteristics and symptoms with sleep and mental health in athletes needs to be gathered. This study aimed to examine this association in German exercising women and athletes.

DESIGN

322 women (mean age: 23.13 ± 4.36) participated in a cross-sectional study. The survey included the Menstrual Symptom index (MSi), the Depression Anxiety Stress Scales (DASS-21), the Pittsburgh Sleep Quality Index (PSQI), and the Athletes Sleep Behavior Questionnaire (ASBQ). Additionally, demographic, sport-specific data and further menstrual cycle characteristics were examined. Multiple regression models were used for the statistical analyses.

RESULTS

The MSi score demonstrated a highly significant (p < 0.001) positive association with Depression, Anxiety, Stress, PSQI, and ASBQ. The most prevalent menstrual cycle symptoms were cravings/increased appetite, mood changes/anxiety, and tiredness/fatigue. A difference between individual and team sport athletes could not be found. Moreover, there was no association between the constructs and menses length, irregularity, or heaviness of bleeding.

CONCLUSIONS

Menstrual cycle symptoms occur very frequently in female athletes. In this study, they were related to mental health, sleep quality, and sleep behavior, regardless of the cycle phase. This evidence demonstrates the relevance of considering the menstrual cycle and menstrual symptoms in future studies with female athletes and in sport practice.

Higher number of steps is related to lower endogenous progesterone but not estradiol levels in women

OBJECTIVES

Sex steroid hormones are important not only for reproduction but also for many aspects of women's health, including the risk of breast cancer. Physical activity has been shown to influence sex hormone levels in women. This study aimed to investigate a relationship between the average daily number of steps and the sex hormone (estradiol and progesterone) levels in premenopausal women.

MATERIALS AND METHODS

Data were collected from 85 healthy, urban women of reproductive age who performed at least 180 minutes/week of moderate physical activity for two complete menstrual cycles. Physical activity was measured using wrist bands. Estradiol and progesterone concentrations were measured in daily-collected saliva samples in the second menstrual cycle.

RESULTS

There was a significant negative association between the average number of steps taken daily and salivary progesterone levels after adjusting for potential confounding factors (age, BMI). Women who took more than 10,000 steps a day had significantly lower progesterone levels compared to women who took less than 10,000 steps. The association between physical activity and estradiol levels was statistically insignificant.

DISCUSSION

Our results indicate that taking at least 10,000 steps a day reduces progesterone levels, but this intensity of physical activity may not be high enough to affect estradiol levels. Daily step tracking is a valuable element of health promotion, but currently recommended levels of physical activity may not be high enough for healthy premenopausal women to significantly reduce both sex hormone levels and thus their risk of postmenopausal breast cancer.

Effects of injectable contraception with depot medroxyprogesterone acetate or norethisterone enanthate on estradiol levels and menstrual, psychological and behavioral measures relevant to HIV risk: The WHICH randomized trial

BACKGROUND

Observational data suggest lower HIV risk with norethisterone enanthate (NET-EN) than with depo-medroxyprogesterone acetate intramuscular (DMPA-IM) injectable contraceptives. If confirmed, a switch between these similar injectable methods would be programmatically feasible and could impact the trajectory of the HIV epidemic. We aimed in this paper to investigate the effects of DMPA-IM and NET-EN on estradiol levels, measures of depression and sexual activity and menstrual effects, relevant to HIV risk; and to ascertain whether these measures are associated with estradiol levels.

METHODS

This open-label trial conducted at two sites in South Africa from 5 November 2018 to 30 November 2019, randomized HIV-negative women aged 18-40 to DMPA-IM 150 mg intramuscular 12-weekly (n = 262) or NET-EN 200 mg intramuscular 8-weekly (n = 259). Data were collected on hormonal, behavioral and menstrual effects at baseline and at 25 weeks (25W).

RESULTS

At 25W, median 17β estradiol levels were substantially lower than at baseline (p<0.001) for both methods: 76.5 pmol/L (interquartile range (IQR) 54.1 to 104.2) in the DMPA-IM group (n = 222), and 69.8 pmol/L (IQR: 55.1 to 89.3) in the NET-EN group (n = 225), with no statistical difference between the two methods (p = 0.450). Compared with DMPA-IM, NET-EN users reported significantly less amenorrhoea, fewer sexual acts, fewer users reporting at least one act of unprotected sex, more condom use with steady partner, more days with urge for sexual intercourse, more days feeling partner does not love her, and more days feeling sad for no reason. We did not find a clear association between estradiol levels and sexual behavior, depression and menstrual effects. Behavioral outcomes suggest less sexual exposure with NET-EN than DMPA-IM. The strength of this evidence is high due to the randomized study design and the consistency of results across the outcomes measured.

CONCLUSIONS

Estradiol levels were reduced to postmenopausal levels by both methods. Secondary outcomes suggesting less sexual exposure with NET-EN are consistent with reported observational evidence of less HIV risk with NET-EN. A randomized trial powered for HIV acquisition is feasible and needed to answer this important question.

TRIAL REGISTRATION

PACTR 202009758229976.

The Association Between SHBG and Osteoporosis: A NHANES Cross-Sectional Study and A Bidirectional Mendelian Randomization

This study aimed to examine the association between sex hormone-binding globulin (SHBG) and osteoporosis through a cross-sectional study and a two-sample bidirectional Mendelian randomization (MR). We used the National Health and Nutrition Examination Survey (NHANES) 2013-2014 and 2015-2016 data, with exposure as serum SHBG and outcome as osteoporosis and performed multivariate logistic regression to test the correlation between SHBG and osteoporosis. To determine the causal relationship between SHBG and osteoporosis, a two-sample bidirectional MR was employed. The genome-wide association study (GWAS) dataset for SHBG (n = 189,473) was obtained from the IEU database, and the GWAS dataset for osteoporosis (n = 212,778) was obtained from the FinnGen bioBank. The principal MR technique was inverse-variance weighting (IVW). In MR analyses, the MR-Egger intercept and Cochran Q test were used to detect multiple validity and horizontal heterogeneity. 1249 older adult participants (age ≥ 60) were involved in the cross-sectional study, including 113 osteoporosis cases. We identified a significant relationship between circulating SHBG concentration and osteoporosis risk [OR 3.963, 95% CI (2.095-7.495), P < 0.05]. Subgroup analysis indicated that SHBG was closely linked to the risk of osteoporosis in the female population [OR 1.008, 95% CI (1.002-1.013), P = 0.005] but not in males (P = 0.065). In addition, The IVW approach suggested a causal connection between SHBG and increased osteoporosis risk [OR 1.479, 95% CI (1.144-1.912), P = 0.003], and the MR-Egger intercept and the Cochran Q test validated the consistency of the MR results. Finally, the reverse MR analysis declined to identify a causal relation between SHBG and osteoporosis. Our research demonstrates a significant causal connection between circulating SHBG levels and increased osteoporosis risk. These results indicate that high SHBG may be associated with the risk of osteoporosis in postmenopausal women, but more research is needed.

Association between sleep duration and depression in menopausal women: a population-based study

Aims

This research investigated menopausal women older than 50 years to find whether there were any independent relationships between the duration of sleep they got and their prevalence of depression.

Methods

National Health and Nutrition Examination Survey (NHANES) datasets from 2011-2020 were utilized in a cross-sectional study. Using multivariate linear regression models, the linear relationship between sleep duration and depression in menopausal women was investigated. Fitted smoothing curves and thresholds impact evaluation were used to investigate the nonlinear relationship. Then, subgroup analyses were performed according to smoking, drinking alcohol, diabetes, hypertension, heart disease, and moderate activities.

Results

This population-based study included a total of 3,897 menopausal women (mean age 65.47 ± 9.06 years) aged≥50 years; 3,159 had a depression score <10, and 738 had a depression score≥10. After controlling for all covariates, the prevalence of depression was 17% higher among participants with short sleep duration [OR=1.17, 95%CI=(0.65, 1.70), P<0.0001] and 86% [OR=1.86, 95%CI=(1.05, 2.66), P<0.0001] compared to participants with normal sleep duration. In subgroup analyses stratified by smoking and diabetes, the sleep duration and depression scores of non-smokers [β=-0.18, 95%CI= (-0.33, -0.02), P=0.0241] and diabetics were independently negatively correlated [β=-0.32, 95%CI= (-0.63, -0.01), P=0.0416]. Using a two-segment linear regression model, we discovered a U-shaped relationship between sleep duration and depression scores with an inflection point of 7.5 hours. Less than 7.5 hours of sleep was associated with an increased risk of developing depression [β=-0.81, 95%CI= (-1.05, -0.57), P<0.001]. However, sleeping more than 7.5 hours per night increased the risk of depression considerably [β=0.80, 95%CI= (0.51, 1.08), P<0.001].

Conclusions

Depression is associated with sleep duration in menopausal women. Insufficient or excessive sleep may increase the risk of depression in menopausal women.

An RCT META analysis based on the effect of tai chi exercise therapy on the outcome of elderly patients with moderate-to-severe sleep disorders-A systematic review study

Background

According to statistics, about one-fifth of the world's elderly people suffer from sleep disorders, and the problem of sleep disorders in the elderly is extremely serious, and this problem is one of the important causes of chronic diseases such as hypertension, hyperlipidemia, diabetes mellitus, and coronary heart disease in the elderly. The positive effect of Tai Chi exercise therapy on sleep problems has been confirmed, but at present, the effect of the specific duration of Tai Chi exercise on the improvement of elderly people with moderate to severe sleep disorders varies.

Objective

META analysis was used to investigate and find that long-term Tai Chi exercise therapy has the best effect on improving sleep in elderly patients with moderate to severe sleep disorders. Methods: META analysis was performed using Revman 5.3 after searching Web of science, Pubmed, Scopus, The Cochroae Library, OVID, CBM, CNKI, VIP, and other databases, and then filtering and extracting.

Results

A total of seven papers were included. Meta-analysis showed that tai chi exercise was more effective in improving sleep problems in elderly patients with sleep disorders compared to the control group, and the difference was significant. This was demonstrated by a decrease in the global Pittsburgh Sleep Quality Index (PSQI) score [SMD = -0.66, 95 % CI (-0.91, -0.41), P < 0.00001], as well as its subdomains of subjective sleep quality [SMD = -0.79, 95 % CI (-1.06, -0.52), P < 0.00001], sleep latency [SMD = -0.80, 95 % CI (-1.21, -0.40), P < 0.00001], sleep duration [SMD = -0.38, 95 % CI (-0.72, -0.04), P = 0.03], habitual sleep efficiency [SMD = -0.58, 95 % CI (-0.84, -0.31), P < 0.0001], sleep disturbance [SMD = -0.51, 95 % CI (-0.78, -0.25), P = 0.00001] and daytime dysfunction [SMD = -0.33, 95 % CI (-0.59, -0.07), P = 0.01]. Improvement was also observed in the Epworth Sleepiness Scale (ESS) and Insomnia Severity Index Scale (ISI). The results showed that the optimal duration and frequency of Tai Chi exercise therapy for improving moderately severe elderly patients with sleep disorders was long-term.

Conclusion

This study systematically assessed the efficacy of Tai Chi exercise therapy for elderly patients with moderate-to-severe sleep disorders. Through a meta-analysis of relevant randomized controlled trials (RCTs), it aims to determine the effectiveness of Tai Chi exercise in improving sleep quality in elderly patients with moderate-to-severe sleep disorders, as well as to compare its effects with those of traditional treatments; to analyze the safety of Tai Chi exercise for this patient population and assess its feasibility as a non-pharmacological therapy; and to fill the research gaps and provide more comprehensive and systematic evidence support. This study provides a practical approach to reducing the risk of medication side effects in older adults with sleep disorders and offers a potentially effective non-pharmacological treatment option, especially for those who are unable or unwilling to use medication. Tai chi exercise may not only improve sleep, but also improve coordination, muscle strength, balance, and reduce stress and anxiety in older adults. It also helps older adults socialize and enhances their social connections and emotional support. This study suggests that community centers or activity centers for the elderly can organize tai chi classes to promote the participation of older adults, and can be used as a scientific exercise rehabilitation tool in clinical treatment, incorporating tai chi practice into daily life, such as tai chi practice at a fixed time every day or every week, which not only helps to improve the sleep disorders of older adults, but also improves their overall quality of life.

Effects of thermal exposure to disposable plastic tableware on human gut microbiota and metabolites: A quasi-experimental study

The aim of this quasi-experimental study was to determine the alterations in gut microbiota and metabolism in humans who consume hot food served in disposable plastic tableware (DPT). Participants in the exposure and control groups were provided three hot meals in DPT (n = 30) or non-DPT (n = 30), respectively. After a month of observation, individuals in the exposure group discontinued the three meals provided in DPT (n = 27) for 1 month as the post-exposure group. Fecal samples were collected and tested for microplastics (MPs) detection using LDIR and gut microbiota identification based on the 16 S rRNA. Urine samples were used for metabolite analysis using LC-MS/MS. Results showed that the level of MPs in feces was lower in the post-exposure group compared with the exposure group. Furthermore, the abundance of the phyla Actinobacteria, Proteobacteria, Firmicutes, and Bacteroidota in the exposure and post-exposure groups were significantly different compared with the control group. Changes in microbiota abundance and metabolite levels were mainly associated with central nervous system effects, energy metabolism, and inflammation, suggesting that thermal exposure to DPT for 1 month has considerable health effects.

Sex Differences in Sleep Architecture After Traumatic Brain Injury: Potential Implications on Short-Term Episodic Memory and Recovery

Sleep-wake disturbances (SWDs) are common after TBI and often extend into the chronic phase of recovery. Such disturbances in sleep can lead to deficits in executive functioning, attention, and memory consolidation, which may ultimately impact the recovery process. We examined whether SWDs post-TBI were associated with morbidity during the post-acute period. Particular attention was placed on the impact of sleep architecture on learning and memory. Because women are more likely to report SWDs, we examined sex as a biological variable. We also examined subjective quality of life, depression, and disability levels. Data were retrospectively analyzed for 57 TBI patients who underwent an overnight polysomnography. Medical records were reviewed to determine cognitive and functional status during the period of the sleep evaluation. Consideration was given to medications, owing to the fact that a high number of these are likely to have secondary influences on sleep characteristics. Women showed higher levels of disability and reported more depression and lower quality of life. A sex-dependent disruption in sleep architecture was observed, with women having lower percent time in REM sleep. An association between percent time in REM and better episodic memory scores was found. Melatonin utilization had a positive impact on REM duration. Improvements in understanding the impact of sleep-wake disturbances on post-TBI outcome will aid in defining targeted interventions for this population. Findings from this study support the hypothesis that decreases in REM sleep may contribute to chronic disability and underlie the importance of considering sex differences when addressing sleep.

Mapping insomnia symptoms and circadian preferences to mental health problems in men and women across the lifespan

This study identified subgroups in the general population based on combinations in three night-time insomnia symptoms and four dimensions of circadian preferences ("sleep profiles") and investigated the associations between sleep profiles and nine common mental health problems. The data came from the Lifelines cohort add-on study "Comorbid Conditions of ADHD" and included 37,716 individuals (aged 4-91 years) from the Dutch general population who completed a digital survey. Latent profile analysis was used to identify sleep profiles in twelve age-sex subgroups. Linear regression was used to investigate whether sleep profiles differ in mental health problems. Participants were classified into three sleep profiles: "Healthy Larks", who had early circadian preferences and no insomnia symptoms; "Sleepy Owls" with late circadian preferences and nonrestorative sleep; and "Sleepless Doves" with intermediate circadian preferences and severe insomnia symptoms. Compared to "Healthy Larks", all mental health problems were significantly more severe in "Sleepy Owls" and even worse in "Sleepless Doves". These associations were similar in men and women but weakened with age. However, "Sleepy Owls" and "Sleepless Doves" did not differ in heavy alcohol drinking, drug use, and smoking. Our findings strengthened the evidence for the universal role of healthy sleep in mental wellbeing.

Poor Sleep Quality and Its Influencing Factors Among Iranian Patients with Esophageal and Gastric Cancer

Background

Sleep quality is a notable factor of well-being. It also may play a role in the development and progression of chronic diseases and cancers. Therefore, this study was performed to investigate poor sleep quality and its influencing factors among Iranian patients with esophageal and gastric cancer.

Methods

In this cross-sectional study, a total of 312 Iranian adult patients who suffered from esophageal and gastric cancers were employed from a gastrointestinal cancer-based cohort study conducted in a referral hospital in Tehran between 2015 and 2018. Persian version of the Pittsburg Sleep Quality Index (PSQI) was used to measure poor sleep quality. Univariate and multiple logistic regression models were applied to determine the related factors to poor sleep quality.

Results

Of the participants, 203 (65.06%) were men, and 75.96% had gastric cancer. The mean age was 63.13±12.10 years. The results demonstrated that more than 62% of the patients had poor sleep quality. 148 (62.44%) patients out of 237 patients with gastric cancer had poor-quality sleep. Also, 46 (64.38%) patients out of 237 patients with esophageal cancer had poor-quality sleep. Based on the results of multiple logistic regression models, marital status has a negative association with poor sleep quality (odds ratio [OR]=0.32, P=0.015). In addition, having chronic disease (OR=2.16; P=0.028) and wealth index (OR=3.11, P=0.013; OR=3.81, P=0.003; OR=3.29, P=0.009; OR=3.85, P=0.003 for rich, moderate, poor, and poorest subgroups, respectively) had a positive association with poor sleep quality.

Conclusion

The findings showed that about two-thirds of the patients studied were poor sleepers. Also, it was observed that marital status, chronic disease, and wealth index were important factors associated with poor sleep quality.

Increased risk of sleep disturbances in patients with rosacea: A nationwide population-based cohort study

Rosacea is a chronic inflammatory skin disorder linked to various mental disorders, but little is known about the impact of rosacea on sleep disorders. The aim of this study is to confirm the association of rosacea with sleep disorders using a large administrative data set. This nationwide population-based retrospective cohort study enrolled 1129 individuals with rosacea and 11 017 age- and sex-matched controls without rosacea from the Korean National Health Insurance System database from 2002 to 2015. The prevalence of sleep disorder (7.8%) was significantly higher in patients with rosacea than in controls (5.81%; p < 0.001). Rosacea was associated with an increased risk of sleep disorder (adjusted odds ratio [aOR], 1.287 [95% confidence interval (CI), 1.022-1.623]). Among a variety of sleep disorders, patients with rosacea were likely to have an increased risk of insomnia (aOR, 1.318 [95% CI, 1.002-1.743]). In subgroup analysis, female patients with rosacea (aOR, 1.297 [95% CI, 1.010-1.722]) and those with rosacea and dyslipidemia (aOR, 1.417 [95% CI, 1.062-1.891]) were at a higher risk of having a sleep disorder. Rosacea is associated with an increased risk of having sleep disorders. The management of modifiable risk factors is important for managing sleep disorders in patients with rosacea.

Sex differences in cortisol levels in depression: A systematic review and meta-analysis

Higher prevalence of depression in females might be associated with sex-specific cortisol levels. Evidence exists that cortisol levels differ between healthy females and males, however a sex-specific association in depression has not been systematically assessed. Thus, the current study quantifies the existing literature on different cortisol parameters, i.e., basal cortisol, hair cortisol, cortisol awakening response (CAR), and cortisol stress reactivity comparing depressed females and males as well as sex-specific comparisons with healthy controls. Following an extensive literature research, fifty original articles were included. Depressed females had significantly higher hair cortisol, higher CAR, and lower cortisol stress reactivity compared to depressed males. In comparison with sex-matched controls, female patients had significantly higher evening basal cortisol, higher CAR and lower cortisol stress reactivity, and male patients had significantly higher general, morning and evening basal cortisol. Overall, sex as a fundamental driver of cortisol levels in depression needs to be taken into account.

Insomnia as a Risk Factor for Substance Use Disorders in Women

Gender differences exist for both insomnia and substance use disorders. Women show a higher prevalence of insomnia and increased susceptibility to the effects of drugs than men. Importantly, a growing body of evidence suggests that insufficient sleep predicts and puts individuals at a higher risk for substance use and associated psychosocial problems. However, the role of insomnia in substance use disorders among women remains poorly understood. The present article discusses gender differences in insomnia and in substance use disorders and reviews evidence suggesting that an increased prevalence of insomnia may be a risk factor for substance use disorders in women.

Brain-based Sex Differences in Depression: A Systematic Review of Neuroimaging Studies

Major depressive disorder (MDD) is a common psychiatric illness with a wide range of symptoms such as mood decline, loss of interest, and feelings of guilt and worthlessness. Women develop depression more often than men, and the diagnostic criteria for depression mainly rely on female patients' symptoms. By contrast, male depression usually manifests as anger attacks, aggression, substance use, and risk-taking behaviors. Various studies have focused on the neuroimaging findings in psychiatric disorders for a better understanding of their underlying mechanisms. With this review, we aimed to summarize the existing literature on the neuroimaging findings in depression, separated by male and female subjects. A search was conducted on PubMed and Scopus for magnetic resonance imaging (MRI), functional MRI (fMRI), and diffusion tensor imaging (DTI) studies of depression. After screening the search results, 15 MRI, 12 fMRI, and 4 DTI studies were included. Sex differences were mainly reflected in the following regions: 1) total brain, hippocampus, amygdala, habenula, anterior cingulate cortex, and corpus callosum volumes, 2) frontal and temporal gyri functions, along with functions of the caudate nucleus and prefrontal cortex, and 3) frontal fasciculi and frontal projections of corpus callosum microstructural alterations. Our review faces limitations such as small sample sizes and heterogeneity in populations and modalities. But in conclusion, it reflects the possible roles of sex-based hormonal and social factors in the depression pathophysiology.

Sleep problems in adolescents with depression: Role of childhood trauma, alexithymia, rumination, and self-esteem

BACKGROUND

While sleep problems are common in adolescents with depression, the exact prevalence has not been reported. Although previous studies have shown that childhood trauma, alexithymia, rumination, and self-esteem are related to sleep problems, the interactions between these factors remain unclear.

METHODS

This study, conducted from March 1, 2021 to January 20, 2022, employed a cross-sectional design. The participants were 2192 adolescents with depression with a mean age of 15 years. The Chinese version of the Pittsburgh Sleep Quality Index, Childhood Trauma Questionnaire, Toronto Alexithymia Scale-20, Ruminative Response Scale, and Rosenberg Self-Esteem Scale were used to measure sleep problems, childhood trauma, alexithymia, rumination, and self-esteem, respectively. We used PROCESS 3.3 for SPSS to determine the chain mediating effect of alexithymia and rumination and the moderating effect of self-esteem in the relationship between childhood trauma and sleep problems.

RESULTS

Up to 70.71 % of adolescents with depression had sleep problems. Furthermore, alexithymia and rumination played a chain mediation role in the relationship between childhood trauma and sleep problems. Finally, self-esteem moderated the relationships between alexithymia and sleep problems and rumination and sleep problems.

LIMITATIONS

Owing to the study design, we cannot derive causal relationships between variables. Further, the self-reported data may have been influenced by subjective participant factors.

CONCLUSIONS

This study reveals potential ways of how childhood trauma influences sleep problems in adolescents with depression. These findings suggest that interventions targeting alexithymia, rumination, and self-esteem in adolescents with depression may be effective in reducing their sleep problems.

Sleep quality, circadian preferences, and mood among patients with acne vulgaris: a case-control study

PURPOSE

Poor sleep and mood may be predisposing factors for acne. We aimed to investigate the associations between acne and sleep quality, circadian preferences, and mood.

METHODS

This case-control study recruited patients with acne and age- and sex-matched healthy controls. We used the Investigator's Global Assessment to evaluate acne severity and various validated questionnaires to measure sleep quality, daytime sleepiness, sleep apnea, circadian preference, and mood symptoms.

RESULTS

A total of 81 patients with acne (age: 21.6 ± 5.0 years, 52% female) and 76 controls were recruited. Compared to controls, patients had a higher score on the Pittsburgh Sleep Quality Index (5.2 ± 2.6 vs. 4.1 ± 2.3, p = 0.008) and State-Trait Anxiety Inventory (State: 44.6 ± 9.7 vs. 40.6 ± 6.6, p = 0.003; Trait: 47.9 ± 8.2 vs. 45.3 ± 6.2, p = 0.03), and a lower score on a reduced version of the Morningness and Eveningness Questionnaire (13.9 ± 2.6 vs. 14.7 ± 2.3, p = 0.05) and Epworth Sleepiness Scale (7.4 ± 3.4 vs. 8.6 ± 3.6, p = 0.04). Acne severity was associated with sleep quality (β = 0.33), eveningness (β = 0.34), depression (β = 0.66), and anxiety (State: β = 1.73; Trait: β = 1.21), even when adjusted for education level and family history of acne.

CONCLUSION

Acne is highly associated with poor sleep and mood. Dermatologists are advised to attend closely to the psychological impact of acne. Improvements in sleep and mood may benefit the treatment of acne.

Sleep time and quality associated with depression and social anxiety among children and adolescents aged 6-18 years, stratified by body composition

BACKGROUND

Sleep has been suggested as risk factors for depression and social anxiety in children and adolescents, but little is known about the role of individual body composition on these association.

METHOD

We conducted a cross-sectional survey of children and adolescents aged 6-18 years in Beijing, China, in 2020, and assessed body composition by using iDXA dual-energy X-ray bone densitometer. Generalized liner model (GLM) and restricted cubic spline (RCS) were employed to analyze the associations between sleep and depression and social anxiety with different body composition. The attributable fraction (AFs) to assess the benefits of improvements of sleep in reducing depression and social anxiety odds.

RESULTS

Depression and social anxiety accounted for 13.1 % and 30.3 % of the study population. Sleep time was significantly associated with depression (HR = 2.35[1.58, 3.50]), and social anxiety (HR = 1.65[1.24, 2.20]); and sleep quality was significantly associated with depression (HR = 7.27[4.87, 10.84]), and social anxiety (HR = 2.54 [1.99, 3.25]) among children and adolescents. The exposure to both insufficient sleep time and poor sleep quality were associated with a higher odd of depression and social anxiety, but lower BF%, higher muscle rate and FFM/FM alleviated the adverse effects of sleep quality on depression and social anxiety.

LIMITATIONS

Conclusions about causality remain speculative because of the cross-sectional design.

CONCLUSION

Insufficient sleep time, poor sleep quality, high BF%, low muscle rate and FFM/FM can jointly associate with anxiety and depression. This study provides new evidence support for accurate prevention and control of mental diseases in children and adolescents with different body types.

Catastrophizing and acceptance are mediators between insomnia and pain intensity-an SQRP study of more than 6,400 patients with non-malignant chronic pain conditions

Background

Sleep problems (insomnia) and chronic pain are associated. Chronic pain and insomnia/insufficient sleep quality share similar symptoms and features. Although they have a bidirectional relationship, more research is needed to understand how they interact via mediators and how moderators influence this relationship.

Aims

In this large clinical registry-based cohort study (N = 6,497), we investigate important mediators between insomnia and pain intensity in a cross-sectional sample of chronic pain patients using advanced path analysis. In addition, we investigate whether some background variables were moderators of the identified important paths or not and the correlation patterns between insomnia and pain intensity in relation to the mediators.

Methods

This study includes a cohort of adult patients with chronic non-cancer pain from the Swedish Quality Registry for Pain Rehabilitation (SQRP) with data on patient-reported outcome measures (PROMs) (2008-2016). The PROMs cover the background, pain aspects, psychological distress, pain-related cognitions, activity/participation, and health-related quality of life variables of the patients. Partial least squares structural equation modeling was used to explore the direct and indirect (via mediators) relationships between insomnia and pain intensity at baseline.

Results

In this cohort study, insomnia was prevalent at 62.3%, and both direct and indirect mediating paths were present for the insomnia-pain intensity relationship. All of the mediating effects combined were weaker than the direct effect between insomnia and pain intensity. The mediating effects via catastrophizing and acceptance showed the strongest and equal mediating paths, and mediating effects via fear avoidance were the second strongest. Insomnia showed stronger direct significant correlations with psychological distress, catastrophizing, and acceptance compared with those of pain intensity. Sex, age, education level, spatial extent of pain, or body mass index did not moderate the mediating paths.

Discussion and conclusion

This study confirms the existence of significant direct and mediating paths between reported insomnia and pain intensity. Future studies should focus on illuminating how sleep interventions influence pain intensity and other important key factors that contribute to the distress of chronic pain patients.

Loneliness, depression and sleep quality among the type 2 diabetic patients during COVID-19 local epidemic: A mediation analysis

AIMS

To investigate loneliness, depression and sleep quality in patients with Type 2 Diabetes (T2DM) and to examine the mediating role of depression between loneliness and sleep quality among this group of patients with T2DM.

DESIGN

A cross-sectional study.

METHODS

A group of T2DM patients was recruited from a tertiary hospital affiliated with a university in Wuhu City, Anhui Province from May to October 2021 by convenient sampling. Pearson correlation analysis and structural equation modelling were used for data analysis in this study.

RESULTS

The direct effect of loneliness on sleep quality was not statistically significant, but the indirect effect of depression on sleep quality was statistically significant. Depression mediated the relationship between loneliness and sleep quality. Depression can affect emotional health and reduce sleep quality. We should reduce the loneliness of patients, prevent the occurrence of depression and improve the quality of sleep.

A phase 1/2, open-label, parallel group study to evaluate the preliminary efficacy and usability DARE-HRT1 (80 μg estradiol/4 mg progesterone and 160 μg estradiol/8 mg progesterone intravaginal RinGSM) over 12 weeks in healthy postmenopausal women

OBJECTIVES

The exploratory objectives of this study were to evaluate the usability and acceptability and to conduct a preliminary evaluation of the efficacy of DARE-HRT1. DARE-HRT1 is an intravaginal ring (IVR) that releases 17β2-estradiol (E2) with progesterone (P4) over 28 days. It is the first combination E2 and P4 IVR being developed for the treatment of vasomotor symptoms (VMS) in healthy postmenopausal women with an intact uterus.

METHODS

This was a randomized, open-label, 2-arm, parallel group study in 21 healthy postmenopausal women. Women were randomized (1:1) to either DARE-HRT1 IVR1 (E2 80 μg/d with P4 4 mg/d) or DARE-HRT1 IVR2 (E2 160 μg/d with P4 8 mg/d). They used the assigned IVR for three 28-day cycles, inserting a new IVR monthly. Preliminary genitourinary syndrome of menopause (GSM) treatment efficacy was estimated by measuring changes from baseline in vaginal pH, vaginal maturation index (VMI), and changes in the severity of GSM symptoms. Preliminary systemic VMS efficacy was measured by changes in responses to the Menopause-Specific Quality of Life (MENQOL) questionnaire. Acceptability was assessed by product experience surveys.

RESULTS

Preliminary local GSM treatment efficacy was supported by significant decreases in vaginal pH and % parabasal cells, and significant increases in the overall VMI and % superficial cells for both IVR groups (all P values <0.01). Preliminary VMS efficacy was supported by significant decreases in all domains of the MENQOL questionnaire from baseline for both dosing groups (all P values <0.01).

CONCLUSIONS

Data from this study support further development of DARE-HRT1 for the treatment of menopausal symptoms.

Heat of the night: sleep disturbance activates inflammatory mechanisms and induces pain in rheumatoid arthritis

Sleep has a homeostatic role in the regulation of the immune system and serves to constrain activation of inflammatory signalling and expression of cellular inflammation. In patients with rheumatoid arthritis (RA), a misaligned inflammatory profile induces a dysregulation of sleep-wake activity, which leads to excessive inflammation and the induction of increased sensitivity to pain. Given that multiple biological mechanisms contribute to sleep disturbances (such as insomnia), and that the central nervous system communicates with the innate immune system via neuroendocrine and neural effector pathways, potential exists to develop prevention opportunities to mitigate the risk of insomnia in RA. Furthermore, understanding these risk mechanisms might inform additional insomnia treatment strategies directed towards steering and reducing the magnitude of the inflammatory response, which together could influence outcomes of pain and disease activity in RA.

Gender Differences in Anxiety, Depression, Insomnia, and Quality of Life in Heart Failure With Preserved Ejection Fraction: A Multicenter, Cross-sectional Study

BACKGROUND

Patients with heart failure with preserved ejection fraction (HFpEF) are more often female, but gender differences in psychological distress in patients with HFpEF have not been determined.

OBJECTIVE

We aimed to compare anxiety, depression, insomnia, and quality of life (QoL) between women and men with HFpEF.

METHODS

A total of 263 consecutive hospitalized patients with HFpEF were enrolled in a multicenter study. Demographic and clinical characteristics were recorded. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS), insomnia was assessed by the Insomnia Severity Index and Pittsburgh Sleep Quality Index, and QoL was assessed by the Kansas City Cardiomyopathy Questionnaire.

RESULTS

Women accounted for 59% and men accounted for 41% of the patients with HFpEF. Women and men had similar New York Heart Association functional class and N-terminal pro-brain natriuretic peptide levels. Between women and men with HFpEF, similar depression prevalence (HADS-D: 4.9 ± 3.7 vs 4.1 ± 3.6, P = .222), insomnia severity (Insomnia Severity Index: 9.3 ± 6.4 vs 8.0 ± 6.5, P = .120), and QoL (Kansas City Cardiomyopathy Questionnaire: 46.6 ± 12.6 vs 47.6 ± 12.7, P = .738) were found when adjusting for potential confounders. Women had more severe anxiety (HADS-Anxiety: 2.4 ± 2.9 vs 1.6 ± 2.3, P = .025) and worse sleep quality (Pittsburgh Sleep Quality Index: 9.9 ± 4.6 vs 8.7 ± 4.5, P = .046) compared with men after adjustment.

CONCLUSIONS

There were no gender differences in depression, insomnia, and QoL in patients with HFpEF when adjusting for confounders. Women with HFpEF suffered more severe anxiety and sleep quality than men after adjustment. Thus, it is recommended that psychological distress in patients with HFpEF be assessed in clinical practice, and gender differences taken into consideration.

New cut-off points of PHQ-9 and its variants, in Costa Rica: a nationwide observational study

The PHQ-9 questionnaire is a screening test worldwide used to measure depression. But it cannot be used in Costa Rica, due to the fact that it has not previously been validated for its population. The present study aims to show the validation of the PHQ-9 questionnaire and its variants (PHQ-2, PHQ-4, PHQ-8) in a population sample of adults residing in Costa Rica. A sample was collected (n = 1162) using a self-administered questionnaire. Confirmatory Factor Analysis (CFA), Receiver Operating Characteristic (ROC) curve, and Multiple Group Confirmatory Factor Analysis (MGCFA) were tested. One factor was found that explained 73.33% of the variance with excellent internal consistency (α = 0.928). Goodness-of-fit measures were adequate (RMSEA = 0.107; CFI = 0.948), as was diagnostic power at a cut-off of 10 (78.60 for Sensitivity and 27.95 for 1-Specificity). External validation indices were good (r = 0.843 with GAD-7, r = - 0.647 with RS14, and r = 0.301 with FCV19S), and the model showed invariance by sex (∆χ2 = 27.90; df = 27; p < 0.001). Additionally, new cut-off points were proposed for PHQ-9 and its variants for Costa Rican male, female, and general populations. The PHQ-9 and its variants (PHQ-2, 4, and 8) are valid tools for detecting depression (and anxiety for PHQ-4) in Costa Rican population. In addition, new cut-off points differentiated by sex are proposed.

Hair androgen concentrations and depressive disorders in adolescents from the general population

Although the link between androgens and depression is well established in adults, the effects of cofactors on this association are less clearly understood, particularly in youth. Epidemiological cohort study of adolescents in Dresden, Germany. Analyses comprised data of 985 individuals assessed at baseline and of 512 individuals at 1-year follow-up. We investigated multivariable regression models for cross-sectional and longitudinal associations of hair testosterone, dehydroepiandrosterone (DHEA), and their cortisol ratios with 12-month diagnoses of major depressive disorder (MDD) and MDD without any anxiety disorder assessed with standardized diagnostic interview (DIA-X-5), and with dimensional depression scores (PHQ-9, PROMIS), separately for males and females. The potential moderating effect of social support was determined. Cross-sectional analyses yielded inverse associations of testosterone and DHEA with MDD and MDD without any anxiety disorders in males. In cross-sectional and longitudinal analyses, baseline ratio cortisol/DHEA was significantly, inversely associated to PROMIS-depression in males. Only cross-sectional associations for ratio cortisol/DHEA and PROMIS-depression remained significant after Bonferroni-Holm correction. No robust associations were observed in female participants. Social support exerted no consistent moderating effect on the investigated association. The present observational cohort study showed no consistent association of hair androgen concentrations with depressive disorders in adolescents. However, findings provide some support for the association between the cortisol/DHEA ratio and depression in males. Longitudinal research designs in large samples are needed to understand the interplay between androgens, depression, and developmental and social factors in youth.

Better Mental Health and Sleep under Behavioral Restrictions Due to COVID-19 in Japanese University Students: A Cross-Sectional Survey

Coronavirus disease (COVID-19) is a global pandemic, which is not only a severe public health issue but also significantly impacts the physical activity, sleep habits, and mental health of university students. Thus, we examined the association between behavioral restrictions due to COVID-19 and sleep patterns and mental health in first-year Japanese university students. Four hundred and twenty-two students (253 males and 169 females; age, 18.7 ± 1.0 years) participated in our questionnaire study. Under the behavioral restrictions due to COVID-19, 193 students (127 males and 66 females) responded to the questionnaire online from home. The participants did not visit the university during the survey period. The data acquired the year before the COVID-19 pandemic (2018 and 2019) were used as control data (126 males and 103 females). The questionnaire consisted of four sections: (1) demographic and lifestyle variables, (2) the Pittsburgh Sleep Quality Index, (3) the Japanese version of the Epworth Sleepiness Scale, and (4) the Patient Health Questionnaire-9. Our data revealed that self-restraint due to COVID-19 was associated with better sleep and mental health. In addition, mental health was independent of sleep, while sleep was related to mental health. These differences were more pronounced in male than in female students. This finding could be due to physical activity at night, part-time work, and long commuting times during the pre-pandemic period.

The alteration of gut microbiota in venlafaxine-ameliorated chronic unpredictable mild stress-induced depression in mice

Depression is associated with intestinal dysbiosis. Venlafaxine is a commonly used antidepressant in clinical practice as a serotonin and noradrenaline reuptake inhibitor. However, its effects on gut bacteria in depression remain unclear. Here, we established a mouse model of depression induced by chronic unpredictable mild stress (CUMS), and investigated the alterations of venlafaxine on the gut microbiota and potential key bacteria. Our data show that venlafaxine exerts antidepressant effects by restoring the serotonin (5-HT) system and glutamate (Glu) levels in CUMS mice. Moreover, we revealed that venlafaxine altered the diversity of gut bacteria in CUMS mice, and at genus level, Blautia, Oscillibacter, Tyzzerella, Butyricicoccus, and Enterorhabdus are the key bacteria responsible for venlafaxine-ameliorated depression in mice. Among these potential key bacteria, Blautia, Oscillibacter, and Butyricicoccus are correlated significantly with the 5-HT and 5-hydroxyindoleacetic acid levels; while Tyzzerella is correlated markedly with Glu levels. We further show that venlafaxine affected multiple functional metabolic pathways of gut bacteria in mice with CUMS-induced depression. Our results suggest that venlafaxine possibly ameliorates depression via modulating gut bacteria, and found the potential targets of its antidepressant effects.

Complex Extract of Polygonatum sibiricum and Nelumbinis semen Improves Menopause Symptoms via Regulation of Estrogen Receptor Beta in an Ovariectomized Rat Model

Menopause is a hormone-deficiency state that causes facial flushing, vaginal dryness, depression, anxiety, insomnia, obesity, osteoporosis, and cardiovascular disease as ovarian function decreases. Hormone-replacement therapy is mainly used to treat menopause; however, its long-term use is accompanied by side effects such as breast cancer and endometriosis. To identify the effect of a complex extract of Polygonatum sibiricum (PS) and Nelumbinis semen (NS) on improving menopause without side effects, an ovariectomized rat model was established to analyze several menopause symptoms. Compared to single extracts, the complex extract restored vaginal epithelial cell thickness and decreased serotonin concentration by increasing the estrogen receptors ERα (ESR1) and ERβ (ESR2), depending on the ratio. Although the complex extract exerted a lower weight-loss effect than the single extracts, improved blood-lipid metabolism was observed after increasing high-density lipoprotein cholesterol levels and decreasing low-density lipoprotein cholesterol and triglyceride levels, and ovariectomy-induced osteoporosis was alleviated by suppressing osteoclast production. Thus, by increasing only ERβ expression without regulating ERα expression in the uterus, the complex extract of PS and NS may be a natural treatment for improving menopause symptoms without side effects, such as endometriosis.

Sex hormones, insomnia, and sleep quality: Subjective sleep in the first year of hormone use in transgender persons

STUDY OBJECTIVES

Transgender persons can use gender-affirming hormone therapy (GAHT) to align their physical appearance with their identified gender. Many transgender persons report poor sleep, but the effects of GAHT on sleep are unknown. This study examined the effects of a 12 months of GAHT use on self-reported sleep quality and insomnia severity.

METHODS

A sample of 262 transgender men (assigned female at birth, started masculinizing hormone use) and 183 transgender women (assigned male at birth, started feminizing hormone use), completed self-report questionnaires on insomnia (range 0-28), sleep quality (range 0-21) and sleep onset latency, total sleep time and sleep efficiency before start of GAHT and after 3, 6, 9, and 12 months of GAHT.

RESULTS

Reported sleep quality showed no clinically significant changes after GAHT. Insomnia showed significant but small decreases after 3 and 9 months of GAHT in trans men (-1.11; 95%CI: -1.82; -0.40 and -0.97; 95%CI: -1.81; -0.13, respectively) but no changes in trans women. In trans men, reported sleep efficiency decreased by 2.8% (95%CI: -5.5%; -0.2%) after 12 months of GAHT. In trans women, reported sleep onset latency decreased by 9 min (95%CI: -15; -3) after 12 months of GAHT.

CONCLUSIONS

These findings show that 12 months of GAHT use did not result in clinically significant changes in insomnia or sleep quality. Reported sleep onset latency and reported sleep efficiency showed small to modest changes after 12 months of GAHT. Further studies should focus on underlying mechanisms by which GAHT could affect sleep quality.

Associations between sleep disturbance, inflammatory markers and depressive symptoms: Mediation analyses in a large NHANES community sample

Both depression and sleep disturbance have been linked to inflammation. However, the role that inflammation plays in the relationship between sleep disturbance and depression remains unclear. We examined pairwise associations between inflammatory markers (neutrophil-to-lymphocyte ratio [NLR] and C-reactive protein level [CRP]), sleep disturbance, and depressive symptoms in a robust, ethnically diverse sample (n = 32,749) from the National Health and Nutrition Examination Survey (NHANES). We found higher levels of inflammatory markers in participants with depression and/or sleep disturbance compared to those without depression or sleep disturbance. Sleep disturbance was positively associated with inflammatory markers and depressive symptoms even after considering a wide range of potential confounders (e.g., age, sex, body mass index). Inflammatory marker levels were nonlinearly associated with depressive symptoms and were positively associated with depressive symptoms after reaching the inflection point (NLR, 1.67; CRP, 0.22 mg/dL). Inflammatory markers mediated a marginal portion (NLR, 0.0362%, p = 0.026; CRP, 0.0678%; p = 0.018) of the potential effects of sleep disturbance on depressive symptoms. Our research showed that inflammatory markers, sleep disturbance, and depression are pairwise correlated. Increased inflammatory markers levels slightly mediate the association between sleep disturbance and depression.

Associations between exposure to phthalates, phenols, and parabens with objective and subjective measures of sleep health among Mexican women in midlife: a cross-sectional and retrospective analysis

Endocrine-disrupting chemicals (EDCs) may impact sleep during the menopausal transition by altering sex hormones. However, these studies are scarce among Latin American women. This investigation utilized cross-sectional and retrospective data from midlife women enrolled in the Early Life Exposure in Mexico to Environmental Toxicants (ELEMENT) study to examine associations between exposure to EDCs (phthalates, phenols, and parabens) and sleep health measures. For cross-sectional analyses, single spot urine samples were collected between 2017-2019 from a pilot sample of women (N = 91) of midlife age to estimate the urinary concentration of individual phthalates, phenols, and parabens and to calculate the summary concentration of phthalate mixtures. Seven-day nightly sleep duration, midpoint, and fragmentation were obtained from wrist-actigraphy devices and estimated from the actigraphy data using a pruned dynamic programming algorithm. Self-reported poor sleep quality was assessed by one item from the Pittsburgh Sleep Quality Index (PSQI). We examined associations between urinary summary phthalate mixtures, phthalate metabolites, phenol, and paraben analytes with each sleep measure using linear or logistic (to compute odds of poor sleep quality only) regression models adjusted for specific gravity, age, and socioeconomic status. We ran similar regression models for retrospective analyses (N = 74), except that urine exposure biomarker data were collected in 2008 when women were 24-50 years old. At the 2017-2019 midlife visit, 38% reported poor sleep quality. Cross-sectionally, EDCs were associated with longer sleep duration, earlier sleep timing, and more fragmented sleep. For example, every 1-unit IQR increase in the phenol triclosan was associated with a 26.3 min per night (95% CI: 10.5, 42.2; P < 0.05) longer sleep duration and marginally associated with 0.2 decimal hours (95% CI: -0.4, 0.0; P < 0.10) earlier sleep midpoint; while every 1-unit IQR increase in the phthalate metabolite MEHP was associated with 1.1% higher sleep fragmentation (95% CI: 0.1, 2.1; P < 0.05). Retrospective study results generally mirrored cross-sectional results such that EDCs were linked to longer sleep duration, earlier sleep timing, and more fragmented sleep. EDCs were not significantly associated with odds of self-reported poor sleep quality. Results from cross-sectional and retrospective analyses revealed that higher exposure to EDCs was predictive of longer sleep duration, earlier sleep timing, and more fragmented sleep among midlife women.

The stress of losing sleep: Sex-specific neurobiological outcomes

Sleep is a vital and evolutionarily conserved process, critical to daily functioning and homeostatic balance. Losing sleep is inherently stressful and leads to numerous detrimental physiological outcomes. Despite sleep disturbances affecting everyone, women and female rodents are often excluded or underrepresented in clinical and pre-clinical studies. Advancing our understanding of the role of biological sex in the responses to sleep loss stands to greatly improve our ability to understand and treat health consequences of insufficient sleep. As such, this review discusses sex differences in response to sleep deprivation, with a focus on the sympathetic nervous system stress response and activation of the hypothalamic-pituitary-adrenal (HPA) axis. We review sex differences in several stress-related consequences of sleep loss, including inflammation, learning and memory deficits, and mood related changes. Focusing on women's health, we discuss the effects of sleep deprivation during the peripartum period. In closing, we present neurobiological mechanisms, including the contribution of sex hormones, orexins, circadian timing systems, and astrocytic neuromodulation, that may underlie potential sex differences in sleep deprivation responses.

Sleep behaviour differs in women and men with psoriatic arthritis and axial spondyloarthritis with impact on quality of life and depressive symptoms

OBJECTIVES

Axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) may have a profound impact on sleep and health-related quality of life. The aim of this study was to assess sleep quality and quality of life and determine associated factors in patients treated with spondyloarthritides (SpA).

METHODS

Cross-sectional questionnaire-based assessment of sleep behaviour, quality of life, functional impairment and depression (Regensburg Insomnia Scale, WHO Quality of Life questionnaire, Funktionsfragebogen Hannover questionnaire, Beck Depression Inventory II, Patient health questionnaire 9) and retrospective medical chart analysis of a monocentric cohort of 330 patients with SpA (n=168 PsA and n=162 axSpA).

RESULTS

46.6% of patients with SpA demonstrated abnormal sleep behaviour. Linear regression models showed HLA-B27 positivity, Bath Ankylosing Spondylitis Disease Activity Index, depressive symptoms, functional capacity and disease duration to be predictive of insomnia symptoms in axSpA, respectively, depressive symptoms, female sex and Disease Activity Score 28 in patients with PsA. Patients with unrestful sleep had a significantly reduced health-related quality of life (p<0.001) as well as significantly more depressive symptoms (p<0.001). Satisfaction with health was rated significantly lower (p<0.001), indicating poor sleep as a burden on general well-being.In particular, female patients had a significantly worse sleep quality with a prolonged sleep latency (p=0.009), increased sleep disturbances (p=0.014) and unrestful sleep (p<0.001) as well as a reduced physical and mental health-related quality of life (p=0.015, p<0.001) and more depressive symptoms (p=0.015).

CONCLUSION

Despite treatment, many patients with SpA demonstrate abnormal sleep behaviour with symptoms of insomnia and a reduced quality of life with significant differences between male and female patients. An interdisciplinary and holistic approach may be needed to address unmet needs.

Sleep-related problems as a mediator in the association between depression and work-family conflict in middle-aged female workers: A population-based study

AIM

To investigate the mediating effect of sleep-related problems on the relationship between depression and work-family conflicts (WFCs) among middle-aged female workers.

DESIGN

Secondary analysis of cross-sectional study.

METHODS

Overall, 15,718 female workers aged 40-65 years from the Sixth Korean Working Conditions Survey (KWCS) were included. Depression was assessed using the WHO-5 wellbeing index; sleep-related problems and WFCs were measured with five items on a Likert scale. The mediating effect of sleep-related problems between depression and WFCs was analysed using model 4 of Hayes PROCESS macro for SPSS.

RESULTS

There was a significant positive correlation between depression and both sleep-related problems (r = 0.225, p < 0.001) and WFCs (r = 0.124, p < 0.001). Depression also had a significant effect on sleep-related problems (β = 0.221, p < 0.001) and WFCs (β=0.061, p < 0.001). Sleep-related problems had a significant effect on WFCs (β = 0.282, p < 0.001). The indirect effect of depression on WFCs by mediating sleep-related problems was β = 0.062 (95% bootstrap confidence interval = 0.057-0.068). The study also confirmed the significance of the mediating effect of sleep-related problems in the relationship between depression and WFCs.

Women's reproductive traits and major depressive disorder: A two-sample Mendelian randomization study

BACKGROUND

Evidence suggested strong associations between women's reproductive factors and major depressive disorder (MDD), but their causalities are unclear.

METHODS

Using female-specific SNPs as genetic instruments obtained from large-scale genome-wide association studies for women's reproductive traits, we designed two-sample univariable and multivariable Mendelian randomization (MR) analysis to evaluate the causal effects of women's reproductive traits on MDD. For both univariable MR (UVMR) and multivariable MR (MVMR), the inverse variance weighting estimates were reported as main results. MR-Egger, weighted median, and generalized summary-data-based MR (GSMR) methods for UVMR, and MVMR-Egger and MVMR-robust methods for MVMR were used as sensitivity analyses. Negative control analyses, MVMR of age at first birth (AFB) and age at first sexual intercourse (AFS) on MDD, and sex-combined genetic variants for AFB and AFS were performed to enhance the robustness of our study.

RESULTS

There was substantial evidence for associations of genetically predicted later age at menarche (AAM) (odds ratio (OR) = 0.97, 95 % confidence interval (CI) = 0.94-0.99, P = 0.007), AFB (OR = 0.91, 95 % CI = 0.86-0.97, P = 0.002) and AFS (OR = 0.70, 95 % CI = 0.60-0.80, P < 0.001) with lower MDD risk in UVMR. After adjustment of BMI and educational attainment using MVMR, we found consistently significant causal effects of AAM (OR = 0.95, 95 % CI = 0.92-0.99, P = 0.006), AFB (OR = 0.88, 95 % CI = 0.84-0.91, P < 0.001) and AFS (OR = 0.71, 95 % CI = 0.64-0.79, P < 0.001) on MDD.

CONCLUSIONS

Our results provide compelling evidence that early AAM, AFB, and AFS are risk factors for MDD. Promoting the cognition of reproductive health care for women may reduce the risk of MDD.