Cardiovascular disease risk factors and depression in Korean women: results from the fourth Korean National Health and Nutrition Examination Survey

Investigation of hemorheological parameters in patients with major depressive disorder

BACKGROUND

Hemorheological parameters have been reported to be altered in cardiovascular disease. Major depression has been associated with increased risk of cardiovascular disease.

OBJECTIVE

Our hypothesis is that hemorheological parameters are disturbed in major depressive disorder.

METHODS

Major depressive disorder and control groups consisted of 50 subjects. Plasma viscosity, erythrocyte aggregation, erythrocyte deformability, hematological parameters and hematological parameters were examined.

RESULTS

Plasma viscosity was statistically significantly higher, erythrocyte elongation index at 0.53 Pa and 0.95 Pa was lower, and MCV, MCH, and MCHC values were also lower in the major depression group (P < 0.05). Elongation index and plasma viscosity were correlated with depressive symptomatology.

CONCLUSIONS

The increased plasma viscosity and decreased elongation index of erythrocytes indicate an unfavorable hemorheological situation in patients with major depressive disorder compared with healthy controls. The results of this study confirm the findings of studies finding a potential threat to cardiovascular health from major depressive disorder. Increased plasma viscosity and decreased erythrocyte elongation index in depressed patients may be risk factors for cardiovascular events and provide data on the causality of the association between depression and cardiovascular disease.

Impact of Alexithymia on the Lipid Profile in Major Depressed Individuals

Background

The cooccurrence of major depression and dyslipidaemia is associated with negative cardiovascular outcome, which seems to justify a better identification of the factors favouring the development of dyslipidaemia in major depressed individuals. In the literature, there are arguments in favour of a special relationship between dyslipidaemia and alexithymia. However, despite a high prevalence of alexithymia in major depressed individuals, no study has investigated the impact of this personality trait on the lipid profile in this particular subpopulation. Given these elements, the aim of this study was therefore to investigate the risk of dyslipidaemia associated with alexithymia in major depressed individuals to allow better cardiovascular prevention in this subpopulation. Subjects and Methods. Demographic and polysomnographic data from 242 major depressed individuals recruited from the clinical database of the sleep laboratory were analysed. Only individuals with a diagnosis of dyslipidaemia according to the diagnostic criteria of the International Diabetes Federation at admission were included in the “dyslipidaemia” group. Logistic regression analyses were used to determine the risk of dyslipidaemia associated with alexithymia in major depressed individuals.

Results

The prevalence of dyslipidaemia was 43.8% in our sample of major depressed individuals. After adjusting for the main confounding factors, multivariate logistic regression analyses demonstrated that alexithymia was a risk factor for dyslipidaemia in major depressed individuals.

Conclusions

In this study, we found that alexithymia is a risk factor for dyslipidaemia in major depressed individuals, which seems to justify better identification and adequate management of this personality trait in order to allow a better lipid profile in this subpopulation at high cardiovascular risk.

Associations of depression and anxiety with cardiovascular risk among people living with HIV/AIDS in Korea

OBJECTIVES

As HIV/AIDS is becoming a chronic disease, the risk of developing cardiovascular disease (CVD) among people living with HIV/AIDS is rising. Anxiety and depression, which are common among people living with HIV/AIDS, have been linked with CVD. This study investigated the risk of CVD in people living with HIV/AIDS and explored the effects of depression and anxiety on CVD risk.

METHODS

Data were collected for 457 people enrolled in the Korea Cohort HIV/AIDS study after 2010. Framingham risk scores were calculated to quantify the 10-year risk of developing CVD. Depression and anxiety variables were re-coded as a single combined variable. Multivariable logistic regression analysis was performed, adjusting for age, body mass index, low-density lipoprotein (LDL) cholesterol, triglycerides (TG), duration of human immunodeficiency virus (HIV) positivity after entry into the cohort, and depression/anxiety.

RESULTS

Participants with both depression and anxiety were 2.28 times more likely than those with neither depression nor anxiety to have moderate/high-risk CVD risk. The 10-year risk of developing CVD was affected by LDL cholesterol, TG, age, and duration of HIV infection. LDL cholesterol and TG levels change according to the duration of HIV infection, and metabolic disorders affect the risk of CVD. Thus, a longer duration of HIV infection is associated with a higher risk of developing CVD.

CONCLUSIONS

Screenings for depression and anxiety need to be provided regularly to assess the severity of those symptoms. To help decrease their risk of developing CVD, people living with HIV/AIDS should be offered behavioral modification interventions aimed at developing healthy lifestyle habits.

Factors and help-seeking behaviors associated with depression in Korean adults: Review of data from 2014 and 2016 Korea national health and nutrition examination surveys

As a health problem in Korea, the prevalence of depression is continuously increasing. This study examines factors and help-seeking behaviors associated with depression in Korean adults. Data was extracted from Korea National Health and Nutrition Examination Surveys (2014 and 2016) using the PHQ-9 depression screening instrument. Among 10,459 participants (weighted frequency = 36,418,292) over 19 years old, 7.2% were classified as having depression including depressive symptoms (PHQ-9 scores ≥ 10) or depressive disorders diagnosed by psychiatrists. Among those with depression, 58.6% responded that they had never sought help. Statistically high odds ratios for being at risk for depression include being female, aged 19-39, living alone, low household income, low level of education (middle school or lower), occupation (unemployed/inactive), an ex- or current smoker, having a chronic disease, and being underweight. Statistically low odds ratios for seeking counselling, age ≥ 60 and lower than high household income; for seeing doctor, age 19-39 or ≥60; and for treatment, age 19-39, lower than middle household income, and more than once per week drinking frequency. Overall, there is a need to find persons having these risk factors and to develop tailored strategies that will encourage help-seeking behavior with help-seeking intention.

Probiotic food consumption is associated with lower severity and prevalence of depression: A nationwide cross-sectional study

OBJECTIVE

It has been suggested that probiotics have beneficial effects on a variety of health problems including immunologic diseases and metabolic disorders, however, the effects on brain function are yet to be fully studied. The aim of this study was to evaluate the association between probiotic food consumption and depression status through a cross-sectional analysis of a nationwide, large population-based data.

METHODS

The study population included 26 118 individuals 19 to 64 y of age who participated in the Korean National Health and Nutrition Examination Survey (KNHANES, 2012-2016). A food frequency questionnaire was used to assess probiotic food consumption. Depression status was determined by two different methods including a Patient Health Questionnaire (PHQ-9) and self-reported clinical diagnosis.

RESULTS

Compared with the lowest tertile of probiotic food consumption, the highest tertile had significantly lower odds in PHQ-9 depression severity (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.28-0.81; P = 0.0065) and self-reported clinical depression (OR, 0.59; 95% CI, 0.35-0.96; P = 0.0129). Although there was no significant association between probiotic food consumption and clinical depression in women (OR, 0.85; 95% CI, 0.47-1.54; P = 0.3081), men showed a significantly lower prevalence of clinical depression (OR, 0.24; 95% CI, 0.06-0.92; P = 0.0256) in the highest tertile.

CONCLUSIONS

These results suggest that probiotic food consumption might have beneficial effects on depression, particularly in men. Further studies are required to identify the mechanistic relations between probiotics and depression.

Higher dietary inflammation is associated with increased odds of depression independent of Framingham Risk Score in the National Health and Nutrition Examination Survey

Cardiovascular disease (CVD) may increase depression risk. Risk for future CVD, which can be estimated by the Framingham Risk Score (FRS), and depression risk are both linked to systemic inflammation. Dietary consumption of proinflammatory food can be measured using the Dietary Inflammatory Index (DII) score. We examined the potential impact of DII on depression and whether this effect is independent of FRS. We hypothesized that (1) both FRS and DII would be associated with depression (Patient Health Questionnaire-9 ≥ 10) and (2) associations between DII and depressive symptoms (continuous) would be mediated by FRS. Data were included from adults without CVD who were participants of the 2007-2012 National Health and Nutrition Examination Survey (n = 11 624). Using logistic regression, we tested cross-sectional associations of FRS, DII (adjusting for FRS), and joint effects of FRS and DII with depression. Finally, using the Sobel method, we tested whether FRS mediates the relationship between DII and depressive symptoms. Individuals with FRS or DII scores in the top 2 quartiles had higher odds of depressive symptoms than those in the bottom quartile. The association of DII with depressive symptoms remained after FRS adjustment. The joint effects of elevated DII and FRS were additive. There was no evidence for mediation by FRS between DII and depressive symptoms. Thus, higher DII remained associated with increased odds of depressive symptoms net CVD risk. Collectively, the joint effects of CVD risk and DII indicate that a proinflammatory diet could add to risk for depressive symptoms even in those with a high FRS.

A comparative study on cardiovascular disease risk factors in Korean adults according to clinical depression status

This study was conducted to compare the association between depression and cardiovascular disease risk factors among Korean adults. This study was based on the data from the Korea National Health and Nutrition Examination Survey conducted in 2012-2014. Using a multivariable logistic regression model, we calculated odds ratios (ORs) and 95% confidence intervals (CIs). A total of 10,359 subjects aged 19-64 years were selected, and 432 subjects (74 men, 358 women) were included in the physician-diagnosed depression group. Several cardiovascular risk factors were associated with higher odds of clinical depression. For men, high waist circumference (≥91.3 cm) and body mass index (≥25.0 kg/m²) were significantly associated with increased odds of depression, and high physical activity (≥50 MET h/week) was associated with decreased odds of depression. Men with dyslipidemia and metabolic syndrome had 2.43-fold and 2.0-fold higher odds of depression than those without the diseases. For women, current smokers had 2.25-fold higher odds of depression than nonsmokers, and frequent alcohol drinkers (≥4 times/week) also had 2.88-fold higher odds of depression than nondrinkers. Korean adults with clinical depression had a higher prevalence of some risk factors for cardiovascular diseases than those without depression.

Cultural Adaptation and Psychometric Properties of the Persian Version of Self-Efficacy in Chronic Disease Patients

INTRODUCTION

Self-efficacy is an essential factor for effective self-management in chronic-disease patients. Therefore, the measurement of self-efficacy with a valid and reliable instrument is required. In this study, cultural adaptation and psychometric properties of the Persian version of "Self-Efficacy for Managing Chronic Disease" (SES6G) are illustrated in a sample of Iranian chronic-disease patients.

MATERIALS AND METHODS

This was a cross-sectional study in which translation and backward translation was performed by bilingual translators. The final version of the Persian scale was assessed to determine the content validity index (CVI) and the content validity ratio (CVR). A panel of experts reviewed items of the scale. Factor analysis was performed for the final version of the Persian scale to assess internal consistency and construct validity among chronic-disease patients attending government health care centers from March 2015 to June 2015 in Isfahan, Iran (n = 483).

RESULTS

CVI and CVR scores were 0.87 and 0.89, respectively. There were no eliminated items in the cross-cultural adaptation process. Internal consistency met the criterion for a reliable measure (Cronbach's alpha = 0.89). An initial factor analysis produced a one-dimensional scale (6 items) with Eigenvalues more than 1 that explained 69.49% of the extracted variance.

CONCLUSIONS

The SES6G is a reliable and valid instrument to assess patients' self-efficacy for managing chronic diseases in Persian language. Because the self-efficacy score determines the educational strategies to have effective educational programs, the use of this simple and brief scale could be considered among Persian patients.

Association between depression and metabolic syndrome in korean women: Results from the korean national health and nutrition examination survey (2007-2013)

BACKGROUND

A considerable amount of research suggests that depression may be associated with cardiovascular disease (CVD) and the risk factors for the development of CVD such as metabolic syndrome (MetS). This study aimed to investigate the associations between depression, MetS, and combinations of the individual MetS components in Korean women.

METHODS

Cross-sectional data for 23,385 women who aged 19 years and older were obtained from the nationally representative Korean National Health and Nutrition Examination Survey (2007-2013). Associations between prior diagnosis of depression and MetS were estimated after adjusting for related factors using multivariable logistic regression analysis.

RESULTS

MetS was more prevalent in women with a prior diagnosis of depression than those without diagnosed depression (26.20% vs. 19.07%, p<.001). Depression was significantly associated with MetS (odds ratio, 1.20; 95% confidence interval, 1.01-1.43) after adjusting for age, education, monthly household income, smoking status, alcohol use, physical activity, and postmenopausal status. There was a higher prevalence of most MetS combinations among women with depression than women without depression. Specifically, significant differences between the two groups were found for MetS combinations including high triglycerides.

LIMITATIONS

A cross-sectional study design and lack of a standardized objective measure for depression.

CONCLUSIONS

Diagnosed depression is associated with MetS in Korean women. Specifically, women with diagnosed depression have significantly elevated levels of several combinations of MetS components including high triglycerides. Addressing these MetS combinations could help reduce CVD events and mortality among women with depression.

Cardiovascular disease risk factors associated with depression among Korean adults with coronary artery disease and cerebrovascular disease

OBJECTIVE

This study investigated the cardiovascular risk factors associated with depression among Korean adults with coronary artery disease (CAD) and cerebrovascular disease (CBVD).

METHODS

A total of 487 coronary artery disease and 434 cerebrovascular disease subjects from the Fourth Korean National Health and Nutrition Examination Survey were analyzed according to sex using multiple logistic regression.

RESULTS

The prevalence of depression was 21.7% in those with CAD and 25.5% in those with CBVD. The associated risk factors for depression were female sex (odds ratio [OR] 15.77; 95% confidence interval [CI], 2.44-102.03, P = 0.004), less education (OR 7.09 and 10.36, 95% CI, 1.24-40.75, 1.86-57.70 for an elementary and middle school education, respectively), and hypertension (OR 5.35; 95% CI, 1.48-19.40) in those with CAD and were female sex (OR 4.06, 95% CI, 1.12-14.76) and diabetes mellitus (OR 3.31, 95% CI, 1.36-8.05) in CBVD. These significant associations remained in males, but not in females in those with both CAD and CBVD.

CONCLUSIONS

This study found the associations between hypertension and depression in those with CAD and diabetes mellitus and depression in those with CBVD in males, but not in females. Further studies are needed to explore the associated psychosocial factors of depression in those with different CAD kinds in females.

A qualitative analysis of stress and coping in Korean immigrant women in middle-age and older-adulthood

This qualitative grounded theory study explored stress-coping mechanisms in 14 Korean immigrant women (age ≥40) in the USA, by analyzing existing focus group data about relevant concepts that had been collected in a parent study. Using content analysis, stressors related primarily to socioenvironmental changes following immigration: language barriers, lack of trusting human relationships, and role changes were identified. Both healthy (activities, church, staying busy) and unhealthy (being alone and keeping negative feelings inside) coping strategies were reported by participants. The findings reveal unique aspects of stress-coping among Korean women who had immigrated after being culturally engrained with Confucian influences.

Personality disorders in heart failure patients requiring psychiatric management: comorbidity detections from a routine depression and anxiety screening protocol

Several international guidelines recommend routine depression screening in cardiac disease populations. No previous study has determined the prevalence and comorbidities of personality disorders in patients presenting for psychiatric treatment after these screening initiatives. In the first stage 404 heart failure (HF) patients were routinely screened and 73 underwent structured interview when either of the following criteria were met: (a) Patient Health Questionnaire ≥10; (b) Generalized Anxiety Disorder Questionnaire ≥7); (c) Response to one item panic-screener. Or (d) Suicidality. Patients with personality disorders were compared to the positive-screen patients on psychiatric comorbidities. The most common personality disorders were avoidant (8.2%), borderline (6.8%) and obsessive compulsive (4.1%), other personality disorders were prevalent in less than <3% of patients. Personality disorder patients had significantly greater risk of major depression (risk ratio (RR) 1.2; 95% confidence interval (CI) 1.2-13.3), generalized anxiety disorder (RR 3.2; 95% CI 1.0-10.0), social phobia (RR 3.8; 95% CI 1.3-11.5) and alcohol abuse/dependence (RR 3.2; 95% 1.0-9.5). The findings that HF patients with personality disorders presented with complex psychiatric comorbidity suggest that pathways facilitating the integration of psychiatric services into cardiology settings are warranted when routine depression screening is in place.

Diabetes and depressive symptoms in korean women: the fifth korean national health and nutrition examination survey (2010-2011)

BACKGROUND

The purpose of this study was to investigate the association between diabetes and depressive symptoms among Korean women.

METHODS

We performed an analysis of data for 6,572 women aged 30 or over obtained from the Fifth Korean National Health and Nutrition Examination Survey conducted in 2010 to 2011. We examined the presence of depressive symptoms and the treatment of depression according to diabetes status.

RESULTS

The presence of depressive symptoms was observed in 22.6% of subjects with diabetes. In the multiple logistic regression model, diabetes was associated with an increased risk of depressive symptoms (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.20 to 1.21) but the treatment of depression among diabetics was less common (OR, 0.54; 95% CI, 0.54 to 0.55). Uncontrolled diabetes (glycosylated hemoglobin ≥ 7%) was associated with an increased risk of depressive symptoms (OR, 1.71; 95% CI, 1.69 to 1.73) among diabetics.

CONCLUSION

Physicians should manage individuals with diabetes in consideration of the presence of depressive symptoms, especially in those with uncontrolled diabetes.

Vascular risk factors and depression in later life: a systematic review and meta-analysis

Reports of the association between cardiovascular risk factors and depression in later life are inconsistent; to establish the nature of their association seems important for prevention and treatment of late-life depression. We searched MEDLINE, EMBASE, and PsycINFO for relevant cohort or case control studies over the last 22 years; 1097 were retrieved; 26 met inclusion criteria. Separate meta-analyses were performed for Risk Factor Composite Scores (RFCS) combining different subsets of risk factors, Framingham Stroke Risk Score, and single factors. We found a positive association (odds ratio [OR]: 1.49; 95% confidence interval [CI]: 1.27-1.75) between RFCS and late-life depression. There was no association between Framingham Stroke Risk Score (OR: 1.25; 95% CI: .99-1.57), hypertension (OR: 1.14; 95% CI: .94-1.40), or dyslipidemia (OR: 1.08; 95% CI: .91-1.28) and late-life depression. The association with smoking was weak (OR: 1.35; 95% CI: 1.00-1.81), whereas positive associations were found with diabetes (OR: 1.51; 95% CI: 1.30-1.76), cardiovascular disease (OR: 1.76; 95% CI: 1.52-2.04), and stroke (OR: 2.11; 95% CI: 1.61-2.77). Moderate to high heterogeneity was found in the results for RFCS, smoking, hypertension, dyslipidemia, and stroke, whereas publication bias was detected for RFCS and diabetes. We therefore found convincing evidence of a strong relationship between key diseases and depression (cardiovascular disease, diabetes, and stroke) and between composite vascular risk and depression but not between some vascular risk factors (hypertension, smoking, dyslipidemia) and depression. More evidence is needed to be accumulated from large longitudinal epidemiological studies, particularly if complemented by neuroimaging.

Clinical and sociodemographic factors in a sample of older subjects experiencing depressive symptoms

OBJECTIVES

This study aims to determine the frequency of clinically significant depressive symptoms (CSDS) in a community sample of older Brazilians and to examine their relationship with sociodemographic factors, cognitive and functional impairment (CFI), and medical illness.

METHODS

A total of 1145 subjects aged 60 years or older living in the City of Ribeirao Preto, State of Sao Paulo, Brazil, were interviewed. The following instruments were used: a 10-item scale for screening of depressive symptoms in older people, the mini mental state examination, the Fuld object memory evaluation, the informant questionnaire on cognitive decline in the elderly, the Bayer activities of daily living scale, and a sociodemographic and clinical questionnaire.

RESULTS

The frequency of CSDS was 15.7%. Logistic regression analysis indicated that being previously depressed, having CFI, having lower level of education, using psychotropics, and not engaging in physical exercise were related to CSDS. On the other hand, being a woman, older, medically ill, employed, or married was not associated with CSDS.

CONCLUSIONS

Consistent with previous reports, lower education, lack of physical activity, and CFI were significantly associated with higher frequencies of CSDS. Further investigations are necessary to clarify the occurrence of depression and possible modifiable factors in developing countries such as Brazil.