Gender differences in longitudinal relationships between depression and anxiety symptoms and inflammation in the health and retirement study

Social determinants of inflammatory markers linking depression and type 2 diabetes among women: A scoping review

OBJECTIVE

Inflammation is implicated in the pathophysiology of depression and type 2 diabetes (T2D) and is linked to social determinants of health (SDoH) associated with socioeconomic disadvantage. The objective of this review is to identify and map the range of SDoHs associated with inflammation in depression, T2D, or their co-occurrence among women.

METHODS

PubMed, CINAHL, PsychINFO, and Web of Science were searched March-July 2023 to identify studies where 1) an SDoH was a predictor or independent variable, 2) depression or T2D was a clinical focus, 3) inflammatory markers were collected, and 4) analysis was specific to women. We used the National Institute on Minority Health and Health Disparities research framework to guide searching SDoHs, organize findings, and identify gaps.

RESULTS

Of the 1135 studies retrieved, 46 met criteria. Within the reviewed studies, the most used inflammatory measures were C-reactive protein, interleukin-6, and tumor necrosis factor-α, and the most studied SDoHs were early life stress and socioeconomic status. Individual and interpersonal-level variables comprised the bulk of SDoHs in the included studies, while few to no studies examined built environment (n = 6) or health system level (n = 0) factors. Disadvantageous SDoHs were associated with higher levels of inflammation across the included studies.

CONCLUSION

The scope and intersection of depression and T2D represent a syndemic that contributes to and results from socioeconomic inequities and disproportionately affects women. Simultaneous inclusion of social and inflammatory measures, particularly understudied SDoHs, is needed to clarify potent targets aimed at advancing health and equity.

Bidirectional relationship between C-reactive protein and depressive symptoms considering cumulative effect among Chinese middle-aged and older adults

Introduction

Research examining the bidirectional relationship between C-reactive protein (CRP) and depressive symptoms, while accounting for cumulative effect of repeated episodes of CRP or depressive symptoms, is currently deficient in non-Western populations.

Methods

A nationally representative population-based cohort data from the Chinese Health and Retirement Longitudinal Study (CHARLS) was utilized. In bi-directional analysis, we considered both single determinations and two successive determinations of CRP or depressive symptoms. Multivariate logistic regression assessed the association between elevated CRP levels at baseline or repeated episodes of CRP elevations over two successive determinations and subsequent elevated depressive symptoms, and vice versa.

Results

Although single determinations of CRP or depressive symptoms yielded non-significant results in both directions, full multivariate models, adjusting for baseline depressive symptoms, socio-demographic characteristics, health-related behaviors, metabolic measures, and health status, revealed a significantly positive association based on two successive determinations of CRP or depressive symptoms. This significant association was observed between cumulative effects of sustained CRP elevations over two successive determinations (2 vs. 0) and subsequent elevated depressive symptoms (OR=1.58; 95% CI: 1.15 to 2.17) and between cumulative effect of repeated episodes of depression (2 vs. 0) and later elevated CRP (OR=1.26; 95% CI: 1.02 to 1.56). Furthermore, sex-stratified analyses confirmed the robustness of these relationships.

Conclusion

There are bidirectional associations between depressive symptoms and CRP, driven by the cumulative effect of repeated episodes of CRP or depressive symptoms among middle-aged and older Chinese adults. These findings hold significant clinical implications, highlighting the potential of both anti-inflammatory and anti-depression approaches.

Estimating the Sex Gap in Depression-Free Life Expectancy Among Widowed Americans Aged 50 and Older: An Application Using the Interpolated Markov Chain Approach

OBJECTIVES

Using Interpolated Markov Chain software, we compare the length of life with and without depression among married individuals and widowers, and the related sex differences.

METHODS

We applied a multi-state life table approach to estimate depression-free life expectancy among recent cohorts of older married and widowed women and men in the United States, using data from the Health and Retirement Study over a 7-year period (2012-2018).

RESULTS

The study revealed that the difference in life expectancy between sexes widens in the context of widowhood. At age 50, the sex gap in depression-free life expectancy is 0.8 years among married people, whereas the gap almost doubles to 1.7 years among widowed people.

DISCUSSION

By quantifying disparities in the duration of life affected by depression between married and widowed women and men, policymakers could properly allocate resources specifically to address the mental health needs of these groups.

Red cell distribution width and depressive symptoms: A failed replication in female adolescents

OBJECTIVES

Despite the increasingly high prevalence and serious consequences of depression in adolescents, there is a lack of economical and reliable biomarkers to aid the diagnostic process. Recent findings suggest that red blood cell distribution width (RDW) is an easily obtainable biomarker of depression in adults. Here, we aimed to replicate the finding of increased RDW in clinically depressed adolescents.

METHODS

Data from depressed adolescent female patients (n = 93) and healthy controls (HC) (n = 43) aged 12-17 years from the AtR!Sk-bio cohort study were retrospectively analysed. We compared RDW between groups and tested whether there was an association between RDW and depression severity and global (psychiatric) symptom severity. We also examined the influence of age on RDW.

RESULTS

There was no significant difference between depressed patients and healthy controls and no association between RDW and depression severity. However, higher RDW values were associated with greater global symptom severity. Regardless of group, there was a positive association between RDW and age.

CONCLUSIONS

RDW appears to be unfit as an aid for clinical diagnosis of depression in adolescents, but may be useful in assessing global psychiatric symptom burden.

Does depression in mid-life predispose to greater cognitive decline in later life in the Whitehall II cohort?

BACKGROUND

Later-life depression appears to have different symptomatology and possibly underlying pathology to younger adults. Depression is linked to dementia but whether it is a risk factor or an early sign of dementia remains unclear. Neuroinflammation is increasingly recognised in both conditions.

AIMS

To investigate the link between depression, inflammation and dementia. We hypothesised that recurrent depression increases the rate of cognitive decline in older adults and that this effect is modified by anti-inflammatory medication.

METHODS

We used data from Whitehall II including cognitive test results and reliable measures to assess depression. Depression was defined as a self-reported diagnosis or a score of ≥20 on the CESD. The presence/absence of inflammatory illness was assessed using a standardised list of inflammatory conditions. Individuals with dementia, chronic neurological and psychotic conditions were excluded. Logistic and linear regression was used to examine the effect of depression on cognitive test performance and the effect of chronic inflammation.

LIMITATIONS

Lack of clinical diagnoses of depression.

RESULTS

There were 1063 individuals with and 2572 without depression. Depression did not affect deterioration in episodic memory, verbal fluency or the AH4 test at 15-year follow up. We found no evidence of an effect of anti-inflammatory medication. Depressed individuals had worse cross-sectional performance on the Mill Hill test and tests of abstract reasoning and verbal fluency at both baseline and 15-year follow-up.

CONCLUSIONS

Using a UK based study with a long follow-up interval we have shown that depression in individuals aged >50 is not associated with increased cognitive decline.

Interferon-γ moderation of poor sleep maintenance and depressed mood in community-dwelling older adults

BACKGROUND

Depressive symptoms, such as depressed mood, are common in older adults and associated with an increased risk for morbidity and mortality. Given the evidence that sleep disturbance and alterations in interferon (IFN)-γ biology are associated with depression risk, this study examines the separate and joint contributions of poor sleep maintenance and IFN-γ to depressed mood in older adults.

METHODS

Community-dwelling, non-depressed older adults (n = 36, 72.1 ± 6.8 years) underwent a night of polysomnography to assess sleep maintenance [i.e. wake time after sleep onset (WASO)]. The morning after polysomnography, plasma levels of IFN-γ were evaluated along with self-reported depressed mood throughout the day. Multivariate linear regression tested associations of WASO and IFN-γ with the severity of depressed mood. In addition, moderation and mediation models examined the role of IFN-γ for the relationship between WASO and depressed mood.

RESULTS

A greater amount of WASO (p < 0.05) and higher levels of IFN-γ (p < 0.01) were both associated with the severity of depressed mood. Moreover, IFN-γ moderated the relationship between WASO and depressed mood (p < 0.01), such that WASO was more strongly related to the depressed mood among those with higher IFN-γ, than among those with lower IFN-γ. However, IFN-γ did not mediate the relationship between WASO and depressed mood.

CONCLUSION

In this study of older adults, poor sleep maintenance and higher levels of IFN-γ were both related to depressed mood. Moreover, IFN-γ moderated the relationship between poor sleep maintenance and depressed mood. Together, these findings suggest that older adults with higher IFN-γ are at heightened risk for depressive symptoms following sleep disturbance.

Mean affect and affect variability may interact to predict inflammation

INTRODUCTION

Individuals with greater affect variability (i.e., moment-to-moment fluctuations possibly reflecting emotional dysregulation) are at risk for greater systemic inflammation, which is associated with cardiovascular disease. Some evidence suggests that affect variability is linked with poorer health indicators only among those with higher average levels of affect, particularly for positive affect (PA), and that associations may be non-linear. The present study sought to examine whether links between both PA and negative affect (NA) variability and inflammation are moderated by average level of affect.

METHODS

Participants (N = 300, 50 % female, ages 21-70, 60 % non-Hispanic White, 19 % Hispanic, 15 % non-Hispanic Black) completed a lab assessment and provided a blood sample to measure systemic inflammation (i.e., TNF-α, IL-6, CRP). Affect was collected via a two-day ecological momentary assessment protocol where reports were collected about every 45-min during waking hours. Momentary affect ratings were averaged across both days (i.e., iM), separately for PA and NA, for each participant. Affect variability was calculated as the person-specific SD (i.e., iSD) of affect reports, separately for PA and NA. Linear and quadratic interactions were tested. Models included covariates for sex, race, and body mass index.

RESULTS

There were significant interactions between NA iM and NA iSD predicting TNF-α (b = 6.54; p < 0.05) and between PA iM and PA iSD predicting IL-6 (b = 0.45; p < 0.05). Specifically, the association between these affect variability indicators and inflammatory markers were suggestive of a positive association among those with higher average affect but a negative association among those with lower average affect. There was no evidence of non-linear associations between affect and inflammation.

DISCUSSION

Incorporating interactive effects between affect variability and average affect may be an important consideration in understanding affective-inflammatory associations.

Excess body weight and specific types of depressive symptoms: Is there a mediating role of systemic low-grade inflammation?

OBJECTIVES

Obesity is associated with an increased risk of depression. Systemic low-grade inflammation, a plausible consequence of obesity, has also been linked to depression. However, the potential mediating effects of systemic low-grade inflammation on the association between excess body weight and specific symptom domains of depression remain uncertain. This study examined whether systemic low-grade inflammation mediated the associations of excess body weight (overweight and obesity) with subsequent overall, cognitive-affective, and somatic depressive symptoms.

DESIGN

This study used a prospective cohort design.

METHODS

The final analytical sample included 4,942 adults aged ≥50 years drawn from the English Longitudinal Study of Ageing (ELSA). Body mass index (BMI) and covariates were ascertained at baseline (wave 4, 2008/09). Continuous BMI scores were divided into four categories: 'normal weight' (18.5 ≤ BMI <25 kg/m2); 'overweight' (25 ≤ BMI <30 kg/m2); 'obesity' (BMI ≥30 kg/m2); in addition to 'excess body weight' ('overweight' and 'obesity' combined). Covariates included sociodemographic variables, behavioural factors, and chronic physical conditions. Serum concentrations of CRP were measured at wave 6 (2012/13). Depressive symptoms were assessed at baseline and ten years later (wave 9, 2018/19), using the 8-item Centre for Epidemiological Studies Depression (CES-D) Scale. Two symptom domains were constructed, distinguishing between cognitive-affective (depressed mood, loneliness, sadness, enjoyment in life, and happiness) and somatic (sleep problems, low energy levels, and fatigue) symptoms. Mediation analyses were performed to examine whether CRP statistically mediated the associations between BMI categories and depressive symptoms.

RESULTS

In multivariable-adjusted analyses, excess body weight was associated with elevated somatic (OR = 1.231, 95% CI: 1.029, 1.473), but not cognitive-affective or overall depressive symptoms at follow-up. Higher CRP was associated with elevated somatic (OR = 1.156, 95% CI: 1.061, 1.259), but not cognitive-affective or overall depressive symptoms. CRP acted as a partial mediator (14.92%) of the association between excess body weight and elevated somatic, but not cognitive-affective, or overall depressive symptoms.

CONCLUSION

Systemic low-grade inflammation may partially explain the association of excess body weight with somatic depressive symptoms, but not the associations with cognitive-affective or overall depressive symptoms.

The role of inflammatory markers and cortisol in the association between early social cognition abilities and later internalising or externalising problems: Evidence from a UK birth cohort

OBJECTIVE

Deficits in social cognition are associated with internalising (emotional and peer problems) and externalising (conduct problems and hyperactivity/inattention) symptoms in youth. It has been suggested that stress may be one of the mechanisms underlying these associations. However, no empirical studies have investigated if physiological stress can explain the prospective associations between social cognition deficits and internalising and externalising symptoms in the general youth population. This study addressed this question and focused on two indicators of physiological stress, dysregulated diurnal cortisol patterns and systemic inflammation.

METHOD

Participants were 714 individuals from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK population-based birth cohort. Bayesian structural equation modelling was used to investigate a) the associations of social cognition abilities at ages 8, 11, and 14 years with internalising and externalising problems at age 17 years and b) the potential mediating effects of cortisol parameters at age 15 years and inflammatory markers [interleukin 6 (IL-6) and C-reactive protein (CRP)] at ages 9 and 16 years.

RESULTS

We found that social cognition difficulties were associated with later internalising and externalising problems. Flattened diurnal cortisol slope was associated with hyperactivity/inattention problems two years later. Lower morning cortisol partially mediated the direct association between social communication deficits at 8 years and hyperactivity/inattention and conduct problems at 17 years, even after adjustments for inflammation and confounders (for hyperactivity/inattention: indirect effect = 0.07, 95% CI [0.00, 0.18], p = .042; for conduct problems: indirect effect = 0.04, 95% CI [0.00, 0.11], p = .040). We did not find a significant association between systemic inflammation and social cognition difficulties, internalising problems, or externalising problems.

CONCLUSION

Our findings suggest that part of the effect of social communication difficulties in childhood on externalising problems in adolescence was mediated by lower morning cortisol. Hence, our study indicates that the hypoactivity of the hypothalamic-pituitary-adrenal (HPA) axis may be one of the physiological mechanisms linking some social cognition deficits to externalising problems.

Immune transcriptional profiles in mothers with clinically elevated depression and anxiety symptoms several years post-delivery

BACKGROUND

Most research on maternal mental health focuses on the perinatal period and does not extend beyond 12 months postpartum. However, emerging evidence suggests that for some women (30%-50%), psychological symptoms may persist beyond the first year postpartum or even emerge later increasing the risk of chronic mood and anxiety symptoms. Despite the high prevalence rates and devastating maternal-child consequences, studies examining maternal depression, anxiety, and post-traumatic stress disorder (PTSD) beyond the first year postpartum are rare and our understanding of the underlying biological mechanisms is incomplete. Inflammatory processes are thought to be involved in the pathophysiology of depression, anxiety, & PTSD outside of the postpartum period. Therefore, the purpose of the current investigation was to examine the relationship between depression, anxiety, and PTSD two to three years post-delivery, and transcriptional control pathways relevant to inflammatory and antiviral processes.

METHODS

Women over 18 years of age enrolled in ongoing research studies at Cedars Sinai Medical Center who were 2-3 years postpartum were invited to participate in the current study. Women (N = 33) reported on their levels of depression, anxiety, and PTSD and provided a blood sample approximately 2-3 years post-delivery. Bioinformatic analyses of differential gene expression (DGEs) to infer transcription factor activity were used. Gene expression was assayed by RNA sequencing and TELiS bioinformatics analysis of transcription factor-binding motifs in the promoters of differentially expressed genes.

RESULTS

DGE analyses revealed that women with clinically elevated symptoms of depression, anxiety and PTSD (n = 16) showed upregulation of genes activated by transcription control pathways associated with inflammation (NF-_Κ B, p = 0.004; JUN, p = 0.02), including ꞵ-adrenergic responsive CREB (p = 0.01) and reduced activation of genes associated with the antiviral response (IRFs, p = 0.02) and the glucocorticoid signaling pathway (GR, p = 0.02) compared to women without clinical symptoms (n = 17).

CONCLUSIONS

This is one of the first investigations into the immune signaling pathways involved in depression, anxiety, and PTSD two to three years post-delivery. The results of this study suggest that clinically elevated symptoms of depression, anxiety, and PTSD two to three years post-delivery are associated with a gene expression profile characterized by upregulated expression of pro-inflammatory genes and downregulated expression of antiviral genes. The data also point to two potential stress responsive pathways linking symptoms to increased inflammatory signaling in immune cells: sympathetic nervous system mediated ꞵ-adrenergic signaling and reduced hypothalamic pituitary adrenal axis activity. Together, these findings highlight the need for investigations into maternal mental health beyond the first year postpartum. This article is protected by copyright. All rights reserved.

Networks of inflammation, depression, and cognition in aging males and females

BACKGROUND

Prioritizing the maintenance of healthy cognitive aging and personalizing preventive interventions to enhance their effectiveness is crucial as the global population ages. Systemic inflammation and depression in older people have been associated with decreased levels of cognition but results have been inconsistent.

AIMS

To explore the interactive network of inflammation, depression and cognition by sex in older people.

METHODS

We used novel network analysis to explore the unique associations between inflammatory biomarkers, depression, cognition, and somatic, genetic, and lifestyle risk factors in an older (aged 70-90 years), non-demented, community-dwelling sample from the longitudinal Sydney Memory and Aging Study (N = 916) at baseline and at a two-year follow-up.

RESULTS

The networks of biomarkers, depression, cognition, and relevant covariates were significantly different between males and females. A stable negative link between depression and cognition was found in females only; a stable positive association between biomarker interleukin-6 and depression was found in females only; and a stable positive association between biomarker interleukin-8 and alcohol was found in females only. For both males and females, a stable, positive relationship was found between the presence of APOE-ε4 gene and biomarker C-reactive protein; between education and cognition; and between biomarker interleukin-6 and all other biomarkers.

CONCLUSIONS

These findings suggest different psychophysiological mechanisms underlie the interactive network of biomarkers, depression and cognition in males and females that should be considered when designing personalized preventive interventions to maintain cognitively healthy aging.

Negative correlation between IL-1β, IL-12 and TNF-γ, and cortisol levels in patients with panic disorder

INTRODUCTION

Chronic exposure to stress is a major risk factor in anxiety disorders (ADs) and can be accompanied by an altered microbiome-gut-brain axis and a compromised immune system. In recent years, the study of inflammatory processes in AD has gained special attention. Continued stress causes the reactivity of the hypothalamic-pituitary-adrenal (HPA) axis, the alteration of the intestinal microbiota and the consequent release of pro-inflammatory cytokines, affecting the sensitivity to stress and the similar behavior of anxiety.

METHOD

The aim of the present study was to evaluate the interrelationships between measures of proinflammatory cytokines and cortisol in patients with panic disorder (PD).

RESULTS

The main results of the correlation analysis revealed that the levels of pro-inflammatory cytokines interleukin (IL)-1β, IL-12, and tumor necrosis factor gamma were negatively correlated with cortisol scores (area under the curve with respect to the ground).

CONCLUSIONS

These results suggest that the inflammatory response is associated with the reactivity of the HPA axis in patients with PD and may influence the maintenance of anxiety behavior.

Recurrent depression has persistent effects on cognition but this does not appear to be mediated by neuroinflammation

BACKGROUND

Later-life depression appears to be different to depression in younger adults. The underlying pathology may also differ. Depression is linked to dementia but whether it is a risk factor or an early sign of a developing dementia remains unclear. Neuroinflammation is increasingly recognised in both depression and Alzheimer's Disease.

AIMS

To investigate the link between depression, inflammation and dementia. We hypothesised that recurrent depression has adverse effects on performance in cognitive tests in middle to older age and that this effect is modified by anti-inflammatory medication.

METHODS

We identified UK based cohort studies which included individuals aged >50, had medical information, results from detailed cognitive testing and had used reliable measures to assess depression. Individuals with recurrent depression had ≥ 2 episodes of depression. Controls had no history of depression. The presence/absence of inflammatory illness was assessed using a standardised list of inflammatory conditions. Individuals with dementia, chronic neurological and psychotic conditions were excluded. Logistic and linear regression were used to examine the effect of depression on cognitive test performance and the mediating effect of chronic inflammation.

RESULTS

Unexpectedly in both studies there was evidence that those with recurrent depression performed better in some cognitive tasks (e.g Mill Hill vocabulary) but worse in others (e.g. reaction time). In UK Biobank there was no evidence that anti-inflammatories moderated this effect.

LIMITATIONS

Cross-sectional assessment of cognition.

CONCLUSIONS

Although previous recurrent depression has small effects on cognitive test performance this does not appear to be mediated by chronic inflammatory disease.

The longitudinal connection between depressive symptoms and inflammation: Mediation by sleep quality

Although there is a strong association between depressive symptoms and markers of inflammation, it remains unclear whether depressive symptoms at one point in life may predict inflammation later in life. Moreover, despite extant literature linking sleep with both depressive symptoms and inflammation, there is little research investigating poor sleep as a mechanism linking depressive symptoms with later inflammation. The links between depression and physical health can also vary by gender. In longitudinal analyses with data from the Midlife in the United States (MIDUS) study, we examined whether depressive symptoms were associated with inflammatory markers 11 years later and whether these associations were mediated by sleep disturbances or moderated by gender. Participants reported depressive symptoms and demographic information at baseline. At 11-year follow-up, the same participants (n = 968) reported depressive symptoms, sleep quality and duration using validated scale items, and provided a blood sample from which inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP) were quantified. Actigraphy assessment of sleep was obtained in a subsample (n = 276). After adjusting for concurrent depressive symptoms and other relevant covariates, baseline depressive symptoms were associated with CRP 11 years later in the full sample, and with IL-6 among women. Subjective sleep quality mediated the association between depressive symptoms and CRP. Results suggest that depressive symptoms may be longitudinally associated with inflammation; however, directionality issues cannot be determined from the present work, particularly as inflammation markers (which might have been associated with baseline depressive symptoms) were not available at baseline. Findings further suggest that longitudinal associations between depressive symptoms and inflammation may potentially be explained by sleep and may reflect gender specific patterns.

Effects of Health-Related Behaviors and Changes on Successful Aging among Indonesian Older People

Whether changes in health behaviors can improve successful aging has not been well explored. The purpose of this study was to assess the effects of health-related behaviors and changes on successful aging in Indonesian older adults. Data were from the fourth and fifth waves of the Indonesia Family Life Survey (IFLS), the participants were aged 60 years and older and who completed both waves (n = 1289). Successful aging indicators were defined as no chronic diseases, no physical function difficulties, no depressive symptoms, intact cognitive function, with social support, and with social participation. Health-related behaviors focused on smoking, physical activities, and protein intake. A logistic regression analysis was conducted. The overall successful aging rate in 2007 was 23.6%, and it had decreased to 5.6% by 2014. There were gender differences in smoking, physical activities, and behavioral changes, including promoting increased physical activity, no smoking/smoking cessation, and adequate protein intake by older adults. Quitting smoking, performing medium physical activity, and increasing protein intake were protective factors for successful aging, but the effects of behavioral changes differed by gender. Health-related behaviors and changes may impact successful aging among older adults. A healthy lifestyle is suggested to be adopted as early as possible in one's life course.

A novel 4 immune-related genes as diagnostic markers and correlated with immune infiltrates in major depressive disorder

Background

Immune response is prevalently related with major depressive disorder (MDD) pathophysiology. However, the study on the relationship between immune-related genes (IRGs) and immune infiltrates of MDD remains scarce.

Methods

We extracted expression data of 148 MDD patients from 2 cohorts, and systematically characterized differentially expressed IRGs by using limma package in R software. Then, the LASSO and multivariate logistic regression analysis was used to identify the most powerful IRGs. Next, we analyzed the relationship between IRGs and immune infiltrates of MDD. Finally, GSE76826 was used to to verificate of IRGs as a diagnostic markers in MDD.

Results

203 different IRGs s in MDD has been identified (P < 0.05). GSEA revealed that the different IRGs was more likely to be enriched in immune-specific pathways. Then, a 9 IRGs was successfully established to predict MDD based on LASSO. Next, 4 IRGs was obtained by multivariate logistic regression analysis, and AUC for CD1C, SPP1, CD3D, CAMKK2, and IRGs model was 0.733, 0.767, 0.816, 0.800, and 0.861, suggesting that they have a good diagnostic performance. Furthermore, the proportion of T cells CD8, T cells γδ, macrophages M0, and NK cells resting in MDD group was lower than that in the healthy controls, suggesting that the immune system in MDD group is impaired. Simultaneously, CD3D was validated a reliable marker in MDD, and was positively correlated with T cells CD8. GSEA revealed high expression CD3D was more likely to be enriched in immune-specific pathways, and low expression CD3D was more likely to be enriched in glucose metabolism metabolism-specific pathways.

Conclusions

We applied bioinformatics approaches to suggest that a 4 IRGs could serve as diagnostic markers to provide a novel direction to explore the pathogenesis of MDD.

Depressive symptoms and other negative psychological states relate to ex vivo inflammatory responses differently for men and women: Cross-sectional and longitudinal evidence

An array of negative psychological states - including depressive symptoms, perceived stress, rumination, and negative affect - have been linked to immune function and inflammatory responses. Herein we show evidence of gender-dependent associations between ex vivo lipopolysaccharide (LPS)-stimulated cytokine responses and such psychological states, in both cross-sectional and longitudinal analyses from three annual waves (N = 162 at baseline, 67.3% female). In cross-sectional analyses (at baseline), gender moderated the associations of depressive symptoms (previously reported), perceived stress (B = -0.043, 95%CI [-0.080, -0.015]), rumination (B = -0.500, [-1.015, -0.232]), negative affect (B = -0.020, [-0.020, -0.005]), and positive affect (B = 0.024, [0.008, 0.047]) with LPS-stimulated cytokine responses. In each analysis, negative psychological states were positively associated with LPS-stimulated cytokine responses among men but negatively among women (with associations for positive affect in the opposite direction). In longitudinal analyses (across three annual measurements), similar associations were seen for depressive symptoms (B = -0.024, [-0.059, -0.004]), perceived stress (B = -0.045, [-0.069, -0.024]), and rumination (B = -0.381, [-0.622, -0.120]). These results indicate that gender is a critical factor in associations between a broad array of negative psychological states and inflammatory responses and identify one pathway by which gender may influence psychosomatic health.

The Association between Multiple Chronic Conditions and Depressive Symptoms: Intersectional Distinctions by Race, Nativity, and Gender

Using random coefficient growth curve analysis, this study utilizes 12 waves of data from the Health and Retirement Study (1994-2016; person-waves = 145,177) to examine the association between multiple chronic conditions (MCC) and depressive symptoms among older adults. Applying cumulative disadvantage and intersectionality theories, we also test whether the association between MCC and depressive symptoms differs by race, nativity, and gender. Findings reveal that MCC prevalence is highest among U.S.-born black women, whereas depressive symptoms are highest among foreign-born Hispanic women. Compared to men, MCC has a stronger effect on women's depressive symptoms. Furthermore, the MCC-depressive symptoms association is strongest for foreign-born Hispanic women. Despite an increase in MCC in the transition from midlife to late life, all race-nativity-gender groups experience a decline in depressive symptoms as they age. The decline in depressive symptoms is steepest for U.S.-born black and foreign-born Hispanic women. Study implications are discussed.

Increased inflammation predicts nine-year change in major depressive disorder diagnostic status

Cytokine theory of depression proposes that increased baseline inflammatory activity may accumulate over time and lead to future major depressive disorder (MDD). However, most research conducted on this topic has been cross-sectional and examined between- (vs. within-) persons and symptom severity (vs. diagnosis). Therefore, we tested if elevated inflammatory activity at Time 1 (T1) would predict future within-person 9-year change in MDD diagnosis. Community-dwelling adults (n = 945) participated in the Midlife Development in the United States (MIDUS) study. T1 and Time 2 (T2) MDD status was assessed using the Composite International Diagnostic Interview-Short Form, and markers of inflammatory activity at T1 were measured (e.g., levels of serum interleukin-6 [IL-6], C-reactive protein [CRP], fibrinogen). Latent change score modeling was conducted. Higher T1 IL-6, CRP, and fibrinogen levels of inflammatory activity predicted T1-T2 development/relapse of MDD within persons. This effect occurred more strongly among women (vs. men; d = .149 vs. .042), younger (vs. older) adults (d = .137 vs. .119), persons with more (vs. less) chronic health issues (d = .133 vs. .065), low- (vs. middle- or high-) income earners (d = .161 vs. .050), and persons with more (vs. less) frequent childhood trauma (d = .156 vs. .017). Findings aligned with expanded cytokine theories, which posit that the impact of increased T1 inflammatory activity on future change in MDD status will be larger for subgroups vulnerable to increased stress exposure. Cognitive-behavioral or pharmacological approaches to reduce markers of inflammatory activity may prevent development/relapse of MDD. General Scientific Summary: Increased C-reactive protein (CRP), fibrinogen, and interleukin-6 (IL-6) levels predicted 9-year major depressive disorder (MDD) diagnostic status change more strongly in younger than older adults, women but not men, those with low (vs. high) income, as well as persons with high (vs. low) childhood trauma frequency and number of chronic illnesses. Findings aligned with expanded cytokine theories (e.g., social signal transduction theory of depression), which posit that markers of inflammatory activity predict future change in MDD status especially for populations vulnerable to heightened, chronic, and long-term exposure to environmental stressors. Continued efforts to empirically test expanded cytokine theories of depression may improve delineation of patterns of health disparities and facilitate effective measures to prevent the onset or recurrence of MDD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Depression symptoms mediate the association between workplace stress and interleukin 6 in women, but not men: The Whitehall II study

Workplace stress and depression are positively related with inflammation, and each other. Low-grade inflammation and concurrent high levels of workplace stress or depression has been related with future morbidity. The potential pathway between constructs however, remains elusive. For the first time, this study explored the concurrent relationship between workplace stress, depressive symptomology and low-grade inflammation, and considered the role of gender in these relationships. Data from the Whitehall II cohort study (N ​= ​2528, M_age ​= ​57.01, 23.7% females) provided measures of workplace stress (job demand-control; JDC), depressive symptomology (Centre for Epidemiological Studies Depression scale; CES-D) and circulating inflammatory markers, interleukin-6 (IL-6) and C-reactive protein (CRP) collected on the same day from a single time point. Females had higher workplace stress, depressive symptoms and lower serum IL-6 concentrations. For males, higher workplace stress was associated with higher depressive symptoms. For females, higher depressive symptoms were related with elevated IL-6 levels, and both higher workplace stress and IL-6 levels were associated with higher depressive symptoms. Higher depressive symptoms were related with higher CRP levels in men only. Higher depressive symptoms statistically mediated the relationship between higher workplace stress and IL-6 levels in females only, b ​= ​0.016, CI [0.002, 0.039]. Females in this large cohort had higher levels of job strain, depression and lower IL-6 concentrations than males. In females, higher depressive symptoms were associated with higher serum IL-6 levels and workplace stress was not. Considered together, these findings suggest that low job control may be more apparent in females than males, but it is primarily negative affect that drives the positive relationship between work stress and serum IL-6 concentrations in females. Replicating the current design with a suitably proximal follow-up is required to determine if the associations identified are causal.

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Females had higher workplace stress, depressive symptoms and lower IL-6.

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Association between stress, depression and inflammation was stronger in women.

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Among females, depressive symptoms and not stress associated with serum IL-6. .

Vitamin D and the Risks of Depression and Anxiety: An Observational Analysis and Genome-Wide Environment Interaction Study

Previous studies have suggested that vitamin D (VD) was associated with psychiatric diseases, but efforts to elucidate the functional relevance of VD with depression and anxiety from genetic perspective have been limited. Based on the UK Biobank cohort, we first calculated polygenic risk score (PRS) for VD from genome-wide association study (GWAS) data of VD. Linear and logistic regression analysis were conducted to evaluate the associations of VD traits with depression and anxiety traits, respectively. Then, using individual genotype and phenotype data from the UK Biobank, genome-wide environment interaction studies (GWEIS) were performed to identify the potential effects of gene × VD interactions on the risks of depression and anxiety traits. In the UK Biobank cohort, we observed significant associations of blood VD level with depression and anxiety traits, as well as significant associations of VD PRS and depression and anxiety traits. GWEIS identified multiple candidate loci, such as rs114086183 (p = 4.11 × 10⁻⁸, LRRTM4) for self-reported depression status and rs149760119 (p = 3.88 × 10⁻⁸, GNB5) for self-reported anxiety status. Our study results suggested that VD was negatively associated with depression and anxiety. GWEIS identified multiple candidate genes interacting with VD, providing novel clues for understanding the biological mechanism potential associations between VD and psychiatric disorders.

Anxiety and depression status prior to radiotherapy in patients with nasopharyngeal carcinoma and its effect on acute radiation toxicities

OBJECTIVE

The objective of this work is to explore anxiety and depression status prior to radiotherapy in patients with nasopharyngeal carcinoma (NPC) and its effect on acute radiation toxicities.

METHODS

A total of 267 NPC patients were enrolled between August 2013 and September 2016. The anxiety and depression status of the patients prior to radiotherapy was evaluated using the Hospital Anxiety and Depression Scale. Acute radiation toxicities were assessed weekly and recorded according to the Common Terminology Criteria for Adverse Events version 4.0. Logistic regression analysis was used to identify the predictive factors for acute radiation toxicities.

RESULTS

The rates of anxiety and depression status prior to radiotherapy were 35.2% and 25.5%, respectively. Anxiety was a significant predictor of vomiting (P = 0.001, OR = 2.874) and dysphagia (P = 0.029, OR = 2.080). Depression was a significant predictor of dysgeusia (P = 0.030, OR = 2.957). In addition, age was a significant predictor of dysphagia (P = 0.001, OR = 1.131).

CONCLUSIONS

Anxiety and depression status prior to radiotherapy aggravate acute radiation toxicities in patients with NPC. Assessment of the anxiety and depression status and appropriate interventions should be an integral part of treatment to relieve radiation injury during intensity-modulated radiotherapy.

Proactive Personality and Social Support With Pre-retirement Anxiety: Mediating Role of Subjective Career Success

The main objective of this paper is to investigate the mediating role of subjective career success (SCS) in the relationship between proactive personality, social support (SS), and pre-retirement anxiety. Using a two-wave longitudinal design, 624 pre-retirees were sampled (M = 56.49 years; SD = 4.56); of these, 237 (37.98%) were males and 387 (62.02%) were females. Measurement model and mediation test were performed using the SmartPLS and IBM SPSS Amos software. The result indicated that proactive personality, SS, and SCS showed negative relationships with the dimensions of pre-retirement anxiety (financial preparedness, social obligation, and social alienation). Subjective career success mediated the relationship between proactive personality and pre-retirement anxiety.

The longitudinal associations of inflammatory biomarkers and depression revisited: systematic review, meta-analysis, and meta-regression

The innate immune system is dysregulated in depression; however, less is known about the longitudinal associations of depression and inflammatory biomarkers. We investigated the prospective associations of depression and inflammatory biomarkers [interleukin-6 (IL-6), Tumor Necrosis Factor-Alpha (TNF-α), and C-reactive protein (CRP)] in community samples, both unadjusted and adjusted for covariates. The review, registered with PROSPERO, searched for published and unpublished studies via MEDLINE/PsycINFO/PsycARTICLES/EMBASE/Proquest Dissertation. Standardized Fisher transformations of the correlation/beta coefficients, both unadjusted and adjusted for covariates, were extracted from studies examining the prospective associations of depression and inflammatory biomarkers. Systematic review conducted in January, 2019 included 38 studies representing 58,256 participants, with up to 27 studies included in random-effects meta-analysis. Higher CRP/IL-6 were associated with future depressive symptoms, and higher depressive symptoms were associated with higher future CRP/IL-6 in both unadjusted and adjusted analyses - this is the first meta-analysis reporting an adjusted association of IL-6 with future depression. The adjusted prospective associations of depression with CRP/CRP with depression were substantially attenuated and small in magnitude. No significant associations were observed for TNF-α. No conclusive results were observed in studies of clinical depression. Meta-regression indicated that the association of CRP and future depression was larger in older samples and in studies not controlling for possible infection. Small, prospective associations of depression and inflammatory biomarkers are observed in both directions, particularly for IL-6; however, the strength and importance of this relationship is likely obscured by the heterogeneity in depression and profound study/methodological differences. Implications for future studies are discussed.

Major Depressive Disorder in Older Patients as an Inflammatory Disorder: Implications for the Pharmacological Management of Geriatric Depression

Depression is a common and highly disabling condition in older adults. It is a heterogenous disorder and there is emerging evidence of a link between inflammation and depression in older patients, with a possible inflammatory subtype of depression. Persistent low-level inflammation, from several sources including psychological distress and chronic disease, can disrupt monoaminergic and glutaminergic systems to create dysfunctional brain networks. Despite the evidence for the role of inflammation in depression, there is insufficient evidence to recommend use of any putative anti-inflammatory agent in the treatment of depression in older adults at this stage. Further characterisation of markers of inflammation and stratification of participants with elevated rates of inflammatory markers in treatment trials is needed.

The prevalence of sarcopenia and relationships between dietary intake and muscle mass in head and neck cancer patients undergoing radiotherapy: A longitudinal study

PURPOSE

Our study aims to investigate dietary intake characteristics and their association with skeletal muscle mass in head and neck cancer patients treated with radiotherapy.

METHODS

From March 2017 to August 2018, patients with head and neck cancer who received radiotherapy at our affiliated hospital were enrolled. Dietary intake was assessed through 24-hr dietary recall and skeletal muscle mass was evaluated by bioelectrical impedance analysis at three-time points. Appendicular skeletal muscle mass was adjusted for height squared defined sarcopenia and correlated with dietary intake by generalized estimating equations (GEE).

RESULTS

This study sample comprised 287 patients [median age: 54 years; 187 (65.2%) men]. Median dietary intake at post-treatment was 14.95 kcal/kg/day energy and 0.63 g/kg/day protein. Skeletal muscle mass decreased significantly in all patients. The prevalence of sarcopenia increased from 24.4% before treatment to 46.7% at the end of treatment. Exploratory univariate GEE analysis revealed that radiotherapy time-point, male-gender, age ≥60 and decreased dietary energy intake significantly impacted on muscle loss represented by the appendicular skeletal muscle index. After controlling covariates, dietary energy intake was only positively associated with muscle loss in women (P = 0.013, 95% CI = 0.003-0.027) but not in men (P = 0.788, 95% CI = -0.007-0.009).

CONCLUSION

While the loss in skeletal muscle is more prevalent in men receiving radiotherapy, the effects of dietary energy intake were only associated with women. A prospective randomized clinical trial is required to identify the appropriate amount of dietary energy supplement by gender in cancer patients treated with radiotherapy.

Depression and worry symptoms predict future executive functioning impairment via inflammation

BACKGROUND

Scar models posit that heightened anxiety and depression can increase the risk for subsequent reduced executive function (EF) through increased inflammation across months. However, the majority of past research on this subject used cross-sectional designs. We therefore examined if elevated generalized anxiety disorder (GAD), major depressive disorder (MDD), and panic disorder (PD) symptoms forecasted lower EF after 20 months through heightened inflammation.

METHODS

Community-dwelling adults partook in this study (n = 614; MAGE = 51.80 years, 50% females). Time 1 (T1) symptom severity (Composite International Diagnostic Interview - Short Form), T2 (2 months after T1) inflammation serum levels (C-reactive protein, fibrinogen, interleukin-6), and T3 (20 months after T1) EF (Brief Test of Adult Cognition by Telephone) were assessed. Structural equation mediation modeling was performed.

RESULTS

Greater T1 MDD and GAD (but not PD) severity predicted increased T2 inflammation (Cohen's d = 0.21-1.92). Moreover, heightened T2 inflammation forecasted lower T3 EF (d = -1.98 to -1.87). T2 inflammation explained 25-32% of the negative relations between T1 MDD or GAD and T3 EF. T1 GAD severity predicting T3 EF via T2 inflammation path was stronger among younger (v. older) adults. Direct effects of T1 MDD, GAD, and PD forecasting decreased T3 EF were found (d = -2.02 to -1.92). Results remained when controlling for socio-demographic, physical health, and lifestyle factors.

CONCLUSIONS

Inflammation can function as a mechanism of the T1 MDD or GAD-T3 EF associations. Interventions that successfully treat depression, anxiety, and inflammation-linked disorders may avert EF decrements.

Inflammatory phenotype of depression symptom structure: A network perspective

BACKGROUND

There has been increasing interest in classifying inflammatory phenotypes of depression. Most investigations into inflammatory phenotypes only have tested whether elevated inflammation is associated with elevated levels of depression symptoms, or risk for a diagnosis. This study expanded the definition of phenotype to include the structure of depression symptoms as a function of inflammation.

METHODS

Network models of depression symptoms were estimated in a sample of 4157 adults (mean age = 47.6, 51% female) from the 2015-2016 National Health and Nutrition Examination Survey (NHANES). Analyses included comparisons of networks between those with elevated (C-reactive protein (CRP) values ≥ 3.0 mg/L; N = 1696) and non-elevated CRP (N = 2841) as well as moderated network models with CRP group status and raw CRP values moderating the associations between depression symptoms.

RESULTS

Differences emerged at all levels of analysis (global, symptom-specific, symptom-symptom associations). Specifically, the elevated CRP group had greater symptom connectivity (stronger total associations between symptoms). Further, difficulty concentrating and psychomotor difficulties had higher expected influence (concordance with other symptoms) in the elevated CRP group. Finally, there was evidence that several symptom-symptom associations were moderated by CRP.

CONCLUSIONS

This study provides consistent evidence that the structure of depression symptoms varies as a function of CRP levels. Greater symptom connectivity might contribute to why elevated CRP is associated with treatment-resistant depression. Additionally, differences in symptom structure might highlight different maintenance mechanisms and treatment targets for individuals with compared to those without elevated CRP. Finally, differences in symptom structure as a function of CRP highlight a potential misalignment of standard depression measures (the structure of which are evaluated on groups unselected for CRP levels) and the presentation of depression symptoms in those with elevated CRP.

How handling extreme C-reactive protein (CRP) values and regularization influences CRP and depression criteria associations in network analyses

Increasingly, it has been recognized that analysis at the symptom, rather than diagnostic, level will drive progress in the field of immunopsychiatry. Network analysis offers a useful tool in this pursuit with the ability to identify associations between immune markers and individual symptoms, independent of all other variables modeled. However, investigation into how methodological decisions (i.e., including vs. excluding participants with C-reactive protein (CRP) >10 mg/L, regularized vs. nonregularized networks) influence results is necessary to establish best practices for the use of network analysis in immunopsychiatry. In a sample of 3,464 adult participants from the 2015-2016 National Health and Nutrition Examination Survey dataset, this study found consistent support for associations between CRP and fatigue and changes in appetite and some support for additional CRP-criterion associations. Methodologically, results consistently demonstrated that including individuals with CRP >10 mg/L and estimating nonregularized networks provided better estimates of these associations. Thus, we recommend considering the use of nonregularized networks in immunopsychiatry and inclusion of cases with CRP values >10 mg/L when testing the association between CRP and depression criteria, unless contraindicated by the research question being tested. Additionally, results most consistently suggest that CRP is uniquely related to fatigue and changes in appetite, supporting their inclusion in an immunometabolic phenotype of depression. Finally, these associations suggest that fatigue and changes in appetite might be particularly receptive to anti-inflammatory treatments. However, future research with more nuanced measures is necessary to parse out whether appetite increases or decreases drive this association. Further, longitudinal research is an important next step to test how these relationships manifest over time.

Anxiety Symptoms After Orthopedic Injury: A Systematic Review

BACKGROUND

Millions of Americans are injured each year, with 75% suffering orthopedic injuries. Those with orthopedic injury often experience postinjury symptoms, such as anxiety, that negatively influence long-term outcomes. The purpose of this systematic review was to evaluate (1) the prevalence of anxiety symptoms chronologically in relation to time of orthopedic injury, (2) the associations of anxiety symptoms with other symptoms in individuals with orthopedic injury, and (3) the associations between anxiety symptoms and functional performance and mental health outcomes in individuals with orthopedic injury.

METHODS

The databases CINAHL, Ovid MEDLINE, Ovid PsycInfo, Ovid Embase, ProQuest, and ClinicalTrials.gov were searched on June 25, 2020. Studies were selected for review if (1) participants were 16 years or older, (2) the prevalence of anxiety symptoms was listed, (3) anxiety symptoms were assessed using a validated instrument, (4) the study was published in English, and (5) more than 50% of the participants suffered orthopedic injury to the appendicular skeleton or pelvic ring.

RESULTS

Anxiety symptoms were present in 11.5%-55.9% of individuals up to 10 years after orthopedic injury and often co-occurred with those of depression, pain, and posttraumatic stress disorder to negatively influence functional performance and mental health outcomes.

CONCLUSIONS

Anxiety symptoms post-orthopedic injury are highly prevalent and persistent. Anxiety symptoms are associated with other distressing symptoms and influence long-term outcomes. These findings highlight the need to screen for and treat anxiety symptoms following orthopedic injury and may help in designing future self-management interventions.

Relationships of inflammation trajectories with white matter volume and integrity in midlife

OBJECTIVE

Elevated inflammation is associated with worse late-life cognitive functioning and brain health. Our goal was to examine the relationship between inflammation trajectories and white matter integrity in midlife.

METHODS

Participants were 508 adults from the Coronary Artery Risk Development in Young Adults Study (CARDIA; 51% female). Latent class analysis was used to identify inflammation trajectories based on repeated measures of the inflammatory marker C-reactive protein (CRP) over the 18 years before brain magnetic resonance imaging (MRI). Outcomes were brain MRI measures of total and region-specific white matter volume and integrity at a mean age of 50.6 ± 3.4 years. Linear regression was used to examine if inflammation trajectories were associated with brain MRI outcomes, adjusting for potential confounds in all models and for disease and health behaviors in follow-up models.

RESULTS

Lower-stable (38%), moderate-increasing (7%), and consistently-higher (54%), trajectories emerged. Compared to the lower-stable group, the moderate-increasing group showed lower white matter volume (β = -0.18, 95% CI -0.29, -0.06) and worse white matter integrity as indexed by lower fractional anisotropy (FA; β = -0.37, 95% CI -0.70, -0.04) and higher mean diffusivity (β = 0.44, 95% CI 0.11, 0.78) in the whole brain. The consistently-higher group showed lower whole-brain FA (β = -0.20, -0.38, -0.03). In exploratory analyses, the moderate-increasing group showed lower white matter volume, lower FA and higher MD in the frontal, temporal, and parietal lobes compared to the lower-stable group. The consistently-higher group showed lower white matter volume in the parietal lobe and lower FA in the frontal, temporal, and parietal lobes, but similar MD, compared to the lower-stable group. Findings for the moderate-increasing, but not the consistently-higher, group were robust to adjustment for disease and lifestyle factors.

CONCLUSION

Increasing or high inflammation trajectories from early to mid adulthood are associated with worse brain health, as indexed by lower white matter volume and/or worse white matter integrity.

Positive affect and peripheral inflammatory markers among adults: A narrative review

BACKGROUND

Previous research suggests that positive affect (PA) may promote health and longevity and that one potential mechanism involves inflammation. However, it remains unclear to what extent PA is associated with specific inflammatory markers and whether such associations are driven by main effects of PA and/or due to PA operating as a stress-buffer.

METHODS

The present narrative review incorporates studies (N = 28) that have examined the association between PA and peripheral inflammatory markers obtained using venous puncture or dried blood spots. We separate results by whether the study tested direct effects or stress-buffering, and by type of inflammatory marker [including C-reactive protein (CRP), and proinflammatory and anti-inflammatory cytokines], also paying close attention to type of PA assessment (state, aggregated state, or retrospective, the latter involving recall over one to two weeks), and study design (cross-sectional, longitudinal, and experimental).

RESULTS

Limited evidence suggests that studies were more supportive of a stress-buffering association, compared to a relatively direct association. When significant direct associations were observed, results suggested that studies using measures of state/aggregated PA exhibited more consistent associations with inflammatory markers than studies using retrospective PA. When significant, higher PA tended to be associated with lower pro- and anti-inflammatory markers, suggestive of lower overall inflammatory load.

DISCUSSION

Recommendations for the field and future research are discussed, including the value of utilizing state/aggregated PA measures and of examining stress-buffering mechanisms.

Brainstem volume mediates seasonal variation in depressive symptoms: A cross sectional study in the UK Biobank cohort

Seasonal differences in mood and depressive symptoms affect a large percentage of the general population, with seasonal affective disorder (SAD) representing the most common presentation. SAD affects up to 3% of the world’s population, and it tends to be more predominant in females than males. The brainstem has been shown to be affected by photoperiodic changes, and that longer photoperiods are associated with higher neuronal density and decreased depressive-like behaviours. We predict that longer photoperiod days are associated with larger brainstem volumes and lower depressive scores, and that brainstem volume mediates the seasonality of depressive symptoms. Participants (N = 9289, 51.8% females and 48.1% males) ranging in age from 44 to 79 years were scanned by MRI at a single location. Photoperiod was found to be negatively correlated with low mood and anhedonia in females while photoperiod was found to be positively correlated with brainstem volumes. In females, whole brainstem, pons and medulla volumes individually mediated the relationship between photoperiod and both anhedonia and low mood, while midbrain volume mediated the relationship between photoperiod and anhedonia. No mediation effects were seen in males. Our study extends the understanding of the neurobiological factors that contribute to the pathophysiology of seasonal mood variations.

Associations Between Somatic Multimorbidity Patterns and Depression in a Longitudinal Cohort of Middle-Aged and Older Chinese

OBJECTIVES

Depressive symptoms are commonly seen among patients with multiple chronic somatic conditions, or somatic multimorbidity (SMM); however, little is known about the relationships between depressive symptoms and different SMM combinations. Our study aimed to delineate the patterns of SMM and their longitudinal associations with depressive symptoms among a nationally representative sample of middle-aged and older Chinese adults.

DESIGN

We employed a longitudinal design.

SETTING AND PARTICIPANTS

Older adults (N = 10,084) aged ≥45 years from the China Health and Retirement Longitudinal Study 2011-2015 participated (mean age = 57.7 years at baseline; 53.3% men).

METHODS

Sixteen chronic somatic conditions were ascertained at baseline via questionnaires. Depression was assessed with the Center for Epidemiological Studies Depression Scale at baseline and during follow-up. Patterns of SMM were identified via exploratory factor analyses. Generalized estimating equations were used to evaluate the longitudinal associations between patterns of SMM and the presence of depressive symptoms at follow-up.

RESULTS

Compared with participants with no somatic condition, those with 1, 2, and 3 or more somatic conditions had a 21%, 66%, and 111% greater risk, respectively, for the presence of depressive symptoms. Increased factor scores for 4 patterns identified, cardio-metabolic pattern [adjusted odds ratio (AOR) 1.12, 95% confidence interval (CI) 1.06, 1.20], respiratory pattern (AOR 1.25, 95% CI 1.17, 1.33), arthritic-digestive-visual pattern (AOR 1.29, 95% CI 1.22, 1.37), and hepatic-renal-skeletal pattern (AOR 1.09, 95% CI 1.02, 1.16), were all associated with a higher risk of having depressive symptoms.

CONCLUSIONS AND IMPLICATIONS

All SMM patterns were independently associated with depression among middle-aged and older Chinese adults, with greater odds for people with comorbid arthritic-digestive-visual conditions and respiratory conditions. Clinical practitioners should treat the middle-aged and older population under a multiple-condition framework combining SMM and mental disorders.

Inflammation and the dimensions of depression: A review

Patients with depressive disorders show a wide range of clinical manifestations including cognitive and neurovegetative symptoms. Importantly, these symptoms can differ in terms of biological etiology, and deconstructing depression into specific symptoms may provide valuable insight into the underlying neurobiology. Little research has examined inflammation in the context of depressive dimensions. Here we conduct a narrative review of the existing literature (21 studies) to elucidate whether the depression-inflammation link is symptom specific. Overall, there is evidence that an association exists between neurovegetative symptoms of depression and inflammation, independent of cognitive symptoms. The same cannot be said of cognitive symptoms and inflammation. There is also some evidence of gender differences in the directionality of the relationship between depression and inflammation. Potential explanations for these findings, limitations of the existing literature and recommendations for future research design are discussed.

Inflammatory and metabolic disturbances are associated with more severe trajectories of late-life depression

Late-life depression is a highly prevalent mental health condition with devastating consequences even from its earliest stages. Alterations in physiological functions, such as inflammatory and metabolic, have been described in patients with depression. However, little is known on the association between depression symptom course and metabolic and inflammation dysregulation. This study aimed to depict the course of depression symptoms while ageing, taking into consideration inter-individual heterogeneity. Moreover, it intended to study the associations between inflammatory and metabolic risk profiles and symptom trajectories. To do so, data from 13,203 adults aged 50-90 years (52.75% women; mean age at baseline = 65.07, SD = 10.00) were used. Blood sample and blood pressure measures were taken from 1536 participants (56.58% women; mean age at baseline = 61.73 years, sd = 7.64). Depression symptoms were assessed every two years across a 10-year follow-up. Trajectories were identified by means of latent class mixed modelling. Inflammation and metabolic risk profile scores were obtained from plasma and diagnostic-based indicators in the follow-up, using a robust latent-factor approach. Multigroup modelling was used to study the associations between the profiles and symptom trajectories. As a result, three heterogeneous trajectories of symptoms were identified (low-symptom, moderate-symptom and high-symptom trajectory). Participants depicting a high-symptom trajectory showed the greatest inflammation profile score and high metabolic risk. Moderate-symptom trajectory was also related to high inflammation and metabolic risk. To sum up, at-risk trajectories of symptoms were associated with high inflammation and risk of metabolic diseases. This study provides valuable evidence to advance personalised medicine and mental health precision, considering person-specific profiles and physiological concomitants.

The Prospective Association Between Inflammation and Depressive Symptoms in Type 2 Diabetes Stratified by Sex

OBJECTIVE

We tested whether inflammation is associated with worsening depressive symptoms in type 2 diabetes and examined whether sex moderated this association.

RESEARCH DESIGN AND METHODS

In a prospective cohort study of people with newly diagnosed type 2 diabetes, we measured depressive symptoms over a 2-year follow-up using the Patient Health Questionnaire-9 (PHQ-9). The independent variable was a composite inflammation burden score at diagnosis of diabetes, derived from hs-CRP, white cell count, interleukin (IL)-1β, IL-1 receptor antagonist, monocyte chemotactic protein-1, and vascular endothelial growth factor concentrations. General linear models assessed 1) the association between overall inflammation burden and estimated marginal mean PHQ-9 score (ln transformed) at 2 years and 2) whether sex interacted with elevated inflammation burden (above-median score) in predicting change in PHQ-9 score. Models were adjusted for age, ethnicity, BMI, blood pressure, cholesterol, HbA_1c, antidepressants, anti-inflammatory medications, and baseline ln PHQ-9 score.

RESULTS

Of 1,174 people with complete inflammation data, mean (SD) age was 56.7 (11.0) years and 46.1% were of nonwhite ethnicity and 44.1% female. After full adjustment, inflammation burden was not associated with worsening ln PHQ-9 score (P = 0.65). However, female sex interacted with elevated inflammation in predicting higher 2-year ln PHQ-9 score (β = 0.32, P = 0.005), showing that the difference by inflammation burden in females was 0.32 larger than in males. In post hoc comparisons, ln PHQ-9 score was higher in females than males with elevated inflammation (P = 0.003) but not with low inflammation (P = 0.34) burden.

CONCLUSIONS

In type 2 diabetes, female sex confers specific vulnerability to the effects of inflammation on depressive symptoms.

How acute and chronic physical disease may influence mental health - An Analysis of neurotransmitter precursor amino acid levels

Patients with somatic diseases are more likely to develop depression than physically healthy individuals, and comorbid depression has been shown to incrementally worsen patients´ health. Physical conditions are known to influence neurotransmitter precursor amino acids, changes in which are associated with depressive symptoms. In this prospective study we investigated neurotransmitter precursor amino acids levels in patients with acute and chronic physical disease and evaluated their association with depressive symptoms. 177 subjects with and without chronic medical comorbidity (factor: chronic physical disease) admitted to the trauma and orthopaedic surgery ward for a surgical intervention (factor: acute physical disease) were included in the analysis. Chronic medical comorbidity was scored using Charlson Index and depressive and anxiety symptoms using the Hospital Anxiety and Depression Scale (HADS, factor: mental health). The effect of covariates was also evaluated. C-reactive protein (CRP), neopterin, kynurenine/tryptophan (KYN/TRP) and phenylalanine/tyrosine (PHE/TYR) were analysed by HPLC or ELISA prior to surgery and at discharge. Mixed Model as well as correlation analyses were performed. CRP and neopterin levels were influenced by the factors "acute physical disease" (both p < 0.001) and "chronic physical disease" (p = 0.024, p = 0.001 respectively). PHE/TYR, an index of the catecholamine pathway) was related to the factors "acute physical disease" (p < 0.001) and "mental health-depression" (p = 0.012), while KYN/TRP (an index of the kynurenine pathway affecting also serotonin) was associated with "chronic physical disease" (p = 0.005). No significant effect of "mental health-anxiety" was found. The effect of "mental health-depression" on PHE/TYR was more pronounced in females (gender p = 0.003). Differences in HADS depression values correlated with changes in PHE/TYR and both correlated with CRP values. In conclusion, inflammatory reactions related to acute or chronic physical conditions can influence the availability of neurotransmitter precursor amino acids l and these changes are associated with mental health.

Depressive symptoms and immune transcriptional profiles in late adolescents

BACKGROUND

Rates of depression increase and peak during late adolescence and alterations in immune processes are thought to be both a risk factor and outcome of depression. However, few studies have examined depression-immune dynamics among adolescents. Using a functional genomics approach, the current study examined whether depressive symptoms were associated with activation of a gene expression profile, characterized by upregulated expression of pro-inflammatory-related genes and downregulated expression of antiviral-related genes in a sample of older adolescents (M_age = 18.37, SD = 0.51).

METHOD

Participants (n = 87) reported on their depressive symptoms during the past week using the CES-D, and provided blood samples for genome-wide transcriptional profiling of mRNA.

RESULTS

Adolescents with clinically-significant levels of depressive symptoms (CES-D ≥ 16) exhibited upregulated expression of inflammation-related genes and downregulated expression of antiviral-related genes compared to their peers with lower levels of depressive symptoms (CES-D < 16). Bioinformatics analyses suggested that this pattern of differential gene expression was mediated by greater activity of the pro-inflammatory transcription factor, nuclear factor-kappa B (NF-κB), and reduced activity of glucocorticoid receptors (GRs) and interferon response factors (IRFs). Additional analyses implicated monocytes, B cells, and dendritic cells as primary cellular sources of the observed gene expression patterns associated with depressive symptoms.

CONCLUSION

Results are consistent with past work demonstrating links between depression and altered immunity. They provide a molecular basis for these associations and suggest that the underlying molecular signature may emerge as early as late adolescence when rates of depression tend to increase.

Stress-induced disturbances along the gut microbiota-immune-brain axis and implications for mental health: Does sex matter?

Women are roughly twice as likely as men to suffer from stress-related disorders, especially major depression and generalized anxiety. Accumulating evidence suggest that microbes inhabiting the gastrointestinal tract (the gut microbiota) interact with the host brain and may play a key role in the pathogenesis of mental illnesses. Here, the possibility that sexually dimorphic alterations along the gut microbiota-immune-brain axis could play a role in promoting this female bias of mood and anxiety disorders will be discussed. This review will also analyze the idea that gut microbes and sex hormones influence each other, and that this reciprocal crosstalk may come to modulate inflammatory players along the gut microbiota-immune-brain axis and influence behavior in a sex-dependent way.

Longitudinal effects of race, ethnicity, and psychosocial disadvantage on systemic inflammation

Objective

Psychosocial factors likely contribute to racial and ethnic inequalities in cardiovascular diseases (CVDs). However, precise social, psychological, and physiological pathways linking race and ethnicity to the development of CVDs are not well understood. Systemic inflammation, commonly indexed by C-reactive protein (CRP), is a biomarker for CVD risk and progression. The objective of this study was to identify mediating pathways from race and ethnicity to CRP through social, psychological, and behavioral variables.

Methods

Using data from 12,382 participants aged 51 and older in the Health and Retirement Study, structural equation models tested for direct and indirect effects of race and ethnicity on CRP measured over four years through educational disadvantage, everyday discrimination, depressive symptoms, external locus of control, and smoking.

Results

Educational disadvantage mediated Black-White and Hispanic-White disparities in baseline CRP directly, as well as indirectly through elevated depressive symptoms, higher external locus of control, and smoking. Educational disadvantage also mediated Black-White and Hispanic-White disparities in CRP change directly, as well as indirectly through higher external locus of control and smoking. Independent of education, discrimination mediated Black-White differences in baseline CRP via elevated depressive symptoms, higher external locus of control, and smoking. Discrimination also mediated Black-White disparities in CRP change via external locus of control.

Conclusions

Results from this population-based, longitudinal study support the view that racially patterned social disadvantage is prospectively associated with longitudinal inflammatory processes, and some of these effects are independently mediated by psychological and behavioral factors. Biopsychosocial pathways to health disparities also differ between minority groups.

Longitudinal association of inflammation with depressive symptoms: A 7-year cross-lagged twin difference study

BACKGROUND

The direction of the association between inflammation and depressive symptoms remains inconsistent. The objective of this study was to evaluate the temporal relationship between inflammation and depressive symptoms, and to assess the role of genetic factors on this association.

METHODS

In this longitudinal cross-lagged twin difference study, we examined 166 (83 pairs) middle-aged male twins recruited from the Vietnam Era Twin Registry, who were assessed at baseline and after 7 years of follow-up. We assayed plasma levels of two inflammatory biomarkers, interleukin-6 (IL-6) and high sensitivity C-reactive protein (CRP) and measured depressive symptoms using the Beck Depression Inventory-II (BDI). To evaluate the direction of the association, we constructed multivariable mixed-effects regression models and calculated standardized beta-coefficients to compare the strength of the within-pair association for both pathways. We then conducted a stratified analysis by zygosity and assessed the associations in monozygotic and dizygotic twin pairs separately.

RESULTS

The 166 twins were 95% white and had a mean (SD) age of 54 (3) years at baseline. The cross-lagged analysis showed significant and positive associations from visit 1 IL-6 to visit 2 BDI across all models (beta-coefficients ranging from 0.18 to 0.22). However, the opposite pathway (visit 1 BDI to visit 2 IL-6) was not significant after adjusting for confounding factors. In contrast, visit 1 BDI was significantly associated with visit 2 CRP in all models (beta-coefficients ranging from 0.23 to 0.33), while the opposite pathway (visit 1 CRP to visit 2 BDI) showed no significant association. When stratifying by zygosity, significant associations from IL-6 to depression were only seen in monozygotic twins, but associations from depression to CRP were more robust in dizygotic twins, which implies that genetic factors may play a role in this association.

CONCLUSIONS

The association between inflammation and depression may be bidirectional. Elevated IL-6 levels are more likely to be a risk factor of depression rather than a consequence, while the opposite may be true for elevated CRP. The biological underpinnings of these bidirectional pathways need further evaluation.

Insomnia symptoms are associated with elevated C-reactive protein in young adults

OBJECTIVE

Insomnia is associated with elevated inflammation; however, studies have not investigated if this relationship is confounded with depression and neuroticism, which are associated with insomnia and inflammation. The current study examined the association of insomnia symptoms with C-reactive protein (CRP) and with interleukin-6 (IL-6), independently and after controlling for depressive symptoms and neuroticism.

DESIGN

Fifty-two young adults (mean age = 25.2 ± 3.9 years, 52% female) completed a baseline survey to assess psychological characteristics, followed by a plasma blood draw.

MAIN OUTCOME MEASURES

Plasma CRP and IL-6.

RESULTS

When examined alone, insomnia symptoms were significantly associated with elevated CRP (β = 0.52; R² = 0.27), as was neuroticism (β = 0.41, R² = 0.17), but not depressive symptoms (β = 0.21, R² = 0.05). The association between insomnia symptoms and CRP remained significant when depressive symptoms and neuroticism were entered into the model simultaneously; this model did not explain more variance than the model with insomnia symptoms alone. No variables were associated with IL-6.

CONCLUSIONS

Results suggest that insomnia symptoms are independently associated with elevated CRP in young adults, even after controlling for presumed overlapping psychological constructs. Findings highlight the potential importance of treating insomnia to reduce systemic inflammation.