Epidemiologic evidence for the relation between socioeconomic status and depression, obesity, and diabetes

The association of socioeconomic status with the success of chat-based online counseling for children and youth: A latent change score modeling approach

Children and youth from lower subjective socioeconomic status (SES) backgrounds are at a heightened risk of mental disorders. Online counseling is a valuable tool to reach those less likely to seek professional help, but its success across different SES backgrounds remains unclear. This study explores the association between subjective SES and online counseling outcomes. Children and youth (N = 2139) between 10 and 24 years-of-age received chat-based online counseling and reported on SES, negative feelings before and after the chat, and perceived helpfulness of the chat via an online assessment tool. The results of a latent change score model showed a significant association between SES and negative feelings before chatting, indicating that lower SES predicted more negative feelings (r = -0.26, p < .001). Further, SES was indirectly associated with the change in negative feelings from before to after counseling, mediated by the extent of negative feelings before the chat (β = 0.07, 95%CFI = [0.05-0.10]). Current findings extend research on online counseling programs in the context of SES. Despite higher counseling needs among low SES individuals, they do not benefit proportionally from existing online services in this sample. Future research should investigate barriers to help-seeking and implement specialized counselor training programs.

Cultural Beliefs About Diabetes-Related Social Exclusion and Diabetes Distress Impact Self-Care Behaviors and HbA1c Among Patients with Type 2 Diabetes

BACKGROUND

Type 2 diabetes mellitus (T2DM) disproportionally impacts Latin Americans (Latinos) in the U.S. compared to non-Latino Whites, as reflected by an increased risk for disease complications and higher mortality rates. Guided by an Integrative Model of Culture, Psychological Processes, and Health Behavior, the purpose of the present study was to examine the role of cultural beliefs and diabetes distress as determinants of self-care behaviors and HbA1c among Latino patients with T2DM.

METHODS

Participants included 109 Latino patients with T2DM recruited from a diabetes treatment center located in a region of Southern California with high diabetes mortality rates. Structural equation modeling was employed to examine the extent to which cultural beliefs about diabetes-related social exclusion and diabetes distress impact self-care behaviors and self-reported HbA1c.

RESULTS

Consistent with the study hypotheses, cultural beliefs about diabetes-related social exclusion predicted diabetes distress, which in turn predicted poor diabetes self-care.

CONCLUSIONS

Findings suggest an important need for intervention efforts that address both cultural and psychological factors in order to improve diabetes self-care behaviors and associated disease outcomes among Latino patients with T2DM. Future research could benefit from investigating protective aspects of culture that could help counter the negative implications of cultural beliefs about social exclusion and diabetes distress associated with poor self-care.

The mental health of first- and second-generation migrant vs. native healthcare workers during the COVID-19 pandemic: The VOICE survey of 7,187 employees in the German healthcare sector

The COVID-19 pandemic exacerbated the challenging working conditions of healthcare workers (HCWs) in many regions. A considerable proportion of HCWs in Germany are migrants facing additional migration-related stressors. The aim of this cross-sectional web-based survey was to examine depressive and generalized anxiety symptoms among migrant and native HCWs in Germany during the pandemic. We compared 780 migrant (first- and second-generation) HCWs from different backgrounds with 6,407 native HCWs. Multiple linear regression analyses were used to examine associations between occupational and COVID-19 related variables, controlling for sociodemographics. Migrant HCWs from low-/middle-income countries more frequently had clinically relevant depressive symptoms (PHQ-2 ≥ 3) than did those from high-income countries (29.9% vs. 16.7%, p = .002, ϕ = .156) (all other ϕs/Cramer's Vs ≤ .036). There were no clinically relevant differences in anxiety levels (GAD-2 ≥ 3) between native vs. migrant HCWs, native vs. the individual migrant HCW groups, or between the sexes (all ϕs/Cramer's Vs ≤ .036). After controlling for key sociodemographic characteristics, native HCWs did not differ from the individual migrant HCW groups on depression and anxiety severity (depression: all βs ≤ |.030|, anxiety: all βs ≤ |.014|). A high percentage of HCWs reported distress, with migrants from low-/middle-income countries reporting highest burden. The results indicate the need to establish prevention programmes for HCWs, with special consideration to vulnerable populations including certain migrant groups.

Examining illness perceptions over time: an exploratory prospective analysis of causal attributions in individuals with depressive symptoms

BACKGROUND

According to the Common-Sense Model of Illness Representations, illness beliefs, such as causal attributions, can influence the way people assess and cope with their illness and vice versa. To date, causal attributions in people with depressive symptoms have been studied mainly cross-sectionally, quantitatively and independently. The purpose of this study is to examine the causal attributions of people with depressive symptoms in terms of their stability over time, dependence on treatment experience, and differentiation of causal concepts.

METHODS

In a population-based prospective sample, people with at least mild depressive symptoms (PHQ-9 Score ≥ 5) were interviewed via telephone at T0 and twelve months later (T1). Causal attributions were assessed using the Brief Illness Perception Questionnaire. After the open responses were qualitatively analysed using a deductive-inductive approach, stability over time was assessed for causal attributions and concepts by comparing answers between the two time points. Subsequent exploratory quantitative analyses were conducted using chi-square tests, t-tests, and logistic regression analyses.

RESULTS

A total of 471 individuals (age M = 53.9, 53.6% female) with a mean PHQ-9 Score of 8.4 were included in the analyses. Causal attributions related to participants' social environment, workplace, and past are the most stable over time. However, individuals with and without a time-stable causal concept showed no differences in terms of sociodemographic characteristics, severity of depressive symptoms, risk of comorbidity, and treatment experiences. Overall, the causal concepts of people with depressive symptoms appear to be very diverse. Those with treatment experience (M = 2.21, SD = 0.80) named significantly more causal attributions compared to people without treatment experience (M = 1.98, SD = 0.81, t(471) = -3.060, p < 0.01). In addition, logistic regression analyses revealed that treatment-experienced respondents were more likely to attribute "childhood/youth/parental home" and "predisposition".

CONCLUSIONS

Our study reveals that people with treatment experience tend to report treatment-congruent causal attributions, such as childhood and family environment, as well as predisposition, more frequently. Understanding how causal attributions and concepts are formed and change can be helpful for addressing causal attributions in treatment. Future studies should take into account the benefits of employing qualitative survey methods for exploring causal attributions.

Machine learning for detection of heterogeneous effects of Medicaid coverage on depression

In 2008, Oregon expanded its Medicaid program using a lottery, creating a rare opportunity to study the effects of Medicaid coverage using a randomized controlled design (Oregon Health Insurance Experiment). Analysis showed that Medicaid coverage lowered the risk of depression. However, this effect may vary between individuals, and the identification of individuals likely to benefit the most has the potential to improve the effectiveness and efficiency of the Medicaid program. By applying the machine learning causal forest to data from this experiment, we found substantial heterogeneity in the effect of Medicaid coverage on depression; individuals with high predicted benefit were older and had more physical or mental health conditions at baseline. Expanding coverage to individuals with high predicted benefit generated greater reduction in depression prevalence than expanding to all eligible individuals (21.5 vs 8.8 percentage-point reduction; adjusted difference = +12.7 [95% CI, +4.6 to +20.8]; P = 0.003), at substantially lower cost per case prevented ($16 627 vs $36 048; adjusted difference = -$18 598 [95% CI, -156 953 to -3120]; P = 0.04). Medicaid coverage reduces depression substantially more in a subset of the population than others, in ways that are predictable in advance. Targeting coverage on those most likely to benefit could improve the effectiveness and efficiency of insurance expansion. This article is part of a Special Collection on Mental Health.

The impact of depressive and anxious symptoms on quality of life in adults on the autism spectrum

Quality of life (QoL) is lower in adults on the autism spectrum (AS) compared with typically developing (TD) adults. In this context, recent studies have examined the role of depression and anxiety in reducing QoL in AS adults. The aim of this study was to (1) replicate these findings of lower QoL and (2) assess the negative influence of depressive and anxious symptoms on QoL in an adult AS (N = 86) and TD (N = 87) German sample with a broad age range (18-70 years). For this, we used questionnaires that have been validated for the AS and TD population: the World Health Organization Quality of Life Brief Version, the Autism-Specific QoL items, and the Hospital Anxiety and Depression Scale. We replicated previous findings and extended them to autism-specific QoL. Our AS sample had lower QoL compared with the TD adults. However, depressive symptoms were the largest contributor to lower QoL in both samples, more so than group membership and anxious symptoms. We conclude that interventions to improve QoL in AS adults should specifically target depressive symptoms and for this, improvements to the diagnostic process and treatment of depression in AS are necessary.

The effect of socioeconomic status, depression, and diabetes symptoms severity on diabetes patient's life satisfaction in India

Evidence suggests that diabetes is on the rise in India, affecting many people's life satisfaction. Comprehensive estimation of life satisfaction among diabetes patients does not exist in the country. This study examined the effects of socioeconomic status, depression, and diabetes symptoms severity on the life satisfaction of diabetes patients by controlling various demographic variables. It was a cross-sectional study comprising 583 diabetes patients from Punjab, India. Patients were interviewed using a multi-stage purposeful random sampling method. Descriptive analysis and partial least squares structural equation modelling were used in the study to test the hypotheses. Results revealed that socioeconomic status, depression and diabetes symptoms severity significantly influence the life satisfaction of diabetes patients. A 1% drop in diabetes symptoms severity corresponds to a 0.849% increase in life satisfaction, whereas a 1% decrease in depression results in a 0.898% increase in life satisfaction. Patients with higher diabetes symptoms severity were coping with common mental disorders. Women reported higher diabetes symptoms severity and depression than men, resulting in lower life satisfaction. An experimental evaluation of the effects of socioeconomic status, depression and diabetes symptoms severity, and numerous demographic factors on life satisfaction was reported. The findings will help policymakers understand the problem associated with life satisfaction among diabetes patients in the country.

Knowledge and attitude on the role of lifestyle modifications in the management of diabetes in Jeddah, Saudi Arabia

BACKGROUND

Public knowledge about the role of lifestyle in managing type two diabetes (T2D) is an essential preventive strategy. Despite efforts in public awareness, the prevalence continues to rise, with the majority relying on the availability of effective therapeutics, underestimating the role of healthy lifestyle changes. This study aims to assess public awareness of the impact of lifestyle modification in managing T2D in a major metropolitan city in Saudi Arabia, which will help inform the health management authority in the country on the level of public awareness and advise on the development of educational programs.

METHODS

An observational cross-sectional survey study comprising 16 knowledge and 6 attitude questions was conducted among the population over 18 years old using online survey. After validation, the online self-developed questionnaire was distributed through social media.

RESULTS

The knowledge and attitude scores were similar between males and females. Participants with a family member or friend with T2D demonstrated higher knowledge scores. However, the attitude scores did not differ significantly based on family or friend relationships.

CONCLUSION

The knowledge and attitude on the role of lifestyle modifications in preventing and managing T2D is moderate, implying an opportunity for innovative strategies to raise public knowledge and attitude.

Measuring algorithmic bias to analyze the reliability of AI tools that predict depression risk using smartphone sensed-behavioral data

AI tools intend to transform mental healthcare by providing remote estimates of depression risk using behavioral data collected by sensors embedded in smartphones. While these tools accurately predict elevated depression symptoms in small, homogenous populations, recent studies show that these tools are less accurate in larger, more diverse populations. In this work, we show that accuracy is reduced because sensed-behaviors are unreliable predictors of depression across individuals: sensed-behaviors that predict depression risk are inconsistent across demographic and socioeconomic subgroups. We first identified subgroups where a developed AI tool underperformed by measuring algorithmic bias, where subgroups with depression were incorrectly predicted to be at lower risk than healthier subgroups. We then found inconsistencies between sensed-behaviors predictive of depression across these subgroups. Our findings suggest that researchers developing AI tools predicting mental health from sensed-behaviors should think critically about the generalizability of these tools, and consider tailored solutions for targeted populations.

Measuring algorithmic bias to analyze the reliability of AI tools that predict depression risk using smartphone sensed-behavioral data

AI tools intend to transform mental healthcare by providing remote estimates of depression risk using behavioral data collected by sensors embedded in smartphones. While these tools accurately predict elevated symptoms in small, homogenous populations, recent studies show that these tools are less accurate in larger, more diverse populations. In this work, we show that accuracy is reduced because sensed-behaviors are unreliable predictors of depression across individuals; specifically the sensed-behaviors that predict depression risk are inconsistent across demographic and socioeconomic subgroups. We first identified subgroups where a developed AI tool underperformed by measuring algorithmic bias, where subgroups with depression were incorrectly predicted to be at lower risk than healthier subgroups. We then found inconsistencies between sensed-behaviors predictive of depression across these subgroups. Our findings suggest that researchers developing AI tools predicting mental health from behavior should think critically about the generalizability of these tools, and consider tailored solutions for targeted populations.

Understanding the etiopathogenesis of lumbar intervertebral disc herniation: From clinical evidence to basic scientific research

Lumbar intervertebral disc herniation, as a leading cause of low back pain, productivity loss, and disability, is a common musculoskeletal disorder that results in significant socioeconomic burdens. Despite extensive clinical and basic scientific research efforts, herniation etiopathogenesis, particularly its initiation and progression, is not well understood. Understanding herniation etiopathogenesis is essential for developing effective preventive measures and therapeutic interventions. Thus, this review seeks to provide a thorough overview of the advances in herniation-oriented research, with a discussion on ongoing challenges and potential future directions for clinical, translational, and basic scientific investigations to facilitate innovative interdisciplinary research aimed at understanding herniation etiopathogenesis. Specifically, risk factors for herniation are identified and summarized, including familial predisposition, obesity, diabetes mellitus, smoking tobacco, selected cardiovascular diseases, disc degeneration, and occupational risks. Basic scientific experimental and computational research that aims to understand the link between excessive mechanical load, catabolic tissue remodeling due to inflammation or insufficient nutrient supply, and herniation, are also reviewed. Potential future directions to address the current challenges in herniation-oriented research are explored by combining known progressive development in existing research techniques with ongoing technological advances. More research on the relationship between occupational risk factors and herniation, as well as the relationship between degeneration and herniation, is needed to develop preventive measures for working-age individuals. Notably, researchers should explore using or modifying existing degeneration animal models to study herniation etiopathogenesis, as such models may allow for a better understanding of how to prevent mild-to-moderately degenerated discs from herniating.

Explainable Model Using Shapley Additive Explanations Approach on Wound Infection after Wide Soft Tissue Sarcoma Resection: "Big Data" Analysis Based on Health Insurance Review and Assessment Service Hub

Background and Objectives: Soft tissue sarcomas represent a heterogeneous group of malignant mesenchymal tissues. Despite their low prevalence, soft tissue sarcomas present clinical challenges for orthopedic surgeons owing to their aggressive nature, and perioperative wound infections. However, the low prevalence of soft tissue sarcomas has hindered the availability of large-scale studies. This study aimed to analyze wound infections after wide resection in patients with soft tissue sarcomas by employing big data analytics from the Hub of the Health Insurance Review and Assessment Service (HIRA). Materials and Methods: Patients who underwent wide excision of soft tissue sarcomas between 2010 and 2021 were included. Data were collected from the HIRA database of approximately 50 million individuals' information in the Republic of Korea. The data collected included demographic information, diagnoses, prescribed medications, and surgical procedures. Random forest has been used to analyze the major associated determinants. A total of 10,906 observations with complete data were divided into training and validation sets in an 80:20 ratio (8773 vs. 2193 cases). Random forest permutation importance was employed to identify the major predictors of infection and Shapley Additive Explanations (SHAP) values were derived to analyze the directions of associations with predictors. Results: A total of 10,969 patients who underwent wide excision of soft tissue sarcomas were included. Among the study population, 886 (8.08%) patients had post-operative infections requiring surgery. The overall transfusion rate for wide excision was 20.67% (2267 patients). Risk factors among the comorbidities of each patient with wound infection were analyzed and dependence plots of individual features were visualized. The transfusion dependence plot reveals a distinctive pattern, with SHAP values displaying a negative trend for individuals without blood transfusions and a positive trend for those who received blood transfusions, emphasizing the substantial impact of blood transfusions on the likelihood of wound infection. Conclusions: Using the machine learning random forest model and the SHAP values, the perioperative transfusion, male sex, old age, and low SES were important features of wound infection in soft-tissue sarcoma patients.

The Effect of Income and Wealth on Behavioral Strategies, Personality Traits, and Preferences

Individuals living in either harsh or favorable environments display well-documented psychological and behavioral differences. For example, people in favorable environments tend to be more future-oriented, trust strangers more, and have more explorative preferences. To account for such differences, psychologists have turned to evolutionary biology and behavioral ecology, in particular, the literature on life-history theory and pace-of-life syndrome. However, critics have found that the theoretical foundations of these approaches are fragile and that differences in life expectancy cannot explain vast psychological and behavioral differences. In this article, we build on the theory of optimal resource allocation to propose an alternative framework. We hypothesize that the quantity of resources available, such as income, has downstream consequences on psychological traits, leading to the emergence of behavioral syndromes. We show that more resources lead to more long-term orientation, more tolerance of variance, and more investment in low marginal-benefit needs. At the behavioral level, this translates, among others, into more large-scale cooperation, more investment in health, and more exploration. These individual-level differences in behavior, in turn, account for cultural phenomena such as puritanism, authoritarianism, and innovation.

Exploring Sexual Orientation Disparities Regarding the Interplay of Childhood Sexual Abuse, Self-Reported Diabetes Status, and Depression Among Adults in the United States

Previous research has revealed a strong link between the experience of childhood sexual abuse (CSA) and diabetes in adulthood. Moreover, research has shown that sexual minorities (SM) are exposed to adverse childhood experiences (ACEs) (i.e. CSA) and experience depression at higher rates than their heterosexual counterparts. Thus, it is imperative to further investigate the role of depression and the differential associations of exposure to ACEs with diabetes prevalence by sexual orientation. We explored sexual orientation disparities regarding the relationship between CSA and diabetes and examined the moderating role of depression. A total of 29,903 participants from the 2021 Behavioral Risk Factor Surveillance System (BRFSS) were included in this study. Secondary data analysis was conducted using the survey data, and weighted logistic regression and moderation analysis were performed. Heterosexuals who experienced CSA (AOR = 1.25; p < .05) and SM who experienced CSA (AOR = 2.13; p < .05) reported higher odds of having diabetes. Among heterosexuals, depression (AOR = 1.38; p < .001) was significantly associated with having diabetes. Additionally, depression was a significant moderator among heterosexuals with and without CSA. Further understanding of the impact of ACEs on diabetes among specific subgroups of SM should be assessed in future studies.

Age affects the association between socioeconomic status and infertility: a cross-sectional study

BACKGROUND

Previous studies have shown the interaction between age and socioeconomic status (SES) on the risk of infertility in the UK, but the association is still unclear in the United States. Therefore, the present study investigated the effect of age on the relationship between SES and the risk of infertility in American women.

METHODS

The study included adults who participated in the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018. The poverty income ratio (PIR) was used to represent the SES of the population. With participants stratified according to age category (< 35 years; ≥ 35 years), we further assessed differences in the relationship between PIR and infertility risk among participants of different age groups using multivariate logistic regression and interaction tests.

RESULTS

Approximately 3,273 participants were enrolled in the study. There were 399 cases of infertility and 2,874 cases without infertility. In women ≥ 35 years of age, PIR levels were significantly higher in infertile participants than in non-infertile participants, but no such difference was found in those < 35 years of age. The association of PIR with the risk of infertility appeared to differ between age < 35 years and age ≥ 35 years (OR: 0.99, 95%Cl: 0.86-1.13 vs. OR: 1.24, 95%Cl: 1.12-1.39) in a fully adjusted model. Furthermore, an interaction between age and PIR increased the risk of infertility (p-value for interaction < 0.001).

CONCLUSION

Our study found that age may influence the association between PIR and infertility. It is imperative to perform further studies to provide more evidence.

Using digital phenotyping to capture depression symptom variability: detecting naturalistic variability in depression symptoms across one year using passively collected wearable movement and sleep data

Major Depressive Disorder (MDD) presents considerable challenges to diagnosis and management due to symptom variability across time. Only recent work has highlighted the clinical implications for interrogating depression symptom variability. Thus, the present work investigates how sociodemographic, comorbidity, movement, and sleep data is associated with long-term depression symptom variability. Participant information included (N = 939) baseline sociodemographic and comorbidity data, longitudinal, passively collected wearable data, and Patient Health Questionnaire-9 (PHQ-9) scores collected over 12 months. An ensemble machine learning approach was used to detect long-term depression symptom variability via: (i) a domain-driven feature selection approach and (ii) an exhaustive feature-inclusion approach. SHapley Additive exPlanations (SHAP) were used to interrogate variable importance and directionality. The composite domain-driven and exhaustive inclusion models were both capable of moderately detecting long-term depression symptom variability (r = 0.33 and r = 0.39, respectively). Our results indicate the incremental predictive validity of sociodemographic, comorbidity, and passively collected wearable movement and sleep data in detecting long-term depression symptom variability.

Depressive Symptom Subgroups and Their Association with Prevalent and Incident Cardiovascular Risk Factors in the Coronary Artery Risk Development in Young Adults (CARDIA) Study

BACKGROUND

We sought to identify depressive symptom subgroups in a community sample of young adults, investigate their stability over time, and determine their association with prevalent and incident cardiovascular disease (CVD) risk factors.

METHOD

Participants were 3377 adults from the Coronary Artery Risk Development in Young Adults study. Using latent class and latent transition analysis, we derived subgroups based on items of the 20-item version of the Center for Epidemiologic Studies Depression Scale in 1990, and examined patterns of change over a 10-year period (1990-2000). Cox regression models were used to examine associations between subgroup membership and prevalent (2000) and incident (2000 to 2016) obesity, hypertension, and diabetes.

RESULTS

Three baseline subgroups were identified and labeled: "No Symptoms" (63.5%), "Lack of Positive Affect" (PA, 25.6%), and "Depressed Mood" (10.9%). At 10-year follow-up, individuals in "No Symptoms" subgroup had the highest probability (0.84) of being classified within the same subgroup. Participants classified as "Lack of PA" were likely (0.46) to remain in the same subgroup or be classified as "No Symptoms." Participants in the "Depressed Mood" were most likely to transition to the "Lack of PA" subgroup (0.38). Overall, 30.5% of participants transitioned between subgroups, with 11.4% classified as "Worsening" and 19.1% as "Improving." Relative to the "No Symptoms Stable," other subgroups ("Depressed Stable," "Worsening," and "Improving") were associated with prevalent obesity and hypertension.

CONCLUSION

We identified distinct depressive symptom subgroups that are variably stable over time, and their change patterns were differentially associated with CVD risk factor prevalence.

A Scoping Review of Personal, Financial, and Environmental Determinants of Mobility Among Older Adults

OBJECTIVE

To synthesize available evidence of factors comprising the personal, financial, and environmental mobility determinants and their association with older adults' self-reported and performance-based mobility outcomes.

DATA SOURCES

PubMed, EMBASE, PsychINFO, Web of Science, AgeLine, Sociological Abstract, Allied and Complementary Medicine Database, and Cumulative Index to Nursing and Allied Health Literature databases search for articles published from January 2000 to December 2021.

STUDY SECTION

Using predefined inclusion and exclusion criteria, multiple reviewers independently screened 27,293 retrieved citations from databases, of which 422 articles underwent full-text screening, and 300 articles were extracted.

DATA EXTRACTION

The 300 articles' information, including study design, sample characteristics including sample size, mean age and sex, factors within each determinant, and their associations with mobility outcomes, were extracted.

DATA SYNTHESIS

Because of the heterogeneity of the reported associations, we followed Barnett et al's study protocol and reported associations between factors and mobility outcomes by analyses rather than by article to account for multiple associations generated in 1 article. Qualitative data were synthesized using content analysis. A total of 300 articles were included with 269 quantitative, 22 qualitative, and 9 mixed-method articles representing personal (n=80), and financial (n=1), environmental (n=98), more than 1 factor (n=121). The 278 quantitative and mixed-method articles reported 1270 analyses; 596 (46.9%) were positively and 220 (17.3%) were negatively associated with mobility outcomes among older adults. Personal (65.2%), financial (64.6%), and environmental factors (62.9%) were associated with mobility outcomes, mainly in the expected direction with few exceptions in environmental factors.

CONCLUSIONS

Gaps exist in understanding the effect of some environmental factors (eg, number and type of street connections) and the role of gender on older adults' walking outcomes. We have provided a comprehensive list of factors with each determinant, allowing the creation of core outcome set for a specific context, population, or other forms of mobility, for example, driving.

Comorbidity among depression, anxiety and stress symptoms in naturalistic clinical samples: A cross-cultural network analysis

Comorbidity between depression and anxiety is well-established across various settings and cultures. We approached comorbidity from the network psychopathology perspective and examined the depression, anxiety/autonomic arousal and stress/tension symptoms in naturalistic clinical samples from Serbia, Italy and Croatia. This was a multisite study in which regularized partial correlation networks of the symptoms, obtained via self-reports on the Depression Anxiety and Stress Scales-21 (DASS-21) in three cross-cultural, clinical samples (total N = 874), were compared with respect to centrality, edge weights, community structure and bridge centrality. A moderate degree of similarity in a number of network indices across the three networks was observed. While negative mood emerged to be the most central node, stress/tension nodes were the most likely bridge symptoms between depressive and anxiety/autonomic arousal symptoms. We demonstrated that the network structure and features in mixed clinical samples were similar across three different languages and cultures. The symptoms such as agitation, restlessness and inability to relax functioned as bridges across the three symptom communities explored in this study. Important theoretical and clinical implications were derived.

Ancestry-attenuated effects of socioeconomic deprivation on type 2 diabetes disparities in the All of Us cohort

Background

Diabetes is a common disease with a major burden on morbidity, mortality, and productivity. Type 2 diabetes (T2D) accounts for roughly 90% of all diabetes cases in the USA and has a greater observed prevalence among those who identify as Black or Hispanic.

Methods

This study aimed to assess T2D racial and ethnic disparities using the All of Us Research Program data and to measure associations between genetic ancestry (GA), socioeconomic deprivation, and T2D. We used the All of Us Researcher Workbench to analyze T2D prevalence and model its associations with GA, individual-level (iSDI), and zip code-based (zSDI) socioeconomic deprivation indices among participant self-identified race and ethnicity (SIRE) groups.

Results

The study cohort of 86,488 participants from the four largest SIRE groups in All of Us: Asian (n = 2311), Black (n = 16,282), Hispanic (n = 16,966), and White (n = 50,292). SIRE groups show characteristic genetic ancestry patterns, consistent with their diverse origins, together with a continuum of ancestry fractions within and between groups. The Black and Hispanic groups show the highest levels of socioeconomic deprivation, followed by the Asian and White groups. Black participants show the highest age- and sex-adjusted T2D prevalence (21.9%), followed by the Hispanic (19.9%), Asian (15.1%), and White (14.8%) groups. Minority SIRE groups and socioeconomic deprivation, both iSDI and zSDI, are positively associated with T2D, when the entire cohort is analyzed together. However, SIRE and GA both show negative interaction effects with iSDI and zSDI on T2D. Higher levels of iSDI and zSDI are negatively associated with T2D in the Black and Hispanic groups, and higher levels of iSDI and zSDI are negatively associated with T2D at high levels of African and Native American ancestry.

Conclusions

Socioeconomic deprivation is associated with a higher prevalence of T2D in Black and Hispanic minority groups, compared to the majority White group. Nonetheless, socioeconomic deprivation is associated with reduced T2D risk within the Black and Hispanic groups. These results are paradoxical and have not been reported elsewhere, with possible explanations related to the nature of the All of Us data along with SIRE group differences in access to healthcare, diet, and lifestyle.

The effect of occupational status on health: Putting the social in socioeconomic status

High status occupations support positive health outcomes through providing access to both material and psychosocial resources. However, common measures of occupational status such as occupational prestige scores fail to capture cultural esteem that certain occupations can provide because they are primarily associated with the material dimensions of status, like income. Drawing on Weberian conceptions of status and a body of social psychological research on the measurement of cultural meaning, we argue that measuring people's ratings of their occupations on three dimensions-evaluation (good/bad), potency (powerful/weak), and activity (active/inactive)-provides an occupational status indicator that more fully captures psychosocial resources like esteem that are associated with health than more commonly used occupational prestige scores. Using a nationally representative longitudinal health and wellbeing survey of 940 American law enforcement officers collected between 2020 and 2022, we evaluate the predictive ability of evaluation, potency, and activity (EPA) ratings across thirteen measures of health and wellbeing. We find that EPA ratings were significant and positive predictors of eleven of thirteen outcomes with stronger effects for mental health outcomes compared to physical health outcomes. EPA ratings were more predictive than more commonly used occupational prestige scores. We conclude that EPA ratings are better predictors of health outcomes than occupational prestige scores and so may allow health researchers to better understand the relationship between occupational status and health.

Regional disparities in food security and depression among single-person households in the Republic of Korea

BACKGROUND

Single-person households constitute over 40% of all households in the Republic of Korea and are more vulnerable to food insecurity and depression than multi-person households. There is a lack of research on examining whether regional characteristics are associated with the degree of food insecurity and depression among single-person households. This study aimed to examine the regional disparities in food security and depression among single-person households in the Republic of Korea.

METHODS

A total of 227,873 adults from the 2019 Korean Community Health Survey was included in the analysis. According to population density and poverty rate, the residence of the participants was classified into four regions: metropolitan areas with high population density were classified into areas with low poverty rates (Region 1) and high poverty rates (Region 2), and provinces with low population density were classified into areas with low poverty rates (Region 3) and high poverty rates (Region 4). Using a single item of household food security, those who had experienced a lack of food due to financial difficulties over the past year were classified as food insecure. Depression was measured using the Patient Health Questionnaire-9. Odds ratios and 95% confidence intervals (CI) for the risk of food insecurity and depression according to regional characteristics were calculated after adjusting for potential confounding variables.

RESULTS

After adjusting for confounding variables, single-person households in regions with high population density, Regions 1 and 2, had 1.16 times (95% CI = 1.04-1.30) and 1.43 times (95% CI = 1.27-1.61) higher odds of food insecurity, respectively, compared to those in Region 4. Single-person households in regions with low poverty rates, Regions 1 and 3, had 1.54 times (95% CI = 1.34-1.77) and 1.21 times (95% CI = 1.01-1.46) higher odds of depression, respectively, than those in Region 4. Among those who lived alone, the middle-aged, having low income, receiving livelihood benefits, or having a low educational attainment had higher odds of experiencing both food insecurity and depression than their counterparts.

CONCLUSIONS

As the risk of food insecurity and depression in single-person households differs according to regional characteristics, local governments need to implement policies for single-person households in consideration of these distinct characteristics.

Age and Sex Differences in the Associations Among Socioeconomic Status, Affective Reactivity to Daily Stressors, and Physical Health in the MIDUS Study

BACKGROUND

Low socioeconomic status (SES) is robustly associated with increased risks of morbidity and mortality. Affective reactivity to daily stressors has been proposed to be a mediator for this association. However, few longitudinal studies have empirically tested the indirect effect of SES on health through affective reactivity to daily stressors.

PURPOSE

This study aimed to test the indirect effect of SES on physical health via affective reactivity to daily stressors over a 10-year period and to explore age and sex differences in such indirect effect.

METHODS

Data were drawn from a subsample of 1,522 middle-aged and older adults (34-83 years of age, 57.2% female, 83.5% White) from the Midlife in the United States study. SES (i.e., education, household income, indicators of financial distress) was assessed in 2004-2006. Affective reactivity to daily stressors was computed using data collected during the 8-day daily stress assessment in 2004-2009. Self-reported physical health conditions were assessed in 2004-2006 and 2013-2014.

RESULTS

There was a significant indirect effect of lower SES on more physical health conditions via elevated negative affective reactivity to daily stressors among women but not men. The indirect effect of SES on physical health conditions via negative affective reactivity to daily stressors was consistent across the middle and older adulthood.

CONCLUSIONS

Our findings suggest that negative affective reactivity to daily stressors might be a key intermediate process contributing to persistent SES disparities in physical health, particularly among women.

Education is power: preserving cognition in the UK biobank

Introduction

Dementia is a debilitating syndrome characterized by the gradual loss of memory and cognitive function. Although there are currently limited, largely symptomatic treatments for the diseases that can lead to dementia, its onset may be prevented by identifying and modifying relevant life style risk factors. Commonly described modifiable risk factors include diet, physical inactivity, and educational attainment. Importantly, however, to maximize the utility of our understanding of these risk factors, tangible and meaningful changes to policy must also be addressed.

Objectives

Here, we aim to identify the mechanism(s) by which educational attainment influences cognition.

Methods

We investigated data from 502,357 individuals (Mage = 56.53, SDage = 8.09, 54.40% female) from the UK Biobank cohort via Structural Equation Modelling to illustrate links between predictor variables (i.e., Townsend Deprivation Index, coastal distance, greenspace, years of education), covariates (i.e., participant age) and cognitive function as outcome variables (i.e., pairs-matching, trail-making task B, fluid intelligence).

Results

Our model demonstrated that higher education was associated with better cognitive performance (ps < 0.001), and this relationship was mediated by indices of deprivation, and coastal distance.

Conclusion

Accordingly, our model evinces the mediating effect of socioeconomic and environmental factors on the relationship between years of education and cognitive function. These results further demonstrate the utility and necessity of adapting public policy to encourage equitable access to education and other supports in deprived areas.

Socioeconomic Position and Type 2 Diabetes: The Mediating Role of Psychosocial Work Environment- the Maastricht Study

Objective: We examined the association between low socioeconomic position (SEP) and Type 2 Diabetes Mellitus (T2DM), and the mediating role of psychosocial work environment by using counterfactual mediation analysis. Methods: Data from 8,090 participants of The Maastricht Study were analysed. SEP indicators (education, income, occupation), self-reported psychosocial work stressors, (pre)diabetes by oral glucose tolerance test were measured at baseline. Incident T2DM was self-reported per annum up to 9 years. Cox regression and causal mediation analyses were performed. Results: 2.8% (N = 172) of the participants without T2DM at baseline reported incident T2DM. People with lower SEP more often had prevalent T2DM (e.g., education OR = 2.49, 95% CI: 2.16-2.87) and incident T2DM (e.g., education HR = 2.21, 95% CI: 1.53-3.20) than higher SEP. Low job control was associated with prevalent T2DM (OR = 1.44 95% CI: 1.25-1.67). Job control partially explained the association between income and prevalent T2DM (7.23%). Job demand suppressed the associations of education and occupation with prevalent T2DM. The mediation models with incident T2DM and social support were not significant. Conclusion: Socioeconomic inequalities in T2DM were present, but only a small part of it was explained by the psychosocial work environment.

Gathering the Evidence on Diet and Depression: A Protocol for an Umbrella Review and Updated Meta-Analyses

Our objectives are to perform (1) an umbrella review on diet and depression, (2) a systematic review update on dietary patterns and depression, and (3) updated meta-analyses using studies from the previous two objectives. Systematic reviews examining the relationships between diet and depression and primary studies on the relationship between dietary patterns and depression will be systematically retrieved via several databases. All articles identified through the database searches will be imported into Covidence. Following duplicates removal, two authors will independently perform title and abstract screening and full-text assessment against eligibility criteria. Data will be extracted using tables developed for both systematic reviews and primary studies. The methodological quality of systematic reviews will be assessed using the AMSTAR-2 tool. The risk of bias in randomized trials, cohort and cross-sectional studies, as well as case-control studies, will be assessed with the Cochrane risk-of-bias (RoB-2) tool, the NHLBI Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, and the NHLBI Quality Assessment Tool for Case-Control studies, respectively. For each dietary variable, data extracted will be used to produce: (1) a summary of systematic reviews' characteristics and results table, (2) a summary of the primary studies characteristics table, (3) a qualitative summary of results from the primary studies table, and (4) a quantitative summary of results in the form of forest plots. The certainty of evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Upon completion, this systematic review will be the most comprehensive and up-to-date synthesis of currently available evidence on the relationships between diet and depression. It will serve as a key reference to guide future research and as a resource for health professionals in the fields of nutrition and psychiatry. PROSPERO CRD42022343253.

Socioeconomic inequalities in diabetes prevalence: the case of Egypt between 2008 and 2015

BACKGROUND

There is a steady increase in diabetes prevalence globally and many studies imply that high socioeconomic status (SES) is inversely related to diabetes prevalence. However, there is scarcity in literature from countries like Egypt regarding this topic.

METHODS

This study aims to investigate prevalence of diabetes in Egypt between 2008 and 2015, and the effect of SES. Diabetes prevalence -based on self-reports of past diagnosis- was measured using two datasets Egypt DHS 2008 (10,917 participants) and EHIS 2015 (16,485 participants). Logistic regression and odds ratios (ORs) with 95% confidence intervals (CIs) were applied for diabetes controlling for age, gender, educational level, employment status and place of residence. Extend of difference in diabetes prevalence between the two time points was measured by combining the two datasets using the EDHS 2008 as reference.

RESULTS

Diabetes prevalence was higher in 2015 (4.83%) compared to 2008 (3.48%). It was more in women at both time points (4.08% and 5.16% in 2008 and 2015 respectively) compared to men (2.80% and 4.43% in 2008 and 2015 respectively). Older age and living in urban areas were positively related to diabetes prevalence at both time points. Men had a significant higher chance of developing diabetes in 2015 (OR = 1.45, p-value = 0.001). Men with higher education had higher chance of developing diabetes (OR = 1.76), in contrast to women (OR = 0.59). Employment decreased the chance of developing diabetes for men (OR = .72), but had minimal effect on women (OR = 1.06).

CONCLUSION

Diabetes prevalence in Egypt has increased between the years 2008 and 2015 and evident social inequalities were found. Women had more diabetes than men and were more affected with low SES. Unlike women, highly educated men had higher chance of developing diabetes in 2015 compared to 2008. This might be attributed to behavioral and sociocultural factors.

Development of risk prediction models for depression combining genetic and early life risk factors

Background

Both genetic and early life risk factors play important roles in the pathogenesis and progression of adult depression. However, the interplay between these risk factors and their added value to risk prediction models have not been fully elucidated.

Methods

Leveraging a meta-analysis of major depressive disorder genome-wide association studies (N = 45,591 cases and 97,674 controls), we developed and optimized a polygenic risk score for depression using LDpred in a model selection dataset from the UK Biobank (N = 130,092 European ancestry individuals). In a UK Biobank test dataset (N = 278,730 European ancestry individuals), we tested whether the polygenic risk score and early life risk factors were associated with each other and compared their associations with depression phenotypes. Finally, we conducted joint predictive modeling to combine this polygenic risk score with early life risk factors by stepwise regression, and assessed the model performance in identifying individuals at high risk of depression.

Results

In the UK Biobank test dataset, the polygenic risk score for depression was moderately associated with multiple early life risk factors. For instance, a one standard deviation increase in the polygenic risk score was associated with 1.16-fold increased odds of frequent domestic violence (95% CI: 1.14-1.19) and 1.09-fold increased odds of not having access to medical care as a child (95% CI: 1.05-1.14). However, the polygenic risk score was more strongly associated with depression phenotypes than most early life risk factors. A joint predictive model integrating the polygenic risk score, early life risk factors, age and sex achieved an AUROC of 0.6766 for predicting strictly defined major depressive disorder, while a model without the polygenic risk score and a model without any early life risk factors had an AUROC of 0.6593 and 0.6318, respectively.

Conclusion

We have developed a polygenic risk score to partly capture the genetic liability to depression. Although genetic and early life risk factors can be correlated, joint predictive models improved risk stratification despite limited improvement in magnitude, and may be explored as tools to better identify individuals at high risk of depression.

Psychiatric morbidities among patients with type-2 diabetes mellitus attending outpatient department in a rural area of North India

Background

Both diabetes mellitus and psychiatric morbidities are widely prevalent diseases which show a discerning upward trend globally. Coexistence of diabetes and psychiatric morbidities usually manifests as impaired quality of life and poor treatment adherence.

Objectives

The study aimed to estimate the prevalence of psychiatric morbidities among rural diabetic patients and to determine their association with different variables.

Methodology

The present cross-sectional study was conducted in CHC of Rural Health Block attached with PG Department of Community Medicine GMC (Government Medical College) Jammu. The eligible diabetic patients attending medical outpatient department services were enrolled using a consecutive sampling method. DAS scale was used to assess psychiatric morbidity among the study subjects.

Results

The findings revealed that the prevalence of psychiatric morbidity in the study participants was 38.9%, 68.5% and 25.64% for depression, anxiety and stress, respectively. Psychiatric morbidities were slightly higher in female patients and were significantly associated with age, marital status, sedentary lifestyle, history of substance abuse, duration of diabetes, presence of complications and underlying morbidities (P < 0.05).

Conclusions

The prevalence of anxiety and depression among rural diabetic patients was found to be quite high. Diabetic patients need thorough screening for psychiatric evaluation, and there is an urgent need for psychiatric counselling at regular intervals.

Maternal Diet Quality and Prenatal Depressive Symptoms: The Moderating Role of Economic Well-Being

Prenatal depression is prevalent and adversely impacts maternal and infant health. This study addresses a critical literature gap and investigates the association between maternal diet quality and prenatal depressive symptoms, as well as the moderating effect of economic well-being on this link. A cross-sectional design was used, including 43 healthy pregnant women in the second trimester aggregated from two research projects. Prenatal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. Dietary quality was evaluated using two non-consecutive 24 h dietary recalls, from which the Adapted Dietary Inflammatory Index (ADII) and the Healthy Eating Index (HEI)-2015 were derived. Economic well-being was indicated by the income-to-poverty ratio. A higher HEI-2015 (adherence to dietary guidelines; β = -0.53, p = 0.01) and negative ADII (anti-inflammatory diet; β = 0.40, p = 0.06) were associated with fewer prenatal depressive symp-toms. Among pregnant women with worse economic well-being, a pro-inflammatory diet was as-sociated with more prenatal depressive symptoms (b = 1.69, p = 0.004), but among those with better economic well-being, the association was not significant (b = 0.51, p = 0.09). Dietary interventions aimed at reducing dietary inflammation might hold some promise for improving mental health among pregnant women who are economically vulnerable.

The risk of experiencing depression among older adults in India: A cross-sectional study

Background

The comorbidity of diabetes and depression poses a major challenge to older adults. While a few small scale studies have investigated the diabetes associated risk of experiencing depression, there is no national-level study available for India on the same. In this context, this study estimates the burden and risk of depression due to diabetes among older adults aged 45 and above in India while adjusting for socio-economic and demographic characteristics of the individuals.

Methods

Longitudinal Ageing Study in India (LASI), 2017-2018 wave 1 data was utilised in this study. The prevalence of depression and diabetes were estimated by background characteristics using bivariate cross-tabulation. In addition, multivariate logistic regression was applied to examine the likelihood of depression associated with diabetes and other covariates.

Result

Empirical estimation demonstrated that 14% of males and 8% of females with diabetes suffer from depression in the 45-59 age group. A diabetic person aged 45 and above was 16% more likely to suffer from depression than a non-diabetic person; whereas, a diabetic elderly aged 60 and above was 24% more likely to experience depression than their non-diabetic counterparts. The multivariate analysis confirmed a highly statistically significant association between diabetes and depression indicating a substantial risk to experience depression among those older adults and elderly who suffer from diabetes.

Conclusion

Elderly population (60 +) is at higher risk of experiencing depression due to diabetes. Therefore, public health care awareness should be raised, particularly among endocrinologists or specialist doctors who provide treatment at the tertiary-care hospitals in India. The health care experts should refer/recommend the diabetic patients to screen for depressive symptoms.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01185-6.

Depressive Symptoms of Public Health Medical Residents during the COVID-19 Pandemic, a Nation-Wide Survey: The PHRASI Study

Depression is a widespread condition, which increased during the COVID-19 pandemic among healthcare workers as well. The large workload of the pandemic response also affected Public Health Residents (PHRs) who played an important role in infection prevention and control activities. This work aims to assess depression in Italian PHRs, based on data collected through the PHRASI (Public Health Residents' Anonymous Survey in Italy) study. In 2022, 379 PHRs completed the self-administered questionnaire containing Patient Health Questionnaire-9 to evaluate clinically relevant depressive symptoms (PHQ-9 ≥ 10). Multivariate logistic regression shows that the intention (aOR = 3.925, 95% CI = (2.067-7.452)) and the uncertainty (aOR = 4.949, 95% CI = (1.872-13.086)) of repeating the test to enter another postgraduate school/general practitioner course and the simultaneous attendance of two traineeships (aOR = 1.832, 95% CI = (1.010-3.324)) are positively related with depressive symptoms. Conversely, the willingness to work in the current traineeship place (aOR = 0.456, 95% CI = (0.283-0.734)) emerged as a protective factor. Similar results were obtained considering mild-to-severe (PHQ-9 ≥ 5) depressive symptoms and/or stratifying by sex. The findings, suggesting the protective role of job satisfaction toward depression, might entail future interventions to improve the learning experience and promote work-life balance.

Quality of Life Perception among Portuguese Celiac Patients: A Cross-Sectional Study Using the Celiac Disease Questionnaire (CDQ)

The aim of this study is to assess Portuguese celiac patients' quality of life (QoL) perception. A cross-sectional study was performed with a non-probability convenience sample of Portuguese celiac patients using an online self-administered celiac disease quality of life questionnaire (CDQ), previously validated for the Portuguese population. The final sample comprised 234 celiac patients, which included the following: primarily women (69.2%); aged between 18 and 49 years old (56.4%); with a partner (60.6%); with a high educational level (58.9%-graduated or post-graduated); following a gluten-free diet (GFD) (55.1%); and not using antidepressants (93.1%). The Portuguese CDQ presented good reliability and responsiveness in this sample of Portuguese celiac patients. In general, the CDQ in Portugal was affected by age at diagnosis (p = 0.017), educational level (p = 0.005), and compliance with GFD (p = 0.034). The emotion domain was affected only by using antidepressants (p = 0.036). The social domain was affected by gender (females had lower rates, p = 0.016), age at diagnosis (p = 0.009), educational level (p = 0.000), and compliance with a GFD (p = 0.002). The worries domain did not differ according to socioeconomic data. The symptoms domain was affected by compliance with GFD (p = 0.000), age at diagnosis (p = 0.000), and educational level (p = 0.014). Data on celiac QoL is essential to support the formulation and implementation of strategies to minimize the issues suffered by celiac patients, lowering their physical, emotional, and social burden. Additionally, data on Portuguese celiac disease patients using the CDQ will allow future comparative research among celiac populations from different countries.

Prior differences in previous trauma exposure primarily drive the observed racial/ethnic differences in posttrauma depression and anxiety following a recent trauma

BACKGROUND

Racial and ethnic groups in the USA differ in the prevalence of posttraumatic stress disorder (PTSD). Recent research however has not observed consistent racial/ethnic differences in posttraumatic stress in the early aftermath of trauma, suggesting that such differences in chronic PTSD rates may be related to differences in recovery over time.

METHODS

As part of the multisite, longitudinal AURORA study, we investigated racial/ethnic differences in PTSD and related outcomes within 3 months after trauma. Participants (n = 930) were recruited from emergency departments across the USA and provided periodic (2 weeks, 8 weeks, and 3 months after trauma) self-report assessments of PTSD, depression, dissociation, anxiety, and resilience. Linear models were completed to investigate racial/ethnic differences in posttraumatic dysfunction with subsequent follow-up models assessing potential effects of prior life stressors.

RESULTS

Racial/ethnic groups did not differ in symptoms over time; however, Black participants showed reduced posttraumatic depression and anxiety symptoms overall compared to Hispanic participants and White participants. Racial/ethnic differences were not attenuated after accounting for differences in sociodemographic factors. However, racial/ethnic differences in depression and anxiety were no longer significant after accounting for greater prior trauma exposure and childhood emotional abuse in White participants.

CONCLUSIONS

The present findings suggest prior differences in previous trauma exposure partially mediate the observed racial/ethnic differences in posttraumatic depression and anxiety symptoms following a recent trauma. Our findings further demonstrate that racial/ethnic groups show similar rates of symptom recovery over time. Future work utilizing longer time-scale data is needed to elucidate potential racial/ethnic differences in long-term symptom trajectories.

A Multidisciplinary Quality Improvement Program to Improve Diabetes Care at a Free Clinic

OBJECTIVE

To evaluate the effectiveness of an intensive, multidisciplinary patient-centered approach involving a pharmacist and a dietician in a population of uninsured free clinic patients with diabetes and hypertension.

METHODS

 A single-center retrospective chart review of a quality improvement project. All patients had diagnoses of diabetes and hypertension and a most recent hemoglobin A1c ≥ 9.0%. Patients met individually with a pharmacist and a dietician during 6 encounters over 12 months. The pharmacist made medication changes, encouraged lifestyle reflections, and helped patients create and track self-management goals. The dietician helped patients plan strategies for diet and exercise. The primary outcome was a change in mean hemoglobin A1c.

RESULTS

Of 30 enrolled patients, 17 completed three months of treatment, and seven completed 12 months. The 17 patients who completed three months of treatment had the following characteristics: mean age 55.5 years; mean hemoglobin A1c 11.5%; 82% were taking two or more antidiabetic medications; 59% were taking two or more antihypertensive medications. Significant reductions in mean hemoglobin A1c values were observed at three months (-3.4%, P<0.0001) and twelve months (-4.0%, P=0.0156). Reductions in systolic blood pressure were also observed at three months (-6 mmHg, P=0.1060) and twelve months (-17 mmHg, P=0.2188).

CONCLUSIONS

Large and significant hemoglobin A1c reductions were observed in free clinic patients with diabetes refractory to traditional medical management. Goal-oriented patient empowerment effectively improves a wide range of patient outcomes in the free clinic setting. Other free clinics can implement this collaborative, multidisciplinary model with access to similar personnel.

Subjective social status and mental health among adolescents in Ethiopia: Evidence from a panel study

Numerous studies have found that a relationship between subjective status and measures of human health persists even after controlling for objective measures, including income, education, and assets. However, few studies have probed how status shapes health among adolescents, particularly those in low-and-middle-income settings. This study examines the relative effects of subjective and objective status on mental health among Ethiopian adolescents. Using data from two waves of the Jimma Longitudinal Family Survey of Youth (N = 1,045), this study uses a combination of linear regression and linear mixed-effects models to examine the relationships between objective social status, subjective social status, and mental well-being among adolescents in Ethiopia. Three measures of objective status, including household income, adolescent education, and a multidimensional measure of material wealth, were assessed. Social network and support variables were constructed using factor analysis. A community version of the 10-rung McArthur ladder was used to assess the subjective socioeconomic status of adolescents. The self-reporting questionnaire was used to assess mental well-being during both waves of the study. The significant effect of higher subjective status on reports of fewer non-specific psychological distress (-0.28; 95% CI: -0.43 to -0.14) was not mediated by objective status, material deprivation, or social support covariates. The observed relationship between status and mental well-being was consistent across successive study waves. Among a cohort of adolescents in Jimma, Ethiopia, several measures of objective status are associated with subjective status. However, akin to research among adults, the findings of our study suggest that the relationship between adolescent subjective social status and mental health persists above and beyond the effects of objective status. Future research is needed on the factors, environments, and experiences that inform adolescent perceptions of status and well-being over time.

Genetic propensity, socioeconomic status, and trajectories of depression over a course of 14 years in older adults

Depression is one of the leading causes of disability worldwide and is a major contributor to the global burden of disease among older adults. The study aimed to investigate the interplay between socio-economic markers (education and financial resources) and polygenic predisposition influencing individual differences in depressive symptoms and their change over time in older adults, which is of central relevance for preventative strategies. The sample encompassing n = 6202 adults aged ≥50 years old with a follow-up period of 14 years was utilised from the English Longitudinal Study of Ageing. Polygenic scores for depressive symptoms were calculated using summary statistics for (1) single-trait depressive symptoms (PGS-DS_single), and (2) multi-trait including depressive symptoms, subjective well-being, neuroticism, loneliness, and self-rated health (PGS-DS_multi-trait). The depressive symptoms over the past week were measured using the eight-item Centre for Epidemiologic Studies Depression Scale. One standard deviation increase in each PGS was associated with a higher baseline score in depressive symptoms. Each additional year of completed schooling was associated with lower baseline depression symptoms (β = -0.06, 95%CI = -0.07 to -0.05, p < 0.001); intermediate and lower wealth were associated with a higher baseline score in depressive symptoms. Although there was a weak interaction effect between PGS-DSs and socio-economic status in association with the baseline depressive symptoms, there were no significant relationships of PGS-DSs, socio-economic factors, and rate of change in the depressive symptoms during the 14-year follow-up period. Common genetic variants for depressive symptoms are associated with a greater number of depressive symptoms onset but not with their rate of change in the following 14 years. Lower socio-economic status is an important factor influencing individual levels of depressive symptoms, independently from polygenic predisposition to depressive symptoms.

Environmental exposures in machine learning and data mining approaches to diabetes etiology: A scoping review

BACKGROUND

Environmental exposures are implicated in diabetes etiology, but are poorly understood due to disease heterogeneity, complexity of exposures, and analytical challenges. Machine learning and data mining are artificial intelligence methods that can address these limitations. Despite their increasing adoption in etiology and prediction of diabetes research, the types of methods and exposures analyzed have not been thoroughly reviewed.

OBJECTIVE

We aimed to review articles that implemented machine learning and data mining methods to understand environmental exposures in diabetes etiology and disease prediction.

METHODS

We queried PubMed and Scopus databases for machine learning and data mining studies that used environmental exposures to understand diabetes etiology on September 19th, 2022. Exposures were classified into specific external, general external, or internal exposures. We reviewed machine learning and data mining methods and characterized the scope of environmental exposures studied in the etiology of general diabetes, type 1 diabetes, type 2 diabetes, and other types of diabetes.

RESULTS

We identified 44 articles for inclusion. Specific external exposures were the most common exposures studied, and supervised models were the most common methods used. Well-established specific external exposures of low physical activity, high cholesterol, and high triglycerides were predictive of general diabetes, type 2 diabetes, and prediabetes, while novel metabolic and gut microbiome biomarkers were implicated in type 1 diabetes.

DISCUSSION

The use of machine learning and data mining methods to elucidate environmental triggers of diabetes was largely limited to well-established risk factors identified using easily explainable and interpretable models. Future studies should seek to leverage machine learning and data mining to explore the temporality and co-occurrence of multiple exposures and further evaluate the role of general external and internal exposures in diabetes etiology.

Combinational Regularity Analysis (CORA) - a new method for uncovering complex causation in medical and health research

BACKGROUND

Modern configurational comparative methods (CCMs) of causal inference, such as Qualitative Comparative Analysis (QCA) and Coincidence Analysis (CNA), have started to make inroads into medical and health research over the last decade. At the same time, these methods remain unable to process data on multi-morbidity, a situation in which at least two chronic conditions are simultaneously present. Such data require the capability to analyze complex effects. Against a background of fast-growing numbers of patients with multi-morbid diagnoses, we present a new member of the family of CCMs with which multiple conditions and their complex conjunctions can be analyzed: Combinational Regularity Analysis (CORA).

METHODS

The technical heart of CORA consists of algorithms that have originally been developed in electrical engineering for the analysis of multi-output switching circuits. We have adapted these algorithms for purposes of configurational data analysis. To demonstrate CORA, we provide several example applications, both with simulated and empirical data, by means of the eponymous software package CORA. Also included in CORA is the possibility to mine configurational data and to visualize results via logic diagrams.

RESULTS

For simple single-condition analyses, CORA's solution is identical with that of QCA or CNA. However, analyses of multiple conditions with CORA differ in important respects from analyses with QCA or CNA. Most importantly, CORA is presently the only configurational method able to simultaneously explain individual conditions as well as complex conjunctions of conditions.

CONCLUSIONS

Through CORA, problems of multi-morbidity in particular, and configurational analyses of complex effects in general, come into the analytical reach of CCMs. Future research aims to further broaden and enhance CORA's capabilities for refining such analyses.

The impact of socioeconomic deprivation on the risk of atrial fibrillation in patients with diabetes mellitus: A nationwide population-based study

Objective

To evaluate the relationship between socioeconomic status and the risk of atrial fibrillation (AF) in patients with diabetes mellitus (DM).

Research design and methods

From the National Health Insurance Service (NHIS) database, we identified 2,429,610 diabetic patients who underwent national health check-ups between 2009 and 2012. Tracing back the subjects for 5 years from the date of health check-up, we determined the subjects’ income and whether they received medical aid (MA) during the past 5 years. Subjects were divided into six groups according to the number of years of receiving (MA groups 0 through 5) and into four groups according to socioeconomic status change during the past 5 years. We estimated the risk of AF for each group using the Cox proportional-hazards model.

Results

During a median follow-up of 7.2 ± 1.7 years, 80,257 were newly identified as AF. The MA groups showed a higher risk of AF than the non-MA group with the hazard ratios (HRs) and 95% confidence interval (CI) 1.32 (1.2–1.44), 1.33 (1.22–1.45), 1.23 (1.13–1.34), 1.28 (1.16–1.4), and 1.50 (1.39–1.63) for MA groups 1 through 5, respectively. Dividing subjects according to socioeconomic condition change, those who experienced worsening socioeconomic status (non-MA to MA) showed higher risk compared to the persistent non-MA group (HR 1.54; 95% CI 1.38–1.73).

Conclusion

Low socioeconomic status was associated with the risk of AF in patients with diabetes. More attention should be directed at alleviating health inequalities, targeting individuals with socioeconomic deprivation to provide timely management for AF.

The Relationship between Social Anhedonia and Perceived Pleasure from Food-An Exploratory Investigation on a Consumer Segment with Depression and Anxiety

Anhedonia, the diminished ability to experience pleasure, is a key symptom of a range of mental and neurobiological disorders and is associated with altered eating behavior. This research study investigated the concept of anhedonia in relation to mental disorders and the perception of pleasure from food to better understand the link between anhedonia and eating behavior. A consumer survey (n = 1051), including the Food Pleasure Scale, the Chapman Revised Social Anhedonia Scale, the Patient Health Questionnaire, and the Generalized Anxiety Disorder scale, was conducted to explore the perception of pleasure from food among people with anhedonic traits. Comparative analyses were performed between people with symptoms of depression and/or anxiety and people with no symptoms of these conditions. A segmentation analysis was furthermore performed based on three levels of anhedonia: Low, Intermediate and High anhedonia. Thus, insights into how food choice and eating habits may be affected by different levels of anhedonia are provided for the first time. Our findings showed that the 'Low anhedonia' segment found pleasure in all aspects of food pleasure, except for the aspect 'eating alone'. 'Eating alone' was, however, appreciated by the 'Intermediate anhedonia' and 'High anhedonia' segments. Both the 'Intermediate anhedonia' and 'High anhedonia' segments proved that their perceptions of food pleasure in general were affected by anhedonia, wherein the more complex aspects in particular, such as 'product information' and 'physical sensation', proved to be unrelated to food pleasure. For the 'High anhedonia' segment, the sensory modalities of food were also negatively associated with food pleasure, indicating that at this level of anhedonia the food itself is causing aversive sensations and expectations. Thus, valuable insights into the food pleasure profiles of people with different levels of anhedonia have been found for future research in the fields of mental illness, (food) anhedonia, and consumer behaviors.

Longstanding health risk across the life course: The influence of early-life experience on health status throughout the life span

This study tracked the longstanding effect of childhood adversities on health status over the course of a life. This study used the data from China Health and Retirement Longitudinal Study which was a nationally representative survey and documented the generation who had arrived in the middle- and old-age phase and experienced the difficult time in the early founding of PR China in their childhood. Results shown the significant associations between multiple forms of children adversities (economic distress, child neglect, child abuse, lack of friends, parental mental health problems) and health status in adolescence (from 0.068 to 0.102, p<0.01), and health status in mid and late adulthood, including self-rated general health problems (from 0.039 to 0.061, p<0.01), chronic conditions (from 0.014 to 0.120, p<0.01 except for lack of friends), body aches (from 0.016 to 0.062, p<0.01 except for child neglect), and depression (from 0.047 to 0.112, p<0.01). Meanwhile, results also shown an underlying pathway (i.e., health status in adolescence) linking childhood adversities and health status in mid and late adulthood. Results suggested that the experience of multiple forms of adversities in childhood represented a substantial source of health risk throughout life.

Integrative Resource Model of Workplace Inclusion for Reduced Inequality: Conservation of Resources Perspective

This study provides much-needed empirical study of workplace inclusion of underresourced employees of low socioeconomic status. Based upon a conservation of resources perspective, we have examined the centrality of resources as a key inclusion process for well-being outcomes for employees with insufficient resources. In the context of misuse of institutional power over operative workers within highly segmented and hierarchical work settings, this study validates the importance of economic inclusion for fostering workers' well-being via fair employment practices. This study also offers new knowledge of the integrative resource model of workplace inclusion research by validating workers' personal resources of learning orientation as an internal condition for strengthening the positive effect of economic inclusion on well-being.

Association between Sleep Quality and Depression Symptoms in Chinese College Students during the COVID-19 Lockdown Period

Background: The outbreak of COVID-19 has seriously threatened the health of people around the world. To prevent the spread of the epidemic, Chinese universities have implemented closed management of campuses. The implementation of restrictive measures has gradually caused changes in the quality of sleep and the psychological state of college students. In addition, college students are faced with the dual pressure of employment and study, and the psychological pressure is huge. Therefore, it is necessary to investigate sleep and depressive symptoms among college students. Methods: Using the method of stratified cluster sampling, 6695 college students were selected from three universities in Jiangxi, Anhui, and Xinjiang provinces from April to May 2022. The Chinese version of the Pittsburgh sleep quality index (PSQI) and the self-rating depression scale (SDS) were used for the survey. Hierarchical logistic regression analysis was used to analyze the relationship between the PSQI and the SDS. Results: Overall, during the outbreak of COVID-19, 69.0% of males and 73.5% of females had poor sleep quality among Chinese college students and the detection rate of depressive symptoms was 43.6% for males and 47.8% for females, respectively. Taking students with good sleep quality as references, after controlling for covariates, hierarchical logistic regression shows that Chinese college students with poor sleep quality have a higher OR value (OR = 12.0, 95%CI: 10.2~14.1, p < 0.001), especially in males (OR = 43.8, 95%CI:30.2~63.6, p < 0.001). For both males and females, the OR value of college students with the following characteristics was higher: rural college students (males, OR = 50.32, 95%CI: 32.50−77.93; females, OR = 8.03, 95%CI: 6.45−9.99), overweight college students (males, OR = 62.17, 95%CI: 19.47−198.53; females, OR = 16.67, 95%CI: 6.48−42.88), and college students drinking sugar-sweetened beverages (males, OR = 59.00, 95%CI: 36.96−94.18; females, OR = 8.16, 95%CI: 6.63−10.05) (p < 0.001). Conclusions: Poor sleep quality is associated with depressive symptoms among Chinese college students, especially college males. Our research suggests that it is necessary to consider the improvement of sleep quality and depressive symptoms among college students during the COVID-19 epidemic.

Efficacy and safety of vortioxetine in treatment of patients with major depressive disorder and common co-morbid physical illness

BACKGROUND

The multimodal antidepressant vortioxetine is effective in reducing somatic symptoms in patients with major depressive disorder (MDD), but little is known about its effects in reducing depressive symptoms in patients with common comorbid physical illnesses.

METHODS

This was a pooled analysis of 13 randomized, placebo-controlled trials which evaluated the efficacy (using the Montgomery-Åsberg Depression Rating Scale [MADRS]) and safety of vortioxetine (5-20 mg/day) in adult patients with MDD. We evaluated stable somatic comorbid conditions that were verified by a diagnosis and had sufficient database representation.

RESULTS

Of the 5982 patients included in the database, 963 (16.1%) patients had a diagnosis of cardiovascular disease, 152 (2.5%) had diabetes mellitus and 26 (0.4%) had chronic obstructive pulmonary disorder (COPD). At Week 8, adjusted mean[95%CI] treatment differences (vortioxetine vs. placebo) on MADRS total scores were -2.7[-4.2, -1.3] (p = 0.0002) points for the cardiovascular disease, -4.0[-7.7, -0.4] (p = 0.03) for the diabetes, and -6.2[-21.3, 8.9] (p = 0.36) for the COPD groups. The rate and pattern of adverse events were similar across the sub-groups with comorbidities and was consistent with that expected for vortioxetine treatment.

LIMITATIONS

The primary studies were not designed to investigate the relationship between vortioxetine and comorbidities, nor were the post hoc analyses powered to detect group differences.

CONCLUSIONS

Patients with MDD and comorbid cardiovascular disease or diabetes respond to vortioxetine in a similar way to the broader MDD population. Vortioxetine was generally safe and well tolerated and without unexpected adverse events in these subpopulations, most of whom are taking multiple concomitant medications.

Diabetes Treatment and Mental Illness: A Call for an Integrated Health Care System in Underserved Semi-Rural Malaysia

Diabetes mellitus (DM) management imposes a tremendous psychological burden on patients. The study investigates the association between DM treatment with blood glucose (BG) control and common mental health conditions. A cross-sectional study was conducted among 1821 individuals with DM in a community-based survey conducted in 2013. Information on respondents’ sociodemographic, mental health, DM treatment, and BG levels was collected. Multinomial logistic regression was employed to examine the association of diabetes treatment with controlled BG levels (<11.1 mmol/L) (42.5%, n = 774) or uncontrolled BG levels (34.3%, n = 625) compared with those not undergoing treatment (23.2%, n = 422) on depression anxiety, and stress. Having DM treatment and controlled BG was associated with high depressive symptoms (Relative Risk Ratio, RRR: 2.42; 95% CI 1.33−4.41) and high anxiety symptoms (1.66; 1.08−2.56) but not with perceived stress. However, treated DM with uncontrolled BG was associated with anxiety (high: 1.64; 1.05−2.56; low: 2.59; 1.10−6.09) but not depression or perceived stress. Our results suggest that being treated for DM, regardless of glucose control status, was associated with anxiety symptoms, whereas being treated with controlled BG was associated with high depressive symptoms. This situation highlights the need for integrative, multidisciplinary care for DM patients with mental health comorbidities.

Mental Health Condition among University Students of Bangladesh during the Critical COVID-19 Period

Bangladesh's education sector has been in a state of flux since COVID-19. During the pandemic, all university campuses were closed. There was a mental health issue among the students. This study aims to examine the mental health condition and the determinants that contribute to adverse mental health conditions among university students of Bangladesh. A survey was performed online among university students in Bangladesh, in mid-June 2020 when averaging 3345 affected cases of the population daily. The convenience sampling technique was used and the survey gathered data from 365 university students. The relationship between general information and Depression, Anxiety, and Stress Scale 21 (DASS-21) subscales of university students was determined. The questionnaire was administered to respondents during the pandemic, which ensured fast replies. Linear regression models were used for statistical analysis. University students indicated normal levels of depression (30.41%), anxiety (43.29%), and stress (47.40%). However, a disproportionate number of extremely depressed, anxious, and stressed university students suggested a mental health status of concern. There were significant connections between the individual's opinion of social satisfaction, mental health concerns, and the present location's safety with an undesirable mental health condition. Female students were shown to be much more anxious and stressed than male students. Capital Dhaka city students were more depressed and anxious than students outside of Dhaka. Financial and psychological support for students may help mitigate the psychological impact. Authorities should make effective efforts to reduce mental health problems among these students. This research may aid organizations, health care providers, and social workers in their attempts to prepare for and respond to pandemics.

The role of rurality on factors associated with major depressive episode screening among Brazilian adults in a national household survey

BACKGROUND

Worldwide, depression is one of the leading causes of disability, contributing significantly to the global burden of disease. The aim of this study was to evaluate in Brazil the effect of living in rural or urban areas on the prevalence of major depressive episode (MDE), as well as the differences among associated factors in both contexts.

METHODS

Data from 60,202 adult residents from a household-based cross-sectional survey conducted in Brazil were analyzed. The prevalence of MDE, evaluated using PHQ-9, as well as the prevalence ratios between the categories of the independent variables were estimated. Multiple hierarchical Poisson regression analyses based on a theoretical model were reproduced for both rural and urban areas.

RESULTS

Residents of rural areas showed lower MDE prevalence (3.3% [95% CI: 2.9-3.9] vs. 4.2% [95% CI: 3.9-4.6], p < .05) and the effect of rurality remained even adjusted by potential confounders (PR = 0.8 [95% CI: 0.7-0.9]). Better education, social network, and access to health services were protective factors for both rural and urban areas, while previous diagnosis of depression, chronic diseases, and obesity were risk factors. Living in the northern region, being indigenous, presenting higher income and number of goods were protective factors only in rural areas. In urban areas, being younger and having an occupation were protective factors, whereas female sex and having some disability were risk factors.

CONCLUSIONS

Rural and urban areas differ not only in the prevalence of depression, but also in the way in which different factors influence its occurrence.

Depressive and Anxiety Symptoms among Children and Adolescents in Rural China: A Large-Scale Epidemiological Study

Although children living in low- and middle-income countries (LMICs) account for 90% of the global population of children, depression, and anxiety among children in LMICs have been understudied. This study examines the prevalence of depression and anxiety and their associations with biological and psychosocial factors among children across China, with a focus on rural areas. We conducted a large-scale epidemiological study of depression and anxiety among 53,421 elementary and junior high school-aged children across China. The results show that 20% are at risk for depression, 6% are at risk for generalized anxiety, and 68% are at risk for at least one type of anxiety. Girls and junior high school students show a higher risk for both depression and anxiety symptoms, while socioeconomic status has varying associations to depression and anxiety symptoms. Our results also show consistent correlations between depression and anxiety symptoms and standard math test scores. These findings underscore the importance of identification, prevention, and treatment of youth depression and anxiety in underdeveloped areas. As China constitutes 15% of the global population of children under age 18, this study offers valuable information to the field of global mental health.

Maternal low protein diet and fetal programming of lean type 2 diabetes

Maternal nutrition is found to be the key factor that determines fetal health in utero and metabolic health during adulthood. Metabolic diseases have been primarily attributed to impaired maternal nutrition during pregnancy, and impaired nutrition has been an immense issue across the globe. In recent years, type 2 diabetes (T2D) has reached epidemic proportion and is a severe public health problem in many countries. Although plenty of research has already been conducted to tackle T2D which is associated with obesity, little is known regarding the etiology and pathophysiology of lean T2D, a variant of T2D. Recent studies have focused on the effects of epigenetic variation on the contribution of in utero origins of lean T2D, although other mechanisms might also contribute to the pathology. Observational studies in humans and experiments in animals strongly suggest an association between maternal low protein diet and lean T2D phenotype. In addition, clear sex-specific disease prevalence was observed in different studies. Consequently, more research is essential for the understanding of the etiology and pathophysiology of lean T2D, which might help to develop better disease prevention and treatment strategies. This review examines the role of protein insufficiency in the maternal diet as the central driver of the developmental programming of lean T2D.