Comparing anxiety and depression to obesity and smoking as predictors of major medical illnesses and somatic symptoms

The longitudinal association between physical health and depressive symptoms over eight years: Evidence from the health and retirement study

BACKGROUND

The bidirectional relationship between physical health (PH) and depressive symptoms (DS) remains unclear.

METHODS

Data were extracted from the Health and Retirement Study in the United States. PH was measured with a composite of chronic diseases, functional limitations and difficulties in basic and instrumental activities of daily living, and DS with a modified Center for Epidemiological Studies of Depression. Latent growth curve models (LGCM) were employed to examine how the change in PH or DS affected their mutual trajectories in later life. In addition, multilevel models were utilized.

RESULTS

There were 6144 participants included, with an average age of 69.82 ± 6.85 years at baseline, of whom 3686 (59.99 %) were women. PH scores increased from 5.65 in 2010 to 7.72 in 2018, while depression scores increased from 1.14 to 1.31. LGCM results showed that the initial levels of PH and DS were associated (β = 0.558, P < .001), and the initial level of PH could predict the trajectory of DS (β = 0.089, P < .001). Likewise, the initial level of DS was also related to initial PH (β = -0.563, P < .001) but couldn't predict the trajectory of PH. Furthermore, the slopes of PH and DS were predicted bidirectionally by each other. Two-level logistic models further demonstrated the bidirectional association between PH and DS.

CONCLUSION

There was a bidirectional association between physical health and depressive symptoms, which highlights the necessity of comprehensive health management for older adults with poor physical health or depression symptoms.

Evidence-Based Therapist-Supported Digital Mental Health Intervention for Patients Experiencing Medical Multimorbidity: A Retrospective Cohort Intent-to-Treat Study

OBJECTIVE

Multimorbidity or the co-occurrence of multiple health conditions is increasing globally and is associated with significant psychological complications. It is unclear whether digital mental health (DMH) interventions for patients experiencing multimorbidity are effective, particularly given that this patient population faces more treatment resistance. The goal of the current study was to examine the impact of smartphone-delivered DMH interventions for patients presenting with elevated internalizing symptoms that have reported multiple lifetime medical conditions.

METHODS

This preregistered (see https://osf.io/vh2et/ ) retrospective cohort intent-to-treat study with 2819 patients enrolled in a therapist-supported DMH intervention examined the associations between medical multimorbidity (MMB) and mental health outcomes.

RESULTS

Results indicated that more MMB was significantly associated with greater presenting mental health symptom severity. MMB did not have a deleterious influence on depressive symptom trajectories across treatment, although having one medical condition was associated with a steeper decrease in anxiety symptoms compared to patients with no medical conditions. Finally, MMB was not associated with time to dropout, but was associated with higher dropout and was differentially associated with fewer beneficial treatment outcomes, although this is likely attributable to higher presenting symptom severity, rather than lesser symptom reductions during treatment.

CONCLUSIONS

Overall, the Meru Health Program was associated with large effect size decreases in depressive and anxiety symptoms regardless of the number of MMB. Future DMH treatments and research might investigate tailored barrier reduction and extended treatment lengths for patients experiencing MMB to allow for greater treatment dose to reduce symptoms below clinical outcome thresholds.

Memory support training and lifestyle modifications to promote healthy aging in persons at risk for Alzheimer's disease: a digital application supported intervention (Brain Boosters)

BACKGROUND

Evidence-based interventions to protect against cognitive decline among older adults at risk for Alzheimer's disease and related dementias (ADRD) are urgently needed. Rehabilitation approaches to support memory and behavioral/lifestyle interventions are recognized as promising strategies for preserving or improving cognitive health, although few previous interventions have combined both approaches. This paper describes the protocol of the Brain Boosters intervention, which synergistically combines training in compensatory and healthy lifestyle behaviors and supports implementation and tracking of new behaviors with a digital application.

METHODS

The study utilizes a single-site, single-blinded, randomized controlled design to compare a structured lifestyle and compensatory aid intervention to an education-only self-guided intervention. We plan to enroll 225 community-dwelling adults (25% from underrepresented groups) aged 65 + who endorse subjective cognitive decline (SCD) and low baseline levels of healthy lifestyle behaviors. Both interventions will be administered in group format, consisting of 15 two-hour classes that occur weekly for ten weeks and taper to bi-monthly and monthly, for an intervention duration of 6 months. Participants in both interventions will receive education about a variety of memory support strategies and healthy lifestyle behaviors, focusing on physical and cognitive activity and stress management. The structured intervention will also receive support in adopting new behaviors and tracking set goals aided by the Electronic Memory and Management Aid (EMMA) digital application. Primary outcomes include global cognition (composite of memory, attention, and executive function tests) and everyday function (Everyday Cognition Questionnaire). Data will be collected at baseline and outcome visits, at approximately 6, 12, and 18 months. Qualitative interviews, self-report surveys (e.g., indicators of self-determination, health literacy) and EMMA data metrics will also be used to identify what components of the intervention are most effective and for whom they work.

DISCUSSION

Successful project completion will provide valuable information about how individuals with SCD respond to a compensation and preventative lifestyle intervention assisted by a digital application, including an understanding of factors that may impact outcomes, treatment uptake, and adherence. The work will also inform development, scaling, and personalization of future interventions that can delay disability in individuals at risk for ADRD.

TRIAL REGISTRATION

ClinicalTrials.gov. (NCT05027789, posted 8/30/2021).

Predictors of somatic symptom burden in healthcare professionals during the COVID-19 pandemic: an 8-week follow-up study

BACKGROUND

Literature investigating the impact of COVID-19 on healthcare professionals barely addresses predictors of somatic symptom burden during the COVID-19 pandemic.

AIMS

As biopsychosocial models propose that not only the disease but also sociodemographic and psychosocial factors contribute to the development and maintenance of symptoms, this study investigates the predictive value of these factors for bothersome somatic symptoms in SARS-CoV-2 negative healthcare professionals.

METHODS

German healthcare professionals were assessed with self-rating questionnaires and underwent SARS-CoV-2 IgG antibody tests at baseline and 8 weeks later between April and August 2020. Differences in psychosocial variables between the time points were analyzed and regression analyses were performed to predict somatic symptoms at follow-up.

RESULTS

1185 seronegative healthcare professionals completed both assessments. Previous somatic symptom burden, higher levels of anxiety, being a nurse, younger age, higher psychological symptom burden, lower efficiency, and higher fatigability at baseline predicted somatic symptom burden at follow-up. Comparisons between baseline and follow-up showed a significant improvement in psychological impairment and deterioration of physical exhaustion.

CONCLUSIONS

Our study applies a biopsychosocial perspective to bothersome somatic symptoms during the COVID-19 pandemic and contributes to the identification of potential risk factors as a starting point for future interventions that could support the handling of symptoms.

Physical Activity and Self-Perception of Mental and Physical Quality of Life during Pregnancy: A Systematic Review and Meta-Analysis

Self-perception of health status (quality of life) is considered one of the best indicators of health and well-being. However, during pregnancy, it could be impacted not only by physiological and anatomical changes, but by poor lifestyle habits like high sedentary behaviour or bad nutrition. This study assesses the effects of physical activity RCT interventions during pregnancy on both mental and physical components of quality of life. A systematic review and two meta-analyses were performed (PROSPERO registration number: CRD42022370467). Of the 207 articles captured both in English and Spanish, seven articles were deemed eligible for inclusion. The two analyses performed found that physically active pregnant women had better scores of mental self-perception of quality of life (z = 2.08, p = 0.04; SMD = 0.34, 95% CI = 0.02, 0.67, I2 = 76%, Pheterogeneity = 0.0004) and in physical self-perceived health status (z = 2.19, p = 0.03; SMD = 0.33, 95% CI = 0.03, 0.63, I2 = 71%, Pheterogeneity = 0.002) compared to control group pregnant women. Physical activity interventions could potentially increase mental and physical self-perception of quality of life during pregnancy.

Sleep timing, sleep regularity, and psychological health in early late life women: Findings from the Study of Women's Health Across the Nation (SWAN)

OBJECTIVES

To examine the associations of actigraphy-assessed sleep timing and regularity with psychological health in early late life women, whose circadian rhythms may be impacted by aging.

DESIGN

Cross-sectional.

PARTICIPANTS

A racially/ethnically diverse sample of 1197 community-dwelling women (mean age 65 years) enrolled in the Study of Women's Health Across the Nation.

MEASURES

Actigraphy-assessed sleep measures included timing (mean midpoint from sleep onset to wake-up) and regularity (standard deviation of midpoint in hours). Psychological health measures included a composite well-being score, the Center for Epidemiological Studies Depression Scale, and the Generalized Anxiety Disorder-7 Scale. Linear and logistic regression models, adjusted for covariates (including sleep duration), tested associations between sleep and psychological health measures.

RESULTS

After covariate adjustment, a sleep midpoint outside of 2:00-4: 00 AM was significantly associated with depressive symptoms (β = 0.88, 95% CI = 0.06, 1.70) and scoring above the cut-point for clinically significant depressive symptoms (OR = 1.72, 95% CI = 1.15, 2.57). Sleep irregularity was significantly associated with lower psychological well-being (β = -0.18, 95% CI = -0.33, -0.03), depressive (β = 1.36, 95% CI = 0.29, 2.44) and anxiety (β = 0.93, 95% CI = 0.40, 1.46) symptoms, and scoring above the cut-point for clinically significant depressive (OR = 1.68, 95% CI = 1.01, 2.79) and anxiety (OR = 1.62, 95% CI = 1.07, 2.43) symptoms.

CONCLUSION

Above and beyond sleep duration, a sleep midpoint outside of 2:00-4:00 AM was associated with depressive symptoms while sleep irregularity was associated with multiple psychological health domains in late life women.

Psychological and biological mechanisms linking trauma with cardiovascular disease risk

Cardiovascular disease (CVD) is the leading cause of death and disability worldwide, and experiences of psychological trauma have been associated with subsequent CVD onset. Identifying key pathways connecting trauma with CVD has the potential to inform more targeted screening and intervention efforts to offset elevated cardiovascular risk. In this narrative review, we summarize the evidence for key psychological and biological mechanisms linking experiences of trauma with CVD risk. Additionally, we describe various methodologies for measuring these mechanisms in an effort to inform future research related to potential pathways. With regard to mechanisms involving posttraumatic psychopathology, the vast majority of research on psychological distress after trauma and CVD has focused on posttraumatic stress disorder (PTSD), even though posttraumatic psychopathology can manifest in other ways as well. Substantial evidence suggests that PTSD predicts the onset of a range of cardiovascular outcomes in trauma-exposed men and women, yet more research is needed to better understand posttraumatic psychopathology more comprehensively and how it may relate to CVD. Further, dysregulation of numerous biological systems may occur after trauma and in the presence of posttraumatic psychopathology; these processes of immune system dysregulation and elevated inflammation, oxidative stress, mitochondrial dysfunction, renin-angiotensin system dysregulation, and accelerated biological aging may all contribute to subsequent cardiovascular risk, although more research on these pathways in the context of traumatic stress is needed. Given that many of these mechanisms are closely intertwined, future research using a systems biology approach may prove fruitful for elucidating how processes unfold to contribute to CVD after trauma.

Factors associated with hopelessness, depression and anxiety in the Honduran-Central America population during the COVID-19 pandemic

Introduction

The mental health of the population has been affected by COVID-19, reporting in many populations higher levels of depressive, anxious and stress symptoms, however, in Honduras there are no studies showing the impact of COVID-19 on the mental health of the population.

Aim

To determine the factors associated with hopelessness, depression and anxiety in times of COVID-19 in the Honduran population.

Methods

Cross-sectional analytical study. Three scales were used, Beck for hopelessness, Hamilton for depression and anxiety, through interviews with the population attending different levels of health care throughout the country. Descriptive and analytical statistics were obtained. For hopelessness, the Beck Hopelessness Scale was used; for depression and anxiety, the Hamilton Scale was used.

Results

Of the 8,125 participants, the population in general showed results of hopelessness 14.9%, depression 12.9% and anxiety 1.2%, there was less hopelessness among women (p = 0.004), university students (p &lt; 0.001), but greater among those who had a family member deceased by COVID-19 (p &lt; 0.001), among those who had diabetes mellitus (DM) (p &lt; 0.001), history of mental illness (p &lt; 0.001) or had consumed drugs in the last 6 months (p &lt; 0.001). There was more depression among those with arterial hypertension (p = 0.002), obesity (p = 0.019), DM (p = 0.004), history of mental illness (p &lt; 0.001) or had consumed drugs in the last 6 months (p &lt; 0.001). There was more anxiety among those infected with COVID-19 (p = 0.023), according to having a family member deceased by COVID-19 (p = 0.045) and in those with a history of mental illness (p &lt; 0.001).

Discussion

The Honduran population presented important differences in the socio-pathological, according to the loss of family members or having previous illnesses, this according to the presentation of problems in the mental sphere.

Conclusion

We found factors associated with hopelessness, we found factors associated with hopelessness, depression and anxiety in times of COVID-19 in the Honduran population.

Comparison on the clinical features in patients with or without treatment-resistant depression: A National Survey on Symptomatology of Depression report

Patients with treatment-resistant depression (TRD) have fewer treatment options and worse prognoses than those without TRD. Although the etiology or pathophysiology of TRD remains unclear, certain clinical variables have been found to be related to its severity and prognosis. Therefore, 1151 patients with recurrent depression were recruited from the National Survey on Symptomatology of Depression (NSSD) and their depressive symptoms were assessed by using the doctor-rating assessment questionnaire. Then, the differences between patients with or without TRD were compared by parametric or nonparametric tests and the risk factors for TRD were explored by logistic regression. The results showed there were differences in clinical variables between patients with and without TRD. Additionally, we found depression with more somatic symptoms had a higher risk for TRD. Further analysis by stepwise logistic regression showed that age, gender, religious belief, drinking habit, the total course of depression, the number of hospitalizations, characteristics of seasonal episode remission, depressed mood, hypersexuality, emotionally incoherent psychotic symptoms, psychomotor agitation, respiratory system symptoms and history of suicide attempts were strongly associated with TRD. So, it is crucial for clinicians to identify these clinical features and adjust treatments timely.

The critical role of physical frailty and function on depressive symptoms among community-dwelling older adults in China: A cross-sectional study

INTRODUCTION

With rapid population aging in China, geriatric depression has imposed a heavy burden on public health and society. This study aimed to investigate the prevalence and influencing factors of depressive symptoms among community-dwelling older adults in China. The findings of this study will contribute to the early detection and effective interventions for older adults with depressive symptoms.

METHODS

A cross-sectional study was conducted among people aged ≥65 years old in urban communities in Shenzhen, China, in 2021. This study assessed depressive symptoms (Geriatric Depression Scale-5, GDS-5), physical frailty (FRAIL Scale, FS), and physical function (Katz index of independence in the Activities of Daily Living, ADL). Multiple linear regression was used to examine potential predictors of depressive symptoms.

RESULTS

A total of 576 participants aged 71.73 ± 6.41 years were included in the analysis. More than half of them were females (53.0%). The average score of GDS-5 was 0.57 ± 1.11, with 78 (13.61%) participants with depressive symptoms (≥2). The mean scores of FS and ADL were 0.80 ± 1.08 and 9.49 ± 1.67, respectively. The final regression model indicated that those who were living alone, less satisfied with their personal life, frailer, and with worse abilities in ADL had a higher level of depression symptoms (R² = 0.406, p < 0.001).

CONCLUSION

The prevalence of depressive symptoms is high in this urban community-dwelling older adults in China. Given the critical role of frailty and ADL on depressive symptoms, specific attention to psychological support should be paid to older adults who are living alone and with poor physical conditions.

Risk factors for worsening of somatic symptom burden in a prospective cohort during the COVID-19 pandemic

Introduction

Little is known about risk factors for both Long COVID and somatic symptoms that develop in individuals without a history of COVID-19 in response to the pandemic. There is reason to assume an interplay between pathophysiological mechanisms and psychosocial factors in the etiology of symptom persistence.

Objective

Therefore, this study investigates specific risk factors for somatic symptom deterioration in a cohort of German adults with and without prior SARS-CoV-2 infection.

Methods

German healthcare professionals underwent SARS-CoV-2 IgG antibody testing and completed self-rating questionnaires at baseline and 21 months later between April 2020 and February 2022. Differences in variables between the time points were analyzed and a regression analysis was performed to predict somatic symptom deterioration at follow-up.

Results

Seven hundred fifty-one adults completed both assessments. Until follow-up, n = 58 had contracted SARS-CoV-2 confirmed by serology. Between baseline and follow-up, signs of mental and physical strain increased significantly in the sample. Symptom expectations associated with COVID-19 and a self-reported history of COVID-19, but not serologically confirmed SARS-CoV-2 infection, significantly predicted somatic symptom deterioration at follow-up. A further predictor was baseline psychological symptom burden.

Conclusions

This study supports a disease-overarching biopsychosocial model for the development of burdensome somatic symptoms during the COVID-19 pandemic and supports research findings that symptom burden may be more related to the psychosocial effects of the pandemic than to infection itself. Future studies on Long COVID should include SARS-CoV-2 negative control groups and consider symptom burden prior to infection in order to avoid an overestimation of prevalence rates.

Pain Is Associated With Depressive Symptoms, Inflammation, and Poorer Physical Function in Older Adults With HIV

OBJECTIVE

People living with HIV (PLWH) frequently experience pain, which often co-occurs with psychological symptoms and may impact functional outcomes. We investigated cross-sectional associations between pain, depressive symptoms, and inflammation, and then explored whether pain was related to poorer physical function among older PLWH.

METHODS

We examined data from PLWH aged 54 to 78 years ( n = 162) recruited from a single outpatient program for a larger study on HIV and aging. Participants reported depressive symptoms (10-item Center for Epidemiological Studies Depression Scale) and then attended a biomedical visit in which they reported past-month pain (Medical Outcomes Study-HIV pain subscale), completed physical function assessments, and provided blood samples (assayed for interleukin 6, interferon-γ, tumor necrosis factor α, and C-reactive protein). Links between pain, depressive symptoms, inflammation, and physical function were tested using linear regression models.

RESULTS

PLWH with greater depressive symptoms experienced more pain than did those with fewer depressive symptoms ( B = 1.31, SE = 0.28, p < .001), adjusting for age, sex, race, body mass index, smoking, disease burden, time since HIV diagnosis, and medication use. Higher composite cytokine levels were associated with worse pain ( B = 5.70, SE = 2.54, p = .027 in adjusted model). Poorer physical function indicators, including slower gait speed, weaker grip strength, recent falls, and prefrail or frail status, were observed among those with worse pain. Exploratory mediation analyses suggested that pain may partially explain links between depressive symptoms and several physical function outcomes.

CONCLUSIONS

Pain is a potential pathway linking depressive symptoms and inflammation to age-related health vulnerabilities among older PLWH; longitudinal investigation of this pattern is warranted. PLWH presenting with pain may benefit from multidisciplinary resources, including behavioral health and geriatric medicine approaches.

Effects of a Mindfulness-Based Weight Loss Intervention on Long-Term Psychological Well-Being Among Adults with Obesity: Secondary Analyses from the Supporting Health by Integrating Nutrition and Exercise (SHINE) Trial

Objective

This study tested whether a mindfulness-based intervention for obesity that included components aimed at emotion regulation and mindful eating improved psychological outcomes including stress, anxiety, positive emotion, and depression, during the intervention period and at longer-term follow-up.

Methods

Adults with obesity (N=194) were randomized to a 5.5-month diet-exercise weight loss intervention with or without mindfulness training focused on emotion regulation and mindful eating. Participants completed self-report measures of mindfulness and psychological well-being, which were planned secondary outcomes, at baseline, mid-intervention (3 months), and at 6-, 12-, and 18-months post-baseline (maintenance period). Mixed effects models and linear regression were used to test between- and within-group changes in psychological well-being. Finally, this study explored whether changes in mindfulness (from baseline to each 6- and 18-months post-baseline) mediated the effects of intervention arm on changes in psychological outcomes during those respective time periods. This study explored whether changes in mindfulness from baseline to 6 months mediated the effects of intervention arm on changes in psychological outcomes from baseline to 18 months.

Results

Participants randomized to the mindfulness arm had significant increases in positive emotions at all follow-up times compared to controls. There were statistically significant increases in mindfulness, psychological flexibility, and reflection, as well as decreases in anxiety and depressive symptoms at 12 months compared to control participants. These changes remained significant for psychological flexibility and reflection at 18 months. There were no significant differences in perceived stress. Among mindfulness participants, greater increases in mindfulness from 6-18 months was associated with greater positive emotions and psychological flexibility as well as lower perceived stress, anxiety, depressive symptoms, and rumination at 18 months, adjusting for 6-month values. Mediation analyses indicated that randomization to the mindfulness intervention arm was associated with 6-month increases in mindfulness, and these increases were in turn associated with improved psychological outcomes at 6 months and 18 months. Changes from baseline to 18 months did not mediate 18-month changes in psychological outcomes.

Conclusions

Mindfulness training in emotion regulation and mindful eating may provide greater longer-term psychological well-being benefits in non-clinical populations with obesity compared to conventional diet-exercise interventions.

Female sex and femininity independently associate with common somatic symptom trajectories

BACKGROUND

Multiple predictors have been associated with persistent somatic symptoms. However, previous studies problematically defined the persistence of symptoms, conflated participants' sex and gender, and focused on patient populations. Therefore, we studied associations between predictors, especially sex and gender, and longitudinal patterns of somatic symptoms in the general adult population. We also assessed whether predictors for persisting symptoms differ between sexes.

METHOD

To identify developmental trajectories of somatic symptoms, assessed by the SCL-90 SOM, we used latent class trajectory modeling in the Dutch Lifelines Cohort Study [N = 150 494; 58.6% female; median time to follow-up: 46.0 (min-max: 22.0-123.0) months]. To identify predictors of trajectories, we applied multiple logistic regression analyses. Predictors were measured by surveys at baseline and a composite gender index was previously developed.

RESULTS

A five-class linear LCGA model fitted the data best: 93.7% of the population had a stable symptom trajectory, whereas 1.5% and 4.8% of the population had a consistently increasing or decreasing symptom trajectory, respectively. Female sex predicted severe, stable symptom severity (OR 1.74, 95% CI 1.36-2.22), but not increasing symptom severity (OR 1.15, 95% CI 0.99-1.40). Femininity was protective hereof (OR 0.60, 95% CI 0.44-0.82 and OR 0.66, 95% CI 0.51-0.85, respectively). Merely a few predictors of symptom severity, for instance hours of paid employment and physical functioning, differed in strength between sexes. Yet, effect sizes were small.

CONCLUSION

Female sex and femininity predict symptom trajectories. No large sex differences in the strength of additional predictors were found, thus it may not be clinically useful to distinguish between predictors specific to male or female patients of persistent somatic symptoms.

Nature-Based Meditation, Rumination and Mental Wellbeing

Novel approaches for children and young people (CYP) in the prevention and intervention of mental illness are needed and nature-based interventions (NBI) may be clinically useful. This proof-of-principle study tested the effects of a novel brief nature-based meditation on rumination, depressive symptoms and wellbeing in young people. Sixty-eight university students were randomised to one of three conditions: active control (n = 23), indoor meditation (n = 22) or nature-based meditation (n = 23). Participants completed self-report measures on state and trait rumination post intervention and depression and wellbeing at a 2-week follow-up. Depressive rumination significantly decreased post intervention in the nature condition and depressive symptoms improved for both intervention groups. Wellbeing only significantly improved at follow-up in the nature condition. Nature condition participants demonstrated one minimal clinically important difference (MCID) for wellbeing at follow-up. Depressive symptoms for this condition were below the clinically significant threshold for depression. The number needed to treat (NNT) analysis suggested that two to five young people would need to complete the intervention. Preliminary evidence suggests NBIs, such as the one in the present study, can reduce depressive rumination and symptoms and improve wellbeing. Replication with larger clinical samples is required to substantiate findings.

Association of Depression and Anxiety With the Accumulation of Chronic Conditions

IMPORTANCE

Longitudinal associations between comorbid depression and anxiety with the accumulation of chronic illnesses are unclear, and questions remain about the contributions associated with each condition in the increasing prevalence of multimorbidity.

OBJECTIVE

To compare the risk and rate of accumulating chronic conditions in people with depression, anxiety, and comorbid depression and anxiety vs individuals with neither depression nor anxiety.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used the Rochester Epidemiology Project medical records-linkage system to identify residents of Olmsted County, Minnesota, from January 1, 2005, to December 31, 2014, with follow-up ending December 31, 2017. The sample was divided into cohorts anchored at birthday ages of 20, 40, and 60 years. Individuals were classified at anchoring birthday age as having depression alone, anxiety alone, comorbid depression and anxiety, or neither depression nor anxiety (reference group), using electronically extracted diagnosis codes from the International Classification of Diseases, Ninth Revision (ICD-9) in the 5 years before each anchoring birthday. Data were analyzed from August 2020 through November 2021.

EXPOSURES

Depression alone, anxiety alone, comorbid depression and anxiety, or neither depression nor anxiety (reference group).

MAIN OUTCOMES AND MEASURES

The main outcome was sex-specific risk, calculated as hazard ratios (HRs) and rates of accumulation, calculated as mean annual incidence rates per 100 person-years, of 15 common chronic conditions within each birthday age cohort through the end of study.

RESULTS

Among the 40 360 individuals included across all 3 age cohorts, 21 516 (53.3%) were women. After balancing cohorts on race, Hispanic ethnicity, education level, body mass index, smoking status, and calendar year at index birthday, the risk of accumulating chronic conditions was significantly increased among women with depression alone (cohort aged 20 years: HR, 1.20 [95% CI, 1.02-1.42]; cohort aged 40 years: HR, 1.20 [95% CI, 1.10-1.31]; cohort aged 60 years: HR, 1.09 [95% CI, 1.02-1.16]) and women with comorbid depression and anxiety (cohort aged 20 years: HR, 1.60 [95% CI, 1.28-1.99]; cohort aged 40 years: HR, 1.41 [95% CI, 1.21-1.65]; cohort aged 60 years: HR, 1.29 [95% CI, 1.15-1.44]) compared with referent women in the same birthday cohorts and in men with comorbid depression and anxiety compared with referent men in the cohort aged 20 years (HR, 1.77 [95% CI, 1.08-2.91]). For women, the rates of accumulation of conditions were significantly higher across birthday cohorts in the comorbid depression and anxiety group compared with the depression alone group (eg, cohort aged 20 years: difference, 1.2 [95% CI, 0.2-2.1] per 100 person-years) and reference group (eg, cohort aged 20 years: difference, 1.7 [95% CI, 0.9-2.6] per 100 person-years). For men, compared with the reference group, the rates of accumulation of conditions were significantly higher in men with comorbid depression and anxiety in the cohort aged 20 years (difference, 1.4 [95% CI, 0.1-2.6] per 100 person-years) and in men with depression in the cohort aged 40 years (difference, 2.0 [95% CI, 0.8-3.2] per 100 person-years).

CONCLUSIONS AND RELEVANCE

In this cohort study, the risk of accumulating chronic conditions was increased with depression and comorbid depression and anxiety in women across the age span and in younger men with comorbid depression and anxiety. Compared with women without depression or anxiety, there was a more rapid rate of accumulation of chronic conditions in women with depression and anxiety individually and an even higher rate when depression and anxiety cooccurred.

Physical Health Complaints in Adolescents

Abstract. Background: Some of the physical health complaints adolescents have, such as headaches and stomachaches, cannot be explained on a somatic level. It is unclear which psychological factors can explain these complaints: stress and social support are often discussed, but emotions rarely are. Aims: This cross-sectional study aims to use social support, stress, the tendency toward negative emotions, and health behaviors to predict physical health complaints in adolescents. Method: The 2018 HBSC (Health Behavior in School-aged Children) data from the German state of Brandenburg was analyzed via structural equation and path modeling ( N = 3,068, age M = 13.05). Results: Results showed that the tendency toward negative emotions seems to be a better predictor for health complaints (β = .35) than stress (β = .17), and even better suited than social support (β = −.08) or health behavior (β = −.06 to β = .16). In the analysis of specific emotions (anger, sadness, and fear), correlations were low and between sadness and complaints they were highest (average β = .19). Limitations: The present cross-sectional study could not examine long-term outcomes. In addition, the results are limited to only a few physical complaints. Future long-term studies should examine multiple disease symptoms in adolescence. Conclusion: The investigated tendency toward negative emotions demonstrated promising results to better understand the relationship between psychological factors and physical health complaints. As negative emotions were particularly important in predicting physical health, prevention programs for adolescents should focus on dealing with negative emotions to improve their health.

Factors connected with anxiety and other neuropsychiatric symptoms in advanced gastric cancer

OBJECTIVE

The aim of study was to determine factors connected with neuropsychiatric symptoms and anxiety in patients with terminal stomach cancer.

METHODS

We analysed retrospectively 134 terminal stomach cancer patients admitted to Palliative Care Unit.

RESULTS

Patients with anxiety had a greater chance for emergency admission, higher Numerical Rating Scale result, occurrence of cachexia and neuropsychiatric symptoms, longer duration of treatment, higher albumin concentration and lower glucose concentration.Patients with neuropsychiatric symptoms had greater chance for emergency admission, higher Performance Status scale note, occurrence of dyselectrolytemia, lower albumin concentration. Patients with those symptoms had more than 7 times greater chance for death.

CONCLUSION

It is important to know factors connected with neuropsychiatric symptoms and anxiety because thanks to that we could avoid those dangerous clinical symptoms.

An Evidence-Based Nursing Intervention Decreases Anxiety, Depression, Sleep Quality and Somatic Symptoms of Patients with Acute Ischemic Stroke

PURPOSE

This study aimed to explore the effects of evidence-based nursing (EBN) intervention on anxiety, depression, sleep quality and somatic symptoms of patients with acute ischemic stroke (AIS).

METHODS

The eligible AIS patients were randomized into the intervention group and control group in a 1:1 ratio. Patients in both groups received routine nursing care. On the basis of routine nursing, patients in the intervention group also received EBN. Self-rating anxiety scale (SAS), self-rating depression scale (SDS), Pittsburgh Sleep Quality Index (PSQI), and the Patient Health Questionnaire-15 (PHQ-15) were used to assess patients' anxiety, depression, sleep quality, and somatic symptoms at baseline (T0) and 6 months after intervention (T1), respectively.

RESULTS

There was no difference in SAS, SDS, PSQI, and PHQ-15 scores at T0 between the 2 groups (all P > 0.05). Comparing to the control group, the intervention group had significantly lower SAS and SDS scores at T1 (P = 0.002, P < 0.001, respectively). The SAS and SDS score changes (T1-T0) were more evident in the intervention group than in the control group (all P < 0.001). No difference of PSQI or PHQ-15 score between the 2 groups was observed at T1. However, the PSQI and PHQ-15 score changes were more evident in the intervention group than in the control group (P = 0.044 and P = 0.007, respectively).

CONCLUSION

EBN invention significantly improved anxiety, depression, sleep quality and somatic symptoms of patients with AIS.

Prenatal Anxiety and Exercise. Systematic Review and Meta-Analysis

The prevalence of prenatal anxiety has increased during the COVID-19 pandemic. Anxiety is associated with other cardiovascular, physiological, and mental illnesses, resulting in adverse health effects for the mother and foetus. The purpose of this study was to evaluate the effects of physical activity (PA) during pregnancy on the prevalence of prenatal anxiety or symptoms of anxiety. A systematic review and two meta-analyses were performed (Registration No. CRD42021275333). Peer-reviewed articles reporting the effect of a PA intervention on anxiety during pregnancy were included. The first meta-analysis (MA) included 10 studies reporting final scores of prenatal anxiety. A negative association between moderate PA during pregnancy and prenatal anxiety was found in this analysis (z = −2.62, p < 0.01; ES = −0.46, 95% CI = −0.80, −12, I2 = 84%, Pheterogeneity = 0.001). The second MA included eight studies in which measures both before and after a PA intervention were reported. The findings of this analysis revealed a positive association between exercise practice during pregnancy and a decrease in prenatal anxiety scores (z = −3.39, p < 0.001; ES = −0.48, 95% CI = −0.76, −0.20, I2 = 71%, Pheterogeneity = 0.001). Supervised PA during pregnancy could prevent and reduce prenatal anxiety and anxiety symptoms.

Association between anxiety and hypertension in adults: A systematic review and meta-analysis

We assessed the association between anxiety and hypertension in adults via a systematic review/meta-analysis. We searched PubMed, Ovid, and PsycINFO through 27 March 2020 with no language or publication type restrictions and systematically contacted study authors for unpublished information/data. We meta-analysed 59 studies including a total of 4,012,775 participants. Study quality was rated with the Newcastle-Ottawa Scale and random-effects analyses were performed. A significant anxiety-hypertension association was found in cross-sectional (OR = 1.37, 95 % CI = 1.21-1.54) and prospective studies (OR = 1.40, 95 % CI = 1.23-1.59). In sensitivity analyses, results were influenced by method of hypertension diagnosis, but not by study quality, method of anxiety diagnosis, study population, and effect size type. In subgroup analyses, study location, in particular country economic status, but not participant age, influenced the results. Longitudinal data and theoretical literature indicate that anxiety may precede hypertension. These findings have important clinical implications for the early detection and treatment of both anxiety and hypertension. Suggestions for future research are discussed.

Factors associated with smoking in low-income persons with and without chronic illness

INTRODUCTION

Tobacco disparities persist among low-income smokers who seek care from safety-net clinics. Many of these patients suffer from chronic illnesses (CILs) that are associated with and exacerbated by smoking. The objective of the current study was to examine the differences between safety-net patients with and without CILs in terms of nicotine dependence and related factors (such as depression, anxiety) and self-efficacy regarding ability to abstain from smoking.

METHODS

Sixty-four low-income smokers who thought about or intended to quit smoking were recruited from the San Francisco Health Network (SFHN) and assessed for CILs, nicotine dependence, depression, anxiety, and smoking abstinence self-efficacy. Four one-way analyses of variance were used to examine the difference between those with and without CIL on the latter four variables.

RESULTS

The CIL group had significantly higher anxiety (CIL: 8.0 ± 5.35; non-CIL: 4.44 ± 3.48; p=0.02) and tended to have higher nicotine dependence (CIL: 5.40 ± 2.58; non-CIL: 3.88 ± 2.28; p=0.04). In the CIL group, nicotine dependence was positively correlated with anxiety [r(62)=0.39; p<0.01] and negatively correlated with smoking abstinence self-efficacy [r(62)= -0.38; p<0.01]. Both depression (Spearman’s rho=0.39; p<0.01) and anxiety (Spearman’s rho=0.29; p<0.05) were associated with total number of CIL categories.

CONCLUSIONS

Safety-net patients who smoke and suffer from CILs may be suffering from higher levels of anxiety and have less confidence in their ability to quit smoking. Incorporating mood management and developing interventions that increase a sense of self-efficacy for refraining from smoking may be necessary to help low-income smokers quit smoking.

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.

Mood disorder and cancer onset: evidence from a population-based sample of Australian women

OBJECTIVE

The role of mood disorders in cancer onset is unclear. The aim of this study was to investigate the association between mood disorder and incident cancer in a population-based sample of women.

METHODS

Data were derived from women aged 28-94 years participating in the Geelong Osteoporosis Study. Mood disorder was identified via Clinical Interview (SCID-I/NP). Cancer data was obtained following linkage with the Victorian Cancer Registry. Demographic and lifestyle factors were self-reported. Nested case-control and retrospective study designs were utilized.

RESULTS

In the case-control study (n=807), mood disorder was documented for 18 of the 75 (9.3%) cancer cases and among 288 controls (24.0% vs. 39.3%, p = 0.009). Prior exposure to mood disorder was associated with reduced cancer incidence (OR 0.49, 95%CI 0.28-0.84); this was sustained following adjustment for confounders (ORadj 0.52, 95%CI 0.30-0.90). In the retrospective cohort study (n=655), among 154 women with a history of mood disorder at baseline, 13 (8.5%) developed incident cancer during follow-up, whereas among 501 women with no history of mood disorder, 54 (10.8%) developed incident cancer. Exposure to mood disorder was not associated with incident cancer over the follow-up period (HR 0.58, 95%CI 0.31-1.08, p = 0.09).

CONCLUSION

Mood disorder was associated with reduced odds of cancer onset. However, this finding was not supported in the retrospective cohort study. Larger studies able to investigate specific cancers and mood disorders as well as underlying mechanisms in both men and women are warranted.

An Empirical Study on Diabetes Depression over Distress Evaluation Using Diagnosis Statistical Manual and Chi-Square Method

Diabetes distress is an alternative disorder that is often associated with depression syndromes. Psychosocial distress is an alternative disorder that acts as a resistance to diabetes self-care management and compromises diabetes control. Yet, in Nigeria, the focus of healthcare centers is largely inclined toward the medical aspect of diabetes that neglects psychosocial care. In this retrospective study, specific distress was measured by the Diabetes Distress Screening (DDS) scale, and depression was analyzed by the Beck Depression Inventory (BDI) and Diagnosis Statistics Manual (DSM) criteria in type 2 diabetes mellitus (T2DM) patients of Northwestern Nigeria. Additionally, we applied the Chi-square test and linear regression to measure the forecast prevalence ratio and evaluate the link between the respective factors that further determine the odd ratios and coefficient correlations in five nonintrusive variables, namely age, gender, physical exercise, diabetes history, and smoking. In total, 712 sample patients were taken, with 51.68% male and 47.31% female patients. The mean age and body mass index (BMI) was 48.6 years ± 12.8 and 45.6 years ± 8.3. Based on the BDI prediction, 90.15% of patients were found depressed according to the DSM parameters, and depression prevalence was recorded around 22.06%. Overall, 88.20% of patients had DDS-dependent diabetes-specific distress with a prevalence ratio of 24.08%, of whom 45.86% were moderate and 54.14% serious. In sharp contrast, emotion-related distress of 28.96% was found compared to interpersonal (23.61%), followed by physician (16.42%) and regimen (13.21%) distress. The BDI-based matching of depression signs was also statistically significant with p < 0.001 in severe distress patients. However, 10.11% of patients were considered not to be depressed by DSM guidelines. The statistical evidence indicates that depression and distress are closely correlated with age, sex, diabetes history, physical exercise, and smoking influences. The facts and findings in this work show that emotional distress was found more prevalent. This study is significant because it considered several sociocultural and religious differences between Nigeria and large, undeveloped, populated countries with low socioeconomic status and excessive epidemiological risk. Finally, it is important for the clinical implications of T2DM patients on their initial screenings.

Psychobiological markers of allostatic load in depressed and nondepressed mothers and their adolescent offspring

BACKGROUND

A substantial body of research has emerged suggesting that depression is strongly linked to poor physical health outcomes, which may be partly due to increased allostatic load across stress response systems. Interestingly, health risks associated with depression are also borne by the offspring of depressed persons. Our aim was to simultaneously investigate whether maternal depression is associated not only with increased allostatic load across cardiac control, inflammation, cellular aging, but also if this is transmitted to adolescent children, possibly increasing the risk for early onset of psychiatric conditions and disease in these offspring.

METHODS

A preregistered, case-control study of 180 low-income mothers (50% mothers depressed, 50% mothers nondepressed) and their adolescent offspring was conducted to determine how depressed mothers and their adolescent offspring systematically differ in terms of autonomic, sympathetic, and parasympathetic cardiac control; inflammation; cellular aging; and behavioral health in offspring, which are indicators suggestive of higher allostatic load.

RESULTS

Findings indicate that depressed mothers and their adolescent offspring differ in terms of comorbid mental and physical health risk profiles that are suggestive of higher allostatic load. Findings indicate that depressed mothers exhibit elevated resting heart rate and decreased heart rate variability, and adolescent offspring of depressed mothers exhibit greater mental health symptoms, elevated heart rate, and accelerated biological aging (shorter telomeres). These effects persisted after controlling for a range of potential covariates, including medication use, sex, age, and adolescents' own mental health symptoms.

CONCLUSIONS

Findings indicate that maternal depression is associated with increased allostatic load in depressed women and their adolescent children, possibly increasing risk for early onset of psychiatric conditions and disease in these offspring. Future research is needed to delineate why some biological systems are more impacted than others and to explore how findings might inform preventative programs targeted at adolescent offspring of depressed mothers.

COVID-19 and subsequent lockdown: Adverse effects on psychological health of Indian women

Context:

COVID-19 pandemic and subsequent lockdown have led to adverse psychological outcomes in general population. Stress is mounting at an unbelievable pace and one gender is taking the brunt more than the other. While it’s easy to understand the predicaments of working women and how stressful they are during the lockdown, what escapes the notice is the condition of homemaker women who face a lot of challenges as their workload has increased due to lack of house help. Hence the study was conducted to assess anxiety and stress related to problems arising out of COVID-19 and the subsequent lockdown among Indian women.

Methods and Material:

Cross-sectional study was carried out among women across India using snowball sampling technique. Data was collected by a semi-structured online questionnaire based on GAD-7 and PSS scales. It was done using STATA 10.1 and Spearman’s correlation coefficient, Kendall’s Tau, etc., were applied.

Results:

Majority of study participants mentioned either improvement or no change in their personal relations. Anxiety was present in 55.97% and moderate stress in 90.53% of the female participants. Mean GAD and PSS scores were 5.91 and 21.91 respectively. Anxiety and stress were found to be significantly related to getting help in the household work and occupational status. Watching movies and trying different recipes were the main destressors.

Conclusions:

More than half of the women are having anxiety and almost all have some form of stress due to COVID-19 pandemic and the subsequent lockdown.

Number of Pain Locations as a Predictor of Cause-Specific Disability Pension in Sweden-Do Common Mental Disorders Play a Role?

OBJECTIVE

The aim of this study was to investigate the associations between number of pain locations, common mental disorders (CMDs), and disability pension (DP).

METHODS

Survey data in 1998 to 2003 for 27,165 Swedish twins born in 1935 to 1958 were linked to national DP data until 2013. Pain locations were evaluated for back, low back, sciatica, shoulder, or neck pain, and CMDs for lifetime major depression and 1-month anxiety.

RESULTS

The number of pain locations was associated with DP in a dose-response manner. One pain location had a hazard ratio of 1.50 (95% confidence interval 1.35 to 1.68) and five pain locations hazard ratio 4.67 (95% confidence interval 4.11 to 5.30) for DP. Also, CMDs were associated with DP.

CONCLUSION

The number of pain locations has a dose-response association with the risk of DP. CMDs predict DP. In strategies to prevent DP, early signs of pain or CMDs should be taken into consideration.

Comorbid depressive and anxiety symptoms and frailty among older adults: Findings from the West China health and aging trend study

BACKGROUND

Depression and anxiety are two common mental disorders in older people. Studies have reported that depression is strongly associate with frailty, but few studies focus on anxiety disorder and comorbid two mental disorders. In this study, we aimed to identify associations between comorbid depressive and anxiety symptoms with frailty in older adults.

METHODS

4,103 community-dwellings adults aged 60 and older from the baseline of the West China Health and Aging Trend (WCHAT) study were included. Frailty was measured by the Fried frailty phenotype criteria. The 15-item Geriatric Depression Scale (GDS-15) and 7-item Generalized Anxiety Disorder Scale (GAD-7) assessed for depressive and anxiety symptoms with a cut-off value of 5. Multinomial logistic regression was used to explore the association between different depressive and anxiety status and frailty.

RESULTS

8.7% of old adults suffered comorbid depressive and anxiety symptoms in the present study. The prevalence of pre-frailty and frailty was 47.0% and 6.7%, respectively. After adjusting for covariates, individuals with comorbid depressive and anxiety symptoms had higher odds of being pre-frail (OR=1.86, 95% CI=1.41, 2.45) and frail (OR=7.03, 95% CI=4.48, 11.05) compared to those without depressive and anxiety symptoms. In the comorbidity group, those with severe comorbid symptoms also had higher prevalence of pre-frailty and frailty.

LIMITATIONS

Depressive and anxiety symptom assessments were based on screening tools.

CONCLUSIONS

This study suggested comorbid depressive and anxiety symptoms were associated with frailty among Chinese older adults. Further efforts to screen and target depression and anxiety comorbidity may be warranted.

The Impact of Lung Function on Extra-Pulmonary Diseases and All-Cause Mortality in US Adult Population with and without COPD

Objective

Spirometric lung function is usually used to evaluate respiratory health. However, the impact of lung function on extra-pulmonary diseases and all-cause mortality has not been fully elucidated, especially in people without chronic obstructive pulmonary disease (COPD).

Patients and Methods

Participants aged ≥20 and underwent spirometry test from the US National Health and Nutrition Examination Surveys (NHANES) 2007-2012 were analyzed in this study. Multivariate logistic and Cox regressions were used to evaluate the impact of forced expiratory volume in 1 second percent of predicted (FEV₁% predicted) and forced vital capacity percent of predicted (FVC% predicted) on 14 extra-pulmonary diseases and all-cause morbidity after adjusting for multiple confounders.

Results

During 2007-2012, 1800 COPD patients and 11,437 non-COPD subjects were included. The prevalence of hypertension, diabetes mellitus (DM), dyslipidemia, metabolic syndrome (MS), congestive heart failure (CHF), coronary disease, stroke, chronic kidney disease (CKD), arthritis, cancer, underweight and osteoporosis in COPD patients was higher than that in the non-COPD population. After adjusting for confounders, the decrease of FEV₁% predicted and FVC% predicted was related with higher odds of having hypertension, DM, obesity, MS, CHF, coronary disease and depression (OR > 1, P<0.05) in both the COPD and non-COPD populations. These 2 indices were also related with higher odds of dyslipidemia, CKD, arthritis and osteoporosis in the non-COPD population. The risk of stroke, anemia and cancer was not related with the decrease of lung function. In addition, the decrease of lung function was independent risk factors for the increase of all-cause mortality. These risks were gradually increased with the decrease of lung function.

Conclusion

The decrease of FEV₁% predicted and FVC% predicted was related with higher risk of multiple extra-pulmonary diseases and all-cause mortality in both the COPD and non-COPD population.

Recent physical conditions and health service utilization in people with common mental disorders and severe mental illness in England: Comparative cross-sectional data from a nationally representative sample

Background.

Policies addressing the physical health of people with mental disorders have historically focused on those with severe mental illness (SMI), giving less prominence to the more prevalent common mental disorders (CMDs). Little is known about the comparative physical health outcomes of these patient groups. We aimed to first compare the: (a) number of past-year chronic physical conditions and (b) recent physical health service utilization between CMDs vs. SMI, and secondly compare these outcomes between people with CMDs vs. people without mental disorders.

Methods.

We analyzed cross-sectional data from the third Adult Psychiatric Morbidity Survey, a representative sample of the English population. We determined the presence of physical conditions and health service utilization by self-report and performed logistic regression models to examine associations of these outcomes between participant groups.

Results.

Past-year physical conditions were reported by the majority of participants (CMDs, n = 815, 62.1%; SMI = 27, 63.1%) with no variation in the adjusted odds of at least one physical condition between diagnoses (odds ratio [OR] = 0.96, 95% confidence intervals [CI] 0.42–1.98, p = 0.784). People with CMDs were significantly more likely to be recently hospitalized relative to with those with SMI (OR = 6.33, 95% CI 5.50–9.01, p < 0.05). Having a CMD was associated with significantly higher odds of past-year physical conditions and recent health service utilization (all p < 0.001) compared with the general population.

Conclusions.

People with CMDs experience excess physical health morbidities in a similar pattern to those found among people with SMI, while their somatic hospitalization rates are even more elevated. Findings highlight the importance of recalibrating existing public health strategies to bring equity to the physical health needs of this patient group.

Relationship between neighbourhood social participation and depression among older adults: A longitudinal study in China

Previous research has found a negative linkage between neighbourhood social participation and depressive symptoms in Western countries, but the cross-sectional design of these studies limits the ability to infer causality. Little attention has been paid to socio-psychological pathways linking neighbourhood social participation to depressive symptoms among older adults in China. This study aimed to examine the impact of neighbourhood social participation on depressive symptoms among older adults in China. It also further explored the mediating roles of physical activity, social contact among neighbours, and contact with own children in the relationship between social participation and depressive symptoms. Data obtained through three waves (2011, 2013, and 2015) of the China Health and Retirement Longitudinal Study were used. The sample consisted of 10,105 individuals aged 60 and above and 24,623 person-year records captured during these three waves. Depressive symptoms were assessed using the Center for Epidemiology Studies of Depression scale. Results showed that respondents' depression decreased with an increasing level of neighbourhood social participation, more time spent on physical activities, and a higher frequency of contact with neighbours and with own children. These factors were found to partly mediate the relationship between neighbourhood social participation and depression. The negative relationships between social contact and depression and contact with own children and depression were both strengthened by neighbourhood social participation. In conclusion, physical activity, social contact among neighbours and contact with own children are mechanisms through which neighbourhood social participation lowers the risk of depression among older adults in China.

Allostatic load in the association of depressive symptoms with incident coronary heart disease: The Jackson Heart Study

African Americans are at heightened risk for coronary heart disease (CHD), with biologic pathways poorly understood. We examined the role of allostatic load (AL) in the association of depressive symptoms with incident CHD among 2,670 African American men and women in the prospective Jackson Heart Study. Depressive symptoms were quantified using the Center for Epidemiologic Studies Depression Scale (CES-D). Incident CHD was ascertained by self-report, death certificate survey, and adjudicated medical record surveillance. Baseline AL was quantified using biologic parameters of metabolic, cardiovascular, immune, and neuroendocrine subsystems and as a combined meta-factor. Sequential models adjusted for demographic, socioeconomic, and behavioral covariates, stratified to examine differences by sex. Greater depressive symptomatology was associated with greater metabolic, cardiovascular, and immune AL (p-values≤0.036) and AL meta-factor z-scores (p = 0.007), with findings driven by observations among females. Each 1-point increase in baseline depressive symptomatology, and 1-SD increase in metabolic AL, neuroendocrine AL, and AL meta-factor z-scores was associated with 3.3%, 88%, 39%, and 130% increases in CHD risk, respectively (p-values <0.001). Neuroendocrine AL and AL meta-factor scores predicted incident CHD among males but not females in stratified analyses. Metabolic AL partially mediated the association of depressive symptoms with incident CHD (5.79% mediation, p = 0.044), a finding present among females (p = 0.016) but not males (p = 0.840). Among African American adults, we present novel findings of an association between depressive symptomatology and incident CHD, partially mediated by metabolic AL. These findings appear to be unique to females, an important consideration in the design of targeted interventions for CHD prevention.