Course of depressive symptoms in men and women: differential effects of social, psychological, behavioral and somatic predictors

How do men and women differ in their depressive symptomatology? A gendered network analysis of depressive symptoms in a French population-based cohort

BACKGROUND

The experience of depressive manifestations and the presentation of symptoms in clinical settings may differ in men and women. Despite the extensive literature, it remains unclear how depressive manifestations interact at symptom levels in men and women. First, we aimed to describe and compare depressive networks by sex. Second, we examined symptom connections to Clinical depression and Functional Limitations as a proxy of self-recognition of a depressive episode.

METHODS

We estimated networks from the 20 CES-D items in men and women from a large population-based French cohort. We computed centrality measures and ran comparisons. Then, we re-estimated two networks in men and women separately, adding, on the one hand, Clinical Depression and, on the other hand, Limitations due to a depressive episode.

RESULTS

Over 200,000 participants were included in this study. Women were twice as likely to have a previous diagnosis of depression. Sex-ratio was less pronounced (1,7:1) for Limitations due to depression. Centrality measures revealed similar symptom patterns. However, network structures differed between men and women. We found some symptom connections to Clinical depression and Limitations to be non-invariant according to sex.

LIMITATIONS

Cross-sectional data does not capture the direction of the connections between symptoms and an eventual diagnosis. We lacked data about the diagnosis's context and could not account for other factors influencing depressive symptomatology.

CONCLUSIONS

Network structures differed, suggesting gender-specific mechanisms in activating symptoms and depressive states. Addressing central symptoms evoking depressed moods with tailored interventions may serve to tackle depressive states in men and women.

Factors associated with change in moderate or severe symptoms of anxiety and depression in community-living adults and older adults during the COVID-19 pandemic

OBJECTIVES

Few are the longitudinal studies on the changes in moderate or severe symptoms of anxiety or depression (MSS-ANXDEP) from before to during the COVID-19 pandemic in Canada. The aim was to study the change in MSS-ANXDEP and associated sociodemographic, economic, psychosocial, health behaviour and lifestyle, and clinical factors.

METHODS

The current sample includes 59,997 adults aged ≥ 35 years participating in the 2018 and 2020 health surveys of the 5 established cohorts of the Canadian Partnership for Tomorrow's Health (CanPath). MSS-ANXDEP was based on a cutoff score ≥ 10 on the 7-item Generalized Anxiety Disorder Scale and Patient Health Questionnaire (PHQ-8). Change in MSS-ANXDEP was categorized as follows: no MSS-ANXDEP, remitted, incident, and persistent. Multinomial regressions were used to study MSS-ANXDEP as a function of sociodemographic, economic, psychosocial, health behaviours and lifestyle, and clinical factors.

RESULTS

Sociodemographic and economic (i.e. age, gender, cohort, race/ethnicity, lower income, decreased in income, work status, being an essential worker), lifestyle and health behaviours (i.e. smoking, cannabis and alcohol use, drinking more alcohol), psychosocial (i.e. provide help to others, information and instrumental support, and change in relationships with friends, family, and partner) and clinical factors (i.e. lifetime mental disorder and multimorbidity) were associated with remitted, incident, and persistent MSS-ANXDEP.

CONCLUSION

Health and socio-economic factors were associated with changes in symptoms of anxiety and depression during the pandemic, further increasing inequities in mental health needs. Public health campaigns on the importance of healthy behaviours should continue and health policies should reduce economic and social barriers to integrated substance use and mental health care.

Depressive symptoms predict the incidence of common chronic diseases in women and men in a representative community sample

BACKGROUND

Depression, the most frequent and harmful mental disorder, has been associated with specific somatic diseases as the leading cause of death. The purposes of this prospective study were to predict incident chronic diseases based on baseline depressive symptoms and to test sex-dependent effects.

METHODS

In a representative German community sample of over 12 000 participants, baseline depressive symptoms (assessed using the Patient Health Questionnaire-9) were tested as a predictor of new onset of cardiovascular disease (CVD), chronic obstructive lung disease, diabetes, cancer, and migraine at 5-year follow-up. To study disease incidence, we created subsamples for each chronic disease by excluding participants who already had the respective disease at baseline. Potential confounders were included in logistic regression models and sex-specific analyses were performed.

RESULTS

Controlling for demographic characteristics and loneliness, in men and women, baseline depressive symptoms were predictive of CVD, chronic obstructive lung disease, diabetes, and migraine, but not of cancer. When we additionally adjusted for metabolic and lifestyle risk factors, there was an 8% increase of chronic obstructive lung disease and migraine per point of depressive symptoms. There was a trend for CVD (4%; p = 0.053). Sex-sensitive analyses revealed trends for the relevance of depressive symptoms for CVD in men (p = 0.065), and for diabetes in women (p = 0.077).

CONCLUSIONS

These findings underscore the need to implement screening for depression in the treatment of major somatic illnesses. At the same time, depressed patients should be screened for metabolic and lifestyle risk factors and for somatic diseases and offered lifestyle interventions.

Neuroticism modulates the qualitative effects of inferior parietal tDCS on negatively-valenced memories

For individuals with increased levels of neuroticism, experiencing criticism or receiving negative feedback has been associated with worse psychological and cognitive outcomes. Transcranial direct current stimulation (tDCS) can change cognitive processes in clinical populations. We bilaterally stimulated the posterior inferior parietal lobule (pIPL), a critical superficial node of the default model network. We investigated how baseline neuroticism modulates the impact of bilateral tDCS to pIPL on qualitative measures of memory after hearing criticism, hypothesizing that cathodal stimulation of the IPL would offer qualitative memory improvements for individuals with higher levels of neuroticism. Ninety individuals from the community were randomly assigned to receive anodal, cathodal, or sham stimulation while they were exposed to critical comments before and after stimulation. Participants then recalled the critical comments, and their linguistic responses were analyzed using Pennebaker's Linguistic Inquiry and Word Count software, a quantitative analysis software for linguistic data. Results showed that for individuals receiving cathodal tDCS, higher neuroticism scores corresponded with greater proportions of non-personal language (i.e., words such as "us," "they," or "other" instead of "I" or "me") when recalling negative feedback. For individuals with higher neuroticism, cathodal tDCS stimulation, rather than anodal or sham, of the pIPL prompted increased emotional distancing and perspective taking strategies when recalling criticism. These results further highlight the state-dependent nature of tDCS effects and the role of the IPL in interpersonal processing - a clinically meaningful outcome that current tDCS studies solely examining quantitative measures of memory (e.g., task-based accuracy or speed) do not reveal.

Functional Activity in the Effect of Transcranial Magnetic Stimulation Therapy for Patients with Depression: A Meta-Analysis

Depression is a long-lasting mental disorder that affects more than 264 million people worldwide. Transcranial magnetic stimulation (TMS) can be a safe and effective choice for the treatment of depression. Functional neuroimaging provides unique insights into the neuropsychiatric effects of antidepressant TMS. In this meta-analysis, we aimed to assess the functional activity of brain regions caused by TMS for depression. A literature search was conducted from inception to 5 January 2022. Studies were then selected according to predetermined inclusion and exclusion criteria. Activation likelihood estimation was applied to analyze functional activation. Five articles were ultimately included after selection. The main analysis results indicated that TMS treatment for depression can alter the activity in the right precentral gyrus, right posterior cingulate, left inferior frontal gyrus and left middle frontal gyrus. In resting-state studies, increased activation was shown in the right precentral gyrus, right posterior cingulate, left inferior frontal gyrus and left superior frontal gyrus associated with TMS treatment. In task-related studies, clusters in the right middle frontal gyrus, left sub-gyrus, left middle frontal gyrus and left posterior cingulate were hyperactivated post-treatment. Our study offers an overview of brain activity changes in patients with depression after TMS treatment.

Screening for loneliness in representative population samples: Validation of a single-item measure

BACKGROUND

Loneliness is a highly relevant public mental health issue. This work presents the validation of a single-item measure of loneliness and its subjective experience: "I am frequently alone/have few contacts". It can be used in large-scale population surveys where an economical assessment is of key importance.

METHODS

Data was drawn from two representative German population surveys conducted in early and late 2020 (combined N = 4,984; 52.9% women; age: M = 48.39 years (SD = 17.88)). We determined the prevalence of loneliness in men and women across different age groups. In order to test concurrent validity, bivariate correlation analyses and Chi-square tests were performed. Convergent and discriminant validity were tested by investigating intercorrelations of the single-item measure of loneliness with another loneliness measure, other mental health outcomes, and associations with sociodemographic characteristics.

RESULTS

Based on the single-item measure, 23.4% of participants reported some degree of loneliness, 3.4% among them severe loneliness. Comparisons with the LS-S showed similar prevalence rates of loneliness. A moderately positive relationship between the two loneliness measures was found by bivariate correlation analysis (ρ = .57, p < .001), but results indicated only weak convergent validity. Construct validity was supported by associations with depressive symptoms, anxiety symptoms, satisfaction with life, household size, and partnership.

CONCLUSIONS

Loneliness is frequently reported in the general population. The single-item measure of loneliness is suitable as a brief screening measure in population-based assessments.

Mediational pathways of tobacco use among adult daily smokers with psychiatric symptoms in the Population Assessment of Tobacco and Health (PATH) survey

INTRODUCTION

Individuals with psychiatric conditions suffer disproportionately from tobacco-related morbidity and mortality, but the factors driving this relationship remain unclear. We used data from the Population Assessment of Tobacco and Health (PATH) to investigate whether associations between internalizing psychiatric symptoms and change in smoking heaviness (as measured by cigarettes per day (CPD) were mediated by self-reported respiratory symptoms, smoking risk perceptions, and cigarette dependence.

METHODS

This study used data from PATH Waves 1 through 4 (2013-2017, n = 4,152). Psychiatric symptoms were indexed with the internalizing sub-scale of the Global Appraisal of Individual Needs-Short Screener (GAIN-SS) among daily smokers. We fit auto-regressive structural equation models (SEM) to data from Wave 1-3 and 2-4 to determine the direct and indirect associations between internalizing symptom scores and CPD through each mediator.

RESULTS

The association between internalizing symptoms and CPD was mediated by cigarette dependence (indirect: B = 0.004, SE = 0.041, p = 0.023) and respiratory symptom severity (indirect: B = 0.018, SE = 0.097, p < 0.001). Internalizing symptoms predicted higher harm perceptions (B = 0.056, SE = 0.035, p < 0.001) but the indirect relationship with CPD was non-significant. Findings from Waves 2-4 replicated these results.

CONCLUSION

Our results indicate that cigarette dependence and respiratory symptom severity partially mediate the relationship between internalizing symptoms and CPD but risk perceptions were not significant predictors in our models. This suggests that efforts to reduce smoking among people with internalizing disorders should focus on decreasing nicotine dependence and increasing awareness of respiratory symptoms to encourage a quit attempt or switch to a less harmful source of nicotine.

The association of depression and all-cause mortality: Explanatory factors and the influence of gender

BACKGROUND

The association of depression with mortality and the significance of explanatory factors, in particularly gender, have remained an issue of debate. We therefore aimed to estimate the effect of depression on all-cause mortality, to examine potential explanatory factors and to assess effect modification by gender.

METHODS

We used Cox regression models to estimate the effect of depression on mortality based on data from the Gutenberg Health Study, which is a prospective cohort study of the adult population in the districts of Mainz and Mainz-Bingen, Germany. Baseline assessment was between 2007 and 2012. Effect modification by gender was measured on both additive and multiplicative scales.

RESULTS

Out of 14,653 participants, 7.7% were depressed according to Patient Health Questionnaire 9 (PHQ-9), and 1,059 (7.2%) died during a median follow-up of 10.7 years. Depression elevated the risk of mortality in men and women in age-adjusted models (HR: 1.41, 95%-CI: 1.03-1.92; resp. HR: 1.96, 95%-CI: 1.43-2.69). Adjustment for social status, physical health and lifestyle covariates attenuated the effect and in the fully-adjusted model the hazard ratio was 0.96 (95%-CI: 0.69-1.33) in men and 1.53 (95%-CI: 1.10-2.12) in women. For effect modification by gender, the measure on multiplicative interaction was 0.68 (95%-CI 0.44-1.07) and on additive interaction was RERI=-0.47 (95%-CI -1.24-0.30).

LIMITATIONS

The PHQ-9 is a single self-report measure of depression reflecting symptoms of the past two weeks, limiting a more detailed assessment of depression and course of symptoms, which likely affects the association with mortality.

CONCLUSIONS

Depression elevates mortality by multifactorial pathways, which should be taken into account in the biopsychosocially informed treatment of depression. Effect modification by gender was not statistically significant.

Cancer as a risk factor for distress and its interactions with sociodemographic variables in the context of the first wave of the COVID-19 pandemic in Germany

The COVID-19 pandemic poses a psychological challenge, especially for individuals with chronic illnesses. The aim of this study was to investigate associations of cancer with distress, including its interplay with further risk and protective factors. We conducted a representative survey of the German population (N = 2503, including N = 144 with a cancer diagnosis) during the first wave of the pandemic. In multiple linear and logistic regression analyses, we tested associations of cancer with depression and anxiety symptoms and suicidal ideation. We also investigated moderating effects of age, gender, income, living situation, marital status, and loneliness. Individuals with cancer were more likely to report anxiety symptoms (φ = .061), suicidal ideation (φ = .050), and loneliness (φ = .044) than other participants. In regression analyses that controlled for sociodemographic differences, cancer was still associated with anxiety symptoms. We also observed interaction effects, indicating that this relation was especially strong in men with cancer and that cancer survivors with a low income were particularly likely to report anxiety symptoms. The findings demonstrate that cancer survivors are a vulnerable group and that factors of different life domains interact in shaping well-being in the population, necessitating comprehensive risk assessment and support offers during the pandemic and beyond.

Gender-specific associations of loneliness and suicidal ideation in a representative population sample: Young, lonely men are particularly at risk

BACKGROUND

Loneliness has been related to negative physical and mental health outcomes including suicidal ideation (SI). However, it is not clear whether loneliness is equally important for SI in women and men and in individuals of all age groups.

METHODS

Participants were a representative population sample (N=2,450) comprising the entire adult age range (18-95 years). Participants filled out established questionnaires (UCLA Three-Item Loneliness Scale, Beck Scale for Suicide Ideation, Patient Health Questionnaire-4). We tested a multiple linear regression model of SI (controlling for income, living alone, and mental distress) with interaction terms (loneliness x gender, loneliness x age, gender x age, loneliness x gender x age). We also investigated women and men separately.

RESULTS

Women and men did not differ regarding mean levels of SI, but women reported more loneliness. Loneliness was related to SI regardless of participants' gender (β=.410; p<.001). Gender-specific analyses showed that the association of loneliness and SI was especially strong among younger men (loneliness x age within the male sample: β=-.149; p=.014). Living in a shared household was negatively associated with SI in men (β=-.072; p=.019), but not in women.

LIMITATIONS

The cross-sectional study design does not allow for interpretations regarding the direction of effects.

CONCLUSIONS

Besides similarities, the study indicated gender-specific potential risk- and protective factors, i.e. age and living together with others. Young men who report loneliness could be at particularly high risk for suicidal ideation. Gender- and age-specific approaches can contribute to a more precise identification of vulnerable groups in the population.

Higher rates of allergies, autoimmune diseases and low-grade inflammation markers in treatment-resistant major depression

Only 30% of patients with major depressive disorder (MDD) reach full recovery or remission. Treatment-resistant depression (TRD) is MDD that does not respond to adequate treatment attempts with at least two antidepressants. TRD is associated more with immune activation than with treatment responsive depression. The current retrospective population-based cross-sectional study, utilizing data from a large nation-wide health maintenance organization in Israel which provides services to estimated 725,000 members, aimed to assess the clinical signs and laboratory markers of autoimmune comorbidity and low-grade inflammation, in patients with TRD. Included were participants aged 18-70 years, diagnosed twice within one year with ICD-9-CM MDD and two control groups, MDD responders (MDD-r) consisting of people with MDD and no TRD and a non-MDD group that included people with no MDD or TRD. The case (570 subjects in TRD group) to control ratio in both control groups (2850 subjects in MDD-r and 2850 subjects in non-MDD control group) was 1:5. Compared to MDD-r, the overall proportion of allergic diseases was higher among the TRD than among the MDD-r [OR 1.52 (1.19-1.94); p ​< ​0.001]. Any systemic autoimmune disease was associated with increased likelihood of MDD-r [OR 1.52 (1.04-2.24); p ​= ​0.03] or TRD [OR 2.22 (1.30-3.78); p ​= ​0.003]. Higher rates of positive (>1:80) antinuclear antibodies [33 (5.79%)] were found among the TRD than among the MDD-r [98 (3.44%); p ​= ​0.011). More allergy and autoimmune comorbidities and presence of low-grade inflammation biomarkers, were found mainly in TRD.

Neglected cardiovascular risk factors: Relationship of anxiety and depression with percutaneous coronary angioplasty

Introduction:

Coronary artery disease (CAD) is the leading cause of mortality in Malaysia. Psychological risk factors are associated with detrimental outcomes in CAD. Our study aimed to evaluate procedural anxiety and depression levels among subjects who underwent coronary angioplasty.

Methods:

A single-centre prospective cohort study was conducted on patients electively admitted to a tertiary hospital in Malaysia for percutaneous coronary intervention (PCI) over a half-year period. The Hospital Anxiety and Depression Scale (HADS) and the EuroQol-5 Dimension (EQ5D) Health Questionnaire were used to evaluate subjects’ psychological statuses. The EQ Visual Analogue Scale was used for the global assessment of their health.

Results:

The analysis included 65 patients with a mean age of 63 years from a predominately educated population ( n=54; 83.1%). Before the PCI procedure, female sex was found to be protective against depression, with an odds ratio (ORs) of 0.29 (95% confidence interval (CI) 0.08–1.03). A high level of education was protective against anxiety (OR=0.21; 95% CI 0.06–0.83). After the PCI, females were more likely to be depressed (OR=3.89; 95% CI 1.13–13.37), and those of Malay ethnicity were more likely to be anxious (OR=4.2; 95% CI 1.03–17.07). Using the HADS, subjects were significantly less anxious and depressed (pre-PCI: median (IQR) score=4 (7.0)); post-PCI: median (IQR) score=3 (5.0), p=0.02), measured by the HADS. Using the EQ5D, subjects had an improved mean VAS score (post-PCI: 75±14.9; pre-PCI: 68±12.6; p<0.05).

Conclusions:

PCI may predispose patients with CAD to psychological stressors. Female patients and those of Malay ethnicity are more likely to experience psychological stress. Being highly educated is protective against such stress.

Suffering and Salutogenesis: A Conceptual Analysis of Lessons for Psychiatry From Existential Positive Psychology (PP2.0) in the Setting of the COVID-19 Pandemic

The COVID-19 pandemic has had a widespread effect on the thoughts, emotions and behavior of millions of people all around the world. In this context, a large body of scientific literature examining the mental health impact of this global crisis has emerged. The majority of these studies have framed this impact in terms of pre-defined categories derived from psychiatric nosology, such as anxiety disorders, depression or post-traumatic stress disorder. These constructs often fail to capture the complexity of the actual experiences of the individuals being studied; more specifically, they describe these experiences exclusively in terms of disease, while neglecting their potentially adaptive or “salutogenic” aspects. Similarly, discussion of psychological assistance for these individuals has largely been confined to a reiteration of “evidence-based” psychological or pharmacological techniques which can be delivered using remote access technology. In the context of the COVID-19 pandemic, these approaches are likely to be of mixed efficacy. Conversely, “negative emotions” or distressing psychological experiences may actually be functional in the setting of a disaster or crisis, serving to minimize harm, maximize social coherence and compliance, and facilitate adherence to safety measures. The limitations of the “conventional” approach are, to a certain degree, inherent to the prevailing medical model of mental health. Beyond these considerations lies the concept of “salutogenesis,” a term which refers to the innate capacity of individuals to create and maintain health and well-being in the face of adversity. Using principles derived from the second wave of positive psychology (PP2.0), particularly its emphasis on the totality of human experience and the possibility of deriving meaning and character growth from suffering, this paper conceptually analyses the relevant aspects of salutogenesis and PP2.0, and proposes an alternate approach for addressing mental health concerns during the COVID-19 pandemic. Such an approach, while acknowledging the utility of the conventional medical-psychotherapeutic model in specific cases, reduces the risk of medicalizing human experience, and provides individuals and communities with opportunities for growth and adaptation. The benefits of this proposal could potentially extend far beyond the current crisis, offering an opportunity for the field of psychiatry and mental health research to move away from a purely “disease-centered” model.

Inflammation predicts new onset of depression in men, but not in women within a prospective, representative community cohort

Depression has been associated with increased inflammation. However, only few large-scale, prospective studies have evaluated whether inflammation leads to new cases of depression and whether this association can be found in men and women. Longitudinal data of N = 10,357 adult participants with no evidence of depression at baseline (based on Patient Health Questionnaire (PHQ-9), lifetime diagnoses, and current antidepressant medication) were evaluated for depression 5 years later. Multivariate logistic regression models were used to predict the onset of depression based on C-reactive protein (CRP) and white blood cell count (WBC). We used interaction terms and separate analyses in men and women to investigate gender-dependent associations. Based on both markers, inflammation was predictive of new cases of depression 5 years later, even when adjusting for sociodemographic, physical health, health behavior variables, and baseline depression symptoms. As established by interaction terms and separate analyses, inflammatory markers were predictive of depression in men, but not in women. Additional predictors of new onset of depression were younger age, loneliness, smoking (only in men), cancer and less alcohol consumption (only in women). The study indicates gender differences in the etiology of depressive disorders within the community, with a greater role of physical factors in men.

[Psychosomatic medicine in the Gutenberg Health Study (GHS) - research questions, measurement instruments, selected results]

Psychosomatic medicine in the Gutenberg Health Study (GHS) - research questions, measurement instruments, selected results Goal: Main questions from the Gutenberg Health Study (GHS) related to psychosomatic medicine are presented: (1) Prevalence and incidence of mental illnesses, (2) Sex-specific risk- and protective factors for mental health, (3) Interplay between psychological and somatic diseases and (4) methodical-psychometric developments. Methods: The GHS is an ongoing, prospective and interdisciplinary cohort study in Mainz. The comprehensive examinations include psychological characteristics and clinical and laboratory tests. 15010 respondents were selected in the baseline study from 2007 until 2012 and re-examined after 2.5 years and 5 years. Results: Of the first 5000 respondents in the baseline study 413 women (8.7 %) and 276 men (5.8 %) indicated depressive symptoms (PHQ-9 > = 10). After five years, half of the participants with depressive symptoms at baseline also indicated depressive symptoms five years later. Risk factors for men were a lack of social support, for women smoking and Type D personality. The proportion of new cases of depression at follow-up was 4.4 %. Risk factors were symptoms of anxiety, Type D, smoking and comorbid cancer. Protective were age and social support. Findings on the association of physical and mental disorders and their behavioral and biological links (atherosclerosis, inflammation) are presented. Conclusions: Prospective assessment of biological, psychological and social parameters offers the possibility to study their interplay in the development of mental and somatic illnesses.

Stressful Events in Old Age: Who are Most Exposed and Who are Most Likely to Overcome Them

Objectives: This study investigated self-reported events that were rated as stressful and being affecting wellbeing among older people. It also examined the variables associated with the perception of overcoming these stressful events. Methods: Face-to-face survey on a representative sample of 1,431 older people in Santiago-Chile. Instruments included open-ended questions for distinguishing events as losses, problems, conflicts, and others’ difficulties. The associations between the occurrence and overcoming of events with individual and social characteristics were examined through multivariate logistic regression. Results: 39.5% mentioned at least one stressful event, being mostly perceived as solvable problems rather than losses. Higher-income, better health, self-efficacy, and social support were associated with a higher perception of event overcoming. Conclusion: The occurrence and the probability of events’ overcoming does not increase in old-old age in this sample group. Better health and individual and social resources such as self-efficacy and social support, are protective resources for overcoming the stressful events, but they are not generally considered in public policies.

Neuroimaging in the effect of transcranial magnetic stimulation therapy for patient with depression: a protocol for a coordinate-based meta-analysis

INTRODUCTION

As a prevalent psychiatric disease, depression is a life-threatening mental disorder that may cause work disability and premature death. Transcranial magnetic stimulation (TMS) is a non-invasive neuromodulation procedure, which has been reported to have a significant effect on antidepressant treatment in recent years. However, the parameters of TMS for depression that can produce the best clinical benefits remain unknown. In the present study, we will evaluate the effect of TMS treatment for depression from the perspective of functional neuroimaging by performing a meta-analysis based on included studies.

METHODS AND ANALYSIS

Two independent reviewers will search published studies in the following five databases: PubMed, Web of Science, Embase, China National Knowledge Infrastructure and WANGFANG DATA from inception to 1 June 2020. Then we will select studies according to predesigned inclusion and exclusion criteria. After extracting data from included studies, activation likelihood estimation will be applied to data synthesis. Any disagreement will be checked by the third reviewer who will also make the final decision.

ETHICS AND DISSEMINATION

This work does not require ethics approval as it will be based on published studies. This review will be published in peer-reviewed journals.PROSPERO registration numberCRD42020165436.

[Measurement invariance and normative data of the 8-item short form of the Center of Epidemiological Studies-Depression Scale (CES-D-8)]

Measurement invariance and normative data of the 8-item short form of the Center of Epidemiological Studies-Depression Scale (CES-D-8) Objectives: Female gender is a risk factor for depression. It is questionable whether a given psychometric instrument depicts depressive symptom severity in men and women alike. Therefore, we examined measurement invariance of the Center of Epidemiological Studies Depression Scale-8 (CES-D-8) between women, men and different age groups. Additionally, we aimed providing normative data for CES-D-8. Methods: We assessed depressive symptoms in a German population-based sample (N = 2,507) with the CES-D-8. Gender-distorted items were excluded in the short form. Results: Using confirmatory factor analysis (CFA), we found good model fit for men, women and the overall sample. A multi-group CFA confirmed measurement invariance of CES-D-8 regarding the tested factors and their interaction. Gender- and age-group-specific norms were computed. Conclusion: The use of the CES-D-8 can be recommended in epidemiological contexts, for practice and research. Different values between women and men of different age groups can be compared appropriately from a psychometric perspective.

Frequency of stressful life events and associations with mental health and general subjective health in the general population

Aim

We aim to determine the frequency of stressful life events (SLEs) and investigate the association of single and aggregated SLEs with mental health and general subjective health, which has not been reported for an aging representative sample to date.

Subjects and methods

A total of 12,947 participants (35–74 years old) of the Gutenberg Health Study (GHS) in Germany were analyzed. SLEs were analyzed at the item and aggregated level with unweighted and weighted sum scores. Additionally, the survey included measures of mental health, general subjective health and demographics. Descriptive analyses were stratified by sex, age and socioeconomic status.

Results

Multivariate analyses of variance with SLE at the item level revealed large main effects for sex (ηp2 = 0.30) and age (ηp2 = 0.30); a moderate effect was found for socioeconomic status (ηp2 = 0.08). Interaction effects of sex with age and SES were also significant, but with negligible effect sizes. Regression analyses revealed similar results for unweighted and weighted SLE sum scores controlling for sociodemographic variables, supporting the detrimental relations among cumulated SLEs, depression (β = 0.18/0.19) and anxiety (β =0.17/0.17), but not general health. Mental health indicators showed the highest correlations with single SLEs such as change of sleep habits or personal finances. Severe SLEs according to proposed weight scores showed no or only weak associations with mental health.

Conclusion

Representative data support a more distinct impact of SLEs on mental health than on general health. Single SLEs show strong associations with mental health outcome (e.g., change of sleep habits). The low associations between severe single SLEs and mental health merit further attention.