African American Ethnicity, Hypertension, Diabetes, and Arthritis Independently Predict Co-occurring Depression and Obesity among Community-dwelling Older Adult Alabamians

Income inequality and comorbid overweight/obesity and depression among a large sample of Canadian secondary school students: The mediator effect of social cohesion

Background

Comorbid overweight/obesity (OWO) and depression is emerging as a public health problem among adolescents. Income inequality is a structural determinant of health that independently increases the risk for both OWO and depression among youth. However, no study has examined the association between income inequality and comorbid OWO and depression or tested potential mechanisms involved. We aimed to identify the association between income inequality and comorbid OWO and depression and to test whether social cohesion mediates this relationship.

Methods

We used data from the 2018-2019 Cannabis, Obesity, Mental health, Physical activity, Alcohol, Smoking and Sedentary behavior (COMPASS) project. Our sample was composed of 46,171 adolescents from 136 schools distributed in 43 census divisions in 4 provinces in Canada (Ontario, Alberta, British Columbia, and Quebec). Gender-stratified multilevel path analyses models were used to examine whether income inequality (Gini coefficient) was associated with comorbid OWO and depression and whether the association was mediated by school connectedness, a proxy measure for social cohesion.

Results

The direct effect between income inequality and OWO-depression comorbidity was not significant. However, income inequality was significantly associated with increased risk of comorbidity via social cohesion. One standard deviation increase in the Gini coefficient was associated with a 9% and 8% increase in the odds of comorbidity in females (OR=1.09; 95% CI=1.03, 1.16) and males (OR=1.08; 95% CI=1.03, 1.13).

Conclusion

Policies aimed at reducing income inequality, and interventions to improve social cohesion, may contribute to reducing the risk of OWO-depression comorbidity among adolescents.

Determinants of depressive symptoms in older outpatients with cardiometabolic diseases in a Japanese frailty clinic: Importance of bidirectional association between depression and frailty

INTRODUCTION

Frailty and depression may play important roles in the management of older patients with cardiometabolic diseases. We explored the determinants of depressive symptoms and their association with frailty among patients with cardiometabolic diseases (hypertension, diabetes, and atrial fibrillation) in a cross-sectional study.

METHODS

A total of 633 outpatients aged 65 years or older with cardiometabolic disease and suspected symptoms of frailty participated in this study. Depressive symptoms, physical activity, and social network were assessed using the Geriatric Depression Scale (GDS)-15, International Physical Activity Questionnaire, and Lubben Social Network Scale-6 (LSNS-6), respectively. Frailty was evaluated using the Kihon Checklist (KCL) based on the Comprehensive Geriatric Assessment (CGA), the modified Cardiovascular Health Study (mCHS), and the Clinical Frailty Scale (CFS). Binomial logistic regression analysis was used to examine the determinants of depressive symptoms and their association with frailty.

RESULTS

Depressive symptoms with GDS-15 scores ≥ 5 were present in 43.6% of the patients. In logistic regression, after adjusting for covariates, the determinants of depressive symptoms in all patients were lack of social network, low years of education, and frailty. In contrast, in logistic regression with frailty as the dependent variable, depressive symptoms were independently associated KCL-defined frailty (OR = 6.28, 95% CI: 4.13-9.55) and mCHS-defined frailty (OR = 2.66, 95% CI: 1.70-4.17), but not with CFS. Similarly, significant associations between depression and frailty were observed in patients with hypertension, diabetes, or atrial fibrillation.

CONCLUSIONS

Lack of social networks, low education, and frailty based on the KCL and mCHS were important determinants of depressive symptoms in all patients. The relatively strong associations between depressive symptoms and frailty based on CGA in patients with hypertension, diabetes, or atrial fibrillation suggest that the assessment of depressive symptoms is of great importance in clinical practice in those patients at high risk of frailty.