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Liu S, Chen J, Guan L, Xu L, Cai H, Wang J, Zhu DM, Zhu J, Yu Y. The brain, rapid eye movement sleep, and major depressive disorder: A multimodal neuroimaging study. Prog Neuropsychopharmacol Biol Psychiatry 2024; 136:111151. [PMID: 39326695 DOI: 10.1016/j.pnpbp.2024.111151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 09/10/2024] [Accepted: 09/22/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND Evidence has established the prominent involvement of rapid eye movement (REM) sleep disturbance in major depressive disorder (MDD). However, the neural correlates of REM sleep in MDD and their clinical significance are less clear. METHODS Cross-sectional and longitudinal polysomnography and resting-state functional MRI data were collected from 131 MDD patients and 71 healthy controls to measure REM sleep and voxel-mirrored homotopic connectivity (VMHC). Correlation and mediation analyses were performed to examine the associations between REM sleep, VMHC, and clinical variables. Moreover, we conducted spatial correlations between the neural correlates of REM sleep and a multimodal collection of reference brain maps to facilitate genetic, structural and functional annotations. RESULTS MDD patients exhibited REM sleep abnormalities manifesting as higher REM sleep latency and lower REM sleep duration, which were correlated with decreased VMHC of the precentral gyrus and inferior parietal lobe and mediated their associations with more severe anxiety symptoms. Longitudinal data showed that VMHC increase of the inferior parietal lobe was related to improvement of depression symptoms in MDD patients. Spatial correlation analyses revealed that the neural correlates of REM sleep in MDD were linked to gene categories primarily involving cellular metabolic process, signal pathway, and ion channel activity as well as linked to cortical microstructure, metabolism, electrophysiology, and cannabinoid receptor. CONCLUSION These findings may add important context to the growing literature on the complex interplay between sleep and MDD, and more broadly may inform future treatment for depression via regulating sleep.
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Affiliation(s)
- Siyu Liu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China; Research Center of Clinical Medical Imaging, Anhui Province, Hefei 230032, China; Anhui Provincial Institute of Translational Medicine, Hefei 230032, China; Anhui Provincial Key Laboratory for Brain Bank Construction and Resource Utilization, Hefei 230032, China
| | - Jingyao Chen
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China; Research Center of Clinical Medical Imaging, Anhui Province, Hefei 230032, China; Anhui Provincial Institute of Translational Medicine, Hefei 230032, China; Anhui Provincial Key Laboratory for Brain Bank Construction and Resource Utilization, Hefei 230032, China
| | - Lianzi Guan
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China; Department of Sleep Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei 230022, China; Hefei Fourth People's Hospital, Hefei 230022, China; Anhui Mental Health Center, Hefei 230022, China
| | - Li Xu
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China; Department of Sleep Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei 230022, China; Hefei Fourth People's Hospital, Hefei 230022, China; Anhui Mental Health Center, Hefei 230022, China
| | - Huanhuan Cai
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China; Research Center of Clinical Medical Imaging, Anhui Province, Hefei 230032, China; Anhui Provincial Institute of Translational Medicine, Hefei 230032, China; Anhui Provincial Key Laboratory for Brain Bank Construction and Resource Utilization, Hefei 230032, China
| | - Jie Wang
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China; Research Center of Clinical Medical Imaging, Anhui Province, Hefei 230032, China; Anhui Provincial Institute of Translational Medicine, Hefei 230032, China; Anhui Provincial Key Laboratory for Brain Bank Construction and Resource Utilization, Hefei 230032, China
| | - Dao-Min Zhu
- The School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei 230032, China; Department of Sleep Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei 230022, China; Hefei Fourth People's Hospital, Hefei 230022, China; Anhui Mental Health Center, Hefei 230022, China.
| | - Jiajia Zhu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China; Research Center of Clinical Medical Imaging, Anhui Province, Hefei 230032, China; Anhui Provincial Institute of Translational Medicine, Hefei 230032, China; Anhui Provincial Key Laboratory for Brain Bank Construction and Resource Utilization, Hefei 230032, China.
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China; Research Center of Clinical Medical Imaging, Anhui Province, Hefei 230032, China; Anhui Provincial Institute of Translational Medicine, Hefei 230032, China; Anhui Provincial Key Laboratory for Brain Bank Construction and Resource Utilization, Hefei 230032, China.
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Martin ZT, Shah AJ, Ko YA, Sheikh SAA, Daaboul O, Haddad G, Goldberg J, Smith NL, Lewis TT, Quyyumi AA, Bremner JD, Vaccarino V. Exaggerated Peripheral and Systemic Vasoconstriction During Trauma Recall in Posttraumatic Stress Disorder: A Co-Twin Control Study. Biol Psychiatry 2024; 96:278-286. [PMID: 38142719 PMCID: PMC11192861 DOI: 10.1016/j.biopsych.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/23/2023] [Accepted: 12/14/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Individuals with posttraumatic stress disorder (PTSD) face an increased risk of cardiovascular disease, but the mechanisms linking PTSD to cardiovascular disease remain incompletely understood. We used a co-twin control study design to test the hypothesis that individuals with PTSD exhibit augmented peripheral and systemic vasoconstriction during a personalized trauma recall task. METHODS In 179 older male twins from the Vietnam Era Twin Registry, lifetime history of PTSD and current (last month) PTSD symptoms were assessed. Participants listened to neutral and personalized trauma scripts while peripheral vascular tone (Peripheral Arterial Tone ratio) and systemic vascular tone (e.g., total vascular conductance) were measured. Linear mixed-effect models were used to assess the within-pair relationship between PTSD and vascular tone indices. RESULTS The mean age of participants was 68 years, and 19% had a history of PTSD. For the Peripheral Arterial Tone ratio analysis, 32 twins were discordant for a history of PTSD, and 46 were discordant for current PTSD symptoms. Compared with their brothers without PTSD, during trauma recall, participants with a history of PTSD had greater increases in peripheral (β = -1.01, 95% CI [-1.72, -0.30]) and systemic (total vascular conductance: β = -1.12, 95% CI [-1.97, -0.27]) vasoconstriction after adjusting for cardiovascular risk factors. Associations persisted after adjusting for antidepressant medication use and heart rate and blood pressure during the tasks. Analysis of current PTSD symptom severity showed consistent results. CONCLUSIONS PTSD is associated with exaggerated peripheral and systemic vasoconstrictor responses to traumatic stress reminders, which may contribute to elevated risk of cardiovascular disease.
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Affiliation(s)
- Zachary T Martin
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Amit J Shah
- Rollins School of Public Health, Emory University, Atlanta, Georgia; Emory University School of Medicine, Emory University, Atlanta, Georgia; Joseph Maxwell Cleland Atlanta VA Medical Center, Decatur, Georgia
| | - Yi-An Ko
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Obada Daaboul
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - George Haddad
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center, U.S. Department of Veterans Affairs Office of Research and Development, Seattle, Washington
| | - Nicholas L Smith
- Seattle Epidemiologic Research and Information Center, U.S. Department of Veterans Affairs Office of Research and Development, Seattle, Washington
| | - Tené T Lewis
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Arshed A Quyyumi
- Emory University School of Medicine, Emory University, Atlanta, Georgia
| | - J Douglas Bremner
- Emory University School of Medicine, Emory University, Atlanta, Georgia; Joseph Maxwell Cleland Atlanta VA Medical Center, Decatur, Georgia
| | - Viola Vaccarino
- Rollins School of Public Health, Emory University, Atlanta, Georgia; Emory University School of Medicine, Emory University, Atlanta, Georgia.
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Janssen Daalen JM, van den Bergh R, Prins EM, Moghadam MSC, van den Heuvel R, Veen J, Mathur S, Meijerink H, Mirelman A, Darweesh SKL, Evers LJW, Bloem BR. Digital biomarkers for non-motor symptoms in Parkinson's disease: the state of the art. NPJ Digit Med 2024; 7:186. [PMID: 38992186 PMCID: PMC11239921 DOI: 10.1038/s41746-024-01144-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/22/2024] [Indexed: 07/13/2024] Open
Abstract
Digital biomarkers that remotely monitor symptoms have the potential to revolutionize outcome assessments in future disease-modifying trials in Parkinson's disease (PD), by allowing objective and recurrent measurement of symptoms and signs collected in the participant's own living environment. This biomarker field is developing rapidly for assessing the motor features of PD, but the non-motor domain lags behind. Here, we systematically review and assess digital biomarkers under development for measuring non-motor symptoms of PD. We also consider relevant developments outside the PD field. We focus on technological readiness level and evaluate whether the identified digital non-motor biomarkers have potential for measuring disease progression, covering the spectrum from prodromal to advanced disease stages. Furthermore, we provide perspectives for future deployment of these biomarkers in trials. We found that various wearables show high promise for measuring autonomic function, constipation and sleep characteristics, including REM sleep behavior disorder. Biomarkers for neuropsychiatric symptoms are less well-developed, but show increasing accuracy in non-PD populations. Most biomarkers have not been validated for specific use in PD, and their sensitivity to capture disease progression remains untested for prodromal PD where the need for digital progression biomarkers is greatest. External validation in real-world environments and large longitudinal cohorts remains necessary for integrating non-motor biomarkers into research, and ultimately also into daily clinical practice.
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Affiliation(s)
- Jules M Janssen Daalen
- Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands.
| | - Robin van den Bergh
- Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Eva M Prins
- Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Mahshid Sadat Chenarani Moghadam
- Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Rudie van den Heuvel
- HAN University of Applied Sciences, School of Engineering and Automotive, Health Concept Lab, Arnhem, The Netherlands
| | - Jeroen Veen
- HAN University of Applied Sciences, School of Engineering and Automotive, Health Concept Lab, Arnhem, The Netherlands
| | | | - Hannie Meijerink
- ParkinsonNL, Parkinson Patient Association, Bunnik, The Netherlands
| | - Anat Mirelman
- Tel Aviv University, Sagol School of Neuroscience, Department of Neurology, Faculty of Medicine, Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility (CMCM), Tel Aviv, Israel
| | - Sirwan K L Darweesh
- Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
| | - Luc J W Evers
- Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands
- Radboud University, Institute for Computing and Information Sciences, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands.
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Chen F, Lin H, Zhang Y, Zhang Y, Chen L. The mediating role of sleep disturbance in the relationship between depression and cardiovascular disease. Front Psychiatry 2024; 15:1417179. [PMID: 38903636 PMCID: PMC11188478 DOI: 10.3389/fpsyt.2024.1417179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 05/27/2024] [Indexed: 06/22/2024] Open
Abstract
Background Studies suggest that both depression and disrupted sleep disturbance are linked to cardiovascular disease (CVD). However, the precise role of sleep disturbance in the connection between depression and CVD is poorly understood. Therefore, we sought to examine the associations among these factors and further explore the mediating role of sleep disturbance in the association between depression and CVD. Methods This study included data from 29,831 adults (≥20 years old). Multifactorial logistic regression analyses were conducted to examine the relationships among depression, sleep disturbance, and CVD. Additionally, bootstrap tests were used to investigate whether the association between depression and CVD was mediated by sleep disturbance. Results Our research showed that individuals who experienced depression or sleep disturbance had a notably greater likelihood of developing CVD than those who did not have these issues (depression: OR: 2.21, 95% CI=1.96-2.49; sleep disturbance: OR: 1.74, 95% CI=1.6-1.9). Even after adjusting for potential confounders, depression was still positively associated with the risk of sleep disturbance (OR: 4.07, 95% CI=3.73-4.44). Furthermore, sleep disturbance significantly mediated the association between depression and CVD, with a mediating effect of 18.1%. Conclusion Our study demonstrated that depression, sleep disturbance, and CVD are interrelated. The increased risk of CVD among patients with depression may be attributed to the mediating role of sleep disturbance. This finding underscores the importance of interventions focused on sleep disturbances as a means to address the connection between depression and CVD.
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Affiliation(s)
- Feng Chen
- Department of Child Healthcare, Wenzhou People’s Hospital, Wenzhou, Zhejiang, China
| | - Hao Lin
- Department of Gastroenterology, Pingyang Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yuansi Zhang
- Department of Traditional Chinese Medicine, Wenzhou Yebo Proctology Hospital, Wenzhou, Zhejiang, China
| | - Yu Zhang
- Department of Child Healthcare, Wenzhou People’s Hospital, Wenzhou, Zhejiang, China
| | - Linlin Chen
- Department of Child Healthcare, Wenzhou People’s Hospital, Wenzhou, Zhejiang, China
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Shah AJ, Vaccarino V, Goldberg J, Huang M, Ko YA, Ma X, Levantsevych OM, Smith NL, Alagar N, Mousselli I, Johnson DA, Clifford GD, Bremner JD, Bliwise DL. Posttraumatic Stress Disorder and Obstructive Sleep Apnea in Twins. JAMA Netw Open 2024; 7:e2416352. [PMID: 38913378 PMCID: PMC11197451 DOI: 10.1001/jamanetworkopen.2024.16352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 03/13/2024] [Indexed: 06/25/2024] Open
Abstract
Importance Obstructive sleep apnea (OSA) is a common condition in older adult (aged >65 years) populations, but more mechanistic research is needed to individualize treatments. Previous evidence has suggested an association between OSA and posttraumatic stress disorder (PTSD) but is limited by possible selection bias. High-quality research on this association with a careful evaluation of possible confounders may yield important mechanistic insight into both conditions and improve treatment efforts. Objective To investigate the association of current PTSD symptoms and PTSD diagnosis with OSA. Design, Setting, and Participants This cross-sectional study of twin pairs discordant for PTSD, which allows for adjustment for familial factors, was conducted using in-laboratory polysomnography from March 20, 2017, to June 3, 2019. The study sample comprised male veteran twins recruited from the Vietnam Era Twin Registry. The data analysis was performed between June 11, 2022, and January 30, 2023. Exposure Symptoms of PTSD in twins who served in the Vietnam War. Diagnosis of PTSD was a secondary exposure. Main Outcomes and Measures Obstructive sleep apnea was assessed using the apnea-hypopnea index (AHI) (≥4% oxygen saturation criterion as measured by events per hour) with overnight polysomnography. Symptoms of PTSD were assessed using the PTSD Checklist (PCL) and structured clinical interview for PTSD diagnosis. Results A total of 181 male twins (mean [SD] age, 68.4 [2.0] years) including 66 pairs discordant for PTSD symptoms and 15 pairs discordant for a current PTSD diagnosis were evaluated. In models examining the PCL and OSA within pairs and adjusted for body mass index (BMI) and other sociodemographic, cardiovascular, and psychiatric risk factors (including depression), each 15-point increase in PCL was associated with a 4.6 (95% CI, 0.1-9.1) events-per-hour higher AHI. Current PTSD diagnosis was associated with an adjusted 10.5 (95% CI, 5.7-15.3) events-per-hour higher AHI per sleep-hour. Comparable standardized estimates of the association of PTSD symptoms and BMI with AHI per SD increase (1.9 events per hour; 95% CI, 0.5-3.3 events per hour) were found. Conclusions and Relevance This cross-sectional study found an association between PTSD and sleep-disordered breathing. The findings have important public health implications and may also enhance understanding of the many factors that potentially affect OSA pathophysiology.
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Affiliation(s)
- Amit J. Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Atlanta Veterans Affairs Healthcare System, Decatur, Georgia
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center, Office of Research and Development, Department of Veterans Affairs, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle
| | - Minxuan Huang
- Department of Pediatrics, Stanford University, California
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Xin Ma
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Oleksiy M. Levantsevych
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Nicholas L. Smith
- Seattle Epidemiologic Research and Information Center, Office of Research and Development, Department of Veterans Affairs, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle
| | - Nikila Alagar
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Iman Mousselli
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Dayna A. Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - J. Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Donald L. Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
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Gao C, Scullin MK. Objective and Subjective Intraindividual Variability in Sleep: Predisposing Factors and Health Consequences. Psychosom Med 2024; 86:298-306. [PMID: 38439637 DOI: 10.1097/psy.0000000000001301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
OBJECTIVE We investigated the factors that predispose or precipitate greater intraindividual variability (IIV) in sleep. We further examined the potential consequences of IIV on overall sleep quality and health outcomes, including whether these relationships were found in both self-reported and actigraphy-measured sleep IIV. METHODS In Study 1, 699 US adults completed a Sleep Intra-Individual Variability Questionnaire and self-reported psychosocial, sleep quality, and health outcomes. In Study 2, 100 university students wore actigraphy and completed psychosocial, sleep, and health surveys at multiple timepoints. RESULTS In cross-sectional analyses that controlled for mean sleep duration, predisposing/precipitating factors to greater IIV were being an underrepresented racial/ethnic minority (Study 1: F = 13.95, p < .001; Study 2: F = 7.03, p = .009), having greater stress (Study 2: r values ≥ 0.32, p values ≤ .002) or trait vulnerability to stress (Study 1: r values ≥ 0.15, p values < .001), and showing poorer time management (Study 1: r values ≤ -0.12, p values ≤ .004; Study 2: r values ≤ -0.23, p values ≤ .028). In addition, both studies showed that greater sleep IIV was associated with decreased overall sleep quality, independent of mean sleep duration (Study 1: r values ≥ 0.20, p values < .001; Study 2: r values ≥ 0.33, p values ≤ .001). Concordance across subjective and objective IIV measures was modest ( r values = 0.09-0.35) and similar to concordance observed for subjective-objective mean sleep duration measures. CONCLUSION Risk for irregular sleep patterns is increased in specific demographic groups and may be precipitated by, or contribute to, higher stress and time management inefficiencies. Irregular sleep may lead to poor sleep quality and adverse health outcomes, independent of mean sleep duration, underscoring the importance of addressing sleep consistency.
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Affiliation(s)
- Chenlu Gao
- From the Department of Psychology and Neuroscience (Gao, Scullin), Baylor University, Waco, Texas; Department of Anesthesia, Critical Care and Pain Medicine (Gao), Massachusetts General Hospital; Division of Sleep and Circadian Disorders (Gao), Brigham and Women's Hospital; and Division of Sleep Medicine (Gao), Harvard Medical School, Boston, Massachusetts
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Dong X, Wang Y, Kang Y, Zhou X, Li J, Cao H, Li Y, Li Y, Yang P, Duan Y, Xie J. Protein-enriched and anti-inflammatory dietary patterns, healthy lifestyle index and depressive symptoms: A cross-sectional study of 287,945 adults in China. J Affect Disord 2024; 351:863-869. [PMID: 38342321 DOI: 10.1016/j.jad.2024.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 01/18/2024] [Accepted: 02/08/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVES Depressive symptoms have a considerable negative impact on mental health. This study aimed to understand the relationship between the protein-enriched and anti-inflammatory dietary index scores, modified healthy lifestyle index scores (Modified HLIS), and depressive symptoms. METHODS This study used convenience sampling to conduct a single-center cross-sectional survey. From January 1, 2015 to December 31, 2020, a total of 287,945 Chinese adults from a health management center of a general hospital completed an online self-reported health questionnaire, which included demographic characteristics, the Dietary Diversity Scale, the Modified Healthy Lifestyle Index Scores and the Patient Health Questionnaire-9. RESULTS The higher anti-inflammatory dietary index scores (POR = 0.87; 95 % CI: 0.86-0.87; p < 0.001), moderate modified healthy lifestyle index scores (POR = 0.76; 95 % CI: 0.75-0.78; p < 0.001) and sufficient modified healthy lifestyle index scores (POR = 0.53; 95 % CI: 0.52-0.54; p < 0.001) were negatively associated with depressive symptoms, while the higher protein-enriched dietary index scores (POR = 1.01; 95 % CI: 1.01-1.02; p < 0.001) was positively correlated with depressive symptoms. CONCLUSIONS This study demonstrated that protein-enriched and anti-inflammatory dietary index scores, and multiple healthy lifestyles are associated depressive symptoms in adults.
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Affiliation(s)
- Xiaoqian Dong
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha 410000, China; Xiangya Nursing School, Central South University, Changsha 410000, China.
| | - Yaqin Wang
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha 410000, China.
| | - Yue Kang
- Xiangya Nursing School, Central South University, Changsha 410000, China.
| | - Xing Zhou
- Xiangya Nursing School, Central South University, Changsha 410000, China
| | - Jing Li
- Xiangya Nursing School, Central South University, Changsha 410000, China
| | - Huan Cao
- Xiangya Nursing School, Central South University, Changsha 410000, China
| | - Yuxuan Li
- Xiangya Nursing School, Central South University, Changsha 410000, China.
| | - Ying Li
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha 410000, China.
| | - Pingting Yang
- Health Management Center, The Third Xiangya Hospital, Central South University, Changsha 410000, China
| | - Yinglong Duan
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha 410000, China.
| | - Jianfei Xie
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha 410000, China.
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8
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Zhang P, Huang N, Yang F, Yan W, Zhang B, Liu X, Peng K, Guo J. Determinants of depressive symptoms at individual, school and province levels: a national survey of 398,520 Chinese children and adolescents. Public Health 2024; 229:33-41. [PMID: 38394705 DOI: 10.1016/j.puhe.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 11/06/2023] [Accepted: 01/18/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES The aims of this study were to describe the national distribution of depressive symptoms in Chinese children and adolescents, to examine the determinants of depressive symptoms at individual, school and province levels and to assess the gender and age differences in the effect of school factors on depressive symptoms. STUDY DESIGN This was a national cross-sectional study. METHODS A school-based online survey was conducted in mainland China from between December 1, 2021, and January 1, 2022. A total of 398,520 eligible participants were included in the analysis. School-level data were drawn from students, headteachers and Baidu Maps, and province-level data were obtained from the national human development report. The Patient Health Questionnaire-2 was used to measure depressive symptoms. RESULTS Areas with the highest mean scores for depressive symptoms were in the northeastern, inner central and southwestern regions of China. At the individual level, younger age, male sex, being an only child, Han ethnicity, lower body mass index, more days of exercise, less drinking and smoking behaviours, higher subjective family socio-economic status (SES) and popularity in school were related to fewer depressive symptoms; however, objective family SES and maternal education were not related to fewer depressive symptoms. The school-level variables of public status, psychological activities and psychological courses and province-level variable of higher Human Development Index were associated with fewer depressive symptoms. The effect of psychological courses and activities on depressive symptoms was greater in females. CONCLUSIONS The results showed multilevel factors related to depressive symptoms and emphasised the importance of implementing school-based psychological activities to ameliorate depressive symptoms in Chinese children and adolescents across age and gender.
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Affiliation(s)
- P Zhang
- Department of Psychology, Tsinghua University, Beijing 100084, China
| | - N Huang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China
| | - F Yang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China
| | - W Yan
- Department of Psychology, Tsinghua University, Beijing 100084, China.
| | - B Zhang
- Department of Neurology, Boston Children's Hospital, Boston, MA 02215, United States
| | - X Liu
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China
| | - K Peng
- Department of Psychology, Tsinghua University, Beijing 100084, China
| | - J Guo
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing 100191, China.
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Zhang C, Zhu DM, Zhang Y, Chen T, Liu S, Chen J, Cai H, Zhu J, Yu Y. Neural substrates underlying REM sleep duration in patients with major depressive disorder: A longitudinal study combining multimodal MRI data. J Affect Disord 2024; 344:546-553. [PMID: 37848093 DOI: 10.1016/j.jad.2023.10.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/19/2023]
Abstract
INTRODUCTION Prior studies have discussed rapid eye movement (REM) sleep disturbance as a potential endophenotype of major depressive disorder (MDD). However, the neural substrates underlying the percentage of REM sleep duration (REM%) and its association with disease progression in MDD remain unclear. METHODS One hundred and fourteen MDD patients and 74 healthy controls (HCs) underwent resting-state functional and perfusion magnetic resonance imaging (MRI) scans as well as overnight polysomnography examination to assess brain function and REM%, with 48 patients completing follow-up visits. Correlation and mediation analyses were conducted to investigate the associations among baseline REM%, multimodal brain imaging measures, and the improvement of depressive symptoms at follow-up in MDD. RESULTS We found voxel-wise correlations between baseline REM% and multimodal brain imaging metrics in many brain regions involved in sensorimotor, visual processing, emotion, and cognition in patients with MDD. Moreover, the baseline REM% was correlated with the improvement of depressive symptoms from acute to remitted status in patients through regulating brain activity in the left inferior temporal gyrus and cerebral blood flow in the bilateral paracentral lobule. CONCLUSION Our findings help to identify the neural underpinnings of REM% in depression and highlight REM% as a potential prognostic biomarker to predict disease progression. These may inform future novel interventions of MDD from the perspective of regulating REM sleep.
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Affiliation(s)
- Cun Zhang
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China; Research Center of Clinical Medical Imaging, Anhui Province, Hefei 230032, China; Anhui Provincial Institute of Translational Medicine, Hefei 230032, China
| | - Dao-Min Zhu
- Department of Sleep Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei 230022, China; Hefei Fourth People's Hospital, Hefei 230022, China; Anhui Mental Health Center, Hefei 230022, China
| | - Yu Zhang
- Department of Sleep Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei 230022, China; Hefei Fourth People's Hospital, Hefei 230022, China; Anhui Mental Health Center, Hefei 230022, China
| | - Tao Chen
- Department of Sleep Disorders, Affiliated Psychological Hospital of Anhui Medical University, Hefei 230022, China; Hefei Fourth People's Hospital, Hefei 230022, China; Anhui Mental Health Center, Hefei 230022, China
| | - Siyu Liu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China; Research Center of Clinical Medical Imaging, Anhui Province, Hefei 230032, China; Anhui Provincial Institute of Translational Medicine, Hefei 230032, China
| | - Jingyao Chen
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China; Research Center of Clinical Medical Imaging, Anhui Province, Hefei 230032, China; Anhui Provincial Institute of Translational Medicine, Hefei 230032, China
| | - Huanhuan Cai
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China; Research Center of Clinical Medical Imaging, Anhui Province, Hefei 230032, China; Anhui Provincial Institute of Translational Medicine, Hefei 230032, China
| | - Jiajia Zhu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China; Research Center of Clinical Medical Imaging, Anhui Province, Hefei 230032, China; Anhui Provincial Institute of Translational Medicine, Hefei 230032, China.
| | - Yongqiang Yu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China; Research Center of Clinical Medical Imaging, Anhui Province, Hefei 230032, China; Anhui Provincial Institute of Translational Medicine, Hefei 230032, China.
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Fattal D, Platti N, Hester S, Wendt L. Vivid dreams are associated with a high percentage of REM sleep: a prospective study in veterans. J Clin Sleep Med 2023; 19:1661-1668. [PMID: 37128719 PMCID: PMC10476037 DOI: 10.5664/jcsm.10642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 05/03/2023]
Abstract
STUDY OBJECTIVES Vivid dreams are dreams that feel real or are associated with dream enactment behavior. They are prevalent in veterans, especially in those with psychiatric disorders such as post-traumatic stress disorders. Such psychiatric disorders have known association with abnormalities in rapid eye movement (REM) sleep. Vivid dreams are also described in neurological conditions, such Lewy body dementias, which are also associated with REM sleep abnormality. Although vivid dreams occur in neuropsychiatric disorders that have REM sleep abnormalities, there are no studies that have directly investigated an association between vivid dreams and REM sleep. We sought to study vivid dreams and REM sleep in veterans. METHODS Veterans undergoing polysomnography at our hospital were invited to enroll. Participants completed a dream-related questionnaire the morning after their polysomnography. RESULTS We prospectively enrolled 505 veterans. After a night in the sleep laboratory, 196 of 504 (39%) reported experiencing a dream, and, of those, 117 of 190 (62%) described their dream as vivid. Discrepancies in patient totals are secondary to missing questionnaire data. Our novel finding is that participants with a high percentage of REM sleep (above 25%) were more than twice likely to report a vivid dream than participants with a lower percentage of REM sleep (P < .0001). Nonvivid dreams were not associated with a high percentage of REM sleep. CONCLUSIONS Vivid dreams are associated with a high percentage of REM sleep. Further research into the role of REM sleep abnormalities in vivid dreams may help to advance understanding of neuropsychiatric disorders. CITATION Fattal D, Platti N, Hester S, Wendt L. Vivid dreams are associated with a high percentage of REM sleep: a prospective study in veterans. J Clin Sleep Med. 2023;19(9):1661-1668.
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Affiliation(s)
- Deema Fattal
- Neurology Department, University of Iowa, Iowa City, Iowa
- Iowa City VA Medical Center, Iowa City, Iowa
| | - Nicole Platti
- University of Iowa Carver College of Medicine, Iowa City, Iowa
| | | | - Linder Wendt
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa
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Wan Y, Lv M, Zhou K, Li Z, Du X, Wu W, Xue R. Mood Disorders are Correlated with Autonomic Nervous Function in Chronic Insomnia Patients with OSA. Nat Sci Sleep 2023; 15:511-522. [PMID: 37426309 PMCID: PMC10327906 DOI: 10.2147/nss.s396773] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/21/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose To evaluate the correlation between sleep microstructure, autonomic nervous system activity, and neuropsychological characteristics in chronic insomnia (CI) patients with obstructive sleep apnea (OSA). Patients and Methods Forty-five CI-OSA patients, forty-six CI patients and twenty-two matched healthy control subjects (HCs) were enrolled. CI-OSA patients were then divided into two groups: mild OSA and moderate-to-severe OSA. All participants completed neuropsychological tests, which included the Hamilton Depression and Anxiety Scales (HAMD and HAMA), the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), the Epworth Sleepiness Scale (ESS), and the Mini-mental State Examination (MMSE). The autonomic nervous system activity and sleep microstructure were examined by the PSM-100A. Results The CI-OSA patients exhibited higher scores on the PSQI, ESS, ISI, HAMA, and HAMD than HCs and CI patients (all p < 0.01). The CI-OSA patients had a lower proportion of stable sleep, REM sleep and a higher proportion of unstable sleep ratio (all p < 0.01) than HCs and CI patients (all p < 0.01). The CI-OSA patients had higher ratios of LF and LF/HF, and lower ratios of HF and Pnn50% (all p < 0.01) than HCs and CI patients (all p < 0.01). Compared to CI-mild OSA patients, the CI-moderate-to-severe OSA patients presented with a higher ESS scores, higher ratios of LF and LF/HF, and lower ratios of HF (all p < 0.05). In CI-OSA patients, higher HAMD scores were correlated with decreased MMSE scores (r=-0.678, p < 0.01). A higher LF ratio was correlated with higher HAMD and HAMA scores (r=0.321, p=0.031, r =0.449, p =0.002), and a higher HF ratio was correlated with lower HAMD and HAMA scores (r=-0.321, P =0.031, r =-0.449, p =0.002). Conclusion OSA exacerbates the abnormalities of sleep microstructure and the autonomic nervous dysfunction in CI patients. Dysfunction of the autonomic nervous system could contribute to mood deterioration in CI with OSA patients.
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Affiliation(s)
- Yahui Wan
- Departments of Neurology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, 300308, People’s Republic of China
| | - Mengdi Lv
- Departments of Neurology, Tianjin First Central Hospital, Tianjin, 300190, People’s Republic of China
| | - Kaili Zhou
- Departments of Neurology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, 300308, People’s Republic of China
| | - Zheng Li
- Departments of Neurology, Binhai Hospital, Peking University, Tianjin, 300450, People’s Republic of China
| | - Xueyun Du
- Departments of Neurology, Tianjin Medical University General Hospital Airport Hospital, Tianjin, 300308, People’s Republic of China
| | - Wei Wu
- Departments of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China
| | - Rong Xue
- Departments of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China
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Gao Y, Tang W, Mao D, Chen L, Ding X. Association between Nocturnal Sleep Duration and Insomnia symptoms with depressive symptoms among 44,900 Chinese Han adults aged 30-79 in Southwest China. BMC Psychiatry 2023; 23:127. [PMID: 36849922 PMCID: PMC9972728 DOI: 10.1186/s12888-023-04601-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 02/09/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Although there are several cross-sectional and prospective studies on the relationship between sleep duration /insomnia symptoms and depression symptoms, the results of these studies are still not conclusive, and few studies have further analyzed the association between sleep duration and depressive symptoms in adults by gender and age. Thus, this study aimed to investigate the relationship between nocturnal sleep duration and insomnia symptoms with depression symptoms, and further examine whether the association was impacted by age and gender in a large-scale Han Chinese population in southwest China. METHODS A cross-sectional study was performed that included 44,900 participants from 18 districts in southwest China from September 2018 to January 2019. The study comprised 42,242 individuals in the final analysis. Depressive symptoms were investigated using the PHQ-2 questionnaires. Multivariate logistic regression analysis was performed to investigate the relationship between nocturnal sleep duration and insomnia symptoms with depression symptoms as well as the influence of age and gender. RESULTS After adjusting for multiple variables, those with nocturnal sleep duration < 7 h had a higher odds ratio for depression (OR:1.47, 95%CI 1.31-1.65) compared to participants whose nocturnal sleep duration was in the range of 7-8 h. Notably, there is a higher association in those aged below 45 years (OR:1.91, 95%CI 1.52-2.41) and in female participants (OR:1.57, 95%CI 1.35-1.82). However, nocturnal sleep duration longer than 9 h was not associated with depression symptoms in either the whole population analysis or the subgroup analysis. Insomniacs had a higher odds ratio for depression(OR:1.87, 95%CI 1.84-2.36, respectively) compared to non-insomniacs. There is a higher association in those aged 45-60 years (OR:2.23, 95%CI 1.82-2.73) and in female participants (OR:2.17, 95%CI 1.84-2.56). Further subgroup analysis by age and gender at the same time showed the association between sleep deprivation and depression was highest among women aged below 45 years, while the association between insomnia and depression was the highest among men aged 45-59 years. CONCLUSION Short nocturnal sleep duration and insomnia symptoms were positively associated with the risk of depressive symptoms among Chinese Han adults aged 30-79 in Southwest China, especially the middle-aged population and females should be more concerned.
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Affiliation(s)
- Yang Gao
- Chongqing Center for Disease Control and Prevention, 400042, Chongqing, China
| | - Wenge Tang
- Chongqing Center for Disease Control and Prevention, 400042, Chongqing, China
| | - Deqiang Mao
- Chongqing Center for Disease Control and Prevention, 400042, Chongqing, China
| | - Liling Chen
- Chongqing Center for Disease Control and Prevention, 400042, Chongqing, China
| | - Xianbin Ding
- Chongqing Center for Disease Control and Prevention, 400042, Chongqing, China.
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Alday EAP, Poian GD, Levantsevych O, Murrah N, Shallenberger L, Alkhalaf M, Haffar A, Kaseer B, Yi-An K, Goldberg J, Smith N, Lampert R, Bremner JD, Clifford GD, Vaccarino V, Shah AJ. Association of Autonomic Activation with traumatic reminder challenges in posttraumatic stress disorder: A co-twin control study. Psychophysiology 2023; 60:e14167. [PMID: 35959570 PMCID: PMC10157622 DOI: 10.1111/psyp.14167] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/04/2022] [Accepted: 07/31/2022] [Indexed: 01/04/2023]
Abstract
Post-traumatic stress disorder (PTSD) has been associated with cardiovascular disease (CVD), but the mechanisms remain unclear. Autonomic dysfunction, associated with higher CVD risk, may be triggered by acute PTSD symptoms. We hypothesized that a laboratory-based trauma reminder challenge, which induces acute PTSD symptoms, provokes autonomic dysfunction in a cohort of veteran twins. We investigated PTSD-associated real-time physiologic changes with a simulation of traumatic experiences in which the twins listened to audio recordings of a one-minute neutral script followed by a one-minute trauma script. We examined two heart rate variability metrics: deceleration capacity (DC) and logarithmic low frequency (log-LF) power from beat-to-beat intervals extracted from ambulatory electrocardiograms. We assessed longitudinal PTSD status with a structured clinical interview and the severity with the PTSD Symptoms Scale. We used linear mixed-effects models to examine twin dyads and account for cardiovascular and behavioral risk factors. We examined 238 male Veteran twins (age 68 ± 3 years old, 4% black). PTSD status and acute PTSD symptom severity were not associated with DC or log-LF measured during the neutral session, but were significantly associated with lower DC and log-LF during the traumatic script listening session. Long-standing PTSD was associated with a 0.38 (95% confidence interval, -0.83,-0.08) and 0.79 (-1.30,-0.29) standardized unit lower DC and log-LF, respectively, compared to no history of PTSD. Traumatic reminders in patients with PTSD lead to real-time autonomic dysregulation and suggest a potential causal mechanism for increased CVD risk, based on the well-known relationships between autonomic dysfunction and CVD mortality.
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Affiliation(s)
- Erick A. Perez Alday
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Giulia Da Poian
- Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Oleksiy Levantsevych
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Nancy Murrah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lucy Shallenberger
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mhmtjamil Alkhalaf
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ammer Haffar
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Belal Kaseer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ko Yi-An
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center, United States Department of Veterans Affairs Office of Research and Development, Seattle, Washington, USA
| | - Nicholas Smith
- Seattle Epidemiologic Research and Information Center, United States Department of Veterans Affairs Office of Research and Development, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Rachel Lampert
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - J. Douglas Bremner
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Health Care System, Decatur, Georgia, USA
| | - Gari D. Clifford
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, Georgia, USA
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amit J. Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Health Care System, Decatur, Georgia, USA
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Alexithymia and depressive symptoms mediated the relationship between childhood trauma and suicidal risk in Chinese male prisoners. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03975-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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