The association of asthma and wheezing with major depressive episodes: an analysis of 245 727 women and men from 57 countries

Immunoregulatory role of hesperidin against ovalbumin (OVA)-induced bronchial asthma and depression in rats

Links between bronchial asthma and depression have recently become a great subject of interest. The present study was carried out to assess the protective role of hesperidin against ovalbumin (OVA)-induced bronchial asthma that is associated with depression in rats, for this purpose, four groups. Rats were sensitized with intraperitoneal administration of 200 μg OVA/10 mg aluminum hydroxide (Al (OH) 3 for 3 consecutive days then at day 11 followed by intranasal challenge with OVA (1.5 mg/kg) at days 19, 20, and 21. Rats were pretreated with hesperidin (100 & 200 mg/kg) 1h before OVA challenge. At the end of the study, behavioral tests, biochemical indices, and histopathological architectures of lung and brain tissues were evaluated. Our findings showed that hesperidin significantly ameliorated the reduction in motor activity, motor coordination, forced swimming, CD4, CD25 and foxp3, interleukin-10 (IL-10), dopamine, serotonin, and neurotrophin-3 (NT3) as well as alleviated the elevation in transforming growth factor-beta (TGF-β), tumor necrosis factor-alpha (TNF-α), iL-5, and immunoglobulin E (IgE). In addition, hesperidin reduced cellular infiltration, alveolar sacs damage, the bronchioles wall disruption, and nuclei pyknosis in neuron cells. Finally, hesperidin may provide protection against OVA-induced asthma and depression. This impact could be mediated in part by its anti-inflammatory and immunoregulatory properties.

Estimating the joint association of adverse childhood experiences and asthma with subsequent depressive symptoms: a marginal structural modelling approach

BACKGROUND

The relationship between adverse childhood experiences (ACEs) and depression risk has been well documented. However, it remains unclear whether stress-related chronic conditions associated with ACEs, such as asthma, increase the long-term mental health burden of ACEs.

OBJECTIVE

To investigate the joint association of ACEs and asthma with subsequent depressive symptoms among US adults.

METHODS

This study used data from the Behavioural Risk Factor Surveillance System 2010, including 21 544 participants over 18 years old from four states where participants were questioned about ACEs. We used logistic regression models to calculate the adjusted OR (aOR) for elevated depressive symptoms evaluated by Patient Health Questionnaire-8 according to ACEs and asthma, along with marginal structural models (MSM) to consider ACE-related confounders between asthma and depression. We evaluated the additive interaction between ACEs and asthma on depressive symptoms with the relative excess risk due to interaction (RERI).

FINDINGS

Of the 21 544 participants (mean age: 56, women: 59.5%), 52.3% reported ≥1 ACEs, 14.9% reported a history of asthma and 4.0% had depressive symptoms. ACEs and asthma were independently associated with elevated depressive symptoms (aORs (95% CI) were 2.85 (2.30 to 3.55) and 2.24 (1.50 to 3.27), respectively). Furthermore, our MSM revealed an additive interaction between ACEs and asthma for depressive symptoms (RERI (95% CI)=+1.63 (0.54 to 2.71)).

CONCLUSIONS

These findings suggest that asthma amplifies the risk of depressive symptoms associated with ACEs.

CLINICAL IMPLICATIONS

Prevention and treatment of asthma, along with establishing preventive environments and services against ACEs, are effective in mitigating the potential burden of ACEs on mental health.

The influence of asthma on neuroinflammation and neurodevelopment: From epidemiology to basic models

Asthma is a highly heterogeneous inflammatory disease that can have a significant effect on both the respiratory system and central nervous system. Population based studies and animal models have found asthma to be comorbid with a number of neurological conditions, including depression, anxiety, and neurodevelopmental disorders. In addition, maternal asthma during pregnancy has been associated with neurodevelopmental disorders in the offspring, such as autism spectrum disorders and attention deficit hyperactivity disorder. In this article, we review the most current epidemiological studies of asthma that identify links to neurological conditions, both as it relates to individuals that suffer from asthma and the impacts asthma during pregnancy may have on offspring neurodevelopment. We also discuss the relevant animal models investigating these links, address the gaps in knowledge, and explore the potential future directions in this field.

Association between dimensions of trauma-related psychopathology and asthma in trauma-exposed women

Introduction

Exposure to traumatic events and stressful life experiences are associated with a wide range of adverse mental and physical health outcomes. Studies have found post-traumatic stress disorder (PTSD), depression, and anxiety sensitivity occurrence to be common in addition to inflammatory diseases like asthma, especially in women. Moreover, overlapping neurobiological mechanisms have been linked to both PTSD and asthma.

Methods

In the current study, n = 508 women reported on presence of lifetime asthma diagnosis and symptoms of trauma-related psychopathology including PTSD and depression. A separate group of female participants (n = 64) reported on asthma, PTSD, depression and anxiety sensitivity, and underwent functional MRI scans during a fearful faces task, and their anterior insula responses were analyzed.

Results

Overall, PTSD and depression severity were significantly higher in those with asthma versus those without asthma. There was a positive association between anterior insula response to social threat cues and depression symptoms only among individuals without a lifetime presence of asthma.

Discussion

These findings provide continued evidence on the interactions between stress, neural mechanisms involved in interoception and salience detection, and trauma-related psychopathology.

Bidirectional Associations Between Asthma and Types of Mental Disorders

BACKGROUND

Asthma and mental disorders frequently co-occur. Studies of their comorbidity have generally focused on associations related to a subset of mental disorders.

OBJECTIVE

To estimate bidirectional associations between asthma and 10 broad types of mental disorders.

METHODS

In a population-based cohort study, including all individuals born in Denmark between 1955 and 2011 (N = 5,053,471), we considered diagnoses of comorbid mental disorders among those with asthma, and vice versa, between 2000 and 2016. We used Cox regression models to calculate overall and time-dependent hazard ratios for mental disorder-asthma pairs and competing-risks survival analyses to estimate absolute risks.

RESULTS

Altogether, 376,756 individuals were identified as having an incident mental disorder and 364,063 incident asthma during follow-up. An increased risk was seen for all bidirectional mental disorder-asthma pairs. Following an asthma diagnosis, adjusted hazard ratios for different subsequent mental disorders ranged from 1.75 (95% CI, 1.64-1.87) for organic disorders to 2.75 (95% CI, 2.69-2.81) for personality disorders. Following a prior mental disorder diagnosis, hazard ratios for asthma ranged from 1.06 (95% CI, 1.00-1.12) for developmental disorders to 2.33 (95% CI, 2.28-2.39) for substance use disorders. Risks varied with time since prior disorder diagnosis but remained elevated. Cumulative incidence of (1) asthma after a mental disorder and (2) a mental disorder after asthma was higher in those with prior disorders than in matched reference groups.

CONCLUSIONS

Our findings provide evidence of bidirectional associations between asthma and each of the mental disorder types, suggesting possible shared etiological factors or pathophysiologic processes.

Association between physical activity and comorbid anxiety/depression in 46 low- and middle-income countries

BACKGROUND

Evidence on the association of low physical activity (PA) with depression or anxiety is well established. Yet, evidence on the association between PA and comorbid anxiety/depression remains scarce, especially in low- and middle-income countries (LMICs). Thus, this study explored this relationship among adults aged ≥18 years from 46 LMICs.

METHODS

Cross-sectional, community-based data were analyzed from the World Health Survey (WHS). Multivariable multinomial logistic regression analysis was conducted to examine the association between low PA and comorbid anxiety/depression with no anxiety or depression as the base category.

RESULTS

237,023 participants [mean (SD) age = 38.4 (16.0) years; 50.8 % female] were included in the analysis. Low PA was significantly associated with depression alone (OR = 1.33; 95%CI = 1.12-1.57) and anxiety alone (OR = 1.37; 95%CI = 1.23-1.53), while the OR was highest among those with comorbid anxiety/depression (OR = 1.75; 95%CI = 1.52-2.01).

CONCLUSION

Low PA is associated with particularly increased odds for comorbid anxiety/depression. Increasing PA may have a beneficial effect on the prevention of comorbid anxiety/depression. However, future longitudinal research establishing the direction of this relationship is warranted.

Multimorbidity, depression with anxiety symptoms, and decrements in health in 47 low- and middle-income countries

BACKGROUND

Comorbid depression and anxiety is associated with worse health outcomes compared to depression or anxiety occurring in isolation, but there is little data on its association with multimorbidity. Thus, we investigated this association across 47 low- and middle-income countries, and further explored whether having anxiety symptoms in addition to depression is associated with significant declines in health outcomes among those with multimorbidity.

METHODS

Cross-sectional, predominantly nationally representative, community-based data were analyzed from the World Health Survey. DSM-IV depression was assessed with the Composite International Diagnostic Interview. Anxiety symptoms referred to severe/extreme problems with worry or anxiety. Ten chronic conditions and health status across five domains (cognition, interpersonal activities, sleep/energy, self-care, pain/discomfort) were assessed. Multivariable regression analyses conducted.

RESULTS

Data included 237,952 adults aged ≥18 years [mean age (SD) 38.4 (16.0); 50.8 % females]. Compared to no chronic conditions, 2 (OR = 6.86; 95%CI = 5.59-8.42), 3 (OR = 12.33; 95%CI = 9.72-15.63), and ≥4 (OR = 26.55; 95%CI = 20.21-35.17) chronic conditions were associated with significantly higher odds for comorbid depression/anxiety symptoms (vs. no depression or anxiety symptoms) in the multinomial logistic regression model. Among those with depression and multimorbidity, anxiety symptoms were associated with significantly worse health status across all domains.

LIMITATIONS

Cross-sectional design, depression and anxiety symptoms were not based on a clinical assessment.

CONCLUSIONS

Comorbid depression/anxiety is common in people with multimorbidity, and anxiety symptoms in people with depression and multimorbidity signify worse health status. Future studies should assess the utility of screening for and treating comorbid depression/anxiety in patients with multimorbidity in terms of clinical outcomes.

Bi-directional associations between depressive symptoms and asthma in middle-aged and elderly adults in China

BACKGROUND

There is currently no evidence of an association between depressive symptoms and asthma among older adults in China. We explored the bi-directional associations between depressive symptoms and asthma, and their changes in middle-aged and elderly adults from a national cohort.

METHODS

A longitudinal cohort study was conducted with a total of 17,708 individuals from 150 urban communities and 450 rural villages in 28 provinces in China.

RESULTS

After making exclusions, 11,492 and 8604 participants were included for incident asthma and incident depressive symptoms analysis, respectively. The incidence density was 4.46 and 10.24 for every 1000 person-years, respectively. Baseline depressive symptoms were associated with a higher risk of incident asthma (Hazard ratio [HR] = 1.60, 95 % confidence interval [CI]: 1.27, 2.02). Decreased depressive symptoms during baseline or follow-ups or both baseline and follow-ups were associated with a lower risk of incident asthma (P_{for trend} < 0.0001). Every 1-score increment of CES-D score was associated with a 4 % increase in asthma, with a non-linear association (P = 0.04) between CES-D score (break point = 7) and asthma. Asthma status increased the risk of participants with severe depressive symptoms (HR = 1.51, 95 % CI: 1.19, 1.92), especially in males (P_{for interaction} = 0.02).

LIMITATIONS

Depressive symptoms and asthma were assessed by validated questionnaires instead of clinical diagnosis.

CONCLUSIONS

Bi-directional associations between asthma and depressive symptoms do exist. Effective measures should be taken to reduce depressive symptoms and the risk of incident asthma in middle aged and elderly adults in China.

Physical activity and visual difficulties in 36 low- and middle-income countries

BACKGROUND

Data on the association between visual difficulty and physical activity (PA) from low- and middle-income countries (LMICs) are scarce. Thus, the aim of the study was to investigate the association between visual difficulty and PA among adults from 36 LMICs, and to assess the mediators in this association.

METHODS

Cross-sectional, community-based, predominantly nationally representative data from the World Health Survey were analysed. The final sample included 199,110 individuals aged ≥18 years [mean (SD) age 38.6 (16.1) years; 49.4% males]. Visual difficulty referred to having severe/extreme difficulties in seeing and recognizing a person that the participant knows across the road. Low PA was defined as not complying with PA recommendations of 150 min of moderate-vigorous PA per week. Multivariable logistic regression, meta-analysis, and mediation analysis were conducted to assess associations.

RESULTS

Meta-analysis based on country-wise multivariable logistic regression analysis showed that overall, visual difficulty is associated with a 1.53 (95% CI = 1.38-1.71) times higher odds for low PA. Particularly strong associations were observed in males (OR = 1.72; 95% CI = 1.45-2.05) and adults aged ≥65 years (OR = 1.95; 95% CI = 1.67-2.29). Interpersonal activities, cognition, and sleep/energy explained >10% of the association between visual difficulty and low PA.

CONCLUSIONS

In conclusion, we found evidence that especially in the case of males and older adults with visual difficulties in LMICs, there were low levels of engagement with PA. Addressing issues such as interpersonal activities, cognition, and sleep/energy in people with visual difficulties may increase levels of PA.

Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries

Tuberculosis (TB) is a leading cause of mortality in low- and middle-income countries (LMICs). TB multimorbidity [TB and ≥1 non-communicable diseases (NCDs)] is common, but studies are sparse. Cross-sectional, community-based data including adults from 21 low-income countries and 27 middle-income countries were utilized from the World Health Survey. Associations between 9 NCDs and TB were assessed with multivariable logistic regression analysis. Years lived with disability (YLDs) were calculated using disability weights provided by the 2017 Global Burden of Disease Study. Eight out of 9 NCDs (all except visual impairment) were associated with TB (odds ratio (OR) ranging from 1.38-4.0). Prevalence of self-reported TB increased linearly with increasing numbers of NCDs. Compared to those with no NCDs, those who had 1, 2, 3, 4, and ≥5 NCDs had 2.61 (95% confidence interval (CI) = 2.14-3.22), 4.71 (95%CI = 3.67-6.11), 6.96 (95%CI = 4.95-9.87), 10.59 (95%CI = 7.10-15.80), and 19.89 (95%CI = 11.13-35.52) times higher odds for TB. Among those with TB, the most prevalent combinations of NCDs were angina and depression, followed by angina and arthritis. For people with TB, the YLDs were three times higher than in people without multimorbidity or TB, and a third of the YLDs were attributable to NCDs. Urgent research to understand, prevent and manage NCDs in people with TB in LMICs is needed.

Evaluation of changing trend in depression, suicidal ideation, and suicide attempts among adolescents with asthma and identification of associated factors: 11-year national data analysis in 788,411 participants

OBJECTIVES

We identified associated factors for depression and suicidality in adolescents with asthma.

METHODS

We obtained data from the annual Korea Youth Risk Behavior Web-based Surveys, completed from 2007 to 2017, as a stratified, multistage, clustered sample. Using self-reported questionnaires, students provided yes-or-no answers to questions addressing doctor-diagnosed asthma and self-experienced depression and suicidality. Associated factors for depression and suicidality were tested by logistic regression models after controlling for potential confounding factors. A total of 788,411 adolescents completed the survey.

RESULTS

The prevalence of asthma was similar every year during the survey with 8.9% overall rate. Among them, the prevalence of depression (45.8-29.9%), suicidal ideation (28.6-15.5%), and suicide attempts (9.3-3.9%) decreased. Participants with asthma perceived themselves as unhealthier and unhappier, had more stress, sleep dissatisfaction, depression, suicidal ideation and suicide attempts than did subjects without asthma. In the multivariate model, perception of stress was most strongly associated with depression (adjusted Odds ratio: 4.78, 95% confidence intervals; 4.17-5.06) and suicide attempts (2.51; 1.67-2.93), whereas, perceived unhappiness was most strongly associated with suicidal ideation (4.81; 3.87-5.46) among adolescents with asthma. Asthma itself was also associated with depression, suicidal ideation and suicide attempts (1.12; 1.09-1.22, 1.18; 1.07-1.24, and 1.15; 1.04-1.19, respectively).

CONCLUSION

Although the prevalence of asthma was similar every year, the prevalence of depression and suicidality among adolescents with asthma decreased. Nevertheless, clinical physicians should pay more attention to screen for depression and suicidality among adolescents with asthma, especially having associated factors.

Perceived stress and depression in 45 low- and middle-income countries

BACKGROUND

There is limited research examining the association between perceived stress and depression using large population-based datasets, particularly from low- and middle-income countries (LMICs). Thus, the aim of the study was to assess the association between perceived stress and depression in 45 LMICs.

METHODS

We analyzed cross-sectional, predominantly nationally representative data from the World Health Survey. A perceived stress score [range 2 (lowest stress) -10 (highest stress)] was computed based on two questions from the Perceived Stress Scale. DSM-IV depression was based on past 12-month symptoms. Multivariable logistic regression analysis (adjusting for sex and age) and meta-analysis were used to examine the associations.

RESULTS

Data on 232,243 adults aged ≥18 years were analyzed. The overall mean (SD) perceived stress score was 4.8 (2.2), while the prevalence of depression was 6.2% (95%CI=5.9%-6.5%). Overall, there was a linear increase in the prevalence of depression with increasing perceived stress scores [i.e., score 2 (1.9%) to score 10 (22.0%)]. Country-wise analysis showed that higher perceived stress levels were significantly associated with increased odds for depression in all countries with the exception of Georgia and Vietnam. The results of the meta-analysis showed that a one-unit increase in the perceived stress score was associated with a 1.40 (95%CI=1.35-1.44) times higher odds for depression.

LIMITATIONS

The cross-sectional nature of the study limits interpretations about causation.

CONCLUSION

Perceived stress is positively associated with depression across the globe. Future longitudinal and intervention studies from LMICs are warranted to elucidate the potential impact of addressing stress on depression in this setting.

Informal caregiving and physical activity among 204,315 adults in 38 low- and middle-income countries: A cross-sectional study

Data on the association between informal caregiving and physical activity (PA) levels are scarce, especially from low- and middle-income countries (LMICs). Furthermore, previous research has yielded conflicting results. Thus, we investigated this association in adults from 38 LMICs. Data from the World Health Survey (WHS), a cross-sectional, predominantly nationally representative survey conducted in 2002-2004, were analyzed. PA was assessed by the International Physical Activity Questionnaire and participants were dichotomized into those who do (≥150 min of moderate-to-vigorous PA per week) and do not (<150 min = low PA) comply with the World Health Organization PA recommendations. Those who provided help to a relative or friend (adult or child), because this person has a long-term physical or mental illness or disability, or is getting old and weak in the past year were considered to be informal caregivers. Multivariable logistic regression analysis was conducted to assess the associations. There were 204,315 adults aged ≥18 years from 38 LMICs included in this study [mean (standard deviation) age 38.6 (16.1) years; 50.7% female]. Overall, the prevalence of caregiving and low PA was 19.5% and 29.9%, respectively. After adjustment for potential confounders, caregivers were at a lower risk for low PA compared to non-caregivers (OR = 0.79; 95% CI = 0.72-0.86). Engagement in greater number of caregiving activities was associated with lower odds for low PA dose-dependently. Informal caregiving was associated with higher levels of PA in adults in LMICs. Future studies of longitudinal design are warranted to understand causality and the underlying mechanisms of this association.

General practitioner visits and physical activity with asthma-the role of job decision authority: a cross-sectional study

PURPOSE

Psychosocial working conditions-in terms of job decision authority, among others-may influence asthma self-management at work and in leisure time, as recent qualitative research has shown. We sought to statistically investigate potential relationships between job decision authority and two types of self-management behaviours: physical activity (PA) and visits to the general practitioner (GP).

METHODS

We combined data from waves 1 and 2 of the Survey of Health, Ageing and Retirement in Europe (SHARE) for cross-sectional analyses. The sample was restricted to participants who were employed and reported asthma but no other chronic lung disease (n = 387). The three key variables were each measured by one item. We estimated the prevalence ratios of adequate PA (i.e., more than once a week) and regular GP visits (i.e., ≥ 4 per year) according to job decision authority (low vs. high) using Poisson regression with the robust variance.

RESULTS

We found no evidence of a relationship between job decision authority and PA. However, employees with low levels of job decision authority had a higher prevalence of reporting that they consulted their GP at least four times per year (prevalence ratio = 1.30; 95% confidence interval = 1.03-1.65).

CONCLUSIONS

This study was the first to quantitatively investigate the relationship between job decision authority and PA specifically among individuals with asthma. Our results contradict prior epidemiological studies among general working populations, which reported a positive relationship between job decision authority and PA. Our results concerning the association between low job decision authority and more GP visits are inconsistent with our qualitative findings but supported by epidemiological studies among general occupational samples.

Asthma and affective traits in adults: a genetically informative study

Depression, anxiety and high neuroticism (affective traits) are often comorbid with asthma. A causal direction between the affective traits and asthma is difficult to determine; however, there may be a common underlying pathway attributable to shared genetic factors. Our aim was to determine whether a common genetic susceptibility exists for asthma and each of the affective traits.An adult cohort from the Swedish Twin Registry underwent questionnaire-based health assessments (n=23 693) and genotyping (n=15 908). Firstly, questionnaire-based associations between asthma and affective traits were explored. This was followed by genetic analyses: 1) polygenic risk scores (PRS) for affective traits were used as predictors of asthma in the cohort, and 2) genome-wide association results from UK Biobank were used in linkage-disequilibrium score regression (LDSC) to quantify genetic correlations between asthma and affective traits. Analyses found associations between questionnaire-based asthma and affective traits (OR 1.67, 95% CI 1.50-1.86 major depression; OR 1.45, 95% CI 1.30-1.61 anxiety; and OR 1.60, 95% CI 1.40-1.82 high neuroticism). Genetic susceptibility for neuroticism explained the variance in asthma with a dose-response effect; that is, study participants in the highest neuroticism PRS quartile were more likely to have asthma than those in the lowest quartile (OR 1.37, 95% CI 1.17-1.61). Genetic correlations were found between depression and asthma (r_g=0.17), but not for anxiety or neuroticism.We conclude that the observed comorbidity between asthma and the affective traits may in part be due to shared genetic influences between asthma and depression (LDSC) and neuroticism (PRS), but not anxiety.

Injury and depression among 212 039 individuals in 40 low- and middle-income countries

AIMS

Although injuries have been linked to worse mental health, little is known about this association among the general population in low- and middle-income countries (LAMICs). This study examined the association between injuries and depression in 40 LAMICs that participated in the World Health Survey.

METHODS

Cross-sectional information was obtained from 212 039 community-based adults on the past 12-month experience of road traffic and other (non-traffic) injuries and depression, which was assessed using questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview. Multivariable logistic regression analysis and meta-analysis were used to examine associations.

RESULTS

The overall prevalence (95% CI) of past 12-month traffic injury, other injury, and depression was 2.8% (2.6-3.0%), 4.8% (4.6-5.0%) and 7.4% (7.1-7.8%), respectively. The prevalence of traffic injuries [range 0.1% (Ethiopia) to 5.1% (Bangladesh)], and other (non-traffic) injuries [range 0.9% (Myanmar) to 12.1% (Kenya)] varied widely across countries. After adjusting for demographic variables, alcohol consumption and smoking, the pooled OR (95%CI) for depression among individuals experiencing traffic injury based on a meta-analysis was 1.72 (1.48-1.99), and 2.04 (1.85-2.24) for those with other injuries. There was little between-country heterogeneity in the association between either form of injury and depression, although for traffic injuries, significant heterogeneity was observed between groups by country-income level (p = 0.043) where the pooled association was strongest in upper middle-income countries (OR = 2.37) and weakest in low-income countries (OR = 1.46).

CONCLUSIONS

Alerting health care providers in LAMICs to the increased risk of worse mental health among injury survivors and establishing effective trauma treatment systems to reduce the detrimental effects of injury should now be prioritised.

The relationship between asthma and depression in a community-based sample

OBJECTIVE

Asthma is an increasingly prevalent disease that is associated with substantial physical and financial burdens. Additionally, asthma is linked to psychiatric disorders. This study examines the relationship between asthma diagnosis, current depressive symptoms, and lifetime psychiatric disorder history in a large, community-based sample.

METHODS

We analyzed data from 2168 participants in the Dallas Heart Study, a large, diverse, community-based sample of people designed to be representative of the Dallas County population. Logistic regressions analyzing the relationship between asthma diagnosis and history of a psychiatric disorder, as well as between asthma diagnosis and the Quick Inventory of Depressive Symptomatology (QIDS) scores were performed, controlling for demographic data.

RESULTS

13.4% of the sample had an asthma diagnosis. Asthma diagnosis was significantly associated with a history of nervous, emotional, or mental health disorder diagnosis [OR 1.810 (95% CI 1.280-2.559) p = 0.001], and with QIDS scores consistent with moderate or greater current depressive symptom severity [OR 1.586 (95%CI 1.106-2.274) p = 0.012]. The relationships were not moderated by age, gender, race, smoking status, or Body Mass Index.

CONCLUSIONS

A diagnosis of asthma may be associated with current clinically significant levels of depressive symptoms and a lifetime psychiatric disorder. The current report adds to the existing literature in this area by assessing both current and lifetime symptoms and by using a large and diverse population. The findings highlight the clinical importance of considering the possibility of psychiatric illness in asthma patients and suggest further research in this area is needed.

Risk of Postpartum Depression Among Women with Asthma

BACKGROUND

Several epidemiological studies have suggested that the risk of depression is increased in patients with asthma, but the impact of asthma during pregnancy on postpartum depression remains unknown.

OBJECTIVE

To assess the association between maternal asthma and postpartum depression in a population-based cohort study retrieved from administrative databases.

METHODS

A cohort of 35,520 pregnancies in women with asthma during pregnancy and 197,057 pregnancies in women without asthma who delivered between 1998 and 2009 was extracted from the Quebec Asthma and Pregnancy Database. They were followed from the day of delivery up to 1 year postpartum. A generalized estimating equation model was used to estimate the adjusted odds ratios of postpartum depression with 95% CIs in women with asthma during pregnancy versus women without asthma.

RESULTS

Postpartum depression within 1 year after delivery occurred in 6.1% of women with asthma versus 2.9% of women without asthma. After adjusting for several potential confounders, including depression/postpartum depression up to 10 years before pregnancy, we found that women with asthma were 58% more likely to experience postpartum depression within 1 year after delivery than women without asthma during pregnancy (adjusted odds ratio, 1.58; 95% CI, 1.50-1.67).

CONCLUSIONS

Our findings suggest that women with asthma are more likely to suffer from postpartum depression. A close monitoring of signs of depression for pregnant women with asthma is indicated, allowing prompt and efficient interventions if needed.

What are the perceived influences on asthma self-management at the workplace? A qualitative study

OBJECTIVES

Asthma can represent a substantial challenge to the affected individual, but is usually well controlled by adequate asthma self-management behaviour (SMB). Asthma SMB comprises symptom prevention, symptom monitoring, acute symptom management and communication with important others. The implementation of asthma SMB seems to depend on contextual factors. For employed adults, working conditions may be important in this respect. We, therefore, aimed to explore the perceived influences on effective asthma SMB at work.

DESIGN

Our qualitative study built on semi-structured interviews and qualitative content analysis.

SETTING

Participants were recruited in two pulmonary rehabilitation clinics in Northern Germany.

PARTICIPANTS

We conducted 27 interviews among employees with asthma (female: n=15) who worked at least 20 hours per week and were diagnosed with asthma at least 6 months prior to interviewing. Patients with chronic obstructive pulmonary disease were excluded.

RESULTS

According to participants, the most influential factors with regard to asthma SMB at work appeared to be job decision latitude (JDL) and social support. JDL (ie, the control over one's tasks and when and how things were done) was perceived to affect symptom prevention, symptom monitoring, and acute symptom management, but not communication. Support by colleagues, line managers, and the employer, for example, practical, emotional, or structural support, was perceived to exert effects on symptom prevention, acute symptom management, and communication (ie, self-disclosure of one's condition).

CONCLUSIONS

Perceived JDL and social support were experienced as influencing successful implementation of asthma SMB at the workplace.

TRIAL REGISTRATION NUMBER

German Clinical Trials Register no: DRKS00011309.

Epidemiology of Depression and Associated Factors among Asthma Patients in Addis Ababa, Ethiopia

BACKGROUND

Depression in asthma patients can cause worsening of respiratory symptoms. Addressing mental illness in those with asthma improves asthma outcomes. This study aimed to assess the epidemiology of depression and associated factors among asthma patients attending government hospitals in Ethiopia.

METHODS

Institutional based cross-sectional study was conducted on patients with asthma at three governmental hospitals of Addis Ababa from June to July 2017. Patient health questionnaire (PHQ-9) depression scale was used to assess prevalence of depression among asthmatic patients. The data were entered and analyzed using SPSS version 20 statistical software. Binary logistic regression analysis was conducted to identify associated factors for depression. To indicate the strength of association, odds ratios (OR) and 95% confidence intervals (95% CI) were used.

RESULT

A total of 405 participants were enrolled in the study giving an overall response rate of 96%. The respondents had mean age of 54.46 and standard deviation (SD) of 10.01 years. About 273 (67.4%) were females. The prevalence of depression among asthma patients was 85 (21%). The odds of developing depression among single asthma patients were increased by 1.63 with 95% CI [1. 8, 3.493]. Depression among asthma patients who had comorbid cardiac illness was 6.2 times higher than those who do not have at CI [1.145, 24.109]. The prevalence of depression among uncontrolled asthma patients was 8 times higher than those with well-controlled asthma at CI [1.114, 19.025].

CONCLUSION

One-fifth of asthmatic patients were experiencing depression. Uncontrolled asthma, comorbid cardiac illness, and single patients were important predictors of depression among asthmatic patients. Proper control of asthmatic attack and cardiac illnesses is very important to reduce the burden of depression.

Fluoxetine protects against OVA induced bronchial asthma and depression in rats

Depression is very common in asthmatic patients and may increases risk for morbidity and mortality. The present work aimed to investigate the protective effect of fluoxetine, on behavioral and biochemical changes, associated with ovalbumin (OVA) - induced bronchial asthma and depression in rats. Rats were sensitized with intraperitoneal administration of OVA plus aluminum hydroxide for 3 consecutive days then at day 11 followed by OVA intranasal challenge at days 19, 20, 21. Rats were either pretreated with dexamethasone, fluoxetine10mg/kg or fluoxetine 20 mg/kg. At the end of the experiment, various tests were performed, including open field, forced swimming and respiratory function tests. Blood was drawn for serum IgE detection. Finally, rats were euthanized, brain-derived neurotrophic factor (BDNF) was estimated in bronchoalveolar lavage (BAL) fluid and lung content of reduced glutathione (GSH), superoxide dismutase (SOD), tumor necrosis factor-alpha (TNF-α) and interleukin 4 (IL-4) were determined. Histopathological study was also performed. The results showed that fluoxetine significantly ameliorated OVA- induced biochemical and behavioral changes. Fluoxetine may protect against OVA-induced asthma and depression in rats. This effect may be mediated at least in part by its antioxidant, anti-inflammatory and immunosuppressant effect.

Criminal victimization and psychotic experiences: cross-sectional associations in 35 low- and middle-income countries

OBJECTIVE

Criminal victimization has been associated with elevated risk for psychotic symptoms in the United Kingdom, but has not been studied in low- and middle-income countries (LMICs). Understanding whether crime exposure may play a role in the social etiology of psychosis could help guide prevention and intervention efforts.

METHOD

We tested the hypothesis that criminal victimization would be associated with elevated odds of psychotic experiences in 35 LMICs (N = 146 999) using cross-sectional data from the World Health Organization World Health Survey. Multivariable logistic regression analyses were used to test for associations between criminal victimization and psychotic experiences.

RESULTS

Victimization was associated with greater odds of psychotic experiences, OR (95% CI) = 1.72 (1.50-1.98), and was significantly more strongly associated with psychotic experiences in non-urban, OR (95% CI) = 1.93 (1.60-2.33), compared to urban settings, OR (95% CI) = 1.48 (1.21-1.81). The association between victimization and psychosis did not change across countries with varying aggregated levels of criminal victimization.

CONCLUSIONS

In the largest ever study of victimization and psychosis, the association between criminal victimization and psychosis appears to generalize across a range of LMICs and, therefore, across nations with a broad range of crime rates, degree of urban development, average per capita income, and racial/ethnic make-up.

Allergic disorders and risk of depression: A systematic review and meta-analysis of 51 large-scale studies

BACKGROUND

Previous studies have suggested that allergic disorders are associated with an increased risk of depression. However, the results are conflicting.

OBJECTIVE

To determine the association between allergic disorders and depression based on large-scale studies.

METHODS

We reviewed relevant articles obtained from PubMed and Embase. Studies were eligible if they reported an association between allergic disorders and depression and provided available data. Study selection, data extraction, and analyses were undertaken. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated.

RESULTS

Of 1,827 studies identified, 51 including more than 2.5 million participants met our inclusion criteria. Overall, the results showed that allergic disorders were associated with a significant increased risk of depression (pooled RR 1.59, 95% CI 1.48-1.71). A higher risk of depression also was observed in patients with asthma (RR 1.59, 95% CI 1.46-1.74) and those with allergic rhinitis (RR 1.57, 95% CI 1.27-1.93). Subgroup analyses were conducted based on sex and age. Children (RR 1.66, 95% CI 1.41-1.96) and adults (RR 1.58, 95% CI 1.44-1.74) with allergic disorders had a higher risk of depression than controls. However, no significant association was found between allergic disorders and risk of depression in male subjects (RR 1.37, 95% CI 0.98-1.91), but a positive association was detected in female subjects (RR 1.65, 95% CI 1.44-1.89).

CONCLUSION

The results from our study showed that allergic disorders significantly increased the risk of depression.

Physical activity correlates among people with psychosis: Data from 47 low- and middle-income countries

BACKGROUND

People with schizophrenia engage in low levels of physical activity (PA). However, few large-scale studies have investigated the factors that may influence PA participation in individuals with psychosis and data from low- and middle-income countries (LMICs) is especially scarce. Thus, we investigated PA correlates in a large sample of people with a psychosis diagnosis across 47 LMICs.

METHODS

Cross-sectional data from the World Health Survey, restricting to those with a self-reported lifetime diagnosis of schizophrenia/psychotic disorder, was analyzed. PA was assessed by the International Physical Activity Questionnaire (IPAQ) and participants were dichotomized into those that do and do not (low PA) meet the minimum recommended PA weekly targets (≥150min). A range of socio-demographic, health behavior, and mental and physical health variables were examined using random effects logistic regression.

RESULTS

Overall 2407 people (mean 42.0years, 41.5% males) with schizophrenia/psychosis were included. The prevalence of low PA was 39.2% (95%CI=37.0%-41.2%). Male sex (odds ratio (OR)=1.33), increasing age, unemployment (vs. employed OR=2.50), urban setting (vs. rural OR=1.75), inadequate fruit consumption (vs. adequate fruit intake OR=3.03), depression (OR=1.33), sleep/energy disturbance, and mobility limitations were significantly associated with low PA. Marital status, education, wealth, smoking, vegetable and alcohol consumption, anxiety, cognition, pain, and chronic medical conditions were not significant correlates.

CONCLUSION

PA is influenced by a range of factors among people with psychosis. These correlates should be considered in interventions aiming to facilitate PA in psychotic individuals living in LMICs.

The association of self-reported diabetes with impaired social functioning in low-, middle- and high-income countries: findings from the World Health Survey

AIM

Epidemiological studies from high-income countries show that diabetes is associated with impaired social functioning. As healthcare systems in middle- and low-income countries offer fewer resources to curtail the potential social impact of diabetes, we performed a comparative study on the diabetes-social impairment link in low-, middle- and high-income countries.

METHODS

We use data from the cross-sectional World Health Survey (n = 235 428 from 10 low-income, 29 middle-income and 9 high-income countries). Diabetes was defined by self-reports of a diagnosis. Impaired social functioning was considered present if participants reported severe or extreme difficulties with personal relationships or participation in the community. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) in the overall sample and by income regions. ORs were corrected for demographics and health-related lifestyles, and then additionally adjusted for impairments that may explain any observed association (i.e. impaired vision, mood, cognition and mobility).

RESULTS

In the overall sample, we confirmed an association between self-reported diabetes and impaired social functioning (OR = 1.47, 95% CI = 1.18-1.83). The strength of that relationship increased with decreasing country income (e.g. OR in low-income countries = 2.23, 95% CI = 1.14-4.37). Associations were substantially attenuated by further correction for impairments, in particular mood problems, in the overall sample (OR = 0.92, 95% CI = 0.72-1.16) and all income regions.

CONCLUSIONS

Self-reported diabetes is associated with impaired social functioning in high- and middle-income countries, and this relationship is even stronger in low-income countries. Associations are largely explained by physical and mental impairments, which may be due to diabetes.

Reports of wheezing and of diagnosed asthma are associated with impaired social functioning: Secondary analysis of the cross-sectional World Health Survey data

OBJECTIVE

We sought to investigate whether there are associations between asthma and social functioning in adults from Western and non-Western countries.

METHODS

We analyzed data on individuals (94% aged 20+, 52% female) from 50 countries participating in the cross-sectional World Health Survey. We used information on self-reports of wheezing and an asthma diagnosis. Social functioning was defined by reports of severe or extreme difficulties related to personal relationships or participation in the community. Logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Wheezing was associated with impaired social functioning both in the overall sample (OR=2.40, 95%CI=2.09-2.75) and in Africa, South America and Asia (ORs≥2.47), but not in Europe (aOR=1.26, 95%CI=0.90-1.77). Analyses with self-reports of diagnosed asthma yielded similar, albeit weaker, associations (e.g. OR for the overall sample=1.63, 95%CI=1.38-1.92). We also combined asthma and wheezing into a single variable (reference group: no asthma diagnosis/no wheezing). We observed that in particular reports of wheezing were associated with impaired social functioning regardless of whether a concomitant asthma diagnosis was reported (OR=2.19, 95%CI=1.81-2.64) or not (OR=2.50, 95%CI=2.09-2.99).

CONCLUSION

Self-reports of wheezing and of diagnosed asthma are associated with impaired social functioning among adults in Africa, South America and Asia, but less so in Europe. These relationships are mainly driven by the experience of respiratory symptoms (i.e. wheezing). Our findings may partly be explained by regional variations in asthma control. Further research should elucidate the determinants and mechanisms of asthma-related impaired social functioning.

Depression, sleep problems, and perceived stress among informal caregivers in 58 low-, middle-, and high-income countries: A cross-sectional analysis of community-based surveys

Caregiving has been associated with adverse health outcomes. However, there is a paucity of multi-country, population-based studies on mental health outcomes of caregivers especially from low- and middle-income countries (LMICs). Thus, we assessed the association of caregiving with depression, sleep problems, and perceived stress in 10 high-, 27 middle-, and 21 low-income countries. Cross-sectional community-based data of the World Health Survey including 258,793 adults aged ≥18 years were analyzed. Multivariable logistic and linear regression analyses were conducted to explore the association of past 12-month caregiving with past 12-month DSM-IV depression, and past 30-day perceived stress [range 0 (low)-100 (high)] and severe/extreme sleep problems. Nearly 20% of the individuals were engaged in caregiving with particularly high rates observed in high-income countries (HICs) (e.g., Finland 43.3%). Across the entire sample, after adjustment for potential confounders, caregivers had a significantly higher likelihood of having depression (OR = 1.54; 95%CI = 1.37-1.73), sleep problems (OR = 1.37; 95%CI = 1.25-1.50), while their mean perceived stress score was 3.15 (95%CI = 2.46-3.84) points higher. These associations tended to be stronger in HICs. A greater number of caregiving activities was associated with a greater likelihood of depression, sleep problems, and perceived stress regardless of country income levels. In conclusion, caregiving has a negative impact on mental health worldwide with possibly greater effects in HICs. Given the growing contribution of caregivers in long-term care, interventions and policies to alleviate the mental health burden of caregivers are urgently needed to maintain sustainable and effective care practices.

Physical activity correlates in people with anxiety: Data from 46 low- and middle-income countries

OBJECTIVE

There is a lack of nationally-representative data on the correlates of physical activity (PA) among people with anxiety symptoms. Thus, we investigated PA correlates among community-dwelling adults with anxiety symptoms in 46 low- and middle-income countries (LMICs) using predominantly nationally-representative data.

METHOD

Cross-sectional data from the World Health Survey were analysed. PA was assessed by the International Physical Activity Questionnaire (IPAQ) and participants were dichotomised into those that do (≥150min moderate-vigorous PA) and do not (<150min) meet recommended PA weekly targets. Multivariable logistic regression was used to assess the correlates.

RESULTS

The analysis included 24,850 people with anxiety symptoms (43.3±16.6years; 39.7% males). The prevalence of low PA was 33.1% (95%CI=31.6%-34.6%). Older age [e.g., OR=4.57 for age≥65 vs. 18-24years], not married/cohabiting (vs. married/cohabiting OR=1.36), being in the richest quintile (vs. poorest OR=1.41), unemployed (vs. employed OR=2.18), inadequate vegetable consumption (vs. adequate OR=1.66), and poor sleep/energy, worse cognition, pain/discomfort and mobility difficulties were all significant correlates of low PA.

CONCLUSIONS

PA is associated with a range of factors among people with anxiety symptoms. Future interventions might target the identified correlates in order to facilitate people with anxiety to be more physically active.

Perceived Stress and Its Relationship With Chronic Medical Conditions and Multimorbidity Among 229,293 Community-Dwelling Adults in 44 Low- and Middle-Income Countries

In this study, we assessed the association of chronic medical conditions and multimorbidity with perceived stress among community-dwelling adults in 44 low- and middle-income countries. Data from the World Health Survey (2002-2004), including 229,293 adults, were analyzed. A perceived stress score (range, 0 (lowest stress)-100 (highest stress)) was computed on the basis of 2 questions from the Perceived Stress Scale. Eleven chronic conditions were assessed. Multivariable linear regression analyses were conducted to explore the associations. All chronic conditions were associated with significantly higher mean perceived stress scores, with the exception of edentulism. The associations were particularly strong for depression (β = 14.71, 95% confidence interval (CI): 13.68, 15.74), visual impairment (β = 10.66, 95% CI: 8.09, 13.23), and schizophrenia (β = 9.98, 95% CI: 7.71, 12.24). Compared with no chronic conditions, the β coefficients for perceived stress with the presence of 1, 2, 3, and ≥4 chronic conditions were 5.58 (95% CI: 4.94, 6.23), 9.58 (95% CI: 8.67, 10.49), 14.15 (95% CI: 12.63, 15.67), and 20.17 (95% CI: 18.29, 22.05), respectively. The associations with perceived stress were significantly stronger among the poorest individuals for arthritis, asthma, diabetes, edentulism, and ≥4 chronic conditions. Our data suggest that a range of chronic conditions and multimorbidity are associated with greatly increased perceived stress among people in low- and middle-income countries, and that the poorest persons may be a particularly vulnerable group.

Factors associated with depressive symptoms in uncontrolled asthmatics

RATIONALE

Recent epidemiological data indicate that approximately 6.7% of US adults suffer from depression in any given year. The purpose of the study is to identify factors associated with depressive symptoms in a large diverse group of patients with poorly controlled asthma. The factors include quality of life (QOL), lung function, asthma knowledge, attitudes, self-efficacy, symptoms and control of disease.

METHODS

Baseline characteristics of a cohort of 599 subjects with asthma recruited from twenty Asthma Clinical Research Centers across the United States were examined. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to stratify subjects into those with depressive symptoms (CES-D score ≥ 16) and those without depressive symptoms (CES-D < 16). Bivariate statistics were used to compare the two groups; additionally, logistic regression was used to determine factors that have the greatest association with depressive symptoms.

RESULTS

Subjects with depressive symptoms had significantly lower QOL scores and less knowledge about their disease than subjects with no depression; however, lung function (FEV1%) and asthma control were not significantly associated with depressive symptoms in the logistic regression analysis. Subjects who were non-white had lower household income, high school diploma or less, and those who were unemployed or disabled had significantly higher scores for depressive symptoms.

CONCLUSION

Subjects with depressive symptoms have significantly less knowledge of their disease and poorer QOL compared to those without depressive symptoms. Evaluating depressive symptoms in subjects with asthma will provide a more complete picture of their overall condition. The role of asthma education on depressive symptoms in this population needs to be further investigated. The effect of QOL on treating depression in asthma patients also needs to be studied.

Mental Health Services Claims and Adult Onset Asthma in Ontario, Canada

BACKGROUND

Living with asthma is associated with a decrease in quality of life due to reductions in activities of daily living and increased psychological stress, both of which are associated with poor mental health outcomes.

OBJECTIVE

The objective of this study was to quantify the burden of mental disorders on the adult asthma population and compare the risk of mental health services claims (MHSCs) in the 1 year before and 1 year after asthma diagnosis.

METHODS

Ontario residents aged 25 to 65 years with incident physician-diagnosed asthma between April 1, 2005, and March 31, 2012, were included. MHSCs, which consisted of hospitalizations, emergency department (ED), and outpatient physician visits, were identified from universal health administrative data. Poisson regression models with repeated measures were used to estimate the relative risk (RR) of MHSCs for 2 time periods: 1 year after asthma diagnosis compared with the 1 year before and 2 years after compared with 2 years before.

RESULTS

A total of 145,881 adults had incident asthma. In the 1 year after asthma diagnosis, 27% had an MHSC. The risk of ED visits for any mental disorders increased by 13% in the 1 year after asthma diagnosis compared with the 1 year before (adjusted RR [aRR], 1.13; 95% confidence interval [CI], 1.06-1.21). This increased risk of ED visits was not found when comparing 2 years after asthma diagnosis with 2 years before. The risk for outpatient physician visits for substance-related disorders increased by 21% at 1 year (aRR, 1.21; 95% CI, 1.14-1.28) and 37% at 2 years (aRR, 1.37; 95% CI, 1.28-1.46).

CONCLUSIONS

The significant comorbid burden of mental disorders in adults with newly diagnosed asthma highlights the need for primary care physicians to assess mental health needs and provide appropriate care.

The relationship between chronic physical conditions, multimorbidity and anxiety in the general population: A global perspective across 42 countries

OBJECTIVE

This cross-sectional study assessed the association of chronic physical conditions and multimorbidity with anxiety among community-dwelling adults in 42 countries.

METHOD

Data were analyzed from the World Health Survey including 181,845 adults aged ≥18years. Anxiety in the past 30days and nine chronic physical conditions (angina, arthritis, asthma, chronic back pain, diabetes, edentulism, hearing problem, tuberculosis, and visual impairment) were assessed. Multivariable logistic regression analyses were conducted to explore the associations between chronic physical conditions or the number of them and anxiety.

RESULTS

After adjustment for confounders, most of the individual chronic physical conditions were significantly associated with anxiety. Compared to those with no physical health conditions, one condition was associated with an almost twofold increased odds of anxiety symptoms (OR=1.94; 95%CI=1.76-2.13), while this figure rose to 5.49 (3.73-8.09) in those with ≥5 conditions.

CONCLUSIONS

Our data suggest that increasing numbers of chronic physical conditions are associated with higher odds for anxiety. Health care providers should consider the presence of anxiety symptoms especially in individuals with physical multimorbidity.

Epidemiology of depression with psychotic experiences and its association with chronic physical conditions in 47 low- and middle-income countries

BACKGROUND

The co-existence of depression and psychotic experiences (PEs) is associated with more pronounced adverse health outcomes compared to depression alone. However, data on its prevalence and correlates are lacking in the general adult population, and there is no published data on its association with chronic physical conditions.

METHOD

Cross-sectional, community-based data from 201 337 adults aged ⩾18 years from 47 low- and middle-income countries from the World Health Survey were analyzed. The presence of past 12-month PE and DSM-IV depression was assessed with the Composite International Diagnostic Interview (CIDI). Information on six chronic medical conditions (chronic back pain, edentulism, arthritis, angina, asthma, diabetes) were obtained by self-report. Multivariable logistic regression analysis was performed.

RESULTS

The crude overall prevalence of co-morbid depression/PEs was 2.5% [95% confidence interval (CI) 2.3-2.7%], with the age- and sex-adjusted prevalence ranging from 0.1% (Sri Lanka, Vietnam) to 9.03% (Brazil). Younger age, urban setting, current smoking, alcohol consumption, and anxiety were significant correlates of co-existing depression/PEs. Co-occurring depression/PEs was associated with significantly higher odds for arthritis, angina, and diabetes beyond that of depression alone after adjusting for sociodemographics, anxiety, and country, with odds ratios (depression/PEs v. depression only) being: arthritis 1.30 (95% CI 1.07-1.59, p = 0.0086); angina 1.40 (95% CI 1.18-1.67, p = 0.0002); diabetes 1.65 (95% CI 1.21-2.26, p = 0.0017).

CONCLUSIONS

The prevalence of co-existing depression/PEs was non-negligible in most countries. Our study suggests that when depression/PE or a chronic condition (e.g. arthritis, angina, diabetes) is detected, screening for the other may be important to improve clinical outcomes.

The impact of out-of-pocket payments for dental care on household finances in low and middle income countries

BACKGROUND

Dental care is extremely costly and beyond most people means in developing countries. The primary aim of this study was to determine the impact of out-of-pocket payments for dental care on household finances in 40 low and middle income countries. A second aim was to compare the burden of payments for dental care with that for other health services.

METHODS

We used data from 174,257 adults, aged 18 years and above, who reported their total and itemized household expenditure in the past four weeks as part of the World Health Surveys. The financial burden on households was measured using the catastrophic health expenditure (CHE) and impoverishment approaches. A household was classified as facing CHE if it spent 40% or more of its capacity to pay, and as facing impoverishment if it fell below the country-specific poverty line after spending on health care was subtracted from household expenditure. The odds of experiencing CHE and impoverishment due to expenditure on dental care were estimated from two-level logistic regression models, controlling for various individual- and country-level covariates.

RESULTS

Households that paid for dental care had 1.88 (95% Confidence Interval: 1.78-1.99) greater odds of incurring CHE and 1.65 (95% CI: 1.52-1.80) greater odds of facing impoverishment, after adjustment for covariates. Furthermore, the impact of paying for dental care was lower than that for medications or drugs, inpatient care, outpatient care and laboratory tests but similar to that of health care products, traditional medicine and other health services.

CONCLUSION

Households with recent dental care spending were more likely to use a large portion of their disposable income and fall below the poverty line. Policy makers ought to consider including dental care as part of universal health care and advocate for the inclusion of dental care coverage in health insurance packages.

Depression and inflammatory arthritis are associated in both Western and Non-Western countries: Findings from the World Health Survey 2002

OBJECTIVES

Epidemiological studies have linked arthritis to depression. However, it remains unclear to what degree the association between arthritis and depression extends to low income countries and whether it can be replicated for inflammatory arthritis (IA). We aimed to address these knowledge gaps based on a large multi-national sample.

METHODS

Cross-sectional data was drawn from the 2002 World Health Survey. IA was defined as reports of either a diagnosis or treatment of arthritis and morning stiffness for >30min. Self-reported depression was defined as positive if participants reported its prior diagnosis or treatment or if they were classified as suffering from a major depressive episode by a seven-item screening instrument. Multivariable logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) for the entire sample and stratified by sex and continent.

RESULTS

The odds of IA was 2.6-fold increased in those with depression compared to those without (OR=2.64, 95% CI 2.18-3.21) in the entire sample. This association was observed in both men (OR=3.06, 95% CI 2.19-4.27) and women (OR=2.50, 95% CI 1.95-3.21). Similar associations were found on the continent level, but were generally stronger for the Americas and Asia compared to Africa and Europe.

CONCLUSIONS

Although our definition of IA was limited by the use of self-reported morning stiffness, this study suggests that there is a positive association between inflammatory arthritis and depression in Western and Non-Western countries, suggesting that this relationship represents a universal phenomenon.

Physical activity and depression: a large cross-sectional, population-based study across 36 low- and middle-income countries

OBJECTIVE

Physical activity (PA) is good for health, yet several small-scale studies have suggested that depression is associated with low PA. A paucity of nationally representative studies investigating this relationship exists, particularly in low- and middle-income countries (LMICs). This study explored the global association of PA with depression and its mediating factors.

METHOD

Participants from 36 LMICs from the World Health Survey were included. Multivariable logistic regression analyses were undertaken exploring the relationship between PA and depression.

RESULTS

Across 178 867 people (mean ± SD age = 36.2 ± 13.5 years; 49.9% male), the prevalence of depression and the prevalence of low PA were 6.6% and 16.8% respectively. The prevalence of low PA was significantly higher among those with depression vs. no depression (26.0% vs. 15.8%, P < 0.0001). In the adjusted model, depression was associated with higher odds for low PA (OR = 1.42; 95% CI = 1.24-1.63). Mediation analyses demonstrated that low PA among people with depression was explained by mobility limitations (40.3%), pain and discomfort (35.8%), disruptions in sleep and energy (25.2%), cognition (19.4%) and vision (10.9%).

CONCLUSION

Individuals with depression engage in lower levels of PA in LMICs. Future longitudinal research is warranted to better understand the relationships observed.

Stress Sensitivity and Psychotic Experiences in 39 Low- and Middle-Income Countries

Stress has a central role in most theories of psychosis etiology, but the relation between stress and psychosis has rarely been examined in large population-level data sets, particularly in low- and middle-income countries. We used data from 39 countries in the World Health Survey (n = 176 934) to test the hypothesis that stress sensitivity would be associated with psychotic experiences, using logistic regression analyses. Respondents in low-income countries reported higher stress sensitivity (P < .001) and prevalence of psychotic experiences (P < .001), compared to individuals in middle-income countries. Greater stress sensitivity was associated with increased odds for psychotic experiences, even when adjusted for co-occurring anxiety and depressive symptoms: adjusted odds ratio (95% CI) = 1.17 (1.15-1.19) per unit increase in stress sensitivity (range 2-10). This association was consistent and significant across nearly every country studied, and translated into a difference in psychotic experience prevalence ranging from 6.4% among those with the lowest levels of stress sensitivity up to 22.2% among those with the highest levels. These findings highlight the generalizability of the association between psychosis and stress sensitivity in the largest and most globally representative community-level sample to date, and support the targeting of stress sensitivity as a potential component of individual- and population-level interventions for psychosis.

Risk of developing major depression and bipolar disorder among adolescents with atopic diseases: A nationwide longitudinal study in Taiwan

BACKGROUNDS

Previous studies have found an increased prevalence of atopic diseases among patients with major depression and bipolar disorder. But the temporal association between atopic diseases in adolescence and the subsequent risk of developing mood disorders has been rarely investigated.

METHODS

Using the Taiwan National Health Insurance Research Databases, 5075 adolescents with atopic diseases (atopic cohort) and 44,729 without (non-atopic cohort) aged between 10 and 17 in 2000 were enrolled into our study and followed to the end of 2010. Subjects who developed major depression or bipolar disorder during the follow-up were identified.

RESULTS

The atopic cohort had an increased risk of developing major depression (HR: 2.45, 95% CI: 1.93~3.11) and bipolar disorder (HR: 2.51, 95% CI: 1.71~3.67) compared to the non-atopic cohort, with a dose-dependent relationship between having a greater number of atopic comorbidities and a greater likelihood of major depression (1 atopic disease: HR: 1.80, 95% CI: 1.29~2.50; 2 atopic comorbidities: HR: 2.42, 95% CI: 1.93~3.04;≥3 atopic comorbidities: HR: 3.79, 95% CI: 3.05~4.72) and bipolar disorder (HR: 1.40, 95% CI: 0.57~3.44; HR: 2.81, 95% CI: 1.68~4.68; HR: 3.02, 95% CI: 1.69~5.38).

DISCUSSION

Having atopic diseases in adolescence increased the risk of developing major depression and bipolar disorder in later life. Further studies may be required to clarify the underlying mechanism between atopy and mood disorders, and to investigate whether prompt intervention may decrease the risk of subsequent mood disorders.

Asthma and atopic diseases in adolescence and antidepressant medication in middle age

This Swedish register-based cohort study examined whether asthma, hay fever and allergic dermatitis in late adolescence identified in the early 1970s are associated with antidepressant medication in middle age, between 2006 and 2009. After adjustment for childhood and adulthood sociodemographic characteristics, psychological, cognitive and physical function, and comorbidity, the magnitude of the associations diminished for asthma, while hay fever and atopic dermatitis retained associations. Hay fever and atopic dermatitis in adolescence have potentially important implications for future mental health, while asthma may already have influenced an individual's ability to cope with stress by late adolescence.

Anxiety and depression among Nigerian patients with asthma; Association with sociodemographic, clinical, and personality factors

OBJECTIVE

To estimate the rate of anxiety and depression in adult asthma patients and examine the possible association with sociodemographic, clinical and other significant variables.

METHODS

Adult asthmatics (n = 203) were recruited from the asthma outpatient clinic and assessed for sociodemographic and clinical profiles, their levels of disability, social support, asthma treatment stigma and personality traits. The Mini International Neuropsychiatric Interview (M.I.N.I) was used to assess for the diagnosis of Anxiety and Depression in comparison with matched healthy controls (n = 205).

RESULTS

Seventy (34.5%) of the patients with asthma have a diagnosis of Anxiety or Depression compared with 15 (7.3%) of matched healthy controls and the difference was significant (OR 6.67, 95% CI 3.58-13.04). Although older age, lower income, use of oral corticosteroid, patients perceived severity of asthma, disability, social support and personality traits were initially significant in univariate analysis, a subsequent logistic regression analysis revealed that only disability scores above the group mean (OR 4.50, 95% CI 2.28-8.87) and not having a strong social support (OR 2.88, 95% CI 1.443-5.78) were the only variables independently associated with diagnosis of Anxiety and Depression in the group of patients with asthma.

CONCLUSION

Anxiety and depression are significantly more common in adult outpatients with asthma when compared with healthy control in Nigeria and was significantly associated with levels of disability and social support. These factors should be considered while formulating predictive models for management of psychosocial problems in asthma in this environment.

A graphical model approach to systematically missing data in meta-analysis of observational studies

When studies in meta-analysis include different sets of confounders, simple analyses can cause a bias (omitting confounders that are missing in certain studies) or precision loss (omitting studies with incomplete confounders, i.e. a complete-case meta-analysis). To overcome these types of issues, a previous study proposed modelling the high correlation between partially and fully adjusted regression coefficient estimates in a bivariate meta-analysis. When multiple differently adjusted regression coefficient estimates are available, we propose exploiting such correlations in a graphical model. Compared with a previously suggested bivariate meta-analysis method, such a graphical model approach is likely to reduce the number of parameters in complex missing data settings by omitting the direct relationships between some of the estimates. We propose a structure-learning rule whose justification relies on the missingness pattern being monotone. This rule was tested using epidemiological data from a multi-centre survey. In the analysis of risk factors for early retirement, the method showed a smaller difference from a complete data odds ratio and greater precision than a commonly used complete-case meta-analysis. Three real-world applications with monotone missing patterns are provided, namely, the association between (1) the fibrinogen level and coronary heart disease, (2) the intima media thickness and vascular risk and (3) allergic asthma and depressive episodes. The proposed method allows for the inclusion of published summary data, which makes it particularly suitable for applications involving both microdata and summary data. Copyright © 2016 John Wiley & Sons, Ltd.

Patients' needs in asthma treatment: development and initial validation of the NEAT questionnaire

OBJECTIVE

We aimed to develop and tentatively validate an instrument assessing patients' needs related to asthma treatment.

METHODS

Patients were recruited through various approaches (e.g. physicians, pharmacies and patient organizations). Utilizing a mixed methods design, we first conducted five focus groups to explore needs among patients. Next, we devised an item pool which was revised, reduced and evaluated by patients. Finally, data from a survey (n = 362) were used to further reduce the item pool and to examine the questionnaire's psychometric properties and validity.

RESULTS

Four broad needs categories emerged from the focus groups: (1) information needs; (2) consideration of patient views in diagnosis; (3) consideration of patient views in treatment planning; and (4) addressing patients' fears. We devised 45 items, which were reduced to 22 items based on patient feedback. The survey data suggested a 13-item scale with four subscales ("patient expertise", "drug effects", "handling drugs" and "exacerbations"). Cronbach's alpha was acceptable for those subscales (>0.7) and for the total score (0.9). Increasing scores on subscales and the total score (implying more unmet needs) showed close and consistent associations with poor asthma control, reduced quality of life and low treatment satisfaction.

CONCLUSIONS

The development process of the Needs in Asthma Treatment (NEAT) questionnaire ensured that needs of asthma patient are captured with high validity. The NEAT questionnaire has been shown to be valid, thereby representing a promising tool for research and delivery of patient-centered care.

The Association between Sleep Problems and Psychotic Symptoms in the General Population: A Global Perspective

STUDY OBJECTIVES

To assess the prevalence of sleep problems and their association with psychotic symptoms using a global database.

DESIGN

Community-based cross-sectional study.

SETTING

Data were analyzed from the World Health Organization's World Health Survey (WHS), a population-based survey conducted in 70 countries between 2002 and 2004.

PATIENTS OR PARTICIPANTS

261,547 individuals aged ≥ 18 years from 56 countries.

INTERVENTIONS

N/A.

MEASUREMENTS AND RESULTS

The presence of psychotic symptoms in the past 12 months was established using 4 questions pertaining to positive symptoms from the psychosis screening module of the Composite International Diagnostic Interview. Sleep problems referred to severe or extreme sleep problems in the past 30 days. Multivariable logistic regression was used to estimate the associations. The overall prevalence of sleep problems was 7.6% and ranged from 1.6% (China) to 18.6% (Morocco). Sleep problems were associated with significantly higher odds for at least one psychotic symptom in the vast majority of countries. In the pooled sample, after adjusting for demographic factors, alcohol consumption, smoking, and chronic medical conditions, having sleep problems resulted in an odds ratio (OR) for at least one psychotic symptom of 2.41 (95% confidence interval [CI] 2.18-2.65). This OR was 1.59 (1.40-1.81) when further adjusted for anxiety and depression.

CONCLUSIONS

A strong association between sleep problems and psychotic symptoms was observed globally. These results have clinical implications and serve as a basis for future studies to elucidate the causal association between psychotic symptoms and sleep problems.

The association between psychosis and severe pain in community-dwelling adults: Findings from 44 low- and middle-income countries

Previous studies examining the association between schizophrenia and pain have produced mixed results and data on sub-threshold psychosis or psychotic symptoms and pain are scarce. This study assessed the association between psychosis and severe pain among community-dwelling adults in 44 low- and middle-income countries (LMICs) where no data exists. Data on 235,370 adults aged ≥18 years from the World Health Survey (WHS) 2002-2004 were analyzed. The presence of past 12-month psychotic symptoms was established using four questions from the Composite International Diagnostic Interview. Participants were categorized into four mutually exclusive groups based on whether they had at least one psychotic symptom and/or a lifetime psychosis or schizophrenia diagnosis. Multivariable logistic regression was used to estimate the association between psychosis and past 30-day severe pain. The prevalence of severe pain among those with 0, 1, 2, ≥3 psychotic symptoms was 8.7%, 16.7%, 21.8%, 30.5% respectively. Compared to those with no psychotic symptoms or diagnosis, the ORs (95% CIs) were: at least one symptom without diagnosis [2.17 (1.99-2.38)]; no symptom with diagnosis [2.33 (1.71-3.17)]; at least one symptom and diagnosis [4.27 (3.20-5.71)]. Associations were partly mediated by chronic physical conditions, anxiety, and depression. Despite some limitations such as the use of a single-item question to assess pain, the results of this study suggest that individuals with psychotic symptoms or a psychosis diagnosis should be systematically assessed for pain, and if necessary, receive treatment for pain and its underlying conditions. Future research on the effect of pain management on psychosis outcome is warranted.

Depression and Its Comorbid Conditions More Serious in Women than in Men in the United States

BACKGROUND

Depression is a major public health problem by itself and for its comorbid conditions. We aimed to determine gender differences in the prevalence of depression and how depression is related to comorbid conditions and metabolic biomarkers.

METHODS

This study included men (n=986) and women (n=1,280) aged 20-79 years who were included in the 2007-2010 National Health and Nutrition Examination Survey. Depression was assessed with the Patient Health Questionnaire (PHQ-9). The associations between depression (PHQ-9 score ≥10), self-reported comorbid conditions, and metabolic biomarkers of comorbid conditions were determined by multivariable logistic regressions adjusting for potential confounders.

RESULTS

The prevalence of depression in men and women were 7.9% and 12.1%, respectively (p<0.01). The odds ratios (OR) of various comorbid conditions (asthma, arthritis, gout, coronary heart disease, heart attack, stroke, diabetes mellitus, thyroid problem, and metabolic syndrome) by the status of depression were significantly higher in women. High C-reactive protein (CRP) was a significant predictor of depression in men (OR 2.02, 95% confidence interval [CI] 1.11-3.67) in unadjusted model. In women, high fasting blood glucose, high glycohemoglobin, and high CRP were significant predictors of depression (OR 1.20, 95% CI 1.28-3.01; OR 2.44, 95% CI 1.21-4.92; OR 1.44, 95% CI 1.01-2.06; OR 1.79, 95% CI 0.19-2.67, respectively) after controlling for age, education, race/ethnicity, marital status, ratio of family income to poverty, and physical activity.

CONCLUSIONS

Women had higher prevalence of depression and higher number of significant associations between socioeconomic status, comorbid conditions, and metabolic risk factors by the status of depression than men. Public health attentions are needed to improve women's mental health.

Transcriptomic profiling of peripheral blood CD4⁺ T-cells in asthmatics with and without depression

BACKGROUND

Cumulative studies have shown that asthma is associated with depression but the underlying mechanisms are poorly understood. This study aimed to determine whether asthma with depression is characterized by unique pathophysiological pathways by analyzing the global gene expression patterns of CD4(+) T-cells from asthmatics with or without depression.

MATERIALS AND METHODS

Four groups of subjects (non-depressive asthmatics, depressive asthmatics, depression patients, and healthy controls) consisting of 6 participants in each group were studied. Peripheral CD4(+) T-cells were isolated and the global transcriptomic profiles were defined by using the Agilent SurePrint G3 Human GE 8x60K microarray. The differences in transcriptomic profiles between asthma with or without depression, depression patients and healthy controls were examined. Pathway enrichment analyses of differentially expressed genes were performed using the Ingenuity Pathway Analysis. Selected genes were verified and correlated to the clinical characteristics.

RESULTS

A total of 1448 differentially expressed transcripts were identified in any of the non-depressive asthma vs. healthy control, depressive asthma vs. healthy control, or depression vs. healthy control comparisons after correction for multiple comparisons. Among these, 156 were demonstrated as differentially expressed genes only in depressive asthma vs. healthy control. Twenty significant biological pathways were identified and were involved in inflammation, metabolism, immunity, tumor and cell cycle. Increased expression of phosphoinositide-3-kinase, regulatory subunit 1 (alpha) was confirmed in depressive asthmatics and it was inversely correlated with lung function (FEV1/FVC%).

CONCLUSIONS

Asthmatics with depression exhibit unique pathophysiological pathways and this result may provide clues for specific molecular mechanisms underlying asthma with depression.

Risk of suicide for individuals reporting asthma and atopy in young adulthood: findings from the Glasgow Alumni study

There is emerging evidence that asthma and atopy may be associated with a higher risk of suicide. We investigated the association of asthma and atopy with mortality from suicide (n=32) in the Glasgow Alumni cohort, adjusting for the key confounders of socioeconomic position and smoking. We found no evidence of an association in our a priori atopy phenotypes with suicide, and there were insufficient suicides in the asthma phenotypes to draw any conclusions. In additional analyses, individuals reporting both eczema-urticaria and hay fever and those with family history of atopy were at higher risk of suicide. As these were secondary analyses and based on small numbers of events we cannot rule out chance findings. The lack of evidence in our main hypothesis may be due to the small number of suicides or reported associations between asthma and atopy may be confounded.

Association between mental disorders and subsequent adult onset asthma

BACKGROUND AND OBJECTIVES

Associations between asthma and anxiety and mood disorders are well established, but little is known about their temporal sequence. We examined associations between a wide range of DSM-IV mental disorders with adult onset of asthma and whether observed associations remain after mental comorbidity adjustments.

METHODS

During face-to-face household surveys in community-dwelling adults (n = 52,095) of 19 countries, the WHO Composite International Diagnostic Interview retrospectively assessed lifetime prevalence and age at onset of 16 DSM-IV mental disorders. Asthma was assessed by self-report of physician's diagnosis together with age of onset. Survival analyses estimated associations between first onset of mental disorders and subsequent adult onset asthma, without and with comorbidity adjustment.

RESULTS

1860 adult onset (21 years+) asthma cases were identified, representing a total of 2,096,486 person-years of follow up. After adjustment for comorbid mental disorders several mental disorders were associated with subsequent adult asthma onset: bipolar (OR = 1.8; 95%CI 1.3-2.5), panic (OR = 1.4; 95%CI 1.0-2.0), generalized anxiety (OR = 1.3; 95%CI 1.1-1.7), specific phobia (OR = 1.3; 95%CI 1.1-1.6); post-traumatic stress (OR = 1.5; 95%CI 1.1-1.9); binge eating (OR = 1.8; 95%CI 1.2-2.9) and alcohol abuse (OR = 1.5; 95%CI 1.1-2.0). Mental comorbidity linearly increased the association with adult asthma. The association with subsequent asthma was stronger for mental disorders with an early onset (before age 21).

CONCLUSIONS

A wide range of temporally prior mental disorders are significantly associated with subsequent onset of asthma in adulthood. The extent to which asthma can be avoided or improved among those with early mental disorders deserves study.