Mortality in unipolar depression preceding and following chronic somatic diseases

Intranasal administration of the essential oil from Perillae Folium ameliorates social defeat stress-induced behavioral impairments in mice

ETHNOPHARMACOLOGICAL RELEVANCE

Perillae Folium, the leaves and twigs of Perilla frutescens (L.) Britton, has been included in many traditional Chinese medicine herbal formulas to treat depression. However, the precise antidepressant mechanism of the essential oil from Perillae Folium (PFEO) has not been fully investigated.

AIM OF THE STUDY

To assess the effects and potential mechanisms of PFEO on depression using animal models and network pharmacology analysis.

MATERIALS AND METHODS

PFEO was intranasally administered to a mouse model of social defeat stress (SDS). The antidepressant effects of PFEO on SDS-induced mice were evaluated using behavioral tests. Enzyme-linked immunosorbent assay (ELISA) and western blot were performed to measure the levels of depression-related biomarkers in the hippocampus and serum of the mice. The chemical compounds of PFEO were determined using gas chromatography-mass spectrometry (GC-MS). Network pharmacology and molecular docking analyses were conducted to investigate the potential bioactive components of PFEO and the mechanisms underlying the antidepressant effects. To validate the mechanisms of the bioactive compounds, in vitro models using PC12 and BV2 cells were established and the blood-brain barrier (BBB) permeability was evaluated.

RESULTS

The intranasal administration of PFEO suppressed SDS-induced depression in mice by increasing the time spent in the social zone and the social interactions in the social interaction test and by decreasing the immobility time in the tail suspension and forced swimming tests. Moreover, the PFEO treatment reduced the SDS-induced anxiety-like behavior, as inferred from the increased activity in the central zone observed in the open field test and in the open arms observed in the elevated plus maze test. PFEO administration recovered the SDS-induced decrease in the levels of 5-HT, NE, gamma-aminobutyric acid (GABA), and p-ERK in the hippocampus of mice. Furthermore, the increased serum corticosterone level was also attenuated by the PFEO treatment. A total of 21 volatile compounds were detected in PFEO using GC-MS, among which elemicin (15.52%), apiol (15.16%), and perillaldehyde (12.79%) were the most abundant ones. The PFEO compounds targeted 32 depression-associated genes, which were mainly related to neural cells and neurotransmission pathways. Molecular docking indicated good binding affinities between the bioactive components of PFEO (apiol, β-caryophyllene, elemicin, and myristicin) and the key targets, including ACHE, IL1B, IL6, MAOB, SLC6A2, SLC6A3, SLC6A4, and tumor necrosis factor. Among the four compounds, β-caryophyllene, elemicin, and myristicin were more effective in reducing neurotoxicity and neuroinflammation. Elemicin showed the highest BBB permeability rate.

CONCLUSIONS

This study shows the antidepressant activities of PFEO in an SDS-induced mouse model and suggests its potential mechanisms of action: regulation of the corticosterone levels, hippocampal neurotransmitters, and ERK signaling. Apiol, β-caryophyllene, elemicin, and myristicin may be the main contributors to the observed effects induced by PFEO. Further studies are needed to fully elucidate the underlying mechanisms and the main PFEO bioactive components.

Effects of weekend rehabilitation on vertebral compression fractures in the elderly

INTRODUCTION

This retrospective cohort study aimed to investigate the effect of rehabilitation and without weekend therapy on Activities of daily living (ADL) and readmission in vertebral fracture patients aged 60 years and older.

METHODS

The present study used a hospital-based database created by JMDC Inc. The JMDC hospital-based database is an epidemiological database that has been storing medical claims and Diagnosis Procedure Combination survey data. This study included 40,743 admitted patients aged 60 years or older who were admitted for rehabilitation purposes with a diagnosis of compression fracture of the thoracic and/or lumbar spine based on a previous diagnostic survey. We extracted the medical information from the database. Patients who received rehabilitation 7 days a week were classified into two groups: the "weekend rehabilitation group" and "nonweekend rehabilitation group." To reduce confounding effects related to differences in patient background, we used propensity score with multiple logistic regression models. Analysis of the JMDC database was conducted with the approval of the Institutional Review Board (approval number: 1228-1). Because all data were anonymized, informed consent was not required.

RESULTS

Propensity score matching resulted in 13,790 cases being included in the analysis. Barthel index (BI) at discharge, change in BI, and readmission were significantly different between the weekend rehabilitation and nonweekend rehabilitation groups. Multiple logistic regression analysis suggested a reduced odds of readmission with weekend rehabilitation (odds ratio = 0.907, 95% confidence interval [CI] = 0.843-0.975, p-value = 0.008). Furthermore, greater changes in BI and BI at discharge were associated with the effect of weekend rehabilitation (unstandardized [B] = 3.922, 95% CI = 2.925-4.919), (unstandardized [B] = 3.512, 9% CI = 2.424-4.6), respectively.

CONCLUSIONS

Weekend rehabilitation was considered as an important part of the treatment program to acquire ADL and to prevent readmission.

Cancer mortality in Common Mental Disorders: A 10-year retrospective cohort study

PURPOSE

Individuals with Common Mental Disorders (CMDs) may have a higher cancer mortality. The purpose of this study was to examine cancer-related mortality among patients with CMDs and verify which cancer types are predominantly involved.

METHODS

We used the Regional Mental Health Registry of the Emilia-Romagna region, in Northern Italy to identify patients aged ≥ 18 years who received an ICD 9-CM diagnosis of CMDs (i.e., depressive and neurotic disorders) over a 10 year period (2008-2017). Information on cause of death was retrieved from the Regional Cause of Death Registry. Comparisons were made with data from the regional population without CMDs.

RESULTS

Among 101,487 patients suffering from CMDs (55.7% depression; 44.3% neurotic disorders), 3,087 (37.8%) died from neoplasms. The total standardized mortality ratio (SMR) was 1.82 (95% CI 1.78-1.86) while the SMR for all neoplasms was 2.08 (95% CI 2.01-2.16). Individuals of both genders, with both depressive and neurotic disorders had a higher risk of death from almost all cancers compared with the regional population.

CONCLUSION

Patients with CMDs have considerably higher cancer mortality risk than the general population. Higher mortality was observed for a broad range of cancers associated with different aetiologies. It is imperative to promote cancer awareness, prevention and treatment for people with CMDs.

Risk factors associated with mortality among individuals with type 2 diabetes and depression across two cohorts

OBJECTIVE

Depression has been linked to excess mortality in individuals with type 2 diabetes, but it remains unclear what drives this association. We examined if the association depends on unhealthy lifestyle and medical comorbidity.

METHODS

We followed a clinically recruited cohort of Danish people with type 2 diabetes (n = 8175) with fine-grained clinical information and a population-wide register-based cohort of Danish individuals with HbA1c-defined type 2 diabetes (n = 87 500) representing everyday clinical practice. Antidepressant drug use prior to the onset of type 2 diabetes was used as a proxy for preexisting depression. In both cohorts, we first estimated the association between depression and 5-year mortality following type 2 diabetes, using a Cox proportional hazards model, yielding sex- and age-adjusted mortality rate ratios (MRRs). We subsequently examined how further adjustment for markers of unhealthy lifestyle (smoking, physical inactivity, obesity, alcohol abuse, and marital status) and medical comorbidity affected the association.

RESULTS

Preexisting depression was associated with an approximately 50% increased age- and sex-adjusted all-cause mortality rate in both the clinically recruited- (5-year MRR: 1.46; 95% CI: 1.12-1.90) and the register-based type 2 diabetes cohort (5-year MRR: 1.51; 95% CI: 1.45-1.57). The excess mortality associated with depression almost disappeared when the analyses were adjusted for unhealthy lifestyle and medical comorbidity in both the clinically recruited- (MRR: 1.05; 95% CI: 0.72-1.52) and the register-based type 2 diabetes cohort (MRR: 1.14, 95% CI: 1.09-1.19).

CONCLUSIONS

A large fraction of the excess mortality associated with preexisting depression in type 2 diabetes is attributable to the unhealthy lifestyle and medical comorbidity accompanying depression.

An association between multi-morbidity and depressive symptoms among Indian adults based on propensity score matching

Keeping in view the cascade of disturbances caused by the co-existence of multi-morbidity and depression among aged population, this study aims to ascertain the independent impact of multi-morbidity as a risk factor for the development of depressive symptoms among adults living in India. The present study utilizes data from the nationally representative survey “Longitudinal Ageing Study in India” (LASI, Wave-1, 2017–2018). The eligible sample size was 62,244 adults aged 45 years and above. Descriptive statistics along with bivariate analysis was used to understand the prevalence of depressive symptoms. Further, binary logistic regression and Propensity Score Matching (PSM) methods were applied to examine the independent effect of multi-morbidity on depressive symptoms while controlling the selected background characteristics. Overall, around one-third respondents had at least one chronic disease and one-fifth had multi-morbidity. The most prevalent chronic disease reported in the sampled population was hypertension followed by diabetes and joint disease. It is observed that older adults with multiple chronic diseases had 77% higher odds of having depressive symptoms as compared to those without a history of chronic disease in the multivariable logistic regression model. Results obtained from PSM indicate that the risk of having depressive symptoms was 3.7% higher for adults with multi- morbidity. Depressive symptom was identified to be associated with a wider range of multiple physical health problems and people with multi-morbidity are at a higher risk of having depressive symptoms. It is imperative that multi-morbidity can be used as a screener for identifying people with depressive symptoms.

A systematic review on the prevalence of preoperative and postoperative depression in lumbar fusion

BACKGROUND

Depression and Degenerative Spine Disease (DSD) frequently co-exist. Pooled prevalence estimates of depression before and after lumbar fusion surgery has not been analyzed before. The purpose of this systematic review was to estimate the pre- and post-operative prevalence of depression in patients with DSD undergoing lumbar fusion.

METHODS

A literature review until April 30th 2022 was performed. All studies on DSD patients undergoing lumbar spine fusion surgery with either a history of formal diagnosis of depression or a recording of depression using a validated tool were included. Patients with other psychiatric conditions or undergoing a different form of spinal surgery were excluded. Risk of bias of the included studies was evaluated using the Newcastle-Ottawa Scale.

RESULTS

Fifteen (15) studies with a total of 98.375 patients met the inclusion and exclusion criteria and were included in the analysis. The prevalence estimate of depression in patients before surgery was 15,35 % (95% CI: 10,56-20,86%). In the 7 studies including patients who had undergone lumbar fusion, the pooled prevalence was estimated 11,46% (95% CI: 8,11-15,30%).

CONCLUSION

An increased prevalence of depression in patients undergoing lumbar spine fusion was noted. Given the correlation between depression and poor surgical outcomes, strategies should be identified to prevent and treat depression in these patients.

Incidence and predictors of multimorbidity among older adults in Korea: a 10-year cohort study

BACKGROUND

Due to the rapid growth of the older adult population, multimorbidity has become a global concern for an aging society. Multimorbidity has been associated with poor health outcomes, including low quality of life and a high risk of mortality, resulting in an overload of healthcare systems. However, multimorbidity incidence and its related factors are poorly understood among older adults. This study aimed to determine whether sociodemographic characteristics, lifestyle, and psychosocial factors predict multimorbidity incidence among older adults in Korea.

METHODS

This longitudinal study used the Korean Longitudinal Study of Aging (KLoSA) dataset from 2008 to 2018. The KLoSA is a panel survey of nationally representative samples aimed at providing data for developing socioeconomic policies for the increasing aging population in Korea. The study sample included 1967 older adults aged 65 years and over who had none or one of the chronic diseases at the baseline in 2008. Multimorbidity incidence was defined as the co-existence of two or more chronic diseases among 12 doctor-diagnosed diseases based on self-reports. Cox's proportional hazards models were used to identify significant predictors of multimorbidity incidence over a 10-year follow-up period.

RESULTS

Among 1967 respondents (female 54.5%, mean age 72.94), 625 (31.8%) incidents of multimorbidity were reported, contributing to 47.5 incidents per 1000 people after 10 years of follow-up. Low levels of social interaction, obesity, past smoking habits, and current or past drinking habits were identified as significant predictors of multimorbidity incidence among older adults in Korea.

CONCLUSIONS

This study identified older adults at high risk for multimorbidity incidence. These groups require more attention from health care providers in the course of chronic disease monitoring and management. Specific interventions and health policies to promote social interaction and a healthy lifestyle are essential to delay multimorbidity incidence. This longitudinal approach will contribute to developing preventive strategies to reduce the incidence of multimorbidity among older adults.

Prevalence and Outcomes of Major Psychiatric Disorders Preceding Index Surgery for Degenerative Thoracic/Lumbar Spine Disease

The relationship between preexisting major psychiatric disorders and outcomes of spine surgery for degenerative thoracic/lumbar disease remains unclear. A 5% subset of inpatients was randomly selected from the Taiwan National Health Insurance Research Database. A total of 10,109 inpatients aged 18 years or over with degenerative thoracic/lumbar disease and underwent spine surgery met inclusion criteria. Major psychiatric disorders diagnosed by psychiatrists preceding index surgery, including anxiety disorder, depression disorder, bipolar disorder, schizophrenia and dementia, were identified. The prevalence of psychiatric disorders, and their differential risks on in-hospital and post-discharge outcomes were examined. 10.4% had major psychiatric disorders, of which depression (6.6%) and anxiety (4.9%) were most common. Logistic regression revealed increased risks of ventilator use in depression (OR = 1.62, 95% CI = 1.04-2.54, p < 0.05), extended hospitalization length in bipolar (OR = 1.77, 95% CI = 1.08-2.89, p < 0.05), and higher rehabilitation utilization in depression (OR = 1.25, 95% CI = 1.06-1.47, p < 0.01) and bipolar (OR = 1.69, 95% CI = 1.04-2.76, p < 0.05). Those patients with anxiety had a decreased risk of longer hospitalization duration (OR = 0.77, 95% CI = 0.60-0.98, p < 0.05), while those with dementia and schizophrenia had no change in risks. Preoperative recognition of major psychiatric disorders for risk and treatment assessment is suggested as people with preexisting depression or bipolar disorder have worse outcomes after spine surgery.

Predictors of Psychological Distress in Women with Endometriosis: The Role of Multimorbidity, Body Image, and Self-Criticism

While large numbers of women report high levels of psychological distress associated with endometriosis, others report levels of distress that are comparable to those of healthy women. Thus, the aim of the current study was to develop an explanatory model for the effect of endometriosis on women’s psychological distress. Furthermore, it sought to further investigate the role of body image, self-criticism, and pain intensity on the psychological distress associated with endometriosis and establish the effect of chronic illness load on the development of this distress. This study comprised a total of 247 women aged 20–49 (M = 31.3, SD = 6.4)—73 suffering from endometriosis only, 62 suffering from endometriosis and an additional chronical illness (ACI), and 112 healthy peers (HP)—who completed the Patient Health Questionnaire, the Generalized Anxiety Disorder-Item Scale, the Body Appreciation Scale-2, and the Self-Criticism Sub-Scale. When comparing each endometriosis group to their HP’s, we found that the differences between HP and endometriosis ACI in depression and anxiety were mediated by body image (Betas = 0.17 and 0.09, respectively, p’s < 0.05) and self-criticism (Betas = 0.23 and 0.26, respectively, p’s < 0.05). When comparing endometriosis participants to endometriosis ACI participants, differences in depression were mediated by body image, self-criticism, and pain intensity (Betas = 0.12, 0.13, 0.13 respectively, p’s < 0.05), and the differences in anxiety were mediated by self-criticism and pain intensity (Betas = 0.19, 0.08, respectively, p’s < 0.05). Physicians and other health professionals are advised to detect women with endometriosis ACI who are distressed, and to offer them appropriate intervention.

Beyond Haemostasis and Thrombosis: Platelets in Depression and Its Co-Morbidities

Alongside their function in primary haemostasis and thrombo-inflammation, platelets are increasingly considered a bridge between mental, immunological and coagulation-related disorders. This review focuses on the link between platelets and the pathophysiology of major depressive disorder (MDD) and its most frequent comorbidities. Platelet- and neuron-shared proteins involved in MDD are functionally described. Platelet-related studies performed in the context of MDD, cardiovascular disease, and major neurodegenerative, neuropsychiatric and neurodevelopmental disorders are transversally presented from an epidemiological, genetic and functional point of view. To provide a complete scenario, we report the analysis of original data on the epidemiological link between platelets and depression symptoms suggesting moderating and interactive effects of sex on this association. Epidemiological and genetic studies discussed suggest that blood platelets might also be relevant biomarkers of MDD prediction and occurrence in the context of MDD comorbidities. Finally, this review has the ambition to formulate some directives and perspectives for future research on this topic.

Medical diseases prior to first-time depression diagnosis and subsequent risk of admissions for depression: A nationwide study of 117,585 patients

BACKGROUND

Medical diseases and depression frequently co-occur, but it remains uncertain whether specific medical diseases or the disease load, affect the clinical course of depression.

METHODS

We identified all adults (≥18 years) at their first hospital-based diagnosis of unipolar depression in Denmark between 1996 and 2015. All medical hospital contacts since 1977 and all drug prescriptions during the previous year were identified. We followed patients for up to five years regarding hospital admissions with depression and performed adjusted Cox regression analyses calculating hazard rate ratios (HRR) including 95%-confidence intervals (CI) to test the association between medical diseases and depression admission following the index depressive episode.

RESULTS

Among 117,585 patients with depression (444,696 person-years follow-up), any prior medical hospital contact (N = 114,206; 97.1%) was associated with increased risks of admission for depression among individuals aged 18-30 (HRR=1.50; 95%CI=1.15-1.95), 31-65 (HRR=1.69; 95%CI=1.28-2.21), and >65 years (HRR=1.38; 95%CI=1.10-1.75), fitting a dose-response relationship (p<0.005) with increasing number of prior medical diseases among those aged <65. All specific medical diseases were associated with increased risks of admission for depression, particularly among individuals aged<65 (HRR ranging from 1.57 to 2.38). Drug prescriptions and medical hospital contacts in the year before the depression diagnosis were associated with reduced risks of admission.

CONCLUSION

The medical load seems to be associated with an increased risk for depression admission, particularly among individuals aged <65. The lower risk for people in medical care during the previous year may indicate better compliance and care/treatment.

Physical health in affective disorders: a narrative review of the literature

This article reviews the most common non-psychiatric comorbidities associated with affective disorders, examining the implications of their possible bidirectional link. A narrative review was conducted on the association among the three most common non-psychiatric diseases in major depressive disorder and bipolar disorder (obesity, metabolic syndrome, and cardiovascular diseases) in articles published from January 1994 to April 2020. The evidence suggests that obesity, metabolic syndrome, and cardiovascular diseases are highly prevalent in patients diagnosed with affective disorders. The presence of non-psychiatric comorbidities significantly worsens the therapeutic management and prognosis of affective disorders and vice versa. In many cases, these comorbidities may precede the onset of affective disorders, although in most cases they appear after it. The presence of these concurrent non-psychiatric diseases in an individual diagnosed with an affective disorder is associated with a more complex disease presentation and management. For professionals, the evidence unequivocally supports routine surveillance of comorbidities from a multidisciplinary approach.

Comorbid depression in medical diseases

Depression is one of the most common comorbidities of many chronic medical diseases including cancer and cardiovascular, metabolic, inflammatory and neurological disorders. Indeed, the prevalence of depression in these patient groups is often substantially higher than in the general population, and depression accounts for a substantial part of the psychosocial burden of these disorders. Many factors can contribute to the occurrence of comorbid depression, such as shared genetic factors, converging biological pathways, social factors, health behaviours and psychological factors. Diagnosis of depression in patients with a medical disorder can be particularly challenging owing to symptomatic overlap. Although pharmacological and psychological treatments can be effective, adjustments may need to be made for patients with a comorbid medical disorder. In addition, symptoms or treatments of medical disorders may interfere with the treatment of depression. Conversely, symptoms of depression may decrease adherence to treatment of both disorders. Thus, comprehensive treatment plans are necessary to optimize care.