The association between physical illness and major depressive episode in general practice

Anxiety and Associated Factors during the COVID-19 Pandemic Confinement in the Moroccan Adult Celiac Disease Population

Introduction

The widespread lockdown due to the COVID-19 pandemic was insured by Moroccan authorities in early 2020 to preserve the health of citizens. The lockdown and the pandemic imposed psychological effects on the population including anxiety. Celiac disease (CeD), a chronic disease among the most common inflammatory intestinal disorders, has been linked to adult emotional disturbances. Hence, CeD patients may suffer from anxiety or increase this condition due to the concomitant situation. The objective of this study was to assess COVID-19-related anxiety in a sample of adults with CeD in comparison with a matched healthy group.

Method

CeD patients (103) and matched healthy group (101) were investigated using a web-based COVID-19 and related lockdown anxiety survey. Anxiety was assessed with the State and Trait Anxiety Inventory (STAI test: Y1 for state anxiety and Y2 for trait anxiety).

Results

State anxiety was present among 65.3% of CeD and 41.6% of the comparison group, and the difference was statistically significant. CeD women suffered more from state anxiety than their compeers in the comparison group (t = 3.23; p = 0.002), and a significant correlation between good compliance to GFD and less state anxiety was found among CeD patients (r = 0.31; p = 0.002). 61.8% of CeD participants thought they were at higher risk of contamination by COVID-19, and they were mostly women (χ2 = 7.66, p < 0.006) and had significantly higher state anxiety mean scores than their compatriots who did not express these thoughts (t = 2.93; p = 0.004). Additionally, 41.5% of CeD participants had anxiety as a trait against 26.7% in the comparison group and the difference between the two groups was statistically significant.

Conclusion

Results of this survey allow a better understanding of the health-related pandemic effects on Moroccan CeD patients. It demonstrates that COVID-19 and related lockdowns had a serious impact on the psychological balance of these patients by increasing their anxiety. The survey results underlined the need to improve the psychological care of CeD patients notably by considering remote medical visits during this ongoing pandemic to provide mental health support.

Associations of Underlying Health Conditions With Anxiety and Depression Among Outpatients: Modification Effects of Suspected COVID-19 Symptoms, Health-Related and Preventive Behaviors

Objectives: We explored the association of underlying health conditions (UHC) with depression and anxiety, and examined the modification effects of suspected COVID-19 symptoms (S-COVID-19-S), health-related behaviors (HB), and preventive behaviors (PB). Methods: A cross-sectional study was conducted on 8,291 outpatients aged 18-85 years, in 18 hospitals and health centers across Vietnam from 14th February to May 31, 2020. We collected the data regarding participant's characteristics, UHC, HB, PB, depression, and anxiety. Results: People with UHC had higher odds of depression (OR = 2.11; p < 0.001) and anxiety (OR = 2.86; p < 0.001) than those without UHC. The odds of depression and anxiety were significantly higher for those with UHC and S-COVID-19-S (p < 0.001); and were significantly lower for those had UHC and interacted with "unchanged/more" physical activity (p < 0.001), or "unchanged/more" drinking (p < 0.001 for only anxiety), or "unchanged/healthier" eating (p < 0.001), and high PB score (p < 0.001), as compared to those without UHC and without S-COVID-19-S, "never/stopped/less" physical activity, drinking, "less healthy" eating, and low PB score, respectively. Conclusion: S-COVID-19-S worsen psychological health in patients with UHC. Physical activity, drinking, healthier eating, and high PB score were protective factors.

Systematic review on the instruments used for measuring the association of the level of multimorbidity and clinically important outcomes

OBJECTIVES

There are multiple instruments for measuring multimorbidity. The main objective of this systematic review was to provide a list of instruments that are suitable for use in studies aiming to measure the association of a specific outcome with different levels of multimorbidity as the main independent variable in community-dwelling individuals. The secondary objective was to provide details of the requirements, strengths and limitations of these instruments, and the chosen outcomes.

METHODS

We conducted the review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO registration number: CRD42018105297). We searched MEDLINE, Embase and CINAHL electronic databases published in English and manually searched the Journal of Comorbidity between 1 January 2010 and 23 October 2020 inclusive. Studies also had to select adult patients from primary care or general population and had at least one specified outcome variable. Two authors screened the titles, abstracts and full texts independently. Disagreements were resolved with a third author. The modified Newcastle-Ottawa Scale was used for quality assessment.

RESULTS

Ninety-six studies were identified, with 69 of them rated to have a low risk of bias. In total, 33 unique instruments were described. Disease Count and weighted indices like Charlson Comorbidity Index were commonly used. Other approaches included pharmaceutical-based instruments. Disease Count was the common instrument used for measuring all three essential core outcomes of multimorbidity research: mortality, mental health and quality of life. There was a rise in the development of novel weighted indices by using prognostic models. The data obtained for measuring multimorbidity were from sources including medical records, patient self-reports and large administrative databases.

CONCLUSIONS

We listed the details of 33 instruments for measuring the level of multimorbidity as a resource for investigators interested in the measurement of multimorbidity for its association with or prediction of a specific outcome.

The role of gender and anxiety in the association between somatic diseases and depression: findings from three combined epidemiological studies in primary care

AIMS

Although associations between various somatic diseases and depression are well established, findings concerning the role of gender and anxiety disorders for these associations remain fragmented and partly inconsistent. Combining data from three large-scaled epidemiological studies in primary care, we aim to investigate interactions of somatic diseases with gender and anxiety disorders in the association with depression.

METHODS

Self-reported depression according to the International Classification of Diseases, Tenth Edition (ICD-10) was assessed in n = 83 737 patients from three independent studies [DETECT (Diabetes Cardiovascular Risk Evaluation: Targets and Essential Data for Commitment of Treatment), Depression-2000 and Generalized Anxiety and Depression in Primary Care (GAD-P)] using the Depression Screening Questionnaire (DSQ). Diagnoses of depression, anxiety disorders and somatic diseases were obtained from treating physicians via standardised clinical appraisal forms.

RESULTS

In logistic regressions, adjusted for gender, age group and study, each somatic disease except for arterial hypertension and endocrine diseases was associated with self-reported depression (odds ratio, OR 1.3-2.6) and each somatic disease was associated with physician-diagnosed depression (OR 1.1-2.4). Most of these associations remained significant after additional adjustment for anxiety disorders and other somatic diseases. The associations with depression increased with a higher number of somatic diseases. Cardiovascular diseases (OR 0.8), diabetes mellitus (OR 0.8) and neurological diseases (OR 0.8) interacted with gender in the association with self-reported depression, while endocrine diseases (OR 0.8) interacted with gender in the association with physician-diagnosed depression. That is, the associations between respective somatic diseases and depression were less pronounced in females v. males. Moreover, cardiovascular diseases (OR 0.7), arterial hypertension (OR 0.8), gastrointestinal diseases (OR 0.7) and neurological diseases (OR 0.6) interacted with anxiety disorders in the association with self-reported depression, and each somatic disease interacted with anxiety disorders in the association with physician-diagnosed depression (OR 0.6-0.8). That is, the associations between respective somatic diseases and depression were less pronounced in patients with v. without anxiety disorders; arterial hypertension was negatively associated with self-reported depression only in patients with anxiety disorders, but not in patients without anxiety disorders.

CONCLUSIONS

A range of somatic diseases as well as anxiety disorders are linked to depression - and especially patients with co-/multi-morbidity are affected. However, interactions with gender and anxiety disorders are noteworthy and of relevance to potentially improve recognition and treatment of depression by physicians. Somatic diseases are associated more strongly with depression in males v. females as well as in patients without v. with anxiety disorders, primarily because women and patients with anxiety disorders per se are characterised by considerably increased depression prevalence that only marginally changes in the presence of somatic comorbidity.

[Frequency of physical symptoms in anxiety-depressive disorders: cross-sectional study in a population of 202 psychiatric consultants]

Introduction

les symptômes physiques associés aux troubles anxio-dépressifs ont fait l'objet de plusieurs études depuis plusieurs décennies, vu leurs fréquences et leurs conséquences. Le but de notre étude est de préciser la fréquence des principaux symptômes physiques dans les troubles anxieux: trouble panique (TP), trouble anxiété généralisée (TAG) et troubles phobiques (TPh), ainsi que dans les troubles dépressifs: épisode dépressif majeur (EDM) dans le cadre d'un trouble dépressif.

Méthodes

nous avons mené une étude transversale à visée descriptive, réalisée sur un échantillon de 202 consultants dans un service de psychiatrie.

Résultats

l'âge moyen des patients est de 42 ans (19 à 70 ans), avec une légère prédominance féminine: 118 (58%). Les troubles anxio-dépressifs constatés sont: l'EDM: 113(56%), le TP: 61 (30.2%), le TAG: 55 (27.2%) et les TPh: 30 (14.9%). La fréquence des patients présentant de 2 à 5, et plus de 5 symptômes était respectivement de 15.9% et 39.6% dans les troubles dépressifs, et de 9.5% et 62.9% dans les troubles anxieux. Les symptômes les plus rapportés sont d'ordre cardiopulmonaire (75%), général (73.8%) et neurologique (65.8%).

Conclusion

les symptômes physiques qui accompagnent les troubles anxio-dépressifs sont variables et souvent nombreux. Ils peuvent aggraver le pronostic de ces troubles psychiatriques en rendant difficile leur prise en charge. Un dépistage précoce de ces troubles, en portant une attention particulière à ces symptômes physiques, permettra de prévenir ces complications.

Multimorbidity and depression: A systematic review and meta-analysis

BACKGROUND

Multimorbidity, the presence of two or more chronic conditions, is increasingly common and complicates the assessment and management of depression. The aim was to investigate the relationship between multimorbidity and depression.

METHOD

A systematic literature search was conducted using the databases; PsychINFO, Medline, Embase, CINAHL and Cochrane Central. Results were meta-analysed to determine risk for a depressive disorder or depressive symptoms in people with multimorbidity.

RESULTS

Forty articles were identified as eligible (n = 381527). The risk for depressive disorder was twice as great for people with multimorbidity compared to those without multimorbidity [RR: 2.13 (95% CI 1.62-2.80) p<0.001] and three times greater for people with multimorbidity compared to those without any chronic physical condition [RR: 2.97 (95% CI 2.06-4.27) p<0.001]. There was a 45% greater odds of having a depressive disorder with each additional chronic condition compared to the odds of having a depressive disorder with no chronic physical condition [OR: 1.45 (95% CI 1.28-1.64) p<0.001]. A significant but weak association was found between the number of chronic conditions and depressive symptoms [r = 0.26 (95% CI 0.18-0.33) p <0.001].

LIMITATIONS

Although valid measures of depression were used in these studies, the majority assessed the presence or absence of multimorbidity by self-report measures.

CONCLUSIONS

Depression is two to three times more likely in people with multimorbidity compared to people without multimorbidity or those who have no chronic physical condition. Greater knowledge of this risk supports identification and management of depression.

Association of social anxiety disorder with depression and quality of life among medical undergraduate students

Objective:

Social anxiety disorder (SAD), (also known as social phobia), is characterized by intense fear of social interaction and often associated with social avoidance and impairments. There is high risk for depression, substance use disorder, and suicide among them.

Subjects and Methods:

It is an observational, cross-sectional, single centered, questionnaire-based study assessing the frequency of SAD and depression and their possible association with quality of life among 290 consenting medical undergraduate students. Social Phobia Inventory (SPIN), Beck's Depression Inventory (BDI II), and the World Health Organization Quality of Life assessment scale (WHOQOL-BREF) were used to screen and assess severity of SAD, depression, and quality of life, respectively. The statistical analysis of proportions was done by Chi-square test, while the scores of SPIN, BDI II, and WHOQOL-BREF was compared using Mann–Whitney test or Kruskal–Wallis test followed by Dunn posttest multiple comparison, using GraphPad InStat version 3.06.

Results:

Frequency of SAD is 11.37%, and depression is 8.96%. Females are more likely to experience SAD. Participants with SAD are more likely to experience depression (P < 0.0001) and have poor quality of life (P = 0.01). Participants with depression have higher SPIN score (P < 0.0001) and poor quality of life (P < 0.0001). Females are more likely to experience social fear (P = 0.02). Participants staying away from their family are more likely to experience social anxiety in comparison to their peers (P = 0.01). Severity of depression is correlated with severity of social anxiety (Spearman r = 0.4423 [0.3416–0.5329], P < 0.0001).

Conclusion:

Participants with SAD are more likely to experience depressive symptoms and have poor quality of life and vice versa.

Parental social networks during childhood and offspring depression in early adulthood: a lifecourse approach

BACKGROUND

Little is known on how parental social relationships may affect their children's mental health. We sought to examine the relation between parental social relationship characteristics and subsequent offspring depression in young adulthood.

METHODS

We used 2009 Trajectoires Épidémiologiques en Population (TEMPO) study data from 1087 French young adults ages 22 to 35 and parental data from the corresponding Gaz et Eléctricité (GAZEL) study in 1991. Multivariable logistic regression was used to examine parental social networks, quality of parental relationships, and reciprocity of parental social support measured in 1991 in relation to offspring depression in young adulthood measured using the Adult Self Report in 2009. Analyses were stratified by participant sex.

RESULTS

In adjusted models, daughters of parents who reported giving more support to others than they received had 1.72 higher odds (95% CI, 1.09-2.70) of depression in young adulthood. Daughters of parents who were unsatisfied with their social relationships had 2.14 (95% CI, 1.22-3.76) higher odds of depression. Among male participants, there was no statistically significant association between parental relationship satisfaction, reciprocity of parental exchanges, and depression.

CONCLUSIONS

Parental relationships during mid-childhood have long-term associations with offspring depression. Results suggest that enhancing social support for parents may have positive implications for their children's mental health.

Do self-referent metacognition and residential context predict depressive symptoms across late-life span? A developmental study in an Italian sample

OBJECTIVES

There is controversial evidence concerning the variables favoring depression in community-dwelling elderly individuals. This study mainly investigates the impact of lifestyle, residential environment, cognitive efficiency and social desirability in predicting self-assessed depressive signs in late adult span.

METHOD

One hundred forty-nine elders were recruited in Northern Italy and Sardinia - an Italian island characterized by the longevity of people living in the inner areas. Participants were presented a battery of questionnaires assessing cognitive efficiency and self-referent measures of depression, metacognition and social desirability.

RESULTS

A hierarchical regression analysis showed that residential environment was the most effective predictor of depressive symptoms, along with gardening and spending time for hobbies. In contrast, social desirability and metacognitive scores played a minor role in predicting mental health. An analysis of variance showed that Sardinian elders showed fewer signs of depression than age-matched elders residing in Northern Italy.

CONCLUSION

The Sardinian residential environment is a strong predictor of preserved mental health in late adulthood. In contrast, self-rated metacognitive efficiency and social desirability play a very marginal role in predicting depression among the elderly.

Psychological well-being and metacognition in the fourth age: an explorative study in an Italian oldest old sample

OBJECTIVES

The research largely aimed at exploring the impact of marital status, cognitive efficiency, gender, physical health and sociocultural context on self-rated emotional competence, depression, memory and cognitive measures.

METHOD

Ninety-four healthy adults aged 75-99 were recruited in the Sardinian province of Ogliastra, where a collectivistic culture prevails, and in northern Italy, which in turn is characterized by the prevalence of individualistic cultural traits. Participants were administered self-referent metacognitive efficiency, subjective wellness and depression measures.

RESULTS

Sardinian elders self-rated lower levels of depression and cognitive failures and had greater levels of emotional competence.

CONCLUSIONS

Perceived psychological well-being, metacognitive efficiency and depression seem to be affected by sociocultural context.

Personality disorder and self-rated health: a population-based cross-sectional survey

Little is known about the impact of personality disorder (PD) on the health of people living in the community. The authors set out to examine the association between PD and general health, using a cross-sectional survey of a representative community sample in London, UK. A total of 1,698 adults aged 16 years or over from 1,075 randomly selected households were recruited and interviewed face-to-face by trained interviewers. Using multivariable logistic regression, the authors examined the cross-sectional association between PD screen status, as assessed by the Standardised Assessment of Personality-Abbreviated Scale (SAPAS), and self-rated health, adjusting for demographic and health covariates. Of the participants, 14.5% screened positively for PD. A greater proportion of those scoring positively for PD reported poor self-rated health, compared to screen negative participants (41.3% versus 15.0%). This association was reduced, but remained significant, after adjustment for potential confounders (unadjusted odds ratio (OR) = 3.99, 95% CI [2.93, 5.42]; fully adjusted OR = 1.53, 95% CI [1.02, 2.29]. Of note, subthreshold symptoms of PD were significantly associated with poor self-rated health (unadjusted OR per unit SAPAS score increment = 1.53, 95% CI [1.40, 1.67]; fully adjusted OR = 1.19, 95% CI [1.07, 1.33]. Furthermore, people screening positive for PD were more likely to report multiple (three or more) long-standing illnesses. The authors conclude that in the general population, individuals who are at high risk for PD are independently at increased risk of poor general health.

Risk factors for suicide among 34,671 patients with psychotic and non-psychotic severe depression

BACKGROUND

Severe unipolar depression is associated with increased risk of suicide, but it remains unknown whether the same risk factors are present in the non-psychotic (non-PD) and psychotic (PD) subtypes respectively. Therefore, this study aimed to identify risk factors for suicide in non-PD and PD separately, and to investigate if the presence of psychotic symptoms is an independent risk factor for suicide in severe depression.

METHODS

This register-based, nationwide, historical prospective cohort study used logistic regression analyses to ascertain risk factors for suicide among all adults diagnosed with severe depression at Danish psychiatric hospitals between January 1, 1994 and December 31, 2010. The risk for suicide was expressed as adjusted odds ratios (AOR).

RESULTS

A total of 34,671 individuals with severe depression (non-PD: n=26,106 and PD: n=12,101) were included in the study. Of these, 755 completed suicide during follow up. PD was not found to be an independent risk factor for suicide in severe depression (AOR=0.97 [0.83-1.15]). Older age (non-PD AOR=1.05 [per year], PD AOR=1.04 [per year]), male sex (non-PD AOR=1.89, PD AOR=1.98), and a previous incident of self-harm (non-PD AOR=5.02, PD AOR=5.17) were significant risk factors for both groups.

LIMITATIONS

As the study population was comprised only of patients with contact to psychiatric hospitals, the results cannot be extrapolated to the primary care setting.

CONCLUSION

The following risk factors for non-PD and PD were identified: older age, male gender and previous incidents of self-harm. In suicide prevention efforts, equal attention should be paid to non-PD and PD patients.

Factors affecting the presence of depression, anxiety disorders, and suicidal ideation in patients attending primary health care service in Lithuania

OBJECTIVE

The aim of this study was to establish prevalence, recognition, and risk factors for mental disorders and suicidal ideation in PC patients.

DESIGN

A cross-sectional survey based on standard mental health evaluation.

SETTING

Lithuanian primary care.

SUBJECTS

998 patients from four urban PC clinics.

MAIN OUTCOME MEASURES

Current mental disorders and suicidal ideation assessed using the Mini International Neuropsychiatric Interview (MINI).

RESULTS

According to the MINI, 27% of patients were diagnosed with at least one current mental disorder. The most common mental disorders were generalized anxiety disorder (18%) and major depressive episode (MDE) (15%), followed by social phobia (3%), panic disorder (3%), and post-traumatic stress disorder (2%). Some 6% of patients reported suicidal ideation. About 70% of patients with current mental disorder had no documented psychiatric diagnosis and about 60% received no psychiatric treatment. Greater adjusted odds for current MDE were associated with being widowed or divorced patients (odds ratio, OR = 1.8, 95% CI 1.2-2.8) and with lower education (OR = 1.6, 95% CI 1.1-2.3), while greater adjusted odds for any current anxiety disorder were found for women (OR = 1.9, 95% CI 1.3-2.8) and for patients with documented insomnia (OR = 2.2, 95% CI 1.2-4.2). Suicidal ideation was independently associated with use of antidepressants (OR = 5.4, 95% CI 1.7-16.9), with current MDE (OR = 2.9, 95% CI 1.5-5.8), and with excessive alcohol consumption (OR = 2.0, 95% CI 1.1-3.8).

CONCLUSIONS

Depression, anxiety disorders, and suicidal ideation are prevalent but poorly recognized among PC patients. The presence of current MDE is independently associated with marital status and with lower education, while current anxiety disorder is associated with female gender and insomnia. Suicidal ideation is associated with current MDE, and with antidepressants and alcohol use.

Correlates of depressive symptoms in urban middle-aged and elderly Lithuanians

PURPOSE

The study aimed to examine the prevalence of depressive symptoms and their correlates in urban middle-aged and elderly Lithuanian adults.

METHODS

Data from the survey was collected within the framework of the international project HAPIEE (Health, Alcohol and Psychosocial Factors in Eastern Europe). A random sample of 7,115 individuals aged 45-72 years was screened in 2006-2008.

RESULTS

Depressive symptoms were differently associated with independent variables by sex. In men, deprivation (OR 1.85, 95 % CI 1.54-2.17), being divorced (OR 2.34, 95 % CI 1.61-3.39) or widowed (OR 3.64, 95 % CI 2.40-5.52), physical inactivity (OR 1.30, 95 % CI 1.02-1.65), having a history of spine and joint disease (OR 1.72, 95 % CI 1.36-2.17), average perceived health (OR 2.14, 95 % CI 1.55-2.95), poor perceived health (OR 5.13, 95 % CI 3.39-7.76), average quality of life (OR 2.0, 95 % CI 1.55-2.95), or poor quality of life (OR 8.86, 95 % CI 5.19-15.13) were significantly associated with depressive symptoms. In women, deprivation (OR 1.28, 95 % CI 1.15-1.43), being widowed (OR 1.52, 95 % CI 1.23-1.88), mean dose of alcohol per occasion 40-79.9 g (OR 1.65, 95 % CI 1.18-2.30) and more than 80 g (OR 2.09, 95 % CI 1.14-3.82), physical inactivity in leisure time (OR 1.27, 95 % CI 1.04-1.57), having a history of spine and joint disease (OR 1.26, 95 % CI 1.06-1.51), average perceived health (OR 2.56, 95 % CI 1.89-2.72), poor perceived health (OR 5.07, 95 % CI 3.62-7.11), average quality of life (OR 2.27, 95 % CI 1.89-2.72), or poor quality of life (OR 7.21, 95 % CI 4.73-11.00) were significantly associated with depressive symptoms.

CONCLUSIONS

Health status and lifestyle factors are associated with depressive symptoms. Associations between depressive symptoms and long-term health problems are partially mediated by self-rated quality of life and self-rated health.

The association between physical morbidity and subtypes of severe depression

BACKGROUND

Physical illness and depression are related, but the association between specific physical diseases and diagnostic subtypes of depression remains poorly understood. This study aimed to clarify the relationship between a number of physical diseases and the nonpsychotic and psychotic subtype of severe depression.

METHODS

This is a historical prospective cohort study. The study population consisted of all patients diagnosed with ICD-10 severe depression, either nonpsychotic or psychotic subtype, in Danish psychiatric hospitals between 1994 and 2008. The patients' history of physical disease was assessed using the Danish National Patient Register. Using logistic regression it was investigated whether specific physical diseases were associated with relative increased risk for subsequent development of either the nonpsychotic or psychotic depressive subtype.

RESULTS

A total of 24,173 patients with severe depression were included in the study. Of those, 8,260 (34%) were of the psychotic subtype. A history of the following physical diseases, as opposed to their absence, increased the relative risk for subsequent development of the nonpsychotic compared to the psychotic depressive subtype [adjusted incidence odds ratio (AIOR) nonpsychotic vs. psychotic]: ischemic heart disease (AIOR = 1.3, p < 0.001), hypertension (AIOR = 1.2, p = 0.008), stroke (AIOR = 1.2, p = 0.042) and chronic lower pulmonary disease (AIOR = 1.2, p = 0.005). The total load of physical disease also increased the relative risk of nonpsychotic depression [AIOR = 1.05 (per disease), p = 0.001].

CONCLUSIONS

This study revealed that, in severe depression, a history of physical disease increased the relative risk of the nonpsychotic rather than the psychotic subtype.

Incidence and risk of mood disorders in patients with breast cancers in Taiwan: a nationwide population-based study

OBJECTIVE

The objective of this study is to assess the incidence and risk of mood disorders, including major depression, anxiety, and bipolar disorders, in Taiwanese patients after the diagnosis of breast cancer compared with a matched cohort.

METHODS

From January 2000 to December 2005, 26,629 newly diagnosed breast cancer patients were enrolled by the Taiwan National Health Insurance program database. The control cohort was selected randomly from 1,000,000 National Health Insurance beneficiaries from a population of 21,400,826 enrolled throughout Taiwan. Each patient was matched with one subject without breast cancer by age, sex, and presence of comorbidities with the same diagnosis index date. The diagnosis of mood disorders was defined by compatible International Classification of Diseases, 9th revision, clinical modification codes plus the prescription of antidepressants for at least 30 days.

RESULTS

The overall incidence rate ratio of mood disorders was 1.33 (95% CI 1.28-1.39, p < 0.001) in the breast cancer cohort compared with the matched cohort. The incidence rate ratios for specific mood disorders were 2.06 for bipolar disorder (95% CI 1.37-3.15 p = 0.0003), 1.94 for major depressive disorder (95% CI 1.76-2.13 p < 0.001), and 1.22 for anxiety (95% CI 1.16-1.27 p < 0.001). Independent risk factors for developing mood disorders included breast cancer, as well as age, hypertension, chronic obstructive pulmonary disease, autoimmune disease, ischemic heart disease, and cerebrovascular disease.

CONCLUSIONS

Breast cancer is a prominent risk factor for mood disorders, including major depressive disorder, anxiety, and bipolar disorder. The impact is most potent in the first year after diagnosis. Psychological support is a critical issue in these patients.

Meta-analysis on anxiety and depression in adult celiac disease

OBJECTIVE

We used meta-analysis to test hypotheses concerning whether adult celiac disease is reliably linked with anxiety and/or depression.

METHOD

We examined published reports on anxiety and depression in adult celiac disease.

RESULTS

Eighteen studies on depression and eleven studies on anxiety in adult celiac disease met selection criteria. They show that depression is reliably more common and/or more severe in adults with celiac disease than in healthy adults (overall meta-analysis effect size: 0.97). The fail-safe margin of unpublished reports that would be required to negate the finding exceeds 8000. Adults with celiac disease do not, however, differ reliably in terms of depression from adults with other physical illnesses, nor do they differ reliably from healthy adults or adults with other physical illnesses in terms of anxiety.

CONCLUSION

Depression is common in adult celiac disease and resembles the condition in other physical illnesses. We view the findings as support for the notion that non-specific mechanisms mediate emotional disorders in adult celiac disease.