Study of depression influencing factors with zero-inflated regression models in a large-scale population survey

Air pollution and age-dependent changes in emotional behavior across early adolescence in the U.S

Recent studies have linked air pollution to increased risk for behavioral problems during development, albeit with inconsistent findings. Additional longitudinal studies are needed that consider how emotional behaviors may be affected when exposure coincides with the transition to adolescence - a vulnerable time for developing mental health difficulties. This study investigates if annual average PM2.5 and NO2 exposure at ages 9-10 years moderates age-related changes in internalizing and externalizing behaviors over a 2-year follow-up period in a large, nationwide U.S. sample of participants from the Adolescent Brain Cognitive Development (ABCD) Study®. Air pollution exposure was estimated based on the residential address of each participant using an ensemble-based modeling approach. Caregivers answered questions from the Child Behavior Checklist (CBCL) at the baseline, 1-year follow-up, and 2-year follow-up visits, for a total of 3 waves of data; from the CBCL we obtained scores on internalizing and externalizing problems plus 5 syndrome scales (anxious/depressed, withdrawn/depressed, rule-breaking behavior, aggressive behavior, and attention problems). Zero-inflated negative binomial models were used to examine both the main effect of age as well as the interaction of age with each pollutant on behavior while adjusting for various socioeconomic and demographic characteristics. Against our hypothesis, there was no evidence that greater air pollution exposure was related to more behavioral problems with age over time.

Iron Deficiency is Related to Depressive Symptoms in United States Nonpregnant Women of Reproductive Age: A Cross-Sectional Analysis of NHANES 2005-2010

BACKGROUND

Findings of the association between iron status and depressive symptoms in nonpregnant women of reproductive age (WRA) are equivocal, limited by a small sample size, or did not consistently control for confounders.

OBJECTIVE

We tested the association between iron status and depressive symptoms in WRA with the NHANES data (2005-2010).

METHODS

Nonpregnant WRA (20-44 y) with complete data on iron (ferritin and transferrin receptor (TfR)) and anemia (hemoglobin) biomarkers, depressive symptoms (Patient Health Questionnaire-9), and sociodemographic variables were included. Logistic and negative binomial regressions were used to estimate presence (odds ratios) and magnitude (prevalence ratios), respectively, for depressive symptoms by iron deficiency (ID)/anemia/ID anemia in the total sample and stratified by poverty:income ratio (≤ 1.85 or >1.85).

RESULTS

Among 2516 females, the prevalence of ID was 8 to 16% (depending on the iron biomarker used), of anemia 8%, of which 52 to 65% were also ID. The prevalence of depressive symptoms was 10%. Crude logistic models showed that females with ID (TfR ≥ 8.3 mg/L or body iron <0 mg/kg) from the total sample had 1.82 (95% confidence interval [CI]: 1.24, 2.68) and 1.62 (95% CI: 1.05, 2.48), respectively, higher odds of depressive symptoms than females with iron sufficiency; these associations were attenuated after adjustments for confounders. Adjusted negative binomial models showed that females with ID (TfR ≥ 8.3 mg/L) from the total and low-income samples showed 1.19 (95% CI: 1:00, 1.40) and 1.27 (95% CI: 1.03, 1.58), respectively, higher prevalence ratios of depressive symptoms scores than females with iron sufficiency.

CONCLUSIONS

These nationally representative data indicate that nonpregnant WRA with ID (based on high TfR) in the United States have higher prevalence of somatic depressive symptoms scores than those with iron sufficiency, especially if they are of low income.

COVID-19 government measures and their impact on mental health: a cross-sectional study of older primary care patients in Germany

Background

With the outbreak of COVID-19, government measures including social distancing and restrictions of social contacts were imposed to slow the spread of the virus. Since older adults are at increased risk of severe disease, they were particularly affected by these restrictions. These may negatively affect mental health by loneliness and social isolation, which constitute risk factors for depressiveness. We aimed to analyse the impact of perceived restriction due to government measures on depressive symptoms and investigated stress as mediator in an at-risk-population in Germany.

Methods

Data were collected in April 2020 from the population of the AgeWell.de-study, including individuals with a Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) score ≥9, using the depression subscale of the Brief Symptom Inventory (BSI-18) and the Perceived Stress Scale (PSS-4). Feeling restricted due to COVID-19 government measures was surveyed with a standardized questionnaire. Stepwise multivariate regressions using zero-inflated negative binomial models were applied to analyse depressive symptoms, followed by a general structural equation model to assess stress as mediator. Analysis were controlled for sociodemographic factors as well as social support.

Results

We analysed data from 810 older adults (mean age = 69.9, SD = 5). Feeling restricted due to COVID-19 government measures was linked to increased depressiveness (b = 0.19; p < 0.001). The association was no longer significant when adding stress and covariates (b = 0.04; p = 0.43), while stress was linked to increased depressive symptoms (b = 0.22; p < 0.001). A final model confirms the assumption that the feeling of restriction is mediated by stress (total effect: b = 0.26; p < 0.001).

Conclusion

We found evidence that feeling restricted due to COVID-19 government measures is associated with higher levels of depressive symptoms in older adults at increased risk for dementia. The association is mediated by perceived stress. Furthermore, social support was significantly associated with less depressive symptoms. Thus, it is of high relevance to consider possible adverse effects of government measures related to COVID-19 on mental health of older people.

Air pollution and emotional behavior in adolescents across the U.S

Recent studies have linked air pollution to increased risk for behavioral problems during development, albeit with inconsistent findings. Additional longitudinal studies are needed that consider how emotional behaviors may be affected when exposure coincides with the transition to adolescence - a vulnerable time for developing mental health difficulties. This study examines how annual average PM2.5 and NO2 exposure at ages 9-10 years relates to internalizing and externalizing behaviors over a 2-year follow-up period in a large, nationwide U.S. sample of participants from the Adolescent Brain Cognitive Development (ABCD) Study®. Air pollution exposure was estimated based on the residential address of each participant using an ensemble-based modeling approach. Caregivers answered questions from the Child Behavior Checklist (CBCL) at baseline and annually for two follow-up sessions for a total of 3 waves of data; from the CBCL we obtained scores on internalizing and externalizing problems plus 5 syndrome scales (anxious/depressed, withdrawn/depressed, rule-breaking behavior, aggressive behavior, and attention problems). Zero-inflated negative binomial models were used to examine both the main effect of age as well as the interaction of age with each pollutant on behavior while adjusting for various socioeconomic and demographic characteristics. Overall, the pollution effects moderated the main effects of age with higher levels of PM2.5 and NO2 leading to an even greater likelihood of having no behavioral problems (i.e., score of zero) with age over time, as well as fewer problems when problems are present as the child ages. Albeit this was on the order equal to or less than a 1-point change. Thus, one year of annual exposure at 9-10 years is linked with very small change in emotional behaviors in early adolescence, which may be of little clinical relevance.

Healthy Aging at Family Mealtimes: Associations of Clean Cooking, Protein Intake, and Dining Together with Mental Health of Chinese Older Adults amid COVID-19 Pandemic

The present study aims to examine whether multiple dietary factors affect the mental health of older adults amid the COVID-19 pandemic. It proposes an integrative dietary framework that highlights environmental, nutritional, and social aspects of diet for healthy aging. Based on a sample of 7858 Chinese older adults, the associations between diet and depressive symptoms, along with the rural-urban divide, were examined using zero-inflated negative binomial regression. Overall, protein intake (incidence-rate ratio [IRR] = 0.89, p < 0.001), frequency of family dining together (IRR = 0.98, p < 0.001), and using tap water for cooking (IRR = 0.92, p < 0.01) were associated with lower incidence rates of depressive symptoms among older adults. Among rural older adults, frequency of family dining together (IRR = 0.97, p < 0.001) and tap water use (IRR = 0.89, p < 0.001) were associated with fewer depressive symptoms. However, urban residents who had a higher frequency of family dining together (IRR = 0.98, p < 0.05) and protein intake (IRR = 0.81, p < 0.001) exhibited fewer depressive symptoms. The findings revealed multifaceted dietary pathways towards healthy aging, which call for policies and interventions that improve diet quality for community-dwelling older adults.

Randomized quantile residuals for diagnosing zero-inflated generalized linear mixed models with applications to microbiome count data

BACKGROUND

For differential abundance analysis, zero-inflated generalized linear models, typically zero-inflated NB models, have been increasingly used to model microbiome and other sequencing count data. A common assumption in estimating the false discovery rate is that the p values are uniformly distributed under the null hypothesis, which demands that the postulated model fit the count data adequately. Mis-specification of the distribution of the count data may lead to excess false discoveries. Therefore, model checking is critical to control the FDR at a nominal level in differential abundance analysis. Increasing studies show that the method of randomized quantile residual (RQR) performs well in diagnosing count regression models. However, the performance of RQR in diagnosing zero-inflated GLMMs for sequencing count data has not been extensively investigated in the literature.

RESULTS

We conduct large-scale simulation studies to investigate the performance of the RQRs for zero-inflated GLMMs. The simulation studies show that the type I error rates of the GOF tests with RQRs are very close to the nominal level; in addition, the scatter-plots and Q-Q plots of RQRs are useful in discerning the good and bad models. We also apply the RQRs to diagnose six GLMMs to a real microbiome dataset. The results show that the OTU counts at the genus level of this dataset (after a truncation treatment) can be modelled well by zero-inflated and zero-modified NB models.

CONCLUSION

RQR is an excellent tool for diagnosing GLMMs for zero-inflated count data, particularly the sequencing count data arising in microbiome studies. In the supplementary materials, we provided two generic R functions, called rqr.glmmtmb and rqr.hurdle.glmmtmb, for calculating the RQRs given fitting outputs of the R package glmmTMB.

National Norms and Correlates of the PHQ-8 and GAD-7 in Parents of School-age Children

Anxiety and depressive disorders are global public health concerns, and research suggests that these disorders are common in parents and can adversely influence family functioning. However, little is known about normative levels of anxiety and depressive symptoms in parents of school-age children. The present study reports on generalized anxiety and depressive symptoms in 1570 parents and guardians of a nationally representative sample of children ages five to twelve years using two widely used and validated questionnaires: the eight-item variant of the Patient Health Questionnaire depression scale (PHQ-8) and the seven-item Generalized Anxiety Disorder scale (GAD-7). Moderate to severe levels of generalized anxiety symptoms were reported in 12.7% of the total sample and moderate to severe levels of depressive symptoms were reported in 14.1% of the sample; 17.7% of the sample reported moderate to severe levels of either generalized anxiety or depressive symptoms. This percentage was higher for females, younger parents and guardians, and parents and guardians reporting lower household incomes. These data, collected online in early 2018, may be useful for researchers and clinicians studying and treating anxiety and depression in parents. Further, these data provide a baseline for researchers currently studying the impact of changes related to the novel coronavirus (COVID-19) pandemic (e.g., school closures) on the mental health of parents of school-age children.

The association between natural outdoor environments and common somatic symptoms

There is growing evidence that urban natural outdoor environments (NOE) may positively impact health by reducing stress and stress-related symptoms. However, there is limited research investigating this link across a range of NOE indicators. This cross-sectional study investigated the association between neighbourhood NOE (availability, use, and satisfaction with NOE) and common somatic symptoms and the role of potential mediators. Data were analysed from 3481 adults from Barcelona (Spain), Doetinchem (Netherlands), Kaunas (Lithuania) and Stoke-on-Trent (United Kingdom). NOE data were obtained through self-reported data and environmental measurements. Common somatic symptom data were self-reported. Mixed effects regression models were used for analysis, with models adjusted for potential sociodemographic confounders. Higher satisfaction with neighbourhood NOE was associated with lower prevalence of common somatic symptoms (exp(β) 0.97; 95% CI 0.96, 0.98); an association partially mediated by mental health, social cohesion and air quality concern. A longer time spent in NOE was associated with lower prevalence of common somatic symptoms in low socioeconomic status neighbourhoods (exp(β) 0.98; 95% CI 0.96, 1.00). A higher number of neighbourhood green spaces (300m buffer) was associated with higher prevalence of common somatic symptoms (exp(β) 1.03; 95% CI 1.00, 1.05). No statistically significant associations were found for other NOE indicators. Study findings suggest that higher satisfaction with NOE may be associated with lower prevalence of common somatic symptoms, with mental health, social cohesion and concern about air quality playing partial mediating roles. Little evidence was found of an association between objective NOE measurements and common somatic symptoms, underlining the importance of perceptions of NOE for conferring health benefits.

Problems paying medical bills and mental health symptoms post-Affordable Care Act

Healthcare affordability is a worry for many Americans. We examine whether the relationship between having problems paying medical bills and mental health problems changed as the Affordable Care Act (ACA) was implemented, which increased health insurance coverage. Data from the 2013–2016 Health Reform Monitoring Survey, a survey of Americans aged 18–64, were used. Using zero-inflated negative binomial regression, adjusted for predisposing, enabling, and need factors, we examined differences in days of mental health symptoms by problems paying medical bills (n = 85,430). From 2013 to 2016, the rates of uninsured and problems paying medical bills decreased from 15.1% to 9.0% and 22.0% to 18.6%, respectively. Having one or more days of mental health symptoms increased from 39.3% to 42.9%. Individuals who reported problems paying medical bills had more days of mental health symptoms (Beta = 0.133, p < 0.001) than those who did not have this problem. Insurance was not significantly associated with days of mental health symptoms. Over the 4-year period, there were not significant differences in days of mental health symptoms by problems paying medical bills or insurance status. Despite improvements in coverage, the relationship between problems paying medical bills and mental health symptoms was not modified.

Association of Race and Ethnicity With Late-Life Depression Severity, Symptom Burden, and Care

Importance

Knowledge gaps persist regarding racial and ethnic variation in late-life depression, including differences in specific depressive symptoms and disparities in care.

Objective

To examine racial/ethnic differences in depression severity, symptom burden, and care.

Design, Setting, and Participants

This cross-sectional study included 25 503 of 25 871 community-dwelling older adults who participated in the Vitamin D and Omega-3 Trial (VITAL), a randomized trial of cancer and cardiovascular disease prevention conducted from November 2011 to December 2017. Data analysis was conducted from June to September 2018.

Exposure

Racial/ethnic group (ie, non-Hispanic white; black; Hispanic; Asian; and other, multiple, or unspecified race).

Main Outcomes and Measures

Depressive symptoms, assessed using the Patient Health Questionnaire-8 (PHQ-8); participant-reported diagnosis, medication, and/or counseling for depression. Differences across racial/ethnic groups were evaluated using multivariable zero-inflated negative binomial regression to compare PHQ-8 scores and multivariable logistic regression to estimate odds of item-level symptom burden and odds of depression treatment among those with diagnosed depression.

Results

There were 25 503 VITAL participants with adequate depression data (mean [SD] age, 67.1 [7.1] years) including 12 888 [50.5%] women, 17 828 [69.9%] non-Hispanic white participants, 5004 [19.6%] black participants, 1001 [3.9%] Hispanic participants, 377 [1.5%] Asian participants, and 1293 participants [5.1%] who were categorized in the other, multiple, or unspecified race group. After adjustment for sociodemographic, lifestyle, and health confounders, black participants had a 10% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (rate ratio [RR], 1.10; 95% CI, 1.04-1.17; P < .001); Hispanic participants had a 23% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (RR, 1.23; 95% CI, 1.10-1.38; P < .001); and participants in the other, multiple, or unspecified group had a 14% higher severity level of PHQ-8 scores compared with non-Hispanic white participants (RR, 1.14; 95% CI, 1.04-1.25; P = .007). Compared with non-Hispanic white participants, participants belonging to minority groups had 1.5-fold to 2-fold significantly higher fully adjusted odds of anhedonia (among black participants: odds ratio [OR], 1.76; 95% CI, 1.47-2.11; among Hispanic participants: OR, 1.96; 95% CI, 1.43-2.69), sadness (among black participants: OR, 1.31; 95% CI, 1.07-1.60; among Hispanic participants: OR, 2.09; 95% CI, 1.51-2.88), and psychomotor symptoms (among black participants: OR, 1.77; 95% CI, 1.31-2.39; among Hispanic participants: OR, 2.12; 95% CI, 1.28-3.50); multivariable-adjusted odds of sleep problems and guilt appeared higher among Hispanic vs non-Hispanic white participants (sleep: OR, 1.24; 95% CI, 1.01-1.52; guilt: 1.84; 95% CI, 1.31-2.59). Among those with clinically significant depressive symptoms (ie, PHQ-8 score ≥10) and/or those with diagnosed depression, black participants were 61% less likely to report any treatment (ie, medications and/or counseling) than non-Hispanic white participants after adjusting for confounders (adjusted OR, 0.39; 95% CI, 0.27-0.56).

Conclusions and Relevance

In this cross-sectional study, significant racial and ethnic differences in late-life depression severity, item-level symptom burden, and depression care were observed after adjustment for numerous confounders. These findings suggest a need for further examination of novel patient-level and clinician-level factors underlying these associations.

Role of container type, behavioural, and ecological factors in Aedes pupal production in Dhaka, Bangladesh: An application of zero-inflated negative binomial model

The container-inhabiting Aedes mosquitoes are the major vectors transmitting dengue and several other arboviral diseases such as chikungunya and zika across the tropical world. Surveillance for immature Aedes, particularly pupae, is an effective tool for measuring dengue outbreak risk. While in Bangladesh, the greatest burden of dengue fever and dengue hemorrhagic fever cases has periodically been occurring since the first major outbreak in 2000, very limited research has yet been pursued to understand the dynamics of Aedes pupal production in this country. In this backdrop, this study was carried out to i) identify containers at household premises contributing to dengue vector productivity; ii) measure the extent of pupae productivity of household containers; and, iii) determine the effects of household ecological factors upon productivity of pupae in the city of Dhaka, Bangladesh. During the monsoon months of 2013, a total of 1,033 containers (674 wet and 363 dry) in 727 household premises in 12 wards of the city of Dhaka were inspected to measure container productivity and collect household ecological, and human behavioural data. The results reveal that the majority of immature mosquitoes (73.52% larvae and 84.91% pupae) developed in containers located outdoor that are used mostly for household chores. Plastic containers (57.55% of all immature mosquito-positive containers) used for household chores produce most of the immature mosquitos. The results of the zero-inflated negative binomial (ZINB) model reveal that pupae production significantly varies by container type (p-value = 0.0136) for the count regression group. However, when considering container size along with container type, container size is found significant for pupae production (p-value = 0.0041), showing that container size is confounded with the container type and the pupae production. Containers greater than 50 litres (L) are likely to produce 4.9 times more pupae than containers with <1L. Two household ecological factors are found to be significant (shade: p-value = 0.005 in the count regression group and type of water: p-value = 0.001 in the excess zero group) for pupae production. We found that containers with partial shade produce 4.6 times more pupae than without any shade, whereas in the excess zero group the expected number of observed zero pupae count is 86.5% lower in containers filled with rain water than those with tap water, tube-well water, ring well water and water from other sources. The most commonly used plastic-made containers (i.e., refrigerator trays, drums, buckets) and flower tubs/trays are the most abundant immature mosquito-positive containers. These findings would help the concerned authorities to formulate programs for changing human behaviour targeting the most productive containers for Aedes habitat management and vector control in the city of Dhaka, Bangladesh.