Depression and Anxiety Trajectories in Chronic Disease: A Systematic Review and Meta-Analysis

Urinary arsenic and depressive symptoms among adults: A moderated mediation analysis of folate and dietary inflammation index

BACKGROUND

Few studies have explored the effects of arsenic exposure on depressive symptoms and the underlying mechanisms of its influence on this relationship. This study aimed to assess the impact of urinary arsenic on depressive symptoms and the mediating and moderating roles of folate and dietary inflammation index (DII).

METHODS

Cross-sectional data from 9775 participants (≥20 years) in the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2020 were used for analysis. Total urinary arsenic and its compounds (urinary arsenobetaine and dimethylarsenic acid), folate, and DII were objectively measured, and depressive symptoms were assessed using the PHQ-9 scale. A logistic regression model weighted by the dietary two-day sample was used to analyze the effects, and a moderated mediation analysis was performed using the PROCESS macro.

RESULTS

Elevated urinary arsenic concentrations significantly increased the risk of depressive symptoms among adults in the United States. That is, the odds ratio (OR) of depressive symptoms increased as urinary arsenic concentrations increased (from the first quartile to the fourth quartile), and all of these results are statistically significant (P < 0.05). High urinary arsenic levels reduced folate levels and ultimately increased the risk of depressive symptoms, and DII moderated this association. The effect of urinary arsenic on depressive symptoms was not different among subgroups.

CONCLUSION

High levels of anti-inflammatory diet and enhanced folate intake helped reduce the effects of urinary arsenic on depressive symptoms.

Association of social support with depression and anxiety among the migrant population of Henan, China: Based on a large cross-sectional study

Amid China's rapid urbanization, the growing migrant population has increasingly drawn attention due to the rising prevalence of mental health concerns. Based on a large cross-sectional study, we explored the relationship between social factors and depression and anxiety among the migrant population and also quantified the correlations of different dimensions of social support and the varying levels of depression and anxiety. Results showed that the prevalence of depression and anxiety are 47.0% and 34.9%, respectively, among the 19,498 migrant populations. Females and individuals with chronic conditions were found to be more vulnerable to experiencing symptoms of anxiety and depression within the migrant population. Participants who received higher levels of social support were less likely to experience symptoms of depression and anxiety. Additionally, various dimensions of social support (including subjective, objective, and utilization) exhibited significant negative associations with different levels of depression and anxiety within the migrant population. Social support plays a crucial role in alleviating depression and anxiety among the migrant population, particularly in mitigating moderate and severe symptoms, which provides an important reference for improving the mental well-being of the migrant population.

Efficacy of a Standalone Smartphone Application to Treat Postnatal Depression: A Randomized Controlled Trial

INTRODUCTION

Smartphone app interventions based on cognitive-behavioral therapy (CBT) are promising scalable alternatives for treating mental disorders, but the evidence of their efficacy for postpartum depression is limited. We assessed the efficacy of Motherly, a standalone CBT-based smartphone app, in reducing symptoms of postpartum depression.

METHODS

Women aged 18-40 with symptoms of postpartum depression were randomized either to intervention (Motherly app) or active control (COMVC app). The primary outcome was symptoms of depression measured by the Edinburgh Postnatal Depression Scale (EPDS) at post-treatment. Secondary outcomes were anxiety symptoms, parental stress, quality of sleep, behavioral activation, availability of response-contingent positive reinforcement, and clinical improvement at post-treatment and 1-month follow-up. Exploratory analyses were performed to investigate if app engagement was associated with treatment response.

RESULTS

From November 2021 to August 2022, 1,751 women volunteered, of which 264 were randomized, and 215 provided primary outcome data. No statistically significant differences were found between groups at post-treatment: intervention: mean (SD): 12.75 (5.52); active control: 13.28 (5.32); p = 0.604. There was a statistically significant effect of the intervention on some of the secondary outcomes. Exploratory analyses suggest a dose-response relationship between Motherly app engagement and outcomes.

CONCLUSION

Our standalone app intervention did not significantly reduce postnatal depression symptoms when compared to active control. Exploratory findings suggest that negative findings might be associated with insufficient app engagement. Consistent with current literature, our findings suggest that standalone app interventions for postpartum depression are not ready to be implemented in clinical practice.

Parental emotional support, self-efficacy, and mental health problems among adolescents in Hong Kong: a moderated mediation approach

Introduction

Early signs of mental health issues may develop into severe mental illnesses over time. The influence of parental emotional support on adolescent mental health problems is well acknowledged. However, prior research has predominantly focused on psychological symptoms, often neglecting the somatic symptoms associated with mental health. Additionally, there has been insufficient exploration of the mediating role of self-efficacy and the relationship between socioeconomic status (SES) and adolescent mental health, particularly within the context of Hong Kong.

Methods

Using data from 3,613 adolescents aged 15 years from 109 schools in Hong Kong who participated in the Programme for International Student Assessment 2018, this study explored the relationship between parental emotional support and two dimensions of adolescent mental health symptoms (psychological and somatic symptoms), and the mediating effect of self-efficacy and the moderating role of SES.

Results

We found that parental emotional support significantly reduced psychological and somatic symptoms, primarily by enhancing self-efficacy. MoreovSES moderated these relationships, with the impact of parental emotional support on psychological symptoms being more pronounced among adolescents from lower SES backgrounds.

Discussion

This study deepens the understanding of the mechanisms underlying adolescent mental health in Hong Kong. By highlighting the importance of parental emotional support and self-efficacy, as well as the moderating effect of SES, the findings offer valuable insights for effective interventions aimed at improving adolescent mental health.

Mechanisms of erectile dysfunction induced by aging: A comprehensive review

BACKGROUND

With the increasing trend ofpopulation aging, erectile dysfunction (ED) among elderly men has emerged as apressing health concern. Despite extensive research on the relationship betweenED and aging, ongoing discoveries and evidence continue to arise.

OBJECTIVE

Through this comprehensiveanalysis, we aim to provide a more nuanced theoretical framework for thedevelopment of preventive and therapeutic strategies for senile ED, ultimatelyenhancing the quality of life for elderly men.

METHODS

This review delves deeper into thecore mechanisms underlying ED in the context of aging and offers acomprehensive overview of published meta-analyses and systematic reviewspertinent to these conditions.

RESULTS AND CONCLUSION

Our findings revealthat local structural damage to the penis, vascular dysfunction, neuronalinjury, hormonal alterations, other physiological changes, and psychologicalbarriers all play pivotal roles in the pathogenesis of aging-related ED.Furthermore, more than 20 diseases closely associated with aging have beenimplicated in the occurrence of ED, further compounding the complexity of thisissue.

The bidirectional relationships of optimism and pessimism with depressive symptoms in adulthood - A 15-year follow-up study from Northern Finland Birth Cohorts

BACKGROUND

Low optimism and high pessimism have predicted depressive symptoms in several studies, but the associations in the other direction, from depressive symptoms to future optimism and pessimism, have been unexplored. We examined bidirectional associations of optimism and pessimism with depressive symptoms in adulthood.

METHODS

A population-based sample of 4011 Finnish adults (55 % women) was analyzed with a 15-year prospective follow-up period from age 31 to age 46. Optimism and pessimism were measured with the Life Orientation Test-Revised, and depressive symptoms were measured with the Symptom Checklist-25. Temporal associations were investigated with cross-lagged panel models.

RESULTS

According to the model fit indices (RMSEA < 0.04, CFI ≥ 0.97) optimism and pessimism had bidirectional relationships with depressive symptoms: optimism predicted lower depressive symptoms (β = -0.09, p < .001), and depressive symptoms predicted lower optimism (β = -0.10, p < .001) in the follow-up. Also, pessimism predicted higher depressive symptoms (β = 0.08, p < .001), and depressive symptoms predicted higher pessimism (β = 0.09, p < .001) in the follow-up. In the participants with clinically high depressive symptoms at age 31, the predictive associations from optimism and pessimism to depressive symptoms remained, but associations in the other direction were attenuated.

LIMITATIONS

The follow-up study included only two time points with a 15-year time gap, which does not consider the possible fluctuation in the study variables between the measured times.

CONCLUSION

Dispositional optimism and pessimism may have bidirectional relationships with depressive symptoms in adulthood when the baseline depressive symptoms are below the clinical level.

Prophylactic Effects of Betaine on Depression and Anxiety Behaviors in Mice with Dextran Sulfate Sodium-Induced Colitis

Ulcerative colitis (UC) is a typical type of inflammatory bowl disease, which is accompanied by an increased risk of depression and anxiety-related psychological symptoms. Betaine is a naturally derived compound that can function as an anti-inflammatory drug and a neuromodulator. In-depth exploration of the potential role of betaine in treating UC-related depression and anxiety is crucial. This study aimed to elucidate the effects of betaine on UC-related depression and anxiety and clarify the underlying mechanisms. A dextran sulfate sodium (DSS)-induced mice model was established by 4% DSS drinking ad libitum for 7 days. The colonic injury was measured using hematoxylin-eosin (HE) staining and Alcian blue-periodic acid Schiff (AB-PAS) staining. Depression and anxiety-like behaviors were separately evaluated using a forced swimming test (FST), a tail suspension test (TST), a light-dark box test (LDBT), and an open field test (OFT). Immunohistochemistry was used to detect DNA damage and neurogenesis in the hippocampus. Western blotting was applied to detect the protein levels of macrophage polarization in mice colons and the alteration of mitochondrial dysfunction and the cGAS-STING pathway in the hippocampus. Betaine strongly alleviated mucosal structural disorder and mucin secretion reduction and promoted M2-macrophage polarization in the colon of DSS-treated mice. In addition, betaine could mitigate depression- and anxiety-like behaviors in DSS-treated mice, reduce the DNA damage and mitochondrial dysfunction, and inhibit the cGAS-STING signaling pathway. Our study reveals the antidepression/anxiety effects of betaine and further demonstrates the potential mechanism by which betaine inhibits DNA damage and mitochondrial dysfunction to block the cGAS-STING pathway, thereby repairing neurogenesis in the hippocampus.

Association of blood cadmium, lead, and mercury with anxiety: a cross-sectional study from NHANES 2007-2012

Objectives

The purpose of this paper is to explore the relationship between blood levels of cadmium, lead, and mercury and anxiety in American adults.

Methods

Blood metals and self-reported anxiety days were extracted from laboratory data and questionnaire data, respectively, using NHANES data from 2007-2012. Weighted logistic regression was used to assess the relationship between cadmium, lead and mercury with anxiety. Restricted cubic spline was used to visualize the non-linear relationship between metal concentrations and anxiety. Weighted quantile sum (WQS) regression was used to investigate the effect of combined exposure to the three metals on anxiety.

Results

The prevalence of anxiety in adults was 26.0%. After adjusting for potential confounding variables, cadmium levels in the highest quartile (Q4) were associated with a higher risk of anxiety compared to the lowest quartile (Q1) (OR = 1.279, 95% CI: 1.113-1.471, p < 0.01). Restricted cubic spline analysis indicated a positive association between blood cadmium levels and anxiety. Furthermore, co-exposure to multiple heavy metals was positively associated with anxiety risk (WQS positive: OR = 1.068, 95% CI: 1.016-1.160, p < 0.05), with cadmium contributing the most to the overall mixture effect. Compared to the Light RPA, the Vigorous/Moderate RPA group had a relatively low risk of anxiety after cadmium exposure.

Conclusion

High levels of blood cadmium are positively associated with the development of anxiety disorders, which needs to be further verified in future studies.

Association of blood metals with anxiety among adults: A nationally representative cross-sectional study

BACKGROUND

Previous evidence demonstrated the inconsistent associations between metals and anxiety. The purpose of this study was to evaluate the individual and joint effects of blood lead (Pb), cadmium (Cd), mercury (Hg), selenium (Se) and manganese (Mn) on anxiety in the general population.

METHODS

Data of 4000 participants (aged≥20 years) in the study were retrieved from the National Health and Nutrition Examination Survey (NHANES) 2011-2012. Multiple logistic regression, restricted cubic splines (RCS) logistic analysis, and weighted quantile sum (WQS) regression were fitted to explore the possible effects of single and mixed metal exposures on anxiety. Moreover, this association was assessed by smoking group.

RESULTS

In the study, 24.60 % of participants were in an anxiety state. In logistic regression, blood Pb, Cd, Hg, Se and Mn were not significantly associated with anxiety in all participants. After stratified by smoking group, blood Cd was positively associated with anxiety in the current smoking group [P = 0.029, OR (95 %): 1.708(1.063, 3.040)], whereas not in other groups. In RCS regression, we observed a linear dose-response effect of blood Cd on anxiety stratified by smoking group. In WQS analysis, mixed metal exposures were positively associated with anxiety [P = 0.033, OR (95 %): 1.437(1.031, 2.003)], with Cd (33.69 %) contributing the largest weight to the index.

CONCLUSIONS

Our study showed that excessive exposure to Cd is a significant risk factor for anxiety, and the co-exposures to Pb, Cd, Hg, Se and Mn were positively related with the risk of anxiety in current smokers.