Depression and chronic diseases: it is time for a synergistic mental health and primary care approach

Exploring cariprazine as a treatment option for varied depression symptom clusters

Major depressive disorder (MDD) is among the most prevalent psychiatric conditions and a leading cause of disability worldwide. MDD presents a diverse range of symptoms that significantly impact personal, societal, and economic dimensions. Despite the availability of numerous antidepressant treatments (ADTs) targeting different molecular mechanisms, a substantial proportion of patients experience inadequate response, presenting a considerable challenge in MDD management. As a result, adjunctive strategies, particularly involving atypical antipsychotics, are often employed to enhance treatment efficacy. Cariprazine, a D2/D3 partial agonist, is distinguished from other atypical antipsychotics by its selective action on the D3 receptor and its modulation of 5-HT1A, 5-HT2A, and alpha 1B receptors. This distinctive pharmacological profile warrants investigation into its potential effectiveness and tolerability across various symptom domains of MDD, including pleasure, interest, and motivation; mood and suicidality; sleep and appetite; fatigue; psychomotor activity and anxiety; and cognitive function. Preliminary evidence from animal studies and clinical trials suggests that cariprazine may improve motivation, anhedonia, and cognitive function symptoms. Cariprazine shows promise in alleviating mood-related symptoms, though its impact on anxiety and its effects on agitation and psychomotor retardation remains uncertain. Cariprazine may be particularly beneficial for patients with MDD exhibiting anhedonia, cognitive deficits, and possibly fatigue and hypersomnia. Evaluating cariprazine's efficacy across these symptom domains could reveal patterns that support more personalized treatment approaches for depression. Further research is essential to elucidate the role of cariprazine as an adjunctive therapy for adults with major depressive disorder who have an inadequate response to antidepressant monotherapy.

Higher serum chromium level may be associated with the presentation of depression in patients with metabolic dysfunction-associated fatty liver disease: evidence from NHANES survey

Background

Depressive symptoms are frequently observed in patients with Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD), a prevalent metabolic disorder that affects many individuals. It is not yet clear whether there is an association between serum chromium levels and depression.

Objective

The purpose of this research was to explore the association between serum chromium level and the manifestation of depression among patients with MAFLD.

Methods

The selection of 1837 patients diagnosed with MAFLD was based on data obtained from the 2017-2018 National Health and Nutrition Examination Survey (NHANES) database in this research. The Patient Health Questionnaire-9 (PHQ-9) was employed to evaluate the severity of depression. The researchers utilized logistic regression models that were weighted for multiple variables to investigate the association between depression and serum chromium levels.

Results

In our study, we found that 8.98% of US adults with MAFLD were suffering from depression at the time of evaluation. In the logistic regression model, serum chromium levels showed an inverse association with depression (OR=0.82, 95%CI: 0.69-0.96; p=0.016), this relationship remained after adjusting for fully confounding factors (OR=0.83, 95%CI: 0.71-0.97; p=0.021), subgroup analyses showed that the association between serum chromium levels and depression existed in relatively high-prevalence of depression groups.

Conclusion

Patients diagnosed with MAFLD have a greater likelihood of experiencing depression, whereas individuals with higher levels of serum chromium are less likely to suffer from depression, and this association persists even after adjusting for other factors. These findings indicate supplementing chromium may be a viable treatment for their depressive symptoms.

Primary care use and depression screening among young adults with sickle cell disease during their final year of pediatric hematology care

Depression may contribute to transition risk among young adults with sickle cell disease (SCD). It is unclear if they receive depression screening because primary care providers (PCPs) routinely perform this screening, but PCP use declines with age. This retrospective study of young adults with SCD during their final year of pediatric hematology care identified 51 (91%) had PCPs. Among those with hospital system PCPs, 20% saw their PCP and 50% of those were screened for depression by the PCP. This suggests young adults with SCD may not receive depression screening or see PCPs, leading to potential missed opportunities for intervention.

Physical Activity Reduces Depression among Healthcare Workers during the COVID-19 Pandemic in Jordan

Aims

This study aimed to assess mental health status by measuring depression and investigating the effect of physical activity in lessening the mental health burden among HCWs during the COVID-19 pandemic in Jordan.

Background

The COVID-19 pandemic has caused distress and depression among healthcare workers and drastic disruptions in social, economic, and health systems worldwide.

Methods

A cross-sectional online study through google forms involved HCWs across Jordan for two months. The 10-item short form of the Center for Epidemiological Studies Depression Scale Revised (CESD-R10) was used to assess depressive symptoms.

Results

The total sample was 295, females were 50.5% with mean age of 33.1 (>80% less than 40 years old), married 51.9%, 63% were physicians, 88.1% had contact with patients, and 64.7% were smokers. Depression symptoms were perceived by 59.3% of the total samples (53.1).

Conclusion

During the COVID-19-induced nationwide lockdown in Jordan, HCWs who engaged in enough physical exercise reported fewer depressive symptoms. Promoting physical exercise among HCWs may lead to better results for their mental health. Various clinical implications support promoting designated time and space for physical activity at work.

Trading mental and physical health in vestibular schwannoma treatment decision

Objective

Observation, radiotherapy and surgery are treatment options in vestibular schwannomas (VS). Decision making differs between centers and is usually based on tumor characteristics (e.g., size) and the expected physical health (PH) outcome (i.e., hearing and facial function). However, mental health (MH) is often under-reported. The objective of the present study was to ascertain the impact of VS treatment on PH and MH.

Methods

PH and MH were assessed in a prospective cross-sectional study including 226 patients with unilateral sporadic VS before and after surgical removal (SURG). Quality-of-life (QoL) was estimated by self-rating questionnaires: general Short-Form Health Survey (SF-36), Penn Acoustic Neuroma Quality-of-Life Scale (PANQOL), Dizziness Handicap Inventory (DHI), Hearing Handicap Inventory (HHI), Tinnitus Handicap Inventory (THI), and Facial Disability Index (FDI). QoL changes over time as well as predictive factors were accessed by multivariate analyses of covariance (MANCOVA).

Results

In total, 173 preoperative and 80 postoperative questionnaires were analyzed. There was a significant PH deterioration related to facial function (FDI, PANQOL-face) after surgery. In line with facial rehabilitation, however, FDI improved within the first five years after surgery and did not differ compared to the preoperative patient cohort, eventually. In contrast, MH (i.e., PANQOL-anxiety) and general health (i.e., PANQOL-GH) improved with surgery and correlated with the extent-of-resection.

Conclusion

Physical and mental health is significantly influenced by VS surgery. While PH might decrease after surgery, MH potentially increases when patient is cured. Practitioners should take MH into account before advising an incompletely VS treatment (e.g., subtotal resection, observation or radiosurgery).

Magnitude of depression and its associated factors among patients with diabetes mellitus at public hospitals in Southwest Ethiopia, 2021

Depression is the third-leading cause of disability measured in terms of disability-adjusted life-years. When depression coexists with diabetes mellitus, it is associated with major health consequences and results in poor health outcomes, decreased quality of life, lost productivity and increased risk of death. The current study aimed to assess the magnitude of depression and its associated factors among adult patients with diabetes mellitus attending follow-up at the public hospitals of Buno Bedele zone, Southwest Ethiopia. A multi-centre cross-sectional study was done among people living with diabetes mellitus at an outpatient clinic of Buno Bedele zone hospitals. The study period was from April to May 2021. A systematic random sampling technique was used to select the study participants. Data were collected using a structured questionnaire. Depression was assessed by the Patient Health Questionnaire-9. Patient Health Questionnaire-9 is a validated tool to assess depression with sensitivity 86% and specificity 67%. The collected data were cleaned, edited, and entered into epi-data version 3.1, and analysed using SPSS version 24. Logistic regression analysis was employed to identify factors associated with depression occurrence. A p value of 0.05 was considered statistically significant. A total of 310 study participants were included in this study. Among study participants, 41.6% fulfilled the criteria for depression. Variables significantly associated with depression were female gender [AOR: 2.26, 95% CI (1.30, 3.95)], duration of diabetes greater than 5 years [AOR: 2.68, 95% CI (1.57, 4.56)], poor social support [AOR: 2.46, 95% CI (1.10, 5.49)], moderate social support [AOR: 2.63, 95% CI (1.34, 5.16)], current alcohol consumption [AOR: 3.55, 95% CI (1.20, 10.52)] and previous alcohol consumption [AOR = 2.81, 95% CI (1.40, 5.60)]. According to this study, depression is relatively common among diabetic individuals. Being a female, having diabetes for a long time, having poor social support, using alcohol now and in the past were factors that substantially linked to depression. Healthcare professionals should consider screening for depression using the Patient Health Questionnaire-9 or other validated tools in all diabetic patients, especially in those who are at higher risk.

Network Pharmacology and Experimental Validation to Investigate the Antidepressant Potential of Atractylodes lancea (Thunb.) DC

Atractylodes lancea (Thunb.) DC. (AL) has been indicated in traditional prescriptions for the treatment of depression. However, the mechanism of action of AL in the treatment of depression is still unclear. This study aimed to investigate the antidepressant potential of AL using network pharmacology, molecular docking, and animal experiments. The active components of AL were retrieved from the traditional Chinese medicine systems pharmacology database and analysis platform (TCMSP), and the depression-related targets were screened through the DisGeNET database. Overlapping targets of AL and depression were selected and analyzed. Ten active compounds of AL showed anti-depressant potential, including stigmasterol, 3β-acetoxyatractylone, wogonin, β-sitosterol, selina-4(14),7(11)-dien-8-one, atractylenolide I, atractylenolide II, atractylenolide III, patchoulene, and cyperene. These compounds target 28 potential antidepressant genes/proteins. Gene Ontology (GO) enrichment analysis revealed that the potential targets might directly influence neural cells and regulate neuroinflammation and neurotransmitter-related processes. The potential Kyoto Encyclopedia Genes and Genomes (KEGG) pathways for the antidepressant effects of AL include neuroactive ligand-receptor interactions, calcium signaling pathways, dopaminergic synapse, interleukin (IL)-17 signaling pathways, and the pathways of neurodegeneration. IL-6, nitric oxide synthase 3 (NOS), solute carrier family 6 member 4 (SLC6A4), estrogen receptor (ESR1), and tumor necrosis factor (TNF) were the most important proteins in the protein-protein interaction network and these proteins showed high binding affinities with the corresponding AL compounds. AL showed an antidepressant effect in mice by decreasing immobility time in the tail suspension test and increasing the total contact number in the social interaction test. This study demonstrated the antidepressant potential of AL, which provides evidence for pursuing further studies to develop a novel antidepressant.

A Multi-Center Study on the Negative Psychological Impact and Associated Factors in Chinese Healthcare Workers 1 Year After the COVID-19 Initial Outbreak

Objectives: The study aimed at analyzing the prevalence of five psychological outcomes (depression, anxiety, stress, post-traumatic stress disorder (PTSD), and suicidal ideation) among Chinese healthcare workers (HCWs), and measured the total possible negative psychological impact 1 year after the COVID-19 initial outbreak. Methods: A cross-sectional nationwide multi-center study was performed between November 2020 and March 2021 in China. A self-report questionnaire was applied, and three psychological scales were used. Binary logistic regression was performed to analyze the risk factors associated with each psychological outcome. Results: The findings demonstrated that the COVID-19 pandemic had a negative psychological impact on HCWs, which was still evident 1 year after the initial outbreak. Nurses showed higher depression and anxiety than other HCWs. Female gender, passive coping, long working hours, having a chronic disease, and experiencing violence, among other factors, were all risk factors for psychological impairment. Conclusion: Developing and promoting programs to improve mental health among HCWs, and identifying those who might need psychological support is still relevant 1 year after the initial outbreak.

The Relationship Between Specific Age-Related Chronic Conditions of Comorbidity and Depression Scores Among Men in an Elderly Population: A Cross-Sectional Study

Objective

There had been an observed increase in the prevalence of depression as well as many chronic conditions of comorbidity among the elderly population of Ireland above the age of 50. The relationship between different prominent conditions of comorbidity and depression scores amongst older adult men in Ireland was sought to be examined and explored.

Methods

A cross-sectional analysis of data from wave 1 of The Irish Longitudinal Study on Aging (TILDA) had been used for statistical analysis, which served to be the representative cohort study sample of elderly adults living in Ireland aged 50 and older. Summary statistics (cross-tabulation, t-test, analysis of variance/ANOVA and odds ratio) were used to explore the relationship between depression scores and different conditions of comorbidity.

Results

Results were drawn from the three different tests conducted; cross-tabulation, t-test, and analysis of variance/ANOVA. Cross-tabulation served to provide the total population of men who suffered from depression (CES-D score ≥ 16), which totaled 123 (1.4%) of the entire 8,504 available candidates. Of the participants that met the criteria for having a significant risk of clinical depression along with an accompanying chronic illness odds ratio (OR) had been calculated. All but one of the conditions yielded a significant increase in OR between having a chronic condition and depression; with the exception of chronic lung disease. Congestive heart failure demonstrated the highest OR of 4.40 (CI 95% 1.77-10.95), followed by arthritis, diabetes and cancer. Subsequent t-tests used to construct an ANOVA then illustrated the mean CES-D score for males suffering from one of the five concomitant illnesses selected (congestive heart failure, chronic lung disease, arthritis, cancer, and diabetes) as well as those free of the selected diseases of the study, with a total count of 2,117. All results had been deemed to be significant with p-values < 0.05, with men suffering from congestive heart failure having the highest mean score of 7.28 (n=39). Those who do not suffer from any of the five conditions reported the lowest scores and also accounted for the largest population group with 3.88 and 1,387, respectively.

Conclusions

Consistent and significant findings of elderly men suffering from a chronic condition of comorbidity demonstrated having elevated OR and CES-D scores in comparison to those who are disease-free. The findings of this study can be used to evaluate alternative preventative management of chronic diseases of comorbidity in order to improve the depression scores of patients.

Anxiety/Depression Predominance in Liaison-Psychiatry Users of a South-East Mexico Tertiary Hospital

Patients at tertiary hospitals may find themselves in need of mental health support due to the distress associated with the illness that may or not lead to a psychiatric condition. Here is an overview of the clinical cases treated by the liaison psychiatry service of a public tertiary hospital from Southeast Mexico during its first years of operation (2008–2018), with the purpose of gathering information about the status and needs of this population. A sample of 304 clinical records of patients treated for the first time by the psychiatry service was reviewed, and the distribution by demographic characteristics, diagnosis of mental illness and medical area of reference was analyzed. Anxiety and depression symptoms were the most frequent. Most patients were women, lived in Merida and returned after the first appointment. The neurology service referred most patients, yet most attended directly. General tertiary hospitals should prioritize integrating ad hoc mental and physical health care. Adult women with a profile of anxiety and/or depression would be the first target group. Some areas of opportunity for further research and improvement of mental health services are: preventive services for anxiety and depression, follow-up of patients, attention to relatives of patients at intensive care units, implementation of telehealth alternatives, training on mental health screening and inter- and intra-institutional collaboration.

The Impact of Chronic Unpredictable Mild Stress-Induced Depression on Spatial, Recognition and Reference Memory Tasks in Mice: Behavioral and Histological Study

Depression-induced cognitive impairment has recently been given more attention in research. However, the relationship between depression and different types of memory is still not clear. Chronic unpredictable mild stress (CUMS) is a commonly used animal model of depression in which animals are exposed to chronic unpredictable environmental and psychological stressors, which mimics daily human life stressors. This study investigated the impact of different durations of CUMS on various types of memory (short- and long-term spatial memory and recognition memory) and investigated CUMS’ impact on the ultrastructural level by histological assessment of the hippocampus and prefrontal cortex. Twenty male C57BL/J6 mice (6 weeks old, 21.8 ± 2 g) were randomly divided into two groups (n = 10): control and CUMS (8 weeks). A series of behavioral tasks were conducted twice at weeks 5–6 (early CUMS) and weeks 7–8 (late CUMS). A tail-suspension test (TST), forced swimming test (FST), elevated zero maze (EZM), elevated plus maze (EPM), open field test (OFT), and sucrose-preference test (SPT) were used to assess anxiety and depressive symptoms. The cognitive function was assessed by the novel object recognition test (NORT; for recognition memory), Y-maze (for short-term spatial memory), and Morris water maze (MWM: for long-term spatial memory) with a probe test (for reference memory). Our data showed that 8 weeks of CUMS increased the anxiety level, reported by a significant increase in anxiety index in both EPM and EZM and a significant decrease in central preference in OFT, and depression was reported by a significant increase in immobility in the TST and FST and sucrose preference in the SPT. Investigating the impact of CUMS on various types of memory, we found that reference memory is the first memory to be affected in early CUMS. In late CUMS, all types of memory were impaired, and this was consistent with the abnormal histological features of the memory-related areas in the brain (hippocampus and prefrontal cortex).

Depression and non-alcoholic fatty liver disease: Association and potential mechanisms

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in the world, and is closely related to the high incidence of obesity, metabolic syndrome, type 2 diabetes, arteriosclerotic cardiovascular disease, and colorectal tumor. Depression is a common mental disorder that is characterized by high incidence, high recurrence rate, high disability rate, and high suicide rate, which has serious harm to patients' physical and mental health, reduce the quality of life of patients. In recent years, as more and more attention has been paid to mental health of NAFLD patients, the relationship between NAFLD and depression has become one of the hot research topics. Studies have shown that the incidence of depression in NAFLD patients is higher than that in non-NAFLD patients, and the incidence of NAFLD in depressed patients is also higher. Some research results have been published on the mechanism of comorbidity between the two. This paper reviews the research progress on the correlation and common mechanism between NAFLD and depression, aiming to lay a foundation for further research on the comorbidities of NAFLD and depression, and provide a basis and research direction for the diagnosis and treatment of patients with both comorbidities.

Effects of Combination Treatment in Hypertensive Patients with Depression: A Systematic Review and Meta-Analysis of 27 Randomized Controlled Trials

Background

Hypertension commonly co-exists with depression and is associated with adverse health outcomes. This meta-analysis aimed to examine whether combination treatment can improve the outcomes of patients with comorbid hypertension and depression.

Methods

We searched for relevant randomized controlled trials (RCTs) published through July 2021 using PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang Data. RCTs on patients with an antihypertensive outcome and data on mean blood pressure differences were extracted for both intervention and control groups. Continuous and dichotomous measures of outcomes were pooled using weighted mean differences (WMD) and risk ratios (RR) with 95% confidence intervals (CI) by random or fixed effects. Subgroup and meta-regression analyses were performed to identify any existing heterogeneous sources.

Results

A total of 27 RCTs with 2606 participants were included. Combination treatment significantly improved systolic blood pressure (SBP) by 11.27 mmHg (WMD = −11.27, 95% CI: −14.12 to −8.43), I² = 95.4%), diastolic blood pressure (DBP) by 8.21 mmHg (WMD = −8.21, 95% CI: −10.73 to −5.69), I² = 96.9%), and antihypertensive efficiency by 42% (RR = 1.42, 95% CI: 1.32 to 1.52, I² = 0.0%) compared with in the control group. Combination treatment improved SBP and DBP levels in patients aged <65 years compared with those in patients aged ≥65 years (p = 0.020 and 0.007, respectively).

Conclusion

Pooled evidence suggests that combination treatment significantly improves both blood pressure levels and antihypertensive efficiency in hypertensive patients with depression. Elderly patients with comorbid hypertension and depression may require a more collaborative approach to improve their outcome.

Registration

PROSPERO registration number CRD42020213430. Registered on November 08, 2020.

Staying Physically Active Is Associated with Better Mental Health and Sleep Health Outcomes during the Initial Period of COVID-19 Induced Nation-Wide Lockdown in Jordan

Jordan, a Middle Eastern country, initially responded to an outbreak of COVID-19 cases within its own borders by imposing a 7-week strict lockdown and closure of international and domestic travel. Such measures drastically influenced lifestyle behaviors of the population. This study aimed to investigate the prevalence of physical activity, and its association with mental and sleep health outcomes among Jordanians during a period of COVID-19 induced lockdown. Validated questionnaires were administered using a web-based platform to evaluate moderate-to-vigorous physical activity (MVPA), anxiety and depressive symptoms, sleep health, and sociodemographic characteristics. A modified Poisson regression model with robust error variance was used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). Compared to participants who met the guidelines, those who did not had significantly higher prevalence of moderate or severe anxiety symptoms than that of minimal or mild anxiety symptoms and increased depressive symptoms. Insufficient MVPA was associated with higher prevalence of poor sleep quality, short sleep duration (<7 h) and sleep problems. Overall, sufficient MVPA was associated with better mental and sleep health during the COVID-19 induced nation-wide lockdown in Jordan. While further research is necessary, promoting physical activity during the lockdown could potentially improve mental and sleep health outcomes among the population.

The status of serum cortisol before and after treatment of schizophrenia and its correlation to disease severity and improvement: A longitudinal study

BACKGROUND

Hypothalamic-pituitary-adrenal axis functioning, with cortisol as its major output hormone, has been presumed to play a key role in the development of psychopathology of schizophrenia.

OBJECTIVE

We examined the association of serum cortisol with disease severity and improvement in schizophrenia patients in Jimma, Ethiopia.

METHOD

A total of 34 newly diagnosed schizophrenics were included in this study. Data on demographic, behavioral, clinical state, serum cholesterol level, and antipsychotic usage were obtained at baseline and after 8 weeks. The Positive and Negative Syndrome Scale was used to assess psychotic symptoms severity. A paired sample t-test was used to compare baseline and post-treatment values. Linear regression was used to assess associations.

RESULT

Post-treatment serum cortisol level was significantly lower than its baseline value (p = 0.001). There was also a significant positive and negative psychotic symptoms decrease after treatment (baseline positive psychotic vs post-treatment positive psychotic symptoms: t(33) = 6.24 (95% confidence interval = 7.03,13.84, p = 0.000) and (baseline negative psychotic vs post-treatment negative psychotic symptoms: t(33) = 4.21 (95% confidence interval = 3.82, 10.99, p = 0.000).At baseline, neither positive nor negative subscore on the Positive and Negative Syndrome Scale showed an association with serum cortisol level (B = -0.016, p = 0.794 and B = -0.032, p = 0.594). However, serum cortisol level showed strong associations with post-treatment positive sub scores and negative sub scores (B = 0.167, p = 0.007) and (B = 0.144, p = 0.010) on the Positive and Negative Syndrome Scale.

CONCLUSION

We found a significant decrease in serum cortisol level after antipsychotics treatment and that was associated with improvement in psychotic symptoms in schizophrenics in Jimma, Ethiopia.

The Effect of Multimorbidity Patterns and the Impact of Comorbid Anxiety and Depression on Primary Health Service Use: The Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) Study

This study sought to determine patterns of multimorbidity and quantify their impact on use of primary health services in the presence and absence of anxiety and depression among a cohort of urban community-dwelling men in Australia. The analytic sample consisted of men (n = 2039; age 38–85) from the follow-up wave of a prospective cohort study of all participants of the Florey Adelaide Male Ageing Study (FAMAS; Stage 2 [2007–2010]) and age-matched men from the North-West Adelaide Health Study (NWAHS; Stage 3 [2008–2010]). Self-reported data and linkage with a national universal health coverage scheme (Medicare) provided information on the prevalence of eight chronic conditions and health service utilization information (including annual GP visits). Obesity and cardiovascular disease (CVD) were associated with the highest number of comorbid conditions. Two nonrandom multimorbidity “clusters” emerged: “CVD, Obesity, Diabetes” and “CVD, Obesity, Osteoarthritis.” Participants with conditions comorbid with CVD were more likely to have 10 or more annual GP visits, compared to multimorbidity involving other conditions. In comparison to participants without CVD, the presence of CVD increased the chance of having 10 or more annual GP visits (adjusted risk ratio: 3.7; 95% CI [2.8, 4.8]). When CVD was comorbid with anxiety and depression, having 10 or more annual GP visits was more common (adjusted risk ratio: 1.8; 95% CI [1.2, 2.5]). Multimorbidity patterns involving CVD, especially for multimorbidity that includes CVD with comorbid anxiety and depression, should be considered in developing clinical trials to better inform medical decision-making and care for patients with CVD and comorbid conditions.

Effectiveness of a nurse-led hospital-to-home transitional care intervention for older adults with multimorbidity and depressive symptoms: A pragmatic randomized controlled trial

OBJECTIVE

To evaluate the effectiveness of a nurse-led hospital-to-home transitional care intervention versus usual care on mental functioning (primary outcome), physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use costs in older adults with multimorbidity (≥ 2 comorbidities) and depressive symptoms.

DESIGN AND SETTING

Pragmatic multi-site randomized controlled trial conducted in three communities in Ontario, Canada. Participants were allocated into two groups of intervention and usual care (control).

PARTICIPANTS

127 older adults (≥ 65 years) discharged from hospital to the community with multimorbidity and depressive symptoms.

INTERVENTION

This evidence-based, patient-centred intervention consisted of individually tailored care delivery by a Registered Nurse comprising in-home visits, telephone follow-up and system navigation support over 6-months.

OUTCOME MEASURES

The primary outcome was the change in mental functioning, from baseline to 6-months. Secondary outcomes were the change in physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use cost, from baseline to 6-months. Intention-to-treat analysis was performed using ANCOVA modeling.

RESULTS

Of 127 enrolled participants (63-intervention, 64-control), 85% had six or more chronic conditions. 28 participants were lost to follow-up, leaving 99 (47 -intervention, 52-control) participants for the complete case analysis. No significant group differences were seen for the baseline to six-month change in mental functioning or other secondary outcomes. Older adults in the intervention group reported receiving more information about health and social services (p = 0.03) compared with the usual care group.

CONCLUSIONS

Although no significant group differences were seen for the primary or secondary outcomes, the intervention resulted in improvements in one aspect of patient experience (information about health and social services). The study sample fell below the target sample (enrolled 127, targeted 216), which can account for the non-significant findings. Further research on the impact of the intervention and factors that contribute to the results is recommended.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT03157999.

Prevalence of depressive symptoms in urban primary care settings: Botswana

BACKGROUND

The prevalence of depression is estimated to be high in primary care settings, especially amongst people with chronic diseases. Early identification and management of depression can improve chronic disease outcomes and quality of life, however, there are many missed opportunities in primary care.

AIM

This study aimed to determine the prevalence and correlates of depression and depressive symptoms in two urban primary care settings.

SETTING

The study was conducted at two primary care facilities in the capital city of Botswana.

METHODS

We administered a demographic questionnaire and the Patient Health Questionnaire-9 (PHQ-9) to adults attending two primary care facilities. The association between depressive symptoms and demographic variables was determined using Chi-square; level of significance was set at 0.05. We carried out a multivariate analysis using Kruskal-Wallis test to determine the association between demographic characteristics and depression.

RESULTS

A sample of 259 participants were recruited (66.8% women, median age 32). The mean PHQ-9 score was 8.71. A total of 39.8% of participants screened positive for depression at a cut-off of 9.0% and 35.1% at a cut-off of 10. Depressive symptoms were significantly associated with employment status and income using the Kruskal-Wallis test, χ2 (1) = 5.649, p = 0.017.

CONCLUSION

The high rates of depressive symptoms amongst the study population highlight the need for depression screening in primary care settings. The association between unemployment and income underscore the impact of socio-economic status on mental health in this setting.

Core prescription pattern of Chinese herbal medicine for depressive disorders in Taiwan: a nationwide population-based study

Background

Depressive disorders (DD) affect not only mood and behavior but also various physical functions. Traditional Chinese medicine (TCM) has been shown to have some benefits in treating DD. However, one formula or one single herb might be not show high efficacy when used to treat depression. Thus, this study aimed to examine the core prescription pattern of Chinese herbal medicine (CHM) among patients with DD in Taiwan as a reference for related research and clinical applications.

Methods

All patients, who had been diagnosed with major depressive disorder or minor depression or dysthymia without any other baseline diseases and had at least one CHM outpatient clinical visit from 2002 to 2011, were extracted from three randomly sampled cohorts, namely the 2000, 2005 and 2010 cohorts of the National Health Insurance Research Database (NHIRD) of Taiwan. The collected data was analyzed to explore the patterns of herbal products.

Results

There were 197,146 patients with a diagnosis of DD and of these 1806 subjects had only a diagnosis of DD and utilized CHM. The most common formula was Gan-Mai-Da-Zao-Tang (12.19%), while Suan-Zao-Ren (3.99%) was the most commonly prescribed single herb. The core pattern of prescriptions consisted of a combination of Gan-Mai-Da-Zao-Tang, Jia-Wei-Xiao-Yao-San, Chai-Hu-Jia-Long-Gu-Mu-Li-Tang, He-Huan-Pi, Yuan-Zhi and Shi-Chang-Pu.

Conclusions

This study describes the CHM core prescription pattern used to treat patients in Taiwan with DD and it is a potential candidate for study in future pharmacological or clinical trials targeting DD.

Dysregulated thyroid hormones correlate with anxiety and depression risk in patients with autoimmune disease

Background

Autoimmune disease (AID) patients always present with increased risk of psychiatric disorders, and thyroid function or thyroid hormone may play a critical role in the development of anxiety and depression. Thus, this study aimed to assess the free triiodothyronine (FT3), free tetraiodothyronine (FT4), thyroid‐stimulating hormone (TSH) levels, and their correlations with anxiety/depression in patients with AID.

Methods

Ninety‐eight AID patients and 100 health controls (HCs) were recruited. Serum samples were obtained from all the participants to detect FT3, FT4, and TSH levels. Anxiety and depression were determined using the HADS assessment.

Results

HADS‐Anxiety score, anxiety subject percentage, HADS‐Depression score, and depression subject proportion were elevated in AID patients compared with HCs. FT3 and FT4 were downregulated while TSH was upregulated in AID patients compared with HCs. In AID patients, FT3 and FT4 negatively correlated with HADS‐Anxiety score, and they were downregulated in patients with anxiety compared to patients without anxiety. Meanwhile, FT3 and FT4 were negatively associated while TSH level positively associated with HADS‐Depression score. Besides, FT3 and FT4 reduced, but TSH level was of no difference in patients with depression compared to patients without depression. Additionally, increased FT4 independently correlated with both reduced anxiety risk and depression risk.

Conclusions

FT3, FT4, and TSH are dysregulated, and FT4 has the potential to serve as an independent biomarker related to anxiety as well as depression in AID patients. These findings may provide some information on the values of thyroid hormones in facilitating the management of AID patients with anxiety/depression.

Evaluation of Mental Health Factors among People with Systemic Lupus Erythematosus during the SARS-CoV-2 Pandemic

There are considerable psychological and psychiatric consequences of the pandemic. Researchers have started to take into account the real or perceived sense of social threats that may be expressed, such as anxiety, depression, and sleep disorders. However, analyses on pandemic-related anxiety, depression, and sleep disorders mostly rarely addresses the situation of people with autoimmune diseases. Therefore, the aim of this study was to assess the mental health factors among people with systemic lupus erythematosus by quantifying the severity of anxiety, depression, and sleep disorders during the SARS-CoV-2 pandemic. In total, 723 people took part in the study. The study group consisted of 134 individuals with a systemic lupus erythematosus. The control group consisted of 589 people without systemic lupus erythematosus. The regression adjusted by age, gender, and diagnosis of other chronic diseases showed individuals with systemic lupus erythematosus were at a much higher risk of elevated symptoms of anxiety on the GAD-7 scale (OR = 3.683; p < 0.001), depression on the PHQ-9 scale (OR = 4.183; p < 0.001), and sleep disorders on the Insomnia Severity Index (ISI) scale (OR = 6.781; p < 0.001). Therefore, the mental health of patients with systemic lupus erythematosus in the times of the SARS-CoV-2 pandemic is not only an extremely important medical problem but also a social one and must require special attention.

Mood Disorders in Late Life: A Population-based Analysis of Prevalence, Risk Factors, and Consequences in Community-dwelling Older Adults in Ontario: Troubles de l'humeur en âge avancé : Une analyse dans la population de la prévalence, des facteurs de risque et des conséquences chez des adultes âgés vivant en milieu communautaire en Ontario

OBJECTIVE

Mental health issues in late life are a growing public health challenge as the population aged 65 and older rapidly increases worldwide. An updated understanding of the causes of mood disorders and their consequences in late life could guide interventions for this underrecognized and undertreated problem. We undertook a population-based analysis to quantify the prevalence of mood disorders in late life in Ontario, Canada, and to identify potential risk factors and consequences.

METHOD

Individuals aged 65 or older participating in 4 cycles of a nationally representative survey were included. Self-report of a diagnosed mood disorder was used as the outcome measure. Using linked administrative data, we quantified associations between mood disorder and potential risk factors such as demographic/socioeconomic factors, substance use, and comorbidity. We also determined associations between mood disorders and 5-year outcomes including health service utilization and mortality.

RESULTS

The prevalence of mood disorders was 6.1% (4.9% among males, 7.1% among females). Statistically significant associations with mood disorders included younger age, female sex, food insecurity, chronic opioid use, smoking, and morbidity. Individuals with mood disorders had increased odds of all consequences examined, including placement in long-term care (adjusted odds ratio [OR] =2.28; 95% confidence interval [CI], 1.71 to 3.02) and death (adjusted OR = 1.35; 95% CI, 1.13 to 1.63).

CONCLUSIONS

Mood disorders in late life were strongly correlated with demographic and social/behavioral factors, health care use, institutionalization, and mortality. Understanding these relationships provides a basis for potential interventions to reduce the occurrence of mood disorders in late life and their consequences.

Immune dysregulation in depression: Evidence from genome-wide association

A strong body of evidence supports a role for immune dysregulation across many psychiatric disorders including depression, the leading cause of global disability. Recent progress in the search for genetic variants associated with depression provides the opportunity to strengthen our current understanding of etiological factors contributing to depression and generate novel hypotheses. Here, we provide an overview of the literature demonstrating a role for immune dysregulation in depression, followed by a detailed discussion of the immune-related genes identified by the most recent genome-wide meta-analysis of depression. These genes represent strong evidence-based targets for future basic and translational research which aims to understand the role of the immune system in depression pathology and identify novel points for therapeutic intervention.

Factors associated with work impairment and productivity among Lebanese community pharmacists

Background Community pharmacists provide an essential service by promoting, maintaining and improving the health of the community. However, factors affecting community pharmacists' work productivity remain poorly studied. Objective Our study aimed to assess, on a national level, work productivity components and its correlates among Lebanese community pharmacists. Methods: The study was carried out between March and July 2018, using a representative sample of community pharmacies from all districts of Lebanon. Main outcome measure: The work productivity components were assessed using the Work Productivity and Activity Impairment questionnaire. Results The study included 435 community pharmacists, the prevalence of sickness presenteeism and sickness absenteeism reached 91% and 45%, respectively. Presenteeism was positively associated with reporting higher depression score (β = 0.26) and insomnia (β = 0.20) whereas better mental (β = - 0.35) and physical health (β = - 0.38) were negatively associated with presenteeism. Absenteeism was positively associated with male gender (adjusted OR 2.05, 95% CI 1.14-3.70), reporting higher depression score (adjusted OR = 1.07, 95% CI 1.02-1.11) and negatively associated with better mental and physical health (adjusted OR = 0.93, 95% CI 0.90-0.96 and adjusted OR = 0.96, 95% CI 0.93-0.99; respectively). Activity impairment was positively associated with depression (β = 0.16) and insomnia (β = 0.12) and negatively associated with better mental (β = - 0.22) and physical health (β = - 0.015). Conclusion This is the first study assessing work productivity and activity impairment among Lebanese community pharmacists. Further research is needed to predict sickness absenteeism and presenteeism and this information will be useful to ensure quality of care is delivered.

Longitudinal Relationships Between Depression and Chronic Illness in Adolescents: An Integrative Review

INTRODUCTION

Depression is prevalent among adolescents with chronic illness. However, little is known about how depression affects chronic illness over time. This review aimed to synthesize longitudinal relationships between depression and disease control, self-management behaviors, illness-related morbidity, and quality of life.

METHOD

Four databases were searched, including PubMed, Cumulative Index of Nursing and Allied Health Literature, PsycINFO, and EMBASE. Inclusion criteria were cohort studies examining depression among adolescents aged 10-21 years with a chronic illness and studies published in English. Study quality was appraised using the Newcastle-Ottawa scale and data was synthesized by the outcome.

RESULTS

Of the 3,463 articles identified, 11 were included in the review. For adolescents with diabetes, increased depressive symptoms predicted decreased metabolic control and monitoring, medication adherence, quality of life, and increased hospitalization. Studies on cystic fibrosis, congenital heart disease, sickle cell disease, and juvenile idiopathic arthritis were limited but demonstrated that depressive symptoms affected the quality of life, disability, pain, and hospitalization rates/costs.

DISCUSSION

Evidence supports the need for mental health care strategies suitable for adolescents with chronic illness. Future research is needed to examine the effects of depressive symptoms across diversified chronic illness populations.

The validity and reliability of the Patient Health Questionnaire-9 for screening depression in primary health care patients in Botswana

BACKGROUND

The lack of locally validated screening instruments contributes to poor detection of depression in primary care. The Patient Health Questionnaire-9 (PHQ-9) is a brief and freely available screening tool which was developed for primary care settings; however, its accuracy may be affected by the population in which it is administered. This study aimed to determine the validity and reliability of PHQ-9 for screening depression in a primary care population in Botswana.

METHODS

Data was collected from a conveniently selected sample of 257 adult primary care attendants. The Mini International Neuropsychiatric Interview (MINI) depression module was used as a gold standard to assess criterion validity.

RESULTS

Sensitivity and specificity of the PHQ-9 for screening for major depression were 72.4 and 76.3 respectively at a cut off score of nine or more. The area under the ROC curve was 0.808. The PHQ-9 demonstrated good internal consistency with a Cronbach alpha of 0.799. Criterion validity was demonstrated by significant correlation (r = 0.528, p < 0.001) between PHQ-9 and the MINI. Significant negative correlation between PHQ-9 scores and all four domains of the WHO quality of life questionnaire- brief version scores demonstrated good convergent validity.

CONCLUSIONS

The PHQ-9 is a reliable and valid instrument to screen for depression in primary care facilities in Botswana. Primary care clinicians in Botswana may use the PHQ-9 to screen for depression with a cut -off score of nine. Further studies should focus on integrating routine depression screening in primary care.

Mental and somatic comorbidity of depression: a comprehensive cross-sectional analysis of 202 diagnosis groups using German nationwide ambulatory claims data

BACKGROUND

Depression is frequently accompanied by other mental disorders and various somatic diseases; however, previous comorbidity studies often relied on self-reported data and have not simultaneously assessed the entire spectrum of mental and somatic diagnoses. The aim is to provide a complete picture of mental and somatic comorbidity of depression in routine outpatient care in a high income country with a relatively well equipped health care system.

METHODS

Using ambulatory claims data covering 87% of the German population (age 15+), we designed a cross-sectional study by identifying persons diagnosed with mild, moderate and severe depression in 2017 (N = 6.3 million) and a control group matched 4:1 on sex, 5-year age group and region of residence (N = 25.2 million). Stratified by severity, we calculated the prevalence of 202 diagnosis groups included in the ICD-10 in persons with depression as compared to matched controls using prevalence ratios (PR).

RESULTS

Nearly all mental disorders were at least twice as prevalent in persons with depression relative to controls, showing a dose-response relationship with depression severity. Irrespective of severity, the three most prevalent somatic comorbid diagnosis groups were 'other dorsopathies' (M50-M54), 'hypertensive diseases' (I10-I15) and 'metabolic disorders' (E70-E90), exhibiting PRs in moderate depression of 1.56, 1.23 and 1.33, respectively. Strong associations were revealed with diseases of the central nervous system (i.e. multiple sclerosis) and several neurological diseases, among them sleep disorders, migraine and epilepsy, most of them exhibiting at least 2- to 3-fold higher prevalences in depression relative to controls. Utilization of health care was higher among depression cases compared to controls.

CONCLUSIONS

The present study based on data from nearly the complete adolescent and adult population in Germany comprehensively illustrates the comorbidity status of persons diagnosed with depression as coded in routine health care. Our study should contribute to increasing the awareness of the strong interconnection of depression with all other mental and the vast majority of somatic diseases. Our findings underscore clinical and health-economic relevance and the necessity of systematically addressing the high comorbidity of depression and somatic as well as other mental diseases through prevention, early identification and adequate management of depressive symptoms.

The prevalence of depression in patients living with implantable cardioverter defibrillator: a systematic review and meta-analysis

Depression is a common disorder in patients with implantable cardioverter defibrillator (ICD). There are a variety of studies estimated the prevalence of depression in these patients. The present study aimed to investigate the prevalence of depression in patients with ICD.

METHODS

In the present study, we conducted a systematic review of studies published in PubMed, Scopus, Web of Science (WoS), Medline, and EMBASE without any time filtration to obtain studies investigated the prevalence of depression in patients with ICD. Search terms consisted of "Implantable Cardioverter Defibrillator(s)" in combination with "depression," "depressive," "prevalence," "implanted cardioverter," "implantable," and "implantable defibrillator."

RESULTS

We identified 15 relevant studies, comprising data from 10,182 patients with ICD from whom 2400 (23.58%) (95% CI, 15.36-31.79) had depression. The results of the subgroup analysis showed that the prevalence of depression among middle-aged patients (28.58% with confidence interval of 95%, 21.51-35.65) was higher than elderly patients (22.23% with confidence interval of 95%, 11.21-33.24) and it was not significantly correlated with the mean age of samples (P = 0.255), sample size (P = 0.686), and the publication date (P = 0.784), although there was a significant correlation between the prevalence of depression and the quality of articles so that the prevalence was decreasing with an increase in the quality (P = 0.046).

CONCLUSION

Around 1 in 4 patients with ICD (23.58%) experiences depression progression after an ICD placement. This prevalence is comparable to that in the general population, and close to that of the patients with common chronic diseases.

The Effects of a Multidimensional Exercise Program on Health Behavior and Biopsychological Factors in Mexican Older Adults

Background: The population of older adults is increasing worldwide, which brings attention to the importance of healthy aging. Adoption of healthy lifestyle activities such as participating in physical activity on a daily basis is key to maintaining physical and mental health. The aim of this study was to investigate the effects of participation in a 12-week multidimensional exercise program on health behavior and biopsychological factors of older adults living in Northeastern Mexico. Methods: A quasi-experimental study was conducted with 45 older adults (35 females and 10 males; M = 67.24 ± 5.73 years). The participants were assigned to an experimental group (EG; n = 23) that participated in a 12-week exercise program and a control group (CG; n = 22). Pre- and post-analyses of the exercise intervention data were carried out to investigate the participants' health-related variables including physical activity levels, blood pressure, self-esteem, depressive symptoms, and blood lipids profiles. Results: The results indicated that the exercise intervention contributed to significant improvements in the older adults' health-related variables for the EG when contrasted with the control group. For instance, the EG significantly improved systolic (p < 0.001) and diastolic (p < 0.027) blood pressure, blood lipids [e.g., cholesterol (p < 0.05)], triglycerides (p < 0.05), self-esteem (p < 0.005), and depressive symptoms (p < 0.002) as well as physical activity (p < 0.001) levels. The results also demonstrated that only those individuals in the EG diagnosed with disease benefited from improved self-esteem and physical activity levels when contrasted with their healthy counterparts.

Effect of Mental Health Problems on the Quality of Life in Children with Lupus Nephritis

INTRODUCTION

Mental health problems, such as anxiety, depression, and ineffective family coping, in children with lupus nephritis (LN) can increase the severity and affect the management of the disease, thus affecting the quality of life (QoL) of patients.

OBJECTIVE

Analyzing the association between levels of depression, anxiety, coping, disease activity on the QoL of pediatric patients with LN.

PATIENTS AND METHODS

There were 62 pediatric LN participants (16 participants in the induction phase and 46 participants in the maintenance phase). Participants were measured for anxiety, depression, coping, disease activity (systemic lupus erythematosus disease activity index/SLEDAI), and QoL. The measurement results were compared between induction and maintenance groups. Analysis of the association between anxiety, depression, coping, and disease activity with the QoL of children with LN used a multiple logistic regression test with p <0.05.

RESULTS

The measurement results obtained anxiety (induction = 69.06±3.92 and maintenance = 45.24±10.33; p <0.001), depression (induction = 69.88±3.34 and maintenance = 42.20±9.12; p <0.001), coping (induction = 99.88±12.93 and maintenance = 115.67±7.34; p <0.001), SLEDAI (induction = 15.81±12.58 and maintenance = 0.43±1.26; p <0.001), and QoL (induction = 49.92±12.44 and maintenance = 88.15±8.06; p <0.001).. Anxiety level in the induction group (p = 0.043) and maintenance group (p <0.001; p = 0.032; p = 0.008; p = 0.009). Depression level in the induction group (p = 0.031) and maintenance group (p = 0.024; p = 0.042; p = 0.003). SLEDAI score in the maintenance group (p = 0.003; p = 0.003). Coping in induction group (p = 0.016; p = 0.016) and maintenance group (p = 0.005).

CONCLUSION

Mental health disorders reduce the QoL of LN children, and the level of QoL in induction phase is lower than maintenance phase.

Recent Studies on Anti-Depressant Bioactive Substances in Selected Species from the Genera Hemerocallis and Gladiolus: A Systematic Review

Herbal therapy is a potential alternative applied to pharmacological alleviation of depression symptoms and treatment of this disorder, which is predicted by the World Health Organization (WHO) to be the most serious health problem worldwide over the next several years. It has been well documented that many herbs with psychotropic effects have far fewer side effects than a variety of pharmaceutical agents used by psychiatrists for the treatment of depression. This systematic review presents literature data on the antidepressant activity of representatives of the genera Hemerocallis (H. fulva and H. citrina Baroni, family Xanthorrhoeaceae) and Gladiolus (G. dalenii, family Iridaceae) and on biologically active compounds and their mechanisms of action to consider the application of herbal preparations supporting the treatment of depression.

Association of Mental Health Disorders With Health Care Utilization and Costs Among Adults With Chronic Disease

IMPORTANCE

A population-based study using validated algorithms to estimate the costs of treating people with chronic disease with and without mental health disorders is needed.

OBJECTIVE

To determine the association of mental health disorders with health care costs among people with chronic diseases.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cohort study in the Canadian province of Alberta collected data from April 1, 2012, to March 31, 2015, among 991 445 adults 18 years and older with a chronic disease (ie, asthma, congestive heart failure, myocardial infarction, diabetes, epilepsy, hypertension, chronic pulmonary disease, or chronic kidney disease). Data analysis was conducted from October 2017 to August 2018.

EXPOSURES

Mental health disorder (ie, depression, schizophrenia, alcohol use disorder, or drug use disorder).

MAIN OUTCOMES AND MEASURES

Resource use, mean total unadjusted and adjusted 3-year health care costs, and mean total unadjusted 3-year costs for hospitalization and emergency department visits for ambulatory care-sensitive conditions.

RESULTS

Among 991 445 participants, 156 296 (15.8%) had a mental health disorder. Those with no mental health disorder were older (mean [SD] age, 58.1 [17.6] years vs 55.4 [17.0] years; P < .001) and less likely to be women (50.4% [95% CI, 50.3%-50.5%] vs 57.7% [95% CI, 57.4%-58.0%]; P < .001) than those with mental health disorders. For those with a mental health disorder, mean total 3-year adjusted costs were $38 250 (95% CI, $36 476-$39 935), and for those without a mental health disorder, mean total 3-year adjusted costs were $22 280 (95% CI, $21 780-$22 760). Having a mental health disorder was associated with significantly higher resource use, including hospitalization and emergency department visit rates, length of stay, and hospitalization for ambulatory care-sensitive conditions. Higher resource use by patients with mental health disorders was not associated with health care presentations owing to chronic diseases compared with patients without a mental health disorder (chronic disease hospitalization rate per 1000 patient days, 0.11 [95% CI, 0.11-0.12] vs 0.06 [95% CI, 0.06-0.06]; P < .001; overall hospitalization rate per 1000 patient days, 0.88 [95% CI, 0.87-0.88] vs 0.43 [95% CI, 0.43-0.43]; P < .001).

CONCLUSIONS AND RELEVANCE

This study suggests that mental health disorders are associated with substantially higher resource utilization and health care costs among patients with chronic diseases. These findings have clinical and health policy implications.

Learned helplessness reveals a population at risk for depressive-like behaviour after myocardial infarction in mice

Aims

Myocardial infarction (MI) and heart failure (HF) are risk factors for the development of depression, additionally worsening the quality of life and patient outcome. How HF causes depression and how depression promotes HF remain mechanistically unclear, which is at least partly caused by the difficulty of in vivo modelling of psychosomatic co‐morbidity. We aimed to study the potential sequence of events with respect to different depression aspects upon HF.

Methods and results

Male C57BL6 mice underwent MI, followed by behavioural and echocardiographic characterization. Motility, exploration, and anxiety‐like behaviour were unaffected in mice after MI. We did not observe increased depressive‐like behaviour in the sucrose preference, tail suspension, or Porsolt forced swim test. Mice did not display signs of learned helplessness (LH) when compared to sham. Accordingly, cluster analysis revealed only a slightly higher quota of LH in HF (38%) vs. sham mice (32%). But strikingly, three‐group cluster analysis revealed an additional intermediate subpopulation at risk for LH after HF (29%). Interestingly, this population featured elevated cardiac expression of nr4a1.

Conclusions

The LH paradigm uncovered a subtle predisposition to depressive‐like behaviour after MI, whereas testing for anhedonia and despair was insufficient to show a behavioural shift in mice. Therefore, we suggest an accumulating risk profile and a multiple‐hits hypothesis regarding the pathogenesis of co‐morbid depression after MI. Symptoms of LH may present a marker of subclinical depression after MI, the impact of which remains to be investigated. The proposed sequence of behavioural testing enables the mechanistic dissection of cardio‐psychogenic signalling in the future.

Positive Psychology in Lifestyle Medicine and Health Care: Strategies for Implementation

Prevention and treatment of lifestyle-related diseases are realized through leading a healthy lifestyle. Activities supporting positive psychology can facilitate healthy behaviors and improve physiological health. Adding such activities to clinical care promotes attainment of the physical, social, and emotional elements of health, as defined by the World Health Organization-leading to (1) prolonged lifespan and quality of life, (2) lowered costs of care, and (3) reduced rates of provider burnout. A key challenge remains the translation of positive psychology-based practices into practical, implementable strategies by health care providers. An essential step is collaboration of positive psychology and health care researchers and practitioners to develop standards, terms, and measures and arrive at evidence-based clinical approaches addressing total well-being. The first Summit on Happiness Science in Healthcare enabled national experts and stakeholders in lifestyle medicine, medical education, health care administration, psychology, and community welfare to convene and identify best practices for practical implementation of positive psychology science into health care. This article draws on the summit discussions to address the gap between positive psychology theory and practical implementation in health care. We briefly summarize the positive psychology-health outcomes relationship and present key strategies needed to bridge this gap.

The Efficacy of Acceptance and Commitment Therapy (ACT) Matrix on Depression and Psychological Capital of the Patients with Irritable Bowel Syndrome

BACKGROUND:

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders, worldwide. Psychological disorders are common among patients with IBS.

AIM:

This study aims to investigate the efficacy of acceptance and commitment therapy (ACT) matrix on depression and psychological capital of patients with IBS.

MATERIAL AND METHODS:

In a quasi-experimental study, a total number of 30 patients with IBS were selected using convenience sampling. Those patients who meet the inclusion criteria were randomly assigned to control and experimental groups (15 patients in each group). Data were collected using the Beck Depression Inventory (BDI) and the Psychological Capital Questionnaire (PCQ). The experimental group was subjected to the acceptance and commitment therapy (ACT) amtrix, but the control group do not receive this treatment. Questionnaires were completed before (pre-test) and after (post-test) the intervention by patients in two groups. All patients in two groups responded to the questionnaires and returned them to the researcher. Data were analyzed using chi-square test, independent t-test, analysis of covariance (ANCOVA) and multivariate analysis of covariance (MANCOVA).

RESULTS:

Analyzing the data showed that there were significant differences regarding depression and psychological capital between experimental and control group, before and after the study (p < 0.05).

CONCLUSION:

Using ACT matrix is a useful modality to improve the depression and psychological capital among patients with IBS.

A comparative study of psychosocial determinants and mental well-being in chronic kidney disease patients: A closer look

BACKGROUND

Depressive illness in chronic kidney disease (CKD) is an independent risk factor for morbidity and mortality. The relation between depressive illness and quality of life (QoL) in this vulnerable group is complex. We attempted to study the burden of depressive illness, the QoL in patients of CKD on hemodialysis (HD), and peritoneal dialysis (PD) as well as those who were not on any dialysis but on conservative medical management only.

MATERIALS AND METHODS

Observational study with cross-sectional analytical controlled design.

STATISTICAL METHODS USED

Chi-square statistic or Fisher's exact test for categorical variables and t-test and ANOVA for continuous variables. Correlational analysis was done using Spearman's correlation coefficient. P <0.05 was considered as statistically significant.

RESULTS

Depressive symptoms were present significantly across all 3 groups of CKD patients. Depressive disorder was significantly higher in the HD group. Mean QoL was significantly better in patients of CKD on PD.

DISCUSSION

There is huge hidden burden of depressive symptoms and depressive illness in patients of CKD whether on dialysis or on conservative medical management. The study found significantly higher burden of depressive illness and lower QoL among the HD vis a vis PD patients, even though the majority of our CKD who require dialysis are on HD.

CONCLUSION

Depressive burden is the hidden factor behind poor QoL, poor overall satisfaction as well as treatment outcome in patients of CKD whether or not on dialysis. To address this hidden depressive burden comprehensively, close cooperation between nephrologist and psychiatrist is called for.

The effect of depression management on diabetes and hypertension outcomes in low- and middle-income countries: a systematic review protocol

BACKGROUND

Depression and non-communicable diseases (NCDs) account for a growing burden on health systems in low- and middle-income countries (LMICs). Depression is generally associated with the outcomes of NCDs and is an important barrier to consistent NCD care management. There is great need to understand the efficacy of interventions to treat depression for people with NCDs, but there is a paucity of evidence of the efficacy of the interventions in LMICs. Therefore, the broad objective of this review is to systematically review the literature on the effectiveness of depression management among patients with diabetes and hypertension to improve outcomes.

METHODS

This is a systematic review to assess the evidence of the effect of depression management in diabetic and hypertensive patients on diabetes and hypertension outcomes in LMICs. Two independent reviewers will search articles on PubMed, EMBASE, PsycINFO, and Global Index Medicus. Two reviewers will then screen the articles independently based on predefined criteria. We will use standard methods as recommended by the Cochrane Collaboration of assessing quality of evidence and publish our report using the PRISMA guidelines.

DISCUSSION

The findings from this review will provide evidence to be used in guiding practice and policy on how to integrate depression management in diabetes and hypertension clinics.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017068257.

Citalopram and group psychotherapy in breast cancer patients: A randomized clinical trial

Background: Depression is a common psychiatric disorder in breast cancer patients. This study was designed to evaluate the clinical efficacy of group psychotherapy on breast cancer patients with depressive disorder who took citalopram.

Methods: This clinical trial was conducted on 40 breast cancer patients with depressive disorder. The control group received citalopram 20-40 mg/ day for 12 weeks and the intervention group participated in 8 sessions of group psychotherapy in addition to the same dose of citalopram. At the baseline and 3, 6, and 12 weeks after treatment, patients were followed- up. Treatment outcomes and quality of life were compared between the 2 groups.

Results: Overall, the depression score of Hospital Anxiety and Depression Scale (HADS) at baseline with the mean of 11.6±1.6 was signed in the range of clinical depression and after intervention it declined to 8.8±3.6 (in the 3rd week), 7.1±3.9 (6th week), and 5.9±4.5 (12th week). Furthermore, HADS anxiety score at baseline with the mean of 12.6±2.6 was signed in the range of clinical anxiety and after intervention it declined to 9.1±3.0, 7.3±4.1, and 6.0±4.0, respectively. This improvement was significantly more in the combined therapy intervention group (p<0.001). The mean score of quality of life based on WHO QOL-BREF questionnaire increased by 1.85 fold in the case group, improved from 44.09 to 81.70, while the slight change was observed in the control group (p<0.001). During the treatment, no significant adverse drug event was observed in the 2 groups (p>0.05).

Conclusion: Group psychotherapy has a significant effect on improving depression, anxiety, and quality of life in breast cancer patients.

Chronic Physical Conditions, Multimorbidity, and Mild Cognitive Impairment in Low- and Middle-Income Countries

OBJECTIVES

To assess the association between chronic physical conditions and multimorbidity and mild cognitive impairment (MCI) in low- and middle-income countries (LMICs).

DESIGN

Nationally representative, cross-sectional, community-based study.

SETTING

Six countries that participated in the World Health Organization Study on Global Ageing and Adult Health.

PARTICIPANTS

Individuals aged 50 and older (N=32,715; mean age 62.1 ± 15.6; 51.7% female).

MEASUREMENTS

The definition of MCI was based on the recommendations of the National Institute on Ageing and Alzheimer's Association. Ten chronic conditions were assessed (angina pectoris, arthritis, asthma, cataract, chronic lung disease, diabetes mellitus, edentulism, hearing problems, hypertension, stroke). Multivariable logistic regression analysis was conducted to assess the association between chronic physical conditions, multimorbidity (≥2 chronic conditions), and MCI.

RESULTS

The prevalence of multimorbidity was 49.8% (95% confidence interval (CI)=48.1-51.5%) and of MCI was 15.3% (95% CI=14.4-16.3%). After adjustment for potential confounders, edentulism (odds ratio (OR)=1.24), arthritis (OR=1.24), chronic lung disease (OR=1.29), cataract (OR=1.33), stroke (OR=1.94), hearing problems (OR=2.27), and multimorbidity (OR=1.40) were significantly associated with MCI. There was a gradual increase in the likelihood of MCI (1 condition: OR=1.21, 95% CI=1.03-1.42; ≥4 conditions: OR=2.07, 95% CI=1.70-2.52).

CONCLUSION

These results highlight the need to investigate the underlying mechanisms linking chronic conditions and MCI and whether prevention or treatment of chronic conditions or multimorbidity can reduce the onset of cognitive decline and subsequent dementia, especially in LMICs.

The European Gaucher Alliance: a survey of member patient organisations' activities, healthcare environments and concerns

Background

The European Gaucher Alliance (EGA) was established in 1994 and constituted in 2008 as an umbrella group supporting patient organisations for Gaucher disease. Every two years, the EGA conducts a questionnaire survey of member associations to help develop its priorities and annual work programme. Results of the latest survey are presented.

Methods

Between June 2012 and April 2013, the 36 members and associate members of the EGA were asked to complete a questionnaire detailing membership numbers, disease specific treatments used by patients, means of access to treatment, availability of treatment centres and home infusions, sources of support for patients with Gaucher disease, patient organisations’ activities, collaborations, funding sources and any issues of concern. Questionnaires completed in 2012 were revised in January 2013 and responses analysed between July and September 2013.

Results

Thirty three members returned data on one or more questions. Findings identified inequalities in access to treatment both within and between members’ countries. Three of 27 countries, for which data were available, relied totally on humanitarian aid for treatment and 6% of untreated patients in 20 countries were untreated because of funding issues, a situation many feared would worsen with deteriorating economic climates. Access to treatment and reimbursement represented 45% of members’ concerns, while 35% related to access to specialist treatment centres, home infusions and doctors with expertise in Gaucher disease. Member associations’ main activities centred on patient support (59% of responses) and raising awareness of Gaucher disease and patients’ needs amongst the medical community, government and healthcare decision makers and the general public (34% of responses). Twenty one (78% of respondents) indicated they were the only source of help for Gaucher disease patients in their country. For many, activities were constrained by funds; two members had no external funding source. Activities were maximised through collaboration with other patient organisations and umbrella organisations for rare diseases.

Conclusion

The survey provided a ‘snapshot’ of the situation for patients and families affected by Gaucher disease, helping the EGA direct its activities into areas of greatest need.

A review of peripheral biomarkers in major depression: the potential of inflammatory and oxidative stress biomarkers

Biomarkers are regularly used in medicine to provide objective indicators of normal biological processes, pathogenic processes or pharmacological responses to therapeutic interventions, and have proved invaluable in expanding our understanding and treatment of medical diseases. In the field of psychiatry, assessment and treatment has, however, primarily relied on patient interviews and questionnaires for diagnostic and treatment purposes. Biomarkers in psychiatry present a promising addition to advance the diagnosis, treatment and prevention of psychiatric diseases. This review provides a summary on the potential of peripheral biomarkers in major depression with a specific emphasis on those related to inflammatory/immune and oxidative stress/antioxidant defences. The complexities associated with biomarker assessment are reviewed specifically around their collection, analysis and interpretation. Focus is placed on the potential of peripheral biomarkers to aid diagnosis, predict treatment response, enhance treatment-matching, and prevent the onset or relapse of major depression.

β-phenylethylamine, a small molecule with a large impact

During a screen of bacterial nutrients as inhibitors of Escherichia coli O157:H7 biofilm, the Prüß research team made an intriguing observation: among 95 carbon and 95 nitrogen sources tested, β-phenylethylamine (PEA) performed best at reducing bacterial cell counts and biofilm amounts, when supplemented to liquid beef broth medium. This review article summarizes what is known about PEA. After some starting information on the chemistry of the molecule, we focus on PEA as a neurotransmitter and then move on to its role in food processing. PEA is a trace amine whose molecular mechanism of action differs from biogenic amines, such as serotonin or dopamine. Especially low or high concentrations of PEA may be associated with specific psychological disorders. For those disorders that are characterized by low PEA levels (e.g. attention deficit hyperactivity disorder), PEA has been suggested as a 'safe' alternative to drugs, such as amphetamine or methylphenidate, which are accompanied by many undesirable side effects. On the food processing end, PEA can be detected in food either as a result of microbial metabolism or thermal processing. PEA's presence in food can be used as an indicator of bacterial contamination.