Geschlechtsspezifische Aspekte bei depressiven Erkrankungen

The journey of medical field students: uncovering medical student syndrome, personality traits, and their interactions

BACKGROUND

Medical students commonly experience Medical Student Syndrome (MSS), a condition where they compare their vague symptoms to the medical problems and life-threatening diseases they are learning about in medical school, even though their health profile is free. Our research aims to investigate the symptoms of MSS (anxiety-related illness) and hypochondriasis, as well as their impact on the lives of students. Additionally, we aim to study various types of personalities and, finally, investigate the demographic determinants of MSS and their interactions with various personality types among medical students in Egypt in the period between September and December 2023.

METHODS

This analytical cross-sectional study targeted 300 students recruited from the medical field at Zagazig University. The data was collected using a self-administered questionnaire, which consisted of four main components: demographic data, the MSS questionnaire, the personality-type questionnaire, and the MSS's impact. The collected data was coded and analyzed using R statistical software.

RESULTS

Out of the 300 medical field students recruited, 261 (87.0%) were Egyptian, 164 (54.67%) were female, and 216 (72.0%) were medical students without co-morbidity. 181 (60.33%) were aware of the MSS. Only 11 (3.67%) individuals met all criteria of the DSM-V for anxiety disorder, while 20 (6.67%) individuals met all criteria of the DSM-IV for hypochondriasis. The most common anxiety symptoms were difficulty sleeping (50.00%), lack of productivity or difficulty concentrating (44.0%), and rapid heart rate (31.67%). In terms of personality, being sympathetic and warm received the highest median of 6.00 while being critical and quarrelsome received the lowest median score of 2.00. The health anxiety score significantly negatively correlates with dependable and self-disciplined personality traits, while it significantly positively correlates with anxiety and upset personality traits.

CONCLUSION

Around one-third of the sample experienced preoccupation with fears of having a serious disease, with a trivial number of students meeting the criteria for anxiety disorder or hypochondriasis. More than one-third reported negative impacts on sleep, productivity, concentration, and heart rate. Females, Egyptian students, those from rural areas, and dentistry students had higher anxiety scores, whereas medical students had the lowest scores.

Loneliness and mental burden among German medical students during the fading COVID-19 pandemic: a mixed-methods approach

Introduction

Medical students experience significantly more mental burdens compared to the general public. This circumstance was further exacerbated by the pandemic, particularly with regard to loneliness. While previous studies have identified risk factors for loneliness among students of different subjects, recent data focusing on medical students during the late stages of the pandemic remain insufficient. This study aims to address this gap.

Methods

We performed a cross-sectional study at a German Medical School, consisting of two online surveys conducted in winter 2021/22 and summer 2022. The study sample, composed of 283 undergraduate students in winter 2021/22 (231 in summer 2022), answered five well-established scales for measuring loneliness (R-UCLA3), distress (DT-NCCN), anxiety (GAD-2), depression (PHQ-2), and perceived stress (PPS-4). Additionally, we evaluated burdensome aspects of students' current situation through qualitative analysis. Longitudinal analyses were conducted for 80 medical students who participated in both surveys.

Results

Around 20% of all students responded to each survey. In winter 2021/22, 55.1% of students reported loneliness above the cut-off (M = 5.77 [2.02]; decreasing to 45.0% by summer 2022 (M = 5.22 [1.90]). Lonely students reported significantly higher levels of depression, anxiety, and self-perceived stress in both survey periods. Overall distress increased substantially throughout our study (Cohen's d = -0.54). Binary regression models indicated a shift in loneliness risk factors: in winter 2021/22, being single, higher self-perceived stress levels, and decreased study motivation were associated with increased loneliness. Lower peer connectedness emerged as the sole significant factor associated with loneliness in summer 2022. While the pandemic-related burden on students' study motivation lessened, issues related to exam preparation and lack of study organization through the faculty increased, varying significantly depending on students' study year.

Conclusion

Our data suggest that loneliness among German medical students decreased in the late stages of the COVID-19 pandemic. However, other mental burdens persisted at high levels compared to other data in the general public and medical students. Students' responses underscore the need for improved academic support by eased study program structure, improved counseling, and tailored services for students of different study years.

Association between periodontitis and depression severity - A cross-sectional study of the older population in Hamburg

The aim of the current study is to investigate the association between periodontitis (exposure variable) and depression severity (outcome variable) in an older German population. We evaluated data from 6,209 participants (median age 62 years) of the Hamburg City Health Study (HCHS). The HCHS is a prospective cohort study and is registered at ClinicalTrial.gov (NCT03934957). Depression severity were assessed with the 9-item Patient Health Questionnaire (PHQ-9). Periodontal examination included probing depth, gingival recession, plaque index, and bleeding on probing. Descriptive analyses were stratified by periodontitis severity. Multiple linear regression models were adjusted for age, sex, diabetes, education, smoking, and antidepressant medication. Linear regression analyses revealed a significant association between log-transformed depression severity and periodontitis when including the interaction term for periodontitis * age, even after adjusting for age, sex, diabetes, education, smoking and antidepressant medication. We identified a significant association between severe periodontitis and elevated depression severity, which interacts with age. Additionally, we performed a linear regression model for biomarker analyses, which revealed significant associations between depression severity and severe periodontitis with log-transformed inflammatory biomarkers interleukin 6 (IL-6) and high-sensitivity C-reactive protein (hsCRP). In order to identify new therapeutic strategies for patients with depression and periodontal disease, future prospective studies are needed to assess the physiological and psychosocial mechanisms behind this relationship and the causal directionality.

[Comparison of behavioral orthopedic and classical orthopedic rehabilitation : A retrospective cohort study on the factors of mental comorbidity, gender and employment status]

BACKGROUND

Mental comorbidity plays an increasingly important role in determining the specific rehabilitation needs of patients in Germany in the context of other personal, social and occupational factors. In order to make the DRV's list of criteria more meaningful when assigning patients to one type of rehabilitation, this retrospective analysis is intended to determine from which of the two rehabilitation concepts examined (orthopedic rehabilitation or healing procedures (HV)/behavioral-medical orthopedic rehabilitation (BMOR)) patients with mental comorbidity (taking into account gender, employment status of the main orthopedic diagnosis) benefit more.

METHODS

Using the screening questionnaires HADS‑A, HADS‑D, SIMBO and BPI as well as a hospital questionnaire at the beginning of rehabilitation, data from 913 subjects (529 m/384 w) were collected and evaluated. Of these, 43% were assigned to HV and 57% to BMOR. Thus, in addition to the main orthopedic diagnosis, the frequency distribution of the factors psychological comorbidity, sex and, employment status (in the sense of unemployment) was determined. Using HADS, the benefit was determined at the end of the therapy by comparing the score medians.

RESULTS

Frequency distributions and the development of HADS scores show that the prior classification according to psychological comorbidity was correct. Women were more often affected by mental comorbidity and women achieved greater success in BMOR. Regarding the main orthopedic diagnosis, a high prevalence of cervical and lumbar spine complaints was found. According to logistic regression with model decomposition, the variables gender, HADS‑A and -D at the beginning of rehabilitation and the psychological comorbidity (yes/no) are suitable to correctly allocate the patients with 76.86% to one of the two types of therapy.

CONCLUSIONS

The presence of mental comorbidity appears to be a useful indicator that should be retained in the DRV's criteria catalog as one of the main criteria for allocation to BMOR. Female gender in connection with the presence of mental co-morbidity can also be considered a conclusive criterion. With regard to the main orthopedic diagnosis, cervical spine complaints may be particularly suitable as an allocation criterion.

Psychosocial adjustment of U.S. college students in the early months of the COVID-19 pandemic

Objective: Examine the psychosocial adjustment of U.S. college and university students during the early months of the COVID-19 pandemic. Participants: Higher education students in the U.S. (N = 228), recruited between March 2020 and May 2020. Methods: Participants completed self-report measures regarding their psychosocial functioning online. Qualitative and quantitative methods were used to explore participants' psychosocial adjustment. Results: Participants reported increased concerns about such stressors as academics, job loss, health, and social isolation. They reported significantly elevated symptoms of depression, anxiety, perceived stress, and somatization, and prior history of psychological counseling was associated with greater levels of distress. Approximately one-third of participants reported inadequate perceived social support, which in turn was linked to psychosocial adjustment. Conclusions: College students reported experiencing a wide range of stressors related to the pandemic. Increasing access to mental health services and providing supportive services in such areas as social connection and employment are encouraged.

„Sie erscheint durch ihr Übergewicht keineswegs entstellt.“

Wie nehmen Psychoanalytiker*innen ihre männlichen bzw. weiblichen Patient*innen wahr? Anhand von Textanalysen der Berichte an den Gutachter aus Anträgen zur Kostenübernahme für Psychotherapien untersuchten wir, ob es hierbei geschlechtsspezifische Unterschiede gibt. Es wurden 20 Berichte von Patienten und 20 Berichte von Patientinnen qualitativ analysiert, resultierend in 399 kodierten Textsegmenten.

Es zeigte sich, dass bei Frauen deutlich häufiger über deren Aussehen (Frisur, Körperbau, Augen, Kleidungsstil und so weiter) geschrieben wird. Auch in der Bewertung des Aussehens zeigten sich Unterschiede: Patientinnen wurden häufiger als hübsch/attraktiv oder als kindlich/jünger wirkend beschrieben, während diese Attribute fast nie bei Männern verwendet wurden. Diese wurden hingegen häufiger als überdurchschnittlich intelligent geschildert.

In der Gegenübertragung zeigten sich bei Frauen häufiger Gefühle von Vorsichtig-sein-Müssen, aber auch von Mitgefühl und Sympathie, bei Männern hingegen häufiger der Wunsch, sie zu beschützen und ihnen zu helfen, der Wunsch, sie zu begrenzen, sowie Ärger/Wut.

Diese Befunde legen nahe, dass Genderstereotype bei der Wahrnehmung von (und dem Schreiben über) Patient*innen eine wesentliche Rolle spielen.

Mental and physical health correlates of the psychological impact of the first wave of COVID-19 among general population of Pakistan

The primary aim was to assess the role of mental and physical health of COVID-19 and its psychological impact in the general population of Pakistan during the first wave of COVID-19. It was hypothesized that there would be a significant predictive association among socio-demographic variables, psychological impact and mental health status resulting from COVID-19, and poor self-reported physical health would be significantly associated with adverse psychological impact and poor mental health status because of COVID-19. A cross-sectional survey research design was used in which 1,361 respondents were sampled online during lockdown imposed in the country. The Impact of Events Scale-Revised (IES-R) was used to assess the psychological impact of COVID-19, and the Depression Anxiety Stress Scales (DASS-21) was used to assess participants’ mental health status. 18% of the respondents reported moderate to severe event-specific distress, 22.6% reported moderate to severely extreme depression, 29% reported moderate to extreme anxiety, and 12.1% reported moderate to extreme stress. Female gender, having graduate-level education, currently studying, and self-reported physical symptoms (persistent fever, chills, headache, cough, breathing difficulty, dizziness, and sore throat) were significantly associated with higher levels of psychological impact exhibited through higher scores on the IES-R and poorer mental health status exhibited through higher scores on the DASS-21 (Depression, Anxiety, and Stress Subscales).

Incidence of Anxiety in Latest Life and Risk Factors. Results of the AgeCoDe/AgeQualiDe Study

Research on anxiety in oldest-old individuals is scarce. Specifically, incidence studies based on large community samples are lacking. The objective of this study is to assess age- and gender-specific incidence rates in a large sample of oldest-old individuals and to identify potential risk factors. The study included data from N = 702 adults aged 81 to 97 years. Anxiety symptoms were identified using the short form of the Geriatric Anxiety Inventory (GAI-SF). Associations of potential risk factors with anxiety incidence were analyzed using Cox proportional hazard models. Out of the N = 702 older adults, N = 77 individuals developed anxiety symptoms during the follow-up period. The incidence rate was 51.3 (95% CI: 41.2-64.1) per 1000 person-years in the overall sample, compared to 58.5 (95% CI: 43.2-72.4) in women and 37.3 (95% CI: 23.6-58.3) in men. Multivariable analysis showed an association of subjective memory complaints (HR: 2.03, 95% CI: 1.16-3.57) and depressive symptoms (HR: 3.20, 95% CI: 1.46-7.01) with incident anxiety in the follow-up. Incident anxiety is highly common in late life. Depressive symptoms and subjective memory complaints are major risk factors of new episodes. Incident anxiety appears to be a response to subjective memory complaints independent of depressive symptoms.

Gender-specified mediation of depression between sleep quality and short-term memory in older adults: Study in a semi-closed Island of Xiamen, China

BACKGROUND

Both the quality of sleep and depression impact short-term memory (STM) while they influence each other. However, the underlying mechanisms are not yet clear. Herein, we aimed to explore the mediating effect of depression between sleep quality and STM in older adults and further test the gender differences in this relationship.

METHODS

A cluster sampling survey was carried out among 903 residents that were aged 60+ years in a semi-closed island of Xiamen, China, in 2019. The subjects' sleep quality and depression were measured using the Pittsburgh Sleep Quality Index (PSQI) and the 15-item Geriatric Depression Scale (GDS-15), respectively. The three-item recall test was utilized to measure STM function. Mediation analyses were performed using the structural equation model and bias-corrected bootstrap method. Next, the Wald-test was utilized to determine gender differences in the pathway.

RESULTS

Overall, 355 men and 508 women, with a mean age of 69.55 and 70.97, respectively, had valid data on the main variables. Depression was found to mediate the effect of sleep quality on STM (a*b = -0.076, p < 0.05). Interestingly, while this indirect effect existed in the female group (a_f *b_f  = -0.126, p < 0.05), it did not in the male group (a_m *b_m  = 0.017, p = 0.677). The Wald-test indicated no gender differences in the pathway from sleep quality to depression (p = 0.303). However, the pathway from depression to STM function was found to be significantly stronger for females than males (p = 0.0198).

CONCLUSION

Higher sleep quality was found to be associated with improved STM function. Furthermore, the association was found to be regulate indirectly by lower depressive symptoms for females, but directly for males. Therefore, appropriate psychological interventions may be beneficial to the maintenance of STM for older adults, particularly for women.

Relationship between chronic diseases and depression: the mediating effect of pain

BACKGROUND

Chronic diseases have a high incidence in China and may cause pain and depression. However, the association of chronic diseases with pain and the incidence of depression has not been comprehensively investigated.

METHODS

The study population was obtained from the 2015 China Health and Retirement Longitudinal Study (CHARLS). The cross-sectional data from15,213 persons were included. CHARLS provides nationally representative data from21,097 individuals aged 45 years and older in approximately 150 districts and 450 villages. The main outcome was the incidence of depression. The main independent variable was chronic disease (no chronic disease, one chronic disease, and two or more chronic diseases). The mediators were the degree of pain (no pain, mild pain, and moderate to severe pain) and whether measures were taken to relieve pain (measures taken and no measures taken). We performed chi-square and binary logistic regression analyses of the associations of chronic disease with pain and the incidence of depression. The mediation model was examined using the Sobel test.

RESULTS

Patients with more chronic diseases had more severe pain (OR = 3.697, P < 0.001, CI = 2.919-4.681) and were more likely to develop depression (OR = 2.777, P < 0.001, CI = 2.497-3.090). The degree of pain partially mediated the interaction between chronic disease and depression in this study (t = 7.989, P < 0.001). The incidence of depression was high in people who were female, less educated, unmarried, living in rural areas, and working.

CONCLUSIONS

The degree of pain had a partial mediating effect on chronic disease and depression. Pain relief measures should be considered when treating patients with depression.

[Unipolar depression: a gender-based comparative analysis]

OBJECTIVE

To compare socio-demographic and clinical characteristics in men and women with depression.

MATERIAL AND METHODS

We studied 388 patients with unipolar depression, 74 men and 314 women. The survey was carried out using the clinical-psychopathological method and psychometric scales for depression.

RESULTS AND CONCLUSION

Gender differences are identified for several parameters. Women are older, more often had comorbid somatic and organic disorders; men have personality disorders and chronic depression. The severity of depression in women was higher due to symptoms such as reported sadness, anxiety, reduced sleep and appetite, concentration difficulties, and suicidal thoughts. Apparent sadness did not significantly differ in men and women. Anhedonia was more pronounced in men.

Mapping Brain Microstructure and Network Alterations in Depressive Patients with Suicide Attempts Using Generalized Q-Sampling MRI

Depressive disorder is one of the leading causes of disability worldwide, with a high prevalence and chronic course. Depressive disorder carries an increased risk of suicide. Alterations in brain structure and networks may play an important role in suicidality among depressed patients. Diffusion magnetic resonance imaging (MRI) is a noninvasive method to map white-matter fiber orientations and provide quantitative parameters. This study investigated the neurological structural differences and network alterations in depressed patients with suicide attempts by using generalized q-sampling imaging (GQI). Our study recruited 155 participants and assigned them into three groups: 44 depressed patients with a history of suicide attempts (SA), 56 depressed patients without a history of suicide attempts (D) and 55 healthy controls (HC). We used the GQI to analyze the generalized fractional anisotropy (GFA) and normalized quantitative anisotropy (NQA) values in voxel-based statistical analysis, topological parameters in graph theoretical analysis and subnetwork connectivity in network-based statistical analysis. GFA indicates the measurement of neural anisotropy and represents white-matter integrity; NQA indicates the amount of anisotropic spins that diffuse along fiber orientations and represents white-matter compactness. In the voxel-based statistical analysis, we found lower GFA and NQA values in the SA group than in the D and HC groups and lower GFA and NQA values in the D group than in the HC group. In the graph theoretical analysis, the SA group demonstrated higher local segregation and lower global integration among the three groups. In the network-based statistical analysis, the SA group showed stronger subnetwork connections in the frontal and parietal lobes, and the D group showed stronger subnetwork connections in the parietal lobe than the HC group. Alternations were found in the structural differences and network measurements in healthy controls and depressed patients with and without a history of suicide attempt.

A Hypothesis of Gender Differences in Self-Reporting Symptom of Depression: Implications to Solve Under-Diagnosis and Under-Treatment of Depression in Males

The phenomenon of female preponderance in depression has been well-reported, which has been challenged by higher rates of suicide and addictive behaviors in males, and a longer life-span in females. We thus propose an alternative hypothesis "Gender differences in self-reporting symptom of depression," suggesting mild-moderate depression tends to be reported more often by females, and severe depression and suicide tend to be reported more often by males. Potential mechanisms that account for this difference may include three aspects: covariation between estrogen levels and the incidence peak of female depression, gender differences in coping style (e.g., comparative emotional inexpressiveness and non-help-seeking in males), and gender differences in symptom phenotypes (e.g., atypical symptoms in male depression). Our newly presented hypothesis implied the overlooked under-diagnosis and under-treatment of depression in males. For effective diagnoses and timely treatment of male depression, it is critical to incorporate symptoms of depression in males into the relevant diagnostic criteria, encourage males to express negative emotions, and increase awareness of suicidal behavior in males.

Poorer sleep quality correlated with mental health problems in college students: A longitudinal observational study among 686 males

OBJECTIVE

Poor sleep quality and mental health problems are common in college students. The objective of this study is to examine whether sleep quality predicts the risk of future mental health problems, and vice versa.

METHODS

The sleep quality and mental health status of 686 male college students were estimated, and 582 of them were followed up a year later. Subjective sleep quality and mental health problems were measured with the Pittsburgh Sleep Quality Index (PSQI) and the Depression Anxiety Stress Scale-21 (DASS-21), respectively.

RESULTS

Either at baseline or during follow-up, the PSQI global score was positively associated with scores for depression, anxiety, and stress on the DASS-21 (p's < 0.001). Longitudinal analyses revealed that DASS-21 total score increased in line with increased of PSQI global score during the year (p < .001). More importantly, the cross-lagged analysis showed that (i) PSQI global score at baseline was positively related to depression (β = 0.261), anxiety (β = 0.321), and stress (β = 0.311) scores a year later (p's < 0.001) and (ii) depression (β = 0.259), stress (β = 0.245) and anxiety (β = 0.292) scores at baseline were related to PSQI global score a year later (p's < 0.001). Finally, we further found that among those without mental health problems at baseline, poorer baseline sleep quality predicted a higher risk of anxiety symptoms a year later (RR 3.07, 95% CI 1.36-6.97, p = .007).

CONCLUSIONS

These data may suggest a bidirectionally relationship between sleep quality and mental health problems.

Relationship of physical activity and sleep with depression in college students

Objectives: This study examined the relationship between physical activity, sleep and depression among college students and gender differences in physical activity, sleep and depression. Methods: Participants were 1143 students from a large public university in Beijing and completed three questionnaires to measure their physical activity habits, sleep patterns, and depression levels. Data from were analyzed using descriptive statistics, stepwise regression, and an independent t test. Results: Results indicated that vigorous physical activity and sleep variables significantly predicted depression levels for the overall sample (F = 77.286, p = .000). When examined by gender, vigorous and moderate physical activity variables significantly predicted depression for males (t = -2.772, p = .006; t = -2.622, p = .009), whereas no level of physical activity had a significant relationship with depression for females. Conclusions: Rigorous physical activity and quality sleep may be beneficial to helping college students reduce and regulate depressive symptoms, however may vary by gender.

Mental health professionals view about the impact of male gender for the treatment of men with depression - a qualitative study

BACKGROUND

The underestimation of depression among men may result from atypical depression symptoms and male help-seeking behaviour. However, higher suicide rates among men than among women indicate a need for gender-specific services for men with depression. In order to develop gender-specific services, it is essential to examine professionals' attitudes towards men's depressive symptoms and treatment needs as well as barriers to and facilitators of treatment. This study examined gender-specific treatment needs in male patients and treatment approaches to male patients from a professional perspective.

METHODS

Semi-structured face-to-face interviews were conducted with 33 mental health professionals (MHPs) from five German psychiatric institutions. The study assessed the characteristics and attributes of male patients with depression risk factors for the development of depression among men, their condition at the beginning of treatment, male patients' depressive symptoms, the needs and expectations of male patients, the importance of social networks in a mental health context, and MHPs' treatment aims and treatment methods. Transcripts were analysed using qualitative content analysis.

RESULTS

The professionals' reference group of male patients were men who were characterised in accordance with traditional masculinity. Attributes reported as in line with this type of men were late initiations of inpatient treatment after crisis, suicidal ideation or attempted suicide, and high expectations towards treatment duration, success rate in recovery and therapeutic sessions. In contrast, male patients who deviate from these patterns were partially described with reference to female stereotypes. Professionals referred to psychosocial models in their explanations of the causes of depression and provided sociological explanations for the development of masculine ideals among men. The consequences of these for treatment were discussed against the background of normative expectations regarding the male gender. From the professionals' point of view, psychoeducation and the acceptance of depression (as a widespread mental illness) were the most important goals in mental health treatment.

CONCLUSIONS

In order to improve mental health among men, gender-specific services should be offered. Awareness of the role of gender and its implications on mental health treatment should be an integral part of MHPs' education and their daily implementation of mental health treatment practices.

Persistent depressive disorder across the adult lifespan: results from clinical and population-based surveys in Germany

BACKGROUND

Although the individual and economic disease burden of depression is particularly high for long-term symptoms, little is known of the lifetime course of chronic depression. Most evidence derives from clinical samples, and the diagnostic distinction between persistent depressive disorder (PDD) and non-chronic major depression (NCMDD) is still debated. Thus, we examined characteristics of PDD among clinical vs. non-clinical cases, and the associated disease burden at a population level.

METHODS

Data were drawn from the mental health module of the German Health Interview and Examination Survey for Adults (DEGS1-MH, 2009-2012, n = 4483) and a clinical sample of PDD inpatients at Charité - Universitätsmedizin Berlin (2018-2019, n = 45). The DSM-5 definition of PDD was operationalized a priori to the study using interview-based DSM-IV diagnoses of dysthymia and major depression lasting at least 2 years in both surveys. Additional depression characteristics (depression onset, self-classified course, suicidality, comorbid mental disorders, treatment history and current depressive symptoms [Patient Health Questionnaire-9]) were assessed. In the DEGS1-MH, health-related quality of life (Short Form Health Survey-36, SF-36), chronic somatic conditions, number of sick days (past 12 months) or days with limitations in normal daily life activities (past 4 weeks), and health service utilization (past 12 months) were compared for PDD vs. NCMDD.

RESULTS

PDD cases from the clinical sample had a significantly earlier depression onset, a higher proportion of self-classification as persistent course, and treatment resistance than PDD and NCMDD cases in DEGS1-MH. At a population level, PDD cases showed worse outcomes compared with NCMDD cases in terms of somatic comorbidity, SF-36 mental component score, and activity limitations owing to mental health problems, as well as a higher risk for outpatient mental health care contact.

CONCLUSIONS

The distinction between PDD and NCMDD proposed for DSM-5 seems warranted. Early onset depression, self-classification as persistent depressive course, and treatment resistance are suggested as markers of more severe and chronic depression courses. At a population level, PDD is associated with remarkably higher individual and economic disease burden than NCMDD, highlighting the need to improve medical recognition of chronic courses and establish specific treatment concepts for chronic depression.

Depressive symptoms in a European comparison - Results from the European Health Interview Survey (EHIS) 2

Depression is associated with a significant individual and social burden of disease. The European Health Interview Survey (EHIS) provides data that can be used to compare the situation in Germany to that of other European countries. Data was evaluated from 254,510 interviewees from Germany and 24 additional Member States of the European Union (EU). Depressive symptoms as defined by the Patient Health Questionnaire (PHQ-8) were used as an indicator of depression. The prevalence in Germany (9.2%) is higher than the European average (6.6%). However, when the severity of depression is taken into account, only the prevalence of mild depressive symptoms is higher (6.3% versus 4.1%). In Germany, young people display depressive symptoms more frequently (11.5% versus 5.2%) than older people (6.7% versus 9.1%). These results should be discussed against the backdrop of differences in age and social structure and point toward a need for prevention and provision of care targeting younger people in Germany, in particular.

The association of endocannabinoid receptor genes (CNR1 and CNR2) polymorphisms with depression: A meta-analysis

Studies investigating the association between gene variants and depression susceptibility found inconsistent data. The present study aimed to clarify whether CNR1rs1049353, CNR1 AAT triplet repeat, and CNR2rs2501432 polymorphisms confer higher risk for depressive disorder.Literature from PubMed, Medline, Embase, Scopus, Cochrance Library, and Wanfang databases was searched (up to August 20, 2018). Seven case-control studies with various comorbidities were eligible. We targeted CNR single-nucleotide polymorphisms (SNPs) that have been reported by 2 or more studies to be involved in the current meta-analysis, resulting in a final list of 3 SNPs: CNR1rs1049353, CNR1 AAT triplet repeat polymorphism, and CNR2rs2501432. Odds ratios (ORs) and 95% confidence intervals (CIs) for allele and homozygote comparisons, dominant and recessive models, and triplet repeat polymorphism ((AAT)n≥5, ≥5 vs (AAT)n<5, <5 or <5, ≥5) were assessed using a random effect model as measures of association. Heterogeneity among included studies was analyzed using sensitivity test. Publication bias was also explored by Egger and rank correlation test.overall, no significant association was found between depression and CNR1rs1049353 (G vs A: OR [95% CI] = 1.09 [0.61-1.95]; GG vs AA: 1.29 [0.73-2.26]; GG vs GA+AA: 1.10 [0.57-2.10]; GG+GA vs AA: 1.25 [0.72-2.18]; and AAT triplet repeat polymorphism ((AAT)n≥5, ≥5 vs (AAT)n<5, <5 or <5, ≥5): 1.92 [0.59-6.27]. In contrast, a significant association between CNR2rs2501432 and depression was detected, and the ORs and 95% CIs are as follows: allele contrast (OR = 1.39, 95% CI = [1.12-1.72], P = .003); homozygous (OR = 2.19, 95% CI = [1.34-3.59], P = .002); dominant (OR = 1.93,95% CI = [1.23-3.04], P = .005); and recessive (OR = 1.41, 95% CI = [1.04-1.92], P = .03).This meta-analysis revealed that CNR1rs1049353 or AAT triplet repeat polymorphism had no association with susceptibility to depression, while CNR2rs2501432 polymorphism was a remarkable mark for depression patients.

Text-Based Detection of the Risk of Depression

This study examines the relationship between language use and psychological characteristics of the communicator. The aim of the study was to find models predicting the depressivity of the writer based on the computational linguistic markers of his/her written text. Respondents' linguistic fingerprints were traced in four texts of different genres. Depressivity was measured using the Depression, Anxiety and Stress Scale (DASS-21). The research sample (N = 172, 83 men, 89 women) was created by quota sampling an adult Czech population. Morphological variables of the texts showing differences (M-W test) between the non-depressive and depressive groups were incorporated into predictive models. Results: Across all participants, the data best fit predictive models of depressivity using morphological characteristics from the informal text "letter from holidays" (Nagelkerke r ² = 0.526 for men and 0.670 for women). For men, models for the formal texts "cover letter" and "complaint" showed moderate fit with the data (r ² = 0.479 and 0.435). The constructed models show weak to substantial recall (0.235 - 0.800) and moderate to substantial precision (0.571 - 0.889). Morphological variables appearing in the final models vary. There are no key morphological characteristics suitable for all models or for all genres. The resulting models' properties demonstrate that they should be suitable for screening individuals at risk of depression and the most suitable genre is informal text ("letter from holidays").

Time trends in depression prevalence and health-related correlates: results from population-based surveys in Germany 1997-1999 vs. 2009-2012

BACKGROUND

Although an "epidemic" of depression is frequently claimed, empirical evidence is inconsistent, depending on country, study design and depression assessment. Little is known about changes in depression over time in Germany, although health insurance companies report frequency increases. Here we examined time trends in depression prevalence, severity and health-related correlates in the general population.

METHODS

Data were obtained from the mental health module of the "German Health Interview and Examination Survey for Adults" (2009-2012, n = 3265) and the mental health supplement of the "German National Health Interview and Examination Survey 1998" (1997-1999, n = 4176), excluding respondents older than 65. 12-month major depressive disorder (MDD), severity and symptoms were assessed based on the WHO Composite International Diagnostic Interview. Health-related quality of life (SF-36), self-reported sick days or days with limitations in normal daily life activities were examined, too. Calculations were carried out population-weighted. Additional age-standardized analyses were conducted to account for demographic changes.

RESULTS

Overall, MDD 12-month prevalence remained stable at 7.4%. Women showed a shifted age distribution with increased prevalence at younger ages, and increasing MDD severity. Time trends in health-related correlates occurred both in participants with and without MDD. Mental health disability increased over time, particularly among men with MDD, reflected by the mental component score of the SF-36 and days with activity limitation due to mental health problems. Demographic changes had a marginal impact on the time trends.

CONCLUSIONS

In contrast to the ongoing international debate regarding increased depression rates in western countries, we found no increase in overall MDD prevalence in Germany over a long period. In conclusion, increased depression frequencies in national health insurance data and growing health care costs associated with depression are not attributable to overall prevalence changes at a population level. However, shifted age distribution and increased severity among women may reflect a rising depression risk within this specific subgroup, and changes in health-related correlates indicate a growing mental health care need for depression, particularly among men.

Loss experiences in old age and their impact on the social network and depression- results of the Leipzig Longitudinal Study of the Aged (LEILA 75+)

BACKGROUND

Loss experiences and bereavement are common among the oldest old. This study aims to investigate the effects of loss experiences and the social network type on depression in old age.

METHODS

As part of the Leipzig Longitudinal Study of the Aged (LEILA 75+), a representative population-based cohort study, 783 persons aged 75+ years were assessed via standardized interviews including the Practitioner Assessment of Network Type Instrument (PANT) and the Center for Epidemiologic Studies-Depression Scale (CES-D). Effects of loss experiences and network type on depression were analysed cross-sectionally (baseline survey) using logistic regressions. Effects over time were analysed longitudinally (follow-up1 and follow-up2) using hybrid techniques.

RESULTS

More than half of the elderly (57%) continuously lived in a restricted network. Only 12.1% lived in an integrated network. Although 30.9% had a change in their network, no significant association with loss experiences was found. Nevertheless, loss experiences (OR 7.56 (1.60-35.72)) and a restricted social network (OR 4.08 (1.52-10.95)) appeared to be the significant predictors of depression.

LIMITATIONS

Our study captures only a selected time window of the individual life and loss experience was only assessed at the time of the baseline survey.

CONCLUSION

Our findings revealed that elderly individuals, who experienced social loss or lived in restricted social networks, were more likely to develop depression compared to individuals who lived in integrated social networks or without loss experiences. The social integration of elderly individuals is an urgent issue that should be addressed in order to reduce depression in old age.

Depression treatment use among stroke individuals with depression: A cross-sectional analysis of the Medical Expenditure Panel Survey

BACKGROUND

Depression is the most prevalent psychiatric comorbidity among stroke individuals. Despite the effectiveness of antidepressants and psychotherapy, data on the use of these treatments among stroke survivors is limited.

OBJECTIVE

The main objective of this study was to document prevalence of antidepressant use, types of antidepressants utilized, and adherence to antidepressants among stroke individuals.

METHODS

Retrospective, cross-sectional data obtained from the Medical Expenditure Panel Surveys (MEPS), for the years 2011, 2013 and 2015, was utilized for this study. Treatment for depression was categorized into three mutually exclusive categories: 1) antidepressants only, 2) antidepressants and psychotherapy (combination), and 3) No treatment. Adherence to antidepressants was measured using the Proportion of Days Covered (PDC) ratio. Adherence between antidepressant only and combination therapy group was compared using Student's t-test. A multinomial logistic regression analysis was used to further examine the association between patient characteristics and likelihood of receiving depression treatment.

RESULTS

A total of 759 stroke individuals with comorbid depression were identified. Of these, 51.2% utilized only antidepressants, 12.6% utilized a combination treatment of antidepressants and psychotherapy and 31.7% did not receive treatment for depression. Selective Serotonin Reuptake Inhibitors (SSRI's) was the most commonly used antidepressants in the stroke population. Males (P = 0.04), age group of 40-64 years (P < 0.001), and African Americans (P = 0.02) constituted for the highest proportions of untreated stroke survivors. Among treated stroke individuals, adherence was higher for combination therapy users compared to those using antidepressants only (mean PDC = 65.8 ± 6.89 and 57.6 ± 3.74, respectively).

CONCLUSION

Almost 70% of stroke individuals received some form of treatment for depression and several patient-related factors (gender, age, race, marital status, and comorbidity burden) were associated with the utilization of depression treatment. Future researchers need to investigate the factors responsible for lack of depression treatment in stroke individuals and policy makers should aim for a more patient centered care.

Symptoms of Depression and Anxiety among Women attending Primary Health Care in Gilgit-Baltistan (GB), Pakistan

Objective:

To assess symptoms of anxiety and depression among women reporting to primary health care (PHC women) in Gilgit Baltistan (GB), Pakistan.

Methods:

This was a cross-sectional study conducted on PHC women belonging GB including other three provinces of Pakistan. PHQ-9 and GAD-7 were used to assess anxiety and depression. Descriptive and inferential statistical techniques were applied to analyze the collected data.

Results:

PHC women from GB reported higher level of depressive symptoms (t=7.58, p=0.00) and lower level of anxiety symptoms (t=8.3, p=0.00) when compared with cut-off score. Insignificant differences were found in depressive (t=1.5, p>.05) and anxiety (t=1.2, p>.05) scores between GB women and women from rest of Pakistan. However, inter-province differences in depressive (F=5.78, p= 00) and anxiety (F=4.5, p=0.00) symptoms were significant. Increasing age and lack of education were found significant risk factors for GB PHC women’s depressive and anxiety symptoms.

Conclusions:

PHC women from GB have higher level of depressive and lower level of anxiety symptoms like women from other provinces of Pakistan. Their demographics should be considered while addressing their emotional problems.

Changes in prevalence of psychotropic drug use and alcohol consumption among the elderly in Germany: results of two National Health Interview and Examination Surveys 1997-99 and 2008-11

BACKGROUND

Psychotropic drug use and alcohol consumption among older adults need to be monitored over time as their use or combined use bears risks of harms. Representative data on changes in prevalence, patterns and co-relates of substance use are lacking in Germany.

METHODS

Participants were older adults (60-79 years) from two German National Health Surveys: 1997-99 (GNHIES98, N = 1,606) and 2008-11 (DEGS1, N = 2,501). Included were drugs acting on the nervous system used during the last 7 days. Alcohol consumption was measured by frequency (daily drinking) and quantity (risky drinking: ≥20/10 g/day alcohol for men/women). Changes in prevalence adjusted for potential socio-economic and health-related confounders were calculated by logistic regression models approximated by the SAS LSMEANS statement.

RESULTS

The prevalence of overall psychotropic drug use (20.5% vs. 21.4%) remained constant between the two surveys. Significant changes were observed in the use of some psychotropics (all GNHIES98 vs. DEGS1): Synthetic antidepressants (3.9% vs. 6.9%), St. John's wort (2.9% vs. 1.1%), benzodiazepines (3.7% vs. 2.5%), benzodiazepine related drugs (0.2% vs. 0.8%), narcotic analgesics (3.0% vs. 4.1%), anti-dementia drugs (2.2% vs. 4.2%) and anti-epileptics (1.0% vs. 2.3%). Significant changes were also observed in long-term use of synthetic anti-depressants (3.2% vs. 5.9%), St. John's wort (2.0% vs. 0.6%) and opioid analgesics (1.0% vs. 2.2%). Further, we found significant changes in benzodiazepines use (3.3% vs. 1.4%) among men, opioids use (2.9% vs. 7.3%) among people with a lower social status, and overall psychotropics (26.8% vs. 32.5%) as well as opioids use (4.4% vs. 8.1%) among those with a worse health status. Moderate alcohol consumption increased significantly (58.0% vs. 66.9%). Risky drinking remained unchanged (16.6% vs. 17.0%). In spite of significant increases in daily alcohol drinking (13.2% vs. 18.4%) psychotropic drug use combined with daily drinking remained unchanged (1.8% vs. 2.7%).

CONCLUSIONS

Although prevalence of overall psychotropic drug use remained stable, changes in the use of some psychotropic drug groups and alcohol consumption patterns have been observed. Further studies are required to investigate resulting health consequences and public health relevance of those outcomes.

The Effects of High-fat-diet Combined with Chronic Unpredictable Mild Stress on Depression-like Behavior and Leptin/LepRb in Male Rats

Leptin plays a key role in the pathogenesis of obesity and depression via the long form of leptin receptor (LepRb). An animal model of comorbid obesity and depression induced by high-fat diet (HFD) combined with chronic unpredictable mild stress (CUMS) was developed to study the relationship between depression/anxiety-like behavior, levels of plasma leptin and LepRb in the brains between four groups of rats, the combined obesity and CUMS (Co) group, the obese (Ob) group, the CUMS group and controls. Our results revealed that the Co group exhibited most severe depression-like behavior in the open field test (OFT), anxiety-like behavior in elevated plus maze test (EMT) and cognitive impairment in the Morris water maze (MWM). The Ob group had the highest weight and plasma leptin levels while the Co group had the lowest levels of protein of LepRb in the hypothalamus and hippocampus. Furthermore, depressive and anxiety-like behaviors as well as cognitive impairment were positively correlated with levels of LepRb protein and mRNA in the hippocampus and hypothalamus. The down-regulation of leptin/LepRb signaling might be associated with depressive-like behavior and cognitive impairment in obese rats facing chronic mild stress.

Psychiatric comorbidities in patients with hypertension--a study of registered diagnoses 2009-2013 in the total population in Stockholm County, Sweden

OBJECTIVE

The objective of this study was to investigate the prevalence of concomitant hypertension and psychiatric disorders in the general population, using administrative healthcare data in Stockholm County.

DESIGN AND METHOD

The study population, included all living persons who resided in Stockholm County 1 January 2011 (N = 2 ,058 ,408). Individuals with a diagnosis of hypertension were identified with data from all consultations in primary care, specialized outpatient care, and inpatient care 2009-2013. As outcome, data were obtained on all consultations because of certain psychiatric diagnoses between 2011 and 2013, including specifically depression, anxiety disorders, bipolar disorder, and schizophrenia. Age-adjusted odd ratios (ORs) with 95% confidence intervals (95% CI) were calculated for men and women with and without hypertension, with individuals without hypertension as referents.

RESULTS

The age-adjusted ORs for depression in persons with hypertension were 1.293 (95% CI 1.256-1.331,) for men and 1.036 (95% CI 1.013-1.058) for women. The age-adjusted ORs for anxiety in persons with hypertension were 1.279 (95% CI 1.238-1.322) for men and 1.050 (95% CI 1.024-1.076) for women. The OR for bipolar disease were 0.904 (95% CI 0.826-0.990) for men and 0.709 (95% CI 0.656-0.767) for women. For schizophrenia, the ORs were 0.568 (95% CI 0.511-0.632) for men and 0.537 (95% CI 0.478-0.603) for women.

CONCLUSION

Increased awareness of the risk of depression and anxiety among hypertensive patients is needed to combat hypertension, its complications, and psychiatric suffering in the population. Hypertension is probably underdiagnosed and neglected in individuals with severe psychiatric disorders. We warrant efforts to integrate psychiatric and hypertensive care.

On the Effect of Sex on Prefrontal and Cerebellar Neurometabolites in Healthy Adults: An MRS Study

In neuropsychiatric research, the aspects of sex have received increasing attention over the past decade. With regard to the neurometabolic differences in the prefrontal cortex and the cerebellum of both men and women, we performed a magnetic resonance spectroscopic (MRS) study of a large group of healthy subjects. For neurometabolic measurements, we used single-voxel proton MRS. The voxels of interest (VOI) were placed in the pregenual anterior cingulate cortex (pACC) and the left cerebellar hemisphere. Absolute quantification of creatine (Cre), total choline (t-Cho), glutamate and glutamine (Glx), N-acetylaspartate, and myo-inositol (mI) was performed. Thirty-three automatically matched ACCs and 31 cerebellar male-female pairs were statistically analyzed. We found no significant neurometabolic differences in the pACC region (Wilks' lambda: p = 0.657). In the left cerebellar region, we detected significant variations between the male and female groups (p = 0.001). Specifically, we detected significantly higher Cre (p = 0.005) and t-Cho (p = 0.000) levels in men. Additionally, males tended to have higher Glx and mI concentrations. This is the first study to report neurometabolic sex differences in the cerebellum. The effects of sexual hormones might have influenced our findings. Our data indicates the importance of adjusting for the confounding effects of sex in MRS studies.

The assessment of met and unmet care needs in the oldest old with and without depression using the Camberwell Assessment of Need for the Elderly (CANE): Results of the AgeMooDe study

BACKGROUND

Depression belongs to the most common mental disorders in late life and will lead to a significant increase of treatment and health care needs in the future. The Camberwell Assessment of Need for the Elderly (CANE) evaluates met and unmet care needs in older individuals. Reports on needs of the elderly with depression are currently lacking. The aim of the present study was to identify met and unmet needs in older primary care patients with and without depression using the German-language version of the CANE. Furthermore, the association between unmet needs and depression ought to be explored.

METHODS

As part of the study "Late-life depression in primary care: needs, health care utilization and costs (AgeMooDe)", a sample of 1179 primary care patients aged 75 years and older was assessed. Descriptive and inferential statistics as well as logistic regression analyses were conducted.

RESULTS

This study, for the first time in Germany, provides data on the distribution of met and unmet needs in depressive and non-depressive older primary care patients. As a main result, unmet needs were significantly associated with depression; other risk factors identified were gender, institutionalization, care by relatives and impaired functional status.

LIMITATIONS

The conclusions about directions and causality of associations between the variables are limited due to the cross-sectional design.

CONCLUSIONS

The study results provide an important contribution to generate a solid base for an effective and good-quality health and social care as well as to an appropriate allocation of health care resources in the elderly population.

Social Support and Health Service Use in Depressed Adults: Findings From the National Health and Nutrition Examination Survey

OBJECTIVE

We investigated the relationship between social support and health service use among men and women with depression.

METHODS

Participants were 1379 adults with symptoms of depression (Patient Health Questionnaire-9 score ≥ 5) in the National Health and Nutrition Examination Survey. Using the framework of the Andersen Behavioral Model of Health Services Use, multivariable regression models used social support, stratified by depression severity, to estimate association with utilization of mental health and nonmental health services. Partial F-tests examined a priori interactions between social support and gender.

RESULTS

Among those with adequate social support, odds of seeing a nonmental health provider were much higher when depression was moderate [Odds Ratio (OR): 2.6 (1.3-5.3)] or severe [OR: 3.2 (1.2-8.7)], compared to those lacking social support. Conversely, odds of mental health service use were 60% lower among those with moderate depression [OR: 0.4 (0.2-1.0)] when social support was adequate as opposed to inadequate. Social support was unrelated to service use when depression was mild. Gender moderated the relationship between social support and health service use among individuals with severe depression.

CONCLUSIONS

Social support has opposite associations with mental and nonmental health service use among adults with clinically significant depression. This association is largely attributable to the effect of male gender on the relationship between social support and health service use.

Association of Periodontitis and Subsequent Depression: A Nationwide Population-Based Study

Periodontitis is a systemic and chronic inflammatory disease associated with multiple physical conditions. Distress and depression are other problems affecting the progression of periodontitis. However, the causal relationship between depression and periodontitis has not been adequately investigated. This aim of this study was to determine the association between periodontitis and the subsequent development of depression.We identified 12,708 patients with newly diagnosed periodontitis from 2000 to 2005 and 50,832 frequency-matched individuals without periodontitis. Both groups were followed until diagnosed with depression, withdrawal from the National Health Insurance program, or the end of 2011. The association between periodontitis and depressio was analyzed using Cox proportional hazard regression models.The incidence density rate of depression was higher in the periodontitis group than in the nonperiodontitis group, with an adjusted hazard ratio of 1.73 (95% confidence interval 1.58-1.89) when adjusting for sex, age, and comorbidity. Cox models revealed that periodontitis was an independent risk factor for depression in patients, except for comorbidities of diabetes mellitus (DM), alcohol abuse, and cancer.Periodontitis may increase the risk of subsequent depression and was suggested an independent risk factor regardless of sex, age, and most comorbidities. However, DM, alcohol abuse, and cancer may prevent the development of subsequent depression because of DM treatment, the paradoxical effect of alcohol, and emotional distress to cancer, respectively. Prospective studies on the relationship between periodontitis and depression are warranted.

Vitamin D supplementation reduces depressive symptoms in patients with chronic liver disease

BACKGROUND AND AIMS

Vitamin D deficiency and depression frequently occur in patients with chronic liver diseases (CLD). Depression has recently been inversely associated with vitamin D in a meta-analysis, and vitamin D receptor is expressed in brain. This pilot study investigates whether vitamin D replacement ameliorates depressive symptoms in CLD patients and consists of a cross-sectional and an interventional analysis.

METHODS

Overall, 111 patients with CLD were included in the cross-sectional analysis. The Beck Depression Inventory II (BDI-II) was used to assess depression. Chemiluminescence immunoassay and LC-MS/MS quantified serum 25-hydroxyvitamin D levels. For the interventional analysis, 77 patients with inadequate vitamin D concentrations received 20,000 IU vitamin D per week for six months. The final follow-up was carried out six months post supplementation.

RESULTS

In the cross-sectional analysis, 81% of patients (median age 55 years, 47% women) had inadequate baseline vitamin D levels (<30 ng/ml), and 31% presented with depressive symptoms (BDI-II score ≥14). Depression severity correlated inversely with vitamin D level in depressed patients (β = -0.483, P = 0.004). Depression scores improved significantly from baseline in depressed patients after three and six months (P = 0.003 and P = 0.004, respectively) of supplementation, with vitamin D levels increasing to normal (P < 0.0001). Subgroup analyses revealed this anti-depressant effect of vitamin D to occur predominantly in women. The final follow-up showed increases in median BDI-II scores in the setting of decreased vitamin D levels.

CONCLUSIONS

Vitamin D levels correlated with BDI-II scores, and vitamin D replacement significantly improved depressive symptoms in women with CLD. Adjuvant vitamin D may be considered in these patients.

REGISTRATION NO

DRKS00007782 German Clinical Trials Registry (DRKS).