Overweight, obesity, and individual symptoms of depression: A multicohort study with replication in UK Biobank

The association between depressive symptoms and high-sensitivity C-reactive protein: Is body mass index a moderator?

Objective

Depression and obesity are highly comorbid conditions with shared biological mechanisms. It remains unclear how depressive symptoms and body mass index (BMI) interact in relation to inflammation. This cross-sectional study investigated the independent associations of depressive symptoms and BMI with high sensitivity C-reactive protein (hs-CRP), as well as the moderating role of BMI on the depressive symptoms-hs-CRP association.

Methods

Participants (n = 8827) from the 2015-2018 National Health and Nutrition Examination Surveys were aged ≥20 with a BMI ≥18.5 kg/m2, completed the Depression Screener, and had hs-CRP data. Multivariable linear regression was used to analyze hs-CRP in relation to depressive symptoms and BMI. An interaction term was included to examine whether the depressive symptoms-hs-CRP relationship differs depending on BMI.

Results

There was a slight, albeit non-significant, increase in hs-CRP levels with each one-point increase in depressive symptoms (aCoef.Estm. = 0.01, 95% CI = -0.05, 0.06, p = 0.754). Participants with overweight (aCoef.Estm. = 1.07, 95% CI = 0.61, 1.53, p < 0.001) or obese (aCoef.Estm. = 3.51, 95% CI = 3.04, 3.98, p < 0.001) BMIs had higher mean hs-CRP levels than those with a healthy BMI. There were no significant interactions between depressive symptoms and overweight (aCoef.Estm. = 0.04, 95% CI = -0.04, 0.13, p = 0.278) or obese (aCoef.Estm. = 0.11, 95% CI = -0.01, 0.22, p = 0.066) BMI indicating a lack of difference in the depressive symptoms-hs-CRP association across participants in the healthy versus overweight and obese ranges.

Conclusions

This study suggests that BMI might not act as a moderator in the association between depressive symptoms and hs-CRP. Results should be replicated in larger samples. Further research is warranted to understand underlying mechanisms.

Obesity, psychological well-being related measures, and risk of seven non-communicable diseases: evidence from longitudinal studies of UK and US older adults

BACKGROUND

We examined the role of psychological well-being related measures in explaining the associations between obesity and increased risk of non-communicable diseases (NCDs: hypertension, heart disease, stroke, diabetes, arthritis, cancer, and memory-related disease) in older adults.

METHODS

Data were from the English Longitudinal Study of Ageing (ELSA), UK (baseline: Wave 4-2008/2009; n = 8127) and the Health and Retirement Study (HRS), US (baseline: Waves 9 and 10-2008/2010; n = 12,477). Objective body mass index was used to define obesity. A range of psychological well-being related measures (e.g., depressive symptoms, life satisfaction) was available in ELSA (n = 7) and HRS (n = 15), and an index of overall psychological well-being was developed separately in each study. NCDs were from a self-reported doctor diagnosis and/or other assessments (e.g., biomarker data) in both studies; and in ELSA, NCDs from linked hospital admissions data were examined. Longitudinal associations between obesity status, psychological well-being measures, and NCDs were examined using Cox proportional hazard models (individual NCDs) and Poisson regression (a cumulative number of NCDs). Mediation by psychological well-being related measures was assessed using causal mediation analysis.

RESULTS

Obesity was consistently associated with an increased prospective risk of hypertension, heart disease, diabetes, arthritis, and a cumulative number of NCDs in both ELSA and HRS. Worse overall psychological well-being (index measure) and some individual psychological well-being related measures were associated with an increased prospective risk of heart disease, stroke, arthritis, memory-related disease, and a cumulative number of NCDs across studies. Findings from mediation analyses showed that neither the index of overall psychological well-being nor any individual psychological well-being related measures explained (mediated) why obesity increased the risk of developing NCDs in both studies.

CONCLUSION

Obesity and psychological well-being may independently and additively increase the risk of developing NCDs.

Obesity and lipid indices as predictors of depressive symptoms in middle-aged and elderly Chinese: insights from a nationwide cohort study

BACKGROUND

Depressive symptoms are one of the most common psychiatric disorders, with a high lifetime prevalence rate among middle-aged and elderly Chinese. Obesity may be one of the risk factors for depressive symptoms, but there is currently no consensus on this view. Therefore, we investigate the relationship and predictive ability of 13 obesity- and lipid-related indices with depressive symptoms among middle-aged and elderly Chinese.

METHODS

The data were obtained from The China Health and Retirement Longitudinal Study (CHARLS). Our analysis includes individuals who did not have depressive symptoms at the baseline of the CHARLS Wave 2011 study and were successfully follow-up in 2013 and 2015. Finally, 3790 participants were included in the short-term (from 2011 to 2013), and 3660 participants were included in the long-term (from 2011 to 2015). The average age of participants in short-term and long-term was 58.47 years and 57.88 years. The anthropometric indicators used in this analysis included non-invasive [e.g. waist circumference (WC), body mass index (BMI), and a body mass index (ABSI)], and invasive anthropometric indicators [e.g. lipid accumulation product (LAP), triglyceride glucose index (TyG index), and its-related indices (e.g. TyG-BMI, and TyG-WC)]. Receiver operating characteristic (ROC) analysis was used to examine the predictive ability of various indicators for depressive symptoms. The association of depressive symptoms with various indicators was calculated using binary logistic regression.

RESULTS

The overall incidence of depressive symptoms was 20.79% in the short-term and 27.43% in the long-term. In males, WC [AUC = 0.452], LAP [AUC = 0.450], and TyG-WC [AUC = 0.451] were weak predictors of depressive symptoms during the short-term (P < 0.05). In females, BMI [AUC = 0.468], LAP [AUC = 0.468], and TyG index [AUC = 0.466] were weak predictors of depressive symptoms during the long-term (P < 0.05). However, ABSI cannot predict depressive symptoms in males and females during both periods (P > 0.05).

CONCLUSION

The research indicates that in the middle-aged and elderly Chinese, most obesity- and lipid-related indices have statistical significance in predicting depressive symptoms, but the accuracy of these indicators in prediction is relatively low and may not be practical predictors.

Association of Cardiovascular Health With Risk of Incident Depression and Anxiety

OBJECTIVE

To investigate the association between cardiovascular health (CVH), defined by the American Heart Association's Life's Essential 8 (LE8) score, and incident depression and anxiety.

DESIGN

A prospective cohort study using data from UK Biobank.

SETTING

Participants were enrolled from March 2006 to October 2010.

PARTICIPANTS

Participants without cardiovascular diseases and common mental disorders at baseline and having complete data on metrics of LE8 were included.

MEASUREMENTS

CVH was assessed by LE8 score including eight components. The overall CVH was categorized as low (LE8 score <50), moderate (50≤ LE8 score <80), and high (LE8 score ≥80).

RESULTS

We included 115,855 participants (mean age: 55.7 years; female: 52.6%). During a median follow-up of 12.4 years, 3,194 (2.8%) and 4,005 (3.5%) participants had incident depression and anxiety, respectively. Compared with participants having low CVH, those having moderate and high CVH had 37% (HR = 0.63, 95% CI: 0.57-0.70) and 52% (HR = 0.48, 95% CI: 0.41-0.55) lower risk of incident depression. Similarly, moderate and high CVH were related to a lower risk of incident anxiety (HR = 0.81, 95% CI: 0.73-0.89 and HR = 0.68, 95% CI: 0.60-0.78). Restricted cubic spline showed that LE8 score was inversely related to incident depression and anxiety in a linear manner, and the risk of incident depression and anxiety decreased by 17% (HR = 0.83, 95% CI: 0.80-0.85) and 10% (HR = 0.90, 95% CI: 0.88-0.92) for 10-point increment in LE8 score, respectively.

CONCLUSIONS

Higher CVH, evaluated by LE8 score, is strongly associated with a lower risk of incident depression and anxiety, suggesting the significance of optimizing CVH by adopting LE8.

Comparison of the associations between Life's Essential 8 and Life's Simple 7 with depression, as well as the mediating role of oxidative stress factors and inflammation: NHANES 2005-2018

BACKGROUND

Cardiovascular health (CVH) is closely associated with depression. However, Life's Essential 8 (LE8), a novel CVH measure, has not yet been clearly linked to depression. This study aims to explore the association between LE8 and depression, compare its advantages over Life's Simple 7 (LS7), and investigate the mediating effects of oxidative stress and inflammation.

METHODS

This study investigated cross-sectional data of adults aged 20 and above from National Health and Nutrition Examination Survey (NHANES) 2005 to 2018. The LE8 score (ranging from 0 to 100) was derived from the American Heart Association's definition, based on the unweighted average of 8 metrics, classified as low cardiovascular health (CVH) (0-49), moderate CVH (50-79), and high CVH (80-100). Similar to LE8, LS7 scores were categorized into inadequate (0-7), average (8-10), or optimal (11-14) after calculating the unweighted mean of each component. Depression was diagnosed using the Patient Health Questionnaire (PHQ-9), with a score of ≥10 defining depression. Adjusted for sociodemographic factors and other risk factors for depression, weighted logistic regression and restricted cubic spline analysis were used to explore the correlation. Receiver operating characteristic (ROC) curves were used to study the associations between CVH scores and depression. Subsequently, subgroup analysis and sensitivity analysis were conducted, followed by an exploration of the mechanisms involved.

RESULTS

A total of 7 cycles from 2005 to 2018 contained complete data. Weighted logistic regression showed that both LS7 and LE8 were significantly associated with depression. Specifically, for LE8, after adjustment, the risk of depression decreased by 52 % for moderate CVH compared to low CVH (OR: 0.48, 95 % CI: 0.41-0.57, P < 0.0001), while the risk decreased by 80 % for high CVH (OR: 0.20, 95 % CI: 0.15-0.26, P < 0.0001, Ptrend < 0.0001). For LS7, after adjustment, compared with inadequate CVH, the risk of depression decreased by 49 % for average CVH (OR: 0.51, 95 % CI: 0.34-0.78, P = 0.002), and by 55 % for optimal CVH (OR: 0.45, 95 % CI: 0.27-0.74, P = 0.002, Ptrend < 0.0001). Area under ROC curves for predicting depression were 0.672 (95 % CI, 0.66-0.684; P < 0.001) and 0.605 (95 % CI, 0.59-0.619; P < 0.001) for LE8 and LS7 (PDeLong < 0.001), respectively. Sensitivity analysis demonstrated the robustness of the association. GGT and WBC jointly mediated 9.62 % of this association (all P < 0.001).

LIMITATIONS

The cross-sectional study cannot infer causality.

CONCLUSIONS

The association between Life's Essential 8 and depression was stronger and more practical. Oxidative stress and inflammation mediate this association. Individuals with extremely poor cardiovascular health have a 7-fold increased risk of depression, highlighting the necessity of maintaining at least moderate cardiovascular health.

Protein-enriched and anti-inflammatory dietary patterns, healthy lifestyle index and depressive symptoms: A cross-sectional study of 287,945 adults in China

OBJECTIVES

Depressive symptoms have a considerable negative impact on mental health. This study aimed to understand the relationship between the protein-enriched and anti-inflammatory dietary index scores, modified healthy lifestyle index scores (Modified HLIS), and depressive symptoms.

METHODS

This study used convenience sampling to conduct a single-center cross-sectional survey. From January 1, 2015 to December 31, 2020, a total of 287,945 Chinese adults from a health management center of a general hospital completed an online self-reported health questionnaire, which included demographic characteristics, the Dietary Diversity Scale, the Modified Healthy Lifestyle Index Scores and the Patient Health Questionnaire-9.

RESULTS

The higher anti-inflammatory dietary index scores (POR = 0.87; 95 % CI: 0.86-0.87; p < 0.001), moderate modified healthy lifestyle index scores (POR = 0.76; 95 % CI: 0.75-0.78; p < 0.001) and sufficient modified healthy lifestyle index scores (POR = 0.53; 95 % CI: 0.52-0.54; p < 0.001) were negatively associated with depressive symptoms, while the higher protein-enriched dietary index scores (POR = 1.01; 95 % CI: 1.01-1.02; p < 0.001) was positively correlated with depressive symptoms.

CONCLUSIONS

This study demonstrated that protein-enriched and anti-inflammatory dietary index scores, and multiple healthy lifestyles are associated depressive symptoms in adults.

Construction of a depression risk prediction model for type 2 diabetes mellitus patients based on NHANES 2007-2014

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a prevalent global health issue that has been linked to an increased risk of depression. The objective of this study was to construct a nomogram model for predicting depression in T2DM patients.

METHODS

A total of 4280 patients with T2DM were included in this study from the 2007-2014 NHANES. The entire dataset was split randomly into training set comprising 70 % of the data and a validation set comprising 30 % of the data. LASSO and multivariate logistic regression analyses identified predictors significantly associated with depression, and the nomogram was constructed with these predictors. The model was assessed by C-index, calibration curve, the hosmer-lemeshow test and decision curve analysis (DCA).

RESULTS

The nomogram model comprised of 9 predictors, namely age, gender, PIR, BMI, education attainment, smoking status, LDL-C, sleep duration and sleep disorder. The C-index of the training set was 0.780, while that of the validation set was 0.752, indicating favorable discrimination for the model. The model exhibited excellent clinical applicability and calibration in both the training and validation datasets. Moreover, the cut-off value of the nomogram is 223.

LIMITATIONS

This study has shortcomings in data collection, lack of external validation, and results non-extrapolation.

CONCLUSIONS

Our nomogram exhibits high clinical predictability, enabling clinicians to utilize this tool in identifying high-risk depressed patients with T2DM. It has the potential to decrease the incidence of depression and significantly improve the prognosis of patients with T2DM.

The role of obesity severity in Minnesota multiphasic personality inventory-2-restructured form prediction of 12-month bariatric surgery outcomes

BACKGROUND

The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) has been widely used in bariatric surgery samples. However, questions remain regarding its utility when predicting changes in body mass index over time following bariatric surgery.

OBJECTIVES

Examine whether MMPI-2-RF scales differentially predict 12-month changes in body mass index (BMI) following bariatric surgery when comparing patients with Class III or higher versus Class II or lower obesity.

SETTING

Military hospital in the Northwestern United States.

METHODS

This retrospective study evaluated data from 193 bariatric surgery patients who completed the MMPI-2-RF as part of presurgical evaluation requirements. Hierarchical linear modeling was used to predict body mass index over a 12-month postsurgical period based on MMPI-2-RF scales. Loss to follow-up rate was 30% during this period.

RESULTS

Among patients with Class II or lower obesity, the Symptom Validity, Adjustment Validity, Response Bias, Cynicism, Aggression, Stress/Worry, and Anger Proneness scales showed a significant relationship to BMI after bariatric surgery. Among patients with Class III or higher obesity, the Infrequent Psychopathology Responses, Emotional / Internalizing Dysfunction, Ideas of Persecution, Multiple Specific Fears, and Inefficacy scales showed a significant relationship to body mass index after bariatric surgery.

CONCLUSIONS

Certain MMPI-2-RF scales may have better utility in predicting bariatric surgery outcomes based on the patient's obesity severity. The interaction of metabolic and personality factors may play a significant role in weight change following bariatric surgery.

The potential causal relationship between various lifestyles and depression: a univariable and multivariable Mendelian randomization study

Background

Previous studies have shown that lifestyle was associated with depression. Thus, the aim of this study was to examine the causality between multiple lifestyles and depression by Mendelian randomization (MR) analysis.

Methods

The single-nucleotide polymorphisms (SNPs) of depression, alcoholic drinks per week, sleeplessness or insomnia, body mass index (BMI), mood swings, weekly usage of mobile phone in the last 3 months, beef intake, cooked vegetable intake, and "smoking status: never" were acquired from the Integrative Epidemiology Unit Open genome-wide association study database. Causal effects of eight exposure factors and depression were investigated using MR-Egger, weighted median, inverse variance weighted (IVW), simple mode, and weighted mode, and results were primarily referred to IVW. Subsequently, univariable MR (UVMR) analysis was performed on eight exposure factors and depression, separately. In addition, sensitivity analysis, including heterogeneity test, horizontal pleiotropy, and leave-one-out (LOO) methods, was conducted to evaluate the stability of MR results. Furthermore, multivariable MR (MVMR) analysis was carried out.

Results

UVMR analysis revealed that all eight exposure factors were causally associated with depression; alcoholic drinks per week, sleeplessness or insomnia, BMI, mood swings, weekly usage of mobile phone in the last 3 months, and cooked vegetable intake were risk factors, and beef intake and "smoking status: never" were protection factors. Heterogeneity tests revealed no heterogeneity for alcoholic drinks per week, sleeplessness or insomnia, mood swings, weekly usage of mobile phone in the last 3 months, and cooked vegetable intake. Meanwhile, there was no horizontal pleiotropy in UVMR, and LOO analysis verified that univariable analysis results were reliable. Moreover, MVMR analysis indicated that mood swings and weekly usage of mobile phone in the last 3 months were risk factors, and beef intake was a protection factor for depression when multiple factors occurred at the same time.

Conclusion

Alcoholic drinks per week, sleeplessness or insomnia, BMI, mood swings, weekly usage of mobile phone in the last 3 months, and cooked vegetable intake were risk factors, and beef intake and "smoking status: never" were protection factors. In addition, mood swings, weekly usage of mobile phone in the last 3 months, and beef intake had a direct effect on depression when multiple factors occurred simultaneously.

Heartache and Heartbreak: An Observational and Mendelian Randomization Study

Background

Depression has a significant effect on cardiovascular disease (CVD), but uncertainties persist regarding which modifiable risk factors mediate the causal effects. We aim to determine whether depression is causally linked to CVD and which modifiable risk factors play potential mediating roles.

Methods

We used a two-sample Mendelian randomization (MR) approach and NHANES 2007-2018 data to estimate the effects of depression on various CVD cases and investigated 28 potential mediators of the association between depression and CVD.

Results

The results of our MR analysis indicated that genetically determined depression was associated with increased risk of several CVD, including coronary heart disease (odds ratio (OR) = 1.14; 95% confidence interval (CI): 1.05,1.22), myocardial infarction (OR = 1.19; 95% CI, 1.09,1.31), atrial fibrillation (OR = 1.14; 95% CI, 1.06,1.22), and stroke (OR = 1.13; 95% CI, 1.05,1.22). However, there was no causal association between depression and heart failure. Four out of 28 cardiometabolic risk factors, including hyperlipidemia, hypertension, diabetes, and prescription opioid use, were identified as mediators of the association between depression and various CVDs. Observational association analyses from NHANES data yielded consistent results.

Conclusion

Our findings demonstrated that depression has a causal detrimental effect on various CVDs. Four causal mediators (hyperlipidemia, hypertension, diabetes, and prescription opioid use) were screened to explain the causal effect. Implementing targeted management strategies for these risk factors may be warranted to mitigate the public health burden of CVD among individuals with depression.

Inhibition of Pancreatic Lipase by Flavonoid Derivatives: In Vitro and In Silico Investigations

Obesity, characterized by excessive adipose tissue accumulation, has emerged as a crucial determinant for a wide range of chronic medical conditions. The identification of effective interventions for obesity is of utmost importance. Widely researched antiobesity agents focus on pancreatic lipase, a significant therapeutic target. This study presented the evaluation of ten flavonoid compounds in terms of their inhibitory activities against pancreatic lipase, utilizing both in vitro and in silico approaches. The results indicated that all tested compounds demonstrated modest and weaker inhibitory activities compared to the reference compound, orlistat. Among the compounds investigated, F01 exhibited the highest potency, with an IC50 value of 17.68 ± 1.43 µM. The enzymatic inhibition kinetic analysis revealed that F01 operated through a competitive inhibition mechanism with a determined Ki of 7.16 μM. This value suggested a moderate binding affinity for the pancreatic lipase enzyme. Furthermore, the associated Vmax value was quantified at 0.03272 ΔA·min-1. In silico studies revealed that F01 displayed a binding mode similar to that of orlistat, despite lacking an active functional group capable of forming a covalent bond with Ser152 of the catalytic triad. However, F01 formed a hydrogen bond with this crucial amino acid. Furthermore, F01 interacted with other significant residues at the enzyme's active site, particularly those within the lid domain. Based on these findings, F01 demonstrates substantial potential as a candidate for further investigations.

Investigation of the relationship between heavy metals in the blood and depression in people with different body mass indices using the NHANES database: A cross-sectional study

BACKGROUND

Exposure to heavy metals considered a major risk factor for mental health.

OBJECTIVE

Examining how heavy metals in blood are associated with depression in individuals of various body mass indexes.

METHODS

A total sample of 15,560 individuals was screened, with 4355 participants finally enrolled to study. The PHQ-9 was used to assess participants' depressive symptoms.

RESULTS

A logistic regression analysis was used to investigate the relationship between the levels of heavy metals in the blood and the depression. Serum cadmium levels were found to be associated with risk of depression, with an odds ratio of 2.247 (95 % CI: 1.584-3.244). However, no significant correlations were observed between depression and blood levels of lead, selenium, and manganese. Subgroup analysis was performed and found that higher Cd concentrations were associated with a greater risk of depression at the same BMI. With the same Cd concentration, the risk of depression was lowest when participants' BMI was ≥30 kg/m2 and increased with increasing BMI when participants' BMI was <30 kg/m2.

LIMITATIONS

It is not possible to analyze the effect of external exposure to Cd.

CONCLUSION

Cd in blood may be positively correlated with depression in American adults, and the effect of this trend is different in people with different body mass indices. With the increase in BMI, the risk gradually rises. However, it is lowest among obese people.

A Greek Translation of the Brunel Mood Scale: Initial Validation among Exercise Participants and Inactive Adults

The aim of the present study was to provide initial validity evidence of a Greek translation of the 24-item Brunel Mood Scale, referred to as the BRUMS-Greek, a measure of anger, confusion, depression, fatigue, tension, and vigour. Data were collected from 1417 Greek adult exercise participants and 369 physically inactive adults, totaling 1786 adults (male = 578, female = 1208) aged 18-64 years (M = 34.73 ± 11.81 years). Given the large univariate and multivariate non-normality, a confirmatory factor analyses treating responses as ordered categorical variables was conducted which supported the hypothesised six-correlated factor measurement model. The internal consistency reliability of the BRUMS-Greek subscales was supported via Cronbach alpha coefficients. The construct validity of the scales was supported (a) via correlations in the hypothesised direction with trait positive and negative affect, (b) with more positive and less negative moods reported immediately after participation in a single exercise class compared to pre-exercise mood, and (c) with exercise participants reporting more positive and less negative mood states compared to physically inactive adults. Women reported higher tension and lower vigour scores than men. Tension scores were higher and confusion scores lower among younger participants (≤35 years) than older participants (≥36 years). Participants with obesity reported higher negative mood scores than those who were underweight or normal weight. In sum, the BRUMS-Greek demonstrated acceptable psychometric characteristics, and is proposed to be a suitable measure for use with exercise participants, physically inactive adults, and other Greek populations to explore research questions related to mood.

Relationship between composite dietary antioxidant index and depression among overweight and obese adults

BACKGROUND

The use of specific dietary patterns to alleviate depressive symptoms has gained increasing recognition. The Composite Dietary Antioxidant Index (CDAI) is a crucial criterion for assessing antioxidant diets. We examined the relationship between CDAI and depression among overweight and obese adults through a cross-sectional study conducted in the United States.

METHODS

We used weighted multivariate logistic regression models with subgroup analysis to study the relationship between CDAI and depression. Generalized additive models were used to determine whether there was a nonlinear association between them. We developed a two-piece linear regression model to calculate the inflection point utilizing a recursive strategy.

RESULTS

After adjusting for confounding variables, the odds ratios (ORs; 95 % CI) for the correlation between CDAI and depression were 0.75 (0.67, 0.84). A saturation effect emerged for the overweight group, following which we calculated the inflection point for the overweight population, which displayed ORs (95 % CI) of 0.62 (0.47, 0.80) before the inflection point of 0.83 and the ORs (95 % CI) of 1.01 (0.77, 1.31) after 0.83. The interaction was statistically significant in the sex stratification of the obese population.

CONCLUSIONS

Our study highlighted a negative association between CDAI and depression among overweight and obese adults. Saturation effects and sex differences were observed in the overweight population.

Untreated major depression in healthcare workers: Results from the nationwide AMADEUS survey

AIMS

Recent studies have suggested increased rates of depression in healthcare workers (HCWs), with direct impact on care quality and productivity. The objective was to determine the proportion of HCWs adequately treated for their major depression in a nationwide survey, the proportion of lifestyle risk factors for depression, and to determine if working in psychiatry department or professional status may modulate these outcomes.

DESIGN

The method followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement guidelines. A survey comprising the Center for Epidemiologic Studies-Depression Scale was sent to public and private national healthcare facilities.

RESULTS

Overall, 10,325 participants were recruited; 3438 (33.3%) [95% confidence interval 32.4-34.2] met likely diagnostic criteria for clinical depression. Almost 80% of them declared that they had a history of major depressive episode. However, only approximately 23% of them were treated with antidepressants and approximately 13% had a psychiatric follow-up. Depressed HCWs working in psychiatry departments received slightly better care for their depression, but they also consumed more anxiolytics and hypnotics and had more risk factors for depression (including smoking and hazardous drinking). We found specificities according to professions, physicians reported higher rates of hazardous drinking while nurses, nurse assistants, and health executives had higher rates of smoking and twice as much obesity as physicians.

CONCLUSION

Disseminating tools to detect major depression, programs destigmatizing depression and antidepressants, promoting physical activity, weight loss, tobacco cessation and reduced alcohol consumption are promising strategies to improve the care of major depression in HCWs.

RELEVANCE TO CLINICAL PRACTICE

Reducing depression in healthcare workers is necessary to improve the quality of care, to limit burnout, medical errors, absenteeism and turn-over and globally to improve the wellbeing at work.

The effect of serum calcium on the association of depression with infertility among U.S. women

This study aimed to explored the association between depressive symptoms and infertility among U.S. women, and the effect of serum calcium on this association. We used data from the National Health and Nutrition Examination Survey (2013-2018), relating to women aged 20-45 years. Depressive symptoms were determined using the nine-item Patient Health Questionnaire (PHQ-9 scores ≥10), and interview data were used to identify self-reported infertility. Of 2708 women (mean age: 32.7 ± 7.5 years), 274 were depressed and 12.0 % self-reported being "ever-infertile." Depressive symptoms were associated with infertility in multivariable logistic regression (OR, 1.62; 95 % CI, 1.11-2.38). Depressive symptoms were associated with infertility among participants who were obese (OR, 1.68; 95 % CI, 1.03-2.74), had not received psychological counseling (OR, 1.60; 95 % CI, 1.03-2.50), were antidepressant users (OR 3.22; 95 % CI, 1.15-9.00), and had high serum calcium levels (OR, 2.05; 95 % CI, 1.25-3.35). A significant interaction between serum calcium and depression was observed for infertility (P = .038, interaction likelihood ratio test). In sensitivity analyses, the association between depressive symptoms and infertility remained after excluding women aged ≥35 years (OR, 1.87; 95 % CI, 1.08-3.23), lowering the cut-off for PHQ-9 scores (≥5) (OR, 1.48; 95 % CI, 1.12-1.96), excluding women with some gynecological diseases (OR, 1.63; 95 % CI, 1.07-2.49), and using inverse probability of treatment weighting (OR, 1.64; 95 % CI, 1.17-2.31).

Conclusion

Our findings indicate that depression is associated with infertility among U.S. women and serum calcium may have an effect on the association. Interventions such as serum calcium reduction, weight management and psychosocial counseling for infertility treatment in individuals with depression may be integrated into routine clinical practice. Additionally, more caution could be exercised when using antidepressants.

Obesity and psychological distress

The relationship between high body weight and mental health has been studied for several decades. Improvements in the quality of epidemiological, mechanistic and psychological research have brought greater consistency to our understanding of the links. Large-scale population-based epidemiological research has established that high body weight is associated with poorer mental health, particularly depression and subclinical depressive symptoms. There is some evidence for bidirectional relationships, but the most convincing findings are that greater body weight leads to psychological distress rather than the reverse. Particular symptoms of depression and distress may be specifically related to greater body weight. The psychological stress induced by weight stigma and discrimination contributes to psychological distress, and may in turn handicap efforts at weight control. Heightened systemic inflammation and dysregulation of the hypothalamic-pituitary-adrenal axis are biological mechanisms that mediate in part the relationship of greater body weight with poorer mental health. Changing negative societal attitudes to high body weights would improve the wellbeing of people living with obesity, and promote more effective weight-inclusive attitudes and behaviours in society at large, particularly in healthcare settings. This article is part of a discussion meeting issue 'Causes of obesity: theories, conjectures and evidence (Part II)'.

Causal influence of sleeping phenotypes on the risk of coronary artery disease and sudden cardiac arrest: A Mendelian randomization analysis

OBJECTIVES

To assess the causal influence of sleep and circadian traits on coronary artery disease and sudden cardiac arrest with adjustment for obesity through a two-sample Mendelian randomization study.

METHODS

We used summary statistics of 5 sleep and circadian traits for genome-wide association studies, including chronotype, sleep duration, long sleep (≥9 h a day), short sleep (<7 h a day), and insomnia (sample size range: 237,622-651,295). Coronary artery disease genome-wide association studies with 60,801 cases and 123,504 controls, sudden cardiac arrest genome-wide association studies with 3939 cases and 25,989 controls, and obesity genome-wide association studies with 806,834 individuals were also used. Multivariable Mendelian randomization was performed to estimate the causality.

RESULTS

After adjusting for obesity, genetically predicted short sleep (odds ratio = 1.87 and p = .02), and genetically predicted insomnia (odds ratio = 1.17 and p = .001) were causally associated with increased odds of coronary artery disease. Genetically predicted long sleep (odds ratio = 0.06 and p = .02) and genetically predicted longer sleep duration (odds ratio = 0.36 for per-hour increase in sleep duration and p = .0006) were causally associated with decreased odds of sudden cardiac arrest.

CONCLUSIONS

The findings of this Mendelian randomization study indicate that insomnia and short sleep contribute to the development of coronary artery disease, whereas a longer sleep duration protects from sudden cardiac arrest, independent of the influence of obesity. The mechanisms underlying these associations warrant further investigation.

The moderating effect of self-efficacy between social constraints, social isolation, family environment, and depressive symptoms among breast cancer patients in China: a cross-sectional study

BACKGROUND

For female breast cancer patients, the psychological status after surgery, especially the social and family psychological-related factors, deserves more attention. This study analyzed the influence of social constraints, social support, social isolation, family conflict, and family emotion expression on depression. At the same time, this study conducted the relationship between the variables and the mechanism of action.

METHODS

We conducted a cross-sectional study and 522 breast cancer patients finished questionnaires consisting of Self-Rating Depression Scale (SDS), General Self-Efficacy Scale (GSES), Multi-Dimensional Scale of Perceived Social Support (MSPSS), Social Constraints Scale-5 (SCS-5), Family Environment Scale (FES), and Lubben Social Network Scale (LSNS-6). Multivariable logical regression was used to explore influencing factors. Pearson's correlation, hierarchical regression, and simple slope analysis were conducted to verify the role of self-efficacy.

RESULTS

71.6% of patients had depressive symptoms. Family contradiction (OR = 10.086), social constraints (OR = 2.522), social isolation (OR = 2.507), and high blood glucose (OR = 2.156) were risk factors of depressive symptoms. Family emotional expression (OR = 0.480), family intimacy (OR = 0.235), and self-efficacy (OR = 0.246) were protective factors against depressive symptoms. The interactive items interpretation quantity were as follows: Contradiction*Self-efficacy (ΔR2 = 2.3%, P < 0.001), Emotional expression*Self-efficacy (ΔR2 = 2.6%, P < 0.001), Intimacy*Self-efficacy (ΔR2 = 1.0%, P = 0.018), Social constraints*Self-efficacy (ΔR2 = 1.0%, P = 0.008), Social networks*Self-efficacy (ΔR2 = 1.0%, P = 0.010), Blood Glucose*Self-efficacy (ΔR2 = 0.6%, P = 0.023). The influence of independent variables on depressive symptoms was gradually decreased in the low, mean, and high groups of self-efficacy.

CONCLUSION

Postoperative Chinese breast cancer survivors reported higher depressive symptoms. Social, family, and physiological factors could affect depressive symptoms, in which self-factor played moderator roles.

Association between serum copper, zinc, and selenium concentrations and depressive symptoms in the US adult population, NHANES (2011-2016)

BACKGROUND

Evidence suggests that alterations in serum trace element concentrations are closely associated with mental illness. However, ​studies on the relationship between serum copper, zinc, and selenium concentrations and depressive symptoms are limited and with controversial results. We aimed to investigate the association between serum concentrations of these trace elements and depressive symptoms in US adults.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) (2011-2016) were used in this cross-sectional study. The Patient Health Questionnaire-9 Items (PHQ-9) was employed to assess depressive symptoms. Multiple logistic regression was performed to determine the relationship between the serum concentrations of copper, zinc, and selenium and depressive symptoms.

RESULTS

A total of 4552 adults were included. Subjects with depressive symptoms had higher serum copper concentrations (123.88 ± 1.87) than those without depressive symptoms (116.99 ± 0.86) (p < 0.001). In Model 2, weighted logistic regression analysis showed that the second (Q2) quartile of zinc concentrations (odds ratio [OR] = 1.534, 95% confident interval [CI]: 1.018 to 2.313) were significantly associated with an increased risk of depressive symptoms. Subgroup analysis revealed that the third (Q3) and fourth (Q4) quartiles of copper concentrations (Q3: OR = 2.699, 95% CI: 1.285 to 5.667; Q4: OR = 2.490, 95% CI: 1.026 to 6.046) were also positively associated with depressive symptoms in obese individuals after controlling for all confounders. However, no significant relationship between serum selenium concentrations and depressive symptoms was observed.

CONCLUSIONS

Obese US adults with high serum copper concentrations, as well as US adults in general with low serum zinc concentrations, were susceptible to depressive symptoms. Nevertheless, the causal mechanisms underlying these relationships need to be further explored.

Association Between Depression and Physical Conditions Requiring Hospitalization

Importance

Depression is associated with an increased risk of physical illness, but the most common causes of hospitalization among people with depression are unclear.

Objective

To examine the association of depression with an array of physical conditions requiring hospital treatment.

Design, Setting, and Participants

In this outcomewide prospective multicohort study, primary analysis was based on data from the UK Biobank, a population-based study in the United Kingdom. Analyses were repeated in an independent data set of 2 cohorts in Finland, a population-based study and an occupational cohort. Data analysis was conducted between April and September 2022.

Exposures

Self-reported depression, recurrent severe major depression, recurrent moderate major depression, and a single major depressive episode.

Main Outcomes and Measures

A total of 77 common health conditions ascertained from linkage data to national hospital and mortality registries.

Results

The analytical sample of UK Biobank participants consisted of 130 652 individuals (71 565 women [54.8%]; 59 087 men [45.2%]; mean [SD] age at baseline, 63.3 [7.8] years). The pooled data from the Finnish replication cohorts included 109 781 participants (82 921 women [78.6%]; 26 860 men [21.4%]; mean [SD] age, 42 [10.8] years). In the main analysis, severe/moderately severe depression was associated with the incidence of 29 nonoverlapping conditions requiring hospital treatment during a 5-year follow-up. Twenty-five of these associations remained after adjustment for confounders and multiple testing (adjusted hazard ratio [HR] range, 1.52-23.03) and were confirmed in the analysis of the Finnish cohorts. These included sleep disorders (HR, 5.97; 95% CI, 3.27-10.89), diabetes (HR, 5.15; 95% CI, 2.52-10.50), ischemic heart disease (HR, 1.76; 95% CI, 1.36-2.29), chronic obstructive bronchitis (HR, 4.11; 95% CI, 2.56-6.60), bacterial infections (HR, 2.52; 95% CI, 1.99-3.19), back pain (HR, 3.99; 95% CI, 2.96-5.38), and osteoarthritis (HR, 1.80; 95% CI, 1.46-2.20). The highest cumulative incidence was observed for endocrine and related internal organ diseases (245 per 1000 persons with depression; risk difference relative to unaffected individuals: 9.8%), musculoskeletal diseases (91 per 1000 persons; risk difference, 3.7%), and diseases of the circulatory system and blood (86 per 1000 persons; risk difference, 3.9%). The cumulative incidence was lower for hospital-treated mental, behavioral, and neurological disorders (20 in 1000 persons; risk difference, 1.7%). Depression was also associated with disease progression in people with prevalent heart disease or diabetes, and for 12 conditions, there was evidence of a bidirectional relationship.

Conclusions and Relevance

In this study, the most common causes of hospitalization in people with depression were endocrine, musculoskeletal, and vascular diseases, not psychiatric disorders. These findings suggest that depression should be considered as a target for the prevention of physical and mental disease.

Obesity as a causal risk factor for depression: Systematic review and meta-analysis of Mendelian Randomization studies and implications for population mental health

BACKGROUND/OBJECTIVES

Obesity has been associated with elevated risk of depression. If this association is causal, the increasing obesity prevalence might lead to worsening population mental health, but the strength of the causal effect has not been systematically evaluated.

SUBJECTS/METHODS

The current study provides a systematic review and meta-analysis of studies examining associations between body mass index and depression using Mendelian randomization with multiple genetic variants as instruments for body mass index. We used this estimate to calculate the expected changes in prevalence of population psychological distress from the 1990s-2010s, which were compared with the empirically observed trends in psychological distress in the Health Survey for England (HSE) and U.S. National Health Interview Surveys (NHIS).

RESULTS

Meta-analysis of 8 Mendelian randomization studies indicated an OR = 1.33 higher depression risk associated with obesity (95% confidence interval 1.19, 1.48). Between 15% and 20% of the participants of HSE and NHIS reported at least moderate psychological distress. The increase of obesity prevalence from the 1990s-2010s in HSE and NHIS would have led to a 0.6 percentage-point increase in population psychological distress.

CONCLUSIONS

Mendelian randomization studies suggest that obesity is a causal risk factor for elevated risk of depression. The increasing obesity rates may have modestly increased the prevalence of depressive symptoms in the general population. Mendelian randomization relies on methodological assumptions that may not always hold, so other quasi-experimental methods are needed to confirm the current conclusions.

Impact of insulin and insulin resistance on brain dopamine signalling and reward processing- an underexplored mechanism in the pathophysiology of depression?

Type 2 diabetes and major depressive disorder (MDD) are the leading causes of disability worldwide and have a high comorbidity rate with fatal outcomes. Despite the long-established association between these conditions, the underlying molecular mechanisms remain unknown. Since the discovery of insulin receptors in the brain and the brain's reward system, evidence has accumulated indicating that insulin modulates dopaminergic (DA) signalling and reward behaviour. Here, we review the evidence from rodent and human studies, that insulin resistance directly alters central DA pathways, which may result in motivational deficits and depressive symptoms. Specifically, we first elaborate on the differential effects of insulin on DA signalling in the ventral tegmental area (VTA) - the primary DA source region in the midbrain - and the striatum as well as its effects on behaviour. We then focus on the alterations induced by insulin deficiency and resistance. Finally, we review the impact of insulin resistance in DA pathways in promoting depressive symptoms and anhedonia on a molecular and epidemiological level and discuss its relevance for stratified treatment strategies.

The efficacy of topical aminophylline in local fat reduction: A systematic review

Background and aims

Some studies have reported that the topical forms with aminophylline as the active ingredient appear to be relatively effective on local fat burning while having no/minimal side effects. This systematic review accumulates all of the data on the local fat-burning potency of aminophylline topical formulation.

Methods

Documents were retrieved from PubMed, Web of Science, and Scopus databases until Aug 2022. Data were extracted from clinical trials reporting the reduction in thigh or waist circumference as a result of using topical forms containing aminophylline. Screening of included studies was performed independently by two authors and the quality assessment of included studies was performed based on the Cochrane Collaboration's approach.

Results

Of the 802 initial studies, 5 studies were included in the systematic review. Several concentrations of aminophylline were used in different studies. Most studies administred the topical formulation on participants' one thigh, and the other thigh was considered to be the control for comparing the fat reduction amount. Except for one study, all other studies reported that all participants lost more fat on the treated area than the control groups. The amount of fat reduction differed in studies regarding their different aminophylline concentrations and administration routines. In the case of side effects, except for some studies reporting skin rashes, other studies reported no significant side effects at all.

Conclusions

Aminophylline topical formulation offers a safe, effective, and much less invasive alternative to cosmetic surgery for localized fat reduction. It seems that the 0.5% concentration, administered five times a week for five weeks is the most potent concentration. However, more high-quality clinical trials are needed to verify this conclusion.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42022353578.

Association between depressive symptoms and pericardial fat in healthy older men and women

Depressive symptoms are associated with increased risk for cardiovascular disease (CVD), and inflammation may contribute to this relationship. Pericardial fat, a highly metabolically active fat depot, is implicated in the pathogenesis of CVD, but its association with depressive symptoms is unclear. This study examined the cross-sectional and longitudinal association between depressive symptoms and pericardial fat over a three-year period. Participants were 543 healthy men and women (mean age = 62.9 years) without history or objective signs of coronary heart disease from the Whitehall II cohort. In men, depressive symptoms were positively associated with pericardial fat at baseline after adjustment for sociodemographics, waist to hip ratio and conventional cardiovascular risk factors. Inflammation, indexed by plasma interleukin 6 concentration, accounted for 17% of this association. Longitudinally, depressive symptoms did not predict pericardial fat three years later in men once baseline levels of pericardial fat were accounted for. No significant associations between depressive symptoms and pericardial fat were found in women. Overall, our findings suggest that greater pericardial fat might be a mechanism by which depressive symptoms are associated with increased risk for CVD in men, and inflammation may also lie on this pathway.