Psychological distress, depressive symptoms, and cellular immunity among healthy individuals: a 1-year prospective study

Predicting Depressive Symptoms and Psychological Distress by Circulating Inflammatory Mediators: A 16-Month Prospective Study in Japanese White-Collar Employees

OBJECTIVE

Although increasing evidence suggests that depression/distress involves inflammatory processes, its potential sex differences and the temporal directions for this association remain elusive.

METHODS

We examined the temporal association between serum inflammatory mediators and depression/distress as measured by the Center for Epidemiologic Studies Depression Scale (CES-D) and the Kessler Psychological Distress Scale (K6), in nondepressed working men and women (n = 61 and 43, respectively) by a 16-month prospective design.

RESULTS

Fully adjusted partial correlation analyses revealed that, in men, a lower IFN-γ predicted subsequent increases in CES-D and K6 scores, whereas a higher TNF-α predicted increased K6 scores. In women, a higher IFN-γ predicted a subsequent increase in the CES-D score. CES-D and K6 scores did not predict inflammatory mediators at follow-up.

CONCLUSIONS

The finding suggests that inflammatory activation precedes depression/distress with distinct sex differences.

A matched case-control study on the attributable risk of CES-D positivity to the incidence of COVID-19 breakthrough infections

Objectives

To investigate whether the Center for Epidemiologic Studies Depression Scale (CES-D) positivity (16 and above) is a risk factor for breakthrough infections of coronavirus disease 2019 (COVID-19), a matched case-control study was conducted among hospital employees.

Methods

Participants were matched based on known risk factors, including serum SARS-CoV-2 anti-S antibodies. A multivariate logistic regression analysis was conducted with CES-D score measured at baseline as the explanatory variable and the presence of breakthrough infection after a specified period as the outcome variable, and gender, age, and other covariates were included.

Results

Logistic regression analysis showed that CES-D positivity was significantly associated with the breakthrough COVID-19 infections (odds ratio 4.393; 95% confidence interval, 1.318-14.642, P=0.016).

Conclusions

An increase in the number of hospital employees with CES-D positivity during the pandemic might contribute to a rise in breakthrough infections. It is considered necessary to alleviate people's stress levels through the enhancement of mental health care interventions, complementing infection control measures.

Distress Signals: Age Differences in Psychological Distress before and during the COVID-19 Pandemic

Psychological distress reached historically high levels in 2020, but why, and why were there pronounced age differences? We address these questions using a relatively novel, multipronged approach, part narrative review and part new data analyses. We first updated previous analyses of national surveys that showed distress was increasing in the US and Australia through 2017 and then re-analyzed data from the UK, comparing periods with and without lockdowns. We also analyzed the effects of age and personality on distress in the US during the pandemic. Results showed distress levels and age differences in distress were still increasing through 2019 in the US, UK, and Australia. The effects of lockdowns in 2020 revealed the roles of social deprivation and fear of infection. Finally, age-related differences in emotional stability accounted for the observed age differences in distress. These findings reveal the limitations of analyses comparing pre-pandemic and pandemic periods without accounting for ongoing trends. They also suggest that differences in personality traits such as emotional stability modulate responses to stressors. This could explain age and individual differences in both increases and decreases in distress in response to changes in the level of stressors such as those occurring prior to and during the COVID-19 pandemic.

White blood cell inflammatory markers are associated with depressive symptoms in a longitudinal study of urban adults

Total white blood cell count (TWBCC) and percentage (%) composition of lymphocytes (PL) or neutrophils (PN) are linked to mid- and late-life depression, though sex-specific temporal relationships between those inflammatory markers and depressive symptoms remain unclear. The association between inflammation and depressive symptoms in longitudinal data on ethnically and socioeconomically diverse urban adults was examined with two hypotheses. In hypothesis 1, we examined the relationship between TWBCC, PL and PN with change in level of depressive symptoms from baseline to follow-up, stratifying by sex. In hypothesis 2, we examined reverse causality, by testing the relationship of depressive symptoms with change in TWBCC, PL and PN. Multiple linear mixed-effects regression models were performed to examine both the hypotheses. The sample sizes of participants (n) and repeated observations (n') were: Hypothesis 1 (n=2009; n'=3501); Hypothesis 2 (n=2081; n'=3560). Among key findings (Hypothesis 1), in women, higher TWBCC was linked to a faster increase in depressive symptom total score (γ1112±s.e.: +0.81±0.28, P=0.003), with a slower increase over time in the positive affect subdomain coupled with faster increases in depressed affect and somatic complaints. Among women, baseline score on somatic complaints was positively associated with low PN (γ01a=+1.61±0.48, P<0.001) and high PL (γ01a=+1.16±0.45, P=0.011), whereas baseline score on positive affect was inversely related to higher PL (γ01a=-0.69±0.28, P=0.017). Results among men indicated that there was a positive cross-sectional relationship between low TWBCC and depressive symptoms, depressed affect and an inverse cross-sectional relationship with positive affect. However, over time, a low TWBCC in men was linked to a higher score on positive affect. There was no evidence of a bi-directional relationship between WBC parameters and depressive symptoms (Hypothesis 2). In sum, TWBCC and related markers were linked to depressive symptoms, mostly among women. Further longitudinal studies are needed to replicate this sex-specific association.

Persistent systemic inflammation and symptoms of depression among patients with COPD in the ECLIPSE cohort

BACKGROUND

Depression is highly prevalent among patients with Chronic Obstructive Pulmonary Disease (COPD). The relationship of depression with systemic inflammation in COPD remains unknown. The objective of this observational study was to compare depression scores at baseline and after 36 months follow-up between COPD patients with persistent systemic inflammation (PSI) and never inflamed patients (NI) in the ECLIPSE cohort.

METHODS

The ECLIPSE study included 2164 COPD patients. Parameters assessed at baseline and at 36 months follow-up included: demographics, clinical characteristics and symptoms of depression (Center for Epidemiologic Studies of Depression, CES-D). Patients classified as NI had zero and patients with PSI had ≥2 inflammatory biomarkers (white blood cell count, hsCRP, IL-6, and fibrinogen) in the upper quartile, at baseline and 12 months later.

FINDINGS

350 patients (29.1%) were NI and 131 patients (10.9%) had PSI. At baseline, mean CES-D score was higher in patients with PSI than in NI patients (11.7 (8.6) vs. 9.2 (8.9) points, p = 0.01). Differences were not confirmed after adjustment for possible confounders (β (95% CI) = 0.02 (-3.87 to 15.29), adjusted p = 0.98). At 36 months follow-up, CES-D scores were comparable in PSI and NI patients (12.2 (9.3) vs. 10.5 (9.0) points, p = 0.08) as were their temporal changes (0.5 (8.3) vs. 1.3 (7.9) points, p = 0.30).

CONCLUSION

The ECLIPSE study does not support a strong relationship between PSI and symptoms of depression at baseline and after 36 months follow-up in COPD.

FUNDING

The study was sponsored by GlaxoSmithKline.

The social determinants of health and pandemic H1N1 2009 influenza severity

OBJECTIVES

We explored the effects of social determinants of health on pandemic H1N1 2009 influenza severity and the role of clinical risk factors in mediating such associations.

METHODS

We used multivariate logistic regression with generalized estimating equations to examine the associations between individual- and ecological-level social determinants of health and hospitalization for pandemic H1N1 2009 illness in a case-control study in Ontario, Canada.

RESULTS

During the first pandemic phase (April 23-July 20, 2009), hospitalization was associated with having a high school education or less and living in a neighborhood with high material or total deprivation. We also observed the association with education in the second phase (August 1-November 6, 2009). Clinical risk factors for severe pandemic H1N1 2009 illness mediated approximately 39% of the observed association.

CONCLUSIONS

The main clinical risk factors for severe pandemic H1N1 2009 illness explain only a portion of the associations observed between social determinants of health and hospitalization, suggesting that the means by which the social determinants of health affect pandemic H1N1 2009 outcomes extend beyond clinically recognized risk factors.

Ageing-associated changes in cellular immunity based on the SENIEUR protocol

To investigate ageing-associated changes in cellular immunity, we recruited three groups of healthy subjects based on SENIEUR protocol criteria. In addition, 10 subjects were randomly selected from each group to isolate their T cells from peripheral blood mononuclear cells; T cell proliferation after phytohemagglutinin (PHA) stimulation was determined by methyl thiazolyl tetrazolium assays. There were no marked differences in the absolute numbers of peripheral blood T cells, NK cells or B cells among the three groups (P > 0.05). Also, no significant differences were noted in the numbers of CD4+ cells, CD8+ cells, or the CD4+/CD8+ ratios (P > 0.05). After PHA stimulation, T cell proliferation was markedly increased, with the highest level in group C and the lowest level in group A (P < 0.05). Cytokine-induced killer tumouricidal activities were also dramatically increased, with the highest activity in group C and the lowest activity in group A (P < 0.05). Our findings suggest that the number of immune cells remains unchanged with advanced age. However, there is a trend for decreased cellular immunity with an increase in age.