A review of lifestyle factors that contribute to important pathways associated with major depression: diet, sleep and exercise

Assessing health lifestyles in contemporary China: Patterns, transitions, and socioeconomic antecedents

Health lifestyles in China reflect complex interplays of various structural forces, yielding intricate and evolving patterns. Leveraging data from the 2004-2015 China Health and Nutrition Survey (N = 9,986), this study discerns latent health lifestyles, tracks transitional dynamics, and probes socioeconomic disparities in these shifts. Three distinct lifestyle categories emerge: 'high risk', 'overall healthy but inactive', and 'modernized and active'. Notably, the prevalent trend favours the 'overall healthy but inactive' lifestyle, steadily expanding over time, followed by the 'high-risk' group. Conversely, the 'modernized and active' lifestyle, while being the least common, exhibits a modest decline. Individuals engaged in primary industries are more likely to sustain an overall healthy but inactive lifestyle. Socioeconomic advantages, particularly in education and income, were linked to maintaining or transitioning into a modernised and active lifestyle, while lower income and unemployment were more prone to maintaining high-risk behaviours. These findings illuminate the intricate dynamics of health lifestyles in China's rapidly evolving landscape, highlighting socioeconomic influences on lifestyle transitions.

Bootstrap inference and machine learning reveal core differential plasma metabolic connectome signatures in major depressive disorder

BACKGROUND

Major depressive disorder (MDD) involves molecular alterations and pathway dysregulation. Metabolic interconnections are crucial for normal functioning, yet current analysis focuses on individual pathways or biomarkers, overlooking intricate metabolic biomarker interactions.

METHODS

Plasma metabolomic data from 182,053 UK Biobank participants [9425 MDD, and 172,628 healthy controls (HC)] were used to construct metabolic correlation networks through bootstrap inference analysis (bootstrap step size: 1000, 3000, 5000, 7000, 9000; n = 1000 times/size). Differential core metabolic network signatures between MDD and HC were identified by machine learning, followed by metabolic pathway analysis. Various deep learning and machine learning models were employed to differentiate MDD from HC groups using the identified network features and baseline characteristics.

RESULTS

The MDD metabolic network showed marked reorganization, with a sparser and more streamlined network structure compared to controls (p < 0.05 for both Vnet-edge and Vnet-node). Analysis of the core network in MDD revealed four key altered pathways, with linoleic acid metabolism being the most influential (p < 0.01, impact = 0.29). An extreme gradient boosting model combining network signatures and baseline features achieved 73 % accuracy, and an AUROC of 0.82 in differentiating MDD from HC groups.

CONCLUSIONS

This large-scale, metabolomic connectome analysis revealed consistent dysregulated metabolic network features in MDD, providing a robust and distinguishable framework compared to controls. The MDD network exhibits distinct connectivity patterns, particularly within linoleic acid metabolism. Integrating metabolomics as networks, rather than isolated markers, offers a promising approach for elucidating MDD pathophysiology and identifying diagnostic biomarkers.

Adult offspring's education and parental mortality: A nationwide cohort study of the mediating role of lifestyle-related diseases

Aim: The mechanisms behind the association between adult offspring's socioeconomic position and their parents' mortality are not well understood. This study investigates lifestyle-related diseases as a potential mediating pathway between adult offspring's education and parental mortality. Methods: This nationwide register-based cohort study consists of 963,742 older adults aged 65 years between 2000 and 2018. Lifestyle-related diseases were measured between 60 and 65 years and those with prior lifestyle-related diseases were excluded. Natural Effect Models were performed to assess potential mediation through lifestyle-related diseases of the association between offspring's education and parental mortality measured by additive hazard estimates with 95% confidence intervals (CIs). Results: Between 60 and 65 years, 150,501 (15.6%) older adults were diagnosed with lifestyle-related diseases and 149,647 (15.5%) died during follow-up. Compared with having offspring with long education, short education was associated with 631 (95% CI: 555; 707) and 581 (95% CI: 525; 638) additional deaths per 100,000 person-years for women and men, respectively, of which 15.4% (95% CI: 9.0; 21.6) and 16.8% (95% CI: 14.6; 18.9) were mediated by lifestyle-related diseases. The corresponding numbers for medium education were 276 (95% CI: 205; 347) and 299 (95% CI: 255; 343) with 26.2% (95% CI: 12.0; 40.6) and 27.6% (95% CI: 25.1; 31.8) mediated by lifestyle-related diseases. Conclusions: Lifestyle-related diseases accounted for 15-28% of the association between offspring's education and parental mortality for both men and women.

The relationship between unhealthy lifestyle behaviors and depression: evidence from NHANES

BACKGROUND

With increasing recognition of the complex interplay between lifestyle behaviors and mental health, this study aims to explore the relationship between Unhealthy Lifestyle Behaviors (ULB) and depression in a representative sample of the US population. The study proposes ULB as a holistic measure for assessing depression risk.

METHODS

We analyzed data from 21,854 participants from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018. ULB's impact on depression was examined via multivariate logistic and linear regression, with nonlinear relationships assessed using weighted restricted cubic splines. Stratified analyses evaluated consistency across different demographics and health conditions.

RESULTS

The cohort's average age was 45.63 ± 0.26 years, with 51.89 % males. A higher depression prevalence was observed in females (p < 0.001). After adjusting for covariates, a significant association emerged between higher ULB scores and increased depression risk [OR: 1.232, 95 % CI: 1.106,1.372]. No significant interactions were found in subgroup analyses by gender, age, ethnicity, hypertension, and hyperlipidemia (all P for interaction >0.05), indicating a consistent ULB-depression link across groups.

CONCLUSIONS

This study highlights ULB's potential as a predictive indicator for depression, emphasizing its importance in mental health evaluations. The findings suggest that incorporating comprehensive lifestyle assessments into mental health screenings could enhance the identification and prevention of depression. Additional research is needed to confirm these initial results and to investigate the causal pathways involved.

Prospective association of depression symptoms with exceptional longevity among older women

Older women may experience elevated depression symptoms, which have been associated with morbidity and mortality. Yet, few studies have examined associations of depression symptoms with longevity. We examined associations among older women of depression symptoms with survival to ages 90, 95, and 100, and survival to age 90 with intact mobility and cognitive functioning. Participants were 70,560 women enrolled in the Women's Health Initiative with potential, due to birth year, to reach age ≥ 90 as of February 2022. Depression symptoms were assessed at baseline (1993-1998) using the Burnam screen, which comprises the 6-item Center for Epidemiologic Studies Depression Scale and 2 items from the Diagnostic Interview Schedule. Depression symptoms were classified as elevated (vs. not) using an established cut point of ≥ 0.06 for detecting depressive disorders. Survival (vs. death) to ages 90, 95, and 100 years was assessed. Among women surviving to age ≥ 90, maintenance of mobility and cognitive function were assessed in relation to depression symptoms. A total of 37,460 women (53.1%) survived to age ≥ 90. Women with (vs. without) elevated depression symptoms had 15% lower odds of surviving to age 90, 18% lower odds of surviving to age 95, and 23% lower odds of surviving to age 100. Among women surviving to 90, those with (vs. without) elevated depression symptoms had 46% lower odds of surviving with intact mobility and cognition. Depression symptoms associated with lower odds of healthy longevity. Findings underscore importance of depression intervention to increase women's odds of healthy longevity.

The association between lifestyle risk score and mental health in Iranian overweight and obese women: a cross-sectional study

Background

Since evidence on the relationship between a combination of lifestyle factors and mental health in the Iranian population is limited, this study employed a cross-sectional design which is a quick and low-cost method to provide more information on the potential association between lifestyle and mental health. This study addresses this gap by focusing on Iranian overweight and obese women.

Methods

This cross-sectional study analyzed 278 Iranian overweight and obese women. A multistage random sampling method was used to recruit the participants. The lifestyle risk score (LRS) was created based on diet, physical activity (PA), sleep, obesity, and sociodemographic characteristics. Multinomial logistic regression analysis was used to evaluate the association between LRS and the odds of depression, anxiety, and stress. Participants were assigned a score of 0 for each healthy behavior and a score of 1 for each unhealthy behavior. A higher LRS indicates an unhealthier lifestyle. A binary logistic regression analysis was used to examine LRS and the stress and depression anxiety stress scale (DASS).

Results

Significant positive associations between high LRS and moderate and severe depression were found (p < 0.05). Furthermore, there were significant positive associations between higher LRS and mild and extremely severe stress (p < 0.05).

Conclusion

This is the first study that examined associations between LRS and total DASS-21 and demonstrated that participants with lower LRS had lower levels of depression and stress. This study highlights the crucial role of healthy lifestyle choices in psychological wellbeing. These findings inform the design of interventions to address mental health disorders in Iran. Further prospective studies, including a larger sample size of both genders, are needed to expand our understanding of lifestyle scores' associations with mental health.

Does healthy lifestyle attenuate the associations of phthalates with depression? A cross-sectional study

Phthalates have raised concerns on health outcomes including depression, due to its ubiquity. Knowledge is lacking on the role of modifiable lifestyle in attenuating phthalates' adverse effects. We aimed to evaluate the interaction effects of lifestyle with urinary phthalate metabolites (UPMs) on depression. A total of 3588 participants aged ≥ 20 from the National Health and Nutrition Examination Survey 2011-2018 were involved. We used multivariate logistic regression models and Bayesian Kernel Machine Regression models to evaluate the associations of UPMs (individual or mixture) and lifestyle with depression. Positive associations of individual UPMs and its mixture with depression were observed in total population and participants maintaining an unfavorable lifestyle. No such association was found in participants with a healthy lifestyle. Interactions between lifestyle category with MECPP (P for interaction = 0.028), and ΣDEHP (P for interaction = 0.087) on depression were observed. Additionally, smoking, alcohol consumption and physical activity in healthy levels showed the greatest effect against depression among the common lifestyle combinations. In conclusion, positive associations of UPMs with depression risk, and interaction effects of lifestyle and UPMs on depression were observed. Our findings indicate that healthy lifestyle might weaken the adverse effects of phthalate exposure on depression risk.

Improvements of depression, anxiety, stress, and social support through a telerehabilitation system in discharged COVID-19 patients: a randomized controlled pilot study

INTRODUCTION

Post-acute COVID-19 patients who were discharged from hospitals during the epidemic faced significant challenges, not only physical sequelae, but also psychological distress, anxiety, and depression. It is already known that continued exercise improves psychosocial components, but few studies have explored the impact of multimodal rehabilitation programs, including therapeutic education, in this type of patient. There are no studies that explore the application of these programs through asynchronous telerehabilitation, which would open up new therapeutic windows.

METHODS

This pilot single-blinded randomized controlled trial included 35 post-discharge COVID-19 patients allocated to two intervention arms: an asynchronous telerehabilitation group (ATG) and a booklet-based rehabilitation group (BRG). The aim was to analyze the preliminary changes in depression, anxiety, stress, and social support comparing both groups.

RESULTS

The ATG exhibited statistically significant reductions in depression (p = 0.048) and stress (p = 0.033) compared to the BRG after intervention. While both groups showed improvements in psychosocial variables, the ATG demonstrated consistent lower depression levels at 3- and 6-month follow-ups (p = 0.010, p = 0.036 respectively) and notably higher social support at 3- and 6-month follow-ups (p = 0.038, p = 0.028 respectively).

DISCUSSION

This pilot study suggests that a multimodal rehabilitation program using asynchronous telerehabilitation provides substantial benefits in terms of alleviating psychological distress and improving social support in discharged COVID-19 patients. These data will enable for larger studies to confirm these results.

Modifiable lifestyle factors influencing neurological and psychiatric disorders mediated by structural brain reserve: An observational and Mendelian randomization study

BACKGROUND

Modifiable lifestyle factors are implicated as risk factors for neurological and psychiatric disorders, but whether these associations are causal remains uncertain. We aimed to evaluate associations and ascertain causal relationships between modifiable lifestyle factors, neurological and psychiatric disorder risk, and brain structural magnetic resonance imaging (MRI) markers.

METHODS

We analyzed data from over 50,000 UK Biobank participants with self-reported lifestyle factors, including alcohol consumption, smoking, physical activity, diet, sleep, electronic device use, and sexual factors. Primary outcomes were stroke, all-cause dementia, Parkinson's disease (PD), Major depression disorder (MDD), Anxiety Disorders (ANX), and Bipolar Disorder (BIP), alongside MRI markers. Summary statistics were obtained from genome-wide association studies and Mendelian randomization (MR) analyses investigated bidirectional associations between lifestyle factors, neurological/psychiatric disorders, and MRI markers, with mediation assessed using multivariable Mendelian randomization (MVMR).

RESULTS

Cross-sectional analyses identified lifestyle factors were associated with neurological and psychiatric disorders and brain morphology. MR confirmed causal relationships, including lifetime smoking index on Stroke, PD, MDD, ANX and BIP; play computer games on BIP; leisure screen time on Stroke and MDD; automobile speeding propensity on MDD; sexual factors on MDD and BIP; sleep characteristics on BIP and MDD. Brain structure mediated several lifestyle-disorder associations, such as daytime dozing and dementia, lifetime smoking and PD and age first had sexual intercourse and PD.

CONCLUSION

Our results provide support for a causal effect of multiple lifestyle measures on the risk of neurological and psychiatric disorders, with brain structural morphology serving as a potential biological mediator in their associations.

Effect of Low-Fat Diet on Depression Score in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials

CONTEXT

Current evidence on the effect of a low-fat (LF) diet on depression scores has been inconsistent.

OBJECTIVE

To explore the effect of an LF diet on depression scores of adults by systematic review and meta-analysis of randomized controlled trials (RCTs).

DATA SOURCES

The PubMed, ISI Web of Science, Scopus, and CENTRAL databases were searched from inception to June 7, 2023, to identify trials investigating the effect of an LF diet (fat intake ≤30% of energy intake) on the depression score.

DATA EXTRACTION

Random-effects meta-analyses were used to estimate pooled summary effects of an LF diet on the depression score (as Hedges g).

DATA ANALYSIS

Finding from 10 trials with 50 846 participants indicated no significant change in depression score following LF diets in comparison with usual diet (Hedges g = -0.11; 95% CI, -0.25 to 0.03; P = 0.12; I2 = 70.7% [for I2, 95% CI, 44%, 85%]). However, a significant improvement was observed in both usual diet and LF diets when the content of protein was 15-20% of calorie intake (LF, normal protein diet: n = 5, Hedges g = -0.21, 95% CI, -0.24 to -0.01, P = 0.04, I2 = 0%; usual, normal protein diet: n = 3, Hedges g = -0.28, 95% CI, -0.51 to -0.05, P = 0.01, I2 = 0%). Sensitivity analysis also found the depression score improved following LF diet intervention in participants without baseline depression.

CONCLUSION

This study revealed that LF diet may have small beneficial effect on depression score in the studies enrolled mentally healthy participants. Moreover, achieving to adequate dietary protein is likely to be a better intervention than manipulating dietary fat to improve depression scores. However, it is not clear whether this effect will last in the long term. Conducting more studies may change the results due to the low-certainty of evidence.

SYSTEMATIC REVIEW REGISTRATION

CRD42023420978 (https://www.crd.york.ac.uk/PROSPERO).

Circadian rhythm, epigenetics and disease interaction

Identifying the circadian clock first provided the genetic basis for behaviour, and our understanding of circadian rhythms has since expanded to provide molecular insight into disease and physiology. The synchronization of central and peripheral clocks and robust daily rhythms can be achieved in a wide range of physiological systems and homeostatic responses can be supplemented. The rhythmical epigenome, which works as a central regulator, determines the circadian transcription of cell types. The rhythmical epigenome imposes oscillation on biological systems that momentarily split metabolism within 24 h. Interactions between the endogenous circadian system govern blood pressure, sleep, obesity and postural variations. Human health is dependent on the circadian rhythm. It can depict disease dynamics as well as overall drug efficacy monitoring to optimize the therapy effect. Circadian rhythms can collectively drive various metabolic activities, but dietary habits, sleep patterns, and other factors can also influence the circadian rhythm. The synergy of circadian rhythm and metabolism can bring new insights and personalized analysis for disease development causes and prevention. The understanding of the molecular clock and disease relationship can be exploited to determine treatment timing as well as new therapy targets.

Electrochemical Probing of Dopamine Dynamics During Poly(I:C)-Induced Neuroinflammation

Viruses can infiltrate the central nervous system and contribute to depression, which may include alterations in dopamine (DA) metabolism triggered by immune responses though the specific mechanisms involved remain unclear. Here, an electrochemical system to realize the real-time dynamic monitoring of DA with high sensitivity is proposed and it is demonstrated that the viral simulator polyinosinic-polycytidylic acid (poly(I:C)) can inhibit the release of DA (from 5.595 to 0.137 µm) in neurons from the perspective of single cells, cell populations and even in vivo through the combination of multiscale electrodes, including single nanowires, carbon fibers (CFs) and 2D flexible electrodes. These findings are associated with the increase in reactive oxygen species (ROS) produced by microglia. At the molecular level, poly(I:C) significantly decreases the expression of α-synuclein and increases its phosphorylation level, whereas ROS inhibitors can reverse these pathological changes and salvage DA release to half the initial level (≈2.6 µM). These results suggest that viruses may indirectly inhibit DA system function through ROS produced in inflammatory responses and that antioxidant activity may be a potential therapeutic strategy.

Depression and Accelerated Aging: The Eveningness Chronotype and Low Adherence to the Mediterranean Diet Are Associated with Depressive Symptoms in Older Subjects

BACKGROUND AND OBJECTIVES

Depression often results in premature aging, which increases the risk of other chronic diseases, but very few studies have analyzed the association between epigenetic biomarkers of aging and depressive symptoms. Similarly, limited research has examined the joint effects of adherence to the Mediterranean diet (MedDiet) and chronotype on depressive symptoms, accounting for sex differences. Therefore, these are the objectives of our investigation in a Mediterranean population at high cardiovascular risk.

METHODS

We analyzed 465 older subjects (aged 55-75) with metabolic syndrome and assessed depressive symptoms by the Beck Depression Inventory (BDI-II). MedDiet adherence was measured with the 17-item MedDiet score, and chronotype with the Morningness-Eveningness Questionnaire (MEQ). Blood DNA methylation was analyzed, and epigenomic biomarkers of age acceleration were determined. We focused on the Dunedin Pace of Aging Computed from the Epigenome (DunedinPACE). We fitted multivariable models with interaction terms.

RESULTS

Prevalence of depression was statistically higher in women (p < 0.001). MedDiet adherence was strongly and inversely associated with depressive symptoms in the whole population (p < 0.01), while the MEQ score was inversely associated (p < 0.05). In the joint analysis, both MedDiet adherence and chronotype remained statistically associated with the BDI-II score (p < 0.05), showing additive effects. No interaction effects were observed. In women, a higher score in depressive symptoms was significantly associated with faster age acceleration (measured with the DunedinPACE biomarker). This association remained significant even after adjustment for MedDiet adherence and chronotype.

CONCLUSIONS

In older subjects with metabolic syndrome, the eveningness chronotype was associated with greater depressive symptoms, but a higher adherence to the MedDiet could potentially counteract the chronotype risk with additive effects. Women showed stronger associations, and importantly, we reported for the first time in this population that depressive symptoms were associated with accelerated aging.

Synergistic Effects of Omega-3 Fatty Acids and Physical Activity on Oxidative Stress Markers and Antioxidant Mechanisms in Aged Rats

BACKGROUND

Aging induces degenerative processes in the body, contributing to the onset of various age-associated diseases that affect the population. Inadequate dietary habits and low physical activity are major contributors to increased morbidity during aging. This study aimed to investigate the combined effects of omega-3 fatty acid supplementation and physical activity on the markers of oxidative stress and antioxidant defense mechanisms in aged male Wistar rats (23-24 months).

METHODS

The rats were randomly divided into four experimental groups: a sedentary control (placebo, no exercise), a trained (placebo and moderate-intensity graded aerobic exercise; Ex), and two trained groups supplemented with low (160 mg/kg of body weight; O1 + Ex) and high (320 mg/kg of body weight; O2 + Ex) doses of omega-3 fatty acids. The biochemical and functional parameters related to sarcopenia and the markers of oxidative stress were measured in blood and gastrocnemius muscle.

RESULTS

The results demonstrated dose-dependent, synergistic effects of omega-3 fatty acid supplementation and physical activity. The higher dose (320 mg/kg of body weight) improved plasma antioxidant capacity (TEAC, +21.01%, p < 0.01) and GPx activity (+78.05%, p < 0.05) while reducing CAT activity in erythrocytes (-19.92%, p < 0.05), likely as an adaptive stress response. Combined interventions also normalized cholesterol levels, improved the functional parameters of sarcopenia (stride length, +14.82%, p < 0.001), and enhanced antioxidant protection in aged rats.

CONCLUSIONS

These findings highlight the potential of combining omega-3 fatty acid supplementation and physical activity to counteract aging-related degenerative changes. Further research is needed to elucidate the underlying mechanisms and evaluate the long-term benefits of these strategies in aging populations.

Active bodies - active minds? A deep dive into the voluntary sports programs for individuals with psychiatric disorders in Switzerland: participants view

BACKGROUND

The positive influence of physical activities on a person's physical and mental health has been proven many times. These findings were implemented in the regular exercise therapy offered within psychiatric hospitals in Switzerland. However, after leaving a psychiatric hospital, there are insufficient opportunities for individuals with psychiatric disorders to engage in sports. Therefore, voluntary sports groups for this specific population have been offered in Switzerland by the disability sports systems since 2015. Still, the perspective of individuals with psychiatric disorders as well as perceived barriers and facilitators for participating in these groups have neither been assessed nor included in the design of sports programs.

METHODS

This study consists of 15 semi-structured interviews (N = 15) lasting up to one hour each with individuals with psychiatric disorders who participated in voluntary sports groups for this specific population in Switzerland. The results were analyzed employing Thematic Analysis using Nvivo.

RESULTS

Interviewees named offer-specific (disability-related), emotional (social exchange), and rational motives (health) for their participation in voluntary sports groups for individuals with psychiatric disorders. In addition, intrapersonal (psychological/physical deficits), sociocultural (stigmatization), and structural (unsuitable location) factors were mentioned as possible inhibitors in the context of participation in voluntary sports groups for individuals with psychiatric disorders. Furthermore, participants experienced predominantly positive outcomes from participation.

CONCLUSION

Individuals with psychiatric disorders benefit socially, physically, and psychologically from participating in voluntary sports groups for this specific population. However, participation is associated with barriers that need to be minimized in the future. Additionally, a large-scale survey is necessary to validate the results among the population.

Association between sleep disorder and depression in stroke in the National Health and Nutrition Examination Surveys (NHANES) 2005 to 2014

BACKGROUND

To investigate the association between sleep disorder and depression in stroke population using data from the National Health and Nutrition Examination Surveys (NHANES) conducted between 2005 and 2014.

METHODS

Participants included stroke population who reported on sleep disorder and completed the Patient Health Questionnaire-9 (PHQ-9) to assess depressive symptom. Sleep disorder was self-reported and categorized dichotomously. Multivariate logistic regression, subgroup analysis, receiver operating characteristic curve (ROC) and restricted cubic spline (RCS) were used to explore the association between sleep disorder and depression.

RESULTS

The final sample included 566 stroke survivors (weighted n = 3,326,625). Multivariate logistic regression analysis confirmed that sleep disorder was independently associated with an increased risk of depression even after adjusting for potential confounders (OR = 2.616, 95 % CI: 2.561 to 2.599, P < 0.0001). Subgroup analysis indicated that this association was particularly strong among female stroke population (OR = 5.515). Sleep disorder as a significant predictor of depression, while the relationship between sleep time and depression is characterized by non-linearity.

CONCLUSIONS

Sleep disorder is significantly associated with an increased risk of depression in stroke. This relationship remains robust across various sociodemographic and lifestyle factors, highlighting the need for integrated interventions targeting both sleep and mood disturbances in stroke care.

The effects of sleep on body image: examining the roles of depression, perceived stress, and anxiety

Objective: Although health and wellness behaviors are associated with positive body image, research is limited regarding the relationship between sleep and positive body image. We propose that negative affective states may link sleep and body image. Specifically, we examined whether better sleep may relate to positive body image through reductions in negative affective experiences. Participants: Participants were 269 undergraduate women. Methods: Cross-sectional surveys were administered. Results: We found correlations in the expected directions between sleep, positive body image variables (i.e., body appreciation, appearance evaluation, and appearance orientation), and negative affective states (i.e., depression, anxiety, and stress). There were group differences in negative affective states and body image based on adequate sleep. Data supported indirect effects of sleep through depression on appearance evaluation, and through depression and stress on body appreciation, respectively. Conclusions: Our findings indicate sleep warrants further research attention as a wellness behavior related to more positive body image.

Correlates and Barriers of Exercise, Stress, and Wellness in Medical Students

Medical students report higher stress and increased mental illness than peers of similar age. Burnout and depression among medical students and physicians have also been correlated with increased risk of medical errors and decreased importance of altruistic values, such as providing care to medically underserved populations. This study works to analyze the effects of exercise, nutrition, sleep, and other factors affecting wellness and performance of medical students, as well as identifying barriers to exercise and possible solutions. A survey was distributed to medical students in the Midwest to evaluate exercise habits, dietary intake, sleep, and other factors affecting wellness. An investigation of the correlation of variables and comparison of year in school for the variables was conducted. Satisfaction with social relationship and performance in school correlated with exercise, stress, and sleep variables. Several variables, including satisfaction with exercise, social life, and performance in school, showed significant differences based on year in school. No significant findings were noted between students from the various medical institutions at which the survey was distributed regarding satisfaction with exercise, academic performance, social life, personal relationships, hours spent in clerkship/class, hours spent studying, and stress. Students tended to have higher satisfaction with school and social relationships if they engaged in exercise more often, exercised with greater intensity, and slept better. Students identified barriers to exercise including cost, availability, and lack of time. Potential solutions include a workout facility in school buildings/hospitals, allocated wellness periods for exercise, and a more consistent schedule.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-024-02134-5.

Psychological stressors involved in the pathogenesis of premature ovarian insufficiency and potential intervention measures

Premature ovarian insufficiency (POI) is a common gynecological endocrine disease, which seriously affects women's physical and mental health and fertility, and its incidence is increasing year by year. With the development of social economy and technology, psychological stressors such as anxiety and depression caused by social, life and environmental factors may be one of the risk factors for POI. We used PubMed to search peer-reviewed original English manuscripts published over the last 10 years to identify established and experimental studies on the relationship between various types of stress and decreased ovarian function. Oxidative stress, follicular atresia, and excessive activation of oocytes, caused by Stress-associated factors may be the main causes of ovarian function damage. This article reviews the relationship between psychological stressors and hypoovarian function and the possible early intervention measures in order to provide new ideas for future clinical treatment and intervention.

Splenic γδ T cells mediate antidepressant and prophylactic actions of arketamine in lipopolysaccharide-induced depression in mice

Arketamine, the (R)-enantiomer of ketamine, exhibits both therapeutic and sustained prophylactic effects in an inflammation-driven model of depression, although the precise mechanisms remain elusive. Given the involvement of γδ T cells in inflammatory processes, this study explored their role in the effects of arketamine. To assess therapeutic outcomes, mice received lipopolysaccharide (LPS:1.0 mg/kg), followed by either arketamine (10 mg/kg) or saline. For prophylactic assessment, arketamine or saline was administered six days prior to LPS exposure. A single dose of LPS (1.0 mg/kg) reduced the proportion of γδ T cells in the spleen but did not affect their levels in the blood, prefrontal cortex, or small intestine. Arketamine mitigated LPS-induced splenomegaly, counteracted the elevation of plasma interleukin-6 levels and the reduction in the proportion of splenic γδ T cells, and alleviated depression-like behavior as assessed by the forced swimming test. Notably, negative correlations were observed between the proportion of splenic γδ T cells and indicators of inflammation and depression. Furthermore, pretreatment with a γδ TCR antibody significantly countered the therapeutic and prophylactic effects of arketamine on LPS-induced changes. These findings highlight a novel role for splenic γδ T cells in inflammation-associated depression and suggest the potential of arketamine as a treatment option. Consequently, γδ T cells may represent a novel therapeutic target for inflammation-related depression. Further studies on the role of γδ T cells in depressed patients with inflammation are warranted.

Combined mindfulness-based stress reduction and physical activity improved psychological factors and sleep quality in patients with MDD: A randomized controlled trial study

Non-pharmacological interventions are available to improve sleep quality including mindfulness-based stress reduction (MBSR) and physical activity (PA). The present study aimed to evaluate the effectiveness of the combination of MBSR and PA interventions as an augmentation to treatment as usual with sertraline to improve sleep and psychological factors among patients with MDD. Sixty-seven patients in outpatient care diagnosed with MDD for a minimum of 2 months (mean age: 35.32 ± 7.8; 65 % female) and currently on sertraline treatments were randomized into four groups including: 1) Physical activity, 2) MBSR, 3) Combination MBSR and physical activity (MBSRPA), and 4) Control. All participants completed self-reported questionnaires on sleep quality, depression, anxiety, and perceived stress from baseline to 8 weeks later at post-test and four weeks later at follow-up. Over time, sleep disturbance and psychological problems were reduced in all conditions when compared to the control. Moreover, MBSRPA had a more positive impacts on perceived stress, anxiety, depressive symptoms and sleep quality. The results of the present study confirmed the effectiveness of MBSRPA as an augmentation to standard therapy to help reduce symptoms of depression, anxiety, perceived stress, and sleep problems in patients with MDD.

Pleiotropic Associations with Alzheimer's Disease and Physical Activity: Sex Differences and the Effects of Environment

Physical activity (PA) is a modifiable factor in mitigating/preventing Alzheimer's disease (AD). It is crucial to identify the conditions under which PA's effects on AD risk would be beneficial. This study aims to gain insights into pleiotropic predisposition to AD and PA within and across sexes and environmental effects. We performed a genome-wide association study (GWAS) of pleiotropic AD-PA associations in individuals (65 years and older) of European ancestry in a US sample (14,628 individuals), for men and women separately and combined, and contrasted them with the UK biobank (204,789 individuals) to elucidate the effects of the environment. Fisher's method and Wald's test were used for estimating the significance of pleiotropic associations and differences between the samples. We identified genetic markers in 60 loci with significant pleiotropic associations. Of them, 91.7% of loci exhibited antagonistic relationships characterized by a misalignment of the signs of the associations of the same alleles with AD and PA and a correlation between these phenotypes. Only 16.7% of associations were replicated in the UKB. Phosphorylation and the regulation of transcription were identified as more pronounced biological mechanisms of AD-PA pleiotropy in females and males, respectively. Our results demonstrate the intrinsic heterogeneity of AD-PA pleiotropy and suggest that PA should be used as an intervention against AD with caution, after identifying groups of individuals and combinations of gene-environment interactions with beneficial effects.

Mendelian randomization of individual sleep traits associated with major depressive disorder

BACKGROUND

Observational studies have shown that individual sleep traits habits are potential risk factors for major depression. However, it is not known whether there is a causal relationship between individual sleep traits habits such as continuous sleep duration, short sleep duration, short sleep duration, insomnia, nap during the day, snoring, and major depression. In this study, Mendelian randomization (MR) was used to predict major depressive disorder (MDD) in individuals sleep traits habits.

METHODS

Data were obtained from the genome-wide association study (GWAS). Nine MR analysis methods were used: Inverse Variance Weighted (IVW) [fixed effects/multiplicative random effects], simple mode, simple mode, weighted mode, simple median, weighted median, penalised weighted median, and MR-Egger, MR Egger (bootstrap). IVW was used as the main analysis method for the MR analysis of two samples, and the other methods were used as supplements.

RESULTS

The results obtained through the IVW method supported a causal relationship between sleep duration and decreased risk of MDD (odds ratio, ORivw: 0.998; 95 % CI: 0.996-0.999, P<0.001). Two-Sample MR, results showed that short sleep duration has a causal effect on the increased risk of MDD (odds ratio, ORivw: 1.179; 95 % CI: 1.108-1.255, P<0.001). However, there were no sufficient evidence supported that long sleep duration has a causal effect on the decreased risk of MDD (odds ratio, ORivw: 0.991; 95 % CI: 0.924-1.062, P = 0.793). A significant causal relationship between insomnia and increased risk of MDD was observed (OR: 1.233; 95 % CI: 1.214-1.253, P<0.001). Interestingly, our study also found that daytime napping has a causal effect on the increased risk of MDD (odds ratio, ORivw: 1.519; 95 % CI: 1.376-1.678, P<0.001). The present results did not show a significant causal relationship between snoring and the risk of MDD (ORivw: 1.000; 95 % CI: 0.998-1.002, P = 0.906). Obstructive sleep apnea (odds ratio, ORivw: 1.021; 95 % CI: 0.972-1.072, P = 0.407) and morning person (odds ratio, ORivw: 1.021; 95 % CI: 0.972-1.072, P = 0.407) have no causal effect on the increased risk of MDD.

LIMITATIONS

The study could not ascertain whether there were genetic differences among different ethnicities, nations, and regions, as it only included participants of European ancestry.

CONCLUSIONS

In summary, our research provides genetic evidence for the relationship between individual sleep traits (short sleep duration, insomnia, daytime napping) and the increased risk of MDD. Interventions targeting lifestyle factors may reduce the risk of MDD.

The Effect of Lifestyle Interventions on Anxiety, Depression and Stress: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

BACKGROUND/OBJECTIVES

Depression, anxiety, and stress are common mental health issues that affect individuals worldwide. This systematic review and meta-analysis examined the effectiveness of various lifestyle interventions including physical activity, dietary changes, and sleep hygiene in reducing the symptoms of depression, anxiety, and stress. Using stress as an outcome and conducting detailed subgroup analyses, this study provides novel insights into the differential effects of lifestyle interventions across diverse populations.

METHODS

Five databases were systematically searched: PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar, for gray literature searches. Keywords were used to search each database. The search period was from the conception of the databases until August 2023 and was conducted in English. For each analysis, Hedges' g was reported with a 95% confidence interval (CI) based on the random-effects method. Subgroups were analyzed and heterogeneity and publication bias were examined.

RESULTS

Ninety-six randomized clinical trial studies were included in this meta-analysis. Lifestyle interventions reduced depression (Hedges g -0.21, 95% confidence interval -0.26, -0.15; p < 0.001; I2 = 56.57), anxiety (Hedges g -0.24, 95% confidence interval -0.32, -0.15; p < 0.001; I2 = 59.25), and stress (-0.34, -0.11; p < 0.001; I2 = 61.40).

CONCLUSIONS

Lifestyle interventions offer a more accessible and cost-effective alternative to traditional treatments and provide targeted benefits for different psychological symptoms.

The influence of healthy eating index on cognitive function in older adults: chain mediation by psychological balance and depressive symptoms

BACKGROUND

This study aims to investigate the relationships between the Chinese Healthy Eating Index (CHEI), psychological balance, depressive symptoms, and cognitive function in the rural older population. Additionally, it examines the impact of CHEI on cognitive function and the potential chain mediating roles of psychological balance and depressive symptoms.

METHODS

The study utilized data from 2,552 rural older adults aged 65 and above, drawn from the Chinese Longitudinal Healthy Longevity Study (CLHLS). The CHEI was self-reported, with scores ranging from 0 to 50, representing adherence to healthy eating habits. Psychological balance was assessed using status and personality-emotion characteristics recorded in the database, with scores ranging from 6 to 30. Cognitive function was measured using the Mini-Mental State Examination (MMSE), with scores ranging from 0 to 30; higher scores indicated better cognitive function. Depressive symptoms were evaluated using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10), with scores ranging from 0 to 30, where higher scores reflected more severe depressive symptoms.

RESULTS

The median CHEI score was 40.0 (IQR: 34.0-45.0), reflecting moderate adherence to healthy dietary practices. The median Psychological Balance score was 19.0 (IQR: 17.0-21.0), and the median Depressive Symptoms score was 13.0 (IQR: 10.0-15.0), indicating mild depressive symptoms among participants. Additionally, the median Cognitive Function score was 28.0 (IQR: 27.0-29.0), suggesting relatively stable cognitive abilities within the sample. Correlational analysis revealed the following: (1) Depressive symptoms were negatively correlated with both cognitive function (rs = -0.100, p < 0.001) and CHEI (rs = -0.206, p < 0.001), as well as with psychological balance (rs = -0.142, p < 0.001). (2) CHEI was positively correlated with both cognitive function (rs = 0.144, p < 0.001) and psychological balance (rs = 0.131, p < 0.001). (3) Cognitive function was also positively correlated with psychological balance (rs = 0.096, p < 0.001). Mediation analysis demonstrated that both psychological balance and depressive symptoms partially mediated the relationship between CHEI and cognitive function, forming a chain-mediating effect.

CONCLUSION

The Chinese Healthy Eating Index was found to have a direct positive impact on cognitive function in rural older adults. Furthermore, it exerted an indirect effect through the independent and chain-mediating roles of psychological balance and depressive symptoms. These findings suggest that dietary adherence can influence cognitive health not only directly but also by improving psychological well-being and reducing depressive symptoms.

Association of modifiable risk factors with progression to dementia in relation to amyloid and tau pathology

BACKGROUND

Dementia preventive interventions targeting multiple modifiable risk factors are a promising approach. However, the impact of modifiable risk factors in the presence of beta-amyloid or phosphorylated-tau (p-tau) pathology is unclear.

METHODS

The objective of the study was to examine the role of modifiable risk factors (vascular factors, depression, and smoking) in the progression to mild cognitive impairment (MCI) or dementia among 434 cognitively unimpaired (CU) and 611 individuals with MCI from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database. Vascular risk factors were summarized with the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) score, dichotomized into higher versus lower risk. Depression and smoking (yes/no) were categorised according to medical history or current symptoms. Analyses were stratified by beta-amyloid negative (A-) and positive (A +), p-tau negative (T-) and positive (T +), or beta-amyloid and p-tau negative (A-T-) and positive (A + T +) biomarker status. Cox proportional hazard models were adjusted for age, sex, education, baseline MMSE score, baseline hippocampal volume and ApoE4 carrier status.

RESULTS

Higher CAIDE score was associated with increased risk of progression to all-cause dementia in most MCI subgroups: adjusted hazard ratios (aHR) [95% CI] were 3.1 [1.43; 6.53] in the A- subgroup, 1.7 [1.20-2.27] in T + , 2.6 [1.06-6.59] in A-T-, and 1.6 [1.15-2.22] in the A + T + subgroup. Smoking (yes/no) was associated with increased dementia aHR in the A + MCI subgroup: 1.6 [1.07-2.34]. Depression increased dementia aHR in the T + MCI subgroup: 1.5 [1.06-2.02]. No significant associations were found in the CU biomarker subgroups.

CONCLUSION

Addressing modifiable risk factors carries an important potential for reducing the risk of dementia even after the onset of Alzheimer's pathology. Knowledge of biomarker status can further optimize prevention strategies.

Effect of physical activity on anxiety and depression in COVID-19 adults: A systematic review and meta-analysis

While the benefits of physical activity on mental health are well-known, systematic reviews and meta-analyses on its impact on mental illness in adults with COVID-19 are scarce. This study of 25 randomized controlled trials shows that physical activity significantly reduces anxiety (standardized mean difference [SMD] = -0.915; 95% confidence interval [CI] = -1.182 to -0.648; I2 = 82.0%; p < 0.001) and depression (SMD = -0.752; 95% CI = -1.034 to -0.470; I2 = 81.4%; p < 0.001). Traditional Chinese ethnic sports are notably effective. Interventions under 3 weeks best reduce depression, while 3 ≤ 7 weeks optimally reduce anxiety. Sessions ≤5 times weekly, with 30 ≤ 60 min for anxiety and >60 min for depression, yield the best outcomes. These results highlight the specific effectiveness of physical activity in alleviating anxiety and depression in COVID-19 patients.

Nutritional Modulation of the Gut-Brain Axis: A Comprehensive Review of Dietary Interventions in Depression and Anxiety Management

Mental health is an increasing topic of focus since more than 500 million people in the world suffer from depression and anxiety. In this multifactorial disorder, parameters such as inflammation, the state of the microbiota and, therefore, the patient's nutrition are receiving more attention. In addition, food products are the source of many essential ingredients involved in the regulation of mental processes, including amino acids, neurotransmitters, vitamins, and others. For this reason, this narrative review was carried out with the aim of analyzing the role of nutrition in depression and anxiety disorders. To reach the review aim, a critical review was conducted utilizing both primary sources, such as scientific publications and secondary sources, such as bibliographic indexes, web pages, and databases. The search was conducted in PsychINFO, MedLine (Pubmed), Cochrane (Wiley), Embase, and CinAhl. The results show a direct relationship between what we eat and the state of our nervous system. The gut-brain axis is a complex system in which the intestinal microbiota communicates directly with our nervous system and provides it with neurotransmitters for its proper functioning. An imbalance in our microbiota due to poor nutrition will cause an inflammatory response that, if sustained over time and together with other factors, can lead to disorders such as anxiety and depression. Changes in the functions of the microbiota-gut-brain axis have been linked to several mental disorders. It is believed that the modulation of the microbiome composition may be an effective strategy for a new treatment of these disorders. Modifications in nutritional behaviors and the use of ergogenic components are presented as important non-pharmacological interventions in anxiety and depression prevention and treatment. It is desirable that the choice of nutritional and probiotic treatment in individual patients be based on the results of appropriate biochemical and microbiological tests.

Regular exercise ameliorates high-fat diet-induced depressive-like behaviors by activating hippocampal neuronal autophagy and enhancing synaptic plasticity

Exercise enhances synaptic plasticity and alleviates depression symptoms, but the mechanism through which exercise improves high-fat diet-induced depression remains unclear. In this study, 6-week-old male C57BL/6J mice were administered a high-fat diet (HFD, 60% kcal from fat) to a HFD model for 8 weeks. The RUN group also received 1 h of daily treadmill exercise in combination with the HFD. Depressive-like behaviors were evaluated by behavioral assessments for all groups. The key mediator of the effect of exercise on high-fat diet-induced depressive-like behaviors was detected by RNA-seq. The morphology and function of the neurons were evaluated via Nissl staining, Golgi staining, electron microscopy and electrophysiological experiments. The results showed that exercise attenuated high-fat diet-induced depressive-like behavior and reversed hippocampal gene expression changes. RNA-seq revealed Wnt5a, which was a key mediator of the effect of exercise on high-fat diet-induced depressive-like behaviors. Further work revealed that exercise significantly activated neuronal autophagy in the hippocampal CA1 region via the Wnt5a/CamkII signaling pathway, which enhanced synaptic plasticity to alleviate HFD-induced depressive-like behavior. However, the Wnt5a inhibitor Box5 suppressed the ameliorative effects of exercise. Therefore, this work highlights the critical role of Wnt5a, which is necessary for exercise to improve high-fat diet-induced depression.

The Interrelationship between Stress, Sugar Consumption and Depression

Depression is a leading cause of disability in the United States. Previous research has shown that added sugar consumption and stress are both risk factors for depression. Despite evidence that stress predicts added sugar consumption, and both affect the HPA axis, no research has explored how stress, added sugar consumption and depression are related. In this study, we investigated the possible effects of total added sugar and sugar-sweetened beverage consumption on depression, as well as their potential interactions with chronic stress. Measures of sugar consumption, chronic stress and depression were taken in an adult community sample at two time points. We hypothesized that high sugar consumption would predict more depression even after stress was statistically adjusted for, but that stress would moderate the relationship between added sugar consumption and depressive symptoms, amplifying the effect. We found that both total sugar consumption and sugar-sweetened beverage consumption at baseline predicted depressive symptoms one month later. However, only sugar-sweetened beverage consumption was a significant predictor of depression after controlling for stress, possibly because stress is related to diet quality. Stress did not moderate the relationship between added sugar consumption and depressive symptoms. These results suggest that stress should be included in future research on sugar and depression.

Contribution of obesity in the association between fast-food consumption and depression: A mediation analysis

BACKGROUND

Depression is a significant mental health concern, and the ubiquitous presence of fast-food in modern diets raises questions about its impact on mental well-being. Understanding the intricate relationship between fast-food consumption, obesity, and depression is essential for addressing the complex web of factors contributing to this public health issue.

METHODS

In this study, we analyzed data from the National Health and Nutritional Examination Surveys (NHANES) spanning from 2008 to 2018, involving 31,460 participants.

RESULTS

Among the 31,460 subjects in the survey, 2871 exhibited signs of depression, with an average age of 48.2 years. Each additional weekly fast-food meal was linked to 4 % higher odds of depression, with consuming over two such meals increasing the odds by 24 %. Adjusted models exploring the relationship between body mass index (BMI), fast-food consumption, and depression indicated an increased risk with greater fast-food intake, especially within subgroups based on obesity status. Mediation analysis revealed that fast-food consumption and depression were largely independent of obesity, with obesity accounting for only 6.5 % of the total effect. No significant mediation effect was found in the overweight subgroup, but the mediated effect was increased with higher BMI in more obese patients, notably in those with BMI ≥ 30 or ≥40. Sensitivity analysis confirmed these findings with more conservative estimates across all subgroups.

CONCLUSION

This study highlights a substantial connection between fast-food consumption and depression. While obesity plays a role, it does not fully mediate the relationship, suggesting the presence of other contributing factors.

Associations of menopausal status and eating behaviour with subjective measures of sleep

Eating and sleeping behaviour are known to interact with each other, yet research is limited in the context of menopausal women. The aim of this study was to examine whether menopausal status is associated with perceived problems in sleeping. Furthermore, we studied different aspects of eating behaviour as potential risk factors for poor sleep in menopausal women. The present study is exploratory in nature, thus the results should be interpreted as hypothesis-generating. We analysed the sleeping and eating behaviour of 1098 women aged 47-55 years and represented different menopausal statuses with regression analyses. Over 20% of them reported fairly poor or poor perceived sleep quality. A higher number of postmenopausal women reported experiencing at least fairly poor sleep quality compared with the other menopausal groups. However, in regression models controlled for several confounding factors menopausal status was not associated with measures of sleep. Women who reported more snacking-type eating behaviour were more likely to report shorter sleep duration, and more daytime tiredness. Externally cued eating was associated with shorter sleep duration and emotional eating was associated with experiencing daytime tiredness. However, after adjusting for multiple testing, it appears that eating behaviour is associated only with daytime tiredness. Menopausal women with sleeping problems may benefit from nutritional interventions targeting eating behaviour.

A follow-up study with a double-blinded, randomized controlled vitamin D supplementation trial in patients with major depressive episode (DepFuD): A study protocol and baseline characteristics

Promising initial studies on vitamin D (VD) supplementation as an adjunct treatment for major depressive disorder (MDD) require rigorously designed randomized controlled trials (RCTs). We aim to investigate the effects of augmenting standard MDD treatment with VD supplementation and examine factors influencing the treatment outcome. This article describes the study design, measures, and baseline characteristics. This multicenter RCT compares the efficacy of a six-month VD intervention at 100 micrograms/day versus 10 micrograms/day (μg/day) (4000 IU (international units)/day vs. 400 IU/day) added to a standard treatment in outpatients aged 20-61 years with MDD. The primary outcome is change in the Montgomery-Åsberg Depression Rating Scale (MADRS) score. Secondary outcomes are other indicators of mental health and functionality (BDI, SOC, 15-D, PSS10, LS-4, LOT-R, YSQ-S2-extended, CORE-OM, TAS-20, BRCS, TADS, SCL-90, DIAD, GAF), and circulating biomarkers. Intervention assessments are conducted at baseline, 3, and 6 months, and follow-ups at 18 months and 6 years post-baseline. The baseline sample had 319 subjects (74% women; median age 31 (inter-quartile range (IQR) 15), mean MADRS score 21.38 (SD 6.04)), with 281 assigned to the RCT. At present, the study continues as a follow-up study. DepFuD project will provide extensive information regarding the potential benefits of VD and enables to identify various biopsychosocial depression-associated risk factors.

Health enhancing behaviors in early adolescence: an investigation of nutrition, sleep, physical activity, mindfulness and social connectedness and their association with psychological distress and wellbeing

Introduction

Nutrition, sleep and physical activity are termed the "big three" health enhancing behaviors (HEB) associated with psychological distress and wellbeing. This study sought to understand differential associations between an expanded group of HEB (nutrition, sleep, physical activity, mindfulness, social connectedness) and psychological distress/wellbeing in early adolescents.

Methods

Correlational and regression analyses were conducted in N=103 (51% females) adolescents (12.6 ± 0.3 years of age) recruited from the Longitudinal Adolescent Brain Study.

Results

Higher scores on sleep, social connectedness and mindfulness scales were significantly associated with lower psychological distress scores. While higher scores on social connectedness and mindfulness scales were significantly associated with higher wellbeing scores. When adjusting for sex, nutrition, sleep, social connectedness and mindfulness accounted for a significant proportion of variance in the psychological distress model whereas physical activity and social connectedness accounted for a significant proportion of the variance in the wellbeing model.

Discussions

Overall findings make a strong case for expansion of the "big three" HEB to include mindfulness and social connectedness, especially given social connectedness emerged as the strongest predictor of both psychological distress and wellbeing. In addition, this research suggests that early adolescent nutrition, sleep quality, and mindfulness should be prioritized in efforts to reduce risk of difficulties, and physical activity prioritized as a protective factor for wellbeing in this population. Findings have implications for interventions, emphasizing the importance of addressing HEB factors comprehensively and tailoring strategies to the unique needs of early adolescents to foster positive mental health outcomes.

Association between dietary patterns and depression symptoms among adults with or without diabetes in Qatar: a population-based study

BACKGROUND

Diabetes is a major public health problem in Qatar and is associated with an increased risk of depression. However, no study has been conducted in Qatar on the relationship between dietary patterns and depression symptoms in adults. The aim of this study was to assess the association between dietary patterns and depression symptoms among adults with or without diabetes in Qatar.

METHODS

A total of 1000 participants from the Qatar Biobank (QBB) were included in this cross-sectional study. Food intake was assessed using a computer-administered food frequency questionnaire (FFQ), and dietary patterns were identified using factor analysis. Depression symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9).

RESULTS

Depression symptoms were present in 13.5% of the sample. Two dietary patterns were identified: "unhealthy" (high consumption of fast food, biryani, mixed dish (chicken/meat/fish), croissant) and "prudent" (high consumption of fresh fruit, salads/raw vegetables, canned/dried fruit, and dates). After adjusting for sociodemographic, lifestyle factors (smoking and physical activity), diabetes and medication use for diabetes and hypertension, a high intake of "unhealthy" pattern was associated with an increased prevalence of depressive symptoms in individuals with diabetes (prevalence ratio, PR = 1.41; 95% CI = 1.28, 1.56; p-value < 0.001), while there was no statistically significant association between depressive symptoms and the "prudent" dietary pattern. The "prudent" pattern was inversely and significantly associated with depressive symptoms in individuals with a normal body weight (PR = 0.21; 95% CI = 0.06, 0.76; p-value = 0.018).

CONCLUSION

The "unhealthy" dietary pattern was positively associated with depression symptoms in those with diabetes, whereas the "prudent" dietary pattern was inversely associated with depression symptoms in those with a normal body weight. Promoting healthy eating habits should be considered in the prevention and management of depression.

Effectiveness of craniosacral therapy, Bowen therapy, static touch and standard exercise program on sleep quality in fibromyalgia syndrome: A randomized controlled trial

BACKGROUND

Sleep disturbance is commonly seen in fibromyalgia syndrome (FMS); however, high quality studies involving manual therapies that target FMS-linked poor sleep quality are lacking for the Indian population.

OBJECTIVE

Craniosacral therapy (CST), Bowen therapy and exercises have been found to influence the autonomic nervous system, which plays a crucial role in sleep physiology. Given the paucity of evidence concerning these effects in individuals with FMS, our study tests the effectiveness of CST, Bowen therapy and a standard exercise program against static touch (the manual placebo group) on sleep quality in FMS.

DESIGN, SETTING, PARTICIPANTS AND INTERVENTION

A placebo-controlled randomized trial was conducted on 132 FMS participants with poor sleep at a hospital in Bangalore. The participants were randomly allocated to one of the four study groups, including CST, Bowen therapy, standard exercise program, and a manual placebo control group that received static touch. CST, Bowen therapy and static touch treatments were administered in once-weekly 45-minute sessions for 12 weeks; the standard exercise group received weekly supervised exercises for 6 weeks with home exercises until 12 weeks. After 12 weeks, all study participants performed the standard exercises at home for another 12 weeks.

MAIN OUTCOME MEASURES

Sleep quality, pressure pain threshold (PPT), quality of life and fibromyalgia impact, physical function, fatigue, pain catastrophizing, kinesiophobia, and positive-negative affect were recorded at baseline, and at weeks 12 and 24 of the intervention.

RESULTS

At the end of 12 weeks, the sleep quality improved significantly in the CST group (P = 0.037) and Bowen therapy group (P = 0.023), and the PPT improved significantly in the Bowen therapy group (P = 0.002) and the standard exercise group (P < 0.001), compared to the static touch group. These improvements were maintained at 24 weeks. No between-group differences were observed for other secondary outcomes.

CONCLUSION

CST and Bowen therapy improved sleep quality, and Bowen therapy and standard exercises improved pain threshold in the short term. These improvements were retained within the groups in the long term by adding exercises. CST and Bowen therapy are treatment options to improve sleep and reduce pain in FMS.

TRIAL REGISTRATION NUMBER

Registered at Clinical Trials Registry of India with the number of CTRI/2020/04/024551. Please cite this article as: Ughreja RA, Venkatesan P, Gopalakrishna DB, Singh YP, Lakshmi VR. Effectiveness of craniosacral therapy, Bowen therapy, static touch and standard exercise program on sleep quality in fibromyalgia syndrome: a randomized controlled trial. J Integr Med. 2024; 22(4): 474-484.

The protective effect of vitamin D supplementation as adjunctive therapy to antidepressants on brain structural and functional connectivity of patients with major depressive disorder: a randomized controlled trial

BACKGROUND

Growing evidence points to the pivotal role of vitamin D in the pathophysiology and treatment of major depressive disorder (MDD). However, there is a paucity of longitudinal research investigating the effects of vitamin D supplementation on the brain of MDD patients.

METHODS

We conducted a double-blind randomized controlled trial in 46 MDD patients, who were randomly allocated into either VD (antidepressant medication + vitamin D supplementation) or NVD (antidepressant medication + placebos) groups. Data from diffusion tensor imaging, resting-state functional MRI, serum vitamin D concentration, and clinical symptoms were obtained at baseline and after an average of 7 months of intervention.

RESULTS

Both VD and NVD groups showed significant improvement in depression and anxiety symptoms but with no significant differences between the two groups. However, a greater increase in serum vitamin D concentration was found to be associated with greater improvement in depression and anxiety symptoms in VD group. More importantly, neuroimaging data demonstrated disrupted white matter integrity of right inferior fronto-occipital fasciculus along with decreased functional connectivity between right frontoparietal and medial visual networks after intervention in NVD group, but no changes in VD group.

CONCLUSIONS

These findings suggest that vitamin D supplementation as adjunctive therapy to antidepressants may not only contribute to improvement in clinical symptoms but also help preserve brain structural and functional connectivity in MDD patients.

Psychoneuroimmunology in multiple myeloma and autologous hematopoietic stem cell transplant: Opportunities for research among patients and caregivers

Multiple myeloma (MM) is an incurable cancer and is the leading indication for autologous hematopoietic stem cell transplantation (HSCT). To be eligible for HSCT, a patient must have a caregiver, as caregivers play a central role in HSCT preparation and recovery. MM patients remain on treatment indefinitely, and thus patients and their caregivers face long-term challenges including the intensity of HSCT and perpetual therapy after transplant. Importantly, both patients and their caregivers show heightened depressive and anxiety symptoms, with dyadic correspondence evidenced and caregivers' distress often exceeding that of patients. An extensive psychoneuroimmunology (PNI) literature links distress with health via immune and neuroendocrine dysregulation as well as biological aging. However, data on PNI in the context of multiple myeloma - in patients or caregivers - are remarkably limited. Distress in MM patients has been associated with poorer outcomes including higher inflammation, greater one year post-HSCT hospital readmissions, and worse overall survival. Further, anxiety and depression are linked to biological aging and may contribute to the poor long-term health of both patients and caregivers. Because MM generally affects older adults, individual differences in biological aging may represent an important modifier of MM biology and HSCT treatment outcomes. There are a number of clinical scenarios in which biologically younger people could be prescribed more intensive therapies, with potential for greater benefit, by using a personalized cancer therapy approach based on the quantification of physiologic reserve. Further, despite considerable psychological demands, the effects of distress on health among MM caregivers is largely unexamined. Within this context, the current critical review highlights gaps in knowledge at the intersection of HSCT, inflammation, and biological aging in the context of MM. Research in this area hold promise for opportunities for novel and impactful psychoneuroimmunology (PNI) research to enhance health outcomes, quality of life, and longevity among both MM patients and their caregivers.

Mining key circadian biomarkers for major depressive disorder by integrating bioinformatics and machine learning

OBJECTIVE

This study aimed to identify key clock genes closely associated with major depressive disorder (MDD) using bioinformatics and machine learning approaches.

METHODS

Gene expression data of 128 MDD patients and 64 healthy controls from blood samples were obtained. Differentially expressed were identified and weighted gene co-expression network analysis (WGCNA) was first performed to screen MDD-related key genes. These genes were then intersected with 1475 known circadian rhythm genes to identify circadian rhythm genes associated with MDD. Finally, multiple machine learning algorithms were applied for further selection, to determine the most critical 4 circadian rhythm biomarkers.

RESULTS

Four key circadian rhythm genes (ABCC2, APP, HK2 and RORA) were identified that could effectively distinguish MDD samples from controls. These genes were significantly enriched in circadian pathways and showed strong correlations with immune cell infiltration. Drug target prediction suggested that small molecules like melatonin and escitalopram may target these circadian rhythm proteins.

CONCLUSION

This study revealed discovered 4 key circadian rhythm genes closely associated with MDD, which may serve as diagnostic biomarkers and therapeutic targets. The findings highlight the important roles of circadian disruptions in the pathogenesis of MDD, providing new insights for precision diagnosis and targeted treatment of MDD.

Are dietary pattern associated with alexithymia in Saudi adults?

BACKGROUND

Alexithymia is characterized by difficulties in describing feelings and physical sensations. Few studies have shown that there is a relation between alexithymia and dietary habits.

OBJECTIVES

To determine the prevalence of alexithymia and its association with dietary patterns among a sample of communities in the Eastern Region of the Kingdom of Saudi Arabia.

MATERIALS AND METHODS

A cross-sectional study was conducted using a sample of 247 participants, were selected using convenience sampling. A well-organized and valid online questionnaire was administered, which covered variables related to socio-demographic data, anthropometric measurements, dietary patterns, and the Toronto Alexithymia Scale (TAS).

RESULTS

The prevalence of Alexithymia was found as 39.3%. Moreover, among the alexithymia and possible alexithymia groups, the majority eat pasta 1-4 times per week (70% and 67% respectively). Alexithemic participants eat fewer vegetables and fruits 46%), while the remaining eat more (70%), p = .001. Only 34% of the cases eat breakfast regularly (p = .005). Furthermore, the cases drink soft drinks and juices at meals more than controls in this study (p = .025).

CONCLUSION

The present study provides further experimental evidence which supports existing literature that indicating the strong association between alexithymia and unhealthy dietary patterns. Also, Alexithymia prevalence in our study is (39.3%) ; because of the cultural impact of the Saudi environment due to the fact that the face of Saudi women is not revealed, and because the face is one of the main sources of expression of feelings, which makes females unable to express or read feelings well.

Intention to change multiple health risk behaviors and predictors of behavior change in vocational education students

Objective: No studies have examined vocational education students' intention to change multiple health risk behaviors and whether baseline characteristics predict behavior change. Participants: Paticipants were vocational education students in New South Wales, Australia. Methods: Students in the no-intervention control arm of a cluster randomized controlled trial completed an online survey at baseline and 6 months later. Results: Of 450 participants (83.3%) who reported multiple health risk behaviors at baseline, one-third (33.1%) intended to change at least two risk behaviors within 6 months. Participants experiencing symptoms of anxiety [OR = 7.43, 95% CIs 1.26-43.87; p = 0.03] and who intended to change three to four risk behaviors [OR = 23.30, 95% CIs 4.01-135.40; p = 0.001] rather than one behavior had significantly greater odds of changing at least one behavior in 6 months. Conclusions: Interventions could support vocational education students to change behaviors they wish to as well as motivate them to address other risk behaviors.

The Economics of Treatment for Depression

The global prevalence of depression has risen over the past three decades across all socioeconomic groups and geographic regions, with a particularly rapid increase in prevalence among adolescents (aged 12-17 years) in the United States. Depression imposes large health, economic, and societal costs, including reduced life span and quality of life, medical costs, and reduced educational attainment and workplace productivity. A wide range of treatment modalities for depression are available, but socioeconomic disparities in treatment access are driven by treatment costs, lack of culturally tailored options, stigma, and provider shortages, among other barriers. This review highlights the need for comparative research to better understand treatments' relative efficacy, cost-effectiveness, scalability, and potential heterogeneity in efficacy across socioeconomic groups and country and cultural contexts. To address the growing burden of depression, mental health policy could consider reducing restrictions on the supply of providers, implementing digital interventions, reducing stigma, and promoting healthy lifestyles.

The digestion and dietary carbohydrate pathway contains 100% gene mutations enrichment among 117 patients with major depressive disorder

Introduction

Major depressive disorder (MDD) is partially inheritable while its mechanism is still uncertain.

Methods

This cross-sectional study focused on gene pathways as a whole rather than polymorphisms of single genes. Deep sequencing and gene enrichment analysis based on pathways in Reactome database were obtained to reveal gene mutations.

Results

A total of 117 patients with MDD and 78 healthy controls were enrolled. The Digestion and Dietary Carbohydrate pathway (Carbohydrate pathway) was determined to contain 100% mutations in patients with MDD and 0 mutation in matched healthy controls.

Discussion

Findings revealed in the current study enable a better understanding of gene pathways mutations status in MDD patients, indicating a possible genetic mechanism of MDD development and a potential diagnostic or therapeutic target.

Healthy lifestyle and the risk of depression recurrence requiring hospitalisation and mortality among adults with pre-existing depression: a prospective cohort study

BACKGROUND

Although lifestyle-based treatment approaches are recommended as important aspects of depression care, the quantitative influence of aggregated healthy lifestyles on depression recurrence and mortality remains unknown.

OBJECTIVE

To investigate the association between healthy lifestyle and the risks of first-time hospitalisation for recurrent depression and mortality.

METHODS

26 164 adults with depression (mean (SD) age, 56.0 (7.9) years) were included from UK Biobank between 2006 and 2010 and followed up until 2022. Depression was defined as a physician's diagnosis in hospital admissions or the use of prescribed antidepressant medication. A weighted healthy lifestyle score (HLS) was calculated based on smoking, alcohol consumption, diet, sleep pattern, physical activity, social health, employment status and greenspace interaction.

FINDINGS

Over a 13.3-year follow-up, 9740 cases of first-time hospitalisation due to depression recurrence and 1527 deaths were documented. Compared with the lowest HLS tertile, the highest tertile was associated with a 27% lower risk (HR=0.73, 95% CI 0.69 to 0.77) of first-time hospitalisation for depression recurrence and a 22% (HR=0.78, 95% CI 0.68 to 0.91) lower risk of mortality among adults with depression. Lower risks of first-time hospitalisation for depression recurrence were observed among those who smoked less, drank more alcohol, followed healthier diets and sleep patterns, spent more time employed in current job or had greater exposure to greenspace.

CONCLUSION AND IMPLICATIONS

Greater adherence to healthy lifestyle was associated with a lower risk of hospitalisation and mortality among adults with pre-existing depression. Incorporating behaviour modification as an essential part of clinical practice for depressed patients could complement medication-based therapies.

Individual differences in the long-term impact of the pandemic: moderators of COVID-related hardship, worry, and social support

PURPOSE

Understanding people's response to the pandemic needs to consider individual differences in priorities and concerns. The present study sought to understand how individual differences in cognitive-appraisal processes might moderate the impact of three COVID-specific factors-hardship, worry, and social support-on reported depression.

METHODS

This longitudinal study of the psychosocial impact of the COVID-19 pandemic included 771 people with data at three timepoints over 15.5 months. Participants were recruited from panels of chronically ill or general population samples. Depression was measured by an item response theory validated depression index created using items from existing measures that reflected similar content to the Patient Health Questionnaire-8. COVID-specific factors of hardship, worry, and social support were assessed with items compiled by the National Institutes of Health. The Quality of Life Appraisal Profilev2 Short-Form assessed cognitive appraisal processes. A series of random effects models examined whether appraisal moderated the effects of hardship, worry, and social support on depression over time.

RESULTS

Over time the association between low social support and depression was greater (p = 0.0181). Emphasizing the negative was associated with exacerbated depression, in particular for those with low social support (p = 0.0007). Focusing on demands and habituation was associated with exacerbated depression unless one experienced greater hardship (p = 0.0074). There was a stronger positive connection between recent changes and depression for those people with higher worry scores early in the pandemic as compared to later, but a stronger positive correlation for those with lower worry scores later in the pandemic (p = 0.0015). Increased endorsement of standards of comparison, emphasizing the negative, problem goals, and health goals was associated with worse depression scores (all p < 0.0001). People who were younger, disabled, or had greater difficulty paying bills also reported worse depression (p < 0.0001, 0.0001, and 0.002, respectively).

CONCLUSION

At the aggregate level, COVID-specific stressors changed over the course of the pandemic, whereas depression and social-support resources seemed stable. However, deeper analysis revealed substantial individual differences. Cognitive-appraisal processes showed considerable variability across individuals and moderated the impact of COVID-specific stressors and resources over time. Future work is needed to investigate whether coaching individuals away from maladaptive cognitive-appraisal processes can reduce depression and lead to better overall well-being.

Unraveling the associations between unhealthy lifestyle behaviors and mental health in the general adult Chinese population: A cross-sectional study

BACKGROUND

This study examined the cumulative risk of unhealthy lifestyle behaviors and the associations between overall lifestyle and common mental disorders (CMDs), insomnia, stress, health-related quality of life (HRQOL), and functional impairment. Additionally, the treatment preferences for managing CMDs and insomnia were examined.

METHODS

A survey was conducted on 1487 Chinese Hong Kong adults, assessing their lifestyle behaviors (i.e., diet and nutrition, substance use, physical activity, stress management, restorative sleep, social support, and environmental exposures), mental health-related outcomes, and treatment preferences via a vignette.

RESULTS

The findings revealed significant additive relationships between the number of 'worse' lifestyle domains and the risk of all outcomes. A healthier overall lifestyle was significantly associated with reduced risks of all outcomes (AORs = 0.88 to 0.93). Having healthier practices in diet and nutrition, substance use, stress management, restorative sleep, and social support domains were significantly associated with lower risks of all outcomes (AORs = 0.93 to 0.98), except that substance use was not significantly associated with stress. Physical activity was inversely associated with only depressive symptoms (AOR = 0.98), anxiety symptoms (AOR = 0.99), and stress (AOR = 0.99). Environmental exposures were not significantly associated with functional impairment but with all other outcomes (AORs = 0.98 to 0.99). Besides, lifestyle interventions (55 %) were significantly more preferred for managing CMDs and insomnia relative to psychotherapy (35.4 %) and pharmacotherapy (9.6 %).

CONCLUSIONS

Our findings underscore the importance of considering lifestyle factors when managing CMDs, insomnia, stress, HRQOL, and functional impairment, with a particular emphasis on adopting a multicomponent treatment approach.

Mechanisms underlying the relationship between the intersectionality of multiple social identities with depression among US adults: A population-based study on the mediating roles of lifestyle behaviors

BACKGROUND

Despite substantial efforts to investigate the inequalities in mental health among people with marginalized identities, most research has concentrated on single social identities rather than complete persons. The current study aimed to explore the mechanisms underlying the relationship between the intersectionality of multiple social identities with depression among US adults.

METHODS

Data for this study came from the National Health and Nutrition Examination Survey waves between 2015 and 2018, including a total of 11,268 US adults. A latent class analysis (LCA) was conducted to identify latent subpopulations based on sex, race/ethnicity, immigrant status, disability, household income, employment status, and education level. Interclass differences in lifestyle factors and depression were examined. Multiple mediation analysis was used to examine the mediating roles of lifestyle behaviors.

RESULTS

LCA identified four potential subpopulations: "least marginalized", "immigrant minorities", "disabled, less-educated non-workers", and "low-income minorities" groups. There was enormous heterogeneity in mental health among immigrant minority individuals. The "disabled, less-educated non-workers" group had the highest rates of depression; in contrast, the "immigrant minorities" group had the best mental health, even better than that of the "least marginalized" group. Distributions of lifestyle factors followed a similar pattern. In addition, lifestyle behaviors significantly mediated the relationship between intersectional social identities and depression.

LIMITATIONS

The cross-sectional design prevented establishment of the causality of relationships.

CONCLUSIONS

This study suggests that applying a person-centered approach is important when examining intersectional inequalities in mental health and highlights the effects of structural social hierarchies on individuals' health behaviors and mental health.

Metabolomics on depression: A comparison of clinical and animal research

BACKGROUND

Depression is a major cause of suicide and mortality worldwide. This study aims to conduct a systematic review to identify metabolic biomarkers and pathways for major depressive disorder (MDD), a prevalent subtype of clinical depression.

METHODS

We searched for metabolomics studies on depression published between January 2000 and January 2023 in the PubMed and Web of Science databases. The reported metabolic biomarkers were systematically evaluated and compared. Pathway analysis was implemented using MetaboAnalyst 5.0.

RESULTS

We included 26 clinical studies on MDD and 78 metabolomics studies on depressive-like animal models. A total of 55 and 77 high-frequency metabolites were reported consistently in two-thirds of clinical and murine studies, respectively. In the comparison between murine and clinical studies, we identified 9 consistently changed metabolites (tryptophan, tyrosine, phenylalanine, methionine, fumarate, valine, deoxycholic acid, pyruvate, kynurenic acid) in the blood, 1 consistently altered metabolite (indoxyl sulfate) in the urine and 14 disturbed metabolic pathways in both types of studies. These metabolic dysregulations and pathways are mainly implicated in enhanced inflammation, impaired neuroprotection, reduced energy metabolism, increased oxidative stress damage and disturbed apoptosis, laying solid molecular foundations for MDD.

LIMITATIONS

Due to unavailability of original data like effect-size results in many metabolomics studies, a meta-analysis cannot be conducted, and confounding factors cannot be fully ruled out.

CONCLUSIONS

This systematic review delineated metabolic biomarkers and pathways related to depression in the murine and clinical samples, providing opportunities for early diagnosis of MDD and the development of novel diagnostic targets.

Effects of physical fitness on mental health of Chinese college students: across-sectional study

BACKGROUND

The physical and mental health of college students is often mentioned, but there is limited research on a direct relationship between the mental health status of college students and their physical fitness level. This study mainly proves the relationship between Chinese college students' mental health and physical fitness indicators.

METHOD

This study collected SCL-90 Scale test results from 5262 students (4012 boys and 1250 girls) through a questionnaire survey and conducted a Sport Quality Test on these students. Statistical software SPSS was applied for differential analysis and logistic regression analysis. Specifically, the differences in sport quality indicators between normal and abnormal mean total scores of psychological tests were analyzed first. Then, the binary logistic regression model was used to explore the impacts of sports quality indicator scores on students' psychological fitness.

RESULTS

There are differences in the results of physical fitness tests between students with abnormal psychology and students with normal psychology. The four indexes of students' vital capacity, speed, explosive power of lower limbs, and endurance running are effective in improving students' psychologically abnormal state, and endurance running and improving vital capacity are the most effective methods to improve students' psychologically abnormal state. In the physical tests of Chinese college students, the risk of psychological abnormalities was reduced by 9% for every one-point increase in lung capacity and 10.4% for every one-point increase in endurance running performance.

CONCLUSIONS

Chinese college students' physical fitness and mental health are related. The best methods for treating psychological disorders are lung capacity improvement and endurance running. According to the physical test results of Chinese college students, for every 1-point increase in lung capacity and endurance running, the risk of psychological abnormalities decreased by 9% and 10.4%, respectively.

Lifestyle Intervention for the Prevention of Cardiovascular Disease

Lifestyle medicine is a cornerstone of cardiovascular disease prevention and early disease intervention. A leading cause of death in developed countries, modifiable risk factors of cardiovascular disease like diet, exercise, substance use, and sleep hygiene have significant impacts on population morbidity and mortality. One should address these amendable risks in all patients, independently, and stress the importance of intervention adherence while avoiding the sacrifice of patient trust. One must also understand a patient's psychological well-being can be compromised by organic chronic disease states, and poor psychological well-being can have a negative impact on patient compliance and overall health.