Association of subsyndromal and depressive symptoms with inflammatory markers among different ethnic groups: the multi-ethnic study of atherosclerosis (MESA)

Atherosclerosis and depression: is carotid intima-media thicker in patients with depression compared to matched control individuals? A systematic review and meta-analysis

OBJECTIVE

To investigate if there is an association between atherosclerosis and depression by using as imaging biomarker the carotid intima media thickness (cIMT), a surrogate marker for atherosclerosis.

METHODS

PubMed/Medline, Embase and Cochrane databases were comprehensively searched to identify studies investigating the association between cIMT and depression. The results were pooled using a random-effects statistical model, appropriate for the expected high heterogeneity. Sensitivity and subgroup analyses were conducted where data was available.

RESULTS

Overall, 22 and 13 studies met inclusion criteria for the qualitative and the quantitative synthesis, respectively, with a total of 4466 patients and 21,635 control participants. Results showed that cIMT is significantly higher in the depression, compared to the control groups with an overall mean difference of 0.07 mm (95% CI 0.04-0.10, p < 0.01). Subgroup analysis showed that diabetes could present as a confounding factor in patients with depression and an increased cIMT.

CONCLUSIONS

This study confirms a significantly increased cIMT in patients with depression, compared with controls and suggests a possible bidirectional link between atherosclerosis and depression. An early screening of cardiovascular disease in individuals suffering with depression should be considered.

Association of anxiety and depressive symptoms with C-reactive protein in diverse Latinos: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

BACKGROUND

High sensitivity C-reactive protein (hsCRP) is a marker of systemic inflammation that has been associated with persistent depressive symptoms. Depression and anxiety are frequently associated with a chronic inflammatory state, yet the nature of this relationship has not been rigorously examined in diverse Hispanic/Latino populations. We aimed to study the association of anxiety and depressive symptoms as well as comorbid presentations, with circulating high sensitivity C-reactive protein (hsCRP) levels in a large Latino cohort of diverse heritages. We hypothesized a significant positive associations of both anxiety and depressive symptoms and hsCRP levels and potential variations among the heritage groups.

METHODS

Depressive symptoms and anxiety were measured by the Center for Epidemiological Studies Depression Scale (CES-D) and State-Trait Anxiety Inventory (STAI), respectively. Serum hsCRP (hsCRP) levels of 15,448 participants (age 18 to 75 years; 52.3% women) from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) were measured and categorized based on the established cardiovascular disease (CVD) risk reference values (< 1mg/L, low; 1-<3 mg/L, intermediate; ≥ 3mg/L, high).

RESULTS

Mean CES-D, STAI scores, and hsCRP levels were 7.0 (SD = 5.9), 17.0 (SD = 5.7), and 3.84 (SD = 7.85), respectively. Generalized linear modeling, adjusted for sociodemographic characteristics revealed significant associations between depression (exp(β) = 1.12; p<0.01) and anxiety symptoms (exp(β) = 1.10; p<0.05) with continuous hsCRP levels. For categorical values of hsCRP, one SD increase in CES-D and STAI scores was associated with a 10% and 8% increase in the RRRs of high vs. low hsCRP, respectively. However, these relationships between CES-D or STAI and hsCRP were no longer statistically significant after adjustment for CVD risk factors and medications.

CONCLUSION

We found modest associations between anxiety and depressive symptoms and systemic inflammation measured by hsCRP among diverse Hispanics/Latinos that did not appreciably differ between heritage groups.

Association between Psychological, Biochemical and Personal Factors with the Inflammatory Marker High-Sensitive C Reactive Protein (Hs-CRP) in Mexican Healthy Population

In the last decades, it has been shown that inflammatory processes play a role in the development of mental and physical problems; although some studies have researched the relationship between inflammation and psychological variables, the inclusion of biochemical variables as possible confounders has been limited. Therefore, the aim of this study was to determine whether psychological variables are associated with the inflammatory marker, highly sensitive CRP (hs-CRP), after controlling for personal and biochemical variables in the Mexican population. The study was performed at the University of Guadalajara facilities, during the second half of 2022. Healthy subjects were invited to participate in the study, which consisted of the measurement of personal, psychological, and biochemical variables. We included 172 participants, 92 (52.9%) of which were women; the median (range) of age of the whole sample was 22 (18-69) years old. In the bivariate analysis, significant positive correlations were observed between hs-CRP and body mass index (BMI) and waist/hip ratio (WHR) in both sexes, together with leukocytes, uric acid, low-density lipoprotein (LDL), triglycerides, and the liver enzymes gamma glutamyl transferase (GGT) and alkaline phosphatase (ALP). In the multivariate regression analysis of the global and men's samples, anxiety was positively associated with hs-CRP, while depression and positive relations with others were negatively associated with hs-CRP. In conclusion, psychological variables influence inflammation mainly in men, and anxiety was the main contributor; in addition, positive relation with others is a variable that should be further explored as a psychological protector of inflammation in both sexes.

Patients with palpitations experience a higher symptom burden prior to breast cancer surgery

PURPOSE

Anxiety, depression, sleep disturbance, fatigue, cognitive dysfunction, and pain are common symptoms reported by patients with breast cancer. Recent evidence suggests that palpitations, a feeling of the heart racing or pounding, may be equally common. Study purpose was to compare the severity and clinically meaningful occurrence rates of common symptoms and quality of life (QOL) outcomes between patients with breast cancer who did and did not report palpitations prior to surgery.

METHODS

Patients (n = 398) were classified as having or not having palpitations using a single item from the Menopausal Symptoms Scale. Valid and reliable measures were used to assess state and trait anxiety, depression, sleep disturbance, fatigue, energy, cognitive function, breast symptoms, and QOL. Between group differences were evaluated using parametric and non-parametric tests.

RESULTS

Patients with palpitations (15.1%) reported significantly higher severity scores for state and trait anxiety, depression, sleep disturbance, and fatigue as well as significant decrements in energy and cognitive function (all p < .05). A higher percentage of these patients had clinically meaningful levels of state anxiety, depression, sleep disturbance and decrements in cognitive function (all p < .05). Except for spiritual well-being, QOL scores were lower in the palpitations group (all p < .001).

CONCLUSION

Findings support the need for routine assessment of palpitations and management of multiple symptoms in women prior to breast cancer surgery.

Association of depression and obesity with C-reactive protein in Germany: A large nationally representative study

INTRODUCTION

Depression and obesity often occur comorbidly, and once both are present, they further increase the risk of developing other medical comorbidities, likely due to the underlying chronic low-grade inflammation. We investigated to what extent depression and obesity are associated with levels of high-sensitivity C-reactive protein (hsCRP) in a nationally representative sample of the German adult population.

METHODS

We analyzed data from the German Health Interview and Examination Survey for Adults (DEGS1, N = 7115), and its mental health module (DEGS1-MH; N = 4483). Two different depression measures were used: current depressive symptoms assessed by the self-administered German version of the Patient Health Questionnaire-9 and major depressive disorder (MDD) in the last 12 months assessed by a modified German version of the Composite International Diagnostic Interview. Obesity was defined by body mass index calculated from measured data. Associations with log(x + 1)-transformed hsCRP levels were analyzed using multivariable linear regression models.

RESULTS

Obese participants with depressive symptoms had significantly higher hsCRP compared to non-obese participants with depressive symptoms adjusted for sociodemographic and behavioral variables and medication use. In non-obese individuals, depressive symptoms were inversely associated with hsCRP, whereas MDD was not associated with hsCRP after adjustment for covariates. Additional analyses suggested symptom-specific associations of hsCRP as higher levels were linked to fatigue (β = 0.10, p <.001) while lower levels were linked to cognitive problems (β = -0.09, p <.001). Low SES, current smoking, lower levels of physical exercise, and the use of anti-inflammatory/anti-rheumatic medication and antidepressants were additional determinants of hsCRP in the fully adjusted models.

CONCLUSIONS

Our data suggest that obesity status is more strongly associated with increased inflammation than depressive symptoms or MDD. The relationship between depression and hsCRP in our population-based sample is substantially influenced by obesity status as well as other medical factors, lifestyle, and socioeconomic status. Furthermore, our findings suggest that the association between hsCRP and depression is symptom-specific rather than generalized.

C-Reactive Protein in Bipolar Disorder and Unipolar Depression

ABSTRACT

This study aimed to explore the role of C-reactive protein (CRP) in the pathological mechanism and differential diagnoses of bipolar disorder (BD) and unipolar depression (UD). We tested serum CRP levels of 176 BD and 86 UD patients, and 82 healthy controls (HCs), at acute and remission phases. In the acute phase, CRP levels were higher in BD than in UD patients and HC, and lower in UD patients than in HC. The CRP levels of BD patients in a manic episode were higher than those of HC; in a depressive or mixed episode, they were comparable to those of HC. The CRP levels of BD and UD patients during an acute depressive episode yielded an area under the curve of 0.676. CRP may be a state marker of acute manic episodes in BD and acute depressive episodes in UD, and a biomarker for distinguishing BD and UD.

Subthreshold depression - concept, operationalisation and epidemiological data. A scoping review

Purpose: In diagnostic systems (e.g., DSM-5, ICD-10), depression is defined categorically. However, the concept of subthreshold depression (SD) has gained increasing interest in recent years. The purpose of the present paper was to review, based on a scoping review, the relevant papers in this field published between October 2011 and September 2020.Materials and methods: Of the 1,160 papers identified, 64 records could be included in further analysis. The scoping review was conducted using both electronic and manual methods.Results: The main result of the analysis is that the operationalisation criteria used are highly heterogeneous, which also leads to very heterogenous epidemiological data.Conclusions: Clear conclusions are not possible scrutinising the reported results. Most definitions seem to be arbitrary, with considerable overlap (e.g., between SD and minor depression). The review also revealed that the impact of SD on quality of life and related parameters appear to be in the range of the respective impact of major depression (MD) and therapeutic approaches might be helpful for SD and also for the prevention of conversion from SD to MD. Keeping the presented difficulties in mind, a proposal for the definition of SD is made in the present paper in order to facilitate the discussion leading to more homogeneous criteria.

Symptomatic plaque enhancement is associated with early-onset post-stroke depression

BACKGROUND

The association between imaging features closely associated with symptomatic intracranial atherosclerotic plaques and early-onset post-stroke depression (PSD) is currently unclear.

MATERIALS AND METHODS

76 ischemic stroke patients who underwent high-resolution vessel wall magnetic resonance imaging (HR-VWI) were divided into PSD and non-PSD groups according to their DSM-V diagnoses and HAMD-17 scores at 14 days after onset. Clinical data and the imaging features associated with symptomatic plaques (including the enhancement index (EI), remodeling index, and plaque surface irregularity) were compared between groups. Multifactorial logistic regression analysis was used to find independent predictors of early-onset PSD. Spearman rank correlation analysis explores the association between clinical data, symptomatic plaque imaging features, and HAMD-17 in patients.

RESULTS

The sample comprised 36 patients with early-onset PSD. The symptomatic plaque EI and infarct volume were significantly higher in depressed patients than in patients without depression (P < 0.05). Multivariate logistic regression showed that symptomatic plaque EI could be used as an independent predictor of early-onset PSD after correcting for the confounding factor of infarct volume (OR = 1.034, 95% CI:1.014-1.055, P = 0.001). In the total sample, symptomatic plaque EI, infarct volume, and HAMD-17 had a significant positive correlation with each other (P < 0.05).

LIMITATIONS

This study focused only on the patients' symptomatic plaques and did not monitor patients' systemic inflammation levels at the time of HR-VWI.

CONCLUSIONS

The degree of symptomatic plaque enhancement is an independent predictive imaging marker of early-onset PSD and can be used the early diagnosis of early-onset PSD.

Acculturative Stress and Depressive Symptoms Among Chinese Immigrants: the Role of Gender and Social Support

The USA has among the largest immigrant population of any country in the world, and over the past few decades, the proportion of Chinese immigrants in the USA has increased significantly. Immigrants may experience substantial acculturative stress as they learn to navigate their new environment, and this stress can contribute to depressive symptoms and poor mental health. Social support can help mitigate the effects of stress on depressive symptoms, but the protective effects of social support have been reported to differ between men and women. Thus, the present study examined associations of acculturative stress and depressive symptoms among Chinese immigrants and explored whether the effects of social support on depressive symptoms varied by gender. Participants included 620 foreign-born Chinese men and women who completed questionnaires on acculturative stress, social support, and depressive symptoms. In nested regression analyses, acculturative stress was positively associated with depressive symptoms among both men and women. However, the interaction of social support and acculturative stress on depressive symptoms was statistically significant among men (β = - 0.89, p < 0.001), but not women (β = - 0.43, p = 0.21). These findings suggest that social support moderates the association of acculturative stress with depressive symptoms, but only among Chinese immigrant men. Future research should explore factors that can enhance resilience and mitigate acculturative stress effects on psychological well-being among Chinese immigrant women.

Elevated hs-CRP level is associated with depression in younger adults: Results from the Korean National Health and Nutrition Examination Survey (KNHANES 2016)

INTRODUCTION

Reports on the association between the level of circulating high-sensitivity C-reactive protein (hs-CRP) and depression have been inconsistent. The aim of this study was to examine the association between hs-CRP and depression in a large sample.

METHODS

This study used data obtained from a representative Korean sample of 5447 people who participated in the first (2016) year of the seventh Korean National Health and Nutrition Examination Survey (KNHNES VII-1). Depression was identified using a cutoff of 5 on the Patient Health Questionnaire-9 (PHQ-9), and high hs-CPR level was defined as ≥ 3.0 mg/L.

FINDINGS

Participants with a high CRP levels had a significantly higher rate of depression than did those with a low hs-CRP levels (25.1% vs. 19.8%, p = 0.007). Serum hs-CRP was independently associated with the PHQ-9 total score after adjusting for potentially confounding factors (B = 0.014; 95% CI = 0.008-0.020). After controlling for body mass index (BMI), smoking, alcohol use problems, hypertension, diabetes, dyslipidemia, chronic illness related hs-CRP, and metabolic syndrome. Furthermore, elevated hs-CRP level was significantly associated with an increased risk of depression (adjusted OR = 1.44; 95% CI = 1.01-2.07) in younger adults, but no significant association was observed among older adults.

CONCLUSION

These findings suggest a significant correlation between high hs-CRP levels and depression in younger adults. Further studies are necessary to investigate the age-specific association and the biological mechanism involved.

Subsyndromal and syndromal depressive symptoms among older adults with schizophrenia spectrum disorder: Prevalence and associated factors in a multicenter study

BACKGROUND

Few studies have examined the prevalence and correlates of subsyndromal and syndromal depressive symptoms (SSSD) among older adults with schizophrenia spectrum disorder. In this report, we examined the prevalence of SSSD and their associations with sociodemographic characteristics, clinical characteristics of schizophrenia, comorbidity, psychotropic medications, quality of life, functioning and mental health care utilization in a large, multicenter sample of older adults with schizophrenia spectrum disorder.

METHODS

Data from the Cohort of individuals with Schizophrenia Aged 55 years or more (CSA) were used to examine the prevalence of SSSD, defined using the Center of Epidemiologic Studies Depression (CESD) scale. Clinical characteristics associated with SSSD were explored.

RESULTS

Among 343 older adults with schizophrenia spectrum disorder, 78.1% had either subsyndromal (30.6%) or syndromal (47.5%) depressive symptoms. SSSD were independently associated with positive and negative symptoms, lower quality of life, non-late-onset psychosis, benzodiazepine use and urbanicity. There were no significant associations of SSSD with other sociodemographic characteristics and psychotropic medications, or with general medical conditions. We found no significant differences in the proportion of participants who were treated with antidepressants between those with syndromal depressive symptoms and those without depression (22.1% vs. 20.0%, p = 0.89). SSSD were not associated with higher mental health care utilization.

LIMITATIONS

Data were cross-sectional and depression was not evaluated with a semi-structured interview.

CONCLUSION

SSSD may be highly prevalent and under-assessed and/or undertreated among older adults with schizophrenia spectrum disorder. Our findings should alert clinicians about the need to assess systematically and regularly depression in this vulnerable population.

Associations of C-reactive protein and psychological distress are modified by antidepressants, supporting an inflammatory depression subtype: Findings from UKHLS

BACKGROUND

Clinical evidence increasingly suggests inflammation may be important specifically for an etiologically distinct depression subtype, characterised by resistance to antidepressant medication. However, epidemiological investigations of the relationship of inflammation with depression and psychological distress have failed to acknowledge these developments, which may have resulted in bias or masking of associations driven by the subtype. This may have contributed to inconsistent results in epidemiological studies, and equivocal support for an inflammation-depression link.

METHODS

An antidepressant-resistant, inflammatory depression subtype would result in stronger associations of depressive symptomatology with inflammation among antidepressant users than non-users, due to over-representation of subtype individuals among antidepressant users experiencing severe or persistent symptoms. We investigate, in a sample of 10,363 UK adults aged 16-98, modification by antidepressants of cross-sectional and longitudinal associations between C-reactive protein and psychological distress (General Health Questionnaire score, GHQ). We account for confounding by age, gender, income, inflammatory somatic illness, body mass index and, in longitudinal models, baseline psychological distress. Sensitivity analyses consider smoking, ethnicity, and other medications.

RESULTS

Robust associations of log-CRP and GHQ were seen for antidepressant users but not for non-users in both cross-sectional (coeff: 0.54, p=0.01vs 0.06, p=0.28) and longitudinal models (coeff: 0.57, p=0.006vs 0.04, p=0.39 two waves post-baseline). Cross-sectional associations were strongest for tricyclic users, and longitudinal associations strongest for SSRI users. In multilevel, repeated-measures longitudinal models, associations for antidepressant users peaked two waves after baseline before declining.

CONCLUSIONS

Results suggest evidence for existence of an inflammatory depression subtype. Previous studies' exclusion of antidepressant users and failure to consider interactive effects may have obscured associations driven by the subgroup. Follow-up work is now needed in community samples with clinical depression measures and prescription histories, to further elucidate the mechanisms involved.

Depression and anxiety both associate with serum level of hs-CRP: A gender-stratified analysis in a population-based study

BACKGROUND

Depression and anxiety are two important mood disorders that are frequently associated with chronic diseases such as cardiovascular diseases (CVDs). Hyper-inflammation is related to both CVDs and psychological conditions such as depression and anxiety. Therefore, inflammation may partially explain the relationship between depression and cardiovascular disease.

OBJECTIVE

The objective of this study was to perform a gender-stratified examination of the association between symptoms of depression/anxiety disorders and serum hs-CRP and inflammation linked conditions in a large Iranian population.

METHODS

Symptoms of depression and anxiety disorders and serum hs-CRP levels were measured in 9759 participants (40% males and 60% females) aged 35-65 years, enrolled in a population-based cohort (MASHAD) study in north-eastern Iran. Symptoms of depression and anxiety were evaluated with Beck Depression and Anxiety Inventories. According to the scores of depression and anxiety, individuals were categorized into four groups of no or minimal, low, moderate and severe categories.

RESULTS

The median serum hs-CRP concentration increased with increasing severity of depression and anxiety disorders. Male participants with severe depression had significantly higher levels of hs-CRP (p<0.001); however, this relationship was less marked among women (p=0.04). Subjects with severe anxiety also had significantly higher levels of hs-CRP (p<0.001). Moreover, women with severe depression and anxiety had higher BMI. There was also a positive association between current smoking habit and depression/anxiety disorders.

CONCLUSION

Depression and anxiety disorders are associated with elevated levels of hs-CRP, particularly among men. Also, there is a significant positive association between depression/anxiety disorders and inflammation linked conditions such as smoking and obesity; however, in the case of obesity this association is only present in women.

Lack of association between depression and C-reactive protein level in the baseline of Longitudinal Study of Adult Health (ELSA-Brasil)

BACKGROUND

Depression has been linked to increased levels of inflammatory markers in clinical studies, but results from general population samples are inconsistent. We aimed to investigate whether depression was associated with serum CRP levels in a cross-sectional analysis of a large cohort from a middle-income country.

METHODS

We analyzed baseline data from 14,821 participants (35-74 years) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Current depression (last 7 days) was assessed by the Clinical Interview Schedule-Revised (CIS-R). Because individuals on antidepressants could be negative on CIS-R due to their therapeutic effect, the explanatory variable had three categories: (1) negative on CIS-R and not using antidepressant (reference); (2) negative on CIS-R but using antidepressant; (3) positive on CIS-R with/without antidepressant use. Associations with CRP were investigated by general linear model (GLM).

RESULTS

After adjustments for confounders, neither current depression, nor antidepressant use was statistically associated with elevated CRP levels. Additionally, analyzes stratified by gender, type and severity of depression did not change the results.

LIMITATIONS

The reference group in our analysis might include participants with a lifetime history of depression. Additionally, the exclusion of questions on weight fluctuation and appetite from the CIS-R applied in ELSA-Brasil may have slightly underestimated the prevalence of depression, as well as limited our ability to assess the presence of somatic symptoms.

CONCLUSION

This study found no association between current depression, use of antidepressants, and serum CRP levels.

Lipids, lipoprotein distribution and depressive symptoms: the Multi-Ethnic Study of Atherosclerosis

Previous studies suggest lower concentrations of total and high-density lipoprotein (HDL) cholesterol to be predictive of depression. We therefore investigated the relationship of lipids and lipoprotein distribution with elevated depressive symptoms (EDS) in healthy men and women from the Multi-Ethnic Study of Atherosclerosis (MESA). Participants were followed up over a 9.5-year period. EDS were defined as a Center for Epidemiological Studies Depression (CES-D) score ⩾16 and/or use of antidepressant drugs. Lipoprotein distribution was determined from plasma using nuclear magnetic resonance spectroscopy. Among 4938 MESA participants (mean age=62 years) without EDS at baseline, 1178 (23.9%) developed EDS during follow-up. In multivariable Cox regression analyses, lower total, low-density lipoprotein (LDL) and non-HDL cholesterol concentrations at baseline were associated with incident EDS over 9.5 years (hazards ratio (HR)=1.11-1.12 per s.d. decrease, all P<0.01), after adjusting for demographic factors, traditional risk factors including LDL cholesterol, HDL cholesterol and triglycerides. Lipoprotein particle subclasses and sizes were not associated with incident EDS. Among participants without EDS at both baseline and visit 3, a smaller increase in total or non-HDL cholesterol between these visits was associated with lower risk of incident EDS after visit 3 (HR=0.88-0.90 per s.d. decrease, P<0.05). Lower baseline concentrations of total, LDL and non-HDL cholesterol were significantly associated with a higher risk of incident EDS. However, a short-term increase in cholesterol concentrations did not help to reduce the risk of EDS. Further studies are needed to replicate our findings in cohorts with younger participants.

Depression among Asian-American Adults in the Community: Systematic Review and Meta-Analysis

OBJECTIVES

In this systematic review, we provide an overview of the literature on depression among Asian-Americans and explore the possible variations in depression prevalence estimates by methodological and demographic factors.

METHODS

Six databases were used to identify studies reporting a prevalence estimate for depression in Asian-American adults in non-clinical settings. Meta-analysis was used to calculate pooled estimates of rates of depression by assessment type. Statistical heterogeneity was assessed for subgroup analyses by gender, age, ethnicity, and other participant characteristics.

RESULTS

A total of 58 studies met the review criteria (n = 21.731 Asian-American adults). Heterogeneity across the studies was considerably high. The prevalence of major depression assessed via standardized clinical interviews ranged between 4.5% and 11.3%. Meta-analyses revealed comparable estimated prevalence rates of depression as measured by the Center for Epidemiologic Studies Depression Scale (35.6%, 95% CI 27.6%-43.7%) and the Geriatric Depression Scale (33.1%, 95% CI 14.9%-51.3%). Estimates varied by Asian racial/ethnic group and other participant characteristics. Estimates of depression among special populations, which included maternity, caregivers, and homosexuals, were significantly higher than estimates obtained from other samples (58.8% vs 29.3%, p = .003). Estimates of depression among Korean and Filipino-Americans were similar (33.3%-34.4%); however, the estimates were twice as high as those for Chinese-Americans (15.7%; p = .012 for Korean, p = .049 for Filipino).

CONCLUSION

There appears to be wide variability in the prevalence rates of depression among Asian-Americans in the US. Practitioners and researchers who serve Asian-American adults need to be sensitive to the potential diversity of the expression of depression and treatment-seeking across Asian-American subgroups. Public health policies to increase Asian-American access to mental health care, including increased screening, are necessary. Further work is needed to determine whether strategies to reduce depression among specific Asian racial/ethnic groups is warranted.