Socioeconomic status and depressive symptoms and suicidality: The role of subjective social status

Depression leading to suicide in United States: A retrospective analysis of CDC WONDER from 1999 to 2022

BACKGROUND

Depressive disorder is a prevalent mental health condition in the United States, where suicide has been a leading cause of death among depressive patients. This study aimed to analyze suicide mortality trends in depressive disorder patients in the U.S. from 1999 to 2022.

METHODS

Data were extracted from the CDC WONDER database, identifying depression-related and suicide-related deaths using ICD-10-CM codes (F32, F33, F41.2, F92.0) and ICD-10-CM codes (U03, X60-X84, Y87.0) respectively. Age-adjusted mortality rates (AAMRs) per 1,000,000 and annual percent changes (APCs) were calculated and stratified by year, gender, age-group, race/ethnicity, region, and urbanization status.

RESULTS

A total of 57,103 deaths due to suicide and depressive disorder were analyzed. From 1999 to 2022, the AAMR significantly increased from 1999 to 2015 (APC: 2.05; 95 % CI: 1.65-2.74; p < 0.0001), followed by a stable trend from 2015 to 2022 (APC: 0.81; 95 % CI: 3.67 to 0.36; p = 0.14). Men consistently exhibited higher AAMRs (10) than women (3.9), with particularly highest rates observed in the 50-59 age group (11.2). Non-Hispanic (NH) White individuals had the highest AAMRs (9.9), followed by NH American Indian/Alaska Native populations (3.7), and NH Black individuals exhibiting the lowest rates (1.9). Rural areas showed significantly higher rates (12.5) compared to urban areas (5.4), with the Western U.S. region experiencing the steepest increases [Average Annual Percent Change (AAPC): 2.44; 95 % CI: 1.76 to 3.49].

CONCLUSION

This study reveals critical demographic and geographic disparities in suicide and depression-related mortality. Addressing the disproportionate burden on high-risk groups can guide future preventive strategies to mitigate the rising trends (Central Illustration).

Psychosocial factors and the development of childhood overweight and obesity: a UK cohort study

BACKGROUND

We examined the role of psychosocial factors in overweight and obesity development.

METHODS

UK Millennium Cohort Study data of children with normal weight at baseline were analysed. Weight changes were determined from baselines at ages 11 (n = 7979) and 14 (n = 6906) to follow-up at age 17. Baseline individual psychosocial factors were combined into two distinct indexes (caregiver-reported child mental health, child-reported psychosocial well-being). Regression models examined the associations between baseline indexes and individual psychosocial factors and overweight and obesity development (vs. no development) and body mass index (BMI) z-score changes.

RESULTS

Worse child mental health, but not psychosocial well-being, at age 11 was associated with overweight and obesity development (OR = 1.14; 95% CI = 1.02, 1.27) and increased BMI z-scores (β = 0.08; 95% CI = 0.04, 0.12) to age 17. No psychosocial indexes at age 14 predicted the outcomes. Further analyses showed that child mental health at ages 11 vs. 14 was more likely to predict the outcomes. Based on individual factors, externalising symptoms and experiencing peer bullying at age 11 may be important contributors to overweight and obesity development.

CONCLUSIONS

Poor child mental health at age 11 is associated with overweight and obesity development by age 17. Late childhood/early adolescence may be a sensitive period in which psychosocial factors predict body weight trajectories.

IMPACT

Worse psychosocial factors, particularly poor mental health, at ages 11, but not 14, were associated with overweight and obesity development and increased BMI z-scores by age 17. Late childhood/early adolescence may be a sensitive period for mental health in predicting future weight change. Future research will benefit from exploring this potential sensitive period and understanding potential mechanisms.

Trends in socioeconomic inequalities in suicide mortality over the six past decades (1960-2021): A systematic review of 49 time-trends studies

Suicide rates has steadily and significantly declined over the past decades worldwide, but this global decline may hide a more complex trends by socioeconomic status. Our systematic review aimed to summarize the existing literature on time-trends in socioeconomic inequalities in suicide mortality over the past decades. An electronic search was performed in 5 databases on March 2024 with no restrictions on location or year of publication. Studies were included if they assessed socioeconomic inequalities through a measure of education level, income level, deprivation level, or occupation class, and time-trends with respect to suicide mortality. A total of 49 articles of overall good quality met the criteria for inclusion. The study period ranged from 1960 to 2021. Study settings were primarily Europe (n = 26) and Asia (n = 11). The majority of studies demonstrated an overall increase or stability in socioeconomic inequalities in suicide mortality, particularly among the middle-aged and especially in Asia. Inequalities based on occupational status showed the strongest tendency to increase. Mental health promotion programs targeting suicidal behaviors in the most-deprived and less-educated populations are urgently warranted.

Perturbations in the microbiota-gut-brain axis shaped by social status loss

Social status is closely linked to physiological and psychological states. Loss of social dominance can lead to brain disorders such as depression, but the underlying mechanisms remain unclear. The gut microbiota can sense stress and contribute to brain disorders via the microbiota-gut-brain axis (MGBA). Here, using a forced loss paradigm to demote dominant mice to subordinate ranks, we find that stress alters the composition and function of the gut microbiota, increasing Muribaculaceae abundance and enhancing butanoate metabolism, and gut microbial depletion resists forced loss-induced hierarchical demotion and behavioral alteration. Single-nucleus transcriptomic analysis of the prefrontal cortex (PFC) indicates that social status loss primarily affected interneurons, altering GABAergic synaptic transmission. Weighted gene co-expression network analysis (WGCNA) reveals modules linked to forced loss in the gut microbiota, colon, PFC, and PFC interneurons, suggesting changes in the PI3K-Akt signaling pathway and the glutamatergic synapse. Our findings provide evidence for MGBA perturbations induced by social status loss, offering potential intervention targets for related brain disorders.

Objective socioeconomic status, subjective social status, and mental disorders in Iranian mental health survey (IranMHS): A mediation analysis

BACKGROUND

There is ample evidence that socioeconomic status, objectively quantified by tangible resources, impacts mental health outcomes. However, the psychosocial mechanism linking objective socioeconomic status (OSS) with mental health is not clear. This study examined to what extent associations between OSS and the twelve-month prevalence of mental disorders, are mediated by the individual perception of social conditions-the subjective social status (SSS).

METHODS

We employed data from the Iranian Mental Health Survey (IranMHS), collected through interviews with 7886 Iranian adults. We used the Composite International Diagnostic Interview (CIDI 2.1) to assess any mental disorder, any anxiety disorder, and any major depressive disorder (MDD). We measured OSS based on education, occupation, wealth, and a composite OSS index, while SSS was evaluated using the MacArthur scale. We investigated the indirect associations and stratified the analyses by gender.

RESULTS

In this national sample, 4499 (57.0 %) were women, 4380 (55.5 %) were urban, and the mean (SE) age was 31.7 (0.2) years. SSS had a partial to full mediating effect. Specifically, there were significant indirect effects for the impact of wealth (mediation percentage: 78.9 %), education (73.3 %), OSS index (56.0 %), and occupation (33.3 %) on any mental disorder through SSS.

LIMITATIONS

The cross-sectional nature of the data presents constraints in establishing causal relationships.

CONCLUSIONS

Our findings highlight the role of SSS as the psychosocial mechanism linking OSS with mental disorders. A better understanding of the social factors that influence the association between OSS and SSS may enhance our insight into the mental health effects of socioeconomic status.

Identification of distinct pesticide poisoning patterns in Brazil: a cross-sectional cluster analysis of epidemiological data

PURPOSE

This study aimed to identify distinct patterns of pesticide poisoning in Brazil through the cluster analysis of epidemiological data from 2011 to 2019.

METHODS

A cross-sectional analysis of 49,233 confirmed pesticide poisoning cases was conducted using multiple correspondence analysis and hierarchical clustering. Data from the Brazilian Notifiable Diseases Information System were analyzed by region, demographics, and exposure types.

RESULTS

Three distinct clusters were identified. Cluster 1 was characterized by severe cases, predominantly involving suicide attempts (~90%), required treatment (99.1%) and fatality rates (93.2% of all cases). Exposures were mostly domestic and occurred via ingestion, with a strong prevalence in the Northeast. Cluster 2 consisted mainly of pediatric cases, marked by accidental and acute domestic exposures, and showed minimal representation in the Southeast and South regions. Cluster 3 had a male predominance (80.1%) and was strongly associated with occupational and chronic exposures, involving cutaneous and respiratory routes, and was most prevalent in the Central-West.

CONCLUSION

The study reveals significant regional and demographic disparities in pesticide poisoning across Brazil. These findings underscore the urgent need for targeted public health interventions and stricter pesticide regulations to address regional vulnerabilities and mitigate pesticide-related harm.

Protective factors for suicidal ideation and suicide attempts in adolescence: a longitudinal population-based cohort study examining sex differences

BACKGROUND

Adolescence is a critical period with elevated vulnerability to suicidality. Despite the importance of protective factors in reducing suicidal ideation (SI) and suicide attempts (SA), research in this area remains limited. This study investigated the associations between protective factors in early adolescence and the subsequent outcomes of SI and SA a year later, while also examining sex differences in these associations.

METHODS

This study utilized data from a representative sample at two timepoints, T1 (N = 2464, 50.8% females, mean age = 13.7, SD = 0.6) in 1998 and T2 (N = 2432, 50.4% females, mean age = 14.9, SD = 0.6) one year later, collected as part of the longitudinal Youth and Mental Health Study (YAMHS) in Norway. Individual, social and environmental protective factors were identified based on prior research and theoretical frameworks. We used linear (or ordinal logistic) regression analyses with SI (or SA) as dependent variable, and one protective factor, sex and their interaction as covariates.

RESULTS

Positive self-perceptions (T1) were significantly associated with reduced SI and SA one year later (T2) for both sexes. Specifically, self-worth was more strongly associated with reduced SI in females (B = -0.16, 95% CI: -0.20 to -0.12, p <.001) than males (B = -0.08, 95% CI: -0.12 to -0.04, p <.001). The interaction between sex and social competence influenced the likelihood of SA, with males (OR = 0.24, 95% CI: 0.13 to 0.42, p <.001) showing a greater reduction than females (OR = 0.53, 95% CI: 0.35 to 0.80, p =.009), although this association only showed a trend towards significance (p =.083). Higher physical activity and school connectedness/wellbeing were associated with lower SI, and school connectedness/wellbeing to lower SA, with no sex differences. No significant associations were found between task-oriented coping, attachment, family functioning or socio-economic status and SI or SA.

CONCLUSIONS

Fostering positive self-perception, physical activity, and school connectedness/wellbeing is important for adolescent suicide prevention, as these factors contribute to reducing suicidality. Sex differences were observed in the associations between self-worth and SI, as well as social competence and SA. Future research should explore additional protective factors across sex and gender groups.

Socioeconomic disparities in depression risk: Limitations of the moderate effect of physical activity changes in Korea

This study investigates the influence of changes in physical activity (PA) patterns on depression risk across different socioeconomic statuses (SES) in Korea. Utilizing National Health Insurance Data (NHID) from over 1.2 million individuals during 2013-2016, we matched medical aid beneficiaries with health insurance beneficiaries, excluding those with prior depression or incomplete PA data. Changes in moderate-to-vigorous PA (MVPA) were categorized into 16 groups, and depression incidence was tracked from 2019 to 2021. After adjustment, medical aid beneficiaries consistently showed higher risks of depression compared to health insurance enrollees with the same physical activity (PA) change patterns. For those consistently inactive, the risk was 1.68 times higher (aOR, 1.68; 95% CI, 1.37-2.05). Those who increased PA from inactivity to moderate-to-vigorous activity 3-4 times per week had a 3.33 times higher risk (aOR, 3.33; 95% CI, 1.72-6.43). Additionally, the risk was 2.64 times higher for those increasing from 1-2 times to ≥5 times per week (aOR, 2.64; 95% CI, 1.35-5.15), and 2.83 times higher for those consistently engaging in PA 3-4 times per week (aOR, 2.83; 95% CI, 1.35-5.94). Across the overall PA patterns, medical aid beneficiaries consistently faced higher depression risks, with risk increases of 1.80 times for increased activity, 1.68 times for continuous inactivity, and 1.34 times for decreased activity compared to health insurance beneficiaries with the same PA change patterns. However, in the consistently very active group, no significant difference in the risk of depression was observed between the two groups. Limitations include potential bias in self-reported PA and the NHIS data not fully capturing depression severity. The findings underscore the significant impact of SES on mental health, with consistently high PA levels potentially mitigating SES-related depression risk.

Integrating Social Determinants With the Interpersonal Theory of Suicide in a Study of Bipolar Outpatients

INTRODUCTION

Bipolar disorder, socioeconomic deprivation, and social isolation are major risk factors for suicide. The interpersonal theory of suicide (IPTS) posits perceived burdensomeness and thwarted belongingness as proximal causes of suicidal thoughts and behaviors, while the social determinants of health (SDOH) framework highlights distal socioeconomic factors. Studies of suicidality in bipolar disorder have used the IPTS and the SDOH framework, but few have integrated them to explore connections between distal and proximal factors.

METHODS

This study examined perceived burdensomeness and thwarted belongingness as mediators of the relationship between cumulative socioeconomic risk and suicide risk. Participants were 171 outpatients in a United States (U.S.) bipolar clinic (mean age = 39.0, 69.6% female, 73.7% Black/African American).

RESULTS

Cumulative socioeconomic risk, perceived burdensomeness, and thwarted belongingness were positively associated with suicide risk. Perceived burdensomeness mediated the relationship between cumulative socioeconomic risk and suicide risk, but thwarted belongingness did not.

CONCLUSION

Findings broadly suggest the IPTS and the SDOH framework can be fruitfully integrated to guide research and prevent suicide. The pathway from cumulative socioeconomic risk to suicide risk via perceived burdensomeness warrants further attention, particularly for individuals diagnosed with bipolar disorder. Implications for future studies of the IPTS, SDOH, and suicidality are discussed.

Suicidality, resilience and burnout in a population of oncology nurses

Oncology care gives employees the opportunity to care for people during the most difficult periods of their lives, which can affect the psychological well-being of nurses in different domains. The aim of this work is to examine is suicidality connected with resilience and burnout in the populations of oncology and non-oncology nurses, nursing students and administrative workers, as well as to determine if oncology nurses differ from other groups. The study included a total of 75 oncology nurses, 74 non-oncology nurses, 71 administrative workers and 70 nursing students. The respondents filled out the Serbian version of the Risk Assessment Suicidality Scale, the Serbian version of the Brief Resilience Scale, and the Maslach Burnout Inventory. The observed variables were compared by Spearman's Rho correlation. In the population of oncology nurses, resilience and suicidality are negatively correlated (r = - 0.375, p = 0.001). In the same population, suicidality and burnout are not correlated, but the correlation was significant in all other control groups. Our research established the importance of strengthening the resilience of employees in the health sector, through various programs and trainings. Working professionals are more often forced to develop individual protective strategies and incorporate them into daily practice.

Subjective social status, depressive symptoms, and suicidal ideation in U.S. college students: A cross-sectional examination on race and gender

Objective: Grounded in the Social Rank Theory, this study examined the levels and associations of subjective social status (SSS), depressive symptoms (DEP), and suicidal ideation (SI). Participants: Participants included 956 U.S. college students (Mage = 19.94, SDage = 2.78; 75% females [n = 716], 24% males [n = 228], 41% Whites [n = 395], 59% students of color [n = 561]. Methods: Participants completed a questionnaire including their SSS, DEP, and SI. Results: Females scored significantly higher than males on DEP and SI. There was a significant, negative SSS-DEP correlation in males, females, Whites, students of color, males and females of color. A significant, negative SSS-DEP correlation was found in males, females, Whites, students of color, and females of color, except in males of color. The negative SSS-DEP and SSS-SI links were stronger in students of color than Whites. Conclusion: Study contributions, limitations, and practical implications are discussed.

The mediating role of job fairness and job burnout between subjective social status and depressive symptoms in Chinese migrant workers: a generational difference analysis

BACKGROUND

In China, migrant workers (MWs) constitute a significant vulnerable group that may be highly susceptible to depression. However, there is a lack of empirical research exploring the correlation between subjective social status (SSS) and depressive symptoms among MWs. The objective of this study is to examine the mediating roles of job fairness and job burnout, as well as to investigate potential generational differences in this association.

METHODS

A cross-sectional study was conducted in China among two groups of 1,158 MWs (response rate, 89.08%): first generation migrant workers (FGMWs) and new generation migrant workers (NGMWs). The survey assessed SSS, depressive symptoms, job fairness, and job burnout using a questionnaire. Structural equation model was used to primarily analyze mediating roles of job fairness and job burnout in the relationship between SSS and depressive symptoms, as well as to explore potential generational differences in this association.

RESULTS

The study findings indicate that SSS significantly predicted higher depressive symptoms among MWs. However, the relationship between SSS and depressive symptoms was mediated by job fairness or job burnout. Notably, the indirect effect of SSS on depressive symptoms through job burnout was significant for FGMWs, but not for NGMWs.

CONCLUSION

This study fills a critical gap in understanding the connections between SSS, depressive symptoms, job fairness, and job burnout among MWs in China. It emphasizes the role of job fairness and job burnout as significant mediators that either worsen or alleviate the impact of SSS on depressive symptoms among MWs. Moreover, the findings suggest that the mediation differs significantly between FGMWs and NGMWs. These findings imply the need for different intervention methods to address the depressive symptoms of the two generations of MWs.

Exploring the Co-Occurrence of Depressive Symptoms and Aggression among Chinese Adolescents: Patterns and Stability

Depressive symptoms and aggression frequently occur together, and this co-occurrence may result in more severe developmental problems. However, it is unclear if there are distinct patterns of co-occurrence. This study investigated the co-occurrence patterns of depressive symptoms and aggression, and examined their stability and demographic characteristics. A total of 1010 Chinese adolescents (50.6% girls; mean age at T1 = 12.54 years, SD = 0.42) participated in annual surveys over three years (2019-2021). Three different patterns of co-occurrence were found except for the normal group: depression-dominant co-occurrence (13.6%), aggression-dominant co-occurrence (3.2%), and moderate co-occurrence (6.0%) (T1). In these co-occurrence patterns, adolescents classified as aggression-dominant co-occurrence exhibited the most instability and frequent changes, while adolescents classified as depression-dominant co-occurrence exhibited the most stability. Boys or younger adolescents were more likely to exhibit the aggression-dominant co-occurrence, while girls or older adolescents were more likely to exhibit the depression-dominant co-occurrence. The findings indicate that the co-occurrence patterns observed are distinct and are dominated by aggression or depression, which implies the need for targeted intervention practices.

Use of Cigarettes and E-Cigarettes, Impulsivity, and Anxiety: Influences on Suicidal Ideation Among Youth and Young Adults in Texas

INTRODUCTION

Cigarette use and smoking intensity increase risk of suicidal ideation. Less is known about e-cigarette use. Here we examine direct influences of cigarette versus e-cigarette use on suicidal ideation among 16- to 23-year-olds in Texas.

AIMS AND METHODS

Since 2019, the Texas Adolescent Tobacco and Marketing Surveillance Study collected data on suicidal ideation every 6 months covering the previous 2 weeks. Youths answering that they had "thoughts that you would be better off dead, or of hurting yourself" on more than 2 of 14 days were categorized as having suicidal ideation. Generalized linear mixed-effects logistic regressions examined the influence of ever and past 30-day (P30D) use of cigarettes, e-cigarettes, impulsivity, and anxiety on suicidal ideation, controlling for gender, race/ethnicity, socioeconomic status (SES), and grade in school. Interactions between ever and P30D use of both products and (a) impulsivity and (b) gender were examined.

RESULTS

Of the 2329 participants, 29.1% reported ever and 6.5% reported P30D cigarette use, 48.2% reported ever and 11.6% reported P30D e-cigarette use, and 18.5% reported suicidal ideation. Ever cigarette use among females (aOR = 1.83; 95% CI: 1.36 to 2.46), P30D e-cigarette use (aOR = 1.30; 95% CI: 1.00 to 1.68), and P30D cigarette use (aOR = 1.47; 95% CI: 1.06 to 2.05) were independently associated with higher risk for suicidal ideation after adjusting for covariates. Impulsivity and anxiety directly increased risk of suicidal ideation regardless of product type used. Hispanic youth had higher risk of suicidal ideation than White youth, while higher levels of SES were protective.

CONCLUSIONS

Cigarette/e-cigarette use, as well as impulsivity and anxiety, directly increase the risk of suicidal ideation.

IMPLICATIONS

Clinicians should ask young adults with a history of tobacco use, anxiety, or impulsive behavior about suicidal ideation. Nicotine prevention and cessation programs might be more effective if they simultaneously target substance use and mental health. Culturally appropriate support is needed for ethnic and racial minority youth and young adults in school, college, and at work. When evaluating and understanding risk, the role of multiple social identities (such as minority status, gender, and SES) is important.

The association between socioeconomic position and depression or suicidal ideation in low- and middle-income countries in Southeast Asia: a systematic review and meta-analysis

BACKGROUND

Mental illnesses contribute to a significant burden of disease in low- and middle- income countries (LMICs). Understanding risk factors for poor mental health is essential to reducing the burden, and for preventative measures to be implemented. The role of socioeconomic position (SEP) in poorer mental health is well established in high income countries, but less is known in LMICs. This study aimed to identify and synthesise epidemiological evidence for the associations between SEP and depression and suicidal ideation in LMICs in Southeast Asia, and to describe the strength and direction of any associations identified.

METHODS

This systematic review identified evidence by searching four databases in February 2023 (Medline, Embase, PsycInfo and Web of Science), grey literature and reference searching of included papers. Papers were included if they were based in a Southeast Asian LMIC general or hospital populations (= 16 years of age) and explored at least one measure of SEP in association with depression or suicidal ideation. Study quality was assessed using the Joanna Briggs Institute tool. A meta-analysis and narrative synthesis were performed.

RESULTS

Fifty-nine papers from six out of nine Southeast Asian LMICs were identified, with education the most commonly examined measure of SEP. Several papers explored more than one measure of SEP. Around half of the papers were rated as higher quality. Meta-analyses of education (OR: 1.87, 95% CI: 1.49-2.35) and working status (OR: 1.30, 95% CI: 0.99-1.71) provided evidence of lower levels of education and not being employed being associated with higher odds of depression. Consistent associations between lower SEP and higher odds of depression were also found for financial difficulty and subjective economic status. Three papers used suicidal ideation as their outcome, and there was some evidence of an association with lower SEP and higher ideation.

CONCLUSIONS

Evidence indicates that lower SEP is associated with higher likelihood of depression, whereas for suicidal ideation, the evidence available is insufficient to reach a conclusion. The lack of longitudinal studies prevents the temporal nature of these associations being established.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO: CRD42023410444.

Suicidal ideation in male UK military personnel who sustained a physical combat injury in Afghanistan and the mediating role of leaving service: The ADVANCE cohort study

BACKGROUND/AIMS

Suicidal Ideation (SI) is a risk factor for suicide, a leading cause of death amongst young men globally. In this study we assess whether sustaining a serious physical combat injury is associated with SI and whether leaving service mediates this association.

METHODS

We analysed data from male UK Armed Forces personnel who sustained a combat injury in Afghanistan and a frequency-matched comparison group who did not sustain such an injury (the ADVANCE cohort). SI was measured from the Patient Health Questionnaire-9 item 'thoughts that you would be better off dead or of hurting yourself in some way'.

RESULTS

Approximately, 11.9% (n = 61) of the uninjured group, 15.3% (n = 83) of the overall injured group, 8.5% (n = 13) of an Amputation injury (AI) subgroup and 17.6% (n = 70) of a Non-Amputation Injury (NAI) subgroup reported SI in the past 2 weeks. The NAI subgroup reported greater likelihood of SI (Relative Risk Ratio (RR) = 1.44, 95% confidence interval (CI) [1.04, 2.00]) compared to the comparison group, whereas the overall injured group (RR = 1.23, 95% CI [0.90, 1.68]) and AI subgroup (RR = 0.65, 95% CI [0.36, 1.18]) did not. Leaving service fully mediated the association between sustaining a NAI and SI (natural direct effect RR = 1.08, 95% CI [0.69, 1.69]).

CONCLUSIONS

UK military personnel with NAI reported significantly higher rates of SI compared to demographically similar uninjured personnel, while those who sustained AIs reported no significant difference. Leaving service was associated with greater rates of SI for both injured and uninjured personnel and fully mediated the association between sustaining a NAI and SI.

The effects of subjective family status and subjective school status on depression and suicidal ideation among adolescents: the role of anxiety and psychological resilience

Background

Depression and suicidal tendencies are notably prevalent among adolescents, yet few studies have revealed the impact of social status on them. This study aimed to explore the mediating and moderating effects of anxiety and psychological resilience on family status, school status, depression, and suicidal ideation.

Methods

A total of 1,190 secondary school students aged 13 to 17 years (mean age: 13.57 ± 2.02 years) were evaluated depression, anxiety, and suicidal ideation using the PHQ-8 and GAD-7 questionnaires. Subjective family and school status were also assessed. Data analysis was conducted using Mplus, SPSS's Process, and the RSA 3.0 plugin.

Results

Subjective family/school status, anxiety, psychological resilience, depression, and suicidal ideation were significantly correlated. Anxiety played a partial mediating role in the influence of subjective family status and subjective school on depression and suicidal ideation, and psychological resilience moderated the impact of anxiety on adolescent depression and suicidal ideation (βdepression = -0.05, p < 0.01; βsuicidal ideation = -0.06, p < 0.05).

Conclusions

Subjective family status and school status played important roles in depression and suicidal ideation in adolescents, and anxiety and psychological resilience played mediating and moderating roles.

The influence of different conflict management styles on depressive symptoms in employees: the mediating role of emotional exhaustion

Although some studies have found that conflict management styles impact employees' levels of depression, the expressions of employees' depressive symptoms under various conflict management styles and the underlying mechanisms remain to be elucidated. In this study, a total of 1,312 employees were gathered through an online survey to examine their current depressive status. Drawing on the conservation of resources theory, the mediating role of emotional exhaustion in the association between conflict management style and employee depression was further explored. The findings revealed that the prevalence of moderate to severe depression among the workers was 13.9%. Employees with different conflict management styles displayed distinct depression scores. The high coordination style group exhibited a significantly lower depression score compared to the high concession style group. Emotional exhaustion played a mediating role in the impact of both the coordination style and the concession style on employees' depression. It can be seen that the mental health needs of the workplace are imminent. The intervention measures to improve the mental health of employees in the working environment should take into account the cultivation of the coordination style of employee conflict management, reduce their emotional exhaustion, and stay away from depression through the acquisition of constructive and positive coping styles.

Income rank and depressive symptoms among employees in Germany - A 5-year cross-lagged panel analysis

Background/Objective

Socioeconomic disparities in mental health are well-established. Previous research suggests that relative income rank is associated with depressive symptoms above and beyond absolute income. This study aimed to investigate the predictive value of income rank for future depressive symptoms while accounting for absolute income. Exploring potential reverse pathways from depressive symptoms to income rank was a secondary objective.

Method

A two-wave cross-lagged panel design with a 5-year follow-up was used to analyze data for income rank, absolute income, and two dimensions of depressive symptoms (i.e., cognitive-affective and somatic symptoms) from initially 4,201 employees. Income rank was calculated for reference groups, based on the same gender, the same 5-year age band, and the same occupational skill level.

Results

Lower income rank at baseline predicted a higher severity of cognitive-affective depressive symptoms at five-year follow-up, even after adjusting for absolute income. In contrast, income rank did not demonstrate a significant unique longitudinal association with somatic depressive symptoms when simultaneously taking absolute income into account. There was no evidence for the assumption that depressive symptoms are predictive for future income rank (i.e., reverse pathway).

Conclusions

Cognitive-affective symptoms of depression might be particularly responsive to social comparisons and a relatively low social rank.

Decoding depression by exploring the exposome-genome edge amidst COVID-19 lockdown

Risk of depression increased in the general population after the COVID-19 pandemic outbreak. By examining the interplay between genetics and individual environmental exposures during the COVID-19 lockdown, we have been able to gain an insight as to why some individuals are more vulnerable to depression, while others are more resilient. This study, conducted on a Spanish cohort of 9218 individuals (COVICAT), includes a comprehensive non-genetic risk analysis, the exposome, complemented by a genomics analysis in a subset of 2442 participants. Depression levels were evaluated using the Hospital Anxiety and Depression Scale. Together with Polygenic Risk Scores (PRS), we introduced a novel score; Poly-Environmental Risk Scores (PERS) for non-genetic risks to estimate the effect of each cumulative score and gene-environment interaction. We found significant positive associations for PERSSoc (Social and Household), PERSLife (Lifestyle and Behaviour), and PERSEnv (Wider Environment and Health) scores across all levels of depression severity, and for PRSB (Broad depression) only for moderate depression (OR 1.2, 95% CI 1.03-1.40). On average OR increased 1.2-fold for PERSEnv and 1.6-fold for PERLife and PERSoc from mild to severe depression level. The complete adjusted model explained 16.9% of the variance. We further observed an interaction between PERSEnv and PRSB showing a potential mitigating effect. In summary, stressors within the social and behavioral domains emerged as the primary drivers of depression risk in this population, unveiling a mitigating interaction effect that should be interpreted with caution.

Disparities by Social Determinants of Health: Links Between Long COVID and Cardiovascular Disease

Long COVID has been defined by the World Health Organisation as "continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation." Cardiovascular disease is implicated as a risk factor, concomitant condition, and consequence of long COVID. As well as heterogeneity in definition, presentation, and likely underlying pathophysiology of long COVID, disparities by social determinants of health, extensively studied and described in cardiovascular disease, have been observed in 3 ways. First, underlying long-term conditions, such as cardiovascular disease and its risk factors, are associated with incidence and severity of long COVID, and previously described socioeconomic disparities in these factors are important in exacerbating disparities in long COVID. Second, socioeconomic disparities in management of COVID-19 may themselves lead to distal disparities in long COVID. Third, there are socioeconomic disparities in the way that long COVID is diagnosed, managed, and prevented. Together, factors such as age, sex, deprivation, and ethnicity have far-reaching implications in this new postviral syndrome across its management spectrum. There are similarities and differences compared with disparities for cardiovascular disease. Some of these disparities are in fact, inequalities, that is, rather than simply observed variations, they represent injustices with costs to individuals, communities, and economies. This review of current literature considers opportunities to prevent or at least attenuate these socioeconomic disparities in long COVID and cardiovascular disease, with special challenges for research, clinical practice, public health, and policy in a new disease which is evolving.

Reducing the risk of suicidal behaviors in medical graduate students: exploration of student-supervisor relationship and subjective family socioeconomic status

Objective

This study aimed to investigate the association between the risk of suicidal behaviors and student-supervisor relationships and subjective family socioeconomic status (SFSS) in medical graduate students, and to propose preventive strategies to reduce the suicidal risk among medical graduate students.

Materials and methods

A total of 1,310 validated questionnaires were collected from medical graduate students, which included demographic information, study programs, the Suicidal Behaviors Questionnaire-Revised (SBQ-R) questionnaire, the Leader-Member Exchange 7 (LMX-7) questionnaire, and SFSS by MacArthur Scale. Multiple regression analysis was employed to examine the associations between variables and adjust for confounders. A moderation analysis, containing simple slope analysis and Johnson-Neyman interval plots were used to analyze the moderating effect of the SFSS in the association of SBQ-R and LMX-7 scores.

Results

A total of 88 participants (6.7%) were at risk of suicidal behaviors. In the high-quality student-supervisor relationship group (LMX-7 score ≥ 25), SFSS was significantly higher than in the low- and moderate-quality relationship group (p=0.002). The median SBQ-R score and proportion of suicide risk was significantly lower (p<0.001) in the high-quality student-supervisor relationship group. Multiple regression analysis indicated LMX-7 scores (β=-0.098, 95% CI [-0.118, -0.077], p<0.001) and SFSS (β=-0.073, 95% CI [-0.127, -0.019], p=0.008) were significantly negatively associated with SBQ-R, whereas the interaction term of SFSS with LMX-7 (β=0.018, 95% CI [0.007, 0.029], p=0.001) showed a significant positive association with SBQ-R. The Johnson-Neyman interval showed a significant association between LMX-7 and SBQ-R scores only when SFSS was less than 7.82 (p<0.05).

Conclusion

The risk of suicidal behaviors was associated with student-supervisor relationships and SFSS among medical graduate students. Poor relationships with supervisor were associated with an elevated risk of suicidality, and SFSS moderated this association. Educators should pay increased attention to the suicidal risk of medical graduate students with poor supervisor relationships, especially those from families with low SFSS, and provide timely preventive strategies.

Latent profile analysis of depression in US adults with obstructive sleep apnea hypopnea syndrome

Objective

This study used latent profile analysis to explore the level of depression among US adults with obstructive sleep apnea hypopnea syndrome (OSAHS) symptoms and to identify different latent categories of depression to gain insight into the characteristic differences between these categories.

Methods

The data of this study were obtained from the National Health and Nutrition Examination Survey (NHANES) database, and the subjects with OSAHS symptoms were aged 18 years and older. The latent profile analysis (LPA) method was used to fit the latent depression categories in subjects with OSAHS symptoms. The chi-square test, rank sum test, and binary logistic regression were used to analyze the influencing factors of depression subgroups in subjects with OSAHS symptoms.

Results

Three latent profiles were identified: low-level (83.7%), moderate-level (14.5%) and high-level (1.8%) depression. The scores of 9 items in the high-level depression group were higher than those in the other two groups. Among them, item 4 "feeling tired or lack of energy" had the highest score in all categories.

Conclusion

Depression in subjects with OSAHS symptoms can be divided into low-level, moderate-level and high-level depression. There are significant differences among different levels of depression in gender, marital status, PIR, BMI, smoking, general health condition, sleep duration and OSAHS symptom severity.

Prevalence of Mental Disorders Among Patients with Multimorbidity Visiting Primary Care Settings in Slums of Karachi, Pakistan

BACKGROUND

Anxiety and depression often exacerbate multimorbidity conditions, leading to increased disability rates among affected individuals.

OBJECTIVE

The study aimed to assess the mental health status of individuals with multimorbidity belonging to the marginalized population of Karachi, Pakistan. Specifically, the prevalence of anxiety and depression was investigated.

METHODS

A multicenter cross-sectional study was conducted between July 2022 and June 2023 in 10 primary healthcare clinics located in 4 peri-urban areas of Karachi. A total of 9331 participants were included in the study. The Patient Health Questionnaire 4 (PHQ-4), Generalized Anxiety Disorder 7 (GAD-7), and Patient Health Questionnaire 9 (PHQ-9) were used to assess symptoms of anxiety and depression. The data collected were analyzed using the statistical analysis system (SAS) version 9.4.

RESULTS

Among the study participants, 2894 (31%) were men and 5534 (59.3%) were women. The prevalence of moderate to severe anxiety was 31% among men and 59.3% among women. The age group between 41 and 60 years exhibited the highest rates of moderate to severe anxiety, 19.3% as evaluated by GAD-7 and 34.6% by PHQ-9. The Pathan ethnic group had the highest prevalence of anxiety (11%) and depression (28.3%) in the neighborhoods. Unemployed participants showed moderate to severe anxiety in 21.3% of the cases and moderate to severe depression in 25.5% of the cases.

CONCLUSION

The study revealed a significant cooccurrence of anxiety and depression among individuals with multimorbidity in the marginalized population of Karachi, Pakistan. Furthermore, the presence of anxiety symptoms in multimorbidity patients with depression indicates a more unfavorable health state. It is essential to explore the implementation of screening measures and therapeutic interventions for comorbid anxiety and depression in this population to improve clinical outcomes.

Multiphasic Personality Assessment in a Case Series of Adolescent Patients with Suicidal Ideation and/or Attempts

Suicide is an important public health issue. To examine the differences in personality characteristics between a group of adolescents with suicidal ideation (SI) and a group with a history of suicidal attempts (SA), we conducted a cross-sectional study. We enrolled 55 adolescents (51 females; 12-18 y.o.) who presented SI and/or SA. Using the Columbia Suicide Severity Rating Scale, we divided the sample into two groups: adolescents with SI and adolescents with SA. All participants filled in the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A). Adolescents in the SA group had greater difficulties in social relations, risky behaviors, and more intense suicidal ideation compared to those in the SI group. Adolescents in the SA group scored higher in Omission, in the Lie Scale, the Conduct Problem Scale, the Less Aspirations Scale, the Repression Scale in the MMPI-A, and item 283 of the MAST compared to the other group. The results suggest that using the MMPI-A to assess certain features (e.g., tendency to lie, repression) may be helpful in identifying young people who are at high risk of suicide. However, further research is required to determine the effectiveness of using this instrument.