Role of age, gender and marital status in prognosis for adults with depression: An individual patient data meta-analysis

Social determinants of health and their impact on depression in family caregivers of those with dementia: The importance of intermediary determinants

INTRODUCTION

Dementia family caregivers face a significant burden due to the progressive nature of the disease, which places them at high risk for depression. Because a lack of information is available on the social determinants of health that impact depression, this study investigated this relationship.

METHODS

This study was a secondary data analysis using the 2017 National Health and Aging Trends Study (NHATS) Round 11 and the National Study of Caregiving (NSOC) Round 4, which included a nationally representative sample of American older adults and their family caregivers. Weighted multivariate logistic regression models were used for data analysis.

RESULTS

Among 528 family caregivers of persons living with dementia, ≈15.9% had depression. The final logistic regression model showed that intermediary determinants, such as living with a spouse/partner or utilizing a caregiver training program, lowered the likelihood of depression.

DISCUSSION

Health care professionals should pay greater attention to these individuals, and caregiver training programs should be made widely accessible and available.

HIGHLIGHTS

Approximately 15.9% of dementia family caregivers had depression. Family caregivers who were married or living with a partner were less likely to have depression. Family caregivers involved in caregiving training programs were less likely to have depression.

Understanding the incidence and recurrence of depression and associated risk factors in 9 years of follow-up: Results from a population-based sample

INTRODUCTION

This paper aims to analyse depression incidence and recurrence rates in a Spanish adult cohort, while also investigating associated risk factors based on depression status at baseline.

METHODS

Longitudinal, prospective study data of the Edad con Salud cohort was used, which comprises a sample representative of the non-institutionalized adult populace at the national level with a final sample size of 2655 Spanish adults. Competing risk regression models were estimated to determine the main risk factors for incident and recurrent depression.

RESULTS

The study found depression incidence at 6.11 per 1,000 person years, with recurrence rates up to 47.8 and 21.3 per 1,000 person years in those with depression at baseline and only history of depression, respectively, with higher rates found among women. Sociodemographic factors were found to primarily predict incident depression, while health and mental health indicators were significant predictors for recurrent depression.

CONCLUSIONS

Our results confirm the augmented risk of experiencing a new episode among individuals with proximal depression, where different risk factors seemed to play a role depending on episode type and depression proximity. These findings provide valuable insights for developing preventive strategies for depression in both the general population and those at risk.

The prevalence and determinants of alcohol use in the adult population of Tehran: insights from the Tehran Cohort Study (TeCS)

BACKGROUND

Although alcohol has been illegal in Iran for over four decades, its consumption persists. This study aims to determine the prevalence and determinants of alcohol consumption in Tehran, the Middle East's third-largest city, using data from the Tehran Cohort Study (TeCS).

METHODS

Our study encompasses data from 8420 individuals recorded between March 2016 and March 2019. We defined alcohol use as the lifetime consumption of alcoholic beverages and/or products. We calculated the age- and sex-weighted prevalence of alcohol use in addition to crude frequencies. We also determined the weighted prevalence of alcohol use in both genders. Multivariable logistic regressions were employed to investigate the adjusted odds ratios for the determinants of alcohol use.

RESULTS

The mean age of participants was 53.8 ± 12.7 years. The lifetime prevalence of alcohol use was 9.9% (95% confidence interval [95% CI]: 8.3-11.8%) among the total population, with a prevalence of 3.3% (95% CI: 2.4-4.5%) among females and 16.6% (95% CI: 14.3-19.3%) among males. Alcohol use showed a decreasing trend with age in both sexes (women: 4.4% and men: 1.5% per year) as well as in the total population (1.7%). The geographical distribution of alcohol use in Tehran indicated a significantly higher concentration (95% CI: 6.5-13%) in the southern regions compared to other areas. Younger age, higher education levels, smoking, opium use, hyperlipidemia, physical activity, and being overweight determined a higher prevalence of alcohol use.

CONCLUSIONS

The prevalence of alcohol use in Tehran is significant and exceeds previous estimates. Policymakers must address the rising incidence of alcohol use, particularly among the younger population.

Psychological interventions for preventing relapse in individuals with partial remission of depression: a systematic review and individual participant data meta-analysis

Partial remission after major depressive disorder (MDD) is common and a robust predictor of relapse. However, it remains unclear to which extent preventive psychological interventions reduce depressive symptomatology and relapse risk after partial remission. We aimed to identify variables predicting relapse and to determine whether, and for whom, psychological interventions are effective in preventing relapse, reducing (residual) depressive symptoms, and increasing quality of life among individuals in partial remission. This preregistered (CRD42023463468) systematic review and individual participant data meta-analysis (IPD-MA) pooled data from 16 randomized controlled trials (n = 705 partial remitters) comparing psychological interventions to control conditions, using 1- and 2-stage IPD-MA. Among partial remitters, baseline clinician-rated depressive symptoms (p = .005) and prior episodes (p = .012) predicted relapse. Psychological interventions were associated with reduced relapse risk over 12 months (hazard ratio [HR] = 0.60, 95% confidence interval [CI] 0.43-0.84), and significantly lowered posttreatment depressive symptoms (Hedges' g = 0.29, 95% CI 0.04-0.54), with sustained effects at 60 weeks (Hedges' g = 0.33, 95% CI 0.06-0.59), compared to nonpsychological interventions. However, interventions did not significantly improve quality of life at 60 weeks (Hedges' g = 0.26, 95% CI -0.06 to 0.58). No moderators of relapse prevention efficacy were found. Men, older individuals, and those with higher baseline symptom severity experienced greater reductions in symptomatology at 60 weeks. Psychological interventions for individuals with partially remitted depression reduce relapse risk and residual symptomatology, with efficacy generalizing across patient characteristics and treatment types. This suggests that psychological interventions are a recommended treatment option for this patient population.

Efficacy of Vortioxetine Versus Escitalopram on the Cognitive Profile of Patients With Depressive Disorder: A Comparative Study

BACKGROUND

Major depressive disorder (MDD) is a prevalent mental health condition with significant cognitive impairments, affecting millions worldwide. Cognitive dysfunction in MDD, encompassing attention, memory, executive function, and processing speed deficits, increases the disease burden and impacts treatment outcomes. Vortioxetine, a multimodal antidepressant, and escitalopram, a selective serotonin reuptake inhibitor, have both been utilized for MDD treatment, yet their comparative effects on cognitive function remain under-explored.

AIM

This study aimed to compare the effects of vortioxetine and escitalopram on cognitive function in patients with MDD.

METHODOLOGY

This prospective, randomized follow-up study (October 2023-2024) assessed 150 MDD patients meeting the following criteria: Montreal Cognitive Assessment Scale (MoCA) score ≤ 26 and Brief Cognitive Rating Scale (BCRS) score ≥ 1. Patients were randomly assigned to escitalopram (10 mg, n = 78) or vortioxetine (10 mg, n = 72), with 50 per group analyzed at the final evaluation. Cognitive function was assessed using MoCA and BCRS at baseline, week two, and week four.

RESULTS

Both vortioxetine and escitalopram improved cognitive function over four weeks. While the reduction in BCRS scores showed no statistically significant difference between the groups, MoCA scores indicated a slight advantage for escitalopram by the fourth week (p = 0.05). These findings suggest that both drugs effectively improve cognitive function, with escitalopram demonstrating a slight cognitive advantage over the study period.

CONCLUSION

Both vortioxetine and escitalopram improve cognitive symptoms in MDD, with escitalopram showing a modest cognitive advantage by the 4th week. These results support the efficacy of both medications for cognitive symptoms in MDD, with escitalopram potentially offering a slight edge in cognitive enhancement. Further long-term studies are warranted to confirm these findings and investigate the underlying neurobiological mechanisms.

Processed and ultra-processed foods are associated with depression and anxiety symptoms in a cross-sectional sample of urban Lebanese adults

While low dietary quality has been linked to poor mental health, evidence on more direct relations of specific dietary quality indicators, namely degrees of food processing, with mental health disorders remains limited. This study aims to investigate the association between food groups' intakes, defined based on their degree of food processing, with depression and anxiety symptoms in a sample of Lebanese adults. We hypothesized that higher intakes of ultra-processed foods (UPF) will be related to higher risk of depression and anxiety while an opposite association will be observed for unprocessed or minimally processed foods (MPF). Data come from a Lebanese cross-sectional study (n = 188 adults). The NOVA classification was adopted for evaluating the intakes of the 4 food groups: unprocessed or minimally processed foods (MPF); processed culinary ingredients (PCI); processed foods (PF) and ultra-processed foods (UPF). Associations between food group intakes in quartiles with depression and anxiety symptoms were analyzed using multivariable regression analyses adjusted for several confounders. Median energy intake was 2481.65 (2617.2) kcal/d, with 36.12% of Total Energy Intakes coming from MPF, 29.71% from PF, 25.25% from UPF, and 5.75% from PCI. Among participants, 33% and 27.7% had elevated depression and anxiety symptoms, respectively. Higher PF intake was associated with significantly lower odds of both depression and anxiety symptoms while a higher UPF intake was associated with higher odds of depression. Results confirm the hypothesized links between UPF and adverse mental health outcomes and highlight the need for further studies on PF intakes and mental health given the culture-specific nature of foods constituting this group.

Sociodemographics and clinical factors associated with depression treatment outcomes in 65,741 first-time users of selective serotonin reuptake inhibitors: A Danish cohort study in older adults

OBJECTIVE

To investigate a wide range of sociodemographic and clinical factors associated with treatment outcomes in older adults who initiated an SSRI for depression treatment in a real-world setting.

METHODS

This cohort study used Danish registry data covering all older adults (aged ≥65) who initiated SSRIs for depression from 2006 to 2017, first-time (since 1995). We followed the individuals for one year after their SSRI prescription. Six different outcomes were analyzed, including treatment discontinuation, switching, augmentation, psychiatric hospital contacts for depression, psychiatric hospital admission, and suicide attempt/self-harm. Association analyses employed Poisson regression, estimating incidence rate ratios with 95 % confidence intervals.

RESULTS

The study included 65,741 individuals with a mean age of 78.23 years, and 55.6 % were females. During follow-up, 40.1 % discontinued, 4.8 % switched, 20.3 % received augmentation, 3.0 % had psychiatric hospital contacts for depression, 3.2 % had psychiatric admission, and 0.1 % had suicide attempt/self-harm records. Differential treatment outcomes were observed based on sociodemographic and clinical factors. For example, being female, residing predominantly in rural areas, having psychiatric or somatic diagnoses, and using medications acting on blood/blood-forming organs, the cardiovascular system, or musculo-skeletal systems were linked to fewer unfavorable clinical outcomes. Conversely, marital status as being single or separated and the use of nervous system drugs were associated with a higher risk of unfavorable outcomes.

LIMITATIONS

Confounding by indication might remain a problem, and depression severity data was not unavailable.

CONCLUSIONS

Our findings emphasize considering patient characteristics in clinical decisions, as they can influence the clinical course of those undergoing depression treatment.

The protective role of employment in depression: insights from 2005 to 2018 NHANES information

Background

Depression is closely associated with employment status, which serves as a complex social determinant. This study explores the relationship between employment status and depression.

Methods

Data from the National Health and Nutrition Examination Survey (NHANES) spanning 2005 to 2018 were analyzed. The study included 29,452 participants aged 20 and older with complete data on employment and depression. Logistic regression models were applied to examine the association between employment and depression, adjusting for covariates such as age, gender, ethnicity, marital status, education, poverty-to-income ratio (PIR), BMI, diabetes, hypertension, smoking, and alcohol status.

Results

The study revealed an overall depression prevalence of 8.61%, with significant variation across employment statuses-non-employed (11.77%), part-time (6.58%), and full-time (4.52%) workers. Employed individuals, particularly those in the 40-59 age group and with lower PIRs, showed reduced odds of depression (OR 0.42, 95% CI: 0.36-0.48, p=0.000). Stratified analyses confirmed lower depression odds for employed individuals regardless of gender or marital status.

Conclusion

Employment status has a significant impact on depression risk, with full-time work showing the strongest protective effect against depressive symptoms. The study underscores the role of sociodemographic factors in depression and highlights the need for policies promoting stable employment and mental health support, especially for economically vulnerable groups.

Relationship between serum neurofilament light chain protein and depression: A nationwide survey and Mendelian randomization study

BACKGROUND

Investigating the link between serum neurofilament protein (sNfL) levels and depression remains an area of limited understanding. This study explores the correlation in US adults and employs Mendelian randomization (MR) to ascertain causality.

METHODS

Our cross-sectional study analyzed data from participants aged 20 and above in the National Health and Nutrition Examination Survey (2013-2014). We employed a weighted multiple logistic regression model to examine the relationship between ln (sNfL) and depression. Restricted cubic splines (RCS) were used to visualize non-linear relationships. Stratified analyses examined associations between ln(sNfL) and depression in different subgroups. Subsequently, we conducted a two-sample bidirectional Mendelian randomization (MR) to assess the causal relationship between sNfL and depression. The inverse variance-weighted (IVW) method was utilized as the primary analysis.

RESULTS

Among 1765 participants (mean age 45.19 years; 49.37 % male), 166 had depression with a Patient Health Questionnaire (PHQ-9) score ≥ 10. After adjusting for covariates, a positive correlation remained between sNfL and depression (OR 1.511, 95 % CI: 1.050-2.175). RCS curves indicated a non-linear association, with a turning point at 2.76 pg/ml. Stratified analyses revealed positive correlations in specific subgroups, with interactions involving age, race, family income, recreational activity, and ln(sNfL). MR using IVW found no significant causal relationship between sNfL and depression genetically (OR = 0.956, 95 % CI: 0.878-1.042), with reverse analysis yielding similar results (OR = 0.897, 95 % CI: 0.756-1.065).

CONCLUSIONS

This cross-sectional study highlights a significant correlation between ln(sNfL) and depression. However, MR results indicate no causal relationship between sNfL and depression.

Development and validation of a prognostic model to predict relapse in adults with remitted depression in primary care: secondary analysis of pooled individual participant data from multiple studies

BACKGROUND

Relapse of depression is common and contributes to the overall associated morbidity and burden. We lack evidence-based tools to estimate an individual's risk of relapse after treatment in primary care, which may help us more effectively target relapse prevention.

OBJECTIVE

The objective was to develop and validate a prognostic model to predict risk of relapse of depression in primary care.

METHODS

Multilevel logistic regression models were developed, using individual participant data from seven primary care-based studies (n=1244), to predict relapse of depression. The model was internally validated using bootstrapping, and generalisability was explored using internal-external cross-validation.

FINDINGS

Residual depressive symptoms (OR: 1.13 (95% CI: 1.07 to 1.20), p<0.001) and baseline depression severity (OR: 1.07 (1.04 to 1.11), p<0.001) were associated with relapse. The validated model had low discrimination (C-statistic 0.60 (0.55-0.65)) and miscalibration concerns (calibration slope 0.81 (0.31-1.31)). On secondary analysis, being in a relationship was associated with reduced risk of relapse (OR: 0.43 (0.28-0.67), p<0.001); this remained statistically significant after correction for multiple significance testing.

CONCLUSIONS

We could not predict risk of depression relapse with sufficient accuracy in primary care data, using routinely recorded measures. Relationship status warrants further research to explore its role as a prognostic factor for relapse.

CLINICAL IMPLICATIONS

Until we can accurately stratify patients according to risk of relapse, a universal approach to relapse prevention may be most beneficial, either during acute-phase treatment or post remission. Where possible, this could be guided by the presence or absence of known prognostic factors (eg, residual depressive symptoms) and targeted towards these.

TRIAL REGISTRATION NUMBER

NCT04666662.

Interpersonal symptoms in adolescence depression across Asian and European regions: a network approach

BACKGROUND

Major Depressive Disorder (MDD) poses a significant global health challenge, with symptom presentation potentially varying between adolescents and adults. Adolescence is a critical period marked by heightened vulnerability to interpersonal stresses, yet the impact of these stresses on the structure of depressive symptoms is not well understood. Recognizing the cultural nuances in how depression manifests among adolescents is crucial. To this end, this paper employs a network analysis approach, utilizing a comprehensive symptom checklist from the Multidimensional Depression Assessment Scale (MDAS). Our study investigates the role of interpersonal symptoms within the broader cluster of emotional, cognitive, and somatic symptoms and explores variations in adolescent groups in four Asian and European regions.

METHODS

We recruited a diverse sample of 6,348 adolescents aged 12 to 18 from Hong Kong, Taiwan, the UK, China, and the Netherlands using the Qualtrics platform. Employing the Gaussian Graphical Model, we established a network model of depressive symptoms as measured by the MDAS, segregating the sample into Asian and European regions to examine the interconnections between them. The study focused on identifying central symptom nodes and comparing the network structures between the two groups.

RESULTS

The analysis identified feeling worthless, low energy, being a burden to others, and low mood as central symptoms of depression. Notably, there were significant differences in the connections between depressive symptoms among Asian (Hong Kong, China and Taiwan) and European (UK and the Netherlands) adolescents, highlighting cultural variations in how interpersonal symptoms interact with emotional, cognitive, and somatic symptoms.

CONCLUSION

This study is pioneering in applying network analysis to include interpersonal symptoms in examining depression among a diverse adolescent population. It demonstrates that interpersonal symptoms are integral to the central features of depressive symptoms. Furthermore, our findings suggest that, compared to their UK and Dutch peers, interpersonal symptoms in Asian adolescents are uniquely connected to other symptom clusters, reflecting distinct cultural patterns.

LIMITATIONS

The study engaged a broad community sample; however, future research could benefit from including a larger sample size to allow for a more detailed analysis of a greater number of symptom nodes.

Differences in psychological treatment outcomes by ethnicity and gender: an analysis of individual patient data

PURPOSE

There are discrepancies in mental health treatment outcomes between ethnic groups, which may differ between genders. NHS Talking Therapies for anxiety and depression provide evidence-based psychological therapies for common mental disorders. This study examines the intersection between ethnicity and gender as factors associated with psychological treatment outcomes. Aims were to explore by gender: (1) differences in psychological treatment outcomes for minoritized ethnic people compared to White-British people, (2) whether differences are observed when controlling for clinical and socio-demographic factors associated with outcomes, and (3) whether organization-level factors moderate differences in outcomes between ethnic groups.

METHODS

Patient data from eight NHS Talking Therapies for anxiety and depression services (n = 98,063) was used to explore associations between ethnicity and outcomes, using logistic regression. Stratified subsamples were used to separately explore factors associated with outcomes for males and females.

RESULTS

In adjusted analyses, Asian (OR = 0.82 [95% CI 0.78; 0.87], p < .001, 'Other' (OR = 0.79 [95%CI 0.72-0.87], p < .001) and White-other (0.93 [95%CI 0.89-0.97], p < .001) ethnic groups were less likely to reliably recover than White-British people. Asian (OR = 1.48 [95% CI 1.35-1.62], p < .001), Mixed (OR = 1.18 [95% CI 1.05-1.34], p = .008), 'Other' (OR = 1.60 [95% CI 1.38-1.84], p < .001) and White-other (OR = 1.18 [95% CI 1.09-1.28], p < .001) groups were more likely to experience a reliable deterioration in symptoms. Poorer outcomes for these groups were consistent across genders. There was some evidence of interactions between ethnic groups and organization-level factors impacting outcomes, but findings were limited.

CONCLUSIONS

Across genders, Asian, 'Other' and White-other groups experienced worse treatment outcomes across several measures in adjusted models. Reducing waiting times or offering more treatment sessions might lead to increased engagement and reduced drop-out for some patient groups.

Efficacy and safety of Chinese patent medicines combined with antidepressants for treatment of depression in adults: A multiple-treatment meta-analysis

BACKGROUND

Combinations of Chinese patent medicines (CPM) with antidepressants (including selective serotonin reuptake inhibitors (SSRI), selective serotonin-norepinephrine reuptake inhibitors (SNRI), tricyclic antidepressants (TCA), and noradrenergic and specific serotonergic antidepressants (NaSSA)) are frequently utilized for treating depression in adults. However, the efficacy and safety of these combination treatments remain to be established.

METHODS

Systematic search was conducted in seven electronic databases, regulatory websites and international registers of trials from 1994 to 2023 that included adult patients with depressive disorders who received CPM combined with antidepressants. The Multiple-Treatment Meta-Analysis (MTMA) was conducted using a random effects model with Stata/MP17 and R4.3.5 software. Primary outcomes were total efficacy rate, Hamilton Depression Scale (HAMD) score, and Treatment Emergency Symptom Scale (TESS) score. Secondary outcomes included brain-derived neurotrophic factor (BDNF) levels.

RESULTS

A total of 146 randomized controlled trials (13,754 participants: 6929 in intervention and 6825 in control groups) were included. For total effective rate, Multiple-Treatment Meta-Analysis results showed that the overall effect of combined intervention was better compared with antidepressants alone, where Jieyuanshenkeli (JYASKL) presented the optimal option for improving total efficacy (OR = 5.39, 95% CI [2.60, 11.18], SUCRA = 84.50%). In reduding the HAMD, Shuganjieyujiaonang (SGJYJN) was most likely to reduce the HAMD score (SMD = -2.20, 95% CI [-3.06, -1.33], SUCRA = 86.10%), Jieyuanshenkeli (JYASKL),Tianewangbuxindan (TWBXD), Shuyukeli (SYKL), Anshenbuxinwan (ASBXW) combination intervention did not appear to be statistically superior to antidepressants alone. In theTreatment Emergency Symptom Scale (TESS), Wulinjiaonang induced the most significant reduction in TESS score (SMD = -1.98, 95% CI [-3.59, -0.36], SUCRA = 90.40%). Tianmengjiaonang (TMJN) + Antidepressants(AD) (SUCRA = 88.30%) displayed the highest scores in increasing the levels of BDNF, although not statistically significant compared to Antidepressants(AD) alone (SMD = 1.23, 95% CI [0.90, 1.55]).

CONCLUSION

Combinations of CPM and antidepressants showed superior efficacy over antidepressants alone. The optimal combinations were determined as Shuganjieyu Jiaonang (SGJYJN)/SSRIs and Jieyuanshenkeli (JYASKL)/SSRIs. In terms of safety, results showed that combination therapy did not show better TESS efficacy than antidepressants alone.Although some of the combination interventions were not superior than antidepressants alone in reducing HAMD scores,our findings provide a potentially significant alternative option for clinical complementary therapy. However, these results require further validation through larger sample sizes, multicenter randomized controlled trials, and real-world data.

Pet Attachment and Anxiety and Depression in Middle-Aged and Older Women

Importance

Understanding how attachment to pets can alleviate depression and anxiety offers valuable insights for developing preventive and therapeutic strategies, particularly for those with insecure attachment styles from childhood trauma.

Objective

To determine if a close bond with a pet is associated with reduced depression and anxiety, especially among women who experienced childhood abuse.

Design, Setting, and Participants

This cross-sectional study involved women who voluntarily enrolled in the Mind Body Study (MBS), a substudy of the Nurses' Health Study II (NHS2) focusing on psychosocial factors. Women reporting childhood abuse were oversampled to capture their psychosocial distress in adulthood. MBS participants were invited to complete comprehensive online questionnaires, which were administered twice (March 2013 and February 2014).

Exposure

Pet attachment measured by Lexington Attachment to Pets Scale (LAPS).

Main Outcomes and Measures

Levels of depression and anxiety (10-item Centre for Epidemiologic Studies Depression Scale [CESD-10]; Kessler Psychological Distress Scale [K6]; 7-item Generalized Anxiety Disorder scale [GAD-7]; Crown Crisp Experiential Index phobic anxiety subscale [CCI]), considered individually and combined into an overall z-score measure of anxiety and depression symptoms.

Results

A total of 214 women (mean [SD] age, 60.8 [3.9] years) were included; 156 women (72.6%) reported a history of childhood abuse. Of 688 invited MBS participants in 2013, 293 (42.6%) expressed interest; there were 228 completed questionnaires (response rate, 77.8%) in 2013 and 208 questionnaires (response rate, 71.0%) in 2014. LAPS scores were provided by 140 participants (65.4%), 78 (55.7%) for dogs and 46 (32.9%) for cats. Overall higher pet attachment on the LAPS score was significantly associated with lower GAD-7 scores (β = -0.17; 95% CI, -0.29 to -0.06), but there was no association for phobic anxiety or depression. There were no statistically significant associations between cat attachment and depression or anxiety. Higher dog attachment was associated with significantly lower scores in depression (CESD-10: β, -0.47; 95% CI, -0.68 to -0.26; K6: β = -0.42; 95% CI, -0.54 to -0.31), generalized anxiety (GAD-7: β = -0.47; 95% CI, -0.65 to -0.3), and the overall measure of anxiety and depression (z score: β = -0.12; 95% CI, -0.17 to -0.08), but there was no association between dog attachment and phobic anxiety (CCI: β = -0.08; 95% CI, -0.24 to 0.09). All effect sizes for associations were higher when analyses were restricted to women with a history of childhood abuse.

Conclusions and relevance

In this explorative cross-sectional study, strong attachment to pets, especially dogs, was associated with lower anxiety and depression symptoms. The favorable association was particularly apparent in women with a history of childhood abuse.

Parent-Child Relationships: A Shield Against Maternal Depression in the Midst of Household Chaos

Background

Depression, a severe mental disorder, not only jeopardizes the health of mothers but also significantly negative impacts on families and their children. This study investigates the correlation between household chaos and maternal depression.

Methods

This study adopted a cross-sectional design and used the Confusion, Hubbub, and Order Scale, Dyadic Adjustment Scale, Parent-Child Relationship Scale, and Beck Depression Inventory to assess 1947 mothers of children in seven kindergartens in Shanghai, China.

Results

The findings revealed a significant positive correlation between household chaos, marital conflict, and maternal depression. Marital conflict also showed a significantly positively correlated with maternal depression. Marital conflict mediates the relationship between household chaos and maternal depression. Parent-child relationships moderated the direct effect of household chaos on maternal depression. When parent-child relationships were low, household chaos had a greater predictive effect on maternal depression. Conversely, when parent-child relationships were high, the predictive effect of household chaos on maternal depression was reduced.

Conclusion

This study reveals that parent-child relationships play a protective role in the impact of household chaos on maternal depression. This study significantly contributes to enriching the social support buffering model.

Mistakes are not an option: aggression from peers and other correlates of anxiety and depression in pediatricians in training

Introduction

Pediatricians in training are a population at risk for anxiety and depression: they face long working hours, they are confronted with the suffering and death of a vulnerable population and may have personal characteristics that put them in danger. Nonetheless, few studies have looked at their prevalence and associated factors. We aimed to compare demographic, professional activities, adversities and perfectionism personality features between a group of pediatricians in training with depression and/or anxiety and a group of pediatricians in training without depression nor anxiety and, to identify the variables that increase the probabilities of depression and/or anxiety in pediatricians in training.

Methods

Pediatric residents who voluntarily answered an online survey distributed via personal and institutional social media channels from October 2019 to April 2021, as part of a cross-sectional study with medical specialists and residents from Mexico were included. Demographic information, professional activities and adversities, perfectionism personality features (Multidimensional Perfectionism Scale), depression and anxiety (ICD-11 PHC) were evaluated. For comparison purposes Chi-square tests (χ2) and independent sample t-tests were used. A logistic regression analysis was used to identify those variables that increase the probabilities of depression and/or anxiety.

Results

934 pediatric residents answered the survey. 11.6% reported having depression and 20% anxiety. Being single, a history of anxious or depressive episodes, being the resident in charge of a patient who died, aggressions from colleagues and a high concern for errors were associated with current depression and/or anxiety.

Discussion

Screening for depressive and anxious symptoms should be routinely performed from entry to the residency to favor early intervention. A shift from promoting perfectionism to a more compassionate training could serve a population facing so many adversities.

Prediction of Positive Patient Health Questionnaire-2 Screening Using Area Deprivation Index in Primary Care

Depression is recognized as a significant public health issue in the United States. The National Survey on Drug Use and Health reports that 21.0 million adults aged 18 or older had major depressive disorder in 2020, including 14.8 million experiencing a major depressive episode with severe impairment. The aim is to predict the positivity of Patient Health Questionnaire-2 (PHQ-2) outcomes among patients in primary care settings by analyzing a range of variables, including socioeconomic status, demographic characteristics, and health behaviors, thereby identifying those at increased risk for depression. Employing a machine learning approach, the study utilizes retrospective data from electronic health records across 15 primary care clinics in South Florida to explore the relationship between social determinants of health (SDoH), including area of deprivation index (ADI) and PHQ-2 positivity. The study encompasses 15 primary care clinics located in South Florida, where a diverse patient population receives care. Analysis included 94,572 patient visits; 74,636 records were included in the study. If a zip+4 was not available or an ADI score did not exist, the visit was not included in the final analysis. Screening involved the PHQ-2, assessing depressed mood and anhedonia, with a cutoff >2 indicating positive screening. ADI was used to assess SDoH by matching patients' residential postal codes to ADI national percentiles. Demographics, sexual history, tobacco use, caffeine intake, and community involvement were also evaluated in the study. Over 40 machine learning algorithms were explored for their accuracy in predicting PHQ-2 outcomes, using software tools including Scikit-learn and stats models in Python. Variables were normalized, scored, and then subjected to predictive regression models, with Random Forest showing outstanding performance. Feature engineering and correlation analysis identified ADI, age, education, visit type, coffee intake, and marital status as significant predictors of PHQ-2 positivity. The area under the curve and model accuracies varied across clinics, with specific clinics showing higher predictive accuracy and others (p > .05). The study concludes that the ADI, as a proxy for SDoH, alongside other individual factors, can predict PHQ-2 positivity. Health organizations can use this information to anticipate health needs and resource allocation.

What predicts response to sertraline for people with depression in primary care? a secondary data analysis of moderators in the PANDA trial

PURPOSE

Antidepressants are a first-line treatment for depression, yet many patients do not respond. There is a need to understand which patients have greater treatment response but there is little research on patient characteristics that moderate the effectiveness of antidepressants. This study examined potential moderators of response to antidepressant treatment.

METHODS

The PANDA trial investigated the clinical effectiveness of sertraline (n = 326) compared with placebo (n = 329) in primary care patients with depressive symptoms. We investigated 11 potential moderators of treatment effect (age, employment, suicidal ideation, marital status, financial difficulty, education, social support, family history of depression, life events, health and past antidepressant use). Using multiple linear regression, we investigated the appropriate interaction term for each of these potential moderators with treatment as allocated.

RESULTS

Family history of depression was the only variable with weak evidence of effect modification (p-value for interaction = 0.048), such that those with no family history of depression may have greater benefit from antidepressant treatment. We found no evidence of effect modification (p-value for interactions≥0.29) by any of the other ten variables.

CONCLUSION

Evidence for treatment moderators was extremely limited, supporting an approach of continuing discuss antidepressant treatment with all patients presenting with moderate to severe depressive symptoms.

Purpose in life, loneliness and depression among patients with substance use disorders in the psychiatric hospitals in Ghana

Substance use disorder is a global mental health issue. Purpose in life, Loneliness and depression are key indicators of poor mental health, and people with substance use disorder are more likely to experience low purpose in life, depression, and loneliness. This study aims to further the understanding of purpose in life, depression and loneliness among substance use disorders (SUD) patients in three hospitals in Ghana. It uses a cross-sectional survey design. A total of 425 SUD inpatients were screened. Beck Depression Inventory-II, the revised UCLA Loneliness Scale, and the Purpose in Life Test were utilised to measure depression, loneliness, and purpose in life respectively. Data were analysed using the SPSS version 23 for Windows. Data from 378 participants were collected for this study using a cross sectional survey design; after data cleaning, frequency tables (for categorical variables) and descriptive statistics (for continuous variables) were used to summarise the demographics and the three outcome variables depression, purpose in life, and loneliness. Our findings indicate that overall, participants are more likely to experience low sense of purpose in life, depression, and loneliness compared to the general population. There was no statistically significant relationship between depression and loneliness (r = 0.030, p = 0.567). There was a statistically significant negative relationship between depression and purpose in life (r = -0.514, p < 0.001). There was a statistically significant positive relationship between purpose in life and loneliness (r = 0.147, p = 0.004). There was no gender difference in depression, purpose in life, and loneliness among SUDs patients in psychiatric hospitals. There were no significant differences in purpose in life, depression and loneliness based on marital status. It is anticipated that the findings of this study will inform policies and clinical practice regarding service provision for patients with SUDs.

Long-term depressive symptom trajectories and related baseline characteristics in primary care patients: Analysis of the PsicAP clinical trial

BACKGROUND

There is heterogeneity in the long-term trajectories of depressive symptoms among patients. To date, there has been little effort to inform the long-term trajectory of symptom change and the factors associated with different trajectories. Such knowledge is key to treatment decision-making in primary care, where depression is a common reason for consultation. We aimed to identify distinct long-term trajectories of depressive symptoms and explore pre-treatment characteristics associated with them.

METHODS

A total of 483 patients from the PsicAP clinical trial were included. Growth mixture modeling was used to identify long-term distinct trajectories of depressive symptoms, and multinomial logistic regression models to explore associations between pre-treatment characteristics and trajectories.

RESULTS

Four trajectories were identified that best explained the observed response patterns: "recovery" (64.18%), "late recovery" (10.15%), "relapse" (13.67%), and "chronicity" (12%). There was a higher likelihood of following the recovery trajectory for patients who had received psychological treatment in addition to the treatment as usual. Chronicity was associated with higher depressive severity, comorbidity (generalized anxiety, panic, and somatic symptoms), taking antidepressants, higher emotional suppression, lower levels on life quality, and being older. Relapse was associated with higher depressive severity, somatic symptoms, and having basic education, and late recovery was associated with higher depressive severity, generalized anxiety symptoms, greater disability, and rumination.

CONCLUSIONS

There were different trajectories of depressive course and related prognostic factors among the patients. However, further research is needed before these findings can significantly influence care decisions.

Association between drinking behaviors, sleep duration, and depressive symptoms

Excessive alcohol consumption has been consistently linked to depression. This study, utilizing nationwide samples from the Korea National Health and Nutrition Examination Survey (n = 21,440) examined the association between drinking behaviors and depressive symptoms while also exploring the influence of sleep duration on this relationship. Demographic, socioeconomic, and health-related factors were included as covariates in the multivariable logistic regression analysis to assess their relationships with depressive symptoms. Based on their sleep duration, the participants were divided into subgroups to explore how sleep duration affects the relationship between drinking behaviors and depressive symptoms. Moderate alcohol consumption (1-4 times a month) was associated with reduced likelihood of experiencing depressive symptoms in women (p = 0.024), with a similar trend observed among men (p = 0.001). Men who started consuming alcohol before the age of 19 had a higher likelihood of experiencing depressive symptoms (p = 0.048). Only women who consumed more alcohol per occasion (≥ 7 drinks) had higher odds of depressive symptoms (p = 0.001). This study revealed complex factors that influence depressive symptoms, including alcohol consumption and sleep duration. This highlights the importance of tailored interventions based on sleep duration and sociodemographic characteristics for preventing and treating depression.

Associations of perceived stress with loneliness and depressive symptoms: the mediating role of sleep quality

BACKGROUND

Whether perceived stress is associated with loneliness and depressive symptoms in general adults, and to what extent sleep quality mediates the associations, remains unknown. The aim of this study was to estimate the associations of perceived stress with loneliness and depressive symptoms, and the mediating role of sleep quality in these associations.

METHODS

Cross-sectional data on 734 participants (aged 18-87 years) were analyzed. Perceived stress was assessed using the 10-item Perceived Stress Scale (PSS-10; range 0-40). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI; range 0-21). Loneliness was assessed using the three-item short form of the Revised University of California, Los Angeles (UCLA) loneliness scale (range 3-9). Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression (CESD-10) Scale (range 0-30). General linear regression models, multivariable logistic regression models, and formal mediation analysis were performed.

RESULTS

After adjustment for age and sex, we found that with each 1-point increment in the perceived stress score, both the loneliness score (β = 0.07; 95% confidence interval [CI]: 0.06, 0.08) and depression score (β = 0.45; 95% CI: 0.40, 0.49) increased significantly. Robust results were observed when adjusting for more confounders. Furthermore, sleep quality mediated 5.3% (95% CI: 1.3%, 10.0%; P = 0.014) and 9.7% (95% CI: 6.2%, 14.0%; P < 0.001) of the associations of perceived stress score with loneliness score and depression score, respectively.

CONCLUSIONS

In general Chinese adults, perceived stress was positively associated with loneliness and depressive symptoms, and sleep quality partially mediated these associations. The findings reveal a potential pathway from perceived stress to mental health through sleep behaviors, and highlight the importance of implementing sleep intervention programs for promoting mental health among those who feel highly stressed.

Demographic and clinical characteristics associated with anxiety and depressive symptom outcomes in users of a digital mental health intervention incorporating a relational agent

BACKGROUND

Digital mental health interventions (DMHIs) may reduce treatment access issues for those experiencing depressive and/or anxiety symptoms. DMHIs that incorporate relational agents may offer unique ways to engage and respond to users and to potentially help reduce provider burden. This study tested Woebot for Mood & Anxiety (W-MA-02), a DMHI that employs Woebot, a relational agent that incorporates elements of several evidence-based psychotherapies, among those with baseline clinical levels of depressive or anxiety symptoms. Changes in self-reported depressive and anxiety symptoms over 8 weeks were measured, along with the association between each of these outcomes and demographic and clinical characteristics.

METHODS

This exploratory, single-arm, 8-week study of 256 adults yielded non-mutually exclusive subsamples with either clinical levels of depressive or anxiety symptoms at baseline. Week 8 Patient Health Questionnaire-8 (PHQ-8) changes were measured in the depressive subsample (PHQ-8 ≥ 10). Week 8 Generalized Anxiety Disorder-7 (GAD-7) changes were measured in the anxiety subsample (GAD-7 ≥ 10). Demographic and clinical characteristics were examined in association with symptom changes via bivariate and multiple regression models adjusted for W-MA-02 utilization. Characteristics included age, sex at birth, race/ethnicity, marital status, education, sexual orientation, employment status, health insurance, baseline levels of depressive and anxiety symptoms, and concurrent psychotherapeutic or psychotropic medication treatments during the study.

RESULTS

Both the depressive and anxiety subsamples were predominantly female, educated, non-Hispanic white, and averaged 38 and 37 years of age, respectively. The depressive subsample had significant reductions in depressive symptoms at Week 8 (mean change =-7.28, SD = 5.91, Cohen's d = -1.23, p < 0.01); the anxiety subsample had significant reductions in anxiety symptoms at Week 8 (mean change = -7.45, SD = 5.99, Cohen's d = -1.24, p < 0.01). No significant associations were found between sex at birth, age, employment status, educational background and Week 8 symptom changes. Significant associations between depressive and anxiety symptom outcomes and sexual orientation, marital status, concurrent mental health treatment, and baseline symptom severity were found.

CONCLUSIONS

The present study suggests early promise for W-MA-02 as an intervention for depression and/or anxiety symptoms. Although exploratory in nature, this study revealed potential user characteristics associated with outcomes that can be investigated in future studies.

TRIAL REGISTRATION

This study was retrospectively registered on ClinicalTrials.gov (#NCT05672745) on January 5th, 2023.

The association of changes in leisure-time physical activity on depressive symptoms during Covid-19 in German adults: A longitudinal study

This longitudinal survey assessed preventive and curative antidepressant effects of at least 75 min/week of leisure-time physical activity (LTPA) at different timepoints of the Covid-19 pandemic. We further investigated if high self-regulation skills were associated with higher odds of initiating or maintaining LTPA during the pandemic. Data was collected online from 4253 participants (age: m = 33.65 years, SD = 0.79; 79 % female) during the first quarantine measures in Germany (T1), as well as 4 weeks (T2), and 8 months (T3) later. We performed linear mixed models with changes (T2-T1, T3-T1) in LTPA and baseline major depressive disorder (MDD) as predictors (main effects and interaction effect) and depressive symptoms (at T2, T3) as the primary outcome. We found significant interaction effects of baseline depression and change in LTPA on depressive symptoms at T2 and T3 (p < 0.001). For probable cases of MDD an increasing LTPA to ≥75 min/week (vs. no change, <75 min/week) was associated with less depressive symptoms at T2 and T3 (p = 0.003, d = 0.28). For absence of depression at baseline, remaining at ≥75 min/week of LTPA was associated with less depressive symptoms at T2 and T3 compared to remaining at <75 min/week (p = 0.006, d = 0.11) or decreasing LTPA to <75 min/week (p = 0.018, d = 0.11). Reporting high self-regulation at T1 was associated with higher odds of performing ≥75 min/week of LTPA at T2/T3 (OR = 1.74, p < 0.001). In general, studies report reduced LTPA during Covid-19. To benefit from the reported preventive and interventional effects, further interventions should focus on improving physical activity related self-regulation to identify and overcome barriers for LTPA.

Prevalence of depression and association with all-cause and cardiovascular mortality among individuals with type 2 diabetes: a cohort study based on NHANES 2005-2018 data

BACKGROUND

Individuals with diabetes have increased risk of depression, but there are limited nationally representative studies on this topic. We aimed to investigate the prevalence and predictors of depression, as well as its impact on all-cause and cardiovascular mortality in adults with type 2 diabetes (T2DM) using a prospective cohort study and a representative sample of the U.S.

POPULATION

METHODS

We analyzed National Health and Nutrition Examination Survey (NHANES) data from 2005 to 2018 and linked it with the most recent publicly available National Death Index (NDI) data. Individuals aged 20 years or old who had depression measurements were included. Depression was defined as a Patient Health Questionnaire (PHQ-9) score ≥ 10, and categorized into moderate (10-14 points) and moderately severe to severe (≥ 15 points). Cox proportional hazard models were used to estimate the association between depression and mortality.

RESULTS

Among 5695 participants with T2DM, 11.6% had depression. Depression was associated with female gender, younger age, overweight, lower education, being unmarried, smoking, and a history of coronary heart disease and stroke. During a mean follow-up period of 78.2 months, 1161 all-cause deaths occurred. Total depression and moderately severe to severe depression significantly increased all-cause mortality (adjusted hazard ratio [aHR] 1.36, 95% CI [1.09-1.70]; 1.67 [1.19-2.34]) and non-cardiovascular mortality (aHR 1.36, 95% CI [1.04-1.78]; 1.78, 95% CI [1.20-2.64]), but not cardiovascular mortality. Subgroup analysis showed a significant association between total depression and all-cause mortality in males (aHR 1.46, 95% CI [1.08-1.98]) and those aged 60 years or older (aHR 1.35, 95% CI [1.02-1.78]). Any severity of depression was not significantly associated with cardiovascular mortality in age- or gender- stratified subgroups.

CONCLUSIONS

In a nationally representative sample of U.S. adults with T2DM, approximately 10% experienced depression. Depression did not significantly associate with cardiovascular mortality. However, comorbid depression in T2DM patients increased the risk of all-cause and non-cardiovascular mortality. The impact of depression on mortality varied across subgroups. Therefore, healthcare providers should consider incorporating depression screening and management into routine care, especially for subgroups with specific risk factors, due to the increased risk of all-cause mortality in T2DM patients with depression.

Influence of Sociodemographic, Premorbid, and Injury-Related Factors on Post-Traumatic Stress, Anxiety, and Depression after Traumatic Brain Injury

Psychopathological symptoms are common sequelae after traumatic brain injury (TBI), leading to increased personal and societal burden. Previous studies on factors influencing Post-traumatic Stress Disorder (PTSD), Generalized Anxiety Disorder (GAD), and Major Depressive Disorder (MDD) after TBI have produced inconclusive results, partly due to methodological limitations. The current study investigated the influence of commonly proposed factors on the clinical impairment, occurrence, frequency, and intensity of symptoms of PTSD, GAD, and MDD after TBI. The study sample comprised 2069 individuals (65% males). Associations between psychopathological outcomes and sociodemographic, premorbid, and injury-related factors were analyzed using logistic regression, standard, and zero-inflated negative binomial models. Overall, individuals experienced moderate levels of PTSD, GAD, and MDD. Outcomes correlated with early psychiatric assessments across domains. The clinical impairment, occurrence, frequency, and intensity of all outcomes were associated with the educational level, premorbid psychiatric history, injury cause, and functional recovery. Distinct associations were found for injury severity, LOC, and clinical care pathways with PTSD; age and LOC:sex with GAD; and living situation with MDD, respectively. The use of suitable statistical models supported the identification of factors associated with the multifactorial etiology of psychopathology after TBI. Future research may apply these models to reduce personal and societal burden.

Psychological therapies for depression and cardiovascular risk: evidence from national healthcare records in England

AIMS

People with depression are up to 72% more at risk to develop cardiovascular disease (CVD) in their lifetime. Evidence-based psychotherapies are first-line interventions for the treatment of depression and are delivered nationally in England through the National Health Service via the Improving Access to Psychological Therapy (IAPT) primary care programme. It is currently unknown whether positive therapy outcomes may be associated with cardiovascular risk reduction. This study aimed to examine the association between psychotherapy outcomes for depression and incident CVD.

METHODS AND RESULTS

A cohort of 636 955 individuals who have completed a course of psychotherapy was built from linked electronic healthcare record databases of national coverage in England: the national IAPT database, the Hospital Episode Statistics (HES) database, and the HES-ONS (Office of National Statistics) mortality database. Multivariable Cox models adjusting for clinical and demographic covariates were run to estimate the association between reliable improvement from depression and the risk of subsequent incidence of cardiovascular events. After a median follow-up of 3.1 years, reliable improvement from depression symptoms was associated with a lower risk of new onset of any CVD [hazard ratio (HR): 0.88, 95% confidence interval (CI): 0.86, 0.89], coronary heart disease (HR: 0.89, 95% CI: 0.86, 0.92), stroke (HR: 0.88, 95% CI: 0.83, 0.94), and all-cause mortality (HR: 0.81, 95% CI: 0.78, 0.84). This association was stronger in the under 60 compared with the over 60 for all outcomes. Results were confirmed in sensitivity analyses.

CONCLUSION

Management of depression through psychological interventions may be associated with reduced risk of CVD. More research is needed to understand the causality of these associations.

Understanding the psychological therapy treatment outcomes for young adults who are not in education, employment, or training (NEET), moderators of outcomes, and what might be done to improve them

BACKGROUND

To determine: whether young adults (aged 18-24) not in education, employment or training (NEET) have different psychological treatment outcomes to other young adults; any socio-demographic or treatment-related moderators of differential outcomes; and whether service-level changes are associated with better outcomes for those who are NEET.

METHODS

A cohort was formed of 20 293 young adults treated with psychological therapies in eight Improving Access to Psychological Therapies services. Pre-treatment characteristics, outcomes, and moderators of differential outcomes were compared for those who were and were not NEET. Associations between outcomes and the following were assessed for those that were NEET: missing fewer sessions, attending more sessions, having a recorded diagnosis, and waiting fewer days between referral and starting treatment.

RESULTS

Those who were NEET had worse outcomes: odds ratio (OR) [95% confidence interval (CI)] for reliable recovery = 0.68 (0.63-0.74), for deterioration = 1.41 (1.25-1.60), and for attrition = 1.31 (1.19-1.43). Ethnic minority participants that were NEET had better outcomes than those that were White and NEET. Living in deprived areas was associated with worse outcomes. The intensity of treatment (high or low) did not moderate outcomes, but having more sessions was associated with improved outcomes for those that were NEET: odds (per one-session increase) of reliable recovery = 1.10 (1.08-1.12), deterioration = 0.94 (0.91-0.98), and attrition = 0.68 (0.66-0.71).

CONCLUSIONS

Earlier treatment, supporting those that are NEET to attend sessions, and in particular, offering them more sessions before ending treatment might be effective in improving clinical outcomes. Additional support when working with White young adults that are NEET and those in more deprived areas may also be important.

Circadian rhythm biomarker from wearable device data is related to concurrent antidepressant treatment response

Major depressive disorder (MDD) is associated with circadian rhythm disruption. Yet, no circadian rhythm biomarkers have been clinically validated for assessing antidepressant response. In this study, 40 participants with MDD provided actigraphy data using wearable devices for one week after initiating antidepressant treatment in a randomized, double-blind, placebo-controlled trial. Their depression severity was calculated pretreatment, after one week and eight weeks of treatment. This study assesses the relationship between parametric and nonparametric measures of circadian rhythm and change in depression. Results show significant association between a lower circadian quotient (reflecting less robust rhythmicity) and improvement in depression from baseline following first week of treatment (estimate = 0.11, F = 7.01, P = 0.01). There is insufficient evidence of an association between circadian rhythm measures acquired during the first week of treatment and outcomes after eight weeks of treatment. Despite this lack of association with future treatment outcome, this scalable, cost-effective biomarker may be useful for timely mental health care through remote monitoring of real-time changes in current depression.

Measurement invariance of the PHQ-9 and GAD-7 across males and females seeking treatment for common mental health disorders

BACKGROUND

The nine-item Patient Health Questionnaire (PHQ-9) and the seven-item Generalised Anxiety Disorder scale (GAD-7) scales are routinely used in research and clinical practice. Whilst measurement invariance of these measures across gender has been demonstrated individually in general population studies and clinical samples, less is known about invariance of the distinct but correlated latent factors ('depression' and 'anxiety'). The current study assessed measurement invariance of these constructs across males and females seeking treatment for common mental health disorders.

METHODS

Data were provided from eight psychological treatment services in London, England. Data from initial assessments with the services where individual items on the PHQ-9 and GAD-7 were available were included in analyses. Measurement invariance was explored across self-identified genders, with 'male' and 'female' categories available in the dataset. Sensitivity analyses were conducted using propensity score matching on sociodemographic and clinical variables.

RESULTS

Data were available for 165,872 patients (110,833 females, 55,039 males). There was evidence of measurement invariance between males and females in both the full sample and a propensity score matched sample (n = 46,249 in each group).

CONCLUSIONS

Measurement invariance of the correlated depression and anxiety factors of PHQ-9 and GAD-7 were indicated in this sample of individuals seeking psychological treatment for CMHDs. These results support the use of these measures in routine clinical practice for both males and females. This is of particular importance for assessing the prevalence of clinically significant levels of symptoms as well as comparing treatment outcomes across genders.

Examining Contextual Influences Affecting health-related Quality of life Among under-resourced Appalachian Patients Attending pop-up Medical Clinics

Appalachian residents face substantial barriers to accessing health care and these barriers have negative ramifications for this community's health-related quality of life (HRQoL) [1, 2]. Pop-up medical clinics address some of these barriers by offering a range of free health care services throughout Appalachia. Although these services are undoubtedly helpful, information on how these clinics may be linked to HRQoL changes among under-resourced communities is limited. The present study is among the first to examine how (1) individuals attending pop-up medical clinics present on HRQoL indicators, (2) how HRQoL changes 3-months post-clinic, and (3) how individual, social, and community factors interact with HRQoL at presentation and change in HRQoL 3-months post-clinic. Data were collected from 243 individuals attending one of seven pop-up medical clinics across Central, South Central, and Southern Appalachia. During the week of the clinic, participants completed a survey assessing individual, social, and community factors as well as HRQoL variables (i.e., overall health, depressive symptoms, pain, sleep quality, and several physical symptoms). Participants completed the same survey 3-months post-clinic. Results revealed that baseline individual, social, and community factors were predictive of HRQoL indicators at baseline; individual and social factors also uniquely predicted change in HRQoL at 3-months post-clinic. Within the Social Ecological Framework, these data emphasize the significance of individual and social level factors on an individual's HRQoL. Clinical implications and directions for future research are discussed.

COVID-19 Vaccination Is Not Associated with Psychiatric Adverse Events: A Meta-Analysis

Coronavirus disease 2019 (COVID-19) has been a global health problem since December 2019. Vaccination has been widely considered the best way to prevent COVID-19 pandemic, but public concerns about the safety of vaccines remain. There have been many studies reporting adverse events in the vaccinated. However, to date, no meta-analysis of the association of COVID-19 vaccination with psychiatric adverse events has been conducted yet. In this meta-analysis, studies on depression, anxiety and distress after COVID-19 vaccination were searched in the PubMed, Cochrane and Embase from January 2020 to April 2022. The OR of depression in four studies with a total sample size of 462,406 is obtained as 0.88 (95% CI; 0.75, 1.03), and the OR of anxiety as 0.86 (95% CI; 0.71, 1.05). However, there were no statistically significant differences between the groups. The mean difference of distress in two studies was −0.04 (95%CI; −0.05, −0.02; p < 0.0001). As a result of the moderator analysis, married people experienced less depression and anxiety after vaccination, and in White people, depression after vaccination was lower than others. We also found that people with a history of COVID-19 infection were more depressed and anxious after vaccination. We suggest that COVID-19 vaccination was not associated with a worsening of depression and anxiety.

Proinflammatory dietary pattern and depression risk in older adults: Prospective analyses from the Seniors-ENRICA studies

BACKGROUND & AIMS

Only a few studies have assessed the association between a proinflammatory diet and the risk of depression in older adults, and they have rendered weak results. The present study analysed the association between the Dietary Inflammatory Index (DII) and incident self-reported diagnosis or symptoms of depression in two cohorts of community-dwelling older adults in Spain.

METHODS

We used data from the Seniors-ENRICA-I (SE-I) and Seniors-ENRICA-II (SE-II) cohorts. In both cohorts, the baseline DII was calculated from habitual food consumption estimated with a validated computer-based diet history. The incidence of both physician self-reported diagnosis of depression and mild-to-major depressive symptoms (≥3 on the 10-item Geriatric Depression Scale) was analysed. Logistic regression models were adjusted for the main potential confounders, such as sociodemographics, lifestyles, and comorbidities. The results of both cohorts were pooled using a random effects model.

RESULTS

Among the 1627 participants in SE-I (mean age 71.5 ± 5.5 y, 53.1% women) and the 1579 in SE-II (mean age 71.4 ± 4.2, 46.7% women), 86 (5.3%) and 140 (8.9%) incident cases of depression were identified after a mean 3.2-y and 2.3-y follow-up, respectively. The fully adjusted odds ratio (95% confidence interval) of incident depression for the highest (the highest proinflammatory diet) versus the lowest quartile of DII was 2.76 (1.25-6.08, p-for-trend = 0.005) in the SE-I, 1.90 (1.04-3.40, p-for-trend = 0.005) in the SE-II and 2.07 (1.01-3.13) in the pooled cohorts. The results were consistent across strata defined by sex, age, physical activity, loneliness/poor social network, and morbidity.

CONCLUSIONS

A proinflammatory dietary pattern is associated with depression risk in older adults. Future research should evaluate whether reducing the inflammatory component of diet leads to reduced depression symptoms in this population.

The Mediating Role of Cumulative Fatigue on the Association between Occupational Stress and Depressive Symptoms: A Cross-Sectional Study among 1327 Chinese Primary Healthcare Professionals

Occupational stress and depressive symptoms are common among professionals in the primary healthcare system, and the former can lead to a more severe level of the latter. However, there are few studies on the mediating effect of occupational stress on depressive symptoms using cumulative fatigue as a mediating variable. The Core Occupational Stress Scale, the Self Diagnosis Scale of Workers' Cumulative Fatigue, and the Patient Health Questionnaire were used in the proposed study. To analyze and test the mediating effect, the hierarchical regression analysis method and the Bootstrap method were applied. Our results showed that occupational stress was positively correlated with the level of cumulative fatigue (p < 0.01) and depressive symptoms (p < 0.01). Cumulative fatigue played a partial, mediating role between the four dimensions of occupational stress and depressive symptoms, and the effect size of occupational stress and each dimension was 0.116 (95% CI: 0.096-0.135, p < 0.001), -0.204 (95% CI: -0.245--0.166, p < 0.001), 0.179 (95% CI: 0.143-0.218, p < 0.001), 0.333 (95% CI: 0.283-0.385, p < 0.001), and -0.210 (95% CI: -0.292--0.132, p < 0.001), respectively, while the percentages of the mediating effects were 43.56%, 44.46%, 48.58%, 71.26%, and 45.80%, respectively. Occupational stress can directly or indirectly affect depressive symptoms through the mediating effect of cumulative fatigue. Therefore, primary healthcare professionals can reduce occupational stress, which in turn relieves depressive symptoms, and thus reduce cumulative fatigue levels.

Are students less likely to respond to routinely delivered psychological treatment? A retrospective cohort analysis

BACKGROUND

Depression and anxiety disorders are increasingly prevalent among university students, making the provision of effective treatment in this population a priority. Whilst campus-based services provide some psychological treatments, many students are treated by routine adult psychological treatment services which have no focus or adaptations to treatment for student populations. We aimed to compare psychological treatment outcomes between university students and young adults (aged 18-25) in employment to explore whether routinely delivered psychological interventions are equally effective for these groups, or whether students report poorer outcomes.

METHODS

A retrospective cohort was formed of 19,707 patients treated by eight National Health Service (NHS) Improving Access to Psychological Therapies (IAPT) services in England. Associations between student status (compared to same-age employed adults) and psychological treatment outcomes were explored using logistic regression models. Models were adjusted for important treatment, clinical and demographic characteristics, and propensity score matching was used to explore the robustness of effects.

RESULTS

Students and the employed comparison group were similar on baseline characteristics at assessment, but students were less likely to reliably recover (OR = 0.90 [95% CI = 0.83;0.96]) and reliably improve (OR = 0.91 [95% CI = 0.84;0.98]) by the end of treatment in fully adjusted models. Students and the employed group did not differ regarding the likelihood of deterioration (OR = 0.89 [95% CI = 0.78;1.02]) or treatment dropout (OR = 1.01 [95% CI = 0.93;1.11]).

CONCLUSIONS

Students appear at risk of poorer outcomes compared to employed younger adults when treated in routine psychological treatment services. Students may require additional support and treatment adaptations that account for student-specific stressors as this might improve psychological treatment outcomes.

Temporal Trends and Differences in Sexuality among Depressed and Non-Depressed Adults in the United States

This study aimed to examine temporal trends and differences in sexuality between depressed and non-depressed adults aged 18-59 in the United States from 2005 to 2016. A total of 21,437 people (5432 with depression) were enrolled in this cross-sectional study. From 2005-2008 to 2013-2016, the average age at first sexual intercourse decreased, while the proportion of normal frequency of sexual activity and heterosexual sexual orientation increased among all the participants. Some differences in sexuality were found between the depressed and non-depressed groups. The average age at first sexual intercourse (p < 0.001), the proportion of normal frequency of sexual activity (p < 0.001), and heterosexual sexual orientation (p < 0.001) were lower in depressed participants, and the differences did not change over time (p_{for trend} = 0.926 of average age at first sexual intercourse, p_{for trend} = 0.823 of normal frequency of sexual activity, p_{for trend} = 0.926 of heterosexual sexual orientation). Moreover, these differences were associated with marital status (p_{for interaction} < 0.001 by average age at first sexual intercourse), employment status (p_{for interaction} < 0.001 by average age at first sexual intercourse), education status (p_{for interaction} = 0.023 by heterosexual sexual orientation) and family income status (p_{for interaction} = 0.013 by average age at first sexual intercourse and p_{for interaction} = 0.017 by normal frequency of sexual activity). In conclusion, the study found that the age at first sexual intercourse decreased and the frequency of sexual intercourse increased in all the participants, and differences in sexuality between depressed and non-depressed participants were present; however, these differences had no further increase or decrease during the 12-year period. These differences were associated with marital status, employment status, education status, and family income status. These findings show differences in sexuality between depressed and non-depressed patients but are somewhat different from previous studies; the results may provide directions for future research and social work.

Marital status as an independent prognostic factor for patients of malignant pleural mesothelioma

Objectives

The prognostic impact of marital status on malignant pleural mesothelioma (MPM) is not investigated. This paper probes into the relationship between the prognosis of MPM and marital status.

Materials and methods

The Surveillance, Epidemiology, and End Results (SEER) database of American had been applied to choose eligible patients over the 2004–2015 periods. Moreover, cancer-specific survival (CSS) and overall survival (OS) of unmarried and married groups were compared.

Results

A total of 3,997 patients in total had been identified, including 2,735 (68.43%) married patients. In comparison to unmarried patients, married ones tended to be younger, male, white, and received active treatment (surgery, chemotherapy, or radiotherapy). In addition, the 1, 3, and 5-year CSS rates were 44.40, 12.09, and 6.88% in married patients, while 35.75, 12.12, and 6.37% in unmarried group (p = 0.0014). At the same time, the 1, 3, and 5-year OS rates were 41.84, 10.56, and 5.91% in married patients, while 33.67, 10.44, and 4.93%, respectively, in the unmarried group (p < 0.0001). As revealed by the multivariate analysis results, the marital status was an independent favorable prognostic factor, in which the married groups showed better CSS [hazard ratio (HR): 0.870; 95% confidence interval (CI): 0.808–0.938; p < 0.001] as well as OS (HR: 0.871; 95% CI: 0.810–0.936; p < 0.001). According to the results of subgroup analysis, the CSS and OS survival of married groups were better than the unmarried groups in almost all the subgroups.

Conclusion

Marital status is an independent favorable prognostic indicator of MPM. Poor prognosis in unmarried patients is likely to be related to insufficient treatments and socioeconomic and psychosocial factors.

The effect of polluting cooking fuels on depression among older adults in six low- and middle-income countries

BACKGROUND

Little is known about the association between polluting cooking fuel and depression among older adults living in low- and middle-income countries (LMICs).

OBJECTIVE

To evaluate the association between polluting cooking fuel and depression in older population of LMICs.

METHODS

We derived data from WHO Study on global AGEing and adult health (SAGE), which was conducted in six LMICs including China, India, Ghana, South Africa, Mexico and Russia. We applied logistic regression with the propensity score method to examine the relationship of polluting cooking fuel and depression among adults ≥50 years old.

RESULTS

Overall, the odds ratio (OR) of depression was 1.57 [95% confidence intervals (CIs), 1.26-1.93] for older adults relying on polluting cooking fuel in six LMICs. In India and China, polluting cooking fuel was associated with depression with ORs of 2.06 (95%CI, 1.44-2.94) and 1.59 (95%CI, 1.01-2.49), respectively. Positive OR of depression was identified for those polluting cooking fuel users aged over 65 years old (OR, 1.65; 95%CI,1.16-2.36) and those aged 50-65 (OR, 1.50; 95%CI,1.14-1.97). Polluting cooking fuel was associated with depression for females (OR, 1.80; 95%CI, 1.32-2.46), however we did not observe significant association for males. Positive effect of polluting cooking fuel was identified in both rural (OR, 1.72; 95%CI, 1.26-2.34) and urban areas (OR, 1.44; 95%CI, 1.07-1.95). For individuals relying on solid fuel, cooking in a room used for living/sleeping and using open stove/fire was associated with depression with ORs of 1.30 (95%CI, 1.14-1.48) and 1.15 (95%CI, 1.01-1.31), respectively. However, no significant effect was identified for hood.

CONCLUSION

Polluting cooking fuel was related to depressive symptoms among older adults in LMICs. In addition, cooking ventilation could be useful intervention to control health hazard of solid fuel.

Six-year prognosis of anxiety and depression caseness and their comorbidity in a prospective population-based adult sample

BACKGROUND

Anxiety and depression are amongst the most prevalent mental health problems. Their pattern of comorbidity may inform about their etiology and effective treatment, but such research is sparse. Here, we document long-term prognosis of affective caseness (high probability of being a clinical case) of anxiety and depression, their comorbidity, and a no-caseness condition at three time-points across six years, and identify the most common prognoses of these four conditions.

METHODS

Longitudinal population-based data were collected from 1,837 participants in 2010, 2013 and 2016. Based on the Hospital Anxiety and Depression Scale they formed the four groups of anxiety, depression and comorbidity caseness, and no caseness at baseline.

RESULTS

The three-year associations show that it was most common to recover when being an anxiety, depression or comorbidity caseness (36.8 - 59.4%), and when not being a caseness to remain so (89.2%). It was also rather common to remain in the same caseness condition after three years (18.7 - 39.1%). In comorbidity it was more likely to recover from depression (21.1%) than from anxiety (5.4%), and being no caseness it was more likely to develop anxiety (5.9%) than depression (1.7%). The most common six-year prognoses were recovering from the affective caseness conditions at 3-year follow-up (YFU), and remain recovered at 6-YFU, and as no caseness to remain so across the six years. The second most common prognoses in the affective conditions were to remain as caseness at both 3-YFU and 6-YFU, and in no caseness to remain so at 3-YFU, but develop anxiety at 6-YFU.

CONCLUSIONS

The results suggest that only 37 - 60% of individuals in the general population with high probability of being a clinical case with anxiety, depression, and their comorbidity will recover within a three-year period, and that it is rather common to remain with these affective conditions after 6 years. These poor prognoses, for comorbidity in particular, highlight the need for intensified alertness of their prevalence and enabling treatment in the general population.

Using the Biopsychosocial Approach to Identify Factors Associated with Major Depressive Disorder for Individuals with Hypothyroidism

Previous research has found that major depressive disorder (MDD) commonly occurs in hypothyroid populations. The purpose of this study was to use the biopsychosocial model to investigate factors associated with MDD and hypothyroidism by comparing hypothyroid patients with MDD and without MDD. A sample of 386 participants with hypothyroidism completed both cognitive and psychosocial self-reported assessments along with a questionnaire rating the severity of common hypothyroid symptoms. Participants were divided into two groups (MDD and no MDD) using the diagnostic criteria of the Patient Health Questionnaire. Univariate comparisons were used to assess differences in the severity of physical, psychological, and social correlates in participants with and without MDD. Participants with MDD reported significantly worse symptom severity, increased stress, and disruptions of cognitive functioning. Compared to individuals without MDD, they also indicated poorer quality of life, doctor-patient relationships, and treatment adherence. Individuals with comorbid depression and hypothyroidism reported worse outcomes across physical symptoms, social factors, and psychological and cognitive states than individuals without MDD. Integrating depression screeners and independent treatment for MDD, in addition to the patient's hypothyroid treatment plan, may result in hypothyroid symptom relief and greater quality of life.

Transdiagnostic symptom dynamics during psychotherapy

Psychotherapy is an effective treatment for many common mental health problems, but the mechanisms of action and processes of change are unclear, perhaps driven by the focus on a single diagnosis which does not reflect the heterogeneous symptom experiences of many patients. The objective of this study was to better understand therapeutic change, by illustrating how symptoms evolve and interact during psychotherapy. Data from 113,608 patients from psychological therapy services who completed depression and anxiety symptom measures across three to six therapy sessions were analysed. A panel graphical vector-autoregression model was estimated in a model development sample (N = 68,165) and generalizability was tested in a confirmatory model, fitted to a separate (hold-out) sample of patients (N = 45,443). The model displayed an excellent fit and replicated in the confirmatory holdout sample. First, we found that nearly all symptoms were statistically related to each other (i.e. dense connectivity), indicating that no one symptom or association drives change. Second, the structure of symptom interrelations which emerged did not change across sessions. These findings provide a dynamic view of the process of symptom change during psychotherapy and give rise to several causal hypotheses relating to structure, mechanism, and process.

Relationship of depression and sleep quality, diseases and general characteristics

BACKGROUND

Depression is the most common type of depressive disorder. The most common sleep disorder associated with depression is insomnia. Insomnia and depression are closely related.

AIM

To investigate the relationship of designed questionnaire items and depression, and analyze the related factors with depression.

METHODS

Questionnaire included Patient Health Questionnaire-9 (PHQ-9) and Pittsburgh sleep quality index (PSQI), 12 kinds of diseases, 8 general characteristics, and 20 insomnia characteristics, totally 56 items were filled out by 411 patients enrolled.

RESULTS

All the 9 items of PHQ-9, 6 components of PSQI (except sleep duration), education, living situation, exercise, years of insomnia, western medicine treatment, Chinese medicine treatment, psychotherapy, kinds of insomnia, treatment expected to treat insomnia, psychological counseling, habit of 1 h before bed, habit of lunch break, diagnosed depression, coronary heart disease, mental illness showed significant difference between without and with depression group. By univariate analysis and multivariate analysis. The odds ratio of education, exercise, kinds of insomnia, habit of 1 h before bed, diagnosed depression, coronary heart disease (P = 0.01) showed significant difference. Their odds ratios were 0.71 (0.55, 0.93), 2.09 (1.32, 3.31), 0.76 (0.63, 0.91), 0.89 (0.81, 0.98), 0.32 (0.17, 0.60), 0.43 (0.23, 0.79).

CONCLUSION

We demonstrated that education, exercise, kinds of insomnia, habit of 1 h before bed, diagnosed depression and coronary heart disease affect the depression.

Socioeconomic Indicators of Treatment Prognosis for Adults With Depression: A Systematic Review and Individual Patient Data Meta-analysis

Importance

Socioeconomic factors are associated with the prevalence of depression, but their associations with prognosis are unknown. Understanding this association would aid in the clinical management of depression.

Objective

To determine whether employment status, financial strain, housing status, and educational attainment inform prognosis for adults treated for depression in primary care, independent of treatment and after accounting for clinical prognostic factors.

Data Sources

The Embase, International Pharmaceutical Abstracts, MEDLINE, PsycINFO, and Cochrane (CENTRAL) databases were searched from database inception to October 8, 2021.

Study Selection

Inclusion criteria were as follows: randomized clinical trials that used the Revised Clinical Interview Schedule (CIS-R; the most common comprehensive screening and diagnostic measure of depressive and anxiety symptoms in primary care randomized clinical trials), measured socioeconomic factors at baseline, and sampled patients with unipolar depression who sought treatment for depression from general physicians/practitioners or who scored 12 or more points on the CIS-R. Exclusion criteria included patients with depression secondary to a personality or psychotic disorder or neurologic condition, studies of bipolar or psychotic depression, studies that included children or adolescents, and feasibility studies. Studies were independently assessed against inclusion and exclusion criteria by 2 reviewers.

Data Extraction and Synthesis

Data were extracted and cleaned by data managers for each included study, further cleaned by multiple reviewers, and cross-checked by study chief investigators. Risk of bias and quality were assessed using the Quality in Prognosis Studies (QUIPS) and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tools, respectively. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses-Individual Participant Data (PRISMA-IPD) reporting guidelines.

Main Outcomes and Measures

Depressive symptoms at 3 to 4 months after baseline.

Results

This systematic review and individual patient data meta-analysis identified 9 eligible studies that provided individual patient data for 4864 patients (mean [SD] age, 42.5 (14.0) years; 3279 women [67.4%]). The 2-stage random-effects meta-analysis end point depressive symptom scale scores were 28% (95% CI, 20%-36%) higher for unemployed patients than for employed patients and 18% (95% CI, 6%-30%) lower for patients who were homeowners than for patients living with family or friends, in hostels, or homeless, which were equivalent to 4.2 points (95% CI, 3.6-6.2 points) and 2.9 points (95% CI, 1.1-4.9 points) on the Beck Depression Inventory II, respectively. Financial strain and educational attainment were associated with prognosis independent of treatment, but unlike employment and housing status, there was little evidence of associations after adjusting for clinical prognostic factors.

Conclusions and Relevance

Results of this systematic review and meta-analysis revealed that unemployment was associated with a poor prognosis whereas home ownership was associated with improved prognosis. These differences were clinically important and independent of the type of treatment received. Interventions that address employment or housing difficulties could improve outcomes for patients with depression.

Association of depressive symptoms with marital status among the middle-aged and elderly in Rural China-Serial mediating effects of sleep time, pain and life satisfaction

OBJECTIVE

This study aimed to explore the potential effect of sleep time, pain and life satisfaction on the association between marital status and depressive symptoms.

METHODS

This study included 9780 individuals aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS) in 2015. Regression analysis was used to explore the mediating effect of targeted mediators on the association between marital status and depressive symptoms. Bootstrap method was used to examine the statistical significance of the mediating effects.

RESULTS

In the mediation model incorporating sleep time, pain and life satisfaction as mediators between marital status and depressive symptoms, the direct effect of marital status on depressive symptoms was statistically significant (p < 0.001, 95% CI = 0.699, 1.428). Approximately 39.28% (Indirect effect/Total effect) of the significant association between marital status and depressive symptoms was mediated by sleep time, pain, and life satisfaction.

LIMITATIONS

Limitations include non-representativeness other than rural residents and unclear cause-and-effect relationship.

CONCLUSIONS

Those separated/divorced/widowed/never-married middle-aged and elderly individuals might be high risk population of depressive symptoms. It could be possible to relieve the depressive symptoms of these people by guaranteeing sufficient sleep, relieving pain and improving life satisfaction.

Gender differences in clinical and biochemical parameters of patients consecutively hospitalized for unipolar depression

Major Depressive Disorder (MDD) is a medical illness twice as common in women than in men lifetime. Purpose of this study is to identify gender differences in clinical and biochemical parameters in subjects affected by MDD to implement individualized treatment strategies. We recruited 234 patients (112 males and 122 females) consecutively hospitalized for MDD in Milan (Italy). Data were obtained through a screening of the clinical charts and blood analyses. Univariate analyses, binary logistic regressions and a final logistic regression model were performed. The final logistic regression model showed that female patients (compared to males) had lower plasmatic levels of hemoglobin (p = 0.020) and uric acid (p = 0.002), higher levels of cholesterol (p < 0.001), had been treated with a lower number of antidepressants (p = 0.011), presented lower red blood cells (p < 0.001) and showed more frequently comorbidity with hypothyroidism (p = 0.036). Univariate analyses identified also that women had an earlier age at onset (p = 0.043), were less likely to have comorbidity with diabetes (p = 0.002) and were less frequently treated with a psychiatric polytherapy (p < 0.001). Finally, female patients had achieved more frequently remission in the last depressive episode (p = 0.001) and were more likely to have family history for psychiatric disorders (p < 0.001) than males. Female patients globally have a better response to treatments, but they seem to be more vulnerable to specific metabolic abnormalities as showed by more frequent hypercholesterolemia and lower plasma levels of uric acid. These results have to be confirmed by further studies.

Association of Visual Impairment with Psychological Distress in Older Adults: A Survey of 105,092 Older People in Taiwan

This study aimed to evaluate the association between visual impairment (VI) and psychological distress (PD) among older adults in Taiwan. The present cohort study included participants aged >65 years who participated in a physical examination program. Participants were divided into two groups on the basis of whether they had PD at baseline. The association between PD and VI with other variables was compared using the two-sample t-test for continuous variables and chi-squared test for discrete variables. Cox regression analyses were used to calculate the hazard ratio (HR). Cumulative incidence of PD was analyzed using the Kaplan-Meier method, and differences among participants with different severities of VI were analyzed using the two-tailed log-rank test. Subgroup analyses were performed to calculate the HR for PD among participants with different severities of VI. The PD group showed a significantly high percentage of VI. In addition, participants with VI showed a significantly higher HR and seven-year cumulative incidence rate of PD than those without VI. VI was independently and significantly associated with a higher incidence of PD among older Asian people. Therefore, identifying and treating correctible VI is important to prevent PD and improve the overall quality of life.

Life events and treatment prognosis for depression: A systematic review and individual patient data meta-analysis

OBJECTIVE

To investigate associations between major life events and prognosis independent of treatment type: (1) after adjusting for clinical prognostic factors and socio-demographics; (2) amongst patients with depressive episodes at least six-months long; and (3) patients with a first life-time depressive episode.

METHODS

Six RCTs of adults seeking treatment for depression in primary care met eligibility criteria, individual patient data (IPD) were collated from all six (n = 2858). Participants were randomized to any treatment and completed the same baseline assessment of life events, demographics and clinical prognostic factors. Two-stage random effects meta-analyses were conducted.

RESULTS

Reporting any major life events was associated with poorer prognosis regardless of treatment type. Controlling for baseline clinical factors, socio-demographics and social support resulted in minimal residual evidence of associations between life events and treatment prognosis. However, removing factors that might mediate the relationships between life events and outcomes reporting: arguments/disputes, problem debt, violent crime, losing one's job, and three or more life events were associated with considerably worse prognoses (percentage difference in 3-4 months depressive symptoms compared to no reported life events =30.3%(95%CI: 18.4-43.3)).

CONCLUSIONS

Assessing for clinical prognostic factors, social support, and socio-demographics is likely to be more informative for prognosis than assessing self-reported recent major life events. However, clinicians might find it useful to ask about such events, and if they are still affecting the patient, consider interventions to tackle problems related to those events (e.g. employment support, mediation, or debt advice). Further investigations of the efficacy of such interventions will be important.

A Patient Stratification Approach to Identifying the Likelihood of Continued Chronic Depression and Relapse Following Treatment for Depression

Background: Subgrouping methods have the potential to support treatment decision making for patients with depression. Such approaches have not been used to study the continued course of depression or likelihood of relapse following treatment. Method: Data from individual participants of seven randomised controlled trials were analysed. Latent profile analysis was used to identify subgroups based on baseline characteristics. Associations between profiles and odds of both continued chronic depression and relapse up to one year post-treatment were explored. Differences in outcomes were investigated within profiles for those treated with antidepressants, psychological therapy, and usual care. Results: Seven profiles were identified; profiles with higher symptom severity and long durations of both anxiety and depression at baseline were at higher risk of relapse and of chronic depression. Members of profile five (likely long durations of depression and anxiety, moderately-severe symptoms, and past antidepressant use) appeared to have better outcomes with psychological therapies: antidepressants vs. psychological therapies (OR (95% CI) for relapse = 2.92 (1.24–6.87), chronic course = 2.27 (1.27–4.06)) and usual care vs. psychological therapies (relapse = 2.51 (1.16–5.40), chronic course = 1.98 (1.16–3.37)). Conclusions: Profiles at greater risk of poor outcomes could benefit from more intensive treatment and frequent monitoring. Patients in profile five may benefit more from psychological therapies than other treatments.

Older adults respond better to psychological therapy than working-age adults: evidence from a large sample of mental health service attendees

BACKGROUND

Older adults commonly experience depression and anxiety, yet are under-represented in psychological treatment services. There is uncertainty about the outcomes from psychological therapies for older adults relative to working-age adults. This study explored: pre-treatment differences between older and working-age patients with depression or anxiety disorders; whether outcomes from psychological therapy differ between groups controlling for pre-treatment clinical severity, functioning, and socio-demographics; and whether the impact of a long-term health condition (LTC) on outcome differs by age.

METHODS

Data on >100,000 patients treated with psychological therapies in eight Improving Access to Psychological Therapies services were analyzed. We compared pre-treatment characteristics and therapy outcomes for older (≥65 years) and working-age (18-64 years) patients, and investigated associations between age and outcomes.

RESULTS

Older adults had less severe clinical presentations pre-treatment. In adjusted models older adults were more likely to reliably recover (OR=1.33(95%CI=1.24-1.43)), reliably improve (OR=1.34(95%CI =1.24-1.45)), and attrition was less likely (OR=0.48(95%CI =0.43-0.53)). Effects were more pronounced in patients with anxiety disorders compared to depression. Having an LTC was associated with a much lower likelihood of reliable recovery for working-age patients but had only a modest effect for older adults.

LIMITATIONS

There are potential selection biases affecting the characteristics of older people attending these services. Residual confounding cannot be ruled out due to limits on data available.

CONCLUSIONS

Older adults experienced better outcomes from psychological treatments than working-age adults. Given the deleterious effects if mental health conditions go untreated, increasing access to psychological therapies for older people should be an international priority.