The Association of Cigarette Smoking With Depression and Anxiety: A Systematic Review

Cumulative associations between health behaviours, mental well-being, and health over 30 years

BACKGROUND

Both the number of risky health behaviours and the duration of exposure to these behaviours over time may increase the risk of later adverse outcomes. This study examined cumulative associations of risky health behaviours with both positive and negative aspects of mental well-being and health. It has a uniquely long follow-up period of over 30 years, from early adulthood to the beginning of late adulthood.

MATERIALS AND METHODS

The data were from the Jyväskylä Longitudinal Study of Personality and Social Development. The participants represent the Finnish age cohort born in 1959. This study utilized data collected at ages 27 (1986), 36 (1995), 42 (2001), 50 (2009), and 61 (2020-2021) (n = 206-326). Risk scores indicating the current number of risky behaviours of smoking, heavy alcohol consumption, and physical inactivity and their temporal accumulation over time were calculated. The associations of risk scores with mental well-being (depressive symptoms, psychological well-being) and health (self-rated health, number of metabolic risk factors) from age 36 onwards were analyzed with linear multilevel models adjusted for gender and education.

RESULTS

More current risky behaviours were associated with more depressive symptoms (B = 0.10, p = 0.032), lower psychological well-being (B = -0.10, p = 0.010), lower self-rated health (B = -0.45, p < 0.001), and more metabolic risk factors (B = 0.53, p = 0.013). The associations of temporal risk scores with the outcomes were even stronger (depressive symptoms: B = 0.38, p < 0.001; psychological well-being: B = -0.15, p = 0.046; self-rated health: B = -0.82, p < 0.001; metabolic risk factors: B = 1.49, p < 0.001). Among individual behaviours, the temporal risk score of alcohol consumption was negatively associated with most outcomes, while smoking was associated with poorer mental well-being and physical inactivity with poorer health.

CONCLUSIONS

The current and temporal accumulation of multiple risky health behaviours were associated with poorer mental well-being and health. Preventing these behaviours early in adulthood and midlife is crucial to avoid their accumulation and subsequent health risks.

Interactive effect of sleep duration, lifestyle factors and comorbidity on depressive symptoms: Insights from the China health and retirement longitudinal study

BACKGROUND

As population aging intensifies, depression emerges as a major global public health issue, especially affecting middle-aged and elderly individuals. While studies have investigated factors like sleep duration, physical activity, smoking, drinking habits, and comorbidity, the complex interplay and cumulative effect of these factors on the risk of depressive symptoms remain not fully understood.

METHODS

This research utilizes data from the China Health and Retirement Longitudinal Study (CHARLS), encompassing observations from 2015 to 2020. The subjects included 8234 middle-aged and elderly individuals, accounting for a total of 22,570 observations. Lifestyle factors were represented by physical activity, smoking, and drinking habits, with the volume of moderate-to-vigorous physical activity (MVPA) quantified by quoting metabolic equivalents (MET). Multivariate logistic regression models were conducted for baseline analysis, and mixed-effects logistic regression models with random participant intercepts were constructed for the longitudinal analysis of the cohort. Moreover, interaction terms between these factors were included to assess their combined impact on the risk of depressive symptoms.

RESULTS

Longitudinal analysis revealed a notable correlation between short sleep duration (<7 h) and an elevated risk of depressive symptoms, evidenced by an adjusted odds ratio (OR) of 3.13 (95 % CI: 2.73-3.74). Conversely, long sleep duration (>9 h) was not associated with a marked change in risk of depressive symptoms (OR = 1.11, 95 % CI: 0.78-1.59, p = 0.59). High levels of physical activity (192-336 MET-h/week) were significantly linked to an elevated risk of depressive symptoms (OR = 1.70, 95 % CI: 1.19-2.42). Discontinuing smoking was significantly correlated with a lower risk of depressive symptoms (OR = 0.68, 95 % CI: 0.52-0.90). Subjects with two or more concurrent conditions exhibited a substantially higher risk of depressive symptoms (OR = 3.19, 95 % CI: 3.13-3.25). Investigating the combined influence of sleep duration, lifestyle elements, and concurrent conditions revealed that enhanced physical activity levels significantly decreased risk of depressive symptoms in participants with short sleep duration, adjusting the OR from 3.16 to 0.83 (95 % CI, 0.53-1.30). Among participants with short sleep duration, smoking and alcohol consumption patterns were linked to a decreased risk of depressive symptoms, although these associations lacked statistical significance. Relative to subjects without concurrent conditions, those harboring two or more such conditions faced a significantly heightened risk of depressive symptoms in the context of short sleep duration (OR = 3.00, 95 % CI: 2.24-4.03), a risk not observed in subjects with extended sleep duration. Moderate napping (0.5-1 h) among participants with short sleep duration was found to significantly mitigate risk of depressive symptoms (OR = 0.64, 95 % CI: 0.44-0.95), whereas in subjects with prolonged sleep duration, extended napping did not significantly alter risk of depressive symptoms.

LIMITATIONS

The results, derived from a middle-aged and elderly Chinese population, may not be generalizable to other demographic groups or cultural contexts.

CONCLUSION

This study shows that short sleep duration, unhealthy lifestyle factors, and comorbidities significantly increase the risk of depressive symptoms in middle-aged and elderly individuals. Moderate physical activity, smoking cessation, moderate drinking, and appropriate napping can mitigate this risk, especially for those with short sleep duration. These findings highlight the need to address sleep quality, promote healthy habits, and manage comorbidities in mental health interventions for this population.

The association between red blood cell distribution width-to-albumin ratio and risk of depression: A cross-sectional analysis of NHANES

BACKGROUND

The red blood cell distribution width-to-albumin ratio (RAR) serves as an indicator of systemic inflammation and nutritional status. This study examines the relationship between RAR and depressive disorder in U.S. adults, utilizing data from the National Health and Nutrition Examination Survey (NHANES).

METHODS

We applied logistic regression to evaluate the link between RAR and depressive risk, with its corresponding odds ratios (OR) and 95 % confidence intervals (CI) calculated. Restricted cubic spline (RCS) was adopted to assess the potential linear association, while the receiver operating characteristic (ROC) curve was used to evaluate the ability of RAR to predict the depressive risk, with the result presented as an area under the curve (AUC).

RESULTS

After adjusting for relevant covariates, a positive association between RAR and clinically relevant depression persisted (OR = 1.33, 95 % CI: 1.18-1.51, P < 0.001). Participants in the highest RAR quartile exhibited a greater risk of clinically relevant depression than those in the lowest quartile (OR = 1.36, 95 % CI: 1.10-1.67, P = 0.005). A linear relationship between RAR and clinically relevant depression was identified (P for non-linear = 0.473), with RAR showing a strong predictive ability for depressive risk (AUC = 0.7467). Stratified analysis showed significant interactions among smoking (P = 0.045), marital status (P < 0.001), and RAR's effect on depression outcome.

CONCLUSIONS

Elevated RAR is independently linked to clinically relevant depression, indicating its potential as a novel biomarker for mental health risk assessment. Further longitudinal studies are necessary to establish causality and evaluate its clinical relevance.

Impact of depression status and antidepressant use on mortality rates and clinical outcomes following acute myocardial infarction

OBJECTIVE

This study aims to assess the impact of depression and antidepressant use on Major Adverse Cardiac Events (MACE), defined as myocardial infarction, ischemic stroke, and death, post-acute myocardial infarction.

METHODS

A retrospective analysis of deidentified electronic health records was conducted on adults with a primary hospital admission diagnosis of acute myocardial infarction between January 1, 2017, and December 31, 2019. International Classification of Disease diagnosis codes for depression were used to identify depression. Patients were grouped by depressive phenotype and the presence or absence of an antidepressant on their discharge medication list. The primary outcome was the incidence of Major Adverse Cardiac Events within one year following index visit, illustrated by Kaplan-Meier analysis. Baseline variables were evaluated for independent association with the primary outcome via Cox Proportional-Hazards model.

RESULTS

This study identified an association between depression and increased incidence of Major Adverse Cardiac Events post-acute myocardial infarction. Multivariate Cox proportional hazards model evaluation shows that antidepressant use was not a significant predictor for Major Adverse Cardiac Events among patients with depression. Chronic kidney disease and congestive heart failure were independently associated with increased risk of events.

CONCLUSION

Patients with depression should be closely monitored post-acute myocardial infarction due to a potential increased risk of MACE. Consideration should be given to factors that may contribute to worse outcomes, including antidepressant pharmacotherapy.

Temporal dynamic changes of intrinsic brain regional activity in depression with smoking

BACKGROUND

Depression is often accompanied by high levels of smoking behavior, and smoking can act as a risk factor for depression. However, there is limited neuroimaging evidence regarding the association between depression and smoking, especially the impact of this association on the brain stability remains unclear. Therefore, this study aimed to assess the interaction effect between smoking and depression from a neurodynamic perspective.

METHOD

We assessed the resting-state functional magnetic resonance imaging from 193 participants (55 depressed smokers; 51 depressed non-smokers; 25 healthy smokers; 62 healthy non-smokers) and calculated 3 regional activity dynamic indicators, including dynamic regional homogeneity (dReHo), dynamic amplitude of low-frequency fluctuations (dALFF), and dynamic fractional ALFF (dfALFF). Principal component analysis was conducted on these 3 dynamic indicators, and the first component was extracted for the subsequent 2 × 2 factor designs statistical analysis.

RESULT

We observed the interaction between smoking and depression increases the instability of regional activity in the precentral gyrus and precuneus. Compared with HCs, patients with depression showed increased instability of regional activity across widespread regions such as the precentral gyrus, thalamus, and medial frontal gyrus. No main effects of smoking were observed. In depressed smokers, the instability of regional activity in left precuneus is positively correlated with anxiety symptoms.

CONCLUSIONS

Our findings indicate that smoking potentially exacerbates brain abnormal instability in depression, implying a clinical need to require patients with depression to abstain from smoking.

Neural Networks and Chemical Messengers: Insights into Tobacco Addiction

This study investigates changes in resting-state networks (RSNs) associated with tobacco addiction (TA) and whether these changes reflect alterations in neurotransmitter systems. A total of 90 patients with TA and 46 healthy controls (HCs) matched for age, education, and body mass index undergo functional magnetic resonance imaging (fMRI) scans. Independent component analysis (ICA) is employed to extract RSNs based on a customized network template using the HCP ICA MATCHING toolbox. Additionally, a correlation study is conducted to examine the relationship between changes in functional connectivity (FC) within RSNs and positron emission tomography and single photon emission computed tomography-derived maps, aiming to identify specific neurotransmitter system changes underlying abnormal FC in TA. Compared to HCs, the TA group exhibits decreased FC values in the left precentral gyrus of the sensorimotor network B and in the right calcarine of the visual network B. Furthermore, changes in FC within the visual network B are associated with the 5-hydroxytryptamine system (1a) and opioid receptor system (Kappa) maps. Post-hoc power analysis confirms the adequacy of the sample size, with effect sizes (d) all greater than 0.9, supporting the robustness of the findings. Patients with TA show reduced intranetwork connectivity in the sensorimotor network B and visual network B, which may reflect underlying molecular changes. These findings improve understanding of the neurobiological aspects of TA.

Association between eveningness and depressive symptoms in daytime workers: A cross-sectional analysis of the Aichi Workers' Cohort Study

Objectives

Eveningness (evening preference in chronotype) has been reported to be associated with a number of psychiatric problems. We examined a cross-sectional association between eveningness and depressive symptoms in daytime workers.

Methods

The subjects were 4410 civil servants (71.7% male, aged 18-69 years [mean, 43.5 years]) with no history of depressive disorder who did not perform shift work, and for whom there were no missing data. The association between eveningness, determined using the reduced Morningness-Eveningness Questionnaire, and depressive symptoms, determined using the shorter form of the Central Epidemiological Studies Depression scale, was assessed with logistic regression analysis adjusted for potential confounding factors (gender, income, living alone, breakfast intake, coffee consumption, drinking habits, exercise, smoking, working hours, sleep duration, and difficulty falling asleep).

Results

Of the subjects, 529 (12.0%) had eveningness, and 1408 (31.9%) reported depressive symptoms. Depressive symptoms were reported more frequently by those with eveningness than by those with other chronotypes (57.3% vs 28.5%). The association between eveningness and depression (gender- and age-adjusted odds ratio, 3.27; 95% confidence interval, 2.71-3.95) was significant after adjustment for the other confounding factors (odds ratio, 2.40; 95% confidence interval, 1.96-2.95).

Conclusions

Our results suggest that eveningness is associated with depressive symptoms among day workers and that this association is independent of potential confounding factors. Further longitudinal studies are needed to examine the causal relationship.

Bidirectional association between clustering of health-related behaviours and depression in mid- and older-aged adults: A longitudinal study in China and Japan

OBJECTIVES

To disentangle the direction between health-related behaviours (HRBs) and depression in East Asia, we examined the bidirectional longitudinal relationship of HRBs clustering and depression in Chinese and Japanese ageing populations gender-specifically.

METHODS

Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS) (N = 18,739) (2011-2015) and the Japan Study of Ageing and Retirement (JSTAR) (N = 7116) (2007-2011). Cross-lagged panel models (CLPM) were applied to assess bidirectional longitudinal relationships between HRB clustering and depression in adjacent waves, stratified by cohort and gender. Sensitivity analyses were conducted to explore key risk factors in risky clusters.

RESULTS

The prevalence of baseline depression was approximately 20 % in China and 4 % in Japan, with over 70 % of participants belonging to the risky cluster. A unidirectional negative association between the risky cluster and depression was observed only in Chinese females (βstandardized = -0.039, 95%CI: -0.054 to -0.024, P < 0.001). However, no association was found in Japanese females or males in either country. Further sensitivity analyses revealed that this association was primarily driven by overweight/obesity cluster. Sensitivity analyses also identified a positive effect of depression on the smoking and drinking cluster and a negative effect on the overweight/obesity cluster in Chinese females.

LIMITATION

This study was limited by reliance on self-report data, the CES-D cannot be used to diagnose depression and some other confounding factors were not considered (e.g., use of antidepressants).

CONCLUSIONS

Our findings highlight a unidirectional negative association of the risky cluster on depression in Chinese females, with notable variations observed across different countries and genders.

Determinants of substance use patterns in patients with narcolepsy type 1: A multi-center comparative cross-sectional study

OBJECTIVES

In this multi-center cross-sectional study, we compared substance use patterns (SUPs) between patients with narcolepsy type 1 (NT1) and controls, and investigated, among patients, factors associated with the consumption of the main psychoactive substances.

METHODS

Adult patients with NT1 and controls completed questionnaires about tobacco, alcohol, and cannabis use patterns. Unadjusted bivariable then multivariate analyses (adjusted for sex, age, education, family status, and depression) were performed to compare SUPs between controls and patients, and to explore socio-demographic, psycho-behavioral, and clinical determinants of consumptions.

RESULTS

We included 235 patients (63.8 % women, 36.4 ± 14.7 years) and 166 controls (69.9 % women, 40.3 ± 14.4 years). Substances co-consumptions were frequent in both groups. Patients with NT1 were more frequently current smokers (32.3 % vs. 20.1 %, p < 0.01) or e-cigarettes users (12.1 % vs 2.4 %, p < 0.001) than controls, while no difference was observed for cannabis use and alcohol misuse. Only the increased likelihood of vaping remained significant in adjusted analysis. Among NT1 patients, smoking was associated with disrupted nighttime sleep (OR[95%CI] = 2.28[1.02-5.12], p < 0.05) and less obesity (OR = 0.24[0.09-0.59], p < 0.05). Alcohol misuse was associated with sleep paralysis (OR = 2.11[1.13-3.91], p < 0.05) and treatments (modafinil: OR = 2.14[1.15-4.01], p < 0.05; sodium oxybate: OR = 0.41[0.17-0.97], p < 0.05). Tobacco and cannabis consumptions were associated with lower physical activity (OR = 0.46 [0.24-0.87], p < 0.05 and OR = 0.25[0.10-0.66], p < 0.01). Alcohol misuse and cannabis use were associated with rule breaking behaviors (OR = 5.89[1.61-21.60], p < 0.05 and OR = 8.52[1.79-40.48], p = 0.01).

CONCLUSION

Patients with NT1 do not seem less vulnerable to psychoactive substance use/misuse. Consumptions patterns are associated with multiple dimensions of the disease including sleep-related symptoms, comorbidities, treatments, and psycho-behavioral factors.

Association of the "life's crucial 9" cardiovascular health with all-cause and cardiovascular disease mortality: a national cohort study

BACKGROUND

In 2022, the American Heart Association launched an updated algorithm for quantifying cardiovascular health (CVH), termed Life's Essential 8 (LE8). This new approach has been shown to be associated with various noncommunicable chronic diseases and mortality. However, LE8 did not take into consideration the importance of psychological health on CVH. Recently, a perspective article proposed Life's Crucial 9 (LC9), which would add psychological health as another component to LE8, as a novel metric to assess CVH. This study aims to investigate the association of LC9 with all-cause and cardiovascular disease (CVD) mortality.

METHODS

This study included 23,080 adults from National Health and Nutrition Examination Survey 2005-2018, and mortality was ascertained by linkage to National Death Index records through 31 December 2019. The LC9 scoring algorithm was categorized into low (0-49), moderate (50-79), and high (80-100) CVH. Weighted Cox proportional hazards regression models and restricted cubic spline analysis were applied to evaluate the association of LC9 with mortality.

RESULTS

During a median follow-up of 7.8 years, a total of 2,388 overall deaths were identified, covering 613 CVD deaths. Compared with adults with a low CVH score, those with a high CVH score had 52% (hazard ratio, 0.48; 95% confidence interval, 0.38-0.60) and 64% (0.36; 0.23-0.56) reduced risk of all-cause and CVD mortality. Similarly, a moderate CVH score was associated with 33% (0.67; 0.58-0.78) and 49% (0.51; 0.40-0.64) reduced risk of all-cause and CVD mortality. The population-attributable fractions of high vs. moderate or low CVH score were 46.0% for all-cause mortality and 75.8% for CVD mortality. Elevated blood lipids, high body mass index, and poor sleep quality were the three major contributors to all-cause mortality, whereas nicotine exposure, unhealthy psychology, and elevated blood lipids were the three significant ones to CVD mortality. There were approximately negative linear dose-response relationships of total LC9 score with all-cause and CVD mortality.

CONCLUSIONS

Adhering to a high LC9 score is related to a reduced risk of all-cause and CVD mortality. This new CVH definition shows promise as a primordial preventive strategy to reduce mortality rates.

Development and validation of a nomogram for predicting depression risk in patients with chronic kidney disease based on NHANES 2005-2018

BACKGROUND

Depression is common among patients with chronic kidney disease (CKD) and is associated with poor outcomes. This study aims to develop and validate a nomogram for predicting depression risk in patients with CKD.

METHODS

This cross-sectional study utilized data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES) database. Participants were randomly divided into training and validation sets (7:3 ratio). A nomogram was developed based on predictors identified using Least Absolute Shrinkage and Selection Operator (LASSO) regression and multivariate logistic regression. Model performance was evaluated using ROC curves, calibration curves, and decision curve analysis.

RESULTS

A total of 4414 participants were included. Gender, age, race, poverty-to-income ratio, diabetes mellitus, cardiovascular diseases, trouble sleeping, sleep hours, and smoking were included as predictors in the nomogram. The area under the curve (AUC) of the nomogram for predicting depression risk in patients with CKD was 0.785 (95% CI: 0.761-0.809) in the training set and 0.773 (95% CI: 0.737-0.810) in the validation set. The corrected C-index, calculated using bootstrap resampling, was 0.776, indicating good predictive performance. Calibration curves and decision curve analysis showed good calibration and clinical utility. Subgroup and sensitivity analyses further confirmed the robustness of the nomogram. A web-based risk calculator based on the nomogram was developed to enhance clinical applicability. A flowchart demonstrating the application of the nomogram for risk assessment and clinical decision-making in routine practice is provided.

CONCLUSIONS

This nomogram effectively predicts depression risk in patients with CKD and may serve as a user-friendly tool for the early identification of patients with CKD at high risk for depression using key demographic, comorbid, and lifestyle factors.

Association between dietary flavonoid intake and anxiety: data from NHANES 2017-2018

BACKGROUND

Anxiety disorders are among the most prevalent mental health conditions, characterized by excessive fear, tension, avoidance behaviors, and heightened threat perception. Approximately 1 in 14 individuals meets the diagnostic criteria for an anxiety disorder. Flavonoids, bioactive compounds found in fruits, vegetables, and tea, possess antioxidant, anti-inflammatory, and neuroprotective properties. However, evidence on the relationship between flavonoid intake and anxiety risk remains limited. This study examines the association between flavonoid intake and anxiety risk and explores the effects of specific flavonoid subclasses.

METHODS

This study utilized data from the National Health and Nutrition Examination Survey (NHANES). Individual flavonoid intake was assessed using two-day 24-hour dietary recalls, and anxiety status was evaluated through a standardized anxiety questionnaire. To assess the relationship between flavonoid intake and anxiety risk, weighted logistic regression analysis was performed. Additionally, restricted cubic spline (RCS) analysis was employed to evaluate potential nonlinear associations. We conducted subgroup analyses for flavonoids that showed significant associations in the logistic regression, including theaflavin-3-gallate, total flavones, total flavanones, total isoflavones, and naringenin. These analyses aimed to explore the moderating effects of demographic characteristics such as sex, age, marital status, smoking status, and body mass index (BMI).

RESULTS

We analyzed data from 1,637 participants in the NHANES. Significant differences were observed between the anxious and non-anxious groups in age, poverty-income ratio (PIR), BMI, smoking status, marital status, education level, and flavonoid intake. The anxious group had higher age (47.12 vs. 42.81 years, P < 0.0001), PIR (P < 0.0001), and BMI (P = 0.01). They also had a higher proportion of females, unmarried individuals, and current smokers (P < 0.0001). Logistic regression analysis showed that genistein, petunidin, naringenin, apigenin, and total flavones were significantly associated with reduced anxiety risk (P < 0.05). Subgroup analysis confirmed protective effects in males, married individuals, participants with General Educational Development (GED)-level education, and specific ethnic groups. RCS analysis suggested nonlinear relationships, with total flavones, total flavanones, and naringenin showing protective effects at low intake levels (P < 0.05). All models demonstrated good fit (P < 0.001).

CONCLUSION

Flavonoid intake is inversely associated with anxiety risk, particularly Theaflavin-3-gallate, Total Flavones, Total Flavanones, Total Isoflavones, and Naringenin. Further studies are needed to confirm optimal intake levels and underlying mechanisms.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Combined influence of healthy lifestyles, nutritional and inflammatory status on mortality among US adults with depression

OBJECTIVE

Healthy lifestyles, nutritional and inflammatory status are interrelated and influence mortality. This study aimed to evaluate their separate and combined effects on all-cause and cause-specific mortality in individuals exhibiting depression.

METHODS

6143 individuals with depression (median age 47) were recruited from the US National Health and Nutrition Examination Survey (NHANES 2005-2018), with mortality followed up through December 31, 2019. A healthy lifestyle score (0-5) was constructed based on current non-smoking, low-to-moderate alcohol consumption, adequate sleep, sufficient physical activity and healthy diet. Higher scores indicated healthier lifestyles. The Advanced Lung Cancer Inflammation Index (ALI), a composite marker of inflammation and nutritional status, was calculated as Body Mass Index (BMI) (kg/m2) × albumin (g/dl)/Neutrophil-to-Lymphocyte Ratio (NLR). Higher ALI values denoted lower inflammation and better nutrition. Weighted Cox proportional-hazards models were used to estimate mortality hazard ratios.

RESULTS

Healthier lifestyles significantly lowered all-cause (hazard ratio [HR] 0.72, 95 % confidence interval [CI] 0.66-0.78), cardiovascular (HR 0.70, 95 % CI 0.58-0.83), and non-cardiovascular mortality (HR 0.72, 95 % CI 0.64-0.81). High ALI reduced all-cause (HR 0.70, 95 % CI 0.54-0.91) and cardiovascular mortality (HR 0.46, 95 % CI 0.28-0.77) compared with low ALI. Joint analyses showed that individuals with both healthy lifestyle scores ≥3 and high ALI had the lowest risk of all-cause, cardiovascular, and non-cardiovascular mortality (HR 0.44, 95 % CI 0.33-0.60; 0.32, 95 % CI 0.16-0.63; 0.49, 95 % CI 0.35-0.68).

CONCLUSION

The joint presence of healthy lifestyles and high ALI was significantly associated with lower risk of mortality among individuals with depression.

Risk of mood disorders after epilepsy diagnosis: A nationwide retrospective cohort study in South Korea

ObjectiveEpilepsy is a globally prevalent neurological condition, significantly associated with mood disorders like depression and bipolar disorder. This study analyzed the prevalence of and hazard ratios for mood disorders, as well as risk factors, among patients with newly diagnosed epilepsy using comprehensive South Korean national health data.MethodHealth insurance and health examination data (2004-2013) were utilized in this retrospective cohort study. Patients newly diagnosed with epilepsy based on International Classification of Diseases-10th revision codes and without mood disorder history were included. The mean follow-up duration was 3.57 years and 4.07 years for the epilepsy and control cohorts, respectively. Cox proportional hazards models adjusted for demographic and health variables were used to estimate the risk of developing mood disorders post-epilepsy diagnosis.ResultsA total of 2210 patients with epilepsy and 22,100 matched controls without epilepsy were included. Patients exhibited a 3-fold increased risk of developing mood disorders compared with controls (incidence rate ratio: 3.10 [95% confidence interval (CI): 2.75-3.49]). The risk was highest in the first two years post-diagnosis (adjusted hazard ratio: 3.42 [95% CI: 2.90-4.03]). A notable increase in risk was also observed 8-10 years post-diagnosis (adjusted hazard ratio: 3.07 [(95% CI: 1.14-8.22]), indicating a sustained long-term risk.ConclusionsEpilepsy significantly increases the risk of mood disorders, with the highest risk observed shortly after diagnosis. Continuous monitoring and tailored interventions are essential for managing patients' mental health. Integrated care approaches are needed to treat epilepsy and associated mood disorders.

Curvilinear relationship between life's crucial 9 and metabolic syndrome in U.S. adults: a cross-sectional study

Background

Metabolic Syndrome (MetS) is closely linked to cardiovascular disease. However, no studies have examined the relationship between Life's Crucial 9 (LC9) and MetS. Our goal is to investigate the potential association between LC9 and MetS.

Methods

We employed a weighted multivariate logistic regression model to evaluate the relationship between LC9, health behavior score, health factors score, and MetS. To assess the robustness of this association, we conducted sensitivity analyses. Furthermore, we utilized smooth curve fitting to investigate the potential curvilinear relationships between LC9, health behavior score, health factors score, and MetS. To pinpoint inflection points, we integrated recursive partitioning algorithms with a two-stage linear regression model. Additionally, we performed stratified analyses to explore heterogeneity across different population subgroups.

Results

Our study included a total of 28,555 participants. In the regression model that accounted for all covariates, the OR for LC9 and MetS was 0.941 (0.939, 0.944), indicating a significant negative correlation between the two. Smooth curve analysis confirmed a curvilinear relationship between LC9 and MetS, with an inflection point at 70.56. The negative correlation was evident both before and after the inflection point, with a more pronounced effect after the inflection point. Subgroup analyses of Health behavior score and Health factors score, as well as stratified analyses by age, sex, and BMI, showed that all groups exhibited curvilinear relationships consistent with the overall pattern.

Conclusion

The curvilinear relationship between LC9 scores and metabolic syndrome indicates that higher LC9 scores act as a protective factor against MetS.

Leisure time exercise and depressive symptoms in sedentary workers: exploring the effects of exercise volume and social context

Background

Workers in sedentary occupations often engage in prolonged periods of low physical activity, which may be associated with depressive symptoms. Leisure-time exercise plays a significant role in alleviating these symptoms. Previous studies have shown that adults who engage in physical exercise report fewer depressive symptoms than those who do not. However, the relationship between exercise volume and mental health remains inconsistent. Leisure-time exercise can be categorized into individual and group exercise. Despite its potential importance, little is known about the differential effects of individual and group exercise on depressive symptoms in sedentary occupational populations. The objective of this study was to analyze the association between leisure-time exercise volume and depressive symptoms in sedentary workers, as well as to evaluate the disparities in the effects of individual and group exercise on depressive symptoms.

Methods

From September to October 2024, a cross-sectional survey was conducted to collect data from sedentary workers. The participants' sociodemographic characteristics, exercise patterns, exercise volume, and depressive symptoms were gathered. Chi-square tests and hierarchical logistic regression were employed to analyze the obtained data.

Results

Of the 1,277 respondents, 13.16% reported depressive symptoms. The prevalence of depressive symptoms was higher in those with low exercise volume than in those with medium or high exercise volume. Medium and high exercise volumes were associated with a lower risk of depressive symptoms, with odds ratios (OR) of 0.517 and 0.559, respectively. Group exercisers reported fewer depressive symptoms than individual exercisers, with an OR of 0.624.

Conclusion

The benefits of leisure-time exercise on depressive symptoms in sedentary workers do not always increase with higher exercise volume. Additionally, sedentary workers who participated in group exercise exhibited a lower risk of depressive symptoms than those who participated in individual exercise.

The Role of Statistical Power: A Study of Relationship Between Emotional and Conduct Problems, Sociodemographic Factors, and Smoking Behaviours in Large and Small Samples of Latvian Adolescents

Background and Objectives: Adolescent smoking is influenced by sociodemographic and psychological factors, including emotional and conduct problems. Understanding how sample size impacts the interpretation of these associations is critical for improving study design and public health interventions. This study examines the relationships between smoking behaviours, sociodemographic factors, and emotional and conduct problems, focusing on how sample size affects statistical significance and effect size interpretation. Materials and Methods: Data from the Latvian Health Behaviour in School-aged Children study was analysed. Chi-square tests and logistic regression were conducted to evaluate associations between smoking behaviours, sociodemographic factors, and emotional and conduct problems. Analyses were performed on both a large general sample and ten smaller generated subsamples to compare the impact of sample size on statistical outcomes. Results: Age and conduct problems emerged as the most consistent predictors of adolescent smoking behaviours across large and small samples, while other predictors, such as family affluence and family structure, showed weaker and less consistent associations. A large sample produced significant results even for weak predictors. Conclusions: This study highlights the importance of integrating effect size interpretation with statistical significance, particularly in large datasets, to avoid overstating findings. By leveraging real-world data, it provides practical recommendations for improving study design and interpretation in behavioural, medical, and public health research, contributing to more effective interventions targeting adolescent smoking.

Effectiveness of nurse-initiated smoking cessation intervention: a systematic review and meta-analysis

BACKGROUND

Smoking is a major preventable cause of death, associated with cancers and chronic diseases. Nurse-initiated smoking cessation programs have proven effective, providing counseling, education, and mental health support. These interventions increase quit rates by tackling nicotine addiction, emphasizing the important role of nurses and the need for targeted training. Systematic reviews and meta-analyses are essential for gaining a deeper understanding of the effectiveness of various cessation strategies.

METHODS

A literature search was conducted using eight electronic databases (CINAHL, EMbase, MEDLINE, Cochrane, RISS, KMbase, KISS, and NDSL). The literature search was conducted from March, 27, 2024, to August 1, 2024. All included studies were randomized controlled trials (RCTs). Quality assessment was conducted using the Risk of Bias (ROB) tool. RevMan 5.4 was used for qualitative analysis, with effect sizes measured as odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Thirteen studies, all published after 2005, were included in the evidence assessment of nurse-initiated smoking cessation programs. The interventions examined comprised 11 intensive or personalized counseling programs and 3 telephone-based approaches. The OR for self-reported quit success 7-day smoking cessation rate at 6-month follow-up was 1.43 (95% CI [1.08, 1.90]), indicating a significant difference in quit effectiveness (Z = 2.27, p =.01), with moderate heterogeneity observed across studies (I2 = 67.0%, p =.001). A meta-analysis of 7-day point abstinence rate at 12-month follow-up revealed a pooled OR of 1.18 (95% CI [0.96, 1.44]), showing no significant difference in quit effectiveness (Z = 1.58, p =.11) and moderate heterogeneity among the studies (I2 = 55.0%, p =.02).

CONCLUSIONS

A comprehensive approach by trained nursing professionals is essential in addressing the complexities of smoking cessation. Further clinical trials are needed to assess intervention methods and follow-up strategies. Future research should emphasize long-term outcomes and ongoing support to sustain behavior change, contributing to more effective, tailored cessation programs and improved public health outcomes.

Association of tobacco use with depressive symptoms in adults: Considerations of symptom severity, symptom clusters, and sex

OBJECTIVE

We aim to assess the association between depressive symptoms, depressive symptom severity and symptom clusters with tobacco use. We will also evaluate sex differences in these associations.

METHOD

This cross-sectional study used data from the National Health and Nutrition Examination Survey (2005-2018). Depressive symptoms were assessed using the Patient Health Questionnaire-9. Tobacco use was categorized into four groups: cigarette use, smoked tobacco products (pipes and cigars), smokeless tobacco products (chewing tobacco and snuff), and non-tobacco use (reference group).

RESULTS

This study included 33,509 participants. Cigarette use was associated with a 0.83-unit increase in total PHQ-9 scores (95% CI =  [0.63, 1.04]), and 1.73 times higher odds of reporting depressive symptoms (95% CI =  [1.48, 2.02]) compared to non-tobacco use. However, the use of smoked and smokeless tobacco was not associated with depressive symptoms. In females, cigarette use showed a stronger association with total PHQ-9 scores (aCoef =  1.23, 95% CI =  [0.92, 1.55]) than in males (aCoef =  0.45, 95% CI =  [0.21, 0.69]). Additionally, female smoked tobacco users showed positive associations with both PHQ-9 scores and the presence of depressive symptoms, but this relationship was not observed in males. Furthermore, subgroup analysis revealed associations between cigarette use and cognitive-affective and somatic symptom clusters, as well as a relationship between the logarithm of total cigarette consumption and depressive symptoms.

CONCLUSION

Cigarette use was associated with higher odds of depressive symptoms with females having a stronger association. Further studies are needed to replicate these findings and examine the underlying mechanisms.

Influence of tobacco smoking and alcohol drinking on anxiety in sample of 30 836 individuals in Taiwan Biobank

BACKGROUND

Anxiety disorders are among the most common mental disorders worldwide, and most previous studies have focused solely on alcohol drinking or tobacco smoking as risk factors for anxiety.

AIM

This study investigated the associations of alcohol drinking and tobacco smoking with anxiety.

METHOD

The data of 30 836 individuals in the Taiwan Biobank were retrieved and analysed in our study. To investigate the associations of tobacco and alcohol use with anxiety, we analysed Patient Health Questionnaire 4 (specifically scores for the first two questions assessing generalised anxiety disorder) results of the included participants and data on their tobacco and alcohol use, and other covariates.

RESULTS

Participants who used only tobacco and those using both tobacco and alcohol were more likely to experience anxiety than were those who did not use tobacco or alcohol. Among men, the use of alcohol and/or tobacco was associated with a significantly higher risk of anxiety. Among women, the use of both alcohol and tobacco was associated with a significantly higher risk of anxiety. Older age was associated with a lower risk of anxiety.

CONCLUSIONS

Tobacco and alcohol use significantly influence the risk of anxiety, particularly in men, and older age also influences this risk. The associations of anxiety with tobacco and alcohol use in women may change because of the increasing prevalence of their use among women in Taiwan in recent years.

Smoking cessation services and willingness to receive quitting support among people living in prison in Finland

INTRODUCTION

Smoking is frequent among people living in prison (PLIP) yet little is known about smoking cessation support in prison. This study aims to investigate correlates of being offered help for smoking cessation and willingness to receive smoking cessation support among PLIP.

METHODS

A cross-sectional, nationally representative study of Finnish PLIP in 2020-2022 was used (N = 529 of whom n = 364 (69%) smoked daily) (response rate 82.5%). Dependent variables included not having been offered help for smoking cessation during the prison time and willingness to receive cessation support. Independent variables included socio-demographic, health- and wellbeing-related, and prison-related variables. Regression analyses were utilised.

RESULTS

Of daily smoking PLIP, 75% were not offered support for smoking cessation. In the multiple adjusted model, women had a higher prevalence of not being offered help for smoking cessation than men. Among men, the use of pharmacotherapy for smoking cessation (vs. never use) or longer imprisonment time (vs. shorter imprisonment time) were associated with a lower prevalence of being offered help for smoking cessation. Among both genders, at least moderate willingness to stop smoking (vs. low) was associated with a higher prevalence of wishing to receive support for smoking cessation, while smoking 11-20 cigarettes per day (vs. 1-10 cigarettes per day) was associated with a higher willingness to receive cessation support among men.

DISCUSSION AND CONCLUSIONS

Smoking cessation support is wanted among PLIP who are willing to quit smoking, while support services should be targeted more for women and for men who have spent relatively little time in prison.

The associations between paternal postpartum depressive symptoms and testosterone and cortisol levels in hair over the first two years postpartum

BACKGROUND

After the birth of a child, also fathers may develop postpartum depression. Altered steroid hormone concentrations are discussed as a possible underlying mechanism, as these have been associated with depressive symptoms in previous studies outside the postpartum period. While higher paternal testosterone levels have been found to protect against paternal postpartum depressive symptoms (PPDS), an association between higher cortisol levels and PPDS has been seen in postpartum mothers, with no comparable studies available on fathers.

OBJECTIVE

This study aimed to investigate cross-sectional and longitudinal associations between testosterone and cortisol levels in hair and PPDS over a period of 2 years postpartum.

METHODS

Data from N = 226 fathers, who took part in the endocrine sub-study DREAMHAIR of the longitudinal prospective cohort study DREAM, were used. PPDS were assessed 8 weeks, 14 months, and 24 months after birth using the Edinburgh Postnatal Depression Scale. At the same time, fathers provided 2 cm scalp-near hair samples in which testosterone (HairT) and cortisol (HairF) levels were determined. Cross-sectional and longitudinal associations between HairT, HairF and paternal PPDS were investigated.

RESULTS

Correlation analyses showed a negative cross-sectional association between HairF levels and paternal PPDS 14 months after birth. A random intercept cross-lagged panel model revealed prospective relationships between paternal PPDS 8 weeks postpartum and HairF 14 months postpartum, and additionally between 14 months and 2 years postpartum in an exploratory model with similarly good model fit. No further significant associations of HairF with paternal PPDS emerged, and none of the analyses with HairT became significant. The overall pattern of results was confirmed when controlling for the influence of batch and storage time on HairT and HairF levels.

CONCLUSION

No consistent relationships between HairT or HairF and paternal PPDS emerged in this relatively healthy cohort. In HairF analyses with significant results, lower HairF was associated with more severe PPDS. Longitudinal results imply that altered cortisol secretion may rather follow than precede changes in paternal PPDS. Further research on hormonal changes in PPDS in fathers should consider possible covariates and examine fathers with higher depressive burden, which may help to identify fathers at risk and inform future preventive and interventive approaches.

Prevalence and correlates of depression among Thai university students: nationwide study

BACKGROUND

Depression is a growing mental health concern among university students worldwide, including in Thailand. Studies show that between 17 and 40% of Thai university students experience depressive symptoms, although these studies often focus on specific groups and use different measures.

AIMS

This study aimed to investigate the prevalence and associated factors of depressive disorders among university students across Thailand.

METHOD

Data were collected with the HAPPINOMETER and the Patient Health Questionnaire-9 scale as part of a nationwide cross-sectional survey. A total of 14 621 students from 33 universities participated in the survey. A series of binary logistic regression analyses were performed to examine the effect of sociodemographic characteristics and health behaviours on the presence of depression.

RESULTS

The results revealed that 31.4% of students experienced depressive symptoms, with 14.2% having major depressive disorder. The students who identified as non-binary had the highest odds of having depression (adjusted odds ratio 2.10, 95% CI 1.7-2.6, P < 0.001). Other specific subgroups were also found to be particularly vulnerable, including women, fourth-year students and those studying in Bangkok, without part-time jobs, living alone and engaging in risky health behaviours like smoking, heavy drinking and poor diet.

CONCLUSIONS

The findings underscore the need for comprehensive mental health support and targeted interventions within Thai universities, especially for at-risk subpopulations. Leveraging the existing collaborative networks among Thai universities presents a unique opportunity to mount a coordinated effort in developing and implementing comprehensive mental health strategies tailored to the needs of this vulnerable population.

Effect of a Nursing Program on Anxiety, Depression, and Insomnia in Patients After Liver Transplantation: A Randomized Controlled Trial

BACKGROUND The incidence of anxiety, depression, and sleep disturbances is high among patients after liver transplantation, significantly impacting their quality of life. However, existing nursing programs often lack a comprehensive focus on psychological and physical health outcomes. This study aimed to evaluate the effectiveness of a targeted nursing program in reducing anxiety, depression, and sleep disturbances among liver transplantation patients through psychological care, lifestyle guidance, pain management, and rehabilitation training. MATERIAL AND METHODS A randomized controlled trial was conducted with 80 liver transplantation patients at Beijing Youan Hospital (2021-2023). Patients were randomly assigned to the control group (traditional nursing, n=40) or the intervention group (targeted nursing, n=40). The intervention included psychological care, lifestyle guidance, pain management, and rehabilitation training. Anxiety, depression, and sleep quality were assessed using the SDS, HAMA, and PSQI at 4 time points: 0-60, 61-120, 121-180, and 181-360 days after surgery. RESULTS The incidence of anxiety, depression, and insomnia at 0-60, 61-120, 121-180, and 181-360 days after liver transplantation was 42.50%, 37.50%, 35.00%, and 30.00%; 14.50%, 9.40%, 3.20%, and 1.20%; and 15.80%, 12.10%, 7.30%, and 6.50%, respectively. After the care program, the depression, anxiety, and sleep scores were lower in the intervention group than in the control group and gradually decreased over time (p<0.05). CONCLUSIONS The nursing program after liver transplantation includes postoperative psychology, pain care, life strategies, and rehabilitation training, which can effectively reduce the depression, anxiety, and sleep scores of patients and is recommended for wide use.

Factors associated with cigarette smoking among learners at a high school in KwaZulu-Natal

Background

Young smokers are said to have increased risk of nicotine addiction, even at lower levels of consumption compared to adults, making smoking cessation among this group much more difficult. A survey previously conducted in South Africa indicated an early smoking debut age of below 18 years.

Aim

This study investigated the prevalence of cigarette smoking and associated factors among high school learners.

Setting

The study was conducted at a high school located in Madadeni township of KwaZulu-Natal.

Methods

This cross-sectional study collected data through interviews using self-administered questionnaires. Data analysis was conducted on Epi Info 7 and STATA 17.

Results

Eighty-four (21%) of the 400 participants reported smoking cigarettes. Of these, forty-nine (58.3%) had a smoking friend. Sixty out of 81 (74.1%) accessed cigarettes from the shops, whilst 69.2% (n = 54/78) smoked inside the school premises. Seventy-seven (92.7%) of 83 smokers expressed intention to quit smoking. Higher odds of cigarette smoking were observed among participants who were male and those who had a smoking family member, respectively, (adjusted odds ratio [AOR] = 2.33, 95% CI = 1.29-4.17) and (AOR = 5.82, 95% CI = 3.08-11.0), p = < 0.05.

Conclusion

This study found 21% of high school learner participants who smoked cigarettes. Laws prohibiting smoking in schools and sale of cigarettes to minors should be reinforced.

Contribution

intention to quit cigarette smoking as expressed by smoking learners calls for the establishment of school-based programme for smoking cessation.

Loneliness and Social Isolation in Individuals with Acute Myocardial Infarction and Takotsubo Syndrome: A Scoping Review

BACKGROUND/OBJECTIVES

Loneliness and social isolation are considered significant social determinants of myocardial infarction (MI) or Takotsubo syndrome (TS). However, research on these factors in MI populations is highly heterogeneous, and evidence regarding TS is sparse. The present scoping review aimed at mapping the extent and breadth of the literature on loneliness and social isolation in individuals with MI or TS.

METHODS

Following PRISMA-ScR guidelines and JBI methodology, we conducted a systematic search in PubMed, Web of Science, and EBSCO/PsycINFO, supplemented by a manual search, for studies published up to 25 June 2024. Primary research studies on loneliness and/or social isolation in individuals with MI or TS were included based on predefined inclusion and exclusion criteria, with title-abstract and full-text screening.

RESULTS

Sixteen studies met the inclusion criteria, all of which focused on MI. Studies were categorized into three key concepts: loneliness (k = 5), social isolation (k = 7), and both loneliness and social isolation (k = 4). The findings showed that MI impacts subjective experiences and interpersonal relationships, often leading to identity shifts and increased social isolation and loneliness. These factors have been shown to be associated with severe physical health outcomes, including heightened mortality risk; however, these associations appear to be highly mediated by unhealthy lifestyle behaviors. Notably, no studies on TS met the inclusion criteria, highlighting a significant research gap. Additionally, no study explored clinical interventions targeting social isolation or loneliness.

CONCLUSIONS

MI has a profound impact on social and emotional well-being, with loneliness and social isolation contributing to severe health outcomes. Further research is needed to understand the impact of these factors on individuals with TS.

Impact of the COVID-19 pandemic on tobacco product consumption and behavioral patterns from a low-middle income country perspective: A qualitative study

INTRODUCTION

Previous studies investigating socioeconomic status and tobacco consumption during the COVID-19 pandemic were survey-based. To extend knowledge beyond prevalence rates and trends of tobacco consumption, qualitative research is needed to identify individual's experiences. There is a critical gap within this context, particularly in low-middle income countries. The aim of the study was to perform a qualitative analysis on consumption patterns of tobacco users from a low-middle income country during the COVID-19 pandemic, and to identify factors influencing motivation to quit tobacco products during the pandemic and the perceptions of self-risk for complications of tobacco consumption and COVID-19.

METHODS

A qualitative study was conducted in São Paulo, Brazil in September 2020. We used a focus group with semi-structured interviews. Participants were invited to answer questions about behavioral and consumption patterns of tobacco products during early stages of COVID-19 pandemic. Two investigators independently performed triangulation of content of the transcripts. Data were analyzed using inductive content analysis.

RESULTS

Eighteen participants were evaluated (66.7% males) with mean age 34.1 ± 14.9 years. Many participants presented high levels (33.3%) of nicotine dependence. Thematic analysis of participants' narratives resulted in two themes: Theme 1: Behavioral and psychological factors impacting consumption; and Theme 2: Consumption patterns, dependence, and information. Open-coding process resulted on four codes: 1) Behavioral and lifestyle changes; 2) Psychological and motivational factors; 3) Consumption patterns and dependence; and 4) Information exposure and awareness. Nine categories were generated from the codes.

CONCLUSIONS

Behavioral and consumption patterns varied significantly in tobacco users in Brazil during the early stages of the COVID-19 pandemic, ranging from increases to no changes. Individuals consuming tobacco products showed awareness about the harmful effects of smoking and COVID-19 complications.

The correlation between patient health questionnaire-4 scores and major depressive disorder: a population-based study

Background

This study aims to investigate the association between PHQ-4 scores and major depressive disorder (MDD) among participants from the Taiwan Biobank.

Methods

We analyzed data from 5,629 individuals who completed the PHQ-4 questionnaire. Self-reported MDD cases in the Taiwan Biobank (TWB) were linked to their information in the National Health Insurance Research Database (NHIRD), requiring at least two outpatient visits or one inpatient hospitalization for confirmation. The PHQ-4 scores, a validated screening tool for anxiety and depression, were assessed as continuous variables due to the small sample size. Logistic regression models, adjusted for relevant covariates, were employed to examine the relationship between PHQ-4 scores and MDD.

Results

Participants with MDD exhibited significantly higher mean PHQ-4 scores (mean ± SD: 2.17 ± 2.61) compared to controls (1.02 ± 1.69, p < 0.001). The odds ratio (OR) for a one-unit increase in PHQ-4 score was 1.26 (95% CI: 1.19-1.34), indicating a 26% increased risk of MDD. The combined OR for anxiety items (PHQ1 and PHQ2) was 1.51 (95% CI: 1.36-1.68), while for depression items (PHQ3 and PHQ4), the OR was 1.42 (95% CI: 1.28-1.58). Notably, females had an OR of 1.22, while males had a higher OR of 1.31. Additionally, older adults (≥70 years) showed an OR of 4.56. Unemployed individuals had an OR of 1.83, and current smokers had an OR of 2.18.

Conclusion

The findings highlight a significant association between higher PHQ-4 scores and the prevalence of MDD, suggesting that depression and anxiety components may contribute to the overall correlation with MDD.

Vaping transitions and incident depressive symptoms among young adults: a marginal structural model analysis

The extent to which vaping influences depression is unclear but could be estimated through application of novel epidemiologic methods. Among a prospective cohort of young adults from California who screened negative for depression, we estimated repeated-measures marginal structural models to examine the association of 4 vaping transitions from time T to T + 1 (persistent use, discontinuation, initiation, persistent nonuse) with risk of clinically significant depressive symptoms at T + 1, simultaneously across three ~ 1.5-year time intervals between 2017 and 2021. Stabilized inverse probability of treatment and censoring weights adjusted for time-dependent confounders and selection bias. Among n = 3496 observations (1806 participants, mean pooled baseline age = 19.5), 8.1% reported persistent vaping from T to T + 1, 6.2% reported discontinuation (ie, use at T and no use at T + 1), 6.5% initiated e-cigarettes (ie, no use at T and use at T + 1), and 79.2% reported persistent nonuse at both time points. Compared to persistent vaping at 2 waves, persistent nonuse (relative risk [RR] = 0.76; 95% CI, 0.62-0.93) and discontinuation (RR = 0.71; 95% CI, 0.52-0.96) were associated with lower risk of depression. Associations were robust to sensitivity analyses, including restricting to tobacco-naive participants and varying temporal assumptions to reduce potential for reverse causation. Young adults who consistently avoid or discontinue vaping may be protected from depressive symptom occurrence.

Prevalence and Associated Factors for Depression Among Patients With Sarcoma

PURPOSE

Prevalence and risk factors for depression among patients with sarcoma and survivors of sarcoma are not well characterized.

METHODS

A sarcoma survivorship cohort was constructed from patients diagnosed between April 2022 and September 2023. Depression symptoms were assessed via the eight-item Patient-Reported Outcomes Measurement Information System-57 depression scale at enrollment. Standardized T-score levels (<50, 50-59, and ≥60) were calculated and evaluated in association with demographics, lifestyle characteristics, clinical data, and modifiable factors using multinomial logistic regression models.

RESULTS

Among 612 participants, the mean T-score was 48.3 (standard deviation, 10.0); 58.8% had a T-score <50, 27.9% scored between 50 and 59, and 13.2% scored ≥60. Participants age 18-39 years and age 40-59 years were more likely to have a T-score ≥60, with respective odds ratios (ORs) of 3.65 (95% CIs, 1.70 to 7.83) and 2.80 (1.52 to 5.17) compared with participants older than 60 years. Household incomes of $70,000-$120,000 in US dollars (USD) (OR, 0.46 [95% CI, 0.23 to 0.92]) and >$120,000 USD (OR, 0.15 [95% CI, 0.06 to 0.37]) were inversely associated with T-score ≥60 compared with household incomes <$45,000 USD. Marijuana use within the past 30 days was positively (OR, 3.48 [95% CI, 1.46 to 8.27]) associated, while regular exercise (OR, 0.43 [95% CI, 0.24 to 0.75]) and emotional support (OR, 0.37 [95% CI, 0.28 to 0.48]) were inversely associated with having T-score ≥60.

CONCLUSION

A higher prevalence of depression symptoms was notable in younger participants, marijuana users, and households with lower incomes. Regular exercise and increased emotional support were inversely associated with depression symptoms. Our study provides information for developing personalized supportive care strategies to ameliorate depression symptoms among patients with sarcoma.

Intensive smoking cessation treatment as an adjunct to concurrent psychotherapy: study protocol for a randomized controlled trial

BACKGROUND

Tobacco use is globally recognized by the World Health Organization as the foremost risk factor for premature mortality. Individuals with mental disorders exhibit a notably heightened dependence on tobacco, approximately twice as high as that of the general population. The long-term effects of nicotine consumption include an exacerbation of depressive symptoms and a decline in mental health, which can be considered additional risk factors for the vulnerable population of smokers with preexisting mental disorders. Successful smoking cessation is associated with an increase in mental health, comparable or superior to that of pharmacological antidepressant treatments. However, smoking is frequently disregarded within the realm of psychotherapeutic care, unlike in the treatment of other substance use disorders. Smoking may hinder patients' recovery and responsiveness to psychotherapy, potentially distorting improvements in symptom severity or negative affect. Integrating smoking cessation initiatives into standard psychotherapeutic interventions thus holds significant potential and may be considered essential for long-term mental health. The current study's objective is to assess the potential of a guideline-based smoking cessation intervention within an outpatient psychotherapeutic setting concerning changes in smoking intensity, nicotine dependence, and mental health outcomes among patients with a mental disorder adjunct to concurrent psychotherapy. This trial aims to bridge the gap between the state of research in light of evidence of the positive effects of successful smoking cessation and the actual practical provision of care in Germany.

METHODS

The effects of an intensified smoking cessation intervention versus a treatment-as-usual (TAU) control intervention on smokers' smoking intensity, nicotine dependence, and mental health symptoms related to a primary mental disorder will be examined in a single-center randomized controlled trial in an outpatient psychotherapeutic clinic using variance analysis methods. In this case, TAU is referred to as regular psychotherapy sessions without any additional smoking cessation treatment. The smoking intervention consists of a common guideline-based cognitive-behavioral program supplemented by a digital health application. Secondary outcomes include patients' motivation to quit, self-efficacy, and attitudes toward online interventions. Potential moderators or mediators will be investigated in exploratory analyses.

DISCUSSION

This study aims to elucidate the potential benefits of integrating smoking cessation interventions into standard psychotherapeutic treatment, akin to approaches used for other substance use disorders. While existing research highlights the positive impact of smoking cessation on mental health, its practical implications within the field of psychotherapy remain unclear. To address this gap, the current study examines the effectiveness of an intensive smoking cessation program alongside ongoing psychotherapy, focusing on both smoking status and mental health outcomes. By doing so, we aim to provide practical insights for psychotherapeutic providers regarding the integration of smoking cessation into comprehensive mental health care.

TRIAL REGISTRATION

Prospectively registered on ISCRTN on 01.05.2024, reference number ISRCTN12859609.

Distribution and association of depression with tobacco consumption among middle-aged and elderly Indian population: nested multilevel modelling analysis of nationally representative cross-sectional survey

BACKGROUND

Research on the distribution and association of depression with tobacco consumption among young population is commonly prioritised in India, while studies on tobacco use among middle-aged (45-59 years) and elderly (≥ 60 years) adults are noticeably lacking. Thus, we conducted this study with the objectives of estimating the prevalence, distribution and determining the association of depression and tobacco consumption among middle-aged and elderly Indian population; overall and stratified into age group, gender, and geographical location.

METHODS

Using dataset from Longitudinal Aging Study in India (LASI), a bivariate analysis was conducted among middle-aged (45-59 years) and elderly (≥ 60 years) Indians to estimate the prevalence of depression and tobacco consumption. States and Union Territories were categorised as low, medium, and high as per prevalence of depression and tobacco consumption, and spatial distribution maps were created. To reduce the confounding effects of demographic & socioeconomic and health-related & behavioural covariates; propensity score matching (PSM) was conducted. Nested multilevel regression modelling was employed to explore the association between depression (outcome variable) and tobacco consumption (explanatory variable) using STATA version 17. The p value < 0.05 was considered statistically significant.

RESULTS

Overall, 36.78% (36.03-37.55%) participants documented using any form of tobacco; with higher consumption of smokeless tobacco (SLT) (19.88%) than smoking (SM) (13.92%). The overall prevalence of depression was 7.62% irrespective of tobacco consumption, and 8.51% among participants consuming any form of tobacco. Mizoram had the highest consumption of tobacco in any form (78.21%), whereas Madhya Pradesh recorded the highest (14.62%) depression prevalence. Bihar, Uttar Pradesh, West Bengal, and Uttarakhand had both high prevalence of depression and any form of tobacco consumption. The average estimated treatment effect (ATE) indicated a positive association both between depression and any form of tobacco consumption (p value = 0.001) and with smokeless tobacco (p value = 0.001) consumption. Participants ever consuming any form of tobacco had 28% higher odds (aOR-1.28 (1.18-1.38). The odds of having depression were higher among females (aOR = 1.28 (1.17-1.41); richest (aOR-1.48 (1.32-1.65); living alone (aOR = 1.14 (1.01-1.33). Participants with comorbidity (aOR = 1.20 (1.10-1.30) and multimorbidity (aOR = 1.24 (1.13-1.36)) had higher odds of depression.

CONCLUSION

The study has established significant positive association between depression and tobacco consumption stratified into gender and age group. Prioritisation of mental health disorders like depression and tobacco prevention and cessation programmes must be implemented with focusing on females and the middle-aged population with community awareness and intersectoral collaborative effort irrespective of subnational-variations.

The effect of smoking cessation on mental health: Evidence from a randomized trial

One in nine Americans smokes cigarettes, and a disproportionate share of smokers suffer from mental illness. Despite this correlation, there exists little rigorous evidence on the effects of smoking cessation on mental health. We re-use data from a randomized trial of a smoking cessation treatment to estimate short and long-term impacts on previously un-analyzed measures of mental distress. We find that smoking cessation increases short-run mental distress, while reducing milder forms of long-run distress. We provide suggestive evidence on mechanisms including physical health, marriage, employment and substance use. Our results suggest that cessation efforts and mental health supports are complementary interventions in the short run and provide new evidence of welfare gains from cessation in the long run.

Nicotine dependence and incident psychiatric disorders: prospective evidence from US national study

We examined the prospective associations between nicotine dependence and the likelihood of psychiatric and substance use disorders in the general adult population. Participants came from a nationally representative sample of US adults aged 18 years or older, who were interviewed 3 years apart in the National Epidemiologic Survey on Alcohol and Related Conditions (Wave 1, 2001-2002; Wave 2, 2004-2005). The primary analyses were limited to 32,671 respondents (13,751 male (47.9% weighted); mean age of 45 years (SD = 0.18)) who were interviewed in both waves. We used multiple regression and propensity score matching (PSM) to estimate the strength of independent associations between nicotine dependence related to the use of tobacco products at Wave 1 and incident psychiatric disorders at Wave 2. Psychiatric disorders were measured with a structured interview (Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV). All analyses adjusted for multiple potential confounders, including childhood (family history of substance use disorders, parental loss, vulnerable family environment), early-adolescence (self-esteem, social deviance, conduct disorder), late-adolescence (education, personality and psychiatric disorders), adulthood (divorce, stressful life events, social deviance, quality of life, history of alcohol or other substance use disorder), and sociodemographic factors. Multiple regression analysis and PSM converged in indicating that nicotine dependence was associated with significantly increased incidence of any psychiatric disorder (OR = 1.39(95%CI:1.20;1.60)), including substance use disorders (OR = 1.91(95%CI:1.47;2.47)), and anxiety disorders (OR = 1.31(95%CI:1.06;1.62)). Population Attributable Risk Proportions were substantial, ranging from 12.5%(95%CI:8.10;17.0) for any psychiatric disorder to 33.3%(95%CI:18.7;48.0) for any other drug use disorder. Supplementary analyses also indicated significant associations between nicotine dependence and persistence of psychiatric and substance use disorders among patients having a disorder at Wave 1. In the general adult population, nicotine dependence is associated with an increased likelihood for several psychiatric and substance use disorders. Given its high prevalence, these findings have important public health implications.

From planetary health diet (PHD) to mental health: Higher PHD index protects against depression among the U.S. population

BACKGROUND

Depression is a growing public health concern, and the modest efficacy of current treatments has led to efforts to identify modifiable risk factors. Many nutritional and dietary patterns are linked to depression. The Planetary Health Diet Index (PHDI) measures adherence to sustainable dietary guidelines by the EAT-Lancet Commission. However, the relationship between PHDI and depression has not been studied. This study evaluates this relationship using data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018.

METHODS

Multivariate logistic regression and weighted quantile sum (WQS) regressions examined the relationship between PHDI, single nutrients, and depression. A generalized additive model with a smoothing plot analyzed the dose-response relationship.

RESULTS

Among 30,446 participants, the highest quartile of PHDI was linked to a reduced risk of depression. WQS analyses showed consistent associations (OR = 0.71, 95%CI: 0.66, 0.76), with Vitamin C, Fiber, and Selenium significant factors. The dose-response curve indicated a linear association between PHDI and depression, with higher PHDI associated with lower depression risk.

CONCLUSIONS

The results of this study show a strong negative correlation between PHDI and depression.

Is the affordability of cigarettes associated with the prevalence of smoking and quitting at the regional level in Russia?

INTRODUCTION

Tobacco prices and income determine the affordability of cigarettes. Affordability in turn affects smoking prevalence. Both prices and incomes can vary widely across a large country. The aim of this paper is to find out whether there is an association between affordability of cigarettes and smoking/cessation prevalence across Russian regions. We assess the proportions of people who smoke and those who smoked and quit.

METHODS

We use microdata from a repeated survey on the living conditions of the Russian population that is representative at the regional level (2014, 2016, 2018, 2020, 2022, 77 regions). We aggregate the microdata by region and combine them with official macro data. Using descriptive and multivariable analyses, we identify factors that correlate with the prevalence of smoking and quitting in the regions.

RESULTS

A one per cent increase in real prices was associated with a 0.1% decrease in the smoking prevalence rate and with a 0.2% increase in quitting prevalence rate. A 1% decrease in real income is associated with a 0.5% increase in the proportion of those who quit. The more cigarettes that can be purchased for a daily per capita income, the higher the smoking prevalence rate and the lower the proportion of quitting, with affordability elasticities of 0.1 and -0.27 respectively.

CONCLUSIONS

Rising real prices, as well as reduced affordability of cigarettes not only reduce the proportion of people who smoke, but also increase the proportion of those who quit. In a country with a large geographical spread and high regional income inequality, tobacco taxes should be set at the regional level to eliminate significant differences in the affordability of cigarettes.

Examining the influence of mental health and structural determinants of health on the stage of motivational readiness for health behaviour changes: A path analysis study

This study explores the influence of mental health and structural determinants of health on motivational readiness for health behaviour change in 1462 Spanish primary healthcare users. Chi-square test and structural equation modelling were performed. Results showed that depression and anxiety were negatively associated with being in the action stages of motivational readiness for a healthy diet and physical activity. This association was statistically significant only for motivational readiness for a healthy diet and depression (β = - 0 . 076 ; p = 0 . 046 ). Furthermore, women and workers were more likely to be in the action stages of motivational readiness for a healthy diet while older adults and adults with higher health-related quality of life were more likely to be in the action stages of motivational readiness for physical activity. The present study suggests that structural (being older, being a woman and being employed) and intermediary (suffering from depression and higher health-related quality of life) determinants of health influence motivational readiness for health behaviour changes.

Effect of e-cigarettes for smoking cessation on depressive and anxiety symptoms: Secondary analysis of a randomized controlled trial

OBJECTIVE

This study aims to assess differences in depressive and anxiety symptoms at 6-month follow-up in a smoking cessation trial using e-cigarettes as quitting aids.

METHODS

We conducted a secondary analysis of the Swiss multicentre ESTxENDS smoking cessation randomized controlled trial (RCT) assessing differences in depressive (Patient Health Questionnaire-9, PHQ-9, range: 0-27) and anxiety symptoms (General Anxiety Disorder-7, GAD-7, range: 0-21) at 6-month follow-up comparing participants who received e-cigarettes to those who received smoking cessation counseling alone.

RESULTS

Of 1244 participants 913 completed the PHQ-9 and 884 the GAD-7 at 6-month follow-up. Mean PHQ-9 scores (SD) at 6 months for the intervention group were 3.7 (3.9), control group: 4.0 (4.2); mean GAD-7 scores (SD) at 6 months for the intervention group were 4.6 (4.3), control group: 4.6 (4.4). Multivariable analyses showed no evidence of a clinically relevant intervention effect on the PHQ-9 [coefficient - 0.101, 95 % CI -0.182 to -0.019, p = .016, corresponding to a 0.9 decrease of the original PHQ-9 score] and the GAD-7 scores [coefficient - 0.056, 95 % CI -0.135 to 0.022, p = .160] in the main adjusted models.

CONCLUSIONS

Among smokers who participated in the ESTxENDS smoking cessation trial, we found distribution of e-cigarettes for smoking cessation in addition to standard counseling compared to counseling alone had no clinically relevant effect on depressive or anxiety symptoms at 6-month follow-up.

TRIAL REGISTRATION

ClinicalTrials NCT03603340.

Parental smoking is associated with adolescent loneliness: evidence from 71 low- and middle-income countries

Introduction

The association between parental smoking and adolescent mental health is not well understood. We aimed to examine the association between parental smoking and adolescent loneliness using global data collected from the Global School-based Student Health Survey (GSHS) between 2009 and 2019.

Methods

A total of 187,552 adolescents aged 12-15 years in 71 low- and middle-income countries (LMIC) from the GSHS with cross-sectional design were included in this study. Loneliness was defined as feeling lonely sometimes or more frequently in the past 12 months. Parental smoking, reported by the adolescent, was defined as the use of any form of tobacco by the father and/or mother. Logistic regression models were used to examine the odds ratio (OR) of adolescent loneliness according to parental smoking status.

Results

Compared with neither parent smoking, parental smoking was associated with adolescent loneliness (father only: OR = 1.18, 95% CI = 1.10-1.26; mother only: OR = 1.39, 95% CI = 1.15-1.67; both: OR = 1.65, 95% CI = 1.41-1.93) after adjustment for potential covariates. Subgroup analyses stratified by sex, age, and WHO region showed similar results (except not in the African and Western Pacific regions).

Discussion

Parental smoking is associated with loneliness in adolescents from LMIC. Our finding expands the well-known physical damage of parental smoking in adolescents to the psychological damage. Strict policies and strategies should be established to encourage smoking cessation for parents who are current smokers.

Urban-Rural Disparities in Depressive Symptoms Among Employed Individual: Education Plays an Important Role

Objective

Focusing on the relationship between education level and the occurrence of depressive symptoms, the purpose of this study was to investigate the factors influencing urban-rural differences in depressive symptoms among employed Chinese workers and to measure the contribution of relevant influencing factors.

Measurements

This study utilized the nationally representative resampled data from the China Family Panel Studies (CFPS) in 2018. A binary logistic regression model was established to explore the major factors influencing depressive symptoms among employed individuals. The Fairlie decomposition method was employed to investigate the impact of education level and other influencing factors on the urban-rural differences in the occurrence of depressive symptoms.

Results

The proportion of depressive symptoms among employed persons in China was 14.51%. The results showed that the proportion of depressive symptoms was higher among rural workers (17.09%) than urban workers (11.75%). The Fairlie model was developed with 65.70% explanatory power, and the differences in depressive symptoms between urban and rural employed persons were mainly related to literacy (39.10%), self-rated health (12.39%), life satisfaction (8.36%), job satisfaction (7.60%), marital status (-4.96%), gender (-3.61%), chronic disease status (2.99%) and BMI (1.41%) were related.

Conclusion

This study found that the prevalence of depressive symptoms was higher among rural employed persons than among urban employed persons, which was mainly related to the differences between urban and rural residents in factors such as education level, health status and marital status. The Chinese government should pay more attention to the mental health of the working population and take measures to reduce the differences in depressive symptoms between urban and rural areas in China.

Aboriginal and Torres Strait Islander People Who Smoke and Want to Quit-A Cohort Profile From the Koori Quit Pack study

INTRODUCTION

Reducing the prevalence of smoking is a national priority; however, there is limited evidence on what smoking cessation supports are utilized, accessible, and effective among Aboriginal and Torres Strait Islander people. This paper describes a cohort profile of Aboriginal and Torres Strait Islander people who smoke and want to quit to inform tailored smoking cessation interventions.

AIMS AND METHODS

Aboriginal and Torres Strait Islander people residing in New South Wales, Australian Capital Territory (ACT), and Victoria, who were smokers wanting to quit, were recruited through health services and online advertisements from May to October 2022. Descriptive and inferential statistics were used to summarize participant characteristics and explore factors associated with previous use and adherence to Nicotine Replacement Therapy (NRT) and intention to use Quitline services.

RESULTS

One hundred and sixty-five participants were recruited. Almost all (93.9%) had made at least one previous quit attempt, and 40.6% had used behavioral support. The majority believed NRT was safe (80.6%), effective (70.3%), and tried NRT previously (89%). Preferred forms of NRT for current quit attempts were nicotine patches (85.5%) and inhalers (69.7%). Intention to use Quitline was found to be higher among participants aged 31-45 years compared to participants under 30 years (AOR = 3.12, 95% CI: 1.01 to 9.76).

CONCLUSIONS

Aboriginal and Torres Strait Islander people are highly motivated to be smoke-free. However, efforts to enhance access and adherence to cessation supports are needed. The rapid recruitment and interest in the mailout cessation support should be scaled up to support Aboriginal and Torres Strait Islander peoples to quit.

IMPLICATIONS

The Australian Government has recently launched a national tobacco strategy which includes targets for reducing smoking prevalence to less than 27% among Aboriginal and Torres Strait Islander peoples. In order to meet these targets Aboriginal and Torres Strait Islander people who smoke and want to quit should have access to culturally safe and responsive support. We found that Aboriginal and Torres Strait Islander people have made quit attempts, accessed evidence-based smoking cessation care, and have positive attitudes towards NRT. However, acknowledging relapse, further evidence is required to understand the factors associated with sustained quitting.

Development and Validation of Prediction Models for Perceived and Unmet Mental Health Needs in the Canadian General Population: Model-Based Synthetic Estimation Study

Background

Research has shown that perceptions of a mental health need are closely associated with service demands and are an important dimension in needs assessment. Perceived and unmet mental health needs are important factors in the decision-making process regarding mental health services planning and resources allocation. However, few prediction tools are available to be used by policy and decision makers to forecast perceived and unmet mental health needs at the population level.

Objective

We aim to develop prediction models to forecast perceived and unmet mental health needs at the provincial and health regional levels in Canada.

Methods

Data from 2018, 2019, and 2020 Canadian Community Health Survey and Canadian Urban Environment were used (n=65,000 each year). Perceived and unmet mental health needs were measured by the Perceived Needs for Care Questionnaire. Using the 2018 dataset, we developed the prediction models through the application of regression synthetic estimation for the Atlantic, Central, and Western regions. The models were validated in the 2019 and 2020 datasets at the provincial level and in 10 randomly selected health regions by comparing the observed and predicted proportions of the outcomes.

Results

In 2018, a total of 17.82% of the participants reported perceived mental health need and 3.81% reported unmet mental health need. The proportions were similar in 2019 (18.04% and 3.91%) and in 2020 (18.1% and 3.92%). Sex, age, self-reported mental health, physician diagnosed mood and anxiety disorders, self-reported life stress and life satisfaction were the predictors in the 3 regional models. The individual based models had good discriminative power with C statistics over 0.83 and good calibration. Applying the synthetic models in 2019 and 2020 data, the models had the best performance in Ontario, Quebec, and British Columbia; the absolute differences between observed and predicted proportions were less than 1%. The absolute differences between the predicted and observed proportion of perceived mental health needs in Newfoundland and Labrador (-4.16% in 2020) and Prince Edward Island (4.58% in 2019) were larger than those in other provinces. When applying the models in the 10 selected health regions, the models calibrated well in the health regions in Ontario and in Quebec; the absolute differences in perceived mental health needs ranged from 0.23% to 2.34%.

Conclusions

Predicting perceived and unmet mental health at the population level is feasible. There are common factors that contribute to perceived and unmet mental health needs across regions, at different magnitudes, due to different population characteristics. Therefore, predicting perceived and unmet mental health needs should be region specific. The performance of the models at the provincial and health regional levels may be affected by population size.

Psychological burden of smoking in women: Experiences of anxiety and social stigma

This study aims to examine women's experiences of social stigmatization due to smoking and its effects on mental health and social relationships. The study was completed in May and June 2024 with a total of 251 women participants. Women who were over 18 years of age, smoked, were literate and volunteered to participate were included in the study.The data were collected online using the Descriptive Information Form, which includes socio-demographic information and smoking characteristics of the participants; the Fagerström Nicotine Dependence Test (FNDT), which measures smoking dependence levels, and the Beck Anxiety Scale (BAS), which assesses anxiety levels. Analyses were performed in SPSS 24.0 software; t test, ANOVA, chi-square and Pearson correlation analyses were used. Among the women, 58.6% were between 26 and 40 years of age, 49.8% were single, and 59.8% were university graduates and above. No significant correlation was found between FNDT and socio-demographic characteristics (p > 0.05), whereas a significant correlation was found between BAS and age, marital status, and income status (p < 0.05). Significant correlations were found between FNDT scores and duration of smoking, age of starting smoking, the reason for starting smoking, and its effect on work life. Significant correlations were found between the effects of smoking on the environment due to being a woman, its effects on social relations, and its effects on social stigmatization and BAS scores (p < 0.05). This study revealed that social stigma related to smoking negatively affects women's mental health and social relationships. Awareness campaigns, accessible psychological support, and gender-sensitive policies are essential to reduce stigma and improve women's quality of life.

Determinants of generalized anxiety and construction of a predictive model in patients with chronic obstructive pulmonary disease

BACKGROUND

Patients with chronic obstructive pulmonary disease (COPD) frequently experience exacerbations requiring multiple hospitalizations over prolonged disease courses, which predispose them to generalized anxiety disorder (GAD). This comorbidity exacerbates breathing difficulties, activity limitations, and social isolation. While previous studies predominantly employed the GAD 7-item scale for screening, this approach is somewhat subjective. The current literature on predictive models for GAD risk in patients with COPD is limited.

AIM

To construct and validate a GAD risk prediction model to aid healthcare professionals in preventing the onset of GAD.

METHODS

This retrospective analysis encompassed patients with COPD treated at our institution from July 2021 to February 2024. The patients were categorized into a modeling (MO) group and a validation (VA) group in a 7:3 ratio on the basis of the occurrence of GAD. Univariate and multivariate logistic regression analyses were utilized to construct the risk prediction model, which was visualized using forest plots. The model's performance was evaluated using Hosmer-Lemeshow (H-L) goodness-of-fit test and receiver operating characteristic (ROC) curve analysis.

RESULTS

A total of 271 subjects were included, with 190 in the MO group and 81 in the VA group. GAD was identified in 67 patients with COPD, resulting in a prevalence rate of 24.72% (67/271), with 49 cases (18.08%) in the MO group and 18 cases (22.22%) in the VA group. Significant differences were observed between patients with and without GAD in terms of educational level, average household income, smoking history, smoking index, number of exacerbations in the past year, cardiovascular comorbidities, disease knowledge, and personality traits (P < 0.05). Multivariate logistic regression analysis revealed that lower education levels, household income < 3000 China yuan, smoking history, smoking index ≥ 400 cigarettes/year, ≥ two exacerbations in the past year, cardiovascular comorbidities, complete lack of disease information, and introverted personality were significant risk factors for GAD in the MO group (P < 0.05). ROC analysis indicated that the area under the curve for predicting GAD in the MO and VA groups was 0.978 and 0.960. The H-L test yielded χ 2 values of 6.511 and 5.179, with P = 0.275 and 0.274. Calibration curves demonstrated good agreement between predicted and actual GAD occurrence risks.

CONCLUSION

The developed predictive model includes eight independent risk factors: Educational level, household income, smoking history, smoking index, number of exacerbations in the past year, presence of cardiovascular comorbidities, level of disease knowledge, and personality traits. This model effectively predicts the onset of GAD in patients with COPD, enabling early identification of high-risk individuals and providing a basis for early preventive interventions by nursing staff.

Cannabis and mental health in adolescents: changes in associations over 15 years

PURPOSE

Recent changes in the cannabis market, including decreased adolescence usage, increased Δ9-tetrahydrocannabinol levels and rising mental disorders over the last decade raises questions about the changing profile of cannabis consumers.

METHODS

This study explores the trends of associations between regular cannabis use and mental health in five waves of a national representative survey of 17-year-old French adolescents, including more than 150,000 participants. Multivariable models, adjusted for gender and socioeconomic variables, were used.

RESULTS

Cannabis use and mental health indicators showed some variations over time, with increasing divergence between 2017 and 2022. Regular use of cannabis decreased from 7.4% in 2008 to 3.8% in 2022 (p < 0.001). In contrast, suicidal ideation in the past year increased from 16% in 2008 to 18% in 2022 (p = 0.009), although it followed a U-shaped trend. The association between regular cannabis use and suicidal ideation in the past year increased from 1.44 (CI: 1.29-1.61) in 2008 to 2.52 (CI: 2.05-3.10) in 2022. Similarly, the association between cannabis use and antidepressant use in the past year increased from 2.57 (CI: 2.18-3.03) in 2008 to 4.47 (CI: 3.35-5.97) in 2022.

CONCLUSION

These results suggest that cannabis users are now more prone to mental health disorders compared to 15 years ago. Several mechanisms might explain these findings, including the self-selection of a population with both vulnerabilities, changes in the effects of cannabis, or the use of cannabis as a self-medication strategy.

Relationship between sleep disorders and depressive symptoms among young women in Japan: a web-based cross-sectional study

OBJECTIVES

Japanese people are known to get the least amount of sleep in the world, and in particular, the increase in sleep deprived young women is a serious problem. Sleep deprivation is considered to be associated with depression, but the factors involved in this problem are unclear. This study aimed to examine the association between sociodemographic factors, lifestyle choices, sleep-related characteristics and depressive symptoms in young Japanese women.

DESIGN

Web-based cross-sectional study.

PARTICIPANTS

We distributed an online survey aiming to recruit young Japanese women ages 18 to 29 from 8 November 2022 to 2 February 2023.

PRIMARY AND SECONDARY OUTCOME MEASURES

Sociodemographic, lifestyle, health, and sleep characteristics were compared among participants according to the presence or absence of depressive symptoms, as assessed by the Patient Health Questionnaire 2 (Cut-off value: 3 points).

RESULTS

Overall, 540 participants aged between 19 and 29 years were enrolled in the study. The overall prevalence of depressive symptoms was 15.6%. The group with depressive symptoms had a higher rate of current smoking status at 38.5% (unadjusted OR 3.716, 95% CI 1.624 to 8.502). Multiple logistic analyses revealed that depressive symptoms were associated with increased sleep onset latency (β=0.282; p=0.048; OR, 1.325; 95% CI, 1.003 to 1.752) and daytime dysfunction (β=0.550; p<0.001; OR, 1.733; 95% CI, 1.281 to 2.343) after adjusting for the effects of smoking habits.

CONCLUSIONS

Depressive symptoms were found to be associated with sleep disorders in young Japanese women, and paying attention to sleep onset latency and daytime dysfunction which are one of the strongest related factors to depressive symptoms could be a clue to improving sleep disorders and depressive symptoms.

Prospective Associations Between Tobacco Product Use and Mental Health and Substance Use Problems Among U.S. Adolescents and Adults

OBJECTIVE

The authors examined prospective associations between tobacco product use and mental health and substance use problems among U.S. adolescents and adults.

METHODS

Covariate-adjusted models using discrete-time survival analysis of five annual waves (2013-2014 to 2018-2019) were used to examine the links between specific tobacco product use and mental health and substance use problems among adolescent and adult participants in the nationally representative Population Assessment of Tobacco and Health study. The sample included up to 32,320 adults and 13,651 adolescents.

RESULTS

Among adolescents, externalizing problems predicted cigarette, electronic nicotine delivery system (ENDS), and hookah use. Sex-specific findings were found for female subjects (internalizing problems predicted cigarette, ENDS, and cigar use) and male subjects (externalizing problems predicted cigar and smokeless tobacco use). Among adults, cigarette use predicted internalizing and externalizing problems; ENDS use was associated bidirectionally with internalizing problems. Across age groups, use of each tobacco product predicted substance use problems, and substance use problems predicted ENDS use.

CONCLUSIONS

Intervening when mental health problems are seen among adolescents may minimize tobacco uptake. Likewise, preventing tobacco use may curtail substance use problems, and treatment of substance use problems may reduce tobacco use. Findings highlight the critical need to incorporate the bidirectionality among mental health, tobacco use, and substance use into prevention and treatment efforts.

Smoking to your kids gain? Childhood exposure to parental smoking and obesity

We empirically investigate the link between parental smoking during childhood or adolescence and the probability of adult obesity. Utilizing data from Household, Income and Labour Dynamics Survey for Australia spanning 2006-2021, our analysis reveals that individuals who were exposed to parental smoking during their childhood exhibit a 4.7 percentage point higher likelihood of being obese in later stages of life. Several robustness checks indicate that the results can be suggestive of a causal relationship. Our findings indicate that health, social capital, and personality traits act as significant pathways through which early exposure to parental smoking during childhood raises the risk of adult obesity. The implications of our findings are significant for early-life interventions aimed at addressing obesity stemming from exposure to passive smoking.