Association of depression trajectories and subsequent hypertension and cardiovascular disease: findings from the CHARLS cohort

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.

Additive impact of depression and social isolation on future cardiovascular disease and mortality: The mediated effect of cardiometabolic diseases

BACKGROUND

Depression and social isolation are significant public health issues worldwide, characterized by a bidirectional relationship between the two. This study aims to evaluate the combined effects of depression and social isolation on cardiovascular disease (CVD) and mortality, as well as to assess the mediating role of cardiometabolic diseases in these associations.

METHODS

This nationwide prospective cohort study utilized data from the China Health and Retirement Longitudinal Study. Depression was assessed using the 10-item Center for Epidemiologic Studies Depression Scale, while social isolation was measured using 4 dichotomized indicators. The outcomes were CVD and all-cause mortality. Logistic regression models and mediation analyses were conducted, and population attributable fractions (PAFs) were calculated.

RESULTS

8567 participants were included in the study, with a mean age of 59.2 (±10.0) years and 48.7 % being men. Among the participants, 5773 (67.4 %) reported neither depression nor social isolation, 1143 (13.3 %) had depression only, 1190 (13.9 %) experienced social isolation only, and 461 (5.4 %) had both depression and social isolation. Individuals with both conditions exhibited the highest odds of CVD (odds ratio (OR): 1.61; 95 % confidence interval (CI): 1.27, 2.04) and mortality (OR: 1.61; 95 % CI: 1.22, 2.12) (p for trend across groups <0.001). The estimated PAFs indicated that a significant number of CVD and mortality events could potentially be prevented by addressing depression and social isolation. Mediator analyses revealed significant indirect effects of hypertension and suboptimal BMI on the relationships between depression, social isolation, and the incidence of CVD and mortality.

LIMITATIONS

Depression, social isolation, and outcomes were self-reported.

CONCLUSION

A significant combined effect of depression and social isolation on CVD and all-cause mortality was observed among middle-aged and older Chinese adults, underscoring the importance of preventing and managing depression and social isolation to alleviate the burden of CVD.

Prospective association between depressive symptoms and incident hypertension: Results from the Hispanic community health study/study of Latinos

OBJECTIVE

Previous research on depressive symptoms with incident hypertension has yielded mixed results, and this relationship has not been studied in a diverse group of Hispanic/Latino adults.

METHODS

We studied 5927 Hispanic/Latino adults aged 18-74 years from four U.S. cities who attended baseline (2008-2011) and follow-up (2014-2017) examinations of the Hispanic Community Health Study/Study of Latinos. Baseline depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale-10; clinically relevant depressive symptoms were defined as ≥10 points. Blood pressure (BP) was measured using a standardized protocol at both examinations. Hypertension was defined as measured systolic BP ≥130 mmHg, or diastolic BP ≥80 mmHg, or self-reported antihypertension medication use. Analyses accounted for the complex survey design.

RESULTS

Among 5927 persons without hypertension at baseline, the six-year age-adjusted incidence rates of hypertension were 40 and 31 per 1000 person-years among those with and without elevated depressive symptoms, respectively. Persons with elevated depressive symptoms had a 25 % (p = .003) higher 6-year incidence of hypertension than those with fewer symptoms, after adjusting for sociodemographic and clinical covariates. There was an interaction between depressive symptoms and age (pinteraction < 0.05). Among adults aged 18-34 years without hypertension at baseline (n = 1748), those with elevated depressive symptoms had 80 % higher 6-year incidence of hypertension than those with fewer symptoms (p = .001).

CONCLUSIONS

These findings suggest that depressive symptoms are a risk factor for hypertension in young Hispanic/Latino adults. Early screening and treatment of depressive symptoms may aid in the prevention of hypertension.

Cardiac history and post-stroke depression association in Chinese stroke survivors: a cross sectional study

A substantial body of evidence indicates that stroke is a primary cause of death and disability on a global scale. The presence of post-stroke depression has been demonstrated to exert a substantial influence on the prognosis of stroke patients, underscoring the imperative for the identification and early prevention of post-stroke depression. The objective of this study was to examine the association between cardiac history and post-stroke depression (PSD) in Chinese stroke patients, with the aim of identifying high-risk groups, promoting early intervention strategies, and enhancing patient prognosis. This study was based on data from the 2020 China Health and Retirement Longitudinal Study (CHARLS), which included 933 respondents with a history of stroke. Univariate and multivariate logistic regression analyses were used to assess the effects of cardiac history and other variables on post-stroke depression (PSD). The results indicated a correlation between cardiac history and post-stroke depression (PSD). In addition, the data showed that gender, activities of daily living (ADLs), cognitive functioning, and life satisfaction also had an effect on post-stroke depression (PSD). The findings presented here indicate that patients with a history of cardiac disease are more likely to develop post-stroke depression. This provides valuable insights into the clinical management of stroke patients and the prevention of post-stroke depression. The emotional health assessment of such patients should be emphasized in clinical management, and appropriate psychological support and interventions should be provided to improve their overall prognosis.

A vascular endothelial cell, neuron, and microglia tri-culture model to study hypertension-related depression

Hypertension-related Depression (HD) is a complex mental disorder that exerts a significant negative impact on patients' quality of life. Previous studies have demonstrated that damages to vascular endothelial and hippocampus are the primary pathological features in HD rats. Under hypertensive conditions, inflammatory cytokines in peripheral blood vessels can induce central nervous system inflammation through penetration of a damaged blood-brain barrier, peripheral immune cells, and neural pathways, damaging the brain and triggering HD. Therefore, interactions between vascular endothelial cells, neurons, and glial cells are critical for the understanding of HD. However, in vivo animal models are often limited by the complexity of intrinsic systems, high inter-individual variability, and stringent ethical regulations. A reliable model that could be easily manipulated is needed for investigating the mechanisms involved in communication between vascular endothelial cells, neurons, and glial cells in HD. We therefore aimed to create a composite tri-culture model consisting of rat aortic endothelial cells (RAECs), neurons, and microglia to study HD. First, RAECs were stimulated with lipopolysaccharide to mimic endothelial injury under hypertensive conditions. Vascular endothelial function and inflammatory levels were assessed using fluorescent probes and enzyme-linked immunosorbent assays. RAECs treated with 1 μg/ml LPS for 24 h had reduced levels of nitric oxide, increased levels of endothelin-1 and inflammatory mediators. These findings are consistent with the endothelial dysfunction and inflammatory responses observed in spontaneously hypertensive rats, which suggests that the lipopolysaccharide-induced RAECs model effectively mimics key pathological features of hypertension-related endothelial injury. Subsequently, the supernatants from lipopolysaccharide-induced RAECs were combined with 200 μM corticosterone and transferred to neuron-microglia co-cultures to simulate damages to hippocampal neuron under HD conditions. To evaluate the features of cells, neuronal viability was measured by CCK-8 and live-dead assays. Nissl staining was used to assess neuronal Nissl bodies, while the levels of inflammatory factors and monoamine neurotransmitters in the culture supernatants were evaluated by enzyme-linked immunosorbent assays. Reactive oxygen species in neurons were visualized by a fluorescent probe, apoptosis was detected using TUNEL assays, and immunofluorescence was used to assess microglial phenotypes and the levels of TLR4 and NF-κB. It was found that neurons in the tri-culture model had reduced viability, higher levels of apoptosis, fewer Nissl bodies, increased inflammation, and reduced levels of monoamine neurotransmitters. Additionally, the number of M1 microglia was increased, along with elevated levels of TLR4 and NF-κB proteins. These findings were similar to damages of hippocampal neuron, abnormal levels of monoamine neurotransmitters, microglia polarization, and hippocampal inflammatory response observed in the HD rat model. In conclusion, our findings indicate that the tri-culture model can effectively simulate the pathological characteristics of HD, especially in vascular endothelial damage, neuroinflammation, monoamine neurotransmitters disorders. Therefore, the tri-culture model would provides a reliable and invaluable experimental tool for further research on the pathogenesis and treatment of HD.

Curvilinear association between cardiometabolic index and depressive symptoms in individuals aged 45 and older: a cross-sectional study of CHARLS

Objective

This research is aimed at investigating the association between the cardiometabolic index (CMI) and depressive symptoms in Chinese population of middle and older age, using data derived from the CHARLS study.

Methods

Using data from 7,800 participants in the 2011-2012 wave of the CHARLS cohort, this cross-sectional analysis concentrated on examining the association between CMI and depressive symptoms, assessed through CESD-10 scores. The study utilized multivariate logistic regression, multiple linear regression, and restricted cubic spline (RCS) models to investigate the link between CMI and depression, with subgroup analyses offering further insights. Sensitivity analyses included propensity score matching and data from 8,457 participants in the 2015-2016 CHARLS wave.

Results

In fully adjusted models, higher CMI was significantly associated with an elevated risk of depression, with participants having a CMI ≥ 0.594 showing a 162% higher risk compared to those with lower CMI. The RCS analysis identified a threshold at CMI = 0.594, where participants with CMI ≥ 0.594 had a 162% elevated possibility of depression in comparison to those with CMI < 0.594 [OR = 2.62, 95% CI: 2.36-2.91]. Sensitivity analyses, including propensity score matching and data from the 2015-2016 CHARLS wave, confirmed the robustness of the findings.

Conclusion

Our analysis demonstrates that elevated CMI levels are independently correlated with a heightened likelihood of experiencing depressive symptoms, highlighting the significance of metabolic interventions in mitigating depressive tendencies in middle-aged and older individuals.

Relationship Between Sleep Time and Depressive Symptoms in Middle-Aged and Elderly Chinese: Mediating Role of Body Pain

Objective

Existing research has yet to adequately examine the correlation between sleep time, body pain, and depressive symptoms. This study seeks to elucidate the interconnections between these three elements.

Methods

The study used 2020 CHARLS data for analysis. To assess the intricate association among sleep time, body pain, and depressive symptoms, the study employed Spearman correlation analysis, multiple logistic regression, restricted cubic splines, and mediation effect analysis based on bootstrap testing.

Results

Risk factors for depressive symptoms in middle-aged and elderly Chinese include physical pain and reduced sleep duration. Results from the RCS suggest that the lowest risk of depressive symptoms occurs when the sleep time for the middle-aged and elderly population is approximately 7.5 hours. Body pain accounts for a 19.05% mediating effect between sleep time and depressive symptoms, and even after controlling confounding factors, there remains a 7.5% mediating effect.

Conclusion

The research findings indicate that there is a significant correlation among sleep time, body pain, and depressive symptoms. Insufficient sleep time and body pain can lead to depressive symptoms. Body pain plays a partial mediating role between sleep time and depressive symptoms.

Metabolomic Profiling Reveals Biomarkers in Coronary Heart Disease Comorbidity

Background and Aims: Coronary heart disease (CHD), hypertension (HTN), depression (Dep), and Type 2 diabetes mellitus (T2DM) are often comorbid, resulting in an exacerbated patient condition and worsened prognosis. A lack of systematic metabolomic studies on comorbidities of CHD remains. Therefore, comprehensive metabolomic-based evaluation of comorbidities of CHD is necessary. Methods and Results: In the current study, 169 healthy subjects, 149 CHD subjects, 107 CHD + HTN subjects, 126 CHD + Dep subjects, and 58 CHD + T2DM subjects were recruited. Gas chromatography-mass spectrometry was used for metabolite determination, and multivariate statistical analysis was conducted to identify metabolites that are differentially expressed with the comorbidities of CHD. There were 9, 16, 14, and 10 metabolites identified in the healthy and CHD group, the CHD and CHD + HTN group, the CHD and CHD + Dep group, and the CHD and CHD + T2DM group, respectively. Six metabolic pathways were affected, involving starch and sucrose metabolism; fructose and mannose metabolism; citrate cycle; alanine, aspartate, and glutamate metabolism; fatty acid biosynthesis; and glycolysis. Conclusion: Our study has systematically elucidated the metabolic changes underlying the comorbidities of CHD, thereby providing insight into the mechanisms associated with these alterations.

Association of metalloestrogens exposure with depression in women across reproductive lifespan

BACKGROUND

Exposure to metal could impact women's depression risk. However, the connection and mechanisms between metalloestrogens exposure and depression are still not fully understood. We aim to explore the associations between metalloestrogens and the risk of depression in women across reproductive lifespan.

METHODS

Using data from NHANES 2011-2018, we employed logistic regression and baknernel machine regression (BKMR) to study links between metalloestrogen exposure and depression in US women. We analyzed how contraceptive use affects this relationship.

RESULTS

The study involved 3,374 adult women, with 345 of them experiencing depression. Our research revealed that certain metalloestrogens like Ba, Ca, Pb, Sb, and Sn were linked to higher depression risk in women, while Hg was associated with lower depression risk in older women. For women aged 18-44, a blend of metalloestrogens showed a significant positive correlation with depression risk, and the likelihood of depression in later years notably rose when the metal mixture concentration reached or exceeded the 60th percentile. Oral contraceptives would have an effect on the impact of metalloestrogen mixture exposure on depression in women during the reproductive stage.

CONCLUSIONS

Our study indicates a significant link between metalloestrogen exposure and a higher risk of depression in adult women in the United States. This finding can aid in identifying the connection and enhancing women's mental well-being.

The relationship between healthy lifestyles and cognitive function in Chinese older adults: the mediating effect of depressive symptoms

BACKGROUND

Previous studies have proven the positive relationship between healthy lifestyles and cognitive function in older adults. However, the specific impacts and mechanisms require further investigation. Therefore, this study aimed to investigate whether healthy lifestyles and cognitive function were associated with Chinese older adults and whether depressive symptoms mediated their association.

METHODS

8272 valid samples were included using the latest data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Pearson's test was applied to investigate the relationship between the key variables. Regression models were employed to examine the mediating effects of healthy lifestyles, using Sobel's test and the bootstrap method to confirm path effects.

RESULTS

There was a significant correlation between healthy lifestyles, depressive symptoms, and cognitive function (p < 0.01). Healthy lifestyles directly impact cognitive function (β = 0.162, p < 0.01). Healthy lifestyles had a significant effect on depressive symptoms (β=-0.301, p < 0.01), while depressive symptoms have a significant impact on cognitive function (β=-0.108, p < 0.01). Depressive symptoms partially mediated the effect of healthy lifestyles on cognitive function (β = 0.032, p < 0.01). The Sobel and bootstrap tests confirmed the robustness of the regression analysis results.

CONCLUSION

Depressive symptoms mediate the relationship between healthy lifestyles and cognitive function. Our findings suggest that prevention strategies for cognitive impairment in older adults should focus on healthy lifestyles and mental health.