Anxiety, Depression, and Common Chronic Diseases, and Their Association With Social Determinants in Saudi Primary Care

Tocilizumab Reduces Depression Risk in Rheumatoid Arthritis Patients: A Systematic Review and Meta-Analysis

Depression is a possible cause of the increased mental health risks associated with rheumatoid arthritis (RA), including depression-related complications. Biological disease-modifying antirheumatic drug (bDMARDs) therapies have emerged as innovative anti-inflammatory drugs with positive effects on mental well-being. Tocilizumab is a bDMARDs commonly used to treat RA and its influence on depression needs to be studied. It targets interleukin-6 (IL-6) receptors, reducing inflammation, which may also alleviate depressive symptoms due to the role of inflammation in the pathophysiology of depression. Thus, its influence on depression needs to be studied. To assess the strength of the association between exposure to tocilizumab and the rate of development of depression in patients with RA and to evaluate tocilizumab as an exposure and depression as an outcome in these patients, a search was conducted in the MEDLINE, PreMEDLINE, Cochrane, and Scopus databases from January 1980 to April 2024. Inclusion criteria were studies that diagnosed RA according to the latest American College of Rheumatology/European League Against Rheumatism guidelines or a rheumatologist and provided information on tocilizumab exposure and diagnosed depression as an outcome. The present meta-analysis was conducted following the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. These studies were assessed for eligibility by the author and an independent assessor. To summarize the findings, the meta-analysis combined the relative risk estimates from each study with raw data counts. Twelve studies in the meta-analysis fulfilled the inclusion criteria. Tocilizumab monotherapy exhibited a promising beneficial effect on the risk of depression, indicated by the decreased risk in RA patients (Relative risk 0.68, 95% CI 0.20, 2.31). Patients with RA on tocilizumab treatment had a lower risk of developing depression compared to those unexposed to tocilizumab treatment. Therefore, future longitudinal studies are needed to confirm the beneficial effect of tocilizumab on depression in the RA population.

Social determinants of anxiety and mood disorders in a nationally-representative sample - Results from the Saudi National Mental Health Survey (SNMHS)

INTRODUCTION

Social determinants of health (SDH) influence and modify the risk for mental health disorders. To our knowledge, no study has explored SDH in the context of mental health in Saudi Arabia (SA) using population-based data. This study investigated the association between several SDH and anxiety and mood disorders in SA.

METHODS

We utilized data from the nationally-representative Saudi National Mental Health Survey (SNMHS) conducted in 2014 to 2016. This study examined associations between personal-level, socioeconomic, physical health, and family environment characteristics and anxiety and mood disorders. Participants were classified as having anxiety-only disorders, mood-only disorders, or comorbidity of both disorders. Multinomial logistic regression models were employed to examine the associations between SDH and anxiety and/or mood disorders, comparing them to participants who had not experienced these disorders.

RESULTS

A total of 4,004 participants were included in this analysis; the lifetime prevalence of disorders was: anxiety only (18%), mood only (3.8%), and comorbidity of both (5.3%). Regression models indicated that females, young adults (26-35 years), individuals with a higher level of education, and those who were separated or widowed had higher odds of experiencing anxiety and/or mood disorders. Furthermore, there was a significant and direct association between having physical chronic conditions and all three categories of anxiety and mood disorders. Experiencing Adverse Childhood Events (ACEs) was also associated with a significant risk of developing anxiety and/or mood disorders, with the highest risk associated with physical or sexual abuse, followed by violence and neglect.

CONCLUSION

This study underscores the correlation between several personal-level, socioeconomic, and environmental SDH and anxiety and mood disorders in SA. These findings provide a foundation for future analyses examining the intricate interplay between upstream and downstream SDH in SA. Such research can enhance local scientific knowledge, aid in planning for social services, and inform policy decisions and treatment strategies.

The Association of Asthma with Anxiety, Depression, and Mild Cognitive Impairment among Middle-Aged and Elderly Individuals in Saudi Arabia

Asthma is a common chronic inflammatory condition with increasing global prevalence. There is some evidence highlighting the effect of asthma on brain functioning. In Saudi Arabia, limited studies have examined the relationship between asthma and mental health, including cognition and mood disorders in older adults in particular. In this study, we examine the association between asthma and mental health outcomes in middle-aged and elderly individuals in Riyadh, Saudi Arabia. In a cross-sectional study, 243 subjects were recruited from outpatient clinics between 2020-2021 (non-asthmatic: n = 159, asthmatic: n = 84). The Montreal Cognitive Assessment test, the Hospital Anxiety and Depression Scale, and the Asthma Control Test were used to assess cognition, anxiety and depression, and asthma control, respectively. Logistic regression analysis while controlling for covariates revealed an association between asthma and symptoms of anxiety and depression (OR = 2.40 [95% CI: 1.07-5.35]) and mild cognitive impairment (MCI) (OR = 1.80 [95% CI: 1.00-3.24]). Poorly controlled asthma increased the odds of anxiety cases (OR = 4.88 [95% CI: 1.09-17.2]). Stratifying analysis by age intervals revealed that asthma was associated with symptoms of anxiety and depression (OR = 2.5 [95% CI: 1.00-6.08]) in middle-aged patients only, while elderly asthmatics had increased odds of having MCI (OR = 7.4 [95% CI: 2.34-23.31]). These findings highlight the possible effects of asthma and its control on mental health among middle-aged and elderly individuals in Saudi Arabia.

Prevalence of Psychiatric Illness Among Keratoconus Patients

Background  Keratoconus is a chronic corneal disorder characterized by progressive thinning of the cornea resulting in visual deterioration. Keratoconus patients have a higher rate of psychiatric morbidities. Therefore, this study will assess the prevalence of psychiatric illness among keratoconus patients. Methods We conducted a quantitative retrospective study in three centers across Saudi Arabia from June 2016 to February 2023. We included all patients previously diagnosed with keratoconus and any psychiatric illness. We excluded patients with other ocular diseases in addition to keratoconus. After we extracted the data, we coded and analyzed them using IBM SPSS Statistics for Windows, Version 21.0 (2012; IBM Corp., Armonk, New York, United States) and GraphPad Prism Version 8.4.2 (Dotmatics, Boston, Massachusetts, United States). Results The study included 57 keratoconus patients, with the majority being Saudi (96.5%), female (2:1), in the age group of 31-40 years (40.4%), and with a high-school level of education. The majority of patients were also obese (42.4%) and non-smokers (82%). Most patients had comorbid medical disorders. Of the 57 patients, 63.2% had anxiety disorders, 56.1% had depression, 10.5% had schizophrenia, and 1.8% had bipolar disorder. Patients with only a primary-school level of education were significantly more likely to be diagnosed with bipolar disorder, whereas those who were single were significantly more likely to be diagnosed with schizophrenia. Corneal transplant was also significantly associated with schizophrenia. Most patients (51%) were diagnosed with a psychiatric illness before keratoconus was diagnosed. Conclusion Among the keratoconus patients, single relationship status, primary-school level of education, and comorbidities were significantly associated with schizophrenia, bipolar disorder, and anxiety disorder, respectively. In addition, corneal transplant was significantly associated with schizophrenia. Lastly, the occurrence of psychiatric illness before keratoconus diagnosis was observed in the majority of patients.

Effect of type of disease-modifying antirheumatic drugs on depression and anxiety of patients with rheumatoid arthritis in Saudi Arabia: a cross-sectional study

Background

Rheumatoid arthritis (RA) can cause depression and anxiety. This study evaluated the factors associated with depression and anxiety in patients with RA and examined the effect of conventional and biologic disease-modifying antirheumatic drugs (DMARDs).

Methods

This cross-sectional study was conducted in a regional hospital in Riyadh between March and November 2022 and included 213 patients with RA. Depression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS) and data about patients' DMARDs use was obtained from the hospital's medical records.

Results

Based on the HADS scores, 35 (16.4%) and 49 (23%) patients with RA had depression and anxiety, respectively. There was a significant association between the level of depression and anxiety and the use of leflunomide and tocilizumab among patients with RA (p = 0.006 and p = 0.009, respectively). Patients with RA who took leflunomide had significantly higher scores for anxiety (β = 0.158, value of p = 0.037) when compared to patients who did not take leflunomide. Patients with RA who took etanercept showed a significantly lower depression score even after adjusting for confounders, including sociodemographic, clinical, and lifestyle factors (β = -0.189, p = 0.043).

Conclusion

The present study highlighted the prevalence of psychiatric disorders among patients with RA and the level of depression and anxiety may differ between patients with RA depending on the type of DMARDs used. We recommend patients with RA be screened regularly for depression and anxiety to avoid further extra-articular systemic complications associated with RA.

Relationship between nutritional status and anxiety and depression in hospitalized diabetic patients in Turkey

BACKGROUND

Anxiety and depression often coexist in patients with chronic diseases. We evaluated the nutritional status of diabetic patients and its relationship with anxiety and depression.

METHODS

Demographic, diabetic information (disease duration, treatment, hospitalization) information and anthropometric measurements (weight, height, waist, and hip circumference) were recorded. The Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression. 24-h food records were obtained to determine daily energy and nutrient intake.

RESULTS

In this study of 222 patients, the rates of anxiety, depression and anxious depression were 23.8%, 21.6%, 12.2%, respectively. Those who skipped medication/insulin doses and did not exercise regularly had significantly higher anxiety and depression scores. Anxiety and depression scores were positively correlated with disease duration, waist circumference, waist/hip, and waist/height. Being married, engaging in regular exercise, and increased vitamin B₆ consumption were inversely related to anxiety and depression. According to food records, patients with anxiety and depression have a higher proportion of energy from dietary carbohydrates. Anxiety and depression scores were negatively related to dietary energy, protein, fat, some vitamin (retinol, group B, C, and D), and mineral (K, Mg, P, Fe, Zn, Cu) intake.

CONCLUSIONS

Maintaining healthy body weight, compliance with medication/insulin treatment, and regular exercise may help in the prevention of anxiety and depression in hospitalized diabetic patients. Alternatively, anxiety and depression may adversely affect body weight, compliance with treatment, and engaging in regular exercise. Prospective studies are needed to determine the direction of causality.

Network Structure of Comorbidity Patterns in U.S. Adults with Depression: A National Study Based on Data from the Behavioral Risk Factor Surveillance System

Background

People with depression are at increased risk for comorbidities; however, the clustering of comorbidity patterns in these patients is still unclear.

Objective

The aim of the study was to identify latent comorbidity patterns and explore the comorbidity network structure that included 12 chronic conditions in adults diagnosed with depressive disorder.

Methods

A cross-sectional study was conducted based on secondary data from the 2017 behavioral risk factor surveillance system (BRFSS) covering all 50 American states. A sample of 89,209 U.S. participants, 29,079 men and 60,063 women aged 18 years or older, was considered using exploratory graphical analysis (EGA), a statistical graphical model that includes algorithms for grouping and factoring variables in a multivariate system of network relationships.

Results

The EGA findings show that the network presents 3 latent comorbidity patterns, i.e., that comorbidities are grouped into 3 factors. The first group was composed of 7 comorbidities (obesity, cancer, high blood pressure, high blood cholesterol, arthritis, kidney disease, and diabetes). The second pattern of latent comorbidity included the diagnosis of asthma and respiratory diseases. The last factor grouped 3 conditions (heart attack, coronary heart disease, and stroke). Hypertension reported higher measures of network centrality.

Conclusion

Associations between chronic conditions were reported; furthermore, they were grouped into 3 latent dimensions of comorbidity and reported network factor loadings. The implementation of care and treatment guidelines and protocols for patients with depressive symptomatology and multimorbidity is suggested.

Ethnicity affects the risk factors of acute myocardial infarction and should be considered in educational programs

Acute Myocardial infarction is a non-communicable disease representing the leading cause of death in Saudi Arabia. Studying the ethnicity in its risk factors has been poorly investigated.

Network Analysis of Depressive Symptomatology in Underweight and Obese Adults

BACKGROUND

Depressive symptoms can affect people's quality of life and social environment. In addition, in severe situations, they can lead to suicidal behaviors.

OBJECTIVE

This study aimed to analyze the differences in depressive symptoms in underweight and obese Peruvian adults.

METHODS

A cross-sectional study was carried out based on secondary data obtained from the Instituto Nacional de Estadística e Informática (INEI), Lima, Peru. A sample of 10 053 participants was considered, of which 55.96% were women. Two Gaussian plot models were estimated and the levels of depressive symptomatology were compared between the 2 groups (adults with underweight and obese).

RESULTS

A total of 1510 (15.02%) were underweight adults and 8543 (84.98%) were obese adults. There were differences in the reporting of depressive symptoms in the underweight group; the most central items were "Depressed mood" (PH2), "Tiredness/low energy" (PH4), and "Psychomotor difficulties" (PH8).

CONCLUSION

This study provides new evidence on the dynamic relationship between depressive symptoms according to the body mass index categories (underweight and obese) assessed.