Relationship between chronic diseases and depression: the mediating effect of pain

Depressive and Insomnia Symptoms Among Older Adults With Different Chronic Pain Trajectories: A Network Analysis Based on Observation Over an Eight-Year Period

Background: Depressive and insomnia symptoms are common among older adults with chronic pain. We aimed to examine different chronic pain trajectories of older adults over an 8-year observation period and explore the network structures of depression and insomnia in each chronic pain group. Methods: The trajectories of pain in the USA-based Health and Retirement Study (HRS) data from 2010 to 2018 were examined using latent class growth analyses (LCGA) method. Depressive and insomnia symptoms were measured with the eight-item version of the Center for Epidemiological Studies Depression (CESD-8) Scale and the four-item Jenkins Sleep Scale (JSS-4), respectively. Network models were constructed using the Ising model. Central symptoms and bridge symptoms were identified via expectedInfluence (EI) and bridge EI, respectively. Results: A total of 11,132 older adults were included in the trajectory analysis, with three chronic pain trajectories identified, including "severe pain trajectory," "moderate pain trajectory," and "non or mild pain trajectory". From these trajectories, "Lack of happiness" (CESD4), "Feeling depressed" (CESD1), and "Feeling sad" (CESD7) emerged as the most central symptoms, while "Feeling tired in the morning" (JSS4) was identified as the key bridge symptom. However, the findings may not be generalizable to other parts of the world outside the USA. Conclusion: Older adults with different chronic pain trajectories exhibited similar depression and insomnia network structure. Implementing timely interventions that target central and bridge symptoms might mitigate the co-occurrence of depression and insomnia in this population.

Body Pain and Depressive Symptoms: Patterns and Associations in Middle-Aged and Older Chinese Adults

Background: Depressive symptoms (DS) and body pain are prevalent conditions that significantly impact the quality of life of older adults, often co-occurring with chronic diseases. This study aimed to explore the patterns of body pain characteristics and their association with DS among middle-aged and older Chinese adults. Methods: This cross-sectional study analysed data from 16,039 participants aged ≥45 years in the 2020 wave of the China Health and Retirement Longitudinal Study (CHARLS). DS were assessed using the 10-item Centre for Epidemiologic Studies Depression Scale (CESD-10). Body pain characteristics included pain severity and location. Multiple linear regression and mediation analyses were conducted to examine the relationships between chronic diseases, body pain, and DS. Results: Among participants, 5442 (33.9%) reported DS (CESD-10 score ≥12). The DS group showed significantly higher body pain severity (2.66 ± 1.42 vs. 1.84 ± 1.11, p < 0.001) and more painful body parts (5.06 ± 3.87 vs. 3.68 ± 3.03, p < 0.001) compared to the non-depressive group. Both pain severity and number of pain sites were independently associated with higher CESD-10 scores. Mediation analysis revealed that body pain severity mediated 29.0% of the total effect between chronic diseases and DS. Conclusion: Body pain plays a significant mediating role in the relationship between chronic diseases and DS among middle-aged and older Chinese adults. These findings emphasize the importance of implementing comprehensive healthcare approaches that integrate pain management with mental health support in primary care settings.

Association between atherogenic index of plasma and depression in individuals with different glucose metabolism status

Background

The atherogenic index of plasma (AIP) has been implicated in various disease processes, yet its relationship with depression, particularly in the context of differing glucose metabolism status, remains underexplored. This study aimed to investigate the association between AIP and depression in middle-aged and older adults with varying glucose metabolism profiles.

Methods

Data were derived from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011 and 2018, encompassing 7,723 participants aged 45 years and above. Depression was defined using a cutoff score of ≥12 on the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). The primary outcome of interest was incident depression. Logistic regression and restricted cubic spline (RCS) models were applied to assess the relationship between baseline AIP levels and depression risk across distinct glucose metabolism categories.

Results

Elevated AIP was strongly associated with increased odds of depression. In fully adjusted models, a graded relationship was observed, with higher quartiles of AIP corresponding to greater depression risk. Participants in the highest AIP quartile (Q4) had significantly increased odds of depression (odds ratio [OR]: 3.36, 95% confidence interval [CI]: 2.67-4.24, P < 0.001) compared to those in the lowest quartile (Q1). Furthermore, RCS analyses revealed a significant positive association between AIP and incident depression among individuals with prediabetes mellitus (Pre-DM) and diabetes mellitus (DM) (P < 0.001), whereas no such association was found in participants with normal glucose regulation (NGR) (P = 0.086). These findings suggest that glucose metabolism status modifies the relationship between AIP and depression risk.

Conclusion

Higher baseline AIP levels are significantly associated with an increased risk of depression in middle-aged and older adults, with distinct effects modulated by glucose metabolism status. These results highlight the potential utility of AIP as a biomarker for depression risk and suggest that metabolic health should be considered in the development of targeted strategies for depression prevention and intervention.

Predictors of mood disturbance in older adults: a longitudinal cohort study

PURPOSE

Given the significant mental health challenges faced by the aging population, this study aimed to identify key predictors of mood disturbances among older adults, focusing on socioeconomic, health, and cognitive factors.

METHODS

This post-hoc analysis utilized publicly available data from the National Health and Aging Trends Study (NHATS), a nationally representative longitudinal cohort study conducted in the United States. The analysis included 2,820 adults aged 65 years and above who were followed for three years (age average range 75-79 years, 54.7% female).

RESULTS

During the follow-up period, 21.8% of participants developed new-onset mood disturbances. High-income status is associated with decreased risk (OR 0.71, 95% CI 0.52-0.96), while being Black showed a risk effect compared to White participants (OR 1.38, 95% CI 1.06-1.29). With not good health status (OR 1.58, 95% CI 1.04-2.41), without presence of diabetes (OR 0.74, 95% CI 0.58-0.95), and poor memory status (OR 2.14, 95% CI 1.10-4.15) were significant predictors. Without fear of falling (OR 0.77, 95% CI 0.61-0.97) and increased physical performance (OR 0.94, 95% CI 0.91-0.98) also decreased risk. Income-stratified analysis revealed that low-income groups were particularly affected by cognitive function, middle-income by health status, and high-income by physical activity levels.

CONCLUSION

Socioeconomic status, race, health conditions, and cognitive function are significant predictors of mood disturbances in older adults. These findings suggest the importance of developing targeted interventions based on income levels and addressing modifiable risk factors.

Chronic pain as a mediator in the falls-frailty association: Evidence from middle-aged and older ethnic minorities in Yunnan, China

BACKGROUND

Falls are associated with an increased risk of frailty in middle-aged and older adults; however, the mediating role between falls and frailty remains underexplored, particularly among ethnic minority groups with distinct sociocultural and environmental exposures. Ethnic minority populations exhibit significant disparities in the prevalence of falls, frailty, and chronic pain compared to the majority. The primary objective of this study is to examine the relationship between falls and frailty in middle-aged and elderly individuals residing in Yunnan Province, China, with a specific emphasis on exploring the potential mediating effect of chronic pain across different ethnic groups.

METHODS

Employing a cross-sectional design, data were collected from July to December 2022 from adults aged ≥45 years in five ethnically diverse counties of Yunnan Province, China. Structured face-to-face interviews and stratified multistage cluster sampling were used for data collection. Baron and Kenny's causal steps method was used to explore the mediating effect of chronic pain on the relationship between falls and frailty. Spearman correlation analysis, multiple linear regression models, and bootstrap method were used for data analysis.

RESULTS

A total of 2710 respondents participated in this study. The age distribution was as follows: 1161 (42.84 %) aged 45-59 years, 863 (31.85 %) aged 60-69 years, and 686 (25.31 %) aged 70 years or older. The sample comprised 1218 males (44.94 %) and 1492 females (55.06 %). The prevalence of falls among middle-aged and older individuals was 12.77 %, while the prevalence of frailty in the same population was observed to be 21.62 %. Spearman correlation analysis revealed significant positive association between chronic pain and both falls (r = 0.135, P < 0.05) as well as frailty (r = 0.383, P < 0.05). Frailty also exhibited a significant positive correlation with falls (r = 0.162, P < 0.05). After adjusting for all covariates, the total effect of falls on frailty was estimated to be 1.065 (95 % bootstrap CI: 0.804∼1.326), with a direct effect estimate of 0.797 (95 % bootstrap CI: 0.511∼1.083). The indirect effect of chronic pain on this association was found to be approximately one-quarter at 0.268 (95 % bootstrap CI: 0.170∼0.366). The subgroup analysis discovered differences in the mediating effects across different ethnic groups; specifically, the proportions mediated by chronic pain were found to be 28.2 %, 18.4 %, and 21.5 % for Han majority group, Zhiguo ethnic minorities, and other ethnic minority groups, respectively.

CONCLUSION

This study provides valuable insights into the intricate association between frailty, falls, and chronic pain among middle-aged and older adults from diverse ethnic backgrounds in a western province of China. Effective management strategies targeting chronic pain and falls prevention could serve as crucial interventions to address frailty.

Mental health and hypertension: assessing the prevalence of anxiety and depression and their associated factors in a tertiary care population

Background

Anxiety and depression are more common in those with hypertension. Identifying factors may lead to earlier assessment and treatment of depression and anxiety. So the study was aimed to assess the prevalence of anxiety and depression and examine the associated factors among hypertensive patients in a tertiary care hospital.

Methods

This cross sectional study was conducted over a six-months period (October 2023 to March 2024) in the Department of Medicine at Karuna Medical College Hospital, Kerala, India. The Hospital Anxiety and Depression Scale (HADS) was used to assess the symptoms of anxiety and depression. Multivariate logistic regression analysis was used to identify factors associated with anxiety and depression.

Results

Among 262 hypertensive patients, the prevalence of symptoms of anxiety were 43.8% and symptoms of depression were present in 51.3%. Female gender [OR 1.607 95% CI (0.962-2.687)] and BMI ≥ 25 [OR 0.608 95% CI (0.361-1.024)] were found to be significantly associated with anxiety (p < 0.05). Uncontrolled BP and stage1/stage 2 hypertension were found to be significantly associated with anxiety and depression (p < 0.05). Whereas factors like age (>50 years), living with alone, unmarried/widow, unemployed/retired/house wife, illiterate, living in rural area and patients with comorbidities showed to be non-significantly association with anxiety and depression (p > 0.05) in patients with hypertension.

Conclusion

According to the findings, overall 50% of hypertensive patients experience anxiety and depression, which were significantly associated with uncontrolled BP, stage1/stage 2 hypertension, female gender and obesity. Healthcare providers can help identify mental health issues early, improving outcomes, with special attention needed for women with comorbidities and limited social support.

The impact of pain on depression among middle-aged and older adult individuals in China: the chain mediation effect of self-rated health and life satisfaction

Background

This research seeks to explore the association between pain and depression in middle-aged and older adult populations, with a particular focus on the mediating roles of self-rated health and life satisfaction within this framework.

Methods

The study employed data from the 2020 China Health and Retirement Longitudinal Study. Utilizing linear regression modeling, we examined the primary determinants influencing depressive symptoms in the target demographic. Throughout the investigation, we applied Pearson correlation analysis to clarify the relationships among pain, depression, self-rated health, and life satisfaction. Additionally, the PROCESS 3.4 macro was utilized to evaluate the potential mediating effects of self-rated health and life satisfaction on the connection between pain and depression.

Result

A significant negative correlation was observed between pain and both self-rated health and life satisfaction (r = -0.381, p < 0.01; r = -0.158, p < 0.01), while a notable positive correlation with depression was identified (r = 0.356, p < 0.01). Self-rated health exhibited a positive correlation with life satisfaction (r = 0.265, p < 0.01) and a negative correlation with depression (r = -0.399, p < 0.01). Furthermore, life satisfaction was negatively correlated with depression (r = -0.359, p < 0.01). Additional analyses suggest that self-rated health and life satisfaction act as significant mediators in the relationship between pain and depression. The mediation analysis revealed that the direct effect of pain, self-reported health, life satisfaction, and depression on the outcome was 62.13%, while the indirect effect accounted for 37.87%.

Conclusion

The findings of this study contribute to a deeper understanding of the dynamics between pain and depression, providing essential insights for addressing depression in the middle-aged and older adult demographic.

Concomitant Administration of Ozanimod and Serotonergic Antidepressants in Patients With Ulcerative Colitis or Relapsing Multiple Sclerosis

BACKGROUND

Ozanimod, approved for the treatment of moderately to severely active ulcerative colitis (UC) and relapsing multiple sclerosis (RMS), is a weak in vitro monoamine oxidase B (MAO-B) inhibitor. MAO-B inhibitors can cause serotonin accumulation with concomitant use of selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). We evaluated the incidence of treatment-emergent adverse events (TEAEs) potentially associated with serotonin accumulation during ozanimod and concomitant SSRI/SNRI use in this post hoc analysis of pooled UC studies and the open-label extension RMS DAYBREAK.

METHODS

Data for ozanimod 0.92 mg from pooled UC studies (n = 1158; cutoff: January 10, 2022) and RMS DAYBREAK (n = 2257; cutoff: February 1, 2022) were analyzed. Concomitant SSRI/SNRI use was allowed in the UC (n = 67) and RMS (n = 274) studies. A narrow Medical Dictionary for Regulatory Activities search ("serotonin syndrome," "neuroleptic malignant syndrome," and "malignant hyperthermia") and a broad search including terms potentially associated with serotonin accumulation were conducted. The percentages of patients with TEAEs in both searches were analyzed by concomitant SSRI/SNRI use when the TEAE occurred.

RESULTS

No patients had TEAEs matching the narrow search criteria. No differences were observed in the percentages of patients with ≥1 TEAE matching the broad search regardless of SSRI/SNRI use in UC (with: 25.4% [n = 17 of 67]; without: 15.0% [n = 164 of 1091]) and RMS (with: 12.4% [n = 34 of 274]; without: 15.6% [n = 310 of 1982]) studies.

CONCLUSIONS

No evidence of increased TEAEs potentially associated with serotonin accumulation was observed with concurrent use of ozanimod and SSRIs/SNRIs.

CLINICAL TRIAL REGISTRATION

NCT01647516, NCT02531126, NCT02435992, NCT02576717.

Mental illness and suicidality among Roma and traveller communities in the UK, Ireland, and other countries: a systematic review

BACKGROUND

Romas and Irish Travellers are two distinct, traditionally nomadic ethnicities of people who experience lower socioeconomic position and social exclusion. This occurs within the context of long-term attempts to maintain their traditional culture. They are known to have significantly worse health outcomes than the general population. This systematic review identified and appraised the existing literature on the mental health status of Romas and Travellers, as well as suicidality in these communities. It aimed to determine how their mental health status compares to that of the general population and propose mechanisms for any differences observed.

METHODS

All databases on OVID were searched using three search strings for relevant articles, which were then manually screened to ensure that they were relevant. All studies included were assessed for quality standards.

RESULTS

The evidence shows that Romas/Travellers have a far higher prevalence of mental health problems than the general population. The most recent evidence suggests Romas/Travellers have a higher rate of suicide compared to any other ethnicity in the UK. A range of factors were associated with this disparity, including socioeconomic deprivation (issues with housing, education/employment, and discrimination), poor physical health, and barriers to accessing healthcare. Women faced worse mental health outcomes, possibly due to enforced gender roles, early marriage, and domestic violence.

CONCLUSIONS

Romas/Travellers face higher rates of mental illness and suicidality, which is largely multifactorial in nature. Significant stigma around mental health and suicide still exists in these communities, making it difficult for affected individuals to seek help. Community-based, targeted interventions are urgently needed to alleviate the harmful impacts of poor mental health and suicide on these communities.

Understanding the reasons to avoid seeking mental health professionals: Validation of the MITOS-MENTAL questionnaire in Peru population

There is still much resistance, myths, beliefs, and misconceptions regarding the seeking of mental health services for diagnosis and treatment. The objective was to validate an instrument to determine why Peruvian workers would not seek mental health professionals. In an instrumental study, literature was searched, and mental health professionals were asked about the most common reasons for not attending consultations. An expert panel undertook exploratory and confirmatory factor analyses (CFA), which were applied to a large population. Descriptive and instrumental statistics were used for the data. The 20 experts gave excellent ratings to the initial questions. In the pilot (250 people), it was confirmed that all questions had saturations >0.40. The item modification technique was also performed, eliminating six questions. With the CFA in 1312 respondents, it was seen that the goodness-of-fit indices were not adequate for three questions, then the index modification technique was used, achieving a satisfactory factorial structure model (χ2 = 61.497; df = 9; p < 0.001; RMR = 0.015; TLI = 0.984; CFI = 0.990, and RMSEA = 0.067). A scale of six questions was validated to measure the most important reasons why Peruvian workers do not want to attend mental health consultations.

Chronic health conditions and disability are prevalent among community users of a digital mental health service: a scoping survey

Objectives: Digital interventions can offer accessible and scalable treatment for chronic conditions, though often focus separately on physical or mental health. People accessing digital health services may live with multiple conditions or experience overlapping symptoms. This study aimed to describe the breadth and characteristics of chronic health conditions and self-reported disability among routine users of a digital mental health service, and to examine related motivations to engage with digital mental health interventions.

Methods: A cross-sectional survey of adults registered with a digital mental health service in the Australian community (THIS WAY UP) was conducted. Participant demography, chronic health conditions, self-reported disability and motivations for accessing digital treatment were collected and analyzed descriptively.

Results: 366 participants responded (77% female, mean age 50 ± 15 years). 71.6% of participants (242/338) reported ≥1 chronic health condition and one-third reported multimorbidity (112/338, 33.1%). Chronic pain, musculoskeletal and connective tissue disorders were most common. 26.9% of respondents (90/334) reported a disability, most commonly physical disabilities. 95% of those with chronic conditions reported negative mental health effects and 46% reported heightened interest in digital mental health treatments because of their condition. Primary motivations for digital service use were receiving a recommendation from a health professional and service accessibility.

Discussion: People who access digital mental health services in routine care report high rates of heterogenous chronic illness and related disability. There is interest in accessible digital treatments to support mental health at scale among people who live with varied chronic conditions and disabilities.

Psychological, Relational, and Fertility-Related Characteristics of Italian Women with Vulvodynia: A Comparative Study with Controls

Vulvodynia, a chronic pain condition affecting the vulvar area, is associated with significant psychological distress and profoundly impacts women's quality of life. This study examines the psychological and relational experiences of women with vulvodynia, focusing on attachment styles, resilience, fertility-related distress, and sexual functioning. A total of 203 women (96 with vulvodynia and 107 controls), aged 19 to 50 years, were recruited and completed a series of validated psychological measures. The results revealed that women with vulvodynia reported higher levels of attachment anxiety and avoidance, lower resilience, greater fertility-related distress, impaired sexual function, reduced dyadic adjustment, and elevated depressive symptoms compared to the controls. These findings underscore the complex interplay of psychological, relational, and fertility-related challenges experienced by women with vulvodynia. This study highlights the need for integrated, multidisciplinary approaches to address the medical, psychological, and relational dimensions of the condition, ultimately improving the well-being and quality of life for affected women.

The mediating roles of activities of daily living and depression in the relationship between pain and sleep duration among rural older adults in China: a cross-sectional study

Background

As the population ages, the health of rural older adults is of increasing concern to society. Pain, decreased activity of daily living, depression, and sleep are important factors affecting the quality of life of older adults. This study aimed to explore the complex relationship between pain, activity of daily living, depression, and sleep in rural older adults, with the goal of providing new perspectives and intervention strategies to improve sleep quality.

Methods

This study was based on the data from the 2020 China Health and Retirement Longitudinal Study, and rural older adults aged 60 years and above were selected as the study subjects, with a final sample size of 5,352. Stata 18.0 and SPSS 27.0 software were used for statistical analysis, and t-tests, analysis of variance (ANOVA), and Pearson correlation analyses were used for one-way analyses, and PROCESS 4.2 was used for mediation effect analysis and testing.

Results

Pain in older adults was negatively correlated with sleep duration (r = -0.212) and positively correlated (p < 0.001) with impairment to activity of daily living (r = 0.339) and depression (r = 0.355). The mediation test reported that pain in older adults had a direct effect on sleep duration (95% CI: -0.076 to -0.043), with activity of daily living (95% CI: -0.014 to -0.004) and depression (95% CI: -0.026 to -0.017) acting as chained mediators between the two.

Conclusion

This study reveals the interrelationships between pain, activity of daily living, depression and sleep in rural older adults. It is recommended that medical resources be strengthened, health awareness be increased, community care services be improved, recreational activities be provided, and family emotional support be encouraged to improve the health and quality of life of older adults.

Assessing Self-reported and Device-Derived Sleep Quality in a Sample of Older Adults with Chronic Musculoskeletal Pain

Objectives

Our primary aim was to evaluate the agreement between subjective and objective methods of measuring sleep quality in a musculoskeletal pain sample. Secondly, we aimed to explore the relationship between subjective and objective sleep quality-and its impact on function-and clinical and experimental pain.

Methods

We assessed subjective sleep using the Pittsburgh Sleep Quality Index (PSQI) and objective sleep using the Oura ring-a wearable characterizing sleep stages. Participants had musculoskeletal pain (intensity>4/10 most days in past 3 months) and poor sleep (PSQI total>5). To enable direct comparisons, via correlations, between subjective and objective sleep (primary aim), we emulated the equivalent of PSQI's answers and components by averaging the appropriate Oura data over the month covered by the PSQI. We used partial correlations to assess sleep-pain relationships (second aim)-controlling for age and sex.

Results

Answers to PSQI questions about total bedtime and sleep duration, and the PSQI duration component, correlated with their Oura equivalents, whereas PSQI failed to capture Oura's Sleep Latency, Efficiency, and Disturbances. On the other hand, PSQI total score and its sleep latency component correlated with WOMAC-pain score, MPQ scores (total, neuropathic, continuous, and intermittent) and GCPS-pain intensity, while Oura's Sleep Latency correlated with conditioned pain modulation. No significant association between Oura measures and pain was found.

Conclusions

The findings highlight the complementary roles of subjective and objective measures and the need for integrated approaches to refine sleep assessments in musculoskeletal pain. Future studies should investigate the causes of these discrepancies to enhance understanding of sleep-related health outcomes.

A mixed studies systematic review on the health and wellbeing effects, and underlying mechanisms, of online support groups for chronic conditions

This pre-registered systematic review aimed to examine whether online support groups affect the health and wellbeing of individuals with a chronic condition, and what mechanisms may influence such effects. In September 2024, literature searches were conducted across electronic databases (Medline, Embase, PsycInfo, Web of Science and Google Scholar), pre-publication websites (MedRxiv and PsyArXiv) and grey literature websites. Qualitative and quantitative studies were included if they explored the impact of online support groups on the health and wellbeing outcomes of individuals with a chronic condition. The Mixed Methods Appraisal Tool was used to appraise the quality of the included studies. In total 100 papers met the inclusion criteria with their findings presented in a thematic synthesis. Health and wellbeing outcomes were categorised as: physical health, mental health, quality of life, social wellbeing, behaviour and decision-making, and adjustment. Mechanisms reported in these studies related to exchanging support, sharing experiences, content expression, and social comparison. User and group characteristics were also explored. The included studies suggest that online support groups can have a positive impact on social wellbeing, behaviour, and adjustment, with inconclusive findings for physical health and quality of life. However, there is also the possibility of a negative effect on anxiety and distress, particularly when exposed to other group members' difficult experiences. Research comparing different online group features, such as platforms, size, and duration is needed. In particular, future research should be experimental to overcome the limitations of some of the cross-sectional designs of the included studies. The review was funded by the National Institute for Health and Care Research Health Protection Research in Emergency Preparedness and Response. Pre-registration ID: CRD42023399258.

Psychiatric morbidity in acromegaly: a cohort study and meta-analysis of the literature

PURPOSE

We aimed to evaluate the risk of psychiatric disorders through a retrospective cohort study comparing acromegaly and non-functioning pituitary adenomas (NFPAs) and a meta-analysis of existing literature.

METHODS

The cohort study included data from patient records analyzed using Chi2-, T-tests and binary regression. The meta-analysis included studies retrieved from PubMed, Embase and PsycINFO that reported risk of psychopathology in acromegaly compared to NFPA or healthy controls, using a random effects model.

RESULTS

The study population comprised 105 acromegaly and 211 NFPA patients, with similar sex distributions. Patients with acromegaly presented with smaller pituitary adenomas (17.9 (SD: 9.9) mm vs. 22.9 (SD: 10.6) mm, p < 0.001), more frequent pituitary surgery (89.1 vs. 60.2%, p < 0.001) and hormone replacement therapy (25.7 vs. 16.1%, p = 0.042). Acromegaly patients had higher risk of depression (RR: 1.9, CI95% [1.2-3.2], p = 0.009), and increased need of admissions to the psychiatric ward (5.7 vs. 0.5%, p = 0.006). The relative risk of anxiety was 1.4 (CI95% [0.5-4.4], p = 0.53). Daily opioid use was higher in acromegaly patients with psychiatric morbidity which was associated with a diagnosis of arthropathy (p = 0.009). From the meta-analysis (8 studies, 1387 patients) an increased risk of depression (RR:1.8, CI95% [1.3-2.5]) and anxiety (RR:1.9, CI95% [1.1-3.2]) was observed in acromegaly compared to NFPAs.

CONCLUSION

This study reveals a higher risk of psychiatric disorders in acromegaly, particularly depression and anxiety. Consequently, a need for increased psychiatric awareness in acromegaly is warranted.

Association between chronic diseases and depressive inclinations among rural middle-aged and older adults

This study investigates the association between chronic diseases and depressive inclinations among middle-aged and older adults in rural Northwest China, emphasizing the moderating role of social relationships. Data collected via face-to-face surveys in a cross-sectional design conducted in March 2021, encompassing 395 participants aged 45 and above, were analyzed using Ordinary Least Squares (OLS) regression. The results indicate that, excluding metabolic diseases (such as dyslipidemia and diabetes), other chronic diseases significantly increase depressive inclinations, particularly eye diseases, chronic lung diseases, heart disease, rheumatoid arthritis, and gastrointestinal diseases. Additionally, a greater number of chronic diseases show a positive association with depressive inclinations. Among social relationships, spousal trust and intergenerational relationship satisfaction were associated with a mitigation of the association between chronic diseases and depressive inclinations, whereas skipped generational caregiving exacerbated this association. Other social relationships, including kinship and friendship network size, neighbor relationships, and villager relationships, exhibited no significant moderating associations. These findings underscore the critical role of positive family relationships and robust social support systems in improving the mental health of rural middle-aged and older adults. They provide practical insights for designing targeted policies and interventions to promote healthy aging and mental well-being in resource-limited rural settings.

Anxiety, depression and acromegaly: a systematic review

PURPOSE

scientific literature highlights risk factors linked to the onset of psychopathology in different medical pathological contexts. Acromegaly is a rare condition, particularly noteworthy due to the associated clinical psychological features. This research aimed at understanding the main psychopathological outcomes related to acromegaly, with particular emphasis to anxiety and depression.

METHODS

In January 2024, in line with PRISMA guidelines, a systematic search based on PubMed, Scopus, Web of Science and PsycInfo was conducted to detect studies considering anxiety, depression and alexithymia in patients suffering from acromegaly. The Keywords used for the search phase were "Acromegaly" AND "Depression" OR "Anxiety" OR "Alexithymia".

RESULTS

Fifty-five studies were eligible. Anxiety and depression were significantly present in patients with acromegaly, with prevalence rates variable based on disease status and psycho-diagnostic instruments. None of the included studies reported alexithymia in patients with acromegaly. No significant difference was found regarding anxiety and depressive symptoms in patients with acromegaly in comparison with patients suffering from different pituitary diseases and chronic conditions. Anxiety and depression were associated with lower perceived HR-QoL, presence of comorbidity, joint issues, delayed diagnosis, disease duration and body image concerns.

CONCLUSIONS

Anxiety and depression may be encountered in patients with acromegaly, impacting HR-QoL and the course of the disease. This systematic review suggests that a deeper evaluation of clinical psychological features in patients suffering from acromegaly is needed. Particularly, the early detection of clinical psychological symptoms may lead to multi-integrate interventions promoting individuals' well-being and a better HR-QoL.

The relationship between family conflict resolution methods and depressive symptoms in patients with chronic diseases

BACKGROUND

Individuals with chronic diseases are more sensitive to depressive symptoms and stress compared to the general population. The complexity and unpredictability of these diseases necessitate family involvement in their management. However, long-term disease can exhaust both patients and their families, leading to conflicts and increased stress, thus exacerbating depressive symptoms. This longitudinal study investigated the impact of family conflict resolution methods on depressive symptoms among chronic disease patients in Korea.

METHODS

We used data from the Korean Welfare Panel Study, collected from 2012 to 2022, analyzing 10,969 chronically ill cohabiting or married individuals. Chi-square tests were used to compare group characteristics, and generalized estimating equation models were used for regression analysis, focusing on Center for Epidemiologic Studies Depression Scale-11 scores, family conflict resolution changes, and covariates.

RESULTS

Participant groups that changed from positive to negative conflict resolution methods were more likely to have depressive symptoms than the group that did not change from positive methods (positive →  negative odds ratios (OR) =  1.34, confidence intervals (CI) =  1.24-1.44). In addition, participants who did not change from negative methods were significantly more depressed than those who maintained positive methods over time (negative →  negative OR =  1.48, 95% CI =  1.37-1.59). Uncollaborative discussions and domestic violence resolution methods were related to depressive symptoms in family conflict resolution methods.

CONCLUSION

Negative family conflict resolution methods influence depressive symptoms in individuals with chronic diseases. Even after transitioning to positive conflict resolution methods, prior negative experiences continued to impact depressive symptoms.

Exploring disparities in depressive symptoms between rural and urban middle-aged and elderly adults in China: evidence from CHARLS

The study was to investigate the relevant factors that were associated with differences in depressive symptoms between urban and rural middle-aged and elderly population in China, measuring the contribution of related influencing factors. We constructed binary logistic regression models to investigate the primary factors influencing depressive symptoms and employed Fairlie models to examine these factors contributing to the differences in depressive symptoms between urban and rural middle-aged and elderly individuals. The proportion of depressive symptoms among middle-aged and older individuals in China was 38.16%, with findings indicating that rural areas exhibited higher rates (44.47%) of depressive symptoms compared to urban areas (31.85%). The Fairlie decomposition analysis demonstrated 53.51% of the disparities in depressive symptoms could be accounted for, which was mainly linked to differences in self-reported health status (19.16%), education level (14.45%), insurance (8.28%), instrumental activities of daily living dysfunction (6.16%), gender (-3.72%), sleep time (2.35%), falling history (2.31%), age (-2.17%), physical examination (2.03%), and chronic disease condition (-0.50%). The prevalence of depressive symptoms in rural middle-aged and elderly was greater than urban, linked to demographics, lifestyle, health status and social status. This study aided policymakers in reducing health disparities and designing targeted mental health interventions for vulnerable populations.

Key modifiable factors in urban-rural differences in depression among older adults in China: A comparative study between China and the United States

OBJECTIVES

Urban-rural differences in depression are evident among older adults in China but not in the United States. By comparing the two countries, this study aims to explore strategies for promoting regional equality in depression in China.

METHODS

Data from the China Health and Retirement Longitudinal Study (CHARLS) and the Health and Retirement Study (HRS) were utilized. Longitudinal data were used to describe urban-rural differences in depression prevalence among older adults in China (2011-2020) and the United States (2010-2020). Cross-sectional data from 2018 (CHARLS: 9840 participants; HRS: 10,381 participants) were used to identify key modifiable factors. A random forest algorithm was employed to determine the most important factors influencing depression, and comparisons between the two countries were made to identify modifiable factors. Multivariate logistic regression was used to analyze the relationship between these key modifiable factors and depression. A mediation model was applied to assess the mediating role of key modifiable factors in the relationship between residence and depression.

RESULTS

1) From 2011 to 2020, Urban-rural differences in depression prevalence among older adults were observed in China, but not in the United States. 2) In both China and the U.S., the top five factors ranked by importance were activities of daily living disability (ADLs), instrumental activities of daily living disability (IADLs), pain levels, self-reported health (SRH), and age. However, Urban-Rural Differences in ADLs, IADLs, and SRH were present in China but not in the United States. 3) ADLs, IADLs, and SRH collectively mediated 31.6 % (95 % CI: 0.268 - 0.360) of the relationship between residence and depression scores among older adults in China.

CONCLUSION

Urban-rural differences in physical health status (ADLs, IADLs, and self-reported health) among older adults in China are associated with Urban-Rural Differences in depression. The absence of such inequalities in the U.S. may offer insights for developing policies to promote regional equality in depression among older adults in China.

Developing an individual depression risk score based on traditional risk factors and routine biochemical markers

BACKGROUND

Early identification of individuals at high risk for depression is essential for effective implementation of interventions. This study utilized the UK Biobank database to construct an individual depression risk score using nomogram and explored the potential of traditional risk factors and routine biochemical markers for the auxiliary diagnosis of individual depression.

METHODS

A total of 369,407 participants were included in the study and divided into training and testing sets. LASSO regression was employed to select predictive variables for depression from 16 traditional risk factors and 28 routine biochemical markers. Following variable selection, two multivariable logistic regression models were constructed. Nomograms were then generated to visualize the relationships between these variables and depression risk, and to facilitate the calculation of individual depression risk scores.

RESULTS

Twelve traditional risk factors and nine biochemical markers were selected for model building. Model 1, using only traditional risk factors, achieved the area under the curve (AUC) of 0.913 (95 % CI: 0.910-0.915), while Model 2, incorporating both traditional and routine biochemical markers, yielded an AUC of 0.914 (95 % CI: 0.912-0.917). Based on optimal cut-off values, Model 1 exhibited a sensitivity of 81.99 % and a specificity of 83.76 %, while Model 2 demonstrated a sensitivity of 81.54 % and a specificity of 84.31 %.

LIMITATIONS

External validation is still needed to confirm the model's generalizability.

CONCLUSIONS

While the depression risk scoring model built using traditional risk factors effectively identifies high-risk individuals for depression and demonstrates good clinical performance, incorporating routine biochemical markers did not significantly improve the model's performance.

Effects of chronic diseases on health related quality of life is mediated by sleep difficulty in middle aged and older adults

Middle-aged and older adults with chronic diseases are more likely to encounter sleep difficulty and have a reduced Health-Related Quality of Life (HRQoL), but there is little research on their possible mechanisms. Therefore, the main objective of this study was to explore how sleep difficulty mediates the impact of chronic diseases on the HRQoL of middle-aged and older adults. The survey data were from a cross-sectional study carried out in 2019 in Hangzhou, China. We used a multi-stage cluster random sampling method to recruit participants from seven districts in Hangzhou. Multiple regression was used to analyze the relationship between chronic diseases, sleep difficulty and HRQoL. And the mediate package in the R language was used to analyze the mediating effect. A total of 3,550 middle-aged and older adults were enrolled, including 2,273 patients with chronic diseases and 1,277 patients without them. Patients with chronic diseases had lower health utility values (β=-0.0084, P < 0.01) and were more likely to suffer from sleep difficulty (β = 0.5737, P < 0.001). After correcting for demographic and life characteristics, the mediation analysis results indicated that sleep difficulty mediated the relationship between chronic diseases and HRQoL (β=-0.0022, 95% Bca CI: -0.0034 -0.0014). Additionally, sleep difficulty influenced the association between chronic diseases and daily activities as well as pain (or discomfort) (β = 0.0083, 95% Bca CI: 0.0042-0.0111; β = 0.0162, 95% Bca CI: 0.0107-0.0225) in the analysis of the dimensions. Sleep difficulty partially mediated the relationship between chronic diseases and HRQoL, and primarily in the daily activities and pain (or discomfort) dimensions in middle-aged and older adults.

The Diagnostic Journey of Dysautonomia Patients: Insights from a Patient-Reported Outcome Study

Dysautonomia refers to any disorder involving altered function of the autonomic nervous system. Dysautonomia can be debilitating as it often affects multiple organ systems. The diagnostic journey for individuals affected by dysautonomia can be hindered by symptom overlap with other conditions and by limited access to autonomic specialists. The present patient-reported outcome study aims to characterize the diagnostic journey of 672 adult individuals affected by different types of dysautonomia. The average time to diagnosis was 7.7 years (SD 10 years) and diagnosis was made primarily by cardiologists, followed by neurologists, and internists or primary care physicians. Common comorbid conditions are Ehlers-Danlos syndrome, mast cell disorders, vitamin deficiency, fibromyalgia, and myalgic encephalomyelitis, all of which can contribute to the symptoms burden and can potentially confound the diagnostic process. We suggest that the prolonged time to diagnosis contributes to morbidity and compounds the psychological and economic burden of dysautonomia. Raising awareness about the numerous obstacles that hinder the diagnostic process among both clinicians and dysautonomia patients is the first step to reduce morbidity and improve clinical outcomes.

Association between internet use and depression among the middle-aged and elderly adults with multimorbidity in China: do gender differences exist?

Objectives

Internet use and the results of mental health are related. Numbers of studies presented the association between Internet use and depression, and the middle-aged and elderly adults with multimorbidity are of concern. The study aimed to explore the relationship between Internet use and depression in middle-aged and elderly adults with multimorbidity.

Methods

We selected 2550 respondents aged 45 years and above with multimorbidity from the China Health and Retirement Longitudinal Study (CHARLS) 2018 database. Logistic regression models were constructed to examine the effects of Internet use on depression, as well as comparing gender differences. Meanwhile, propensity score matching (PSM) was used to test the robustness of the results.

Results

Overall, 49.8% of respondents had a risk of developing depression, and 14.9% of the participants used the Internet. Internet use (OR = 0.66, P = 0.002), type of devices (one type: OR = 0.69, P = .011;≥2 types: OR = 0.53, P = 0.03), frequency of Internet use (regularly: OR = 0.67, P = 0.005) were all inversely associated with depression. Significant differences between genders were observed, Internet use was associated with a lower prevalence of depression among men, while the association was not statistically significant among women.

Conclusions

There is a significantly negative association between Internet use and depression in the middle-aged and elderly adults with multimorbidity in China, and this relationship varies across different genders. This suggests that Internet use may be a protective factor for depressive symptoms in the older population, offering a guideline for policymakers to develop specific strategies for different genders.

The Relationship Between Quality of Life and Depressive Symptoms Among Jordanian Community-Dwelling Older Adults

OBJECTIVE

The current study aimed to examine the relationship between depressive symptoms and quality of life among Jordanian community-dwelling older adults.

METHODS

A cross-sectional, descriptive correlational design was used. A convenience sample (N = 602) was selected to recruit the participants in the Amman governorate during the period from August to November 2021.

RESULTS

Findings demonstrated that the mean (SD) age of older adults was 67.5 (7.0) years and 51.5% of participants were females. Also, 54.1% of the participants experienced moderate to severe depressive symptoms with a total mean (SD) score was 8.57 on a scale of 0 to 15, while the mean (SD) for the quality of life scale was 12.12 (3.85) on a scale of 4 to 20. Significant differences existed in quality of life and depressive symptoms based on marital status (p < .001), educational level (p < .001), working status (p < .01), income (p < .001), and chronic disease (p < .01). Quality of life and its domains were negatively associated with depressive symptoms (B= - 0.596, p < .001). Also, marital status, working, educational level, income, and chronic disease were associated with depressive symptoms.

CONCLUSION

Strategies to improve quality of life should be promoted to minimize depressive symptoms among older adults and consider significant demographic factors.

The mediating role of depression and disability in the association between widowhood and cognitive function among elderly Chinese individuals

OBJECTIVE

The incidence of mild cognitive impairment among the elderly in China was increasing. Widowhood, depression, and disability were significant factors that impacted cognitive function. Yet, there was currently no research, both domestically and internationally, that comprehensively examines all these factors together. Therefore, in order to achieve successful aging, the objective of this study is to investigate the impact and pathway of depression and disability on the association between widowhood and cognitive function in the elderly population of China, with the aim of establishing a robust foundation for developing evidence-based strategies to prevent and manage cognitive impairment among older adults in China.

METHODS

The 2018 Chinese Longitudinal Healthy Longevity Survey data was utilized to assess cognitive function, depression level, and disability status using the Mini-Mental State Examination, The Center for Epidemiological Studies Depression-10 scale, and the Katz scale. The mediating role of depression and disability in the association widowhood and cognitive function were tested by the bruceR package in R Studio.

RESULTS

A total of 7973 elderly individuals aged over 65 were included in the study, with nearly 50% being widowed. Widowhood was identified as a significant risk factor for cognitive impairment in the elderly population. The results from the analysis of mediating effects indicated that both depression and disability independently mediated this relationship, while also contributing to a chain-mediated effect on the association between widowhood and cognitive function in the population.

CONCLUSION

We recommend that greater attention be dedicated to this population, and measures be implemented to enhance their mental well-being and disability management, thereby improving cognitive function.

The Mediating Effects of Chronic Diseases in the Relationship Between Adverse Childhood Experiences and Trajectories of Depressive Symptoms in Later Life: A Nationwide Longitudinal Study

Background: Numerous studies have established a link between adverse childhood experiences (ACEs) and the development of depression in later life. However, the interactive relationships between ACEs, depression, and chronic diseases are still not well understood. In this study, the aim was to investigate the impact of ACEs on depressive trajectories among middle-aged and elderly individuals in China, as well as to examine the mediating roles of chronic diseases in this association. Methods: Data were drawn from 6921 participants aged 45 and older, using the China Health and Retirement Longitudinal Study (CHARLS) data from 2011, 2013, 2015, and 2018, combined with the 2014 life history survey. Depressive symptom scores were assessed using the widely recognized CES-D-10 scale. The trajectories of depressive symptoms were identified via group-based trajectory modeling (GBTM). The association between ACEs and depressive trajectories was analyzed using multinomial logistic regression, and the KHB method was employed to test the mediating effects of different chronic diseases. Results: The age of the 6921 participants was 57.2 ± 8.0 years, with females comprising 53.9% and males 46.1%. We found that approximately 70% of Chinese middle-aged and older adults had experienced at least one ACE, and 4.8% had experienced four or more ACEs. The following four distinct trajectories of depressive symptoms were identified: continuing-low (N = 1897, 27.4%), continuing-low-to-middle (N = 2937, 42.4%), continuing-middle-to-high (N = 1649, 23.8%), and continuing-high (N = 438, 6.3%). Compared to individuals without ACEs, those with four or more ACEs had a significantly higher likelihood of following the continuing-low-to-middle trajectory (OR = 2.407, 95%CI: 1.633-3.550), the continuing-middle-to-high trajectory (OR = 7.458, 95%CI: 4.999-11.127), and the continuing-high trajectory (OR = 20.219, 95%CI: 12.115-33.744), rather than the continuing-low trajectory. Exposure to a greater number of ACEs was associated with an increased risk of following an adverse trajectory of depressive symptoms. Multiple chronic diseases significantly mediated the relationship between ACEs and depressive trajectories, with arthritis or rheumatism exerting the largest mediating effect, followed by digestive and respiratory diseases. Conclusions: These findings indicated that ACEs were associated with a higher risk of worse depressive symptom trajectories, with different chronic diseases mediating this relationship. Therefore, developing public measures to prevent ACEs can reduce the risk of chronic diseases and depression in middle-aged and elderly people. Additionally, strengthening the prevention and management of chronic diseases in individuals exposed to ACEs may further reduce their subsequent risk of depression.

Impact of Dental Anxiety on the Dental Health Status of Nepali Adult Patients

BACKGROUND

Patients with high dental anxiety are found to visit dental offices less frequently and have a higher number of severely diseased teeth so they are at a greater need for intensive oral care and rehabilitation.

OBJECTIVES

The aim of this study was to assess the prevalence of dental anxiety and its impact on the dental status of Nepali adult patients.

MATERIAL AND METHODS

A semi-structured questionnaire of the Modified Dental Anxiety Scale (MDAS) in the Nepali version was used for data collection. The data analysis was done using Statistical Package for Social Sciences (SPSS IBM, Chicago, IL, USA, version 24). Variables were calculated as frequency and percentage, while the comparisons of different factors were done using the ANOVA and t-test. A difference with p < 0.05 was considered statistically significant.

RESULTS

The study population consisted of 446 subjects, among them 205 were male (45.96%), 241 were female (54.04%), 357 (80.04%) were married, and 222 (49.78%) were employed. The mean age of the patients was 41.24 years (ranging between 18 and 79 years). Only 41 subjects (9.19%) showed high dental anxiety (MDAS ≥ 19). The mean MDAS for the total study population was 10.81. The highest mean MDAS was seen in the age group 30-39 (11.78) and the lowest mean MDAS was seen in the age group 40-49 (9.64). While comparing dental anxiety among genders, dental anxiety was higher in females (mean MDAS = 11.78) compared to males (mean MDAS = 9.67). Patients having high dental anxiety had a significantly higher number of decayed teeth (p-value = 0.001, t-test).

CONCLUSION

Oral health and dental status both are negatively affected by dental anxiety. It interferes with dental attendance, service delivery, prevention of dental diseases, and early diagnosis. Thus, dental practitioners have a major role to play in the management of dental anxiety.

Longitudinal relationships among number of chronic diseases, depression, and anxiety: A cross-lagged model analyses

BACKGROUND

Research is increasingly highlighting the intricate relationship between mental and physical health. However, longitudinal studies investigating the interplay between chronic diseases (CDs), depression and anxiety are still relatively scarce. This study aimed to delve into the longitudinal connections among these variables.

METHODS

This study conducted a 4-year prospective survey involving 486 participants from rural communities in Shandong Province, China. The relationships among these variables were analyzed using multiple linear regression, cross-lagged path analysis, and multiple-group analysis.

RESULTS

Our analysis revealed that the number of CDs reported at wave 1 significantly predicted anxiety levels (β = 0.126, p < .01) at wave 2, while depression symptoms also predicted anxiety (β = 0.220, p < .01) at wave 2. Furthermore, anxiety levels at wave 1 significantly predicted both the number of CDs (β = 0.219, p < .01) and depression symptoms (β = 0.160, p < .05) at wave 2. However, the study did not find support for a relationship between CDs and depression.

CONCLUSION

The study uncovered a bidirectional association between CDs and anxiety, depression and anxiety, but found no direct longitudinal relationship between CDs and depression. Research has indicated that CDs indirectly affect depression through anxiety.

The Association of Sexual Minority Status with the Prevalence, Diagnosis, and Treatment of Depression among NYC Adults

Major depressive disorder (MDD) is a common mental health disorder with a lifetime prevalence of 20.6% among United States (US) adults. Multiple US surveys have shown a consistently higher burden of mental health struggles among lesbian, gay, bisexual, trans, and questioning (LGBTQ+) adults compared to non-LGBTQ+ adults. However, it is not known whether diagnosis and treatment for those adults who do report symptoms of MDD differ based on sexual orientation. We test for differences in prevalence, diagnosis, and treatment of MDD in sexual minorities using appropriate multivariable logistic regression using the New York City Health and Nutrition Examination Survey (NYC HANES). About 10% of NYC adults (≥ 20 years old) self-identify as a sexual minority and 8.5% of adults in NYC have MDD based on the Patient Health Questionnaire (PHQ-9) score. Significantly higher proportion of sexual minorities in NYC have depression compared to non-sexual minorities (17.7% vs. 7.6%, p = 0.01). In the multivariable model, sexual minorities were 2.33 (CI = [1.24-4.39], p = 0.009) times more likely to have depression compared to non-sexual minorities. Additionally, people with multimorbidity were more likely to be diagnosed for depression (OR = 3.78, CI = [1.33, 10.75], p = 0.013). Disparities exist in the prevalence, diagnosis, and treatment of MDD in NYC adults. Targeted outreach toward the LGBTQ + community should be considered by public health officials when designing primary and secondary prevention programs for depression.

Associations between physical diseases and subsequent mental disorders: a longitudinal study in a population-based cohort

People with physical diseases are reported to be at elevated risk of subsequent mental disorders. However, previous studies have considered only a few pairs of conditions, or have reported only relative risks. This study aimed to systematically explore the associations between physical diseases and subsequent mental disorders. It examined a population-based cohort of 7,673,978 people living in Denmark between 2000 and 2021, and followed them for a total of 119.3 million person-years. The study assessed nine broad categories of physical diseases (cardiovascular, endocrine, respiratory, gastrointestinal, urogenital, musculoskeletal, hematological and neurological diseases, and cancers), encompassing 31 specific diseases, and the subsequent risk of mental disorder diagnoses, encompassing the ten ICD-10 groupings (organic, including symptomatic, mental disorders; mental disorders due to psychoactive substance use; schizophrenia and related disorders; mood disorders; neurotic, stress-related and somatoform disorders; eating disorders; personality disorders; intellectual disabilities; pervasive developmental disorders; and behavioral and emotional disorders with onset usually occurring in childhood and adolescence). Using Poisson regression, the overall and time-dependent incidence rate ratios (IRRs) for pairs of physical diseases and mental disorders were calculated, adjusting for age, sex and calendar time. Absolute risks were estimated with the Aalen-Johansen estimator. In total, 646,171 people (8.4%) were identified as having any mental disorder during follow-up. All physical diseases except cancers were associated with an elevated risk of any mental disorder. For the nine broad pairs of physical diseases and mental disorders, the median point estimate of IRR was 1.51 (range: 0.99-1.84; interquartile range: 1.29-1.59). The IRRs ranged from 0.99 (95% CI: 0.98-1.01) after cancers to 1.84 (95% CI: 1.83-1.85) after musculoskeletal diseases. Risks varied over time after the diagnosis of physical diseases. The cumulative mental disorder incidence within 15 years after diagnosis of a physical disease varied from 3.73% (95% CI: 3.67-3.80) for cancers to 10.19% (95% CI: 10.13-10.25) for respiratory diseases. These data document that most physical diseases are associated with an elevated risk of subsequent mental disorders. Clinicians treating physical diseases should constantly be alert to the possible development of secondary mental disorders.

The Impact of Pregnancy Readiness on Lupus Activity, Maternal Mental Health, and Pregnancy Outcomes

OBJECTIVE

Among individuals with systemic lupus erythematosus (SLE) who became pregnant, we explored the impact of medical readiness for pregnancy and personal readiness for pregnancy on the following aspects of maternal health: (1) provider-reported disease activity, (2) patient-perceived disease activity, (3) mood symptoms, (4) pregnancy-related health behaviors, and (5) pregnancy outcomes.

METHODS

All study participants were enrolled in a prospective registry, met Systemic Lupus Collaborating Clinics (SLICC) criteria for SLE, and had at least one pregnancy. Patient-reported outcomes were collected at the first rheumatology visit during pregnancy. "Medically ready" for pregnancy was defined as (1) <1 g of proteinuria, (2) no rheumatic teratogens at conception, and (3) continuing pregnancy-compatible SLE medications after conception. "Personally ready" was defined as planned pregnancy based on a London Measure of Unplanned Pregnancy score ≥10. Multivariable logistic regression models estimated the association of pregnancy readiness with each outcome of interest.

RESULTS

Among the 111 individuals enrolled, lack of medical readiness for pregnancy was associated with significantly higher rates of active disease and worse pregnancy outcomes; however, these patients did not perceive themselves as having higher disease activity. Lack of personal readiness for pregnancy was associated with significantly higher patient-perceived disease activity. Although medical readiness did not impact depressive symptoms substantially, lack of personal readiness for pregnancy was associated with much higher maternal depressive symptoms.

CONCLUSION

To improve pregnancy outcomes among individuals with SLE, greater focus is needed on improving medical optimization before conception. For maternal mental health and quality of life, greater focus is needed on decreasing the incidence of unplanned pregnancy.

The impact of chronic diseases on the health-related quality of life of middle-aged and older adults: the role of physical activity and degree of digitization

BACKGROUND

The incidence of chronic diseases is on the rise worldwide, with a high mortality rate in China, posing a serious threat to the health-related quality of life (HRQoL) of middle-aged and older adults. This study explores the association between chronic diseases and the HRQoL of middle-aged and older adults, as well as the role of physical activity (PA) and degree of digitization in this relationship.

METHODS

The data used in this study was obtained from the 2018 China Health and Retirement Longitudinal Study (CHARLS), which included 13,620 middle-aged and older Chinese adults (≥ 45 years). The study utilized correlation analysis, and bootstrapping to investigate the mediating role of PA and the moderating influence of the degree of digitization. Data analysis was conducted using SPSS 26.0.

RESULTS

The study findings indicate that the severity of chronic disease has a significant negative predictive effect on HRQoL (PCS, physical component summary; MCS, mental component summary) (PCS: β = -2.515, p < 0.01, MCS: β = -0.735, p < 0.01). Further analysis revealed that PA plays a mediating and masking role in the impact of chronic disease on PCS and MCS. Additionally, the degree of digitization moderates the relationship between chronic disease and PA, chronic disease and PCS, and PA and PCS.

CONCLUSION

For middle-aged and older persons, chronic diseases have a detrimental effect on their HRQoL; nevertheless, PA can help. Furthermore, proper internet usage can help older individuals to some extent in mitigating the negative impact of chronic diseases. Therefore, it is encouraged to promote PA among the elderly with chronic diseases to improve their physical health, as well as to guide them in the proper use of the Internet to establish healthy behaviors.

Depression among general outpatient department attendees in selected hospitals in Somalia: magnitude and associated factors

BACKGROUND

Depressive disorders are among the common mental health conditions in the general outpatient setting and affect patients' load and treatment outcomes. People who suffer from depression frequently consult general practitioners and prefer to attribute their symptoms to physical illness rather than mental illness. Little is known about the magnitude and associated factors of depression among patients attending general outpatient services in Somalia. The study aimed at determining the prevalence and associated factors of depression among them.

METHODS

This is an institution-based cross-sectional study among randomly selected 422 patients who attended general outpatient services of two hospitals in Mogadishu. We applied three standardized instruments, such as the Somali version of the Patient Health Questionnaire (PHQ-9), the Oslo Social Support Scale (OSSS-3), and the Perceived Stress Scale-10 (PSS-10). We analyzed data using the statistical software SPSS version 29. We calculated prevalence and its 95% Confidence Interval (CI) and identified associated factors by bivariate and Multivariate analysis. We considered the association significant when p value is < 0.05.

RESULTS

The prevalence of depression symptoms was found to be 55% (95% CI 50-60%). The result also showed that 55.0% were females, 50.7% were aged between 26 and 44 years, 44.3% were single, 29.9% achieved tertiary education, and 44.3% were unemployed. Multivariate analysis established that age of between 26 and 44 years (aOR = 2.86, 95%CI:1.30-6.29, p = 0.009), being separated/divorced (aOR = 2.37, 95%CI: 1.16-4.82, p = 0.018), income level of ≤$100 (aOR = 3.71, 95% CI:1.36-10.09, p = 0.010), and high stress levels (aOR = 20.06, 95%CI:7.33-54.94, p < 0.001) were independent factors that significantly associated with depressive symptoms.

CONCLUSION

This study found high levels of depression among patients attending outpatient clinics, with age, marital status, education level, income level, family history of psychiatry disorder, and stress level being key predictors. Regular screening among patients in outpatient clinics and proper referral are crucial in ensuring that those at high risk of depression are managed effectively.

Outcomes of a Self-Management Program for People with Non-Communicable Diseases in the Context of COVID-19

OBJECTIVE

To evaluate the effectiveness of the online version of the Chronic Disease Self-Management Program (CDSMP) on physical activity and depressive symptoms in individuals with non-communicable diseases (NCDs) in Mexico and Peru during the COVID-19 pandemic.

MATERIALS AND METHODS

Quasi-experimental study with a non-probability sample of 114 people with NCDs, recruited by invitation in Mexico and by convenience in Peru. The participants were assigned to intervention (n = 85) and control (n = 29) groups. The Personal Health Questionnaire (PHQ-8) and the Physical Activity Scale were used to assess the outcomes. Measurements were taken before and after the intervention. The CDSMP comprises six sessions that take place once per week and last 2.5 h each.

RESULTS

The intervention group showed a significant reduction in depressive symptoms and an increase in physical activity (PA) at the end of the program. In contrast, the control group showed no significant improvement in depression and presented a significant decrease in PA.

Objective Ischemia, Subjective Angina, and Psychological Distress in Angina With No Obstructive Coronary Disease

BACKGROUND

Angina with no obstructive coronary disease (ANOCA) and ischemia with no obstructive coronary disease, prevalent yet underrecognized conditions, mostly affect women. Previous studies rarely distinguished between them. We aimed to compare the prevalence of objective ischemia through various examinations in women with ANOCA and assess the impact of objective and subjective ischemia on their mental health.

METHODS AND RESULTS

A total of 84 eligible women with ANOCA and 42 controls underwent mental stress, pharmacological stress, exercise stress, and Holter testing. Objective evidence of myocardial ischemia was assessed by positron emission tomography-computed tomography and ECG, and subjective symptoms were graded using the Canadian Cardiovascular Society scale (CCS). Psychological assessments were conducted using 6 scales. Among 84 women with ANOCA, 37 (44%) received a diagnosis of ischemia with no obstructive coronary disease following mental stress testing, 20 (28.6%) through pharmacological stress testing, 14 (21.2%) via exercise stress testing, and 24 (32.9%) from Holter. Mental stress-induced myocardial ischemia was more prevalent (P<0.05). Among 54 patients with ANOCA who completed all tests, 30% showed no ischemia, and only 1 (1.9%) showed ischemia in all tests. In addition, patients with ANOCA had higher psychological scores than controls (P<0.01). No significant differences was observed in psychological scores between ANOCA with positive and negative ischemia test results (P>0.05). However, ANOCA with milder angina (CCS I) exhibited higher scores across the Hospital Anxiety and Depression Scale, State-Trait Anxiety Inventory, Perceived Stress Scale, and Posttraumatic Stress Disorder Checklist-Civilian Version and a higher prevalence of Type D personality traits (P<0.05).

CONCLUSIONS

In patients with ANOCA, the positive rate of myocardial ischemia exhibits variability among several noninvasive tests. A worsened psychological state is more closely linked to milder angina symptoms than to ischemia performance, highlighting the importance of focusing on symptom management in their psychological care.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03982901.

Associations between socioeconomic inequalities and progression to psychological and cognitive multimorbidities after onset of a physical condition: a multicohort study

Background

Chronic physical conditions (e.g., heart diseases, diabetes) increase with population ageing, contributing to psychological and cognitive multimorbidities. Yet, little is known about socioeconomic inequalities in this process. We examined the associations between socioeconomic status (SES) and progression to psychological and cognitive multimorbidities after onset of a physical condition.

Methods

We used harmonized individual-level data from five prospective cohort studies across 24 countries in the US, Europe and Asia, with repeated morbidity measurements between 2002 and 2021. Participants with at least one new-onset physical conditions (hypertension, diabetes, heart diseases, stroke, chronic lung diseases, cancer, or arthritis) were followed up for progression to physical-psychological multimorbidity, physical-cognitive multimorbidity, and physical-psychological-cognitive multimorbidity. SES was determined based on educational level and total household wealth at the onset of a physical condition. Time to and incidence rates of progressing psychological and cognitive multimorbidities were estimated in analyses stratified by SES. Fine-Gray subdistribution hazard models and multi-state models were used to estimate the associations between SES and progression to psychological and cognitive multimorbidities.

Findings

Among 20,250 participants aged ≥45 years (mean age at a physical condition onset 65.38 years, standard deviation 8.37) with at least one new-onset physical conditions in the analysis, 7928 (39.2%) progressed to psychological and cognitive multimorbidities during a median follow-up of 8.0 years (168,575 person-years). The mean survival time free from physical-psychological-cognitive multimorbidity was 11.96 years (95% confidence interval 11.57-12.34) in low SES individuals, compared to 15.52 years (15.40-15.63) in high SES individuals, with the corresponding incidence rate of 18.44 (16.32-20.82) and 3.15 (2.48-4.01) per 1000 person-years, respectively. The associations of education, household wealth and SES with multimorbidities followed a dose-dependent relation, with subdistribution hazard ratios per decreasing SES category being 1.24 (1.19-1.29) for physical-psychological multimorbidity, 1.47 (1.40-1.54) for physical-cognitive multimorbidity, and 1.84 (1.72-1.97) for physical-psychological-cognitive multimorbidity. The strongest SES-multimorbidities associations were observed in participants with arthritis, hypertension or diabetes. In multi-state models SES was linked to all five transitions from physical condition to physical-psychological multimorbidity, physical-cognitive multimorbidity and physical-psychological-cognitive multimorbidity.

Interpretation

Socioeconomic inequalities are associated with the progression of a chronic physical condition, with the lower SES groups had both an earlier time to and a higher incidence of psychological and cognitive multimorbidities. These findings underscore the need for more effective equity-oriented policies and healthcare practices to address reduced psychological wellness and cognitive maintenance among individuals with low SES and physical conditions.

Funding

Zhejiang University Hundred Talents Program Research Initiation Fund, Fundamental Research Funds for the Central Universities in China, Wellcome Trust, Medical Research Council, National Institute on Aging, Academy of Finland.

Maternal Psychological Well-Being as a Protector in Infantile Colic

(1) Background: Infantile colic (IC) is a functional gastrointestinal disorder that affects around 20% of infants, and postpartum (PPD) depression is a common disorder that affects between 15 and 22% of mothers. In this study, our objective was to evaluate the relationship between the maternal psychological state in the first postpartum year and IC, with the aim of assessing the importance of feeding type in infants and maternal well-being. (2) Methods: A cross-sectional study was conducted in women in their first year postpartum. Demographic, medical, and obstetric data of the mothers and infants were collected, and the type of feeding was identified. The emotional status of the mother was evaluated using the Edinburgh Postnatal Depression Scale (EPDS), and the Infant Colic Severity Questionnaire (ICSQ) was used for IC diagnosis. (3) Results: A total of 528 women were analyzed, of which 170 (32%) were diagnosed with possible PPD. Two-thirds of the women without depression breastfed their babies on demand; therefore, we report that exclusive breastfeeding (EBF) appears to reduce the risk of possible PPD (p < 0.001; OR = 2.353). IC was present in 39% of babies, and around 70% of babies without colic were breastfed on demand. Infants who were not exclusively breastfed showed almost double the risk of developing colic (p = 0.016; OR = 1.577). There was a significant association between the EPDS and ICSQ scores (p < 0.001). More than half of the women with PPD had babies with colic. However, our results show that 75% of babies without colic had mothers who reported optimal postpartum emotional well-being (p < 0.001; OR = 2.105). (4) Conclusions: The results of this study suggest that postpartum maternal psychological well-being reduces the risk of IC. Therefore, we report that EBF on demand, together with a healthy emotional state in new mothers, may be a protective factor against colic in infants.

Hyperexcitation of the glutamatergic neurons in lateral hypothalamus induced by chronic pain contributes to depression-like behavior and learning and memory impairment in male mice

Chronic pain can induce mood disorders and cognitive dysfunctions, such as anxiety, depression, and learning and memory impairment in humans. However, the specific neural network involved in anxiety- and depression-like behaviors and learning and memory impairment caused by chronic pain remains poorly understood. In this study, behavioral test results showed that chronic pain induced anxiety- and depression-like behaviors, and learning and memory impairment in male mice. c-Fos immunofluorescence and fiber photometry recording showed that glutamatergic neurons in the LH of mice with chronic pain were selectively activated. Next, the glutamatergic neurons of LH in normal mice were activated using optogenetic and chemogenetic methods, which recapitulates some of the depressive-like behaviors, as well as memory impairment, but not anxiety-like behavior. Finally, inhibition of glutamatergic neurons in the LH of mice with chronic pain, effectively relieved anxiety- and depression-like behaviors and learning and memory impairment. Taken together, our findings suggest that hyperexcitation of glutamatergic neurons in the LH is involved in depression-like behavior and learning and memory impairment induced by chronic pain.

Exploring the Feasibility of Estrogen Replacement Therapy as a Treatment for Perimenopausal Depression: A Comprehensive Literature Review

Perimenopausal depression (PMD) is a psychological disorder that occurs in women during perimenopause. In addition to the common clinical symptoms of depression, it often manifests as a perimenopausal complication, and its notable cause is the decline in estrogen levels. Despite numerous studies and trials confirming the benefits of estrogen replacement therapy (ERT) for PMD, ERT remains unapproved for treating PMD. Therefore, we conducted a literature search using selected keywords in PubMed and Google Scholar to write a review discussing the feasibility of using ERT for PMD. This review examines the potential of ERT for PMD in terms of its underlying mechanisms, efficacy, safety, and time window. These four aspects suggest that ERT is a viable option for PMD treatment. However, the risk of thrombosis and stroke with ERT is a matter of contention among medical experts, with a paucity of clinical data. Consequently, further clinical trial data are required to ascertain the safety of ERT.

Examining associations between mental health and Chronic Non-Communicable Diseases (C-NCDs) among older adults in Wakiso, Uganda

BACKGROUND

Globally, the prevalence of chronic non-communicable diseases (C-NCDs) and occurrence of multi-morbidity specifically, has been increasing and will continue to rise as life expectancy increases. The burden of mental health disorders has also been rising globally. In sub-Saharan Africa (SSA), literature on these health issues, which are interrelated, is scarce. This study assesses the prevalence of C-NCDs, and depressive and anxiety symptomology and examines the relationship between these issues among a sample of older adults in Uganda.

METHODS

Between 2021-2022, 604 consenting adults aged 35 years and older were surveyed on a broad range of health issues for the ongoing AMBSO Population Health Surveillance (APHS) cohort study in Wakiso district. Descriptive analyses were performed to characterize the burden of C-NCDs (e.g. diabetes, hypertension), depression (PHQ-9 using a cutoff of <5 scores for minimal/no and 5+ for mild to severe symptomology) and anxiety (GAD-7 using a cutoff of 5+ scores for mild to severe symptomology). Bivariate analysis and multivariable logistic regression models were built using STATA software version 16.0 to examine associations between mental health disorders and having at least one C-NCD. Our exposures of interest were depressive and anxiety symptoms and our outcomes of interest was presence of C-NCDs.

RESULTS

Majority of participants were females (63.6%), median age was 46 (IQR: 39-54). Any C-NCDs prevalence was 18.7%, while 18.9% and 11.4%, had screening scores indicative of depressive and anxiety symptomology, respectively. Three percent (3.2%) had PHQ-9 scores indicative of moderate to severe depressive symptomology. In models adjusted for sociodemographic characteristics, there was 12% increased odds of suffering from C-NCDs for every unit increase in PHQ-9 score (AOR = 1.12, 95% CI: 1.10-1.20). Participants with any anxiety symptoms had 2.1 greater odds of suffering from C-NCD compared to those who did not have anxiety symptoms (AOR = 2.10, 95% CI: 1.21-3.70).

CONCLUSION

C-NCDs were prevalent in older adults, particularly among those experiencing mental health symptoms. Screening for C-NCDs and mental health disorders should be integrated into routine health care for older adults in the country. Early screening and identification of these health issues through primary health care could significantly reduce the public health burden attributable to mental health disorders and the incidence of multi-morbidity in Uganda.

A control study on pain characteristics and influencing factors in patients with depressive disorders-based on a 5-year follow-up report from the epidemiological survey of mental disorders in Shandong Province, China

BACKGROUND

This study extends from the 2015 Shandong Province Epidemiological Survey of Mental Disorders in adults aged 18 and above. Over five years, it investigates pain characteristics and influencing factors in individuals with depressive disorders in Shandong Province.

METHODS

The study encompasses 871 individuals who met DSM-IV criteria for depressive disorders in 2015. Using 1:1:1 matching by gender, age, and residence, 825 non-afflicted individuals were selected as high-risk controls, and 825 screening-negative individuals became low-risk controls. A follow-up study in 2020 involved 1848 participants. Survey tools included a general information questionnaire, General Health Questionnaire-12 (GHQ-12), SCID-I/P, Global Pain Scale (GPS), Quality of Life Questionnaire (QLQ), PSQI, MoCA, and clinical data questionnaire.

RESULTS

GPS scores in the current depressive group were higher than in non-current depressive group (Z = 14.36, P < 0.01). GPS scores in study group exceeded those in high-risk and low-risk control groups (H = 93.71, P < 0.01). GPS scores in non-remission group were higher than in the remission group (Z = 8.90, P < 0.01). Regression analysis revealed positive correlations between GPS scores and physical illnesses, current depression, incumbency, GHQ-12 total score, and PSQI total score. Negative correlations were observed with QLQ total score and MoCA total score.

LIMITATIONS

The study could not assess pain during the 2015 survey, limiting controlled pain analysis before and after five years.

CONCLUSION

Depression sufferers may experience prolonged heightened pain, potentially relieved when depression subsides. Individual pain is influenced by depression, physical illnesses, sleep quality, quality of life, cognitive function, gender, residence, and occupation.

The Intersection of Mental Health and Sexual and Gender Minority Identities for Older Adults Living with Human Immunodeficiency Virus: A Narrative Review

The transition of HIV into a chronic illness has brought to the forefront the pressing need to address the complex web of social determinants of HIV outcomes. A structured literature search and narrative review of studies describing intervention strategies for mental health among sexual/gender minority (SGM) older adults living with HIV (OALWH) published in the last decade identified 2 studies for inclusion. This narrative review identifies age-sensitive and culturally adapted therapies, mindfulness and meditation-based stress reduction, group therapy, digital mental health resources, and psilocybin-assisted group therapy as emerging intervention models tailored to meet the unique needs of SGM OALWH.

Intervention effects of telenursing based on M-O-A model in empty-nest older adult individuals with chronic diseases: a randomized controlled trial

Aim

This study aims to verify the effectiveness of M-O-A telenursing intervention model in improving the health status and quality of life of the empty-nest older adult individuals with chronic diseases by a randomized comparative trial.

Methods

M-O-A telenursing intervention model was constructed based on the needs of the participants. The control group (N = 39) received routine nursing, the experimental group (N = 39) received M-O-A telenursing intervention in addition to routine nursing. After 12 weeks of intervention, the intervention effects of being a participant in the two groups were evaluated. SPSS 26.0 was used for data analysis.

Results

After 12 weeks of intervention, for the experimental group, each dimension of quality of life based on EQ-5D-3L became better, especially for "pain/discomfort," "anxiety/depression," "HRQoL" and "EQ-VAS" (all p < 0.05) and each dimension of quality of life based on SF-36 became better too, especially for "GH," "BP," "RE," "MH," "VT," "SF," "PCS," "MCS," "SF-36" (all p < 0.05). In addition, there was a statistical downward trend in blood pressure, blood glucose, weight, BMI, fat rate, nap duration, number of nocturnal awakenings, light sleep rate and a statistical upward trend in water rate, basal metabolic rate, nighttime sleep duration, deep sleep rate, rapid eye movement sleep rate, especially at the end of intervention (all p < 0.05). While for the control group, there was no statistical improvement in all these aspects.

Conclusion

The M-O-A telenursing model could effectively regulate quality of life and health condition of the empty-nest older adult individuals with chronic diseases, making it worthy of further promotion and application.

Influence of Depression on Pain and Disability in Patients with Chronic Low Back Pain after Physical Therapy: A Secondary Analysis of a Randomized Controlled Trial

Background

Depressive complications in chronic pain are detrimental to rehabilitation. This study was aimed at determining the influence of the presence of depressive symptoms on the efficacy of physical therapy among participants with chronic low back pain (CLBP).

Methods

Data was collected from a randomized controlled trial on 113 participants with CLBP. Participants were reallocated into the depressed or nondepressed groups based on the 50-cutoff point of the self-rating depression scale. All patients received 60 min sessions of physical therapy twice a week for 12 weeks. The primary outcome was back-related disability. Secondary outcomes included pain ratings, sleep quality, life quality, other psychological outcomes, and minimal clinically important differences. These outcomes were collected at baseline, 12, 26, and 52 weeks.

Results

31 (27.4%) were accompanied by depressive symptoms. At 12 weeks, the initial depression score was only associated with anxiety score (β = 1.196 [0.531 to 1.860], P = 0.001) and depression score (β = 0.742 [0.200 to 1.284], P = 0.009) in the depressed group, but the initial depression score was associated with anxiety score (β = 0.409 [0.138 to 0.681], P = 0.004), depression score (β = 0.920 [0.658 to 1.184], P < 0.001), sleep quality (β = 0.108 [0.018 to 0.199], P = 0.020), and pain anxiety (β = 0.465 [0.034 to 0.897], P = 0.035) and negatively associated with life quality (β = -0.815 [-1.267 to -0.363], P = 0.001) in the nondepressed group.

Conclusions

Physical therapy is effective to CLBP with depressive symptoms. A higher initial depression score may weaken the efficacy of physical therapy in the nondepressed group. Depressive complications may adversely influence intervention efficacy for CLBP. This trial is registered with ChiCTR1800016396.

The importance of assessing the triglyceride-glucose index (TyG) in patients with depression: A systematic review

Insulin resistance (IR) has been proposed as a potential risk factor for depression, a major common disorder affecting a significant proportion of adults worldwide. Based on this premise, this study systematically investigated all the studies examining the triglyceride-glucose (TyG) index, a surrogate marker of IR, in patients with depression or suicidal ideas/attempts. Four online databases (PubMed, Scopus, Embase, and Web of Science) were comprehensively searched. After screening, seven studies were included, comprised of 58,981 participants and 46.4% male. While there were some discrepancies among the reports of studies, most of the included studies reported higher levels of TyG index in patients with depression. Moreover, in most cases, a 1-unit increase in the TyG index was associated with significantly higher odds of depression. At last, higher TyG levels were associated with suicidal ideation and attempts. Therefore, this study emphasizes the critical need to further research in this regard and possibly integrate the TyG index measure with routine depression screening to avoid fatal events in the future.

Mechanisms of pain in aging and age-related conditions: Focus on caregivers

Pain is a complex, subjective experience that can significantly impact quality of life, particularly in aging individuals, by adversely affecting physical and emotional well-being. Whereas acute pain usually serves a protective function, chronic pain is a persistent pathological condition that contributes to functional deficits, cognitive decline, and emotional disturbances in the elderly. Despite substantial progress that has been made in characterizing age-related changes in pain, complete mechanistic details of pain processing mechanisms in the aging patient remain unknown. Pain is particularly under-recognized and under-managed in the elderly, especially among patients with Alzheimer's disease (AD), Alzheimer's disease-related dementias (ADRD), and other age-related conditions. Furthermore, difficulties in assessing pain in patients with AD/ADRD and other age-related conditions may contribute to the familial caregiver burden. The purpose of this article is to discuss the mechanisms and risk factors for chronic pain development and persistence, with a particular focus on age-related changes. Our article also highlights the importance of caregivers working with aging chronic pain patients, and emphasizes the urgent need for increased legislative awareness and improved pain management in these populations to substantially alleviate caregiver burden.

The Level of Expectations Regarding Aging Among Older Adults: A Systematic Review and Meta-analysis

OBJECTIVE

To systematically review the level of expectations regarding aging (ERA) among older adults.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Adults aged 60 years and older in any setting.

METHODS

We searched 11 databases for cross-sectional studies that reported ERA scores among older adults using the ERA survey from inception to May 1, 2022, without language restrictions. Two researchers independently selected studies, extracted data, and assessed quality. The mean scores and standard deviations of the ERA survey and its subscales were pooled using the Stata software (version 17.0).

RESULTS

Twelve studies with 3664 participants were included in this study. The pooled mean scores of overall ERA were 37.85 (95% CI, 33.54-42.16). Specifically, the pooled scores for expectations regarding physical health, mental health, and cognitive function were 31.67 (95% CI, 27.42-35.92), 43.69 (95% CI, 38.99-48.39), and 33.28 (95% CI, 29.56-37.00), respectively. No statistically significant differences between groups were observed in any subgroup analysis.

CONCLUSIONS AND IMPLICATIONS

The level of ERA among older adults is relatively low, particularly concerning cognitive function and physical health dimensions. These findings may provide a valuable reference for public health professionals and policymakers to intervene and manage the health problems of older adults.