Baseline CES-D Scores Research Articles

Depressive symptoms over the final menstrual period: Study of Women's Health Across the Nation (SWAN)

BackgroundWomen may be vulnerable to elevated depressive symptoms during the menopause transition (MT). Studies generally have not considered premenopausal depressive symptom history or examined symptoms in relation to the final menstrual period (FMP). ObjectiveTo identify specific time points in relation to the FMP when depressive symptoms increase or decrease. MethodsParticipants were 1582 multiracial/ethnic women from the longitudinal Study of Women's Health Across the Nation (SWAN). Biological, psychosocial, and depressive symptom data were collected approximately annually. Depressive symptoms were measured by the Center for Epidemiological Studies-Depression (CESD) scale. ResultsWomen with high baseline depressive symptoms (CES-D ≥ 16) declined in symptoms (M = −1.04/yr., 95 % CI = −1.58, −0.50) until 4 years before the FMP, followed by a smaller decrease (M = −0.50/yr., 95 % CI = −0.72, −0.28) until 18 months after the FMP. Depressive symptoms increased (M = 0.21/yr., 95 % CI = 0.11, 0.30) in those with low baseline symptoms until 1 year before the FMP, and decreased (M = −0.06/yr., 95 % CI = −0.11, −0.008) going forward. Greater social support, higher levels of follicle stimulating hormone and estradiol, and less sleep disturbance contributed to greater decline in depressive symptoms among those with high baseline depressive symptoms. Anxiety, experiencing stressful life events, lower body mass index, and poor role-physical function contributed to an increase in depressive symptoms among those with low baseline symptoms. LimitationsExcluded women had higher baseline CES-D scores. Lacked pre-MT depression for pre/early perimenopausal women at baseline. ConclusionAccounting for baseline depressive symptom level and focusing on the FMP more precisely characterize depressive symptom change over the MT.

Urea Level and Depression in Patients with Chronic Kidney Disease.

Depression is common in patients with chronic kidney disease (CKD). Experimental studies suggest the role of urea toxicity in depression. We assessed both the incidence of antidepressant prescriptions and depressive symptoms (measured by CESD (Center for Epidemiologic Depression) scale) in 2505 patients with CKD (Stage 3-4) followed up over 5 years in the Chronic Kidney Disease Renal Epidemiology and Information Network (CKD-REIN) cohort. We used a joint model to assess the association between the serum urea level and incident antidepressant prescriptions, and mixed models for the association between the baseline serum urea level and CESD score over the 5-year follow-up. Among the 2505 patients, 2331 were not taking antidepressants at baseline. Of the latter, 87 started taking one during a median follow-up of 4.6 years. After adjustment for confounding factors, the hazard ratio for incident antidepressant prescription associated with the serum urea level (1.28 [95%CI, 0.94,1.73] per 5 mmol/L increment) was not significant. After adjustment, the serum urea level was associated with the mean change in the CESD score (β = 0.26, [95%CI, 0.11,0.41] per 5 mmol/L increment). Depressive symptoms burden was associated with serum urea level unlike depression events. Further studies are needed to draw firm conclusions and better understand the mechanisms of depression in CKD.

Incidence and risk factors of depression in patients with metabolic syndrome.

Many studies have explored the relationship between depression and metabolic syndrome (MetS), especially in older people. China has entered an aging society. However, there are still few studies on the elderly in Chinese communities. To investigate the incidence and risk factors of depression in MetS patients in mainland China and to construct a predictive model. Data from four waves of the China Health and Retirement Longitudinal Study were selected, and middle-aged and elderly patients with MetS (n = 2533) were included based on the first wave. According to the center for epidemiological survey-depression scale (CESD), participants with MetS were divided into depression (n = 938) and non-depression groups (n = 1595), and factors related to depression were screened out. Subsequently, the 2-, 4-, and 7-year follow-up data were analyzed, and a prediction model for depression in MetS patients was constructed. The prevalence of depression in middle-aged and elderly patients with MetS was 37.02%. The prevalence of depression at the 2-, 4-, and 7-year follow-up was 29.55%, 34.53%, and 38.15%, respectively. The prediction model, constructed using baseline CESD and Physical Self-Maintenance Scale scores, average sleep duration, number of chronic diseases, age, and weight had a good predictive effect on the risk of depression in MetS patients at the 2-year follow-up (area under the curve = 0.775, 95% confidence interval: 0.750-0.800, P < 0.001), with a sensitivity of 68% and a specificity of 74%. The prevalence of depression in middle-aged and elderly patients with MetS has increased over time. The early identification of and intervention for depressive symptoms requires greater attention in MetS patients.

Does sleep link child maltreatment to depressive symptoms among incoming first-year college students?

We examined whether sleep (i.e. quality, regularity, and duration) mediated associations between child maltreatment (CM) and depressive symptoms among emerging adults undergoing the major life transition of starting college. Students (N = 1400; 44% male; 48% non-Hispanic white, 20% non-Hispanic Asian, 15% Hispanic all races, 7% non-Hispanic black, and 10% non-Hispanic other races) completed daily sleep diaries for 9 weeks, followed by the Childhood Trauma Questionnaire-Short Form, Pittsburgh Sleep Quality Index, and the Center for Epidemiologic Studies Depression Scale (CES-D). DSD data were used to compute participants' Sleep Regularity Index and average 24-hour total sleep time. We used a nonparametric structural equation modeling bootstrap approach and full information maximum likelihood to account for missing data. In model 1, we controlled for sex and race and ethnicity. In model 2, we further adjusted for baseline CES-D scores. The prevalence of self-reported moderate-to-severe CM was 22%. Small but significant indirect effects of CM on greater depressive symptoms through worse sleep quality (β = 0.06, 95% CI = 0.04, 0.09) and lower sleep regularity (β = 0.02, 95% CI = 0.005, 0.03) were observed in model 1. In model 2, only the indirect effect of sleep quality remained significant (β = 0.03, 95% CI = 0.01, 0.06). Poorer sleep quality may partially account for associations between CM and depressive symptoms during the first semester of college. Including sleep as a target in student health interventions on college campuses may not only help buffer against poor mental health outcomes for students with CM, but also poor academic and socioeconomic outcomes long-term.

Low plasma 25-hydroxyvitamin D levels are associated with an increased risk of depressive symptoms in community-dwelling Japanese people aged between 40 and 74 years: The Murakami cohort study

BackgroundAssociation between vitamin D levels and the occurrence of depression are not always consistent. The present cohort study aimed to determine this association in older adults, using a method for measuring vitamin D levels which is more accurate than those used in previous studies. MethodsParticipants were 3447 individuals aged 40–74 years without depressive symptoms at baseline who participated in the 5-year follow-up survey. The baseline investigation, including a self-administered questionnaire survey and blood collection, was conducted in 2011–2013. Plasma 25-hydroxyvitamin D (25[OH]D) levels were measured, and divided into overall quartiles summed up by sub-quartiles and stratified by age, sex, and season. The outcome was depressive symptoms determined by the CES-D (11-item, cut-off score of 6/7) 5 years later. Covariates were demographics, lifestyles, baseline CES-D score, and disease history. ResultsMean plasma 25(OH)D levels were 58.0 nmol/L in men and 45.7 in women (P < 0.0001), and cumulative incidences of depressive symptoms were 249/1577 (15.8 %) in men and 313/1870 (16.7 %) in women (P = 0.4526). The lower 25(OH)D quartile group had higher adjusted ORs in men and women combined (P for trend = 0.0107) and women (P for trend = 0.0003), but not in men. Adjusted ORs of the lowest quartile group were significantly higher than the highest group in men and women combined (OR = 1.39, 95 % CI: 1.06–1.81) and women (OR = 1.89, 95 % CI: 1.31–2.72). LimitationDepressive symptoms were self-reported. ConclusionsLow vitamin D levels were associated with a high risk of depressive symptoms, especially in women. Women are thus considered a major target for preventing vitamin D deficiency to address depression.

Association of Proinflammatory Diet With Frailty Onset Among Adults With and Without Depressive Symptoms: Results From the Framingham Offspring Study.

Dietary inflammation is associated with increased risk of frailty. Those with depressive symptoms may be at higher risk of frailty onset because they typically have higher levels of inflammation. The study objective was to determine the association between a proinflammatory diet and frailty onset in those with and without clinically relevant depressive symptoms. This prospective study included 1 701 nonfrail individuals with self-reported baseline (1998-2001) data available for the evaluation of energy-adjusted dietary inflammatory index (E-DIITM; calculated from food frequency questionnaires), depressive symptoms (from the Center for Epidemiologic Studies Depression; CES-D), and follow-up frailty measurements (2011-2014). Frailty was defined as fulfilling ≥3 Fried frailty criteria (i.e., slow gait, weak grip strength, unintentional weightloss, low physical activity, and self-reported exhaustion). Results are presented by baseline CES-D scores <16 or ≥16 points, which denotes the absence or presence of clinically relevant depressive symptoms, respectively. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (95% CI) between E-DII and frailty onset, adjusting for confounders. In all study participants, mean (SD) age was 58(8) years and E-DII was -1.95 (2.20; range: -6.71 to +5.40, higher scores denote a more proinflammatory diet), and 45% were male. In those without clinically relevant depressive symptoms, 1-unit higher E-DII score was associated with 14% increased odds (95% CI: 1.05-1.24) of frailty. In those with depressive symptoms, 1-unit higher E-DII score was associated with 55% increased odds of frailty (95% CI: 1.13-2.13). The association between inflammatory diet and increased odds of frailty appeared somewhat stronger among those with depressive symptoms. This preliminary finding warrants further investigation.

Association between Treatment for Localized Prostate Cancer and Mental Health Outcomes.

We aimed to compare patient-reported mental health outcomes for men undergoing treatment for localized prostate cancer longitudinally over 5 years. We conducted a prospective population-based analysis using the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study. Patient-reported depressive symptoms (Centers for Epidemiologic Studies Depression [CES-D]) and domains of the Medical Outcomes Study 36-item Short Form survey evaluating emotional well-being and energy/fatigue were assessed through 5 years after treatment with surgery, radiotherapy (with or without androgen deprivation therapy) and active surveillance. Regression models were adjusted for outcome-specific baseline function, demographic and clinicopathological characteristics, and treatment approach. A total of 2,742 men (median [quartiles] age 64 [59-70]) met inclusion criteria. Baseline depressive symptoms, as measured by the CES-D, were low (median 4, quartiles 1-8) without differences between groups. We found no effect of treatment modality on depressive symptoms (p=0.78), though older age, poorer health, being unmarried and baseline CES-D score were associated with declines in mental health. There was no clinically meaningful association between treatment modality and scores for either emotional well-being (p=0.81) or energy/fatigue (p=0.054). This prospective, population-based cohort study of men with localized prostate cancer showed no clinically important differences in mental health outcomes including depressive symptoms, emotional well-being, and energy/fatigue according to the treatment received (surgery, radiotherapy, or surveillance). However, we identified a number of characteristics associated with worse mental health outcomes including: older age, poorer health, being unmarried, and baseline CES-D score which may allow for early identification of patients most at risk of these outcomes following treatment.

Endocrine and psychosocial moderators of mindfulness-based stress reduction for the prevention of perimenopausal depressive symptoms: A randomized controlled trial

BackgroundThe menopause transition is associated with an increased risk of depressive symptoms. The current study aimed to test whether Mindfulness-Based Stress Reduction, an 8-week group intervention involving meditation and yoga, might reduce the risk of depressive symptoms among perimenopausal women. A secondary aim was to examine baseline characteristics, including sensitivity to estradiol fluctuation, as a moderator of treatment effects. Methods104 healthy women from the community in the menopause transition were enrolled and randomized to MBSR (n = 52) or a waitlist control condition (n = 52). Randomization was carried out using a random number generator and opaque sealed envelopes. Depressive symptoms, the main outcome, were assessed every two weeks for 6 months using the Center for Epidemiologic Studies Depression Scale (CES-D). The occurrence of an elevated CES-D score (≥16) and of a major depressive episode were pre-identified secondary outcomes. The following surveys were used to assess additional outcomes of interest every two months: the Perceived Stress Scale, Spielberger Trait Anxiety Inventory, Connor-Davidson Resilience Scale, and Pittsburgh Sleep Quality Index. Baseline characteristics examined as potential moderators of treatment benefit included: baseline CES-D score, past depressive episodes, recent stressful life events, a history of physical or sexual abuse, and emotional sensitivity to reproductive hormone fluctuation. Outcome assessors were blinded to the participants’ assigned treatment arm. ResultsOutcome data were available for 44 women assigned to MBSR and 51 women in the waitlist condition. Women randomized to MBSR reported fewer depressive symptoms, less perceived stress, less anxiety, increased resilience, and improved sleep (ps < 0.001). Furthermore, several baseline characteristics predicted a greater mood benefit of MBSR, including: a history of major depression (p for the interaction <0.001), a greater number of recent stressful life events (p < .001), being in the early menopause transition (p = .002), and an increased emotional sensitivity to reproductive hormone fluctuation (p = .004). There were no group differences in the occurrence of major depressive episodes (p > .05). ConclusionsMBSR appears to be an effective intervention for the prevention of depressive symptoms in the menopause transition.

Randomized trial of exercise on depressive symptomatology and brain derived neurotrophic factor (BDNF) in ovarian cancer survivors: The Women's Activity and Lifestyle Study in Connecticut (WALC)

ObjectivesDepression is one of the most prevalent mental disorders, and rates are higher among cancer survivors than the general population, and higher in ovarian cancer patients compared to cohorts of other cancer survivors. Physical activity has been associated with lower depressive symptoms in cancer survivors, yet no trial has examined this association in women with ovarian cancer. We examined the effect of exercise on depression symptomatology and serum brain derived neurotrophin factor (BDNF) which has been associated with depression, in women with ovarian cancer. MethodsWe conducted a 6-month home-based randomized trial of exercise vs. attention-control (AC) in 144 ovarian cancer survivors. Depressive symptomatology was measured via the Center for Epidemiologic Studies Depression Scale (CES-D). Serum total and free BDNF was measured at baseline and 6-months. Student's t-statistic and mixed-model repeated measures analysis was used to evaluate six-month change between arms in CES-D scores and BDNF. ResultsWomen were 57.3 ± 8.6 (mean ± SD) years old, 1.7 ± 1.0 years post-diagnosis with a baseline CES-D score of 11.79 ± 10.21. The majority (55%) were diagnosed with stage III/IV ovarian cancer. CES-D scores decreased in the exercise arm by 2.7 points (95% CI: −4.4, −0.9) or a 21% decrease compared to a 0.3 point decrease (−2.2, 1.5) (3% decrease) in the AC arm (P = 0.05). There was no difference in change in total or free BDNF between the exercise and AC arms. ConclusionsOvarian cancer survivors are able to exercise at recommended levels, and exercise was associated with a significant reduction in depressive symptomatology.

Omega-3 Fatty Acids and Depressive Symptomology and the Influence of Psychosocial Stress: The Hispanic Community Health Study/Study of Latinos

Abstract Objectives The literature on n-3 fatty acid (FA) intake and depressive symptoms is inconsistent, potentially due in part to the influence of psychosocial stress. Some evidence supports that n-3 intake may have greater benefit on depressive symptoms among those with high oxidative stress. We quantified the associations between dietary and plasma n-3 FA and 6-y depressive symptoms and measured the modifying effect of psychosocial stress. Methods Data are from the Hispanic Community Health Study/Study of Latinos (age 48 y, 63% female). At baseline (2008–11), EPA, DHA and n-3 very-long-chain FAs (n-3VLCFAs) were estimated using two 24-hr recalls and the NCI method. Plasma n-3 FAs were measured by mass spectrometry. Depressive symptoms were measured at baseline and 6-y follow-up with the 10-item Center for Epidemiological Studies Depression Scale (CESD). Approximately 9 months from baseline, the 10-item Perceived Stress (PSS) and Chronic Burden of Stress scales were obtained. Unstratified and psychosocial stress-stratified associations were analyzed using survey linear regression among those with dietary (n = 3537) and plasma (n = 718) FA data. Model covariates included, but were not limited to, baseline CESD score, ethnicity, study site, antidepressant use, total energy intake, and dietary or plasma n-6 FA. Results Baseline DHA and n-3VLCFA intake were inversely associated with 6-y CESD (P &amp;lt; 0.05). All examined dietary n-3 FA exposures were inversely associated with CESD among those in the highest PSS quartile (Q4) (P &amp;lt; 0.05), but this was attenuated after considering n-6 FA intake. DHA and n-3VLCFA intakes were associated with lower CESD among those with 2 chronic stressors, but not &amp;lt;1 or &amp;gt;2 stressors. Plasma n-3 FAs were not associated with CESD in PSS stratified and unstratified analyses. However, plasma n-3 FA were associated with lower CESD score among those with only 2 chronic stressors. Conclusions Dietary n-3VLCFAs, but not plasma, were inversely associated with 6-y CESD. Psychosocial stress did not clearly modify these associations. These results provide some evidence that greater n-3VLCFA intake may reduce depressive symptoms among Hispanic/Latino adults. However, considering the limitations of self-reported intake, further research is needed using biomarkers of long-term n-3 consumption and psychosocial stress to confirm our findings. Funding Sources None.

MP67-17 ASSOCIATION BETWEEN TREATMENT FOR LOCALIZED PROSTATE CANCER AND MENTAL HEALTH OUTCOMES

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy III (MP67)1 Apr 2020MP67-17 ASSOCIATION BETWEEN TREATMENT FOR LOCALIZED PROSTATE CANCER AND MENTAL HEALTH OUTCOMES Amy Luckenbaugh*, Daniela Wittmann, Ann Arbor, MI, Zighuo Zhao, Tatsuki Koyama, Li-Ching Huang, Aaron Laviana, Christopher Wallis, Karen Hoffman, David Penson, and Daniel Barocas Amy Luckenbaugh*Amy Luckenbaugh* More articles by this author , Daniela WittmannDaniela Wittmann More articles by this author , Ann Arbor, MIAnn Arbor, MI More articles by this author , Zighuo ZhaoZighuo Zhao More articles by this author , Tatsuki KoyamaTatsuki Koyama More articles by this author , Li-Ching HuangLi-Ching Huang More articles by this author , Aaron LavianaAaron Laviana More articles by this author , Christopher WallisChristopher Wallis More articles by this author , Karen HoffmanKaren Hoffman More articles by this author , David PensonDavid Penson More articles by this author , and Daniel BarocasDaniel Barocas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000947.017AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Management options for localized prostate cancer are similar with respect to intermediate-term survival outcomes and differ with respect to disease-specific functional outcomes. However, little is known about the impact of prostate cancer treatment on mental health. In this context, we evaluated the association between prostate cancer treatment choice and patient-reported mental health outcomes over time. METHODS: We enrolled a population-based cohort of men who underwent active surveillance, surgery or radiation therapy as part of the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study. Depression (using the CES-D score, range 0-27, higher score indicating worse depression) and emotional well-being, energy and vitality (using the SF-36, range 0-100, higher scores indicating better function) were evaluated longitudinally through five years. Patients who did not complete at least one CES-D or SF-36 follow-up survey were excluded from the analysis. Univariate and multivariate analysis were performed to assess factors associated with CES-D and SF-36 scores. RESULTS: Among 1509 (52.4%) patients undergoing radical prostatectomy, 961 (33.4%) undergoing radiation therapy and 409 (14.2%) undergoing active surveillance there were no significant differences in CES-D or SF-36 scores between treated patients and those undergoing active surveillance (Table 1). The most significant predictors of decline in CES-D score included: older age (p=0.0075), poor overall health (p<0.0001), being unmarried (p<0.0195) and lower baseline CES-D score (p<0.0001). Baseline sexual function and urinary control were not correlated with longitudinal CES-D scores. Similar factors were found to be correlated with SF-36 emotional well-being, energy and vitality scores. CONCLUSIONS: Treatment with surgery or radiation was not associated with depression symptoms, or emotional well-being, energy, and vitality scores when compared to active surveillance through five years. Factors associated with development of declining mental health included: older age, being unmarried, poor overall health and lower baseline scores. Further analysis is warranted to determine if post-treatment sexual, urinary and bowel function are associated with longitudinal changes in mental health. Source of Funding: Grants (1R01HS019356 and 1R01HS022640) from the Agency for Healthcare Research and Quality and an award (CE12-11- 4667) from the Patient-Centered Outcomes Research Institute. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1031-e1032 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Amy Luckenbaugh* More articles by this author Daniela Wittmann More articles by this author Ann Arbor, MI More articles by this author Zighuo Zhao More articles by this author Tatsuki Koyama More articles by this author Li-Ching Huang More articles by this author Aaron Laviana More articles by this author Christopher Wallis More articles by this author Karen Hoffman More articles by this author David Penson More articles by this author Daniel Barocas More articles by this author Expand All Advertisement PDF downloadLoading ...

Association between saturated fatty acid intake and depressive symptoms in midlife women: A prospective study

BackgroundThis prospective investigation examined relations between baseline dietary saturated fatty acid (SFA) intake of women at midlife and prevalence of depressive symptoms 4 years later. MethodsWomen enrolled in the Study of Women's Health Across the Nation (SWAN) had measures of CES-D depression scores 4 years later and SFA intake at baseline. Logistic regression models were used to study prospective associations between SFA intake and depressive symptoms. ResultsA total of 2400 women aged 42–52 years were included in the present study. The ORs of depressive symptoms in model 1 adjustment for baseline CES-D score indicated that baseline SFA intake was positively associated with depressive symptoms. After additional adjustment for age, race/ethnicity, education, financial strain, physical activity, smoking currently, BMI, menopausal status, VMS, chronic stress and use of antidepressant in model 2, the results were similar to those of the model 1. This association remained statistically significant and changed little when additional controlling for SHBG and FSH in fully adjusted model 3. The fully adjusted OR of depressive symptoms in model 3 was 2.423 (1.142–5.143) in quartile 4 (the highest) versus quartile 1 (the lowest) of the baseline SFA intake. LimitationsAssessment of depression and SFA intake was based on a self-report scale. ConclusionsBaseline SFA intake is a predictor for depressive symptoms assessed 4 years later in midlife women. This underlines the importance of targeting SFA intake in the prevention of major depression in midlife women.

Prospective association between trans fatty acid intake and depressive symptoms: Results from the study of women's health across the nation

BackgroundThis prospective investigation examined relations between dietary trans fatty acid intake of women at midlife in baseline and prevalence of depressive symptoms 5 years later. MethodsWomen enrolled in the Study of Women's Health Across the Nation (SWAN) had measures of CES-D depression scores 5 years later and trans fatty acid intake at baseline. Logistic regression models were used to study prospective associations between trans fatty acid intake and depressive symptoms. ResultsIn overall 2376 women, baseline trans fatty acid intake did not predict depressive symptoms (p = 0.139) in model 1 adjusting for total caloric intake. However, after additional adjustment for age, race/ethnicity, education, financial strain, physical activity, BMI, menopausal status, VMS, chronic stress and use of antidepressant in model 2, baseline trans fatty acid intake predicted depressive symptoms 5 years later. This association remained statistically significant when additional controlling for SHBG, testosterone and estradiol in fully adjusted model 3. The fully adjusted OR of depressive symptoms was 1.637 (1.087–2.467) in quartile 4 (the highest) versus quartile 1 (the lowest) of the trans fatty acid intake. Sensitivity analyses performed in women with baseline CES-D score <16 showed that this association remained statistically significant. LimitationsAssessment of depression and trans fatty acid intake was based on a self-report scale. ConclusionsTrans fatty acid intake is a predictor for depressive symptoms 5 years later in midlife women independent health and psychosocial profiles. This underlines the importance of targeting trans fatty acid in the prevention of major depression in midlife women.

The Effect of a Behavioral Weight Loss Intervention With or Without Exercise on Depressive Symptoms

Depressive symptoms have been associated with less weight loss in some behavioral weight loss interventions (BWLI), and although it has been speculated that adding moderate-to-vigorous physical activity (MVPA) may improve outcomes, the relationship is not well understood. PURPOSE: To examine the relationship between weight loss, MVPA participation, and depressive symptoms over time in subjects enrolled in a BWLI. METHODS: Secondary analyses of depressive symptoms and weight loss in sedentary subjects (n=379; 45.0±7.9 years; BMI=32.4kg/m2±3.8) enrolled in a BWLI and randomized to a reduced calorie diet (DIET, N=104), diet plus a moderate dose of MVPA (MOD-EX, N=97), or diet plus a high dose of MVPA (HIGH-EX, N=102) were completed. All groups reduced energy intake (1200-1800 kcal/day), received weekly intervention sessions (months 1-6), followed by 2 group and 2 telephone contacts per month (months 7-12). MOD-EX was prescribed unsupervised MVPA that progressed to 150 min/wk, and HIGH-EX was progressed to 250 min/wk. Depressive symptoms (CES-D) and weight were assessed at 0, 6, and 12 months. RESULTS: Weight decreased [6mo:-9.18±5.9kg; 12mo:-10.0±7.8 kg] and depressive symptoms modestly increased from baseline to 6 months [BL: 6.45± 2.34; 6mo: 7.05](p<0.001) and baseline to 12 months [BL: 6.45± 2.34; 12mo: 6.93](p<0.05), with no significant differences between randomized groups. There was a modest, yet significant correlation between baseline CES-D score and weight change at months 6 (r=.126) and 12 months (r=.122)(p<0.05). Subjects who completed 6 months of the intervention (n=337) had significantly lower baseline CES-D scores compared to the non-completers (n=42) (p<.05), but there were no differences for 12 month completers (p=.49). CONCLUSIONS: The data revealed an inverse relationship between baseline depressive symptoms and success in the BWLI. This relationship was not different between DIET, MOD-EX, and HIGH-EX, indicating that exercise participation may not influence this relationship. While depressive symptoms increased slightly over time regardless of group assignment, the 6 month completers had lower baseline depressive symptoms than non-completers. Thus, baseline depressive symptoms may be an important marker of both success and attrition in a BWLI.

Multimorbidity is associated with more subsequent depressive symptoms in three months: a prospective study of community-dwelling adults in Hong Kong.

Multimorbid adults are more likely to have depression. However, existing data are mostly cross-sectional or retrospective with poor control of baseline depressive symptoms and a focus on long-term effects. This prospective study examined the short-term independent predictive association of multimorbidity with depressive symptoms. We collected baseline and three-month follow-up data from a population-based sample of 300 community-dwellers (aged 18-77) in Hong Kong. Multiple regression was used to examine the predictive association of baseline multimorbidity (two or more physical chronic conditions), relative to having one or zero conditions, with depressive symptoms in three months measured by the Center for Epidemiological Studies-Depression (CES-D, out of 60) scale. Multivariable adjustments were made for socio-demographics, baseline CES-D scores, and baseline self-perceived physical health status. A sub-analysis was conducted to compare multimorbid participants with monomorbid (one condition) ones. In our sample, 48 participants (16%) had multimorbidity. Adjusted analysis showed that on average, multimorbid participants had 2.71 (95% CI, 0.36-5.06, Cohen's d = 0.128) more points in the CES-D scale at three-month follow-up than non-multimorbid participants (zero or one condition) did, which was independent of baseline CES-D scores, self-perceived physical health status, and socio-demographics. Compared with monomorbid participants, multimorbidity was associated with a similar difference of 2.92 (95% CI, 0.81-5.66, Cohen's d = 0.220) points. Incremental R-square changes associated with the inclusion of multimorbidity were significant (P < 0.05). In conclusion, the effect of multimorbidity on depressive symptoms may take a shorter period to manifest than previously assumed. The mental health of adults with multimorbidity warrants more attention.

Trends in and Predictors of Depression Among Participants in the Collaborative Initial Glaucoma Treatment Study (CIGTS)

To characterize longitudinal trends and factors predictive of depressive symptoms following glaucoma diagnosis in Collaborative Initial Glaucoma Treatment Study (CIGTS) participants. Cohort study using follow-up data from a clinical trial. A total of 607 participants with newly diagnosed open-angle glaucoma were enrolled at 14 clinical centers in the United States from October 1993 through April 1997, randomized to treatment with medication or surgery, and followed every 6months through 2004. The 8-item Center for Epidemiologic Studies Depression Scale (CES-D) was administered at baseline and follow-up visits. Three outcome measures were investigated: overall CES-D depression score, presence of mild or worse depression (CES-D score ≥ 7), and number of depressive symptoms endorsed. The average baseline CES-D score was 2.4 (SD= 3.8), 12.5% of subjects reported symptoms associated with mild or worse depression, and 55.3% reported at least 1 depressive symptom. By 1 year posttreatment, depression measures decreased (1.5, 6.7%, and 38.4%, respectively), with modest decreases thereafter. Baseline factors predictive of mild or worse depression included worse vision-related quality of life (VRQOL) (odds ratio [OR]= 2.41), female sex (OR= 1.42), younger age (OR per 10 years younger= 1.24), and less than high school education (OR= 2.93); other outcomes showed similar results. Depressive symptoms decreased considerably during the first year after treatment initiation, but were elevated in those with impaired VRQOL. Given the potential of depression to reduce treatment adherence and thus increase the risk of glaucoma progression, eye care providers should ask patients about depressive symptoms, provide reassurance when appropriate, and make referrals as necessary.

Depressive symptoms and adipokines in women: Study of women’s health across the nation

Small clinical studies suggest depression is associated with alterations in adiponectin and leptin, adipocyte-derived secretory proteins involved in metabolic regulation; however, longitudinal data on these association are lacking. This study examined cross-sectional and longitudinal associations of depressive symptoms and major depressive disorder (MDD) with adiponectin and leptin in healthy middle-aged women (mean (SD) age, 45.6 (2.5) years). Cross-sectional analyses included 575 women with baseline adipokine data; longitudinal analyses included 262 women with 2–4 adipokine measurements over 5 years. The 20-item Center for Epidemiologic Studies Depression scale (CES-D) was used to assess depressive symptoms; history of MDD was determined by the Structured Clinical Interview for DSM-IV. Adipokines were assayed from stored serum specimens; values were log-transformed for analyses. Linear and repeated measure random effects regression models evaluated associations of baseline CES-D scores with baseline adipokine concentrations and changes over time, respectively. Secondary analyses evaluated the relation of MDD history with adipokine concentrations. Mean (SD) baseline concentrations of adiponectin and leptin were 9.90 (4.92) μg/mL and 27.02 (20.06) ng/mL; both increased over time (p < .0001). CES-D scores were associated with lower adiponectin at baseline (per 1-SD: estimate=-0.04, SE=.02, p=.03) and over time (per 1-SD: estimate=-0.055, SE = .024, p=.02). Associations were unchanged in risk factor-adjusted models. Women with elevated CES-D scores (≥16) had 6.9% (95% CI: −1.1%, 14.3%; p = .089) lower median adiponectin at baseline and 11.5% (95% CI: 1.5%, 20.4%, p = .025) lower median adiponectin over time in adjusted models, compared to women with CES-D<16. Rate of change in adipokines did not vary by baseline depressive symptoms or MDD history. Depressive symptoms and MDD history were unrelated to leptin.In women at midlife, depressive symptoms are associated with lower adiponectin, a critical anti-inflammatory biomarker involved in metabolic and cardiovascular conditions.

Association between HIV status and psychological symptoms in perimenopausal women.

HIV-infected women are burdened by depression and anxiety, which may impact adherence to antiretroviral therapy and overall quality of life. Yet, little is known about the scope of psychological symptoms in the growing number of HIV-infected women reaching menopause, when affective symptoms are more prevalent in the general population. We conducted a longitudinal study to compare affective symptoms between perimenopausal HIV-infected and non-HIV-infected women. The Center for Epidemiologic Studies Depression Scale (CES-D), and the Generalized Anxiety Disorder scale (GAD-7) were completed at baseline and 12 months among 33 HIV-infected and 33 non-HIV-infected perimenopausal women matched by race, age, menstrual patterns, and BMI. Linear regression models estimated the relationship of baseline GAD-7 and CES-D scores with clinical factors. All women were perimenopausal at baseline, and the vast majority remained perimenopausal throughout follow-up. HIV status was associated with higher baseline CES-D scores (median [interquartile range] 21 [12, 29] vs 10 [5, 14]; P = 0.03) and GAD-7 scores (7 [5, 15] vs 2 [1, 7]; P = 0.01), controlling for smoking, substance use, and antidepressant use. Depressive symptoms and anxiety remained significantly higher in the HIV-infected women at 12 months (P ≤ 0.01). Significant relationships of depressive symptoms (P = 0.048) and anxiety (P = 0.02) with hot flash severity were also observed. Perimenopausal HIV-infected women experienced a disproportionately high level of affective symptom burden over a 12-month observation period. Given the potential for these factors to influence adherence to HIV clinical care and quality of life, careful assessment and referral for treatment of these symptoms is essential.

Exploring the Role of Depression as a Moderator of a Workplace Obesity Intervention for Latino Immigrant Farmworkers.

We explored if and how depression moderated the treatment effect of Pasos Saludables, a successful pilot workplace obesity intervention for Latino immigrant farmworkers. The original randomized controlled study assigned 254 participants 2:1 to a 10-session educational intervention versus control. We assessed the relationship between change in BMI (primary outcome) and interaction of treatment allocation and baseline risk for depression. Baseline CES-D scores indicated that 27.3% of participants were at risk for depression. The interaction between treatment allocation and baseline risk for depression was significant (p = 0.004). In adjusted modelsamong women, intervention participants with no indication of depression at baseline reduced their BMI by 0.77 on average (95% CI - 1.25, - 0.30) compared to controls. The reduction im BMI between the intervention group at risk for depression at baselineand eithercontrol was not significantly different from zero. Findings from our post-hoc, exploratory study indicate that depression may inhibit significant weight loss.

Predictors of remission from probable depression among Hong Kong adolescents – A large-scale longitudinal study

BackgroundThis study investigated the incidence of remission from probable depression among adolescents in Hong Kong. Remissions were defined as having Center for Epidemiological Studies Depression Scale (CESD) scores changed from ≥16 at baseline to <16 over the 12-month follow-up period. The study tested the predictors of remissions, including perceived changes in family support, self-efficacy, self-esteem, positive affect, negative events, social anxiety, and loneliness. MethodsThe study surveyed 9666 secondary school students and identified 5487 (57%) students with probable depression in Hong Kong. A questionnaire assessing the levels of the aforementioned variables was completed at baseline and at the 12-month follow-up. ResultsAmong participants with probable depression at baseline, 23.2% remitted from depression at follow-up. Remissions were more common among males than females. Univariate logistic regression showed that perceived changes in all the aforementioned variables significantly predicted remission for both males and females. The same is true for most of these variables when they were entered together into multiple logistic regression models (with and without controlling for baseline CESD scores), except for family support in the female model and self-efficacy in both male and female models. LimitationsLimitations include potential self-report bias and only one follow-up observation over time. The design treats cases of probable mild to severe depression as a single group (CESD≥16). ConclusionsThe findings are potentially useful for designing and guiding related intervention programs. Results highlight the importance of long-term follow-up of those screened as probable depression to understand the course of changes in levels of depression.