CES-D Research Articles

Depression and anxiety before and at the beginning of the COVID-19 pandemic and incident persistent symptoms: a prospective population-based cohort study.

Many patients affected by COVID-19 suffer from debilitating persistent symptoms whose risk factors remained poorly understood. This prospective study examined the association of depression and anxiety symptoms measured before and at the beginning of the COVID-19 pandemic with the incidence of persistent symptoms. Among 25,114 participants [mean (SD) age, 48.72 years (12.82); 51.1% women] from the SAPRIS and SAPRIS-Sérologie surveys nested in the French CONSTANCES population-based cohort, depression and anxiety symptoms were measured with the Center for Epidemiologic Studies-Depression scale and the 12-item General Health Questionnaire before the pandemic, and with the 9-item Patient Health Questionnaire and the 7-Item Generalized Anxiety Disorder scale at the beginning of the pandemic (i.e., between April 6, 2020 and May 4, 2020). Incident persistent symptoms were self-reported between December 2020 and January 2021. The following variables were also considered: gender, age, educational level, householdincome, smoking status,BMI, hypertension, diabetes, self-rated health, and SARS-CoV-2 infection according to serology/PCR test results. After a follow-up of seven to ten months, 2329 participants (9.3%) had been infected with SARS-CoV-2 and 4262 (17.0%) reported at least one incident persistent symptom that emerged from March 2020, regardless of SARS-CoV-2 infection. In multi-adjusted logistic regression models, participants in the highest (versus the lowest) quartile of depressive or anxiety symptom levels before or at the beginning of the pandemic were more likely to have at least one incident persistent symptom (versus none) at follow-up [OR (95%CI) ranging from 2.10 (1.89-2.32) to 3.01 (2.68-3.37)], with dose-response relationships (p for linear trend <0.001). Overall, these associations were significantly stronger in non-infected versus infected participants, except for depressive symptoms at the beginning of the pandemic. Depressive symptoms at the beginning of the pandemic were the strongest predictor of incident persistent symptoms in both infected and non-infected participants [OR (95%CI): 2.88 (2.01-4.14) and 3.03 (2.69-3.42), respectively]. In exploratory analyses, similar associations were found for each symptom taken separately in different models. Depression and anxiety symptoms should be tested as a potential target for preventive interventions against persistent symptoms after an infection with SARS-CoV-2.

Impact of COVID-19 pandemic on insomnia and sleep efficiency in parents and caregivers of young children

IntroductionDuring the COVID-19 pandemic, sleep problems were highly prevalent. However, few studies assess sleep quality among parents and caregivers with young children. This study aimed to describe the impacts of the COVID-19 pandemic on sleep patterns among parents and caregivers with young children (&amp;lt;6 years) and identify the factors associated with insomnia and sleep efficiency.MethodsAn internet sample of 136 caregivers (age: 35 ± 9.7 y, 70.6% female) were recruited internationally from May 21, 2020 to July 1, 2020. Participants completed the Center for Epidemiological Studies–Depression Scale-10 (CES-D-10), Sleep Hygiene and Practices Scale (SHPS), Coronavirus Impact Scale (CIS), Insomnia Severity Index (ISI), and sleep patterns prior to and during the pandemic. Hierarchical regressions were conducted to examine the factors associated with insomnia and sleep efficiency.ResultsNearly 40% of the caregivers reported household incomes &amp;lt;$10,000. More than half reported clinical levels of depressive symptoms (59.2%) and low sleep efficiency (65.8%). Approximately 90% reported that their sleep-wake routine was altered with delayed bedtime and midpoint, and more naps and nightmares. Almost half (51.5%) were experiencing clinically meaningful insomnia symptoms. Greater insomnia symptom severity was independently associated with lower income, greater depressive symptoms, poor sleep hygiene behaviors, altered sleep-wake routine, and greater COVID-related disruptions in daily life. The predictors associated with poor sleep efficiency during the pandemic were lower income and poor sleep efficiency before the pandemic.DiscussionThe study highlighted the factors associated with insomnia and poor sleep efficiency during the COVID-19 pandemic. Interventions are needed to support caregivers' sleep during global crises.

Psychological Capital and Self-Acceptance Modified the Association of Depressive Tendency with Self-Rated Health of College Students in China during the COVID-19 Pandemic.

To explore the association between the self-reported health status, depressive tendency, psychological capital, and self-acceptance of college students in China during the COVID-19 pandemic. Using the online survey platform "questionnaire star", a two-phase cross-sectional study was conducted on a total number of 1438 undergraduates with informed consents. The questionnaires of Self-Rated Health Measurement Scale (SRHMS), the Center for Epidemiological Studies-Depression Scale (CES-D), Psychological Capital Questionnaire (PCQ-24), and self-acceptance questionnaire were administered to each participant. Male college students had significantly higher depressive tendency scores than female (17.59 vs. 15.82) (p < 0.01). College students having no siblings had significantly higher psychological capital scores than those having siblings (108.63 vs. 105.60) (p < 0.05). Exercise had significantly positive associations with self-rated health, psychological capital, and self-acceptance scores, while online time per day had significantly negative associations. Multivariate analysis showed that the interaction between depressive tendency, psychological capital, and self-acceptance was statistically significant (β = 0.004, p = 0.013 for phase 1 and β = 0.002, p = 0.025 for phase 2) in health status with depressive tendency ranking the top (β = -0.54 for phase 1 and -0.41 for phase 2, p < 0.001). Mediation analysis showed that psychological capital and self-acceptance modified the association of depressive tendency with health status. Physical exercise is beneficial to both physical and psychological health. Depressive tendency is the main risk factor that associates with self-rated health. Regardless of depressive tendency level, high psychological capital and self-acceptance could improve college students' health.

Early Life Disadvantage and the Risk of Depressive Symptoms among Young Black Women.

We examined the association between early-life socioeconomic disadvantage and depressive symptoms in adulthood and assessed whether social factors in adulthood modify the association. The11-item Center for Epidemiologic Studies-Depression Scale (CES-D) assessed adult depressive symptoms among 1612 Black women and other participants with a uterus (hereafter participants) in the Study of Environment, Lifestyle and Fibroids. Baseline self-reported childhood factors (i.e., parents in the household, mother's educational attainment, food insecurity, neighborhood safety, childhood income, and quiet bedroom for sleep) were included in a latent class analysis to derive an early life disadvantage construct. Multivariable log-binomial models estimated the association between early life disadvantage and adult depressive symptoms. Potential effect modifiers included adult educational attainment, social support, and financial difficulty. Participants classified as having high early life disadvantage had 1.34 times (95% CI: 1.20, 1.49) the risk of high depressive symptoms than those in the low early life disadvantage class after adjusting for age, first born status, and childhood health. Adult educational attainment and social support modified the association. Early life disadvantage increased the risk of depressive symptoms in adulthood. Participants with at least some college education and with high social support had greater risk than those with less than college education and low social support, respectively. Thus, the mental health ofBlack women and other participants with a uterusexposed to early life disadvantage do not necessarily benefit from higher education or from social support.

Longitudinal changes in depressive symptoms associated with social isolation after the Great East Japan Earthquake in Iwate Prefecture: findings from the TMM CommCohort study

BackgroundWhether past disaster experiences affect the association between changes in social isolation and depressive symptoms is largely unknown. This study examined the association between changes in social isolation and depressive symptoms among survivors who experienced earthquake damage in the aftermath of the Great East Japan Earthquake (GEJE).MethodsWe analyzed longitudinal data from 10,314 participants who responded to self-report questionnaires on the Lubben Social Network Scale-6 (LSNS-6) and the Center for Epidemiological Studies-Depressive Scale (CES-D) in both the baseline survey (FY2013 to FY2015) and follow-up survey (FY2017 to FY2019) after the GEJE. According to changes in the presence of social isolation (< 12 of LSNS-6) at two time points, participants were categorized into four groups: “not socially isolated,” “improved socially isolated,” “newly socially isolated,” and “continuously socially isolated.” At the follow-up survey, a CES-D score of ≥ 16 indicates the presence of depressive symptoms. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated using the logistic regression analysis to examine the influence of the change in social isolation over four years on depressive symptoms.ResultsParticipants who were newly socially isolated had a significantly higher prevalence of depressive symptoms than those who were not socially isolated (AOR = 1.89, 95% CI = 1.61 − 2.23). In addition, AORs were highest for those who were continuously socially isolated and had experienced house damage (AOR = 2.17, 95% CI = 1.73 − 2.72) and those who were newly socially isolated and had not experienced the death of family members due to the GEJE (AOR = 1.88, 95%CI = 1.60 − 2.22).ConclusionOur longitudinal findings suggest that being newly or continuously socially isolated is associated with a risk of depressive symptoms, not only among those who had experienced house damage or the death of a family member, but also those who had not, in the disaster-affected area. Our study underlines the clinical importance of social isolation after a large-scale natural disaster and draws attention to the need for appropriate prevention measures.

Sex differences in the psychometric properties of the Center for Epidemiological Studies-Depression (CES-D) Scale in older Filipinos.

The literature has yet to fully account for sex differences in the symptomatology and measurement of depressive symptoms, especially in developing settings like the Philippines. Thus, we established the factor structure and assessed the reliability of the 11-item version of the Center for Epidemiological Studies-Depression (CES-D) Scale for assessing depressive symptoms in older Filipino men and women. Using cross-sectional data from 5,209 community-dwelling Filipinos aged 60 and above from a nationally representative survey, Confirmatory Factor Analysis (CFA) and methods in Item Response Theory (IRT) were applied to provide complementary insights into the properties of the scale and its individual items. CFA supported the multidimensionality of the scale. The scale is also sex-invariant, but the relationship between the subfactors and the higher-order factor may differ between men and women. In addition, findings from IRT analysis confirmed the overall utility of the CES-D scale, but positively stated items were found to be internally inconsistent with the rest of the scale. The scale is desirably informative for assessing more severe symptoms, although sex differences were found in the precision of individual items. In general, the 11-item CES-D Scale is an adequate multidimensional tool for assessing moderate to severe depressive symptoms in the older population, especially in older men.

#4818 IMPACT OF COMBINED PHYSICAL FRAILTY AND DEPRESSIVE SYMPTOMS ON MORTALITY IN PATIENTS ON HEMODIALYSIS

Abstract Background and Aims Patients receiving hemodialysis [HD] are getting older, with 38.8% of patients in Japan being 75 years or older. HD patients also have multiple comorbidities, which are known to be associated with poor clinical outcomes, especially in the older patients. Moreover, physical frailty and depressive symptoms are common in HD patients and these are known to be risk factors for poor prognosis. However, it is unclear whether the coexistence of physical frailty and depressive symptoms contributes to an increased risk of mortality in older patients with multiple comorbidities. As a result, the goal of this study was to look at the relationship between physical frailty and depressive symptoms and mortality in HD patients of different ages. Method This study included 409 Japanese outpatients with HD (mean age 65.9 years, 62.6% male, and 2.0 years of hemodialysis history). Slow walking speed and/or weak hand grip strength were used to define physical frailty. The Center for Epidemiological Studies-Depression scale was used to assess depressive symptoms. Patients were divided into four groups: (1) no depressive symptoms, no physical frailty; (2) depressive symptoms, no physical frailty; (3) no depressive symptoms, physical frailty; and (4) depressive symptoms, physical frailty. All-cause mortality was the outcome; Cox regression analysis was performed, with analysis stratified by age group (&amp;lt;75 years, ≥75 years) to examine differences by age. Results Physical frailty and depressive symptoms were prevalent in 268 (65.5%) and 143 (35.0%) of the population, respectively. Physical frailty and depressive were present in 103 people (25.2%). 129 (31.5%) people died during the follow-up period (median 49 months). In all patients, Cox regression analysis revealed that physical frailty and no depressive symptoms (hazard ratio [HR], 1.86, 95% confidence interval [CI], 1.01–3.44) and coexistence of physical frailty and depressive symptoms (HR, 2.30, 95% CI, 1.23–4.28) were significantly associated with an increased risk of death. In the &amp;lt;75-year-old group, a combination of physical frailty and depressive symptoms was significantly associated with an increased risk of death (HR, 2.45; 95% CI, 1.23–4.88). In the ≥75-year-old group, however combined physical frailty and depressive symptoms were not significantly associated with mortality (HR, 2.06; 95% CI, 0.34–12.55), whereas C-reactive protein was (HR, 1.59; 95% CI, 1.10–2.28). Conclusion Physical frailty and depressive symptoms were common in HD patients. In terms of prognosis, the coexistence of physical frailty and depressive symptoms were linked to mortality in the &amp;lt;75-year-old group, whereas in the &amp;lt;75-year-old group, the coexistence of physical frailty and depressive symptoms was not associated with death, but higher inflammation was associated.

Associations of depression and anxiety and adolescent telomere length

BackgroundTelomere length (TL), a biomarker of cellular aging, is influenced by adverse life experiences. Although depression and anxiety are associated with shorter TL in adults, the relationship in younger ages has received little attention. We examined relationships between depression and anxiety diagnoses and symptomatology and TL in adolescence, an important developmental window for early intervention. Sex differences in relationships were also examined. MethodsWave 1 survey and TL data from the Adolescent Health and Development in Context study were analyzed (N = 995). Depression and anxiety diagnosis were parent-reported measures categorized as: current diagnosis, prior diagnosis, and never diagnosed (reference category). Depressive symptoms were measured via adolescent-report using nine items from the Center for Epidemiologic Studies-Depression scale, short form. Anxiety symptoms were measured via adolescent-report using eight items from the pediatric anxiety scale obtained from the Patient-Reported Outcomes Measurement Information System. Genomic DNA was isolated from 500 μL saliva via ethanol precipitation. Genomic DNA TL was assessed using monoplexed quantitative polymerase chain reactions. Relative T/S quantities were calculated in accordance with established procedures. Covariates included sociodemographic factors (sex, age, race/ethnicity, caregiver marital status and education level, and household income), pubertal development, and season of collection. Descriptive and multivariable linear regression analyses were conducted, including an examination of sex as a moderator in the relationships between depression, anxiety, and TL. ResultsIn multivariable analysis, adolescents with a current depression diagnosis (b = −0.26, p < .05), but not a prior diagnosis (b =0.05, p > .05) had shorter TL than those who were never diagnosed; higher depressive symptom scores were associated with shorter TL (b = −0.12, p < .05). No significant associations were found between anxiety diagnosis and TL; however, higher anxiety symptom scores were associated with shorter TL (b = −0.14, p < .01). Sex did not significantly moderate any of the relationships between depression, anxiety and TL. ConclusionsDepression and anxiety were associated with shorter TL in this diverse community sample of adolescents and the findings highlight the potential for impaired mental health to contribute to cellular senescence as early as adolescence. Prospective research on the long-term effect of depression and anxiety occurring earlier in the life span on TL over time is needed, including examination of potential mechanisms that may accelerate or buffer the negative effects of impaired mental health on TL.

Cognitive dysfunction in patients with systemic lupus erythematosus. A cross-sectional study in a Brazilian sample.

Cognitive dysfunction (CD) is frequently found in patients with systemic lupus erythematosus (SLE) and contributes to impairment in the patient's quality of life. To study CD in a sample of patients and the possible associations with cumulative damage, disease activity, clinical/serological profile, and cumulative glucocorticoid dose. Included in this study are 103 patients with SLE and 95 controls for cognitive performance through MoCA (Montreal Cognitive Assessment) and MMSE (Mini-Mental State Examination). Disease activity was measured by SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) and cumulative organ damage by SLICC/ACR/DI (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index). CES-D (Center for Epidemiological Studies-Depression) scale was used to evaluate depression. Data on clinical and serological profile, treatment, and cumulative glucocorticoid dose were also collected. Patients with SLE had worse performance in the MoCA (p = 0.009) and MMSE (p = 0.01) than controls. The MoCA results showed that visuospatial and abstraction domains (p = 0.03 and p = 0.002, respectively) were impaired, and the MMSE results showed that language and spatial orientation were reduced (p = 0.002 and p = 0.01, respectively) when compared to controls. Both questionnaires (MoCA with r = -0.29 and MMSE r = -0.21) correlated negatively with SLICC/ACR/DI and the MoCA with SLEDAI (r = -0.22). No associations were found with cumulative glucocorticoid dose, degree of depression, and clinical or serological profile. According to the MoCA, visuospatial cognition and abstraction were impaired, and according to the MMSE, spatial orientation and language were impaired in patients with SLE. The CD was correlated with cumulative damage and disease activity. These findings demonstrate that both disease-activity and disease-injury associated CD is found broadly in SLE patients in a Brazilian population, supporting the prior reports of CD in other regional SLE populations.

Sexual stigmas among lesbian, gay, and bisexual individuals with problematic internet use and depression.

Sexual stigma causes psychological distress among lesbian, gay, and bisexual (LGB) individuals. LGB individuals are more likely to exhibit both problematic Internet use (PIU) and significant depression than are heterosexual individuals. Whether the severities of sexual stigma varied among LGB individuals with various statuses of comorbid PIU and depression warrants study. The present study aimed to investigate the differences in the experiences of familial sexual stigma (FSS), internalized sexual stigma (ISS), and sexual orientation microaggressions (SOMs) among LGB individuals with various statuses of comorbid PIU and depression. In total, 1,000 self-identified LGB young adult individuals participated in the study. The level of PIU was assessed using the Chen Internet Addiction Scale, depression was assessed using the Center for Epidemiological Studies-Depression Scale, the experience of FSS was assessed using the Homosexuality-Related Stigma Scale, the experience of ISS was assessed using the Measure of Internalized Sexual Stigma for Lesbians and Gay Men, and the experience of sexual orientation microaggression was assessed using the Sexual Orientation Microaggression Inventory. The differences in the levels of FSS, ISS, and SOMs among the four groups [i.e., the groups with both PIU and depression (comorbid group), only depression, only PIU, and neither PIU nor depression (neither group)] were investigated using multivariate analysis of covariance. The results indicated that LGB individuals with comorbid PIU and depression reported higher levels of ISS and SOMs than did those with depression only and PIU only, respectively. Moreover, LGB individuals with PIU or significant depression had higher levels of FSS and SOMs than did those with neither PIU nor depression. The results of this study supported that the experiences of FSS, ISS, and SOMs were significantly associated with various levels of PIU and depression in LGB individuals.

Trajectories of depressive symptoms over 20 years and subsequent lower urinary tract symptoms and impact among women.

The aim of the study is to examine the association between depressive symptoms and subsequent lower urinary tract symptoms (LUTS) and impact (a composite outcome) among women (N = 1,119) from the Coronary Artery Risk Development in Young Adults study. The Center for Epidemiologic Studies-Depression Scale (CES-D) was administered in 1990-1991 and every 5 years through 2010-2011. In 2012-2013, LUTS and impact data were collected for the first time. Accumulation of risk was examined in the following three ways: (1) mean CES-D score across 20 years (5 observations); (2) depressive symptom trajectory group, determined by group-based trajectory modeling; and (3) intercepts and slopes obtained from women's individual CES-D score trajectories through two-stage mixed effects modeling. For each approach, ordinal logistic regression analyses examined odds of having "greater LUTS/impact" for each unit change in a depressive symptom variable. (1) With each one-unit increase in mean CES-D score over the 20-year period, women were 9% more likely to report greater LUTS/impact (odds ratio [OR] = 1.09, 95% CI = 1.07-1.11). (2) In comparison with women with consistently low depressive symptoms, women with consistently threshold depression or consistently high depressive symptoms were twice (OR = 2.07, 95% CI = 1.59-2.69) and over five times (OR = 5.55, 95% CI = 3.07-10.06) as likely, respectively, to report greater LUTS/impact. (3) Women's individual symptom intercept and slope interacted. Increases in depressive symptoms across 20 years (greater slopes) were associated with greater LUTS/impact when women's initial CES-D score (intercept) was in the moderate-to-high range relative to the sample. Depressive symptoms over 20 years, examined with different degrees of nuance, were consistently associated with subsequently measured LUTS and impact.

Housing conditions and changes in professional activity during lockdown and the risk of prevalent and incident depression: Findings from the CONSTANCES cohort

BackgroundMaterial conditions of lockdown and changes in regular functioning may have played a role on depressive manifestations. We aimed to examine the association between housing conditions and changes in professional activity and depression during the first COVID-19 outbreak in France. MethodParticipants of the CONSTANCES cohort were followed online. A first questionnaire covered the lockdown period (assessing housing conditions and changes in professional activity), and a second the post-lockdown period (assessing depression using the Center of Epidemiologic Studies Depression-Scale (CES-D)). Incident depression was also estimated (with a previous CES-D measure). Logistic regression models were applied. Results22,042 participants (median age 46 years, 53.2 % women) were included and 20,534 had a previous CES-D measure. Depression was associated with female gender, lower household income and past history of depression. A negative gradient between the number of rooms and the likelihood of depression was consistently observed (OR = 1.55 95 % [1.19–2.00] for one room, OR = 0.76 [0.65–0.88] for seven rooms), while a U-shape relationship was observed with the number of people living together (OR = 1.62 [1.42–1.84] for living alone, OR = 1.44 [1.07–1.92] for six persons). These associations were also observed with incident depression. Changes in professional activity were associated with depression (Started distance working (OR = 1.33 [1.17–1.50]). Starting distance working was also associated with incident depression (OR = 1.27 [1.08–1.48]). LimitationA cross-sectional design was used. ConclusionThe consequences of lockdown on depression may vary depending on living conditions and changes in professional activity, including distance working. These results could help to better identify vulnerable people to promote mental health.

Effects of gender nonconformity and biological sex on the relationship between sexual orientation microaggressions and anxiety and depressive symptoms among lesbian, gay, and bisexual Taiwanese young adults: A moderated-moderation study

BackgroundSexual orientation microaggressions (SOMs) may negatively affect lesbian, gay, and bisexual (LGB) individuals' mental health. However, the moderating effects of gender nonconformity and biological sex on the relationship between SOMs and anxiety and depressive symptoms has never been examined. We evaluated the moderating effect of gender nonconformity on the association of SOMs with anxiety and depressive symptoms among LGB young male and female adults. We hypothesized that the associations of SOMs with anxiety and depressive symptoms weakened with increasing gender nonconformity among gay and bisexual men but strengthened with increasing gender nonconformity among lesbian and bisexual women. MethodsIn total, 1000 self-identified LGB young adult individuals participated in the study. The experience of sexual orientation microaggression was assessed using the Sexual Orientation Microaggression Inventory, anxiety was assessed using the State subscale on the State-Trait Anxiety Inventory, and depression was assessed using the Center for Epidemiological Studies-Depression Scale. The two-way moderation models stratified by sex examined the moderating effects of gender nonconformity on the association between SOMs and anxiety symptoms in the male and female participants. The three-way moderated moderation models were used to determine whether gender nonconformity and sex jointly moderated the associations between SOMs and anxiety and depressive symptoms. ResultsIn the two-way moderation models stratified by sex, gender nonconformity exerted opposite moderating effects on the association between SOMs and anxiety and depressive symptoms in the male and female participants. For the male participants, the association between SOMs and anxiety (β = −0.08) and depressive symptoms (β = −0.09) weakened with increasing gender nonconformity. For the female participants, the association between SOMs and anxiety (β = 0.08) and depressive symptoms (β = 0.13) strengthened with increasing gender nonconformity. The three-way moderated moderation models further confirmed that sex moderated the moderating effects of gender nonconformity on the associations between SOM and anxiety (β = −0.16, p = .047) and depressive symptoms (β = −0.22, p < .001). LimitationThe cross-sectional study design limited the inferences that could be made concerning the temporal relationship between SOMs and mental health problems. ConclusionsThe association between SOMs and anxiety and depressive symptoms weakened with increasing gender nonconformity in gay and bisexual men, whereas the association between SOMs and anxiety and depressive symptoms strengthened with increasing gender nonconformity in lesbian and bisexual women.

How to Procrastinate Productively With ADHD: A Study of Smartphone Use, Depression, and Other Academic Variables Among University Students With ADHD Symptoms

Objective: The association between chemical dependency and Attention-Deficit Hyperactivity Disorder is widely recognized, but there is less data regarding modern behavioral addictions among young adults. Method: In this cross-sectional study, a sample of 408 Hungarian college students (67.2% female, mean age 23.37 years [SD = 3.87]) responded to an online survey including the Adult ADHD Self-Report Scale, the Center for Epidemiologic Studies-Depression Scale (CES-D), the Procrastination Scale, the Short College Boredom Scale, and the Smartphone Addiction Scale (SAS-SV). Results: Regression analyses showed that passive procrastination (ß = .31, p < .001), depression (ß = .20, p < .001), academic boredom (ß = .18, p < .001), active procrastination (ß = −.12, p < .001), and smartphone addiction (ß = .13, p < .001) were significantly related to ADHD symptoms, accounting for 41% of the variance. Conclusion: Findings provide important additions to knowledge of mental health challenges among young adults with ADHD.

Depressive and generalized anxiety symptoms in adults awaiting cataract surgery in India.

Background Systematic data on mental health issues among adults awaiting cataract treatment are not readily available in India. We explored the prevalence and predictors of depressive and generalized anxiety (GA) symptoms in a cohort of adults awaiting cataract surgery. Methods Our study is based on data from baseline assessments which were conducted as part of a multicentre prospective, longitudinal cohort study. Subjects were recruited from four eye hospitals to assess depression and GA and associated risk factors using standardized scales, i.e. Center for Epidemiologic Studies-Depression Scale (CES-D) and Generalised Anxiety Disorder (GAD-7). Variation in the intensity of depression and GA was assessed using multiple classification analysis (MCA). Results A total of 813 adults awaiting cataract surgery participated, of whom 456 (56.1%) were men. The mean (SD) CES-D and GAD-7 scores were 24.6 (7.8) and 6.3 (SD 4.2) for men and 25.8 (8.9) and 6.9 (4.4) for women, respectively. The overall prevalence of depression score of >16 was 87.4% (95% confidence interval [CI] 84.7%- 89.6%), and GA score of >10 was 57.1% (95% CI 53.5%-60.7%). The prevalence of comorbid depressive and anxiety symptoms was 56.6% (95% CI 52.9%- 60.2%). MCA showed that being neglected and mistreated by family/friends because of vision condition and facing difficulty and requiring help with daily tasks had the highest effect on the intensity of both depression (beta=0.254 and 0.238, respectively) and GA (beta=0.219 and 0.211, respectively). Conclusion The majority of adults with untreated cataract had both depressive and GA symptoms. These findings could be used for planning mental health interventions for adults awaiting cataract surgery.

Sleep symptoms signaling the menopausal transition.

To describe changes in sleep quality and associated sleep symptoms as women begin menopausal transition compared with premenopausal controls. In a repeated-measures design, we analyzed data collected every 2-6 months from a community-based sample of 223 women aged 40-50 (45.6 ± 2.3) years old over a 2-year period. Each 6-month visit included urinary follicle-stimulating hormone (FSH) as a marker of ovarian function and the Pittsburgh Sleep Quality Index (PSQI) and other questionnaires (Center for Epidemiological Studies-Depression Scale; Perceived Stress Scale). Menstrual cycle and vasomotor symptoms (Seattle Women's Health Symptom Checklist) were tracked every 2 months by phone. For women entering menopausal transition (n = 68) we used data from the two consecutive visits prior to their FSH rise and the next two visits. Data from the last four consecutive visits were used for controls remaining premenopausal (n = 155). The transition group did not differ from controls on age, vasomotor symptoms (hot flashes/night sweats), stress, or depression but did have a higher body mass index. Measures were stable over time for controls. However, the transition group experienced an increase in PSQI scores (initial PSQI = 5.7 ± 3.2 and final PSQI = 6.3 ± 3.8; P = .030) and frequency of trouble sleeping because of feeling too hot (P = .016), which lagged the FSH rise by 6 months with no notable change in report of hot flashes/night sweats. Trouble sleeping because of feeling too hot, distinct from awareness of vasomotor symptoms, was the only uniform contribution to higher PSQI scores after the initial FSH increase and may signal the onset of the menopausal transition. Zak R, Zitser J, Jones HJ, Gilliss CL, Lee KA. Sleep symptoms signaling the menopausal transition. J Clin Sleep Med. 2023;19(8):1513-1521.

Social Isolation, Loneliness, and Cognitive Performance in Older Adults: Evidence From the ELSI-Brazil Study

The association between social isolation and cognitive performance has been less investigated in low-to-middle-income countries (LMIC) and the presence of depression as a moderator on this association has not been examined. The authors examined the associations of social isolation and perceived loneliness with cognitive performance in the Brazilian Longitudinal Study of Aging. In this cross-sectional analysis, social isolation was evaluated by a composite score including marital status, social contact, and social support. The dependent variable was global cognitive performance, which considered memory, verbal fluency, and temporal orientation tests. Linear and logistic regressions were adjusted for sociodemographic and clinical variables. The authors added interaction terms of depressive symptoms with social isolation and loneliness to examine whether depression, measured through the Center for Epidemiologic Studies-Depression Scale, modified these associations. Among 6,986 participants (mean age=62.1 ± 9.2 years), higher levels of social connections were associated with better global cognitive performance (B=0.02, 95%CI: 0.02; 0.04). Perceived loneliness was associated with worse cognition (B=-0.26, 95%CI=-0.34; -0.18). Interactions of depressive symptoms with social connections scores were found on memory z-score and with loneliness on global and memory z-scores, suggesting a weaker association between social isolation or loneliness and cognition among those with depressive symptoms. In a large sample from an LMIC, social isolation and loneliness were associated with worse cognitive performance. Surprisingly, depressive symptoms decrease the strength of these associations. Future longitudinal studies are important to assess the direction of the association between social isolation and cognitive performance.

Increased anxiety and depression among collegiate athletes with comorbid ADHD and history of concussion

BackgroundAttention Deficit Hyperactivity Disorder (ADHD) is prevalent among student-athletes when compared to the general population. Mental health disruptions (i.e., depression or anxiety) are common among student-athletes, and risk of experiencing depressive and anxious symptoms may be even greater among student-athletes that have incurred concussion. ObjectiveTo examine the influence of pre-existing ADHD and history of concussion on mental health in collegiate student-athletes. DesignRetrospective cross-sectional study. SettingNational Collegiate Athletic Association Division-I (NCAA) athletics. PatientsBetween 2010 and 2017, student-athletes at a Southeastern NCAA Division-I institution were surveyed as part of a Performance, Health, and Wellness Program. Analyses were conducted using a sample of 324 student athletes (212 female) with either a prior diagnosis of ADHD, a prior history of a sport-related concussion, both prior diagnosis of ADHD and a history of sport-related concussion, or neither (controls). Main outcome measure(s)Symptomatology associated with ADHD was characterized using the Behavior Assessment System for Children Self-Report of Personality College Version. The State-Trait Anxiety Inventory and the Center of Epidemiological Studies-Depression Scale examined anxious and depressive symptomatology. ResultsStudent-athletes with ADHD and a history of concussion had 16.4 times greater odds of exhibiting clinically significant symptoms of state anxiety and 7.9 times greater odds of exhibiting clinically significant symptoms of depression, relative to control student-athletes. Every participant with both a diagnosis of ADHD and a history of concussion exhibited clinically significant attentional problems. ConclusionsHaving both ADHD and a history of concussion may have a synergistic effect on mental health beyond that of ADHD and/or concussion alone. Additional longitudinal research is necessary to verify current findings. However, athletic trainers and other health care professionals are encouraged to be mindful of student-athletes with ADHD, as they may be more vulnerable to experiencing symptoms of depression and state anxiety with elevated inattentive behaviors following a concussion.

Mediating effects of meaning in life on the relationship between family care, depression, and quality of life in Chinese older adults.

The study explored sources of meaning in older adults and the action path among family care, meaning in life, quality of life, and depression. We investigated 627 older adults using the Sources of Meaning in Life Scale for the Elderly (SMSE), the Family Care Index (APGAR), the Center for Epidemiological Studies Depression Scale-10 (CES-D-10), and the EuroqOL-5 Dimensions (EQ-5D). Scores categorized 454 older adults with good family function, 99 with moderate, and 47 with severe family dysfunction; 110 older adults had depression. The structural equation model showed that family care affected the quality of life and depression by influencing meaning, and depression had a significant negative effect on the quality of life (P < 0.05). The model was a good fit for the data (χ2/df = 3.300, SRMR = 0.0291, GFI = 0.975, IFI = 0.971, TLI = 0.952, CFI = 0.971, RMSEA = 0.062). Meaning in life is an intermediary factor that affects depression and quality of life in older adults. Family care had a significant positive impact on SMSE and a negative influence on depression. The SMSE effectively clarifies the sources of meaning in life and can be used to improve meaning and promote mental health in older adults.

"More is better" or "better near the middle"? A U.S.-based individual participant data meta-analysis of socioeconomic status and depressive symptoms.

Socioeconomic status (SES) is a widely researched construct in developmental science, yet less is known concerning relations between SES and adaptive behavior. Specifically, is the relation linear, with higher SES associated with better outcomes, or does the direction of association change at different levels of SES? Our aim was to examine linear ("more is better") and quadratic ("better near the middle") associations between components of SES (i.e., income, years of education, occupational status/prestige) and depressive symptoms (Center for Epidemiologic Studies-Depression Scale), and to explore moderation by developmental period (adolescence, young, middle, and older adulthood), gender/sex (female, male), and race/ethnicity (Asian American, Black, Latinx, multiracial, Native American, White). We hypothesized that there would be more support for a model containing quadratic associations. We conducted a two-stage meta-analytic structural equation model of 60 data sets (27,242 correlations, 498,179 participants) within the United States, accounting for dependencies between correlations, which were identified via the Interuniversity Consortium for Political and Social Research and handled using a two-step approach. Income was quadratically associated with depressive symptoms, but the quadratic model did not explain more variance in depressive symptoms than the linear model. Developmental period and race/ethnicity moderated the associations: Income was quadratically associated with depressive symptoms among middle-aged adults, and years of education were quadratically associated with depressive symptoms among White samples. Our findings suggest that researchers and clinical practitioners should consider the elevated risk of depressive symptoms for individuals from low and high-income backgrounds in the United States. (PsycInfo Database Record (c) 2023 APA, all rights reserved).