Center For Epidemiologic Studies Depression Score Research Articles

Long-Term Particulate Matter Exposure and Onset of Depression in Middle-Aged Men and Women.

Background:Long-term exposure to particulate matter (PM) air pollution is associated with all-cause mortality and adverse cognitive outcomes, but the association with developing depression remains inconsistent.Objective:Our goal was to evaluate the prospective association between PM air pollution and developing depression assessed using the Center for Epidemiological Studies Depression (CES-D) scale.Methods:Subjects were drawn from a prospective cohort study of 123,045 men and women free of depressive symptoms at baseline who attended regular screening exams in Seoul and Suwon, South Korea, from 2011 to 2015. Exposure to PM with an aerodynamic diameter of ( and , respectively) was estimated using a land-use regression model based on each subject’s residential postal code. Incident depression was defined as a CES-D score during follow-up. As a sensitivity analyses, we defined incident depression using self-reports of doctor’s diagnoses or use of antidepressant medications during follow-up.Results:The mean baseline 12-month concentrations of and were 50.6 (4.5) and , respectively. The hazard ratios (HRs) and 95% confidence intervals (CIs) for developing depression associated with a increase in 12- and 60-month exposure were 1.11 (95% CI: 1.06, 1.16) and 1.06 (95% CI: 1.01, 1.11), respectively. The corresponding HRs for 12-month exposure was 0.96 (95% CI: 0.64, 1.43). Similar results were obtained when incident depression was identified using self-reports of doctor’s diagnoses or the use of antidepressant medications.Conclusion:In this large cohort study, we found a positive association between long-term exposure to outdoor air pollution and the developing depression. We did not find an association for outdoor air pollution; however, we had a much shorter follow-up for subjects’ exposure to . https://doi.org/10.1289/EHP4094

Socioeconomic disparities of depressive symptoms and cytokines in hepatocellular carcinoma.

To examine the associations among socioeconomic factors, depressive symptoms, and cytokines in patients diagnosed with hepatocellular carcinoma (HCC). A total of 266 patients diagnosed with HCC were administered a battery of questionnaires including a sociodemographic questionnaire and the Center for Epidemiologic StudiesDepression (CES-D) scale. Blood samples were collected to assess serum levels of cytokines using Luminex. Descriptive statistics, Mann-Whitney U, Kruskal-Wallis, linear regression, and Bonferroni corrections were performed to test the hypotheses. Of the 266 patients, 24% reported depressive symptoms in the clinical range (CES-D≥22). Females had higher CES-D score than males (Mann-Whitney U=7135, P=.014, Padj =.028). Being unemployed/disabled (Kruskal-Wallis=14.732, P=.001, Padj =.005) was found to be associated with higher depressive symptoms in males but not in females. Serum level of IL-2 (Kruskal-Wallis=17.261, P=.001, Padj =.005) were found to be negatively associated with education level. Gender (β=.177, P=.035), income (β=-.252, P=.004), whether the patient's income met their basic needs (β=.180, P=.035), and IL-1β (β=-.165, P=.045) independently predicted depressive symptoms and together explained 19.4% of variance associated with depressive symptoms. Sociodemographic and socioeconomic factors were predictive of inflammation and depressive symptoms. Recommendations include the development of gender-targeted interventions for patients diagnosed with HCC who have low socioeconomic status (SES) and may suffer from depressive symptoms.

Effects of thyroid hormone and depression on common components of central obesity.

ObjectiveWe investigated the prevalence of abnormal thyroid function and depression in centrally obese participants, and to analyze the relationship of thyroid hormones and depression with components of central obesity.MethodsWe randomly selected 858 centrally obese participants and 500 non-obese controls in this study. For all participants, we measured serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), body mass index (BMI), waist–hip ratio (WHR), fasting blood glucose and insulin, homeostasis model assessment of insulin resistance (HOMA-IR), lipid concentrations, and blood pressure. Depression was assessed using the Center for Epidemiological Studies-Depression (CES-D) scale.ResultsCentrally obese participants had a higher prevalence of hypothyroidism and depression than non-obese controls. Serum FT4 levels negatively correlated with BMI and serum TSH levels and positively correlated with BMI, WHR, total triglycerides (TG), total cholesterol (TC), and low density lipoprotein cholesterol (LDL-C). After excluding participants with hypothyroidism and hyperthyroidism, serum FT4 levels showed negative correlation and serum TSH levels showed positive correlation with BMI in the remaining centrally obese participants. CES-D scores positively correlated with BMI.ConclusionWe found high prevalences of hypothyroidism and depression among centrally obese participants. FT4 and TSH are important in weight regulation. Depression positively correlated with obesity.

Depression Over the Lifespan in a Population-Based Cohort of Women With Polycystic Ovary Syndrome: Longitudinal Analysis.

To (i) determine whether women with polycystic ovary syndrome (PCOS) from a population-based cohort experience elevated depression symptoms and (ii) characterize the trajectory of symptoms over the lifespan. The association between PCOS and longitudinal depression scores was investigated among 1127 black and white women participating in Coronary Artery Risk Development in Young Adults study. PCOS was ascertained at baseline (ages 20 to 32) by U.S. National Institutes of Health (NIH) criteria, incorporating androgens and symptoms of oligomenorrhea and hirsutism. The Center for Epidemiologic Studies-Depression (CES-D) scale was repeated prospectively in 5-year intervals over 25 years. Mixed-effects models evaluated the association between depression scores and PCOS after adjustment for confounders and characterized the trajectory of scores. The impact of race was explored. Eighty-three of 1127 (7.4%) participants met NIH PCOS criteria. Of these, 33 (40%) were black and 50 (60%) were white. CES-D scores were higher among women with PCOS [coefficient (coef) 2.51; 95% CI 1.49, 3.54; P < 0.01] across the lifespan. Scores decreased across the lifespan in women with and without PCOS (coef -0.1 point per year; P < 0.001). Black women experienced higher depression burden than white women (coef 1.80; 95% CI 1.20, 2.41; P < 0.001); however, an interaction was not detected between PCOS and race (P = 0.68). Women with PCOS-NIH from a population-based cohort are at risk for higher depression scores across the lifespan. Depression scores decline over time in women with PCOS in a trajectory similar to that in women without PCOS. Racial differences in depression risk should be acknowledged clinically and further explored.

An examination of grit in black men who have sex with men and associations with health and social outcomes.

This study sought to examine the prevalence and correlates of grit in a sample of Black men who have sex with men (BMSM) in Baltimore, Maryland. A trained research assistant administered the Short-Grit and Center for Epidemiological Studies Depression (CES-D) scales and surveyed participants of a community-based behavioral health intervention for demographic, health, and sexual behaviors. Of 239 participants, two-thirds scored in the high grit category. A greater proportion of men with high grit demonstrated higher educational attainment, were employed in the prior 6 months, reported very good/excellent health, were human immunodeficiency virus-positive, scored < 16 on the CES-D, and had more friends who were gay. After controlling for other variables, high grit was associated with higher odds of having more friends who are gay and lower odds of alcohol use, unemployment, and a high CES-D score. These findings demonstrate that grit could be an important mechanism upon which to focus health and behavioral interventions for BMSM.

What Factors Are Associated With Outcomes Scores After Surgical Treatment Of Ankle Fractures With a Posterior Malleolar Fragment?

Psychosocial factors, such as depression and catastrophic thinking, might account for more disability after various orthopaedic trauma pathologies than range of motion and other impairments. However, little is known about the influence of psychosocial aspects of illness on long-term symptoms and limitations of patients with rotational-type ankle fractures, including a posterior malleolar fragment. Knowledge of the psychosocial factors associated with long-term outcome after operative treatment of trimalleolar ankle fractures might improve recovery. (1) Which factors related to patient demographics, physical exam, diagnosis, or psychological well-being (in particular, depression), if any, are associated with better or worse scores on validated lower-extremity outcomes instruments after surgical treatment for rotational ankle fractures (including a posterior malleolar fragment) at long-term followup? Between 1974 and 2002, 423 patients underwent open reduction internal fixation for rotational ankle fractures with posterior malleolar fragments according to the basic principles of the AO (Arbeitsgemeinshaft für Osteosynthesfragen). Minimum followup for inclusion here was 10 years (range, 12.5-39.4 years). When posterior malleolar fragments involved more than 25% of the articular surface as assessed on plain lateral radiographs, the fracture was generally fixed with AP or posterior-anterior (PA) screws. Of those treated surgically during the period in question, 319 were lost to followup, had too much missing data to include, or declined to participate in this study (or could not because of reasons of mental illness) (68%), leaving 104 (32%) for analysis in this retrospective study. Independent observers not involved in patient care measured disability using the patient-based Foot and Ankle Ability Measure questionnaire and using the subscale Activities in Daily Living (ADL) and pain score of the Foot and Ankle Outcome Score. General physical and mental health status was evaluated using the SF-36. Depressive symptoms were measured with the Center for Epidemiologic Studies-Depression scale score (range, 0-60 points). A score above 16 indicated a depressive disorder. Misinterpretation or overinterpretation of nociception was measured with the Pain Catastrophizing Scale score. Scores above 13.9 were considered abnormal. Statistical analyses included uni- and multivariate regression analysis. In general, patients in this series reported good to excellent outcomes; the mean ± SD scores were 91 ± 15 for Foot and Ankle Ability Measure, 93 ± 16 for Foot and Ankle Outcome Score (ADL), 91 ± 15 for Foot and Ankle Outcome Score (pain), 49 ± 9 for SF-36 mental component score, and 52 ± 9 for SF-36 physical component score. Implant removal (β = -8.199, p < 0.01) was associated with worse Foot and Ankle Ability Measure scores. Better flexion/extension arc (β = 0.445, p < 0.01) and lower Center for Epidemiologic Studies-Depression scores (β = -0.527, p < 0.01) were associated with better Foot and Ankle Ability Measure scores. Osteoarthritis (β = -4.823, p < 0.01) was associated with worse Foot and Ankle Outcome Score (pain) scores. Better flexion/extension arc (β = 0.454, p < 0.01) and lower Center for Epidemiologic Studies-Depression scores (β = -0.596, p < 0.01) were associated with better Foot and Ankle Outcome Score (pain) scores. Better flexion/extension arc (β = -0.431, p < 0.01) and lower Center for Epidemiologic Studies-Depression scores (β = -0.557, p < 0.01) were associated with better Foot and Ankle Outcome Score (ADL) scores. Finally, we found that a better inversion/eversion arc (β = 0.122, p = 0.024) was associated with better SF-36 physical component score and that a lower Center for Epidemiologic Studies-Depression score (β = -0.567, p < 0.01) was associated with better SF-36 mental component score. Psychological aspects of recovery from musculoskeletal injury merit greater attention, perhaps even over objective, unmodifiable predictors. A mean of 24 years after surgical treatment of ankle fractures with a posterior malleolar fragment, patient-reported outcome measures have little to do with pathophysiology; they mostly reflect impairment and depression symptoms. Further research is needed to determine whether early indentification and treatment of at-risk patients based on psychosocial factors can improve long-term outcomes. Level III, therapeutic study.

Demographic and lifestyle correlates of brain-derived neurotrophic factor in a working population: The Furukawa Nutrition and Health Study

This study aimed to examine the cross-sectional association of demographic and lifestyle factors with serum brain-derived neurotrophic factor (BDNF) concentrations in a Japanese working population. Participants were 1678 men and 172 women aged 19–69 years who received health check-ups and participated in a nutrition and health survey. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Dietary intake was assessed using a validated self-administered diet history questionnaire. Serum BDNF concentrations were measured using a solid phase sandwich enzyme-linked immunosorbent assay. Multiple linear regression analysis was used to estimate the mean and 95% confidence interval of serum BDNF concentrations according to demographic and lifestyle factors. Higher body mass index (BMI) was significantly associated with higher circulating BDNF concentrations. Current smokers had significantly higher mean BDNF concentrations than never-smokers. BDNF concentrations were not associated with folate and 25-hydroxyvitamin D concentrations in serum, or dietary eicosapentaenoic acid and docosahexaenoic acid intake. Serum BDNF concentrations were not associated with depressive symptoms or CES-D score per se. In this study, higher BMI and smoking were associated with higher concentrations of serum BDNF, while nutrients that have been linked to depression were not associated with BDNF concentrations among Japanese workers.

Electronic cigarette use is associated with depressive symptoms among smokers and former smokers: Cross-sectional and longitudinal findings from the Constances cohort

AimsTo examine the cross-sectional and longitudinal associations between depressive symptoms and electronic cigarette (e-cig) use in a large population-based sample while taking into account smoking status and sociodemographic confounders. MethodsParticipants from the French Constances cohort were included from February 2012 to December 2016. Smoking status, e-cig use (never/ever/current) and nicotine concentration were self-reported. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression (CES-D) scale. Logistic regressions were used to provide odds ratios (ORs) and 95% confidence intervals (95%CI) of e-cig use according to depressive symptoms, adjusting for age, sex and education. ResultsIn cross-sectional analyses (n = 35,337), depressive symptoms (i.e. a CES-D score ≥ 19) were associated with both ever (OR [95%CI]: 1.67 [1.53–1.82]) and current (1.73 [1.53–1.96]) e-cig use with a dose-dependent relationship (p-trend<0.001). In longitudinal analyses (n = 30,818), depressive symptoms at baseline were associated with current e-cig use at follow-up (2.02 [1.72–2.37]) with a similar dose-dependent relationship. These associations were mainly significant among smokers or former smokers at baseline. Furthermore, among smokers at baseline, depressive symptoms were associated with dual consumption at follow-up (1.58 [1.41–1.77]), whereas among former smokers, they were associated with either smoking only (1.52 [1.34–1.73]) or e-cig use only (2.02 [1.64–2.49]), but not with dual consumption (1.11 [0.73–1.68]) at follow-up. Finally, depressive symptoms were positively associated with nicotine concentration among e-cig users at baseline. ConclusionsDepressive symptoms were positively associated with e-cig use in both cross-sectional and longitudinal analyses with a dose-dependent relationship. In addition, nicotine concentration and depressive symptoms were positively associated.

1547P - Evaluation of the distinction and temporal relationship between prolonged grief disorder and depression in terminally ill cancer patients’ caregivers’ first two years of bereavement

Background: Prolonged grief disorder (PGD) and depression are common emotional disorders influencing bereaved caregivers’ quality of life (QOL). However, the conceptual distinctiveness and temporal relationship of PGD and depression have been partially and not established, respectively. To fill these knowledge gaps, we conducted this longitudinal study. Methods: Our convenience sample included 291 caregivers of terminally ill cancer patients. Caregivers’ PGD, depression, and psychological QOL were measured 6, 13, 18, and 24 months postloss using the Prolonged Grief-13 scale (PG-13), Center for Epidemiologic Studies-Depression (CESD) scale, and Short Form-36 Health Survey mental health summary, respectively. We examined the associations of PGD and depression with psychological QOL by an incremental validity test, thereby clarifying their conceptual distinctiveness. The temporal relationship between PGD and depression was examined by longitudinal, lower-level mediation analysis with a lagged approach. Results: After the variance in psychological QOL was significantly explained by CESD scores (pseudo R2=44.19%, p<.001), PGD significantly, incrementally increased the explained variance in psychological QOL (pseudo R2=.21%, p<.001), confirming the distinction between PGD and depression. Lower-level mediation analysis showed that CESD scores (depressive symptoms) mediated 90% of the relationship between time and PG-13 scores, whereas PG-13 scores only mediated 76% of the relationship between time and CESD scores. This result indicates that CESD scores assessed at a previous time mediated caregivers’ current PGD during bereavement rather than vice versa. Conclusions: PGD and depression are conceptually distinct disorders, and depression precedes development of PGD. Clinicians must distinguish between the two disorders and appropriately manage bereaved caregivers’ depressive symptoms. Alleviating caregivers’ depressive symptoms will prevent development of PGD, thus improving QOL. Clinical trial identification: (NHRI-EX107-10704PI) and Ministry of Science and Technology (MOST 104-2314-B-182-027-MY3), National Science Council (NSC 96-2314-B-182-029-MY2), and Chang Gung Memorial Hospital (BMRP888). Legal entity responsible for the study: Chang Gung University. Funding: Ministry of Science and Technology, National Science Council, and Chang Gung Memorial Hospital. Disclosure: All authors have declared no conflicts of interest.

Interpersonal Relationships Among Black Couples and Depressive Symptoms During Pregnancy.

The purpose of this study was to examine associations of the mother-father relationship and social support with depressive symptoms during pregnancy among Black mothers and fathers. Fifty Black mother-father dyads from the Midwest completed a packet of questionnaires that included conflict with partner, social support, depressive symptoms, and sociodemographic characteristics. Twenty-four percent of mothers and 16% of fathers had Center for Epidemiological Studies-Depression scores ≥23, which have been correlated with a major depression diagnosis. There were no differences in depressive symptoms between mothers and fathers. Fathers reporting high depressive symptoms were not more likely to be partnered with mothers reporting high depressive symptoms. Controlling for age, higher levels of conflict with partner, and lower levels of social support predicted higher levels of depressive symptoms for both mothers and fathers. Black expectant mothers and fathers may be at risk for clinical depression. Fathers experienced comparable levels of depressive symptoms with mothers, indicating the need to consider fathers' psychological adjustment during pregnancy. Higher levels of conflict with partner and lower levels of social support predicted higher levels of depressive symptoms for both parents. Maternal-child nurses should assess for mothers' as well as fathers' experiences of depressive symptoms and the mother-father relationship when providing prenatal care.

Pain severity as a mediator of the association between depressive symptoms and physical performance in knee osteoarthritis

Depressive symptoms in knee osteoarthritis (OA) are associated with increased pain severity and declines in physical performance. This study examined whether pain severity mediates the association between depressive symptoms and physical performance in persons with radiographic knee OA. Three years of annual data from participants (n=1,463) with radiographic knee OA in the Osteoarthritis Initiative (OAI) were analyzed. Depressive symptoms were measured using the Center for Epidemiological Studies Depression (CES-D) scale. Pain severity was evaluated with the Western Ontario and McMaster Universities Arthritis Index. Physical performance was assessed via standardized gait speed. Marginal structural models were used to assess the direct (unmediated) effects of depressive symptoms on physical performance and indirect (mediated) effects through pain severity. Direct and indirect effects for a difference in CES-D score of 0-1 were-0.0051 (95% confidence intervals (CI):-0.0053,-0.0049) and-0.0016 (95% CI:-0.0024,-0.0007) standard deviations in gait speed, respectively. Higher depressive symptom severity exhibited diminishing, incremental, direct and indirect effects and for a difference in CES-D score of 15-16 were-0.0045 (95% CI:-0.0047,-0.0042) and-0.0009 (95% CI:-0.0014,-0.0004) standard deviations in gait speed, respectively. Therefore, the magnitude of the mediated, indirect effect, was never larger than 24%. Pain severity mediated approximately one-fifth of the association between depressive symptoms and physical performance in persons with radiographic knee OA, and the diminishing incremental effects may explain why unimodal treatment strategies with a single disease target are often ineffective in depressed OA patients.

Associations of self-reported physical activity and depression in 10,000 Irish adults across harmonised datasets: a DEDIPAC-study

BackgroundDepression is a prevalent, debilitating, and often recurrent mood disorder for which successful first-line treatments remains limited. The purpose of this study was to investigate the cross-sectional associations between self-reported physical activity (PA) and depressive symptoms and status among Irish adults, using two existing datasets, The Irish Longitudinal Study on Ageing (TILDA) and The Mitchelstown Cohort Study.MethodsThe two selected databases were pooled (n = 10,122), and relevant variables were harmonized. PA was measured using the short form International Physical Activity Questionnaire. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression (CES-D) questionnaire. Participants were classified as meeting World Health Organization moderate-to-vigorous PA (MVPA) guidelines or not, and divided into tertiles based on weekly minutes of MVPA. A CES-D score of ≥16 indicated elevated depressive symptoms. Data collection were conducted in 2010–2011.ResultsSignificantly higher depressive symptoms were reported by females (7.11 ± 7.87) than males (5.74 ± 6.86; p < 0.001). Following adjustment for age, sex, BMI, and dataset, meeting the PA guidelines was associated with 44.7% (95%CI: 35.0 to 52.9; p < 0.001) lower odds of elevated depressive symptoms. Compared to the low PA tertile, the middle and high PA tertiles were associated with 25.2% (95%CI: 8.7 to 38.6; p < 0.01) and 50.8% (95%CI: 40.7 to 59.2; p < 0.001) lower odds of elevated depressive symptoms, respectively.ConclusionMeeting the PA guidelines is associated with lower odds of elevated depressive symptoms, and increased volumes of MVPA are associated with lower odds of elevated depressive symptoms.

Depressive Symptoms and Glycemic Control among Puerto Rican Adults with Diabetes

A bidirectional relationship between depression and diabetes risk has been suggested. Less is known about the dynamics between depressive symptomatology and glycemic control among individuals already at risk of both conditions. We aimed to examine the prospective bidirectional associations between depressive symptomatology and glycemic control. We used data from 488 participants of the Boston Puerto Rican Health Study (mean (SD) age= 58.9 (7.2) y) with type 2 diabetes (fasting plasma glucose ≥ 126 mg/dL or use of medication). At baseline, participants were categorized as having uncontrolled hemoglobin A1c (≥7%) vs. controlled, and as having depressive symptomatology (Center for Epidemiological Studies-Depression (CES-D) score ≥16) vs. not. Categories for 2-year changes in glycemic control were set as (&amp;gt;-0.5%=improved; -0.5% to 0.5%=stable; ≥0.5%=worsened); 2-year changes in CES-D score as (&amp;gt;-3=improved; -3 to 3=stable; ≥3=worsened). In logistic regressions adjusted for sociodemographic and lifestyle variables and number of medical conditions, having baseline depressive symptomatology was associated with 1.96 (95% CI: (1.10, 3.50; p=0.022) higher odds of having worsened hemoglobin A1c at 2-year compared to keeping it stable. Baseline uncontrolled hemoglobin A1c was not associated with change in depression score. When modeling 2-year change categories as predictors, improved depression score (vs. stable) was associated with lower odds (0.42 (0.21, 0.81); p=0.01) of worsened hemoglobin A1c, while worsened glycemic control (vs. stable) was associated with lower odds (0.40 (0.21, 0.78); p=0.007) of improved depression score. In conclusion, a bidirectional association between changes in depressive symptomatology and glycemic control over 2 years among individuals with diabetes suggests that timely attention to both conditions should be given simultaneously. Interconnected diabetes and depression management practices should be recommended for adults with diabetes. Disclosure J. Mattei: None. L.M. Falcon: None. K.L. Tucker: None.

The Effect of Paid Leave on Maternal Mental Health.

Objectives I examined the relationship between paid maternity leave and maternal mental health among women returning to work within 12 weeks of childbirth, after 12 weeks, and those returning specifically to full-time work within 12 weeks of giving birth. Methods I used data from 3850 women who worked full-time before childbirth from the Early Childhood Longitudinal Study-Birth Cohort. I utilized propensity score matching techniques to address selection bias. Mental health was measured using the Center for Epidemiologic Studies Depression (CESD) scale, with high scores indicating greater depressive symptoms. Results Returning to work after giving birth provided psychological benefits to women who used to work full-time before childbirth. The average CESD score of women who returned to work was 0.15 standard deviation (p < 0.01) lower than the average CESD score of all women who worked full-time before giving birth. Shorter leave, on the other hand, was associated with adverse effects on mental health. The average CESD score of women who returned within 12 weeks of giving birth was 0.13 standard deviation higher (p < 0.05) than the average CESD score of all women who rejoined labor market within 9 months of giving birth. However, receipt of paid leave was associated with an improved mental health outcome. Among all women who returned to work within 12 weeks of childbirth, those women who received some paid leave had a 0.17 standard deviation (p < 0.05) lower CESD score than the average CESD score. The result was stronger for women who returned to full-time work within 12 weeks of giving birth, with a 0.32 standard deviation (p < 0.01) lower CESD score than the average CESD score. Conclusions The study revealed that the negative psychological effect of early return to work after giving birth was alleviated when women received paid leave.

Posttraumatic stress and depressive symptoms characterize cardiac arrest survivors' perceived recovery at hospital discharge.

To test the hypothesis that posttraumatic stress and depressive symptoms, not cognitive or functional impairment, are associated with cardiac arrest survivors' negative recovery perceptions at hospital discharge. Prospective observational cohort of cardiac arrest patients admitted between 9/2015-5/2017. Survival to discharge with sufficient mental status to complete a psychosocial interview was the main inclusion criterion. Perceived recovery was assessed through the question, "Do you feel that you have made a complete recovery from your arrest?" The following measures were examined as potential correlates of perceived recovery: Repeatable Battery for Assessment of Neuropsychological Status, Modified Lawton Physical Self-Maintenance Scale, Barthel Index, Modified Rankin Scale, Cerebral Performance Category, Center for Epidemiological Studies-Depression (CES-D), and PTSD Checklist-Specific (PCL-S). Logistic regression evaluated associations between perceived recovery and potential correlates of recovery. 64/354 patients (58% men, 48% white, mean age 52 ± 17) were included. 67% (n = 43) had a negative recovery perception. There were no differences among patients' cognitive and functional domains. In individual models, patients with higher PCL-S and CES-D scores were more likely to have a negative recovery perception after adjusting for age and gender (OR: 1.2, 95% CI [1.1, 1.4], p = 0.003) and (OR: 1.1, 95% CI [1.0, 1.1], p = 0.05). Within one month after a cardiac arrest event, survivors' negative recovery perceptions are associated with psychological distress.

Cumulative Burden of Depression and All-Cause Mortality in Women Living With Human Immunodeficiency Virus.

Research linking depression to mortality among people living with human immunodeficiency virus (PLWH) has largely focused on binary "always vs never" characterizations of depression. However, depression is chronic and is likely to have cumulative effects on mortality over time. Quantifying depression as a cumulative exposure may provide a better indication of the clinical benefit of enhanced depression treatment protocols delivered in HIV care settings. Women living with HIV (WLWH), naive to antiretroviral therapy, from the Women's Interagency HIV Study were followed from their first visit in or after 1998 for up to 10 semiannual visits (5 years). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. An area-under-the-curve approach was used to translate CES-D scores into a time-updated measure of cumulative days with depression (CDWD). We estimated the effect of CDWD on all-cause mortality using marginal structural Cox proportional hazards models. Overall, 818 women contributed 3292 woman-years over a median of 4.8 years of follow-up, during which the median (interquartile range) CDWD was 366 (97-853). Ninety-four women died during follow-up (2.9 deaths/100 woman-years). A dose-response relationship was observed between CDWD and mortality. Each additional 365 days spent with depression increased mortality risk by 72% (hazard ratio, 1.72; 95% confidence interval, 1.34-2.20). In this sample of WLWH, increased CDWD elevated mortality rates in a dose-response fashion. More frequent monitoring and enhanced depression treatment protocols designed to reduce CDWD may interrupt the accumulation of mortality risk among WLWH.

Factor structure and psychometric properties of the Pittsburgh Sleep Quality Index in community-based adolescents.

The Pittsburgh Sleep Quality Index (PSQI) is a widely used self-report questionnaire that assesses general sleep quality. This study aimed to validate the single-factor scoring structure and related psychometric properties in the English language version of the PSQI in community-based adolescents. Participants were 889 (352 males, 39.6%) students (age M = 15.71 ± 1.57; 12.08-18.92 years) recruited from 14 Australian secondary schools. Participants completed the PSQI, Center for Epidemiological Studies-Depression (CES-D) scale, and Spence Children's Anxiety Scale (SCAS). Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) of PSQI component scores were performed on two independent random half-samples (i.e. cross-validation approach). The internal consistency of PSQI components and convergent validity of the PSQI global score with CES-D and SCAS total scores were also assessed. EFA yielded a single-factor model. CFA of the single-factor model in a separate sample yielded acceptable model fit to the data after important relationships were modeled. Namely, modification indices suggested improved model fit by correlating residual scores of PSQI components of sleep duration and sleep efficiency, and sleep efficiency and sleep latency. Internal consistency was acceptable (Cronbach's α = 0.73). The PSQI global score had moderate-to-large positive correlations with CES-D (r = 0.58) and SCAS (r = 0.45) total scores, demonstrating good convergent validity with emotional problems as predicted. The findings validate the single-factor scoring structure of the PSQI in an adolescent sample and highlight important covariation between poor sleep duration, efficiency, and latency in this age group. Further validation studies are required to determine an appropriate PSQI clinical cut-off score for adolescents.

Correlates of anxiety and depression in chronic lymphocytic leukemia (CLL) survivors.

153 Background: CLL is an indolent lymphoma effecting aging populations. Early stage patients are assigned to active surveillance and only 10% of patients require treatment at diagnosis. Active surveillance for CLL may increase susceptibility to anxiety and depression, resulting in enhanced comorbidities and reduced quality of life. However, little is known about the prevalence and risk factors of anxiety and depression in CLL. Methods: 125 CLL patients that were treatment naïve (n = 86) or previously chemotherapy-treated (n = 39) completed anxiety and depression questionnaires (State Trait Anxiety Index (STAI) and Center for Epidemiologic Studies Depression (CES-D)). Multivariable linear regression was used to examine associations with STAI/CES-D score. Logistic regression was used to examine clinically meaningful anxiety and depression, using validated cut points of 40 for the STAI and 16 (or on antidepressants) for the CES-D. All models included treatment status (treatment naïve vs. treated), age, gender, ECOG grade, time since diagnosis, education, &amp; disease stage. Results: Patients had a median age of 65, were mostly male (60.8%), Caucasian (96%), well educated (55% ≥ college), and had low stage CLL (66% stage 0) and good performance status (67% ECOG 0). 20 and 24% of patients had clinically meaningful anxiety or depression (11% had both). Treatment and time since diagnosis were not associated with anxiety or depression. Older age was associated with better STAI and CES-D scores (STAI β = -0.34 (95%CI -0.52, -0.17) CES-D β = -0.27 (95%CI -0.42, -0.12)), and each 1 year increase in age was associated with a 9% decrease in odds of anxiety and a 7% decrease in odds of depression (OR 0.91(95%CI 0.86, 0.96) OR 0.93 (95%CI 0.88, 0.98) respectively). An ECOG grade of 3 or 4 was a significant predictor of increased depression risk (OR 2.84 (95%CI 1.03, 7.82)) and worse CES-D scores (β = 4.69 (95%CI 8.09, 1.29)) but not of anxiety. Conclusions: Anxiety and depression are common among CLL patients. Poor performance status was associated with more depression while older age was associated with less anxiety and depression. Future studies should investigate potential interventions for anxiety and depression in younger CLL patients.

Subclinical Hypothyroidism and Incident Depression in Young and Middle-Age Adults.

The role of subclinical hypothyroidism in the development of depression remains controversial. We examined the prospective association between subclinical hypothyroidism and incident depressive symptoms. We conducted a prospective cohort study of 220,545 middle-age adults without depression who had undergone at least two comprehensive health examinations between 1 January 2011 and 31 December 2014. Thyroid-stimulating hormone, free triiodothyronine (FT3), and free thyroxine (FT4) levels were measured using an electrochemiluminescent immunoassay. The study outcome was incident depressive symptoms, defined as a Center for Epidemiologic Studies-Depression score >16. During a median follow-up period of 2 years, incident depressive symptoms occurred in 7323 participants. The multivariable-adjusted hazard ratio for incident depressive symptoms comparing subclinical hypothyroid and euthyroid participants was 0.97 (95% confidence interval, 0.87 to 1.09). Similarly, among euthyroid participants (n = 87,822), no apparent association was found between thyroid hormone levels and an increased risk of incident depressive symptoms. No apparent association was found between subclinical hypothyroidism and incident depressive symptoms in a large prospective cohort of middle-age men and women.

Prolonged grief disorder and depression are distinct for caregivers across their first bereavement year.

Prolonged grief disorder (PGD) and depression are recognized as distinct emotional-distress disorders for bereaved family caregivers. However, this distinction has been mostly validated in cross-sectional studies, neglecting the dynamic characteristics of bereaved caregivers' emotional distress. To validate the distinction between symptoms of PGD and depression across the first bereavement year for family caregivers of terminally ill cancer patients. In this descriptive, longitudinal study of 394 bereaved Taiwanese family caregivers, we measured symptoms of PGD and depression by the Prolonged Grief-13 and Center for Epidemiologic Studies Depression (CES-D) scales at 6 and 13months postloss, respectively. Agreement between cases of PGD and severe depressive symptoms (CES-D score≥16) was analyzed by Cohen's kappa. Structural distinctiveness was longitudinally examined using confirmatory bifactor modeling. Agreement was poor between cases of PGD and severe depressive symptoms at 6 and 13months postloss (kappa=.16 [confidence interval=.09, .22] and .12 [confidence interval=.03, .19], respectively). Symptoms of PGD and depression shared a general factor, but were distinct as shown by their significant specific factor loadings at 6 and 13months postloss. Confirmatory bifactor models showed structural invariance (confirmatory fit index difference<.01 and χ2 difference P>.05) between 6 and 13months postloss. Symptoms of PGD and depression were confirmed as distinct across the first year of bereavement. Health care professionals should recognize early in bereavement that symptoms of PGD and depression are distinct, identify high-risk groups, and provide care tailored to caregivers' unique needs to facilitate recovery from bereavement-related emotional-distress disorders.