Center For Epidemiologic Studies Depression Research Articles

The next generation of collaborative care: The design of a novel web-based stepped collaborative care intervention delivered via telemedicine for people diagnosed with cancer

BackgroundThe NIH consensus statement on cancer-related symptoms concluded the most common and debilitating were depression, pain and fatigue [1–6]. Although the comorbidity of these symptoms is well known and may have similar underlying biological mechanisms no intervention has been developed to reduce these symptoms concurrently. The novel web-based stepped collaborative care intervention delivered by telemedicine is the first to be tested in people diagnosed with cancer. MethodsWe plan to test a web-based stepped collaborative care intervention with 450 cancer patients and 200 caregivers in the context of a randomized controlled trial. The primary endpoint is quality of life with other primary outcomes including patient-reported depression, pain, fatigue. Secondary outcomes include patient serum levels of pro-inflammatory cytokines and disease progression. We also will assess informal caregiver stress, depression, and metabolic abnormalities to determine if improvements in patients' symptoms also relate to improvement in caregiver outcomes. ResultsThe trial is ongoing and a total of 382 patients have been randomized. Preliminary analyses of the screening tools used for study entry suggest that Center for Epidemiological Studies-Depression (CESD) scale has good sensitivity and specificity (0.81 and 0.813) whereas the scale used to assess pain (0.47 and 0.91) and fatigue (0.11 and 0.91) had poor sensitivity but excellent specificity. Using the AUROC, the best cut point for the CES-D was 19, for pain was 4.5; and for fatigue was 2.5. Outcomes not originally proposed included health care utilization and healthcare charges. The first 100 patients who have been followed a year post-treatment, and who were less than 75 years and randomized to the web-based stepped collaborative care intervention, had lower rates of complications after surgery [χ2 = 5.45, p = 0.02]. For patients who survived 6 months or less and were randomized to the web-based stepped collaborative care intervention, had lower rates of 90-day readmissions when compared to patients randomized to the screening and referral arm [χ2 = 4.0, p = 0.046]. Patients randomized to the collaborative care intervention arm had lower overall health care activity-based costs of $16,758 per patient per year when compared to the screening and referral arm. DiscussionThis novel web-based stepped stepped collaborative care intervention, delivered via telemedicine, is expected to provide a new strategy to improve the quality of life in those diagnosed with cancer and their caregivers. Trial registrationClinicalTrials.govNCT02939755

224 The association between perinatal depressive symptoms and child neurodevelopment

Prior studies suggest that maternal depression adversely impacts child development. Our objective is to determine the association between perinatal depressive symptoms and child neurodevelopment. Secondary analysis of a RCT of thyroxine therapy for low risk pregnant women with subclinical hypothyroidism. Patients without a clinical diagnosis of depression were assessed for depressive symptoms using the Center for Epidemiological Studies-Depression (CESD) scale at 11-20 and 34-38 weeks, and 1-year postpartum. The CESD was not scored until completion of the trial. A CESD score ≥16 is considered screen positive for depression. In the primary trial, thyroxine therapy did not improve child cognitive outcomes or maternal depressive symptoms, thus all patients with available CESD scores were included in this analysis. Our primary outcome was child IQ score <85 at 5 years of age using the WPPSI-III Full Scale test. Associations between a positive depression screen and neurodevelopmental outcomes were determined with multivariable logistic regressions. 209 maternal/child dyads were analyzed. 24% of patients screened positive for depression at baseline and 15% at 1-year postpartum. Compared to patients with a CESD <16, those who screened positive had a higher BMI, were more likely to smoke, and less likely to have higher education. Children born to patients with a positive depression screen, either antenatally or at 1-year postpartum, had a higher rate of IQ <85 at 5 years of age (35% vs. 18 % and 47% vs. 21%) compared with children born to patients with a CES-D <16. Additionally, they had higher rates of other adverse neurodevelopmental outcomes. However, these associations did not persist on multivariable analysis (Tables). Findings were similar for patients with a positive antepartum screen that persisted to 1 year postpartum. In this cohort of pregnant women with subclinical hypothyroidism, having a positive perinatal depression screen was not associated with child neurodevelopmental outcomes after controlling for covariates including social determinants of health.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Increased Serum Cystatin C Levels Were Associated with Depressive Symptoms in Patients with Type 2 Diabetes.

BackgroundExisting studies have reported that patients with diabetes mellitus (DM) have an increased risk of depressive symptoms. We aimed to evaluate the association between serum cystatin C levels and depressive symptoms in DM patients.MethodsSerum levels of cystatin C were measured in 254 patients with DM at baseline. Cox proportional hazard analysis was used to evaluate the value of serum cystatin C in predicting depressive symptoms in patients with DM.ResultsMultivariate linear regression analysis showed that serum cystatin C levels were independently associated with Centre for Epidemiological Studies Depression (CES-D) scores after adjusting for age, sex, body mass index (BMI), current smoking status, current drinking, admission systolic and diastolic blood pressure (BP), cardiovascular disease (CVD) history and laboratory measurements in patients with DM at baseline (Sβ= −0.127; 95% CI, - 0.185– - 0.083; P=0.002). The multivariate Cox proportional hazard analysis revealed that serum cystatin C (HR=2.360, 95% CI 1.500–3.891, P-trend <0.001) was an independent prognostic factor for cognitive decline in these patients with DM during the follow-up period.ConclusionOur results showed that increased serum cystatin C levels were significantly and independently associated with depressive symptoms and had independent predictive value for depressive symptoms in patients with DM. Serum cystatin C might enable early recognition of depressive symptoms among DM patients.

Effects of hearing impairment and hearing aid use on the incidence of cognitive impairment among community-dwelling older adults: evidence from the Taiwan Longitudinal Study on Aging (TLSA)

BackgroundPrevious studies have reported associations between hearing impairment (HI) and cognitive impairment, but the evidence is not conclusive while considering concurrent geriatric syndromes. Especially, evidence from previous studies rarely came from Asian studies. This study aimed to evaluate the independent effects of HI and hearing aid use on the incidence of cognitive impairment while considering most geriatric confounders.MethodsThis population-based, propensity-score matched cohort study used cohort from Waves IV–VII (1999–2011) survey of the Taiwan Longitudinal Study on Aging (TLSA). Cognitive impairment was identified based on Short Portable Mental Status Questionnaire (SPMSQ) scores. The hazard ratio (HR) was calculated using the Cox proportional hazard regression adjusting for age, sex, comorbidities, socioeconomic status, Center for Epidemiologic Studies Depression (CES-D) scores, the instrumental activities of daily living scale, mobility condition and quality of life. In addition, social support and participation were also considered as confounders in the analysis. To assess the robustness of our findings, we conducted a sensitivity analysis designed to access unmeasured confounding factors by calculating E-values.ResultsAfter 1:1 propensity-score matching, we included 709 participants in both the HI and non-HI groups with a mean age of 73.4 years and 39.4% of participants were female. The mean follow-up was 8.9 ± 3.9 years. The HI group had a higher incidence of cognitive impairment than the non-HI group (74.5% vs. 69.1%, respectively), with an adjusted HR of 1.16 (95% confidence interval [CI], 1.03–1.32) based on a 12-year follow up. The E-value was 1.45 for the estimate, which provided evidence for this study’s robustness. Although, a subgroup analysis showed that hearing aid use was associated with lower incidences of cognitive impairment (66.3% vs. 75.6%) when compared to non-users in the HI group, the adjusted HR of 0.82 (95% CI, 0.61–1.09) revealed no significant differences.ConclusionsHI was an independent risk factor of incident cognitive impairment on top of concurrent geriatric syndromes. Early HI detection may thus be effective for preventing cognitive decline. Further studies are needed to evaluate the effect of hearing aid use on the prevention of cognitive decline.

Depressive symptoms and allostatic load have a bidirectional association among Puerto Rican older adults.

Depression is strongly associated with chronic disease; yet, the direction of this relationship is poorly understood. Allostatic load (AL) provides a framework for elucidating depression-disease pathways. We aimed to investigate bidirectional, longitudinal associations of baseline depressive symptoms or AL with 5-year AL or depressive symptoms, respectively. Data were from baseline, 2-year, and 5-year visits of 620 adults (45-75 years) enrolled in the Boston Puerto Rican Health Study. The Center for Epidemiology Studies Depression (CES-D) scale (0-60) captured depressive symptoms, which were categorized at baseline as low (<8), subthreshold (8-15), or depression-likely (⩾16) symptoms. AL was calculated from 11 parameters of biological functioning, representing five physiological systems. Baseline AL scores were categorized by the number of dysregulated parameters: low (0-2), moderate (3-5), or high (⩾6) AL. Multivariable, multilevel random intercept and slope linear regression models were used to examine associations between 3-category baseline CES-D score and 5-year continuous AL score, and between baseline 3-category AL and 5-year continuous CES-D score. Baseline subthreshold depressive symptoms [(mean (95% CI)): 4.8 (4.5-5.2)], but not depression-likely symptoms [4.5 (4.2-4.9)], was significantly associated with higher 5-year AL scores, compared to low depressive symptoms [4.3 (3.9-4.7)]. Baseline high AL [19.4 (17.6-21.2)], but not low AL [18.5 (16.5-20.6)], was significantly associated with higher 5-year CES-D score, compared to baseline moderate AL [16.9 (15.3-18.5)]. Depressive symptoms and AL had a bi-directional relationship over time, indicating a nuanced pathway linking depression with chronic diseases among a minority population.

Depressive symptoms among young adults in the Philippines: Results from a nationwide cross-sectional survey

This study aims to estimate the proportion of young adults in the Philippines who experience moderate to severe depressive symptoms, identify the most frequently reported depressive symptoms, and, examine factors associated with depressive symptoms. Data were from a 2013 nationwide probability survey of 19,017 respondents, age 15–24. Depressive symptoms were assessed using a 12-item version of the Center for Epidemiological Studies Depression (CES-D) scale. The distribution of depressive symptoms was examined using descriptive statistics and the adjusted and unadjusted association between sociodemographic factors, suicidal ideation, and moderate to severe depressive symptoms were estimated using log-binomial regression. Up to 8.9% (95% CI=8.3–9.6) of young Filipino adults experience moderate to severe depressive symptoms and the prevalence is higher in females (10.2%) than males (7.6%). The symptom most often experienced in the general population was “not enjoying life”, while “loneliness” was the most frequently reported symptom in those with moderate to severe depressive symptoms. The prevalence of moderate to severe depressive symptoms was higher in those with less education, persons who were separated/widowed/divorced, and residents in urban areas. Those with moderate to severe depressive symptoms are about twice more likely to experience suicidal ideation. The version of CES-D included in the survey has not been validated for use among young Filipino adults. Close to 1 in 10 young adults (8.9%) in the Philippines experience moderate to severe depressive symptoms. Policies and mental health resources are needed to support young adults who are experiencing moderate to severe depressive symptoms.

Association of chronotype as assessed by the midpoint of sleep with the dietary intake and health-related quality of life for elderly Japanese women.

The relationship of chronotype differences with dietary habits and health-related outcomes among elderly people is not fully understood, although sex and generation differences are observed in human chronotype. Accordingly, we analysed the association of chronotype (as assessed by the midpoint of sleep) with dietary intake and health-related quality of life (HRQoL) in elderly Japanese women. The subjects in this cross-sectional study were 1618 women aged 65 years and older who were grandmothers or acquaintances of dietetics students. The subjects were classified into quintiles with respect to the midpoint of sleep, from the earliest to the latest quintile. HRQoL was assessed by the Japanese version of the short-form 36-item health survey score. Mental health was assessed by the Center for Epidemiologic Studies Depression (CES-D) Scale. Dietary intake was assessed by a brief-type self-administered diet history questionnaire. A later midpoint of sleep was associated with a lower intake of vitamin D and a higher intake of bread and caffeinated drinks. No correlations were observed between chronotype and other nutrient and food intake. The subjects with a late midpoint of sleep (eveningness) showed poor general health perception (GH) and high CES-D scores. Other HRQoL scores did not differ among groups with different midpoints of sleep. In conclusion, chronotype as assessed by the midpoint of sleep is associated with poor GH and depressive tendencies in elderly Japanese women. Additionally, a few associations were found between dietary intake and chronotype in elderly Japanese women.

Mental health status of adults under institutional quarantine: a cross-sectional survey in Tunisia.

Introductionrestrictive measures imposed during the COVID-19 pandemic, such as quarantine, may induce psychiatric outcomes among concerned individuals. The present study aimed to describe the mental health status of Tunisian adults under mandatory institutional quarantine imposed during the COVID-19 pandemic, and to determine factors influencing the occurrence of psychiatric symptoms.Methodsa cross-sectional phone survey was conducted from April to November 2020 using convenience sampling of persons who had experienced mandatory institutional quarantine. A standardized questionnaire was administered to participants including questions about socio-demographic characteristics and quarantine related information. Generalized anxiety disorder, depression symptoms, and sleep quality during quarantine were assessed using, respectively, the generalized anxiety disorder-7 (GAD-7), the centre for epidemiological studies depression (CES-D-10) and the insomnia severity index (ISI) scales. Bivariate and multivariate analyses were performed to determine factors associated with anxiety and/or depression and with clinical insomnia.Resultsamong 506 participants, 38.3% experienced anxiety and/or depression symptoms (anxiety: 15.4%; depression: 37.4%) and 19.2% had clinical insomnia. The prevalence of anxiety and/or depression symptoms and insomnia were higher among women those who spent three hours or above on COVID-19 news, those who had economic difficulties due to COVID-19 pandemic, those who were not satisfied by the accommodation conditions of quarantine facilities, and those who had experienced stigma.Conclusionhigh prevalence of psychiatric symptoms among quarantined individuals was found in this study. Psychological interventions should thus be an integral part of the COVID-19 control strategy in order to provide adequate psychological support to persons quarantined due to COVID-19.

Correlation between Child Behavior and Depression in Mother with Autism Spectrum Disorders Child

Background: The behavioural characteris­tics of an autistic child can lead to challenging relationships with the mother. For mothers who serve as the key person in the care of their children with ASD, maintaining good mental health, which may be directly related to the growth and development of their children, is an important issue for professionals engaged in parenting support. The aim of this study was to determine the interaction between the behavioural problems of children with ASD (from toddlers to adolescents) and their mothers’ depression. Subjects and Method: This was a cross-sectional study carried out in Yamaguchi Prefecture, Japan. The recruitment of subjects was through a paediatric out-patient unit. Eighty-six mothers with ASD participated in this observational study. The Center for Epidemiological Studies-Depression (CES-D) scalewas used as a measure of depression in mothers, and the Child Behaviour Checklist (CBCL) was used as an assessment of the children’s behavioral characteristics. The prevalence of depression among mothers of children with ASD was estimated and related factors were also examined. Results: There were 66 boys (76.7%), 12 girls (14.0%) and 8 (9.3%) non-responders. Comparing the pre- adolescent and adolescent groups, there were significant differences in the ages of mothers and children (P <0.001). In this study, the prevalence rate of depression in mothers of children with ASD was 47.7% (95% CI= 36.8 to 58.7), and the prevalence rate of depression in mothers of adolescent children group was 48.6% (95% CI= 31.4 to 6.0). The predictive factors of maternal depression were others’ problems (toileting problems, and masturbation) in CBCL and children’s age group. Conclusion: These children’s behavioural characteristics were recognised as serious problems by their mothers, which in turn can negatively affect their mental health, particularly the depression of mothers in the adolescent group was probably due to concerns about their children’s unsocial behaviour. Keywords: Mental health, behavioural problems, pre-adolescent, adolescent Correspondence: Kumiko Kido, Department of Nursing, Faculty of Health Sciences, Kagawa Prefectural Univer­sity of Health Sciences, Murechohara 281-1 Taka­matsu, Kagawa, Japan. Email: kkumiko0­305@gmail.com. Mobile:+819013360452 Journal of Maternal and Child Health (2021), 06(04): 475-485 https://doi.org/10.26911/thejmch.2021.06.04.09

Relationship Between Depression/Anxiety and Cognitive Function Before and 6 Weeks After Major Non-Cardiac Surgery in Older Adults.

To determine the relationship between affective measures and cognition before and after non-cardiac surgery in older adults. Observational prospective cohort study in 103 surgical patients age ≥ 60 years old. All participants underwent cognitive testing, Center for Epidemiologic Studies-Depression, and State Anxiety Inventory screening before and 6 weeks after surgery. Cognitive test scores were combined by factor analysis into 4 cognitive domains, whose mean was defined as the continuous cognitive index (CCI). Postoperative global cognitive change was defined by CCI change from before to after surgery, with negative CCI change indicating worsened postoperative global cognition and vice versa. Lower global cognition before surgery was associated with greater baseline depression severity (Spearman's r = -0.30, p = 0.002) and baseline anxiety severity (Spearman's r = -0.25, p = 0.010), and these associations were similar following surgery (r = -0.36, p < 0.001; r = -0.26, p = 0.008, respectively). Neither baseline depression or anxiety severity, nor postoperative changes in depression or anxiety severity, were associated with pre- to postoperative global cognitive change. Greater depression and anxiety severity were each associated with poorer cognitive performance both before and after surgery in older adults. Yet, neither baseline depression or anxiety symptoms, nor postoperative change in these symptoms, were associated with postoperative cognitive change.

Psychological and nutritional effects on a COVID-19-quarantined population in Bangladesh

ABSTRACT With the novel coronavirus (COVID-19) outbreak worldwide, many people were instructed to stay at home as a precautionary measure for not catching the disease. The same measure was imposed in Bangladesh, where people were in self and mandatory quarantine for 14 days. The objectives of this study were to assess the psychological and nutritional changes of a quarantined population in Bangladesh during the COVID-19 outbreak. A total of 5792 individuals comprised the population of this study. Subjects were respondents to an online questionnaire that was administered through social media. The questionnaire included questions on personal information, items of the Impact of Event Scale-Revised (IES-R), and the Center for Epidemiologic Studies–Depression (CES-D) scale. Data were collected and analyzed by factor analysis and regression utilizing an SPSS program. Results of the CES-D scale indicated that 24% of respondents (scored ≥16) were depressed and had a significant association with nutritional behavior changes (misconceptions). Data of the IER-S scale showed that 35% of respondents scored ≥20, which indicated that they had a probability of post-traumatic stress disorder (PTSD)—however, there this did not have a significant relationship with nutritional misconceptions. The quick spread of the COVID-19 outbreak caused people to be depressed and made them adopt nutritional attitudes that can be considered as misconceptions. If the government and health care workers become aware of such findings, measures and policies can be taken to alleviate the resultant sufferings.

Hopelessness and Depression Predict Sarcopenia in Advanced CKD and Dialysis: A Multicenter Cohort Study.

Depression and hopelessness are frequently experienced in chronic kidney disease (CKD) and are generally associated with lessened physical activity. The aim of this study was to quantify the associations between sarcopenia as determined by SARC-F with both depression and hopelessness. This multicenter cohort study involving cross-sectional and longitudinal analyses was conducted in a university hospital and four general hospitals, each with a nephrology center, in Japan. Participants consisted of 314 CKD patients (mean age 67.6), some of whom were receiving dialysis (228, 73%). The main exposures were depression, measured using the Center for Epidemiologic Studies Depression (CES-D) questionnaire, and hopelessness, measured using a recently developed 18-item health-related hope scale (HR-Hope). The outcomes were sarcopenia at baseline and one year after, measured using the SARC-F questionnaire. Logistic regression models were applied. The cross-sectional and longitudinal analyses included 314 and 180 patients, respectively. Eighty-nine (28.3%) patients experienced sarcopenia at baseline, and 44 (24.4%) had sarcopenia at the one-year follow-up. More hopelessness (per 10-point lower, adjusted odds ratio [AOR]: 1.33, 95% confidence interval [95% CI] 1.12-1.58), depression (AOR: 1.87, 95% CI 1.003-3.49), age (per 10-year higher, AOR: 1.70, 95% CI 1.29-2.25), being female (AOR: 2.67, 95% CI 1.43-4.98), and undergoing hemodialysis (AOR, 2.92; 95% CI, 1.41-6.05) were associated with a higher likelihood of having baseline sarcopenia. More hopelessness (per 10-point lower, AOR: 1.69, 95% CI 1.14-2.51) and depression (AOR: 4.64, 95% CI: 1.33-16.2) were associated with a higher likelihood of having sarcopenia after one year. Among patients with different stages of CKD, both hopelessness and depression predicted sarcopenia. Provision of antidepressant therapies or goal-oriented educational programs to alleviate depression or hopelessness can be useful options to prevent sarcopenia.

Back Pain and Heart Failure in Older Adults: Findings From the Health ABC Study

Both back pain and heart failure (HF) have negative influence on all aspects of life. Little is known about the impact of back pain on older adults with HF. We include 1295 older adults who had data collected in the 11th year (2007-2008) of the Health, Aging and Body Composition (Health ABC) study to evaluate the effect of back pain on health status among older adults with and without HF. The participants aged 79-91, 54.8% were female and 34.8% were African American. Among 94 participants with HF, 63 (67.0%) had back pain; among 1201 participants without HF, 649 (54.0%) had back pain. Females reporting back pain had 4.76 (95% CI: 1.83, 12.37) times the odds of having HF compared to those without back pain. Male with back pain, compared to those without back pain, had 1.14 times (95% CI: 0.65, 2.02) the odds of having HF. Depressive symptoms were measured by the Center for Epidemiological Studies-Depression (CES-D) scale. Performance and functions were measured by the Established Populations for Epidemiologic Studies in the Elderly (EPESE) performance score, the Health ABC performance battery score and self-reported difficulty with functional tasks. These symptom and performance measures were significantly associated with both back pain and HF, but not the interaction terms of back pain and HF after adjusting demographic variables including gender, race, smoking status and BMI category. The high incidence and negative impact of back pain highlighted the needs of developing strategies in pain management among older adults with and without HF.

Greater Perceived Physical Fatigability Is Associated with Lower Cognition: The Long Life Family Study

Greater perceived physical fatigability is associated with physical functional decline, but few studies have examined its relation with cognition. Adults ≥60 (mean±SD age 73.7±10.5, 54.7% female, 99.6% white) from the Long Life Family Study (n=2355) completed the Pittsburgh Fatigability Scale (PFS, 0-50, higher=greater fatigability) and a neurocognitive examination. Generalized estimating equations were used to account for family structure. Covariates included age, sex, field center, depressive symptoms (Center for Epidemiological Studies-Depression), education, and self-reported health. Each 1-point greater PFS was associated with lower: (1) global cognition (Mini-Mental Status Exam; β=-0.36,p<.0001), (2) verbal fluency (phonemic: β=-0.09,p=.029 and semantic: β=-0.14,p<.0001), (3) memory (Hopkins Verbal Learning Test-Revised: β=-0.06,p=.037), and (4) psychomotor speed (Digit Symbol Substitution Test: β=-0.10,p<.0001), after covariate adjustment. Greater perceived physical fatigability was significantly associated with lower memory and cognitive function in older adults, and may represent a promising new biomarker of biological aging reflecting declining brain reserve, resilience, and neurodegeneration.

Association Between Depressive Symptoms and Incident Cardiovascular Diseases

It is uncertain whether depressive symptoms are independently associated with subsequent risk of cardiovascular diseases (CVDs). To characterize the association between depressive symptoms and CVD incidence across the spectrum of lower mood. A pooled analysis of individual-participant data from the Emerging Risk Factors Collaboration (ERFC; 162 036 participants; 21 cohorts; baseline surveys, 1960-2008; latest follow-up, March 2020) and the UK Biobank (401 219 participants; baseline surveys, 2006-2010; latest follow-up, March 2020). Eligible participants had information about self-reported depressive symptoms and no CVD history at baseline. Depressive symptoms were recorded using validated instruments. ERFC scores were harmonized across studies to a scale representative of the Center for Epidemiological Studies Depression (CES-D) scale (range, 0-60; ≥16 indicates possible depressive disorder). The UK Biobank recorded the 2-item Patient Health Questionnaire 2 (PHQ-2; range, 0-6; ≥3 indicates possible depressive disorder). Primary outcomes were incident fatal or nonfatal coronary heart disease (CHD), stroke, and CVD (composite of the 2). Hazard ratios (HRs) per 1-SD higher log CES-D or PHQ-2 adjusted for age, sex, smoking, and diabetes were reported. Among 162 036 participants from the ERFC (73%, women; mean age at baseline, 63 years [SD, 9 years]), 5078 CHD and 3932 stroke events were recorded (median follow-up, 9.5 years). Associations with CHD, stroke, and CVD were log linear. The HR per 1-SD higher depression score for CHD was 1.07 (95% CI, 1.03-1.11); stroke, 1.05 (95% CI, 1.01-1.10); and CVD, 1.06 (95% CI, 1.04-1.08). The corresponding incidence rates per 10 000 person-years of follow-up in the highest vs the lowest quintile of CES-D score (geometric mean CES-D score, 19 vs 1) were 36.3 vs 29.0 for CHD events, 28.0 vs 24.7 for stroke events, and 62.8 vs 53.5 for CVD events. Among 401 219 participants from the UK Biobank (55% were women, mean age at baseline, 56 years [SD, 8 years]), 4607 CHD and 3253 stroke events were recorded (median follow-up, 8.1 years). The HR per 1-SD higher depression score for CHD was 1.11 (95% CI, 1.08-1.14); stroke, 1.10 (95% CI, 1.06-1.14); and CVD, 1.10 (95% CI, 1.08-1.13). The corresponding incidence rates per 10 000 person-years of follow-up among individuals with PHQ-2 scores of 4 or higher vs 0 were 20.9 vs 14.2 for CHD events, 15.3 vs 10.2 for stroke events, and 36.2 vs 24.5 for CVD events. The magnitude and statistical significance of the HRs were not materially changed after adjustment for additional risk factors. In a pooled analysis of 563 255 participants in 22 cohorts, baseline depressive symptoms were associated with CVD incidence, including at symptom levels lower than the threshold indicative of a depressive disorder. However, the magnitude of associations was modest.

The prevalence of depressive symptoms and its determinants among adults in mainland China: Results from a national household survey

BackgroundDepression have become a widespread health concern in Chinese society. MethodsWe analyzed the factors influencing the risk of depression among residents aged 16 and over using data from the 2016 China Family Panel Studies (CFPS), in which depression was measured using the Center for Epidemiologic Studies Depression (CES-D20) scale. A total of 26,464 individuals were sampled in a weighted manner to represent the entire country. Univariate and multivariate analysis were used to explore the risk factors for depression and the odds of depression in people with different characteristics. ResultsA total of 76.6% of adult residents were mentally healthy. Females had higher rates of depression than males (OR=1.515). There was an “inverted U-shaped” distribution between age and risk of depression. Higher levels of education and better physiological health were associated with a lower risk of depression. Self-evaluated income and social status were not linearly related to the risk of depression but rather had a “U-shaped” distribution. For social capital, better social relationships and a higher level of social trust were associated with a lower risk of depression. Nonsmokers had a lower risk of depression than smokers (OR=0.818). LimitationsAll items were self-reported and some results depend on single item responses. This is a cross-sectional survey so that causative interpretations cannot be drawn. ConclusionThese findings suggest potential public health measures whose efficacy needs to be tested and confirmed.

Racial Disparities in Mental Health Outcomes Among Women With Early Pregnancy Loss.

To explore the relationship between race and depression symptoms among participants in an early pregnancy loss clinical trial. We performed a planned secondary analysis of a randomized trial by comparing treatments for medical management of early pregnancy loss. We hypothesized that Black participants would have higher odds of risk for major depression (measured with the CES-D [Center for Epidemiological Studies-Depression] scale) 30 days after early pregnancy loss treatment when compared with non-Black participants. We analyzed the data as a cohort, with the primary exposure being race and secondary exposure being high adverse childhood experience scores (measured with the Adverse Childhood Experience scale). Our primary outcome was risk for major depression (score of 21 or higher on the CES-D scale) 30 days after early pregnancy loss treatment. Three hundred participants diagnosed with a nonviable intrauterine pregnancy from 5 to 12 weeks of gestation were randomized as part of the original trial from May 2014 to April 2017. Of 275 respondents included in this analysis, 120 [44%] self-identified as Black and 155 [56%] self-identified as non-Black. After early pregnancy loss treatment, 65 [24%] participants were at risk for major depression. Black participants had an increased risk for major depression (57%) after early pregnancy loss treatment compared with non-Black participants (43%; odds ratio [OR] 2.02; 95% CI 1.15-3.55). After adjustment for risk for baseline depression, adverse childhood experience score, and parity, the odds of risk for major depression 30 days after pregnancy loss treatment remained higher for Black participants when compared with non-Black participants (OR 2.02; 95% CI 1.15-3.55; adjusted OR 2.48; 95% CI 1.28-4.81). Overall, approximately one quarter of women who experience an early pregnancy loss are at an increased risk for major depression 30 days after treatment. This risk is about twice as high for Black women compared with non-Black women. There is a need for appropriate mental health resources for women undergoing early pregnancy loss care. ClinicalTrials.gov, NCT02012491.

Depressive Symptom Trajectories in Family Caregivers of Stroke Survivors During First Year of Caregiving.

The purpose of this study was to identify patterns of depressive symptom trajectory and examine the associations of the symptom trajectory with caregiving burden, family function, social support, and perceived health status of caregivers of stroke survivors during the first year of caregiving after discharge from rehabilitation center. Caregivers of stroke survivors completed a survey of depressive symptoms, caregiving burden, family function, perceived availability of social support, and perceived health status at postdischarge and 1 year. Patterns of depressive symptom trajectory (ie, symptom-free, symptom relieved, symptom developed, and persistent symptom groups) were identified by grouping depressive symptoms based on 2 assessments using the Center for Epidemiologic Studies-Depression. Repeated-measures analysis of variance and multinomial logistic regression were used to examine the associations. Of the 102 caregivers, 57.8% were symptom-free, 20.6% experienced persistent depressive symptoms, 11.8% relieved depressive symptoms, and 9.8% developed depressive symptoms. There were significant changes in family function (Wilks λ = 0.914, P = .038) and perceived health status (Wilks λ = 0.914, P = .033) among the groups during the first year of caregiving. The persistent symptom group reported the highest level of burden and the lowest level of family function and perceived availability of social support at both assessment times. Compared with symptom-free caregivers, caregivers with persistent depressive symptoms were 7 times more likely to have fair/poor health rather than excellent/very good health at 1 year (odds ratio, 7.149; P = .012). Caregivers with persistent depressive symptoms are the most vulnerable to negative psychosocial outcomes and poor perceived health status during the first year of caregiving from discharge for stroke survivors.

Relationship Between Mood and Somatic Symptom at Initial Presentation of mTBI to a Concussion Clinic

To examine the relationship between self-reported mood symptoms and severity of presenting concussion symptoms in an adult sports and non-sports post-concussion population. Past studies have identified a relationship between pre-morbid and concurrent anxiety and depression and number, severity, and duration of postconcussion symptoms. Using our structured clinical documentation support toolkit for concussion patients, we analyzed previously collected discrete standardized data. Each patient with a confirmed mTBI diagnosis by the clinician, reported mood symptoms on the Generalized Anxiety Disorder 7-item (GAD-7) scale and Center for Epidemiology Studies Depression (CES-D) scale. Rivermead Post-concussion Symptoms Questionnaire (RPQ) was self-reported for non-sports concussion patients and the Sport Concussion Assessment Tool (SCAT) symptom checklist was self-reported for sports concussion patients. RPQ or SCAT scores were correlated with GAD-7 and CES-D scores at initial visit. Cohorts were stratified by gender and age decile. RPQ score was weakly correlated with GAD-7 scores and peaked at 0.71 for males in their 40s and 0.69 for females in their 50s. RPQ was weakly correlated with CES-D for males: corr = 0.65 for all age groups, and females around 0.50, peaking at 0.76 for females in their 50s. For SCAT and GAD-7, males had a stronger correlation than females (0.58-0.21) in their 20s, while females exhibited a stronger correlation for SCAT and CES-D than males (0.63-0.23) in their 20s. Correlations were found between symptom scores and mood scores. Strongest correlations were found for non-sports mTBI patients between RPQ scores and GAD-7 scores in males in their 40s and females in their 50s, and between RPQ scores and CES-D scores in females in their 50s. This analysis lends support to the relationship between mood symptoms and intensity of somatic concussion symptoms following injury and may encourage clinicians to discuss mental health treatment or resources when appropriate.

Aircraft noise control policy and mental health: a natural experiment based on the Longitudinal Aging Study Amsterdam (LASA)

BackgroundThis study examines the impact of environmental noise policy on depressive symptoms by exploiting the national experiment afforded by the New Deal aircraft noise control policy introduced in Schiphol (Amsterdam)...