Center For Epidemiologic Studies Depression Research Articles

Biomarkers Associated with Depression Improvement in Veterans with Gulf War Illness Using the Low-Glutamate Diet

Gulf War Illness (GWI) is a chronic multi-symptom neurological disorder affecting veterans of the Gulf War that is commonly comorbid with depression. A secondary data analysis was conducted to examine serum homocysteine and inflammatory cytokines (IFN-γ, IL-6, IL-1β, TNF-α) as potential biomarkers of depression improvement among veterans with GWI after a one-month dietary intervention aimed at reducing excitotoxicity and increasing micronutrients. Analyses, including multiple linear and logistic regression, were conducted in R studio. Dietary adherence was estimated using a specialized excitotoxin food frequency questionnaire (FFQ), and depression was measured using the Center for Epidemiologic Studies Depression (CES-D) scale. After one month on the diet, 52% of participants reported a significant decrease in depression (p < 0.01). Greater dietary adherence (FFQ) was associated with increased likelihood of depression improvement; OR (95% CI) = 1.06 (1.01, 1.11), (p = 0.02). Reduced homocysteine was associated with depression improvement after adjusting for FFQ change (β = 2.58, p = 0.04), and serum folate and vitamin B12 were not mediators of this association. Reduction in IFN-γ was marginally associated with likelihood of depression improvement (OR (95% CI) = 1.11 (0.00, 1.42), (p = 0.06)), after adjustment for potential confounders. Findings suggest that homocysteine, and possibly IFN-γ, may serve as biomarkers for depression improvement in GWI. Larger trials are needed to replicate this work.

Childhood Sexual Abuse and Compulsive Sexual Behavior Among Men Who Have Sex with Men Newly Diagnosed with HIV.

Childhood sexual abuse (CSA) continues to be a public health challenge. The prevalence of experiencing CSA is higher among men who have sex with men (MSM) than the general population. CSA has been linked to compulsive sexual behavior (CSB) among varying populations but has not been examined among MSM who were newly diagnosed with HIV. Therefore, the aims of this study were to assess the direct association between CSA and CSB among newly diagnosed MSM living with HIV, and to identify the potential mediating roles of depressive symptoms and emotion regulation in the association between CSA and CSB. The study was a secondary data analysis using data obtained from 2012 to 2017 from two community HIV clinics in New York City (n = 202). CSA was operationalized with questions asking about sexual abuse during childhood/adolescence. CSB was measured using the 13-item Compulsive Sexual Behavior Inventory (CSBI). Depressive symptoms were measured using the 20-item Centers for Epidemiologic Studies Depression (CES-D) scale and emotion regulation was measured using a 36-item Difficulties in Emotion Regulation Scale (DERS). Path analysis was conducted to determine the mediating role of depressive symptoms and emotion regulation in the association between CSA and CSB. There was a statistically significant association between CSA and CSB (β = 0.160; p = 0.019). There were statistically significant indirect associations between CSA, depressive symptoms, emotion regulation, and CSB (depressive symptoms β = 0.0.071; p = 0.010; DERS: β = 0.080; p = 0.006). Depressive symptoms were also correlated with emotion regulation (r = 0.596; p < 0.001). The relationship between CSA and CSB was significantly mediated by depressive symptoms and emotion regulation. Trauma-informed interventions addressing depressive symptoms and difficulties in emotion regulation may help to reduce CSB among MSM living with HIV.

Malnutrition and Its Determinants among Older Adults Living in French Caribbean Nursing Homes: A Cross-Sectional Study

Background: This study aimed to assess the prevalence of malnutrition and its determinants in older adults living in French Caribbean nursing homes. Methods: This cross-sectional study was taken from the KASEHAD (Karukera Study of Ageing in EHPAD) study. Nutritional status was assessed with the Mini Nutritional Assessment Short-Form (MNA-SF). Clinical characteristics and scores on geriatric scales (Mini-Mental State Examination (MMSE), Activities of Daily Living (ADL), Short Physical Performance Battery (SPPB), Center for Epidemiologic Studies-Depression (CESD) and Questionnaire Quality of Life Alzheimer’s Disease (QoL-AD)) were extracted. Bivariate analysis and logistic models adjusted were performed to test the association between nutritional status and both socio-demographic variables and geriatric scales. Results: A total of 332 older adults from six nursing homes were included in the KASEHPAD study. Among the participants, 319 had an MNA-SF score. The mean age was 81.3 ± 10.6 years, and half of the participants were men. The frequency of malnutrition (MNA-SF ≤ 7) was 27.6% (95% confidence interval (CI): 22.0–32.5) (n = 88). Based on the multivariable analysis, a low MMSE was associated with malnutrition (OR: 0.81 (0.68–0.92); p = 0.015) and there was a borderline significant link between a higher CESD score and malnutrition (OR: 1.05 (1.00–1.12); p = 0.07). Conclusions: Cognitive decline and a tendency toward depression were associated with malnutrition in nursing homes in the French West Indies. Although this study cannot establish causal relationships, the identification of these three geriatric syndromes in nursing homes is crucial for preventing adverse health events.

Associations between Early-pregnancy Vitamin D Status and Postpartum Depressive and Anxiety Symptoms.

Maternal postpartum depressive and anxiety symptoms are risk factors for subsequent maternal and child mental health problems. Little is known about the potential role of antepartum vitamin D and C-reactive protein (CRP) in the etiology of maternal postpartum affective symptoms. We investigated associations between antepartum vitamin D status and postpartum depressive and anxiety symptoms and whether antepartum CRP mediated these associations. In 2,483 participants of the Amsterdam Born Children and their Development prospective cohort, maternal serum vitamin D and CRP were measured at a median of 13 weeks' gestation. Vitamin D status was defined as deficient (≤29.9 nM), insufficient (30-49.9 nM), sufficient (50-79.9 nM), or normal (≥80 nM). Maternal depressive symptoms (Center for Epidemiologic Studies-Depression) and anxiety (State-Trait Anxiety Inventory) were assessed 3 months postpartum. After adjustments for confounders vitamin D deficiency was only associated with increased postpartum anxiety symptoms (B = 0.17, 95% CI [0.03, 0.30], p = .017) compared to normal vitamin D levels (>80 nM). In women not taking vitamin D supplementation (n = 2,303), vitamin D deficiency was associated with increased postpartum depressive and anxiety symptoms (B = 0.14, 95% CI 0.03, 0.28, p = .045; and B = 0.17, 95% CI 0.03, 0.32, p = .015). Antepartum CRP did not mediate these links. We found some evidence that antepartum vitamin D deficiency was associated with increased postpartum affective symptoms, especially in women not taking vitamin D supplementation. Clinical trials should determine whether vitamin D supplementation can reduce the risk for postpartum affective disorders.

Associations between Early-pregnancy Vitamin D Status and Postpartum Depressive and Anxiety Symptoms.

Maternal postpartum depressive and anxiety symptoms are risk factors for subsequent maternal and child mental health problems. Little is known about the potential role of antepartum vitamin D and C-reactive protein (CRP) in the etiology of maternal postpartum affective symptoms. We investigated associations between antepartum vitamin D status and postpartum depressive and anxiety symptoms and whether antepartum CRP mediated these associations. In 2,483 participants of the Amsterdam Born Children and their Development prospective cohort, maternal serum vitamin D and CRP were measured at a median of 13 weeks' gestation. Vitamin D status was defined as deficient (≤29.9 nM), insufficient (30-49.9 nM), sufficient (50-79.9 nM), or normal (≥80 nM). Maternal depressive symptoms (Center for Epidemiologic Studies-Depression) and anxiety (State-Trait Anxiety Inventory) were assessed 3 months postpartum. After adjustments for confounders vitamin D deficiency was only associated with increased postpartum anxiety symptoms (B = 0.17, 95% CI [0.03, 0.30], p = .017) compared to normal vitamin D levels (>80 nM). In women not taking vitamin D supplementation (n = 2,303), vitamin D deficiency was associated with increased postpartum depressive and anxiety symptoms (B = 0.14, 95% CI 0.03, 0.28, p = .045; and B = 0.17, 95% CI 0.03, 0.32, p = .015). Antepartum CRP did not mediate these links. We found some evidence that antepartum vitamin D deficiency was associated with increased postpartum affective symptoms, especially in women not taking vitamin D supplementation. Clinical trials should determine whether vitamin D supplementation can reduce the risk for postpartum affective disorders.

Associations between sarcopenia and depression in middle-aged and older adults: the moderating effect of smoking

The aim of this study were to estimate associations of sarcopenic status with depressive symptoms. We used mixed-effects linear model to estimate longitudinal association between sarcopenic status and rate of change in 10-item Center for Epidemiologic Studies Depression (CES-D) scores, and used Cox regression model to estimate the association between sarcopenic status and incident depression (CES-D ≥ 10). Stratification analyses were performed when the interactions between sarcopenic status and covariates were significant. A total of 6522 participants were ultimately included. After adjusting for covariates, participants with possible sarcopenia (β = 0.117; 95% CI 0.067 to 0.166; P < 0.001) and sarcopenia (β: 0.093; 95% CI 0.027–0.159; P < 0.001) had a faster increase in CES-D scores compared with normal individuals. Interactions between smoking and sarcopenic status were significant (Pinteraction < 0.05). We found significantly positive associations of sarcopenic status with CES-D scores in nonsmokers, but not in current and past smokers. Besides, compared with normal participants, those with possible sarcopenia (HR 1.15; 95% CI 1.05 to 1.27) and sarcopenia (HR 1.28; 95% CI 1.12 to 1.46) (Ptrend < 0.001) had elevated risks of incident depression. Sarcopenia is associated with a faster increase in CES-D scores and increased risks of depression among Chinese middle-aged and older adults. Stronger associations between sarcopenia and trajectory of CES-D scores were found in nonsmokers than in smokers.

Prevalence and Factors Associated with Depression among High School Students in Ho Chi Minh City, Vietnam

Background: Depression in high school students is a common mental health problem and requires evaluation for early intervention. The study was carried out to determine the prevalence of depression symptoms and associated characteristics among high school students in Ho Chi Minh City, Vietnam. Methods: This cross-sectional study enrolled participants between February 2022 and June 2022. The instrument utilized was a questionnaire of socioeconomic-demographic variables, educational characteristics, and the self-reported depression scale obtained from the Centre for Epidemiological Studies-Depression (CES-D). Results: 384 high school students (165 males and 219 females) were questioned. The CES-D had a mean score of 17.3, with 57.6% of participants reporting depressed symptoms. The frequency was 63.3% among male students (OR = 1.84, 95% CI = 1.19-2.83, p = .005). Multiple logistic regression revealed that adolescents with poor health, weak friendships, limited participation in school activities, family problems, financial worries, and negative educational environments were significantly more likely to experience depressive symptoms (odds ratios ranging from 1.60 to 9.97, confidence intervals spanning 1.03 to 78.05, and p-values from &lt;.001 to .044). Conclusion: The study emphasized the necessity of health promotion programs that target mental health awareness, improve social support networks, and introduce stress reduction techniques in schools to reduce the prevalence of depression among teenagers in Ho Chi Minh City, Vietnam.

Tumor location is associated with mood dysfunction in patients with diffuse glioma

Gliomas are primary brain tumors that can cause neuropsychiatric symptoms, including severe depressive symptoms (SDS; in 14%) and an absence of depressive symptoms (ADS; in 29%), determined by Center for Epidemiologic Studies Depression (CES-D) scores. We examined the association between both SDS and ADS and brain tumor location in 201 patients with diffuse glioma before surgery. Tumors and white matter disconnectomes did not relate to CES-D using sparse canonical correlation analysis. SDS were associated with tumors in the right corticospinal tract, fornix, and inferior fronto-occipital fasciculus and the left uncinate fasciculus, whereas ADS was associated with tumors in the left uncinate fasciculus and first segment of the superior longitudinal fasciculus and the right temporal cingulum and thalamus using Bayesian regression analyses. ADS occurs even more frequently in patients with diffuse glioma than does SDS, which is explained partly by tumor location. This research aids the understanding of gliomas and mood dysfunction in general.

Longitudinal trajectories and associated risk factors of paternal mental illness in the nine years surrounding the transition to fatherhood

BackgroundThe arrival of one's first child is a known risk factor for mental illness, yet investigations on fathers' mental health are limited. We conducted a longitudinal investigation on paternal depression and anxiety in the nine years surrounding the transition to fatherhood. MethodsUsing a national cohort of French men (CONSTANCES, n = 6299), we investigated the prevalence and associated risk factors of mental illness amongst first-time fathers. Responses to the Center for Epidemiological Studies Depression (CES-D) and 12-item General Health Questionnaire (GHQ-12) scales were used to identify clinically significant symptom scores. Self-declared mental illness was also reported by participants. Group-based modelling was used to identify latent trajectory groups for both measures. ResultsLevels of self-declared anxiety (averaging 4.9 % pre-fatherhood, 7.8 % post) exceeded that of depression (1.9 % pre- fatherhood, 3.3 % post) or other disorders. However, rates of clinically significant symptom scores (17–27 %) were consistently higher. Participants' mental health appeared to worsen from two-years prior to their child's arrival and improve from two-years after. We identified three trajectory groups for fathers' self-declared mental illness: Low stable (90.3 %); Low risk with high temporary increase (5.6 %); and Consistent high risk (4.1 %). Risk factors associated with worsening mental health trajectories were unemployment, not living with one's partner, having had adverse childhood experiences and foregoing healthcare due to financial reasons. LimitationsAll measures of mental illness relied on participant self-reports and are thus subject to bias. ConclusionsThis study reveals an important period of heightened psychological vulnerability amongst first-time fathers, emphasising the need for increased and better adapted paternal mental health screening.

Organophosphate ester flame retardant chemicals and maternal depression during pregnancy

BackgroundDepression substantially contributes to pregnancy-related morbidity, and pregnancy is increasingly recognized as a vulnerable window for exposure effects on maternal mental health. Exposures to organophosphate esters (OPEs) are ubiquitous and may have neurotoxic effects; however, their impacts on prenatal depression remain unknown. We evaluated associations of third trimester OPE metabolites on maternal depressive symptoms during pregnancy. MethodsThis study included 422 participants in the Maternal and Developmental Risks from Environmental and Social Stressors (MADRES) cohort, a prospective pregnancy cohort of primarily low-income and Hispanic participants residing in Los Angeles, California. We measured concentrations of nine OPEs in third trimester spot urine samples (mean gestational age = 31.5 ± 2.0 weeks). Using the Center for Epidemiologic Studies-Depression (CES-D) scale, we classified participants as having probable depression during pregnancy (N = 137) or not (N = 285) if one or more CES-D scores administered at each trimester met the suggested cutoff score for clinically significant depressive symptoms (≥16). We estimated associations of prenatal OPE metabolite concentrations in tertiles and risk of prenatal depression using modified Log-Poisson regression. We examined associations of the OPE mixture on depression during pregnancy using Bayesian kernel machine regression (BKMR). ResultsParticipants with the highest tertiles of DPHP and BDCIPP exposure had a 67% (95% CI: 22%, 128%) and 47% (95% CI: 4%, 108%) increased risk of maternal depressive symptoms during pregnancy, respectively. No associations between other OPE metabolites and maternal depression symptoms were observed. In mixture analyses, we observed a positive and linear association between higher exposure to the OPE metabolite mixture and odds of prenatal maternal depression, primarily driven by DPHP. ConclusionsOur findings provide new evidence of associations between frequently detected OPE metabolites on maternal depression symptoms during pregnancy. Results could inform future intervention efforts aimed at reducing perinatal maternal depression.

Cross-sectional and longitudinal associations between late-life depressive symptoms and cognitive deficits: 20-year follow-up of the Kuakini Honolulu-Asia aging study

ObjectiveTo examine depressed affect, somatic complaints, and positive affect as longitudinal predictors of fluid, crystallized and global cognitive performance in the Kuakini Honolulu-Asia Aging Study (HAAS), a large prospective cohort study of Japanese-American men. MethodsWe assessed 3,088 dementia-free Kuakini-HAAS participants aged 71–93 (77.1 ± 4.2) years at baseline (1991–1993). Depressive symptoms were evaluated by the Center for Epidemiologic Studies Depression (CES-D) Scale. Baseline CES-D depression subscales (depressed and positive affects; somatic complaints) were computed. The Cognitive Abilities Screening Instrument (CASI) measured cognitive performance on a 100-point scale; fluid and crystallized cognitive abilities were derived from CASI factor analysis. Cognition was also evaluated at 4 follow-up examinations over a 20-year period. Multiple regression assessed baseline CES-D subscales as predictors of cognitive change. The baseline covariates analyzed were CASI, age, education, prevalent stroke, APOE ε4 presence, and the longevity-associated FOXO3 genotype. ResultsCross-sectionally, baseline CES-D subscales were related to cognitive measures; e.g., higher depressed affect was associated with lower crystallized ability (β = −0.058, p ≤ 0.01), and somatic complaints were linked to poorer fluid ability (β = −0.045, p ≤ 0.05) and to worse global cognitive function as measured by total CASI score (β = −0.038, p ≤ 0.05). However, depression subscales did not significantly or consistently predict fluid ability, crystallized ability, or global cognitive performance over time. ConclusionPsychological and physical well-being were associated with contemporaneous but not subsequent cognitive functioning. Assessment of depressive symptoms may identify individuals who are likely to benefit from interventions to improve mood and somatic health and thereby maintain or enhance cognition.

Internal migration and depressive symptoms: Exploring selection and outcomes in a South African cohort

IntroductionInvestigations of migration effects on mental health conditions, including depression are sparse in low- and middle-income countries (LMIC), yet mental health may play a role in a decision to migrate, and migration in turn can impact on mental health outcomes. MethodsThis paper uses two waves of data from the Migrant Health Follow-Up Study, a young adult cohort of 2967 internal migrants and residents of the Agincourt study site in rural northeast South Africa to explore the relationship between internal migration and depressive symptoms, as measured on the Center for Epidemiological Studies Depression (CES-D) scale. We employ logistic regression analysis to investigate selectivity of migrants in relation to depressive symptoms, and we fit generalized linear models to analyse depressive symptoms (CES-D scores) as a function of migration status and sociodemographic and health characteristics, accounting for temporal sequence. ResultsAlthough we observe systematically low reporting of depressive symptoms, average CES-D scores are lower among migrants (comprising approximately 53% of the cohort) compared to Agincourt residents at both survey timepoints. We do not find evidence of a selection effect in relation to mental health among those newly migrating between Wave 2 and 3 (n = 1393). In analyses of the CES-D score outcome, the significant influence of migration status on depressive symptoms is reduced with the inclusion of controls in the models. Consistent employment and higher levels of education are associated with lower CES-D scores, while diagnosis of a chronic condition is associated with higher scores. ConclusionThe relationship between migration and depressive symptoms is influenced by factors preceding a migration and destination-place characteristics and experiences. Further examination of the role of migration at different stages of the process, along with continuing attention to psychosocial measurement considerations for LMIC subpopulations, can improve our understanding of these complex interrelationships and contribute to evidence.

The possible association of dietary fiber intake with the incidence of depressive symptoms in the Korean population

ABSTRACT Objectives This study investigates the effect of dietary fiber on the prevention of depressive symptoms. Methods In a cohort of 88,826 Korean adults (57,284 men and 31,542 women), we longitudinally evaluated the risk of depressive symptoms according to quartiles of dietary fiber intake for 5.8 years of follow-up. A food frequency questionnaire was used in evaluating dietary fiber intake. Depressive symptoms were assessed by the Center for Epidemiological Studies-Depression (CES-D) scale, in which CES-D ≥ 16 was defined as depressive symptoms. The Cox proportional hazards model was used to calculate the adjusted hazard ratio (HR) and 95% confidence intervals (CI) for depressive symptoms (adjusted HR [95% CI]). Subgroup analysis was performed for gender and BMI (≥25 or <25). Result In men, the risk of depressive symptoms significantly decreased with the increase of dietary fiber (quartile 1: reference, quartile 2: 0.93 [0.87–0.99], quartile 3: 0.91 [0.85–0.98] and quartile 4: 0.84 [0.77–0.92]). This association was more prominently observed in men with BMI ≥ 25 (quartile 1: reference, quartile 2: 0.95 [0.86–1.06], quartile 3: 0.88 [0.79–0.99] and quartile 4: 0.84 [0.73–0.97]). Women did not show a significant association between quartile groups of dietary fiber intake and the risk of depressive symptoms across subgroup analysis for BMI. Conclusion High intake of dietary fiber is potentially effective in reducing depressive symptoms in Korean men. The protective effect of dietary fiber on depressive symptoms may vary by gender and obesity.

"He Stole My Meds to Get High:" The Mental Health and Well-Being of Women Abused by Intimate Partners and Their Disability Status.

While population-based research confirms that women with disabilities abused by their intimate partners experience significant mental health issues, few studies compare this in intimate partner violence (IPV)-specific samples of women with or without disabilities and none analyze possible impacts based on disability type. This secondary mixed methods analysis examined 660 Canadian women (50.6% Indigenous, 43.1% White, and 6.1% visible minority) with respect to whether they reported having a disability that impacted their employability or daily living (291 or 44% yes; 369 or 56% said no). In the 291 women with disabilities, about one-third (30.7%) had a physical disability-only, one-quarter had a mental health disability-only, and 44.1% reported both physical and mental health disabilities. Women with mental health and both physical and mental health disabilities reported significantly more Severe Combined IPV on the Composite Abuse Scale, depression (CES-D-10; Center for Epidemiological Studies-Depression), psychological distress (Symptom Checklist Shortform-10; SCL-10; in the clinical range), PTSD symptoms (PTSD Checklist), and lower quality of life (Quality of Life Questionnaire or QoL-9) than women without disabilities. Education about disabilities is needed for IPV advocates and disability practitioners need education about IPV. Developing services specific to survivors of IPV with disabilities is recommended.

Prospective bidirectional relations between depression and metabolic health: 30-year follow-up from the National Heart, Lung, and Blood Institute (NHLBI) Coronary Artery Disease in Young Adults (CARDIA) study.

This study investigated prospective bidirectional relationships between depressive symptoms and metabolic syndrome (MetS) and the moderating effects of race, sex, and health behaviors in a diverse cohort followed for 30 years. Data were analyzed from the National Heart, Lung, and Blood Institute (NHLBI) Coronary Artery Disease in Young Adults (CARDIA) study, a 30-year prospective study of young adults (N = 5,113; Mage = 24.76 [SD = 3.63] at baseline; 45% male) who were tested every 5 years between 1985 and 2015. Measures included biological assessments of MetS components and self-reported depressive symptoms based on the Center for Epidemiologic Studies Depression (CESD) scale. Data analyses included bidirectional general estimating equations analyses of time-lagged associations between depressive symptoms and MetS. There was a consistent, bidirectional relationship between depressive symptoms and MetS over time. Individuals with more CESD depressive symptoms were more likely to develop MetS over time compared to those reporting fewer symptoms, Wald χ²(1) = 7.09, p < .008, and MetS was similarly predictive of CESD. MetS more consistently predicted CESD scores at each 5-year exam than CESD predicted MetS. Race and sex moderated these relationships, with White females, White individuals overall, and females overall demonstrating significant relationships between CESD depressive symptoms and MetS. Health behaviors were not related to associations between CESD and MetS. In a diverse young adult population prospectively followed into late middle age, MetS more consistently predicted depressive symptoms over time than depressive symptoms predicted MetS. The relation between MetS and depressive symptoms was moderated by race and sex, but not health behaviors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Associations between Household Food Insecurity and Depressive Symptomology among Adolescent Girls and Young Women during the COVID-19 Pandemic in South Africa

Evidence suggests an association between food insecurity and depressive symptomatology; however, little is known about the association between adolescent girls and young women (AGYW) in the context of COVID-19. This study aimed to investigate the relationship between household food insecurity (HFI) and depressive symptomology among AGYW in South Africa during the COVID-19 pandemic. Secondary data analysis was conducted using cross-sectional data collected from the HERStory2 study conducted during the COVID-19 pandemic. The data were collected from 515 AGYW (aged 15–24 years) recruited from six South African districts using a demographic detail and socio-economic questionnaire as well as the Center for Epidemiological Studies Depression (CESD-10) Scale. Data were fitted using a multi-variable robust Poisson regression model and controlled for sociodemographic and health factors. The results suggest that the majority of the sample of AGYW were 20 years old, with 74% exposed to HFI and 30.29% experiencing depressive symptomology. AGYW exposed to HFI were 1.80 times at risk of depressive symptomology compared to those from food-secure households [adjusted risk ratio (aRR): 1.80; 95% CI: 1.35–2.42, p &lt; 0.0001)]. Future pandemic-preparedness strategies should incorporate screening for HFI as a means to identify AGYW who may require psychosocial support.

Lifestyle factors and BMI attenuate relationships between biomarkers of inflammation and depressive symptoms and well-being: A cross-sectional study

BackgroundMental disorders are a growing public health concern and evidence has linked chronic low-grade inflammation with depression and well-being. Research also suggests that certain modifiable lifestyle factors such as smoking, alcohol use, physical activity, diet quality and BMI are related to psychological health. These may modulate the relationship between low-grade inflammation and mental health conditions. In this study we examined inflammatory biomarker associations with two psychological health scores and investigated whether relationships are influenced by lifestyle factors and BMI. MethodsThis was a cross-sectional study of 1824 middle-to older-aged men and women randomly selected from a large primary care centre. Depressive symptoms and well-being were assessed using the 20-item Centre for Epidemiologic Studies Depression (CES-D) Scale and the World Health Organization-Five (WHO-5) Well-Being Index. Linear regression analyses were performed to examine depression and well-being score relationships with six inflammatory biomarkers, and a composite inflammatory biomarker score, adjusting for demographic characteristics, health conditions, lifestyle factors and BMI. ResultsDepression and well-being score associations with complement component 3 (CES-D only) c-reactive protein, interleukin 6, leptin, white blood cell counts, neutrophils and the inflammatory biomarker score were observed. These relationships survived adjustment for demographic variables and health conditions but were attenuated in models which included lifestyle factors and BMI. In final models, only leptin (β = 0.566, p = 0.018) and inflammatory score (β = 0.137, p = 0.004) associations with the CES-D score remained. ConclusionsThese findings suggest that the relationship between systemic low-grade inflammation and depressive symptoms and well-being may be largely explained by lifestyle factors and adiposity, highlighting the potential importance of promoting a healthy lifestyle in the treatment of depressive disorders.

The prevalence of and factors associated with depressive and anxiety symptoms during the COVID-19 pandemic among healthcare workers in South Africa.

Healthcare workers globally have experienced increased social and occupational stressors in their working environments and communities because of COVID-19 which has increased the risk of mental health concerns. This study aimed to explore the prevalence and correlates of depression and anxiety amongst healthcare workers during the COVID-19 pandemic in the Western Cape, South Africa. In addition, role-related stressors and coping strategies were explored. We conducted a cross-sectional survey of doctors and nurses working in public healthcare facilities across the Western Cape, South Africa. Participants completed the Generalized Anxiety Disorder-7 (GAD-7), the Center for Epidemiologic Studies Depression (CES-D), the Professional Quality of Life (PROQL-R-IV), and the Brief Coping Orientation to Problems Experienced (COPE-R) scales. Data were analysed using multivariable logistic regression analysis. The sample comprised 416 health workers (303 nurses, 113 doctors). Almost 40% of the sample (n = 161) had CES-D scores suggestive of probable depression, and 45.9% (n = 186) had GAD-7 scores suggestive of anxiety. In the logistic regression model, the odds of probable depression were higher for female participants compared to men (OR = 2.26, 95% CI 1.00-5.10) and for participants who used behavioural disengagement as a coping strategy (OR = 1.50, 95% CI 1.14-1.97). More time spent working with COVID patients was associated with increased odds of having high levels of anxiety [OR = 1.13, 95% CI (1.02-1.25). Substance use (OR = 1.39, 95% CI 1.08-1.81), venting (OR = 1.31, 95% CI 1.01-1.70), and self-blame (OR = 1.42, 95% CI 1.08-1.87) were some of the coping strategies used by healthcare workers. High levels of secondary traumatic stress and burnout were found to increase the odds of both depression and anxiety. Findings of this study suggest that there is a high prevalence of mental health issues among healthcare workers, and a critical need to focus on workplace mental health interventions to support these frontline workers.

Dietary Habits and Depression in Community-Dwelling Chinese Older Adults: Cross-Sectional Analysis of the Moderating Role of Physical Exercise.

Healthy diets and physical exercise, two modifiable lifestyle factors, are protective against depression in older adults. This study aimed to investigate whether physical exercise may influence the associations of dietary habits with depression in Chinese community-dwelling older adults. In the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey, 12,708 community-dwelling older adults aged ≥65 years were included for analyses. Older adults' dietary habits (including daily intake of food components such as fruits, vegetables, animal oil, and so on) and physical exercise were assessed. Depression was evaluated via the 10 item Center for Epidemiologic Studies Depression (CES-D-10) scale. The influences of physical exercise on the associations of dietary habits with depression were estimated using logistic regression models adjusted for confounders. Older adults who took physical exercise had a significantly decreased probability of depression (adjusted OR = 0.73, p < 0.001). As for dietary habits, the intake of fruits, vegetables, eggs, nut products, mushrooms or algae, and vitamins were inversely associated with the prevalence of depression (adjusted ORs = 0.61-0.81; p-values: from <0.001 to 0.025), while animal oil was positively associated with it (adjusted OR = 1.52, p < 0.001). When stratified by physical exercise, older adults who ate fruits or vegetables had consistent decreased risk of depression, no matter whether they took physical exercise or not (adjusted ORs = 0.52-0.70), while the intake of eggs, nut products, and vitamins were inversely associated, and animal oil was consistently positively associated with depression only in older adults who did not take physical exercise (adjusted ORs = 0.79, 0.68, 0.63, and 1.67, respectively). Physical exercise may conceal the potential protective effects of some healthy dietary habits in terms of depression and counteract the detrimental effects of the unhealthy habits. Some dietary habits may be considered as alternative protective measures for depression in community-dwelling older adults when physical exercise cannot be performed.

Associations of perceived stress with loneliness and depressive symptoms: the mediating role of sleep quality

BackgroundWhether perceived stress is associated with loneliness and depressive symptoms in general adults, and to what extent sleep quality mediates the associations, remains unknown. The aim of this study was to estimate the associations of perceived stress with loneliness and depressive symptoms, and the mediating role of sleep quality in these associations.MethodsCross-sectional data on 734 participants (aged 18–87 years) were analyzed. Perceived stress was assessed using the 10-item Perceived Stress Scale (PSS-10; range 0–40). Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI; range 0–21). Loneliness was assessed using the three-item short form of the Revised University of California, Los Angeles (UCLA) loneliness scale (range 3–9). Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression (CESD-10) Scale (range 0–30). General linear regression models, multivariable logistic regression models, and formal mediation analysis were performed.ResultsAfter adjustment for age and sex, we found that with each 1-point increment in the perceived stress score, both the loneliness score (β = 0.07; 95% confidence interval [CI]: 0.06, 0.08) and depression score (β = 0.45; 95% CI: 0.40, 0.49) increased significantly. Robust results were observed when adjusting for more confounders. Furthermore, sleep quality mediated 5.3% (95% CI: 1.3%, 10.0%; P = 0.014) and 9.7% (95% CI: 6.2%, 14.0%; P < 0.001) of the associations of perceived stress score with loneliness score and depression score, respectively.ConclusionsIn general Chinese adults, perceived stress was positively associated with loneliness and depressive symptoms, and sleep quality partially mediated these associations. The findings reveal a potential pathway from perceived stress to mental health through sleep behaviors, and highlight the importance of implementing sleep intervention programs for promoting mental health among those who feel highly stressed.