Clinical Interview Schedule-Revised Research Articles

Association of mental health symptoms with the migraine-tension-type headache spectrum in the Brazilian longitudinal study of adult health

ObjectiveTo investigate the relationship between mental health symptoms and the migraine-tension-type headache (TTH) spectrum in middle-aged adults from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil study). MethodsIn this cross-sectional analysis (baseline data: 2008–2010), it was evaluated the relationship between each mental health symptom assessed by the Clinical Interview Schedule-Revised (CIS-R) questionnaire and headache subtypes (migraine and TTH) according to international criteria. It was performed binary logistic regression models, with estimated odds ratios (OR) with their respective 95% confidence intervals (CI) adjusted for confounders including migraine attack frequency. ResultsAmong 13,916 participants, 70.1% reported any major primary headache subtype within the last year. The most common subtype was definite TTH (33.4%), followed by probable migraine (21.0%), definite migraine (8.5%), and probable TTH (7.2%). Our main findings indicated positive associations between anxiety-related symptoms and the migraine-tension type headache (TTH) spectrum with a clear trend toward definite migraine more than tension-type headache. The presence of somatic symptoms presented a high likelihood for the associations with headaches, mainly definite migraine (OR: 7.9, 95% CI: 6.4–9.8), probable migraine (OR: 4.5, 95% CI 3.7–5.4) and probable TTH (OR: 3.0, 95% CI: 2.3–3.8). Other symptoms associated with headache disorders included fatigue, panic, irritability, anxiety symptoms, concentration problems, forgetfulness, depressive symptoms, and worry. The effect of associations remained significant after controlling for headache attack frequency. ConclusionThis study provides evidence of consistent associations between mental health symptoms and primary headache disorders, with a higher burden of anxiety-based symptoms observed in people with migraine than those with TTH.

Maternal experienced bereavement and offspring mental health in early adulthood: the role of modifiable parental factors.

It is estimated that 78% of children experience the death of a close friend or family member by 16 years of age, yet longitudinal research examining the mental health outcomes of wider experiences of bereavement is scarce. We conducted a longitudinal investigation of the association between maternal experienced bereavement before the age of 11 years and offspring depressive and anxiety disorders at age 18 and examined moderation of this association by modifiable parental factors. We analysed data from the Avon Longitudinal Study of Parents and Children, a UK-based birth cohort, including 9,088 child participants with data available on bereavement. Bereavement was measured via maternal report at eight timepoints until children were 11 years. Offspring depressive and anxiety-related disorders were self-reported at 18 years old using the Clinical Interview Schedule-Revised (CIS-R). The potential moderating roles of maternal anxiety, maternal depression, parental monitoring, positive parenting and negative parenting practices were examined. Maternal experienced bereavement was not associated with depression or anxiety-related disorders in early adulthood among offspring. In addition, no support was found for negative parenting practices, parental monitoring or maternal anxiety and depression as moderators of the relationship between maternal experienced bereavement and offspring mental health problems at 18 years old. Findings in relation to the moderating role of positive parenting practices were inconsistent. Findings suggest that a large number of children are exposed to maternal experienced bereavement. We found no evidence that maternal experienced bereavement during childhood increases the risk for offspring psychiatric disorders in early adulthood. Several methodological considerations prudent to bereavement research are discussed.

Non‐physical Leisure Activity patterns and Cognitive Function in 4,121 Hong Kong older adults with no major neurocognitive disorders

AbstractBackgroundEmerging evidence supports the role of lifestyle in maintenance of cognitive function. Physical exercise, diet and sleep are found to play important roles in cognitive health at later life. In this recently completed epidemiological study in Hong Kong, we explored if non‐physical leisure activity participation also contributes to cognitive function in older adults.MethodThe Hong Kong Mental Morbidity Survey for Older People (HKMMSOP) is a commissioned study supported by the Health and Medical Research Fund of the Hong Kong SAR. From 2019 till 2022, we have successfully assessed 4,369 community dwelling older adults (60 years or over). 4,121 participants satisfied clinical Dementia Rating (CDR) of either 0 or 0.5. Assessments included Montreal cognitive assessment (MoCA), cumulative illness rating for physical disease burden, Clinical Interview Schedule – Revised (CIS‐R) for depressive and anxiety symptoms, types of physical exercise (aerobic, mind body, resistance muscle training, stretch), types of non‐physical activities (cognitive, social, spiritual, volunteering, passive solitary) activities were counted as positive if regular practice frequency were once weekly or more.ResultOf the 4,121 participants, 3118 were cognitively healthy (CDR = 0), 1003 had mild neurocognitive disorder with CDR 0.5. The mean age and education (years) was 68.9(SD 6.9)(range 60‐98) and 9(SD 4.5) respectively. 44% were men. The mean MoCA score was 24.4 (SD 4.0). Regression analysis with MoCA score as the dependent variable showed that cognitive, volunteer and spiritual activities were significant factors (after controlling for gender, age, education, physical health burden, psychological symptoms (CIS‐R), and total number of physical exercise)(R2 = 295). In the CDR 0 group, cognitive and spiritual activities are significant factors (R2 = 0.184). In the CDR 0.5 group, cognitive and volunteer activities are significant (R2 = 0.196).ConclusionThe HKMMSOP provides empirical evidence on the association between cognitive function and apparently pro‐mental wellbeing leisure activities. The observation that the introspective spiritual activities being significant factor in healthy, and external volunteering activities being significant in mild cognitively impaired group should invite further replication and exploration on the associated mechanisms.

Addressing the mental health needs of India's aging population: Understanding depression prevalence and social risk factors in tertiary care outpatients.

Depression is a major public health problem among older persons. Identifying the prevalence and recognizing modifiable risk factors of depression in older persons is essential for early diagnosis and appropriate management. Apart from traditional risk factors, medical comorbidities, chronic illness, and social factors can contribute to depression in the older person. This study aimed to estimate the prevalence of depression and identify the medical and social risk factors associated with depression in older persons attending a geriatric outpatient clinic. Consecutive patients aged over 60 years presented to the geriatric outpatient clinic of the Christian Medical College (CMC) and Hospital, Vellore, were screened using the Physical Health Questionnaire-2 (PHQ-2) and Geriatric Depression Scale (GDS). Medical, social, and financial information were collected. Following a detailed clinical interview, the Clinical Interview Schedule-Revised (CIS-R) was administered and the ICD-10 diagnosis of depression was derived. A total of 171 participants were recruited. The prevalence of depression was found to be 53.2% with PHQ-2 and 35.6% with GDS. Using CIS-R, 41.5% had an ICD-10 diagnosis of depression. The risk factors associated with depression in older persons were female gender, financial insecurity, lack of pension, and financial dependence. This study revealed a high prevalence of depression among older persons attending a geriatric outpatient clinic. Financial insecurities, particularly lack of pension or financial dependence, were identified as significant social risk factors for depression. Addressing these risk factors may help prevent the onset or progression of depression, thus improving their quality of life.

The use of culturally adapted and translated depression screening questionnaires with South Asian haemodialysis patients in England.

Depression is common amongst patients receiving haemodialysis (HD). Assessment and intervention when faced with language and cultural barriers is challenging. To support clinician decisions, we conducted a cross-sectional study to assess the use of culturally adapted and translated versions of commonly-used depression screening questionnaires with South Asian patients receiving HD in England. Patients completed adapted versions of the Patient Health Questionnaire (PHQ-9), the Centre for Epidemiological Studies Depression Scale Revised (CESD-R), and the Beck Depression Inventory II (BDI-II). All questionnaires were available in Gujarati, Punjabi, Urdu, and Bengali. A comparative sample of white-Europeans completed the questionnaires in English. The research was based across 9 National Health Service (NHS) Trusts in England. Structural validity of translated questionnaires was assessed using confirmatory factor analysis. Diagnostic accuracy was explored in a subgroup of South Asians against ICD-10 categories using the Clinical Interview Schedule Revised (CIS-R) with receiver operating curve (ROC) analysis. 229 South Asian and 120 white-European HD patients participated. A single latent depression factor largely accounted for the correlations between items of the PHQ-9, CESD-R and BDI-II. Issues with measurement equivalence implied that scores on the translations may not be comparable with the English language versions. Against CIS-R based ICD-10 diagnosis of depression, sensitivity was modest across scales (50-66.7%). Specificity was higher (81.3-93.8%). Alternative screening cut-offs did not improve positive predictive values. Culturally adapted translations of depression screening questionnaires are useful to explore symptom endorsement amongst South Asian patients. However, data indicate that standard cut-off scores may not be appropriate to classify symptom severity. Use of the CIS-R algorithms for optimal case identification requires further exploration in this setting. Strategies to encourage recruitment of under-represented groups in renal research are also warranted, especially for in-depth discussions related to psychological care needs.

Association of Interparental Violence and Maternal Depression With Depression Among Adolescents at the Population and Individual Level

Parental intimate partner violence (IPV) and maternal depression are associated with increased risk of depression in children at the population level. However, it is not known whether having information about these experiences can accurately identify individual children at higher risk of depression. To examine the extent to which experiencing parental IPV and/or maternal depression before age 12 years is associated with depression at age 18 years at the population and individual level. This cohort study used data from the Avon Longitudinal Study of Parents and Children, a UK population-based birth cohort, which initially recruited pregnant mothers with estimated due dates in 1991 and 1992. Data used in this study were collected from 1991 to 2009. Data analysis was performed from February to March 2022. Mother-reported parental IPV was assessed on 8 occasions (child age, 1-11 years). Maternal depression was assessed via the Edinburgh Postnatal Depression Scale or by the mother taking medication for depression, as reported by the mother on 8 occasions (child age, 2-12 years). Depressive symptoms were measured with the Short Mood and Feelings Questionnaire (SMFQ) and Clinical Interview Schedule-Revised (CIS-R) when the child was aged 18 years. Binary indicators of a case of depression were derived the cutoff point of 11 points or above for the SMFQ and 12 points or above for the CIS-R. The study included 5029 children (2862 girls [56.9%]; 2167 boys [43.1%]) with a measure of depressive symptoms at age 18 years. IPV only was associated with a 24% (adjusted risk ratio, 1.24; 95% CI, 0.97-1.59) higher risk of depression at age 18 years, exposure to maternal depression only was associated with a 35% (adjusted risk ratio, 1.35; 95% CI, 1.11-1.64) higher risk, and exposure to both IPV and maternal depression was associated with a 68% (adjusted risk ratio, 1.68; 95% CI, 1.34-2.10) higher risk. At the individual level, the area under the receiver operating characteristic curve was 0.58 (95% CI, 0.55-0.60) for depression according to the SMFQ and 0.59 (95% CI, 0.55-0.62) for the CIS-R, indicating a 58% to 59% probability (ie, 8%-9% above chance) that a random participant with depression at age 18 years had been exposed to IPV and/or maternal depression compared with a random participant who did not have depression. In this cohort study, parental IPV and maternal depression were associated with depression in adolescence at the population level. However, estimation of an individual developing depression in adolescence based only on information about IPV or maternal depression is poor. Screening children for maternal depression and IPV to target interventions to prevent adolescent depression will fail to identify many children who might benefit and may unnecessarily target many others who do not develop depression.

Physical activity domains and incident clinical depression: A 4-year follow-up analysis from the ELSA-Brasil cohort

AimTo analyze the prospective dose-response relationships between total and domain-specific physical activity (PA) with incident clinical depression. MethodsWe used data from two waves (Wave 1: August/2008–December 2010; Wave 2: September/2012-December/2014) of the Brazilian Longitudinal Health Study (ELSA-Brasil) cohort study. Self-reported PA (total, transport, and leisure-time) was the main exposure. Incident clinical depression (new cases of depression between waves) was assessed through the Clinical Interview Schedule-Revised (CIS-R). Poisson regression models, adjusting for potential confounders, were used for data analysis. ResultsIn 12,709 adults (53.8 % women, mean age: 51.9 ± 9.0), moderate and high volumes of total PA (1-149 min/week: RR = 0.81, 0.58–1.13, 150–299 min/week: RR = 0.55, 95%CI: 0.40–0.76; ≥300 min/week: RR = 0.64, 95%CI: 0.52–0.80), and any volume of leisure-time PA (1-149 min/week: RR = 0.65, 95%CI: 0.50–0.83; 150–299 min/week: RR = 0.67, 95%CI: 0.52–0.88; RR = 0.61, 95%CI: 0.45–0.82) were associated with a lower risk of incident clinical depression. Transport PA protective only in the lower category (0.1–4.4 mMET-h/wk) (RR = 0.71, 95%CI: 0.54–0.94). LimitationsOther PA domains such as occupational and domestic were not assessed; the use of self-report measures for PA which may be subject to bias and recall issues; lack of assessment of additional potential confounders, such as sedentary behavior and family history of depression. ConclusionTotal and leisure-time PA were associated with lower incidence of clinical depression, even at lower doses. Low, moderate, and high volumes of total and leisure-time PA were associated with lower risk of incident clinical depression. Public health PA interventions aiming to prevent development of clinical depression should consider focusing on leisure-time PA.

Toward a conceptual framework of health and its operational definition: an application in the 1958 British birth cohort

BackgroundDefining and measuring Health presents a challenge, partly due to its conceptual pluralism. To measure Health as an ability to adapt and self-manage, we developed an approach within the theoretical framework of resources and reserves over the life course, recently proposed in the literature. We aimed to (i) use the conceptual framework developed to identify indicators of deteriorating health reserves, (ii) construct an overall health measure from these indicators, (iii) evaluate the association between the overall health measure and subsequent health outcomes and (iv) assess the robustness of our method.MethodsWe used data from 7,043 individuals born in 1958 in Great Britain included in the National Child Development Study. An overall health measure was constructed via the sum of three selected indicators of deteriorating health reserves in mid-life: chronic widespread pain (CWP), Clinical Interview Schedule - revised (CIS-r), and allostatic load (AL). A three-category variable was defined: impaired/medium/optimal overall health. We explored criterion validity by modelling the relationships between the overall health measure, or each reserve taken separately at 44–45 years, and self-rated health at 46 years and mortality up to 58 years, corresponding to 14 years of follow up, using Cox and logistic regressions respectively. We performed comparative analyses to assess the robustness of the method.ResultsHaving an impaired overall health measure was significantly associated with all-cause premature mortality (HRimpaired = 2.74 [1.86; 4.05]) and an increased risk of later fair/poor/very poor self-rated health (ORimpaired = 7.50 [6.29; 8.95]). The overall health measure had a greater effect on the self-rated health estimates than each indicator of deteriorating health reserves considered separately (ORAL medium = 1.82 [1.59; 2.09]; ORAL high = 2.74 [2.37; 3.16]; ORCIS-r = 5.20 [4.45; 6.08]; ORCWP = 2.85 [2.53; 3.21]). CIS-r and allostatic load were also associated with premature mortality contrary to chronic widespread pain (HRAL medium1.82 [1.27; 2.61]; HRAL high = 3.10 [2.19; 4.40]; HRCIS-r = 1.77 [1.22; 2.56]; HRCWP = 1.32 [0.98; 1.76]). The multiple comparative analyses conducted allowed us to assess the robustness of our method within this cohort.ConclusionsWe proposed a method for measuring Health in mid-life in line with the concept of Health as the ability to adapt and self-manage and the concept of health reserves. This method may be applied and further developed within the field of social and positive epidemiology.

Prevalence of post-traumatic stress disorder and common mental disorders in health-care workers in England during the COVID-19 pandemic: a two-phase cross-sectional study

Previous studies on the impact of the COVID-19 pandemic on the mental health of health-care workers have relied on self-reported screening measures to estimate the point prevalence of common mental disorders. Screening measures, which are designed to be sensitive, have low positive predictive value and often overestimate prevalence. We aimed to estimate prevalence of common mental disorders and post-traumatic stress disorder (PTSD) among health-care workers in England using diagnostic interviews. We did a two-phase, cross-sectional study comprising diagnostic interviews within a larger multisite longitudinal cohort of health-care workers (National Health Service [NHS] CHECK; n=23 462) during the COVID-19 pandemic. In the first phase, health-care workers across 18 NHS England Trusts were recruited. Baseline assessments were done using online surveys between April 24, 2020, and Jan 15, 2021. In the second phase, we selected a proportion of participants who had responded to the surveys and conducted diagnostic interviews to establish the prevalence of mental disorders. The recruitment period for the diagnostic interviews was between March 1, 2021 and Aug 27, 2021. Participants were screened with the 12-item General Health Questionnaire (GHQ-12) and assessed with the Clinical Interview Schedule-Revised (CIS-R) for common mental disorders or were screened with the 6-item Post-Traumatic Stress Disorder Checklist (PCL-6) and assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) for PTSD. The screening sample contained 23 462 participants: 2079 participants were excluded due to missing values on the GHQ-12 and 11 147 participants due to missing values on the PCL-6. 243 individuals participated in diagnostic interviews for common mental disorders (CIS-R; mean age 42 years [range 21-70]; 185 [76%] women and 58 [24%] men) and 94 individuals participated in diagnostic interviews for PTSD (CAPS-5; mean age 44 years [23-62]; 79 [84%] women and 15 [16%] men). 202 (83%) of 243 individuals in the common mental disorders sample and 83 (88%) of 94 individuals in the PTSD sample were White. GHQ-12 screening caseness for common mental disorders was 52·8% (95% CI 51·7-53·8). Using CIS-R diagnostic interviews, the estimated population prevalence of generalised anxiety disorder was 14·3% (10·4-19·2), population prevalence of depression was 13·7% (10·1-18·3), and combined population prevalence of generalised anxiety disorder and depression was 21·5% (16·9-26·8). PCL-6 screening caseness for PTSD was 25·4% (24·3-26·5). Using CAPS-5 diagnostic interviews, the estimated population prevalence of PTSD was 7·9% (4·0-15·1). The prevalence estimates of common mental disorders and PTSD in health-care workers were considerably lower when assessed using diagnostic interviews compared with screening tools. 21·5% of health-care workers met the threshold for diagnosable mental disorders, and thus might benefit from clinical intervention. UK Medical Research Council; UCL/Wellcome; Rosetrees Trust; NHS England and Improvement; Economic and Social Research Council; National Institute for Health and Care Research (NIHR) Biomedical Research Centre at the Maudsley and King's College London (KCL); NIHR Protection Research Unit in Emergency Preparedness and Response at KCL.

Variant connective tissue (joint hypermobility) and its relevance to depression and anxiety in adolescents: a cohort-based case–control study

ObjectiveTo test whether variant connective tissue structure, as indicated by the presence of joint hypermobility, poses a developmental risk for mood disorders in adolescence.DesignCohort-based case–control study.SettingData from the Avon Longitudinal...

Association between meatless diet and depressive episodes: A cross-sectional analysis of baseline data from the longitudinal study of adult health (ELSA-Brasil)

BackgroundThe association between vegetarianism and depression is still unclear. We aimed to investigate the association between a meatless diet and the presence of depressive episodes among adults. MethodsA cross-sectional analysis was performed with baseline data from the ELSA-Brasil cohort, which included 14,216 Brazilians aged 35 to 74 years. A meatless diet was defined from in a validated food frequency questionnaire. The Clinical Interview Schedule-Revised (CIS-R) instrument was used to assess depressive episodes. The association between meatless diet and presence of depressive episodes was expressed as a prevalence ratio (PR), determined by Poisson regression adjusted for potentially confounding and/or mediating variables: sociodemographic parameters, smoking, alcohol intake, physical activity, several clinical variables, self-assessed health status, body mass index, micronutrient intake, protein, food processing level, daily energy intake, and changes in diet in the preceding 6 months. ResultsWe found a positive association between the prevalence of depressive episodes and a meatless diet. Meat non-consumers experienced approximately twice the frequency of depressive episodes of meat consumers, PRs ranging from 2.05 (95%CI 1.00–4.18) in the crude model to 2.37 (95%CI 1.24–4.51) in the fully adjusted model.Limitations.The cross-sectional design precluded the investigation of causal relationships. ConclusionsDepressive episodes are more prevalent in individuals who do not eat meat, independently of socioeconomic and lifestyle factors. Nutrient deficiencies do not explain this association. The nature of the association remains unclear, and longitudinal data are needed to clarify causal relationship.

Consumption of Omega-3 and Maintenance and Incidence of Depressive Episodes: The ELSA-Brasil Study.

Depression affects 264 million persons in the world, accounting for some 4.3% of the global burden of disease. Current studies indicate that the decrease in the consumption of omega-3 food sources is associated with the increasing incidence of depression. The study aims to assess the association between the consumption of omega-3 and the maintenance and incidence of depressive episodes in adults (39–64 years) and elderly adults (>65 years). This was a longitudinal study using data from the baseline and first follow-up wave of the Longitudinal Study of Adult Health (ELSA-Brasil). Depressive episodes were obtained with the Clinical Interview Schedule Revised (CIS-R), and food consumption was measured with the Food Frequency Questionnaire (FFQ). Logistic regression was used to analyze associations between the consumption of omega-3 and depressive episodes. Fatty acids from the omega-3 family showed a protective effect against the maintenance of depressive episodes. In relation to incidence, the estimates suggest that the higher the consumption of omega-3 acids, the lower the risk of developing depressive episodes, and significant associations were found between the consumption of omega-3 and alpha-linolenic acid. Dietary consumption of omega-3, DHA, EPA, DPA, and alpha linolenic fatty acids may have a protective effect against the maintenance and incidence of depressive episodes.

The association between diabetes mellitus and incidence of depressive episodes is different based on sex: insights from ELSA-Brasil.

Objective:To investigate the association between diabetes mellitus (DM) and incidence of depressive episodes among men and women.Methods:Data were used from 12,730 participants (5866 men and 6864 women) at baseline (2008–2010) and follow-up 1 (2012–2014) of the Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort of Brazilian civil servants. Participants were classified for diabetes using self-reported and clinical information, and evaluated for presence of depressive episodes by the Clinical Interview Schedule–Revised (CIS-R). Associations were estimated by means of logistic regression models (crude and adjusted for socio-demographic variables).Results:Women classified as with DM prior to the baseline were at 48% greater risk (95% confidence interval (CI) = 1.03–2.07) of depressive episodes in the crude model and 54% greater risk (95% CI = 1.06–2.19) in the final adjusted model compared to women classified as non-DM. No significant associations were observed for men. The regression models for duration of DM and incidence of depressive episodes (n = 2143 participants; 1160 men and 983 women) returned no significant associations.Conclusion:In women classified as with prior DM, the greater risk of depressive episodes suggests that more frequent screening for depression may be beneficial as part of a multi-factorial approach to care for DM.

Common mental disorders among women and its social correlates in an urban marginalized populace in South India.

Common mental disorders (CMD) cause a range of health, social and economic burden, and disorders like depression and anxiety are more prevalent among women. Prevalence and factors contributing to increased vulnerability for CMDs have regional variation. Identification of factors contributing to the vulnerability is essential to both psychiatric epidemiology and in addressing mental health challenges in the community. This cross-sectional study aimed at understanding the burden of CMD and its association with social determinants of mental health. Women hailing from urban slum attending the outpatient family care facility for their medical problems constituted the sample. Data was collected using a clinical research form with variables such as sociodemographic profile, health profile, and psychosocial profile. The questionnaire had specific questions on indicators of poverty, certain stressors, and support system. Presence of CMD was assessed using Clinical Interview Schedule-Revised (CIS-R), a standard tool for CMD research in primary care settings. A cut off score of 12 and above was considered for detecting CMD. Research ethical principles were adhered to and data was analyzed using SPSS 21.0. Among 172 women, 77 (44.8%) were diagnosed to have CMDs. Univariate analysis revealed a significant association between age, marital status, living arrangement, educational level, difficulty with buying food, presence of debt, chronic medical illness, husband's alcohol use, marital satisfaction, experiencing abuse, family support, religious participation, and a diagnosis of CMD. Multivariate analysis showed high burden with nuclear family arrangement, difficulty to buy food, experiencing abuse and, low burden with higher educational level, family support, and religious participation. Considering the high prevalence and the treatment gap of CMDs in primary setting, family-physician should be sensitized for detection and management of CMDs. Social interventions targeting poverty, women's education and empowerment, and support system are likely to decrease the burden of CMDs in this population.

Social Capital and Depressive Episodes: Gender Differences in the ELSA-Brasil Cohort.

Introduction: The association between social capital and depression is a frequent research topic in developed countries, often with inconclusive results. Furthermore, for both social capital and depression, there are gender differences established in the literature. This study investigates gender differences in the association of social capital with the incidence and maintenance of depressive episodes.Methods: Baseline and second wave data (4 years of follow-up) from the Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort of civil servants with 15,105 workers aged 35–74 years, were used. Social capital was assessed using the Resource Generator, a scale composed of two different dimensions: “social support” and “prestige and education.” Depressive episodes were assessed using the Clinical Interview Schedule - Revised (CIS-R). The statistical analysis was performed using multinomial regression with adjustments for possible confounding factors.Results: Among men, low social capital in the “social support” dimension was associated with the incidence of depressive episodes (RR = 1.66; 95% CI: 1.01–2.72). Among women, social support was associated with the maintenance of depressive episodes (RR = 2.66; 95% CI: 1.61–4.41). Social capital was not associated with the incidence or maintenance of depressive episodes in the “prestige and education” dimension in both genders.Conclusion: The results highlight the importance of the dimension “social support” in both genders in its association with mental health. The resource-based social capital approach proved to be adequate for investigating mental health and confirms the idea that social networks can be useful in the treatment and prevention of depressive episodes.

POS-545 Identifying depression in South Asian patients receiving haemodialysis in England: A multi-centre study

Depression affects approximately 20-30% of patients receiving haemodialysis (HD). It is problematic because of association with a range of negative outcomes such as lower adherence to treatment and early mortality. This has led to greater effort to identify those experiencing associated symptoms and to offer suitable psychosocial care. The completion of self-report questionnaires is often a first step towards referral for further intervention but in countries with multi-ethnic demographics, language and or cultural barriers act to disadvantage those who cannot or do not want to engage in English. In this study, we assessed the use of culturally adapted and translated versions of commonly-used depression screening questionnaires with patients in England who identified with a South Asian heritage and had language needs or preferences in Gujarati, Punjabi, Urdu or Bengali. Patients completed adapted versions of the Patient Health Questionnaire (PHQ-9), the Centre for Epidemiological Studies Depression Scale Revised (CESD-R), and the Beck Depression Inventory II (BDI-II). A comparative sample of white-Europeans completed the questionnaires in English. The research took place across nine National Health Service (NHS) Trusts in England. Structural validity of translated questionnaires was assessed using confirmatory factor analysis (CFA). Diagnostic accuracy was explored in a subgroup of patients against ICD-10 categories using the Clinical Interview Schedule Revised (CIS-R) with receiver operating curve (ROC) analysis. 229 South Asian and 120 white-European HD patients participated. We found that a single latent depression factor largely accounted for the correlations between items of the PHQ-9, CESD-R and BDI-II. There were issues with measurement equivalence, which implied that scores on the translations may not be comparable with the English language versions. Against CIS-R based ICD-10 diagnosis of depression, sensitivity was modest (50-66.7%) across scales. Specificity was higher (81.3-93.8%). Alternative screening cut-offs did not improve positive predictive values. Culturally adapted translations of depression screening questionnaires are useful to explore symptom endorsement amongst South Asian patients in England. Consent rates and data completeness were excellent, suggesting that the exclusion of South Asians from existing research says more about methodological factors as opposed to patients being ‘hard to reach’. Data did not support the use of standard cut-off scores to classify symptom severity (i.e. mild, moderate, or severe). We also suggest that use of the CIS-R algorithms for optimal case identification requires further exploration in this setting. Taken together our findings raise important questions for how we collect and interpret patient reported outcomes from different patient communities within renal services. The study will be of interest to those working in the area of patient reported experience/ outcome measures, quality improvement, and addressing under-representation of non-indigenous kidney patients in research.

Thyroid-stimulating hormone levels and incident depression: Results from the ELSA-Brasil study.

This study aimed to prospectively evaluate whether TSH levels at baseline were associated with incident depression after four years of follow-up in a cohort of middle-aged adults, the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). TSH and free-thyroxine (FT4) levels were evaluated at baseline. Depression diagnoses were performed using the Clinical Interview Schedule-Revised (CIS-R) at baseline and after a 4-year follow-up. Poisson regression models (95% Confidence Intervals) were built to evaluate the association between TSH quintiles at baseline and incident depression. All analyses were stratified by sex. Models were presented crude, adjusted for age and sex; and further adjusted for race, education, BMI, smoking, alcohol consumption, use of antidepressants/benzodiazepines, kidney function and comorbidities. Mean age was 51.5 years, and 51.2% were women. Overall, low TSH levels (1st quintile) were associated with incident depression (adjusted RR=1.36, 95% CI 1.02-1.81), remaining significant for women (adjusted RR=1.64, 95% CI 1.15-2.33), but not for men. The same results were found when restricting analysis to euthyroid participants (adjusted RR=1.46, 95% CI 1.08-1.99), also significant for women only (adjusted RR=1.63, 95% CI 1.12-2.38). Our results showed that low TSH levels were positively associated with incident depression, particularly among women. Similar results were found when restricting the analysis to euthyroid participants. In contrast, high TSH levels were inversely associated with incident depression, also among women.

Inhibitory control of positive and negative information and adolescent depressive symptoms: a population-based cohort study.

Large population-based cohort studies of neuropsychological factors that characterise or precede depressive symptoms are rare. Most studies use small case-control or cross-sectional designs, which may cause selection bias and cannot test temporality. In a large UK population-based cohort, we investigated cross-sectional and longitudinal associations between inhibitory control of positive and negative information and adolescent depressive symptoms. Cohort study of 2328 UK adolescents who completed an affective go/no-go task at age 18. Depressive symptoms were assessed with the Clinical Interview Schedule Revised (CIS-R) and short Mood and Feeling Questionnaire (sMFQ) at age 18, and with the sMFQ 1 year later (age 19). Analyses were multilevel and traditional linear regressions, before and after adjusting for confounders. Cross-sectionally, we found little evidence that adolescents with more depressive symptoms made more inhibitory control errors [after adjustments, errors increased by 0.04% per 1 s.d. increase in sMFQ score (95% confidence interval 0.02-0.06)], but this association was not observed for the CIS-R. There was no evidence for an influence of valence. Longitudinally, there was no evidence that reduced inhibitory control was associated with future depressive symptoms. Inhibitory control of positive and negative information does not appear to be a marker of current or future depressive symptoms in adolescents and would not be a useful target in interventions to prevent adolescent depression. Our lack of convincing evidence for associations with depressive symptoms suggests that the affective go/no-go task is not a promising candidate for future neuroimaging studies of adolescent depression.

Biopsychosocial factors associated with a current depressive episode in diabetes: the ELSA-Brasil study.

AimsDepression is more prevalent in people with diabetes, and is associated with worse diabetes outcomes. Depression in diabetes is more treatment resistant, and as underlying mechanisms are unknown, development of more effective treatment strategies is complicated. A biopsychosocial model may improve our understanding of the pathophysiology, and therewith help improving treatment options.MethodsDiabetes was diagnosed according to American Diabetes Association (ADA) criteria and a current depressive episode according to the International Classification of Diseases (ICD‐10), based on the Clinical Interview Schedule Revised (CIS‐R). From the Brazilian Longitudinal Study of Adult Health (ELSA‐Brasil), we included 455 participants without diabetes with a current depressive episode and 10 900 without either diabetes or a current depressive episode. Furthermore, 2183 participants had diabetes alone and 106 had both diabetes and a current depressive episode. Variable selection was based on their relationship with depression and/or diabetes. Multinomial multivariate logistic regression was used to determine how the models differed between participants with and without diabetes.ResultsA current depressive episode in diabetes was related to being older and female, having poorer education, financial problems, experiencing discrimination at work, home and school, higher waist circumference, albumin to creatinine ratio and insulin resistance, and the presence of hypertension and cardiovascular disease. In non‐diabetes, a current depressive disorder was related to being female, not being black, low income, psychological and social factors, non‐current alcohol use, lower HDL cholesterol, higher insulin resistance and the presence of cardiovascular disease.ConclusionsA current depressive episode in the presence compared with the absence of diabetes was related more to biological than to psychosocial factors.

Sleep problems and their association with weight and waist gain - The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

ObjectiveTo evaluate the association of sleep problems with weight and waist size gain during four years of follow-up. MethodsWe investigated 13,030 participants (35–74 years) of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicentric cohort conducted with civil servants from six academic institutions recruited between 2008 and 2010. Sleep problems were assessed at baseline by the Clinical Interview Schedule - Revised (CIS-R), designed to detect common mental disorders based on somatic, depressive and anxiety symptoms. Weight and waist size were measured at baseline and at follow-up (2012–2014). Large weight and waist size gain were defined as ≥ 90th percentile (≥1.65 kg/year and ≥2.41 cm/year, respectively). ResultsSleep problems were associated with higher risk of a large weight gain (RR = 1.11; 95% CI 1.01–1.24) and large waist size gain (RR = 1.19; 95% CI 1.07–1.32), adjusted for age, sex, ethnicity, income, educational level, investigation center, smoking, alcohol intake, dietary energy intake, leisure-time physical activity and body mass index (BMI) or waist circumference at baseline. After additional adjustment for common mental disorders the associations became non-significant (RR = 0.99; 95% CI 0.88–1.12; RR = 1.08; 95% CI 0.97–1.22, respectively). ConclusionSleep problems are associated with increased risk of developing large weight and waist size gain, but are not independently associated with common mental disorders.