Higher Risk Of Depression Research Articles

Age and gender differences in the association between depression and body mass index among Saudi adults

BackgroundBoth obesity and depression pose significant public health challenges. Understanding the age-gender differences in the BMI-depression associations is crucial, especially in the Saudi context, where cultural norms, lifestyle factors, and socio-economic conditions may significantly influence these associations. We aimed to explore and elucidate these associations in Saudi adults, considering age and gender as crucial factors.MethodsThe research utilized a cross-sectional web-based survey to examine the impact of age and gender on the associations between BMI and depression. The study included 4,683 Saudi adults aged 18–60 years. The questionnaire assessed socio-demographics, lifestyle factors, chronic illnesses, and self-reported height and weight to calculate BMI. Depression Inventory-II (BDI-II), a self-reported scale, was used to evaluate depression, categorizing participants into depression and non-depression groups. A snowball convenience sampling was utilized, with clear inclusion and exclusion criteria established to mitigate potential biases. Data analysis was stratified by age and gender, and binary logistic regression was utilized to determine the associations between depression and BMI, incorporating odds ratios (ORs) in both crude and adjusted forms, along with 95% confidence intervals (CIs).ResultsThe prevalence of depression was found to be 43.3%, while 21% of participants were classified as obese. Notably, individuals in the depression group were significantly older, predominantly female, and more likely to reside in the Western and Southern regions of Saudi Arabia. They had lower family income, were more frequently non-smokers, had a higher prevalence of chronic diseases, and had higher BMI. Moreover, obese individuals had significantly higher depression scores (p < 0.05). After adjusting for confounding factors, OR for depression was significantly higher among obese individuals (1.92 [1.56–3.36]). Stratified analysis by age and gender revealed higher ORs for depression among obese participants in older age and among women.ConclusionThis study highlights a significant association between obesity and increased prevalence of depression, with notable age and gender differences in this association. The findings suggest that older adults and women, particularly those with obesity, are at a higher risk for depression. These insights emphasize the importance of tailoring public health strategies and mental health interventions to address the specific needs of these vulnerable groups in Saudi Arabia.

Risk factors of the antenatal depression in a sample of Italian pregnant women: a preliminary study.

Antenatal depression is characterized by low mood, insomnia, disorganised behaviour, irritability, and agitation during the pregnancy. If underestimated, antenatal depression is untreated during the pregnancy. It is associated to higher levels of suicide, higher risk of depression after childbirth, preeclampsia, preterm birth, low birth weight, poor interactions between child and mother and severe obstetric outcomes. New data underlined the importance to prevent the risk of depression during the pregnancy. This study examines the predictive validity of potential risk factors, such as socio-demographic and psychological factors, in developing the antenatal depression. The sample was composed by Italian pregnant women (N = 247, mean age of 33.77, SD = 4.78 years). This sample completed the Edinburg Postnatal Depression Scale (EPDS), the Teate Depression Inventory (TDI) and questionnaires about demographic variables. To study associations among variables examined bivariate correlations were computed. To analyse the role of socio-demographic factors and the psychological dimension to predict the severity of the antenatal depression a logistic regression was performed. Results showed significantly positive correlations between the EPDS and the TDI, and no associations among the EPDS and all socio-demographic factors. Therefore, only the psychological factors were significant predictive risk factors of antenatal period. Finally, higher score of the depression measured via TDI predicted higher score of the EPDS. Our results had implications in clinical field. Indeed, the early diagnosis of depression during the pregnancy can help operators in the gynaecological field to prevent the depression in the post-partum period.

Risk of Suicide and Suicidality in Patients with Moderate to Severe Psoriasis: results from the British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR).

Psoriasis is associated with poor mental health and reduced quality of life. Although the high risk for depression in patients with psoriasis is well-established, their suicidality risk is uncertain. Previous studies provide contrasting results and have not included patients with clinically-confirmed severe disease. Our aim was to determine risk of suicide among patients with moderate to severe psoriasis compared with the general population, and investigate if psychiatric comorbidity or history of suicidality increases future suicidality risk in psoriasis. We further estimated the incidence of suicidal and self-injurious behaviours in patients. Analysis was performed using the British Association of Dermatologists Biologics and Immunomodulators Register (BADBIR). As controls, general population mortality and suicide data were used. There were 9 suicides in BADBIR. The incidence rate of suicide was 12.5 per 100,000 person-years (95% CI 6.53, 24.11) in BADBIR versus 11.0 per 100,000 person-years (95% CI 10.7, 11.3) in the general population in England and Wales. Among patients, psychiatric comorbidity or past suicidality was associated with higher risk for suicidal ideation, suicide attempts and self-injurious behaviours. Suicide rates among patients with moderate to severe psoriasis were not significantly higher compared with the general population. Suicide is a rare event and our results are limited by the uncertainty in the estimate reliability. However, considering the high depression prevalence in psoriasis, our findings support the need for prompt assessment of patients for psychiatric comorbidities and suicidality history. Further research is required on suicidal behaviours and the role of psoriasis severity.

The prevalence, course, and risk factors of suicidal ideation and suicide attempts among students in vocational education

BackgroundWorldwide, suicide is one of the leading causes of death among adolescents and young adults. Given that suicide in this age group is common within vocational students, this study aims to provide insights into the prevalence, course, and risk factors of suicidal ideation (SI) and suicide attempts (SA) among students in vocational education over the past 10 years.MethodsThis study has a repeated cross-sectional design, utilizing data from 2013 to 2023 provided by the ‘Testjeleefstijl’ foundation in the Netherlands (‘Test Your Lifestyle’). In total, 101,182 students in vocational education completed a web-based standardized questionnaire. Univariate logistic regression was used to test the predictive value of risk factors separately (anxiety and depression, gender, age and school year) on SI and SA. In addition, a machine learning model (Berkelmans et al., 2023) ​was used for high-risk identification of combined risk factors (multivariate models).ResultsWithin vocational students, 12-month SI and SA prevalence increased from respectively 17.7% and 2.3% in schoolyear 2013–2014 to 23% and 3.2% in 2022–2023. Although female gender significantly predicted SI and SA in the univariate analyses, the multivariate models revealed that female gender decreased the likelihood of both SI (OR 0.9) and SA (OR 0.7). A high risk for anxiety and depression was the strongest predictor in the multivariate models for SI (OR 42.8) and SA (OR 19.0).ConclusionOver the past decade, the prevalence of SI and SA increased in students in vocational education, with the risk of anxiety and depression being the strongest contributing factor. While females had a higher prevalence of anxiety and depression, the results suggest these conditions tend to lead to SI and SA more quickly among male students. Early intervention in suicide prevention is crucial, highlighting the need to identify and address anxiety and depression. Vocational education schools have a critical role in this, emphasizing early screening and intervention, with specific attention to gender-specific factors.

Association between Adverse Childhood Experiences and Internalizing Symptoms in Adults at a Wellness Centre in India

Abstract Background: Adverse childhood experiences (ACE or childhood trauma) include very stressful and potentially traumatic events linked to a higher risk of mental health challenges and chronic conditions. India has an opportunity to study the association between ACE exposure and internalizing symptoms (depression and anxiety). To evaluate the association between exposure to ACE and internalizing symptoms (depression and anxiety) at a wellness centre in India. Methods and Material: This cross-sectional study studied a convenience sample of 909 individuals who self-assessed ACE exposure, depression (Major Depression Inventory: MDI), and anxiety levels (Generalized Anxiety Disorder: GAD-7). Logistic regression models evaluated the association between ACE and depression and anxiety levels. Results: The results show a strong association between ACE levels and depression as well as anxiety. Individuals with medium (1-3 ACEs), high (4-6 ACEs), and very high (&gt; =7 ACEs) exposure to childhood trauma are at 2–7 odds of having major depression and 1–3 odds of having anxiety. Moreover, both Gen Z and Gen Y are at a higher risk of depression and anxiety compared with Gen X. Conclusions: The research extends the findings from global research on ACE and mental health (depression, anxiety) in India, highlighting the strong association. Future work should expand the samples across the geography to enhance the insights.

Depressive Symptoms in Multiple Sclerosis: Links to Body Composition, Physical Activity, and Functional Ability.

BACKGROUND In patients with multiple sclerosis, depression and its associated symptoms are factors that reduce the health-related quality of life can affect the course of the disease and the patient's compliance with therapeutic recommendations, or may even increase the risk of suicide. This study aimed to determine the relationship between body composition, motor function of limbs, physical activity, and the occurrence of depressive symptoms in patients with multiple sclerosis. MATERIAL AND METHODS The study group included 110 patients - 84 women (76.4%) and 26 men (23.6%) - with multiple sclerosis and with or without depression. Disability status was assessed using the EDSS scale. Depressive symptoms were recognized based on the Beck Depression Inventory-II, while motor function was determined with the 9-Hole Peg Test and Timed 25-Foot Walk test. Accelerometers were used to evaluate physical activity of patients. Statistical analysis of collected data was performed using logistic regression. RESULTS Depressive symptoms (BDI-II score ≥14) were observed in 24.55% of the participants. MS patients with and without depression symptoms differed significantly in terms of fat mass, T25-FW, and 9-HPT-dominant hand. Multivariate regression analyses demonstrated that increased adiposity (OR=1.09; 95% CI=1.02-1.16; P=.008; and decreased motor ability of the upper limb, both dominant (OR=1.07; 95% CI=1.01-1.15; P=.043) and non-dominant one (OR=1.10 95% CI 1.01-1.18; P=.025) were associated with a higher risk of depression. The differences in physical activity and T25-FW between groups were statistically insignificant. CONCLUSIONS The severity of depression symptoms was related to higher body mass and decreased functional ability of the upper limbs in patients with MS. Thus, a detailed evaluation of the patient's upper-limb function should constitute an integral part of motor function assessment of patients with MS.

Self-Assessment of Self-Worth and Its Relationship with Depression Level: A Case Study of Female Students in Banyuwangi, Indonesia

Background: This study was motivated by the important role of self-esteem in mental health, where low self-esteem is often associated with a higher risk of depression, especially among female college students who are vulnerable to academic and social pressures. The prevalence of depression in Indonesia is significant, with the 15-24 age group recording a prevalence of 6.2%, where many female college students face challenges that can worsen their mental well-being. Therefore, this study aims to explore the relationship between self-esteem and depression levels in female university students in Banyuwangi, in order to provide a deeper understanding and support depression prevention interventions. Methods: This study applies a quantitative approach with a correlational design. The research sample consisted of 81 people, selected by accidental random sampling technique. The research instrument used the Rosenberg Self-Esteem Scale (SES) and Beck Depression Inventory (BDI) which were distributed through online Goggle form. Results: Data analysis showed that there was a significant relationship or association between the level of self-esteem and the level of depression in respondents. Pearson correlation analysis showed a correlation coefficient of -0.457 (p &lt;0.01), indicating a strong and negative relationship between the two variables. Conclusion: approximately 20.9% of the variation in the level of depression can be explained by variations in the level of self-esteem.

Predicted vitamin D levels and risk of depression in the SUN Project: A prospective cohort study

The current study aimed to investigate the association between predicted vitamin D status and depression in a prospective Spanish cohort of university graduates. The SUN Project is a dynamic cohort study designed to investigate multiple aspects of health and lifestyle. Participants were asked to complete a comprehensive questionnaire consisting of 556 items, that included a validated food-frequency questionnaire. Participants initially free of depression were classified as incident cases if they reported a medical diagnosis of depression during follow-up. Serum vitamin D levels were predicted by a previously validated equation. Vitamin D deficiency was defined as vitamin D levels below 20 ng/mL. Cox models were used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI). We included 15,175 Spanish university graduates [mean (SD) age: 36.9 year (11.5)] followed-up for a median of 12.7 years. Among 192,976 person-years of follow-up, we identified 753 incident cases of depression. Participants with vitamin D deficiency had a 27% higher risk of depression as compared to those with vitamin D sufficiency (HR: 1.27, 95% CI: 1.09–1.48; p = 0.002) after adjusting for potential confounders. Furthermore, a significant effect modification by female sex was observed with higher depression risks associated with vitamin D deficiency in women than in men (p for interaction = 0.034). In educated middle-aged Spanish adults, we observed a direct association between vitamin D deficiency and the risk of depression, that was stronger among women.

Empirical insights into the interaction effects of groups at high risk of depression on online social platforms with NLP-based sentiment analysis

With the proliferation of digital technology and the increasing prevalence of social media, some users at high risk of depression have opted to seek solace, acceptance, and assistance in online communities. However, the extant research is deficient in terms of the segmentation of groups, particularly subcultural groups. By analyzing the “Super Hashtags” and “Tree Hole” groups on Sina Weibo from January to March 2023 using a crawler and the ERNIE 3.0-Base model for sentiment analysis, the study uncovers distinct sentiment profiles and interaction patterns, revealing significant correlations between interaction metrics and sentiment levels. The findings indicate that while there are no significant differences in sentiment levels between the two communities, the “Tree Hole” community exhibits greater sentiment variability. Moreover, the study identifies that interaction behaviors are closely linked to sentiment states, emphasizing the importance of understanding the complex dynamics between online interactions and mental well-being. These insights contribute to the development of more effective support mechanisms within online platforms for individuals at risk of depression.

Predicting Depression Among Chinese Patients with Narcolepsy Type 1: A Machine-Learning Approach.

Depression is a common psychiatric issue among patients with narcolepsy type 1 (NT1). Effective management requires accurate screening and prediction of depression in NT1 patients. This study aims to identify relevant factors for predicting depression in Chinese NT1 patients using machine learning (ML) approaches. A total of 203 drug-free NT1 patients (aged 5-61), diagnosed based on the ICSD-3 criteria, were consecutively recruited from the Sleep Medicine Center at Peking University People's Hospital between September 2019 and April 2023. Depression, daytime sleepiness, and impulsivity were assessed using the Center for Epidemiologic Studies Depression Scale for Children (CES-DC) or the Self-Rating Depression Scale (SDS), the Epworth Sleepiness Scale for adult or children and adolescents (ESS or ESS-CHAD), and the Barratt Impulse Scale (BIS-11). Demographic characteristics and objective sleep parameters were also analyzed. Three ML models-Logistic Regression (LR), Random Forest (RF), and Support Vector Machine (SVM)-were used to predict depression. Model performance was evaluated using receiver operating curve (AUC), accuracy, precision, recall, F1 score, and decision curve analysis (DCA). The LR model identified hallucinations (OR 2.21, 95% CI 1.01-4.90, p = 0.048) and motor impulsivity (OR 1.10, 95% CI 1.02-1.18, p = 0.015) as predictors of depression. Among the ML models, SVM showed the best performance with an AUC of 0.653, accuracy of 0.659, sensitivity of 0.727, and F1 score of 0.696, reflecting its effectiveness in integrating sleep-related and psychosocial factors. This study highlights the potential of ML models for predicting depression in NT1 patients. The SVM model shows promise in identifying patients at high risk of depression, offering a foundation for developing a data-driven, personalized decision-making tool. Further research should validate these findings in diverse populations and include additional psychological variables to enhance model accuracy.

Managing opioids and mitigating opioid risks in patients with cancer: An environmental scan of the attitudes, confidence, and practices of ambulatory, community and hospital pharmacists practicing in Canada.

Canada is in the midst of an overdose crisis. The use of prescription opioids in Canada has increased steadily over the past two decades, with stark increases in opioid-induced respiratory depression and related deaths. Opioids are the mainstay of treatment for cancer-related pain. Patients with cancer are not immune to the risks associated with opioid use but are underrepresented in available literature outlining risk mitigation strategies. Pharmacists are ideally placed to employ opioid risk mitigation practices to support safe and effective opioid use for patients with cancer-related pain. However, the current attitudes, confidence, and safety practices of pharmacists around how to best support these patients are not known. This study was a descriptive environmental scan of pharmacists who provide direct patient care in Canada. An electronic questionnaire was built using the web based Opinio software. It was distributed via email by several provincial and national pharmacy organizations and online platforms. The questionnaire consisted of Likert-scale and open-ended questions and was open to participants for a 6-week period from February 12th to March 23rd, 2020. Analysis was conducted using descriptive statistics and qualitative content analysis. Eighty-one responses from pharmacists in nine provinces were included in the analysis. Respondents endorsed limited and varied practices when caring for patients receiving opioids for cancer-related pain. Further, they demonstrated wide ranging confidence and attitudes regarding opioid risk mitigation practices and beliefs. Less than 50% of pharmacists were aware of resources available for their patients with non-medical opioid use, and/or patients at high risk of opioid-induced respiratory depression. Education, resources, and communication were the most commonly reported perceived facilitators and barriers to resource use. Pharmacists in Canada report employing opioid risk mitigation practices with low and varied frequency when caring for patients receiving opioids for cancer-related pain. They endorsed varied confidence and limited awareness of available provider and patient resources. These findings may help inform the development of new education models and evidence-based guidelines. New education models and evidence-based guidelines will support pharmacists in their pharmaceutical care of this vulnerable patient population, ultimately aiming to improve patient outcomes.

The joint associations of physical activity and ultra-processed food consumption with depression: A cohort study in the UK Biobank

BackgroundDespite substantial evidence regarding independent associations between physical activity (PA) and ultra-processed foods (UPF) consumption with depression, the joint effects of these two factors remain unknown. MethodsThis study included 99,126 participants without depression in the UK Biobank at baseline. A 24-h recall method was used to assess UPF consumption, and self-reported total physical activity (TPA), moderate-to-vigorous physical activity (MVPA), and vigorous physical activity (VPA) were assessed by metabolic equivalent task (MET). A series of Cox proportional hazard regression models were used to explore the independent and joint effects of TPA, MVPA, VPA and UPF consumption on depression. ResultsThe incidence rate of depression was 1.94 % [95 % confidence interval (CI): 1.80 %–2.10 %] per 1000 person-years after an average follow-up of 12.10 years. We found that MVPA and UPF consumption had additive interactions on depression risk (p < 0.05). Participants in Q1 of TPA and Q4 of UPF consumption (HR: 1.83, 95%CI: 1.45–2.31) showed a higher risk for depression than those in Q4 of TPA and Q1 of UPF consumption. Compared with the participants with WHO guideline-recommended MVPA and the lowest UPF consumption, those below recommended MVPA (HR: 1.51, 95%CI: 1.20–1.89) or above recommended MVPA (HR: 1.40, 95%CI: 1.10–1.78) and with the highest UPF consumption had a higher risk for depression. LimitationsStudy limitations include use of self-reported data, observational study and concerns regarding generalizability. ConclusionHigher UPF consumption, accompanied by lower PA levels regardless of TPA, MVPA, and VPA, is associated with a higher risk of depression. Our study offers insights on public health priorities to decrease the risk of depression in the population by addressing both PA and UPF consumption together.

Mental health during the COVID-19 pandemic compared to the years before – a cohort study on sports students

PurposeWithin the student population, students who study sport at the university level represent a special cohort struggling with specific academic and developmental challenges. Therefore, it is reasonable to assume that sports students are particularly affected by the COVID-19 pandemic in terms of their mental health. The aim of this study is to examine whether mental health (i.e. depression and well-being) among sports students changed during the COVID-19 pandemic compared to the data before the COVID-19 pandemic.Design/methodology/approachThe current study compared 907 German sports students before the COVID-19 pandemic to 1,124 German sports students during the COVID-19 pandemic (55.7% BA students, 13.3% MA students and 29.4% PE students). Mental health was assessed with the Patient Health Questionnaire (PHQ-2) (risk for depression) and the well-being index (WHO-5). To identify students at risk, a cut-off score of = 3 (PHQ-2) or of = 12 (WHO-5) was used.FindingsThe results show that across all study programs, the risk for depression was significantly higher and well-being was significantly lower during the COVID-19 pandemic compared to the pre-pandemic period. Moreover, remarkably more sports students were at high risk for depression (11.1% vs 38.3%) or showed strongly decreased well-being (24.6% vs 57.3%) during the COVID-19 pandemic compared to the pre-pandemic period.Originality/valueThe results are comparable to those of other fields of study that do not involve physical activity. Implications for further research, for sports students’ mental health practice and for mental health professionals are discussed. It remains to be examined to what extent this impairment also has an impact on the further psychological development of the students after the pandemic.

Depression among general outpatient department attendees in selected hospitals in Somalia: magnitude and associated factors

BackgroundDepressive disorders are among the common mental health conditions in the general outpatient setting and affect patients’ load and treatment outcomes. People who suffer from depression frequently consult general practitioners and prefer to attribute their symptoms to physical illness rather than mental illness. Little is known about the magnitude and associated factors of depression among patients attending general outpatient services in Somalia. The study aimed at determining the prevalence and associated factors of depression among them.MethodsThis is an institution-based cross-sectional study among randomly selected 422 patients who attended general outpatient services of two hospitals in Mogadishu. We applied three standardized instruments, such as the Somali version of the Patient Health Questionnaire (PHQ-9), the Oslo Social Support Scale (OSSS-3), and the Perceived Stress Scale-10 (PSS-10). We analyzed data using the statistical software SPSS version 29. We calculated prevalence and its 95% Confidence Interval (CI) and identified associated factors by bivariate and Multivariate analysis. We considered the association significant when p value is < 0.05.ResultsThe prevalence of depression symptoms was found to be 55% (95% CI 50–60%). The result also showed that 55.0% were females, 50.7% were aged between 26 and 44 years, 44.3% were single, 29.9% achieved tertiary education, and 44.3% were unemployed. Multivariate analysis established that age of between 26 and 44 years (aOR = 2.86, 95%CI:1.30–6.29, p = 0.009), being separated/divorced (aOR = 2.37, 95%CI: 1.16–4.82, p = 0.018), income level of ≤$100 (aOR = 3.71, 95% CI:1.36–10.09, p = 0.010), and high stress levels (aOR = 20.06, 95%CI:7.33–54.94, p < 0.001) were independent factors that significantly associated with depressive symptoms.ConclusionThis study found high levels of depression among patients attending outpatient clinics, with age, marital status, education level, income level, family history of psychiatry disorder, and stress level being key predictors. Regular screening among patients in outpatient clinics and proper referral are crucial in ensuring that those at high risk of depression are managed effectively.

Higher caloric ratio of carbohydrate intake associated with increased risk of depression: A cross-sectional analysis of NHANES data from 2005 to 2020

IntroductionDepression remains a significant global mental health challenge. However, the relationship between the Caloric Ratio of Carbohydrate Intake (CRC) and depression remains unclear. MethodsThis study utilizes data from the NHANES database spanning 2005–2020 and employs R programming language for data analysis. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). CRC was calculated as total carbohydrate intake*4/total caloric intake. Multivariable logistic regression models and regression spline models were applied to further explore the relationship between CRC and Depression. ResultsData from 9254 participants were included, with 1530 individuals identified with depression. A higher CRC, exceeding 54.1 % (Quartile 4 (Q4) of the population), was associated with higher levels of depressive symptoms. Adjusted multivariable logistic regression models indicated a higher depression level (β = 0.5102, 95%CI [0.2419–0.7784], P = 0.0002), higher risk of depression (HR = 1.3380, 95 % CI [1.1331–1.5812], P = 0.0006) and higher impact of depression on life (HR = 1.5133, 95 % CI [1.1656–1.9746], P = 0.0020) at CRC-Q4 levels compared to Quartile 1 (Q1) of the population levels. ConclusionIn this extensive cross-sectional study, our findings suggest that a higher CRC is significantly associated with an increased likelihood of depressive symptoms among U.S. adults.

The associations of socioeconomic status, social activities, and loneliness with depressive symptoms in adults aged 50 years and older across 24 countries: findings from five prospective cohort studies

Depression is the leading cause of mortality among mental health disorders. Evidence about the associations of socioeconomic status, social activities, and loneliness with depression is scarce. We aimed to identify whether social activities and loneliness mediate the association between socioeconomic status and depression, and the extent of interactive or joint relationships between social activities, loneliness, and socioeconomic status on depression. In this population-based, cross-national cohort study we used data from five nationally representative surveysacross 24countries between Feb 15, 2008, and Feb 27, 2019: the Health and Retirement Study (HRS); theEnglish Longitudinal Study of Ageing (ELSA); the Survey of Health, Ageing and Retirement in Europe (SHARE); theChina Health and Retirement Longitudinal Study (CHARLS); and the Mexican Health and Ageing Study (MHAS). We included participants who were aged 50years and older with reported information on socioeconomic status, social activities, and loneliness at baseline, and who had been assessed at least twice. We excluded participants with depressive symptoms at baseline; those with missing data on depressive symptoms and covariates; and those lost to follow-up. We defined socioeconomic status as high and low using latent class analysis based on family income, education, and employment status. Depression was assessed using the Center for Epidemiological Studies Depression Scale (CES-D) or EURO-D. We applied Cox proportional hazard models to estimate the association of socioeconomic status with depression. We used random-effects models to obtain pooled results. Joint and interactive effects of socioeconomic status, social activities, and loneliness on depression were explored, and the mediating roles of social activities and loneliness in the association between socioeconomic status and depression were explored using causal mediation analysis. A total of 69 160participants were included in our study and, during a median follow-up of 5years, a total of 20 237participants developed depression with a pooled incidence of 7·2 (95% CI 4·4-10·0) per 100 person-years. Compared with participants with high socioeconomic status, those with low socioeconomic status had a higher risk of depression (pooled hazard ratio [HR] 1·34; 95% CI 1·23-1·44). The proportion of the associations between socioeconomic status and depression mediated by social activities and loneliness were 6·12% (1·14-28·45) and 5·54% (0·71-27·62), respectively. We only observed a significant multiplicative interaction of socioeconomic status and loneliness with depression (pooled HR 0·84; 0·79-0·90). Compared with participants with high socioeconomic status and who were socially active and not lonely, those with low socioeconomic status and who were socially inactive and lonely had a higher risk of depression (pooled HR 2·45; 2·08-2·82). Social inactivity and loneliness positively mediated a small proportion of the association between socioeconomic status and depression, indicating that other approaches in addition to interventions targeting social isolation and loneliness are required to mitigate the risk of depression in older adults. Additionally, the joint effects of socioeconomic status, social activities, and loneliness highlight the benefits of simultaneous and integrated interventions to reduce the global burden of depression. National Natural Science Foundation of China.

Health care needs and barriers to care among the transgender population: a study from western Rajasthan

BackgroundTransgender people comprise an estimated 0.3–0.5% (25 million) of the global population. The public health agenda focuses on understanding and improving the health and well-being of gender minorities. Transgender (TG) persons often have complex healthcare needs and suffer significant health disparities in multiple arenas. The international literature suggests that this community is at a higher risk of depression, and other mental health problems, including HIV. Many transgender people experience gender dysphoria and seek specific medical needs such as sex reassignment surgeries, implants, hormonal therapies, etc., but are unable to access these services due to financial or social reasons. The objective of this study was to assess the healthcare needs and associated barriers experienced by transgender people in Western Rajasthan. Methodology: A qualitative study was carried out in which multilevel stakeholder interviews were conducted using interview and focus group discussion guides. Data was analyzed using the qualitative thematic analysis technique. Results: Findings reveal that transgender people have expressed their need to access health services for general health needs, including but not limited to mental health, non-communicable diseases, and infectious diseases. Barriers to healthcare services were identified on 3 levels: health system, social and personal. Health system barriers include policy, accessibility, affordability, and acceptability issues. Social factors such as inadequate housing, education, and job opportunities also play an important role in affecting the individual’s health-seeking behavior. The knowledge of healthcare providers in this context was also limited in context of health insurance schemes, package of services available for transgenders and the importance of gender sensitive healthcare. Conclusion: Transgender people expressed the need for mental health services, programs targeting nutritional improvement, gender-affirmation procedures besides regular screening of non-communicable diseases as operational for males and females. Levels of barriers have been identified at various levels ranging from absence of targeted policies to individual behavior.

Alternation of psychological resilience may moderate mentalization toward mental health conditions from macro- and microstructure aspects

ObjectiveWe aim to investigate the interplay between mentalization, brain microstructure, and psychological resilience as potential protective factors against mental illness. MethodFour hundred and twenty-six participants (mean age 40.12±16.95; 202 males, 224 females), without psychiatric or neurological history, completed assessments: Dissociative Process Scale (DPS), Peace of Mind (PoM), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Resilience Scale for Adults (RSA), and Magnetic Resonance Imaging (MRI) structures with selected regions of interest, and Diffusion Tensor Imaging (DTI) maps from various tracts in the right hemisphere and connection to the frontal areas, including anterior thalamic radiation (ATR), Cingulum (hippocampus) (CH), Corticospinal tract (CST), Superior longitudinal fasciculus (SLF), Inferior fronto-occipital fasciculus (IFOF), and Uncinate fasciculus (UF) were analyzed. ResultsTwo clusters, representing hypomentalization (HypoM) and hypermentalization (HyperM), were identified based on DPS, CPSS, and RFQ responses. One-way ANOVA showed no significant age or gender differences between clusters. The HypoM group exhibited lower PoM scores, higher BDI and BAI scores, and lower RSA scores (ps< 0.05). Structural brain metric comparison showed significant differences in GMV in the right caudal middle frontal gyrus (rcMFG), right superior frontal gyrus (rsFG), and right frontal pole (rFP) between groups. In addition, the HyperM individuals with a higher risk of depression and a higher ratio of intrapersonal to interpersonal factors of resilience were found with reduced GMV on the rcMFG. Additionally, analyses of DTI metrics revealed significant differences between two groups in rATR and rSLF in terms of fractional anisotropy (FA) values; rATR, rCST, rUF, rSLF, rCH and rIFOF in terms of mean diffusivity (MD) values, and radial diffusivity (RD) (corrected p = 0.05). Moreover, the positive correlation between different domains of resilience and white matter (WM) integrity implied further enhancement of intrapersonal or interpersonal resilience factors that are different for people with different mentalization. ConclusionsThe findings underscore the importance of considering both intrapersonal and interpersonal factors in understanding the interactions between psychological resilience and mental health conditions relevant to brain mechanisms.

Development, validation, and visualization of a novel nomogram to predict depression risk in patients with stroke

BackgroundThis study aimed to develop and validate a predictive nomogram model applicable to depression risk in stroke patients. MethodsParticipants from the NHANES database (n = 1097) were enrolled from 2005 to 2018; 767 subjects were randomly assigned to the training cohort, and the remaining subjects composed the testing cohort. A nomogram containing the optimal predictors identified by the least absolute shrinkage and selection operator (LASSO) and logistic regression methods was constructed to estimate the probability of depression in stroke patients. To evaluate the performance of the nomogram, the area under the receiver operating characteristic curve (AUC), calibration plot, decision curve analysis (DCA) and internal validation were utilized. ResultsAge, family income, trouble sleeping, coronary heart disease, and total cholesterol were included in the nomogram after filtering predictive variables. The AUCs of the nomogram for the training and testing cohorts were 0.782 (95 % CI = 0.742–0.821) and 0.755 (95 % CI = 0.675–0.834), respectively. The calibration plot revealed that the predicted probability was extremely close to the actual probability of depression occurrence in both the training and testing cohorts. DCA revealed that the nomogram model in the training and testing cohorts had a net benefit when the risk thresholds were 0–0.59 and 0–0.375, respectively. LimitationsThis study was limited by the absence of clinical external validation, which hindered the estimation of the nomogram's external applicability. In addition, this study has a cross-sectional design. ConclusionsA novel nomogram was successfully constructed and proven to be beneficial for identifying individuals at high risk for depression among stroke patients.

Mental Health Care Support in Rural India

More than 150 million people in India need mental health care but few have access to affordable care, especially in rural areas. To determine whether a multifaceted intervention involving a digital health care model along with a community-based antistigma campaign leads to reduced depression risk and lower mental health-related stigma among adults residing in rural India. This parallel, cluster randomized, usual care-controlled trial was conducted from September 2020 to December 2021 with blinded follow-up assessments at 3, 6, and 12 months at 44 rural primary health centers across 3 districts in Haryana and Andhra Pradesh states in India. Adults aged 18 years and older at high risk of depression or self-harm defined by either a Patient Health Questionnaire-9 item (PHQ-9) score of 10 or greater, a Generalized Anxiety Disorder-7 item (GAD-7) score of 10 or greater, or a score of 2 or greater on the self-harm/suicide risk question on the PHQ-9. A second cohort of adults not at high risk were selected randomly from the remaining screened population. Data were cleaned and analyzed from April 2022 to February 2023. The 12-month intervention included a community-based antistigma campaign involving all participants and a digital mental health intervention involving only participants at high risk. Primary health care workers were trained to identify and manage participants at high risk using the Mental Health Gap Action Programme guidelines from the World Health Organization. The 2 coprimary outcomes assessed at 12 months were mean PHQ-9 scores in the high-risk cohort and mean behavior scores in the combined high-risk and non-high-risk cohorts using the Mental Health Knowledge, Attitude, and Behavior scale. Altogether, 9928 participants were recruited (3365 at high risk and 6563 not at high risk; 5638 [57%] female and 4290 [43%] male; mean [SD] age, 43 [16] years) with 9057 (91.2%) followed up at 12 months. Mean PHQ-9 scores at 12 months for the high-risk cohort were lower in the intervention vs control groups (2.77 vs 4.48; mean difference, -1.71; 95% CI, -2.53 to -0.89; P < .001). The remission rate in the high-risk cohort (PHQ-9 and GAD-7 scores <5 and no risk of self-harm) was higher in the intervention vs control group (74.7% vs 50.6%; odds ratio [OR], 2.88; 95% CI, 1.53 to 5.42; P = .001). Across both cohorts, there was no difference in 12-month behavior scores in the intervention vs control group (17.39 vs 17.74; mean difference, -0.35; 95% CI, -1.11 to 0.41; P = .36). A multifaceted intervention was effective in reducing depression risk but did not improve intended help-seeking behaviors for mental illness. Clinical Trial Registry India: CTRI/2018/08/015355.