Higher Risk Of Major Depressive Disorder Research Articles

The long-term spatio-temporal trends in burden and attributable risk factors of major depressive disorder at global, regional and national levels during 1990-2019: a systematic analysis for GBD 2019.

Caused by multiple risk factors, heavy burden of major depressive disorder (MDD) poses serious challenges to public health worldwide over the past 30 years. Yet the burden and attributable risk factors of MDD were not systematically known. We aimed to reveal the long-term spatio-temporal trends in the burden and attributable risk factors of MDD at global, regional and national levels during 1990-2019. We obtained MDD and attributable risk factors data from Global Burden of Disease Study 2019. We used joinpoint regression model to assess the temporal trend in MDD burden, and age-period-cohort model to measure the effects of age, period and birth cohort on MDD incidence rate. We utilized population attributable fractions (PAFs) to estimate the specific proportions of MDD burden attributed to given risk factors. During 1990-2019, the global number of MDD incident cases, prevalent cases and disability-adjusted life years (DALYs) increased by 59.10%, 59.57% and 58.57%, respectively. Whereas the global age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR) and age-standardized DALYs rate (ASDR) of MDD decreased during 1990-2019. The ASIR, ASPR and ASDR in women were 1.62, 1.62 and 1.60 times as that in men in 2019, respectively. The highest age-specific incidence, prevalence and DALYs rate occurred at the age of 60-64 in women, and at the age of 75-84 in men, but the maximum increasing trends in these age-specific rates occurred at the age of 5-9. Population living during 2000-2004 had higher risk of MDD. MDD burden varied by socio-demographic index (SDI), regions and nations. In 2019, low-SDI region, Central sub-Saharan Africa and Uganda had the highest ASIR, ASPR and ASDR. The global PAFs of intimate partner violence (IPV), childhood sexual abuse (CSA) and bullying victimization (BV) were 8.43%, 5.46% and 4.86% in 2019, respectively. Over the past 30 years, the global ASIR, ASPR and ASDR of MDD had decreased trends, while the burden of MDD was still serious, and multiple disparities in MDD burden remarkably existed. Women, elderly and populations living during 2000-2004 and in low-SDI regions, had more severe burden of MDD. Children were more susceptible to MDD. Up to 18.75% of global MDD burden would be eliminated through early preventing against IPV, CSA and BV. Tailored strategies-and-measures in different regions and demographic groups based on findings in this studywould be urgently needed to eliminate the impacts of modifiable risk factors on MDD, and then mitigate the burden of MDD.

The impact of genetic risk for schizophrenia on eating disorder clinical presentations

A growing body of literature recognizes associations between eating disorders (EDs) and schizophrenia and suggests that familial liability to schizophrenia in individuals with anorexia nervosa (AN) reveals distinct patterns of clinical outcomes. To further investigate the influence of schizophrenia genetic liability among individuals with EDs, we evaluated the associations between schizophrenia polygenic risk scores (PRS) and clinical presentations of individuals with EDs including their overall health condition and ED-related symptoms. Using data from two previous studies of the genetics of EDs comprising 3,573 Anorexia Nervosa Genetics Initiative (ANGI) cases and 696 Binge Eating Genetics Initiative (BEGIN) cases born after 1973 and linked to the Swedish National Patient Register, we examined the association of schizophrenia PRS on ED clinical features, psychiatric comorbidities, and somatic and mental health burden. Among ANGI cases, higher schizophrenia PRS was statistically significantly associated with higher risk of major depressive disorder (MDD) measured by hazard ratio (HR) with 95% confidence interval (CI) (HR [95% CI]: 1.07 [1.02, 1.13]) and substance abuse disorder (SUD) (HR [95% CI]: 1.14 [1.03, 1.25]) after applying multiple testing correction. Additionally, higher schizophrenia PRS was associated with decreased clinical impairment assessment scores (−0.56, 95% CI: [−1.04, −0.08]) at the conventional significance level (p < 0.05). Further, in BEGIN cases, higher schizophrenia PRS was statistically significantly associated with earlier age at first ED symptom (−0.35 year, 95% CI: [−0.64, −0.06]), higher ED symptom scores (0.16, 95% CI: [0.04, 0.29]), higher risk of MDD (HR [95% CI]: 1.18 [1.04, 1.34]) and SUD (HR [95% CI]: 1.36 [1.07, 1.73]). Similar, but attenuated, patterns held in the subgroup of exclusively AN vs other eating disorder (OED) cases. These results suggest a similar pattern of influence of schizophrenia PRS for AN and OED cases in terms of psychiatric comorbidities, but a different pattern in terms of ED-related clinical features. The disparity of the effect of schizophrenia PRS on AN vs OED merits further investigation.

Four modifiable factors that mediate the effect of educational time on major depressive disorder risk: A network Mendelian randomization study.

Major depressive disorder (MDD) is a mental illness, which is a notable public health problem that aggravates the global economic burden. This study aimed to investigate the causal relationship between education and MDD risk and the contributions of effects mediated by four modifiable factors. Instrumental variables were screened from several large-scale genome-wide association study (GWAS) data (years of schooling with 766,345 participants, MDD with 59,851 cases and 113,154 controls, neuroticism with 329,821 individuals, smoking behavior with 195,068 cases and 164,638 controls, body mass index [BMI] with 336,107 individuals, and household income with 397,751 individuals). The data were used to evaluate the association of the four modifiable factors (neuroticism, smoking behavior, BMI, and household income) that mediate the effect of education on MDD risk via Mendelian randomization (MR) analysis. Each standard deviation increase in years of schooling could reduce the risk for MDD by 30.70%. Higher neuroticism and BMI were associated with a higher risk of MDD. Non-smoking status and increased household income were protective factors for MDD. Notably, the mediator neuroticism, BMI, smoking behavior, and household income explained 52.92%, 15.54%, 31.86%, and 81.30% of the effect of years of schooling on MDD risk, respectively. Longer years of schooling have a protective effect on MDD risk. Reasonable interventions to reduce neuroticism, BMI, smoking, and increasing household income are beneficial for MDD prevention. Our work provides new ideas for the development of prevention strategies for MDD.

Family coaggregation of type 1 diabetes mellitus, major depressive disorder, attention-deficiency hyperactivity disorder and autism spectrum disorder in affected families: a nationwide study.

This study aimed to examine the risk of T1D, major depressive disorder (MDD), attention-deficiency hyperactivity disorder (ADHD), and autism spectrum disorder (ASD), in first-degree relatives (FDRs) of patients with T1D. We enrolled 24,555 FDRs of individuals with T1D and 1:4 matched controls (N = 98,220) based on age and sex using data from the Taiwan National Health Insurance Research Database between 2001 and 2011. Poisson regression analyses were performed to estimate the risks of MDD, attention-deficiency hyperactivity disorder (ADHD), and autism spectrum disorder among the FDRs. Finally, we assessed the impact of DKA in the familial coaggregation. After adjusting for demographic characteristics, FDRs of individuals with T1D had higher risk of T1D (reported as relative risk with 95% confidence interval: 46.07, 33.36-63.63) and MDD (1.17, 1.04-1.32) than controls. Stratified by sex, female FDRs had increased risk of MDD (1.30, 1.13-1.51), while male FDRs had increased risk of ADHD (1.21, 1.01-1.44). Stratified by kinship, parents of individuals with T1D had increased risk of MDD (1.24, 1.06-1.44); offspring of individuals with T1D had increased risk of ADHD (1.41, 1.11-1.79). Importantly, FDRs of individuals with T1D and DKA had higher risk of MDD (1.35, 1.11-1.64) and ADHD (1.40, 1.07-1.82) than controls; however, such risks were not observed in FDRs of individuals with T1D but without DKA. The individual risks of T1D, MDD, and ADHD were increased in families that included patients with T1D, and DKA might play a role in such coaggregation with MDD and ADHD. Future studies are warranted to investigate the underlying mechanisms.

Associations between parental socioeconomic-, family-, and sibling status and risk of eating disorders in offspring in a Danish national female cohort.

ObjectiveStudies on parental socioeconomic status (SES) and family risk factors for eating disorders (EDs) have yielded inconsistent results; however, several studies have identified high parental educational attainment as a risk factor. The aim was to evaluate associations of parental SES and family composition with anorexia nervosa (AN), bulimia nervosa (BN), and eating disorders not otherwise specified (EDNOS) in the offspring, adjusting for parental age and parental mental health.MethodsThe cohort included women born in Denmark between January 1, 1989 and December 31, 2010, derived from Danish national registers. Each person was followed from their sixth birthday until onset of the disorder of interest or to December 31, 2016. Exposure variables were: childhood SES, defined as individually evaluated parental level of income, occupation, and education; sibling status; and family composition. Outcomes were: AN, BN, EDNOS, and major depressive disorder (MDD), included as a psychiatric comparison disorder. Risks were estimated using Cox proportional hazards.ResultsHigh parental SES was associated with increased risk of especially AN, and less so BN and EDNOS, in offspring. In comparison, low SES was associated with a higher risk of MDD. No differences between maternal or paternal socioeconomic risk factors were found. Family composition and sibling status showed limited influence on ED risk.DiscussionSES shows opposite associations with AN than MDD, whereas associations with BN and EDNOS are intermediate. The socioeconomic backdrop of AN differs markedly from that reported in other psychiatric disorders. Whether that is due to genetic and/or environmental factors remains unknown.Public Significance statementParental socioeconomic background (SES) may influence eating disorders risk in offspring somewhat differently than other psychiatric disorders. In Denmark, higher parental SES was associated with increased risk of, particularly, anorexia nervosa (AN). Importantly AN does strike across the SES spectrum. We must ensure that individuals of all backgrounds have equal access to care and are equally likely to be detected and treated appropriately for eating disorders.

Prevalence and Unmet Need for Mental Healthcare of Major Depressive Disorder in Community-Dwelling Chinese People Living With Vision Disability.

ObjectiveMental health services have been recognized as an essential part of the comprehensive eye care services, but data regarding the mental health of people living with vision disability (PLwVD) remain very limited. This study examined the epidemiology of major depressive disorder (MDD) among Chinese PLwVD, as well as their perceived needs for and utilization of mental health services.MethodsBy using stratified cluster sampling method, a total of 1,753 PLwVD were successfully recruited from 73 urban communities and 169 rural villages in Wuhan, China, and interviewed with the Mini-international Neuropsychiatric Interview 5.0. Standardized questions were used to measure perceived mental healthcare needs and use of mental health services of PLwVD with MDD.ResultsThe one-month prevalence of MDD was 24.4%. Among the PLwVD with MDD, 26.0% perceived needs for mental healthcare and only 1.2% sought treatment from mental health specialists for their emotional problems. Factors associated with MDD were middle age [vs. young adulthood, odds ratio (OR) = 1.96, P < 0.001], older adulthood (vs. young adulthood, OR = 1.79, P = 0.004), being never-married (vs. married, remarried, and cohabiting, OR = 1.96, P < 0.001), being separated, divorced, and widowed (vs. married, remarried, and cohabiting, OR = 12.30, P < 0.001), a low level of objective social support (vs. high, OR = 1.83, P < 0.001), currently drinking (OR = 1.81, P < 0.001), having childhood-onset eye conditions (OR = 1.89, P = 0.005), and having difficulties in performing daily activities (OR = 2.78, P < 0.001).ConclusionsChinese PLwVD are at high risk for MDD and have a high level of unmet need for mental healthcare. Public strategies are warranted to improve the mental health literacy of PLwVD and make the mental health services available, accessible, and affordable for PLwVD.

Association of the Combined Effects between Insulin-Like Growth Factor-1 Gene Polymorphisms and Negative Life Events with Major Depressive Disorder among Chinese population in the Context of Oxidative Stress

Background Oxidative stress may be increased in a number of psychiatric disorders, including major depressive disorder (MDD). MDD has been shown to be related to insulin-like growth factor-1 (IGF-1) as well as to negative life events; exploring the interaction of IGF-1 polymorphisms and negative life events on the risk of MDD is needed. The aim of this study was to analyze the single and combined effects of IGF-1 polymorphisms (rs972936 and rs978458) and negative life events with MDD among Chinese population. Methods 420 MDD patients (according to DSM-V) and 420 age- and gender-matched control subjects were recruited in a case-control study. Negative life events were assessed using standard rating scales. IGF-1 rs972936 and rs978458 were identified by sequencing. The chi-square (χ2) tests were performed to explore the association of negative life events and IGF-1 polymorphisms with MDD. Results Our results found that the negative life events were associated with the risk of MDD (P < 0.001; OR = 3.28, 95% CI: 2.19-4.85). The genotypes of IGF-1 were associated with the risk of MDD (P < 0.001); carrying the IGF-1 rs972936 C allele (OR = 1.53, 95% CI: 1.26-1.85) and rs978458 T allele (OR = 1.92, 95% CI: 1.58-2.34) had a higher risk of MDD. The combined effects between IGF-1 rs978458 and negative life events were associated with the risk of MDD (P < 0.05; OR = 2.94, 95% CI: 1.23-7.03), but IGF-1 rs972936 was not associated (P > 0.05). Conclusions Based on the oxidative stress hypothesis, we confirm that carrying IGF-1 rs972936 C allele and rs978458 T allele have a higher risk of MDD and the combined effects between IGF-1 rs978458 and negative life events were associated with the risk of MDD among Chinese population.

Community-Level Social Support Infrastructure and Adult Onset of Major Depressive Disorder in a South Asian Postconflict Setting

Individual-level social support protects against major depressive disorder (MDD) among adults exposed to trauma. Little is known about the consequences of community-level interventions in the general population. To determine the potential consequences of neighborhood social infrastructure on incident MDD in a high-risk general population. This longitudinal, multilevel study estimated associations between a neighborhood-level program in a case-control design and subsequent individual outcomes across 10 years (2006-2015) in a cohort of young adults. Exogenously placed social programs simulate natural experiment conditions in a high-poverty population experiencing armed conflict (1998-2006). The western Chitwan valley in Nepal has a general population at high risk of MDD, with neighborhoods exposed to interventions to improve social support. From a random sample (response rate 93%) selected to represent the general population in 2016, participants aged 25 to 34 years in 2006 were studied. These individuals resided within 149 neighborhoods that varied in their availability of active social support programs. The analyses were conducted between October 2020 and November 2021. The Small Farmers Development Program (SFDP) uses shared, joint liability financial credit among neighbors to build social capital and cohesion within neighborhoods. Onset of DSM-IV MDD after the conflict, assessed by the Nepal-specific, clinically validated World Mental Health Composite International Diagnostic Interview with a life history calendar. The hypothesis tested was that exposure to SFDP reduced adult onset of MDD. Of the 1917 survey participants, 886 (46.2%) were women, and 856 (44.7%) were of Brahmin or Chhetri ethnicity. Of the 149 neighborhoods, 21 had an active SFDP group, and 156 of 1917 (8.1%) participants experienced MDD between 2006 and 2015. Discrete-time hazard models showed participants living in neighborhoods with an SFDP experienced incident MDD at nearly half the rate as others (odds ratio = 0.55; 95% CI, 0.30-1.02; P = .06). A multivariate, multilevel matching analysis showed the incidence of MDD among adults living in neighborhoods with an SFDP was 19 of 256 (7.4%), compared with 33 of 256 (12.9%) in the matched sample with no SFDP (z = 2.05; P = .04). Living in a neighborhood with community-level social support infrastructure was associated with reduced subsequent rates of adult-onset MDD, even in this high-risk population. Investments in such infrastructure may reduce population-level MDD, supporting clinical focus on potentially unpreventable cases.

Risk of major depressive disorder in adolescent and young adult cancer patients in Japan.

ObjectiveTo estimate the risk of major depressive disorder (MDD) in adolescent and young adult (AYA) patients with cancer in Japan and identify risk factors for MDD among these patients.MethodsThis was a matched cohort study using a large claims database in Japan. Included patients were aged 15–39 years, newly diagnosed with cancer during 2012–2017 and assessable for a follow‐up period of 12 months. Kaplan–Meier estimates and Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for MDD in the AYA patients with cancer versus age‐, sex‐ and working status‐matched cancer‐free controls. A subgroups analysis of the AYA patients with cancer was performed to explore MDD risk factors.ResultsA total of 3559 AYA patients with cancer and 35,590 matched controls were included in the analysis. Adolescent and young adult patients with cancer had a three‐fold higher risk for MDD compared with cancer‐free controls (HR, 3.12; 95% CI, 2.64–3.70). Among cancer categories with >100 patients, patients with multiple cancer categories, including those with metastatic cancer (HR, 6.73, 95% CI, 3.65–12.40) and leukemia (HR, 6.30; 95% CI, 3.75–10.58), had the greatest MDD risk versus matched controls. Patients who received inpatient chemotherapy as initial treatment had a higher risk for MDD than patients without chemotherapy (HR, 0.43; 95% CI, 0.30–0.62).ConclusionsAdolescent and young adult patients in Japan with cancer are at high risk for MDD. Particularly, those with multiple cancer categories, leukemia, and those who receive aggressive anticancer treatments should be monitored closely for symptoms of MDD.

The importance of social activity to risk of major depression in older adults.

Several social determinants of health (SDoH) have been associated with the onset of major depressive disorder (MDD). However, prior studies largely focused on individual SDoH and thus less is known about the relative importance (RI) of SDoH variables, especially in older adults. Given that risk factors for MDD may differ across the lifespan, we aimed to identify the SDoH that was most strongly related to newly diagnosed MDD in a cohort of older adults. We used self-reported health-related survey data from 41 174 older adults (50-89 years, median age = 67 years) who participated in the Mayo Clinic Biobank, and linked ICD codes for MDD in the participants' electronic health records. Participants with a history of clinically documented or self-reported MDD prior to survey completion were excluded from analysis (N = 10 938, 27%). We used Cox proportional hazards models with a gradient boosting machine approach to quantify the RI of 30 pre-selected SDoH variables on the risk of future MDD diagnosis. Following biobank enrollment, 2073 older participants were diagnosed with MDD during the follow-up period (median duration = 6.7 years). The most influential SDoH was perceived level of social activity (RI = 0.17). Lower level of social activity was associated with a higher risk of MDD [hazard ratio = 2.27 (95% CI 2.00-2.50) for highest v. lowest level]. Across a range of SDoH variables, perceived level of social activity is most strongly related to MDD in older adults. Monitoring changes in the level of social activity may help identify older adults at an increased risk of MDD.

Changes in depressive symptoms among family caregivers of patients with cancer after bereavement and their association with resilience: A prospective cohort study.

ObjectivesTo elucidate changes in depressive symptoms after bereavement and the impact of pre‐loss resilience on such changes and on the extent of complicated grief and posttraumatic growth.MethodsProspective cohort surveys were provided to family caregivers of patients with cancer in four palliative care units (PCUs) before and after bereavement. Pre‐loss Connor–Davidson Resilience Scale scores, pre‐ and post‐loss Patient Health Questionnaire‐9 scores, post‐loss Brief Grief Questionnaire scores, and the expanded Posttraumatic Growth Inventory scores were determined.ResultsOut of 186 bereaved family caregivers, 71 (38.2%) responses were analyzed, among which 47% pre‐loss and 15% post‐loss responses suggested to be a high risk for major depressive disorder (MDD). Approximately 90% of family caregivers at a high risk for post‐loss MDD were already at a high risk for pre‐loss MDD. Even after adjustment of the background variables as covariates, the interaction effect between family caregivers' pre‐loss depressive symptoms and resilience on post‐loss depressive symptoms was observed (F = 7.29; p < 0.01). Moreover, pre‐loss resilience was not associated with other bereavement outcome measures.ConclusionsAmong family caregivers of patients with cancer in PCUs, 47% and 15% had high risk for MDD before and after bereavement, respectively. Moreover, pre‐loss resilience mitigated post‐loss depressive symptoms among family caregivers who had high risk for MDD before bereavement. However, considering the study's small sample size, further research is needed.

Major depressive disorders in young immigrants: A cohort study from primary healthcare settings in Sweden.

Previous studies on major depressive disorder (MDD) among immigrants have reported mixed results. Using data from primary healthcare settings in Sweden, we compared the incidence of MDD among first- and second-generation immigrants aged 15-39 years with natives. This was a retrospective nationwide open cohort study. Eligible individuals were born 1965-1983, aged 15-39 years at baseline, and resided in Sweden for at least one year during the study period 2000-2015. We identified MDD cases through the Primary Care Registry (PCR). The follow-up for each individual started when they met the inclusion criteria and were registered in the PCR and ended at MDD diagnosis, death, emigration, moving to a county without PCR coverage, or the end of the study period, whichever came first. Results: The final sample included 1,341,676 natives and 785,860 immigrants. The MDD incidence rate per 1000 person-years ranged from 6.1 (95% confidence intervals: 6.1, 6.2) to 16.6 (95% confidence intervals: 16.2, 17.0) in native males and second-generation female immigrants with a foreign-born father, respectively. After adjusting for income, the MDD risk did not differ substantially between first-generation male and female immigrants and natives. However, male and female second-generation immigrants had a 16-29% higher adjusted risk of MDD than natives. This cohort study using primary healthcare data in Sweden, albeit incomplete, indicated that second-generation immigrants seem to be at a particularly high risk of MDDs. The underlying mechanisms need further investigation.

Functional neuroimaging biomarkers of resilience in major depressive disorder.

In this review we provide an overview of definitions and determinants of resilience in the context of neuroimaging research in major depressive disorder (MDD). We summarize emerging literature on functional neuroimaging biomarkers of resilience in MDD and discuss their clinical relevance and implications for future research. Resilience in MDD is characterized by dissociable profiles of activation and functional connectivity within brain networks involved in cognitive control, emotion regulation, and reward processing. Increased activation of frontal cortical brain regions implicated in cognitive appraisal and emotion regulation is a common characteristic of resilient individuals at high risk for MDD and of individuals with MDD with a favorable illness course. Furthermore, significant associations between fronto-striato-limbic functional connectivity and both positively interpreted stressful life events in resilient high-risk individuals and a favorable response to first-line treatments in depressed individuals suggest that neuro-compensatory changes and experience-dependent plasticity underlie resilience in MDD. Emerging research has identified functional neuroimaging biomarkers of resilience in MDD. A continued focus on identifying neurobiological underpinnings of resilience, in the context of dynamic environmental and developmental influences, will advance our understanding of resilience and improve approaches to prevention and treatment of MDD.

Mental Health and Suicidality in Separating U.S. Reserve and National Guard Personnel

Objective We examined the association of U.S. Reserve Component (RC) personnel separating from military service with the risk of mental health problems at three time periods. Methods Structured interviews were conducted with a nationally representative sample of 1,582 RC personnel at baseline and three follow-up waves from 2010 to 2013. Multivariate logistic regression analyses examined posttraumatic stress disorder (PTSD), major depressive disorder (MDD), binge drinking, suicide ideation, and mental health diagnosis by a health provider. Results Approximately 10%, 20%, and 28% of RC personnel reported separating from military service at waves 2–4. At an estimated 6 months since leaving military service, there were no differences between those who left and those who remained in service. However, at 1 year after leaving service, those who had left had a higher risk of MDD, suicidal ideation, and reporting having mental health diagnosis by a health provider. At 1.6 years after leaving military service, those who had left had a higher risk of reporting having mental health diagnosis by a health provider. The results were essentially unchanged after adjusting for baseline mental disorder for each outcome. Conclusion Results suggest a higher risk of mental health problems in RC veterans separating, compared to those who remained in the military. This risk may not occur immediately following separation but may occur within the first year or two after separation. Transition from military to civilian life may be a critical period for interventions to address the unique needs of the RC’s citizen-soldiers and reduce their risk of adverse mental health outcomes.

Accuracy of 12 short versions of the Geriatric Depression Scale to detect depression in a prospective study of a high-risk population with different levels of cognition.

To determine the accuracy of 12 previously validated short versions of the Geriatric Depression Scale (GDS) to detect major depressive disorder (MDD) in a high-risk population with and without global cognitive impairment. Cross-sectional study. Five hospitals, Western Sweden. Older adults (age ≥70 years, n = 60) assessed at a home visit 1 year after hospital care in connection with suicide attempt. Depression symptoms were rated using the established 15-item GDS. Eleven short GDS versions identified by a recent systematic review were derived from this administered version. Receiver operating characteristic curves and area under the curve (AUC) for the identification of MDD diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, were obtained for each version. The Youden Index optimal criterion was used to determine the appropriate cutoffs. Analyses were repeated after stratification by cognitive status (Mini Mental State Examination score ≤24 and >24) for the best performing GDS short versions and the established 15-item GDS. The 7-item GDS according to Broekman et al. (), with a cutoff 3, was the most accurate among the 12 short versions (AUC 0.90, 95% confidence interval 0.80-1.00), identifying MDD with sensitivity 88% and specificity 81%. The cutoff score remained consistent in the presence of global cognitive impairment, which was not the case for the standardized 15-item GDS. The Broekman 7-item GDS had high accuracy to detect MDD in this prospective clinical cohort at high risk for MDD. Further testing of GDS short versions in diverse settings is required.

Depression in lung cancer patients: A nationwide analysis.

83 Background: Depression is a major ongoing problem with cancer patients and survivors. Depression can lead to functional impairment, decreased utilization of treatment, decreased quality of life and increased suicide risk. It also leads to an extended hospital stay and increased cost of treatment. Previous studies have shown that lung cancer has a high incidence for depression. Methods: We conducted a cross-sectional study using the National Inpatient Sample (NIS) database for the year 2016. Patients who were admitted with a principal diagnosis of Malignant Neoplasm of Bronchus and Lung (MNBL) and Major Depressive Disorder (MDD) were identified using ICD-10 codes. The prevalence of MDD and the risk factors contributing to MDD were studied. Statistical analysis was performed using STATA tool and tested with Pierson Chi-Square test. Results: A total of 79096 hospitalizations with a principal diagnosis of MNBL were identified. The prevalence of depression among lung cancer patients was found to be 12.49% (n = 9881). The mean age of lung cancer patients with depression was 62.27 ± 0.10. Females with lung cancer have more risk for MDD (15%, p &lt; 0.001). Caucasian patients with lung cancer have a higher risk of MDD (13.6%, p &lt; 0.001). It was also found that lung cancer patients who are ≤ 55 years have a higher risk of MDD (p &lt; 0.001). The average length of stay for lung cancer patients with MDD was slightly higher than lung cancer patients without MDD (6.39 days and 5.99 days respectively). The average cost of stay also had a similar pattern. Severe morbidity was seen in a greater proportion of the MDD group. Conclusions: Younger patients who are ≤ 55 years of age, Caucasians or females with lung cancer have a higher risk of MDD. Particular attention should be given to them while being in the hospital which can decrease the morbidity, and will also help to improve their quality of life.

Negative life events and major depressive disorder among HIV-positive individuals in Guangdong, China: A cross-sectional study.

HIV-positive individuals encounter a number of negative life events (NLEs). This cross-sectional study aimed to evaluate the association between NLEs and major depressive disorder (MDD) among HIV-positive individuals in Guangdong, China, about which little is known.HIV-positive individuals were recruited from the Centers for Disease Prevention and Control of Guangzhou, Zhongshan, and Yangjiang from September 2007 to September 2008. Data on NLEs were collected using a questionnaire. The Structured Clinical Interview for DSM-IV-TR Axis I Disorders-Patient Edition (SCID-I/P) based on the DSM-IV criteria was used to diagnose MDD. Multiple logistic regression analyses were conducted to evaluate the association between NLEs and MDD.Among the 339 participants, 306 (90.27%) reported that one or more NLEs had ever occurred. Participants who reported NLEs that included HIV infection, financial problems, AIDS diagnosis, HIV/AIDS discrimination, conflict with spouse or lover, conflict with other family members, problems in childbearing, and conflict with nonfamily were at a higher risk of MDD. Participants who reported more NLEs in the last year had a higher risk of MDD (OR = 2.86, 95%CI: 1.76–4.65) than individuals who reported fewer NLEs. Individuals with higher chronic stress scores had a higher risk of MDD (OR = 4.36, 95%CI: 2.44–7.78) than individuals with lower chronic stress scores. However, acute stress was not associated with MDD.NLEs were common among HIV-positive individuals. MDD was associated with a greater number of NLEs and the increased chronic stress caused by the NLEs. Interventions should be tailored to those who reported NLEs to help reduce the risk of MDD and increase the quality of life among HIV-positive individuals.

DIGITAL MONITORING OF SLEEP, MEALS, AND PHYSICAL ACTIVITY AS A PREVENTIVE INTERVENTION FOR DEPRESSION IN OLDER BEREAVED ADULTS: A PILOT STUDY ON FEASIBILITY, ACCEPTABILITY, AND SYMPTOM IMPROVEMENT

Introduction Following the death of a spouse, many older adults have difficulty performing self-care activities. For example, they may feel no reason to wake up, eat meals, or go to bed on a regular schedule. Disruptions of these key social “time cues”, or zeitgebers, in turn decrease the stability of circadian rhythms, placing these individuals at high risk for major depressive disorder (MDD) and other adverse health consequences related to poor self-care. Preserving the stability of individuals’ time cues (sleep, meals, and physical activity) after the death of a spouse may reduce depression symptoms, thereby preventing the onset of MDD and promoting a healthy adaptation to bereavement. The purpose if this study is to examine the feasibility and acceptability of a behavioral intervention that is grounded in the circadian timing system and its impact on depression symptoms in older spousally bereaved adults. Methods We developed the Widowed Elders’ Lifestyle after Loss (WELL), a pilot randomized controlled prevention trial of digital monitoring of sleep, meals, and physical activity for older spousally-bereaved adults who were at high risk for MDD. The design of WELL builds on prior studies addressing circadian rhythms in bereaved adults for the reduction of depression symptoms. The intervention arm involved 12 weeks of behavioral self-monitoring using a tablet-based app (designed by the STS), in which older adults aged 60+ track the timing and regularity of sleep, meals, and physical activities. Participants in the intervention arm also received weekly motivational health coaching. Participants were assessed at baseline, directly after the 12-week intervention period, and then at 3, 6, and 9 months post-intervention using structured diagnostic interviews and symptom rating scales. Participants in the enhanced usual care arm who reported new depression symptoms were referred to their primary care physician, as in the intervention arm. The primary outcomes of the trial were feasibility and acceptability of intervention components. The secondary outcomes were change in depression symptoms. Actigraphic technology was used to examine the 24-hour rest-activity rhythm – a downstream indicator of the circadian clock – as a mediator of depression outcomes. Results WELL randomized 50 participants, 96.2% of eligible and 34.5% of all older adults screened. Participants in the treatment arms were similar at baseline in structured self-reports. WELL was rated highly by participants; 88% were compliant in digital monitoring and 96% were retained over follow-up. One comment speaks for many in that “WELL helped organize my life.” Depression symptom burden in the intervention arm significantly declined over follow-up, compared to enhanced usual care. There was a significant increase in the regularity of participants’ rest-activity rhythm from pre- to post-intervention. The significant increase in rhythm regularity was correlated with reductions in depression symptoms, as measured by the Hamilton Rating Scale for Depression. These data will be used in confirmatory clinical trial of efficacy. Conclusions A behavioral intervention that is based on the circadian timing system, using both digital monitoring and motivational health coaching, appears to be feasible and acceptable to participants. An intervention that targets the regularity of day- and nighttime activities may reduce depression in older spousally-bereaved adults. The methodological innovations of this project may advance the field of late-life depression prevention. This research was funded by Supported in part by NIH MH103467

Increased risk for major depressive disorder in severely obese patients after bariatric surgery — a 12-year nationwide cohort study

Background: Bariatric surgery is associated with a significant improvement in depressive mood in the initial postoperative years, but the maintenance of the improvement is under debate.Aim: To explore the association between bariatric surgery and major depressive disorder (MDD) in a 12-year nationwide cohort study.Method: Using the National Health Insurance Research Database of Taiwan, we identified 2302 patients who underwent bariatric surgery in 2001–2009. These patients were matched by propensity score to 6493 obese patients who did not receive bariatric surgery. We followed the surgical and control cohorts until death, any diagnosis of MDD or 31 December 2012. We used Cox proportional hazard regression models to calculate the relative risk of MDD in those who received bariatric surgery.Results: Overall, there was a 1.70-fold (95% CI: 1.27–2.27) higher risk of MDD in the surgical group. Subjects receiving malabsorptive procedures showed a higher risk of MDD (3.01, 95% CI: 1.78–5.09) than those receiving restrictive procedures (1.51, 95% CI: 1.10–2.07). Stratified by follow-up period, there was a higher risk of MDD in the surgical group (2.92, 95% CI: 1.75–4.88) than in the restrictive group four years after bariatric surgery.Conclusions: Bariatric surgery was significantly associated with an elevated risk of MDD.KEY MESSAGESBariatric surgery is associated with a significant improvement in depressive mood in the initial postoperative years, but the improvement is not maintained. Less is known about the relationship between bariatric surgery and risk of major depressive disorder.This was the first nationwide cohort study which found that bariatric surgery was significantly associated with an elevated risk of MDD (aHR: 1.70; CI: 1.27–2.27), mainly with malabsorptive procedures (aHR: 3.01; CI: 1.78–5.09) and at time points more than four years after surgery (aHR: 2.92; CI: 1.75–4.88) compared with the risk in matched controls. These findings imply an association between long-term malabsorption and the postoperative incidence of MDD.Long-term malabsorption might be related to the incidence of major depressive disorder after bariatric surgery. The possible causal relationship between nutritional deficiency after bariatric surgery and major depressive disorder warrants further investigation.

Occupational factors associated with major depressive disorder: A Brazilian population-based study

BackgroundThere have been very few studies exploring the occupational risk factors for major depressive disorder (MDD) in the working populations in Latin America. The aim of this study was to explore the associations between a large set of occupational factors and MDD in the Brazilian working population. MethodsThe study was based on the cross-sectional data from the Brazilian National Health Survey, 2013. 60,202 people were interviewed (response rate: 91.9%). Among them, 36,442 were working, 19,450 men and 16,992 women. MDD was measured using the diagnostic algorithm (DSM-IV criteria) of the PHQ-9. Occupational factors included job characteristics, working time factors, psychosocial work stressors and physico-chemical exposures. Logistic regression models were performed and adjusted for sociodemographic factors. All analyses were conducted using weighted and stratified data by gender. ResultsThe following occupational factors were associated with a higher risk of MDD: working part time (≤20 h a week) and stress at work for both genders, workplace violence, intense physical activity, exposure to noise and chemicals among women, and prolonged exposure to sun among men. Associations of stress and violence at work with MDD were particularly strong. LimitationsCross-sectional study design, healthy worker effect and reporting bias may have impacted the results. ConclusionsThis study, one of the first studies among the Brazilian working population, showed that psychosocial work stressors were the strongest risk factors for MDD. Physico-chemical exposures deserve more attention in association with MDD. Prevention policies oriented toward the work environment may help to prevent depression at the workplace.