Independent Effects Of Depression Research Articles

Depression, Diabetes Mellitus and Mortality in Older Adults: A National Cohort Study in Taiwan.

Diabetes mellitus (DM) increases the risk of cardiovascular and all-cause mortality. The coexistence of depression and DM is associated with an increased risk of DM complications and functional morbidity. The independent effect of depression on mortality in patients with DM is unclear, and relevant Asian studies have provided inconsistent results. Accordingly, this study assessed the independent and additive effects of DM and depression on mortality in a nationally representative cohort of older adults in Taiwan over a 10-year observation period. A total of 5041 participants aged 50 years or older were observed between 1996 and 2007. We defined depression as a score of ≥8 on the 10-item Center for Epidemiologic Studies Depression (CES-D 10) scale. Additionally, we defined participants as having type 2 DM if they had received a diagnosis of type 2 DM from a health-care provider. Cox proportional hazard models were applied to analyze predictors of mortality in depression and DM comorbidity groups. During the 10-year follow-up period, 1637 deaths were documented. After adjustment for potential confounders, the hazard ratios for mortality in participants with both depression and DM, DM only, and depression only were 2.47 (95% confidence interval [CI]: 2.02-3.03), 1.95 (95% CI: 1.63-2.32), and 1.23 (95% CI: 1.09-1.39), respectively. The co-occurrence of depression with DM in Asian adults increased overall mortality rates. Our results indicate that the increased mortality hazard in individuals with DM and depression was independent of sex.

Patient Satisfaction Following Lumbar Decompression: What is the Role of Mental Health?

To determine the association between patient-reported depressive symptoms and patient satisfaction following minimally invasive lumbar decompression. Primary, single-level/multilevel minimally invasive lumbar decompression was identified. Patient-reported outcome measures (PROMs) collected preoperatively/postoperatively included visual analog scale back/leg, Oswestry Disability Index, 9-Item Patient Health Questionnaire (PHQ-9), and 12-Item Short Form Mental Composite Score (SF-12 MCS). Patients rated current satisfaction level (0-10) with back/leg pain and disability. A paired Student's t-test compared each postoperative PROM score to its preoperative baseline. At each timepoint, patients were categorized by PHQ-9 and SF-12 MCS scores. One-way analysis of variance compared patient satisfaction with back/leg pain and disability among PHQ-9 subgroups. The Student's t-test for independent samples compared patient satisfaction between SF-12 MCS subgroups. Analysis of covariance (ANCOVA) assessed differences in satisfaction between depression subgroups while controlling for preoperative/postoperative values in corresponding PROMs. 193 patients were included. All PROMs demonstrated significant postoperative improvement from 6-weeks through 2-years (P < 0.001, all), except PHQ at 9 2-years (P= 0.874). Mean satisfaction scores ranged from 6.9-7.9 (back pain), 7.3-8.0 (leg pain), and 7.6-8.0 (disability). Satisfaction with back/leg pain and disability significantly differed among PHQ-9 subgroups at all postoperative timepoints (P < 0.001, all). Accounting for baseline and current pain/disability values, ANCOVA revealed differences between PHQ-9 subgroups only in satisfaction with back pain at 2 years (P < 0.001), leg pain at 12 weeks/1 year/2 years (P ≤ 0.047, all), and disability at 6 months/2 years (P ≤ 0.049, both). Satisfaction differed between SF-12 MCS subgroups at all timepoints (P ≤ 0.047), except back pain 6 months (P= 0.263). Accounting for baseline and postoperative pain/disability, ANCOVA revealed differences in satisfaction between SF-12 MCS groups only for back/leg pain at 2 years (P ≤ 0.001, both). Independent effect of depression at long-term follow-up was significant. This highlights the importance of understanding the interaction between physical and mental health outcomes to optimize patients' perceptions of surgical outcomes.

Impact of Psychiatric Diagnosis and Treatment on Medication Adherence in Youth With Systemic Lupus Erythematosus.

Youth with systemic lupus erythematosus (SLE) experience high rates of psychiatric comorbidities, which may affect medication adherence. We undertook this study to examine the association between psychiatric disorders and hydroxychloroquine adherence and to determine whether psychiatric treatment modifies this association. We identified incident hydroxychloroquine users among youth with SLE (ages 10-24 years) using de-identified US commercial insurance claims in Optum Clinformatics Data Mart (2000-2016). Adherence was estimated using medication possession ratios (MPRs) over a 365-day time period. Multivariable linear regression models were used to estimate the effect of having any psychiatric disorder on MPRs, as well as the independent effects of depression, anxiety, adjustment, and other psychiatric disorders. We tested for interactions between psychiatric diagnoses and treatment with psychotropic medications or psychotherapy. Among 873 subjects, 20% had a psychiatric diagnosis, most commonly depression. Only adjustment disorders were independently associated with decreased MPRs (β -0.12, P = 0.05). We observed significant crossover interactions, in which psychiatric disorders had opposite effects on adherence depending on the receipt of psychiatric treatment. Among youth with any psychiatric diagnosis, psychotropic medication use was associated with a 0.15 increase in the MPR compared with no psychotropic medication use (P = 0.02 for interaction). Among youth with depression or anxiety, psychotherapy was also associated with a higher MPR compared with no psychotherapy (P = 0.05 and P < 0.01 for interaction, respectively). The impact of psychiatric disorders on medication adherence differed by whether youth had received psychiatric treatment. Improving recognition and treatment of psychiatric conditions may increase medication adherence in youth with SLE.

Posttraumatic Stress Disorder, Parenting, and Marital Adjustment among a Civilian Population.

While psychopathology in general is linked to poorer marital and parental satisfaction, there is a paucity of data regarding these interactions in parents with Posttraumatic stress disorder (PTSD). The current study addresses this issue among a civilian population. Two hundred trauma-exposed parents, mean age of 37.2, 62% mothers, were assessed using self-report questionnaires, for background variables, PTSD symptoms using the Posttraumatic Stress Diagnostic Scale (PDS), depression symptoms (Beck Depression Inventory, BDI), marital satisfaction (Dyadic Adjustment Scale, DAS-7), parenting behavior (Alabama Parenting Questionnaire, APQ-9), and parenting satisfaction (Parenting Satisfaction Questionnaire). We hypothesized that positive parenting behavior and parenting satisfaction would be negatively correlated with PTSD symptom levels, and that this relationship would be mediated by marital satisfaction; the independent effects of depression on marital and parenting functioning were also examined. Data was analyzed using structural equation modeling (SEM). Results indicated that PTSD was related to poorer parenting behavior (B = 0.089, p = 0.033), depression had a negative impact on parenting satisfaction (B = 0.983, p = 0.003), and marital satisfaction (B = −0.672, p = 0.004), and marital satisfaction fully mediated the relationship between depression and parenting. The findings demonstrated that the effects of PTSD can cast a pall not only over the individual but over the entire family. Interventions are needed to address these issues.

Abstract P297: Depressive Symptoms, Weight Gain and Risk of Obesity in U.S. Black Women

Background: Depression may lead to weight gain and obesity. Few prospective studies have examined the relation of depression to weight gain and obesity among African-American women, though obesity disproportionately affects this population. Methods: We assessed the association of depressive symptoms with weight gain and risk of obesity in the Black Women’s Health Study (BWHS), an ongoing prospective cohort study initiated in 1995. We included 22,240 non-obese women who completed the Center for Epidemiologic Studies Depression Scale (CES-D) in 1999 and followed them for weight change through 2013. We categorized depressive symptoms into CES-D &lt;16, 16-22, 23-32, and ≥33; values of ≥16 have a moderate to high sensitivity for major depression. We used generalized estimating equations to estimate mean weight change in relation to symptoms of depression and Cox regression models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between depressive symptoms and incident obesity. The basic multivariate model was adjusted for age, time period, height, antidepressants use, education, and marital status. To this model, we added lifestyle factors (dietary patterns, energy intake, exercise, hours of TV watching, smoking, and alcohol drinking) to assess whether the association of depressive symptoms with weight gain and obesity was independent of these factors. Results: Relative to CES-D &lt;16, mean weight-gain difference (95% CI) during 14 years of follow-up for CES-D 16-22, 23-32, and ≥33 were 0.88 kg (0.40, 1.36), 0.28 kg (-0.35, 0.90), and 1.15 kg (0.07, 2.22) (P-trend = 0.001), respectively. After adjustment for lifestyle factors, the respective differences decreased to 0.80 kg (0.32, 1.27), 0.15 kg (-0.48, 0.78), and 1.01 kg (-0.06, 2.09) (P-trend = 0.008). Participants with CES-D ≥16 had a mean weight difference of 0.73 kg (0.34, 1.12) in the basic multivariate model, and 0.62 kg (0.24, 1.01) in the lifestyle-adjusted model compared to subjects with CES-D &lt;16. Regarding incident obesity, in the basic multivariate model, HRs (95% CI) of obesity for CES-D 16-22, 23-32, and ≥33 were 1.17 (1.10, 1.25), 1.07 (0.98, 1.16), and 1.21 (1.08, 1.37) (P-trend &lt;0.0001), respectively. Corresponding HRs decreased to 1.14 (1.07, 1.22), 1.03 (0.95, 1.12), and 1.16 (1.03, 1.31) (P-trend = 0.001) after adjustment for dietary and physical activity covariates. Women with CES-D ≥16 had a HR of obesity equal to 1.14 (1.08, 1.20) in the basic multivariate model, and 1.11 (1.05, 1.17) in the lifestyle-adjusted model. Conclusions: Our results suggest a modest association of symptoms of depression with higher weight gain and risk of obesity. The association was attenuated but persisted after successive adjustment for lifestyle factors, suggesting an independent effect of depression on weight gain and obesity.

THE IMPACT OF DEPRESSION ON MATERNAL RESPONSES TO INFANT FACES IN PREGNANCY.

ABSTRACTResearch has suggested that prenatal depression may be associated with disrupted maternal responses to infant stimuli, with depressed pregnant women not showing the bias toward distressed infants as that observed in nondepressed pregnant women. The current study examined the effects of depression on self‐ reported responses to infant stimuli, in early pregnancy. Women with clinical depression (n = 38), and nondepressed women (n = 67) were recruited from a wider cognitive behavioral therapy trial. They completed Maternal Response Scales in which they were presented with images of distressed, neutral, and happy infant faces, with no time limit. The women rated their responses to these images along three dimensions—wanting to comfort, wanting to turn away, and feelings of anxiety—using Likert scales via a computerized task. There was evidence that women with depression in pregnancy showed different responses than did women without depression. Women with depression were substantially more likely to be in the highest quartile for ratings of wanting to turn away, odds (OR) ratio = 4.15, 95% confidence intervals (CIs) = 1.63–10.5, p = .003, and also were substantially less likely to be in the highest quartile for wanting to comfort a distressed infant face, OR = 0.22, 95% CIs = 0.09–0.54, p < .001. Findings are consistent with there being both a heightened avoidant and a reduced comforting response toward distressed infants in depressed pregnant women, providing some support that depression disrupts maternal preparations at a conscious level.

The association of anxiety and depression with future dementia diagnosis: a case-control study in primary care

Background.Depression is identified as a risk factor for dementia. Little research has been carried out on the importance of anxiety, despite strong evidence of co-morbidity with depression.Objective.To examine the association of anxiety and depression with future dementia diagnosis.Methods.This case-control study was set in the Consultations in Primary Care Archive. Cases (n = 400), were patients aged >65 years old. About 1353 controls were matched to cases by gender, practice, age group and year of case diagnosis. Read codes of risk factors for dementia were searched in patient records. The associations of prior consultations for anxiety and depression, with future diagnosis of dementia were determined using multivariable logistic regression.Results.A past anxiety diagnosis was associated with a future dementia diagnosis [odds ratio 2.76 (95% confidence interval 2.11–3.62)]. The association of depression with dementia was attenuated by the high prevalence of anxiety within those who have depression. Including an interaction of depression and anxiety showed that having only depression was associated with future dementia diagnosis but a diagnosis of depression alongside anxiety did not increase the likelihood of a dementia diagnosis compared to having just an anxiety diagnosis.Conclusion.Prior diagnosis of anxiety was strongly associated with dementia diagnosis after adjustment for other risk factors. The independent effect of depression was weaker compared to anxiety. Given the higher prevalence of anxiety primary care physicians should consider anxiety as well as depression as premorbid risk factors of dementia to improve early recognition and facilitate greater access to services.

Neuropsychological Function 5 Years after Cardiac Surgery and the Effect of Psychological Distress

Research has shown conflicting results with regard to the influence of depression and anxiety on neuropsychological performance following coronary artery bypass graft (CABG) surgery. Notably, the independent effects of depression and anxiety have not been examined among CABG candidates in the longer term where it is has been suggested that these patients show marked cognitive deterioration. A neuropsychological test battery and measures of psychological distress were completed by 86 CABG patients and 50 nonsurgical control participants at baseline and 6 months, whereas 75 patients and 36 controls, respectively, completed a 5-year follow-up. In CABG patients, cognitive and affective depressive symptoms were independently associated with lower and worse performance on the Boston Naming Test, Purdue Peg Board, and Digit Symbol Coding 6 months after surgery, whereas at 5-year follow-up an effect for Digit Symbol persisted, and an association was also observed for the Trail Making Test (TMT). On average, CABG patients performed worse on TMT and Digit Symbol at 6 months, whereas at 5-year follow-up their performance was worse on short-term delayed verbal recall. The results among the CABG patients did not show a consistent pattern of association between psychological distress and those neuropsychological domains that were on average significantly lower than a nonsurgical control group. The results here also support the use of nonbiased statistical methodology to document dysfunction among heterogeneous cognitive domains after CABG surgery.

Depression and functional impairment independently contribute to decreased quality of life in cancer patients prior to chemotherapy

Background. An inverse association either between depression or impaired functional status and quality of life (QoL) has been reported for cancer patients, but the independent effect of depression or depressive symptoms and of functional impairment on QoL is unclear. Patients and methods. We investigated the prevalence of depression or depressive symptoms with the Beck Depression Inventory (BDI), the functional impairment with the ECOG-Performance-Status (ECOG-PS) and the QoL with the EORTC-QLQ-C30 questionnaire in a sample of 175 hospitalised cancer patients prior to the start of chemotherapy. Results. Sixteen of 175 patients (9.1%) screened positive for major depression, 29 (16.6%) had mild to moderate depressive symptoms. In 11 of 15 scales of the EORTC-QLQ-C30 questionnaire depression or depressive symptoms were significantly associated with worse QoL in univariate analysis and in 12 of 15 scales poor ECOG-PS was significantly associated with worse QoL. In multivariate analysis including ECOG-PS and BDI, the effect of depression and/or depressive symptoms on QoL was persistent in seven scales: global QoL, physical- and role functioning, fatigue, nausea & vomiting, pain, and constipation, that of ECOG-PS in five scales: global QoL, emotional functioning, nausea & vomiting, pain, and appetite loss. Conclusions. Signs of major depression or depressive symptoms and impaired functional status contribute independently to poorer QoL in cancer patients prior to chemotherapy.

Meta-analysis urges the development of new strategies to treat depression in order to improve cardiac prognosis: reply

de Jonge and Van Melle's model, suggesting that the somatic symptoms of depression may impair prognosis in CHD independently of severity of disease, offers a useful framework for future work.1 The first step will be to confirm that such an independent effect exists. Their findings need to be confirmed in other studies which control effectively for the severity of cardiac disease and examine different dimensions of depression. A meta-analysis using individual patient data would allow systematic adjustment for confounders and severity of disease. If an independent effect of depression is confirmed …

Dissociation of inflammatory markers and natural killer cell activity in major depressive disorder

Major depressive disorder is associated with increases in infectious disease risk as well as the incidence of inflammatory disorders. Declines of natural killer (NK) cell activity are reliably found in depression, whereas other studies report evidence of inflammation in depressed patients. The potential association between NK activity and circulating markers of immune activation has not been previously examined in the context of major depression. In this study, we measured levels of NK activity, circulating levels of interleukin-6 (IL-6), soluble interleukin-2 receptor, and acute phase proteins in 25 male patients with current major depressive disorder and 25 age, gender, and body weight comparable controls. As compared to controls, patients with major depressive disorder showed lower NK activity ( p = .05) and higher circulating levels of IL-6 ( p < .05). Levels of NK activity were not correlated with IL-6 or with other markers of immune activation. The independent effect of depression on inflammatory markers and natural killer immune responses has implications for understanding individual differences in the adverse health effects of major depressive disorder.