Lower CES-D Scores Research Articles

The trajectory of depressive symptoms over time and the presence of depressive symptoms at a single time point with the risk of dementia among US older adults: A national prospective cohort study.

This study aims to assess the association between trajectories of depressive symptoms and the risk of dementia, and to compare the predictive ability of trajectories using multiple data points with depressive symptoms at a single data point. We included 5306 older adults from the Health and Retirement Study. We assessed depressive symptoms using the Center for Epidemiology Depression Scale (CES-D), and identified its 8- year trajectories (2002-2010) using latent class trajectory modeling. We calculated hazard ratios (HR) using Cox proportional hazards models. The concordance index (C-index) was used to compare the discriminative power of the models. We identified two trajectories of depressive symptoms, characterized by maintaining low CES-D scores, and moderate starting scores that steadily increased throughout the follow-up period. During 40,199 person-years, compared to the low trajectory, the increasing trajectory of depressive symptoms was associated with a higher risk of dementia (HR = 1.35; 95% CI: 1.09-1.67) (C-index = 0.759). For every point increase in the degree of depressive symptoms (CES-D scores) in 2010, the risk of dementia increased by 7% (95% CI: 1.03-1.12) (C-index = 0.760). The presence of depressive symptoms (CES-D scores ≥3) in 2010 was not associated with an increased risk of dementia (HR = 1.18; 95% CI: 0.98-1.43) (C-index = 0.759). The C-index values of cox models showed similar discriminative power. The increasing trajectory of depressive symptoms at multiple data points and the degree of depressive symptoms at a single data point were associated with an increased risk of subsequent dementia among older adults.

The cross-sectional relationship among omega-3 fatty acid levels, cardiorespiratory fitness, and depressive symptoms from the Cooper Center Longitudinal Study

ObjectiveOmega-3 polyunsaturated fatty acids (omega-3 PUFAs) are implicated in numerous illnesses including depression. The literature is mixed regarding the relationship between n-3 PUFA levels and depression, and studies based on self-reported dietary n-3 PUFA intake may not accurately reflect in vivo levels. MethodThe current cross-sectional analysis examined the relationship between erythrocyte levels (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and depressive symptoms (Center for Epidemiologic Studies Depression Scale; CESD), adjusting for health-related factors and omega-3 supplement use in 16,398 adults assessed at the Cooper Clinic in Dallas, Texas for preventative medical examinations between April 6, 2009, and September 1, 2020. A three-stage hierarchical linear regression was conducted to examine the EPA and DHA levels on CES-D before and after inclusion of cardiorespiratory fitness (CRF) and high sensitivity C-reactive protein (hs-CRP) in the model. ResultsDHA level, but not EPA level, was significantly associated with CES-D scores. Taking omega-3 supplements was associated with lower CES-D scores even when adjusting for CRF, while hs-CRP was non-significantly associated with CES-D scores. These findings suggest that DHA levels are related to depressive symptom severity. Omega-3 PUFA supplement use was associated with lower CES-D scores when controlling for EPA and DHA levels. ConclusionThe findings from this cross-sectional study suggest that lifestyle and/or other contextual factors unrelated to EPA and DHA levels may also be associated with depressive symptom severity. Longitudinal studies are needed to evaluate the role of health-related mediators among these relationships.

A longitudinal and qualitative analysis of caregiver depression and quality of life in the Cape Town adolescent antiretroviral cohort

• Depression in caregivers of adolescents living with perinatal HIV (PHIV) was associated with poor physical health, poor overall quality of life and externalizing and internalizing behaviour problems in PHIV adolescents. • However, depression, physical health and family resources in caregivers of PHIV adolescents improved significantly longitudinally. • Improved quality of life was associated with less depression and improved access to family resources and social support. • Main concerns of caregivers include educational/learning and health problems in PHIV adolescents. This study aimed to investigate depression and quality of life longitudinally in caregivers of adolescents with perinatally acquired HIV (PHIV) enrolled in the Cape Town Adolescent Antiretroviral Cohort (CTAAC). Depression, socioeconomic factors and quality of life were assessed in caregivers (n=121) at baseline and 36 months follow-up using the Centers for Epidemiological Studies Depression Scale (CESD), the Family Resources Scale (FRS), Family Support Scale (FSS), and the World Health Organization's Quality of Life Scale (WHOQoL). Internalizing and externalizing behaviors in PHIV adolescents were assessed using the Child Behaviour Checklist (CBCL). Qualitative analysis was conducted to highlight key concerns raised by caregivers in caring for PHIV adolescents. CESD was significantly lower at follow-up compared to baseline (p=0.001), with FRS (p=0.003) and WHOQoL physical health (p=0.038) significantly higher at follow-up. Higher CESD scores were predicted by increased CBCL internalizing (baseline: p=0.002; follow-up: p=0.021) and externalizing behavior (baseline: p=0.010; follow-up: p=0.015) in PHIV adolescents and decreased WHOQoL physical health (baseline: p=0.001; follow-up: p=0.016) and WHOQoL overall quality of life (baseline: p=0.003; follow-up: p=0.019). Higher WHOQoL Total Score was predicted by lower CESD scores (baseline: p<0.001; follow-up: p=0.010) and higher FRS (p<0.001) and FSS (baseline: p<0.001; follow-up: p=0.001). Qualitative analysis indicated that caregivers’ main concerns were PHIV adolescent educational and health problems. Self-report measures and small sample size. This study highlights the need for adequate intervention strategies to provide resources and social support to caregivers of PHIV adolescents in order to improve their mental health.

Distinct depressive symptom trajectories are associated with incident diabetes among Chinese middle-aged and older adults: The China Health and Retirement Longitudinal Study

ObjectivePrevious studies have reported that depression and depressive symptom are associated with diabetes incident. However, the association between long-term depressive symptom patterns and risk of diabetes remains unknown. The aim of present study was to evaluate the association between depressive symptom trajectories and risk of diabetes. MethodsWe used data of 8806 participants (≥45 years old) from the China Health and Retirement Longitudinal Study (CHARLS). Trajectories of depressive symptom were identified by latent mixture modeling. Multivariable logistic regression model was used to examine the association of depressive symptom trajectories with diabetes. ResultsFive depressive symptom trajectories were identified, characterizing by maintaining a low CES-D scores throughout the follow-up (low-stable; 3227 participants [36.65%]); maintaining a moderate CES-D scores throughout the follow-up (moderate-stable; 3402 participants [38.63%]); moderate starting CES-D scores then increasing scores (moderate-increasing; 681 participants [7.73%%]); high starting CES-D scores but then decreasing scores (high-decreasing; 1061 participants [12.05%]); and maintained high CES-D scores throughout the follow-up (high-stable; 435 participants [4.94%]). During 2015 to 2018 (Wave 3 to Wave 4), a total of 312 respondents experienced diabetes. Compared with participants in the low-stable depressive symptom trajectory, those following a high-decreasing (ORs = 2.04; 95%CIs 1.48–2.98) and high-stable depressive symptom trajectories (ORs = 3.26; 95%CIs 2.06–5.16) were at substantially higher risk of developing diabetes. ConclusionsIndividuals with high-decreasing and high-stable depressive symptom trajectories over time were associated with increased risk of incident diabetes. Long-term depressive symptom may be a strong predictor of having diabetes.

Trajectories of depressive symptoms in systemic lupus erythematosus over time.

The objectives of this study were to determine the trajectories of depressive symptoms in patients with SLE and to identify baseline characteristics that are associated with a patient's trajectory of depression. Data from the Lupus Outcomes Study at the University of California, San Francisco were analysed. Depressive symptomatology was assessed in years two through seven using the Center for Epidemiologic Studies Depression Scale (CES-D), with higher scores representing more severe depressive symptoms. Group-based trajectory modelling was used to determine latent classes of CES-D scores over time. Ordinal logistic regression analyses were performed to identify baseline characteristics associated with worse classes of depressive symptoms. CES-D scores for 763 individuals with SLE over 6years were mapped into four distinct classes. Class 1 (36%) and class 2 (32%) comprised the largest proportion of the cohort and were defined by the lowest and low CES-D scores (no depression), respectively. Class 3 (22%) and class 4 (10%) had high and the highest scores (depression), respectively. Greater age [odds ratio (OR): 0.97, 95% CI: 0.96, 0.99] and higher education level (OR: 0.79, 95% CI: 0.70, 0.89) at baseline were associated with lower odds of membership in worse classes of depressive symptoms. Conversely, lower income (OR: 1.73, 95% CI: 1.03, 2.92), worse SF-36 physical functioning scores (OR: 1.12, 95% CI: 1.12, 1.13) and worse SF-36 bodily pain scores (OR: 1.58, 95% CI: 1.55, 1.61) were positively associated with membership in worse classes of depressive symptoms. Four classes of depressive symptoms were identified in patients with SLE. Understanding the trajectories of depressive symptoms and the associated risk factors can aid in the management of these symptoms in individuals living with SLE.

The impact of son or daughter care on Chinese older adults' mental health

RationaleThe traditional cultural norm in China is that eldercare should be offered by a son and his family. However, several decades of family planning policies and rapid economic growth have led to low fertility rates, urbanisation, and cultural change, resulting in both reduced household size and the availability of sons. The traditional eldercare system is thus being challenged, especially in urban areas, with an increasing number of daughters supporting their parents, enabled by rising female empowerment, formal economic employment and improved financial capacities. Existing studies examine and compare the amount and types of support provided by sons and daughters, but very little is known about the differential health outcomes of parents experiencing eldercare offered by sons and by daughters. ObjectiveThis study investigates the difference in mental health outcomes of parents who receive eldercare from their sons and from their daughters. MethodWe analyse waves 2013, 2015, and 2018 of the China Health and Retirement Longitudinal Study, with mental health measured by a 10-item Center for Epidemiological Studies-Depression (CES-D-10) score. We compare the CES-D-10 score between parents with different sources of care — son's family, daughter's family or other — with multivariate statistical analysis. ResultsReceiving regular care from a son (or a daughter-in-law) is associated with a lower CES-D score than from a daughter (or a son-in-law). The difference mainly exists amongst those with a stronger son preference and those who are heavily deponent on their children, in particular rural parents, mothers, and those with less wealth. ConclusionOur study explores the evidence on mental health inequalities among parents with different sources of care, highlighting that lack of son care creates an apparent mental health disadvantage. Lowering older adults’ dependency on their children may alleviate this inequality by improving their financial independence. We also suggest the development of a long-term care system and greater facilitation of older adults to take-up supplementary services for family care.

Perceived Neighborhood Disorder, Social Cohesion, and Depressive Symptoms among Spousal Caregivers

Most prior research on caregivers’ mental health focused on individual or household factors, we know much less about the influence of neighborhood factors on mental health of spousal caregivers. The current study fills the gap in our knowledge by examining the association of neighborhood characteristics (i.e., perceived neighborhood disorder and neighborhood social cohesion) and depressive symptoms among spousal caregivers. We used data from 2006 to 2016 waves of the Health and Retirement Study, which includes 2,362 spousal caregivers. Negative binomial regression models were estimated to examine the association of perceived neighborhood disorder and neighborhood social cohesion with depressive symptoms. A greater perceived neighborhood disorder was associated with higher CES-D scores, which indicates more depressive symptoms. On the other hand, a higher level of neighborhood social cohesion was associated with lower CES-D scores. When they were included in the same model, the association between neighborhood disorder and depression disappeared, while respondents who reported higher levels of neighborhood social cohesion continue to exhibit lower CES-D scores than those lived in less cohesive neighborhoods. This study highlights the importance of neighborhood contexts in understanding caregivers’ well-being. Findings of this study suggest that neighborhood social cohesion may attenuate the negative effects of neighborhood disorder. Therefore, enhancing positive characteristics of the neighborhood may promote well-being of spousal caregivers.

Perceived Neighborhood Disorder, Social Cohesion, and Depressive Symptoms among Spousal Caregivers

Although individual sleep characteristics are related to frailty, these characteristics do not occur separately. A multidimensional measure of sleep might provide a better estimation of frailty compared to isolated sleep characteristics. This study investigated the association of a multidimensional measure of sleep health with frailty and examined whether such relationship differed by sex. Data were from the Taiwan Longitudinal Study on Aging (2011), a survey with a nationally representative sample of Taiwanese older adults (N=2,015). Frailty was defined using the Fried-criteria. Self-reported sleep during the past month was used to conceptualize the five sleep health dimensions in the SATED model (satisfaction-alertness-timing-efficiency-duration; higher scores representing better sleep health). Their relationship was estimated using logistic regression analysis adjusting for sociodemographic (age, sex, education), health (chronic conditions, cognitive function, pain, depressive symptoms [excluding items overlapping with frailty and sleep]), and lifestyle (drinking, smoking, exercise) characteristics. The results showed that having a better sleep health composite score was significantly related to lower odds of being frail in both sexes adjusting for sociodemographic information. Such effect remained significant among females but not males after adding health and lifestyle characteristics to the models. Sleep satisfaction and daytime alertness in both sexes and sleep duration among females were significantly associated with frailty adjusting for sociodemographic information. Only alertness among males was significantly related to frailty in model with all covariates. Our findings show that having a better sleep health across multiple dimensions is related to a lower risk of being frail, and the association differs by sex.

Cognitive Function Trajectories in Association With the Depressive Symptoms Trajectories in Systemic Lupus Erythematosus Over Time.

Cognitive function may change over time in patients with systemic lupus erythematosus (SLE), and cognitive function trajectories have not been well studied. We aimed to identify cognitive function trajectories in SLE and describe them with depressive symptoms trajectories, and we also aimed to identify baseline factors associated with class membership in the dual trajectories. Longitudinal data from the University of California San Francisco Lupus Outcomes Study were analyzed. Two outcome trajectories were studied jointly, the Hopkins Verbal Learning Test-Revised and the Center for Epidemiologic Studies Depression Scale (CES-D) (administered annually). Univariate/multivariable logistic regression analyses examined baseline factors associated with class memberships. A total of 755 patients were studied, and 4 latent classes were identified: 1) low CES-D scores and low cognitive scores (no depression plus cognitive impairment; 20%), 2) lowest CES-D scores and highest normal cognitive scores (no depression plus normal cognition; 48%), 3) highest CES-D scores and lowest cognitive scores (depression plus cognitive impairment; 9%), and 4) high CES-D scores and cognitive score at borderline (depression plus borderline cognition; 23%). In all, 4 distinct classes of dual cognitive function and depressive symptoms were identified. Persistently low cognitive performance in 28% of patients (classes 1 and 3) did not significantly improve over 7 years. Cognitive impairment was associated with depression status in 9% of patients (class 3). Other factors also predicted latent class membership: ethnicity, education, disease activity, physical functioning, and bodily pain. These results highlight the importance of periodic assessment of cognitive function and of different aspects relevant for assessing and managing cognitive function over time in SLE.

Medication adherence is influenced by resilience in patients with systemic lupus erythematosus.

Evidence on the relationship between resilience and medication adherence in systemic lupus erythematosus (SLE) patients is lacking. We aimed to examine the impact of resilience on medication adherence in SLE patients. In a cross-sectional analysis SLE outpatients were assessed for resilience (Connor-Davison Resilience Scale, CD-RISC), depressive symptoms (CES-D) and medication adherence (Compliance Questionnaire for Rheumatology [CQR]). The disease activity index (mexSLEDAI) and damage (SLICC Damage Index) were administered. Factors independently associated with adherence were identified using multivariate logistic regression. Of the 157 patients, 152 (96.8%) were female with a median age of 45.9 (IQR: 39.0-55.5) years and disease duration of 14 (IQR: 10.0-19.0) years. Medication adherence (CQR ≥80%) and depressive symptoms were found in 74.5% and 43.9% of patients, respectively. Adherent patients had a lower CES-D score and a higher CD-RISC score. In the multivariate analysis adjusting for demographic and clinical confounders, resilience and older age protected against non-adherence (OR 0.96, [95% CI 0.94-0.99] and OR 0.96 [95% CI 0.93-0.98], respectively). In SLE patients, resilience and older age, which possibly associated with better medication adherence, may protect against non-adherence.

Omega-3 Fatty Acids and Depressive Symptomology and the Influence of Psychosocial Stress: The Hispanic Community Health Study/Study of Latinos

Abstract Objectives The literature on n-3 fatty acid (FA) intake and depressive symptoms is inconsistent, potentially due in part to the influence of psychosocial stress. Some evidence supports that n-3 intake may have greater benefit on depressive symptoms among those with high oxidative stress. We quantified the associations between dietary and plasma n-3 FA and 6-y depressive symptoms and measured the modifying effect of psychosocial stress. Methods Data are from the Hispanic Community Health Study/Study of Latinos (age 48 y, 63% female). At baseline (2008–11), EPA, DHA and n-3 very-long-chain FAs (n-3VLCFAs) were estimated using two 24-hr recalls and the NCI method. Plasma n-3 FAs were measured by mass spectrometry. Depressive symptoms were measured at baseline and 6-y follow-up with the 10-item Center for Epidemiological Studies Depression Scale (CESD). Approximately 9 months from baseline, the 10-item Perceived Stress (PSS) and Chronic Burden of Stress scales were obtained. Unstratified and psychosocial stress-stratified associations were analyzed using survey linear regression among those with dietary (n = 3537) and plasma (n = 718) FA data. Model covariates included, but were not limited to, baseline CESD score, ethnicity, study site, antidepressant use, total energy intake, and dietary or plasma n-6 FA. Results Baseline DHA and n-3VLCFA intake were inversely associated with 6-y CESD (P &amp;lt; 0.05). All examined dietary n-3 FA exposures were inversely associated with CESD among those in the highest PSS quartile (Q4) (P &amp;lt; 0.05), but this was attenuated after considering n-6 FA intake. DHA and n-3VLCFA intakes were associated with lower CESD among those with 2 chronic stressors, but not &amp;lt;1 or &amp;gt;2 stressors. Plasma n-3 FAs were not associated with CESD in PSS stratified and unstratified analyses. However, plasma n-3 FA were associated with lower CESD score among those with only 2 chronic stressors. Conclusions Dietary n-3VLCFAs, but not plasma, were inversely associated with 6-y CESD. Psychosocial stress did not clearly modify these associations. These results provide some evidence that greater n-3VLCFA intake may reduce depressive symptoms among Hispanic/Latino adults. However, considering the limitations of self-reported intake, further research is needed using biomarkers of long-term n-3 consumption and psychosocial stress to confirm our findings. Funding Sources None.

Exploring the role of built environments and depressive symptoms in community-dwelling older adults: A case of Taiwan

Objectives Depression in older adults is a growing public health concern. However, limited research has focused on the issues of physical environments and depression in the elderly in Asia. The purpose of the study is to examine the relationship between the built environments and depressive symptoms in older adults using Taiwan as an example. Methods Two national datasets were used in this study, including the 2009 National Health Interview Survey and the 2006 National Land Use Investigation in Taiwan. A total of 2,155 older adults were recruited, and eight built environments were examined among 161 townships. Depressive symptoms were measured using a 10-item CES-D scale, and four sophisticated models were built using a multi-level analysis. Results Five types of built environments were found to be significantly associated with depressive symptoms in older adults. Among them, two types of built environments, ‘health and medical services’ and ‘schools’ were highly related to a lower CES-D score and lower odds of being depressed, whereas the other three built environments, ‘cultural and historical facilities,’ ‘recreational and amusement areas,’ and ‘playgrounds and sports venues’ were significantly associated with an increasing risk of being depressed. Conclusions Different built environments had different effects on depression and some even showed a dose-response relationship. These results can help urban planners or city designers reconsider how to facilitate the construction of built environments in neighborhoods that will improve the mental health of older adults.

Association of Positive Family Relationships With Mental Health Trajectories From Adolescence to Midlife

National longitudinal studies that examine the linkages between early family experiences and sex-specific development of depression across the life course are lacking despite the urgent need for interventions in family settings to prevent adult depression. To examine whether positive adolescent family relationships are associated with reduced depressive symptoms among women and men as they enter midlife. This study analyzed data from the National Longitudinal Study of Adolescent to Adult Health, which used a multistage, stratified school-based design to select a prospective cohort of 20 745 adolescents in grades 7 to 12 from January 3, 1994, to December 26, 1995 (wave 1). Respondents were followed up during 4 additional waves from April 14 to September 9, 1996 (wave 2); April 2, 2001, to May 9, 2002 (wave 3); April 3, 2007, to February 1, 2009 (wave 4); and March 3, 2016, to May 8, 2017 (sample 1, wave 5), when the cohort was aged 32 to 42 years. The study sample of 8952 male adolescents and 9233 female adolescents that were analyzed was a US national representation of all population subgroups by sex, race/ethnicity, socioeconomic status, and geography. Adolescent family cohesion and low parent-child conflict. Levels of depressive symptoms (Center for Epidemiologic Studies-Depression Scale [CES-D]) from ages 12 to 42 years were used to estimate propensity score-weighted growth curve models to assess sex differences in trajectories of depression by levels of positive adolescent family relationships. A total of 18 185 individuals (mean [SD] age at wave 1, 15.42 [0.12] years; 9233 [50.8%] female) participated in the study. Females and males who experienced positive adolescent family relationships had significantly lower levels of depressive symptoms from early adolescence to midlife than did those who experienced less positive adolescent family relationships. For example, depressive symptoms were lower among those with high levels of family cohesion compared with those with low cohesion between 12 (1.26 lower CES-D score; 95% CI, 1.10-1.42) and 40 (0.78 lower CES-D score; 95% CI, 0.50-1.06) years of age among females and between 12 (0.72 lower CES-D score; 95% CI, 0.57-0.86) and 37 (0.21 lower CES-D score; 95% CI, 0.00-0.41) years of age among males. The reduction in depressive symptoms associated with positive adolescent family relationships was greater for females than males during the adolescent and early adulthood years (ie, early 20s) (eg, low-high cohesion difference in mean CES-D score, -1.26 [95% CI, -1.42 to -1.10] for females and -0.72 [95% CI, -0.86 to -0.57] for males at 12 years of age; low-high cohesion difference in mean CES-D score, -0.61 [95% CI, -0.69 to -0.53] for females and -0.40 [95% CI, -0.48 to -0.31] for males at 20 years of age), after which females and males benefited equally from positive adolescent relationships throughout young adulthood to midlife. The findings suggest that positive adolescent family relationships are associated with better mental health among females and males from early adolescence to midlife. Interventions in early family life to foster healthy mental development throughout the life course appear to be important.

Relationship satisfaction, communication self-efficacy, and chronic fatigue syndrome-related fatigue

RationaleRelationship dissatisfaction has been linked with worse health outcomes in many patient populations, though the mechanism(s) underlying this effect are unclear. Among patients with chronic fatigue syndrome (CFS) and their partners, there is evidence for a bi-directional association between poorer relationship satisfaction and the severity of CFS-related fatigue. ObjectiveHere, we hypothesized that relationship dissatisfaction negatively impacts fatigue severity through greater depression and less patient satisfaction about communication about symptoms to partners. MethodBaseline data were drawn from diagnosed CFS patients (N = 150) participating in a trial testing the efficacy of a stress management intervention. Data derived from fatigue severity (Fatigue Symptom Index, FSI), depression (Center for Epidemiologic Survey-Depression, CES-D), relationship quality (Dyadic Adjustment Scale, DAS) and communication satisfaction (Patient Symptom Disclosure Satisfaction, PSDS) questionnaires were used for bootstrapped indirect effect analyses using parallel mediation structural equation modeling in Mplus (v8). Age and BMI were entered as covariates. ResultsGreater relationship satisfaction predicted greater communication satisfaction (p < 0.01) and lower CES-D scores (p < 0.01), which in turn were each significantly related to greater fatigue severity (p < 0.05). Tests of the indirect paths indicated that relationship satisfaction had a significant effect on fatigue severity through both constructs, but primarily via depression. There was no direct association between relationship satisfaction and fatigue severity after the intermediate variables (depression, communication satisfaction) were included in the model. ConclusionResults highlight the importance of considering depression and communication-related factors when examining the effects of relationship satisfaction on CFS symptoms such as fatigue. Further mechanism-based, longitudinal research might identify relationship-related mediating variables that can be targeted therapeutically.

Nutrition and Functional Status

Bias from unmeasured confounding is a challenge in observational gerontology research. Vitamin D research exemplifies the problem: results on extra-skeletal outcomes from observational studies of serum 25-hydroxyvitamin D [25(OH)D] concentrations are often not replicated in randomized vitamin D supplementation trials. Unmeasured factors such as sunlight exposure and skin color are the presumed culprit, motivating the National Institute on Aging to issue a request for applications for vitamin D supplement trials of functional outcomes. However, determining health effects of 25(OH)D and those from supplements are fundamentally different research questions. Since 25(OH)D concentrations cannot be randomized, observational studies are still key to answering this question. To address unmeasured confounding, two statistical methods to examine associations of 25(OH)D with depressive symptoms are described and applied. The first method uses season of blood draw in a modified instrumental variable analysis that overcomes the survival bias present in Mendelian randomization studies. Using data from 3,147 person-visits from the InCHIANTI study, a prospective cohort of older Italian adults, low 25(OH)D (< 20 ng/mL) was associated with 4.62 (95% confidence interval[CI] 3.25, 6.56) times greater risk of depressed mood (Center for Epidemiologic Studies Depression [CES-D] scale >= 16), as compared with 25(OH)D >= 20 ng/mL. The second method is a joint mixed-effects model that leverages repeated 25(OH)D measurements in longitudinal studies. Low 25(OH)D at three visits was associated with 1.80 (95% CI 0.18, 3.42) lower CES-D scores than low 25(OH)D at no visits.

Abstract P241: Health Literacy and Patient Activation Are not Predictors of Positive Health Behaviors Among Young Adult Women

Young adulthood is an important phase during which health behaviors are established. Inadequate health behaviors during this phase may increase susceptibility to future poor health. Health behaviors of young adult women, in particular, will most likely not only affect their health, but that of their families. Research exploring health literacy (enabling informed decision making) and patient activation (confidence to maintain/improve health) as predictors of health behaviors is growing. We examined these variables as predictors of positive health behaviors among a cohort of 22-23 year old females (n=476). Health literacy was assessed using the Newest Vital Sign; scores were categorized as low, marginal, and adequate. The Patient Activation Measure (PAM) was used to assess participant health activation. Scores were categorized as low (&lt;27) or high (&gt;27). Eleven health behavior variables related to nutrition, physical activity, sedentary behavior, sleep, alcohol, and smoking were used to create a health behavior score. These data were collected through health surveys and accelerometry. The health score had a possible range of 0 to 22. We included race/ethnicity, education, body mass index (BMI), and depressive symptoms (CES-D) as potential covariates in multivariable models. About 46% of the cohort was White, 25% Black, and 10% Hispanic; about 77% of middle or low socioeconomic status (SES). About 71% had adequate health literacy (18% marginal, 11% low), while 89% had a high PAM score. Participants who were White (p&lt;0.01), had higher education (p&lt;0.01), reported higher SES (p&lt;0.01), and had a lower CES-D score (p&lt;0.02) had higher health literacy. Participants who had lower CES-D scores (p&lt;0.01) also had higher PAM scores. The mean health behavior score was 12.68 (SD=3.39). Univariate analyses indicated adequate health literacy was associated with individual positive health behaviors: breakfast consumption (p&lt;0.01), low sugar sweetened beverage consumption (p&lt;.01), high physical activity (p&lt;0.01), and no smoking (p&lt;0.04). High PAM score was associated with low sugar sweetened beverage consumption (p&lt;0.04). In univariate linear regression models, higher health literacy was associated with a higher composite health score (p&lt;0.01). PAM score was not associated with health score. Multivariable linear regression models controlling for race/ethnicity, education, BMI, and CES-D score, indicated that neither health literacy nor PAM score were associated with composite health score. Among young adult women, positive health behaviors appear to not be influenced by either their individual health literacy or PAM score. Potential associations may emerge later in adulthood as they become fully independent individuals. Young adults may still be closely tied to their parents; thus parent health literacy and PAM score may predict health behaviors among young adults.

Adherence to the Mediterranean diet is associated with better quality of life: data from the Osteoarthritis Initiative

The Mediterranean diet has positively influenced various medical conditions, but only a paucity of studies has considered the relation between the Mediterranean diet and quality of life (QOL) among people living in North America. We investigated whether a higher adherence to the Mediterranean diet (aMED) was associated with better QOL and decreased pain, stiffness, disability, and depression in a large cohort of North Americans from the Osteoarthritis Initiative. aMED was evaluated through a validated Mediterranean diet score categorized into quintiles. Outcomes of interest were QOL [assessed with the 12-Item Short-Form Health Outcome Survey (SF-12)]; disability, pain, and stiffness [assessed in both knees with the Western Ontario and McMaster Universities Arthritis Index (WOMAC)]; and depressive symptoms [assessed with the Center for Epidemiologic Studies Depression Scale (CES-D)]. Of the 4470 participants (2605 women; mean age: 61.3 y), those with a higher aMED had significantly more favorable scores on all outcomes investigated (P < 0.0001 for all comparisons). After adjustment for potential confounders in linear regression analyses, a higher aMED was significantly associated with a higher SF-12 physical composite scale value (β: 0.10; 95% CI: 0.05, 0.15; P < 0.0001), lower WOMAC scores (except for stiffness), and lower CES-D scores (β: -0.05; 95% CI: -0.09, -0.01; P = 0.01). An adjusted logistic regression analysis, taking as reference those in the 2 highest quintiles of the aMED score, confirmed these findings. Higher aMED is associated with better QOL and decreased pain, disability, and depressive symptoms. This trial was registered at clinicaltrials.gov as NCT00080171.

The contribution of lifestyle factors to depressive symptoms: A cross-sectional study in Chinese college students.

It is well known that some lifestyle factors are related to depression, but their cumulative contribution to the depression remains unclear. This study aimed to assess the importance of multiple lifestyle factors in contributing to depressive symptoms among Chinese college students. Between September and December in 2012, we conducted a cross-sectional study among 1907 Chinese college students from Guangzhou, Southern China. College students completed self-administered questionnaires and reported their lifestyle factors including sleep quality and duration, Internet use, smoking, drinking, exercise, outdoor activity or sunlight exposure, and eating breakfast. Depression was measured using the Center for Epidemiologic Studies Depression Scale (CES-D), and mild-to-moderate depressive symptoms were defined as the CES-D score ≥16. Among all the students, 29.7% reported mild-to-moderate depressive symptoms. Higher quality and longer duration of sleep, more exercises, more outdoor activities or sunlight exposures, and eating breakfast daily were associated with a lower CES-D score, which could explain 11.3% of variance of the CES-D score, after adjusting for socio-demographics, family history, interpersonal relationship, and academic characteristics using hierarchical multivariable linear regression. These associations were comparable between males and females. The protective role of healthy lifestyles should be considered in intervention programs for improving mental health among college students.

10-year trajectories of depressive symptoms and risk of dementia: a population-based study

Late-life depressive symptoms have been extensively studied for their relationship with incident dementia, but have been typically assessed at a single timepoint. Such an approach neglects the course of depression, which, given its remitting and relapsing nature, might provide further insights into the complex association of depression with dementia. We therefore repeatedly measured depressive symptoms in a population of adults over a decade to study the subsequent risk of dementia. Our study was embedded in the Rotterdam Study, a population-based study of adults aged 55 years or older in Rotterdam (Netherlands), ongoing since 1990. The cohort is monitored continuously for major events by data linkage between the study database and general practitioners. We examined a cohort of participants who were free from dementia, but had data for depressive symptoms from at least one examination round in 1993-95, 1997-99, or 2002-04. We assessed depressive symptoms with the validated Dutch version of the Center for Epidemiology Depression Scale (CES-D) and the Hospital Anxiety and Depression Scale-Depression. We used these data to identify 11-year trajectories of depressive symptoms by latent class trajectory modelling. We screened participants for dementia at each examination round and followed up participants for 10 years for incident dementia by latent trajectory from the third examination round to 2014. We calculated hazard ratios (HR) for dementia by assigned trajectory using two Cox proportional hazards models (model 1 adjusted for age and sex only, and model 2 adjusted additionally for APOEɛ4 carrier status, educational level, body-mass index, smoking, alcohol consumption, cognitive score, use of antidepressants, and prevalent disease status at baseline). We repeated the analyses censoring for incident stroke, restricting to Alzheimer's disease as an outcome, and accounting for mortality as a competing risk for dementia. From 1993-2004, we obtained data for depressive symptoms from at least one examination round for 3325 participants (median age: 74·88 years [IQR 70·62-80·06], 1995 [60%] women). We identified five trajectories of depressive symptoms in these 3325 individuals, characterised by maintained low CES-D scores (low; 2441 [73%]); moderately high starting scores but then remitting (decreasing; 369 [11%]); low starting scores, increasing, then remitting (remitting; 170 [5%]); low starting scores that steadily increased (increasing; 255 [8%]); and maintained high scores (high; 90 [3%]). During 26 330 person-years, 434 participants developed incident dementia. Only the trajectory with increasing depressive symptoms was associated with a higher risk of dementia compared with the low depressive symptom trajectory, using model 2 (HR 1·42, 95% CI 1·05-1·94; p=0·024). Additionally, only the increasing trajectory was associated with a higher risk of dementia compared with the low trajectory after censoring for incident stroke (1·58, 1·15-2·16; p=0·0041), restricting to Alzheimer's disease as an outcome (1·44, 1·03-2·02; p=0·034), and accounting for mortality as a competing risk (1·45, 1·06-1·97; p=0·019). Risk of dementia differed with different courses of depression, which could not be captured by a single assessment of depressive symptoms. The higher risk of dementia only in the increasing trajectory suggests depression might be a prodrome of dementia. Erasmus Medical Center; ZonMw; the Netherlands Ministry of Education Culture and Science; and the Netherlands Ministry for Health, Welfare and Sports.

Depression in hypertension and blood pressure variability over shorter time periods.

Depression and hypertension are common diseases, and the combination of depression and hypertension is not rare. The association between depression and blood pressure (BP) level has been controversial. In the Three-City Study, depression diagnosed using the Center for Epidemiological Study Depression Scale (CES-D) was shown to be significantly associated with lower BP.1 The association remained significant after adjusting for the subjects’ use of antihypertensive and antidepressant medication. Licht et al.2 also reported that depression is associated with decreased BP. On the other hand, Shar et al. examined 2087 participants from the Baltimore Longitudinal Study of Aging,3 and an age-stratified analysis showed that a greater CES-D score was significantly associated with higher average systolic BP (SBP) and diastolic BP for older adults (58.8 years at first visit). In the same study’s younger age cohort, gender moderated the relationship of CES-D to SBP; higher CES-D scores in women, but lower CES-D scores in men, were associated with higher SBP.