New-onset Depressive Symptoms Research Articles

Physical activity and the prevention of depression: A cohort study

ObjectiveThis study aims to identify the optimal amount and appropriate state of physical activity for reducing incident depressive symptoms. MethodThe data of 107,901 Korean adults who had undergone at least two annual health examinations from 2012 to 2015 were analyzed. At baseline, the amount of physical activity was measured using the International Physical Activity Questionnaire-Short Form and metabolic equivalents (METs)-min/wk., which is the amount of oxygen consumed while sitting at rest per week. In addition, one-year changes in physical activity were categorized into four groups: persistent sedentary, maintenance, relapse, and adoption groups. For the study's endpoint, new-onset depressive symptoms (score of ≥21) were considered, defined by the Center for Epidemiologic Studies Rating Scale for Depression. A Cox proportional hazards model was used to identify the optimal amount and appropriate state of physical activity for reducing incident depressive symptoms. ResultsCompared with sedentary status (<600 METs-min/wk), achieving 1200–3000 METs-min/wk. was associated with a lower risk of incident depressive symptoms, illustrating a U-shaped relationship. The results show that the amount of physical activity for reducing the onset of depressive symptoms was higher for men (1800–3000 METs-min/wk.: HR, 0.84 [95% CI, 0.74–0.95]) than women (1200–1800 METs-min/wk.: HR, 0.84 [95% CI, 0.71–0.99]). In terms of one-year changes in physical activity, compared to the persistent sedentary group, the maintenance group was associated with a lower risk of the development of depressive symptoms in both sexes (men: HR, 0.81 [95% CI, 0.71–0.93]; women: HR, 0.84 [95% CI, 0.75–0.94]). Women in the adoption group showed a positive effect in terms of a decrease in incident depressive symptoms (HR, 0.87 [95% CI, 0.76–0.99]). ConclusionsThis study suggests an optimal amount of physical activity for reducing the onset of depressive symptoms. In addition, maintaining an appropriate level of physical activity for one year proved beneficial for decreasing incident depressive symptoms.

Association between family conflict resolution methods and depressive symptoms in South Korea: a longitudinal study.

We investigated the relationship between family conflict resolution and depression, focusing on each component of family conflict resolution to determine which factors have stronger associations with depression. We used data from 2008 to 2015 of the Korea Welfare Panel Study. Our final sample included 3565 participants. For each participant, we included at least 2-8years of follow-up data with a mean follow-up time of 4.05 ± 2.52years. To identify the relationship between new-onset depressive symptoms and participants' family conflict resolution styles, we performed generalized estimating equation analysis with autoregressive working correlations to estimate adjusted odds ratios for new-onset depressive symptoms adjusted for covariates. Compared with positive family conflict resolution, negative family conflict resolution had a higher odds ratio for depressive symptoms (aOR 1.80, 95% CI 1.42-2.29). This relationship was strongly founded on participants who were women (aOR 2.35, 95% CI 1.55-3.94) with experience of verbal aggression (aOR 1.84, 95% CI 1.42-2.37) and threatening behaviors (aOR 1.89, 95% CI 1.25-2.85). Negative family conflict resolution has long-term associations with an elevated risk of depressive symptoms. In particular, we observed higher risks of depression with verbal and psychological conflict than with physical conflict. Health care providers and health policymakers should support the management and development of methods for dealing with family conflict to improve mental health at a family level, as well as an individual level.

Cystatin C and risk of new-onset depressive symptoms among individuals with a normal creatinine-based estimated glomerular filtration rate: A prospective cohort study

The association between cystatin C and depressive symptoms in the general population has not been thoroughly elucidated to date. We investigated the association of cystatin C with new-onset depressive symptoms among individuals with normal creatinine-based estimated glomerular filtration rates (eGFR). In the China Health and Retirement Longitudinal Study, 5111 participants without depressive symptoms or renal dysfunction (eGFR < 60 ml/min/1.73 m2) were included. The outcome was new-onset depressive symptoms over 4 years, defined as a score of ≥12 on the 10-item Center for Epidemiologic Studies Depressive Symptoms Scale. The incidence risk ratio (IRR) and 95% confidence interval (CI) were calculated using modified Poisson regression models. During a 4-year follow-up period, 1746 (34.16%) incidents of depressive symptoms occurred. In a multivariable-adjusted model, the risk of incident depressive symptoms was 1.07 (95% CI 1.02–1.11) per-SD change in cystatin C. A greater cystatin C level was associated with a higher risk of new-onset depressive symptoms among subjects with relatively normal renal function.

Enhanced psychological care in cardiac rehabilitation services for patients with new-onset depression: the CADENCE feasibility study and pilot RCT.

Around 19% of people screened by UK cardiac rehabilitation programmes report having moderate or severe symptoms of depression. These individuals are at an increased risk of cardiac mortality and morbidity, reduced quality of life and increased use of health resources compared with their non-depressed counterparts. Maximising psychological health is a goal of cardiac rehabilitation, but psychological care is patchy. To examine the feasibility and acceptability of embedding enhanced psychological care (EPC) within cardiac rehabilitation, we tested the feasibility of developing/implementing EPC and documented the key uncertainties associated with undertaking a definitive evaluation. A two-stage multimethods study; a feasibility study and a qualitative evaluation, followed by an external pilot cluster randomised controlled trial (RCT) with a nested qualitative study. UK comprehensive cardiac rehabilitation teams. Adults eligible for cardiac rehabilitation following an acute coronary syndrome with new-onset depressive symptoms on initial nurse assessment. Patients who had received treatment for depression in the preceding 6 months were excluded. The EPC intervention comprised nurse-led mental health-care co-ordination and behavioural activation within cardiac rehabilitation. The comparator was usual cardiac rehabilitation care. Measures at baseline, and at the 5- (feasibility and pilot) and 8-month follow-ups (pilot only). Process measures related to cardiac team and patient recruitment, and participant retention. Outcomes included depressive symptoms, cardiac mortality and morbidity, anxiety, health-related quality of life and service resource use. Interviews explored participant and nurses' views and experiences. Between September 2014 and May 2015, five nurses from four teams recruited participants into the feasibility study. Of the 203 patients screened, 30 were eligible and nine took part (the target was 20 participants). At interview, participants and nurses gave valuable insights into the EPC intervention design and delivery. Although acceptable, the EPC delivery was challenging for nurses (e.g. the ability to allocate sufficient time within existing workloads) and the intervention was modified accordingly. Between December 2014 and February 2015, 8 out of 20 teams approached agreed to participate in the pilot RCT [five were randomised to the EPC arm and three were randomised to the usual-care (UC) arm]. Of the 614 patients screened, 55 were eligible and 29 took part (the target was 43 participants). At baseline, the trial arms were well matched for sex and ethnicity, although the EPC arm participants were younger, from more deprived areas and had higher depression scores than the UC participants. A total of 27 out of 29 participants were followed up at 5 months. Interviews with 18 participants (12 in the EPC arm and six in the UC arm) and seven nurses who delivered EPC identified that both groups acknowledged the importance of receiving psychological support embedded within routine cardiac rehabilitation. For those experiencing/delivering EPC, the intervention was broadly acceptable, albeit challenging to deliver within existing care. Both the feasibility and the pilot studies encountered significant challenges in recruiting patients, which limited the power of the pilot study analyses. Cardiac rehabilitation nurses can be trained to deliver EPC. Although valued by both patients and nurses, organisational and workload constraints were significant barriers to implementation in participating teams, suggesting that future research may require a modified approach to intervention delivery within current service arrangements. We obtained important data informing definitive research regarding participant recruitment and retention, and optimal methods of data collection. Consideration should be given to the delivery of EPC by dedicated mental health practitioners, working closely with cardiac rehabilitation services. Current Controlled Trials ISRCTN34701576. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 30. See the NIHR Journals Library website for further project information.

Assessing the effectiveness of Enhanced Psychological Care for patients with depressive symptoms attending cardiac rehabilitation compared with treatment as usual (CADENCE): a pilot cluster randomised controlled trial

BackgroundAround 17% of people attending UK cardiac rehabilitation programmes have depression. Optimising psychological wellbeing is a rehabilitation goal, but provision of psychological care is limited. We developed and piloted an Enhanced Psychological Care (EPC) intervention embedded within cardiac rehabilitation, aiming to test key areas of uncertainty to inform the design of a definitive randomised controlled trial (RCT) and economic evaluation.MethodsAn external pilot randomised controlled trial (RCT) randomised eight cardiac rehabilitation teams (clusters) to either usual care of cardiac rehabilitation provision (UC), or EPC in addition to UC. EPC comprised mental health care coordination and patient-led behavioural activation with nurse support. Adults eligible for cardiac rehabilitation following an acute coronary syndrome and identified with new-onset depressive symptoms during an initial nurse assessment were eligible. Measures were performed at baseline and 5- and 8-month follow-ups and compared between EPC and UC. Team and participant recruitment and retention rates, and participant outcomes (clinical events, depression, anxiety, health-related quality of life, patient experiences, and resource use) were assessed.ResultsEight out of twenty teams were recruited and randomised. Of 614 patients screened, 55 were eligible and 29 took part (5%, 95% CI 3 to 7% of those screened), with 15 patient participants cluster randomised to EPC and 14 to UC. Nurse records revealed that 8/15 participants received the maximum number of EPC sessions offered; and 4/15 received no sessions. Seven out of fifteen EPC participants were referred to another NHS psychological service compared to none in UC. We followed up 27/29 participants at 5 months and 17/21 at 8 months. The mean difference (EPC minus UC) in depressive symptoms (Beck Depression Inventory) at follow-up (adjusting for baseline score) was 1.7 (95% CI − 3.8 to 7.3; N = 26) at 5 months and 4.4 (95% CI − 1.4 to 10.2; N = 17) at 8 months.DiscussionWhile valued by patients and nurses, organisational and workload constraints are significant barriers to EPC implementation. There remains a need to develop and test new models of psychological care within cardiac rehabilitation. Our study offers important data to inform the design of future trials of similar interventions.Trial registrationISRCTN34701576. Registered on 29 May 2014.Funding details: UK NIHR HTA Programme (project 12/189/09).

Relationship Between Depression and Stress Coping Ability Among Residents in Japan: A Two-Year Longitudinal Study.

BackgroundDepression among medical residents is a critical issue. The early detection of depression and provision of appropriate care is necessary for fostering healthy conditions during clinical training. To investigate whether Sense of Coherence (SOC), an indicator of stress coping ability, could be a predictor of depression 2 years after the start of clinical training, we conducted a national longitudinal study.MethodsWe distributed self-administered questionnaires to residents in 251 postgraduate educational hospitals just before the start of their clinical training. The questionnaire contained the Center for Epidemiologic Studies Depression (CES-D) scale (a screening tool for depression), the SOC scale, and demographic factors. After 2 years, we distributed questionnaires to residents who responded to the first survey. The second questionnaire contained the CES-D scale and questions about working conditions. We categorized respondents into three groups according to their SOC score and analyzed the relationship between SOC groups (low, middle, high) and depressive symptoms on the follow-up survey.ResultsIn total, 1,738 of 2,935 residents (59.2%) responded to the first survey. Of these, 1,169 residents (67.3%) also responded to the follow-up survey. A total of 169 residents were excluded because they screened positive for depressive symptoms at the time of the first survey. On the follow-up survey, 187 residents (19.5%) had new-onset depressive symptoms: 33.3% in the low SOC group, 18.2% in the middle SOC group, and 11.4% in the high SOC group (P < 0.01). Compared with the high SOC group, the odds ratio for new-onset depressive symptoms in the low SOC group was 2.04 (95% confidence interval, 1.02 - 4.05) after adjusting for demographic factors, baseline CES-D score, and mean working time.ConclusionsSOC score is significantly associated with future depressive symptoms among residents after 2 years. Residents in the low SOC group had a 2-fold higher risk of future depressive symptoms than those in the high SOC group. The SOC scale might be a useful predictor of future depression and allow for the provision of appropriate support to residents during clinical training.

Depressive Symptoms at Critical Times in Youth With Type 1 Diabetes: Following Type 1 Diabetes Diagnosis and Insulin Pump Initiation

PurposeDepressive symptoms occur at various times during the life cycle in persons with type 1 diabetes. We investigated depressive symptoms prospectively in youth with new-onset type 1 diabetes and in those beginning pump therapy. MethodsYouth with type 1 diabetes (N = 96), ages 10–17 years, completed the Children's Depression Inventory (CDI) at baseline and at 1, 6, and 12 months after diabetes onset or pump start; scores ≥13 indicated clinical elevation. The change in depressive symptoms and the association between CDI score and hemoglobin A1c (HbA1c) level were assessed over 1 year. ResultsThe new-onset group (n = 54) had an HbA1c level of 11.4% ± 2.5%. The pump group (n = 42) had a diabetes duration of 4.1 ± 3.4 years and an HbA1c level of 8.3% ± 1.3%. The baseline median CDI was 5.0 in both groups and remained low over time (ranging from 2.0 to 3.5). Most youth (new onset 72%, pump 81%) scored <13 at all times. Those with a CDI score of ≥13 in month 1 had 9-fold (95% confidence interval: 3–28) and 11-fold (95% confidence interval: 3–38) higher risks of CDI score of ≥13 at 6 and 12 months, respectively, than those with a CDI score of <13. New-onset youth with a CDI score of ≥13 in month 1 had a higher HbA1c level at 6 months (8.3% ± 1.7%) than new-onset youth with a CDI score of <13 (7.2% ± 1.6%, p = .04). ConclusionsCDI scores over 1 year were similar in the new-onset and pump groups. Youth with elevated CDI in the first month after diagnosis or pump start were significantly more likely to have a CDI score of ≥13 at 6 or 12 months, supporting recommendations to screen for depressive symptoms because of persistence over time. Those with new-onset diabetes and depressive symptoms in the first month had higher HbA1c at 6 months; confirmatory research is needed.

Stress Underestimation and Mental Health Outcomes in Male Japanese Workers: a 1-Year Prospective Study.

Being appropriately aware of the extent of stress experienced in daily life is essential in motivating stress management behaviours. Excessive stress underestimation obstructs this process, which is expected to exert adverse effects on health. We prospectively examined associations between stress underestimation and mental health outcomes in Japanese workers. Web-based surveys were conducted twice with an interval of 1year on 2359 Japanese male workers. Participants were asked to complete survey items concerning stress underestimation, depressive symptoms, sickness absence, and antidepressant use. Multiple logistic regression analysis revealed that high baseline levels of 'overgeneralization of stress' and 'insensitivity to stress' were significantly associated with new-onset depressive symptoms (OR = 2.66 [95% CI, 1.54-4.59], p < .01) and antidepressant use (OR = 4.91 [95% CI, 1.22-19.74], p < .05), respectively, during the 1-year follow-up period. This study clearly demonstrated that stress underestimation, including stress insensitivity and the overgeneralization of stress, could exert adverse effects on mental health.

Sarcopenic obesity and risk of new onset depressive symptoms in older adults: English Longitudinal Study of Ageing.

Background:We examined the role of sarcopenic obesity as a risk factor for new-onset depressive symptoms over 6-year follow-up in a large sample of older adults.Methods:The sample comprised 3862 community dwelling participants (1779 men, 2083 women; mean age 64.6±8.3 years) without depressive symptoms at baseline, recruited from the English Longitudinal Study of Ageing. At baseline and 4-year follow-up, handgrip strength (kg) of the dominant hand was assessed using a hand-held dynamometer, as a measure of sarcopenia. The outcome was new onset depressive symptoms at 6-year follow-up, defined as a score of ⩾4 on the 8-item Centre of Epidemiological Studies Depression scale. Sarcopenic obesity was defined as obese individuals (body mass index ⩾30 kg m−2) in the lowest tertile of sex-specific grip strength (<35.3 kg men; <19.6 kg women).Results:Using a multivariable logistic regression model, the risk of depressive symptoms was greatest in obese adults in the lowest tertile of handgrip strength (odds ratio (OR), 1.79, 95% confidence interval (CI), 1.10, 2.89) compared with non-obese individuals with high handgrip strength. Participants who were obese at baseline and had a decrease of more than 1 s.d. in grip strength over 4-year follow-up were at greatest risk of depressive symptoms (OR=1.97, 95% CI, 1.22, 3.17) compared with non-obese with stable grip strength.Conclusions:A reduction in grip strength was associated with higher risk of depressive symptoms in obese participants only, suggesting that sarcopenic obesity is a risk factor for depressive symptoms.

Cerebrospinal Fluid CRH Levels in Late Pregnancy Are Not Associated With New-Onset Postpartum Depressive Symptoms.

CRH participates in the hypothalamic-pituitary-adrenal axis and in neural circuits involved in the pathophysiology of depression. During pregnancy, the placenta produces large amounts of CRH, and production ceases abruptly after delivery. The relationship between CRH in the cerebrospinal fluid (CSF) during pregnancy and peripartum mood disorders has not been investigated. The objectives were to determine whether there are differences in CSF CRH concentrations of pregnant and nonpregnant women and whether CSF CRH concentrations in late pregnancy are associated with the presence of depressive symptoms during pregnancy and in the early postpartum period. This was a prospective cohort study conducted from January to April, 2011. The study was conducted in one public and two private hospitals in Brasilia, Brazil. Patients included 107 healthy pregnant women who underwent elective cesarean delivery and 22 nonpregnant healthy women who underwent spinal anesthesia for elective surgical sterilization. CRH in CSF was measured in pregnant and nonpregnant women by ELISA. The association between CSF CRH concentration at delivery and maternal depression assessed before cesarean section and postpartum (4 to 8 wk) with the Edinburgh Postnatal Depression Scale (EPDS), with a cutoff of ≥ 13. CRH concentration in the CSF was significantly higher in pregnant (4.1 ± 0.51 log CRH) than in nonpregnant women (3.6 ± 0.26 log CRH) (P < .001). Depressive symptoms starting after delivery occurred in 5.6% of women. CRH concentration in CSF was not different between women without depressive symptoms and women showing such symptoms during pregnancy or in the postpartum period. CRH concentration in the CSF was higher in pregnant women than in nonpregnant women. However, in this sample, CSF CRH in late pregnancy was not associated with new-onset depressive symptoms in the early postpartum period.

Precarious employment and new-onset severe depressive symptoms: a population-based prospective study in South Korea.

Considering the effect of sex and head of household responsibilities, this study was designed to evaluate whether precarious employment is associated with the development of new-onset severe depressive symptoms. We followed 2214 male and 1276 female waged workers, ≤59 years of age and without moderate depressive symptom, from the Korean Welfare Panel Study 2007-2013. Their employment status was classified as full-time permanent, precarious, self-employed, or unemployed after baseline. Except for occupation and company size, all variables were treated as time-dependent. Severe depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression Scale (CES-D-11). A generalized estimating equation was used to evaluate the effect of employment status on the development of new-onset severe depressive symptoms. After adjusting for initial baseline CES-D-11 score, chronic disease, and other socioeconomic covariates, precarious employment was associated with the development of new-onset severe depressive symptoms among male heads of household [odds ratio (OR) 1.52, 95% confidence interval (95% CI) 1.02-2.25] and female heads of household (OR 4.19, 95% CI 1.70-10.32). In addition, the transition from full-time permanent employment to another employment status was associated with the development of new-onset severe depressive symptoms among both sexes, with an especially strong association among females. The present study suggests that, depending on head of household status and sex, precarious employment is associated with the development of new-onset severe depressive symptoms.

Can we predict future depression in residents before the start of clinical training?

Depression among medical residents is a very serious problem. It is, however, very difficult to detect signs of depression early, despite the severity and frequency of depression. We designed a nationwide longitudinal study to investigate whether the Sense of Coherence (SOC) Scale, an indicator of ability to cope with stress, could predict future depressive symptoms among medical residents. We distributed self-administered questionnaires to first-year residents in 251 postgraduate education hospitals just before the start of their clinical training. The questionnaire contained the Center for Epidemiologic Studies Depression (CES-D) Scale (a screening tool for depression), the SOC Scale, and items on demographic factors. After 3months, we again distributed questionnaires to residents who had responded to the first survey. The second questionnaire contained the CES-D Scale and items on the respondents' working conditions. We categorised respondents into three groups according to their SOC scores and analysed the relationships between the three SOC groups (low, middle and high scores) and the occurrence of depressive symptoms at the follow-up survey. In all, 1738 of 2935 residents (59.2%) responded to the first survey. Of these, 1245 residents (71.6%) also responded to the follow-up survey. A total of 189 residents were excluded because they screened positive for depressive symptoms at the first survey. Data for a further 36 were excluded because they were incomplete. At the follow-up survey, 238 of the remaining 1020 residents (23.3%) had new-onset depressive symptoms. These included 61 (41.2%) respondents in the low SOC group, 159 (22.3%) in the middle SOC group, and 18 (11.3%) in the high SOC group (p<0.01). The odds ratio of the low SOC group for new-onset depressive symptoms, adjusted for demographic factors, baseline CES-D score and mean working time, was 3.11 (95% confidence interval 1.48-6.53), using the high SOC group as the reference. The SOC score was significantly related to future depressive symptoms among medical residents. The SOC Scale might be a useful and easy-to-use predictor of future depression.

Omega‐3 fatty acid biomarkers and subsequent depressive symptoms

We sought to determine the relationship between the omega-3 fatty acid content of red blood cell membranes (RBC), in particular docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), and baseline and new-onset depressive symptoms in post-menopausal women. We secondarily sought to characterize the association between dietary omega-3 fatty acid intake and depressive symptomatology. Study participants included 7086 members of the Women's Health Initiative Memory Study (aged 63-81 years) who had an assessment of RBC omega-3 fatty acid concentrations at the baseline screening visit. Depressive symptoms at baseline and follow-up were characterized using the Burnam eight-item scale for depressive disorders (Center for Epidemiologic Studies Depression Scale/Diagnostic Interview Schedule short form) and secondarily additionally inferred by antidepressant medication use. In multivariable-adjusted models, our primary exposure, RBC DHA + EPA, was not related to depressive symptoms by any measure at baseline or follow-up, nor were RBC total omega-3, DHA, or EPA (all p > 0.2). In contrast, dietary intake of omega-3 was positively associated with depressive symptoms at baseline (adjusted odds ratio 1.082, 95% confidence interval 1.004-1.166; p = 0.04 for dietary DHA + EPA and Burnam score ≥0.06), although this generally did not persist at follow-up. No relationship between RBC omega-3 levels and subsequent depressive symptoms was evident, and associations between dietary omega-3 and depressive symptoms were variable. Biomarkers of omega-3 status do not appear to be related to risk of new depression in post-menopausal women.

How baseline, new-onset, and persistent depressive symptoms are associated with cardiovascular and non-cardiovascular mortality in incident patients on chronic dialysis

ObjectiveDepressive symptoms are associated with mortality among patients on chronic dialysis therapy. It is currently unknown how different courses of depressive symptoms are associated with both cardiovascular and non-cardiovascular mortality. MethodsIn a Dutch prospective nation-wide cohort study among incident patients on chronic dialysis, 1077 patients completed the Mental Health Inventory, both at 3 and 12months after starting dialysis. Cox regression models were used to calculate crude and adjusted hazard ratios (HRs) for mortality for patients with depressive symptoms at 3months only (baseline only), at 12months only (new-onset), and both at 3 and 12months (persistent), using patients without depressive symptoms at 3 and 12months as reference group. ResultsDepressive symptoms at baseline only seemed to be a strong marker for non-cardiovascular mortality (HRadj 1.91, 95% CI 1.26–2.90), whereas cardiovascular mortality was only moderately increased (HRadj 1.41, 95% CI 0.85–2.33). In contrast, new-onset depressive symptoms were moderately associated with both cardiovascular (HRadj 1.66, 95% CI 1.06–2.58) and non-cardiovascular mortality (HRadj 1.46, 95% CI 0.97–2.20). Among patients with persistent depressive symptoms, a poor survival was observed due to both cardiovascular (HRadj 2.14, 95% CI 1.42–3.24) and non-cardiovascular related mortality (HRadj 1.76, 95% CI 1.20–2.59). ConclusionThis study showed that different courses of depressive symptoms were associated with a poor survival after the start of dialysis. In particular, temporary depressive symptoms at the start of dialysis may be a strong marker for non-cardiovascular mortality, whereas persistent depressive symptoms were associated with both cardiovascular and non-cardiovascular mortality.

Glycemia, Insulin Resistance, Insulin Secretion, and Risk of Depressive Symptoms in Middle Age

OBJECTIVEThe extent to which abnormal glucose metabolism increases the risk of depression remains unclear. In this study, we investigated prospective associations of levels of fasting glucose and fasting insulin and indices of insulin resistance and secretion with subsequent new-onset depressive symptoms (DepS).RESEARCH DESIGN AND METHODSIn this prospective cohort study of 3,145 adults from the Whitehall II Study (23.5% women, aged 60.6 ± 5.9 years), baseline examination included fasting glucose and insulin level, the homeostasis model assessment of insulin resistance (HOMA2-%IR), and the homeostasis model assessment of β-cell insulin secretion (HOMA2-%B). DepS (Center for Epidemiologic Studies Depression Scale ≥16 or use of antidepressive drugs) were assessed at baseline and at 5-year follow-up.RESULTSOver the 5-year follow-up, DepS developed in 142 men and 84 women. Women in the lowest quintile of insulin secretion (HOMA2-%B ≤55.3%) had 2.18 (95% CI 1.25–3.78) times higher odds of developing DepS than those with higher insulin secretion. This association was not accounted for by inflammatory markers, cortisol secretion, or menopausal status and hormone replacement therapy. Fasting insulin measures were not associated with DepS in men, and fasting glucose measures were not associated with new-onset DepS in either sex.CONCLUSIONSLow insulin secretion appears to be a risk factor for DepS in middle-aged women, although further work is required to confirm this finding.

Vascular Risk Status as a Predictor of Later-Life Depressive Symptoms: A Cohort Study

BackgroundCommon etiology of vascular diseases and later-life depression may provide important synergies for prevention. We examined whether standard clinical risk profiles developed for vascular diseases also predict depressive symptoms in older adults.MethodsData were drawn from the Whitehall II study with baseline examination in 1991; follow-up screenings in 1997, 2003, and 2008; and additional disease ascertainment from hospital data and registry linkage on 5318 participants (mean age 54.8 years, 31% women) without depressive symptoms at baseline. Vascular risk was assessed with the Framingham Cardiovascular, Coronary Heart Disease, and Stroke Risk Scores. New depressive symptoms at each follow-up screening were identified by General Health Questionnaire caseness, a Center for Epidemiologic Studies Depression Scale score ≥16, and use of antidepressant medication.ResultsDiagnosed vascular disease (that is, coronary heart disease or stroke) was associated with an increased risk for depressive symptoms, age- and sex-adjusted odds ratios from 1.5 (95% confidence interval 1.0–2.2) to 2.0 (1.4–3.0), depending on the indicator of depressive symptoms. Among participants without manifest vascular disease, the Stroke Risk Score was associated with Center for Epidemiologic Studies Depression Scale depressive symptoms before age 65 (age- and sex-adjusted odds ratio per 10% absolute change in the score = 3.1 [1.5–6.5]), but none of the risk scores predicted new-onset depressive symptoms in those aged ≥65 (odds ratios from .8 to 1.2).ConclusionsThese data suggest that public health measures to improve vascular risk status will influence the incidence of later-life depressive symptoms via reduced rates of manifest vascular disease.

Association between change in employment status and new-onset depressive symptoms in South Korea – a gender analysis

This study aimed to investigate the association of change in employment status with new-onset depressive symptoms, particularly differences stemming from workers' gender, in South Korea. We analyzed data from the ongoing Korean Welfare Panel Study. After excluding participants who had depressive symptoms at baseline (2007), we analyzed 2891 participants who became a precarious or permanent worker or unemployed at follow-up (2008) among waged workers who were permanent or precarious workers at baseline. Workers were classified as permanent workers if they had full-time, secure jobs and were directly hired by their employers; workers not meeting all these criteria were classified as precarious workers. Depressive symptoms were assessed annually using the 11-item Center for Epidemiologic Studies Depression Scale. To reduce potential bias due to pre-existing health conditions, we also examined the association in a subpopulation excluding participants with any pre-existing chronic disease or disability. Compared to those who maintained permanent employment, workers who became unemployed following precarious employment had higher odds of developing depressive symptoms [odds ratio (OR) 2.30, 95% confidence interval (95% CI) 1.01-5.25]. In gender-stratified analyses, new-onset depressive symptoms were strongly associated with the change from precarious to permanent employment (OR 2.57, 95% CI 1.20-5.52) as well as the change from permanent to precarious employment (OR 2.88, 95% CI 1.24-6.66) among females; no significant association was observed in the male subpopulation. This study found that changes from precarious to permanent work or from permanent to precarious work were associated with new-onset depressive symptoms among South Korean women.

Metabolic Syndrome and Onset of Depressive Symptoms in the Elderly

OBJECTIVEGiven the increasing prevalence of both metabolic syndrome (MetS) and depressive symptoms during old age, we aimed to examine prospectively the association between MetS and the onset of depressive symptoms according to different age-groups in a large, general elderly population.RESEARCH DESIGN AND METHODSThis was a prospective cohort study of 4,446 men and women aged 65–91 years who were free of depression or depressive symptoms at baseline (the Three-City Study, France). MetS was defined using the National Cholesterol Education Program Adult Treatment Panel III criteria. New onset of depressive symptoms (the Center for Epidemiologic Studies Depression Scale score ≥16 and use of antidepressant treatment) was assessed at 2- and 4-year follow-ups.RESULTSAfter adjusting for a large range of potential confounders, we observed MetS to be associated with 1.73-fold (95% CI 1.02–2.95) odds for new-onset depressive symptoms in the youngest age-group (65–70 years at baseline), independently of cardiovascular diseases. No such association was seen in older age-groups.CONCLUSIONSOur findings suggest that the link between MetS and depressive symptoms evidenced until now in middle-aged people can be extended to older adults but not to the oldest ones. Additional research is needed to examine if a better management of MetS prevents depressive symptoms in people aged 65–70 years.

A Prospective Study of Hormone Therapy and Depression in Community-Dwelling Elderly Women

The potential benefits of hormone therapy (HT) in treating depressed postmenopausal women are controversial, and data on depression (re)emergence in the context of HT discontinuation are lacking. To determine whether HT is associated with a modified risk of new-onset depressive symptoms in elderly women. Current depressive symptomatology was evaluated in 4,069 community-dwelling postmenopausal women aged 65 years and over who were randomly recruited from 3 French cities between 1999 and 2001. Depressive symptomatology was assessed using the Center for Epidemiologic Studies-Depression Scale at baseline and as part of the 2- and 4-year follow-up. Over the follow-up period, multivariate logistic regression analyses adjusted for sociodemographic variables, measures of physical health, and cognitive impairment failed to find a significant association between HT at baseline and the incidence of depressive symptoms. However further analysis indicated an increased risk of incident depressive symptoms for women using transdermal estradiol treatment combined with synthetic progestin specifically (odds ratio [OR] = 1.59; 95% CI, 1.01-2.50; P = .046). In addition, while women taking HT continuously over the 4-year follow-up did not show an increased risk of depressive symptoms, women who stopped their treatment early after study inclusion, had a significantly higher risk (OR = 2.63; 95% CI, 1.52-4.55; P = .0005). Hormone therapy was not associated with a protective effect against the emergence of depressive symptoms in elderly postmenopausal women. However, discontinuing treatment could increase the risk of depressive symptoms. Data on the appropriate management of depression in the context of HT discontinuation among postmenopausal women require further investigation.

Predictors of Incident Depression After Hip Fracture Surgery

Depression after hip fracture surgery is prevalent and associated with increased mortality rates and impaired functional recovery. The incidence of new-onset depressive symptoms in patients initially not depressed after hip fracture surgery and their relationship with functional recovery is unknown. A cohort of 139 nondepressed elderly patients (>60 years) hospitalized for hip fracture surgery were followed up for six months. Clinically significant depressive symptoms were defined as a score of 7 or more on the 15-item Geriatric Depression Scale. The authors found a cumulative incidence rate of 20.5% adjusted for dropouts. Multiple Cox-regression analyses yielded the presence of subthreshold symptoms of depression, anxiety, pain, and cognitive impairment at baseline, the premorbid level of mobility, and a history of (treated) depression as risk factors for incident depression (p <0.05). A forward, conditional procedure identified postoperative pain (hazard ratio [HR] = 1.32, 95% confidence interval [CI]: 1.14-1.53, Wald chi(2) = 13.57, df = 1, p <0.001) and baseline anxiety (HR = 1.25, 95% CI: 1.08-1.44, Wald chi(2) = 8.86, df = 1, p = 0.003) as the strongest independent risk factors. Incident depression was associated with a less favorable outcome at 3 months follow-up. This exploratory study identified two treatable baseline characteristics that predicted incident depression in nondepressed patients after hip-fracture surgery.