New-onset Depressive Symptoms Research Articles

Longitudinal association of spirituality with depressive symptom trajectories among older adults in mainland China.

The relationship between spirituality and depressive symptoms among the Chinese elderly is not well known. The current study explores this relationship using longitudinal data and trajectory modeling of depressive symptoms. A longitudinal study design was used to measure depressive symptoms repeatedly from 2012 to 2021 using the Geriatric Depression Scale (GDS). Group-based trajectory modeling analysis was conducted to determine the trajectories of depressive symptoms, and multiple logistic regression was used to explore the association between spirituality and depressive symptom trajectories. A total of 2333 participants completed at least two GDS measures, and these were included in the Group-based trajectory modeling analysis. An optimal model of three trajectories was derived: no depressive symptoms group (75.2%), new-onset depressive symptoms group (14.4%), and persistent depressive symptoms group (10.4%). Logistic regression modeling revealed that higher spirituality was associated with a lower risk of both new-onset depressive symptoms (OR=0.68, 95% CI=0.49-0.93) and persistent depressive symptoms (OR=0.32, 95% CI=0.23-0.45). Spirituality predicts a lower risk of new-onset depressive symptoms and persistent symptoms among older adults in mainland China.

Bidirectional associations between dietary diversity and depressive symptoms in Chinese adult women: A retrospective cohort study

ObjectiveThis study aimed to examine the bidirectional associations between dietary diversity and clinical depressive symptoms in adult women, and influencing factors of clinical depressive symptoms. MethodsThis longitudinal study included a total of 22,385 participants, each of whom underwent at least two data collections. We used convenience sampling to recruit women from a health management center of a general hospital in southern China from April 2015 to December 2021. They completed an online self-reported health questionnaire, which included demographic characteristics, lifestyle information, the Dietary Diversity Scale (DDS), and the Patient Health Questionnaire-9. ResultsNew-onset depressive symptoms and low dietary diversity were observed in this study among 1285 and 3223 participants, respectively. Negative associations were observed between baseline low dietary diversity and new-onset depressive symptoms (P < 0.05) and between baseline depressive symptoms and low dietary diversity (P < 0.001). Cross-lagged panel analysis indicated that dietary diversity negatively and prospectively predicted depressive symptoms, but vice versa (P < 0.05). Strong evidence of a nonlinear association between DDS scores and incident depressive symptoms was found (P nonlinear < 0.05) regardless of whether the variables were adjusted. Besides, age, menarche age, physical activity, sleep duration, longer sedentary behavior and other lifestyle factors were influencing factors of depressive symptoms (P < 0.05). ConclusionsThe present study identified bidirectional associations between dietary diversity and depressive symptoms, and the associations were found to have a non-linear pattern. Adherence to dietary diversity and a healthy lifestyle could be effective non-pharmacological preventive measures to reduce the incidence of depressive symptoms.

Socioeconomic status and incident depressive symptoms among older adults: A 3-year longitudinal study from the Japan Gerontological Evaluation Study.

The association between socioeconomic status (SES) and the onset of depressive symptoms has attracted considerable attention. However, few studies have simultaneously examined the association of multiple SES indicators, including "assets," with the onset of depressive symptoms. Therefore, this study examined the association of four SES indicators in old age ('years of education' 'equivalent income,' 'equivalent assets,' and 'the longest-held job') with new-onset depressive symptoms in a large Japanese dataset. This longitudinal study used panel data of cognitively and physically independent older adults from the Japan Gerontological Evaluation Study (JAGES) conducted in 2013 and 2016. Multivariate logistic regression analysis was conducted to examine the association of each SES indicator with new-onset depressive symptoms, and odds ratios and 95% confidence intervals (CIs) were calculated. We analyzed the data of 40,257 older adults, with a mean age (± standard deviation) of 72.9 (±5.5) years. In the follow-up survey, 4292 older adults had new-onset depression symptoms (10.7%). 39.3% had 10-12years of education. 36.9% had an equivalent income of up to JPY 1.99 million. 24.4% had equivalent assets of JPY 4-17.99 million. Most had a clerical job for the long time. Furthermore, fewer years of education (males: OR=1.42, 95% CI=1.22-1.64, p-value <0.001/females: 1.26, [1.09-1.47], p=0.002), lower income (males: 1.64, [1.34-2.01], p<0.001/females: 1.82, [1.49-2.22], p<0.001), and fewer assets (males: 1.40, [1.16-1.68], p<0.001/females: 1.21, [1.02-1.42], p=0.025) resulted in higher odds of having new-onset depressive symptoms, even when other SES indicators were entered simultaneously. All four SES indicators have an independent association with the development of new-onset depressive symptoms among older adults, reflecting different aspects of SES. The association between the "longest-held job" and new-onset depressive symptoms can be largely explained by other SES indicators. A multifaceted and lifetime approach is required to prevent the onset of depressive symptoms in old age.

Bidirectional longitudinal associations between depressive symptoms and somatic conditions after adverse childhood experiences in middle-aged and older Chinese: A causal mediation analysis

BackgroundWhether adverse childhood experiences (ACEs) preferentially induce depressive symptoms or somatic conditions remains to be explored. MethodsData were from the China Health and Retirement Longitudinal Study (CHARLS) 2011–2018. Fourteen ACEs were retrospectively reported and divided into 0, 1, 2, 3, and 4 or more. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression (CESD-10) scale. Somatic conditions were assessed by pain, falls, chronic diseases, multimorbidity, activities of daily living (ADL), and instrumental activities of daily living (IADL). Weibull regression and mediation analysis were used to explore the bidirectional associations between depressive symptoms and somatic conditions after ACEs. Results4 or more (vs. 0) ACEs were associated with new-onset pain, falls, chronic diseases, multimorbidity, ADL limitations, and IADL limitations, with HRs (95% CIs) of 1.57 (1.37–1.79), 1.84 (1.55–2.18), 1.43 (1.19–1.72), 1.55 (1.32–1.83), 1.85 (1.54–2.23), and 1.46 (1.24–1.71), all of which were mediated by depressive symptoms by 12.3%, 8.6%, 9.6%, 11.9%, 15.3%, and 22.5%, respectively. 4 or more (vs. 0) ACEs were also associated with about 1.90-time higher risk of new-onset depressive symptoms. However, only pain, chronic diseases, and multimorbidity mediated the association by 4.1%, 3.3%, and 2.2%. All the above associations were more pronounced in women than men. ConclusionACEs tend to induce depressive symptoms before somatic conditions assessed by pain, falls, chronic diseases, multimorbidity, and functional limitations rather than vice versa. Future strategies should focus first on mental health in older Chinese to lessen the burden attributed to ACEs to the greatest extent.

Factors associated with new-onset depressive symptoms in patients starting cardiac rehabilitation: Pre-COVID-19 and COVID-19 period comparison

ObjectiveWe aim to: 1) investigate whether starting cardiac rehabilitation (CR) during the COVID-19 period was influential on new-onset depressive symptoms, 2) examine the relationship between sociodemographic and medical factors with the new-onset of depressive symptoms before and during the COVID-19 period in UK patients commencing CR. MethodsThe national audit of cardiac rehabilitation (NACR) data were used and the two years of data before COVID-19 and during COVID-19 were analysed (Feb,2018 – Nov,2021). Hospital Anxiety and Depression Scale measurement was used to assess depressive symptoms. Bivariate analysis and logistic regression were conducted to examine the influence of the COVID-19 period on new-onset depressive symptoms and the patient characteristics associated with it. Results71055 patients screened for new-onset depressive symptoms were included in the analysis. Based on multivariate analysis, patients commencing CR during COVID-19 were 8% more likely to have new onset depressive symptoms compared to patients commencing before COVID-19. Smoking (OR: 1.26, 95%CI: 1.11, 1.43), physical inactivity (OR: 1.86, 95%CI: 1.74, 1.98), high anxiety (OR: 1.45, 95%CI: 1.44, 1.46), being male (OR: 1.21, 95%CI: 1.12, 1.30), single (OR: 1.25, 95%CI: 1.16, 1.35), having comorbidities of arthritis, diabetes, chronic bronchitis, emphysema, claudication (OR range: 1.19 to 1.60), receiving CABG treatment (OR: 1.47, 95%CI: 1.25, 1.73), and having heart failure (OR: 1.33, 95%CI: 1.19, 1.48) were the factors associated with having new-onset depressive symptoms at the start of CR. ConclusionOur findings have shown that starting CR during the COVID-19 period was associated with increased odds of having new-onset depressive symptoms.

Bidirectional associations and a causal mediation analysis between depressive symptoms and chronic digestive diseases: A longitudinal investigation

Chronic digestive diseases (CDDs) and depression shared major pathogeneses. We aimed to prospectively examine the bidirectional incidence associations between depressive symptoms and CDDs and explore biologically and behaviorally relevant mediators in the bidirectional associations. Multivariable-adjusted Cox proportional hazard models were used to examine baseline depressive symptoms in relation to incident CDDs among 10,974 adults and the relation of baseline CDDs with new-onset elevated depressive symptoms among 7489 participants in the China Health and Retirement Longitudinal Study of nationally representative middle-aged and older adults. Elevated depressive symptoms were defined as the 10-item Center for Epidemiologic Studies Depression scale (CES-D-10) score at or higher than 10 and CDDs (except for tumor and cancer) were determined by self-reported physician diagnoses. Causal mediation analysis was performed to assess the mediated effects of a priori selected blood biomarkers and lifestyle factors in the bidirectional associations. Prevalence of elevated depressive symptoms and nonmalignant CDDs at baseline was 33.05% and 17.8% respectively. During a mean of 5.47years of follow-up, elevated depressive symptoms significantly increased hazard of CDDs by 1.66 folds (95%CI=1.49-1.84). Having CDDs at baseline was associated with a 27% (95%CI=16%-39%) increased hazard of developing elevated depressive symptoms. Shorter sleeping duration at night nominally significantly mediated 8.76% of the association between depressive symptoms and incident CDDs while no significant mediators were identified in the converse association. Limited mediator information and inadequately long follow-up may reduce chance of identifying significant mediators. Depressive symptoms and CDDs were mutual independent risk factors. Early screening and management of depressive symptoms and sleep disturbance are suggested in the prevention of CDDs and related comorbidities.

Frailty transition and depression among community-dwelling older adults: the Korean Longitudinal Study of Aging (2006–2020)

BackgroundFrailty is recognized as a geriatric syndrome associated with depression. The consequences and mechanism of frailty transitions are still understudied. This study assessed the influence of frailty transitions on new-onset depressive symptomology using longitudinal, nationwide data of Korean community-dwelling older adults.MethodsLongitudinal population-based study conducted in every even-numbered year starting from 2006 to 2020 (eight waves) with a sample of older adults aged ≥ 60 years old. After the application of exclusion criteria, a total of 2,256 participants were included in the 2008 baseline year. Frailty transition was determined through the biennial assessment of change in frailty status using the frailty instrument (FI); depression was measured using the Center for Epidemiological Studies Depression 10 Scale. We employed the lagged general estimating equations to assess the temporal effect of frailty transition on obtaining depressive symptoms.ResultsCompared to non-frail individuals, the risk of depression was higher in transitioned into frailty and constantly frail participants over a 2-year interval: men (odds ratio (OR) 1.26, 95% confidence interval (CI) 1.21–1.32; OR 1.29, 95% CI 1.21–1.38), women (OR 1.34, 95% CI 1.28–1.40; OR 1.51, 95% CI 1.41–1.62), respectively.ConclusionsFrailty transition is found to be associated with new-onset depressive symptoms. Frail individuals and those who transitioned into frailty were associated with a higher risk of depression. Particular attention should be paid to these frailty transitioned groups. Early intervention and implementation of prevention strategies at physical, nutritional, and social levels are warranted to ameliorate frailty and depression in late life.

The Association between New-Onset Depressive Symptoms and Participating in Medical Check-Ups among Elderly Individuals.

The association between adherence to medical check-ups and new-onset depressive symptoms, after adjusting for comprehensive risk factors such as social characteristics, remains unclear. This study aimed to assess the association between mental health and participating in medical check-ups. The survey data of participants aged 60 to 89 were recruited from the seventh Korean Longitudinal Study on Aging. The primary outcome was new-onset depressive symptoms within 2 years measured using the Center for Epidemiologic Studies Depression Scale. Participating in medical check-ups was defined as undergoing biennial medical check-ups. Multivariable logistic regression was performed to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) with consideration of a 2-year time lag. Among 4255 participants, the prevalence of new-onset depressive symptoms was 7.36% (n = 313). The prevalence of non-participation in medical check-ups was 11.96% (n = 509). The adjusted OR of new-onset depressive symptoms by non-participation in medical check-ups was 1.65 [95% CI 1.22–2.24; p = 0.001] after adjusting for various demographic, behavioral, occupational, and social participation characteristics. Our findings demonstrated a significant inverse relationship between participation in medical check-ups and new-onset depressive symptoms. It is necessary to monitor and manage depressive symptoms in vulnerable elderly individuals who do not participate in medical check-ups.

Association of serum bisphenol AF concentration with depressive symptoms in adolescents: A nested case–control study in China

BackgroundAs an important alternative to bisphenol A (BPA), bisphenol AF (BPAF) is widely used and can be detected in multiple human biological samples. However, there are few studies on neurotoxicity of BPAF at present. In particular, no epidemiological studies have investigated BPAF in relation to depressive symptoms in adolescents. Here, our study aimed to evaluate the associations between serum BPAF concentrations and depressive symptoms in adolescents. MethodsA nested case-control study within an ongoing longitudinal prospective adolescent cohort that was established in Huaibei, China was conducted. A total of 175 participants who had new-onset depressive symptoms (cases) and 175 participants without depressive symptoms (controls) were included. Serum BPAF concentrations was measured using ultra–high–performance liquid chromatography–tandem mass spectrometry. The associations between BPAF exposure and the risk of depressive symptoms in adolescents were assessed using conditional logistic regression. The dose-response relationship between BPAF level and depressive symptoms was estimated using restricted cubic spline analyses. ResultsIn this study, the detection rate of serum BPAF was 100%, and the median (interquartile range, IQR) serum BPAF concentration was 5.24 (4.41–6.11) pg/mL in the case group and 4.86 (4.02–5.77) pg/mL in the control group (P = 0.009). Serum BPAF exposure was a risk factor for depressive symptoms (odds ratio (OR)= 1.132, 95% confidence interval (CI):1.013–1.264). After adjustment for all for confounders, compared with the low–exposure group, the high–exposure group had a 2.806-fold increased risk of depressive symptoms (OR=2.806, 95% CI: 1.188–6.626). Stratified analysis by sex revealed that males were more vulnerable to BPAF exposure than females. After adjustment for all confounders, compared with the low-exposure group, the relative risk of depressive symptoms in the high-exposure group was 3.858 (95% CI: 1.118–12.535) for males, however, no significant association between BPAF exposure and depressive symptoms was found in females. In addition, there was a marked linear association between BPAF exposure and the risk of depressive symptoms in the total population and in males. ConclusionsThe adolescents in this study were widely exposed to low levels of BPAF. A significant positive association was found between serum BPAF levels and the risk of depressive symptoms. The association was significantly modified by sex, and males were more vulnerable to BPAF exposure than females.

Recurrent versus new-onset depressive symptoms: Relationships with biomarkers of cardiovascular health following acute coronary syndrome

ObjectiveNew-onset depressive symptoms commonly arise among persons without a history of major depressive disorder (MDD) in the setting of acute medical illness. Although depressive symptoms in general are associated with alterations in prognostic biomarkers following acute coronary syndrome (ACS), the nature of specifically new-onset depressive symptoms is less well-characterized. It is unclear whether such symptoms neurobiologically resemble recurrent symptoms of MDD or instead represent a distinct condition. In this exploratory analysis, we aimed to examine the effects of prior MDD history on the relationships between post-ACS depressive symptoms and cardiovascular biomarkers. MethodsOne-hundred sixty-four participants attended study visits 2 weeks and 6 months after ACS to complete self-report measures and provide biomarker samples. MDD history was identified by a psychiatrist through systematic electronic medical record review. Generalized estimating equations were performed to examine the moderating effects of MDD history on concurrent relationships between depressive symptoms and several biomarkers (endothelin-1, soluble intercellular adhesion molecule-1, high-sensitivity C-reactive protein, interleukin-6, and tumor necrosis factor-alpha). ResultsTwenty percent (n = 33) of participants had a history of MDD. Depressive symptoms were more strongly associated with levels of endothelin-1 in patients with prior MDD compared to those without (B = 0.024, 95% CI [0.005, 0.043], p = .012), adjusting for age, sex, medical factors, and anxiety. MDD history did not moderate relationships between depressive symptoms and other biomarkers. ConclusionRecurrent post-ACS depressive symptoms are more strongly associated with elevated endothelin-1 levels than new-onset symptoms. Further work is needed to clarify the mechanism and clinical implications of this relationship.

Corrigendum to: Longitudinal Changes in Depressive Symptoms and Risks of Cardiovascular Disease and All-Cause Mortality: A Nationwide Population-Based Cohort Study.

Background There remains a relative paucity of evidence for the association between changes in depressive symptoms with cardiovascular disease (CVD) and mortality. This study aimed to evaluate the association of change in depressive symptoms and incident CVD and mortality in a large prospective cohort of middle-aged and older adults. Methods A total of 6,810 participants free of CVD in the China Health and Retirement Longitudinal Study with two assessments of depressive symptoms at wave 1 (2011-2012) and wave 2 (2013-2014) were included. Elevated depressive symptoms were defined as a score of ≥12 on the 10-item Center for Epidemiologic Studies Depression scale. We used a modified Poisson regression to examine the association of changes in depressive symptoms (never, onset, remitted, and persistent) and incident CVD (a composite endpoint of heart disease or stroke) and mortality at wave 3 (2015-2016). Results During follow-up, 457 CVDs and 148 deaths occurred. Multivariable analyses revealed that persistent depressive symptoms were associated with an elevated risk of CVD (risk ratio = 1.77, 95% confidence interval = 1.38-2.26) and mortality (risk ratio = 1.63, 95% confidence interval = 1.01-2.64) compared with participants without any depressive symptoms. New-onset depressive symptoms increased the mortality risk (risk ratio = 2.37, 95% confidence interval = 1.52-3.69), but not CVD (risk ratio = 1.15, 95% confidence interval = 0.84-1.58). Remitted depressive symptoms were associated with a 35% and 13% excess risk of CVD and mortality, respectively. Conclusion Persistent and remitted depressive symptoms were associated with an increased risk of CVD. New-onset depressive symptoms predicted elevated mortality risk.

Employment Status Change and New-Onset Depressive Symptoms in Permanent Waged Workers.

BackgroundThis study aimed to investigate the relationship between changes in employment status and new-onset depressive symptoms through a one-year follow-up of permanent waged workers.MethodsWe analyzed the open-source data from the Korea Welfare Panel Study. Using the 2017 data, we selected 2,314 permanent waged workers aged 19 to 59 years without depressive symptoms as a base group. The final analysis targeted 2,073 workers who were followed up in 2018. In 2018, there were five categories of employment status for workers who were followed up: permanent, precarious, unemployed, self-employed, and economically inactive. Multiple logistic regression was used to determine the association between employment status change and new-onset depressive symptoms.ResultsAdjusted multiple logistic regression analysis showed that among male workers, workers who went from permanent status to being unemployed (odds ratio: 4.50, 95% confidence interval: 1.19 to 17.06) and from permanent status to being precarious workers (odds ratio: 3.15, 95% confidence interval: 1.30 to 7.65) had significantly high levels of new-onset depressive symptoms compared with those who retained their permanent employment status. There were no significant increases in new-onset depressive symptoms of male workers who went from permanent status to being self-employed or economically inactive. On the other hand, no significant differences were found among female workers.ConclusionOur study suggests that the change of employment status to precarious workers or unemployment can cause new-onset depressive symptoms in male permanent waged workers.

Is improvement in depression in patients attending cardiac rehabilitation with new-onset depressive symptoms determined by patient characteristics?

BackgroundPatients with cardiovascular disease (CVD) commonly experience depressive symptoms which is associated with adverse outcome and increased mortality. Examining the baseline characteristics of cardiac rehabilitation (CR) patients that determine Hospital Anxiety and Depression Scale (HADS) depression outcome may facilitate adjustments in CR programme delivery. This study aims to investigate whether comorbidities, demographic and clinical characteristics of patients, with new-onset post-cardiac event depressive symptoms, determine change in their depression following CR.MethodsAnalysing the routine practice data of British Heart Foundation National Audit of Cardiac Rehabilitation between April 2012 and March 2018, an observational study was conducted. Patients with new-onset post-cardiac event depressive symptoms and no previous documented history of depression constituted the study population.ResultsThe analyses included 64 658 CR patients (66.24±10.69 years, 75% male) with new-onset HADS measures, excluding patients with a history of depression. The comorbidities determining reduced likelihood of improvement in depression outcomes after CR were angina, diabetes, stroke, emphysema and chronic back problems. In addition, higher total number of comorbidities, increased weight, a higher HADS anxiety score, smoking at baseline, physical inactivity, presence of heart failure and being single were other significant determinants. However, receiving coronary artery bypass graft treatment was associated with better improvement.ConclusionThe study identified specific baseline comorbid conditions of patients with new-onset depressive symptoms including angina, diabetes, stroke, emphysema and chronic back problems that were determinants of poorer mental health outcomes (HADS) following CR. Higher total number of comorbidities, increased weight, physical inactivity, smoking, presence of heart failure and being single were other determinants of a negative change in depression. These findings could help CR programmes focus on tailoring the CR intervention around comorbidity, physical activity status, weight management and smoking cessation in patients with new-onset depressive symptoms.

Perinatal Depressive Symptom Trajectories Among Adolescent Women in New York City

PurposeThe aim of the study was to estimate distinct trajectories of depressive symptoms among adolescent women across the perinatal period. MethodsUsing longitudinal depressive symptom data (Center for Epidemiologic Studies Depression Scale) from control participants in the Centering Pregnancy Plus Project (2008–2012), we conducted group-based trajectory modeling to identify depressive symptomatology trajectories from early pregnancy to 1-year postpartum among 623 adolescent women in New York City. We examined associations between sociodemographic, psychosocial, and pregnancy characteristics and the outcome, depressive symptom trajectories. ResultsWe identified three distinct trajectory patterns: stable low or no depressive symptoms (58%), moderate depressive symptoms declining over time (32%), and chronically high depressive symptoms (11%). Women with chronically high symptoms reported higher levels of pregnancy distress and social conflict and lower perceived quality of social support than other women. ConclusionsThis study found heterogeneity in perinatal depressive symptom trajectories and identified a group with chronically high symptoms that might be detected during prenatal care. Importantly, we did not identify a trajectory group with new-onset high depressive symptoms postpartum. Findings have important implications for screening and early treatment.

Longitudinal Changes in Depressive Symptoms and Risks of Cardiovascular Disease and All-Cause Mortality: A Nationwide Population-Based Cohort Study.

There remains a relative paucity of evidence for the association between changes in depressive symptoms with cardiovascular disease (CVD) and mortality. This study aimed to evaluate the association of change in depressive symptoms and incident CVD and mortality in a large prospective cohort of middle-aged and older adults. A total of 6,810 participants free of CVD in the China Health and Retirement Longitudinal Study with two assessments of depressive symptoms at wave 1 (2011-2012) and wave 2 (2013-2014) were included. Elevated depressive symptoms were defined as a score of ≥12 on the 10-item Center for Epidemiologic Studies Depression scale. We used a modified Poisson regression to examine the association of changes in depressive symptoms (never, onset, remitted, and persistent) and incident CVD (a composite endpoint of heart disease or stroke) and mortality at wave 3 (2015-2016). During follow-up, 457 CVDs and 148 deaths occurred. Multivariable analyses revealed that persistent depressive symptoms were associated with an elevated risk of CVD (risk ratio = 1.77, 95% confidence interval = 1.38-2.26) and mortality (risk ratio = 1.63, 95% confidence interval = 1.01-2.64) compared with participants without any depressive symptoms. New-onset depressive symptoms increased the mortality risk (risk ratio = 2.37, 95% confidence interval = 1.52-3.69), but not CVD (risk ratio = 1.15, 95% confidence interval = 0.84-1.58). Remitted depressive symptoms were associated with a 35% and 13% excess risk of CVD and mortality, respectively. Persistent and remitted depressive symptoms were associated with an increased risk of CVD. New-onset depressive symptoms predicted elevated mortality risk.

Predictors of Post-Concussion Depressive Symptoms in Patients without an Underlying Mood Disorder

ObjectiveTo identify predictors of post-concussion depressive symptoms (PCDS) in patients without baseline depressive symptoms.BackgroundDepression is common after concussion and affects quality of life and recovery. To date, the most reliable predictor for development of PCDS is existence of an underlying mood disorder. However, few predictors for PCDS in patients without an underlying mood disorder have been found.Design/MethodsA systematic search was conducted using PubMed for all original articles on post-concussion syndrome in subjects older than 18 years and depression published up to May 2, 2019. Studies that described baseline characteristics for those with and without post-concussion depression were included. Two independent authors reviewed all titles/abstracts to identify studies that met selection criteria. Studies describing pediatric presentation were excluded.ResultsPost-concussion depressive symptoms appear to be associated with symptoms of the concussion itself and with increased number of symptoms reported. Repeat concussions may also increase the risk of developing depressive symptoms. In those with persistent post-concussive symptoms, symptoms seem to appear in a predictable sequence, such that symptoms later in the sequence are more likely to be present if symptoms earlier in the sequence were already present. As such, patients reporting persistent depressive symptoms were more likely to also report existence of correlated cognitive (difficulty concentrating or remembering, feeling dazed) and somatic (headache, fatigue, sensitivity to noise and/or light) symptoms that appear earlier in sequence (OR 2.2). No association between age and gender and experience of new-onset depressive symptoms following concussion was found.ConclusionsIn patients without underlying depressive symptoms, predictors such as quantity and characterization of post-concussive symptoms may help elucidate patient profiles vulnerable to development of PCDS. Multiple concussions, presence of multiple post-concussive symptoms, and presence of correlated symptoms appear to be predictive. Familiarization with these predictors may lead to earlier detection and optimal treatment of PCDS.

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.