New-onset Depression Research Articles

Longitudinal survey of depressive symptoms among university students during the COVID-19 pandemic in Japan.

While changes in response to the different stages of the pandemic remain unknown, this study investigated the longitudinal impact of the COVID-19 pandemic on depressive symptoms in Japanese university students and identified factors associated with new onset of depression and suicidal ideation. Two surveys were conducted at one university in Akita, Japan, during the first COVID-19 outbreak period (T1: May–June 2020) and 1 year later (T2: March–May 2021). Moderate depressive symptoms were defined as a Patient Health Questionnaire-9 score ≥ 10 and suicide-related ideation score ≥ 1 on question 9 of the questionnaire. Among 985 students who completed surveys in T1 and T2, participants with moderate depressive symptoms and suicide-related ideation increased from 11 to 17% and from 5.8 to 11.8%, respectively. Among 872 students at risk after excluding those with moderate depressive symptoms at T1, 103 students (11.8%) developed moderate depressive symptoms at T2. Among the 928 students at risk, after excluding those who had suicidal ideation at T1, 79 (8.5%) developed suicidal ideation. Multivariate logistic modeling revealed financial insecurity and academic performance as risk factors (ps < 0.01), while having someone to consult about worries was a coping factor for depressive symptoms and suicidal ideation (ps < 0.001). Our findings demonstrated that socioenvironmental factors may determine depressive symptoms of university students.

Pre-existing and new-onset depression among patients undergoing esophageal cancer surgery: a nationwide cohort study in South Korea.

Esophageal cancer is believed to be related to psychological stress. This study aimed to examine the prevalence and risk factors for new-onset depression after esophageal cancer surgery among patients who had no pre-existing depression. In addition, we examined whether pre-existing depression affected postoperative 1-year mortality. The National Health Insurance Service database in South Korea was used for data extraction in this population-based cohort study. This study included all adult patients diagnosed with esophageal cancer who underwent esophageal surgery between January 1, 2011, and December 31, 2018. A total of 7039 adult patients who underwent esophageal cancer surgery at 95 South Korean hospitals were included in the analyses. Of the total, 608 patients (8.6%) were diagnosed with new-onset depression within 1year after esophageal cancer surgery. Female sex, adjuvant chemotherapy, increased Charlson comorbidity index, pre-existing anxiety disorder, and pre-existing insomnia disorder were potential risk factors for new-onset depression. In multivariable Cox regression analysis, the pre-existing depression group showed a 1.27-fold (hazard ratio: 1.27; 95% confidence interval: 1.08-1.48; P = 0.004) higher risk of 1-year all-cause mortality than those who had no pre-existing depression. In South Korea, 8.6% of patients are newly diagnosed with depression after esophageal cancer surgery, and some potential risk factors have been identified. Moreover, pre-existing depression was associated with increased 1-year all-cause mortality. Patients with esophageal cancer and pre-existing depression may be at high risk, requiring interventions after esophageal cancer surgery.

0257 Testing the directionality of sleep and stress during the perinatal period: what's the impact on perinatal depression?

Abstract Introduction Pregnancy is a time of pronounced sleep disturbance, with a majority (~85%) of women endorsing shorter, more fragmented sleep as gestation progresses. While new-onset antenatal depression (AND) is a known risk factor for postpartum depression, its etiology remains less understood, despite well-established evidence that incidence is the same among healthy first-time mothers as compared to women with established riskfactors inclusive of family or personal history of psychopathology. Heightened daily stress appraisals may be one critical pathway through which disrupted sleep gives rise to AND. The current study tested the directionality of the relationship between habitual nighttime sleep parameters and daytime stress ratings using a prospective amulatory field study design. Methods Fifty primiparous women (38% White; 32% Black; 30% Other race/ethnicity; mean age = 32 years, 28 weeks gestation) without a history of sleep disorders nor psychopathology completed 10-days (9-nights) of actigraphy and sleep diaries. They also engaged in 3-days of superimposed ecological momentary assessments (EMA) rating stress, positive, and negative affect at four intervals throughout the day. Analyses examined negative affective responses to social conflict and task-based demand througout days of EMA, at the within-person and between-women levels. Sleep variables explored included total sleep time (TST), sleep efficiency (SE; log-transformed), sleep onset latency (SOL) and sleep quality as measured by the Pittsburgh Sleep Quality Index. Cross-lagged hierarchical mixed models tested directionality of sleep-stress relationship. Time-varying covariates included time-of-day, previous day stress for sleep outcomes, and previous night sleep for stress outcomes, at the within-person levels. Results After days of greater stress (demand and conflict), women experienced significantly shorter, less efficient sleep and took longer to fall asleep (by both diary and actigraphy; [Beta(SE)=-6.3(1.4); 1.2(.12,), R^2=.27, .32, respectively; ps&amp;lt;.01]. Following nights of shorter sleep, women endorsed greater negative affective responses to stress (Beta=.12, SE=.01, p&amp;lt;.001; R^2=.27). Over the assessment period, women who had shorter, less efficient sleep experienced greater frequency, higher severity stressors, after adjusting for time-of-day, and baseline sleep characteristics, depression and anxiety levels (Betas = -7.4(2.6); .14(.01), ps&amp;lt;.001, respectively). Given this bidirectional support, stress was examined as a moderator of the relationship between TST and depression severity at 34-36 weeks gestation, indicating that greater stress explained the relationship between shorter TST and heightened AND after adjustment for baseline measures. Conclusion This is the first study to explore directionality of sleep-stress relationships in a perinatal sample; results provide support for the idea that heightened daily stress engenders greater sleep disturbance (difficulty initiating and maintaining sleep; shorter duration). Bidirectional support for shorter sleep duration and increased stress appraisal was also found. The current project provides preliminary evidence for stress "spill-over" effects (i.e., stress transmission) as a potential mechanism for heightened antenatal depression symptoms. Support (If Any) NIMH 1R36MH118000-01, CTSI89431, SRS Mentor/Mentee Grant; T32 HL007713

The associated burden of mental health conditions in alopecia areata: a population-based study in UK primary care.

BackgroundAlopecia areata (AA) is a common cause of nonscarring hair loss that can have a profound psychological impact.ObjectivesTo assess the co‐occurrence of depression and anxiety in adults with AA compared with the general population, and to evaluate the mental health treatment burden and impact on time off work and unemployment.MethodsIn total, 5435 people with newly diagnosed AA in UK primary care were identified from the Oxford Royal College of General Practitioners Research and Surveillance Centre network database, and matched to 21 740 controls. In cases and controls, we compared the prevalence and incidence of depressive episodes, recurrent depressive disorder and anxiety disorder, rates of time off work and unemployment, and, in those with pre‐existing mental health conditions, rates of mental health‐related prescribing and referral rates. This observational was registered with ClinicalTrials.gov (NCT04239521).ResultsDepression and anxiety were more prevalent in people diagnosed with AA than in controls (P < 0·001). People with AA were also more likely to subsequently develop new‐onset depression and anxiety: adjusted hazard ratio (aHR) for recurrent depressive disorder 1·38 [95% confidence interval (CI) 1·13–1·69], depressive episodes aHR 1·30 (95% CI 1·04–1·62) and anxiety disorder aHR 1·33 (95% CI 1·09–1·63); to be issued time off work certificates (aHR 1·56, 95% CI 1·43–1·71); and to be recorded as unemployed (aHR 1·82, 95% CI 1·33–2·49). Higher rates of antidepressant prescribing were also seen in people with AA.ConclusionsPeople with AA have higher rates of depression and anxiety than those without AA. This impacts deleteriously on mental health treatment burden, time off work and unemployment. Evidence‐based mental health treatment programmes are needed for people with AA.

New-Onset Depression Among Surgical Interns

New-Onset Depression Among Surgical Interns

Bidirectional association between inflammatory bowel disease and depression among patients and their unaffected siblings.

Background and AimApproximately 30% of inflammatory bowel disease (IBD) patients develop depression. Conversely, several studies reported increased IBD risk among patients with depression. Such bidirectional relationship has not been reported within one representative cohort, nor investigated among patients' family members. These associations may further implicate the gut–brain axis in IBD.MethodsWe conducted parallel retrospective cohort analyses to investigate depression risk among IBD patients and their unaffected siblings, and IBD risk among patients with depression and their unaffected siblings using the Taiwanese National Health Insurance Research Database. Individuals were followed up to 11 years for new‐onset depression or IBD. Controls were matched to unaffected siblings based on predefined characteristics.ResultsTo investigate depression risk among IBD ‐ 422 IBD patients, 537 unaffected siblings, and 2148 controls were enrolled. During follow‐up, 78 (18.5%) IBD patients, 26 (4.8%) unaffected siblings, and 54 (2.5%) controls developed depression. Adjusted odds ratios (ORs) for depression among IBD patients and unaffected siblings were 9.43 (95% CI 6.43–13.81; P < 0.001) and 1.82 (95% CI 1.14–2.91; P = 0.013), respectively. To investigate IBD risk among depression ‐ 25 552 patients with depression, 26 147 unaffected siblings, and 104 588 controls were enrolled. During follow‐up, 18 (0.70/1000) depression patients, 25 (0.96/1000) unaffected siblings, and 58 (0.55/1000) controls developed IBD. ORs for IBD among depression patients and unaffected siblings were 1.87 (95% CI 1.07–3.26; P = 0.028) and 1.69 (95% CI 1.05–2.69; P = 0.029), respectively.ConclusionsThis population‐based study elucidates bidirectional association between IBD and depression. Elevated risks for either disease among patients and their unaffected siblings suggest shared etiologic contributors, offering novel insight into the gut–brain axis' influence in IBD pathophysiology.

Association between gastric cancer and the risk of depression among South Korean adults

ObjectivesThe diagnosis and treatment of cancer are stressful events that could trigger psychological distress in a large number of cancer patients. The aim of this study was to examine the association between gastric cancer and the risk of new onset of depression among South Korean adults.MethodsData from 12,664 participants aged over 40 years was derived from the National Health Service National Sample Cohort (2002–2013). The case cohort consists of patients who received a diagnosis of gastric cancer between 2002 and 2009, and the corresponding control group was selected through 1:1 propensity score matching (case: 6332, control: 6332). The new onset of depression was considered as the dependent variable. A Cox proportional hazards regression model was built to analyze the associations between variables in consideration.ResultsIndividuals with gastric cancer had a higher risk of new onset of depression than those without cancer (hazard ratio [HR] = 1.28, 95% confidence interval [CI] = 1.13–1.45.) Female gastric patients had a higher risk of depression compared to male patients (Female; HR = 1.89, 95% CI = 1.66–2.16, Male; HR = 1.25, 95% CI = 1.10–1.41). Gastric cancer patients in their 60s had the highest risk of new onset of depression compared to other age groups and no cancer group (HR = 1.61, 95% CI = 1.40–1.85). Gastric cancer patients who were previously diagnosed with depression prior to their diagnosis of cancer had a higher risk of new onset of depression than gastric cancer patients without antecedent diagnosis of depression (Past Depression (Yes); HR = 5.17, 95% CI = 4.10–6.51, Past Depression (No); HR = 1.35, CI = 1.21–1.51).ConclusionsThe study identified a significant relationship between gastric cancer and depression among South Korean adults, suggesting that the diagnosis and treatment of gastric cancer increases the risk of new onset of depression, especially among female patients between 60 and 69 years old of high income and living in metropolitan regions. Pre-existing health conditions also appeared to be a risk factor. Thus, in consideration of treatment efficacy and patients’ quality of life, the results of the study emphasizes the need for attentive intervention, while distinguishing the most vulnerable groups.

High body weight variability is associated with increased risk of depression: a nationwide cohort study in South Korea.

Body weight variability (BWV) negatively affects the incidence and outcomes of various diseases, but the nature of the association between BWV and depression remains unclear. In this study, we aimed to test the hypothesis that BWV is associated with the risk of new-onset depression. Data from a nationwide population-based cohort in the Korean National Health Insurance Service database were analyzed for 6 598 570 adults with no history of depression and reports of at least three health examinations. BWV was estimated using variability independent of the mean indices and divided into quartiles (Q1 lowest, Q4 highest BWV). Cox proportional hazard models were applied to assess the risk of depression according to the quartile of BWV. The incident rate for depression from Q1 to Q4 of BWV was 20.7, 20.3, 20.8, and 22.2 per 1000 person-years, respectively. BWV, especially high BWV, was associated with an increased risk of depression after adjusting for age, sex, smoking, alcohol consumption, physical activity, income, diabetes mellitus, hypertension, and dyslipidemia. The hazard ratio (HR) of new-onset depression was highest in Q4 relative to Q1 in the total population (HR 1.12, p < 0.0001) and was higher in women than in men (HR 1.72 v. 1.16, p < 0.0001). In stratified analyses, regardless of obesity or weight change status at baseline, the risk of depression was increased when bodyweight fluctuated highly during follow-up. High BWV was associated with an increased risk of depression. Further studies need to evaluate the role of high BWV with respect to the onset of depression.

Risk of depression after coronary artery bypass grafting: a SWEDEHEART population-based cohort study.

AimsA diagnosis of depression in patients with coronary heart disease is associated with worse outcomes. This study examined the long-term risk for new onset of depression after coronary artery bypass grafting (CABG) compared to an age- and sex-matched control group from the general population.Methods and resultsIn total, 125 418 primary isolated CABG patients and 495 371 matched controls were included from 1992 to 2017. The SWEDEHEART registry and three other national registers were used to acquire information about baseline characteristics and depression. The adjusted risk of depression was estimated by using Cox regression models adjusted for patient characteristics, and socioeconomic variables, described by hazard ratios (HR) and 95% confidence intervals (CI). In total, 6202 (4.9%) CABG patients and 17 854 (3.6%) controls developed depression. The cumulative incidence of depression was higher in CABG patients than in the control population [6.1%, 95% CI 6.0–6.3 vs. 4.7% (4.7–4.8), P < 0.0001]. Overall, the CABG group had a marginally increased adjusted risk of depression compared to controls [adjusted HR (aHR): 1.05 (1.01–1.09), P = 0.0091]. In age-specific analyses, the increased risk compared to controls was only present in patients <65 years [aHR: 1.19 (1.11–1.27), P <0.0001] and was only evident during the first 5 years after surgery.ConclusionPatients who underwent CABG had a higher risk of new onset of depression compared to sex- and age-matched controls in the general population. The risk of depression was especially pronounced in younger patients during the first 5 years after surgery.

Association between Hypertensive Disorders in Pregnancy and Postpartum Mental Health

Aim: To determine the relation between prevalence of Postpartum Depression and varying degrees of severity of Hypertensive Disorders in Pregnancy. Study design: A cross sectional study . Place &amp; duration of study: Department of Obs. &amp; Gynae, Avicenna Hospital, Lahore from June 2020 to December 2021. Methodology: A total of 220 women with and without hypertensive disorders of pregnancy (110 in each group) delivered during this period were enrolled in the study. A survey in the post partum period from second to sixth week postpartum was carried out. It was done according to the Edinburgh Postnatal Depression Scale (EPDS) to assess the effect of severity of Hypertensive disorders of pregnancy to develop new-onset postpartum depression. Results: 220 women were enrolled in the study. Among them Forty five women showed sign and symptoms of post partum depression. On the other hand 175 had no manifestation of depression according to the scale. The prevalence of PPD was 27 % (30/110) in women with hypertensive disorders, being twice the value in normotensive subjects (13.6%). The risk of Post partum depression surged with the aggressiveness of hypertensive disease in pregnancy. Conclusion: Preeclampsia has an independent association with Post partum depression. The risk of Post partum depressive disorder seemed to increase with the rising severity of hypertension in pregnancy. Therefore support and additional preventive strategies should be planned for women with Preeclampsia to reduce the likelihood of Post partum deterioration of mental health. Keywords: Hypertensive disorders in Pregnancy, Preeclampsia , Postpartum Depression.

High Bodyweight Variability Increases Depression Risk in Patients With Type 2 Diabetes Mellitus: A Nationwide Cohort Study in Korea.

Objectives: Although obesity is associated with increased risk for depression in patients with type 2 diabetes mellitus (DM), the relationship between body weight variability (BWV) and depression remains poorly studied. This study was to investigate the incidence of depression in patients with type 2 DM according to their BWV.Methods: Intraindividual variation in body weight were measured in the nationwide, population-based retrospective cohort of 540,293 patients with type 2 DM from the Korean national health insurance system between 2009 and 2010. The diagnoses of new-onset depression occurring until the end of 2017 were ascertained. Risk of new-onset depression was examined using multivariate-adjusted Cox proportional hazards regression analysis by BWV quartile.Results: 93,149 (17.2%) patients developed new-onset depression for the follow up. BWV was significantly associated with an increased risk of depression after adjusting for confounding factors. The highest BWV quartile group had a hazard ratio (HR) of 1.17 (95% CI 1.15–1.19) compared to the lowest BWV quartile group as a reference. Obese patients in the highest BWV quartile group showed 12% increased risk of depression (HR 1.12, 95% CI 1.09–1.15) while non-obese patients in the highest BWV quartile group showed 20% increased risk of depression (HR: 1.20, 95% CI: 1.17–1.23) compared to their respective lowest BWV quartile groups.Conclusion: A higher BWV was significantly associated with an increased risk of depression in patients with type 2 DM. Thus, BWV may serve as an indicator for early detection of depression in type 2 DM patients.

Clinical utility of family history of depression for prognosis of adolescent depression severity and duration assessed with predictive modeling.

BackgroundFamily history of depression (FHD) is a known risk factor for the new onset of depression. However, it is unclear if FHD is clinically useful for prognosis in adolescents with current, ongoing, or past depression. This preregistered study uses a longitudinal, multi‐informant design to examine whether a child’s FHD adds information about future depressive episodes and depression severity applying state‐of‐the‐art predictive out‐of‐sample methodology.MethodsWe examined data in adolescents with current or past depression (age 11–17 years) from the National Institute of Mental Health Characterization and Treatment of Adolescent Depression (CAT‐D) study. We asked whether a history of depression in a first‐degree relative was predictive of depressive episode duration (72 participants) and future depressive symptom severity in probands (129 participants, 1,439 total assessments).ResultsFamily history of depression, while statistically associated with time spent depressed, did not improve predictions of time spent depressed, nor did it improve models of change in depression severity measured by self‐ or parent‐report.ConclusionsFamily history of depression does not improve the prediction of the course of depression in adolescents already diagnosed with depression. The difference between statistical association and predictive models highlights the importance of assessing predictive performance when evaluating questions of clinical utility.

Long-term prescription opioid users' risk for new-onset depression increases with frequency of use.

Long-term opioid therapy (LTOT) is associated with increased risk for depression. It is not known if the frequency of opioid use during LTOT is associated with new-onset depression. We used Optum's de-identified Integrated Claims-Clinical dataset (2010-2018) to create a cohort of 5146 patients, 18 to 80 years of age, with an encounter or claims in the year before new LTOT. New LTOT was defined by >90-day opioid use after remaining opioid free for 6 months. Opioid use frequency during the first 90 days of LTOT was categorized into occasional use (<50% days covered), intermittent use (50% to <80% days covered), frequent use (80% to <90% days covered), and daily use (≥90% days covered). Propensity scores and inverse probability of exposure weighting controlled for confounding in models estimating risk for new-onset depression. Patients were on average 54.5 (SD ± 13.6) years of age, 55.7% were female, 72.5% were White, and 9.5% were African American. After controlling for confounding, daily users (hazard ratio = 1.40; 95% confidence interval: 1.14-1.73) and frequent users (hazard ratio = 1.34; 95% confidence interval: 1.05-1.71) were significantly more likely to develop new-onset depression compared with occasional users. This association remained after accounting for the contribution of post-index pain diagnoses and opioid use disorder. In LTOT, risk for new depression episodes is up to 40% greater in near-daily users compared with occasional users. Patients could reduce depression risk by avoiding opioid use on as many low pain days as possible. Repeated screening for depression during LTOT is warranted.

New-onset depression after hip fracture surgery among older patients: Effects on associated clinical outcomes and what can we do?

BACKGROUNDHip fracture in the elderly is a worldwide medical problem. New-onset depression after hip fracture has also received attention because of its increasing incidence and negative impact on recovery.AIMTo provide a synthesis of the literature addressing two very important questions arising from postoperative hip fracture depression (PHFD) research: the risk factors and associated clinical outcomes of PHFD, and the optimal options for intervention in PHFD.METHODSWe searched the PubMed, Web of Science, EMBASE, and PsycINFO databases for English papers published from 2000 to 2021.RESULTSOur results showed that PHFD may result in poor clinical outcomes, such as poor physical function and more medical support. In addition, the risk factors for PHFD were summarized, which made it possible to assess patients preoperatively. Moreover, our work preliminarily suggested that comprehensive care may be the optimal treatment option for PHFDs, while interdisciplinary intervention can also be clinically useful.CONCLUSIONWe suggest that clinicians should assess risk factors for PHFDs preoperatively, and future research should further validate current treatment methods in more countries and regions and explore more advanced solutions.

Depressive symptoms and chronic lung disease in middle-aged and older Chinese adults: Prospective bidirectional association and mediation analysis

BackgroundWe investigated the prospective bidirectional association between depressive symptoms and chronic lung disease (CLD) and explored biologically and behaviorally relevant mediators in this bidirectional association among Chinese middle-aged and older population in the China Health and Retirement Longitudinal Study. MethodsMultivariable-adjusted Cox proportional hazard models were used to examine baseline depressive symptoms in relation to incident CLD risk among 12,546 adults and examine CLD condition in association with incidence of elevated depressive symptoms among 6,929 participants from 2011 to 2018. Elevated depressive symptoms were assessed with the 10-item Center for Epidemiologic Studies Depression scale and CLD was determined by self-reported physician diagnosis. Causal mediation analysis was performed to examine the direct and indirect effects of a priori selected nine blood biomarkers and four lifestyle factors in the bidirectional association. ResultsElevated depressive symptoms significantly increased CLD risk by 68% (HR=1.68, 95%CI=1.46–1.93) after a mean follow-up of 5.9 years and the strong positive association was consistently shown in almost all the subgroups. Having positive CLD status at baseline was associated with 17% increased risk of developing elevated depressive symptoms (HR=1.17, 95%CI=1.01–1.35) during an average of 4.6 years follow-up period. Significant inflammatory, metabolic or pulmonary function related mediators were not identified. LimitationsInadequate follow-up time and limited mediator variable information may reduce chance of identifying significant mediators. ConclusionsElevated depressive symptoms and CLD were mutual risk factors in middle-aged and older Chinese adults. Early screening and treatment of depression is needed to reduce CLD risk and related comorbidities including new-onset depression so as to relieve substantial disease burdens of CLD and depression in China.

Cerebral Small Vessel Disease and Depression Among Intracerebral Hemorrhage Survivors.

Intracerebral hemorrhage (ICH) is an acute manifestation of cerebral small vessel disease (CSVD), usually cerebral amyloid angiopathy or hypertensive arteriopathy. CSVD-related imaging findings are associated with increased depression incidence in the general population. Neuroimaging may, therefore, provide insight on depression risk among ICH survivors. We sought to determine whether CSVD CT and magnetic resonance imaging markers are associated with depression risk (before and after ICH), depression remission, and effectiveness of antidepressant treatment. We analyzed data from the single-center longitudinal ICH study conducted at Massachusetts General Hospital. Participants underwent CT and magnetic resonance imaging imaging and were followed longitudinally. We extracted information for neuroimaging markers of CSVD subtype and severity. Outcomes of interest included pre-ICH depression, new-onset depression after ICH, resolution of depressive symptoms, and response to antidepressant treatment. We followed 612 ICH survivors for a median of 47.2 months. Multiple CSVD-related markers were associated with depression risk. Survivors of cerebral amyloid angiopathy-related lobar ICH were more likely to be diagnosed with depression before ICH (odds ratio, 1.68 [95% CI, 1.14-2.48]) and after ICH (sub-hazard ratio, 1.52 [95% CI, 1.12-2.07]), less likely to achieve remission of depressive symptoms (sub-hazard ratio, 0.69 [95% CI, 0.51-0.94]), and to benefit from antidepressant therapy (P=0.041). Cerebral amyloid angiopathy disease burden on magnetic resonance imaging was associated with depression incidence and treatment resistance (interaction P=0.037), whereas hypertensive arteriopathy disease burden was only associated with depression incidence after ICH. CSVD severity is associated with depression diagnosis, both before and after ICH. Cerebral amyloid angiopathy-related ICH survivors are more likely to experience depression (both before and after ICH) than patients diagnosed with hypertensive arteriopathy-related ICH, and more likely to report persistent depressive symptoms and display resistance to antidepressant treatment.

Prophylactic Antidepressants in a Patient With Multiple Sclerosis Receiving Interferon-β.

The relationship between INF-β and depression and suicidality has not been strongly established. Here read about a woman with multiple sclerosis with new-onset depression who was taking fluoxetine in addition to INF-β treatment.

Effects of Bilateral STN-DBS on Psychiatric Profile, Cognitive Aspects, and Quality of Life in Patients with Parkinson's Disease

Background: Apart from motor manifestations, Parkinson's disease (PD) and associated treatment modalities including DBS are associated with less studied psychiatric and cognitive symptoms. Aim: This study aims to evaluate psychiatric profile, cognition, and quality of life in patients with advanced PD and the effects on STN-DBS on them. Study Design: A prospective, single center, observational study using a direct, structured interview of PD patients. Materials and Methods: All consecutive patients undergoing bilateral STN-DBS between the period June 2017 and December 2019 were evaluated with mini international neuropsychiatric interview (MINI), Addenbrooke's Cognitive Examination (ACE), and PD questionnaire-39 (PDQ-39) before surgery. All these patients were evaluated at 6 weeks postsurgery with MINI and with MINI, ACE and PDQ-39 at 6 months postsurgery. Lead position in magnetic resonance imaging was correlated with psychiatric manifestations. Paired t-test and Wilcoxon sign-rank test were used to study the difference between means. Results: There were a total of 40 cases operated in the study period. There were two patients who had cerebral hemorrhage and two had leads removed due to infection and these patients were excluded from the final analysis. Out of 36 patients, depression was noted in 7 (19.4%), psychosis in 5 (13.8%), anxiety in 10 (27.7%), and suicidal ideation in 2 (5.5%) cases. Postoperatively, 85% of patients with depression, 80% with psychosis, and 80% of patients with anxiety disorders improved. One patient developed new-onset depression and one patient developed visual hallucination. Two patients had acute deterioration in the immediate postoperative period. The patient who developed depression and hallucination had their leads medially located. Mild cognitive decline was noted in verbal fluency which was significant (P = 0.003), and however, there was a significant improvement in quality of life (P = 0.001). Conclusions: Bilateral STN-DBS is a safe and effective therapeutic option and improves psychiatric disorders if the leads are appropriately placed. Although mild cognitive decline occurs, there is overall significant improvement in quality of life.

Influences of antidepressant medications on the risk of developing hyperlipidemia in patients with depression by a population-based cohort study and on in vitro hepatic lipogenic-related gene expression

BackgroundDepression increases the risk of cardiovascular disease (CVD). The association between antidepressant medications (ADMs) and CVD remains controversial. Hyperlipidemia is a risk factor for CVD. We conducted a nationwide population-based retrospective cohort study to examine depression and ADM use on the risk of developing hyperlipidemia. The effects of ADMs on the expression of lipogenesis-related hepatic genes were also evaluated. MethodsWe obtained data from the Longitudinal Health Insurance Database of Taiwan on patients with new-onset depression and a comparison cohort without depression. A Cox proportional hazards regression model was used to analyze the differences in the risk of developing hyperlipidemia between these two cohorts. We also examined the influence of ADMs on the expression of lipogenesis-related hepatic genes. ResultsAfter adjustment for comorbidities and confounding factors, the case group (N = 38,322) had a higher risk for hyperlipidemia than that of the control cohort (N = 38,322) [adjusted hazards ratio (aHR) =1.16]. Patients with depression who did not receive ADM therapy exhibited a significantly higher risk of hyperlipidemia (aHR = 1.61). However, in patients with depression treated with ADMs, the risk of developing hyperlipidemia was significantly lowered compared to the patients without ADMs (all aHR < 0.81). Gene expression analysis indicated that ADMs downregulated the expression of lipogenesis-related hepatic genes. LimitationsUnmeasured confounding risk factors for hyperlipidemia might not have been included in the study. ConclusionsADMs reduced hyperlipidemia risk in patients with depression, partly by downregulating the expression of lipogenesis-related genes and improving the patients’ lipid profiles. Early diagnosis and management of hyperlipidemia would further facilitate the prevention of CVD.

Association between the severity of new-onset depression and unmet healthcare needs of South Korean adults.

ObjectivesIdentifying whether the demand for medical services is catered to is an important issue. Given that depression is a major contributor to the overall global burden of disease, it could affect the use of healthcare. This study aims to examine the association between the severity of new-onset depression and unmet healthcare needs among South Korean adults.MethodsData from 15,588 participants, derived from the 2014, 2016, and 2018 Korean National Health and Nutrition Examination Survey, were examined. Only individuals who were not diagnosed with depression was included to exclude those who visited hospitals to treat depression or were experiencing unmet healthcare needs due to depression. Depression was measured using the Patient Health Questionnaire-9 and unmet healthcare needs acted as the dependent variable. A multiple/multinomial logistic regression analysis was built to analyze the association between the variables.ResultsIndividuals with severe depression had a higher risk of having unmet healthcare needs compared to those without (men: adjusted OR = 2.05, 95% CI = 1.40–3.00; women: adjusted OR = 2.20, 95% CI = 1.72–2.82). White-collar men with severe depression also had a higher risk of having unmet healthcare needs (adjusted OR = 9.72, 95% CI = 4.73–20.00). Individuals with severe depression had a higher risk of having unmet healthcare needs due to economic hardship than those without depression (men: adjusted OR = 3.01, 95% CI = 1.76–5.14, women: adjusted OR = 2.93, 95% CI = 1.96–4.38).ConclusionsThis study identified a significant relationship between the severity of new-onset depression and the risk of having unmet healthcare needs among South Korean adults. Our study suggests that having severe depression contributed to a higher risk of unmet healthcare needs. Proper care to manage depression can be promoted through future intervention programs that alleviate the risk of having unmet healthcare needs.