Nondepressed Patients Research Articles

Depression as a Driving Force for Low Time in Therapeutic Range and Dementia in Patients With and Without Atrial Fibrillation

Both time in therapeutic range (TTR) for anticoagulation and depression are associated with dementia risk. The purposes of this study were to examine the impact of depression on TTR and to describe the partitioned contribution of depression and TTR on long-term dementia risk. We studied 14,953 patients anticoagulated with warfarin (target INR 2-3) for atrial fibrillation (AF), venous thromboembolism (VTE), or a mechanical heart valve from 2003 to 2015. We excluded patients with a diagnosis of dementia before or within 6 months of warfarin initiation. We examined the association of depression with TTR using finite mixture modeling and logistic regression and utilized multivariable Cox hazard regression to determine the association of TTR and depression with incident dementia at 3 and 13 years. Forty % (n=6055) of patients were diagnosed with depression before or while on warfarin. Patients with depression had significantly lower TTR and were 1.37 times more likely to have TTR <50% than non-depressed patients (p <0.0001). During follow-up, 4.2% of patients received the diagnosis of dementia within 3 years as compared to 12% during all-time follow up. The 3-year risk of dementia was highest for patients with a ≤50% TTR regardless of depression status. The 3-year dementia risk was associated with TTR (p <0.0001) but not depression. However, for all-time dementia both TTR (p <0.0001) and depression (p <0.0001) as well as their interaction (p=0.049) were associated with dementia. Depression increased the risk of long-term dementia by 1.69 fold (95% CI: 1.33, 2.15) for patients with the lowest TTR. Depression is prevalent in patients managed with warfarin and is associated with significant decreases in TTR. In conclusion, decreased TTR appears to increase 3-year dementia risk and both low TTR and depression interact to increase risk for all-time dementia in patients taking warfarin.

The Relationship Between Decisional Regret and Well-Being in Patients With and Without Depressive Disorders: Mediating Role of Shared Decision-Making.

Background: The objectives of this study were two-fold: (1) to assess the relationship between patients' decisional regret and their well-being and (2) to examine the mediated effect of shared decision-making (SDM) on this relationship.Methods: A cross-sectional survey was conducted in five cities in Southern China. Patients were asked to fill out questionnaires assessing their decisional regret, SDM, subjective well-being, and depressive status. Mediation analysis was used to investigate the effect of SDM on the relationship between patients' decisional regret and their subjective well-being.Results: The findings showed significant direct negative effects of decisional regret on subjective well-being and SDM. For non-depressive patients, SDM exerted a significant and indirect effect on reducing the negative influence of decisional regret on subjective well-being.Conclusions: Findings suggest that implementation of SDM can decrease patients' decisional regret and improve their well-being; however, there is a need to examine their depressive status as part of routine healthcare.

Regulation of TWIK-related K+ channel 1 in the anterior hippocampus of patients with temporal lobe epilepsy with comorbid depression

Epilepsy with comorbid depression has recently attracted increasing attention. Temporal lobe epilepsy (TLE) may represent an increased risk of developing depression, especially if the seizures do not generalize. The two-pore domain potassium channel-TWIK-related K+ channel (TREK-1) plays important roles in both epilepsy and depression. However, the changes in its expression in patients with epilepsy with comorbid depression remain unclear. In the present study, we analyzed depressive symptoms using neuropsychiatric scales in forty-two patients with drug-resistant TLE, who also underwent EEG in waking and sleeping states, as well as 3.0 T brain MRI. We tested for TREK-1 positive neurons and microglial cells in the anterior hippocampi of patients with drug-resistant TLE with and without comorbid depression (n=5/group). Approximately 31% of patients with TLE had comorbid depression (13/42). Meanwhile, the patients who had hippocampal sclerosis had much higher scores on the depression rating scale. The results indicated the contribution of hippocampal sclerosis to the development of depression. Immunostaining of TREK-1 channels was observed in neurons and glia in the anterior hippocampus. Increased immunoreactivity of TREK-1 neurons was observed in the hippocampi of patients with TLE with comorbid depression compared with nondepressed patients with TLE. TREK-1 was expressed in almost all microglia. Curiously, more activated TREK-1-positive microglia were observed in patients with TLE with depression than in those without depression. The results suggested that a change in TREK-1 immunoreactivity was involved, at least partly, in the development of depression as a comorbidity of TLE. Imbalance of the TREK-1 channel may be a potential target for the treatment of patients with epilepsy with comorbid depression.

575-P: Serum Soluble Epoxide Hydrolase-Related Oxylipins Are Associated with Depression and Increased Symptom Severity in T2DM

Depression in T2DM is associated with inflammation (e.g., interleukin-6 [IL-6]), but specific inflammatory pathways, and depressive symptoms involved, have not been identified. Cytochrome P450s (CYP450s) convert dietary fatty acids into pro-resolving epoxides but soluble epoxide hydrolase (sEH) metabolizes these into inactive diols, thereby limiting their anti-inflammatory benefits. We hypothesized that sEH oxylipins (diols and epoxides) will be associated with depression and increased symptom severity in T2DM. Patients with T2DM were diagnosed with depression (Structured Clinical Interview, DSM-5) and matched 1:1 to non-depressed patients for sex, HbA1c and BMI. Fasting serum oxylipins were quantified by ultra-high-performance liquid chromatography tandem mass spectrometry. All analyses controlled for IL-6, measured by ELISA. Diol/epoxide ratios were calculated to estimate sEH pathway flux. Among 20 depressed and 20 non-depressed patients (mean age 58.9±8.5, mean HbA1c 7.0±0.9%, 65% women), the 17,18 sEH derived eicosapentaenoic acid (EPA) diol was higher in depressed participants (F(1,37)=5.753, p=0.022). Somatic, negative affective, and anhedonic symptoms were screened (Center for Epidemiological Studies-Depression Scale). Three diol/epoxide oxylipin ratios were associated with higher somatic symptoms in the depressed group: the 16,17 docosahexaenoic acid (DHA) derived ratio (β=0.489, p=0.007), and both linoleic acid derived ratios (9,10 [β=0.549, p=0.017] and 12,13 [β=0.547, p=0.003]). The 14,15 arachidonic acid derived ratio was associated with higher negative affective symptoms (β=0.559, p=0.006). These associations were not found in non-depressed T2DM. This increased flux of omega-3 and omega-6 fatty acids through the sEH pathway associated with depression and symptom severity suggests the potential role of sEH inhibitors for T2DM-related depressive symptoms. Disclosure N. Z. Anita: None. P. Oh: None. B. R. Shah: None. J. Gilbert: Speaker’s Bureau; Self; Abbott Diabetes, Amgen Canada, AstraZeneca, Boehringer Ingelheim (Canada) Ltd., Dexcom, Inc., Eli Lilly and Company, HLS Therapeutics Inc., Janssen Pharmaceuticals, Inc., Novo Nordisk Canada Inc., Sanofi. A. Assal: None. W. Swardfager: None. N. Forkan: None. R. Kamal: None. M. M. Nguyen: None. D. Yu: None. C. Major-orfao: None. S. K. Wong: None. K. L. Lanctôt: None. N. Herrmann: None. Funding Canadian Institutes of Health Research; Banting &amp; Best Diabetes Centre; National Institute of Diabetes and Digestive and Kidney Diseases

Diagnostic Values of miR-221-3p in Serum and Cerebrospinal Fluid for Post-Stroke Depression and Analysis of Risk Factors.

Background:We aimed to explore the diagnostic values of miR-221-3p in serum and cerebrospinal fluid (CSF) for post-stroke depression (PSD) and to analyze the risk factors of the disease.Methods:Admitted to the Second Affiliated Hospital of Harbin Medical University, Harbin, China from May 2013 to May 2020, 136 stroke patients were enrolled, among which 76 PSD patients were taken as a PSD group and 60 non-depressed patients were taken as a Non-PSD group. miR-221-3p expression in serum and CSF and concentrations of inflammatory cytokines (IL-6, TNF-α) in serum were detected, to analyze the diagnostic and prognostic values of the indicators for PSD. Correlations of miR-221-3p in serum with that in CSF, with the National Institute of Health Stroke Scale (NIHSS) score and the Hamilton Depression Rating Scale (HAMD) score, and with inflammatory cytokines were analyzed, so as to analyze the risk factors affecting the occurrence of PSD.Results:Compared with the Non-PSD group, miR-221-3p remarkably upregulated in serum and CSF in the PSD group, and its areas under the curves (AUCs) for PSD identification were 0.900 and 0.925, respectively. According to the correlation analysis, miR-221-3p in serum was remarkably positively correlated with that in CSF, NIHSS score, HAMD score, IL-6 and TNF-α. In addition, a history of mental illness, NIHSS score, HAMD score, IL-6, TNF-α and miR-221-3p were risk factors of PSD.Conclusion:miR-221-3p in serum and CSF can be used as the diagnostic and risk warning indicators of PSD.

Elective Lumbar Spine Surgery in Depressed Patients: Is it Worth it?

The objective of this study is to compare surgical results (pain, function, and satisfaction) between a group of depressed patients and a nondepressed group who had been operated on for a degenerative lumbar condition. Prospective observational study. Preoperative pain (lumbar and radicular visual analog scale [VAS]), function (Oswestry Disability Index [ODI]), and depression (Zung depression scale) data were collected in patients listed to be operated on for a lumbar degenerative condition. One year postoperatively, ODI and VAS data were collected again as well as a satisfaction question (are you satisfied with the surgical results? Yes/no). Ninety-seven patients were included in the study, 78 nondepressed patients (80.4%) and 19 depressed patients (19.6%). Preoperatively, depressed patients had more lumbar pain (P = .00) and more functional limitation (P = .01) than nondepressed patients. One year postoperatively, depressed patients had more radicular pain (P = .029) and more functional limitation (P = .03) than non-depressed patients. The overall improvement of pain and function was similar between both groups (not significant). Seventy percent of depressed patients and 80% of nondepressed patients were satisfied with the surgical outcome (P = .52) 1 year postoperatively. Depressed patients experience the same overall level of improvement as nondepressed patients, despite having more pain and functional limitation preoperatively and 1 year after elective lumbar spine surgery than nondepressed patients. The level of satisfaction does not differ significantly between the two groups. 2.

Outcomes of total joint arthroplasty in patients with depression: A systematic review

BackgroundDepression has been implicated as a poor predictor of outcomes after total joint arthroplasty (TJA) of the lower extremity in some studies. We aimed to determine whether depression as a comorbidity affects the TJA outcomes and whether pain reduction associated with successful TJA alters depressive symptoms. MethodsA search of PUBMED was performed using keywords “depression”, “arthroplasty”, “depressive disorder”, and “outcomes.” All English studies published over the last ten years were considered for inclusion. Quantitative and qualitative analysis was then performed on the data. ResultsThirty articles met inclusion criteria (16 retrospective, 14 prospective). Three showed that depressed patients were at higher risk for readmission. Two reported that depressed patients had higher likelihood of non-home discharge after TJA compared to non-depressed patients. Four noted that depressed patients incur higher hospitalization costs than non-depressed patients. Ten suggest depression is a predictor of poor patient-reported outcome measures, pain, and satisfaction after TJA. Five suggested the gains depressed patients experience in functional outcome scores after TJA are similar to gains experienced by patients without depression. Another eight suggested that TJA improves not only function and pain but also depressive symptoms in patients with depression. ConclusionThe results of this review show that depression increases the risk of persistent pain, dissatisfaction, and complications after TJA. Additionally, depressed patients may incur higher costs than non-depressed patients undergoing TJA and may have worse preoperative and postoperative patient reported outcome measures (PROMs). However, the gains in function that depressed patients experience after TJA are equivalent to gains experienced by non-depressed patients and depressed patients may experience improvement in their depressive symptoms after TJA. Patient selection for TJA is critical and counseling regarding increased risk for complications is crucial in depressed patients undergoing TJA.

Clinimetric properties of the Chinese version of the Euthymia Scale.

The present study was conducted to primarily evaluate the clinimetric sensitivity of the Chinese version of the Euthymia Scale (ES), testing whether this measure discriminated between different groups of patients. Concurrent validity, a clinimetric property that refers to the assessment of the extent to which the rating scale under examination correlates with another related, previously validated, assessment instrument, was also tested investigating whether the ES significantly and negatively correlated with measures of depression and anxiety. A cross-sectional study was conducted. A total of 295 inpatients were recruited from different medical settings and included in this study. In addition to the ES, participants completed the PHQ-9 for the assessment of depression and the GAD-7 for the evaluation of symptoms of generalized anxiety. The clinimetric sensitivity of the ES was evaluated using the Mann-Whitney test and the Kruskal-Wallis analysis of variance, whereas the concurrent validity was tested via Spearman's correlation coefficients. The ES total score and its subscales of psychological flexibility and well-being discriminated between different groups of inpatients and sensitively differentiated depressed from non-depressed patients. Negative and statistically significant correlations between the ES and measures of depression and anxiety were found. Findings of the present study indicate that the Chinese version of the ES is a valid and sensitive clinimetric index that can be used not only to differentiate depressed from non-depressed patients but also as a screening measure to detect vulnerability to depression in a wide range of medical patients.

Comparative indicators of atherogenicity, body weight, gender differences in the group of depressive and non-depressive patients with cardiovascular diseases

IntroductionMany studies show that obesity, dyslipidemia, and physical inactivity are closely related to depressive spectrum of symptoms (DSS), depressive disorder (DD). DD significantly reduces the patient’s quality of life and vital activity.ObjectivesTo study laboratory and physical parameters with DSS, DD in patients with cardiovascular diseases (CVD) to determine the number of patients requiring complex antidepressant therapy.MethodsThe cross-sectional study of 127 inpatients with CVD was conducted. Depression and anxiety symptoms were evaluated using HADS, anhedonia by Snaith-Hamilton Pleasure Scale (SHAPS) and pain by visual analog scale (VAS). Acquired data was statistically processed.ResultsThe non-depressive patients was observed in 67 (53.0%) and 60 (47%) with DSS in CVD patients. When clinical assessing 29 (22.5%) met the criteria for major (DD), 39 (31%) for minor DD. When comparing body mass index (BMI) in patients with depression, the indicator was 31 (28.5; 33.5), in patients without depression 30 (26; 32) p &lt;0.2828; atherogenic coefficient in patients with depression was 2.93 (2.41; 3.575), in non-depressive patients - 2.375 (2.07; 3.07) p&lt;0.0083.ConclusionsMore than 1/5 of patients with CVD need antidepressant therapy. &gt;90% of all patients had a high BMI regardless of gender and the presence of depression. Depressive patients in 95% of cases were obese or overweight. Severe dyslipidemia in women with depression increases the risk of CVD. Conflict of interest: No.DisclosureNo significant relationships.

Abnormal regional homogeneity (ReHo) and fractional amplitude of low frequency fluctuations (fALFF) in first-episode drug-naïve schizophrenia patients comorbid with depression.

The current study aimed to characterize the regional homogeneity (ReHo) or fractional amplitude of low frequency fluctuations (fALFF) alterations in first-episode drug-naïve schizophrenia comorbid with depression. Sixty-nine first-episode drug-naïve schizophrenia patients and 34 healthy controls (HC) were included in the final analysis. Schizophrenia patients were divided into depressive patients (DP) and non-depressive patients (NDP), with 35 and 34 patients respectively, using the Hamilton Rating Scale for Depression -17(HRSD-17). All participants underwent resting-state fMRI (rs-fMRI), the fALFF (slow-4 and slow-5 bands) and ReHo were used to process the data. The results revealed eleven brain regions with altered slow-5 fALFF, eleven brain regions with altered slow-4 fALFF and ten brain regions with altered ReHo among DP, NDP and HC groups. Compared to NDP, the DP group had increased slow-5 fALFF in the Right Inferior Temporal Gyrus, increased ReHo in the Right Superior and Inferior Frontal Gyrus. The altered slow-5 fALFF in the Right Inferior Temporal Gyrus, altered ReHo in the Right Inferior Frontal Gyrus and Superior Frontal Gyrus were all positively correlated with the depressive symptoms in patients. However, there were no significant differences in slow-4 fALFF between DP and NDP groups. Our results indicate that the increased slow-5 fALFF in the Right Inferior Temporal Gyrus, increased ReHo in the Right Superior and Inferior Frontal Gyrus were associated with depressive symptoms in schizophrenia, which may provide preliminary evidence in better understanding the neural mechanisms underlying depressive symptoms in schizophrenia.

The concept of anorexia of aging in late life depression: A cross-sectional analysis of a cohort study.

IntroductionAnorexia of aging (AA) is classically associated with depression. However, robust evidence is lacking regarding general clinic populations. Our aim was to evaluate the association between AA and major depressive disorder (MDD) in geriatric outpatients from a middle-income country. MethodsWe conducted a cross-sectional analysis of a cohort study. MDD diagnosis was assessed with a psychiatric interview (SCID-5-CV) according to DSM-5 criteria. Depressive symptomatology was assessed by a 15-items Geriatric Depression Scale (GDS) and the PHQ-9 questionnaire. Appetite was measured with the Simple Nutrition Appetite Questionnaire (SNAQ), whereas AA was defined as a SNAQ score ≤13 points). Linear and logistic regression analysis adjusted for potential confounders were applied to assess the association between depressive symptomatology, MDD and AA. ResultsOf the total 339 participants, MDD was present in 65. AA was more frequent in patients with MDD compared to non-depressed patients (30.7 versus 7.7%; p<0.001). The SNAQ score was lower in depressed patients (14.5 vs. 16.6, p<0.001). Adjusted for confounding, linear and logistic regression showed a significant association between the GDS score, PHQ-9 score and MDD with the SNAQ score (p<0.001) and cut-off representing AA (p<0.001), respectively. Moreover, MDD and AA interacted significantly with their association with weight loss (p<0.001). ConclusionsDepression scales (even without somatic complaints) and MDD were associated with AA in geriatric outpatients. AA is associated with weight loss in MDD. Prospective studies should expand these findings.

Impact of subthreshold depression on health-related quality of life in patients with Parkinson\u2019s disease based on cognitive status

BackgroundIn patients with Parkinson’s disease (PD), depression has a strong impact on quality of life (QoL). However, little is known about the influence of subthreshold depression (STD) on QoL in PD patients.MethodsA total of 230 hospitalized PD patients with normal and impaired cognitive status were included in this observational study. We collected the following data for analysis: Beck Depression Inventory level, Montreal Cognitive Assessment (MOCA) score, non-motor symptoms questionnaire score, PD questionnaire-39 (PDQ-39) score, Hoehn–Yahr stage, and Movement Disorder Society-sponsored revision of the unified PD rating scale III (MDS-UPDRS III) score. To study the impact of STD on the PDQ-39 summary index (SI) and its domains, we used multivariate analysis of variance and multivariate analysis of covariance.ResultsIn this cohort, 80 (34.8%) patients had STD [44 (32.3%) with high MOCA score (> 21) and 36 (38.3%) with low MOCA score (< 21)]. In PDQ-39 SI, there was a significant effect on depression level. In patients with higher MOCA score, STD was associated with worse PDQ-39 domains emotional well-being and cognition, whereas in patients with lower MOCA score, STD had no significant effect on PDQ-39 SI or its subdomains.ConclusionIn PD patients, QoL is significantly affected by STD, and thus, more attention in medical care should be focused on treating STD. However, the impact is only observable in PD patients with normal cognitive function. STD patients show more reduced QoL than non-depressed patients, indicating that STD should be treated as a transition zone between normal mood and depression.

Effects of agomelatine on heart rate variability in patients with coronary artery disease and depression

Aim. To determine heart rate variability (HRV) in depressed patients with chronic coronary artery disease (CAD) and to assess the effects of agomelatine on HRV.Methods. 74 patients with CAD (class 3-4 angina pectoris) were recruited in a study. Patients (n = 45) with CAD and depression were assigned to Group 1, whereas CAD patients (n = 29) without any signs of depression were assigned to Group 2. 17 patients received agomelatine (Subgroup 1) and 28 patients did not take any antidepressants (Subgroup 2). HRV was measured using SCHILLER MT-200 Holter-ECG apparatus at baseline and after 6 months.Results. Patients with depression demonstrated a significant decrease in HRV compared to non-depressed patients (pNN50% (3.9 [2.2; 5.4] vs 5.7 [2.9; 12.6], p = 0.03), SDANN (81 [63; 97] ms vs 91 [79; 102] ms, p = 0.06), SDNNindx (46 [36; 56] ms vs 55 [48; 66] ms, p = 0.002), rMSSD (28 [21; 36] ms vs 33 [ 29; 45] ms, p = 0.02), SDNN (97 [75; 121] ms vs 110 [98; 127] ms, p = 0.02). Subgroups 1 and 2 did not differ in HRV (p&gt;0.05). After 6 months, significant differences in the following parameters were found in those patients who received agomelatine therapy and those who did not: rMSSD (36.5 [28.5; 51] ms vs 26.5 [25; 32] ms, p = 0.02), SDANN (88 [72,5; 114,5] ms vs 67,5 [58; 83] ms, p = 0.03), SDNN strives to a significant difference - 100 [87; 133.5] ms vs 85.5 [75; 103] ms, p = 0.07.Conclusion. HRV significantly decreased in depressed patients with CAD suggesting autonomic dysfunction and worsening their prognosis. Agomelatine therapy in patients with CAD is effective in treating heart rate variability and reducing the risk of developing life-threatening arrhythmias.Key

Depression and Nigral Neuron Density in Lewy Body Spectrum Diseases.

Parkinson's disease and other Lewy body spectrum diseases (LBDs) are associated with a specific risk for clinical depression. In the present clinicopathological study with 73 patients with LBD, we observed that the substantia nigra pars compacta dopamine neuron density was markedly lower in patients who had comorbid depression antemortem than in nondepressed patients (1.52 vs 2.32 n/mm2 , p = 0.004). There were no differences in cognition, motor disease severity, antiparkinsonian medications, or disease duration between groups. The results implicate the substantia nigra as an important psychomotor modulatory area of mood in patients with Lewy body disorders. ANN NEUROL 2021;;89:1046-1050.

The neutrophil-lymphocyte ratio and immunosuppressive acidic protein may be useful parameters for predicting depression among middle-aged patients with diffuse large B cell lymphoma.

Patients with diffuse large B cell lymphoma (DLBCL) may experience depression. Growing evidence shows that depression interacts with immunity. However, the relationship between depression and immunity among DLBCL patients has not been investigated, despite reports indicating that patients with DLBCL often suffer from depression. To accurately investigate the relationship between depression and immunity, 82 primarily diagnosed middle-aged patients with DLBCL who received standard chemotherapy were enrolled. The patients were divided into depressed and nondepressed groups according to Zung Self-rating Depression Scale (SDS) scores. Prozac was used to treat patients with depression until their symptoms were alleviated. The concentration of immunosuppressive acidic protein (IAP); percentages of cluster of differentiation (CD)3+, CD4+, and CD8+ T lymphocytes and CD56+ natural killer (NK) cells; absolute lymphocyte count (ALC); and neutrophil--lymphocyte ratio (NLR) were calculated at enrollment and after treatment. A higher score on the depression test was positively associated with serum IAP levels and NLR, and negatively associated with ALC. The levels of NLR and serum IAP in the depressed patients were significantly higher compared to those in the nondepressed patients. Our results suggest for the first time that IAP and the NLR are closely correlated with depression and may be parameters for predicting depression.

A Study of Depression, Quality of Life and Breast Cancer

Breast cancer and its subsequent treatment are a great source of anxiety and depression in patients. However, it remains unclear whether this decrease in mental and physical health is temporary or if long-term effects would appear once the patient is well out of these stressful times. Methods: a total of 204 women were included in the present analysis. Participants were recruited at tertiary care hospital (EL- Maadi oncology hospital). Results: the mean age of the included patients was 56.76 ±17.5 years old; almost one-third of them aged between 51-60 years old. In our cohort, the mean BDI-II was 15.4 ±29.4. A total of 48 patients (22.5%) had depression. Of them, 13 patients had mild depression (6.4%), 14 patients had moderate depression (6.9%), 9 patients had severe depression (4.4%), and 10 patients had extreme depression (4.9%). there were statistically significant associations between presence of depression and overall WHOQOL-BREF score (p < 0.001), physical domains (p <0.001), psychological health (p <0.001), social relation (p <0.001), and environment score (p <0.001); depressed patients exhibited lower scores in all of these domains than non-depressed patients. Conclusion: breast cancer is often accompanied by severe psychological distress, which is associated with a significant prevalence of anxiety and depression disorders in the course of the disease. Depression may reduce the efficacy of chemotherapy, and therefore the survival chances of cancer patients. This study provided evidence that depressive symptoms in patients with breast cancer undergoing treatments detrimentally affected various aspects of the QOL in a real- world setting.

Depression and time perspectives in patients with brain tumors: Novel measurements in the circle test

• The circles drawn by participants could be indicative of their time perspectives. • The novel circle test measurement results differed among groups. • Depressed patients with brain tumors may experience changes in time perspective. • Changes in the time perspective may be related to treatment adherence. Tumors trigger both depression and anxiety about death because they can be terminal. However, the relationship between depression and time perspective in patients with life-threatening diseases remains unclear. In this study, we examined the effects of depression on time perspective in patients with brain tumors using a projective method, i.e., the Circle Test. Participants (40 depressed patients, Dp; 35 non-depressed patients, NDp; and 40 healthy non-depressed controls, NDc) were administered the Circle Test of time perspectives and self-rating depression scales before and after surgery. The Circle Test data were analyzed using traditional indices, i.e., time dominance and relatedness, and novel measurements, i.e., time area and proportion. Although the traditional indices showed no differences, the results for the novel measurements differed among the Dp, NDp, and NDc groups. The overall time perspective was smaller in the Dp group than in the NDc group; furthermore, the proportions of the future and past perspectives were higher and lower, respectively, in the Dp group compared to the NDp group. Patients with brain tumors and depressed controls could not be compared, because no healthy control was depressed. Differences in depression-related changes in time perspective between patients with brain tumors and healthy controls should be examined in future studies. Depressed patients with brain tumors may experience changes in time perspectives according to the results for our novel measurements, and this might play an important role in treatment adherence.

Impact of history of depression on 1-year outcomes in patients with chronic coronary syndromes: An analysis of a contemporary, prospective, nationwide registry

BackgroundDepression is common in patients with acute cardiovascular conditions and it is associated with adverse clinical events. MethodsUsing the data from a nationwide, prospective registry on patients with chronic coronary syndromes (CCS), we assessed the impact of depression on major adverse cardiovascular events (MACE), a composite of all-cause death and hospitalization for myocardial infarction, revascularization, heart failure or stroke, and quality of life (QoL) at 1-year follow-up. ResultsFrom the 5070 consecutive CCS patients enrolled in the registry, 531 (10.5%) presented a history of depression and the remaining 4539 (89.5%) did not. At 1 year (median 369; IQR 362–378 days) from enrolment, the incidence of the primary composite outcome was 9.8% for patients with a history of depression and 7.2% for non-depressed patients (p = 0.03). Patients with history of depression had a significantly higher rate of all-cause mortality (3.0% vs 1.4%; p = 0.004) and hospital admission for heart failure (3.4% vs 1.3%; p = 0.0002) compared to the group without depression. However, history of depression did not result as an independent predictor of MACE at multivariable analysis [hazard ratio 1.17, 95% confidence interval (0.87–1.58), p = 0.31]. Depressed patients had worse QoL according to all domains of the EQ. 5D-5L questionnaire as compared to non-depressed patients (all p < 0.001), at both enrolment and follow-up. ConclusionsIn this contemporary, large cohort of consecutive patients with CCS, patients with a history of depression experienced a two-fold rate of mortality, a higher incidence of MACE and a worse QoL at 1-year follow-up, compared to non-depressed patients.

Accelerated brain aging in chronic low back pain

Chronic low back pain (CLBP) is a leading cause of disability and is associated with neurodegenerative changes in brain structure. These changes lead to impairments in cognitive function and are consistent with those seen in aging, suggesting an accelerated aging pattern. In this study we assessed this using machine-learning estimated brain age (BA) as a holistic metric of morphometric changes associated with aging. Structural imaging data from 31 non-depressed CLBP patients and 32 healthy controls from the Pain and Interoception Imaging Network were included. Using our previously developed algorithm, we estimated BA per individual based on grey matter density. We then conducted multivariable linear modeling for effects of group, chronological age, and their interaction on BA. We also performed two voxel-wise analyses comparing grey matter density between CLBP and control individuals and the association between gray matter density and BA. There was an interaction between CLBP and greater chronological age on BA such that the discrepancy in BA between healthy and CLBP individuals was greater for older individuals. In CLBP individuals, BA was not associated with sex, current level of pain, duration of CLBP, or mild to moderate depressive symptoms. CLBP individuals had lower cerebellar grey matter density compared to healthy individuals. Brain age was associated with lower gray matter density in numerous brain regions. CLBP was associated with greater BA, which was more profound in later life. BA as a holistic metric was sensitive to differences in gray matter density in numerous regions which eluded direct comparison between groups.

Prevalence of depression and anxiety in patients with chronic obstructive pulmonary disease and their association with psychosocial outcomes: A cross-sectional study from Pakistan

Objectives:Chronic obstructive pulmonary disease contributes to substantial health and economic burden worldwide. Co-morbid depression and anxiety are highly prevalent in patients with chronic obstructive pulmonary disease. Depressive symptoms in chronic obstructive pulmonary disease are associated with poorer survival, longer hospitalisation and impaired quality of life. Literature on chronic obstructive pulmonary disease is largely derived from high-income countries; yet 90% of deaths related to chronic obstructive pulmonary disease occur in low- and middle-income countries. We aimed to establish the prevalence of anxiety and depression in patients with chronic obstructive pulmonary disease, as well as the association with psychosocial outcomes.Methods:This was a cross-sectional study of chronic obstructive pulmonary disease patients attending outpatient primary care clinics in Karachi, Pakistan. The Patient Health Questionnaire-9 was used to assess depression and the Generalised Anxiety Disorder-7 scale was used for the assessment of anxiety. Health-related quality of life was assessed with EuroQol–Five Dimensions, social support with Oslo-3 and social stress with Life Events Checklist. We recruited 293 subjects.Results:The prevalence of depression and anxiety in the sample was 51% (n = 149) and 20% (n = 59), respectively. Depressed chronic obstructive pulmonary disease patients reported significantly lower health-related quality of life scores as compared to non-depressed patients. Participants with depression had significantly higher levels of anxiety, less social support, higher social stress and more subjective impairment in quality of life.Conclusion:Given the association with reduced social support and increased perceived stress, the role of psychosocial interventions must be explored in improving outcomes of chronic obstructive pulmonary disease patients in Pakistan.