Synergistic Effects Of Depression Research Articles

The synergistic effect of depression and moderate chronic kidney disease on the all-cause and cardiovascular disease mortality among adults: a retrospective cohort study

BackgroundThe relationship between the coexistence of depression and moderate chronic kidney disease (CKD) and mortality is unclear. We aimed to investigate whether there is a synergistic effect of depression and moderate CKD on the all-cause and cardiovascular disease (CVD) mortality among adults.MethodsWe studied 24,412 participants from the National Health and Nutrition Examination Survey 2005–2014 with a mortality follow-up assessment in 2015. Four groups were created based on depression and CKD status: Group 1, no depression and no CKD; Group 2, depression present and no CKD; Group 3: no depression and CKD present; Group 4: depression present and CKD present. Moderate CKD was defined as an estimated glomerular filtration rate of 15–59 mL/min/1.73 m2 (Stage 3–4) or one-time urine albumin-to-creatinine ratio ≥ 30 mg/g. Depression was defined as the 9-item Patient Health Questionnaire score of 10 or more. Cox proportional hazards regression models were used to calculate the multivariate-adjusted hazard ratios (HRs) of death for Group 4 with other groups.ResultsOver a mean follow-up of 5.8 years, 1783 deaths were documented, including 338 deaths from CVD. The HR for all-cause mortality in Group 4 was 3.62 (95% CI: 2.69–4.87), 2.99 (1.92–4.66), and 1.75 (1.29–2.37) when compared with Group 1, 2, and 3, respectively. The HR for CVD mortality in Group 4 was 3.89 (1.68–9.00), 1.90 (0.86–4.21), and 1.97 (1.17–3.32) when compared with Group 1, 2, and 3, respectively.ConclusionsThere might be a synergistic effect of depression and moderate CKD on all-cause mortality. Moreover, depression might increase the risk of CVD mortality in individuals with moderate CKD.

The combined role of obesity and depressive symptoms in the association with ischaemic heart disease and its subtypes

This cross-sectional study aimed to explore the combined effects of depression and obesity on ischemic heart disease and its subtypes. Data from the National Health and Nutrition Examination Survey 2007–2018 were used. A total of 29,050 participants aged 20 years or older were included in the analyses. Logistic regression models and restricted cubic spline models were applied to evaluate the associations between depression symptom and ischemic heart disease. There were significant correlations between depressive symptoms and ischemic heart disease [OR and 95% CI 2.44 (1.91, 3.10)] and its subtypes: coronary heart disease [2.32 (1.67, 3.23)], heart attack [2.18 (1.71, 2.78)], and angina [2.72 (1.96, 3.79)].The synergistic effects of depression with obesity (BMI ≥ 30) and central obesity (waist ≥ 102/88 cm for men/women) on ischemic heart disease were estimated and expressed using the relative excess risk due to interaction (RERI) and the attributable proportion due to interaction (AP). The RERI and AP with 95% CIs of depression and central obesity for ischemic heart disease were 1.10 (0.01, 2.19) and 0.35 (0.06, 0.64). When we analysed the other three subtypes of ischemic heart disease, we only found depressive symptoms and central obesity could have a meaningful synergistic effect on heart attack (RERI: 0.84 (− 0.28, 1.96) AP: (0.31 (0.00, 0.69)).

Costs associated with depression and obesity among cardiovascular patients: medical expenditure panel survey analysis

BackgroundThere is a lack of information on the cost of depression associated with metabolic syndrome and cardiovascular diseases in the literature.MethodsWe evaluated the synergistic effects of depression and obesity on total expenditures for cardiovascular conditions using data from the Medical Expenditure Panel Survey (MEPS) database. We analyzed MEPS data from 1996 to 2017 comprising adult cardiovascular subjects. We categorized individuals following a combination of International Classification of Diseases ICD-9-CM and ICD-10 codes, and depression symptoms as evaluated using the Patient Health Questionnaire-2 (PHQ-2) depression screening tool. Our sample comprised cardiovascular patients aged 18 years and older, with a body mass index (BMI) between 18.5 and 60. Our study comprised unweighted sample of 96,697 (weighted sample of 938,835,031) adults, a US-nationwide representative sample of cardiovascular disease patients. The four response categories were: no depression; unrecognized depression; asymptomatic depression; and symptomatic depression. Our evaluated outcomes were total annual healthcare expenditures, including dental, emergency room, hospital outpatient, hospital inpatient, office-based, prescription, and home health care expenses.ResultsAsymptomatic and symptomatic depression was more frequent among obese individuals than in individuals with a normal BMI (p < 0.001). Total expenditure was highest among symptomatic depression individuals (17,536) and obese (9871) with cardiovascular disease. All the expenditure outcomes were significantly higher among symptomatic depression individuals than those without depression (p < 0.001), except for dental costs. All healthcare expenditures associated with obesity were higher compared to individuals with normal BMI with p < 0.001, except for emergency and home healthcare costs. Most importantly, among obese individuals, all healthcare expenditures were significantly higher (p < 0.001) in those with symptomatic depression than those without depression, except for dental costs, where the difference was not significant (0.899). Therefore, obesity and depression entail increased expenses in patients with cardiovascular disease.ConclusionsWe found incremental expenditures among unrecognized, asymptomatic, and symptomatic depressed individuals with obesity compared to non-depressed, non-obese subjects. However, these are preliminary results that should be further validated using different methodologies.

Testing the Synergistic Effects of Depression, Anxiety, and Substance Use in Unsafe Sex: a Cross-sectional Study

Condom use is the most affordable method to prevent sexually transmitted infections (STIs). Anxiety, depression, and substance use have been used as covariates of condom use, but little is known about the possibility of synergistic effects. The objective of this study was to determine the synergist effect of depression, anxiety, and substance use in unsafe sex. Individuals receiving residential treatment for substance use were recruited in 21 centers in Mexico City. Data on substance use, depression (PHQ-9), anxiety (GAD-7), and condom use (number of unsafe sex occasions) was collected. Four Poisson regression models were adjusted to compare the additive or interactive effect of these variables. We found that model 2 (anxiety and depression interactive model) showed a better fit when compared with its additive-only counterpart (model 1), χ2[1] = 29.538, p < .001; model 4 (anxiety, depression, and substance use interactive model) had a better fit that model 3 (anxiety, depression, and substance use additive model), χ2[1] = 23.479, p < .001. Models with interactive terms produced better predictions of condom use. Only depression symptoms displayed a synergistic effect with substance use. These findings may be the result of unique components of the symptoms, and they stress the importance of including interactive terms when testing the associations or the effects of mental health variables in health outcomes, particularly in condom use.

Late-life depression and cognitive function among older adults in the U.S.: The National Health and Nutrition Examination Survey, 2011–2014

Discrepancies exist on the associations of late-life depression with cognition, and synergistic effect of depression and diabetes on cognition among older adults was suggested in literature. We aimed to examine the associations of late-life depression with cognitive function in a representative sample of older adults in the U.S., and to examine the associations among individuals with diabetes. A total of 3101 adults aged 60 and above of the 2011–2014 National Health and Nutrition Examination Survey who completed measurements of depressive symptoms and diabetes were included in cross-sectional analyses. The 9-item Patient Health Questionnaire (PHQ-9) was used to measure depressive symptoms (including overall, somatic and cognitive). Clinically relevant depression (CRD) and clinically significant depression (CSD) were defined by cutoffs of PHQ-9. Domain-specific cognitive function was examined using Delayed Word Recall Test, Digit Symbol Substitution Test, and Animal Fluency Test for memory, executive function/processing speed, and language, respectively. Z scores were created for overall cognition and specific domains. Multivariable linear regression models were applied to examine the association of depressive symptoms and scale-defined depression with cognition z scores. The overall, somatic and cognitive depressive symptoms were associated with lower cognitive function among older adults. Both CRD (β = −0.20, 95% CI: −0.28, −0.12) and CSD (β = −0.56, 95% CI: −0.75, −0.37) were associated with lower cognition. A synergistic relationship was found between depression and diabetes on lower cognition. These results suggested that cognition among older adults may be modified by late-life depression, and older adults with both depression and diabetes may be particularly impacted on cognition.

Synergistic Effects of Depression and Poor Impulse Control on Physical Partner Violence; A National Study in United States.

Although major depressive disorder (MDD) also increases the risk of Intimate Partner Violence (IPV) perpetration, poor mental health has been mostly conceptualized as a consequence of IPV victimization rather than a risk factor for IPV perpetration. Poor impulse control is another IPV risk factor. Building on a risk / risk framework, this study investigates additive and multiplicative effects of male partners' MDD and poor impulse control on physical IPV victimization reported by female partner. This national longitudinal study followed a random sample of 2,500 male and female cohabiting partners for two years in United States. Data came from the Fragile Families and Child Wellbeing Study (FFCWS). Male partner's MDD was the independent variable. Baseline socio-demographic factors (age, relation status, education level, income, and minority status) and Generalized Anxiety Disorder (GAD), and Alcohol Use Disorder (AUD) were covariates. Outcome was female partner's physical IPV victimization measured at baseline and two years later. Male partner's impulse control was the moderator. Model I tested independent effects of MDD and impulse control on physical IPV. Model II used multi-group structural equation model to test the effect of MDD in those with low and poor impulse control. All participants provided written consent and SPSS and AMOS were used for data analysis. In Model 1 that tested additive effects of SES, GAD, AUD, MDD, and poor impulse control did not show main effects of MDD or impulse control on an increase in perpetration of physical IPV over two years. Model 2 showed that MDD predicts an increase in perpetration of physical IPV of men with poor impulse control, but not men with high impulse control. Based on the findings, poor impulse control and MDD have synergistic effects on IPV committed by men. Given the synergistic effects of psychological determinants of IPV, there is a need for prevention of IPV in male partners who have multiple risk factors such as MDD and poor impulse control. Self-regulation trainings of depressed men with poor impulse control may reduce IPV risk among men.

Electroconvulsive Therapy in the Setting of Implantable Cardioverter-Defibrillators

Electroconvulsive therapy has potent cardiovascular effects, which may pose a challenge in treating patients with preexisting cardiac disease. Although it is well studied in the treatment of refractory depression, there are still pitfalls to overcome when treating those with comorbid cardiovascular disease. The synergistic effects of depression and cardiovascular disease in affecting the morbidity and mortality of patients make treatment a significant issue. The authors discuss 3 elderly patients treated for major depression, all of whom previously had implantable cardioverter-defibrillators placed. All 3 patients were effectively treated, with no major adverse effects. The cases illustrate how taking the appropriate preventative measures allow even the most medically challenging patient to undergo effective treatment and highlight the debate surrounding the intraoperative management of implantable cardioverter-defibrillator devices.