Search

Background and Objectives: The 21-point Brain Care Score (BCS) is an index that ranks behaviors and clinical measurements with the aim of encouraging lifestyle adjustments to lower the incidence of age-related brain disease, including stroke, late-life depression (LLD), and dementia. A higher BCS at baseline is associated with a lower risk of these outcomes. We aimed to investigate whether the associations between BCS and stroke, LLD, and dementia risks are independent of genetic predisposition for these conditions and quantify the effect of healthy lifestyle across genetic risk distributions for these outcomes., Methods: Using the UK Biobank (UKB) prospective cohort study, we computed baseline BCSs and polygenic scores to estimate genetic predisposition for stroke and LLD and APOE ε allele status to stratify dementia risk. As for outcomes again in UKB, we measured incidence of stroke, LLD, and dementia. We used multivariate Cox proportional hazard models to assess associations between BCS, genetic predisposition, and these outcomes. We also conducted stratified and interaction analyses to estimate the incidence of these outcomes across quartiles of genetic risk and BCS., Results: We included 368,340 UKB participants (median age 58 years (interquartile range 51-63 years), 46.3% male). Independent of genetic risk, a 5-point increase in BCS corresponded to lowered hazards of stroke (hazard ratio [HR] 0.70, 95% CI 0.68-0.73), LLD (HR 0.65, 95% CI 0.63-0.67), and dementia (HR 0.82, 95% CI 0.78-0.85). Incidences of all 3 outcomes were higher among participants with high genetic risk of these outcomes. However, these increased risks were offset for individuals with a higher BCS (incidence rates per 1,000 person-years were 2.76 vs 1.19 for stroke, 7.34 vs 4.46 for LLD, and 3.64 vs 2.05 for dementia, when comparing low and high BCS)., Discussion: Across different genetic predispositions for stroke, LLD, and dementia, healthier lifestyle behaviors are protective for brain health, demonstrating the nondeterminism of genetic risk. Furthermore, differences in BCS behave as aggregate risk estimators of all 3 outcomes. Further work is needed to prospectively investigate the utility and performance of the BCS as a targeted intervention in populations at elevated genetic risk of age-related brain disease.

Background and Objectives: Mounting evidence points to a strong connection between cardiovascular risk during middle age and brain health later in life. The American Heart Association's Life's Essential 8 (LE8) constitutes a research and public health construct capturing key determinants of cardiovascular health. However, the overall effect of the LE8 on global, clinically relevant metrics of brain health is still unknown. We tested the hypothesis that worse LE8 profiles are associated with higher composite risk of the most important clinical endpoints related to poor brain health., Methods: We conducted a two-stage (discovery and replication) prospective study using data from the UK Biobank (UKB) and All of Us (AoU), 2 large population studies in the United Kingdom and the United States, respectively. The primary exposure was the LE8 score, a validated tool that captures 8 modifiable cardiovascular risk factors (blood pressure, glucose, cholesterol, body mass index, smoking, physical activity, diet, and sleep duration), organized in 3 categories (optimal, intermediate, and poor). The primary outcome was a composite of stroke, dementia, or late-life depression. We evaluated associations using multivariable Cox proportional hazard models., Results: The discovery stage included 316,127 UKB participants (mean age 56, 52% female). Over a mean (SD) follow-up time of 4.9 (0.4) years, the unadjusted risk of the composite outcome was 0.7% (95% CI 0.61-0.74), 1.2% (95% CI 1.11-1.22), and 1.8% (95% CI 1.70-1.91) in participants with optimal, intermediate, and poor cardiovascular health, respectively ( p < 0.001). This association remained significant in multivariable Cox models (intermediate vs optimal cardiovascular health hazard ratio [HR], 1.37; 95% CI 1.24-1.52, and poor vs optimal cardiovascular health HR, 2.11; 95% CI 1.88-2.36, p trend <0.001). The replication stage included 68,407 AoU participants (mean age 56, 60% female). Over a mean (SD) follow-up time of 2.9 (1.41) years, the unadjusted risk of the composite outcome was 2.8% (95% CI 2.49-3.05), 6% (95% CI 5.76-6.22), and 9.7% (95% CI 9.24-10.24) in participants with optimal, intermediate, and poor cardiovascular health, respectively ( p < 0.001). This association remained significant in multivariable Cox models (intermediate vs optimal cardiovascular health, HR 1.35; 95% CI 1.21-1.51, and poor vs optimal cardiovascular health, HR 1.94; 95% CI 1.72-2.18; p trend <0.001)., Discussion: Among middle-aged adults enrolled in 2 large population studies, poor cardiovascular health profiles were associated with two-fold higher risk of developing a composite outcome that captures the most important diseases related to poor brain health. Because the evaluated risk factors are all modifiable, our findings highlight the potential brain health benefits of using the Life's Essential 8 to guide cardiovascular health optimization.

Abstract: Informal caregivers of patients with cancer are known to experience extensive burdens, whereas this issue remains unresolved in the setting of hematological malignancies. Yet, these diseases are characterized by a prolonged course, numerous relapses, and implementation of multiline therapy, administered in outpatient facilities. This study aimed to assess the factors contributing to burden and depressive symptoms in informal caregivers of patients with hematological malignancies, while concentrating on the role of medical visits. The study population comprised patients and their caregivers, recruited at the Rambam Hematology Ambulatory Unit. Participants completed validated questionnaires, including the Center for Epidemiologic Studies Depression Scale and the Zarit Caregiver Burden Interview. The cohort (n = 185) included 115 patients (average age, 62.8 ± 14.5 years; 54 males) and 70 caregivers. Among caregivers, 80% reported high psychological burden, and 50% reported significant depressive symptoms. The burden was higher if caregivers were females and if patients were less educated, less healthy, and more depressed. The caregiver burden and depressive symptoms were significantly linked, and the medical visit frequency predicted the level of both. The caregiver burden fully mediated the link between the independent variables of self-rated health and medical visits and the dependent variable of caregiver depressive symptoms. Informal caregivers of ambulatory patients with hemato-oncological malignancies experience high levels of psychological burden and depressive symptoms. This is partly attributed to the medical visit frequency. Hence, a decrease in the number and length of such visits via the implementation of advanced technology could essentially reduce burden and depressive symptoms of caregivers, without compromising patient outcomes., (© 2024 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)

The relationship between depression and severe non-alcoholic fatty liver disease (NAFLD) has not been clearly defined. We conducted a longitudinal cohort study and a two-sample Mendelian randomization (MR) analysis to assess the association of depression with severe NAFLD risk. We used individual data from the UK Biobank study with 481,181 participants, and summary data from published genome-wide association studies. The association between depression and severe NAFLD was assessed using Cox proportional hazards regression analysis. Two-sample MR for depression with NAFLD was conducted, the principal analysis employed the inverse variance weighted (IVW) approach. In the observational study, after a median follow-up of 13.46 years, 4,563 participants had severe NAFLD. In multivariable-adjusted model, participants with depression had an increased risk of severe NAFLD (hazards ratio:1.21, 95% confidence interval (CI):1.09-1.34), as compared to those without depression. In subgroup analyses, the association between depression and severe NAFLD risk was generally observed across different subgroups. For the MR, result also showed that genetically predicted depression was causally associated with a higher risk of NAFLD (odds ratio:1.55, 95%CI:1.10-2.19) in IVW. Our study revealed a prospective association of depression with severe NAFLD, thus potentially necessitating clinical monitoring of individuals with depression for severe NAFLD., Competing Interests: Declarations Competing interests The authors declare no competing interests. Ethical approval The UK Biobank study has approval from the North West Multi-centre Research Ethics Committee, all methods were performed in accordance with the relevant guidelines and regulations, and all participants provided written informed consent. As our MR study was based on publicly available data, no additional ethical approval or consent was required., (© 2024. The Author(s).)

Background: Frontline health care staff are frequently exposed to traumatic events as part of their work. Although this study commenced before the emergence of COVID-19, levels of exposure were heightened by the pandemic. Many health care staff members report intrusive memories of such events, which can elicit distress, affect functioning, and be associated with posttraumatic stress disorder symptoms in the long term. We need evidence-based interventions that are brief, preventative, nonstigmatizing, suitable for the working lives of frontline health care staff, and effective for repeated trauma exposure. A brief, guided imagery-competing task intervention involving a trauma reminder cue and Tetris gameplay may hold promise in this regard, given evidence that it can prevent and reduce the number of intrusive memories following trauma across various settings., Objective: This case series aims to investigate the impact of a brief imagery-competing task intervention on the number of intrusive memories, general functioning, and symptoms of posttraumatic stress, anxiety, and depression, and examine the feasibility and acceptability of the intervention for UK National Health Service frontline health care staff. The intervention was delivered with guidance from a clinical psychologist., Methods: We recruited 12 clinical staff from the UK National Health Service, specifically from emergency departments, the intensive care unit, and the ambulance service. We evaluated the intervention using an AB single-case experimental design, where the baseline (A) was the monitoring-only phase and the postintervention (B) period was the time after the intervention was first administered. Methods were adapted once the COVID-19 pandemic began., Results: There was a decrease (59%) in the mean number of intrusive memories per day from baseline (mean 1.29, SD 0.94) to postintervention (mean 0.54, SD 0.51). There was a statistically significant reduction in the number of intrusive memories from baseline to postintervention, as shown by an aggregated omnibus analysis with a small effect size (τ-U=-0.38; P<.001). Depression, anxiety, and posttraumatic stress symptoms all significantly reduced from preintervention to postintervention. Participants also reported improvements in functioning based on both quantitative and qualitative measures. The intervention was feasible to deliver and rated as acceptable by participants., Conclusions: These preliminary findings suggest that this brief therapist-guided imagery-competing task intervention offers a potential approach to mitigating the impact of work-related traumatic events in frontline health care staff, both during a pandemic and beyond. Randomized controlled trials will be an important next step., (©Veronika Kubickova, Craig Steel, Michelle L Moulds, Marie Kanstrup, Sally Beer, Melanie Darwent, Liza Keating, Emily A Holmes, Lalitha Iyadurai. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 18.11.2024.)

Background: There is no relevant research on the symptoms and emotions of patients with advanced thyroid cancer in mainland China., Aim: To investigate the symptoms and negative emotions of patients with advanced thyroid cancer and to analyze the correlation between the two preliminarily., Methods: Using a convenience sampling method, 180 patients who visited a multidisciplinary outpatient service for advanced thyroid cancer at West China Hospital of Sichuan University from January 2023 to December 2023 were selected as the research subjects. A cross-sectional survey was conducted using the M.D. Anderson Symptom Inventory-Thyroid Cancer module (MDASI-THY) and Hospital Anxiety and Depression Scale (HADS). The correlation between symptom severity and negative emotions was determined by Spearman correlation analysis., Results: Disturbed sleep was the symptom with the highest incidence (74.4%) and the greatest severity (3.0 points), while mood distress was the symptom with the highest incidence (63.3%) and the greatest severity (2.0 points). 71 patients (39.4%) had anxiety, and 62 patients (34.4%) had depression. All symptoms and symptom interference were positively correlated with anxiety and depression (P < 0.05)., Conclusion: Patients with advanced thyroid cancer have multiple symptoms that seriously affect their daily lives and emotions. Medical staff should conduct targeted observation and preventive treatment to reduce the burden of symptoms and improve the negative emotions of patients., Competing Interests: Declarations Ethics approval and consent to participate The study was approved by the Ethics Committee on Biomedical Research, West China Hospital of Sichuan University [Ethics Approval Number 2022(1781)]. Each participant had a face-to-face meeting with the researchers during which the researchers ensured that the patients met the study criteria and explained the study in detail. The researchers provided enough time for the patients to ask questions. Each participant signed the written consent to the study. All methods were ensured by following the relevant guidelines and regulations. Consent for publication Informed consent was obtained from the patient for publication of this article. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

The association between problematic social networking sites use and depression is established, yet the directionality remains to be clarified. This longitudinal study investigated the causal dynamics between the two phenomena by administering a questionnaire to 191 college students from a university in Shandong Province, China, across four assessment points with an interlude of four weeks. The study found that the impact of depression on problematic social networking sites use is not consistently sustained throughout the academic semester. Initially, this impact reached significance, but it waned and ceased to be significant during the mid- and late-semester phases. These findings allude to the possibility that depression acts as a significant precursor to problematic social networking sites use. However, the interaction between them appears to be subject to temporal and contextual shifts. Consequently, interventions tackling problematic social networking sites use should progressively pivot from moderating screen time and social media engagement towards enhancing emotional robustness., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Li, Li. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Aims: Psychotic-like experiences (PLEs), especially for persistent PLEs, are highly predictive of subsequent mental health problems. Hence, it is crucial to explore the psychopathological associations underlying the occurrence and persistence of PLEs. This study aimed to explore the above issues through a longitudinal dynamic network approach among PLEs and psychological and psychosocial factors., Methods: A total of 3,358 college students completed two waves of online survey (from Oct 2021 to Oct 2022). Socio-demographic information was collected at baseline, and PLEs, depressive and anxiety symptoms, and adverse life events were assessed in both waves. Cross-lagged panel network analyses were used to establish networks among individuals with baseline PLEs as well as those without., Results: At baseline, 455(13.5%) students were screened positive for PLEs. Distinct dynamic network structures were revealed among participants with baseline PLEs and those without. While 'psychomotor disturbance' had the strongest connection with PLEs in participants with baseline PLEs, 'suicide/self-harm' was most associated with PLEs in those without. Among all three subtypes of PLEs, bizarre experiences and persecutory ideation were the most affected nodes by other constructs in participants with baseline PLEs and those without, respectively. Additionally, wide interconnections within the PLEs construct existed only among participants without baseline PLEs., Conclusions: The study provides time-variant associations between PLEs and depressive symptoms, anxiety symptoms, and adverse life events using network structures. These findings help to reveal the crucial markers of the occurrence and persistence of PLEs, and shed high light on future intervention aimed to prevent and relieve PLEs.

Objective: To investigate the relationship between internet use, physical activity, social adaptability, and depressive tendencies of college students, and to reveal the "advantages" and "disadvantages" of internet use around the "dose-effect"., Method: The Revised Chinese Internet Addiction Scale (CIAS-R), Physical Activity Rating Scale (PARS-3), Chinese College Student Social Adjustment Scale (CCSAS), and Self-rating Depression Scale (SDS) were used to conduct a random sampling survey among 3008 college students in China., Results: (1) Internet use could directly and positively predict the depressive tendencies of college students. (2) Physical activity and social adaptability have a significant chain mediating effect between internet use and depressive tendencies. (3) There was a "U-shaped" dose-effect relationship between internet use and depression tendencies, indicating that normal internet use could directly and negatively predict depressive tendencies, and through the chain mediating effect of physical activity and social adaptability negatively predict depressive tendencies. In contrast, internet use dependence and addiction could directly predict depressive tendencies, and through the chain mediating effect of physical activity and social adaptability positively predict it., Conclusion: Therefore, normal or moderate internet use has potential protective benefits on the physical and mental health of college students and can promote the positive development of physical activity and social adaptability to a certain extent, and prevent or reduce depressive tendencies, otherwise, it is not conducive to the healthy development of related behaviors and psychology., Competing Interests: Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of the School of Physical Education, Southwest University, China (SWU-TY202107), and was conducted with written informed consent obtained from all participants following the Declaration of Helsinki. Consent to participate Informed consent was obtained from all individual participants included in the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objective: To investigate the characteristics of adolescents' school adjustment and their associations with anxiety, depression, and stress, respectively, as well as their differences by gender., Methods: A convenience sampling method was used to measure 3,922 secondary school students from 10 secondary schools in five locations in the Xinjiang Uygur Autonomous Region using the Anxiety-Depression-Stress Scale and the School Adjustment Scale, and latent profile analysis was used to identify the subjects' school adjustment categories, and network analysis was subsequently used to explore the relationship between different school adjustment categories and anxiety, depression, and stress, respectively, as well as their gender characteristics., Results: In the symptom network of adolescents at risk for school maladjustment, "school emotions and attitudes" was the core symptom (Expected Impact Index: 0.86); in the co-morbidity network of school adjustment and anxiety, depression, and stress in adolescents at risk for school maladjustment, the core symptom was "uneasiness" (Expected Impact Index: 0.86); and "stress" (Expected Impact Index: 0.86) was the core symptom. "(EI: 1.12), "difficulty relaxing" (EI: 1.14) in males, and "depression" (EI: 1.06) in females, all with significant gender differences. Significant gender differences were found., Conclusion: Adolescents' school adjustment was strongly associated with symptoms of anxiety, depression and stress, with significant gender differences in the structure of the network of co-morbid symptoms., Competing Interests: Declarations Human ethics and consent to participate Informed consent was obtained from the parent or legal guardian of each participant under 16 years of age. And in accordance with the principles of the Declaration of Helsinki, this study was approved by the Ethics Committee of Xinjiang Medical University (approval number: XJYKDXR20240724003). Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Presently, a diverse range of Western medical interventions are accessible for the management of irritable bowel syndrome with diarrhea (IBS-D) concomitant with comorbid anxiety and depression. However, the concomitant adverse effects have also surfaced, exerting strain on healthcare resources and the socio-economic structure. In recent times, the benefits of acupuncture in the management of IBS-D with coexisting anxiety and depression have become progressively evident. Nevertheless, a paucity of evidence-based medicine exists to substantiate the utilization of acupuncture for the treatment of IBS-D with anxiety and depression. The objective of this study is to examine the effectiveness of acupuncture as an intervention for IBS-D with comorbid anxiety and depression., Methods: We searched 7 databases, including the Chinese Journal Full-text Database, Wanfang Academic Journals Full-text Database, VIP Chinese Scientific Journals Full-text Database, China Biomedical Literature Database, PubMed, Embase, and Cochrane Library, for randomized controlled trials (RCTs) related to acupuncture treatment for IBS with anxiety and depression, published from database inception to August 1, 2023. RevMan 5.4 and Stata 17.0 software were used for meta-analysis of relevant outcome measures., Results: This study included a total of 16 RCTs, involving 1305 IBS-D patients (691 in the experimental group and 614 in the control group). The meta-analysis results showed that compared to oral medication, acupuncture therapy improved HAMD scores (MD = 0.88, 95% CI = [0.68, 1.07], P < .00001), HAMA scores (MD = 2.32, 95% CI = [1.70, 2.93], P < .00001), self-rating anxiety scale scores (MD = 11.67, 95% CI = [10.85, 12.49], P < .00001), SDS scores (MD = 9.84, 95% CI = [8.52, 11.16], P < .00001), IBS-SSS scores (MD = 37.48, 95% CI = [12.17, 62.78], P = .004), overall response rate (MD = 1.27, 95% CI = [1.20, 1.35], P < .00001), and relapse rate (MD = 0.27, 95% CI = [0.16, 0.47], P < .00001) in patients with IBS-D comorbid with anxiety and depression., Conclusion: Acupuncture treatment has a definite and beneficial effect on IBS-D patients with comorbid anxiety and depression., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Depression and suicide attempts are reported to be high among medical students. It has also been reported that depression, suicide attempts, and autistic traits may be significantly related. The aim of this study was to determine the suicide probability and autistic traits of medical students with and without depression symptoms, and to examine the relationship between depression symptoms, suicide probability, and autistic traits together in these students. This cross-sectional study was conducted among 313 medical students, 206 female, and 107 male, who, according to the sociodemographic form, did not have any current psychiatric diagnosis, chronic medical or neurological disorders requiring treatment, or regular use of psychotropic medications, and who completed the forms in full. All the study participants completed a sociodemographic form, the Beck depression inventory (BDI), the suicide probability scale (SPS), and the autism spectrum quotient (ASQ).The entire study sample was divided into 2 groups: students with and without symptoms of depression, based on BDI scores. In the multivariate analysis, independent predictors of depression symptoms were examined using logistic regression analysis. The BDI total points (z = -13.99, P < .001), SPS total points (z = 10.61, P < .001), and subscale points of hopelessness (z = -9.28, P < .001), suicidal ideation (z = 8.48, P < .001), negative self-evaluation (z = -9.26, P < .001), and hostility (z = -8.10, P < .001), and the ASQ subscale points of communication (z = -5.05, P < .001), social skills (z = -6.05, P < .001), imagination (z = -3.27, P = .001), attention shifting (z = -4.35, P < .001), and ASQ total points (z = -6.64, P < .001) were significantly higher for the participants with BDI total points above the cutoff value compared to those with BDI total points below the cutoff value. Statistically significant positive correlations were found between BDI total points and SPS total points (R = 0.710, P < .001), ASQ total points (R = 0.451, P < .001), and between ASQ total points and SPS total points (R = 0.534, P < .001). The contribution of age, gender, ASQ, and SPS total points to explaining depression symptoms was evaluated using logistic regression analysis. This analysis showed that the SPS total points could be a significant predictor of depression symptoms (B = 0.112, P < .001). The findings of this study showed that the probability of suicide and the ASQ total and subscale points of communication, social skills, imagination, and attention shifting were significantly higher in medical students with symptoms of depression compared to those without depressive symptoms. Given the important relationship between symptoms of depression, suicidality, and autistic traits, it is crucial to raise awareness of these issues among medical education departments, health practitioners, medical students, and to provide the necessary guidance and clinical support for medical students to address these problems., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Depression is a common comorbidity among individuals with otolaryngologic disorders, particularly those with longstanding conditions. This study aims at analysing the sociodemographic profile of depressive disorders in patients with chronic otolaryngology symptoms or conditions, and the correlation with PHQ-9 score., Methods: A cross-sectional study was conducted on a hundred patients presenting to the outpatient department with chronic otolaryngology symptoms or conditions. They were requested to fill in the PHQ-9 questionnaire, containing questions based on the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) for major depressive disorder (MDD)., Results: Median age was 39, male: female ratio was 1.17. Nasal obstruction (29%), ear discharge (25%), and headache (17%) were the common presenting complaints. Mean and median PHQ-9 scores were 5.03 and 4 respectively. Seven patients (7%) had MDD, while eleven (11%) had other depressive disorder; 9% of cases were found to have no significant otolaryngologic problem despite presenting with symptoms, two of which were found to have depressive disorder. Thirty-five (35%) and thirty-six (36%) patients had minimal and mild depressive symptoms respectively, while one (1%) had severe depressive symptoms. Statistical significance was noted for the duration of symptoms (p-value 0.005); high statistical significance was found for occupation and otolaryngology diagnosis (p-value < 0.001 each). PHQ-9 score showed statistical significance in comparison with gender and duration of symptoms (p-value 0.046 and 0.005 respectively). Correlation of severity of depressive disorder revealed statistical significance with gender (p-value 0.049) and high statistical significance with duration of symptoms (p-value < 0.001)., Conclusion: Chronic otolaryngology conditions are associated with significant morbidity, attributable to longstanding disturbing symptoms and prolonged treatment protocols, leading to depression. Nevertheless, depression in chronic otolaryngology disorders may aggravate or overlap the clinical symptoms or may go undetected. Hence it may be worthwhile to evaluate for depressive disorders in chronic patients presenting to otolaryngology., Competing Interests: Declarations Ethics approval The study was approved by the Institutional Ethics Committee, KMC Mangalore (IEC KMC MLR 06-2021/194) and was performed following the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. No animals were involved in the study. Consent to publish Obtained from all individual participants included in the study. Competing interests The authors declare no competing interests. Consent for publication Obtained from all individual participants included in the study. Informed consent Written informed consent was obtained from all individual participants included in the study. Research involving human participants and/or animals The study was approved by the Institutional Ethics Committee, KMC Mangalore (IEC KMC MLR 06-2021/194) and was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. No animals were involved in the study. Code availability Not applicable., (© 2024. The Author(s).)

This study investigates the relationship between risk and protective factors and suicidal ideation among teachers, a group often overlooked in suicide prevention efforts. Using the diathesis-stress model as a partial framework, the research explores how depression and anxiety, as risk factors, and emotional intelligence, resilience, and positive thoughts, as protective factors, influence suicidal ideation. A cross-sectional design was employed, involving 1,270 Spanish teachers (median age: 46, 70.2% female). Key measures included the Positive and Negative Suicidal Ideation scale (PANSI), the Brief Emotional Intelligence Scale (BEIS-10), the Brief Resilient Coping Scale (BRCS) for resilience, and the General Health Questionnaire (GHQ-12) for depression and anxiety. A network approach was used to examine the relationships between these variables. Results showed that depression had a stronger relationship with negative ideation than anxiety, while emotional intelligence and positive thoughts acted as protective factors. Positive ideation was negatively associated with depression and anxiety, and positively linked to emotional intelligence and resilience. Emotional intelligence emerged as the most critical protective factor. These findings provide valuable evidence to inform the development of emotional management and resilience-building programs aimed at enhancing teachers' mental health and performance, which could also indirectly benefit students., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

A better understanding of the causal relationship between spousal cognitive functioning and depression levels among middle-aged and older adults is vital for effective health policymaking under the globally severe aging challenge. However, the related evidence is often limited by potential omitted-variable bias and reverse causation. This study uses an instrumental variables approach, namely the two-stage least squares (2SLS) method, to examine the impact of spousal cognitive functioning on depression levels among middle-aged and older adults in China. The data were sourced from the China Health and Retirement Longitudinal Study (CHARLS) of 2020, including a total of 3,710 couples aged 45 years and above. Depression levels were measured using the Center for Epidemiologic Studies Depression Scale (CES-D-10), while cognitive functioning was assessed using the Mini-Mental State Examination (MMSE). Spousal social participation was employed as the instrumental variable to address omitted-variable bias and reverse causation. Additionally, an interaction effect test between gender and spousal cognitive functioning was conducted. The results show that for each one-point increase in the spouse's MMSE score, the CES-D-10 score of middle-aged and older adults decreased by 17.1% to 68.2%. The OLS results indicated that women, rural residents, and middle-aged individuals were more sensitive to these changes. The interaction effect test results confirmed that women were more affected by changes in spousal cognitive functioning. However, after a more reliable 2SLS analysis, the results for age groups shifted, showing that middle-aged individuals were more sensitive to these changes, with a decrease in depression levels reaching 70.0%, compared to 60.2% for the elderly group. Nonetheless, given the prevalence of depression among the elderly, the impact of spousal cognitive decline on depression in this group should not be overlooked. Our findings highlight the importance of spousal cognitive health in managing depression among both middle-aged and older adults, with particular attention to women and rural populations.

Introduction: Attention deficit hyperactivity disorder (ADHD) in adults could be frequently underdiagnosed due to concomitant psychiatric disorders, including depressive symptomatology, which could determine inappropriate treatments. Our study aims at clinically characterizing adult ADHD with or without depressive symptomatology in order to identify the relationship with specific affective temperamental profiles and coping strategies., Methods: A total of 225 outpatients consecutively afferent to our outpatient adult ADHD service since September 2019 were retrospectively screened for eligibility and administered Beck Depression Inventory-II (BDI-II), Coping Orientation to Problems Experienced Inventory (COPE-NV) and Temperament Evaluation of the Memphis, Pisa, Paris and San Diego (TEMPS-M)., Results: 64.7 % of patients displayed a significant comorbid depressive symptomatology. According to the multivariate linear regression model, depressive levels were positively predicted by TEMPS-M cyclothymic subscale (B = 0.567, p = 0.004) and negatively predicted by COPE-NVI "positive attitude" subscale (B = -0.438, p = 0.024) (R = 0.496, R 2  = 0.246, F(2,66) = 10.747, p < 0.001)., Limitation: While considering the results, it should be taken in consideration that: the assessment was carried out only at baseline, our sample is constituted only by adult ADHD patients and mostly without a previous ADHD diagnosis, the presence of a discrepancy between the rates of ADHD subtypes, the absence of a healthy control group and emotional dysregulation was not directly assessed., Conclusion: Affective temperamental profiles and coping strategies could help in clinically characterizing and personalizing treatment in adult comorbid ADHD-depressive symptomatology patients. Further research is warranted to explore the efficacy of targeted psychotherapeutic and pharmacological interventions within this ADHD sub-sample., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: To assess the parental stress, coping mechanism and quality of life of caregivers of children with Differences of Sex Development (DSD)., Methods: Mothers of children (6 months - 12 years) with DSD were enrolled after excluding mothers of children with syndromic diagnosis, developmental delay, cognitive impairments, chronic diseases, or if the duration of DSD diagnosis was less than six months, and mothers with psychiatric illnesses (n = 35). Mothers of age and gender-matched children with congenital hypothyroidism served as controls (n = 35). Psychological assessments were performed using structured questionnaires: the Parent Stress Scale, PRIME MD PHQ-9 Scale, and Ways of Coping Questionnaire., Results: Mothers of children with DSD exhibited significantly higher mean (SD) stress levels [24.34 (4.25) vs 19.57 (1.89); P < 0.001]. Prevalence of depression prevalence was higher in mothers in the DSD group than in the hypothyroidism group (71% vs 42.9%, P < 0.001). Mothers of children with DSD also had poorer quality of life, and both high negative coping behavior and low positive coping behavior (P < 0.001) compared to controls, and stigma related to social exclusion was more pronounced., Conclusion: Beyond medical interventions, addressing family members' psychological well-being is essential in effectively managing DSD in the Indian context.

Objective: To examine associations between depression, anxiety, and stress, as measured by the Depression, Anxiety and Stress Scale (DASS-21) scale, with current e-cigarette use., Methods: Data from the Truth Longitudinal Cohort - a nationally representative sample of youth and young adults - was collected between October 2022 to February 2023. The analytic sample was comprised of participants who provided information on e-cigarette use and the DASS-21 scale (N = 4198). Chi-square statistics were used to determine differences by current e-cigarette use across covariates and DASS-21 items. Logistic regression analyses were applied to the cross-sectional data to determine which scales predicted current e-cigarette use, adjusted for the effects of age, gender identity, race and ethnicity, parental educational attainment, perceived financial situation, and current use of alcohol, marijuana, and other tobacco use., Results: Those who had severe/extremely severe levels of depression, anxiety, and stress had greater odds of current e-cigarette use, relative to those who had normal levels of depression, anxiety, and stress, even after adjusting for covariates. Results also demonstrated associations between age, race/ethnicity, parental education, and current use of alcohol, marijuana, and other tobacco products with current e-cigarette use., Limitations: Cross-sectional analyses of self-reported data limit the ability to determine directionality of effects between depression, anxiety, stress, and current e-cigarette use., Discussion: More severe levels of depression, anxiety, and stress were associated with a greater likelihood of current e-cigarette use. Future research is needed to evaluate changes in e-cigarette use, in response to depression, anxiety, and stress symptomatology., Competing Interests: Declaration of competing interest The authors report no competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

According to biopsychosocial models, experiencing parental child abuse increases susceptibility to adulthood psychopathology. However, there is a paucity of studies examining potential mechanisms of the parental child abuse and adulthood psychopathology relationship. The purpose of the current study was to determine if Time 2 (T2) trait self-esteem mediated levels of Time 1 (T1) retrospectively recalled parental child abuse predicting (T3) past-year major depressive disorder (MDD), generalized anxiety disorder (GAD), panic disorder (PD), alcohol use disorder (AUD), and substance use disorder (SUD) symptoms. The 18-year Midlife Development in the United States (MIDUS) study included participants (N = 3294; T1 average age of 45.62 years) assessed at three different time points, each spaced about nine years apart. We performed structural equation mediation modeling analyses to determine how maternal and paternal child abuse at T1 would independently predict T3 MDD, GAD, PD, AUD, and SUD symptoms. We also examined whether T2 self-esteem mediated these relations while controlling for adulthood T1 psychopathology symptoms, demographics, socioeconomic status, somatic symptoms, and parental psychopathology. Consistent with our hypotheses, higher T1 maternal and paternal abuse predicted increased T3 GAD, PD, AUD, and SUD symptoms via diminished T2 self-esteem as the mediator (% proportion mediated = 33.0-100). However, childhood paternal, but not maternal, abuse predicted adulthood MDD symptoms via reduced self-esteem. Findings remained after adjusting for covariates. Our research highlights the importance of understanding retrospectively recalled parental child abuse-adulthood psychopathology relations, their potential mechanisms, and self-esteem as a malleable treatment target for adults with heightened child abuse., Competing Interests: Declaration of competing interest None of the authors have any conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Depressive symptoms are prevalent in adolescents. We aimed to investigate the association between body image and depressive symptoms, and how Body Mass Index (BMI) affects this., Methods: Survey data from 2017 with 9963 9th-grade Danish adolescents. Information from the survey about the exposure, body image, was divided into 3 categories: too fat, too thin, and adequate. Depressive symptoms, was measured with Center for Epidemiological Studies Depression Scale for Children (CES-DC4). BMI was categorized as underweight, normal weight and overweight. We used logistic regression and examined for effect modification by sex and BMI and adjusted for self-esteem and bullying., Results: An association was found between body image and depressive symptoms, when adjusting for BMI, sex, self-esteem, and bullying. The association was strongest for adolescents feeling too fat compared with adolescents feeling adequate OR:1.61(1.45-1.78), for adolescents feeling to thin compared to adequate: OR:1.21 (1.06-1.37). No effect modification by either BMI or sex was found, but those who perceive their bodies in contrast to their reported BMI faced the highest odds of depressive symptoms, and the results were confounded by self-esteem and bullying, that reduced the estimates after adjusting., Limitations: This is a cross-sectional study with limited information regarding drop-out, with risk of selection bias., Conclusion: We found an association between negative body image and depressive symptoms among Danish adolescents. This confirms previous studies and is a relevant aspect to adolescents' mental health, especially the contrast between BMI and perceived body image, and the confounding by self-esteem and bulling, with potential for prevention., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: This study aimed to examine acute and chronic stressors, and perceived lack social support, and their associations with depression and suicidal ideation in adolescents during the COVID-19 pandemic., Methods: Deidentified data from (N = 270,153) U.S. adolescents aged 11 to 17 who completed the Patient Health Questionnaire 9-item tool (PHQ-9) in the years 2020 and 2021 were sourced from a collection of online screening tools that are free, confidential, anonymous, and scientifically validated. In addition to depression, the survey included questions about suicidality, past/chronic stressful events, and contributors to mental health problems and sociodemographic variables. SPSS software version 28 for descriptive analyses, and Mplus version 7.31 for confirmatory factor analysis (CFA) and structural equation modeling (SEM), were respectively used., Results: Participants were predominantly female, White, and heterosexual, and exhibited a high prevalence of severe depression and a significant frequency of suicidal thoughts. Significant associations were found between past/chronic stressful events, and lack of social support, with suicidality and depression. Mental health stress due to the COVID-19 pandemic itself presented no significant associations with depression and suicidality and was weakly and negatively associated with lack of social support and past/chronic stressors., Discussion: These findings reinforce the notion that prior traumatic events can create vulnerabilities in the face of acute stressors, while social support can enhance resilience in adolescents. Factors that increase resilience, such as preventing traumatic events, reducing social stressors, and increasing social support, can serve as valuable guidelines for clinical and public health interventions., Competing Interests: Declaration of competing interest Dr. Vidal receives funding from the NIDA/AACAP Physician Scientist Training Program in Substance Abuse Research, supported by NIDA Career Development Award (K12)., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Sleep disturbance may impact response to psychological treatment for depression. Understanding how sleep disturbance changes during the course of psychological treatment, and identifying the risk factors for sleep disturbance response may inform clinical decision-making., Method: This analysis included 18,915 patients receiving high-intensity psychological therapy for depression from one of eight London-based Improving Access to Psychological Therapies (IAPT) services between 2011 and 2020. Distinct trajectories of change in sleep disturbance were identified using growth mixture modelling. The study also investigated associations between identified trajectory classes, pre-treatment patient characteristics, and eventual treatment outcomes from combined PHQ-9 and GAD-7 metrics used by the services., Results: Six distinct trajectories of sleep disturbance were identified: two demonstrated improvement, while one showed initial deterioration and the other three groups displayed only limited change in sleep disturbance, each with varying baseline sleep disturbance. Associations with trajectory class membership were found based on: gender, ethnicity, employment status, psychotropic medication use, long-term health condition status, severity of depressive symptoms, and functional impairment. Groups that showed improvement in sleep had the best eventual outcomes from depression treatment, followed by groups that consistently slept well., Limitation: Single item on sleep disturbance used, no data on treatment adherence., Conclusions: These findings reveal heterogeneity in the course of sleep disturbance during psychological treatment for depression. Closer monitoring of changes in sleep disturbance during treatment might inform treatment planning. This includes decisions about when to incorporate sleep management interventions, and whether to change or augment therapy with interventions to reduce sleep disturbance., Competing Interests: Declaration of competing interest All authors declare that there are no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: This study aimed to develop and validate a predictive nomogram model applicable to depression risk in stroke patients., Methods: Participants from the NHANES database (n = 1097) were enrolled from 2005 to 2018; 767 subjects were randomly assigned to the training cohort, and the remaining subjects composed the testing cohort. A nomogram containing the optimal predictors identified by the least absolute shrinkage and selection operator (LASSO) and logistic regression methods was constructed to estimate the probability of depression in stroke patients. To evaluate the performance of the nomogram, the area under the receiver operating characteristic curve (AUC), calibration plot, decision curve analysis (DCA) and internal validation were utilized., Results: Age, family income, trouble sleeping, coronary heart disease, and total cholesterol were included in the nomogram after filtering predictive variables. The AUCs of the nomogram for the training and testing cohorts were 0.782 (95 % CI = 0.742-0.821) and 0.755 (95 % CI = 0.675-0.834), respectively. The calibration plot revealed that the predicted probability was extremely close to the actual probability of depression occurrence in both the training and testing cohorts. DCA revealed that the nomogram model in the training and testing cohorts had a net benefit when the risk thresholds were 0-0.59 and 0-0.375, respectively., Limitations: This study was limited by the absence of clinical external validation, which hindered the estimation of the nomogram's external applicability. In addition, this study has a cross-sectional design., Conclusions: A novel nomogram was successfully constructed and proven to be beneficial for identifying individuals at high risk for depression among stroke patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Psychiatric disorders, including attention-deficit hyperactivity disorder (ADHD), depression, anxiety disorders, and dementia, manifest differently across life stages, impacting cognitive, emotional, and behavioral health. Understanding the causal relationships between various types of physical activity and these disorders is crucial for developing targeted interventions., Methods: The summary level data from GWAS was utilized to conduct a two-sample Mendelian Randomization (MR) analysis. We assessed the potential causal relationships between different types of physical activity including light do it yourself (DIY) activities, heavy DIY activities, strenuous sports, and aerobic exercises/other exercises and the prevalence of psychiatric disorders (ADHD, depression, anxiety disorders, and dementia) across different life stages., Results: The MR analysis showed no causal relationship between light DIY activities and any of the psychiatric disorders studied. Heavy DIY activities showed a significant negative association with anxiety disorders but no links with ADHD, depression, or dementia. Strenuous sports did not demonstrate any causal relationship with the psychiatric disorders examined. Aerobic exercises were notably correlated with a reduced risk of depression, although no significant associations were found with ADHD, anxiety disorders, or dementia., Conclusions: The findings indicate that heavy DIY activities might contribute to reducing anxiety disorders, while aerobic exercises potentially lower the risk of depression. These results emphasize the potential benefits of promoting specific types of physical activity to improve mental health outcomes across different life stages. Future research could further investigate the mechanisms underlying these relationships and consider diverse populations and objective measures of physical activity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The authors confirm that the content of the manuscript has not been published, or submitted for publication elsewhere., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: This study explores the combinations of conditional variables contributing to depressive symptoms in rural children., Methods: We analyzed data from 715 children from a rural mental health database, conducting detailed follow-up investigations on 129 children in Zhejiang and Henan provinces. We used fuzzy set Qualitative Comparative Analysis (fsQCA) and regression analysis to identify causal pathways leading to depression., Results: The results indicate that depression in rural children does not stem from a single, necessary condition but arises from multiple factors. Our findings highlight significant contributions from both maternal and paternal involvement. Specifically, maternal involvement, combined synergistically with peer support and problematic behaviors, as well as paternal involvement, together with peer support and anxiety, significantly affects depressive outcomes. Additionally, anxiety and strong peer relationships independently have a substantial impact on these outcomes. Effective mitigation strategies involve active parental engagement and robust peer support, reducing the influence of risk factors such as problematic behaviors and anxiety., Limitations: The generalizability of the results is limited by cultural and geographical variations. The study also does not account for all potential factors influencing depression in rural children., Conclusion: Depression in rural children results from multiple interacting factors. Tailored interventions addressing these specific combinations are recommended., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objectives: To explore the relationship between adverse childhood experiences and falls in older adults, and the mediating effects of depression on such associations., Methods: This is a prospective study used survey data from the China Health and Retirement Longitudinal Study. Twelve expanded ACEs obtained from the 2014 Life History Survey. Depression levels were assessed using the Centre for Epidemiologic Studies Depression Scale-10. Self-reported outcomes of falling evaluated based on "Have you fallen down since the last survey?" and "How many times have you fallen down seriously enough to need medical treatment?" Logistic regression models were used to explore the relationship between ACEs with falls and recurrent falls. Poisson regression models were used to explore the relationship between ACEs and number of severe falls. Besides, mediation analysis was used to explore whether depression mediates the relationship between ACEs and falls in older adults., Results: The more adverse childhood experiences experienced, the higher the risk of fall and recurrent falls, and the more severe the falls. Additionally, depression partially mediated the relationship between adverse childhood experiences and falls. Besides, middle-aged individuals were more susceptible to the impact of adverse childhood experiences on falls than older individuals, especially males., Conclusions: Exposure to adverse childhood experiences is associated with falls in older adults, and depression partially mediates this association. Middle-aged adults were more susceptible to the impact of adverse childhood experiences on falls. These offer important information for clinical practice and public health interventions to prevent falls and reduce fall-related injuries among older adults., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: Depressive symptoms during the perinatal period have broad and enduring health implications for birthing parents and their offspring. Rising prevalence rates of perinatal depression highlight the need for research examining factors influencing depressive symptoms during pregnancy, and trajectories during the early postnatal period. Grounded in bioecological systems theory, this longitudinal multimethod study examined whether prenatal bioecological factors predict depressive symptoms from pregnancy to 36 months postpartum., Methods: Participants were 162 pregnant individuals, oversampled for high emotion dysregulation, who completed a life stress interview and physiological assessment during the 3rd trimester and a self-report measure of depression at five time-points (3rd trimester, within 48 h of birth, 7, 18, and 36 months postpartum). Multilevel models were used to test study aims., Results: Participants exhibited the highest levels of depressive symptoms at 3rd trimester, and substantial variability in depressive symptom trajectories over time. Lower resting respiratory sinus arrhythmia (RSA), an index of parasympathetic nervous system functioning, in the 3rd trimester was associated with higher concurrent depressive symptoms. Higher levels of stress related to partner relationships, finances, and health were concurrently associated with more depressive symptoms during pregnancy and decreases in depressive symptoms over time. Specifically, depressive symptoms decreased only for individuals who reported high levels of stress during pregnancy., Limitations: Although grounded in bioecological systems theory, this study did not assess the macrosystem., Conclusions: Results of this study underscore the importance of multilevel predictors of perinatal health and highlights potential targets for preventing depression and promoting well-being during the perinatal transition., Competing Interests: Declaration of competing interest The authors declare they have no conflicts of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

People are paying more and more attention to the effects of environmental factors such as heavy metals on depression, and heavy metals may destroy the homeostasis of vitamin D in the body by affecting human metabolism, and the lack of vitamin D will increase the risk of depression. There are few studies on vitamin D deficiency in depression caused by heavy metals, and it is not deep enough. Therefore, this study used logistic regression, restricted cubic spline curve, weighted quantile and Quantile g-computation model to analyze the effects of heavy metal exposure alone and in combination on vitamin D and depression, as well as the potential role of vitamin D deficiency in the process of heavy metal-induced depression. The results showed that cadmium exposure alone or in combination increased the risk of depression (P < 0.05). When Cd increased by 1 unit, the risk of depressive symptoms increased by 1.178 units. Arsenic and its compounds and lead affected vitamin D levels in the body and contributed the second highest or highest weight in the mixture (P < 0.05). It is worth noting that after grouping according to vitamin D deficiency, compared with the normal group, the mixed exposure of heavy metals in the vitamin D deficiency group had more types of metals related to depression and contributed more weight (P < 0.05). This study found that single metal or multi-metal mixed exposure is associated with depression. Vitamin D deficiency may increase the risk of depression. Vitamin D may be a potential factor in the treatment of depression caused by metal, and the specific mechanism of action needs further study., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Adolescent depression is a major public health concern. Although stress has been linked to more severe depression, its association with mild depression among adolescents is not understood. This study assesses the relationship between perceived stress and cortisol (a physiologic measure of stress) and examines the relationships between these stress measures and depressive symptoms among adolescents 13-19 years of age., Methods: Stress was measured with the Perceived Stress Scale-10 and through salivary sampling for cortisol four times throughout the day. The Patient Health Questionnaire-9 was used to measure depressive symptoms (range 0-27), where ≥5 indicated the threshold for experiencing at least mild depressive symptoms. Spearman coefficients and multiple logistic regression models were used to examine the relationships between our variables of interest., Results: The mean age of the 73 participants in our study was 15.82 years. 49 % of the participants reported depressive symptoms (PHQ-9 score ≥ 5). Both higher perceived stress (odds ratio [OR] = 1.11, p = 0.022) and lower cortisol (area-under-the curve; AUC G ) (OR = 0.99, p = 0.009) were associated with increased odds of having depressive symptoms., Limitations: Few participants had moderate to severe PHQ-9 depression, therefore our study reported findings on mild depression or greater., Conclusions: Perceived stress and cortisol appear to reflect distinct, independent components of the stress experience. However, both greater perceived stress and less circulating cortisol may indicate difficulties in regulating stress as potential factors underlying depressive symptoms. Future research should focus on the different types of adolescent stressors and the importance of routine screening of stress and depression, including mild depression., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Depression and anxiety are prevalent in older adults with cancer but are often undertreated. Older adults are also at increased risk of chemotherapy toxicity (CT). This study evaluated the impact of depression and anxiety symptoms on severe CT risk in older adults with cancer., Methods: This is a secondary analysis of a randomized trial (2:1) evaluating geriatric assessment-driven intervention (GAIN) versus standard of care (SOC) to reduce grade 3+ CT in older adults with cancer. Mental health was assessed via the Mental Health Inventory 13. CT was graded by National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0., Results: A total of 605 patients enrolled (402 GAIN; 203 SOC). Overall, 35% were depressed and 47% were anxious. Patients with depression had increased CT in the SOC arm (70.7% vs. 54.3%; p = .02) but not in the GAIN arm (54.3% vs. 48.5%; p = .27). CT was more likely in SOC patients with depression (odds ratio [OR], 2.03; 95% CI, 1.10-3.72). This association persisted after adjusting for Cancer and Aging Research Group toxicity score (OR, 1.98; 95% CI, 1.07-3.65) and for demographic, disease, and treatment factors (OR, 2.00; 95% CI, 1.03-3.85). Depression and CT were not associated in the GAIN arm (OR, 1.26; 95% CI, 0.84-1.91). Anxiety and CT were not associated in either arm., Conclusions: Elevated depression symptoms are associated with increased risk of severe CT in older adults with cancer, which was mitigated with GAIN. This suggests that treating depression symptoms may lower toxicity risk. Future studies are needed to confirm and investigate the impact of depression-specific interventions on outcomes., (© 2024 The Author(s). Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Background: The association between body shape and depressive symptoms has been reported in adults. The present study aimed to investigate the association between body shape-specific abdominal obesity and depressive symptoms among multi-regional Asian adults., Methods: The 2011-2012 China Health and Retirement Longitudinal Study and 2022-2023 Hangzhou study were used as the discovery and validation datasets, respectively. Body shape was assessed by body mass index categories. Abdominal obesity was defined as a body shape index (ABSI) ≥ 75th centile. Depression was measured using 10-item Centre for Epidemiological Studies Depression Scale and Geriatric Depression Scale short 15-item version, respectively. General linear and multinomial logistic models were used to explore the association of ABSI, abdominal obesity with depressive scores and presence, respectively., Results: A total of 12,229 and 1210 participants were included in the discovery and validation datasets, respectively. A non-linear reverse L-shaped association was found between ABSI and depressive scores. Participants with abdominal obesity had higher depressive scores (β = 0.05, 95%CI = 0.01-0.09; and β = 0.13, 95%CI = 0.01-0.24; respectively). Stratified analyses showed that abdominal obesity was associated with higher depressive scores (β = 0.09, 95%CI = 0.00-0.17; and β = 0.25, 95%CI = 0.05-0.46; respectively) and presence (OR = 1.46, 95%CI = 1.02-2.10; and OR = 3.95, 95%CI = 1.58-9.84; respectively) in overweight adults. Furthermore, abdominal obesity was associated with depressive symptoms among overweight females, but not among males., Limitation: Causal links weren't addressed because of the observational study design., Conclusion: Abdominal obesity exhibited a positive association with depressive symptoms among Asian overweight adults, particularly in females. Prevention and early diagnosis of depressive symptoms should focus on overweight females., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The regional boom in digital economy has provided people with remote conversations and socialization while reducing the risk of depression. This study aims to elucidate whether regional digital economy can be a savior for individual depression. The multi-source dataset collects 11,845 individuals from the China Health and Retirement Longitudinal Study 2018 (CHARLS), with the combination of corresponding regional data from China City Statistical Yearbooks. A series of regressions with integrated mediation and moderation analyses are employed to bridge the link between the digital economy and depression. The results suggest that people living in areas with a higher level of digital economy are less likely to suffer from depression. The development of the digital economy helps people find solace or air grievances more easily, thereby reducing the risk of depression. Individual information and communications technology (ICT) engagement is found to mediate the relationship between the regional digital economy and individual depression. Residence type moderates the association between the three casual pairs of digital economy, ICT engagement, and depression. Improved digitization stimulates personal engagement with ICTs, which in turn expands social connections and support. Strengthened social interactions naturally keep depression away. Moreover, the urban-rural differences further confirm the underlying mechanism. Properly embracing the new digital world can therefore benefit from the transformative potential and mitigate depressive outcomes., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: In recent years, several studies have suggested that obesity may play an important role in cognitive impairment. Individuals with cognitive impairment often also exhibit depressive symptoms. This study aimed to explore the association between obesity and cognitive impairment and to elucidate the mediating role of depressive symptoms in this association., Methods: Older participants in the U.S. were examined in this cross-sectional study (n = 2391). The WWI was computed as follows: WWI = waist circumference/square root of body weight. The Consortium for Alzheimer's Disease Word Learning (CERAD-WL), the Animal Fluency Test (AFT), and the Digit Symbol Substitution Test (DSST) were used to evaluate cognitive function. Depression symptoms were evaluated with the Patient Health Questionnaire 9 (PHQ-9). Subgroup analysis and multiple logistic regression analysis were utilized to investigate the relationships between the WWI and depressive symptoms and cognitive decline. Threshold effects were computed using a two-segment linear regression model. To ascertain whether depression mediates the relationship between the WWI and cognitive impairment, mediation analysis was also employed., Results: A total of 2391 participants were included, 33.29 % of whom had cognitive impairment. There was a significant correlation between the WWI and depressive symptoms and cognitive function (P < 0.05). With increasing WWI quartiles, the prevalence of cognitive impairment increased (Q1: 27.09 %, Q2: 33.00 %, Q3: 31.44 %, Q4: 41.64 %). It was highly likely that the WWI and cognitive impairment were positively correlated (OR = 1.34, 95 % CI = 1.13, 1.59), and this link was steady across all subgroups (P for trend >0.05). A nonlinear curve with an inflection point of 10.71 connected the WWI and cognitive deterioration. A significant correlation was found between the WWI and cognitive impairment on the left side of the inflection point (OR = 3.58, 95 % CI = 1.57, 8.15). With a 5.4 % mediation rate, mediation analysis revealed that depressive symptoms mediated the relationship between cognitive impairment and the WWI., Conclusions: There was a positive association between the WWI and the incidence of cognitive impairment in older Americans. Among other factors, depressive symptoms slightly mediated the association between the WWI and cognitive impairment. However, large-scale prospective studies are still needed to analyse the interactions between the three factors in depth., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Previous studies have mainly focused on the effects of individual fatty acids on depressive symptoms, while the combined effect of fatty acids on the risk of depressive symptoms has not yet been extensively reported. This study evaluate the associations between individual and multiple fatty acids with depressive symptoms in U.S. adults., Methods: Data sets were obtained from the National Health and Nutrition Examination Survey (NHANES) 2007-2018 cycles. Both males and females aged above 18 years with complete information about dietary fatty acids intake, depression symptoms, and covariates were included. Weighted linear regression models were conducted to evaluate the relationships between individual fatty acid intake and depressive symptoms, and restricted cubic spline (RCS) models were utilized to explore the corresponding dose-response relationships. Additionally, we implemented the weighted quantile sum (WQS) regression and quantile g-computation (QGC) models to estimate the mixed effects of 19 fatty acids and identify the predominant types., Results: After multivariable adjustments, an increase of one unit in Linoleic acid (LA), Alpha-Linolenic Acid (ALA), Arachidonic acid (AA), Docosapentaenoic acid(DPA), Docosahexaenoic acid(DHA), was associated with a decrease in depressive scores by -0.021 (95 % CI: -0.039,-0.003, p = 0.021),-0.028 (95 % CI: -0.045,-0.011, p = 0.002),-0.026 (95 % CI: -0.044,-0.008, p = 0.005), -0.026 (95 % CI: -0.042,-0.009, p = 0.003), and - 0.022 (95 % CI: -0.041,-0.003, p = 0.022), respectively. However, a per unit increase in Hexanoic acid and Octanoic acid was associated with an increase in depressive scores of 0.020 (95 % CI: 0.002,0.038, p = 0.029) and 0.026 (95 % CI: 0.004,0.048, p = 0.020), respectively. Meanwhile, significant dose-response relationships were supported by the RCS models. As for the mixed effects, both WQS and QGC models demonstrated that the mixture of polyunsaturated fatty acids (PUFAs) was inversely related to depressive symptoms, and ALA and DPA were the most critical contributors. DHA was negatively correlated with depressive symptoms in WQS analysis, but positively correlated with depressive symptoms in QGC analysis., Limitations: The cross-sectional design limits our ability to establish causality, and 24-hour dietary recall can lead to potential inaccuracies reflecting participants' true eating habits., Conclusion: Our study suggests that the single effects of each PUFA were inversely associated with depressive symptoms, except for octadecatetraenoic acid. Moreover, higher combined intake of dietary PUFAs is inversely associated with depressive symptoms in U.S. adults. Among the mixed effects of PUFAs, ALA and DPA may play predominant roles. However, DHA mixed with other fatty acids may have different effects on depressive symptoms, and further study is needed., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Purpose: The aim of this study is to determine the effects of proactive personality and individual innovation characteristics of university students on their mental health together with their socio-demographic characteristics., Methods: This cross-sectional study was conducted among students of Yozgat Bozok University in 2022. Data was collected using a sociodemographic information form, Individual Innovation Scale (IIS), Proactive Personality Scale (PPS), and the Depression-Anxiety-Stress Scale (DASS-21). The questionnaire forms were presented to students online through Google Forms. Data were analyzed by t-test, ANOVA, correlation and multinomial logistic regression (MLR)., Results: In this study, the mean scores of the anxiety, depression and stress subscales of DASS were found to be 6.0 ± 3.7, 6.8 ± 4.4 and 7.4 ± 3.8, respectively. The percentage of students showing moderate levels of anxiety, depression, and stress symptoms were 22.2%, 32.0%, and 15.1%, respectively, while those with high or very high levels of symptoms were 31.5%, 17.0%, and 9.8%, respectively. This study provides evidence that proactive personality, individual innovativeness traits, age, and familial characteristics may not significantly influence anxiety, depression, or stress in college students. The probability of students showing moderate and high levels of mental health symptoms was found to be associated with being female and having poor health status., Conclusion: Anxiety was found to be the most common mental health problem among university students, followed by depression and stress. No relationship was found between students' proactive personality, individual innovation traits, and their mental health., Competing Interests: Declarations Ethics approval and consent to participate The research was carried out in accordance with the rules and ethical codes specified in the Declaration of Helsinki. University students were informed about the study and their informed consent was obtained for the participation. Before starting the survey, those who approved to participate in the survey online were allowed to complete the survey. The study was approved by the Yozgat Bozok University’s Ethics Committee on November 18, 2020, with decision number 15/10. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Apathetic and depressive symptoms are frequently observed among older adults, and are risk factors for functional decline and dementia progression. However, how these symptoms influence functional capacity remains unclear. This study investigated the relationship between apathetic and depressive symptoms and functional capacity, considering the interaction between apathetic and depressive symptoms., Methods: A cross-sectional questionnaire survey targeting community dwelling middle-aged or older adults was conducted. We sent a questionnaire to 984 individuals and received 320 responses. Data with missing values and participants aged under 50 were excluded, resulting in 212 participants (88 men and 124 women, mean age = 73.4 ± 9.3 years). Apathetic symptoms were evaluated using the Dimensional Apathy Scale (J-DAS), which comprises executive, emotional, and cognitive and behavioral initiation aspects of apathy. Depressive symptoms were evaluated using the Geriatric Depression Scale (GDS). Functional capacity was assessed using the Japan Science and Technology Agency Index of Competence, which comprises technology usage, information practice, life management, and social engagement., Results: Mean score of each J-DAS factor and GDS was 5.3 ± 3.4 (executive), 12.0 ± 3.0 (emotional), 11.8 ± 5.1 (initiation), and 4.5 ± 3.3, respectively. The emotional and initiation aspects of J-DAS were significantly associated with information practice (β = -0.15, p < .05 for emotional; β = -0.27, p < .001 for initiation) and life management (β = -0.20, p < .01 for emotional; β = -0.22, p < .01 for initiation) in functional capacity. GDS was associated only with social engagement (β = -0.31, p < .001). Although the interaction between the initiation factor of J-DAS and GDS was significantly associated with life management (β = -0.16, p < .05), the R 2 change was insignificant. The emotional factor of J-DAS was associated with technology usage (β = -0.13, p < .05), although less strongly than age. The executive factor of J-DAS had insignificant associations with all aspects of functional capacity., Conclusions: Apathetic and depressive symptoms are independently, rather than interactively, associated with different aspects of functional capacity. As older adults with apathetic or depressive symptoms might struggle to seek help from public health services, they should be targeted with active interventions from healthcare professionals., Competing Interests: Declarations Ethics approval and consent to participate Informed consent was obtained from all subjects. Participants were informed about the objective of research, freedom to consent and retraction, and contact name along with the questionnaire. As the questionnaire was anonymous, answering it was assumed as consenting to the survey. The Ethics Committee of Hirosaki University School of Medicine approved the study (number: 2020 − 109). Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

The mental health needs of young people in sub-Saharan African societies remain understudied. This study builds upon the everyday perspectives of young people in Gorongosa, a rural district in central Mozambique, to determine the frequency and severity of key mental health issues, identify significant risk and protective factors, and their associations with demographic factors and mental health predictors. This cross-sectional study gathered culturally and ecologically relevant variables, such as sociodemographic indicators and risk and protective factors. The Beck Depression Inventory-II (BDI-II), Self-Report Questionnaire (SRQ) and Nocturnal Intrusions after Traumatic Experiences Questionnaire (NITE) were used to determine the prevalence and severity of key mental health issues. A convenience sampling was used involving n = 794 young people of those (45.8%) were females and the mean age of all participants was 17.24 years (SD 2.9). To examine the results, univariate analysis, chi-square tests, binary logistic regression analyses and odds ratio were used. Risk factors were pervasive in households, communities, and schools. Mental health problems were commonly linked to severe depression (14.2%), anxiety-related disorders (39.3%), sleep disturbances (37.3%), and anxiety dreams (27.5%). Gender, age, and protective factors were associated with the frequency and severity of mental health outcomes, while living with both parents protected against the severity of anxiety-related disorders. Understanding the contextual mental health needs of young people in rural Mozambique is crucial for developing insights to craft and implement targeted public mental health interventions in resource-limited settings. Addressing mental health issues among young people necessitates a concentrated effort on understanding and managing the interplay of risks and protective factors within families, communities, and schools., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. Crown.)

Background: Left-behind children(LBC) in rural China are at increased risk for mental health problems, including depression. This study aimed to estimate the prevalence of depression and identify key associate factors among Chinese rural LBC., Methods: A cross-sectional study was conducted using data from 36,612 LBC aged 6 to 18 years old across 596 data collection sites in Nanchong, Sichuan Province, China. Participants completed questionnaires assessing individual factors, family parenting situation, living events, and health-related data. Depression was measured using the Center for Epidemiological Studies-Depression Scale (CES-D). T-tests, chi-square, and logistic regression were performed to identify factors associated with depression., Results: The overall prevalence of depression among LBC was 6.75%. Logistic regression analysis revealed that family parenting situations, such as being from blended families (OR = 1.45) or being cared for by other family members (OR = 1.64), and dissatisfaction with the parenting situation (OR = 1.57) were significantly associated with higher odds of depression. Living events, including being misunderstood (OR = 1.82) and having disputes (OR = 1.48), and health-related factors, such as chronic diseases and regular medication use (OR = 2.38), also increased the risk of depression., Conclusions: This study highlights the high prevalence of depression among Chinese rural LBC and identifies key associate factors, including family parenting situation, negative living events and health-related factors. Targeted interventions and policies addressing these factors are needed to promote the mental health of this vulnerable population., Competing Interests: Declarations Ethics approval and consent to participate The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. All procedures involving human subjects/patients were approved by IRB in Wenzhou Seventh People’s Hospital (EC-KY-2022048). Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Anxiety and depressive symptoms are common among patients with heart failure (HF). Physical limitations, lifestyle changes, and uncertainties related to HF can result in the development or exacerbating of anxiety and depressive symptoms. However, the central and bridge symptoms of anxiety and depressive symptoms network among patients with HF remain unclear. Network analysis is a statistical method that can discover and visualize complex relationships between multiple variables. This study aimed to establish a network of anxiety and depressive symptoms and identify the central and bridge symptoms in this network among patients with HF., Methods: This study employed a cross-sectional study design and convenience sampling to recruit patients with HF. This study followed the Helsinki Declaration and was approved by the Research Ethics Committee of Hospital. The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire (PHQ-9) were administered to evaluate anxiety and depressive symptoms among patients with HF, respectively. Network analysis of anxiety and depressive symptoms was performed using R., Results: In the anxiety and depressive symptoms network, PHQ2 (feeling down, depressed, or hopeless), PHQ7 (inability to concentrate), and GAD4 (difficulty relaxing) were the most central symptoms. Anxiety and depressive symptoms were linked by PHQ2 (feeling down, depressed, or hopeless), GAD6 (becoming easily annoyed or impatient), GAD5 (unable to sit still because of anxiety), GAD7 (feeling afraid that something terrible is about to happen), and PHQ6 (feeling bad or like a failure, or disappointing oneself or family)., Conclusions: This study identified the central and bridge symptoms in a network of anxiety and depressive symptoms. Targeting these symptoms can contribute to interventions for patients with HF at risk of-or suffering from-anxiety and depressive symptoms, which can be effective in reducing the comorbidity of anxiety and depression., Competing Interests: Declarations Ethics approval and consent to participate This study followed the Helsinki Declaration and was approved by the Medical Ethics Committee of Henan Provincial People’s Hospital (No. 2021207). Written’ informed consent was obtained from all of the participants. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Despite the growing incidence of burn injuries globally and the advancements in physical recovery, the psychological aspect of burn trauma recovery remains inadequately addressed. This review aims to consolidate existing literature on posttraumatic stress disorder (PTSD) and depression in adult burn survivors, recognizing the need for a holistic approach to burn recovery that encompasses both physical and mental health. The comprehensive analysis of 156 studies revealed significant variations in methodological approaches, leading to challenges in creating standardized protocols for mental health assessment in burn care. Key findings include the identification of a wide range of psychological assessment tools and a substantial research gap in low- and middle-income countries, where the majority of burn injuries occur. Only 7.0% of the studies assessed interventions for PTSD or depression, indicating a lack of focus on treatment modalities. The studies identified demographic factors, patient history, psychosocial factors, burn injury characteristics, and treatment course as risk factors for PTSD and depression postburn injury. The review highlights the need for early screening, intervention, and attention to subjective experiences related to burn injury, as these are strong predictors of long-term psychological distress. It also emphasizes the complexity of addressing psychological distress in burn survivors and the need for more standardized practices in assessing PTSD and depression specific to this population., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

The prevalence of psychological symptoms in burn survivors has been well documented; however, the role of biological sex requires further investigation. This study explored sex differences among burn survivors and examined the impact of sex, age, and total body surface area (TBSA) of the burn injury on the risk of developing posttraumatic stress disorder (PTSD) and depression and, subsequently, the influence of initial risk on symptom outcomes 30 days postinjury. Participants included 374 adult patients enrolled in the Burn Behavioral Health program at a regional Burn Center. T-tests and chi-square tests were conducted to determine differences between sexes on outcome measures. A path analysis was conducted to evaluate relationships between variables of interest. Findings revealed significant sex discrepancies in risk and symptom outcomes. Compared to men, women reported greater total risk scores of developing PTSD and depression (P = .005) early after their burn injury. A subscale analysis showed that women reported greater risk scores for depression (P < .001), but not on PTSD. Women did not report higher depression scores 30 days postinjury compared to men but did report higher PTSD scores than men (P = .020). When sex, age, and TBSA were included in a path analysis, female sex (P = .001), younger age (P < .001), and larger TBSA of the burn injury (P = .024) were associated with greater risk. In addition, risk scores significantly predicted PTSD (P < .001) and depression (P < .001) symptoms 30 days postinjury. Our research shows how sex, age, and TBSA affect the risk of PTSD and depression among burn survivors. It underscores the importance of accounting for sex and age differences in mental health risk, especially in women and younger patients. This emphasizes the urgency of early screening and intervention., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: This study proposed a moderated mediation model to examine the mediating role of core self-evaluation in the relationship between cumulative family risk and depression among left-behind children, and whether this process was moderated by school climate., Methods: A total of 415 rural left-behind children from 35 townships in Anhui Province (54.46% males; mean age = 12.53, SD = 2.27) were randomly conducted in June 2023 using convenience sampling. Data were processed and analyzed using SPSS 25.0 and PROCESS 3.3., Results: After controlling for gender, age, grade, and left-behind type, cumulative family risk positively predicted depression in left-behind children (β = 0.18, p < 0.001). Core self-evaluation fully mediated the relationship between cumulative family risk and depression in left-behind children (indirect effect = 0.10, 95%CI = [0.06, 0.15]). Moreover, school climate moderated the relationship between cumulative family risk and core self-evaluation (the first half of the mediation pathway) (β =-0.13, p < 0.01). Specifically, as the school climate level increased, cumulative family risk became more predictive of core self-evaluation (B low  = - 0.001, p > 0.05; B high  = - 0.26, p < 0.001)., Conclusion: Creating a favourable family and school climate and improving core self-evaluation are beneficial to reduce depression in left behind children., Competing Interests: Declarations Ethics approval and consent to participate The original study have been performed in accordance with the Declaration of Helsinki and have been approved by the Biomedical Ethics Committee of Anhui Medical University (reference number: 2022H005) where the researchers were affiliated. The participants obtained informed consent from parents or grandparents before participating in the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: This study investigated the prevalence and determinants of psychosocial distress among hospitalized patients undergoing radiotherapy to identify opportunities for interventions to enhance patient well-being., Methods: Between January 2021 and May 2023, 137 hospitalized patients received radiotherapy treatment at the Department of Radiation Oncology of the Fondazione A. Gemelli IRCCS were recruited. Participants completed a questionnaire comprising the Distress Thermometer (DT) and the Hospital Anxiety and Depression Scale (HADS)., Results: The study revealed a significant correlation among anxiety, depression, total HADS scores, and Distress Thermometer scores (p < 0.001). Female patients exhibited higher total HADS scores and anxiety levels compared to males (p < 0.004, p < 0.010, respectively). Sleep disturbances were associated with increased anxiety, depression, and overall distress (p < 0.05). Younger patients (< 65 years old) demonstrated elevated anxiety and depression levels, while no significant depressive tendency was observed among older participants (> 65 years old)., Conclusion: These findings underscore the intricate interplay between demographic variables, psychological distress, and treatment-related symptoms among patients during radiotherapy treatments. The study highlights the critical necessity of promptly identifying and addressing psychosocial distress in this population. It suggests that implementing a psychological therapeutic approach, particularly one focused on support, could effectively deter the onset of depression, especially among younger patients. Future research should focus on longitudinal studies to explore distress trajectories and interventions' effectiveness in mitigating distress, with collaborative efforts to translate research findings into evidence-based clinical practice for improved patient care., Competing Interests: Declarations Ethics approval All participants gave their informed consent for inclusion before they participated in the study. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of the Fondazione Policlinico Universitario A. Gemelli IRCCS (ID 5913, Prot. N. 0030394/23 – 26/10/2023). Conflict of interest The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

We sought to explore the risk factors for anxiety and depression in patients with coronary heart disease and subclinical hypothyroidism through logistic regression analysis. A retrospective analysis was conducted on 168 patients with coronary heart disease and subclinical hypothyroidism admitted to the Department of Cardiology of our hospital from February 2020 to November 2022. Patients were categorized into the control group, anxiety group, and depression group based on the Hamilton Anxiety Scale (HAMA) and Hamilton Depression Rating Scale (HAMD) scores. All participants were informed about the protocol and provided signed informed consent upon inclusion. The study examined influencing factors for anxiety and depression in patients with coronary heart disease and subclinical hypothyroidism. Collect patients' gender, age, presence or absence of chronic diseases (including Diabetes, hypertension and hyperthyroidism), sleep quality, dietary habits, psychosocial stress, living environment, social support, education level, and blood TSH levels. The linear relationship between anxiety, depression, and each influencing factor was quantified using the Pearson correlation coefficient. Blood level of TSH and free T4 were detected by chemiluminescence immunoassay. Multiple logistic regression was applied to analyze the factors influencing anxiety and depression in these patients. Various factors were identified as significant influencers of anxiety and depression in patients with coronary heart disease and subclinical hypothyroidism. For anxiety, presence or absence of chronic diseases, sleep quality, dietary habits, psychosocial pressure, living environment, and blood TSH levels were found to be influential (P < 0.05). Similarly, for depression, presence or absence of chronic diseases, sleep quality, social support, quality of life, social support, education level, and blood TSH levels were identified as significant factors (P < 0.05). The study revealed positive correlations between presence or absence of chronic diseases, psychosocial stress, and TSH levels with anxiety symptoms in patients with coronary heart disease and subclinical hypothyroidism (P < 0.05). Conversely, sleep quality, dietary patterns, and living environment showed negative correlations with anxiety symptoms (P < 0.05).Gender and age had no correlation with anxiety levels (P > 0.05). Presence or absence of chronic diseases and TSH levels were positively correlated with depressive symptoms in patients with coronary heart diseaseand subclinical hypothyroidism (P < 0.05). On the other hand, sleep quality, social support, quality of life, and educational level were negatively correlated with anxiety symptoms (P < 0.05). Gender and age had no correlation with depression (P > 0.05). Notably, TSH levels in both the anxiety and depression groups were higher than those in the control group (P < 0.05), with no significant difference in free T4 levels among the groups (P > 0.05). The combination of chronic illness types, living habits (sleep quality, dietary habits), psychosocial pressure, living environment, and TSH levels emerged as risk factors for anxiety in patients with coronary heart disease and subclinical hypothyroidism (P < 0.05). Similarly, the combination of chronic illness types, sleep quality, social support, quality of life, education level, and TSH levels were identified as risk factors for depression in these patients (P < 0.05). This logistic regression analysis underscores the significant impact of factors such as types of chronic illness, sleep quality, social support, living environment, education level, and TSH levels on anxiety and depression symptoms in patients with coronary heart disease and subclinical hypothyroidism. These findings highlight the importance of considering these multiple risk factors collectively when devising treatment and management strategies to reduce the risk of mental health issues in this patient population., Competing Interests: Declarations Competing interests The authors declare no competing interests. Ethics approval and consent to participate This study protocol was in accordance with the Declaration of Helsinki of the World Medical Association. This study obtained approval from the relevant ethics review committee at the First Hospital of Hebei Medical University. Inclusion in the research project was contingent upon providing informed consent, and all procedures complied with ethical norms and regulations., (© 2024. The Author(s).)

Background: Depression is a common mental illness that increases the risk of suicide, substance abuse, and chronic pain. Nationally, 21 million adults have had one untreated depressive episode, 1.4 million people have had suicide attempts, and 1 death occurs every 10 minutes. Depression has an annual economic burden of $326 billion for the American economy. Objectives: This quality improvement project aims to review the existing literature on depression, audit local businesses, survey clients, and team members to identify a gap in practice and then collect and analyze data to draw conclusions and make recommendations based on the findings. Methods: This initiative used four Plan-Do-Study-Act rapid quality improvement cycles. Data were collected and analyzed, and the results were used to make iterative changes. Results: Depression screening improved by 90%, and 317 clients were screened over 8 weeks. Twenty-eight percent of those screened had depression and were engaged in managing their symptoms. Both screening and care improved, and the aim of 89% was met. Conclusions: This initiative bridged a gap in depression screening and care. It also demonstrated a positive outcome, had the potential for sustainability, and spread to other faith communities. Implications for Nursing: A system should be put in place for depression screening, care, and referrals., (© 2024 Springer Publishing Company, LLC.)

Background: Men who have sex with men studying in universities (MSM-US) frequently face multiple sexual minority stressors that potentially lead to maladaptive emotional regulations and mental problems. This study compared the prevalence of depression/insomnia between MSM-US and non-MSM male university students (NUS) and hypothesized that the potential differences would be mediated via emotional dysregulation styles (rumination and catastrophizing)., Methods: The study design was a cross-sectional study. NUS were recruited from a university-based survey using cluster sampling in three universities in China from June to October 2018, while MSM-US from the same university-based survey and the other community-based survey using convenience sampling. The effective samples size was 2,531 (292 MSM-US and 2,239 NUS). Structural equation modeling (SEM) was performed., Results: MSM-US had significantly higher prevalence of both probable depression (55.1% versus 35.7%; OR = 4.85, 95% CI: 3.38-6.94) and moderate-to-severe clinical insomnia (17.3% versus 4.1%; OR = 2.21, 95% CI: 1.73-2.83) than NUS. MSM-US were also more likely than NUS to use emotional dysregulation styles (rumination/catastrophizing), which were correlated with probable depression/insomnia (r = 0.17 to 0.31). In the SEM, the differences in depression/insomnia between MSM-US and NUS were partially mediated by the latent variable of emotional dysregulation (rumination and catastrophizing), with effect sizes of 55.0% for probable depression and 33.6% for insomnia, respectively., Conclusions: Depression and insomnia were prevalent among male university students in Sichuan, China. Furthermore, MSM-US were at increased risk than NUS for both mental problems; emotional dysregulation partially explained such differences. Future studies are warranted to confirm the findings, develop tailored interventions to address general and MSM-specific stressors and reduce rumination and catastrophizing, and examine whether similar patterns exist in other sexual minority groups., Competing Interests: Declarations Ethical approval and consent to participate The study was approved by the Survey and Behavioral Research Ethics Committee of the Chinese University of Hong Kong (No. SBRE-21-0635). All participants provided informed consent. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: As global aging accelerates, depression among the elderly becomes more common. Research had revealed that patients with late-life depression (LLD) face a higher risk of suicide compared to their counterparts in other age groups, with the pathways to suicide being multifaceted. Thus, investigating the various factors linked to the elevated risk of suicide in patients with LLD is critical., Objective: To investigate the factors associated with a high level of suicide risk among patients with LLD., Methods: A total of 108 patients with LLD were recruited for this study. From October 2022 to November 2023, a cross-sectional study was conducted on patients with LLD from the Affiliated Brain Hospital of Guangzhou Medical University. Suicide risk was evaluated using the Chinese version of the Nurses' Global Assessment of Suicide Risk Scale (NGASR). Potential influencing factors were included and analyzed through multivariate linear regression to identify the factors associated with a high level of suicide risk among patients with LLD., Results: The mean NGASR score among patients with LLD was 7.30 ± 4.34 (range: 0 ~ 19). Multiple linear regression analyses revealed that depression-anxiety of the Brief Psychiatric Rating Scale (BPRS) (β = 0.31, 95% CI = 0.13, 0.45, p<0.001), activation of the BPRS (β=-0.29, 95% CI=-1.22, -0.35, p<0.001), normal cognitive function of the Mini-Mental State Examination (MMSE) (β = 0.21, 95% CI = 0.50, 3.48, p<0.05), involuntary admission (β = 0.20, 95% CI = 0.44, 3.43, p<0.05), and objective support of the Social Support Rating Scale (SSRS) (β = 0.21, 95% CI = 0.08, 0.66, p<0.05) were statistically associated with a high level of suicide risk in patients with LLD., Conclusion: This study found that LLD patients with severe depression-anxiety, low activation, normal cognitive function, involuntary admission, and strong objective support exhibited a high level of suicide risk. These patients should receive intensified monitoring and comprehensive measures should be implemented to prevent the occurrence of suicidal behaviors during hospitalization., Competing Interests: Declarations Ethics approval and consent to participate This study obtained ethical approval from the IRB of the Affiliated Brain Hospital of Guangzhou Medical University (approval number: 2024-003). The entire study was carried out in accordance with the Declaration of Helsinki. The participants’ data were used solely for this research study and kept confidential. Informed consent was obtained from all participants before enrollment in the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Copyright Statement An unauthorized version of the Chinese MMSE was used by the study team without permission, however this has now been rectified with PAR. The MMSE is a copyrighted instrument and may not be used or reproduced in whole or in part, in any form or language, or by any means without written permission of PAR (www.parinc.com)., (© 2024. The Author(s).)

Objective: The aim of this study was to investigate factors associated with reported need of weight loss support among adults with overweight or obesity in the general population., Design: A cross-sectional population study based on a survey questionnaire sent to a random population sample. Multivariate odds ratios for reported need of weight loss support were calculated for socio-economic, lifestyle and health indicators, in total and by gender and age group., Setting: Five counties in Sweden in 2022., Participants: The study includes 10 069 persons with overweight or obesity (BMI ≥ 25 kg/m 2 ) aged 30-69 years. BMI was based on self-reported weight and height., Results: In total, about 20 % reported needing weight loss support. The factors most strongly associated with reported need of weight loss support were obesity and female gender. Lack of social support, economic difficulties, physical inactivity, poor self-rated health, musculoskeletal pain and depression were also associated with reported need of weight loss support, whereas diabetes and hypertension were not. Some differences in these associations were observed between age groups., Conclusion: Reported need of weight loss support is more common among women than among men and associated with obesity, lack of social support, economic difficulties, physical inactivity, poor self-rated health, musculoskeletal pain and depression in both genders. These factors are important for planning preventive and weight-control measures among adults with overweight or obesity.

Background: Suboptimal health status (SHS) is an intermediate status between ideal heath and illness, it is characterized by the perception of health complaints, general weakness, decreased immunity and low energy. An increasing number of Chinese middle school students are suffering from psychological symptoms (PS), particularly anxiety and depression. The relationship between SHS and PS is unclear in adolescents. This study aimed to investigate the prevalence of SHS and the correlation between SHS and PS among Chinese middle school students and to identify the SHS-related risk factors from the perspective of public health., Methods: A cross-sectional study was conducted with the cluster sampling method among 1955 middle school students in Shantou, China. SHS was assessed by Suboptimal Health Status Questionnaire-25 (SHSQ-25). And the PS of anxiety and depression were assessed with Generalized Anxiety Disorder Scale (GAD-7) and Beck Depression Inventory-II Scale (BDI-II) self-assessment questionnaires. Variate logistic analysis was applied to explore risk factors of SHS. The relationship between SHS and PS among Chinese middle school students was subsequently analyzed., Results: Among the 1955 participants, 1904 middle school students were finally included in the analysis, the effective response rate was 97.39%. The prevalence of SHS was 10.3% (197/1904) while the prevalence of anxiety and depression was 30.7% (585/1904) and 34.1% (649/1904), respectively. A strong correlation was identified between SHS and PS among middle school students. With the aggravation of anxiety and depression, the probability of suffering from SHS increased (both P<0.01). The scores for various dimensions of SHS among the depression and anxiety groups were higher compared to those of the non-depression and non-anxiety groups (all P<0.01 ). Multivariate regression showed that compared with sleeping less than six hours, 6-8 h is a protective factor for SHS (OR = 0.486, 95%CI = 0.278-0.851)., Conclusions: Attention should be given to SHS and PS in Chinese middle school students, as they are strongly associated. Lack of sleep is a risk factor for SHS, so sufficient sleep should be recommended to prevent it. Identifying additional risk factors and promoting adequate sleep will improve adolescent health., Competing Interests: Declarations Consent for publication Not Applicable. Competing interests The authors declare no competing interests. Ethics approval and consent to participant This study was approved by the Ethics Committee of Shantou University Medical School (No. SUMC-2022-076) and we had also obtained the consent of participants and their parents or legal guardians. Before filling out the questionnaire, participants voluntarily signed an informed consent form., (© 2024. The Author(s).)

Depression impairs self-management in diabetic patients, exacerbates insulin resistance, and elevates glycated hemoglobin (HbA1c) levels, thereby increasing diabetes risk. This study analyzed data from 30,386 participants in the National Health and Nutrition Examination Survey (NHANES), assessing depression severity using the 9-item Patient Health Questionnaire (PHQ-9) and evaluating diabetes status through clinical markers such as HbA1c, random blood glucose, and fasting blood glucose. Participants were stratified by depression severity and diabetes status to examine the relationship between depression and diabetes risk. We applied descriptive statistics, logistic regression models, subgroup analyses, and restricted cubic spline (RCS) modeling to explore this association. The results revealed that greater depression severity was significantly associated with increased diabetes incidence, elevated HbA1c, fasting glucose, and insulin levels. Multivariate regression analysis confirmed a consistent positive correlation between depression severity and diabetes risk. Subgroup analyses further identified significant relationships between depression and various demographic and behavioral factors, including gender, race, BMI, smoking status, and prediabetic conditions. Additionally, the RCS model demonstrated a clear increase in diabetes risk with rising PHQ-9 scores. In conclusion, our study demonstrates that the severity of depression is positively correlated with the risk of diabetes, and this association may be closely linked to various glycemic and lipid metabolic parameters., Competing Interests: Declarations Ethics approval and consent to participate This study used publicly available summary data, and ethics approval was not necessary. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)