Healthy and Unhealthy Dietary Patterns Are Related to Depression: A Case-Control Study

Objective

Major depressive disorder is the leading cause of disability around the world. The relationship between depression and dietary patterns has been reported in a few studies but with controversial results. This study aimed to investigate this relationship in an Iranian population.

Methods

In our study, 330 depressed patients (cases) and healthy people (controls) (1:2) were individually matched according to age, sex and area of residence. New cases of depression were recruited from two psychiatric clinics in Tehran. Interviewers went to each patient''s residential area, and invited qualified individuals to participate in the study as controls. Food intake over the past year was collected using a validated semi quantitative food frequency questionnaire. Dietary patterns were determined by the principal components method. Binary logistic regression was used to test the effect of dietary patterns on depression.

Results

We identified two major dietary patterns by using factor analysis: the healthy and unhealthy dietary patterns. We categorized the scores of these patterns to quartiles. After adjusting for non-depression drug use, job, marital status, children number, and body mass index, the relations of depression and quartiles of two dietary patterns are significant (p=0.04 & p=0.01, respectively). Compared with participants in the lowest quartile, those in the highest quartile had significantly lower odds ratio (OR) for depression in healthy dietary pattern, and higher OR for depression in unhealthy dietary pattern.

Conclusion

This study indicates that healthy and unhealthy dietary patterns may be associated with the risk of depression. The results can be used for developing interventions that aim to promote healthy eating for the prevention of depression.     

Three-year follow-up of women with the sole diagnosis of depressive personality disorder: subsequent development of dysthymia and major depression

OBJECTIVE: The authors sought to determine whether subjects with the sole diagnosis of depressive personality disorder are at higher risk for developing dysthymia and major depression than are healthy comparison subjects. METHOD: Eighty-five women with depressive personality disorder who had no comorbid axis I or axis II disorders and 85 age-matched healthy comparison women were initially recruited and reinterviewed 3 years later to evaluate the cumulative incidence rate of dysthymia and major depression. RESULTS: At the 3-year follow-up assessment, the women with depressive personality disorder had a significantly greater odds ratio for developing dysthymia than did the healthy comparison women. The difference in odds ratios for the development of major depression between women with and without depressive personality disorder did not reach statistical significance. CONCLUSIONS: The present study, the first to determine the subsequent development of dysthymia and major depression in subjects with the sole diagnosis of depressive personality disorder, found that subjects with depressive personality disorder had a greater risk of developing dysthymia than did healthy comparison subjects at 3-year follow-up. Findings of the current study also suggest that depressive personality disorder may mediate the effects of a family history of axis I unipolar mood disorders.     

Dietary patterns and sleep symptoms in Japanese workers: the Furukawa Nutrition and Health Study

ObjectiveExperimental studies have shown that some nutrients are involved in initiating and maintaining sleep, but epidemiological evidence on overall dietary patterns and insomnia is scarce. We investigated the relationship between dietary patterns and sleep symptoms in a Japanese working population.MethodsThe participants were 2025 workers, aged 18–70 years, who participated in a health survey during a periodic checkup in 2012 and 2013. Dietary intake was assessed with a self-administered diet history questionnaire. Dietary patterns were extracted by principal component analysis on the basis of the energy-adjusted intake of 52 food and beverage items. Sleep duration, difficulty initiating and maintaining sleep, and poor quality of sleep were self-reported. Logistic regression was used to estimate the odds ratios of each sleep symptom according to quartile categories of each dietary pattern with adjustment for potential confounding variables.ResultsWe identified three major dietary patterns. A healthy pattern, characterized by a high intake of vegetables, mushrooms, potatoes, seaweeds, soy products, and eggs, was associated with a decreased prevalence of difficulty initiating sleep once or more a week (P for trend = 0.03); the multivariate adjusted odds ratio in the highest quartile of this score compared with the lowest was 0.75 (95% CI: 0.57–0.99). This association persisted after the exclusion of individuals with severe depressive symptoms. However, there was no significant association with difficulty initiating sleep at least three times a week.ConclusionsOur findings suggest that a healthy dietary pattern may be associated with difficulty initiating sleep at least once a week.     

Lifetime history of depression and carotid atherosclerosis in middle-aged women

BACKGROUND: Depression is associated with clinical coronary events, but the association between history of major depression and subclinical cardiovascular disease in women is not yet known. We determined the association between lifetime history of major depression and subclinical carotid atherosclerosis in middle-aged women. METHODS: Participants included 336 healthy middle-aged women (one third African American) from 1 of the 7 sites of the Study of Women's Health Around the Nation, a prospective study of the perimenopausal transition. Psychiatric diagnoses were assessed using the Structured Clinical Interview for the DSM-IV Axis I Disorders-Non-Patient Edition. Two measures of subclinical carotid atherosclerosis were assessed using B-mode ultrasonography: plaque and intima-media thickness. RESULTS: Lifetime history of major depression was associated with plaque, and substance abuse was related to intima-media thickness. Lifetime history of an anxiety disorder was not associated with either measure. After controlling for standard cardiovascular risk factors, only the association between major depression and plaque was maintained. The risk of plaque was 2-fold in women with a lifetime history of recurrent major depressive episodes relative to women with no history of depression (odds ratio = 2.30; 95% confidence interval, 1.10-4.82). Lifetime history of a single major depressive episode was not associated with plaque. CONCLUSIONS: Recurrent major depressive episodes may be a risk factor for subclinical atherosclerosis. Prevention of recurrent episodes may also prevent further progression of atherosclerosis.     

Quality of life in older adults receiving medications for anxiety, depression, or insomnia: findings from a community-based study.

OBJECTIVE: Depression and anxiety are associated with substantially reduced health-related quality of life (HRQoL) in healthy and medically ill adults. The authors examined the association between these conditions, as indicated by the use of antidepressant, anxiolytic, or hypnotic medications, and HRQoL parameters in older men and women. METHODS: This is a cross-sectional study of white, middle-class, older (median age 75 years) men (n=533) and women (n=826) within a defined community setting. Short Form-36 Health Survey (SF-36) scores were compared between persons currently taking medicine(s) for depression, anxiety, and/or insomnia or none of these. RESULTS: The chronic physical illness summary score (dichotomized into scores of less than 2 versus 2 or more) was associated with significantly greater odds of perceiving oneself as ill and was also significantly correlated with poorer HRQoL in both men and women. Taking a psychotropic medication for anxiety, depression, or sleep was associated (in men and in women) with significantly greater odds of perceiving oneself as ill, before and after adjusting for age and chronic physical disorder scores. After these adjustments, use of medications remained significantly associated with lower scores on both the Physical and Mental Composite Scales of the SF-36 in women; a similar but nonsignificant association was seen in men. CONCLUSIONS: Among older, community-dwelling adults, anxiety, depression, and insomnia that require pharmacological treatment are associated with reductions in HRQoL that extend beyond the impact of comorbid physical illnesses.     

Relationships among pain, anxiety, and depression in primary care

Pain, anxiety, and depression are commonly seen in primary care patients and there is considerable evidence that these experiences are related. This study examined associations between symptoms of pain and symptoms and diagnoses of anxiety and depression in primary care patients. Results indicate that primary care patients who endorse symptoms of muscle pain, headache, or stomach pain are approximately 2.5-10 times more likely to screen positively for panic disorder, generalized anxiety disorder, or major depressive disorder. Endorsement of pain symptoms was also significantly associated with confirmed diagnoses of several of the anxiety disorders and/or major depression, with odds ratios ranging from approximately 3 to 9 for the diagnoses. Patients with an anxiety or depressive disorder also reported greater interference from pain. Similarly, patients endorsing pain symptoms reported lower mental health functioning and higher scores on severity measures of depression, social anxiety, and posttraumatic stress disorder. Mediation analyses indicated that depression mediated some, but not all of the relationships between anxiety and pain. Overall, these results reveal an association between reports of pain symptoms and not only depression, but also anxiety. An awareness of these relationships may be particularly important in primary care settings where a patient who presents with reports of pain may have an undiagnosed anxiety or depressive disorder.     

Can pill placebo augment cognitive-behavior therapy for panic disorder?

Background

There are limited findings about dietary patterns and food preferences among patients suffering from schizophrenia. The main objective of this study was therefore to compare the nutritional pattern of schizophrenia patients with that of matched healthy subjects.

Methods

The dietary pattern of 30 hospitalized 16–67 years old schizophrenic patients (11 female) was compared with that of 30 healthy age and sex matched individuals as control group. Subjects' anthropometric measurements including weight, height and body mass index (BMI), semi-quantitative food frequency (FFQ), medical and food history questionnaires were also collected and FFQs were then scored using Food Guide Pyramid to obtain the dietary scores. Percent body fat (%BF) was measured using bioelectrical impedance analysis (BIA) method.

Results

Female patients had more %BF and lower dietary pattern scores than that of their controls (32 ± 3.6 vs 27.7 ± 4.6 percent and 43.2 ± 11.9 vs 54.5 ± 10.7 points; respectively, p < 0.05 for both). They also consumed less milk and dairy products, fresh vegetables, fruits, chicken, and nuts compared with the female controls (p < 0.03). However, these patients used to eat more full-fat cream and carbonated drinks (p < 0.05). Male patients had lower BMI (22 ± 4.7 vs 25.6 ± 4.4; p < 0.05) than their counterpart controls but there was no significant difference between their %BFs. Moreover, they used to have more full-fat cream, hydrogenated fats, less red meat and nuts compared with the male controls (p < 0.05).

Conclusion

Schizophrenia patients have poor nutritional patterns. In particular, female patients have more percent body fat and lower dietary pattern scores compared with their healthy controls. All patients used to consume more fats and sweet drinks frequently. The findings of this study suggest that schizophrenia patients need specific medical nutrition therapies through limiting dietary fats and sugars intakes and weight control. Whether obesity is the consequence of disease, dietary preference or medications used remains to be cleared.     

Association of somatoform disorders with anxiety and depression in women in low and middle income countries: A systematic review

Abstract

Background: Across cultures, women are more likely than men to report somatoform disorders (SD), depression and anxiety. The aim of this article is to describe the co-morbidity of SD with depression/anxiety and to investigate the possible mechanisms of this relationship in women in low and middle income countries (LMIC). Methods: We reviewed two databases: MEDLINE and PsycINFO from 1994 to 2012 for studies which assessed the association between any SD and depression/ anxiety in women from LMIC. Our focus was on community and primary healthcare based studies. Both quantitative and qualitative studies were included. Results: A total of 21 studies covering eight LMICs were included in our analysis. Our findings suggest a strong association between SD and depression/anxiety (with odds ratios ranging from 2.5–3.5), though we also observed that the majority of women with SD did not have depression/anxiety. The likely mechanisms for this association are multidimensional, and may include shared aetiologies, that both conditions are in fact variants of the same primary mental disorder, and that one disorder is a risk factor for the other. Anthropological research offers a number of frameworks through which we can view these mechanisms. Conclusion: The current evidence indicates that service providers at the primary care level should be sensitized to consider SD in women as variants of CMD (Common Mental Disorders) and address both groups of disorders concurrently. Further research should explicitly seek to unpack the mechanisms of the relationship between SD and CMD.     

Association between obesity and psychiatric disorders in the US adult population

BACKGROUND: Epidemiologic data suggest an association between obesity and depression, but findings vary across studies and suggest a stronger relationship in women than men. OBJECTIVE: To evaluate the relationship between obesity and a range of mood, anxiety, and substance use disorders in the US general population. DESIGN: Cross-sectional epidemiologic survey. SETTING: Nationally representative sample of US adults. PARTICIPANTS: A total of 9125 respondents who provided complete data on psychiatric disorder, height, and weight. Response rate was 70.9%. MAIN OUTCOME MEASURES: Participants completed an in-person interview, including assessment of a range of mental disorders (assessed using the World Health Organization Composite International Diagnostic Interview) and height and weight (by self-report). RESULTS: Obesity (defined as body mass index [calculated as weight in kilograms divided by the square of height in meters] of > or =30) was associated with significant increases in lifetime diagnosis of major depression (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.09-1.35), bipolar disorder (OR, 1.47; 95% CI, 1.12-1.93), and panic disorder or agoraphobia (OR, 1.27; 95% CI, 1.01-1.60). Obesity was associated with significantly lower lifetime risk of substance use disorder (OR, 0.78; 95% CI, 0.65-0.93). Subgroup analyses found no difference in these associations between men and women, but the association between obesity and mood disorder was strongest in non-Hispanic whites (OR, 1.38; 95% CI, 1.20-1.59) and college graduates (OR, 1.44; 95% CI, 1.14-1.81). CONCLUSIONS: Obesity is associated with an approximately 25% increase in odds of mood and anxiety disorders and an approximately 25% decrease in odds of substance use disorders. Variation across demographic groups suggests that social or cultural factors may moderate or mediate the association between obesity and mood disorder.     

Homicide and major mental disorders: a 25-year study

OBJECTIVE: This study was designed to investigate the association between major mental disorders (MMDs) and homicide. METHOD: The rates of exculpations because of MMDs among 1087 Austrian homicide offenders during 1975 and 1999 were compared with the rates of the respective disorders in the general population. RESULTS: MMDs were associated with an increased likelihood of homicide (two-fold in men and six-fold in women). This was exclusively because of schizophrenia (age-adjusted ORs in men 5.85, CI 4.29-8.01; in women 18.38, CI 11.24-31.55) and delusional disorder in men (OR 5.98, CI 1.91-16.51). Comorbid alcohol abuse/dependence (additionally) increased the odds in schizophrenia, major depression and bipolar disorder. CONCLUSION: The increased likelihood of homicide in subjects with MMDs cannot be fully explained by comorbid alcoholism. The results point to the special importance of sufficient treatment for a subgroup of mentally ill individuals being at higher risk of violence.     

No association between the Clara cell secretory protein (CC16) gene polymorphism and personality traits

Clara cell secretory protein (CC16) is an anti-inflammatory protein expressed in the respiratory tract. Several studies have suggested the association between CC16 and mental disturbances, such as schizophrenia, depression, and post-traumatic stress disorder. In the present study, we investigated the association between the CC16 gene A38G polymorphism and personality traits in 214 healthy Japanese subjects. Personality traits were evaluated by using the Revised NEO Personality Inventory (NEO PI-R) and the State-Trait Anxiety Inventory (STAI). As a result, no significant association was observed between the genotypes and the scores of the NEO PI-R or the STAI. The present results suggest that CC16 may not have a major role in the development of personality traits.     

Relationship between obesity and depression in older Australian adults and examination of dietary patterns as influencing factors

This study aims to investigate the association between depression and obesity in older adults in Australia and the influencing effects of dietary patterns. The cross-sectional study design was used for the study. The study was conducted across nine community settings in Gold Coast, Queensland. The study cohort included 301 randomly selected men and women, aged 50–88 years. Depression was measured using the General Health Questionnaire. Body mass index (BMI) was assessed according to the Australian Bureau of Statistics criteria, and obesity was classified as a BMI of 30.0 kg/m². Dietary pattern was measured using a standardized Food Frequency Questionnaire. The associations between anxiety or depression and BMI and the dietary patterns were estimated using multinomial logistic regression models. In all participants, dietary patterns were associated with both depression and obesity. Diets had mediating effects on the association between depression and obesity. Participants who consumed more high-fat meat products and fewer fruits and vegetables had an increased chance of obesity. Participants who were depressed did not have an increased chance of obesity when dietary patterns were adjusted in the multinomial logistic regression model. The results of the study suggest that dietary patterns are related to both depression and obesity and are important mediators in the increasing probability of obesity. The results have implications to inform intervention programmes to target dietary-intake behaviour change so that depression and obesity can be prevented in older adults.     

Insight and neuropsychological function in patients with schizophrenia and bipolar disorder with psychotic features.

OBJECTIVES: This study investigates the pattern of association between patient unawareness of illness and neuropsychological tests of frontal lobe function in subjects with schizophrenia and bipolar disorder (BD) with psychotic features. METHOD: We administered the Wisconsin Card Sort Test (WCST) and a shortened version of the Scale to Assess Unawareness of Mental Disorder (SUMD) to a sample of 64 patients with psychosis (42 with schizophrenia and 22 with BD). RESULTS: None of the correlations between WCST scores and insight scores were statistically significant, either in the total group or in each group analyzed separately. Further, no differences were seen in insight scores between sexes and between the diagnostic groups. CONCLUSIONS: The 3 insight dimensions (that is, awareness of mental disorder, awareness of social consequences of mental disorder, and awareness of the benefits of medication) do not appear to be associated with frontal impairment, as measured by the WCST.     

Health-related quality of life and its association with alexithymia and difficulties in emotion regulation in patients with psoriasis

BackgroundHealth-related quality of life (HRQoL) in psoriasis patients could be negatively affected by medical (e.g., obesity) and psychological (e.g., depression, anxiety, and alexithymia) conditions the presence of which suggests difficulties in understanding and regulating inner states and emotions. Thus, the aim of this study was to investigate HRQoL and its association with obesity and difficulties in understanding and regulating inner states and emotions in patients with psoriasis. A second objective was to examine whether the presence of difficulties in understanding and regulating inner states and emotions may mediate the association between psoriasis and poor HRQoL.MethodOne hundred adult outpatients and 97 healthy controls were administered a checklist assessing major socio-demographic variables, and measures of HRQoL, difficulties in emotion regulation, alexithymia, anxiety, depression, and food craving.ResultsPsoriasis patients (compared to controls) reported more frequently obesity, alexithymia, anxiety, depression and food craving, and reported lower scores on the mental and physical components of HRQoL. A mediation model, with mental health as the dependent variable, indicated significant direct and indirect (through BMI, difficulties in emotion regulation, anxiety, depression, and food craving) effects of psoriasis on the quality of life, so that psoriasis was associated with worse mental health. A second mediation model with physical health as dependent variable indicated only a significant indirect effect (through BMI and depression) of psoriasis on the quality of life.ConclusionsPsoriasis is characterized by poor HRQoL and the presence of difficulties in understanding and regulating inner states and emotions. In patients with psoriasis the possible influence of food craving on abnormal eating habits should be carefully assessed.     

Psychopharmacologic treatment of generalized anxiety disorder and the risk of major depression

OBJECTIVE: The authors sought to determine the association between treatment for generalized anxiety disorder and the risk of major depression among adults in the community. METHOD: Data were drawn from the National Comorbidity Survey (N=8,098), a representative sample of the United States population age 15-54. Cox proportional hazards were used to determine the association between specific forms of treatment for generalized anxiety disorder and the risk of major depression. RESULTS: Psychopharmacologic treatment of generalized anxiety disorder was associated with a significantly lower risk of major depression. There was no significant association between either having seen a mental health professional for generalized anxiety disorder or having been prescribed a medication for generalized anxiety disorder and the risk of depression. CONCLUSIONS: These results suggest an association between treatment for generalized anxiety disorder and lower risk of depression, which appears specific to pharmacologic treatment. Future research that leads to a more precise delineation of the underlying mechanism of the observed association is needed to identify and develop effective strategies to prevent onset of depression.     

Factors associated with household food insecurity and depression in pregnant South African women from a low socio-economic setting: a cross-sectional study

Purpose

Food insecurity has been linked with maternal depression in low-income settings. Few studies have looked at factors associated with both food insecurity and maternal depression as outcomes. This study aimed to assess factors associated with food insecurity and depression in a sample of pregnant South African women.

Methods

We conducted a cross-sectional study at a Midwife Obstetric Unit in a low-income suburb in Cape Town. Pregnant women attending the clinic for their first antenatal visit were invited to participate. The shortened form of the US Household Food Security Survey Module was used to measure food insecurity. The Expanded Mini-International Neuropsychiatric Interview was used to diagnose depression, anxiety, alcohol and drug dependence, and assess for suicidal ideation and behaviour. Logistic regression modelling was conducted to explore factors associated with food insecurity and depression in separate models.

Results

We found that 42% of households were food insecure and that 21% of participants were depressed (N?=?376). The odds of being food insecure were increased in women with suicidal behaviour (OR?=?5.34; 95% CI 1.26–22.57), with depression (4.27; 1.43–12.70) and in those with three or more children (3.79; 1.25–11.55). The odds of depression was greater in women who were food insecure (5.30; 1.63–17.30), substance dependent (15.83; 1.31–191.48) or diagnosed with an anxiety disorder (5.04; 1.71–14.82).

Conclusions

Food insecurity and depression are strongly associated in pregnant women. The relationship between food insecurity and depression is complex and requires further investigation. Interventions that improve both food security and mental health during the perinatal period are likely to benefit the physical and mental well-being of mothers and children.

     

Cigarette smoking,suicidal behavior,and serotonin function in major psychiatric disorders

OBJECTIVE: Cigarette smoking is associated with a higher risk for suicide and attempted suicide, but psychopathological or biological explanations for this association have not been explored. Lower serotonin function and impulsive/aggressive traits are associated with suicidal acts, including completed suicide. The authors hypothesized that the relationship that may exist between cigarette smoking and suicidal behavior may be associated with lower serotonin function and the presence of impulsive/aggressive traits. METHOD: Study subjects were 347 patients with a psychiatric disorder (175 with depression, 127 with schizophrenia, and 45 with other disorders). Fifty-three percent of the subjects (N=184) had a lifetime history of suicide attempt, and 47% (N=163) had never attempted suicide. Smoking behavior, lifetime suicidal behavior, and psychopathology were assessed. Serotonin function was assessed in a subgroup of patients with depression (N=162) by using a fenfluramine challenge test and/or measurement of CSF levels of 5-hydroxyindoleacetic acid. RESULTS: Among all patients, smokers were more likely to have made a suicide attempt (adjusted odds ratio=2.60, 95% confidence interval=1.60-4.23) and had higher suicidal ideation and lifetime aggression scores, compared with nonsmokers. An inverse relationship was observed between amount of cigarette smoking and both indices of serotonin function. CONCLUSIONS: The association between cigarette smoking and the presence and severity of suicidal behavior across major psychiatric disorders may be related to lower brain serotonin function in smokers with depression. Further investigation is required to replicate these findings, to measure serotonin function in patients with disorders other than depression, and to test potential therapeutic effects of serotonin-enhancing treatments on both smoking behavior and suicide risk.     

Asthma and mental disorders in primary care

This study examines relationships between asthma and likelihood of current mental disorders and suicidal ideation in an urban primary care population. A systematic waiting room sample of 998 adult patients was screened for mental disorders using the PRIME-MD PHQ. Asthma diagnoses were provided by primary care physicians. Multivariate logistic regression analyses were used to determine the odds of current major depression, panic attacks, generalized anxiety disorder, alcohol and drug use disorder, and suicidal ideation among patients with a diagnosis of asthma, as compared to those without asthma. After controlling for differences in sociodemographic characteristics and comorbid mental disorders, asthma was associated with increased likelihood of panic attack (OR=1.7 (1.1, 2.6)) and suicidal ideation (OR=1.9 (1.03, 3.4)). There was no statistically significant association between asthma and major depression, generalized anxiety disorder, alcohol, or drug use disorders after adjustment. Results suggest that physician-diagnosed asthma is associated with self-reported panic attacks and suicidal ideation in a systematic sample of primary care patients. Physicians who treat patients with asthma should remain vigilant for the presence of comorbid psychiatric problems and carefully evaluate whether there is a clinical need to treat each condition.     

The Zurich study

Summary The purpose of the present epidemiological study is to investigate and describe panic disorder and sporadic panic attacks among a cohort of young adults, aged 28 years, from the Canton of Zurich in Switzerland. Both DSM-III panic disorder and sporadic panic are characterized by frequent symptoms of somatic anxiety and tension, as well as by frequent symptoms of depressed mood and low vitality. Sporadic panic is more prevalent than panic disorder and shows a greater excess of females over males. The association with depressions (major depression and recurrent brief depression) is similarly high for both types of panic syndromes, while the association with other anxiety disorders is negligible. Several indicators suggest a marked similarity between sporadic panic and DSM-III panic disorder. More impressive differences were observed between subjects with panic disorder alone and subjects with comorbidity of panic and depression. For the latter group, the SCL-90R scores indicated higher severity. Comparison of the scores of life events, conflicts, self-esteem, and the number of chronic problems in childhood suggests a more specific nosological pattern for subjects with panic and depression as compared with those with panic alone.Supported by grant 3.948.0.85 from the Swiss National Science Foundation