Comorbid anxiety disorders alter the association between cardiovascular diseases and depression: the German National Health Interview and Examination Survey

Purpose

This study aims to examine whether specific anxiety disorder comorbidity alters the purported association between depression and specific cardiovascular diseases (CVDs).

Methods

In 4,181 representative German participants of the general population, 12-month prevalence of psychiatric disorders was assessed through the Composite International Diagnostic Interview and CVDs by physician verified diagnosis. Adjusting for conventional risk factors logistic regression analyzed the association between CVDs (peripheral vascular disease (PVD), hypertension, cerebrovascular disease and heart disease) and combinations of comorbidity between depression and anxiety disorder types (panic disorder, specific phobia, social phobia and generalized anxiety).

Results

There were 770 cases of hypertension (18.4 %), 763 cases of cerebrovascular disease (18.2 %), 748 cases of PVD (17.9 %), and 1,087 cases of CVD (26.0 %). In adjusted analyses phobia comorbid with depression was associated with cerebrovascular disease (odds ratio (OR) 1.61; 95 % confidence interval (CI) 1.04–2.50) as was panic disorder (OR 2.89; 95 % CI 1.47–5.69). PVD was significantly associated with panic disorder (adjusted OR 2.97; 95 % CI 1.55–5.69). Panic disorder was associated with CVDs (adjusted OR 2.28; 95 % CI 1.09–4.77) as was phobia (adjusted OR 1.35; 95 % CI 1.04–1.78).

Conclusions

Classification of anxiety and depression according to comorbidity groups showed discrete effects for panic disorder and specific phobia with CVDs, independent from covariates and depression.     

Asthma, life events and psychiatric disorders: a population-based study

Purpose

Although asthma and other chronic physical conditions have been shown to be associated with psychiatric symptoms, the relative contributions of negative life events to this association and impaired quality of life (QOL) are not clear.

Methods

This is a cross-sectional study of a nationally representative sample of Singaporean adults aged 20–59 (n = 2,847). Individuals were grouped by asthma, other chronic physical conditions, and no chronic physical conditions. Participants were assessed life events (list of threatening experiences questionnaire), psychiatric disorders [schedule for clinical assessment in neuropsychiatry diagnoses of psychiatric disorder including any psychiatric disorder, major depressive disorder (MDD) and generalized anxiety disorder (GAD)], and QOL (medical outcomes study 12-item short form).

Results

In multivariate analyses controlling for confounding variables, asthma and other chronic physical conditions, compared to no chronic physical conditions, both showed similarly (two- to four-fold) elevated odds ratio (OR) of association with MDD and GAD. However, the asthma group reported more life events as compared to other chronic physical conditions (OR = 4.33, 95 % CI: 2.09–8.95) or no chronic physical conditions (OR = 7.64, 95 % CI: 3.87–15.06). Life events accounted significantly for excess coexistence of psychiatric disorders with asthma over participants without chronic physical conditions. It also contributed significantly to relatively worse QOL observed among individuals with asthma.

Conclusions

In this cross-sectional study, life events among adults in Singapore appeared to mediate the co-occurrence of psychiatric disorders and functional impairment with asthma, more than with other chronic physical conditions. This should be further investigated in longitudinal studies.     

Gender-based violence and mental disorders in female college students

Purpose

To assess the association between gender-based violence and DSM-IV Axis I disorders in female college students.

Methods

A stratified random sample of 1,043 college women (average age 22.2?years) participated in the study. We collected sociodemographic, socioeconomic and academic information as well as information on the participants’ experience of gender-based violence victimization. The presence of mental disorders during the 12?months preceding the study was assessed by clinically trained interviewers applying the Structured Clinical Interview for DSM-IV Axis I disorders-Clinician Version (SCID-CV).

Results

15.2% of the participants reported lifetime gender-based violence victimization. Almost two-thirds of the victims had suffered some Axis I disorder during the past year, a significantly larger proportion than among non-victims (OR?=?3.72; 95% CI 2.61–5.30). Mood disorders and anxiety disorders were both significantly more common among victims than non-victims (OR?=?4.26; 95% CI 2.81–6.46 and OR?=?1.97; 95% CI 1.20–3.24, respectively). The most prevalent individual disorder among victims was major depressive disorder (26.41%). Among victims of purely psychological violence, the overall rate of Axis I disorder was similar to the rate among other victims (67 and 61%, respectively).

Conclusions

Among female university students, the experience of physical or psychological gender-based violence is associated with mental disorder. These findings suggest the need for treatment and prevention interventions designed specifically for this population.     

The association between depression and parental ethnic affiliation and socioeconomic status: a 27-year longitudinal US community study

Purpose

This study examined the extent to which parental SES and ethnic affiliation during adolescence are associated with Center for Epidemiologic Studies Depression Scale (CES-D) scores compatible with depression during adulthood.

Methods

The data were extracted from the US National Longitudinal Survey of Youth (NLSY79) conducted in 1979 on several ethnic groups (African-Americans, Hispanics and Others). These data included paternal socio-economic status (SES) when respondents (N = 8,331) were on average aged 18. The CES-D was re-administered 27?years later to assess the presence of depression.

Results

Adjusted for age, binary logistic regression modeling showed that parental low SES increased the risk of CES-D of scores compatible with depression across ethnic groups for both genders. A gradient was observed of an increased likelihood of depression scores with lower parental SES levels: among African-American respondents, depression scores were highest at the lowest parental SES levels (OR?=?3.25, 95% CI 2.19–4.84) and the risk dropped at medium (OR?=?3.00, 95% CI 1.96–4.59), and highest SES levels (OR?=?1.85, 95% CI 1.12–3.07). An analogous pattern was generally found for each ethnic group.

Conclusions

Low parental SES during adolescence significantly increases the likelihood of CES-D scores compatible with depression during adulthood across US ethnic groups and in both genders.     

The association of Toxoplasma gondii infection with neurocognitive deficits in a population-based analysis

Purpose

To examine the relationship between infection with Toxoplasma gondii (toxo) and cognition.

Methods

Multivariate logistic regression was used to test the association of toxo seropositivity with indices of cognitive function among over 4,200 adults in the third National Health and Nutrition Examination Survey.

Results

Toxo-seropositive participants were more likely than seronegative participants to score in the worst quartile of the simple reaction time test (OR 1.3, 95 % CI 1.0, 1.6), symbol-digit substitution test (SDST, OR 1.5, 95 % CI 1.2, 1.9) and the serial-digit learning test (trials to criterion) (SDLTNT, OR 1.4, 95 % CI 1.1, 1.8) in models adjusted for age, race/ethnicity, gender and foreign birth. After further adjustment for all cofactors, the association between toxo seropositivity and these outcomes was no longer significant. However, seropositivity was associated with worse scores on the SDST (OR 2.9, 95 % CI 1.8, 4.8) among those in the lowest income category and the SDLTNT (OR 1.5, 95 % CI 1.1, 2.5) among those foreign born.

Conclusions

Toxo seropositivity may be associated with poor cognitive test scores in certain subgroups; however, causation cannot be established in this cross-sectional study.     

Association of gender disadvantage factors and gender preference with antenatal depression in women: a cross-sectional study from rural Maharashtra

Purpose

Maternal depression is a major public health problem in low- and middle-income countries including India. Very few studies have assessed association of various risk factors with antenatal depression in rural Indian women, especially the effect of marital conflict, gender disadvantage and gender preference on antenatal depression. This paper describes the prevalence of probable antenatal depression in rural Maharashtra, a state in the western part of India and specifically assesses the association of marital and gender disadvantage factors and gender preference for a male child with antenatal depression.

Methods

Primary Health Centre-based cross-sectional survey of antenatal women in rural Maharashtra was carried out. The outcome of interest was a probable diagnosis of depression in antenatal women which was measured using the Edinburgh postnatal depression scale (EPDS). Data were analyzed using simple and multiple logistic regression.

Results

302 women in their antenatal period were included in this study. The outcome of antenatal depression (EPDS?>?12) was found in 51 women (16.9%, 95% CI 12.6–21.1%). Feeling pressurized to deliver a male child was strongly associated with the outcome of antenatal depression (adjusted odds ratio (OR): 3.0; 95% CI 1.4–6.5). Unsatisfactory reaction of in-laws to dowry (adjusted OR 11.2; 95% CI 2.4–52.9) and difficult relationship with in-laws (adjusted OR 5.3; 95% CI 2.4–11.6) were also significantly associated with antenatal depression.

Conclusions

Our findings demonstrate that antenatal depression in rural women of Western Maharashtra is associated with gender disadvantage factors, especially related to preference for a male child. The agenda to improve maternal mental health should be ultimately linked to address the broader social development goals and gender empowerment.

     

Foster care, residential care and public care placement patterns are associated with adult life trajectories: population-based cohort study

Objectives

Childhood experiences of public care may be associated with adult psychosocial outcomes. This study aimed to evaluate the associations of four public care exposures: type of placement, length of placement, age at admission to care and number of placements, as well as the reasons for admission to public care with emotional and behavioural traits at age 30?years.

Methods

Participants included 10,895 respondents at the age 30 survey of the 1970 British Cohort Study (BCS70) who were not adopted and whose care history was known. Analyses were adjusted for individual, parental and family characteristics in childhood.

Results

Cohort members with a public care experience presented lower childhood family socio-economic status compared with those in the no public care group. After adjusting for confounding, exposure to both foster and residential care, longer placements and multiple placements were associated with more extensive adult emotional and behavioural difficulties. Specifically, residential care was associated with increased risk of adult criminal convictions (OR?=?3.09, 95% CI: 2.10–4.55) and depression (1.81, 1.23–2.68). Multiple placements were associated with low self-efficacy in adulthood (OR?=?3.57, 95% CI: 2.29, 5.56). Admission to care after the age of 10 was associated with increased adult criminal convictions (OR?=?6.03, 95% CI: 3.34–10.90) and smoking (OR?=?3.32, 95% CI: 1.97–5.58).

Conclusion

Adult outcomes of childhood public care reflect differences in children’s experience of public care. Older age at admission, multiple care placements and residential care may be associated with worse outcomes.     

Socio-economic,trafficking exposures and mental health symptoms of human trafficking returnees in Ethiopia: using a generalized structural equation modelling

Background

Mental health problems among trafficked persons could be the result of concomitantly interwoven effects of various factors. Analyzing the networked relationships concurrently could be a more substantive approach to better understand the role of risk factors in this population. This study aimed to assess the magnitude of mental health symptoms as well as the association among socio-demographic, trafficking related exposure variables, and mental health problems of Ethiopian returnees from trafficking.

Methods

A sample of 1387 returnees who were trafficked via three major human trafficking corridors of Ethiopia were selected consecutively. Data related to socio-economic, trafficking exposure variables, and symptoms of mental illness were collected in personal interviews. Anxiety was measured with a brief measure for generalized anxiety disorder (GAD-7), depression with a patient health questionnaire (PHQ-9), and PTSD with post-traumatic checklist (PCL-C). Generalized structural equation modeling was employed to estimate the relationships among exogenous, mediating, and endogenous variables simultaneously.

Results

The prevalence of symptoms of anxiety was estimated at 51.9% (95% CI 49.3–54.6%); PTSD was estimated at 34.5% (95% CI 32.1–37.1%) and depression at 58.3% (95% CI 55.6–60.9%). Restricted freedom of movement had a direct positive effect on anxiety (β?=?1.24, 95% CI 0.97–1.51), depression (β?=?0.94, 95% CI 0.71–1.17) and PTSD (13.00, 95% CI 11.23–14.77). Violence experienced during the trafficking period was a mediator variable and significantly associated with anxiety (β?=?0.46; 95% CI 0.26–0.66) and PTSD (β?=?4.00; 95% CI 2.06–5.94). History of detention had a positive total effect on GAD (total β?=?1.380, 95% CI 1.074–1.687) and PTSD (total β?=?15.63, 95% CI 13.708–17.545), and direct positive effect on depression (β?=?0.89, 95% CI 0.65–1.13).

Conclusion

Ethiopian trafficked persons were highly likely to return with increased levels of mental health symptoms, namely anxiety, depression, and PTSD. Socio-economic and trafficking related exposures mediated by violence were factors affecting mental health symptoms. Thus, in addition to economic re-integrations of victims, strategies should be designed and implemented to address the prevalent mental health problems.

     

Ante- and perinatal circumstances and risk of attempted suicides and suicides in offspring: the Northern Finland birth cohort 1966 study

Purpose

To investigate those ante- and perinatal circumstances preceding suicide attempts and suicides, which have so far not been studied intensively.

Methods

Examination of the Northern Finland Birth Cohort 1966 (n?=?10,742), originally based on antenatal questionnaire data and now followed up from mid-pregnancy to age 39, to ascertain psychiatric disorders in the parents and offspring and suicides or attempted suicides in the offspring using nationwide registers.

Results

A total of 121 suicide attempts (57 males) and 69 suicides (56 males) had occurred. Previously unstudied antenatal factors (maternal depressed mood and smoking, unwanted pregnancy) were not related to these after adjustment. Psychiatric disorders in the parents and offspring were the risk factors in both genders. When adjusted for these, the statistically significant risk factors among males were a single-parent family for suicide attempts (OR 3.71, 95% CI 1.62–8.50) and grand multiparity for suicides (OR 2.67, 95% CI 1.15–6.18). When a psychiatric disorder in females was included among possible risk factors for suicide attempts, it alone remained significant (OR 15.55, 8.78–27.53).

Conclusions

A single-parent family was a risk factor for attempted suicides and grand multiparity for suicides in male offspring even after adjusting for other ante- and perinatal circumstances and mental disorders in the parents and offspring. Mothers’ antenatal depressed mood and smoking and unwanted pregnancy did not increase the risk of suicide, which is a novel finding.     

Psychotic disorders are more common in ethnic minority than in Dutch native defendants

Purpose

The prevalence of psychotic disorders among prisoners from racial or ethnic minority groups remains uncertain. We therefore compared the frequency of psychotic disorder in ethnic minority and Dutch native defendants using the nationwide database of elaborate pre-trial reports.

Methods

Analysis of a nationwide database of pre-trial reported defendants in the Netherlands between 2000 and 2006 (n = 12,752).

Results

A diagnosis of a psychotic disorder was more common in ethnic minority than in Dutch native defendants (21.1 vs. 10.2 %). The odds ratio of this diagnosis, adjusted for age, gender, IQ below 85 and abuse of cannabis or hard drugs, was 2.6 (95 % CI 2.2–3.0). This odds ratio was highest for African defendants (OR = 5.2; 95 % CI 3.7–7.4).

Conclusions

Psychotic disorders were more common among pre-trial reported defendants from ethnic minorities than among their Dutch native counterparts.     

Maternal flu or fever,medications use in the first trimester and the risk for neural tube defects: a hospital-based case–control study in China

Purpose

This study aims to evaluate the effects of maternal flu or fever, and medications (antibiotics and antipyretics) use in the first trimester on neural tube defects (NTDs) risk in offspring.

Methods

Data came from a hospital-based case–control study conducted between 2006 and 2008 in Shandong/Shanxi provinces including 459 mothers with NTD-affected births and 459 mothers without NTD-affected births. Logistic regression models were used to evaluate the effects of maternal flu, fever, and medications use on NTD risk. The effects were evaluated by adjusted odds ratio (OR) and 95 % confidence intervals (CIs) with SAS9.1.3.software.

Results

NTDs risks were significantly associated with maternal flu or fever (OR?=?2.63, 95 % CI?=?1.64–4.23) and antipyretics use (OR?=?3.38, 95 % CI?=?1.68–6.79), but not with antibiotics use (OR?=?1.82, 95 % CI?=?0.85–3.93). The risk effect of antipyretics use on anencephaly (OR?=?7.81, 95 % CI?=?1.96–31.13) was markedly higher than on spina bifida (OR?=?3.02, 95 % CI?=?1.08–8.42). Maternal flu or fever together with antipyretics use showed a higher OR for total NTDs (3.27 vs.1.87), anencephaly (7.38 vs.2.08), and spina bifida (2.97 vs.2.07) than maternal flu or fever with no antipyretics use.

Conclusions

Maternal flu or fever and antipyretics use in the first trimester were risk for NTDs. Maternal flu or fever together with antipyretics use increased NTD risk than only maternal flu or fever.     

Associations of Depressive and Anxiety Disorders with Periodontal Disease Prevalence in Young Adults: Analysis of 1999–2004 National Health and Nutrition Examination Survey (NHANES) Data

Background

Depression and anxiety have been linked to periodontal disease, an emerging risk factor for chronic diseases. However, this literature is mixed, and few studies have concurrently evaluated depression and anxiety.

Purpose

We simultaneously examined the associations of depressive and anxiety disorders with periodontal disease prevalence and explored tobacco use as a mediator.

Methods

Participants were 1,979 young adults from the National Health and Nutrition Examination Survey 1999–2004 who underwent a diagnostic interview and a dental examination.

Results

Adults with panic disorder had a threefold higher odds of having periodontal disease than those without this disorder (OR?=?3.07, 95 % CI 1.17–8.02). This relationship was partially mediated by tobacco use and remained after adjustment for major depressive disorder and generalized anxiety disorder, which were not related to periodontal disease.

Conclusions

Young adults with panic disorder may have greater odds of having periodontal disease, in part, due to increased tobacco use.     

Social support and suicidal ideation in Japan: are home visits by commissioned welfare volunteers associated with a lower risk of suicidal ideation among elderly people in the community?

Aims

Social support has consistently been reported to be effective in reducing suicidal ideation. This cross-sectional study was performed to determine whether home visits by commissioned welfare volunteers (i.e., organizations of community residents appointed by national or prefectural governments) are associated with a lower risk of suicidal ideation among the elderly.

Methods

In August 2010, questionnaires were sent to all residents aged ≥65 years in three municipalities (n = 21,232) in Okayama prefecture, Japan, and 13,929 returned the questionnaire (response rate: 65.6 %). We finally analyzed 11,218 subjects. Both home visits by commissioned welfare volunteers and suicidal ideation within the last 30 days were assessed in the questionnaire. Odds ratios (ORs) and 95 % confidence intervals (CIs) for suicidal ideation were calculated adjusting for age, sex, educational attainment, and marital status. We then additionally adjusted for instrumental and emotional support, separately.

Results

The prevalence of suicidal ideation was 10.0 % and higher in women than in men (11.4 % vs. 8.0 %). Home visits were significantly associated with a lower risk of suicidal ideation after adjusting for instrumental and emotional support, respectively (OR: 0.60, 95 % CI: 0.53–0.69; OR: 0.67, 95 % CI: 0.59–0.78). In sex-stratified analysis, the association was clearer for women than for men: the corresponding ORs among women were 0.55 (95 % CI: 0.46–0.65) and 0.61 (95 % CI: 0.52–0.73), whereas they were 0.71 (95 % CI: 0.56–0.90) and 0.78 (95 % CI: 0.61–0.99) among men.

Conclusion

Our findings suggest that home visits by commissioned welfare volunteers are significantly associated with lower suicidal ideation among the elderly, particularly in women.     

Correlates of depressive symptoms in urban middle-aged and elderly Lithuanians

Purpose

The study aimed to examine the prevalence of depressive symptoms and their correlates in urban middle-aged and elderly Lithuanian adults.

Methods

Data from the survey was collected within the framework of the international project HAPIEE (Health, Alcohol and Psychosocial Factors in Eastern Europe). A random sample of 7,115 individuals aged 45–72 years was screened in 2006–2008.

Results

Depressive symptoms were differently associated with independent variables by sex. In men, deprivation (OR 1.85, 95 % CI 1.54–2.17), being divorced (OR 2.34, 95 % CI 1.61–3.39) or widowed (OR 3.64, 95 % CI 2.40–5.52), physical inactivity (OR 1.30, 95 % CI 1.02–1.65), having a history of spine and joint disease (OR 1.72, 95 % CI 1.36–2.17), average perceived health (OR 2.14, 95 % CI 1.55–2.95), poor perceived health (OR 5.13, 95 % CI 3.39–7.76), average quality of life (OR 2.0, 95 % CI 1.55–2.95), or poor quality of life (OR 8.86, 95 % CI 5.19–15.13) were significantly associated with depressive symptoms. In women, deprivation (OR 1.28, 95 % CI 1.15–1.43), being widowed (OR 1.52, 95 % CI 1.23–1.88), mean dose of alcohol per occasion 40–79.9 g (OR 1.65, 95 % CI 1.18–2.30) and more than 80 g (OR 2.09, 95 % CI 1.14–3.82), physical inactivity in leisure time (OR 1.27, 95 % CI 1.04–1.57), having a history of spine and joint disease (OR 1.26, 95 % CI 1.06–1.51), average perceived health (OR 2.56, 95 % CI 1.89–2.72), poor perceived health (OR 5.07, 95 % CI 3.62–7.11), average quality of life (OR 2.27, 95 % CI 1.89–2.72), or poor quality of life (OR 7.21, 95 % CI 4.73–11.00) were significantly associated with depressive symptoms.

Conclusions

Health status and lifestyle factors are associated with depressive symptoms. Associations between depressive symptoms and long-term health problems are partially mediated by self-rated quality of life and self-rated health.     

Accuracy of Weight Perception Among Urban Early Adolescents with Uncontrolled Asthma and Their Caregivers

Background

Obesity is associated with poor asthma outcomes; weight loss improves such outcomes. Inaccurate recognition of obesity may impede weight control.

Purpose

We examined perception of weight by early adolescents with uncontrolled asthma and their caregivers, and tested the relationship between medical visit frequency and accuracy of perceived weight status.

Methods

A total of 373 adolescents and their caregivers reported the adolescent’s height/weight and weight perception; caregivers reported healthcare utilization. We measured height/weight. Logistic regression modeled accuracy of weight perception.

Results

A total of 43.7 % of the overweight/obese adolescents and caregivers accurately perceived weight status. BMI percentile [odds ratio (OR)?=?1.19, confidence interval (CI)?=?1.10–1.28] and total medical visits (OR?=?1.18, CI?=?1.05–1.33) were associated with higher accuracy in caregivers. Total medical visits (OR?=?0.84, CI?=?0.74–0.96) was associated with lower accuracy in adolescents.

Conclusions

Accurate perception of weight status was poor for overweight adolescents with uncontrolled asthma and their caregivers. Frequent medical visits were associated with improved caregivers’ but not adolescents’ perceptions.     

Psychiatric diagnoses in 3275 suicides: a meta-analysis

Background

It is well known that most suicide cases meet criteria for a psychiatric disorder. However, rates of specific disorders vary considerably between studies and little information is known about gender and geographic differences. This study provides overall rates of total and specific psychiatric disorders in suicide completers and presents evidence supporting gender and geographic differences in their relative proportion.

Methods

We carried out a review of studies in which psychological autopsy studies of suicide completers were performed. Studies were identified by means of MEDLINE database searches and by scanning the reference list of relevant publications. Twenty-three variables were defined, 16 of which evaluating psychiatric disorders. Mantel-Haenszel Weighted Odds Ratios were estimated for these 16 outcome variables.

Results

Twenty-seven studies comprising 3275 suicides were included, of which, 87.3% (SD 10.0%) had been diagnosed with a mental disorder prior to their death. There were major gender differences. Diagnoses of substance-related problems (OR = 3.58; 95% CI: 2.78–4.61), personality disorders (OR = 2.01; 95% CI: 1.38–2.95) and childhood disorders (OR = 4.95; 95% CI: 2.69–9.31) were more common among male suicides, whereas affective disorders (OR = 0.66; 95% CI: 0.53–0.83), including depressive disorders (OR = 0.53; 95% CI: 0.42–0.68) were less common among males. Geographical differences are also likely to be present in the relative proportion of psychiatric diagnoses among suicides.

Conclusions

Although psychopathology clearly mediates suicide risk, gender and geographical differences seem to exist in the relative proportion of the specific psychiatric disorders found among suicide completers.