Depression in healthcare workers during COVID-19 pandemic: results from Czech arm of HEROES Study.

The pandemic due to COVID-19 brought new risks for depression of health care workers, which may have differently influenced men and women. We aimed to investigate (1) whether health care workers in Czechia experienced an increase in depression during the COVID-19 pandemic, (2) which factors contributed the most to this change, and (3) whether the magnitude of the associations differed by gender. We studied 2564 participants of the Czech arm of the international COVID-19 HEalth caRe wOrkErS (HEROES) Study. Online questionnaire was administered to health care workers in summer 2020 (wave 0) and spring 2021 (wave 1). Depression was defined by reaching 10 or more points on the Patient Health Questionnaire. Logistic regression investigated the association of participant´s characteristics with depression and multivariable decomposition for non-linear models assessed, to what extent the characteristic explained the change in depression occurrence. The prevalence of depression increased twice during the pandemic (11% in wave 0 and 22% in wave 1). Stress accounted for 50% of the difference, experience of death due to COVID-19 for 15% and contact with COVID-19 patients for 14%. Greater resilience and sufficient personal protective equipment were strongly associated with lower occurrence of depression. The protective association of resilience with depression was stronger in men than in women. We conclude that interventions to promote mental health of health care workers in future health crisis should aim at decreasing stress and enhancing resilience. They should be delivered especially to individuals who have contact with the affected patients and may face their death.

Educational attainment and anxiety in middle-aged and older Europeans.

We examined the relationship between educational attainment (EA) and anxiety symptoms in a sample of 77,792 individuals (median age = 64 years, 55% female) from the Survey of Health, Ageing and Retirement in Europe. Using logistic regression, we estimated odds ratio (OR) with 95% confidence interval (CI) for the association between EA (7 educational levels based on International Standard Classification of Education) and anxiety symptoms (12 or more points from the shortened 5-item version of the Beck Anxiety Inventory), adjusting for sociodemographic and health-related factors. We further explored whether the relationship varied by region, sex and age group. Independent of sociodemographic and health-related factors, higher levels of EA were associated with lower odds of anxiety symptoms. The magnitude of this association plateaued at first stage of tertiary education (OR 0.40; 95% CI 0.35-0.47, p < 0.001). The association was stronger in females, middle-aged individuals and in Central and Eastern Europe while not apparent in Northern Europe. Our findings suggest that individuals with higher education might be protected against anxiety throughout life. The protective effect of education against anxiety symptoms is more pronounced in less egalitarian regions and in females.

Household crowding in childhood and trajectories of depressive symptoms in mid-life and older age.

AIMS: We aimed to investigate the association of household crowding in childhood with trajectories of depressive symptoms in middle-aged and older adults. METHODS: We studied 47,010 participants (56 % women, 63 years at baseline) from SHARE. Using multinomial logistic regression, we estimated odds ratio (OR) with 95 % confidence interval (CI) for the association of household crowding in childhood (number of household members/number of rooms at the age of 10) with trajectories of depressive symptoms (EURO-D scale), which were generated with growth mixture modeling. We adjusted for resources in childhood, sociodemographic and health-related characteristics in mid-life and older age and tested effect modification by sex. RESULTS: We identified four trajectories of depressive symptoms: constantly low (n = 33,969), decreasing (n = 5595), increasing (n = 5574) and constantly high (n = 1872). When compared to the those with constantly low depressive symptoms and adjusting for all covariates, household crowding in childhood was associated with greater odds of constantly high (OR 1.12; 95 % CI 1.08-1.17), decreasing (OR 1.11; 95 % CI 1.07-1.15) and increasing (OR 1.09; 95 % CI 1.06-1.13) depressive symptoms. The associations were stronger in women than in men. CONCLUSIONS: Prevention of household crowding in childhood may ameliorate the development of constant as well as transient depressive symptoms during ageing. The effect can be stronger in women than in men.

Between-person and within-person effects in the temporal relationship between depressive symptoms and cognitive function.

BACKGROUND: We aimed to disentangle within-person and between-person effects in the temporal relationship between depressive symptoms and cognitive function. METHODS: We performed a prospective population-based cohort study on participants of the Survey of Health, Ageing and Retirement in Europe. Cognitive function was assessed by tests on verbal fluency, immediate recall and delayed recall. Depressive symptoms were measured with EURO-D scale. To determine the temporal order of the association between cognitive function and depressive symptoms, we employed the fully saturated cross-lagged panel model (between-person effects), and random intercept cross-lagged panel model (within-person effects). RESULTS: In 59,311 participants (mean age 65, ranging 46-100), between-person effects showed a bi-directional relationship that could be seen in three stages: First, the effect of cognitive function on depressive symptoms was initially slightly stronger than vice versa. Second, the effect of depressive symptoms on cognitive function became stronger during the follow-up. Third, all effects were small and no direction dominated. Within-person effects, however, revealed a dominant effect from depressive symptoms on cognitive function. Some effects from cognitive function on depressive symptoms were apparent only in older adults, in particular men. All effects were small and strongest for individuals aged 65 years and above. LIMITATIONS: The sample is healthier than general population and thus not fully representative. A comprehensive cognitive battery was not available. CONCLUSIONS: Long-term relationship between depressive symptoms and cognitive function is bi-directional. However, to achieve improvement in an individual in the short-term, the focus should be on decreasing depressive symptoms to improve cognitive function.

Parental education, cognition and functional connectivity of the salience network.

The aim was to investigate the association of parental education at birth with cognitive ability in childhood and young adulthood and determine, whether functional connectivity of the salience network underlies this association. We studied participants of the Czech arm of the European Longitudinal Study of Pregnancy and Childhood who underwent assessment of their cognitive ability at age 8 (Wechsler Intelligence Scale for Children) and 28/29 years (Wechsler Adult Intelligence Scale) and measurement with resting state functional MRI at age 23/24. We estimated the associations of parental education with cognitive ability and functional connectivity between the seeds in the salience network and other voxels in the brain. We found that lower education of both mothers and fathers was associated with lower verbal IQ, performance IQ and full-scale IQ of the offspring at age 8. Only mother´s education was associated with performance IQ at age 28/29. Lower mother´s education correlated with greater functional connectivity between the right rostral prefrontal cortex and a cluster of voxels in the occipital cortex, which, in turn, was associated with lower performance IQ at age 28/29. We conclude that the impact of parental education, particularly father´s, on offspring´s cognitive ability weakens during the lifecourse. Functional connectivity between the right rostral prefrontal cortex and occipital cortex may be a biomarker underlying the transmission of mother´s education on performance IQ of their offspring.

Sons and parental cognition in mid-life and older adulthood.

Prior research suggests a relationship between number of sons and maternal long-term health outcomes, including dementia. We assessed the relationship between having sons and parental cognitive aging. Specifically, we investigated the relationship between having at least 1 son and parental baseline cognition level and rate of cognitive decline, accounting for life course sociodemographic characteristics in a cohort of 13 222 adults aged ≥50 years from the US Health and Retirement Study. We included only participants with at least one child. We further explored whether this relationship varies by parental sex and whether the magnitude of the relationship increases with each additional son. Cognition was assessed biennially for a maximum of nine times as a sum of scores from immediate and delayed 10-noun free recall tests, a serial 7s subtraction test, and a backwards counting test. Associations were evaluated using linear mixed-effects models, stepwise adjusting for sociodemographic and health-related factors. In our analytic sample of parents, a total of 82.3% of respondents had at least 1 son and 61.6% of respondents were female. Parents of at least 1 son had a faster rate of cognitive decline in comparison to parents without any son. Our results also suggest that cognitive decline was faster among parents of multiple sons, compared to parents with only daughters. Thus, the results support the theory that having sons might have a long-term negative effect on parental cognition.

Physical activity partly mediates the association between cognitive function and depressive symptoms.

Cognitive function, physical activity, and depressive symptoms are intertwined in later life. Yet, the nature of the relationship between these three variables is unclear. Here, we aimed to determine which of physical activity or cognitive function mediated this relationship. We used large-scale longitudinal data from 51,191 adults 50 years of age or older (mean: 64.8 years, 54.7% women) from the Survey of Health, Ageing and Retirement in Europe (SHARE). Results of the longitudinal mediation analyses combined with autoregressive cross-lagged panel models showed that the model with physical activity as a mediator better fitted the data than the model with cognitive function as a mediator. Moreover, the mediating effect of physical activity was 8-9% of the total effect of cognitive function on depressive symptoms. Our findings suggest that higher cognitive resources favor the engagement in physical activity, which contributes to reduced depressive symptoms.

Variation in depressive symptom trajectories in a large sample of couples.

The occurrence of depression is influenced by social relationships, however, most studies focus on individuals, not couples. We aimed to study how depressive symptoms of couples evolve over time and determine, which characteristics are associated with their distinct trajectories. A multi-centric cohort sample of 11,136 heterosexual couples (mean age = 60.76) from 16 European countries was followed for up to 12 years (SHARE study). Information on depressive symptoms measured by EURO-D scale was collected every 2 years. Dyadic growth mixture modeling extracted four distinct classes of couples: both non-depressed (76.91%); only women having consistently high depressive symptoms while men having consistently low depressive symptoms (8.08%); both having increasing depressive symptoms (7.83%); and both having decreasing depressive symptoms (7.18%). Couples with increasing depressive symptoms had the highest prevalence of relationship dissolution and bereavement. In comparison to the nondepressed class, individuals with any depressive symptoms were less psychologically and physically well. Our results suggest that distinct mechanisms are responsible for couples' various longitudinal trajectories of depressive symptoms.

Gender/Sex Differences in the Association of Mild Behavioral Impairment with Cognitive Aging.

BACKGROUND: While the gender/sex differences in neuropsychiatric symptoms in dementia population are well described, gender/sex differences in mild behavioral impairment (MBI) in dementia-free populations and the relationship to cognitive performance and to subsequent cognitive decline have not been studied. OBJECTIVE: We aimed to explore gender/sex differences in the association of MBI with the level of cognitive performance and its rate of decline in a dementia-free cohort. METHODS: We studied 8,181 older adults enrolled in the online PROTECT UK Study. MBI was assessed using the MBI Checklist and cognition was measured by digit span, paired associate learning, spatial working memory, and verbal reasoning. Statistical analysis was conducted using linear regression models and linear mixed-effects models. RESULTS: Out of 8,181 individuals (median age 63 years, 73% females), 11% of females and 14% of males had MBI syndrome. Females exhibited less often symptoms of decreased motivation (45% versus 36% in males), impulse dyscontrol (40% versus 44% in males; p = 0.001) and social inappropriateness (12% versus 15%; p < 0.001), while they showed more often symptoms of emotional dysregulation (45% versus 36%; p < 0.001). The associations of MBI domains with some measures of cognitive performance and decline were stronger in males than females, with the exception of the association of emotional dysregulation with the rate of cognitive decline in verbal reasoning, which was present exclusively in females. CONCLUSION: MBI may influence cognition to a greater extent in males than in females. We propose that predictors and biomarkers of dementia should consider gender/sex as an effect modifier.

Season of birth has no effect on symptoms of depression and anxiety in older adults.

There remains a lack of conclusive evidence as to the merit of season of birth as a predictor of mental illness across contexts. We studied 72,370 individuals (55% women; mean age 66) from the Survey on Health, Ageing and Retirement in Europe. Depressive symptoms were assessed with EURO-D scale and symptoms of anxiety with modified Beck Anxiety Inventory. Multilevel modeling was used to assess the association of season of birth as well as month of birth with symptoms of depression and anxiety, by sex and region. Adjusting for sex and age, month of birth explained only 0.01% to 0.07% of anxiety and depressive symptoms with non-significant improvement in the overall models; using season of birth instead of month of birth added 0.00% to 0.04% of explained variance. When stratified by sex and European region, age explained 0.23% to 5.19% of anxiety and depressive symptoms; the addition of month of birth or season of birth improved the models by negligible amount. Season of birth and month of birth are not reliable predictors of anxiety and depression across the life course.

Socioeconomic deprivation in early life and symptoms of depression and anxiety in young adulthood: mediating role of hippocampal connectivity.

BACKGROUND: Experience of early-life socioeconomic deprivation (ELSD) may increase the risk of mental disorders in young adulthood. This association may be mediated by structural and functional alterations of the hippocampus. METHODS: We conducted a prospective cohort study on 122 participants of the European Longitudinal Study of Pregnancy and Childhood. Information about ELSD was collected via questionnaire from mothers during the first 18 months of participants' lives. At age 23-24, participants underwent examination by structural magnetic resonance imaging, resting-state functional connectivity and assessment of depressive symptoms (Mood and Feelings Questionnaire) and anxiety (Spielberger State-Trait Anxiety Inventory). The association of ELSD with brain outcomes in young adulthood was assessed with correlations, linear regression (adjusting for sex, socioeconomic position and mother's mental health) and moderated mediation analysis. RESULTS: Higher ELSD was associated with greater depressive symptoms (B = 0.22; p = 0.001), trait anxiety (B = 0.07; p = 0.02) and lower global connectivity of the right hippocampus (B = -0.01; p = 0.02). These associations persisted when adjusted for covariates. In women, lower global connectivity of the right hippocampus was associated with stronger trait anxiety (B = -4.14; p = 0.01). Global connectivity of the right hippocampus as well as connectivity between the right hippocampus and the left middle temporal gyrus mediated the association between ELSD and trait anxiety in women. Higher ELSD correlated with a lower volume of the right hippocampus in men, but the volume of the right hippocampus was not related to mental health. CONCLUSIONS: Early preventive strategies targeted at children from socioeconomically deprived families may yield long-lasting benefits for the mental health of the population.

Socioeconomic and cognitive roots of trait anxiety in young adults.

In 54 participants (41% women) from the Czech arm of the European Longitudinal Study of Pregnancy and Childhood, a national birth cohort with prospectively collected data from their birth until young adulthood, we aimed to study the association between early-life socioeconomic deprivation (ELSD), cognitive ability in adolescence, trait anxiety and resting state functional connectivity of the lateral prefrontal cortex (LPFC) in young adulthood. We found that ELSD was associated with lower cognitive ability in adolescence (at age 13) as well as higher trait anxiety in young adulthood (at age 23/24). Higher cognitive ability in adolescence predicted lower trait anxiety in young adulthood. Resting state functional connectivity between the right LPFC and a cluster of voxels including left precentral gyrus, left postcentral gyrus and superior frontal gyrus mediated the relationship between lower cognitive ability in adolescence and higher trait anxiety in young adulthood. These findings indicate that lower cognitive ability and higher trait anxiety may be both consequences of socioeconomic deprivation in early life. The recruitment of the right LPFC may be the underlying mechanism, through which higher cognitive ability may ameliorate trait anxiety.

Risk and protective factors of neurocognitive disorders in older adults in Central and Eastern Europe: A systematic review of population-based studies.

BACKGROUND: A wide range of potentially modifiable risk factors, indicating that the onset of neurocognitive disorders can be delayed or prevented, have been identified. The region of Central and Eastern Europe has cultural, political and economic specifics that may influence the occurrence of risk factors and their link to the cognitive health of the population. OBJECTIVE: We aimed to systematically review population-based studies from Central and Eastern Europe to gather evidence on risk and protective factors for neurocognitive disorders. METHODS: We searched the electronic databases PubMed, Cochrane Database of Systematic Reviews, PsycINFO, Web of Science, and Embase. The search was performed on 26th of February 2020 and repeated at the end of the review process on 20th May 2021. RESULTS: We included 25 papers in a narrative synthesis of the evidence describing cardiovascular risk factors (n = 7), social factors (n = 5), oxidative stress (n = 2), vitamins (n = 2), genetic factors (n = 2) and other areas (n = 7). We found that there was a good body of evidence on the association between neurocognitive disorders and the history of cardiovascular disease while there were gaps in research of genetic and social risk factors. CONCLUSION: We conclude that the epidemiological evidence from this region is insufficient and population-based prospectively followed cohorts should be established to allow the development of preventive strategies at national levels.

Changes in national rates of psychiatric beds and incarceration in Central Eastern Europe and Central Asia from 1990-2019: A retrospective database analysis.

BACKGROUND: Numbers of psychiatric beds (general, forensic, and residential) and prison populations have been considered to be indicators of institutionalisation of people with mental illnesses. The present study aimed to assess changes of those indicators across Central Eastern Europe and Central Asia (CEECA) over the last three decades to capture how care has developed during that historical period. METHODS: We retrospectively obtained data on numbers of psychiatric beds and prison populations from 30 countries in CEECA between 1990 and 2019. We calculated the median of the percent changes between the first and last available data points for all CEECA and for groups of countries based on former political alliances and income levels. FINDINGS: Primary national data were retrieved from 25 out of 30 countries. Data from international registries were used for the remaining five countries. For all of CEECA, the median decrease of the general psychiatric bed rates was 33•8% between 1990 and 2019. Median increases were observed for forensic psychiatric beds (24•7%), residential facility beds (12•0%), and for prison populations (36•0%). Greater reductions of rates of psychiatric beds were observed in countries with lower per capita income as well as in countries that were formerly part of the Soviet Union. Seventeen out of 30 countries showed inverse trends for general psychiatric beds and prison populations over time, indicating a possible shift of institutionalisation towards correctional settings. INTERPRETATION: Most countries had decreased rates of general psychiatric beds, while there was an increase of forensic capacities. There was an increase in incarceration rates in a majority of countries. The large variation of changes underlines the need for policies that are informed by data and by comparisons across countries. FUNDING: Agencia Nacional de Investigación y Desarrollo in Chile, grant scheme FONDECYT Regular, grant number 1190613.

Association Between Season of Birth and Cognitive Aging in Older Adults: Pan-European Population-Based Study on 70,000 Individuals.

BACKGROUND: Several early-life factors have been associated with higher risk of developing dementia. It is unclear whether season of birth (SOB) can affect cognitive aging in older adults or not. OBJECTIVE: We aimed to study the association of SOB with the level of cognitive performance as well as with the rate of cognitive decline. METHODS: We studied 70,203 individuals who participated in the Survey of Health, Aging and Retirement in Europe. Cognition was measured with tests on verbal fluency and immediate and delayed recall. We assessed the association of SOB with the level of cognitive performance using multiple linear regression and with the rate of cognitive decline using linear mixed-effects models. RESULTS: When compared to individuals born in winter and adjusted for sociodemographic and health-related characteristics, being born in summer was associated with a higher level of delayed recall (B 0.05; 95%CI 0.01 to 0.09) and verbal fluency (B 0.15; 95%CI 0.00 to 0.29) and being born in fall with a higher level of immediate recall (B 0.04; 95%CI 0.01 to 0.08) and verbal fluency (B 0.15; 95%CI 0.01 to 0.29). Individuals born in summer had a higher yearly decline in delayed recall (B -0.005; 95%CI -0.009 to 0.000), while the scores in delayed recall in participants born in spring showed an inverse trend (B 0.005; 95%CI 0.000 to 0.010). CONCLUSION: Individuals born in winter seem to carry a life-long disadvantage in a lower level of cognitive performance; however, being born in winter does not seem to affect the rate of cognitive decline.

Role of sex in the association between childhood socioeconomic position and cognitive ageing in later life.

We aimed to explore sex differences in the association of childhood socioeconomic position (SEP) with the level of cognitive performance and the rate of cognitive decline. We studied 84,059 individuals (55% women; mean age 64 years) from the Survey on Health, Ageing and Retirement in Europe. Sex differences in the association of childhood SEP (household characteristics at age 10) with the level of cognitive performance (verbal fluency, immediate recall, delayed recall) were analysed using multilevel linear regression. Structural equation modelling tested education, depressive symptoms and physical state as mediators. The relationship between childhood socioeconomic advantage and disadvantage and the rate of cognitive decline was assessed using linear mixed-effects models. Higher childhood SEP was associated with a higher level of cognitive performance to a greater extent in women (B = 0.122; 95% CI 0.092-0.151) than in men (B = 0.109; 95% CI 0.084-0.135). The strongest mediator was education. Childhood socioeconomic disadvantage was related to a higher rate of decline in delayed recall in both sexes, with a greater association in women. Strategies to prevent impaired late-life cognitive functioning, such as reducing childhood socioeconomic disadvantages and improving education, might have a greater benefit for women.

Sex differences in the association of childhood socioeconomic position and later-life depressive symptoms in Europe: the mediating effect of education.

PURPOSE: We aimed to study sex differences in the association of childhood socioeconomic position (SEP) with later-life depressive symptoms, the mediating effect of education and explore regional differences across Europe. METHODS: The study included 58,851 participants (55% women, mean age 65 years) from the multicentre, population-based Survey on Health, Ageing and Retirement in Europe. Interviews were conducted in six waves and included measurements of childhood SEP (household characteristics at the age of 10) and depressive symptoms (EURO-D scale). Linear regression was used to study the association of childhood SEP with depressive symptoms, adjusting for covariates, and structural equation modelling assessed the mediating effect of education. RESULTS: In the fully adjusted model, higher childhood SEP was associated with lower depressive symptoms with a greater magnitude in women (B = - 0.07; 95% CI - 0.08, - 0.05) than in men (B = - 0.02; 95% CI - 0.03, - 0.00). Relative to men, childhood SEP had 3 times greater direct effect on depressive symptoms in women, and education had 3.7 times stronger mediating effect against childhood SEP. These associations and the sex differences were particularly pronounced in Southern, Central and Eastern Europe. CONCLUSION: Growing up in poor socioeconomic conditions is a stronger risk factor for the development of depressive symptoms for women than for men. Education may have a stronger preventive potential for women in reducing the adverse effects of childhood socioeconomic hardship. Central and Eastern European populations experience disproportionately higher risk of later-life depression due to lower SEP and greater sex differences.

Association between physical-activity trajectories and cognitive decline in adults 50 years of age or older.

Aims: To investigate the associations of physical-activity trajectories with the level of cognitive performance and its decline in adults 50 years of age or older. Methods: We studied 38729 individuals (63 ± 9 years; 57% women) enrolled in the Survey of Health, Ageing and Retirement in Europe (SHARE). Physical activity was self-reported and cognitive performance was assessed based on immediate recall, verbal fluency, and delayed recall. Physical-activity trajectories were estimated using growth mixture modelling and linear mixed effects models were used to investigate the associations between the trajectories and cognitive performance. Results: The models identified two physical-activity trajectories of physical activity: constantly-high physical activity (N=27634: 71%) and decreasing physical activity (N=11095; 29%). Results showed that participants in the decreasing physical-activity group exhibited a lower level of cognitive performance compared to the high physical-activity group (immediate recall: ß=0.94; 95% confidence interval [CI]=0.92 to 0.95; verbal fluency: ß=0.98; 95% CI=0.97 to 0.98; delayed recall: ß=0.95; 95% CI=0.94 to 0.97). Moreover, compared with participants in the constantly-high physical-activity group, participants in the decreasing physical-activity group showed a steeper decline in all cognitive measures (immediate recall: ß=-0.04; 95% CI=-0.05 to -0.04; verbal fluency: ß=-0.22; 95% CI=-0.24 to -0.21; delayed recall: ß=-0.04; 95% CI=-0.05 to -0.04). Conclusions: Physical-activity trajectories are associated with the level and evolution of cognitive performance in adults over 50 years. Specifically, our findings suggest that a decline in physical activity over multiple years is associated with a lower level and a steeper decline in cognitive performance.

Educational inequalities in mental disorders in the Czech Republic: data from CZEch Mental health Study (CZEMS).

PURPOSE: We aimed to study the association of educational attainment with occurrence of mental disorders in the Czech Republic. METHODS: Data were derived from the CZEch Mental health Study (CZEMS), a cross-sectional study of community-dwelling individuals. Mental disorders were assessed with Mini International Neuropsychiatric Interview (M.I.N.I.), and information on completed education was acquired as a part of a paper and pencil interview. Logistic regression was used to estimate odds ratio (OR) with 95% confidence intervals (CI) for the association of educational attainment with all mental disorders as well as with specific groups (affective, anxiety, alcohol use and substance use disorders), stepwise adjusting for socio-demographic, social and health-related characteristics. RESULTS: We studied 3175 individuals (average age 50 years, range 18-96 years; 54% women). Compared to individuals with higher education, those educated below high school graduation had higher odds of mental disorders (OR 2.07; 95% CI 1.58-1.71), even after adjustment for all covariates (OR 1.64; 95% CI 1.21-2.23). Education showed the strongest association with alcohol use disorders, even when covariates were adjusted for, but was not related to anxiety disorders. The association of education with affective as well as substance use disorders was explained by covariates. CONCLUSIONS: Interventions aimed at reducing the burden of mental disorders should target individuals with low education. Strategies to improve population mental health need to go hand in hand with policies to enhance education as well as reduce alcohol consumption in the Czech Republic.