The association of depression and all-cause mortality: Explanatory factors and the influence of gender.

BACKGROUND: The association of depression with mortality and the significance of explanatory factors, in particularly gender, have remained an issue of debate. We therefore aimed to estimate the effect of depression on all-cause mortality, to examine potential explanatory factors and to assess effect modification by gender. METHODS: We used Cox regression models to estimate the effect of depression on mortality based on data from the Gutenberg Health Study, which is a prospective cohort study of the adult population in the districts of Mainz and Mainz-Bingen, Germany. Baseline assessment was between 2007 and 2012. Effect modification by gender was measured on both additive and multiplicative scales. RESULTS: Out of 14,653 participants, 7.7% were depressed according to Patient Health Questionnaire 9 (PHQ-9), and 1,059 (7.2%) died during a median follow-up of 10.7 years. Depression elevated the risk of mortality in men and women in age-adjusted models (HR: 1.41, 95%-CI: 1.03-1.92; resp. HR: 1.96, 95%-CI: 1.43-2.69). Adjustment for social status, physical health and lifestyle covariates attenuated the effect and in the fully-adjusted model the hazard ratio was 0.96 (95%-CI: 0.69-1.33) in men and 1.53 (95%-CI: 1.10-2.12) in women. For effect modification by gender, the measure on multiplicative interaction was 0.68 (95%-CI 0.44-1.07) and on additive interaction was RERI=-0.47 (95%-CI -1.24-0.30). LIMITATIONS: The PHQ-9 is a single self-report measure of depression reflecting symptoms of the past two weeks, limiting a more detailed assessment of depression and course of symptoms, which likely affects the association with mortality. CONCLUSIONS: Depression elevates mortality by multifactorial pathways, which should be taken into account in the biopsychosocially informed treatment of depression. Effect modification by gender was not statistically significant.

Measurement invariance, validation and normative data of the Jenkins Sleep Scale-4 (JSS-4) in the German general population across the life span.

OBJECTIVE: As sleep disorders have become a major concern in public health, there is strong need for a brief and sound measure for sleep problems. The purposes of the study were to 1) evaluate factor structure and measurement invariance, 2) validate the scale based on sociodemographic data and distress, and 3) provide norm values for the general population. METHODS: In a representative survey of the German population N = 2515 participants (14 to 95 years) filled in the 4-item Jenkins Sleep Scale (JSS-4), sociodemographic questions and the Brief Symptom Inventory-18 (anxiety, depression, somatic symptom load). The JSS-4 was analyzed by principal component analysis, confirmatory and multi-group confirmatory factor analyses. A multiple-indicator-multiple-cause model was tested to investigate the relationship of the JSS-4 to distress and sociodemographic variables. RESULTS: The one-factor structure of JSS-4 was confirmed. Given the heterogeneity of facets of sleep problems captured in the four items, internal consistency of the JSS-4 was remarkably high. The JSS-4 was strictly invariant across both sexes, and partially strictly invariant across income groups and individuals living with or without a partner. With regard to the full age range, it showed partial scalar invariance. CONCLUSION: Female sex, higher age, living without a partner, lower education, lower income and increased distress were associated with more sleep problems. Calculated normative data of sleep problems allow comparisons of JSS-4 scores stratified by sex and age.

Sex-dependent associations of childhood neglect and bodyweight across the life span.

Eating disorders and weight problems across the life span have been linked to adverse childhood experiences. Previous research often focused on child abuse and omitted investigating effects of child neglect. The present study evaluates effects of neglect on bodyweight across the life span and how emotional neglect and bodyweight are linked via mental distress. Within a large survey representative of the German population (N = 2,500), individuals completed measures of mental distress, childhood trauma, and height and weight. We conducted logistic regression analyses on bodyweight extremes and a moderated mediation analysis. In men, physical neglect aggravated the risk to be underweight. In women, emotional neglect was linked to severe obesity. In both sexes, emotional neglect was related to mental distress. We found an indirect effect of emotional neglect on bodyweight via mental distress, however, it was only present in women. Our results attest to long-term consequences of adverse early experiences. We showed a possible mechanism for women's higher vulnerability towards eating disorders. In general, investigations of eating and weight disorders should also include men and employ sex-specific methods of analyses. Lastly, neglect should also receive more attention to prevent suffering and negative sequelae over the life span.