The association between lipid accumulation products and depression in U.S. adults: A cross-sectional study from NHANES 2005-2018.

OBJECTIVE: To investigate the potential correlation between lipid accumulation products (LAP) and depression in adults in the United States. METHODS: We analyzed data from 13,051 participants from the NHANES 2005-2018 cycle. The LAP index was calculated using the waist circumference (WC) and serum triglyceride (TG) levels, which reflect lipid toxicity. Participants who scored ≥10 on the patient health questionnaire-9 (PHQ-9) were considered depressed. Multivariate logistic regression analyses were conducted to explore the association between the LAP index and depression. Furthermore, we conducted subgroup analysis to identify potentially sensitive populations. Smoothed curve fitting and generalized additive model (GAM) regression were performed to verify the association between the LAP index and depression. RESULTS: A total of 13,051 participants were eligible for analysis. After adjusting for all potential confounders, the risk of depression tended to increase with an increasing LAP index (odds ratio [OR]: 1.0011, 95% confidence interval [CI]: 1.0001, 1.0021). Compared to participants with LAP quartile 1, participants with LAP quartile 3 exhibited the highest risk of depression (OR: 1.43, 95%CI: 1.03, 1.99). Subgroup analysis demonstrated a strong association between the LAP index and depression in men (OR: 1.002, 95%CI: 1.001, 1.004) or those with hypertension (OR: 1.002, 95%CI: 1.000, 1.003). Additionally, smoothed curve fitting and GAM regression demonstrated a positive linear correlation between the LAP index and depression. CONCLUSIONS: Our findings suggest that individuals with a higher LAP index may be at higher risk of depression, particularly men or those with hypertension. However, further studies are required to confirm these findings.

Association of total bilirubin with depression risk in adults with diabetes: A cross-sectional study.

BACKGROUND: Individuals with diabetes mellitus are more likely to experience depression, although most patients remain undiagnosed. The relation between total bilirubin and depression has been increasingly discussed, but limited studies have examined the association of total bilirubin with depression risk in adults with diabetes, which warrants attention. AIM: To investigate the association between total bilirubin levels and the risk of depression in adults with diabetes. METHODS: The study included adults with diabetes from the National Health and Nutrition Examination Survey 2007-2018. Depression was determined using the Patient Health Questionnaire-9. Multivariable logistic regression, propensity score-matched analysis and restricted cubic spline models were utilized to investigate the association between total bilirubin levels and depression risk in adults with diabetes. RESULTS: The study included 4758 adults with diabetes, of whom 602 (12.7%) were diagnosed with depression. After adjusting for covariates, we found that diabetic adults with lower total bilirubin levels had a higher risk of depression (OR = 1.230, 95%CI: 1.006-1.503, P = 0.043). This association was further confirmed after propensity score matching (OR = 1.303, 95%CI: 1.034-1.641, P = 0.025). Subgroup analyses showed no significant dependence of age, body mass index, sex, race or hypertension on this association. Restricted cubic spline models displayed an inverted U-shaped association of total bilirubin levels with depression risk within the lower range of total bilirubin levels. The depression risk heightened with the increasing levels of total bilirubin, reaching the highest risk at 6.81 µmol/L and decreasing thereafter. CONCLUSION: In adults with diabetes, those with lower levels of total bilirubin were more likely to have depressive symptoms. Serum total bilirubin levels may be used as an additional indicator to assess depression risk in adults with diabetes.

Assessing the Relationship Between Vitiligo and Major Depressive Disorder Severity: Cross-Sectional Study.

BACKGROUND: Vitiligo, a common dermatological disorder in Saudi Arabia, is associated with significant psychological impacts. This study explores the relationship between vitiligo and the severity of major depressive disorder (MDD), highlighting the broader implications on mental health among affected individuals. OBJECTIVE: We aim to assess the prevalence and predictors of depression among adult patients with vitiligo, and to examine the relationship between MDD severity and vitiligo. METHODS: Using a cross-sectional design, the research used the vitiligo area severity index and the Patient Health Questionnaire-9 to measure the extent of vitiligo and depression severity, respectively. This study involved 340 diagnosed patients with vitiligo from various health care settings. Logistic and ordinal regression analysis were applied to evaluate the impact of sociodemographic variables and vitiligo types on MDD severity. RESULTS: The prevalence of MDD was 58.8% (200/340) of participants. Depression severity varied notably: 18.2% (62/340) of patients experienced mild depression, 17.9% (61/340) moderate, 11.8% (40/340) moderately severe, and 10.9% (37/340) severe depression. Female patients had higher odds of severe depression than male patients (adjusted odds ratio [aOR] 3.14, 95% CI 1.93-5.1; P<.001). Age was inversely related to depression severity, with patients aged older than 60 years showing significantly lower odds (aOR 0.1, 95% CI 0.03-0.39; P<.001). Lower income was associated with higher depression severity (aOR 10.2, 95% CI 3.25-31.8; P<.001). Vitiligo types also influenced depression severity; vulgaris (aOR 5.3, 95% CI 2.6-10.9; P<.001) and acrofacial vitiligo (aOR 2.8, 95% CI 1.5-5.1; P<.001) were significantly associated with higher depression levels compared to focal vitiligo. CONCLUSIONS: The findings suggest that vitiligo contributes to an increased risk of severe depression, highlighting the need for integrated dermatological and psychological treatment approaches to address both the physical and mental health aspects of the disease.

Does Managing Patients With Chronic Rhinosinusitis Improve Their Depression Score? Prospective Study.

BACKGROUND: To assess the risk of depression in patients with chronic rhinosinusitis (CRS) in a tertiary care center and the effect of treatment on depression scores. METHODS: This prospective cohort study was conducted at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, between November 2021 and June 2022 and included adult patients (≥14 years) with CRS. The validated Arabic or English Sinonasal Outcome Test (SNOT-22) and Patient Health Questionnaire-9 (PHQ-9) were used before treatment and 3 to 6 months after surgery and maximal medical treatment. PHQ-9 scores were compared at baseline and follow-up visits. The relationship between changes in SNOT-22 and PHQ-9 scores were assessed using Spearman's correlation and simple linear regression. RESULTS: Overall, 38 participants with a mean ± SD age of 32.7 ± 12 years were enrolled. CRS with nasal polyps (55.26%) was the most frequently seen condition, followed by allergic fungal CRS (31.58%) and CRS without nasal polyps (13.16%). Six patients (15.7%) had PHQ-9 scores ≥10, indicating they had major depressive disorder. PHQ-9 and SNOT-22 scores improved significantly after treatment (3.7 ± 5.8 vs 6.5 ± 6.9 pretreatment, P = .001; 20.7 ± 20.5 vs 45.6 ± 28.9 pretreatment, P < .0001, respectively). Mean ± SD change in PHQ-9 and SNOT-22 scores was -2.7 ± 7 and -24.9 ± 29.8, respectively. SNOT-22 and PHQ-9 scores were positively correlated (r = .522, P < .001). PHQ-9 score change was significantly associated with SNOT-22 score change (ß = .178, 95% confidence interval 0.12-0.23, P < .0001). CONCLUSION: CRS affects the quality of life and psychological well-being of patients. Patient-centered care with maximal medical and surgical treatment help overcome its deleterious consequences.

Exploring the association between depression and diabetes among type 1 and type 2 diabetic mellitus patients: A cross-sectional study in Gujarat, India.

Background: Depression and anxiety are common among patients with diabetes mellitus and it affects the control of diabetes negatively. Depression is the third leading reason for the most disability-adjusted life years. Once depression coexists with diabetes mellitus, it is related to major health consequences and ends up in poor health outcomes. Aim: The study aimed to estimate the prevalence of depression in diabetes mellitus people and to find an association of depressive symptoms with sociodemographic and clinical predictors among patients with diabetes mellitus attending follow-ups at the general public hospital, in western Gujarat. Materials and Methods: It is an institutional-based cross-sectional study conducted among people living with diabetes mellitus at Tertiary Hospitals, Urban Health Training Center, and Rural Health Training Center. The study period was from January 2023 to May 2023. Data were collected using a structured questionnaire. Depression was assessed by the Patient Health Questionnaire 9. The collected data were cleaned, edited, entered into MS Excel (2006), and analyzed using SPSS software (version 26). A P value of <0.05 was considered statistically significant. Results: A total of 380 study participants were included in this study. Among 380 participants, 282 (74%) were having depressive symptoms. Of 282, 61 (21.6%) have mild depressive symptoms, 106 (37.5%) have moderate symptoms, 111 (39%) have moderately severe symptoms, and four (1.4%) have severe symptoms. Of 380 participants, 221 (58%) have clinical depression (moderate, moderately severe, and severe symptoms). Variables significantly associated with depression were marital status, number of family members, socio-economic status, type of diabetes mellitus, treatment given, presence of comorbidities, and duration of diabetes more than 5 years. Conclusion: The present study has shown a considerably higher amount of depression in diabetic participants. So, healthcare professionals should consider screening for depression using the Patient Health Questionnaire 9 or other validated tools in all diabetic patients, especially in those who are at a higher risk.

Sex Differences in the Association of Depression Symptoms and Cardiovascular Disease in Adults in the United States.

PURPOSE: This study explores the relationship between depression and cardiovascular disease (CVD) in the US adult population, focusing on sex differences. DESIGN: Cross-sectional study. SETTING: National Health and Nutrition Examination Survey data (2013-2018). PARTICIPANTS: A total of 14 699 community-dwelling adults (≥20 years). MEASURE: The Patient Health Questionnaire (PHQ-9) depression screening tool assessed depressive symptoms. CVD events included heart failure, coronary heart disease, angina, heart attack, or stroke. ANALYSIS: Adjusted prevalence ratios were estimated using a Poisson regression model. RESULTS: The study finds a positive association between CVD incidents and both mild to moderate depressive symptoms (aPR:1.42, P = .002) and moderately severe to severe depression (aPR:1.72, P = .024). Overall, females exhibit a 47% lower likelihood of CVD incidents compared to males. However, in a subgroup analysis, increased depressive symptoms correlate with higher CVD incidents in females (aPRs range: 2.09 to 3.43, P < .001) compared to males (aPRs range: 1.45 to 1.77, P < .001). CONCLUSION: Depression is associated with increased cardiovascular disease (CVD) risk. Females generally have a lower CVD risk than males, but more severe depressive symptoms elevate CVD risk in females. These findings emphasize the significance of considering sex differences. Further research is needed to understand the underlying mechanisms.

Prognostic Value of Depressive Symptoms for Cardiovascular Events in Female Patients With Heart Failure With Reduced Ejection Fraction and Heart Failure With Preserved Ejection Fraction.

BACKGROUND: Among those with heart failure (HF), women are more likely to develop depression than men. Few studies have focused on the outcomes of female patients with HF with depressive symptoms. METHODS AND RESULTS: A total of 506 female patients with HF with preserved ejection fraction were included in this secondary analysis from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) cohort, and 439 female patients with HF with reduced ejection fraction were included from the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) cohort. Depressive symptoms were measured using the Patient Health Questionnaire-9 and Beck Depression Inventory-II. The depression class was categorized by severity, and the change in clinical depression class was defined as aggravated (1-grade increase) or improved (1-grade decrease). The prognostic value of depressive symptoms was determined by using multivariable Cox proportional hazards models. Female patients with improved depressive symptoms had worse depressive status at baseline and lower baseline Kansas City Cardiomyopathy Questionnaire scores. Depression class at the 12-month visit and depression class change were the dominant prognostic factors for cardiovascular death in female patients with HF with preserved ejection fraction (hazard ratio [HR], 1.43 [95% CI, 1.02-2.01], P=0.036; HR, 1.71 [95% CI, 1.14-2.55], P=0.009). Among the patients with HF with reduced ejection fraction, both the depression class at baseline and depression class change had significant prognostic effects on cardiovascular death (HR, 3.30 [95% CI, 1.70-6.39], P<0.001; HR, 2.21 [95% CI, 1.28-3.80], P=0.004). However, the prognostic value of depressive assessments for hospitalization in patients with HF is unclear. CONCLUSIONS: In female patients with HF with reduced ejection fraction, the depression class at baseline was most strongly associated with cardiovascular death, whereas in female patients with HF with preserved ejection fraction, the change in depression class exhibited a more significant prognostic trend.

Association between allostatic load and depression in patients with sleep disorders: Evidence from national health and nutrition examination survey.

OBJECTIVE: Allostatic load (AL) is an indicator of cumulative wear and tear on the body's physiological systems that can predict the onset of a range of health problems. However, the relationship between AL and depression in patients with sleep disorders remains unclear. This study aimed to explore the association between AL and depression in patients with sleep disorders. METHODS: Using data from the 2015-2016 National Health and Nutrition Examination Survey, a total of 4618 adults aged 18 years and older in the United States were included in this cross-sectional analysis. AL was calculated using nine biological markers, with a score of ≥3 indicating a high level. Depression was assessed using the Patient Health Questionnaire-9, and a score of 10 or higher indicated a potential risk of depression. Logistic regression models were employed to analyze the relationship between AL and depression. RESULTS: Among the 1309 participants diagnosed with sleep disorders, 212 (16.2%) were identified as being at risk of depression. A total of 55.2% (n = 117) of the depressed persons had high AL levels. In the unadjusted model, AL levels were associated with depression in those with sleep disorders (OR:1.53, 95% CI = 1.14-2.05; P < .01). This relationship remained significant in the adjusted model (OR:1.52, 95% CI = 1.11-2.10, P < .05), after controlling for potential confounding factors. CONCLUSION: The findings showed that high AL levels in patients with sleep disorders were positively associated with depression, indicating that elevated AL may increase the risk of depression in this population, or alternatively, depression may increase the risk of AL.

Association between sleep duration and depression in menopausal women: a population-based study.

Aims: This research investigated menopausal women older than 50 years to find whether there were any independent relationships between the duration of sleep they got and their prevalence of depression. Methods: National Health and Nutrition Examination Survey (NHANES) datasets from 2011-2020 were utilized in a cross-sectional study. Using multivariate linear regression models, the linear relationship between sleep duration and depression in menopausal women was investigated. Fitted smoothing curves and thresholds impact evaluation were used to investigate the nonlinear relationship. Then, subgroup analyses were performed according to smoking, drinking alcohol, diabetes, hypertension, heart disease, and moderate activities. Results: This population-based study included a total of 3,897 menopausal women (mean age 65.47 ± 9.06 years) aged≥50 years; 3,159 had a depression score <10, and 738 had a depression score≥10. After controlling for all covariates, the prevalence of depression was 17% higher among participants with short sleep duration [OR=1.17, 95%CI=(0.65, 1.70), P<0.0001] and 86% [OR=1.86, 95%CI=(1.05, 2.66), P<0.0001] compared to participants with normal sleep duration. In subgroup analyses stratified by smoking and diabetes, the sleep duration and depression scores of non-smokers [ß=-0.18, 95%CI= (-0.33, -0.02), P=0.0241] and diabetics were independently negatively correlated [ß=-0.32, 95%CI= (-0.63, -0.01), P=0.0416]. Using a two-segment linear regression model, we discovered a U-shaped relationship between sleep duration and depression scores with an inflection point of 7.5 hours. Less than 7.5 hours of sleep was associated with an increased risk of developing depression [ß=-0.81, 95%CI= (-1.05, -0.57), P<0.001]. However, sleeping more than 7.5 hours per night increased the risk of depression considerably [ß=0.80, 95%CI= (0.51, 1.08), P<0.001]. Conclusions: Depression is associated with sleep duration in menopausal women. Insufficient or excessive sleep may increase the risk of depression in menopausal women.

Presurgical depressive symptom and anaesthetic requirements in patients undergoing surgery for malignant and non-malignant conditions: A prospective observational cohort study.

The incidence and magnitude of depression are rarely assessed during preanaesthetic evaluation. The shared physiological mechanisms of depression and anaesthetic drugs are likely to alter the pharmacodynamics of propofol. Therefore, the study aimed to evaluate the burden of presurgical depression and its effect on propofol consumption during anaesthesia. This prospective, observational, cross-sectional, analytical study included adult patients (> 18 years) undergoing surgery. During the preoperative period, depressive symptoms were evaluated by the psychiatrist on 9-point Patient Health Questionnaire-9 (PHQ-9). The propofol requirements were recorded during anaesthesia and compared with those for patients without depression. One hundred and seventy-four patients (87 patients each with and without cancer) underwent presurgical evaluation. The prevalence of depression (>4 Patient Health Questionnaire-9) and moderate to severe depression (>9 PHQ-9) among patients with cancer was 58.6% and 35.6%, respectively. The prevalence of depression (>4 PHQ-9) and moderate to severe depression (>9 PHQ-9) among patients without cancer was 18.4% and 3.4%, respectively. In the cancer group, propofol requirement was significantly lower (114.7 ± 22.9mg vs. 126.4 ± 24.3mg; p = 0.025) in patients with depression than that in those without depression. In conclusion, the burden of depression during the preanaesthetic period among patients with cancer is substantial, and depression reduces propofol requirement during surgery.

Anxiety and depression symptoms among patients with long COVID: a retrospective cohort study.

Patients suffering from post-acute sequelae of COVID-19 (PASC) have a higher prevalence of anxiety and depression than the general population. The long-term trajectory of these sequelae is still unfolding. To assess the burden of anxiety and depression among patients presenting to the University of Iowa Hospitals and Clinics (UIHC) post-COVID-19 clinic, we analyzed how patient factors influenced Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scores. In this retrospective cohort study, the GAD-7 and PHQ-9 questionnaire scores of patients presenting to the UIHC post-COVID clinic between March 2021-February 2022 (N = 455) were compared to the scores of a sample of patients presenting to the general internal medicine (GIM) clinic during the same period (N = 94). Our analysis showed that patients with an absent history of depression on their electronic medical record (EMR) problem list scored significantly higher on the GAD-7 (mean difference -1.62, 95% CI -3.12 to -0.12, p = 0.034) and PHQ-9 (mean difference -4.45, 95% CI -5.53 to -3.37, p < 0.001) questionnaires compared to their similar counterparts in the GIM clinic. On the other hand, patients with an absent history of anxiety on their EMR problem list scored significantly higher on the GAD-7 (mean difference -2.90, 95% CI -4.0 to -1.80, p < 0.001) but not on the PHQ-9 questionnaire (p = 0.196). Overall, patients with PASC may have experienced a heavier burden of newly manifest anxiety and depression symptoms compared to patients seen in the GIM clinic. This suggests that the mental health impacts of PASC may be more pronounced in patients with no prior history of anxiety or depression.

Food cravings after bariatric surgery: comparing laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass.

BACKGROUND: Research suggests that food choices, preferences, and tastes change after bariatric surgery, but evidence regarding changes in food cravings is mixed. OBJECTIVES: The primary aim of this cohort study was to compare food cravings during the first year following bariatric surgery in patients who had undergone sleeve gastrectomy (SG) versus Roux-en-Y gastric bypass (RYGB). SETTING: Integrated multispecialty health system, United States. METHODS: Patients aged ≥ 18 years seen between May 2017 and July 2019, provided informed consent, completed the Food Craving Inventory (FCI), and had ≥ 1 year of follow-up after undergoing primary SG or RYGB were included in the study. Secondary data captured included psychological and behavioral measures. Preoperative and postoperative (3, 6, 9, and 12 months) FCI scores of patients who underwent SG and RYGB were compared. RESULTS: Some attrition occurred postoperatively (N = 187 at baseline, 141 at 3 months, 108 at 6 months, 89 at 9 months, and 84 at 12 months). No significant relationship between pre- or postoperative food cravings and surgery type was found except on the carbohydrate subscale. Patients with higher preoperative food addiction symptoms were not more likely to experience an earlier reoccurrence of food cravings during the first 12 months after surgery. Likewise, patients with higher levels of preoperative depression and anxiety were not more likely to have early reoccurrence of food cravings during the first 12 months after surgery; however, those with higher PHQ9 scores at baseline had uniformly higher food craving scores at all timepoints (pre-surgery, 3 m, 6 m, 9 m, and 12 m). CONCLUSIONS: Results suggest that food cravings in the year after bariatric surgery are equivalent by surgery type and do not appear to be related to preoperative psychological factors or eating behaviors. LEVEL OF EVIDENCE: Level III: Evidence obtained from well-designed cohort.

An exploratory study on the possible association of serum etonogestrel concentrations with mood concerns and symptoms among contraceptive implant users.

OBJECTIVE: To evaluate if inter-individual variability in serum etonogestrel (ENG) concentrations accounts for variability in mood-related side effects among ENG implant users. STUDY DESIGN: Participants underwent a single-time blood draw for measurement of serum ENG concentrations using a liquid-chromatography mass-spectrometry assay, and completed a questionnaire at enrollment that retrospectively assessed mood-related side effects during the period of implant use. For a subset of participants, Patient Health Questionnaire-9 (PHQ-9) scores, obtained for other clinical purposes, were also compared. We used independent medians tests and linear regression to evaluate associations between mood symptoms and serum ENG concentrations as our primary outcome. RESULTS: Among 900 enrolled participants, 34% (306/900) reported mood changes on the baseline questionnaire. Of these, 31 (3.4%) participants also had documented PHQ-9 scores. Serum ENG concentrations (median 126.9 pg/mL [range 39.4-695.1]) were not associated with reported mood changes on the questionnaire (p = 0.19) or on the PHQ-9 (ß = 0.00, 95% CI -0.03, 0.03). CONCLUSION: Pharmacokinetic variability does not explain the inter-individual variability in mood-related side effects among ENG implant users. IMPLICATIONS: Mood-related side effects and altered mental health metrics are commonly reported by etonogestrel contraceptive implant users but demonstrate wide inter-individual variability. Individual differences in serum drug levels do not appear to account for this variability in mood-related side effects, and so future research should focus on novel personal factors.

Psychometric Properties of the Patient Health Questionnaire-9 for Saudi Caregivers: A Cross-Sectional Study in Saudi Arabia.

To evaluate the psychometric properties of the Arabic-language Patient Health Questionnaire-9 (PHQ-9) among Saudi caregivers of patients with chronic diseases. Using a cross-sectional design, 94 Saudi caregivers (37 male and 57 female) in the medical city participated in the study. A comparative assessment was conducted on 4 models proposed in the existing PHQ-9 literature to gauge their compatibility through confirmatory factor analyses. This study evaluates convergent validity through a correlation analysis, examining the relationship between the PHQ-9 and the Depression, Anxiety, and Stress Scale-21 (DASS-21). Among the various models we examined, the single-factor structure of the PHQ-9 displayed the best fit with the data we gathered. Notably, the Cronbach alpha coefficient for the PHQ-9 registered at .81, indicating a high level of internal consistency. Factor loadings spanned a range from .39 to .76. The convergent validity of the PHQ-9 and DASS-21 was deemed satisfactory. It is established that the PHQ-9 serves as an effective tool for depression screening among Saudi caregivers in Saudi Arabia. Its strengths lie in its demonstrated validity, dependability, brevity, and convenience of administration, positioning it as a valuable resource for preventative measures and performance assessment within mental health settings.

Patient Health Questionnaire-9 Item Pairing Predictiveness for Prescreening Depressive Symptomatology: Machine Learning Analysis.

BACKGROUND: Anhedonia and depressed mood are considered the cardinal symptoms of major depressive disorder. These are the first 2 items of the Patient Health Questionnaire (PHQ)-9 and comprise the ultrabrief PHQ-2 used for prescreening depressive symptomatology. The prescreening performance of alternative PHQ-9 item pairings is rarely compared with that of the PHQ-2. OBJECTIVE: This study aims to use machine learning (ML) with the PHQ-9 items to identify and validate the most predictive 2-item depressive symptomatology ultrabrief questionnaire and to test the generalizability of the best pairings found on the primary data set, with 6 external data sets from different populations to validate their use as prescreening instruments. METHODS: All 36 possible PHQ-9 item pairings (each yielding scores of 0-6) were investigated using ML-based methods with logistic regression models. Their performances were evaluated based on the classification of depressive symptomatology, defined as PHQ-9 scores ≥10. This gave each pairing an equal opportunity and avoided any bias in item pairing selection. RESULTS: The ML-based PHQ-9 items 2 and 4 (phq2&4), the depressed mood and low-energy item pairing, and PHQ-9 items 2 and 8 (phq2&8), the depressed mood and psychomotor retardation or agitation item pairing, were found to be the best on the primary data set training split. They generalized well on the primary data set test split with area under the curves (AUCs) of 0.954 and 0.946, respectively, compared with an AUC of 0.942 for the PHQ-2. The phq2&4 had a higher AUC than the PHQ-2 on all 6 external data sets, and the phq2&8 had a higher AUC than the PHQ-2 on 3 data sets. The phq2&4 had the highest Youden index (an unweighted average of sensitivity and specificity) on 2 external data sets, and the phq2&8 had the highest Youden index on another 2. The PHQ-2≥2 cutoff also had the highest Youden index on 2 external data sets, joint highest with the phq2&4 on 1, but its performance fluctuated the most. The PHQ-2≥3 cutoff had the highest Youden index on 1 external data set. The sensitivity and specificity achieved by the phq2&4 and phq2&8 were more evenly balanced than the PHQ-2≥2 and ≥3 cutoffs. CONCLUSIONS: The PHQ-2 did not prove to be a more effective prescreening instrument when compared with other PHQ-9 item pairings. Evaluating all item pairings showed that, compared with alternative partner items, the anhedonia item underperformed alongside the depressed mood item. This suggests that the inclusion of anhedonia as a core symptom of depression and its presence in ultrabrief questionnaires may be incompatible with the empirical evidence. The use of the PHQ-2 to prescreen for depressive symptomatology could result in a greater number of misclassifications than alternative item pairings.

Association between work-related physical activity and depressive symptoms in Korean workers: data from the Korea national health and nutrition examination survey 2014, 2016, 2018, and 2020.

BACKGROUND: The workplace experiences of employees can impact their mental health. Depressive symptoms, which are experienced by workers, are a mental health issue that deserves attention. Several studies have evaluated physical activity to prevent possible depression in workers in a work environment, however, research on physical activity and depression symptoms directly related to work is still insufficient. Therefore, we aimed to identify the relationship between work-related physical activity and depression among South Korean workers. METHODS: We used data from the Korean National Health and Nutrition Examination Survey conducted in 2014, 2016, 2018, and 2020, which included 31,051 participants. We excluded, participants aged < 15 years (n = 4,663), unemployed and economically inactive persons (n = 9,793), those who did not engage in work-related physical activities (n = 1,513) and leisure physical activities (n = 1,558), or those with missing data (n = 450). Therefore, the study included 13,074 participants. Work-related activity was measured by self-reporting, while depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). Multiple logistic regression analysis was performed to investigate the association between work-related physical symptoms and depressive symptoms among workers. RESULTS: Individuals who engaged in work-related physical activity had higher PHQ-9 scores than those who did not (male: odds ratio [OR]: 1.71, 95% confidence interval [CI]: 1.16-2.52; female: OR: 2.33, 95% CI: 1.66-3.29). High-intensity work-related physical activity significantly increased depressive symptoms (male: OR: 2.15, 95% CI: 1.04-4.43; female: OR: 2.90, 95% CI: 1.46-5.96). When classified according to the severity of depressive symptom, the OR of depressive symptoms of workers engaged in both leisure and work-related physical activities tended to be lower than that of those engaged only in work-related physical activities. CONCLUSION: Korean workers who engaged in work-related physical activities exhibited more depressive symptoms. Therefore, our findings suggest that balancing work-related and leisure physical activities can help Korean workers prevent development of depressive symptoms.

Cultural Adaptation of Patient Health Questionnaire-9 in Hindi for Use with Patients with Cancer in Community Palliative Care Settings.

Objectives: Patient Health Questionnaire-9 (PHQ-9) in Indian settings is yet not very often used in palliative care with the Hindi-speaking population. The Hindi version of PHQ-9 is available but its cultural adaptation to the Hindi-speaking population in North India receiving palliative care services is required to be tested. PHQ-9 as a depression screening questionnaire may help to identify depression symptoms among patients with cancer. This study aimed to examine the cultural equivalence of PHQ-9 Hindi for use with patients with cancer receiving palliative care services in North India. Material and Methods: Based on the standard methodology of translation and adaptation of the scale, the following process was used: (i) Two focused group discussions with 17 experts working in a cancer palliative care setting, (ii) qualitative interviewing with 11 patients, and (iii) research team review. All interviews were audio recorded, transcribed, and item-wise content analysis was conducted. Results: A few difficult phrases in the original PHQ-9 were 'dilchaspi', 'avasadgrast', 'kam urja', 'nakaam', parivar ko neecha dhikhana and 'ashthir' which were changed to Kam Mann Lagna, Mann Dukhi hona, kamjori, saksham nahi hain' 'asafal', Parivar ko nirash karna' and 'bechain,' respectively. Two items, namely no. 6 and 8 were changed to shorten the length for appropriately conveying the meaning. Conclusion: Hindi language involves various dialects which change from region to region bringing variations in understanding the meaning of the words. It is recommended that culturally equivalent scales are used in practice and research. PHQ-9 is now culturally adapted for the Hindi-speaking population in North India. PHQ-9 will help identidy depressive symptoms at an early stage. Psychometric testing of PHQ-9 is underway.

Association between depression and risk of type 2 diabetes and its sociodemographic factors modifications: A prospective cohort study in southwest China.

BACKGROUND: Depression may be associated with the risk of developing type 2 diabetes. The goal of this study was to explore the association of severe of depression with the risk of type 2 diabetes in adults in Guizhou, China. METHODS: A 10-year prospective cohort study of 7158 nondiabetes adults aged 18 years or older was conducted in Guizhou, southwest China from 2010 to 2020. The Patient Health Questionnaire-9 (PHQ-9) was used to measure the prevalence of depression. Cox proportional hazard models were used to estimated hazard ratios (HRs) and 95% confidence intervals (95% CIs) of depression and incident type 2 diabetes. A quantile regression (QR) analytical approach were applied to evaluate the associations of PHQ-9 score with plasma glucose values. RESULTS: A total of 739 type 2 diabetes cases were identified during a median follow-up of 6.59 years. The HR (95% CI) per 1-SD increase for baseline PHQ-9 score was 1.051 (1.021, 1.082) after multivariable adjustment. Compared with participants without depression, those with mild or more advanced depression had a higher risk of incident type 2 diabetes (HR:1.440 [95% CI, 1.095, 1.894]). Associations between depression with type 2 diabetes were suggested to be even stronger among women or participants aged ≥45 years (p < .05). There are significant positive associations of PHQ-9 score with 2-h oral glucose tolerance test blood glucose levels. CONCLUSION: Depression significantly increased the risk of incident type 2 diabetes, especially in women, participants aged ≥45 years, Han ethnicity, and urban residents. These findings highlighted the importance and urgency of depression health care.

Association of cannabis use with depression among cancer patients.

The rate of cannabis use by cancer patients is climbing. However, as the risk of mental illness caused by cannabis use in cancer patients has not been effectively evaluated, this study will analyze the association between cannabis use and depression in cancer patients. This study collected data from respondents to the National Health and Nutrition Examination Survey from 2005 to 2018. A total of 22,181 respondents self-reported information about cannabis use in questionnaire, of which 893 were diagnosed with cancer. We found that the rate of cannabis use among cancer patients increased each year from 2005 to 2018. We analyzed the association between cannabis use and depression in cancer patients by multivariable logistic regression. Results found that the current cannabis use had a significant positive correlation with increased risk of depression in cancer patients (OR = 2.135, 95% CI = 1.21-3.777, p = 0.009). In our stratified analysis, current cannabis use was associated with an increased risk of depression in cancer patients who were female, had a history of cocaine use, and initiated cannabis use after age 17. (OR = 1.981, 95% CI = 1.024-3.85, P = 0.043; OR = 3.19, 95% CI = 1.61-6.41, P < 0.001; OR = 2.236, 95% CI = 1.018-4.967, P = 0.045). In conclusion, the use of cannabis by cancer patients has an associated risk of depression and the cancer patients who currently use cannabis are more likely to have depression.