The association between perceived stress with sleep quality, insomnia, anxiety and depression in kidney transplant recipients during Covid-19 pandemic.

BACKGROUND: The psychological distress and sleep problems caused by current Covid-19 outbreak is not well known in kidney transplant recipients. In this study, we aimed to investigate the association between perceived stress with sleep quality, insomnia, anxiety, depression and kidney function in kidney transplant recipients during the Covid-19 pandemic. MATERIAL AND METHODS: A hundred-six kidney transplant recipients were enrolled. Questionnaire of "Socio-demographics", "Perceived Stress Scale (PSS)", "Pittsburgh Sleep Quality Index (PSQI)", "Insomnia Severity Index (ISI)" and "Hospital Anxiety Depression Scale (HADS)" are performed. The laboratory data is recorded. The perceived stress related to Covid-19 pandemic and its associations were investigated. RESULTS: The mean age of patients was 44.2±13.3 years, and 65 of the patients (61.3%) were men. Forty-nine (46.2%) of the patients had high-perceived stress; 51 (48.1%) of the patients had poor sleep quality, 40 (37.7%) of the patients had insomnia, 25 (23.6%) of the patients had anxiety and 47 (44.3%) of the patients had depression. The patients having a history of Covid-19 infection in own or closed relatives (9.09±4.17 vs 6.49±4.16, p:0.014) and the patients who have a rejection episode any of time (8.24±5.16 vs 6.37±3.57, p:0.033) have had significantly higher anxiety scores, when they compared to others. The high PSS were positively correlated with PSQI, ISI, HAD-A and HAD-D. Regression analyses revealed that high-perceived stress is an independent predictor of anxiety and depression. There was not significant difference between kidney function with PSS, PSQI, ISI, HAD-A and HAD-D. CONCLUSIONS: High PSS is positively correlated with poor sleep quality and insomnia and also an independent predictor of anxiety and depression in kidney transplant recipients during the outbreak of Covid-19. As the pandemic is still spreading worldwide quickly early identification and intervention of sleep disturbances and psychiatric disorders are essential to protect graft function with high compliance to treatment in transplantation patients.

The impact of major depression on heart rate variability and endothelial dysfunction in patients with stable coronary artery disease.

BACKGROUND: Depression is an independent risk factor in cardiovascular diseases. Changes in the cardiac autonomic functions and pro-inflammatory processes are potential biological factors. Endothelial dysfunction plays an important role in the etiopathogenesis of atherosclerosis. Our objective was to evaluate the impact of major depression on heart rate variability and endothelial dysfunction in patients with stable CAD. METHODS: The study group included 65 CAD patients with a diagnosis of major depression and 54 CAD patients without major depression. All study population underwent transthoracic echocardiography, measurement of flow mediated dilatation (FMD) and 24-h holter recording for heart rate variability (HRV). Blood samples were drawn to determine the inflammatory parameters. Severity of depressive episode was assessed by Montgomery-Asberg Depression Scale (MADRS). RESULTS: The distribution of age and sex was similar in the patient and control groups (P=0.715, 0.354, respectively). There was no significant difference in medications used between the groups. Echocardiographic parameters were similar between the groups. Inflammatory parameters were also similar between the groups. HRV parameters were significantly lower in the patient group than controls. The absolute FMD value and percentage FMD were significantly lower in the patient group than controls (P<0.001). The MADRS score correlated with pNN50 in both groups (P<0.05), and with FMD in the control group (P<0.001), even after adjusting for age and gender (P<0.001). CONCLUSIONS: MADRS score was an independent predictor of pNN50 level, percentage and absolute FMD values regardless of age and gender. Clinician should pay more attention for evaluation of depressive patients with CAD.

The Effect of Synthetic Cannabinoids on P-Wave Dispersion: An Observational Study.

OBJECTIVE: The aim of this study was to investigate the effect of synthetic cannabinoids (SC) on P-wave dispersion (PD) in patients who consume SC. MATERIALS AND METHODS: The study population included 72 patients who consumed SC and 36 age- and sex-matched healthy controls. The severity of addiction was detected using the addiction profile index (BAPI). The PD was measured by 12-lead ECG obtained upon admission to hospital. Statistical analyses were performed using the SPSS v20.0 statistical software package. RESULTS: The mean age of the patients and controls was 26.9 ± 7.0 and 26.3 ± 6.5 years, respectively. Mean duration of SC consumption was 1.7 ± 0.7 years. Mean BAPI score of patients who consumed SC was 12.8 ± 3.4. Patients who consumed SC had a significantly higher PD value than controls (37.7 ± 11.5 vs. 30.6 ± 6.4 ms, p < 0.001). The BAPI score was significantly correlated with PD value (r = 0.675, p < 0.001). In the linear regression model that included PD value, age and heart rate, PD value was significantly and independently correlated with BAPI score (r2 of the model = 0.339; p < 0.001). CONCLUSIONS: In this study, patients who consumed SC had significantly higher PD values than controls, and the BAPI score correlated with the PD value. Hence SC consumption could lead to an increased risk of cardiovascular disease through prolonged PD. We recommend the use of the simple and inexpensive ECG to assess cardiovascular risk in patients who consume SC.

Increased Neutrophil/Lymphocyte Ratio in Patients with Depression is Correlated with the Severity of Depression and Cardiovascular Risk Factors.

OBJECTIVE: Chronic inflammation is associated with cardiovascular (CV) risk factors and psychiatric disorders. The neutrophil to lymphocyte ratio (NLR) has been investigated as a new biomarker for systemic inflammatory response. The aim of the study is to investigate the relation of NLR with severity of depression and CV risk factors. METHODS: The study population consisted of 256 patients with depressive disorder. Patients were evaluated with the Hamilton Rating Scale for Depression (HAM-D). Patients were classified into four groups according to their HAM-D score such as mild, moderate, severe, and very severe depression. Patients were also evaluated in terms of CV risk factors. RESULTS: Patients with higher HAM-D score had significantly higher NLR levels compared to patients with lower HAM-D score. Correlation analysis revealed that severity of depression was associated with NLR in depressive patients (r=0.333, p<0.001). Patients with one or more CV risk factors have significantly higher NLR levels. Correlation analysis revealed that CV risk factors were associated with NLR in depressive patients (r=0.132, p=0.034). In logistic regression analyses, NLR levels were an independent predictor of severe or very severe depression (odds ratio: 3.02, 95% confidence interval: 1.867-4.884, p<0.001). A NLR of 1.57 or higher predicted severe or very severe depression with a sensitivity of 61.4% and specificity of 61.2%. CONCLUSION: Higher HAM-D scores are associated with higher NLR levels in depressive patients. NLR more than 1.57 was an independent predictor of severe or very severe depression. A simple, cheap white blood cell count may give an idea about the severity of depression.

Burden and depressive symptoms associated with adult-child caregiving for individuals with heart failure.

BACKGROUND: The primary purpose of this study was to investigate adult-child caregiver burden in heart failure (HF) patients. Secondary purpose of the study was to identify the possible influencing factors for caregiver burden and depressive symptoms in a young adult-child caregiver group. METHODS: A total of 138 adult-child caregivers and 138 patients with HF participated in this study. Caregivers' burden, depressive symptoms, and anxiety levels were assessed by using Zarit Caregiver Burden Scale (ZCBS), Beck Depression Inventory, and State-Trait Anxiety Inventory, respectively. RESULTS: The mean ZCBS scores of the female caregivers were significantly higher than male caregivers. Approximately one-third of the adult-child caregivers had at least mild depressive symptoms. Caregivers with higher depressive symptoms had higher levels of caregiver burden. There were positive correlations between caregiving time, severity of depressive symptoms, and perceived caregiver burden. There was a negative correlation between education level of caregivers and perceived caregiver burden. Age, socioeconomic level, and marital status of patients were affecting factors for depressive symptoms in caregivers. Among caregiver characteristics, gender, marital status, and ZCBS scores seem to influence the depression in caregivers. CONCLUSIONS: The study findings suggest significant levels of burden and depressive symptoms even in adult-child caregivers of HF patients.

Psychometric properties of the Turkish version of the Patient Health Questionnaire-Somatic, Anxiety, and Depressive Symptoms.

OBJECTIVE: In this study, we examined the psychometric properties of the Turkish version of the Patient Health Questionnaire-Somatic, Anxiety, and Depressive Symptoms (PHQ-SADS) developed by Kroenke, Spitzer, and Williams. METHOD: This study sample consisted of 200 outpatients admitted to Erenköy Mental Health Training and Research Hospital, Erenköy Physiotherapy and Rehabilitation Hospital, and Kartal Training and Research Hospital and 240 graduate students in Karadeniz Technical University. Participants were administered the 90-item Symptoms Checklist (SCL-90R) and the 7-item Whiteley Index, along with the PHQ-SADS. A month later, the PHQ-SADS was readministered to 60 of the students. To investigate the internal consistency of the scale and its subscales, corrected item-total correlations were examined to establish the effect on the Cronbach coefficients and internal consistency of each item of the subscales. Test-retest correlations were also analyzed for reliability. Factorial structure was investigated using principal component analysis. The validity of distinguishing congruent and specific groups was also investigated for validity. RESULTS: Total scores on the scale showed an adequate test-retest consistency (r = 0.54, 0.52, and 0.76, respectively). All items showed adequate correlations (r > 0.26) in the test-retest analysis. Cronbach α values were 0.86 (control), 0.93 (patient), and 0.92 (total) on the test of internal consistency. When the questions were analyzed individually, the item-total correlation for item 7 of the PHQ somatization subscale was found to be inadequate in the control group. Exploratory factorial analysis and varimax rotation results showed that the scale provided a 4-factor structure. In the validity analysis, a significant difference between the patient and the control group mean values was determined. The SCL-90R, 7-item Whiteley Index, and SCL-90R somatization subscales were found to be sufficiently related to the number of symptoms to establish criterion-related validity. CONCLUSION: Findings with respect to internal consistency, test-retest consistency, item-total correlation, factorial structure, distinguishing validity for specific groups, and criterion-related validity for the PHQ-SADS show that the scale is acceptable in terms of validity and reliability for the Turkish population.