Because depression is a multidimensional construct and few studies have compared the relative importance of its facets in predicting cardiovascular risk, we evaluated the utility of depressive ...symptom clusters in predicting the 5-year incidence of coronary artery calcification (CAC).
Participants were 2171 middle-aged adults (58% female; 43% black) from the Coronary Artery Risk Development in Young Adults (CARDIA) study who were free of cardiovascular disease. Depressive symptom clusters (z scores) were measured by questionnaires in 2000 to 2001, and CAC was measured by electron beam computed tomography in 2000 to 2001 and 2005 to 2006. There were 243 cases (11%) of incident CAC, defined as the absence of CAC at baseline and the presence of CAC at follow-up. Total depressive symptoms (odds ratio, 1.16; 95% confidence interval, 1.02-1.33; P=0.03) and the depressed affect cluster (odds ratio, 1.17; 95% confidence interval, 1.03-1.33; P=0.02) predicted incident CAC; however, the somatic, interpersonal distress, low positive affect, and pessimism clusters did not. The depressed affect-incident CAC relationship was independent of age, sex, race, education, and antidepressant use; was similar across sex and racial groups; and was partially accounted for by tobacco use and mean arterial pressure.
In contrast to recent results indicating that the somatic cluster is the most predictive of cardiovascular outcomes, we found that the prospective association between depressive symptoms and incident CAC was driven by the depressed affect cluster. Our findings raise the possibility that there may not be 1 facet of depression that is the most cardiotoxic across all contexts.
Background Methicillin-resistant Staphylococcus aureus infections can be difficult to manage in ventral hernia repair (VHR). We aimed to determine whether a history of preoperative MRSA infection, ...regardless of site, confers increased odds of 30-day surgical site infection (SSI) after VHR. Study Design A retrospective cohort study of patients undergoing VHR with class I to III wounds between 2005 and 2012 was performed using Vanderbilt University Medical Center's Perioperative Data Warehouse. Preoperative MRSA status, site of infection, and 30-day SSI were determined. Univariate and multivariate analyses adjusting for confounding factors were performed to determine whether a history of MRSA infection was independently associated with SSIs. Results A total of 768 VHR patients met inclusion criteria, of which 46% were women. There were 54 (7%) preoperative MRSA infections (MRSA positive); 15 (28%) soft tissue, 9 (17%) bloodstream, 4 (7%) pulmonary, 3 (6%) urinary, and 5 (9%) other. Overall SSI rate was 10% (n = 80), SSI rate in the MRSA-positive group was 33% (n = 18), compared with 9% (n = 62) in controls (p < 0.001). Multivariate analysis demonstrated that a history of MRSA infection significantly increased odds of 30-day SSI after VHR by 2.3 times (95% CI, 1.1-4.8; p = 0.035). Other factors associated with postoperative SSI were performance of myofascial release, increasing BMI, length of operation, open repair, and clean-contaminated wound classification. Conclusions A history of site-independent MRSA infection confers significantly increased odds of 30-day SSI after VHR. Additional investigation is needed to determine perioperative treatment regimens that might decrease odds of SSI in VHR, and optimal prosthetic types and techniques for this population.
We sought to determine whether depressive symptoms are associated with attempting to lose weight and engaging in weight loss behaviors in a large, diverse sample of adults representative of the U.S. ...population.
Respondents were 23,106 adults, free of cardiovascular disease and diabetes, who participated in the 2005–2014 years of the National Health and Nutrition Examination Survey (NHANES). Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9), and weight loss variables were obtained from a Weight History Questionnaire.
PHQ-9 total was not associated with attempting to lose weight in the past year (OR = 1.03, 95%CI = 1.00–1.06, p = 0.074; n = 23,106). Among respondents who attempted to lose weight (n = 9582), PHQ-9 total was associated with a lower odds of exercising (OR = 0.84, 95%CI = 0.79–0.89, p < 0.001) and a greater odds of skipping meals (OR = 1.31, 95%CI = 1.22–1.41, p < 0.001), eating diet foods/products (OR = 1.16, 95%CI = 1.08–1.24, p < 0.001), eating less food (OR = 1.09, 95%CI = 1.04–1.15, p < 0.001), taking non-prescription supplements (OR = 1.31, 95%CI = 1.23–1.41, p < 0.001), taking prescription diet pills (OR = 1.28, 95%CI = 1.10–1.49, p = 0.001), and taking laxatives/vomiting (OR = 1.55, 95%CI = 1.28–1.88, p < 0.001).
Although depressive symptoms were not associated with attempting to lose weight in the past year, adults who attempted to lose weight tended to employ potentially ineffective/unhealthy weight loss behaviors and avoid effective behaviors. This pattern of behaviors may be another mechanism that explains the excess risk of obesity in depressed adults and may be a modifiable target for future interventions. Given the cross-sectional nature of this study, reverse causality is a possibility. Future studies should investigate the prospective associations between depressive symptoms and weight loss behaviors.
•Greater depressive symptoms are not associated with odds of trying to lose weight.•Among those who tried to lose weight:•Depressive symptoms related to use of ineffective/unhealthy weight loss behaviors (e.g., skipping meals)•Depressive symptoms related to avoidance of effective behaviors (exercise).•Depression may be another mechanism explaining excess risk of obesity in depressed adults.
Background/Purpose
Given that emotional risk factors for coronary artery disease (CAD) tend to cluster within individuals, surprisingly little is known about how these negative emotions might ...influence one another over time. We examined the longitudinal associations among measures of depressive symptoms and hostility/anger in a cohort of 296 healthy, older adults.
Methods
Participants completed the Beck Depression Inventory-II (BDI-II), Cook–Medley Hostility (Ho) scale, and Anger-In and Anger-Out subscales of the State–Trait Anger Expression Inventory at baseline and 6-year follow-up. We conducted a series of path analyses to evaluate the directionality of the depression–hostility/anger relationship.
Results
Baseline Ho scale was a predictor of 6-year increases in BDI-II (
β
= 0.15,
p
= 0.004), Anger-In (
β
= 0.14,
p
= 0.002), and Anger-Out (
β
= 0.11,
p
= 0.01). In contrast, baseline BDI-II, Anger-In, and Anger-Out did not predict change in any of the emotional variables. Additional path analytic models revealed that the pattern of relationships was not altered after controlling for demographic, biomedical, and behavioral covariates; anxiety symptoms; social support; and subjective sleep quality.
Conclusions
The present results suggest that the cognitive aspects of hostility/anger may precede and independently predict future increases in depressive symptoms but not vice versa. Our findings lead us to speculate that (a) hostility may exert part of its cardiotoxic influence by acting to precipitate and/or maintain symptoms of depression and that (b) the potency of depression interventions designed to improve cardiovascular outcomes might be enhanced by incorporating treatments addressing hostility.
In HIV treatment program, gaps in the "cascade of care" where patients are lost between diagnosis, laboratory evaluation, treatment initiation, and retention in HIV care, is a well-described ...challenge. Growing access to internet-enabled mobile phones has led to an interest in using the technology to improve patient engagement with health care.
The objectives of this trial were: (1) to assess whether a mobile phone-enabled app could provide HIV patients with laboratory test results, (2) to better understand the implementation of such an intervention, and (3) to determine app effectiveness in improving linkage to HIV care after diagnosis.
We developed and tested an app through a randomized controlled trial carried out in several primary health care facilities in Johannesburg. Newly diagnosed HIV-positive patients were screened, recruited, and randomized into the trial as they were giving a blood sample for initial CD4 staging. Trial eligibility included ownership of a phone compatible with the app and access to the internet. Trial participants were followed for a minimum of eight months to determine linkage to HIV care indicated by an HIV-related laboratory test result.
The trial outcome results are being prepared for publication, but here we describe the significant operational and technological lessons provided by the implementation. Android was identified as the most suitable operating system for the app, due to Android functionality and communication characteristics. Android also had the most significant market share of all smartphone operating systems in South Africa. The app was successfully developed with laboratory results sent to personal smartphones. However, given the trial requirements and the app itself, only 10% of screened HIV patients successfully enrolled. We report on issues such as patient eligibility, app testing in a dynamic phone market, software installation and compatibility, safe identification of patients, linkage of laboratory results to patients lacking unique identifiers, and present lessons and potential solutions.
The implementation challenges and lessons of this trial may assist future similar mHealth interventions to avoid some of the pitfalls. Ensuring sufficient expertise and understanding of the programmatic needs by the software developer, as well as in the implementation team, with adequate and rapid piloting within the target groups, could have led to better trial recruitment. However, the majority of screened patients were interested in the study, and the app was installed successfully in patients with suitable smartphones, suggesting that this may be a way to engage patients with their health care data in future.
ClinicalTrials.gov NCT02756949; https://clinicaltrials.gov/ct2/show/NCT02756949 (Archived by WebCite at http://www.webcitation.org/6z1GTJCNW).
Abstract Objective Taken in isolation, depression, anxiety, and hostility/anger have been shown to predict obesity. It is unknown whether these negative emotional factors are associated with ...adiposity, independently of each other. The objective of this review was to determine whether negative emotional factors have independent associations with adiposity. Methods We searched for observational studies examining adiposity and two or more negative emotional factors. Studies which examined a negative emotional factor using analyses which controlled for other emotional factor(s) were selected for the review. Results Three prospective and 11 cross-sectional studies met our inclusion/exclusion criteria. Of these investigations, 64% indicated that depression had positive associations with adiposity, independent of anxiety or hostility, and 56% indicated that anxiety had independent associations with adiposity. Only 33% of studies found independent associations for hostility and adiposity; however, far fewer studies were available. Conclusion Depression and anxiety have independent associations with excess adiposity when controlling for other emotional factors. Additional studies are needed to determine whether hostility/anger is independently associated with excess adiposity. These results have implications for the design of effective obesity prevention programs.
The mechanisms underlying the depression-obesity relationship are unclear. Food attentional bias (FAB) represents one candidate mechanism that has not been examined. We evaluated the hypothesis that ...greater depressive symptoms are associated with increased FAB.
Participants were 89 normal weight or overweight adults (mean age = 21.2 ± 4.0 years, 53% female, 33% non-white, mean body mass index in kg/m2 = 21.9 ± 1.8 for normal weight; 27.2 ± 1.5 for overweight). Total, somatic, and cognitive-affective depressive symptom scores were computed from the Patient Health Questionnaire-8 (PHQ-8). FAB scores were calculated using reaction times (RT) and eye-tracking (ET) direction and duration measures for a food visual probe task. Age, gender, race/ethnicity, and body fat percent were covariates.
Only PHQ-8 somatic symptoms were positively associated with RT-measured FAB (β = 0.23, p = .04). The relationship between somatic symptoms and ET direction (β = 0.18, p = .17) and duration (β = 0.23, p = .08) FAB indices were of similar magnitude but were not significant. Somatic symptoms accounted for 5% of the variance in RT-measured FAB. PHQ-8 total and cognitive-affective symptoms were unrelated to all FAB indices (ps ≥ 0.09).
Only greater somatic symptoms of depression were linked to food attentional bias as measured using reaction time. Well-powered prospective studies should examine whether this bias replicates, particularly for eye-tracking measures, and whether it partially mediates the depression-to-obesity relationship.
•Depression may lead to obesity via increased attention to and intake of food.•Greater somatic depressive symptoms were linked to greater food attentional bias measured using reaction time.•Food bias may ultimately result in increased calorie intake in depression.
Objective: Fatigue is one of the most common and debilitating symptoms reported by cancer patients, yet relatively little is understood about its etiology. Recently, as researchers have begun to ...focus attention on cancer-related fatigue (CRF), depression has emerged as its strongest correlate. Few longitudinal studies, however, have examined directionality of the relationship between the two symptoms. Our aim was to evaluate the directionality of the association between depression and CRF. Method: The study used a single-group cohort design of longitudinal data (N = 329) from a randomized controlled trial of an intervention for pain and depression in a heterogeneous sample of cancer patients. Participants met criteria for clinically significant pain and/or depression. Our hypothesis that depression would predict change in fatigue over 3 months was tested using latent variable cross-lagged panel analysis. Results: Depressive symptoms and fatigue were strongly correlated in the sample (baseline correlation of latent variables = 0.71). Although the model showed good fit to the data, χ2 (66, N = 329) = 88.16, p = .04, SRMR = 0.030, RMSEA = 0.032, and CFI = 1.00, neither structural path linking depression and fatigue was significant, suggesting neither symptom preceded and predicted the other. Conclusions: Our findings did not support hypotheses regarding the directionality of the relationship between depressive symptoms and fatigue. The clinical implication is that depression-specific treatments may not be sufficient to treat CRF and that instead, interventions specifically targeting fatigue are needed.
PDF
