Association and biological pathways between lung function and incident depression: a prospective cohort study of 280,032 participants.

BACKGROUND: Lung health is increasingly recognized as an essential factor in mental health. However, prospective evidence on lung function with incident depression remains to be determined. The study aimed to examine the prospective association between impaired lung function and incident depression and the underlying biological mechanisms. METHODS: This prospective cohort study comprised 280,032 non-depressed individuals with valid lung function measurements from the UK Biobank. Lung function was assessed through the forced vital capacity (FVC) or forced expiratory volume in 1 s (FEV1). Cox proportional hazard models were applied to estimate the associations between lung function and incident depression. Mediation analyses were fitted to investigate the potential mediating role of biomarkers and metabolites in the association. RESULTS: A total of 9514 participants (3.4%) developed depression during a median follow-up of 13.91 years. Individuals in the highest quartile had a lower risk of depression (FVC % predicted: HR = 0.880, 95% CI = 0.830-0.933; FEV1% predicted: HR = 0.854, 95% CI = 0.805-0.905) compared with those in the lowest quartile of the lung function indices. Additionally, the restricted cubic splines suggested lung function indices had reversed J-shaped associations with incident depression (nonlinear P < 0.05 for FVC % predicted and FEV1% predicted). Impaired lung function yielded similar risk estimates (HR = 1.124, 95% CI = 1.074-1.176). Biomarkers involving systemic inflammation, erythrocytes, and liver and renal function may be potential mediators in the lung function-depression association. CONCLUSIONS: This study revealed that the higher risk of developing depression was associated with impaired lung function. Also, the association might be partially mediated by biomarkers including systemic inflammation, erythrocytes, and liver and renal function, though these mediation findings should be interpreted with caution due to potential temporal ambiguity.

Exposure to residential green and blue space and the natural environment is associated with a lower incidence of psychiatric disorders in middle-aged and older adults: findings from the UK Biobank.

BACKGROUND: There is increasing evidence for the role of environmental factors and exposure to the natural environment on a wide range of health outcomes. Whether exposure to green space, blue space, and the natural environment (GBN) is associated with risk of psychiatric disorders in middle-aged and older adults has not been prospectively examined. METHODS: Longitudinal data from the UK biobank was used. At the study baseline (2006-2010), 363,047 participants (women: 53.4%; mean age 56.7 ± 8.1 years) who had not been previously diagnosed with any psychiatric disorder were included. Follow-up was achieved by collecting records from hospitals and death registers. Measurements of green and blue space modeled from land use data and natural environment from Land Cover Map were assigned to the residential address for each participant. Cox proportional hazard models with adjustment for potential confounders were used to explore the longitudinal associations between GBN and any psychiatric disorder and then by specific psychiatric disorders (dementia, substance abuse, psychotic disorder, depression, and anxiety) in middle-aged and older adults. RESULTS: During an average follow-up of 11.5 ± 2.8 years, 49,865 individuals were diagnosed with psychiatric disorders. Compared with the first tertile (lowest) of exposure, blue space at 300 m buffer [hazard ratio (HR): 0.973, 95% confidence interval (CI): 0.952-0.994] and natural environment at 300 m buffer (HR: 0.970, 95% CI: 0.948-0.992) and at 1000 m buffer (HR: 0.975, 95% CI: 0.952-0.999) in the third tertile (highest) were significantly associated with lower risk of incident psychiatric disorders, respectively. The risk of incident dementia was statistically decreased when exposed to the third tertile (highest) of green space and natural environment at 1000 m buffer. The third tertile (highest) of green space at 300 m and 1000 m buffer and natural environment at 300 m and 1000 m buffer was associated with a reduction of 30.0%, 31.8%, 21.7%, and 30.3% in the risk of developing a psychotic disorder, respectively. Subgroup analysis suggested that the elderly, men, and those living with some comorbid conditions may derive greater benefits associated with exposure to GBN. CONCLUSIONS: This study suggests that GBN has significant benefits for lowering the risk of psychiatric disorders in middle-aged and older adults. Future studies are warranted to validate these findings and to understand the potential mechanistic pathways underpinning these novel findings.

Lifetime pathogen burden, inflammatory markers, and depression in community-dwelling older adults.

The link between pathogen exposure and mental health has long been hypothesized, but evidence remains limited. We investigated the association of seropositivity to common pathogens and total pathogen burden with depression and mental health and explored the role of mediating inflammatory cytokines. We profiled in 884 participants in the Singapore Longitudinal Ageing Studies, mean (SD) age: 67.9 (8.1) years, their seropositivities for 11 pathogens (CMV, HSV 1, HSV 2, HHV-6, EBV, VZV, RSV, Dengue, Chikungunya, H. Pylori and Plasmodium) and pathogen burden, Geriatric Depression Scale (GDS) score at baseline and 3-4 and 6-8 years follow-up, and baseline Mental Component Score (MCS) of 12-Item Short Form Survey (SF-12). Inflammatory markers included CRP, TNF-α, IL-6, MIP-1α, sgp130, sTNF-RI, sTNF-RII, C3a, and MCP-2. Controlling for age, sex, ethnicity, education, marital status, living alone, and smoking status, high pathogen burden (7 + cumulative infections) compared to low pathogen burden (1-5 cumulative infections) was significantly associated with period prevalence (the highest GDS score from baseline and follow-up measurements) of depressive symptoms (OR = 2.36, 95% CI = 1.05-5.33) and impaired mental health (OR = 2.25, 95% CI = 1.18-4.30). CMV seropositivity and HSV1 seropositivity, which are highly prevalent and most widely studied, were associated with estimated 2-fold increased odds of depression, but only HSV1 seropositivity was significantly associated with depression after adjusting for confounders. Notably, adjusted for confounders, RSV, H. pylori and Plasmodium seropositivity were significantly associated with increased odds, and Dengue seropositivity was associated with unexpectedly deceased odds of depressive symptoms and impaired mental health. The association of pathogen exposure with depression and mental health were at least in parts explained by inflammatory markers. Adding certain inflammatory markers to the models attenuated or weakened the association. Bootstrap method showed that MIP-1α significantly mediated the association between pathogen burden and mental health. In conclusion, lifelong pathogen burden and specific infections are associated with depression and impaired mental health in older adults.

Nightmare frequency and psychopathological problems in a large sample of Chinese adolescents.

PURPOSE: Nightmares are common, especially in pediatric populations and psychiatric patients. Nightmares are associated with daytime distress and negative health outcomes. The data on the prevalence and psychopathological profiles of nightmares in Chinese adolescents are limited. This study examined age and gender differences in nightmare frequency and associated psychopathological problems in a large sample of Chinese adolescents. METHODS: A total of 11,831 adolescent students (mean age = 14.9, 12-18 years) participated in the baseline survey of Shandong Adolescent Behavior and Health Cohort. Participants completed a self-administered questionnaire to report their nightmare frequency, trait anger, hopelessness, and multiple domains of behavioral/emotional problems. Univariate and multivariate analyses were performed to examine psychopathological problems in relation to nightmare frequency. RESULTS: Of the sample, 45.2% reported having nightmares at least once in the past month and 7.9% at least once/week. Girls reported more frequent nightmares than boys. Nightmare frequency significantly declined with age for both boys and girls. Mean scores on trait anger, hopelessness, attention, internalizing problems, and externalizing problems significantly increased with nightmare frequency. Frequent nightmares (at least once/week) were significantly associated with 2-4-fold increased likelihood of behavioral/emotional problems after adjusting for adolescent and family covariates. CONCLUSION: Nightmares are prevalent in Chinese adolescents. Frequent nightmares are associated with multiple domains of psychopathological problems. Assessment and intervention of frequent nightmares should be incorporated into routine clinical practice and mental health services in adolescents.

Family Functioning and Suicide Among the Elderly in Rural China: A Case-Control Psychological Autopsy Study.

This study aimed to examine the association between family functioning and suicide among the elderly in rural China. This 1:1 paired case-control psychological autopsy study included 242 suicides at age 60 or more and an equal number of controls matched on age (±3 years), gender, and residency. Family functioning was assessed by the Family Adaptation Partnership Growth Affection Resolve Index. Family dysfunction was reported more frequently in suicides than in paired controls. Severe family dysfunction denoted a significant risk factor for suicide only in women after adjusting for potential confounding factors. Suicides with family dysfunction were prone to have unstable marital status, physical illness, mental disorders, family suicide history, and more stressful life events than those with good family functioning. The findings suggest that the intervention enhancing family functioning may be effective in decreasing suicide among the elderly in rural China.

Behavior Characteristics and Risk Factors for Suicide Among the Elderly in Rural China.

We examine the characteristics of suicide behavior and associated risk factors in the elderly in rural China, compared with the nonelderly. Paired case-control design and psychological autopsy were used for subject recruitment and data collection. The included cases were 104 suicides of the elderly aged 60 years or older, 86 suicides of the nonelderly, and sex- and age-paired controls from the same villages. Although the characteristics of suicide behavior were similar between the two age groups of victims, the elderly who died by suicide had a greater tendency to experience negative life events and not live with a spouse. Suicide of the nonelderly was associated with family history of suicide, poor social support, and impulsivity. The influence of negative life events on the risk of suicide was greater in the elderly. Thus, efforts for suicide prevention must be tailored to the needs of specific age groups.

Characteristics of suicide completers and attempters in rural Chinese population.

OBJECTIVE: This study aimed to compare the similarities and differences between suicide completers and attempters in rural China. METHODS: Two paired case-control studies of completed suicide and suicide attempts were conducted in rural Shandong, China. This analysis included 409 suicide attempters (SA) with a mean age of 43.90 (SD=13.31), 117 suicide completers (SC) with a mean age of 50.38 (SD=13.02) and their controls matched by gender, age (within 3years), and residence. Logistic regression models were used to examine risk factors of suicide attempts and completed suicide and the differences between SA and SC. RESULTS: Compared to their matched controls, suicide attempters and completers shared the following common risk factors: low levels of education (middle school or under) (OR, 95% CI: 2.79, 1.40-5.55 for SA and 16.98, 1.59-181.60 for SC), negative life events (OR, 95% CI: 7.37, 4.73-11.50 for SA and 21.08, 4.74-93.71 for SC), and mental disorders (OR, 95% CI: 7.52, 3.85-14.69 for SA and 22.39, 2.65-189.60 for SC). Compared to suicide attempts, completed suicide was associated with the following risk factors: male gender (OR, 95% CI: 1.75, 1.06-2.90), advancing age (OR, 95% CI: 1.02, 1.00-1.04), poor family economic status (OR, 95% CI: 6.74, 3.22-14.13), prior suicide attempts (OR, 95% CI: 2.43, 1.18-4.97), family suicide history (OR, 95% CI: 2.59, 1.33-5.06), high suicide intent (OR, 95% CI: 1.15, 1.05-1.27), and highly lethal methods (OR, 95% CI: 13.65, 6.51-28.59). CONCLUSIONS: Although suicide completers and attempters share some common risk factors, suicide completers are more likely to have prior suicide attempts, family suicide history, and higher suicidal intent, and to use highly lethal methods in rural Chinese.

The relationship between psychological pain and suicidality in patients with major depressive disorder: A meta-analysis.

OBJECTIVE: To systematically review the association between psychological pain and suicidality in patients with major depressive disorder (MDD). METHOD: The databases of PubMed, Web of Science and PsycINFO were used to search and articles were screened for inclusion and exclusion criteria until February 2022. Two researchers independently screened the papers, extracted data, and evaluated the risk of bias of the included studies. Comprehensive Meta-Analysis software (CMA) was used for meta-analysis and the combined OR (95 % CI) values were calculated. RESULTS: A total of 7 articles were included, with a sample size of 1364. The present study showed that psychological pain was a risk factor for suicidality in patients with MDD (OR = 1.322, 95 % CI:1.165-1.500). After Duval and Tweedie trim and fill to rectify potential publication bias, psychological pain was still a risk factor for suicidality in patients with MDD [OR = 1.196 (95 % CI: 1.030-1.388), P < 0.001]. Subgroup analyses showed that average age ≥ 40 [r = 0.57 (95 % CI: 0.32-0.81), P < 0.001] was moderating variable for psychological pain and suicidality. CONCLUSIONS: Reducing psychological pain in MDD patients is somewhat important for preventing their suicidality, especially for the patients with advancing age.

Associations and Mediating Pathways Between Childhood Adversity and Risk of Dementia: A Cohort Study in the UK Biobank.

BACKGROUND: While childhood adversity (CA) is known to be associated with multiple adverse outcomes, its link with dementia is an area with limited exploration and inconsistent agreement. The study aimed to examine the longitudinal associations of CA with incident all-cause dementia and to quantify the potential mediating pathways. METHODS: Data from the UK Biobank. CA, encompassing neglect and abuse, was evaluated retrospectively by an online mental health questionnaire. Physical performance, psychological factors, lifestyles, and biological indicators assessed at baseline were considered potential mediators. Incident all-cause dementia was defined by International Classification of Diseases, Tenth Revision codes obtained through self-reported medical conditions, primary care, hospital admission, and death registrations. Cox proportional hazard models were applied to estimate the longitudinal associations. Mediation analyses were conducted on potential mediators to examine their contribution. RESULTS: This cohort study comprised 150 152 nondemented individuals (mean [SD] age, 55.9 [7.7] years) at baseline (2006-2010). Compared to individuals who did not experience CA, those exposed to any CA exhibited a 30.0% higher risk of dementia (hazard ratio = 1.300, 95% confidence interval [CI]: 1.129-1.496). Each additional CA was associated with a 15.5% (95% CI: 8.8%-22.5%, pfor trend < .001) increased dementia risks. Depression, smoking, and low grip strength explained 8.7%, 2.4%, and 0.9% of the associations, respectively. Biomarkers involving inflammation, erythrocytes, liver, and kidney function mediated the associations by 0.6%-1.4%. CONCLUSIONS: The study revealed the detrimental effects of CA on dementia and identified some potential mediators, namely depression, smoking, low grip strength, and several targeted biomarkers. In addition to calling more attention to CA, the findings underscore the importance of interventions targeting modifiable mediators in preventing dementia.

Explaining how childhood physical abuse and physical neglect influence adult depression: An analysis with multiple sequential mediators.

BACKGROUND: Substantial evidence indicates that experiencing physical abuse and neglect during childhood significantly elevates the likelihood of developing depression in adulthood. Nevertheless, there remains a dearth of understanding regarding the mechanisms underpinning this correlation. OBJECTIVE: In this study, we aimed to examine the associations of childhood physical abuse and physical neglect with depression using follow-up data from UK Biobank and quantified the contribution of smoking, insomnia, and BMI in these associations. PARTICIPANTS AND SETTINGS: This study included 144,704 participants (64,168 men and 80,536 women) from UK Biobank, most of whom were white (97 %). METHODS: Physical abuse and physical neglect were measured using two items of Childhood Trauma Screener (CTS). Data on the incidence of depression were obtained from primary care, hospital inpatient records, self-reported medical conditions, and death registries. We used a sequential mediation analysis based on the "g-formula" approach to explore the individual and joint effects of potential mediators. RESULTS: The depression incidence rate was 1.85 per 1000 person-years for men and 2.83 per 1000 person-years for women, respectively. Results of Cox proportional risk regression showed that physical abuse (HRs: 1.39-1.53, P < 0.001) and physical neglect (HRs: 1.43-1.60, P < 0.001) are associated with depression. Smoking, insomnia, and BMI together mediated 3 %-26 % of the associations. CONCLUSIONS: These findings contribute to our understanding of how physical abuse and physical neglect influence depression. Furthermore, a more effective reduction in the burden of depression can be achieved by managing modifiable mediators.

Shift work schedule and sleep patterns in relation to incident depression: Evidence from a prospective cohort study.

This study aims to explore the joint associations of shift work and sleep patterns with incident depression. The present prospective cohort using data from UK biobank, included 220,651 participants aged 38 to 71 years recruited between 2006 and 2010. Every participant finished a self-completed touch-screen questionnaire. Hazards ratios (HRs) with corresponding 95% confidence intervals (CIs) of incident depression were reported for shift work and sleep patterns by Cox-proportional hazard models. The average follow-up time was 12.13±1.94 years and the incidence rate of depression was 2.95 (2.89-3.02) per 1000 person-years. After fully adjustment, the participants with irregular and permanent night shifts companied by any sleep pattern were significantly associated with increased risk of incident depression compared with no shift work companied by favorable sleep patterns. The females seemed to be more vulnerable when having night shifts and unfavorable sleep patterns compared with the males. The increased risk of incident depression associated with shift work regardless of night shifts and evening/weekend shifts was not able to offset by favorable sleep patterns. The workers with unhealthy sleep patterns, especially inappropriate sleep duration and insomnia companied by shift work schedule should be paid more attention considering higher risk of depression.

The associations of physical activity and lifetime depression with all-cause and cause-specific mortality: evidence from a prospective cohort study.

This study aims to explore the joint associations of physical activity and lifetime depression with all-cause and cause-specific mortality. The present study using data from UK Biobank, included 316568 participants aged 37 to 73 years recruited from 22 centers between 2006 and 2010. Total physical activity (TPA), moderate-to-vigorous physical activity (MVPA) and vigorous physical activity (VPA), assessed by metabolic equivalent task (MET) were used and Cox-proportional hazard models were performed in this study. The incidence rate of all-cause, CVD, and cancer mortality was 4.35(95%CI: 4.29-4.42), 0.69 (95%CI: 0.67-0.72), and 2.23 (95%CI: 2.19-2.28) per 1000 person-years after an average follow-up time of 12.49 years. Lower levels of TPA, MVPA, and VPA were all independently associated with elevated risk of all-cause and cancer mortality. Lifetime depression was significantly associated with increased risk of all-cause (HR=1.46, 95%CI: 1.40-1.52), CVD (HR=1.48, 95%CI: 1.33-1.64), and cancer mortality (HR=1.13, 95%CI: 1.06-1.21). Significant interactive effect of low levels of TPA, MVPA, and VPA and lifetime depression on all-cause mortality were found in this study. The risk of all-cause mortality associated with lifetime depression was deteriorated with low levels of physical activity. Relevant interventions for regular PA should be performed among depressed population.

The association of weight control attempts with suicidality: The role of objective weight status and weight perception among adolescents of United States.

BACKGROUND: The evidence for the association of weight control attempts with suicidality by objective weight status, subjective weight perception, and distorted weight perception among adolescents was limited. METHODS: Data were extracted from a national representative sample of Youth Risk Behavior Surveys in the United States from 2011 to 2019. Binary logistic regression models with complex sampling designs were used to explore the association of weight control attempts, objective weight status, and weight perception with suicidality. FINDINGS: The adolescents attempting to lose weight had higher weighted prevalence of suicidal ideation, suicide plan, suicide attempt, and suicide attempt with medical treatment compared with other attempts of weight control. Totally, attempting to lose weight was significantly associated with increased risk of suicidal ideation (OR: 1.17, 95%CI: 1.05-1.30) and suicide attempt (OR: 1.26, 95%CI: 1.10-1.46) when adjusting objective weight status, weight perception and all other covariates. In the subgroup analyses, attempting to lose weight was significantly associated with increased risk of suicidality in the adolescents of normal weight, underweight, perceived normal weight, perceived underweight, right estimation of objective weight status. LIMITATIONS: Uncertain causal relationship existed because of cross-sectional design. CONCLUSIONS: The risk of suicidality associated with weight control attempts varied among different subgroups. The findings in this study suggest that not only objective weight status but also weight perception should be with consideration when performing weight control attempts.

The associations between DNA methylation and depression: A systematic review and meta-analysis.

BACKGROUND: Growing evidence suggests that epigenetic modification is vital in biological processes of depression. Findings from studies exploring the associations between DNA methylation and depression have been inconsistent. METHODS: A systematical search of EMBASE, PubMed, Web of Science, and PsycINFO databases was conducted to include studies focusing on the associations between DNA methylation and depression (up to November 1st 2021) according to PRISMA guidelines with registration in PROSPERO (CRD42021288664). RESULTS: A total of 47 studies met inclusion criteria and 31 studies were included in the meta-analysis. This meta-analysis found that genes hypermethylation, including BDNF (OR: 1.15, 95%CI: 1.01-1.32, I2 = 90 %), and NR3C1 (OR: 1.43, 95%CI: 1.09-1.87, I2 = 88 %) was associated with increased risk of depression. Significant association of SLC6A4 hypermethylation with depression was only found in the subgroup of using original data (OR: 1.09, 95%CI: 1.01-1.19, I2 = 52 %). BDNF hypermethylation could increase the risk of depression only in the Asian population (OR: 1.18, 95%CI: 1.01-1.40, I2 = 91 %), and significant associations of NR3C1 hypermethylation with depression were found in the group for depressive symptoms (OR: 1.34, 95%CI: 1.08-1.67, I2 = 85 %), but not for depressive disorder (OR: 1.89, 95%CI: 0.54-6.55, I2 = 94 %). LIMITATIONS: More studies are needed to explore the factors that might influence the estimates owing to the contextual heterogeneity of the pooling of included studies. CONCLUSIONS: It is noted that DNA hypermethylation, namely BDNF and NR3C1, is associated with increased risk of depression. The findings in this study could provide some material evidence for preventing and diagnosing of depression.

Temporal and spatial trends in road traffic fatalities from 2001 to 2019 in Shandong Province, China.

OBJECTIVE: This study explored the temporal and spatial trends in road traffic fatalities in Shandong Province from 2001 to 2019 and discusses the possible influencing factors. METHODS: We collected data from the statistical yearbooks of the China National Bureau of Statistics and the Shandong Provincial Bureau of Statistics. Join-point Regression Program 4.9.0.0 and ArcGIS 10.8 software were used to analyze the temporal and spatial trends. RESULTS: The mortality rate of road traffic injuries in Shandong Province decreased from 2001 to 2019, with an average annual decrease of 5.8% (Z = -20.7, P < 0.1). The three key time points analyzed in the Join-point regression model roughly corresponded to the implementation times of traffic laws and regulations in China. The temporal trend in case fatality rate in Shandong Province from 2001 to 2019 was not statistically significant (Z = 2.8, P < 0.1). The mortality rate showed spatial autocorrelation (global Moran's I = 0.3889, Z = 2.2043, P = 0.028) and spatial clustering. No spatial autocorrelation was observed in the case fatality rate (global Moran's I = -0.0183, Z = 0.2308, P = 0.817). CONCLUSIONS: The mortality rate in Shandong Province decreased significantly over the studied period, but the case fatality rate did not decline significantly and remains relatively high. Many factors influence road traffic fatalities, among which laws and regulations are the most important.

Menstrual pain mediated the association between daytime sleepiness and suicidal risk: A prospective study.

BACKGROUND: Adolescents with daytime sleepiness have been demonstrated to have a higher level of suicidal risk than those without. Currently, few studies had examined the pathway from daytime sleepiness to suicidal risk among female adolescents. This study aimed to explore the association among menstrual pain, daytime sleepiness, and suicidal risk among female adolescents in China. METHODS: Of 7072 adolescents who participated in the follow-up survey of Shandong Adolescents Behavior & Health Cohort (SABHC), 3001 were female adolescents who had begun to menstruate and included for the analysis. A structured self-administrated questionnaire was used to measure menstrual pain, daytime sleepiness, suicidal risk and demographic characteristics. Participants were first surveyed in November-December 2015 and resurveyed 1 year later. RESULTS: Of 3001 participants, 11.43 % had suicidal risk, 79.8 % experienced menstrual pain. Cross-lagged analysis showed that there was cause-and-effect relationship between menstrual pain and daytime sleepiness. Moderate (OR = 1.79, 95%CI: 1.22-2.63) and severe (OR = 2.73, 95%CI: 1.80-4.12) menstrual pain (follow-up) were associated with suicidal risk (follow-up). Daytime sleepiness (baseline: OR = 1.04, 95%CI: 1.02-1.06, follow-up: OR = 1.07, 95%CI: 1.05-1.09) had effects on suicidal risk (follow-up). Mediation analysis showed that menstrual pain played a partially mediating role between daytime sleepiness and suicidal risk, with the indirect effect being 0.002 (95%CI: 0.001-0.004). LIMITATIONS: All data were self-reported. CONCLUSIONS: Menstrual pain and daytime sleepiness had effects on each other, and they both were the risk factors of suicidal risk. Among female adolescents, the association between daytime sleepiness and suicidal risk could be partially mediated by menstrual pain. Releasing the menstrual pain of female adolescents with daytime sleepiness could reduce their suicidal risk.

The Impact of Physical Activity Intensity on the Dynamic Progression of Cardiometabolic Multimorbidity: Prospective Cohort Study Using UK Biobank Data.

BACKGROUND: Although many studies have reported on the associations between the amount of physical activity (PA) and the transitions of cardiometabolic multimorbidity (CMM), the evidence for PA intensity has not been fully evaluated. OBJECTIVE: This study aimed to explore the impact of PA intensity on the dynamic progression of CMM. METHODS: The prospective cohort of this study using data from the UK Biobank included 359,773 participants aged 37-73 years who were recruited from 22 centers between 2006 and 2010. The diagnoses of CMM, which included the copresence of type 2 diabetes (T2D), ischemic heart disease, and stroke, were obtained from first occurrence fields provided by the UK Biobank, which included data from primary care, hospital inpatient record, self-reported medical condition, and death registers. The PA intensity was assessed by the proportion of vigorous PA (VPA) to moderate to vigorous PA (MVPA). Multistate models were used to evaluate the effect of PA intensity on the dynamic progression of CMM. The first model (model A) included 5 transitions, namely free of cardiometabolic disease (CMD) to first occurrence of CMD (FCMD), free of CMD to death, FCMD to CMM, FCMD to mortality, and CMM to mortality. The other model (model B) used specific CMD, namely T2D, ischemic heart disease, and stroke, instead of FCMD and included 11 transitions in this study. RESULTS: The mean age of the included participants (N=359,773) was 55.82 (SD 8.12) years at baseline, and 54.55% (196,271/359,773) of the participants were female. Compared with the participants with no VPA, participants with intensity levels of >0.75 to <1 for VPA to MVPA had a 13% and 27% lower risk of transition from free of CMD to FCMD (hazard ratio [HR] 0.87, 95% CI 0.83-0.91) and mortality (HR 0.73, 95% CI 0.66-0.79) in model A, respectively. The HR for the participants with no moderate PA was 0.82 (95% CI 0.73-0.92) compared with no VPA. There was a substantially protective effect of higher PA intensity on the transitions from free of CMD to T2D and from T2D to mortality, which reveals the importance of PA intensity for the transitions of T2D. More PA and greater intensity had a synergistic effect on decreasing the risk of the transitions from free of CMD to FCMD and mortality. Male participants, younger adults, adults with a higher BMI, current or previous smokers, and excessive alcohol drinkers could obtain more benefits from higher PA intensity for the lower risk of at least 1 transition from free of CMD, then to CMM, and finally to mortality. CONCLUSIONS: This study suggests that higher PA intensity is an effective measure for preventing CMM and mortality in the early period of CMM development. Relevant interventions related to higher PA intensity should be conducted.

The Association of Soft Drink Consumption and the 24-Hour Movement Guidelines with Suicidality among Adolescents of the United States.

BACKGROUND: Evidence is lacking for the association of the behaviors of the 24 h movement guidelines including sleep duration, physical activity, screen time, and soft drink consumption with suicidality among adolescents. METHODS: Data were extracted from a national representative sample of Youth Risk Behavior Surveys (YRBS) in the United States from 2011 to 2019. Binary logistic regression models with complex sampling designs were used to explore the association of the recommendations of the 24 h movement guidelines and soft drink consumption with suicidality. RESULTS: The total prevalence of suicidal ideation, suicide plan, suicide attempt, and suicide attempt with medical treatment was higher among adolescents who did not meet all the recommendations in the 24 h movement guidelines and had a higher level of soft drink consumption. Totally, not meeting all the recommendations of the 24 h movement guidelines was significantly associated with an increased risk of suicidal ideation (OR: 1.69, 95% CI: 1.30-2.19) and suicide plan (OR: 1.76, 95% CI: 1.34-2.33) compared with adolescents who meet all the recommendations. Soft drink consumption of ≥3 times/day was associated with an increased risk of suicidality including suicidal ideation, suicide plan, suicide attempt, and suicide attempt with medical treatment, regardless of sex. Soft drink consumption of ≥3 times/day was significantly associated with an increased risk of suicide attempt and suicide attempt with medical treatment, regardless of whether the recommendations of physical activity, screen time, and sleep duration were met. CONCLUSION: Age-appropriate sleep duration, no more than 2 h of screen time per day, at least 1 h of physical activity per day as contained in the 24 h movement guidelines and less than one soft drink consumption per day are good targets to prevent involvement in suicidality. More actions for intervening in the movement and dietary behaviors among adolescents are needed to maintain physical and mental health.

The Serial Mediation of the Association between Breakfast Skipping and Suicidality by Weight Status and Depressive Symptoms: Findings from the National Youth Risk Behavior Surveys of the United States.

BACKGROUND: The evidence is limited for the dose-response association between breakfast skipping and suicidality. The underlying pathway from breakfast skipping to suicidality has also rarely been explored in previous studies. METHODS: The data of Youth Risk Behavior Surveys (YRBSs) of the United States from 2011 to 2019 were used with a sample size of 74,074. The male: female ratio was nearly 1:1. Binary logistic regression models with complex sampling design were adopted to show the effect of breakfast skipping on weight status, depressive symptoms, and suicidality. Serial mediation was used to explore the association between breakfast skipping and suicidality by overweight/obesity and depressive symptoms. FINDINGS: The weighted prevalence rates (95% confidence interval) of suicidal ideation, suicide plan, suicide attempt, and medically serious suicide attempt for skipping breakfast totally (0 times/week) were 25.6% (24.4-26.8%), 21.7% (20.5-22.9%), 14.2% (13.0-15.3%), and 5.3% (4.6-5.9%). Breakfast skipping was significantly associated with increased risk of suicidal ideation, suicide plan, suicide attempt, and medically serious suicide attempt. There was statistical significance for the linear dose-response association between breakfast skipping and overweight/obesity, depressive symptoms, and suicidality regardless of sex and age. A serial mediation with effect sizes between 39.68% and 51.30% for the association between breakfast skipping and suicidality by overweight/obesity and depressive symptoms was found in this study. CONCLUSIONS: This study emphasizes the hazards of breakfast skipping, which could increase the risk of suicidality among adolescents. Overweight/obesity and depressive symptoms as the mediating factors for the association between breakfast skipping and suicidality should also be with more attention.

Soft drink consumption and depressive symptoms among the adolescents of United States: The mediating role of aggressive behaviors.

BACKGROUND: There is limited evidence for the association among soft drink consumption, aggressive behaviors, and depressive symptoms among the adolescents. METHODS: Data were derived from a national representative sample of Youth Risk Behavior Surveys of United States during 2011 to 2019. Binary logistic regression models with complex sampling design were used to estimate the effect of soft drink consumption on aggressive behaviors and depressive symptoms. Mediating analysis was used to explore the association between soft drink consumption and depressive symptoms by aggressive behaviors. FINDINGS: The total prevalence of depressive symptoms was 3l.2 % (30.3 %-32.0 %). Compared with none of soft drink consumption, <1 time/day (OR: 1.29, 95%CI: 1.19-1.41), 1-2 times/day (OR: 1.49, 95%CI: 1.33-1.67), and ≥3 times/day (OR: 1.95, 95%CI: 1.70-2.24) were significantly associated with increased risk of aggressive behaviors. High levels of soft drink consumption (1-2 times/day, OR: 1.19, 95%CI: 1.07-1.32; ≥3 times/day, OR: 1.61, 95%CI: 1.42-1.81) and aggressive behaviors (OR: 1.98, 95%CI: 1.84-2.13) were found to be significantly associated with increased risk of depressive symptoms. A linear dose-response relationship of soft drink consumption with aggressive behaviors and depressive symptoms was found in this study (all p < 0.001). Aggressive behaviors partially mediated the association between soft drink consumption and depressive symptoms and each pathway was statistically significant. LIMITATIONS: The causal relationship was not able to certain because of the cross-sectional design. CONCLUSIONS: The mediating role of aggressive behaviors on the association of high levels of soft drink consumptions with depressive symptoms should be paid more attention among the adolescents.