Individual and joint effects of diabetes and depression on incident cardiovascular diseases and all-cause mortality: Results from a population-based cohort study.

AIMS: To assess the individual and joint effects of diabetes and depression on all-cause mortality and cardiovascular disease (CVD) in the middle-aged and elderly Chinese populations. METHODS: 9105 individuals without CVD from the China Health and Retirement Longitudinal Study (CHARLS) were included and followed up for 9 years. Participants were divided into four comparative groups: diabetes alone, depression alone, both conditions, and neither condition. Multivariate binary logistic regression models were performed to compare the risks of all-cause mortality and CVD among the four groups. RESULTS: When compared to those without diabetes and depression, the multivariate adjusted odds ratios (aORs) for CVD in individuals who had diabetes only, depression only, and both diabetes and depression were 1.245 (95 % CI 1.023 to 1.515), 1.318 (95 % CI 1.171 to 1.485) and 1.722 (95 % CI 1.361 to 2.178), respectively. The aORs for all-cause mortality were 1.366 (95 % CI 1.035-1.804) for diabetes alone, 1.082 (95 % CI 0.916-1.279) for depression alone, and 1.590 (95 % CI 1.152-2.195) for both conditions when compared with those with neither condition. CONCLUSIONS: Individuals with both diabetes and depression had greater risk of CVD and all-cause mortality when compared to those with diabetes or depression alone, or those without either condition.

The combined effects of depression or anxiety with high-sensitivity C-reactive protein in predicting the prognosis of coronary heart disease patients.

BACKGROUND: Depression, anxiety and high-sensitivity C-reactive protein (hs-CRP) are individually associated with poor prognosis in patients with coronary heart disease (CHD). However, the combined effects of depression with inflammation or anxiety with inflammation on the prognosis have been rarely explored. METHODS: This prospective cohort study included 414 patients diagnosed with CHD. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess depression and anxiety. A score ≥ 5 points was defined as elevated depression or anxiety. High hs-CRP was defined as ≥ 3 mg/L. Follow-up was performed 2 years after the patients were discharged. The clinical results included noncardiac readmission, cardiac readmission, major cardiovascular events (MACEs), and composite events. The composite events included noncardiac readmission and MACEs. The Cox proportional hazard regression model was used to analyze the prognostic risk. RESULTS: After full adjustment, patients with elevated depression and high hs-CRP had a higher risk in predicting noncardiac readmission (hazard ratio (HR) = 3.87, 95% confidence interval (CI) = 1.10-9.02, p = 0.002) and composite events (HR = 1.93, 95% CI = 1.13-3.30, p = 0.016) than those with high hs-CRP alone. For the anxiety and hs-CRP group, high hs-CRP alone predicted a higher risk of noncardiac readmission (HR = 3.32, 95% CI = 1.57-7.03, p = 0.002) and composite events (HR = 1.75, 95% CI = 1.12-2.76, p = 0.015) than references. Elevated anxiety had no significant effects on all the endpoints. Furthermore, we didn't find interactions between depression and hs-CRP or anxiety and hs-CRP. CONCLUSION: In patients with CHD, elevated depression with high hs-CRP was found to be significant in predicting the risk of noncardiac readmission and composite events. Early diagnosis and treatment of depression with inflammation are necessary in CHD patients.

Prevalence and management of depressive symptoms in coronary heart disease patients and relationship with cardiovascular prognosis: a prospective cohort study.

AIMS: Depressive symptoms are comorbid with coronary heart disease (CHD). There is a controversial debate about whether screening and intervention for depressive symptoms could improve cardiovascular prognosis. This study characterizes the prevalence, characteristics, cardiovascular prognosis and management need of depressive symptoms among CHD patients. METHODS: CHD patients were recruited between November 18, 2020 and November 26, 2021. Depressive symptoms were evaluated with the Patient Health Questionnaire (PHQ-9). During the 12-month follow-up, cardiovascular disease (CVD) was the endpoint. Time-to-event data were estimated by Kaplan-Meier curves and Cox models. RESULTS: Of 582 patients (25% women), 21.0% had mild depressive symptoms, and 7.5% had moderate-to-severe depressive symptoms during hospitalization. Mild and moderate-to-severe depressive symptoms were risk factor-adjusted predictors of the primary composite endpoints (adjusted HR = 2.20; 95%CI 1.19-4.03, and adjusted HR = 2.70; 95%CI 1.23-5.59, respectively). Platelet count and low-density lipoprotein were higher in mild depressive symptoms compared to no depressive symptoms. CONCLUSION: Depressive symptoms are prevalent in CHD patients. Mild and moderate-to-severe depressive symptoms are associated with higher risk of further CVD in CHD patients. Platelet function and behavioral mechanisms may contribute to this association. TRIAL REGISTRATION: This research was registered at https://www.chictr.org.cn . Full data of first registration is 11/09/2020. The registration number is ChiCTR2000038139.

Perinatal maternal depression and the risk of childhood asthma in offspring: A meta-analysis.

BACKGROUND: Previous studies have yielded conflicting results regarding the link between maternal perinatal depression and asthma in children. To provide a clearer understanding of this relationship, a comprehensive meta-analysis was carried out to evaluate the association mentioned above. METHODS: A comprehensive review of observational studies was conducted by searching electronic databases including Medline, Embase, and Web of Science. The data were combined using a randomized-effects model taking into account potential variations. Subgroup analyses were performed to evaluate the possible impact of study characteristics on outcomes. RESULTS: Ten cohort studies, which included 833,230 mother-child pairs, were examined in the analysis. Maternal depressive symptoms during the perinatal period were associated with an increased risk of asthma in offspring (risk ratio [RR]: 1.24, 95% confidence interval [CI]: 1.19 to 1.30, p < 0.001; I2 = 0%). Further sensitivity analyses restricted to multivariate studies (RR: 1.24, 95% CI: 1.19 to 1.30, p < 0.001; I2 = 0%) or studies where asthma was diagnosed in children aged three years or older (RR: 1.24, 95% CI: 1.19 to 1.30, p < 0.001; I2 = 0%) revealed consistent outcomes. Subgroup analyses according to study design, methods for the diagnosis of maternal depression, timing for the evaluation of maternal depression, methods for the validation of asthma in offspring, adjustment of maternal smoking during pregnancy and of maternal asthma, or study quality score showed similar results (p for subgroup difference all > 0.05). CONCLUSIONS: Maternal perinatal depression appears to be significantly linked to a higher occurrence of childhood asthma in children.

Construction and verification of a risk prediction model for cognitive frailty in older patients with chronic obstructive pulmonary disease and diabetes mellitus.

OBJECTIVE: We explored risk factors for cognitive frailty in older patients with chronic obstructive pulmonary disease (COPD) and diabetes mellitus to develop and verify a risk prediction model for cognitive frailty. METHODS: This was a cross-sectional study. Convenience sampling was used to randomly select 378 patients hospitalized between February 2022 and December 2023. We allocated 265 patients who visited between February 2022 and February 2023 to a modeling group to analyze risk factors for cognitive frailty and create a logistic regression model for risk prediction. Another 113 patients who visited between March 2023 and December 2023 were included in a validation group for model verification. RESULTS: The cognitive frailty incidence in the 265 patients was 35.09% (93/265). Regression analysis showed that age >80 years (odds ratio [OR] = 4.576), regular exercise (OR = 0.390, polypharmacy (OR = 3.074), depression (OR = 2.395) duration of COPD combined with diabetes (OR = 1.902), Family APGAR index score (OR = 0.428), and chronic pain (OR = 2.156) were factors influencing the occurrence of cognitive frailty in older patients with COPD accompanied by diabetes. CONCLUSIONS: The constructed risk prediction model for cognitive frailty in older patients with COPD and diabetes showed good predictive value, aiding in the clinical identification of high-risk patients and facilitating timely intervention and guidance.

Association of periodontitis with all-cause and cause-specific mortality among individuals with depression: a population-based study.

To detect the association between periodontitis and all-cause as well as cause-specific mortality rates among adults diagnosed with depression. Participants diagnosed with depression were selected from NHANES across three periods (1988-1994; 1999-2004; 2009-2014). Cox proportional hazards and Weibull accelerated failure time (AFT) models were utilized to calculate hazard ratios (HRs), time ratios (TRs), and their 95% confidence intervals (CIs) to evaluate the association between moderate-to-severe periodontitis and all-cause as well as cause-specific mortality among participants with depression. white blood counts and C-reactive protein were used to assess the mediating role of systemic inflammation. Among the 1,189 participants with a median follow-up of 9.25 years, 133 deaths were recorded. After adjusting for multiple variables, moderate-to-severe periodontitis was obvious associated with an increased risk of cancer-related mortality in individuals with depression (Cox: HR 3.22, 95% CI 1.51-6.83, P = 0.002; AFT: TR 0.70, 95% CI 0.52-0.94, P = 0.017). Neither WBC nor CRP significantly mediate the association between periodontitis and cancer-related mortality. The risk of cancer-related mortality rose with the severity of periodontitis (P for trend = 0.021). However, no association was observed between moderate-to-severe periodontitis and other kinds of mortality. Moderate-to-severe periodontitis is linked to an elevated risk of cancer-related mortality among adults diagnosed with depression, with the mortality risk increasing alongside the severity of periodontitis. No significant mediating effect of systemic inflammation was found in this association. These findings highlight the importance of addressing periodontal health in individuals with depression. By uncovering the association between periodontitis and mortality in this population, our study underscores the potential benefits of preventive dental care and periodontal treatment in reducing the risk of cancer-related mortality in individuals with depression.

Increased risk of depression and associated symptoms in poststroke aphasia.

Poststroke aphasia hinders patients' emotional processing and social adaptation. This study estimated the risks of depression and related symptoms in patients developing or not developing aphasia after various types of stroke. Using data from the US Collaborative Network within the TriNetX Diamond Network, we conducted a retrospective cohort study of adults experiencing their first stroke between 2013 and 2022. Diagnoses were confirmed using corresponding International Classification of Diseases, Tenth Revision, Clinical Modification codes. Patients were stratified by poststroke aphasia status and stroke type, with propensity score matching performed to control for confounders. The primary outcome was depression within one year post-stroke; secondary outcomes included anxiety, fatigue, agitation, emotional impact, and insomnia. Each matched group comprised 12,333 patients. The risk of depression was significantly higher in patients with poststroke aphasia (hazard ratio: 1.728; 95% CI 1.464-2.038; p < 0.001), especially those with post-hemorrhagic-stroke aphasia (hazard ratio: 2.321; 95% CI 1.814-2.970; p < 0.001). Patients with poststroke aphasia also had higher risks of fatigue, agitation, and emotional impact. Anxiety and insomnia risks were higher in those with post-hemorrhagic-stroke aphasia. Poststroke aphasia, particularly post-hemorrhagic-stroke aphasia, may increase the risks of depression and associated symptoms, indicating the need for comprehensive psychiatric assessments.

Obesity mediates the relationship between depression and infertility: insights from the NHANES 2013-2018 cross-sectional study and a Mendelian randomization study.

Background: Depression is increasingly recognized as a factor affecting infertility and the causal relationship between them remains controversial. The aim of this study was to explore the relationship between depression and infertility using Mendelian randomization (MR) and cross-sectional study, and to explore the potential mediating role of obesity. Methods: The cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) 2013-2018. Multivariable-adjusted logistic regression was used to assess the association between depression and infertility risk, and mediation analysis was to examine the mediating effect of obesity. Then, we performed MR analyses to investigate the causal effect of depression on infertility. Instrumental variables for depression were obtained from a genome-wide association meta-analysis (135,458 cases and 344,901 controls), and summary level data for infertility were obtained from the FinnGen database (6,481 cases and 68,969 controls). Results: In the cross-sectional study, a total of 2,915 participants between the ages of 18 and 45 were included, of whom 389 were infertile. We observed that depression was strongly associated with an increased risk of infertility (OR=1.66, 95%CI: 1.19, 2.33), and this relationship remained significant in mild (OR=1.45, 95% CI: 1.09, 1.93), moderate (OR=1.89, 95% CI: 1.26, 2.84), and severe depression (OR=1.74, 95% CI: 1.02, 2.99). Mediation analysis showed that obesity mediated 7.15% and 15.91% of the relationship between depression and infertility for body mass index and waist circumference. Furthermore, depression significantly increased the risk of infertility in both the general obesity (OR=1.81, 95%CI=1.20-2.73, P<0.01) and abdominal obesity populations (OR=1.57, 95%CI=1.08-2.27, P=0.02) populations. In addition, the MR analysis also revealed a significant positive causal relationship between genetically predicted depression and infertility (OR=1.32, 95% CI: 1.03, 1.70). Conclusion: Depression is associated with an increased risk of infertility, with obesity playing a significant mediating role. This study underscores the importance of incorporating mental health and weight management in infertility treatment strategies.

Probiotics may be useful for drug-induced liver dysfunction in patients with depression - A secondary analysis of a randomized clinical trial.

BACKGROUND & AIMS: There is a need to identify new treatment options for depression with its comorbidities. Depression often coexists with liver steatosis and the two may share a pathophysiological overlap, including inflammation and microbiota changes. Probiotics might represent a safe option as an adjunctive therapy in patients with depression and possible liver steatosis. The paper presents the secondary analysis of a clinical trial of the effect of probiotic supplementation on the levels of non-invasive markers of liver steatosis and fibrosis in adult patients with depressive disorders. METHODS: The research had a two-arm, parallel-group, prospective, randomized, double-blind, controlled design on probiotics in depression. 116 participants received a probiotic preparation containing Lactobacillus helveticus Rosell®-52 and Bifidobacterium longum Rosell®-175 over 60 days. Here, data from 92 subjects was analyzed. The following were assessed: alanine aminotransferase (ALT), alanine aminotransferase/aspartate aminotransferase (ALT/AST) ratio, Hepatic Steatosis Index, Framingham Steatosis Index, as well as non-invasive biomarkers of liver fibrosis (AST to Platelet Ratio Index, Fibosis-4 Index), or baseline socio-demographic, clinical, and laboratory parameters. RESULTS: The probiotics did not influence liver steatosis and fibrosis parameters compared with placebo (p = 0.940 for HSI). However, the subgroup analysis revealed significant differences in liver-related parameters when stratified by the main diagnosis group (better improvement in steatosis indices after probiotics in depressive episode than mixed depression and anxiety disorder patients) or psychotropic medications use (better improvement in ALT-based indices after probiotics in antidepressant-treated subjects than those non-antidepressant-treated). The interplay between probiotics, medications, clinical and metabolic profiles of depression, and the changes in liver-related parameters has been discussed. CONCLUSIONS: Multiple factors may modulate the postulated hepatoprotective properties of probiotics efficacy in patients with depression. Further studies with larger sample sizes, different probiotic strains, and longer intervention period are necessary to assess the real significance of probiotics for liver health in this population. GOV IDENTIFIER: NCT04756544.

Association between adolescent depression and adult suicidal behavior: A systematic review and meta-analysis.

This meta-analysis aims to estimate the association between adolescent depression and adult suicidal behavior, while systematically evaluating gender differences reported in literature. A random-effects model was used to determine the pooled association, reporting odds ratios (ORs) with corresponding 95 % confidence intervals (CIs). Nine articles comprising over 6084 adolescents together showed that people with a history of depression in adolescence are more likely to gain suicidal behaviors during adulthood (OR = 3.97, 95 % Cl: 2.79, 5.63). Sex-specific analysis indicated that males who experienced depression in adolescence developed a higher incidence of suicidal behavior in adulthood compared to females with a similar history (Males: OR = 3.61, 95 % Cl: 1.02, 12.78; Females: OR = 3.56, 95 % Cl: 1.71, 7.43). Furthermore, suicide attempts emerged as the predominant outcome among various suicidal behaviors (OR = 3.43, 95 % Cl: 1.75, 6.71). This meta-analysis provides robust evidence that depression in adolescence significantly increases the risk of suicidal behavior in adulthood.

Intravenous patient-controlled analgesia with esketamine improves early depressive symptoms in patients with postherpetic neuralgia: a single-center retrospective cohort study.

OBJECTIVE: Patients with Postherpetic Neuralgia (PHN) often exhibit depressive-like symptoms, significantly impacting their quality of life. Esketamine, known for its analgesic properties, has also been recognized for its rapid antidepressant effects. However, its efficacy in the treatment of PHN requires further exploration. This study aims to evaluate the impact of intravenous patient-controlled analgesia(PICA) with esketamine on depressive mood in PHN patients. METHODS: This retrospective study analyzed PHN patients hospitalized and treated at the affiliated hospital of Southwest Medical University from June 2021 to March 2023. Patients were divided into the esketamine group (E group) and the sufentanil group (S group) based on their treatment regimens. Primary outcomes included pain numerical rating scale(NRS), depression patient health questionaire-9(PHQ-9), and anxiety generalized anxiety disorder-7(GAD-7) scores measured before treatment, and at 3 days, 7 days, 1 month, 2 months, and 3 months post-treatment. RESULTS: A total of 83 patients were included in the analysis. Before treatment, there were no statistically significant differences in pain NRS, depression PHQ-9, and anxiety GAD-7 scores between the two groups (P > 0.05). Compared to before treatment, significant reductions in pain NRS scores were observed at all post-treatment time points in both groups (P < 0.05), with no differences between groups (P > 0.05). The E group exhibited significantly lower depression PHQ-9 scores than the S group at 3 days and 7 days post-treatment (P < 0.05), but no significant differences were observed at 1 month, 2 months, and 3 months (P > 0.05). Anxiety GAD-7 scores were significantly lower in the E group compared to the S group at 3 days, 7 days post-treatment (P < 0.05), with no statistical differences at 1 month, 2 months, and 3 months post-treatment (P > 0.05). CONCLUSION: Both PICA with esketamine and sufentanil alleviated pain equally in PHN patients. However, PICA with esketamine specifically improved early symptoms of anxiety and depression.

The multiple mediating effects of vision-specific factors and depression on the association between visual impairment severity and fatigue: a path analysis study.

BACKGROUND: Severe fatigue is a common symptom for people with visual impairment, with a detrimental effect on emotional functioning, cognition, work capacity and activities of daily living. A previous study found that depression was one of the most important determinants of fatigue, but less is known about disease-specific factors in this patient population. This study aimed to explore the association between visual impairment severity and fatigue in adults with low vision, both directly and indirectly, with vision-specific factors and depression as potential mediators. METHODS: Cross-sectional data were collected from 220 Dutch low vision service patients by telephone interviews. Fatigue was defined as a latent variable by severity and impact on daily life. Potential mediators included vision-related symptoms, adaptation to vision loss and depression. Hypothesized structural equation models were constructed in Mplus to test (in)direct effects of visual impairment severity (mild/moderate, severe, blindness) on fatigue through above mentioned variables. RESULTS: The final model explained 60% of fatigue variance and revealed a significant total effect of visual impairment severity on fatigue. Patients with severe visual impairment (reference group) had significantly higher fatigue symptoms compared to those with mild/moderate visual impairment (ß = -0.50, 95% bias-corrected confidence interval [BC CI] [-0.86, -0.16]) and those with blindness (ß = -0.44, 95% BC CI [-0.80, -0.07]). Eye strain & light disturbance, depression and vision-related mobility mediated the fatigue difference between the severe and mild/moderate visual impairment categories. The fatigue difference between the severe visual impairment and blindness categories was solely explained by eye strain & light disturbance. Moreover, depressive symptoms (ß = 0.65, p < 0.001) and eye strain & light disturbance (ß = 0.19, p = 0.023) were directly associated with fatigue independent of visual impairment severity. CONCLUSIONS: Our findings indicate an inverted-U shaped relationship between visual impairment severity and fatigue in patients with low vision. The complexity of this relationship is likely explained by the consequences of visual impairment, in particular by strained eyes and depressive mood, rather than by severity of the disability itself.

Avoidance and Rumination as Predictors of Substance Use, Mental Health, and Pain Outcomes Among People Living With HIV.

Pain, substance use, and mental health conditions are common among people living with HIV (PLWH), and avoidance and rumination may influence the co-occurrence of these conditions. The present study examined longitudinal associations between avoidance/rumination and pain outcomes, anxiety, anger, and substance use among PLWH. Participants (N = 187) with chronic pain and depressive symptoms completed self-report assessments over a 1-year period. Greater avoidance/rumination was positively associated with mental health outcomes (anxiety, anger), pain interference, and alcohol use across participants after controlling for depression severity. At time points with greater avoidance/rumination than average, participants also reported increased pain severity and interference, anxiety and anger symptoms, and alcohol use. No associations were found between avoidance/rumination and cannabis use. Results suggest a mechanistic effect of avoidance/rumination, such that increases in avoidance/rumination correspond with poorer health outcomes among PLWH over time. Targeting avoidance/rumination through intervention approaches may be beneficial for addressing comorbid health conditions among PLWH. Additional research is necessary to investigate this possibility and further characterize the effects of avoidance/rumination on health outcomes for PLWH.

Ultrasound evaluation contrasts clinical disease activity evaluation in rheumatoid arthritis patients with concomitant anxiety or depression.

OBJECTIVES: To compare disease activity as assessed by ultrasonography (US) between rheumatoid arthritis (RA) patients with and without anxiety or depression, and to compare clinical disease activity and sociodemographic measures between these patient groups. METHODS: Anxious or depressed patients were identified by EuroQoL-5D-3L question "I am not/moderately/extremely anxious or depressed." US assessments of 36 joints and 4 tendons were performed and power Doppler (PD) and grey scale (GS) sum scores calculated (both range 0-120). Comparisons between anxious/depressed and not anxious/depressed patients were performed in unadjusted analyses, adjusted logistic regression, and sensitivity analyses. RESULTS: A total of 201 RA patients starting biological disease-modifying antirheumatic drugs were included (82 % women, mean age 52 years, disease duration 10 years). Hundred-and-nine patients (54.2 %) were moderately or extremely anxious/depressed. Median (IQR) PD (13 (4, 21) vs. 10 (3, 20), p = 0.53) and GS (28 (18, 42) vs. 25 (14, 41), p = 0.51) sum scores were similar between anxious/depressed and not anxious/depressed patients, respectively, whereas composite scores of disease activity were significantly worse in the anxious/depressed patients (p < 0.001), as were also patient-reported outcomes, ESR, CRP and plasma calprotectin (all p ≤ 0.02). Sensitivity analyses confirmed these findings, except for CRP. Self-reported economy and sleep difficulties were also worse in the anxious/depressed patients and a higher proportion were not working (all p < 0.001). CONCLUSION: This study highlights the negative impact of anxiety and depression on RA patients in standard care, and underscores the challenges in disease activity assessment. US examination may be a valuable objective tool in the evaluation of these patients.

Triglyceride-glucose index as a potential predictor of major adverse cardiovascular and cerebrovascular events in patients with coronary heart disease complicated with depression.

Background: Triglyceride-glucose (TyG) index is a surrogate marker of insulin resistance and metabolic abnormalities, which is closely related to the prognosis of a variety of diseases. Patients with both CHD and depression have a higher risk of major adverse cardiovascular and cerebrovascular events (MACCE) and worse outcome. TyG index may be able to predict the adverse prognosis of this special population. Methods: The retrospective cohort study involved 596 patients with both CHD and depression between June 2013 and December 2023. The primary outcome endpoint was the occurrence of MACCE, including all-cause death, stroke, MI and emergent coronary revascularization. The receiver operating characteristic (ROC) curve, Cox regression analysis, Kaplan-Meier survival analysis, and restricted cubic spline (RCS) analysis were used to assess the correlation between TyG index and MACCE risk of in patients with CHD complicated with depression. Results: With a median follow-up of 31 (15-62) months, MACCE occurred in 281(47.15%) patients. The area under the ROC curve of TyG index predicting the risk of MACCE was 0.765(0.726-0.804) (P<0.01). Patients in the high TyG index group(69.73%) had a significantly higher risk of developing MACCE than those in the low TyG index group(23.63%) (P<0.01). The multifactorial RCS model showed a nonlinear correlation (nonlinear P<0.01, overall P<0.01), with a critical value of 8.80 for the TyG index to predict the occurrence of MACCE. The TyG index was able to further improve the predictive accuracy of MACCE. Conclusions: TyG index is a potential predictor of the risk of MACCE in patients with CHD complicated with depression.

Migraine and gastroesophageal reflux disease: Disentangling the complex connection with depression as a mediator.

OBJECTIVE: Gastroesophageal reflux disease (GERD) and migraine are public health concerns worldwide. No observational study has conclusively elucidated the causal relationship between these two conditions. We employed Mendelian randomization (MR) methods to explore the potential causal links between GERD and migraine. METHODS: Genome-wide association studies were subjected to MR to infer the causality between GERD and migraine. Bidirectional two-sample MR was performed to establish causal relationships. Multivariable MR analysis was conducted to adjust potential confounding factors, and mediation MR analysis was utilized to assess the role of depression between GERD and migraine as a mediator. We primarily utilized the inverse variance weighted method (IVW) and sensitivity analysis methods, including MR-Egger, weighted median, and leave-one-out methods. We assessed heterogeneity and pleiotropy to ensure the reliability of the results. RESULTS: Bidirectional two-sample MR revealed a positive causal effect of GERD on migraine (IVW: OR = 1.49, 95% CI: 1.34-1.66, p = 3.70E-13). Migraine did not increase the risk of GERD (IVW: OR = 1.07, 95% CI: 0.98-1.17, p = 0.1139). Multivariable MR indicated that the positive causal effect of GERD on migraine remained after adjustment for factors, such as smoking, alcohol consumption, obesity, type 2 diabetes, and depression. Mediation MR revealed that depression mediated 28.72% of GERD's effect on migraine. MR analysis was supported by all sensitivity analyses and was replicated and validated in another independent dataset on migraine. CONCLUSION: Our findings elucidate the positive causal effect of GERD on migraine and underscores the mediating role of depression in increasing the risk of migraine due to GERD. Effective control of GERD, particularly interventions targeting depression, may aid in preventing the occurrence of migraine. Future research should delve deeper into the specific pathophysiological mechanisms through which GERD affects migraine risk, facilitating the development of more effective drug targets or disease management strategies.

Examining the Longitudinal Effects of Insomnia on Depression and Medication Adherence in People Living with HIV.

OBJECTIVE: The management of HIV has shifted from a focus solely on the disease to a broader perspective encompassing co-occurring medical conditions and quality of life. Mental health concerns such as depression and sleep disturbances, particularly insomnia, are often overlooked in HIV care. The aim of the study was to investigate the longitudinal impact of insomnia on depression and medication adherence among (PLWH). METHODS: This study, conducted in an urban HIV clinic, involved active patients and assessed depression, insomnia, and medication adherence at baseline, 3-month, and 6-month intervals. Hierarchical linear models were employed to analyze the fixed and random effects of time, within-person and between-person insomnia on depression, as well as the effects of time, within-person and between-person depression on ART adherence. RESULTS: Within-person effects revealed that each one unit increase in the Insomnia Severity Index (ISI) was associated with a b = 0.267-point rise in Patient Health Questionnaire-9 (PHQ-9) scores (p < .001). Between-person effects revealed that each one-point increase in an individual's average ISI score was associated with a 0.476-point elevation in their PHQ-9 scores (p < .001). The between-person effects of depression on medication adherence indicated significance, with each point increase in an individual's average PHQ-9 score being linked to a 0.36% decrease in adherence (p = .012). CONCLUSION: The study underscores the potential impact of insomnia on mental health and treatment adherence in people living with HIV (PLWH). This study emphasizes the necessity of comprehensive care models considering the interplay between sleep quality, mental health, and medication adherence for PLWH.

Interaction effects between sleep-related disorders and depression on hypertension among adults: a cross-sectional study.

BACKGROUND: Hypertension, sleep disorders, and depression represent notable public health issues, and their interconnected nature has long been acknowledged. The objective of this study is to explore the interplay between sleep disorders and depression in the context of hypertension. METHODS: This cross-sectional study involved 42,143 participants aged 18 and above from the NHANES database across seven survey cycles between 2005 and 2018. After excluding those with missing data on depression, sleep disorders, and hypertension, as well as incomplete main variables, 33,383 participants remained. We used weighted logistic regression to examine the relationship between sleep disorders, depression, and hypertension. Additionally, we assessed the interaction between sleep disorders and depression on hypertension using both multiplicative and additive approaches to quantify their combined effect. RESULTS: Compared to individuals without sleep disorders, those with sleep disorders have an increased risk of hypertension (OR = 1.51, 95% CI: 1.37-1.67). Furthermore, individuals with depression experience a significantly higher risk of hypertension compared to those with sleep disorders alone (OR = 2.34, 95% CI: 1.95-2.80). Our study reveals a positive interaction between sleep disorders and depression in relation to hypertension risk (OR = 1.07, 95% CI: 1.02-1.13). In addition, we observed the quantitative additive interaction indicators (RERI = 0.73, 95% CI: 0.56 ~ 0.92; API = 0.31, 95% CI: 0.11 ~ 0.46; SI = 2.19, 95% CI: 1.08-3.46) influencing hypertension risk. Furthermore, our research also identified that individuals with less than 7 h of sleep, a sleep latency period between 5 and 30 min, or a latency period exceeding 30 min experience a significantly increased risk of hypertension. CONCLUSIONS: Our research uncovered separate links between sleep disorders, depression, and hypertension prevalence. Moreover, we identified an interaction between depression and sleep disorders in hypertension prevalence. Enhancing mental well-being and tackling sleep disorders could help prevent and manage hypertension. Yet, more investigation is required to establish causation and clarify mechanisms.