The association of material deprivation with major depressive disorder and the role of loneliness and social support: A cross-sectional study.

BACKGROUND: Existing research has highlighted the positive association of material deprivation, loneliness, and poor social support with major depressive disorder (MDD). However, there is limited information on the complex interplay between these risk factors. In this study, we investigated (1) whether loneliness and social support moderate the relationship between material deprivation and MDD and (2) whether social support moderates the association between material deprivation and loneliness. METHODS: We conducted a cross-sectional study analyzing responses from a representative sample of the Spanish adult population, comprising 2790 individuals who were interviewed between 2019 and 2021. The 12-month prevalence of MDD was assessed using the Composite International Diagnostic Interview (CIDI). Loneliness was measured using the three-item UCLA Loneliness Scale, and social support was evaluated with the Oslo social support scale. Material deprivation was measured using an instrument developed by the Spanish National Institute of Statistics (INE). Regression models were constructed to investigate moderating effects. RESULTS: About 25 % of participants experienced material deprivation and 2.8 % had MDD. Among those with lower levels of loneliness, the probability of MDD was almost 0.10 and no significant differences were found in relation to material deprivation. Conversely, differences depending on material deprivation ranged from 0.10 (95 % CI 0.03, 0.18) to 0.44 (95 % CI 0.24, 0.65) among those with higher levels of loneliness. Social support effectively moderated the association between material deprivation and loneliness. LIMITATION: The cross-sectional nature limits causal inferences. CONCLUSION: Social support has the potential to improve loneliness and mental health in individuals with economic difficulties.

Conceptualization of Depression among Medical Students and Its Differences during Medical Education.

The definition of mental disorders has been traditionally a matter of discussion, and it has relevant implications in research and healthcare. Our aim was to explore the conceptualization medical students have of depression and to determine differences across academic years. The Maudsley Attitudes Questionnaire was adapted through a double translation, double back-translation and a preliminary validation, obtaining a Spanish edition. All students of the Faculty of Medicine of the University of Zaragoza and doctors who graduated from this University in 2020 were invited to answer the online questionnaire, and we received 222 answers (response rate: 15.2%). The results were compared by years and levels of education using an ANOVA. The social realist, behavioral, biological, cognitive and psychodynamic models were the most endorsed. The psychodynamic and nihilist models were less embraced by students in later educational years. These students also reported greater confidence in their understanding of depression and of its biological, cognitive and behavioral models. In conclusion, the conceptualization of depression among medical students is complex and multidimensional, and appears to be similar across different years of education. In later years, we found less support for the psychodynamic model, increased confidence in psychiatry and greater ease in handling the concepts of its leading models.

Economic evaluations of eHealth interventions targeting mental health problems in the workplace: a systematic review.

BACKGROUND: Work-related mental health problems impose significant economic and personal burdens. eHealth interventions may offer low-cost, practical solutions, but guidance on their cost-effectiveness in workplace mental health is limited. OBJECTIVE: The objective of this study was to systematically review economic evaluations of workplace eHealth interventions for mental health, offering insights into methodologies and cost-effectiveness outcomes. METHODS: Adhering to PRISMA guidelines, searches were conducted in Embase, MEDLINE, Web of Science, Google Scholar, Cochrane library, PsycInfo and EconLit databases in May 2022, selecting peer-reviewed papers that performed economic evaluations on workplace eHealth interventions for adult mental health. Quality was assessed using the Drummond checklist. RESULTS: From 3213 references, eight met the inclusion criteria. These studies varied in economic perspective, types of economic analysis type, primary outcome measures, intervention focus (e.g. stress, alcohol, insomnia & return-to-work) and direct non-medical costs. Five eHealth interventions were found to be cost-effective and/or have a positive return on investment, with seven studies rated as high quality according to the Drummond checklist. CONCLUSIONS: The study outcomes unveiled the potential cost-effectiveness of eHealth interventions targeting mental health issues, particularly these focusing on workplace stress. However, generalization is challenging due to variations in the methodologies across studies.

Corrigendum/Erratum to "Treatment coverage for depression in the general Spanish population and the impact of the Covid-19 pandemic" [Heliyon 10(11) June 2024 e32594].

[This corrects the article DOI: 10.1016/j.heliyon.2024.e32594.].

Differential attrition and engagement in randomized controlled trials of occupational mental health interventions in person and online: A systematic review and meta-analysis.

OBJECTIVE: This study systematically reviewed and meta-analyzed the differential attrition and utilization of occupational mental health interventions, specifically examining delivery methods (internet-based versus in-person). METHODS: The research, with papers spanning 2010-2024, involved filtering criteria and comprehensive searches across PubMed, Scopus, and Web of Science Core (PROSPERO registration n. CRD42022322394). Of 28 683 titles, 84 records were included in the systematic review, with 75 in meta-analyses. Risk of bias was assessed through the revised Cochrane risk of bias tool for randomized control trials and funnel plots. Differential attrition across studies was meta-analysed through a random-effects model with limited maximum-likelihood estimation for the degree of heterogeneity. RESULTS: Findings reveal higher mean differential attrition in the intervention group, indicating a potential challenge in maintaining participant engagement. The attrition rates were not significantly influenced by the mode of intervention delivery (internet versus in-person). Compensation for participation and year of publication could potentially influence differential attrition from baseline to follow-up measurements. CONCLUSIONS: These results suggest a need for cautious consideration of attrition in occupational mental health intervention study designs and emphasize the importance of adapting statistical analyses to mitigate potential bias arising from differential attrition.

Treatment coverage for depression in the general Spanish population and the impact of the Covid-19 pandemic.

Background: Despite the availability of effective antidepressant strategies, numerous people with depressive disorders remain untreated. The Covid-19 pandemic has affected healthcare services, especially the mental health sector. This study aims to explore the coverage of depression treatments in the general Spanish population and the impact of the Covid-19 pandemic. Methods: We used longitudinal data (2018 and 2022) from the general Spanish population: pre-pandemic n = 1512; mean age = 65.43 years ± 14.90; 56 % females; post-pandemic n = 909; mean age = 68.00 years ± 14.24; 54 % women. The International Classification of Disease 10th edition was used to diagnose lifetime depressive episodes and severity. We explored psychological and pharmacological treatment coverage via multiple logistic regressions adjusted for 4 covariates (sex assigned at birth, education level, age, Covid-19 pandemic) for participants with a diagnosis of depression. Results: Treatment coverage for depression in the pre-pandemic and post-pandemic samples was, respectively, 53.3 % and 51.9 %. We observed an association between severe depression and treatment coverage (OR = 2.77, 95%CI 1.05 to 7.75). We found no association between the COVID-19 pandemic and treatment coverage. Conclusions: The pharmacological treatment coverage was associated with severe types of depression. The prevalence rates of treatment coverage were similar in the pre- and post-COVID-19 pandemic attesting to the resilience of the mental health system in Spain.

The EMPOWER Occupational e-Mental Health Intervention Implementation Checklist to Foster e-Mental Health Interventions in the Workplace: Development Study.

BACKGROUND: Occupational e-mental health (OeMH) interventions significantly reduce the burden of mental health conditions. The successful implementation of OeMH interventions is influenced by many implementation strategies, barriers, and facilitators across contexts, which, however, are not systematically tracked. One of the reasons is that international consensus on documenting and reporting the implementation of OeMH interventions is lacking. There is a need for practical guidance on the key factors influencing the implementation of interventions that organizations should consider. Stakeholder consultations secure a valuable source of information about these key strategies, barriers, and facilitators that are relevant to successful implementation of OeMH interventions. OBJECTIVE: The objective of this study was to develop a brief checklist to guide the implementation of OeMH interventions. METHODS: Based on the results of a recently published systematic review, we drafted a comprehensive checklist with a wide set of strategies, barriers, and facilitators that were identified as relevant for the implementation of OeMH interventions. We then used a 2-stage stakeholder consultation process to refine the draft checklist to a brief and practical checklist comprising key implementation factors. In the first stage, stakeholders evaluated the relevance and feasibility of items on the draft checklist using a web-based survey. The list of items comprised 12 facilitators presented as statements addressing "elements that positively affect implementation" and 17 barriers presented as statements addressing "concerns toward implementation." If a strategy was deemed relevant, respondents were asked to rate it using a 4-point Likert scale ranging from "very difficult to implement" to "very easy to implement." In the second stage, stakeholders were interviewed to elaborate on the most relevant barriers and facilitators shortlisted from the first stage. The interview mostly focused on the relevance and priority of strategies and factors affecting OeMH intervention implementation. In the interview, the stakeholders' responses to the open survey's questions were further explored. The final checklist included strategies ranked as relevant and feasible and the most relevant facilitators and barriers, which were endorsed during either the survey or the interviews. RESULTS: In total, 26 stakeholders completed the web-based survey (response rate=24.8%) and 4 stakeholders participated in individual interviews. The OeMH intervention implementation checklist comprised 28 items, including 9 (32.1%) strategies, 8 (28.6%) barriers, and 11 (39.3%) facilitators. There was widespread agreement between findings from the survey and interviews, the most outstanding exception being the idea of proposing OeMH interventions as benefits for employees. CONCLUSIONS: Through our 2-stage stakeholder consultation, we developed a brief checklist that provides organizations with a guide for the implementation of OeMH interventions. Future research should empirically validate the effectiveness and usefulness of the checklist.

Physical Activity Participation Decreases the Risk of Depression in Older Adults: The ATHLOS Population-Based Cohort Study.

BACKGROUND: To which extent physical activity is associated with depression independent of older adults' physical and cognitive functioning is largely unknown. This cohort study using harmonised data by the EU Ageing Trajectories of Health: Longitudinal Opportunities and Synergies consortium, including over 20 countries, to evaluate the longitudinal association of physical activity (light-to-moderate or vigorous intensity) with depression in older adults (aged ≥ 50 years). RESULTS: We evaluated 56,818 participants (light-to-moderate models; 52.7% females, age 50-102 years) and 62,656 participants (vigorous models; 52.7% females, age 50-105 years). Compared to never, light-to-moderate or vigorous physical activity was associated with a lower incidence rate ratio (IRR) of depression (light-to-moderate model: once/week: 0.632, 95% CI 0.602-0.663; twice or more/week: 0.488, 95% CI 0.468-0.510; vigorous model: once/week: 0.652, 95% CI 0.623-0.683; twice or more/week: 0.591, 95% CI 0.566-0.616). Physical activity remained associated with depression after adjustment for the healthy ageing scale, which is a scale that incorporated 41 items of physical and cognitive functioning (light-to-moderate model: once/week: 0.787, 95% CI 0.752-0.824; twice or more/week: 0.711, 95% CI 0.682-0.742; vigorous model: once/week: 0.828, 95% CI 0.792-0.866; twice or more/week: 0.820, 95% CI 0.786-0.856). CONCLUSIONS: Physical activity, of any intensity and weekly frequency, was a strong protective factor against depression, independent of physical and mental functioning. Health policies could stimulate the incorporation of lower physical activity intensity to protect against depression, which might be more feasible at the population level.

Design and development of a digital intervention for workplace stress and mental health (EMPOWER).

Purpose: We describe the design and development of the European Platform to Promote health and wellbeing in the workplace (EMPOWER) digital intervention that provides an integrative user programme meeting the needs of employees and employers in addressing work stress. Results: A user-centred design process was followed from January 2020 until November 2021. A tailored algorithm was developed to provide support at the individual employee level and the company level. Each element of the digital intervention was developed in English and then translated in Spanish, English, Polish and Finnish. The digital intervention consists of a website and a mobile application (app) that provides algorithm-based personalised content after assessing a user's somatic and psychological symptoms, work functioning, and psychosocial risk factors for work stress. It has a public section and an employer portal that provides recommendations to reduce psychosocial risks in their company based upon clustered input from employees. Usability testing was conducted and showed high ease of use and completion of tasks by participants. Conclusion: The EMPOWER digital intervention is a tailored multimodal intervention addressing wellbeing, work stress, mental and physical health problems, and work productivity. This will be used in a planned RCT in four countries to evaluate its effectiveness.

Sex differences in the symptom network structure of depression: Findings from a nationwide sample of the Spanish adult population.

BACKGROUND: Sex differences in the prevalence and clinical features of depression have been widely described. However, some authors argue that categorical diagnostic systems do not adequately capture the complexity of depression. The aim of this study was to examine sex differences in the symptom network structure of depressive symptoms among individuals with a major depressive episode. METHODS: The study sample consisted of 510 participants (age 62.17 ± 14.43, 71.96 % women) from a nationwide study of the Spanish non-institutionalised adult population (Edad con Salud). To estimate the presence of a 12-month major depressive episode according to DSM-IV criteria, participants were administered an adapted version of the Composite International Diagnostic Interview (CIDI 3.0). A network analysis was carried out to determine possible interrelationships between different depressive symptoms by sex. RESULTS: Men and women showed a similar overall structure and network strength. However, sex-specific variations emerged in relation to individual symptom associations and symptom centrality. Specifically, for individual symptom associations "loss of confidence" and "suicide attempts" were more strongly related in women, and "suicidal ideation" and "impaired thinking" in men. For symptom centrality, "anxiety" played a central role in men's symptomatology, whereas "hopelessness", "loss of confidence", "distress" and "slowness of movement" were the most central symptoms in the women's group. LIMITATIONS: Reliance on cross-sectional data precludes us from determining the direction and temporality of the association between different symptoms. CONCLUSIONS: This study suggests that specific symptoms should be prioritised in the prevention, diagnosis assessment and treatment of depressed patients based on sex.

Loneliness during the last phase of the COVID-19 pandemic in Spain: A longitudinal study of group-based trajectories, risk factors, and consequences in mental health.

INTRODUCTION: The present study aims to investigate the courses of loneliness following a national state of emergency including a curfew due to a rise in COVID-19 cases, associated risk factors, and the effect of loneliness on symptoms of depression and anxiety. METHODS: Data of 2,000 adults in Spain which were interviewed by telephone at the first follow-up of the MINDCOVID project (February-March 2021) and of whom 953 were interviewed nine months later (November-December 2021) were analyzed. Group-based trajectories and mixed models were constructed. RESULTS: Three courses of loneliness were detected: (1) invariant low loneliness (42.6%), (2) decreasing medium loneliness (51.5%), and (3) fairly invariant high loneliness (5.9%). Loneliness courses were associated with the severity and variability of symptoms of depression and anxiety. In contrast to the majority of pre-pandemic studies, younger adults more frequently reported loneliness compared to middle-aged and, particularly, older individuals. Other risk factors for loneliness were being female, being unmarried, and, notably, having pre-pandemic mental disorders. CONCLUSIONS: Future studies should validate whether the newly observed loneliness patterns across age groups persist and assess the evolution of loneliness courses and their impact on mental health, with particular attention given to young adults and individuals with pre-existing mental disorders.

The Mediating Role of General and Cognitive Stress on the Effect of an App-Based Intervention on Productivity Measures in Workers: Randomized Controlled Trial.

BACKGROUND: Loss of productivity is a result of absence from work (absenteeism) or of working with limitations due to illness (presenteeism). Recently, occupational mental health interventions have increasingly been delivered in digital format, as this is thought to be more convenient, flexible, easily accessible, and anonymous. However, the effectiveness of electronic mental health (e-mental health) interventions in the workplace to improve presenteeism and absenteeism remains unknown, and could be potentially mediated by psychological variables such as stress levels. OBJECTIVE: The aim of this study was to determine the effectiveness of an e-mental health intervention to reduce absenteeism and presenteeism in employees, as well as to investigate the mediating role of stress in this effect. METHODS: Employees of six companies in two countries participated in a randomized controlled trial (n=210 in the intervention group and n=322 in the waitlist control group). Participants in the intervention group could use the Kelaa Mental Resilience app for 4 weeks. All participants were asked to complete assessments at baseline, during the intervention, postintervention, and at a 2-week follow-up. Absenteeism and presenteeism were assessed by means of the Work Productivity and Activity Impairment Questionnaire: General Health, while general and cognitive stress were assessed through the Copenhagen Psychosocial Questionnaire-Revised Version. Regression and mediation analyses were performed to evaluate the effect of the Kelaa Mental Resilience app on presenteeism and absenteeism. RESULTS: The intervention did not have a direct effect on presenteeism or absenteeism, neither at postintervention nor at follow-up. Nevertheless, general stress significantly mediated the intervention effect on presenteeism (P=.005) but not on absenteeism (P=.92), and cognitive stress mediated the effect of the intervention on both presenteeism (P<.001) and absenteeism (P=.02) right after the intervention. At the 2-week follow-up, the mediating effect of cognitive stress on presenteeism was significant (P=.04), although this was not the case for its mediating effect on absenteeism (P=.36). Additionally, at the 2-week follow-up, general stress did not mediate the intervention effect on presenteeism (P=.25) or on absenteeism (P=.72). CONCLUSIONS: While no direct effect of the e-mental health intervention on productivity was found in this study, our findings suggest that stress reduction could mediate the effect of the intervention on presenteeism and absenteeism. As such, e-mental health interventions that address stress in employees might also indirectly reduce presenteeism and absenteeism in these employees. However, due to study limitations such as an overrepresentation of female participants in the sample and a high proportion of attrition, these results should be interpreted with caution. Future research is needed to better understand the mechanisms of interventions on productivity in the workplace. TRIAL REGISTRATION: ClinicalTrials.gov NCT05924542; https://clinicaltrials.gov/study/NCT05924542.

Connecting and feeling: Associations between social factors and emotions in nine countries.

We aimed to explore the distribution of positive and negative emotions across nine low-, middle- and high-income countries; and the association between social factors and these emotions. Data were drawn from the SAGE and the COURAGE studies, with 52,553 participants. Emotions were assessed through the day reconstruction method.Sociodemographic characteristics and social factors were also measured. Multiple linear regressions were performed. Finland, China and African countries showed significantly lower scores on the negative emotions, whereas positive emotions were more homogeneous across countries. Loneliness was positively associated with negative emotions and negatively associated with positive ones; frequent social participation was related with higher scores in positive emotions; and lower trust with higher levels of feeling rushed, irritated, depressed and less calm. The extent to which each emotion was felt varied across countries, but there seems to exist an association of social factors with the emotions.

What factors explain the changes in major depressive disorder symptoms by age group during the COVID-19 pandemic? A longitudinal study.

BACKGROUND: Data collected during the COVID-19 pandemic suggest an increase in major depressive disorder (MDD) among younger adults. The current study aims to assess the association of age groups and MDD risk before and during the COVID-19 pandemic and quantify the effect of potential mediating variables such as loneliness, social support, resilience, and socioeconomic factors. METHODS: A representative sample of Spanish adults was interviewed before (2019, N = 1880) and during (2020, N = 1103) the COVID-19 pandemic. MDD was assessed using the CIDI, loneliness through the UCLA scale, social support through the OSSS-3, resilience with the 6-BRS, and worsened economic circumstances and unemployment through a single question. Mixed-models were used to study changes in MDD by age group. Regression models were constructed to quantify the association between age and potential mediators, as well as their mediating effect on the association between age group and MDD. RESULTS: Among the younger age cohorts (18-29 and 30-44 years) the probability of having MDD during the pandemic increased from 0.04 (95 % CI: 0.002-0.09) to 0.25 (0.12-0.39) and from 0.02 (-0.001-0.03) to 0.11 (0.04-0.17), respectively. Some 36.6 % of the association between age and risk of MDD during the pandemic was explained by loneliness (12.0 %), low resilience (10.7 %), and worsened economic situation (13.9 %). LIMITATIONS: Reliance on self-report data and generalizability of the findings limited to the Spanish population. CONCLUSIONS: Strategies to decrease the impact of a pandemic on depressive symptoms among young adults should address loneliness, provide tools to improve resilience, and enjoy improved financial support.

Association between mental disorders and mortality: A register-based cohort study from the region of Catalonia.

We estimated all-cause and cause-specific mortality associated with mental disorder diagnoses using outpatient and inpatient registers from Catalonia. A historical register-based cohort was used, including 516,944 adults diagnosed with psychotic, mood, or anxiety disorders in 2005-2016, and their matched controls. Six psychiatric groups were created using hierarchical rules. Mortality rate ratios (MRRs), calculated with stratified Cox proportional-hazards models adjusted for mental comorbidity, ranged from 2.45 (95%CI = 2.28-2.64) for other non-organic psychoses to 1.11 (95%CI = 1.08-1.15) for anxiety disorders. Higher MRRs were found in males compared to females with non-organic psychoses, other affective and anxiety disorders, and the excess risk of death was higher in younger ages for all the diagnoses except for schizophrenia. Overall, suicide mortality rates were higher for those with mental disorder diagnoses. The highest MRRs due to natural causes were found for metabolic disorders in schizophrenia, infectious diseases in other non-organic psychoses, and respiratory diseases for bipolar, other affective and anxiety disorders. In the most comprehensive study in Southern Europe, excess mortality is observed not only in people with diagnoses of severe mental disorders, but also in those with other mental disorder diagnoses considered less severe, with an important contribution of both natural and unnatural causes.

The role of social support, detachment, and depressive and anxiety symptoms in suicidal thoughts and behaviours during the Covid-19 lockdown: Potential pathways.

During the COVID-19 pandemic, anxiety and depressive symptoms, as well as problems related to social relationships, such as available social support and feelings of detachment from others, have worsened. These factors are strongly associated with suicidal thoughts and behaviours (STB). The effects of feelings of detachment on mental health and on STB have been scarcely studied, together with the relation that it may have with available social support. Therefore, the aim of the present study was to assess potential pathways connecting these conditions. A nationally representative sample of Spanish adults (N = 3305) was interviewed during the COVID-19 pandemic (June 2020). STB, social support, and depressive and anxiety symptoms were measured with the C-SSRS (modified version), OSSS-3, PHQ-8, and GAD-7 scales, respectively. Multivariable logistic regression models and mediation analyses were performed. Social support and some of its components (i.e., social network size and relations of reciprocity) were associated with lower odds of STB. Detachment significantly mediated (22% to 25%) these associations. Symptoms of emotional disorders significantly mediated the association between social support components (29% to 38%) - but not neighbourhood support - with STB, as well as the association between detachment and higher odds of STB (47% to 57%). In both cases, depressive symptoms were slightly stronger mediating factors when compared to anxiety symptoms. Our findings suggest that interventions aimed at lowering depressive and anxiety symptoms, and STB should provide social support and help tackle the feeling of detachment in a complementary way.

Determinants of verbal fluency trajectories among older adults from the English Longitudinal Study of Aging.

BACKGROUND: Prevalence of dementia and cognitive impairment increase creating the need for identifying modifiable risk factors to reduce their burden. The aim of this study was to identify latent groups following similar trajectories in cognitive performance assessed with the verbal fluency test, as well as their determinants. METHODS: Data from English Longitudinal Study of Aging (ELSA) were studied. Latent groups of similar course through a 6-year period in the outcome variable (verbal fluency) were investigated, along with their determinants, using Group Based Trajectory Modeling (GBTM). RESULTS: Four latent groups of verbal fluency trajectories were revealed. Education was the strongest predictor for a favorable trajectory, while cardiovascular disease and depression symptoms were associated with lower within each trajectory. CONCLUSION: Cardiovascular diseases and depressive symptoms are associated with a worse course of verbal fluency through aging, implying that they might serve as targets for interventions to prevent cognitive decline in the aging population. Contrarily, higher level of education is associated with a more favorable course through aging.

The Association of Age With Depression, Anxiety, and Posttraumatic Stress Symptoms During the COVID-19 Pandemic in Spain: The Role of Loneliness and Prepandemic Mental Disorder.

OBJECTIVE: Older adults may be at lower risk of common mental disorders than younger adults during the coronavirus disease 2019 (COVID-19) pandemic. Previous research has shown shown differences by age in psychosocial well-being during the pandemic and have highlighted the moderating effect of prepandemic mental disorders on that association. In this line, we examined the association of age with self-reported symptoms of loneliness, depression, anxiety, and posttraumatic stress, as well as potential roles of loneliness symptoms and prepandemic mental disorders on the association between age and mental disorder symptoms. METHODS: Cross-sectional data of 2000 adults in Spain interviewed by telephone during the COVID-19 pandemic (February-March 2021) were analyzed. Depression, anxiety, and posttraumatic stress were measured with the eight-item Patient Health Questionnaire, the seven-item Generalized Anxiety Disorder Scale, and the four-item checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), respectively. Loneliness was measured with the three-item University of California at Los Angeles Loneliness Scale. Several regression models were constructed to assess factors related to loneliness and mental disorders. RESULTS: According to cutoff points used, 12.4% of participants revealed depression, 11.9% revealed anxiety, and 11.6% revealed posttraumatic stress. Age was negatively related to mental disorder symptoms and loneliness. Loneliness was associated with higher levels of mental disorder symptoms. This association was stronger in younger adults without prepandemic mental disorders and in older adults with them. The association between age and loneliness was stronger in those with prepandemic mental disorders. Loneliness mediated the association of age with mental disorder symptoms. CONCLUSIONS: Interventions focused on loneliness could alleviate the impact of the COVID-19 pandemic on mental health.

The Association Between Substance Use Disorder and Depression During the COVID-19 Lockdown in Spain and the Moderating Role of Social Support: a Cross-Sectional Study.

Substance use disorder is on the rise; it has increased massively during the COVID-19 lockdown and has been found as a risk factor for depressive symptoms and major depressive disorder. Less is known about the hypothetical moderating effect of social support in that association. Three thousand five hundred Spanish adults were interviewed by phone during the COVID-19 lockdown (May-June 2020). The 8-item Patient Health Questionnaire Depression Scale (PHQ-8) was used to measure the symptoms of depression. The CAGE Adapted to Include Drugs (CAGE-AID) questionnaire was used to assess substance use disorder during the previous month. Social support was measured through the Oslo Social Support Scale (OSSS-3). Regression models were constructed to assess factors related to depressive symptoms. People with substance use disorder (alcohol and drugs) showed considerable high levels of depressive symptoms, particularly among those with low levels of social support, which reported levels above major depressive disorder cut-off.

To be happy and behave in a healthier way. A longitudinal study about gender differences in the older population.

INTRODUCTION: Subjective well-being plays a key role in health. The objectives of this study are to analyse the longitudinal associations between subjective well-being dimensions and healthy behaviours, and to examine gender differences. METHOD: A representative sample of 1,190 Spanish non-institutionalised adults aged 50+ were interviewed over a 6-year follow-up period. The Cantril scale was used to measure evaluative well-being. The Day Reconstruction Method measured experienced well-being. The Global Physical Activity Questionnaire was used, whereas fruit and vegetables, tobacco and alcohol consumption, and sleep quality were self-reported. The Generalised Estimating Equation was calculated. RESULTS: Women show significantly worse subjective well-being than men longitudinally. Higher scores in life satisfaction and positive affect were significantly related to a higher level of physical activity and better-quality sleep for both women and men. Associations between a higher life satisfaction and an adequate intake of fruits and vegetables and being a non-smoker was only found in women (OR = 1.05; 95% IC = 1.00, 1.10 and OR = 1.16; 95% IC = 1.09, 1.23, respectively). CONCLUSION: Subjective well-being levels and frequencies in healthy behaviours are different in women and men. Subjective well-being interventions should take into account these differences in the frequency of healthy-unhealthy behaviours.