Browsing by Subject "depressive symptoms"

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  • Neuvonen, Elisa; Lehtisalo, Jenni; Ngandu, Tiia; Levälahti, Esko; Antikainen, Riitta; Hänninen, Tuomo; Laatikainen, Tiina; Lindström, Jaana; Paajanen, Teemu; Soininen, Hilkka; Strandberg, Timo; Tuomilehto, Jaakko; Kivipelto, Miia; Solomon, Alina (2022)
    Depression and cognition are associated, but the role of depressive symptoms in lifestyle interventions to prevent dementia needs further study. We investigated the intervention effect on depressive symptoms and their associations with cognition in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER; NCT01041989), a two-year multidomain lifestyle trial. One thousand two-hundred and sixty individuals (60-77 years) at risk for dementia were randomised into a multidomain intervention (diet, exercise, cognitive training, and vascular/metabolic risk monitoring) or control group (regular health advice). Depressive symptoms (Zung scale) and cognition (modified Neuropsychological Test Battery) were evaluated at baseline, 12, and 24 months. One thousand one-hundred and twenty-five participants had baseline Zung data. Mean Zung score decreased 0.73 (SD 5.6) points in the intervention and 0.36 (5.6) points in the control group, with nonsignificant between-group difference (group x time coefficient -0.006, 95% CI -0.019 to 0.007). Overall, higher baseline Zung score was associated with less improvement in global cognition (-0.140, p = 0.005) and memory (-0.231, p = 0.005). Participants with clinically significant baseline depressive symptoms (Zung >= 40 points) had less intervention benefit to executive functioning (group x time x Zung -0.096, 95% CI -0.163 to -0.028). Change in Zung score was not associated with change in cognition. Clinically significant depressive symptoms warrant more attention when designing dementia-prevention interventions.
  • Ketvel, Laila (Helsingin yliopisto, 2021)
    Objective: Both stress-related exhaustion and depression have previously been associated with a decline in cognitive performance, but there is a lack of evidence on whether these conditions have different associations with different cognitive domains and whether they have additive effects on cognitive performance. Furthermore, very little is known about the cognitive effects of chronic stress-related exhaustion. Consequently, the aims of this study were to 1) examine the associations between current stress-related exhaustion and cognitive performance, 2) investigate whether different developmental trajectories of stress-related exhaustion are differently associated with cognitive performance, 3) compare the association between stress-related exhaustion and cognitive performance to the relationship between depressive symptoms and cognitive performance, 4) examine if individuals with comorbid stress-related exhaustion and depression have lower cognitive performance than individuals with at most one of these conditions (i.e., whether clinical stress-related exhaustion and clinical depression might have additive effects on cognitive performance). Methods: The data used in the study was a Finnish population-based sample of six cohorts born between 1962 and 1977 from the Cardiovascular Risk in Young Finns Study. Stress-related exhaustion was assessed using the Maastricht Questionnaire, depressive symptoms with the Beck Depression Inventory, and cognitive performance with four subtests of the Cambridge Neuropsychological Test Automated Battery, measuring visuospatial associative learning, reaction time, sustained attention, and executive functions. Cognitive performance and depressive symptoms were assessed in 2012, and stress-related exhaustion in 2001, 2007, and 2012. Participants were 35 to 50 years old in 2012. Linear associations between stress-related exhaustion and cognitive performance (N = 905) and depressive symptoms and cognitive performance (N = 904) were examined by conducting multivariate regression analyses. Age, sex, socioeconomic status, and parents’ socioeconomic status were controlled in the regression models. Additionally, multivariate analyses of variance were performed to investigate the different developmental trajectories of stress-related exhaustion and their relation to cognitive performance (N = 541) and the associations of comorbid stress-related exhaustion and depression with cognitive performance (N = 1273). Results and conclusion: The main finding was that high stress-related exhaustion is associated with slower reaction times, but not with performance in spatial working memory, visuospatial associative learning, or executive functions. Ongoing, chronic stress-related exhaustion was more strongly associated with slower reaction times than short-term exhaustion experienced years ago. Compared to depressive symptoms, high stress-related exhaustion was associated with slower reaction times also when subclinical cases were included, whereas only clinical levels of depressive symptoms had an association with slower reaction times. There were no differences in cognitive performance between individuals with only stress-related exhaustion or depression and those with comorbid stress-related exhaustion and depression, which supports the notion that these conditions do not have additive effects on cognitive performance. These findings add to the existing evidence of the cognitive effects of stress-related exhaustion in the general population and have several practical implications. Further research is needed on the topic, preferably with longitudinal designs, more comprehensive cognitive measures, and clinical assessment of the psychiatric symptoms.
  • Raatikainen, Ilkka; Mäntyselkä, Pekka; Heinonen, Ari; Vanhala, Mauno; Kautiainen, Hannu; Koponen, Hannu; Korniloff, Katariina (2021)
    Objectives The aims of this study were to investigate whether baseline leisure-time physical activity (LTPA) is associated with future recovery from depression among patients with a depression diagnosis and whether baseline LTPA is associated with total physical activity after five years of follow-up. Methods A total of 258 patients aged >= 35 years with clinically confirmed depression at baseline participated. The study was conducted between 2008 and 2016 in municipalities within the Central Finland Hospital District. Depressive symptoms (DS) were determined with the Beck Depression Inventory (BDI) with a cutoff score >= 10, and depression diagnoses were confirmed by the Mini-International Neuropsychiatric Interview (MINI). Blood pressure and anthropometric parameters were measured and blood samples for glucose and lipid determinations were drawn at baseline. LTPA, physical activity, and other social and clinical factors were captured by standard self-administered questionnaires at baseline and the five-year follow-up point. Results Of the 258 patients, 76 (29%) had DS at follow-up. Adjusted odds ratio (OR) for future DS was 1.43 (confidence interval [CI] 0.69-2.95) for participants with moderate LTPA and 0.92 (CI 0.42-2.00) for participants with high LTPA, compared with low LTPA at baseline. Higher baseline LTPA levels were associated with higher total physical activity in the future (beta=0.14 [95% CI: 0.02-0.26] for linearity = 0.024). Conclusion Baseline LTPA did not affect the five-year prognosis of depression among depressed patients in a Finnish adult population. Because the baseline LTPA level predicted the future total physical activity, it could be included as a part of the overall health management and treatment of depression in clinical practices.
  • Wesolowska, Karolina; Elovainio, Marko; Hintsa, Taina; Jokela, Markus; Pulkki-Raback, Laura; Lipsanen, Jari; Juonala, Markus; Raitakari, Olli; Keltikangas-Jarvinen, Liisa (2018)
    Objective: Depressive symptoms have been associated with Type 2 diabetes, but the temporal direction of this association and the underlying mechanisms remain unclear. The present study examined a potential bidirectional association between depressive symptoms and glucose levels in women and men, and the factors mediating this association. Method: The participants were from the Cardiovascular Risk in Young Finns Study, a prospective, population-based, cohort study (N = 2,534). Depressive symptoms were assessed using a modified Beck Depression Inventory. Fasting glucose was measured concurrently with depressive symptoms. To analyze the data, a multiple-group cross-lagged analysis and parallel multiple mediation in structural equation modeling were used. Results: Depressive symptoms in 2001 were positively associated with glucose levels in 2012 in women (beta = .07, p = .023) but not in men (beta = -.03, p = .45). This sex difference was statistically significant (p = .042). Glucose levels in 2001 did not predict depressive symptoms in 2012 in either women or men (ps = .96). Changes in body mass index, high-sensitivity C-reactive protein, alcohol consumption, or tobacco or cigarette smoking did not mediate the observed association (ps > .05). Conclusions: The results showed a positive association between depressive symptoms and glucose levels in women but not in men. The direction of this relationship seems to be from depressive symptoms to glucose levels rather than the reverse. Changes in body fat, inflammation, alcohol consumption, or tobacco or cigarette smoking may not play a mediating role in this observed association.
  • Mikkonen, Janne (Helsingfors universitet, 2015)
    Studies on the intergenerational transmission of depressive symptoms form a long research tradition. Numerous studies have indicated that children of depressed mothers face an up to 3-fold risk of exhibiting depressive symptoms later in life compared with those children whose mother has not had depressive symptoms. Later studies have observed that paternal depressive symptoms pose an almost equal risk factor particularly for boys. After having established the association between parental and offspring depressive symptoms, research has focused on exploring the mechanisms underlying the transmission of risk. These are also the principal point of interest in the present thesis that gives particular weight to the role of gender, socioeconomic circumstances (parental education and household income) and timing of exposure, belonging to often-hypothesized but seldom-examined shapers of the transmission of risk. Besides these, the study sheds light on the significance of gender of which previous research has produced mixed results. The interpretation of the results leans on the conceptual framework of life course epidemiology, which understands the development of a disease or a disorder as the outcome of biological, psychosocial, and environmental processes that entangle with each other throughout the life course. The study utilized the register-based EKSY014 data set that contains a 20% random sample of all Finnish households with at least one child aged 0-14 years at the end of 2000. Information on the purchases of prescription medicines and visits to inpatient and outpatient care were used as proxy for the incidence of depressive symptoms. Cox proportional hazards regression model, which belongs to the field of survival analysis, was used to compare the event rates between the groups of interest. Exposure to depression of biological parents was measured when persons were 9-14 years old, and the follow-up of an individual’s own depressive symptoms started on the first day of the year the person turned 15 and ended on the last day of the year the person turned 20. Altogether, the principal study population included more than 130,000 persons born between 1986 and 1996. A smaller sub-sample was used to study the effects of an early-life exposure at age 0-5 years and recurrent parental depressive symptoms. According to the analysis, exposure to maternal depressive symptoms at age 9-14 years poses an equally large 2-fold risk for boys and girls. Paternal depressive symptoms put boys at an equal risk as maternal depressive symptoms, but for girls, they pose a smaller 1.5-fold risk. Among those persons who are living with their biological parents, controlling for the effects of socioeconomic factors weakens the association only little and no differences are seen in the risk of intergenerational transmission across the groups of socioeconomic status. Exposure to both maternal depressive symptoms and paternal depressive symptoms poses a bigger risk than a single exposure among both girls and boys. The analysis conducted with the smaller sub-sample implies that an exposure at age 9-14 years poses a bigger risk than an exposure at age 0-5 years. Recurrent exposure to maternal depressive symptoms appears to be a particularly severe risk factor. The results of the study support the life course epidemiological processes of accumulation of risk and chains of risk: Exposure to depressive symptoms in both parents and the long-term chaining of parental depressive symptoms put the person at the greatest risk. Parental depressive symptoms and socioeconomic status appear as largely independent risk factors of adolescent depressive symptoms; thus, those adolescents having a low socioeconomic status and a history of parental depressive symptoms face a particularly elevated risk of exhibiting depressive symptoms. The preliminary analysis did not give support to the assumed sensitive period in the first years of life, but the question should be examined further with a larger sample. Overall, the results advocate a more holistic approach to the prevention of adolescent depressive symptoms, beginning from the identification of familial risk and leading to actions that target all members of the family.
  • Puuskari, Varpu; Aalto-Setälä, Terhi; Komulainen, Erkki; Marttunen, Mauri (2017)
    Background: Increasing psychiatric disorders and alcohol intoxication challenge the pediatric emergency departments (PEDs) to which adolescents are referred owing to acute alcohol intoxication. Objective: This study examined the degree to which adolescents presenting to PED with alcohol intoxication or deliberate self-harm report symptoms of depression and how they differed from non-depressed patients in terms of alcohol use, perceived social support, psychological distress, self-esteem, and suicidal thoughts. Methods: In a sample of 138 adolescents, 12- to 16-years old (62 % females), we assessed the patients' psychiatric status using self-report scales and analyzed blood samples for alcohol. Before discharge, a consulting psychiatrist interviewed each patient to evaluate possible suicidality and organized aftercare when necessary. The mediating data-driven hypothesis was examined. Adolescents scoring >= 10 on the Beck Depression Inventory (BDI) were deemed as screening positive for depression. Results: In 55% of participants, intoxication was by alcohol consumption. Deliberate self-harm was found in 17% of the participants. Of the 138 adolescents, 39 % scored positive on the BDI for depressive symptoms, occurring more commonly in girls. Logistic regression showed that the most significant variables associated with depressive symptoms were female gender, high psychological distress, and low self-esteem. Symptoms of depression served as a mediator between gender and self-esteem and the blood alcohol level. Conclusions: Our findings underscore the importance of identifying mood disorders, suicidality, and self-esteem among adolescents with acute alcohol intoxication at the PED. Intensive psychiatric evaluation in an emergency department is necessary in order to detect those adolescents requiring additional treatment and support.
  • Vihlman, Outi (Helsingin yliopisto, 2019)
    Objective Depression and high blood pressure are becoming more common problems, but their relation remains unclear. This master's thesis studied the relation between depression and high blood pressure in the longitudinal Young Finns Study over a follow-up of four years. The aim was to examine whether 1) baseline depressive symptoms predict blood pressure over the follow-up, 2) the relation between depression and blood pressure differs among men and women, 3) health choices affect the relation, and 4) there is a relation between the duration of depression and blood pressure. Methods The participants (N=909) were about 42 years old, and 61 % of them were women. Their blood pressure and BDI-II depression scores were measured in 2007 ja 2011. Three-step regression analysis was used to predict the systolic and diastolic blood pressure based on the baseline depression score. The first model was controlled for age, gender and baseline blood pressure, the second model also for education and income, and the third model additionally for health choices. The average blood pressures of non-depressed, once depressed and twice depressed participants were compared in analysis of variance. The group comparisons were additionally controlled for age, gender and baseline blood pressure in analysis of covariance. Results and conclusions Baseline depressive symptoms did not predict blood pressure. Among women, a positive relation between depression and blood pressure was found in the first model, but not in the more controlled models. The relation between depression and blood pressure was partly explained by health choices; higher body mass index predicted higher blood pressure. Controlling for age, gender and baseline blood pressure, the duration of depression was connected to higher blood pressure; the diastolic blood pressure was higher, when the participant was depressed both in the beginning and end of the follow-up.
  • Lahti-Pulkkinen, Marius; Girchenko, Polina; Robinson, Rachel; Lehto, Soili M.; Toffol, Elena; Heinonen, Kati; Reynolds, Rebecca M.; Kajantie, Eero; Laivuori, Hannele; Villa, Pia M.; Hamalainen, Esa; Lahti, Jari; Raikkonen, Katri (2020)
    Background Maternal depression during pregnancy increases the risk for adverse developmental outcomes in children. However, the underpinning biological mechanisms remain unknown. We tested whether depression was associated with levels of and change in the inflammatory state during pregnancy, if early pregnancy overweight/obesity or diabetes/hypertensive pregnancy disorders accounted for/mediated these effects, and if depression added to the inflammation that typically accompanies these conditions. Methods We analyzed plasma high-sensitivity C-reactive protein (hsCRP) and glycoprotein acetyls at three consecutive stages during pregnancy, derived history of depression diagnoses before pregnancy from Care Register for Healthcare (HILMO) (N= 375) and self-reports (N= 347) and depressive symptoms during pregnancy using the Center for Epidemiological Studies Depression Scale completed concurrently to blood samplings (N= 295). Data on early pregnancy body mass index (BMI) and diabetes/hypertensive pregnancy disorders came from medical records. Results Higher overall hsCRP levels, but not change, during pregnancy were predicted by history of depression diagnosis before pregnancy [HILMO: mean difference (MD) = 0.69 standard deviation (s.d.) units; 95% confidence interval (CI) 0.26-1.11, self-report: MD = 0.56s.d.; 95% CI 0.17-0.94] and higher depressive symptoms during pregnancy (0.06s.d.pers.d.increase; 95% CI 0.00-0.13). History of depression diagnosis before pregnancy also predicted higher overall glycoprotein acetyls (HILMO: MD = 0.52s.d.; 95% CI 0.12-0.93). These associations were not explained by diabetes/hypertensive disorders, but were accounted for and mediated by early pregnancy BMI. Furthermore, in obese women, overall hsCRP levels increased as depressive symptoms during pregnancy increased (p= 0.006 for interaction). Conclusions Depression is associated with a proinflammatory state during pregnancy. These associations are mediated by early pregnancy BMI, and depressive symptoms during pregnancy aggravate the inflammation related to obesity.
  • LifeLines Cohort Study; Sun, Daokun; Richard, Melissa A.; Musani, Solomon K.; Kilpeläinen, Tuomas O. (2021)
    Psychological and social factors are known to influence blood pressure (BP) and risk of hypertension and associated cardiovascular diseases. To identify novel BP loci, we carried out genome-wide association meta-analyses of systolic, diastolic, pulse, and mean arterial BP, taking into account the interaction effects of genetic variants with three psychosocial factors: depressive symptoms, anxiety symptoms, and social support. Analyses were performed using a two-stage design in a sample of up to 128,894 adults from five ancestry groups. In the combined meta-analyses of stages 1 and 2, we identified 59 loci (p value < 5e−8), including nine novel BP loci. The novel associations were observed mostly with pulse pressure, with fewer observed with mean arterial pressure. Five novel loci were identified in African ancestry, and all but one showed patterns of interaction with at least one psychosocial factor. Functional annotation of the novel loci supports a major role for genes implicated in the immune response (PLCL2), synaptic function and neurotransmission (LIN7A and PFIA2), as well as genes previously implicated in neuropsychiatric or stress-related disorders (FSTL5 and CHODL). These findings underscore the importance of considering psychological and social factors in gene discovery for BP, especially in non-European populations.
  • Lindgren, Noora; Rinne, Juha O.; Palviainen, Teemu; Kaprio, Jaakko; Vuoksimaa, Eero (2019)
    Objectives The modified Telephone Interview for Cognitive Status (TICS-m) is an efficient and cost-effective screening instrument of dementia, but there is less support for its utility in the detection of mild cognitive impairment (MCI). We undertook a comprehensive evaluation of the utility of different TICS-m versions with or without an education-adjusted scoring method to classify dementia and MCI in a large population-based sample. Methods Cross-sectional assessment of cognition (TICS-m), depressive symptoms (CES-D), and apolipoprotein E (APOE) epsilon 4 status was performed on 1772 older adults (aged 71-78 y, education 5-16 y, 50% female) from the population-based older Finnish Twin Cohort. TICS-m classification methods with and without education adjustment were used to classify individuals with normal cognition, MCI, or dementia. Results The prevalence of dementia and MCI varied between education-adjusted (dementia = 3.7%, MCI = 9.3%) and unadjusted classifications (dementia = 8.5%-11%, MCI = 22.3%-41.3%). APOE epsilon 4 status was associated with dementia irrespective of education adjustment, but with MCI only when education adjustment was used. Regardless of the version, poorer continuous TICS-m scores were associated with higher age, lower education, more depressive symptoms, male sex, and being an APOE epsilon 4 carrier. Conclusions We showed that demographic factors, APOE epsilon 4 status, and depressive symptoms were similarly related to continuous TICS-m scores and dementia classifications with different versions. However, education-adjusted classification resulted in a lower prevalence of dementia and MCI and in a higher proportion of APOE epsilon 4 allele carriers among those identified as having MCI. Our results support the use of education-adjusted classification especially in the context of MCI.
  • Jokela, Markus (2022)
    Several studies have associated religiosity with better mental health, but these studies have only partially addressed the problem of confounding. The present study pooled data from multiple cohort studies with siblings to examine whether associations between religiosity and mental health are confounded by familial factors (i.e., shared family background and siblings' shared genetics). Data were collected between 1982 and 2017. Mental health was assessed with self-reported psychological distress (including depressive symptoms) and psychological well-being. Religious attendance was associated with lower psychological distress (standard-deviation difference between weekly vs. never attendance, B = -0.14, confidence interval (CI): -0.19, -0.09; n = 24,598 pairs), and this was attenuated by almost half in the sibling analysis (B = -0.08, CI: = -0.13, -0.04). Religious attendance was also related to higher well-being (B = 0.29, CI: = 0.14, 0.45; n = 3,728 pairs), and this estimate remained unchanged in sibling analysis. Results were similar for religiousness. The findings suggest that previous longitudinal studies may have overestimated the association between religiosity and psychological distress, as the sibling estimate was only one-third of the previously reported meta-analytical association (standardized correlation -0.03 vs. -0.08).
  • Halonen, Jaana I.; Shiri, Rahman; Hanson, Linda L. Magnusson; Lallukka, Tea (2019)
    Study Design. Prospective longitudinal cohort study. Objective. To determine the associations for workload and health-related factors with incident and recurrent low back pain (LBP), and to determine the mediating role of health-related factors in associations between physical workload factors and incident LBP. Summary of Background Data. It is not known whether the risk factors for the development of LBP are also prognostic factors for recurrence of LBP and whether the associations between physical workload and incident LBP are mediated by health-related factors. We used data from the Swedish Longitudinal Occupational Survey of Health study. Those responding to any two subsequent surveys in 2010 to 2016 were included for the main analyses (N = 17,962). Information on occupational lifting, working in twisted positions, weight/height, smoking, physical activity, depressive symptoms, and sleep problems were self-reported. Incident LBP was defined as pain limiting daily activities in the preceding three months in participants free from LBP at baseline. Recurrent LBP was defined as having LBP both at baseline and follow-up. For the mediation analyses, those responding to three subsequent surveys were included (N = 3516). Methods. Main associations were determined using generalized estimating equation models for repeated measures data. Mediation was examined with counterfactual mediation analysis. Results. All risk factors at baseline but smoking and physical activity were associated with incident LBP after adjustment for confounders. The strongest associations were observed for working in twisted positions (risk ratio = 1.52, 95% CI 1.37, 1.70) and occupational lifting (risk ratio = 1.52, 95% CI 1.32, 1.74). These associations were not mediated by health-related factors. The studied factors did not have meaningful effects on recurrent LBP. Conclusion. The findings suggest that workload and health-related factors have stronger effects on the development than on the recurrence or progression of LBP, and that health-related factors do not mediate associations between workload factors and incident LBP.
  • Salo, S. J.; Flykt, M.; Mäkelä, Jukka; Biringen, Z.; Kalland, M.; Pajulo, Marjukka; Punamaki, R. L. (2019)
    Aim: This randomised control trial (RCT) study examined the effectiveness of a mentalisation-based perinatal group intervention, Nurture and Play (NaP), in improving mother–infant interaction quality and maternal reflective functioning and in decreasing depressive symptoms. Background: Few preventive prenatal interventions have been developed for primary health care settings for mothers with depressive symptoms. Furthermore, previous prenatal intervention studies have only concentrated on reducing depressive symptoms and have not directly addressed enhancing optimal parenting qualities. Methods: The participants were 45 pregnant women with depressive symptoms. Women in the randomly assigned intervention group (n = 24) participated in the manualised, short-term NaP intervention group from pregnancy until the baby’s age of seven months, whereas control group women received treatment as usual (TAU). Maternal emotional availability (EA), reflective functioning (RF) and depressive symptoms were measured before the intervention and at the infants’ 12 months of age, and changes were evaluated using repeated measure analyses of variances (ANOVAs). Findings: The results showed that the intervention group displayed higher maternal sensitivity and RF and more reduction in depressive symptoms than the control group when babies were 12 months old. These findings provide preliminary support for the effectiveness of the NaP intervention.
  • Tusa, Nina; Koponen, Hannu; Kautiainen, Hannu; Korniloff, Katariina; Raatikainen, Ilkka; Elfving, Pia; Vanhala, Mauno; Mäntyselkä, Pekka (2019)
    Objective: To examine health service (HS) utilization profiles among a non-depressive population and patients with depressive symptoms (DS) with and without clinical depression. Design, subjects and setting: The study population was based on primary care patients with DS scoring >= 10 in the 21-item Beck Depression Inventory (BDI) and who were at least 35 years old and had been referred to depression nurse case managers (n = 705). Their psychiatric diagnosis was confirmed with the Mini-International Neuropsychiatric Interview (M.I.N.I.). Of these patients, 447 had clinical depression. The number of patients with DS without clinical depression was 258. The control group consisted of a random sample of 414 residents with a BDI score <10. Use of HS (visits and phone calls to a doctor and a nurse) was based on patient records. Main outcome measures: Number of visits and calls to physicians and nurses. Results: Patients with DS regardless of their depression diagnosis used primary health care (PHC) services three times more than the controls (p <0.001). In the secondary care, the differences were smaller but significant. Of the controls, 70% had 0-4 HS contacts per year whereas a majority of the patients having DS had more than 5 contacts per year. The number of contacts correlated with the BDI from a score of 0 to 10 but not as clearly in the higher scores. Conclusion: Depressive symptoms, both with or without clinical depression, are associated with increased HS use, especially in PHC. This study suggests that even mild depressive symptoms are associated with an increased use of HS.