Depression and its Somatic Consequences: Allostatic Load as the Connecting Link

Stress-related psychiatric disorders, such as depressive and anxiety disorders, have been associated with increased risk of overall mortality as well as with the onset of various aging-related somatic diseases. In addition to unhealthy lifestyles and poorer (self) care, various stress-related physiological processes likely contribute to these detrimental health consequences of psychiatric disorders. Considering the fact that the impact of stress-related disorders is visible on many different somatic health outcomes, it is unlikely that contributing biological systems are very specific. In fact, it is likely that multiple dysregulations of stress systems, including the immune, HPA-axis and autonomic nervous systems, but also various general proteomic or metabolomic pathways are involved. The concept of Allostatic Load (AL) emphasizes the presence of a multi-system physiological dysregulation.In this talk I will summarize what the evidence is for somatic health consequences of psychiatric conditions, with depression as an important example. Subsequently, I will provide an overview of the various stress systems that are dysregulated in depressed patients. In addition, I will provide empirical data from the Netherlands Study of Depression and Anxiety (n = 2981) that illustrate that there is evidence that depressed patients are especially at risk for a dysregulation in multiple physiological stress systems. I will also illustrate how such a state of AL can impact on basis cellular aging indicators like telomere length and epigenetic age.In sum, this talk will highlight the current state-of-evidence for an association between depressions with the onset of many adverse somatic health outcomes, and will provide insight into the contributing role of a multisystem physiological dysregulation.Disclosure of interestThe author has not supplied his declaration of competing interest.

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Environment and ageing biology

Oxford Textbook of Geriatric Medicine ◽

10.1093/med/9780198701590.003.0043 ◽

2017 ◽

pp. 317-322

Author(s):

Arun S. Karlamangla ◽

Teresa E. Seeman

Keyword(s):

Older Adults ◽

Health Outcomes ◽

Functional Status ◽

Life Events ◽

Allostatic Load ◽

The Body ◽

Major Life Events ◽

Major Life ◽

The Life Course ◽

The Impact

Psychosocial factors over the life course and major life events are associated with the health, functional status, and survival of older adults. This chapter discusses the biological mechanisms through which these influences are thought to operate, and how life stresses might accelerate the usual ageing of biological systems. It starts with a brief description of psychosocial determinants of health and functioning before elaborating on the allostatic mechanisms by which the body adapts its internal physiological milieu in response to perceived stressors. The price paid for frequent and recurring adaptation is eventual dysregulation of the mediators of allostasis, or allostatic load. We close with a brief discussion of allostatic load links to health outcomes in older adults and potential interventions that might ameliorate the impact of psychosocial adversities on health.

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Cancer Risk in Children and Young Adults (Offspring) Born after Medically Assisted Reproduction: A Systematic Review and Meta-Analysis

J ◽

10.3390/j2040028 ◽

2019 ◽

Vol 2 (4) ◽

pp. 430-448

Author(s):

Manuela Chiavarini ◽

Andrea Ostorero ◽

Giulia Naldini ◽

Roberto Fabiani

Keyword(s):

Cancer Risk ◽

Health Outcomes ◽

Childhood Cancer ◽

Assisted Reproduction ◽

Meta Analysis ◽

Cancer Data ◽

Medically Assisted Reproduction ◽

Increased Risk ◽

Risk Of Cancer ◽

The Impact

Many studies have investigated the relationship between medically assisted reproduction (MAR) and health outcomes, particularly cancer, in the offspring. This meta-analysis investigated the association between MAR and childhood cancer. Data sources were PubMed, Scopus, and Web of Science up until June 2018. From the selected studies, we extracted the cancer risk estimates of the exposure of interest (MAR, assisted reproductive technology—ART, and in fitro fertilization—IVF). We conducted the meta-analysis using a random effects model. The outcomes of interest were childhood cancers, classified according to the international classification of childhood cancer (ICCC-3). In our meta-analysis (18 cohort and 15 case-control studies) the overall cancer risk was significantly increased in children conceived by MAR, ART, or IVF. MAR and ART significantly increased the risk for hematological tumors, hepatic tumors, and sarcomas (odds ratio (OR) 1.54; 95% CI 1.18–2.02 and OR 1.92; 95% CI 1.34–2.74, respectively). MAR increased acute myeloid leukemia risk (OR 1.41; 95% CI 1.02–1.95) and ART increased neural cancer risk (OR 1.21; 95% CI 1.01–1.46). Our results suggest an increased risk of cancer in children conceived by MAR. Further studies are needed to investigate the impact of fertility treatments, parental subfertility status, and their association on health outcomes in the offspring.

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The impact of the COVID-19 pandemic on suicide rates

QJM ◽

10.1093/qjmed/hcaa202 ◽

2020 ◽

Vol 113 (10) ◽

pp. 707-712 ◽

Cited By ~ 43

Author(s):

Leo Sher

Keyword(s):

Mental Health ◽

Substance Use ◽

General Population ◽

Psychiatric Disorders ◽

Suicidal Behavior ◽

Health Consequences ◽

Media Campaigns ◽

Suicide Rates ◽

Long Time ◽

The Impact

Summary Multiple lines of evidence indicate that the coronavirus disease 2019 (COVID-19) pandemic has profound psychological and social effects. The psychological sequelae of the pandemic will probably persist for months and years to come. Studies indicate that the COVID-19 pandemic is associated with distress, anxiety, fear of contagion, depression and insomnia in the general population and among healthcare professionals. Social isolation, anxiety, fear of contagion, uncertainty, chronic stress and economic difficulties may lead to the development or exacerbation of depressive, anxiety, substance use and other psychiatric disorders in vulnerable populations including individuals with pre-existing psychiatric disorders and people who reside in high COVID-19 prevalence areas. Stress-related psychiatric conditions including mood and substance use disorders are associated with suicidal behavior. COVID-19 survivors may also be at elevated suicide risk. The COVID-19 crisis may increase suicide rates during and after the pandemic. Mental health consequences of the COVID-19 crisis including suicidal behavior are likely to be present for a long time and peak later than the actual pandemic. To reduce suicides during the COVID-19 crisis, it is imperative to decrease stress, anxiety, fears and loneliness in the general population. There should be traditional and social media campaigns to promote mental health and reduce distress. Active outreach is necessary, especially for people with a history of psychiatric disorders, COVID-19 survivors and older adults. Research studies are needed of how mental health consequences can be mitigated during and after the COVID-19 pandemic.

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Food Insecurity and Mental Health Outcomes among Low Income, Minority Cohorts during the COVID-19 Pandemic

Proceedings of IMPRS ◽

10.18060/25947 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Sai Kodukula ◽

Amy Han

Keyword(s):

Mental Health ◽

Food Security ◽

Health Outcomes ◽

Food Insecurity ◽

Low Income ◽

Mental Health Outcomes ◽

Anecdotal Evidence ◽

Increased Risk ◽

Anxiety Depression ◽

The Impact

Objective: To examine the impact of the COVID-19 shutdowns on food insecurity and mental health outcomes among low income, minority communities in Northwest Indiana. Methods: Surveys were distributed to 160 households during the Northwest Indiana food bank distribution hours to assess food security mental health status. The survey assessed participant food security through questions adapted from the USDA food security survey module. Participant anxiety, depression, and stress scores were aggregated from questions adapted from the PHQ-4. A multiple logit regression model was utilized to estimate the risk associated with food security status and the surveyed variables. Anecdotal evidence was also collected to understand pandemic specific factors impacting participant food security. Results: Food insecurity was linked to significantly increased risk of anxiety, depression and stress. Those who identify to be food insecure have an 811 % increased risk of anxiety, 411% increased risk of depression, and 535% increased risk of stress compared to those who are food secure. In addition, a significant correlation exists between median household income and poor mental health. Anecdotal evidence identifies poor job security, food distributions, and support networks as exacerbating factors towards participant’s declining mental health. Conclusions: Our findings highlights the exacerbated impact the pandemic has had on the food security and mental health of vulnerable populations. In the light of these results and anecdotal feedback, public health measures must focus on getting increased funding towards local food banks to increase the frequency of mobile distribution markets coupled with direct subsidies to allow for food purchases, especially for those households with children. Given its impact on mental health, food insecurity status should regularly be screened by physicians access to the right resources must be provided for those screening as high risk.

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An Objective Metric of Individual Health And Aging For Population Surveys

10.21203/rs.3.rs-952500/v1 ◽

2021 ◽

Author(s):

Qing Li ◽

Véronique Legault ◽

Vincent-Daniel Girard ◽

Luigi Ferrucci ◽

Linda P. Fried ◽

...

Keyword(s):

Health Status ◽

Health Outcomes ◽

Allostatic Load ◽

Individual Health ◽

Clinical Biomarkers ◽

Physiological Dysregulation ◽

Objective Metrics ◽

Different Populations ◽

Self Assessed Health ◽

Better Than

Abstract Background: Generalized, biomarker-based metrics of health status have numerous applications in fields ranging from sociology and economics to clinical research. We recently proposed a novel metric of health status based on physiological dysregulation measured as a Mahalanobis distance (DM) among clinical biomarkers. While DM was not particularly sensitive to the choice of biomarkers, it required calibration when used in different populations, making it difficult to compare findings across studies. To facilitate its use, here we aimed to identify and validate a standard version of DM that would be highly stable across populations, while using fewer biomarkers drawn exclusively from common blood panels. Methods: Using three datasets, we identified nine-biomarker (DM9) and seventeen-biomarker (DM17) versions of DM, choosing biomarkers based on their consistent levels across populations. We validated them in a fourth dataset. We assessed DM stability within and across populations by looking at correlations of DM versions calibrated using different populations or their demographic subsets. We used regression models to compare these standard DM versions to allostatic load and self-assessed health in their association with diverse health outcomes. Results: DM9 and DM17 were highly stable across population subsets (mean r = 0.96 and 0.95, respectively) and across populations (mean r = 0.94 for both). Performance predicting health outcomes was competitive with allostatic load and self-assessed health, though performance of these markers were somewhat variable for different health outcomes. Conclusions: Both DM9 and DM17 are highly stable within and across populations, supporting their use as objective metrics of health status. DM17 performs slightly better than DM9 and at least as well as other comparable metrics, but requires more biomarkers. The metrics we propose here are easy to measure with data that are available in a wide array of panel, cohort, and clinical studies.

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Incidence and Predictors of Mental Health Outcomes Among Survivors of Adolescent and Young Adult Cancer: A Population-Based Study Using the IMPACT Cohort

Journal of Clinical Oncology ◽

10.1200/jco.20.02019 ◽

2021 ◽

pp. JCO.20.02019

Author(s):

Riddhita De ◽

Rinku Sutradhar ◽

Paul Kurdyak ◽

Suriya Aktar ◽

Jason D. Pole ◽

...

Keyword(s):

Mental Health ◽

Young Adult ◽

Health Outcomes ◽

Psychotic Disorder ◽

Population Based ◽

Mental Health Outcomes ◽

Adolescent And Young Adult ◽

Increased Risk ◽

The Impact

PURPOSE Risk and predictors of long-term mental health outcomes in survivors of adolescent and young adult (AYA) cancers are poorly characterized. Mental health is consequently neglected in long-term follow-up. METHODS We identified all AYA in Ontario, Canada age 15-21 years when diagnosed with one of six common cancers between 1992-2012 using a population-based database, and compared them with matched controls. Linkage to provincial healthcare data allowed analysis of rates of outpatient (family physician and psychiatrist) visits for psychiatric indications and time to severe psychiatric events (emergency room visit, hospitalization, and suicide). Demographic-, disease-, and treatment-related predictors of adverse outcomes, including treatment setting (adult v pediatric), were examined. RESULTS Among 2,208 survivors and 10,457 matched controls, 5-year survivors experienced higher rates of outpatient mental health visits than controls (671 visits per 1,000 person-years v 506; adjusted rate ratio [RR] 1.3; 95% CI, 1.1 to 1.5; P = .006). Risk of a severe psychiatric episode was also increased among survivors (adjusted hazard ratio [HR], 1.2; 95% CI, 1.1 to 1.4, P = .008). Risk of a psychotic disorder–associated severe event was doubled in survivors (HR, 2.0, 95% CI, 1.3 to 2.4; P = .007) although absolute risk remained low (15-year cumulative incidence 1.7%; 95% CI, 1.0 to 2.7). In multivariable analysis, survivors treated in adult centers experienced substantially higher outpatient visit rates compared with those treated in pediatric settings (RR 1.8; 95% CI, 1.0 to 3.1; P = .04). CONCLUSION Survivors of AYA cancer are at substantially increased risk of adverse mental health outcomes, with those treated in adult centers at particular risk. Although absolute incidence was low, survivors were at increased risk of psychotic disorder–associated severe events. Long-term mental health surveillance is warranted, as is research into effective interventions during or after cancer treatment.

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Advanced maternal age compromises fetal growth and induces sex-specific changes in placental phenotype in rats

Scientific Reports ◽

10.1038/s41598-019-53199-x ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 5

Author(s):

Tina Napso ◽

Yin-Po Hung ◽

Sandra T. Davidge ◽

Alison S. Care ◽

Amanda N. Sferruzzi-Perri

Keyword(s):

Oxidative Stress ◽

Health Outcomes ◽

Maternal Age ◽

Advanced Maternal Age ◽

Placental Lactogen ◽

Rat Offspring ◽

Placental Transport ◽

Increased Risk ◽

Glucocorticoid Metabolism ◽

The Impact

AbstractAdvanced maternal age is associated with an increased risk of pregnancy complications. It programmes sex-specific cardiovascular dysfunction in rat offspring, however the intrauterine mechanisms involved remain unknown. This study in the rat assessed the impact of advanced maternal age on placental phenotype in relation to the growth of female and male fetuses. We show that relative to young (3–4 months) dams, advanced maternal age (9.5–10 months) compromises growth of both female and male fetuses but affects the placental phenotype sex-specifically. In placentas from aged versus young dams, the size of the placental transport and endocrine zones were increased and expression of Igf2 (+41%) and placental lactogen (Prl3b1: +59%) genes were upregulated in female, but not male fetuses. Placental abundance of IGF2 protein also decreased in the placenta of males only (−95%). Moreover, in placentas from aged versus young dams, glucocorticoid metabolism (11β-hsd2: +63% and 11β-hsd1: −33%) was higher in females, but lower in males (11β-hsd2: −50% and 11β-hsd1: unaltered). There was however, no change in the placental abundance of 11β-HSD2 protein in aged versus young dams regardless of fetal sex. Levels of oxidative stress in the placenta were increased in female and male fetuses (+57% and +90%, respectively) and apoptosis increased specifically in the placenta of males from aged rat dams (+700%). Thus, advanced maternal age alters placental phenotype in a sex-specific fashion. These sexually-divergent changes may play a role in determining health outcomes of female and male offspring of aged mothers.

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Potentially inappropriate prescribing in dementia, multi-morbidity and incidence of adverse health outcomes

Age and Ageing ◽

10.1093/ageing/afaa147 ◽

2020 ◽

Author(s):

João Delgado ◽

Lindsay Jones ◽

Marie C Bradley ◽

Louise M Allan ◽

Clive Ballard ◽

...

Keyword(s):

Health Outcomes ◽

Inappropriate Prescribing ◽

Hazard Ratio ◽

Potentially Inappropriate Prescribing ◽

Prevalence Odds Ratio ◽

Discharge Data ◽

Adverse Health ◽

Adverse Health Outcomes ◽

Increased Risk ◽

The Impact

Abstract Importance treatment of dementia in individuals with comorbidities is complex, leading to potentially inappropriate prescribing (PIP). The impact of PIP in this population is unknown. Objective to estimate the rate of PIP and its effect on adverse health outcomes (AHO). Design retrospective cohort. Setting primary care electronic health records linked to hospital discharge data from England. Subjects 11,175 individuals with dementia aged over 65 years in 2016 and 43,463 age- and sex-matched controls. Methods Screening Tool of Older Persons’ Prescriptions V2 defined PIP. Logistic regression tested associations with comorbidities at baseline, and survival analyses risk of incident AHO, adjusted for age, gender, deprivation and 14 comorbidities. Results the dementia group had increased risk of PIP (73% prevalence; odds ratio [OR]: 1.92; confidence interval [CI]: 83–103%; P < 0.01) after adjusting for comorbidities. Most frequent PIP criteria were related to anti-cholinergic drugs and therapeutic duplication. Risk of PIP was higher in patients also diagnosed with coronary-heart disease (odds OR: 2.17; CI: 1.91–2.46; P < 0.01), severe mental illness (OR: 2.09; CI: 1.62–2.70; P < 0.01); and depression (OR: 1.81; CI: 1.62–2.01; P < 0.01). During follow-up (1 year), PIP was associated with increased all-cause mortality (hazard ratio: 1.14; CI: 1.02–1.26; P < 0.02), skin ulcer and pressure sores (hazard ratio: 1.66; CI: 1.12–2.46; P < 0.01), falls (hazard ratio: 1.37; CI: 1.15–1.63; P < 0.01), anaemia (hazard ratio: 1.61; CI: 1.10–2.38; P < 0.02) and osteoporosis (hazard ratio: 1.62; CI: 1.02–2.57; P < 0.04). Conclusion patients with dementia frequently receive PIPs, and those who do are more likely to experience AHO. These results highlight the need to optimise medication in dementia patients, especially those with comorbidities.

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Lifetime experience of multiple common mental disorders and 19-year mortality: results from a Canadian population-based cohort

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796018000859 ◽

2019 ◽

Vol 29 ◽

Author(s):

M. Kingsbury ◽

E. Sucha ◽

N. J. Horton ◽

H. Sampasa-Kanyinga ◽

J. M. Murphy ◽

...

Keyword(s):

Major Depression ◽

Alcohol Use ◽

Mental Disorders ◽

Panic Disorder ◽

Psychiatric Disorders ◽

Alcohol Use Disorders ◽

Risk Of Death ◽

Risk Of Mortality ◽

Increased Risk ◽

The Impact

Abstract Aims To examine the impact of multiple psychiatric disorders over the lifetime on risk of mortality in the general population. Methods Data came from a random community-based sample of 1397 adults in Atlantic Canada, recruited in 1992. Major depression, dysthymia, panic disorder, generalised anxiety disorder and alcohol use disorders were assessed using the Diagnostic Interview Schedule (DIS). Vital status of participants through 2011 was determined using probabilistic linkages to the Canadian Mortality Database. Cox proportional hazard models with age at study entry as the time scale were used to investigate the relationship between DIS diagnoses and mortality, adjusted for participant education, smoking and obesity at baseline. Results Results suggested that mood and anxiety disorders rarely presented in isolation – the majority of participants experienced multiple psychiatric disorders over the lifetime. Elevated risk of death was found among men with both major depression and dysthymia (HR 2.56; 95% CI 1.12–5.89), depression and alcohol use disorders (HR 2.45; 95% CI 1.18–5.10) and among men and women who experienced both panic disorder and alcohol use disorders (HR 3.80; 95% CI 1.19–12.16). Conclusion The experience of multiple mental disorders over the lifetime is extremely common, and associated with increased risk of mortality, most notably among men. Clinicians should be aware of the importance of considering contemporaneous symptoms of multiple psychiatric conditions.

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A conceptual model for understanding the rapid COVID-19–related increase in food insecurity and its impact on health and healthcare

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqaa226 ◽

2020 ◽

Vol 112 (5) ◽

pp. 1162-1169 ◽

Cited By ~ 7

Author(s):

Anna M Leddy ◽

Sheri D Weiser ◽

Kartika Palar ◽

Hilary Seligman

Keyword(s):

Chronic Disease ◽

Health Outcomes ◽

Food Insecurity ◽

Conceptual Model ◽

Morbidity And Mortality ◽

Increased Risk ◽

Short And Long Term ◽

The Impact ◽

Related Increase

ABSTRACT Food insecurity, a well-established determinant of chronic disease morbidity and mortality, is rapidly increasing due to the coronavirus disease 2019 (COVID-19) pandemic. We present a conceptual model to understand the multiple mechanisms through which the economic and public health crises sparked by COVID-19 might increase food insecurity and contribute to poor health outcomes in the short- and long-term. We hypothesize that, in the short-term, increased food insecurity, household economic disruption, household stress, and interruptions in healthcare will contribute to acute chronic disease complications. However, the impact of the pandemic on food security will linger after social-distancing policies are lifted and the health system stabilizes, resulting in increased risk for chronic disease development, morbidity, and mortality among food-insecure households in the long-term. Research is needed to examine the impact of the pandemic-related increase in food insecurity on short- and long-term chronic health outcomes, and to delineate the underlying causal mechanisms. Such research is critical to inform the development of effective programs and policies to address food insecurity and its downstream health impacts during COVID-19 and future pandemics.

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