Dynamic risk for first onset of depressive disorders in adolescence: does change matter?

2021 ◽  
pp. 1-9
Author(s):  
Wenting Mu ◽  
Kaiqiao Li ◽  
Yuan Tian ◽  
Greg Perlman ◽  
Giorgia Michelini ◽  
...  
Keyword(s):  
Risk Factors ◽  
Depressive Disorders ◽  
Cox Regression ◽  
Average Level ◽  
Risk Level ◽  
Social Risk ◽  
Dynamic Risk ◽  
First Onset ◽  
Time Varying Covariates ◽  
Chronic Risk

Abstract Background Risk factors for depressive disorders (DD) change substantially over time, but the prognostic value of these changes remains unclear. Two basic types of dynamic effects are possible. The ‘Risk Escalation hypothesis’ posits that worsening of risk levels predicts DD onset above average level of risk factors. Alternatively, the ‘Chronic Risk hypothesis’ posits that the average level rather than change predicts first-onset DD. Methods We utilized data from the ADEPT project, a cohort of 496 girls (baseline age 13.5–15.5 years) from the community followed for 3 years. Participants underwent five waves of assessments for risk factors and diagnostic interviews for DD. For illustration purposes, we selected 16 well-established dynamic risk factors for adolescent depression, such as depressive and anxiety symptoms, personality traits, clinical traits, and social risk factors. We conducted Cox regression analyses with time-varying covariates to predict first DD onset. Results Consistently elevated risk factors (i.e. the mean of multiple waves), but not recent escalation, predicted first-onset DD, consistent with the Chronic Risk hypothesis. This hypothesis was supported across all 16 risk factors. Conclusions Across a range of risk factors, girls who had first-onset DD generally did not experience a sharp increase in risk level shortly before the onset of disorder; rather, for years before onset, they exhibited elevated levels of risk. Our findings suggest that chronicity of risk should be a particular focus in screening high-risk populations to prevent the onset of DDs. In particular, regular monitoring of risk factors in school settings is highly informative.

scholarly journals Association of genetic and behavioral characteristics with the onset of diabetes

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Carmen D. Ng ◽  
Jordan Weiss
Keyword(s):  
Risk Factors ◽  
Diabetes Management ◽  
Cox Regression ◽  
Critical Role ◽  
The United States ◽  
Behavioral Risk ◽  
Survey Period ◽  
Genetic Endowment ◽  
Onset Of Diabetes ◽  
Time Varying Covariates

Abstract Background Prior work has established sociodemographic, lifestyle, and behavioral risk factors for diabetes but the contribution of these factors to the onset of diabetes remains unclear when accounting for genetic propensity for diabetes. We examined the contribution of a diabetes polygenic score (PGS) to the onset of diabetes in the context of modifiable known risk factors for diabetes. Methods Our sample consisted of 15,190 respondents in the United States-based Health and Retirement Study, a longitudinal study with up to 22 years of follow-up. We performed multivariate Cox regression models stratified by race (non-Hispanic white and non-Hispanic black) with time-varying covariates. Results We observed 4217 (27.76%) cases of incident diabetes over the survey period. The diabetes PGS was statistically significantly associated with diabetes onset for both non-Hispanic whites (hazard ratio [HR] = 1.38, 95% confidence interval [CI] = 1.30, 1.46) and non-Hispanic blacks (HR = 1.22, 95% CI = 1.06, 1.40) after adjusting for a range of known risk factors for diabetes, highlighting the critical role genetic endowment might play. Nevertheless, genetics do not downplay the role that modifiable characteristics could still play in diabetes management; even with the inclusion of the diabetes PGS, several behavioral and lifestyle characteristics remained significant for both race groups. Conclusions The effects of genetic and lifestyle characteristics should be taken into consideration for both future studies and diabetes management.

scholarly journals Risk Factors for Patient–Ventilator Asynchrony and Its Impact on Clinical Outcomes: Analytics Based on Deep Learning Algorithm

2020 ◽  
Vol 7 ◽  
Author(s):  
Huiqing Ge ◽  
Kailiang Duan ◽  
Jimei Wang ◽  
Liuqing Jiang ◽  
Lingwei Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tidal Volume ◽  
Clinical Outcomes ◽  
Regression Models ◽  
Negative Binomial ◽  
Cox Regression ◽  
Plateau Pressure ◽  
Care Hospital ◽  
Time Varying ◽  
Time Varying Covariates

Background and objectives: Patient–ventilator asynchronies (PVAs) are common in mechanically ventilated patients. However, the epidemiology of PVAs and its impact on clinical outcome remains controversial. The current study aims to evaluate the epidemiology and risk factors of PVAs and their impact on clinical outcomes using big data analytics.Methods: The study was conducted in a tertiary care hospital; all patients with mechanical ventilation from June to December 2019 were included for analysis. Negative binomial regression and distributed lag non-linear models (DLNM) were used to explore risk factors for PVAs. PVAs were included as a time-varying covariate into Cox regression models to investigate its influence on the hazard of mortality and ventilator-associated events (VAEs).Results: A total of 146 patients involving 50,124 h and 51,451,138 respiratory cycles were analyzed. The overall mortality rate was 15.6%. Double triggering was less likely to occur during day hours (RR: 0.88; 95% CI: 0.85–0.90; p < 0.001) and occurred most frequently in pressure control ventilation (PCV) mode (median: 3; IQR: 1–9 per hour). Ineffective effort was more likely to occur during day time (RR: 1.09; 95% CI: 1.05–1.13; p < 0.001), and occurred most frequently in PSV mode (median: 8; IQR: 2–29 per hour). The effect of sedatives and analgesics showed temporal patterns in DLNM. PVAs were not associated mortality and VAE in Cox regression models with time-varying covariates.Conclusions: Our study showed that counts of PVAs were significantly influenced by time of the day, ventilation mode, ventilation settings (e.g., tidal volume and plateau pressure), and sedatives and analgesics. However, PVAs were not associated with the hazard of VAE or mortality after adjusting for protective ventilation strategies such as tidal volume, plateau pressure, and positive end expiratory pressure (PEEP).

scholarly journals Depressive episodes–evidence for a causal role of primary anxiety disorders?

2003 ◽  
Vol 18 (8) ◽  
pp. 384-393 ◽  
Author(s):  
Hans-Ulrich Wittchen ◽  
Katja Beesdo ◽  
Antje Bittner ◽  
Renee D. Goodwin
Keyword(s):  
Risk Factors ◽  
Anxiety Disorders ◽  
Depressive Disorders ◽  
Common Mental Disorders ◽  
Future Research ◽  
Severe Impairment ◽  
First Onset ◽  
Depressive Episodes ◽  
Course Of Depression

AbstractAnxiety and depressive disorders are common mental disorders in general population, imposing tremendous burden on both affected persons and society. Moreover, comorbidity between anxiety and depressive conditions is high, leading to substantial disability and functional impairment. Findings consistently suggest that anxiety disorders are primary to depression in the majority of comorbid cases. Yet, the question of whether anxiety disorders are risk factors for depression, and potentially even causal risk factors for the first onset of depression, remains unresolved. Recent results have shown that anxiety disorders increase the risk for subsequent depression, and also affect the course of depression, resulting in a poorer prognosis. Further, some results suggest a dose–response-relationship in revealing that a higher number of anxiety disorders and more severe impairment associated with anxiety disorders additionally increase the risk for subsequent depression. The goal of this paper is to review recent literature, summarize implications of previous findings, and suggest directions for future research regarding preventive and intervention strategies.

The long-term course of depressive disorders in the Lundby Study

2007 ◽  
Vol 37 (6) ◽  
pp. 883-891 ◽  
Author(s):  
CECILIA MATTISSON ◽  
MATS BOGREN ◽  
VIBEKE HORSTMANN ◽  
POVL MUNK-JÖRGENSEN ◽  
PER NETTELBLADT
Keyword(s):  
Risk Factors ◽  
Depressive Disorders ◽  
Significant Risk ◽  
Total Sample ◽  
First Episode ◽  
Alcohol Disorders ◽  
Field Investigations ◽  
First Onset ◽  
The Lundby Study

Background. The Lundby Study is a longitudinal cohort study on a geographically defined population consisting of 3563 subjects. Information about episodes of different disorders was collected during field investigations in 1947, 1957, 1972 and in 1997. Interviews were carried out about current health and past episodes since the last investigation; for all subjects information was also collected from registers, case-notes and key informants. This paper describes the course and outcome of 344 subjects who had their first onset of depression during the follow-up.Method. In this study individuals who had experienced their first episode of depression were followed up. Their course was studied with regard to recurrence of depression related to duration of follow-up, transition to other psychiatric disorders including alcohol disorders, as well as incidence and risk factors of suicide.Results. Median age at first onset of depression was around 35 years for individuals followed up for 30–49 years. The recurrence rate was about 40% and varied from 17% to 76% depending on length of follow-up. Transition to diagnoses other than depression was registered in 21% of the total sample, alcohol disorders in 7% and bipolar disorder in 2%. Five per cent committed suicide; male gender and severity of depression were significant risk factors.Conclusion. The low rates of recurrence and suicide suggest a better prognosis for community samples than for in- and out-patient samples.

scholarly journals Risk factors of damage in early diagnosed systemic lupus erythematosus: results of the Italian multicentre Early Lupus Project inception cohort

Rheumatology ◽  
2019 ◽  
Vol 59 (9) ◽  
pp. 2272-2281 ◽  
Author(s):  
Matteo Piga ◽  
Alberto Floris ◽  
Gian Domenico Sebastiani ◽  
Imma Prevete ◽  
Florenzo Iannone ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lupus Erythematosus ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Damage Index ◽  
Inception Cohort ◽  
Damage Development ◽  
Increased Risk ◽  
Time Varying Covariates ◽  
Improve Patient

Abstract Objective To investigate risk factors for damage development in a prospective inception cohort of early diagnosed SLE patients. Methods The Early Lupus Project recruited an inception cohort of patients within 12 months of SLE classification (1997 ACR criteria). At enrolment and every 6 months thereafter, the SLICC/ACR Damage Index was recorded. The contribution of baseline and time-varying covariates to the development of damage, defined as any SLICC/ACR Damage Index increase from 0 to ≥1, was assessed using univariate analysis. Forward-backward Cox regression models were fitted with covariates with P < 0.05 to identify factors independently associated with the risk of damage development. Results Overall, 230 patients with a mean (s.d.) age of 36.5 (14.4) years were eligible for this study; the mean number of visits per patient was 5.3 (2.7). There were 51 (22.2%) patients with SLICC/ACR Damage Index ≥1 after 12 months, 59 (25.6%) after 24 months and 67 (29.1%) after 36 months. Dyslipidaemia [P = 0.001; hazard ratio (HR) 2.9; 95% CI 1.5, 5.6], older age (P = 0.001; HR 3.0; 95% CI 1.6, 5.5), number of organs/systems involved (P = 0.002; HR 1.4; 95% CI 1.1, 1.8) and cardiorespiratory involvement (P = 0.041; HR 1.9; 95% CI 1.0, 3.7) were independently associated with an increased risk of developing damage. Risk profiles for damage development differed for glucocorticoid-related and -unrelated damage. HCQ use (P = 0.005; HR 0.4; 95% CI 0.2, 0.8) reduced the risk of glucocorticoid-unrelated damage. Conclusion We identified risk factors of damage development, but little effect of glucocorticoids, in this early SLE cohort. Addressing modifiable risk factors from the time of SLE diagnosis might improve patient outcomes.

scholarly journals Association between Central Serous Chorioretinopathy and Risk of Depression: A Population-Based Cohort Study

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Yu-Yen Chen ◽  
Li-Ying Huang ◽  
Wei-Ling Liao ◽  
Pesus Chou
Keyword(s):  
Risk Factors ◽  
Peptic Ulcer ◽  
Low Income ◽  
Cox Regression ◽  
Significant Risk ◽  
Female Gender ◽  
Population Based ◽  
Cumulative Hazard ◽  
First Onset ◽  
Risk For Depression

Purpose. To investigate the association between central serous chorioretinopathy (CSC) and the risk of developing depression. The risk factors associated with depression in CSC patients were also assessed. Methods. A population-based retrospective cohort study using the Taiwan National Health Insurance Research Database was conducted from the beginning of 2001 through the end of 2013. CSC patients and age- and gender-matched (1 : 4 matched) control subjects without CSC were enrolled in the study. Kaplan–Meier curves were generated to compare the cumulative hazard of subsequent depression between the CSC and control groups. A Cox regression analysis estimated the crude and adjusted hazard ratios (HRs) for depression. Risk factors leading to depression were investigated among the CSC patients. Results. 25,939 CSC patients and 103,756 controls were enrolled in the study. The CSC group had a significantly higher cumulative hazard for depression compared to the control group (p value < 0.0001). The Cox regression model indicated that the CSC group had a significantly higher risk for depression (adjusted HR = 1.33). Within the CSC group, significant risk factors for depression included age, female gender, low income, first-onset CSC, peptic ulcer, and smoking. The recent use of steroids prior to CSC, by all routes of administration, also significantly increased the risk for depression. However, treatment of CSC did not significantly reduce the risk for depression. Conclusion. Patients with CSC are at significantly greater risk of developing depression. Among CSC patients, age, female gender, low income, first-onset CSC, peptic ulcer, smoking, and recent use of steroids prior to CSC were significant risk factors for depression.

scholarly journals Social Risk Assessment and Management for Major Construction Projects in China Based on Fuzzy Integrated Analysis

Complexity ◽  
2019 ◽  
Vol 2019 ◽  
pp. 1-17 ◽  
Author(s):  
Junxia Miao ◽  
Dechun Huang ◽  
Zhengqi He
Keyword(s):  
Risk Factors ◽  
Construction Projects ◽  
Risk Level ◽  
Integrated Analysis ◽  
Social Risk ◽  
Social Risk Factors ◽  
Social Risks ◽  
The Social ◽  
Critical Social ◽  
Overall Risk

With the vigorous development of major engineering projects in China, the social risks associated with major construction projects not only challenge the success of projects but also threaten social harmony and stability. Therefore, it is of great practical significance to assess and manage social risks. This paper aims to identify and evaluate the social risk factors by conducting a survey and assess the overall risk level of major construction projects (MCPs) with fuzzy integrated approach. First, 35 social risk factors and related stakeholders were identified based on literature analysis and case study. Then, 18 critical social risk factors (CSRFs) were selected and classified into six groups (CSRGs) based on a questionnaire survey. Next, using fuzzy integrated method, the probability of occurrence (PO), magnitude of impact (MI), the integrated risk level (IRL) of each CSRF and CSRG, and the overall risk of MCPs were calculated. As a result, “unfair compensation for housing demolition and land requisition” was the most critical social risk factor, and “policy/legal risk” was the most critical social risk group. The overall risk of MCPs was between moderate and high. At last, a social risk synthetic management framework was established, which can provide reference for policymakers and project decision makers to effectively manage the social risks.

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