Bidirectional Association Between Knee Osteoarthritis and Depressive Symptoms: A Nationwide Cohort Study

Abstract Both knee osteoarthritis (KOA) and depressive symptoms are common health issues affecting the quality of life of old adults. Although it is presumed that KOA has a bidirectional relationship with the depressive symptoms, no cohort study has proven it. This is the first study to determine the strength of association for the bidirectional relationship between KOA and depressive symptoms. Data were gathered from the nationally survey of China Health and Retirement Longitudinal Study in 2011-2015. The presence of depressive symptoms was defined by the 10-item Center for Epidemiologic Studies Depression Scale score of 10 or higher. The adjusted Cox proportional hazards regression model was conducted to estimate hazards ratios (HRs). Controlled covariates include gender, age, education, marital status, residence, number of chronic diseases, and disability. The analysis of KOA predicting the depressive symptoms onset consisted of 4,377 participants free from depressive symptoms at baseline. During 4 years follow-up, diagnosed KOA participants were more likely to have depressive symptoms than their peers without KOA (HR = 1.50, 95% CI: 1.23-1.83). The parallel analysis of depressive symptoms predicting KOA onset included 6,848 participants without KOA at baseline, those with depressive symptoms had a higher relative risk of developing KOA (HR = 1.64, 95% CI: 1.41-1.92). Our results provide compelling evidence that the KOA-depressive symptoms association is bidirectional, highlighting the importance of evaluating the relationship between physical and mental health among older people. Particularly, taking this association into consideration in the risk assessment and primary prevention of KOA and depression symptoms.

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Abstract MP60: Depressive Symptoms and Risk of Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis

Circulation ◽

10.1161/circ.137.suppl_1.mp60 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Parveen K Garg ◽

Wesley T O'Neal ◽

Ana V Diez Roux ◽

Alvaro Alonso ◽

Elsayed Soliman ◽

...

Keyword(s):

Atrial Fibrillation ◽

Depressive Symptoms ◽

Proportional Hazards ◽

Depression Scale ◽

Epidemiologic Studies ◽

Cox Proportional Hazards ◽

Fee For Service ◽

Score Distribution ◽

Ethnic Study ◽

Increased Risk

Background: Depression has been suggested as a potential risk factor for atrial fibrillation (AF) through effects on the autonomic nervous system and hypothalamus-pituitary-adrenal axis. Current literature examining the prospective relationship between depression and AF is inconsistent and limited to studies performed in predominantly white populations. We determined the relationship of both depressive symptoms and anti-depressant use with incident AF in a multi-ethnic cohort. Methods: The Multi-Ethnic Study of Atherosclerosis is a prospective study of 6,814 individuals without clinical cardiovascular disease. Depressive symptoms were assessed at baseline by the 20-item Center for Epidemiologic Studies Depression Scale (CES-D) and use of anti-depressant medications. Five CES-D groups were created based on the score distribution in approximate quartiles, and the top quartile split in 2 such that the top group represented persons with a score ≥16, a value commonly used to identify clinically relevant symptoms. Incident AF was identified from study ECGs verified for AF, ICD-9 hospital discharge diagnoses consistent with AF, and, for participants enrolled in fee-for-service Medicare, inpatient and outpatient AF claims data. Results: 6,644 participants (mean age=62; 53% women; 38% white; 28% black; 22% Hispanic; 12% Chinese-American) were included and followed for a median of 13 years. In separate adjusted Cox proportional hazards analyses, a CES-D≥16 (referent=CES-D<2) and anti-depressant use were each associated with higher incidence of AF (Table). Associations did not differ by race or gender (interaction p-values of 0.18 and 0.17 respectively). Similar results were obtained using time-updated measures of depression. Conclusions: Depressive symptoms are associated with an increased risk of incident AF. Further study into whether improving depressive symptoms reduces AF incidence is important.

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Changes in severity of depressive symptoms and mortality: the Italian Longitudinal Study on Aging

Psychological Medicine ◽

10.1017/s0033291712000645 ◽

2012 ◽

Vol 42 (12) ◽

pp. 2619-2629 ◽

Cited By ~ 12

Author(s):

E. Scafato ◽

L. Galluzzo ◽

S. Ghirini ◽

C. Gandin ◽

A. Rossi ◽

...

Keyword(s):

Depressive Symptoms ◽

Proportional Hazards ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Late Life ◽

Population Based ◽

Cox Proportional Hazards ◽

Late Life Depression ◽

Longitudinal Changes ◽

The Impact

BackgroundDepression is recognized as being associated with increased mortality. However, there has been little previous research on the impact of longitudinal changes in late-life depressive symptoms on mortality, and of their remission in particular.MethodAs part of a prospective, population-based study on a random sample of 5632 subjects aged 65–84 years, with a 10-year follow-up of vital status, depressive symptoms were assessed by the 30-item Italian version of the Geriatric Depression Scale (GDS). The number of participants in the GDS measurements was 3214 at baseline and 2070 at the second survey, 3 years later. Longitudinal changes in depressive symptoms (stable, remitted, worsened) were examined in participants in both evaluations (n=1941). Mortality hazard ratios (MHRs) according to severity of symptoms and their changes over time were obtained by means of Cox proportional hazards regression models, adjusting for age and other potentially confounding factors.ResultsSeverity is significantly associated with excess mortality in both genders. Compared to the stability of depressive symptoms, a worsened condition shows a higher 7-year mortality risk [MHR 1.46, 95% confidence interval (CI) 1.15–1.84], whereas remission reduces by about 40% the risk of mortality in both genders (women MHR 0.55, 95% CI 0.32–0.95; men MHR 0.59, 95% CI 0.37–0.93). Neither sociodemographic nor medical confounders significantly modified these associations.ConclusionsConsistent with previous reports, the severity and persistence of depression are associated with higher mortality risks. Our findings extend the magnitude of the association demonstrating that remission of symptoms is related to a significant reduction in mortality, highlighting the need to enhance case-finding and successful treatment of late-life depression.

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Late-life depression and mortality: influence of gender and antidepressant use

The British Journal of Psychiatry ◽

10.1192/bjp.bp.107.039164 ◽

2008 ◽

Vol 192 (1) ◽

pp. 12-18 ◽

Cited By ~ 67

Author(s):

Joanne Ryan ◽

Isabelle Carriere ◽

Karen Ritchie ◽

Robert Stewart ◽

Gwladys Toulemonde ◽

...

Keyword(s):

Depressive Symptoms ◽

Proportional Hazards ◽

Depression Scale ◽

Severe Depression ◽

Epidemiological Studies ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

Late Life Depression ◽

Cox Proportional Hazards Models ◽

Antidepressant Use

BackgroundDepression may increase the risk of mortality among certain subgroups of older people, but the part played by antidepressants in this association has not been thoroughly explored.AimsTo identify the characteristics of older populations who are most at risk of dying, as a function of depressive symptoms, gender and antidepressant use.MethodAdjusted Cox proportional hazards models were used to determine the association between depression and/or antidepressant use and 4-year survival of 7363 community-dwelling elderly people. Major depressive disorder was evaluated using a standardised psychiatric examination based on DSM-IV criteria and depressive symptoms were assessed using the Center for Epidemiological Studies Depression scale.ResultsDepressed men using antidepressants had the greatest risk of dying, with increasing depression severity corresponding to a higher hazard risk. Among women, only severe depression in the absence of treatment was significantly associated with mortality.ConclusionsThe association between depression and mortality is gender-dependent and varies according to symptom load and antidepressant use.

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Subjective cognitive decline and subsequent dementia: a nationwide cohort study of 579,710 people aged 66 years in South Korea

10.21203/rs.2.19062/v2 ◽

2020 ◽

Author(s):

Yeong Chan Lee ◽

Jae Myeong Kang ◽

Hyewon Lee ◽

Kiwon Kim ◽

Soyeon Kim ◽

...

Keyword(s):

Depressive Symptoms ◽

South Korea ◽

Cognitive Decline ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Depression Scale ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Subjective Cognitive Decline ◽

Increased Risk

Abstract Background Subjective cognitive decline (SCD) is a potential risk factor for dementia. We aimed to investigate the association between SCD and subsequent dementia in a nationwide population-based cohort in South Korea. Methods This cohort included 579,710 66-year-old adults who were followed for a total of 3,870,293 person-years (average 6.68±1.33 years per person). All subjects completed a questionnaire about subjective memory impairment, the Pre-screening Korean Dementia Screening Questionnaire (KDSQ-P), which included a validated 5-item derivative, and were determined to have SCD based on a single question assessing memory decline. Depressive symptoms were assessed in all subjects using a 3-item modified geriatric depression scale. Hazard ratios were estimated using the Cox proportional hazards model and compared between subjects with and without SCD. Results Compared to subjects without SCD, those with SCD were more likely to develop dementia (incidence per 1,000 person-years: non-SCD: 5.66; SCD: 8.59). After adjusting for potential confounding factors, the risk of subsequent dementia significantly increased in subjects with SCD, with an adjusted hazard ratio (aHR) of 1.38 (95% confidence interval [CI] 1.34 to 1.41). The risk of subsequent dementia was greatly increased in subjects with higher KDSQ-P scores (aHR = 2.77, 95% CI 2.47 to 3.11). A significant association between SCD and dementia was observed in both depressive and non-depressive symptom groups (aHR = 1.50, 95% CI 1.42 to 1.57 in subjects with depressive symptoms; aHR = 1.33, 95% CI 1.29 to 1.37 in subjects without depressive symptoms; P = 0.001). Conclusions In this population of 66-year-old individuals, SCD was significantly associated with an increased risk of subsequent dementia. This association was found in both depressive and non-depressive groups, with an increased risk of dementia in the presence of depressive symptoms. Our findings suggest that SCD indicates a risk for dementia. Further studies are needed to delineate potential approaches to preventing the development of dementia in individuals with SCD.

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The combination of depressive symptoms and smoking shorten life expectancy among the aged

International Psychogeriatrics ◽

10.1017/s1041610211002201 ◽

2011 ◽

Vol 24 (4) ◽

pp. 624-630 ◽

Cited By ~ 4

Author(s):

Cristina Fortes ◽

Simona Mastroeni ◽

Sperati Alessandra ◽

Juliana Lindau ◽

Sara Farchi ◽

...

Keyword(s):

Depressive Symptoms ◽

Life Expectancy ◽

Elderly People ◽

Proportional Hazards ◽

Depression Scale ◽

Cox Proportional Hazards ◽

Secondary Outcome ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality

ABSTRACTBackground: Depression is a potential risk factor for mortality among the aged and it is also associated with other chronic diseases and unhealthy lifestyles that may also affect mortality. The purpose of this study was to investigate the association between depressive symptoms and mortality, controlling for health, nutritional status, and life-style factors.Methods: A cohort of elderly people (N = 167) was followed-up for ten years. Information on socio-demographic characteristics, medical history, smoking, and alcohol consumption was collected. The primary outcome was all-cause mortality; the secondary outcome was cancer-specific mortality. The Geriatric Depression Scale (GDS-15) was used to assess depression. Using a multivariable Cox proportional hazards regression, we examined the association between depressive symptoms and mortality.Results: Elderly people with depression (scoring above the depression cut-off of 7) had a 53% increased risk of mortality (relative risk (RR) 1.53; 95%CI: 1.05–2.24) compared to non-depressed subjects. The combination of depressive symptoms with smoking was associated with a particularly higher risk of mortality (RR: 2.61; 95%CI: 1.28–5.31), after controlling for potential confounders.Conclusions: Depressive symptoms are associated with a significantly increased risk of all-cause mortality. The combination of depressive symptoms and smoking shorten life expectancy among the aged.

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Trajectories of Depression and Their Associations with Mortality in Older People in Korea over 12 Years

Korean Journal of Health Promotion ◽

10.15384/kjhp.2021.21.2.45 ◽

2021 ◽

Vol 21 (2) ◽

pp. 45-55

Author(s):

Sinhyung Lee ◽

Hyeon Ho Choi ◽

Seung Hee Kim ◽

Jungun Lee

Keyword(s):

Depressive Symptoms ◽

Proportional Hazards ◽

Depression Scale ◽

Epidemiological Studies ◽

Cox Proportional Hazards ◽

Men And Women ◽

Women Subjects ◽

Cox Proportional Hazards Models ◽

Hazard Ratios ◽

Korean Elderly

Background: As the course of depression and depressive symptoms over a lifetime varies between individuals, we used trajectory models based on the Korean Longitudinal Study of Aging to repeatedly measure symptoms over a follow-up period of 12 years to reveal the association with mortality.Methods: Three thousand five hundred sixty-one (1,483 men and 2,078 women) subjects aged over 65 years were included. Using the 10-item Center for Epidemiological Studies Depression Scale (CES-D 10), a trajectory model was classified into different depressive symptom groups by gender. Cox proportional hazards models were used to investigate the association between depression trajectory and all-cause mortality.Results: We identified four trajectories of depressive symptoms in both men and women characterized by low CES-D 10 scores throughout the study: Low trajectory (LT), Moderate high trajectory (MHT), High, but increasing trajectory (HIT), and High, but decreasing trajectory (HDT). The adjusted hazard ratios of the HIT, HDT, and MHT compared with LT in men were 2.12 (95% confidence interval [CI], 1.43-3.16), 1.52 (95% CI, 0.96-2.40), and 1.58 (95% CI, 1.10-2.26), respectively. In women, ratios of each group were 1.62 (95% CI, 1.25-2.10), 0.84 (95% CI, 0.61-1.16), and 1.20 (95% CI, 0.99-1.46).Conclusions: Highly depressive symptoms that increased over the 12 years period were associated with the highest risk of mortality in the Korean elderly population. The trajectory group with remitting depressive symptoms (HDT), despite having a similar baseline level of mood symptoms as the high increasing group (HIT) experienced a lower mortality risk in both men and women.

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Relationship between radiological severity and physical and mental health in elderly individuals with knee osteoarthritis

10.21203/rs.3.rs-28598/v2 ◽

2020 ◽

Author(s):

Isadora Ribeiro ◽

Arlete Maria Valente Coimbra ◽

Beatriz Lavras Costallat ◽

Ibsen Bellini Coimbra

Keyword(s):

Quality Of Life ◽

Knee Osteoarthritis ◽

Depression Scale ◽

Womac Score ◽

Depression Symptoms ◽

Physical And Mental Health ◽

Timed Up And Go ◽

Risk Of Falls ◽

The Individual

Abstract BACKGROUND: This study aimed to investigate the relationship between radiological severity, as assessed by the individual grades and grouped grades (grades "0 and 1" and "2 to 4") of the Kellgren-Lawrence scale (K&Ls), and depression symptoms, cognitive loss, risk of falls and quality of life in relation to knee osteoarthritis, as assessed by other instruments. METHODS: Data recorded between 2013 and 2014 in Amparo (São Paulo, Brazil) were retrieved for analysis. A total of 181 elderly patients who had knee osteoarthritis and underwent a radiologic exam were evaluated for depressive symptoms, cognitive loss, quality of life and risk of falls by the geriatric depression scale (GDS), mini-mental state examination (MMSE), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), timed up-and-go test (TUG) and Berg balance scale (BBS). For statistical analyses, Fisher's exact test, Mann-Whitney test, Kruskal-Wallis test and Spearman's coefficient analysis were used. RESULTS: There was no significant relationship between the scores of the instruments investigated and the individual K&Ls grades. However, when the K&Ls scores were assessed by groups, grades “2 to 4” were associated with the worst WOMAC score and the highest frequency and risk of falls according to the BBS but not according to TUG. For the GDS and MMSE, no significant relationships with the K&Ls grades were found. In addition, the K&Ls grade was correlated with the WOMAC score, regardless of the domain. CONCLUSION: The radiological scores of the Kellgren-Lawrence (K&L) scale were associated with poorer WOMAC and BBS scores only when the K&Ls scores were evaluated in groups, and the WOMAC score was associated with an increase in the radiological grade.

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The Inflammatory Potential of the Diet is Directly Associated with Incident Depressive Symptoms Among French Adults

Journal of Nutrition ◽

10.1093/jn/nxz045 ◽

2019 ◽

Vol 149 (7) ◽

pp. 1198-1207 ◽

Cited By ~ 3

Author(s):

Moufidath Adjibade ◽

Cédric Lemogne ◽

Mathilde Touvier ◽

Serge Hercberg ◽

Pilar Galan ◽

...

Keyword(s):

Depressive Symptoms ◽

Proportional Hazards ◽

Middle Age ◽

Scientific Evidence ◽

Depression Scale ◽

Cox Proportional Hazards ◽

Low Grade ◽

Wide Range ◽

Incident Cases

ABSTRACTBackgroundLow-grade chronic inflammation has been suggested to play a substantial role in the etiology of depression; however, studies on the prospective association between the inflammatory potential of the diet and depression are limited.ObjectiveThe aim of this study was to investigate the association between the inflammatory potential of the diet (measured using the Alternate Dietary Inflammatory Index, ADII) and incident depressive symptoms. We also tested the potential modulating effect of sex, age, BMI, and lifestyle indicators.MethodsThe study sample consisted of 26,730 participants (aged 18–86 y) from the NutriNet-Santé study. Baseline ADII was computed using repeated 24-h dietary records collected during the first 2 y of the follow-up. Incident cases of depressive symptoms were defined by a Center for Epidemiologic Studies Depression scale ≥17 for men and ≥23 for women at least once during follow-up. HR and 95% CI were estimated using multivariable Cox proportional hazards models.ResultsA total of 2221 incident cases of depressive symptoms were identified over a mean follow-up of 5.4 y. After accounting for a wide range of potential confounders, the highest quartile of the ADII was associated with a 15% (95% CI: 2, 31) increase in the risk of depressive symptoms compared with the lowest quartile. In the stratified analyses, associations were statistically significant only among women (HRquartile4 vs. quartile1: 1.19; 95% CI: 1.02, 1.37), middle-age adults (HRquartile4 vs. quartile1: 1.16; 95% CI: 1.00, 1.35), and participants with a BMI ≥25 (HRquartile4 vs. quartile1: 1.29; 95% CI: 1.04, 1.60).ConclusionsOverall, a proinflammatory diet was associated with a higher risk of depressive symptoms, especially among women, middle-age adults, and participants with overweight or obesity. These findings contribute to the increasing scientific evidence showing a detrimental role of the proinflammatory diet. The NutriNet-Santé study is registered at clinicaltrials.gov as NCT03335644.

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Relationship between radiologic gravity and predicting instruments of physical and mental health in elderly with knee osteoarthritis

10.21203/rs.3.rs-28598/v1 ◽

2020 ◽

Author(s):

Isadora Ribeiro ◽

Arlete Maria Valente Coimbra ◽

Beatriz Lavras Costallat ◽

Ibsen Bellini Coimbra

Keyword(s):

Quality Of Life ◽

Knee Osteoarthritis ◽

Geriatric Depression Scale ◽

Depression Scale ◽

Womac Score ◽

Depression Symptoms ◽

Physical And Mental Health ◽

Timed Up And Go ◽

Risk Of Fall

Abstract BACKGROUND: This study aimed to investigate the relationship between radiologic severity by the grades of the Kellgren-Lawrence scale (K&Ls) independently and in two groups (grades "0 and 1" and "2 to 4") and instruments that assess depression symptoms, cognitive loss, risk of fall and quality of life related to knee osteoarthritis. METHODS: The analyzed materials were derived from a database and collected between 2013-2014 in Amparo (São Paulo, Brazil). 181 elderly with knee osteoarthritis who had a radiologic exam were evaluated for depressive symptoms, cognitive loss, quality of life and risk of fall by: Geriatric Depression Scale (GDS), Mini Mental State Examination (MMSE), WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), Timed Up and Go test (TUG) and Berg Balance Scale (BBS). To statistical analyses was used Fisher's exact test, Mann-Whitney test, Kruskal-Wallis test and Spearman's coefficient. RESULTS: There was no significant relationship between the instruments investigated and the grades assessed individually. However, when assessed by groups, grades “2 to 4” had the worst WOMAC score, the highest frequency and the worst risk of fall in the BBS, but not in the TUG. For GDS and MMSE, no significant relationships were found. In addition, K&Ls was correlated with the WOMAC socre, with no differences between their domains. CONCLUSION: Only when evaluated in groups, the radiological scores of the Kellgren-Lawrence scale pointed to a worse status in the WOMAC and BBS and the WOMAC score accompanies the increase in the radiological grade.

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