Search Results (231)

Knee osteoarthritis prognostic tools often target structural progression or surgery and require imaging or biomarker inputs that are not routinely available. Using Osteoarthritis Initiative data, we developed a fully clinical nomogram to estimate both the probability of long-term pain non-resilience (clinically important worsening) and, by complement, maintenance of acceptable pain in radiographic knee osteoarthritis. We included participants with radiographic knee osteoarthritis and complete worst-knee WOMAC pain scores at baseline, 24 and 48 months; non-resilience was defined as a ≥9-point increase on the 0–100 WOMAC pain scale over 4 years. A six-predictor Firth logistic regression model (age, body mass index, Kellgren–Lawrence grade, baseline pain, 0–24-month pain change and Center for Epidemiologic Studies Depression Scale score) was fitted and translated into a point-based nomogram. Among 2365 eligible participants, 527 (22.3%) were non-resilient. The model showed good performance, with optimism-corrected AUC 0.74 and Brier score 0.15, and decision-curve analysis indicated positive net benefit versus treat-none across 1–15% thresholds and small gains versus treat-all. Early pain worsening and higher depressive symptoms were the strongest predictors of non-resilience. This six-variable, clinic-ready nomogram provides a simple, well-calibrated tool for prognostic counseling and risk stratification in radiographic knee osteoarthritis and requires external validation before wider clinical use. Full article

Background/Objectives: A medical–government conflict in South Korea in 2024 led to the collective resignation of resident physicians, causing severe workforce shortages in tertiary hospitals. This study aimed to investigate temporal changes in stress, anxiety, and depression among healthcare workers during this conflict following the COVID-19 pandemic. Methods: This retrospective study analyzed data from 56,137 adults who completed validated questionnaires on stress (KNHANES), anxiety (Clinically Useful Anxiety Outcome Scale, CUXOS), and depression (Center for Epidemiologic Studies Depression Scale, CES-D) between January 2019 and February 2025 at Samsung Changwon Hospital. Temporal trends were assessed using linear mixed-effects models adjusted for demographic variables. Results: Among attending physicians, stress increased by 1.44 points in the post-COVID period (p < 0.001) and 1.17 points during the conflict (p = 0.006), while anxiety increased by 1.25 (p = 0.012) and 1.36 points (p = 0.013), respectively. The most vulnerable subgroups were women, those aged 30–40 years, and physicians with <5 years of service. Depression increased significantly among physicians in their 40s during the post-COVID period (p = 0.018). Nurses demonstrated a significant reduction in stress during the conflict (−0.91, p = 0.002), possibly reflecting a temporary decrease in direct clinical workload, whereas office workers showed continuous increases in depression (+1.66 post-COVID, p = 0.003; +1.74 conflict, p = 0.001). Conclusions: The psychological effects of systemic crises differed by occupation. Attending physicians, who bore the greatest clinical and organizational burden, experienced persistent psychological strain during the medical–government conflict following post-pandemic stress. Tailored, occupation-specific strategies are required to protect healthcare workers’ mental health during future systemic disruptions. Full article

Background: Prenatal depression, affecting up to a quarter of all pregnancies in the United States, contributes to morbidity and mortality and is associated with increased risk of adverse birth and long-term mental health outcomes. Adverse childhood experiences (ACEs, or experiences of abuse, neglect, or family dysfunction experienced prior to age 18) are a strong predictor of adult depression and adverse health outcomes. The present study investigated whether epigenetic modification in the form of DNA methylation (DNAm) of four stress-related, glucocorticoid pathway genes (CRH, CRHR1, FKBP5, NR3C1) mediates associations between ACEs and depressive symptoms among Black pregnant women. Methods: Using a cross-sectional design, we examined the mediating role of DNAm on the relationship between depressive symptoms (Center for Epidemiologic Studies Depression Scale (CES-D)) and ACEs (Centers for Disease Control and Prevention 10-item questionnaire), in a subsample (n = 61) of Black pregnant women who were participants of the Biosocial Impacts of Black Births (BIBB) study. Results: A significant association was found between ACEs and depressive symptoms scores (TE α_X = 2.29 with p_TE = 6.60 × 10⁵). DNAm on five CpG sites within two genes significantly mediated the relationship between ACEs and depressive symptoms (cg03238273 on CRHR1, and cg08845721, cg16594263, cg19820298, and cg23430507 on NR3C1). Conclusions: This study provides evidence that DNAm partially mediated the association of ACEs and depressive symptoms during pregnancy among Black pregnant women. Understanding the molecular pathways underlying the mediating effect of ACEs on depressive symptoms among Black pregnant women can illuminate biological markers that help identify and treat pregnant women who are at an increased risk for depression following childhood trauma. Full article

Background/Objectives: Long working hours are a recognized risk factor for poor mental health, but their impact may vary across generations. Millennials and Generation Z (MZ generation) have received attention for their distinct values, work–life expectations, and communication styles compared with older cohorts. The present study assessed generational differences (MZ vs. non-MZ) in the association between weekly working hours and depressive and anxiety symptoms among Korean employees. Methods: We analyzed cross-sectional data from 11,372 employees (68.0% men; mean age = 36.7 years) who underwent mental health screenings between 2020 and 2022. Participants born on or after 1 January 1980, were classified as belonging to the MZ generation (n = 7538). Symptoms of depression and anxiety were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Clinically Useful Anxiety Outcome Scale (CUXOS). Multiple linear regression models tested the interaction between mean-centered weekly working hours and generation, adjusting for sociodemographic covariates. Results: Longer working hours were significantly associated with greater depressive (B = 0.080, p < 0.001) and anxiety (B = 0.119, p < 0.001) symptom severity. Significant interactions between generation and working hours were observed for both depression (B = 0.140, p < 0.001) and anxiety (B = 0.182, p < 0.001). Generation-stratified models showed that the increase in symptom severity per additional work hour was approximately three-fold higher in the MZ generation than in the non-MZ generation. Conclusions: The mental health burden of long working hours is amplified in the MZ generation. Generation-sensitive workplace health strategies are needed to address this vulnerability. Full article

We tested the longitudinal invariance of seven short versions of the Center for Epidemiological Studies Depression Scale (CES-D) in maternal caregivers, following recent analytic recommendations for ordered categorical responses. Data for this study were drawn from the Longitudinal Studies in Child Abuse and Neglect (LONGSCAN) consortium, based on responses from 427 maternal caregivers across five waves corresponding to their children’s ages: 4, 6, 12, 14, and 16 years. We employed a comprehensive approach using differences in two approximate fit indices (CFI and RMSEA), the chi-square difference test (χ²), and a sensitivity analysis based on predicted response differences. Only one version demonstrated full invariance across all levels, while the others showed only partial evidence for loading or threshold invariance. These findings highlight concerns regarding the use of brief CES-D versions in longitudinal research, particularly over extended time periods. They also underscore the need to reassess whether item content aligns with current definitions of depressive syndrome. Our results suggest that evaluating the longitudinal invariance of short depression measures is essential to ensure the validity of conclusions about changes over time. Full article

Previous cross-sectional studies have explored associations between basic psychological need satisfaction, fear of missing out (FoMO), and depression. However, the longitudinal nature of these relationships and their underlying mechanisms remain unclear. This study aimed to utilize longitudinal tracking methods to investigate the relationships among basic psychological need satisfaction, fear of missing out, and depression in university students. Longitudinal data collection was conducted among 750 university students (mean age = 18.12 ± 0.73) in China over two years at three time points. Participants were investigated using paper–pencil survey versions of the Basic Psychological Needs Scale, the Fear of Missing Out scale, and The Center for Epidemiological Studies Depression Scale. The results revealed that, over the two-year study period, basic psychological need satisfaction (β = −6.239, p < 0.001) among university students demonstrated a declining trend, while FoMO (β = 1.360, p < 0.001) and depression (β = 3.602, p < 0.001) demonstrated an upward trend. The initial levels and development rates of basic psychological need satisfaction directly predicted the initial levels (β = −0.236, p = 0.031) and development rates of depression (β = −0.144, p < 0.001; β = −0.181, p = 0.005). The initial level of FoMO mediated the relationship between basic psychological need satisfaction and depression (β = −0.132, p = 0.007; β = −0.104, p = 0.036), and this mediating effect did not exhibit significant gender differences. These findings help to reveal the temporal relationships among the three variables from a dynamic perspective, providing important practical guidance for mental health education in universities. Full article

Background/Objectives: Depression is the most common mental health problem in older adults and is closely associated with meaning in life. This study aimed to investigate the interconnections between depressive symptoms and meaning in life and their association with health-related quality of life (HRQoL) in older adults using a network analysis. Methods: This cross-sectional study was performed between July and August 2021. The 10-item Center for Epidemiologic Studies Short Depression Scale (CES-D), the Meaning in Life Questionnaire, and the EQ-5D-3L were used. Central and bridge symptoms were identified using strength and bridge strength. Furthermore, a flow network was employed to examine whether depressive symptoms and meaning in life were associated with HRQoL. Results: Overall, 213 community-dwelling older adults participated. “Sadness,” “loneliness,” and “depressed” were found to be the central symptoms in the depressive symptoms and meaning in life network. “Presence of meaning” and “inability to get going” each had the highest bridge strength values in the depressive symptoms and meaning in life network. Moreover, “inability to get going”, “loneliness”, and “everything was an effort” had the strongest relationships with HRQoL. Conclusions: This study highlights the inter-relationships between depressive symptoms, meaning in life, and HRQoL. Interventions targeting the central and bridging symptoms are crucial for reducing depressive symptoms associated with a low sense of meaning in life among older adults. These findings offer insights to inform symptom-focused interventions aimed at reducing depressive symptoms (i.e., affective symptoms, loneliness, and motivational deficit) and at enhancing meaning in aging populations. Full article

Background and Objectives: This study investigated changes in quality of life (QOL), depression, and menopausal symptoms after surgical menopause, and the efficacy of hormone replacement therapy (HRT) in gynecological cancer survivors (GCS). Materials and Methods: Participants undergoing gynecologic cancer surgery (N = 155) were divided into those who received HRT after surgical menopause (SH, N = 47), those after surgical menopause (SM, N = 54), and those after natural menopause (NM, N = 54). QOL, depression, and menopausal symptoms were assessed using the Functional Assessment of Cancer Therapy-General (FACT-G), Center for Epidemiologic Studies Depression Scale (CES-D), and Endocrine Symptoms Subscale-19 (ESS-19), respectively. Assessments were conducted before and at 6 and 12 months after surgery. Results: In SH and SM, FACT-G and CES-D were worst before surgery, gradually improved by 6 months, and remained stable for the following 6 months. FACT-G and CES-D showed an inverse relationship. ESS-19 did not change in SH and SM for 12 months. Among the items on the ESS-19, worsened vasomotor symptoms (VMSs), assessed with ES1, showed more improvement in SH than in SM, while worsened arthralgia assessed with BRM1 was maintained in SM. Multivariate analysis showed that HRT was not independently correlated with changes in QOL and depression status. Conclusions: In GCS, the prevalence of depression was highest at cancer disclosure along with declining QOL. QOL gradually improved by 6 months after surgery in SH and SM, but not in NM. Although menopausal HRT is known to alleviate VMS, anxiety, and depression, its efficacy for cancer-related emotional distress and the associated decline in QOL seems limited. Full article

Background: Spirituality has emerged as a potential protective factor that may promote mental well-being and resilience among healthcare workers. Aim: This study aims to examine the relationship between spirituality, stress, and depression among healthcare professionals in Greece. Methods: This cross-sectional study surveyed 412 employees at the Corinth General Hospital in Greece, including medical, nursing, and administrative personnel. The data were collected using the Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being 12 (FACIT-SP12), the Perceived Stress Questionnaire (PSQ), and the Center for Epidemiologic Studies Depression Scale (CES-D). The statistical analyses included non-parametric tests, correlation coefficients, and multiple regression. Results: The mean spirituality score was 34.6 (±6.83), while the stress and depression scores were 74.6 (±14.87) and 14.7 (±10.20), respectively. Spirituality was significantly and negatively correlated with both stress (r = −0.479, p < 0.001) and depression (r = −0.452, p < 0.001). Gender, years of service, educational level, and marital status were also associated with variations in stress, depression, and spirituality levels. Women and those with lower education reported significantly higher levels of stress and depression. Additionally, some demographic variables such as age and sector of employment did not show significant associations with spirituality or depression. The regression analysis confirmed spirituality as an independent predictor of lower stress levels (B = −1.158, p < 0.001). Conclusions: Spirituality is a significant predictor in mitigating stress and depression among healthcare workers. Promoting a supportive spiritual climate and incorporating elements of spiritual leadership in healthcare settings may enhance employee well-being and resilience. Future research should expand on these findings across diverse institutional and cultural contexts. Full article

Aims: To examine the association between depressive symptoms and metabolic profile in women with prior gestational diabetes mellitus (GDM) and early postpartum prediabetes, and to explore whether a mobile-based lifestyle intervention affected mental health outcomes. Methods: Secondary, exploratory analysis of a multi-centric randomized controlled trial (MELINDA), evaluating a mobile-based lifestyle intervention versus standard follow-up (control group) in women with prediabetes after GDM. The analysis included 166 participants who completed the Center for Epidemiologic Studies–Depression (CES-D) questionnaire [score of ≥16 being suggestive for (sub)clinical depression] at baseline (6–16 weeks postpartum) and one year post-randomization. Results: At one year, 26.5% of women (n = 44) reported depressive symptoms, with no significant difference between the intervention and control groups (30.5% vs. 22.6%, p = 0.293). Women with depressive symptoms (symptomatic women) were younger (30.9 ± 4.9 vs. 32.5 ± 3.8 years, p = 0.033) and were less often highly educated (61.4% vs. 80.3%, p = 0.028). At baseline, symptomatic women had a higher rate of metabolic syndrome (38.6% vs. 21.9%, p = 0.044), higher LDL-cholesterol [3.2 ± 0.8 vs. 2.8 ± 0.8 mmol/L, p = 0.009], lower quality of life (lower SF-36 scores, p < 0.050) and a higher level of anxiety based on the STAI-6 questionnaire (14.5 ± 3.6 vs. 11.2 ± 2.6, p < 0.001). These differences persisted at one year postpartum with worse metabolic profile, more anxiety and lower quality of life in symptomatic women. Conclusions: Depressive symptoms are common in women with prediabetes in early postpartum after GDM and are associated with a persistent worse metabolic profile, increased anxiety and lower quality of life postpartum. The mobile-based lifestyle intervention did not improve mental health. Full article

Positive psychology interventions in higher education can be pivotal in reducing depression rates among university students while also enhancing their optimism and well-being. This study aims to examine the effectiveness of implementing a 15-week group intervention on a sample of 194 students who were assigned to either the intervention group (N = 126) or the control group (N = 68). Utilizing a quasi-experimental design with experimental and control conditions, pre- and post-intervention measures were administered to assess depression, optimism, pessimism, and perseverance towards long-term goals. Specifically, the Life Orientation Test-Revised (LOT-R), the Center for Epidemiologic Studies Depression Scale (CES-D), the Attributional Style Questionnaire (ASQ), and the GRIT Scale were employed. The results indicate that students in the experimental group reported significantly higher levels of optimism and reduced depression rates compared to the control group, where no significant differences were observed between pre- and post-intervention outcomes. In conclusion, the implementation of the Hallenges group intervention program may be effective in contributing to the well-being of university students. However, further research is needed to refine and enhance this intervention and to apply it across different university grades and courses. Full article

Background/Objectives: Poor sleep quality, depression, and anxiety are associated with subjective cognitive decline (SCD) and greater risk for developing cognitive impairment and Alzheimer’s disease. The COVID-19 pandemic negatively impacted sleep habits and psychological well-being in many individuals, yet their relationship to SCD in this context remains understudied. We examined sociodemographic characteristics, depression, anxiety, and sleep changes during the pandemic (i.e., increased problems/poorer quality) and SCD in older individuals living in the US. Methods: In total, 288 older adults (M_age = 67.4 [7.4]) completed an online survey including a sociodemographic questionnaire, the Center for Epidemiologic Studies Depression Scale (Revised) (CES-D-10; depression), General Anxiety Disorder-7 (GAD-7; anxiety), the Everyday Cognition scale (ECog; SCD), and a question about increased sleep problems/worsened sleep quality during the pandemic. Hierarchical and logistic regression analyses were used to assess relations among sociodemographic factors, depression, anxiety, changes in sleep quality, and SCD. Results: Self-reported pandemic-related impairments in sleep were associated with greater SCD (β = 0.16, p = 0.01). Depression (β = 0.46, p < 0.001) and anxiety (β = 0.29, p < 0.001) were also associated with greater SCD. Depression (OR = 1.17, p < 0.001) and anxiety (OR = 1.15, p = 0.017) predicted reported poorer sleep during the pandemic. Conclusions: Depression, anxiety, and poorer sleep quality during the COVID-19 pandemic were associated with greater SCD concerns. Greater depression and anxiety were also associated with the reported sleep problems/worsened sleep quality. Prevention and management of anxiety and depressive symptoms may help maintain sleep quality and reduce risk of cognitive decline. Full article

Background/Objectives: Research suggests that diet influences oxidative stress status in pregnant women and is related to their stress and depressive symptoms. This study aimed to investigate how maternal diet during late pregnancy affects oxidative stress status, maternal stress, depression, and fetal physical development. Methods: This study included 58 mother–child pairs. Dietary intake, depressive symptoms, and clinical information were obtained through questionnaires and clinical records. Maternal and cord blood concentrations of malondialdehyde (MDA), paraoxonase-1, platelet activating factor-acetylhydrolase, and cortisol were measured using spectrophotometric and enzyme-linked immunosorbent assays. Results: Maternal serum MDA levels were inversely associated with nut consumption (β = −0.40, p = 0.01) and positively associated with vitamin B2 (β = 2.43, p = 0.04) and manganese intake (β = 0.44, p = 0.02). Fruit consumption was positively associated with Center for Epidemiologic Studies Depression Scale score (β = 0.35, p = 0.03). Intakes of beans (β = −3.37, p = 0.04), vitamin B1 (β = −738.92, p = 0.04), vitamin B6 (β = −562.21, p = 0.04), vitamin C (β = −4.75, p = 0.009), iron (β = −106.63, p = 0.03), and copper (β = −863.31, p = 0.01) were inversely associated with maternal serum cortisol level, whereas dairy intake (β = 1.45, p = 0.003) showed a positive association. Cord plasma cortisol levels were inversely associated with the consumption of other vegetables (β = −2.89, p = 0.02). Conclusions: The findings encourage further research towards the refinement of dietary guidelines for pregnant women and recommendations for expecting mothers. Full article

Background: Depressive symptoms (DepS) are prevalent among patients with breast cancer. Offering an anti-inflammatory diet is a promising strategy for DepS management, but it is costly and difficult to scale up. Instead, anti-inflammatory dietary education is cost-effective and may be more conducive to the promotion of an anti-inflammatory diet strategy. Methods: A prospective, assessor-blinded, two-arm randomized controlled trial was designed to determine the effects of 12-week anti-inflammatory dietary education on DepS in breast cancer patients with depression. Adult female patients with depression and receiving adjuvant chemotherapy were recruited. Participants in the intervention group received anti-inflammatory dietary education, while the control group received routine nursing care. Outcomes included the Center for Epidemiologic Studies Depression Scale (CES-D) score, energy-adjusted dietary inflammatory index (E-DII), plasma inflammatory biomarkers, and quality of life (QoL), which were all assessed at baseline and after a 12-week follow-up. The robustness of the estimates was investigated through sensitivity analyses. A post hoc power analysis was conducted to establish the observed effect sizes for the primary outcomes. Results: A total of 88.6% (62/70) of the participants completed the entire 12-week follow-up. No statistically significant between-group differences were found in the baseline characteristics, including sociodemographic factors, disease-related characteristics, and lifestyle factors. After the intervention, both the CES-D score (p = 0.040) and E-DII (p < 0.001) in the intervention group were significantly lower than in the control group, while the QoL was significantly increased (p < 0.001). Compared with the baseline, the tumor necrosis factor-α (TNF-α) (p = 0.002) and C-reactive protein (CRP) (p = 0.045) levels were significantly lower in the intervention group but not in the control group. Conclusions: Anti-inflammatory dietary education may improve DepS and QoL in breast cancer patients with depression and undergoing chemotherapy by regulating inflammation. Given its acceptability and practicality, this strategy may be incorporated into routine cancer care. Full article

Background: Fruit and vegetable (FV) intake is critical for optimizing pregnancy outcomes. Several socio-demographic factors are associated with FV intake, but less is known about behavioral and mental health correlates. Furthermore, existing knowledge is largely based on self-reported FV intake. The current cross-sectional study examined depressive symptoms and income as moderators of the association between eating behaviors and skin carotenoids (FV status biomarker) in pregnancy. Methods: Participants living in an urban area of the south-astern part of the U.S. (N = 299) and who were in their third trimester of pregnancy were recruited for lab visits between 2019 and 2022 and completed the Dutch Eating Behavior Questionnaire and the Center for Epidemiological Studies Depression Scale. FV status was assessed using a pressure-mediated reflection spectroscopy to determine skin carotenoids. Hypotheses were tested via multiple regression. Results: There was an interaction between dietary restraint and depressive symptomatology such that greater restraint predicted higher skin carotenoids at low levels of depressive but not high levels. There was an interaction between restrained eating and family income in predicting skin carotenoids that was significant at high- but not low-income level. External and emotional eating did not predict skin carotenoids. Conclusions: Restrained eating might positively influence skin carotenoids during pregnancy. However, those who suffer from higher levels of depressive symptoms and/or live in lower-income households face additional barriers that might impede FV status. Further research is warranted to advance our understanding of the interplay between mental health, restrained eating and income on FV status in pregnancy. Full article