28 research outputs found
A GWAS top hit for circulating leptin is associated with weight gain but not with leptin protein levels in lithium-augmented patients with major depression
No full textLithium-treated patients often suffer from weight gain as a common adverse event. In an earlier investigation, we found an impact of two single-nucleotide polymorphisms (rs10487506 and rs2278815) at the leptin gene on weight gain but not on leptin protein levels in serum under lithium augmentation. A recent genome-wide association study identified a polymorphism at the leptin gene locus (rs10487505) associated with circulating leptin protein levels. To characterize potential effects of this variant in acute major depressive disorder, we investigated body mass indices from 180 lithium-augmented patients and serum concentrations of leptin protein from 89 patients using linear mixed model analyses and rs6979832, a proxy SNP of rs10487505. Body mass index was measured before and after 4 weeks of lithium augmentation, in a subsample also after 4 and 7 months. Leptin serum levels were measured before and during lithium augmentation. G-allele homozygotes of rs6979832 had a significantly lower body mass index increase during observation compared to A-allele hetero- and homozygotes. However, we found no influence on leptin serum levels. Joint analyses of rs6979832 with the previously investigated polymorphisms rs10487506 and rs2278815, and expressed quantitative trait data, suggest a complex interplay between SNP alleles at the leptin locus. These results strongly support our earlier findings that common genetic variation at the leptin gene locus may be involved in lithium augmentation-associated weight gain in major depressive disorder
Studying the interplay between inflammation, minority stress, and mental health among trans- and cis-gender individuals
No full textTransgender and gender non-conforming (TGNC) individuals are a growing demographic with unique healthcare needs. Relative to the general population or cisgender individuals, TGNC individuals are at a higher risk for mental health conditions such as depression1 and show higher suicidality 2, especially during the COVID-19 pandemic 3. The increased risk for mental health conditions is often explained with the minority stress model, which postulates that stigma, prejudice, and discrimination of marginalized communities create a stressful social environment that causes mental health burden 4,5. In addition to general stressors, disadvantaged status and protective factors, minority stress is often operationalized as distal (external, e.g., prejudice and discrimination) and proximal stress processes (internal, e.g., concealment and/or negative feelings about one’s own minority status), which accrue over time and result in negative mental health outcomes 6. Although the importance of minority stress for mental health is well-established 5, it remains unclear how biological factors such as stress-related immune responses interact with psychosocial factors and constitute risk for or resilience to depression in TGNC individuals 7.
A large body of evidence suggests inflammatory processes in the development and maintenance of depression 8-10. Inflammation is the body’s response to a wide range of irritants such as pathogens, and under most conditions immune responses are arrested if the irritant is fought off. However, according to the social signal transduction theory of depression, early and prolonged experiences of social threat and adversity up-regulate pro-inflammatory cytokines, involved in systemic inflammation, which can trigger and maintain depressive symptoms8, even when the threat is no longer present. In line with this theory, several studies reported on higher pro-inflammatory cytokines, such as interleukin (IL)-6, in individuals with depression relative to healthy controls, and in the context of psychosocial stress exposure11. Although the social signal transduction theory of depression is intriguing, only a few studies have investigated this theory in the context of minority stress in TGNC individuals and cisgender individuals with depression12. McQuillan and colleagues found higher C-reactive protein (CRP, acute phase inflammatory marker) levels with greater gender-based stress and a lack of support in TGNC youth when investigating a composite score of the Gender Minority Stress and Resilience Tool (GMSR)13. However, this study only focused on CRP, neglecting the complex interplay between different inflammatory measures, such as cytokines. For instance, cytokines can have redundant, synergistic, and antagonistic in a cell, and can increase the production of other cytokines 14. The work by Real and colleague was the first to account for several inflammation markers, previously liked to depression 10, among TGNC individuals relative to cis-gender individuals. The authors found, however, no significant differences in cytokine levels (i.e., IL-1β, IL-6, IL-10, and tumor necrosis factor-alpha (TNF-α)) between 34 trans* women and 31 cisgender men, despite more discrimination experience, higher rates of childhood maltreatment, and higher suicidal ideation and previous suicide attempts among trans* women 15. This null finding might be influenced by sample size limitations and the exclusion of biological females assigned at birth (i.e., trans* men and cisgender women). Females assigned at birth/cisgender women are disproportionally affected by depression relative to males assigned at birth/cisgender men (2:1), and emerging evidence suggests the role of inflammatory processes in this prominent sex and gender difference 16,17.
In summary, although several studies report on the importance of minority stress and increased inflammation with depression, comprehensive immunological studies in TGNC individuals, across the sex and gender spectrum, with a focus on depression and minority stress are currently lacking. In addition, emerging evidence suggests substantial inter-individual differences and potential subgroups of inflammatory profiles in individuals with depression10,18, which case-control studies fail to detect. The objective of the current study is to close this knowledge gap by studying covariance patterns between inflammatory markers and minority stress-related domains and further elucidating heterogeneity in a large sample of TGNC and cis-gender individuals, using already acquired data from the Department of Psychiatry and Neuroscience at Charité - Berlin Universitätsmedizin, Berlin, Germany and the Hormone and Fertility Centre at the Ludwig-Maximilian-Universität Munich, Munich, Germany. In detail, we will use (1) canonical correlation analysis (CAA) to study covariation between cytokines and minority stress domains and (2) hierarchical clustering on these patterns of covariance to investigate heterogeneity across sex, gender, and depressive symptom load. As most TGNC individuals are at different stages of transition, a particular focus will be placed on whether gender affirming hormone therapy affects inflammatory and minority stress profiles. Lastly, we will investigate whether sex assigned at birth and gender differently modulate inflammatory and minority stress profiles in TGNC and cisgender individuals with and without depressive symptoms
Preoperative depression and hospital length of stay in surgical patients
No full textEinleitung: Bei operativen Patienten wurde bislang die Assoziation von
Depressivität und Krankenhausverweildauer vor allem in der kardiovaskulären
Chirurgie untersucht. Sehr selten sind Studien aus anderen chirurgischen
Fachgebieten. In dieser Studie soll untersucht werden, ob klinisch relevante
Depressivität bei Patienten diverser chirurgischer Gebiete mit der
Krankenhausverweildauer assoziiert ist. In der Analyse sollen wesentliche
somatische Einflussfaktoren auf die Krankenhausverweildauer berücksichtigt
werden. Methodik: In dieser prospektiven Beobachtungsstudie wurden 2.624
operative Patienten aus der Anästhesieambulanz der Klinik für Anästhesiologie
mit Schwerpunkt operative Intensivmedizin der Charité - Universitätsmedizin
Berlin eingeschlossen. Vor der Prä- medikationsvisite wurde eine
computergestützte Lebensstilbefragung durchgeführt, die unter anderem
verschiedene psychosoziale Selbstbeurteilungsfragebögen beinhaltete. Es wurden
zur Erfassung von Depressivität drei standardisierte Screeninginstrumente
eingesetzt: Allgemeine Depressionsskala (ADS-K), World Health Organization
5-Item Well-Being Index (WHO-5) und Two-Item Patient Health Questionnaire
(PHQ-2). Sechs Monate nach der Operation wurden aus elektronischen
Datenverwaltungssystemen der Klinik ergänzende peri- und postoperative
somatische Patientencharakteristika entnommen. Ergebnisse: Patienten mit
klinisch relevanter Depressivität auf der ADS-K (n=296; Median: 5 Tage,
Interquartilbereich: 3-8 Tage) zeigten eine statistisch signifikant höhere
Krankenhausverweildauer (p<0,001) als Patienten ohne klinisch relevante
Depressivität (n=2.328; Median: 4 Tage, Interquartilbereich: 2-6 Tage). In der
multivariaten binär-logistischen Regression mit der abhängigen Variable
Krankenhausverweildauer (kleiner oder gleich Median versus über dem Median)
zeigte die klinisch relevante Depressivität (gemessen mit der ADS-K) eine
statistisch unabhängige Assoziation mit der Krankenhausverweildauer (OR: 1,822
[95% CI 1,360–2,441], p<0,001) bei gleichzeitiger Berücksichtigung von Alter,
Geschlecht, Klassifikation der American Society of Anesthesiologists, Charlson
Comorbidity Index, chirurgischem Fachgebiet und Operationsschwere aus dem
Physiological and Operative Severity Score for the enUmeration of Mortality
and Morbidity. Unabhängig vom Erhebungsinstrument der Depressivität hat sich
in den jeweiligen Regressionsmodellen die klinisch relevante Depressivität als
signifikanter Prädiktor für die Krankenhausverweildauer herausgestellt (ADS-K
p<0,001, WHO-5 p=0,003, PHQ-2 p=0,023). Darüber hinaus konnte in einem
erweiterten Regressionsmodell gezeigt werden, dass klinisch relevante
Depressivität ein unabhängiger statistisch signifikanter Prädiktor (p<0,001)
für erhöhte Krankenhausverweildauer bleibt, wenn weitere soziodemographische
Charakteristika sowie klinische Risikofaktoren für Depressivität
(Partnerschaftsstatus, Erwerbstätigkeitsstatus, Schulbildung, Body Mass Index,
Raucherstatus, alkoholkonsumbezogene Störungen und Drogenkonsum)
berücksichtigt werden. Schlussfolgerung: Die Assoziation zwischen klinisch
relevanter Depressivität und erhöhter Krankenhausverweildauer ist signifikant
unabhängig von Alter, Geschlecht, Schwere der somatischen Komorbidität,
Schwere der Operation und chirurgischem Fachgebiet. Patienten mit klinisch
relevanter Depressivität haben ein 82% höheres Risiko für einen längeren
Krankenhausaufenthalt als Patienten ohne klinisch relevante Depressivität. Ein
möglicher Behandlungsansatz wäre die Einführung eines multimodalen
psychosozialen Stufenkonzepts in die Routineversorgung operativer Patienten,
das es ermöglicht, klinisch relevante Depressivität im Rahmen einer
Screeninguntersuchung zu erkennen und belasteten Patienten adäquate
psychotherapeutische und psychiatrische Interventionen anzubieten.Background: Until now the association between depression and hospital length
of stay has rarely been examined in surgical patients outside of
cardiovascular surgery. The purpose of this study was to investigate whether
clinically relevant preoperative depression shows an independent association
with hospital length of stay in patients from various surgical fields, after
adjusting for age, gender and important somatic factors. Methods: In this
prospective observational study, a total of 2.624 surgical patients were
included at the preoperative assessment clinics of the Department of
Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin
Berlin, Germany. Data were collected before the preoperative anesthesiological
examination within a computer-assisted psycho- social self-assessment
including three screening instruments for depression: Center for Epidemiologic
Studies Depression Scale (CES-D), World Health Organization 5-Item Well- Being
Index (WHO-5) and Two-Item Patient Health Questionnaire (PHQ-2). Data on peri-
and postoperative somatic parameters were obtained from the hospital’s
electronic patient management system six months after the preoperative
assessment. Results: The hospital length of stay of patients with clinically
relevant depression on the CES-D (n=296; median: 5 days, interquartile range:
3-8 days) was significantly longer (p<0,001) than for patients without
depression (n=2.328; median: 4 days, interquartile range: 2-6 days). A
multivariate logistic regression model with the binary dependent variable
hospital length of stay (below or equal to the median versus above the median)
showed that the significant association between depression and hospital length
of stay persisted (OR: 1,822 [95% CI 1,360–2,441], p<0.001) when
simultaneously including the covariates age, gender, classification of the
American Society of Anesthesiologists, Charlson Comorbidity Index, surgical
field and operative severity rating from the Physiological and Operative
Severity Score for the enUmeration of Mortality and Morbidity. Independent of
the screening instruments, depression was a significant predictor for hospital
length of stay (CES-D p<0,001, WHO-5 p=0,003, PHQ-2 p=0,023). Furthermore, it
was shown in an expanded regression model that the association between
depression and hospital length of stay (p<0.001) remained independent even
when including other sociodemographic characteristics and clinical risk
factors for depression (partnership status, employment status, education, Body
Mass Index, smoking status, alcohol use disorders and drug use). Conclusion:
Data suggest that the association of depression and hospital length of stay is
independent of the impact of age, gender, and the somatic factors surgical
field, preoperative physical health, severity of medical comorbidity and
extent of surgical procedure. The risk of having a hospital length of stay
above the median was 82% higher in patients with clinically relevant
depression than in patients without clinically relevant depression. Therefore
a multimodal psychosocial stepped care approach of depression therapy might be
integrated in routine care of surgical patients
Turning the spotlight: Hostile behavior in creative higher education and links to mental health in marginalized groups.
No full textHostile, discriminatory, and violent behavior within the creative industries has attracted considerable public interest and existing inequalities have been discussed broadly. However, few empirical studies have examined experiences of hostile behavior in creative higher education and associated mental health outcomes of early career artists. To address this gap, we conducted a survey among individuals studying at higher education institutions for art and music (N = 611). In our analyses of different types of hostile behaviors and their associations with mental health and professional thriving, we focused on differences and similarities between marginalized and more privileged groups across multiple diversity domains. A substantial percentage of participants reported hostile behaviors in their creative academic environments. Individuals from marginalized groups reported more hostile behaviors, which partially explained their worse mental health and lower professional thriving. These findings indicate a clear need for the creative sector to implement strategies to create safer environments, particularly for early career artists from specific socio-demographic backgrounds. We conclude by suggesting strategies for prevention in this highly competitive industry
Efficacy and Adverse Effects of Tranylcypromine and Tricyclic Antidepressants in the Treatment of Depression
No full textSocial networks of men who have sex with men engaging in chemsex in Germany: differences in social resources and sexual health
No full textAbstract Meyer’s minority stress model posits that sexual minority communities can act as protective factors for individuals within the sexual minority. Given that existing evidence on this proposition is inconclusive, a social network approach was employed to capture diversity in the social environment of individuals involved in chemsex that might account for variations in social resources and sexual health. This study examined the social networks of men who have sex with men (MSM) involved in sexualised drug use, using data from a cross-sectional online survey. Utilising cluster analysis, four distinct social network types were identified based on network composition: MSM-diverse, partner-focused, family-diverse, and chemsex-restricted. In terms of social resources, the four network types did not exhibit significant differences in social support. However, individuals with a chemsex-restricted social network reported stronger social influence related to chemsex and less social engagement outside of chemsex. Contrary to initial expectations, the four network types did not differ in chemsex-related consequences or sexual satisfaction. MSM engaged in chemsex for over 5 years reported more chemsex-related consequences and lower sexual satisfaction, particularly those with a family-diverse social network. Additionally, indicators of network quality, such as perceived emotional closeness, reciprocity with network members, and overall satisfaction with the network, were more influential in predicting sexual health outcomes than social resources. The findings of the study suggest that the social environment of MSM engaged in chemsex plays a role in shaping their experiences. Insufficient inclusion in a sexual minority community is potentially associated with an elevated risk of poor sexual health. These findings underscore the importance of tailoring interventions to address the diverse needs of individuals exposed to different social environments
Akademische und klinische Produktivität – Eine Bedarfsanalyse (CharitéStärken)
No full textIn the following study, the occurrence of certain underrepresented groups with different forms of diversity (gender, LGBTIQ* status, age, health/ability, non-academic background, education, religion, regional background, migration or ethnicity, care or nursing work) will be determined using a survey at the Charité - Universitätsklinik Berlin among students and employees. In addition, potential positive and negative influences on the productivity and well-being of underrepresented groups will be explored to subsequently identify potential needs for developing prevention programs in higher education medicine, and life sciences. All findings will demonstrate contrasts between underrepresented groups and commonly occurring groups
Mental health in people with minority sexual orientations: A meta‐analysis of population‐based studies
No full textLoneliness and depressive symptoms differ by sexual orientation and gender identity during physical distancing measures in response to COVID‐19 pandemic in Germany
No full textDuring the COVID-19 pandemic, physical distancing measures to prevent transmission of the virus have been implemented. The effect of physical distancing measures on loneliness especially for vulnerable groups remained unclear. Thus, we aimed to investigate loneliness in relation with depressive symptoms among lesbian, gay, bisexual, trans, inter, asexual, and queer (LGBT) persons compared with cis-heterosexual persons during the pandemic. We conducted an online survey during the first two waves of the COVID-19 pandemic in Germany. The survey contained self-categorizations regarding sexual orientation and gender identity, questions on loneliness, social contacts, depressive symptoms, and healthcare. Descriptive and regression analysis and propensity score matching across cohorts was conducted using R; 2641 participants took part in first wave of the survey and 4143 participants in the second wave. The proportion of lonely people was higher in the second wave compared with the first wave. LGBT persons were more lonely than cis-heterosexual persons. In both waves, being LGBT was associated with depressive symptoms, but loneliness mediated the effect, even when adjusting for social contacts. Psychologists and other practitioners should be aware that LGBT clients might have an increased risk for loneliness and depressive symptoms and of the potential burden of the pandemic measures
Depression in primary care and the role of evidence-based guidelines: cross-sectional data from primary care physicians in Germany
No full textBACKGROUND: Depression is the most common mental health burden worldwide. Primary care physicians (PCPs) play a key role in the care provision for people with depression. The first objective of the present study was to examine the health care situation of depression in primary care, focusing on the cooperation between PCPs and mental health specialists. Secondly, we aimed at examining the role of the German S3 Guideline for Unipolar Depression in the primary care provision. METHODS: Data of N = 75 PCPs were analysed from a cross-sectional online survey. Analysis of descriptive information on the current status of primary health care and depression was conducted. Further, to examine factors that are related to the usage of guidelines, multiple regression was performed. RESULTS: Only 22.1% of PCPs described the quality of cooperation with ambulatory mental health specialist as good. The most frequent problems in the cooperation were of structural nature (49.3%, long waiting list, few therapy units, as well as barriers in the communication and the information exchange). With regard to the role of the guideline, 65% of PCPs reported never or seldom using the guideline and 31.7% of PCPs perceived the guideline as not useful at all. In addition, perceived usefulness of the S3 guideline was positively associated with the usage of the guideline. Results of the logistic regression revealed a significant association between the usage of the German S3 Guideline for Unipolar Depression and rating of perceived usefulness of the guideline (OR: 4.771; 95% CI: 2.15–10.59; p < 0.001). CONCLUSION: This study highlights the central role of PCPs and demonstrates major barriers in the outpatient health care provision of depression. Present findings suggest a strong need for collaborative health care models to resolve obstacles resulting from fragmented mental health care systems. Finally, reported perceived barriers in the implementation of the German S3 Guideline for Unipolar Depression indicate the urge to involve PCPs in the development of evidence-based guidelines, in order to ensure a successful implementation and usage of guidelines in clinical practice
