BDNF is a novel marker of cognitive function in ageing women: the DR's EXTRA Study

Brain-derived neurotrophic factor (BDNF) is one of the key molecules modulating brain plasticity. While low circulating levels of BDNF have been suggested to predispose to Alzheimer's disease, very little data are available on its association with cognitive function in general population. We evaluated the association between plasma BDNF levels and cognition in a representative population sample of ageing men and women. The subjects (n=1389) were participants of the Dose-Responses to Exercise Training (DR's EXTRA) Study and represent a random sample of Eastern Finnish people (684 men and 705 women), 57-79 years of age at baseline of the study. Plasma BDNF levels were measured by enzyme-linked immunosorbent assay (ELISA). Cognitive function was evaluated using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological test battery. Women had a higher mean (+/-SEM) plasma BDNF level than men (1721+/-55vs. 1495+/-54pg/ml, P<0.001). In women, 1 SD decrease in BDNF increased the risk for a low score in Naming Test by 53% (95% CI 1.21-1.92, P<0.001), in Mini-Mental State Examination by 63% (95% CI 1.21-2.20, P=0.001), in Word List Memory by 56% (95% CI 1.08-2.26, P=0.019), in Word List Recall by 50% (95% CI 1.10-2.05, P=0.010), in Word List Saving by 49% (95% CI 1.12-1.99, P=0.007), and in Word List Recognition by 64% (95% CI 1.19-2.25, P=0.002). Data were adjusted for age, education, depression, impaired glucose metabolism, cardiovascular disease, antihypertensive medication, lipid lowering medication, use of sex hormones, smoking, alcohol consumption, storing time of plasma in the freezer and platelet count. BDNF was not associated with cognition in men. Present data suggest that plasma BDNF is a biomarker of impaired memory and general cognitive function in ageing women.     

Suicidal ideation and attitudes toward suicide

Although hopelessness and depression are known risk factors for suicide, most individuals who are hopeless or depressed never make a suicide attempt. In this study, we tested the hypothesis that college students' (n = 230) attitudes toward suicide (the degree to which they see it as an acceptable option under some circumstances) would moderate the link between both hopelessness and depressive symptoms and their levels of suicidal ideation. This moderation hypothesis was supported, but only among men. Specifically, among men, levels of hopelessness and depressive symptoms were significantly related to suicidal ideation among only those with relatively positive attitudes toward suicide.     

Suicidality, clinical depression, and anxiety disorders are highly prevalent in men who have sex with men in Mumbai, India: findings from a community-recruited sample

In India men who have sex with men (MSM) are a stigmatized and hidden population, vulnerable to a variety of psychosocial and societal stressors. This population is also much more likely to be HIV-infected compared to the general population. However, little research exists about how psychosocial and societal stressors result in mental health problems. A confidential, quantitative mental-health interview was conducted among 150 MSM in Mumbai, India at The Humsafar Trust, the largest non-governmental organization serving MSM in India. The interview collected information on sociodemographics and assessed self-esteem, social support and DSM-IV psychiatric disorders using the Mini International Neuropsychiatric Interview (MINI). Participants' mean age was 25.1 years (SD?=?5.1); 21% were married to women. Forty-five percent reported current suicidal ideation, with 66% low risk, 19% moderate risk, and 15% high risk for suicide per MINI guidelines. Twenty-nine percent screened in for current major depression and 24% for any anxiety disorder. None of the respondents reported current treatment for any psychiatric disorder. In multivariable models controlling for age, education, income, and sexual identity, participants reporting higher levels of self-esteem and greater levels of satisfaction with the social support they receive from family and friends were at lower risk of suicidality (self-esteem AOR?=?0.85, 95% CI: 0.78-0.93; social support AOR?=?0.76, 95% CI: 0.62-0.93) and major depression (self-esteem AOR?=?0.79, 95% CI: 0.71-0.89; social support AOR?=?0.68, 95% CI: 0.54-0.85). Those who reported greater social support satisfaction were also at lower risk of a clinical diagnosis of an anxiety disorder (AOR?=?0.80; 95% CI: 0.65-0.99). MSM in Mumbai have high rates of suicidal ideation, depression, and anxiety. Programs to improve self-esteem and perceived social support may improve these mental health outcomes. Because they are also a high-risk group for HIV, MSM HIV prevention and treatment services may benefit from incorporating mental health services and referrals into their programs.     

Medical Conditions and Nearly Lethal Suicide Attempts

P hysical illness has been studied as a risk factor for suicidal behavior, but little is known about this relationship among younger persons. We conducted a population‐based, case‐control study in Houston, Texas, from November 1992 through September 1995. The final sample consisted of 153 case‐ and 513 control‐subjects aged 13 to 34 years. Case patients were identified at hospital emergency departments and met criteria for a nearly lethal suicide attempt. Control subjects were recruited via a random‐digit‐dial telephone survey. Case patients were more likely than controls to report having any serious medical conditions (crude OR = 3.23; 95% CI = 2.12–4.91). After controlling for age, race/ethnicity, alcoholism, depression, and hopelessness, the adjusted odds ratio for men was 4.76 (95% CI = 1.87–12.17), whereas the adjusted odds ratio for women was 1.60 (95% CI‐0.62–4.17), suggesting that young men with medical conditions are at increased risk for nearly lethal suicide attempts. Increased efforts to identify and appropriately refer these patients are needed.     

Efficacy of physical activity interventions on psychological outcomes in refugee,asylum seeker and migrant populations: A systematic review and meta-analysis

ObjectivesThe role of physical activity (PA) in the promotion of mental wellbeing and prevention of psychological disorders in population groups at increased risk for mental health conditions, such as migrant populations, has never been systematically investigated.MethodsWe conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Pubmed, Web of Science, SportDiscus. We included randomized (RCTs), controlled clinical trials (CCT), and pre-post intervention studies, that assessed the efficacy of PA interventions in migrants, compared with any types of controls.ResultsWe included 27 studies (4166 participants) (16 RCTs; 2 CCTs; 9 pre-post design) between 1997 and 2020. Meta-analysis showed a significant beneficial effect of PA over control conditions for general functioning (SMD -0.35, 95% CI -0.83 to −0.16; 400 participants), outcome expectancies (SMD -0.78, 95% CI -1.17 to −0.40; 118 participants), self-efficacy/coping (SMD -0.28, 95% CI -0.52 to −0.03; 269 participants), and psychological symptoms (SMD -0.48, 95% CI -0.88 to −0.08; 6 RCTs; 597 participants). Similar findings were produced by pre-post intervention studies (SMD -0.35, 95% CI -0.60 to −0.10; 7 studies; 302 participants).ConclusionsMigrant populations may benefit from PA interventions to improve psychological outcomes. Uncertainty remains about the best approach to promote PA in this population, and future research should consider the complex factors that characterize the migration experience.     

Completed suicides in Colorado: differences between Hispanics and non-Hispanic Whites

All suicides by Hispanics (n = 434) and non-Hispanic Whites (n = 3,370) in Colorado from 2004 to 2008 using the Violent Death Reporting System were examined. Hispanic victims were significantly younger. Adjusting for age and gender, Hispanic victims were less likely to have reported depressed mood [odds ratio (OR) 0.78; 95% confidence interval (CI) 0.63-0.97], mental health diagnosis (OR 0.53; 95% CI 0.41-0.7), or current psychiatric treatment (OR 0.47; 95% CI 0.43-0.77). There were no differences in reports of financial, relationship, job, or legal stresses. Hispanic suicides were equally likely to be by overdose, firearm, or hanging, but more likely to be in jail (OR 2.68; 95% CI 1.55-4.65). To prevent suicides, stronger partnerships are needed among public health, medical, mental health, and criminal justice professionals.     

Psychosocial correlates of hopelessness among men

This study examined overall hopelessness, explored differences in various variables (e.g. burnout) between men reporting no/mild hopelessness and moderate/severe hopelessness, and scrutinized factors associated with hopelessness. The study design was cross-sectional, and the participants were 517 men randomly selected from the general population. About 12% of men reported moderate/severe hopelessness, and men with moderate/severe hopelessness were more often older, divorced/widowed, low educated, employed in blue-collar positions, on sick leave/other/unemployment/retirement, and financially strained. They also reported more depression, posttraumatic symptoms, and burnout. Only unemployment/retirement, depression, and posttraumatic symptoms were independently associated with an increased risk for moderate/severe hopelessness in the regression analysis, with unemployment and retirement as the most important factors. In conclusion, this study seems to corroborate previous findings and may provide new insights into men's experiences and predictors of hopelessness. More research into the predictors of hopelessness in men is warranted.     

Prospective cohort study of stress, life satisfaction, self-rated health, insomnia, and suicide death in Japan

The association between many psychosocial factors and risk of suicide was examined. A cohort was conducted over 14 years of follow up among the general population (15,597 people) in Japan. A baseline survey of psychosocial characteristics was conducted by self-administrated questionnaire. The relative risks of occasional emotional stress, difficulty maintaining sleep, and reporting unhealthy as their self-rated health are 3.2 (95% CI: 1.3, 7.6), 2.4 (95% CI: 1.3, 4.3) and 2.6 (95% CI: 1.1, 6.2), respectively. The importance of these observations lie in its potential for improving physician and public awareness of psychosocial factors as an early indication of mental health morbidity.     

Evidence Supporting an Independent Association between Childhood Physical Abuse and Lifetime Suicidal Ideation

A regionally representative Canadian sample was used to investigate the gender-specific relationship between childhood physical abuse and lifetime suicidal ideation. The prevalence of suicidal ideation was about five times higher in abused men and women compared with their nonabused counterparts. After controlling for five clusters of potentially confounding factors (adverse childhood conditions, socioeconomic factors, health behaviors, psychosocial stressors/chronic illnesses, and mental health), childhood physical abuse was significantly associated with suicidal ideation (OR(adjusted) women = 4.48, 95% CI = 3.32-6.04; men = 3.57, 95% CI = 2.08-6.14). These findings suggest childhood physical abuse is independently associated with suicidal ideation and highlight the importance of providing preventative treatment to childhood abuse survivors.     

Assault victimization and suicidal ideation or behavior within a national sample of U.S. adults

Data from a nationally representative sample of 5,238 U.S. adults were used to examine the extent to which physical assault victimization was associated with suicidal ideation or behavior (SIB). The results from multivariable logistic regression analyses indicate that physical assault victimization was positively associated with SIB after adjusting for sociodemographic characteristics and alcohol use (OR = 3.6; 95% CI = 2.4-5.5). Those who were injured during the most recent physical assault (OR = 2.7; 95% CI = 1.2-6.0) and those who were assaulted by a relative (OR = 3.4; 95% CI= 1.0-11.0) or intimate partner (OR = 7.7; 95% CI = 2.7-22.5) were significantly more like to report SIB than victims who were not injured or were assaulted by a stranger. Also, those who were victimized but not injured (OR = 5.6; 95% CI = 3.8-8.2) and those who were victimized by a stranger (OR = 2.9; 95% CI = 1.4-6.0) were more likely to report SIB than non-victims. These results highlight the need for legal, medical, mental health, and social service providers to address the co-occurrence of violent victimization and suicidal ideation, particularly, but not exclusively, victimization by family members and intimates.     

The association between adolescent risk behaviours and feelings of sadness or hopelessness: a cross-sectional survey of South African secondary school learners

Poor mental health in adolescents has shown associations with engagement in other risk behaviours. However, evidence of this association in Sub-Saharan Africa, particularly South Africa, is lacking. This study examines the associations between pertinent risk behaviours and feelings of sadness or hopelessness amongst a nationally representative sample of South African school going adolescents. Data was analysed from the South African Youth Risk Behaviour Survey 2011 (n=10,997), a cross-sectional national survey among grades 8–11 school learners. Logistic regression examined the association of demographic, substance use, violent behaviour, sexual activity and suicidal plans and attempts with the primary outcome, feelings of sadness or hopelessness. Having feelings of sadness or hopelessness was significantly associated with more senior grades, being bullied (AOR:1.67, 95% CI: 1.42–1.96), being assaulted by a partner (1.33 [1.05–1.68]), forced sex (1.78 [1.37–2.32]); gang membership (1.32 [1.06–1.65]), binge drinking (1.37 [1.14–1.65]), ever having sex (1.23 [1.02–1.47]), having ≥1 partner/s in preceding three months (1.25 [1.02–1.53]), having made a plan to attempt suicide (2.50 [1.95–3.21]) and suicide attempt (1.49 [1.21–1.85]). Adolescents in South Africa are experiencing a multiple burden of risk. Health promotion strategies targeting adolescent mental health and risk behaviours need to be developed and implemented in a timely and comprehensive manner.     

The psychological impact of AIDS on gay men

The profound psychological impact of the acquired immunodeficiency syndrome (AIDS) epidemic on gay men needs to receive greater attention from mental health professionals. The specific treatment approach depends upon the individual's location on the AIDS-related conditions continuum. For men already diagnosed with AIDS, psychological themes include fears of death and dying, guilt, concerns about exposure of a homosexual life-style, fear of contagion, loss of self-esteem, decreased social support and increased dependency needs, stigmatization, loss of occupational and financial security, confusion over medical treatment options, and severe depression. The integration of a mental health service into AIDS special care hospital wards and participation in support groups are particularly useful for men with AIDS. Anxiety is the major clinical symptom among those who have not developed full-blown AIDS, but show signs of immune suppression. Issues for men in this "gray zone" include isolation, poor social and occupational functioning due to fatigue, shame, and frustration of achievement needs. Stress- reduction techniques are especially important with this population, to eliminate further compromise to the immune system or even to strengthen it. Many asymptomatic gay men ("the worried well") are manifesting acute psychological symptoms such as panic, generalized anxiety, obsessional thinking about AIDS, and somatization. Training in the negotiation of safe-sex agreements can reduce some of this anxiety. In general, the AIDS epidemic has introduced an existential component to psychotherapy with gay men, with a concern over issues such as the meaning of life and death.     

Psychache and suicide ideation among men who are homeless: a test of Shneidman's model

Suicide ideation among the homeless is 10 times more common than in the general population. Cognitive theories of depression and hopelessness propose to explain suicidality; however, as yet, none of these fully account for the phenomenon. Shneidman has suggested a theory of psychache or unbearable psychological pain to explain suicidality. This theory has found support among low-risk populations but has not been extensively tested within a high-risk population. The current research assessed the utility of psychache among men who are homeless (N = 97). In support of Shneidman's theory, analyses revealed that psychache was a stronger predictor of suicide ideation than was depression, hopelessness, or life meaning.     

Relationship Between Social Relations and Mortality of Older Japanese People Living Alone

The association of social relations with mortality was studied over a 54-month period in 535 older Japanese people living alone. Sex-specific proportional hazard analyses indicated that finding it difficult to establish and maintain relationships with other people was significantly related to mortality, regardless of age, general health status, history of health management, psychological conditions, or economic status. The adjusted hazard ratio for finding relations with other people difficult was 4.61 [95% confidence interval (CI): 1.39–15.30] for men and 4.56 (95% CI: 2.19–9.48) for women. The adjusted hazard ratio for nonparticipation in social activities was 1.45 (95% CI: 0.42–4.97) for men and 1.72 (95% CI: 0.70–4.22) for women and did not reach statistical significance. On the other hand, there was a gender difference in the direction of the association between a low-level contact with children, siblings, or other relatives and mortality, for which the adjusted hazard ratio was 3.16 (95% CI: 0.94–10.62) for men and 0.51 (95% CI: 0.27–0.97) for women. These results suggest the need to create a different model for the relationship between social relations and mortality for men and for women living alone.     

A case-control study of hopelessness and suicidal behavior in the city of Athens,Greece. The role of the financial crisis

This study aimed to examine the psychometric properties of Beck Hopelessness Scale (BHS) in Greek patients with a recent suicide attempt, the predictive ability of BHS especially in terms of age and the possible effect of the financial crisis on hopelessness as it has been identified as a significant suicide risk factor. The study included a total of 510 individuals, citizens of Athens, Greece. Three hundred and forty individuals (170 attempted suicide patients, and 170 -age and gender- matched healthy individuals used as controls) completed BHS before the financial crisis onset (from 2009 to 2010). A sample of 170 healthy individuals also completed the BHS after the financial crisis onset (from 2013 to 2014), when the impact of the austerity measures was being felt by the Greek society. The Greek BHS version demonstrated good psychometric properties and a sufficient degree of internal consistency. Attempted suicide patients (M = 9) presented higher hopelessness than the controls (M = 3). The patients’ age positively correlated with hopelessness (r_s = .35, p < .001), and the ROC curve revealed that the BHS ability to discriminate the individuals with pathological rates of hopelessness from those without, strengthened as age increased. No significant differences were found between the individuals evaluated before (M = 3) and after (M = 3, p > .05) the crisis onset. Nevertheless, regarding the latter group, the women, the younger individuals, the less educated, the unemployed and the participants with low or mediocre self-reported financial status presented increased hopelessness. Our findings suggest that BHS could be a useful instrument especially when screening for suicide risk in people of older age, and that the financial crisis in Greece had a greater impact on subgroups of the population regarding hopelessness.     

Cognitive impairment and the 10-year survival probability of a normal 62-year-old population

The predictive value of cognitive impairment together with demographic and health factors on long-term survival was evaluated. The population sample comprised 389 subjects, all 62 years old. Cognitive performances were measured using verbal, visuomotor and memory tests. Cognitive impairment was determined by comparing performances with norms derived from healthy controls. Ten years after testing, the probability of survival was 89% for the cognitively preserved subjects, 80% for those with mild impairment, and 71% for those with moderate impairment (p = 0.009). Relative risk (RR) for shortened survival was 1.7 (95% CI 0.9-3.2) for the mildly, and 2.6 (95% CI 1.4-4.8) for the moderately impaired. Perceived health problems were, as expected, related to reduced survival (p < 0.001, RR 3.6, 95% CI 2.1-6.0), and there was an association between cognitive impairment and impaired perceived health (p = 0.040). Multivariate analyses with Cox's regression models showed that cognitive impairment, in particular, impaired episodic memory had an association with survival, in addition to the expected effects. Thus, memory impairment may reflect very early signs of underlying disease, and so the findings provide predictive validity for the cognitive methods used.     

Sympathetic nervous activity, depressive symptoms, and metabolic syndrome in black Africans: the sympathetic activity and ambulatory blood pressure in Africans study

The aim of this study was to examine the association between sympathetic nervous activity, depressive symptoms, and metabolic syndrome in a sample of black and Caucasian Africans. The sample consisted of healthy men and women: 194 blacks (aged, mean?±?SD, 44.1?±?7.9 years) and 206 Caucasians (aged, mean?±?SD, 44.7?±?10.8 years). Salivary 3-methoxy-phenylglycol (MHPG) concentration, the major metabolite of norepinephrine, was measured during the Stroop mental challenge. Depressive symptoms were assessed from the 9-item Patient Health Questionnaire. Metabolic syndrome (defined as central obesity plus any other two risk factors including raised serum triglycerides, reduced serum high-density lipoprotein- cholesterol, raised blood pressure, and raised fasting plasma glucose) was prevalent in 43.0% and 36.4% of blacks and Caucasians, respectively. In blacks there was, on average, a 16.4% increase in salivary MHPG concentration following mental stress, although no significant response was observed in Caucasians. The salivary MHPG response in blacks was associated with risk of metabolic syndrome (odds ratio [OR]?=?1.11, 95% CI, 1.00-1.24) after adjusting for age, sex, and baseline salivary MHPG concentration. This association was mainly driven by the central obesity component of the metabolic syndrome. The salivary MHPG response was also related to moderate-severe depressive symptoms (OR?=?1.16, 95% CI, 1.04-1.30), and further adjustment for depressive symptoms attenuated the association between salivary MHPG response and metabolic syndrome (OR?=?1.07, 95% CI, 0.96-1.20). These data indicate an association between sympathetic activity, depressive symptoms, and metabolic syndrome in a sample of black Africans.     

A Nationwide Panel Study on Religious Involvement and Depression in South Africa: Evidence from the South African National Income Dynamics Study

Panel data from the South African National Income Dynamics Study, a nationally representative sample of households (years 2008, 2010 and 2012), were used to examine the longitudinal association between religious involvement and depression risk. Approximately 89.6–91.8% identified themselves as religiously affiliated, while 88.0–90.3% perceived religion to be important in South Africa during the observed study periods. A short-term association between religious involvement and significant depressive symptomatology was not detected, but logistic regression models that accounted for the clustering of repeated observations within participants indicated that, over time, those with religious affiliations (aOR 0.85, 95% CI 0.76–0.96) were at a lower risk than those not affiliated. Furthermore, individuals who reported religious activity as being important (aOR 0.81; 95% CI 0.73–0.91) were at less risk of significant depressive symptomatology over time than those rating religious activity as not important. Our study points to the potentially important role of religious involvement as an emerging area of investigation toward improving mental health at a population level in resource-limited settings.     

The Effect of Cancer on Suicide among Elderly Holocaust Survivors

Jewish‐Israelis of European origin with cancer have higher suicide rates relative to their counterparts in the general population. We investigated whether this effect results from the high proportion of Holocaust survivors among them, due to vulnerabilities arising from the earlier traumas they sustained. The study was based on all Jewish‐European persons with cancer, 60 years and over, diagnosed in Israel between 1999 and 2007. The standardized incidence ratios were not significantly different between the exposed and nonexposed groups (men: 0.90, 95% CI 0.60–1.19; women: 0.95, 95% CI 0.55–1.37). Past exposure to maximum adversity did not increase the suicide risk among persons with cancer.     

When simplifying life is not so bad: the link between rigidity, stressful life events, and mental health in an undergraduate population

Decades of research have generally shown that being more rigid is associated with poorer mental health. We investigated whether all aspects of what has been termed “rigidity” are harmful. In particular, we hypothesized that the desire for simple structure (DSS) will not be associated with poor mental health, and in some cases might be associated with better mental health. In contrast, the intolerance of uncertainty (IU) was hypothesized to be associated with a wide range of indices of poor mental health. We also hypothesized that people high in IU would be less resilient in the face of stressful life events. Results across two cross-sectional surveys (N=240; N=331) supported our hypotheses. DSS was associated with less hopelessness, whereas IU was associated with more depression, anxiety, stress, suicidal ideation, and hopelessness. In addition, moderational analysis supported the hypothesis that IU magnifies the adversive effect of stressful life events on depression, anxiety and hopelessness. IU was more strongly related to the negative indices of well-being than to the positive index of life satisfaction. The implications of these findings for cognitive behavioural therapy practice are discussed.