Cm McKercher

Physical activity and depression in young adults

BACKGROUND Epidemiologic research suggests that physical activity is associated with decreased prevalence of depression. However, the relationship between physical activity accumulated in various domains and depression remains unclear. Further, previous population-based studies have predominantly utilized self-reported measures of physical activity and depression symptom subscales. Associations between physical activity in various domains (leisure, work, active commuting, yard/household) and depression were examined using both subjective and objective measures of physical activity and a diagnostic measure of depression. METHODS Analyses (conducted in 2007) included data from 1995 young adults participating in a national study (2004-2006). Physical activity was measured by self-report (International Physical Activity Questionnaire) and objectively as pedometer steps/day. Depression (DSM-IV 12-month diagnosis of major depression or dysthymic disorder) was assessed using the Composite International Diagnostic Interview. RESULTS For women, moderate levels of ambulatory activity (>or=7500 steps/day) were associated with approximately 50% lower prevalence of depression compared with being sedentary (<5000 steps/day) (p trend=0.005). Relatively low durations of leisure physical activity (>or=1.25 hours/week) were associated with approximately 45% lower prevalence compared with the sedentary group (0 hours/week) (p trend=0.003). In contrast, high durations of work physical activity (>or=10 hours/week) were associated with an approximate twofold higher prevalence of depression compared with being sedentary (0 hours/week) (p trend=0.005). No significant associations were observed for steps/day in men or for other types of self-reported activity including total physical activity in both men and women. CONCLUSIONS These findings indicate that the context in which physical activity is assessed and the measurement methods utilized are important considerations when investigating associations between physical activity and depression.

Overweight and obesity in childhood and risk of mental disorder: a 20-year cohort study.

Objective: Very little is known about whether overweight and obese children have long-term risk for mental health problems. This study examined the association between overweight and obesity in childhood and DSM-IV mood, anxiety, and substance use disorders in young adulthood. Method: Participants in a national Australian school survey when aged 7–15 years in 1985 were re-interviewed 20 years later as young adults aged 26–36 years (1135 women, 1108 men). Body mass index (BMI) was calculated from measured height and weight in childhood and adulthood. Children were classified as overweight or obese based on a BMI ≥85th centile for age and sex-specific height and weight. Obesity in adulthood was defined as BMI of ≥30. Twelve-month DSM-IV diagnoses of mood, anxiety and substance use disorders were obtained from the Composite International Diagnostic Interview. The relative risk (RR) for each class of mental disorder was estimated for childhood overweight/obesity versus non-overweight, and for four weight trajectories: non-overweight in childhood and non-obese in adulthood; overweight in childhood and non-obese in adulthood; non-overweight in childhood and obese in adulthood; and overweight in childhood and obese in adulthood. Results: Childhood overweight and obesity was associated with an increased risk of mood disorder in adulthood (RR = 1.54, 95%CI 1.06–2.23, p = 0.03), with a similar risk observed among girls and boys. When weight in adulthood was taken into consideration, increased risk of mood disorder was observed only among overweight girls who were obese in adulthood (adjusted RR = 2.03, 95%CI 1.22–3.66, p = 0.006), with childhood overweight or obesity in non-obese adults not associated with any mental disorder. Conclusions: Childhood overweight may increase risk for mood disorder in adulthood, especially among overweight girls who become obese women. These results suggest that prevention of childhood overweight is equally important in both sexes for reducing risk of diagnosed mood disorder in adulthood.

Childhood and adolescent predictors of leisure time physical activity during the transition from adolescence to adulthood: a population based cohort study.

BackgroundFew studies have investigated factors that influence physical activity behavior during the transition from adolescence to adulthood. This study explores the associations of sociodemographic, behavioral, sociocultural, attitudinal and physical factors measured in childhood and adolescence with physical activity behavior during the transition from adolescence to adulthood.MethodsChildhood and adolescent data (at ages 7-15 years) were collected as part of the 1985 Australian Health and Fitness Survey and subdivided into sociodemographics (socioeconomic status, parental education), behavioral (smoking, alcohol, sports diversity, outside school sports), sociocultural (active father, active mother, any older siblings, any younger siblings, language spoken at home), attitudinal (sports/recreational competency, self-rated health, enjoyment physical education/physical activity, not enjoying school sports) and physical (BMI, time taken to run 1.6 km, long jump) factors. Physical activity between the ages 15 and 29 years was reported retrospectively using the Historical Leisure Activity Questionnaire at follow-up in 2004-2006 by 2,048 participants in the Childhood Determinants of Adult Health Study (CDAH). Australias physical activity recommendations for children and adults were used to categorize participants as persistently active, variably active or persistently inactive during the transition from adolescence to adulthood.ResultsFor females, perceived sports competency in childhood and adolescence was significantly associated with being persistently active (RR = 1.88, 95% CI = 1.39, 2.55). Smoking (RR = 0.31 CI = 0.12, 0.82) and having younger siblings (RR = 0.69 CI = 0.52, 0.93) were inversely associated with being persistently active after taking physical and attitudinal factors into account. For males, playing sport outside school (RR = 1.47 CI = 1.05, 2.08), having active fathers (RR = 1.25 CI = 1.01, 1.54) and not enjoying school sport (RR = 4.07 CI = 2.31, 7.17) were associated with being persistently active into adulthood. Time taken to complete the 1.6 km run was inversely associated with being persistently active into adulthood (RR = 0.85 CI = 0.78, 0.93) after adjusting for recreational competency.ConclusionsPerceived sports competency (females) and cardiorespiratory fitness, playing sport outside school and having active fathers (males) in childhood and adolescence were positively associated with being persistently active during the transition from adolescence to adulthood.

Physical activity and depression symptom profiles in young men and women with major depression.

Objective This study explored whether young adults with major depression who are physically active differ in their depression symptom profile from those physically inactive. Methods Analyses included data from 950 (47.6%) men and 1045 women (mean [standard deviation] age = 31.5 [2.6] years) participating in a national study. Participants reported leisure physical activity (International Physical Activity Questionnaire) and ambulatory activity (pedometer steps per day). Diagnosis and symptoms of major depression were assessed using the Composite International Diagnostic Interview. Results Prevalence of major depression was 5.5% (n = 52) for men and 11.6% (n = 121) for women. Interactions between physical activity and sex were observed for depressed mood, appetite changes, vacillating thoughts, and suicidality (all, p < .050). Among those with major depression, physically active men were significantly less likely to endorse the presence of insomnia (prevalence ratio [PR] = 0.78, 95% confidence interval [CI] = 0.63–0.96), fatigue (PR = 0.82, 95% CI = 0.69–0.99), and suicidality (PR = 0.69, 95% CI = 0.49–0.96) compared with inactive men. Physically active women were significantly less likely to endorse hypersomnia (PR = 0.50, 95% CI = 0.27–0.95), excessive/irrational guilt (PR = 0.76, 95% CI = 0.59–0.97), vacillating thoughts (PR = 0.74, 95% CI = 0.58–0.95), and suicidality (PR = 0.43, 95% CI = 0.20–0.89) compared with inactive women. Associations were adjusted for age, physical health, educational attainment, depression severity, and other depressive symptoms. Conclusions Among adults with major depression, those physically active seem to differ in their depression symptom profile from those physically inactive.

Psychosocial factors in people with chronic kidney disease prior to renal replacement therapy

Increasing evidence implicates psychosocial factors including depression, anxiety, perceived social support and health‐related quality of life in the pathophysiology of various chronic diseases. Research examining the psychosocial aspects of kidney disease has focussed predominantly on depressive disorders in dialysis patients where they are independently associated with increased risk of mortality and poor health‐related quality of life. In contrast, studies examining the influence of psychosocial factors in people with chronic kidney disease (CKD) prior to the initiation of renal replacement therapy are sparse. Limited data indicate that clinical depression and depressive symptoms are common and may independently predict progression to dialysis, hospitalization and death. In contrast, the influence of anxiety disorders, lower perceived social support and impaired health‐related quality of life on the clinical course of CKD have received little attention. Large‐scale prospective cohort studies are needed to clarify the burden and prognostic impact of these factors in this vulnerable population. Given the escalating burden of CKD worldwide examining the role of these potentially modifiable risk factors is crucial. Identifying and implementing targeted interventions in order to prevent or delay the progression of CKD and improve quality of life will be a major challenge.

Associations of fish oil and vitamin B and E supplementation with cardiovascular outcomes and mortality in people receiving haemodialysis: a review

BackgroundCardiovascular complications are the leading cause of mortality in patients with end-stage kidney disease. Research indicates that the Mediterranean diet is protective of cardiovascular disease in the general population. Components of this diet have been trialled in haemodialysis patients with the aim of reducing the risk of cardiovascular disease and improving associated risk factors. Components include fish, fruit and vegetables in the form of fish oil supplements and vitamin and antioxidant supplements. This narrative review provides an overview of observational studies, and interventional and randomised controlled trials examining the association of these supplements with cardiovascular outcomes in haemodialysis patients.MethodsWe reviewed the relevant literature by searching English-language publications in Web of Science and references from relevant articles published since 1992. Eight-seven abstracts were reviewed and 38 relevant articles were included.ResultsThe extant literature suggests that risk of mortality is reduced in patients with a higher fish intake and those with higher serum omega-3 fatty acid levels. However, the pathways by which risk of mortality is reduced have not been fully extrapolated. While only a few studies have examined the effect of vitamin B supplementation in haemodialysis patients, these studies suggest that supplementation alone does not reduce the risk of mortality. Finally, studies examining vitamin E supplementation have drawn inconsistent conclusions regarding its pro-oxidant or antioxidant effects. Differences between studies are likely due to methodological variations in regards to dose, route of administration and treatment duration.ConclusionsNutritional and dietary supplementation in haemodialysis patients is an area which requires larger, more methodologically robust randomised controlled trials to determine if risk of cardiovascular outcomes can be improved.

Dialysis outcomes of elderly Indigenous and non-Indigenous Australians

Whilst increasing numbers of elderly people in Australia are commencing dialysis, few Indigenous patients are aged ≥65 years and their outcomes are unknown. We compared the long‐term survival, mortality hazards and causes of death between elderly Indigenous and elderly non‐Indigenous dialysis patients.

Medication Regimen Complexity and Hospital Readmission in Older Adults With Chronic Kidney Disease

Background: Chronic kidney disease (CKD) is characterized by high rates of hospital admissions and readmissions. However, there is a scarcity of research into medication-related factors predicting such outcomes in this patient group. Objective: To evaluate the effect of medication regimen complexity at hospital discharge on subsequent readmissions and their timing in older adults with CKD. Methods: This was a 12-month retrospective cohort study of 204 older (⩾65 years) CKD patients in an Australian tertiary care hospital. Medication regimen complexity was quantified using the 65-item medication regimen complexity index (MRCI). The outcomes were the occurrence of readmission in 30 days and time to readmission within 12 months. Logistic regression was used to identify factors predicting 30-day readmission, and a competing risks proportional subdistribution hazard model, accounting for deaths, was used for factors predicting time to readmission. Results: Overall, 50 (24%) patients, predominantly men (72%), were readmitted within 30 days of follow-up. MRCI was not significantly associated with 30-day readmission (odds ratio [OR] = 1.27; 95% CI = 0.94-1.73). The median (interquartile range) time to readmission within 12 months was 145 (31-365) days. On a multivariate analysis, a 10-unit increase in MRCI was associated with a shorter time to readmission within 12 months (subdistribution HR = 1.18; 95% CI = 1.01-1.36). Conclusion and Relevance: Medication regimen complexity was not significantly associated with 30-day readmission; however, it was associated with a significantly shorter time to 12-month readmission in older CKD patients. This finding highlights the importance of medication regimen complexity as a potential target for medical interventions to reduce readmission risks.

Gender differences in the dialysis treatment of Indigenous and non-Indigenous Australians

Objective: Access to dialysis treatment and the types of treatments employed in Australia differs by Indigenous status. We examined whether dialysis treatment utilisation in Indigenous and non‐Indigenous Australians also differs by gender.