Eystein Stordal

Association between social support and depression in the general population: the HUNT study, a cross-sectional survey.

AIM The aim was to investigate the associations between perceived social support and depression in a general population in relation to gender and age. BACKGROUND Social support is seen as one of the social determinants for overall health in the general population. Studies have found higher probability of experiencing depression among people who have a lack of social support; evidence from the general population has been more limited. Subjective perception that support would be available if needed may reduce and prevent depression and unnecessary suffering. DESIGN A cross-sectional survey with self-reported health was used. METHOD A total of 40,659 men and women aged 20-89 years living in Nord-Trøndelag County of Norway with valid ratings of depression subscale of the Hospital Anxiety and Depression Scale in the The Nord-Trøndelag Health Study 3 were used. Logistic regression was used to quantify associations between two types of perceived support (emotional and tangible) and depression. Gender, age and interaction effects were controlled for in the final model. RESULTS The main finding was that self-rated perceived support was significantly associated with Hospital Anxiety and Depression Scale-defined depression, even after controlling for age and gender; emotional support (OR = 3·14) and tangible support (OR = 2·93). The effects of emotional and tangible support differ between genders. Interaction effects were found for age groups and both emotional and tangible support. CONCLUSION Self-rated perceived functional social support is associated with Hospital Anxiety and Depression Scale-defined depression. In the group of older people who have a lack of social support, women seem to need more emotional support and men tangible support. RELEVANCE TO CLINICAL PRACTICE Health care providers should consider the close association between social support and depression in their continuing care, particularly in the older people.

Association of low blood pressure with anxiety and depression: the Nord-Trondelag Health Study.

Background: Low blood pressure has mainly been regarded as ideal, but recent studies have indicated an association with depression in elderly people. Objective: To investigate whether low blood pressure is associated with anxiety and depression in the general population. Design: Cross-sectional study. Setting: Participants in the population-based Nord-Trøndelag Health Study (HUNT-2, 1995–7), Norway. Participants: 60 799 men and women aged 20–89 years filled in the Hospital Anxiety and Depression Scale as part of a general health study. Systolic and diastolic blood pressure was classified in age-stratified and sex-stratified centile groups. Main results: Compared with participants with systolic blood pressure within the 41–60 centile (reference) group, the odds ratio for anxiety was 1.31 (95% confidence intervals (CI) 1.16 to 1.49), for depression 1.22 (95% CI 1.03 to 1.46), and for comorbid anxiety and depression 1.44 (95% CI 1.24 to 1.68) in the group with ⩽5 centile systolic blood pressure. Slightly weaker associations were found of low diastolic blood pressure with anxiety and depression. These associations were similar across sex and age groups. Physical impairment, smoking and angina pectoris influenced the associations only marginally, whereas stroke, myocardial infarction, use of drugs for hypertension, body mass index and several other covariates had no influence. Conclusions: This study represents epidemiological evidence for an association of low blood pressure with anxiety and depression, which is not caused by cardiovascular disease.

Anxiety and depression in multiple sclerosis. A comparative population-based study in Nord-Trøndelag County, Norway.

Anxiety and depression are widely distributed symptoms among multiple sclerosis patients and in the general population. We assessed the prevalence of anxiety and depression in the multiple sclerosis population in Nord-Trøndelag County, Norway compared with Norway’s general population. The Hospital Anxiety and Depression Scale questionnaire was completed by 172 MS patients and 56,000 controls. A cut-off of ≥8 was used to define significant symptoms of anxiety and depression. Fatigue was measured using Krupp’s Fatigue Severity Scale, with a mean cut-off of >4. Among men, 31.1% of the multiple sclerosis patients reported anxiety, while only 12.1% of the control population reported this symptom (p = 0.002). For women, the prevalence of anxiety was 29.7% versus 17.4% (p < 0.001). Depression was reported by 26.2% of the men with multiple sclerosis compared with 10.8% of the controls (p < 0.001). The corresponding figures for women were 25.2% versus 10.4% (p < 0.001). Anxiety and depression were not correlated with duration of disease or disability measured by the Expanded Disability Status Scale. Among women, fatigue was associated with anxiety (p ≤ 0.010) and depression (p = 0.007). No such association was found among men. Anxiety and depression occur more frequently in multiple sclerosis patients than in the general population. Fatigue was associated with these neuropsychiatric manifestations in only women.

Anxiety and depression in individuals with somatic health problems. The Nord-Trøndelag Health Study (HUNT)

There is a high occurrence of depressive symptoms in patients with somatic health problems. About one-third of individuals with somatic health problems have anxiety disorders and/or depression. Comorbid anxiety disorder and depression are found to be more strongly associated with somatic health problems than pure anxiety disorder and pure depression. Objective - To examine the relationship between anxiety disorders and depression and various somatic health problems in the general population. Design - Cross-sectional study with survey methods and clinical examinations. Setting - The Health Study of Nord-Trøndelag, Norway (the HUNT study). Participants - 60 t 869 individuals aged 20-89 years. Main outcome measures - Anxiety disorder, depression and their comorbidity are categorized based on scores on the Hospital Anxiety and Depression Scale. All somatic health variables are self-reported, while blood pressure, height and weight are measured. Multivariate nominal logistic regression analyses are used to investigate the relationship between somatic variables and the anxiety/depression categories. Results - Most somatic health variables show a stronger association with comorbid anxiety disorder/depression than with anxiety disorder or depression alone. About one-third of individuals reporting somatic health problems also have anxiety disorder and/or depression. Conclusion - Somatic health problems carry a high risk of both anxiety disorder and depression. Active identification and treatment of these co-occurring mental disorders are of practical importance.

Increased prevalence of depression in cohorts of the elderly: an 11-year follow-up in the general population – the HUNT study

BACKGROUND Depression is a common disorder in late life. As the elderly population continues to grow worldwide, depression is also likely to become an increasing health problem. The aim of this study was to examine changes in prevalence of depression in various age cohorts over an 11-year period. METHODS This study involved two cross-sectional studies (HUNT 2 and HUNT 3) of all adult inhabitants of the Norwegian county of Nord-Trøndelag with an 11 year-interval between the two studies. The participants aged 45 years or above at HUNT 2 and with a valid depression rating at both HUNT 2 (baseline) and HUNT 3 (follow-up) (N = 16517), were included and divided into five-year age cohorts. Depression was measured by the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). RESULTS A significant increase in depression was found in all age cohorts from 76 years at follow-up, with the greatest increase (9.6%) in the oldest age cohort (86-90 years at follow-up). The incidence of depression is increasing with age, with over 10% new cases in all age cohorts aged 81 years and above at follow-up. About 5% of the participants in all age cohorts reported depression at both measure points, and there is a decrease in recovery from depression from baseline to follow-up with increasing age. CONCLUSIONS We found increased prevalence of depression and a large number of new cases of depression in the oldest age cohorts.

A dimensional versus a categorical approach to diagnosis: Anxiety and depression in the HUNT 2 study

The aim of this study was to compare a dimensional and a categorical approach to diagnosis, using as an illustration co‐occurring symptoms of anxiety and depression concerning description, associations and predictive power. We analysed data from 60 869 individuals with valid ratings on the Hospital Anxiety and Depression Scale (HADS) and on mental impairment in the age range of 20 to 89 years of the cross‐sectional Nord‐Trøndelag Health Study 1995–1997. There was a wide variation of the dimensional symptom level (subscale scores) within both diagnostic categories (cut‐offs ≥8 on both subscales), as is usually true with categorical and dimensional diagnosis. The dimensional (Spearman) correlation coefficients between anxiety and depression was 0.51 compared to 0.38 for the categorical. The power to predict impairment was weaker with the categorical than with the dimensional approach of the HADS, showing fewer statistically significant coefficients in the logistic regression models and lower area under curve (0.82 versus 0.87). This is an example illustrating the impact use of dimensional diagnoses would have on research and clinical practice. Copyright

Depression and anxiety in relation to catechol-O-methyltransferase Val158Met genotype in the general population: the Nord-Trondelag Health Study (HUNT).

BackgroundThe catechol-O-methyltransferase (COMT) gene contains a functional polymorphism, Val158Met, which has been linked to anxiety and depression, but previous results are not conclusive. The aim of the present study was to examine the relationship between the Val158Met COMT gene polymorphism and anxiety and depression measured by the Hospital Anxiety and Depression Scale (HADS) in the general adult population.MethodsIn the Nord-Trøndelag Health Study (HUNT) the association between the Val158Met polymorphism and anxiety and depression was evaluated in a random sample of 5531 individuals. Two different cut off scores (≥ 8 and ≥ 11) were used to identify cases with anxiety (HADS-A) and depression (HADS-D), whereas controls had HADS-A <8 and HADS-D <8.ResultsThe COMT genotype distribution was similar between controls and individuals in the groups with anxiety and depression using cut-off scores of ≥ 8. When utilizing the alternative cut-off score HADS-D ≥ 11, Met/Met genotype and Met allele were less common among men with depression compared to the controls (genotype: p = 0.017, allele: p = 0.006). In the multivariate analysis, adjusting for age and heart disease, depression (HADS-D ≥ 11) was less likely among men with the Met/Met genotype than among men with the Val/Val genotype (OR = 0.37, 95% CI = 0.18–0.76).ConclusionIn this population-based study, no clear association between the Val158Met polymorphism and depression and anxiety was revealed. The Met/Met genotype was less likely among men with depression defined as HADS-D ≥ 11, but this may be an incidental finding.

The Relationship among Neuroticism, Extraversion, and Depression in The HUNT Study: In Relation to Age and Gender

The purpose of this study was to examine the relationship between personality and depression in a general population in relation to gender and age. The Nord-Trøndelag Health Study (2006–2008), a large cross-sectional survey, was used. The sample consists of 35,832 men (16,104) and women (19,728) aged 20–89 years, living in the Nord-Trøndelag County of Norway, with valid ratings on the depression subscale of the Hospital Anxiety and Depression Scale (HADS) and Eysenck Personality Questionnaire (EPQ). This study demonstrates a relationship between depression and both neuroticism and extraversion in a general population. Older people score low more often on Extraversion (E) than younger people. Interactions were observed between neuroticism and age, gender, and extraversion with depression. The interaction term indicates a high score on Neuroticism (N) enhanced by introversion, older age, and being a male with depression. The findings suggest that health professionals may need to put extra effort into the care of patients with low extraversion and high neuroticism, in order to help those patients avoid depression.

Headache as a risk factor for dementia: a prospective population-based study.

Background Headache has not been established as a risk factor for dementia. The aim of this study was to determine whether any headache was associated with subsequent development of vascular dementia (VaD), Alzheimer’s disease (AD) or other types of dementia. Methods This prospective population-based cohort study used baseline data from the Nord-Trøndelag Health Study (HUNT 2) performed during 1995–1997 and, from the same Norwegian county, a register of cases diagnosed with dementia during 1997–2010. Participants aged ≥20 years who responded to headache questions in HUNT 2 were categorized (headache free; with any headache; with migraine; with nonmigrainous headache). Hazard ratios (HRs) for later inclusion in the dementia register were estimated using Cox regression analysis. Results Of 51,383 participants providing headache data in HUNT 2, 378 appeared in the dementia register during the follow-up period. Compared to those who were headache free, participants with any headache had increased risk of VaD (n = 63) (multivariate-adjusted HR = 2.3, 95% CI 1.4–3.8, p = 0.002) and of mixed dementia (VaD and AD (n = 52)) (adjusted HR = 2.0, 95% CI 1.1–3.5, p = 0.018). There was no association between any headache and later development of AD (n = 180). Conclusion In this prospective population-based cohort study, any headache was a risk factor for development of VaD.

Cohort Profile: The Health and Memory Study (HMS): a dementia cohort linked to the HUNT study in Norway

The aim of the Health and Memory Study (HMS) of Nord-Trøndelag, Norway, was primarily to establish a database suitable as basis for a large number of studies on dementia. Data from the HMS study were collected via questionnaires and examinations during the period from 1995 to 2011. The dementia panel consists of 620 participants residing in nursing homes and 920 participants referred to memory clinics of Nord-Trøndelag. Data from this dementia panel may be linked to the Nord-Trøndelag Health Study (the HUNT study), three large population based health surveys that took place in 1984-86 (HUNT1), 1995-97 (HUNT2) and 2006-08 (HUNT3). Data collection is complete and the participation rate in the HUNT1 for patients diagnosed with dementia was 86%. The sub-studies in the HMS are focused on examining risk factors, caregiver burden, healthcare consumption and economic consequences of treating and having dementia. Researchers interested in the HMS study are invited to contact HUNT at hunt@medisin.ntnu.no.