Understanding depressive symptoms through psychological traits and physiological stress reactivity

Peer reviewe

Association of the PHACTR1/EDN1 genetic locus with spontaneous coronary artery dissection

Background: Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndromes (ACS) afflicting predominantly younger to middle-aged women. Observational studies have reported a high prevalence of extracoronary vascular anomalies, especially fibromuscular dysplasia (FMD) and a low prevalence of coincidental cases of atherosclerosis. PHACTR1/EDN1 is a genetic risk locus for several vascular diseases, including FMD and coronary artery disease, with the putative causal noncoding variant at the rs9349379 locus acting as a potential enhancer for the endothelin-1 (EDN1) gene. Objectives: This study sought to test the association between the rs9349379 genotype and SCAD. Methods: Results from case control studies from France, United Kingdom, United States, and Australia were analyzed to test the association with SCAD risk, including age at first event, pregnancy-associated SCAD (P-SCAD), and recurrent SCAD. Results: The previously reported risk allele for FMD (rs9349379-A) was associated with a higher risk of SCAD in all studies. In a meta-analysis of 1,055 SCAD patients and 7,190 controls, the odds ratio (OR) was 1.67 (95% confidence interval [CI]: 1.50 to 1.86) per copy of rs9349379-A. In a subset of 491 SCAD patients, the OR estimate was found to be higher for the association with SCAD in patients without FMD (OR: 1.89; 95% CI: 1.53 to 2.33) than in SCAD cases with FMD (OR: 1.60; 95% CI: 1.28 to 1.99). There was no effect of genotype on age at first event, P-SCAD, or recurrence. Conclusions: The first genetic risk factor for SCAD was identified in the largest study conducted to date for this condition. This genetic link may contribute to the clinical overlap between SCAD and FMD

Rumination and its link to depression

Depression is an affective disorder that causes low mood and feelings of guilt and hopelessness. Rumination is a persistent, negative and self-focused form of thinking. Rumination has been found to predict higher levels of depressive symptoms, but also the onset of depressive episodes. The connection between rumination and depression should be studied more in order to develop better methods for intervention The purpose of this study was to examine the associations between rumination, self-reflection and depression. The participants were recruited from the University of Helsinki by sending online questionnaires to the student associations' mailing-lists. Rumination was measured with the self-rumination scale, self-reflection with self-reflection scale and depression with BDI. 588 students answered the questionnaire (512 women). The second questionnaire was sent 18 months later to those who gave their email in the first data collection. 296 students answered the second questionnaire (266 women). Participants ranged in age from 18 to 60 years, with a mean of 27 years. Rumination was a relatively stable trait in the study. Changes in rumination appeared to be closely linked to changes in depressive symptoms. Those who were depressed in the second data point and those who were depressed in the first data point but not in the second one, ruminated more than those who had never been depressed. Rumination also predicted depression in the 18-month longitudinal study. Self-reflection was only weakly linked to depression. Rumination had an independent role in maintaining and predicting depression. Tendency to ruminate was still high after recovery in previously depressed participants. Focused interventions could help people with ruminative tendencies to get over depression and prevent depression.Masennus on mielialahäiriö, johon liittyy mielialan laskua sekä epäonnistumisen ja toivottomuuden tunteita. Märehtiminen on toistuvaa ja negatiivista itseen kohdistuvaa huomiota. Sen on tutkimuksissa havaittu olevan yhteydessä masennuksen vakavuuteen ja ennustavan masennuksen alkua. Märehtimisen roolia masennuksen syventäjänä ja aiheuttajana olisi syytä tutkia tarkemmin ja tätä tietoa voitaisiin hyödyntää parempien interventiokeinojen kehittämisessä. Tämän tutkimuksen tarkoitus oli tarkastella märehtimisen, itsereflektion ja masennuksen välisiä yhteyksiä. Märehtimistaipumusta (self-rumination scale), itsereflektiota (self-reflection scale) sekä masennusta (BDI) kartoitettiin kahdella verkkokyselyllä, joista ensimmäistä mainostettiin Helsingin yliopistojen ainejärjestöjen sähköpostilistoilla. Kyselyyn vastasi 588 opiskelijaa (naisia 512). Vastaukseensa sähköpostiosoitteen jättäneille lähetettiin 18 kuukautta myöhemmin toinen kysely. Tähän vastasi 296 opiskelijaa (naisia 266). Vastanneiden ikäjakauma oli 18–60 vuotta (ka. 27 vuotta). Märehtimistaipumus oli tutkimuksessa suhteellisen pysyvä piirre. Muutokset märehtimistaipumuksessa olivat yhteydessä muutoksiin masennuksessa. Mittaushetkellä masentuneet sekä jo masennuksestaan parantuneet märehtivät enemmän kuin ei-masentuneet. Tutkimuksessa märehtimistaipumus selitti itsenäisesti masentuneisuutta 18 kuukauden seurantajaksolla. Itsereflektio oli vain heikosti yhteydessä masennukseen. Märehtimistaipumuksella oli tutkimuksessa itsenäinen rooli masennuksen ylläpidossa sekä masennuksen ennustamisessa. Lisäksi masennuksestaan parantuneilla märehtimistaipumus jäi kohonneelle tasolle. Märehtimistaipumukseen puuttuminen voisi olla toimiva keino ennaltaehkäistä ja vähentää masennusta

Understanding depressive symptoms through psychological traits and physiological stress reactivity

Understanding the relationship between psychological and physiological factors in depression and depressive symptoms may help us define depression subcategories based on their parasympathetic nervous system activity and reactivity, and perhaps in the future, develop more effective symptom-based treatments. In this study we aimed to shed light on the relationship between selected psychological traits (harm avoidance and self-rumination) and physiological stress (high-frequency heart rate variability, HF-HRV). We recruited 58 females to participate in a laboratory study where they completed a public speech preparation task designed to induce stress. We found that participants with higher scores in self-reported harm avoidance and self-rumination had lower HF-HRV during the stress task, indicating a parasympathetic withdrawal (i.e. more stress). The associations between self-reported depressive symptoms and HF-HRV were not statistically significant. Thus, we linked psychological depression risk factors to specific indices of higher physiological stress

Positive affect state is a good predictor of movement and stress: combining data from ESM/EMA, mobile HRV measurements and trait questionnaires

Personality describes the average behaviour and responses of individuals across situations; but personality traits are often poor predictors of behaviour in specific situations. This is known as the “personality paradox”. We evaluated the interrelations between various trait and state variables in participants’ everyday lives. As state measures, we used 1) experience sampling methodology (ESM/EMA) to measure perceived affect, stress, and presence of social company; and 2) heart-rate variability and real-time movement (accelerometer data) to indicate physiological stress and physical movement. These data were linked with self-report measures of personality and personality-like traits. Trait variables predicted affect states and multiple associations were found: neuroticism and rumination decreased positive affect and increased negative affect. Positive affect state, in turn, was the strongest predictor of observed movement. Positive affect was also associated with heart rate and heart rate variability (HRV). Negative affect, in turn, was not associated with neither movement, HR or HRV. The study provides evidence on the influence of personality-like traits and social context to affect states, and, in turn, their influence to movement and stress variables

First cases of Omicron in France are exhibiting mild symptoms, November 2021–January 2022

International audienceObjectivesWe aimed to investigate the first Omicron cases detected in France in order to assess case characteristics and provide supporting information on the possible impact of this variant on the healthcare system.MethodsA standardized questionnaire was used to collect information from confirmed and probable Omicron cases.ResultsMedian age of 468 investigated cases was 35 years, 376 were symptomatic (89%); 64% were vaccinated with two doses and 7% had received three doses. Loss of smell and taste were reported by 8.3% and 9% of cases, respectively. Seven cases were hospitalized, three of those were unvaccinated (including two with reported precondition). No admissions to intensive care and no deaths were reported.ConclusionsOur results confirm a mild clinical presentation among the first Omicron cases detected in France and highlight the importance for the national COVID-19 surveillance system to quickly detect and adapt to the emergence of a new variant

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes

Liver injury in hospitalized patients with COVID-19: An International observational cohort study

Background: Using a large dataset, we evaluated prevalence and severity of alterations in liver enzymes in COVID-19 and association with patient-centred outcomes.MethodsWe included hospitalized patients with confirmed or suspected SARS-CoV-2 infection from the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) database. Key exposure was baseline liver enzymes (AST, ALT, bilirubin). Patients were assigned Liver Injury Classification score based on 3 components of enzymes at admission: Normal; Stage I) Liver injury: any component between 1-3x upper limit of normal (ULN); Stage II) Severe liver injury: any component & GE;3x ULN. Outcomes were hospital mortality, utilization of selected resources, complications, and durations of hospital and ICU stay. Analyses used logistic regression with associations expressed as adjusted odds ratios (OR) with 95% confidence intervals (CI).ResultsOf 17,531 included patients, 46.2% (8099) and 8.2% (1430) of patients had stage 1 and 2 liver injury respectively. Compared to normal, stages 1 and 2 were associated with higher odds of mortality (OR 1.53 [1.37-1.71]; OR 2.50 [2.10-2.96]), ICU admission (OR 1.63 [1.48-1.79]; OR 1.90 [1.62-2.23]), and invasive mechanical ventilation (OR 1.43 [1.27-1.70]; OR 1.95 (1.55-2.45). Stages 1 and 2 were also associated with higher odds of developing sepsis (OR 1.38 [1.27-1.50]; OR 1.46 [1.25-1.70]), acute kidney injury (OR 1.13 [1.00-1.27]; OR 1.59 [1.32-1.91]), and acute respiratory distress syndrome (OR 1.38 [1.22-1.55]; OR 1.80 [1.49-2.17]).ConclusionsLiver enzyme abnormalities are common among COVID-19 patients and associated with worse outcomes