Psychological distress is common among patients with heart disease, necessitating valid and reliable assessment tools for measuring cardiac distress. The Cardiac Distress Inventory (CDI) has been developed for this purpose, but its psychometric properties require validation in different cultural contexts. This study aimed to evaluate the psychometric properties of the Farsi version of the CDI in an Iranian population with heart disease, focusing on its validity, reliability, and factor structure. A cross-sectional study was conducted from October to December 2024 with 400 adult patients diagnosed with heart disease. Participants were recruited from cardiac departments and clinics using convenience sampling. The CDI was translated into Farsi following WHO guidelines and assessed for face and content validity. Exploratory factor analysis using Maximum Likelihood Estimation (MLEFA) with Promax rotation and confirmatory factor analysis were conducted to determine construct validity. Convergent and discriminant validity were examined using average variance extracted (AVE) and heterotrait-monotrait (HTMT) ratio, while reliability was assessed via Cronbach's alpha, McDonald's omega, and composite reliability. Measurement invariance across gender groups was also analyzed. The mean age of participants was 42.95 years (SD = 14.02), and 56.8% were women. EFA identified a two-factor structure-Existential and Emotional Distress and Uncertainty and Maladaptive Coping-explaining 69.15% of the variance, with 10 retained items. CFA confirmed the model fit (χ234 = 45.714, p = 0.086, CFI = 0.991, RMSEA = 0.036). The CDI demonstrated strong internal consistency (Cronbach's alpha > 0.8) and good convergent (AVE > 0.5) and discriminant validity (HTMT = 0.374). Measurement invariance across gender was established at the configural, metric, and scalar levels. The Farsi version of the CDI is a valid and reliable tool for assessing cardiac distress in Iranian patients with heart disease. These findings support its use in clinical and research settings to better understand and address the psychosocial challenges faced by this population, ultimately improving psychological assessment and intervention strategies.

Depression is prevalent among patients with congestive heart failure (CHF) and is associated with increased mortality and healthcare use. However, most research on this association has focused on high-income countries, leaving a gap in knowledge regarding the relationship between depression and CHF in low-to-middle-income countries.

To identify changes in depressive symptoms and potential risk factors for poor outcomes among CHF patients.

Longitudinal data from 783 patients with CHF from public hospitals in Karachi, Pakistan, were analysed. Depressive symptom severity was assessed using the Beck Depression Inventory. Baseline and 6-month follow-up Beck Depression Inventory scores were clustered using Gaussian mixture modelling to identify separate depressive symptom subgroups and extract trajectory labels. Further, a random forest algorithm was used to determine baseline demographic, clinical and behavioural predictors for each trajectory.

Four separate patterns of depressive symptom changes were identified: 'good prognosis', 'remitting course', 'clinical worsening' and 'persistent course'. Key factors related to these classifications included behavioural and functional factors such as quality of life and disability, as well as the clinical severity of CHF. Specifically, poorer quality of life and New York Heart Association (NYHA) class 3 symptoms were linked to persistent depressive symptoms, whereas patients with less disability and without NYHA class 3 symptoms were more likely to exhibit a good prognosis.

By examining the progression of depressive symptoms, clinicians can better understand the factors influencing symptom development in patients with CHF and identify those who may require closer monitoring and appropriate follow-up care.

Elevated night resting heart rate (HR) has been associated with increased depression severity, yet the underlying mechanisms remain elusive. This study aimed to investigate the mediating role of sleep disturbance and the influence of anxiety on the relationship between night resting HR and depression severity.

This is a secondary data analysis of data collected in the Remote Assessment of Disease and Relapse (RADAR) Major Depressive Disorder (MDD) longitudinal mobile health study, encompassing 461 participants (1774 observations) across three national centers (Netherlands, Spain, and the UK). Depression severity, anxiety, and sleep disturbance were assessed every three months. Night resting HR parameters in the 2 weeks preceding assessments were measured using a wrist-worn Fitbit device. Linear mixed models and causal mediation analysis were employed to examine the impact of sleep disturbance and anxiety on night resting HR on depression severity. Covariates included age, sex, BMI, smoking, alcohol consumption, antidepressant use, and comorbidities with other medical conditions.

Higher night resting HR was linked to subsequent depressive severity, through the mediation of sleep disturbance. Anxiety contributed to an exacerbated level of sleep disturbance, subsequently intensifying depression severity. Anxiety exhibited no direct effect on night resting HR.

Our findings underscore the mediating role of sleep disturbance in the effect of night resting HR on depression severity, and anxiety on depression severity. This insight has potential implications for early identification of indicators signalling worsening depression symptoms, enabling clinicians to initiate timely and responsive treatment measures.

Little is known regarding the relationship between perceived control and depression in patients with chronic heart failure (CHF), particularly in terms of their dose-response relationship.

The aim of this study was to explore this relationship based on linear and nonlinear hypotheses and potential subgroup differences in patients with CHF.

A total of 308 patients with CHF were included in the study. Data on perceived control, depression, and relevant covariates, such as gender, age, New York Heart Association classification, and comorbidity burden, were collected. Logistic regression, Spearman correlation, and restricted cubic spline analysis were used for data analysis.

Compared with the patients in the first quartiles of perceived control scores (0-16), those in the other 3 quartiles had a lower risk of depression (odds ratios of 0.29, 0.21, and 0.20, respectively; P < .05). Furthermore, a negative correlation between perceived control and depression ( r = -0.317, P < .01) was observed. The restricted cubic spline analysis revealed an "L-shaped" curve relationship between perceived control and the presence of depression ( P for nonlinear < .01). Compared with patients with a perceived control within the 5th percentile (10 scores), as the perceived control increased, the risk of depression rapidly decreased from "1" until it reached a threshold (20 scores) and stabilized. This trend remained consistent across the subgroups grouped by gender, age, New York Heart Association classification, and comorbidity burden.

Interventions targeting perceived control may hold valuable implications for reducing the risk of depression in patients with CHF, particularly those who have not yet reached the threshold.

The comorbidity of cardiovascular diseases (CVDs) and mental disorders (MD) has become a significant challenge in modern medicine, severely affecting patients' quality of life and prognosis. The heart-brain axis, a bidirectional pathway connecting the central nervous system and the cardiovascular system, plays a critical role in the comorbidity mechanisms of CVDs and MD. In recent years, brain-derived neurotrophic factor (BDNF) has emerged as a key molecule in the study of CVDs and MD. By binding with high affinity to TrkB receptors and activating various signaling pathways, BDNF exerts multiple functions in both the nervous and cardiovascular systems. BDNF may participate in the pathogenesis of CVDs combined with MD through multiple mechanisms such as regulating inflammatory responses, oxidative stress (OS), and the hypothalamic-pituitary-adrenal (HPA) axis, making it a promising new target for future diagnosis and treatment. This review systematically summarizes the mechanisms by which BDNF functions in heart-brain comorbidity, particularly its multifaceted influence on inflammation, OS, and neuroendocrine regulation. Additionally, we discuss the clinical application prospects of BDNF in disease diagnosis and treatment, as well as progress in related drug development. A deeper understanding of BDNF's role in the heart-brain axis will provide new insights and strategies for the prevention, diagnosis, and treatment of CVDs and MD.

Heart failure (HF) is a growing public health concern, with an increasing incidence among younger populations. Traditionally, HF was considered a condition primarily affecting the elderly, but of late, emerging evidence hints at a rapidly rising HF incidence in youth in the past 2 decades. HF in youth has been linked to a complex interaction between emerging risk factors, such as metabolic syndrome, environmental exposures, genetic predispositions, and lifestyle behaviors. This review examines these evolving determinants, including substance abuse, autoimmune diseases, and the long-term cardiovascular effects of coronavirus disease 2019, which disproportionately affect younger individuals. Through a comprehensive analysis, the study highlights the importance of early detection, targeted prevention strategies, and multidisciplinary management approaches to address this alarming trend. Promoting awareness and integrating age-specific interventions could significantly reduce the burden of HF and improve long-term outcomes among younger populations.

Patients with heart failure (HF) and their caregivers are a dyad inextricably linked that exert influence on patients' quality of life (QoL).

The aim of this study was to explore factors affecting HF patients' QoL. Factors were: (a) HF patients' characteristics, (b) anxiety/depression of the dyad (patient-caregiver) and (c) caregivers' QoL.

In this cross-sectional study, we enrolled 340 patients and 340 caregivers. Data collection was performed by the method of an interview using "The Hospital Anxiety and Depression Scale", HADS) to assess anxiety and depression (patient-caregiver) as well as the "Minnesota Living with Heart Failure" and the "SF-36 Health Survey (SF-36)" to assess QoL (patient-caregiver, respectively).

From the 340 dyads who comprised the sample, 81.3% and 77.5% of patients experienced anxiety and depression, respectively, while 79.3% and 62.2% of caregivers experienced anxiety and depression, respectively. A statistically significant difference between patients and caregivers was only detected for depression (p = 0.001) and not for anxiety (p = 0.567). Patients with scores in HADS that indicate anxiety and depression had a worse QoL (total, physical, and mental). All subscales of the caregiver's QoL were significantly associated with the patient's QoL (p < 0.001) apart from the physical functioning scale. The correlation coefficients were all negative, indicating that a better caregiver's QoL (higher SF36 scores) is associated with a better patient's QoL (lower Minnesota scores). After controlling for the patient's characteristics, the anxiety and depression of caregivers did not affect the patient's QoL (confounding effect) whereas the patient's anxiety/depression remained significant factors. Patients with anxiety and depression had 5.58 and 6.49 points, respectively, higher QoL score, meaning a worse QoL, compared to those with no anxiety/depression.

Evaluating the impact of HF on patients' QoL and anxiety/depression along with their caregivers permits acknowledgment of this dyadic relationship.

Sleep quality is crucial in heart failure (HF) patients, yet its associations with clinical, demographic, and psychosocial factors remain underexplored. This study examined these relationships to identify predictors of poor sleep quality. Study Design: A cross-sectional study.

This cross-sectional was conducted on 354 HF patients at Shahid Chamran Heart Hospital, Isfahan, Iran (September 2023-2024). Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS) were used to evaluate sleep quality, anxiety, and depression, respectively. Random forest (RF) modeling and ordinary least squares (OLS) regression identified predictors of poor sleep quality.

Poor sleep quality (PSQI>7) was observed in 18% of patients who were older (70.00±6.30, P<0.001) and had lower ejection fraction (EF) (23.75±12.79%, P<0.001). This group also had higher systolic blood pressure (BP 140.67±12.50 mmHg, P=0.014). Complex medication regimens, including angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and diuretics, were associated with poor sleep (P<0.001). Moreover, depression (HADS-depression: 5.36±0.70, P<0.001) and anxiety (HADS-anxiety: 4.84±1.32, P<0.001) were correlated with poor sleep. The RF model had an area under the curve of 0.79, and OLS regression (R2=0.280) highlighted New York Heart Association (NYHA) class and medication type as significant predictors.

Overall, poor sleep quality in HF patients was related to older age, reduced cardiac function, higher blood pressure (BP), complex medication regimens, and increased anxiety and depression. Accordingly, multidimensional management strategies are needed to improve sleep outcomes.

Psychological stress is a major contributor to individual health disparities. Accurate and quantitative detection of stress markers is crucial preventing mental health related problems. Supramolecular chemistry is widely used in drug delivery, catalysis, sensors and other applications. However, due to the difficulty of host functionalization such as cyclodextrins and solid-state pillar[n], it is still a challenge to directly realize the detection of guests through host-guest recognition behavior. Here, we reported an atom transfer radical polymerization (ATRP) fluorescent biosensor for direct and selective detection of guest molecule stress marker cortisol, translating molecular recognition behavior into quantifiable detection signals. Realizes quantitative chemical detection and builds a portable and affordable sensing platform for quantitative detection of target molecules without complex cross-linking steps. Overcomes the disadvantages of traditional methods that require the use of antibodies or are difficult to functionalize during the host-guest recognition process. This ATRP fluorescent biosensor was fabricated by employing zinc phthalocyanine (ZnPc) as a photocatalyst under 630 nm wavelength radiation, β-CD-Br15 as a macromolecular initiator, and fluorescein O-methacrylate (FMA-O) as a monomer for polymerization. The system provides ultra-high sensitivity for the detection of cortisol (limit of detection 0.47 ng/mL) and specificity for the detection of cortisol in the presence of interfering substances such as progesterone and urea. Selective and real sample experiments confirm the specificity and scalability of this mechanism can also be customized by the rational design of the host-guest complex to quantitatively detect various molecules. This study confirms the feasibility of using a cyclodextrin-centered macromolecular initiator as a capture and label-free fluorescent biosensor for cortisol, a stress biomarker.

Older adults with heart failure often exhibit poor self-care maintenance. Frailty could exacerbate self-care, leading to deteriorating health. Social support and depression may play a role in self-care maintenance in older adults with heart failure combined with frailty. Confirming this potential mechanistic relationship could provide valuable reference for nurses to formulate and improve the targeted intervention strategies and health education programs for older adults with heart failure.

This study analyzed the relationship between frailty and self-care maintenance in older adults with heart failure and determined the sequential mediation effect of social support and depression. Its goal was to provide valuable theoretical insights for formulating targeted clinical nursing interventions for older adults with heart failure.

A cross-sectional study was conducted from July 2023 to February 2024, during which older adults with heart failure were recruited using a convenience sampling method from the cardiovascular department of a tertiary Class A hospital in Qingdao, China. A total of 241 completed the Tilburg Frailty Indicator, the Self-Care of Heart Failure Index, the Social Support Rating Scale, and the Patient Health Questionnaire-9. t -Tests and one-way analysis of variance were used to examine differences in self-care maintenance among participants with distinct characteristics; correlation analysis was used to identify variable relationships within the study. The mediation model was tested using the SPSS PROCESS macro and the bootstrap method.

Frailty was negatively correlated with self-care maintenance, and both social support and depression were significantly related to frailty and self-care maintenance. Social support and depression not only independently mediated the relationship between frailty and self-care maintenance but also exhibited a significant sequential mediation effect.

The frailty of older adults with heart failure and its correlation with self-care maintenance is a complex and multidimensional phenomenon. Frailty not only directly influenced self-care maintenance in participants but also indirectly affected it through the mediating factors of social support and depression. Future research should emphasize innovative, targeted interventions to enhance social support quality and accessibility and alleviate depression, ultimately boosting patients' self-care capabilities and elevating their quality of life.

Heart failure is a condition with significant symptom burden and high hospitalization rates. Effective self-management, including recognizing symptoms and making behavior changes, is crucial but often inadequately addressed by current educational methods. To improve this, heart failure self-care vignettes were developed to measure knowledge of managing physical and psychological symptoms. However, the vignettes' face validity and reliability have not been thoroughly evaluated.

To ensure the understandability of a novel instrument to measure knowledge of heart failure symptom recognition and self-management and to examine its inter-rater reliability with individuals diagnosed with heart failure.

Cognitive interviews were conducted with heart failure patients admitted to an academic hospital in the Midwest U.S. Vignette segments and interview questions were analyzed, totaling 74 items. Five patients aged 65 and older, participated without cognitive, visual, or hearing impairments. The interviews were coded by two independent raters using a cognitive interview coding book. Vignettes were evaluated qualitatively with a 3-point Likert scale (1 = misunderstanding, 2 = partial understanding, and 3 = full understanding). Inter-rater reliability was assessed using percent agreement and Cohen's kappa.

Patients understood an average of 76% of the psychological and 83% of the physical vignette items, indicating acceptable preliminary understandability. Inter-rater reliability was moderate, with Cohen's kappa values of 0.39 (psychological) and 0.43 (physical).

This pilot study suggests that vignettes could be a useful tool for assessing knowledge of symptom recognition and self-management. Cognitive interviewing helped evaluate how vignette segments were interpreted before using them in future data collection.

Heart failure with preserved ejection fraction (HFpEF) disproportionately affects older adults.

This study aimed to elucidate the prevalence and prognostic implications of geriatric vulnerabilities across multiple health domains in HFpEF.

We examined consecutive patients with HFpEF enrolled from the Weill Cornell Medicine (WCM) and the OPTIMISE HFpEF Programs. The primary exposure was the following: multimorbidity, polypharmacy, cognitive impairment, depressive symptoms, frailty, and limited mobility. The primary outcome was a 1-year composite of all-cause hospitalization and mortality. We conducted Cox proportional hazard models to examine associations of the primary outcome with each geriatric vulnerability and the number of impaired domains, adjusting for race and the Meta-Analysis Global Group in Chronic Heart Failure risk score.

The WCM cohort included 188 patients with a median age of 76.3 years, the majority of which were NYHA functional class III HF (52.1%); the OPTIMISE cohort included 93 patients with a median age of 79.6 years, the majority of which were NYHA functional class II HF (62.0%). Nearly half of each cohort (42.6% WCM, 46.2% OPTIMISE) had geriatric vulnerabilities spanning all 3 health domains. In fully adjusted models, frailty (WCM: HR: 2.89, 95% CI: 1.65-5.09; OPTIMISE: HR: 2.89, 95% CI: 1.65-5.09) and an increasing number of impaired domains were associated with the primary outcome: with 3 impaired domains conferring a near 4-fold increase in risk (WCM: HR: 3.97, 95% CI: 1.49-10.5, P = 0.007]; OPTIMISE: HR: 3.74, 95% CI: 1.26-11.10, P = 0.017]).

Geriatric vulnerabilities across multiple health domains commonly co-occur in adults with HFpEF and are associated with a worse prognosis.

Patients who have experienced an inpatient hospitalization for heart failure are at increased risk of mortality, particularly during the months following discharge. This study described patient characteristics associated with suicide death and examined the time course of death by suicide compared to that of other types of death amongst patients with a recent medical hospitalization for heart failure.

Using Department of Veterans Affairs (VA) electronic medical records from 2011 to 2020, we identified a cohort of Veterans hospitalized with a heart failure diagnosis who died after discharge. We merged the VA Mortality Database Record, a compilation of death sources and causes, with the VA electronic health record and compared characteristics of Veterans who died by suicide and by other causes.

In the cohort of 348,840 Veterans, 1,097 died by suicide and 347,743 died by other causes. Compared to those who died by other causes, Veterans who died by suicide were, on average, younger, had fewer comorbidities, more likely to have a depression diagnosis, more likely to be White, and had lower prior year healthcare costs (Standardized mean differences [SMD] ranged from 0.25 to 0.46). Unadjusted analyses showed longer length of time between hospital discharge and death for those who died by suicide compared to other causes (SMD = 0.18); however, analyses adjusting for comorbidities revealed no difference in time to death between those who died by suicide versus other causes.

Demographic, clinical, and healthcare utilization characteristics distinguished Veterans with heart failure who died by suicide from those who died by other causes. Time to death following hospital discharge did not differ between groups when accounting for relevant factors. Comprehensive suicide screening and intervention is needed following a heart-failure hospital discharge, particularly for Veterans at elevated risk.

To identify and report results from studies of anxiety and depression, as measured by The Hospital Anxiety and Depression Scale (HADS) in patients ≥ 80 years admitted to hospital settings, and to inform nurses, researchers and educators in nursing about these findings.

Systematic review.

MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane, Epistemonikos, Scopus and Web of Science Core Collection of studies published until October 2023.

A search strategy was developed with a university librarian. Four independent reviewers screened titles and abstracts based on predefined inclusion criteria. Data were systematically extracted, descriptively analysed, and Critical Appraisal Skills Programme checklists were used to assess studies.

Out of 7076 identified studies, three met the eligibility criteria. Data from 420 participants aged ≥ 80 years were analysed, revealing anxiety prevalence rates between 6% and 18% and mean scores below 4. Depression prevalence rates ranged from 7% to 17%, with a mean score below 4. Most patients with depression were not previously recognised as being depressed.

Few publications reported on anxiety and/or depression in hospitalised patients aged ≥ 80 years using HADS. A gap in the knowledge base has been identified.

Anxiety and depression are mental health conditions that can lead to adverse events and strongly affect aging. Increased understanding of the role that these conditions have on hospitalised patients ≥ 80 years is important for nurses when in contact with this patient group.

There is a need for more studies to generate evidence regarding anxiety and depression in an increasingly common and challenging hospital population by building upon evidence that is based on validated instruments such as the Hospital Anxiety and Depression Scale.

The PRISMA guideline was followed, and the review registered in PROSPERO (Registration number CRD 42022380943).

No patient or public contribution.

CRD 42022380943.

Electrolyte disturbances are relatively common in patients with depression, but they are often overlooked, and the relationship between electrolyte changes and adverse outcomes in depression is not yet clear. This study aims to explore the impact of serum electrolyte levels on the all-cause and cardiovascular disease (CVD) mortality rates in patients with depression.

This prospective cohort study included 3127 patients with depression who participated in the National Health and Nutrition Examination Survey (NHANES) from 2005 through 2018. Depression was assessed using the Patient Health Questionnaire (PHQ-9), with a PHQ-9 score ≥10 defined as depression. The data were analyzed from April 1 to July 30, 2024. Multivariable Cox proportional hazards regression model was used to calculate the hazard ratios (HRs) and 95% confidence intervals (CIs) between serum sodium, potassium, and chloride levels and the CVD risk and all-cause mortality in patients with depression. Three multivariable models were constructed. We further stratified the analysis by age, gender, hypertension, smoking, alcohol consumption, diabetes, and drinking status. Interaction significance was estimated using P-values for the product terms between serum sodium, potassium, chloride, and stratification factors.

This cohort study included data from 2946 participants in the analysis (mean [SD] age, 50.13 [16.48] years; 1116 men [37.88]); During a median (IQR) follow-up of 7.2 (3.6-10.5) years, 398 deaths were recorded, of which 117 were attributed to CVD.After multivariable adjustment, compared with participants in the first quartile of serum sodium levels, the HRs of CVD mortality were 0.90(95% CI, 0.53-1.53) in the fourth quartile (p for trend = 0.484). The HRs of all-cause mortality were 0.73(95% CI, 0.55-0.99) for the fourth quartile (p for trend = 0.003). A nonlinear association was observed between serum sodium levels and all-cause mortality in patients with depression (p for overall = 0.003, p for nonlinear = 0.047). Compared with participants in the first quartile of serum potassium levels, the HRs of CVD mortality were and 1.58(95% CI, 0.98-2.54) in the fourth quartile (p for trend = 0.050), the HRs of all-cause mortality were 1.52(95% CI, 1.16-1.99) for the fourth quartile (p for trend <0.001). A nonlinear association was observed between serum potassium levels and all-cause (p for overall<0.001, p for nonlinear = 0.005) and CVD (p for nonlinear = 0.003) mortality in patients with depression. Compared with participants in the first quartile of serum chlorine levels, the HRs of CVD mortality were 0.84(95% CI, 0.49-1.46) in the fourth quartile(p for trend = 0.284). The HRs of all-cause mortality were 0.70(95% CI, 0.51-0.95) for the fourth quartile(p for trend <0.001). A nonlinear association was observed between serum chlorine levels and all-cause (p for nonlinear<0.001) and CVD (p for nonlinear<0.001) mortality in patients with depression.

This cohort study found that in patients with depression, higher sodium is significantly correlated with lower all-cause mortality, higher potassium is significantly correlated with higher all-cause and CVD mortality, and higher chloride is significantly correlated with lower all-cause and CVD mortality.

Psychiatric disorders have been reported to influence many health outcomes, but evidence about their impact on chronic kidney disease (CKD) has not been fully explored, as well as possible mechanisms implicated are still unclear.

Four hundred forty-one thousand eight hundred ninety-three participants from UK Biobank were included in this study. To assess the association between psychiatric disorders mainly including depression, anxiety, stress-related disorders, substance misuse as well as psychotic disorder, and CKD, a Cox regression model using age as the underlying time scale was employed. This approach considers the age progression of participants from the beginning to the end of the study as the elapsed time. Flexible nonparametric smoothing model was conducted to illustrate the temporal patterns. Subgroup analyses were performed by stratification of gender, genetic susceptibility to CKD, age at entry or exit the cohort, follow-up duration, and the number of psychiatric disorders at baseline. Mediation analysis was implemented to evaluate the roles of body mass index (BMI), hypertension, and diabetes.

Compared with individuals without psychiatric disorders, an increased risk of CKD was observed in patients with psychiatric disorders (hazard ratios (HR) = 1.52, 95% confidence intervals (CI): 1.40-1.65, p-value < 0.001). The hazard ratio among psychiatric patients gradually increased, and became significant after about 10 years follow-ups. The HR for patients followed up for 10-12 years was 1.60 (95% CI: 1.34-1.91, p-value < 0.001), and the HR was 1.66 (95% CI: 1.29-2.13, p-value < 0.001) for patients followed up for 12-13 years. Five distinct psychiatric disorders were found to be significantly associated with an increased risk of developing CKD. The highest HR was observed between stress-related disorder and CKD (HR = 1.95, 95%CI: 1.28-2.97, p-value = 0.002). When adjusting genetic susceptibility to CKD, the HR for the association between stress-related disorders and CKD became 1.86 (95%CI: 1.14-3.04, p-value = 0.013). Although these associations were nominally significant, they did not reach statistical significance after applying the Bonferroni multiple corrections, potentially due to the limited sample size. Subgroup analysis revealed that psychiatric patients who are under age 60, with multiple psychiatric morbidities or having been diagnosed with psychiatric disorders for over 10 years may be high-risk populations. Hypertension, BMI and diabetes mediated 49.13% (95% CI: 37.60%-67.08%), 12.11% (95% CI: 8.49%-17.24%) and 3.78% (95% CI: 1.58%-6.52%) of the total effect, respectively.

Psychiatric disorders were associated with a delayed onset of an elevated risk for CKD, this association was only observed in patients with psychiatric disorders for more than 10 years. Our study highlights the significance of lifestyle interventions, routine monitoring of kidney function, early screening for CKD, and personalized management strategies for psychiatric patients as potential approaches to the precise prevention of CKD.

Mental health and wellbeing are fundamental and integral components of healthy functioning, and psychological resources significantly contribute to its maintenance and enhancement. This study aimed to investigate the mediating effects of psychological flexibility and emotion regulation in the association between future anxiety, depression, and stress.

A total of 528 undergraduate students participated in this study (M = 20.14, SD = 1.76).

The findings of the study showed that future anxiety was negatively associated with psychological flexibility and cognitive reappraisal, and positively associated with expressive suppression, depression and stress. Psychological flexibility and cognitive reappraisal had negative relationships with depression and stress, and expressive suppression had a positive relationship with depression and stress. The associations between future anxiety, depression and stress were mediated by psychological flexibility, cognitive reappraisal and expressive suppression.

This study deepened our understanding of the possible mechanisms of depression and stress. For individuals suffering from future anxiety, psychological flexibility and emotion regulation may be a coping strategy that leads individuals to less depression and stress. This study suggests that psychological flexibility and emotion regulation skills are fundamental aspects of psychological health.

Diabetic individuals are at an increased risk of mental illness and comorbidities. However, the precise association between depressive symptoms and comorbidity remains uncertain. Our study aimed to investigate this relationship among elderly Chinese diabetic patients.

Data from the China Health and Retirement Longitudinal Study (CHARLS) in 2020 were utilized for the cross-sectional analysis. Depressive status was defined as the dependent variable, while the presence, number, and type of comorbidities served as independent variables. Logistic regression analyses were performed, adjusting for potential demographic factors, and health status and functioning factors.

Our findings indicate that diabetic patients with complications are more likely to experience depression. With the exception for dyslipidemia (OR = 1.195, 95% CI: 0.969, 1.475), individuals with hypertension, heart disease, stroke, kidney disease, memory-related disease, or arthritis/rheumatism were prone to develop depressive status in the fully adjusted model. After adjusting for covariates, diabetic patients with memory-related diseases exhibited the most pronounced association with depressive symptoms (OR = 2.673, 95% CI: 1.882, 3.797). Furthermore, an increasing number of depression-related comorbidities strengthened the association (p < 0.05). Sensitivity analysis revealed that there were no significant differences stratified by gender or marital status (p < 0.05).

In the elderly diabetic population in China, the presence, number, and type of comorbidities were independently associated with depressive symptoms. Diabetic patients with memory-related diseases displayed the highest likelihood of experiencing depressive status. These findings underscore the importance of implementing effective strategies for multimorbidity management in diabetic patients.

Both coronary heart diseases (CHD) and depression are highly prevalent and bidirectionally related. The precise nature of this relationship remains unclear. Defining depressive subtypes could help unravel this relationship. Therefore, the aim of this study was to explore depressive subtypes in patients with CHD.

1530 patients (21.3 % women, mean age: 64.7 years (SD = 10.1)) were included in latent class analysis with nine indicators derived from the PHQ-9 and BDI-II representing symptoms of depression as described in the DSM-5 criteria. The best-fitting latent class model was confirmed with double cross-validation. Classes were characterized using demographic, medical, psychiatric, and cardiovascular (risk) factors.

A 3-class model demonstrated the best fit to the data, resulting in a depressed (5.4 %), fatigued (13.5 %), and non-depressed class (81.1 %). Having medical comorbidities, a history of psychiatric problems, negative affectivity, and anxiety symptoms increased the odds of belonging to the depressed group (OR 3.02, 95%CI 1.19-7.68, OR 3.61, 95%CI 1.44-9.02, OR 1.16, 95%CI 1.04-1.30, and OR 1.89, 95%CI 1.66-2.15, respectively). Belonging to the fatigued group was associated with increased odds of having an elective PCI (OR 2.12, 95%CI 1.27-3.55), insufficient physical activity (OR 2.19, 95%CI 1.20-3.99), comorbid medical conditions (OR 2.15, 95%CI 1.21-3.81), a history of psychiatric problems (OR 2.25, 95%CI 1.25-4.05), and anxiety symptoms (OR 1.48, 95%CI 1.34-1.63) compared with the non-depressed group.

Future studies should include more people with depressive symptoms.

Patients with CHD and medical or psychiatric risk factors should be offered support to decrease or prevent depressive or fatigue symptoms.

Current evidence that supports palliative care interventions predominantly focuses on individuals with cancer or hospitalized patients. However, the effectiveness of palliative care on patient-reported outcomes and mortality in community-dwelling adults with heart failure has not been evaluated.

We aimed to evaluate the effectiveness of palliative care interventions on patient-reported outcomes and all-cause mortality in community-dwelling adults with heart failure.

A systematic review and meta-analysis of randomized controlled trials.

MEDLINE, Embase, Cochrane Library, and CINAHL databases were searched from inception to October 2023. Randomized controlled trials were considered if they compared palliative care interventions with usual care, attention control, or waiting-list control primarily in a community-dwelling heart failure patient population. The primary outcome was patient-reported generic health-related or heart failure-specific quality of life. Secondary outcomes were patient-reported symptom burden, psychological health (anxiety and depression), spiritual well-being, and all-cause mortality. Two independent reviewers screened the retrieved articles and extracted data from the included studies. A random-effects meta-analysis was performed to pool the data, followed by sensitivity analysis, subgroup analysis, and meta-regression. All analyses were performed using R version 4.2.2.

Eleven eligible studies were included in this review with a total of 1535 patients. Compared to usual care, palliative care interventions demonstrated statistically significant effects on improving generic health-related quality of life (SMD, 0.30 [95 % CI, 0.12 to 0.48]) and heart failure-specific quality of life (SMD, 0.17 [95 % CI, 0.03 to 0.31]). Palliative care interventions also reduced anxiety (SMD, -0.22 [95 % CI, -0.40 to -0.05]) and depression (SMD, -0.18 [95 % CI, -0.33 to -0.03]), and enhanced spiritual well-being (SMD, 0.43 [95 % CI, 0.05 to 0.81]), without adversely affecting all-cause mortality (RR, 1.00 [95 % CI, 0.76 to 1.33]). Yet, the interventions had no significant effects on symptom burden (SMD, -0.09 [95 % CI, -0.40 to 0.21]). The certainty of evidence across the outcomes ranged from very low to moderate based on the GRADE approach.

Palliative care interventions are beneficial for community-dwelling adults with heart failure in that the interventions improved patient-reported quality of life, psychological health, and spiritual well-being, and importantly, did not lead to higher mortality rates. Findings of this review support the implementation of palliative care for adults with heart failure in community settings.

CRD42023482495.

Anxiety and depressive symptoms are common among patients with heart failure (HF). Physical limitations, lifestyle changes, and uncertainties related to HF can result in the development or exacerbating of anxiety and depressive symptoms. However, the central and bridge symptoms of anxiety and depressive symptoms network among patients with HF remain unclear. Network analysis is a statistical method that can discover and visualize complex relationships between multiple variables. This study aimed to establish a network of anxiety and depressive symptoms and identify the central and bridge symptoms in this network among patients with HF.

This study employed a cross-sectional study design and convenience sampling to recruit patients with HF. This study followed the Helsinki Declaration and was approved by the Research Ethics Committee of Hospital. The Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire (PHQ-9) were administered to evaluate anxiety and depressive symptoms among patients with HF, respectively. Network analysis of anxiety and depressive symptoms was performed using R.

In the anxiety and depressive symptoms network, PHQ2 (feeling down, depressed, or hopeless), PHQ7 (inability to concentrate), and GAD4 (difficulty relaxing) were the most central symptoms. Anxiety and depressive symptoms were linked by PHQ2 (feeling down, depressed, or hopeless), GAD6 (becoming easily annoyed or impatient), GAD5 (unable to sit still because of anxiety), GAD7 (feeling afraid that something terrible is about to happen), and PHQ6 (feeling bad or like a failure, or disappointing oneself or family).

This study identified the central and bridge symptoms in a network of anxiety and depressive symptoms. Targeting these symptoms can contribute to interventions for patients with HF at risk of-or suffering from-anxiety and depressive symptoms, which can be effective in reducing the comorbidity of anxiety and depression.

Recent studies have indicated that obstructive sleep apnea (OSA) is linked to a higher likelihood of heart failure (HF). However, the causal connection between the two conditions is uncertain. We aimed to investigate the causal association of OSA with HF and its risk factors.

The OSA summary statistics are derived from the FinnGen database, including 38,998 cases and 336,659 controls. HF summary statistics come from HERMES, the UK Biobank, and the FinnGen database. A two-sample mendelian randomization (MR) analysis was conducted to examine the causality of OSA on HF risk. Furthermore, the mediator effect of potential risk factors was assessed by a two-step MR.

The results of MR analysis demonstrated that genetically determined OSA is causal associated with the higher likelihood of HF (HERME: odds ratio [OR] = 1.222; 95% confidence interval [CI]: 1.091, 1.369; p = 5.19 × 10-4) (FinnGen: OR = 1.233; 95% CI: 1.129, 1.346; p = 3.32 × 10-6) (UK Biobank: OR = 1.002; 95% CI: 1.000, 1.003; p = 0.014). Two-step MR analysis indicated that obesity, blood glucose, depression, and other CVDs have significant mediating effects on the causal effect between OSA and HF.

This MR study emphasizes the causal effect of OSA on HF risk. Adiposity traits play a major role in the process of OSA leading to HF. Considering the detrimental impact of OSA on HF, it becomes imperative to prioritize the prevention and management of HF in individuals afflicted with OSA. The foremost intervention strategy should revolve around effective obesity management.

The effects of heart failure (HF) on cortical brain structure remain unclear. Therefore, the present study aimed to investigate the causal effects of heart failure on cortical structures in the brain using Mendelian randomization (MR) analysis.

We conducted a two-sample MR analysis utilizing genetically-predicted HF trait, left ventricular ejection fraction (LVEF), and N-terminal prohormone brain natriuretic peptide (NT-proBNP) levels to examine their effects on the cortical surface area (SA) and thickness (TH) across 34 cortical brain regions. Genome-wide association study summary data were extracted from studies by Rasooly (1,266,315 participants) for HF trait, Schmidt (36,548 participants) for LVEF, the SCALLOP consortium (21,758 participants) for NT-proBNP, and the ENIGMA Consortium (51,665 participants) for cortical SA and TH. A series of MR analyses were employed to exclude heterogeneity and pleiotropy, ensuring the stability of the results. Given the exploratory nature of the study, p-values between 1.22E-04 and 0.05 were considered suggestive of association, and p-values below 1.22E-04 were defined as statistically significant.

In this study, we found no significant association between HF and cortical TH or SA (all p > 1.22E-04). We found that the HF trait and elevated NT-proBNP levels were not associated with cortical SA, but were suggested to decrease cortical TH in the pars orbitalis, lateral orbitofrontal cortex, temporal pole, lingual gyrus, precuneus, and supramarginal gyrus. Reduced LVEF was primarily suggested to decrease cortical SA in the isthmus cingulate gyrus, frontal pole, postcentral gyrus, cuneus, and rostral middle frontal gyrus, as well as TH in the postcentral gyrus. However, it was suggested to causally increase in the SA of the posterior cingulate gyrus and medial orbitofrontal cortex and the TH of the entorhinal cortex and superior temporal gyrus.

We found 15 brain regions potentially affected by HF, which may lead to impairments in cognition, emotion, perception, memory, language, sensory processing, vision, and executive control in HF patients.

This comprehensive article delves into the intricate and multifaceted issue of noise pollution, shedding light on its diverse sources, profound health implications, and the economic burden it imposes on societies. Noise pollution is an increasingly prevalent environmental challenge, impacting millions of people worldwide, often without their full awareness of its adverse effects. Drawing from a wealth of scientific research, the article underscores the well-established links between noise pollution and a spectrum of health issues, including cardiovascular diseases, sleep disturbances, and psychological stress. While exploring the sources and consequences of noise pollution, the article highlights the urgent need for a holistic and collaborative approach to mitigate its impact. This entails a combination of regulatory measures, technological innovations, urban planning strategies, and public education campaigns. It is increasingly evident that the detrimental effects of noise pollution extend beyond physical health, encompassing mental and social well-being. The article also addresses the synergistic relationship between noise pollution and other environmental stressors, emphasizing the importance of considering noise in conjunction with factors like air pollution and access to green spaces. It examines the potential of green spaces to mitigate the effects of noise pollution and enhance overall health.

Somatic symptoms and related factors in patients with chronic heart failure have been extensively researched. However, more insight into the complex interconnections among these constructs is needed, as most studies focus on them independently from each other.

The aim of this study is to gain a comprehensive understanding of how somatic symptoms and related factors are interconnected among patients with chronic heart failure.

A total of 379 patients were enrolled. Network analysis was used to explore the interconnections among the somatic symptoms and related risk factors.

The four core symptoms of chronic heart failure were daytime dyspnea, dyspnea when lying down, fatigue and difficulty sleeping. Within the network, the edge weights of depression-anxiety, subjective social support-objective social support, and subjective social support-social support availability were more significant than others. Among physiological, psychological and environmental factors, the edge weights of NYHA-dyspnea, depression-difficulty sleeping, and social support availability-dyspnea when lying down were more significant than others. Depression and anxiety had the highest centrality, indicating stronger and closer connections with other nodes.

Psychological and environmental factors stood out in the network, suggesting the potential value of interventions targeting these factors to improve overall health.

Nowadays, high morbidity and mortality of cardiovascular diseases (CVDs) and high comorbidity rate of neuropsychiatric disorders contribute to global burden of health and economics. Consequently, a discipline concerning abnormal connections between the brain and the heart and the resulting disease states, known as psychocardiology, has garnered interest among researchers. However, identifying a common pathway that physicians can modulate remains a challenge. Gut microbiota, a constituent part of the human intestinal ecosystem, is likely involved in mutual mechanism CVDs and neuropsychiatric disorder share, which could be a potential target of interventions in psychocardiology. This review aimed to discuss complex interactions from the perspectives of microbial and intestinal dysfunction, behavioral factors, and pathophysiological changes and to present possible approaches to regulating gut microbiota, both of which are future directions in psychocardiology.

The prevalence of depression is higher in heart failure (HF) patients. Early screening of depressive symptoms in HF patients and timely intervention can help to improve patients' quality of life and prognosis. This study aims to explore diagnostic biomarkers by examining the expression profile of serum exosomal miRNAs in HF patients with depressive symptoms.

Serum exosomal RNA was isolated and extracted from 6 HF patients with depressive symptoms (HF-DS) and 6 HF patients without depressive symptoms (HF-NDS). High-throughput sequencing was performed to obtain miRNA expression profiles and target genes were predicted for the screened differentially expressed miRNAs. Biological functions of the target genes were analyzed through Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG). Subsequently, we collected serum exosomal RNAs from HF-DS (n = 20) and HF-NDS (n = 20). The differentially expressed miRNAs selected from the sequencing results were validated using reverse transcription quantitative polymerase chain reaction (RT-qPCR). Finally, the diagnostic efficacy of the differentially expressed exosomal miRNAs for HF-DS was evaluated by using receiver operating characteristic (ROC) curves.

A total of 19 significantly differentially expressed exosomal miRNAs were screened by high-throughput sequencing, consisting of 12 up-regulated and 7 down-regulated exosomal miRNAs. RT-qPCR validation demonstrated that the expression level of exo-miR-144-3p was significantly down-regulated in the HF-DS group, and the expression levels of exo-miR-625-3p and exo-miR-7856-5p were significantly up-regulated. In addition, the expression level of exo-miR-144-3p was negatively correlated with the severity of depressive symptoms in HF patients, and that the area under the curve (AUC) of exo-miR-144-3p for diagnosing HF-DS was 0.763.

In this study, we examined the serum exosomal miRNA expression profiles of HF patients with depressive symptoms and found that lower level of exo-miR-144-3p was associated with more severe depressive symptoms. Exo-miR-144-3p is a potential biomarker for the diagnosis of HF-DS.

The left ventricle segmentation (LVS) is crucial to the assessment of cardiac function. Globally, cardiovascular disease accounts for the majority of deaths, posing a significant health threat. In recent years, LVS has gained important attention due to its ability to measure vital parameters such as myocardial mass, end-diastolic volume, and ejection fraction. Medical professionals realize that manually segmenting data to evaluate these processes takes a lot of time, effort when diagnosing heart diseases. Yet, manually segmenting these images is labour-intensive and may reduce diagnostic accuracy.

This paper, propose a combination of different deep neural networks for semantic segmentation of the left ventricle based on Tri-Convolutional Networks (Tri-ConvNets) to obtain highly accurate segmentation. CMRI images are initially pre-processed to remove noise artefacts and enhance image quality, then ROI-based extraction is done in three stages to accurately identify the LV. The extracted features are given as input to three different deep learning structures for segmenting the LV in an efficient way. The contour edges are processed in the standard ConvNet, the contour points are processed using Fully ConvNet and finally the noise free images are converted into patches to perform pixel-wise operations in ConvNets.

The proposed Tri-ConvNets model achieves the Jaccard indices of 0.9491 ± 0.0188 for the sunny brook dataset and 0.9497 ± 0.0237 for the York dataset, and the dice index of 0.9419 ± 0.0178 for the ACDC dataset and 0.9414 ± 0.0247 for LVSC dataset respectively. The experimental results also reveal that the proposed Tri-ConvNets model is faster and requires minimal resources compared to state-of-the-art models.

With great interest, we have read the article "Anxiety and depression in heart failure: An updated review" by Sarim Rashid et al. For its clarity and conciseness, we applaud the author for his extensive research on this delicate topic. The authors have concisely written several scenarios including the risk factors that contribute to the development and exacerbation of anxiety and depression in individuals with heart conditions, including biological, psychological, and social factors. Nonetheless, we thought it would be helpful to add a few more things to the article's conclusion to strengthen it. Exploring the pathogenesis and pathophysiology of post-sepsis related depression is of positive significance for reducing the occurrence of long-term depression and improving the prognosis of sepsis patients.