Post-stroke smoking and mental health burden: sex-specific analysis of NHIS 2019-2023.

Healthy Eating Index-2020 and post-stroke depression (PSD): cross-sectional analysis of NHANES data.

HEI-2020 was inversely associated with PSD, with nonlinear and race-specific patterns and DI-GM showed a significant but inconsistent indirect association, suggesting a suppressive rather than mediating role.

Association between stroke history, depression, and suicidal ideation: National health and nutrition examination survey, 2011-2018.

OBJECTIVE Stroke patients often have mental health comorbidities such as depression and suicidal ideation. Stroke is a leading cause of long-term disability and is associated with increased risk of death, with mental illness playing a large role in this relationship. However, the impact of stroke on suicidal ideation among individuals with co-morbid depression is not well understood. We aim to determine if stroke in combination with depression was associated with a higher prevalence and severity of suicidal ideation. METHODS We performed a retrospective cross-sectional study using data from the National Health and Nutrition Examination Survey, 2011-2018. All respondents were divided into four mutually exclusive categories based on their diagnosis of stroke and depression. Weighted prevalence estimates and 95% confidence intervals (CI) were reported across clinical and demographic categories. Multivariable logistic regression models were used to identify the independent association between stroke, depression, and suicidal ideation. Adjusted odds ratios (AOR) and a p-value of < 0.05 were used to determine statistical significance. RESULTS The analytic sample included 19,397 participants, of whom 863 (4%) had a history of stroke. Depression was present in 154 (0.7%) participants with stroke and 2709 (11.6%) participants without stroke. The mean age of participants with stroke and depression was 59 years. This group was more likely to be female (64%), non-Hispanic White (67.7%), have more than a high school education (38.9%), and be overrepresented among those living at or below the federal poverty level (69.8%). Stroke was independently associated with an increased risk of suicidal ideation in those with depression (adjusted odds ratio [AOR] = 1.86; 95% CI: 1.21-2.85; p = 0.005) when compared to those with depression but without stroke. Living at or below the poverty level was also independently associated with increased suicidality risk (AOR = 1.39; 95% CI: 1.11-1.74; p = 0.005). CONCLUSION A history of stroke was found to significantly increase the odds of suicidal ideation in those with depression. These findings can help inform better integrative screening and treatment of mental health among stroke patients, especially those with co-morbid depression.

Healthcare burden of comorbid depression and type 2 diabetes and conventional risk factors - a population-based mediation analysis of 0.5 million Chinese people.

BACKGROUND Limited population-based analyses of associations of comorbid depression and diabetes have tested metabolic risk factors as mediating variables for the association between depression and clinical outcomes. METHODOLOGY We included Chinese adults with type 2 diabetes attending structured diabetes risk assessment in Hong Kong between 1 January 2000 and 30 June 2024. Depression was identified using International Classification of Disease-9 codes or prescription of anti-depressants. People with baseline cardiovascular disease or end-stage kidney disease (ESKD) were excluded. We estimated the hazard ratio (HR) of cardiovascular diseases, ESKD, all-cause death associated with depression compared to those without depression. We examined the mediating effects of eight cardiometabolic risk factors in these risk associations. RESULTS Among 571,129 people with type 2 diabetes, 7.5% had depression (mean age 60.4 years, 66.1% women, mean HbA1c 7.2%). People with depression had greater number of all-cause hospitalisation and longer length of stay. Compared to no depression, depression was associated with higher hazards for incident cardiovascular disease (HR: 1.21 [1.17, 1.24]), all-cause death (HR: 1.30 [1.26, 1.33]), but not ESKD (HR 0.95 [0.89, 1.01]), adjusted for age, sex and diabetes duration. Mediation analyses revealed the association between depression, cardiovascular disease and all-cause death were mediated predominantly by the direct effect of depression. CONCLUSION Depression is associated with greater risks for incident cardiovascular disease and all-cause death in people with type 2 diabetes. Mediation analyses revealed minor contributions from metabolic risk factors on these associations, highlighting the need for enhanced screening for depression and integrated care.

Sociodemographic, lifestyle, work- and health-related correlates of mental health outcomes: a large-scale cross-sectional web-based study of 1.19 million adult internet users in Poland (2020-2024).

BACKGROUND Mental health represents a growing public health challenge, exacerbated by recent global and regional crises. This study aimed to identify sociodemographic, lifestyle, work- and health-related correlates of key mental health outcomes - primarily depression, insomnia, and job burnout - in a large sample of adult internet users in Poland. METHODS We analyzed pooled cross-sectional data from 1 196 102 adults participating in an annual web-based health survey in Poland between 2020 and 2024. Ordinal and binary logistic regression models (2021-2024 waves; N = 655 427) were used to assess associations between predictors (sociodemographics, lifestyle factors, chronic diseases, stress, social relationships, work characteristics) and self-reported mental health outcomes. Self-rated general health, neurological diseases, memory complaints, and frequent headaches were also assessed as secondary outcomes. RESULTS Significant gender disparities were observed, with women reporting higher odds of depression, insomnia, and job burnout (p < 0.001). Daily stress and infrequent social contact were the strongest correlates, markedly associated with increased odds of all adverse mental health outcomes (p < 0.001). The presence of chronic diseases (particularly arthritis and heart disease) and specific lifestyle factors (e.g., lack of physical activity and unhealthy dietary patterns) were also significantly associated factors. Conversely, regular physical activity and frequent social contact were protective. CONCLUSIONS Mental health outcomes among Polish adult internet users are strongly associated with a complex interplay of psychosocial, health, and lifestyle factors. High stress, poor social contact, and chronic illness burden are major correlates of poor mental health. These findings emphasize the need for targeted, broad-based public health interventions promoting stress management and social connection.

The role of social and community engagement and its associations with healthcare utilization and depressive symptoms among older adults: A longitudinal panel data analysis.

BACKGROUND Social and community engagement is a modifiable factor that may influence healthcare use and mental health in older adults. However, existing evidence has rarely integrated the examination of association, mechanism, and population heterogeneity within a single analytical framework. From a nursing perspective, understanding these relationships is crucial for developing holistic care plans that address the social determinants of health. AIM This study aimed to investigate the association between the intensity of social and community engagement and key health-related outcomes, including healthcare utilization and depressive symptoms, from a nursing-centric viewpoint. METHODS The study utilized linked data from the RAND Health and Retirement Study Core (2004-2022) and the Consumption and Activities Mail Survey (2003-2021), which comprised 47,604 person-wave observations. Two-part models were employed to estimate associations with healthcare utilization (doctor contacts, hospital admissions, and hospital nights). As exploratory secondary analyses, mediation by depressive symptoms (Center for Epidemiologic Studies Depression scale) was tested using a product-of-coefficients framework, and a random-forest T-learner was used to describe individual-level heterogeneity in the estimated associations. Both analyses are interpreted as descriptive given timing limitations and the absence of cross-validation. RESULTS Higher social and community engagement was associated with a greater likelihood of initiating any doctor contact (odds ratio = 1.09) but was not associated with the number of visits. It was also linked to lower depressive symptoms (β = -0.043). No significant mediation by depressive symptoms was detected for the relationship between engagement and healthcare utilization. CONCLUSION Social and community engagement is associated with the initiation of healthcare contact and better mental health but not with the intensity of healthcare use or inpatient services. The benefits of engagement appear to be greater for individuals with more significant health challenges and those from specific ethnic groups, suggesting that nurse-led interventions to promote engagement could be a valuable strategy for improving well-being in vulnerable populations.

Predictors of Stroke Among U.S. Adults: A Survey-Weighted Analysis of the Behavioral Risk Factor Surveillance System, 2021 to 2023