Developing Multimodal IoMT Monitoring System of Geriatric Depression: A Feasibility Study

The Internet of Medical Things (IoMT) is a promising tool to monitor depression and relevant symptoms. However, the multimodal IoMT monitoring system has been rarely developed considering the characteristics of older adults, particularly living in the community. Therefore, it is necessary to know how to develop multimodal IoMT monitoring systems tailored for older adults and evaluate the feasibility for research and practice. We developed a multimodal IoMT monitoring system that included a smartphone for facial and verbal expressions, smartwatch for activity and heart rates, and ecological momentary assessment (EMA) application. A convenience sample of 21 older Korean adults aged over 65 years was recruited from a community center, and 19 participants completed it. The data were collected in four weeks using self-report questionnaires, IoMT devices, and semi-structured interviews between July and December 2020 and were analyzed in mixed methods. Based on the Geriatric Depression Scale-Short Form scores, eight participants were classified in the depressive group (38.1%) and 13 in the non-depressive group (61.9%). A total of 1,505 (70.72%) EMA data were collected, and 1,277 (60.00%) were analyzed. Furthermore, 1,421 (66.78%) facial expression data were collected and labeled, including anger, happiness, neutral, sadness, surprise, and exception. Voice dialogues were transformed into 5,264 scripts. The depressive group showed lower user acceptance relative to the non-depressive group. However, both groups experienced positive emotions, had regular life patterns, and increased their self-interest. Thus, our multimodal IoMT monitoring system is a feasible and useful measure for acquiring mental health information in older adults’ depression.

Comparison of thyroid function in different emotional states of drug-naïve patients with bipolar disorder

Background Previous studies have shown that bipolar disorder is closely related to thyroid dysfunction. Psychiatric drugs have a large or small effect on thyroid function, and thyroid hormone levels can also affect the effect of drug treatment. Therefore, the purpose of this study is assessment the thyroid function of drug-naive bipolar disorder across different mood states, with the expectation of providing support for treatment options. Methods The present study is a cross-sectional study. Patients diagnosed with bipolar disorder according to the International Classification of Diseases diagnostic Criteria, Edition 10 (ICD 10) and who had never received medication were included in the study. The Montgomery Depression Scale (MADRS) was used to assess depressive symptoms and the Young Mania Rating Scale (YMRS) for manic symptoms. Thyroid function indicators include thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), total triiodothyronine (TT3), free thyroxine (FT4), and total thyroxine (TT4). Levels of TSH, TT4, FT4, TT3, and FT3 were measured within 48 h of hospitalization, between 06:00 and 08:00. Results The data analysis finally covered the data of 291 subjects (136 in a bipolar manic group, 128 in a bipolar depressive group, and 27 in a bipolar mixed group), including 140 males and 151 females, with an average age of 27.38 ± 8.01. There was no significant difference in age, sex, marital status, work status, family history, and course of illness among the manic group, depressive group, and mixed group. The level of FT3, the rate of thyroid hormone increased secretion, and the total abnormality rate of thyroid hormone secretion in the manic group were significantly higher than those in the depressive group. Conclusion These findings indicate that thyroid functions were significantly different between depressive and manic episodes in BD patients. In clinical practice, it is necessary to take into account the differences in thyroid hormone levels in patients with BD across different emotional states in choosing drug.

Perceived Stress, Positive Resources and Their Interactions as Possible Related Factors for Depressive Symptoms

Objective The present study aimed to explore how the patterns of interaction between stress and positive resources differ according to the severity of depression and which resources play the most important role among the various positive resources.Methods The study included 1,806 people who had visited a health screening center for a mental health check-up to evaluate the levels of perceived stress, positive resources, and depressive symptoms. The participants were divided into a depressive group (n=1,642, mean age 50.60, female 68%) and a non-depressive group (n=164, mean age 48.42, female 66.6%). We conducted hierarchical regression analyses and simple slope analyses to examine the interaction between perceived stress and positive resources.Results The interaction between perceived stress and optimism was significantly associated with depression in non-depressive groups. In depressive groups, the interactions between five types of positive resources (optimism, purpose in life, self-control, social support and care) and perceived stress were all significantly related to depression.Conclusion Interventions that promote optimism can be helpful for preventing inevitable stress from leading to depression. A deficiency in positive resources may be a factor in aggravating depression in stressful situations for people reporting moderate to severe depressive symptoms.

Oculometric Behavior Assessed by Pupil Response is Altered in Adolescent Depression

Oculometric behaviour assessed by pupil response provides important information about central autonomic activity and emotional regulation. However, studies regarding pupil response to emotional stimuli in adolescent depression are rare. We aimed to study emotional-linked pupil response in adolescent depression. Twenty depressive adolescents (average age: 15.4±1.2 years) and 20 age/gender-matched healthy subjects were examined. Average pupil diameter assessed by eye-tracking and pupillary light reflex were evaluated during protocol – baseline, free-view task, recovery phase. Regarding right eye, significantly greater initial pupil diameter and pupil dilation to positive pictures free-viewing (p=0.013, p=0.031, respectively), significantly slower average and maximum constriction velocity in baseline and positive pictures free-viewing (p=0.036, p=0.050, p=0.021, p=0.015, respectively), significantly slower maximum constriction velocity in recovery phase (p=0.045), and significantly faster average dilation velocity in negative pictures free-viewing (p=0.042) were observed in depressive group. Regarding left eye, significantly lower constriction percentual change in negative pictures free-viewing (p=0.044) and significantly greater baseline pupil diameter and pupil diameter at the peak of constriction in positive vs. negative pictures free-viewing (p=0.002, p=0.015, respectively) were observed in depressive group. Our study revealed discrete central autonomic dysregulation – parasympathetic hypoactivity associated with relative sympathetic dominance influenced by impairments in emotional processing already in adolescent depression.

Association between Changes in Depressive State and Cognitive Function

Dementia is defined as a severe form of cognitive impairment. Research concerning the two-way relationship between depression and cognitive impairment has been conducted; however, there has been little analysis of cognitive function following changes in depressive status. This study describes the association between changes in depressive state and cognitive function in a Korean geriatric population sample. Using the Korean Longitudinal Study of Aging (KLoSA) database, Mini-Mental State Examination (MMSE) scores and Center for Epidemiologic Studies Depression Scale (CESD-10) indexes were used for measuring cognitive function and depression, respectively. The survey population was divided into four case categories by change in depressive status: normal to normal (Group A), normal to depressive (Group B), depressive to normal (Group C), and depressive to depressive (Group D). Analysis of variance, multiple regression analysis, and subgroup analysis were used for statistical examination. In the multiple regression analysis between MMSE values and depressive status change groups, with Group A as the reference, β in all other groups was negative, and its absolute value was large in the order of D, B, and C in both men (B: −0.717, C: −0.416, D: −1.539) and women (B: −0.629, C: −0.430, D: −1.143). There were also significant results in the subgroup analysis in terms of age, working status, participation in social activities, regular physical activities, and number of chronic medical conditions. In conclusion, both cases—those suffering from depression and those having suffered from it before—experience cognitive impairment. The degree of cognitive function being impaired is greater in the case of depression-onset than that of depression-remission. Age, stimulating activities, and chronic conditions are also strongly relevant to cognitive decline accompanied by changes in depressive state.

Influence of Depressive Symptoms on Clinical Outcomes of Total Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: Recently, there have been many reports on the relationship between depression and clinical outcome of knee or hip arthroplasty. However, there is no study on the association between depression and total clinical outcome of total ankle arthroplasty (TAA). This study investigated the relationship between depressive symptoms and clinical outcome after TAA. Methods: Forty patients who underwent TAA for end-stage ankle arthritis from July 2014 to July 2017 and were able to follow- up at least 12 months were selected. Depressive symptoms were evaluated using Center for Epidemiologic Studies Depression Scale (CES-D) and Patient Health Questionnaire-9 (PHQ-9). The subjects were divided into Depressive group and Non-depressive group, and the preoperative and postoperative clinical results were compared using a visual analogue scale (VAS), American orthopedic foot and ankle-hindfoot score (AOFAS). The preoperative and postoperative radiological results were also compared using anterior surface angle of distal tibia (TAS), talar tilt of ankle joint (TT), lateral surface angle of distal tibia (TLS), and heel alignment distance (HD). Results: The mean age of the patients was 61.6±18.2 years and the average follow-up period was 24.3±7.3 months. 13 subjects were in Depression group and 27 subjects were in Non-depression group. There was no statistical difference in baseline characteristics between the two groups. Additionally, there was no statistical difference in preoperative VAS and AOFAS between the two groups (p>.05). Preoperative and postoperative VAS and AOFAS showed statistically significant improvement in both groups (p<.05). However, the depressive group showed higher result in postoperative VAS than the Non-depressive group significantly (3.1±2.4 vs 1.4±2.3, p<.05). The postoperative AOFAS was also higher in the non-depressive group significantly (89.3±13.4 vs 95.0±8.1, p<.05). Both groups showed improvement in postoperative radiologic index. Preoperative and postoperative radiologic index showed no difference in both groups. Conclusion: The clinical outcome after TAA was poor in patients with depressive symptoms when compared to patients without depressive symptoms. Since depressive symptoms is a patient-specific factor that result in less improvement in clinical outcomes after TAA, clinical considerations for depressive symptoms are needed prior to TAA surgery.

A Study of Perceived Stress and Loneliness in Older People with Depression

It has been documented that elderly are more prone to psychological problems and depression is the commonest geriatric psychiatric disorders. In fact, the elderly in India face a multitude of psychological, social and physical health problems. In a cross-sectional study, it was found that in persons of 65 years and older, the perceived adequacy of emotional and tangible support was clearly associated with depressive symptoms. Aim and Objective: To study the relationship between Perceived Stress and Loneliness in Older People with and without Depression. Sample and Methodology: This study comprised of 60 (30 with depression and 30 without depression) participants of age 60 years or above. The sample was selected with purposive incidental sampling technique. Material used: Geriatric Depression Scale- 30, Perceived Stress Scale (PSS) and UCLA-loneliness scale were administered after taking consent from the participants. Results: Result shows the comparison of means between depressive (case-group) and non-depressive (control-group) as per the scores on Perceived Stress Scale and University of California Log Angeles Loneliness Scale. On UCLA-loneliness scale, the scores of depressive group were found to be statistically significant at 0.01 levels (t-value 19.547) in comparison to non-depressive group and on Perceived Stress Scale, the scores of depressive groups were also found to be statistically significant at 0.01 levels (t-value 14.716) in comparison to non-depressive group. Conclusion: In brief, the findings of the study show that perceived stress and loneliness are the contributory factors of depression. It has also been observed that depressed people perceive more stress, loneliness than non-depressed older people.

Pupillary Light Reflex is Altered in Adolescent Depression

Major depressive disorder is associated with abnormal autonomic regulation which could be noninvasively studied using pupillometry. However, the studies in adolescent patients are rare. Therefore, we aimed to study the pupillary light reflex (PLR), which could provide novel important information about dynamic balance between sympathetic and parasympathetic nervous system in adolescent patients suffering from major depression. We have examined 25 depressive adolescent girls (age 15.2±0.3 year) prior to pharmacotherapy and 25 age/gender-matched healthy subjects. PLR parameters were measured separately for both eyes after 5 min of rest using Pupillometer PLR-2000 (NeurOptics, USA). The constriction percentual change for the left eye was significantly lower in depressive group compared to control group (-24.12±0.87 % vs. –28.04±0.96%, p˂0.01). Furthermore, average constriction velocity and maximum constriction velocity for the left eye were significantly lower in depressive group compared to control group (p˂0.05, p˂0.01, respectively). In contrast, no significant between-groups differences were found for the right eye. Concluding, this study revealed altered PLR for left eye indicating a deficient parasympathetic activity already in adolescent major depression. Additionally, the differences between left and right eye could be related to functional lateralization of autonomic control in the central nervous system.