Browsing by Author "Vrany, Elizabeth A."
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Item Are Cardiovascular Risk Factors Stronger Predictors of Incident Cardiovascular Disease in U.S. Adults With Versus Without a History of Clinical Depression?(Oxford University Press, 2018-12) Polanka, Brittanny M.; Berntson, Jessica; Vrany, Elizabeth A.; Stewart, Jesse C.; Psychology, School of ScienceBackground Several mechanisms underlying the depression-to-cardiovascular disease (CVD) relationship have been proposed; however, few studies have examined whether depression promotes CVD through potentiating traditional cardiovascular risk factors. Purpose To test the combined influence of three cardiovascular risk factors and lifetime depressive disorder on incident CVD in a large, diverse, and nationally representative sample of U.S. adults. Methods Respondents were 26,840 adults without baseline CVD who participated in Waves 1 (2001–2002) and 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Lifetime depressive disorder, tobacco use, hypertension, and incident CVD were determined from structured interviews, and body mass index (BMI) was computed from self-reported height and weight. Results Logistic regression models predicting incident CVD (1,046 cases) revealed evidence of moderation, as the interactions between lifetime depressive disorder and current tobacco use (p = .002), hypertension (p < .001), and BMI (p = .031) were significant. The Former Tobacco Use × Lifetime Depressive Disorder interaction was not significant (p = .85). In models stratified by lifetime depressive disorder, current tobacco use (OR = 1.78, 95% CI = 1.36–2.32, p < .001 vs. OR = 1.41, 95% CI = 1.24–1.60, p < .001), hypertension (OR = 2.46, 95% CI = 1.98–3.07, p < .001 vs. OR = 1.39, 95% CI = 1.28–1.51, p < .001), and BMI (OR = 1.10, 95% CI = 1.01–1.20, p = .031 vs. OR = 1.03, 95% CI = 0.99–1.07, p = .16) were stronger predictors of incident CVD in adults with versus without a lifetime depressive disorder. Conclusions Our findings suggest that amplifying the atherogenic effects of traditional cardiovascular risk factors may be yet another candidate mechanism that helps to explain the excess CVD risk of people with depression.Item Association between depressive symptom clusters and food attentional bias(Elsevier, 2018-12) Hawkins, Misty A. W.; Vrany, Elizabeth A.; Cyders, Melissa A.; Ciciolla, Lucia; Wells, Tony T.; Stewart, Jesse C.; Psychology, School of ScienceBackground The mechanisms underlying the depression-obesity relationship are unclear. Food attentional bias (FAB) represents one candidate mechanism that has not been examined. We evaluated the hypothesis that greater depressive symptoms are associated with increased FAB. Method Participants were 89 normal weight or overweight adults (mean age = 21.2 ± 4.0 years, 53% female, 33% non-white, mean body mass index in kg/m2 = 21.9 ± 1.8 for normal weight; 27.2 ± 1.5 for overweight). Total, somatic, and cognitive-affective depressive symptom scores were computed from the Patient Health Questionnaire-8 (PHQ-8). FAB scores were calculated using reaction times (RT) and eye-tracking (ET) direction and duration measures for a food visual probe task. Age, gender, race/ethnicity, and body fat percent were covariates. Results Only PHQ-8 somatic symptoms were positively associated with RT-measured FAB (β = 0.23, p = .04). The relationship between somatic symptoms and ET direction (β = 0.18, p = .17) and duration (β = 0.23, p = .08) FAB indices were of similar magnitude but were not significant. Somatic symptoms accounted for 5% of the variance in RT-measured FAB. PHQ-8 total and cognitive-affective symptoms were unrelated to all FAB indices (ps ≥ 0.09). Conclusions Only greater somatic symptoms of depression were linked to food attentional bias as measured using reaction time. Well-powered prospective studies should examine whether this bias replicates, particularly for eye-tracking measures, and whether it partially mediates the depression-to-obesity relationship.Item Associations between immigrant status and pharmacological treatments for diabetes in U.S. adults(APA, 2018) Hsueh, Loretta; Vrany, Elizabeth A.; Patel, Jay S.; Hollingshead, Nicole A.; Hirsh, Adam T.; de Groot, Mary; Stewart, Jesse C.; Psychology, School of ScienceObjectives: Although treatment disparities in diabetes have been documented along racial/ethnic lines, it is unclear if immigrant groups in the United States experience similar treatment disparities. Our objective was to determine whether immigrant status is associated with differences in pharmacological treatment of diabetes in a nationally representative sample of adults with diabetes. We were specifically interested in differences in treatment with oral hypoglycemic agents (OHA) and insulin. Method: Respondents were 2,260 adults from National Health and Nutritional Examination Survey (NHANES) 2003–2012 with a self-reported diabetes diagnosis. Immigrant status was indicated by birth within (U.S.-born) or outside (foreign-born) the 50 U.S. States or Washington, DC. Multinomial logistic regression analyses examined associations between immigrant status and (a) treatment with OHAs only and (b) treatment with insulin only or insulin and OHA combination therapy, using no treatment as the reference group. Results: Adjusting for demographics, diabetes severity and duration, cardiovascular disease (CVD), and CVD risk factors, being foreign-born versus U.S.-born was not associated with treatment with OHAs only (odds ratio [OR] = 1.59; 95% confidence interval [CI] [0.97, 2.60]). However, being foreign-born was associated with decreased odds (OR = 0.53; 95% CI [0.28, 0.99]) of treatment with insulin. Conclusions: Pharmacological treatment of diabetes differs along immigrant status lines. To understand these findings, studies capturing the processes underlying treatment differences in diabetes among immigrants are needed. Findings raise the possibility that integrating information about a patient’s immigrant status, in addition to racial/ethnic identity, may be an important component of culturally sensitive diabetes care.Item Depressive Disorder Subtypes as Predictors of Incident Obesity in US Adults: Moderation by Race/Ethnicity(Oxford, 2017-05-01) Polanka, Brittanny M.; Vrany, Elizabeth A.; Patel, Jay; Stewart, Jesse C.; Psychology, School of ScienceWe compared the relative importance of atypical major depressive disorder (MDD), nonatypical MDD, and dysthymic disorder in predicting 3-year obesity incidence and change in body mass index and determined whether race/ethnicity moderated these relationships. We examined data from 17,787 initially nonobese adults in the National Epidemiologic Survey on Alcohol and Related Conditions waves 1 (2001-2002) and 2 (2004-2005) who were representative of the US population. Lifetime subtypes of depressive disorders were determined using a structured interview, and obesity outcomes were computed from self-reported height and weight. Atypical MDD (odds ratio (OR) = 1.68, 95% confidence interval (CI): 1.43, 1.97; P < 0.001) and dysthymic disorder (OR = 1.66, 95% CI: 1.29, 2.12; P < 0.001) were stronger predictors of incident obesity than were nonatypical MDD (OR = 1.11, 95% CI: 1.01, 1.22; P = 0.027) and no history of depressive disorder. Atypical MDD (B = 0.41 (standard error, 0.15); P = 0.007) was a stronger predictor of increases in body mass index than were dysthymic disorder (B = -0.31 (standard error, 0.21); P = 0.142), nonatypical MDD (B = 0.007 (standard error, 0.06); P = 0.911), and no history of depressive disorder. Race/ethnicity was a moderator; atypical MDD was a stronger predictor of incident obesity in Hispanics/Latinos (OR = 1.97, 95% CI: 1.73, 2.24; P < 0.001) than in non-Hispanic whites (OR = 1.54, 95% CI: 1.25, 1.91; P < 0.001) and blacks (OR = 1.72, 95% CI: 1.31, 2.26; P < 0.001). US adults with atypical MDD are at particularly high risk of weight gain and obesity, and Hispanics/Latinos may be especially vulnerable to the obesogenic consequences of depressions.Item Depressive Symptom Severity as a Predictor of Attendance in the HOME Behavioral Weight Loss Trial(Elsevier, 2020-04) Shell, Aubrey L.; Hsueh, Loretta; Vrany, Elizabeth A.; Clark, Daniel O.; Keith, NiCole R.; Xu, Huiping; Stewart, Jesse C.; Psychology, School of ScienceObjective We examined whether total depressive symptoms and symptom clusters predicted behavioral weight loss attendance among economically disadvantaged adults in a randomized controlled trial. Methods 150 adults with obesity were randomized to 12 months of in-person, video conference, or enhanced usual care weight loss groups. We categorized percent session attendance in the intervention arms into three levels: no attendance, poorer attendance, and better attendance. Results Higher baseline Patient Health Questionnaire-8 (PHQ-8) score was associated with a greater odds of being in the poorer versus better attendance group (OR = 1.94, 95% CI: 1.02–3.69, p = .04). A similar relationship between PHQ-8 score and odds of being in the no attendance versus better attendance group was observed but was not statistically significant (OR = 1.63, 95% CI: 0.94–2.81, p = .08). Both cognitive/affective and somatic clusters contributed to the depressive symptoms-attendance relationships. Conclusion Greater depressive symptoms at the start of a behavioral weight loss program may predict poorer subsequent session attendance. Screening for and addressing depression may improve intervention uptake.Item Depressive Symptoms and Weight Loss Behaviors in U.S. Adults(Elsevier, 2018) Vrany, Elizabeth A.; Hawkins, Misty A. W.; Wu, Wei; Stewart, Jesse C.; Psychology, School of ScienceObjective We sought to determine whether depressive symptoms are associated with attempting to lose weight and engaging in weight loss behaviors in a large, diverse sample of adults representative of the U.S. population. Methods Respondents were 23,106 adults, free of cardiovascular disease and diabetes, who participated in the 2005–2014 years of the National Health and Nutrition Examination Survey (NHANES). Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9), and weight loss variables were obtained from a Weight History Questionnaire. Results PHQ-9 total was not associated with attempting to lose weight in the past year (OR = 1.03, 95%CI = 1.00–1.06, p = 0.074; n = 23,106). Among respondents who attempted to lose weight (n = 9582), PHQ-9 total was associated with a lower odds of exercising (OR = 0.84, 95%CI = 0.79–0.89, p < 0.001) and a greater odds of skipping meals (OR = 1.31, 95%CI = 1.22–1.41, p < 0.001), eating diet foods/products (OR = 1.16, 95%CI = 1.08–1.24, p < 0.001), eating less food (OR = 1.09, 95%CI = 1.04–1.15, p < 0.001), taking non-prescription supplements (OR = 1.31, 95%CI = 1.23–1.41, p < 0.001), taking prescription diet pills (OR = 1.28, 95%CI = 1.10–1.49, p = 0.001), and taking laxatives/vomiting (OR = 1.55, 95%CI = 1.28–1.88, p < 0.001). Conclusions Although depressive symptoms were not associated with attempting to lose weight in the past year, adults who attempted to lose weight tended to employ potentially ineffective/unhealthy weight loss behaviors and avoid effective behaviors. This pattern of behaviors may be another mechanism that explains the excess risk of obesity in depressed adults and may be a modifiable target for future interventions. Given the cross-sectional nature of this study, reverse causality is a possibility. Future studies should investigate the prospective associations between depressive symptoms and weight loss behaviors.Item Diet composition as a candidate mechanism underlying the depression-to-obesity association: the CARDIA study(2018) Vrany, Elizabeth A.; Stewart, Jesse C.People with depression are at elevated risk for future obesity; however, little is known about the potential mechanistic role of diet composition in this association. The aims of the present study were: (1) to examine depressive symptom severity as a predictor of 13-year change in seven diet composition factors over time, (2) to test 13-year change in diet composition factors as mediators of the association between depressive symptom severity and 13-year change in adiposity, and (3) to explore whether the Aim 2 mediation models are moderated by sex and race. Participants were 2,449 non-Hispanic Black and White adults who participated in the 1990, 1992, and 2005 years of the CARDIA study (mean baseline age = 35 years, 54% women, 56% non-Hispanic Black, mean baseline waist circumference = 84.0 cm, mean change in waist circumference = 8.3 cm). Depressive symptoms were assessed in 1990 using the Center for Epidemiologic Studies-Depression Scale (CES-D). Waist circumference and seven diet composition factors were assessed in 1992 and 2005. Diet composition factors included intake of total energy, saturated fatty acid, monounsaturated fatty acid, polyunsaturated fatty acid, fiber, sugar, and protein. PROCESS bootstrapping analyses were used to test for mediation and moderated mediation (see Figure 1 for the conceptual model). All models included adjustment for age; sex; race; education; prevalent and incident cardiovascular disease, diabetes, and cancer; incident pregnancy; and 13-year change in physical activity. Greater baseline CES-D Total predicted greater 13-year increases in waist circumference (path c β = 0.032, p = .006). In separate models, there was a trend for greater baseline depressive symptoms predicting 13-year increases in total energy intake (path a β = 0.040, p = .054), and greater baseline depressive symptoms predicted 13-year increases in protein intake (path a β = 0.059, p = .004) and fiber intake (path a β = 0.040, p = .0496). Depressive symptoms were unrelated to 13-year changes in intake of the other diet composition factors of saturated fatty acid, monounsaturated fatty acid, polyunsaturated fatty acid, and sugar (all ps ≥ .129). Mediation models revealed that 13-year change in total energy intake and protein intake partially mediated the association between baseline depressive symptoms and 13-year change in waist circumference (total energy intake indirect effect = 0.001, 95% CI=0.0001-0.004; protein intake indirect effect = 0.002, 95% CI=0.0004-0.005); mediation was not observed for the other diet composition factors. Exploratory moderated mediation models detected a significant interaction for CES-D Total by sex predicting 13-year change protein intake only (Index of moderated mediation=0.004, 95%CI=0.001-0.010). All other tests of moderated mediation were non-significant (95% CIs included zero). Analyses stratified by sex revealed that CES-D Total was more strongly associated with 13-year increases protein intake in men (β = 0.011, p=.004) than in women (β = 0.027, p = .246). Findings from this larger, longitudinal, epidemiologic study suggest that the prospective relationship between depression and future obesity risk may be explained, in part, by intake of certain diet composition factors. Advancing the understanding of the relationship between depression and diet changes will inform clinical efforts to prevent or manage depression-related obesity.Item Differences in Mexican Americans’ Prevalence of Chronic Pain and Co-Occurring Analgesic Medication and Substance Use Relative to Non-Hispanic White and Black Americans: Results from NHANES 1999–2004(Oxford, 2016-06) Hollingshead, Nicole A.; Vrany, Elizabeth A.; Stewart, Jesse C.; Hirsh, Adam T.; Department of Psychology, School of ScienceObjective. Little is known about the burgeoning Mexican American (MA) population’s pain experience. Methods. Using 1999–2004 National Health and Nutrition Examination Survey (NHANES) data, prevalence of chronic pain, analgesic medication use, and substance use were examined among MA, non-Hispanic White (NHW), and non-Hispanic Black (NHB) respondents. Logistic and linear regression models examined racial/ethnic differences in: 1) chronic pain prevalence among all respondents, 2) location and number of pain sites among respondents with chronic pain, and 3) analgesic medication and substance use among respondents with chronic pain. Results. Compared to NHWs and NHBs, MAs were less likely to report any chronic pain. Among respondents with chronic pain, MAs had higher odds of reporting headache, abdominal pain, and a greater number of pain sites than NHWs. Compared to NHWs, MAs with chronic pain had lower odds of reporting past-month analgesic medication and COX-2 inhibitor use. MAs with chronic pain had lower odds of being a current cigarette smoker and heavy alcohol drinker but had similar street drug/cocaine use relative to NHWs. Conclusions. Results suggest that: 1) MAs are less likely to develop chronic pain than NHWs, 2) MAs with chronic pain report greater headache and abdominal pain than NHWs, and 3) MAs with chronic pain are less likely to use analgesic medications and other substances compared to NHWs. These results suggest that providers should consider taking extra time to discuss analgesic medications with MAs. Future investigations should examine reasons underlying these racial/ethnic differences in chronic pain, as well as differences in the use of other substances, such as marijuana.Item Effect of Modernized Collaborative Care for Depression on Depressive Symptoms and Cardiovascular Disease Risk Biomarkers: eIMPACT Randomized Controlled Trial(Elsevier, 2023) Stewart, Jesse C.; Patel, Jay S.; Polanka, Brittanny M.; Gao, Sujuan; Nurnberger, John I., Jr.; MacDonald, Krysha L.; Gupta, Samir K.; Considine, Robert V.; Kovacs, Richard J.; Vrany, Elizabeth A.; Berntson, Jessica; Hsueh, Loretta; Shell, Aubrey L.; Rollman, Bruce L.; Callahan, Christopher M.; Psychology, School of ScienceAlthough depression is a risk and prognostic factor for cardiovascular disease (CVD), clinical trials treating depression in patients with CVD have not demonstrated cardiovascular benefits. We proposed a novel explanation for the null results for CVD-related outcomes: the late timing of depression treatment in the natural history of CVD. Our objective was to determine whether successful depression treatment before, versus after, clinical CVD onset reduces CVD risk in depression. We conducted a single-center, parallel-group, assessor-blinded randomized controlled trial. Primary care patients with depression and elevated CVD risk from a safety net healthcare system (N = 216, Mage = 59 years, 78% female, 50% Black, 46% with income <$10,000/year) were randomized to 12 months of the eIMPACT intervention (modernized collaborative care involving internet cognitive-behavioral therapy [CBT], telephonic CBT, and/or select antidepressants) or usual primary care for depression (primary care providers supported by embedded behavioral health clinicians and psychiatrists). Outcomes were depressive symptoms and CVD risk biomarkers at 12 months. Intervention participants, versus usual care participants, exhibited moderate-to-large (Hedges' g = -0.65, p < 0.01) improvements in depressive symptoms. Clinical response data yielded similar results - 43% of intervention participants, versus 17% of usual care participants, had a ≥ 50% reduction in depressive symptoms (OR = 3.73, 95% CI: 1.93-7.21, p < 0.01). However, no treatment group differences were observed for the CVD risk biomarkers - i.e., brachial flow-mediated dilation, high-frequency heart rate variability, interleukin-6, high-sensitivity C-reactive protein, β-thromboglobulin, and platelet factor 4 (Hedges' gs = -0.23 to 0.02, ps ≥ 0.09). Our modernized collaborative care intervention - which harnessed technology to maximize access and minimize resources - produced clinically meaningful improvements in depressive symptoms. However, successful depression treatment did not lower CVD risk biomarkers. Our findings indicate that depression treatment alone may not be sufficient to reduce the excess CVD risk of people with depression and that alternative approaches are needed. In addition, our effective intervention highlights the utility of eHealth interventions and centralized, remote treatment delivery in safety net clinical settings and could inform contemporary integrated care approaches.Item Race/Ethnicity Moderates Associations between Depressive Symptoms and Diet Composition among U.S. Adults(American Psychological Association, 2021) Vrany, Elizabeth A.; Polanka, Brittanny M.; Hsueh, Loretta; Hill-Briggs, Felicia; Stewart, Jesse C.; Psychology, School of ScienceObjective: Although depression is associated with poorer overall diet quality, few studies have examined its association with levels of particular macronutrients, and none have examined moderation by race/ethnicity. The present study examined (a) associations between depressive symptom severity and nine indices of diet composition and (b) whether race/ethnicity moderates these associations. Method: Participants were 28,940 adults (mean age = 49 years, 52% female, 52% nonwhite) from NHANES 2005-2018. Depressive symptom severity was measured using the Patient Health Questionnaire-9 (PHQ-9). Nine diet composition indices were derived from the average of two 24-hr dietary recalls (e.g., total energy, total fat, saturated fat, total carbohydrate, sugar, fiber, and protein). Results: Separate linear regression analyses revealed that PHQ-9 total was positively associated with saturated fat and sugar and negatively associated with protein and fiber. Moderation by race/ethnicity was observed (interaction ps < .05). Among non-Hispanic Whites, PHQ-9 total was positively associated with sugar and negatively associated with protein and fiber. Among non-Hispanic Blacks, PHQ-9 total was positively associated with total energy, total fat, saturated fat, monounsaturated fat, polyunsaturated fat, total carbohydrate, and sugar. Among Mexican Americans, PHQ-9 was positively associated with saturated fat. Among other Hispanics, PHQ-9 total was negatively associated with fiber, protein, and total, monounsaturated, and polyunsaturated fat. Conclusions: Findings from this large, nationally representative sample demonstrate that associations between depressive symptom severity and diet composition vary by race/ethnicity. Critically, an unhealthy diet composition pattern may be one mechanism explaining the excess risk of obesity and cardiometabolic diseases in individuals with depression, especially in non-Hispanic Blacks.