Introduction
The investigation of disease course‐associated brain structural alterations in Major Depressive Disorder (MDD) have resulted in heterogeneous findings, possibly due to low reliability of single clinical variables used for defining disease course. The present study employed a principal component analysis (PCA) on multiple clinical variables to investigate effects of cumulative lifetime illness burden on brain structure in a large and heterogeneous sample of MDD patients.
Methods
Gray matter volumes (GMV) was estimated in n = 681 MDD patients (mean age: 35.87 years; SD = 12.89; 66.6% female) using voxel‐based‐morphometry. Five clinical variables were included in a PCA to obtain components reflecting disease course to associate resulting components with GMVs.
Results
The PCA yielded two main components: Hospitalization reflected by patients' frequency and duration of inpatient treatment and Duration of Illness reflected by the frequency and duration of depressive episodes. Hospitalization revealed negative associations with bilateral dorsolateral prefrontal cortex (DLPFC) and left insula volumes. Duration of Illness showed significant negative associations with left hippocampus and right DLPFC volumes. Results in the DLPFC and hippocampus remained significant after additional control for depressive symptom severity, psychopharmacotherapy, psychiatric comorbidities, and remission status.
Conclusion
This study shows that a more severe and chronic lifetime disease course in MDD is associated with reduced volume in brain regions relevant for executive and cognitive functions and emotion regulation in a large sample of patients representing the broad heterogeneity of MDD disease course. These findings were only partly influenced by other clinical characteristics (e.g., remission status, psychopharmacological treatment).
People with vascular risk factors (VRFs) are at higher risk for depressive symptoms. Given recent findings implicating low-grade systemic inflammation in both vascular and mental health, this study examined the extent to which the VRF–depressive symptom association might be mediated by low-grade systemic inflammation. To this end, we analysed longitudinal data of 9,034 participants from the UK Biobank (mean age = 56.54 years), who took part in three consecutive assessments over the course of about 8 years. Cumulative VRF burden at baseline was defined as the presence of 5 VRFs (hypertension, obesity, hypercholesterolemia, diabetes, and smoking). Low-grade systemic inflammation was assessed using serum-derived C-reactive protein (CRP) and depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). We performed mediation models using longitudinal data and a path analytic framework, while controlling for age, gender, racial-ethnic background, socioeconomic status, and baseline mood. VRFs at baseline showed a small association with higher depressive symptoms at follow-up (total effect = 0.014, 95% CI [0.007; 0.021]). CRP mediated this association (indirect effect = 0.003, 95% CI [0.001; 0.005]) and accounted for 20.10% of the total effect of VRF burden on depressive symptoms. Exploratory analyses taking a symptom-based approach revealed that mediating pathways pertained to specific depressive symptoms: tiredness and changes in appetite. These results suggest that the small association between VRF burden and depressive symptoms may be partly explained by the inflammation-promoting effects of VRFs, which might promote a specific symptom-profile of depression.
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