Emily Smith

As childhood obesity rates continue to increase, experts agree that more information is needed about the implications of being overweight as a step toward reversing current trends.

Now, a new University of Missouri study, published in the journal Applied Developmental Science, has found that overweight children, especially girls, show signs of the negative consequences of being overweight as early as kindergarten.

"We found that both boys and girls who were overweight from kindergarten through third grade displayed more depression, anxiety and loneliness than kids who were never overweight, and those negative feelings worsened over time," said Sara Gable, associate professor of human development and family studies in the MU College of Human Environmental Sciences. "Overweight is widely considered a stigmatizing condition and overweight individuals are typically blamed for their situation. The experience of being stigmatized often leads to negative feelings, even in children."

MU researchers used the Early Childhood Longitudinal Study-Kindergarten Cohort (ECLS-K) to examine the social and behavioral development of 8,000 school-age children from kindergarten entry through third grade. The researchers evaluated factors that have not been studied previously: age at becoming overweight and length of time being overweight.

"Girls who were consistently overweight, from kindergarten through third grade, and girls who were approaching being overweight were viewed less favorably than girls who were never overweight," said Gable, an MU State Extension Specialist. "Teachers reported that these girls had less positive social relations and displayed less self-control and more acting out than never-overweight girls."

The results indicate that larger than average children, especially girls, experience social and behavioral challenges before they reach the 95th percentile of the Body Mass Index and are classified as being overweight. More research is needed to develop alternative approaches for categorizing children's weight and creating effective intervention programs, Gable said.

"Most appearance-based social pressure likely originates in the eye of the beholder," Gable said. "Therefore, intervention and prevention efforts should be designed for everyone. All kids should learn what constitutes a healthy weight and healthy lifestyle."

MU researchers will continue to use the ECLS-K to study the implications of being overweight for children's development.

The study was funded by the United States Department of Agriculture, Food Assistance and Nutrition Research Programs.

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Sara Gable S, Krull JL, Chang Y. Implications of Overweight Onset and Persistence for Social and Behavioral Development Between Kindergarten Entry and Third Grade. Appl. Developmental. Sci. 2009;13(2):88-103   [Abstract]

Andersohn F, Schade R, Suissa S, Garbe E.

OBJECTIVE: Use of antidepressants has been reported to cause considerable weight gain. The aim of this study was to assess the risk of diabetes mellitus associated with antidepressant treatment and to examine whether the risk is influenced by treatment duration or daily dose.

METHOD: This was a nested case-control study in a cohort of 165,958 patients with depression who received at least one new prescription for an antidepressant between January 1, 1990, and June 30, 2005. Data were from from the U.K. General Practice Research Database. Patients were at least 30 years of age and without diabetes at cohort entry.

RESULTS: A total of 2,243 cases of incident diabetes mellitus and 8,963 matched comparison subjects were identified. Compared with no use of antidepressants during the past 2 years, recent long-term use (>24 months) of antidepressants in moderate to high daily doses was associated with an increased risk of diabetes (incidence rate ratio=1.84, 95% CI=1.35-2.52). The magnitude of the risk was similar for long-term use of moderate to high daily doses of tricyclic antidepressants (incidence rate ratio=1.77, 95% CI=1.21-2.59) and selective serotonin reuptake inhibitors (incidence rate ratio=2.06, 95% CI=1.20-3.52). Treatment for shorter periods or with lower daily doses was not associated with an increased risk.

CONCLUSIONS: Long-term use of antidepressants in at least moderate daily doses was associated with an increased risk of diabetes. This association was observed for both tricyclic antidepressants and selective serotonin reuptake inhibitors.

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Cougnard A, Verdoux H, Grolleau A, Moride Y, Begaud B, Tournier M.

University Victor Segalen Bordeaux 2, INSERM U657, IFR of Public Health, Bordeaux, France; Faculty of Pharmacy, Université de Montréal, Montréal, Canada

Background The impact of antidepressant drug treatment (ADT) on the risk of suicide is uncertain. The aim of this study was to determine in a real-life setting whether ADT is associated with an increased or a reduced risk of suicide compared to absence of ADT (no-ADT) in patients with depression.

Method A decision analysis method was used to estimate the number of suicides prevented or induced by ADT in children and adolescents (10-19 years old), adults (20-64 years old) and the elderly (≥65 years) diagnosed with major depression. The impact of gender and parasuicide history on the findings was explored within each age group. Sensitivity analyses were used to assess the robustness of the models.

Results: Prescribing ADT to all patients diagnosed with depression would prevent more than one out of three suicide deaths compared to the no-ADT strategy, irrespective of age, gender or parasuicide history. Sensitivity analyses showed that persistence in taking ADT would be the main characteristic influencing the effectiveness of ADT on suicide risk.

Conclusions: Public health decisions that contribute directly or indirectly to reducing the number of patients with depression who are effectively administered ADT may paradoxically induce a rise in the number of suicides.

(Emphasis added; ed.)

Sleep may act as a moderator between risk factors for depression and the onset of depression in women vulnerable to sleep changes during the postpartum period

Kelly Wagner - AASM

A study in the July 1 issue of the journal SLEEP suggests that postpartum depression may aggravate an already impaired sleep quality, as experiencing difficulties with sleep is a symptom of depression. Twenty-one percent of depressed postpartum women included in the study reported having also been depressed during pregnancy and 46 percent reported at least one previous depressive episode prior to conception, suggesting that new mothers diagnosed with postpartum depression are not merely reporting symptoms of chronic sleep deprivation.

Results indicate that two months after delivery, poor sleep was associated with depression when adjusted for other significant risk factors, such as poor partner relationship, previous depression, depression during pregnancy and stressful life events. Sleep disturbances and subjective sleep quality were the aspects of sleep most strongly associated with depression. Overall, nearly 60 percent of the postpartum women experienced poor global sleep quality, and 16.5 percent had depressive symptoms.

According to lead author Karen Dørheim, MD, PhD, psychiatrist at Stavanger University Hospital in Norway, depression after delivery is often not identified by new mothers, whereas tiredness and lack of sleep are common complaints. These symptoms may be attributed to poor sleep, but the tiredness could also be caused by depression.

"It is important to ask a new mother suffering from tiredness about how poor sleep affects her daytime functioning and whether there are other factors in her life that may contribute to her lack of energy," said Dørhei. "There are also helpful depression screening questionnaires that can be completed during a consultation. Doctors and other health workers should provide an opportunity for postpartum women to discuss difficult feelings."

Data were collected between October 2005 and September 2006 from 2,830 women who gave birth to a live child at Stavanger University Hospital in Norway. Sleep was measured using the Pittsburgh Sleep Quality Index (PSQI) and depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS). The mean self-reported nightly sleep duration was 6.5 hours, and sleep efficiency was 73 percent. The mean age of the mothers at the time of reply was 30 years, and the mean age of the infants was 8.4 weeks.

Depression, previous sleep problems, being a first time mother, not exclusively breastfeeding or having a younger or male infant were factors associated with poor postpartum sleep quality. Better maternal sleep was associated with the baby sleeping in a different room.

According to authors, the first three months after delivery are characterized by continually changing sleep parameters. Women who are tired during this period may attribute this to poor sleep, but the tiredness could alternatively be caused by depression; thus talking about sleep problems may provide an entry point for also discussing the woman's overall well-being. Individual women may react differently to shorter sleep duration and lower sleep efficiency during the postpartum period, and that the sleep of women with a history of depression may be more sensitive to the psychobiological (hormonal, immunological, psychological and social) changes associated with childbirth.

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Dørheim SK, Bondevik GT, Eberhard-Gran M, Bjorvatn B. Sleep and Depression in Postpartum Women: A Population-Based Study. SLEEP 2009;32(7):847-855   [Abstract]

Study finds hormone reduces emergence delirium rates

Tom Vasich

A scary unknown for many children, the prospect of surgery can cause intense preoperative anxiety. While some amount of stress is normal, what many parents do not know is that extreme anxiety before surgery can contribute to the occurrence of emergence delirium, a distressing incidence of acute behavioral changes experienced when "waking up" from anesthesia.

Now in a study published in the July issue of Anesthesiology, physicians focused on reducing anxiety in children and their families report that oral treatment with melatonin before surgery can significantly reduce the occurrence of emergence delirium in children.

Affecting up to 20 percent of children who undergo surgery, emergence delirium in the post-anesthesia care unit (PACU) consists of acute behavior changes including crying, thrashing and need for restraint. According to researchers, this can also lead to the development of behavioral changes outside the recovery suite with the onset of nightmares, bed wetting and separation anxiety.

"Studies conducted in adults have revealed that oral administration of melatonin before surgery beneficially reduced anxiety levels, but relevant similar treatment data for children undergoing anesthesia and surgery are limited," said study lead author Zeev N. Kain, MD, MBA, Chair of UC Irvine Anesthesiology and Associate Dean for Clinical Research at the UC Irvine School of Medicine.

Seeking confirmation of additional options for anxiety management, researchers first set out to determine if melatonin could decrease anxiety levels when compared to midazolam, a sedative widely used to ease preoperative anxiety. Melatonin is a hormone secreted by the pineal gland, regulates sleep, moods and reproductive cycles. Secretions of melatonin increase during exposure to light.

In a study group that consisted of 148 subjects between the ages of 2 and 8 undergoing outpatient surgery under general anesthesia, children were randomly assigned to receive midazolam or melatonin orally before surgery. Children were followed throughout their surgical experience as researchers measured anxiety and secondary study outcomes of anesthesia administration compliance and emergence behavior. Behaviors were measured using the Yale Preoperative Anxiety Scale (mYPass), the Induction Compliance Checklist and the Keegan scale.

"Results indicated that preoperative melatonin administration did not effectively reduce anxiety levels," said Dr Kain. "However, it was found that melatonin significantly reduced the incidence of emergence delirium in these children. As 3 million children undergo surgery in the U.S. each year, these findings reveal noteworthy health care and treatment implications."

Melatonin showed a direct dose dependent effect on emergence delirium. Children in the melatonin premedication group received any of three doses of melatonin: 0.05 mg/kg, .2 mg/kg and 0.4 mg/kg, while the incidence of delirium at each dose was 25 percent, 8.3 percent and 5.4 percent.

Midazolam remains the recommended premedication for anxiety reduction in children scheduled for surgery.

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Kain ZN, MacLaren JE, Herrmann L, et al. Preoperative Melatonin and Its Effects on Induction and Emergence in Children Undergoing Anesthesia and Surgery. Anesthesiology. 2009 Jul;111(1):44-49   [Full text]

By Joene Hendry

NEW YORK (Reuters Health) - Among children showing high levels of stress in reaction to exposure to community violence, researchers found stress hormone responses similar to children diagnosed with posttraumatic stress disorder.

Patten SB, Williams JV, Lavorato DH, Brown L, McLaren L, Eliasziw M.

Department of Community Health Sciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alta.; School of Public Health, University of Alberta, Edmonton, Alta., Canada

Background: Cross-sectional studies have reported an association between major depressive episode (MDE) and obesity. The objective of this longitudinal analysis was to determine whether MDE increase the risk of becoming obese over a 10-year period.

Method: We used data from the Canadian National Population Health Survey (NPHS), a longitudinal study of a representative cohort of household residents in Canada. The incidence of obesity, defined as a body mass index (BMI) of 30, was evaluated in respondents who were 18 years or older at the time of a baseline interview in 1994. MDE was assessed using a brief diagnostic instrument.

Results: The risk of obesity was not elevated in association with MDE, either in unadjusted or covariate-adjusted analyses. The strongest predictor of obesity was a BMI in the overweight (but not obese) range. Effects were also seen for (younger) age, (female) sex, a sedentary activity pattern, low income and exposure to antidepressant medications. Unexpectedly, significant effects were seen for serotonin-reuptake-inhibiting antidepressants and venlafaxine, but neither for tricyclic antidepressants nor antipsychotic medications.

Conclusions: MDE does not appear to increase the risk of obesity. The cross-sectional associations that have been reported, albeit inconsistently, in the literature probably represent an effect of obesity on MDE risk. Pharmacologic treatment with antidepressants may be associated with an increased risk of obesity, and strategies to offset this risk may be useful in clinical practice.

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