OBJECTIVE:Depressive symptoms predict suicidal behavior, but the specific pathways linking individual symptoms to suicide attempts remain incompletely characterized. Network analysis combined with cross-lagged panel models (CLPM) offers a framework to identify bridge symptoms and disentangle their temporal directionality. METHODS:Using Waves 1 (2001-2002) and 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions, we examined longitudinal associations between depressive symptoms during a past-12-month major depressive episode (MDE) at baseline (N = 3485) and suicide attempts three years later (n = 102). We estimated an Ising network, computed bridge centrality, and fitted five a priori CLPMs using the WLSMV estimator. Two sensitivity analyses excluded participants with a lifetime manic episode or with past-12-month alcohol or non-nicotine substance use disorders. RESULTS:Suicidal ideation at follow-up emerged as the strongest bridge symptom to suicide attempt (bridge expected influence = 0.282), followed by baseline suicidal ideation and thoughts of death. In CLPMs, worthlessness at follow-up predicted concurrent suicidal ideation (β = 0.509, 95% CI [0.477; 0.541]) and thoughts of death (β = 0.508, [0.477; 0.540]), whereas baseline guilt predicted the same outcomes with substantially smaller coefficients (β = 0.067; β = 0.066) - a 7- to 8-fold differential. Follow-up suicidal ideation predicted suicide attempt (β = 0.515, p < 0.001). The worthlessness-guilt hierarchy replicated in both sensitivity analyses. LIMITATIONS:Suicide attempts occurred in a small sub-sample (n = 102), and binary symptom measures limit granularity. CONCLUSIONS:Interventions targeting the schematic self-devaluation captured by worthlessness, rather than guilt-focused strategies, may offer greater clinical leverage in preventing the transition from depressive symptomatology to suicidal cognitions.

BACKGROUND:Late-life depression refers to a depression occurring in older adults, defined as individuals aged 65 years and older. It is common and often mismanaged due to complex clinical profiles, polypharmacy, and limited evidence-based guidance. Existing tools poorly address psychiatric nuances in older adults. This work aims to develop French recommendations based on experts' consensus on the use of antidepressants in unipolar late-life depression, to guide safer prescribing practices. METHODS:This tool was developed using a Delphi survey, based on a review of literature published between 2014 and 2024 and focused on "antidepressants" and "late-life depression" Experts from various fields: geriatric psychiatry, clinical pharmacy and general practice, rated items using a 9-point Likert scale. Items with a median score ≥ 7 and at least 80% agreement were validated and included in the final version of the tool. RESULTS:Twenty to 23 experts per round, different from the authors of the proposed items, participated in a four-round Delphi process. The resulting tool includes 57 validated items across 10 sections and a stepped-care algorithm for treating major depression in older adults. It addresses drug choice, dosing, monitoring, comorbidities, and treatment resistance, prioritizing safe first-line options like sertraline, citalopram, and escitalopram. CONCLUSION:A Delphi survey involving multidisciplinary experts led to a French consensus tool for prescribing antidepressants in unipolar late-life depression. It integrates clinical evidence and expert judgment to address treatment complexity, drug safety, and resistance. The tool offers practical, stepwise recommendations tailored to primary care, aiming to optimize antidepressant use, reduce iatrogenesis, and improve patient outcomes.

OBJECTIVE:Differences in the effectiveness of antidepressant medications by age are uncertain, with no compelling evidence of medication outperforming others in older adults. This real-world study compared the acceptability (efficacy and tolerability) of 20 antidepressants in younger and older patients using filled prescription sequences. MATERIAL AND METHODS:A nationwide cohort from the French national health system (SNDS) identified new antidepressant users over one year. The primary outcome was clinical acceptability, measured by the continuation/change ratio over the six-month period after initiating first-line treatment. Continuation was defined as at least two refills of the same treatment. Change was defined as at least one filled prescription of another antidepressant, an antipsychotic medication, or a mood-stabilizer. Antidepressant medications were compared by clinical acceptability while stratifying on age (<65 vs ≥65 years). Multivariable logistic regression models were used to calculate odds ratios adjusted for sex, social deprivation, comorbidity, specialty of first prescriber and benzodiazepine or Z-drug prescriptions. To further examine the moderating effect of age, we searched for an age by medication interaction. RESULTS:Escitalopram had the highest acceptability in both participants aged <65 (n = 257,504) and ≥65 (n = 83,673). Acceptability substantially differed between groups, in particular for mianserin and mirtazapine, ranking 2nd and 7th in older patients and 15th and 19th among younger ones. CONCLUSION:This large real-world study suggests differences in the acceptability of first-line antidepressants between older and younger patients. Although escitalopram ranked first regardless of age, alpha-2 blockers (mianserin and mirtazapine) emerged as acceptable options in older patients only. ARTICLE SUMMARY:Differences in the effectiveness of antidepressant medications according to age are uncertain. In a nationwide cohort from the French national health system, filled prescription sequences were used to compare the acceptability of 20 antidepressants by patient age. The primary outcome was clinical acceptability measured by the continuation/change ratio over the six-month period following introduction of the first-line treatment. 257,504 participants aged <65 and 83,673 aged ≥65 were included. Acceptability substantially differed between age groups.

Background Major depressive episode remains largely untreated, and identifying symptom-level predictors of help-seeking is a clinical priority. This study uses network analysis to examine these predictors in a longitudinal nationally representative cohort. Methods The population consisted of individuals who had experienced a major depressive episode in the year prior to the interview and who had not sought care during that period. We estimated a symptom network including DSM-IV major depressive episode criteria at baseline (Wave 1), depressive symptoms at three years, and help-seeking behavior at three years (Wave 2). Bridge centrality indices were computed to identify key symptoms linking depressive symptoms to help-seeking behavior. Sensitivity analyses tested robustness to adjustment for symptom burden, episode duration, and functional impairment. Results Among the 1,900 individuals with major depressive episode at Wave 1, 16.4% (312) sought help three years later, with 81.1% (256) consulting a healthcare professional and 78.8% (244) receiving a prescription. Three symptoms at follow-up were significantly linked to help-seeking: fatigue, insomnia, and suicidal ideation. Suicidal ideation at baseline was indirectly linked to help-seeking through its persistence at three-year follow-up. Sensitivity analyses confirmed that the three key symptoms remained significantly associated with help-seeking after adjustment for symptom count, episode duration, and functional impairment. Conclusion Fatigue, insomnia, and suicidal ideation represent key predictors of help-seeking in individuals with untreated major depressive episode. The persistence of suicidal ideation underscores the importance of its systematic assessment in clinical practice. These findings support the development of symptom-anchored interventions to facilitate earlier engagement with care.

Major depressive disorder (MDD) represents a leading cause of disability. Despite decades of research focused on monoaminergic dysregulation, the exact pathophysiological mechanisms underlying MDD remain incompletely understood. This gap in knowledge has contributed to suboptimal therapeutic outcomes, with approximately one-third of MDD patients showing resistance to conventional treatments. Recent advances in lipidomics support that sphingolipids—including ceramides, sphingomyelins, and their metabolites—could play important roles in depression pathophysiology. This review examines the role of sphingolipid dysregulation in MDD and associated cognitive impairment, with a particular focus on interactions with neurogenesis and apoptosis, monoaminergic signaling, neuroinflammation, mitochondrial dysfunction and oxidative stress, glutamatergic signaling, and synaptic plasticity. Several clinical studies demonstrate altered sphingolipid profiles in MDD patients, with elevated ceramide levels correlating with depression severity. Preclinical evidence supports potential causal relationships between sphingolipid alterations and depressive behaviors through effects on neurotransmission, neuroplasticity, neurogenesis, mitochondrial function, and inflammatory processes. Many established antidepressants influence sphingolipid metabolism through distinct mechanisms—acting directly as functional inhibitors of acid sphingomyelinase (ASM) or modulating this pathway indirectly. This mechanistic convergence positions sphingolipid dysregulation as a potential central mediating node across major pathophysiological pathways in MDD and as a common pathway through which key risk factors may converge, potentially explaining its biological heterogeneity. Sphingolipid metabolism also offers a potential mechanistic explanation for the frequently observed cognitive deficits in MDD. This review synthesizes current evidence regarding sphingolipid involvement in depression pathophysiology and outlines promising avenues for personalized medicine through biomarker development and sphingolipid-targeted therapeutics.

BACKGROUND:Besides the usual characterization of metabolic syndrome as a cluster of markers arbitrarily defined by thresholds, it is unclear to which extent these markers as continuous traits are correlated with each other in the general population. The present study aimed to explore these correlations across a wide array of biological, social and behavioral characteristics. METHODS:The cross-sectional analyses were performed in a large population-based French cohort (CONSTANCES) of 159,476 adults in whom blood glucose, low-density lipoproteins (LDL) and high-density lipoproteins (HDL), triglycerides, body mass index, waist and hip circumferences, systolic and diastolic blood pressures were measured at the time of recruitment between 2012 and 2021. Correlations between each pair of continuous marker distributions were assessed by calculating raw and partial correlation coefficients (r). RESULTS:The same pattern of partial correlations is observed with little variation in all groups of sex, age, individual and parental histories of cardiovascular disease, diagnosis of metabolic syndrome, social position, work environment, lifetime unemployment exposure, smoking, non-moderate alcohol consumption, leisure-time physical inactivity and diet quality. This pattern is composed of strong and expected intercorrelations between systolic and diastolic blood pressures (r ranging from 0.62 to 0.74), between body mass index and waist (r from 0.50 to 0.63) and hip (r from 0.58 to 0.70) circumferences and between waist and hip circumferences (r from 0.07 to 0.19). It also includes intercorrelations of systolic blood pressure with waist (r from 0.10 to 0.21) and hip (r from -0.07 to -0.12) circumferences and with blood glucose (r from 0.09 to 0.15), those of triglycerides with blood glucose (r from 0.07 to 0.16), LDL (r from 0.24 to 0.33), HDL (r from -0.20 to -0.29) and waist circumference (r from 0.07 to 0.15), and finally those of waist and hip circumferences with blood glucose (r from 0.09 to 0.17 and from -0.08 to -0.13) and HDL (r from -0.12 to -0.24 and from 0.08 to 0.18). CONCLUSIONS:These results show that metabolic syndrome markers are correlated with each other whatever the biological, social or behavioral characteristics of individuals. They suggest that it makes sense to systematically consider these markers all together rather than separately in terms of etiology, prevention and treatment of metabolic diseases and cardiovascular risk in the general population.

OBJECTIVES:Uncertainty exists as to what extent common risk factors are involved in the associations of unemployment with major health outcomes and mortality. DESIGN:A retrospective and prospective observational study. SETTING:A large population-based French cohort (CONSTANCES). PARTICIPANTS:99 430 adults at baseline who have been exposed to unemployment during their lifetime and 54 679 of them who were followed for 7 years after baseline. PRIMARY OUTCOME MEASURES:Testing the mediating roles of several risk factors at baseline in the associations of lifetime unemployment exposure with cardiovascular disease, cancer and mortality rates during a 7-year follow-up. Direct and indirect effects were calculated for each risk factor and all together using logistic regression models adjusted for major confounders including sex, age, parental histories of cardiovascular disease and cancer, social position and working conditions. RESULTS:Estimates (95% CIs) of the direct and indirect effects for smoking are 0.0083 (0.0044 to 0.0122), p<0.0001 and 0.0010 (0.0007 to 0.0014), p<0.0001 on cardiovascular disease rate; 0.0059 (0.0028 to 0.0089), p=0.0002 and 0.0007 (0.0004 to 0.0010), p<0.0001 on cancer rate; 0.0105 (0.0058 to 0.0151), p<0.0001 and 0.0010 (0.0005 to 0.0014), p<0.0001 on all-cause mortality. The figures for alcohol consumption are, respectively, 0.0076 (0.0034 to 0.0118), p=0.0004 and 0.0004 (0.0002 to 0.0005), p=0.0006; 0.0067 (0.0035 to 0.0100), p<0.0001 and 0.0004 (0.0002 to 0.0005), p<0.0001; 0.0114 (0.0064 to 0.0164), p<0.0001 and 0.0004 (0.0001 to 0.0006), p=0.0009. For depressive symptoms, 0.0084 (0.0040to 0.0128), p=0.0002 and 0.0007 (0.0002 to 0.0011), p=0.005; 0.0053 (0.0017 to 0.0089), p=0.004 and 0.0001 (-0.0002 to 0.0005), p=0.51; 0.0088 (0.0031 to 0.0144), p=0.002 and 0.0010 (0.0004 to 0.0015), p=0.0005. For leisure-time physical inactivity, 0.0083 (0.0044 to 0.0122), p<0.0001 and 0.0003 (0.0001 to 0.0005), p=0.0006; 0.0057 (0.0026 to 0.0088), p=0.0004 and 0.0002 (0.0001 to 0.0003), p=0.002; 0.0105 (0.0058 to 0.0152), p<0.0001 and 0.0004 (0.0002 to 0.0007), p<0.0001. For blood triglycerides, 0.0080 (0.0042 to 0.0119), p<0.0001 and 0.0005 (0.0004 to 0.0007), p<0.0001; 0.0057 (0.0026 to 0.0087), p=0.0003 and 0.0001 (-0.0001 to 0.0002), p=0.32; 0.0103 (0.0057 to 0.0149), p<0.0001 and 0.0002 (0.0000 to 0.0004), p=0.06. The figures for all risk factors when tested together were 0.0075 (0.0022 to 0.0128), p=0.005 and 0.0020 (0.0011 to 0.0027), p<0.0001; 0.0052 (0.0011 to 0.0093), p=0.01 and 0.015 (0.0009 to 0.0020), p<0.0001; 0.0102 (0.0035 to 0.0169), p=0.003 and 0.0022 (0.0011 to 0.0031), p<0.0001. CONCLUSIONS:These analyses show that common risk factors such as smoking, alcohol consumption, depressive symptoms, leisure-time physical inactivity and blood triglycerides mediate up to 10% of the associations of lifetime unemployment exposure with cardiovascular disease, cancer and mortality rates when tested separately and approximately 20% when tested all together. This highlights the existence of other major mediating pathways that have yet to be identified.

OBJECTIVE:Due to the uncertainty whether atypical and typical antipsychotics have a stronger association with mortality among older people with schizophrenia, we examined the rates and causes of mortality in older adults with schizophrenia who take atypical or typical antipsychotics. METHODS:In a 5-year prospective multicenter study of patients aged = 55 years with an ICD-10 diagnosis of schizophrenia, we used a multivariable logistic regression model to examine the association between atypical vs. typical antipsychotics and mortality, adjusting for sociodemographic and clinical characteristics. RESULTS:Of 313 older adults with schizophrenia, the 5-year all-cause mortality rates in patients who took atypical (n=192) and typical (n=167) antipsychotics were 36.4% and 24.3%, respectively. Following adjustment, no significant differences were found in all-cause mortality (AOR = 1.56; 95%CI 0.75-3.27; p = 0.24) or causes of mortality (all p > 0.05) between medication groups. Atypical antipsychotics were significantly associated with lower overall mortality in the subpopulation with baseline Mini Mental State Examination scores < 24 (AOR = 0.24; 95%CI 0.07-0.84; p = 0.025). CONCLUSION:Although atypical antipsychotics may not be associated with lower odds of overall mortality than typical antipsychotics in older people with schizophrenia, they might be associated with lower mortality among those with substantial cognitive impairment.

OBJECTIVE:As the population ages, the number of older adults with psychiatric disorders in long-term care facilities is expected to significantly increase. To our knowledge, no study has examined the association between long-term care utilization and all-cause mortality among older adults with psychiatric disorders. METHODS:In this report, we used data from the Cohort of Individuals with Schizophrenia, Bipolar and Major Depressive Disorder Aged 55 Years or More, a 5-year prospective multicenter study, to examine this association. All analyses were adjusted for a wide range of potential confounders, including sociodemographic and clinical characteristics and psychotropic medication use. RESULTS:The prevalence of long-term care utilization was 23.6% (n=132) among 559 older adults with major psychiatric disorders. Living in a long-term care facility was significantly and independently associated with increased all-cause mortality in both the crude (OR = 2.54; 95%CI 1.67-3.87; p < 0.001) and fully-adjusted multivariable logistic regression models (AOR = 1.86; 95%CI 1.10-3.16; p = 0.021). This association did not vary significantly across most subgroups defined by sociodemographic and clinical characteristics. CONCLUSION:In this multicenter prospective observational study of older adults with major psychiatric disorders, long-term care utilization was significantly associated with increased all-cause mortality. Physicians and policy makers should take this association under careful consideration.

Background: Distinguishing between primary and secondary mood disorders (illness-or substance-induced) is important for appropriate treatment, yet their prevalence and outcomes in the general population remain understudied. Aim: To compare psychiatric and mental health outcomes between primary and secondary mood disorders over a 3-year follow-up. Methods: We used longitudinal data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative survey of the US adult population (Wave 1, 2001-2002; Wave 2, 2004-2005). Primary and secondary mood disorders were assessed following DSM-IV criteria. Outcomes assessed 3 years later included recurrence and persistence of mood disorders, suicide attempt, mental and physical health-related quality of life, and mental health help-seeking behavior. All analyses were adjusted for a wide range of sociodemographic and clinical characteristics. Results: Among 3,602 participants with mood disorders during the 12 months before Wave 1, 298 (8.3%) had secondary and 3,304 (91.7%) primary mood diagnoses. Following adjustments, secondary mood disorders were associated with significantly poorer physical health-related quality of life (β=-2.75; 95% CI, -4.27 to -1.23) and lower 3-year recurrence (adjusted odds ratio [AOR]=0.51; 95% CI, 0.36 to 0.72) and persistence rates (AOR=0.49; 95% CI, 0.31 to 0.79) compared to primary mood disorders. Other outcomes showed no significant differences (all P>.05). Conclusion: Secondary mood disorders were not rare and associated with poorer physical health-related quality of life than primary mood disorders. However, both groups showed similar risks of suicide attempts, impaired mental health-related quality of life, and rates of mental health help-seeking behavior. The findings for adults with secondary mood disorders align with efforts to integrate physical and mental health care.

“Oldest old”, although increasingly numerous, remain insufficiently described in mental health services. By studying those who visit the busiest Psychiatric Emergency Services (PES) in France, our primary objective was to describe the “oldest old” seeking psychiatric care and, secondly, to identify predictive factors of hospitalization. We chose a cut-off age of 80 years and recruited all patients who visited our monocentric PES over a five-year period between 2018 and 2022. This retrospective observational study relied on clinical assessments and medical records. A total of 306 visits from 274 distinct patients were analyzed. Patients were mostly women, living alone at home, with a psychiatric history and using psychotropic medications. The majority were diagnosed with mood disorders and did not appear to have cognitive impairment. Patients were primarily referred to either inpatient or outpatient psychiatric care. These results enhance our understanding of the psychiatric needs of the “oldest-old”.

Introduction Borderline personality disorder (BPD) features span internalizing and externalizing dimensions of psychopathology, and their expression varies across biological sexes. Despite substantial research efforts, major gaps remain in our understanding of this heterogeneity, particularly regarding its developmental underpinnings. Life history theory, a leading framework in evolutionary developmental biology, can help make sense of this heterogeneity. Methods In a large nationally representative prospective survey (n = 34 653), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), we used Multi-group MIMIC models to investigate whether and how the degree to which individuals trade off somatic maintenance against short-term reproductive goals relates to severity of BPD at a general and a single symptom level, and whether these associations differ between men and women in the general adult population. Results Men and women prioritizing short-term reproductive goals over somatic maintenance were more likely to endorse each of the 9 DSM-IV BPD symptoms through higher BPD severity, and were more likely to express impulsivity (b=0.11; SE, 0.018; p <.001) and suicidal/self-mutilation behavior (b =0.24; SE, 0.026; p < .001) and less likely to endorse stress-related paranoid ideation (b=-0.066; SE, 0.023; p =.004). Finally, females with a reproduction-oriented life history strategy were more likely to endorse affective instability than males (Females: b=0.12; SE, 0.025; p <.001; Males: b=-0.015; SE, 0.044; p =0.73). Conclusions An evolutionary-developmental framework, rooted in human life history theory can help make sense of the heterogeneous manifestations of BPD. Our work also opens the door for future research on the interplay of the reproduction/maintenance trade-off with other genetic and environmental factors and developmental processes in explaining the occurrence of BPD symptoms. ### Competing Interest Statement The authors have declared no competing interest. Fondation pour la Recherche MM-CM-)dicale (FRM), SPF202209015876 Agence Nationale de la Recherche, ANR-22-CE28-0012-01 eLIFUN

BackgroundSocial media (SM) platforms have become increasingly prevalent in adolescents' lives, and concerns have arisen regarding their potential contribution to depression. This study examined whether excessive SM use contributes to rising adolescent depression rates and evaluated potential mitigation strategies.Methods and findingsWe developed an individual-based microsimulation model of 18.6 million French adolescents born 1990-2012, tracking depression outcomes from 2000-2022 (analyses conducted August 2024-July 2025). The model incorporated 95 parameters, including demographics, SM use patterns, and established depression risk factors (childhood adversities, chronic physical conditions, physical inactivity, obesity, substance use). The main outcome was cumulative depression cases, and secondary outcomes were suicide deaths, health-adjusted life expectancy (HALE) loss, and associated costs. The model was well-calibrated and validated adequately against US-specific data. It showed that excessive SM use likely played an important role in the recent increase in rates of adolescent depression. Among French adolescents, simulations indicated that excessive SM use was associated with an additional cumulative lifetime 590,000 depression cases (95%CI [400,000, 760,000]), 799 suicide deaths (95%CI [547, 1,028]), 137,000 (95%CI [94,000, 176,000]) HALE loss years, and 3.94 (95%CI [2.70, 5.07]) billion euros, compared to scenarios without SM platforms. Key limitations are that microsimulation modeling cannot establish causality from observational data and the reliance on duration-based exposure measures without capturing content type or engagement quality.ConclusionsIn this study, we estimated that limiting SM use to 1 h per day for all adolescents, replacing 30 min of SM use with 30 min of physical activity, or stopping its use for adolescents most at-risk for depression, would be associated with a reduction in cumulative lifetime prevalence of depression by 14.7%, 12.9%, and 12.0%, respectively, and diminished associated costs. Targeted SM interventions could potentially reduce adolescent depression burden, though real-world implementation and effectiveness require validation.

BACKGROUND:Numerous studies have reported an association between depression and periodontitis, though results are inconsistent and highly heterogeneous. The present study aimed to examine the potential confounding role of poor socioeconomic status (SES) in the association between depression and periodontitis by performing a secondary analysis of the National Health and Nutrition Examination Survey (NHANES) data. METHODS:Among participants of the 2009-2014 NHANES cycles, those who fulfilled sociodemographic (education level, household income, ethnicity, marital status), medical, and depression questionnaires, and underwent full-mouth periodontal examination were selected. Periodontitis (mild, moderate, and severe) was assessed based on the Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) criteria. Depression was defined by a Patient Health Questionnaire (PHQ-9) total score ≥10. Weighted multivariable regressions for complex design models were used to assess the association between periodontitis and depression accounting for the role of SES. Adjusted odds ratio (OR) with 95% confidence intervals (CIs) were provided. RESULTS:Among 9537 participants [mean age: 51.9 years (SD: 14.1), 50.1% females], 4768 (41.2%) and 830 (7.3%) presented with periodontitis and depression, respectively. Depression was significantly associated with periodontitis (weighted OR [95% CI]: 1.26 [1.01-1.56]). However, this association was no longer significant when adjusting for SES indicators (0.94 [0.75-1.18]), especially poverty (91.4% of OR reduction when adjusting for poverty only). CONCLUSION:The association between depression and periodontitis may largely be explained by SES, which should thus be considered at both the population- and individual levels in preventive and management strategies. PLAIN LANGUAGE SUMMARY:Depression and periodontitis are two common health problems, and some studies suggest they might be linked. But could this connection actually be due to other factors, like low income or education levels? To find out, we analyzed data from a national US health survey involving over 9500 adults who answered questions about their mental health, income, education, and lifestyle, and who also underwent a full-mouth periodontal examination. We found that depression and periodontitis appeared to be connected at first glance. However, when we considered socioeconomic factors-especially low income-the link between the two disappeared. This suggests that financial challenges and limited access to resources might play a bigger role than previously thought. Our findings highlight the need for health professionals to look beyond individual conditions and consider a person's broader life circumstances when providing care. At a public health level, addressing social inequalities could help improve both mental and oral health outcomes.

INTRODUCTION:Sleep quality is associated with diminished quality of life. Substance use disorders (SUD) may constitute one leading contributory factor to this relationship. METHODS:In a nationally representative sample of US adults aged 18 years or older who were interviewed 3 years apart in the National Epidemiologic Survey on Alcohol and Related Conditions (wave 1, 2001-2002; wave 2, 2004-2005), we used structural equation modeling to examine the shared and specific effects of three sleep complaints at Wave 1 (i.e., trouble falling asleep, early morning awakening, and hypersomnia) on physical and mental health-related quality of life at Wave 2, based on SF-12v2 norm-based physical (PCS) and mental (MCS) scores. We estimated the proportions of these associations mediated by SUD, adjusting for various sociodemographic and clinical characteristics. RESULTS:Sleep complaints were significantly associated with lower MCS and PCS scores among the 34,653 respondents who completed both interviews (β = -0.094, SE = 0.010, p < 0.001; β = -0.042, SE = 0.009, p < 0.001, respectively). These associations were not specific to one type of sleep complaint, but rather were mediated by a single latent factor, representing mechanisms shared by all sleep complaints. A total of 14.42 % and 18.4 % of the effect of that latent factor on MCS and PCS was mediated by a SUD latent factor, representing the shared effects across SUDs. CONCLUSION:Our findings highlight the importance of adopting dimensional approaches to model the co-occurrence of SUDs and sleep disturbance and suggest the importance of prevention and treatment measures for SUDs among adults with sleep disturbance.

BACKGROUND:Lifetime unemployment exposure increases in a cumulative way the risk of chronic diseases and premature death but the linearity of these relationships is still unclear. METHODS:The analyses were performed using individual data from 114,307 participants aged 18 to 75 years who were followed for 7 years after inclusion in the large population-based French cohort CONSTANCES. Unemployment exposure was measured as the total number of unemployed quarters accumulated during the lifetime and categorized into quartiles (low, average, high, very high exposure) along with the group of participants who were never exposed to unemployment. The associations of lifetime unemployment exposure with cardiovascular disease, cancer and all-cause mortality rates during follow-up were assessed by using logistic regression models adjusted for major confounding factors. Adjusted logistic regression models were also used to examine the associations between lifetime unemployment exposure and the prevalence of bad working conditions at inclusion. RESULTS:The associations of lifetime unemployment exposure with cardiovascular disease and all-cause mortality rates appear to be J-shaped with lower rates observed in participants with a low unemployment exposure compared to those never exposed (odds ratios (95% CI) of 0.78 (0.63-0.96) and 0.81 (0.60-0.97) respectively). In contrast, an increase in cardiovascular disease and all-cause mortality rates is observed in participants with a high (1.40 (1.17-1.67) and 1.50 (1.18-1.89) respectively) and even more a very high unemployment exposure (1.64 (1.42-1.89) and 2.09 (1.74-2.50) respectively). These J-shaped associations are no longer significant when adjusted for working conditions at inclusion. The prevalence of bad working conditions at inclusion is also reduced in participants with a low unemployment exposure compared to those never exposed (0.83 (0.79-0.86)) while it is increased in participants with a high (1.61 (1.55-1.68)) and even more a very high unemployment exposure (2.12 (2.04-2.21)). CONCLUSIONS:The non-linear relationships of lifetime unemployment exposure with cardiovascular disease and all-cause mortality rates may be related to the health benefits of having the occasional opportunity to leave jobs with bad working conditions over the life course.

Objective: The large body of literature examining the association between parenthood and mortality in the general population contrasts with a lack of such studies on older adults with schizophrenia. Identifying potential protective factors of premature death in this population is important to help guide prevention measures. Here, we examined whether all-cause and cause-specific mortality rates significantly differ between older parents and non-parents with schizophrenia during a 5-year follow-up. Methods: We used data from a 5-year prospective multicenter sample of older adults with an ICD-10 diagnosis of schizophrenia (aged 55 years or more) recruited in France. We performed a forward stepwise logistic regression to examine the association between parenthood and all-cause mortality, including only independent variables that best explain outcome. Results: Of the 323 older adults with schizophrenia, 133 (41.2%) were parents (mean age = 67.0, SD = 6.1) and 190 were not (mean age = 67.2, SD = 6.6). Following adjustments, parenthood was significantly associated with lower all-cause mortality compared to patients without children (21.1% [n=28] vs. 35.8% [n=68]; AOR = 0.50; 95%CI 0.27-0.94; p = 0.032); the association involved no significant sex differences. Conclusion: Parenthood could be a protective factor against mortality among older patients with schizophrenia who live in France. Further research is needed to understand the specific mechanisms underlying this association.