Cerisse Gunasinghe - Academia.edu (original) (raw)

Papers by Cerisse Gunasinghe

JMIR Research Protocols, Oct 2, 2020

Background: Alcohol misuse is higher in the UK Armed Forces than in the general population. Previ... more Background: Alcohol misuse is higher in the UK Armed Forces than in the general population. Previous research has shown that interventions delivered via smartphones are efficacious in promoting self-monitoring of alcohol use, have utility in reducing alcohol consumption, and have a broad reach. Objective: This single-blinded randomized controlled trial (RCT) aims to assess the efficacy of a 28-day brief alcohol intervention delivered via a smartphone app (Drinks:Ration) in reducing weekly self-reported alcohol consumption between baseline and 3-month follow-up among veterans who drink at a hazardous or harmful level and receive or have received support for mental health symptoms in a clinical setting. Methods: In this two-arm, single-blinded RCT, a smartphone app that includes interactive features designed to enhance participants' motivation and personalized messaging is compared with a smartphone app that provides only government guidance on alcohol consumption. The trial will be conducted in a veteran population that has sought help through Combat Stress, a UK veteran's mental health charity. Recruitment, consent, and data collection will be carried out automatically through the Drinks:Ration platform. The primary outcome is the change in self-reported weekly alcohol consumption between baseline (day 0) and 3-month follow-up (day 84) as measured using the Time-Line Follow back for Alcohol Consumption. Secondary outcome measures include (1) change in the baseline to 3-month follow-up (day 84) Alcohol Use Disorder Identification Test score and (2) change in the baseline to 3-month follow-up (day 84) World Health Organization Quality of Life-BREF score to assess the quality of adjusted life years. Process evaluation measures include (1) app use and (2) usability ratings as measured by the mHealth App Usability Questionnaire. The primary and secondary outcomes will also be reassessed at the 6-month follow-up (day 168) to assess the longer-term benefits of the intervention, which will be reported as a secondary outcome.

Molecular Psychiatry, Sep 19, 2017

The fortieth author's name was listed incorrectly. The correct presentation is A Keski-Rahkonen.

International Journal of Geriatric Psychiatry, Aug 4, 2014

The Alzheimer's Disease Neuroimaging Initiative 3.0T MRI image acquisition scheme changed between... more The Alzheimer's Disease Neuroimaging Initiative 3.0T MRI image acquisition scheme changed between the original ADNI-1 grant and the two subsequent grants (ADNI-GO and ADNI-2). The aim of the current study was to investigate the compatibility of the 3.0T ADNI-1 and ADNI-2 T1-weighted volumes using voxel-based morphometry (VBM). Methods: T1-weighted images of 30 subjects were acquired using a 3T GE Signa HDx using the ADNI-1 and ADNI-2 T1-weighted volume sequences. Images were pre-processed and analysed using SPM8. Global grey matter (GM), white matter (WM) and cerebrospinal fluid (CSF) volumes were compared, as well as voxel-by-voxel differences in GM and WM. Results: Correlation coefficients and percentage differences for each tissue type between ADNI-1 and ADNI-2 were as follows: ((GM: intraclass correlation coefficient (ICC) = 0.86, ADNI-1 3.09% < ADNI-2) (WM: ICC = 0.91, ADNI-1 2.92% > ADNI-2) (CSF: ICC = 0.90, ADNI-1 1.94% > ADNI-2)). For ADNI-2, widespread increases in GM were found relative to ADNI-1 (cerebellum and pre-central gyrus), with localised decreases along the midline and temporal lobes. For ADNI-1, widespread increases in WM were found relative to ADNI-2 (cerebellum and pre-central gyrus), together with localised decreases in the temporal gyrus. Conclusions: The widespread increase in GM and localised decrease in WM in ADNI-2 compared to ADNI-1 images suggests that the image acquisition protocols are not directly comparable using SPM-8. Total volumes of GM, WM and CSF also differed between the protocols in the following order of magnitude: GM > WM > CSF. This has implications for studies aiming to analyse images acquired using the ADNI-1 and ADNI-2 protocols under VBM.

Alzheimers & Dementia, Jul 1, 2013

P3-084 AVOXEL-BASED MORPHOMETRY COMPARISON OF THE 3.0TADNI-1 AND ADNI-2 MPRAGE PROTOCOLS Simon Br... more P3-084 AVOXEL-BASED MORPHOMETRY COMPARISON OF THE 3.0TADNI-1 AND ADNI-2 MPRAGE PROTOCOLS Simon Brunton, Cerisse Gunasinghe, Nigel Jones, Matthew Kempton, Eric Westman, Andrew Simmons, King’s College London, London, United Kingdom; Kings College London, London, United Kingdom; Karolinska University, Stockholm, Sweden; King’s College London, London, United Kingdom. Contact e-mail: simon.1.brunton@kcl.ac.uk

Molecular Psychiatry, Sep 1, 2018

The fortieth author's name was listed incorrectly. The correct presentation is A Keski-Rahkonen.

AimTo understand how student nurse experiences on clinical placement, within NHS hospitals, diffe... more AimTo understand how student nurse experiences on clinical placement, within NHS hospitals, differ for ethnic minority and White British groups.DesignA qualitative thematic analysis with an inductive approach.MethodsData from semi-structured interviews with 21 London (United Kingdom) hospital-based student nurses were examined using thematic analysis. Participants were interviewed as part of theTackling Inequalities and Discrimination Experiences in health Services(TIDES) study and asked about their experiences during clinical placement.ResultsFive main themes were identified: 1) Role of mentors, 2) Discrimination and unfair treatment, 3) Speaking up/out, 4) Career progression, and 5) Consequences of adverse experiences. All themes were linked, with the social dynamics and workplace environment (referred to as ‘ward culture’) providing a context that normalises mistreatment experienced by nursing students. Students from ethnic minority backgrounds reported racism as well as cultural...

Depression and Anxiety, 2007

Both childhood trauma (CT) and genetic factors contribute to the pathophysiology of depression. W... more Both childhood trauma (CT) and genetic factors contribute to the pathophysiology of depression. We studied the relationship of CT to age of onset (AO) of depression, personality traits, and expression of symptom dimensions in 324 adults with recurrent unipolar depression. Subjects received structured psychiatric interviews and completed CT, depressive symptom, and personality rating questionnaires. Experience of at least one type of trauma was reported by 79.9% of subjects, and the most common forms of trauma were physical neglect, emotional abuse, and emotional neglect. There was an earlier AO of depression in the groups that reported CT compared to those that reported none, with earliest AO occurring in those who had experienced the highest levels of CT. There were no significant correlations between overall CT scores and neuroticism or extraversion. Total CT was a significant (P 5.008) predictor of the Mood symptom dimension, mostly accounted for by emotional abuse (P 5.019), and physical neglect predicted the Anxiety symptom dimension (P 5.002). All types of CT are commonly reported in individuals with depression, and emotional abuse and physical neglect, though previously less well identified, appear to have an important role in the pathogenesis of depressive disorders. The effect of CT on individuals with an underlying genetic vulnerability to depression may result in differences in depressive phenotype characterized by earlier AO of depression and the expression of specific depressive symptom dimensions. Depression and Anxiety 24:163-168, 2007.

Mental health conditions tend to go unrecognised and untreated in adolescence, and therefore it i... more Mental health conditions tend to go unrecognised and untreated in adolescence, and therefore it is crucial to improve the health and social outcomes for these individuals through age and culturally appropriate interventions. This paper aims firstly to describe the development and implementation of the HYPE project platform (a research and resource platform co-designed and co-produced with young people). The second aim is to describe the characteristics of participants who engaged with the platform and an embedded pilot online survey.A mixed methods design (including focus groups and repeated measures surveys) was used to address aims of the HYPE project. Data were analysed using thematic analysis and descriptive statistics to: (1) help improve access to health and social services, (2) guide provision of information of online resources and (3) deliver complementary community-based events/activities to promote mental health and to ultimately prevent mental health issues.Pilot and main...

Sociology of Health & Illness, 2021

This is an open access article under the terms of the Creat ive Commo ns Attri bution License, wh... more This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Journal of Social Welfare and Family Law, 2022

Utility of the pooling approach as applied to whole genome association scans with highdensity

In the UK, a nationwide lockdown was announced on 23 March 2020 in response to the coronavirus pa... more In the UK, a nationwide lockdown was announced on 23 March 2020 in response to the coronavirus pandemic. The lockdown initially lasted for three weeks but has since been extended. This has raised many questions as to how people cope with extended periods of lockdown, as quarantine has been reported to have various negative effects on wellbeing. Indeed, a recent priority paper highlighted the need for studies which collect high-quality data on the mental health effects of the pandemic and its consequences. This study seeks to explore the health and wellbeing of young adults in the UK.

Ethnicity & Health, 2021

Objective: COVID-19-related inequities experienced by racial and ethnic minority groups including... more Objective: COVID-19-related inequities experienced by racial and ethnic minority groups including healthcare professionals mirror wider health inequities, which risk being perpetuated by lower uptake of vaccination. We aim to better understand lower uptake among racial and ethnic minority staff groups to inform initiatives to enhance uptake. Design: Twenty-five semi-structured interviews were conducted (October 2020-January 2021) with UK-based healthcare staff. Data were inductively and thematically analysed. Results: Vaccine decision-making processes were underpinned by an overarching theme, 'weighing up risks of harm against potential benefits to self and others'. Sub-themes included 'fear of harm', 'moral/ethical objections', 'potential benefits to self and others', 'information and misinformation', and 'institutional or workplace pressure'. We identified ways in which these were weighted more heavily towards vaccine hesitancy for racial and ethnic minority staff groups influenced by perceptions about institutional and structural discrimination. This included suspicions and fear around institutional pressure to be vaccinated, racial injustices in vaccine development and testing, religious or ethical concerns, and legitimacy and accessibility of vaccine messaging and communication. Conclusions: Drawing on a critical race perspective, we conclude that acknowledging historical and contemporary abuses of power is essential to avoid perpetuating and aggravating mistrust by decontextualising hesitancy from the social processes affecting hesitancy, undermining efforts to increase vaccine uptake.

eLife, 2021

We performed a systematic analysis of blood DNA methylation profiles from 4483 participants from ... more We performed a systematic analysis of blood DNA methylation profiles from 4483 participants from seven independent cohorts identifying differentially methylated positions (DMPs) associated with psychosis, schizophrenia, and treatment-resistant schizophrenia. Psychosis cases were characterized by significant differences in measures of blood cell proportions and elevated smoking exposure derived from the DNA methylation data, with the largest differences seen in treatment-resistant schizophrenia patients. We implemented a stringent pipeline to meta-analyze epigenome-wide association study (EWAS) results across datasets, identifying 95 DMPs associated with psychosis and 1048 DMPs associated with schizophrenia, with evidence of colocalization to regions nominated by genetic association studies of disease. Many schizophrenia-associated DNA methylation differences were only present in patients with treatment-resistant schizophrenia, potentially reflecting exposure to the atypical antipsyc...

ABSTRACTObjectivePsychosis - a complex and heterogeneous neuropsychiatric condition characterized... more ABSTRACTObjectivePsychosis - a complex and heterogeneous neuropsychiatric condition characterized by hallucinations and delusions - is a common feature of schizophrenia. There is evidence for altered DNA methylation (DNAm) associated with schizophrenia in both brain and peripheral tissues. We aimed to undertake a systematic analysis of variable DNAm associated with psychosis, schizophrenia, and treatment-resistant schizophrenia, also exploring measures of biological ageing, smoking, and blood cell composition derived from DNAm data to identify molecular biomarkers of disease.MethodsWe quantified DNAm across the genome in blood samples from 4,483 participants from seven case-control cohorts including patients with schizophrenia or first-episode psychosis. Measures of biological age, cellular composition and smoking status were derived from DNAm data using established algorithms. DNAm and derived measures were analyzed within each cohort and the results combined by meta-analysis.Resul...

Inflammatory markers such as cytokines represent potential biomarkers for major depressive disord... more Inflammatory markers such as cytokines represent potential biomarkers for major depressive disorder (MDD). Many, generally small studies have examined the role of single markers and found significant associations. We assessed 42 inflammatory markers, namely cytokines, in the blood of 321 control subjects and 887 MDD cases. We tested whether individual inflammatory marker levels were significantly affected by MDD case/control status, current episode, or current depression severity, co-varying for age, sex, body mass index (BMI), smoking, current antidepressant use, ethnicity, assay batch and study effects. We further used machine learning algorithms to investigate if we could use our data to blindly discriminate MDD patients, or those in a current episode. We found broad and powerful influences of confounding factors on log-protein levels. Notably, IL-6 levels were very strongly influenced by BMI (p = 1.37 × 10−43, variance explained = 18%), while Interleukin-16 was the most signific...

JMIR Research Protocols, Oct 2, 2020

Background: Alcohol misuse is higher in the UK Armed Forces than in the general population. Previ... more Background: Alcohol misuse is higher in the UK Armed Forces than in the general population. Previous research has shown that interventions delivered via smartphones are efficacious in promoting self-monitoring of alcohol use, have utility in reducing alcohol consumption, and have a broad reach. Objective: This single-blinded randomized controlled trial (RCT) aims to assess the efficacy of a 28-day brief alcohol intervention delivered via a smartphone app (Drinks:Ration) in reducing weekly self-reported alcohol consumption between baseline and 3-month follow-up among veterans who drink at a hazardous or harmful level and receive or have received support for mental health symptoms in a clinical setting. Methods: In this two-arm, single-blinded RCT, a smartphone app that includes interactive features designed to enhance participants' motivation and personalized messaging is compared with a smartphone app that provides only government guidance on alcohol consumption. The trial will be conducted in a veteran population that has sought help through Combat Stress, a UK veteran's mental health charity. Recruitment, consent, and data collection will be carried out automatically through the Drinks:Ration platform. The primary outcome is the change in self-reported weekly alcohol consumption between baseline (day 0) and 3-month follow-up (day 84) as measured using the Time-Line Follow back for Alcohol Consumption. Secondary outcome measures include (1) change in the baseline to 3-month follow-up (day 84) Alcohol Use Disorder Identification Test score and (2) change in the baseline to 3-month follow-up (day 84) World Health Organization Quality of Life-BREF score to assess the quality of adjusted life years. Process evaluation measures include (1) app use and (2) usability ratings as measured by the mHealth App Usability Questionnaire. The primary and secondary outcomes will also be reassessed at the 6-month follow-up (day 168) to assess the longer-term benefits of the intervention, which will be reported as a secondary outcome.

Molecular Psychiatry, Sep 19, 2017

The fortieth author's name was listed incorrectly. The correct presentation is A Keski-Rahkonen.

International Journal of Geriatric Psychiatry, Aug 4, 2014

The Alzheimer's Disease Neuroimaging Initiative 3.0T MRI image acquisition scheme changed between... more The Alzheimer's Disease Neuroimaging Initiative 3.0T MRI image acquisition scheme changed between the original ADNI-1 grant and the two subsequent grants (ADNI-GO and ADNI-2). The aim of the current study was to investigate the compatibility of the 3.0T ADNI-1 and ADNI-2 T1-weighted volumes using voxel-based morphometry (VBM). Methods: T1-weighted images of 30 subjects were acquired using a 3T GE Signa HDx using the ADNI-1 and ADNI-2 T1-weighted volume sequences. Images were pre-processed and analysed using SPM8. Global grey matter (GM), white matter (WM) and cerebrospinal fluid (CSF) volumes were compared, as well as voxel-by-voxel differences in GM and WM. Results: Correlation coefficients and percentage differences for each tissue type between ADNI-1 and ADNI-2 were as follows: ((GM: intraclass correlation coefficient (ICC) = 0.86, ADNI-1 3.09% < ADNI-2) (WM: ICC = 0.91, ADNI-1 2.92% > ADNI-2) (CSF: ICC = 0.90, ADNI-1 1.94% > ADNI-2)). For ADNI-2, widespread increases in GM were found relative to ADNI-1 (cerebellum and pre-central gyrus), with localised decreases along the midline and temporal lobes. For ADNI-1, widespread increases in WM were found relative to ADNI-2 (cerebellum and pre-central gyrus), together with localised decreases in the temporal gyrus. Conclusions: The widespread increase in GM and localised decrease in WM in ADNI-2 compared to ADNI-1 images suggests that the image acquisition protocols are not directly comparable using SPM-8. Total volumes of GM, WM and CSF also differed between the protocols in the following order of magnitude: GM > WM > CSF. This has implications for studies aiming to analyse images acquired using the ADNI-1 and ADNI-2 protocols under VBM.

Alzheimers & Dementia, Jul 1, 2013

P3-084 AVOXEL-BASED MORPHOMETRY COMPARISON OF THE 3.0TADNI-1 AND ADNI-2 MPRAGE PROTOCOLS Simon Br... more P3-084 AVOXEL-BASED MORPHOMETRY COMPARISON OF THE 3.0TADNI-1 AND ADNI-2 MPRAGE PROTOCOLS Simon Brunton, Cerisse Gunasinghe, Nigel Jones, Matthew Kempton, Eric Westman, Andrew Simmons, King’s College London, London, United Kingdom; Kings College London, London, United Kingdom; Karolinska University, Stockholm, Sweden; King’s College London, London, United Kingdom. Contact e-mail: simon.1.brunton@kcl.ac.uk

Molecular Psychiatry, Sep 1, 2018

The fortieth author's name was listed incorrectly. The correct presentation is A Keski-Rahkonen.

AimTo understand how student nurse experiences on clinical placement, within NHS hospitals, diffe... more AimTo understand how student nurse experiences on clinical placement, within NHS hospitals, differ for ethnic minority and White British groups.DesignA qualitative thematic analysis with an inductive approach.MethodsData from semi-structured interviews with 21 London (United Kingdom) hospital-based student nurses were examined using thematic analysis. Participants were interviewed as part of theTackling Inequalities and Discrimination Experiences in health Services(TIDES) study and asked about their experiences during clinical placement.ResultsFive main themes were identified: 1) Role of mentors, 2) Discrimination and unfair treatment, 3) Speaking up/out, 4) Career progression, and 5) Consequences of adverse experiences. All themes were linked, with the social dynamics and workplace environment (referred to as ‘ward culture’) providing a context that normalises mistreatment experienced by nursing students. Students from ethnic minority backgrounds reported racism as well as cultural...

Depression and Anxiety, 2007

Both childhood trauma (CT) and genetic factors contribute to the pathophysiology of depression. W... more Both childhood trauma (CT) and genetic factors contribute to the pathophysiology of depression. We studied the relationship of CT to age of onset (AO) of depression, personality traits, and expression of symptom dimensions in 324 adults with recurrent unipolar depression. Subjects received structured psychiatric interviews and completed CT, depressive symptom, and personality rating questionnaires. Experience of at least one type of trauma was reported by 79.9% of subjects, and the most common forms of trauma were physical neglect, emotional abuse, and emotional neglect. There was an earlier AO of depression in the groups that reported CT compared to those that reported none, with earliest AO occurring in those who had experienced the highest levels of CT. There were no significant correlations between overall CT scores and neuroticism or extraversion. Total CT was a significant (P 5.008) predictor of the Mood symptom dimension, mostly accounted for by emotional abuse (P 5.019), and physical neglect predicted the Anxiety symptom dimension (P 5.002). All types of CT are commonly reported in individuals with depression, and emotional abuse and physical neglect, though previously less well identified, appear to have an important role in the pathogenesis of depressive disorders. The effect of CT on individuals with an underlying genetic vulnerability to depression may result in differences in depressive phenotype characterized by earlier AO of depression and the expression of specific depressive symptom dimensions. Depression and Anxiety 24:163-168, 2007.

Mental health conditions tend to go unrecognised and untreated in adolescence, and therefore it i... more Mental health conditions tend to go unrecognised and untreated in adolescence, and therefore it is crucial to improve the health and social outcomes for these individuals through age and culturally appropriate interventions. This paper aims firstly to describe the development and implementation of the HYPE project platform (a research and resource platform co-designed and co-produced with young people). The second aim is to describe the characteristics of participants who engaged with the platform and an embedded pilot online survey.A mixed methods design (including focus groups and repeated measures surveys) was used to address aims of the HYPE project. Data were analysed using thematic analysis and descriptive statistics to: (1) help improve access to health and social services, (2) guide provision of information of online resources and (3) deliver complementary community-based events/activities to promote mental health and to ultimately prevent mental health issues.Pilot and main...

Sociology of Health & Illness, 2021

This is an open access article under the terms of the Creat ive Commo ns Attri bution License, wh... more This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Journal of Social Welfare and Family Law, 2022

Utility of the pooling approach as applied to whole genome association scans with highdensity

In the UK, a nationwide lockdown was announced on 23 March 2020 in response to the coronavirus pa... more In the UK, a nationwide lockdown was announced on 23 March 2020 in response to the coronavirus pandemic. The lockdown initially lasted for three weeks but has since been extended. This has raised many questions as to how people cope with extended periods of lockdown, as quarantine has been reported to have various negative effects on wellbeing. Indeed, a recent priority paper highlighted the need for studies which collect high-quality data on the mental health effects of the pandemic and its consequences. This study seeks to explore the health and wellbeing of young adults in the UK.

Ethnicity & Health, 2021

Objective: COVID-19-related inequities experienced by racial and ethnic minority groups including... more Objective: COVID-19-related inequities experienced by racial and ethnic minority groups including healthcare professionals mirror wider health inequities, which risk being perpetuated by lower uptake of vaccination. We aim to better understand lower uptake among racial and ethnic minority staff groups to inform initiatives to enhance uptake. Design: Twenty-five semi-structured interviews were conducted (October 2020-January 2021) with UK-based healthcare staff. Data were inductively and thematically analysed. Results: Vaccine decision-making processes were underpinned by an overarching theme, 'weighing up risks of harm against potential benefits to self and others'. Sub-themes included 'fear of harm', 'moral/ethical objections', 'potential benefits to self and others', 'information and misinformation', and 'institutional or workplace pressure'. We identified ways in which these were weighted more heavily towards vaccine hesitancy for racial and ethnic minority staff groups influenced by perceptions about institutional and structural discrimination. This included suspicions and fear around institutional pressure to be vaccinated, racial injustices in vaccine development and testing, religious or ethical concerns, and legitimacy and accessibility of vaccine messaging and communication. Conclusions: Drawing on a critical race perspective, we conclude that acknowledging historical and contemporary abuses of power is essential to avoid perpetuating and aggravating mistrust by decontextualising hesitancy from the social processes affecting hesitancy, undermining efforts to increase vaccine uptake.

eLife, 2021

We performed a systematic analysis of blood DNA methylation profiles from 4483 participants from ... more We performed a systematic analysis of blood DNA methylation profiles from 4483 participants from seven independent cohorts identifying differentially methylated positions (DMPs) associated with psychosis, schizophrenia, and treatment-resistant schizophrenia. Psychosis cases were characterized by significant differences in measures of blood cell proportions and elevated smoking exposure derived from the DNA methylation data, with the largest differences seen in treatment-resistant schizophrenia patients. We implemented a stringent pipeline to meta-analyze epigenome-wide association study (EWAS) results across datasets, identifying 95 DMPs associated with psychosis and 1048 DMPs associated with schizophrenia, with evidence of colocalization to regions nominated by genetic association studies of disease. Many schizophrenia-associated DNA methylation differences were only present in patients with treatment-resistant schizophrenia, potentially reflecting exposure to the atypical antipsyc...

ABSTRACTObjectivePsychosis - a complex and heterogeneous neuropsychiatric condition characterized... more ABSTRACTObjectivePsychosis - a complex and heterogeneous neuropsychiatric condition characterized by hallucinations and delusions - is a common feature of schizophrenia. There is evidence for altered DNA methylation (DNAm) associated with schizophrenia in both brain and peripheral tissues. We aimed to undertake a systematic analysis of variable DNAm associated with psychosis, schizophrenia, and treatment-resistant schizophrenia, also exploring measures of biological ageing, smoking, and blood cell composition derived from DNAm data to identify molecular biomarkers of disease.MethodsWe quantified DNAm across the genome in blood samples from 4,483 participants from seven case-control cohorts including patients with schizophrenia or first-episode psychosis. Measures of biological age, cellular composition and smoking status were derived from DNAm data using established algorithms. DNAm and derived measures were analyzed within each cohort and the results combined by meta-analysis.Resul...

Inflammatory markers such as cytokines represent potential biomarkers for major depressive disord... more Inflammatory markers such as cytokines represent potential biomarkers for major depressive disorder (MDD). Many, generally small studies have examined the role of single markers and found significant associations. We assessed 42 inflammatory markers, namely cytokines, in the blood of 321 control subjects and 887 MDD cases. We tested whether individual inflammatory marker levels were significantly affected by MDD case/control status, current episode, or current depression severity, co-varying for age, sex, body mass index (BMI), smoking, current antidepressant use, ethnicity, assay batch and study effects. We further used machine learning algorithms to investigate if we could use our data to blindly discriminate MDD patients, or those in a current episode. We found broad and powerful influences of confounding factors on log-protein levels. Notably, IL-6 levels were very strongly influenced by BMI (p = 1.37 × 10−43, variance explained = 18%), while Interleukin-16 was the most signific...