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Few prospective cohort studies describe the risk of type 2 diabetes mellitus associated with depression or anxiety. We aimed to determine the 2-year diabetes incidence and pattern of explanatory factors associated with depressive and/or anxiety disorders.
A prospective cohort of 2,981 participants (aged 18–65 years, 66% women) recruited in the NESDA from community, primary care and outpatient psychiatric clinics were followed-up for two years. Complete data were analyzed from 2,460 participants without baseline diabetes. Lifetime or current (past 6-month) depressive and/or anxiety disorders at baseline were assessed using the CIDI and classified by the DSM-IV. Diabetes was classified by either self-report, medications, or fasting plasma glucose ≥7.0mmol/L. Baseline covariates included age, gender, lifestyle factors, and medical conditions. Odds ratios (OR[95% confidence intervals]) for diabetes were determined using exact logistic regression.
The unadjusted 2-year diabetes incidence was 0.2% (1/571), 1.1% (6/548), and 1.8% (24/1,340) for no, remitted, and current depressive and/or anxiety disorders, respectively. In comparison to controls, current depressive and/or anxiety disorders was associated with diabetes incidence in unadjusted (OR 10.4[1.7,429.0]) and age-adjusted (OR 11.9[1.9,423.0]) analyses. The strength of this association (β) was slightly changed after further adjustments for impaired fasting glucose (11.4%), high triglycerides (−7.8%), and lifestyle cumulative risk score (−5.0%), in contrast to other covariates when assessed in separate models.
The relative odds of developing diabetes within two years was increased for persons with current depressive and/or anxiety disorders, which was partially explained by, but remained independent of, lifestyle cumulative risk factors.
Depression is associated with the metabolic syndrome (MS). Recently, the concept of ‘metabolic depression’ has been proposed based on a protracted course of depressive symptoms over time.
Objective and aims
Within the Netherlands study of depression in older persons, we examined whether metabolic dysregulation predicted the two-year course of depression.
A cohort study (n = 285) of depressed persons (≥60 years) with two-year follow up. Depression was classified according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Severity of depression was assessed with sum score as well as subscale scores of the Inventory of Depressive Symptomatology (IDS) at six-month intervals. The metabolic syndrome was defined according the National Cholesterol Education Program (NCEP-ATP III). We applied logistic regression and linear mixed models adjusted for a wide range of confounders and severity of depression at baseline.
The number of MS-components predicted non-remission at two-years (OR = 1.28 [95% CI: 1.00–1.58], P = 0.047), which was driven by waist-circumference, HDL-cholesterol and triglycerides. MS was only associated with the somatic symptom subscale score of the IDS over time, but not with its sum score (interaction time × somatic subscale, P = 0.002). This effect was driven by waist circumference, elevated fasting glucose level and hypertension.
Metabolic dysregulation predicts the course of late-life depression. This effect seems to be driven by visceral obesity (as indicated by the waist circumference) and lipid dysregulations and with respect to the somatic symptoms of depression.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Depression is associated with the metabolic syndrome (MS). We examined whether metabolic dysregulation predicted the 2-year course of clinical depression.
A total of 285 older persons (⩾60 years) suffering from depressive disorder according to DSM-IV-TR criteria was followed up for 2 years. Severity of depression was assessed with the Inventory of Depressive Symptomatology (IDS) at 6-month intervals. Metabolic syndrome was defined according the National Cholesterol Education Programme (NCEP-ATP III). We applied logistic regression and linear mixed models adjusted for age, sex, years of education, smoking, alcohol use, physical activity, somatic co-morbidity, cognitive functioning and drug use (antidepressants, anti-inflammatory drugs) and severity of depression at baseline.
MS predicted non-remission at 2 years (odds ratioper component = 1.26, 95% confidence interval 1.00–1.58), p = 0.047), which was driven by the waist circumference and HDL cholesterol. MS was not associated with IDS sum score. Subsequent analyses on its subscales, however, identified an association with the somatic symptom subscale score over time (interaction time × somatic subscale, p = 0.005), driven by higher waist circumference and elevated fasting glucose level.
Metabolic dysregulation predicts a poor course of late-life depression. This finding supports the concept of ‘metabolic depression’, recently proposed on population-based findings of a protracted course of depressive symptoms in the presence of metabolic dysregulation. Our findings seem to be driven by abdominal obesity (as indicated by the waist circumference) and HDL cholesterol dysregulation.
Much is still unclear about the role of personality in the structure of common psychiatric disorders such as depressive/anxiety disorders and alcohol dependence. This study will therefore examine whether various traits of negative emotionality and impulsivity showed shared or specific associations with these disorders.
Cross-sectional data were used from the Netherlands Study of Depression and Anxiety (NESDA), including individuals with no DSM-IV psychiatric disorder (n = 460), depressive/anxiety disorder only (i.e. depressive and/or anxiety disorder; n = 1398), alcohol dependence only (n = 32) and co-morbid depressive/anxiety disorder plus alcohol dependence (n = 358). Aspects of negative emotionality were neuroticism, hopelessness, rumination, worry and anxiety sensitivity, whereas aspects of impulsivity included disinhibition, thrill/adventure seeking, experience seeking and boredom susceptibility.
Aspects of negative emotionality formed a homogeneous dimension, which was unrelated to the more heterogeneous construct of impulsivity. Although all aspects of negative emotionality were associated with alcohol dependence only, associations were much stronger for depressive/anxiety disorder only and co-morbid depressive/anxiety disorder with alcohol dependence. The results for impulsivity traits were less profound and more variable, with disinhibition and boredom susceptibility showing modest associations with both depressive/anxiety disorder and alcohol dependence, whereas low thrill/adventure seeking and high disinhibition were more strongly related with the first and the latter, respectively.
Our results suggest that depressive/anxiety disorder and alcohol dependence result from shared as well as specific aetiological pathways as they showed the same associations with all aspects of negative emotionality, disinhibition and boredom susceptibility as well as specific associations with thrill/adventure seeking and disinhibition.
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