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From the Center for Obesity Research and Education (E.M.G.), Temple University, Philadelphia, Pennsylvania; and the Departments of Epidemiology (J.B., K.A.M.), Psychiatry, and Psychology (K.A.M.), University of Pittsburgh, Pittsburgh, Pennsylvania.
Address correspondence and reprint requests to Edie M. Goldbacher, Center for Obesity Research and Education, 3223 N. Broad Street, Suite 175, Philadelphia, PA 19140. E-mail: ediemg{at}temple.edu
Objective: To prospectively examine the association of major depression with incidence of the metabolic syndrome in women.
Methods: Data were drawn from one of seven sites of the Study of Women’s Health Across the Nation (SWAN), a prospective cohort study of the menopausal transition. Participants were 429 (34.5% African-American) women. Major depression and comorbid diagnoses were assessed via the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Axis I Disorders at baseline and seven annual follow-up evaluations. The metabolic syndrome was measured at baseline and each follow-up evaluation (except the second) based on National Cholesterol Education Program (NCEP) criteria.
Results: Longitudinal generalized estimating equations (GEE) models indicated that, in women who were free of the metabolic syndrome at baseline, a lifetime major depression history or current major depressive episode at baseline was significantly associated with the onset and presence of the metabolic syndrome during the follow-up (odds ratio = 1.82; 95% Confidence Interval (CI) = 1.06–3.14). Survival analyses showed that, in women who were free of the metabolic syndrome at baseline, a lifetime major depression history or current major depressive episode at baseline predicted increased risk of developing the metabolic syndrome during the follow-up (hazard ratio = 1.66; 95% CI = 0.99-3.75). Lifetime history of alcohol abuse or dependence predicted incident metabolic syndrome and attenuated the association between depression and the metabolic syndrome in both models.
Conclusions: This study documents that major depression is a significant predictor of the onset of the metabolic syndrome. Intervention studies targeting depression may prevent the development of the metabolic syndrome in women.
Key Words: metabolic syndrome • depression • women • menopause • alcohol
Abbreviations: CAD = coronary artery disease; NHANES = National Health and Nutrition Examination Study; SWAN = Study of Women’s Health Across the Nation; SCID-IV/NP = Structured Clinical Interview for the Diagnostic and Statistical Manual-IV Axis-I Disorders-Non-Patient Edition; HDL-C = high-density lipoprotein cholesterol; SBP/DBP = systolic/diastolic blood pressure; GEE = generalized estimating equations; OR = odds ratio; CI = Confidence Interval; HR = hazard ratio; HPA = hypothalamic pituitary adrenal; ANS = autonomic nervous system.
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