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Social Psychiatry and Psychiatric Epidemiology

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Open Access 01-09-2018 | Original Paper

The association of depression and posttraumatic stress disorder with the metabolic syndrome in a multi-ethnic cohort: the HELIUS study

Authors: Marieke J. van Leijden, Brenda W. J. H. Penninx, Charles Agyemang, Miranda Olff, Marcel C. Adriaanse, Marieke B. Snijder

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 9/2018

Abstract

Purpose

Depression and posttraumatic stress disorder (PTSD) may be linked to the metabolic syndrome (MetS). Consistency of this association across ethnic groups and the influence of comorbidity of depression/PTSD were examined.

Methods

Cross-sectional baseline data from the HELIUS study were used (4527 Dutch, 2999 South-Asian Surinamese, 4058 African Surinamese, 2251 Ghanaian, 3522 Turkish and 3825 Moroccan participants). The Patient Health Questionnaire-9 (PHQ-9) (score range 0–27) measured depressive symptoms. A 9-item questionnaire (score range 0–9) measured PTSD symptoms. The MetS was defined according to the International Diabetes Federation. The association of a depressed mood (PHQ-9 sum score ≥ 10) and severe PTSD symptoms (sum score ≥ 7) with the MetS was examined using logistic regression. Interaction with ethnicity and between a depressed mood and severe PTSD symptoms was tested.

Results

A depressed mood was associated with the MetS [OR (95% CI) = 1.37 (1.24–1.51)] in the total sample and consistent across ethnic groups (p values for interaction all > 0.05). Severe PTSD symptoms were significantly associated with the MetS in the Dutch [OR (95% CI) = 1.71 (1.07–2.73)]. The South-Asian Surinamese, Turks and Moroccans showed weaker associations than the Dutch (p values for interaction all < 0.05). A depressed mood and severe PTSD symptoms did not interact in the association with the MetS (p values for interaction > 0.05).

Conclusions

A depressed mood was consistently associated with the MetS across ethnic groups, but the association between severe PTSD symptoms and the MetS maybe ethnicity dependent. The association with the MetS was not different in case of depressed mood/severe PTSD symptoms comorbidity.

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Alberti KGMM, Eckel RH, Grundy SM et al (2009) Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation. Int Circ 120:1640–1645. https://doi.org/10.1161/CIRCULATIONAHA.109.192644 CrossRef

DeBoer MD, Gurka MJ, Morrison JA, Woo JG (2016) Inter-relationships between the severity of metabolic syndrome, insulin and adiponectin and their relationship to future type 2 diabetes and cardiovascular disease. Int J Obes 40:1353–1359. https://doi.org/10.1038/ijo.2016.81 CrossRef

Rosenbaum S, Stubbs B, Ward PB et al (2015) The prevalence and risk of metabolic syndrome and its components among people with posttraumatic stress disorder: a systematic review and meta-analysis. Metabolism 64:926–933. https://doi.org/10.1016/j.metabol.2015.04.009 CrossRefPubMed

Ghanei Gheshlagh R, Parizad N, Sayehmiri K (2016) The relationship between depression and metabolic syndrome: systematic review and meta-analysis study. Iran Red Crescent Med J 18:e26523. https://doi.org/10.5812/ircmj.26523 PubMedPubMedCentralCrossRef

Conway KP, Green VR, Kasza KA et al (2017) Co-occurrence of tobacco product use, substance use, and mental health problems among adults: findings from Wave 1 (2013–2014) of the Population Assessment of Tobacco and Health (PATH) Study. Drug Alcohol Depend 177:104–111. https://doi.org/10.1016/j.drugalcdep.2017.03.032 CrossRefPubMedPubMedCentral

Penninx BWJH. (2017) Depression and cardiovascular disease: epidemiological evidence on their linking mechanisms. Neurosci Biobehav Rev 74:277–286. https://doi.org/10.1016/j.neubiorev.2016.07.003 CrossRefPubMed

Steudte-Schmiedgen S, Kirschbaum C, Alexander N, Stalder T (2016) An integrative model linking traumatization, cortisol dysregulation and posttraumatic stress disorder: insight from recent hair cortisol findings. Neurosci Biobehav Rev 69:124–135. https://doi.org/10.1016/j.neubiorev.2016.07.015 CrossRefPubMed

Lamers F, Milaneschi Y, de Jonge P et al (2017) Metabolic and inflammatory markers: associations with individual depressive symptoms. Psychol Med. https://doi.org/10.1017/S0033291717002483 CrossRefPubMed

Olff M, van Zuiden M (2017) Neuroendocrine and neuroimmune markers in PTSD: pre-, peri- and post-trauma glucocorticoid and inflammatory dysregulation. Curr Opin Psychol 14:132–137CrossRefPubMed

10.

Vancampfort D, Correll CU, Wampers M et al (2014) Metabolic syndrome and metabolic abnormalities in patients with major depressive disorder: a meta-analysis of prevalences and moderating variables. Psychol Med 44:2017–2028. https://doi.org/10.1017/S0033291713002778 CrossRefPubMed

11.

Pan A, Keum N, Okereke OI et al (2012) Bidirectional association between depression and metabolic syndrome: a systematic review and meta-analysis of epidemiological studies. Diabetes Care 35:1171–1180. https://doi.org/10.2337/dc11-2055 CrossRefPubMedPubMedCentral

12.

Hiles SA, Révész D, Lamers F et al (2016) Bidirectional prospective associations of metabolic syndrome components with depression, anxiety, and antidepressant use. Depress Anxiety 33:754–764. https://doi.org/10.1002/da.22512 CrossRefPubMedPubMedCentral

13.

Vogelzangs N, Beekman ATF, Kritchevsky SB et al (2007) Psychosocial risk factors and the metabolic syndrome in elderly persons: findings from the Health, Aging and Body Composition Study. J Gerontol Ser A Biol Sci Med Sci 62:563–569. https://doi.org/10.1093/gerona/62.5.563 CrossRef

14.

Kinder LS, Carnethon MR, Palaniappan LP et al (2004) Depression and the metabolic syndrome in young adults: findings from the Third National Health and Nutrition Examination Survey. Psychosom Med 66:316–322CrossRefPubMed

15.

Dedert EA, Harper LA, Calhoun PS et al (2013) The impact of race on metabolic disease risk factors in women with and without posttraumatic stress disorder. J Clin Psychol Med Settings 20:46–55. https://doi.org/10.1007/s10880-012-9305-4 CrossRefPubMedPubMedCentral

16.

Sims M, Redmond N, Khodneva Y et al (2015) Depressive symptoms are associated with incident coronary heart disease or revascularization among Blacks but not among Whites in the Reasons for Geographical and Racial Differences in Stroke (REGARDS) Study. Ann Epidemiol 25:426–432. https://doi.org/10.1016/j.annepidem.2015.03.014 CrossRefPubMedPubMedCentral

17.

Lewis TT, Guo H, Lunos S et al (2011) Depressive symptoms and cardiovascular mortality in older African-American and white adults: evidence for a differential association by race. Circ Cardiovasc Qual Outcomes 4:293–299. https://doi.org/10.1161/CIRCOUTCOMES.110.957548 CrossRefPubMedPubMedCentral

18.

Read JG, Gorman BK (2007) Racial/ethnic differences in hypertension and depression among US adult women. Ethn Dis 17:389–396PubMed

19.

Wolf EJ, Bovin MJ, Green JD et al (2016) Longitudinal associations between post-traumatic stress disorder and metabolic syndrome severity. Psychol Med 46:2215–2226. https://doi.org/10.1017/S0033291716000817 CrossRefPubMedPubMedCentral

20.

Babić D, Jakovljević M, Martinac M et al (2007) Metabolic syndrome and combat post-traumatic stress disorder intensity: preliminary findings. Psychiatr Danub 19:68–75PubMed

21.

Jakovljević M, Sarić M, Nad S et al (2006) Metabolic syndrome, somatic and psychiatric comorbidity in war veterans with post-traumatic stress disorder: Preliminary findings. Psychiatr Danub 18:169–176PubMed

22.

Maslov B, Jakovljević M, Crncević Z et al (2008) Metabolic syndrome and schizophrenia from integrative medicine perspective. Psychiatr Danub 20:384–389PubMed

23.

Linnville S, Hoyt RE, Moore JL et al (2011) Posttraumatic stress disorder and metabolic syndrome: retrospective study of repatriated prisoners of war. Mil Med 176:369–374CrossRefPubMed

24.

Heppner PS, Crawford EF, Haji UA et al (2009) The association of posttraumatic stress disorder and metabolic syndrome: a study of increased health risk in veterans. BMC Med 7:1. https://doi.org/10.1186/1741-7015-7-1 CrossRefPubMedPubMedCentral

25.

Jakovljević M, Babić D, Crncević Z et al (2008) Metabolic syndrome and depression in war veterans with post-traumatic stress disorder. Psychiatr Danub 20:406–410PubMed

26.

Nobles CJ, Valentine SE, Borba CPC et al (2016) Black-white disparities in the association between posttraumatic stress disorder and chronic illness. J Psychosom Res 85:19–25. https://doi.org/10.1016/j.jpsychores.2016.03.126 CrossRefPubMedPubMedCentral

27.

Alegría M, Fortuna LR, Lin JY et al (2013) Prevalence, risk, and correlates of posttraumatic stress disorder across ethnic and racial minority groups in the United States. Med Care 51:1114–1123. https://doi.org/10.1097/MLR.0000000000000007 CrossRefPubMedPubMedCentral

28.

Fassaert T, Peen J, van Straten A et al (2010) Ethnic differences and similarities in outpatient treatment for depression in the Netherlands. Psychiatr Serv 61:690–697. https://doi.org/10.1176/ps.2010.61.7.690 CrossRefPubMed

29.

Ikram UZ, Snijder MB, Fassaert TJL et al (2015) The contribution of perceived ethnic discrimination to the prevalence of depression. Eur J Public Health 25:243–248. https://doi.org/10.1093/eurpub/cku180 CrossRefPubMed

30.

Ikram UZ, Snijder MB, Agyemang C et al (2017) Perceived Ethnic Discrimination and the Metabolic Syndrome in Ethnic Minority Groups: The Healthy Life in an Urban Setting Study. Psychosom Med 79:101–111. https://doi.org/10.1097/PSY.0000000000000350 CrossRefPubMed

31.

Williams ED, Nazroo JY, Kooner JS, Steptoe A (2010) Subgroup differences in psychosocial factors relating to coronary heart disease in the UK South Asian population. J Psychosom Res 69:379–387. https://doi.org/10.1016/j.jpsychores.2010.03.015 CrossRefPubMedPubMedCentral

32.

Gualdi-Russo E, Zironi A, Dallari GV, Toselli S (2009) Migration and health in Italy: a multiethnic adult sample. J Travel Med 16:88–95. https://doi.org/10.1111/j.1708-8305.2008.00280.x CrossRefPubMed

33.

Skogberg N, Laatikainen T, Jula A et al (2017) Contribution of sociodemographic and lifestyle-related factors to the differences in metabolic syndrome among Russian, Somali and Kurdish migrants compared with Finns. Int J Cardiol 232:63–69. https://doi.org/10.1016/j.ijcard.2017.01.051 CrossRefPubMed

34.

Marmot M (2016) Society and health of migrants. Eur J Epidemiol 31:639–641. https://doi.org/10.1007/s10654-016-0174-2 CrossRefPubMedPubMedCentral

35.

Farhood LF, Fares S, Sabbagh R, Hamady C (2016) PTSD and depression construct: prevalence and predictors of co-occurrence in a South Lebanese civilian sample. Eur J Psychotraumatol 7:31509CrossRefPubMed

36.

Horesh D, Lowe SR, Galea S et al (2017) An in-depth look into PTSD-depression comorbidity: A longitudinal study of chronically-exposed Detroit residents. J Affect Disord 208:653–661. https://doi.org/10.1016/j.jad.2016.08.053 CrossRefPubMed

37.

Yang H, Wang L, Cao C et al (2017) The underlying dimensions of DSM-5 PTSD symptoms and their relations with anxiety and depression in a sample of adolescents exposed to an explosion accident. Eur J Psychotraumatol 8:1272789. https://doi.org/10.1080/20008198.2016.1272789 CrossRefPubMedPubMedCentral

38.

Weiss T, Skelton K, Phifer J et al (2011) Posttraumatic stress disorder is a risk factor for metabolic syndrome in an impoverished urban population. Gen Hosp Psychiatry 33:135–142. https://doi.org/10.1016/j.genhosppsych.2011.01.002 CrossRefPubMedPubMedCentral

39.

Bartoli F, Crocamo C, Clerici M, Carra G (2015) The association between PTSD and metabolic syndrome: a role for comorbid depression? Metabolism 64:1373–1375CrossRefPubMed

40.

Phillips AC, Batty GD, Gale CR et al (2009) Generalized anxiety disorder, major depressive disorder, and their comorbidity as predictors of all-cause and cardiovascular mortality: the Vietnam experience study. Psychosom Med 71:395–403. https://doi.org/10.1097/PSY.0b013e31819e6706 CrossRefPubMed

41.

Carroll D, Phillips AC, Gale CR, Batty GD (2010) Generalized anxiety and major depressive disorders, their comorbidity and hypertension in middle-aged men. Psychosom Med 72:16–19. https://doi.org/10.1097/PSY.0b013e3181c4fca1 CrossRefPubMed

42.

Stronks K, Snijder MB, Peters RJ et al (2013) Unravelling the impact of ethnicity on health in Europe: the HELIUS study. BMC Public Health 13:402. https://doi.org/10.1186/1471-2458-13-402 CrossRefPubMedPubMedCentral

43.

Stronks K, Kulu-Glasgow I, Agyemang C (2009) The utility of “country of birth” for the classification of ethnic groups in health research: the Dutch experience. Ethn Health 14:255–269. https://doi.org/10.1080/13557850802509206 CrossRefPubMed

44.

Kroenke K, Spitzer RL, Williams JBW, Löwe B (2010) The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry 32:345–359. https://doi.org/10.1016/j.genhosppsych.2010.03.006 CrossRefPubMed

45.

Galenkamp H, Stronks K, Snijder MB, Derks EM (2017) Measurement invariance testing of the PHQ-9 in a multi-ethnic population in Europe: the HELIUS study. BMC Psychiatry 17:349. https://doi.org/10.1186/s12888-017-1506-9 CrossRefPubMedPubMedCentral

46.

Foa EB, Riggs DS, Dancu CV, Rothbaum BO (1993) Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. J Trauma Stress 6:459–473. https://doi.org/10.1002/jts.2490060405 CrossRef

47.

WHO Collaborating Centre for Drug Statistics Methodology (2013) Guidelines for ATC Classification and DDD Assignment 2012. Oslo

48.

Wendel-Vos GCW, Schuit AJ, Saris WHM, Kromhout D (2003) Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity. J Clin Epidemiol 56:1163–1169. https://doi.org/10.1016/S0895-4356(03)00220-8 CrossRefPubMed

49.

Block A, Schipf S, Van der Auwera S et al (2016) Sex- and age-specific associations between major depressive disorder and metabolic syndrome in two general population samples in Germany. Nord J Psychiatry 70:611–620. https://doi.org/10.1080/08039488.2016.1191535 CrossRefPubMed

50.

Assari S, Sonnega A (2016) Racial differences in the predictive role of high depressive symptoms on incident heart disease over 18 years: results from the Health and Retirement Study. Res Cardiovasc Med. https://doi.org/10.5812/cardiovascmed.34767 CrossRef

51.

Gishti O, Gaillard R, Felix JF et al (2015) Early origins of ethnic disparities in cardiovascular risk factors. Prev Med (Baltim) 76:84–91. https://doi.org/10.1016/j.ypmed.2015.03.027 CrossRef

52.

Dekker LH, van Dam RM, Snijder MB et al (2015) Comparable dietary patterns describe dietary behavior across Ethnic Groups in the Netherlands, but different elements in the diet are associated with glycated hemoglobin and fasting glucose concentrations. J Nutr 145:1884–1891. https://doi.org/10.3945/jn.114.207472 CrossRefPubMed

53.

Romeike K, Abidi L, Lechner L et al (2016) Similarities and differences in underlying beliefs of socio-cognitive factors related to diet and physical activity in lower-educated Dutch, Turkish, and Moroccan adults in the Netherlands: a focus group study. BMC Public Health 16:813. https://doi.org/10.1186/s12889-016-3480-4 CrossRefPubMedPubMedCentral

54.

Sumner JA, Kubzansky LD, Elkind MSV et al (2015) Trauma exposure and posttraumatic stress disorder symptoms predict onset of cardiovascular events in women. Circulation 132:251–259. https://doi.org/10.1161/CIRCULATIONAHA.114.014492 CrossRefPubMedPubMedCentral

55.

Agyemang C, Goosen S, Anujuo K, Ogedegbe G (2012) Relationship between post-traumatic stress disorder and diabetes among 105 180 asylum seekers in the Netherlands. Eur J Public Health 22:658–662. https://doi.org/10.1093/eurpub/ckr138 CrossRefPubMed

56.

Chang J-C, Yen AM-F, Chen H-H et al (2017) Comorbid diseases as risk factors for incident posttraumatic stress disorder (PTSD) in a large community cohort (KCIS no.PSY4). Sci Rep 7:41276CrossRefPubMedPubMedCentral

57.

Eraly SA, Nievergelt CM, Maihofer AX et al (2014) Assessment of plasma C-reactive protein as a biomarker of PTSD Risk. JAMA psychiatry 71:423–431. https://doi.org/10.1001/jamapsychiatry.2013.4374 CrossRefPubMedPubMedCentral

58.

Penninx BW, Lange SM (2018) Metabolic syndrome in psychiatric patients: overview, mechanisms and implications. Dialogues Clin Neurosci 20:75–84

59.

Penninx BW, Milaneschi Y, Lamers F, Vogelzangs N (2013) Understanding the somatic consequences of depression: biological mechanisms and the role of depression symptom profile. BMC Med 11:129. https://doi.org/10.1186/1741-7015-11-129 CrossRefPubMedPubMedCentral

60.

Martins CS, Elias D, Colli LM et al (2016) HPA axis dysregulation, NR3C1 polymorphisms and glucocorticoid receptor isoforms imbalance in metabolic syndrome. Diabetes Metab Res Rev 33:e2842. https://doi.org/10.1002/dmrr.2842 CrossRef

61.

Kinlein SA, Wilson CD, Karatsoreos IN (2015) Dysregulated hypothalamic–pituitary–adrenal axis function contributes to altered endocrine and neurobehavioral responses to acute stress. Front Psychiatry 6:31. https://doi.org/10.3389/fpsyt.2015.00031 CrossRefPubMedPubMedCentral

62.

Farr OM, Sloan DM, Keane TM, Mantzoros CS (2014) Stress- and PTSD-associated obesity and metabolic dysfunction: a growing problem requiring further research and novel treatments. Metabolism 63:1463–1468. https://doi.org/10.1016/j.metabol.2014.08.009 CrossRefPubMedPubMedCentral

63.

O’Donovan A (2016) PTSD is associated with elevated inflammation. Any impact on clinical practice? Evid Based Ment Health 19:120. https://doi.org/10.1136/eb-2016-102376 CrossRefPubMedPubMedCentral

Title: The association of depression and posttraumatic stress disorder with the metabolic syndrome in a multi-ethnic cohort: the HELIUS study
Authors: Marieke J. van Leijden
Brenda W. J. H. Penninx
Charles Agyemang
Miranda Olff
Marcel C. Adriaanse
Marieke B. Snijder
Publication date: 01-09-2018
Publisher: Springer Berlin Heidelberg
Published in: Social Psychiatry and Psychiatric Epidemiology / Issue 9/2018
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-018-1533-y

At a glance: The STEP trials

Springer Medicine

The association of depression and posttraumatic stress disorder with the metabolic syndrome in a multi-ethnic cohort: the HELIUS study

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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