Top

BMC Psychiatry

Published in:

Open Access 01-12-2018 | Research article

Does presence of metabolic syndrome impact anxiety and depressive disorder screening results in middle aged and elderly individuals? A population based study

Authors: Jurate Butnoriene, Vesta Steibliene, Ausra Saudargiene, Adomas Bunevicius

Published in: BMC Psychiatry | Issue 1/2018

Abstract

Background

Depressive and anxiety disorders are common in primary care setting but often remain undiagnosed. Metabolic syndrome (MetS) is also prevalent in the general population and can impair recognition of common mental disorders due to significant co-morbidity and overlap with psychiatric symptoms included in self-reported depression/anxiety screening tools. We investigated if MetS has an impact on the accuracy of current major depressive disorder (MDD) and generalized anxiety disorder (GAD) screening results using the Hospital Anxiety and Depression scale (HADS).

Methods

A total of 1115 (562 men; mean age 62.0 ± 9.6 years) individuals of 45+ years of age were randomly selected from the general population and evaluated for current MetS; depressive and anxiety symptoms (HADS); and current MDD and GAD (Mini International Neuropsychiatric Interview [MINI]).

Results

The MetS was diagnosed in 34.4% of the study participants. Current MDD and GAD were more common in individuals with MetS relative to individuals without MetS (25.3% vs 14.2%, respectively, p < 0.001; and 30.2% vs 20.9%, respectively, p < 0.001). The ROC analyses demonstrated that optimal thresholds of the HADS-Depression subscale for current MDE were ≥9 in individuals with MetS (sensitivity = 87%, specificity = 73% and PPV = 52%) and ≥8 in individuals without MetS (sensitivity = 81%, specificity = 78% and PPV = 38%). At threshold of ≥9 the HADS-Anxiety subscale demonstrated optimal psychometric properties for current GAD screening in individuals with MetS (sensitivity = 91%, specificity = 85% and PPV = 72%) and without MetS (sensitivity = 84%, specificity = 83% and PPV = 56%).

Conclusions

The HADS is a reliable screening tool for current MDE and GAD in middle aged and elderly population with and without MetS. Optimal thresholds of the HADS-Depression subscale for current MDD is ≥9 for individuals with MetS and ≥8 - without MetS. Optimal threshold of the HADS-Anxiety subscale is ≥9 for current GAD in individuals with and without MetS. The presence of MetS should be considered when interpreting depression screening results.

Bunevicius R, Liaugaudaite V, Peceliuniene J, Raskauskiene N, Bunevicius A, Mickuviene N. Factors affecting the presence of depression, anxiety disorders, and suicidal ideation in patients attending primary health care service in Lithuania. Scand J Prim Health Care. 2014;32(1):24–9. https://doi.org/10.3109/02813432.2013.873604.PubMedPubMedCentralCrossRef

Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51(1):8–19.PubMedCrossRef

Wittchen HU, Kessler RC, Beesdo K, Krause P, Hofler M, Hoyer J. Generalized anxiety and depression in primary care: prevalence, recognition, and management. The Journal of clinical psychiatry. 2002;63(Suppl 8):24–34.PubMed

Kroenke K, Spitzer RL, Williams JB, Monahan PO, Lowe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317–25.PubMedCrossRef

Combs H, Markman J. Anxiety disorders in primary care. The Medical clinics of North America. 2014;98(5):1007–23. https://doi.org/10.1016/j.mcna.2014.06.003.PubMedCrossRef

Roy-Byrne PP, Wagner A. Primary care perspectives on generalized anxiety disorder. J Clin Psychiatry. 2004;65(Suppl 13):20–6.PubMed

Kessler RC, Keller MB, Wittchen HU. The epidemiology of generalized anxiety disorder. The Psychiatric clinics of North America. 2001;24(1):19–39.PubMedCrossRef

Stein MB, Sherbourne CD, Craske MG, Means-Christensen A, Bystritsky A, Katon W, et al. Quality of care for primary care patients with anxiety disorders. Am J Psychiatry. 2004;161(12):2230–7. https://doi.org/10.1176/appi.ajp.161.12.2230.PubMedCrossRef

Munk-Jorgensen P, Allgulander C, Dahl AA, Foldager L, Holm M, Rasmussen I, et al. Prevalence of generalized anxiety disorder in general practice in Denmark, Finland, Norway, and Sweden. Psychiatr Serv. 2006;57(12):1738–44. https://doi.org/10.1176/appi.ps.57.12.1738.PubMedCrossRef

10.

Stein MB. Public health perspectives on generalized anxiety disorder. The Journal of clinical psychiatry. 2004;65(Suppl 13):3–7.PubMed

11.

Rickels K, Rynn MA. What is generalized anxiety disorder? J Clin Psychiatry. 2001;62(Suppl 11):4–12. discussion 3-4PubMed

12.

Andrews G, Hobbs MJ, Borkovec TD, Beesdo K, Craske MG, Heimberg RG, et al. Generalized worry disorder: a review of DSM-IV generalized anxiety disorder and options for DSM-V. Depress Anxiety. 2010;27(2):134–47. https://doi.org/10.1002/da.20658.PubMedCrossRef

13.

Hawgood J, De Leo D. Anxiety disorders and suicidal behaviour: an update. Current opinion in psychiatry. 2008;21(1):51–64. https://doi.org/10.1097/YCO.0b013e3282f2309d.PubMedCrossRef

14.

Cougle JR, Keough ME, Riccardi CJ, Sachs-Ericsson N. Anxiety disorders and suicidality in the National Comorbidity Survey-Replication. J Psychiatr Res. 2009;43(9):825–9. https://doi.org/10.1016/j.jpsychires.2008.12.004.PubMedCrossRef

15.

Culpepper L. Generalized anxiety disorder in primary care: emerging issues in management and treatment. J Clin Psychiatry. 2002;63(Suppl 8):35–42.PubMed

16.

Roberge P, Normand-Lauziere F, Raymond I, Luc M, Tanguay-Bernard MM, Duhoux A, et al. Generalized anxiety disorder in primary care: mental health services use and treatment adequacy. BMC Fam Pract. 2015;16(1):146. https://doi.org/10.1186/s12875-015-0358-y.PubMedPubMedCentralCrossRef

17.

Katon W, Roy-Byrne P. Anxiety disorders: efficient screening is the first step in improving outcomes. Ann Intern Med. 2007;146(5):390–2.PubMedCrossRef

18.

Garcia-Campayo J, del Hoyo YL, Valero MS, Yus MC, Esteban EA, Guedea MP, et al. Primary prevention of anxiety disorders in primary care: a systematic review. Prev Med. 2015;76(Suppl):S12–5. https://doi.org/10.1016/j.ypmed.2014.10.015.PubMedCrossRef

19.

Screening for depression in adults. U.S. preventive services task force recommendation statement. Ann Intern Med. 2009;151(11):784–92. https://doi.org/10.7326/0003-4819-151-11-200912010-00006.CrossRef

20.

Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602. https://doi.org/10.1001/archpsyc.62.6.593.PubMedCrossRef

21.

Qin X, Wang W, Jin Q, Ai L, Li Y, Dong G, et al. Prevalence and rates of recognition of depressive disorders in internal medicine outpatient departments of 23 general hospitals in Shenyang, China. J Affect Disord. 2008;110(1–2):46–54. https://doi.org/10.1016/j.jad.2007.12.237.PubMedCrossRef

22.

Sartorius N, Ustun TB, Costa e Silva JA, Goldberg D, Lecrubier Y, Ormel J, et al. An international study of psychological problems in primary care. Preliminary report from the World Health Organization collaborative project on ‘Psychological problems in general health Care’. Arch Gen Psychiatry. 1993;50(10):819–24.PubMedCrossRef

23.

Lecrubier Y. Widespread underrecognition and undertreatment of anxiety and mood disorders: results from 3 European studies. The Journal of clinical psychiatry. 2007;68(Suppl 2):36–41.PubMed

24.

Simon GE, VonKorff M. Recognition, management, and outcomes of depression in primary care. Arch Fam Med. 1995;4(2):99–105.PubMedCrossRef

25.

Guide to Clinical Preventive Services. 2 ed. Baltimore: Williams & Wilkins; 1996.

26.

Depression: The Treatment and Management of Depression in Adults (Updated Edition). National Institute for Health and Clinical Excellence: Guidance. Leicester (UK)2010.

27.

Thombs BD, Ziegelstein RC. Does depression screening improve depression outcomes in primary care? BMJ. 2014;348:g1253. https://doi.org/10.1136/bmj.g1253.PubMedCrossRef

28.

Allaby M. Revised report. Screening for depression: a report for the UK National Screening Committee. 2010;

29.

Joffres M, Jaramillo A, Dickinson J, Lewin G, Pottie K, Shaw E, et al. Recommendations on screening for depression in adults. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2013;185(9):775–82. https://doi.org/10.1503/cmaj.130403.PubMedCrossRef

30.

Siu AL, Bibbins-Domingo K, Grossman DC, Baumann LC, Davidson KW, Ebell M, et al. Screening for depression in adults: US preventive services task force recommendation statement. JAMA. 2016;315(4):380–7. https://doi.org/10.1001/jama.2015.18392.PubMedCrossRef

31.

Pan A, Keum N, Okereke OI, Sun Q, Kivimaki M, Rubin RR, et al. Bidirectional association between depression and metabolic syndrome: a systematic review and meta-analysis of epidemiological studies. Diabetes Care. 2012;35(5):1171–80. https://doi.org/10.2337/dc11-2055.PubMedPubMedCentralCrossRef

32.

Procopiou M, Philippe J. The metabolic syndrome and type 2 diabetes: epidemiological figures and country specificities. Cerebrovasc Dis. 2005;20(Suppl 1):2–8. https://doi.org/10.1159/000088231.PubMedCrossRef

33.

van Vliet-Ostaptchouk JV, Nuotio ML, Slagter SN, Doiron D, Fischer K, Foco L, et al. The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies. BMC Endocr Disord. 2014;14:9. https://doi.org/10.1186/1472-6823-14-9.PubMedPubMedCentralCrossRef

34.

Dunbar JA, Reddy P, Davis-Lameloise N, Philpot B, Laatikainen T, Kilkkinen A, et al. Depression: an important comorbidity with metabolic syndrome in a general population. Diabetes Care. 2008;31(12):2368–73. https://doi.org/10.2337/dc08-0175.PubMedPubMedCentralCrossRef

35.

Heiskanen TH, Niskanen LK, Hintikka JJ, Koivumaa-Honkanen HT, Honkalampi KM, Haatainen KM, et al. Metabolic syndrome and depression: a cross-sectional analysis. The Journal of clinical psychiatry. 2006;67(9):1422–7.PubMedCrossRef

36.

Skilton MR, Moulin P, Terra JL, Bonnet F. Associations between anxiety, depression, and the metabolic syndrome. Biol Psychiatry. 2007;62(11):1251–7. https://doi.org/10.1016/j.biopsych.2007.01.012.PubMedCrossRef

37.

Carroll D, Phillips AC, Thomas GN, Gale CR, Deary I, Batty GD. Generalized anxiety disorder is associated with metabolic syndrome in the Vietnam experience study. Biol Psychiatry. 2009;66(1):91–3. https://doi.org/10.1016/j.biopsych.2009.02.020.PubMedCrossRef

38.

Butnoriene J, Bunevicius A, Norkus A, Bunevicius R. Depression but not anxiety is associated with metabolic syndrome in primary care based community sample. Psychoneuroendocrinology. 2014;40:269–76. https://doi.org/10.1016/j.psyneuen.2013.11.002.PubMedCrossRef

39.

Tziallas D, Kostapanos MS, Skapinakis P, Milionis HJ, Athanasiou T, SE M, et al. The association between type D personality and the metabolic syndrome: a cross-sectional study in a university-based outpatient lipid clinic. BMC research notes. 2011;4:105. https://doi.org/10.1186/1756-0500-4-105.PubMedPubMedCentralCrossRef

40.

Kaur J. A comprehensive review on metabolic syndrome. Cardiol Res Pract. 2014;2014:943162. https://doi.org/10.1155/2014/943162.PubMedPubMedCentralCrossRef

41.

Martinac M, Pehar D, Karlovic D, Babic D, Marcinko D, Jakovljevic M. Metabolic syndrome, activity of the hypothalamic-pituitary-adrenal axis and inflammatory mediators in depressive disorder. Acta clinica Croatica. 2014;53(1):55–71.PubMed

42.

Remus JL, Stewart LT, Camp RM, Novak CM, Johnson JD. Interaction of metabolic stress with chronic mild stress in altering brain cytokines and sucrose preference. Behav Neurosci. 2015;129(3):321–30. https://doi.org/10.1037/bne0000056.PubMedPubMedCentralCrossRef

43.

Miettola J, Niskanen LK, Viinamaki H, Kumpusalo E. Metabolic syndrome is associated with self-perceived depression. Scand J Prim Health Care. 2008;26(4):203–10. https://doi.org/10.1080/02813430802117624.PubMedPubMedCentralCrossRef

44.

Kessler RC. The categorical versus dimensional assessment controversy in the sociology of mental illness. J Health Soc Behav. 2002;43(2):171–88.PubMedCrossRef

45.

Bunevicius A, Peceliuniene J, Mickuviene N, Valius L, Bunevicius R. Screening for depression and anxiety disorders in primary care patients. Depression and anxiety. 2007;24(7):455–60. https://doi.org/10.1002/da.20274.PubMedCrossRef

46.

Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70.PubMedCrossRef

47.

Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the hospital anxiety and depression scale. An updated literature review. J Psychosom Res. 2002;52(2):69–77.PubMedCrossRef

48.

Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of clinical psychiatry. 1998;59(Suppl 20):22–33. quiz 4-57PubMed

49.

DSM-IV-TR. Diagnostic and statistical manual of mental disorders. Fourth ed. text revision ed. Washington: American Psychiatric Association; 2000.

50.

Bunevicius A, Staniute M, Brozaitiene J, Pop VJ, Neverauskas J, Bunevicius R. Screening for anxiety disorders in patients with coronary artery disease. Health Qual Life Outcomes. 2013;11:37. https://doi.org/10.1186/1477-7525-11-37.PubMedPubMedCentralCrossRef

51.

Genuth S, Alberti KG, Bennett P, Buse J, Defronzo R, Kahn R, et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care. 2003;26(11):3160–7.PubMedCrossRef

52.

Katsuki A, Sumida Y, Gabazza EC, Murashima S, Furuta M, Araki-Sasaki R, et al. Homeostasis model assessment is a reliable indicator of insulin resistance during follow-up of patients with type 2 diabetes. Diabetes Care. 2001;24(2):362–5.PubMedCrossRef

53.

International Standards for Anthropometric Assessment. International Society for the Advancement of Kinanthropometry (ISAK); 2001.

54.

Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. Obes Res. 1998;6(Suppl 2):51S–209S.

55.

Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabetic medicine : a journal of the British Diabetic Association. 1998;15(7):539–53. https://doi.org/10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S.CrossRef

56.

Gonen M. Selecting an optimal threshold. Analyzing receiver operating characteristic curves with SAS. Cary: SAS Institute Inc; 2007. p. 25–6.

57.

Strauss RS. Childhood obesity and self-esteem. Pediatrics. 2000;105(1):e15.PubMedCrossRef

58.

Botega NJ, Bio MR, Zomignani MA, Garcia CJ, Pereira WA. Mood disorders among inpatients in ambulatory and validation of the anxiety and depression scale HAD. Rev Saude Publica. 1995;29(5):355–63.PubMedCrossRef

59.

Morriss RK, Wearden AJ. Screening instruments for psychiatric morbidity in chronic fatigue syndrome. J R Soc Med. 1998;91(7):365–8.PubMedPubMedCentralCrossRef

60.

Spinhoven P, Ormel J, Sloekers PP, Kempen GI, Speckens AE, Van Hemert AM. A validation study of the hospital anxiety and depression scale (HADS) in different groups of Dutch subjects. Psychol Med. 1997;27(2):263–70.CrossRef

61.

Hopwood P, Howell A, Maguire P. Screening for psychiatric morbidity in patients with advanced breast cancer: validation of two self-report questionnaires. Br J Cancer. 1991;64(2):353–6.PubMedPubMedCentralCrossRef

62.

Razavi D, Delvaux N, Bredart A, Paesmans M, Debusscher L, Bron D, et al. Screening for psychiatric disorders in a lymphoma out-patient population. Eur J Cancer. 1992;28A(11):1869–72.PubMedCrossRef

63.

Berard RM, Boermeester F, Viljoen G. Depressive disorders in an out-patient oncology setting: prevalence, assessment, and management. Psychooncology. 1998;7(2):112–20.PubMedCrossRef

64.

Haworth JE, Moniz-Cook E, Clark AL, Wang M, Cleland JG. An evaluation of two self-report screening measures for mood in an out-patient chronic heart failure population. International journal of geriatric psychiatry. 2007;22(11):1147–53. https://doi.org/10.1002/gps.1807.PubMedCrossRef

65.

Bunevicius A, Staniute M, Brozaitiene J, Bunevicius R. Diagnostic accuracy of self-rating scales for screening of depression in coronary artery disease patients. J Psychosom Res. 2012;72(1):22–5. https://doi.org/10.1016/j.jpsychores.2011.10.006.PubMedCrossRef

66.

Martin CR, Thompson DR, Barth J. Factor structure of the hospital anxiety and depression scale in coronary heart disease patients in three countries. J Eval Clin Pract. 2008;14(2):281–7. https://doi.org/10.1111/j.1365-2753.2007.00850.x.PubMedCrossRef

67.

Miettola J, Niskanen LK, Viinamäki H, Kumpusalo E. Metabolic syndrome is associated with self-perceived depression. Scand J Prim Health Care. 2008;26(4):2013–0. https://doi.org/10.1080/02813430802117624.CrossRef

68.

Freeman A, Tyrovolas S, Koyanagi A, Chatterji S, Leonardi M, Ayuso-Mateos JL, et al. The role of socio-economic status in depression: results from the COURAGE (aging survey in Europe). BMC Public Health. 2016;16(1):1098. https://doi.org/10.1186/s12889-016-3638-0.PubMedPubMedCentralCrossRef

69.

el-Rufaie OE, Absood GH. Retesting the validity of the Arabic version of the hospital anxiety and depression (HAD) scale in primary health care. Soc Psychiatry Psychiatr Epidemiol. 1995;30(1):26–31.PubMedCrossRef

70.

Butnoriene J, Bunevicius A, Saudargiene A, Nemeroff CB, Norkus A, Ciceniene V, et al. Metabolic syndrome, major depression, generalized anxiety disorder, and ten-year all-cause and cardiovascular mortality in middle aged and elderly patients. Int J Cardiol. 2015;190:360–6. https://doi.org/10.1016/j.ijcard.2015.04.122.PubMedCrossRef

71.

Lecrubier Y. The burden of depression and anxiety in general medicine. J Clin Psychiatry. 2001;62(Suppl 8 (4-9 )):discussion 10–1.

72.

Kassi E, Pervanidou P, Kaltsas G, Chrousos G. Metabolic syndrome: definitions and controversies. BMC Med. 2011;9:48. https://doi.org/10.1186/1741-7015-9-48.PubMedPubMedCentralCrossRef

73.

Alberti KG, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, et al. 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; international atherosclerosis society; and International Association for the Study of obesity. Circulation. 2009;120(16):1640–5. https://doi.org/10.1161/CIRCULATIONAHA.109.192644.PubMedCrossRef

Title: Does presence of metabolic syndrome impact anxiety and depressive disorder screening results in middle aged and elderly individuals? A population based study
Authors: Jurate Butnoriene
Vesta Steibliene
Ausra Saudargiene
Adomas Bunevicius
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Psychiatry / Issue 1/2018
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-017-1576-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Does presence of metabolic syndrome impact anxiety and depressive disorder screening results in middle aged and elderly individuals? A population based study

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Prospective observational cohort study of ‘treatment as usual’ over four years for patients with schizophrenia in a national forensic hospital

Requirements for the implementation of open door policies in acute psychiatry from a mental health professionals’ and patients’ view: a qualitative interview study

Depression and glycaemic control among type 2 diabetes patients: a cross-sectional study in a tertiary healthcare facility in Ghana

Decision making and support available to individuals considering and undertaking electroconvulsive therapy (ECT): a qualitative, consumer-led study

The “Clinician’s illusion” and the epidemiology, diagnosis and treatment of depressive disorders

Prospective, randomized, double-blind, placebo-controlled phase IIa clinical trial on the effects of an estrogen-progestin combination as add-on to inpatient psychotherapy in adult female patients suffering from anorexia nervosa