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BMC Medicine
Published in: BMC Medicine 1/2020

01-12-2020 | Obesity | Research article

Anxiety and depression in children and adolescents with obesity: a nationwide study in Sweden

Authors: Louise Lindberg, Emilia Hagman, Pernilla Danielsson, Claude Marcus, Martina Persson

Published in: BMC Medicine | Issue 1/2020

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Abstract

Background

Anxiety and depression are more common in children with obesity than in children of normal weight, but it is unclear whether this association is independent of other known risk factors. Interpretation of results from previous studies is hampered by methodological limitations, including self-reported assessment of anxiety, depression, and anthropometry. The aim of this study was to investigate whether obesity increases the risk of anxiety or depression independently of other risk factors in a large cohort of children and adolescents, using robust measures with regard to exposure and outcome.

Methods

Children aged 6–17 years in the Swedish Childhood Obesity Treatment Register (BORIS, 2005–2015) were included (n = 12,507) and compared with a matched group (sex, year of birth, and area of residence) from the general population (n = 60,063). The main outcome was a diagnosis of anxiety or depression identified through ICD codes or dispensed prescribed medication within 3 years after the end of obesity treatment. Hazard ratios (HRs) with 95% confidence intervals (CIs) from Cox proportional models were adjusted for several known confounders.

Results

Obesity remained a significant risk factor for anxiety and depression in children and adolescents after adjusting for Nordic background, neuropsychiatric disorders, family history of anxiety/depression, and socioeconomic status. Girls in the obesity cohort had a 43% higher risk of anxiety and depression compared to girls in the general population (adjusted HR 1.43, 95% CI 1.31–1.57; p < 0.0001). The risk in boys with obesity was similar (adjusted HR 1.33, 95% CI 1.20–1.48; p < 0.0001). In sensitivity analyses, excluding subjects with neuropsychiatric disorders and a family history of anxiety/depression, the estimated risks in individuals with obesity were even higher compared with results from the main analyses (adjusted HR [95% CI]: girls = 1.56 [1.31–1.87], boys = 2.04 [1.64–2.54]).

Conclusions

Results from this study support the hypothesis that obesity per se is associated with risk of both anxiety and depression in children and adolescents.
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Literature
1.
Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015;56(3):345–65.CrossRefPubMed
2.
Charlson F, van Ommeren M, Flaxman A, Cornett J, Whiteford H, Saxena S. New WHO prevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis. Lancet. 2019;394(10194):240–8.CrossRefPubMedPubMedCentral
3.
Quek YH, Tam WWS, Zhang MWB, Ho RCM. Exploring the association between childhood and adolescent obesity and depression: a meta-analysis. Obes Rev. 2017;18(7):742–54.CrossRefPubMed
4.
Esposito M, Gallai B, Roccella M, Marotta R, Lavano F, Lavano SM, et al. Anxiety and depression levels in prepubertal obese children: a case-control study. Neuropsychiatr Dis Treat. 2014;10:1897–902.PubMedPubMedCentral
5.
Erermis S, Cetin N, Tamar M, Bukusoglu N, Akdeniz F, Goksen D. Is obesity a risk factor for psychopathology among adolescents? Pediatr Int. 2004;46(3):296–301.CrossRefPubMed
6.
Goodman E, Whitaker RC. A prospective study of the role of depression in the development and persistence of adolescent obesity. Pediatrics. 2002;110(3):497–504.CrossRefPubMed
7.
Anderson SE, Cohen P, Naumova EN, Jacques PF, Must A. Adolescent obesity and risk for subsequent major depressive disorder and anxiety disorder: prospective evidence. Psychosom Med. 2007;69(8):740–7.CrossRefPubMed
8.
Herva A, Laitinen J, Miettunen J, Veijola J, Karvonen JT, Laksy K, et al. Obesity and depression: results from the longitudinal Northern Finland 1966 Birth Cohort Study. Int J Obes. 2006;30(3):520–7.CrossRef
9.
Anderson SE, Murray DM, Johnson CC, Elder JP, Lytle LA, Jobe JB, et al. Obesity and depressed mood associations differ by race/ethnicity in adolescent girls. Int J Pediatr Obes. 2011;6(1):69–78.CrossRefPubMed
10.
Pryor L, Brendgen M, Boivin M, Dubois L, Japel C, Falissard B, et al. Overweight during childhood and internalizing symptoms in early adolescence: the mediating role of peer victimization and the desire to be thinner. J Affect Disord. 2016;202:203–9.CrossRefPubMed
11.
Gibson LY, Allen KL, Davis E, Blair E, Zubrick SR, Byrne SM. The psychosocial burden of childhood overweight and obesity: evidence for persisting difficulties in boys and girls. Eur J Pediatr. 2017;176(7):925–33.CrossRefPubMed
12.
Emerson E. Prevalence of psychiatric disorders in children and adolescents with and without intellectual disability. J Intellect Dis Res. 2003;47(Pt 1):51–8.CrossRef
13.
Meinzer MC, Pettit JW, Viswesvaran C. The co-occurrence of attention-deficit/hyperactivity disorder and unipolar depression in children and adolescents: a meta-analytic review. Clin Psychol Rev. 2014;34(8):595–607.CrossRefPubMed
14.
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.CrossRefPubMedPubMedCentral
15.
16.
Shrewsbury V, Wardle J. Socioeconomic status and adiposity in childhood: a systematic review of cross-sectional studies 1990-2005. Obesity (Silver Spring). 2008;16(2):275–84.CrossRef
17.
Segal M, Eliasziw M, Phillips S, Bandini L, Curtin C, Kral TV, et al. Intellectual disability is associated with increased risk for obesity in a nationally representative sample of U.S. children. Disability Health J. 2016;9(3):392–8.CrossRef
18.
Gavin AR, Walton E, Chae DH, Alegria M, Jackson JS, Takeuchi D. The associations between socio-economic status and major depressive disorder among Blacks, Latinos, Asians and non-Hispanic Whites: findings from the Collaborative Psychiatric Epidemiology Studies. Psychol Med. 2010;40(1):51–61.CrossRefPubMed
19.
Emilsson L, Lindahl B, Koster M, Lambe M, Ludvigsson JF. Review of 103 Swedish Healthcare Quality Registries. J Intern Med. 2015;277(1):94–136.CrossRefPubMed
20.
Ludvigsson JF, Otterblad-Olausson P, Pettersson BU, Ekbom A. The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research. Eur J Epidemiol. 2009;24(11):659–67.CrossRefPubMedPubMedCentral
21.
Cole TJ, Lobstein T. Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatr Obes. 2012;7(4):284–94.CrossRefPubMed
22.
Ford AL, Hunt LP, Cooper A, Shield JP. What reduction in BMI SDS is required in obese adolescents to improve body composition and cardiometabolic health? Arch Dis Child. 2010;95(4):256–61.CrossRefPubMed
23.
Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, et al. External review and validation of the Swedish national inpatient register. BMC Public Health. 2011;11:450.CrossRefPubMedPubMedCentral
24.
Wallerstedt SM, Wettermark B, Hoffmann M. The first decade with the Swedish prescribed drug register - a systematic review of the output in the scientific literature. Basic Clin Pharmacol Toxicol. 2016;119(5):464–9.CrossRefPubMed
25.
Ludvigsson JF, Almqvist C, Bonamy AK, Ljung R, Michaelsson K, Neovius M, et al. Registers of the Swedish total population and their use in medical research. Eur J Epidemiol. 2016;31(2):125–36.CrossRefPubMed
26.
UNESCO. International standard classification of education: Isced 1997. Re-edition. Paris: UNESCO Institute for Statistics; 2011.
27.
Eschenbeck H, Kohlmann CW, Dudey S, Schurholz T. Physician-diagnosed obesity in German 6- to 14-year-olds. Prevalence and comorbidity of internalising disorders, externalising disorders, and sleep disorders. Obesity Facts. 2009;2(2):67–73.CrossRefPubMedPubMedCentral
28.
Boutelle KN, Hannan P, Fulkerson JA, Crow SJ, Stice E. Obesity as a prospective predictor of depression in adolescent females. Health Psychol. 2010;29(3):293–8.CrossRefPubMedPubMedCentral
29.
Smoller JW. The genetics of stress-related disorders: PTSD, depression, and anxiety disorders. Neuropsychopharmacol. 2016;41(1):297–319.CrossRef
30.
Kane P, Garber J. The relations among depression in fathers, children’s psychopathology, and father–child conflict: a meta-analysis. Clin Psychol Rev. 2004;24(3):339–60.CrossRefPubMed
31.
Goodman SH, Rouse MH, Connell AM, Broth MR, Hall CM, Heyward D. Maternal depression and child psychopathology: a meta-analytic review. Clin Child Fam Psychol Rev. 2011;14(1):1–27.CrossRefPubMed
32.
Goodman E, Slap GB, Huang B. The public health impact of socioeconomic status on adolescent depression and obesity. Am J Public Health. 2003;93(11):1844–50.CrossRefPubMedPubMedCentral
33.
Pagoto S, Bodenlos JS, Kantor L, Gitkind M, Curtin C, Ma Y. Association of major depression and binge eating disorder with weight loss in a clinical setting. Obesity (Silver Spring). 2007;15(11):2557–9.CrossRef
34.
Braden A, Musher-Eizenman D, Watford T, Emley E. Eating when depressed, anxious, bored, or happy: are emotional eating types associated with unique psychological and physical health correlates? Appetite. 2018;125:410–7.CrossRefPubMed
35.
WorldHealthOrganization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 1992.
36.
Berk M, Williams LJ, Jacka FN, O’Neil A, Pasco JA, Moylan S, et al. So depression is an inflammatory disease, but where does the inflammation come from? BMC Med. 2013;11:200.CrossRefPubMedPubMedCentral
37.
Harbron J, van der Merwe L, Zaahl MG, Kotze MJ, Senekal M. Fat mass and obesity-associated (FTO) gene polymorphisms are associated with physical activity, food intake, eating behaviors, psychological health, and modeled change in body mass index in overweight/obese Caucasian adults. Nutrients. 2014;6(8):3130–52.CrossRefPubMedPubMedCentral
38.
Sidorchuk A, Isomura K, Molero Y, Hellner C, Lichtenstein P, Chang Z, et al. Benzodiazepine prescribing for children, adolescents, and young adults from 2006 through 2013: a total population register-linkage study. PLoS Med. 2018;15(8):e1002635.CrossRefPubMedPubMedCentral
39.
Bachmann CJ, Aagaard L, Burcu M, Glaeske G, Kalverdijk LJ, Petersen I, et al. Trends and patterns of antidepressant use in children and adolescents from five western countries, 2005–2012. Eur Neuropsychopharmacol. 2016;26(3):411–9.CrossRefPubMed
40.
Reekie J, Hosking SP, Prakash C, Kao KT, Juonala M, Sabin MA. The effect of antidepressants and antipsychotics on weight gain in children and adolescents. Obes Rev. 2015;16(7):566–80.CrossRefPubMed
41.
Weisz JR, Chorpita BF, Palinkas LA, Schoenwald SK, Miaranda J, Bearman SK, et al. Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: a randomized effectiveness trial. Arch Gen Psychiatry. 2012;69(3):274–82.CrossRefPubMed
42.
Reeves GM, Postolache TT, Snitker S. Childhood obesity and depression: connection between these growing problems in growing children. Int J Child Health Hum Dev. 2008;1(2):103–14.PubMedPubMedCentral
43.
Puhl RM, King KM. Weight discrimination and bullying. Best Pract Res Clin Endocrinol Metab. 2013;27(2):117–27.CrossRefPubMed
44.
Eriksson M, Lingfors H, Golsäter M. Trends in prevalence of thinness, overweight and obesity among Swedish children and adolescents between 2004 and 2015. Acta Paediatr. 2018;107(10):1818-25.
45.
Kohn R, Saxena S, Levav I, Saraceno B. The treatment gap in mental health care. Bull World Health Organ. 2004;82:858–66.PubMedPubMedCentral
Metadata
Title
Anxiety and depression in children and adolescents with obesity: a nationwide study in Sweden
Authors
Louise Lindberg
Emilia Hagman
Pernilla Danielsson
Claude Marcus
Martina Persson
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2020
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-020-1498-z

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