Major Depressive Episode,

1
Major Depressive Episode, Subsyndromal Depression
and Obesity in Young Adults
Bruce S. Jonas, Sc.M., Ph.D. Juan Rafael
Albertorio-Diaz, MA Marc Safran, MD, MPA Mark S.
Eberhardt, Ph.D.
2
Background

• Depression is prospectively associated with
  incidence of diabetes
• Obesity is a risk factor for diabetes
• Depression measured by
• Symptom checklists
• Psychiatric interview schedules

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Past research

• Obesity has reached epidemic proportions.
• The association of obesity and depression is not
  conclusive.
• Subsyndromal Depression has been under researched
  in the general population.
• Obesity and depression in young adults has been
  under researched.

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Research questions

• Are depression categories Major Depressive
  Episode (MDE) and Subsyndromal Depression (sD)
  associated with obesity?
• Are depression categories (MDE and sD) associated
  with obesity by gender?

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Major Depressive EpisodeDefinitions

• Persistent (for at least 2 weeks) lowered mood
• Sad, empty, and depressed
• Loss of interest
• Irritable most of the time

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Major Depressive EpisodeDefinitions (continued)

• At least four of the eight symptom groups

• Fatigue
• Feelings of worthlessness or guilt
• Difficulty in concentrating
• Preoccupation with death or a wish to die

• Change in appetite or weight
• Sleep disturbance
• Changes in psychomotor activity
• Loss of ability to experience pleasure and
  interest

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Subsyndromal DepressionDefinition

• Persistent (for at least 2 weeks) lowered mood
• Sad, empty, and depressed
• Loss of interest
• Irritable most of the time

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Subsyndromal DepressionBackground

• sDumbrella term for elevated depressive symptoms
  that do not meet MDE criteria.
• Current criteria used to identify those with MDE
  may leave many misdiagnosed, incorrectly treated,
  or not treated.

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Major Depressive Episode and Subsyndromal
DepressionImpact

• WHO found that MDE is a leading cause of
  disability worldwide.
• MDE is associated with increased health care
  costs and chronic physical conditions.
• sD is associated with poor health and impaired
  functioning.
• sD is a risk factor for MDE onset.

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Data sources

• National Health and Nutrition Examination Survey
  (NHANES 19992004)
• NHANES is a program of studies designed to assess
  the health and nutritional status of adult and
  children in the united States
• Multistage national probability sample
• First NHANES to use the Composite International
  Diagnostic Interview (CIDI), WHO
• Participants were administered three different
  modules Major Depressive Episode (MDE), Panic
  Disorder, and Generalized Anxiety Disorder
• Young adults (2039) who completed the CIDI MDE
  module (n2,266)

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Obesity assessment

• Body Mass Index (BMI) was measured using standard
  exam protocols in accordance with the WHO class
  I-III standard.
• Defined as normal weight (18.5 BMIlt25)
  overweight (25 BMIlt30), and obese(BMI 30).

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Prevalence of Major Depressive Episode and
Subsyndromal Depression
Percent
MDE
sD
NOTE Age-adjusted to U.S. 2000 Standard
Population. Data available on young adults aged
2039. SOURCE CDC/NCHS, National Health and
Nutrition Examination Survey (NHANES), 19992004.
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Prevalence of Major Depressive Episode and
Subsyndromal Depression by gender
Percent
20
15
18.8
10
18.0
5
8.9
6.4
0
MDE
sD
MDE
sD
Men
Women
NOTE Age-adjusted to U.S. 2000 Standard
Population. Data available on young adults aged
2039. SOURCE CDC/NCHS, National Health and
Nutrition Examination Survey (NHANES), 19992004.
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Prevalence of obesity (BMI gt 30) by depression
categories
Percent
Absence
MDE
sD
Depression
NOTE Age-adjusted to U.S. 2000 Standard
Population. Data available on young adults aged
2039. SOURCE CDC/NCHS, National Health and
Nutrition Examination Survey (NHANES), 19992004.
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Prevalence of obesity (BMI gt 30) by gender
Percent
Overall
Women
Men
NOTE Age-adjusted to U.S. 2000 Standard
Population. Data available on young adults aged
2039. SOURCE CDC/NCHS, National Health and
Nutrition Examination Survey (NHANES), 19992004.
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Methods

• Logistic regression
• SUDAAN
• Weighted analyses

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Covariates

• Gender
• Ethnicity
• Mexican Americans, Non-Hispanic black,
  Non-Hispanic white
• Education
• Less than high school, high school, or more
• Depression
• MDE, sD, Absence of depression
• Age-continuous

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Odds ratios and 95 confidence intervals (CIs) of
obesity associated with depression categories by
gender
Odds Ratio (95CIs)
SOURCE CDC/NCHS, National Health and Nutrition
Examination Survey (NHANES), 19992004.
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Conclusions
Higher prevalence of sD than MDE sD associated
with obesity overall MDE is marginally
associated with obesity overall MDE and sD is
associated with obesity in women MDE and sD is
not associated with obesity in men
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Strengths

• National probability sample of the civilian
  noninstitutionalized U.S. population
• Standardized assessment of MDE utilized for
  epidemiological studies
• Included the assessment of sD
• BMI based on exam measurements

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Limitations

• Cannot determine pathway
• Cannot distinguish between
• Direct and Indirect pathways
• Data only available on young adults aged 2039

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Implications for future research

• Associations of MDE and sD with obesity were only
  found for women
• Further research on MDE and sD with obesity is
  needed for all aged adults
• Associations of MDE and sD with diabetes maybe
  mediated by obesity