Lifetime History of Major Depression Predicts the Development of the Metabolic Syndrome in Middle-Aged Women

Abstract

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. 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.