Associations between depression and different measures of obesity (BMI, WC, WHtR, WHR).

BACKGROUND: Growing evidence suggests that abdominal obesity is a more important risk factor for the prognosis of cardiovascular and metabolic diseases than BMI. Somatic-affective symptoms of depression have also been linked to cardiovascular risk. The relationship between obesity and depression, however, has remained contradictory. Our aim was therefore to relate body mass index (BMI) and different measures for abdominal obesity (waist circumference, WC, waist-to-hip ratio, WHR, waist-to-height ratio, WHtR) to somatic vs. cognitive-affective symptoms of depression. METHODS: In a cross-sectional population based study, data on the first N = 5000 participants enrolled in the Gutenberg Health Study (GHS) are reported. To analyze the relationship between depression and obesity, we computed linear regression models with the anthropometric measure (BMI, WC, WHR, WHtR) as the dependent variable and life style factors, cardiovascular risk factors and psychotropic medications as potential confounders of obesity/depression. RESULTS: We found that only the somatic, but not the cognitive-affective symptoms of depression are consistently positively associated with anthropometric measures of obesity. CONCLUSIONS: We could demonstrate that the somatic-affective symptoms of depression rather than the cognitive-affective symptoms are strongly related to anthropometric measures. This is also true for younger obese starting at the age of 35 years. Our results are in line with previous studies indicating that visceral adipose tissue plays a key role in the relationship between obesity, depression and cardiovascular disease.

Complaints of sleep disturbances are associated with cardiovascular disease: results from the Gutenberg Health Study.

BACKGROUND: Despite their high prevalence, sleep disorders often remain unrecognized and untreated because of barriers to assessment and management. The aims of the present study were to examine associations of complaints of sleep disturbances with cardiovascular disease, related risk factors, and inflammation in the community and to determine the contribution of sleep disturbances to self-perceived physical health. METHOD: The sample consists of n = 10.000 participants, aged 35 to 74 years of a population based community sample in Germany. Cross-sectional associations of complaints of sleep disturbances with cardiovascular risk factors and disease, biomarkers of inflammation, depression, anxiety, and physical health status were analyzed. RESULTS: 19% of our sample endorsed clinically significant sleep disturbances. In the unadjusted analyses severity of sleep disturbances increased with female sex, low socioeconomic status, living without a partnership, cardiovascular disease, depression, anxiety, poor physical health, increased levels of C-reactive protein and fibrinogen. After multivariate adjustment robust associations with coronary heart disease, myocardial infarction and dyslipidemia remained. Complaints of sleep disturbances were strong and independent contributors to self-perceived poor physical health beyond depression, anxiety and medical disease burden. CONCLUSIONS: Given the high prevalence of complaints of sleep disturbances and their strong impact on health status, increased efforts should be undertaken for their identification and treatment.

Association of hypertension with depression in the community: results from the Gutenberg Health Study.

OBJECTIVE: The literature on the depression-hypertension (HTN) relationship came to conflicting results. Previous studies reported close positive as well as close negative associations between HTN and depression. Against this background, the present study sought to analyze this relationship in a large population-based study. METHODS: This cross-sectional population-based study (N = 5000) analyzed the association of depression and HTN in persons with different conditions of HTN (unaware of HTN, controlled HTN, uncontrolled HTN) as compared to persons without HTN. Furthermore, the relationships of depressive symptoms with antihypertensive drugs and blood pressure were examined. RESULTS: A total of 48.6% of participants were classified as 'no HTN', 13.5% had controlled HTN, 23.4% had uncontrolled HTN and 14.2% were unaware of their HTN. Unawareness of HTN was inversely associated with burden of depression. Controlled HTN was positively associated with depression. However, this association was due to generally increased disease burden (e.g. stroke, diabetes). Severity of cognitive symptoms of depression was negatively associated with SBP in persons free of antihypertensive drugs (ß = -0.64, P = 0.0005). Intake of ß-blockers and agents acting on the renin-angiotensin system was associated with severity of somatic symptoms of depression (e.g. fatigue). CONCLUSION: The competing literature about the relationships between depression and HTN may be the result of the insufficient recognition of multiple pathways of opposite directions linking depressive symptoms with blood pressure, HTN and related medications.

Association of mental distress with smoking status in the community: Results from the Gutenberg Health Study.

BACKGROUND: Exposition to tobacco smoke is among the major modifiable risk factors in the general population. There is strong evidence for a close association between smoking exposure and mental disorders. METHODS: Cross-sectional associations of different conditions of smoking status (former, current, and second hand smoking (SHS)) with indicators of mental distress were analyzed in a sample of N=5000 participants (aged 35-74 years) of the population-based survey "Gutenberg Health Study". RESULTS: In the general population clinically significant depression (OR 1.59, 95%CI 1.17-2.17) and a previous diagnosis of depression (OR 1.50, 95%CI 1.16-1.94) were associated with current smoking. Each cigarette per day was associated with a 3% increase for the likelihood of clinically significant depression. We did not find a decreased prevalence for current first and second hand exposure in persons with established cardiovascular or lung disease. In this subgroup mental distress was strongly associated with SHS at home. LIMITATIONS: Main limitations of the study pertain to the reliance on self-report of distress and smoking status and the cross-sectional nature of the data. CONCLUSIONS: Despite public health efforts, smoke exposure is still alarmingly high in the general population, especially in persons with mental distress and with established cardiovascular or lung disease. In the management of persons with chronic cardiovascular and lung disease, enquiry of the medical history should include exposure to SHS at home and offer special counseling.

Differential associations of depressive symptom dimensions with cardio-vascular disease in the community: results from the Gutenberg health study.

A current model suggested that the somatic symptom dimension accounts for the adverse effect of depression in patients with coronary heart disease (CHD). In order to test this model we sought to determine in a large population-based sample how symptom dimensions of depression are associated with CHD, biomarkers and traditional risk factors. The associations of cognitive and somatic symptom dimensions of depression with CHD, risk factors, endothelial function, and biomarkers of inflammation and myocardial stress were analyzed cross-sectionally in a sample of n = 5000 Mid-Europeans aged 35-74 years from the Gutenberg Health Study (GHS). Only the somatic symptom dimension of depression was associated with CHD, biomarkers (inflammation, vascular function) and cardio-vascular risk factors. When multivariable adjustment was applied by demographic and cardiovascular risk factors, the weak associations of the somatic symptom dimension with the biomarkers disappeared. However, the associations of the somatic symptom dimension with CHD, myocardial infarction, obesity, dyslipidemia and family history of myocardial infarction remained. Both dimensions of depression were independently associated with a previous diagnosis of depression and distressed personality (type D). Thus, our results partly confirm current models: Somatic, but not cognitive-affective symptom dimensions are responsible for the association between depression and CHD, inflammation, vascular function and cardiovascular risk factors in the general population. However, our findings challenge the assumptions that somatic depression might be due to inflammation or vascular dysfunction as consequence of progressed atherosclerotic disease. They rather emphasize a close interplay with life-style factors and with a family history of MI.