Abstract
Accumulating evidence supports a link between depression and being overweight in women. Given previously reported sex differences in fat accumulation and depression prevalence, as well as the likely role of sex hormones in both overweight and mood disorders, we hypothesised that the depression-overweight association may be mediated by sex hormones. To this end, we investigated the association of being overweight with depression, and then considered the role of sex hormones in relation to being overweight and depression in a large population-based cohort. We included a total of 3124 women, 970 premenopausal and 2154 postmenopausal from the LIFE-Adult cohort study in our analyses. We evaluated associations between being overweight (BMI >25 kg/m2), sex hormone levels, and depressive symptomatology according to Centre for Epidemiologic Studies Depression (CES-D) scores, and explored mediation of depression in a mediation model. Being overweight was significantly associated with depressive symptoms in premenopausal but not postmenopausal women. Both premenopausal and postmenopausal overweight women had higher free testosterone levels compared with normal weight women. Premenopausal women with depressive symptomatology had higher free testosterone levels compared to women without. We found a significant mediation effect of depressive symptomatology in overweight premenopausal women through free testosterone level. These findings highlight the association between being overweight and depressed, and suggest that high free testosterone levels may play a significant role in depression of overweight premenopausal women. Based on this, pharmacological approaches targeting androgen levels in overweight depressed females, in particular when standard anti-depressive treatments fail, could be of specific clinical relevance.
Highlights
The worldwide increasing prevalence of obesity and depression are among the leading and most challenging health problems faced today, for women[1,2,3]
Association between being overweight and depression In the premenopausal group, we found significantly higher Centre for Epidemiologic Studies Depression (CES-D) scores in overweight women compared with women of normal weight (11.2 ± 7.7 vs. 10.0 ± 7.4, p = 0.01)
Overweight premenopausal women had a significantly higher prevalence of depressive symptomatology compared to women of normal weight (10.5% vs. 6.6%, p = 0.042) with the OR = 1.65 (CI = 1.032–2.651, p = 0.036)
Summary
The worldwide increasing prevalence of obesity and depression are among the leading and most challenging health problems faced today, for women[1,2,3]. Studies have found that higher rates of both depression and obesity diminish quality of life and increase risk of morbidity and premature mortality[8,9,10] Beyond their independent impact on morbidity and mortality, depression and obesity are highly comorbid, Stanikova et al Translational Psychiatry (2019)9:160 and their co-occurrence is largely associated with adverse health[3]. Several large epidemiologic studies and metaanalyses[11,12] support an association between obesity and depression, which appears to be stronger in women than in men[13,14,15,16] Being both overweight and depressed is more prevalent in women than in men, indicating a potential common underlying mechanism. Chronic low-grade inflammation[17], oxidative stress[18], metabolic and endocrinologic disturbances[19,20] have been suggested as possible contributing factors
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