Association between depressive symptoms and metabolic syndrome is not explained by antidepressant medication: Results from the PPP-Botnia Study

Figures & data

Table I. Characteristics of the sample according to the harmonized clinical criteria of the metabolic syndrome (MetS).

	MetS
Characteristic	No n = 3,586 (72.2%)	Yes n = 1,381 (27.8%)	P
Sex, men, n (%)	1,641 (45.8)	695 (50.3)	0.004
Age (years)	46.1 ± 15.4	56.6 ± 13.2	0.001
Fasting glucose (mmol/L)	5.2 ± 0.8	5.9 ± 1.1	0.001
120 minute glucose (mmol/L)	5.0 ± 1.6	6.8 ± 2.9	0.001
New diabetes based on OGTT, n(%)	32 (0.9)	78 (5.6)	0.001
Previously known diabetes, n (%)	31 (0.9)	140 (10.1)	0.001
Established CVD, n (%)	176 (4.9)	239 (17.3)	0.001
Waist circumference (cm)
Men	91.0 ± 8.8	105.0 ± 10.4	0.001
Women	79.5 ± 9.5	96.6 ± 10.9	0.001
Triglycerides (mmol/L)	1.1 ± 0.5	1.9 ± 1.1	0.001
HDL cholesterol (mmol/L)
Men	1.33 ± 0.33	1.07 ± 0.31	0.001
Women	1.63 ± 0.37	1.30 ± 0.37	0.001
SBP (mmHg)	130 ± 18	144 ± 19	0.001
DBP (mmHg)	79 ± 10	86 ± 10	0.001
Current smoker, n (%)	507 (14.2)	218 (16.1)	0.098
Regular exercise, n (%)	2,017 (57.2)	652 (48.5)	0.001
Alcohol consumption, n (%)
None	829 (23.9)	424 (31.9)	0.001
12–48 g/week	1,654 (47.6)	568 (42.8)
≥ 60 g/week	989 (28.5)	336 (25.3)
Occupational status, n (%)
Senior clerical	655 (18.7)	169 (12.4)	0.001
Junior clerical	1,096 (31.4)	335 (24.6)
Manual workers	890 (25.5)	344 (25.3)
Retired	645 (18.5)	506 (37.2)
Students	209 (6.0)	8 (0.6)
First-degree family history for diabetes, n (%)	932 (26.0)	549 (39.8)	0.001

Self-reported alcohol dose per week was converted into g/week.

Table II. Prevalence of the metabolic syndrome according to presence of depressive symptoms and use of antidepressant medication.

	Total sample			Subjects without diabetes or CVD^a
Depression	n	Odds ratio (95% CI)	P	n	Odds ratio (95% CI)	P
Depressive symptoms (SD units)
Sex and age-adjusted model	4,967	1.11 (1.04–1.19)	0.002	4,428	1.10 (1.02–1.18)	0.013
Fully adjusted model	4,967	1.10 (1.03–1.18)	0.006	4,428	1.07 (1.00–1.16)	0.067
Participants with antidepressant medication use excluded^a,b	4,793	1.10 (1.03–1.17)	0.006	4,280	1.09 (1.01–1.17)	0.026
Depressive symptoms (top quartile versus lower three quartiles)
Sex and age-adjusted model	4,967	1.28 (1.11–1.49)	0.001	4,428	1.24 (1.05–1.46)	0.010
Fully adjusted model	4,967	1.26 (1.07–1.47)	0.004	4,428	1.19 (1.00–1.41)	0.053
Participants with antidepressant medication use excluded^a,b	4,793	1.28 (1.10–1.49)	0.002	4,280	1.24 (1.05–1.47)	0.011
Antidepressant medication use (no versus yes)
Sex and age-adjusted model	4,967	1.51 (1.08–2.10)	0.015	4,428	1.51 (1.05–2.18)	0.027
Fully adjusted model	4,967	1.52 (1.07–2.15)	0.019	4,428	1.46 (0.99–2.14)	0.054

The metabolic syndrome was defined using the harmonized clinical criteria. Fully adjusted refers to a model adjusting for sex, age, physical activity, alcohol consumption, current smoking status, occupational status, and family history for diabetes.

^aNumber of participants excluded was 539.

^bModel was adjusted for sex and age.

Table III. Associations between depressive symptoms and use of antidepressant medication with fasting and 2-h glucose, triglycerides and HDL-cholesterol. Participants with established diabetes or cardiovascular disease are excluded (n = 539).

		Fasting glucose		2-Hour glucose		Triglycerides		HDL-cholesterol
Depression	n	% change (95% CI)	P	% change (95% CI)	P	% change (95% CI)	P	% change (95% CI)	P
Depressive symptoms (SD units)
Sex and age-adjusted model	4,428	0.07 (−0.27–0.41)	0.688^a	1.45 (0.53–2.37)	0.002	3.49 (2.06–4.92)	0.001	−1.22 (−2.00–−0.44)	0.002
Fully adjustedmodel	4,428	−0.03 (−0.38–0.33)	0.880^b	1.00 (0.04–1.97)	0.041	2.50 (1.02–3.99)	0.001	−0.84 (−1.65–−0.03)	0.041
Participants with antidepressant medication use excluded^h	4,280	−0.01 (−0.36–0.33)	0.937^c	1.49 (0.53–2.44)	0.002	3.17 (1.69–4.64)	0.001	−1.05 (−1.86–−0.24)	0.011
Depressive symptoms (top quartile versus lower three quartiles)
Sex and age-adjusted model	4,428	0.47 (−0.29–1.24)	0.222^d	4.14 (2.06–6.23)	0.001	7.37 (4.14–10.60)	0.001	−2.89 (−4.66–−1.13)	0.001
Fully adjusted model	4,428	0.43 (−0.37–1.23)	0.290^e	3.84 (1.67–6.00)	0.001	5.48 (2.13–8.82)	0.001	−2.07 (−3.89–−0.26)	0.025
Participants with antidepressant medication use excluded^h	4,280	0.41 (−0.37–1.20)	0.302^f	4.39 (2.24–6.54)	0.001	6.56 (3.24–9.89)	0.001	−2.65 (−4.47–−0.82)	0.004
Antidepressant medication use (no versus yes)
Sex and age-adjusted model	4,428	1.23 (−0.62–3.07)	0.192	0.59 (−4.44–5.63)	0.818	10.08 (2.26–17.90)	0.012	−2.96 (−7.25–1.32)	0.175^g
Fully adjusted model	4,428	1.28 (−0.63–3.19)	0.190	−0.05 (−5.22–5.13)	0.984	10.51 (2.50–18.51)	0.010	−2.05 (−6.38–2.30)	0.357

Fully adjusted refers to a model adjusting for sex, age, physical activity, alcohol consumption, current smoking status, occupational status, and family history for diabetes. Fasting glucose, 2-hour glucose, triglycerides,and HDLcholesterol values were log-transformed.

Association is statistically significant (P < 0.05) when participants with established diabetes or CVD are included: ^a0.52 (0.13–0.90), P = 0.008; ^b0.40 (0.04–0.80), P = 0.048; ^c0.41 (0.01–0.81), P = 0.044; ^d1.36 (0.49–2.23), P = 0.002; ^e1.27 (0.37–2.17), P = 0.006; ^f1.26 (0.36–2.16), P = 0.006; ^g−4.07 (−8.06– −0.08), P = 0.046.

^hModel was adjusted for sex and age.

Table IV. Associations between depressive symptoms and use of antidepressant medication with waist circumference and SBP and DBP. Participants with established diabetes or cardiovascular disease are excluded (n = 539).

		Waist circumference		SBP		DBP
Depression	n	Change in cm (95% CI)	P	Change in mmHg (95% CI)	P	Change in mmHg (95% CI)	P
Depressive symptoms (SD units)
Sex and age-adjusted model	4,428	0.76 (0.44–1.09)	0.001	−0.28 (−0.76–0.21)	0.265	0.05 (−0.24–0.34)	0.748
Fully adjusted model	4,428	0.55 (0.21–0.89)	0.001	−0.24 (−0.74–0.26)	0.347	−0.05 (−0.31–0.30)	0.974
Participants with antidepressant medication use excluded^d	4,280	0.67 (0.35–1.02)	0.001	−0.17 (−0.68–0.33)	0.497	0.08 (−0.29–0.31)	0.960
Depressive symptoms (top quartile versus lower three quartiles)
Sex and age-adjusted model	4,428	1.58 (0.83–2.32)	0.001	−1.06 (−2.16–0.03)	0.058^a	−0.24 (−0.89–0.41)	0.472
Fully adjusted model	4,428	1.17 (0.41–1.94)	0.003	−0.93 (−2.06–0.20)	0.108	−0.17 (−0.85–0.51)	0.625
Participants with antidepressant medication use excluded^d	4,280	1.52 (0.76–2.27)	0.001	−0.93 (−2.06–0.21)	0.108	−0.37 (−1.05–0.30)	0.278
Antidepressant medication use (no versus yes)
Sex and age-adjusted model	4,428	3.57 (1.77–5.36)	0.001	−2.93 (−5.58–−0.28)	0.030^c	1.25 (−0.33–2.83)	0.121
Fully adjusted model	4,428	3.72 (1.89–5.55)	0.001	−2.70 (−5.40–−0.00)	0.050	1.57 (−0.06–3.19)	0.059^b

Fully adjusted refers to a model adjusting for age, sex, physical activity, alcohol consumption, current smoking status, occupational status, and family history for diabetes.

Association is statistically significant (P < 0.05) when participants with established diabetes or CVD are included:^a−1.11 (2.16– −0.58), P = 0.039; ^b1.69 (0.18–3.20), P = 0.028.

^cAssociation is statistically not significant (P > 0.05) when participants with established diabetes or CVD are included: −2.50 (−5.01–0.16), P = 0.052.

^dModel was adjusted for sex and age.