Depression trajectories and the association with metabolic adversities among the middle-aged adults

Despite both depression and metabolic disturbances confer substantial burden of disease, natural course of depressive symptoms and the relationship with metabolic adversities have not examined. We explore associations between trajectories of depressive symptoms and metabolic disturbance, lifestyle factors and comorbidities.

This retrospective cohort study included 13,745 subjects (8113 men and 5632 women) 40-59 years of age who underwent health examinations at the Seoul National University Hospital Healthcare System, Gangnam Center, in Korea. The median follow-up duration was 4.0 years. We estimated the mean trajectories of the Beck Depression Inventory scores using latent-class growth-curve analysis.

We identified four distinctive trajectories of depressive symptoms in both sex. The probabilities of group membership were 35.1% (n=2374) in minimal, 47.4% (n=4545) in persistent-mild, 14.4% (n=987) in persistent-moderate, and 3.0% (n=207) in persistent-severe in men, and 36.3% (n=1883), 50.0% (n=3069), 12.3% (n=601) and 1.5% (n=79) in women. We found significant increasing trend in the prevalence of metabolic abnormalities in more severe depressive trajectory. The adjusted odds ratios of persistent-severe were significantly increased for the following variables: low HDL, hypertriglyceridemia, and metabolic syndrome (MetS) in men and hypertriglyceridemia, MetS in women, and smoking, alcohol consumption and lack of exercise in both genders.

Medical and psychiatric histories were obtained using a self-reported questionnaire rather than formal diagnostic assessments.

The higher level of depressive symptoms trajectory was associated with MetS, especially lipid abnormalities, and several modifiable lifestyle factors. Our findings provide important implications for developing health policy and guidelines for reducing depressive symptom burden.