Association between environmental endocrine disruptors and depression risk: a meta-analysis

Environmental endocrine disruptors (EEDs) are common environmental pollutants. A close association exists between EEDs exposure and depression. However, related research findings have shown inconsistencies due to the wide variety of EEDs. This study aimed to evaluate, through a systematic meta-analysis, the associations between exposure to Phthalate Esters (PAEs), Per- and polyfluoroalkyl substances (PFAs), Bisphenol A (BPA), and Hexachlorobenzene (HCB) and the risk of depression. We systematically searched PubMed, Web of Science, and Embase, and finally enrolled 28 eligible studies involving 81,154 participants who underwent assessment of EEDs exposure and were evaluated for incident depression or depression-related outcomes. Relevant studies published between 2004 and December 2024 were included in this study. The biological samples used for human exposure assessment in the included studies included peripheral serum, urine, breast milk, maternal serum, and umbilical cord serum. A meta-analysis was then conducted, and the results showed that: Mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) (Odds Ratio [OR] = 1.19, 95% Confidence intervals [CI]: 1.06, 1.33), Mono (2-ethyl-5-oxohexyl) phthalate (MEOHP) (OR = 1.21, 95% CI: 1.07, 1.36), Mono-benzyl phthalate (MBzP) (OR = 1.14, 95% CI: 1.07, 1.22), Mono-N-butyl phthalate (MnBP) (OR = 1.18, 95% CI: 1.02, 1.37), Mono-isobutyl phthalate (MiBP) (OR = 1.16, 95% CI: 1.07, 1.25), Mono-n-butyl phthalate (MBP) (OR = 1.28, 95% CI: 1.13, 1.45), and Mono (2-ethyl-5-carboxypentyl) phthalate (MECPP) (OR = 1.22,95% CI: 1.04, 1.43) were all positively associated with the risk of depression. Additionally, exposure to ∑ PAEs (OR = 1.11, 95% CI: 1.08, 1.14) was identified as a risk factor for depression. The exposure to Perfluorononanoic acid (PFNA) (OR = 1.24, 95% CI: 1.01, 1.51) and ∑ PFAs (OR = 1.09, 95% CI: 1.01, 1.17) was significantly positively associated with postpartum depression among women. Human exposure to PAEs significantly increases the prevalence of depression, and a significant positive association exists between PFAs exposure in women and postpartum depression.