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Epidemiology and Population Health

Depressive symptoms, perceived stress, and metabolic health: The REGARDS study

International Journal of Obesity (2018) | Download Citation



To describe the relationship between metabolic health parameters and depressive symptoms and perceived stress, and whether the co-occurrence of these two psychological stressors has an additive influence on metabolic dysregulation in adults at different levels of body mass index (BMI) without diabetes.


Participants without diabetes (N = 20,312) from the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) study (recruited between 2003–2007) who had a body mass index (BMI) ≥ 18.5 kg/m2 were included in this cross-sectional analysis. Mean age of sample was 64.4 years, with 36% African American, and 56% women. Depressive symptoms and perceived stress were measured using brief versions of the Center for Epidemiologic Studies Depression (CES-D-4 item) questionnaire and Cohen Perceived Stress Scale (PSS), respectively. Metabolic health parameters included waist circumference, blood pressure (systolic and diastolic), low- and high-density lipoprotein (LDL, HDL) cholesterol, triglycerides, fasting glucose, and high sensitivity C-reactive protein (hs-CRP). Sequentially adjusted general linear regression models (GLM) for each metabolic parameter were used to assess the association between having both elevated depressive symptoms and stress, either of these psychological risk factors, or none with all analyses stratified by BMI category (i.e., normal, overweight, and obesity).


The presence of elevated depressive symptoms and/or perceived stress was generally associated with increased waist circumference, higher CRP, and lower HDL. The combination of depressive symptoms and perceived stress, compared to either alone, was typically associated with poorer metabolic health outcomes. However, sociodemographic and lifestyle factors generally attenuated the associations between psychological factors and metabolic parameters.


Elevated depressive symptoms in conjunction with high levels of perceived stress were more strongly associated with several parameters of metabolic health than only one of these psychological constructs in a large, diverse cohort of adults. Findings suggest that healthy lifestyle factors may attenuate the association between psychological distress and metabolic health impairment.

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The authors thank the other investigators, the staff, and the participants of the REGARDS study for their valuable contributions. A full list of participating REGARDS investigators and institutions can be found at


This work was supported by a cooperative agreement U01‐NS041588 from the National Institute of Neurological Disorders and Stroke. Dr. Gowey was supported by NIDDK T32DK062710, UAB/AHRQ K12HS023009, and NIDDK P30DK056336. Drs. Safford and Khodneva were supported by R01 NHLBI R01 HL080477 and NHLBI K24 HL111154.

Author information


  1. Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA

    • Marissa A. Gowey
  2. Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    • Yulia Khodneva
    • , Andrea L. Cherrington
    •  & Gareth R. Dutton
  3. Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

    • Stephanie E. Tison
  4. Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

    • April P. Carson
    •  & Virginia J. Howard
  5. Department of Medicine, Weill Cornell Medicine, New York, NY, USA

    • Monika M. Safford


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The authors declare that they have no conflict of interest.

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Correspondence to Gareth R. Dutton.

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