Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Epidemiology and Population Health

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

International Journal of Obesity volume 43, pages 615–632 (2019)Cite this article

Subjects

Abstract

Objective

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.

Methods

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).

Results

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.

Conclusions

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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

References

  1. Mottillo S, Filion KB, Genest J, Joseph L, Pilote L, Poirier P, et al. The metabolic syndrome and cardiovascular risk: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;56:1113–32.

    Article  Google Scholar 

  2. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet. 2005;365:1415–28.

    Article  CAS  Google Scholar 

  3. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129(25 Suppl 2):S102–38.

    Article  Google Scholar 

  4. Sena CM, Pereira AM, Seiça R. Endothelial dysfunction—a major mediator of diabetic vascular disease. Biochim Et Biophys Acta (BBA) - Mol Basis Dis. 2013;1832:2216–31.

    Article  CAS  Google Scholar 

  5. Hajer GR, van Haeften TW, Visseren FLJ. Adipose tissue dysfunction in obesity, diabetes, and vascular diseases. Eur Heart J. 2008;29:2959–71.

    Article  CAS  Google Scholar 

  6. Egan BM, Greene EL, Goodfriend TL. Insulin resistance and cardiovascular disease. Am J Hypertens. 2001;14(6, Supplement 1):S116–S125.

    Article  Google Scholar 

  7. Bergmann N, Gyntelberg F, Faber J. The appraisal of chronic stress and the development of the metabolic syndrome: a systematic review of prospective cohort studies. Endocr Connect. 2014;3:R55–80.

    Article  CAS  Google Scholar 

  8. Bove M, Carnevali L, Cicero AFG, Grandi E, Gaddoni M, Noera G, et al. Psychosocial factors and metabolic parameters: Is there any association in elderly people? The Massa Lombarda Project. Aging Ment Health. 2010;14:801–6.

    Article  Google Scholar 

  9. Butnoriene J, Bunevicius A, Norkus A, Bunevicius R. Depression but not anxiety is associated with metabolic syndrome in primary care based community sample. Psychoneuroendocrinology. 2014;40:269–76.

    Article  Google Scholar 

  10. Morikawa M, Okamoto N, Kiuchi K, Tomioka K, Iwamoto J, Harano A, et al. Association between depressive symptoms and metabolic syndrome in Japanese community-dwelling older people: a cross-sectional analysis from the baseline results of the Fujiwara-kyo prospective cohort study. Int J Geriatr Psychiatry. 2013;28:1251–9.

    Article  Google Scholar 

  11. Pan A, Keum N, Okereke OI, Sun Q, Kivimaki M, Rubin RR, et al. Bidirectional association between depression and metabolic syndrome: a systematic review and meta-analysis of epidemiological studies. Diabetes Care. 2012;35:1171–80.

    Article  Google Scholar 

  12. Räikkönen K, Matthews KA, Kuller LH. The relationship between psychological risk attributes and the metabolic syndrome in healthy women: Antecedent or consequence? Metabolism. 2002;51:1573–7.

    Article  Google Scholar 

  13. Rhee SJ, Kim EY, Kim SH, Lee HJ, Kim B, Ha K, et al. Subjective depressive symptoms and metabolic syndrome among the general population. Progress Neuro-Psychopharmacol Biol Psychiatry. 2014;54:223–30.

    Article  Google Scholar 

  14. Trief PM, Cibula D, Delahanty LM, Weinstock RS. Depression, stress, and weight loss in individuals with metabolic syndrome in SHINE, a DPP translation study. Obes (Silver Spring). 2014;22:2532–8.

    Google Scholar 

  15. Howard VJ, Cushman M, Pulley L, Gomez CR, Go RC, Prineas RJ, et al. The reasons for geographic and racial differences in stroke study: objectives and design. Neuroepidemiology. 2005;25:135–43.

    Article  Google Scholar 

  16. National Institute on Alcohol Abuse and Alcoholism (NIAAA). Drinking levels defined. In: http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking, 2017.

  17. Tsivgoulis G, Judd S, Letter AJ, Alexandrov AV, Howard G, Nahab F, et al. Adherence to a Mediterranean diet and risk of incident cognitive impairment. Neurology. 2013;80:1684–92.

    Article  Google Scholar 

  18. Melchior LA, Huba G, Brown VB, Reback CJ. A short depression index for women. Educ Psychol Meas. 1993;53:1117–25.

    Article  Google Scholar 

  19. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.

    Article  Google Scholar 

  20. McClellan WM, Abramson J, Newsome B, Temple E, Wadley VG, Audhya P, et al. Physical and psychological burden of chronic kidney disease among older adults. Am J Nephrol. 2010;31:309–17.

    Article  Google Scholar 

  21. Irwin M, Artin KH, Oxman MN. Screening for depression in the older adult: criterion validity of the 10-item Center for Epidemiological Studies Depression Scale (CES-D). Arch Intern Med. 1999;159:1701–4.

    Article  CAS  Google Scholar 

  22. Cohen S. Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S, (eds). The Claremont Symposium on Applied Social Psychology. The social psychology of health. Thousand Oaks, CA: Sage Publications; 1988. p. 31–67.

    Google Scholar 

  23. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–96.

    Article  CAS  Google Scholar 

  24. Gillett SR, Boyle RH, Zakai NA, McClure LA, Jenny NS, Cushman M. Validating laboratory results in a national observational cohort study without field centers: the Reasons for Geographic and Racial Differences in Stroke cohort. Clin Biochem. 2014;47:243–6.

    Article  Google Scholar 

  25. Alberti KGMM, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA. et al. Harmonizing the metabolic syndrome: A Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation. 2009;120:1640–5.

    Article  CAS  Google Scholar 

  26. Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO, Criqui M. et al. Markers of inflammation and cardiovascular disease: application to clinical and publichealth practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003;107:499–511.

    Article  Google Scholar 

  27. Lasserre AM, Glaus J, Vandeleur CL, et al. Depression with atypical features and increase in obesity, body mass index, waist circumference, and fat mass: a prospective, population-based study. JAMA Psychiatry. 2014;71:880–8.

    Article  Google Scholar 

  28. Cooper-McCann R, Ayers C, Albert M, de Lemos J, Neeland I, McClurkin M, et al. Abstract P093: Psychological Stress is Associated with Increases in Weight and Waist Circumference over Time: Longitudinal Data from the Dallas Heart Study. Circulation. 2014;129(Suppl 1):AP093–AP093.

    Google Scholar 

  29. Jane W, Yoichi C, Leigh GE, L. WK, Andrew S. Stress and adiposity: a meta‐analysis of longitudinal studies. Obesity. 2011;19:771–8.

    Article  Google Scholar 

  30. Ridker PM, Buring JE, Cook NR, Rifai N. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14 719 initially healthy American women. Circulation. 2003;107:391–7.

    Article  Google Scholar 

  31. Black PH. The inflammatory consequences of psychologic stress: relationship to insulin resistance, obesity, atherosclerosis and diabetes mellitus, type II. Med Hypotheses. 2006;67:879–91.

    Article  CAS  Google Scholar 

  32. Paolucci EM, Loukov D, Bowdish DME, Heisz JJ. Exercise reduces depression and inflammation but intensity matters. Biol Psychol. 2018;133:79–84.

    Article  Google Scholar 

  33. Milaneschi Y, Bandinelli S, Penninx BW, Vogelzangs N, Corsi AM, Lauretani F, et al. Depressive symptoms and inflammation increase in a prospective study of older adults: a protective effect of a healthy (Mediterranean-style) diet. Mol Psychiatry. 2011;16:589–90.

    Article  CAS  Google Scholar 

  34. Cummings DM, Kirian K, Howard G, Howard V, Yuan Y, Muntner P, et al. Consequences of comorbidity of elevated stress and/or depressive symptoms and incident cardiovascular outcomes in diabetes: results from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Diabetes Care. 2016;39:101–9.

    Article  CAS  Google Scholar 

  35. Butnoriene J, Bunevicius A, Saudargiene A, Nemeroff CB, Norkus A, Ciceniene V, et al. Metabolic syndrome, major depression, generalized anxiety disorder, and ten-year all-cause and cardiovascular mortality in middle aged and elderly patients. Int J Cardiol. 2015;190:360–6.

    Article  Google Scholar 

  36. Strike PC, Steptoe A. Psychosocial factors in the development of coronary artery disease. Prog Cardiovasc Dis. 2004;46:337–47.

    Article  Google Scholar 

  37. Bose M, Oliván B, Laferrère B. Stress and obesity: the role of the hypothalamic–pituitary–adrenal axis in metabolic disease. Curr Opin Endocrinol Diabetes Obes. 2009;16:340–6.

    Article  CAS  Google Scholar 

  38. Rosmond R. Role of stress in the pathogenesis of the metabolic syndrome. Psychoneuroendocrinology. 2005;30:1–10.

    Article  CAS  Google Scholar 

  39. Goldbacher EM, Matthews KA. Are psychological characteristics related to risk of the metabolic syndrome? A review of the literature. Ann Behav Med. 2007;34:240–52.

    Article  Google Scholar 

  40. Hamer M, Molloy GJ, Stamatakis E. Psychological distress as a risk factor for cardiovascular events pathophysiological and behavioral mechanisms. J Am Coll Cardiol. 2008;52:2156–62.

    Article  Google Scholar 

  41. Puustinen PJ, Koponen H, Kautiainen H, Mäntyselkä P, Vanhala M. Psychological distress predicts the development of the metabolic syndrome: a prospective population-based study. Psychosom Med. 2011;73:158–65.

    Article  Google Scholar 

  42. Haffner SM. The metabolic syndrome: inflammation, diabetes mellitus, and cardiovascular disease. Am J Cardiol. 2006;97(2, Supplement 1):3–11.

    Article  Google Scholar 

  43. Lorenzo C, Okoloise M, Williams K, Stern MP, Haffner SM. The metabolic syndrome as predictor of type 2 diabetes: the San Antonio heart study. Diabetes Care. 2003;26:3153–9.

    Article  Google Scholar 

  44. Katon WJ, Rutter C, Simon G, Lin EHB, Ludman E, Ciechanowski P, et al. The association of comorbid depression with mortality in patients with type 2 diabetes. Diabetes Care. 2005;28:2668–72.

    Article  Google Scholar 

  45. Carney RM, Freedland KE. Depression, mortality, and medical morbidity in patients with coronary heart disease. Biol Psychiatry. 2003;54:241–7.

    Article  Google Scholar 

Download references

Acknowledgements

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 http://www.regardsstudy.org.

Funding

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

Authors and Affiliations

  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

Authors
  1. Marissa A. Gowey
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yulia Khodneva
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephanie E. Tison
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. April P. Carson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrea L. Cherrington
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Virginia J. Howard
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Monika M. Safford
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gareth R. Dutton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gareth R. Dutton.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gowey, M.A., Khodneva, Y., Tison, S.E. et al. Depressive symptoms, perceived stress, and metabolic health: The REGARDS study. Int J Obes 43, 615–632 (2019). https://doi.org/10.1038/s41366-018-0270-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41366-018-0270-3

This article is cited by

Search

Advanced search

Quick links