Belinda H. Operskalski

Association between obesity and depression in middle-aged women

OBJECTIVE Evaluate the association between obesity and depression among middle-aged women. METHODS A total of 4641 female health plan enrollees aged 40-65 years completed a structured telephone interview including self-reported height and weight, the Patient Health Questionnaire (PHQ) assessment of depression; a brief measure of rate was 62%. RESULTS Prevalence of moderate or severe depression increased from 6.5% among those with body mass index (BMI) under 25 to 25.9% among those with BMI over 35. Prevalence of obesity increased from 25.4% among those with no depressive symptoms to 57.8% among those with moderate to severe depression. Independent of obesity, depression was associated with significant reductions in frequency of moderate (4.6 vs. 5.4 times per week) or vigorous (2.8 vs. 3.7 times per week) physical activity. Depression was associated with significantly higher daily caloric intake (1831 vs. 1543) among those with BMI over 30. CONCLUSIONS Among middle-aged women, depression is strongly and consistently associated with obesity, lower physical activity and (among the obese) higher caloric intake. Public health approaches to reducing the burden of obesity or depression must consider the strong association between these two common conditions.

Associations of child sexual and physical abuse with obesity and depression in middle-aged women ☆

OBJECTIVE Examine whether (1) childhood maltreatment is associated with subsequent obesity and depression in middle-age; (2) maltreatment explains the associations between obesity and depression; and (3) binge eating or body dissatisfaction mediate associations between childhood maltreatment and subsequent obesity. METHODS Data were obtained through a population-based survey of 4641 women (mean age=52 years) enrolled in a large health plan in the Pacific Northwest. A telephone survey assessed child sexual and physical abuse, obesity (BMI>or=30), depressive symptoms, binge eating, and body dissatisfaction. Data were analyzed using logistic regression models incorporating sampling weights. RESULTS Both child sexual and physical abuse were associated with a doubling of the odds of both obesity and depression, although child physical abuse was not associated with depression for the African American/Hispanic/American Indian subgroup. The association between obesity and depression (unadjusted OR=2.82; 95% CI=2.20-3.62) was reduced somewhat after controlling for sexual abuse (adjusted OR=2.54; 1.96-3.29) and for physical abuse (adjusted OR=2.63; 2.03-3.42). Controlling for potential mediators failed to substantially attenuate associations between childhood maltreatment and obesity. CONCLUSIONS This study is the first to our knowledge that compares associations of child abuse with both depression and obesity in adults. Although the study is limited by its cross-sectional design and brief assessments, the fact that child abuse predicted two debilitating conditions in middle-aged women indicates the potential long-term consequences of these experiences.

Randomized trial of a population-based care program for people with bipolar disorder.

BACKGROUND Despite the availability of efficacious medications and psychotherapies, care of bipolar disorder in everyday practice is often deficient. This trial evaluated the effectiveness of a multi-component care management program in a population-based sample of people with bipolar disorder. METHOD Four hundred and forty-one patients treated for bipolar disorder during the prior year were randomly assigned to continued usual care or usual care plus a systematic care management program including: initial assessment and care planning, monthly telephone monitoring including brief symptom assessment and medication monitoring, feedback to and coordination with the mental health treatment team, and a structured group psychoeducational program--all provided by a nurse care manager. Blinded quarterly assessments generated week-by-week ratings of severity of depression and mania symptoms using the Longitudinal Interval Follow-Up Evaluation. RESULTS Participants assigned to the intervention group had significantly lower mean mania ratings averaged across the 12-month follow-up period (Z= 2.44, p=0.015) and approximately one-third less time in hypomanic or manic episode (2.59 weeks v. 1.69 weeks). Mean depression ratings across the entire follow-up period did not differ significantly between the two groups, but the intervention group showed a greater decline in depression ratings over time (Z statistic for group-by-time interaction = 1.98, p = 0.048). CONCLUSIONS A systematic care program for bipolar disorder significantly reduces risk of mania over 12 months. Preliminary results suggest a growing effect on depression over time, but longer follow-up will be needed.

Breast and Cervical Cancer Screening. Specific Effects of Depression and Obesity

BACKGROUND Obesity and depression may each be associated with lower rates of cervical and breast cancer screening. Studies have examined obesity or depression alone, but not together, despite the established link between them. PURPOSE This article aims to disentangle the effects of depression and obesity on receipt of breast and cervical cancer screening. METHODS A stratified sampling design was used to recruit women aged 40-65 years with information on BMI from an integrated health plan in Washington State in 2003-2005. A telephone survey included the Patient Health Questionnaire-9 for depression, weight, and height. Automated data assessed Paps for 3097 women over a 3-year period and screening mammograms over a 2-year period for 2163 women aged > or =51 years. Logistic regression models (conducted in 2008) examined the association between obesity and depression and receipt of screening tests. RESULTS In univariate logistic regression models, women were less likely to receive a Pap if they were obese (OR=0.53, 95% CI=0.41, 0.69) or depressed (OR=0.60, 95% CI=0.42, 0.87). Further, women were less likely to receive a screening mammogram if they were depressed (OR=0.45, 95% CI=0.30, 0.67). In multivariable models, only obesity remained significantly associated with a lower likelihood of Pap screening (OR=0.67, 95% CI=0.0.49, 0.93), and only depression remained significantly associated with lower rates of screening mammography (OR=0.49, 95% CI=0.31, 0.76). Obesity and depression did not interact significantly in either model. CONCLUSIONS Obesity and depression appear to have specific effects on receipt of different cancer-screening tests.

Severity of mood symptoms and work productivity in people treated for bipolar disorder

OBJECTIVE To evaluate the relationship between mood symptoms and work productivity in people with bipolar disorder. METHODS A total of 441 outpatients treated for bipolar disorder were enrolled from mental health clinics of a health plan in Washington State. A baseline assessment included confirmation of diagnosis (using the Structured Clinical Interview for DSM-IV) as well as assessment of employment status, functional impairment, and days missed from work. Eight follow-up interviews over 24 months included self-reported employment status, self-reported days missed from work due to illness, and assessment of current and interval mood symptoms using the Longitudinal Interval Follow-up Examination. RESULTS Averaged over four assessments, patients with current major depression were 15% less likely to be employed than those without significant depressive symptoms [odds ratio (OR) = 0.84, 95% confidence interval (CI): 0.76-0.92]. Manic or hypomanic symptoms were not significantly associated with probability of employment (OR = 0.93, CI: 0.83-1.04). Among those employed, major depression was associated with 4.06 additional days of work missed per month (CI: 1.05-7.06) compared to those without significant depressive symptoms. Meeting criteria for manic or hypomanic episode was associated with a similar number of missed work days, but this difference was not statistically significant (adjusted difference = 4.11 days, CI: -0.18-8.40). CONCLUSIONS Among patients with bipolar disorder, depression is strongly and consistently associated with decreased probability of employment and more days missed from work due to illness. Symptoms of mania or hypomania have more variable effects on work productivity.

Validity of clinical body weight measures as substitutes for missing data in a randomized trial

SUMMARY BACKGROUND Long-term follow-up of weight loss interventions is essential, but collecting weights can be difficult, and self-reports inaccurate. We examined the relationship between weight measures obtained in the context of a weight loss trial and in routine clinical care. METHODS Body weight data from a trial of behavioral obesity treatment among 88 obese women and 203 women age 40-65 years with comorbid obesity and depression were compared against weight data entered into an electronic medical record (EMR) during routine clinical care. Study and EMR weights and weight changes were then compared at 6 and 12 months using scatterplots, Pearsons correlations, and t-tests. RESULTS The 12-month follow-up rate for this trial was 77%. Among the 224 12-month completers, 142 women (63%) had an EMR weight within 90 days of their 12-month study weight. Study and EMR weights were highly correlated (0.99), with a mean difference of 0.1 kg. The correlation between two measures of 12-month weight change using study and EMR weights was 0.96. These results were robust to sensitivity analyses that explored the impact of different-sized windows for matching clinical weights with study weights. Among the 67 women who were missing study weights at 12 months, 33 (49%) had an EMR weight available within 90 days of their missed follow-up appointment. CONCLUSIONS Weight measures routinely obtained in clinical care are highly correlated with those obtained by trained research staff and may be used, without statistical correction, to achieve higher rates of long-term follow-up in weight loss studies.

Association between change in depression and change in weight among women enrolled in weight loss treatment.

OBJECTIVE To examine the association between improvement in depression and loss of weight among women with depressive symptoms entering a behavioral weight loss program. METHODS Women aged 40 to 65 with body mass index (BMI) of 30 or more and co-occurring symptoms of depression were identified by a population-based survey. A total of 203 of these women were enrolled in one of two behavioral treatment programs: one focused on weight loss and another on both weight loss and depression. Both programs included up to 26 group sessions over 12 months. Assessments at baseline, 6 months, 12 months and 24 months included measurement of weight, depressive symptoms, self-reported physical activity and estimated caloric intake (via food frequency questionnaire). RESULTS Over the first 6 months, women with a decrease in depression score were more likely to lose 5 kg or more than women without a significant decrease in depression (38% vs. 22%, odds ratio=2.20, 95% CI=1.09 to 4.44). Over the same period, improvement in depression was associated with increase in physical activity but not with change in caloric intake. Change in depression and change in weight were not significantly associated over later intervals (between 6 and 12 months or between 12 and 24 months). CONCLUSIONS Among women with co-occurring obesity and depression, short-term improvement in depression is associated with weight loss.

Sexually transmitted diseases and managed care: an inquiry and review of issues affecting service delivery.

To understand the potential role of managed care organizations (MCOs) in prevention and control of sexually transmitted diseases (STDs), we conducted a systematic review of articles on STDs and managed care and sought qualitative information from MCOs on STD-related activities. The review focused on prevention, risk assessment, patient education, counseling, screening, and costs of care, but revealed relatively few published articles. Barriers to STD service delivery included competing priorities, lack of time or supporting organizational structures, and differing mandates of health departments and MCOs. Facilitators included collaboration between health departments and MCOs, regulatory and performance incentives, buy-in from key stakeholders, availability of infrastructure to support data collection, and inclusion of chlamydia screening in the Health Employer Data and Information Set to monitor plan performance. Because of the shift of STD service delivery from the public to private sector, incentives need to maximize interest and cooperation of patients, clinicians, and MCOs in STD prevention.

Does Clinical Depression Affect the Accuracy of Self-Reported Height and Weight in Obese Women?

Objective: Recent research from a self‐report survey showed a strong association between obesity and clinical depression in women. The present analysis assessed whether differential bias in self‐reports of height and weight as a function of depression influences the apparent strength of the association.

Relationship between Obesity, Depression, and Disability in Middle-Aged Women.

SUMMARY BACKGROUND Obesity and depression are closely linked, and each has been associated with disability. However, few studies have assessed inter-relationships between these conditions. DESIGN AND METHODS In this study, 4641 women aged 40-65 completed a structured telephone interview including self-reported height and weight, the Patient Health Questionnaire (PHQ) assessment of depression, and the World Health Organization Disability Assessment Schedule II (WHODAS II). The survey response rate was 62%. We used multivariable regression models to assess relationships between obesity, depression, and disability. RESULTS The mean age was 52 years; 82% were White; and 80% were currently employed. One percent were underweight, 39% normal weight, 27% overweight, and 34% obese. Mild depressive symptoms were present in 23% and moderate-to-severe symptoms were present in 13%. After multivariable adjustment, depression was a strong independent predictor of worse disability in all 7 domains (cognition, mobility, self-care, social interaction, role functioning, household, and work), but obesity was only a significant predictor of greater mobility, role-functioning, household, and work limitations (P < 0.05) (overweight was not significantly associated with any disability domain). Overall, the effect on disability was stronger and more pervasive for depression than obesity, and there was no significant interaction between the two conditions (P > 0.05). Overweight and obesity were associated with 5760 days of absenteeism per 1000 person-years, and depression was associated with 18,240 days of absenteeism per 1000 person-years. CONCLUSIONS The strong relationships between depression, obesity and disability suggest that these conditions should be routinely screened and treated among middle-aged women.