The broad spectrum of comorbid depression: implications for treatment

Comorbid Depression and Obesity: Correlates and Synergistic Association With Noncommunicable Diseases Among Australian Men

Introduction

Obesity and depression are among the leading causes of disease worldwide. Their bidirectional relationship often results in comorbid depression and obesity, which further increases the risk of adverse health outcomes. Further evidence is needed on the correlates and synergistic association with other noncommunicable diseases. The objective of our study was to examine the correlates and synergistic association of comorbid depression and obesity with other noncommunicable diseases in a large sample of Australian men.

Methods

Our cross-sectional study used data on 13,763 men aged 18 to 55 from the first wave (2013–2014) of the Australian Ten to Men study. Body mass index was calculated from self-reported weight and height. The Patient Health Questionnaire-9 was used to assess depression. We calculated the weighted prevalence of depression, obesity, and comorbid depression and obesity and examined correlates of comorbid depression and obesity by using logistic regression. We used the synergy index to measure the synergistic association of depression and obesity with other noncommunicable diseases.

Results

The weighted prevalence of depression, obesity, and comorbid depression and obesity among Australian men were 12.5%, 22.2%, and 3.7%, respectively. Age, marital status, area-level socioeconomic index, educational attainment, household income, employment status, and physical activity were significantly associated with comorbid depression and obesity. Men with comorbid depression and obesity, compared with men without comorbid depression and obesity, had 7.6 times the risk of diabetes and 6.7 times the risk of hypertension.

Conclusion

Co-occurrence of depression and obesity among Australian men is associated with a set of individual- and area-level correlates and a higher risk of noncommunicable diseases. The correlates identified in our study are useful in planning interventions and screening in primary care settings.

A systematic review of variables associated with the relationship between obesity and depression

Obesity is one of the leading causes of preventable diseases and disability worldwide, and depression is among the leading causes of burden of disease. Both disorders are increasingly prevalent and comorbid. This comorbidity compounds associated health. While there is consistent evidence of a bidirectional obesity depression relationship, little is known about the biopsychosocial variables associated with this relationship. A systematic review was undertaken to identify variables associated with the relationship between obesity (Body mass index > 30 kg m(-2) ) and depression. Forty-six studies were identified. Obesity, educational attainment, body image, binge eating, physical health, psychological characteristics and interpersonal effectiveness were consistently associated with the relationship between obesity and depression. The current review identified potential biopsychosocial variables associated with the relationship between obesity and depression. This knowledge can inform future research examining moderators, mediators and mechanisms of the relationship between obesity and depression. Improved understanding of this relationship will inform identification, prevention and intervention efforts.

Adding cognitive therapy to dietetic treatment is associated with less relapse in obesity

OBJECTIVE

The treatment of obesity is universally disappointing; although usually some weight loss is reported directly after treatment, eventual relapse to, or even above, former body weight is common. In this study it is tested whether the addition of cognitive therapy to a standard dietetic treatment for obesity might prevent relapse. It is argued that the addition of cognitive therapy might not only be effective in reducing weight and related concerns, depressed mood, and low self-esteem, but also has an enduring effect that lasts beyond the end of treatment.

METHODS

Non-eating-disordered overweight and obese participants in a community health center (N=204) were randomly assigned to a group dietetic treatment+cognitive therapy or a group dietetic treatment+physical exercise.

RESULTS

Both treatments were quite successful and led to significant decreases in BMI, specific eating psychopathology (binge eating, weight-, shape-, and eating concerns) and general psychopathology (depression, low self-esteem). In the long run, however, the cognitive dietetic treatment was significantly better than the exercise dietetic treatment; participants in the cognitive dietetic treatment maintained all their weight loss, whereas participants in the physical exercise dietetic treatment regained part (25%) of their lost weight.

CONCLUSION

Cognitive therapy had enduring effects that lasted beyond the end of treatment. This potential prophylactic effect of cognitive therapy is promising; it might be a new strategy to combat the global epidemic of obesity.

Concurrent anxiety and substance use disorders among outpatients with major depression: clinical features and effect on treatment outcome

BACKGROUND

Depressed patients often present with comorbid anxiety and/or substance use disorder. This report compares the four groups defined by the disorders (anxiety disorder, substance use disorder, both, and neither) in terms of baseline clinical and sociodemographic features, and in terms of outcomes following treatment with citalopram (a selective serotonin reuptake inhibitor).

METHODS

The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial enrolled 2838 outpatients with non-psychotic major depressive disorder (MDD) from 18 primary and 23 psychiatric care clinics. Clinical and sociodemographic features were assessed at baseline. These baseline features and the treatment outcomes following treatment with citalopram were compared among the four groups.

RESULTS

Participants with non-psychotic MDD and comorbid anxiety and/or substance use disorder showed several distinctive baseline sociodemographic and clinical features. They also showed greater depression severity; length of illness; likelihood of anxious, atypical or melancholic features; more intolerance/attrition; and worse remission/response outcomes with treatment. Participants with either anxiety or substance use disorder showed outcomes generally intermediate between those with both and those with neither.

CONCLUSIONS

Comorbid anxiety and/or substance use disorder are clinically identifiable, and their presence may define distinct MDD subgroups that have more problems and worse pharmacological treatment outcomes. They may benefit from more aggressive, multi-faceted treatment and psychosocial rehabilitation targeted at reducing their psychological comorbidity and functional impairment.

Overweight and obesity: the significance of a depressed mood

OBJECTIVE

Comorbid depression has been found to increase morbidity in a variety of disorders. This study aimed to investigate whether the presence of depressive symptoms in overweight and obese people is related to increased specific eating psychopathology and decreased self-esteem.

METHODS

Overweight/obese people seeking dietary treatment were grouped according to their scores on the Beck Depression Inventory (BDI), resulting in a mildly to moderately depressed group (BDI > or = 10; n = 66; the symptomatic group) and a non-depressed group (BDI < 10; n = 83). Eating psychopathology was measured by the Eating Disorder Examination-Questionnaire (EDE-Q); self-esteem was measured by the Rosenberg Self-Esteem Scale.

RESULTS

Symptomatic people had more shape, weight and eating concerns (P-values < 0.001); scored higher on restraint (P < 0.01); had lower self-esteem (P < 0.001); and had a higher BMI (P < 0.05) than non-depressed people. Furthermore, the percentage of bingers was higher in the symptomatic group (P < 0.01).

CONCLUSION

Symptomatic participants suffered more than non-depressed participants, and not only from their depression.

PRACTICE IMPLICATIONS

For dieticians treating overweight and obese people, the BDI is a useful instrument for identifying the subgroup with depressive symptoms--the group that is at risk for (eating) psychopathology.

Relation between adherence and outcome in the group treatment of insomnia

This study evaluated adherence to group cognitive behavioral treatment in 50 adults with chronic insomnia. Adherence was measured using questionnaire data, consistency of sleep scheduling, and % of sessions attended. Results showed that therapists' rated 48% of participants as "very much" to "extremely" adherent. Using stepwise regression, only therapist-rated adherence explained a significant amount of variance in post-treatment outcome. Therapist-rated adherence predicted post-treatment ratings of sleep-related impairment, dysfunctional beliefs about sleep, and overall sleep quality (but not actual sleep duration or efficiency). Using a multivariate analysis of variance (MANOVA) procedure, results revealed that a diagnosis of dysthymia, based on a structured clinical interview, was associated with reduced adherence and less improvement in sleep-onset latency and sleep efficiency, but that scores on a dimensional measure of depression were not associated with either adherence or outcome. Implications of these findings are that the practice of treatment techniques is related to an improved perception of sleep and more healthy and appropriate beliefs about the causes of poor sleep. Therapists should continue to pay close attention to the adherence behavior of those with insomnia, particularly if they are depressed.