Insulin resistance and depression: cross sectional study
http://www.100md.com
《英国医生杂志》
1 Department of Public Health Science and General Practice, University of Oulu, Box 5000, FIN-90014, Finland, 2 Unit of General Practice, Oulu University Hospital, 90029 OYS, Finland, 3 International University Bremen, School of Engineering and Science, D-28725 Bremen, Germany, 4 Oulu Health Centre, Box 8, FIN-90015 City of Oulu, Finland
Correspondence to: M Timonen markku.timonen@oulu.fi
Introduction
Insulin resistance (a low qualitative insulin sensitivity check index) and severity of depressive symptoms (Beck's depression inventory 21) were positively correlated, particularly in people with impaired glucose tolerance. Our findings are at variance with those of Lawlor and colleagues,1 who suggested that a clinical diagnosis of diabetes in itself would be an explanation for their findings regarding diabetic patients. With our database, clinical diagnoses could not have affected the results, because we excluded patients previously diagnosed as having diabetes. Because in our study higher depression scores were already prevalent in those with impaired glucose tolerance without clinically manifest diabetes, our findings might be explained biologically—that is, by pathophysiological changes behind insulin resistance and depression.
Insulin resistance could develop as a consequence of an increased release of counter-regulatory hormones associated with depression.2 This, however, is unconfirmed. The strengths of our study were that the qualitative insulin sensitivity check index has shown to be a reliable instrument in screening insulin sensitivity in epidemiological studies.4 Also this was a population based study consisting of a representative sample of one whole age group. A limitation of our study is that the validity of the findings based on self reported Beck's depression inventory scales is inferior to those of structured diagnostic rating scales; thus, it cannot provide specific depression diagnoses. Neither could we test the causal hypothesis, because we did not know the full history of depression in the participants.
This article was posted on bmj.com on 16 December 2004: http://bmj.com/cgi/doi/10.1136/bmj.38313.513310.F7
A figure showing the results is on bmj.com
Contributors: MT conceived the study, reviewed the literature, and wrote the initial and subsequent drafts. SKK helped to conceive the study and revise the initial and subsequent drafts, and was overseer of the research group. JJ designed the statistical analyses, analysed the data, developed the figure, and helped draft the manuscript. ML and UR collected the data and contributed to the study design, interpretation, and revisions of the manuscript. VBMR helped revising the initial draft and contributed to revisions and discussions. MT is guarantor.
Funding: No additional funding.
Competing interests: None declared.
Ethical approval: Ethics Committee of the Faculty of Medicine, University of Oulu, Finland.
References
Lawlor DA, Smith GD, Ebrahim S. Association of insulin resistance with depression: cross sectional findings from the British Women's Heart and Health Study. BMJ 2003;327: 1383-4.
Musselman DL, Betan E, Larsen H, Phillips LS. Relationship of depression to diabetes types 1 and 2: epidemiology, biology, and treatment. Biol Psychiatry 2003;54: 317-29.
Rasgon NL, Rao RC, Hwang S, Altshuler LL, Elman S, Zuckerbrow-Miller J, et al. Depression in women with polycystic ovary syndrome: clinical and biochemical correlates. J Affect Disord 2003;74: 299-304.
Rajala U, Laakso M, Paivansalo M, Pelkonen O, Suramo I, Keinanen-Kiukaanniemi S. Low insulin sensitivity measured by both quantitative insulin sensitivity check index and homeostasis model assessment method as a risk factor of increased intima-media thickness of the carotid artery. J Clin Endocrinol Metab 2002;87: 5092-7.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4: 561-71.(Markku Timonen, acting professor1, Mauri)
Correspondence to: M Timonen markku.timonen@oulu.fi
Introduction
Insulin resistance (a low qualitative insulin sensitivity check index) and severity of depressive symptoms (Beck's depression inventory 21) were positively correlated, particularly in people with impaired glucose tolerance. Our findings are at variance with those of Lawlor and colleagues,1 who suggested that a clinical diagnosis of diabetes in itself would be an explanation for their findings regarding diabetic patients. With our database, clinical diagnoses could not have affected the results, because we excluded patients previously diagnosed as having diabetes. Because in our study higher depression scores were already prevalent in those with impaired glucose tolerance without clinically manifest diabetes, our findings might be explained biologically—that is, by pathophysiological changes behind insulin resistance and depression.
Insulin resistance could develop as a consequence of an increased release of counter-regulatory hormones associated with depression.2 This, however, is unconfirmed. The strengths of our study were that the qualitative insulin sensitivity check index has shown to be a reliable instrument in screening insulin sensitivity in epidemiological studies.4 Also this was a population based study consisting of a representative sample of one whole age group. A limitation of our study is that the validity of the findings based on self reported Beck's depression inventory scales is inferior to those of structured diagnostic rating scales; thus, it cannot provide specific depression diagnoses. Neither could we test the causal hypothesis, because we did not know the full history of depression in the participants.
This article was posted on bmj.com on 16 December 2004: http://bmj.com/cgi/doi/10.1136/bmj.38313.513310.F7
A figure showing the results is on bmj.com
Contributors: MT conceived the study, reviewed the literature, and wrote the initial and subsequent drafts. SKK helped to conceive the study and revise the initial and subsequent drafts, and was overseer of the research group. JJ designed the statistical analyses, analysed the data, developed the figure, and helped draft the manuscript. ML and UR collected the data and contributed to the study design, interpretation, and revisions of the manuscript. VBMR helped revising the initial draft and contributed to revisions and discussions. MT is guarantor.
Funding: No additional funding.
Competing interests: None declared.
Ethical approval: Ethics Committee of the Faculty of Medicine, University of Oulu, Finland.
References
Lawlor DA, Smith GD, Ebrahim S. Association of insulin resistance with depression: cross sectional findings from the British Women's Heart and Health Study. BMJ 2003;327: 1383-4.
Musselman DL, Betan E, Larsen H, Phillips LS. Relationship of depression to diabetes types 1 and 2: epidemiology, biology, and treatment. Biol Psychiatry 2003;54: 317-29.
Rasgon NL, Rao RC, Hwang S, Altshuler LL, Elman S, Zuckerbrow-Miller J, et al. Depression in women with polycystic ovary syndrome: clinical and biochemical correlates. J Affect Disord 2003;74: 299-304.
Rajala U, Laakso M, Paivansalo M, Pelkonen O, Suramo I, Keinanen-Kiukaanniemi S. Low insulin sensitivity measured by both quantitative insulin sensitivity check index and homeostasis model assessment method as a risk factor of increased intima-media thickness of the carotid artery. J Clin Endocrinol Metab 2002;87: 5092-7.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4: 561-71.(Markku Timonen, acting professor1, Mauri)