Objective:

Major depressive disorder is the leading cause of disability worldwide. Yet, there remain significant challenges in predicting new cases of major depression and devising strategies to prevent the disorder. An important first step in this process is identifying risk factors for the incidence of major depression. There is accumulating biological evidence linking insulin resistance, another highly prevalent condition, and depressive disorders. The objectives of this study were to examine whether three surrogate measures of insulin resistance (high triglyceride-HDL [high-density lipoprotein] ratio; prediabetes, as indicated by fasting plasma glucose level; and high central adiposity, as measured by waist circumference) at the time of study enrollment were associated with an increased rate of incident major depressive disorder over a 9-year follow-up period and to assess whether the new onset of these surrogate measures during the first 2 years after study enrollment was predictive of incident major depressive disorder during the subsequent follow-up period.

Methods:

The Netherlands Study of Depression and Anxiety (NESDA) is a multisite longitudinal study of the course and consequences of depressive and anxiety disorders in adults. The study population comprised 601 NESDA participants (18–65 years old) without a lifetime history of depression or anxiety disorders. The study’s outcome was incident major depressive disorder, defined using DSM-IV criteria. Exposure measures included triglyceride-HDL ratio, fasting plasma glucose level, and waist circumference.

Results:

Fourteen percent of the sample developed major depressive disorder during follow-up. Cox proportional hazards models indicated that higher triglyceride-HDL ratio was positively associated with an increased risk for incident major depression (hazard ratio=1.89, 95% CI=1.15, 3.11), as were higher fasting plasma glucose levels (hazard ratio=1.37, 95% CI=1.05, 1.77) and higher waist circumference (hazard ratio=1.11 95% CI=1.01, 1.21). The development of prediabetes in the 2-year period after study enrollment was positively associated with incident major depressive disorder (hazard ratio=2.66, 95% CI=1.13, 6.27). The development of high triglyceride-HDL ratio and high central adiposity (cut-point ≥100 cm) in the same period was not associated with incident major depression.

Conclusions:

Three surrogate measures of insulin resistance positively predicted incident major depressive disorder in a 9-year follow-up period among adults with no history of depression or anxiety disorder. In addition, the development of prediabetes between enrollment and the 2-year study visit was positively associated with incident major depressive disorder. These findings may have utility for evaluating the risk for the development of major depression among patients with insulin resistance or metabolic pathology.

中文翻译：

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三种胰岛素抵抗指标预测的重度抑郁症事件：荷兰队列研究

客观的：

重度抑郁症是世界范围内导致残疾的主要原因。然而，在预测重度抑郁症的新病例和制定预防该疾病的策略方面仍然存在重大挑战。这个过程中重要的第一步是确定重度抑郁症发病的风险因素。有越来越多的生物学证据将胰岛素抵抗（另一种高度流行的疾病）与抑郁症联系起来。本研究的目的是检查胰岛素抵抗的三个替代指标（高甘油三酯 - HDL [高密度脂蛋白] 比率；糖尿病前期，如空腹血糖水平所示；和高中心性肥胖，

方法：

荷兰抑郁和焦虑研究 (NESDA) 是一项针对成人抑郁和焦虑症的过程和后果的多地点纵向研究。研究人群包括 601 名 NESDA 参与者（18-65 岁），没有抑郁症或焦虑症的终生病史。该研究的结果是使用 DSM-IV 标准定义的重度抑郁症。暴露措施包括甘油三酯-HDL 比率、空腹血糖水平和腰围。

结果：

14% 的样本在随访期间发展为重度抑郁症。Cox 比例风险模型表明，较高的甘油三酯 - HDL 比率与发生重性抑郁症的风险增加呈正相关（风险比 = 1.89，95% CI = 1.15，3.11），空腹血糖水平较高（风险比 = 1.37， 95% CI=1.05, 1.77) 和更高的腰围（风险比=1.11 95% CI=1.01, 1.21）。研究入组后 2 年期间糖尿病前期的发展与重度抑郁症的发生呈正相关（风险比 = 2.66，95% CI = 1.13，6.27）。同期高甘油三酯-HDL比率和高中心肥胖（临界点≥100 cm）的发展与重性抑郁症无关。

结论：

在没有抑郁症或焦虑症病史的成年人中，在 9 年的随访期内，胰岛素抵抗的三个替代指标积极预测了重度抑郁症的发生。此外，从入组到 2 年研究访问之间的前驱糖尿病的发展与重度抑郁症的发生呈正相关。这些发现可能有助于评估患有胰岛素抵抗或代谢病理学的患者患重性抑郁症的风险。