Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-28T06:19:19.742Z Has data issue: false hasContentIssue false

Psychological distress and C-reactive protein in a South African national survey

Published online by Cambridge University Press:  16 July 2019

Ronel Sewpaul*
Affiliation:
Population Health, Health Systems and Innovation, Human Sciences Research Council, Cape Town, South Africa
Petrus J.W. Naudé
Affiliation:
Department of Psychiatry and Mental Health, Brain Behaviour Unit, University of Cape Town, Cape Town, South Africa
Dan J. Stein
Affiliation:
Department of Psychiatry and Mental Health, Brain Behaviour Unit, University of Cape Town, Cape Town, South Africa SU/UCT MRC Unit on Risk and Resilience in Mental Disorders and Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
Demetre Labadarios
Affiliation:
Faculty of Medicine and Health Sciences, University of Stellenbosch, Stellenbosch, South Africa
*
Author for correspondence: Ronel Sewpaul, Email: [email protected]

Abstract

Objective:

To examine the association of psychological distress with serum C-reactive protein (CRP) in a South African cohort.

Methods:

Data were analysed on individuals aged ≥15 years from the South African National Health and Nutrition Examination Survey (SANHANES) of 2012. Psychological distress was evaluated using the Kessler Psychological Distress Scale. Linear regression models assessed the association of psychological distress with serum CRP, adjusting for possible confounding factors.

Results:

The analytic sample comprised n = 3944 individuals (mean age = 40 and sex = 36% males). Psychological distress was significantly associated with increased serum CRP levels (B = 0.31 and p = 0.001). This association was no longer significant after adjusting for demographic variables, lifestyle factors, cardiac disease, diabetes, hypertension, trauma and anti-inflammatory medication use (B = 0.15 and p = 0.062).

Conclusion:

Psychological distress was associated with elevated levels of CRP among South African adults. However, the association was confounded by a range of factors, with demographic variables (age, sex and population group) having the largest confounding effect. These findings indicate that CRP is not a useful biomarker of psychological distress, and that additional work is needed on the underlying psychobiology of psychological distress.

Type
Short Communication
Copyright
© Scandinavian College of Neuropsychopharmacology 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Diabetes Association (2012) Diagnosis and classification of diabetes mellitus. Diabetes Care 35(Suppl. 1), S64S71.CrossRefGoogle Scholar
Andersen, LS, Grimsrud, A, Myer, L, Williams, DR, Stein, DJ and Seedat, S (2011) The psychometric properties of the K10 and K6 scales in screening for mood and anxiety disorders in the South African Stress and Health study. International Journal of Methods in Psychiatric Research 20, 215223.CrossRefGoogle ScholarPubMed
Andrews, G and Slade, T (2001) Interpreting scores on the Kessler Psychological Distress Scale (K10). Australian and New Zealand Journal of Public Health 25, 494497.CrossRefGoogle Scholar
Bush, K, Kivlahan, DR, Mcdonell, MB, Fihn, SD and Bradley, KA (1998) The Audit alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Internal Medicine 158, 17891795.CrossRefGoogle ScholarPubMed
Danner, M, Kasl, S, Abramson, J and Vaccarino, V (2003) Association between depression and elevated C-reactive protein. Psychosomatic Medicine 65, 347356.CrossRefGoogle ScholarPubMed
Dramowski, A, Aucamp, M, Bekker, A and Mehtar, S (2017) Infectious disease exposures and outbreaks at a South African neonatal unit with review of neonatal outbreak epidemiology in Africa. International Journal of Infectious Diseases 57, 7985.CrossRefGoogle Scholar
Feldman, M and Sbong, S (2014) Is CRP, like ESR, age and gender dependent?. Rheumatology (Sunnyvale) 4, 134.CrossRefGoogle Scholar
Ferrucci, L and Fabbri, E (2018) Inflammageing: chronic inflammation in ageing, cardiovascular disease, and frailty. Nature Reviews Cardiology 15, 505522.CrossRefGoogle ScholarPubMed
Goldman-Mellor, S, Brydon, L and Steptoe, A (2010) Psychological distress and circulating inflammatory markers in healthy young adults. Psychological Medicine 40, 20792087.CrossRefGoogle ScholarPubMed
Hamer, M, Molloy, GJ, de Oliveira, C and Demakakos, P (2009) Persistent depressive symptomatology and inflammation: to what extent do health behaviours and weight control mediate this relationship? Brain, Behavior, and Immunity 23, 413418.CrossRefGoogle ScholarPubMed
Horn, SR, Long, MM, Nelson, BW, Allen, NB, Fisher, PA and Byrne, ML (2018) Replication and reproducibility issues in the relationship between C-reactive protein and depression: a systematic review and focused meta-analysis. Brain, Behavior, and Immunity 73, 85114.CrossRefGoogle ScholarPubMed
Kelley-Hedgepeth, A, Lloyd-Jones, DM, Colvin, A, Matthews, KA, Johnston, J, Sowers, MR, Sternfeld, B, Pasternak, RC, Chae, CU and for the SWAN Investigators (2008) Ethnic differences in C-reactive protein concentrations. Clinical Chemistry 54, 10271037.CrossRefGoogle ScholarPubMed
Kessler, RC and Ustun, TB (2004) The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93121.CrossRefGoogle Scholar
Liukkonen, T, Silvennoinen-Kassinen, S, Jokelainen, J, Rasanen, P, Leinonen, M, Meyer-Rochow, VB and Timonen, M (2006) The association between C-reactive protein levels and depression: results from the northern Finland 1966 birth cohort study. Biol Psychiatry 60, 825830.CrossRefGoogle ScholarPubMed
Ma, Y, Chiriboga, DE, Pagoto, SL, Rosal, MC, Li, W, Merriam, PA, Hébert, JR, Whited, MC and Ockene, IS (2011) Association between depression and C-reactive protein. Cardiol Res Prac 286509, 18.Google Scholar
Miller, GE, Stetler, CA, Carney, RM, Freedland, KE and Banks, WA (2002) Clinical depression and inflammatory risk markers for coronary heart disease. The American Journal of Cardiology 90, 12791283.CrossRefGoogle ScholarPubMed
Mirowsky, J and Ross, CE (2003) Social Causes of Psychological Distress. New York: Aldine de Gruyter.Google Scholar
Myer, L, Stein, DJ, Grimsrud, A, Seedat, S and Williams, DR (2008) Social determinants of psychological distress in a nationally representative sample of South African adults. Social Science & Medicine 66, 18281840.CrossRefGoogle Scholar
National Center for Health Statistics, Centers for Disease Control and Prevention (2006) Analytic and Reporting Guidelines. The National Health and Nutrition Examination Survey (NHANES). Prevention, pp. 114. Available at http://www.cdc.gov/nchs/nhanes/nhanes2003-2004/analytical_guidelines.htmGoogle Scholar
Naudé, PJW, Roest, AM, Stein, DJ, de Jonge, P and Doornbos, B (2018) Anxiety disorders and CRP in a population cohort study with 54,326 participants: The LifeLines study. World J Biol Psychiatry 19, 461470. doi: 10.1080/15622975.2018.1433325.CrossRefGoogle Scholar
Nayek, S and Ghosh, S (2018) A comparative study of serum C-reactive protein in patients with generalised anxiety disorder and depression. The Journal of Medical Research 4, 123131.CrossRefGoogle Scholar
Pan, A, Ye, X, Franco, OH, Li, H, Yu, Z, Wang, J, Qi, Q, Gu, W, Pang, X, Liu, H and Lin, X (2008) The association of depressive symptoms with inflammatory factors and adipokines in middle-aged and older Chinese. PLoS ONE 3, 1392.CrossRefGoogle ScholarPubMed
Park, S, Joo, YH, McIntyre, RS and Kim, B (2014) Metabolic syndrome and elevated C-reactive protein levels in elderly patients with newly diagnosed depression. Psychosomatics 55, 640649.CrossRefGoogle ScholarPubMed
Patel, V (2000) The need for treatment evidence for common mental disorders in developing countries. Psychological Medicine 30, 743746.CrossRefGoogle ScholarPubMed
Pikhart, H, Hubacek, JA, Kubinova, R, Nicholson, A, Peasey, A, Capkova, N, Poledne, R and Bobak, M (2009) Depressive symptoms and levels of C-reactive protein. Soc Psychiatr Epidemiol 44, 217222.CrossRefGoogle ScholarPubMed
Pitsavos, C, Panagiotakos, DB, Papageorgiou, C, Tsetsekou, E, Soldatos, C and Stefanadis, C (2006) Anxiety in relation to inflammation and coagulation markers, among healthy adults: The ATTICA Study. Atherosclerosis 185, 320326.CrossRefGoogle ScholarPubMed
Puustinen, PJ, Koponen, H, Kautiainen, H, Mantyselka, P and Vanhala, M (2011) Psychological distress and C-reactive protein: do health behaviours and pathophysiological factors modify the association? European Archives of Psychiatry and Clinical Neuroscience 261, 277284.CrossRefGoogle ScholarPubMed
Rommel, J, Simpson, R, Mounsey, JP, Chung, E, Schwartz, J, Pursell, I and Gehi, A (2013) Effect of body mass index, physical activity, depression, and educational attainment on high-sensitivity C-reactive protein in patients with atrial fibrillation. Am J Cardiol 111, 208212.CrossRefGoogle ScholarPubMed
Shisana, O, Labadarios, D, Rehle, T, Simbayi, L, Zuma, K, Dhansay, A, Reddy, P, Parker, W, Hoosain, E, Naidoo, P, Hongoro, C, Mchiza, Z, Steyn, NP, Dwane, N, Makoae, M, Maluleke, T, Ramlagan, S, Zungu, N, Evans, MG, Jacobs, L, Faber, M and the SANHANES-1 Team (2014) South African National Health and Nutrition Examination Survey (SANHANES-1): 2014 Edition. Cape Town: HSRC Press. Available at http://www.hsrc.ac.za/en/research-outputs/view/6493Google Scholar
Steptoe, A, Hamer, M and Chida, Y (2007) The effects of acute psychological stress on circulating inflammatory factors in humans: a review and meta-analysis. Brain, Behavior, and Immunity 21, 901912.CrossRefGoogle ScholarPubMed
Valkanova, V, Ebmeier, KP and Allan, CL (2013) CRP, IL-6 and depression: a systematic review and meta-analysis of longitudinal studies. Journal of Affective Disorders 150, 736744.CrossRefGoogle ScholarPubMed
Vogelzangs, N, Beekman, AT, de Jonge, P and Penninx, BW (2013) Anxiety disorders and inflammation in a large adult cohort. Translational Psychiatry 3, 249.CrossRefGoogle Scholar
Wium-Andersen, MK, Ørsted, DD, Nielsen, SF and Nordestgaard, BG (2013) Elevated C-reactive protein levels, psychological distress, and depression in 73 131 individuals. JAMA Psychiatry 70, 176184.CrossRefGoogle ScholarPubMed
Supplementary material: File

Sewpaul et al. supplementary material

Tables S1-S4

Download Sewpaul et al. supplementary material(File)
File 19.9 KB