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Body mass index in middle life and future risk of hospital admission for psychoses or depression: findings from the Renfrew/Paisley study

Published online by Cambridge University Press:  04 April 2007

DEBBIE A. LAWLOR*
Affiliation:
Department of Social Medicine, University of Bristol, UK
CAROLE L. HART
Affiliation:
Public Health and Health Policy, Division of Community Based Sciences, University of Glasgow, Glasgow, UK
DAVID J. HOLE
Affiliation:
Public Health and Health Policy, Division of Community Based Sciences, University of Glasgow, Glasgow, UK
DAVID GUNNELL
Affiliation:
Department of Social Medicine, University of Bristol, UK
GEORGE DAVEY SMITH
Affiliation:
Department of Social Medicine, University of Bristol, UK
*
*Address for correspondence: Professor D. A. Lawlor, Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK. (Email: [email protected])

Abstract

Background

There is evidence that greater body mass index (BMI) protects against depression, schizophrenia and suicide. However, there is a need for prospective studies.

Method

We examined the association of BMI with future hospital admissions for psychoses or depression/anxiety disorders in a large prospective study of 7036 men and 8327 women. Weight and height were measured at baseline (1972–76) when participants were aged 45–64. Follow-up was for a median of 29 years.

Results

Greater BMI and obesity were associated with a reduced risk of hospital admission for psychoses and depression/anxiety in both genders, with the magnitude of these associations being the same for males and females. With adjustment for age, sex, smoking and social class, a 1 standard deviation (s.d.) greater BMI at baseline was associated with a rate ratio of 0·91 [95% confidence interval (CI) 0·82–1·01] for psychoses and 0·87 (95% CI 0·77–0·98) for depression/anxiety. Further adjustment for baseline psychological distress and total cholesterol did not alter these associations.

Conclusions

Our findings add to the growing body of evidence that suggests that greater BMI is associated with a reduced risk of major psychiatric outcomes. Long-term follow-up of participants in randomized controlled trials of interventions that effectively result in weight loss and the use of genetic variants that are functionally related to obesity as instrumental variables could help to elucidate whether these associations are causal.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2007

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References

REFERENCES

Altman, D., Machin, D., Bryant, T. & Hanley, J. (2000). Statistics with Confidence (2nd edn). BMJ Books: London.Google Scholar
Avenell, A., Brown, T. J., McGee, M. A., Campbell, M. K., Grant, A. M., Broom, J., Jung, R. T. & Smith, W. C. (2004 a). What are the long-term benefits of weight reducing diets in adults? A systematic review of randomized controlled trials. Journal of Human Nutrition and Diet 17, 317335.CrossRefGoogle ScholarPubMed
Avenell, A., Brown, T. J., McGee, M. A., Campbell, M. K., Grant, A. M., Broom, J. & Smith, W. C. (2004 b). What interventions should we add to weight reducing diets in adults with obesity? A systematic review of randomized controlled trials of adding drug therapy, exercise, behaviour therapy or combinations of these interventions. Journal of Human Nutrition and Diet 17, 293316.CrossRefGoogle ScholarPubMed
Bergman, R. N. & Ader, M. (2005). Atypical antipsychotics and glucose homeostasis. Journal of Clinical Psychiatry 66, 504514.CrossRefGoogle ScholarPubMed
Carpenter, K. M., Hasin, D. S., Allison, D. B. & Faith, M. S. (2000). Relationships between obesity and DSM-IV major depressive disorder, suicide ideation, and suicide attempts: results from a general population study. American Journal of Public Health 90, 251257.Google ScholarPubMed
Citrome, L., Blonde, L. & Damatarca, C. (2005). Metabolic issues in patients with severe mental illness. Southern Medical Journal 98, 714720.CrossRefGoogle ScholarPubMed
Craig, S. R., Amin, R. V., Russell, D. W. & Paradise, N. F. (2000). Blood cholesterol screening: influence of fasting state on cholesterol results and management decisions. Journal of General Internal Medicine 15, 395399.CrossRefGoogle ScholarPubMed
Crisp, A. H. & McGuiness, B. (1976). Jolly fat: relation between obesity and psychoneurosis in the general population. British Medical Journal 1, 79.CrossRefGoogle Scholar
Crisp, A. H., Queenan, M., Sittampaln, Y. & Harris, G. (1980). ‘Jolly fat’ revisited. Journal of Psychoneurosis Research 24, 233241.CrossRefGoogle ScholarPubMed
Davey Smith, G. (2006). Cochrane Lecture. Randomised by (your) god: robust inference from an observational study design. Journal of Epidemiology and Community Health 60, 382388.CrossRefGoogle Scholar
Davey Smith, G. & Ebrahim, S. (2003). ‘Mendelian randomization’: can genetic epidemiology contribute to understanding environmental determinants of disease? International Journal of Epidemiology 32, 122.CrossRefGoogle Scholar
Faubel, M. (1989). Body image and depression in women with early and late onset obesity. Journal of Psychology 123, 385395.CrossRefGoogle ScholarPubMed
Friedman, M. A. & Brownell, K. D. (1995). Psychological correlates of obesity: moving to the next research generation. Psychology Bulletin 117, 320.CrossRefGoogle Scholar
General Register Office (1966). Classification of Occupations 1966. HMSO: London.Google Scholar
Goldberg, D. P. (1972). The Detection of Psychiatric Illness by Questionnaire. Oxford University Press: London.Google Scholar
Golomb, B. A., Tenkanen, L., Alikoski, T., Niskanen, T., Manninen, V., Huttunen, M. & Mednick, S. A. (2002). Insulin sensitivity markers: predictors of accidents and suicides in Helsinki Heart Study screenees. Journal of Clinical Epidemiology 55, 767773.CrossRefGoogle ScholarPubMed
Gunnell, D., Harrison, G., Whitley, E., Lewis, G., Tynelius, P. & Rasmussen, F. (2005). The association of fetal and childhood growth with risk of schizophrenia. Cohort study of 720,000 Swedish men and women. Schizophrenia Research 79, 315322.CrossRefGoogle Scholar
Hafner, H. & an der Heiden, W. (1997). Epidemiology of schizophrenia. Canadian Journal of Psychiatry 42, 139151.CrossRefGoogle ScholarPubMed
Hallstrom, T. & Noppa, H. (1981). Obesity in women in relation to mental illness, social factors and personality traits. Journal of Psychosomatic Research 25, 7582.CrossRefGoogle ScholarPubMed
Han, T. S., Tijhuis, M. A., Lean, M. E. & Seidell, J. C. (1998). Quality of life in relation to overweight and body fat distribution. American Journal of Public Health 88, 18141820.CrossRefGoogle ScholarPubMed
Hart, C. L., Hole, D. J., Lawlor, D. A. & Davey Smith, G. (2007). Obesity and use of acute hospital services in participants of the Renfrew/Paisley study. Journal of Public Health 29, 5356.CrossRefGoogle ScholarPubMed
Hawthorne, V. M., Watt, G. C. M., Hart, C. L., Hole, D. J., Davey Smith, G. & Gillis, C. R. (1995). Cardiorespiratory disease in men and women in urban Scotland: baseline characteristics of the Renfrew/Paisley (Midspan) Study population. Scottish Medical Journal 40, 102107.CrossRefGoogle ScholarPubMed
Istavan, J., Zavelta, K. & Weidner, G. (1992). Body weight and psychological distress in NHANES 1. International Journal of Obesity 16, 9991003.Google Scholar
Jung, R. T. (1997). Obesity as a disease. British Medical Bulletin 53, 307321.CrossRefGoogle ScholarPubMed
Kendrick, S. & Clarke, J. (1993). The Scottish record linkage system. Health Bulletin 51, 7279.Google ScholarPubMed
Kretschmer, E. (1931). Physique and Character: An Investigation of the Nature of Constitution and of the Theory of Temperament. Routledge: London.Google Scholar
Lawlor, D. A., Ben-Shlomo, Y., Ebrahim, S., Davey Smith, G., Stansfeld, S. A., Yarnell, J. W. & Gallagher, J. E. (2005). Insulin resistance and depressive symptoms in middle-aged men: findings from the Caerphilly prospective cohort study. British Medical Journal 330, 705706.CrossRefGoogle ScholarPubMed
Lawlor, D. A., Davey Smith, G. & Ebrahim, S. (2003). Association of insulin resistance with depression: cross-sectional findings from the British Women's Heart and Health Study. British Medical Journal 327, 13831384.CrossRefGoogle ScholarPubMed
Lawlor, D. A., Harbord, R. M., Sterne, J. A. C. & Davey Smith, G. (in press). Mendelian randomization: using genes as instruments for making causal inferences in epidemiology. Statistics in Medicine.Google Scholar
Lawlor, D. A., Hart, C. L., Hole, D. J. & Davey Smith, G. (2006). Reverse causality and confounding and the associations of overweight and obesity with mortality. Obesity 14, 22942304.CrossRefGoogle ScholarPubMed
Liese, A. D., Mayer-Davis, E. J. & Haffner, S. M. (1998). Development of the multiple metabolic syndrome: an epidemiologic perspective. Epidemiologic Reviews 20, 157172.CrossRefGoogle ScholarPubMed
Luchsinger, J. A., Lee, W. N., Carrasquillo, O., Rabinowitz, D. & Shea, S. (2003). Body mass index and hospitalization in the elderly. Journal of the American Geriatrics Society 51, 16151620.CrossRefGoogle ScholarPubMed
Magnusson, P., Rasmussen, F., Lawlor, D. A., Tynelius, P. & Gunnell, D. (2005). Association of body mass index with suicide mortality: a prospective cohort study of more than one million men. American Journal of Epidemiology 163, 18.CrossRefGoogle ScholarPubMed
Middleton, N., Gunnell, D., Whitley, E., Dorling, D. & Frankel, S. (2001). Secular trends in antidepressant prescribing in the UK, 1975–1998. Journal of Public Health Medicine 23, 262267.CrossRefGoogle ScholarPubMed
Newcomer, J. W. (2004). Metabolic risk during antipsychotic treatment. Clinical Therapy 26, 19361946.CrossRefGoogle ScholarPubMed
Noppa, H. & Hallstrom, T. (1981). Weight gain in adulthood in relation to socioeconomic factors, mental illness, and personality traits: a prospective study of middle-aged women. Journal of Psychosomatic Research 117, 320.Google Scholar
O'Meara, S., Riemsma, R., Shirran, L., Mather, L. & ter Reit, G. (2004). A systematic review of the clinical effectiveness of orlistat used for the management of obesity. Obesity Reviews 5, 5168.CrossRefGoogle ScholarPubMed
Onyike, C. U., Crum, R. M., Lee, H. B., Lyketsos, C. G. & Eaton, W. W. (2003). Is obesity associated with major depression? Results from the Third National Health and Nutrition Examination Survey. American Journal of Epidemiology 158, 11391147.CrossRefGoogle ScholarPubMed
Palinkas, L. A., Wingard, D. L. & Barrett-Connor, E. (1996). Depressive symptoms in overweight and obese older adults: a test of the ‘Jolly Fat’ hypothesis. Journal of Psychosomatic Research 40, 5966.CrossRefGoogle ScholarPubMed
Quesenberry, C. P. Jr., Caan, B. & Jacobson, A. (1998). Obesity, health services use, and health care costs among members of a health maintenance organization. Archives of Internal Medicine 158, 466472.CrossRefGoogle ScholarPubMed
Rasul, F., Stansfeld, S. A., Hart, C. L., Gillis, C. & Davey Smith, G. (2002). Common mental disorder and physical illness in the Renfrew and Paisley (MIDSPAN) study. Journal of Psychosomatic Research 53, 11631170.CrossRefGoogle ScholarPubMed
Roberts, R. E., Deleger, S., Strawbridge, W. J. & Kaplan, G. A. (2003). Prospective association between obesity and depression: evidence from the Alameda County Study. International Journal of Obesity 27, 514521.CrossRefGoogle ScholarPubMed
Roberts, R. E., Kaplan, G. A., Shema, S. J. & Strawbridge, W. J. (2000). Are the obese at greater risk for depression? American Journal of Epidemiology 152, 163170.CrossRefGoogle ScholarPubMed
Roberts, R. E., Strawbridge, W. J., Deleger, S. & Kaplan, G. A. (2002). Are the fat more jolly? Annals of Behavioral Medicine 24, 169180.CrossRefGoogle ScholarPubMed
Ross, C. (1994). Overweight and depression. Journal of Health and Social Behavior 35, 6379.CrossRefGoogle ScholarPubMed
Seidell, J. C. (2005). Epidemiology of obesity. Seminars in Vascular Medicine 5, 314.CrossRefGoogle ScholarPubMed
Simon, G. E., Von Korff, M., Saunders, K., Migliaretti, D. L., Crane, P. K., van Belle, G. & Kessler, R. C. (2006). Association between obesity and psychiatric disorders in the US adult population. Archives of General Psychiatry 63, 824830.CrossRefGoogle ScholarPubMed
Sorensen, H. J., Mortensen, E. L., Reinisch, J. M. & Mednick, S. A. (2006). Height, weight and body mass index in early adulthood and risk of schizophrenia. Acta Psychiatrica Scandinavica 114, 4954.CrossRefGoogle ScholarPubMed
Stunkard, A. J., Faith, M. S. & Allison, K. C. (2003). Depression and obesity. Biological Psychiatry 54, 330337.CrossRefGoogle ScholarPubMed
Thompson, D., Edelsberg, J., Colditz, G. A., Bird, A. P. & Oster, G. (1999). Lifetime health and economic consequences of obesity. Archives of Internal Medicine 159, 21772183.CrossRefGoogle ScholarPubMed
Wahlbeck, K., Forsen, T., Osmond, C., Barker, D. J. & Eriksson, J. G. (2001). Association of schizophrenia with low maternal body mass index, small size at birth, and thinness during childhood. Archives of General Psychiatry 58, 4852.CrossRefGoogle ScholarPubMed
Weiser, M., Knobler, H., Lubin, G., Nahon, D., Kravitz, E., Caspi, A., Noy, S., Knobler, K. Y. & Davidson, M. (2004). Body mass index and future schizophrenia in Israeli male adolescents. Journal of Clinical Psychiatry 65, 15461549.CrossRefGoogle ScholarPubMed
Wyatt, R. J., Henter, I. D., Mojtabai, R. & Bartko, J. J. (2003). Height, weight and body mass index (BMI) in psychiatrically ill US Armed Forces personnel. Psychological Medicine 33, 363368.CrossRefGoogle ScholarPubMed