Are Cholesterol and Depression Inversely Related? A Meta-analysis of the Association Between Two Cardiac Risk Factors
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ORIGINAL ARTICLE
Are Cholesterol and Depression Inversely Related? A Meta-analysis of the Association Between Two Cardiac Risk Factors Ju Young Shin, Ph.D., R.N. & Jerry Suls, Ph.D. & René Martin, Ph.D., R.N.
Published online: 12 September 2008 # The Society of Behavioral Medicine 2008
Abstract Background Cholesterol and depression are both cardiac risk factors, but the direction and magnitude of the association between these risk factors is unclear. Purpose Meta-analytic techniques were used to evaluate the associations among total, high-, and low-density cholesterol (TC, HDL, LDL, respectively) and depression in empirical studies. Methods PubMed, CINAHL, PsycINFO, and manual search strategies were used to identify descriptive studies reporting associations among TC, HDL, LDL, and depression; 30 reports were found for TC, 16 for HDL, and 11 for LDL. Effect sizes were computed and aggregated in accord with Hedges and Olkin’s (Statistical methods for metaanalysis. New York: Academic Press; 1985) procedures. Results Higher TC was associated with lower levels of depression, d=−0.29; this association was substantially larger among medication-free samples (d=−0.51). An inverse, non-significant association was observed between
J. Y. Shin : R. Martin College of Nursing, University of Iowa, Iowa City, IA, USA J. Suls (*) : R. Martin Department of Psychology, University of Iowa, Iowa City, IA 52242, USA e-mail: [email protected] R. Martin Center for Research in the Implementation of Innovative Strategies in Practice, Veterans Affairs, Medical Center, Iowa City, IA, USA
LDL and depression (d=−0.17). High HDL was related to higher levels of depression, especially in women (d=0.20). Conclusions TC and depression were inversely related, with the strongest associations in medically naïve samples, which is noteworthy because such samples should involve fewer confounds. One clinical implication is that the lipids of patients treated for depression should be monitored. Keywords Cholesterol . Depression . Cardiac risk factors
Introduction Serum cholesterol has been identified as an important risk factor for cardiac morbidity and morbidity in epidemiologic studies [1]. This has provided the impetus for diet modification and cholesterol-lowering drugs as interventions for hypercholesterolemia [2, 3]. Depression also has been identified as a cardiac risk factor in prospective studies of nominally healthy samples and as a risk factor for reinfarction with patients with existing disease [4–6]. Randomized clinical trials (RCT) involving psychological interventions and anti-depressant medications have tested whether cardiac risk can be lowered in depressed postmyocardial infarction patients, although results have been mixed [7–9]. Some correlational evidence points to depression and high total cholesterol (TC) being inversely related. For example, one study [10] reported that older adults with low serum cholesterol were likely to be more depressed (also see [11]). This is consistent with Engelberg’s [12] proposal that central seroto
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