• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of nihpaAbout Author manuscriptsSubmit a manuscriptNIH Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
Prev Med. Author manuscript; available in PMC Mar 1, 2012.
Published in final edited form as:
PMCID: PMC3062726
NIHMSID: NIHMS269043

Depressive symptoms and self-reported fast-food intake in midlife women

Geoffrey B. Crawford, M.D., M.S.,a Anuprita Khedkar, M.B.B.S.,a Jodi A. Flaws, Ph.D.,b John D. Sorkin, M.D., Ph.D.,c and Lisa Gallicchio, Ph.D.d

Abstract

OBJECTIVE

To examine the association between depressive symptoms and fast-food intake in midlife women.

METHODS

Data were analyzed from a cross-sectional study of 626 women aged 45–54 years conducted from 2000–2004 in Baltimore, Maryland. Presence of depressive symptoms was measured using the Center for Epidemiologic Studies–Depression scale and defined as a score of 16 or greater. The frequency of fast-food intake was assessed using self-reported questionnaire data, and was categorized as “at least weekly”, “at least monthly, but less than weekly” and “less than monthly”.

RESULTS

Approximately 25% of the study sample reported depressive symptoms; 14% consumed fast-food “at least weekly,” and 27% “at least monthly, but less than weekly”. Compared to their counterparts, women with depressive symptoms had significantly greater odds of reporting higher fast-food intake (confounder-adjusted odds ratio: 1.54; 95% confidence interval: 1.06–2.25). Other covariates associated with a higher frequency of fast-food intake included black race and body mass index ≥30 kg/m2.

CONCLUSIONS

Findings from this study indicate that the presence of depressive symptoms is positively associated with fast-food intake in midlife women. These results may have important health implications given that both depression and dietary consumption patterns are risk factors for a number of diseases.

INTRODUCTION

Depressive symptoms have been found to be associated with food consumption patterns in multiple studies, and in different populations and cultures (Jeffery et al., 2009; Akbaraly et al. 2009; Jacka et al. 2010; Liu et al., 2007; Mikolajczyk et al., 2009, Sánchez-Villegas et al., 2009, Kuczmarksi et al., 2010, Nanri et al., 2010, Pagoto et al. 2009). It is hypothesized that depression itself may contribute to patterns of dietary consumption: depressive symptoms may decrease an individual’s motivation to engage in healthy dietary habits and thus may lead to a poor diet (Anton and Miller, 2005). Previous studies have also documented a relationship between depression and overeating (Kubzansky et al., 1998; Carney et al., 1995). However, it should be noted that causal evidence is largely lacking, and the association between depression and dietary patterns/intake may be bidirectional.

The risk of depression appears to increase among females during the menopausal transition (Cohen et al., 2006; Steinberg et al. 2008; Accortt et al., 2008). As such, the relationship between depression and diet has serious health implications given the identification of certain dietary consumption patterns as risk factors for obesity and other co-morbid conditions (Fung et al., 2004; Fung et al., 2001; Heidemann et al., 2008). Limited data exists exploring the relationship between depression and food consumption patterns specifically in midlife women. To address this gap in the literature, the present analysis was undertaken to test the hypothesis that the presence of depressive symptoms is associated with and increased frequency of fast-food intake in midlife women.

MATERIALS AND METHODS

The Midlife Health Study is a cross-sectional study that was conducted during 2000–2004 in the Baltimore metropolitan region. Detailed methods of this study have been published (Gallicchio et al., 2008; Visvanathan et al., 2005). Participants gave written informed consent according to procedures approved by the University of Maryland School of Medicine, University of Illinois, and Johns Hopkins University Institutional Review Boards.

Briefly, women aged 45 to 54 years of age were recruited by mass mailing an invitation to area households in the Baltimore metropolitan region. Women who were interested in participating were invited to call the clinic for more information. To be eligible for the study, women had to be between 45 and 54 years of age, have intact uterus and ovaries, and report at least three menstrual periods in the last 12 months. Women were excluded if they were pregnant, taking hormonal therapy or contraception, or had history of cancer of the reproductive organs.

At the clinic visit, women completed a 26-page questionnaire and had their height and weight measured. In total, 639 women completed the questionnaire and clinic visit.

Depressive symptoms were assessed using the Center for Epidemiologic Studies – Depression scale (CES-D), a 20-item, validated, self-report scale (Radloff, 1977). Participants scoring 16 or greater were categorized as “depressive symptoms present” and those scoring 15 or less were categorized as “depressive symptoms absent” (Radloff, 1977). The frequency of fast-food intake was measured by self-report using the question “How often did you eat foods from the following restaurants during the past year?” Participants were asked to score the frequency of food consumption for the following types of fast-food restaurants: “fried chicken”, “burgers”, and “fried fish” on a six-point scale (0, “never in past year”; 1, “1–4 times in past year”; 2, “5–11 times in pass year”; 3, “1–3 times a month”; 4, “once a week”; 5, “2–4 times a week”; or 6, “almost every day”). The responses were converted to median number of restaurant visits per month, and then added to yield total number of fast-food restaurant visits per month. Based on the distribution of the data, this variable were categorized as “at least weekly”, “at least monthly, but less than weekly” and “less than monthly.”

The following factors were considered as possible confounders in the analysis: age, race, marital status, education, annual household income, body mass index (BMI), current smoking, leisure physical activity, current alcohol use, and antidepressant use. The collection of data pertaining to these covariates has been reported previously (Gallicchio et al., 2008; Visvanathan et al., 2005).

Participants missing data on either depressive symptoms (n=6) or fast-food intake (n=7) were excluded, leaving 626 participants in the analytic dataset. Bivariate analyses were conducted using chi-square tests. Variables that were associated either with depressive symptoms or with fast-food intake in bivariate analyses at p<0.1 were considered potential confounders and inserted into the regression model. Ordinal logistic regression analysis was used to examine both the unadjusted and confounder-adjusted associations between depressive symptoms and the frequency of fast-food intake. Statistical analyses were performed using SAS version 9.2 (Cary, North Carolina).

RESULTS

Approximately 25% of the women reported depressive symptoms and 13.7% reported consuming fast-food “at least weekly”. Women with depressive symptoms were more likely to report being divorced/separated/widowed, to have a lower level of education and income, to be current smokers, to report less leisure physical activity, and to be using an anti-depressant medication compared to women without depressive symptoms (Table 1).

Table 1
Characteristics of the study sample, Baltimore, Maryland, 2000–2004

Women who reported depressive symptoms had statistically greater odds of reporting a higher frequency of fast-food intake compared to women who did not report depressive symptoms (odds ratio (OR) 1.54, 95% confidence interval (CI) 1.08–2.18) (Table 2). After adjustment for potential confounders, this association did not change (OR 1.54, 95% CI 1.06–2.25). Other variables that were significantly associated with a higher frequency of fast-food intake were black race and a BMI of 30 kg/m2 or greater.

Table 2
Unadjusted and adjusted associations between depressive symptoms (and other covariates) and frequency of fast-food intake in midlife women, Baltimore, Maryland, 2000–2004

DISCUSSION

The results of this study demonstrate a statistically significant positive association between the depressive symptoms and the frequency of fast-food intake in midlife women. These findings are consistent with recent publications that showed significant associations between self-reported depression and dietary patterns (Akbaraly et al., 2009; Jacka et al., 2010; Jeffrey et al., 2009; Liu et al., 2007, Sanchez-Villegas et al., 2009, Kuczmarksi et al., 2010, Nanri et al., 2010, Pagoto et al., 2009), although these other studies did not specifically examine the association investigated in this study in midlife women.

A number of plausible mechanisms exists to explain the association between depressive symptoms and food consumption patterns, including an effect of diet on subsequent onset of depression (Akbaraly et al., 2009), conversely, depression leading to poor diet (Anton and Miller, 2005), and finally, a combination of the two contributing to and facilitating the development of the other (Jacka et al., 2010). Evidence for a causal pathway is unclear, and the association is perhaps bidirectional, as data suggest that depression contributes to the development of certain eating patterns (Anton and Miller, 2005; Liu et al., 2007; Mikolajczyk et al., 2009) and that food consumption is a risk factor for depression (Akbaraly et al., 2009; Jacka et al., 2010; Jeffery et al., 2009). Most of the literature exploring the relationship between food consumption patterns and depression is based on cross-sectional data, with the exception of two studies that utilized prospective data (Akbaraly et al., 2009; Sanchez-Villegas et al., 2009). Akbaraly et al. (2009) demonstrated that a “processed food” dietary pattern was associated with CES-D score 5 years later; however dietary pattern was measured only at time 1 and depressive symptoms were measured only at time 2. Hence, reverse causation remains an alternative interpretation of the findings (Akbaraly et al., 2009). Sanchez-Villegas et al. (2009) demonstrated that adherence to the Mediterranean dietary pattern was associated with a lower incidence of depression over a median follow-up time of 4.4 years. However, the possibility of reverse causality exists if subclinical depression preceded dietary adherence (Sanchez-Villegas et al., 2009). Given current data, including the results of this cross-sectional study, causal inferences regarding the association of depressive symptoms with food consumption patterns are limited.

Midlife women are at elevated risk for developing depression, with a number of studies exploring the risk of depression during the menopausal transition (Cohen et al., 2006; Steinberg et al., 2008; Accortt et al., 2008). Depression causes significant psychological and social morbidity, and is an independent risk factor for further morbidity and mortality due to many chronic diseases, including cardiovascular disease (Carney et al., 2008). It may be that dietary factors, including fast-food intake, mediate this association. Given the gravity of potential health implications, especially in the population of midlife women, future prospective investigation is encouraged.

ACKNOWLEDGEMENTS

Source of financial support: This study was supported by NIH grant AG018400, NIA 5P30AG028747, NCRR 5K30RR022682

ABBREVIATIONS

95% CI
95% confidence interval
BMI
Body mass index
CES-D
Center for Epidemiologic Studies – Depression scale
OR
Odds ratio

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

CONFLICT OF INTEREST

The authors declare that there are no conflicts of interest.

REFERENCES

  • Accortt EE, et al. Women and major depressive disorder: clinical perspectives on causal pathways. J. Womens Health (Larchmt) 2008;17:1583–1590. [PubMed]
  • Akbaraly TN, et al. Dietary pattern and depressive symptoms in middle age. Br. J. Psychiatry. 2009;195:408–413. [PMC free article] [PubMed]
  • Anton SD, Miller PM. Do negative emotions predict alcohol consumption, saturated fat intake, and physical activity in older adults? Behav. Modif. 2005;29:677–688. [PubMed]
  • Carney RM, Freedland KE. Depression in patients with coronary heart disease. Am. J. Med. 2008;121:S20–S27. [PubMed]
  • Carney RM, et al. Depression as a risk factor for cardiac events in established coronary heart disease: a review of possible mechanisms. Ann. Behav. Med. 1995;17:142–149. [PubMed]
  • Cohen LS, et al. Risk for new onset of depression during the menopausal transition: the Harvard study of moods and cycles. Arch. Gen. Psychiatry. 2006;63:385–390. [PubMed]
  • Fung TT, et al. Prospective study of major dietary patterns and stroke risk in women. Stroke. 2004;35:2014–2019. [PubMed]
  • Fung TT. Dietary patterns and the risk of coronary heart disease in women. Arch. Intern. Med. 2001;161:1857–1862. [PubMed]
  • Gallicchio L, et al. Endogenous hormones, participant characteristics, and symptoms among midlife women. Maturitas. 2008;59:114–127. [PMC free article] [PubMed]
  • Heidemann C, et al. Dietary patterns and risk of mortality from cardiovascular disease, cancer, and all causes in a prospective cohort of women. Circulation. 2008;118:230–237. [PMC free article] [PubMed]
  • Jacka FN, et al. Association of western and traditional diets with depression and anxiety in women. Am. J. Psychiatry. 2010;167:305–311. [PubMed]
  • Jeffery RW, et al. Reported food choices in older women in relation to body mass index and depressive symptoms. Appetite. 2009;52:238–240. [PMC free article] [PubMed]
  • Kubzansky LD, et al. Anxiety and coronary heart disease: a synthesis of epidemiological, psychological, and experimental evidence. Ann. Behav. Med. 1998;20:47–58. [PubMed]
  • Kuczmarski MF, et al. Higher Healthy Eating Index-2005 scores associated with reduced symptoms of depression in an urban population: findings from the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) study. J. Am. Diet. Assoc. 2010;110:383–389. [PMC free article] [PubMed]
  • Liu C, et al. Perceived stress, depression and food consumption frequency in the college students of China Seven Cities. Physiol. Behav. 2007;92:748–754. [PubMed]
  • Mikolajczyk RT, et al. Food consumption frequency and perceived stress and depressive symptoms among students in three European countries. Nutr. J. 2009;8:31. [PMC free article] [PubMed]
  • Nanri A, et al. Dietary patterns and depressive symptoms among Japanese men and women. Eur. J. Clin. Nutr. 2010;64:832–839. [PubMed]
  • Pagoto SL, et al. Association of depressive symptoms and lifestyle behaviors among Latinos at risk of type 2 diabetes. J. Am. Diet. Assoc. 2009;109:1246–1250. [PMC free article] [PubMed]
  • Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl. Psychol. Meas. 1977;1:385–401.
  • Rozanski A, et al. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation. 1999;99:2192–2217. [PubMed]
  • Sanchez-Villegas A, et al. Association of the Mediterranean dietary pattern with the incidence of depression: the Seguimiento Universidad de Navarra/University of Navarra follow-up (SUN) cohort. Arch. Gen. Psychiatry. 2009;66:1090–1098. [PubMed]
  • Steinberg EM, et al. A cross-sectional evaluation of perimenopausal depression. J. Clin. Psychiatry. 2008;69:973–980. [PMC free article] [PubMed]
  • Visvanathan K, et al. Cytochrome gene polymorphisms, serum estrogens, and hot flushes in midlife women. Obstet. Gynecol. 2005;106:1372–1381. [PubMed]
PubReader format: click here to try

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles