title: The metabolic syndrome and related characteristics in major depression: inpatients and outpatients compared: metabolic differences across treatment settings.
abstract: OBJECTIVE
  We aimed to systematically compare patients with major depressive disorder from three different treatment settings (a primary care outpatient, a secondary care outpatient and one inpatient sample), with regard to metabolic syndrome (MetSyn) prevalences, individual MetSyn components and related metabolic variables.
  
  
  METHODS
  The outpatient samples were drawn from the ongoing Netherlands Study of Depression and Anxiety (302 primary care and 445 secondary care outpatients). The inpatient sample (n=80) was recruited from five Dutch mental health hospitals. The assessments of MetSyn and related variables [waist circumference (WC), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglycerides, glucose, systolic and diastolic blood pressure (SBP, DBP), body mass index (BMI), waist-hip ratio (WHR), LDL and total cholesterol (TC)] were compared using analysis of (co)variance and regression analysis, whereas medication analyses examined the extent to which clinical differences (e.g., depression severity or medication use) mediated the observed metabolic differences across setting.
  
  
  RESULTS
  MetSyn prevalences (26% primary, 24% secondary care and 28% inpatients) did not significantly differ (P=.71). WC, BMI, LDL cholesterol, glucose and DBP were not significantly different across settings. However, WHR, TC and triglyceride levels were higher in inpatients than in both outpatients groups, while HDL cholesterol levels and SBP were lower. There was some mediating role for tricyclic and non-selective serotonin-reuptake inhibitor antidepressant use, but overall, the mediating role of clinical differences was limited.
  
  
  CONCLUSIONS
  Although overall MetSyn prevalences did not differ, patterns of individual MetSyn-related variables differed more markedly across depressed inpatients and outpatients. Inpatients showed more adverse WHR and serum lipid profiles, while SBP levels were lower.
authors.affiliation: Department of Psychiatry, Leiden University Medical Center and GGZ Rivierduinen, The Netherlands. Electronic address: f.s.luppino@lumc.nl.
authors.forename: Floriana S
authors.initials: FS
authors.lastname: Luppino
authors.affiliation: Department of Psychiatry Erasmus Medical Centre, Rotterdam, The Netherlands. Electronic address: p.bouvy@erasmusmc.nl.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Bouvy
authors.affiliation: Department of Psychiatry, Leiden University Medical Center and GGZ Rivierduinen, The Netherlands. Electronic address: e.j.giltay@lumc.nl.
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Giltay
authors.affiliation: Department of Psychiatry, Leiden University Medical Center and GGZ Rivierduinen, The Netherlands; Department of Psychiatry EMGO VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: b.penninx@vumc.nl.
authors.forename: Brenda W J H
authors.initials: BW
authors.lastname: Penninx
authors.affiliation: Department of Psychiatry, Leiden University Medical Center and GGZ Rivierduinen, The Netherlands. Electronic address: f.g.zitman@lumc.nl.
authors.forename: Frans G
authors.initials: FG
authors.lastname: Zitman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology* / Q000503:physiopathology; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010045:Outpatients / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D063127:Secondary Health Care / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents
keywords: Inpatients; Major depressive disorder; Metabolic characteristics; Metabolic syndrome; Outpatients