title: Depressive symptoms are associated with obesity in adults with heart failure: An analysis of gender differences.
abstract: BACKGROUND
  Depression is a predictor and consequence of obesity in the general population. Up to 50% of patients with heart failure exhibit elevated depressive symptoms or depressive disorders; however, research on the depression-obesity relationship in heart failure populations is limited, especially in regard to gender differences.
  
  
  OBJECTIVE
  To conduct total-sample and gender-stratified analyses to determine whether depressive symptoms are associated with body mass index (BMI) in a sample of patients with heart failure.
  
  
  METHODS
  Participants were 348 (39% female, 26% non-White) patients with heart failure (aged 68.7±9.7 years) recruited from urban medical centers. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). Height and weight were used to compute BMI (kg/m(2)). Regressions were performed for total sample and both genders. Regressions for BMI were run with demographic, medical, and psychological covariates in Step 1 and the PHQ-9 in Step 2.
  
  
  RESULTS
  Regression results (total sample) revealed that the PHQ-9 was associated with BMI after adjusting for covariates (β=.22, p=.004). For males, the relationship between PHQ-9 and BMI remained (β=.23, p=.024) and was driven by those with severe obesity (BMI ≥ 40 kg/m(2)). A trend between PHQ-9 and BMI was detected among females (β=.19, p=.091).
  
  
  CONCLUSIONS
  BMI is related to depressive symptoms in adults with heart failure even after adjusting for demographic and medical covariates. Depressive symptoms were associated with BMI in males, whereas a trend was detected among females. These findings could ultimately be used to improve heart failure outcomes for depressed, obese individuals with heart failure.
authors.affiliation: Department of Psychological Sciences, Kent State University, USA mhawki15@kent.edu.
authors.forename: Misty A W
authors.initials: MA
authors.lastname: Hawkins
authors.affiliation: Department of Psychological Sciences, Kent State University, USA Department of Cardiopulmonary Research, Summa Health System, Akron, USA.
authors.forename: Carly M
authors.initials: CM
authors.lastname: Goldstein
authors.affiliation: School of Nursing, Case Western Reserve University, Cleveland, USA.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Dolansky
authors.affiliation: Department of Psychological Sciences, Kent State University, USA.
authors.forename: John
authors.initials: J
authors.lastname: Gunstad
authors.affiliation: Department of Cardiopulmonary Research, Summa Health System, Akron, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Redle
authors.affiliation: School of Medicine, Case Western Reserve University, Cleveland, USA Harrington Heart and Vascular Institute, University Hospitals, Cleveland, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Josephson
authors.affiliation: Department of Psychological Sciences, Kent State University, USA Department of Cardiopulmonary Research, Summa Health System, Akron, USA.
authors.forename: Joel W
authors.initials: JW
authors.lastname: Hughes
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D012044:Regression Analysis; D012720:Severity of Illness Index; D017678:Sex Distribution; D011795:Surveys and Questionnaires
keywords: Body mass index; depressive symptoms; gender; heart failure; obesity