title: The mediation effect of emotional eating between depression and body mass index in the two European countries Denmark and Spain.
abstract: In two European countries with a different prevalence of depression, namely Denmark (high) and Spain (low), we assessed whether the mediation effect of emotional eating between depression and Body Mass Index (BMI) as found in earlier studies can be replicated and whether this mediation effect is contingent on 1) change in appetite and 2) gender. Mediation and moderated mediation was assessed with Hayes' PROCESS macro in SPSS. Emotional eating (DEBQ: Dutch Eating Behavior Questionnaire), depressive symptoms (CES-D: Center for Epidemiologic Studies Depression Scale), change in appetite, weight and height were self-reported. In both countries, emotional eating acted as a mediator between depression and BMI (Denmark: B = 0.03 (SE = 0.01), 95% CI, [0.03, 0.05]; Spain: B = 0.03 (SE = 0.01), 95% CI, [0.02, 0.04]). In Denmark this mediation effect was stronger for participants with increased appetite and for females than for participants with decreases/no change in appetite and for males (more appetite: B = 0.08, (SE = 0.03), [0.03, 0.15]; decreased appetite/no change in appetite: B = 0.03 (SE = 0.01), [0.02, 0.04]); females: B = 0.05 (SE = 0.01), [0.03, 0.07]; males: B = 0.01 (SE = 0.01), [0.004, 0.04]. This supports depression with atypical features as an underlying mechanism in the mediation effect of emotional eating. In Spain there was no support for depression with atypical features as underlying mechanism because the mediation effect was neither moderated by change in appetite nor by gender. Instead, post-hoc analyses suggested 'stress of unemployment' as possible explanatory factor of the mediation effect, with stronger mediation effects for unemployed than for employed people (unemployed: B = 0.05 (SE = 0.01), [0.03, 0.07]; employed B = 0.02 (SE = 0.01), [0.01, 0.04]). The mediating effect of emotional eating between depressive symptoms and body mass index in both countries suggests that obesity interventions should take emotional eating into account.
authors.affiliation: Vrije Universiteit Amsterdam, Faculty of Earth and Life Sciences, Department of Health Sciences and the EMGO Institute for Health and Care Research, Amsterdam, The Netherlands; Radboud University, Behavioural Science Institute, Nijmegen, The Netherlands. Electronic address: t.vanstrien@psych.ru.nl.
authors.forename: Tatjana
authors.initials: T
authors.lastname: van Strien
authors.affiliation: Vrije Universiteit Amsterdam, Faculty of Earth and Life Sciences, Department of Health Sciences and the EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
authors.forename: Laura
authors.initials: L
authors.lastname: Winkens
authors.affiliation: Aarhus University, MAPP Centre, Department of Management, Aarhus BSS, Aarhus, Denmark.
authors.forename: Madeleine Broman
authors.initials: MB
authors.lastname: Toft
authors.affiliation: Aarhus University, MAPP Centre, Department of Management, Aarhus BSS, Aarhus, Denmark.
authors.forename: Susanne
authors.initials: S
authors.lastname: Pedersen
authors.affiliation: Vrije Universiteit Amsterdam, Faculty of Earth and Life Sciences, Department of Health Sciences and the EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Brouwer
authors.affiliation: Vrije Universiteit Amsterdam, Faculty of Earth and Life Sciences, Department of Health Sciences and the EMGO Institute for Health and Care Research, Amsterdam, The Netherlands; VU University Medical Center, Internal Medicine, Nutrition and Dietetics, Amsterdam, The Netherlands.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Visser
authors.affiliation: Aarhus University, MAPP Centre, Department of Management, Aarhus BSS, Aarhus, Denmark.
authors.forename: Liisa
authors.initials: L
authors.lastname: Lähteenmäki
mesh_terms: D000328:Adult; D000368:Aged; D001066:Appetite; D015992:Body Mass Index; D001835:Body Weight; D003430:Cross-Sectional Studies; D003718:Denmark / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology* / Q000523:psychology*; D004435:Eating / Q000523:psychology*; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires
keywords: BMI; Depression with atypical features; Depressive symptoms; Emotional eating; Mediator; Unemployment