title: Prospective Associations Between Depressive Symptoms and the Metabolic Syndrome: the Spirited Life Study of Methodist Pastors in North Carolina.
abstract: BACKGROUND
  Metabolic syndrome (Met-S) has a robust concurrent association with depression. A small, methodologically limited literature suggests that Met-S and depression are reciprocally related over time, an association that could contribute to their overlapping influences on morbidity and mortality in cardiovascular disease, diabetes, and cancer.
  
  
  OBJECTIVE
  Using a refined approach to the measurement of Met-S as a continuous latent variable comprising continuous components, this study tested the prospective associations between Met-S and depression.
  
  
  METHODS
  This study of 1114 clergy included four annual assessments of depressive symptoms and Met-S components. Standard methods were used to measure Met-S risk factors, and the Patient Health Questionnaire-8 was used to assess depressive symptoms. We used confirmatory factor analysis to verify the structure of Met-S and depression and structural equation modeling to quantify the prospective relationships.
  
  
  RESULTS
  The statistical models confirmed the validity of quantifying Met-S as a continuous latent variable, replicated previous evidence of a concurrent association, and indicated a significant prospective association of initial depressive symptoms with subsequent Met-S. Initial Met-S was at most only weakly associated with subsequent depressive symptoms, and the former prospective effect was significantly larger. Associations of depressive symptoms and Met-S were significant for both men and women, but somewhat stronger among men.
  
  
  CONCLUSIONS
  Results support representation of Met-S as a continuous latent variable. The association of initial depressive symptoms with later Met-S suggests that interventions addressing these correlated risk factors may prove useful in preventive efforts.
authors.affiliation: Department of Psychology, University of Utah, Salt Lake City, UT, USA.
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Smith
authors.affiliation: Center for Health Policy and Inequalities Research, Duke University, PO Box 90392, Durham, NC, 27710, USA. david.eagle@duke.edu.
authors.forename: David E
authors.initials: DE
authors.lastname: Eagle
authors.affiliation: Duke Global Health Institute and Duke Center for Health Policy & Inequalities Research, Duke University, Durham, NC, USA.
authors.forename: Rae Jean
authors.initials: RJ
authors.lastname: Proeschold-Bell
mesh_terms: D000328:Adult; D000368:Aged; D002977:Clergy / Q000523:psychology* / Q000706:statistics & numerical data; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D000073222:Patient Health Questionnaire; D033303:Protestantism / Q000523:psychology*; D012307:Risk Factors
keywords: Depression; Metabolic syndrome; Prospective studies