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Depression trajectories and obesity among the elderly in Taiwan

  • S.-Y. Kuo (a1), K.-M. Lin (a2), C.-Y. Chen (a2) (a3), Y.-L. Chuang (a4) and W. J. Chen (a5) (a6)...

The present study aimed to (a) characterize 10-year trajectory patterns of depressive symptoms and (b) investigate the association between depressive trajectory and subsequent obesity, metabolic function and cortisol level.


In a prospective study of Taiwanese adults aged ⩾60 years (n=3922) between 1989 and 1999, depression was assessed using a 10-item short-form of the Center for Epidemiologic Studies Depression Scale and information on body mass index (BMI) was collected by self-report. A subsample (n=445) of the original cohort in 1989 was drawn to assess metabolic variables and cortisol levels in a 2000 follow-up. After trajectory analyses were performed, multinomial logistic regression analyses were used to estimate the association estimates.


We identified four distinctive trajectories of depressive symptoms: class 1 (persistent low, 41.8%); class 2 (persistent mild, 46.8%); class 3 (late peak, 4.2%); and class 4 (high-chronic, 7.2%). The results from both complete cases and multiple imputation analyses indicated that the odds of obesity were lower in the class 2, 3 or 4 elderly, as compared with those in class 1, while the odds of underweight were higher. The classes of older adults with more and persistent depressive symptoms showed a trend toward having both a lower BMI (p=0.01) and a higher cortisol level (p=0.04) compared with those with low depressive symptoms.


Incremental increases in depressive symptoms over time were associated with reduced risk of obesity and higher cortisol levels.

Corresponding author
*Address for correspondence: W. J. Chen, M.D., Sc.D., Institute of Epidemiology, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei 100, Taiwan. (Email:
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Allison DB (2000). Multiple imputation for missing data: a cautionary tale. Social Methods and Research 28, 301309.
Amore M, Tagariello P, Laterza C, Savoia EM (2007). Beyond nosography of depression in elderly. Archives of Gerontology and Geriatrics 44, 1322.
Arterburn DE, Crane PK, Sullivan SD (2004). The coming epidemic of obesity in elderly Americans. Journal of the American Geriatrics Society 52, 19071912.
Beekman AT, Geerlings SW, Deeg DJ, Smit JH, Schoevers RS, de Beurs E, Braam AW, Penninx BW, van Tilburg W (2002). The natural history of late-life depression: a 6-year prospective study in the community. Archives of General Psychiatry 59, 605611.
Blazer DG (2003). Depression in late life: review and commentary. Journals of Gerontology Series A – Biological Sciences and Medical Sciences 58, 249265.
Boey KW (1999). Cross-validation of a short form of the CES-D in Chinese elderly. International Journal of Geriatric Psychiatry 14, 608617.
Bornstein SR, Schuppenies A, Wong ML, Licinio J (2006). Approaching the shared biology of obesity and depression: the stress axis as the locus of gene–environment interactions. Molecular Psychiatry 11, 892902.
Bremmer MA, Deeg DJ, Beekman AT, Penninx BW, Lips P, Hoogendijk WJ (2007). Major depression in late life is associated with both hypo- and hypercortisolemia. Biological Psychiatry 62, 479486.
Chapman IM (2007). The anorexia of aging. Clinics in Geriatric Medicine 23, 735756.
Chi I, Yip PSF, Chiu HFK, Chou KL, Chan KS, Kwan CW, Conwell Y, Caine E (2005). Prevalence of depression and its correlates in Hong Kong's Chinese older adults. American Journal of Geriatric Psychiatry 13, 409416.
Cohen J (1987). Statistical Power Analysis for the Behavioral Sciences, revised edn. Lawrence Erlbaum Associates: Hillsdale, NJ.
Cornman JC, Goldman N, Glei DA, Weinstein M, Chang MC (2003). Social ties and perceived support: two dimensions of social relationships and health among the elderly in Taiwan. Journal of Aging and Health 15, 616644.
Cote S, Tremblay RE, Nagin D, Zoccolillo M, Vitaro F (2002). The development of impulsivity, fearfulness, and helpfulness during childhood: patterns of consistency and change in the trajectories of boys and girls. Journal of Child Psychology and Psychiatry and Allied Disciplines 43, 609618.
Crisp AH, McGuiness B (1976). Jolly fat: relation between obesity and psychoneurosis in general population. British Medical Journal 1, 79.
Djernes JK (2006). Prevalence and predictors of depression in populations of elderly: a review. Acta Psychiatrica Scandinavica 113, 372387.
Faith MS, Matz PE, Jorge MA (2002). Obesity–depression associations in the population. Journal of Psychosomatic Research 53, 935942.
Forman-Hoffman VL, Yankey JW, Hillis SL, Wallace RB, Wolinsky FD (2007). Weight and depressive symptoms in older adults: direction of influence? The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 62, S43S51.
Glei DA, Landau DA, Goldman N, Chuang YL, Rodriguez G, Weinstein M (2005). Participating in social activities helps preserve cognitive function: an analysis of a longitudinal, population-based study of the elderly. International Journal of Epidemiology 34, 864871.
Goldman N, Glei DA, Seplaki C, Liu IW, Weinstein M (2005). Perceived stress and physiological dysregulation in older adults. Stress 8, 95105.
Goldman N, Lin IF, Weinstein M, Lin Y-H (2003). Evaluating the quality of self-reports of hypertension and diabetes. Journal of Clinical Epidemiology 56, 148154.
Graham K, Schmidt G (1999). Alcohol use and psychosocial well-being among older adults. Journal of Studies on Alcohol 60, 345351.
Heo M, Pietrobelli A, Fontaine KR, Sirey JA, Faith MS (2006). Depressive mood and obesity in US adults: comparison and moderation by sex, age, and race. International Journal of Obesity 30, 513519.
Hermalin AI, Liang J, Chang M-C (1989). Survey of Health and Living Status of the Elderly in Taiwan: Questionnaire and Survey Design, Comparative Study of the Elderly in Asia Research Report 89-1. University of Michigan, PSC Publications: Ann Arbor, MI.
Ho RC, Niti M, Kua EH, Ng TP (2008). Body mass index, waist circumference, waist-hip ratio and depressive symptoms in Chinese elderly: a population-based study. International Journal of Geriatric Psychiatry 23, 401408.
Hybels CF, Blazer DG, Pieper CF, Landerman LR, Steffens DC (2009). Profiles of depressive symptoms in older adults diagnosed with major depression: latent cluster analysis. American Journal of Geriatric Psychiatry 17, 387396.
Idler EL, Benyamini Y (1997). Self-rated health and mortality: a review of twenty-seven community studies. Journal of Health and Social Behavior 38, 2137.
Jones BL, Nagin DS, Roeder K (2001). A SAS procedure based on mixture models for estimating developmental trajectories. Sociological Methods Research 29, 374393.
Kohout FJ, Berkman LF, Evans DA, Cornoni-Huntley J (1993). Two shorter forms of the CES-D depression symptoms index. Journal of Aging and Health 5, 179193.
Krause N, Liang J (1992). Cross-cultural variations in depressive symptoms in later life. International Psychogeriatrics 4 (Suppl. 2), 185202.
Kuriyama S, Koizumi Y, Matsuda-Ohmori K, Seki T, Shimazu T, Hozawa A, Awata S, Tsuji I (2006). Obesity and depressive symptoms in elderly Japanese: The Tsurugaya Project. Journal of Psychosomatic Research 60, 229235.
Li ZB, Ho SY, Chan WM, Ho KS, Li MP, Leung GM, Lam TH (2004). Obesity and depressive symptoms in Chinese elderly. International Journal of Geriatric Psychiatry 19, 6874.
Luppino FS, de Wit LM, Bouvy PF, Stijnen T, Cuijpers P, Penninx BWJH, Zitman FG (2010). Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Archives of General Psychiatry 67, 220229.
Markowitz S, Friedman MA, Arent SM (2008). Understanding the relation between obesity and depression: causal mechanisms and implications for treatment. Clinical Psychology: Science and Practice 15, 120.
McCaffery JM, Niaura R, Todaro JF, Swan GE, Carmelli D (2003). Depressive symptoms and metabolic risk in adult male twins enrolled in the National Heart, Lung, and Blood Institute Twin Study. Psychosomatic Medicine 65, 490497.
McTigue KM, Hess R, Ziouras J (2006). Obesity in older adults: a systematic review of the evidence for diagnosis and treatment. Obesity 14, 14851497.
Mojtabai R, Olfson M (2004). Major depression in community-dwelling middle-aged and older adults: prevalence and 2- and 4-year follow-up symptoms. Psychological Medicine 34, 623634.
Nagin DS, Tremblay RE (2001). Analyzing developmental trajectories of distinct but related behaviors: a group-based method. Psychological Methods 6, 1834.
Nelson ME, Rejeski WJ, Blair S, Duncan PW, Judge JO, King A, Macera CA, Castaneda-Sceppa C (2007). Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation 116, 10941105.
Perreira KM, Sloan FA (2002). Excess alcohol consumption and health outcomes: a 6-year follow-up of men over age 50 from the Health and Retirement Study. Addiction 97, 301310.
Radloff LS (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1, 385401.
Roberts RE, Deleger S, Strawbridge WJ, Kaplan GA (2003). Prospective association between obesity and depression: evidence from the Alameda County Study. International Journal of Obesity and Related Metabolic Disorders 27, 514521.
Roberts RE, Kaplan GA, Shema SJ, Strawbridge WJ (2000). Are the obese at greater risk for depression? American Journal of Epidemiology 152, 163170.
Skilton MR, Moulin P, Terra J-L, Bonnet F (2007). Associations between anxiety, depression, and the metabolic syndrome. Biological Psychiatry 62, 12511257.
Strawbridge WJ, Deleger S, Roberts RE, Kaplan GA (2002). Physical activity reduces the risk of subsequent depression for older adults. American Journal of Epidemiology 156, 328334.
Stunkard AJ, Faith MS, Allison KC (2003). Depression and obesity. Biological Psychiatry 54, 330337.
Thompson Martin C, Kayser-Jones J, Stotts N, Porter C, Froelicher ES (2006). Nutritional risk and low weight in community-living older adults: a review of the literature (1995–2005). The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 61, 927934.
Vogelzangs N, Beekman ATF, Dik MG, Bremmer MA, Comijs HC, Hoogendijk WJG, Deeg DJH, Penninx BWJH (2009). Late-life depression, cortisol, and the metabolic syndrome. American Journal of Geriatric Psychiatry 17, 716721.
Weber-Hamann B, Hentschel F, Kniest A, Deuschle M, Colla M, Lederbogen F, Heuser I (2002). Hypercortisolemic depression is associated with increased intra-abdominal fat. Psychosomatic Medicine 64, 274277.
Weinstein M, Glei DA, Yamazaki A, Ming-Cheng C (2004). The role of intergenerational relations in the association between life stressors and depressive symptoms. Research on Aging 26, 511530.
World Health Organization, International Association for the Study of Obesity, International Obesity Taskforce (2000). The Asia-Pacific Perspective: Redefining Obesity and Its Treatment. Health Communications Australia Pty Limited: Sydney.
Yuan YC (2000). multiple imputation for missing data: concepts and new development. In Proceedings of the Twenty-Fifth Annual SAS Users Group International Conference, Indianapolis, IN. SAS Institute Inc.: Rockville, MD.
Zamboni M, Mazzali G, Zoico E, Harris TB, Meigs JB, Di Francesco V, Fantin F, Bissoli L, Bosello O (2005). Health consequences of obesity in the elderly: a review of four unresolved questions. International Journal of Obesity 29, 10111029.
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