Is poor self-rated health a useful indicator of cardiometabolic abnormalities in people on antidepressants? A population-based study

Abstract

Background Research suggests regular screening for metabolic abnormalities in antidepressant users is required to manage the potential adverse metabolic effects of the drugs. Although fragmented evidence suggests poor self-reported health (SRH) may be a useful diagnostic indicator of metabolic dysfunction in antidepressant users research in this area is sparse. This study examined whether SRH explains the excess metabolic dysfunction in patients prescribed antidepressants. Method A total of 622 adults prescribed antidepressants were identified from the 2019 HSE (Health Survey for England). Data on SRH and cardiometabolic variables (HDL-C (mmol/L), BMI (kg/m2), waist/hip ratio (cm), systolic/diastolic blood pressure (mmHg), and HbA1c (mmol/mol)) was also extracted. Bootstrapped regression analysis and structural equation modelling (SEM) were used to analyse the data. Results People on antidepressants showed lower HDL-C (mmol/L) (∆R2 = 0.003, F (1, 2967) = 9.684, p = 0.002), and higher waist/hip ratio (cm) (∆R2 = 0.007, F (1, 2967) = 37.240, p = 0.000), BMI (kg/m2) (∆R2 = 0.014, F (1, 2967) = 42.485, p = 0.000), and HbA1c (mmol/mol) (∆R2 = 0.007, F (1, 2967) = 24.814, p = 0.000), compared to non-depressed participants. However, accounting for SRH negated the association between antidepressant usage and HDL-C (mmol/L) (β = -0.011, p = 0.514). Multiple SEM models showed that SRH mediated the association between antidepressant usage and HDL-C, generating a model with good fit (χ2 (CMIN) = 0.294, df = 1, p = 0.587, χ2 (CMIN)/df = 0.294, RMSEA = 0.000, CFI = 1.000, TLI = 1.006 and NFI = 1.000). Robustness checks (sensitivity analyses), including variations in SRH categorisation, log-transformation, tests for quadratic functions, and management of missing data, confirmed the mediating effect of SRH on relations between antidepressant usage and HDL-C (mmol/L). Conclusion SRH may constitute a useful clinical indicator of dyslipidemia amongst antidepressant users.