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.