Prevalence of Metabolic Syndrome and Its Components in Patients With Major Depressive Disorder

Abstract

Aim and background: This study aimed to determine the prevalence of metabolic syndrome (MetS) and its individual components among treatment-naïve patients with major depressive disorder (MDD) and to evaluate their association with depression severity among patients presenting to a tertiary care hospital. Understanding this relationship is essential, as coexisting MetS in patients with MDD contributes to elevated cardiovascular risk and complicates long-term psychiatric and medical outcomes.

Materials and methods: This cross-sectional study was conducted at the Department of Psychiatry, Lahore General Hospital, Lahore, Pakistan, from January 2023 to August 2024. A total of 290 treatment-naïve patients with MDD were enrolled using non-probability consecutive sampling. Diagnosis was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, and depression severity was assessed via the 17-item Hamilton Depression Rating Scale (HAM-D-17). MetS was defined using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Anthropometric and biochemical measurements were obtained under standardized protocols. Pearson correlation assessed associations between HAM-D scores and metabolic parameters. Binary logistic regression identified predictors of MetS, adjusting for age, sex, waist circumference, triglycerides, and HAM-D score. Statistical significance was set at p < 0.05.

Results: Out of 290 patients, the mean age was 37.39 ± 10.78 years; 181 (62.4%) were female and 109 (37.6%) were male. MetS was present in 81 (27.9%) patients. Central obesity was identified in 102 (35.2%), hypertension in 104 (35.9%), hypertriglyceridemia in 89 (30.7%), impaired fasting glucose in 88 (30.3%), and low high-density lipoprotein cholesterol (HDL-C) in 42 (14.5%). At least one metabolic abnormality was noted in 193 (66.6%) participants. Mean HAM-D scores were significantly higher among patients with MetS (19.42 ± 4.11) than those without (16.93 ± 4.44; p < 0.001). Patients with central obesity (102, 35.2%) had higher depression scores (19.42 ± 3.82 vs. 16.65 ± 4.52; p < 0.001), as did those with hypertriglyceridemia (19.79 ± 4.15 vs. 16.67 ± 4.30; p < 0.001), hypertension (18.69 ± 4.65 vs. 17.03 ± 4.29; p = 0.003), and impaired fasting glucose (19.05 ± 4.26 vs. 17.00 ± 4.45; p < 0.001). No significant difference was observed for low HDL-C (p = 0.829). Chi-square analysis revealed significant associations between the severity of depression and all MetS components except HDL-C (p < 0.05). On binary logistic regression, male gender (adjusted odds ratio (AOR) = 0.019; p = 0.019), increasing age (AOR = 1.083; p = 0.011), triglyceride level (AOR = 1.017; p = 0.028), and HAM-D score (AOR = 1.176; p = 0.005) were significant predictors of MetS.

Conclusion: MetS and its components were commonly observed among patients with MDD and were significantly associated with depression severity. Triglycerides, age, and depression scores were independent predictors of MetS. These findings highlight the importance of routine metabolic screening and integrated care approaches for individuals with depression to reduce cardiovascular risk and improve overall clinical outcomes.

Keywords: hdl-c; lipid profile; major depressive disorder (mdd); metabolic syndrome (mets); obesity.