Association between depression and inflammation--differences by race and sex: the META-Health study

Abstract

Objective: To test whether the association between depression and inflammation differs by race and sex. Depressive symptoms have been associated with higher levels of C-reactive protein (CRP). However, few studies have examined this association in samples including a significant number of African Americans, or examined whether the association differs by race and sex.

Methods: Depressive symptoms and CRP were assessed in 512 African American and white participants, age 30 to 65 years, as part of the community-based Morehouse and Emory Team up to Eliminate Health Disparities (META-Health) Study. Depression was determined by responses to the Beck Depression Inventory II (BDI-II). Multivariable linear regression models were used to adjust for demographic and metabolic risk factors.

Results: African American men had higher total BDI-II scores than white men (p = .03), whereas there was no difference in women. There was a significant race-sex-depression interaction in predicting CRP levels (p = .02). White women with mild to severe depressive symptoms had higher levels of CRP compared with those with minimal to no depressive symptoms (p < .05). There were no differences in levels of CRP by severity of depressive symptoms in white men or African Americans of either sex. Higher BDI-II scores were related to higher CRP levels in white women after adjusting for age and level of education (β = 0.227, p = .006). However, the association was eliminated after further adjustment for metabolic risk factors (β = 0.077, p = .35).

Conclusions: Although depressive symptoms are associated with inflammation, the association varies by race and sex.

Figure 1

Median levels of CRP by severity of depression in men and women, stratified by race. Minimal to no depression was defined as total BDI-II score <14; mild to severe depression was defined as total BDI-II score ≥14. *p<.05. Samples include white men N=104, African American men N=95, white women N=166, and African American women N=147.