Profiles of sociodemographic, behavioral, clinical and psychosocial characteristics among primary care patients with comorbid obesity and depression

Abstract

The objective of this study is to characterize profiles of obese depressed participants using baseline data collected from October 2014 through December 2016 for an ongoing randomized controlled trial (n = 409) in Bay Area, California, USA. Four comorbidity severity categories were defined by interaction of the binary levels of body mass index (BMI) and depression Symptom Checklist 20 (SCL20) scores. Sociodemographic, behavioral, clinical and psychosocial characteristics were measured. Mean (SD) age was 51 (12.1) years, BMI 36.7 (6.4) kg/m2, and SCL20 1.5 (0.5). Participants in the 4 comorbidity severity categories had similar sociodemographic characteristics, but differed significantly in the other characteristics. Two statistically significant canonical dimensions were identified. Participants with BMI ≥ 35 and SCL20 ≥ 1.5 differed significantly from those with BMI < 35 and SCL20 < 1.5 on dimension 1, which primarily featured high physical health (e.g., central obesity, high blood pressure and impaired sleep) and mental health comorbidities (e.g., post-traumatic stress and anxiety), poor health-related quality of life (in general and problems specifically with obesity, anxiety, depression, and usual daily activities), and an avoidance problem-solving style. Participants with BMI < 35 and SCL20 ≥ 1.5 differed significantly from those with BMI ≥ 35 and SCL20 < 1.5 on dimension 2, which primarily included fewer Hispanics, less central obesity, and more leisure-time physical activity, but greater anxiety and post-traumatic stress and poorer obesity- or mental health-related quality of life. In conclusion, patients with comorbid obesity and depression of varying severity have different profiles of behavioral, clinical and psychosocial characteristics. This insight may inform analysis of treatment heterogeneity and development of targeted intervention strategies. Trial registration:ClinicalTrials.gov #NCT02246413.

Keywords: Behavior; Clinical characteristics; Depression; EHR, Electronic health record; EQ-5D-5 L, European Quality of Life-5 Dimension-5 Levels; GAD7, Generalized Anxiety Disorder Scale; MET, Metabolic equivalent of task; MINI, Mini-International Neuropsychiatric Interview; Obesity; PCPs, Primary care providers; PHQ, Patient Health Questionnaire; PTSD, Posttraumatic stress disorder; Psychosocial characteristics; SCL20, Depression Symptom Checklist 20; SF-8, Short Form-8 Health Survey; SPSI-R:S, Social Problem-Solving Inventory—Revised: Short Form.

Figures

Fig. 1

Participant flow of the Research Aimed at Improving Both Mood and Weight (RAINBOW) trial in Bay Area, California, USA, 2014–2016. aTreatment assignments remain masked given that the trial is still ongoing at the time of this study, which uses only baseline data.

Fig. 2

Canonical discriminant analysis results of baseline characteristics for participants in Bay Area, California, USA, 2014–2016. A. Distribution of participants' dimension scores according to the 4 comorbidity severity categories. Each dot represents an individual participant. Individual dots (participants) of one color belong to the ellipse of the same color denoting each comorbidity severity category: black, lowest severity; blue, depression-dominant intermediate severity; green, obesity-dominant intermediate severity; and red, highest severity. Each ellipse indicates an 80% confidence ellipse for the mean of each severity category marked by a star in the center of the ellipse. B. Correlation coefficients of individual characteristics in the 2 canonical dimensions. Abbreviations: AS, Avoidance Style; BMI, body mass index; DASH, Dietary Approaches to Stop Hypertension; DBP, diastolic blood pressure; EQ-5D-5L, European Quality of Life-5 dimensions-5 levels; ICS, impulsivity/carelessness style; Married, marital status, married/living with another person; MET, metabolic equivalent task; NPO, negative problem orientation; PPO, positive problem orientation; PROMIS, Patient-Reported Outcomes Measurement Information System; RPS, rational problem solving; SBP, systolic blood pressure; SCL20, Symptom Checklist-20; SF-8, Short Form 8 Health Survey; SPSI-R:S, Social Problem Solving Inventory -Revised: Short Form. (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.)