American Journal of Public Health251
Objectives. This study sought to
test the relationships between relative
body weight and clinical depression,
suicide ideation, and suicide attempts in
an adult US general population sample.
Methods. Respondents were 40086
African American and White partici-
pants interviewed in a national survey.
Outcome measures were past-year major
depression, suicide ideation, and suicide
attempts diagnosed according to the
Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition. The
primary predictor was relative body
weight, treated both continuously (i.e.,
body mass index [BMI]) and categori-
cally in logistic regression analyses.
Covariates included age, income and
education, disease status, and drug and
Results. Relative body weight was
associated with major depression, sui-
cide attempts, and suicide ideation,
although relationships were different
for men and women. Among women,
increased BMI was associated with
both major depression and suicide
ideation. Among men, lower BMI was
associated with major depression, sui-
cide attempts, and suicide ideation.
There were no racial differences.
Conclusions. Differences in BMI,
or weight status, were associated with
the probability of past-year major
depression, suicide attempts, and sui-
cide ideation. Longitudinal studies are
needed to differentiate the causal path-
ways and mechanisms linking physical
and psychiatric conditions. (Am J Pub-
lic Health. 2000;90:251–257)
A B S T R A C T
Kenneth M. Carpenter, PhD, Deborah S. Hasin, PhD, David B. Allison, PhD,
and Myles S. Faith, PhD
Relationships Between Obesity and
DSM-IV Major Depressive Disorder,
Suicide Ideation, and Suicide Attempts:
Results From a General Population Study
February 2000, Vol. 90, No. 2
Obesity is an increasingly prevalent pub-
lic health problem, with approximately half
the current US population overweight or
obese.1Although many studies have shown
that obesity is associated with numerous med-
ical complications and increased all-cause
mortality,2,3much less is known about its
association with clinical depression and suici-
dal tendencies. Clinical observations since the
turn of the century have postulated a possible
association between obesity and depression.4
These observations have received some sup-
port from epidemiologic studies suggesting a
relationship between being overweight and
having increased psychiatric symptoms.5,6
However, other community studies have failed
to find direct associations between obesity
and depression.7–9These discrepancies may
relate in part to sex differences, as some data
suggest associations between obesity and sub-
clinical depression in females but not males.6
In 1995, a major review paper showed
that the empirical findings on this issue have
remained inconsistent.10This review identified
several methodologic problems in the previous
studies. First, none of the studies assessed the
presence or absence of clinical depression
diagnosed according to a standardized nomen-
clature such as the Diagnostic and Statistical
Manual of Mental Disorders (currently in its
fourth edition [DSM-IV]11). Instead, continu-
ous-scale scores of “psychopathology” were
used. These scales differ among themselves in
content. Moreover, they have also been shown
to have only a modest relationship, at best,
with the specific syndrome of depressed
mood, symptoms, and impairment lasting at
least 2 weeks, which is defined in DSM-IV as
major depressive disorder.12
Second, with rare exceptions (e.g., the
study by Istvan et al.6), nationally representa-
tive samples were not used. Much of the data
came from clinical studies,10many of which
did not include a control group of obese indi-
viduals not seeking treatment. Lack of such a
control group may have introduced several
treatment selection biases.13Among the com-
munity studies to address this topic, many
sampled from a local geographic region, and
none used DSM criteria for diagnosis.
Third, few studies have explicitly exam-
ined whether the association between obesity
and psychopathology varies by race. This is
important because it has been hypothesized
that race may moderate the relationship
between obesity and psychiatric status.10
Consistent with this hypothesis, African
American women appear, on average, to be
more satisfied with their bodies, to have less
desire to be thin, and to have less fear of fat
than do White women.14However, other data
suggest that the association between obesity
and self-esteem is the same between these
races.15The inconsistent findings may be due
in part to the use of nonpsychiatric outcomes
and the inconsistent control of socioeco-
nomic status (SES) across these studies.
Investigating racial differences while control-
ling for SES is particularly important because
SES has been associated with both obesity
and race.16Differences in outcome may also
relate in part to the dieting status of subjects;
certain studies have examined only dieters.15
It is also noteworthy that these studies exam-
ined indicators or “symptoms” of psycho-
Kenneth M. Carpenter and Deborah S. Hasin are
with the Division of Epidemiology, Joseph L. Mail-
man School of Public Health, Columbia University,
New York, NY. David B. Allison and Myles S. Faith
are with the Obesity Research Center, St Luke’s–
Roosevelt Hospital Center, Columbia University
College of Physicians and Surgeons, New York, NY.
Requests for reprints should be sent to Myles
S. Faith, PhD, Obesity Research Center, St Luke’s–
Roosevelt Hospital Center; Columbia University
College of Physicians and Surgeons, 1090 Amster-
dam Ave, 14th Floor, New York, NY 10025 (e-mail:
This article was accepted September 23, 1999.
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Obesity and Depression