Abstract
Prospective studies on the association between depression and telomere length have produced mixed results and have been largely limited to European ancestry populations. We examined the associations between depression and telomere length, and the modifying influence of religion and spirituality, in four cohorts participating in the Study on Stress, Spirituality and Health, each representing a different race/ethnic population. Relative leukocyte telomere length (RTL) was measured by a quantitative polymerase chain reaction. Our result showed that depression was not associated with RTL (percent difference: 3.0 95% CI: − 3.9, 10.5; p = 0.41; p-heterogeneity across studies = 0.67) overall or in cohort-specific analyses. However, in cohort-specific analyses, there was some evidence of effect modification by the extent of religiosity or spirituality, religious congregation membership, and group prayer. Further research is needed to investigate prospective associations between depression and telomere length and resources of resilience including dimensions of religion and spirituality that may impact such dynamics in diverse racial/ethnic populations.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Aarsland, D., Pahlhagen, S., Ballard, C. G., Ehrt, U., & Svenningsson, P. (2011). Depression in Parkinson disease—epidemiology, mechanisms and management. Nature Reviews. Neurology, 8(1), 35–47. https://doi.org/10.1038/nrneurol.2011.189.
Bailey, R. K., Mokonogho, J., & Kumar, A. (2019). Racial and ethnic differences in depression: Current perspectives. Neuropsychiatric Disease and Treatment, 15, 603–609. https://doi.org/10.2147/ndt.s128584.
Berkman, L., Carney, R., Blumenthal, J., Czakowski, S., Hosking, J., Jaffe, A., Babyak, M., Carels, R., Coleman, E., & Curtis, S. (2000). Enhancing recovery in coronary heart disease patients (ENRICHD): Study design and methods. The ENRICHD investigators. American Heart Journal, 139(1 Pt 1), 1–9. https://doi.org/10.1016/s0002-8703(00)90301-6.
Berkman, L. F., & Syme, S. L. (1979). Social networks, host resistance, and mortality: A nine-year follow-up study of Alameda County residents. American Journal of Epidemiology, 109(2), 186–204. https://doi.org/10.1093/oxfordjournals.aje.a112674.
Blackburn, E. H. (2001). Switching and signaling at the telomere. Cell, 106(6), 661–673. https://doi.org/10.1016/s0092-8674(01)00492-5.
Bruin, M. C., Comijs, H. C., Kok, R. M., Van der Mast, R. C., & Van den Berg, J. F. (2018). Lifestyle factors and the course of depression in older adults: A NESDO study. International Journal of Geriatric Psychiatry, 33(7), 1000–1008. https://doi.org/10.1002/gps.4889.
Cawthon, R. M. (2002). Telomere measurement by quantitative PCR. Nucleic Acids Research, 30(10), e47. https://doi.org/10.1093/nar/30.10.e47.
Chang, S. C., Crous-Bou, M., Prescott, J., Rosner, B., Simon, N. M., Wang, W., De Vivo, I., & Okereke, O. I. (2018a). Prospective association of depression and phobic anxiety with changes in telomere lengths over 11 years. Depression and Anxiety, 35(5), 431–439. https://doi.org/10.1002/da.22732.
Chang, S. C., Crous-Bou, M., Prescott, J., Rosner, B., Simon, N. M., Wang, W., De Vivo, I., & Okereke, O. I. (2018b). Relation of long-term patterns in caregiving activity and depressive symptoms to telomere length in older women. Psychoneuroendocrinology, 89, 161–167. https://doi.org/10.1016/j.psyneuen.2018.01.005.
Chang, S. C., Prescott, J., De Vivo, I., Kraft, P., & Okereke, O. I. (2018c). Polygenic risk score of shorter telomere length and risk of depression and anxiety in women. Journal of Psychiatric Research, 103, 182–188. https://doi.org/10.1016/j.jpsychires.2018.05.021.
Crown, S., & Crisp, A. H. (1966). A short clinical diagnostic self-rating scale for psychoneurotic patients. The Middlesex hospital questionnaire (M.H.Q.). The British Journal of Psychiatry, 112(490), 917–923. https://doi.org/10.1192/bjp.112.490.917.
Danese, A., Moffitt, T. E., Harrington, H., Milne, B. J., Polanczyk, G., Pariante, C. M., Poulton, R., & Caspi, A. (2009). Adverse childhood experiences and adult risk factors for age-related disease: Depression, inflammation, and clustering of metabolic risk markers. Archives of Pediatrics & Adolescent Medicine, 163(12), 1135–1143. https://doi.org/10.1001/archpediatrics.2009.214.
DerSimonian, R., & Laird, N. (1986). Meta-analysis in clinical trials. Controlled Clinical Trials, 7(3), 177–188. https://doi.org/10.1016/0197-2456(86)90046-2.
Dervic, K., Grunebaum, M. F., Burke, A. K., Mann, J. J., & Oquendo, M. A. (2006). Protective factors against suicidal behavior in depressed adults reporting childhood abuse. Journal of Nervous and Mental Disease, 194(12), 971–974. https://doi.org/10.1097/01.nmd.0000243764.56192.9c.
Egan, K. J., von Schantz, M., Negrao, A. B., Santos, H. C., Horimoto, A. R., Duarte, N. E., Goncalves, G. C., Soler, J. M., de Andrade, M., Lorenzi-Filho, G., Vallada, H., Taporoski, T. P., Pedrazzoli, M., Azambuja, A. P., de Oliveira, C. M., Alvim, R. O., Krieger, J. E., & Pereira, A. C. (2016). Cohort profile: The Baependi heart study—a family-based, highly admixed cohort study in a rural Brazilian town. BMJ Open, 6(10), e011598. https://doi.org/10.1136/bmjopen-2016-011598.
Fetzer/ National Institute on Aging Working Group. (1999). Multidimensional measurement of religiousness/spirituality for use in health research: A report of the Fetzer Institute/National Institute on Aging Working Group. Kalamazoo, MI: Fetzer Institute.
Ford, D. E., Mead, L. A., Chang, P. P., Cooper-Patrick, L., Wang, N. Y., & Klag, M. J. (1998). Depression is a risk factor for coronary artery disease in men: The precursors study. Archives of Internal Medicine, 158(13), 1422–1426. https://doi.org/10.1001/archinte.158.13.1422.
Franco-de-Moraes, A. C., de Almeida-Pititto, B., da Rocha Fernandes, G., Gomes, E. P., da Costa Pereira, A., & Ferreira, S. R. G. (2017). Worse inflammatory profile in omnivores than in vegetarians associates with the gut microbiota composition. Diabetology and Metabolic Syndrome, 9, 62. https://doi.org/10.1186/s13098-017-0261-x.
GBD. (2016). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: A systematic analysis for the global burden of disease study 2015. Lancet, 388(10053), 1545–1602. https://doi.org/10.1016/s0140-6736(16)31678-6.
Gonzalez, H. M., Tarraf, W., Whitfield, K. E., & Vega, W. A. (2010). The epidemiology of major depression and ethnicity in the United States. Journal of Psychiatric Research, 44(15), 1043–1051. https://doi.org/10.1016/j.jpsychires.2010.03.017.
Higgins, J. P., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. Bmj, 327(7414), 557–560. https://doi.org/10.1136/bmj.327.7414.557.
Hill, T. D., Ellison, C. G., Burdette, A. M., Taylor, J., & Friedman, K. L. (2016). Dimensions of religious involvement and leukocyte telomere length. Social Science & Medicine, 163, 168–175. https://doi.org/10.1016/j.socscimed.2016.04.032.
Hoen, P. W., de Jonge, P., Na, B. Y., Farzaneh-Far, R., Epel, E., Lin, J., Blackburn, E., & Whooley, M. A. (2011). Depression and leukocyte telomere length in patients with coronary heart disease: Data from the heart and soul study. Psychosomatic Medicine, 73(7), 541–547. https://doi.org/10.1097/PSY.0b013e31821b1f6e.
Hoen, P. W., Rosmalen, J. G., Schoevers, R. A., Huzen, J., van der Harst, P., & de Jonge, P. (2013). Association between anxiety but not depressive disorders and leukocyte telomere length after 2 years of follow-up in a population-based sample. Psychological Medicine, 43(4), 689–697. https://doi.org/10.1017/s0033291712001766.
Huang, T., Tobias, D. K., Hruby, A., Rifai, N., Tworoger, S. S., & Hu, F. B. (2016). An increase in dietary quality is associated with favorable plasma biomarkers of the brain-adipose Axis in apparently healthy US women. The Journal of Nutrition, 146(5), 1101–1108. https://doi.org/10.3945/jn.115.229666.
Huang, T., Trudel-Fitzgerald, C., Poole, E. M., Sawyer, S., Kubzansky, L. D., Hankinson, S. E., Okereke, O. I., & Tworoger, S. S. (2019). The mind-body study: Study design and reproducibility and interrelationships of psychosocial factors in the Nurses' health study II. Cancer Causes & Control, 30(7), 779–790. https://doi.org/10.1007/s10552-019-01176-0.
Julin, B., Shui, I., Heaphy, C. M., Joshu, C. E., Meeker, A. K., Giovannucci, E., De Vivo, I., & Platz, E. A. (2015). Circulating leukocyte telomere length and risk of overall and aggressive prostate cancer. British Journal of Cancer, 112(4), 769–776. https://doi.org/10.1038/bjc.2014.640.
Kanaya, A., Ewing, S., Vittinghoff, E., Herrington, D., Tegeler, C., Mills, C., & Kandula, N. (2014). Acculturation and subclinical atherosclerosis among U.S. south Asians: Findings from the MASALA study. Journal of Clinical & Experimental Research in Cardiology, 1(1), 102. https://doi.org/10.15744/2394-6504.1.102
Kanaya, A. M., Kandula, N., Herrington, D., Budoff, M. J., Hulley, S., Vittinghoff, E., & Liu, K. (2013). Mediators of atherosclerosis in south Asians living in America (MASALA) study: Objectives, methods, and cohort description. Clinical Cardiology, 36, 713–720. https://doi.org/10.1002/clc.22219.
Koenig, H. G., & Büssing, A. (2010). The Duke University religion index (DUREL): A five-item measure for use in epidemological studies. Religions, 1(1), 78–85.
Koenig, H. G., King, D., & Carson, V. B. (2012). Handbook of religion and health.
Lagisetty, P. A., Wen, M., Choi, H., Heisler, M., Kanaya, A. M., & Kandula, N. R. (2016). Neighborhood social cohesion and prevalence of hypertension and diabetes in a south Asian population. Journal of Immigrant and Minority Health, 18(6), 1309–1316. https://doi.org/10.1007/s10903-015-0308-8.
Lavange, L. M., Kalsbeek, W. D., Sorlie, P. D., Aviles-Santa, L. M., Kaplan, R. C., Barnhart, J., Liu, K., Giachello, A., Lee, D. J., Ryan, J., Criqui, M. H., & Elder, J. P. (2010). Sample design and cohort selection in the Hispanic community health study/study of Latinos. Annals of Epidemiology, 20(8), 642–649. https://doi.org/10.1016/j.annepidem.2010.05.006.
Lin, P. Y., Huang, Y. C., & Hung, C. F. (2016). Shortened telomere length in patients with depression: A meta-analytic study. Journal of Psychiatric Research, 76, 84–93. https://doi.org/10.1016/j.jpsychires.2016.01.015.
Lu, D., Palmer, J. R., Rosenberg, L., Shields, A. E., Orr, E. H., DeVivo, I., & Cozier, Y. C. (2019). Perceived racism in relation to telomere length among African American women in the black Women's health study. Annals of Epidemiology, 36, 33–39. https://doi.org/10.1016/j.annepidem.2019.06.003.
Mather, K. A., Jorm, A. F., Parslow, R. A., & Christensen, H. (2011). Is telomere length a biomarker of aging? A review. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 66(2), 202–213. https://doi.org/10.1093/gerona/glq180.
McHorney, C. A., Ware Jr., J. E., Lu, J. F., & Sherbourne, C. D. (1994). The MOS 36-item short-form health survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Medical Care, 32(1), 40–66. https://doi.org/10.1097/00005650-199401000-00004.
Mitchell, P. H., Powell, L., Blumenthal, J., Norten, J., Ironson, G., Pitula, C. R., Froelicher, E. S., Czajkowski, S., Youngblood, M., Huber, M., & Berkman, L. F. (2003). A short social support measure for patients recovering from myocardial infarction: The ENRICHD social support inventory. Journal of Cardiopulmonary Rehabilitation, 23(6), 398–403. https://doi.org/10.1097/00008483-200311000-00001.
North, K. E., Howard, B. V., Welty, T. K., Best, L. G., Lee, E. T., Yeh, J. L., Fabsitz, R. R., Roman, M. J., & MacCluer, J. W. (2003). Genetic and environmental contributions to cardiovascular disease risk in American Indians: The strong heart family study. American Journal of Epidemiology, 157(4), 303–314. https://doi.org/10.1093/aje/kwf208.
Pan, A., Okereke, O. I., Sun, Q., Logroscino, G., Manson, J. E., Willett, W. C., Ascherio, A., Hu, F. B., & Rexrode, K. M. (2011a). Depression and incident stroke in women. Stroke, 42(10), 2770–2775. https://doi.org/10.1161/strokeaha.111.617043.
Pan, A., Sun, Q., Okereke, O. I., Rexrode, K. M., & Hu, F. B. (2011b). Depression and risk of stroke morbidity and mortality: A meta-analysis and systematic review. Jama, 306(11), 1241–1249. https://doi.org/10.1001/jama.2011.1282.
Pargament, K. I., Koenig, H. G., & Perez, L. M. (2000). The many methods of religious coping: Development and initial validation of the RCOPE. Journal of Clinical Psychology, 56(4), 519–543. https://doi.org/10.1002/(sici)1097-4679(200004)56:4<519::aid-jclp6>3.0.co;2-1.
Park, L. T., & Zarate, C. A. (2019). Depression in the primary care setting. The New England Journal of Medicine, 380(6), 559–568. https://doi.org/10.1056/NEJMcp1712493.
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population [article]. Applied Psychological Measurement, 1, 385–401.
Reichert, S., & Stier, A. (2017). Does oxidative stress shorten telomeres in vivo? A review. Biology Letters, 13(12), 20170463. https://doi.org/10.1098/rsbl.2017.0463.
Ridout, K. K., Ridout, S. J., Price, L. H., Sen, S., & Tyrka, A. R. (2016). Depression and telomere length: A meta-analysis. Journal of Affective Disorders, 191, 237–247. https://doi.org/10.1016/j.jad.2015.11.052.
Rius-Ottenheim, N., Houben, J. M., Kromhout, D., Kafatos, A., van der Mast, R. C., Zitman, F. G., Geleijnse, J. M., Hageman, G. J., & Giltay, E. J. (2012). Telomere length and mental well-being in elderly men from the Netherlands and Greece. Behavior Genetics, 42(2), 278–286. https://doi.org/10.1007/s10519-011-9498-6.
Rosenberg, L., Adams-Campbell, L., & Palmer, J. R. (1995). The black Women's health study: A follow-up study for causes and preventions of illness. Journal of the American Medical Women's Association (1972), 50(2), 56–58.
Rotella, F., & Mannucci, E. (2013). Diabetes mellitus as a risk factor for depression. A meta-analysis of longitudinal studies. Diabetes Research and Clinical Practice, 99(2), 98–104. https://doi.org/10.1016/j.diabres.2012.11.022.
Sanders, J. L., & Newman, A. B. (2013). Telomere length in epidemiology: A biomarker of aging, age-related disease, both, or neither? Epidemiologic Reviews, 35, 112–131. https://doi.org/10.1093/epirev/mxs008.
Schutte, N. S., & Malouff, J. M. (2015). The association between depression and leukocyte telomere length: A meta-analysis. Depression and Anxiety, 32(4), 229–238. https://doi.org/10.1002/da.22351.
Setty, A. R., Curhan, G., & Choi, H. K. (2007). Smoking and the risk of psoriasis in women: Nurses' Health Study II. The American Journal of Medicine, 120(11), 953–959. https://doi.org/10.1016/j.amjmed.2007.06.020.
Shalev, I., Moffitt, T. E., Braithwaite, A. W., Danese, A., Fleming, N. I., Goldman-Mellor, S., Harrington, H. L., Houts, R. M., Israel, S., Poulton, R., Robertson, S. P., Sugden, K., Williams, B., & Caspi, A. (2014). Internalizing disorders and leukocyte telomere erosion: A prospective study of depression, generalized anxiety disorder and post-traumatic stress disorder. Molecular Psychiatry, 19(11), 1163–1170. https://doi.org/10.1038/mp.2013.183.
Storti, K. L., Arena, V. C., Barmada, M. M., Bunker, C. H., Hanson, R. L., Laston, S. L., Yeh, J. L., Zmuda, J. M., Howard, B. V., & Kriska, A. M. (2009). Physical activity levels in American-Indian adults: The strong heart family study. American Journal of Preventive Medicine, 37(6), 481–487. https://doi.org/10.1016/j.amepre.2009.07.019.
Valdes, A. M., Andrew, T., Gardner, J. P., Kimura, M., Oelsner, E., Cherkas, L. F., Aviv, A., & Spector, T. D. (2005). Obesity, cigarette smoking, and telomere length in women. Lancet, 366(9486), 662–664. https://doi.org/10.1016/s0140-6736(05)66630-5.
Van Dam, N. T., & Earleywine, M. (2011). Validation of the Center for Epidemiologic Studies Depression Scale--Revised (CESD-R): Pragmatic depression assessment in the general population. Psychiatry Research, 186(1), 128–132. https://doi.org/10.1016/j.psychres.2010.08.018.
Vance, M. C., Bui, E., Hoeppner, S. S., Kovachy, B., Prescott, J., Mischoulon, D., Walton, Z. E., Dong, M., Nadal, M. F., Worthington, J. J., Hoge, E. A., Cassano, P., Orr, E. H., Fava, M., de Vivo, I., Wong, K. K., & Simon, N. M. (2018). Prospective association between major depressive disorder and leukocyte telomere length over two years. Psychoneuroendocrinology, 90, 157–164. https://doi.org/10.1016/j.psyneuen.2018.02.015.
Verhoeven, J. E., Penninx, B., & Milaneschi, Y. (2019). Unraveling the association between depression and telomere length using genomics. Psychoneuroendocrinology, 102, 121–127. https://doi.org/10.1016/j.psyneuen.2018.11.029.
Verhoeven, J. E., Revesz, D., Picard, M., Epel, E. E., Wolkowitz, O. M., Matthews, K. A., Penninx, B., & Puterman, E. (2018). Depression, telomeres and mitochondrial DNA: Between- and within-person associations from a 10-year longitudinal study. Molecular Psychiatry, 23(4), 850–857. https://doi.org/10.1038/mp.2017.48.
Verhoeven, J. E., van Oppen, P., Revesz, D., Wolkowitz, O. M., & Penninx, B. W. (2016). Depressive and anxiety disorders showing robust, but non-dynamic, 6-year longitudinal association with short leukocyte telomere length. The American Journal of Psychiatry, 173(6), 617–624. https://doi.org/10.1176/appi.ajp.2015.15070887.
Ware Jr., J. E. (2000). SF-36 health survey update. Spine (Phila Pa 1976), 25(24), 3130–3139. https://doi.org/10.1097/00007632-200012150-00008.
Wink, P., Dillon, M., & Larsen, B. (2005). Religion as moderator of the depression-health connection: Findings from a longitudinal study [research-article]., 27(2), 197–220. https://doi.org/10.1177/0164027504270483.
Wise, L. A., Adams-Campbell, L. L., Palmer, J. R., & Rosenberg, L. (2006). Leisure time physical activity in relation to depressive symptoms in the black Women's health study. Annals of Behavioral Medicine, 32(1), 68–76. https://doi.org/10.1207/s15324796abm3201_8.
Wolkowitz, O. M., Epel, E. S., Reus, V. I., & Mellon, S. H. (2010). Depression gets old fast: Do stress and depression accelerate cell aging? Depression and Anxiety, 27(4), 327–338. https://doi.org/10.1002/da.20686.
Zhao, J., Zhu, Y., Lin, J., Matsuguchi, T., Blackburn, E., Zhang, Y., Cole, S. A., Best, L. G., Lee, E. T., & Howard, B. V. (2014). Short leukocyte telomere length predicts risk of diabetes in american indians: The strong heart family study. Diabetes, 63(1), 354–362. https://doi.org/10.2337/db13-0744.
Zhao, Q., Zhu, Y., Yeh, F., Lin, J., Lee, E. T., Cole, S. A., Calhoun, D., & Zhao, J. (2016). Depressive symptoms are associated with leukocyte telomere length in American Indians: Findings from the strong heart family study. Aging (Albany NY), 8(11), 2961–2970. https://doi.org/10.18632/aging.101104.
Funding
This is a paper of the National Consortium on Psychosocial Stress, Spirituality, and Health and its Study on Stress, Spirituality and Health (SSSH). This work was supported by The John Templeton Foundation (Grant #59607, A.E. Shields). The Black Women’s Health Study is supported by National Institutes of Health (NIH) grants R01CA058420, U01CA164974, and R01CA098663. The MASALA Study was supported by NIH grants 1R01HL093009, 2R01HL093009, R01HL120725, UL1RR024131, UL1TR001872, and P30DK098722. The Nurses’ Health Study II was supported by NIH grants U01CA176726, R01CA163451, and R01CA67262. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Strong Heart Study was supported by cooperative agreement grants U01HL41642, U01HL41652, U01HL41654, U01HL65520, and U01HL65521 and research grants R01HL109315, R01HL109301, R01HL109284, R01HL109282, and R01HL109319 from the NIH National Heart, Lung, and Blood Institute.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing Interests
The authors declare that they have no competing interests.
Ethics Approval
All studies obtained institutional approval for cohort maintenance, as well as participation in the SSSH. SSSH protocols were approved by the Partners Human Research Committee, the Institutional Review Board (IRB) of Partners HealthCare (Boston, MA).
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
ESM 1
(DOCX 32 kb)
Rights and permissions
About this article
Cite this article
Isehunwa, O.O., Warner, E.T., Spiegelman, D. et al. Depression, Religiosity, and Telomere Length in the Study on Stress, Spirituality, and Health (SSSH). Int J Ment Health Addiction 20, 1465–1484 (2022). https://doi.org/10.1007/s11469-020-00455-1
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11469-020-00455-1