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Social Psychiatry and Psychiatric Epidemiology

, Volume 50, Issue 9, pp 1417–1425 | Cite as

Diagnosed thyroid disorders are associated with depression and anxiety

  • Till Ittermann
  • Henry Völzke
  • Sebastian E. Baumeister
  • Katja Appel
  • Hans J. Grabe
Original Paper

Abstract

Purpose

Associations between thyroid diseases and depression have been described since the 1960s but there is a lack of population-based studies investigating associations of thyroid diseases with depression and anxiety defined by gold-standard methods. Thus, the aim was to investigate the association of diagnosed thyroid disorders, serum thyroid-stimulating hormone (TSH) levels, and anti-thyroid-peroxidase antibodies (TPO-abs) with depression and anxiety.

Methods

We used data from 2142 individuals, who participated in the first follow-up of the Study of Health in Pomerania (SHIP-1) and in the Life-Events and Gene-Environment Interaction in Depression (LEGEND). DSM-VI diagnoses of major depression disorder and anxiety were defined using the Munich-Composite International Diagnostic Interview; the Beck depression inventory (BDI-II) was used for the assessment of current depressive symptoms. Thyroid diseases were assessed by interviews and by biomarkers and were associated with depression and anxiety using Poisson regression adjusted for age, sex, marital status, educational level, smoking status, BMI, and the log-transformed time between SHIP-1 and LEGEND.

Results

Untreated diagnosed hypothyroidism was positively associated with the BDI-II-score and with anxiety, while untreated diagnosed hyperthyroidism was significantly related to MDD during the last 12 months. Serum TSH levels and TPO-Abs were not significantly associated with depression and anxiety. In sub-analyses, distinct interactions were found between childhood maltreatment and thyroid disorders in modifying the association on depression and anxiety disorders.

Conclusions

Our results substantiate evidence that diagnosed untreated hypothyroidism is associated with depression and anxiety, and that diagnosed untreated hyperthyroidism is associated with depression.

Keywords

Thyroid Thyroid hormone metabolism Depression Anxiety Epidemiology 

Notes

Acknowledgments

The Study of Health in Pomerania is part of the Community Medicine Research Network of the University Medicine Greifswald, which was funded by the German Federal Ministry for Education and Research, the Ministry for Education, Research and Cultural Affairs, and the Ministry for Social Affairs of the State Mecklenburg-West Pomerania. Analyses were further supported by the German Research Foundation (DFG VO955/10-2 and GR 1912/5-1).

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

References

  1. 1.
    Jacobi FHJ, Wittchen H-U (2004) Seelische Gesundheit in Ost und West: Analysen auf der Grundlage des Bundesgesundheitssurveys. Z Klin Psychol Psychotherapie 33:251–260CrossRefGoogle Scholar
  2. 2.
    Prange AJ Jr, Wilson IC, Rabon AM, Lipton MA (1969) Enhancement of imipramine antidepressant activity by thyroid hormone. Am J Psychiatry 126(4):457–469CrossRefPubMedGoogle Scholar
  3. 3.
    Aronson R, Offman HJ, Joffe RT, Naylor CD (1996) Triiodothyronine augmentation in the treatment of refractory depression. A meta-analysis. Arch Gen Psychiatry 53(9):842–848CrossRefPubMedGoogle Scholar
  4. 4.
    Cooper-Kazaz R, Apter JT, Cohen R, Karagichev L, Muhammed-Moussa S, Grupper D, Drori T, Newman ME, Sackeim HA, Glaser B, Lerer B (2007) Combined treatment with sertraline and liothyronine in major depression: a randomized, double-blind, placebo-controlled trial. Arch Gen Psychiatry 64(6):679–688. doi: 10.1001/archpsyc.64.6.679 CrossRefPubMedGoogle Scholar
  5. 5.
    Nierenberg AA, Fava M, Trivedi MH, Wisniewski SR, Thase ME, McGrath PJ, Alpert JE, Warden D, Luther JF, Niederehe G, Lebowitz B, Shores-Wilson K, Rush AJ (2006) A comparison of lithium and T(3) augmentation following two failed medication treatments for depression: a STAR*D report. Am J Psychiatry 163(9):1519–1530. doi: 10.1176/appi.ajp.163.9.1519 (quiz 1665)PubMedGoogle Scholar
  6. 6.
    Maes M, Meltzer HY, Cosyns P, Suy E, Schotte C (1993) An evaluation of basal hypothalamic-pituitary-thyroid axis function in depression: results of a large-scaled and controlled study. Psychoneuroendocrinology 18(8):607–620CrossRefPubMedGoogle Scholar
  7. 7.
    Almeida OP, Alfonso H, Flicker L, Hankey G, Chubb SA, Yeap BB (2011) Thyroid hormones and depression: the Health in Men study. Am J Geriatr Psychiatry 19(9):763–770. doi: 10.1097/JGP.0b013e31820dcad5 CrossRefPubMedGoogle Scholar
  8. 8.
    Engum A, Bjoro T, Mykletun A, Dahl AA (2002) An association between depression, anxiety and thyroid function–a clinical fact or an artefact? Acta Psychiatr Scand 106(1):27–34 pii: 1o250CrossRefPubMedGoogle Scholar
  9. 9.
    Williams MD, Harris R, Dayan CM, Evans J, Gallacher J, Ben-Shlomo Y (2009) Thyroid function and the natural history of depression: findings from the Caerphilly Prospective Study (CaPS) and a meta-analysis. Clin Endocrinol 70(3):484–492. doi: 10.1111/j.1365-2265.2008.03352.x CrossRefGoogle Scholar
  10. 10.
    Grabe HJ, Volzke H, Ludemann J, Wolff B, Schwahn C, John U, Meng W, Freyberger HJ (2005) Mental and physical complaints in thyroid disorders in the general population. Acta Psychiatr Scand 112(4):286–293. doi: 10.1111/j.1600-0447.2005.00586.x CrossRefPubMedGoogle Scholar
  11. 11.
    Reinelt E, Stopsack M, Aldinger M, John U, Grabe HJ, Barnow S (2013) Testing the diathesis-stress model: 5-HTTLPR, childhood emotional maltreatment, and vulnerability to social anxiety disorder. Am J Med Genet B Neuropsychiatr Genet 162B(3):253–261. doi: 10.1002/ajmg.b.32142 CrossRefPubMedGoogle Scholar
  12. 12.
    Schulz A, Becker M, Van der Auwera S, Barnow S, Appel K, Mahler J, Schmidt CO, John U, Freyberger HJ, Grabe HJ (2014) The impact of childhood trauma on depression: does resilience matter? Population-based results from the Study of Health in Pomerania. J Psychosom Res 77(2):97–103. doi: 10.1016/j.jpsychores.2014.06.008 CrossRefPubMedGoogle Scholar
  13. 13.
    Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571CrossRefPubMedGoogle Scholar
  14. 14.
    Volzke H, Alte D, Schmidt CO, Radke D, Lorbeer R, Friedrich N, Aumann N, Lau K, Piontek M, Born G, Havemann C, Ittermann T, Schipf S, Haring R, Baumeister SE, Wallaschofski H, Nauck M, Frick S, Arnold A, Junger M, Mayerle J, Kraft M, Lerch MM, Dorr M, Reffelmann T, Empen K, Felix SB, Obst A, Koch B, Glaser S, Ewert R, Fietze I, Penzel T, Doren M, Rathmann W, Haerting J, Hannemann M, Ropcke J, Schminke U, Jurgens C, Tost F, Rettig R, Kors JA, Ungerer S, Hegenscheid K, Kuhn JP, Kuhn J, Hosten N, Puls R, Henke J, Gloger O, Teumer A, Homuth G, Volker U, Schwahn C, Holtfreter B, Polzer I, Kohlmann T, Grabe HJ, Rosskopf D, Kroemer HK, Kocher T, Biffar R, John U, Hoffmann W (2011) Cohort profile: the study of health in Pomerania. Int J Epidemiol 40(2):294–307. doi: 10.1093/ije/dyp394 CrossRefPubMedGoogle Scholar
  15. 15.
    Meng W, Scriba P (2002) Jodversorgung in Deutschland, Probleme und erforderliche Maßnahmen: Update 2002 [Iodine supply in Germany, problems and required measures: Update 2002]. Dtsch Ärztebl 99:A2560–A2564Google Scholar
  16. 16.
    Völzke H, Lüdemann J, Robinson DM, Spieker KW, Schwahn C, Kramer A, John U, Meng W (2003) The prevalence of undiagnosed thyroid disorders in a previously iodine-deficient area. Thyroid 13(8):803–810CrossRefPubMedGoogle Scholar
  17. 17.
    Volzke H, Alte D, Kohlmann T, Ludemann J, Nauck M, John U, Meng W (2005) Reference intervals of serum thyroid function tests in a previously iodine-deficient area. Thyroid 15(3):279–285CrossRefPubMedGoogle Scholar
  18. 18.
    Wittchen HU, Pfister H (1997) Diagnostisches Expertensystem für psychische Störungen. Swets & Zeitlinger, FrankfurtGoogle Scholar
  19. 19.
    Appel K, Schwahn C, Mahler J, Schulz A, Spitzer C, Fenske K, Stender J, Barnow S, John U, Teumer A, Biffar R, Nauck M, Volzke H, Freyberger HJ, Grabe HJ (2011) Moderation of adult depression by a polymorphism in the FKBP5 gene and childhood physical abuse in the general population. Neuropsychopharmacology 36(10):1982–1991. doi: 10.1038/npp.2011.81 PubMedCentralCrossRefPubMedGoogle Scholar
  20. 20.
    Bernstein DP, Stein JA, Newcomb MD, Walker E, Pogge D, Ahluvalia T, Stokes J, Handelsman L, Medrano M, Desmond D, Zule W (2003) Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse Negl 27(2):169–190 pii: S0145213402005410CrossRefPubMedGoogle Scholar
  21. 21.
    Wingenfeld K, Spitzer C, Mensebach C, Grabe HJ, Hill A, Gast U, Schlosser N, Hopp H, Beblo T, Driessen M (2010) The German Version of the Childhood Trauma Questionnaire (CTQ): Preliminary Psychometric Properties. Psychother Psychosom Med Psychol 60(8):e13. doi: 10.1055/s-0030-1253494 CrossRefPubMedGoogle Scholar
  22. 22.
    Greenland S (2004) Model-based estimation of relative risks and other epidemiologic measures in studies of common outcomes and in case-control studies. Am J Epidemiol 160(4):301–305. doi: 10.1093/aje/kwh221 CrossRefPubMedGoogle Scholar
  23. 23.
    Royston P, Sauerbrei W (2008) Multivariable model-building: a pragmatic approach to regression anaylsis based on fractional polynomials for modelling continuous variables. John Wiley & Sons, EnglandCrossRefGoogle Scholar
  24. 24.
    Thomsen AF, Kvist TK, Andersen PK, Kessing LV (2005) Increased risk of developing affective disorder in patients with hypothyroidism: a register-based study. Thyroid 15(7):700–707. doi: 10.1089/thy.2005.15.700 CrossRefPubMedGoogle Scholar
  25. 25.
    Dilling H, Mombour W, Schmidt M (1991) Internationale Klassifikation psychischer Störungen: ICD-10 Kapitel V (F). Klinisch-diagnostische Leitlinien, Huber, Bern, Göttingen, TorontoGoogle Scholar
  26. 26.
    Brownlie BE, Rae AM, Walshe JW, Wells JE (2000) Psychoses associated with thyrotoxicosis—‘thyrotoxic psychosis’. A report of 18 cases, with statistical analysis of incidence. Eur J Endocrinol Eur Fed Endocr Soc 142(5):438–444 pii: 1420438CrossRefGoogle Scholar
  27. 27.
    Wu EL, Chien IC, Lin CH, Chou YJ, Chou P (2013) Increased risk of hypothyroidism and hyperthyroidism in patients with major depressive disorder: a population-based study. J Psychosom Res 74(3):233–237. doi: 10.1016/j.jpsychores.2012.12.016 CrossRefPubMedGoogle Scholar
  28. 28.
    Jackson IM (1998) The thyroid axis and depression. Thyroid 8(10):951–956CrossRefPubMedGoogle Scholar
  29. 29.
    Laske C, Zank M, Klein R, Stransky E, Batra A, Buchkremer G, Schott K (2008) Autoantibody reactivity in serum of patients with major depression, schizophrenia and healthy controls. Psychiatry Res 158(1):83–86. doi: 10.1016/j.psychres.2006.04.023 CrossRefPubMedGoogle Scholar
  30. 30.
    Panicker V, Evans J, Bjoro T, Asvold BO, Dayan CM, Bjerkeset O (2009) A paradoxical difference in relationship between anxiety, depression and thyroid function in subjects on and not on T4: findings from the HUNT study. Clin Endocrinol 71(4):574–580. doi: 10.1111/j.1365-2265.2008.03521.x CrossRefGoogle Scholar
  31. 31.
    Pop VJ, Maartens LH, Leusink G, van Son MJ, Knottnerus AA, Ward AM, Metcalfe R, Weetman AP (1998) Are autoimmune thyroid dysfunction and depression related? J Clin Endocrinol Metab 83(9):3194–3197PubMedGoogle Scholar
  32. 32.
    Constant EL, Adam S, Seron X, Bruyer R, Seghers A, Daumerie C (2005) Anxiety and depression, attention, and executive functions in hypothyroidism. J Int Neuropsychol Soc 11(5):535–544. doi: 10.1017/S1355617705050642 CrossRefPubMedGoogle Scholar
  33. 33.
    Larisch R, Kley K, Nikolaus S, Sitte W, Franz M, Hautzel H, Tress W, Muller HW (2004) Depression and anxiety in different thyroid function states. Horm Metab Res 36(9):650–653. doi: 10.1055/s-2004-825925 CrossRefPubMedGoogle Scholar
  34. 34.
    Demet MM, Ozmen B, Deveci A, Boyvada S, Adiguzel H, Aydemir O (2002) Depression and anxiety in hyperthyroidism. Arch Med Res 33(6):552–556 pii: S0188-4409(02)00410-1CrossRefPubMedGoogle Scholar
  35. 35.
    Lee IT, Sheu WH, Liau YJ, Lin SY, Lee WJ, Lin CC (2003) Relationship of stressful life events, anxiety and depression to hyperthyroidism in an asian population. Horm Res 60(5):247–251 pii: 74039 74039CrossRefPubMedGoogle Scholar
  36. 36.
    Samuels MH (2008) Cognitive function in untreated hypothyroidism and hyperthyroidism. Curr Opin Endocrinol Diabetes Obes 15(5):429–433. doi: 10.1097/MED.0b013e32830eb84c CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Till Ittermann
    • 1
  • Henry Völzke
    • 1
  • Sebastian E. Baumeister
    • 1
  • Katja Appel
    • 2
  • Hans J. Grabe
    • 2
  1. 1.Institute for Community MedicineUniversity Medicine GreifswaldGreifswaldGermany
  2. 2.Institute for Psychiatry and PsychotherapyUniversity Medicine GreifswaldGreifswaldGermany

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