Stressor exposure increases depressive mood in iron deficient Hispanic American women

The modifying effect of stressor exposure on the relationship between depressive mood and iron deficiency (ID) was investigated with 1375 premenopausal women of the Hispanic Health and Nutrition Examination survey (HHANES). Data were collected from 1982 to 1984; participants were of Puerto Rican, Mexican, Cuban or general Hispanic descent. Depression was assessed with the Center of Epidemiologic studies – depression scale (CESD, 20 statements). Removing 3 fatigue‐related questions from the CESD‐20 created the variable CESD‐17, which reflects depressive mood (range 0 to 51 points). Prevalence of depressive mood was 7.9 %, with a cut‐off score of 21 points (>90th percentile). Fatigue was created as a summary score from the 3 fatigue related statements (range 0 to 9 points). A total of 6.8% of the sample had iron deficiency anemia, and 18.7% had iron deficiency without anemia. ID was defined as low iron stores according to the algorithm of Cook et al., (Blood, 1986;68:), which calculates a continuous variable from individual values of hemoglobin, ferritin, protoporphyrine, and transferrin saturation. Logistic regression analysis adjusting for survey design was performed, with depressive mood greater than the 90th percentile of the CESD‐17 as the outcome. All models were controlled for fatigue, socio‐economic status (SES) and ethnic group. Stressors were defined based on the reviewed literature and available variables. ID women (iron stores < −200 mg) with exposure to low SES, postpregnant status, or low perceived control over their health had odds ratios of depressive mood that were 1.66 to 5 times greater compared to the reference group (no stressor exposure, iron stores ≥ −200 mg). In conclusion, exposure to stressors is an important modifier of the relationship between depressive mood and ID. This research was supported by the NIH predoctoral training grant 3 T32 DK007158‐29.