Insulin resistance and metabolic syndrome in generalized anxiety disorder: a cross-sectional study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20242929Keywords:
Generalized anxiety disorder, Insulin resistance, Metabolic syndrome, HAM-A, HOMA-IRAbstract
Background: Generalized anxiety disorder (GAD) involves persistent and excessive anxiety affecting daily activities for at least six months, often accompanied by restlessness, fatigue, irritability, muscle tension, and sleep difficulties. Insulin resistance (IR) and metabolic syndrome (MetS) are linked to psychiatric disorders due to their impact on the central nervous system. This study aims to assess IR and MetS prevalence in GAD patients and explore their relationship with GAD severity.
Methods: In a six-month cross-sectional study at a tertiary care center in southern India, 66 patients aged 18-60 diagnosed with GAD per DSM-5 criteria were included. Exclusion criteria were other psychiatric disorders, significant medical conditions, and specific medication use. GAD severity was assessed using the Hamilton anxiety rating scale (HAM-A). IR was calculated using the homeostatic model assessment of insulin resistance (HOMA-IR) formula, with a value of 2.5 or higher indicating significant IR. MetS was diagnosed based on the International Diabetes Federation's criteria.
Results: Among the 66 participants (59.1% female, mean age 43.41 years), 39.4% had severe GAD. Significant IR was present in 39.4% of participants, while 34.8% met the criteria for MetS. No significant correlation was found between GAD severity and IR or MetS, although a sedentary lifestyle was notably higher in GAD patients (57.6%).
Conclusions: The study highlights a high prevalence of IR and MetS among GAD patients, without a significant correlation with GAD severity. Routine metabolic screening and integrated management strategies are recommended for GAD patients to address both mental and metabolic health concerns.
References
Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health. Rockville (MD): Substance Abuse and Mental Health Services Administration (US). 2016. Available at: https://www.ncbi.nlm.nih.gov/books/ NBK519704/table/ch3.t15/. Accessed on 12 July 2024.
Kessler RC, Aguilar-Gaxiola S, Alonso J, Chatterji S, Lee S, Ormel J, et al. The global burden of mental disorders: An update from the WHO World Mental Health (WMH) surveys. Epidemiol Psichiatr Soc. 2009;18:23-33.
Manjunatha N, Jayasankar P, Suhas S, Rao GN, Gopalkrishna G, Varghese M, et al. Prevalence and its correlates of anxiety disorders from India’s National Mental Health Survey 2016. Indian J Psychiatry. 2022;64:138-42.
Philip S, Manjunatha N, Varghese M, Benegal V. Current prevalence and determinants of generalized anxiety disorder from a nationally representative, population-based survey of India. Indian J Psychiatry. 2023;824:23.
Kleinridders A, Cai W, Cappellucci L, Ghazarian A, Collins WR, Vienberg SG, et al. Insulin resistance in brain alters dopamine turnover and causes behavioral disorders. Proc Natl Acad Sci U S A. 2015;112(11):3463-8.
Matza LS, Morlock R, Sexton C, Malley K, Feltner D. Identifying HAM-A cutoffs for mild, moderate, and severe generalized anxiety disorder. Int J Methods Psychiatr Res. 2010;19(4):223-32.
Muniyappa R, Lee S, Chen H, Quon MJ. Current approaches for assessing insulin sensitivity and resistance in vivo: advantages, limitations, and appropriate usage. Am J Physiol Endocrinol Metab. 2008;294(1).
Kassi E, Pervanidou P, Kaltsas G, Chrousos G. Metabolic syndrome: definitions and controversies. BMC Med. 2011;9:48.
Ji S, Chen Y, Zhou Y, Cao Y, Li X, Ding, Tang F. Association between anxiety and metabolic syndrome: An updated systematic review and meta-analysis. Front Psychiatry. 2023;14:1118836.
Scott KM. Sex differences in the disability associated with mental disorders. Curr Opin Psychiatry. 2011;24:331-5.
Chandrupatla SG, Khalid I, Muthuluri T, Dantala S, Tavares M. Diabetes and prediabetes prevalence among young and middle-aged adults in India, with an analysis of geographic differences: findings from the National Family Health Survey. Epidemiol Health. 2020;42:e2020065.
Hung CI, Liu CY, Hsiao MC, Yu NW, Chu CL. Metabolic syndrome among psychiatric outpatients with mood and anxiety disorders. BMC Psychiatry. 2014;14:185.
Deepa R, Shanthirani CS, Premalatha G, Sastry NG, Mohan V. Prevalence of insulin resistance syndrome in a selected south Indian population— the Chennai urban population study-7 [CUPS-7]. Indian J Med Res. 2002;115:118-27.
World Health Organization. Depression and Other Common Mental Disorders: Global Health Estimates. 2017. Available at: https://www.who.int/ publications/i/item/depression-global-health-estimates. Accessed on 12 July 2024.
Sharma D, Goel NK, Kaur R, Khosla N, Shekam M. Prevalence and Predictors of Physical Inactivity among Adults - A Cross-Sectional Study. Indian J Community Med. 2022;47(1):130-2.