Depressive Symptoms and Eating Behaviors: Do Atypical Symptoms Drive Associations with Food Attentional Bias, Emotional Eating, and External Eating?

Abstract

Depression is an emerging risk factor for obesity; however, it is unclear whether certain depressive symptoms drive this relationship. Recent evidence suggests that atypical major depressive disorder (MDD) – whose key features include the reversed somatic-vegetative symptoms of hyperphagia (increased appetite) and hypersomnia (increased sleep) – is a stronger predictor of future obesity than other MDD subtypes. The present study sought to examine food attentional bias (increased attention to food cues), emotional eating (eating in response to negative emotions), and external eating (eating in response to external food cues) as candidate mechanisms of the depression-to-obesity relationship. This cross-sectional laboratory study hypothesized that total depressive symptom severity, hyperphagia severity, and hypersomnia severity would all be positively associated with measures of food attentional bias, emotional eating, and external eating. Data were collected from a sample of 95 undergraduate students. Depressive symptom severity was measured using the Hopkins Symptom Checklist (SCL-20); two measures of food attentional bias were obtained from eye tracking with high calorie food images: direction bias and duration bias; and emotional eating and external eating were assessed using the Dutch Eating Behavior Questionnaire. Simultaneous regression models (adjusted for age, sex, race/ethnicity, body mass index, and subjective hunger) revealed total depressive symptom severity and hypersomnia severity were not associated with measures of food attentional bias, while hyperphagia severity was negatively associated with direction bias but not associated with duration bias for high and low calorie food images. Findings related to emotional and external eating are consistent with previous literature: total depressive symptom severity and hyperphagia severity were positively associated with both emotional eating and external eating, and the pattern of results suggests that hyperphagia may be driving relationships between depressive symptoms and these eating behaviors. Hypersomnia severity was not associated with emotional eating and external eating, suggesting this symptom does not play an important role in the relationships between depressive symptoms and these eating behaviors. Future studies should examine prospective associations of hyperphagia severity with food attentional bias, emotional eating, and external eating in larger, more representative samples.