Association between depression and oxidative balance score: National Health and Nutrition Examination Survey (NHANES) 2005–2018

Depression is a common mood disorder characterized by persistent feelings of sadness, hopelessness, and worthlessness, as well as a lack of interest in activities that were once enjoyable, which severely disrupts the psychosocial functioning of the patient and reduces the quality of life (Thapar et al., 2022). Depression contributes to a large global burden of disease, with the World Health Organization ranking major depression as the third leading cause of the global burden of disease in 2008 and predicting that it will progress to first place by 2030 (Malhi and Mann, 2018; Vos et al., 2020). Currently, depression is treated by psychotherapy, pharmacotherapy, electroconvulsive therapy, and combined therapy (Herrman et al., 2022), among which pharmacotherapy is the main treatment, but it is not effective and has many side effects. Therefore, the prevention of depression is crucial.

The pathogenesis of depression is complex and is influenced by genetic, psychological, environmental, and biological factors (Shadrina et al., 2018). In addition, the oxidative stress (OS) hypothesis of depression suggests that increased production of reactive oxygen species (ROS) and depletion of antioxidant defenses alter brain structure and thus are involved in the onset of depression (Belleau et al., 2019; Bhatt et al., 2020). Under physiological conditions, there is a balance between oxidants and the antioxidant system. When the production of ROS exceeds the scavenging capacity of the antioxidant response system, large amounts of protein are oxidized and lipid peroxidation occurs. This excess ROS leads to oxidative damage, cellular degeneration, and a decrease in physiological function (He et al., 2017). Antioxidant mechanisms safeguard cells by defending against excess free radicals. Plasma levels of important antioxidants including zinc, vitamin E, and coenzyme Q10 (CoQ10) are significantly lower in patients with depression (Pandya et al., 2013).

However, the effect of a single factor on the overall oxidative/antioxidant system is limited. Various dietary components, physical activity, obesity, smoking, and other behaviors all affect the level of oxidative stress in the body. Therefore, to capture the effects of various dietary and lifestyles on the whole oxidative/antioxidant system, the oxidative balance score (OBS) was invented to measure individual pro-oxidant and overall antioxidant exposure (W. Zhang et al., 2022). In general, a higher OBS indicates that antioxidants are superior to pro-oxidants. Previous studies have found that OBS is negatively associated with a variety of diseases, including metabolic syndrome, respiratory diseases, cardiovascular diseases, and type 2 diabetes (Golmohammadi et al., 2021), among others. Nevertheless, no studies have been conducted to assess the relationship between depression and OBS. Considering the role of oxidative stress in depression, the present study aimed to assess the association between OBS and depression in US adults using National Health and Nutrition Examination Survey (NHANES) data.

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