Abstract
With aging, women’s bodies undergo changes that can affect body image perception, yet little is known about body image in midlife. The purpose of this study was to examine associations between body image and depressive symptoms in Caucasian and African–American midlife women from the Study of Women’s Health Across the Nation (SWAN) Chicago site. Body image was measured using the Stunkard Adult Female Figure Rating Scale, and a clinically significant level of depressive symptoms was defined as Center for Epidemiologic Studies Depression Scale (CES-D) score of ≥16 (N = 405; N = 63 (15.6 %) with clinically significant levels of depressive symptoms). Differences between perceived actual, perceived ideal, and actual body size and responses to questions concerning weight satisfaction and attractiveness were examined using logistic regression for associations with a CES-D score of ≥16. Women with body image dissatisfaction (odds ratio (OR) = 1.91; p = 0.04) or who perceived themselves as “unattractive” (OR = 7.74; p < 0.01) had higher odds of CES-D of ≥16. We found no significant difference by race. Our results were not confounded by BMI. These results suggest that midlife women with poor body image may be more likely to have clinically significant levels of depressive symptoms. Larger prospective studies are needed to better understand this association.
Similar content being viewed by others
References
Ainsworth BE, Sternfeld B, Richardson MT et al (2000) Evaluation of the Kaiser Physical Activity Survey in women. Med Sci Sports Exerc 32:1327–1338
Ali MM, Fang H, Rizzo JA (2010) Body weight, self-perception and mental health outcomes among adolescents. J Ment Health Policy Econ 13:53–63
American Psychiatric Association (2000) American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision. American Psychiatric Association, Washington, DC
Bennett GG, Wolin KY (2006) Satisfied or unaware? Racial differences in perceived weight status [electronic article]. Int J Behav Nutr Phys Act 3:40
Bromberger JT, Kravitz HM, Chang Y et al (2013) Does risk for anxiety increase during the menopausal transition? Study of Women’s Health Across the Nation. Menopause 20:488–495
Bulik CM, Wade TD, Heath AC et al (2001) Relating body mass index to figural stimuli: population-based normative data for Caucasians. Int J Obes Relat Metab Disord 25:1517–1524
Cash TF, Szymanski ML (1995) The development and validation of the body-image ideals questionnaire. J Pers Assess 46:466–477
CDC (2009) Differences in prevalence of obesity among black, white, and Hispanic adults—United States, 2006–2008. MMWR 58:740–744
CDC (2012) NCHS Fact Sheet-NCHS Data on obesity. http://www.cdc.gov/nchs/data/factsheets/factsheet_obesity.htm. Accessed 22 January 2014
Chithambo TP, Huey SJ (2013) Black/white differences in perceived weight and attractiveness among overweight women. J Obes 2013:1–4
Deeks AA (2004) Is this menopause? Women in midlife—psychosocial issues. Aust Fam Physician 33:889–893
Deurenberg P, Yap M, van Staveren WA (1998) Body mass index and percent body fat: a meta analysis among different ethnic groups. Int J Obes Relat Metab Disord 22:1164–1171
Evans EM, Rowe DA, Racette SB et al (2006) Is the current BMI obesity classification appropriate for black and white postmenopausal women? Int J Obes (Lond) 30:837–843
Fitzgibbon ML, Blackman LR, Avellone ME (2000) The relationship between body image discrepancy and body mass index across ethnic groups. Obes Res 8:582–589
Freeman EW, Sammel MD, Liu L et al (2004) Hormones and menopausal status as predictors of depression in women in transition to menopause. Arch Gen Psychiatry 61:62–70
Gardner RM (1996) Methodological issues in assessment of the perceptual component of body image disturbance. Br J Psychol 87:327–337
Garner DM, Garfinkel PE, Bonato DP (1987) Body image measurement in eating disorders. Adv Psychosom Med 17:119–133
Gazmararian JA, James SA, Lepkowski JM (1995) Depression in black and white women. The role of marriage and socioeconomic status. Ann Epidemiol 5:455–463
Guajardo VD, Souza BP, Henriques SG et al (2011) Loss of interest, depressed mood and impact on the quality of life: cross-sectional survey. BMC Public Health 11:826
Hosmer DW, Lemshow S (2000) Applied logistic regression, 2nd edn. John Wiley & Sons Inc, New York, NY
Knight JM, Avery EF, Janssen I et al (2010) Cortisol and depressive symptoms in a population-based cohort of midlife women. Psychosom Med 72:855–861
Knight RG, Williams S, Mcgee R et al (1997) Psychometric properties of the Centre for Epidemiologic Studies Depression Scale (CES-D) in a sample of women in middle life. Behav Res Ther 35:373–380
Lerner D, Henke RM (2008) What does research tell us about depression, job performance, and work productivity? J Occup Environ Med 50:401–410
Llaneza P, Garcia-Portilla MP, Llaneza-Suarez D et al (2012) Depressive disorders and the menopause transition. Maturitas 71:120–130
Lynch E, Liu K, Spring B et al (2007) Association of ethnicity and socioeconomic status with judgments of body size: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Am J Epidemiol 165:1055–1062
Lynch E, Liu K, Wei GS et al (2009) The relation between body size perception and change in body mass index over 13 years: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Am J Epidemiol 169:857–866
Marsella AJ, Shizuru L, Brennan J et al (1981) Depression and body image satisfaction. J Cross-Cult Psychol 12:360–371
Moore MT, Fresco DM (2012) Depressive realism: a meta-analytic review. Clin Psychol Rev 32:496–509
National Heart, Lung, and Blood Institute (1998) Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. National Institutes of Health, Bethesda, MD
NHANES (2003) Healthy weight, overweight, and obesity among U.S. adults. http://www.cdc.gov/nchs/data/nhanes/databriefs/adultweight.pdf. Accessed 22 January 2014
Noles SW, Cash TF, Winstead BA (1985) Body image, physical attractiveness, and depression. J Consult Clin Psych 53:88–94
Patt MR, Lane AE, Finney CP et al (2002) Body image assessment: comparison of figure rating scales among urban Black women. Ethn Dis 12:54–62
Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401
Rand CS, Resnik JL (2000) The “good enough” body size as judged by people of varying age and weight. Obes Res 8:309–316
Reeves WC, Strine TW, Pratt LA et al (2011) Mental illness surveillance among adults in the United States. MMWR Surveill Summ 60:1–29
Roberts RE (1980) Reliability of the CES-D scale in different ethnic contexts. Psychiatr Res 2:125–134
Slade PD (1988) Body image in anorexia nervosa. Br J Psychiatry Suppl 153:20–22
Soares CN (2007) Menopausal transition and depression: who is at risk and how to treat it? Expert Rev Neurother 7:1285–1293
Sorensen TI, Stunkard AJ, Teasdale TW et al (1983) The accuracy of reports of weight: children’s recall of their parents’ weights 15 years earlier. Int J Obes 7:115–122
Sowers MF, Crawford SL, Sternfeld B et al (2000) SWAN: a multi-center, multi-ethnic, community-based cohort study of women and the menopause. In: Lobo R, Kelsey J, Marcus R (eds) Menopause: biology and pathobiology. Academic Press, San Diego, CA, pp 175–188
Sowers MF, Zheng H, Tomey K et al (2007) Changes in body composition in women over six years at midlife: ovarian and chronological aging. J Clin Endocrinol Metab 92:895–901
Sternfeld B, Ainsworth BE, Quesenberry CP (1999) Physical activity patterns in a diverse population of women. Prev Med 28:313–323
Stice E, Hayward C, Cameron RP et al (2000) Body-image and eating disturbances predict onset of depression among female adolescents: a longitudinal study. J Abnorm Psychol 109:438–444
Stunkard AJ, Sorensen T, Schulsinger F (1983) Use of the Danish adoption register for the study of obesity and thinness. Res Publ Assoc Res Nerv Ment Dis 60:115–120
Tang J, Yu Y, Du Y et al (2010) Association between actual weight status, perceived weight and depressive, anxious symptoms in Chinese adolescents: a cross-sectional study. BMC Public Health 10:594
Tehard B, van Liere MJ, Com Nouque C et al (2002) Anthropometric measurements and body silhouette of women: validity and perception. J Am Diet Assoc 102:1779–1784
Thompson KJ (2004) The (mis)measurement of body image: ten strategies to improve the assessment for applied and research purposes. Body Image 1:7–14
Wagner DR, Heyward VH (2000) Measures of body composition in blacks and whites: a comparative review. Am J Clin Nutr 71:1392–1402
Weissman MM, Sholomskas D, Pottinger M et al (1977) Assessing depressive symptoms in five psychiatric populations: a validation study. Am J Epidemiol 106:203–214
World Health Organization Scientific Group (1996) Research on the menopause in the 1990s. Report of a WHO Scientific Group. WHO Tech Serv Rep Ser 866:1–107
Acknowledgement
The SWAN has grant support from the National Institutes of Health (NIH), DHHS, through the National Institute on Aging (NIA), the National Institute of Nursing Research (NINR), and the NIH Office of Research on Women’s Health (ORWH; grants U01NR004061, U01AG012505, U01AG012535, U01AG012531, U01AG012539, U01AG012546, U01AG012553, U01AG012554, and U01AG012495). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the NIA, NINR, ORWH, or the NIH.
Conflict of interest statement
The authors have no financial relationship with the NIH, which funded the study (see Acknowledgements) and declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jackson, K.L., Janssen, I., Appelhans, B.M. et al. Body image satisfaction and depression in midlife women: the Study of Women’s Health Across the Nation (SWAN). Arch Womens Ment Health 17, 177–187 (2014). https://doi.org/10.1007/s00737-014-0416-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-014-0416-9