Original Article

High Cadmium Levels in Individuals with Depressive Mood: Re-sults from the 2008–2013 Korean National Health and Nutrition Survey


Background: The relationship between cadmium (Cd) exposure and depression remains unclear. This nationwide study aimed to compare the levels of blood Cd with the presence of depressive mood in Korean adults.

Methods: From the 2008–2013 Korea National Health and Nutrition Examination Survey, 10,968 individuals over 20 yr old were identified. Data on demographics, health behaviors, depressive mood, and blood Cd (B-Cd) levels were used in the analysis. Estimated levels of B-Cd were drawn from multivariate regression models.

Results: Higher age-adjusted B-Cd levels were noted among women, rural residents, people who have a low economic or educational status, smoke currently, drink frequently, or have depressive mood than the counterpart groups. In fully adjusted models, men with depressive mood exhibited significantly higher B-Cd levels than those without depressive mood, and these levels were strongly mediated by smoking status.

Conclusion: Our results suggest a need for Cd accumulation screening among individuals with depressive mood.

1. Shahid M, Dumat C, Khalid S, et al (2017). Cadmium Bioavailability, Uptake, Toxicity and Detoxification in Soil-Plant System. Rev Environ Contam Toxicol, 241:73-137.
2. Disease GBD, Injury I, Prevalence C (2016). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet, 388(10053):1545-1602.
3. Kessler RC, Bromet EJ (2013). The epidemiology of depression across cultures. Annu Rev Public Health, 34:119-38.
4. Haushofer J, Fehr E (2014). On the psychology of poverty. Science, 344(6186):862-7.
5. Taylor G, McNeill A, Girling A, et al (2014). Change in mental health after smoking cessation: systematic review and meta-analysis. BMJ, 348:g2216.
6. Ruggles KV, Fang Y, Tate J, et al (2017). What are the Patterns Between Depression, Smoking, Unhealthy Alcohol Use, and Other Substance Use Among Individuals Receiving Medical Care? A Longitudinal Study of 5479 Participants. AIDS Behav, 21(7):2014-2022.
7. Kawachi I, Adler NE, Dow WH (2010). Money, schooling, and health: Mechanisms and causal evidence. Ann N Y Acad Sci, 1186:56-68.
8. Stanley PC, Wakwe VC (2002). Toxic trace metals in the mentally ill patients. Niger Postgrad Med J, 9(4):199-204.
9. Buser MC, Scinicariello F (2017). Cadmium, Lead, and Depressive Symptoms: Analysis of National Health and Nutrition Examination Survey 2011-2012. J Clin Psychiatry, 78(5):e515-e521.
10. Scinicariello F, Buser MC (2015). Blood cadmium and depressive symptoms in young adults (aged 20-39 years). Psychol Med, 45(4):807-815.
11. Berk M, Williams LJ, Andreazza AC, et al (2014). Pop, heavy metal and the blues: secondary analysis of persistent organic pollutants (POP), heavy metals and depressive symptoms in the NHANES National Epidemiological Survey. BMJ Open, 4(7):e005142.
12. Kostrubiak DE, Vacchi-Suzzi C, Smith DM, et al (2017). Blood cadmium and depressive symptoms: Confounded by cigarette smoking. Psychiatry Res, 256:444-447.
13. Han C, Lim YH, Hong YC (2016). Does cadmium exposure contribute to depressive symptoms in the elderly population? Occup Environ Med, 73:269-74.
14. Minami A, Takeda A, Nishibaba D, et al (2001). Cadmium toxicity in synaptic neurotransmission in the brain. Brain Res, 894(2):336-9.
15. Lafuente A, Gonzalez-Carracedo A, Romero A, et al (2003). Effect of cadmium on 24-h variations in hypothalamic dopamine and serotonin metabolism in adult male rats. Exp Brain Res, 149(2):200-6.
16. Werner FM, Covenas R (2010). Classical neurotransmitters and neuropeptides involved in major depression: a review. Int J Neurosci, 120(7):455-70.
17. Gutierrez-Reyes EY, Albores A, Rios C (1998). Increase of striatal dopamine release by cadmium in nursing rats and its prevention by dexamethasone-induced metallothionein. Toxicology, 131(2-3):145-54.
18. Lafuente A, Marquez N, Perez-Lorenzo M, et al (2001). Cadmium effects on hypothalamic-pituitary-testicular axis in male rats. Exp Biol Med (Maywood), 226:605-11.
19. Crone MR, Reijneveld SA (2007). The association of behavioural and emotional problems with tobacco use in adolescence. Addictive Behaviors, 32:1692-1698.
20. Kweon S, Kim Y, Jang MJ, et al (2014). Data resource profile: the Korea National Health and Nutrition Examination Survey (KNHANES). Int J Epidemiol, 43(1):69-77.
21. Seo MH, Lee WY, Kim SS, et al (2019). 2018 Korean Society for the Study of Obesity Guideline for the Management of Obesity in Korea. J Obes Metab Syndr, 28(1): 40–45.
22. Lee HO, Bak HJ, Shin JY, et al (2015). Association between Metabolic Syndrome and Microalbuminuria in Korean Adults. Korean J Fam Med, 36(2): 60–71.
23. Jarup L, Akesson A (2009). Current status of cadmium as an environmental health problem. Toxicol Appl Pharmacol, 238(3):201-8.
24. Bakhshaie J, Zvolensky MJ, Goodwin RD (2015). Cigarette smoking and the onset and persistence of depression among adults in the United States: 1994-2005. Compr Psychiatry, 60:142-148.
25. Lorant V, Croux C, Weich S, et al (2007). Depression and socio-economic risk factors: 7-year longitudinal population study. Br J Psychiatry, 190:293-8.
26. Fryers T, Melzer D, Jenkins R (2003). Social inequalities and the common mental disorders: a systematic review of the evidence. Soc Psychiatry Psychiatr Epidemiol, 38(5):229-37.
27. Finegan M, Firth N, Wojnarowski C, et al (2018). Associations between socioeconomic status and psychological therapy outcomes: A systematic review and meta-analysis. Depress Anxiety, 35(6):560-573.
28. van den Bosch M, Meyer-Lindenberg A (2019). Environmental Exposures and Depression: Biological Mechanisms and Epidemiological Evidence. Annu Rev Public Health, 40:239-259.
29. Wang X, Jiang B, Liu JS (2017). Generalized R-squared for detecting dependence. Biometrika, 104:129-139.
30. Seabrook JA, Avison WR (2012). Socioeconomic status and cumulative disadvantage processes across the life course: implications for health outcomes. Can Rev Sociol, 49(1):50-68.
31. Husky MM, Mazure CM, Paliwal P, et al (2008). Gender differences in the comorbidity of smoking behavior and major depression. Drug Alcohol Depend, 93(1-2):176-9.
32. Wong SL, Lye EJ (2008). Lead, mercury and cadmium levels in Canadians. Health Rep, 19(4):31-6.
33. Satarug S, Baker JR, Urbenjapol S, et al (2003). A global perspective on cadmium pollution and toxicity in non-occupationally exposed population. Toxicol Lett, 137(1-2):65-83.
34. Lanni C, Govoni S, Lucchelli A, et al (2009). Depression and antidepressants: molecular and cellular aspects. Cell Mol Life Sci, 66(18):2985-3008.
IssueVol 50 No 8 (2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v50i8.6805
Cadmium Depression Causality Smoking South Korea

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How to Cite
Hwang IC, Ahn HY. High Cadmium Levels in Individuals with Depressive Mood: Re-sults from the 2008–2013 Korean National Health and Nutrition Survey. Iran J Public Health. 2021;50(8):1595-1602.