Iron Deficiency, Depression, and Other Affective Disorders in Female State Fair Attendees

Abstract

Iron deficiency persists as the most prevalent nutrient deficiency on the planet, and women of menstruating age are at high risk due to menstrual blood loss. Recent data suggests that iron deficiency in the absence of anemia impacts quality of life, and currently the prevalence of menstruating females with inadequate ferritin values in the US is high. Although the literature on iron status and depression is conflicting, a relationship is suggested with a proposed mechanism of altered neurotransmitter functioning. This cross-sectional study gathered survey data and blood samples from 182 female subjects at the Minnesota State Fair in August of 2015. Whole blood hemoglobin, hematocrit, serum ferritin and serum TIBC were determined and correlated to survey data detailing reported iron deficiency symptoms and their severity, including the PHQ9, a validated depression screen. 15% of subjects were anemic as defined by a hematocrit value under 38% or a hemoglobin value below 12 g/dL. Additionally, 74% had low ferritin status as defined by a value less than 20 g/L. Overall, 10% of subjects reported moderate to severe depression as defined by the PHQ9. Although independent relationships between anemia, low ferritin values, or elevated TIBC values and depression were not seen, inclusion of symptomatic iron deficiency, a variable combining iron deficiency symptoms of dizziness and shortness of breath to assess whether deficiency was exerting a physiological effect, improved the correlation between the biochemical measures of iron status and depression (p < 0.0001), as well as self-reported incidence of other affective and executive functioning disorders, including stress or moodiness, ease of anger, emotional unresponsiveness, and alertness or concentration. This data suggests that iron deficiency must be symptomatic for the association with depression and other affective or executive functioning disorders to be apparent.