BMC Public Health BioMed Central Research article Relationship between body image disturbance and incidence of depression: the SUN prospective cohort Adriano Marçal Pimenta1, Almudena Sánchez-Villegas2,3, Maira Bes-Rastrollo2, Celeste Nicole López4 and Miguel Ángel Martínez-González*2 Open Access Address: 1Department of Maternal and Child Nursing and Public Health, Nursing School, Universidade Federal de Minas Gerais (UFMG), Avenida Alfredo Balena, 190. Belo Horizonte, Minas Gerais, CEP 30130-100, Brazil , 2Department of Preventive Medicine and Public Health, Medical School, Clínica Universitaria/Universidad de Navarra (UNAV), Inrunlarrea, 1. Pamplona, Navarra, E 31080, Spain, 3Department of Clinical Sciences, Medical School, Universidad de Las Palmas de Gran Canaria (ULPGC), PO BOX: 550, Las Palmas, Las Palmas de Gran Canaria, CP. 35080, Spain and 4Harvard Medical School, Harvard University, 25 Shattuck Street, Boston, Massachusetts, 02115, USA E-mail: Adriano Marçal Pimenta - adrianompimenta@yahoo.com.br; Almudena Sánchez-Villegas - asanchez@dcc.ulpgc.es; Maira Bes-Rastrollo - mbes@unav.es; Celeste Nicole López - celestenicole.lopez@gmail.com; Miguel Ángel Martínez-González* - mamartinez@unav.es; *Corresponding author Published: 02 January 2009 BMC Public Health 2009, 9:1 doi: 10.1186/1471-2458-9-1 This article is available from: http://www.biomedcentral.com/1471-2458/9/1 Received: 2 April 2008 Accepted: 2 January 2009 © 2009 Pimenta et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: Body image disturbance is an increasing problem in Western societies and is associated with a number of mental health outcomes including anorexia, bulimia, body dysmorphia, and depression. The aim of this study was to assess the association between body image disturbance and the incidence of depression. Methods: This study included 10,286 participants from a dynamic prospective cohort of Spanish university graduates, who were followed-up for a median period of 4.2 years (Seguimiento Universidad de Navarra – the SUN study). The key characteristic of the study is the permanently open recruitment that started in 1999. The baseline questionnaire included information about body mass index (BMI) and the nine figure schemes that were used to assess body size perception. These variables were grouped according to recommended classifications and the difference between BMI and body size perception was considered as a proxy of body image disturbance. A subject was classified as an incident case of depression if he/she was initially free of depression and reported a physician-made diagnosis of depression and/or the use of antidepressant medication in at least one of the follow-up questionnaires. The association between body image disturbance and the incidence of depression was estimated by calculating the multivariable adjusted Odds Ratio (OR) and its 95% Confidence Interval (95% CI), using logistic regression models. Results: The cumulative incidence of depression during follow-up in the cohort was 4.8%. Men who underestimated their body size had a high percentage of overweight and obesity (50.1% and 12.6%, respectively), whereas women who overestimated their body size had a high percentage of underweight (87.6%). The underestimation exhibited a negative association with the incidence of depression among women (OR: 0.72, 95% CI: 0.54 – 0.95), but this effect disappeared after adjusting for possible confounding variables. The proportion of participants who correctly perceived their body size was high (53.3%) and gross misperception was seldom found, with most cases selecting only one silhouette below (42.7%) or above (2.6%) their actual BMI. Conclusion: We found no association between body image disturbance and subsequent depression in a cohort of university graduates in Spain. Page 1 of 9 (page number not for citation purposes)