Sex Sex Cases Total OR (95% CI)b OR (95% CI)c OR (95% CI)d Male Body image disturbance None 78 1875 1 (ref.) 1 (ref.) 1 (ref.) Underestimated Overestimated 83 2397 0.83 (0.60 – 1.13) 0.83 (0.60 – 1.15) 0.83 (0.60 – 1.16) 1 96 0.24 (0.03 – 1.78) 0.23 (0.03 – 1.70) 0.21 (0.03 – 1.55) Female Body image disturbance None 218 3604 1 (ref.) 1 (ref.) 1 (ref.) Underestimated Overestimated 108 2145 0.81 (0.64 – 1.02) 0.84 (0.66 – 1.07) 0.85 (0.67 – 1.08) 10 169 1.02 (0.53 – 1.97) 0.81 (0.39 – 1.69) 0.82 (0.40 – 1.70) Odds Ratio (OR); 95% Confidence Interval (95% CI); a Depression was defined as a physician diagnosis or the use of antidepressants drugs; b Odds Ratio of the association between body image disturbance and incidence of depression adjusted for age; c Odds Ratio of the association between body image disturbance and incidence of depression adjusted for age, weight change in the past five years (none, lost, gain), marital status (unmarried, married, other), smoking (never, current smoker, past smoker), physical activity (METs-h/week), energy intake (Kcal/day), alcohol consumption (g/day), working hours (< 35 hours/week, >= 35 hours/week, unemployed), chronic diseases (cardiovascular diseases and cancer) at baseline; d Odds Ratio of the association between body image disturbance and incidence of depression adjusted for the same variables in (c) plus pregnancy and chronic diseases (cardiovascular diseases and cancer) during follow-up. association investigated. This problem is avoided in our work which has had a longitudinal design. Other studies have shown that depression can lead to body image disturbance [12, 13, 15]. However, the temporal sequence is a potential major limitation of those studies as well, as they also used a cross sectional design. We have no knowledge of any previous prospective study with a large sample and follow-up period that has evaluated the relationship between body image distur- bance and depression among adults. One study con- ducted with ninety-seven patients with binge eating disorders has reported that body image disturbance is a predictive factor of depression [29]. One possible explanation for the lack of association between body image disturbance and incidence of depression in our adult population is the high educa- tional level amongst our studied population. This characteristic may contribute to more accurate self-report of perceived body size. More than 50.0% of the participants correctly estimated their body size and the misperception was mostly limited to only one silhouette below the actual BMI, which can be considered as acceptable. Studies done by our group have shown that participants of this cohort have also correctly self- reported diagnoses for other important characteristics [23, 28, 30, 31]. The lack of association between body image disturbance and incidence of depression in our study could also be Table 4: Association between body image disturbance and incidence of depressiona in participants of the SUN study according to sex. BMC Public Health 2009, 9:1 http://www.biomedcentral.com/1471-2458/9/1 Table 3: Association between body image disturbance and incidence of depressiona in participants of the SUN study according to sex. Cases Total OR (95% CI)b OR (95% CI)c OR (95% CI)d Male Body image disturbance None 43 1840 1 (ref.) 1 (ref.) 1 (ref.) Underestimated Overestimated 52 2366 0.94 (0.62 – 1.41) 0.92 (0.60 – 1.39) 0.92 (0.60 – 1.39) 0 95 e e e Female Body image disturbance None 163 3549 1 (ref.) 1 (ref.) 1 (ref.) Underestimated Overestimated 71 2108 0.72 (0.54 – 0.95) 0.76 (0.57 – 1.01) 0.77 (0.57 – 1.02) 9 168 1.20 (0.60 – 2.39) 0.95 (0.43 – 2.06) 0.96 (0.44 – 2.09) Odds Ratio (OR); 95% Confidence Interval (CI 95%);a Depression was defined only as a physician diagnosis, excluding those participants who reported use of antidepressant drugs, n = 160; b Odds Ratio of the association between body image disturbance and depression adjusted for age; c Odds Ratio of the association between body image disturbance and depression adjusted for age, body mass index, weight change in the past five years (none, lost, gain), marital status (unmarried, married, other), smoking (never, current smoker, past smoker), physical activity (METs-h/week), energy intake (Kcal/day), alcohol consumption (g/day), working hours (< 35 hours/week, >= 35 hours/week, unemployed), chronic diseases (cardiovascular diseases and cancer) at baseline; d Odds Ratio of the association between body image disturbance and incidence of depression adjusted for the same variables in (c) plus pregnancy and chronic diseases (cardiovascular diseases and cancer) during follow-up; e Odds Ratio could not be calculated. Page 6 of 9 (page number not for citation purposes)