The extensive use and bioaccumulation of Perfluoroalkyl Substances (PFAS) over time raise concerns about their impact on health, including mental issues such as depression. This study aims to evaluate the association between PFAS and depression. In addition, considering the importance of PFAS as an endocrine disruptor and in adipogenesis, the analyses will also be stratified by body fat status. A cross-sectional study with 479 subjects (56.4% women, 25-89 years) was conducted. Four PFAS were measured: perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluorooctane sulfonate (PFOS). The Poisson regression model was applied using robust error variances. The fully adjusted model included age, sex, educational level, income, smoking, physical activity, body fat percentage, and the questionnaire to assess depression. The prevalence of depression and high body fat was 7.9% and 41.1%, respectively. Only PFOA was significantly associated with depression in the entire sample (prevalence rate (PR): 1.91; confidence interval (CI95%): 1.01-3.65). However, in the group with normal adiposity, PFOA (3.20, CI95%: 1.46-7.01), PFNA (2.54, CI95%: 1.29-5.00), and PFDA (2.09, CI95%: 1.09-4.00) were also significant. Future research should investigate the role of obesity as well as the biological plausibility and possible mechanisms increasing the limited number of evidences between PFAS and depression.

Department of Global Health and Population Harvard TH Chan School of Public Health Harvard University Boston MA 02138 USA

Foundation for Clinic Public Health and Epidemiology Research of Venezuela Caracas 3001 Venezuela

International Clinical Research Center 65691 Brno Czech Republic

Research Centre for Toxic Compounds in the Environment Faculty of Science Masaryk University 62500 Brno Czech Republic

Research Department of Epidemiology and Public Health University College London London WC1H 9BT UK

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