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Depressive symptoms were associated with a higher risk for all-cause and cardiovascular disease (CVD) mortality, according to a nationally representative prospective cohort study.

Of nearly 23,700 U.S. adults, mild depressive symptoms were associated with a significantly higher risk of all-cause mortality compared with no symptoms (HR 1.35, 95% CI 1.07-1.72), as were moderate to severe depressive symptoms (HR 1.62, 95% CI 1.24-2.12), reported Zefeng Zhang, MD, PhD, of the CDC in Atlanta, and co-authors.

Significant associations were also observed for CVD mortality, with corresponding hazard ratios of 1.49 (95% CI 1.11-2.00) and 1.79 (95% CI 1.22-2.62), they detailed in .

While moderate to severe depressive symptoms were linked to a significantly higher risk of ischemic heart disease mortality (HR 2.21, 95% CI 1.24-3.91), this was not the case for mild symptoms (HR 0.96, 95% CI 0.58-1.60).

Overall, these associations were largely consistent among age, sex, diabetes status, and poverty subgroups.

"Taken together with the body of literature on associations between depression and CVD mortality, these findings can support public health efforts to develop a comprehensive, nationwide strategy to improve well-being, including both mental and cardiovascular health," Zhang and team wrote.

They pointed out that depressive symptoms might affect lifestyle factors, such as obesity, physical inactivity, and unhealthy diet, which "are associated with an increase in risk of cardiovascular events and all-cause deaths."

In addition, social factors, like poverty, housing instability, lower educational attainment, and lack of health insurance are known to be linked to depression and could be an important factor in the association with mortality rates. Overall, approximately 11% to 16% of the associations between depression and mortality "could be explained by lifestyle factors," they suggested.

Feeling tired or having little energy, poor appetite or overeating, and having little interest in doing things were all independently associated with all-cause and cardiovascular disease mortality, though not with ischemic heart disease mortality, they noted.

Their findings were in line with existing studies and "extend the findings from previous studies by assessing these associations in a large, diverse, and nationally representative sample and by using more nuanced CVD-related causes of death," they added.

Still, they said their findings differed in key ways from prior research. For example, they said "previous studies have reported that associations of depression and mortality differed by gender," but their research did not find any "statistically significant interaction by sex."

However, women did have a higher prevalence of depression, and "hazard ratios for associations between depression and all-cause, CVD, and [ischemic heart disease] mortality were higher in women compared to men." These differences may have been the result of sex-based misclassification of self-reported depression, "especially if men were more hesitant to report depressive symptoms than women," Zhang and colleagues wrote.

For this study, the researchers analyzed data on adults ages 20 and older from the National Health and Nutrition Examination Survey from 2005 to 2018 linked with the National Death Index through 2019.

Ultimately, 23,694 participants were included; mean age was 44.7, 50.2% were women, 66.2% were white, 11% were Black, and 15.3% were Hispanic.

Depressive symptoms were defined using Patient Health Questionnaire-9 scores, and participants were categorized based on if they experienced none or minimal symptoms, mild symptoms, or moderate to severe symptoms; 14.9% had mild symptoms and 7.2% had moderate to severe symptoms.

Zhang and team pointed out that depressive symptoms were only measured at baseline, and they could not account for changes in symptoms over time.

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