Background: Cardiovascular disease (CVD) and depression are the leading causes of disability in the U.S. Using five cycles (2009–2018) of the U.S. National Health and Nutrition Examination Survey, we examined the cross-sectional association between CVD risk factor burden and depression severity in nonpregnant adults with no history of CVD events. Methods: With at least 3000 participants per cycle, the overall N was 18,175. CVD risk factors were ascertained through self-report, lab tests, or medications. The sum of hypertension, diabetes, dyslipidemia, and current smoking represented a CVD risk score variable (range: 0–4). Depression severity was assessed using scores on the 9-item patient health questionnaire: 0–9 (none-mild) and 10–27 (moderate-to-severe). Logistic regression models were performed to investigate the association between CVD risk score categories and moderate-to-severe depression. Cycle-specific odds ratios (OR) were meta-analyzed to obtain a pooled OR (95 % CI) (Q-statistic p > 0.05). Results: Compared to participants with no CVD risk factors, participants with risk scores of 1, 2, 3, and 4, had 1.28 (0.92–1.77), 2.18 (1.62–2.94), 2.53 (1.86–3.49), 2.97 (1.67–5.31) times higher odds of moderate-to-severe depression, respectively, after adjusting for socio-demographics and antidepressant use (linear trend p < 0.0001). This relationship persisted after additionally adjusting for lifestyle variables. Limitations: NHANES data is cross-sectional and self-reported, thus preventing causal assessments and leading to potential recall bias. Conclusions: Among U.S. adults, CVD risk factor burden was associated with worsened depression symptoms. Integrated mental and physical healthcare services could improve risk stratification among persons with CVD and depression, possibly reducing long-term disability and healthcare costs.

Original languageEnglish (US)
Pages (from-to)866-874
Number of pages9
JournalJournal of Affective Disorders
StatePublished - Feb 15 2023

All Science Journal Classification (ASJC) codes

  • Clinical Psychology
  • Psychiatry and Mental health


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