Depression and mortality in population with cardiovascular-kidney-metabolic syndrome

Li Lei; Yali Qu; Weijie Bei

doi:10.1016/j.jad.2025.119773

Depression and mortality in population with cardiovascular-kidney-metabolic syndrome

J Affect Disord. 2025 Jun 25:119773. doi: 10.1016/j.jad.2025.119773. Online ahead of print.

Authors

Li Lei¹, Yali Qu², Weijie Bei³

Affiliations

¹ Department of Cardiology, Shenzhen People's Hospital (The First Affiliated Hospital, Southern University of Science and Technology; The Second Clinical Medical College, Jinan University), Shenzhen, 518020, China.
² Shenzhen Bao'an Center for Chronic Disease Control, Shenzhen, 518101, China.
³ Department of Cardiology, Shenzhen People's Hospital (The First Affiliated Hospital, Southern University of Science and Technology; The Second Clinical Medical College, Jinan University), Shenzhen, 518020, China. Electronic address: weijiebei@163.com.

PMID: 40578696
DOI: 10.1016/j.jad.2025.119773

Abstract

Background: Cardiovascular-kidney-metabolic (CKM) syndrome and depression are both highly prevalent worldwide. However, whether depression worsen the prognosis of CKM syndrome remains unknown. We investigated the association of depressive symptoms and major depression with mortality among adults with CKM syndrome and examined these associations in individuals at different CKM syndrome stages.

Methods: A total of 13,396 participants with CKM syndrome stage 1 to 4 were included. Depressive symptoms and major depression were evaluated and diagnosed through the 9-item Patient Health Questionnaire. Mortality data were obtained from the public-use linked mortality files extending from the date of survey interview participation through December 31, 2019. Cox regression models were conducted to explore the association of depressive symptoms and major depression with mortality.

Results: During the median follow-up period of 86 months, 1467 cases of all-cause mortality occurred, with 469 attributed to cardiovascular disease (CVD) and 998 attributed to non-CVD causes. More severe depressive symptoms were associated with increase all-cause (HR, 1.04 [95 % CI, 1.02-1.05]), CVD (HR, 1.03 [95 % CI, 1.00-1.05]) and non-CVD (HR, 1.03 [95 % CI, 1.01-1.05]) mortality; major depression was associated with increase all-cause (HR, 1.37 [95 % CI, 1.04-1.81]) and CVD (HR, 1.44 [95 % CI, 1.07-1.94]) mortality. The positive association between depressive symptoms and all-cause mortality remains across different CKM stages.

Limitations: Observational study, and lack of data on other CVD and changes in depressive status during the follow-up period.

Conclusions: Depression was associated with mortality in CKM syndrome. Improving depressive symptoms may bring benefits to individuals across all CKM stages.

Keywords: Cardiovascular-kidney-metabolic syndrome; Depression; Mortality; NHANES.