The Impact of Depression on Patients with Coronary Heart Disease and Cancer: A Comprehensive Analysis Based on NHANES and GBD Data (Preprint)

BACKGROUND Depression is highly prevalent in chronic diseases like coronary heart disease (CHD) and cancer. While its links to each condition separately are studied, its independent role in patients with both CHD and cancer remains unassessed. Understanding depression's role in this multimorbidity is clinically and public health critical. OBJECTIVE The objective of this study was to investigate the independent role of depression in the comorbidity of coronary heart disease (CHD) and cancer, leveraging individual-level data from NHANES (2011–2018) and global burden estimates from GBD (1990–2021). Specifically, we aimed to (1) assess the association between depression scores and the risk of comorbid CHD and cancer using multivariable logistic regression, (2) evaluate the predictive power of psychological factors through an artificial neural network (ANN) model, (3) explore the interaction between depression and age using 3D partial dependence plots (PDP), and (4) analyze global trends and interrelationships among depression, CHD, and cancer using GBD data. Ultimately, this study sought to highlight the clinical and public health implications of depression in multimorbidity, advocating for integrated psychological screening and interventions in chronic disease management, particularly for high-risk populations. METHODS Data from NHANES (2011–2018) and GBD (1990–2021) included 14,791 participants. Multivariable logistic regression assessed depression score's association with comorbid CHD and cancer risk. An artificial neural network (ANN) evaluated psychological factors' predictive power. A 3D partial dependence plot (PDP) explored depression-age interaction. GBD data analyzed global trends and interrelationships. RESULTS Depression score was an independent risk factor for CHD comorbid with cancer (OR = 1.081; 95% CI: 1.026–1.138; P = .003). Age, smoking, and diabetes also increased risk. The ANN model's overall multi-class AUC was 0.72. The 3D PDP showed elevated age and depression scores jointly increased the predicted probability of CHD with cancer. GBD analysis revealed consistently rising global prevalence of depression, CHD, and cancer from 1990–2021, especially in high-SDI countries. CONCLUSIONS Depression commonly coexists with CHD and cancer and may act as a key factor exacerbating overall disease burden. Systematic psychological screening and intervention should be integrated into chronic disease and cancer survivorship care, particularly for the elderly and high-risk individuals. Combining individual-level survey data with macro-level burden estimates helps comprehensively identify multimorbidity-associated psychological risks, enabling multi-tiered public health interventions.