The uric acid-to-HDL ratio as a predictive biomarker for depression risk in adult women

Background Depression disproportionately affects women, yet biomarkers for early risk stratification remain limited. This study examines the uric acid-to-HDL cholesterol ratio (UHR), a novel inflammatory and metabolic marker, as a potential predictor of depression in women. Objective To evaluate the association between UHR and depression risk in adult women. Methods This pooled cross-sectional analysis included 7,925 women aged ≥20 years, using the combined 2005–2018 NHANES cycles. Depression was defined by a Patient Health Questionnaire-9 (PHQ-9) score ≥10. UHR was calculated as uric acid (mg/dL) divided by HDL cholesterol (mg/dL) multiplied by 100%. Multivariable logistic regression was adjusted for sociodemographic, clinical, and lifestyle confounders. Threshold effects and subgroup analyses were conducted to explore nonlinear relationships and robustness across population strata. Results Elevated UHR showed a linear association with increased depression risk. Each unit increase in UHR corresponded to a 5% higher likelihood of depression (OR=1.05, 95% CI=1.02–1.09). Women in the highest UHR quartile had nearly double the depression risk compared to the lowest quartile (OR=1.97, 95% CI=1.40–2.77). A critical inflection point at UHR=8.12 indicated a 6% incremental risk per unit beyond this threshold. Subgroup analyses confirmed consistent associations across demographic and clinical groups, with heightened effects in women aged <45 years. Conclusion Higher UHR levels are independently associated with depression in adult women, suggesting its utility as a metabolic-inflammatory biomarker for depression risk stratification. These findings highlight the interplay between lipid metabolism, oxidative stress, and mental health, advocating for UHR integration into preventive strategies for women’s mental well-being.