Association between depression and all-cause, cardiovascular, and non-cardiovascular mortality in the Spanish population: a prospective cohort study

Depression is among the most prevalent mental disorders worldwide and is associated with an increased risk of mortality from all causes and from specific causes (cardiovascular disease or suicide). The aim of this study was to analyze whether depression is a risk factor for all-cause and cardiovascular disease (CVD) mortality in a representative sample of the Spanish population, considering also the competing risk of depression in both CVD mortality and other causes that are not CVD mortality. We used the data of 4,753 individuals from the Edad con Salud study, recruited between 2011 and 2012, and followed up on three occasions. We included sociodemographic, healthy lifestyle, and chronic conditions variables. The association between depression and all-cause mortality was assessed using hazard ratios obtained from Cox regression, and the association between depression with CVD and non-CVD mortality was assessed using sub-hazard ratios from Fine-Gray models for competing risks. A total of 18% of the sample had depression. Of the 279 participants who died during the study and had their causes of death recorded, 57 died from CVD. After adjustment for the main potential confounders, depression was significantly associated with all-cause (HR = 1.81; 95% CI = 1.23–2.65) and CVD mortality (sHR = 2.01; 95% CI = 1.08–3.72), but was not significantly associated with non-CVD mortality (sHR = 1.32; 95% CI = 0.88–1.99). Depression was associated with an increased risk of all-cause and CVD mortality, but was not significantly associated with non-CVD mortality. This may be due to the heterogeneity of the causes of death of the participants comprising this subgroup. One significant limitation is the small number of cases involving CVD mortality and depression ( n = 13). One potential implication of this study is the need to adopt a comprehensive approach to treating depression to address not only mental health, but also actively promote healthy behaviors that reduce the risk of chronic disease and mortality. NCT03343886 (Last Public Release: 10/10/2024).