Mediation of the Association Between Vascular Risk Factors and Depressive Symptoms by C-Reactive Protein: Longitudinal Evidence from the UK Biobank

People with vascular risk factors (VRFs) are at higher risk for depressive symptoms. Given recent findings implicating low-grade systemic inflammation in both vascular and mental health, this study examined the extent to which the VRF–depressive symptom association might be mediated by low-grade systemic inflammation. To this end, we analysed longitudinal data of 9,034 participants from the UK Biobank (mean age = 56.54 years), who took part in three consecutive assessments over the course of about 8 years. Cumulative VRF burden at baseline was defined as the presence of 5 VRFs (hypertension, obesity, hypercholesterolemia, diabetes, and smoking). Low-grade systemic inflammation was assessed using serum-derived C-reactive protein (CRP) and depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). We performed mediation models using longitudinal data and a path analytic framework, while controlling for age, gender, racial-ethnic background, socioeconomic status, and baseline mood. VRFs at baseline showed a small association with higher depressive symptoms at follow-up (total effect = 0.014, 95% CI [0.007; 0.021]). CRP mediated this association (indirect effect = 0.003, 95% CI [0.001; 0.005]) and accounted for 20.10% of the total effect of VRF burden on depressive symptoms. Exploratory analyses taking a symptom-based approach revealed that mediating pathways pertained to specific depressive symptoms: tiredness and changes in appetite. These results suggest that the small association between VRF burden and depressive symptoms may be partly explained by the inflammation-promoting effects of VRFs, which might promote a specific symptom-profile of depression.