Depressive symptom severity is associated with prevalent stroke among US adults in a nationally representative cross sectional study

Depression has been associated with cardiovascular disorders, including stroke. Although, the graded association and the role of antidepressant medication use continue to be uncertain. To examine the link between depression severity (PHQ-9) and stroke, comprising nonlinear effects and interaction with the use of antidepressant. In this study, data was analysed from NHANES 2007–2018 ( n = 35,162), of whom 32,040 participants with complete data were incorporated in the final analysis. Severity of depression was evaluated by using PHQ-9. Self-reported prevalent stroke was the outcome. Odds ratios (ORs) were estimated by survey weighted logistic regression models. Nonlinear associations were evaluated by using natural cubic splines. Greater PHQ-9 scores were significantly linked with augmented odds of self-reported stroke (OR 1.07, 95% CI 1.05–1.09, p < 0.001). Use of antidepressant was independently linked with self-reported stroke (OR 1.74, 95% CI 1.27–2.39). No statistically significant interaction was observed between PHQ-9 score and antidepressant use ( p = 0.061). Natural cubic spline analysis demonstrated a significant overall association between PHQ-9 score and self-reported stroke, with no statistically significant evidence of nonlinearity. Both hypertension and diabetes were strong independent predictors of self-reported stroke, while higher income (PIR) was protective. Severity of depression was independently associated with higher odds of self-reported stroke. These findings highlight an association between depression severity and self-reported stroke history.