Life’s Essential 8 and Depression in the United States: Findings From NHANES

Background Cardiovascular health and mental health are closely interconnected; however, the relationship between the American Heart Association's updated Life's Essential 8 (LE8) cardiovascular health metric and depression severity has not been fully characterized in U.S. adults. The association between LE8 and depressive symptom severity was examined in a nationally representative sample of U.S. adults. Methods Cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) were analyzed. LE8 scores were calculated using behavioral (smoking, diet, physical activity, sleep health, and body mass index) and health factor (blood pressure, cholesterol, and hemoglobin A1c) components. Depressive symptoms were assessed using the Patient Health Questionnaire-9 and categorized as no/minimal (scores <10), moderate (scores 10–18), and severe (scores ≥19) depression. Survey-weighted multinomial logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for moderate and severe depression relative to no/minimal depression after adjustment for sociodemographic covariates. Results Higher LE8 scores were associated with lower odds of moderate depression, with each 1-point increase corresponding to approximately 0.4% lower odds (OR per 1-point increase, 0.996; 95% CI, 0.994–0.998; P=0.001), whereas no significant association was observed for severe depression (OR, 0.996; 95% CI, 0.988–1.003; P=0.230). Among individual LE8 components, favorable smoking status and healthy sleep duration demonstrated the strongest inverse associations with moderate depression, while healthy sleep duration was also associated with lower odds of severe depression. Male sex and higher income-to-poverty ratios were associated with lower odds of moderate depression, whereas single marital status was associated with higher odds. Conclusions Higher cardiovascular health, as measured by LE8, was associated with lower odds of moderate, but not severe, depression among U.S. adults. Behavioral cardiovascular health indicators, particularly smoking status and sleep health, showed the strongest associations with depressive symptom severity. These findings support the broader relevance of cardiovascular health in relation to mental health and highlight the need for longitudinal studies to clarify temporal and potentially bidirectional relationships between LE8 metrics and depression severity.