For each 1-point increase in PHQ-9 score below 11, all-cause mortality risk rose by 3% (HR = 1.03, P = .0001) in adults with cardiovascular-kidney-metabolic syndrome.
Does depression severity (measured by PHQ-9) predict all-cause and cardiovascular mortality in adults with cardiovascular-kidney-metabolic syndrome?
Depressive symptoms have a non-linear, J-shaped association with mortality in CKM syndrome, with risk increasing significantly up to a PHQ-9 score of 11, partially mediated by socioeconomic factors and physical activity.
Absolute Event Rate: 0% vs 0%
Depression is prevalent in cardiovascular-kidney-metabolic (CKM) syndrome, but its complex association with mortality remains incompletely characterized. This prospective cohort study utilized National Health and Nutrition Examination Survey data (2007–2016), including 27,673 adults with CKM syndrome (median follow-up 93.5 months). Associations between patient health questionnaire-9 (PHQ-9) scores and all-cause/cardiovascular mortality were analyzed using multivariable Cox regression, threshold models, subgroup, and mediation analyses. Among 2468 all-cause and 745 cardiovascular deaths, deceased individuals were significantly older, more frequently male, and more often non-Hispanic White. Higher CKM stage (stages 3–4: 63.9% of deaths vs 7.8% survivors), clinical parameters, and lower socioeconomic status predicted mortality (all P < .001). PHQ-9 demonstrated a non-linear, J-shaped association with mortality. Per 1-point PHQ-9 increase, fully adjusted all-cause mortality risk rose 1% (hazard ratio (HR) = 1.01, 95% confidence interval (CI): 1.00–1.02, P = .030). Cardiovascular mortality association was non-significant after full adjustment (HR = 1.02, 95% CI: 1.00–1.04, P = .076). A significant inflection point occurred at PHQ-9 = 11. Below 11, each point increase significantly elevated all-cause (HR = 1.03, 95% CI: 1.01–1.04, P = .0001) and cardiovascular mortality risk (HR = 1.05, 95% CI: 1.02–1.08, P = .0004). Above 11, associations were non-significant. The PHQ-9-mortality association was significantly stronger in participants ≤ 60 years ( P -interaction = .001), with moderate/high chronic kidney disease risk ( P -interaction = .029), and with metabolic syndrome ( P -interaction = .024). Physical activity, poverty income ratio, and marital status were found to significantly account for a portion (12.76–14.80%) of the association between PHQ-9 scores and all-cause mortality (all P < .0001). Depressive symptoms demonstrate threshold-specific mortality risks in CKM syndrome. Socioeconomic factors (income, marital status) and physical activity significantly attenuate depression-associated mortality risk, partly mediating the association.
Lin et al. (Fri,) reported a other. For each 1-point increase in PHQ-9 score below 11, all-cause mortality risk rose by 3% (HR = 1.03, P = .0001) in adults with cardiovascular-kidney-metabolic syndrome.