Association of Allostatic Load With Depression, Anxiety, and Suicide: A Prospective Cohort Study

Allostatic load (AL) is an objective measure of the biological components of chronic stress in clinical practice, which potentially influence depression, anxiety, and suicide. In this study, we investigated the association between AL and these mental disorders.

In this cohort study of 333,017 adults, participants without previous diagnoses of depression, anxiety, or suicide were observed from March 13, 2006, to October 31, 2022. AL was estimated using 10 biomarkers that reflect metabolic, cardiovascular, and inflammatory dysregulation. Diagnoses were based on ICD-10. We performed Cox proportional hazard models to assess the relationship between AL and these mental disorders. We also conducted subgroup analyses for sex, age, and Townsend Deprivation Index, as well as sensitivity analyses.

The median follow-up period was 13 years. Over the follow-up period, 13,441 (4.04%) participants developed depression, 13,903 (4.17%) developed anxiety, and 796 (0.24%) committed suicide. In the fully adjusted model, individuals with high AL had an increased risk of depression (hazard ratio = 1.389, p = 8.38 × 10^-27), anxiety (hazard ratio = 1.304, p = 5.82 ×10^-19), and suicide (hazard ratio = 1.433, p = 4.46 ×10^-3). Women and younger individuals with high AL were vulnerable to depression and anxiety, while moderate AL levels were significantly associated with suicide in men and younger participants. Moreover, individuals with middle and high AL had an elevated risk of comorbid depression and anxiety.

High AL is positively associated with increased risks of depression, anxiety, and suicide, highlighting its potential as a predictive tool in mental health.