Association of depression severity and transition patterns of cardiometabolic multimorbidity

We aimed to assess the association of depression severity with the incidence and progression of cardiometabolic multimorbidity (CMM) in middle-aged and older Chinese adults.

We analyzed data from 12,059 participants in the China Health and Retirement Longitudinal Study (CHARLS). Depression severity was categorized as none, mild-moderate, or severe using CES-D-10 scores. CMM was defined as the coexistence of two or more of type 2 diabetes, heart disease, or stroke. Cox proportional hazards models estimated the association of depression severity with first cardiometabolic disease (FCMD) and CMM. Multi-state models examined transitions from health to FCMD, CMM, and death.

Over 7 years of follow-up, 2080 participants developed FCMD and 305 developed CMM. Compared to no depression, mild-moderate (HR: 1.22, 95%CI: 1.11-1.34) and severe depression (HR: 1.46, 95%CI: 1.24-1.73) were associated with increased risk of FCMD; only severe depression was associated with CMM (HR: 2.08, 95%CI: 1.42-3.04). Multi-state models showed both mild-moderate (HR: 1.19, 95%CI: 1.09-1.31) and severe depression (HR: 1.42, 95%CI: 1.20-1.67) increased the risk of transitioning from health to FCMD, and from health to death (HR: 1.35, 95%CI: 1.17-1.55 and HR: 1.76, 95%CI: 1.40-2.21, respectively). Severe depression also increased the risk of transition from FCMD to CMM (HR: 1.55, 95%CI: 1.05-2.27). Results were robust in subgroup and sensitivity analyses.

Depression, particularly severe depression, was significantly associated with increased risks of incident cardiometabolic diseases, progression to multimorbidity, and mortality in middle-aged and older Chinese adults. Targeted interventions for depression may help delay CMM development.