[Depressive symptoms and the risk for cardiovascular diseases, cancer, and chronic obstructive pulmonary disease: a...

Objective: To investigate the association of depressive symptoms with the incidence of cardiovascular disease (CVD), cancer, and chronic obstructive pulmonary disease (COPD). Methods: Baseline data were derived from the China Chronic Disease and Risk Factor Surveillance Survey conducted in Jiangsu Province in 2010. Depressive status of the study participants was evaluated by using Patient Health Questionnaire-9 (PHQ-9). A total of 7 709 study participants who completed the baseline survey were included in the follow-up, and additional data on the incidence of target diseases or deaths were collected from Jiangsu Provincial Cardiovascular and Cerebrovascular Disease Reporting System, Tumor Registry System, and Cause of Death Registry System, thus establishing a prospective cohort. The follow-up ended on December 31, 2021. In the follow-up, 220 study participants were lost to follow-up (2.85%, 220/7 709). In addition, 271 study participants with confirmed diagnoses of CVD, cancer or COPD at baseline survey were excluded. Finally, a total of 7 218 study participants were included in the final analysis. Cox proportional hazards regression model was used to analyze the association between depressive symptoms and the risk for CVD, cancer and COPD. Stratified analyses were further conducted according to baseline characteristics, including sex, age, marital status, educational level and smoking status. Results: During the follow-up period, a total of 692 cases of CVD, 362 cases of cancer, and 112 cases of COPD occurred. After adjusting for potential confounding factors, compared with the group with PHQ-9 score of 0, the HRs for CVD incidence were 1.44 (95%CI: 1.06-1.94) in the group with score of 5-9, and 2.00 (95%CI: 1.24-3.22) in the group with score of ≥10. For cancer incidence, the HR was 0.67 (95%CI: 0.51-0.89) in the group with PHQ-9 score of 1-4 compared with the group with the score of 0. As for COPD incidence, the HRs were 1.90 (95%CI: 1.25-2.89), 2.42 (95%CI: 1.26-4.66), and 3.52 (95%CI: 1.40-8.87) in the groups with PHQ-9 score of 1-, 5-, and ≥10, respectively. Compared with the study participants without depressive symptoms at baseline survey, those with depressive symptoms had 1.55-fold (HR=1.55, 95%CI: 1.20-2.00) increased risk for CVD and 2.16-fold (HR=2.16, 95%CI: 1.26-3.69) increased risk for COPD. In stratified analyses by baseline characteristics including sex, age, marital status, educational level, and smoking status, no significant interaction effects were found between depressive symptoms and the aforementioned baseline characteristics on the risk for CVD, cancer, and COPD (all interaction P>0.05). Conclusions: Depressive symptoms might be associated with increased risks for CVD and COPD. The prevention and management of depressive symptoms should be considered in the prevention and control of CVD and COPD.