心因性疾病患者憂鬱症之盛行率、特徵、相關因素及其與全因死亡率、心血管死亡率和非心血管死亡率的關係

Background: Depression is highly prevalent among patients with cardiovascular disease (CVD) and has been proposed as an independent predictor of poor prognosis. However, inconsistencies remain regarding its association with mortality when accounting for confounding factors.Methods: We analyzed data from the U.S. National Health and Nutrition Examination Survey (NHANES) 2011–2018, linked with the National Death Index through 2019. Adults with self-reported CVD were included. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9), with a threshold of ≥10 indicating clinically significant depressive symptoms. Weighted prevalence, associated factors, and the relationship between depression and all-cause, cardiovascular, and non-cardiovascular mortality were examined using multivariable Cox regression, propensity score matching (PSM), and inverse probability weighting (IPW). All statistical analyses were conducted with R software version 4.5.0.Results: Among 2,064 adults with CVD, the weighted prevalence of depression was 16.4% (95% CI: 14.2–18.6). Independent factors associated with higher odds of depression included female sex (OR = 2.03, 95% CI: 1.38–2.99), sleep disorder (OR = 3.09, 95% CI: 2.15–4.42), prediabetes and diabetes (OR = 1.61, 95% CI: 1.12–2.31) and CVD subtypes such as stroke (OR = 1.54, 95% CI: 1.04–2.29) and angina (OR = 1.46, 95% CI: 1.06–2.03). Protective factors against depression included older age (per 10 years: OR = 0.70, 95% CI: 0.62–0.80, p < 0.001) and higher education (postgraduate vs. high school or lower: OR = 0.33; 0.16–0.66; p = 0.003). Overall, 403 deaths occurred during follow-up, corresponding to an unweighted prevalence of 19.5%, including 161 cardiovascular and 242 non-cardiovascular deaths. In fully adjusted Cox models, depression was not significantly associated with all-cause mortality (HR = 0.86, 95% CI: 0.62–1.20, p = 0.378), cardiovascular mortality (HR = 0.84, 95% CI: 0.48–1.46, p = 0.532), or non-cardiovascular mortality (HR = 0.88, 95% CI: 0.58–1.32, p = 0.525). Results were consistent across PSM and IPW sensitivity analyses.Conclusions: Depression is common among patients with CVD, disproportionately affecting specific high-risk subgroups. However, after rigorous adjustment for confounders, depression did not independently predict mortality, suggesting it may act as a marker of underlying disease burden and adverse health behaviors rather than a direct causal factor.