| Wang Xianwang,Yuan Qinghui,Du Juan,Chen Liang,Li Dan,Zhang Xiaopei,Tian Yangyang,Association between depressive symptoms and risk of stroke and all-cause mortality in young and middle-aged adults[J].SICHUAN MENTAL HEALTH,2026,(3):246-254 |
| Association between depressive symptoms and risk of stroke and all-cause mortality in young and middle-aged adults |
DOI：10.11886/scjsws20251222003 |
| English keywords:Depressive symptoms Stroke All-cause mortality risk NHANES Young and middle-aged adults |
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| Author Name | Affiliation | Postcode | | Wang Xianwang | 1Handan First Hospital, Handan 056000, China | 056000 | | Yuan Qinghui | 2Handan City Eye Hospital （The Third Hospital of Handan）, Handan 056001, China | 056001 | | Du Juan | 1Handan First Hospital, Handan 056000, China | 056000 | | Chen Liang | 1Handan First Hospital, Handan 056000, China | 056000 | | Li Dan | 1Handan First Hospital, Handan 056000, China | 056000 | | Zhang Xiaopei | 1Handan First Hospital, Handan 056000, China | 056000 | | Tian Yangyang* | 3School of Basic Medical Sciences, Hebei Medical University, Shijiazhuang 050017, China | 050017 |
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| Background Current studies on the relationship between depressive symptoms and the risks of stroke and all-cause mortality mostly focus on the elderly population or high-risk groups with chronic diseases. The long-term impact of depressive symptoms in young and middle-aged people on the risks of stroke and all-cause mortality still lacks systematic assessment， and the relevant evidence is insufficient.Objective To explore the association between depressive symptoms and the risks of stroke and all-cause mortality in young and middle-aged adults， thereby expanding the risk evidence in this age group and providing epidemiological basis for early identification of high-risk individuals and the development of targeted intervention strategies.Methods Based on data from the National Health and Nutrition Examination Survey （NHANES） database （2009–2018）， a total of 14 947 young and middle-aged respondents aged 18 to 64 were included as the research subjects. Logistic regression and restricted cubic spline （RCS） models were employed to examine the association between depressive symptoms and stroke. Cox proportional hazards model， RCS model， and Kaplan-Meier （K-M） survival curves were used to clarify the relationship between depressive symptoms and all-cause mortality risk. To verify the robustness of main findings， sensitivity analysis was conducted stratified by gender， hypertension， diabetes， hyperlipidemia， body mass index （BMI）， and age.Results Logistic regression analysis revealed that compared with the non-depressed group， the risk of stroke in the mild depression group increased by 53.50% （OR=1.535， 95% CI： 1.147–2.053）， while the moderate-to-severe depression group showed the highest risk with a 132.90% increase （OR=2.329， 95% CI： 1.733–3.129）. RCS analysis indicated an approximately linear dose-response relationship between PHQ-9 score and the risk of stroke （Pfor non-linearity=0.089）， with stroke risk increasing as PHQ-9 scores rose. As the PHQ-9 score increased， the risk of stroke also showed an upward trend. Cox regression analysis demonstrated that compared with the non-depressed group， the risk of all-cause mortality in the mild depression group increased by 48.80% （HR=1.488， 95% CI： 1.164–1.902）， and the moderate-to-severe depression group had a 70.60% increased risk （HR=1.706， 95% CI： 1.310–2.221）. RCS analysis showed a linear dose-response relationship between PHQ-9 scores and all-cause mortality risk （Pfor non-linearity=0.440）. K-M curves indicated that as the severity of depressive symptoms increases， the risk of all-cause mortality gradually rises （P<0.05）. Sensitivity analysis confirmed that the associations between depression symptoms and risks of stroke and all-cause mortality were not modified by gender， hypertension， diabetes， hyperlipidemia， BMI， or age， demonstrating robust findings.Conclusion Among the young and middle-aged population， both mild and moderate-to-severe depression were associated with increased risks of stroke and all-cause mortality， with the moderate-to-severe depression group showed more pronounced risk elevations. A positive dose-response relationship was observed between depressive symptoms and these risks. |
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