Cardiovascular

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

TL;DR

Depressive symptoms might be associated with increased risks for CVD and COPD, suggesting that prevention and management of depressive symptoms should be considered in the prevention and control of CVD and COPD.

Key Findings

Depressive symptoms were associated with a dose-dependent increased risk of cardiovascular disease (CVD) incidence.

  • Compared with a PHQ-9 score of 0, the HR for CVD was 1.44 (95% CI: 1.06–1.94) for PHQ-9 score 5–9 and 2.00 (95% CI: 1.24–3.22) for PHQ-9 score ≥10.
  • Participants with depressive symptoms at baseline had a 1.55-fold increased risk for CVD (HR=1.55, 95% CI: 1.20–2.00) compared with those without depressive symptoms.
  • During the follow-up period, 692 incident CVD cases were identified among 7,218 participants.
  • Analyses used Cox proportional hazards regression with adjustment for potential confounding factors.

Depressive symptoms were associated with a dose-dependent increased risk of chronic obstructive pulmonary disease (COPD) incidence.

  • Compared with PHQ-9 score of 0, HRs for COPD were 1.90 (95% CI: 1.25–2.89) for score 1–4, 2.42 (95% CI: 1.26–4.66) for score 5–9, and 3.52 (95% CI: 1.40–8.87) for score ≥10.
  • Participants with depressive symptoms at baseline had a 2.16-fold increased risk for COPD (HR=2.16, 95% CI: 1.26–3.69) compared with those without depressive symptoms.
  • During the follow-up period, 112 incident COPD cases were identified among 7,218 participants.
  • The association showed a clear gradient with increasing severity of depressive symptoms.

A PHQ-9 score of 1–4 (minimal depressive symptoms) was associated with a lower risk of cancer incidence compared with a PHQ-9 score of 0.

  • The HR for cancer in the PHQ-9 score 1–4 group was 0.67 (95% CI: 0.51–0.89) compared with the PHQ-9 score 0 group.
  • During the follow-up period, 362 incident cancer cases were identified among 7,218 participants.
  • No statistically significant associations between higher PHQ-9 scores (5–9 or ≥10) and cancer incidence were reported.
  • This inverse association at low PHQ-9 scores was an unexpected finding.

No significant interaction effects were found between depressive symptoms and sex, age, marital status, educational level, or smoking status on the risk for CVD, cancer, or COPD.

  • Stratified analyses were conducted according to sex, age, marital status, educational level, and smoking status.
  • All interaction P-values were >0.05.
  • This indicates that the associations between depressive symptoms and disease outcomes were generally consistent across these subgroups.

The study established a prospective cohort of 7,218 participants from a 2010 baseline survey with follow-up through December 31, 2021.

  • Baseline data were derived from the China Chronic Disease and Risk Factor Surveillance Survey conducted in Jiangsu Province in 2010.
  • Of 7,709 participants who completed the baseline survey, 220 were lost to follow-up (2.85%) and 271 with confirmed diagnoses of CVD, cancer, or COPD at baseline were excluded.
  • Disease incidence was ascertained by linking to the Jiangsu Provincial Cardiovascular and Cerebrovascular Disease Reporting System, Tumor Registry System, and Cause of Death Registry System.
  • Depressive status was assessed using the Patient Health Questionnaire-9 (PHQ-9).

What This Means

This research followed over 7,200 adults in Jiangsu Province, China for approximately 11 years to examine whether symptoms of depression at the start of the study were linked to the later development of cardiovascular disease (CVD), cancer, or chronic obstructive pulmonary disease (COPD). Depression was measured using a standard questionnaire (PHQ-9) and participants were grouped by symptom severity. Disease cases were tracked through provincial health registries. Over the follow-up period, 692 cases of CVD, 362 cases of cancer, and 112 cases of COPD were recorded. This research suggests that having depressive symptoms is associated with meaningfully higher risks of developing both CVD and COPD, and that these risks increase with the severity of depression. People with moderate-to-severe depressive symptoms (PHQ-9 ≥10) had twice the CVD risk and more than three times the COPD risk compared to those with no depressive symptoms, even after accounting for other factors. These associations were consistent regardless of sex, age, marital status, education, or smoking status. Interestingly, minimal depressive symptoms (PHQ-9 score 1–4) were associated with a lower cancer risk compared to a score of zero, though the reasons for this unexpected finding are unclear. This research suggests that identifying and addressing depression may be an important component of efforts to prevent serious physical illnesses like heart disease and COPD. Incorporating mental health screening and intervention into the prevention and management of these chronic diseases could be beneficial, particularly in community health settings.

Have a question about this study?

Citation

Wu X, Su J, Qin Y, Yang J, Han R, Yu H, et al.. (2026). [Depressive symptoms and the risk for cardiovascular diseases, cancer, and chronic obstructive pulmonary disease: a prospective cohort study].. Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi. https://doi.org/10.3760/cma.j.cn112338-20251224-00923