The Association Between Depression and Advanced Stages of Cardiovascular–Kidney–Metabolic Syndrome

Abstract

This study aimed to investigate the association between depression and advanced stages of cardiovascular-kidney-metabolic (CKM) syndrome. This cross-sectional study utilized nationally representative data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Advanced CKM syndrome was defined as CKM stages 3-4. Weighted logistic regression models were applied to evaluate the association between depression and advanced CKM syndrome. Among 6677 adults, depression was positively associated with advanced CKM syndrome. Each 1-point increase in PHQ-9 score was associated with higher odds of advanced CKM syndrome (odds ratio [OR] = 1.05, 95% CI: 1.02-1.08), and individuals with moderate-to-severe depression had significantly increased odds (OR = 1.89, 95% CI: 1.25-2.87). Restricted cubic spline analysis revealed an L-shaped nonlinear relationship. A least absolute shrinkage and selection operator (LASSO) logistic regression model identified 9 factors associated with advanced CKM syndrome among individuals with depression, demonstrating high discriminative performance. Subgroup analyses indicated heterogeneity by sex, with a more pronounced association observed among women, highlighting the importance of early mental health screening in CKM syndrome risk stratification.