J Glob Health. 2026 Oct 2;16:04306. doi: 10.7189/jogh.16.04306.
ABSTRACT
BACKGROUND: Cardiometabolic multimorbidity (CMM) is a growing concern as global population ages. Although baseline depression is a recognised risk factor for chronic diseases, the dynamic and cumulative effect of depression on CMM remains unclear. We aimed to evaluate the longitudinal association between long-term depressive burden and the risk of incident CMM.
METHODS: This study included 51,416 participants from three large prospective cohorts conducted in China, the USA, and Europe. Incident CMM was defined as co-occurrence of two or more of heart disease, stroke, and diabetes. Long-term depressive burden was assessed by changes in depression and cumulative depressive scores during baseline and first follow-up assessments. Cox proportional hazards model, adjusted for sociodemographic, health status, and lifestyle behaviour factors, was performed to assess incident CMM associated with long-term depressive burden. Subgroup analyses by age and sex were further conducted to evaluate potential effect modification.
RESULTS: During the follow-up period, a total of 2,689 incident CMM cases were documented: 238 in China (average follow-up = 7.61 ± 2.18 years), 829 in the USA (6.81 ± 1.89 years), and 1,622 in Europe (6.00 ± 2.20 years). Depression progression was associated with elevated risks of incident CMM in China (hazard ratio (HR) = 1.474; 95% confidence interval (CI) = 1.002-2.168), the USA (HR = 1.325; 95% CI = 1.006-1.744), and Europe (HR = 1.456; 95% CI = 1.258-1.686). Conversely, depression remission correlated with a reduced risk in China (HR = 0.558; 95% CI = 0.357-0.874) and Europe (HR = 0.764; 95% CI = 0.633-0.923). The CMM risk increased with each SD increase in cumulative depressive scores. Sex was found to modify these associations in the USA and Europe, with a more pronounced impact in females.
CONCLUSIONS: Severe long-term depressive burden is associated with a higher risk of incident CMM, whereas remission from depression correlates with a relatively lower risk. These findings suggest that tracking the longitudinal dynamics of depression may serve as a valuable indicator for identifying individuals at an elevated risk of incident CMM.
PMID:42825401 | DOI:10.7189/jogh.16.04306