The effects of health risk behaviors to excess mortality in the population with depression: A cohort study based on NHANES data

The population with depression had a considerable excess mortality risk. This increased mortality may be attributed to the biological consequences of depression or the substantial prevalence of health risk behaviors (HRBs). This study aimed to quantify the combined effects of four major HRBs - smoking, excessive alcohol use, physical inactivity, and an unhealthy diet - on excess mortality among depressed individuals. This study included 35,738 adults from the National Health and Nutrition Examination Survey 2005–06 to 2017–18, with mortality follow-up data censored through 2019. The standardized prevalence of HRBs was calculated for populations with and without depression. Poisson regression models were used to calculate the mortality rate ratio (MRR). Based on model adjusting for socio-demographic factors, the attenuation of MRR was determined after further adjustment for HRBs. A total of 3147 participants were identified as having depression. All HRBs showed a significantly higher prevalence among the population with depression. After adjusting for socio-demographic factors, depression was associated with 1.7 and 1.8 times higher all-cause and cardiovascular disease mortality rate, respectively. Further adjustment for all current HRBs resulted in a 21.9 % reduction in all-cause mortality rate and a 15.4 % decrease in cardiovascular disease mortality rate. HRBs were reported at a single time point, and we are unable to demonstrate a causal effect. At least 1/5 of excess mortality for population with depression was attributable to HRBs. Efforts should be made to address HRBs among population with depression. •Depression is related to excess mortality due to depression itself and health risk behaviors.•Depression was related to 1.7 and 1.8 times higher all-cause and CVD mortality.•Adjusting for HRBs led to a 21.9 % and 15.4 % drop in all-cause and CVD mortality.