J Affect Disord. 2025 Oct 16:120469. doi: 10.1016/j.jad.2025.120469. Online ahead of print.
ABSTRACT
BACKGROUND: Adverse social determinants of health (SDoH) and depression are risk factors for stroke, but whether depression mediates the link between SDoH and stroke remains unclarified. This study utilized NHANES data to characterize the link between SDoH and stroke, as well as the moderating and mediating roles of depression in this link.
METHODS: This research analyzed NHANES data from 2005 to 2018. First, weighted logistic regression and subgroup analyses were implemented to study the link between SDoH and stroke. Weighted logistic regression and restricted cubic spline (RCS) analyses were utilized to discuss the potential nonlinear link between depression scores and stroke. The moderating and mediating effects of depressive factors on stroke occurrence were systematically examined.
RESULTS: This paper enrolled 26,386 eligible participants, including 955 stroke patients. Compared with the low-SDoH burden group, the high-SDoH burden group exhibited a positive link with stroke (OR: 1.532, 95 % CI: 1.194-1.966). Participants with depression had a markedly higher stroke risk than participants without depression (OR: 1.832, 95 % CI: 1.393-2.410). RCS analysis revealed a marked nonlinear positive link between depression scores and stroke risk (p for nonlinear = 0.023). In the population without depression, SDoH was prominently associated with stroke. The mediating effect of depression with a mediation proportion of 11.15 % (p < 0.001).
CONCLUSION: A positive correlation exists between SDoH and stroke, with depression playing a moderating and mediating role. Depression and SDoH should be considered jointly when developing targeted stroke prevention intervention strategies. Future large-scale cohort studies and clinical trials are warranted for validation.
PMID:41109424 | DOI:10.1016/j.jad.2025.120469
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