Depression is strongly associated with the risk of cardiovascular disease (CVD) and CVD-related mortality across the globe. But, can the increased risk of CVD and mortality in middle-aged adults vary across countries with variable incomes? The objective of this study is to investigate the associations between depressive symptoms and the incidence of CVD and mortality in adults in countries with different levels of economic development. 

This is a multicenter, population-based cohort study conducted across 370 urban and 314 rural communities form 21 economically diverse countries in 5 continents. The study included a total of 145,862 participants, including 61,235 men (58%) and 84,627 women with mean (SD) age 50.05 years. The primary outcomes of the study were incident CVD and mortality.

Out of 145,852 participants, 15,983 (11%) reported four more depressive symptoms. Depression was significantly associated with incident CVD (HR 1.14), all-cause mortality (HR 1.17), and combined CVD/all-cause mortality (HR 1.21). The risk of combined mortality increased with the increase in the number of symptoms, being highest at seven symptoms (HR 1.24) and lowest at one symptom (1.05). The findings also suggested that these associations were stronger in urban areas (HR 1.34) than in rural areas (HR 1.10).

The research concluded that depression is strongly associated with CVD and all-cause mortality in individuals living in economically advanced countries.