Associations Between Neighborhood Socioeconomic Deprivation And Severity Of Depression As A Cardiovascular Risk Marker From The National Health And Nutrition Examination Survey (2011-2014)

Introduction: Depression is a known cardiovascular disease (CVD) risk factor. Neighborhood socioeconomic status (NSES) may increase CVD risk through depression, with lower NSES relating to higher depression. Existing studies have included small, geographically-specific samples and have reported mixed or null findings. We examined associations between NSES and depression severity within a demographically diverse, representative US cohort. We hypothesized that living with lower NSES would associate with greater depression severity. Methods: The sample (N=6,308 US adults) was from the 2011-2014 National Health and Nutrition Examination Surveys. NSES was measured as Neighborhood Deprivation Index (NDI) tertiles at the 2010 US census tract level (low NSES=high NDI). Depression severity was both continuous (Patient Health Questionnaire-9, PHQ-9; higher score=more severe) and binary (Clinically Relevant Depression, CRD; PHQ-9≥10). Multilevel modeling estimated the relationship between NDI (ref=low) and depression, stratifying by gender. Results: US adults living with high NDI were more likely to be non-white, have lower education, not have partners, have poor diets, have higher BMI, be current smokers, and have higher PHQ-9 (all p<0.0001). Prior to covariate adjustment, living with high vs. low NDI associated with higher PHQ-9 and higher odds of CRD among the overall population independent of gender and among both women and men. The relationships between high NDI and depression lost significance after adjusting for all individual-level factors. Living with medium NDI associated with lower odds of CRD among women after adjustment. Conclusions: The relationship between NSES and depression may be attenuated by individual-level factors among US adults. US women in medium NDI neighborhoods may have lower CRD risk, highlighting a need to examine factors that may promote resilience to adverse environment. Future work should also examine other psychosocial factors that may mediate the NSES-CVD relationship.