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.

中文翻译：

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健康风险行为对抑郁症人群超额死亡率的影响：基于 NHANES 数据的队列研究

患有抑郁症的人群有相当大的超额死亡风险。死亡率的增加可能归因于抑郁症的生物学后果或健康风险行为（HRB）的普遍存在。这项研究旨在量化四种主要 HRB（吸烟、过量饮酒、缺乏运动和不健康饮食）对抑郁症患者死亡率过高的综合影响。这项研究包括 2005-06 年至 2017-18 年国家健康和营养检查调查的 35,738 名成年人，死亡率随访数据截至 2019 年进行了审查。计算了患有和不患有抑郁症的人群的 HRB 标准化患病率。使用泊松回归模型计算死亡率比（MRR）。根据社会人口因素的模型调整，进一步调整 HRB 后确定 MRR 的衰减。共有 3147 名参与者被确定患有抑郁症。所有 HRB 都显示抑郁症人群的患病率显着较高。调整社会人口因素后，抑郁症与全因死亡率和心血管疾病死亡率分别升高 1.7 倍和 1.8 倍相关。对当前所有 HRB 的进一步调整导致全因死亡率下降 21.9%，心血管疾病死亡率下降 15.4%。 HRB 是在单个时间点报告的，我们无法证明因果效应。抑郁症患者的超额死亡率至少有 1/5 可归因于 HRB。应努力解决抑郁症患者的 HRB 问题。