Lifestyle factors as mediators in the relationship between depression, obesity, and blood pressure in the post-pandemic era

Aim: The post-COVID-19 pandemic era has witnessed changes in psychological states and lifestyles. This study aims to explore the associations between depression, obesity, and hypertension, and further assess the mediating effects of lifestyle factors such as sleep duration, working hours, and physical activity on these disease relationships. Methods: Using data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2023, we calculated long-term trends in depression, sleep duration, working hours, metabolic equivalent of exercise, obesity, and blood pressure. Data from 42,395 (sleep duration), 23,101 (working hours), and 20,435 participants (physical activity) were used to evaluate the relationships between lifestyle factors, depression, obesity, and blood pressure. Results: Between 2021 and 2023, the average depression score in the U.S. increased to 4.13 (4.74), with prevalence rising to 13.2%. Over the past 18 years, national body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and sleep duration increased (P < 0.001), while working hours decreased (P < 0.001) and physical activity declined post-pandemic (P < 0.001). Depression was positively correlated with BMI, WC, WHtR, and diastolic blood pressure (DBP) (P < 0.0001), and negatively correlated with systolic blood pressure, sleep duration, and physical activity (P < 0.0001). Sleep duration and physical activity mediated 1.72%-4.52% and 9.28%-14.79%, respectively, of the positive correlation between depression and obesity. Physical activity mediated 5.49%-9.96% of the positive correlation between depression and DBP. No mediating effect of working hours was found between depression and obesity or blood pressure (P = 0.500-0.936). Conclusion: In the post-COVID-19 pandemic era, this study advocates for increased attention to lifestyle factors. Moderate extensions in sleep duration, reductions in working hours, and increased physical activity may help alleviate the burdens of depression, obesity, and blood pressure.