Exploring Associations Among Loneliness, Depression, and Cardiovascular Risk Factors in a Free Medical Clinic: A Cross-Sectional Pilot Study

Introduction Depression and loneliness have been linked to cardiovascular disease (CVD), but few studies explore their combined impact. Loneliness has been identified as an independent CVD risk factor, while depression has been tied to elevated CVD risk. This study examined relationships among University of California-Los Angeles (UCLA) Loneliness Scale scores, Patient Health Questionnaire-9 (PHQ-9) depression scores, and CVD risk factors in patients at a free medical clinic in South Carolina. Methods Thirty-one English-speaking adults aged 20-79 with a recent lipid panel completed the PHQ-9 and UCLA Loneliness Scale. Scores were calculated per standard guidelines, and lifetime Atherosclerotic Cardiovascular Disease (ASCVD) risks were computed using the American College of Cardiology (ACC) ASCVD calculator. Pearson correlations, multiple regressions, and t-tests were performed to explore relationships. Subgroup sizes varied for analysis depending on the availability of UCLA Loneliness data, permissible lipid profiles, and unreliable psychosocial responses. Results Multiple regression showed PHQ-9 and UCLA Loneliness scores significantly predicted total cholesterol (TCHOL) (R²=0.27, p=0.024). This association was stronger among non-statin users (n=14; R²=0.54, p=0.014), where PHQ-9 was inversely associated with TCHOL (b=-11.9, p=0.0044) and UCLA Loneliness score was positively associated with TCHOL (b=5.69, p=0.0056), although small sample instability substantially confines this analysis. A similar pattern was observed for high-density lipoprotein (HDL) among non-statin users (R²=0.44, p=0.04). PHQ-9 and UCLA Loneliness scores were strongly correlated (R=0.70, 95% CI: (0.43, 0.85), p<0.0001, n=27). These findings should be interpreted with caution, as relationships may have been inflated by multicollinearity, especially in non-statin group analyses. Current/former smokers had significantly higher PHQ-9 (p=0.009) and UCLA Loneliness scores (p=0.04) compared to never-smokers. Correlations among PHQ-9, UCLA scores, and ASCVD lifetime risk among non-statin users were weak and nonsignificant (PHQ-9: R=0.165, p=0.574; UCLA: R=0.280, p=0.404). Conclusion While no significant associations were observed between psychosocial scores and ASCVD lifetime risk, significant associations among depression, loneliness, and lipid values, particularly among non-statin users, along with associations between psychosocial scores and smoking status, suggest a potential link between mental health and cardiovascular risk factors. Larger studies are warranted to confirm and quantify these relationships.