Depressive symptoms and association with prevalent cardiovascular disease: A cross-sectional analysis in Port-au-Prince, Haiti

Cardiovascular disease (CVD) is the leading cause of mortality in low- and middle-income countries, and depression remains an underexplored CVD risk factor in Haiti. We assessed the association between depressive symptoms (DS) and prevalent CVD in urban Haiti and examined sex differences using a cross-sectional analysis of enrollment data from the Haiti Cardiovascular Disease Cohort (adults ≥18 years; March 2019-August 2021). DS were measured using the Patient Health Questionnaire-9 and categorized as none-mild (<10) versus moderate-severe (≥10). Prevalent CVD (angina, myocardial infarction, transient ischemic attack or stroke and heart failure) was adjudicated using epidemiologic definitions aligned with international cohorts. Prevalence ratios (PRs) were estimated using generalized estimating equation Poisson models with a log link, adjusting for age, sex, education, income, food insecurity, smoking, alcohol use, physical activity, stress, and ody Mass Index; effect modification by sex was assessed on multiplicative and additive scales. Among 2,995 participants (mean age 41.9 years; 58.0% female), 16.2% had moderate-severe DS, with higher prevalence in females (22.0%) than males (8.5%). CVD prevalence was higher among those with moderate-severe DS than none-mild DS in both sexes (males: 21.5% vs. 10.6%; females: 23.3% vs. 15.3%). Moderate-severe DS were independently associated with higher CVD prevalence (adjusted PR = 1.36; 95% CI: 1.08-1.71). Sex-stratified estimates were 1.38 (95% CI: 1.06-1.78) for females and 1.25 (95% CI: 0.75-1.99) for males; evidence for additive interaction by sex was limited (RERI = 0.07, 95% CI: -0.74 to 0.88). DS were independently associated with higher CVD prevalence in urban Haiti, with a consistently stronger pattern among women, although formal tests of effect modification was not statistically significant. Integrating depression screening into CVD prevention may help address the growing burden of both conditions in resource-limited settings. Prospective studies are needed to clarify the underlying mechanisms and causal pathways.