Depression and/or Anxiety and Health-Related Quality of Life Among Adults with Anemia: A National Analysis in the United States

Background: Anemia frequently coexists with depression and anxiety, which may further compromise health-related quality of life (HRQoL). However, limited evidence exists on the independent association of these mental health comorbidities with physical and mental HRQoL among adults with anemia. The study objective is to examine the association between coexisting depression and/or anxiety and HRQoL among adults with anemia in the United States. Methods: A cross-sectional study was conducted among 835 adults with anemia. Participants were categorized into two groups: anemia only and anemia with depression and/or anxiety. HRQoL was assessed using the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the Veterans RAND 12-Item Health Survey (VR-12©). Weighted descriptive statistics were used to characterize the study population, and differences between groups were evaluated using chi-square tests and t-tests. Multivariable linear regression analyses were performed to examine the association between the anemia groups and HRQoL after adjusting for sociodemographic characteristics, health insurance, general health status, physical activity, and chronic comorbidities. Results: Among the adults with anemia, 69.3% had anemia only and 30.7% had anemia with depression and/or anxiety. Participants with depression and/or anxiety had significantly lower mean PCS (39.61 vs. 42.78, p < 0.0001) and MCS (44.24 vs. 52.49, p < 0.0001) scores than those with anemia alone. In adjusted analyses, coexisting depression and/or anxiety was independently associated with significantly lower MCS scores (β = −7.09, SE = 0.91, p < 0.001) but was not associated with PCS (β = 1.04, SE = 1.00, p > 0.05). Poor self-rated health was strongly associated with lower PCS and MCS scores, while younger age, employment, and regular physical activity were associated with better physical HRQoL. Conclusions: Among adults with anemia, coexisting depression and/or anxiety was independently associated with substantially poorer mental health-related quality of life, but not with physical health-related quality of life after adjustment for sociodemographic characteristics, healthcare access, health status, physical activity, and chronic comorbidities. These findings highlight the importance of recognizing and addressing coexisting mental health conditions in adults with anemia as part of comprehensive, patient-centered care.