Causal mediation analysis of the role of platelet count in the association between depression and mortality in US adults

Abstract

Background

Depression is linked to increased mortality, but the underlying mechanisms remain unclear. Recent evidence suggests that elevated platelet count is independently associated with increased risk of mortality, potentially through prothrombotic and inflammatory pathways. This study investigates the mediating role of platelet count in the relationship between depression severity (PHQSCORE) and all-cause mortality.

Method

Data from 34,758 participants in the National Health and Nutrition Examination Survey were analyzed. Depression severity was measured using the 9-item Patient Health Questionnaire (PHQ-9), and the total score was referred to as PHQSCORE. Descriptive statistics and Cox proportional hazards models were used to examine the association between categorical PHQSCORE and all-cause mortality, adjusting for demographic, lifestyle, and laboratory variables. Causal mediation analysis assessed the indirect effect of PHQSCORE on mortality through platelet count.

Results

Descriptive analysis showed that higher PHQSCORE was associated with increased rates of obesity, smoking, diabetes, and elevated platelet count, all linked to higher mortality. In Cox regression, participants with PHQSCORE 5–9, 10–14, and ≥ 15 had significantly higher mortality risks compared to those with PHQSCORE <5, with adjusted hazard ratios of 1.31 (95 % CI: 1.19–1.44), 1.62 (95 % CI: 1.41–1.87), and 1.51 (95 % CI: 1.25–1.81), respectively (all P < 0.0001). Causal mediation analysis revealed that platelet count mediated 22 % of the total effect of PHQSCORE on mortality (proportion mediated = −0.22, P < 0.0001).

Conclusion

These findings suggest that platelet count mediates the relationship between depression and mortality, providing new insights into the mechanisms linking depression to health outcomes and suggesting potential targets for future interventions.