Depressive Symptoms and Prevalent Cardiovascular Disease: A Cross-Sectional Analysis in Port-au-Prince, Haiti

Background: Cardiovascular disease (CVD) is the leading cause of mortality in low- and middle-income countries (LMICs). In Haiti, depression remains an underexplored CVD risk factor. We assessed the association between depressive symptoms (DS) and prevalent CVD in urban Haiti and examined sex differences. Methods: We conducted a cross-sectional analysis of enrollment data from the Haiti Cardiovascular Disease Cohort (adults [&ge;]18 years; March 2019--August 2021). DS were measured using the Patient Health Questionnaire-9 (PHQ-9) and categorized as none--mild (<10) versus moderate--severe ([&ge;]10). Prevalent CVD (angina, myocardial infarction, transient ischemic attack or stroke, heart failure) was adjudicated using epidemiologic definitions aligned with international cohorts. We estimated prevalence ratios (PRs) 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 BMI. Effect modification by sex was assessed on multiplicative and additive scales. Results: Among 2,995 participants (mean age 41.9 years; 58.0% female), 16.2% (95% CI: 14.8-17.5; n=484) had moderate--severe DS. Prevalence was higher in females (22.0%, 95% CI: 19.8-23.6) than males (8.5%, 95% CI: 7.0-10.1). The prevalence of CVD was higher among participants with moderate--severe DS compared with those with none--mild DS, with similar patterns observed in both sexes (males: 21.5% vs 10.6%; females: 23.3% vs 15.3%). Moderate--severe DS were associated with higher CVD prevalence compared with none--mild DS (adjusted PR [aPR]=1.36; 95% CI: 1.08--1.71). In sex-stratified models, aPRs were 1.38 (95% CI: 1.06--1.78) for females and 1.25 (95% CI: 0.75--1.99) for males. Evidence for interaction by sex on the additive scale was limited (RERI=0.07, 95% CI: -0.74 to 0.88). Conclusion: Moderate--severe DS were independently associated with a higher prevalence of CVD in urban Haiti. Associations were consistently stronger among women, although evidence for effect modification by sex was limited. Integrating depression screening and management into CVD prevention efforts may help address the growing burden of both conditions in resource-limited settings. Prospective studies are warranted to better understand the underlying mechanisms and causal pathways.