Among 2,995 adults enrolled in the Haiti Cardiovascular Disease Cohort (2019–2021), moderate-to-severe depressive symptoms — defined by PHQ-9 scores ≥10 — were independently associated with a 36% higher prevalence of cardiovascular disease (adjusted PR=1.36; 95% CI: 1.08–1.71), after controlling for age, income, food insecurity, smoking, physical activity, stress, and BMI. Women carried a disproportionate burden: 22% screened positive for moderate-to-severe depression versus 8.5% of men, and sex-stratified models showed a slightly stronger association in females (aPR=1.38) than males (aPR=1.25), though additive interaction evidence was limited.
The depression–CVD nexus is well-documented in high-income countries, where shared biological pathways — HPA-axis dysregulation, systemic inflammation, autonomic dysfunction — are thought to drive bidirectional risk. This preprint, not yet peer-reviewed, extends that evidence into a critically underrepresented context: a low-and-middle-income Caribbean nation with severely constrained mental health infrastructure. The finding carries real policy weight, suggesting that integrating PHQ-9 screening into Haiti's expanding cardiometabolic care programs could identify high-risk individuals earlier.
Crucial limitations temper interpretation: the cross-sectional design precludes causal inference — depression may follow a CVD diagnosis rather than precede it. The cohort is urban and may not reflect rural Haiti. Nonetheless, for a setting where both conditions are undertreated and often invisible to health systems, this is a clinically meaningful signal warranting prospective follow-up.
