Abstract Body (Do not enter title and authors here): Background:
Depressive symptoms independently double cardiovascular disease risk, yet routine depression screening remains uncommon in Indian outpatient settings despite a high prevalence of hypertension and diabetes. Chronic cardiometabolic conditions often stem from maladaptive self-soothing behaviors such as consuming calorie-dense foods and physical inactivity, which may serve as both cause and consequence of psychological distress. We hypothesized that patients with cardiometabolic risk factors would have higher rates of positive depression screens compared to those without such risk.
Methods:
A cross-sectional survey was conducted among adults (≥18 years) attending a North-Indian medical school-based outpatient clinic. After informed consent, demographic data, cardiometabolic risk factors (hypertension, diabetes, dyslipidemia), and depressive symptoms were documented. These symptoms were assessed using the Patient Health Questionnaire-2 (PHQ-2). The research team performed all screenings. Complete data from 113 patients were analyzed.
Results:
None of the 113 patients were screened for depression by their treating physicians. Thirty-five patients (31.0%, 95% CI: 23.2–40.0%) had at least one cardiometabolic risk factor. The overall incidence of positive PHQ-2 screens in the population was 13.3%. Positive screens (PHQ-2 ≥3) were significantly more common among patients with cardiometabolic risk factors (25.7%, 95% CI: 14.2–42.1%) compared to those without risk factors (7.7%, 95% CI: 3.6–15.8%; p=0.021;
odds ratio=4.15). Depression prevalence increased from 7.7% in patients without risk factors to 10.3% with one risk factor and 40% with two or more risk factors (p-trend=0.03).
Conclusions:
Cardiometabolic risk factors are associated with a fourfold increase in positive depression screens among North-Indian outpatients. PHQ-2 positivity in this context likely reflects a cycle where psychological distress and harmful lifestyle behaviors reinforce each other, worsening both mental and physical health. Despite this elevated burden, provider-initiated mental health referrals were absent. Integrating automated PHQ-2 screening into electronic health records is feasible and addresses India’s substantial depression treatment gap. Embedding cognitive-behavioral therapy within this workflow could help patients break maladaptive cycles, improve emotional regulation, and enhance adherence to healthy behaviors, ultimately reducing morbidity and improving quality of life.