CRCAM Journal

Abstract

Background: Postmenopausal depression poses a significant public health challenge due to its rising prevalence and detrimental impact on physical and cognitive health. While metabolic dysregulation has been implicated in mood disorders, the role of cardiometabolic indices in postmenopausal depression remains poorly elucidated. This study pioneers an investigation into the nonlinear dose-response relationship between the cardiometabolic index (CMI)—a composite marker integrating adiposity and lipid metabolism—and postmenopausal depression. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018 were collected for a cross-sectional investigation. Multivariate logistic regression was used to evaluate the relationship between CMI and depression. Threshold effects analysis and penalized spline smoothing were employed to examine nonlinear relationships. Heterogeneity was evaluated using clinical and demographic variables (e.g., stroke history, mean). We rigorously assessed diagnostic accuracy and clinical utility by subject operating characteristic (ROC) curves and decision curve analysis (DCA) to quantify the discriminatory power and net benefit of CMI compared to traditional anthropometric indices. Results: This study included a total of 956 postmenopausal women with a mean age of 64.67 ± 9.17 years. In a fully corrected model, CMI exhibited a significant, nonlinear, positive association with postmenopausal depression (P < 0.05 for the log-likelihood ratio test) and revealed a key dose-response relationship. The risk of depression increased by 37% for each one-unit increase in CMI below the threshold of 4.97 (OR= 1.37, 95%CI: 1.14–1.60). Further, stratified analyses showed that the positive association between CMI and depression was stronger among women with ≥3 births (P = 0.0025) and a history of stroke (P < 0.05). CMI demonstrated superior predictive efficacy compared with traditional metabolic indicators (AUC = 0.812 vs. WHI = 0.741, BMI = 0.716), and DCA showed a higher net benefit in the risk threshold range of 0.25–0.75. Conclusion: CMI exhibits a non-linear relationship with postmenopausal depression risk, serving as a robust biomarker for early risk stratification. Its integration into clinical practice could enhance personalized prevention strategies, particularly for intermediate-risk populations (CMI<4.97).

Keywords: Cardiometabolic index; Postmenopausal; Depression; NHANES; Cross-sectional study