Depressive symptoms, sleep quality, and mortality risk in heavy drinkers: a National Health and Nutrition Examination Survey cohort study

Background: Heavy drinking significantly increases all-cause mortality (ACM) risk and forms a bidirectional vicious cycle with depressive symptoms and sleep disorders. Systematic evaluation of associations among these factors is lacking, and mortality risk and gender/age heterogeneity in comorbid conditions among heavy drinkers remain unclear.Objective: To examine associations of depressive symptoms and sleep status at baseline with ACM risk in heavy drinkers.Methods: A total of 2276 heavy drinkers from National Health and Nutrition Examination Survey (NHANES, 2007-2014) were included. Weighted Cox regression models analyzed associations of depressive symptoms, sleep disorders, and their comorbidity with ACM. Subgroup analyses assessed gender- and age-specific differences.Results: Among 2276 participants (73.2% male), 399 deaths (12.6%) occurred. After adjusting for all confounders, sleep disorders (HR = 1.31, 95% CI: 1.05-1.63) and depressive symptoms (HR = 1.34, 95% CI: 1.03-1.74) were significantly associated with higher ACM. These significant associations were confined to men and middle-aged individuals (40-60 years), particularly for comorbidity (HR = 2.72, 95%CI: 1.50-4.95 in men; HR = 2.68, 95%CI: 1.18-6.06 in middle-aged), with no significant findings in women or older adults (≥60 years).Conclusion: These findings underscore the critical need to integrate sleep health management and depression screening into clinical care for heavy drinkers. Intervention strategies should be prioritized for male and middle-aged (40-60 years) heavy drinkers, who face the highest mortality risk from these comorbid conditions.