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. 2025 May 7;25(1):464.
doi: 10.1186/s12888-025-06907-z.

Association between red blood cell distribution width-to-albumin ratio and depression: a cross-sectional analysis among US adults, 2011-2018

Yao Zhou  1   2 , Lijuan Zhao  1 , Yunzhu Tang  1 , Shuxia Qian  3
Affiliations

Association between red blood cell distribution width-to-albumin ratio and depression: a cross-sectional analysis among US adults, 2011-2018

Yao Zhou et al. BMC Psychiatry. .

Abstract

Background: Red blood cell distribution width (RDW)-to-albumin ratio (RAR) is a novel index. Its relationship with depression, a common and complex psychiatric disorder, remains unclear. This study utilized the National Health and Nutrition Examination Survey (NHANES) database to investigate this relationship.

Methods: Multivariate logistic regression, restricted cubic spline (RCS) regression, receiver operating characteristic (ROC) analysis, and sensitivity analyses were used to examine the relationship between RAR and depression based on NHANES data from 2011-2018. The study also used subgroup analyses and interaction tests to explore whether the relationship was stable across populations.

Results: RAR was positively associated with depression in 18,150 participants aged ≥ 20 years. In fully adjusted models, each one-unit increase in RAR was associated with a 22% increase in the likelihood of depression [1.22 (1.05, 1.41)]. Participants in the highest quartile of RAR had a 30% higher risk of depression than those in the lowest quartile of RAR [1.30 (1.04, 1.63)]. Subgroup analyses revealed that the association between RAR and depression was significantly stronger among men, alcohol-drinking and high-income groups.

Conclusions: Higher baseline RAR was associated with an increased risk of depression in US adults and was more informative than RDW, albumin, and hemoglobin-to-RDW ratio (HRR). Further large-scale prospective studies are needed to analyze the role of RAR in depression. These findings emphasize that RAR can be a simple, reliable and cost-effective predictor of depression in clinical practice.

Keywords: Cross-sectional study; Depression; NHANES; RAR.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The protocols of NHANES were approved by the institutional review board of the National Center for Health Statistics, CDC ( https://www.cdc.gov/nchs/nhanes/irba98.htm ). NHANES has obtained written informed consent from all participants before enrolment. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the sample selection from NHANES 2011–2018
Fig. 2
Fig. 2
The association between RAR and depression. Adjusted for age, sex, race/ethnicity, education level, marital status, PIR, BMI, sleep duration, smoking status, alcohol drinking status, hypertension status, diabetes status, coronary heart disease status and stroke status
Fig. 3
Fig. 3
Subgroups analyses of the association between RAR and depression
See this image and copyright information in PMC

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