Mental health treatment and its impact on survival outcomes in patients with comorbid mental health and cardiovascular diseases: a retrospective cohort study

Abstract

Background: Mental illness and cardiovascular diseases frequently co-occur and are among the leading causes of global morbidity and mortality. Their comorbidity is associated with poorer health outcomes, including higher mortality, hospital readmissions, and increased healthcare utilization. Although mental health treatment has been shown to improve clinical outcomes, its impact on patient survival outcomes remains underexplored. This study aims to evaluate the effects of mental health treatment on hospital readmissions, emergency department visits, and overall survival time in patients with comorbid mental health and cardiovascular conditions.

Methods: A multi-center retrospective cohort study was carried out among adult comorbid mental health and cardiovascular diseases patients in Ethiopia. Data entry was performed using EpiData Manager, and the dataset was subsequently exported to SPSS version 26 for analysis. A Cox proportional hazards regression model was applied to identify factors influencing the time to hospital readmission and emergency department visits. Adjusted hazard ratios with corresponding 95% confidence intervals were reported, and statistical significance was determined at a P-value threshold of < 0.05. Kaplan-Meier survival curves were used to illustrate differences in time to hospital readmission and emergency department visits between treated and untreated patients.

Results: Depression was the most prevalent mental health condition, affecting 47.3% of participants, while hypertension was the most common cardiovascular illness in 37.3% of participants. The rate of mental health treatment in this study is 35.7%. Determinates of hospital readmission included mental health treatment AHR 3.44 (95% CI: 2.11–5.62) and the presence of comorbid conditions AHR of 1.53 (95% CI: 1.03–2.28). Additionally, emergency department visits were significantly associated with mental health treatment AHR of 2.11 (95% CI: 1.09–4.08). Kaplan-Meier survival curves indicated that patients receiving mental health treatment experienced longer times to readmission and emergency department visits compared to untreated patients.

Conclusions: Mental health treatment is associated with improved survival outcomes and reduced hospital readmissions and emergency department visits, in patients with comorbid mental health and cardiovascular diseases. These findings indicate the importance of integrating mental health care into the management of patients with complex medical conditions to improve long-term outcomes and reduce the burden on healthcare systems. Moreover, it is important to pay attention to patients with comorbid diseases.

Clinical trial number: Not applicable.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12888-025-07035-4.

Keywords: Cardiovascular diseases; Comorbid mental health and cardiovascular diseases; Emergency department visits; Ethiopia; Hospital readmissions; Mental health treatment.

Fig. 1

Kaplan-Meier survival curves for time to hospital readmission among patients with and without mental health treatment (log-rank test, P = 0.034; HR = 0.65, 95% CI: 0.43–0.98)

Fig. 2

Kalpan-Meier survival curves for time to emergency department visit among patients with and without mental health treatment (log-rank test, P = 0.088; HR = 0.76, 95% CI: 0.49–1.18)