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.