Mental Health Services and the Risk of Diabetes-Hypertension Comorbidity: Evidence from NHANES Using DAG-Based Analysis

Objective To investigate the impact of mental health services on the comorbidity of diabetes and hypertension, and to analyze the roles of depression, smoking, alcohol consumption, physical activity, and sleep in the risk of comorbidity, in order to provide empirical evidence for chronic disease management. Methods Data were obtained from the National Health and Nutrition Examination Survey (NHANES) between August 2021 and August 2023, including participants aged 18 years and older. Directed Acyclic Graphs (DAGs) were used to identify potential causal relationships, and Propensity Score Matching (PSM) was applied to adjust for confounding factors. Subsequently, logistic regression models were constructed to evaluate the effect of mental health services on the risk of comorbidity. Results After PSM adjustment, receiving mental health services significantly reduced the risk of comorbid diabetes and hypertension (P < 0.05). Additionally, depression, smoking, and alcohol consumption significantly increased comorbidity risk (P < 0.05), while regular physical activity and adequate sleep were associated with a significantly reduced risk (P < 0.05). Conclusion Mental health services may lower the risk of diabetes and hypertension comorbidity by improving psychological well-being and enhancing adherence to healthy behaviors. It is recommended that mental health interventions and health lifestyle guidance be strengthened in chronic disease management to reduce the burden of comorbidity and improve population health.