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Background  There were few studies exploring the associations between depressive symptoms, anxiety symptoms and health-related quality of life (HRQoL) in the general population, especially in resource limited area. The aims of this study were to assess the associations between depressive symptoms, anxiety symptoms, their comorbidity and HRQoL in rural area.    Methods  A total of 23,496 eligible participants from Henan rural cohort were included. The Patient Health Questionnaire-2 (PHQ-2) and Generalized Anxiety Disorder-2 (GAD-2) were employed to assess depressive and anxiety symptoms, respectively. HRQoL was measured via European Quality of Life Five Dimension Five Level Scale (EQ-5D-5L). Tobit regression and generalized linear model were utilized to explore the associations between depressive symptoms, anxiety symptoms, their comorbidity and HRQoL.    Results  A total of 1320 individuals were identified as depressive symptoms with a prevalence rate of 5.62%, while 1198 participants were classified as anxiety symptoms with a prevalence rate of 5.10%. After multiple adjustment, the regression coefficients ( β ) and 95% confidence interval (CI) of utility index for depressive and anxiety symptoms were − 0.166 (− 0.182, − 0.149) and − 0.132 (− 0.149, − 0.114), respectively. The  β  and 95% CI of VAS score for depressive and anxiety symptoms were − 7.65 (− 8.60, − 6.70) and − 5.79 (− 6.78, − 4.80), respectively. Additionally, the comorbidity was strongly associated with low utility index and VAS score. These findings were observed robustly in men and women.    Conclusion  Depressive symptoms, anxiety symptoms and their comorbidity were associated with low HRQoL in rural population, which needed further efforts on preventive and treatment interventions.    Clinical trial registration  The Henan Rural Cohort Study has been registered at Chinese Clinical Trial Register (Registration number:  ChiCTR-OOC-15006699 ). Date of registration: 06 July, 2015.Supplementary Information  The online version contains supplementary material available at 10.1186/s12889-021-11969-1.

Associations between depressive symptoms, anxiety symptoms, their comorbidity and health-related quality of life: a large-scale cross-sectional study