Eight-Year Depressive Symptom Trajectories and Incident Stroke: A 10-Year Follow-Up of the HRS (Health and Retirement Study)

Abstract

Background: Evidence suggests a link between depressive symptoms and risk of subsequent stroke. However, most studies assess depressive symptoms at only one timepoint, with few examining this relationship using repeatedly measured depressive symptoms. This study aimed to examine the relationship between depressive symptom trajectories and risk of incident stroke. Methods: This prospective cohort included 12 520 US individuals aged ≥50 years enrolled in the Health and Retirement Study, free of stroke at study baseline (1998). We used the 8-item Center for Epidemiologic Studies Depression scale to assess depressive symptoms (high defined as ≥3 symptoms; low <3 symptoms) at 4 consecutive, biennial timepoints from 1998 to 2004. We assigned individuals to 5 predefined trajectories based on their scores at each timepoint (consistently low, decreasing, fluctuating, increasing, and consistently high). Using self-reported doctors’ diagnoses, we assessed incident stroke over a subsequent 10-year period from 2006 to 2016. Cox regression models estimated the association of depressive symptom trajectories with risk of incident stroke, adjusting for demographics, health behaviors, and health conditions. Results: During follow-up, 1434 incident strokes occurred. Compared with individuals with consistently low symptoms, individuals with consistently high depressive symptoms (adjusted hazard ratio, 1.18 [95% CI, 1.02–1.36]), increasing symptoms (adjusted hazard ratio, 1.31 [95% CI, 1.10–1.57]), and fluctuating symptoms (adjusted hazard ratio, 1.21 [95% CI, 1.01–1.46]) all had higher hazards of stroke onset. Individuals in the decreasing symptom trajectory group did not show increased stroke risk. Conclusions: Depressive symptom trajectories characterized by high symptoms at multiple timepoints were associated with increased stroke risk. However, a trajectory with depressive symptoms that started high but decreased over time was not associated with higher stroke risk. Given the remitting-relapsing nature of depressive symptoms, it is important to understand the relationship between depressive symptoms and stroke risk over time through repeated assessments.

Depressive Symptom Trajectories and Cognition Among Older American Couples: A Dyadic Perspective

“…Another study reported six distinct trajectories (Liang et al, 2011). In contrast to Soh et al (2022), we did not identify a fluctuating depressive symptom trajectory. These discrepancies could be attributed to differences in study design (e.g., sample size, statistical approach, or study duration) and research contexts.…”

“…At each wave, about 20,000 nationally representative older adult respondents were recruited, with oversamples from Black and Hispanic households and Florida residents (HRS, 2021). HRS respondents are primarily community-dwelling older adults (Sonnega et al, 2014) and their data have been used widely to investigate depressive symptom trajectories among older Americans (Hybels et al, 2016; Liang et al, 2011; Soh et al, 2022; Xiang & Cheng, 2019), providing important implications for clinical psychological intervention targeted at community-dwelling older adults.…”

Adverse childhood and adulthood experiences and risk of new-onset cardiovascular disease with consideration of social support: a prospective cohort study

“…Further details on the definitions of these covariates can be found in Additional file 1 : Appendix. S1 [ 31 – 33 ].…”

How antidepressants affect the cerebral ischemic injury and ischemic stroke

“…Depression and depressive symptoms are associated with a high risk of stroke, especially the repeated occurrences of depressive symptoms [53]. The biological mechanisms include neuroendocrine dysregulation which is characterized by the activation of sympathetic nervous system, dysregulation of the hypothalamic pituitary adrenocortical axis, neurotransmitter-mediated platelet aggregation dysfunction, and immunologic/inflammatory factors [54].…”

“…This factor may be one of the reasons that antidepressants are not promoting to the recovery of stroke. Developing depressive symptoms or long-term high depression symptoms may indicate the occurrence of cerebrovascular events in the future, suggesting a possible role for antidepressant in stroke prevention [53]. Therefore, antidepressants are of great significance for the prevention and treatment of stroke.…”