Psychological distress, major depressive disorder, and risk of stroke

Surtees, Paul G.; Wainwright, Nick; Luben, Robert; Wareham, Nicholas J.; Bingham, Sheila; Khaw, Kay‐Tee

doi:10.1212/01.wnl.0000304109.18563.81

Cited by 159 publications

(128 citation statements)

References 35 publications

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“…Our study supports prior literature showing a proximal association between depressive symptoms and stroke, which has not been shown to be associated with lifetime or prior history of depressive symptoms,9 and highlights the urgent need for early intervention in patients with depressive symptoms. A recent study showed that collaborative depression care in the primary care setting might lead to decreased risk of incident CVD events in older patients38; however, depressive symptoms continue to be suboptimally recognized, diagnosed, and treated in primary care 39, 40.…”

Section: Discussionsupporting

confidence: 89%

“…Although successive meta‐analyses have shown that depressive symptoms increase the risk of incident CHD and CHD death, with pooled hazard ratios (HRs) estimated at 1.6 and 1.8,2, 3, 6 there has been concern about incomplete risk factor adjustment in the majority of studies included in prior meta‐analyses and limited use of time‐dependent variables 2. Similarly, although depressive symptoms have been considered an inconsistent risk factor for incident cerebrovascular disease,7, 8, 9 a recent meta‐analysis found pooled HRs of 1.5 and 1.6 for total and fatal stroke; again, only 6 of 28 studies simultaneously controlled for alcohol, body mass index, and smoking status, and 1 controlled for medication adherence 10. In addition to unmeasured confounders, research also remains inconsistent as to whether race truly moderates the association between depressive symptoms and incident CVD 11, 12, 13, 14.…”

Section: Introductionmentioning

confidence: 99%

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Elucidating the Association Between Depressive Symptoms, Coronary Heart Disease, and Stroke in Black and White Adults: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Moise

Khodneva

Richman

et al. 2016

JAHA

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BackgroundDepression is a relapsing and remitting disease. Prior studies on the association between depressive symptoms and incident cardiovascular disease (CVD) have been limited by single measurements, and few if any have examined both incident coronary heart disease and stroke in a large biracial national cohort. We aimed to assess whether time‐dependent depressive symptoms conferred increased risk of incident CVD.Methods and ResultsBetween 2003 to 2007, 22 666 black and white participants (aged ≥45 years) without baseline CVD in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were recruited. Cox proportional hazards regression analyses assessed the association between up to 3 measurements of elevated depressive symptoms (4‐item Center for Epidemiologic Studies Depression Scale score ≥4) and incident coronary heart disease, stroke, and CVD death adjusting for age, sex, region, income, health insurance, education, blood pressure, cholesterol, medication, obesity, diabetes mellitus, kidney disease, C‐reactive protein, corrected QT interval, atrial fibrillation, left ventricular hypertrophy, smoking, alcohol, physical inactivity, medication adherence, and antidepressant use. The participants’ average age was 63.4 years, 58.8% were female, and 41.7% black. Time‐varying depressive symptoms were significantly associated with CVD death (adjusted hazard ratio 1.30, 95% CI 1.04–1.63), with a trend toward significance for fatal and nonfatal stroke (adjusted hazard ratio 1.26, 95% CI 0.99–1.60) but not fatal and nonfatal coronary heart disease (adjusted hazard ratio 1.11, 95% CI 0.89–1.38). Race did not moderate the association between depressive symptoms and CVD.ConclusionsProximal depressive symptoms were associated with incident fatal and nonfatal stroke and CVD death even after controlling for multiple explanatory factors, further supporting the urgent need for timely management of depressive symptoms.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Elucidating the Association Between Depressive Symptoms, Coronary Heart Disease, and Stroke in Black and White Adults: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Moise

Khodneva

Richman

et al. 2016

JAHA

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“…As the prevalence of overweight and obesity has increased in the United States and worldwide, it is important to track ORCs including mental disorders, which could further exacerbate the course and outcomes of physical morbidities and ultimately result in disability or impaired health-related quality of life. 24,[58][59][60] Indeed, public health intervention programs aimed to attain an ideal body weight or BMI in the population could beneficially affect both physical and mental health status. …”

Section: Discussionmentioning

confidence: 99%

Depression and anxiety among US adults: associations with body mass index

et al. 2009

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Background: Obesity is associated with an increased risk of developing a variety of chronic diseases, most of which are associated with psychiatric disorders. We examined the associations of depression and anxiety with body mass index (BMI) after taking into consideration the obesity-related comorbidities (ORCs) and other psychosocial or lifestyle factors. Methods: We analyzed the data collected from 177 047 participants (agedX18 years) in the 2006 Behavioral Risk Factor Surveillance System. Current depression was assessed by the Patient Health Questionnaire-8 diagnostic algorithm. Lifetime diagnoses of depression, anxiety and ORCs were self-reported. The prevalence of the three psychiatric disorders was age standardized to the 2000 US population. Multivariate-adjusted prevalence ratios were computed to test associations of depression and anxiety with BMI using SUDAAN software. Results: The age-adjusted prevalence of current depression, lifetime diagnosed depression and anxiety varied significantly by gender. Within each gender, the prevalence of the three psychiatric disorders was significantly higher in both men and women who were underweight (BMIo18.5 kg/m 2 ), in women who were overweight (BMI: 25-o30 kg/m 2 ) or obese (BMIX30 kg/m 2 ), and in men who had class III obesity (BMIX40 kg/m 2 ) than in those with a normal BMI (18.5Ào25 kg/m 2 ). After adjusting for demographics, ORCs, lifestyle or psychosocial factors, compared with men with a normal BMI, men with a BMIX40 kg/m 2 were significantly more likely to have current depression or lifetime diagnosed depression and anxiety; men with a BMIo18.5 kg/m 2 were also significantly more likely to have lifetime diagnosed depression. Women who were either overweight or obese were significantly more likely than women with a normal BMI to have all the three psychiatric disorders.Conclusions: Our results demonstrate that disparities in the prevalence of depression and anxiety exist among people with different BMI levels independent of their disease status or other psychosocial or lifestyle factors.

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“…One critical element of human recovery, however, that has largely been overlooked in the current discourse relating to the improvement of preclinical models is stress. Although psychological stress has long been recognized to be a major risk factor for stroke, [6][7][8][9][10][11][12][13][14] it is also a major, and effectively ubiquitous aspect of stroke recovery. [15][16][17] Importantly, because of its ubiquity, almost all clinical interventions directed at improving recovery occur against a background of stress.…”

Section: Introductionmentioning

confidence: 99%

Stress as Necessary Component of Realistic Recovery in Animal Models of Experimental Stroke

Walker

Jones

Patience

et al. 2013

J Cereb Blood Flow Metab

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Over the last decade there has been a considerable effort directed toward reformulating the standard approach taken to preclinically model stroke and stroke recovery. The principal objective of this undertaking has been to improve the success with which preclinical findings can be translated. Although several advancements have already been introduced, one potentially critical feature that appears to have been overlooked is psychological stress. Stroke is well recognized to produce high levels of stress in patients, and ongoing exposure to stress is recognized to deleteriously interfere with recovery. The presence of high levels of stress (distress) in stroke patients is also relevant because nearly all clinically deployed neurorestorative interventions occur against this background. Somewhat perplexingly, however, we could find no preclinical stroke studies concerned with investigating the efficacy of putative neurorestorative compounds that did so in the presence of stress. The following article will make the case that failure to recognize or compensate for the effects of ongoing stress in standard preclinical experimental models of recovery is likely to result in overestimation of the effectiveness of pharmacological or behavioral neurorestorative interventions.

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Psychological distress, major depressive disorder, and risk of stroke

Abstract: Findings from this large prospective cohort study suggest that increased psychological distress is associated with elevated stroke risk. Episodic major depressive disorder was not associated with incident stroke in this study.

Cited by 159 publications

References 35 publications

Elucidating the Association Between Depressive Symptoms, Coronary Heart Disease, and Stroke in Black and White Adults: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Elucidating the Association Between Depressive Symptoms, Coronary Heart Disease, and Stroke in Black and White Adults: The REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

Depression and anxiety among US adults: associations with body mass index

Stress as Necessary Component of Realistic Recovery in Animal Models of Experimental Stroke

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