Systematic Review and Meta-Analysis of Psychosocial Risk Factors for Stroke

Abstract

Several studies have assessed the link between psychosocial risk factors and stroke; however, the results were inconsistent. We have conducted a systemic review and meta-analysis of cohort or case-control studies to ascertain the association between psychosocial risk factors (psychological, vocational, behavioral, interpersonal, and neuropsychological) and the risk of stroke. Systematic searches were undertaken in MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Database of Systematic Reviews between 2000 and January 2017. Two reviewers independently screened titles, abstracts, and full texts. One reviewer assessed quality and extracted data, which was checked by a second reviewer. For studies that reported risk estimates, a meta-analysis was performed. We identified 41 cohort studies and 5 case-control studies. No neuropsychological papers were found. Overall, pooled adjusted estimates showed that all other psychosocial risk factors were independent risk factors for stroke. Psychological factors increased the risk of stroke by 39% (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.27–1.51), vocational by 35% (HR, 1.35; 95% CI, 1.20–1.51), and interpersonal by 16% (HR, 1.16; 95% CI, 1.03–1.31), and the effects of behavioral factors were equivocal (HR, 0.94; 95% CI, 0.20–4.31). The meta-analyses were affected by heterogeneity. Psychosocial risk factors are associated with an increased risk of stroke.

Death of a Child and the Risk of Stroke

“…6 Similarly, our results are also comparable to associations reported between other psychosocial factors such as work stress, anxiety, and depression and the risk of stroke. [10][11][12][13][14][15] Our findings corroborate studies 1-5 that showed increased risks of acute myocardial infarction, atrial fibrillation, heart failure, and death due to CVD among bereaved parents. To our knowledge, only one study so far has investigated the risk of stroke in parents exposed to the death of a child.…”

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

“…In a meta-analysis that included 46 studies (30 on psychological factors, 13 on vocational factors, 10 on interpersonal factors, and 2 on behavioral factors), the risk of stroke increased by 39% with psychological factors (HR, 1.39 [95% CI, 1.27–1.51]), 35% with vocational factors (HR, 1.35 [95% CI, 1.20–1.51]), and 16% with interpersonal factors (HR, 1.16 [95% CI, 1.03–1.31]); there was no significant relationship with behavioral factors (HR, 0.94 [95% CI, 0.20–4.31]). 167…”

Psychosocial Risk Factors and Cardiovascular Disease and Death in a Population-Based Cohort From 21 Low-, Middle-, and High-Income Countries

“…[1][2][3][4] Previous studies have shown an association between stress and CVD through direct or indirect pathways, [4][5][6][7] and a 1.1-to 1.6-fold increased risk of incident coronary heart disease (CHD) and stroke associated with stress. 8,9 A large retrospective case-control study conducted in 52 countries found that longterm stress was associated with an increased risk of acute myocardial infarction (MI) even after controlling for health behaviors. 6 However, studies in which psychological factors are assessed retrospectively may be more prone to biases.…”

“…Accordingly, the association of psychological factors with CVD risk is more controversial compared with other more traditional risk factors (eg, smoking, obesity, diabetes, high blood pressure, elevated cholesterol levels) . Previous studies have shown an association between stress and CVD through direct or indirect pathways, and a 1.1- to 1.6-fold increased risk of incident coronary heart disease (CHD) and stroke associated with stress . A large retrospective case-control study conducted in 52 countries found that long-term stress was associated with an increased risk of acute myocardial infarction (MI) even after controlling for health behaviors .…”