Key result
Stable high depressive symptoms (HR 2.14; 95% CI 1.69-2.71) and remitted depressive symptoms (HR 1.66; 95% CI 1.22-2.26) were associated with an increased risk of incident stroke compared with stable low/no symptoms.
Why the study?
Do dynamic patterns of depressive symptoms (stable high, onset, or remitted) predict incident stroke in middle-aged and older adults?
Cohort (n=16,178)
Do dynamic patterns of depressive symptoms (stable high, onset, or remitted) predict incident stroke in middle-aged and older adults?
Persistently high and remitted depressive symptoms are associated with an increased risk of incident stroke, suggesting cumulative etiologic mechanisms linking depression and stroke.
Answers are grounded in this paper and cite their sources.
Supports incorporating depressive symptom trajectories into stroke risk models; leaves open whether treatment alters incident stroke.
BACKGROUND: Although research has demonstrated that depressive symptoms predict stroke incidence, depressive symptoms are dynamic. It is unclear whether stroke risk persists if depressive symptoms remit. METHODS AND RESULTS: Health and Retirement Study participants (n=16 178, stroke free and noninstitutionalized at baseline) were interviewed biennially from 1998 to 2010. Stroke and depressive symptoms were assessed through self-report of doctors' diagnoses and a modified Center for Epidemiologic Studies - Depression scale (high was ≥3 symptoms), respectively. We examined whether depressive symptom patterns, characterized across 2 successive interviews (stable low/no, onset, remitted, or stable high depressive symptoms) predicted incident stroke (1192 events) during the subsequent 2 years. We used marginal structural Cox proportional hazards models adjusted for demographics, health behaviors, chronic conditions, and attrition. We also estimated effects stratified by age (≥65 years), race or ethnicity (non-Hispanic white, non-Hispanic black, Hispanic), and sex. Stroke hazard was elevated among participants with stable high (adjusted hazard ratio 2.14, 95% CI 1.69 to 2.71) or remitted (adjusted hazard ratio 1.66, 95% CI 1.22 to 2.26) depressive symptoms compared with participants with stable low/no depressive symptoms. Stable high depressive symptom predicted stroke among all subgroups. Remitted depressive symptoms predicted increased stroke hazard among women (adjusted hazard ratio 1.86, 95% CI 1.30 to 2.66) and non-Hispanic white participants (adjusted hazard ratio 1.66, 95% CI 1.18 to 2.33) and was marginally associated among Hispanics (adjusted hazard ratio 2.36, 95% CI 0.98 to 5.67). CONCLUSIONS: In this cohort, persistently high depressive symptoms were associated with increased stroke risk. Risk remained elevated even if depressive symptoms remitted over a 2-year period, suggesting cumulative etiologic mechanisms linking depression and stroke.
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Gilsanz et al. (2015) conducted a cohort in Depressive symptoms and stroke (n=16,178). Stable high or remitted depressive symptoms vs. Stable low/no depressive symptoms was evaluated on Incident stroke (HR 2.14, 95% CI 1.69 to 2.71). Stable high depressive symptoms (HR 2.14; 95% CI 1.69-2.71) and remitted depressive symptoms (HR 1.66; 95% CI 1.22-2.26) were associated with an increased risk of incident stroke compared with stable low/no symptoms.
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