What is the clinical evidence from this study?

Study design: Cohort. Population: Incident stroke (n=24045). Intervention: Depressive symptoms (CES-D-4 score 1-3 or ≥4) vs. No depressive symptoms (CES-D-4 score 0). Primary outcome: Incident stroke (HR 1.27, 95% CI 1.11-1.43).

October 6, 2020Open Access

Depressive Symptoms and Risk of Stroke in a National Cohort of Black and White Participants From REGARDS

Key Result

Baseline depressive symptoms were associated with a significantly increased risk of incident stroke, with fully adjusted hazard ratios of 1.27 for 1-3 symptoms and 1.25 for ≥4 symptoms.

Study Design

Type

Cohort (n=24,045)

Multicenter

Yes

Structured PICO

Do baseline depressive symptoms increase the risk of incident stroke similarly among Black and White participants aged 45 and older?

Population

24,045 stroke-free participants (9,529 Black and 14,516 White), aged 45 and older, enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) national cohort.

Intervention

Presence of baseline depressive symptoms (assessed via the 4-item Center for Epidemiologic Studies Depression Scale [CES-D-4] score of 1-3 or ≥4).

Comparator

Absence of baseline depressive symptoms (CES-D-4 score of 0).

Outcome

Incident stroke (first occurrence).hard clinical

Depressive symptoms are associated with an increased risk of incident stroke similarly in both Black and White adults, highlighting the potential value of depression screening in primary stroke prevention.

Main Result

Effect estimate: HR 1.27 (95% CI 1.11-1.43)

Limitations

Use of an abbreviated version of the CES-D (CES-D-4) which does not tap the full range of depressive symptoms
CES-D-4 is slightly less reliable and less sensitive than the 20-item measure
Measurement of depressive symptoms at only one point in time
Potential for selection bias as participants may not be representative of the general population

Abstract

OBJECTIVE: The purpose of this study was to examine depressive symptoms as a risk factor for incident stroke and determine whether depressive symptomatology was differentially predictive of stroke among Black and White participants. METHODS: The study comprised 9,529 Black and 14,516 White stroke-free participants, aged 45 and older, enrolled in the REasons for Geographic and Racial Differences in Stroke (2003-2007). Incident stroke was the first occurrence of stroke. Association between baseline depressive symptoms (assessed via the 4-item Center for Epidemiologic Studies Depression Scale CES-D-4: 0, 1-3, or ≥4) and incident stroke was analyzed with Cox proportional hazards models adjusted for demographics, stroke risk factors, and social factors. RESULTS: = 0.53). CONCLUSIONS: The association of depressive symptoms with increased stroke risk was similar among a national sample of Black and White participants. These findings suggest that assessment of depressive symptoms should be considered in primary stroke prevention for both Black and White participants.

Ask AI

Helpful

Bookmark

View Full Paper