People with symptoms of depression are at higher risk of stroke, suggests a new study published in the journal Neurology. They were also more likely to have poor recovery.^1,2

A total of 13,392 patients who had experienced an incident stroke from January 2007 to August 2015 were included in the present study. They were a part of the INTERSTROKE study, an international multicenter study conducted in 32 countries, which had examined the influence of modifiable risk factors on the risk of stroke. A total of 13,485 age-, sex- and race/ethnicity-matched participants, who did not have strokes, were selected as the control group. The mean age of the participants was 61.7 years and majority of them were male with women constituting 40.4% of the study group.

Data about the presence of cardiometabolic risk factors was collected via questionnaires. The participants were asked about symptoms of depression, including use of prescribed antidepressants for ≥2 consecutive weeks in the preceding year. Through this information, the researchers aimed to study the association of depression with risk of acute stroke.

Around 18.3% of patients who had a stroke were found to have experienced symptoms of depression in the previous year compared to 14.1% of those who did not have a stroke. On multivariate analysis, after adjusting for age, sex, education, physical activity and other lifestyle factors, the risk of stroke increased by 46% among those who had symptoms of depression compared to those who did not have any depressive symptoms with odds ratio (OR) of 1.46; the OR for intracerebral hemorrhage was 1.56 and for ischemic stroke it was 1.44.

The risk of stroke increased in proportion with the number of symptoms of depression. Presence of ≥5 symptoms of depression was associated with 54% higher risk of stroke than those who did not have depression. Those who had 1-2 symptoms of depression had 35% higher risk of stroke.

Patients who had pre-stroke depression were more likely to have poor post-stroke prognosis at one month (OR 1.09), though not necessarily have a more severe stroke (OR 1.02).

These findings point to depression as a modifiable risk factor for stroke. Those who had severe depression were at greater risk. While depression did not influence the severity of stroke, it did have a negative impact on the recovery of the patient following the stroke. Appropriate intervention for depression may mitigate the risk of stroke.

References

1. Robert P Murphy, et al; the INTERSTROKE investigators. Depressive symptoms and risk of acute stroke: INTERSTROKE case-control study. Neurology Mar 2023, 10.1212/WNL.0000000000207093; DOI: 10.1212/WNL.0000000000207093.
2. AAN Press release, March 8, 2023. Available at: https://www.aan.com/PressRoom/Home/PressRelease/5061.