Changes in Depressive Symptoms and Incidence of First Stroke Among Middle-Aged and Older US Adults.

TitleChanges in Depressive Symptoms and Incidence of First Stroke Among Middle-Aged and Older US Adults.
Publication TypeJournal Article
Year of Publication2015
AuthorsWalter, S, Tchetgen Tchetgen, EJ, Patton, KK, J Moon, R, Capistrant, BD, Marden, JR, Kubzansky, LD, Gilsanz, P, Kawachi, I, M. Glymour, M
JournalJ Am Heart Assoc
Date Published2015 May 13
ISSN Number2047-9980
KeywordsAdult, Aged, Aged, 80 and over, Aging, depression, Female, Humans, Incidence, Longitudinal Studies, Male, Middle Aged, Proportional Hazards Models, Risk Factors, Sex Factors, Stroke, Time Factors

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.

User Guide Notes

Endnote Keywords

depressive Symptoms/stroke risk/CES Depression Scale/CES Depression Scale/depression/stroke

Endnote ID


Alternate JournalJ Am Heart Assoc
Citation Key8330
PubMed ID25971438
PubMed Central IDPMC4599421
Grant List1RC4 MH092707 / MH / NIMH NIH HHS / United States
R21 AG03438502 / AG / NIA NIH HHS / United States
T32 NS048005 / NS / NINDS NIH HHS / United States
1F31HL112613 / HL / NHLBI NIH HHS / United States
U01AG009740 / AG / NIA NIH HHS / United States
5R25GM055353 / GM / NIGMS NIH HHS / United States
R24HD041023 / HD / NICHD NIH HHS / United States