RT Journal Article
SR Electronic
T1 Depressive Symptoms and Risk of Acute Stroke: INTERSTROKE Case-Control Study
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 10.1212/WNL.0000000000207093
DO 10.1212/WNL.0000000000207093
A1 Robert P Murphy
A1 Catriona Reddin
A1 Annika Rosengren
A1 Conor Judge
A1 Graeme J. Hankey
A1 John Ferguson
A1 Alberto Alvarez-Iglesias
A1 Shahram Oveisgharan
A1 Mohammad Wasay
A1 Clodagh McDermott
A1 Helle Klingenberg Iversen
A1 Fernando Lanas
A1 FAWAZ AL-HUSSAIN
A1 Anna Czlonkowska
A1 Aytekin Oguz
A1 Adesola Ogunniyi
A1 Albertino Damasceno
A1 Denis Xavier
A1 Alvaro Avezum
A1 Xingyu Wang
A1 Peter Langhorne
A1 Salim Yusuf
A1 Martin O'Donnell
A1 for the INTERSTROKE investigators
YR 2023
UL http://n.neurology.org/content/early/2023/03/08/WNL.0000000000207093.abstract
AB Background and ObjectivesDepression has been reported to be a risk factor for acute stroke, based largely on studies in high-income countries. In the INTERSTROKE study, we explored the contribution of depressive symptoms to acute stroke risk and 1-month outcome across regions of the world, within subpopulations and by stroke typeMethodsINTERSTROKE is an international case-control study of risk factors for first acute stroke, conducted in 32 countries. Cases were patients with CT or MRI confirmed incident acute hospitalized stroke, and controls were matched for age, sex, and within sites. Standardized questions asked about self-reported depressive symptoms during the previous 12 months and use of prescribed antidepressant medications were recorded. Multivariable conditional logistic regression was used to determine the association of pre-stroke depressive symptoms with acute stroke risk. Adjusted ordinal logistic regression was used to explore the association of pre-stroke depressive symptoms with post-stroke functional outcome, measured with the modified-Rankin scale at 1-month after stroke.ResultsOf 26,877 participants, 40.4% were women, the mean age was 61.7 ± 13.4 years. The prevalence of depressive symptoms within the last 12 months was higher in cases compared to controls (18.3%vs.14.1%,p < 0.001) and differed by region (pinteraction < 0.001), with lowest prevalence in China (6.9% in controls) and highest in South America (32.2% of controls). In multivariable analyses pre-stroke depressive symptoms were associated with greater odds of acute stroke (OR 1.46, 95%CI 1.34–1.58), which was significant for both intracerebral hemorrhage (OR 1.56, 95%CI 1.28–1.91) and ischemic stroke (OR 1.44, 95%CI 1.31–1.58). A larger magnitude of association with stroke was seen in patients with a greater burden of depressive symptoms. While pre-admission depressive symptoms were not associated with a greater odds of worse baseline stroke severity (OR 1.02, 95%CI 0.94–1.10), they were associated with a greater odds of poor functional outcome at 1-month after acute stroke (OR 1.09, 95%CI 1.01–1.19).DiscussionIn this global study we recorded that depressive symptoms are an important risk factor for acute stroke, including both ischemic and hemorrhagic stroke. Pre-admission depressive symptoms were associated with poorer functional outcome, but not baseline stroke severity, suggesting an adverse role of depressive symptoms in post-stroke recovery.