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Depressive Symptoms Associated With Increased Stroke Risk

November 09, 2020

Having multiple depressive symptoms is associated with increased risk of incident stroke, according to a study published in Neurology: Clinical Practice.

Virginia Howard
Virginia Howard, PhD

“There are a number of well-known risk factors for stroke, such as high blood pressure, diabetes, and heart disease; but we are beginning to understand that there are nontraditional risk factors as well, and having depressive symptoms looms high on that list,” said study senior author Virginia Howard, PhD, professor in the Department of Epidemiology at the University of Alabama at Birmingham School of Public Health. “These nontraditional risk factors need to be in the conversation about stroke prevention.”

Researchers followed 9529 black and 14,516 white stroke-free participants, aged 45 years and older, over an average 9 years to see whether depressive symptoms increased stroke risk and, if so, whether the association differed among people who are black and people who are white. Depressive symptoms at baseline were measured using the four-item Center for Epidemiological Studies Depression (CES-D-4) scale, which evaluates a subset of symptoms and gauges how often participants feel depressed, sad, and lonely, and have crying spells.

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During follow-up, 1262 strokes occurred in the cohort, according to the study. Risk of stroke was 54% higher in participants with CES-D-4 scores 4 or higher, after demographic adjustment, compared with participants with no depressive symptoms. Stroke risk was increased 39%, after adjustment, in participants with CES-D-4 scores from 1 to 3.

Researchers found no evidence of a differential effect by race. The findings suggest, they concluded, that assessment of depressive symptoms should occur for stroke prevention efforts for both black and white patients.

“The standard questions asked in the typical physician/patient encounter need to be updated to include questions regarding depressive symptoms,” Dr. Howard said. “Physicians in primary care, internal medicine, and geriatrics need to consider asking their patients about depressive symptoms.”

—Jolynn Tumolo


Ford CD, Gray MS, Crowther MR, et al. Depressive symptoms and risk of stroke in a national cohort of blacks and whites from REGARDS. Neurology: Clinical Practice. 2020 October 6;[Epub ahead of print].

Shepard B. Study highlights link between depressive symptoms and stroke risk [press release]. Birmingham, Alabama: University of Alabama at Birmingham; October 29, 2020.

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