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Depressive Symptoms and Risk of Acute Stroke: INTERSTROKE Case-Control Study.

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  • 1From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom. robmurph8@hotmail.com.

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Summary

Depressive symptoms are a significant risk factor for acute stroke globally, increasing the likelihood of both ischemic and hemorrhagic events. These symptoms also correlate with poorer functional recovery one month post-stroke.

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Area of Science:

  • Neurology
  • Psychiatry
  • Epidemiology

Background:

  • Depression is a known risk factor for acute stroke, primarily evidenced by studies in high-income nations.
  • The INTERSTROKE study investigated the global contribution of depressive symptoms to stroke risk and outcomes.

Purpose of the Study:

  • To explore the association between depressive symptoms and acute stroke risk across diverse global regions.
  • To examine the impact of depressive symptoms on functional outcomes one month after stroke.

Main Methods:

  • An international case-control study involving 26,877 participants across 32 countries.
  • Data collected on prestroke depressive symptoms and antidepressant use via standardized questionnaires.
  • Multivariable logistic regression analyses used to assess stroke risk and functional outcomes.

Main Results:

  • Prestroke depressive symptoms were prevalent in 18.3% of stroke cases versus 14.1% of controls.
  • Depressive symptoms significantly increased the odds of acute stroke (OR 1.46) and were associated with both intracerebral hemorrhage and ischemic stroke.
  • Preadmission depressive symptoms were linked to poorer functional outcomes at 1 month post-stroke (OR 1.09).

Conclusions:

  • Depressive symptoms represent a substantial global risk factor for acute stroke, encompassing both ischemic and hemorrhagic types.
  • The presence of depressive symptoms before a stroke is associated with adverse functional recovery, independent of initial stroke severity.