Chronic Stress and Stroke Among the Adult Population in the United States

This study aimed to examine the association of chronic psychological distress and stroke among a large sample of the adult population in the United States.

We utilized data from the National Health Interview Survey (NHIS) spanning 10 years (2004-2013). Stroke history was self-reported, as were other stroke risk factors. Psychological distress was measured using the Six-Item Kessler Psychological Distress Scale (a score of ≥13 indicated distress). We used a logistic regression model to examine the strength of the association between psychological distress and stroke. We used the stepwise approach adjusting for age, body mass index (BMI), and sociodemographic and other major risk factors of stroke, such as hypertension, diabetes, hypercholesterolemia, and smoking.

Among the 284497 individuals who participated in the NHIS and fully completed the Six-Item Kessler Psychological Distress Scale, 158665 (55.7%) were women, and 125832 (44.3%) were men. Prevalence of chronic psychological distress was higher among women compared to men (n=6622 (4.2%) vs. n=3596 (2.9%), respectively; p<0.01). Unadjusted odds ratio for stroke among psychologically distressed individuals was 3.1 (95% CI 2.8-3.3; p<0.01). After adjusting for age, hypertension, diabetes, BMI, hypercholesterolemia, and smoking, the odds of stroke in those with psychological distress was nearly threefold (OR 2.7; 95% CI 2.3-3.2; p<0.01). In our logistic regression model, hypertension conferred a high risk of stroke with an OR of 2.6 (95% CI 2.3-2.8; p<0.01). Diabetes increased the odds of stroke with an OR of 1.9 (95% CI 1.8-2.1; p<0.01). Hypercholesterolemia was also strongly associated with stroke risk (OR 1.5; 95% CI 1.3-1.6). Compared to never smoking, current smokers and former smokers had an OR of 1.99 (95% CI 1.7-2.2; p<0.01) and 1.3 (95% CI 1.2-1.4; p<0.01), respectively. In our model, BMI ≥25 conferred a significant risk of stroke (OR 1.28; 95% CI 1.20-1.35; p<0.01); however, after adjusting for cerebrovascular risk factors, including diabetes, hypertension, and high cholesterol, the stroke odds by obesity reversed (OR 0.86; 95% CI 0.75-0.98; p=0.03). While these stroke risk factors attenuated the association between psychological distress and stroke, the relationship remained highly significant in our final model with additional adjustment for sociodemographic factors, where the OR for stroke was 2.17 (95% CI 1.81.3-2.60; p<0.01).

Our study results demonstrate that psychological distress increases, more than twice, the odds of stroke among the adult population in the United States. Behavioral interventions targeting psychological stress may result in lowering the risk of stroke, as well as of other vascular diseases.