Combined healthy lifestyle and post-stroke depression: a cross-sectional study in US adults

Post-stroke depression (PSD) is a serious complication affecting the survival and functional recovery of stroke patients, with a prevalence of approximately 30 %. It predominantly occurs within the first year after stroke, particularly within the first three months. Although individual lifestyle factors are associated with PSD, the combined impact of composite lifestyle factors (smoking, alcohol consumption, physical activity, diet, sleep, and obesity) on PSD remains unclear. This study aims to examine the association between composite healthy lifestyle behaviors and PSD among stroke survivors in the United States.

By analyzing data from the 2005-2020 National Health and Nutrition Examination Survey (NHANES) in the United States, a total of 708 stroke survivors were included. The Healthy Lifestyle Score was used to assess the association between a composite healthy lifestyle and PSD. This score encompasses six factors: non-smoking, moderate alcohol consumption, regular physical activity, a nutritious diet, an ideal waist circumference, and sufficient sleep. Scores range from 0 to 6, with higher scores indicating a healthier lifestyle. Depression was diagnosed using the Patient Health Questionnaire-9 (PHQ-9) with a cutoff score of ≥9.

The weighted prevalence of PSD among stroke survivors was 20.54 %. Multivariate logistic regression analysis indicated a significant negative correlation between healthy lifestyle scores and PSD risk. Compared to stroke survivors with 0-1 healthy lifestyle behaviors, those with 4-6 healthy lifestyle behaviors had an 80 % reduced risk of PSD (OR=0.20, 95 % CI: 0.08-0.45). Furthermore, each additional healthy lifestyle behavior was associated with a 45 % reduction in PSD risk (OR = 0.55, 95 % CI: 0.44-0.68). Subgroup analyses revealed that this inverse association persisted across all subgroups and was more pronounced among individuals with a household poverty-income ratio (PIR) of 3.5 or higher (P for interaction = 0.01). Sensitivity analyses supported the robustness of these findings.

This study demonstrates that adopting a composite healthy lifestyle is significantly associated with reduced risk of PSD among stroke survivors in the United States, underscoring the importance of healthy lifestyles in preventing PSD.