Study Highlights Connection Between Depressive Symptoms and Stroke Risk

Credit: helpguide.org

A study published recently in the journal Neurology: Clinical Practice found a strong correlation between depressive symptoms and stroke risk. Led by a team of researchers from the University of Alabama and the University of Alabama at Birmingham, the study’s goal was to identify “nontraditional” factors that influence the risk of stroke.

Funded by grants from the National Institute of Neurologic Disorders and Stroke and the National Institute on Aging, the study looked at approximately 24,000 stroke-free participants — 9,529 of whom were Black while 14,516 were white. All were age 45 or older and enrolled in the REGARDS study led by the University of Alabama at Birmingham’s School of Public Health. Officially titled “Reasons for Geographic and Racial Differences in Stroke,” the ongoing study is examining the possible causes for the high incidence of stroke and stroke-related death in African Americans, as well as in Black and white Americans living in the area of the Southeastern United States known as the Stroke Belt. 

For the current study, participants were asked to complete an abbreviated version of the Center for Epidemiologic Studies Depression Scale known as CES-D-4 during their initial evaluation. A four-item questionnaire, the scale rates the participants’ answers to questions about the frequency with which they experience feelings of sadness, hopelessness and loneliness or have crying spells. Higher scores correlate with more depressive symptoms.

The researchers then followed the participants for an average of nine years, during which time 1,262 people suffered a stroke. They then compared the CES-D-4 scores of participants who remained stroke-free and those who had a stroke and found that a higher CES-D-4 score correlated with a 39% to 54% higher risk of stroke, with higher scores correlating with more strokes.

Virginia Howard, Ph.D., is the lead author of a study that points to depression as a major risk factor for strokes.
Credit: uab.edu

In a discussion of the study, lead author Virginia Howard, Ph.D., a professor in the Department of Epidemiology in the UAB School of Public Health, noted that most medical professionals are familiar with the well-known risk factors for stroke, such as diabetes, high blood pressure, smoking, and heart disease, but don’t generally think of depression as a contributing factor. 

“Our study provides support for considering nontraditional risk factors during patient assessment, particularly conducting some mental health screenings,” Howard said. “The standard questions asked in the typical physician/patient encounter need to be updated to include questions regarding depressive symptoms,” she said. 

The UAB study did not show any difference in stroke risk and associated depressive symptoms between Black participants and whites. But given that African Americans are 50% more likely to suffer a stroke than their white counterparts and up to 60% more likely to die as a result, adding depression screening to routine health assessments for African Americans seems particularly important in light of these results. 

According to the U.S. Centers for Disease Control and Prevention, stroke is the fifth leading cause of death in the United States, and a major cause of disability in older adults.