Depressive symptoms and increased risk of stroke mortality over a 29-year period

Human Population Laboratory, Public Health Institute, Berkeley, Calif, USA.
Archives of Internal Medicine (Impact Factor: 17.33). 06/1998; 158(10):1133-8.
Source: PubMed


Several lines of evidence indicate that depression is importantly associated with cardiovascular disease end points. However, little is known about the role of depression in stroke mortality.
This study examined the association between depressive symptoms and stroke mortality in a prospective study of behavioral, social, and psychological factors related to health and mortality in a community sample of 6676 initially stroke-free adults (45.8% male; 79.1% white; mean age at baseline, 43.4 years) from Alameda County, California. Depressive symptoms were assessed by the 18-item Human Population Laboratory Depression Scale. Cox proportional hazards regression models were used to evaluate the impact of depressive symptoms after controlling for age, sex, race, and other confounders.
A total of 169 stroke deaths occurred during 29 years of follow-up. Reporting 5 or more depressive symptoms at baseline was associated with increased risk of stroke mortality, after adjusting for age, sex, and race (hazard ratio, 1.66; 95% confidence interval, 1.16-2.39; P<.006). This association remained significant after additional adjustments for education, alcohol consumption, smoking, body mass index, hypertension, and diabetes (hazard ratio, 1.54; 95% confidence interval, 1.06-2.22; P<.02). Time-dependent covariate models, which allowed changes in reported depressive symptoms and risk factor levels during follow-up, revealed the same pattern of associations.
This population-based study provides the strongest epidemiological evidence to date for a significant relationship between depressive symptoms and stroke mortality. These results contribute to the growing literature on the adverse health effects of depression.

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    • "Importantly, this association is not mediated by disability, which can also contribute to post-stroke depression (Ramasubbu et al., 1998). This psychiatric comorbidity is a significant clinical factor, as the presence of depression in stroke patients raises the risk of mortality three-fold within a decade after stroke (Everson et al., 1998). Evidence has linked lesion location to the development of poststroke depression (PSD), offering the possibility that lacunes in certain brain regions may contribute to a greater likelihood of depression. "
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    ABSTRACT: Background: Lacunar stroke is a small (<2 cm) infarction that accounts for approximately 20% of all strokes. While a third of all stroke patients experience depressive symptoms, the prevalence of depression in the lacunar stroke patient population is unclear. This meta-analysis aimed to synthesize the evidence on the effect of lacunar stroke and deep white matter disease on depressive symptoms. Methods: A systematic search of electronic databases was conducted, resulting in the inclusion of 12 studies. Analyses were performed on the effects of lacunar stroke, volume and location of lacunes on depression prevalence, and the effect on depression severity. The effects estimates were calculated in random-effects models. Results: None of the analyses produced statistically significant results. Lacunar stroke patients had a non-significantly higher prevalence of depression compared to patients with non-lacunar cerebrovascular diseases (OR = 1.46, 95% CI: 0.88-2.43, p = 0.15). Neither thalamic (OR = 1.37 (0.85-2.20), p = 0.19), deep white matter (RR = 1.16 (0.85-1.57), p = 0.35), multiple lacunes (OR = 1.34 (0.81-2.22), p = 0.25), or the volume of lacunes (MD = -4.71 (-351.59-342.18), p = 0.98) had an effect on depression prevalence. Lastly, lacunar stroke did not influence depressive symptom severity (MD = 0.96 (-1.57-3.48), p = 0.46). Conclusions: The pooled group of patients with lacunar stroke and deep white matter disease appear to have a similar prevalence of depression compared to those with other types of cerebrovascular diseases. However, the small number of studies, heterogeneous comparison groups, and high statistical heterogeneity between studies posed an obstacle to the meta-analysis. To determine appropriate screening and treatment approaches, future research will need to separate lacunar stroke and deep white matter disease patients, and include larger sample sizes and healthy control groups to determine their distinct contributions to depression.
    International Psychogeriatrics 04/2014; 26(7):1-9. DOI:10.1017/S1041610214000568 · 1.93 Impact Factor
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    • "PSD patients have low physical and cognitive function, and low self-worth compared to those with no depression2), and they have a decreased quality of life3). All these factors can have adverse effects on the functional and mental recovery of stroke patients4). For this reason, various drugs are used to treat PSD, such as tricyclic antidepressant, monoamine oxidase inhibitors, and selective serotonin reuptake inhibitors (SSRIs). "
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    ABSTRACT: [Purpose] The purpose of the present study was to investigate the potential effects of circuit class training (CCT) on poststroke depression through changes in branched-chain amino acids (BCAAs) (isoleucine, leucine, and valine) and free-tryptophan (f-Trp). [Subjects] The study subjects were 40 stroke patients with major depressive disorder. The subjects were group-matched into an experimental and a control group according to sex, age, height, and weight. [Methods] The experimental CCT group performed gradual task-oriented CCT (80 min per session). The control group performed stretching exercises and weight bearing exercises (80 min per session). Both groups performed the exercises three times per week for eight weeks (24 sessions). Blood samples were collected immediately before the exercise (9:10 a.m.) and after the exercise (10:30 a.m.), every two weeks for eight weeks. [Results] The f-Trp/BCAAs ratio in the CCT group showed a significant increase compared to the control group over time. [Conclusion] The results show that the CCT may help to improve depression in people with poststroke depression (PSD).
    Journal of Physical Therapy Science 02/2014; 26(2):243-6. DOI:10.1589/jpts.26.243 · 0.39 Impact Factor
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    • "Depression can also precede physical disease and act as a risk factor. It has been shown to act as a predictor to coronary heart disease (Kendler et al., 2009), stroke (Everson et al., 1998), obesity and metabolic syndrome (Luppino et al., 2010), diabetes (Campayo et al., 2010a, 2010b) colorectal cancer, back pain, irritable bowel syndrome , multiple sclerosis and infant stunting and death if depression occurs during pregnancy (Goldberg, 2010). "
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    ABSTRACT: There is recognition that biomedical research into the causes of mental disorders and their treatment needs to adopt new approaches to research. Novel biomedical techniques have advanced our understanding of how the brain develops and is shaped by behaviour and environment. This has led to the advent of stratified medicine, which translates advances in basic research by targeting aetiological mechanisms underlying mental disorder. The resulting increase in diagnostic precision and targeted treatments may provide a window of opportunity to address the large public health burden, and individual suffering associated with mental disorders. While mental health and mental disorders have significant representation in the "health, demographic change and wellbeing" challenge identified in Horizon 2020, the framework programme for research and innovation of the European Commission (2014-2020), and in national funding agencies, clear advice on a potential strategy for mental health research investment is needed. The development of such a strategy is supported by the EC-funded "Roadmap for Mental Health Research" (ROAMER) which will provide recommendations for a European mental health research strategy integrating the areas of biomedicine, psychology, public health well being, research integration and structuring, and stakeholder participation. Leading experts on biomedical research on mental disorders have provided an assessment of the state of the art in core psychopathological domains, including arousal and stress regulation, affect, cognition social processes, comorbidity and pharmacotherapy. They have identified major advances and promising methods and pointed out gaps to be addressed in order to achieve the promise of a stratified medicine for mental disorders.
    European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 10/2013; 24(1). DOI:10.1016/j.euroneuro.2013.09.010 · 4.37 Impact Factor
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