High depressive symptoms at multiple timepoints carry elevated stroke risk

Among individuals who have undergone repeated assessments for depression, the presence of high symptoms at multiple timepoints raises the risk of developing stroke, according to a study.

The study used data from the Health and Retirement Study in the US and included 12,520 individuals aged ≥50 years who were free of stroke at study baseline. They completed the 8-item Center for Epidemiologic Studies Depression scale at four consecutive, biennial timepoints from 1998 to 2004. High symptoms were defined as the presence of three or more symptoms, while low symptoms were defined as the presence of one or two symptoms.

Researchers grouped the participants into five predefined trajectories of depression based on their scores at each time point: consistently low, decreasing, fluctuating, increasing, and consistently high. They also assessed incident stroke over a subsequent 10-year period from 2006 to 2016 using the patients’ self-reported doctors’ diagnoses.

A total of 1,434 incident cases of stroke occurred during the follow-up. Multivariable Cox regression analysis showed that the risk of developing stroke relative to participants who had consistently low symptoms was 18–21 percent higher for participants with consistently high depressive symptoms (adjusted hazard ratio [aHR], 1.18, 95 percent confidence interval [CI], 1.02–1.36), those with increasing symptoms (aHR, 1.31, 95 percent CI, 1.10–1.57), and those with fluctuating symptoms (aHR, 1.21, 95 percent CI, 1.01–1.46).

Participants in the decreasing symptom trajectory group were not at increased risk of stroke.

The findings underscore the importance of elucidating the relationship between depressive symptoms and stroke risk over time through repeated assessments, in light of the remitting-relapsing nature of depressive symptoms, the researchers said.