Depression Increases Stroke Risk in Older Women

Researchers at Brigham and Women's Hospital (Boston, MA, USA) and the Harvard School of Public Health (HSPS; Boston, MA; USA), conducted a follow-up study of 80,574 women (age 54-79 years) participating in a US Nurses' Health Study. Depressive symptoms were assessed at multiple time points by a Mental Health Index (MHI) score; clinically significant depressive symptoms were defined as an MHI score equal or lower than 52. Antidepressant medication use was asked biennially beginning in 1996, with physician-diagnosed depression also reported biennially, beginning in 2000. Depression was defined as currently reporting or having a history of any of these three criteria.

The results showed that during the six years of follow-up, 1,033 stroke incidents were documented (538 ischemic, 124 hemorrhagic, and 371 unknown strokes). Having a history of depression was associated with a multivariate-adjusted hazard ratio (HR) of 1.29 for total stroke. Women who used antidepressant medications were at increased risk for stroke, whether they also had a MHI score equal or lower than 52, and if they were diagnosed with depression or not. Furthermore, for each cycle, participants who reported current depression had an increased risk of stroke, whereas individuals who only had a history of depression were at nonsignificantly elevated risk compared with women who never reported a diagnosis of depression or antidepressant medication use. The study was published early online on August 11, 2001, in Stroke.

“Aside from neuroendocrine mechanisms that might contribute to cardiovascular disease in depressed women, the clinical manifestations of depression in an older population might relate to subclinical vascular disease,” concluded lead author Kathryn Rexrode, MD, of Harvard, and colleagues. “The data provide additional evidence that depression is associated with a moderately increased risk of incident stroke; further contributing to stroke could be negative health factors such as smoking, lack of physical activity, and obesity.”

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Brigham and Women's Hospital
Harvard School of Public Health