Association between depression and stroke risk in adults: a systematic review and meta-analysis

 

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Post stroke depression(33% chance).

Post stroke anxiety(20% chance). 

Association between depression and stroke risk in adults: a systematic review and meta-analysis

Farheen Ashraf¹Muhammad Saqlain Mustafa¹Muhammad Ashir Shafique^1*†Abdul Haseeb¹Abdullah Mussarat¹Amber Noorani¹Burhanuddin Sohail Rangwala¹Fatimah Kashif Rasool¹Mohammad Arham Siddiq¹Javed Iqbal²

• ¹Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
• ²Department of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan

Introduction: Stroke is a significant global health concern, and numerous studies have established a link between depression and an increased risk of stroke. While many investigations explore this link, some overlook its long-term effects. Depression may elevate stroke risk through physiological pathways involving nervous system changes and inflammation. This systematic review and meta-analysis aimed to assess the association between depression and stroke.

Methodology: We conducted a comprehensive search of electronic databases (PubMed, Embase, Scopus, and PsycINFO) from inception to 9 April 2023, following the Preferred Reporting Items for Systemic Review and Meta-analysis (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. We included all articles assessing the association between different stroke types and depression, excluding post-stroke depression. Two investigators independently extracted data and assessed quality using the Newcastle–Ottawa Scale and Cochrane Risk of Bias tool, utilizing a random-effects model for data synthesis. The primary outcome was the association of depression with stroke, with a secondary focus on the association of antidepressants with stroke.

Results: The initial search yielded 10,091 articles, and 44 studies were included in the meta-analysis. The pooled analysis revealed a significant association between depression and stroke risk, with an overall hazard ratio of 1.41 (95% CI 1.32, 1.50; p < 0.00001), indicating a moderately positive effect size. Subgroup analyses showed consistent associations with ischemic stroke (HR = 1.30, 95% CI 1.13, 1.50; p = 0.007), fatal stroke (HR = 1.39, 95% CI 1.24, 1.55; p < 0.000001), and hemorrhagic stroke (HR = 1.33, 95% CI 1.01, 1.76; p = 0.04). The use of antidepressants was associated with an elevated risk of stroke (HR = 1.28, 95% CI 1.05, 1.55; p = 0.01).

Conclusion and relevance: This meta-analysis indicates that depression moderately raises the risk of stroke. Given the severe consequences of stroke in individuals with depression, early detection and intervention should be prioritized to prevent it.(And you do that by 100% recovery protocols!)

Systematic review registration: Prospero (CRD42023472136).

Introduction

Stroke ranks among the primary causes of mortality and functional impairment worldwide (1). Meanwhile, depression is highly prevalent in the general population, with an estimated occurrence of 5.8% among men and 9.5% among women experiencing a major depressive event within a 12-month timeframe (2). Prior studies suggest a correlation between major depressive disorder and depressive symptoms and an increased risk of developing any form of stroke (3, 4). Numerous investigations have explored the connection between depression and stroke, with some focusing solely on the initial measurements of depression or depressive symptoms as well as potential confounding factors. However, such studies may not adequately capture the long-term implications of depression on the risk of stroke (5). Several potential physiological pathways exist by which depression may elevate the risk of stroke, including neuronal endocrine effects such as the activation of the sympathetic central nervous system and imbalances of the hypothalamic–pituitary–adrenocortical axis. Additionally, depression can lead to changes in behavior and have immunological/inflammatory effects, resulting in elevated levels of C-reactive protein (CRP), interleukin-1 (IL-1), and interleukin-6 (IL-6), all of which can contribute to the risk of stroke (6–8). The association between depressive symptoms and an increased risk of stroke in older adults has been well-documented across previous studies, although predominantly evaluated within high-income nations (3, 4, 9, 10). A single study has indicated that the prevalence of heightened depressive symptoms is higher among the Hispanic population (33%) and the Black population (27%) compared to the white population/other groups (18%). Hence, it is important to consider the influence of race/ethnicity when assessing the relationship between depression and stroke (10). Hence, we conducted a systematic review and meta-analysis to assess the relationship between depression and stroke incidence in adults.

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