Depression may be a risk factor for stroke in men but not in women, reported Michiel J. Bos, MD, MSc, and colleagues in the September Journal of Neurology, Neurosurgery, and Psychiatry.
The prospective study included 4,424 persons from the third Rotterdam Study Survey (1997-1999) who were 61 or older and free from stroke at baseline. Depressive symptoms were assessed using the Dutch version of the Center for Epidemiologic Studies Depression Scale (CES-D), with a cutoff score of 16 indicating the presence of depressive symptoms. Participants who screened positive for depressive symptoms were studied using the Dutch version of the Present State Examination. Diagnostic criteria included major depressive disorder, dysthymia, and minor depressive disorder, as defined in the DSM-IV. Data for incident stroke until January 2005 were complete.
In 24,657 person-years of follow-up, 291 strokes (190 ischemic, 31 hemorrhagic, and 70 unspecified) occurred. “At baseline, the prevalence of major depression was 0.7% among men and 1.7% among women; the prevalence of dysthymia was 0.3% among men and 0.6% among women; and the prevalence of minor depression was 0.8% among men and 1.6% among women,” said Dr. Bos, a postdoctoral student in the Department of Epidemiology and Biostatistics at Erasmus Medical Center in Rotterdam, the Netherlands, and coauthors.
Participants with depressive symptoms at baseline had a nonsignificantly higher risk for stroke (age- and sex-adjusted hazard ratio [HR], 1.20) and ischemic stroke (adjusted HR, 1.43) than those without depressive symptoms. This association was stronger in men than in women—men with depressive symptoms had an increased risk for stroke (adjusted HR, 2.11) and ischemic stroke (adjusted HR, 3.09), compared with men without depressive symptoms. Women had no association between depressive symptoms and risk for ischemic stroke.
Forty-six percent of participants with depressive symptoms on the CES-D had a DSM-IV depressive disorder. Men who met DSM-IV criteria for depressive disorder had an increased, but not statistically significant, risk for stroke (adjusted HR, 1.75). However, men with depressive symptoms who did not meet DSM-IV criteria had a significantly increased risk for stroke (adjusted HR, 2.45). Both associations were stronger when only ischemic strokes were analyzed. Women also had a higher risk for stroke when depressive symptoms were present in the absence of depressive disorder.
“The absence of an association between depressive symptoms and stroke in women might be attributable to the different, and probably more heterogeneous, etiology of depressive symptoms among women compared with men,” commented Dr. Bos’ group.
—Marguerite Spellman