Depressive Symptoms and Risk of Stroke in a National Cohort of Black and White Participants From REGARDS

• Published in: Neurology. Clinical practice Vol. 11; no. 4; pp. e454 - e461
• Main Authors: Ford, Cassandra D., Gray, Marquita S., Crowther, Martha R., Wadley, Virginia G., Austin, Audrey L., Crowe, Michael G., Pulley, LeaVonne, Unverzagt, Frederick, Kleindorfer, Dawn O., Kissela, Brett M., Howard, Virginia J.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-08-2021
• ISSN: 2163-0402; 2163-0933
• DOI: 10.1212/CPJ.0000000000000983

The purpose of this study was to examine depressive symptoms as a risk factor for incident stroke and determine whether depressive symptomatology was differentially predictive of stroke among Black and White participants.
The study comprised 9,529 Black and 14,516 White stroke-free participants, aged 45 and older, enrolled in the REasons for Geographic and Racial Differences in Stroke (2003-2007). Incident stroke was the first occurrence of stroke. Association between baseline depressive symptoms (assessed via the 4-item Center for Epidemiologic Studies Depression Scale [CES-D-4]: 0, 1-3, or ≥4) and incident stroke was analyzed with Cox proportional hazards models adjusted for demographics, stroke risk factors, and social factors.
There were 1,262 strokes over an average follow-up of 9.21 (SD 4.0) years. Compared to participants with no depressive symptoms, after demographic adjustment, participants with CES-D-4 scores of 1-3 had 39% increased stroke risk (hazard ratio [HR] = 1.39, 95% confidence interval [CI] = 1.23-1.57), with slight attenuation after full adjustment (HR = 1.27, 95% CI = 1.11-1.43). Participants with CES-D-4 scores of ≥4 experienced 54% higher risk of stroke after demographic adjustment (HR = 1.54, 95% CI = 1.27-1.85), with risk attenuated in the full model similar to risk with 1-3 symptoms (HR = 1.25, 95% CI = 1.03-1.51). There was no evidence of a differential effect by race (
= 0.53).
The association of depressive symptoms with increased stroke risk was similar among a national sample of Black and White participants. These findings suggest that assessment of depressive symptoms should be considered in primary stroke prevention for both Black and White participants.