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Depression, Distress, and Stroke

Psychological distress, but not major depression, increases the risk for stroke.

Major depression is a known risk factor for heart disease (Journal Watch Psychiatry Nov 27 2006), and psychological distress (i.e., depressive symptoms) has been associated with increased morbidity and mortality (Journal Watch Psychiatry Sep 18 2006). However, it is not clear whether either depression or psychological distress increases the risk for stroke. To learn more, these researchers analyzed data on 20,627 stroke-free adults in the U.K. (8939 men; age range, 41–80) who were participating in a population-based, prospective, cohort study. The researchers examined the associations between baseline health status and the occurrence of fatal and nonfatal strokes (595 incidents) during a median of 8.5 years of follow-up.

Higher baseline rates of major depression and greater psychological distress in the previous year were associated with current cigarette smoking, obesity, prior MI, lower social class, treatment for hypertension, and recent use of antidepressants. Greater psychological distress was also associated with diabetes, higher blood cholesterol, and less education. After adjustment for stroke risk factors, stroke was not associated with either lifetime or prior-year depression. However, stroke risk increased by 11% with each standard-deviation increase in psychological distress.

Comment: Although major depression results in psychological distress, the two states can affect physical health in different ways. Psychiatrists usually concentrate on treating disorders, rather than on preventing them. It may be a leap from the observation of psychological distress as a stroke risk factor to the alleviation of stress as a preventive strategy. However, we should recognize that strategies that mediate stress may have a long-term health benefit, and we should educate patients about the possible advantages of exercise and meditation.

— Jonathan Silver, MD

Published in Journal Watch Psychiatry March 10, 2008

Citation(s):

Surtees PG et al. Psychological distress, major depressive disorder, and risk of stroke. Neurology 2008 Mar 4; 70:788.

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