Depression has been reported to be a risk factor for acute stroke, based largely on studies in high-income countries. In the INTERSTROKE study, we explored the contribution of depressive symptoms to acute stroke risk and 1-month outcome across regions of the world, within subpopulations and by stroke type

Methods

INTERSTROKE is an international case-control study of risk factors for first acute stroke, conducted in 32 countries. Cases were patients with CT or MRI confirmed incident acute hospitalized stroke, and controls were matched for age, sex, and within sites. Standardized questions asked about self-reported depressive symptoms during the previous 12 months and use of prescribed antidepressant medications were recorded. Multivariable conditional logistic regression was used to determine the association of pre-stroke depressive symptoms with acute stroke risk. Adjusted ordinal logistic regression was used to explore the association of pre-stroke depressive symptoms with post-stroke functional outcome, measured with the modified-Rankin scale at 1-month after stroke.

Results

Of 26,877 participants, 40.4% were women, the mean age was 61.7 ± 13.4 years. The prevalence of depressive symptoms within the last 12 months was higher in cases compared to controls (18.3%vs.14.1%,p < 0.001) and differed by region (pinteraction < 0.001), with lowest prevalence in China (6.9% in controls) and highest in South America (32.2% of controls). In multivariable analyses pre-stroke depressive symptoms were associated with greater odds of acute stroke (OR 1.46, 95%CI 1.34–1.58), which was significant for both intracerebral hemorrhage (OR 1.56, 95%CI 1.28–1.91) and ischemic stroke (OR 1.44, 95%CI 1.31–1.58). A larger magnitude of association with stroke was seen in patients with a greater burden of depressive symptoms. While pre-admission depressive symptoms were not associated with a greater odds of worse baseline stroke severity (OR 1.02, 95%CI 0.94–1.10), they were associated with a greater odds of poor functional outcome at 1-month after acute stroke (OR 1.09, 95%CI 1.01–1.19).

Discussion

In this global study we recorded that depressive symptoms are an important risk factor for acute stroke, including both ischemic and hemorrhagic stroke. Pre-admission depressive symptoms were associated with poorer functional outcome, but not baseline stroke severity, suggesting an adverse role of depressive symptoms in post-stroke recovery.

https://n.neurology.org/content/early/2023/03/08/WNL.0000000000207093