Depression, stress, and a negative outlook on life among older individuals appears to predict their risk of dying from a stroke, a longitudinal study showed.

The most distressed seniors were 2.97-fold more likely to die from a stroke, while the next highest quartile was at 1.98-fold elevated risk compared with the least distressed quartile (P<0.0001 and 0.0091, respectively), Susan Everson-Rose, PhD, MPH, of the University of Minnesota in Minneapolis, and colleagues reported online in Stroke.

That association persisted after full adjustment for other stroke risk factors and was largely accounted for by hemorrhagic rather than ischemic strokes among community-dwelling seniors followed in the Chicago Health and Aging Project.

Associations with stroke incidence were also seen but lost significance after adjustment for stroke risk factors.

“People should be aware that stress and negative emotions often increase with age,” Everson-Rose noted in a statement. “Family members and caregivers need to recognize these emotions have a profound effect on health.”

How exactly the link works isn’t clear, whether due to neuroendocrine and inflammatory responses to stress and depression or via poorer lifestyle factors associated with them, her group acknowledged.

In the study, the most distressed seniors were less educated, less physically active, and had more chronic health conditions and antidepressant use—all of which may add up to problems with medication adherence and maintaining a healthy lifestyle.

“Given that psychosocial distress may be modifiable, more research is needed to understand how it contributes to stroke risk,” Everson-Rose and colleagues wrote.

The group analyzed the longitudinal population-based Chicago Health and Aging Project cohort of black or white adults 65 or older living in three neighborhoods on the south side of Chicago.

During a median 6.7 years of follow-up, 13% of the 4,120 participants reported a history of stroke.

Pooling questionnaire scores on depressive symptoms, perceived stress, neuroticism, and life satisfaction into a single composite measure showed correlations with stroke risks.

Each standard deviation increase in composite distress score was associated with:

  18% higher likelihood of an incident stroke (hazard ratio 1.18, 95% CI 1.07 to 1.30)
  47% higher likelihood of stroke mortality (HR 1.47, 95% confidence interval 1.28 to 1.70)

Adding adjustment for stroke risk factors, chronic conditions, education, medication usage, and stroke history attenuated the relationships.

The higher risk of dying from a stroke seen in the age-, race-, and sex-controlled model with greater psychosocial distress persisted in the fully-adjusted model, with a hazard ratio of 1.29 per standard deviation (95% CI 1.10 to 1.52).

However, the link with stroke incidence lost significance (HR 1.09 per standard deviation, 95% CI 0.98 to 1.21).

The dose-response association with incident stroke persisted, but only the most distressed quartile approached statistical significance. Hazard ratios in the fully-adjusted model compared with the least distressed quartile were:

  1.31 for the most distressed quartile (P=0.08)
  1.22 for the next most distressed quartile (P=0.16)
  1.21 for the second quartile (P=0.165)

Analysis by stroke types showed a strong link to Hemorrhagic stroke incidence in the fully-adjusted model, with a hazard ratio of 1.70 per standard deviation higher composite distress score (95% CI 1.28 to 2.25).

Ischemic stroke risk wasn’t elevated with greater psychosocial distress (HR 1.02, 95% CI 0.91 to 1.15).

All the components of the distress score followed the same patterns of association, “at approximately similar levels of risk,” the researchers noted.

They cautioned that the results might not be generalizable to other minority or age groups or across all geographic areas, particularly the Stroke Belt in the Southeast.

Other limitations were lack of clinically-adjudicated outcome data and the single time point for psychosocial assessment.

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Primary source: Stroke
Source reference: Henderson KM, et al “Psychosocial distress and stroke risk in older adults” Stroke 2013; DOI: 10.1161/STROKEAHA.112.679159.