0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Review |

Depression and Risk of Stroke Morbidity and Mortality: A Meta-analysis and Systematic Review

An Pan, PhD; Qi Sun, MD, ScD; Olivia I. Okereke, MD, SM; Kathryn M. Rexrode, MD; Frank B. Hu, MD, PhD
JAMA. 2011;306(11):1241-1249. doi:10.1001/jama.2011.1282.
Text Size: A A A
Published online

Context Several studies have suggested that depression is associated with an increased risk of stroke; however, the results are inconsistent.

Objective To conduct a systematic review and meta-analysis of prospective studies assessing the association between depression and risk of developing stroke in adults.

Data Sources A search of MEDLINE, EMBASE, and PsycINFO databases (to May 2011) was supplemented by manual searches of bibliographies of key retrieved articles and relevant reviews.

Study Selection We included prospective cohort studies that reported risk estimates of stroke morbidity or mortality by baseline or updated depression status assessed by self-reported scales or clinician diagnosis.

Data Extraction Two independent reviewers extracted data on depression status at baseline, risk estimates of stroke, study quality, and methods used to assess depression and stroke. Hazard ratios (HRs) were pooled using fixed-effect or random-effects models when appropriate. Associations were tested in subgroups representing different participant and study characteristics. Publication bias was evaluated with funnel plots and Begg test.

Results The search yielded 28 prospective cohort studies (comprising 317 540 participants) that reported 8478 stroke cases (morbidity and mortality) during a follow-up period ranging from 2 to 29 years. The pooled adjusted HRs were 1.45 (95% CI, 1.29-1.63; P for heterogeneity <.001; random-effects model) for total stroke, 1.55 (95% CI, 1.25-1.93; P for heterogeneity = .31; fixed-effects model) for fatal stroke (8 studies), and 1.25 (95% CI, 1.11-1.40; P for heterogeneity = .34; fixed-effects model) for ischemic stroke (6 studies). The estimated absolute risk differences associated with depression were 106 cases for total stroke, 53 cases for ischemic stroke, and 22 cases for fatal stroke per 100 000 individuals per year. The increased risk of total stroke associated with depression was consistent across most subgroups.

Conclusion Depression is associated with a significantly increased risk of stroke morbidity and mortality.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Place holder to copy figure label and caption
Figure 1. Literature Search for the Meta-analysis
Graphic Jump Location
Place holder to copy figure label and caption
Figure 2. Adjusted Hazard Ratios of Total Stroke for Depressed Participants Compared with Nondepressed Participants
Graphic Jump Location

The summary estimates were obtained using a random-effects model. The data markers indicate the adjusted hazard ratios (HRs) in depressed participants compared with nondepressed individuals. The size of the data markers indicates the weight of the study, which is the inverse variance of the effect estimate. The diamond data marker indicates the pooled HR.

Place holder to copy figure label and caption
Figure 3. Adjusted Hazard Ratios of Fatal Stroke and Ischemic Stroke for Depressed Participants Compared With Nondepressed Participants
Graphic Jump Location

The summary estimates were obtained using a fixed-effect model. The data markers indicate the adjusted hazard ratios (HRs) in depressed participants compared with nondepressed individuals. The size of the data markers indicates the weight of the study, which is the inverse variance of the effect estimate. The diamond data markers indicate the pooled HRs.

Tables

References

CME


You need to register in order to view this quiz.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

7,611 Views
129 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

Care at the Close of Life: Evidence and Experience
Depression

Care at the Close of Life: Evidence and Experience
Treatment of Depression

×
brightcove.createExperiences();