Psychosocial Distress and Stroke Risk in Older Adults

• Authors: Kimberly M. Henderson, University of Minnesota; Cari Clark, Emory University; Tene Lewis, Emory University; Neelum T. Aggarwal, Rush University; Todd Beck, Rush University; Hongfei Guo, University of Minnesota; Scott Lunos, University of Minnesota; Ann Brearley, University of Minnesota; Carlos F. Mendes de Leon, University of Michigan; Denis A. Evans, Rush University; Susan A. Everson-Rose, University of Minnesota
• Journal Title: Stroke
• Volume: Volume 44, Number 2
• Publisher: American Heart Association | 2013-02-01, Pages 367-372
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1161/STROKEAHA.112.679159
• Subjects: Biology, Neuroscience; Health Sciences, Epidemiology; Psychology, Psychobiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Clinical Neurology; Peripheral Vascular Disease; Neurosciences & Neurology; Cardiovascular System & Cardiology; epidemiology; psychosocial stress; risk factors; women and minorities; PSYCHOLOGICAL DISTRESS; ISCHEMIC-STROKE; POPULATION; MORTALITY; DISEASE

Abstract

BACKGROUND AND PURPOSE - : To investigate the association of psychosocial distress with risk of stroke mortality and incident stroke in older adults. METHODS - : Data were from the Chicago Health and Aging Project, a longitudinal population-based study conducted in 3 contiguous neighborhoods on the south side of Chicago, IL. Participants were community-dwelling black and non-Hispanic white adults, aged 65 years and older (n=4120 for stroke mortality; n=2649 for incident stroke). Psychosocial distress was an analytically derived composite measure of depressive symptoms, perceived stress, neuroticism, and life dissatisfaction. Cox proportional hazards models examined the association of distress with stroke mortality and incident stroke over 6 years of follow-up. RESULTS - : Stroke deaths (151) and 452 incident strokes were identified. Adjusting for age, race, and sex, the hazard ratio (HR) for each 1-SD increase in distress was 1.47 (95% confidence interval [CI]=1.28-1.70) for stroke mortality and 1.18 (95% CI=1.07-1.30) for incident stroke. Associations were reduced after adjustment for stroke risk factors and remained significant for stroke mortality (HR=1.29; 95% CI=1.10-1.52) but not for incident stroke (HR=1.09; 95% CI=0.98-1.21). Secondary analyses of stroke subtypes showed that distress was strongly related to incident hemorrhagic strokes (HR=1.70; 95% CI=1.28-2.25) but not ischemic strokes (HR=1.02; 95% CI=0.91-1.15) in fully adjusted models. CONCLUSIONS - : Increasing levels of psychosocial distress are related to excess risk of both fatal and nonfatal stroke in older black and white adults. Additional research is needed to examine pathways linking psychosocial distress to cerebrovascular disease risk.