Depression and increased risk of death in adults with stroke
Received 16 April 2009; received in revised form 2 November 2009; accepted 12 November 2009. published online 15 January 2010.
Abstract
Objective
Depression is a common condition among individuals with stroke and believed to influence post-stroke mortality. The objective of this study was to evaluate the effect of depression on all-cause mortality among adults with and without a history of stroke.
Methods
We studied 10,025 participants in the population-based National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study who were alive and interviewed in 1982 and had complete data for the Center for Epidemiologic Studies Depression Scale. Four groups were created based on history of stroke and depression status in 1982: (1) no stroke, no depression (reference group); (2) no stroke, depression present; (3) history of stroke, no depression; and (4) history of stroke present, depression present. Cox proportional hazards regression models were used to calculate multivariate-adjusted hazard ratios (HRs) of death for each group compared with the reference group.
Results
Over 8 years (83,624 person-years of follow-up), 1,925 deaths were documented. Mortality rate per 1,000 person-years of follow-up was highest in the group with both a history of stroke and depression. Compared with the reference group, HRs for all-cause mortality were: no stroke, depression present, 1.23 (95% CI 1.08–1.40); stroke present, no depression 1.74 (1.06–2.85); and stroke present, depression present, 1.88 (1.27–2.79).
Conclusions
The coexistence of stroke and depression increases the risk of death; however, the combined effect is less than additive.
aDepartment of Medicine, Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC, USA
bCenter for Disease Prevention and Health Interventions for Diverse Populations, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
cDepartment of Health Professions, Medical University of South Carolina, Charleston, SC, USA
Corresponding author. Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC 29425, USA. Tel.: +1 843 792 2969; fax: +1 843 876 1201.
ABSTRACT