Depression and Incident Stroke in Women

Abstract

Background and Purpose— Depression has been associated with an increased risk of coronary heart disease, but prospective data for the association with stroke are limited. Methods— We followed-up 80 574 women aged 54 to 79 years in Nurses' Health Study without a history of stroke from 2000 to 2006. Depressive symptoms were assessed at multiple time points by a Mental Health Index score (1992, 1996, and 2000), and clinical significant depressive symptoms were defined as a score ≤52. Antidepressant medication use was asked biennially beginning in 1996, and physician-diagnosed depression was reported biennially beginning in 2000. Depression was defined as currently reporting or having a history of any of these 3 conditions. Results— During 6 years of follow-up, 1033 incident strokes were documented (538 ischemic, 124 hemorrhagic, and 371 unknown strokes). Having a history of depression was associated with a multivariate-adjusted hazard ratio (HR) of 1.29 (95% confidence interval [CI], 1.13–1.48) for total stroke. Women who used antidepressant medications were at increased risk for stroke, whether they also had a Mental Health Index score ≤52 or diagnosed depression (HR, 1.39; 95% CI, 1.15–1.69) or not (HR, 1.31; 95% CI, 1.03–1.67). Furthermore, for each cycle, participants who reported current depression had an increased risk of stroke (HR, 1.41; 95% CI, 1.18–1.67), whereas individuals who only had a history of depression were at nonsignificantly elevated risk (HR, 1.23; 95% CI, 0.97–1.56) compared with women who never reported a diagnosis of depression or antidepressant medication use. Conclusions— Our results suggest that depression is associated with a moderately increased risk of subsequent stroke.