Psychological distress, major depressive disorder, and risk of stroke
Abstract
BACKGROUND: Studies have suggested that mood status is associated with an increased risk of stroke, though mostly based on measures of depression defined by symptoms alone rather than diagnostic criteria representative of clinically important distress and impairment. We investigated this association based upon a large population-based prospective cohort study. METHODS: Baseline assessment of major depressive disorder (MDD) and of mental health well-being (defined by the Mental Health Inventory, MHI-5) was completed by 20,627 stroke-free participants, aged 41 to 80 years, in the United Kingdom European Prospective Investigation into Cancer-Norfolk study. RESULTS: During 8.5 years of follow-up, 595 incident (fatal and nonfatal) stroke endpoints were recorded. Neither past year nor lifetime MDD was associated with stroke. A one SD decrease in MHI-5 scale score (representing greater emotional distress) was associated with an 11% increased risk of stroke after adjustment for age, sex, cigarette smoking, systolic blood pressure, cholesterol, obesity, preexisting myocardial infarction, diabetes, social class, education, hypertension treatment, family history of stroke, and antidepressant medication use (hazard ratio 1.11, 95% CI 1.00 to 1.22). This association was consistent for men and for women, for fatal and nonfatal stroke, and conformed to a dose-response relationship. CONCLUSIONS: Findings from this large prospective cohort study suggest that increased psychological distress is associated with elevated stroke risk. Episodic major depressive disorder was not associated with incident stroke in this study.
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There is a strong link between mental and physical health.
“A strong link has been found between mental and physical health (Nabi et al., 2008;Surtees et al., 2008).”
From The relationship between physical and mental health: A mediation analysis (2017) · cites this paper as Surtees et al., 2008
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- Authors
- Surtees, P. G., Wainwright, N. W. J., Luben, R. N., Wareham, N. J., Bingham, S. A., & Khaw, K.-T.
- Affiliations
- MRC Elsie Widdowson Laboratory (GB)
- Venue
- Neurology
- Published
- 2008-03-04
- Volume
- 70
- Issue
- 10
- Pages
- 788-794
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- OpenAlex
- W1986822607
- Cited by
- 183
- References
- 35
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 15 · 2023: 10 · 2022: 8 · 2021: 12 · 2020: 6 · 2019: 11 · 2018: 4 · 2017: 6 · 2016: 9 · 2015: 5 · 2014: 10 · 2013: 18 · 2012: 16
- FWCI
- 10.67
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Wellcome Trust
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- psychological distress, major depressive disorder, stroke risk, Mental Health Inventory, emotional distress, incident stroke, sex differences, dose-response relationship, EPIC-Norfolk cohort
- MeSH terms
- Adult, Aged, Aged, 80 and over, Major Depressive Disorder, Female, United Kingdom, Health Status, Humans, Male, Mass Screening, Middle Aged, Prospective Studies, Risk Factors, Stress, Psychological, Cohort Studies, Comorbidity, Incidence, Survival Rate, Sex Distribution, Stroke, Risk Reduction Behavior
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