Background Few studies have reported on the association between psychological distress and stroke risk, with most investigating the effect of psychological distress on stroke mortality rather than incidence. We investigated whether psychological distress is associated with stroke incidence in a large population-based cohort study and examined whether associations differed by gender, age-group and pathological stroke type.
Methods We included 2 28 955 participants without prior stroke from the New South Wales 45 and Up Study. Baseline psychological distress was measured using the 10-item Kessler psychological distress Scale and categorised as low, medium, and high/very high. We identified incident stroke through linkage to hospital admission and mortality records. We analysed men and women separately, using cox survival analysis to obtain unadjusted and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between psychological distress and all stroke and pathological stroke types. We serially adjusted for groups of confounders, including: sociodemographic factors; lifestyle factors; clinical disease history; family history of cardio- and cerebrovascular disease; physical disease co-morbidity (Charlson comorbidity index); and (among women) menopausal status and current hormone replacement therapy and oral contraceptive use.
Results During 1,075,057 person-years of follow-up (mean follow-up time 4.7±0.98 years), we identified 2682 incident strokes among men and women. In men, medium and high/very high psychological distress was associated with a 10% and 34% increased risk of stroke compared to low psychological distress (fully adjusted HRs 1.10, 95% CI 0.95, 1.26 and 1.34, 95% CI 1.11, 1.62, respectively). Similar effect estimates were observed in women (fully adjusted HRs for medium and high/very high versus low psychological distress: 1.17, 95% CI 1.00, 1.37 and 1.44, 95% CI 1.18, 1.77). Effect estimates were similar across age-groups and pathological stroke type, in both men and women.
Conclusion Psychological distress is strongly associated with increased stroke risk, even after adjusting for a wide range of confounding factors. Further investigation is needed to establish whether this relationship is causal and to determine the underlying mechanism(s). Meanwhile, study findings support the need for renewed efforts: to encourage people with mental ill-health to seek medical help; for better screening and treatment for mental health conditions (which might itself reduce cerebrovascular and cardiovascular disease risk); and to encourage screening for established cerebrovascular risk factors in this high-risk, vulnerable group.
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