Depressive symptoms and risk of stroke: the Rotterdam Study
- 1 Department of Epidemiology and Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands
- 2 Department of Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands
- 3 Department of Clinical Neuroscience, Göteborg University, Göteborg, Sweden
- Professor M M B Breteler, Department of Epidemiology and Biostatistics, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands;
- Received 14 September 2007
- Revised 4 December 2007
- Accepted 5 December 2007
- Published Online First 21 January 2008
Background: Previous studies that have assessed whether the presence of depressive symptoms predisposes to stroke in the general elderly population have been contradictory. Moreover, they did not distinguish between men and women and did not perform psychiatric workups in those with depressive symptoms. This study examines the association between depressive symptoms, depressive disorder and the risk of stroke in the general population.
Methods: This prospective population based cohort study included 4424 participants from the third Rotterdam Study Survey (1997–1999) who, at that time, were ⩾61 years of age and free from stroke. Depressive symptoms were assessed using the Centre for Epidemiological Studies Depression Scale (CESD) and considered present if the CESD score was ⩾16. Participants with depressive symptoms had a diagnostic interview for depressive disorder. Follow-up was complete until 1 January 2005. Data were analysed using Cox proportional hazards models with adjustment for relevant confounders.
Results: Men with depressive symptoms (n = 73) were at increased risk of stroke (adjusted hazard ratio (HR) 2.17; 95% CI 1.11 to 4.23) and ischaemic stroke (adjusted HR 3.21; 95% CI 1.62 to 6.38). These associations were at least partly attributable to men who reported depressive symptoms but who did not fulfil Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV diagnostic criteria for depressive disorder (n = 32): they had a very high risk of stroke (adjusted HR 2.70; 95% CI 1.15 to 6.33) and ischaemic stroke (adjusted HR 4.01; 95% CI 1.68 to 9.57). In women there was no association between presence of depressive symptoms and risk of stroke.
Conclusions: Presence of depressive symptoms is a strong risk factor for stroke in men but not in women.
Competing interests: None.
Funding: The Rotterdam Study is supported by Erasmus MC, Erasmus Medical Centre Rotterdam, the Erasmus University Rotterdam, the Netherlands Organisation for Scientific Research (NWO), the Netherlands Organisation for Health Research and Development (ZonMW), the Research Institute for Diseases in the Elderly (RIDE), the Ministry of Education, Culture and Science, and the Ministry of Health, Welfare and Sports. This study was supported by the Netherlands Organisation for Scientific Research (NWO) grants 904-61-093 and 918-46-615 and the Swedish medical Research Council grant K98-99NL-12779-01A.
Ethics approval: The Rotterdam Study was approved by the Medical Ethics Committee of Erasmus University Rotterdam.
See Editorial Commentary, p 977