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Depressive Symptoms and Risk of Stroke: The Rotterdam Study
  1. Michiel J Bos (m.bos{at}
  1. Erasmus Medical Center, Netherlands
    1. Thomas Lindén (tlinden{at}
    1. Göteborg University, Sweden
      1. Peter J Koudstaal (p.j.koudstaal{at}
      1. Erasmus Medical Center, Netherlands
        1. Albert Hofman (a.hofman{at}
        1. Erasmus Medical Center, Netherlands
          1. Ingmar Skoog (ingmar.skoog{at}
          1. Göteborg University, Sweden
            1. Monique M B Breteler (m.breteler{at}
            1. Erasmus Medical Center, Netherlands
              1. Henning Tiemeier (h.tiemeier{at}
              1. Erasmus Medical Center, Netherlands


                Background: Previous studies that assessed whether presence of depressive symptoms predisposes to stroke in the general elderly population are contradictive. Moreover, they did not distinguish between men and women, nor did they perform psychiatric workups in those with depressive symptoms. We examined the association between depressive symptoms, depressive disorder, and risk of stroke in the general population.

                Methods: This prospective population-based cohort study was based on 4424 participants of the third Rotterdam Study survey (1997-1999), who at that time were ≥ 61 years of age, and free from stroke. Depressive symptoms were assessed with the Center for Epidemiological Studies Depression Scale (CESD) and considered present if CESD score was ≥ 16. Participants with depressive symptoms had a diagnostic interview for depressive disorder. Follow-up was complete until January 1, 2005. Data were analyzed with Cox proportional hazards models with adjustment for relevant confounders.

                Results: Men with depressive symptoms (N=73) were at increased risk of stroke (adjusted HR 2.17; 95% CI 1.11-4.23) and ischemic stroke (adjusted HR 3.21; 95% CI 1.62-6.38). These associations were at least partly attributable to men who reported depressive symptoms but who did not fulfil DSM-IV diagnostic criteria for depressive disorder (N=32): they had a very high risk of stroke (adjusted HR 2.70, 95% CI 1.15-6.33) and ischemic stroke (adjusted HR 4.01, 95% CI 1.68-9.57). 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.

                • cerebral infarction
                • depressive disorder
                • dysthymic disorder
                • stroke

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