Details of Publication 631 for Project A422:

Jackson C & Mishra G. Depression and risk of stroke in mid-age women: a prospective longitudinal study. , 2013; : 35(S3) 51

Background Depression is thought to increase stroke risk by about 35%. Although limited, there is evidence for important age differences, with a suggestionfor an even stronger association in younger groups. We therefore examined the effect of depression on stroke incidence in a population-based cohort of mid-aged women.Methods We included 10,546 women without a history of stroke aged 47-52 years from the Australian Longitudinal Study on Women’s Health, surveyed every three years from 1998 to 2010. Depression was defined at each survey by a Center for Epidemiological Studies Depression scale (shortened version) score of >/=10, or past month anti-depressant use. Stroke was ascertained through self-report and mortality data. We determined the association between depression and stroke at the subsequent survey, using generalised estimating equation regression models for binary outcome data. We adjusted for time-varying covariates, including: socioeconomic and marital status; history of hypertension, heart disease, diabetes and hysterectomy/oophorectomy; smoking, physical activity, alcohol use and body mass index.Results At each survey, about 24% of women were defined as depressed. During 12 years of follow-up 177 strokes occurred. In crude analyses, depression increased stroke risk more than twofold (OR 2.41, 95% CI 1.78, 3.27). This relationship attenuated to OR 1.94 (95% CI 1.37, 2.74) after adjustment for confounders. Findings were robust to sensitivity analyses addressing methodological issues such as definition of depression, anti-depressant use and missing covariate data.Conclusion Our findings suggest that depression is a strong risk factor for stroke in mid-aged women, with the association only partially explained by lifestyle and physiological factors. Further research is needed to confirm whether depression is an important stroke risk factor in mid-age women in particular, to inform development of targeted prevention and intervention approaches.