Abstract TMP105: Time Varying Depression And Incident Stroke In Geographic And Racial Diverse Population

Abstract

Introduction: Depression is a risk factor for stroke; however, the impact of changes in the level of depressive symptoms on the risk of incident stroke is less well described. Methods: The study included participants from REGARDS, a national longitudinal cohort study of 30,239 Black and White adults aged ≥ 45 years at baseline 2003-2007. Depressive symptoms were assessed longitudinally using the 4-item Center for Epidemiologic Studies Depression Scales (CES-D-4), and scores of 4+ were categorized as “high.” Over up to 18 years of follow-up, for each participant with each serial assessment, we categorized the transition in depression as moving from low to low (LL), low to high (LH), high to low (HL), and high to high (HH), and used Cox regression to assess stroke risk subsequent to the transition, with incremental adjustment for risk factors. Results: Among 20,691 participants, we observed over 80,447 transitions in depressive symptom level and 832 incident strokes. Participants in the HH group had a higher risk for stroke compared to the LL group in both unadjusted {[HR] = 1.46, 95% confidence interval (CI) = 1.08–1.97}, and adjusted models, regardless of adjustment for demographics [HR] = 1.63, (CI = 1.21–2.20), plus SES [HR] = 1.50, (CI = 1.11–2.03), and stroke risk factors [HR] = 1.38, (CI = 1.01–1.90). However, full adjustment attenuated the effect. In both unadjusted and adjusted models, participants in the LH group were at marginally higher risk than LL and those in the HL group had a low risk like that of the LL group (see Table). Conclusion: Transition in levels of depression symptoms directly impacts the risk for stroke. Screening and intervention delivery for depressive symptoms may consider the level of symptoms as a dynamic process.