Depression and the Risk of Stroke in Women

Abstract

See related article, pages 2770–2775. Major depressive disorder is defined in the DSM-IV-TR as depressed mood or loss of interest or pleasure in usual activities, along with a constellation of other depressive symptoms that persist for >2 weeks, are atypical for usual behavior, cause significant distress or impairment, and are not attributable to bereavement or a medical condition.1 The lifetime prevalence of depression is ≈13% to 16% and is 5% to 7% in 1 year, more commonly affecting women than men.1 The presence of depressive symptoms has been established as an important outcome after stroke.2 The Northern Manhattan Study reported that early depressive symptoms are a risk for future disability.3 Multiple studies, though not all,4 now contribute to the evidence that depression is also a risk factor for first-ever stroke.5,6 Adding to these studies and published in this issue of Stroke , Pan et al7 have analyzed >80 000 women in the Nurses' Health Study cohort who were stroke-free at the time of the initial screen for depressive symptoms. Using the Mental Health Index (MHI-5) scores, a subscale of the Short-Form 36 Health Status Survey, collected in 1992, 1996, and 2000, the investigators assessed the relation between clinically significant depressive symptoms (MHI-5 score ≤52) and incident stroke from 2000 to 2006. For the purposes of analyzing depression, this was defined as an MHI-5 score ≤52, physician-diagnosed depression, or antidepressant medication use. For the 1033 incident strokes documented in the follow-up period, depression was associated with an ≈30% increased risk of total stroke (hazard ratio [HR]=1.29; 95% CI, 1.13–1.48).7 A past history of depression alone …