Changes in Depressive Symptoms and Incidence of First Stroke Among Middle-Aged and Older US Adults

Background: although research has demonstrated that depressive symptoms predict stroke incidence,depressive symptoms are dynamic. it is unclear whether stroke risk persists if depressive symptoms remit.methods and results: health and retirement study participants (n=16 178,stroke free and noninstitutionalized at baseline) were interviewed biennially from 1998 to 2010. stroke and depressive symptoms were assessed through self-report of doctors' diagnoses and a modified center for epidemiologic studies - depression scale (high was ≥3 symptoms),respectively. we examined whether depressive symptom patterns,characterized across 2 successive interviews (stable low/no,onset,remitted,or stable high depressive symptoms) predicted incident stroke (1192 events) during the subsequent 2 years. we used marginal structural cox proportional hazards models adjusted for demographics,health behaviors,chronic conditions,and attrition. we also estimated effects stratified by age (≥65 years),race or ethnicity (non-hispanic white,non-hispanic black,hispanic),and sex. stroke hazard was elevated among participants with stable high (adjusted hazard ratio 2.14,95% ci 1.69 to 2.71) or remitted (adjusted hazard ratio 1.66,95% ci 1.22 to 2.26) depressive symptoms compared with participants with stable low/no depressive symptoms. stable high depressive symptom predicted stroke among all subgroups. remitted depressive symptoms predicted increased stroke hazard among women (adjusted hazard ratio 1.86,95% ci 1.30 to 2.66) and non-hispanic white participants (adjusted hazard ratio 1.66,95% ci 1.18 to 2.33) and was marginally associated among hispanics (adjusted hazard ratio 2.36,95% ci 0.98 to 5.67).conclusions: in this cohort,persistently high depressive symptoms were associated with increased stroke risk. risk remained elevated even if depressive symptoms remitted over a 2-year period,suggesting cumulative etiologic mechanisms linking depression and stroke. © 2015 the authors. published on behalf of the american heart association,inc.,by wiley blackwell.