Depressive symptoms and risk of stroke in a national cohort of blacks and whites from REGARDS

2020 ◽  
pp. 10.1212/CPJ.0000000000000983
Author(s):  
Cassandra D. Ford ◽  
Marquita S. Gray ◽  
Martha R. Crowther ◽  
Virginia G. Wadley ◽  
Audrey L. Austin ◽  
...  
Keyword(s):  
Risk Factor ◽  
Depressive Symptoms ◽  
Stroke Risk ◽  
Proportional Hazards ◽  
Depressive Symptomatology ◽  
National Sample ◽  
Epidemiological Studies ◽  
Cox Proportional Hazards ◽  
Stroke Risk Factor ◽  
Blacks And Whites

AbstractObjective.The purpose of this study was to examine depressive symptoms as a risk factor for incident stroke and determine whether depressive symptomatology was differentially predictive of stroke among blacks and whites.Methods.The study was comprised of 9,529 black and 14,516 white stroke-free participants, aged 45 and older, enrolled in REGARDS (2003-2007). Incident stroke was first occurrence of stroke. Association between baseline depressive symptoms (assessed via the 4-item Center for Epidemiological Studies Depression (CES-D-4) scale: 0, 1-3, or >4) and incident stroke was analyzed with Cox proportional hazards models adjusted for demographics, stroke risk factors, and social factors.Results.There were 1,262 strokes over an average follow-up of 9.21 (SD 4.0) years. Compared to participants with no depressive symptoms, after demographic adjustment, participants with CES-D-4 scores of 1-3 had 39% increased stroke risk (HR = 1.39, 95% CI = 1.23-1.57), with slight attenuation after full adjustment (HR = 1.27, 95% CI = 1.11-1.43). Participants with CES-D-4 scores of > 4 experienced 54% higher risk of stroke after demographic adjustment (HR = 1.54, 95% CI = 1.27-1.85), with risk attenuated in the full model similar to risk with 1-3 symptoms (HR = 1.25, 95% CI = 1.03-1.51). There was no evidence of a differential effect by race (p = 0.53).Conclusions.The association of depressive symptoms with increased stroke risk factor was similar among a national sample of blacks and whites. These findings suggest assessment of depressive symptoms should be considered in primary stroke prevention for both blacks and whites.

Abstract 183: Depressive Symptoms and Incident Stroke in Black and White Participants in the REGARDS Study

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Audrey L Austin ◽  
Michael G Crowe ◽  
Martha R Crowther ◽  
Virginia J Howard ◽  
Abraham J Letter ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Depressive Symptoms ◽  
Racial Differences ◽  
Stroke Risk ◽  
Depression Scale ◽  
Stroke Incidence ◽  
Blacks And Whites ◽  
The Impact

Background and Purpose: Research suggests that depression may contribute to stroke risk independent of other known risk factors. Most studies examining the impact of depression on stroke have been conducted with predominantly white cohorts, though blacks are known to have higher stroke incidence than whites. The purpose of this study was to examine depressive symptoms as a risk factor for incident stroke in blacks and whites, and determine whether depressive symptomatology was differentially predictive of stroke among blacks and whites. Methods: The REasons for Geographic and Racial Differences in Stroke (REGARDS), is a national, population-based longitudinal study designed to examine risk factors associated with black-white and regional disparities in stroke incidence. Among 30,239 participants (42% black) accrued from 2003-2007, excluding those lacking follow-up or data on depressive symptoms, 27,557 were stroke-free at baseline. As of the January 2011 data closure, over an average follow-up of 4.6 years, 548 incident stroke cases were verified by study physicians based on medical records review. The association between baseline depressive symptoms (assessed via the Center for Epidemiological Studies Depression scale, 4-item version) and incident stroke was analyzed with Cox proportional hazards models adjusted for demographic factors (age, race, and sex), stroke risk factors (hypertension, diabetes, smoking, atrial fibrillation, and history of heart disease), and social factors (education, income, and social network). Results: For the total sample, depressive symptoms were predictive of incident stroke. The association between depressive symptoms and stroke did not differ significantly based on race (Wald X 2 = 2.38, p = .1229). However, race-stratified analyses indicated that the association between depressive symptoms and stroke was stronger among whites and non-significant among blacks. Conclusions: Depressive symptoms were an independent risk factor for incident stroke among a national sample of blacks and whites. These findings suggest that assessment of depressive symptoms may warrant inclusion in stroke risk scales. The potential for a stronger association in whites than blacks requires further study.

scholarly journals Is depression a risk factor for mortality in chronic hemodialysis patients?

2008 ◽  
Vol 30 (2) ◽  
pp. 99-103 ◽  
Author(s):  
Edgar C Diefenthaeler ◽  
Mário Bernardes Wagner ◽  
Carlos Eduardo Poli-de-Figueiredo ◽  
Paulo R Zimmermann ◽  
David Saitovitch
Keyword(s):  
Risk Factor ◽  
Beck Depression Inventory ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Depressive Symptomatology ◽  
Hemodialysis Patients ◽  
Cox Proportional Hazards ◽  
Chronic Hemodialysis ◽  
Cox Proportional Hazards Model ◽  
Hazards Model

OBJECTIVE: The present study was conducted to assess the association between depressive symptomatology and mortality in chronic hemodialysis. METHOD: A cohort of 40 patients was followed for a median period of 10.5 months. The Beck Depression Inventory was used to classify patients as exposed to depression (Beck Depression Inventory score > 14) or not (Beck Depression Inventory < 14). Kaplan-Meier survival curves were used to compare the mortality rate between the two groups. The effects of potential confounding factors were adjusted using Cox proportional hazards model. RESULTS: After 24 months of follow-up, survival rates were 39% for exposed and 95% for non-exposed patients (p = 0.029). The Cox proportional hazards model showed results similar to those of the bivariate analysis, indicating that depressive symptomatology tended to be associated with mortality (HR = 6.5, 95%CI: 0.8-55.6; p = 0.085). Other study variables, including age, concurrent systemic diseases, and biochemical markers, were not significantly associated with mortality. Exposed patients remained on dialysis longer and received kidney transplants less frequently (9% vs. 50% for non-exposed patients). When kidney transplantation was included in the Cox regression model, the hazard ratio of mortality for exposed as compared to non-exposed patients lost statistical significance (HR = 4.5; 95%CI: 0.5-40.0; p = 0.17). CONCLUSIONS: Our study suggests that the presence of depressive symptoms may act as an independent risk factor for mortality in chronic hemodialysis patients. However, this finding needs further investigations.

scholarly journals Late-life depression and mortality: influence of gender and antidepressant use

2008 ◽  
Vol 192 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Joanne Ryan ◽  
Isabelle Carriere ◽  
Karen Ritchie ◽  
Robert Stewart ◽  
Gwladys Toulemonde ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Proportional Hazards ◽  
Depression Scale ◽  
Severe Depression ◽  
Epidemiological Studies ◽  
Cox Proportional Hazards ◽  
Community Dwelling ◽  
Late Life Depression ◽  
Cox Proportional Hazards Models ◽  
Antidepressant Use

BackgroundDepression may increase the risk of mortality among certain subgroups of older people, but the part played by antidepressants in this association has not been thoroughly explored.AimsTo identify the characteristics of older populations who are most at risk of dying, as a function of depressive symptoms, gender and antidepressant use.MethodAdjusted Cox proportional hazards models were used to determine the association between depression and/or antidepressant use and 4-year survival of 7363 community-dwelling elderly people. Major depressive disorder was evaluated using a standardised psychiatric examination based on DSM-IV criteria and depressive symptoms were assessed using the Center for Epidemiological Studies Depression scale.ResultsDepressed men using antidepressants had the greatest risk of dying, with increasing depression severity corresponding to a higher hazard risk. Among women, only severe depression in the absence of treatment was significantly associated with mortality.ConclusionsThe association between depression and mortality is gender-dependent and varies according to symptom load and antidepressant use.

scholarly journals Predictors for depressive symptoms by four types of disability

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sun Wook Jung ◽  
Jin-Ha Yoon ◽  
Wanhyung Lee
Keyword(s):  
Depressive Symptoms ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Depressive Symptomatology ◽  
Cox Proportional Hazards ◽  
Community Dwelling ◽  
Cox Proportional Hazards Model ◽  
Mental Disability ◽  
Multivariate Logistic Regression Model ◽  
Industrial Disaster

AbstractThis study aimed to examine the longitudinal relationship between disability and depressive symptoms, by comparing four types of disability in community-dwelling individuals with disabilities in South Korea. A total of 3347 South Koreans with disabilities from the second wave of the Panel Survey of Employment for the Disabled was utilized. Depressive symptomatology was assessed by whether the participant had experienced depressive symptoms for more than two weeks during the past year. A multivariate logistic regression model was used to calculate the odds ratio (OR) for depressive symptoms, and a Cox proportional hazards model to calculate the hazard ratio (HR) for two-year survival analysis. Persons who acquired mental disability from accident or industrial disaster and persons with congenital physical-internal disability were at higher risk for depressive symptoms. Maintaining employment was found to be an effective way to decrease the risk of depressive symptoms in persons with physical-external disability, sensory/speech disability, or mental disability. In contrast, in physical-internal disability, retaining normal ability to work seemed to be the key to reduce the risk of depressive symptoms. Predictors of depressive symptoms were found to differ depending on the type of disability. Such differences should be reflected in clinical and policy-level interventions to address the specific psychiatric needs of persons with different disabilities.

Abstract P089: Adiposity and risk of stroke: body shape matters more than body weight

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Suzanne E Judd ◽  
Virginia J Howard ◽  
George Howard ◽  
Susan Lakoski ◽  
Mary Cushman ◽  
...  
Keyword(s):  
Racial Differences ◽  
Stroke Risk ◽  
Proportional Hazards ◽  
Obesity Paradox ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Stroke Risk Factor ◽  
Medical Risk ◽  
Increased Risk ◽  
History Of

Background: Higher body mass index (BMI) and larger waist circumference (WC), characteristics of increased adiposity, are associated with greater risk of cardiovascular disease (CVD). However, an obesity paradox (improved survival in those with history of stroke) has been observed in some populations. We hypothesized that BMI would be associated with decreased risk of stroke but that this association would be attenuated after accounting for WC. Methods: The REasons for Geographic and Racial Differences in Stroke (REGARDS) study recruited 30,239 black and white participants age 45 years and older from across the United States between 2003 and 2007. WC, height and weight were measured during a baseline in home visit and participants were followed every 6 months. Strokes were adjudicated by physicians after review of medical records. Cox proportional hazards models were used to assess stroke risk. BMI and WC were modeled in quintiles. Results: We observed 1047 incident and recurrent strokes over a mean of 6.3 years. Higher BMI and lower WC were associated with decreased risk of stroke after adjustment for demographic and medical risk factors (Table). Having both BMI and WC in the model dramatically increased the strength of association for the other variable. Collinearity was not present. The observed association was consistent across race, sex, age, WC, and history of stroke (all p for interaction >0.20). Conclusion: Increased BMI, the main measure used to define obesity, was not a stroke risk factor. Increased risk of stroke was observed in WC less than the current recommendations of 88 cm for women and 102 cm for men. Smaller waist sizes and maintenance of lean mass are important targets for stroke prevention.<br

scholarly journals Trajectories of Depression and Their Associations with Mortality in Older People in Korea over 12 Years

2021 ◽  
Vol 21 (2) ◽  
pp. 45-55
Author(s):  
Sinhyung Lee ◽  
Hyeon Ho Choi ◽  
Seung Hee Kim ◽  
Jungun Lee
Keyword(s):  
Depressive Symptoms ◽  
Proportional Hazards ◽  
Depression Scale ◽  
Epidemiological Studies ◽  
Cox Proportional Hazards ◽  
Men And Women ◽  
Women Subjects ◽  
Cox Proportional Hazards Models ◽  
Hazard Ratios ◽  
Korean Elderly

Background: As the course of depression and depressive symptoms over a lifetime varies between individuals, we used trajectory models based on the Korean Longitudinal Study of Aging to repeatedly measure symptoms over a follow-up period of 12 years to reveal the association with mortality.Methods: Three thousand five hundred sixty-one (1,483 men and 2,078 women) subjects aged over 65 years were included. Using the 10-item Center for Epidemiological Studies Depression Scale (CES-D 10), a trajectory model was classified into different depressive symptom groups by gender. Cox proportional hazards models were used to investigate the association between depression trajectory and all-cause mortality.Results: We identified four trajectories of depressive symptoms in both men and women characterized by low CES-D 10 scores throughout the study: Low trajectory (LT), Moderate high trajectory (MHT), High, but increasing trajectory (HIT), and High, but decreasing trajectory (HDT). The adjusted hazard ratios of the HIT, HDT, and MHT compared with LT in men were 2.12 (95% confidence interval [CI], 1.43-3.16), 1.52 (95% CI, 0.96-2.40), and 1.58 (95% CI, 1.10-2.26), respectively. In women, ratios of each group were 1.62 (95% CI, 1.25-2.10), 0.84 (95% CI, 0.61-1.16), and 1.20 (95% CI, 0.99-1.46).Conclusions: Highly depressive symptoms that increased over the 12 years period were associated with the highest risk of mortality in the Korean elderly population. The trajectory group with remitting depressive symptoms (HDT), despite having a similar baseline level of mood symptoms as the high increasing group (HIT) experienced a lower mortality risk in both men and women.

scholarly journals Associations of Dietary Patterns with Incident Depression: The Maastricht Study

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 1034
Author(s):  
Vincenza Gianfredi ◽  
Annemarie Koster ◽  
Anna Odone ◽  
Andrea Amerio ◽  
Carlo Signorelli ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Dietary Patterns ◽  
Proportional Hazards ◽  
A Priori ◽  
Preventive Measure ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Healthy Diet ◽  
Patient Health

Our aim was to assess the association between a priori defined dietary patterns and incident depressive symptoms. We used data from The Maastricht Study, a population-based cohort study (n = 2646, mean (SD) age 59.9 (8.0) years, 49.5% women; 15,188 person-years of follow-up). Level of adherence to the Dutch Healthy Diet (DHD), Mediterranean Diet, and Dietary Approaches To Stop Hypertension (DASH) were derived from a validated Food Frequency Questionnaire. Depressive symptoms were assessed at baseline and annually over seven-year-follow-up (using the 9-item Patient Health Questionnaire). We used Cox proportional hazards regression analyses to assess the association between dietary patterns and depressive symptoms. One standard deviation (SD) higher adherence in the DHD and DASH was associated with a lower hazard ratio (HR) of depressive symptoms with HRs (95%CI) of 0.78 (0.69–0.89) and 0.87 (0.77–0.98), respectively, after adjustment for sociodemographic and cardiovascular risk factors. After further adjustment for lifestyle factors, the HR per one SD higher DHD was 0.83 (0.73–0.96), whereas adherence to Mediterranean and DASH diets was not associated with incident depressive symptoms. Higher adherence to the DHD lowered risk of incident depressive symptoms. Adherence to healthy diet could be an effective non-pharmacological preventive measure to reduce the incidence of depression.

scholarly journals Bidirectional Association Between Knee Osteoarthritis and Depressive Symptoms: A Nationwide Cohort Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 220-220
Author(s):  
Han Lu ◽  
Shaomei Shang ◽  
Limin Wang ◽  
Hongbo Chen
Keyword(s):  
Cohort Study ◽  
Depressive Symptoms ◽  
Knee Osteoarthritis ◽  
Proportional Hazards ◽  
Depression Scale ◽  
Cox Proportional Hazards ◽  
Depression Symptoms ◽  
Physical And Mental Health ◽  
Bidirectional Association ◽  
Bidirectional Relationship

Abstract Both knee osteoarthritis (KOA) and depressive symptoms are common health issues affecting the quality of life of old adults. Although it is presumed that KOA has a bidirectional relationship with the depressive symptoms, no cohort study has proven it. This is the first study to determine the strength of association for the bidirectional relationship between KOA and depressive symptoms. Data were gathered from the nationally survey of China Health and Retirement Longitudinal Study in 2011-2015. The presence of depressive symptoms was defined by the 10-item Center for Epidemiologic Studies Depression Scale score of 10 or higher. The adjusted Cox proportional hazards regression model was conducted to estimate hazards ratios (HRs). Controlled covariates include gender, age, education, marital status, residence, number of chronic diseases, and disability. The analysis of KOA predicting the depressive symptoms onset consisted of 4,377 participants free from depressive symptoms at baseline. During 4 years follow-up, diagnosed KOA participants were more likely to have depressive symptoms than their peers without KOA (HR = 1.50, 95% CI: 1.23-1.83). The parallel analysis of depressive symptoms predicting KOA onset included 6,848 participants without KOA at baseline, those with depressive symptoms had a higher relative risk of developing KOA (HR = 1.64, 95% CI: 1.41-1.92). Our results provide compelling evidence that the KOA-depressive symptoms association is bidirectional, highlighting the importance of evaluating the relationship between physical and mental health among older people. Particularly, taking this association into consideration in the risk assessment and primary prevention of KOA and depression symptoms.

scholarly journals Corneal hysteresis as a risk factor for optic nerve head surface depression and retinal nerve fiber layer thinning in glaucoma patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Guihua Xu ◽  
Zilin Chen
Keyword(s):  
Risk Factor ◽  
Visual Field ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Corneal Hysteresis ◽  
Visual Field Progression ◽  
Increased Risk ◽  
Head Surface ◽  
Sd Oct ◽  
Surface Depression

AbstractTo evaluate the role of corneal hysteresis (CH) as a risk factor for progressive ONH surface depression and RNFL thinning measured by confocal scanning laser ophthalmoscopy (CSLO) and spectral-domain optical coherence tomography (SD-OCT), respectively in glaucoma patients. Prospective study. A total of 146 eyes of 90 patients with glaucoma were recruited consecutively. The CH measurements were acquired at baseline and 4-months interval using the Ocular Response Analyzer (Reichert Instruments, Depew, NY). Eyes were imaged by CSLO (Heidelberg Retinal Tomograph [HRT]; Heidelberg Engineering, GmbH, Dossenheim, Germany) and SD-OCT (Cirrus HD-OCT; Carl Zeiss Meditec AG, Dublin, CA) at approximately 4-month intervals for measurement of ONH surface topography and RNFL thickness, respectively. Significant ONH surface depression and RNFL thinning were defined with reference to Topographic Change Analysis (TCA) with HRT and Guided Progression Analysis (GPA) with Cirrus HD-OCT, respectively. Multivariate cox proportional hazards models were used to investigate whether CH is a risk factor for ONH surface depression and RNFL progression after adjusting potential confounding factors. All patients with glaucoma were followed for an average of 6.76 years (range, 4.56–7.61 years). Sixty-five glaucomatous eyes (44.5%) of 49 patients showed ONH surface depression, 55 eyes (37.7%) of 43 patients had progressive RNFL thinning and 20 eyes (13.7%) of 17 patients had visual field progression. In the cox proportional hazards model, after adjusting baseline diastolic IOP, CCT, age, baseline disc area and baseline MD, baseline CH was significantly associated with ONH surface depression and visual field progression (HR = 0.71, P = 0.014 and HR = 0.54, P = 0.018, respectively), but not with RNFL thinning (HR = 1.03, P = 0.836). For each 1-mmHg decrease in baseline CH, the hazards for ONH surface depression increase by 29%, and the hazards for visual field progression increase by 46%. The CH measurements were significantly associated with risk of glaucoma progression. Eyes with a lower CH were significantly associated with an increased risk of ONH surface depression and visual field progression in glaucoma patients.

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