title: Effect of depression on stroke morbidity and mortality.
abstract: OBJECTIVE
  This narrative review examines the evidence and discusses the clinical relevance of depression as a risk factor for stroke morbidity and mortality. It also proposes recommendations for future research.
  
  
  METHODS
  We used the Medline computer database to search the relevant original studies published in English from January 1966 to December 2001. Our key words were as follows: depressive disorder, cerebrovascular disease, stroke, vascular risk factors, and mortality. Articles that investigated the relation between antecedent depression and subsequent stroke morbidity and mortality were collected and reviewed.
  
  
  RESULTS
  Since 1990, 8 prospective studies have been published. Among these 8 studies, 6 addressed depression and stroke morbidity, 1 investigated the association of depression with stroke morbidity and stroke mortality, and 1 investigated the association with stroke mortality only. Of 7 studies examining the independent effect of depression on stroke morbidity, 6 were positive. With regard to stroke mortality, 2 studies found an independent association between depression and specific stroke mortality. The contributions and methodological limitations of these studies are discussed.
  
  
  CONCLUSIONS
  Emerging data suggest an association between depressive symptoms and increased risk for stroke morbidity and mortality. More methodologically sound studies are needed to elucidate causal pathways that link depression and cerebrovascular disease. They are also needed to determine the effect of depression intervention on reducing the risk of cerebrovascular events. Information on author affiliations appears at the end of the article.
authors.affiliation: Department of Psychiatry, University of Calgary, Calgary, Alberta. rajamannar.ramasubbu@calgaryhealthregion.ca
authors.forename: Rajamannar
authors.initials: R
authors.lastname: Ramasubbu
authors.forename: Scott B
authors.initials: SB
authors.lastname: Patten
mesh_terms: D000328:Adult; D000368:Aged; D003863:Depression / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality; D015996:Survival Rate