title: Depressive symptoms and risk of stroke: the Rotterdam Study.
abstract: BACKGROUND
  Previous studies that have assessed whether the presence of depressive symptoms predisposes to stroke in the general elderly population have been contradictory. Moreover, they did not distinguish between men and women and did not perform psychiatric workups in those with depressive symptoms. This study examines the association between depressive symptoms, depressive disorder and the risk of stroke in the general population.
  
  
  METHODS
  This prospective population based cohort study included 4424 participants from the third Rotterdam Study Survey (1997-1999) who, at that time, were > or =61 years of age and free from stroke. Depressive symptoms were assessed using the Centre for Epidemiological Studies Depression Scale (CESD) and considered present if the CESD score was > or =16. Participants with depressive symptoms had a diagnostic interview for depressive disorder. Follow-up was complete until 1 January 2005. Data were analysed using Cox proportional hazards models with adjustment for relevant confounders.
  
  
  RESULTS
  Men with depressive symptoms (n = 73) were at increased risk of stroke (adjusted hazard ratio (HR) 2.17; 95% CI 1.11 to 4.23) and ischaemic stroke (adjusted HR 3.21; 95% CI 1.62 to 6.38). These associations were at least partly attributable to men who reported depressive symptoms but who did not fulfil Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV diagnostic criteria for depressive disorder (n = 32): they had a very high risk of stroke (adjusted HR 2.70; 95% CI 1.15 to 6.33) and ischaemic stroke (adjusted HR 4.01; 95% CI 1.68 to 9.57). In women there was no association between presence of depressive symptoms and risk of stroke.
  
  
  CONCLUSIONS
  Presence of depressive symptoms is a strong risk factor for stroke in men but not in women.
authors.affiliation: Department of Epidemiology and Biostatistics, Erasmus Medical Centre, 3000 CA Rotterdam, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Bos
authors.forename: T
authors.initials: T
authors.lastname: Lindén
authors.forename: P J
authors.initials: PJ
authors.lastname: Koudstaal
authors.forename: A
authors.initials: A
authors.lastname: Hofman
authors.forename: I
authors.initials: I
authors.lastname: Skoog
authors.forename: M M B
authors.initials: MM
authors.lastname: Breteler
authors.forename: H
authors.initials: H
authors.lastname: Tiemeier
mesh_terms: D000328:Adult; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D019263:Dysthymic Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D011795:Surveys and Questionnaires