Depression and increased risk of death in adults with stroke.
OBJECTIVE
Depression is a common condition among individuals with stroke and believed to influence post-stroke mortality. The objective of this study was to evaluate the effect of depression on all-cause mortality among adults with and without a history of stroke.


METHODS
We studied 10,025 participants in the population-based National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study who were alive and interviewed in 1982 and had complete data for the Center for Epidemiologic Studies Depression Scale. Four groups were created based on history of stroke and depression status in 1982: (1) no stroke, no depression (reference group); (2) no stroke, depression present; (3) history of stroke, no depression; and (4) history of stroke present, depression present. Cox proportional hazards regression models were used to calculate multivariate-adjusted hazard ratios (HRs) of death for each group compared with the reference group.


RESULTS
Over 8 years (83,624 person-years of follow-up), 1,925 deaths were documented. Mortality rate per 1,000 person-years of follow-up was highest in the group with both a history of stroke and depression. Compared with the reference group, HRs for all-cause mortality were: no stroke, depression present, 1.23 (95% CI 1.08-1.40); stroke present, no depression 1.74 (1.06-2.85); and stroke present, depression present, 1.88 (1.27-2.79).


CONCLUSIONS
The coexistence of stroke and depression increases the risk of death; however, the combined effect is less than additive.
Ellis
Charles
C
Department of Medicine, Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC 29425, USA.
Zhao
Yumin
Y
Egede
Leonard E
LE
D000328:Adult; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D003866:Depressive Disorder / Q000401:mortality* / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012306:Risk; D012959:Socioeconomic Factors; D020521:Stroke / Q000401:mortality* / Q000523:psychology*; D016019:Survival Analysis