title: Depression and incident stroke in women.
abstract: OBJECTIVE
  Depression has been associated with an increased risk of coronary heart disease, but prospective data for the association with stroke are limited.
  
  
  METHODS
  We followed-up 80 574 women aged 54 to 79 years in Nurses' Health Study without a history of stroke from 2000 to 2006. Depressive symptoms were assessed at multiple time points by a Mental Health Index score (1992, 1996, and 2000), and clinical significant depressive symptoms were defined as a score≤52. Antidepressant medication use was asked biennially beginning in 1996, and physician-diagnosed depression was reported biennially beginning in 2000. Depression was defined as currently reporting or having a history of any of these 3 conditions.
  
  
  RESULTS
  During 6 years of follow-up, 1033 incident strokes were documented (538 ischemic, 124 hemorrhagic, and 371 unknown strokes). Having a history of depression was associated with a multivariate-adjusted hazard ratio (HR) of 1.29 (95% confidence interval [CI], 1.13-1.48) for total stroke. Women who used antidepressant medications were at increased risk for stroke, whether they also had a Mental Health Index score≤52 or diagnosed depression (HR, 1.39; 95% CI, 1.15-1.69) or not (HR, 1.31; 95% CI, 1.03-1.67). Furthermore, for each cycle, participants who reported current depression had an increased risk of stroke (HR, 1.41; 95% CI, 1.18-1.67), whereas individuals who only had a history of depression were at nonsignificantly elevated risk (HR, 1.23; 95% CI, 0.97-1.56) compared with women who never reported a diagnosis of depression or antidepressant medication use.
  
  
  CONCLUSIONS
  Our results suggest that depression is associated with a moderately increased risk of subsequent stroke.
authors.affiliation: Department of Nutrition and Epidemiology, Harvard School of Public Health, and Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02215, USA.
authors.forename: An
authors.initials: A
authors.lastname: Pan
authors.forename: Olivia I
authors.initials: OI
authors.lastname: Okereke
authors.forename: Qi
authors.initials: Q
authors.lastname: Sun
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Logroscino
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Manson
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.forename: Alberto
authors.initials: A
authors.lastname: Ascherio
authors.forename: Frank B
authors.initials: FB
authors.lastname: Hu
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Rexrode
mesh_terms: D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000453:epidemiology* / Q000209:etiology; D003863:Depression / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D003866:Depressive Disorder / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008875:Middle Aged; D012306:Risk; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology
chemical_list: D000928:Antidepressive Agents