title: Psychosocial distress and stroke risk in older adults.
abstract: OBJECTIVE
  To investigate the association of psychosocial distress with risk of stroke mortality and incident stroke in older adults.
  
  
  METHODS
  Data were from the Chicago Health and Aging Project, a longitudinal population-based study conducted in 3 contiguous neighborhoods on the south side of Chicago, IL. Participants were community-dwelling black and non-Hispanic white adults, aged 65 years and older (n=4120 for stroke mortality; n=2649 for incident stroke). Psychosocial distress was an analytically derived composite measure of depressive symptoms, perceived stress, neuroticism, and life dissatisfaction. Cox proportional hazards models examined the association of distress with stroke mortality and incident stroke over 6 years of follow-up.
  
  
  RESULTS
  Stroke deaths (151) and 452 incident strokes were identified. Adjusting for age, race, and sex, the hazard ratio (HR) for each 1-SD increase in distress was 1.47 (95% confidence interval [CI]=1.28-1.70) for stroke mortality and 1.18 (95% CI=1.07-1.30) for incident stroke. Associations were reduced after adjustment for stroke risk factors and remained significant for stroke mortality (HR=1.29; 95% CI=1.10-1.52) but not for incident stroke (HR=1.09; 95% CI=0.98-1.21). Secondary analyses of stroke subtypes showed that distress was strongly related to incident hemorrhagic strokes (HR=1.70; 95% CI=1.28-2.25) but not ischemic strokes (HR=1.02; 95% CI=0.91-1.15) in fully adjusted models.
  
  
  CONCLUSIONS
  Increasing levels of psychosocial distress are related to excess risk of both fatal and nonfatal stroke in older black and white adults. Additional research is needed to examine pathways linking psychosocial distress to cerebrovascular disease risk.
authors.affiliation: Department of Medicine, University of Minnesota, 717 Delaware St SE, Suite 166, Minneapolis, MN 55414, USA.
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Henderson
authors.forename: Cari J
authors.initials: CJ
authors.lastname: Clark
authors.forename: Tené T
authors.initials: TT
authors.lastname: Lewis
authors.forename: Neelum T
authors.initials: NT
authors.lastname: Aggarwal
authors.forename: Todd
authors.initials: T
authors.lastname: Beck
authors.forename: Hongfei
authors.initials: H
authors.lastname: Guo
authors.forename: Scott
authors.initials: S
authors.lastname: Lunos
authors.forename: Ann
authors.initials: A
authors.lastname: Brearley
authors.forename: Carlos F
authors.initials: CF
authors.lastname: Mendes de Leon
authors.forename: Denis A
authors.initials: DA
authors.lastname: Evans
authors.forename: Susan A
authors.initials: SA
authors.lastname: Everson-Rose
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000208:ethnology / Q000523:psychology; D002641:Chicago / Q000208:ethnology; D015331:Cohort Studies; D003863:Depression / Q000208:ethnology / Q000401:mortality / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011159:Population Surveillance / Q000379:methods*; D012307:Risk Factors; D012944:Social Support; D013315:Stress, Psychological / Q000208:ethnology / Q000401:mortality / Q000523:psychology*; D020521:Stroke / Q000208:ethnology / Q000401:mortality / Q000523:psychology*; D011795:Surveys and Questionnaires; D044465:White People / Q000208:ethnology / Q000523:psychology; D001741:Black or African American