title: Changes in Depressive Symptoms and Incidence of First Stroke Among Middle-Aged and Older US Adults.
abstract: BACKGROUND
  Although research has demonstrated that depressive symptoms predict stroke incidence, depressive symptoms are dynamic. It is unclear whether stroke risk persists if depressive symptoms remit.
  
  
  RESULTS
  Health and Retirement Study participants (n=16 178, stroke free and noninstitutionalized at baseline) were interviewed biennially from 1998 to 2010. Stroke and depressive symptoms were assessed through self-report of doctors' diagnoses and a modified Center for Epidemiologic Studies - Depression scale (high was ≥3 symptoms), respectively. We examined whether depressive symptom patterns, characterized across 2 successive interviews (stable low/no, onset, remitted, or stable high depressive symptoms) predicted incident stroke (1192 events) during the subsequent 2 years. We used marginal structural Cox proportional hazards models adjusted for demographics, health behaviors, chronic conditions, and attrition. We also estimated effects stratified by age (≥65 years), race or ethnicity (non-Hispanic white, non-Hispanic black, Hispanic), and sex. Stroke hazard was elevated among participants with stable high (adjusted hazard ratio 2.14, 95% CI 1.69 to 2.71) or remitted (adjusted hazard ratio 1.66, 95% CI 1.22 to 2.26) depressive symptoms compared with participants with stable low/no depressive symptoms. Stable high depressive symptom predicted stroke among all subgroups. Remitted depressive symptoms predicted increased stroke hazard among women (adjusted hazard ratio 1.86, 95% CI 1.30 to 2.66) and non-Hispanic white participants (adjusted hazard ratio 1.66, 95% CI 1.18 to 2.33) and was marginally associated among Hispanics (adjusted hazard ratio 2.36, 95% CI 0.98 to 5.67).
  
  
  CONCLUSIONS
  In this cohort, persistently high depressive symptoms were associated with increased stroke risk. Risk remained elevated even if depressive symptoms remitted over a 2-year period, suggesting cumulative etiologic mechanisms linking depression and stroke.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA (P.G., J.R.M., L.D.K., I.K., M.G.).
authors.forename: Paola
authors.initials: P
authors.lastname: Gilsanz
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA (S.W., M.G.).
authors.forename: Stefan
authors.initials: S
authors.lastname: Walter
authors.affiliation: Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (E.J.T.T.) Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (E.J.T.T.).
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Tchetgen Tchetgen
authors.affiliation: Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA (K.K.P.).
authors.forename: Kristen K
authors.initials: KK
authors.lastname: Patton
authors.affiliation: Bronx Partners for Healthy Communities, Bronx, NY (R.M.).
authors.forename: J Robin
authors.initials: JR
authors.lastname: Moon
authors.affiliation: Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN (B.D.C.).
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Capistrant
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA (P.G., J.R.M., L.D.K., I.K., M.G.).
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Marden
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA (P.G., J.R.M., L.D.K., I.K., M.G.).
authors.forename: Laura D
authors.initials: LD
authors.lastname: Kubzansky
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA (P.G., J.R.M., L.D.K., I.K., M.G.).
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA (P.G., J.R.M., L.D.K., I.K., M.G.) Department of Epidemiology and Biostatistics, University of California San Francisco School of Medicine, San Francisco, CA (S.W., M.G.).
authors.forename: M Maria
authors.initials: MM
authors.lastname: Glymour
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000208:ethnology / Q000523:psychology*; D003863:Depression / Q000150:complications* / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors
keywords: depression; epidemiology; longitudinal cohort study; marginal structural model; stroke